Hurtigruten's Finale for Physicians: Bergen's Leprosy Museum

Photography by the authors

In the 19th century Norway had the greatest concentration of lepers in Europe. No one knew why. Some felt it was due to the air, like tuberculosis. Others said a great deal was based on poverty and poor nutrition. Others added: “it’s the excessive salting of our food — and fish is bad for your blood.” But most believed it was a hereditary disease.

Gerhard Henrik Armauer Hansen made the search for the cause of this historic, biblical affliction his life. He found the microorganism in 1873.

St. Jorgen’s Hospital, from a drawing in 1768 by J.J. Reichborn (authors’ photograph courtesy Bergen Museum). Sketch of Bergen in 1740s showing hospital marked with number 13 (again courtesy Bergen Museum, location of which shown by our red arrow). Current 2012 map of Bergen, available free all over the city, shows same location of leprosy museum by similar (shaky) red arrow.

Hansen was born in Bergen in 1841. He would be the eighth of 15 children, and when he was 7 years old a Norwegian bank crisis drove his merchant father into bankruptcy.

Hansen worked his way through medical school at what became the University of Oslo. To pay his fees he taught at a girls’ school, then later gave anatomy lessons. He passed his medical degree with Honors in 1866, and then served as a physician to a fishing community in the Lofoten Islands. He had shown considerable ability in scientific research, and when he came back in 1868 to Bergen, a position in the Norwegian center for leprosy research seemed tailor-made for him.

Norvald Johannessen now lives in the house where Hansen lived and was born in at 5 Kroken Gate above the Mariakirken Church. In Norwegian, “

means

.

The Bryggens Museum lies less than a five-minute walk to the south.

gate”“street”

Hansen was not the first to attempt to understand leprosy. J.J. Hjort carried out a survey around the country in 1833. Carl Wilhelm Boeck won a scholarship to study the disease in 1840. And Daniel Cornelius Danielson became a state physician specializing in the disease in 1841.

Danielson published an illustrated monograph with Boeck in 1847 and became the leprosy authority in Norway in the mid 19th century. Danielson felt absolutely the disease was a “hereditary dyscrasia.” It ran in the blood of families with parents passing it on to their children.

St. Jorgen’s (St. George’s) Hospital lies a 10-minute stroll east from the harbor on Kong (King) Oscars Gate. It was common in the Middle Ages for cloister-like hospitals to be built “where religious matters were central.” That way, bed-ridden patients could attend church services. Beyond the altar in St Jorgen’s a door leads to the hospital.

Enter Hansen. By the time Hansen came on the scene Danielson was additionally a powerful politician, a member of parliament. The story goes that the first time Hansen met Danielson, he declined to accept the hereditary explanation and told the senior physician he felt the disease was due to contagion!

The enclosed church pews look claustrophobic and uncomfortable. The ancient Norwegian for leprosy was

; later the term was changed to

(with several spellings). The inscription on the wall of the altar, in old world Norwegian, means something like “Here by Lord’s altar you will have your sins washed and receive Jesus’ blood and be able to heal your leprosy, soul and body.” The lower photograph is of Hansen in the 1880s.

spillsykjespedalskhet

Hanson’s beliefs were initially based on his epidemiological studies. He argued many times with Danielson, but on one different occasion he asked for the hand of Danielson’s attractive daughter! Who knows what the older man thought but the young woman happily became Hansen’s wife. (Sadly, she died of tuberculosis 10 months later.)

An archway from the church leads into the hospital. The original St. Jorgen’s was first mentioned in 1438. Dreadful fires destroyed most of the city in 1640 and 1702. The present building was erected in 1754. The last patient here died in 1946. The patients’ cubicles ran along the walls on two floors, each accommodating two persons. In 1617 there were 52 patients, almost all with leprosy, but in the 1800s epidemics occurred and the hospital had 170 patients in 1840.

Through the 1870s, the hunt was on for Hansen. He had found under his microscope a rod-shaped bacillus that was difficult to stain and poorly seen even under osmic acid, but he felt sure it was the cause of the disease. Time to publish!

The cubicles were small and in them some patients lived their entire lifespan. Grete Eilertsen, a historian and representative for Bergen’s Leprosy Museum, explains to visitors how the hospital vicar, Johan Ernst Wellhaven, published an illustrated report in the

in 1816. He called the hospital “a graveyard for the living.” His report is now in the Hagstromer Medico-Historical Library in Stockholm

our photographs of those illustrations are by courtesy of that library. His report forced the country into action. In 1856, a Norwegian state leprosy doctor Ove G. Hoegh published a register of patients that is “probably the first national register for any disease in the world.” The polished black tablet with white letters shows a portion of a public list of patients

a kind of Who’s Who in the disease. Some visitors to the museum are appalled at the lack of privacy accorded patients, but such a lack of finesse is sadly nothing compared to patients’ other sorrows from this terrible disease.

Swedish Medical Journal — —

In 1874 Hansen published an 88-page report that justified his beliefs on the origin of leprosy from “microbiological studies and epidemiological analyses.” A shorter version in English appeared the following year.

Hansen showed how some people with families free of disease had developed leprosy after contact with patients who had it and how isolation of patients in different districts had created a decline in new patients.

He then investigated intact leprous nodules and found “small staff-like bodies…in many of them.” Hansen then modestly added the words that would come back later to haunt him: “Though unable to discover any difference between these bodies and true bacteria, I will not venture to declare them to be actually identical.”

Life was sad but simple for patients as was typical in medical institutions, but the horror for patients knowing they had the disease must have been watching the cosmetic decline, even disintegration, of other patients who had the disease. The stairs to the kitchen are well worn, the kitchen stove had a large capacity, and for imagined security in a city with hundreds of wooden buildings and a history of frequent fires, a fire bucket with water hung ready on a hook.

Enter the young Albert Ludwig Sigesmund Neisser, an 1877 graduate of the University of Erlangen in Bavaria, Germany. He had attended school in Breslau as a contemporary of Paul Ehrlich — of “magic bullet” fame — and in 1879 visited Hansen from Koch’s lab in Breslau.

Am. J Dermatopathol

Neisser attempted to stain the slides in Bergen but failed. Hansen gave him some specimens to take back to Germany and encouraged him to keep trying. He did; he visualized the stained bacillus. Says Dr. Lorentz M. Irgens in 6:337-343. 1984, “Neisser was prompt to publish his findings, to suggest that these bacteria were the infectious agents in leprosy, and to claim that he had made the discovery by himself.”

In 1849, Bergen built the Lungegard Hospital, a huge advance at a time when there were now three leprosy hospitals in the city. Many doctors felt the disease was hereditary and lepers should not be allowed to mate. The new hospital segregated patients, even married ones. All of the historical artifacts have now been moved from St. Jorgen’s to this hospital, which is about a 10- to 15-minutes walk east along the same street. Here are the microscopes that Hansen and the other leprosy doctors used, here are their lab bottles and equipment, and here is Hansen’s desk and chair. The photograph is Hansen before his beard got really long and white.

hair

Forget the beard. Presumably at this time it was Hansen’s that was going white. (We know a judge in New Hampshire who, when confronted in court by a lawyer who hesitates and says, “Your honor, it is a long story…” responds by saying, “In that case start at the end!”) The Hansen story is a long one.

He reacted to Neisser’s claim by publishing his own argument in an international scientific forum in four languages and presented more details about his discovery. Neisser’s next paper was more emphatic. He “wanted to be honored as the man who had placed these micro-organisms, which no one had seen previously, among the fungi causing diseases.”

The hand is a model from a hand with the disease; the curved rod bacterium photograph is from the hospital collection; the books are mostly Hansen’s; and the lab would really remind any physician of days in medical school

.

The dispute was settled, ironically, in Germany at an 1897 leprosy meeting in Berlin. There, Hansen was declared the true and sole discoverer of the leprosy bacillus. He was the first person to have found a microorganism as the cause of a chronic disease, an astonishing discovery as the incubation period was so long and the communicability so low.

In the former Lungegard Hospital you really are touching history. It is interesting to see how little has changed in simple laboratory work. And when visitors’ interests turn back to more touristy attractions, a 20-minute return along cobbled streets and through medieval arches reveals, once more, the charms of Bergen’s harbor.

And Neisser? He then turned his attentions to a disease with fast incubation and high infectivity, gonorrhea, and ultimately the gonococcus that now bears his name: Neisseria gonorrhoeae. The story unfortunately does not end there. Hansen all through the 1870s had tried to prove what would later be called Koch’s Postulates. He tried to infect lab animals — even although Danielson previously had injected himself, his assistant, his ward sister, a male assistant and three nurses with blood from patients with no results.

Finally, two weeks after Neisser made his claim on history, Hansson took the step that would offend the very society he was trying to help. He chose a young patient with the anesthetic form of the disease such that her eyeball would not feel pain and injected material from another patient’s leprosy nodule into her eye. The patient who had not been asked for informed consent developed a leprous node in the eye.

Hansen had proved his theory, but he had activated the birth of Norwegian patient protection. He was taken to court and ordered to vacate his position as Chief Physician at the Leprosy Hospital, although he continued to hold his state position as Chief Medical Officer for Leprosy until he died of cardiovascular complications in 1912.

Irony again! The German physician, Neisser, whose claims that he, not Hansen, had discovered the organism was involved in similar moral challenges of informed consent. In 1898, he injected cell-free serum from syphilitics — without getting informed consent — into patients, most of whom were prostitutes. When they became syphilitic h

e argued they had developed it from their work as prostitutes. Neisser died aged 61 in 1926. Of septicemia!

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The Andersons, who live in San Diego, are the resident travel & cruise columnists for Physician's Money Digest. Nancy is a former nursing educator, Eric a retired MD. The one-time president of the NH Academy of Family Practice, Eric is the only physician in the Society of American Travel Writers. He has also written five books, the last called