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Lecture 4

plagues and people lecture 4.docx


Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat
Lecture
4

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History
Occurrence of leprosy has been recorded throughout history Egyptian Papyrus document (1550
BC)
Remained a problem until the 16th and 17th century
Indian writings 600 BC
In records of Ancient Greece, after the army of Alexander the Great returned from India 320 BC
In Rome 62BC with the return of Pompeii’s troops from Asia Minor
In Europe dates back 500-700 BC
Mentioned in the Christian bible
Thought to have originated from the far east, and dates back to 1500 BC
Spread to the Mediterranean area and Europe, evidence of leprosy in bone dating from 500-700
AD
Social implications- disease of the soul , outcasts in society
Open sores contributed to the belief that lepers were contagious , belief that they needed to be
ostracised from society
Contagion was thought to be present which worried society
Misinterpreted due to the visible sores that existed
Believed to be a hereditary disease, or curse by punishment from God, believed to be sinners
Deserving of the punishments they got for their sins
Lepers were stigmatized- special clothing with a bell because people wanted to know about
their arrival into society, ring the bell so that others would know that they were entering
society.
Lepers were strapped to posts and buried alive , live burials, tying to posts
Special hospitals for lepers- leprosariums, lazaretto, leper colony , lazar house
Eg. Special clothing, arrival notification, separate hospitals and often had to live in colonies
called leposariums/lazaretto/leper colony/lazar house
Forcefully placed in these colonies against their will
First “leper house” in England in 936 AD
19,000 leprosariums that were created, the peak of the epidemic, the epidemic reached its peak
By the mid-12th century , loss civic status, removal from public office
13th century 19000 “leprosaria” in use- peak of this epidemic
Mas of Separation- formal rituals that would take the lepers and tell them about the rules of
society . Forced to move from their homes to the leprosariums
Decline of leprosarium’s around 1350 AD
Spread to North America
16th and 17th century was the peak of leprosy in the Americas
First case of leprosy in 1823, in Hawaii and the Molokai Island
The American National Leprosarium was established in Louisiana in 1917,
Patients were not allowed to marry until 1952, in 1957 the people kept in the American National
leprosarium were set free
Had to forfeit all the rights of society in order to be placed in leprosarium
MASS OF SEPERATION
Forbidden to enter a church, monastery, fair, a mill, a marked or an assembly of people
Could only leave house if they wore leper clothing , so they could be recognized
Could only use wells if they had their own buckets, barrel

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Were not allowed to share items
Not allowed to touch anything , until it becomes their own- unless the person pays for it
Forbidden to share house with any women
Not allowed to touch the rim of the well, unless they had gloves on
Not allowed to drink or eat form any vessel but your own
Only allowed to wear certain clothing in order to be able to enter society
Dr. Armauer Hansen of Norway 1873
Discovers the leprosy germ under a microscope
Mycobacterium leprae- cannot be grown in tissue culture, only in mice and nine banded
armadillos (armadillios have low body temperature, and are better able to grow the
mycobacterium in their flesh)
Leprosy is now known as Hansen’s disease
ETIOLOGY
M leprae
Slow multiplying bacillus- does not grow very fast , average doubling time of 12-14 d
Incubation is about 3-5 years , will not show any symptoms
Thought to be transmitted via droplets, from the nose during close and frequent contact
Can enter through the nose or through an open wound and it packs the nerve cells and it
spreads into the person
Not highly infections may be related to genetic susceptibility
Mainly affects the skin, nerves and mucous membranes, can lead to deformation around the
mouth and nose
Cross protection between tuberculosis and leprosy. People who get tuberculosis are less
susceptible to getting leprosy. Individuals that take the TB vaccine do not get leprosy
Epidemiology . KIPPLE 834,836
- were about stable since weve developed a way of dealing with the disease
-
Temporal change in terms of leprosy cases worldwide, it appears to have receded after 2007
Worldwide prevalence of leprosy appears to have declined
Where does leprosy exist? green (less leprosy) , orange and red indicate a higher leprosy cases
in those areas
A lot in Brazil, South America, Africa , Southeast Asia, India (2003) not occurring in North
America
2005-
China had a lot of cases in leprosy in the 1960s , it has gone down tremendously because you
can detect it
Areas of concern include : Brazil, Angola, Tanzania , Madagascar and India, overall prevalence
based on regions
Proper surveillance, case attention, proper medications can control the cases of leprosy
Leprosy tends to be spatially differentiated, certain areas, certain places would have different
places than others
(look at diagrams)
Risk Factors
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