DOCSLIB.ORG

Legacies of Leprosy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Legacies of Leprosy Chapter 1 Legacies of Leprosy The world’s “seven billion human beings are all equal,” asserted the Dalai Lama on his March 2014 visit to the Tahirpur Leprosy Complex in the megacity of New Delhi. He continued, “People should not look down on others. It is totally wrong. Discrimination is a sin” (“Condemning Discrimination” 2014). And yet, as a longtime resident of the Tahirpur complex declared, echoing the senti- ments of people living with Hansen’s disease in many parts of the world, “We face a thousand indignities every day” (“Stigma Hinders” 2014).1 Four thousand miles away, on a remote island in Japan’s Inland Sea, Tomita Mikio, a healthy, middle-aged resident of the Ōshima National Sanitarium (国立療養所大島 青松園, Kokuritsu Ryōyōjo Ōshima Seishōen), lamented that he had attempt- ed many times to live outside the sanitarium but was unable to do so. He had not even been able to obtain a driver’s license, having been dismissed from driving school when the staff learned he was from Ōshima and therefore had been treated for leprosy. And so, he says, “I was lucky that I had a place to come back to [i.e., Ōshima] … a place where I felt at home and normal” (Sims 2001).2 Caused by the bacterium Mycobacterium leprae, leprosy, also known as Han- sen’s disease, is a chronic infectious condition that often first manifests with spots on the skin or numbness in a finger or toe.3 Although greatly feared be- cause of how drastically it can alter physical appearance and cause physical impairment, Hansen’s disease is one of the least contagious of the contagious diseases, since the vast majority of the world’s population has natural immu- nity. Hansen’s disease has been readily treatable since the 1940s, in the last few decades with multidrug therapy, but if left unaddressed it can permanently 1 India imposes severe penalties on individuals with leprosy, including forbidding them from working and traveling in public. The nation is home to about 700 leprosaria (Mandavilli 2019). 2 Ōshima was home for seven decades to acclaimed Japanese poet Tō Kazuko (塔和子, 1929– 2014). Tō was diagnosed with Hansen’s disease as a young teenager. Fearing for their reputa- tion, her siblings moved away from their hometown of Seiyo (on Shikoku) and did not inform their spouses about her. But after her death, one of her brothers insisted that her ashes be buried in the family grave, which remains unusual for people with leprosy, whose pseud- onyms, which they are forced to take when entering leprosaria, frequently remain intact (Takaki 2014). 3 Some individuals with this condition prefer the term Hansen’s disease while others prefer the term leprosy (Eunjung Kim 2017: 167–168). I use the terms interchangeably, except when re- flecting historical or contemporary usage. © koninklijke brill nv, leiden, ���� | doi:10.1163/97890044�018�_004 Karen Laura Thornber - 9789004420182 Downloaded from Brill.com10/02/2021 11:08:24AM via free access <UN> 44 Chapter 1 damage the skin, nerves, limbs, and eyes, causing blindness, crippling, and de- formity (Covey 1998: 89–90).4 As recently as the 1980s, millions of people lived with Hansen’s disease. The World Health Organization achieved its stated goal of “eliminating” the disease at the global level in 2000 (i.e., disease prevalence reached <1 case per 10,000 people), and by 2005, with a few exceptions, all the world’s countries had reached the goal of elimination at the national level. But elimination is not eradication, and in several regions leprosy still exists as a public health problem. New cases continue to be diagnosed, with more than 155,000 in Asia, 33,000 in the Americas, and 20,000 in Africa in 2013 (World Health Organization 2014: 389–395).5 These figures stem partly from the con- siderable stigmas that continue to surround leprosy, despite the disease having long been curable. People so fear social ostracism that they delay seeking med- ical care and thereby increase the risk of infecting others. In many communi- ties, even those people who have been cured continue to be stigmatized, their healing impeded and wellbeing imperiled. And even when external stigmas are ameliorated, self-stigma can remain powerful, people having internalized the negative attitudes and behaviors to which they were subjected.6 In fact, no health condition has a longer continuous history of stigmatiza- tion and social and physical segregation than leprosy. For millennia, those with this disease and similar skin conditions have been shunned on all the world’s 4 See also World Health Organization (2019d) and American Leprosy Missions (2019). Lepro- matous Hansen’s Disease takes the form of numerous nodules and lesions on the skin, while neural leprosy can result in facial paralysis. Multidrug therapy includes dapsone, rifampicin, and clofazimine. 5 India alone accounts for nearly 60 percent of global Hansen’s disease cases; India, Brazil, and Indonesia are the most highly endemic countries for the disease (World Health Organization 2014: 391, 400). Although India declared in 2005 that leprosy had ceased to be a problem in the country, according to the who, more than 100,000 new diagnoses are made each year. To be sure, by 2005, symptomatic cases of leprosy in India had dropped to fewer than 1 case per 10,000 people, which meets who standards of the disease being “eliminated as a public health problem.” But resources then were redirected to aids and tuberculosis, public aware- ness of leprosy fell rapidly, stigmas proliferated, and numbers of Indians infected by the dis- ease rose quickly (Mandavilli 2019). In 2014, new cases of leprosy were reported in 121 countries, including the United States. See American Leprosy Missions (2019). In some parts of the world animals carry leprosy, in- cluding in the United Kingdom, where red squirrels have been found to be infected with Mycobacterium lepra (McNeil 2016a). 6 Internalized stigma is common among persons with leprosy, impacting their quality of life in ways similar to stigma experienced as discrimination (Van Brakel 2014: 146). See also Nicholls et al. (2005), Rensen et al. (2011), and Stevelink (2012). Karen Laura Thornber - 9789004420182 Downloaded from Brill.com10/02/2021 11:08:24AM via free access <UN> Legacies of Leprosy 45 inhabited continents.7 The severe stereotypes and stigmas, and especially the considerable fears surrounding leprosy that these attitudes have stoked, have long shaped public policy (Covey 1998: 91). Most notable has been the tenden- cy across the globe to quarantine people living with Hansen’s disease in lepro- saria, permanently separating affected individuals from their families and home communities.8 As Mr. Tomita’s comments above suggest, leprosaria have provided welcome retreats from social hostility. They also have been sites of unfathomable abuse.9 This chapter first outlines the history of leprosy and social responses to the disease in early Christian societies and then in Europe and the United States; the kingdom (1795–1893), republic (1894–1898), and territory of Hawai‘i (1898– 1959); and Nigeria, Japan, and Korea. I follow with several examples of how literature from around the world has been used to amplify stigmas toward the disease, before turning to select writings from Hawai‘i, Japan, Korea, Nigeria and other sites that condemn these stigmas, depicting social attitudes and be- haviors surrounding leprosy as causing greater anguish than the physical symptoms of the disease itself and in so doing, advocating for meaningful change. Special attention is paid to the impact of Western and Japanese impe- rialism on attitudes toward leprosy and to how those with this disease are treated in both imperial and colonial societies. 1 Leprosy, Christianity, Europe Christians for many centuries tended to regard leprosy and similar skin condi- tions more as divine retribution than as diseases, outward manifestations of an individual’s aberrant character, moral corruption, and frequently depraved sexual desire (Covey 1998: 91–94).10 The Bible refers to those with disfiguring 7 As Leung points out, the problem of identifying leprosy in early China is similar to that in much of the ancient world. Leprosy was long associated with the disease şāra‘at, from the famous passage in Leviticus discussed below. Yet recent research suggests that the biblical term actually refers to a variety of skin diseases (2009: 4). See also York (2012: 115). 8 Quarantine sites for leprosy patients have gone by a variety of names; in English alone they have been called leper/leprosy colonies, leper/leprosy hospitals, leper/leprosy hous- es, leper/leprosy settlements, leprosaria, and lazar houses among other names. 9 Most extant leprosaria are in Asia and Africa. One exception is Tichileşti, in a remote corner of Romania, which houses Europe’s last leprosy colony. The fewer than two dozen residents are free to leave, but they do not, given that “in the past too many lepers have been stoned, burnt, and beaten by panicked peasants shouting, ‘Unclean, unclean!’” (Boy- es 2003). 10 See also Brody (2005). Karen Laura Thornber - 9789004420182 Downloaded from Brill.com10/02/2021 11:08:24AM via free access <UN> 46 Chapter 1 skin conditions as dirty, unclean, and impure, and many took seriously the mandate set forth in the Old Testament that “the leper who has the disease shall wear torn clothes and let the hair of his head hang loose, and he shall cover his upper lip and cry, ‘Unclean, unclean.’ He shall remain unclean as long as he has the disease; he is unclean; he shall dwell alone in a habitation outside the camp” (Leviticus 13: 45–46) (May and Metzger 1962: 138). But in the New Testament Jesus Christ is depicted as readily healing a man “full of leprosy” (Luke 5: 12), while the desperate beggar Lazarus, who in life is “full of sores,” in death is seated beside Abraham at the “feast in heaven” (Luke 16: 19–31).
Load more

Recommended publications
  • A History of Leprosy and Coercion in Hawai’I
    THE PURSE SEINE AND EURYDICE: A HISTORY OF LEPROSY AND COERCION IN HAWAI’I A THESIS SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAIʻI AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN ANTHROPOLOGY DECEMBER 2012 By David James Ritter Thesis Committee: Chairperson Eirik Saethre Geoffrey White Noelani Arista Keywords: Leprosy, Capitalism, Hansen’s Disease, Hawaiʻi, Molokaʻi, Kalaupapa, Political Economy, Medical Anthropology Acknowledgements I would like to extend my sincere gratitude to a number of individuals without whom this research would not have been possible. First, I would like to thank each of my committee members- Eirik Saethre, Geoff White, and Noelani Arista- for consistently finding time and energy to commit to my project. I would like to thank the staff and curators of the Asia Pacific collection at the Hamilton Library for their expertise University of Hawai`i at Mānoa. I would also like to thank my friend and office mate Aashish Hemrajani for consistently providing thought provoking conversation and excellent reading suggestions, both of which have in no small way influenced this thesis. Finally, I would like to extend my greatest gratitude to my parents, whose investment in me over the course this thesis project is nothing short of extraordinary. ii Abstract In 1865, the Hawai`i Board of Health adopted quarantine as the primary means to arrest the spread of leprosy in the Kingdom of Hawai`i. In Practice, preventing infection entailed the dramatic expansion of medical authority during the 19th century and included the establishment of state surveillance networks, the condemnation by physicians of a number of Hawaiian practices thought to spread disease, and the forced internment of mainly culturally Hawaiian individuals.
    [Show full text]
  • Evidence for Mycobacterium Leprae Drug Resistance in a Large Cohort of Leprous Neuropathy Patients from India
    Am. J. Trop. Med. Hyg., 102(3), 2020, pp. 547–552 doi:10.4269/ajtmh.19-0390 Copyright © 2020 by The American Society of Tropical Medicine and Hygiene Evidence for Mycobacterium leprae Drug Resistance in a Large Cohort of Leprous Neuropathy Patients from India Niranjan Prakash Mahajan,1 Mallika Lavania,2 Itu Singh,2 Saraswati Nashi,1 Veeramani Preethish-Kumar,1 Seena Vengalil,1 Kiran Polavarapu,1 Chevula Pradeep-Chandra-Reddy,1 Muddasu Keerthipriya,1 Anita Mahadevan,3 Tagaduru Chickabasaviah Yasha,3 Bevinahalli Nanjegowda Nandeesh,3 Krishnamurthy Gnanakumar,3 Gareth J. Parry,4 Utpal Sengupta,2 and Atchayaram Nalini1* 1Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India; 2Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India; 3Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India; 4Department of Neurology, St John’s Medical College, Bangalore, India Abstract. Resistance to anti-leprosy drugs is on the rise. Several studies have documented resistance to rifampicin, dapsone, and ofloxacin in patients with leprosy. We looked for point mutations within the folP1, rpoB, and gyrA gene regions of the Mycobacterium leprae genome predominantly in the neural form of leprosy. DNA samples from 77 nerve tissue samples were polymerase chain reaction (PCR)-amplified for MlepraeDNA and sequenced for drug resistance–determining regions of genes rpoB, folP1, and gyrA. The mean age at presentation and onset was 38.2 ±13.4 (range 14–71) years and 34.9 ± 12.6 years (range 10–63) years, respectively. The majority had borderline tuberculoid leprosy (53 [68.8%]). Mutations associated with resistance were identified in 6/77 (7.8%) specimens.
    [Show full text]
  • Chapter 3 Bacterial and Viral Infections
    GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge.
    [Show full text]
  • Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting As
    Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting as Chronic Ulcers with Vasculitis: A Case Report and Discussion Anny Xiao, DO,* Erin Lowe, DO,** Richard Miller, DO, FAOCD*** *Traditional Rotating Intern, PGY-1, Largo Medical Center, Largo, FL **Dermatology Resident, PGY-2, Largo Medical Center, Largo, FL ***Program Director, Dermatology Residency, Largo Medical Center, Largo, FL Disclosures: None Correspondence: Anny Xiao, DO; Largo Medical Center, Graduate Medical Education, 201 14th St. SW, Largo, FL 33770; 510-684-4190; [email protected] Abstract Leprosy is a rare, chronic, granulomatous infectious disease with cutaneous and neurologic sequelae. It can be a challenging differential diagnosis in dermatology practice due to several overlapping features with rheumatologic disorders. Patients with leprosy can develop reactive states as a result of immune complex-mediated inflammatory processes, leading to the appearance of additional cutaneous lesions that may further complicate the clinical picture. We describe a case of a woman presenting with a long history of a recurrent bullous rash with chronic ulcers, with an evolution of vasculitic diagnoses, who was later determined to have lepromatous leprosy with reactive erythema nodosum leprosum (ENL). Introduction accompanied by an intense bullous purpuric rash on management of sepsis secondary to bacteremia, Leprosy is a slowly progressive disease caused by bilateral arms and face. For these complaints she was with lower-extremity cellulitis as the suspected infection with Mycobacterium leprae (M. leprae). seen in a Complex Medical Dermatology Clinic and source. A skin biopsy was taken from the left thigh, Spread continues at a steady rate in several endemic clinically diagnosed with cutaneous polyarteritis and histopathology showed epidermal ulceration countries, with more than 200,000 new cases nodosa.
    [Show full text]
  • Historical Overview of Leprosy Control in Cuba
    Review Article Historical Overview of Leprosy Control in Cuba Enrique Beldarraín-Chaple MD PhD ABSTRACT Program was established in 1962, implemented in 1963 and revised INTRODUCTION Leprosy, an infectious disease caused by Myco- fi ve times. In 1972, leper colonies were closed and treatment became bacterium leprae, affects the nervous system, skin, internal organs, ambulatory. In 1977, rifampicin was introduced. In 1988, the Program instituted controlled, decentralized, community-based multidrug treat- extremities and mucous membranes. Biological, social and environ- ment and established the criteria for considering a patient cured. In 2003, mental factors infl uence its occurrence and transmission. The fi rst it included actions aimed at early diagnosis and prophylactic treatment of effective treatments appeared in 1930 with the development of dap- contacts. Since 2008, it prioritizes actions directed toward the population sone, a sulfone. The main components of a control and elimination at risk, maintaining fi ve-year followup with dermatological and neurologi- strategy are early case detection and timely administration of multi- cal examination. Primary health care carries out diagnostic and treatment drug therapy. activities. The lowest leprosy incidence of 1.6 per 100,000 population was achieved in 2006. Since 2002, prevalence has remained steady at OBJECTIVES Review the history of leprosy control in Cuba, empha- 0.2 per 10,000 population. Leprosy ceased to be considered a public sizing particularly results of the National Leprosy Control Program, its health problem in Cuba as of 1993. In 1990–2015, 1.6% of new leprosy modifi cations and infl uence on leprosy control. patients were aged <15 years.
    [Show full text]
  • Leprosy in Two Patients with Relapsing Remitting Multiple Sclerosis Treated with Fingolimod Alfred Balasa, M.D.1 and George J
    Leprosy in Two Patients with Relapsing Remitting Multiple Sclerosis Treated with Fingolimod Alfred Balasa, M.D.1 and George J. Hutton, M.D.2 1 Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience; 2 Department of Neurology; Baylor College of Medicine, Houston, Texas Background A B Leprosy (Hansen’s disease) is a chronic infection caused by Mycobacterium leprae. The disease develops over months to years and may cause extensive damage to the skin and peripheral nervous system. A B In multiple sclerosis (MS), fingolimod treatment is Figure 3. Immune response in the polar clinical forms of leprosy. known to increase the risk for infections. There is one prior reported case of leprosy while on [A] In tuberculoid leprosy (TT) patients, the innate immune response is activated by M. leprae through toll-like receptors (TLR2/1). IL-15 fingolimod for relapsing remitting multiple sclerosis stimulates the vitamin D-dependent antimicrobial program in macrophages and inhibits phagocytosis of mycobacteria. These events (RRMS). We report two further cases of leprosy in promote a Th1 T-cell cytokine response (IFN-γ, IL-2, TNF, and IL-15) that contains the infection in well-formed granulomas, and a Th17 patients with RRMS and treated with fingolimod. C D response (IL-17A, IL-17F, IL-21 and IL-22) that leads to tissue inflammation and destruction, neutrophil recruitment, macrophage activation, and enhancement of Th1 effector cells. [B] In lepromatous leprosy (LL) patients, IL-4, IL-10, leukocyte immunoglobulin-like receptor subfamily A member 2 (LILRA2), and oxidized phospholipids inhibit TLR2/1-induced cytokine responses but preserve IL-10 release.
    [Show full text]
  • Toman's Tuberculosis Case Detection, Treatment, and Monitoring
    TOMAN’S TUBERCULOSIS TOMAN’S TUBERCULOSIS CASE DETECTION, TREATMENT, AND MONITORING The second edition of this practical, authoritative reference book provides a rational basis for the diagnosis and management of tuberculosis. Written by a number of experts in the field, it remains faithful to Kurt Toman’s original question-and-answer format, with subject matter grouped under the three headings Case detection, Treatment, and Monitoring. It is a testament to the enduring nature of the first edition that so much CASE DETECTION, TREA material has been retained unchanged. At the same time, the new edition has had not only to address the huge resurgence of tuber- culosis, the emergence of multidrug-resistant bacilli, and the special needs of HIV-infected individuals with tuberculosis, but also to encompass significant scientific advances. These changes in the profile of the disease and in approaches to management have inevitably prompted many new questions and answers and given a different complexion to others. Toman’s Tuberculosis remains essential reading for all who need to AND MONITORING TMENT, QUESTIONS learn more about every aspect of tuberculosis – case-finding, manage- ment, and effective control strategies. It provides invaluable support AND to anyone in the front line of the battle against this disease, from ANSWERS programme managers to policy-makers and from medical personnel to volunteer health workers. SECOND EDITION ISBN 92 4 154603 4 WORLD HEALTH ORGANIZATION WHO GENEVA Toman’s Tuberculosis Case detection, treatment, and monitoring – questions and answers SECOND EDITION Edited by T. Frieden WORLD HEALTH ORGANIZATION GENEVA 2004 WHO Library Cataloguing-in-Publication Data Toman’s tuberculosis case detection, treatment, and monitoring : questions and answers / edited by T.
    [Show full text]
  • January 26, 2020 Towards a Leprosy-Free Country
    China CDC Weekly Announcements Preplanned Studies The 67th World Leprosy Day Towards a Leprosy-Free — January 26, 2020 Country — China, 2011−2018 1,# 1 1 Meiwen Yu ; Peiwen Sun ; Le Wang ; Hongsheng World Leprosy Day was proposed by French Wang1; Heng Gu1; Xiangsheng Chen1 humanitarian Raoul Follereau in 1954 (1) and has been annually observed around the world on the last Sunday of each January with the aim of raising Summary global awareness and knowledge about this What is already known about this topic? ancient disease and calling attention to the fact Leprosy is a chronic infectious disease that is endemic that leprosy can be prevented, treated, and cured. in several countries. Control of leprosy has had targets Since 1988, the China Leprosy Association set by World Health Organization’s (WHO) Global initiated China Leprosy Day on the same day. Strategy 2016–2020 and by China through a national Although leprosy has been declared leprosy-control plan (2011–2020). “eliminated” as a public health problem at a global What is added by this report? level by the World Health Organization (WHO) Data from the Leprosy Management Information in 2005, around 200,000 new cases are reported System in China was analyzed and showed a national globally each year (2). In 2011, the Chinese prevalence of 0.178 per 100,000 and detection rate of Ministry of Health, together with 11 other 0.037 per 100,000 residents in 2018. In addition, all ministries, implemented the “National Strategic the main targets for 2020 have been met by 2018 Plan for Eliminating Harm of Leprosy, except for the proportion of counties or cities to reach a 2011–2020 in China”, aiming to reduce both the prevalence of less than 1/100,000 and the proportion rate of grade 2 disability (G2D) and severe adverse of children cases with grade 2 disability (G2D).
    [Show full text]
  • Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication?
    pharmaceutics Review Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication? Luíse L. Chaves 1,2,*, Yuri Patriota 2, José L. Soares-Sobrinho 2 , Alexandre C. C. Vieira 1,3, Sofia A. Costa Lima 1,4 and Salette Reis 1,* 1 Laboratório Associado para a Química Verde, Rede de Química e Tecnologia, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; [email protected] (A.C.C.V.); slima@ff.up.pt (S.A.C.L.) 2 Núcleo de Controle de Qualidade de Medicamentos e Correlatos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil; [email protected] (Y.P.); [email protected] (J.L.S.-S.) 3 Laboratório de Tecnologia dos Medicamentos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil 4 Cooperativa de Ensino Superior Politécnico e Universitário, Instituto Universitário de Ciências da Saúde, 4585-116 Gandra, Portugal * Correspondence: [email protected] (L.L.C.); shreis@ff.up.pt (S.R.) Received: 30 October 2020; Accepted: 4 December 2020; Published: 11 December 2020 Abstract: Leprosy disease remains an important public health issue as it is still endemic in several countries. Mycobacterium leprae, the causative agent of leprosy, presents tropism for cells of the reticuloendothelial and peripheral nervous system. Current multidrug therapy consists of clofazimine, dapsone and rifampicin. Despite significant improvements in leprosy treatment, in most programs, successful completion of the therapy is still sub-optimal. Drug resistance has emerged in some countries. This review discusses the status of leprosy disease worldwide, providing information regarding infectious agents, clinical manifestations, diagnosis, actual treatment and future perspectives and strategies on targets for an efficient targeted delivery therapy.
    [Show full text]
  • Elisabeth Catherine Mentha Hill
    The Roots of Persecution: a comparison of leprosy and madness in late medieval thought and society by Elisabeth Catherine Mentha Hill A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts in History Department of History and Classics University of Alberta © Elisabeth Catherine Mentha Hill, 2016 Abstract This thesis compares madness and leprosy in the late Middle Ages. The first two chapters explore the conceptualization of madness and leprosy, finding that both were similarly moralized and associated with sin and spiritual degeneration. The third chapter examines the leper and the mad person as social identities and finds that, although leprosy and madness, as concepts, were treated very similarly, lepers and the mad received nearly opposite social treatment. Lepers were collectively excluded and institutionalized, while the mad were assessed and treated individually, and remained within their family and community networks. The exclusionary and marginalizing treatment of lepers culminated, in 1321, in two outbreaks of persecutory violence in France and Aragon, and in lesser but more frequent expulsions through the fourteenth and fifteenth centuries. The mad were not subject to comparable, collective violence. In light of the similar moral and spiritual content of leprosy and madness as concepts, this comparison indicates that a morally condemned or stigmatized condition was not sufficient to generate persecution, or to produce a persecuted social identity. It was the structure of the concept leprosy that produced a collective social identity available to the persecuting apparatus of late medieval society, while the fluid concept of madness produced the more individual identity of the mad person, which was less susceptible to the collective actions of persecution.
    [Show full text]
  • 550 Leprosy in China: a History. by Angela Ki-Che Leung. New York
    550 Book Reviews / T’oung Pao 96 (2011) 543-585 Leprosy in China: A History. By Angela Ki-che Leung. New York: Columbia Uni- versity Press, 2009. 373 pp. Index, bibliography, ill. Angela Leung’s new book adds a very important case study that historicizes the recent “modernist” works on the history of public health in China by Ruth Rogaski,1 Carol Benedict,2 and Kerrie Macpherson.3 Unlike the above three works, which all focus on “modernity” and have rightly been well-received, Leung presents a highly original, postcolonial history of leprosy in China, which was known in antiquity as li/lai, wind-induced skin ailments, or mafeng, “numb skin.” ese symptoms were subsequently combined during the Song dynasty into a single etiology of skin ailments , i.e., dafeng/lai. Leung’s pioneering account successfully provincializes the European narrative of leprosy and public health by presenting: 1) the longer historical memory of “leprosy” in China since antiquity; 2) the important public health changes that occurred during the Song dynasty (960-1280); and 3) how the skin illnesses we call leprosy were reconceptualized during the Ming and Qing dynasties. Leung then concludes her manuscript with two fi nal chapters that successfully parallel but revise the accounts in Rogaski, Benedict, and Macpherson. Leung describes Chinese political eff orts since the nineteenth century to develop not simply a “modern” and “Western” medical regime but a “hybrid,” Sino-Western public health system to deal with the disease. e book reveals overall the centrality of China in the history of the leprosy, and it shows how leprosy played out as a global threat, which provides lessons for dealing with AIDS, SARS, and bird viruses today.
    [Show full text]
  • Epidemiological Scenario of Leprosy in a Province in China: Long Delay in Diagnosis and High Rate of Deformity
    Epidemiological Scenario of Leprosy in a Province in China: Long Delay in Diagnosis and High Rate of Deformity. Ge Li Shaanxi Provincial Institute for Endemic Disease Control Qing-Ping Zhang Shaanxi Provincial Institute for Endemic Disease Control Zhao-Xing Lin Shaanxi Provincial Institute for Endemic Disease Control Ping Chen Shaanxi Provincial Institute for Endemic Disease Control Chao Li ( [email protected] ) Fourth Military Medical University https://orcid.org/0000-0002-6175-5701 Research article Keywords: Leprosy, Mycobacterium leprae, China, Epidemiology Posted Date: June 24th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-34383/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on November 25th, 2020. See the published version at https://doi.org/10.1186/s12889-020-09933-6. Page 1/11 Abstract Background: This ecological study aimed to analyze both the tendency and the characteristics of leprosy in an endemic province in the Chinese Northwest. Methods: The medical records of leprosy in the province of Shaanxi, China, 1998-2018 were collected from the leprosy management information system in China (LEPMIS). Epidemiological variables were analyzed in this study. Results: 477 new cases were diagnosed between 1998-2018 in this area. The average rate of annual detection was 0.070/100,000, and the average annual prevalence was 0.305/100,000. The mean age of new patients was 46.71 years, and the ratio of male to female was 2.46:1. There were 399 cases (83.6%) of multibacillary (MB) forms.
    [Show full text]