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The Story of Leprosy
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ACTIVIT Y OVERVIEW
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TA L KI N G I
SUMMARY
Societal responses to infectious diseases are considered in the context of leprosy
(Hansen’s disease). Questions of the trade-offs of quarantine and the humane treatment of individuals in quarantine are discussed after students complete a reading
about Hansen’s disease.
KEY CONCEPTS AND PROCESS SKILLS
1.
Tracing the history of science demonstrates how individuals contributed to
the development of modern scientific ideas, and reveals important
interactions between science and society.
2.
Disease is a breakdown in the structure or function of a living organism.
3.
Making decisions about complex issues often involves trade-offs (i.e. giving up
one thing in favor of another).
4.
Society sometimes responds to people with infectious diseases with fear,
prejudice, or cruelty.
5.
Hansen’s disease is one of many diseases that have become rare in the United
States due to the availability of effective drug treatments.
KEY VOCABULARY
disease
infectious
ethics
quarantine
evidence
trade-offs
Teacher’s Guide
C-63
Activity 34 • The Story of Leprosy
TEACHING SUMMARY
Getting Started
1.
Identify leprosy as an infectious disease.
Doing the Activity
2.
Students read the story of leprosy.
Follow–Up
3.
The class discusses the scientific, societal, and ethical implications of
quarantine.
Extension
Students can go to the SALI page of the SEPUP website to link to sites with more information about the history of leprosy in the United States.
INTEGRATIONS
Social sciences
You may wish to further explore the history of the treatment of individuals with leprosy. The history of the leper colony on Molokai, Hawaii, is one possible direction for
research.
BACKGROUND INFORMATION
Leprosy
The term leper has been synonymous with outcast for over 2,000 years. People were
often afraid and repulsed by the disfigurement caused by the disease. Their fear of infection caused them to reject and ostracize infected individuals. Although individuals
with leprosy can now be treated with antibiotics and become non-contagious within
only a few days, there is still great fear and misunderstanding about the transmission
of this disease. In fact, evidence suggests that a large proportion of the population is
immune (highly resistant) to the disease. Children are more susceptible than adults.
Although Hansen’s disease (leprosy) can be cured, nerve damage and disfigurement
that occur prior to diagnosis and treatment are irreversible. The disease is caused by
C-64
Science and Life Issues
The Story of Leprosy • Activity 34
Mycobacterium leprae, a bacterial species similar to the bacteria that cause tuberculosis. However, much about leprosy, including the mode of transmission, remains mysterious. The bacteria are found in nasal and oral secretions and in the skin, but not on
the skin surface. Evidence suggests that the disease is usually spread through airborne
droplets, but this is not conclusive. Transmission by insects and animals has not been
ruled out. Certain animals, including armadillos, commonly harbor M. leprae, and
current research suggests that Hansen’s disease may also be transmitted through soil
containing the bacteria.
In 1997, there were an estimated 1.5–2 million cases of Hansen’s disease worldwide. In
the United States, about 200 new cases are reported annually. Most of these cases appear
among individuals who have immigrated from other parts of the world, but some cases
appear in individuals who live in Louisiana, Texas, southern California, or Hawaii, where
the bacteria that cause Hansen’s disease are found in animals and the soil.
REFERENCES
http://www.bphc.hrsa.gov/hdc/hansen1.htm
National Hansen’s Disease Program, Bureau of Primary Health Care and Health
Resources and Services Administration, U.S. Department of Health and Human
Services
Teacher’s Guide
C-65
The Story of Leprosy • Activity 34
TEACHING SUGGESTIONS
GETTING STARTED
1.
Identify leprosy as an infectious disease.
This activity provides an opportunity to discuss the
social implications of disease as well as the variability in mode and frequency of transmission of different diseases. Begin by asking, Had you heard of
Hansen’s disease, leprosy, or the term leper before
cuss responses to Analysis Questions 1 and 2. These
questions are intended to help them identify and
process information provided in the reading. Analysis Question 4 provides an opportunity for an
assessment. Consider assigning this question after
the class has discussed Question 3. You can use the
“Using Evidence to Make Trade-offs” element of the
E VIDENCE
offs to this situation.
FOLLOW–UP
what students know or think they know about the
fear and prejudice, acknowledge the issues and indicate that they will read about and discuss them further.
DOING THE ACTIVIT Y
2.
Students read the story of leprosy.
Assign the reading. Since the focus of the activity is
the relationship between science and society and
thus would benefit from discussion, complete the
T RADE - OFFS (ET) variable to assess
how well students can apply the concept of trade-
Activity 31, “The Range of Disease”? Briefly discuss
disease. If their comments raise the social issues of
AND
3.
The class discusses the scientific, societal,
and ethical implications of quarantine.
The reading first refers to the disease by its historical name, leprosy, and then introduces and uses
the modern name of “Hansen’s disease.” Ask students to suggest reasons for preferring the modern
term. If they are unable to explain it, tell students
that because of the stigma historically attached to
the term leprosy the term Hansen’s disease is now
preferred.
reading as an in-class activity, either as a whole
As a class, discuss student responses to Analysis
class, small group, or individual assignment. You
Questions 4 and 5. You may want to have students
may wish to have volunteers read each paragraph
consider some examples. Even in the case of a short-
aloud, or students can read in groups using recipro-
term illness, the effect of quarantining people can
cal teaching.
be emotionally and economically difficult. In the
n Teacher’s Note: See the Literacy and Communi-
case of a long-term illness like Hansen’s disease, the
cation Appendix for suggestions about how to help
students with science content readings and how to
use Science and Life Issues to develop students’ literacy and communication skills. The appendix
includes a complete overview of literacy and communication connections in this unit.
After students have completed the reading, they dis-
effect was devastating to people’s lives. Of course,
this was partly because quarantine was implemented so cruelly. Contrast this situation with that of
chickenpox. Individuals with chickenpox are not
officially quarantined, but are expected to stay
home until the pox dry up, even if they feel fine and
would prefer to return to work or school. This is
especially important in preventing people with
Teacher’s Guide
C-67
Activity 34 • The Story of Leprosy
compromised immune systems, very young chil-
SUGGESTED ANSWERS
dren, and pregnant women from catching the dis-
TO ANALYSIS QUESTIONS
ease. Thus the advantages and disadvantages to the
infected person and the advantages and disadvan-
1.
How have people with Hansen’s disease
been treated throughout history? Provide
tages to the public are considered in analyzing the
specific examples.
trade-offs involved in making recommendations
regarding chickenpox and other diseases. This deci-
Historically, people with Hansen’s disease have
sion is significantly less difficult than some others
been cast out of the community. During the
because the “quarantine” can be carried out in the
Middle Ages, someone with Hansen’s disease
patient’s home and is relatively short.
was considered dead and had to beg to survive.
Beginning in 1894, people with Hansen’s dis-
In the United States, varying levels of quarantine are
ease in the United States were forced to leave
applied to victims of cholera, diphtheria, infectious
their families and go to the Louisiana Leper
tuberculosis, plague, yellow fever, and viral hemor-
Home. They were kept like prisoners, but not
rhagic fevers. The type of quarantine depends on the
treated as well as prisoners were. People did not
specific circumstances and, in some cases, varies
want to touch them or any of the objects they
among the different states. In these more serious
had used, like drink bottles and eating utensils.
diseases, the risks to the public are greater.
Students can consider how hospitals sometimes
implement “quarantine measures,” such as separate
wards or rooms for those with certain types of diseases. Have students compare the levels of isolation
2.
Imagine that you meet someone who tells
you that he or she has Hansen’s disease.
How would you respond? Support your answer with
evidence from the activity.
required by such public health measures and the
Some students may state that because Hansen’s
complete societal ostracism that once prevailed
disease is not highly infectious (only about 5%
against those with certain diseases such as Hansen’s
of family members living with someone who
disease. For example, the “leper colony” on the
has the disease contract it), they would treat the
island of Molokai, Hawaii, in the 1800s was popu-
person like anyone else. They may also point
lated by infected people who were forced off of
out that the disease is rare, that 90% of the pop-
ships and told to swim to shore.
ulation is immune, and that drugs are available
to prevent the disease from spreading. In addi-
Extension
tion, evidence suggests that becoming infected
Students can go to the SALI page of the
SEPUP website to link to sites with more
requires close contact with an infected person
over a long period of time.
information about the history of
Some students may still be concerned about
leprosy in the United States.
being at risk for catching an infectious disease.
They might encourage the individual to seek
treatment in order to prevent its spread as well
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Science and Life Issues
The Story of Leprosy • Activity 34
3.
as to prevent the onset of the debilitating symp-
chance that the disease will spread. This would
toms that occur when left untreated.
not be true if there was a vector for the disease.
A vector like a mosquito could bite an infected
Discuss what factors should determine how
person and spread the disease even with the
a person with an infectious disease should
quarantine. And quarantining people against
be treated.
their will is not right. But if the disease is seri-
Students may suggest that the severity of the
ous, it might be the only way to stop the dis-
disease, the mode of transmission, whether a
ease from spreading. The trade-off is that you
treatment exists, and the amount of time an
force people away from their families and work.
individual is contagious are factors to consider
I don’t think people should ever be quaran-
in deciding how to treat the person. However,
tined. Even though it could keep other people
emphasize that in all cases, even if an extreme
from getting sick, too many people suffer. That
measure like quarantine is necessary, the person
is what happened with the plague in San Fran-
should be treated with kindness and respect and
cisco. People were forced away from their homes
supported with appropriate medical treatment.
if they were sick and everyone in Chinatown
Modern techniques for isolating patients and
was punished by being quarantined. The disease
protecting medical personnel make it easier to
was spread by rats, so this did not even help. The
provide humane medical treatment to infected
same thing is true of Hansen’s disease and AIDS.
people. However, before modern cures and tech-
People are afraid of these diseases but they don’t
niques were available, some individuals risked
have enough information. The trade-off is that
their personal health to help infected people.
some more people might get sick.
4.
Based on your understanding of infectious dis-
ET
uet
eases, explain whether you think people who have
sidered how to prevent the spread of infectious dis-
an infectious disease should be quarantined. Sup-
ease. Imagine that you were infected with an infec-
port your answer with evidence and identify the
tious disease. Would you volunteer to be
trade-offs of your decision.
quarantined? Explain.
Hint: To write a complete answer, first state your
This question asks students to place the deci-
opinion. Provide two or more pieces of evidence that
sion-making in a personal context. If appropri-
support your opinion. Then consider all sides of the
ate, you may want to ask students to think
issue and identify the trade-offs of your decision.
about times when they have been sick with an
Complete and correct level 3 responses are
shown below:
5.
Reflection: In Activities 30, 32, and 33, you con-
infectious disease such as a cold or the flu: Did
they stay at home to prevent infecting others?
What factors went into making their decision?
I think that people should be quarantined in
some cases. If you quarantine all of the people
Have they ever decided to attend school when
contagious? Why or why not?
who have an infectious disease, there is less
Teacher’s Guide
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