I., ' rt:HNA nON AL J 01 ' H :-.' AL 0,- LH'HOS) Volume 43 . Numoer 2 Prilltet! ill till' U. S .A .

An Overview of Research on the History of Leprosy

Part 1. From Celsus to Simpson, Circa. 1 A.D. 1,2

Part 2. From Virchow to M011er-Christensen, 1845-1973

J 3

Philip A. Kalisch

The histo ry of leprosy, important as it un­doubtedly is, rece ives sca nt a ttention from leprologists today. Occas iona ll y, a signifi­cant article may appear in Danish, German , French, and in iso lated instances British a nd American periodicals , but on the whole the production is but a trickle and largely re­mains unnoticed. This void is unfortunate because the study of leprosy history makes it possible for today's leprologist to immerse himself in the lives and times of the great leprosy investigators of the past, their ac­complishments and id eas, and their influ­ence on their own and subsequent periods. In this way the leprologist can identify him­self with the mature minds of yesteryear and consider himself a link in the great chain of tradition that shapes his work.

Moreover, because the history of leprosy has critical medical, social, cultural, psycho­logical and educational functions; because leprologists are all prisoners of the past, in the sense that their options are limited by what has gone before and their preferences are shaped by their image of who they are and what leprosy has meant to mankind, it is of the utmost importance that they try to free the history of leprosy from the myth and error that surrounds it. The following bibli­ographical survey of works on the history of leprosy seeks to stimulate additional re­search in the field by identifying some of the significant works upon which the contempo­rary leprologist may build.

PART 1

At the time of Christ, what was known as leprosy or elephantiasis had elicited a nebu-

I Received for publica tion 23 May 1973. 1 Part 2 of thi s pa per was presented a t the Tenth In­

te rna tio nal Leprosy Co ng ress , Bergen , No rway, 17 August 1973 .

) P. A. Ka li sch, M.A., Ph . D., Associate Professor and Resea rch Scie nti st , Histo ry of Nurs ing Research Proj­ect , University of Michiga n Medica l Center , 428 Victor Vaughan Building, Ann Arbo r, Michiga n 48104.

lo us a nd now controve rsial literature accu­mulated during an unbroke n co ntinuit y of more than a th ousa nd years , perhaps even severa l millenniums. With thi s disputed a r­cheological a nd semanti c problem we are not conce rned . Needless to say a recent im­plicatio n th a t lep rosy ex ist ed in ancient Egypt has not go ne unchallenged (11 2). Be tha t as it may, the Roma n writer Celsus ( 37 ), who was born in 25 B. C. , a nd th e R oma n politician , Plinius Sec undus, born in 23 A. D. (191), both had many antecedent writings to aid them in their fairly distinct descripti ons of leprosy as .did the la ter Greek physicians. Galenus ( 83 ), Aretaeus (1 0), a nd Soranus, of Ephesus ( 223 ).

The advance of kn ow ledge co nce rning leprosy was abruptly halted by the collapse of the Roman world after 300 A.D., and by three centuries later th ere was almost no medical knowledge available concerning the disease in the Wes tern world. Although copies of the preceding works and other treatises were probably extant, by 600 A.D. practically no layman could read tho se books. Thus, the embryo of leprology was dead in western Europe, a casualty of the semi barbaric hordes who had no tradition of learning.

The knowledge of leprosy had never sunk so low in the East during these centuries as it had in western Europe. Constantinople survived successive attacks by the Arabs and preserved its libraries, and the Greeks who peopled it had a high regard for learn­ing, which was resumed when conditions permitted. During this time such physicians as Aurelianus (15), Aetius, of Amida (3), Paulus Ageineta (1 86), and Oribasius of Per­gamun (1 81) substantiated the existence of the disease and traced it to prehistoric times. Oribasi us very much praised the eating of vipers, for he writes that this gave a wonder­ful help and relief to "lepers." The Arabs, though they lacked the tradition of scholar­ship, were an able people whose ancestors

129

130 International lournal of Leprosy 1975

had lived on the edge of all the great civiliza­tions of antiquity, and they respected erudi­tion. Once firmly in control of a vast empire, the Moslems supported learning, and the great caliphs, including Haroun-al-Raschid , had camel caravans laden with Greek and Latin books brought to Baghdad, where they engaged Nestorians, Jews, and Persians to translate these works containing knowledge of leprosy into Arabic as documented by the laborious efforts of Janus Damascenus (48), Issac Israeli (11 3), the great Rhazes (196), Ali Abbas ( 6), Avicenna (1 8), Abulcasis ( 2), Avenzoar (1 6), and Averroes (1 7). This knowledge was available to the new schools which arose at Baghdad, at Cairo, and fi­nally at Cordova in Spain. Collectively, the Arabs not only helped to preserve the an­cient knowledge of leprosy but may have made important additions to it. By and large, however, the Arabic writers seem to have never entirely abandoned the notion that they were but humble disciples following in the footsteps of great masters, whom they were bound to revere, imitate, and quote, but never overthrow. Thus, they excelled in the synthesis of prior accumulated knowl­edge rather than in original findings.

Meanwhile, Christian Europe slowly struggled to lift itself out of barbarism and superstition aided by Jewish physicians who circulated Greco-Arabic knowledge through­out the Christendom and by translations of Greek and Arabic medical treatises into Latin. About \060, Constantinus Africanus (45) brought a cargo of Islamic medical lore to Salerno and with the aid of his transla­tions of Greek and Arabic works in medicine spurred the resurrection of such knowledge in Italy. His description of leprosy under the title "De morborum cogni.tone and cura­tione" with its theory of four species of lep­rosy was heavily borrowed from an Arabic work by A vicenna ( 18) who in turn had bor­rowed it with a little alteration from the Greeks themselves. Platearius, a 12th cen­tury s ucce sso r to Constantinus, diligently followed up this theory in his compendium entitled Practica 10. Serapionis (190).

The author of the most popular encyclo­pedia of medieval medicine, in the 13th cen­tury, the Franciscan Bartholomaeus Angli­cus (21) testified that persons afflicted with leprosy have "redde whelks and pymples in the face , out of whom oftenne runne blood and matter; en such the noses swellen, and

ben [become] grete, the vertue of smellynge faylyth , and the brethe stynkyth ryght fowle," and when the disease is advanced they are "unclean, spotyed, glemy, and quy­thery [watery], and the nosethrille s ben stopye, the wasen of the voys is rough and the voys is horse, and the heere falls ." Some 200 years later in the late 1400's Valesco de Taranta, a physician of Montpellier, strongly recommended castration as the cure for lep­rosy si nce the disease was caused by too great a dryness and by the removal of the testicles the body would be moistened ( 240 ). Many of his contemporaries held views that were just as far fetched. They included Bar­tolomeo Montagnana of Padua (1 71), Pietro d' Argellata of Bologna (I I), Ferrari de Gradi of Pavia ( 75 ), and Hans von Ger sdorff of Strassbourg ( 84).

An early 20th century historian of leprosy, Hans Carlowitz (36) completed a disserta­tion under the direction of Karl Sudhoff which compared most of the important 13th and 14th century commentators on leprosy including Teodorico Borgognoni (230), Gil­bert, the Englishman ( 86 ), Guglielmo da Sa­liceto (95), Arnaldus de Villanova (12), Lan­franco , of Milan (134), Bernard de Gordon ( 23 ), Vitalis de Furno (245), John of Gaddes­den (125), Henry de Mondeville (170), and Guy de Chavliac (97). Carlowitz found that the authors differed from each other only slightly and that all except those who lived before Bernard (ca. 1285-1308) made use of Bernard's U/ium medicinae. He noted that Henry of Mondeville and John of Gaddes­den were particularly alike as they frequent­ly used the same phraseology, for example. Carlowitz concluded that all these physi­cians relied less upon their own observations than upon the work of such famous Arabian physicians as Rhazes, Ali Abbas, Avicenna, and their 11th century commentator, Con­stantinus Africanus. The most original of the accounts appeared to be those by Gilbert and Bernard de Gordon.

Throndike, Sarton, and Singer have all remarked on the fact that no notable con­tributions were made to medical literature, including that pertaining to leprosy ( 5), for more than a century after the Black Death. The effects of the cataclysmic plague pan­demic that killed an estimated 43 million people in the Christian world during the mid 1300's, are impossible to assess. It is impor­tant to note , however, that an added obstacle

43 , 2 P. A. Kalisch: Research on the History 0/ Lepros.\' 13 1

during that time was implicit in the lack of the printing press to foster th e di stributi o n of the know ledge tha t did ex ist. Boo ks were written by ha nd and copies were ex pensive. Time a nd time aga in an advance had bee n made in medica l knowledge o nl y to be lost , or to be known only to a few who did not pass o n the informa tion . The chief book s on ancient leprosy and medicine were nea rl y all written in class ical Greek , those o f the Arab and J ewis h phys icians in Arabic and He brew, a nd no ne of these la nguages was widely kn ow n in western Europe. Such transla ti o ns as exis ted were very imperfect. Then in the la te 1400's a knowledge revolu­tion was facilitated when mova ble ty pe was d ev ise d and by 1500 Ital y a lo ne had 73 presses employing mova ble type. By about the middle o f the 16th century a n educated medica l profess ion in western Europe had access to nea rl y all the accumulated medical and scientific litera ture that was then avail­able and was again in full com mand of an­cient medicine a nd lep rosy as it had bee n passed down . But it had take n a full 1,000 years o f fumbling effo rt to recove r the lep­rosy knowledge that it had so unwittingly abandoned in the 6th century. Thus, at the onset of the Renaissance (ca. 1500) , leprosy was soo n attacked by an outpouring of new books that touched on the subject. The phy­sician, physicist , and poet Girolamo Fracas­toro' s (19) work on syphili s helped to differ­enti a te between that di sease a nd leprosy. Other general treati ses of the period that touched on leprosy were authored by Philip­pus von Hohenheim , known as Paracelsus ( 184), Girolamo Cardano ( 35 ), Julien Le Paul­mier de Grentemesnil (142), Henrik Smith ( 222 ) and Ha ns Christensen Bartsker (42).

Concomitantly, the first se parate books, either so lely devoted to leprosy or heavily oriented toward that disease, appeared. In 1540 the French physician Pierre Bocellin wrote a 47-page treatise concerning the con­tagiousness and infectious nes s of leprosy ( 25 ). This was soon followed by a tract enti­tled "Examen leprosarum" in Conrad us Gesner's collection, De Chirurgia Scriptores .. . , published in 1555 ( 85 ). One of the best works of the great French military surgeon Ambroise Pare entitled Traicte de fa Peste ... avec une Bre/ve Description de fa Lepre, a bly dealt with leprosy (1 85 ). It was printed in Paris in 1568 and an altered edition was

tran s la ted int o Engli sh in 1630. Philippus Schopff of Augsburg published a not her spe­ciali zed effor t in 1582 (21~ ) followed four yea rs la ter by a 28-page doctoral stud y by Andreas Scholl ( W ) entitled, Theses de ra­t ione exp forandi, et judicandi feprosos . .. , which was written under the direction of Jo­hann Vischer. At the end of the 16th century Guillaume Des Innoce ns ve ry effectivel y synthesized what little was known about the disease oy draw ing from the works o f the Greeks , Romans, Arabs , as well as Renais­sa nce writers. This 132-page compilation probabl y contains the first substantial his­tory of leprosy ( 54 ).

Little a dva nc e in the writing of leprosy hi story occurred during the 17th century. As hi storical source ma teria l, Wilhelm Fabricus Von Hilden's observations on leprosy, con­tained in hi s Opera observationum et cura­tionum medico-chirurgicarum quae extant omnia, published in 1646, are of little value (63). The Danish phys icia n, Thomas Bartho­lin (20) gathered a more substantial body of knowledge in 1671. Other worthwhile works, almost a ll of which contain the traditional interpretations of the leprosy's antecedents include those by Luia (146), Sieboldt ( 217), Helvetius ( 103 ), and De Spina ( 53 ).

Moving into the 18th century, Helyo t of France wrote a s plendid account of the Knights of St. Lazarus, who always had a "leper" for their Grand Master (102). Help­ful as constituting indicators of the then pop­ular thinking on leprosy treatment are the accounts of Ovseel (1 83 ), Voight (247), Brooke ( 29 ), With of ( 255 ), Peysso nel (1 89 ), Udman ( 238 ), Murray (1 76 ), Schilling ( 210), Max y­movycz ( 155), Gislesen ( 87 ), and Scherb ( 209 ). Indeed the slight advance in knowledge con­cerning the malad y was revealed in an offi­cial report to the Roya l Society of Medicine of Paris in 1782 when two investigators cited Gilbert's 13th century de sc ription as the most clear exposition of leprosy that they had uncovered ( 38 ).

The initial attempt at a singularly histor­ical stud y of leprosy was made by Raymond of France in 1767 (194) . His uncritical use of sources and shallowness of much of hi s re­sea rch , however, reduced the va lue of an otherwise valuable work. John Howard's less ambitious account of the principal laza­rettos of Europe is also superficial. This ef­fort was followed in 1790 by the first success-

132 International Journal of Leprosy 1975

ful a tt empt to reco rd the hisro ry of leprosy. It was pu b li shed by Ph ilipp Gab ri el Hensle r, F irst Phys ic ia n to the King of De nmark, a nd Professor of Phys ics, Uni ve rsity o f Kie l ( 105). Unli ke hi s predecessbrs, Hens ler inte nse ly stud ied o rigina l so urces from the G reeks dow n to his own time.

In his fi rs t cha pter H e ns le r inves tiga tes the traces of leprosy fo und in t he wo rk s of a ncient phys ic ia ns a nd then s u bseq ue n t ly desc ribes le p rosy in the W es t durin g the middle ages. He ins ists tha t lep rosy was not bro ught int o the Wes t by the C rusades but ra ther nad re ma ined there from the times of the Ro ma ns. He d oes not d e n y, h oweve r, tha t leprosy raged with grea ter vio lence fo l­lowing the ho ly wa rs a nd ci tes M a tth ew Pa ri s' now questi o na ble estima te of 19,000 " leper ho uses" in the who le of Euro pe. In expla ining the dec line of leprosy in the West, Hensler notes tha t the sympt o ms of true lep­rosy gradua ll y va nished as o ther cuta neous a ffectio ns beca me mo re comm o n towa rd the end of the 15th ce ntury. He further suggests tha t a t length the lepro us co nstitutio n passed into the syphilitic . Appended to the wo rk a re ex tracts fro m a ncient a nd medieva l write rs a lo ng wi th severa l 18th century accounts o f leprosy in va rio us pa rts of the wo rld . Hens­ler's wo rk was r e print e d in 1794 a nd has se rved as a point of depa rture for scho la rly effo rts in leprosy hi sto ry for nea rly two cen­turies (105).

At the beginning of the 19th century the sta ndard clinica l wo rk o n leprosy was tha t of Alibert ( 5). A rou nd the sa me time A lefe ld (4 ), Ottner ( 182 ), Vieira (241) , Brown (31 ), Be rge rn o n ( 22 ), a nd Bre hm ( 27 ) prefaced their m o re spec ia li zed derma to logic studies with a few histo rica l references perta ining to leprosy in a ncient times. Brief hi sto rica l accounts by Lejeune co nce rn i ng the ea rly hi sto ry of the leprose rie in C h a rtres (139 ), Lehma ier o n the Biblica l refe rences to lep­rosy ( m ), a nd S hafter o n the lep rosy o f the middle ages ma rked the ascenda ncy of the cl ass ica l stud y of leprosy histo ry to a new high ( 216). It o nl y re m a in e d fo r Jam es Y. Simpso n ( 218) to publish his la ndma rk " An­tiqua ri a n Notices of Leprosy a nd Leper H os­pita ls in Scotla nd a nd Engla nd" a nd it s suc­cesso r a rtic les o n the "Nosological Na ture of the Di sease" a nd the "Etio logica l His­to ry," to ma rk the culmina ti on o f the c lassi­cal approach to leprosy a nd its history which

stretched bac k mo re tha n 1,800 yea rs to the time o f Ce lsus.

Wha t then sha ll we say o f the yea rs I A.D. to 1845? Fo r kn owledge rega rdi ng leprosy, they we re pe r io d s o f s low evo luti o n, fo l­lowed by near di sso luti o n, a nd subsequent evoluti o n. T he 17th century ha d suppli ed a scientifi c m e th o d fo r le pro log ica l hi sto ry, the 18th ce ntury had provided a n accumula­ti o n of fac ts with which to beg in wo rk , a nd the firs t ha lf of the 19th century sa w the frui­ti o n o f cl ass ica l hi sto ri ca l sc ho la rs hip a nd the initi a ti o n o f the sc ienti fic a pp roac h.

PART 2

T he hi sto ri ca l ma te ria l inse rt ed a t the be­ginning of ma ny present-d ay sc ienti fic lep­rosy mo nogra phs a nd a rti c les, offers a n ex­ce ll ent illustra tio n of w ha t has bee n fo r ma ny centuries the prima ry fo rm a nd a lm ost exclusive source fo r the histo ry o f leprosy. T hat traditio na l genre a ppea red in the ac­counts o f Da nie lssen (4~), Wilso n ( 254) , Ne is­se r (1 77 ), Ka pos i (1 01), Le lo ir (14(1), J ea n­se lme (11 5), Klin g mull e r ( 13 1), R oge rs a nd Muir ( 20 1), a nd Co~ hra ne ( 44) in the las t ha lf o f the 19th century a nd first six decades o f the 20th century. It had prev io usly enj oyed a continuo us hi sto ry fro m the Rena issa nce o n up into the 18th century, when the sco pe was much ex panded by the burgeoning co l­lecti on o f fac ts co ncerning t he di sease in dif­ferent pa rts of the wo rld . As prev io usly in­dica ted , fr o m the las t 50 yea rs of the 18th century co me the ea rli est hi sto ri ca l studies tha t a re so metimes still used as such, a mo ng them the se mina l trea ti ses by Raymo nd ( 194 ) a nd Hensle r (105).

From a pr e limin a ry litera ture exa min a­tio n, we ca n conclude tha t the o ldest a nd the traditio nal fo rm o f leprosy hi sto ry was nar­ra tio n buttresse d by occas io na l measure­ments. Fro m the Eu ro pea n inceptio n o f spe­cia li zed leprosy hi story in the la te 18th a nd ea rly 19th ce ntu r ies, however, bo th Phil ipp Hensle r in Germa ny a nd J a mes Y. Simpson in Engla nd sought to deve lo p it with out re­li a nce on the yet to come scientific a pproach to derma to logy . Mo reover, they seemed to ho ld tha t the centra l pr o bl e m s o f le prosy histo ry, a lth o ug h they might be st a t ed in term s of a particula r hi sto rica l phase, were in essence independent of socia l, econo mic, a nd politica l hi sto ry. With few exceptio ns, this general view permeated the writing o f

43. 2 P. A . Kalisch: Research on the Historr 0/ Leprosy 133

leprosy history in the world until the mid- ' 1900's. While numerous facts a nd stati stical data were collected they were se ldom a na­lyzed or used to test sociological proposi­tions, and ex ha usti ve monographic eva lua­tions of the long-term soc ial impact of leprosy were practically unknown.

Germa n-trained Ie p ro 10 gis t-h is toria ns, who in their rebellion against English clas­sicism called th e mse lv es "scientists," rein­forced this empirica l, pos iti vistic tre nd . Works such as those of Virchow (243), Ehlers ( 5~ . W), and Hirsch (109) were large, useful studies, full of factual detai l a nd stati stics, but generally devoid of theo retical interpre­tations. As a scientist writing history, Vir­chow insisted that hypothes is had only a transitory value, that is, to elicit new facts . Hypotheses could not rest without adequate proof or without verification. He condemned speculative thinking and emphasized the sa­cred ness of fact s.

Mean w h i Ie , the epidemiological-oriented studies of leprologists such as Bidenkap (24), Rogenhagen (200) and Dehio ( 50. 51), and the reports of the Royal College of Phys icians and the India Leprosy Commission (144), along with numerous papers presented at the Berlin Leprosy Congress (161), mar­shalled statistics to prove the contagious na­ture of leprosy . Like so many movements, that of the epidemiologists against deduc­tive, neoclassic leprosy history went to ex­tremes and in some instances resulted in antitheoretical attitudes that prevented de­velopment of new hypotheses. In the minds of many of these empiricists, including Jean­selme ( 11 5.124 ), Zambaco (256·260 ), and Ash­mead (13. 14) , there was an assumption that factually based theory would emerge from the data when it became sufficiently com­plete, but, except for limited propositions, it never did . Several epidemiologist-oriented historians of leprosy did , however, brilliantly fulfill their role as fact gatherers. Scores of articles and a still greater number of reports from various leprosaria form by far the largest part of the scientifically collected and prepared quantitative record of world lep­rosy history.

Both the scientific historiographic tradi­tion of Virchow and the subsequent epidemi­ological-oriented tradition that followed , produced occasional monumental studies such as the prize essays by Newman (1 80 )

a nd Ehlers ( 59). But the major objecti ve of these two traditi ons was to clarify and deep­en the unders ta nding of contem porary lep­rology by tra c in g its evo luti o n. Thus, 75 years ago most of those who wrote the his­tory of leprosy were practicing leprologists, so met imes eminent ones like Hansen (98). Usually leprosy history was for them a by­product of clinical practice or applied re­sea rch . . Moreover, they saw in it , besides intrinsic value, a mea ns to substantiate con­cepts of their current investigations by citing historical a ntecedents.

Since the turn of the century, within the field that might be loosely rega rded as lep­rosy history, there appea rs to be five major su bdisciplines: I) medical leprologica l his­tory; 2) the expe ri ence of leprosy in various politica l unit s; 3) medieva l leprosy history; 4) "Biblical leprosy"; and 5) individual lep­rosaria hi s tory. We will briefly consider some of the most productive efforts within each.

The medical history of leprosy, systemat­ically begun by Hensler, has tended to be scientific rather than therapeutic in its major emphases. Armauer Hanse n and Albert Neisse r have been studied in detail ( 78. 90), while the work of such other important lep­rologists as Arning in Hawaii , and Rake in Trinidad have received scant attention. His­torical output since World War II has cen­tered around the seminal paleopathological studies of Vii helm M~ller-Chri s tensen ( 162.169). His work has facilitated a most productive marriage between science and history and has in spired an unexcelled school of historical research on leprosy his­tory as evidenced by the monumental work of Andersen ( 8), and the more limited study by Brothwell (30). Other illuminating efforts in thi s area include tho se by Dokrr (55), Bourges (26), Fite and Mansfield (77), Goerke (88), and Schmitt (212).

While the national, provincial , and munic­ipal history of leprosy had isolated early precedents, such as those of Minkh (1 60) and Buhler ( JJ), the development of scholarly investigation of governmental reaction to the disease is notable in the late 19th century work of Sederholm (215) in Sweden, and Mouritz (174) in the Hawaiian Islands. Other studies devoted to the history of leprosy in various political units are those by Araujo (9) , Montoya y Florez ( 172 ), Ketting (1 29),

•

134 International Journal of Leprosy 1975

Haug (' 00 ), Denney ( 52 ), McCoy (1 56), Faget ( 64 ), Abee (I) , Spenesberger ( 224 ), Enna ( 61), San Martin Bacaicoa (206 ), Klovekorn ( 132 ), Chirakadze ( 41 ), Tolivar ( 2.1 1. m ), Vogelsand ( 245.246 ), Trevien (234), Richards (1 97), and Kalisch (1 26 ). Some of the most detailed na­tionalistic work has been done on Cuba by Gonzalez Prendes (91), and on France by Fay ( 65.7 1 ). Similar political unit studies in­clude Maurano on Sao Paulo, Brazil ( 15.1. IS.) ) ,

Frohn on the German Rheinland ( XO·X2 ), Cou­goul on Fra nce, Gonzalez Urena on Mexico, and Wellman on the Kingdom of Hawaii .

Leprosy in medieval Europe has fasci­nated numerous investigators among whom the work of Virchow ( 242. 24.1 ), Wickersheim­er ( 252.253 ), MacArthur ( 14X. 150 ), Chaussin­and ( .19. 4U ), and Brody ( 2M) is outstanding. Other useful work has been completed by Lecouvet (135), Lutolf ('47), Sa letes (205), Herey (104), Neret ( m. 179 ), Mercier ( 158 ), Le­Grand ( 1.16. 1.1 7), Lallemand ( 133 ), Duliscouet ( 58 ), Remy (1 95), Pooth (1 92 ), Pawletz (1 87 ). Although largely devoted to the 16th cen­tury, Keussen's history of leprosy inspections in Cologne from 1491-1664 is a very careful compilation of notes and documents.

The controversy over the so-called leprosy mentioned in the Bible has produced an enormous amount of interest beginning with Essinger's 1843 study (62), continuing with those of Horsford (110) , Finaly (16) , Munch ( 175), Schamberg ( 208 ), Sack ( 204) , Fels (14), Unna ( 239 ), Dubreuilh and Bargues ( 57), Hill (107), Jastrow (114), Vorner ( 249), Trenel ( 233), Drogendij k ( 56 ), Lie (145), Gramberg (93), Landrum ('4 ' ), Cochran ( 43. 44), Gold­man ( 89) and concluding with Browne's ( 32 ).

Leprologists' and medical historians' in­terests in recording the history of individual leprosaria are evidenced by the abundant accounts of such institutions from all quar­ters of the globe. Emphasizing the unique social conditions that created and sustained these unique institutions, are studies such as those by the eminent medical historian, Karl Sudhoff who ably dealt with various European leprosaria from the 13th to the 19th centuries. Similar approaches were em­ployed by Pazzini (1 88 ), Harmand (99), Puech (193), Hildenfinger (106) , Kalisch (1 28 ), and Russell ( 203). The interesting organizational story of The Mission to Lepers 1874-19 17, has been compiled by Miller ( 159) .

Several other topical strands in the history of leprosy are worthy of note. Leprosy as

depicted in art through the ages has been a compelling topic with Virchow initiating this inquiry in 1862 (242), followed by Meige (1 57 ), Richer (1 99 ), Sassy ( 207), Hollander (l iN ), Van And~l (7 ), Gr~n ( 'I,)), Tricot-Royer ( 237), Martin (1 52 ), Frohn ( 80 ), and Vogt ( 247). Among the handful of attempts to write a popular world history of leprosy are the less than successfu l accounts of Weymouth ( 25 1), Mouritz (1 73 ), and Feeny ( 72 ). Other broad accounts that deal heavily with European leprosy history and elicit specia l notice are those by Barbez ieux ( 19 ), Zubriczky ( 26 1), Leo (1 42), a nd Burnet ( 34). Most recently, dissertations by Sch lotter (211) , and M a let (1 51), offer a rather general treatment but suffer from an inadequate bibliographical base .

In a ll the previously discussed efforts , medical or institutional, religious or social , the reader cannot help but be impressed by the lack of manifest ideology. Traditional leprosy rationale appears to be based on an empirically based objectivity, which in prac­tice mean s accepting existing folkways, mores, and institutions as the framework for ana lysis. Almost t9tally lacking is historical research that open ly argues for a new lep­rosy ideology or shows a missionary bias in favor of radical change in existing con­ve ntions.

To say a word about methodology, at one extreme the antiquarian approac h, which simply necessitates the co llecti ng of bits and pieces of data , more or less without regard to their importance or interrelationships, is much in evidence. At the other extreme, the highly schematized or focused analytical model, which is all articulation and interre­lationships, is se ldom employed. As a result, most leprosy hi stories are essentially de­scriptive in nature a nd fall toward the lower end of this continuum. Although the history of leprosy is first and foremost a story, there are all kinds of stories: dull or exciting, scru­pulously careful or wild ly imaginative, pain­fully naive or subtly interpretive. Whereas much of this quality depends on the artistic ability of the leprosy historian, needless to say, the affective possibilities of the subject of leprosy are limitless.

The proper course for future work appears to lie not in moving back toward descriptive narration, but rather in broadening the scope and variety of leprosy history to en­compass the findings of social research. So-

43,2 P. A. Kalisch : Research on lhe Hislor)' oj'Lepros.\' 135

ciological and anthropological th eo r y may ex plain, for exa mple, why a nd how irra tion­al motives based on lepropho bia led to total institutional respon ses, but only by interfer­ence may explain why one leprosa rium suc­ceeded and its neighbor failed under approx­imately the same circumstances. Indeed , why did the various leprosaria in the British Empire of the 19th century yield such mixed medical and social results? Yet the historia n should be interested as much in the social incentives as in the actual result s. To bring order into thi s analysis of the total si tua tion it is nece ssa ry for him to use theoretical models and knowledge from the behavioral sciences. The value of such an approach has been borne out by the studies of Skinsnes ( 219-22/ ) , and those of Gussow and Tracy (96). Out of imaginative but scholarly mono­graphic research on these and other topics, on an international level it will begin to be possible to build a convincing synthesis of leprosy history, a synthesis independent of purely emotional responses.

SUMMARY

This overview attempts to evaluate, in general , the results of nearly 2,000 years of writings on the history of leprosy. The an­cients, although prone to confuse other skin diseases with leprosy, laid the emotional foundation for later work in superstition and lore. Their efforts were faithfully copied for hundreds of years and provided at least an accumulation of facts and a documentation of the state of the art. The da wn of scientific medicine in the mid-nineteenth century and the following 125 years has brought an in­creasing specialization of research in the his­tory of leprosy that might be usefully divided into medical , political, Biblical, institution­al, and medieval aspects. Some of the most productive efforts within each of these areas are considered . The challenge of the future is to develop models of analysis and evalua­tion based on the findings of social scientific research rather than relying totally on pure narration. This is the way in which to free the history of leprosy from much of the myth and error that surrounds it.

RESUMEN Esta revisidn trata de evaluar, e{l ge neral , los

resultados de cerca de 2.000 alios de escrituras so­bre la historia de la lepra . Los antiguos, aunque

tendfan a confundir la lepra con otras enfermeda­des de la pie I. colocaron los fundamentos emo­cionales para trabajos posteriores en 10 que res­pecta a supersticid n y conocimientos. Sus esfuer­lOS fueron copiad os fie lmente durante cientos de a li os y proporcionaron por 10 menos una acumu­lacidn de hechos y una documentacidn sobre el es tado del a rte. EI desarrollo de la medicina cien­tlfi ca a mediad os del siglo diecinueve los s iguien­tes 125 a nes han tra ld o un incremento de espe­cia li zacidn en la investigacidn de la historia de la lepra, que puede SCI' dividida ven tajosamen te en aspectos medicos, politicos, B(blicos, institu­cionales y medioevales. Se consideran a lgunos de los esfuerzos mas productivos dcntro de cada una de es tas a reas . EI desaflo del fu turo es ta en dc­san-o llar modelos de a na lisis y eva luacidn basa ­dos en los ha lla zgos de investigaciones socio ldgi­cas, mas bien que dependicndo totalmcnte de la nar racid n pura. Es te es e l medio por el cual se puede liberar la historia de la lepra de muchas de las fabulas y errores que la rodean.

Cet a percu ten te d'evaluer, d'une mani~re ge­nerale, tou t ce qui a ete ecr it sur l'hi stoirc de la f~pre pendant 2.000 ans. Ma lgre qu'ils aien t eu une tendance a confo ndre la lepre avec d'autrcs ma ladies de la peau, les a ncie ns au teurs o nt pose les fondations emotives pour tou t ce qui a sui vi, empreint d e superstiti on et de frayeur. Leurs ef­forts o nt ete final ement pendant de siecles, pro­duisa nt en fin de co mpte un e acc umul ati on de faits et une large d oc umentation conce rnant ce probl~me . A l'aube de la med ecine scient ifique, vers la moitie du di x-neuvieme sj~cl e, et dans les 125 annees qui o nt suivi s, o n a assis te a une spe­ciali sa tion acc ru e de la rec he rc he co ncernant I'hist o ire dc la lepre. Ces recherches peuven t etre utilement di visees en medical es, politiques, bi­bliques, instituti o nnelles et medieva les, d'apres les different s as pects tra ites. Quelques-un s des efforts les plus va la bles, da ns chacun de ces d o­maines, sont passes en revue. Le defi qui se pose aux a uteurs futurs est de develo pper des modeles d'analyse et d'evaluati on qui seron t bases sur les resultats d'une rec herche socia Ie scientifique, et non pas uniquement sur l'anecd ote o u la descrip­ti o n. Ceci est Ie se ul moyen de liberer l'histoire de la I~pre de to us les mythes et les erreurs qui I'encombrent.

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