August 2, 2025 • 22 mins
Explores the historical understanding of leprosy in premodern medicine, focusing on how the disease was diagnosed, defined, and treated. It examines the shift from humoral interpretations to a more empirical approach, highlighting the tension between lay and learned examiners and the evolving social and legal implications of a leprosy diagnosis, which often resulted in isolation. The sources also discuss popular beliefs about contagion and heredity, the various terms used to describe the illness, and the efficacy of remedies, revealing a complex interplay of medical theory, societal fears, and personal experiences.
You can listen and download our episodes for free on more than 10 different platforms:
https://linktr.ee/book_shelter
Get the Book now from Amazon:
https://www.amazon.com/Leprosy-Premodern-Medicine-Malady-Whole-ebook/dp/B002B5571O?&linkCode=ll1&tag=cvthunderx-20&linkId=23d351a292740829cbce73b6b5559d1d&language=en_US&ref_=as_li_ss_tl
You can listen and download our episodes for free on more than 10 different platforms:
https://linktr.ee/book_shelter
Get the Book now from Amazon:
https://www.amazon.com/Leprosy-Premodern-Medicine-Malady-Whole-ebook/dp/B002B5571O?&linkCode=ll1&tag=cvthunderx-20&linkId=23d351a292740829cbce73b6b5559d1d&language=en_US&ref_=as_li_ss_tl
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Deep Dive, your shortcut to being truly
well informed. Today we're plunging into well a fascinating paradox
from medical history. It's about one of the most feared diseases, leprosy,
and how it wasn't just seen as a physical thing,
but almost a disease of the soul. But as we'll discover,
the physicians back then, they had a very different, much
more tangible view. Our mission in this deep dive is
(00:21):
to unpack centuries of how medicine understood leprosy. We're drawing
heavily on Luptimature's incredible book, Leprosy and Pre Modern Medicine,
A malady of the whole body. And this isn't just
dry history, right. It's a really compelling story, shifting views,
tough medical problems and some surprising human ingenuity and sometimes yeah,
sheer desperation.
Speaker 2 (00:40):
It really is a journey that shows this significant divide.
You had poets, preachers focusing on metaphors morality, but the
medical professionals they took a well for their time, a
meticulously scientific approach. There were documenting signs, causes, treatments. They
really saw leprosy as a true malady the body. And
(01:01):
just to set the scene, when we say pre modern,
we're talking about the time before the late eighteenth century,
so specifically before bacteriology kicked in, before Mycobacterium lepre it
was identified in eighteen seventy three what we now call
Hanson's disease, right, and.
Speaker 1 (01:16):
The sources we're pulling from, it's quite a mix, isn't it.
Speaker 2 (01:18):
Oh, Absolutely everything from you know, detailed academic treatises, encyclopedias,
but also public documents, official records, even personal notes from doctors.
Speaker 1 (01:27):
So it shows this constant back and forth between like
high theory and what ordinary.
Speaker 2 (01:31):
People thought exactly. That interplay is key.
Speaker 1 (01:33):
Okay, So let's dive into that impact a medical diagnosis
literally dictating your whole life. You start with this really
dramatic thing, the Iudyssium lepresaorum. The judgment of the lepres
sounds intense.
Speaker 2 (01:43):
It was. The stakes were incredibly high. If you were suspected,
you faced a stark choice go home free, be separated
permanently from society, or maybe get a temporary reprieve separation
meaning often being sent to a leprosarium isolated from the community.
Speaker 1 (01:59):
Wow, you mentioned something surprising people faking it.
Speaker 2 (02:02):
That seems backwards, It does, doesn't it, But think about
extreme poverty. For some destitute individuals faking leprosy, it was
a way to get charity, to get admitted to a
leprosarium where they'd at least be fed and housed.
Speaker 1 (02:15):
So instead of hiding it, they'd try to get diagnosed precisely.
Speaker 2 (02:18):
And this unexpected twist, it really pushed physicians into this
new role. Suddenly they weren't just healers, they were judges, gatekeepers.
Speaker 1 (02:27):
That's immense power. Did that ever go horribly wrong when
fear took over?
Speaker 2 (02:32):
Absolutely there were some truly dark moments where these lines blurred.
Think about fourteenth century France, or these rampant rumors, terrible
stuff accusing lepers and also Jews and Muslims, other marginalized
groups of poisoning wells.
Speaker 1 (02:44):
Poisoning wells series.
Speaker 2 (02:46):
Yes, fueled by fear and prejudice. King Philip the Fifth
even ordered burnings based on these accusations in thirteen twenty one.
It was horrific, but historian at Michael mcvaughs suggests these
tragic events actually pushed for the medicalization of leprosy. How so,
well it's sort of forced society to say, Okay, this
needs to be treated as a medical condition, not a
(03:07):
crime or a sign of moral failing. But physicians were
caught in the middle. Are they protecting the public or
are they somehow involved in these conspiracies. There even claims
that the advice of positions guided how to make the
supposed poisons.
Speaker 1 (03:20):
A moral tightrope. Indeed, let's make this more concrete. You
mentioned a specific case, Elianist de Montel, Yes, Elianis.
Speaker 2 (03:27):
De Montel, a Jew in Boogumbress fourteen sixty two, accused
of being lepres. The controversy was huge. The town officials,
the syndics. They wanted him out immediately. They were terrified
of contagion from just daily life, touching food at the market,
baking bread, drawing water from the well, even just breathing
near Christians and Eliannis. He insisted he was healthy, vehemently
(03:48):
denied it wouldn't admit to anything. The proposed compromise tells
you everything about the weight of the diagnosis. The town said, Okay,
we'll pay for the examination if you're healthy, but if
you're diagnosed, you pay.
Speaker 1 (04:00):
So the financial ruin was part of the threat right
there exactly.
Speaker 2 (04:03):
It shows the massive social and economic pressure. A doctor's
word could mean utter ruin.
Speaker 1 (04:09):
So how did the medical profession itself grapple with this authority?
Did they define their role more clearly?
Speaker 2 (04:15):
They tried. Figures like Marsilio of Paduo were important. Around
thirteen twenty four he wrote this treatise Defenser Passees, and
he made a clear distinction. Clergy deal with diseases of
the soul sins. Physicians deal with bodily diseases like leprosy,
specifically for deciding about separation.
Speaker 1 (04:32):
Ah, So drawing a line in the sand.
Speaker 2 (04:34):
Yes, establishing medical jurisdiction over the body. You see reflected
in universities too. Like Montpellier. Initially, their statutes forbade masters
from even caring for lepers without special permission. But by
the late thirteenth century the focus shifted. It became about
diagnostic competence. Bernardo Gordon around thirteen oh five was already
(04:55):
complaining that lepros sai are judged very poorly in our.
Speaker 1 (04:58):
Day, meaning physicians felt they should be the ones making
the call and doing it better.
Speaker 2 (05:02):
Exactly, they were actively claiming that authority.
Speaker 1 (05:05):
But then you get this credibility crisis, the Nuremberg Shaw. Yeah,
that public examination.
Speaker 2 (05:09):
Right, The famous fourteen ninety three woodcut shows it. This
annual Lent Holy Week, it basically turned into a feast
for the poor. Doctors were less healers, more like gatekeepers
for charity. Thousands would show up. Many weren't actually sick.
They were just desperate, faking symptoms to get aid or
admission to the local lepress areum.
Speaker 1 (05:27):
How bad was the fraud?
Speaker 2 (05:29):
Get this? In fifteen seventy four, records show that out
of three two hundred and forty people seeking help, seven
hund nine were judged to be fraudulent. That's over twenty percent.
Speaker 1 (05:38):
Wow. So the medical aspect kind of got lost.
Speaker 2 (05:41):
It did. The sheer scale of the deception driven them
by piety but also just dire misery. It undermined the
whole medical examination purpose. Eventually the event just died out.
It shows how much doctors struggled to maintain trust and
accuracy in this charged environment.
Speaker 1 (05:59):
So how did they try to be accurate, especially with say,
lay examiners who might have their own agendas.
Speaker 2 (06:04):
Well, that was a constant source of conflict. You had
lay examiners, sometimes even inmates of leprosaria like Cologne's meltin.
They often had financial reasons to admit more people, right,
more inmates, maybe more funding or resources. University physicians often
clashed with them, overturning what they call these brazen judgments.
Speaker 1 (06:22):
So university doctors trying to uphold standards against potentially biased
local examiners.
Speaker 2 (06:27):
Precisely, and there were some really playing it stories. Felix Platter,
a respected doctor in Basil, wrote about a merchant from
Colmar in fifteen eighty two. His merchant's mother and sister
were lepros that he developed some pustules. Local surgeons immediately
declared him lepres exiled. Yeah, but then his symptoms cleared
up completely. Did the surgeons admit their mistake.
Speaker 1 (06:48):
No way.
Speaker 2 (06:49):
They came up with this ridiculous claim that his blood
was now teeming with worms to cover their tracks. Absolutely.
The poor guy was in isolation for five years. Finally
they called in place. He did a careful examination, found
nothing wrong and declared the man healthy. He's just a
powerful reminder of the huge stakes, the potential for error,
(07:10):
and a heavy burden on the physician trying to get
it right.
Speaker 1 (07:12):
So the whole process, the language itself. It became almost legalistic,
didn't it.
Speaker 2 (07:17):
Absolutely. You see terms like inquest, verdict, accused, Innocent. Physicians
had to be diligent, but they also knew how devastating
a wrong judgment could be.
Speaker 1 (07:26):
Okay, let's shift gears a bit. Let's talk about the
words used. You mentioned a French author saying people were
terrified just by hearing the name.
Speaker 2 (07:33):
Yes, language had immense power here. Its evolution is fascinating.
You start with the biblical Hebrews arad that meant unclean,
but in a broad ritual sense, not strictly medical like
we think of disease today. Well, in French, the biblical
figure Lazarus the poor man covered in sores. His name
became a common noun, Lazarus, which then morphed into ladre,
(07:55):
meaning leper. There was also confusion with Greek terms. Originally,
elephantiasis in Greek medical texts likely referred to what we
now call leprosy. Well, the Greek word lepro was just
a minor scaly skin condition.
Speaker 1 (08:08):
But they got mixed up massively.
Speaker 2 (08:09):
And eventually you get this really charged merger. You take
the contagiousness implied by the Hebrews arat and you combine
it with the totality and visible destructiveness of the Latin
term elephantia, and all that negative weight gets poured into
the word lepra. That's the word that became truly terrifying.
Speaker 1 (08:27):
And the descriptions it went with it.
Speaker 2 (08:28):
Oh, they were brutal, unclean, carrying all those sanitary, ritual
and moral judgments, ugly, foul, hideous, abominable. Initially the smell
the fetter was really emphasized, but later the visual aspect
took over. Descriptions like it destroyed the body's beauty, cause
hideous tumors, just awful.
Speaker 1 (08:45):
It was even called horidi or morte.
Speaker 2 (08:47):
More horrible than death. Yes, But interestingly, physicians, even while
using these terms sometimes they did try to push back
against the public hysteria. Did sometimes issue certificates saying someone
was lean meaning not contigious or needing separation, notwithstanding a horrible.
Speaker 1 (09:05):
Appearance, So trying to separate the physical appearance from the
need for isolation.
Speaker 2 (09:10):
Exactly, and crucially, they generally distanced themselves from the idea
that it was direct divine punishment. For them, it was
a physical ailment rooted in the body, even if they
didn't fully understand.
Speaker 1 (09:22):
Its cause, which brings us to the why why did
people get it? Sounds like that was just as confusing.
Speaker 2 (09:27):
Oh deeply confusing. Paulus Uliarius, a physician, basically threw up
his hands lamented. You know, physicians have written in so
many ways about lepra that we are hardly able to
recognize what it is or how to treat.
Speaker 1 (09:37):
So what were the main theories floating around?
Speaker 2 (09:39):
Well, the core ideas came from classical medicine filtered through
Arabic scholars, Galen's idea of a bad complexion or an
assimilative faculty error, basically the body not processing things correctly.
This is all understood through humoral physiology, that ancient framework, right, the.
Speaker 1 (09:54):
Four humors blood, phlem, yellow bile, black bile, health meant
balance exactly.
Speaker 2 (10:01):
So a leading theory, particularly from Avicenna, was that the
liver overheated it essentially burned blood, turning it into excess
black bile melancholy, and that corrupted humor was seen as
the root cause of leprosy.
Speaker 1 (10:14):
So an internal imbalance. But what about external factors? Did
they think things like diet or environment played a role?
Speaker 2 (10:19):
Yes, absolutely, yeah, they considered the six non naturals these
weren't unnatural things, but rather six factors external to the
body's core nature that you could control more or less
to stay healthy. So it was like the air you breathed,
food and drank, exercise, sleep, the motions, and excretion. So Avicenna,
for instance, blamed bad diets. He claimed eating bad fish,
too much salted meat, donkey meat, or even lentils, especially
(10:41):
in hot climate like Alexandria, could cause or spread leprosy
donkey meat.
Speaker 1 (10:45):
Okay, what about more sensitive topics. Was there a connection
made with sex?
Speaker 2 (10:51):
Oh? Definitely, and this is a troubling aspect from our perspective,
but it was central to their thinking. Bernard to Gordon,
the same guy complaining about poor dickeagnosis. He wrote this
incredibly influential work in the fourteenth century and he tells
this very vivid story and anecdote really about accountess. She
supposedly infected a bachelor with leprosy while becoming pregnant by him.
Speaker 1 (11:12):
Wow. So direct transmission through sex was a major theory.
Speaker 2 (11:16):
Huge It led to really stern warnings beware of betting
a leprous woman, but male sexual activity was also implicated.
There were beliefs that the male organ described as spongy
could absorb the poison of leprosy through sexual.
Speaker 1 (11:28):
Contact, fascinating in a grim way. Did they think you
just got it full blown? Or were there stages?
Speaker 2 (11:34):
No, they definitely distinguished stages. This is actually quite important
for the patient's outlook. They talked about a predisposition, maybe
you had the wrong humoral balance to start, then an
incipient stage, early signs appearing, and finally the confirmed status.
Getting diagnosed early in that incipient stage might offer more
hope or at least less immediate segregation.
Speaker 1 (11:53):
And did they see it as just one disease or
different kinds?
Speaker 2 (11:57):
They categorized it again based on those humoral theories, usually
four main types, often named after animals whose characteristics supposedly
match the symptoms. There was Leonina or lion leprosy attributed
to yellow bile. It caused wrinkling, yellowing skin, facial changes
that made the person look angry or lionlike. Then Eliphantia,
linked to black bile. This was characterized by thick, rough,
(12:20):
cracking skin nodules, sort of like an elephant's hide. They
thought Chiria, associated with phlegms, supposedly caused smooth, white scaly patches,
maybe like a snake skin and alopecia linked to blood imbalance,
primarily causing hair loss, especially eyebrows, and reddish skin, perhaps
like a fox.
Speaker 1 (12:37):
It's striking how they tried to systematize it based on
the humoral framework. But did that view ever change? Did
they start looking more at actual physical evidence?
Speaker 2 (12:46):
Slowly? Yes, you see a gradual shift towards more empirical observation.
Someone like Jean de Veranda, writing in the early seventeenth century,
he's still deeply embedded in humoral theory, trying to reconcile
all the conflicting idea is. But then you get later
authors like Isaac Gudman in seventeen sixty five. He's emphasizing
personal observations, trying to give purely descriptive definitions, and some
(13:09):
were even starting to guess at microscopic causes. Udmuand proposed
leprosy might be caused by minuscule spiral worms that could
be expelled from the body.
Speaker 1 (13:17):
Worms. Okay, not quite bacteria, but moving towards a non
humoral cause, that's a big leap.
Speaker 2 (13:22):
It is a clear, if inaccurate, precursor to geram theory.
Speaker 1 (13:26):
So with all this complexity, the social pressure of the
confusing theories, the different types. Let's picture the actual examination.
What was it like.
Speaker 2 (13:33):
We get a great snapshot from a certificate issued in Airis,
France in fifteen seventy four for a man named Adrian
de Bellevala. It details the whole process. The patient had
to swear oaths to tell the truth. They drew blood
from his arm, inspected his urine and did a thorough
head to toe body examination.
Speaker 1 (13:50):
So quite formal and systematic.
Speaker 2 (13:52):
Yes, and there's a famous woodcut from fifteen seventeen inspection
of eleprous patients that gives us an idea of the
ideal setup. You see the physician instantly recognizable because he's
holding the urine flask. The euroscopy flask was like the
badge of the medieval doctor. Beside him, there's often a surgeon,
maybe palpating the patient's head, feeling for nodules. The caption
on that woodcut even suggests they're checking the fetter of
(14:14):
the breath. The smell as a key sign.
Speaker 1 (14:16):
That urine flask seems iconic. But even with all this
diagnosis was hard.
Speaker 2 (14:21):
Incredibly hard. Bernard to Gordon remember him, he created this
whole system of supposedly infallible signs. Yet even he admitted
the difficulty. He focused heavily on the face, saying, the
signs that matter to me are the ones that are
found in the face. But then he tells this humbling
story about examining a man. The man had severe problems
(14:42):
with his limbs like disfigurement for twenty years, but absolutely
no facial signs, and Gordon had to confess basically, God
knows the truth. I do not know.
Speaker 1 (14:51):
That's quite an admission from the expert who wrote the
book on signs. It really highlights the uncertainty they face.
Speaker 2 (14:56):
It does, and it raises the question if the visible
signs were unreliable, how else did they try to test
for it. This leads to the EXPERIMENTA.
Speaker 1 (15:05):
EXPERIMENTA sounds intriguing.
Speaker 2 (15:07):
These were specific diagnostic tests. Some quite peculiar. Blood tests
were common. One involved putting grains of salt and drawn blood.
According to some authorities, if the salt dissolved, the person
was healthy. If it didn't, they were lepros, though others
said the opposite.
Speaker 1 (15:21):
Not exactly standardized procedure, then not at all.
Speaker 2 (15:24):
Another test was mixing blood with vinegar if it foamed leprosy,
or mixing blood with urine if the blood sank leprosy.
Then there was the egg test documented in Provence in
fourteen thirty eight. They'd immerse a fresh egg in the
patient's drawn blood and compare it to an untouched egg
after some time. Very dramatic, almost ritualistic.
Speaker 1 (15:43):
Wow. And what about testing for numbness, that's a classic
sign we associate with Hanson's disease.
Speaker 2 (15:49):
Today, they did test for anesthesia, yes, pricking the fingers
or more commonly the heel with needles. The famous surgeon
Ambrose Peree actually boasted about this, about pushing a thick
and long needle very deep into a patient's heel to
confirm the lack of sensation.
Speaker 1 (16:06):
Pushing it deep. That sounds aggressive, it does.
Speaker 2 (16:09):
It speaks to their determination to find definitive signs, something
concrete amidst all the ambiguity. This focus on aggressive testing
really reflects a desperate search for certainty, especially since, as
we'll see, the available treatments offered very little real hope.
Speaker 1 (16:22):
Right, So diagnosis was fraud often uncertain. What about the
prognosis was it just seen as inevitably fatal and incurable.
Speaker 2 (16:29):
Well, incurability became almost a practical, even legal concept. There's
this fascinating legal case in Antwerp seventeen twenty seven. A
mother superior refused to take in an orphan girl and
a Katherine Spineloy who was suspected of leprosy. The argument
against the mother superior was that the physicians hadn't actually
tried everything possible to cure her yet, so incurability wasn't
(16:51):
just a medical fact, it was something that had to be,
in a sense proven by exhausting all options.
Speaker 1 (16:56):
Interesting what about faith and miracles? Did people look to
saints for cures?
Speaker 2 (17:01):
Saints played a huge symbolic role, but maybe not in
the way you'd expect. You have stories like Saint Francis
kissing a leper, or Saint Elizabeth of Hungary bathing a
leper and even drinking the bathwater.
Speaker 1 (17:11):
Drinking the bathwater well why to conquer her.
Speaker 2 (17:13):
Own physical revulsion to show ultimaturity and humility. These stories
emphasize compassion overcoming disgust, but they rarely feature miraculous healing
of the leprosy itself. Saint Elzere is one rare exception.
A story tells of him having a brief encounter with
a leper who was then suddenly healed, but mostly the
(17:34):
focus was on the soul. These acts reinforced the idea
that spiritual salvation was far more important than curing the body.
Speaker 1 (17:41):
So divine intervention wasn't the go to medical strategy. What
about actual medicine? Did anyone think it was curable?
Speaker 2 (17:47):
Oh? Yes, Paracelsus, the famously defiant physician. He basically blamed
other doctors for calling it incurable. He argued that nature
provided cures for everything, doctors just hadn't found them or
weren't using them correctly. But even peara Celsus admitted that
it advanced forms were probably beyond help, and his own
suggested remedies, well, they were pretty out there, like what
he suggested, using substances that were known to preserve dead bodies,
(18:09):
things like Embalmer's balms, essence of juniper, even pulverized pearls.
The logic was sort of, if it stops de kay,
maybe stops the disease.
Speaker 1 (18:19):
Pulverized pearls, right, So what was the more typical approach
to treatment?
Speaker 2 (18:24):
The dominant approach was pelepharmacy, basically throwing the kitchen sink
at it, using hundreds of different ingredients and complex concoctions,
mostly ineffective, of course, though looking back there are some
intriguing overlaps with modern knowledge. Medieval doctors recommended regular bathing
and soap for hygiene, which makes sense, and some fourteenth
century treatments involved head purges to clear the nasal passages.
(18:47):
We now know the nasal mucosa is a primary site
for the Mycobacterium lepre infection.
Speaker 1 (18:52):
Accidental wisdom perhaps, so bathing and nasal purging anything else
that sounds vaguely sensible? What about the lesson, Well.
Speaker 2 (19:01):
One common recommendation was simply to avoid sex, given the
theories about transmission we discussed.
Speaker 1 (19:05):
Okay, that makes sense within their framework. But then it
got weirder.
Speaker 2 (19:08):
Much weirder. Castoration was actually discussed as a potential treatment castration.
Speaker 1 (19:13):
Seriously, how often was that actually done.
Speaker 2 (19:16):
It's really unclear how often it was applied, but the
idea persisted in medical texts for centuries. The rationale was bizarre.
They thought it might somehow moisten the body or help
retain beneficial seminole material that was otherwise being lost or corrupted.
And for cosmetic relief, especially for facial sores. They sometimes
recommended ointments containing the patient's own blood or even the
(19:39):
blood of children or hairs. Okay, now we're getting into
truly strange territory. Mixing blood into face cream. It gets stranger.
Speaker 1 (19:46):
The ingestible cures were something else. Snake meat was a
very common recommendation, often prepared elaborately like a la eel,
cooked with squabs and spices.
Speaker 2 (19:56):
Snake a la eel. I think I'll pass. What else
was on the menu?
Speaker 1 (19:59):
Hoopo, I that's a type of bird circumcision skin, fresh seamen,
and toad flesh.
Speaker 2 (20:05):
Toad flesh. Right, The desperation just leaps off the page,
doesn't that they were trying literally anything in everything, which leads,
unfortunately to the darkest aspect of treatment, or perhaps lack thereof,
the idea of mercy killing or assisted suicide. Galen himself
tells a story of a leprous man who deliberately drank
toxic wine just to die and have rest, and this
(20:26):
underlying sense of hopelessness of the disease being an unbearable
burden ultimately contributed to the practice of isolating patients completely,
removing them to remote colonies, far away from society, a
grim solution born of fear and despair.
Speaker 1 (20:40):
So we've really journeyed through this complex history. It's clear
that pre modern medicine's view of leprosy was far more
nuanced than just calling it a disease of the soul.
Speaker 2 (20:49):
Absolutely, the major's central point, and it comes through so clearly,
is that physicians overwhelmingly saw it as a malady of
the whole body. They were meticulous in their own way,
documenting its effect skin, flesh, face, limbs, even internal ordins
like the heart and liver, all interpreted through that lens
of humoral physiology. Their focus was really on physical diagnosis, prognosis,
(21:10):
and attempting physical or at least palliative care. They largely
left the care of souls to the clergy, carving out
their own domain over the body and.
Speaker 1 (21:18):
The story of leprosy. Then it's not just about a
specific bacterium. It's a powerful lens on how societies handle threats,
how science, even prescience evolves, and how just the perception
of an illness can dramatically shape people's lives and fates.
That diagnostic power was immense.
Speaker 2 (21:34):
It really was, And what's so fascinating looking back through
this historical deep dive is the reminder that our own
understanding of disease is constantly evolving. It's always shaped by
the knowledge we have, yes, but also by our fears,
our social structures. The technology available makes you wonder, doesn't it.
What current health challenges are we viewing through our own limited,
(21:54):
contemporary lens. What societal assumptions are baked into our scientific
approaches today. How might future generations look back at us.
Speaker 1 (22:02):
That's a really powerful thought to end on. Food for
thought for all of us. Until next time, keep diving
deep into the fascinating stories hidden in plain sight.
Welcome to the Deep Dive, your shortcut to being truly
well informed. Today we're plunging into well a fascinating paradox
from medical history. It's about one of the most feared diseases, leprosy,
and how it wasn't just seen as a physical thing,
but almost a disease of the soul. But as we'll discover,
the physicians back then, they had a very different, much
more tangible view. Our mission in this deep dive is
(00:21):
to unpack centuries of how medicine understood leprosy. We're drawing
heavily on Luptimature's incredible book, Leprosy and Pre Modern Medicine,
A malady of the whole body. And this isn't just
dry history, right. It's a really compelling story, shifting views,
tough medical problems and some surprising human ingenuity and sometimes yeah,
sheer desperation.
Speaker 2 (00:40):
It really is a journey that shows this significant divide.
You had poets, preachers focusing on metaphors morality, but the
medical professionals they took a well for their time, a
meticulously scientific approach. There were documenting signs, causes, treatments. They
really saw leprosy as a true malady the body. And
(01:01):
just to set the scene, when we say pre modern,
we're talking about the time before the late eighteenth century,
so specifically before bacteriology kicked in, before Mycobacterium lepre it
was identified in eighteen seventy three what we now call
Hanson's disease, right, and.
Speaker 1 (01:16):
The sources we're pulling from, it's quite a mix, isn't it.
Speaker 2 (01:18):
Oh, Absolutely everything from you know, detailed academic treatises, encyclopedias,
but also public documents, official records, even personal notes from doctors.
Speaker 1 (01:27):
So it shows this constant back and forth between like
high theory and what ordinary.
Speaker 2 (01:31):
People thought exactly. That interplay is key.
Speaker 1 (01:33):
Okay, So let's dive into that impact a medical diagnosis
literally dictating your whole life. You start with this really
dramatic thing, the Iudyssium lepresaorum. The judgment of the lepres
sounds intense.
Speaker 2 (01:43):
It was. The stakes were incredibly high. If you were suspected,
you faced a stark choice go home free, be separated
permanently from society, or maybe get a temporary reprieve separation
meaning often being sent to a leprosarium isolated from the community.
Speaker 1 (01:59):
Wow, you mentioned something surprising people faking it.
Speaker 2 (02:02):
That seems backwards, It does, doesn't it, But think about
extreme poverty. For some destitute individuals faking leprosy, it was
a way to get charity, to get admitted to a
leprosarium where they'd at least be fed and housed.
Speaker 1 (02:15):
So instead of hiding it, they'd try to get diagnosed precisely.
Speaker 2 (02:18):
And this unexpected twist, it really pushed physicians into this
new role. Suddenly they weren't just healers, they were judges, gatekeepers.
Speaker 1 (02:27):
That's immense power. Did that ever go horribly wrong when
fear took over?
Speaker 2 (02:32):
Absolutely there were some truly dark moments where these lines blurred.
Think about fourteenth century France, or these rampant rumors, terrible
stuff accusing lepers and also Jews and Muslims, other marginalized
groups of poisoning wells.
Speaker 1 (02:44):
Poisoning wells series.
Speaker 2 (02:46):
Yes, fueled by fear and prejudice. King Philip the Fifth
even ordered burnings based on these accusations in thirteen twenty one.
It was horrific, but historian at Michael mcvaughs suggests these
tragic events actually pushed for the medicalization of leprosy. How so,
well it's sort of forced society to say, Okay, this
needs to be treated as a medical condition, not a
(03:07):
crime or a sign of moral failing. But physicians were
caught in the middle. Are they protecting the public or
are they somehow involved in these conspiracies. There even claims
that the advice of positions guided how to make the
supposed poisons.
Speaker 1 (03:20):
A moral tightrope. Indeed, let's make this more concrete. You
mentioned a specific case, Elianist de Montel, Yes, Elianis.
Speaker 2 (03:27):
De Montel, a Jew in Boogumbress fourteen sixty two, accused
of being lepres. The controversy was huge. The town officials,
the syndics. They wanted him out immediately. They were terrified
of contagion from just daily life, touching food at the market,
baking bread, drawing water from the well, even just breathing
near Christians and Eliannis. He insisted he was healthy, vehemently
(03:48):
denied it wouldn't admit to anything. The proposed compromise tells
you everything about the weight of the diagnosis. The town said, Okay,
we'll pay for the examination if you're healthy, but if
you're diagnosed, you pay.
Speaker 1 (04:00):
So the financial ruin was part of the threat right
there exactly.
Speaker 2 (04:03):
It shows the massive social and economic pressure. A doctor's
word could mean utter ruin.
Speaker 1 (04:09):
So how did the medical profession itself grapple with this authority?
Did they define their role more clearly?
Speaker 2 (04:15):
They tried. Figures like Marsilio of Paduo were important. Around
thirteen twenty four he wrote this treatise Defenser Passees, and
he made a clear distinction. Clergy deal with diseases of
the soul sins. Physicians deal with bodily diseases like leprosy,
specifically for deciding about separation.
Speaker 1 (04:32):
Ah, So drawing a line in the sand.
Speaker 2 (04:34):
Yes, establishing medical jurisdiction over the body. You see reflected
in universities too. Like Montpellier. Initially, their statutes forbade masters
from even caring for lepers without special permission. But by
the late thirteenth century the focus shifted. It became about
diagnostic competence. Bernardo Gordon around thirteen oh five was already
(04:55):
complaining that lepros sai are judged very poorly in our.
Speaker 1 (04:58):
Day, meaning physicians felt they should be the ones making
the call and doing it better.
Speaker 2 (05:02):
Exactly, they were actively claiming that authority.
Speaker 1 (05:05):
But then you get this credibility crisis, the Nuremberg Shaw. Yeah,
that public examination.
Speaker 2 (05:09):
Right, The famous fourteen ninety three woodcut shows it. This
annual Lent Holy Week, it basically turned into a feast
for the poor. Doctors were less healers, more like gatekeepers
for charity. Thousands would show up. Many weren't actually sick.
They were just desperate, faking symptoms to get aid or
admission to the local lepress areum.
Speaker 1 (05:27):
How bad was the fraud?
Speaker 2 (05:29):
Get this? In fifteen seventy four, records show that out
of three two hundred and forty people seeking help, seven
hund nine were judged to be fraudulent. That's over twenty percent.
Speaker 1 (05:38):
Wow. So the medical aspect kind of got lost.
Speaker 2 (05:41):
It did. The sheer scale of the deception driven them
by piety but also just dire misery. It undermined the
whole medical examination purpose. Eventually the event just died out.
It shows how much doctors struggled to maintain trust and
accuracy in this charged environment.
Speaker 1 (05:59):
So how did they try to be accurate, especially with say,
lay examiners who might have their own agendas.
Speaker 2 (06:04):
Well, that was a constant source of conflict. You had
lay examiners, sometimes even inmates of leprosaria like Cologne's meltin.
They often had financial reasons to admit more people, right,
more inmates, maybe more funding or resources. University physicians often
clashed with them, overturning what they call these brazen judgments.
Speaker 1 (06:22):
So university doctors trying to uphold standards against potentially biased
local examiners.
Speaker 2 (06:27):
Precisely, and there were some really playing it stories. Felix Platter,
a respected doctor in Basil, wrote about a merchant from
Colmar in fifteen eighty two. His merchant's mother and sister
were lepros that he developed some pustules. Local surgeons immediately
declared him lepres exiled. Yeah, but then his symptoms cleared
up completely. Did the surgeons admit their mistake.
Speaker 1 (06:48):
No way.
Speaker 2 (06:49):
They came up with this ridiculous claim that his blood
was now teeming with worms to cover their tracks. Absolutely.
The poor guy was in isolation for five years. Finally
they called in place. He did a careful examination, found
nothing wrong and declared the man healthy. He's just a
powerful reminder of the huge stakes, the potential for error,
(07:10):
and a heavy burden on the physician trying to get
it right.
Speaker 1 (07:12):
So the whole process, the language itself. It became almost legalistic,
didn't it.
Speaker 2 (07:17):
Absolutely. You see terms like inquest, verdict, accused, Innocent. Physicians
had to be diligent, but they also knew how devastating
a wrong judgment could be.
Speaker 1 (07:26):
Okay, let's shift gears a bit. Let's talk about the
words used. You mentioned a French author saying people were
terrified just by hearing the name.
Speaker 2 (07:33):
Yes, language had immense power here. Its evolution is fascinating.
You start with the biblical Hebrews arad that meant unclean,
but in a broad ritual sense, not strictly medical like
we think of disease today. Well, in French, the biblical
figure Lazarus the poor man covered in sores. His name
became a common noun, Lazarus, which then morphed into ladre,
(07:55):
meaning leper. There was also confusion with Greek terms. Originally,
elephantiasis in Greek medical texts likely referred to what we
now call leprosy. Well, the Greek word lepro was just
a minor scaly skin condition.
Speaker 1 (08:08):
But they got mixed up massively.
Speaker 2 (08:09):
And eventually you get this really charged merger. You take
the contagiousness implied by the Hebrews arat and you combine
it with the totality and visible destructiveness of the Latin
term elephantia, and all that negative weight gets poured into
the word lepra. That's the word that became truly terrifying.
Speaker 1 (08:27):
And the descriptions it went with it.
Speaker 2 (08:28):
Oh, they were brutal, unclean, carrying all those sanitary, ritual
and moral judgments, ugly, foul, hideous, abominable. Initially the smell
the fetter was really emphasized, but later the visual aspect
took over. Descriptions like it destroyed the body's beauty, cause
hideous tumors, just awful.
Speaker 1 (08:45):
It was even called horidi or morte.
Speaker 2 (08:47):
More horrible than death. Yes, But interestingly, physicians, even while
using these terms sometimes they did try to push back
against the public hysteria. Did sometimes issue certificates saying someone
was lean meaning not contigious or needing separation, notwithstanding a horrible.
Speaker 1 (09:05):
Appearance, So trying to separate the physical appearance from the
need for isolation.
Speaker 2 (09:10):
Exactly, and crucially, they generally distanced themselves from the idea
that it was direct divine punishment. For them, it was
a physical ailment rooted in the body, even if they
didn't fully understand.
Speaker 1 (09:22):
Its cause, which brings us to the why why did
people get it? Sounds like that was just as confusing.
Speaker 2 (09:27):
Oh deeply confusing. Paulus Uliarius, a physician, basically threw up
his hands lamented. You know, physicians have written in so
many ways about lepra that we are hardly able to
recognize what it is or how to treat.
Speaker 1 (09:37):
So what were the main theories floating around?
Speaker 2 (09:39):
Well, the core ideas came from classical medicine filtered through
Arabic scholars, Galen's idea of a bad complexion or an
assimilative faculty error, basically the body not processing things correctly.
This is all understood through humoral physiology, that ancient framework, right, the.
Speaker 1 (09:54):
Four humors blood, phlem, yellow bile, black bile, health meant
balance exactly.
Speaker 2 (10:01):
So a leading theory, particularly from Avicenna, was that the
liver overheated it essentially burned blood, turning it into excess
black bile melancholy, and that corrupted humor was seen as
the root cause of leprosy.
Speaker 1 (10:14):
So an internal imbalance. But what about external factors? Did
they think things like diet or environment played a role?
Speaker 2 (10:19):
Yes, absolutely, yeah, they considered the six non naturals these
weren't unnatural things, but rather six factors external to the
body's core nature that you could control more or less
to stay healthy. So it was like the air you breathed,
food and drank, exercise, sleep, the motions, and excretion. So Avicenna,
for instance, blamed bad diets. He claimed eating bad fish,
too much salted meat, donkey meat, or even lentils, especially
(10:41):
in hot climate like Alexandria, could cause or spread leprosy
donkey meat.
Speaker 1 (10:45):
Okay, what about more sensitive topics. Was there a connection
made with sex?
Speaker 2 (10:51):
Oh? Definitely, and this is a troubling aspect from our perspective,
but it was central to their thinking. Bernard to Gordon,
the same guy complaining about poor dickeagnosis. He wrote this
incredibly influential work in the fourteenth century and he tells
this very vivid story and anecdote really about accountess. She
supposedly infected a bachelor with leprosy while becoming pregnant by him.
Speaker 1 (11:12):
Wow. So direct transmission through sex was a major theory.
Speaker 2 (11:16):
Huge It led to really stern warnings beware of betting
a leprous woman, but male sexual activity was also implicated.
There were beliefs that the male organ described as spongy
could absorb the poison of leprosy through sexual.
Speaker 1 (11:28):
Contact, fascinating in a grim way. Did they think you
just got it full blown? Or were there stages?
Speaker 2 (11:34):
No, they definitely distinguished stages. This is actually quite important
for the patient's outlook. They talked about a predisposition, maybe
you had the wrong humoral balance to start, then an
incipient stage, early signs appearing, and finally the confirmed status.
Getting diagnosed early in that incipient stage might offer more
hope or at least less immediate segregation.
Speaker 1 (11:53):
And did they see it as just one disease or
different kinds?
Speaker 2 (11:57):
They categorized it again based on those humoral theories, usually
four main types, often named after animals whose characteristics supposedly
match the symptoms. There was Leonina or lion leprosy attributed
to yellow bile. It caused wrinkling, yellowing skin, facial changes
that made the person look angry or lionlike. Then Eliphantia,
linked to black bile. This was characterized by thick, rough,
(12:20):
cracking skin nodules, sort of like an elephant's hide. They
thought Chiria, associated with phlegms, supposedly caused smooth, white scaly patches,
maybe like a snake skin and alopecia linked to blood imbalance,
primarily causing hair loss, especially eyebrows, and reddish skin, perhaps
like a fox.
Speaker 1 (12:37):
It's striking how they tried to systematize it based on
the humoral framework. But did that view ever change? Did
they start looking more at actual physical evidence?
Speaker 2 (12:46):
Slowly? Yes, you see a gradual shift towards more empirical observation.
Someone like Jean de Veranda, writing in the early seventeenth century,
he's still deeply embedded in humoral theory, trying to reconcile
all the conflicting idea is. But then you get later
authors like Isaac Gudman in seventeen sixty five. He's emphasizing
personal observations, trying to give purely descriptive definitions, and some
(13:09):
were even starting to guess at microscopic causes. Udmuand proposed
leprosy might be caused by minuscule spiral worms that could
be expelled from the body.
Speaker 1 (13:17):
Worms. Okay, not quite bacteria, but moving towards a non
humoral cause, that's a big leap.
Speaker 2 (13:22):
It is a clear, if inaccurate, precursor to geram theory.
Speaker 1 (13:26):
So with all this complexity, the social pressure of the
confusing theories, the different types. Let's picture the actual examination.
What was it like.
Speaker 2 (13:33):
We get a great snapshot from a certificate issued in Airis,
France in fifteen seventy four for a man named Adrian
de Bellevala. It details the whole process. The patient had
to swear oaths to tell the truth. They drew blood
from his arm, inspected his urine and did a thorough
head to toe body examination.
Speaker 1 (13:50):
So quite formal and systematic.
Speaker 2 (13:52):
Yes, and there's a famous woodcut from fifteen seventeen inspection
of eleprous patients that gives us an idea of the
ideal setup. You see the physician instantly recognizable because he's
holding the urine flask. The euroscopy flask was like the
badge of the medieval doctor. Beside him, there's often a surgeon,
maybe palpating the patient's head, feeling for nodules. The caption
on that woodcut even suggests they're checking the fetter of
(14:14):
the breath. The smell as a key sign.
Speaker 1 (14:16):
That urine flask seems iconic. But even with all this
diagnosis was hard.
Speaker 2 (14:21):
Incredibly hard. Bernard to Gordon remember him, he created this
whole system of supposedly infallible signs. Yet even he admitted
the difficulty. He focused heavily on the face, saying, the
signs that matter to me are the ones that are
found in the face. But then he tells this humbling
story about examining a man. The man had severe problems
(14:42):
with his limbs like disfigurement for twenty years, but absolutely
no facial signs, and Gordon had to confess basically, God
knows the truth. I do not know.
Speaker 1 (14:51):
That's quite an admission from the expert who wrote the
book on signs. It really highlights the uncertainty they face.
Speaker 2 (14:56):
It does, and it raises the question if the visible
signs were unreliable, how else did they try to test
for it. This leads to the EXPERIMENTA.
Speaker 1 (15:05):
EXPERIMENTA sounds intriguing.
Speaker 2 (15:07):
These were specific diagnostic tests. Some quite peculiar. Blood tests
were common. One involved putting grains of salt and drawn blood.
According to some authorities, if the salt dissolved, the person
was healthy. If it didn't, they were lepros, though others
said the opposite.
Speaker 1 (15:21):
Not exactly standardized procedure, then not at all.
Speaker 2 (15:24):
Another test was mixing blood with vinegar if it foamed leprosy,
or mixing blood with urine if the blood sank leprosy.
Then there was the egg test documented in Provence in
fourteen thirty eight. They'd immerse a fresh egg in the
patient's drawn blood and compare it to an untouched egg
after some time. Very dramatic, almost ritualistic.
Speaker 1 (15:43):
Wow. And what about testing for numbness, that's a classic
sign we associate with Hanson's disease.
Speaker 2 (15:49):
Today, they did test for anesthesia, yes, pricking the fingers
or more commonly the heel with needles. The famous surgeon
Ambrose Peree actually boasted about this, about pushing a thick
and long needle very deep into a patient's heel to
confirm the lack of sensation.
Speaker 1 (16:06):
Pushing it deep. That sounds aggressive, it does.
Speaker 2 (16:09):
It speaks to their determination to find definitive signs, something
concrete amidst all the ambiguity. This focus on aggressive testing
really reflects a desperate search for certainty, especially since, as
we'll see, the available treatments offered very little real hope.
Speaker 1 (16:22):
Right, So diagnosis was fraud often uncertain. What about the
prognosis was it just seen as inevitably fatal and incurable.
Speaker 2 (16:29):
Well, incurability became almost a practical, even legal concept. There's
this fascinating legal case in Antwerp seventeen twenty seven. A
mother superior refused to take in an orphan girl and
a Katherine Spineloy who was suspected of leprosy. The argument
against the mother superior was that the physicians hadn't actually
tried everything possible to cure her yet, so incurability wasn't
(16:51):
just a medical fact, it was something that had to be,
in a sense proven by exhausting all options.
Speaker 1 (16:56):
Interesting what about faith and miracles? Did people look to
saints for cures?
Speaker 2 (17:01):
Saints played a huge symbolic role, but maybe not in
the way you'd expect. You have stories like Saint Francis
kissing a leper, or Saint Elizabeth of Hungary bathing a
leper and even drinking the bathwater.
Speaker 1 (17:11):
Drinking the bathwater well why to conquer her.
Speaker 2 (17:13):
Own physical revulsion to show ultimaturity and humility. These stories
emphasize compassion overcoming disgust, but they rarely feature miraculous healing
of the leprosy itself. Saint Elzere is one rare exception.
A story tells of him having a brief encounter with
a leper who was then suddenly healed, but mostly the
(17:34):
focus was on the soul. These acts reinforced the idea
that spiritual salvation was far more important than curing the body.
Speaker 1 (17:41):
So divine intervention wasn't the go to medical strategy. What
about actual medicine? Did anyone think it was curable?
Speaker 2 (17:47):
Oh? Yes, Paracelsus, the famously defiant physician. He basically blamed
other doctors for calling it incurable. He argued that nature
provided cures for everything, doctors just hadn't found them or
weren't using them correctly. But even peara Celsus admitted that
it advanced forms were probably beyond help, and his own
suggested remedies, well, they were pretty out there, like what
he suggested, using substances that were known to preserve dead bodies,
(18:09):
things like Embalmer's balms, essence of juniper, even pulverized pearls.
The logic was sort of, if it stops de kay,
maybe stops the disease.
Speaker 1 (18:19):
Pulverized pearls, right, So what was the more typical approach
to treatment?
Speaker 2 (18:24):
The dominant approach was pelepharmacy, basically throwing the kitchen sink
at it, using hundreds of different ingredients and complex concoctions,
mostly ineffective, of course, though looking back there are some
intriguing overlaps with modern knowledge. Medieval doctors recommended regular bathing
and soap for hygiene, which makes sense, and some fourteenth
century treatments involved head purges to clear the nasal passages.
(18:47):
We now know the nasal mucosa is a primary site
for the Mycobacterium lepre infection.
Speaker 1 (18:52):
Accidental wisdom perhaps, so bathing and nasal purging anything else
that sounds vaguely sensible? What about the lesson, Well.
Speaker 2 (19:01):
One common recommendation was simply to avoid sex, given the
theories about transmission we discussed.
Speaker 1 (19:05):
Okay, that makes sense within their framework. But then it
got weirder.
Speaker 2 (19:08):
Much weirder. Castoration was actually discussed as a potential treatment castration.
Speaker 1 (19:13):
Seriously, how often was that actually done.
Speaker 2 (19:16):
It's really unclear how often it was applied, but the
idea persisted in medical texts for centuries. The rationale was bizarre.
They thought it might somehow moisten the body or help
retain beneficial seminole material that was otherwise being lost or corrupted.
And for cosmetic relief, especially for facial sores. They sometimes
recommended ointments containing the patient's own blood or even the
(19:39):
blood of children or hairs. Okay, now we're getting into
truly strange territory. Mixing blood into face cream. It gets stranger.
Speaker 1 (19:46):
The ingestible cures were something else. Snake meat was a
very common recommendation, often prepared elaborately like a la eel,
cooked with squabs and spices.
Speaker 2 (19:56):
Snake a la eel. I think I'll pass. What else
was on the menu?
Speaker 1 (19:59):
Hoopo, I that's a type of bird circumcision skin, fresh seamen,
and toad flesh.
Speaker 2 (20:05):
Toad flesh. Right, The desperation just leaps off the page,
doesn't that they were trying literally anything in everything, which leads,
unfortunately to the darkest aspect of treatment, or perhaps lack thereof,
the idea of mercy killing or assisted suicide. Galen himself
tells a story of a leprous man who deliberately drank
toxic wine just to die and have rest, and this
(20:26):
underlying sense of hopelessness of the disease being an unbearable
burden ultimately contributed to the practice of isolating patients completely,
removing them to remote colonies, far away from society, a
grim solution born of fear and despair.
Speaker 1 (20:40):
So we've really journeyed through this complex history. It's clear
that pre modern medicine's view of leprosy was far more
nuanced than just calling it a disease of the soul.
Speaker 2 (20:49):
Absolutely, the major's central point, and it comes through so clearly,
is that physicians overwhelmingly saw it as a malady of
the whole body. They were meticulous in their own way,
documenting its effect skin, flesh, face, limbs, even internal ordins
like the heart and liver, all interpreted through that lens
of humoral physiology. Their focus was really on physical diagnosis, prognosis,
(21:10):
and attempting physical or at least palliative care. They largely
left the care of souls to the clergy, carving out
their own domain over the body and.
Speaker 1 (21:18):
The story of leprosy. Then it's not just about a
specific bacterium. It's a powerful lens on how societies handle threats,
how science, even prescience evolves, and how just the perception
of an illness can dramatically shape people's lives and fates.
That diagnostic power was immense.
Speaker 2 (21:34):
It really was, And what's so fascinating looking back through
this historical deep dive is the reminder that our own
understanding of disease is constantly evolving. It's always shaped by
the knowledge we have, yes, but also by our fears,
our social structures. The technology available makes you wonder, doesn't it.
What current health challenges are we viewing through our own limited,
(21:54):
contemporary lens. What societal assumptions are baked into our scientific
approaches today. How might future generations look back at us.
Speaker 1 (22:02):
That's a really powerful thought to end on. Food for
thought for all of us. Until next time, keep diving
deep into the fascinating stories hidden in plain sight.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!