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Medicine in Stamps Armauer Hansen (1841-1912): discoverer of the cause of leprosy Tan S Y, MD, JD and Graham C, MD* Professor of Medicine, University of Hawaii * Research carried out during residency elective, University of Hawaii Internal Medicine Residency Program, John A Burns School of Medicine, University of Hawaii

The Egyptian papyrus dates back to 4,000 BC, additional training in histopathology, Hansen went on to and made reference to leprosy, clearly a disease describe " ... in every leprous tubercle extirpated from

of antiquity. Pejoratively called lepers, they a living individual . . . small staff-like bodies, much suffered from disfiguring skin nodules and resembling bacteria, lying within the cells; not in all, auto -amputation, the consequence of neuropathic sensory but many of them." In 1874, the Medical Society of loss. To be a leper was to be ostracised from society, Christiania published these remarkable observations, because the disease was linked to notions of uncleanliness. which established, for the first time, an infectious In public, lepers wore bells around their necks to signal aetiology for the disease. their approach and to warn others to stay clear. This was The organism was Mycobacterium leprae, and a not so much for fear of acquiring the disease; as leprosy, few years later, Albert Neisser, a pupil of Robert Koch, which tends to congregate in certain families, was attempted to assert his own claim to its discovery on thought to be an inherited condition. Another causative the basis of in vitro staining characteristics. History, theory was the excessive consumption of fish, especially however, decided in favour of Hansen (leprosy is now decomposed or diseased fish. However, uncovering called Hansen's disease), even though the ultimate proof the final truth behind leprosy was left to a Norwegian of causation was never forthcoming. What continued doctor named Armauer Hansen, who demonstrated that to stump Hansen was his failure to isolate the organism a bacterium, subsequently identified and to transmit it. He was unable as Mycobacterium leprae, was the q. H AFNLAL[A P9041#2. - to satisfy Koch's postulates, which YILFeLAlASHLLkF.F aetiological agent. oerawcR löf ' a require that any putative pathogen

°+ be first isolated and then shown HANSEN'S DISCOVERY Around to cause the same disease when the mid -1800s, the leading researcher re -introduced into another animal. in the field of leprosy was Daniel Despite many attempts, Hansen

Danielssen, a Norwegian physician i hlORGE,_: WO failed to grow Mycobacterium who headed the newly -opened leprosy leprae on artificial media or in live hospital in Bergen, a town on the west rabbits. To this day, the leprosy coast of Norway. Danielssen was known for his famous bacillus cannot be grown in vitro, surviving only in book, "On Leprosy", which he co-authored with Carl humans and in the footpads of mice and armadillos. Boeck, a fellow Norwegian dermatologist-syphilologist. The book endorsed the view that leprosy was inherited HANSEN ON TRIAL Desperate to prove his case, rather than transmitted. Hansen inoculated himself with extracts of the "yellow Armauer Hansen, yet another Norwegian, was born in granular masses." His chief, Danielssen, also attempted Bergen in 1841, and became Danielssen's protégé shortly self -inoculation several years prior. Neither of them after he graduated with honours from the University of developed the disease, because of the now -recognised Christiana (now Oslo) in 1866. After a brief stint as a low virulence of the organism. On November 3, 1879, general practitioner in Lofoten, a small Norwegian fishing Hansen went one step further, and "used a cataract knife village, he returned to his hometown of Bergen, and began which just previously had been used to cut a nodule from working at the Lungegaard Leper Hospital, eventually a patient suffering from nodular leprosy, on the eye of assuming its directorship. His first scientific publication another female patient in the hospital." It was a reckless dealt with normal and pathological lymph nodes. He attempt at human experimentation. Reasoning that the observed "yellow granular masses" within lymph nodes recipient patient would not have agreed anyway, Hansen and skin nodules of leprosy patients, and suggested that carried out the experiment without her consent. this was a specific finding for the disease. After acquiring In response to a lawsuit for pain and suffering, Singapore Med J 2008; 49 (7) : 521

Hansen offered several feeble defences. These included him and may have contributed to his views. In his book, the argument that the operation was harmless, and that he wrote of watching a poor elderly woman in a church in any pain experienced was simply a result of the patient's Vienna, throwing herself on the flagstones before the altar, anxiety. His most ardent defence for using a human prostrate and in prayer, and the incongruity of a young subject was his failed attempts to infect rabbits. The man politely tipping his hat to the altar, entirely oblivious medical community was mostly on his side, including the to her presence. Hansen also asserted that he had never Director General of the Norwegian Health Directorate, been able to confirm that children derived much benefit who justified the experimentation "by a man who had from being sent to church. already made considerable contribution to the question Hansen does not mention either of his two wives in mentioned." In the end, Hansen was found guilty for his autobiography. His first wife was the daughter of failure to obtain consent, and lost his position as resident chief Danielssen. Tragically, she died from tuberculosis physician at the Bergen Leprosy Hospital, although he shortly after their marriage. Two years later, he remarried was able to remain medical officer of health for leprosy in and had a son who would enter into the field of medicine, Norway. specialising in cardiology. Ironically, Hansen, reputed to have suffered from syphilis, died of a heart attack on PERSONAL LIFE By all accounts, Hansen was well February 12, 1912. He was 71 years old. Today, the respected by his colleagues, though less so by his patients Leprosy Museum in Bergen and the Armauer Hansen whom he kept in strict isolation. He was described as Building, a research facility located at Haukeland humble and hardworking, with a fine sense of humour. University Hospital, stand in lasting tribute to this As he neared his 70th birthday, he chronicled his memoirs Norwegian discoverer of the aetiology of leprosy. in his autobiography: "The Memories and Reflections of Dr. Gerhard Armauer Hansen." Growing up the eighth BIBLIOGRAPHY of fifteen children, he recounted a mischievous childhood Dharmendra. Notes on Leprosy. Calcutta: Navana Printing Works, 1960. that was moderated by his strict father, Claus Hansen, Getz B. Leprosy research in Norway, 1850-1900. Med Hist a merchant who often worked multiple jobs and was 1958; 2:65-7. eventually forced into bankruptcy. Due to the family's Gerhard Armauer Hansen. Available at: en.wikipedia.org/wiki/ Gerhard_Armauer_Hansen.Accessed May 19, 2008. financial difficulties, Hansen worked to put himself Gussow Z. Leprosy, Racism, and Public Health - Social Policy through school, first as a personal tutor and later as a in Chronic Disease Control. Boulder: Westview Press, 1989. teacher at a girl's school. Of his teaching experience, Hansen GA. Watt FB (foreword). The Memories and Reflections of Dr. G. Armauer Hansen. Berlin: German Leprosy he wrote: "Each of us has some peculiarity which is Relief Association, 1976. his Achilles heel and invitation for teasing. Mine, in Jay V. The legacy of Armauer Hansen. Arch Path Lab Med particular, was my use of the expression, 'Now then'-as 1999; 124:496-7. Porter R. The Greatest Benefit of Mankind: A Medical History preface to some point I wished to make. My mischievous of Humanity. New York: WW Norton & Co, 1999. students could always anticipate when it was coming and Talbott JH. A Biographical History of Medicine: Excerpts and before I could speak, I was greeted with a girlish chorus Essays on the Men and Their Work. New York: Grune and of 'Now then'." Stratton, 1970. Vogelsang TM. A serious sentence passed against the Hansen was apparently contemptuous of religion. discoverer of the leprosy bacillus (Gerhard Armauer Hansen) The writings of Charles Darwin had a profound effect on in 1880. Med Hist 1963; 7:182-6.