Editing Leprosy (section)

== History ==
{{Main|History of leprosy}}
[[File:Gerhard Armauer Hansen.jpg|thumb|Norwegian physician Gerhard Armauer Hansen (1841–1912) discovered ''[[Mycobacterium leprae|M. leprae]]'' in 1873]]

=== Historical distribution ===
Using [[comparative genomics]], in 2005, geneticists traced the origins and worldwide distribution of leprosy from East Africa or the Near East along human migration routes. They found four strains of ''M. leprae'' with specific regional locations:<ref name=Monot-et-al-2005>{{cite journal |last1=Monot |first1=Marc |last2=Honoré |first2=Nadine |last3=Garnier |first3=Thierry |last4=Araoz |first4=Romul |last5=Coppée |first5=Jean-Yves |last6=Lacroix |first6=Céline |last7=Sow |first7=Samba |last8=Spencer |first8=John S. |last9=Truman |first9=Richard W. |last10=Williams |first10=Diana L. |last11=Gelber |first11=Robert |last12=Virmond |first12=Marcos |last13=Flageul |first13=Béatrice |last14=Cho |first14=Sang-Nae |last15=Ji |first15=Baohong |last16=Paniz-Mondolfi |first16=Alberto |last17=Convit |first17=Jacinto |last18=Young |first18=Saroj |last19=Fine |first19=Paul E. |last20=Rasolofo |first20=Voahangy |last21=Brennan |first21=Patrick J. |last22=Cole |first22=Stewart T. |year=2005 |title=On the origin of leprosy |journal=Science |volume=308 |issue=5724 |pages=1040–1042 |doi=10.1126/science/1109759 |pmid=15894530 |s2cid=86109194 |url=https://hal-pasteur.archives-ouvertes.fr/pasteur-00204117/file/Monot_science.pdf |access-date=22 November 2022 |archive-date=25 January 2023 |archive-url=https://web.archive.org/web/20230125030851/https://hal-pasteur.archives-ouvertes.fr/pasteur-00204117/file/Monot_science.pdf |url-status=live }}</ref> Monot ''et al.'' (2005) determined that leprosy originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of ''M. leprae'' are based in specific geographic regions where each predominantly occurs:<ref name=Monot-et-al-2005/>
* strain 1 in Asia, the Pacific region, and East Africa;
* strain 2 in Ethiopia, [[Malawi]], Nepal, north India, and [[New Caledonia]];
* strain 3 in Europe, North Africa, and the Americas;
* strain 4 in West Africa and the Caribbean.

This confirms the spread of the disease along the migration, colonisation, and slave trade routes taken from East Africa to India, West Africa to the New World, and from Africa to Europe and vice versa.<ref>{{cite journal | vauthors = Monot M, Honoré N, Garnier T, Araoz R, Coppée JY, Lacroix C, Sow S, Spencer JS, Truman RW, Williams DL, Gelber R, Virmond M, Flageul B, Cho SN, Ji B, Paniz-Mondolfi A, Convit J, Young S, Fine PE, Rasolofo V, Brennan PJ, Cole ST | title = On the origin of leprosy | journal = Science | volume = 308 | issue = 5724 | pages = 1040–1042 | date = May 2005 | pmid = 15894530 | doi = 10.1126/science/1109759 | author-link17 = Jacinto Convit | s2cid = 86109194 | url = https://hal-pasteur.archives-ouvertes.fr/pasteur-00204117/file/Monot_science.pdf | access-date = 22 November 2022 | archive-date = 25 January 2023 | archive-url = https://web.archive.org/web/20230125030851/https://hal-pasteur.archives-ouvertes.fr/pasteur-00204117/file/Monot_science.pdf | url-status = live }}</ref>

Skeletal remains discovered in 2009 represent the oldest documented evidence for leprosy, dating to the 2nd millennium BC.<ref name="Schug2009">{{cite journal | vauthors = Robbins G, Tripathy VM, Misra VN, Mohanty RK, Shinde VS, Gray KM, Schug MD | title = Ancient skeletal evidence for leprosy in India (2000 B.C.) | journal = PLOS ONE | volume = 4 | issue = 5 | pages = e5669 | date = May 2009 | pmid = 19479078 | pmc = 2682583 | doi = 10.1371/journal.pone.0005669 | doi-access = free | bibcode = 2009PLoSO...4.5669R }}</ref><ref name="Schug2013">{{cite journal | vauthors = Robbins Schug G, Blevins KE, Cox B, Gray K, Mushrif-Tripathy V | title = Infection, disease, and biosocial processes at the end of the Indus Civilization | journal = PLOS ONE | volume = 8 | issue = 12 | pages = e84814 | date = December 2013 | pmid = 24358372 | pmc = 3866234 | doi = 10.1371/journal.pone.0084814 | doi-access = free | bibcode = 2013PLoSO...884814R }}</ref> Located at [[Balathal]], Rajasthan, in northwest India, the discoverers suggest that if the disease did migrate from Africa to India during the 3rd millennium BC "at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt, there needs to be additional skeletal and molecular evidence of leprosy in India and Africa to confirm the African origin of the disease".<ref>{{cite journal | vauthors = Robbins G, Tripathy VM, Misra VN, Mohanty RK, Shinde VS, Gray KM, Schug MD | title = Ancient skeletal evidence for leprosy in India (2000 B.C.) | journal = PLOS ONE | volume = 4 | issue = 5 | pages = e5669 | date = May 2009 | pmid = 19479078 | pmc = 2682583 | doi = 10.1371/journal.pone.0005669 | bibcode = 2009PLoSO...4.5669R | doi-access = free }}</ref> A proven human case was verified by DNA taken from the shrouded remains of a man discovered by researchers from the [[Hebrew University of Jerusalem]] in a tomb in [[Akeldama]], next to the [[Old City of Jerusalem]] dated by radiocarbon methods to the first half of the 1st century.<ref>{{cite web |title=DNA of Jesus-Era Shrouded Man in Jerusalem Reveals Earliest Case of Leprosy |website=ScienceDaily |date=16 December 2009 |url=https://www.sciencedaily.com/releases/2009/12/091216103558.htm |access-date=31 January 2010 |url-status=live |archive-url=https://web.archive.org/web/20091220033542/https://www.sciencedaily.com/releases/2009/12/091216103558.htm |archive-date=20 December 2009 }}</ref>

The oldest strains of leprosy known from Europe are from [[Great Chesterford]] in southeast England and date back to AD 415&ndash;545. These findings suggest a different path for the spread of leprosy, meaning it may have originated in western Eurasia. This study also indicates that there were more strains in Europe at the time than previously determined.<ref>{{cite journal | vauthors = Schuenemann VJ, Avanzi C, Krause-Kyora B, Seitz A, Herbig A, Inskip S, Bonazzi M, Reiter E, Urban C, Dangvard Pedersen D, Taylor GM, Singh P, Stewart GR, Velemínský P, Likovsky J, Marcsik A, Molnár E, Pálfi G, Mariotti V, Riga A, Belcastro MG, Boldsen JL, Nebel A, Mays S, Donoghue HD, Zakrzewski S, Benjak A, Nieselt K, Cole ST, Krause J | title = Ancient genomes reveal a high diversity of Mycobacterium leprae in medieval Europe | journal = PLOS Pathogens | volume = 14 | issue = 5 | pages = e1006997 | date = May 2018 | pmid = 29746563 | pmc = 5944922 | doi = 10.1371/journal.ppat.1006997 | doi-access = free }}</ref>

=== Discovery and scientific progress ===
[[File:Distribution of leprosy around the world Wellcome L0032805.jpg|thumb|upright=1.4|Distribution of leprosy around the world in 1891]]Literary attestation of leprosy is unclear because of the ambiguity of many early sources, including the Indian [[Atharvaveda]] and Kausika Sutra, the Egyptian [[Ebers Papyrus]], and the [[Hebrew Bible]]'s various sections regarding signs of impurity (''[[tzaraath]]'').<ref>{{cite book |vauthors=Lendrum FC |date=1954 |contribution=The Name 'Leprosy' |title=Etc: A Review of General Semantics |volume=12 |issue=1 |jstor=24234298 |pages=37–47 |publisher=Institute of General Semantics |contribution-url=http://www.jstor.org/stable/24234298 |access-date=13 April 2022 |archive-date=13 April 2022 |archive-url=https://web.archive.org/web/20220413192502/https://www.jstor.org/stable/24234298 |url-status=live }}</ref> Leprotic symptoms are attested in the Indian doctor [[Sushruta]]'s [[Sushruta Samhita|''Compendium'']], originally dating to c.&nbsp;600&nbsp;BC but only surviving in emended texts no earlier than the 5th century BC. Symptoms consistent with leprosy were possibly described by [[Hippocrates]] in 460&nbsp;BC.<ref>{{Cite journal |date=2021-12-10 |title=Mycobacterium leprae: A historical study on the origins of leprosy and its social stigma |url=https://www.infezmed.it/media/journal/Vol_29_4_2021_18.pdf |journal=Infezioni in Medicina |volume=29 |issue=4 |doi=10.53854/liim-2904-18 |pmc=8805473 |pmid=35146374 |pages=623–632 | vauthors = Santacroce L, Del Prete R, Charitos IA, Bottalico L }}</ref> However, Hansen's disease probably did not exist in Greece or the Middle East before the [[Common Era]].<ref name="Haubrich2003">{{cite book|first=William S. |last=Haubrich|title=Medical Meanings: A Glossary of Word Origins|url=https://books.google.com/books?id=NXmlIwkQBLAC&pg=PA133 |year=2003 |publisher=ACP Press|isbn=978-1-930513-49-5|page=133}}</ref><ref name="WilkinsEvans2013">{{cite book|first1=Michael |last1=Wilkins|first2=Craig A. |last2=Evans|first3=Darrell |last3=Bock|first4=Andreas J. |last4=Köstenberger|title=The Gospels and Acts|url=https://books.google.com/books?id=QPKsBAAAQBAJ&pg=PT194|date=1 October 2013|publisher=B&H |isbn=978-1-4336-8101-1|page=194|access-date=15 July 2018|archive-date=12 January 2023|archive-url=https://web.archive.org/web/20230112232559/https://books.google.com/books?id=QPKsBAAAQBAJ&pg=PT194|url-status=live}}</ref><ref>{{cite book |title=Encyclopedia of Jewish Medical Ethics |url=https://books.google.com/books?id=aaklGZAID08C&pg=PA951|year=2003|publisher=Feldheim Publishers|isbn=978-1-58330-592-8|page=951}}</ref> In 1846, [[Francis Adams (translator)|Francis Adams]] produced ''The Seven Books of Paulus Aegineta'' which included a commentary on all medical and surgical knowledge and descriptions and remedies to do with leprosy from the Romans, Greeks, and Arabs.<ref>{{cite book |first=Francis |last=Adams |title=The Seven Books of Paulus Aegineta: Translated from the Greek with Commentary Embracing a Complete View of the Knowledge Possessed by the Greeks, Romans and Arabians on all Subjects Connected with Medicine and Surgery |location=London |publisher=Sydenham Society |year=1678}}</ref><ref>Roman: [[Celsus]], [[Pliny the Elder|Pliny]]<!--presumably as the Younger was not a scientist-->, [[Serenus Samonicus]], [[Scribonius Largus]], [[Caelius Aurelianus]], [[Themison of Laodicea|Themison]], [[Octavius Horatianus]], [[Marcellus the Emperic]]; Greek: [[Aretaeus]], [[Plutarch]], [[Galen]], [[Oribasius]], Aetius ([[Aëtius of Amida]] or [[Sicamus Aëtius]])<!--assuming they were not distinguished, but perhaps one of the other was meant-->, [[Joannes Actuarius|Actuarius]], Nonnus,<!--unclear who this refers to – none of the people of this name with articles were physicians--> [[Psellus]], Leo,<!--can this be disambiguated?--> [[Myrepsus]]; Arabic: [[Scrapion]], [[Ibn Zuhr|Avenzoar]], [[Al-Zahrawi|Albucasis]], [['Ali ibn al-'Abbas al-Majusi|Haly Abbas]] translated by [[Stephanus Antiochensis]], [[Alsharavius]], Rhases ([[Abū Bakr al-Rāzī]]), and [[Guido de Cauliaco]].</ref>

Leprosy did not exist in the Americas before [[European colonization of the Americas|colonization]] by modern Europeans<ref name="Rotberg2001">{{cite book|first=Robert I. |last=Rotberg|title=Population History and the Family: A Journal of Interdisciplinary History Reader|url=https://books.google.com/books?id=OiQM-GIe69kC&pg=PA132|year=2001|publisher=MIT Press|isbn=978-0-262-68130-8|page=132}}</ref> nor did it exist in [[Polynesia]] until the middle of the 19th century.<ref>{{cite journal | vauthors = Montgomerie JZ | title = Leprosy in New Zealand | journal = The Journal of the Polynesian Society | volume = 97 | issue = 2 | pages = 115–152 | date = 1988 | pmid = 11617451 | url = http://www.jps.auckland.ac.nz/document/Volume_97_1988/Volume_97%2C_No._2/Leprosy_in_New_Zealand%2C_by_J._Z._Montgomerie%2C_p_115-152?action=null | access-date = 3 September 2019 | archive-date = 11 February 2018 | archive-url = https://web.archive.org/web/20180211031412/http://www.jps.auckland.ac.nz/document/Volume_97_1988/Volume_97%2C_No._2/Leprosy_in_New_Zealand%2C_by_J._Z._Montgomerie%2C_p_115-152?action=null | url-status = live }}</ref> The causative agent of leprosy, ''M. leprae'', was discovered by [[Gerhard Armauer Hansen]] in [[Union between Sweden and Norway|Norway]] in 1873, making it one of the first species of pathogenic bacteria identified.<ref name="Irgens_2002">{{cite journal | vauthors = Irgens LM | title = Oppdagelsen av leprabasillen |trans-title = The discovery of the leprosy bacillus |language=no | journal = Tidsskrift for den Norske Laegeforening | volume = 122 | issue = 7 | pages = 708–709 | date = March 2002 | pmid = 11998735 }}</ref>

=== Treatment ===
[[Chaulmoogra]] tree oil was used topically to manage Hansen's disease for centuries. Chaulmoogra oil could not be taken orally without causing nausea or injected without forming an abscess.<ref name="SmithMag">{{cite web |last1=Magazine |first1=Smithsonian |last2=Wong |first2=Kathleen M. |title=The Trailblazing Black Woman Chemist Who Discovered a Treatment for Leprosy |url=https://www.smithsonianmag.com/history/the-trailblazing-black-woman-chemist-who-discovered-a-treatment-for-leprosy-180979772/ |website=Smithsonian Magazine |access-date=27 December 2023 |archive-date=11 December 2023 |archive-url=https://web.archive.org/web/20231211200621/https://www.smithsonianmag.com/history/the-trailblazing-black-woman-chemist-who-discovered-a-treatment-for-leprosy-180979772/ |url-status=live }}</ref> Leprosy was once believed to be highly contagious and was treated with [[Mercury (element)|mercury]], as was [[syphilis]], which was first described in 1530. Many early cases thought to be leprosy could actually have been syphilis.<ref>[https://www.britannica.com/EBchecked/topic/578770/syphilis/253277/Syphilis-through-history#ref252973 "Syphilis through history"]. {{webarchive|url=https://web.archive.org/web/20130513015053/https://www.britannica.com/EBchecked/topic/578770/syphilis/253277/Syphilis-through-history |date=13 May 2013 }} ''[[Encyclopædia Britannica]]''.</ref> In 1915, [[Alice Ball]], the first black woman to graduate from the University of Hawai'i with a masters in chemistry, discovered how to make the oil water soluble.<ref name="SmithMag" /> This technique led to marked improvements in patients with Hansen's disease who were treated in Hawai'i.<ref name="SmithMag" />

The first effective drug ([[promin]]) became available in the 1940s.<ref name="Cam1997">{{cite book|author1=Andrew Baum|display-authors=etal|title=Cambridge handbook of psychology, health and medicine|year=1997|publisher=Cambridge University Press|location=Cambridge, UK|isbn=978-0-521-43686-1|page=521|url=https://books.google.com/books?id=zVh30FrAuDsC&pg=PA521|url-status=live|archive-url=https://web.archive.org/web/20160611001757/https://books.google.com/books?id=zVh30FrAuDsC&pg=PA521|archive-date=11 June 2016}}</ref> In the 1950s, dapsone was introduced. The search for further effective antileprosy drugs led to the use of clofazimine and rifampicin in the 1960s and 1970s.<ref name="Rees_1970">{{cite journal | vauthors = Rees RJ, Pearson JM, Waters MF | title = Experimental and clinical studies on rifampicin in treatment of leprosy | journal = British Medical Journal | volume = 1 | issue = 5688 | pages = 89–92 | date = January 1970 | pmid = 4903972 | pmc = 1699176 | doi = 10.1136/bmj.1.5688.89 }}</ref> Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance.<ref name="Yawalkar_1982">{{cite journal | vauthors = Yawalkar SJ, McDougall AC, Languillon J, Ghosh S, Hajra SK, Opromolla DV, Tonello CJ | title = Once-monthly rifampicin plus daily dapsone in initial treatment of lepromatous leprosy | journal = Lancet | volume = 1 | issue = 8283 | pages = 1199–1202 | date = May 1982 | pmid = 6122970 | doi = 10.1016/S0140-6736(82)92334-0 | s2cid = 38629414 }}</ref> Combining all three drugs was first recommended by the WHO in 1981. These three drugs are still used in the standard MDT regimens.<ref>{{Cite web |date=22 October 2018 |title=Treatment {{!}} Hansen's Disease (Leprosy) |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/leprosy/health-care-workers/treatment.html |access-date=7 October 2022 |archive-date=7 October 2022 |archive-url=https://web.archive.org/web/20221007055454/https://www.cdc.gov/leprosy/health-care-workers/treatment.html |url-status=live }}</ref> Resistance has developed to initial treatment. Until the introduction of MDT in the early 1980s, leprosy could not be diagnosed and treated successfully within the community.<ref name="WHOleprosyFAQ">{{cite web | url=http://www.searo.who.int/en/section10/section373_11716.htm | title=Communicable Diseases Department, Leprosy FAQ | publisher=[[World Health Organization]] (WHO) | date=25 May 2006 | access-date=31 January 2010 | url-status=dead | archive-url=https://web.archive.org/web/20100201182128/http://www.searo.who.int/EN/Section10/Section373_11716.htm | archive-date=1 February 2010 }}</ref>

The importance of the nasal mucosa in the transmission of ''M. leprae'' was recognized as early as 1898 by Schäffer, in particular, that of the ulcerated mucosa.<ref name="Schaffer_1898">''Arch Dermato Syphilis'' 1898; 44:159–174</ref>{{verify source|reason=Unable to find this abbreviated title anywhere online relating to an 1898 journal. Please expand the full name. Possibly "Archives of Dermatology and Syphilis" or "Archives of Dermatology and Syphilology". Latter vol. 1 is 1920, but according to Internet Archive also called vol. 38|date=October 2023}} The mechanism of plantar ulceration in leprosy and its treatment was first described by [[Ernest W. Price]].<ref>{{cite journal | vauthors = Vernon G | title = Dr E W Price, the discoverer of podoconiosis | journal = Journal of Medical Biography | volume = 30 | issue = 1 | pages = 2–5 | date = February 2022 | pmid = 31735101 | doi = 10.1177/0967772019888406 | s2cid = 208142196 }}</ref>