Leprosy is mainly in India. Brazil still widespread today. (Image: pepe/fotolia.com)
When we think of the great epidemics that swept away people like apocalyptic horsemen and destroyed entire cultures, we think first of the plague, which had an impact on the Middle Ages similar to that of a nuclear war. Or of epidemics like cholera, which killed tens of millions of people in a few decades. Leprosy and tuberculosis did not kill as many people in as short a time, but they shaped the societies of the West to this day.
The leprosy bacterium
Mycobacterium leprae causes the disease and is related to Mycobacterium tuberculosis, the causative agent of tuberculosis. Infection is by droplets, but the disease is only weakly contagious. Leprosy only affects those who have intensive contact with the body fluids of lepers over a long period of time. Lack of hygiene, malnutrition and a generally weak immune system promote infection.
Leprosy is a bacterial infectious disease, which, however, is only transmitted through particularly intensive contact with infected persons. (Image: a3701027/fotolia.com)
A genome comparison of medieval leprosy bacteria with present-day pathogens provides evidence for a common ancestor. The incubation period is very long, averaging five years, with some patients having twenty years between infection and outbreak.
In leprosy, the nerves die and the blood vessels become clogged as the blood thickens. Patients no longer feel heat, cold or pain in the affected areas, which in turn can lead to life-threatening injuries, for example, if they put their hand in the fire without realizing it.
The disease itself does not cause limbs to fall off, but dying off is one of the typical consequences. Because without a sense of pain, those affected often injure themselves, these wounds become infected, especially because lepers often have to live under appalling hygienic conditions. As a result, the wounds become inflamed and the inflamed areas die off.
In lepromatous leprosy, the bacteria spread through the blood, nerves, mucous membranes, and lymphatic channels. The skin covered with lumps and spots, the red leprosy. They decompose the skin tie. The sufferers are disfigured, the lepromes form the so-called "lion face". As a result, ulcers spread to muscles, ties and tendons and also affect the internal organs. However, even in this worst form, the affected do not die of leprosy, but of secondary diseases, which have an easy game in the weakened bodies.
The scientific historians Ruffie and Sournia did detective work to research the history of leprosy. You write: "Possibly the old Hebrew word translated as "leprosy" from the five books of Moses is really identical with the disease we call "leprosy" today. It apparently occurred long before the Christian era in India, perhaps also in China."
Leprosy also means leprosy. It is a chronic infectious disease caused by Mycobacterium leprae. Gerhard Armauer Hansen discovered the causative agent in 1873, and that is why we also refer to leprosy as Hansen's disease.
In a medical textbook from sixth-century India v.u.Z. we find the first reliable description of leprosy. India is not only home to a large number of lepers today, it is also believed to be the origin of the epidemic.
From there it migrated to Southeast Asia and Japan, and, as the Persian Empire reached into India, the Persians, and later again the troops of Alexander the Great, probably carried the disease into the Middle East. The Phoenicians, based in Asia Minor and the greatest navigators of the eastern Mediterranean, then probably brought it to the entire Mediterranean coasts, i.e. to the Greeks, Carthaginians, Etruscans, and Romans. The Roman legions introduced it into Central Europe, infecting Germanic tribes and Gauls.
The Moors, who in the 8. Leprosy, which invaded Spain in the sixteenth century, spread in Europe, and the Crusaders carried it as an unwanted souvenir from the Crusades to Jerusalem when they returned to their homelands.
In any case, in the early Middle Ages, leprosy was firmly established in Western and Central Europe and was part of everyday social life.
The troops of Alexander the Great probably brought leprosy to the Near East. (Image: benjaminec/fotolia.com)
From the high Middle Ages many traditions of leprosy exist. At that time it was called Mieselsucht. Anyone suspected of suffering from it was treated like a criminal. People were obliged to report suspected cases of mycosis to the authorities.
In court, the organized lepers were questioned as to whether the suspect or suspects were one of them. Later, the judgment became professionalized in that a tribunal now decided whether or not the person was a "leper". They included a doctor, a priest and a bailiff.
The sick person had the right to a lawyer, but most could not afford it, or from members of his family.
The potential leper now had to undergo numerous tests: If his skin shimmered colorfully in the moonlight, then this was considered proof. If lead was thrown on the urine of a diseased person, it should float on top, unlike healthy people, where it sank.
Physical features were also supposed to identify the leper. Sournia and Ruffie quote, "The leper has a red face, a dull look, the nose seems pointed, the hair very thin and fine, the ears small."
The blood of a "sourpuss" mixed with pure spring water was supposed to clump together, while the blood of a healthy person remained fluid and bright red. If you pricked a patient in the heel, he should not feel any pain; if you laid him on cold marble and he did not react, this proved that he was a leper.
The criteria not only said nothing about leprosy, they were controversial even in the Middle Ages. Because of the arbitrary "marks", firstly, many "lepers" were denounced, secondly, quite a few suspects challenged the verdict that made them "lepers" – and often with success. They used other evaluators, they appealed, or they moved to another jurisdiction.
Diagnosis and treatment
From today's perspective, it not only seems reprehensible to treat a potentially sick person like a criminal, but it is also surprising why those diagnosed as lepers were not treated immediately. Sournia and Ruffie explain this by the fact that leprosy was considered incurable.
In the High Middle Ages, the period from which we know most of the sources on the trials and diagnoses of lepers, many physicians already relied more on observation and experience, but the religious-irrational-emotional understanding of disease was paramount.
The inhumane treatment of lepers can therefore be explained by the fact that diseases that disfigured people were considered a punishment from God. Lepers were considered morally impure, sinful and stained. Healing could only come through repentance, atonement, and prayer, but since leprosy was considered incurable, the "sin" seemed so great that no atonement could cancel it out.
Christian metaphysics, which saw the sick person as the culprit, could not, of course, control infections. Fortunately, physicians in the West also knew the rational and pragmatic method and were not guided by the dogmas of the clergy in their everyday medical work.
Ancient Egypt also became the Mecca of ancient physicians because the concept of disease as punishment was foreign to the Egyptian religion. On the contrary, the Egyptian gods helped to heal.
The lepers in the Middle Ages nevertheless received care that sometimes alleviated their suffering, for example, when physicians dried their ulcers with cloths or spread ointments on them and bandaged the wounds.
Most treatments, however, were of no use at best: The sick had to eat viper-fed chickens or even frogs, or, more digestibly, strawberries pickled in alcohol.
It was rare for men with leprosy to be castrated on the grounds that they were "melancholy and hot-blooded" and suffered from a permanent erection and an unbearable sex drive. If they were castrated, it would cure their insatiable appetites. Presumably, castration also served to prevent those affected from procreating.
From the 11. In the nineteenth century, lepers were considered "lepers" and socially isolated. (Image: a3701027/fotolia.com)
The term leper may not have come from the "leprosy" on the skin, i.e., the ulcers, lichens, and skin rashes of the lepers. For the afflicted were socially killed; the church and authorities excluded them from the community, and they fared like the dogs and cats that cold-hearted people abandon at garbage dumps.
The church organized a regular burial. The priests read the requiem mass to the sick, then the lepers sometimes even had to lie down in a real grave. They were now excluded from the church, followed by their exclusion from the congregation.
From then on they lived in a leprosarium. There the patients remained among themselves. Were allowed to leave the house only under strict criteria. They were not allowed to bathe in rivers or walk barefoot, they were only allowed to address healthy people when the wind did not blow their breath into their noses. The sick wore a rattle to announce their coming and special clothes that made them recognizable from afar. Their marriages were dissolved, they were not allowed to make a will or appear in court. If they died, they were not buried in a Christian cemetery.
Sournia and Ruffie worked through the historical documents and found out that these conditions were rarely strictly observed in reality. Thus, many communities allowed the sick to beg in town, some lepers were allowed to stay in their homes, and some leprosariums developed into communes that farmed, twisted ropes, and sold their products directly in the harbors.
Ruffie and Sournia recognized that those afflicted with leprosy had only been in existence since the 11th century. The disease was isolated in the nineteenth century, when it had already been entrenched in Europe for centuries. And they also wondered why the "lepers" in particular were marginalized to such an extent.
They suggest that leprosy reached epidemic proportions during this period, and the requirements such as not walking barefoot, not having breathing contact with healthy people, and announcing oneself from afar can be interpreted as measures to avoid infection.
Leprosy did not kill as masses as the plague did. It does lead to various secondary diseases, and many lepers die from disorders of the lungs, nerves or blood vessels. But this did not matter in the Middle Ages. For the average life expectancy was little more than thirty years, while the complications of leprosy developed after many years.
One explanation for the exclusion was the appearance of the sick, which, as contemporary reports suggest, frightened and disgusted the healthy: a nodular leprosy thickens the nose and lips, the face looks monstrous. Advanced leprosy leads to mutilation, especially parts of the nose, ears, limbs and fingers fall off. The skin is covered with festering sores. The medically unenlightened of the Middle Ages no longer saw human beings in those who were thus disfigured – they resembled the images with which the Church described the devil and demons.
Ruffie and Sournia conclude: "It is only a small step from the physical disfigurement of a fellow human being to his moral ostracism; after all, God knows only kindness and justice: those who were lepers were obviously punished in this way for their sins. (…) Lepers were no longer pitiable people, but in their embodiment of evil a kind of devil on earth."
Whether natural disasters or unexplained deaths: Lepers were the scapegoats for all bad events. (Image: ohenze/fotolia.com)
Leprosy instead of bacteria
These ideas led to a completely wrong idea about the cause of leprosy. Thus, leprosy was still considered an epidemic in the 18. In the sixteenth century as a venereal disease. The sick were accused of suffering from diabolical lust, and thus there was a danger of tempting chaste Christians.
Similar projections were also used by racists against black people and anti-Semites against Jews. Yet the fiction of physical disfigurement, disease, and excessive sexuality always went hand in hand.
The fantasy of "racial shame" in the sexual intercourse of "blacks" or Jews with "white women" reflects similar extermination fantasies as in the dehumanizing fairy tales of sexual debauchery of the lepers, whom God would therefore have punished with the disease.
Like Jews and other minorities, the lepers were scapegoats for every disaster. If livestock fell ill, people died of unknown causes, a storm destroyed the harvest? Then the lepers had conspired, cast evil spells, or poisoned the healthy ones.
They shared the fate of the Jews: mobs raided their houses, brought them to witch trials or lynched them immediately. In the 14. In the nineteenth century, such "rage bourgeois" murdered the residents of several leper houses in southern France.
Ruffie and Sournia say: "Never before in its history has humanity been so guilty of such a large community over such a long period of time and in such a reckless and cruel way."
Cretins and sick people
In France in the Middle Ages, those affected were called "Chretiens," and from this derived the word cretin, which denoted very different "deformed people. It remains unclear how many people who suffered from rickets or had deformed bones from birth entered leprosy homes.
In early modern times, these cretins were no longer equated with lepers, but they shared their terrible fate. They were not allowed to drink at public fountains, not allowed to walk barefoot, not allowed to enter cities and had to live in isolated houses. They, too, were suspected of indulging in sexual orgies.
It is impossible to estimate the number of people who died as a result of infectious disease in the Middle Ages and early modern period, because all kinds of people were declared lepers: It could be a pigmentary disorder, the skin disease psoriasis or even simple acne.
In any case, the proportion of Europeans who contracted leprosy always remained very small. In the 17. In the 19th century, leprosy houses were closed everywhere due to a shortage of inmates, and in the. In the twentieth century, it only existed on a larger scale on the continent in Norway, where Gerhard Hendrik Armauer Hansen discovered the bacillus in 1873. Why she disappeared remains unexplained.
The disease is still widespread in some countries in Asia, Africa and Latin America, especially in India and Brazil. But overall, WHO believes the epidemic is under control. Sees its eradication in the next few decades as a realistic goal.
Today, the infection can be treated very well and even cured in the long term. Therapy with dapsone, clofazimine and rifampicin gets the disease under control, but it takes years, and requires constant exchange between specialized doctors and patients. This is precisely what is lacking in the most severely affected countries. Even in developing countries, the rate of people affected has been declining for decades. There are currently about 200 cretins worldwide.000 new cases per year.