| Abstract |
Introduction
Hansen’s disease most commonly known as Leprosy is a slowly progressive, chronic
granulomatous disease, which predominantly affects the skin, peripheral nerves and
the mucous membrane of the upper respiratory tract and oral cavity, caused by
Mycobacterium leprae. In order to be transmitted, it is necessary a prolonged, close
contact with someone with untreated disease over many months or even years. The
first 2 clusters of leprosy were found in India and China in 1600 B.C – 400 B.C.
century, but it was not until the end of the 19th century A.D. that physician Gerhard
Armauer Hansen discovered Mycobacterium leprae as the cause of the disease. It is
believed to have been introduced into Europe by Greek soldiers returning from the
Indian campaign of Alexander the Great. From Greece, the disease is thought to have
spread around the Mediterranean basin. At that time the disease was known with the
Greek term “elephantiasis”. Since the ancient times, due to the unknown origin of the
disease and the physical deformities caused by it, leprosy was synonymous to
“madness” and “sin”. Leprosy ravaged across Europe for centuries, and from 10th to
14th century, there was leprosy pandemic in West Europe. In the medieval times,
people with leprosy were to be found around towns where they would beggar. Church
gave them shelter, but they were held in and had to live by the rules of the monastic
order. During that period the conception of Leprosy was a combination of medical
knowledge, unbalanced dietary conditions and the cultural practices of the lower
classes. Gradually and especially after the discovery of Mycobacterium Leprae as the
cause of the disease in 1873 Hansen’s disease considered as a medical problem that
had to be solved. During the period 1850-1900 AC, a Norwegian city named Bergen,
was known as the “capital of leprae”. Considering the nature of the disease and its
infectiousness, the First Leprosy Conference was held in Berlin in 1897 and the international guideline of mandatory isolation of the diseased was determined as a
prevention measure throughout Europe.
Methods
The present thesis is classified mainly in the field of the History of Medicine.
Methodologically, it has the character of a review study on Hansen's disease and
isolation, as a prevention measure, as it was implemented in Greece during the 20th
century. In order to seek the necessary bibliography, search was made both on
medical websites and in archives of different libraries. Also, a great amount of this
study is based on archival material of the under study period.
Results
In Greece the regional unit of Crete suffered the most from Leprosy. Until the end of
the 19th century Crete was under the Ottoman’s Occupation and the disease believed
that it was due to hereditary predisposition. Thus, the diseased people were ostracized
to live with their families outside of the cities’ walls. Those geographical areas are
known as “Meskinohoria”. In Greece at the beginning of the 20th century the
scientific world was divided in two categories: those who believed that the disease
was hereditary and those who believed that the diseased was transmitted via infection.
However, the measure of mandatory isolation applied in order to confront leprosy. In
Greece, at the early years of the 20th century, 3 leprosaria were established in the
island of Samos, Chios and the famous island of Spinalonga in Crete. Until the late
years of 1960s, people with leprosy suffered isolation, social ostracism and stigma. At
first there was no medical treatment for those who were isolated in leprosaria. It was
forbidden to keep contact or get married to healthy population. By the 1920s
chaulmoogra oil and the derivatives of the oil were the principal medication available.
However, the drug was not effective when applied locally to affected areas. It was
abandoned when Dr Faget introduced sulfones, the first truly effective leprosy drug,
in the 1940s. Despite the effectiveness against leprosy, 20 years passed since the fully
acceptance of sulfones as the effective treatment of Hansen’s disease and the release
of isolation burden
Discussion
The measures of isolation and quarantine as manners of protection against infectious
diseases have been applied in the past by the medical community. Disagreements between scientists about the degree of contagion and heredity of the disease, the lack
of effective treatment against the disease, the biases about the disease that have been
deeply engraved in the social unconscious, and the international guidelines on
mandatory patient isolation have favored the application of the isolation measure in
leprosy in a stricter form than had been applied in the past. Multidrug therapies for
Mycobacterial resistant strains, the urbanization of the country and the model of the
nuclear family have led to the gradual eradication of the disease from the Greek area.
Conclusions
In conclusion, the measure of isolation as applied in Greece could be considered by
some as a successful attempt to treat the disease, as it led to a gradual reduction in the
number of patients and by others as a failure. Undoubtedly, the isolation of people
carrying the Hansen’s disease by being completely excluded from society led them to
social stigma that lasted for years after their "liberation" from the leprosaria. At the
same time, however, the significance of the measure of quarantine to diseases in
which there are scientific gaps cannot be disputed. Nowadays, Greece is not
considered to be a leprosy endemic country and it is known that 95% of people
worldwide carry natural immunity against the disease.
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