Chapter 14 Leprosy

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9 Mar 2011

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Aqdas Qasem
Plagues and Peoples
Leprosy (Text. Chpt.14, C.R. 1-9, 11-23, 834-839
Chapter 14 Leprosy, the Striking Hand of God (303)
Leprosy in Christianity & Literature (303)
- To readers of Old Testament, leprosy was an abomination.
- In the story, Job (was once considered the patron of the lepers) wasstruck by the hand of God, which was
assumed to be leprosy because of the black spots on his body.
- The mention of leprosy in the bible has contributed to the fear of the sores associated with leprosy, and the
notion that what is blemished is unclean and displeasing to God.
- Massive literature on the imagery of leprosy as a disease of the soul and one that was highly contagious.
A Look Back (304)
- Leprosy arose in the Far East, about 1400 BC, as described in Hindu (Indian) and Chinese writing.
- First accounts of leprosy between 600 and 400 BC in Indian text.
- Claimed that leprosy brought from Indian to Greece in fourth century BC by soldiers Alexander the Great,
but possibly brought from East to West alone trade routes, arriving in Mediterranean about the time of
- Constantine suffered from leprosy and was told that bathing in the blood of sacrificed children would cure
him, but it did not.
- Sarath was used to describe many skin conditions and can be translated as defiled, accursed, or scaly. The
word was eventually translated to lepra and then leprosy in English.
- The association of the disease with sinfulness stigmatized the leper; they were viewed as suspicious and
having a burning desire for lustful sex.
- Disease aka satyriasis, an insatiable sexual appetite.
- Also confusion between syphilis and leprosy.
- Lepers were segregated from society told not to mix with crows, to use own container in drawing water,
not to touch anything they didnt pay for, wear a distinctive garment an announce their presence with a bell
or clappers, ritual burial.
- Depending on the king of the time, they were strapped to posts and buried alive or buried to death.
- Some Christians sympathized with them and created almhouses or refuges for them, which were known as
Lazar Houses or Lazarets or Lazarettos.
- 12th century it became a pandemic, 13th and 14th century reached its peak because 19,000 lazarets existed.
16th century most lazarets closed, and 18th century they were all gone.
- Dying down of leprosy may be due to outbreak of TB or increased supply of woollen textiles for clothing.
- Pandemic of leprosy became an epidemic in Hawaii. Molokai in Hawaii is where a colony of 142 lepers
- Father Damien, a priest, came to help a colony of lepers for 3 months but stayed for 16 years; he cleaned
and bandaged sores, built homes, a hospital, and buried leprosy victims. He did not avoid contact with the
lepers of Molokai and as a result died of leprosy. He was named theMartyr of Molokai. His death
reiterated the idea that leprosy is very contagious.
- In the US, leprosy was stigmatized as a disease of the Chinese.
- 1917 first leprosarium opened in the US, which was more a prison than a hospital. The patients were not
allowed to marry. They were denied basic freedoms to most Americans: cannot use public transport, fly over
certain states, use public washrooms, live freely in society. They were set free in 1997.
The Disease of Leprosy (309)
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Aqdas Qasem
Plagues and Peoples
Leprosy (Text. Chpt.14, C.R. 1-9, 11-23, 834-839
- Leprosy bacillus = Mycobacterium leprae discovered by Gerhard Armauer Hansen; therefore, known as
Hansens disease. Acid-fast bacillus, cannot be grown in tissue culture and grows very slowly and only in
humans, mice, and nine-banded armadillos (found in 10% of armadillos in Louisiana).
- No known vectors or reservoir hosts.
- Disease is low infectivity and a spectral disease one showing different manifestations: tuberculoid
leprosy, localized in skin nodules where bacteria are abundant and disseminated or lepromatous leprosy,
with bacteria in macrophages (white blood cell within tissues) and skin.
- Tuberculoid type more common, and develops faster (1-2 years) than other type. Causes severe nerve
- Manifestation depends on immune status of host.
- Resistance high in blacks and low in whites.
- Bacteria enters the body through open wounds or via the nose.
- Once it enters, it attacks Schwann cells that surround the nerve cells.
Symptoms (309)
- Causes facial deformity, blindness, osteoporosis, damage to testes.
- Death results most commonly from pneumonia, TB, or kidney (aka renal) failure.
Where Leprosy Is
- Continues to infect millions of people; 15-20 million cases worldwide, mainly in tropics.
- Leads to social ostracism even today.
- The higher the standard of living, the less the incidence of leprosy.
- Often an endemic disease.
- Many of the people that are exposed develop no disease.
- Males more infected than females for unknown reasons.
- Number of new cases has continued to increase.
Leprosy Today (310)
- Leprosy bacilli cannot be cultured in labs, therefore difficult to assess onset (start) of disease.
- Diagnosis: relies on microscopic examination and evaluation of the response of the patient to a pinkprick or
- Leprosy can be treated by Dapson, which controls the growth of the bacilli.
- WHO recommended MDT using dapsone, clofazimine, and rifampin, with treatment lasting 6 24 months.
- Mycobacterium bovis BCG vaccination for TB has lowered incidence by 20-80% and a vaccine called
Mycobacterium w (Mw) has also started being used.
Catching Leprosy (311)
- Leprosy spread as the bacilli are shed with the skin, but most bacilli are found in nasal secretions.
- Bacteria cannot penetrate the skin directly and therefore it is believed that the route of entry is through
- Disease of low virulence
- Susceptibility believed to be based on genetic factors.
- For transmission to occur there must be prolonged contact with the infected individual.
- Do not know how nerve are destroyed and do not know precise mode of transmission.
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