Ebola’s stigma recalls leprosy

46 December-January 2014

BOLA was ﬁrst identiﬁed in 1976

in Sudan in a cotton factory, with

bats suspected as the reservoir

species. The disease typically occurs in

outbreaks in tropical regions of sub-Sa-

haran Africa, though also in Venezuala,

Cambodia and Indonesia. The largest out-

break so far is the ongoing epidemic in

West Africa, which is centred in Guinea,

Sierra Leone and Liberia, and has occa-

sioned 16,203 reported cases and 7,275

deaths. President Obama has called it “a

horriﬁc disease”, “a public health emer-

gency”. The international community

has been providing aid, especially after

the death of Duncan Thomas in the US

in early October. The Irish Department

of Foreign Aﬀairs donated €200,000 in

November.

The paranoia and the stigma associ-

ated with Ebola are nothing new – they

parallel historic, and some contempo-

rary, reactions to leprosy. Moreover the

historic primary incubator for both is

poverty

While Ebola is a virus, leprosy is a bac-

terial infection. The incubation period of

ebola is two days to three weeks while the

incubation period for leprosy is around

ﬁve years. And while Ebola is highly

infectious, 95 per cent of people have

natural immunity to leprosy. Unlike the

Ebola virus, leprosy itself seldom leads

to death. It is a disease of the skin and

nerves that, if untreated, often led to a

lifetime of severe disﬁgurement. There

was no eﬀective medical treatment until

the development of the drug dapsone in

the 1940s. But as yet there is no eﬀective

The history of leprosy in Ireland, though forgotten,

is everywhere. By Caroline Hurley

Ebola’s stigma

recalls leprosy

POLITICS LEPROSY

this modern Liberian

ebola treatment

centre was formerly

a leper colony

December-January 2014 47

thousand at its thirteenth-century peak

before retreating.

The 273 leper houses in England, rap-

idly becoming redundant, had mutated

into almshouses by the fourteenth cen-

tury, harbouring hardly any leprosy

cases. The suppression of monasteries

in 1540 brought destruction and clo-

sures, while concerns increased about

more active diseases.

Leprosy seems to have inspired the

birth of organised charity. Crusaders

in Jerusalem drew up a twelfth-cen-

tury charter to govern the Order of the

Knights of Saint Lazarus. They obtained

royal seals and attracted donations from

all over Europe to build leper shelters.

Knight Orders of Rhodes and Malta fol-

lowed suit, espousing chivalrous humane

values such as those championed in for

example Faber’s nineteenth-century

poems, ‘The Knights of St. John’, and ‘Sir

Lancelot’.

With eﬀective treatments, reduced

prevalence and progressive policies

including integration and independent

living, the outlook for leprosy has never

been better.

The disease continues to baﬄe med-

ical researchers trying to cultivate the

microbe and decipher its mode of trans-

mission. Dr Meny Bergel suspects it could

be an opportunistic metabolic disease,

while others see an interaction with

immune resistance that transmutes it into

tuberculoid form. Uncannily, Dr Mercier,

noting abundant past accounts of leprosy,

but not of tuberculosis, expressed a simi-

lar hypothesis in his 1918 lecture: “…that

the bacillus of leprosy has changed in the

course of time into the tubercular bacil-

lus, that leprosy has disappeared in one

form only to reappear in another. That

strains of micro-organisms do undergo

modiﬁcations…”.

This idea from evolutionary philoso-

phy is accepted for newer diseases like

HIV. Scientists describe ebola, like HIV

and herpes, as an intelligent virus that,

instead of mutating, evades immune

attacks through complex cell attach-

ment behaviours, just as many previously

responsive infections have become unaf-

fected by antibiotics.

Ultimately, leprosy and Ebola have

both been labelled diseases of poverty.

The best vaccines generally are greater

equality and distribution of wealth to

the poorest nations on earth. Meanwhile

those treating, and indeed reporting on,

Ebola can learn from the perennial expe-

rience of leprosy. •

treatment for Ebola.

With luck and vigilance Ebola will never

reach Ireland, but leprosy aﬀected mil-

lion s of people a ll over t he world , including

here. Just 150 years ago, in January 1864,

notice of the death of a young woman

from leprosy appeared in the Limerick

Reporter & Tipperary Vindicator. Leper

houses in Limerick and Waterford were

mentioned. Leprosy predominated as

Ireland’s national disease since at least

the time of St Patrick who, like St Brigid,

healed lepers. Indeed it was widespread

until quicker killers such as the plague,

tuberculosis and famines claimed more

casualties.

Although in 1970 there were over

ten million cases, the World Health

Organisation (WHO) now estimates that

globally less than 200,000 people have

leprosy, including 400 new cases annually

in the US. Aid workers contest the ﬁgure

and the methodology used to reach it. The

WHO deﬁnition of cure, bacterial negativ-

ity, disregards complex after-eﬀects, and

only entitles patients using multi-drug-

treatment (MDT) to be registered. Stigma

still poses an obstacle to treatment-seek-

ing – and the statistics.

Moving into his new oﬃce Ireland’s

Minister for Health, Leo Varadkar.

may have been aware of the reputation

Hawkins House has as a sick building,

but less enlightened about other fac-

ets of its history. For centuries the area

hosted a residence for lepers. Until 1815,

Townsend Street, which adjoins Hawkins

Street, was known as Lazar’s Hill.

The so-called “lane leading to the Long

Stone”, beside the Viking harbour built in

841 became known as Lazar’s Hill after

1220 when Henry of London, Archbishop

of Dublin, established a ‘lazaretto’, a quar-

antine station for maritime travellers. This

particular hospice sheltered leprous pil-

grims sailing to Santiago de Compostela

for a miracle cure. Immigrants assumed

infected were probably quarantined there

too. Floods and storms wreaked periodic

damage on ‘Lazy Hill’ until 1662 when

William Hawkins had a wall built, running

from Corn Exchange Place to modern-day

Temple Bar.

As detailed in Gerard A Lee’s 1968

book, ‘Leprosy and Leper Hospitals in

Ireland’, many place names refer to patron

saints associated with leprosy, such as

Mary Magdalene, Lawrence, Nicholas,

Stephen and Lazarus/Bethany (‘beloved

of Christ’, a term often applied to lep-

ers). Place names reﬂect the Irish word

for inﬁrm or leper, lobbar – Knocknalour,

Dromalour, Flowerhill. Many townlands

recall the old word for hospital and hotel

– spital.

Several other Dublin hospitals speciﬁ-

c a lly ca t er ed fo r le p ro sy c a se s . S t S te ph en ’s

Hospita l, which gave St Stephen’s Green its

name, was situated on Diggis Lane where

Mercer’s Hospital was subsequently built.

The intended transfer to lands bought at

aptly-titled Leopardstown (lepers’ town,

Baile An Lobhar) never took place. The

Order of Hospitaller Knights of Jerusalem

ran leper-houses in Kilmainham, and

Chapelizod, meaning ‘leper church’/

Séipéal an Lazar.

Leprosy is called The Great Disease

in both Sanskrit (maha rog) and Anglo-

Saxon (seo mycle ail). The Indo-European

word for the condition – leper – means

something that peels oﬀ. It is liber, for

tree bark, in Latin.

Sometimes normally-aloof aristo-

crats were spurred to compassion by the

aﬄiction, as necessity dictated. Around

1230, Cashel Leper Hospital was built by

Sir David Latimer after his daughter con-

tracted it. King John set up St Stephen’s

Leper Hospital in Waterford when he and

his family erupted in sores.

In history, leprosy became endemic

around the river Nile from 3000 B.C,

dreaded as the ‘death before death’. Jesus

famously cleansed and healed a leper,

in the New Testament of the Christian

bible.

The ﬁrst-century physician, Aretus,

bemoaned callous public attitudes to

lepers. By the time of the Crusades, the

disease had reached epidemic propor-

tions in Europe, provoking laws requiring

exclusion and isolation, in line with sev-

enth-century decrees restricting leper

marriage. Banished individuals were

obliged to broadcast warnings, wear

long cowls, and sound bells or wooden

clappers when others approached, after

undergoing living funeral ceremonies.

Whoever refused to go, to beg and for-

age for a precarious existence, could be

harshly dealt with by statute, even put to

death. Mere guesswork passed for most

clinical diagnosis.

The rise of leper houses in towns across

Europe started in earnest when early

Church Councils in the sixth century com-

mitted to the cause. As early as 869 Arlaf

the Dane recorded the destruction of leper

houses in Ireland. Some blamed the Irish

for an outbreak in Norway after Viking

raids here around 1000 A.D.

Leprosy rapidly spread from the tenth

century and claimed 10-50 victims per

There was

no medical

treatment

for leprosy

until the

development

of the drug

dapsone in

the 1940s.

But as yet

there is no

eﬀective

treatment

for ebola

“