Dr. Andrey Dyachkovwith assistance of Sharobueva Diana

(medical student from 521 group of PSMU)

E-mail: cd4@inbox.ru30.09.2012

Infectious diseases in literature Part 3.

Pavlov State Medical University, Department of Infectious diseases and Epidemiology, St-Petersburg, Russia

In this quiz you have to find out:

1.From which book we took a description of disease?

2.Which infectious disease is described?

Then you can learna little bit about it

Here comes a description of a disease from a book:

“Look at yourself in the glass.”

Strickland gave him a glance, smiled, and went over to a cheap mirror in a little wooden frame, that hung on the wall.

“Well?”

“Do you not see a strange change in your face?Do you not see the thickening of your features and a look — how shall I describe it? —

the books call it lion-faced. Mon pauvre ami, must I tell you that you have a terrible disease?”

Here are some hints that can help you to guess a name of the book…

William Somerset Maugham (25 January 1874 – 16 December 1965 )

William Somerset Maugham was an English playwright, novelist and short story writer. He was among the most popular writers of his era and reputedly the highest paid author during the 1930s.

«The Moon and Sixpence» is a novel told in episodic form by the first-person narrator as a series of glimpses into the mind and soul of the central character, Charles Strickland, a middle-aged English stockbroker who abandons his wife and children abruptly to pursue his desire to become an artist. The story is said to be loosely based on the life of the painter Paul Gauguin.

Eugène Henri Paul Gauguin

Paul Gauguin was a leading French Post-Impressionist  artist who was not well appreciated until after his death. He was born in Paris in 1848. At the age of 23 he became a successful Parisian businessman and remained one for eleven years. In 1873, he married and had five children.

Gauguin was interested in painting since he was a child but only after meeting Camille Pissarro he started to spend all his time for painting. In 1891 he left his family and sailed to  French Polynesia to escape European civilization.  In French Polynesia, toward the end of his life Suffering from syphilis and leprosy, he died at 11 a.m. on 8 May 1903 of an overdose of morphine and possibly heart attack.

LeprosyLeprosy, also known as Hansen's disease , is a chronic disease caused by the Mycobacterium leprae named after norwegian physician Gerhard Hansen.

Leprosy is primarily a granulomatous disease of the peripheralnerves, skin and mucosa of the upper respiratory tract.

Historically, leprosy has been greatly feared because it causes visible disfigurement and disability, was incurable, and was commonly believed to be highly contagious. (face of 24 y.o. patient).

Thought leprosy is trasmitted from human to human, recent studies in USA showed that armadillos are zoonotic source of infection.

Based on bacterial loads leprosy is classified as (PB) paucibacillary and (MB) multibacillary. On the left - a MB leprosy patient; notice the loss of eyebrows and the nodules in the eyebrows, cheek, nose and ears.

The drugs used in WHO-MDT are provided for free in endemic countries and are a combination of rifampicin, clofazimine and dapsone for MB leprosy patients and rifampicin and dapsone for PB leprosy patients. Antileprosy drug used as monotherapy will always result in development of drug resistance and should be considered as unethical practice.

Leprosy

On the right - Man with advanced deformities caused by unmanaged leprosy. Keratitis, loss of eyebrow, thickened skin, and typical hand impairments. Ho Chi Minh City, Vietnam. (Courtesy of D. Scott Smith, MD)

In the Middle Ages people with leprosy should wear a special dress which included a bell to warn another people about their appearance. In Europe and India there was leper colonies - places to quarantine leprous  people. Leper colonies administered by a Roman Catholic order was often called a lazar house, after Lazarus, the patron saint of lepers.

Spinalonga on Crete, Greece, one of the last leper colonies in Europe, closed in 1957.

Gerhard Armauer HansenGerhard Henrik Armauer Hansen was a Norwegian physician, who concluded on the basis of epidemiological studies that leprosy was a specific disease with a specific cause.

In 1873, he announced the discovery of Mycobacterium leprae in the tissues of all sufferers, although he did not identify them as bacteria, and received little support. 

In 1879 he gave tissue samples to Albert Neisser who successfully stained the bacteria and announced his findings in 1880, claiming to have discovered the disease-causing organism.

There was some conflict between Neisser and Hansen, Neisser put in some effort to downplay the assistance of Hansen.

G.A. Hansen worked in leprosy hospital in Bergen. To proove his theory he had attempted to infect at least one female patient without consent and although no damage was caused, that case ended in court and Hansen lost his post at the hospital.

Hansen remained medical officer for leprosy in Norway and it was through his efforts leading to a steady decline of the disease in Norway from 1,800 known cases in 1875 to just 575 - in 1901.

Building of former leprosy' hospital in Bergen is now operating as a museum of leprosy.

Gerhard Armauer Hansen

Famous people suffered from leprosy

Father Damien or Saint Damien of Molokai was a Roman Catholic Priest from Belgium and member of the Congregation of the Sacred Hearts of Jesus and Mary. He won recognition for his ministry to people with leprosy, who had been placed under a government-sanctioned medical quarantine on the island of Molokai in the Kingdom of Hawai.

Uzziah was the king of the ancient Kingdom of Judah

Louis XI called the Prudent was the King of France from 1461 to 1483.

Edward Norton in the movie Kingdom of Heaven playing Baldwin IV. Baldwin IV of Jerusalem (1161 – 16 March 1185), called the Leper or the Leprous, was king of Jerusalem from 1174 to 1185.

Famous people suffered from leprosy

Robert I (11 July 1274 – 7 June 1329), popularly known as Robert the Bruce , was King of Scots from 25 March 1306, until his death in 1329.

Ōtani Yoshitsugu  was a Japanese samurai of the Sengoky period though Azuchi-Momoyama period. He was also known by his court title, Gyōbu-shōyū. 

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