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Chapter 14

HLTB21H3 Chapter Notes - Chapter 14: John Wycliffe, Mycobacterium Leprae, Gerhard Armauer Hansen


Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat
Chapter
14

Page:
of 4
CHAPTER 14- LEPROSY, THE STRIKING HAND OF GOD
The mention of leprosy in both the Old and New Testament has surely contributed to the fear
of the sores associated with leprosy, as well as the notion that what is blemished is unclean
and is also displeasing to God because it is defiled.
Christ’s curing of lepers became a metaphor for divine salvation.
A LOOK BACK
Leprosy probably arose in the Far East (about 1400 BC), for there are accurate descriptions
in the sacred Hindu writings of the Veda, and there are also descriptions in the Chinese
literature.
Charaka Samhit (written bet. 600& 400 BC)- Indian text where earliest accounts of leprosy
occur.
Nei Chang- (written bet. 250& 230 BC) textbook of medicine that describes a disease
wherein the patient has stiff joints, the eyebrows and beard fall off, flesh becomes nodular
and ulcerates, numbness results, and finally the bridge of the nose changes color and rots.
It has been claimed that soldiers of Alexander the Great brought leprosy from India to
Greece in the 4th century BC, but it is also possible that it spread from the Far East to West
along trade routes, arriving in the Mediterranean about the time of Christ.
The best description of leprosy in Europe comes from Aractus (contemporary of Galen) in
AD 150.
Leprosy then spread further west, where there is evidence of the disease in bones dating
from AD 500 to 700 in the graveyards of Britain and France.
Emperor Constantine (AD 274-337) suffered from leprosy, and pagan priests believed that
bathing in blood of sacrificed children could cure him, but it did not.
Saraath- Hebrew word used to describe many skin conditions; variously translated as
“defiled, accursed, scaly.” When the Bible was translated into Greek, saraath became
lepros.
St. Jerome Latinized lepros into lepra. In the 1st English translation of the Bible (1384), John
Wycliff translated lepra as “leprosy.”
In the Middle Ages, and even before, leprosy was considered a disease of the soul.
Medieval medical authors refer to lepers as being crafty, irascible, suspicious, and above all
having a burning desire for lustful sex.ß
Leprosy was sometimes known as satyriasis---insatiable sexual appetite.
By the 16th century, there was confusion between syphilis and leprosy.
The disfigurement of the face and hands contributed to the alienation of the leper, and the
sores on the body led to the belief that leprosy was contagious.
Lepers were not considered nice people, and they were cast out of society.
In 1179, the Third Lateran Council issued a decree urging the segregation of lepers from
society: the leper was told not to mix with the crowds, use his own container in drawing
water, not to touch anything unless he paid for it first, wear a distinctive garment and
announce his presence with a bell or clappers. There was a ritual burial.
At times, lepers were treated with kindness, but at the time of Henry II and Phillip V of
France, the leper was strapped to a post and burned alive. Edward I buried them alive.
Some good Christian people established almshouses or refuges for lepers. Many were
called Lazar Houses or lazarets, after Lazarus of Bethany, who was believed to suffer from
leprosy and who replaced Job as the patron saint of the leper.
The pandemic of leprosy reached epidemic proportions in the 12th century, and in the 13th
and 14th century, had its peak in Europe (with records showing 19,000 lazarets documenting
this increase).
By 16th century, most lazarets have been closed, and by the 18th century, they had all but
disappeared.
William H. McNeill- historian who suggested that leprosy may have retreated in the 1300s
with the rising incidence of pulmonary tuberculosis, which provoked greater resistance to
leprosy. However, scientific evidence for this notion is scant.
Knights participating in the Crusades contracted leprosy, and in 1048, they formed their own
spiritual order, the Order of Lazarus. Their return was probably a contributing factor to the
spread of leprosy throughout Europe.
Leprosy spread from Spain and Africa to the Americas in the 16th and 17th centuries.
It has been claimed that the last leprosy patient Great Britain died in Scotland in 1798.
As late as the mid-19th century, there were thousands of cases in Scandinavia, and with the
importation of Chinese laborers into the Pacific Islands by colonizing Europeans, the disease
was spread further.
First reference to leprosy in Hawaii was in 1823.
In early 1860s there was a “rediscovery” of leprosy as a disease of those of foreign birth.
By this time, leprosy has reached epidemic proportions on the Hawaiian Islands.
The Hawaiian Kingdom followed a practice of quarantine using isolation and segregation.
Officials rounded up the lepers and loaded them onto ships bound for a settlement at
Kalawao, on an isolated peninsula of Molokai’s north shore. Many of those transported were
shoved off the ships, hundreds of yards from the land, and forced to swim to shore.
In 1865, a leper colony was formally established on Molokai that housed a total of 142
individuals.
Although the Chinese were singled out as the source of leprosy, 97% of the lepers on
Molokai were Hawaiian, because the prevailing view was that leprosy was a very contagious
disease, and the Hawaiians were characterized as lacking in social utility.
Father Damien- a Roman Catholic priest from Belgium; joined the colony as its resident
priest; stayed for 16 years; cleaned and bandaged sores and built homes, a hospital, a
reservoir, and a plumbing system; for the next decade and a half, he buried many hundreds
of leprosy victims.
The story was spread that father Damien had contracted leprosy during his residency. He
came to be called the “Martyr of Molokai” and was beatified in 1995.
The involuntary isolation of those with leprosy on Molokai continued until 1974.
In the United States proper, there was also a fear of the Chinese---a condition that increased
after 1850.
By 1870, leprosy was considered on of the diseases specifically associated with the
Chinese.
In 1894, the state of Louisiana established a Louisiana Home for Lepers, a neglected asylum
run by the Sisters of Charity, located 85 miles from New Orleans.
By 1917, at the height of U.S. racial discrimination and xenophobia, a leprosy bill was
passed to establish a leprosarium. The old Louisiana Home for Lepers became the American
National Leprosarium at Carville, and in 1921 the U.S. flag was raised over the institution. It
was surrounded by a barbed wire fence with a sign reading “No Trespassing.”
The rules and regulations of the leprosarium were more like those of a prison than a hospital.
Patients were sent there by special leper trains, some arrived in shackles accompanied by
armed guards, and their mail both ingoing and outgoing was disinfected. Babies born to
patients were given up for adoption.
Patients were not permitted to marry until 1952, despite the fact that drugs to control the
disease, such as sulfone dapsone, were introduced in the late 1940s.
By 1956, the Carville Leprosarium became a voluntary hospital under the Public Health
Service and was renamed Gillis W. Long Hansen’s Disease Center. Up until the 1960s, strict
public laws forbade those with leprosy to use public transport, fly over certain states, use
public restrooms, or live freely in society. Basic freedoms guaranteed to most Americans
were denied them.
In 1997, the last 135 people hospitalized were “set free” as President Bill Clinton
transferred the facility back to the state of Louisiana, where it has become a school and
training center for at-risk youth. Carville patients will receive $33,000 annually, have lifelong
medical care for their disease, and be able to reside anywhere they desire.
THE DISEASE OF LEPROSY
The 1st objective and scientific appraisal of leprosy came in 1873 with the discovery of the
leprosy bacillus, Mycobacterium leprae, by Gerhard Armauer Hansen in Norway. The
preferred name for the disease today is Hansen’s disease.
M. leprae---an acid-fast bacillus; cannot be grown in tissue culture and grows very slowly
and only in humans, mice, and nine-banded armadillos, taking about 2 weeks to divide.
Leprosy is a disease of low infectivity, and is also a spectral disease (i.e. one showing
different manifestations): tuberculoid leprosy (localized in skin nodules where the bacteria
may be abundant) and disseminated or lepromatous leprosy (with bacteria in
macrophages and skin).
Most patients show the tuberculoid type---develops 1-2 years after exposure, whereas
lepromatous condition requires longer periods.
The manifestations seem to depend on the immune status of the host.
Tuberculoid leprosy---associated with severe nerve damage; involves cell-mediated
immunity with T-helper cells and interleukin-2 secretion, but since bacteria multiply within the
Schwann cells that insulate the nerve, there is damage to the nerves, and anesthesia
results.
Lepromatous leprosy---wherein the T-helper cells do not respond to the bacilli---gamma
interferon is not produced, macrophages are not activated, and as a consequence the
bacteria multiply within the macrophages and the disease spreads with multiple organ
involvement, leading to facial deformity and blindness. There is osteoporosis and shortening
of digits, plus the testes are damaged, and there is no natural remission (i.e. temporary
recovery). Death results mostly from renal failure, pneumonia, and tuberculosis.
Natural resistance to leprosy is highest in African blacks and lowest among Caucasians.
The affinity for Schwann cells by M. leprae is dues to the high affinity of bacterium for a
specific region of the molecule laminin found on the outer surface of these cells; once they
adhere to laminin using a bacterial surface protein called H1p, they invade.
Mechanism of invasion is unknown, but once inside the Schwann cell they are temporarily
protected from the host’s immune system.
Over time, the immune system attacks the infected Schwann cells, destroying nerves in the
process.
WHERE LEPROSY IS
It is estimated that there are 15-20 million cases of leprosy worldwide, found mostly in the
tropics.
Even today, leprosy leads to a lifetime of social ostracism and misery.
The higher standard of living, the less incidence of leprosy.
Leprosy is often an endemic disease. It is usually acquired in childhood, but infection can
occur even at age 70.
In many parts of the world, males are more frequently infected than females (2:1), but the
reasons for this remain unclear as well.
LEPROSY TODAY
Because leprosy bacilli cannot be cultured in the laboratory, it is difficult to assess the onset
of the disease. M. leprae can be grown in nude mice and nine-banded armadillos, so
microbiological analysis and studies on immunology and treatment can be done.
The diagnosis of leprosy has no changed substantially in 100 years. It relies on microscopic
examination and evaluation of the response of the patient to a pinprick or heat.
Examination of individuals with tuberculoid lesions stained for acid-fast bacilli is the
diagnostic method, which was the once used by Hansen in 1873.