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It Happened One Night

It Happened One Night is a 1934 American pre-Code romantic comedy film with elements of screwball comedy directed and co-produced by Frank Capra, in collaboration with Harry Cohn, in which a pampered socialite (Claudette Colbert) tries to get out from under her father's thumb and falls in love with a roguish reporter (Clark Gable). The screenplay by Robert Riskin is based on the August 1933 short story "Night Bus" by Samuel Hopkins Adams, which provided the shooting title. Classified as a "pre-Code" production, the film is among the last romantic comedies created before the MPPDA began rigidly enforcing the 1930 Motion Picture Production Code in July 1934. It Happened One Night was released just four months prior to that enforcement.

It is seen as one of the greatest films ever made''. It Happened One Night is the first of only three films (along with One Flew Over the Cuckoo's Nest and The Silence of the Lambs'') to win all five major Academy Awards: Best Picture, Best Director, Best Actor, Best Actress, and Best Adapted Screenplay. In 1993, it was selected for preservation in the U.S. National Film Registry by the Library of Congress, being deemed "culturally, historically, or aesthetically significant". In 2013, the film underwent an extensive restoration by Sony Pictures. The film's copyright was renewed in 1962, and under current United States law it will enter the public domain on January 1, 2030.

Plot
Spoiled heiress Ellen "Ellie" Andrews has eloped with pilot and fortune-hunter King Westley against the wishes of her extremely wealthy father, Alexander Andrews, who has sequestered his daughter and wants to have the marriage annulled because he knows that Westley is interested only in Ellie's money. Jumping ship in Florida, Ellie runs away and boards a Greyhound bus to New York City to reunite with her husband. She meets fellow passenger Peter Warne, a newspaper reporter who recently lost his job. Soon, Peter recognizes her and gives her a choice. If she gives him an exclusive on her story, he will help her reach Westley. If not, he will tell her father where she is. Ellie agrees.

Ellie loses her initial disdain for Peter and they begin to fall in love. When the bus breaks down, they try hitchhiking. They fail to secure a ride until Ellie displays a shapely leg to Danker, the next driver. When they stop en route, Danker tries to drive away with their luggage, but Peter chases him down and takes his Model T. Near the end of their journey, Ellie confesses her love to Peter. The owners of the motel in which they are staying notice that Peter's car is gone and expel Ellie. Believing Peter has deserted her, Ellie telephones her father, who agrees to let her marry Westley. Meanwhile, Peter has obtained money from his editor to marry Ellie but he misses her on the road. Although Ellie has no desire to be with Westley, she believes that Peter has betrayed her for the reward money and so agrees to have a second, formal wedding with Westley.

On the wedding day, she finally reveals the whole story to her father. When Peter comes to Ellie's home, Andrews offers him the reward money, but Peter insists on being paid only his expenses, a mere $39.60 for items that he had been forced to sell to buy gasoline. When Andrews presses Peter for an explanation of his odd behavior and demands to know if he loves her, Peter first tries to dodge the questions but then admits that he does and storms out. Westley arrives via an autogyro, but at the ceremony, Andrews reveals to his daughter Peter's refusal of the reward money and tells her that her car is waiting by the back gate in case she changes her mind. At the last minute, Ellie dumps Westley at the altar, bolts for her car, and drives away as the newsreel cameras crank.

A few days later, Andrews is working at his desk when Westley calls to tell him that he will take the financial settlement and not contest the annulment. His executive assistant brings him a telegram from Peter: "What's holding up the annulment, you slowpoke? The walls of Jericho are toppling!" That is a reference to a makeshift wall made of a blanket hung over a rope that was tied across the rooms separating the beds they had slept in, in order to give them each privacy while traveling together. With the annulment in hand, Andrews sends the reply, "Let 'em topple."

Peter's battered Model T is parked in a motor court in Glen Falls, Michigan. The mom-and-pop owners talk and wonder why, on such a warm night, the newlyweds (he had seen the marriage license) wanted a clothesline, an extra blanket, and a little tin trumpet. As they look at the cabin, the toy trumpet sounds a fanfare, the blanket falls to the floor, and the lights in the cabin go out.

Cast

 * Clark Gable as Peter Warne
 * Claudette Colbert as Ellen "Ellie" Andrews
 * Walter Connolly as Alexander Andrews
 * Roscoe Karns as Oscar Shapeley, an annoying bus passenger who tries to pick up Ellie
 * Jameson Thomas as "King" Westley
 * Alan Hale as Danker, a singing car driver who wants to steal a suitcase
 * Arthur Hoyt as Zeke, a motel owner
 * Blanche Friderici as Zeke's wife
 * Charles C. Wilson as Joe Gordon, newspaper editor and Peter's boss

 * Uncredited cast

Casting
Neither Gable nor Colbert was the first choice to play the lead roles. Miriam Hopkins rejected the part of Ellie. Robert Montgomery and Myrna Loy were then offered the roles, but both turned down the script. Loy later noted that the final story as filmed bore little resemblance to the script that she and Montgomery had been given. Margaret Sullavan also rejected the part. Constance Bennett was willing to accept the role if she could produce the film herself but Columbia Pictures would not agree to that condition. Bette Davis then wanted the role but she was under contract with Warner Brothers and Jack L. Warner refused to lend her. Carole Lombard was unable to accept because Columbia's proposed filming schedule would conflict with her work on Bolero at Paramount. Loretta Young also turned it down.

Harry Cohn suggested Colbert, who initially turned down the role. Her first film, For the Love of Mike (1927), had been directed by Capra and was such a disaster that neither wanted to work with the other again. Later, she agreed to the role only if her salary was doubled to $50,000 and if her scenes were completed in four weeks so that she could take a planned vacation.

According to Hollywood legend, Gable was lent to Columbia Pictures, then considered a minor studio, as punishment for refusing a role at his own studio. That tale has been partially refuted by more recent biographies. Metro-Goldwyn-Mayer did not have a project ready for Gable and the studio was paying him his contracted salary of $2,000 per week whether he worked or not. Louis B. Mayer lent him to Columbia for $2,500 per week, hence netting MGM $500 per week while he was gone. Capra, however, insisted that Gable was a reluctant participant in the film.

Filming
Filming began in a tense atmosphere as Gable and Colbert were dissatisfied with the quality of the script. Capra understood their dissatisfaction and let screenwriter Robert Riskin rewrite it. Colbert continued to show her displeasure on the set. She also initially balked at pulling up her skirt to entice a passing driver to provide a ride, complaining that it was unladylike. Upon seeing the chorus girl who was brought in as her body double, an outraged Colbert told the director, "Get her out of here. I'll do it. That's not my leg!" Capra claimed that Colbert "had many little tantrums, motivated by her antipathy toward me," however, "she was wonderful in the part." Part of the film was made on Thousand Oaks Boulevard in Thousand Oaks, California.

Reception
After filming was done, Colbert complained to her friend, "I just finished the worst picture in the world." Columbia appeared to have low expectations for the film and did not mount much of an advertising campaign for it. Initial reviews were generally positive. Mordaunt Hall of The New York Times called it "a good piece of fiction, which, with all its feverish stunts, is blessed with bright dialogue and a good quota of relatively restrained scenes". Hall described Colbert's performance as "engaging and lively" and Gable as "excellent". The movie also premiered at the Radio City Music Hall. Variety reported that it was "without a particularly strong plot" but "manages to come through in a big way, due to the acting, dialog, situations and directing". Film Daily praised it as "a lively yarn, fast-moving, plenty humorous, racy enough to be tantalizing, and yet perfectly decorous". The New York Herald Tribune called it "lively and amusing".

John Mosher of The New Yorker panned it as "pretty much nonsense and quite dreary" which was probably the review Capra had in mind when he recalled in his autobiography that "sophisticated" critics had dismissed the film. Despite the positive reviews, the film was only moderately successful in its initial run. After it was released to secondary movie houses, ticket sales became brisk, especially in smaller towns where the film's characters and simple romance struck a chord with moviegoers who were not surrounded by luxury. It turned out to be a major box office smash, easily Columbia's biggest hit until the late 1980s. During its initial release, the film earned $1 million in theater rentals from the United States and Canada.

Rotten Tomatoes compiled 108 reviews of the film to form a 98% score and an average rating of 9.1/10. The consensus reads, "Capturing its stars and director at their finest, It Happened One Night remains unsurpassed by the countless romantic comedies it has inspired". The film holds a score of 87 out of 100 on Metacritic, based on 16 critics.

Colbert was nominated for an Academy Award, but decided not to attend the ceremony since she felt she would not win and planned to take a cross-country railroad trip. After she was named the winner, studio chief Harry Cohn sent someone to "drag her off" the train, which had not yet departed, to bring her to the ceremony. Colbert arrived wearing a two-piece traveling suit which she had had the Paramount Pictures costume designer, Travis Banton, make for her trip.

Academy Awards
The film won all five of the Academy Awards for which it was nominated at the 7th Academy Awards for 1934:

It Happened One Night was the first film to win the "Big Five" Academy Awards (Best Picture, Best Director, Best Actor, Best Actress and Best Writing). , only two other films have matched this feat: One Flew Over the Cuckoo's Nest in 1975 and The Silence of the Lambs in 1991. It Happened One Night was also the last film to win both lead acting Academy Awards until One Flew Over the Cuckoo's Nest in 1975.

On December 15, 1996, Gable's Oscar was auctioned off to Steven Spielberg for $607,500, who donated the statuette to the Motion Picture Academy. In June of the following year, Colbert's Oscar was offered for auction by Christie's but attracted no bids.

Others
The film was included in the following American Film Institute lists:
 * 1998: AFI's 100 Years...100 Movies – #35
 * 2000: AFI's 100 Years...100 Laughs – #8
 * 2002: AFI's 100 Years...100 Passions – #38
 * 2007: AFI's 100 Years...100 Movies (10th Anniversary Edition) – #46
 * 2008: AFI's 10 Top 10: Romantic Comedy – #3

Influence
It Happened One Night made an immediate impact on the public. In one scene, Gable undresses for bed, taking off his shirt to reveal that he is bare-chested. An urban legend claims that, as a result, sales of men's undershirts declined noticeably. The movie also prominently features a Greyhound bus in the story, spurring interest in bus travel nationwide.

The unpublished memoirs of animator Friz Freleng mention that this was one of his favorite films. It Happened One Night has a few interesting parallels with, and may have even inspired certain characteristics of, the cartoon character Bugs Bunny, who made his first appearance six years later, and who Freleng helped develop. In the film, a minor character, Oscar Shapely, continually calls the Gable character "Doc," an imaginary character named "Bugs Dooley" is mentioned once in order to frighten Shapely, and there is also a scene in which Gable eats carrots while talking quickly with his mouth full, as Bugs does.

Restoration
In 2013 It Happened One Night was digitally restored. A new wet-gate master was produced by Sony Colorworks for scanning at 4K. The images were digitally treated at Prasad Corporation to remove dirt, tears, scratches, and other artifacts. Care was taken to preserve the original look of the film.

Remakes and adaptations
The film has inspired a number of remakes, including the musicals Eve Knew Her Apples (1945) starring Ann Miller and You Can't Run Away from It (1956) starring June Allyson and Jack Lemmon, which was directed and produced by Dick Powell.

It Happened One Night was adapted as a one-hour radio play on the March 20, 1939 broadcast of Lux Radio Theatre, with Colbert and Gable reprising their roles. The screenplay was also adapted as a radio play for the January 28, 1940, broadcast of The Campbell Playhouse, starring Orson Welles (Mr. Andrews), William Powell (Peter Warne) and Miriam Hopkins (Ellie Andrews).

It Happened One Night has been adapted into numerous Indian films. These include three Hindi adaptations: Chori Chori (1956), Nau Do Gyarah (1957) and Dil Hai Ke Manta Nahin (1991), one Bengali adaptation Chaoa Paoa (1959), two Tamil adaptations: Chandrodayam (1966) and Kadhal Rojavae (2000), and one Kannada adaptation Hudugaata (2007).

In popular culture
The 1937 Laurel and Hardy comedy Way Out West parodied the famous hitchhiking scene with Stan Laurel managing to stop a stage coach using the same technique. Mel Brooks's film Spaceballs (1987) parodies the wedding scene. As she walks down the aisle to wed Prince Valium, Princess Vespa (Daphne Zuniga) is told by King Roland (Dick Van Patten) that Lone Starr (Bill Pullman) forsook the reward for the princess's return and only asked to be reimbursed for the cost of the trip.

Other films have used familiar plot points from It Happened One Night. In Bandits (2001), Joe Blake (Bruce Willis) erects a blanket partition between motel room beds out of respect for Kate Wheeler's (Cate Blanchett's) privacy. He remarks that he saw people do the same thing in an old movie. In Sex and the City 2, Carrie and Mr. Big watch the film (specifically the hitchhiking scene) in a hotel; later in the film Carrie uses the idea which she got from the film to get a taxi in the Middle East.

In "The Bogman of Letchmoor Heath", the second episode of the horror/comedy television series She-Wolf of London (1990–1991), lead characters Randi Wallace (Kate Hodge) and Ian Matheson (Neil Dickson) rent a motel room, and, uncomfortable with the lack of privacy afforded, Ian stretches a bed sheet like a curtain between the two beds. Ian makes reference to It Happened One Night but Randi is unfamiliar with the film, remarking that she would rather "read a book".

Beginning in January 2014, the comic 9 Chickweed Lane tied a story arc to It Happened One Night when one of the characters, Lt. William O'Malley, is injured during World War II and believes himself to be Peter Warne. As he sneaks through German-occupied France, several plot points run parallel to that of It Happened One Night and he believes his French contact to be Ellen Andrews.

title: It Happened One Night


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Zinoviev letter

The Zinoviev letter was a forged document published and sensationalised by the British Daily Mail newspaper four days before the 1924 United Kingdom general election, which was held on 29 October. The letter purported to be a directive from Grigory Zinoviev, the head of the Communist International (Comintern) in Moscow, to the Communist Party of Great Britain (CPGB), ordering it to engage in seditious activities. It stated that the normalisation of British–Soviet relations under a Labour Party government would radicalise the British working class and put the CPGB in a favourable position to pursue a Bolshevik-style revolution. It further suggested that these effects would extend throughout the British Empire. The right-wing press depicted the letter as a grave foreign subversion of British politics and blamed the incumbent Labour government under Ramsay MacDonald for promoting the policy of political reconciliation and open trade with the Soviet Union on which the scheme appeared to depend. The election resulted in the fall of the first Labour government and a strong victory for the Conservative Party and the continued collapse of the Liberal Party. Labour supporters often blamed the letter, at least in part, for their party's defeat.

The letter was widely taken to be authentic upon publication and for some time afterwards, but historians now agree it was a forgery. The letter perhaps aided the Conservative Party by hastening the ongoing collapse of the Liberal Party vote, which, in turn, produced a Conservative landslide. A. J. P. Taylor argued that the letter's most important impact was on the mindset of Labourites, who for years afterwards blamed foul play for their defeat, thereby misunderstanding the political forces at work and postponing what Taylor regarded as necessary reforms in the Labour Party.

Background
On 22 January 1924, the Labour Party formed a government in the United Kingdom for the first time. However, it was a minority government and therefore liable to fall if the Conservatives and Liberals combined against it. In foreign policy, the government used its executive powers to offer official recognition of the Soviet Union in February 1924. It also proposed to lend it money and to open up trade, but parliament mostly obstructed these measures. On 8 October 1924, the Labour government of Ramsay MacDonald suffered defeat in the House of Commons on a motion of no confidence forwarded by the Liberals, who had until then supported the continuation of the minority government while also blocking most of its signature policy initiatives. Instead of resigning, MacDonald obtained permission from King George V for a dissolution of Parliament and the holding of a new election. The immediate cause of the parliamentary defeat had been the government's decision to drop the prosecution of communist editor John Ross Campbell under the Incitement to Mutiny Act 1797, for publication of an open letter in Workers' Weekly calling on soldiers to "let it be known that, neither in the class war nor in a military war, will you turn your guns on your fellow workers, but instead will line up with your fellow workers in an attack upon the exploiters and capitalists, and will use your arms on the side of your own class." A general election was scheduled for 29 October.

Letter
Near the end of the short election campaign, there appeared in the Daily Mail newspaper the text of a letter addressed to the Central Committee of the Communist Party of Great Britain (CPGB) purporting to have originated from Grigory Zinoviev, head of the Executive Committee of the Communist International (Comintern); Secretary of the Comintern Otto Wille Kuusinen; and Arthur MacManus, a British representative at a conference of the Executive Committee. It predicted that the Labour government's attempted normalisation of Britain's diplomatic and economic relations with the Soviet Union would not only profit the latter but also stir the British proletariat to revolutionary action and allow Soviet influence throughout the British Empire to widen. One particularly damaging section of this letter read: "A settlement of relations between the two countries will assist in the revolutionising of the international and British proletariat not less than a successful rising in any of the working districts of England, as the establishment of close contact between the British and Russian proletariat, the exchange of delegations and workers, etc., will make it possible for us to extend and develop the propaganda of ideas of Leninism in England and the Colonies."

Publication
The document was published in the conservative Daily Mail newspaper four days before the election and then picked up by other right-wing newspapers. The letter rankled at a sensitive time in relations between Britain and the Soviet Union, owing to vehement Conservative opposition to the parliamentary ratification of the Anglo-Soviet trade agreement of 8 August.

The publication of the letter was severely embarrassing to Prime Minister MacDonald and his Labour Party. Although his party faced a high likelihood of losing office, MacDonald had not given up hope in the campaign. Following the letter's publication, any chance of an upset victory was dashed, as the spectre of internal unrest and a government oblivious to, or even complicit in, the alleged peril thereof dominated the headlines and public discourse. MacDonald's attempts to cast doubt on the authenticity of the letter were in vain, hampered by the document's widespread acceptance among government officials. He told his Cabinet that he "felt like a man sewn in a sack and thrown into the sea.".

Election result
The Conservatives decisively won the October 1924 election, ending the country's first Labour government. After the Conservatives formed a government with Stanley Baldwin as Prime Minister, a Cabinet committee investigated the letter and concluded that it was genuine. The Conservative government did not undertake any further investigation, despite continuing suggestions that the letter was forged. On 21 November 1924, the government cancelled the unratified trade agreement with the Soviet Union. At about this juncture, MI5 determined secretly that the letter was beyond question a forgery. In order to protect its reputation and to keep the myth of Labour's acquiescence to the Soviet Union alive, it did not inform the rest of the government, which continued to treat it as genuine.

The Conservatives gained 155 seats, for a total of 413 seats. Labour lost 40 seats, retaining 151. The Liberals lost 118 seats, were left with only 40, and lost over a million votes.

Denial by Zinoviev
The Comintern and the Soviet government strongly and consistently denied the authenticity of the document. Grigory Zinoviev issued a denial on 27 October 1924 (two days before the election), which was finally published in English in the December 1924 issue of The Communist Review, the monthly theoretical magazine of the CPGB, well after the MacDonald government had already fallen. Zinoviev declared:

"The letter of 15th September, 1924, which has been attributed to me, is from the first to the last word, a forgery. Let us take the heading. The organisation of which I am the president never describes itself officially as the "Executive Committee of the Third Communist International"; the official name is "Executive Committee of the Communist International." Equally incorrect is the signature, "The Chairman of the Presidium." The forger has shown himself to be very stupid in his choice of the date. On the 15th of September, 1924, I was taking a holiday in Kislovodsk, and, therefore, could not have signed any official letter. [...]

It is not difficult to understand why some of the leaders of the Liberal-Conservative bloc had recourse to such methods as the forging of documents. Apparently they seriously thought they would be able, at the last minute before the elections, to create confusion in the ranks of those electors who sincerely sympathise with the Treaty between England and the Soviet Union. It is much more difficult to understand why the English Foreign Office, which is still under the control of the Prime Minister, MacDonald, did not refrain from making use of such a white-guardist forgery."

Impact
Most historians now agree that the letter had little immediate impact on the Labour vote, which not only held up but, in fact, increased slightly in terms of its share of the popular vote, although the main reason for this uptick was that the party fielded candidates in 87 more constituencies than it had in the previous election. Still, the letter helped to propel the Conservatives to a large parliamentary majority by allowing them to poach voters frightened by the First Red Scare from the withering Liberal bloc. The Conservative politician Robert Rhodes James claimed that the letter provided Labour "with a magnificent excuse for failure and defeat. The inadequacies that had been exposed in the Government in its brief existence could be ignored". Indeed, many Labourites for years blamed the letter, at least in part, for the defeat of the party. Figures such as Taylor believed that some of them misunderstood the political forces at work and learned the wrong lessons. Many others, however, have held up the letter as a chief factor in the election outcome.

The real significance of the election was that the Liberal Party, whom Labour had displaced as the second-largest political party in 1922, became clearly only a minor party, with their no-confidence gambit completely backfiring on them.

A 1967 British study deemed that the Labour Party was destined for defeat in October 1924 in any event and argued that the primary effect of the purported Comintern communiqué fell on Anglo-Soviet relations: "Under Baldwin, the British Government led the diplomatic retreat from Moscow. Soviet Russia became more isolated, and, of necessity, more isolationist. [...]

The Zinoviev letter hardened attitudes, and hardened them at a time when the Soviet Union was becoming more amenable to diplomatic contact with the capitalist world. The proponents of world revolution were being superseded by more pliant subscribers to the Stalin's philosophy of "Building Socialism in One Country". Thus, after successfully weathering all the early contradictions in Soviet Diplomacy, Britain gave up when the going was about to become much easier. And it gave up largely because the two middle-class parties suddenly perceived that their short-term electoral advantage was best served by a violent anti-Bolshevik campaign."

Current scholarship
Contemporary scholarship on the Zinoviev letter dates from a 1967 monograph published by three British journalists working for The Sunday Times. The authors, Lewis Chester, Steven Fay and Hugo Young, asserted that two members of a Russian monarchist organisation called the "Brotherhood of St. George" composed the document in Berlin. Irina Bellegarde, the widow of Alexis Bellegarde, one of the two men said to have written the document, stated that she had witnessed the forgery as it was performed. She said that her husband had drafted the letter after fellow-émigré Alexander Gumansky told him that a request to forge the letter had come from "a person in authority in London". Gurmansky and Bellegarde were later sentenced to death in absentia by a Soviet court. Bellegarde was later forced to work during the Second World War for the Russian section of the Abwehr (German military intelligence) in Berlin. Some evidence suggests that he was the highly effective British double agent known as "Outcast". He had been an important source on Soviet matters for the Secret Intelligence Service (SIS; commonly known as MI6) since the First World War, raising the possibility that he already had deep links to British intelligence when involved in the fabrication of the Zinoviev letter.

The forgers appear to have studied Bolshevik documents and signatures extensively before creating the letter to undermine the Soviet regime's relations with the United Kingdom. The British Foreign Office had received the forgery on 10 October 1924, two days after the defeat of the MacDonald government on the no-confidence motion initiated by the Liberals. Despite the dubious nature of the document, wheels were set in motion for its publication, members of the Conservative Party combining with Foreign Office officials in what Chester, Fay, and Young characterised as a "conspiracy".

These findings and allegations motivated the British Foreign Office to undertake a study of their own. For three years, Milicent Bagot of MI5 examined the archives and conducted interviews with surviving witnesses. She produced a long account of the affair, but the paper ultimately proved unpublishable because it contained sensitive operational and personnel information. Nevertheless, Bagot's work proved important as a secondary source when the Foreign Office revisited the matter three decades later.

In the first two months of 1998, rumours of a forthcoming book on the true origins of the Zinoviev letter, based on information from Soviet archives, led to renewed press speculation and parliamentary questions. In response, Foreign Secretary Robin Cook announced on 12 February that, in the interests of openness, he had commissioned the historians of the Foreign and Commonwealth Office to prepare a historical memorandum on the Zinoviev letter, drawing upon archival documents.

A paper by the Chief Historian of the Foreign and Commonwealth Office, Gill Bennett, was published in January 1999 and contains the results of this inquiry. Bennett had free and unfettered access to the archives of the Foreign Office, as well as those of the Secret Intelligence Service (SIS) and MI5. She also visited Moscow in the course of her research, working in the archives of the Executive Committee of the Communist International, the Central Committee of the Communist Party of the Soviet Union and the Comintern archive of the Communist Party of Great Britain. Although not every operational detail could be published because of British secrecy laws, the publicly available extracts of Bennett's paper still provided a rich account of the Zinoviev letter affair. Her report showed that the letter contained statements very similar to those made by Zinoviev to other communist parties and at other times to the CPGB, but at the time of the letter (when Anglo-Soviet trade talks were taking place and a general election was impending), Zinoviev and the Soviet government had adopted a more restrained attitude towards propaganda in Britain. Despite her extensive research, she concluded "it is impossible to say who wrote the Zinoviev Letter", though her best guess was that it was commissioned by White Russian intelligence circles from forgers in Berlin or the Baltic states, most likely in Riga. It was then leaked to the papers, probably by MI6, that she had stated, "I have my doubts as to whether [Desmond Morton] thought it was genuine but he treated it as if it was."

In 2006, Bennett incorporated some of her findings on the Zinoviev letter into chapter four of her biography of SIS agent Desmond Morton. Another 2006 book on spycraft attributes authorship to Vladimir Orlov, a former intelligence agent of Baron Wrangel during the Russian Civil War. The British historian Nigel West wrote that the OGPU (Soviet secret police) always initiated investigations into leaks of Soviet documents and into mishandlings of propaganda, and the fact no investigation was opened after the publication of the Zinoviev letter indicates it was certainly a forgery.

In 2011, Jonathan Pile published his book Churchill's Secret Enemy, detailing the mysterious career of Sir George Joseph Ball. Pile accessed Ball's papers (most of which Ball had attempted to destroy) from the Bodleian Library, along with other newly available sources. Pile's thesis, explained in the book, is that the Zinoviev letter was likely composed by Ball (at the time a long-serving MI5 officer) and his cohorts.

In 2017, the British government claimed that it had "lost" a file on the Zinoviev letter scandal. The government added that they were unable to determine whether copies of the material had been made.

In 2018, Bennett published her book The Zinoviev Letter: The Conspiracy that Never Dies.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Zinoviev letter


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Leprosy

Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damage may result in a lack of ability to feel pain, which can lead to the loss of parts of a person's extremities from repeated injuries or infection through unnoticed wounds. An infected person may also experience muscle weakness and poor eyesight. Leprosy symptoms may begin within one year, but, for some people, symptoms may take 20 years or more to occur.

Leprosy is spread between people, although extensive contact is necessary. Leprosy has a low pathogenicity, and 95% of people who contract M. leprae do not develop the disease. Spread is thought to occur through a cough or contact with fluid from the nose of a person infected by leprosy. Genetic factors and immune function play a role in how easily a person catches the disease. Leprosy does not spread during pregnancy to the unborn child or through sexual contact. Leprosy occurs more commonly among people living in poverty. There are two main types of the disease – paucibacillary and multibacillary, which differ in the number of bacteria present. A person with paucibacillary disease has five or fewer poorly pigmented, numb skin patches, while a person with multibacillary disease has more than five skin patches. The diagnosis is confirmed by finding acid-fast bacilli in a biopsy of the skin.

Leprosy is curable with multidrug therapy. Treatment of paucibacillary leprosy is with the medications dapsone, rifampicin, and clofazimine for six months. Treatment for multibacillary leprosy uses the same medications for 12 months. A number of other antibiotics may also be used. These treatments are provided free of charge by the World Health Organization.

Leprosy is not highly contagious. People with leprosy can live with their families and go to school and work. In the 1980s, there were 5.2 million cases globally, but by 2020 this decreased to fewer than 200,000. Most new cases occur in 14 countries, with India accounting for more than half. In the 20 years from 1994 to 2014, 16 million people worldwide were cured of leprosy. About 200 cases per year are reported in the United States. Central Florida accounted for 81% of cases in Florida and nearly 1 out of 5 leprosy cases nationwide. Separating people affected by leprosy by placing them in leper colonies still occurs in some areas of India, China, Africa, and Thailand.

Leprosy has affected humanity for thousands of years. The disease takes its name from the Greek word λέπρα (lépra), from λεπίς (lepís; 'scale'), while the term "Hansen's disease" is named after the Norwegian physician Gerhard Armauer Hansen. Leprosy has historically been associated with social stigma, which continues to be a barrier to self-reporting and early treatment. Some consider the word leper offensive, preferring the phrase "person affected with leprosy". Leprosy is classified as a neglected tropical disease. World Leprosy Day was started in 1954 to draw awareness to those affected by leprosy.

Signs and symptoms
Common symptoms present in the different types of leprosy include a runny nose; dry scalp; eye problems; skin lesions; muscle weakness; reddish skin; smooth, shiny, diffuse thickening of facial skin, ear, and hand; loss of sensation in fingers and toes; thickening of peripheral nerves; a flat nose from destruction of nasal cartilages; and changes in phonation and other aspects of speech production. In addition, atrophy of the testes and impotence may occur.

Leprosy can affect people in different ways. The average incubation period is five years. People may begin to notice symptoms within the first year or up to 20 years after infection. The first noticeable sign of leprosy is often the development of pale or pink coloured patches of skin that may be insensitive to temperature or pain. Patches of discolored skin are sometimes accompanied or preceded by nerve problems including numbness or tenderness in the hands or feet. Secondary infections (additional bacterial or viral infections) can result in tissue loss, causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body. A person's immune response differs depending on the form of leprosy.

Approximately 30% of people affected with leprosy experience nerve damage. The nerve damage sustained is reversible when treated early, but becomes permanent when appropriate treatment is delayed by several months. Damage to nerves may cause loss of muscle function, leading to paralysis. It may also lead to sensation abnormalities or numbness, which may lead to additional infections, ulcerations, and joint deformities.

M. leprae and M. lepromatosis

M. leprae and M. lepromatosis are the mycobacteria that cause leprosy. M. lepromatosis is a relatively newly identified mycobacterium isolated from a fatal case of diffuse lepromatous leprosy in 2008. M. lepromatosis is indistinguishable clinically from M. leprae.

M. leprae is an intracellular, acid-fast bacterium that is aerobic and rod-shaped. M. leprae is surrounded by the waxy cell envelope coating characteristic of the genus Mycobacterium.

Genetically, M. leprae and M. lepromatosis lack the genes that are necessary for independent growth. M. leprae and M. lepromatosis are obligate intracellular pathogens, and cannot be grown (cultured) in the laboratory. The inability to culture M. leprae and M. lepromatosis has creates difficulty definitively identifying the bacterial organism under a strict interpretation of Koch's postulates.

While the causative organisms have to date been impossible to culture in vitro, it has been possible to grow them in animals such as mice and armadillos.

Naturally occurring infection has been reported in nonhuman primates (including the African chimpanzee, the sooty mangabey, and the cynomolgus macaque), armadillos, and red squirrels. Multilocus sequence typing of the armadillo M. leprae strains suggests that they were of human origin for at most a few hundred years. Thus, it is suspected that armadillos first acquired the organism incidentally from early European explorers of the Americas. This incidental transmission was sustained in the armadillo population, and it may be transmitted back to humans, making leprosy a zoonotic disease (spread between humans and animals).

Red squirrels (Sciurus vulgaris), a threatened species in Great Britain, were found to carry leprosy in November 2016. It has been suggested that the trade in red squirrel fur, highly prized in the medieval period and intensively traded, may have been responsible for the leprosy epidemic in medieval Europe. A pre-Norman era skull excavated in Hoxne, Suffolk, in 2017 was found to carry DNA from a strain of Mycobacterium leprae, which closely matched the strain carried by modern red squirrels on Brownsea Island, UK.

Risk factors
The greatest risk factor for developing leprosy is contact with another person infected by leprosy. People who are exposed to a person who has leprosy are 5–8 times more likely to develop leprosy than members of the general population. Leprosy also occurs more commonly among those living in poverty. Not all people who are infected with M. leprae develop symptoms.

Conditions that reduce immune function, such as malnutrition, other illnesses, or genetic mutations, may increase the risk of developing leprosy. Infection with HIV does not appear to increase the risk of developing leprosy. Certain genetic factors in the person exposed have been associated with developing lepromatous or tuberculoid leprosy.

Transmission
Transmission of leprosy occurs during close contact with those who are infected. Transmission of leprosy is through the upper respiratory tract. Older research suggested the skin as the main route of transmission, but research has increasingly favored the respiratory route. Transmission occurs through inhalation of bacilli present in upper airway secretion.

Leprosy is not sexually transmitted and is not spread through pregnancy to the unborn child. The majority (95%) of people who are exposed to M. leprae do not develop leprosy; casual contact such as shaking hands and sitting next to someone with leprosy does not lead to transmission. People are considered non-infectious 72 hours after starting appropriate multi-drug therapy.

Two exit routes of M. leprae from the human body often described are the skin and the nasal mucosa, although their relative importance is not clear. Lepromatous cases show large numbers of organisms deep in the dermis, but whether they reach the skin surface in sufficient numbers is doubtful.

Leprosy may also be transmitted to humans by armadillos, although the mechanism is not fully understood.

Genetics
Not all people who are infected or exposed to M. leprae develop leprosy, and genetic factors are suspected to play a role in susceptibility to an infection. Cases of leprosy often cluster in families and several genetic variants have been identified. In many people who are exposed, the immune system is able to eliminate the leprosy bacteria during the early infection stage before severe symptoms develop. A genetic defect in cell-mediated immunity may cause a person to be susceptible to develop leprosy symptoms after exposure to the bacteria. The region of DNA responsible for this variability is also involved in Parkinson's disease, giving rise to current speculation that the two disorders may be linked at the biochemical level.

Mechanism
Most leprosy complications are the result of nerve damage. The nerve damage occurs from direct invasion by the M. leprae bacteria and a person's immune response resulting in inflammation. The molecular mechanism underlying how M. leprae produces the symptoms of leprosy is not clear, but M. leprae has been shown to bind to Schwann cells, which may lead to nerve injury including demyelination and a loss of nerve function (specifically a loss of axonal conductance). Numerous molecular mechanisms have been associated with this nerve damage including the presence of a laminin-binding protein and the glycoconjugate (PGL-1) on the surface of M. leprae that can bind to laminin on peripheral nerves.

As part of the human immune response, white blood cell-derived macrophages may engulf M. leprae by phagocytosis.

In the initial stages, small sensory and autonomic nerve fibers in the skin of a person with leprosy are damaged. This damage usually results in hair loss to the area, a loss of the ability to sweat, and numbness (decreased ability to detect sensations such as temperature and touch). Further peripheral nerve damage may result in skin dryness, more numbness, and muscle weaknesses or paralysis in the area affected. The skin can crack and if the skin injuries are not carefully cared for, there is a risk for a secondary infection that can lead to more severe damage.

Diagnosis
In countries where people are frequently infected, a person is considered to have leprosy if they have one of the following two signs:
 * Skin lesion consistent with leprosy and with definite sensory loss.
 * Positive skin smears.

Skin lesions can be single or many, and usually hypopigmented, although occasionally reddish or copper-colored. The lesions may be flat (macules), raised (papules), or solid elevated areas (nodular). Experiencing sensory loss at the skin lesion is a feature that can help determine if the lesion is caused by leprosy or by another disorder such as tinea versicolor. Thickened nerves are associated with leprosy and can be accompanied by loss of sensation or muscle weakness, but muscle weakness without the characteristic skin lesion and sensory loss is not considered a reliable sign of leprosy.

In some cases, acid-fast leprosy bacilli in skin smears are considered diagnostic; however, the diagnosis is typically made without laboratory tests, based on symptoms. If a person has a new leprosy diagnosis and already has a visible disability caused by leprosy, the diagnosis is considered late.

In countries or areas where leprosy is uncommon, such as the United States, diagnosis of leprosy is often delayed because healthcare providers are unaware of leprosy and its symptoms. Early diagnosis and treatment prevent nerve involvement, the hallmark of leprosy, and the disability it causes.

There is no recommended test to diagnose latent leprosy in people without symptoms. Few people with latent leprosy test positive for anti PGL-1. The presence of M. leprae bacterial DNA can be identified using a polymerase chain reaction (PCR)-based technique. This molecular test alone is not sufficient to diagnose a person, but this approach may be used to identify someone who is at high risk of developing or transmitting leprosy such as those with few lesions or an atypical clinical presentation.

New approaches propose tools to diagnose leprosy through Artificial Intelligence.

Classification
Several different approaches for classifying leprosy exist. There are similarities between the classification approaches.
 * The World Health Organization system distinguishes "paucibacillary" and "multibacillary" based upon the proliferation of bacteria. ("pauci-" refers to a small quantity.)
 * The Ridley-Jopling scale provides five gradations.
 * The ICD-10, though developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry.
 * In MeSH, three groupings are used.

Leprosy may also occur with only neural involvement, without skin lesions.

Complications
Leprosy may cause the victim to lose limbs and digits but not directly. M. leprae attacks nerve endings and destroys the body's ability to feel pain and injury. Without feeling pain, people with leprosy have an increased risk of injuring themselves. Injuries become infected and result in tissue loss. Fingers, toes, and limbs become shortened and deformed as the tissue is absorbed into the body.

Prevention
Early detection of the disease is important, since physical and neurological damage may be irreversible even if cured. Medications can decrease the risk of those living with people who have leprosy from acquiring the disease and likely those with whom people with leprosy come into contact outside the home. The WHO recommends that preventive medicine be given to people who are in close contact with someone who has leprosy. The suggested preventive treatment is a single dose of rifampicin (SDR) in adults and children over 2 years old who do not already have leprosy or tuberculosis. Preventive treatment is associated with a 57% reduction in infections within 2 years and a 30% reduction in infections within 6 years.

The Bacillus Calmette–Guérin (BCG) vaccine offers a variable amount of protection against leprosy in addition to its closely related target of tuberculosis. It appears to be 26% to 41% effective (based on controlled trials) and about 60% effective based on observational studies with two doses possibly working better than one. The WHO concluded in 2018 that the BCG vaccine at birth reduces leprosy risk and is recommended in countries with high incidence of TB and people who have leprosy. People living in the same home as a person with leprosy are suggested to take a BCG booster which may improve their immunity by 56%. Development of a more effective vaccine is ongoing.

A novel vaccine called LepVax entered clinical trials in 2017 with the first encouraging results reported on 24 participants published in 2020. If successful, this would be the first leprosy-specific vaccine available.

Treatment

A number of leprostatic agents are available for treatment. A three-drug regimen of rifampicin, dapsone and clofazimine is recommended for all people with leprosy, for six months for paucibacillary leprosy and 12 months for multibacillary leprosy.

Multidrug therapy (MDT) remains highly effective, and people are no longer infectious after the first monthly dose. It is safe and easy to use under field conditions because of its presentation in calendar blister packs. Post-treatment relapse rates remain low. Resistance has been reported in several countries, although the number of cases is small. People with rifampicin-resistant leprosy may be treated with second line drugs such as fluoroquinolones, minocycline, or clarithromycin, but the treatment duration is 24 months because of their lower bactericidal activity. Evidence on the potential benefits and harms of alternative regimens for drug-resistant leprosy is not available.

For people with nerve damage, protective footwear may help prevent ulcers and secondary infection. Canvas shoes may be better than PVC boots. There may be no difference between double rocker shoes and below-knee plaster. Topical ketanserin seems to have a better effect on ulcer healing than clioquinol cream or zinc paste, but the evidence for this is weak. Phenytoin applied to the skin improves skin changes to a greater degree when compared to saline dressings.

Outcomes
Although leprosy has been curable since the mid-20th century, left untreated it can cause permanent physical impairments and damage to a person's nerves, skin, eyes, and limbs. Despite leprosy not being very infectious and having a low pathogenicity, there is still significant stigma and prejudice associated with the disease. Because of this stigma, leprosy can affect a person's participation in social activities and may also affect the lives of their family and friends. People with leprosy are also at a higher risk for problems with their mental well-being. The social stigma may contribute to problems obtaining employment, financial difficulties, and social isolation. Efforts to reduce discrimination and reduce the stigma surrounding leprosy may help improve outcomes for people with leprosy.

Epidemiology
Leprosy world map - DALY - WHO2004.svg for leprosy per 100,000 inhabitants in 2004

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In 2018, there were 208,619 new cases of leprosy recorded, a slight decrease from 2017. In 2015, 94% of the new leprosy cases were confined to 14 countries. India reported the greatest number of new cases (60% of reported cases), followed by Brazil (13%) and Indonesia (8%). Although the number of cases worldwide continues to fall, there are parts of the world where leprosy is more common, including Brazil, South Asia (India, Nepal, Bhutan), some parts of Africa (Tanzania, Madagascar, Mozambique), and the western Pacific. About 150 to 250 cases are diagnosed in the United States each year.

In the 1960s, there were tens of millions of leprosy cases recorded when the bacteria started to develop resistance to dapsone, the most common treatment option at the time. International (e.g., the WHO's "Global Strategy for Reducing Disease Burden Due to Leprosy") and national (e.g., the International Federation of Anti-Leprosy Associations) initiatives have reduced the total number and the number of new cases of the disease.

The number of new leprosy cases is difficult to measure and monitor because of leprosy's long incubation period, delays in diagnosis after onset of the disease, and lack of medical care in affected areas. The registered prevalence of the disease is used to determine disease burden. Registered prevalence is a useful proxy indicator of the disease burden, as it reflects the number of active leprosy cases diagnosed with the disease and receiving treatment with MDT at a given point in time. The prevalence rate is defined as the number of cases registered for MDT treatment among the population in which the cases have occurred, again at a given point in time.

Historical distribution
Using comparative genomics, in 2005, geneticists traced the origins and worldwide distribution of leprosy from East Africa or the Near East along human migration routes. They found four strains of M. leprae with specific regional locations: Monot et al. (2005) determined that leprosy originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of M. leprae are based in specific geographic regions where each predominantly occurs:
 * strain 1 in Asia, the Pacific region, and East Africa;
 * strain 2 in Ethiopia, Malawi, Nepal, north India, and New Caledonia;
 * strain 3 in Europe, North Africa, and the Americas;
 * strain 4 in West Africa and the Caribbean.

This confirms the spread of the disease along the migration, colonisation, and slave trade routes taken from East Africa to India, West Africa to the New World, and from Africa into Europe and vice versa.

Skeletal remains discovered in 2009 represent the oldest documented evidence for leprosy, dating to the 2nd millennium BC. Located at Balathal, Rajasthan, in northwest India, the discoverers suggest that, if the disease did migrate from Africa to India during the 3rd millennium BC "at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt, there needs to be additional skeletal and molecular evidence of leprosy in India and Africa to confirm the African origin of the disease". A proven human case was verified by DNA taken from the shrouded remains of a man discovered by researchers from the Hebrew University of Jerusalem in a tomb in Akeldama, next to the Old City of Jerusalem, Israel, dated by radiocarbon methods to the first half of the 1st century.

The oldest strains of leprosy known from Europe are from Great Chesterford in southeast England and dating back to AD 415–545. These findings suggest a different path for the spread of leprosy, meaning it may have originated in Western Eurasia. This study also indicates that there were more strains in Europe at the time than previously determined.

Discovery and scientific progress
Literary attestation of leprosy is unclear because of the ambiguity of many early sources, including the Indian Atharvaveda and Kausika Sutra, the Egyptian Ebers papyrus, and the Hebrew Bible's various sections regarding signs of impurity (tzaraath). Clearly leprotic symptoms are attested in the Indian doctor Sushruta's Compendium, originally dating to c. 600 BC but only surviving in emended texts no earlier than the 5th century. They were separately described by Hippocrates in 460 BC. However, Hansen's disease probably did not exist in Greece or the Middle East before the Common Era. In 1846, Francis Adams produced The Seven Books of Paulus Aegineta which included a commentary on all medical and surgical knowledge and descriptions and remedies to do with leprosy from the Romans, Greeks, and Arabs.

Leprosy did not exist in the Americas before colonization by modern Europeans nor did it exist in Polynesia until the middle of the 19th century.

The causative agent of leprosy, M. leprae, was discovered by Gerhard Armauer Hansen in Norway in 1873, making it the first bacterium to be identified as causing disease in humans.

Treatment
Chaulmoogra tree oil was used topically to manage Hansen's disease for centuries. Chaulmoogra oil could not be taken orally without causing nausea or injected without forming an abscess. In 1915, Alice Ball, the first Black woman to graduate from the University of Hawai'i with a masters in chemistry, discovered how to make the oil water-soluble. This technique led to marked improvements in patients with Hansen's disease who were treated in Hawai'i.

The first effective drug (promin) became available in the 1940s. In the 1950s, dapsone was introduced. The search for further effective antileprosy drugs led to the use of clofazimine and rifampicin in the 1960s and 1970s. Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance. Multi-drug therapy (MDT) combining all three drugs was first recommended by the WHO in 1981. These three antileprosy drugs are still used in the standard MDT regimens.

Leprosy was once believed to be highly contagious and was treated with mercury, as was syphilis, which was first described in 1530. Many early cases thought to be leprosy could actually have been syphilis.

Resistance has developed to initial treatment. Until the introduction of MDT in the early 1980s, leprosy could not be diagnosed and treated successfully within the community.

Japan still has sanatoriums (although Japan's sanatoriums no longer have active leprosy cases, nor are survivors held in them by law).

The importance of the nasal mucosa in the transmission of M. leprae was recognized as early as 1898 by Schäffer, in particular, that of the ulcerated mucosa. The mechanism of plantar ulceration in leprosy and its treatment was first described by Ernest W. Price.

Etymology
The word "leprosy" comes from the Greek word "λέπος (lépos) – skin" and "λεπερός (leperós) – scaly man".

Treatment cost
Between 1995 and 1999, the WHO, with the aid of the Nippon Foundation, supplied all endemic countries with free multidrug therapy in blister packs, channeled through ministries of health. This free provision was extended in 2000 and again in 2005, 2010 and 2015 with donations by the multidrug therapy manufacturer Novartis through the WHO. In the latest agreement signed between the company and the WHO in October 2015, the provision of free multidrug therapy by the WHO to all endemic countries will run until the end of 2025. At the national level, nongovernment organizations affiliated with the national program will continue to be provided with an appropriate free supply of multidrug therapy by the WHO.

Historical texts
Written accounts of leprosy date back thousands of years. Various skin diseases translated as leprosy appear in the ancient Indian text, the Atharava Veda, by 600 BC. Another Indian text, the Manusmriti (200 BC), prohibited contact with those infected with the disease and made marriage to a person infected with leprosy punishable.

The Hebraic root tsara or tsaraath (צָרַע, – tsaw-rah' – to be struck with leprosy, to be leprous) and the Greek (λεπρός–lepros), are of broader classification than the more narrow use of the term related to Hansen's Disease. Any progressive skin disease (a whitening or splotchy bleaching of the skin, raised manifestations of scales, scabs, infections, rashes, etc....), as well as generalized molds and surface discoloration of any clothing, leather, or discoloration on walls or surfaces throughout homes all, came under the "law of leprosy" (Leviticus 14:54–57). Ancient sources such as the Talmud (Sifra 63) make clear that tzaraath refers to various types of lesions or stains associated with ritual impurity and occurring on cloth, leather, or houses, as well as skin. Traditional Judaism and Jewish rabbinical authorities, both historical and modern, emphasize that the tsaraath of Leviticus is a spiritual ailment with no direct relationship to Hansen's disease or physical contagions. The relation of tsaraath to "leprosy" comes from translations of Hebrew Biblical texts into Greek and ensuing misconceptions.

All three Synoptic Gospels of the New Testament describe instances of Jesus healing people with leprosy (Matthew 8:1–4, Mark 1:40–45, and Luke 5:12–16). The Bible's description of leprosy is congruous (if lacking detail) with the symptoms of modern leprosy, but the relationship between this disease, tzaraath, and Hansen's disease has been disputed. The biblical perception that people with leprosy were unclean can be found in a passage from Leviticus 13: 44–46. While this text defines the leper as impure, it did not explicitly make a moral judgement on those with leprosy. Some Early Christians believed that those affected by leprosy were being punished by God for sinful behavior. Moral associations have persisted throughout history. Pope Gregory the Great (540–604) and Isidore of Seville (560–636) considered people with the disease to be heretics.

Middle Ages

The social perception of leprosy in the general population was in general mixed. On one hand, people feared getting infected with the disease and thought of people suspected of leprosy to be unclean, untrustworthy, and occasionally morally corrupt. On the other hand, Jesus' interaction with lepers, the writing of church leaders and the Christian focus on charitable works led to viewing the lepers as "chosen by God" or seeing the disease as a means of obtaining access to heaven.

Early medieval understanding of leprosy was influenced by early Christian writers such as Gregory of Nazianzus and John Chrysostom, whose writings were later embraced by Byzantine and Latin writers. Gregory, for example, did not only compose sermons urging Christians to assist victims of the disease, but also condemned pagans or Christians who justified rejecting lepers on the allegation that God had sent them the disease to punish them. As cases of leprosy increased during these years in the Eastern Roman Empire, becoming a major health issue, the ecclesiastic leaders of the time discussed how to assist those affected as well as change the attitude of society towards them. They also tried this by using the name "Holy disease" instead of the commonly used "Elephant's disease" (elephantiasis), implying that God did not create this disease to punish people but to purify them for heaven. Although not always successful in persuading the public and a cure was never found by Greek medicians, they created an environment where victims could get palliative care and were never expressly banned from society, as sometimes happened in Western Europe. Theodore Balsamon, a 12th-century jurist in Constantinople, noted that lepers were allowed to enter the same churches, cities and assemblies that healthy people attended.

As the disease became more prevalent in Western Europe in the fifth century, efforts began to set up permanent institutions to house and feed lepers. These efforts were, inclusively, the work of bishops in France at the end of the sixth century, such as in Chalon-sur-Saône. The increase in hospitals or leprosaria (sing. leprosarium) that treated people with leprosy in the 12th and 13th century seems to indicate a rise in cases,  possibly in connection with the increase in urbanisation as well as returning crusaders from the Middle East. France alone had nearly 2,000 leprosaria during this period. Additionally to the new leprosia, further steps were taken by secular and religious leaders to prevent further spread of the disease. The third Lateran Council of 1179 required lepers to have their own priests and churches and a 1346 edict by King Edward expelled lepers from city limits. Segregation from mainstream society became common, and people with leprosy were often required to wear clothing that identified them as such or carry a bell announcing their presence. As in the East, it was the Church who took care of the lepers due to the still persisting moral stigma and who ran the leprosaria. Although the leprosaria in Western Europe removed the sick from society, they were never a place to quarantine them or from which they could not leave: lepers would go beg for alms for the upkeep of the leprosaria or meet with their families.

Multiple groups in western Europe from the middle ages faced social ostracization and discrimination that was justified, in part, due to claims that they were the descendants of lepers. These groups included the Cagots and the Caquins.

Norway
Norway was the location of a progressive stance on leprosy tracking and treatment and played an influential role in European understanding of the disease. In 1832, Dr. JJ Hjort conducted the first leprosy survey, thus establishing a basis for epidemiological surveys. Subsequent surveys resulted in the establishment of a national leprosy registry to study the causes of leprosy and for tracking the rate of infection.

Early leprosy research throughout Europe was conducted by Norwegian scientists Daniel Cornelius Danielssen and Carl Wilhelm Boeck. Their work resulted in the establishment of the National Leprosy Research and Treatment Center. Danielssen and Boeck believed the cause of leprosy transmission was hereditary. This stance was influential in advocating for the isolation of those infected by sex to prevent reproduction.

Leprosy and imperialism

Though leprosy rates were again on the decline in the Western world by the 1860s, authorities in the West frequently embraced isolation treatment due to a combination of reasons, including fears of the disease spreading from the Global South, efforts by Christian missionaries and a lack of understanding concerning bacteriology, medical diagnosis and how contagious the disease was. The rapid expansion of Western imperialism during the Victorian era resulted in Westerners coming into increasing contact with regions where the disease was endemic, including British India. English surgeon Henry Vandyke Carter observed isolation treatment for leprosy patients first-hand while visiting Norway, applying these methods in British India with the financial and logistical assistance of Protestant missionaries. Colonialist and religious viewpoints of the disease continued to be a major factor in the treatment and public perception of the disease in the Global South until decolonization in the mid-twentieth century.

India
In 1898, the colonial government in British India enacted the Leprosy Act of 1898, which mandated the compulsory segregation of people with leprosy by authorities in newly established leper asylums, where they were segregated by sex to prevent sexual activity. The act, which proved difficult to enforce, was repealed in 1983 by the Indian government after multidrug therapy had become widely available in India. In 1983, the National Leprosy Elimination Programme, previously the National Leprosy Control Programme, changed its methods from surveillance to the treatment of people with leprosy. India still accounts for over half of the global disease burden. According to WHO, new cases in India during 2019 diminished to 114,451 patients (57% of the world's total new cases). Until 2019, Indians could justify a petition for divorce with their spouse's diagnosis of leprosy.

United States
The National Leprosarium at Carville, Louisiana, known in 1955 as the Louisiana Leper Home, was the only leprosy hospital on the mainland United States. Leprosy patients from all over the United States were sent to Carville in order to be kept in isolation away from the public, as not much about leprosy transmission was known at the time and stigma against those with leprosy was high (see Leprosy stigma). The Carville leprosarium was known for its innovations in reconstructive surgery for those with leprosy. In 1941, 22 patients at Carville underwent trials for a new drug called promin. The results were described as miraculous, and soon after the success of promin came dapsone, a medicine even more effective in the fight against leprosy.

United States
Leprosy incidence peaked in the United States in 1983, followed by a steep decline. However, case numbers have been slowly rising again since 2000. In 2020, 159 cases of leprosy were reported in the country.

Stigma
Despite now effective treatment and education efforts, leprosy stigma continues to be problematic in developing countries where the disease is common. Leprosy is most common amongst impoverished populations where social stigma is likely to be compounded by poverty. Fears of ostracism, loss of employment, or expulsion from family and society may contribute to a delayed diagnosis and treatment.

Folk beliefs, lack of education, and religious connotations of the disease continue to influence social perceptions of those affected in many parts of the world. In Brazil, for example, folklore holds that leprosy is a disease transmitted by dogs, or that it is associated with sexual promiscuity, or that it is a punishment for sins or moral transgressions (distinct from other diseases and misfortunes, which are in general thought of as being according to the will of God). Socioeconomic factors also have a direct impact. Lower-class domestic workers who are often employed by those in a higher socioeconomic class may find their employment in jeopardy as physical manifestations of the disease become apparent. Skin discoloration and darker pigmentation resulting from the disease also have social repercussions.

In extreme cases in northern India, leprosy is equated with an "untouchable" status that "often persists long after individuals with leprosy have been cured of the disease, creating lifelong prospects of divorce, eviction, loss of employment, and ostracism from family and social networks."

Public policy
A goal of the World Health Organization is to "eliminate leprosy" and in 2016 the organization launched "Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world". Elimination of leprosy is defined as "reducing the proportion of leprosy patients in the community to very low levels, specifically to below one case per 10,000 population". Diagnosis and treatment with multidrug therapy are effective, and a 45% decline in disease burden has occurred since multidrug therapy has become more widely available. The organization emphasizes the importance of fully integrating leprosy treatment into public health services, effective diagnosis and treatment, and access to information. The approach includes supporting an increase in health care professionals who understand the disease, and a coordinated and renewed political commitment that includes coordination between countries and improvements in the methodology for collecting and analysing data.

Interventions in the "Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world":

 * Early detection of cases focusing on children to reduce transmission and disabilities.
 * Enhanced healthcare services and improved access for people who may be marginalized.
 * For countries where leprosy is endemic, further interventions include an improved screening of close contacts, improved treatment regimens, and interventions to reduce stigma and discrimination against people who have leprosy.

In some instances in India, community-based rehabilitation is embraced by local governments and NGOs alike. Often, the identity cultivated by a community environment is preferable to reintegration, and models of self-management and collective agency independent of NGOs and government support have been desirable and successful.

Notable cases

 * Josephine Cafrine of Seychelles had leprosy from the age of 12 and kept a personal journal that documented her struggles and suffering.  It was published as an autobiography in 1923.
 * Saint Damien De Veuster, a Catholic priest from Belgium, himself eventually contracting leprosy, ministered to lepers who had been placed under a government-sanctioned medical quarantine on the island of Molokai in the Kingdom of Hawaii.
 * Baldwin IV of Jerusalem was a Catholic Christian king of Latin Jerusalem who had leprosy.
 * Josefina Guerrero was a Filipino spy during World War II, who used the Japanese fear of her leprosy to listen to their battle plans and deliver the information to the American forces under Douglas MacArthur.
 * King Henry IV of England (reigned 1399 to 1413) possibly had leprosy.
 * Vietnamese poet Hàn Mặc Tử
 * Ōtani Yoshitsugu, a Japanese daimyō (feudal lord).
 * British writer Peter Greave (1910-1977).

Leprosy in media

 * — the short story collection Life's Handicap by Rudyard Kipling has a story "The Mark of the Beast" in which a traveller on horseback literally stumbles into a leper colony in India.
 * — Jack London published "Koolau the Leper" in his Tales of Hawai'i about Molokai and people consigned to it circa 1893.
 * — James Michener's novel Hawaii dramatizes the island of Molokai's leper settlement, including Father Damien.
 * — Ben-Hur depicts the title character's mother, Miriam, and younger sister, Tirzah, are imprisoned by the Roman empire. When they are freed years later, they have leprosy and leave town for the Valley of the Lepers, rather than stay and reunite with Ben-Hur. They leave the colony, and when Jesus dies on the cross, they are miraculously cured.
 * — English author Graham Greene's novel A Burnt-Out Case is set in a leper colony in Belgian Congo. The story is also predominantly about a disillusioned architect working with a doctor on devising new cure and amenities for mutilated victims of lepers; the title, too, refers to the condition of mutilation and disfigurement in the disease.
 * — Forugh Farrokhzad made a 22-minute documentary about a leprosy colony in Iran titled The House Is Black. The film humanizes the people affected and opens by saying that "there is no shortage of ugliness in the world, but by closing our eyes on ugliness, we will intensify it."
 * — The Roald Dahl short story The Visitor in the My Uncle Oswald series has a character with leprosy.
 * — The lead character in The Chronicles of Thomas Covenant by Stephen R. Donaldson suffers from leprosy. His condition seems to be cured by the magic of the fantasy land he finds himself in, but he resists believing in its reality, for example, by continuing to perform a regular visual surveillance of extremities as a safety check. Donaldson gained experience with the disease as a young man in India, where his father worked in a missionary for people with leprosy.
 * — Death metal band Death has an album titled Leprosy.
 * — "Weird Al" Yankovic has a song titled "Party at the Leper Colony" on his album Poodle Hat.
 * — In Kingdom of Heaven (film) directed by Ridley Scott and written by William Monahan, Baldwin IV of Jerusalem, played by Edward Norton, is portrayed by wearing a mask to conceal his leprosy. There is no historical account that Baldwin wore a mask to hide his leprosy.
 * — In Monk (TV Series) Season 5, Episode 10, "Mr. Monk and the Leper" directed by Randy Zisk, a person with leprosy asks private investigator Adrian Monk (played by Tony Shalhoub) to act on his behalf at a probate hearing, but proves to be using the outward trappings of chronic illness to conceal a deadly secret agenda.
 * — Moloka'i is a novel by Alan Brennert about a leper colony in Hawaii. This novel follows the story of a seven-year-old girl taken from her family and put on Molokai's leper settlement.
 * — Squint: My Journey with Leprosy is a memoir by Jose P. Ramirez.
 * — In the video game Darkest Dungeon by Red Hook Studios, a hero character known as the Leper suffers from this disease. He was once a benevolent king who embraced the sick and downtrodden, but abdicated his throne following an assassination attempt after he was infected to wander the world and marvel at its beauty.
 * — The Second Life of Mirielle West, a novel by Amanda Skenandore, is set in Carville.
 * — The Wind & the Reckoning is a movie about Pi'ilani, whose husband, Ko'olau, and son, Kalei, contracted Hansen's disease. The family fought those who sought to capture and kill Hawaiians afflicted with Hansen's disease.
 * — In House of the Dragon, the TV adaptation of George R. R. Martin's Fire and Blood, King Viserys I Targaryen suffers from a debilitating disease where parts of his body develop lesions and slowly rot away over time. Paddy Considine, the actor playing the role, explained on a podcast with Entertainment Weekly that Viserys suffers from "a form of leprosy". Leprosy is not mentioned in the novel, where Viserys instead suffers from various health issues relating to his obesity, including infections and gout.
 * — The Covenant of Water, a family saga novel by Abraham Verghese.

Infection of animals
Wild nine-banded armadillos (Dasypus novemcinctus) in south central United States often carry Mycobacterium leprae. This is believed to be because armadillos have a low body temperature. Leprosy lesions appear mainly in cooler body regions such as the skin and mucous membranes of the upper respiratory tract. Because of armadillos' armor, skin lesions are hard to see. Abrasions around the eyes, nose and feet are the most common signs. Infected armadillos make up a large reservoir of M. leprae and may be a source of infection for some humans in the United States or other locations in the armadillos' home range. In armadillo leprosy, lesions do not persist at the site of entry in animals, M. leprae multiply in macrophages at the site of inoculation and lymph nodes.

An outbreak in chimpanzees in West Africa is showing that the bacteria can infect another species and also possibly have additional rodent hosts.

Studies have demonstrated that the disease is endemic in the UK red Eurasian squirrel population, with Mycobacterium leprae and Mycobacterium lepromatosis appearing in different populations. The Mycobacteria leprae strain discovered on Brownsea Island is equated to one thought to have died out in the human population in mediaeval times. Despite this, and speculation regarding past transmission through trade in squirrel furs, there does not seem to be a high risk of squirrel to human transmission from the wild population. Although Leprosy continues to be diagnosed in immigrants to the UK, the last known human case of leprosy arising in the UK was recorded over 200 years ago.

It has been shown that leprosy can reprogram cells in mouse and armadillo  models, similar to how induced pluripotent stem cells are generated by the transcription factors Myc, Oct3/4, Sox2, and Klf4.

title: Leprosy