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Chapter 4

Chapters 4, 5, 6

Health Studies
Course Code
Caroline Barakat

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Leprosy (Hansens disease)
Egyptian Papyrus document (1550 BC); Indian writings, approx. 600 BC; Ancient Greece, after army of Alexander the Great
returned from India (320 BC); Rome (62 BC) returned with Pompeiis troops from Asia Minor
Disease of soul
Thought to be hereditary illness, caused by curse of punishment of God
Lepers were stigmatized – special clothing, arrival notification, separate hospitals, leprosariums
First leper house - England 936 AD
Mid-12th century – loss of civic status removal from public office;13th century - 19,000 leprosaria in use
Mass of Separation;Decline around 1350 AD;Spread to North America
Dr. Armauer Hansen of Norway-1873.
Discovers the leprosy germ under a microscope
Mycobacterium leprae (M. leprae )
Slow multiplying bacillus
- average doubling time of 12 – 14 days
Incubation period of 3 – 5 yrs
Thought to be transmitted via droplets, from the nose during close and frequent contact
Not highly infectiousmay be related to genetic susceptibility
Mainly affects the skin, nerves, and mucous membranes
All races; common in warm, wet areas in the tropics and subtropics; between the ages of 10 and 14 years old, 35-44 years old
Rarely seen in infants; Genetic susceptibility
Indeterminate Leprosy (IL)earliest, mildest form; usually few lesions; loss of sensation is rare
Tuberculosis Leprosy (TT) Development of large lesions; loss of sensation; affected nerves become thick; progression can
occur to BT
Borderline Tuberculoid Leprosy (BT) lesions are smaller and more numerous
Borderline Lepromatous Leprosy (BL) lesions are numerous, papules, plaques; punched-out lesions (inverted saucers);
disease may return
Lepromatous Leprosy (LL) never reverts to less severe; early symptoms (nasal stuffiness, discharge, bleeding, swelling at legs,
skin thickens; eyebrows, eyelashes lost; nose deformation/collapses; ear lobes thicken; photophobia (light sensitivity)/blindness;
enlarged liver and lymph nodes; hoarseness in voice; fingers and toes become deformed
Diagnosis and Treatment
Based on clinical symptoms; laboratory studies
Chaulmoogra nut; promin (1941); Dapsone (1950s); WHO recommends multidrug therapy (MDT)dapsone, rifampicin,
Nine-banded armadillo
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Do not develop human type leprosy, usually more severe and fatal; low body temperature (28-33C) may promote disease; mid-
1980s concern of infection from armadillos
Preventionhand washing; disinfection of fomites, handkerchiefs; nasal secretions; household contacts (young - treat with
drugs); vaccine
Possible causal factors for the disappearance of disease Selective mortality of leprosy patients during plague pandemic;
Cross-immunity with other Mycobacteria; Loss of pathogenecity; Genetic selection of the population; Improved quarantine;
Improved socio-economic conditions; Better housing and sanitation; Climate
DArcy IslandChinese railway laborers (1890s); prison to Chinese people with leprosy; supply shipped 3 months (food,
clothing, opium, coffins); medical officers condemned the conditions but nothing was done; closed in 1957 when last person died
Tracadie, NB may have been introduced by sailors; slowly spread from family to family to neighbor; first case 1815; lepers lived
in hut; 1844 – legislation passed to prevent spread; Sheldrake Island chosen for lazaretto
Where are we now?
212,000 in 2008; did not reach 1 in 10,000 in 1991 – Brazil, Nepal, Timor-Leste; India – 137,685 (2007), 87,228 (2008); Brazil (45
847); Indonesia (21,430)
TuberculosisThe White Plague
TB present since antiquity; Egyptian mummies (2400 BC); Phthisis or consumptionHomer 800BC; 460 BCHippocrates;
disease was due to evil air but did not consider it contagious; Aristotle (384 – 322BC)suggested that TB may be due to bad and
heavy breath
Documented in Egypt, India, and China as early as 5,000, 3,300, and 2,300 years ago respectively; Skeletal abnormalities
Limited to animals in prehistoric times (8000 – 4000BC); TB epidemics likely from changes in the host population and the
Claims of royal supernatural powers during the Middle Ages (AD 500 – 1500); In England, practice of Kings Evil or the Royal
1546 Fracastorius describes Modern Theory of Contagion; 1629 Consumption - leading cause of death in London; 1679
Franciscus D Sylvius discovers the lung nodules - "tubercles; 1720 - Benjamin Marten - speculates that TB may be
communicable from one individual to another; 19th centuryTB spread to rest of Europe and by 1900 reached N America;
(1839) term "tuberculosis" first used; Mid 19th centuryTB was romanticized; Opera productions La Traviata (1853), La
Boheme (1895); Classical movie Camille (1936)based on Alexandre Dumas novel The Woman of the Camellias; (1854) Dr.
Brehmer - Doctoral Dissertation- Tuberculosis is a Curable Disease; 1854 - Jean-Antoine Villemin -specific microorganism as
cause; 1882Dr. Robert Koch – discovered Mycobacterium tuberculosis, developed tuberculin test; 1895 - Wilhelm Konrad von
Rontgen –use of radiation
Agenttubercle bacillus germ Mycobacterium tuberculosis, an acid-fast bacillus
Type 1found in India; least virulent
Type A Africa, China, Japan, Europe, North America; Type BExclusively in Europe and North America
Forms of Tuberculosisanimal forms of bacillus; bovine type may lead to pulmonary TB (most common) or Milliary
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