What is leprosy ?
Leprosy is an infectious disease caused by the leprosy bacillus called Mycobacterium leprae or Hansen bacillus to the Norwegian doctor Armauer Hansen who discovered it in 1873. Leprosy is one of the diseases that were indicated with "leprosy".
Leprosy disease
Infection occurs by breathing, coughing and sneezing. This germs are spread and can thus penetrate others again through the nose and throat or through skin wounds. Most people are naturally resistant to the bacillus and thus will not develop the disease after infection. The bacillus develops very slowly so that the incubation period, the time for the infected person will show symptoms, very long could be: normally between 2 to 6 years, but it can be up to 20 years. Outside the human body, the bacillus can not survive, the risk of contamination by objects is thus extremely small.
The disease is not hereditary, but the natural resistance to the disease may well be hereditary.
The clinical signs are determined by the manner in which the patient responds to the infection and the two extreme forms are:
-Tuberculoid leprosy: also called paucibacillaire leprosy. The average incubation period of this type is 4 years. In this case, the immune system of the infected person responds quite well. The patient will pale exhibit dark rimmed skin spots and skin nerves are affected, which may lead to a mild form of numbness. The number of spots on the skin is limited and this form of leprosy can heal itself. Seventy to eighty percent of the leprosy cases are of this type. Treatment of tuberculoid leprosy takes 6 months.
-Lepromatous leprosy: also called multibacillary leprosy. The immune system of the patient, the bacillus can not control and the bacillus can develop uninhibited. Here, too, it smears and nodules on the skin and peripheral nervous system is affected, with a high degree of numbness as a result. Feet, legs and face to swell. Additionally arise skin thickening, there is hair loss, damage to the nasal cartilage and the nasal mucosa, lesions on the ears and cheeks which gives rise to the facies leonina (lion face, lion mask). Due to degradation of the muscles of the eyelids may be the patient who is not close, which is the cleaning function of the eyelid, and so makes it impossible to infection can lead to blindness. The bones will become affected over time. The numbness sick minor injuries will not notice. Which may then get infected with additional mutilations result. Internal organs such as the liver, kidneys and nervous system will be affected in turn and fall out, allowing the patient eventually dies. For this form of leprosy, the average incubation period of 8 years. A full treatment of this form takes two years.
Since the eighties there is a good medicine against leprosy. The attention of leprosy organizations like Damien (Belgium), the Leprosy Mission (Netherlands) and the Leprosy Foundation (Netherlands) now also focuses on the detection of leprosy. Many leprosy patients, however, have been permanently maimed and driven from their community. Therefore also need good social aftercare, so it can integrate leprosy patient after his recovery back into the society that has disowned him before.
Leprosy history
Origin and distribution
Biological and genetic research have helped to situate the origin of leprosy. From genetic studies indicate that the origin of leprosy to be found in East Africa or Central Asia. A genetic study of the bacillus by the Pasteur Institute came to the conclusion that there are two possibilities for the origin of the disease. According to the first hypothesis illness occur in Asia, but the most likely hypothesis is that leprosy is from East Africa. Direct evidence of leprosy were found in a skeleton from 2000 BC. excavated in Rajasthan in India. Outside India one finds the first evidence from the 2nd century BC. Dakleh in Egyptian oasis, from the 4th to the 1st century BC. in Central Asia and between 300 BC. and 200 AD. in Southeast Asia.
But leprosy is described in documents. One of the earliest documents that give a good description of the disease was found in the tomb of Lu Shui-ti in China dating back to the 3rd or 4th century BC. In the writings of the Indian doctor Susruta from about 600 BC. leprosy is fairly clearly defined.
Antiquity
Egypt was always considered as the place where leprosy was exported to the West. That the disease there in 1600 BC. was known is evident from the Ebers papyrus, although others find the description herein pretty vague. Some think that leprosy was brought to Egypt by the overseas slave trade between Egypt and India. The Phoenicians, a people traded across and along the known seas, have probably contributed to the transmission of the disease from India to the Mediterranean basin. Hippocrates called it the way the Phoenician disease. But the movements of armies during the Persian Wars and the campaigns of Alexander the Great may have contributed to the spread of the bacillus in the Mediterranean.
How leprosy reached Europe is difficult to determine, but it is not unlikely that it happened through trade contacts and through the Roman troops and settlers. Pliny the Elder wrote that troops returning from the battles of Pompey in the Middle East, Asia and Greece in 62 BC. the new disease brought to Rome. The Greek physician Aretaeus of Cappadocia passes in the 1st century AD. a very thorough description of the disease, which he called elephantiasis or leontiasis. In the tradition of Hippocrates and Galen writes the disease to an imbalance of the humours. Leprosy could be a result of too much black bile. This theory about the cause will always be used during the Middle Ages.
Eastern Roman Empire
Galen describes in the 2nd century AD. that leprosy is common in Egypt, then a province of the Roman Empire. From there the disease spread over Palestine, Syria and Asia Minor. With the conversion of Constantine the Great in the 4th century begin the bishops in those areas with leprosy and the lepers to keep busy. In this period were bishops as Gregory of Nyssa, calls the faithful not to disown the lepers. In his homily he indeed gives a perfect description of the disease. Also Gregory Nazianzen would have called to help lepers and condemns their rejection from the community. John Chrysostom, Patriarch of Constantinople from 398 to 403, in turn, will care for the lepers preach and start building a leprosarium outside the city. On this basis some believe to have to revise the attitude of the church in front of lepers, but canon 17 of the Council of Ancyra in 314 clearly refers to (mental) leprosy as a symbol of a sinful mind. It is of course quite possible that in the Greek atmosphere of the Eastern Roman Empire, the attitude was different than a few hundred years later in the German sphere of the Western Roman Empire.
Middle Ages
In the 17th century it was thought (Voltaire and Michelet) that leprosy in Europe was introduced by the returning Crusaders, but for Europe testify separatio leprosum in Edictum Rothari of the Lombard king Rothar in 643 and the laws of Pepin the Short in 757 and of Charlemagne in 789 for the prevention and in the hand of the disease, that leprosy was already known and feared in Europe. Are already in the 7th century lazar houses erected in Verdun, Metz and Maastricht. After Charlemagne there are no documents that still dealing with leprosy, the disease seems to have disappeared, but there are nevertheless founded lazar houses in England, including Canterbury, in the 11th century, before the beginning of the Crusades. Through the colonization of Spain by the Arabs and later by the Crusades takes the spread of leprosy from the 11th, but especially in the 12th and 13th centuries strongly. This is also the period of urbanization, where many people live close together in a walled city, with narrow streets where the waste water running through the middle of the street and the hygienic situation was far from optimal; that Involuntarily, the environment in which even today thrives leprosy.
Lazar houses
Although the first lazar houses already in the 4th century in the Eastern Roman Empire and originated in the former Western Roman Empire from the 6th century, the largest number will be established in the 12th and 13th centuries. One has to lazar houses formerly often seen as a kind of prison where lepers were locked in inhuman conditions, but that is beside the truth. Most lazar houses were medieval hospitals such as the maisons Dieu, where the course of events was very similar to the regime in an abbey. The lepers stayed there voluntarily and those who did not risked to be put outside the rules. Several lazar houses found his statutes which bear witness to a human regime. Often it was the master who presided over the leprosarium was chosen by the lepers themselves from their community. The decree of Alexander III which states that all leprosaria must have its own chapel and a private graveyard so lepers should be no longer in the parish church, nowhere states that the leper had to be deprived of his liberty.
In the later Middle Ages, when lazar houses are managed by the city authorities, the lepers were not required to take oaths or vows and usually had the same rights as other citizens.
Late Middle Ages - Modern Times
From the 15th century and during the 16th century with leprosy infection decreases and eventually disappearing completely. According to the medical profession would this is primarily due to the increased mortality among sufferers leprosy caused by tuberculosis. But the disease remained endemic in the Shetland Islands, Norway and Iceland. Also on the shores of the Baltic Sea, in southern Russia, Greece, Turkey, on the French Riviera, Spain and Portugal came for leprosy at the beginning of the 20th century. According to the same source, there still existed lazar houses in Norway, the Baltic Region, San Remo, Cyprus, Constantinople, Alicante and Lisbon.
Leprosy today
At the beginning of the 21st century, the World Health Organization estimated the number of lepers at 600,000 worldwide in late 2008 this had fallen to 216,000. The majority of these cases is found in Brazil, India, Indonesia and Myanmar. Until today it is unclear how the disease is transmitted and what the exact causes that promote development. Be established annually 250,000 new cases (2008 figures). The World Health Organization had a program that aims to eradicate leprosy by 2005. The incidence of the disease is reduced, but she is far from being eradicated. A simulation of Dutch researchers concluded that the disease could be gone by 2020. In developed countries, the disease is not endemic. The leprosy cases that are still there are fixed either imported through immigration or infections that have occurred elsewhere.
Also in the Netherlands is not leprosy endemic, but an imported disease. In periods of heavy immigration from the tropics (Moluccans in the forties and fifties, Surinamese in the seventies and eighties) there is an upsurge in the number of reports. In recent years, should be established in the Netherlands is estimated that between 5 and 10 new leprosy cases per year. Infections have always taken place in the tropics and, because of the long incubation period, sometimes not discovered until after years in the Netherlands. In the Netherlands, the disease itself behaves as a non-infectious disease import: infections in the Netherlands, do not seem to be or hardly occur.