Leprosy

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Leprosy

Overview

Leprosy is a chronic infectious diseases that attacks the skin, peripheral nerves, and mucous membranes of the eyes and respiratory tract. The disfiguring disease has long been feared by the general public and, unfortunately, its victims have been misunderstood and despised throughout history.

Historically speaking, there are two types of conditions described as leprosy. One is the biblical leprosy described in the book of Leviticus, which was viewed as the result of terrible sin and Jewish law demanded that the afflicted be cast out. The other form is a bacterial leprosy caused by an organism related to tuberculosis called Mycobacterium leprae. During the Middle Ages, the two forms (moral and medical) were confused and the attributes of the bacterial variety acquired the stigma of the Biblical leprosy. In the Middle Ages those who were deemed lepers were cast out of their homes and left to wander alone. Later, those with leprosy were isolated in colonies and leprosariums to die slowly, and usually without treatment, from the illness. As leprosy declined during the twelfth and thirteenth centuries, the condition still occurred in some populations and was treated as a curse. In the nineteenth century the Norwegian scientist Armauer Hansen (1841-1912) discovered the bacteria that causes the disease.

Background

Until the rise of AIDS, leprosy was perhaps the most feared of all infectious disease. While effective treatment for leprosy is now available in the Western world, the disease is still a terrible scourge for millions in South America, Africa, and Asia. Even the Black Death would come and go in its attacks, but leprosy has continued to torment people throughout history into the present.

The disease is often considered not only a physical ailment, but also a spiritual condition. Therefore, the disease has deep-rooted mystical meanings in the human psyche. Still, many in Asia and Africa regard it as one of the most dreaded diseases because those who have it are thought to be cursed.

The origin of leprosy is unknown. An Egyptian papyrus produced between 1552-1350 b.c. describes a condition that may be leprosy. Writings from India dating from 600 b.c. also describe a similar disease. The disease appears in records following the return of Alexander the Great (356-323 b.c.) to Greece from India in 326 b.c. Likewise, Roman accounts show that the army of Pompey brought the disease back from Asia Minor in 62 b.c. It is assumed that the condition originated in Asia.

The Bible refers to a condition called leprosy, which appears 54 times in the text and links the disease with personal sin, as the disease was a punishment by God for transgression. Leviticus, a book of Hebrew law, was written around 1000 b.c. and focuses on the uncleanness of the leper. While the New Testament looks more kindly upon lepers, it sets them apart. When Jesus cleansed the leper, he also cleansed them of all moral stigma.

Some scholars contend that mistranslations of the Old and New Testament have caused much confusion about leprosy. The Hebrew word tsara'ath does not refer at all to leprosy as we know it today. In fact, the Biblical description of leprosy cannot be connected with any known contagious disease.

Thus, there appear to be two forms of leprosy, with bacterial leprosy being completely different from that described in the Bible. Bacterial leprosy can cause destruction of the upper lip and nose and damage to the nerves of the larynx so that the afflicted individual speaks in a hoarse, raspy voice. In addition, the parched skin of the afflicted may cause increased sensitivity to pain. This description does not fit the condition described in Leviticus.

Some think that the leprosy of Leviticus is more akin to elephantiasis, a disease caused by a parasitic worm. This condition was described by Hippocrates (460-377 b.c.) as "lepra" and translated as leprosy. During the early years of Christianity, those with leprosy were looked upon with revulsion. At the Council of Ancyra in 314, the church ordered restrictions upon lepers and defined them as unclean both in body and soul.

Impact

A great irony of history has connected bacterial leprosy to the leprosy of Leviticus. An outbreak of the bacterial version spread through western Europe at about the same time as the rise of Christianity. It was during the Middle Ages that the disease was deliberately linked to the biblical version of leprosy and the method for controlling the disease, which was to drive the afflicted out or to isolate them, was enforced. The clergy were among the few educated people with access to medical texts and translations, giving their authority on the matter even greater significance.

During the early Middle ages dreadful stories about lepers were used to set a moral example, which also justified their exclusion. Constantine, the first Christian Roman emperor, ordered the expulsion of lepers, but, in his zeal to care for the sick, assigned a minister to serve them.

As the Middle Ages continued, lepers were accused of a host of sins. They were said to anger easily, have terrible dreams, and to be deceivers and schemers. Their behavior was viewed as evil, and they were regarded as a threat to society—both through their the disease and by their evil minds. Leprosy was considered a venereal disease and priests sometimes gave the afflicted mock funerals before casting them out of their communities.

In 1179 the Third Lateran Council addressed the problem of leprosy. Laws were passed to guide the treatment of lepers. Priests were instructed to lead the afflicted into an open field and to tell them never to enter churches or houses. Lepers were required to wear a cloak of gray or black with a yellow cross emblazoned upon it. They were ordered to warn people of their unclean presence with the distinct sound of a horn, clapper, or bell. Begging was required to be done with a bag tied to the end of a long stick. They were forbidden to wash their hands or clothes in springs or streams, touch anything they wanted to buy, talk to others unless downwind from them, touch railings without gloves, or touch children or give them gifts.

In the eleventh century Britain experienced a terrible outbreak of leprosy. Lanfranc, the first Norman archbishop of Canterbury, founded a leprosy hospice at Harbledown. Queen Matilda, daughter-in-law of William the Conquerer, also founded a place for victims outside the gate of London in 1101, which she dedicated to Saint Giles, the patron saint of outcasts.

Many other hospices, called lazar houses, were founded before the end of the eleventh century. There were as many as 20,000 hospices in Europe, and over 200 in Britain alone. But even with such an abundance of hospices, many lepers did not find sanctuary there. More likely only the wealthy would go to these hospices, with the poorer individuals going into the forests.

The Church's attitude towards lepers was often contradictory, varying among priests and nobles from time and place between good and bad. Some lepers were provided for as a matter of charity, and some priests taught that the disease was a gift from God, who had chosen the lepers to bear one of the heaviest burdens of man. Others saw the leper as spiritually unclean, and thus unholy and sinful. In this view, God was thought to have given them special grace, but also had punished them for their sins.

There were some kings who hated lepers. Phillip V of France and Henry II of England had them burned at the stake without any religious rites. Henry's great grandson allowed them funeral rites, then took them to cemeteries and buried them alive. Apparently Henry II later changed his mind. He gave 40 marks to Harbledown hospital while on a pilgrimage to Canterbury to do penance for the murder of Thomas Becket. He also made a gift to the lepers and the poor while on a visit to Paris in 1158.

Some kings had relatives who were lepers. Henry II's daughter-in-law, Constance of Brittany, was a leper, and his cousin Baldwin IV became known as the leper king of Jerusalem.

At the close of the Middle Ages both the biblical and bacterial disease began to wane. Several reasons for this include better diagnosis, depopulation as a result of the Black Death and other diseases, and segregation of the lepers from the general community. By the eighteenth century leprosy still existed in the Shetland Islands, and the disease reached a late peak in Norway in the nineteenth century, where the last European leprosy hospital closed in the 1950s.

The association of leprosy with sin is not relegated to Western culture alone. Chinese and Hindu attitudes were similar. While the Muslims claimed more tolerance toward lepers, in 1253 the Saracens killed all of the lepers living in a hospice in Jerusalem.

The stigma associated with leprosy perished with the discovery that the disease occurs naturally in wild armadillos. Also, in 1950 a Danish pathologist related skeletons from a leprosaria of the twelfth and thirteenth centuries with those of bacterial leprosy. As of 1940 leprosy could be treated with the drug dapsone. Although the bacteria is seldom completely removed from the body, it can be halted with multi-drug treatment. A major center for the disease and its study in the United States is at Carville, Louisiana. In 1974 a major effort to develop a vaccine was supported by the World Health Organization.

There is evidence suggesting that when the influential texts of the medieval Arab scholar Avicenna (980-1037) were translated into Latin, biblical leprosy was confused with bacterial leprosy. While it had always been assumed that God visited leprosy upon humans for their sins, the disease has been definitively shown to be a bacterial infection devoid of any religious significance. Sadly, the suffering and stigma endured by many of the afflicted throughout history was unwarranted and mistaken.

EVELYN B. KELLY