International Journal of Paleopathology 4 (2014) 17–24 Contents lists available at ScienceDirect International Journal of Paleopathology jo ur nal home page: www.elsevier.com/locate/ijpp Case Study Biological and social implications of a medieval burial from Cyprus for understanding leprosy in the past  Brenda J. Baker * , Katelyn L. Bolhofner School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287-2402, USA a r t i c l e i n f o Article history: Received 25 June 2013 Received in revised form 23 August 2013 Accepted 27 August 2013 Keywords: Paleopathology Differential diagnosis Disease experience Social stigma Mediterranean a b s t r a c t An early 15th-century burial from a basilica at Polis Chrysochous provides the first archaeological evi- dence of leprosy in Cyprus, extending the temporal depth and illuminating the biological and social history of this disease on the island. The skeletal remains of a young adult female (age 20–34 years) display pathognomonic features of lepromatous leprosy including maxillary alveolar resorption with antemortem loss of all but one incisor, remodeling of the margin of the nasal sill and resorption of the anterior nasal spine, with diaphyseal remodeling of hand and foot phalanges and the distal third through fifth metatarsals of both feet. Periosteal reaction on distal tibiae and the majority of both fibulae demon- strates tracking of inflammation from the feet to lower legs. Use wear on the remaining maxillary incisor signals participation in common occupational activities in life. Although disfigured and debilitated, burial inside the narthex of the basilica indicates that the community did not ostracize this woman in death. This contextualized analysis provides insight into the biological and social consequences of living with leprosy and illustrates the changing attitudes toward those afflicted with this disease in Cyprus. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Skeletal evidence for leprosy is found throughout the Mediter- ranean region by the beginning of the first millennium AD (e.g., Dzier ˙ zykray-Rogalski, 1978, 1980; Molto, 2002; Rubini et al., 2012; Zias, 2002), yet it has not been reported previously in Cyprus, an island that has long been a crossroads in the eastern Mediter- ranean. Until recently, little bioarchaeological research has been conducted in Cyprus, and it tends to be hampered by poor preser- vation, commingling, and lack of information on archaeological context (Harper and Fox, 2008). Analysis of human remains from Polis, on the northwest coast (Fig. 1), is producing considerable insight into life in medieval Cyprus (Baker and Papalexandrou, 2012; Baker et al., 2012). Here, severe pathology in the skeleton of an individual buried within a medieval basilica at Polis and a differential diagnosis are presented. Osseous manifestations are linked with clinical information to reconstruct the biological con- sequences of the disease progression. Contextualization of this individual’s disease experience and treatment in death illuminates social perceptions of illness and debility, especially relating to lep- rosy, within this community.  The article is a contribution based upon a poster presented at the 2012 annual meeting of the Paleopathology Association, Portland, Oregon. * Corresponding author. Tel.: +1 480 965 2087; fax: +1 480 965 7671. E-mail addresses: BrendaJ.Baker@asu.edu (B.J. Baker), Katelyn.Bolhofner@asu.edu (K.L. Bolhofner). 2. Burial context Polis Chrysochous, or “City of Gold,” has been the focus of Prince- ton University’s Archaeological Expedition since 1983 (Childs, 2008; Childs et al., 2012). More than 300 burials excavated between 1983 and 2007 are associated with basilicas in the E.F2 and E.G0 project areas (Fig. 1; an interactive map can be found in the online version at doi:10.1016/j.ijpp.2013.08.006), which date from the late 5th or early 6th century AD. After a hiatus, the E.G0 basilica was reused from the 13th through 16th centuries. Unit E.G0:c13, exca- vated in 2000, included part of the narthex (entry vestibule) and an area outside the basilica’s west end. Burial 11 was located just inside the narthex (Fig. 1). The sole, overexposed excavation photo shows a typical Christian burial. The body was in a supine and extended position with head to the west and feet to the east. Fore- arms were placed across the abdomen with legs crossed left over right at the ankles. Field notes indicate a “pot handle” was on the chest and a coin was recovered from screening. This coin, identified by Christopher Moss (Princeton University), was minted in Cyprus during the reign of Janus, King of Cyprus, Jerusalem, and Arme- nia (1398–1432), providing a secure terminus post quem for the interment and placing it within the Lusignan period (1191–1489) of Frankish rule. 3. Methods All skeletal remains are housed in the Princeton University storage facility in Polis. Field records were consulted to ensure all 1879-9817/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ijpp.2013.08.006