Historical perspective

 

            Although leprosy’s origins have been reportedly existed as late as 3500 BCE in a papyrus documenting the illness of the Egyptian king Hispati (Lechat 158), the earliest written records that accurately reflects leprosy appears to be from the 600 BCE Sushruta Samhita text from India (Browne 1). Indeed, recollections of leprosy throughout mankind’s history have been fraught with confusion, with much controversy in determining who had indeed been infected with leprosy, instead of other diseases such as smallpox or plague.

 

Biblical Accounts

 

The person who has the leprous disease shall wear torn clothes and let the hair of his head be disheveled; and he shall cover his upper lip and cry out, ‘Unclean, unclean.’… He shall live alone…”

From Leviticus 13:45-47

 

1989 Holy Bible, New Revised Standard Version, which includes the footnote

Leprous: A term for several skin diseases; precise meaning uncertain

 

            While the Bible has consistently been used to cite the historical antiquity of leprosy, many academics are uncertain that the described disease in the Old Testament, tsara’ath, is, in fact leprosy (Lechat). Indeed, numerous Christian based leprosy support groups, such as the American Leprosy Missions, note that biblical leprosy is not the same as the leprosy recognized today.

 

Left: A 14th Century manuscript depicting a leper with his warning bell.

Photo Credit: Peter Richards, The Medieval Leper, 2000

 

 

            Instructions for the separation of lepers, however, were well documented within the western tradition, with some far more extreme than others. In Medieval times, leprosy sufferers were subjected to severe punishment, such as forced starvation or immolation while still alive (Browne 6). During the Middle Ages, priests would perform a formal service for the leper to separate them from the community; the use of a leper clapper or bell was required in many locations, as was isolation from others except from those who also had leprosy (Richards 50-51).

 

 

Right: A reproduction of a warning clappers used by lepers in Great Britain.

Photo Credit: Peter Richards, The Medieval Leper, 2000

 

 

 

 

 

 

 

Across the Globe: Major Dates

 

11th Century CE– The return of many Crusaders sickened by leprosy causes a surge in hospices throughout Europe, with renewed vigor by certain groups to care for the sick (Browne 5). Interestingly, the link between the spread of leprosy and the Crusades is controversial, with some experts suggesting that the disease reached epidemic levels in earlier medieval times (Mitchell).

 

1798 CE– The last endemic case of leprosy is diagnosed in Britain (Browne 7).

 

Right: Medieval evaluation of the leprosy patient.

Photo Credit: Peter Richards, The Medieval Leper, 2000

 

 

 

Left: A drawing on John Berns, at the time 28, believed to the last endemic case of leprosy in Great Britain.

Photo Credit: Peter Richards, The Medieval Leper, 2000

 

 

1854 CE—F. Mouat describes the use of chaulmoogra oil as a treatment for leprosy; further investigation reveals that the oil is not particularly useful (Jacobson 193).

 

1866 CE—Norwegian physician Gerhard Henrik Armauer Hansen becomes a medical officer at a leprosy hospital. He will later disagree not only with the medical establishment, but also his father, about how leprosy is transmitted. Hansen argues the disease is infectious, rather than being hereditable, in nature (Rees 31).

 

 

Right: Dr. GH Hansen, in his younger days.

Photo Credit: http://www.bergen.folkebibl.no/utstillinger/bilder/armauer_lille.jpg

 

 

1872 (circa) CE—Hansen identifies Mycobacterium leprae microscopically and publishes report on it 1 year later. Leprosy will later be named, “Hansen’s Disease” in recognition of his efforts, as well as attempting to reduce the stigma associated with the word leprosy.

 

 

Left: A historical drawing of a 13-year old boy in 1847, who would be diagnosed today with multibacillary leprosy. The boy has had the disease at this stage for 7 years.

Photo Credit: Peter Richards, The Medieval Leper, 2000

 

1908 CE—German chemists, Fromm and Wittmann, discover diaminodiphenylsulfone, (Dapsone, DDS), which is later used as a critical part of leprosy treatment (Browne 9). However, it is not utilized as a leprosy treatment for decades.

 

1940 CE—Promin (glucosulfone sodium), a sulfone derivative, is utilized in the United States for the treatment of leprosy. The treatment was an “intensive” regimen of 5 grams injected intravenously three times a day (Jacobson 194).

 

1949-1950 CE—R. G. Cochrine and J. Lowe report remarkable successes with Dapsone (Jacabson 194). Their research allows for Dapsone to rapidly gain acceptance as the standard of care.

 

 

Left: The drug Dapsone in a non-MDT format.

Photo Credit: Bureau of Primary Health Care

 

 

1974 CE – Reports of antibacterial resistance to Dapsone begin to present itself in the medical literature (Jacobson 195), with the alarming realization that Dapsone alone may not be the silver bullet.

 

1977 CE—The World Health Organization urges healthcare providers that Dapsone alone should not be used to treat leprosy; rather, a multi-drug approach should be taken (Jacobson 195).

 

1981-1982 CE—The World Health Organization formally recommends that multi-drug therapy should be used to treat leprosy.

 

1987 CE-- Multi-Drug Therapy becomes available in “blister packs”, becoming simpler to distribute and easier for the patient to comply with the rigorous drug schedule (WHO).

 

 

 

Right: MDT “blister packs”; green for PB leprosy, red for MB leprosy.

PB Leprosy patients get 6 packs, MB patients 12.

Photo Credit: World Health Organization

 

 

 

1994 CE – Multi-Drug Therapy reaches 100% coverage in the Western Pacific region, with the drug provided free to anyone with leprosy, across the globe (WHO).

 

1999 CE—An estimated 10.7 million people cured with MDT since 1985 (McDougall 19).

 

2001 CE—World Health Organization announces global target for leprosy elimination of 1 case/ 10,000 people is achieved (McDougall 17).

 

Archeological Information

 

 

 

 

Left: Skeletal changes, such as the increase porosity seen in the nasal bridge area of this skull, can be key factors in helping researchers identify whether or not the body had leprosy. In this case, the porous edges of the bone suggest that the clinical feature of a saddle-nose was well underway.

Photo Credit: Donald Ortner, Observations on the pathogenesis of skeletal disease in leprosy, the Past and Present of Leprosy. 2002.

 

 

 

 

            Perhaps the most accurate way in determining the prevalence of actual leprosy in the historical record is the use of skeletal evidence. Late stage leprosy—rather commonplace in the past due to a lack of a treatment—can cause recognizable deformations and skeletal abnormalities that can be identified. In particular, researchers look at the rhinomaxillary (nasal bridge) area for evidence of destruction, in addition to the fingers and toes which may suffer from repeated injury or infection due to the lack of sensation (Ortner 75-76).  Understandably, it is possible for other diseases to confound the researcher; trauma to the face and infections like syphilis can mimic the signs of leprosy (Leiker).