Leprosy has left a deep mark on the history and culture of mankind. Until now, lepers are perceived as people who carry a threat and from whom you need to stay away. In the past, the disease was very common, and the only effective means of control was the expulsion of the sick from society, which is still practiced in some countries. "Lenta.ru" tells about leprosy, which became the scourge of Europe before the plague and cholera and continues to terrorize the poor, despite the efforts of international health organizations.
Contagious deformity
Leprosy is a silent and latent disease compared to cholera and plague. After infection, it may take ten or even twenty years before the first symptoms appear. First, pain-insensitive spots appear on the skin, the arms and legs begin to go numb. It is very important to start treatment as soon as possible, because a few months after the disease manifests itself, irreversible damage to the peripheral nerves occurs. The person loses control of the muscles and becomes paralyzed. But even earlier, the body is attacked by secondary infections that affect the eyes, skin, mucous membranes and articular cartilage in the hands and feet. The fingers are deformed and shortened due to the death of the phalanges, the facial features are distorted, trophic ulcers are formed.
By itself, the causative agent of leprosy - the mycobacterium Mycobacterium leprae - is not a deadly killer like the plague bacillus or Vibrio cholerae. It is an obligate parasite that cannot live outside human cells, so it is in its interest not to kill the host quickly. But it destroys the body's primary protective barrier, leaving a person vulnerable to many other pathogens. Secondary infections are the leading cause of death in leprosy patients.
Affected areas of the skin.
A person with leprosy becomes a carrier of mycobacteria, infecting other people. The risk group includes people from poor countries suffering from malnutrition and reduced immunity. Although it is still not entirely clear how M. leprae enters the body, it is believed that infection occurs through the upper respiratory tract. It is now known that one-time close contact with someone with leprosy, such as shaking hands or being around an infected person, rarely leads to infection. M. leprae is not sexually transmitted or passed into the unborn child if the carrier is a pregnant woman.
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From the depths of centuries
Lepra is one of the oldest diseases that was known in ancient China, India, Egypt, Greece and Rome. The first mentions of it date back to 600 BC. At the same time, other fungal skin diseases were often confused with leprosy. The word "leprosy" itself comes from the ancient Greek Λέπος, which means "scales", and literally translates as "a disease that makes the skin scaly." This word was used to refer to any skin disease leading to peeling, but then it became associated with leprosy.
Before the advent of modern medicine in Africa and Eurasia, the fungus Trichophyton Trichophyton schoenleinii was widespread, causing favus, or scab, in which a hard crust forms on the skin. Patients with favus or psoriasis were also declared lepers, expelled from society, or ended up in leper colony. Syphilis was sometimes confused with leprosy.
In the Middle Ages, in the XI century, a major epidemic of leprosy broke out in Europe. Among experts, there is still no single picture of where the disease came from. Many experts believe that the outbreak was caused by the Crusades, as a result of which M. leprae arrived in Europe from Palestine. Leprosy could have come to England with the Vikings, who brought the fur of infected squirrels from the continent. According to an alternative hypothesis, leprosy originated in Europe itself and existed for several thousand years. In any case, the disease spread widely in the XII-XIV centuries, reached its peak in the XVI century, and then suddenly retreated, turning into a "forgotten disease". It is now found only in poor countries.
Eternal outcasts
The medieval epidemic led to the emergence of leper colony - treatment and isolation centers for the care of the sick. Leprosaria have become the main means of containing the disease. Leprosy was so widespread that in some regions it affected about three percent of the population. Naturally, all the sick leper colony could not accommodate, so often lepers were declared "untouchable", they were forced to wear recognizable closed clothes and carry bells, which warned others about the approach of the patient with their ringing.
Image of a leprosy patient.
The leprosy myths popular at the time made the disease scarier than it is. It was believed that leprosy is a divine punishment, which means that the patient carries evil in himself, is sinful and is able to harm others. The infected were perceived by society as damned and unclean in spirit, they were expelled from the city, and experts on sins - priests - were engaged in diagnostics and "treatment".
Lepra put the stigma of a curse on people, they were considered almost dead and arranged a "live" funeral for them, after which they were forever expelled from society. There are also known cases of massacre of the sick, when lepers were buried alive in the ground, burned at the stake like sorcerers, thrown into gorges or drowned.
Leprosaria were created in monasteries, where the sick could feel relatively safe, and the healthy citizens felt relieved that the lepers stayed away from them. By the 13th century, up to twenty thousand leper colony appeared in Europe, including hospitals under the Order of Saint Lazarus, later called infirmaries.
Fighting the curse
Although leper colony limited the spread of the disease to some extent, the main reason for the end of the epidemic, as shown by recent studies, was the development of resistance among the population of Europe. Reconstruction of the genome of mycobacterium showed that the causative agent of leprosy has hardly changed genetically, and modern strains are identical to the ancients. This means that the epidemic is not over because the pathogen itself has somehow changed. The high prevalence of leprosy has led to the fact that among Europeans, more and more people are immune to the disease. This was influenced by natural selection, including the lifelong social isolation of patients who lost the opportunity to continue their family.
Hansen's wand.
A breakthrough in understanding the disease was made in the 19th century, when the Norwegian physician Gerhard Hansen discovered the true culprit of leprosy - M. leprae. He showed that the disease was not inherited, as some of his colleagues believed. Hansen demonstrated that the isolation of patients had a strong scientific basis: the disease was caused by microorganisms that could be transmitted from person to person. On the advice of a doctor in Norway, patients were prohibited from free movement around the country, they were required to be isolated in hospitals or stay at home. Such measures have shown high efficiency, because as a result, the incidence of leprosy fell sharply. The Norwegian experience was then adopted by other European countries.
There was no effective treatment for leprosy until the 1940s, when promin was synthesized - at that time the only known drug with bactericidal activity against M. leprae. However, already in the 60s, mycobacteria developed resistance to it, so doctors switched to other compounds: clofazimine and rifampicin. Then doctors began to use all three drugs as combination therapy, which prevented the emergence of resistant strains of the bacteria.
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Now all over the world there are about 200 thousand cases of leprosy per year, but with timely diagnosis, the disease is completely curable. Despite international measures for prevention, treatment and education, the problem of stigmatization of patients remains acute in developing countries, where leprosy is still widespread and often found among poor and marginalized groups.
In many parts of the world, popular beliefs and religious interpretations of diseases still reign, due to the low level of education. In Brazil, it is believed that leprosy is associated with sexual promiscuity, and that illness is sent as punishment for sins and moral transgressions. In India, lepers are equated with the untouchable caste, and this status persists even after the person is cured. As a result, those with leprosy become outcasts, they lose their jobs and homes, they are kicked out of the family. The justified fear of being alone makes it difficult to diagnose and treat leprosy early, and this is one of the explanations why humanity still has not been able to finally defeat the disease.
