Norway
History of leprosy in this country
It is thought that there were cases of “spedalsk” (leprosy in Norwegian) from medieval times. “Spedalsk” meant a person staying in a hospital. It is possible that the Vikings brought leprosy with them into the country from the British Isles.
In the first half of the nineteenth century leprosy appeared to be spreading, in particular, among peasants in remote areas and along the west coast of Norway.
Hjort began studies into the epidemiological and social aspects of leprosy in 1832, which aroused the interest of the health authorities and subsequently caught the attention of Danielssen and Boeck, who undertook further research.
Censuses to count the number of people affected by leprosy were conducted in 1836 and 1845, although it is thought neither were accurate.
In 1849 Danielssen and Boeck established leprosy as a clinical entity.
In the mid-nineteenth century there were relatively more people in Norway than in any other European country, with the largest number of patients around Bergen.
1,782 cases of leprosy were recorded during the 1852 census conducted by medical officers.
Around 1851 the Norwegian Parliament refused to ratify a ban on marriage for all people with leprosy.
A Chief Medical Officer for Leprosy, Hoegh, was appointed in 1854.
A royal decree of 1856 set up a National Leprosy Register believed to be the first disease-specific public record of cases. Local boards of health in districts affected by leprosy were also established at the same time. The information collected on this Register convinced Hoegh that leprosy was an infectious disease.
Approximately 1,752 cases of leprosy were counted in 1875.
The Norwegian Parliament passed on Act in 1877 denying people affected by leprosy the right of poor people to “lagd” – a right to wander from farm to farm, where farmers were obliged to support them during their stay. They would be allowed to go to one of the hospitals or to be isolated in one of the official homes for the poor in an attempt to prevent the spread of this disease, but only at night time.
An Act of 1885, applicable to all people affected by leprosy, allowed those who did not wish to be in a hospital, because they had leprosy, to stay at home so long as they had a room to themselves to help prevent infecting other members of the family. Married couples were permitted to live together if they wished. Police could forcibly remove people with leprosy from their homes who were not living in isolation.
Delegates met at the First International Congress of Leprology in Berlin in 1897 to determine whether mycobacterium leprae was the cause of leprosy, how it was transmitted and to decide on activities to reduce transmission. Hansen’s suggestion that mycobacterium leprae caused leprosy was accepted as also his suggestion to segregate patients to control leprosy.
Norway recorded 577 people with leprosy in 1901 and by around 1920 there were few, if any, new recorded cases. The last known case was recorded in 1950.
Of Futher Interest
Journey from the Dark:
Leprosy in Spain and the United States in the 19th and 20th Centuries: the Norwegian Connection
by Kirsten Lolita Milnes
http://www.bodoni.no/bodoni/Bodoni-Forlag/Aktuelle-bøker/Journey-from-the-Dark
People
Daniel Cornelius Danielssen (1815 – 1894)
Born in Bergen in 1815, Daniel Cornelius Danielssen became a physician at St Jørgens Hospital in 1839 and began research into leprosy in collaboration with Carl Wilhelm Boeck. He inoculated himself and others several times with leprous tissue to test the contagiousness of leprosy. Transmission failed and he concluded that it must be hereditary since there were instances of several members within a family with leprosy.
In 1847 the Norwegian Government commissioned investigations by Danielssen and Boeck. This lead to the publication in Bergen of Om Spedalskhed (On Leprosy), which included an Atlas of Leprosy with 24 illustrative plates of leprosy. At that time, the Atlas of Leprosy was regarded as the definitive European medical explanation for leprosy. It was translated and made available in French too. Boeck and Danielssen described two types of leprosy in their book: “tubercular” and “anaesthetic” and dismissed the idea that leprosy was contagious. They explained it was mainly hereditary, with some cases caused by the environment. Personal accounts of people affected by leprosy were included.
Danielssen was appointed Chief Physician at the newly built hospital of Lungegaarden in 1849.
Gerhard Henrik Armauer Hansen (29th July 1841 – 12th February 1912)
Hansen was born in Bergen and studied medicine at the Royal Frederik’s University and graduated with honours in 1866. He worked as an intern at the National Hospital in Christiania before being appointed physician of a small fishing community in Lofoten. In the winter of 1868 he returned to Bergen. When they first met, Hansen famously told Danielssen that since leprosy was contagious Danielssen was wrong to support the hereditary theory of leprosy. Subsequently Danielssen encouraged him to investigate the contagion theory, promising he would ensure Hansen had access to a laboratory and all the equipment and resources he might need to conduct his research.
Armauer Hansen studied family history and other demographic features to try and establish whether leprosy was hereditary or contagious. He travelled to Bonn and Vienna in 1870, where he studied advanced histopathology. When he returned to Norway he continued studying biopsy specimens from people with leprosy under the microscope using primitive staining methods to find out as much as possible about the micro-organisms in leprous tissue. In 1873 he isolated rod-shaped bodies, which were later confirmed to be the leprosy bacillus, mycobacterium leprae. This bacillus was the first mycobacterium to be discovered and its discovery identified, also, the cause of a chronic disease in humans for the first time.
In 1887 he spent time in the Upper Mississippi Valley to study the extent to which Norwegian immigrants might be spreading leprosy among the local population.
Improved staining methods enabled Hansen to show great numbers of the rod-shaped bodies, typically grouped in parallel cells, in 1879.
Hansen served as Chairman of the Board of the Bergen Museum. He was the Norwegian delegate to the First International Congress of Leprology in Berlin in 1897 and elected honorary Chair of the Congress that recognised leprosy was a contagious disease and endorsed his discovery and the Norwegian model of leprosy control through isolation. He was selected as President of the Second International Congress of Leprology held in Bergen in 1909.
He cofounded medical publications, including an international journal of leprosy Lepra.
Hansen introduced material from a leprosy nodule into the cornea of one of his patients without obtaining her permission, in an attempt to prove its infectious nature and on 31st May 1880 the courts dismissed him from his position as Senior Physician at the Pleiestiftelsen for Spedalske Nr 1. However, he was allowed to continue as Chief Medical Officer for Leprosy and continued to work, until his death, to improve the conditions of leprosy patients.
One of Hansen’s most well-known articles: On the Etiology of Leprosy, British and Foreign Medico-Chirurgical Review, 55 (1875)
Hospitals
Norwegian missionaries often received training in leprosy at the leprosy hospitals before going to countries such as Madagascar to assist people affected by leprosy.
St Jørgens Hospital
St Jørgens Hospital in Bergen was founded before 1411 on the outskirts of Bergen and was the central institution for treating people affected by leprosy in Western Norway. It had approximately 150 patients. The living conditions were reputedly terrible and the only hope was to be cured by a miracle. Passersby used to leave alms as the hospital was located within the city gates. A fire in 1702 destroyed the buildings and its contents so there is little documentation on the hospital before that year. Care conditions improved with the arrival of a doctor, who was assigned to this hospital in 1816. Danielssen embarked on leprosy research at this hospital in 1839.
Today the former hospital buildings house the Leprosy Museum.
Lepramuseet
Kong Oscarsgate 59
Bergen
Norway
Tel: +47 55 55 20 20
Lungegaard Hospital
This clinical and research centre in Bergen was founded in 1849. Danielssen was Chief Physician there from its opening to 1894. It housed people with other dermatological diseases besides leprosy, facilitating Danielssen’s comparative studies. New premises had to be built following a fire in 1853 at which time a laboratory and library were installed and Lungegaarden became an important centre for research.
In 1895 it ceased to be a leprosy hospital because there were few cases of leprosy and in 1912 it became a hospital to treat and care for people with tuberculosis.
Pleiestiftelsen for Spedalske Nr 1 (Nursing Institution for Leprosy Patients No 1)
Founded in Bergen in 1857 to house the increasing number of people with leprosy, Pleiestiftelsen comprised two wings. Then one of the largest wooden buildings in Norway, it accommodated 280 people with leprosy. Today the building is used as a rehabilitation centre.
Articles
Disappearance of leprosy from Norway: an exploration of critical factors using an epidemiological modelling approach
A Meima, L M Irgens, G J van Oortmarssen, J H Richardus, J D F Habbema
International Journal of Epidemiology, Vol 31, No 5, October 2002, pp 991-1000(10)
http://ije.oxfordjournals.org/cgi/content/full/31/5/991
Epidemiology of leprosy in Norway: the history of the National Leprosy Register of Norway from 1856 until today
Lorentz M Irgens and Tor Bjerkedal
International Journal of Epidemiology, Vol 2, No 1, 1973, pp 81-89
Leprosy in Norway: An epidemiological study based on a national patient registry
L M Irgens
Lepr Rev (1980) 51 (Supplement 1):1-130
Links
Leprosy Archive of Bergen (Lepraarkiva)
The archives on leprosy, held at Bergen in Norway, one of the countries in Europe where leprosy was slowest to be wiped out, document the breakthrough of scientific understanding about leprosy. They also describe leprosy around the world, through documents, inventories, pictures and studies. On 28th June 2001, the Lepraarkiva were elected to the UNESCO Memory of the World.
http://digitalarkivet.uib.no/lepraarkiv/