A Quantitative Approach to Record Skeletal Manifestations of Leprosy and Its Application to St Mary Magdalen Leprosarium, Winchester

Abstract

This paper presents and tests a new method for publishing and diagnosing leprosy-related skeletal lesions while making available the leprosy-related demographic data and pathology for St Mary Magdalen, Winchester (MMW). This method can facilitate interstudy comparisons of leprosy prevalence and severity by improving data comparability. The method scores five pathological changes to the maxillary area, proposes severity classes for periosteal bone formation on limbs, and records changes to the tarsals, metacarpals, metatarsals, and manual and pedal phalanges. Stage images for facial lesions and illustrations of a number of hand/foot lesions are provided. The method was applied to, and tested on, the MMW leprosarium collection (n = 126). Repeatability tests (n = 7–15) were performed at different experience levels. Application of the method to MMW has highlighted that over 65% of individuals show signs of leprosy, with more women showing severe lesions than men. Many individuals had lesions that likely impacted ability and mobility, more so than at other UK leprosaria, supporting the notion that MMW is a specialist institute. Intraobserver and interobserver tests show moderate-excellent agreement and highlighted the importance of definitions provided alongside illustrations. This method provides a coded, detailed short-hand that can replace qualitative descriptions in limited-word publications, thereby improving interstudy comparisons and aid statistical analysis. This can facilitate more complex diachronic and socially grounded research in relation to leprosy. This paper also presents the first formally published overview of all leprosy-related pathology for MMW to improve the usability of this collection for future research.