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HISTORY OF HANSEN'S DISEASE
- 1. Dr.Swathy Lekshmi J L
- 2. 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
- 3. 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
- 4. EGYPT • Ebers Papyrus (1555 BC) – Uchedu • Ebbel – Ghon’s swelling • Yeoli - Clay jar with leonine facies – 1400 – 1300 BC
- 5. 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
- 6. BIBLE • Hebrew-Tsaraath/Zaraath scaly disease spot- white as snow • Old testament- Tsaraath • New Testament- Lepra from Greek • Arabic- Jusam
- 7. • First recognizable description of leprosy-Areteaus of Cappadocia • Middle of 2nd century • elephantiasis
- 8. 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
- 9. • Leprosaria by noble families • Queen Metilda - wife of Henry 1 of England
- 10. 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
- 12. 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
- 13. SPREAD OF LEPROSY TO AMERICA • Command of Columbus • Immigrants from Europe • African slave trade • Louisiana by Acadians in1755
- 14. 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
- 15. 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
- 16. 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
- 18. • Brother Joseph Dutton assisted in 1886 • Father Pierre d’ Orgeval
- 19. CLASSIFICATION 1848-Danielssen & Boeck nodular anaesthetic 1895-Hansen & Looft tuberosa(nodular) maculoanaesthetic 1903-Neisser lepra tuberosa lepra cutanea lepra nervorum
- 20. • 1905-Jadassohn • Darier -1st described term “tuberculoid” in relation to leprosy
- 21. THE MANILA CLASSIFICATION • 1931-Leonard Wood Memorial • cutaneous • neural • mixed
- 22. CAIRO CLASSIFICATION • 1938-International Leprosy Congress • lepromatous • neural-neromacular simple neuromacular tuberculoid neuroanaesthetic
- 23. PAN AMERICAN CLASSIFICATION • 1946-2nd Pan American Leprosy Congress, Rio de Janeiro • Histology lepromatous tuberculoid uncharacteristic
- 24. HAVANA CLASSIFICATION • 1948-International Leprosy Congress • lepromatous • tuberculoid • indeterminate
- 25. WHO EXPERT COMMITTEE • 1952 • lepromatous • tuberculoid • borderline • indeterminate
- 26. 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)
- 27. INDIAN CLASSIFICATION • ORIGINAL INDIAN CLASSIFICATION • Lepromatous • Tuberculoid • Maculoanaesthetic • Borderline • Polyneuritc • indeterminate
- 28. REVISED INDIAN CLASSIFICATION • 1981-IAL,Agra • Removed maculoanaesthetic
- 29. JOB &CHACKO CLASSIFICATION • Lepromatous leprosy • Tuberculoid leprosy • Borderline tuberculoid leprosy • Borderline lepromatous leprosy • Indeterminate leprosy • Polyneuritic leprosy
- 30. RIDLEY-JOPLING CLASSIFICATION • Clinico-bacteriological • Immonological
- 31. LUCIO LEPOSY • 1852-Lucio &Alvarado • 1948-Latapi & Zamora HISTOID LEPROSY • 1963-H.W.Wade
- 32. CHEMOTHERAPY • CHAULMOOGRA OIL Legend –Burmese king- fruit of Kalaw China and Japan-AD 1500 • Frederic John Mouat -1854
- 34. • US-oil by mouth in 1900 • Egypt, France, Philippines-subcutaneous oil • Johansen -1928 added oil soluble benzocaine • Hydnocarpus wightiana
- 35. 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
- 36. DIASONE • Muir, Faget, Pogge- 1940 • Adverse effects-hematuria, gastritis,anaemia,dermatitis
- 37. 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
- 38. RIFAMPIN • Opromolla-1963 Rifamycin SV • Late 1960s-Rifampicin capsule • 1970- Rees et al • Resistance-1976 Jacobson &Hastings
- 39. THALIDOMIDE • Sheskin- 1965 as a sedative , Isreal • Dose -100 mg tds
- 40. 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
- 41. NEWER DRUGS • Since mid 1980 s • Ofloxacin • Pefloxacin • Moxifloxacin • Clarithromycin • Minocycline • Rifapentine
- 42. 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
- 43. • 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
- 44. 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
- 45. Dr Rudolff VirchowDr Daniel Cornelius Danielssen
- 46. 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
- 47. SKIN SCRAPING Herbert Windsor Wade & Rodriguez in 1927 Cochrane modified -1947 Ridley standardised to logarithmic scale -1958
- 48. 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
- 49. BACTERIAL INDICES • Morphological index- Waters and Rees in 1962 • SFG index- Ridley
- 50. LEPROMIN TEST • First one described by Mitsuda in 1919 • Hayashi in 1933 • 1940-Mitsuda lepromin test is used • Dharmendra lepromin -1942
- 51. • 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
- 54. 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
- 55. 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
- 56. 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
- 57. 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
- 58. 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
- 59. 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
- 60. GMLF-GANDHI MEMORIAL LEPROSY FOUNDATION • 1951, WARDHA • 1st unit-Sevagram • Chilkalpalli-1953 • T’Narasipura-1955 • Balarampur-1977 • Transferred to state govt.
- 61. • Concept of socioeconomic rehabilitation • 1st leprosy training curriculum • 1st training centre-Wardha,1952
- 62. MISSIONARIES OF CHARITY,GANDHIJI PREM NIVAS,TITAGARH • Mother Teresa,1958 • Mobile clinic • Titagarh municipality established a permanent centre
- 63. ANANDWAN • 1st of 3 ashrams by Baba Amte • 1951 • Chandrapur district of Maharashtra
- 64. PDLC-PUNE DISTRICT LEPROSY COMMITTE • 1957,Dr. Jal Mehta • Bandorawalla leprosy hospital at YEOLEWADI • 2001-handed over to state govt.
- 65. 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
- 66. 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
- 67. • 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
- 69. “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