![Gerhard Armauer Hansen](https://upload.wikimedia.org/wikipedia/commons/5/53/Gerhard_Armauer_Hansen.jpg)
The history of leprosy was traced to its origins by an international team of 22
geneticist
A geneticist is a biologist or physician who studies genetics, the science of genes, heredity, and variation of organisms. A geneticist can be employed as a scientist or a lecturer. Geneticists may perform general research on genetic processe ...
s using comparative
genomics
Genomics is an interdisciplinary field of biology focusing on the structure, function, evolution, mapping, and editing of genomes. A genome is an organism's complete set of DNA, including all of its genes as well as its hierarchical, three-dim ...
of the worldwide distribution of ''
Mycobacterium leprae
''Mycobacterium leprae'' (also known as the leprosy bacillus or Hansen's bacillus), is one
of the two species of bacteria that cause Hansen’s disease (leprosy), a chronic but curable infectious disease that damages the peripheral nerves and ...
''.
[ Monot ''et al.'' (2005) determined that ]leprosy
Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...
originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of ''M. leprae'' are based in specific geographic regions where each predominantly occurs:[
: Strain 1 – East Africa, Asia, and the Pacific region
: Strain 2 – Ethiopia, Malawi, Nepal/North India, and New Caledonia
: Strain 3 – Europe, North Africa, and the Americas; and
: Strain 4 – West Africa and the Caribbean.
They created a map of the dissemination of leprosy in the world. This confirmed the spread of the disease along the migration, colonisation, and slave trade routes taken from East Africa to India, West Africa to the New World, and from Africa into Europe and vice versa.]
In 1873 G.H. Armauer Hansen in Norway discovered the causative agent of leprosy, ''Mycobacterium leprae
''Mycobacterium leprae'' (also known as the leprosy bacillus or Hansen's bacillus), is one
of the two species of bacteria that cause Hansen’s disease (leprosy), a chronic but curable infectious disease that damages the peripheral nerves and ...
.'' This was the first bacterium to be identified as causing disease in humans. From the 19th century, European nations adopted some practices of India and China, administering naturally occurring oils. They were given by injection and orally, and were believed to cure some people, but results were often disputed. It was not until the 1940s that the first effective treatment, promin
Promin, or sodium glucosulfone is a sulfone drug that was investigated for the treatment of malaria, tuberculosis and leprosy. It is broken down in the body to dapsone, which is the therapeutic form.
History
The first synthesis of Promin is some ...
, became available. The search for additional anti-leprosy drugs led to the use of clofazimine
Clofazimine, sold under the brand name Lamprene, is a medication used together with rifampicin and dapsone to treat leprosy. It is specifically used for multibacillary (MB) leprosy and erythema nodosum leprosum. Evidence is insufficient to suppor ...
and rifampicin
Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), mycobacterium avium complex, ''Mycobacterium avium'' complex, leprosy, and Legionnaires’ disease. ...
in the 1960s and 1970s. Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone
Dapsone, also known as 4,4'-sulfonyldianiline (SDA) or diaminodiphenyl sulfone (DDS), is an antibiotic commonly used in combination with rifampicin and clofazimine for the treatment of leprosy. It is a second-line medication for the treatment a ...
, intended to mitigate bacterial resistance
Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance. Fungi evolve antifungal resistance. Viruses evolve antiviral resistance. P ...
. Multi-drug therapy (MDT) combining all three drugs was first recommended by the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) of the United Nations in 1981. These three anti-leprosy drugs are still used in the standard MDT regimens.
Etymology
The word ''leprosy'' comes from ancient Greek
Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
''Λέπρα'' éprā "a disease that makes the skin scaly", in turn, a nominal derivation of the verb ''Λέπω'' épō "to peel, scale off". ''Λέπος'' (Lepos) in ancient Greek means peel, or scale; so from ''Λέπος'' derives ''Λεπερός'' (''Λεπερός'', "who has peels – scales") and then ''Λεπρός'' ("leprous"). The word came into the English language via Latin and old French. The first attested English use is in the ''Ancrene Wisse,'' a 13th century manual for nuns ("Moyseses hond..bisemde o þe spitel uuel & þuhte lepruse." ''The Middle English Dictionary,'' s.v., "leprous"). A roughly contemporaneous use is attested in the Anglo-Norman ''Dialogues of Saint Gregory,'' "Esmondez i sont li lieprous" (''Anglo-Norman Dictionary,'' s.v., "leprus").
Throughout history, individuals with leprosy have been known as lepers. In the 21st century, this term is falling into disuse as a result of the diminishing number of leprosy patients. Because of the stigma to patients, some prefer not to use the word 'leprosy', preferring 'Hansen's disease'. The term 'leprosy' is still used by the U.S. Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
and the World Health Organization.
Historical accounts
The ability to use historical records to trace the spread and treatment of leprosy in antiquity is greatly limited by confusion over which skin diseases were being discussed. Famously, the "leprosy" of most translations of the Bible
The Bible (from Koine Greek , , 'the books') is a collection of religious texts or scriptures that are held to be sacred in Christianity, Judaism, Samaritanism, and many other religions. The Bible is an anthologya compilation of texts of a ...
as far back as the Septuagint
The Greek Old Testament, or Septuagint (, ; from the la, septuaginta, lit=seventy; often abbreviated ''70''; in Roman numerals, LXX), is the earliest extant Greek translation of books from the Hebrew Bible. It includes several books beyond th ...
seems to have conflated various skin disorders and states of ritual impurity
Ritual purification is the ritual prescribed by a religion by which a person is considered to be free of ''uncleanliness'', especially prior to the worship of a deity, and ritual purity is a state of ritual cleanliness. Ritual purification may ...
known to the Hebrews
The terms ''Hebrews'' (Hebrew: / , Modern: ' / ', Tiberian: ' / '; ISO 259-3: ' / ') and ''Hebrew people'' are mostly considered synonymous with the Semitic-speaking Israelites, especially in the pre-monarchic period when they were still no ...
as '' tzara'ath'' (, "struck") with the Greek ''lépra'' (, "scaly"), whose separate diagnostic history dealt with psoriasis
Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...
and dandruff
Dandruff is a skin condition that mainly affects the scalp. Symptoms include flaking and sometimes mild itchiness. It can result in social or self-esteem problems. A more severe form of the condition, which includes inflammation of the skin, ...
before later being applied to leprosy. Debatably, the oldest known records are the India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
n vedas
upright=1.2, The Vedas are ancient Sanskrit texts of Hinduism. Above: A page from the '' Atharvaveda''.
The Vedas (, , ) are a large body of religious texts originating in ancient India. Composed in Vedic Sanskrit, the texts constitute the ...
whose ''kuṣṭha'' (, "eating away") is clearly focused on leprosy by the time of Suśruta's ''Compendium'', which prescribes chaulmoogra oil
''Hydnocarpus wightianus'' or chaulmoogra is a tree in the Achariaceae family. ''Hydnocarpus wightiana'' seed oil has been widely used in traditional Indian medicine, especially in Ayurveda, and in Chinese traditional medicine for the treatmen ...
as the remedy; unfortunately, its usual dating to 600 is wrong and the present text may be as recent as 600. Similarly, the " Great Chronicle" of Sri Lanka
Sri Lanka (, ; si, ශ්රී ලංකා, Śrī Laṅkā, translit-std=ISO (); ta, இலங்கை, Ilaṅkai, translit-std=ISO ()), formerly known as Ceylon and officially the Democratic Socialist Republic of Sri Lanka, is an ...
describes royal ancestors of Gautama Buddha
Siddhartha Gautama, most commonly referred to as the Buddha, was a wandering ascetic and religious teacher who lived in South Asia during the 6th or 5th century BCE and founded Buddhism.
According to Buddhist tradition, he was born in Lu ...
who contract leprosy, flee to the wilderness, and cure themelves using herbal medicine
Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remed ...
sometime before 700 but the present text dates to the 5th century
The 5th century is the time period from 401 ( CDI) through 500 ( D) ''Anno Domini'' (AD) or Common Era (CE) in the Julian calendar. The 5th century is noted for being a period of migration and political instability throughout Eurasia.
It saw the ...
or later. The Vendidad
The Vendidad /ˈvendi'dæd/ or Videvdat or Videvdad is a collection of texts within the greater compendium of the Avesta. However, unlike the other texts of the Avesta, the ''Vendidad'' is an ecclesiastical code, not a liturgical manual.
Name
...
of the Zoroastrian
Zoroastrianism is an Iranian religion and one of the world's oldest organized faiths, based on the teachings of the Iranian-speaking prophet Zoroaster. It has a dualistic cosmology of good and evil within the framework of a monotheistic on ...
Avesta
The Avesta () is the primary collection of religious texts of Zoroastrianism, composed in the Avestan language.
The Avesta texts fall into several different categories, arranged either by dialect, or by usage. The principal text in the litu ...
, surviving only in texts after 1300 but presumably recording practices nearly as old as the Vedas, discusses leprosy as ''paēsa'' and prescribes direct application of cow
Cattle (''Bos taurus'') are large, domesticated, cloven-hooved, herbivores. They are a prominent modern member of the subfamily Bovinae and the most widespread species of the genus ''Bos''. Adult females are referred to as cows and adult ma ...
's urine
Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra.
Cel ...
as a cure. Writing in the 5th century, Herodotus
Herodotus ( ; grc, , }; BC) was an ancient Greek historian and geographer from the Greek city of Halicarnassus, part of the Persian Empire (now Bodrum, Turkey) and a later citizen of Thurii in modern Calabria ( Italy). He is known f ...
mentions the Persian
Persian may refer to:
* People and things from Iran, historically called ''Persia'' in the English language
** Persians, the majority ethnic group in Iran, not to be conflated with the Iranic peoples
** Persian language, an Iranian language of the ...
practice of shunning native lepers and deporting foreign ones as part of a discussion of that area's peculiar habits; he reported that they considered the condition to have been caused by offense against the sun god
A solar deity or sun deity is a deity who represents the Sun, or an aspect of it. Such deities are usually associated with power and strength. Solar deities and Sun worship can be found throughout most of recorded history in various forms. The ...
.[.] The disease was thought to have entered Egypt
Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
along the Nile
The Nile, , Bohairic , lg, Kiira , Nobiin language, Nobiin: Áman Dawū is a major north-flowing river in northeastern Africa. It flows into the Mediterranean Sea. The Nile is the longest river in Africa and has historically been considered ...
from Nubia
Nubia () (Nobiin: Nobīn, ) is a region along the Nile river encompassing the area between the first cataract of the Nile (just south of Aswan in southern Egypt) and the confluence of the Blue and White Niles (in Khartoum in central Sudan), or ...
to its south and is recorded afflicting pharaoh
Pharaoh (, ; Egyptian: ''pr ꜥꜣ''; cop, , Pǝrro; Biblical Hebrew: ''Parʿō'') is the vernacular term often used by modern authors for the kings of ancient Egypt who ruled as monarchs from the First Dynasty (c. 3150 BC) until the an ...
s as well as commoners. The ancient Greek
Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
and Roman doctors considered that "elephantitis" had been introduced to their areas by the armies of Alexander
Alexander is a male given name. The most prominent bearer of the name is Alexander the Great, the king of the Ancient Greek kingdom of Macedonia who created one of the largest empires in ancient history.
Variants listed here are Aleksandar, Al ...
and Pompey
Gnaeus Pompeius Magnus (; 29 September 106 BC – 28 September 48 BC), known in English as Pompey or Pompey the Great, was a leading Roman general and statesman. He played a significant role in the transformation of ...
, respectively. It is discussed in particular by the authors Aulus Cornelius Celsus
Aulus Cornelius Celsus ( 25 BC 50 AD) was a Roman encyclopaedist, known for his extant medical work, ''De Medicina'', which is believed to be the only surviving section of a much larger encyclopedia. The ''De Medicina'' is a primary source on d ...
(25 37) and Pliny the Elder
Gaius Plinius Secundus (AD 23/2479), called Pliny the Elder (), was a Roman author, naturalist and natural philosopher, and naval and army commander of the early Roman Empire, and a friend of the emperor Vespasian. He wrote the encyclopedic '' ...
( 23–79).
The "Models for Sealing and Investigating" ''Fēngzhěnshì''), written between 266 and 246 in the State of Qin
Qin () was an ancient Chinese state during the Zhou dynasty. Traditionally dated to 897 BC, it took its origin in a reconquest of western lands previously lost to the Rong; its position at the western edge of Chinese civilization permitted ex ...
during the Warring States period
The Warring States period () was an era in History of China#Ancient China, ancient Chinese history characterized by warfare, as well as bureaucratic and military reforms and consolidation. It followed the Spring and Autumn period and concluded ...
, is the earliest known Chinese text which describes the symptoms of leprosy, termed under the generic word ''li'' () used for various skin disorders. This text mentioned the destruction of the nasal septum
The nasal septum () separates the left and right airways of the Human nose, nasal cavity, dividing the two nostrils.
It is Depression (kinesiology), depressed by the depressor septi nasi muscle.
Structure
The fleshy external end of the nasal ...
in those with leprosy, an observation that would not be made outside of China until the writings of Avicenna
Ibn Sina ( fa, ابن سینا; 980 – June 1037 CE), commonly known in the West as Avicenna (), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, philosophers, and writers of the Islamic G ...
in the 11th century; according to Katrina McLeod and Robin Yates it also stated lepers had "swelling of the eyebrows, loss of hair, absorption of nasal cartilage, affliction of knees and elbows, difficult and hoarse respiration, as well as anaesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), am ...
."
Medical texts from the medieval period have loose and seemingly incorrect depictions of leprosy, leading some historians to suspect that doctors of the era were not able to distinguish leprosy from other ailments such as syphilis
Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...
. Nevertheless, analysis of human remains in leper colony graveyards shows that the vast majority were affected by advanced forms of the disease considered as leprosy by modern doctors, so it is possible that medical practitioners of the era were better at distinguishing the disease than the scholars who wrote the manuscripts that survived to modern times.
In 1846, Francis Adams compiled ''The Seven Books of Paulus Aegineta,'' which included a commentary on all medical and surgical knowledge and descriptions and remedies from the Romans, Greeks, and Arabs. Descriptions of what is believed to be leprosy are included. A proven ancient human case was verified by DNA taken from the shrouded remains of a man discovered in a tomb next to the Old City of Jerusalem; it was dated by radiocarbon methods to 1–50.
Skin infections causing symptoms similar to leprosy were likely common in the ancient world. In particular, tinea capitis
Tinea capitis (also known as "herpes tonsurans", "ringworm of the hair", "ringworm of the scalp", "scalp ringworm", and "tinea tonsurans") is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatoph ...
(fungal
A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from th ...
scalp infection) and related infections on other body parts caused by the dermatophyte
Dermatophyte (from Greek '' derma'' "skin" (GEN ''dermatos'') and ''phyton'' "plant") is a common label for a group of fungus of ''Arthrodermataceae'' that commonly causes skin disease in animals and humans. Traditionally, these anamorphic (as ...
fungus ''Trichophyton violaceum'' are abundant in the late 20th century throughout North Africa and the Middle East. They may also have been common in biblical times. Likewise, the disfiguring skin disease favus
Favus (Latin for "honeycomb") or tinea favosa is the severe form of tinea capitis, a skin infectious disease caused by the dermatophyte fungus ''Trichophyton schoenleinii.'' Typically the species affects the scalp, but occasionally occurs as onyc ...
is caused by ''Trichophyton schoenleinii,'' which appears to have been common throughout Africa and Eurasia before the advent of modern medicine.[
As late as the 17th century in Europe, persons with severe favus and similar fungal diseases (and potentially also with severe ]psoriasis
Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...
and other diseases not caused by microorganisms) tended to be classified as having leprosy. The painting ''The Regents of the Leper Hospital in Haarlem 1667'' by Jan de Bray
Jan de Bray (c. 1627 – April 4, 1697) was a Dutch Golden Age painter. He lived and worked in Haarlem until the age of 60, when he went bankrupt and moved to Amsterdam.
Jan de Bray was influenced by his father Salomon de Bray, and the por ...
(Frans Hals Museum
The Frans Hals Museum is a museum located in Haarlem, the Netherlands.
The museum was established in 1862. In 1950, the museum was split in two locations when the collection of modern art was moved to the '' Museum De Hallen'' (since 2018 called ...
, Haarlem
Haarlem (; predecessor of ''Harlem'' in English) is a city and municipality in the Netherlands. It is the capital of the province of North Holland. Haarlem is situated at the northern edge of the Randstad, one of the most populated metropoli ...
, the Netherlands) shows a young Dutchman with a vivid scalp infection. It may have been caused by a fungus, but he is being cared for by three officials of a charitable home intended for people with leprosy. The use of the word "leprosy" before the mid-19th century, when microscopic examination of skin for medical diagnosis was first developed, can seldom be correlated reliably with leprosy as it is understood today.
Genetic analysis
DNA analysis has been applied to the origins and history of leprosy. Geneticists in 2005 used comparative genomics
Genomics is an interdisciplinary field of biology focusing on the structure, function, evolution, mapping, and editing of genomes. A genome is an organism's complete set of DNA, including all of its genes as well as its hierarchical, three-dim ...
to study these aspects, including the paths of how the disease was spread throughout the world. The researchers determined that leprosy
Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...
originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of ''M. leprae'' are based in specific geographic regions where each predominantly occurs:[
: Strain 1 – East Africa, Asia, and the Pacific region
: Strain 2 – Ethiopia, Malawi, Nepal/North India, and New Caledonia
: Strain 3 – Europe, North Africa, and the Americas; and
: Strain 4 – West Africa and the Caribbean.
The researchers created a map showing the dissemination of leprosy by these strains. The disease clearly accompanied humans along their migration, colonisation, and slave trade routes taken since ancient times. Some peoples traveled from East Africa to India, millions were taken in the slave trade from West Africa to the New World, and others traveled from Africa into Europe and vice versa.][
In 2009 skeletal remains from the second millennium BCE were discovered at ]Balathal
Balathal is an archaeological site located in Vallabhnagar tehsil of Udaipur district of Rajasthan state in western India. It is one of the ninety Ahar-Banas culture sites located in the Basins of the Banas river and its tributaries.
Excavatio ...
, in Rajasthan
Rajasthan (; lit. 'Land of Kings') is a state in northern India. It covers or 10.4 per cent of India's total geographical area. It is the largest Indian state by area and the seventh largest by population. It is on India's northwestern si ...
, northwest India. Study and analysis of these remains were documented as the oldest skeletal evidence for leprosy. The scholars who studied these remains suggest that, if the disease did migrate from Africa to India during the third millennium BCE, "at a time when there was substantial interaction among the Indus Civilization
The Indus Valley Civilisation (IVC), also known as the Indus Civilisation was a Bronze Age civilisation in the northwestern regions of South Asia, lasting from 3300 BCE to 1300 BCE, and in its mature form 2600 BCE to 1900&n ...
, Mesopotamia
Mesopotamia ''Mesopotamíā''; ar, بِلَاد ٱلرَّافِدَيْن or ; syc, ܐܪܡ ܢܗܪ̈ܝܢ, or , ) is a historical region of Western Asia situated within the Tigris–Euphrates river system, in the northern part of the F ...
, and Egypt
Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
, there needs to be additional skeletal and molecular evidence of leprosy in India and Africa so as to confirm the African origin of the disease." Evidence for the disease was later confirmed in the human skeletal remains from the archaeological site of Harappa
Harappa (; Urdu/ pnb, ) is an archaeological site in Punjab, Pakistan, about west of Sahiwal. The Bronze Age Harappan civilisation, now more often called the Indus Valley Civilisation, is named after the site, which takes its name from a mode ...
, in Pakistan. The disease was thus present in the urban centers of the Indus civilization before 2000 BCE, further supporting the hypothesis it migrated here as part of the "third millennium BCE interaction sphere" – an exchange network that spanned the Arabian Sea.
Discovery of bacterium
After the end of the 17th century, Norway
Norway, officially the Kingdom of Norway, is a Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of Jan Mayen and t ...
, Iceland
Iceland ( is, Ísland; ) is a Nordic island country in the North Atlantic Ocean and in the Arctic Ocean. Iceland is the most sparsely populated country in Europe. Iceland's capital and largest city is Reykjavík, which (along with its s ...
, and England
England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
were the countries in Western Europe where leprosy was a significant problem. Norway appointed a medical superintendent for leprosy in 1854 and established a national register for people with leprosy in 1856. This was the first national patient register in the world.
''Mycobacterium leprae
''Mycobacterium leprae'' (also known as the leprosy bacillus or Hansen's bacillus), is one
of the two species of bacteria that cause Hansen’s disease (leprosy), a chronic but curable infectious disease that damages the peripheral nerves and ...
'', the causative agent of leprosy, was discovered by G. H. Armauer Hansen in Norway in 1873, making it the first bacterium to be identified as causing disease in humans. Hansen observed a number of nonrefractile small rods in unstained tissue sections. The rods were not soluble in potassium lye, and they were acid- and alcohol-fast. In 1879, he stained these organisms with Ziehl's method and noted the similarities with Koch's bacillus (''Mycobacterium tuberculosis
''Mycobacterium tuberculosis'' (M. tb) is a species of pathogenic bacteria in the family Mycobacteriaceae and the causative agent of tuberculosis. First discovered in 1882 by Robert Koch, ''M. tuberculosis'' has an unusual, waxy coating on its c ...
''). There were three significant differences between these organisms:
:(1) the rods in the leprosy lesions were extremely numerous,
:(2) they formed characteristic intracellular collections (''globii''), and
:(3) the rods had a variety of shapes with branching and swelling.
These differences suggested that leprosy was caused by an organism related to but distinct from ''Mycobacterium tuberculosis''. Hansen worked at St. Jørgens Hospital in Bergen
Bergen (), historically Bjørgvin, is a city and municipality in Vestland county on the west coast of Norway. , its population is roughly 285,900. Bergen is the second-largest city in Norway. The municipality covers and is on the peninsula of ...
, founded early in the fifteenth century. St. Jørgens is now preserved as ''Lepramuseet'' – a museum related to the history and research of leprosy.
Hansen's finding was opposed principally by his father-in-law, Daniel Cornelius Danielssen
Daniel Cornelius Danielssen (4 July 1815 – 13 July 1894) was a Norwegian physician. He was most noted for his research regarding the causes and treatment of leprosy.
Biography
Danielssen was from Bergen, Norway. Dating from 1839, he was asso ...
, who considered it a hereditary disease. He had described it as such in his book, '' Traité de la Spedalskhed ou Elephantiasis des Grecs'' – the standard reference book on leprosy from 1848 until the death of Danielssen in 1895. While Danielssen's book was a highly used source and provided a solid foundation for worldwide leprosy understanding, it was soon surpassed. In 1867 Dr. Gavin Milroy
Gavin Milroy (1805–1886) was a Scottish physician and medical writer.
Life
Born in Edinburgh, where his father was in business, Milroy attended Edinburgh High School, and made medical studies at Edinburgh University. He became M.R.C.S. Edin. i ...
finished the Royal College of Physicians' report on leprosy. His work, which compiled data from all corners of the British Empire
The British Empire was composed of the dominions, colonies, protectorates, mandates, and other territories ruled or administered by the United Kingdom and its predecessor states. It began with the overseas possessions and trading posts esta ...
, agreed with Danielssen that leprosy was a hereditary disease. In addition, he said that leprosy was also a constitutional disease that could be mitigated by improvements to a patient's health, diet, and living conditions.
Historical treatments
The disease was known in Ancient Greece as elephantiasis (elephantiasis graecorum).
At various times blood was considered to be a treatment either as a beverage
A drink or beverage is a liquid intended for human consumption. In addition to their basic function of satisfying thirst, drinks play important roles in human culture. Common types of drinks include plain drinking water, milk, juice, smoothies a ...
or as a bath
Bath may refer to:
* Bathing, immersion in a fluid
** Bathtub, a large open container for water, in which a person may wash their body
** Public bathing, a public place where people bathe
* Thermae, ancient Roman public bathing facilities
Plac ...
; sometimes the blood of children or virgins was required, suggesting associations of ritual purity. Europeans associated this practice with the Ancient Egyptians, but it appears to have been developed independently in China. This practice was used until at least 1790, when the use of dog
The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the wolf. Also called the domestic dog, it is derived from the extinct Pleistocene wolf, and the modern wolf is the dog's nearest living relative. Do ...
blood was mentioned in ''De Secretis Naturae''. Paracelsus
Paracelsus (; ; 1493 – 24 September 1541), born Theophrastus von Hohenheim (full name Philippus Aureolus Theophrastus Bombastus von Hohenheim), was a Swiss physician, alchemist, lay theologian, and philosopher of the German Renaissance.
He w ...
recommended the use of lamb
Lamb or The Lamb may refer to:
* A young sheep
* Lamb and mutton, the meat of sheep
Arts and media Film, television, and theatre
* ''The Lamb'' (1915 film), a silent film starring Douglas Fairbanks Sr. in his screen debut
* ''The Lamb'' (1918 ...
's blood, and blood from dead bodies was sometimes used.
Snakes were also used, according to Pliny
Pliny may refer to:
People
* Pliny the Elder (23–79 CE), ancient Roman nobleman, scientist, historian, and author of ''Naturalis Historia'' (''Pliny's Natural History'')
* Pliny the Younger (died 113), ancient Roman statesman, orator, w ...
, Aretaeus of Cappadocia
Aretaeus ( grc-gre, Ἀρεταῖος) is one of the most celebrated of the ancient Greek physicians. Little is known of his life. He presumably was a native or at least a citizen of Cappadocia (Roman province), Cappadocia, a Roman province in ...
, and Theodorus. Gaucher Gaucher is a French surname. Notable people with the surname include:
*Charles-Étienne Gaucher (1740–1804), French engraver
*Elias Gaucher, French publisher
*Eric Gaucher (born 1972), American biologist
*Guillaume Gamelin Gaucher (1810–1885), ...
recommended treatment with cobra venom. Boinet, in 1913, tried increasing doses of bee
Bees are winged insects closely related to wasps and ants, known for their roles in pollination and, in the case of the best-known bee species, the western honey bee, for producing honey. Bees are a monophyly, monophyletic lineage within the ...
stings (up to 4000). Scorpion
Scorpions are predatory arachnids of the order Scorpiones. They have eight legs, and are easily recognized by a pair of grasping pincers and a narrow, segmented tail, often carried in a characteristic forward curve over the back and always end ...
s and frog
A frog is any member of a diverse and largely Carnivore, carnivorous group of short-bodied, tailless amphibians composing the order (biology), order Anura (ανοὐρά, literally ''without tail'' in Ancient Greek). The oldest fossil "proto-f ...
s were used occasionally instead of snakes. The excreta of '' Anabas'' (the climbing fish) was also tried.
Alternative treatments included scarification with or without the addition of irritants including arsenic
Arsenic is a chemical element with the symbol As and atomic number 33. Arsenic occurs in many minerals, usually in combination with sulfur and metals, but also as a pure elemental crystal. Arsenic is a metalloid. It has various allotropes, but ...
and hellebore
Commonly known as hellebores (), the Eurasian genus ''Helleborus'' consists of approximately 20 species of herbaceous or evergreen perennial flowering plants in the family Ranunculaceae, within which it gave its name to the tribe of Helleboreae. ...
. Castration
Castration is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses pharmaceut ...
was also practiced in the Middle Ages.
A common pre-modern treatment of leprosy was chaulmoogra oil
''Hydnocarpus wightianus'' or chaulmoogra is a tree in the Achariaceae family. ''Hydnocarpus wightiana'' seed oil has been widely used in traditional Indian medicine, especially in Ayurveda, and in Chinese traditional medicine for the treatmen ...
. The oil has long been used in India as an Ayurvedic
Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscientific. Ayurveda is heavily practiced in India and Nepal, where around 80% of the population rep ...
medicine for the treatment of leprosy and various skin conditions. It has also been used in China and Burma
Myanmar, ; UK pronunciations: US pronunciations incl. . Note: Wikipedia's IPA conventions require indicating /r/ even in British English although only some British English speakers pronounce r at the end of syllables. As John Wells explai ...
. It was introduced to the West by Frederic John Mouat, a professor at Bengal Medical College
, mottoeng = Humanity and Science
, type = Public medical school
, established =
, founder = Lord William Bentinck
, principal = Raghunath Mishra
, faculty = ...
. He tried the oil as an oral and topical agent in two cases of leprosy and reported significant improvements in an 1854 paper.
This paper caused some confusion. Mouat indicated that the oil was the product of a tree ''Chaulmoogra odorata'', which had been described in 1815 by William Roxburgh
William Roxburgh FRSE FRCPE Linnean Society of London, FLS (3/29 June 1751 – 18 February 1815) was a Scottish people, Scottish surgeon and botanist who worked extensively in India, describing species and working on economic botany. He is known ...
, a surgeon and naturalist, while he was cataloging the plants in the East India Company
The East India Company (EIC) was an English, and later British, joint-stock company founded in 1600 and dissolved in 1874. It was formed to trade in the Indian Ocean region, initially with the East Indies (the Indian subcontinent and Southea ...
's botanical garden in Calcutta
Kolkata (, or , ; also known as Calcutta , List of renamed places in India#West Bengal, the official name until 2001) is the Capital city, capital of the Indian States and union territories of India, state of West Bengal, on the eastern ba ...
. This tree is also known as ''Gynocardia odorata
''Gynocardia'' is a genus of dioecious evergreen tree belonging to the Achariaceae family, containing the sole species ''Gynocardia odorata''. The trees grow up to 30 m tall. The species is found in moist forests of mountain valleys in South Asi ...
''. For the rest of the 19th century, this tree was thought to be the source of the oil. In 1901, Sir David Prain
Sir David Prain (11 July 1857 – 16 March 1944) was a Scottish botanist who worked in India at the Calcutta Botanical Garden and went on to become Director of the Royal Botanic Gardens, Kew.
Life
Born to David Prain, a saddler, and his wife ...
identified the chaulmoogra seeds of the Calcutta bazaar
A bazaar () or souk (; also transliterated as souq) is a marketplace consisting of multiple small Market stall, stalls or shops, especially in the Middle East, the Balkans, North Africa and India. However, temporary open markets elsewhere, suc ...
and of the Paris and London apothecaries as coming from '' Taraktogenos kurzii'', which is found in Burma
Myanmar, ; UK pronunciations: US pronunciations incl. . Note: Wikipedia's IPA conventions require indicating /r/ even in British English although only some British English speakers pronounce r at the end of syllables. As John Wells explai ...
and Northeast India. The oil mentioned in the Ayurvedic texts was determined to be from the tree ''Hydnocarpus wightiana
''Hydnocarpus wightianus'' or chaulmoogra is a tree in the Achariaceae family. ''Hydnocarpus wightiana'' seed oil has been widely used in traditional Indian medicine, especially in Ayurveda, and in Chinese traditional medicine for the treatmen ...
'', known as ''Tuvakara'' in Sanskrit
Sanskrit (; attributively , ; nominally , , ) is a classical language belonging to the Indo-Aryan branch of the Indo-European languages. It arose in South Asia after its predecessor languages had diffused there from the northwest in the late ...
and ''chaulmugra'' in Hindi
Hindi (Devanāgarī: or , ), or more precisely Modern Standard Hindi (Devanagari: ), is an Indo-Aryan language spoken chiefly in the Hindi Belt region encompassing parts of northern, central, eastern, and western India. Hindi has been de ...
and Persian
Persian may refer to:
* People and things from Iran, historically called ''Persia'' in the English language
** Persians, the majority ethnic group in Iran, not to be conflated with the Iranic peoples
** Persian language, an Iranian language of the ...
.
The first parenteral
A route of administration in pharmacology and toxicology is the way by which a drug, fluid, poison, or other substance is taken into the body.
Routes of administration are generally classified by the location at which the substance is applied. ...
administration was given by the Egyptian doctor Tortoulis Bey, personal physician to the Sultan Hussein Kamel of Egypt
Sultan Hussein Kamel ( ar, السلطان حسين كامل; 21 November 1853 – 9 October 1917) was the Sultan of Egypt from 19 December 1914 to 9 October 1917, during the British protectorate over Egypt. He was the first person to hold the ...
. He had been using subcutaneous injections of creosote
Creosote is a category of carbonaceous chemicals formed by the distillation of various tars and pyrolysis of plant-derived material, such as wood or fossil fuel. They are typically used as preservatives or antiseptics.
Some creosote types were ...
for tuberculosis. In 1894 he administered subcutaneous injection of chaulmoogra oil to a 36-year-old Egypt
Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
ian Copt
Copts ( cop, ⲛⲓⲣⲉⲙⲛ̀ⲭⲏⲙⲓ ; ar, الْقِبْط ) are a Christians, Christian ethnoreligious group indigenous to North Africa who have primarily inhabited the area of modern Egypt and Sudan since Ancient history, antiqui ...
who had been unable to tolerate oral treatment. After 6 years and 584 injections, the patient was declared cured.
An early scientific analysis of the oil was carried out by Frederick B. Power in London in 1904. He and his colleagues isolated a new unsaturated fatty acid from the seeds, which they named 'chaulmoogric acid'. They also investigated two closely related species: ''Hydnocarpus wightiana
''Hydnocarpus wightianus'' or chaulmoogra is a tree in the Achariaceae family. ''Hydnocarpus wightiana'' seed oil has been widely used in traditional Indian medicine, especially in Ayurveda, and in Chinese traditional medicine for the treatmen ...
'' and '' Hydnocarpus anthelmintica.'' By comparing material from the trees, they isolated both chaulmoogric acid and a closely related compound, 'hydnocarpus acid'. They also investigated ''Gynocardia odorata'' and found that it produced neither of these acids. Later investigation showed that 'taraktogenos' ('' Hydnocarpus kurzii'') also produced chaulmoogric acid.
Administration of the oil was difficult. Taken orally it is extremely nauseating. Given by enema may cause peri-anal ulcers and fissures. Given by injection the drug caused fever and other local reactions. Despite these difficulties, a series of 170 patients were studied in 1916 by Ralph Hopkins, the attending physician at the Louisiana
Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is borde ...
Leper Home in Carville, Louisiana
Carville is a neighborhood of St. Gabriel in Iberville Parish in South Louisiana, located sixteen miles south of the capital city of Baton Rouge on the Mississippi River. Carville was the childhood hometown of political consultant James Carville, ...
. He divided the patients into two groups – 'incipient' and 'advanced'. He reported that in the advanced cases, 25% (at most) showed any improvement or arrest of their condition; in the incipient cases, 45% showed an improvement or stabilization of the disease (mortality rates were 4% and 8%, respectively). The remainder absconded from the Home, apparently in improved condition.
Given the apparent usefulness of this agent, a search began for improved formulations. Victor Heiser the Chief Quarantine Officer and Director of Health for Manila
Manila ( , ; fil, Maynila, ), officially the City of Manila ( fil, Lungsod ng Maynila, ), is the capital of the Philippines, and its second-most populous city. It is highly urbanized and, as of 2019, was the world's most densely populate ...
, and Elidoro Mercado the house physician at the San Lazaro Hospital
The San Lazaro Hospital (SLH) is a tertiary health facility in Manila, Philippines. It is a referral facility for communicable diseases and is one of the retained special tertiary hospital of the Department of Health and is funded by subsidy fr ...
for lepers in Manila, decided to add camphor
Camphor () is a waxy, colorless solid with a strong aroma. It is classified as a terpenoid and a cyclic ketone. It is found in the wood of the camphor laurel ('' Cinnamomum camphora''), a large evergreen tree found in East Asia; and in the k ...
to a prescription of chaulmoogra and resorcin, which was typically given orally. This was at the suggestion of Merck and Company
Merck & Co., Inc. is an American multinational pharmaceutical company headquartered in Rahway, New Jersey, and is named for Merck Group, founded in Germany in 1668, of whom it was once the American arm. The company does business as Merck Sharp ...
in Germany to whom Heiser had written. They found that patients could tolerate this new compound without the nausea that had accompanied the earlier preparations.
Heiser and Mercado in 1913 administered the oil by injection to two patients, with the result that they were cured of the disease. Since the doctors had been using the oil in conjunction with other materials, the results were not clear. Two additional patients were treated by injections of oil alone and appeared to be cured of the disease. The following year, Heiser reported on an additional 12 patients, but the results were mixed.
Researchers worked to develop less toxic injectable forms of this oil. Merck of Darmstadt
Darmstadt () is a city in the States of Germany, state of Hesse in Germany, located in the southern part of the Frankfurt Rhine Main Area, Rhine-Main-Area (Frankfurt Metropolitan Region). Darmstadt has around 160,000 inhabitants, making it th ...
had already produced a version of the sodium salts in 1891. They named this sodium gynocardate in the mistaken belief that the origin of the oil was ''Gynocardia odorata''. Bayer
Bayer AG (, commonly pronounced ; ) is a German multinational corporation, multinational pharmaceutical and biotechnology company and one of the largest pharmaceutical companies in the world. Headquartered in Leverkusen, Bayer's areas of busi ...
in 1908 marketed a commercial version of the esters under the name 'Antileprol'. At the University of Hawaii
A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United States, th ...
, the young chemist Alice Ball
Alice Augusta Ball (July 25, 1882 – December 31, 1916) was an American chemist who developed the "Ball Method", the most effective treatment for leprosy during the early 20th century. She was the first woman and first African American to rece ...
developed a chemical process that made the oil less hydrophobic and therefore more readily absorbed by the body. Sadly she died before she could see the results of her work: After being treated with the modified oil, 78 patients were able to return home from leper colonies in 1920. Despite the common side effects and continuing debates about its efficacy, chaulmoogra oil remained the best available treatment for leprosy into the 1940s.
To ensure a supply of this agent, Joseph Rock
Joseph Francis Charles Rock (1884 – 1962) was an Austrian-American botanist, explorer, geographer, linguist, ethnographer and photographer.
Life
Josef Franz Karl Rock was born in Vienna, Austria, the son of a steward of a Polish count. As a r ...
, Professor of Systematic Botany at the College of Hawaii, traveled to Burma to procure seeds of the trees. The local villagers located a grove of trees in seed, which he used to establish a plantation of 2,980 trees on the island of Oahu
Oahu () (Hawaiian language, Hawaiian: ''Oʻahu'' ()), also known as "The Gathering place#Island of Oʻahu as The Gathering Place, Gathering Place", is the third-largest of the Hawaiian Islands. It is home to roughly one million people—over t ...
, Hawaii between 1921 and 1922. There continued to be numerous leprosy patients in the islands.
Asylums
Contrary to popular opinion, people were not universally isolated in leprosy asylums in the Middle Ages. In Europe, asylums offered shelter to all manner of people, including some who would have had skin complaints that included leprosy. The expansion of asylums in England between 1100 and 1250 was not necessarily in response to a major epidemic
An epidemic (from Ancient Greek, Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time.
Epidemics ...
of leprosy.(346)
Additionally, leprosy did not disappear in Europe after the medieval period as a result of a "great confinement" of leprosy-affected people in leprosy asylums. In Portugal, for example, there were 466 cases in 1898. By 1938 there were sufficient numbers to warrant the construction of Rovisco Pais, to treat people affected by the disease. This was not only to treat those returning from the New World, but also for rural dwellers infected within Portugal, as the records of Rovisco Pais show. Spain also had cases enough to engage public attention. In 1902, Jesuits Father Carlos Ferris and Joaquin Ballister founded the Patronato San Francisco de Borja, Fontilles. In 1904, there were still 552 cases treated there and more than 1,000 in total estimated in Spain. This documentation affirms the genetic tracking carried out by Monot ''et al''.[ that traces exchanges along the trade and slave routes from Africa, to Spain and Portugal, to the West Indies, and back again to Spain and Portugal. At the same time, there was an autochthonous strain that had persisted from an earlier period.
Numerous ''leprosaria'', or leper hospitals, were founded in the Middle Ages; ]Matthew Paris
Matthew Paris, also known as Matthew of Paris ( la, Matthæus Parisiensis, lit=Matthew the Parisian; c. 1200 – 1259), was an English Benedictine monk, chronicler, artist in illuminated manuscripts and cartographer, based at St Albans Abbey ...
, a Benedictine monk
, image = Medalla San Benito.PNG
, caption = Design on the obverse side of the Saint Benedict Medal
, abbreviation = OSB
, formation =
, motto = (English: 'Pray and Work')
, found ...
, estimated that in the early thirteenth century, there were 19,000 across Europe. The first recorded leper colony
A leper colony, also known by many other names, is an isolated community for the quarantining and treatment of lepers, people suffering from leprosy. '' M. leprae'', the bacterium responsible for leprosy, is believed to have spread from East Af ...
was in Harbledown
Harbledown is a village in Kent, England, immediately west of Canterbury and contiguous with the city. At local government level the village is designated as a separate civil parish, that of Harbledown and Rough Common. The High Street is a cons ...
, England
England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
. While leprosaria were common throughout Europe in the early, middle, and late Middle Ages, how leprosy was dealt with in the Middle Ages is still viewed through the "distorting lens" of "nineteenth century attempts by physicians, polemicist, and missionaries" who tried to use "the past for evidence to support their own campaigns for mandatory segregation." The leprosy asylum or leprosarium of the past had many designations and variations in structure and degree of restriction. In the medieval period, it also offered basic support to many indigent people, amongst whom some would have had leprosy. In England, these houses were run along monastic lines and required those admitted to take vows of poverty, obedience and chastity. Those flouting the rules could be expelled. Within the Christian framework, the disease was associated with symbolic significance. Withdrawal from everyday life was considered symbolic of ritually separating themselves from the world of the flesh, as a redemptive action, on behalf of the whole of society.
The Order of Saint Lazarus
The Order of Saint Lazarus of Jerusalem, also known as the Leper Brothers of Jerusalem or simply as Lazarists, was a Catholic military order (monastic society), military order founded by crusaders around 1119 at a leprosy, leper hospital in Jerus ...
was a hospitaller and military order of monks that began as a leper hospital outside Jerusalem in the twelfth century. It remained associated with leprosy throughout its history. The first monks in this order were leper knights, and they originally had leper grand masters, although these aspects of the order changed over the centuries. From this order was derived the name lazar house
A leper colony, also known by many other names, is an isolated community for the quarantining and treatment of lepers, people suffering from leprosy. '' M. leprae'', the bacterium responsible for leprosy, is believed to have spread from East Af ...
.
Radegund
Radegund ( la, Radegundis; also spelled ''Rhadegund, Radegonde, or Radigund''; 520 – 13 August 587) was a Thuringian princess and Frankish queen, who founded the Abbey of the Holy Cross at Poitiers. She is the patron saint of several churches ...
was noted for washing the feet of lepers. Orderic Vitalis
Orderic Vitalis ( la, Ordericus Vitalis; 16 February 1075 – ) was an English chronicler and Benedictine monk who wrote one of the great contemporary chronicles of 11th- and 12th-century Normandy and Anglo-Norman England. Modern historia ...
writes of a monk, Ralf, who was so overcome by the plight of lepers that he prayed to catch leprosy himself (which he eventually did). The leper would carry a clapper and bell to warn of his approach. This was as much to attract attention for charity as to warn people that a diseased person was near.
The leprosaria of the Middle Ages had multiple benefits: They provided treatment and safe living quarters for people with leprosy who were granted admission; they eased tension amongst the healthy townspeople; and they provided for a more stable populace for the authorities to govern.
Modern treatments
Promin
Promin, or sodium glucosulfone is a sulfone drug that was investigated for the treatment of malaria, tuberculosis and leprosy. It is broken down in the body to dapsone, which is the therapeutic form.
History
The first synthesis of Promin is some ...
was synthesised in 1940 by Feldman of Parke-Davis
Parke-Davis is a subsidiary of the pharmaceutical company Pfizer. Although Parke, Davis & Co. is no longer an independent corporation, it was once America's oldest and largest drug maker, and played an important role in medical history. In 1970 ...
and company. Although Parke-Davis synthesised the compound, it seems certain that they were not the first. In the same year that Gelmo described sulphanilamide (1908), Emil Fromm, professor of chemistry in the medical faculty of the University of Freiburg im Breisgau, in Germany, described another compound related to the sulphonamides: this was diaminodiphenylsulphone or dapsone (DDS). No one recognised the potential of this compound until Buttle and his colleagues at the Wellcome
Wellcome () is a supermarket chain owned by British conglomerate Jardine Matheson Holdings via its DFI Retail Group subsidiary. The Wellcome supermarket chain is one of the two largest supermarket chains in Hong Kong, the other being Parkn ...
laboratories and Fourneau and the researchers at the Institut Pasteur
The Pasteur Institute (french: Institut Pasteur) is a French non-profit private foundation dedicated to the study of biology, micro-organisms, diseases, and vaccines. It is named after Louis Pasteur, who invented pasteurization and vaccines fo ...
simultaneously found in 1937 that dapsone was ten times as potent against streptococcal infection in mice and about a hundred times as toxic as sulphanilamide.
Until the introduction of treatment with promin in the 1940s, there was no effective treatment for leprosy. The efficacy of promin was first discovered by Guy Henry Faget
Guy Henry Faget (1891–1947) was an American medical doctor who revolutionalized the treatment of leprosy, by demonstrating the efficacy of promin, as described in a paper published in 1943. Promin is a sulfone compound, synthesized by Feldman an ...
and his co-workers in 1943 at Carville, Louisiana. Robert Cochrane was the first to use DDS, the active component of promin, at the Lady Willingdon Leprosy Settlement, in Chingleput, near Madras, India. John Lowe was the first to successfully administer DDS orally at Uzuakoli Leper Settlement, in Nigeria, in spite of indications that the drug was highly toxic. Both innovations made it possible to produce a treatment that was cheap, seemingly effective, and could be distributed on a large scale.
Scientists eventually realised that DDS was only weakly bactericidal against '' M. leprae'', and it was considered necessary for patients to take the drug indefinitely. When dapsone was used alone, the ''M. leprae'' population quickly evolved
Evolution is change in the heritable characteristics of biological populations over successive generations. These characteristics are the expressions of genes, which are passed on from parent to offspring during reproduction. Variation t ...
antibiotic resistance
Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance. Fungi evolve antifungal resistance. Viruses evolve antiviral resistance. ...
. By the 1960s, the world's only known anti-leprosy drug became ineffective against resistant bacteria.
The search for more effective anti-leprosy drugs led to the use of clofazimine
Clofazimine, sold under the brand name Lamprene, is a medication used together with rifampicin and dapsone to treat leprosy. It is specifically used for multibacillary (MB) leprosy and erythema nodosum leprosum. Evidence is insufficient to suppor ...
and rifampicin
Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), mycobacterium avium complex, ''Mycobacterium avium'' complex, leprosy, and Legionnaires’ disease. ...
in the 1960s and 1970s.[ Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance.][ The first trials of combined treatment were carried out in ]Malta
Malta ( , , ), officially the Republic of Malta ( mt, Repubblika ta' Malta ), is an island country in the Mediterranean Sea. It consists of an archipelago, between Italy and Libya, and is often considered a part of Southern Europe. It lies ...
in the 1970s.
Multidrug therapy (MDT) combining all three drugs was first recommended by a WHO Expert Committee in 1981. These three anti-leprosy drugs are still used in the standard MDT regimens. None of them is used alone because of the risk of developing resistance.
As this treatment was quite expensive, it was not quickly adopted in most countries where the disease is endemic. In 1985, leprosy was still considered a public health problem in 122 countries. The 44th World Health Assembly (WHA), held in Geneva in 1991, passed a resolution to eliminate leprosy as a public-health problem by the year 2000 – defined as reducing the global prevalence
In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of the disease to less than 1 case per 10,000. At the Assembly, the World Health Organization (WHO) was given the mandate to develop an elimination strategy by its member states. This was based on increasing the geographical coverage of MDT and patients' accessibility to the treatment. Novartis
Novartis AG is a Swiss-American multinational pharmaceutical corporation based in Basel, Switzerland and
Cambridge, Massachusetts, United States (global research).name="novartis.com">https://www.novartis.com/research-development/research-loc ...
produces this medication for free.
Overview of some nations
India
''The Oxford Illustrated Companion to Medicine'' says that leprosy, as well as cures for it, were described in the Hindu religious book ''Atharva-veda
The Atharva Veda (, ' from ' and ''veda'', meaning "knowledge") is the "knowledge storehouse of ''atharvāṇas'', the procedures for everyday life".Laurie Patton (2004), Veda and Upanishad, in ''The Hindu World'' (Editors: Sushil Mittal and G ...
''. Writing in the '' Encyclopædia Britannica 2008'', Kearns and Nash state that the first mention of leprosy is in the Indian medical treatise ''Sushruta Samhita
The ''Sushruta Samhita'' (सुश्रुतसंहिता, IAST: ''Suśrutasaṃhitā'', literally "Suśruta's Compendium") is an ancient Sanskrit text on medicine and surgery, and one of the most important such treatises on this subj ...
'' (6th century BCE).[Kearns & Nash (2008)] ''The Cambridge Encyclopedia of Human Paleopathology'' (1998) holds that: "The ''Sushruta Samhita'' from India describes the condition quite well and even offers therapeutic suggestions as early as about 600 BC"[Aufderheide, A. C.; Rodriguez-Martin, C. & Langsjoen, O. (1998) ''The Cambridge Encyclopedia of Human Paleopathology''. ]Cambridge University Press
Cambridge University Press is the university press of the University of Cambridge. Granted letters patent by Henry VIII of England, King Henry VIII in 1534, it is the oldest university press
A university press is an academic publishing hou ...
; p. 148. The surgeon Sushruta
Sushruta, or ''Suśruta'' (Sanskrit: सुश्रुत, IAST: , ) was an ancient Indian physician. The ''Sushruta Samhita'' (''Sushruta's Compendium''), a treatise ascribed to him, is one of the most important surviving ancient treatises on ...
lived in the Indian city of Kashi
Kashi or Kaashi may refer to:
Places
* Varanasi (historically known as "Kashi"), a holy city in India
**Kingdom of Kashi, an ancient kingdom in the same place, one of the sixteen Mahajanapadas
**Kashi Vishwanath Temple, Varanasi
* Kashgar, a cit ...
by the 6th century BCE,[Dwivedi & Dwivedi (2007)] and the medical treatise ''Sushruta Samhita'' attributed to him was documented during the 1st millennium BCE.[ The earliest surviving excavated written material that contains the works of Sushruta is the '']Bower Manuscript
The Bower Manuscript is a collection of seven fragmentary Buddhist Hybrid Sanskrit. treatises found buried in a Buddhist memorial stupa near Kucha, northwestern China. Written in early Gupta script (late Brahmi script) on birch bark, it is vario ...
'' – dated to the 4th century CE, almost a millennium after the original work. Despite these earlier works, Europeans believed that the first widely considered accurate description of the disease was that of Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
of Pergamum
Pergamon or Pergamum ( or ; grc-gre, Πέργαμον), also referred to by its modern Greek form Pergamos (), was a rich and powerful ancient Greek city in Mysia. It is located from the modern coastline of the Aegean Sea on a promontory on th ...
in 150 CE.
In 1997, a 4,000 year-old skeleton was uncovered in India that was found to show traces of leprosy.[ The discovery was made at a site called Balathal, which is today part of ]Rajasthan
Rajasthan (; lit. 'Land of Kings') is a state in northern India. It covers or 10.4 per cent of India's total geographical area. It is the largest Indian state by area and the seventh largest by population. It is on India's northwestern si ...
. This is believed to be the oldest known physical case of the disease. This pre-dated by 1,500 years the previous earliest recognized case, dating to 6th century Egypt
Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
. It is believed that the excavated skeleton belonged to a male, who was in his late 30s and belonged to the Ahar Chalcolithic culture.[ Archaeologists have said that this is the first such example that dates to prehistoric India. This finding supports the evidence of the disease spreading to India by human migration routes from its origin in Africa.
In 1874, the Missions to Lepers began to offer support to leprosy asylums that offered shelter to people affected by leprosy in India. Gradually, they instituted a policy of segregating males and females in the institutions. The asylum superintendents believe that this separation was beneficial in order to avoid infecting the children of diseased parents and to prevent further births. At this time, there were still debates about the transmission of the disease. The Leprosy Mission were heartened to find that the separated children did not develop the disease.
In 1881, around 120,000 leprosy patients were documented in India. The central government passed the Lepers Act of 1898, which provided legal provision for forcible confinement of people with leprosy in India, but the Act was not enforced.
]
China
Regarding ancient China
The earliest known written records of the history of China date from as early as 1250 BC, from the Shang dynasty (c. 1600–1046 BC), during the reign of king Wu Ding. Ancient historical texts such as the '' Book of Documents'' (early chapte ...
, Katrina C.D. McLeod and Robin D.S. Yates identify the State of Qin's ''Feng zhen shi'' 封診式 (''Models for sealing and investigating''), dated 266–246 BCE, as offering the earliest-known unambiguous description of the symptoms of low-resistance leprosy, even though it was termed under ''li'' 癘, a general Chinese word for skin disorder.[ Angela Leung's ''Leprosy in China: A History'' (New York: Columbia University Press, 2009) is the authoritative source on leprosy in China.] This 3rd century BCE Chinese text on bamboo slip, found in an excavation of 1975 at Shuihudi, Yunmeng
Yunmeng County () is a county in eastern Hubei province, People's Republic of China. It is administered by Xiaogan City and is located just outside Xiaogan's urban area.
History
During the Spring and Autumn period of Chinese history (770-476 B ...
, Hubei
Hubei (; ; alternately Hupeh) is a landlocked province of the People's Republic of China, and is part of the Central China region. The name of the province means "north of the lake", referring to its position north of Dongting Lake. The prov ...
province, described not only the destruction of the "pillar of the nose" but also the "swelling of the eyebrows, loss of hair, absorption of nasal cartilage, affliction of knees and elbows, difficult and hoarse respiration, as well as anesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
."
Indonesia
In the 21st century, the rate of prevalence across Indonesia is slightly under one new case per 10,000 people, with approximately 20,000 new cases detected each year.["Self-Care: Leprosy-related disabilities," in ''Invisible People: Poverty and Empowerment in Indonesia,'' Irfan Kortschak, 2010] But, the rate is considerably higher in certain regions, particularly South Sulawesi (with more than three new cases per 10,000 people) and North Maluku (with more than five new cases per ten thousand people). MDT is provided free of charge to patients who require it in Indonesia. Several hospitals in major population centers are specifically intended to deal with the medical needs of those affected by the disease. While the early detection and treatment of leprosy has improved over the years, approximately ten percent of patients in Indonesia have already had significant nerve or other damage prior to the identification and treatment of their disease. This is because of lack of awareness as well as the pervasive stigma that discourages those with the disease from seeking treatment.
PERMATA (Perhimpunan Mandiri Kusta) Indonesia was established in 2007 to fight the stigma associated with leprosy and eliminate discrimination against those with the disease. The organization was founded by a small group of individuals who had all been treated for leprosy. The founders worked to establish links with key figures amongst those with the disease in communities in South Sulawesi, East Java and NTT, the three provinces where the rate of incidence of the disease is amongst the highest in Indonesia.
Iran
The Persian
Persian may refer to:
* People and things from Iran, historically called ''Persia'' in the English language
** Persians, the majority ethnic group in Iran, not to be conflated with the Iranic peoples
** Persian language, an Iranian language of the ...
polymath
A polymath ( el, πολυμαθής, , "having learned much"; la, homo universalis, "universal human") is an individual whose knowledge spans a substantial number of subjects, known to draw on complex bodies of knowledge to solve specific pro ...
Avicenna
Ibn Sina ( fa, ابن سینا; 980 – June 1037 CE), commonly known in the West as Avicenna (), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, philosophers, and writers of the Islamic G ...
(c. 980–1037) was the first outside of China to describe the destruction of the nasal septum
The nasal septum () separates the left and right airways of the Human nose, nasal cavity, dividing the two nostrils.
It is Depression (kinesiology), depressed by the depressor septi nasi muscle.
Structure
The fleshy external end of the nasal ...
in those with leprosy.
Japan
In a document written in 833, leprosy was described as "caused by a parasite that eats five organs of the body. The eyebrows and eyelashes come off, and the nose is deformed. The disease brings hoarseness, and necessitates amputations of the fingers and toes. Do not sleep with the patients, as the disease is transmittable to those nearby." This was the first document concerning believed infectious aspect of the disease.
Japan passed leprosy prevention laws in 1907, 1931
Events
January
* January 2 – South Dakota native Ernest Lawrence invents the cyclotron, used to accelerate particles to study nuclear physics.
* January 4 – German pilot Elly Beinhorn begins her flight to Africa.
* January 22 – Sir I ...
, and 1953 that were based on segregation of persons with the disease; this approach intensified leprosy stigma
Leprosy stigma is a type of social stigma, a strong negative feeling towards a person with leprosy relating to their moral status in society. It is also referred to as leprosy-related stigma, leprostigma, and stigma of leprosy. Since ancient times ...
. Lepers were seen as being incurable and infectious. Males admitted to leprosaria in Japan were sterilized, and females found to be pregnant were forced to have abortions. These extreme actions were done to prevent children of diseased parents from being born, lest they carry the disease. (Doctors during this time still mistakenly believed that leprosy was a hereditary disease.) The 1953 law was abrogated in 1996. More than a decade later, in 2008 there were 2,717 ex-patients in 13 national sanatoria and two private hospitals.
References
Citations
Bibliography
* .
* .
* .
* .
* .
* .
Further reading
* 1877:
* 1895:
* 1895:
* 1896:
* 1916:
*
* 1993: Anne Bargès
''Leprosy History and Ethnology in Mali''
In French .
{{History of infectious diseases
Leprosy