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April 2015

Everyone’s Got It … It Must Be Familial

Author Affiliations
  • 1Private practice
  • 2retired
JAMA Dermatol. 2015;151(4):388. doi:10.1001/jamadermatol.2014.360

Today nothing seems clearer than the distinction between infectious and genetic disorders. One is environmental; the other, inherited. But both societies and physicians have struggled with this concept. Until the mid-1800s, infectious agents were unknown, while many societies were tight-knit with inbreeding the normal consequence.

Leprosy is a classic infectious disease. In the 1850s, it had a prevalence of 25:1000 in the region around Bergen, Norway. The local experts in Bergen were Daniel Danielssen, perhaps the first leprologist, and Carl Wilhelm Boeck, a dermatologist (the uncle of Cesar Boeck, whose name is attached to sarcoidosis). They considered leprosy a hereditary dyscrasia and felt that minimizing hereditary transmission was the key to control. Their student Armauer Hansen discovered the lepra bacillus (Mycobacterium leprae), establishing leprosy as an infection.1

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