Download - HISTORY OF HANSEN'S DISEASE
HISTORY OF LEPROSY
Dr.Swathy Lekshmi J L
ORIGIN
• Disease of great antiquity
• Exact origin controversy
• “High up the Nile midst Egypt’s central plain, Springs the dread Leprosy and there alone.” Lucretius( 91-55 BC) De natura Rerum
LEPROSY IN LITERATURE
• INDIA • Sushrutha samhitha – 600 BC
• Vat- Rakta or Vat-Shonitha
• Kushtha- Kshudra ( minor) Kushtha
Maha (major) Kushta
• Tuvarka – Chaulmoogra oil ( Hydnocarpus Wightiana)
• Manu Smriti and Atharva Veda
EGYPT
• Ebers Papyrus (1555 BC) – Uchedu
• Ebbel – Ghon’s swelling
• Yeoli - Clay jar with leonine facies – 1400 – 1300 BC
CHINA
• Pai Niu _ 600 BC
• Nei Ching – 220 BC
• Ko Hung – “Prescriptions for Emergencies” 300 AD lai ping • Chao’s Pathology - 610 AD
• Sun Szu-moh - “Thousand Golden Remedies” Tai Feng
• Chaulmoogra oil – Ta Fung Tzu – 1400 AD
BIBLE
• Hebrew-Tsaraath/Zaraath
scaly disease
spot- white as snow
• Old testament- Tsaraath
• New Testament- Lepra from Greek
• Arabic- Jusam
• First recognizable description of leprosy-Areteaus of Cappadocia
• Middle of 2nd century
• elephantiasis
LEPROSY IN MEDIEVAL PERIOD
• Peak – AD 1000-1400
• Clergy - class of lay physicians
• Leprosy- conceived as a punishment for sin
• 3 options-seclusion at home
entry into leprosarium
life of wandering, begging
• Legally dead
• Leprosaria by noble families
• Queen Metilda - wife of Henry 1 of England
OSTEO ARCHEOLOGICAL STUDIES BY MOLLER CHRISTENSEN
• Naestved St. Jorgen’s Hospital, Denmark- AD 1250-1550
• 1948
• Facies leprosa - atrophy of anterior nasal spine
atrophy of maxillary alveolar process
ST.JORGEN HOSPITAL
DECLINE OF LEPROSY IN WESTERN EUROPE
• 13th-17th century
• Last indigenous case -1798
John Berns , Shetland islander
• Changes in climate
• Plague epidemic
• Preventive measures, improvement in diet and
living conditions
• Scandinavia-organism exist outside human or
animal host
SPREAD OF LEPROSY TO AMERICA
• Command of Columbus
• Immigrants from Europe
• African slave trade
• Louisiana by Acadians in1755
NATIONAL LEPROSARIUM AT CARVILLE
• 1919-Florida
• 1920 July-Carville-site of Louisiana leper home since 1894
• 1921 – US Public health Service
FATHER DAMIEN OF LOUISIANA
• Father Charles Boglioli- Vincentian priest
• Born in Itlay ,1814
• 1866-Charity hospital Louisiana
• 1882
SPEAD TO SOUTH AMERICA
• Brazil-1696
• Portuguese and Africans
• Argentina- infected slaves from Brazil
SPREAD TO AFRICA
• Egypt – 200-300 BC
• Persian invasion in 6th century BC
• Alexander The Great in 4th century BC
FATHER JOSEPH DAMIEN DE VEUESTER• 1840-1889
• Belgian priest
• 1864-Hawaii
• 1865-King Kamehameha V
Honolulu for mild
Molokai for incurable
• First patient in 1865
• 1873- Kalacuao
Kalaupapa ,1890
• 1885
• 1980-National Historic Park
• Brother Joseph Dutton assisted in
1886
• Father Pierre d’ Orgeval
CLASSIFICATION1848-Danielssen & Boeck
nodular anaesthetic
1895-Hansen & Looft tuberosa(nodular) maculoanaesthetic1903-Neisser lepra tuberosa lepra cutanea lepra nervorum
• 1905-Jadassohn
• Darier -1st described term “tuberculoid” in
relation to leprosy
THE MANILA CLASSIFICATION
• 1931-Leonard Wood Memorial • cutaneous• neural• mixed
CAIRO CLASSIFICATION
• 1938-International Leprosy Congress
• lepromatous
• neural-neromacular simple
neuromacular tuberculoid
neuroanaesthetic
PAN AMERICAN CLASSIFICATION
• 1946-2nd Pan American Leprosy Congress, Rio de
Janeiro
• Histology
lepromatous
tuberculoid
uncharacteristic
HAVANA CLASSIFICATION
• 1948-International Leprosy Congress
• lepromatous
• tuberculoid
• indeterminate
WHO EXPERT COMMITTEE
• 1952
• lepromatous
• tuberculoid
• borderline
• indeterminate
MADRID CLASSIFICATION• 1953-International Leprosy Congress• Lepromatous type(L) macular diffuse infiltrated nodular neuritic• Tuberculoid type(T) macular minor tuberculoid major tuberculoid neuritic ,pure• Indeterminate Group(I) macular neuritic, pure• Borderline Group(B) infiltrated,(?others)
INDIAN CLASSIFICATION
• ORIGINAL INDIAN CLASSIFICATION
• Lepromatous
• Tuberculoid
• Maculoanaesthetic
• Borderline
• Polyneuritc
• indeterminate
REVISED INDIAN CLASSIFICATION
• 1981-IAL,Agra
• Removed maculoanaesthetic
JOB &CHACKO CLASSIFICATION
• Lepromatous leprosy
• Tuberculoid leprosy
• Borderline tuberculoid leprosy
• Borderline lepromatous leprosy
• Indeterminate leprosy
• Polyneuritic leprosy
RIDLEY-JOPLING CLASSIFICATION
• Clinico-bacteriological
• Immonological
LUCIO LEPOSY
• 1852-Lucio &Alvarado
• 1948-Latapi & Zamora
HISTOID LEPROSY
• 1963-H.W.Wade
CHEMOTHERAPY
• CHAULMOOGRA OIL
Legend –Burmese king- fruit of Kalaw
China and Japan-AD 1500
• Frederic John Mouat -1854
• US-oil by mouth in 1900
• Egypt, France, Philippines-subcutaneous oil
• Johansen -1928
added oil soluble benzocaine
• Hydnocarpus wightiana
SULFANILAMIDE
• First trial at Carville-1941&1942
• Effective in infected ulcers
PROMIN
• Dr Guy Faget-MO, US Public Health
Service, 1941
• Oral , dose-0.5-1 gm./day
• Parenteral- 5 gm./day
DIASONE
• Muir, Faget, Pogge- 1940
• Adverse effects-hematuria,
gastritis,anaemia,dermatitis
DAPSONE
• Cochrane-1949
• Lowe &Smith-1949
orally
• Resistance- 1964,Malaysia
CLOFAZIMINE
• Browne & Hogerzeil- 1962, Nigeria
• Browne- 1965
anti inflammatory action
• Resistance- 1982 but not yet proved
COCHRANE
RIFAMPIN
• Opromolla-1963
Rifamycin SV
• Late 1960s-Rifampicin capsule
• 1970- Rees et al
• Resistance-1976
Jacobson &Hastings
THALIDOMIDE
• Sheskin- 1965 as a sedative ,
Isreal
• Dose -100 mg tds
MULTIDRUG THERAPY
• Malta trial in 1970
Dapsone + Rifampicin + Isoniazid + Prothionamide - 2
yrs
• Scientific Working Group on Chemotherapy of Leprosy
• THELEP-1976
• Field trials-1979
• WHO –Study Group on Chemotherapy of Leprosy-1981
• MDT-1982
NEWER DRUGS
• Since mid 1980 s
• Ofloxacin
• Pefloxacin
• Moxifloxacin
• Clarithromycin
• Minocycline
• Rifapentine
BRIEF HISTORY OF LEPROSY VACCINE RESEARCH• 1921 – BCG
• 1928 – Health Committee of the League of Nation
• 1979 - Human trials with ICRC Anti-leprosy Vaccine began in Mumbai,
India
• 1980 – ICRC (cultivable leprosy derived mycobacteria belonging to M.
avium intracellulare complex) Vaccine developed
• Feb1998 – Leprosy vaccine, the National Institute of Immunology in New
Delhi
• First commercial batch released in June 1998
• October 2003 – Identification of M. leprae antigens
• May 2005 – Completed screening of the leprosy bacillus for proteins
strongly recognized by the human immune system
• March 2006 – Identified two specific antigens (MLO405 and ML2331)
• Convit et al- mixed vaccine-heat killed armadillo derived M.leprea +BCG
LABORATORY INVESTIGATIONS
• DISCOVERY OF M.LEPRA
• Carl William Boeck (1808-75) & Daniel
Cornelius Danielssen(1815-94)
• Hereditary theory
• Dr .Rudolff Virchow , German physician
lepra cells in late 1850s
• Brown bodies
Dr Rudolff VirchowDr Daniel Cornelius Danielssen
GERHARD HENRICK ARMAUER
HANSEN
• 1841-1912
• Norwegian physician
• 1868-began leprosy work under
Danielssen
• 1871-tiny rods in cells
osmic acid stain
• 1874-published in Journal of
Norwegian Medical Society
“Causes of leprosy”
• Chief of the leprosy service in Bergen
SKIN SCRAPING
Herbert Windsor Wade & Rodriguez in 1927
Cochrane modified -1947
Ridley standardised to logarithmic scale -1958
Ziehl- Neelsen staining method-Franz Ziehl & Friedrich Neelsen
FITE STAIN
• 1933
• Dr. George Liddle Fite & Sister Hilary Rose, research
laboratory at Carville
• Fite stain – carbol fuschin based stain
BACTERIAL INDICES
• Morphological index- Waters and Rees
in 1962
• SFG index- Ridley
LEPROMIN TEST
• First one described by Mitsuda in 1919
• Hayashi in 1933
• 1940-Mitsuda lepromin test is used
• Dharmendra lepromin -1942
• 1st successful inoculation of mouse footpad-
Shepard , 1960
• Prabhakaran et al-nude mice,1976
• 9 banded armadillo-core body temp low
• Susceptibility -1969,leprosy research at Carville
• Kirchheimer &Storrs-1971
• Primates-Rhesus, Sooty mangabey monkeys, African
wild monkeys, chimpanzees
ANIMAL STUDIES
ANTILEPROSY ORGANIZATIONS
• Military & Hospital Order of St. Lazarus of Jerusalem
• Sovereign Military Hospitaller Order of St. John of
Jerusalem,Rhodes,Malta
• LEPROSY MISSION INTERNATIONAL
• 1873, London
• American committee -1906
• American Leprosy Mission to lepers -1917
• American Leprosy Mission -1977
• American Leprosy Mission International -1990s
BELRA- British Empire Leprosy Relief Association
• 1925
• 1929-Leprosy reviews
• 1931-recognised as the “first leprosy prevention
organization” at International Leprosy Congress in
Manila
• 1963-LEPRA
• 1989-LEPRA Society of India formed
• Currently working in- ANDHRA PRADESH,MADHYA
PRADESH,BIHAR,ODISHA,NEW DELHI,JHARKHAND
INTERNATIONAL FEDERATION OF ANTILEPROSY ASSOCIATIONS
• 1966-ELEP (Federation of European Anti-Leprosy Association)
• International federation of 14 autonomous non governmental
anti leprosy organizations
• Funds-public & institutional sources
• Goal-World without leprosy
• HQ- London
ALERT
• Addis Ababa, Ethiopia
• It was originally the All Africa Leprosy
Rehabilitation and Training , now: All
Africa Leprosy, Tuberculosis and
Rehabilitation Training Centre.
• At ALERT is the Armauer Hansen Research
Institute, founded in 1970, specializing in
leprosy research
NCLCA-NOVARTIS COMPREHENSIVE LEPROSY CASE ASSOCIATION
• Provide MDT free of cost
• 1989-CLCP in India
• Objectives-to enhance access to MD
provide service for prevention, correction, care of
disabilities with rehabilitation
HKNS-HINDU KUSHTH NIVARAN SANGH
• Branch of BELRA –Indian Council
• Renamed as HKNS
• Registered in 1950
• Hon’ble President of India
• Governing body- 41 members
• Publishes research journal-”LEPROSY IN INDIA”
Dr. Ernest Muir ,July 1929
• 1984-”INDIAN JOURNAL OF LEPROSY”
• Dr.Dharmendra
GMLF-GANDHI MEMORIAL LEPROSY FOUNDATION
• 1951, WARDHA
• 1st unit-Sevagram
• Chilkalpalli-1953
• T’Narasipura-1955
• Balarampur-1977
• Transferred to state govt.
• Concept of socioeconomic rehabilitation
• 1st leprosy training curriculum
• 1st training centre-Wardha,1952
MISSIONARIES OF CHARITY,GANDHIJI PREM NIVAS,TITAGARH
• Mother Teresa,1958
• Mobile clinic
• Titagarh municipality established a permanent centre
ANANDWAN
• 1st of 3 ashrams by Baba Amte
• 1951
• Chandrapur district of Maharashtra
PDLC-PUNE DISTRICT LEPROSY COMMITTE
• 1957,Dr. Jal Mehta
• Bandorawalla leprosy hospital at YEOLEWADI
• 2001-handed over to state govt.
1898- Indian Lepers’ act
1925- Formation of Indian council of BELRA
1935- All India Leprosy Conference, Calcutta
1950- Indian Council of BELRA- HKNS
1950- Indian Association of Leprologist
1953- Classification of Leprosy was drafted by Dharmendra &
Chatterjee
1955- IAL adopted classification
MILESTONES IN LEPROSY HISTORY OF INDIA
1955-NLCP-National Leprosy Control Program
• 1st five year plan
• Dapsone
• Paramedical worker per 20000 population
• General household surveys in 3-5 yrs
• Annual contact surveys, school surveys
• 1 nonmedical supervisor/ 4-5 paramedical worker
• 1 leprosy medical officer –taluk/block level
• SAPEL- A Special Action Plan for Elimination of Leprosy-
1997-2000
• Elimination-December 2005
• 1997 –SAPEL
• 2002 – 04 – Integration of Leprosy services with GH
system
• 2004- National Conference on Elimination of Leprosy,
Raipur
• 2005- Elimination at national level
• 2012- Special action plan for 209 high endemic districts,
I6 states.
• 1983-NLEP-Dr.Swaminathan Committee
• 1986-Bombay leprosy project
• 1994-NLEP- FD MDT -2yrs
• 1998- FD MDT -1yr
“History is who we are and why we
are the way we are”
_David Mc Collough“History is who we are and why we are the way we are” - David Mc Collough
THANK YOU