Historical texts Written accounts of leprosy date back thousands of years. By 600 BC, various skin diseases translated as leprosy appear in the
Atharva Veda, a principal Hindu scripture. Another Hindu scripture, the
Manusmriti (200 BC), prohibits contact with those infected with the disease and makes marriage to a person infected with leprosy punishable. The Hebraic root tsara or tsaraath (צָרַע, – tsaw-rah' – to be struck with leprosy, to be leprous) and the Greek (λεπρός – lepros), are of broader classification than the more narrow use of the term related to Hansen's Disease. Any progressive skin disease (a whitening or splotchy bleaching of the skin, raised manifestations of scales, scabs, infections, rashes, etc.) — as well as generalized molds and surface discoloration of any clothing, leather, or discoloration on walls or surfaces throughout homes — all came under the "law of leprosy" (
Leviticus 14:54–57). Ancient sources such as the
Talmud (Sifra 63) make clear that
tzaraath refers to various types of lesions or stains associated with
ritual impurity and occurring on cloth, leather, or houses, as well as skin. Traditional
Judaism and Jewish rabbinical authorities, both historical and modern, emphasize that the
tsaraath of Leviticus is a spiritual ailment with no direct relationship to Hansen's disease or physical contagions. The relation of
tsaraath to "leprosy" comes from translations of Hebrew Biblical texts into Greek and ensuing misconceptions. All three
Synoptic Gospels of the
New Testament describe instances of
Jesus healing people with leprosy (Matthew 8:1–4, Mark 1:40–45, and Luke 5:12–16). The Bible's description of leprosy is congruous (if lacking detail) with the symptoms of modern leprosy, but the relationship between this disease,
tzaraath, and Hansen's disease has been disputed. The biblical perception that people with leprosy were unclean can be found in a passage from Leviticus 13:44–46. While this text defines the leper as
impure, it does not explicitly make a moral judgement on those with leprosy. Some
early Christians believed that God was punishing those affected by leprosy for sinful behavior. Moral associations have persisted throughout history. In the 6th century, Pope
Gregory the Great and
Isidore of Seville considered people with the disease to be heretics.
Middle Ages The general population's perception of leprosy was mixed. On one hand, people feared getting infected with the disease and thought of people suspected of leprosy to be unclean, untrustworthy, and occasionally morally corrupt. or seeing the disease as a means of obtaining access to heaven. Early medieval understanding of leprosy was influenced by early Christian writers such as
Gregory of Nazianzus and
John Chrysostom, whose writings were later embraced by Byzantine and Latin writers. Gregory, for example, composed sermons urging Christians to assist victims of the disease, and he condemned pagans or Christians who justified rejecting lepers on the allegation that God had sent them the disease to punish them. As cases of leprosy increased in the
Eastern Roman Empire, becoming a major health issue, the ecclesiastic leaders discussed how to assist those affected as well as how to change the attitude of society towards them. They also tried this by using the name "holy disease" instead of the commonly used "elephant's disease" (elephantiasis), implying that God did not create this disease to punish people but to purify them for heaven. Although not always successful in persuading the public and a cure was never found by Greek medicians, they created an environment where victims could get
palliative care and were never expressly banned from society, as sometimes happened in western Europe. Theodore Balsamon, a 12th-century jurist in
Constantinople, noted that lepers were allowed to enter the same churches, cities, and assemblies that healthy people attended. possibly in connection with the increase in urbanisation as well as returning crusaders from the Middle East. Additionally to the new leprosia, further steps were taken by secular and religious leaders to prevent further spread of the disease. The
third Lateran Council of 1179 required lepers to have their own priests and churches Although the leprosaria in Western Europe removed the sick from society, they were never a place to quarantine them or from which they could not leave: lepers would go beg for
alms for the upkeep of the leprosaria or meet with their families.
19th century Norway was the location of a progressive stance on leprosy tracking and treatment, and played an influential role in European understanding of the disease. In 1832, Dr. JJ Hjort conducted the first leprosy survey, thus establishing a basis for epidemiological surveys. Subsequent surveys led to the establishment of a national leprosy registry to study the causes of leprosy and to track the rate of infection. Early leprosy research throughout Europe was conducted by Norwegian scientists
Daniel Cornelius Danielssen and
Carl Wilhelm Boeck. Their work resulted in the establishment of the National Leprosy Research and Treatment Center. Danielssen and Boeck believed the cause of leprosy transmission was hereditary. This stance was influential in advocating for the isolation of those infected by sex to prevent reproduction. (1887–1957) with a patient with leprosy in
Guntur, India circa 1926 Though leprosy rates were on the decline in the
Western world by the 1860s, authorities frequently embraced isolation treatment due to a combination of reasons, including fears of the disease spreading from the
Global South, efforts by Christian missionaries and a lack of understanding concerning
bacteriology,
medical diagnosis and how contagious the disease was. The rapid expansion of Western imperialism during the
Victorian era resulted in westerners coming into increasing contact with regions where the disease was endemic, including British India. English surgeon
Henry Vandyke Carter observed isolation treatment for leprosy patients first-hand while visiting Norway, applying these methods in British India with the financial and logistical assistance of Protestant missionaries. Colonialist and religious viewpoints of the disease continued to be a major factor in the treatment and public perception of the disease in the Global South until
decolonization in the mid-20th century. The National Leprosarium at
Carville, Louisiana, known in 1955 as the Louisiana Leper Home, was the only leprosy hospital in the mainland United States. Leprosy patients from all over the United States were sent to Carville to be kept in isolation away from the public, as not much about leprosy transmission was known at the time, and
stigma against those with leprosy was high. The Carville leprosarium was known for its innovations in reconstructive surgery for those with leprosy. In 1941, 22 patients at Carville underwent trials for a new drug called Promin. The results were described as miraculous, and soon after the success of promin came dapsone, a medicine even more effective in the fight against leprosy. Leprosy incidence peaked in the United States in 1983, followed by a steep decline.
Stigma Despite effective treatment and education efforts, leprosy stigma remains problematic in developing countries where the disease is common. Leprosy is most common amongst impoverished populations where social stigma is likely to be compounded by poverty. Fears of ostracism, job loss, or expulsion from family and society may contribute to a delayed diagnosis and treatment. Folk beliefs, lack of education, and religious connotations of the disease continue to influence social perceptions of those affected in many parts of the world. In Brazil, for example, folklore holds that leprosy is a disease transmitted by dogs, or that it is associated with sexual promiscuity, or that it is a punishment for sins or moral transgressions (distinct from other diseases and misfortunes, which are in general thought of as being according to the will of God). Socioeconomic factors also have a direct impact. Lower-class domestic workers who are often employed by those in a higher socioeconomic class may find their employment in jeopardy as physical manifestations of the disease become apparent. Skin discoloration and darker pigmentation resulting from the disease also have social repercussions. In extreme cases in northern India, leprosy is equated with an "untouchable" status that "often persists long after individuals with leprosy have been cured of the disease, creating lifelong prospects of divorce, eviction, loss of employment, and ostracism from family and social networks." == Public policy ==