Armauer Hansen’s laboratory

A visit to the Armauer Hansen’s laboratory in the St Georges hospital, Bergen was an interesting but challenging one. The Leprosy Museum (Lepramuseet) in Bergen is housed in the 18th century buildings of St Jorgen’s (St George’s) Hospital, and St. Jorgen’s Church forms part of the old leprosy hospital buildings. The hospital was founded before 1411 and was the central institution for treating people affected by leprosy in Western Norway until its closure in 1946. The present-day buildings date back to the early 18th century.

An enthusiastic historian with his passionate story telling stirred our hearts, minds and souls! Let me share with you some reflections, from what I heard.

It was at St Jørgen that Hansen’s predecessor, Daniel Cornelius Danielssen, embarked on leprosy research in 1839. In 1840, Danielssen began a collaboration with Carl Wilhelm Boeck. This partnership culminated in the celebrated work ‘‘Om Spedalskhed (On Leprosy)’’, putting Bergen in the forefront of leprosy research. This extraordinary treatise presented in meticulous detail the clinical picture of leprosy and included a large atlas of drawings. In 1849, the new Lungegaarden leprosy hospital was established in Bergen, with Danielssen as its chief physician. The hospital not only housed leprosy patients but also patients with other dermatologic afflictions, which allowed Danielssen to do comparative studies of different dermatologic conditions. Sadly, fire destroyed the building in 1853. The new premises that were designed after the fire housed more than 90 leprosy patients. This new hospital also was equipped with a laboratory and library and became an important center for research. In 1862, Danielssen produced another important work that highlighted the anaesthetic form of leprosy. Both Danielssen and Boeck believed that leprosy was a hereditary disease.

But Hansen would come to question Danielssen’s theory about leprosy. Hansen believed that leprosy was infectious not hereditary. An increasing number of leprosy cases in Norway forced the need for more hospital beds and led to the founding of yet another leprosy hospital in Bergen in 1857—Pleiestiftelsen for Spedalske Nr 1 (Nursing Institution for Leprosy Patients No. 1). 

It was there in January 1868 that Hansen embarked on his important quest, with Danielssen as his chief. (The Legacy of Armauer Hansen Venita Jay, MD, FRCPC 496 Arch Pathol Lab Med—Vol 124, April 2000)

The story of Armauer Hansen and his team was challenging because, much before the full understanding of “contagion” but around the days when Robert Koch was working on the postulate of contagion, here was a team, questioning the causation of a disease for which no cause was known. The ability to “question” “reflect” and ask the “why” of what they saw - the scientific discipline of asking the right questions that led to the series of events that followed!

I wonder - Where is the scientific thinking and passion today in Medical field? The discipline of asking the why question, the tenacity of struggling with the question amid multiple failures and challenges till an answer is found! Has Google and Wikipedia replaced our scientific quests? Creativity emerges out of why questions.

What they saw was confusing, they had no infrastructure or modern methodology to understand things with ease, but with a primitive microscope Hansen and his team persevered till they found the bacillus. Next step was to prove that this was the cause of the disease, and not the effect. Despite multiple animal experiments, they couldn’t grow the bacteria or produce the disease. Out of exasperation, Hansen inoculated a lady with the bacteria, and produced the disease. But he lost his job in the clinical side after a legal case against him -because “consent” was never taken for this experiment.

And of course, subsequently the identification of the famous armadillo that became the reservoir for scientific experiments for decades to come! A negative but truthful side of the history, though bit challenging, worth learning from! 

What did that lead to? Much before rest of the world came up with “informed consent” some of the Norwegian centers had set up consent processes!

How truthful are we in communicating our failures? Failures that led to challenges in our life of work and engagement, but failures as opportunities to learn from and innovate! Innovation comes out of learning from failures!

The confusions they had to grapple with, was visible, by looking at the library of articles and books. Books on “Fish eating and Leprosy”, “climate and leprosy” “Families and leprosy” – trying to correlate the various associations, before they could identify the bacillus!

The next was to explore how to tackle the disease which was prevalent across the coastal regions of Norway. A concept that drove them was – “how can a country like Norway still grapple with a Medieval disease?”. They need to eradicate it to move into a developed nation. This led to the first Leprosy registry, mapping of the disease and keeping track of each location and patient, the first few steps in epidemiology of illness, much before some of these were part of the common scientific thinking! Much before the GPS and data base systems – they had these maps – Map of the world with diseases prevalence mapped in (1886) and map of the undivided India (1891) with disease prevalence mapped!

And over next few decades, with a robust system of hospital-based care at St Jorgen’s hospital and regional centers, patient follow up and home-based management, they had eradicated the disease!

Where are the people with passion to eradicate such diseases, and care for people with such illnesses? 

From 1891, when India had the highest prevalence in the world, the world and India has moved ahead. But 128 years down the line, our nation still has the highest numbers in the world! 17% of the world population having 58% of the worlds load of the disease even in 2018!

Scientific thinking and creativity, innovation, vision and passion come out of a heart that desires to see lives changed, a mind that plans to see diseases contained, a perspective to engage in making the world a better place. In one sense living out a life of a vision for a new heaven and earth, where there is no pain or sorrow, and be part of ushering in such a world. 

How is my life?