The history of leprosy was traced to its origins by an international team of 22 geneticists using comparative genomics of the worldwide distribution of Mycobacterium leprae. Monot et al. (2005) determined that leprosy originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of M. leprae are based in specific geographic regions where each predominantly occurs: Strain 1 – East Africa, Asia, and the Pacific region Strain 2 – Ethiopia, Malawi, Nepal/North India, and New Caledonia Strain 3 – Europe, North Africa, and the Americas; and Strain 4 – West Africa and the Caribbean.
They created a map of the dissemination of leprosy in the world. This confirmed the spread of the disease along the migration, colonisation, and slave trade routes taken from East Africa to India, West Africa to the New World, and from Africa into Europe and vice versa.
In 1873 G.H. Armauer Hansen in Norway discovered the causative agent of leprosy, Mycobacterium leprae. This was the first bacterium to be identified as causing disease in humans. From the 19th century, European nations adopted some practices of India and China, administering naturally occurring oils. They were given by injection and orally, and were believed to cure some people, but results were often disputed. It was not until the 1940s that the first effective treatment, promin, became available.Guy Henry Faget The search for additional anti-leprosy drugs led to the use of clofazimine and rifampicin in the 1960s and 1970s. Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance. Multi-drug therapy (MDT) combining all three drugs was first recommended by the World Health Organization (WHO) of the United Nations in 1981. These three anti-leprosy drugs are still used in the standard MDT regimens.
Etymology The word leprosy comes from ancient Greek Λέπρα [léprā], "a disease that makes the skin scaly", in turn, a nominal derivation of the verb Λέπω [lépō], "to peel, scale off". Λέπος (Lepos) in ancient Greek means peel, or scale; so from Λέπος derives Λεπερός (Λεπερός, "who has peels – scales") and then Λεπρός ("leprous"). The word came into the English language via Latin and old French. The first attested English use is in the Ancrene Wisse, a 13th century manual for nuns ("Moyseses hond..bisemde o þe spitel uuel & þuhte lepruse." The Middle English Dictionary, s.v., "leprous"). A roughly contemporaneous use is attested in the Anglo-Norman Dialogues of Saint Gregory, "Esmondez i sont li lieprous" (Anglo-Norman Dictionary, s.v., "leprus").
Throughout history, individuals with leprosy have been known as lepers. In the 21st century, this term is falling into disuse as a result of the diminishing number of leprosy patients. Because of the stigma to patients, some prefer not to use the word 'leprosy', preferring 'Hansen's disease'. The term 'leprosy' is still used by the U.S. Centers for Disease Control and Prevention and the World Health Organization.
Historical accounts Ancient The ability to use historical records to trace the spread and treatment of leprosy in antiquity is greatly limited by confusion over which skin diseases were being discussed. Famously, the "leprosy" of most translations of the Bible as far back as the Septuagint represents a multilayered historical process of confusion. The state of ritual impurity known to the Hebrews as tzara'ath (, "struck")Talmud, Sifra 63. seems to have been a conflation of various skin disorders, owing to the undeveloped state of medical science at that period. The Greek term employed to translate the Hebrew was lépra (, "scaly"), which possessed an entirely separate diagnostic history which dealt with psoriasis and dandruff, only being applied to leprosy in a later period. A tumorous skin disease described in the Ebers Papyrus dating to 1550 has found some identification as leprosy, however, given that the text presents surgical excision of the tumors as an effective treatment, the implicated disorder likely refers to a skin condition such as epidermoid cysts.
The oldest written record of leprosy is from Herodotus. Writing in the 5th century, Herodotus mentions the Persian practice of shunning native lepers and deporting foreign ones as part of a discussion of that area's peculiar habits; he reported that they considered the condition to have been caused by offense against the sun god... The ancient Greek and Roman doctors considered that "elephantitis" had been introduced to their areas by the armies of Alexander and Pompey, respectively. It is discussed in particular by the authors Aulus Cornelius Celsus (25 37) and Pliny the Elder ( 23–79). The "Models for Sealing and Investigating" Fēngzhěnshì), written between 266 and 246 in the State of Qin during the Warring States period, is the earliest known Chinese text which describes the symptoms of leprosy, termed under the generic word li () used for various skin disorders. This text mentioned the destruction of the nasal septum in those with leprosy, an observation that would not be made outside of China until the writings of Avicenna in the 11th century; according to Katrina McLeod and Robin D. S. Yates it also stated lepers had "swelling of the eyebrows, loss of hair, absorption of nasal cartilage, affliction of knees and elbows, difficult and hoarse respiration, as well as anaesthesia."
Debatably, the oldest known records of genuine Hansen's disease are the Indian vedas, whose kuṣṭha (, "eating away") is clearly focused on leprosy by the time of Suśruta's Compendium, which prescribes chaulmoogra oil as the remedy; the present text may be as recent as 600. Similarly, the "Great Chronicle" of Sri Lanka describes royal ancestors of Gautama Buddha who contract leprosy, flee to the wilderness, and cure themselves using herbal medicine sometime before 700 but the present text dates to the 5th century or later. The Vendidad of the Zoroastrian Avesta, surviving only in texts after 1300 but presumably recording practices nearly as old as the Vedas, discusses leprosy as paēsa and prescribes direct application of cow's urine as a cure.
Modern Medical texts from the medieval period have loose and seemingly incorrect depictions of leprosy, leading some historians to suspect that doctors of the era were not able to distinguish leprosy from other ailments such as syphilis. Nevertheless, analysis of human remains in leper colony graveyards shows that the vast majority were affected by advanced forms of the disease considered as leprosy by modern doctors, so it is possible that medical practitioners of the era were better at distinguishing the disease than the scholars who wrote the manuscripts that survived to modern times.Robin S. Reich on Making Sense of Medieval Medicine: Humors, Weird Animal Parts, and Experiential Knowledge
In 1846, Francis Adams compiled The Seven Books of Paulus Aegineta, which included a commentary on all medical and surgical knowledge and descriptions and remedies from the Romans, Greeks, and Arabs. Descriptions of what is believed to be leprosy are included.Roman: Celsus, Pliny, Serenus Samonicus, Scribonius Largus, Caelius Aurelianus, Themison, Octavius Horatianus, Marcellus the Emperic; Greek: Aretaeus, Plutarch, Galen, Oribasius, Aetius, Actuarius, Nonnus, Psellus, Leo, Myrepsus; Arabic: Scrapion, Avenzoar, Albucasis, the Haly Abbas translated by Stephanus Antiochensis, Alsharavius, Rhases, and Guido de Cauliaco A proven ancient human case was verified by DNA taken from the shrouded remains of a man discovered in a tomb next to the Old City of Jerusalem; it was dated by radiocarbon methods to 1–50.
Skin infections causing symptoms similar to leprosy were likely common in the ancient world. In particular, tinea capitis (fungal scalp infection) and related infections on other body parts caused by the dermatophyte fungus Trichophyton violaceum are abundant in the late 20th century throughout North Africa and the Middle East. They may also have been common in biblical times. Likewise, the disfiguring skin disease favus is caused by Trichophyton schoenleinii, which appears to have been common throughout Africa and Eurasia before the advent of modern medicine.
As late as the 17th century in Europe, persons with severe favus and similar fungal diseases (and potentially also with severe psoriasis and other diseases not caused by microorganisms) tended to be classified as having leprosy. The painting The Regents of the Leper Hospital in Haarlem 1667 by Jan de Bray (Frans Hals Museum, Haarlem, the Netherlands) shows a young Dutchman with a vivid scalp infection. It may have been caused by a fungus, but he is being cared for by three officials of a charitable home intended for people with leprosy. The use of the word "leprosy" before the mid-19th century, when microscopic examination of skin for medical diagnosis was first developed, can seldom be correlated reliably with leprosy as it is understood today.
Genetic analysis DNA analysis has been applied to the origins and history of leprosy. Geneticists in 2005 used comparative genomics to study these aspects, including the paths of how the disease was spread throughout the world. The researchers determined that leprosy originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of M. leprae are based in specific geographic regions where each predominantly occurs: Strain 1 – East Africa, Asia, and the Pacific region Strain 2 – Ethiopia, Malawi, Nepal/North India, and New Caledonia Strain 3 – Europe, North Africa, and the Americas; and Strain 4 – West Africa and the Caribbean.
The researchers created a map showing the dissemination of leprosy by these strains. The disease clearly accompanied humans along their migration, colonisation, and slave trade routes taken since ancient times. Some peoples traveled from East Africa to India, millions were taken in the slave trade from West Africa to the New World, and others traveled from Africa into Europe and vice versa.
The first skeletal remains with evidence of leprosy are from circa 2000 BCE, discovered at Balathal, in Rajasthan, northwest India, part of the Indus Valley civilization. Evidence for the disease was later confirmed in the human skeletal remains from the archaeological site of Harappa, in Pakistan. The disease was thus present in the urban centers of the Indus Valley Civilisation before 2000 BCE, further supporting the hypothesis it migrated here as part of the "third millennium BCE interaction sphere" – an exchange network that spanned the Arabian Sea.
Discovery of bacterium After the end of the 17th century, Norway, Iceland, and England were the countries in Western Europe where leprosy was a significant problem. Norway appointed a medical superintendent for leprosy in 1854 and established a national register for people with leprosy in 1856. This was the first national patient register in the world.
Mycobacterium leprae, the causative agent of leprosy, was discovered by G. H. Armauer Hansen in Norway in 1873, making it the first bacterium to be identified as causing disease in humans. Hansen observed a number of nonrefractile small rods in unstained tissue sections. The rods were not soluble in potassium lye, and they were acid- and alcohol-fast. In 1879, he stained these organisms with Ziehl's method and noted the similarities with Koch's bacillus (Mycobacterium tuberculosis). There were three significant differences between these organisms: (1) the rods in the leprosy lesions were extremely numerous, (2) they formed characteristic intracellular collections (globii), and (3) the rods had a variety of shapes with branching and swelling.