Historical perspective
Although leprosy’s origins have been reportedly existed
as late as 3500 BCE in a papyrus documenting the illness of the Egyptian king
Hispati (Lechat 158), the earliest written records that accurately reflects
leprosy appears to be from the 600 BCE Sushruta Samhita text from
Biblical Accounts
“The person who has the leprous disease shall wear
torn clothes and let the hair of his head be disheveled; and he shall cover his
upper lip and cry out, ‘Unclean, unclean.’… He shall live alone…”
From Leviticus 13:45-47
1989
Holy Bible, New Revised Standard Version, which includes the footnote
Leprous:
A term for several skin diseases; precise meaning uncertain
While the Bible has consistently been used to cite the
historical antiquity of leprosy, many academics are uncertain that the
described disease in the Old Testament, tsara’ath, is, in fact leprosy
(Lechat). Indeed, numerous Christian based leprosy support groups, such as the
American Leprosy Missions, note that biblical leprosy is not the same as the
leprosy recognized today.
Left: A 14th Century manuscript
depicting a leper with his warning bell.
Photo Credit: Peter Richards, The Medieval Leper,
2000
Instructions for the separation of lepers, however, were
well documented within the western tradition, with some far more extreme than
others. In Medieval times, leprosy sufferers were subjected to severe
punishment, such as forced starvation or immolation while still alive 
(Browne 6). During the Middle Ages, priests would
perform a formal service for the leper to separate them from the community; the
use of a leper clapper or bell was required in many locations, as was isolation
from others except from those who also had leprosy (Richards 50-51).
Right:
A reproduction of a warning clappers used by lepers in Great Britain.
Photo
Credit: Peter Richards, The Medieval Leper, 2000
Across the Globe: Major
Dates
11th Century CE– The return of many Crusaders sickened by leprosy
causes a surge in hospices throughout Europe, with renewed vigor by certain
groups to care for the sick (Browne 5). Interestingly, the link between the
spread of leprosy and the Crusades is controversial, with some experts
suggesting that the disease reached epidemic levels in earlier medieval times
(Mitchell).
1798 CE– The last endemic case of leprosy is diagnosed in
Right:
Medieval evaluation of the leprosy patient.
Photo
Credit: Peter Richards, The Medieval Leper, 2000
Left: A drawing on John Berns, at the time 28,
believed to the last endemic case of leprosy in
Photo Credit: Peter Richards, The Medieval Leper,
2000
1854 CE—F. Mouat describes the use of chaulmoogra oil as
a treatment for leprosy; further investigation reveals that the oil is not
particularly useful (Jacobson 193).
1866 CE—Norwegian physician Gerhard Henrik Armauer Hansen
becomes a medical officer at a leprosy hospital. He will later disagree not
only with the medical establishment, but also his father, about how leprosy is
transmitted. Hansen argues the disease is infectious, rather than being
hereditable, in nature (Rees 31).
Right:
Dr. GH Hansen, in his younger days.
Photo
Credit: http://www.bergen.folkebibl.no/utstillinger/bilder/armauer_lille.jpg
1872 (circa) CE—Hansen identifies Mycobacterium leprae
microscopically and publishes report on it 1 year later. Leprosy will later be
named, “Hansen’s Disease” in recognition of his efforts, as well as attempting
to reduce the stigma associated with the 
word leprosy.
Left: A historical drawing of a 13-year old boy in
1847, who would be diagnosed today with multibacillary leprosy. The boy has had
the disease at this stage for 7 years.
Photo Credit: Peter Richards, The Medieval Leper,
2000
1908 CE—German chemists, Fromm and Wittmann, discover
diaminodiphenylsulfone, (Dapsone, DDS), which is later used as a critical part
of leprosy treatment (Browne 9). However, it is not utilized as a leprosy
treatment for decades.
1940 CE—Promin (glucosulfone sodium), a sulfone
derivative, is utilized in the
1949-1950 CE—R. G. Cochrine and J. Lowe report remarkable
successes with Dapsone (Jacabson 194). Their research allows for Dapsone to
rapidly gain acceptance as the standard of care.
Left: The drug Dapsone in a non-MDT format.
Photo Credit: Bureau of Primary Health Care
1974 CE – Reports of antibacterial resistance to Dapsone
begin to present itself in the medical literature (Jacobson 195), with the
alarming realization that Dapsone alone may not be the silver bullet.
1977 CE—The World Health Organization urges healthcare
providers that Dapsone alone should not be used to treat leprosy; rather, a
multi-drug approach should be taken (Jacobson 195).
1981-1982 CE—The World Health Organization formally recommends
that multi-drug therapy should be used to treat leprosy.
1987 CE--
Multi-Drug Therapy becomes available in “blister packs”, becoming simpler to
distribute and easier for the patient to comply with the rigorous drug schedule
(WHO).
Right:
MDT “blister packs”; green for PB leprosy, red for MB leprosy.
PB Leprosy
patients get 6 packs, MB patients 12.
Photo
Credit: World Health Organization
1994 CE – Multi-Drug Therapy reaches 100% coverage in the
Western Pacific region, with the drug provided free to anyone with leprosy,
across the globe (WHO).
1999 CE—An estimated 10.7 million people cured with MDT
since 1985 (McDougall 19).
2001 CE—World Health Organization announces global target
for leprosy elimination of 1 case/ 10,000 people is achieved (McDougall 17).
Archeological Information
Left: Skeletal changes, such as the increase
porosity seen in the nasal bridge area of this skull, can be key factors in
helping researchers identify whether or not the body had leprosy. In this case,
the porous edges of the bone suggest that the clinical feature of a saddle-nose
was well underway.
Photo Credit: Donald Ortner, Observations on the
pathogenesis of skeletal disease in leprosy, the Past and Present of Leprosy.
2002.
Perhaps the most accurate way in determining the
prevalence of actual leprosy in the historical record is the use of skeletal
evidence. Late stage leprosy—rather commonplace in the past due to a lack of a
treatment—can cause recognizable deformations and skeletal abnormalities that
can be identified. In particular, researchers look at the rhinomaxillary (nasal
bridge) area for evidence of destruction, in addition to the fingers and toes
which may suffer from repeated injury or infection due to the lack of sensation
(Ortner 75-76). Understandably, it is
possible for other diseases to confound the researcher; trauma to the face and
infections like syphilis can mimic the signs of leprosy (Leiker).