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The author argues that medical care in the Dutch East Indies, should be re-evaluated from successful to disastrous. The author first defines a medical disaster as one in which medical care has fallen short due to its own shortcomings- or even intentionally. This contrasts with a disaster for humankind, in which also many are to be regretted, but for which healthcare is not to blame, because of, for instance, a lack of resources, manpower or knowledge. The author then looks at three different types of medical care: Red Cross aid; the public health policy to eradicate leprosy; and the military medical aid given to the Indonesian population (1946-1949). In all these colonial interests were a priority, if not the driving force. Medical humanitarianism came second at best. This produced outcomes that should be called medically disastrous. Partly this is not new: medical historians have identified colonial medicine as a tool of empire before. But what it nevertheless had achieved, defined as the medical 'good', was seldom questioned, cutting off medical acts and their results from their context. The question must be asked if it isn't it time to call Dutch medical care in Indonesia disastrous in itself?

Our knowledge of how society viewed leprosy and treated its victims in the past is still scarce, especially in geographical regions and archaeological periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of five previously described, probable cases with leprosy from the Avar-period Trans-Tisza region (Hungary). The five skeletons were subject to a detailed macromorphological (re-)evaluation. Where possible, the biological and social consequences of having leprosy were reconstructed based on the observed bony changes and mortuary treatment, respectively. The retrospective, macromorphology-based diagnosis of leprosy could be established in three cases only. Based on the detected skeletal lesions, all of them suffered from near-lepromatous or lepromatous leprosy. The disease resulted in aesthetic repercussions and functional implications, which would have been disadvantageous for these individuals, and limited or changed their possibilities to participate in social situations. They could have even required heavy time investment from their respective communities. The analysis of the mortuary treatment of the confirmed leprosy cases revealed no evidence of a social stigma. These findings indicate that the afflicted have not been systematically expulsed or segregated, at least in death, in the Early Middle Ages of the Carpathian Basin., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Augusto Bonome (1857-1922), professor at the University of Padua until 1922, was involved in a study about a particular kind of pulmonary leprosy, being the first to testify the lepromatous alterations also in the deepest parts of the respiratory tract, even though the same Gerhard Hansen (1841-1912) had denied the possibility that lungs could host Mycobacterium leprae., Objectives: It is necessary to reevaluate the research done by Bonome to also demonstrate how it can still be relevant today in further comprehension of leprosy., Methods: Bonome's advances in leprosy studies are testified by some specimens from the Morgagni Museum of Pathological Anatomy of the University of Padua. Among the specimens, there is a peculiar case of advanced tuberous leprosy in an adolescent, who died in 1908, of which the face, the larynx, the hands and genitals are still preserved today in the Museum., Results: Through autoptic and histological analysis of this specimen, Bonome succeeded in identifying a peculiar case of bone toxoid-infectious dystrophy besides characteristic leprous laryngitis, which caused the death of the young leprosy patient., Conclusions: The results confirmed the innovative research carried on by Bonome during his medical career, being among the first to offer an important contribution to improving and revolutionary knowledge on leprosy which could still be useful today., (© 2023 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Leprosy, one of the oldest recorded diseases in human history, remains prevalent in Asia, Africa, and South America, with over 200,000 cases every year. 1 , 2 Although ancient DNA (aDNA) approaches on the major causative agent, Mycobacterium leprae, have elucidated the disease's evolutionary history, 3 , 4 , 5 the role of animal hosts and interspecies transmission in the past remains unexplored. Research has uncovered relationships between medieval strains isolated from archaeological human remains and modern animal hosts such as the red squirrel in England. 6 , 7 However, the time frame, distribution, and direction of transmissions remains unknown. Here, we studied 25 human and 12 squirrel samples from two archaeological sites in Winchester, a medieval English city well known for its leprosarium and connections to the fur trade. We reconstructed four medieval M. leprae genomes, including one from a red squirrel, at a 2.2-fold average coverage. Our analysis revealed a phylogenetic placement of all strains on branch 3 as well as a close relationship between the squirrel strain and one newly reconstructed medieval human strain. In particular, the medieval squirrel strain is more closely related to some medieval human strains from Winchester than to modern red squirrel strains from England, indicating a yet-undetected circulation of M. leprae in non-human hosts in the Middle Ages. Our study represents the first One Health approach for M. leprae in archaeology, which is centered around a medieval animal host strain, and highlights the future capability of such approaches to understand the disease's zoonotic past and current potential., Competing Interests: Declaration of interests We have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The year 2024 is the Centenary of the foundation of the Leprosy Relief Association (Lepra), formerly the British Empire Leprosy Relief Association (BELRA). The name of the organization changed to the LEProsy Relief Association (LEPRA) in 1976 but has been known as Lepra since 2008. Over the years it has worked closely with members and office holders of the Royal Society of Tropical Medicine and Hygiene. Its work has encompassed activities from the earliest initiatives to ensure appropriate living conditions for those with the disease to the development of leprosy chemotherapy. However, this has now evolved into a strong partnership between the UK- and India-based Lepra hubs, which are carrying out research and public health initiatives ranging from elimination of prejudice against those with leprosy to adopting the recently launched WHO programme for skin NTDs to facilitate integrated control and management regimens. The fight against leprosy has always been a partnership between a wide variety of disease-specific NGOs, health-care workers and international health agencies. The story of Lepra illustrates the central role of these partnerships and national as well as international collaboration., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Between 1867 and 1933, the understanding of leprosy within the colonial medical establishment in Bombay city was fractured on two issues: whether leprosy was contagious and whether individuals with leprosy should be segregated. This article explores how legislation paved the way for resolving these issues in Bombay between 1867 and 1933. Furthermore, the article seeks to problematize the notion of "diseased bodies" or "lepers" through legislation to protect healthy individuals from possible degeneration. Leprosy in Bombay reflected the anxieties of the city's business elite who were averse to accommodating patients from other parts of British India. In addition, the article studies leprosy and "lepers" by analyzing archival documents and public health reports within the context of Bombay city.

This article analyzes an experiment to cure leprosy using the assacu plant (Hura crepitans L.) conducted in Santarém, Pará, in 1847, by an Indigenous man named Antonio Vieira dos Passos. The experiment was later repeated in other Brazilian provinces and abroad. This article establishes relationships between medical practices in other parts of the country while focusing on the dialog between official and Indigenous medicine. Newspaper articles and official documents of the time show that Indigenous knowledge of medicinal plants was widely recognized and utilized by physicians wishing to incorporate it into the official therapeutic repertoire.

Se realizó una revisión bibliográfica sobre la Enfermedad de Hansen; se detalla en este artículo la historia de la lepra desde su surgimiento y su arribo a Cuba. Se comenta el rechazo social que ha existido desde la época bíblica hasta Cuba en el año 1917. Se tratan temas bioéticos como: Justicia, Equidad y principales afectaciones psicológicas de estos pacientes.A bibliographic revision about the Hansen disease was done, detailing the Leprosy`s history, from its begining until its Cuba arriving, social rejection from Biblical`s time until the Cuba in the 1917 was comment, bioethic themes like: Justice, Equity, Beneficence and main psicologicals disturbs in these patients was approached.

Alice Augusta Ball (1892-1916) was a young and dynamic chemist who achieved extraordinary milestones in her short lifespan of 24 years. As an African American and as a woman in the early 20th century, her work and achievements set a benchmark. Her breakthrough work on the extraction of the water-soluble ethyl esters of chaulmoogra oil changed the lives of millions of people affected by Hansen's disease who were socially boycotted and segregated to leprosy colonies and asylums. The chaulmoogra oil esters, which continued to be used for almost two decades, were the first viable treatment of leprosy. Unfortunately, Ball did not receive recognition and honor for her work, and she was forgotten soon after her untimely death., Competing Interests: Conflict of interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The pathogen landscape in the Early European Middle Ages remains largely unexplored. Here, we perform a systematic pathogen screening of the rural community Lauchheim "Mittelhofen," in present-day Germany, dated to the Merovingian period, between fifth and eighth century CE. Skeletal remains of individuals were subjected to an ancient DNA metagenomic analysis. Genomes of the detected pathogens were reconstructed and analyzed phylogenetically., Results: Over 30% of the individuals exhibit molecular signs of infection with hepatitis B virus (HBV), parvovirus B19, variola virus (VARV), and Mycobacterium leprae. Seven double and one triple infection were detected. We reconstructed four HBV genomes and one genome each of B19, VARV, and M. leprae. All HBV genomes are of genotype D4 which is rare in Europe today. The VARV strain exhibits a unique pattern of gene loss indicating that viruses with different gene compositions were circulating in the Early Middle Ages. The M. leprae strain clustered in branch 3 together with the oldest to-date genome from the UK., Conclusions: The high burden of infectious disease, together with osteological markers of physiological stress, reflect a poor health status of the community. This could have been an indirect result of the climate decline in Europe at the time, caused by the Late Antique Little Ice Age (LALIA). Our findings suggest that LALIA may have created an ecological context in which persistent outbreaks set the stage for major epidemics of severe diseases such as leprosy and smallpox hundreds of years later., (© 2022. The Author(s).)

Traditionally, India holds the unenviable position of the origin of leprosy. The disease is thought to have spread, via trade and war, to China, Egypt, and the Middle East, and later to Europe and the Americas. From antiquity to modernity, Indian society treated leprosy singularly for custom and law, a response shaped by both scientific knowledge and cultural attitudes. Over the past centuries, tireless research by eminent physicians and scientists working in India have helped establish a better understanding of clinical, bacteriologic, pathologic, and immunologic aspects of leprosy. Therapeutic modalities that were initially restricted to chaulmoogra expanded to include newer anti-leprotic medications and even surgical reconstruction of deformities. India's future challenges in leprosy control include stigmata, educational knowledge gaps, and multiple systems of medicine. This contribution is an attempt to comprehensively discuss the historic aspect of this exclusive disease focusing on the varied scientific contributions from India., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To document and differentially diagnose facial pathology found in an isolated skull from St. Vincent and the Grenadines, southeastern Caribbean. To directly date this individual using radiocarbon dating., Materials: Isolated skull recovered from Petite Mustique Island., Methods: Describe facial pathology occurring in this individual and compare with known diseases or disease processes that impact the craniofacial complex., Results: Features of the rhinomaxillary syndrome are present, indicating a diagnosis of leprosy. Dating places the time of death to the late 18th or early 19th centuries., Conclusions: Analysis of the rhinomaxillary syndrome produces a diagnosis of early-stage leprosy in an individual that correlates with the apparent attempt to locate a leprosarium on Petite Mustique Island in the first decade of the 19th century., Significance: Location and time corroborate historical records of at least one attempt to locate a leprosarium on Petite Mustique Island. Only directly dated individual with leprosy in the western hemisphere and possibly the earliest yet recorded., Limitations: This is an isolated find that is archaeologically unprovenienced., Suggestions for Further Research: Professional archaeological survey of Petite Mustique., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The aim of our paper is to demonstrate a middle-aged male (KK61) from the 8th-century-CE cemetery of Kiskundorozsma-Kettőshatár I (Duna-Tisza Interfluve, Hungary), who appears to represent the lepromatous form of Hansen's disease. Leprosy has affected not only the rhinomaxillary region of his face but also his lower limbs, with severe deformation and disfigurement of the involved anatomical areas (saddle-nose and flat-foot deformity, respectively). Consequently, he would have experienced disability in performing the basic activities of daily living, such as eating, drinking, standing or walking; and thus, he would have required regular and substantial care from others to survive. Despite his very visible disease and associated debility, it seems that KK61 was accepted as a member of the community in death, since he has been buried within the cemetery boundaries, among others from his community. In addition, his grave has conformed to the mortuary practices characteristic of the Kiskundorozsma-Kettőshatár I cemetery (e.g., burial orientation, position of the body in the grave, and type and quantity of accompanying grave goods). Although distinction or segregation in life do not preclude normative treatment in death, the long-lasting survival of KK61 with Hansen's disease implies that he would not have been abandoned but cared for by others. KK61 is one of the few published historic cases with leprosy from the Avar Age of the Hungarian Duna-Tisza Interfluve. His case gives us a unique insight into the biological consequences of living with Hansen's disease and illustrates the social attitude toward leprosy sufferers in early mediaeval Hungary., Competing Interests: The authors have declared that no competing interests exist.

Objectives: By focusing on two Danish leprosaria (Naestved and Odense; 13th-16th c. CE) and using diet and origin as proxies, we follow a multi-isotopic approach to reconstruct life histories of patients and investigate how leprosy affected both institutionalized individuals and the medieval Danish community as a whole., Materials and Methods: We combine archaeology, historical sources, biological anthropology, isotopic analyses (δ 13 C, δ 15 N, δ 34 S, 87 Sr/ 86 Sr) and radiocarbon dating, and further analyze bones with different turnover rates (ribs and long bones)., Results: The δ 13 C, δ 15 N and δ 34 S results indicate a C 3 terrestrial diet with small contributions of marine protein for leprosy patients and individuals from other medieval Danish sites. A similar diet is seen through time, between males and females, and patients with and without changes on facial bones. The isotopic comparison between ribs and long bones reveals no significant dietary change. The δ 34 S and 87 Sr/ 86 Sr results suggest that patients were local to the regions of the leprosaria. Moreover, the radiocarbon dates show a mere 50% agreement with the arm position dating method used in Denmark., Conclusions: A local origin for the leprosy patients is in line with historical evidence, unlike the small dietary contribution of marine protein. Although only 10% of the analyzed individuals have rib/long bone offsets that undoubtedly show a dietary shift, the data appear to reveal a pattern for 25 individuals (out of 50), with elevated δ 13 C and/or δ 15 N values in the ribs compared to the long bones, which points toward a communal type of diet and reveals organizational aspects of the institution., (© 2021 Wiley Periodicals LLC.)

Objective: This study describes the first evidence of a probable paleopathological case of leprosy from northern Portugal., Materials: An adult male, skeleton 403, exhumed from the Christian cemetery associated with the church dedicated to Saint Mamede (Travanca, Santa Maria da Feira), dated from the 17th-19th century AD., Methods: Standard bioarchaeological methods were used for sex and age-at-death determinations, and leprosy-related bone lesions were identified through macroscopic analysis guided by paleopathological diagnostic criteria., Results: The macroscopic observation revealed probable leprosy-related skeletal lesions, namely tenuous rhinomaxillary changes, bilateral proliferative periosteal reactions on the tibiae and fibulae, as well as concentric atrophy, acro-osteolysis and ankyloses of foot bones., Conclusions: Skeleton 403 represents a probable case of leprosy according to the nature and distribution pattern of bony lesions observed., Significance: This finding fills an important gap in the history of leprosy in Portugal. Although historical sources show that the majority of leprosaria were located in the northern part of the country, suggesting that leprosy was more prevalent in this area of Portugal in the past, no paleopathological evidence of this disease was reported for this region to date. Furthermore, the inhumation of a leprosy sufferer in a 17th-19th century AD Christian parish cemetery is deeply imbued with social meaning., Suggestion for Future Research: The future detailed study of the remaining skeletons unearthed from the cemetery of the Church of São Mamede will hopefully reveal further osteological evidence of leprosy in addition to the application of ancient DNA analysis to confirm the presence of the pathogen of this disease. Also, further documentary research is needed in order to expand appreciation of the epidemiological and social impact of leprosy in the 17th-19th century AD Portugal., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The key to evolution is reproduction. Pathogens can either kill the human host or can invade the host without causing death, thus ensuring their own survival, reproduction and spread. Tuberculosis, treponematoses and leprosy are widespread chronic infectious diseases whereby the host is not immediately killed. These diseases are examples of the co-evolution of host and pathogen. They can be well studied as the paleopathological record is extensive, spanning over 200 human generations. The paleopathology of each disease has been well documented in the form of published synthetic analyses recording each known case and case frequencies in the samples they were derived from. Here the data from these synthetic analyses were re-analysed to show changes in the prevalence of each disease over time. A total of 69,379 skeletons are included in this study. There was ultimately a decline in the prevalence of each disease over time, this decline was statistically significant (Chi-squared, p<0.001). A trend may start with the increase in the disease's prevalence before the prevalence declines, in tuberculosis the decline is monotonic. Increase in skeletal changes resulting from the respective diseases appears in the initial period of host-disease contact, followed by a decline resulting from co-adaptation that is mutually beneficial for the disease (spread and maintenance of pathogen) and host (less pathological reactions to the infection). Eventually either the host may become immune or tolerant, or the pathogen tends to be commensalic rather than parasitic., Competing Interests: The Authors have declared that no competing interests exist.

Zhejiang Wukang sanatorium evolved from Hangchow C. M.S. Hospital, which was founded in 1887. It is the leprosy prevention and treatment center of Zhejiang Province after the founding of the People's Republic of China. Most of the leprosy patients (convalescents)in sanatoriums entered the hospital successively in 1960s. Due to the limitation of dapsone monotherapy and the poor living conditions, the convalescents need to receive long-term isolation treatment and engage in collective production. After the implementation of Reform and Opening-up policy, the leprosy patients' health care has been greatly improved. The leprosy prevention and treatment course has been gradually reduced; the widespread knowledge of leprosy gradually freed leprosy patients from the dilemma of being stigmatized. In the post-leprosy era, Wukang sanatorium changed from the original focus on disease treatment to strengthening the psychological construction of patients. Its function changed from isolation and prevention to rest and pension, and the status of leprosy patients changed from "patients" to "convalescents" . These changes reflect the humanistic care and guidance of destigmatization in the process of leprosy isolation and epidemic prevention from prevention to treatment to the aged.

Mineralized dental plaque (calculus) has proven to be an excellent source of ancient biomolecules. Here we present a Mycobacterium leprae genome (6.6-fold), the causative agent of leprosy, recovered via shotgun sequencing of sixteenth-century human dental calculus from an individual from Trondheim, Norway. When phylogenetically placed, this genome falls in branch 3I among the diversity of other contemporary ancient strains from Northern Europe. Moreover, ancient mycobacterial peptides were retrieved via mass spectrometry-based proteomics, further validating the presence of the pathogen. Mycobacterium leprae can readily be detected in the oral cavity and associated mucosal membranes, which likely contributed to it being incorporated into this individual's dental calculus. This individual showed some possible, but not definitive, evidence of skeletal lesions associated with early-stage leprosy. This study is the first known example of successful multi-omics retrieval of M. leprae from archaeological dental calculus. Furthermore, we offer new insights into dental calculus as an alternative sample source to bones or teeth for detecting and molecularly characterizing M. leprae in individuals from the archaeological record. This article is part of the theme issue 'Insights into health and disease from ancient biomolecules'.

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The present review summarizes the current updates on dental perspectives on leprosy and the affording factors that are responsible for the prevalence of caries and periodontal diseases in leprosy. It also highlights immunopathological phenomena and reactional episodes of leprosy that occur due to daedal interactions between the perio-odontopathic bacteria and M. leprae. In addition, a brief introduction, historiography, classification and clinicopathological aspects are also been covered., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019. Published by Elsevier Inc.)

Leprosy is a bacterial infection causing severe disfigurement of the affected individual. It is considered as an ancient disease affecting humanity since thousands of years and also has tremendous stigma associated with it. It is known as a neglected tropical disease. In spite of all the efforts, the disease remains a major healthcare distress in many underdeveloped and developing countries like India and Brazil. Thus, to understand the disease and implement various strategies successfully, one need to understand the epidemiological aspect of the disease along with various operational factors influencing the epidemiological data. Thus, the present paper describes the various epidemiological facts and figures of leprosy along with the suggestions and measures to tackle this global ailment., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

During the Middle Ages, leprosy sufferers could not live in the city and were forced outside the walls. In the centuries, the Genoese area dedicated several hospitals to lepers, such as S. Lazzaro and Pammatone Hospital, a small leprosarium in the Tigullio area and San Martino Hospital from 1935. The first doctor who recognized to cure leprosy in Genoa was Goffredo, who later was also nominated rector of the community. In the early 1900's, Radaeli promoted the construction of a leprosarium behind the San Martino hospital. In 1936 Giuseppe Mariani was known for using the leprosarium to hide Italian Jews during deportation to the extermination camps. Later, Professor Aldo Baccaredda-Boy instituted the graduate school in "Leprosy and Tropical Dermatology", continued by professor Enrico Nunzi until 1990. The leprosarium was then transformed into the Department of Tropical Dermatology and finally into the Operative Unit of Social Dermatology, a national reference center.

Background: The Paris Catacombs contain the remains of approximately 6 million people dating back to the 15th century, when leprosy was endemic in France. Aims: The aim of this palaeopathological study was to identify the presence of leprosy in skulls from the Paris Catacombs. Subjects and methods: Macroscopic examination of skulls in situ for bone changes secondary to oronasal soft tissue infection by leprosy. Skulls were categorised as having "probable" signs of leprosy if they had an enlarged nasal (pyriform) aperture, resorption of the anterior nasal spine, and resorption of the alveolar processes of maxilla, and as having "possible" signs of leprosy if they met one of these three criteria. Results: Skulls from 123 sections within the Catacombs (approximately 1500 remains in total) were triaged, with 367 skulls identified as suitable for examination. Of these, 74 had central facial bone alterations/abnormalities and underwent detailed examination, yielding 0.5% (2/367) classified as having probable, and 5.7% (21/367) possible signs of leprosy. Conclusions: The proportion of skulls with probable signs of leprosy gives an approximate estimate (0.5%) for the prevalence of this disease in the population of Paris (or districts of Paris) during the 15-18th centuries.

Orosháza site no. 10 (Southeast Hungary) contains the partially excavated archaeological remains of an 11-13 th century CE Muslim merchant village and its cemetery located in close proximity to Christian villages of the same era. The skeleton of a young woman (grave no. 16) from the last phase of the cemetery use was identified with rhinomaxillary lesions associated with lepromatous leprosy. The right parietal bone also exhibited signs of cranial trauma, possibly caused by symbolic trepanation, a well-known ritual practice in the 9-11 th century CE Carpathian Basin. The retrospective diagnosis of the disease was supported by ancient DNA analysis, as the samples were positive for Mycobacterium leprae aDNA, shown to be of genotype 3. Contrary to the general practice of the era, the body of the young female with severe signs of leprosy was interred among the regular graves of the Muslim cemetery in Orosháza, which may reflect the unique cultural background of the community.

Few investigations to date have analyzed the epidemiology of Hansen's disease (leprosy) in the United States, and in particular, if birth location is related to multibacillary versus paucibacillary leprosy. We collected data on 123 patients diagnosed with leprosy in Georgia from the National Hansen's Disease Program from 1923-January 2018. A logistic regression model was built to examine the relationship between country of origin (U.S.-born or immigrant) and the type of leprosy. While the model showed no significant relationship between country of origin and type of leprosy, being Asian or Pacific Islander was associated with a higher odds of multibacillary disease (aOR = 5.71; 95% CI: 1.25-26.29). Furthermore, since the early 1900s, we found an increasing trend of leprosy reports in Georgia among both domestic born and immigrant residents, despite the overall decrease in cases in the United States during the same time period. More research is therefore necessary to further evaluate risk for multibacillary leprosy in certain populations and to create targeted interventions and prevention strategies., Competing Interests: The authors have declared that no competing interests exist.

The purpose of this research is to describe how Hansen's disease patients experienced the modern system of control of Hansen's disease introduced by Japan, and the inimical attitude of society against them in colonial Korea. The study also seeks to reveal the development of the system to eliminate Hansen's disease patients from their home and community to larger society and leprosarium in this era. Sorokdo Charity hospital (SCH), a hospital for Hansen's disease patients, was built in 1916, and vagrant Hansen's disease patients began to be isolated in this hospital beginning in 1917 by the Japanese Government-General of Korea (JGGK). Once the police detained and sent vagrant Hansen's disease patients to SCH, stigma and discrimination against them strengthened in Korean society. Because of strong stigma and discrimination in Korean society, Hansen's disease patients suffered from daily threats of death. First, their family members were not only afraid of the contagiousness of Hansen's disease but also the stigma and discrimination against themselves by community members. If a family had a Hansen's disease patient, the rest of community members would discriminate against the entire family. Furthermore, because Hansen's disease patients were excluded from any economic livelihood such as getting a job, the existence of the patients was a big burden for their families. Therefore, many patients left their homes and began their vagrancy. The patients who could not leave their homes committed suicide or were killed by their family members. The victims of such deaths were usually women, who were at the lower position in the family hierarchy. In the strong Confucian society in Korea, more female patients were killed by themselves than male patients. Moreover, all of patients victims in the murder were women. This shows that the stigma and discrimination against Hansen's disease patients within their families were stronger against women than men. Strong stigma and discrimination made the patients rely on superstition such as cannibalism. Patients believed that there were not any effective medicine. There were a few reports of patients who were cured, and many were treated with chaulmoogra oil in the modern Hansen's disease hospitals. Eating human flesh was known as a folk remedy for Hansen's disease. As such, patients began to kill healthy people, usually children, to eat their flesh. Increased stigma led to increased victims. Hansen's disease patients who left their homes faced many threats during their vagrancy. For survival, they established their own organizations in the late 1920's. The patients who were rejected to be hospitalized in the Western Hansen's disease hospital at Busan, Daegu, and Yeosu organized self-help organizations. The purpose of these organizations was first to secure the medicine supply of chaulmoogra oil. However, as stigma and discrimination strengthened, these organizations formed by Hansen's disease patients demanded the Japanese Government-General of Korea to send and segregate them on Sorok island. They did not know the situation of the inside of this island because news media described it as a haven for patients, and very few patients were discharged from this island to tell the truth. On this island, several hundreds of patients were killed by compulsory heavy labor, starvation, and violence. They were not treated as patients, but as something to be eliminated. Under strong suppression on this island, the patients resisted first by escaping this island. However, in 1937, some patients tried to kill a Korean staff but failed. Attempted murderers were all put in the jail, also located on this island. In 1941, a patient murdered another patient who had harassed other patients, and in 1942, Chunsang Lee, a patient, killed the director of Sorok island. These instances show that there was a system to eliminate Hansen's disease patients in colonial Korea.

During the 12 th and 13 th centuries, numerous leprosy hospitals were founded in Europe. Given that leprosy was not considered infectious, this may reflect social dimensions of the disease. Aiming at exploring the impact of leprosy on medieval people and the organisation of the Danish leprosarium at Næstved, we reconstructed the diet of twenty patients using stable isotopes, and compared our results with relevant historical data. The isotope results revealed a terrestrial C 3 diet with a small contribution of aquatic foods. Contrary to historical evidence of daily fish consumption in the leprosy hospital, only six individuals consumed relatively large amounts of freshwater fish. Leprosaria have been considered monastic institutions, and thus a varied diet, poor in aquatic protein, questions the monastic nature of the hospital and points to a social stratification. A multi-isotope analysis of a larger sample set would add to our understanding of the diet of the leprosy patients, as well as their treatment in the leprosarium .

The consequences of urbanization, such as increased exposure to pathogens, have long been considered detrimental to human health. During the first half of the Danish medieval period, towns were established and throughout the period population increased. The following study analyzes the relationship between urbanization and disease frequency - specifically leprosy and tuberculosis - in four skeletal samples from medieval Denmark using a paleoepidemiological approach. Skeletons from two urban sites (Ole Wormsgade and Ribe Grey Friary) and two rural sites (Øm Kloster and Sejet), all located in the Jutland region of Denmark, were selected for this analysis ( n = 204). All skeletons included date to the middle part of the Danish medieval period (AD 1200-1400). Six skeletal leprosy indicators and six skeletal tuberculosis indicators were analyzed, and disease frequencies in the samples were estimated using a probabilistic approach based on lesion sensitivity and specificity. The effect of tuberculosis on survival in urban and rural samples was evaluated using Kaplan-Meier survival analyses. The frequency of leprosy at death varied between four and 19 percent among the four cemeteries with Ole Wormsgade having the highest frequency. The estimated frequency of tuberculosis at death varied between 39 and 69 percent. Here, Sejet cemetery had the highest frequency. There were significant differences in survival for those with and without tuberculosis-related lesions between sites, but there were no significant differences between urban and rural sites. The analyses presented in this paper suggest that disease prevalence in skeletal samples cannot be sufficiently explained by urbanization alone; rather, there are likely other biological and behavioral sources of heterogeneity that are contributing factors to past disease experience.

In light of the World Health Organization's push to accelerate progress toward a leprosy-free world by 2020, it is fitting to look back on the evolution of progress in treating lepromatous neuropathy and limb deformities. To date, no surgeon has had as great an impact on the understanding and treatment of this disease as Dr Paul Brand. Before Dr Brand's accomplishments, few surgeons participated in the management of the deformed leprous patient. By challenging conventional beliefs, Dr Brand revealed that many of the deformities associated with leprosy were in fact caused by nerve damage and subsequent limb anesthesia. His pioneering work centered on tendon transfers to provide hand and foot mobility to leprous patients, revolutionizing the surgical management of this patient population and restoring functionality to the lives of otherwise stigmatized and functionally handicapped individuals. In the process, he provided us with the surgical principles and techniques that we still apply today. Because of its predilection for the peripheral nervous system, leprosy also provides an excellent opportunity to investigate mechanisms of demyelination and chronic nerve degeneration in nonacute peripheral neuropathies. Processes underlying demyelination of infectious, traumatic, and genetic etiologies overlap and precede the onset of acute neuronal derangement. Glial pathology has been shown to be a common pathological element in leprosy, Charcot-Marie-Tooth type I, multiple sclerosis, and chronic nerve compression injury. The aim of this article is to provide an overview of lepromatous neuropathy with its subsequent deformities as it relates to the pathophysiology, surgical management, and potential therapeutic targets of other modern peripheral neuropathies., (Copyright © 2019 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Context: Tuberculosis and leprosy are readily recognised in human remains due to their typical palaeopathology. Both Mycobacterium tuberculosis (MTB) and Mycobacterium leprae (ML) are obligate pathogens and have been detected in ancient human populations. Objective: To demonstrate historical tuberculosis and leprosy cases in Europe and beyond using molecular methods, as human populations are associated with different mycobacterial genotypes. Methods: MTB and ML ancient DNA (aDNA) has been detected by DNA amplification using PCR, or by whole genome sequencing. Mycobacterial cell wall lipids also provide specific markers for identification. Results: In 18th century Hungary, the European indigenous MTB genotype 4 strains have been found. However, many individuals were co-infected with up to three MTB sub-genotypes. In 8th-14th century Europe significant differences in ML genotypes were found between northwest Europe compared with central, southern, or eastern Europe. In addition, several co-infections of MTB and ML were detected in historical samples. Conclusion: Both MTB and ML strain types differ between geographically separate populations. This is associated with ancient human migration after an evolutionary bottleneck and clonal expansion. The absence of indigenous leprosy in Europe today may be due to the greater mortality of tuberculosis in individuals who are co-infected with both organisms.

Competing Interests: None

Relatively little is known of leprosy in Medieval Ireland; as an island located at the far west of Europe it has the potential to provide interesting insights in relation to the historical epidemiology of the disease. To this end the study focuses on five cases of probable leprosy identified in human skeletal remains excavated from inhumation burials. Three of the individuals derived from the cemetery of St Michael Le Pole, Golden Lane, Dublin, while single examples were also identified from Ardreigh, Co. Kildare, and St Patrick's Church, Armoy, Co. Antrim. The individuals were radiocarbon dated and examined biomolecularly for evidence of either of the causative pathogens, M. leprae or M. lepromatosis. Oxygen and strontium isotopes were measured in tooth enamel and rib samples to determine where the individuals had spent their formative years and to ascertain if they had undertaken any recent migrations. We detected M. leprae DNA in the three Golden Lane cases but not in the probable cases from either Ardreigh Co. Kildare or Armoy, Co. Antrim. M. lepromatosis was not detected in any of the burals. DNA preservation was sufficiently robust to allow genotyping of M. leprae strains in two of the Golden Lane burials, SkCXCV (12-13th century) and SkCCXXX (11-13th century). These strains were found to belong on different lineages of the M. leprae phylogenetic tree, namely branches 3 and 2 respectively. Whole genome sequencing was also attempted on these two isolates with a view to gaining further information but poor genome coverage precluded phylogenetic analysis. Data from the biomolecular study was combined with osteological, isotopic and radiocarbon dating to provide a comprehensive and multidisciplinary study of the Irish cases. Strontium and oxygen isotopic analysis indicate that two of the individuals from Golden Lane (SkCXLVIII (10-11th century) and SkCXCV) were of Scandinavian origin, while SkCCXXX may have spent his childhood in the north of Ireland or central Britain. We propose that the Vikings were responsible for introducing leprosy to Ireland. This work adds to our knowledge of the likely origins of leprosy in Medieval Ireland and will hopefully stimulate further research into the history and spread of this ancient disease across the world., Competing Interests: The authors have declared that no competing interests exist.

Father Adam Wiśniewski (1913-1987), who was a Pallottine and a medical doctor with specialization in tropical diseases, devoted his life to helping and curing leprosy patients in India. His life proved difficult and varied. He began his medical studies during World War II in occupied Warsaw. What is more, he participated in the Warsaw Uprising in 1944, for which he later received the Cross of Valour, one of the highest Polish commendations. He learned about leprosy in France and then moved to India to use his medical knowledge to treat lepers and stop the spread of the disease. He created a center for the impoverished at Jeevodaya, India, which is still serves as a refuge for patients with leprosy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Father Damien de Veuster, or Saint Damien of Molokai (1840-1889), was one of the pioneers of the holistic approach to care provision for leprosy patients and contributed to the overcoming of the patients' social stigmatization. He devoted his life to the lepers living in America's only leper colony, on the Hawaiian island of Molokai, where people with leprosy were required to live under government-sanctioned medical quarantine. Father Damien gained practical skills in caring for the sick, eagerly learning wound cleansing, bandaging techniques, and drug administration from a nurse. Mahatma Gandhi said that Father Damien's work had inspired his own social campaigns in India., (Copyright © 2018. Published by Elsevier Inc.)

Studying ancient DNA allows us to retrace the evolutionary history of human pathogens, such as Mycobacterium leprae, the main causative agent of leprosy. Leprosy is one of the oldest recorded and most stigmatizing diseases in human history. The disease was prevalent in Europe until the 16th century and is still endemic in many countries with over 200,000 new cases reported annually. Previous worldwide studies on modern and European medieval M. leprae genomes revealed that they cluster into several distinct branches of which two were present in medieval Northwestern Europe. In this study, we analyzed 10 new medieval M. leprae genomes including the so far oldest M. leprae genome from one of the earliest known cases of leprosy in the United Kingdom-a skeleton from the Great Chesterford cemetery with a calibrated age of 415-545 C.E. This dataset provides a genetic time transect of M. leprae diversity in Europe over the past 1500 years. We find M. leprae strains from four distinct branches to be present in the Early Medieval Period, and strains from three different branches were detected within a single cemetery from the High Medieval Period. Altogether these findings suggest a higher genetic diversity of M. leprae strains in medieval Europe at various time points than previously assumed. The resulting more complex picture of the past phylogeography of leprosy in Europe impacts current phylogeographical models of M. leprae dissemination. It suggests alternative models for the past spread of leprosy such as a wide spread prevalence of strains from different branches in Eurasia already in Antiquity or maybe even an origin in Western Eurasia. Furthermore, these results highlight how studying ancient M. leprae strains improves understanding the history of leprosy worldwide.

For centuries, patients afflicted with the peripheral nerve damaging disease, leprosy-sometimes referred to as Hansen's Disease-were excluded from society and harshly stigmatized. Such stigmatization often stemmed from the belief that the disease was a punishment by G-d for wrongdoing. Leprosy's origins remain rooted throughout various European countries; however, the disease established its presence in North America around the late 18th century. In particular, major port cities that experienced high volume trade, such as New Orleans, were most susceptible to infection. In response to the ensuing Louisiana leprosy endemic, various medical pioneers established the first hospital in America dedicated solely to the treatment of lepers, the Carville Leprosarium. The World Health Organization's treatment recommendation, multidrug therapy, is one of many lifesaving discoveries made at the facility located nearly 70 miles north of New Orleans. Since opening in 1894, the Carville Leprosarium has treated hundreds of Americans infected with Mycobacterium leprae, the disease-causing agent responsible for leprosy., (Published by Elsevier Inc.)

This essay focuses on the use of the concept of "arrest" in Hansen's disease (leprosy) in the United States in the early to middle part of the 20th century, as well as the transformations the concept underwent with the arrival of sulfone drugs and the implications of these changes for patients and public health officers. An "arrest" was a therapeutic outcome characterized by a long course of treatment, noncontagiousness, a very small chance of reactivation, and a need for postdischarge maintenance that depended on sociomedical infrastructures beyond the clinic as well as self-imposed lifestyle limitations. The concept of disease arrest shows that experts and laypeople alike have valued therapeutic outcomes other than "cure" that signal certain optimal therapeutic milestones, despite the practical difficulties they imply and despite the fact that they do not promise a return to a pre-illness stage.