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Applying the ‘Index of Care’ to a Person Who Experienced Leprosy in Late Medieval Chichester, England


Based on the bioarchaeological record, leprosy, a bacterial infectious disease, has challenged human populations for several thousands of years. It also remains a challenge for management today in certain parts of the world. This socially fascinating disease, past and present, has also attracted stigma, led to ostracism, and ultimately segregation away from affected people’s communities. While the devastating image of the experience of leprosy in the past is changing with new historical and bioarchaeological studies and the development of new perspectives, a key question surrounding the disease is whether people were cared for within their communities, and even medically or surgically treated. What provision was made for these people and can we access that information from the bioarchaeological record? This paper focuses on one skeleton of an adult man who was buried in the twelfth to fourteenth century AD part of the cemetery of the leprosy hospital of St James and St Mary Magdalene, Chichester, Sussex, England. Following the four steps of the Index of Care model (Tilley and Cameron, International Journal of Paleopathology 6:5–9, 2014), the skeleton was assessed. Based on the bone changes and what is known about the disease and how it affects people today (signs and symptoms), the experiences of this person are suggested, and whether impairment may have been a resulting outcome. What cannot be said about the ‘leprosy experience’ of this man, based on his skeleton, is also discussed (i.e. missing data). Finally, the potential care he might have needed is outlined, alongside consideration of the context of the site, and the historical data associated with the hospital, albeit limited. The chapter closes with some thoughts on using the Index of Care, arguing that everyone is an individual and ‘one size does not fit all’. All people today and in the past with leprosy will have had different personal experiences, signs and symptoms, levels of ‘disability’, attitudes from their communities, types of care given (if any), and recovery rates. However, it should not be forgotten that people can also adapt well to having an illness and/or ‘disability’.

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