The first leprosy patient

Burial is uncommon in the Hindu tradition unless the person is highly respected or unfit to be cremated,a category that included outcasts,pregnant women,small children,victims of magic or curses,and lepers. The bone lesions on the skeletons,when studied,finally gave enough evidence of the fact that the skeleton,that now lies interned in the Deccan College in Pune,belonged to the last category. With that,what has been also unveiled is the evidence of the earliest case of leprosy found anywhere in the world.

The findings were recently published in the prestigious online journal PlosOne by research scientist Gwen Robbins of the Department of Anthropology,Appalachian State University,Boone,North Carolina,United States of America,along with her colleagues Veena Mushrif-Tripathy,V.N. Misra,R.K. Mohanty,V.S. Shinde,Kelsey M. Gray and Malcolm D. Schug. Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects almost 250,000 people worldwide.

I first came upon the skeleton at Deccan College Post-Graduate Research Institute as part of the analysis of the skeletal material in 2001-2002. Veena Mushrif and I examined the skeletal collection from Balathal. Upon publishing the site report,we went back and began working on a paper about the pathological conditions, says Gwen Robbins who conducted a differential diagnosis of the remains to distinguish between several diseases that can produce similar changes to bone. Bone has a limited set of responses to disease. Syphilis,maxillary sinus infection,and other problems can cause similar changes to the skull. However,syphilis should also be associated with something called caries sicca (lesions on the surface of the skull) and neither should cause the nasal spine to be eaten away. The nasal spine is a small piece of bone in the center of the lower margin of the nose. When it is eroded away,that is characteristic of leprosy, Robbins explains how the leprosy conclusion was arrived at.

The 4,000-year-old middle-aged adult male skeleton belongs to the Ahar Chalcolithic culture,which flourished at the same time as the Harappans. According to Vasant Shinde,joint director,Deccan College,who is part of the research team,the period saw the growth of the first farming community in Mewar and is characterised by the presence of Black-and-Red pottery,mud,mud-brick and stone structures,and the use of copper.

We do not know the mode of disposal of the dead by the Ahar Chalcolithic people as no evidence is found of this either in the habitation or away from the habitation. A few Chalcolithic sites in the Mewar region,like Ahar,Gilund and Balathal,have been excavated and none of them has yielded evidence of the burial custom. We have found a couple of human skeletons in the habitation at Balathal. One of the skeletons was subjected to detailed studies and has revealed that the person died due the leprosy, he said.

Though leprosy is now curable,the discovery is likely to give important clues of origin and transmission of the disease and may even potentially lead to new insights about the evolution of infectious diseases and eradication efforts. Recent genomics research indicated that an African origin of the disease was possible but did not rule out the possibility of an Indian origin. Robbins is now working on extracting DNA from the skeleton,which she feels would be able to shed further light on this question. According to her,this skeleton demonstrates that the disease was present during a period of increasing urbanisation in India and Pakistan,supporting the long-held association among leprosy and urban life and suggesting that this is the most likely period for the transmission of the disease in West Asia and Africa. Finally,it also supports the hypothesis that leprosy spread to Europe with the return of Alexanders Army from India in the 4th century BC. Balathal sits on the margin of the Indus civilisation and presumably the site was affected by participation in the Third Millennium Interaction Sphere,in which the Indus civilisation traded with Mesopotamia and Egypt. Leprosy may have been transmitted during that time,says Robbins.

The discovery shows that the disease was known to the Indus peoples. They definitely treated individuals who had leprosy as different from others as there were only five individuals buried at the sitean individual in samhadi posture (from the Early Historic period),two women,and a fragmentary individual buried with the leper who was represented only by two bones. The leper skeleton was buried in cow dung ash and was one of the few adults buried at the site. The skeleton is giving us insights into which diseases were known to the Indus people and traditions surrounding burial and disease,as well as possibly indicating a special significance to cow dung ash, says Robbins.

Veena Mushrif-Tripathy says the team now plans to examine additional skeletons from Indus sites like Harappa,Farmana and Kalibangan along with conducting a DNA analysis of the Balathal skeleton to ascertain whether leprosy existed in these areas also. We still have to determine its prevalence. One thing is for surethe lepers were treated very badly in that era, she says. Some things never change,even after 4,000 years.