What is the history of leprosy (Hansen's disease)?
Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. The newest health research suggests that M. leprae has infected people since at least as early as 4000 B.C., while the first known written reference to the disease was found on Egyptian papyrus in about 1550 B.C. The disease was well recognized in ancient China, Egypt, and India, and there are several references to the disease in the Bible. Many cultures thought the disease was a curse or punishment from the gods because they did not understand the disease, it's very disfiguring, slow to show symptoms and signs, and had no known treatment. Consequently, priests or holy men treated leprosy, not physicians.
Picture of a person with leprosy (Hansen's disease)
Since the disease often appeared in family members, some people thought it was hereditary. Other people noted that if there was little or no contact with infected individuals, the disease did not infect others. Consequently, some cultures considered infected people (and occasionally their close relatives) as "unclean" or as "lepers" and ruled they could not associate with uninfected people. Often infected people had to wear special clothing and ring bells so uninfected people could avoid them.
The Romans and the Crusaders brought the disease to Europe, and the Europeans brought it to the Americas. In 1873, Dr. Hansen discovered bacteria in leprosy lesions, suggesting leprosy was an infectious disease, not a hereditary disease or a punishment from the gods. However, many societies still ostracized patients with the disease, and religious personnel at missions cared for those with leprosy. Patients with leprosy were encouraged or forced to live in seclusion up to the 1940s, even in the United States (for example, the leper colony on Molokai, Hawaii, was established by a priest, Father Damien, and another colony or leprosarium established at Carville, La.), often because no effective treatments were available to patients at that time.
Because of Hansen's discovery of M. leprae, researchers made efforts to find treatments (anti-leprosy agents) that would stop or eliminate M. leprae. From the early 1900s to about 1940, medical professionals injected oil from Chaulmoogra nuts into patients' skin with questionable efficacy. At Carville in 1941, promin, a sulfone drug, showed efficacy but required many painful injections. Dapsone pills were found to be effective in the 1950s, but soon (1960s-1970s), M. leprae developed resistance to dapsone. Fortunately, drug trials on the island of Malta in the 1970s showed that a three-drug combination (dapsone, rifampicin [Rifadin], and clofazimine [Lamprene]) was very effective in killing M. leprae. The World Health Organization (WHO) recommended this multi-drug treatment (MDT) in 1981 and remains, with minor changes, the therapy of choice. MDT, however, does not alter the damage done to an individual by M. leprae before starting MDT.
Currently, there are several areas (India, East Timor) of the world where the WHO and other agencies (for example, the Leprosy Mission) are working to decrease the number of clinical leprosy cases and other diseases such as rabies and schistosomiasis that occur in remote regions. Although health researchers hope to eliminate leprosy like smallpox, endemic (meaning prevalent or embedded in a region) leprosy makes complete eradication unlikely. In the U.S., leprosy has occurred infrequently but is endemic in Texas, Louisiana, Hawaii, and the U.S. Virgin Islands by some investigators.
Leprosy is often termed "Hansen's disease" by many clinicians in an attempt to have leprosy patients forgo the stigmas attached to a leprosy diagnosis.