HISTORY OF LEPROSY

Dr.Swathy Lekshmi J L

ORIGIN

• Disease of great antiquity

• Exact origin controversy

• “High up the Nile midst Egypt’s central plain, Springs the dread Leprosy and there alone.” Lucretius( 91-55 BC) De natura Rerum

LEPROSY IN LITERATURE

• INDIA • Sushrutha samhitha – 600 BC

• Vat- Rakta or Vat-Shonitha

• Kushtha- Kshudra ( minor) Kushtha

Maha (major) Kushta

• Tuvarka – Chaulmoogra oil ( Hydnocarpus Wightiana)

• Manu Smriti and Atharva Veda

EGYPT

• Ebers Papyrus (1555 BC) – Uchedu

• Ebbel – Ghon’s swelling

• Yeoli - Clay jar with leonine facies – 1400 – 1300 BC

CHINA

• Pai Niu _ 600 BC

• Nei Ching – 220 BC

• Ko Hung – “Prescriptions for Emergencies” 300 AD lai ping • Chao’s Pathology - 610 AD

• Sun Szu-moh - “Thousand Golden Remedies” Tai Feng

• Chaulmoogra oil – Ta Fung Tzu – 1400 AD

BIBLE

• Hebrew-Tsaraath/Zaraath

scaly disease

spot- white as snow

• Old testament- Tsaraath

• New Testament- Lepra from Greek

• Arabic- Jusam

• First recognizable description of leprosy-Areteaus of Cappadocia

• Middle of 2nd century

• elephantiasis

LEPROSY IN MEDIEVAL PERIOD

• Peak – AD 1000-1400

• Clergy - class of lay physicians

• Leprosy- conceived as a punishment for sin

• 3 options-seclusion at home

entry into leprosarium

life of wandering, begging

• Legally dead

• Leprosaria by noble families

• Queen Metilda - wife of Henry 1 of England

OSTEO ARCHEOLOGICAL STUDIES BY MOLLER CHRISTENSEN

• Naestved St. Jorgen’s Hospital, Denmark- AD 1250-1550

• 1948

• Facies leprosa - atrophy of anterior nasal spine

atrophy of maxillary alveolar process

ST.JORGEN HOSPITAL

DECLINE OF LEPROSY IN WESTERN EUROPE

• 13th-17th century

• Last indigenous case -1798

John Berns , Shetland islander

• Changes in climate

• Plague epidemic

• Preventive measures, improvement in diet and

living conditions

• Scandinavia-organism exist outside human or

animal host

SPREAD OF LEPROSY TO AMERICA

• Command of Columbus

• Immigrants from Europe

• African slave trade

• Louisiana by Acadians in1755

NATIONAL LEPROSARIUM AT CARVILLE

• 1919-Florida

• 1920 July-Carville-site of Louisiana leper home since 1894

• 1921 – US Public health Service

FATHER DAMIEN OF LOUISIANA

• Father Charles Boglioli- Vincentian priest

• Born in Itlay ,1814

• 1866-Charity hospital Louisiana

• 1882

SPEAD TO SOUTH AMERICA

• Brazil-1696

• Portuguese and Africans

• Argentina- infected slaves from Brazil

SPREAD TO AFRICA

• Egypt – 200-300 BC

• Persian invasion in 6th century BC

• Alexander The Great in 4th century BC

FATHER JOSEPH DAMIEN DE VEUESTER• 1840-1889

• Belgian priest

• 1864-Hawaii

• 1865-King Kamehameha V

Honolulu for mild

Molokai for incurable

• First patient in 1865

• 1873- Kalacuao

Kalaupapa ,1890

• 1885

• 1980-National Historic Park

• Brother Joseph Dutton assisted in

1886

• Father Pierre d’ Orgeval

CLASSIFICATION1848-Danielssen & Boeck

nodular anaesthetic

1895-Hansen & Looft tuberosa(nodular) maculoanaesthetic1903-Neisser lepra tuberosa lepra cutanea lepra nervorum

• 1905-Jadassohn

• Darier -1st described term “tuberculoid” in

relation to leprosy

THE MANILA CLASSIFICATION

• 1931-Leonard Wood Memorial • cutaneous• neural• mixed

CAIRO CLASSIFICATION

• 1938-International Leprosy Congress

• lepromatous

• neural-neromacular simple

neuromacular tuberculoid

neuroanaesthetic

PAN AMERICAN CLASSIFICATION

• 1946-2nd Pan American Leprosy Congress, Rio de

Janeiro

• Histology

lepromatous

tuberculoid

uncharacteristic

HAVANA CLASSIFICATION

• 1948-International Leprosy Congress

• lepromatous

• tuberculoid

• indeterminate

WHO EXPERT COMMITTEE

• 1952

• lepromatous

• tuberculoid

• borderline

• indeterminate

MADRID CLASSIFICATION• 1953-International Leprosy Congress• Lepromatous type(L) macular diffuse infiltrated nodular neuritic• Tuberculoid type(T) macular minor tuberculoid major tuberculoid neuritic ,pure• Indeterminate Group(I) macular neuritic, pure• Borderline Group(B) infiltrated,(?others)

INDIAN CLASSIFICATION

• ORIGINAL INDIAN CLASSIFICATION

• Lepromatous

• Tuberculoid

• Maculoanaesthetic

• Borderline

• Polyneuritc

• indeterminate

REVISED INDIAN CLASSIFICATION

• 1981-IAL,Agra

• Removed maculoanaesthetic

JOB &CHACKO CLASSIFICATION

• Lepromatous leprosy

• Tuberculoid leprosy

• Borderline tuberculoid leprosy

• Borderline lepromatous leprosy

• Indeterminate leprosy

• Polyneuritic leprosy

RIDLEY-JOPLING CLASSIFICATION

• Clinico-bacteriological

• Immonological

LUCIO LEPOSY

• 1852-Lucio &Alvarado

• 1948-Latapi & Zamora

HISTOID LEPROSY

• 1963-H.W.Wade

CHEMOTHERAPY

• CHAULMOOGRA OIL

Legend –Burmese king- fruit of Kalaw

China and Japan-AD 1500

• Frederic John Mouat -1854

• US-oil by mouth in 1900

• Egypt, France, Philippines-subcutaneous oil

• Johansen -1928

added oil soluble benzocaine

• Hydnocarpus wightiana

SULFANILAMIDE

• First trial at Carville-1941&1942

• Effective in infected ulcers

PROMIN

• Dr Guy Faget-MO, US Public Health

Service, 1941

• Oral , dose-0.5-1 gm./day

• Parenteral- 5 gm./day

DIASONE

• Muir, Faget, Pogge- 1940

• Adverse effects-hematuria,

gastritis,anaemia,dermatitis

DAPSONE

• Cochrane-1949

• Lowe &Smith-1949

orally

• Resistance- 1964,Malaysia

CLOFAZIMINE

• Browne & Hogerzeil- 1962, Nigeria

• Browne- 1965

anti inflammatory action

• Resistance- 1982 but not yet proved

COCHRANE

RIFAMPIN

• Opromolla-1963

Rifamycin SV

• Late 1960s-Rifampicin capsule

• 1970- Rees et al

• Resistance-1976

Jacobson &Hastings

THALIDOMIDE

• Sheskin- 1965 as a sedative ,

Isreal

• Dose -100 mg tds

MULTIDRUG THERAPY

• Malta trial in 1970

Dapsone + Rifampicin + Isoniazid + Prothionamide - 2

yrs

• Scientific Working Group on Chemotherapy of Leprosy

• THELEP-1976

• Field trials-1979

• WHO –Study Group on Chemotherapy of Leprosy-1981

• MDT-1982

NEWER DRUGS

• Since mid 1980 s

• Ofloxacin

• Pefloxacin

• Moxifloxacin

• Clarithromycin

• Minocycline

• Rifapentine

BRIEF HISTORY OF LEPROSY VACCINE RESEARCH• 1921 – BCG

• 1928 – Health Committee of the League of Nation

• 1979 - Human trials with ICRC Anti-leprosy Vaccine began in Mumbai,

India

• 1980 – ICRC (cultivable leprosy derived mycobacteria belonging to M.

avium intracellulare complex) Vaccine developed

• Feb1998 – Leprosy vaccine, the National Institute of Immunology in New

Delhi

• First commercial batch released in June 1998

• October 2003 – Identification of M. leprae antigens

• May 2005 – Completed screening of the leprosy bacillus for proteins

strongly recognized by the human immune system

• March 2006 – Identified two specific antigens (MLO405 and ML2331)

• Convit et al- mixed vaccine-heat killed armadillo derived M.leprea +BCG

LABORATORY INVESTIGATIONS

• DISCOVERY OF M.LEPRA

• Carl William Boeck (1808-75) & Daniel

Cornelius Danielssen(1815-94)

• Hereditary theory

• Dr .Rudolff Virchow , German physician

lepra cells in late 1850s

• Brown bodies

Dr Rudolff VirchowDr Daniel Cornelius Danielssen

GERHARD HENRICK ARMAUER

HANSEN

• 1841-1912

• Norwegian physician

• 1868-began leprosy work under

Danielssen

• 1871-tiny rods in cells

osmic acid stain

• 1874-published in Journal of

Norwegian Medical Society

“Causes of leprosy”

• Chief of the leprosy service in Bergen

SKIN SCRAPING

Herbert Windsor Wade & Rodriguez in 1927

Cochrane modified -1947

Ridley standardised to logarithmic scale -1958

Ziehl- Neelsen staining method-Franz Ziehl & Friedrich Neelsen

FITE STAIN

• 1933

• Dr. George Liddle Fite & Sister Hilary Rose, research

laboratory at Carville

• Fite stain – carbol fuschin based stain

BACTERIAL INDICES

• Morphological index- Waters and Rees

in 1962

• SFG index- Ridley

LEPROMIN TEST

• First one described by Mitsuda in 1919

• Hayashi in 1933

• 1940-Mitsuda lepromin test is used

• Dharmendra lepromin -1942

• 1st successful inoculation of mouse footpad-

Shepard , 1960

• Prabhakaran et al-nude mice,1976

• 9 banded armadillo-core body temp low

• Susceptibility -1969,leprosy research at Carville

• Kirchheimer &Storrs-1971

• Primates-Rhesus, Sooty mangabey monkeys, African

wild monkeys, chimpanzees

ANIMAL STUDIES

ANTILEPROSY ORGANIZATIONS

• Military & Hospital Order of St. Lazarus of Jerusalem

• Sovereign Military Hospitaller Order of St. John of

Jerusalem,Rhodes,Malta

• LEPROSY MISSION INTERNATIONAL

• 1873, London

• American committee -1906

• American Leprosy Mission to lepers -1917

• American Leprosy Mission -1977

• American Leprosy Mission International -1990s

BELRA- British Empire Leprosy Relief Association

• 1925

• 1929-Leprosy reviews

• 1931-recognised as the “first leprosy prevention

organization” at International Leprosy Congress in

Manila

• 1963-LEPRA

• 1989-LEPRA Society of India formed

• Currently working in- ANDHRA PRADESH,MADHYA

PRADESH,BIHAR,ODISHA,NEW DELHI,JHARKHAND

INTERNATIONAL FEDERATION OF ANTILEPROSY ASSOCIATIONS

• 1966-ELEP (Federation of European Anti-Leprosy Association)

• International federation of 14 autonomous non governmental

anti leprosy organizations

• Funds-public & institutional sources

• Goal-World without leprosy

• HQ- London

ALERT

• Addis Ababa, Ethiopia

• It was originally the All Africa Leprosy

Rehabilitation and Training , now: All

Africa Leprosy, Tuberculosis and

Rehabilitation Training Centre.

• At ALERT is the Armauer Hansen Research

Institute, founded in 1970, specializing in

leprosy research

NCLCA-NOVARTIS COMPREHENSIVE LEPROSY CASE ASSOCIATION

• Provide MDT free of cost

• 1989-CLCP in India

• Objectives-to enhance access to MD

provide service for prevention, correction, care of

disabilities with rehabilitation

HKNS-HINDU KUSHTH NIVARAN SANGH

• Branch of BELRA –Indian Council

• Renamed as HKNS

• Registered in 1950

• Hon’ble President of India

• Governing body- 41 members

• Publishes research journal-”LEPROSY IN INDIA”

Dr. Ernest Muir ,July 1929

• 1984-”INDIAN JOURNAL OF LEPROSY”

• Dr.Dharmendra

GMLF-GANDHI MEMORIAL LEPROSY FOUNDATION

• 1951, WARDHA

• 1st unit-Sevagram

• Chilkalpalli-1953

• T’Narasipura-1955

• Balarampur-1977

• Transferred to state govt.

• Concept of socioeconomic rehabilitation

• 1st leprosy training curriculum

• 1st training centre-Wardha,1952

MISSIONARIES OF CHARITY,GANDHIJI PREM NIVAS,TITAGARH

• Mother Teresa,1958

• Mobile clinic

• Titagarh municipality established a permanent centre

ANANDWAN

• 1st of 3 ashrams by Baba Amte

• 1951

• Chandrapur district of Maharashtra

PDLC-PUNE DISTRICT LEPROSY COMMITTE

• 1957,Dr. Jal Mehta

• Bandorawalla leprosy hospital at YEOLEWADI

• 2001-handed over to state govt.

1898- Indian Lepers’ act

1925- Formation of Indian council of BELRA

1935- All India Leprosy Conference, Calcutta

1950- Indian Council of BELRA- HKNS

1950- Indian Association of Leprologist

1953- Classification of Leprosy was drafted by Dharmendra &

Chatterjee

1955- IAL adopted classification

MILESTONES IN LEPROSY HISTORY OF INDIA

1955-NLCP-National Leprosy Control Program

• 1st five year plan

• Dapsone

• Paramedical worker per 20000 population

• General household surveys in 3-5 yrs

• Annual contact surveys, school surveys

• 1 nonmedical supervisor/ 4-5 paramedical worker

• 1 leprosy medical officer –taluk/block level

• SAPEL- A Special Action Plan for Elimination of Leprosy-

1997-2000

• Elimination-December 2005

• 1997 –SAPEL

• 2002 – 04 – Integration of Leprosy services with GH

system

• 2004- National Conference on Elimination of Leprosy,

Raipur

• 2005- Elimination at national level

• 2012- Special action plan for 209 high endemic districts,

I6 states.

• 1983-NLEP-Dr.Swaminathan Committee

• 1986-Bombay leprosy project

• 1994-NLEP- FD MDT -2yrs

• 1998- FD MDT -1yr

“History is who we are and why we

are the way we are”

_David Mc Collough“History is who we are and why we are the way we are” - David Mc Collough

THANK YOU