Using SXRF and LA-ICP-TOFMS to Explore Evidence of Treatment and Physiological Responses to Leprosy in Medieval Denmark

SIMPLE SUMMARY: Leprosy, a chronic infectious disease, leads to blood mineral imbalances: low levels of zinc, calcium, magnesium, and iron and high levels of copper. Interestingly, in late medieval Europe, minerals were used to treat leprosy. We investigated physiological responses to leprosy and possible evidence of treatment in dental tissues of leprosy sufferers from medieval Denmark and early 20th century Romania when multidrug therapy was not then yet invented. Using Synchrotron Fluorescence (SXRF) and laser ablation (LA-ICP-TOFMS), we show marked covariations in the zinc, calcium, and magnesium distributions, which are compatible with clinical studies but cannot be directly attributed to leprosy. Minerals used historically as a treatment for leprosy show no detectable intake (arsenic, mercury) or a diffuse distribution (lead) related to the daily consumption of contaminated water and food. Intense lead enrichments indicate acute incorporations, potentially through the administration of lead-enriched medication or the mobilization of lead from bone stores to the bloodstream during intense physiological stress related to leprosy. However, comparisons with a healthy control group are needed to ascertain these interpretations. The positive correlations and the patterns observed between lead and essential elements may indicate underlying pathophysiological conditions, demonstrating the potential of the two techniques for investigating diseases in past populations. ABSTRACT: Leprosy can lead to blood depletion in Zn, Ca, Mg, and Fe and blood enrichment in Cu. In late medieval Europe, minerals were used to treat leprosy. Here, physiological responses to leprosy and possible evidence of treatment are investigated in enamel, dentine, and cementum of leprosy sufferers from medieval Denmark (n = 12) and early 20th century Romania (n = 2). Using SXRF and LA-ICP-TOFMS, 12 elements were mapped in 15 tooth thin sections, and the statistical covariation of paired elements was computed to assess their biological relevance. The results show marked covariations in the Zn, Ca, and Mg distributions, which are compatible with clinical studies but cannot be directly attributed to leprosy. Minerals used historically as a treatment for leprosy show no detectable intake (As, Hg) or a diffuse distribution (Pb) related to daily ingestion. Intense Pb enrichments indicate acute incorporations of Pb, potentially through the administration of Pb-enriched medication or the mobilization of Pb from bone stores to the bloodstream during intense physiological stress related to leprosy. However, comparisons with a healthy control group are needed to ascertain these interpretations. The positive correlations and the patterns observed between Pb and essential elements may indicate underlying pathophysiological conditions, demonstrating the potential of SXRF and LA-ICP-TOFMS for paleopathological investigations.