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With the great epidemics that, like apocalyptic horsemen, took people away and destroyed entire cultures, we first think of the plague, which had similar effects to a nuclear war for the Middle Ages. Or epidemics like cholera, which killed dozens of millions of people in just a few decades. Although leprosy and tuberculosis did not kill as many people in just as short a time, they have shaped Western societies to this day.
The leprosy bacterium
Mycobacterium leprae triggers the disease and is related to Mycobacterium tuberculosis, the tuberculosis pathogen. The infection is caused by droplets, but the disease is only slightly contagious. Leprosy only affects people who have had intensive contact with the body fluids of leprosy for a long time. Poor hygiene, malnutrition and a generally weak immune system promote infection.
A genome comparison of medieval leprosy bacteria with today's pathogens shows a common ancestor. The incubation period lasts a very long time, on average five years, with some patients 20 years between infection and outbreak.
With leprosy, the nerves die and the blood vessels become blocked because the blood thickens. Patients no longer feel heat, cold or pain in the affected areas, which in turn can lead to life-threatening injuries if, for example, they put their hand in the fire without realizing it.
The disease itself does not cause limbs to fall off, but death is one of the typical consequences. Because without pain sensation, those affected often injure themselves, these wounds become infected, especially since lepers often have to live in appalling hygienic conditions. As a result, the wounds become inflamed and the inflamed areas die.
With lepromatous leprosy, the bacteria spread in the blood, nerves, mucous membranes and lymph channels. The skin is covered with knots and spots, the red lepromas. These decompose the skin tissue. The sufferers are disfigured, the leprosy forms the so-called “lion face”. As a result, ulcers spread to muscles, tissues and tendons and also affect the internal organs. Even in this worst form, those affected do not die from leprosy, but from secondary diseases that have an easy job in their weakened bodies.
Science historians Ruffié and Sournia did detective work to research the history of leprosy. You write: “The old Hebrew word from the five books of Mosi translated as“ leprosy ”may really be the same as what we call“ leprosy ”today. Apparently it occurred long before the Christian era in India, perhaps also in China. ”
Leprosy also means leprosy. It is a chronic infectious disease caused by the Mycobacterium leprae. Gerhard Armauer Hansen discovered the pathogen in 1873, which is why we also refer to leprosy as Hansen's disease.
In a medical textbook from India of the sixth century B.C.E. we find the first sure description of leprosy. Not only do many lepers live in India today, the plague probably also has its origin here.
From there she migrated to Southeast Asia and Japan, and when the Persian Empire reached India, the Persians, and later the troops of Alexander the Great, probably introduced the disease to the Middle East. The Phoenicians based in Asia Minor, the greatest seafarers of the eastern Mediterranean, then probably brought them to the entire Mediterranean coast, i.e. to the Greeks, Carthaginians, Etruscans and Romans. The Roman legions introduced them to Central Europe and infected Germans and Gauls.
The Moors, which invaded Spain in the 8th century, caused a new spread in Europe, and the Crusaders carried them as an unwanted souvenir from the Crusades to Jerusalem when they returned to their home countries.
In the early Middle Ages, leprosy was firmly anchored in Western and Central Europe and was part of everyday life in society.
There are many leprosy traditions from the High Middle Ages. Back then it was called mieselsucht. Anyone suspected of suffering was treated like a criminal. The people were obliged to report suspect of malnutrition to the authorities.
Organized lepers were asked in court whether the suspect was one of them. The judgment later professionalized in that a tribunal now decided whether it was a "leper" or not. This included a doctor, a priest and a bailiff.
The patient had the right to a lawyer, which most could not afford, or from members of his family.
The potentially leprosy now had to undergo numerous tests: if his skin shimmered colored in the moonlight, then this was considered evidence. If you threw lead on a patient's urine, he should swim up, unlike healthy people, where he sank.
Physical characteristics should also characterize the leper. Sournia and Ruffié quote: "The leper has a red face, a cloudy look, the nose looks pointed, the hair very thin and fine, the ears small."
The blood of a "misery" should be mixed with pure spring water, clump, the blood of a healthy person, on the other hand, should remain liquid and bright red. If you stabbed a sick person in the heel, you shouldn't feel any pain, if you put him on cold marble without reacting, it proved that you had a leper in front of you.
The criteria not only said nothing about leprosy, they were controversial even in the Middle Ages. Because of the arbitrary "characteristics", firstly, many "leper" were denounced, secondly, a number of suspects contested the judgment that made them "leper" - and often with success. They tried other appraisers, appealed or moved to another judicial district.
Diagnosis and treatment
From today's perspective, not only does it seem reprehensible to treat a potentially sick person like a criminal, but it is also surprising why those who were diagnosed as lepers were not treated immediately. Sournia and Ruffié explain this by saying that the leprosy was considered incurable.
In the High Middle Ages, the time from which we know most of the sources on the processes against and the diagnosis of leper, many doctors already trusted more in observation and experience, but the religious-irrational-emotional understanding of diseases was in the foreground.
The inhumane handling of leprosy can therefore also be explained in such a way that illnesses that distort people were considered God's punishment. Lepers were considered morally impure, sinful and defiled. Healing could only bring repentance, atonement and prayer, but since leprosy was considered incurable, the “sin” seemed so great that no atonement could lift it.
Christian metaphysics, which saw the patient as guilty, could of course not control infections. Fortunately, even doctors in the West knew the rational and pragmatic method and were not guided by the dogmas of the clergy in everyday medical practice.
Ancient Egypt also became the Mecca of ancient medicine because the idea of illness as a punishment was foreign to the Egyptian religion. On the contrary, the Egyptian gods helped with healing.
The leprosy in the Middle Ages nevertheless received care that sometimes relieved their suffering, for example by doctors drying their ulcers with towels or applying ointments on them and bandaging the wounds.
Most treatments, however, were of no use at best: the sick had to eat chickens fed with vipers or frogs, or, more easily digestible, strawberries soaked in alcohol.
Seldom have sick men been castrated on the grounds that the lepers are "moody and hot-blooded" and suffer from a permanent erection and an unbearable sex drive. If they were castrated, that would cure their insatiable desires. The castration probably also served to prevent those affected from reproducing.
The term leper may not come from “leprosy” on the skin, the ulcers, lichen, and rashes of the leprosy. Because those affected were socially killed; The church and the authorities excluded them from the community, and they fared like the dogs and cats who abandon the cold-hearted on dumps.
The church organized a regular funeral. The clergymen read the mass for the sick, and then the leper sometimes had to lie in a real grave. They were now expelled from the church, followed by expulsion from the congregation.
From then on they lived in a leprosory. There the sick remained alone and were only allowed to leave the house under strict criteria. They were not allowed to bathe in rivers or walk barefoot, they were only allowed to speak to healthy people if the wind did not blow their noses. The sick wore a rattle to announce their arrival 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 Ruffié went through the historical documents and found that in reality these requirements were rarely strictly observed. For example, many communities allowed the sick to beg in the city, some people were allowed to stay in their homes, and some leprosies developed into communities that farmed, twisted ropes, and sold their products directly in the ports.
Ruffié and Sournia realized that those affected had only been isolated since the 11th century, when the disease had been anchored in Europe for centuries. And they also wonder why the "leper" was marginalized to this extent.
They suspect that leprosy took on epidemic proportions during this time, and that the conditions of not walking barefoot, not having breathing contact with healthy people and announcing yourself from a distance can be interpreted as measures to avoid infection.
The leprosy did not kill as much as the plague. It leads to various secondary diseases and many leprosy people die from disorders of the lungs, nerves or vessels. But that was negligible in the Middle Ages. Because the average life expectancy was little more than thirty years, while the complications with leprosy develop after many years.
One explanation for the exclusion was the appearance of the sick, who, as the contemporary reports suggest, frightened and disgusted the healthy: a knot-like lump 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 wounds. The medically unenlightened of the Middle Ages no longer saw people in front of them in such disfigurement - they resembled the images with which the Church described the devil and the demons.
Ruffié and Sournia conclude: “It is only a small step from the physical disfigurement of a fellow human being to his moral outlaw; after all, God only knows goodness and righteousness: whoever was leper was apparently punished for his sins in this way. (...) Lepers were no longer pitiful people, but in their embodiment of evil a kind of devil on earth. "
Lasciviousness instead of bacteria
These ideas led to a completely wrong idea about the cause of leprosy. Leprosy was still considered an STD in the 18th century. The sick were accused of suffering from devilish lust and there was a risk of tempting chaste Christians.
Racists against black people and anti-Semites against Jews also used similar projections. The fiction of physical disfigurement, illness and excessive sexuality always went hand in hand.
The fantasy of "racial disgrace" in the sexual intercourse of "blacks" or Jews with "white women" reflects fantasies of annihilation similar to those in the dehumanizing fairy tales of sexual debauchery of the leprosy patients, which God would have punished with the disease.
Like Jews and other minorities, the Leprosy were the scapegoats for every catastrophe. Did the cattle fall ill, did people die for unknown reasons, did a storm destroy the harvest? Then the lepers had conspired, cast evil spells or poisoned the healthy.
They shared the fate of the Jews: the mob raided their homes, brought them into the witch trial, or immediately lynched them. In the 14th century, such "rage citizens" murdered the residents of several leprosy houses in southern France.
Ruffié and Sournia judge: "Never in their history has humanity been guilty of such a large community over such a long period of time and so carelessly and cruelly."
Cretins and the sick
In France, those affected were called "Chrétiens" in the Middle Ages, and from this the word cretin was derived, which referred to very different "malformed". It remains unclear how many people who suffered from rickets or had deformed bones from birth came into the leprosy houses.
In the early modern period, these cretins were no longer equated with lepers, but they shared their terrible fate. They were not allowed to drink at public wells, walk barefoot, enter cities and live in isolated houses. She too was suspected of indulging in sexual orgies.
It is impossible to estimate the number of people who died from the effects of the infectious disease in the Middle Ages and early modern times because all sorts of people were declared leprous: this could be a pigment disorder, the skin disease psoriasis or even simple acne.
In any case, the proportion of Europeans who suffered from leprosy has always remained very low. In the 17th century, leprosy houses were closed everywhere due to a lack of occupants, and in the 19th century they were more common on the continent only in Norway, where Gerhard Hendrik Armauer Hansen discovered the bacillus in 1873. Why it disappeared is unclear.
The disease is still widespread in some countries in Asia, Africa and Latin America, especially in India and Brazil. Overall, WHO considers the disease to be controlled and sees its eradication as a realistic goal in the coming decades.
The infection can be treated very well today and can even be cured in the long term. Therapy with dapsone, clofazimin and rifampicin gets the disease under control, but it takes years and requires the constant exchange between specialized doctors and patients. This is precisely what is lacking in the most affected countries. The rate of those affected has also been falling in developing countries for decades. In total there are currently around 200,000 new cases worldwide each year.
It is not only the therapy that is essential for the fight against leprosy, but also the improvement of the circumstances in which sick people live in countries such as Bangladesh or Tanzania. Where the victims are marginalized and have to live under catastrophic hygienic conditions, pathogens firstly spread, and secondly, those infected easily become infected with these secondary infections due to poorly cared for wounds.
Tuberculosis - causes and contagion
In Europe, leprosy is considered a typical disease of the “dark middle ages”, while tuberculosis continued its triumphal march in modern times: “coughing up blood”, ie pulmonary tuberculosis, was the typical cause of death for urban citizens in the 19th and early 20th centuries.
Tuberculosis (TBC) is caused by bacteria from the complex "Mycobacterium tuberculosis". Anyone who suffers from pulmonary TBC spreads these pathogens with wet pronunciation, when sneezing or coughing. If a healthy person inhales these bacteria, inflammation often develops in the lungs, but this usually heals itself in a few weeks.
However, TBC pathogens are also transmitted via the digestive tract, open wounds or, in the case of Mycobacterium bovis, even through cow's milk. However, these infections are very rare.
How common is TBC?
If the Mycobacterium tuberculosis were lethal like rabies or plague, large parts of the world would be depopulated. About a third of all people are infected with TBC, but only about 5% of them develop the disease and need to be treated, and in turn only very few of them take on a dangerous form.
Today almost 95% of all deaths occur in poor countries, in Asia and Africa. There are millions of new TBC diseases in India every year - around 7 million worldwide. Around 1.5 million people die of the disease worldwide each year. In Germany, the disease breaks out in a few thousand people every year.
Danger for addicts
Tuberculosis was typical in the 19th century for sickly people, for hypersensitive people and for people with "immoral lifestyle". That was not a pure prejudice: if the immune system is disturbed, the infection develops into a disease that threatens life. This applies to drug users, alcoholics, people with kidney problems, rheumatism, diabetes mellitus, malnourished and generally people who have a comprehensive history of physical and psychosomatic diseases behind them.
Pulmonary tuberculosis often has no early symptoms. Then there is profuse sweating at night, followed by a slight fever, then a severe cough with a bloody expectoration. A hemorrhage can follow, the sufferers lose their appetite and weight.
That is why tuberculosis was formerly called consumption, because the sick physically "disappeared". The sick dentist, alcoholic and gunslinger Doc Holliday was said to be so thin that his opponents could not meet him during the duel.
The lung TBC can go untreated for years. The symptoms stay away for a long time, then they break out again. Without therapy, this infection often leads to death.
AIDS patients who have no immune system are particularly at risk. The Mycobacterium can not only easily nest in them, they also often die from the outbreak of TBC.
Similar problems are encountered by patients taking drugs that suppress their immune systems, prisoners in prison, the elderly, the homeless and those with eating disorders, toddlers whose defense systems are not yet fully developed, and people in the slums of the Third World, slums in the Balkans and especially war refugees in camps.
Therapy: clean air and chemotherapy
If they could afford it, sick people were treated in the 19th century in lung hospitals where the air was supposed to be particularly clean - today we speak of climatic health resorts. They were out there enjoying a healthy and nutritious diet. At the end of the 19th century, doctors then tried to keep the lungs still so that the inflammation could heal.
In the 1950s, effective chemotherapy began in Germany that actually healed the TBC. The rate of death from TBC has been steadily declining. This was accompanied by awareness campaigns to prevent the plague. You can now get vaccinated against TBC.
In the course of globalization, tuberculosis is again an issue in Germany today. TBC cases of people from Eastern Europe in German clinics show that the disease can break out again at any time, because rates are still alarmingly high, especially in the Baltic States, Romania and the Balkans.
Blood red romance
In contrast to the leprosy of the Middle Ages, tuberculosis was hardly a metaphysical punishment for a “sin against God”, but became a symbol for the fact that even human progress ends in its downfall - a popular figure of thought in Black Romanticism.
She was known in society as "consumption" and inspired the artists of the Black Romantic period from Baudelaire to Poe, especially in the motif of the beautiful woman, who lies at the feet of the men and who fades away in the bloom of her erotic charisma - as in her twin, the sensual youth who is alien to the thought of death and who coughs life out of his lungs in the midst of adventure and debauchery.
The mask of red death
Poe himself saw the death of a beautiful woman as the most important subject in art, and black romanticism was bathed in the interplay of death and eroticism, beauty and impermanence. Specifically, the artists of black romanticism tried to flip out the inevitable decay, illness and death through sensual excesses.
The writer lost his mother Elizabeth when she was 23; she died of tuberculosis just like his beloved Virginia at the age of 24. Vampire characters in Poe's work, such as Ligeia, who first dies of an illness and then rises from the dead, are probably just as influenced by TBC as his story "The Mask of Red Death".
In the vampire, the superstar of the Black Romantic and Gothic Novel, there are also indications of the bacterial infectious disease: the bloodsucker that draws the blood from beautiful women at night so that they pass away and the blood-smeared mouth of the undead may not only remind you associatively the coughing up blood of the sick. Especially since this literature flourished in Victorian England when tuberculosis made people in London disappear.
The consumptive became a symbol for the creeping death, which already shines through in the flowering of the life force and breaks in like a thief at night when the fun-loving least expect it. But tuberculosis is neither a new nor a modern disease, and not only Adonisse died of it.
“Sometimes it seems to me that my brain and lungs have communicated without my knowledge. "It doesn't go on like this," the brain said, and after five years the lungs agreed to help. "Franz Kafka
One of the most prominent victims of tuberculosis was Franz Kafka, who also literarily processed his illness. The writer clearly shows how the physical and mental state influences the effects of TBC. Throughout his life he suffered from countless complaints, which he himself suffered from as psychosomatic.
Although he reflected to a great extent how his psychological suffering was expressed physically, he was too weak to use this reflection to heal himself. At the same time, in a paradox that is also reflected in his oeuvre, he even felt that tuberculosis was a perverse form of liberation.
The illness that destroyed his body and life made it impossible for him to do the hated office job, and he could only be absorbed in his literature.
The popular term for tuberculosis is pulmonary tuberculosis, which affects the lungs. But TBC can affect various parts of the body: meninges, pleura, bones, intestines, skin and genitals. With Kafka it was the Kelkopf.
In 1917 the diagnosis of pulmonary tuberculosis was made, in 1923 the condition had developed into a larynx TBC. Kafka suffered from constant severe coughing, a burning sore throat and slowly but surely lost his voice.
The author, who was already thin anyway, continued to lose weight when he died in 1924, he weighed less than 45 kilograms. He could no longer eat solid food, his larynx was swollen too much, and Kafka was too weak to survive an operation. The pain became unbearable. On June 3, 1924, he died in a sanatorium near Vienna, officially from cardiac paralysis.
An old nuisance
Leprosy was not an epidemic of the Middle Ages, because it was rampant in ancient times and still exists today. Tuberculosis has also seeped into the modern world, but it is an ancient plague.
From early history, mummies show damage to the spine that is typical of tuberculosis. But TBC was only able to spread to a large extent in the big cities. The Stone Age people lived together in small groups - more or less isolated from each other.
Only when people became sedentary, according to Ruffié and Sournia, and the strains of the Mycobacterium that lived in domestic animals adapt to people, did tuberculosis become endemic and eventually epidemic.
Hippocrates described exactly the phthisis, literally "wasting away". Cough, bloody sputum, and progressive weight loss leave no doubt that it was pulmonary TBC. Until the 19th century, the doctors saw no connection between the lung disease and TBC on the genitals or lymph nodes.
An infectious disease
The Italian humanist Geralmo Fracastero (1478-1553) recognized that TBC was an infectious disease, while the doctors previously speculated which disposition led to consumption and actually found evidence because particularly "sickly" people with broken out lungs- TBC suffered.
Fracastero was also far ahead of its time in that it assumed that microparticles were carriers, even though bacteria could not be seen without a microscope in this age.
He wrote verbatim: “This infectious primal substance spreads from the originally infected area to solid bodies, where it can remain for a long time and be preserved without undergoing changes. (…) Thus, through the robe worn by a consumptive, the suffering can still be transmitted after two years, and the same can be said of the chamber, the bed, the floor on which the consumptive died. ”
The curse of progress
Ruffié and Sournia expressly point out that the TBC also circumvented the Middle Ages, but consider it likely that it was mostly not recognized and slowly led to death, so that the "fast" epidemics came into focus, in which the Link between infection, extreme symptoms and dying is obvious.
However, the TBC was most widespread in the 18th and 19th centuries, and it went hand in hand with the industrial revolution. In the crowded, filthy and impoverished quarters of the workers, who often vegetated with 12 people in a single room without water and light, the droplet infection could spread like wildfire.
The poor were also weakened by various other diseases, hardly took any vitamins that would have built their immune systems, and so tuberculosis often passed into death. Children worked up to fifteen hours a day in mines, dirt was everywhere. The urban population of the industrial centers multiplied in a few decades, and this increase consisted almost entirely of rag proletariat.
The tried droplets of saliva sprayed from the workers' slums into the bourgeois salons. Not only did young people die from the disease, but it shocked them especially - but only if they came from the educated or property bourgeoisie.
In the port area of Liverpool or among the poor in Paris, it was normal for young people to leave life, especially small children. The bourgeois saw themselves in industrialization as the spearhead of modern times, and the bourgeois ideology of progress promised to solve all human problems with technology.
Here the TBC robbed the illusions and caused a narcissistic insult. What good was the early wealth of a factory owner's son if he died without drawing on it? The dream burst for wealthy bohemians who discussed God and the world in the salons when bloody sputum announced that they would soon no longer be part of this world.
The disease never led to rapid mass extinction such as plague or cholera and mostly settled to an endemic mean. But this "quieter" spread is deceptive. Presumably, more people died of it than of cholera in modern times.
However, its creeping course ensured that it was not recognized as a dangerous plague. France, for example, did not introduce TBC reporting until 1964 - and it was no longer necessary.
Tuberculosis can be managed today. Except for high-risk groups such as AIDS sufferers, the risk of dying from TBC is low - if it is treated. In the 1990s, however, Ruffié and Sournia drafted a somber forecast for the TBC-infested countries in Asia, Africa and Latin America: “Children will have to die of tuberculous meningitis for a long time to come. Poor hygienic conditions and malnutrition are the main enemies of a renovation that wants to clear up tuberculosis. ”There is also no general vaccination.
Over the past two decades, the fight against infectious disease in the countries of the South has led to some improvements, and the number of deaths annually has halved. But vanishing with bloody expectoration is far from being defeated. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
- E.H. Ackerknecht: History and Geography of the Most Important Diseases, New York / London 1965
- Ruffié, Jacques / Sournia, Jean-Charles : Die Seuche in der Geschichte der Menschheit, München, 1992
- Krämer, Sandra: Franz Kafka (1883–1924): Ein Opfer der Tuberkulose, Dtsch Arztebl, 2014, aerzteblatt.de
- Lisson, Marion: Einblicke in die Geschichte der Tuberkulose, Ärzte Zeitung, 2011, aerztezeitung.de
- Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH): Tuberkulose Grundlagen (Abfruf: 07.08.2019), lungeninformationsdienst.de
- Bundeszentrale für politische Bildung: Seuchen – gestern, heute, morgen (Abruf: 07.08.2019), bpb.de