PDA

View Full Version : Do cases of Leprosy occur in the Developed World these days?


Sarah Woodruff
05-14-2005, 08:50 PM
I saw The Kingdom of Heaven last night. Being both a fan of Medieval History and Edward Norton (mmm...Edward Norton...), I loved it.
Darling Edward plays Baldwin IV, the Latin King of Jerusalem, in a very regal, sensitive performance. The real Baldwin lived from 1161-1185 and indeed died of Leprosy aged 24.
Now I know that Leprosy (Hansen's Disease) was a notorious and widespread disease in the Middle Ages, the "White Death", and in Guns, Germs and Steel Diamond states that the first recorded cases appeared around 200 B.C.
The last time I travelled to India, I saw a few lepers in the streets of Mumbai, and very mournful they looked, poor bastards. I would presume that they were too poor to obtain antibiotic treatment.
My question is: since Leprosy is a bacterium of suprisingly low infectiousness (I think you have to have prolonged contact with a sufferer to contract it), and therefore it can be effectively wiped out in someone's body by proper antibiotic treatment (though I presume the physical damage can't be reversed), do people in the Developed World ever contract it? Are there Lepers in America, Canada, Western Europe, etc.? (I know that there are cases of Leprosy among poor Indigenous communities in the Northern Territory of my country, as well as cases of Trachoma, which is or should be a national disgrace).
Doctors, scientists, et. al. welcome to enlighten me.

Broomstick
05-14-2005, 09:42 PM
Yes, Hansen's Disease does still occur in the "developed world", it's just that people are likely to be diagnosed at an early state, before easily visible damage occurs, and will be given proper treatment to arrest the disease. Because of this, not only are lepers not visible in such societies, the spread of the disease is much, much less likely

I would suspect most cases in North America would tend to overlap armadillo territory, as armadillos are also suspectible to leprosy. In fact, it affects them much more rapidly and severely than it does humans.

inkleberry
05-15-2005, 12:16 AM
I would suspect most cases in North America would tend to overlap armadillo territory, as armadillos are also suspectible to leprosy. In fact, it affects them much more rapidly and severely than it does humans.

ONLY armadillos and humans and mousy feet get leprosy, afaik.

Poor little mousy feet.

KarlGauss
05-15-2005, 01:54 AM
From here (http://www.emedicine.com/DERM/topic223.htm):In the US: Approximately 6000 patients with leprosy live in the United States; 95% of these patients acquired their disease in developing countries. In the United States, 200-300 cases are reported each year. States with large immigrant populations (eg, California, New York, Florida) have the largest proportion of new cases. Small endemic foci exist in Texas, Louisiana, and Hawaii.
BTW, the risk of acquiring leprosy from infected armadillos is thought to be extremely low, essentially neglible. That being said, there is some indirect evidence to suggest that armadillo to human transmission may occur.

KarlGauss
05-15-2005, 01:56 AM
Forgot the link.

Here's a nice summary (http://svm369.vetmed.lsu.edu/truman2.htm) of some data regarding armadillo to human transmission of leprosy.

Mirror Image egamI rorriM
05-15-2005, 11:52 AM
The word "leper" is outdated and insulting. People with Hansen's Disease should be called "Hansen's Patients," which doesn't carry the stigma of "leper."

There's a big Hansen's Disease treatment center in Louisiana, where for years there was a colony for people with Hansen's Disease. A few people still live there full time, but they're allowed to come and go as the please, and have visitors and everything. Most people who have Hansen's Disease in America today are immigrants or the children of immigrants.

An excellent book on the subject is "No Longer Alone" by Stanley Stein, which is kind of hard to find but worth the effort. Stein was diagnosed with Hansen's Disease in the '30's and sent to Louisiana, where he started a newspaper and did all kinds of things to help get better treatment and recognition for the disease.

Sarah Woodruff
05-15-2005, 11:08 PM
The word "leper" is outdated and insulting. People with Hansen's Disease should be called "Hansen's Patients," which doesn't carry the stigma of "leper."

Sorry if I offended anyone by using this term, but I'm not sure how many non-medically trained people would know what Hansen's Disease is. I certainly have enormous sympathy for anyone suffering from it, having seen some of its (advanced) effects and having read that incredibly depressing and informative link of KarlGauss's.

Chronos
05-15-2005, 11:25 PM
in Guns, Germs and Steel Diamond states that the first recorded cases appeared around 200 B.C.So what was that disease that kept getting talked about in the Old Testament?

mhendo
05-15-2005, 11:27 PM
Here's (http://www.cbsnews.com/stories/2003/03/22/health/main545392.shtml) an article that might interest the OP, and there is also a Hansen's Disease FAQ down the left hand side of the page.

Stranger On A Train
05-15-2005, 11:53 PM
So what was that disease that kept getting talked about in the Old Testament?Leprosy is actually a general term for a number of different bacterial and fungal infections which cause necrotic ulcers and other skin disfigurements. O'Neill's Plagues and Peoples (http://www.amazon.com/exec/obidos/tg/detail/-/0385121229/qid=1116218794/sr=8-1/ref=pd_csp_1/104-5083798-8508730?v=glance&s=books&n=507846) goes into some amount of detail as to how it is theorized to have travelled across the world; I don't have the book at hand but IIRC it is hypothesized to have started on the Subcontinent and have worked its way westward. Since it was not a particularly virulent disease (and there seems to be very little genetic protection from it) it doesn't figure much into his central thesis on why the Europeans came to dominate the Common Era, but because it was relatively easy to pathologize (despite being conflated with other, less common afflictions) from writings of clerics and medical men of the day and because it was slow moving it provides a good illustration of how disease propagates from one population to another.

I don't recall correctly what O'Neill suggested as the cause of Biblical leporsy, but I think he argued that it died out or changed into some unrecognizable form.

Stranger

Sarah Woodruff
05-16-2005, 02:54 AM
So is the "modern" Hansen's Disease actually a different, or mutated, bacterium, with different, less severe, symptoms, to that of the old Biblical "White Death" that the old Middle Eastern and European cultures were so afraid of? I mean, from ancient times up until the early medieval period, people used to force sufferers to leave their communities and to ring a bell when they walked in the streets, so healthy people could get out of the area. Medieval scholars viewed the disease as some kind of "curse." That seems like an over-the-top reaction to a not-very-infectious, slow moving disease.
Hansen's Disease seems to have a lot of significant cultural and religious baggage associated with it.

Broomstick
05-16-2005, 03:06 AM
Keep in mind, too, that diagnosis in the Middle Ages and earlier wasn't what it is today. "Leprosy" might have been not one but a number of what now consider separate diseases ranging from bacterial infection to vitiligo.

Someone with Hansen's disease before the ago of antibiotics pretty much suffered for life. Biblical and other references detailing the criteria to be pronounced cured implies that there were at least a few recoveries over the centuries and millenia - which implies diseases other than Hansen's.

At least in the Middle Ages, the lack of bathing might have accounted for a LOT of skin diseases.

The Black Death hit the European leper colonies especially hard, essentially wiping them out. No doubt this served to eliminate what may have been disease resevoirs, which may have reduced the incidence overall in following years.

Sarah Woodruff
05-16-2005, 03:30 AM
The Black Death hit the European leper colonies especially hard, essentially wiping them out. No doubt this served to eliminate what may have been disease resevoirs, which may have reduced the incidence overall in following years.
That's very interesting.
God, I'm glad I wasn't born in 1200.
Something I find intriguing is that, both in the film and in accounts of Baldwin of Jerusalem's reign, he had the same amount of contact with courtiers, advisors and the public as any other ruler. No-one ever made any attempt to shut him away or avoid him. This was also the case with Henry IV of England, who developed Hansen's Disease late in his reign, about 20 years or so after he came back from extended "travels" (otherwise known as political exile) in the same areas in which TKOH is set - the Middle East and Southern Europe. Either people pragmatically realised that acquaintances were highly unlikely to contract the disease (but note that Baldwin, though a teenage and 20-something King, was never married and no moves were ever made to marry him off, and Henry IV's queen didn't live with him in later life because she'd been imprisoned for witchcraft), or powerful members of society who suffered from HD had more leeway to lead freer lives.

Mirror Image egamI rorriM
05-16-2005, 11:57 AM
Hansen's Disease never has white lesions like those described in the Bible. Also, the Bible never mentions the lack of feeling that is the hallmark of Hansen's Disease. Biblical leprosy probably referred to any number of afflictions, but probably not Hansen's Disease.

I did a big research paper about Hansen's Disease this year, so I know a lot of trivia/facts about it.

irishgirl
05-16-2005, 12:02 PM
It's funny, when I was in India, one of the nurses at or hospital told me she was from a "leprosy background". Silly me, I thought it meant she worked with Hansen's patients, but no, apparently, in India, it's a polite way of saying that your parents have Leprosy.

Even there, with overcrowding and lack of basic hygiene, most patients with HD will have healthy children.

PoorYorick
05-16-2005, 03:25 PM
Small endemic foci exist in Texas, Louisiana, and Hawaii.
Yet another reason I'm proud to live in Louisiana. :dubious: