Mardi Gras at the Leprosarium

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Fat Tuesday is only a few days away and the residents of New Orleans are convulsing with anticipatory excitement and glee at the weekend parades, balls and crawfish boils leading to the grand finale. Mardi Gras is one of the finest celebrations in the world and what makes it particularly unique is the egalitarian nature that lies at its very heart – everyone is welcome to come witness and participate in Carnival. And for those very few who are not, Mardi Gras comes to them.

Mardi Gras celebrated at the Carville in 1957. Click for source.

Mardi Gras celebrated at the Louisiana Leper Home in Carville, Louisiana in 1957. There is little information about this image though it appears to be a procession of drumming jesters through the facility – the recreation center, most likely – during their carnival ball. Residents and staff in formalwear can be seen in the background. Click for source.

In 1894, on an abandoned sugar plantation located just outside of Baton Rouge in the small community of Carville, Louisiana, the doors to a new facility dedicated to the quarantine of leprosy were opened. Ostracized by their family and communities, men and women were shipped in barges from New Orleans along the Mississippi River to the Louisiana Leper Home where they were housed in former slave quarters (1). Some were handcuffed on the barges, forcibly exiled from their homes and families and their very lives to be imprisoned and shunned by society (2). The leprosarium would operate for over a century and serve as the last hospital in the industrialized world completely dedicated to the “treatment” of leprosy. Catholic nuns associated with the Daughters of Charity of St. Vincent de Paul would serve as their caretakers.

Just as residents of Louisiana don masks and costumes to watch and revel in the sights of the parades, so too would the quarantined residents of the leprosarium. Concealing their identity and disfigurements, the leprosarium’s residents could have their own day to celebrate Mardi Gras, liberated socially and psychologically from their  disfiguring disease.

Miniature floats rode in their Krewe of Carville parade, constructed from bicycles, wheelchairs and carts scavenged throughout the facility. The King and Queen of Mardi Gras were elected yearly and announced at the carnival ball. In 1995, an observer of the Carville festivities wrote that the doubloons – collectible aluminium coins specific to each Krewe –  were imprinted with the outline of an armadillo, the animal now known as the natural reservoir of Mycobacterium leprae, the bacteria that causes leprosy (1).

The Queen and King of Mardi Gras in 1998 at the Louisiana Leper Home. At that time, the facility had been renamed  the Gillis W. Long Hansen’s Disease Center. Photo: Jeffrey Braverman. Source: M. Gaudet. (2004) Carville: Remembering Leprosy In America. Univ. Press of MississippiPg 139.

The Queen and King of Mardi Gras in 1998 at the Louisiana Leper Home. At that time, the facility had been renamed the Gillis W. Long Hansen’s Disease Center. Photo: Jeffrey Braverman. Source: M. Gaudet. (2004) Carville: Remembering Leprosy In America. University Press of Mississippi.

In her wonderful essay on Mardi Gras at the leprosarium, Marcia Gaudet writes,

Mardi Gras for the Krewe of Carville follows the general structure of urban Mardi Gras celebration in Louisiana, with costumes and masks, a parade with music, food and drink, favors or tokens being thrown or begged for, general revelry, role reversal, and symbolic inversion. It is unique, however, in that the participants are residents or staff members of the Gillis W. Long Hansen’s Disease Center.

To act carnivalesque is to be allowed to be ‘abnormal’ for a while. paradoxically, to celebrate Mardi Gras, like any other masquerade holidays, is normative – it is not only allowable but even expected that one will participate in the seasonal customs. Thus, for people who are already stigmatized as ‘abnormal’ in society, the masks and the occasion allow an opportunity to engage in normative behavior, to act “‘normal.’ (1)

In 1999, the facility closed its doors to receiving resident patients, though a few long-term patients remain on the site out of comfort and security after the many decades of quarantine on the site. The facility now serves as a museum and a research center for leprosy, its masques, balls and floats no more than echoes in the past.

Resources

A heartbreaking article from the New York Times, “Both Home and Prison, Leprosy Site May Shut” on the closure of the facility.

The website for the National Hnsen’s Disease Museum currently operated by the US Department of Health and Human Services. I went to the museum a few years ago and loved it!

Note: A big thank you to Rosemarie Robertson at the Louisiana Office of Public Health for the Mardi Gras picture of parading drummers!

References

Louisiana Office of Public Health (July-August 2003) Carville: The Gillis W. Long Hansen’s Disease Center. Louisiana Morbidity Report. 14(4): 3

(1) M Gaudet. (1998) The world downside up: Mardi Gras at Carville. J American Folklore. 111(439): 23-38

(2) S Jauhar (June 23, 1998) Both Home and Prison, Leprosy Site May Shut. The New York Times [Online]. Accessed on February 8, 2013 here.

ResearchBlogging.org
Gaudet, M. (1998). The World Downside Up: Mardi Gras at Carville The Journal of American Folklore, 111 (439) DOI: 10.2307/541318

Oy Vey!: Pig Tapeworm in the Orthodox Jewish Community

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A few months back, Carl Zimmer published a short article on the startling widespread prevalence of neurocysticercosis; the larval infective form of the pig tapeworm Taenia solium that just so happens to infect the human brain. Check it out, but beware!, you will be learning about a parasite that gives unwelcome deep tissue massages in your gray matter and you will see photographic evidence of it.

The real trouble with this pig parasite, aside from it’s distressing appearance in your cerebral headquarters, is that you can acquire neurocysticercosis even if you don’t consume pork products. This is the surprise kicker, the coal in your Christmas stocking.

The mouth of the adult pork tapeworm, Taenia solium. The tapeworm typically lives in the intestines of pigs but may infect those that eat undercooked pork. The larva produced by the adult worm are passed in the feces and may go on to infect the organs and tissues of humans. Image: Dennis Kunkel Microscopy, Inc.

This is understandably alarming for people who choose to not eat pork but what if your culture and religion prohibits its very consumption? What does it mean to those that belong to a group with strongly delineated food taboos which just so happen to include those of the swinish variety? Say, Jews that are kosher and adhere to kashrut, Judaism’s set of dietary laws, that forbid consumption of pork because pigs don’t ruminate, or “chew the cud” (Leviticus 11:7, Deuteronomy 14:8)?

Sadly, this went beyond being a thought exercise to a reality for Orthodox Jews living in New York City in the early ’90s when isolated cases of neurocysticercosis arose in their community. These are not the sort of folk contemplating whether to include bacon bits into the dinner salad or debating whether to add just one more strip to a breakfast sandwich so just how exactly did they find themselves infected with a pig parasite? This sounds like an far-fetched urban tale but is rather a cautionary story that speaks to fascinating socioeconomic implications that appear in many developed cities worldwide.

In the summer of 1991, three practitioners of the Orthodox Jewish faith appeared on separate occasions in local NYC hospitals with recurrent seizures. Radiology showed evidence of brain lesions that were soon identified as cysticerci, the larval form of the pig tapeworm that had formed protective cysts within the brain. Most peculiarly, the patients were all absent of any of the risk factors that increase susceptibility to neurocysticercosis – consumption of undercooked pork products and/or traveling to foreign countries with endemic taeniasis (1). Examining related family members of the original three patients identified an additional seven people from two families that showed positive antibodies to the infection (known as seropositivity), including a fourth person that had experienced a seizure sending them to the ER.

The life cycle of the pork tapeworm. Infection with the tapeworm is strongly associated with pig husbandry along with poor hygiene. Accidentally ingested eggs can result in larva that migrate throughout the body eventually forming cysts. Image. CDC. Click for source.

After some epidemiological sleuthing, the culprit was soon identified – the families of these patients employed housemaids, all recent emigrees from Latin and Central American immigrants that were infected with the adult tapeworm infection and had transmitted the infective eggs to their employers. Other housemaids fled from investigators after being asked for blood and stool samples, presumably terrified of being implicated in the spread of an epilepsy-causing wormy. A common practice in this Orthodox Jewish community, these families had employed an average of over three housemaids from endemic countries in the past five years (1).

Shortly after this unusual crop of cases, a group of researchers from the CDC in Atlanta and the Maimonides Hospital in Brooklyn conducted a study of the Orthodox Jewish community to identify how prevalent neurocysticercosis had embedded itself in the community. Between November 1992 and February 1993, over 7000 households comprising a total of 35,000 people were examined for infection (2). An impressive number culled for a study into brain parasites, amirite? They must have had a powerfully persuasive representative to sell everyone on relinquishing blood samples.

Thankfully, only 23 people, representing a slim 1.3% of the population, showed positive antibodies to the parasite. Though this seems like a negligible prevalence rate – 1% that’s it?! – consider that populations with a 1% prevalence rate are deemed hyper-endemic regions in the public health world (3). The researchers, in fact, deemed “exposure to T. solium in this community [to be] unexpectedly high” (2). The researchers confirmed that infected Latin housekeepers in Orthodox Jewish households were the etiological cause of local cases of neurocysticercosis. They also found that housemaids originating from Central America and those charged with child care responsibilities were highly correlated with spread of the disease (2).

These women were raised in countries with exemplary levels of pork consumption, along with endemic pig tapeworm, or taeniasis, infection, and physically transported the parasite to non-endemic regions. Though taeniasis and neurocysticercosis is a disease of poverty, it will gladly ascend the socioeconomic ladder given the opportunity. The parasite is a social climber that arises from inauspicious beginnings – wallowing in the pigpen, if you will. But invite it into your home and it will climb another rung.

The global distribution of cysticercosis infection. Hot spots of infection, areas of high endemicity, are found in regions with high rates of pig product consumption. The WHO estimates that the disease affects 50 million people worldwide and causes an estimated 50,000 deaths a year. Image: WHO. Click for source.

A 2005 study documented this particular phenomenon in Peru, looking at housemaids that had left endemic towns to work for the more affluent in cities where the infection is scarce. These ladies migrate from areas that often lack modern amenities, such as closed sewage systems, potable water supplies and electricity, and in nearly 75% of cases, with households that rely on raising pigs to boost home income. In doing so, they carry the tapeworm into unsuspecting homes – investigators found that 1.2% of these women suffered from taeniasis infection. And, yes, the infection is transferred to their employers. Of those Peruvian employers that acquiesced to blood samples and CAT scans, 23% showed antibodies for infection. These Peruvian housemaids are the Typhoid Marys of T. solium.

In the Peruvian study, 60% of families were found to use housemaids to cook, assist with kitchen duties or to help with childcare (3). These services all greatly increase the chances of transmitting neurocysticercosis if proper food and sanitary hygiene isn’t practiced, which may be compromised if you hire someone who hasn’t been raised with, say, tiled bathrooms with flushing toilets and porcelain sinks. Hygiene is a learned luxury that only a few of us in this grimy world are accorded and, lemme tell ya, running water and hand sanitizer really help with these sorts of things. Hygiene has a price.

In the early 1990s, Orthodox Jew’s discovered this principle. Despite their best intentions in diligently adhering to strict dietary laws, rituals and rules that have protected their physical and spiritual health for millennia, they found that they were alarmingly susceptible to a porcine disease owing to their practice of employing people from outside their own cultural and socioeconomic strata.

We all have our own salubrious observances and rituals that we like to think maintain our health and well-being, from washing our hands, splashing bleach around the bathroom and kitchen, or even following certain dietary restrictions. But however aseptic and sanitized you live your day-to-day life, the reality is that we live in a world with other people – our coworkers, our friends, the people who serve us food in restaurants, the people we drink with at the bar, the children our kids play with, in short, everyone else.

Resources

The Wikipedia page devoted to “Taboo food and drink” is a superbly fun and fascinating read.

In a similar vein, this free academic paper on “Food taboos and their origins” is also enjoyable. Get it here. An article in the journal Radiology details a case of neurocysticercosis in an Orthodox Jewish woman. She had employed a Mexican housekeeper who had been infected with taeniasis for several years before presenting with seizures on the left side of her face and arm before being diagnosed in 1999. A handy guide for Jewish family that keep mitzvah, the commandments of the Torah, while employing non-Jewish housekeepers.

References

1. PM Schantz et al. (1992) Neurocysticercosis in an Orthodox Jewish community in New York City. N Engl J Med 327: 692–695

2. AC Moore et al. (1995) Seroprevalence of Cysticercosis in an Orthodox Jewish Community. Am J Trop Med Hyg 53(5):439-442 3. BN Huisa et al. (2005) Taeniasis and cysticercosis in housemaids working in affluent neighborhoods in Lima, Peru. Am J Trop Med Hyg. 73(3): 496–500 ResearchBlogging.org

Moore AC, Lutwick LI, Schantz PM, Pilcher JB, Wilson M, Hightower AW, Chapnick EK, Abter EI, Grossman JR, & Fried JA (1995). Seroprevalence of cysticercosis in an Orthodox Jewish community. The American journal of tropical medicine and hygiene, 53 (5), 439-42 PMID: 7485700

Ophthalmology of the Pharaohs: Antimicrobial Kohl Eyeliner in Ancient Egypt

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The bold eye makeup in the ‘60s, best exemplified by Sophia Loren’s winged ‘cat eye’ liner and Twiggy’s spidery eyelashes, had nothing on the ancient Egyptians and their gods. Their eyelids were heavily smeared with black kohl eyeliner, thick lines rimming the eyes, and the fashion was sported by everyone from peasants to pharaohs to effigies of the worshiped gods Horus and Ra. Though it may seem nothing more than a cosmetic fancy nowadays, kohl was considered to have potent magical powers and it has since turned out to possess unique pharmaceutical and antimicrobial properties. In fact, this deceptively simple beauty product may actually be one of the most ancient ophthalmological preparations known to man.

A piece of limestone pottery shows a woman nursing her child while a servant holds up a mirror and a crayon of khol. Dated from the 19th to 20th dynasty, 1285-1069 BCE, this shard is held at the Louvre, Departement des Antiquites Egyptiennes, Paris, France. Click for source.

Kohl served multiple roles in Egyptian antiquity. Egyptians of all social classes applied the eyeliner daily in veneration of the deities, satisfying both religious obligations and beautifying desires. Wearing the glossiest, highest quality kohl denoted one’s upper class status in society while the less wealthy adulterated their kohl with fire soot. Before the advent of Ray-Bans, it was applied liberally around the eyes to reduce the sun’s glare, to repel flies and to provide cooling relief from the heat. It also trapped errant dust and dirt, a simple remedy to curb the desert’s regular assaults on the body. Besides lining the eyes, the substance was also used to outline the eyebrows and enhance facial tattoos. In death, pouches containing the cosmetic and applicators were buried alongside the deceased, a testament to its importance not just in day-to-day living but also in the afterlife (1).

Kohl’s vast presence throughout history and across the globe testifies to its cultural, social, and hygienic purchase and evidence for its usage has been unearthed at the sites of ancient civilizations across North Africa, Central Asia, the Mediterranean and East Asia (2). It’s an incredibly old product, having been present since the Bronze Age (3500-1100 BC) and it’s usage has even been alluded to in the Old Testament, with two allusions at Kings II 9:30 and Ezekiel 23:40 to “painted eyes”.

An ancient Egyptian alabaster kohl pot dated from 1550 BC to 1070 BC. The opening was large enough to allow for a finger, feather or small stick to be dipped into the pot and then applied to the face. Image: Unknown. Click for source.

As with any product with a wide geographic distribution, it has picked up multiple labels. Arabs and modern Egyptians refer to it as “kohl”, while the Romans and Greeks named the product “kollurion”. The Iranians and those in the Indo-Pakistan region to this day call our eye-lining friend ‘surma” (2).

Kohl is predominantly composed of the mineral galena, a dark, metallic lead-based product that is also known by the chemical name lead sulfide (PbS). The mineral would be crushed and mixed  with several other ingredients such as ground pearls, rubies and emeralds, silver and gold leaves, frankincense, coral, and medicinal herbs such as saffron, fennel, and neem (1)(2). These compounds were then diluted in liquids such as oil, gum, animal fats, milk, or water to solubilize the lead and assist in its eventual facial smearing. Today we use galena for less prestigious and artistic purposes, in rechargeable batteries and as lead shot to fill shotgun shells.

A sample of the mineral galena, an ancient Egyptian source of lead sulphates. Image: Creative Commons. Click for source.

In 2010, French researchers analyzed samples from 52 kohl containers residing at the Louvre museum in Paris and found that the cosmetic contained trace amounts of four uncommon lead species: galena (PbS), cerussite (PbCO3), phosgenite (Pb2Cl2CO3), and laurionite (Pb(OH)Cl) (3). These last two compounds, the lead chlorides, are not naturally found in Egypt, which points to the possibility of deliberate manufacturing using lead oxide (PbO), rock salt (NaCl), natron (Na2Co3 and NaHCo3), and water. The authors of the study reckon that “it is clear that such intentional production remains the first known example of a large scale chemical process.” (4)

When researchers exposed skin cells to the lead sulfates found in kohl, they discovered that the lead ions elicited a profound immunological response. The cultured cells released one of the most important messaging molecules in the immune system, nitric oxide gas (NO); this gaseous molecule serves an activating messenger to bacteria-eating macrophage cells and stimulates blood flow by increasing the diameter of capillaries, encouraging rapid immune cell movement within the bloodstream (3). A 240-fold increase in NO production was sparked by the presence of lead ions, a bona fide tsunami of molecules flooding surrounding cells to respond to invading bacteria. This intense biochemical interaction suggests that kohl was more than just a beautifying cosmetic and the forefather of sunglasses, but also an important antibacterial ointment.

Why does it matter that the Egyptians were smearing black antibacterial gunk around their eyes? Aside from dastardly sandy winds introducing grit and irritating the sensitive eye region, infections of the eye were a serious and widespread concern (5). The desert conditions and annual flooding of the river Nile primed the eye for inflammations and bacterial infections. Antibacterial eyeliner seeping into the conjunctiva of the eye would activate an immune response, killing off pathogenic bacteria and preventing infections before they even started. The cosmetic’s regular usage could have cut down on the prevalence of ocular scarring, cataracts and blindness, nothing for an Egyptian living in antiquity to scoff at.

The Ebers Papyrus, a sort of medical textbook in ancient Egypt. It is considered to be one of the most complete and most exquisite of the medical papyri to be found. Click for source.

Perhaps it’s not all that strange that kohl has been found to have medicinal properties: the chemists and pharmacists in Egypt were considered quite knowledgeable by their Greek and Roman counterparts and their mastery of anatomy, diseases and pharmaceuticals were widely respected throughout the Mediterranean (3). We’re fortunate enough to actually have concrete evidence of this, in the form of several medical papyri scavenged by scrappy archaeologists in the late 1800s and early 1900s.

One of these is the Ebers papyrus dating from 1550 BC, the oldest known medical texts in existence (in existence, ladies and gentlemen!), and the hieroglyphic manuscript describes a plethora of ophthalmological multisyllabic quandaries including “blepharitis, chalazion, ectropion, entropion, trichiasis, granulations, chemosis, pinguecula, pterygium, leucoma, staphyloma, iritis, cataract, hyphaema, inflammation, ophthalmoplegia and dacryocystitis” (6). It contains detailed herbal preparations for eye drops, salves, ointments and even plaster dressings for the eyelids. Some of it seems to be clearly nonsense – beetle honey, anyone? – and in some unfortunate cases the papyrus recommends prayers and magical incantations to cure an ailment, another way of saying “You’re S.O.L., pal. Speak to my falcon-god-friend Horus here.” Aside from attendant ocular dilemmas, there are also remedies for gynecological, intestinal and dermatological issues and more.

The very existence of these papyri suggests a dedicated core of physicians and pharmacists collating their experiences, observations and empirical testing to create one of mankind’s first monstrously large medical textbook. Really, we contemporary humans are so damn lucky to have captured this surviving piece of ancient medical history, thanks to several original Indiana Jones-types from a century ago.

Kohl is still used today in North Africa and Central Asia, despite its considerable toxicity. I know what you’re thinking, “Now, a warning?” Heavy metals such as lead, mercury and arsenic often contaminate today’s product leading to cases of ‘saturnism’ or lead poisoning. This is particularly a serious issue with young children sporting the cosmetic as protection against the evil eye, as they are more likely to engage in hand-to-mouth behavior while learning about their environment (See here).

Even today, women mimic the application of kohl to enhance and brighten eyes but, sadly, there aren’t any therapeutic side-effects to expertly drawn winged cat-eyes. This idea of “cosmetics as medicine” that is vigorously pursued by the beauty industry in the form of “plumping” lipsticks, skin foundations embedded with minerals to combat acne, anti-aging creams and so much more was originally the province of Egyptian chemists. Maybe the secret to Cleopatra’s beauty wasn’t Maybelline but lead sulfate.

Note: The title of this article is derived from this short letter in the British Medical Journal: The Ophthalmology Of The Pharaohs. (1909) Brit Med J (2): 2543: 902. View it here on JSTOR.

Resources

Nothing’s safe from the FDA: Kohl, Kajal, Al-Kahal, or Surma: By Any Name, a Source of Lead Poisoning.

A group at Bard College completed an “interlinear transliteration” and English translation of parts of the Ebers Papyrus that they believe covered what we now know as diabetes mellitus. Neat, huh? Go here to check out their incredible work.

For a short but captivating read on kohl’s usages among women in North Africa in the early 1900s, download this pdf from Harquus, a website devoted to traditional women’s tattoos and facial markings.

References
(1) Cartwright-Jones C (2005) Introduction to Harquus: Part 2: Kohl as traditional women’s adornment in North Africa and the Middle East. Ohio: TapDancing Lizard Publications
(2) Mahmood ZA (2009) Kohl (Surma): Retrospect and Prospect. Pak. J. Pharm. Sci. 22(1): 107-122
(3) Tapsoba I et al (2010) Finding Out Egyptian Gods’ Secret Using Analytical Chemistry: Biomedical Properties of Egyptian Black Makeup Revealed by Amperometry at Single Cells. Anal. Chem. 82(2): 457–460
(4) American Chemical Society (2010, January 11). Ancient Egyptian cosmetics: ‘Magical’ makeup may have been medicine for eye disease. ScienceDaily. Retrieved April 18, 2012, from here.
(5) Finlaysonthe J (1893) Ancient Egyptian Medicine. Brit Med J. 1(1689): 1014-1016
(6) CN Chua. (Date unknown) A Historical Tour To Ophthalmology: The Ancient East. MRCOPTH. Accessed April 18, 2012, from here.
This post was chosen as an Editor's Selection for ResearchBlogging.org

Tapsoba I, Arbault S, Walter P, & Amatore C (2010). Finding out egyptian gods’ secret using analytical chemistry: biomedical properties of egyptian black makeup revealed by amperometry at single cells. Analytical chemistry, 82 (2), 457-60 PMID: 20030333

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