Leper's Skull

The Hoxne Skull and the Enigmatic link between it and the red squirrel

The Skull, presently in Diss Museum, was believed to have been found in a garden in Hoxne between 1960-1990. Recently it has attracted national importance.

When it was found originally the cranium and mandible were examined by bone structure and determined to belong to a young to middle-aged female who lived between the fifth and eleventh century. Bone changes highly indicative of leprosy were evident but, without the rest of the skeleton to examine for deformities of the feet and hands, diagnosis was not definitive.

Leprosy is a long-term infection caused by Mycobacterium leprae (M.leprae), a bacterium that exists in Britain as two main types. It affects the skin and nerves, causing discoloration and lumps and often severe disfiguration and deformities.

Advances in genetic techniques and improvements in radiocarbon dating now offer an opportunity to confirm the diagnosis of leprosy, as well as to assess the infecting type and potentially throw some light on our current knowledge about the context of the disease and its' transmission.

At the end of 2017 Sarah Inskip and others from Cambridge University published their findings on the biomolecular and geochemical analysis of the Hoxne skull. These showed that it was infected with the subtype 31 of M.leprae, - a type intermediate between the ancestral and modern subtypes. This is the same type as found in a skeleton at Great Chesterford (415-545 AD) whereas the Hoxne skull was dated between 885-1015AD, indicating very similar strains existed in East Anglia for several hundred years. Other type 31 cases have been reported from medieval Britain (Winchester and Ipswich), Denmark and Sweden. This might suggest a Scandinavian origin for this lineage especially given the significant population movements that took place between these regions in the Anglo-Saxon period.

It is unclear what caused the decline in European leprosy since there has been very little change in the genetic makeup of the organism over 800 years. Although indigenous human leprosy has been absent from Britain for more than 200 years, a recent study has shown M.leprae infection in red squirrels from Dorset is very closely related to the type found in the Hoxne skull.

Can leprosy be passed from squirrels to humans and, if so, how? Historically this route of transmission would have been possible as squirrel was used commonly for fine fur and meat during the medieval period. They were also kept as pets. King's Lynn and Great Yarmouth became very significant ports for importing fur from Scandinavian and Baltic squirrels during medieval times.

Over half of pre-Norman and Norman leprosy cases in Britain appeared in East Anglia - noteworthy compared with the rest of Britain with a suggestion that the disease was prevalent here earlier.However, three of the earliest reported cases come from the south west but these have not been subjected to radiocarbon dating or M.leprae analysis. Interestingly five cases have been reported along the route of the Icknield Way, an important trade route linking the SW with the east of Britain.

At the time when leprosy was becoming endemic in Britain East Anglia had the most densely populated areas, including Norwich and Ipswich. It is believed that the increase in population density and interconnection between towns and the rural hinterland may have provided the opportunity for the disease to spread. There is a long history of leprosy in East Anglia as evidenced by the foundation of many leper hospitals, or leprosaria(lazar houses), from the 11th century onwards, with hospitals in Eye, Eccles, Dunwich, Sudbury, Ipswich and five in Norwich.

So why was there so much leprosy in East Anglia? Archaeological excavation bias should be considered due to the development of towns and cities with early medieval precursors e.g Norwich but it is not evident in places like London and Bristol.

Another factor may relate to good skeletal preservation in areas dominated by chalk geology. However, no leprosy cases have been recovered from Anglo-Saxon cemeteries in areas with similar geology e.g Dorset and Hampshire.

An interesting aspect of the Hoxne skull relates to the mandible found alongside the skull which has been determined to belong to a different individual. This raises the possibility that there might be an Anglo-Saxon cemetery in Hoxne. We are aware of others just outside the village.

In conclusion, we know that the Vikings brought us shipbuilding, days of the week and Danelaw. Were they also responsible for bringing the deadly disfiguring disease of leprosy via their squirrels to plague Britain for hundreds of years?

Written by Margaret Sillis.