Leprosy: Down But Not Out

Where is the world’s only leprosy museum? Calcutta? Louisiana? No. It’s in Bergen, Norway. I visited the Leprosy Museum in Bergen last year, when visiting my friend, Jan Eggum, a well-known Norwegian singer and composer. The museum houses the original laboratories and surgeries where Dr. Armauer Hansen and his colleagues dld the frst systematic research on leprosy. The “leprosarium” where Hansen discovered the leprosy bacillus is also located in Bergen. Hansen’s microscopes, historical records on the disease, and other memorabilia are preserved in rooms designated “The Armauer Hansen Commemorative Rooms.’)l During a recent visit to the Center for Disease Control (CDC) in Atlanta, Georgia, I mentioned this museum to Dr. Roger A. Feldman, who is now chief of the Enteric Diseases Branch at CDC. During a pleasant dinner at his home, he told me some interesting facts about leprosy. Of course, most people stilf imagine leprosy to be the ancient scourge described in novels such as James Michener’s Hawaii.2 As we shall see, this impression is incorrect. Leprosy, as described in Doriand k, is “a chronic communicable disease, caused by a specific microorganism, the Mycobacten”um lepme, which produces various granulomatous lesions in the skin, the mucous membranes, and the peripheral nervous system.”3 In general, clinical leprosy first appears as discolored patches of skin, which may develop into granulomas— inflamed lesions. Since peripheral nerves in the lesions are also attacked by leprosy bacteria, there is generally some loss of feeling at these sites. Actually, the leprosy bacteria affects indhiduals differently, depending on their immunological response (resistance) to the M. lepme bacterium. d Consequently, researchers and clinicians use a class filcation scheme to describe the various expressions of the diseases Most people who are infected by the bacteria do not develop clinical disease because they develop a resistance to M. lepme.6 Individuals with thk “subclinical infection” may never realize they are infected. People with a less effective resistance may develop tuberculoid leprosy. This may heal spontaneously, though if untreated it can result in some mutilation. Leproma tous leprosy is the disfiguring form with which most people are famtilar. It is characterized by numerous lesions which may cover the whole body. An individual with this form of the disease has the least effective immunological response to the M. leprae bacterium. Untreated, fepromatous leprosy may heal after a number of years, but it is generally progressive. It is believed to be the most communicable form of the dkease. Sometimes the leprosy bacteria are responsible for disfigurement. For example, the depression of the nose is caused by the destruction of the cartilage which supports the bridge of the nose. Contraction of scar tissue pulls the