I NTER:'\ .\TIOXAL JOURXAL OF LEPROSY Volume 41 . Numher 2 Prill ted ill Ihe U.S.A.
Gerhard Henrik Armauer Hansen Seen Through His Own Eyes A Review of His Memoirs
¢ivind Larsen 1
In the course of the century which has vations to the new great hospitals of the elapsed since the discovery of the leprosy first half of the century and to thei r labora bacillus in 1873 by C. H. Armauer Hansen tories. (1841-1912 ), several biographers and med Following Louis Pasteur's ( 1822-1895) ical historians have stressed the importance extension of the general knowledge of the of this event. 2 life and activity of microorganisms through The life span of C. H. Armauer Hansen his fermentation studies, the road was open covers a period when bacteriology was a for thorough investigations designed to de growing specialty in medical science. Ear termine whether or not whole series of lier suggestions that certain diseases might diseases might have infectious etiologies. be associated with infectious organisms New results and achievements foll owed were partly confirmed during the· 1830's each other at short intervals, especially in whcn fungi were demonstrated . in certain the decade beginning with 1877 when Pas skin diseases. In the middle of the 19th teur turned his interest to human bacteriol century, a series of severe epidemics lay as ogy, and even more when Koch in 1882 scourges over European towns and indus found the tubercul.osis bacillus. These trial centers, where poverty and bad sani findings led to further enthusiasm for bac tary conditions made the dense 'populations teriology as a whole. Now that the immedi extremely vulnerable. However, the epi ate cause of a wide range of hitherto unex demics had yielded scarcely any evidence plained common diseases could be demon regarding thc course of their contagion. strated, general medical interest was more Thereforc, a great interest in the problem directed at the specificity and etiology of of contagiousness was quite natural. disease, than to the mere description of The small er bacilli were more difficult to symptoms and functions in the diseased observe than the fungi. Nevertheless, the human body. anthrax bacillus was demonstrated by Pol· Born in 1841, Armauer Hansen's active lender in 1849, and by Davaine and Rayer years lay just within this important period in 1850. The microorganisms were found in of transformation and development in med the blood of animals which had died from icine. In his education and in his work as a the disease. Thus, further use of the micro physician and as an investigator, we know scope in the search for disease causative that he closely watched what was happen microorganisms was an obvious approach. ing in the medical world. He then applied Additionally, at this time the scene of the the new ways of thinking to the fi eld of most successful proceedings and discov prime interest to himself, and also to Nor eries in medical research were shifting from wegian medicine, namely leprosy. that of the house physician's bedside obser- Some of the investigators working on epidemiology and bacteriology were suc I ~i vind Lar~en , M.D., Doccnt , Section of Mcdical History. l'ni\'c rsity of Oslo, Oslo. :'\ol'\l'a),. cessful due to their technical skill and to 2 A cO lllprche11'ivc biography has been published the quality of their scientific methods as a hy the :'\ol'\n.:gian hacteriologist. Thomas Mart in whole. Hansen undoubtedly was among "ogelsa ng (H), in 1968, and a short bill penetrat ing survey hy Irg'ellS (0) , in 1~7 3. HOII'('\('I', a~ these these. On th e other hand, many enthusiasts arc IHillen in :'\ol'\n'gian. rderl'ncc is gilCll to failed in their search for microorganisms. SOIllC or the Illore illlportant a rticles in English on For some of them the explanation was Arm:tucr Ha n sen a ncl his discovery e. n. 10. 1 t) , and 'on the leprosy situation in :'\ol'\l'a)' (I. 7. R. t~). quite simple. They were not clever enough. 208 41, 2 Armauer Hansen Memoirs 209
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C . Armauer Hansen, Memoirs and Contelllplations. (Till e page) 210 Intel'llotiol1a l j OIl/'/wl of L epl'osy 1973
Others, however, perhaps quite as goou taught at a school for yO llng !J(lYS . I Ie scientists as many of their coll eagues who descril )( 's hi s c1ass('s in zoology and botany, later dewlopct! great nan)es, fail ed simply ant! we ullderstand that he had a praglll at because they were seeking microorganisms ie vicw of what the youn g pllpils had to in di seases where nonc coult! bc found, learn and what Illll St be rcgardeu as dead misl ed by theori es ant! hypotheses which kn owledge to them. proved to be wrong. Therefore, it is diffi At the time when he arri veu in Chris cult to assess correctl y the historical signifi ti ania, it seems that Annauer HansclI \\';IS a cance of famous men of achievement from rel igious man. lIe wrote that he prayed this vivit! period of progress. For some, cvery day and wcnt to cllllrch on SUllday. th ei r own impressions of thcmselves help in To judge from his nH'lll oirs, he apparcntly our (' valuati on. In the case of Armauer turncu in the cO llJ'se of a few studcllt years rT ansen we have to some degrce an oppor into an atheist, a devel opmcnt whi ch tunity to compare what we know about meant mueh to him, and apparently prcdi s him with his own worus because, in 1910, posed to his deep personal (,OJllIII itlllent he published, in Norwegian, his memoirs when he encountered the works of Charles (4). This was a volume of 142 small pages, D arwin. reAecting views and contemplations of his Hansen descrihed himself as an inquisi life experi ences. This presentati on is based ti ve student, interested in following hi s on that publication. own observations. This led him into some Armaun Hansen was born in Bergen, conflict with his Ill cdical teachers, hut, nev and through all his life remained a devoted ertheless, the reader gets a charming im son of this city. In the first chaptcr he pression of the relationship between profes describes his childhood and youth in this so rs and students at the still very small town on the west coast of Norway. A rich university. Hansen, however, was of the trade with IOll g traditions had made Ber opinion that the contact b etween the stu gen into a center in many ways, but when a dents in Christiania and the intellectual life youngster wanted to go to a Norwegian in the rest of Europe was not very good. univCl's ity, he had to leave for Christiania, Some discussions were held in private cir the capital situated in the eastern part of cles, for instance, on the relationship be the country. Thence, Armauer H ansen tween religion and natural sci ences. These journeyed. questions interested Armauer IIansen The second chapter describes his student deeply and in his book he presented a life in Christi ania. H e tells that he and his severe criticism of the way the men of the fell ows spent an interesting time, but as his church defended their views against the father had inadequate resources for supply new thoughts on evolution. in g him with money, Hansen had to fin ance Throughout the year of 1867, the first his studies by means of vari ous jobs. At year after his fin al medical cxamination, first, he found work as an "informator" H ansen worked as a physician at the Uni which meant a sort of house teacher- for versity H ospital in Christiallia. After that H erman Schirmer, who was later to be he went to Lofoten, a fi shing district of come an architect. In this home he was northern Norway, to work during the sea treatet! as a fri end of the house and could son as a physi ciall to the fi shermen. His look back to it with veneration and grati description of this time among the native tude. A subsequent job in a young girls' population, and of the dramatic voyage school did not turn out so succcssfull y. H e from Bergen to Lofoten which lasted for 21 had to leave this job and return to Bcrgen days, bein g hampered by a fi ercc winter for lack of money. We read, however, that a storm, shows that he learned much about month later, 11{' got a letter fr orn his teacher the practical fun ction of the medicin e he in anatomy who asked him to work for him had been taught in the rather sheltered and during hi s own stay abroat! . This teaching quite different mili eu of the uni versity city, of anatomy and his own medical studies more than 1,000 km to the south. cl earl y interested him very much. H e also In the fourth chapter he rclated how he 41, 2 Armaller Hansen Memoirs 211 first encountcrcd th e dreadful state of thc rcmoved from the battlefi eld, but dead leprosy patient when he obtain ed a posi men and horses werc still scattered all ti on as a doctor at thc leprosy hospital in over. Hc was dceply impressed by this hi s native town of Bergen. He cntered this sight. He remarked especially on the dis work with great enthusiasm, there bein g tended cadavers of the killed horses and enough interesting problems to engage his the multilated human corpses from which attention. H ere he not only had responsibil robbers had cut off fin gers in order to steal ity for hi s patients but also had a celtain valuables. Hansen gave up his plans to join amount of social life to fill his time. Never the ,Bed Cross. He resumed his journey in theless, hi s first scientific work on leprosy Heidelberg wherc he visited a hospital. was published approximately one year af There all the war casualties caused him to tcr hi s arrival at the leprosy hospital. This write that he was fortunate in not havi ng paper consistcd of a study of the character succeeded in getting involved in thc war. isti cs of leprosy. Some of the material was In Vi enna, he had an experience which, found in a previously concluded study of to judge from his memoirs, must have been the normal and pathologic anatomy of the of immense importance to the rest of his lymph nodes, a work which earned him a life. One day he saw in the window of a gold mcdal from the University of Chris bookstore the book by Darwin, Natiirliche tiania in 1869. Schopfungsgeschichte. Its title evoked his Hansen next received a travel grant and interest; he bought the book and went in th c spring of 1870 he went to Germany, home to read it. He read Darwin that day havi 'lg as hi s first destination Bonn, where and spent also the next day in its perusal. hc planned to work in the laboratory of the In his memoirs he states that by that time microscopist, Max Schultze. The journey the whole world immediately appeared in from Bergen was long and cumbersome. another light to him. All his previous con From Hamburg to Bremen he traveled by cepts and thoughts were confused by this stagecoach. He found the stay in Bonn of new basis for a philosophy. limited value. Dr. Schultze was, Hansen Later, in Bergen, he made more thor wrote, not able to get interested in topics ough studies of Charles Darwin's works, oth er than his own fi eld, which was the and he states that these formed the basis retina of the eye. for his own further philosophical thinking. In the month of July in 1870, the war He wondered why Darwin was not better betwcen Germany and France broke out. known in Norway, and he felt it an obliga The numerous guests at the surrounding tion to write about Darwinism in a local bathing resorts immediately wanted to go Bergen newspaper. In his memoirs Hansen home. The Bhine district was congested criticized the theologically colored philos with traffic, and Hansen noted how the ophies of life severely and revealed him railway station could be overcrowded by self as a rationalist, beli eving only in what passengers and luggage. At the same time, he could deduce from observations. troops were moved westward towards the As a gift from a friend he received a combat zone. Thus, 18,000 men passed round trip ticket to V cnice, a city which through Bonn every day. I-Jansen wrote of impressed him. On his return to Norway he his admiration for the precision and effec stopped in Dresden and Berlin. He ended tiveness that he observed. His own scien his chapter on the journey with some re tific work, however, was interrupted. marks on Catholicism, and again his athe Hansen then left Bonn for Vi enna. On isti c views are quite clear. He concluded by hi s way he placed a red cross on his arm, noting that he did not learn much dlU'ing and apparentl y out of curiosity, went to hi s stay abroad. The exposure to the works Saarbrlicken where he wanted to work as of Charles Darwin, he said, was the most an army surgeon but the Bcd Cross head valuable result. The purposc of his tour, quarters did not givc him work. H c had whi ch was to study pathologic anatomy, is just arrived th day after a great battle. hardly mentioned. The wounded soldiers had already b een On the foll owing pages, we read about 212 International JOllrnal of Leprosy 197:3 how he continued to work on the ctiology reacted quitc calml y because he had al of Icprosy. H c discussed the problcms of ready written a communicati on on the the disease with the physician-in-chicf, causes of leprosy in the Norwegian Maga Daniel Cornelius Danielssen ( 1815-1894 ), zin for Laegevidenskaben. 3 Danielssen, and he received another travel grant, this Hansen says, was very angry over the skir time for the purpose of going out into the mish with Neisser. Later, Hansen pub countryside to examine the occurrence and lished hi s finding also in a German maga suspected causes of leprosy in the nativc zine. He states that there should be no population. For two years, during the sum disagreement over his being the one who mer months, he traveled about the western discovered the leprosy bacillus. From Han parts of Norway. Although often inconclu sen's memoirs, the reader gains the impres sive, his observations indicated that leprosy sion that he, himself, was not so interested had a specific cause which should be in this priority competition. He felt it an sought in the pathologic manifestations, exciting challenge to try to find an infectivc rather than in environmer.t or heredity. origin for leprosy, becaus c, as he said, if the Hansen stated that bacteriology at this disease was hereditary there was little to be on Norwegian peasants. One has to have done for those who were afflicted. If the enough time when you are asking for some disease was infective, however, something thing, and you have to use your personality could be done. to get what you want, he noted. These When he evaluated the precautions tak refl ections on the nature of the native pop en in Norway against leprosy, Hansen ulation of rural Norway led him to a discus found that these had clearl y resultcd in a sion of several characteristic features of decreased prevalence of the disease and Norwegian society. This is witness to an noted that this point was a strong argument ability to make sharp observations and to in support of the irifective theory. The make succinct conclusions. Norwegian health authorities shared Han Hansen states that bacteriology at this sen's opinion and further restricti onswcre time had advanced so far, that it was laid on the patients with leprosy, to avoid natural also for him ~o start searching for infection and spread of the discase. Rc bacteria as pathogenic factors. Bacterial garding the cri ti cis~ which arose in con etiology had not been proven in any chron nection with these new regulations, Hansen ic disease, among which leprosy must be remarked that healthy people also must classified. At first he did not find any mi have the same human rights as sick people. croorganisms, but since he was convinced When the healthy people find that the sick that leprosy had to be an infective disease, pose a danger to them and to society, then he continued his studies. Under the micro it had to be their right to take preventive scope he actually soon discovered bacteria precautions, when this could be done in a like forms, but the study of these was so humane way. difficult that he could not draw any definite On his own role in the gradual eradica conclusions. He had no success applying tion of leprosy in Norway, Hansen re the new staining methods described by marked that it is wrong to lay all the honor Weigert and Koch. for the success upon him. The prophylactic In 1879, Albert Neisser ( 1855-1916 ) from measures against the disease were older Breslau, arrived in Bergen to study leprosy. than himself. H e himself was only fOltunate Hansen tell s us that he discussed his prob to find out that the measures which had lems with him. On his return to Breslau been put into force on quite another scien Neisser brought with ,him some pr e para ~ tific bas is later proved to be ri ght. tions made by Hansen. Neisser was morc The leprosy congress in Berlin in 1897 successful in his coloring and he published :1 The original Norwcgian cOllllllllnica tion from his findings. According to his memoirs, IR74 is tra nsla lcd illlo Ellglish alld n:prilltcd in Hansen apparently looked at this event as Jf)!)!) (!l). a nd sho llld hc read logelher with Vogel a trick by Neisser to gain credit for priority sa ng's commellt s (I I) . The controversy helwcell Hanse n and Neisser is disc llsscd in references ~ alld of discovery, but Hansen notes that he 12. 41 , 2 Arm(lIIer 1J unsell M emoirs 213 regarded him as a famous man because of "I have found," he stated in the conclud his discovery. In hi s memoirs, he humbly ing chapter of the lll emoirs, "that there has remarked that h e himself regarded the been more of pleasure than of sorrow in my discovery of the lepra bacillus as something life; possibly this is so hecause I have a which had to come when anyone began to som('what crude constitution- but I have study the disease with eagerness, intelli- liked it anyhow. The only thing I dislike in gence and skill. In all scientific work, he life is to get old." He noted that after the noted, sound thinking and much work will age of 40 he felt that although the ability to give results. Some of those who work in this worK still was present, he no longer pos manner are perhaps especially gifted, or so sessed the eagerness of his youth for new lucky that new and fruitful directions of tasks and ideas. III his conclusioll he work are revealed to them amI turn them praisl'd the neutral scientific approach to into great names. H ere, Hansen mentioned all questions, as the best basis for work in his beloved Darwin as an example. every neld. The discussion of heredity in leprosy did / Hansen regarded the discoveri es of Pas not fade, Hanscn wrote in his mc-moirs, teur and the evolutionary theori es of Dar despite the weight of evidence for the win as the greatest scientific achievements infection theory. During the great emi- occurrin
2. FELI>~IAN , \V. II. Cerhard II c1lI'ik 1\1' Norway from IR.56 until today. Int. J. mailer Ilanscn. vVhat did he see and Epide miol. ( Jn press) w he n? IlIt e1'1lat. J. Leprosy :3:3 ( 196.5) B. RIC/lAnDS, P . Lcprosy in Scandinavia. 4 12-4Hl. Centaurus 7 ( 1960) 101-133. :3. Fl'rE, C . L. and WAllE, [-I. W. The con 9. VOCELSANG, Th. M. Gerhard Armauer tribution of Neisser to the es tablishme nt I-Iansell. Acta Path. I\licrobio!. Scam!. IB of the Hansen bacillus as the e tiologic ( 1941) 4.5:3-4.'56. agclI t of leprosy and t he so-called J O. VO(;ELSANC , Th. 1\'1. A serious sentellee I-lansen-\Ieisse r con trovcrsy. Inte rllat. J. passed against the discoverer of the le p Leprosy 23 (19.5.5) 41 R-42R. rosy baci llus (Gerhard Annauer Hallsell) -I . J h NSEN, C. AIl~IAUEII. Uv.\·('r;lIr!r;lIg(·r og ill JRRO. Med. lIist. 7 ( 19G:3) lR2-18G. !w /mg /II;lIg('r. Kristiania : J I. Asebelwllg J J. VOCELSANC , Th. 1\1. Discovery of leprosy & Co. ( W . N ygaard) , 1910. h acillus. JAI\IA 184 ( 196.'3) 901-902 . .5 . IIA NS~:N , C. AIIMA UEH. Spf'dalskhedens 12. VO(;El.SANC , Th. 1\1 . The 11 anse n-Neisser arsagf'r. [Causes of leprosy. ] Inte1'1lat. J. C:H1troversv IK 7~)- 1 880 . Illternat. J. Lep Leprosy 23 ( W.5.5) :307-.109. Heprint. rosy 31 ( 1 gG.'3) 74-80. 6. hICENS, L. M. Norsk forskningshragd : 1.'3. VOCELSANC, Th. 1\1. Leprosv in Norway. Amall e rHans e n· .~ oppclagelse av lepra Med . I-list. 9 ( 196.5) 29-3.5. hasillen. Forskningsllytt (ill press). 14. VOGELSANe, Th. M. Gerhllrd 1/(,lIrik 7. [IICE NS, L. M. and BpmKEDAL, T. Epi AI'I1WlU'r 1111/1.\'('1/ 1841-1912. L(']11'1I1J(ls;1- d emiology of leprosy ill Norway: the his lells oppdag('r-lw7Is li v o{!, hailS livsvrrJ..·. tory of the National Leprosy Registry of Oslo, Gyldendal: 196B.