I.,' rt:HNA nON AL J 01 ' H :-.' AL 0,- LH'HOS) Volume 43 . Numoer 2 Prilltet! ill till' U. S .A. An Overview of Research on the History of Leprosy Part 1. From Celsus to Simpson, Circa. 1 A.D. 1,2 Part 2. From Virchow to M011er-Christensen, 1845-1973 3 J Philip A. Kalisch
The hi story of leprosy, important as it un lo us a nd now controversial literature accu doubtedly is, receives sca nt attention from mulated during an unbroke n continuity of leprologists today. Occasiona ll y, a signifi more than a th ousa nd years, perhaps even cant article may appear in Danish, German, several millenniums. With this disputed a r French, and in isolated in stances British a nd cheological a nd semanti c problem we are American periodicals, but on the whole the not conce rned. Needless to say a recent im production is but a trickle and largely re plicatio n tha t lep rosy ex isted in ancient mains unnoticed. This void is unfortunate Egypt has not gone unchallenged (11 2). Be because the study of leprosy history makes that as it may, the Roman writer Celsus ( 37 ), it possible for today's leprologist to immerse who was born in 25 B. C., a nd the R oma n himself in the lives and times of the great politician, Plinius Secundus, born in 23 A. D. leprosy investigators of the past, their ac (191), both had many antecedent writings to complishments and id eas, and their influ aid them in their fairly distinct descriptions ence on their own and subsequent periods. of leprosy as .did the later Greek physicians. In this way the leprologist can identify him Galenus ( 83 ), Aretaeus (1 0), a nd Soranus, of self with the mature minds of yesteryear and Ephesus ( 223 ). consider himself a link in the great chain of The advance of know ledge co nce rning tradition that shapes his work. leprosy was abruptly halted by the collapse Moreover, because the history of leprosy of the Roman world after 300 A.D., and by has critical medical, social, cultural, psycho three centuries later there was almost no logical and educational functions; because medical knowledge available concerning the leprologists are all prisoners of the past, in disease in the Western world. Although the sense that their options are limited by copies of the preceding works and other what has gone before and their preferences treatises were probably extant, by 600 A.D. are shaped by their image of who they are practically no layman could read those and what leprosy has meant to mankind, it books. Thus, the embryo of leprology was is of the utmost importance that they try to dead in western Europe, a casualty of the free the history of leprosy from the myth and semi barbaric hordes who had no tradition of error that surrounds it. The following bibli learning. ographical survey of works on the history of The knowledge of leprosy had never sunk leprosy seeks to stimulate additional re so low in the East during these centuries as search in the field by identifying some of the it had in western Europe. Constantinople significant works upon which the contempo survived successive attacks by the Arabs rary leprologist may build. and preserved its libraries, and the Greeks who peopled it had a high regard for learn PART 1 ing, which was resumed when conditions At the time of Christ, what was known as permitted. During this time such physicians leprosy or elephantiasis had elicited a nebu- as Aurelianus (15), Aetius, of Amida (3), Paulus Ageineta (1 86), and Oribasius of Per gamun (1 81) substantiated the existence of I Received for publicati on 23 May 1973. 1 Part 2 of this pa per was presented a t the Tenth In the disease and traced it to prehistoric times. ternatio nal Leprosy Cong ress, Bergen, No rway, 17 Oribasi us very much praised the eating of August 1973 . vipers, for he writes that this gave a wonder ) P. A. Ka li sch, M.A., Ph. D., Associate Professor and Research Scientist, History of Nursing Research Proj ful help and relief to "lepers." The Arabs, ect, University of Michiga n Medical Center, 428 Victor though they lacked the tradition of scholar Vaughan Building, Ann Arbo r, Mi chi gan 48104. ship, were an able people whose ancestors
129 130 International lournal of Leprosy 1975
had lived on the edge of all the great civiliza ben [become] grete, the vertue of smellynge tions of antiquity, and they respected erudi faylyth, and the brethe stynkyth ryght tion. Once firmly in control of a vast empire, fowle," and when the disease is advanced the Moslems supported learning, and the they are "unclean, spotyed, glemy, and quy great caliphs, including Haroun-al-Raschid, thery [watery], and the nosethrilles ben had camel caravans laden with Greek and stopye, the wasen of the voys is rough and Latin books brought to Baghdad, where they the voys is horse, and the heere falls." Some engaged Nestorians, Jews, and Persians to 200 years later in the late 1400's Valesco de translate these works containing knowledge Taranta, a physician of Montpellier, strongly of leprosy into Arabic as documented by the recommended castration as the cure for lep laborious efforts of Janus Damascenus (48), rosy si nce the disease was caused by too Issac Israeli (11 3), the great Rhazes (196), Ali great a dryness and by the removal of the Abbas ( 6), Avicenna (1 8), Abulcasis ( 2), testicles the body would be moistened ( 240 ). Avenzoar (1 6), and Averroes (1 7). This Many of his contemporaries held views that knowledge was available to the new schools were just as far fetched. They included Bar which arose at Baghdad, at Cairo, and fi tolomeo Montagnana of Padua (1 71), Pietro nally at Cordova in Spain. Collectively, the d' Argellata of Bologna (I I), Ferrari de Gradi Arabs not only helped to preserve the an of Pavia ( 75 ), and Hans von Gersdorff of cient knowledge of leprosy but may have Strassbourg ( 84). made important additions to it. By and large, An early 20th century historian of leprosy, however, the Arabic writers seem to have Hans Carlowitz (36) completed a disserta never entirely abandoned the notion that tion under the direction of Karl Sudhoff they were but humble disciples following in which compared most of the important 13th the footsteps of great masters, whom they and 14th century commentators on leprosy were bound to revere, imitate, and quote, including Teodorico Borgognoni (230), Gil but never overthrow. Thus, they excelled in bert, the Englishman ( 86 ), Guglielmo da Sa the synthesis of prior accumulated knowl liceto (95), Arnaldus de Villanova (12), Lan edge rather than in original findings. franco, of Milan (134), Bernard de Gordon Meanwhile, Christian Europe slowly ( 23 ), Vitalis de Furno (245), John of Gaddes struggled to lift itself out of barbarism and den (125), Henry de Mondeville (170), and superstition aided by Jewish physicians who Guy de Chavliac (97). Carlowitz found that circulated Greco-Arabic knowledge through the authors differed from each other only out the Christendom and by translations of slightly and that all except those who lived Greek and Arabic medical treatises into before Bernard (ca. 1285-1308) made use of Latin. About \060, Constantinus Africanus Bernard's U/ium medicinae. He noted that (45) brought a cargo of Islamic medical lore Henry of Mondeville and John of Gaddes to Salerno and with the aid of his transla den were particularly alike as they frequent tions of Greek and Arabic works in medicine ly used the same phraseology, for example. spurred the resurrection of such knowledge Carlowitz concluded that all these physi in Italy. His description of leprosy under the cians relied less upon their own observations title "De morborum cogni.tone and cura than upon the work of such famous Arabian tione" with its theory of four species of lep physicians as Rhazes, Ali Abbas, Avicenna, rosy was heavily borrowed from an Arabic and their 11th century commentator, Con work by A vicenna ( 18) who in turn had bor stantinus Africanus. The most original of the rowed it with a little alteration from the accounts appeared to be those by Gilbert Greeks themselves. Platearius, a 12th cen and Bernard de Gordon. tury s uccesso r to Constantinus, diligently Throndike, Sarton, and Singer have all followed up this theory in his compendium remarked on the fact that no notable con entitled Practica 10. Serapionis (190). tributions were made to medical literature, The author of the most popular encyclo including that pertaining to leprosy ( 5), for pedia of medieval medicine, in the 13th cen more than a century after the Black Death. tury, the Franciscan Bartholomaeus Angli The effects of the cataclysmic plague pan cus (21) testified that persons afflicted with demic that killed an estimated 43 million leprosy have "redde whelks and pymples in people in the Christian world during the mid the face , out of whom oftenne runne blood 1300's, are impossible to assess. It is impor and matter; en such the noses swellen, and tant to note, however, that an added obstacle 43 , 2 P. A. Kalisch: Research on the History 0/ Lepros.\' 13 1 during that time was implicit in the lack of tran sla ted int o Engli sh in 1630. Philippus the printing press to foster the distributio n Schopff of Augsburg published a nother spe of the knowledge tha t did exist. Books were cialized effort in 1582 (21~ ) followed four written by ha nd and copies were expensive. yea rs la ter by a 28-page doctoral study by Time a nd time again an advance had been Andreas Scholl ( W ) entitled, Theses de ra made in medica l knowledge o nl y to be lost, t ione expforandi, et judicandi feprosos . .. , or to be known only to a few who did not which was written under the direction of Jo pass o n the informa tion. The chief books on hann Vischer. At the end of the 16th century ancient leprosy and medicine were nearl y Guillaume Des Innoce ns very effectivel y all written in classical Greek, those o f the synthesized what little was known about the Arab and J ewish physicians in Arabic and disease oy drawing from the works o f the He brew, a nd no ne of these la nguages was Greeks, Romans, Arabs, as well as Renais widely kn ow n in western Europe. Such sa nce writers. This 13 2-page compilation transla ti o ns as existed were very imperfect. probabl y contains the first substantial his Then in the late 1400's a knowledge revolu tory of leprosy ( 54 ). tion was facilitated when movable ty pe was Little a dva nce in the writing of leprosy d evised and by 1500 Ital y a lo ne had 73 history occurred during the 17th century. As presses employing mova ble type. By about historical source materia l, Wilhelm Fabricus the middle o f the 16th century a n educated Von Hilden's observations on leprosy, con medica l profession in western Europe had tained in his Opera observationum et cura access to nearl y all the accumulated medical tionum medico-chirurgicarum quae extant and scientific literature that was then avail omnia, published in 1646, are of little value able and was again in full command of an (63). The Danish phys icia n, Thomas Bartho cient medicine a nd leprosy as it had been lin (20) gathered a more substantial body of passed down. But it had take n a full 1,000 knowledge in 1671. Other worthwhile works, years o f fumbling effort to recover the lep almost a ll of which contain the traditional rosy knowledge that it had so unwittingly interpretations of the leprosy's antecedents abandoned in the 6th century. Thus, at the include those by Luia (146), Sieboldt ( 217), onset of the Renaissance (ca. 1500), leprosy Helvetius ( 103 ), and De Spina ( 53 ). was soon attacked by an outpouring of new Moving into the 18th century, Helyot of books that touched on the subject. The phy France wrote a s plendid account of the sician, physicist, and poet Girolamo Fracas Knights of St. Lazarus, who always had a toro's (19) work on syphilis helped to differ "leper" for their Grand Master (102). Help entia te between that disease a nd leprosy. ful as constituting indicators of the then pop Other general treatises of the period that ular thinking on leprosy treatment are the touched on leprosy were authored by Philip accounts of Ovseel (1 83 ), Voight (247), Brooke pus von Hohenheim, known as Paracelsus ( 29 ), With of ( 255 ), Peyssonel (1 89 ), Udman ( 184), Girolamo Cardano ( 35 ), Julien Le Paul ( 238 ), Murray (1 76 ), Schilling ( 210), Maxy mier de Grentemesnil (14 2), Henrik Smith movycz ( 15 5), Gislesen ( 87 ), and Scherb ( 209 ). and Ha ns Christensen Bartsker ( 222 ) (42). Indeed the slight advance in knowledge con Concomitantly, the first se parate books, cerning the malady was revealed in an offi either solely devoted to leprosy or heavily cial report to the Royal Society of Medicine oriented toward that disease, appeared. In of Paris in 1782 when two investigators cited 1540 the French physician Pierre Bocellin Gilbert's 13th century description as the wrote a 47-page treatise concerning the con most clear exposition of leprosy that they tagiousness and infectious ness of leprosy had uncovered ( 38 ). ( 25 ). This was soon followed by a tract enti The initial attempt at a singularly histor tled "Examen leprosarum" in Conrad us ical study of leprosy was made by Raymond Gesner's collection, De Chirurgia Scriptores of France in 1767 (194) . His uncritical use of .. . , published in 1555 ( 85 ). One of the best sources and shallowness of much of his re works of the great French military surgeon search, however, reduced the value of an Ambroise Pare entitled Traicte de fa Peste otherwise valuable work. John Howard's ... avec une Bre/ve Description de fa Lepre, less ambitious account of the principal laza a bly dealt with leprosy (1 85 ). It was printed rettos of Europe is also superficial. This ef in Paris in 1568 and an altered edition was fort was followed in 1790 by the first success- 132 International Journal of Leprosy 1975 ful a ttempt to reco rd the hisro ry of leprosy. stretched back mo re tha n 1,800 years to the It was pub li shed by Philipp Gabri el Hensler, time of Celsus. First Phys icia n to the King of Denmark, a nd Wha t then sha ll we say of the yea rs I A.D. Professor of Physics, Uni versit y of Ki el ( 105). to 1845? For knowledge rega rdi ng leprosy, Unli ke hi s predecessbrs, Hensler inte nse ly they we re pe riod s o f s low evo luti o n, fo l studied o ri gina l so urces from the G reeks lowed by near dissolutio n, a nd subsequent down to his own time. evolutio n. T he 17th century ha d supplied a In his fi rs t cha pter H e ns le r investigates scientific m e th od fo r le pro logica l histo ry, the traces of leprosy fo und in t he works of the 18th ce ntury had provid ed a n accumula a ncient phys icia ns a nd then s u bseq ue n t ly ti o n of facts with whi ch to begin work , a nd describes le p rosy in the W es t during the the firs t ha lf of the 19th century saw the frui middle ages. He insists tha t leprosy was not ti o n of cl assical hi sto ri cal sc ho la rs hip a nd bro ught into the West by the C rusades but the initia ti o n of the sc ientific a pproach. ra ther nad re ma ined there from the times of the Ro ma ns. He does not d e ny, h owever, PART 2 tha t leprosy raged with greater violence fo l T he hi sto ri cal ma teria l inserted a t the be lowing the ho ly wa rs a nd ci tes M a tthew ginning of ma ny present-day scientific lep Pa ri s' now questi o na bl e estima te of 19,000 rosy mo nogra phs a nd a rticles, offers a n ex " leper ho uses" in the whole of Euro pe. In cell ent illustra tio n of w ha t has bee n fo r expla ining the decline of leprosy in the West, ma ny centuries the prima ry fo rm a nd a lm ost Hensler notes that the sympto ms of true lep exclusive source for the histo ry of leprosy. rosy gradua ll y vani shed as other cuta neous T hat traditio na l genre a ppeared in the ac a ffecti o ns became mo re commo n towa rd the counts of Da nie lssen (4~), Wilson ( 25 4), Ne is end of the 15th ce ntury. He further suggests ser (1 77 ), Ka posi (1 01), Le lo ir (14(1), J ea n tha t a t length the lepro us constitutio n passed selme (11 5), Kling mulle r ( 13 1), R oge rs a nd into the syphilitic. Appended to the wo rk a re Muir ( 20 1), a nd Co~ hr a n e ( 44) in the last ha lf extracts fro m a ncient a nd medieval writers of the 19th century a nd first six decades of a lo ng with severa l 18th century accounts of the 20th century. It had previo usly enj oyed leprosy in va ri o us pa rts of the wo rld. Hens a continuo us histo ry fro m the Rena issance ler's wo rk was re printe d in 1794 a nd has o n up into the 18th century, when the sco pe served as a point of depa rture for schola rly was much ex panded by the burgeoning col effo rts in leprosy histo ry for nearl y two cen lecti on of facts concerning t he di sease in dif turies (105). ferent pa rts of the wo rld . As previo usly in At the beginning of the 19th century the dicated, fro m the last 50 yea rs of the 18th sta ndard clinical work o n leprosy was tha t century come the earli est hi sto ri cal studies of Alibert ( 5). A round the sa me time A lefeld tha t a re sometimes still used as such, a mo ng (4 ), Ottner ( 182 ), Vieira (241) , Brown (31 ), them the se mina l treati ses by Raymo nd ( 194 ) Be rgerno n ( 22 ), a nd Bre hm ( 27 ) prefaced a nd Hensler (105). their mo re specia li zed derma tologic studies From a pre limina ry literature exa mina with a few histo ri cal references pertaining tio n, we can conclude that the oldest a nd the to leprosy in a ncient times. Brief histo rica l traditio nal fo rm o f leprosy histo ry was nar accounts by Lejeune co nce rn i ng the early ra tio n buttressed by occasio na l measure histo ry of the leproserie in C h a rtres (139 ), ments. Fro m the European inceptio n of spe Lehma ier o n the Biblica l references to lep cia li zed leprosy hi story in the late 18th a nd rosy ( m ), a nd S hafter o n the leprosy of the earl y 19th centuries, however, bo th Philipp middle ages ma rked the ascenda ncy of the Hensler in Germa ny a nd J a mes Y. Simpson cl assical study of leprosy histo ry to a new in Engla nd sought to develo p it without re high ( 216). It o nl y re m a ine d fo r James Y. li a nce on the yet to come scientific a pproach Simpson ( 218) to publish his la ndma rk " An to derma to logy. Mo reover, they seemed to tiqua ri a n Notices of Leprosy a nd Leper H os hold that the centra l pro ble m s of le prosy pita ls in Scotla nd a nd Engla nd" a nd its suc histo ry, a lth o ug h they might be st a t ed in cessor a rticles o n the "Nosological Nature terms of a particula r hi sto rica l phase, were of the Disease" a nd the "Etio logi cal His in essence independent of socia l, econo mic, to ry," to ma rk the culmina ti on of the classi a nd political hi sto ry. With few exceptio ns, cal approach to leprosy a nd its history which this general view permeated the writing of 43. 2 P. A . Kalisch: Research on the Historr 0/ Leprosy 133 leprosy hi story in the world until the mid- ' a nd Ehl ers ( 59). But the major obj ecti ve of 1900's. While numerous facts a nd statistical these two traditions was to clarify and deep data were collected they were se ldom a na en the understa nding of contemporary lep lyzed or used to test sociological proposi rology by trac in g its evoluti o n. Thus, 75 tions, and exha usti ve monographic evalua years ago most of those who wrote the his tions of the long-term social impact of tory of leprosy were practici ng leprologists, leprosy were practically unknown. sometimes eminent ones like Hanse n (98). Germa n-trained Ie p ro 10 gis t-h is toria ns, Us ually leprosy history was for them a by who in their rebellion against English clas product of clinical practice or applied re sicism called the mse lv es "scientists," rein search . . Moreover, they saw in it, besides forced this empirica l, positivistic tre nd. intrinsic value, a means to substantiate con Works such as those of Virchow (24 3), Ehlers cepts of their current investigations by citing ( 5~ . W), and Hirsch (109) were large, useful historical a nt ecedents. studies, full of factual detai l a nd statistics, Since the turn of the century, within the but generally devoid of theo retical interpre field that might be loose ly regarded as lep tations. As a scientist writing history, Vir rosy history, there appears to be five major chow insisted that hypothesis had only a su bdisciplines: I) medical leprologica l his transitory value, that is, to eli cit new facts. tory; 2) the experi ence of leprosy in various Hypotheses could not rest without adequate political units; 3) medieval leprosy history; proof or without verification. He condemned 4) "Biblical leprosy"; and 5) individual lep speculative thinking and emphasized the sa rosaria history. We will briefly consider cred ness of facts. some of the most productive efforts within Mean w h i Ie , the epidemiological-oriented each. studies of leprologists such as Bidenkap (24), The medical hi story of leprosy, systemat Rogenhagen (200) and Dehio ( 50. 51), and the ically begun by Hensler, has tended to be reports of the Royal College of Phys icians scientific rather than therapeutic in its major and the India Leprosy Commission (144), emphases. Armauer Hansen and Albert along with numerous papers presented at Neisse r have been studied in detail ( 78. 90), the Berlin Leprosy Congress (161), mar while the work of such other important lep shalled statistics to prove the contagious na rologists as Arning in Hawaii, and Rake in ture of leprosy. Like so many movements, Trinidad have received scant attention. His that of the epidemiologists against deduc torical output since World War II has cen tive, neoclassic leprosy history went to ex tered around the se minal paleopathological tremes and in some instances resulted in studies of Vii helm M~ller-Chri s tensen antitheoretical attitudes that prevented de ( 162. 169). Hi s work has facilitated a most • velopment of new hypotheses. In the minds productive marriage between science and of many of these empiricists, including Jean history and has in spired an unexcelled selme ( 11 5.124 ), Zambaco (256·260 ), and Ash school of historical research on leprosy his mead (13. 14) , there was an assumption that tory as evidenced by the monumental work factually based theory would emerge from of Anderse n ( 8), and the more limited study the data when it became sufficiently com by Brothwell (30). Other illuminating efforts plete, but, except for limited propositions, in this area include those by Dokrr (55), it never did. Several epidemiologist-oriented Bourges (26), Fite and Mansfield (77), Goerke historians of leprosy did, however, brilliantly (88), and Schmitt (212). fulfill their role as fact gatherers. Scores of While the national, provincial, and munic articles and a still greater number of reports ipal history of leprosy had isolated early from various leprosaria form by far the precedents, such as those of Minkh (1 60) and largest part of the scientifically collected and Buhler ( JJ), the development of scholarly prepared quantitative record of world lep investigation of governmental reaction to rosy history. the disease is notable in the late 19th century Both the scientific historiographic tradi work of Sederholm (215) in Sweden, and tion of Virchow and the subsequent epidemi Mouritz (174) in the Hawaiian Islands. Other ological-oriented tradition that followed, studies devoted to the history of leprosy in produced occasional monumental studies various political units are those by Araujo such as the prize essays by Newman (1 80 ) (9), Montoya y Florez ( 172 ), Ketting (1 29), 134 International Journal of Leprosy 1975
Haug ('00 ), Denney ( 52 ), McCoy (1 56), Faget depicted in art through the ages has been a ( 64 ), Abee (I), Spenesberger ( 224 ), Enna ( 61), compelling topic with Virchow initiating this San Martin Bacaicoa (2 06 ), Klovekorn ( 132 ), inquiry in 1862 (242), followed by Meige (1 57 ), Chirakadze ( 41 ), Tolivar ( 2.1 1. m ), Vogelsand Richer (1 99 ), Sassy ( 207), Hollander (liN ), ( 245.246 ), Trevien (234), Richards (1 97), and Van And~l (7 ), Gr~n ( 'I,)), Tricot-Royer ( 23 7), Kalisch (1 26 ). Some of the most detailed na Martin (1 52 ), Frohn ( 80 ), and Vogt ( 247). tionalistic work has been done on Cuba by Among the handful of attempts to write a Gonzalez Prendes (91), and on France by popular world history of leprosy are the less Fay ( 65.7 1 ). Similar political unit studies in than successful accounts of Weymouth ( 25 1), clude Maurano on Sao Paulo, Brazil ( 15.1. IS.) ) , Mouritz (1 73 ), and Feeny ( 72 ). Other broad Frohn on the German Rheinland ( XO·X2 ), Cou accounts that deal heavily with European goul on Fra nce, Gonzalez Urena on Mexico, leprosy history and elicit special notice are and Wellman on the Kingdom of Hawaii. those by Barbez ieux ( 19 ), Zubriczky ( 26 1), Leprosy in medieval Europe has fasci Leo (1 42), a nd Burnet ( 34). Most recently, nated numerous investigators among whom dissertations by Schlotter (211) , and M a let the work of Virchow ( 242. 24.1 ), Wickersheim (1 51) , offer a rather general treatment but er ( 252.253 ), MacArthur ( 14X. 150 ), Chaussin suffer from an inadequate bibliographical and ( .19. 4U ), and Brody ( 2M) is outstanding. base. Other useful work has been completed by In all the previously discussed efforts, Lecouvet (135), Lutolf ('47), Sa letes (205), medical or institutional, religious or social, Herey (104), Neret ( m. 179 ), Mercier ( 158 ), Le the reader cannot help but be impressed by Grand ( 1.16. 1.1 7), Lallemand ( 133 ), Duliscouet the lack of manifest ideology. Traditional ( 58 ), Remy (1 95), Pooth (1 92 ), Pawletz (1 87 ). leprosy rationale appears to be based on an Although largely devoted to the 16th cen empirically based objectivity, which in prac tury, Keussen's history of leprosy inspections tice means accepting existing folkways, in Cologne from 1491-1664 is a very careful mores, and institutions as the framework for compilation of notes and documents. analysis. Almost t9tally lacking is historical The controversy over the so-called leprosy research that openly argues for a new lep mentioned in the Bible has produced an rosy ideology or shows a missionary bias enormous amount of interest beginning with in favor of radical change in existing con Essinger's 1843 study (62), continuing with ve ntions. those of Horsford (110) , Finaly (16), Munch To say a word about methodology, at one ( 175), Schamberg ( 208 ), Sack ( 204) , Fels (14), extreme the antiquarian approach, which Unna ( 239 ), Dubreuilh and Bargues ( 57), Hill simply necessitates the collecti ng of bits and (10 7), Jastrow (114), Vorner ( 249), Trenel pieces of data, more or less without regard ( 233), Drogendij k ( 56 ), Lie (145), Gramberg to their importance or interrelationships, is (93), Landrum ('4' ), Cochran ( 43 . 44), Gold much in evidence. At the other extreme, the man ( 89) and concluding with Browne's ( 32 ). highly schematized or focused analytical Leprologists' and medical historians' in model, which is all articulation and interre terests in recording the history of individual lationships, is seldom employed. As a result, leprosaria are evidenced by the abundant most leprosy hi stories are essentially de accounts of such institutions from all quar scriptive in nature and fall toward the lower ters of the globe. Emphasizing the unique end of this continuum. Although the history social conditions that created and sustained of leprosy is first and foremost a story, there these unique institutions, are studies such are all kinds of stories: dull or exciting, scru as those by the eminent medical hi storian, pulously careful or wildly imaginative, pain Karl Sudhoff who ably dealt with various fully naive or subtly interpretive. Whereas European leprosaria from the 13th to the much of this quality depends on the artistic 19th centuries. Similar approaches were em ability of the leprosy historian, needless to ployed by Pazzini (1 88 ), Harmand (99), Puech say, the affective possibilities of the subject (193), Hildenfinger (106) , Kalisch (1 28 ), and of leprosy are limitless. Russell ( 203). The interesting organizational The proper course for future work appears story of The Mission to Lepers 1874-19 17, to lie not in moving back toward descriptive has been compiled by Miller ( 159) . narration, but rather in broadening the Several other topical strands in the history scope and variety of leprosy history to en of leprosy are worthy of note. Leprosy as compass the findings of social research. So- 43,2 P. A. Kalisch: Research on lhe Hislor)' oj'Lepros.\' 135
ciological and anthropological theo ry may tendfan a confundir la lepra con otras enfermeda ex plain, for example, why a nd how irration des de la pie I. colocaron los fundamentos emo al motives based on lepropho bia led to total cionales para trabajos posteriores en 10 que res institutional responses, but only by interfer pecta a supersticid n y conocimientos. Sus esfuer ence may explain why one leprosarium suc lOS fueron copiados fie lmente durante cientos de ceeded and its neighbor failed under approx a li os y proporcionaron por 10 menos una acumu imately the same circumstances. Indeed, lacidn de hechos y una documentacidn sobre el estado del a rte. EI desarrollo de la medicina cien why did the various leprosaria in the British tlfica a mediados del siglo diecinueve los siguien Empire of the 19th century yield such mixed tes 125 a nes han tra ldo un incremento de espe medical and social results? Yet the hi storia n cia li zacidn en la investigacidn de la historia de should be interested as much in the social la lepra, que puede SCI' dividida ventajosamente incentives as in the actual result s. To bring en aspectos medicos, politicos, B(blicos, institu order into this analysis of the total si tua tion cionales y medioevales. Se consideran a lgunos de it is necessa ry for him to use theoretical los esfuerzos mas productivos dcntro de cada una models and knowledge from the behavioral de estas a reas. EI desaflo del fu turo esta en dc sciences. The value of such an approach has san-oll ar modelos de a na li sis y evalu acidn basa dos en los ha lla zgos de investigaciones socioldgi been borne out by the studies of Skinsnes cas, mas bien que dependicndo totalmcnte de la ( 219-22/ ), and those of Gussow and Tracy (96). narracidn pura. Este es el medio por el cual se Out of imaginative but scholarly mono puede liberar la historia de la lepra de muchas de graphic research on these and other topics, las fabulas y errores que la rodean. on an international level it will begin to be possible to build a convincing sy nthesis of leprosy hi story, a synthesis independent of Cet a percu tente d'evaluer, d'une mani~re ge purely emotional responses. nerale, tout ce qui a ete ecrit sur l'histoirc de la f~pr e pendant 2. 000 ans. Ma lgre qu'ils aient eu SUMMARY une tendance a confo ndre la lepre avec d'autrcs maladies de la peau, les a nciens auteurs o nt pose This overview attempts to evaluate, in les fondations emotives pour tout ce qui a sui vi, general, the results of nearly 2,000 years of empreint de superstition et de frayeur. Leurs ef writings on the history of leprosy. The an forts o nt ete finalement pendant de siecles, pro cients, although prone to confuse other skin duisant en fin de compte une accumulati on de diseases with leprosy, laid the emotional faits et une large documentation conce rnant ce foundation for later work in superstition and probl~me . A l'aube de la medecine scientifique, lore. Their efforts were faithfully copied for vers la moitie du dix-neuvieme sj~cl e, et dans les 125 annees qui o nt suivis, o n a assiste une spe hundreds of years and provided at least an a cialisation accrue de la reche rc he concernant accumulation of facts and a documentation I'histoire dc la lepre. Ces recherches peuvent etre of the state of the art. The da wn of scientific utilement di visees en medicales, politiques, bi medicine in the mid-nineteenth century and bliques, institutio nnell es et medievales, d'apres the following 125 years has brought an in les differents aspects tra it es. Quelques-uns des creasing specialization of research in the his efforts les plus va la bles, da ns chacun de ces do tory of leprosy that might be usefully divided maines, sont passes en revue. Le defi qui se pose into medical, political, Biblical, institution aux a uteurs futurs est de develo pper des modeles al, and medieval aspects. Some of the most d'analyse et d'evaluation qui seront bases sur les productive efforts within each of these areas resultats d'une recherche socia Ie scientifique, et non pas uniquement sur l'anecdote o u la descrip are considered. The challenge of the future ti o n. Ceci est Ie se ul moyen de liberer l'histoire is to develop models of analysis and evalua de la I~pre de to us les mythes et les erreurs qui tion based on the findings of social scientific I'encombrent. research rather than relying totally on pure narration. This is the way in which to free the history of leprosy from much of the myth NOTES AND BIBLIOGRAPHY and error that surrounds it. I. 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