Leprosy (leprosy) is an infectious disease that affects the peripheral nervous system of a person and his skin. The disease is known as one of the oldest diseases. It can be found in the Old Testament. At that time, those with leprosy were considered unclean. They were shunned by healthy people, they were persecuted, deprived of the right to a normal life. The peak incidence of leprosy occurred in the twelfth and fourteenth centuries, when the infection affected the population of almost all European countries.

It is customary to associate many well-known names with leprosy. suffered from this disease the last king of the Crusader Kingdom of Jerusalem. Famous revolutionary Ernesto Che Guevara He began his career as a doctor in a leper colony (the so-called medical institutions where patients with leprosy are kept).

Who is afraid of leprosy

At present, almost everything is known about leprosy. With leprosy, the infection is not able to pass in the case of a simple touch from a sick person to a healthy one. Not always leprosy leads to death. And in general, no more than five or seven percent of people can catch leprosy. The rest of the inhabitants of the Earth have a very strong immunological defense against the pathogen. regarding the mode of transmission. In most cases, prolonged skin-to-skin contact is needed to become infected. There is a theory that the symptoms of leprosy are capable of appear ten years after the defeat. The human body can penetrate bacteria, that are excreted from the nasal cavity or from the mouth of a sick person. Actually, only this assumption can explain the fact that at present there are approximately eleven million people in the world with leprosy, and most of them have not had skin contacts with infected people.

What causes leprosy

The appearance of leprosy associated with the appearance of rod-shaped microorganisms discovered by G. Hansen in 1874. These microorganisms are endowed with properties close to those of tuberculosis. The difference is that leprosy microbes cannot multiply in nutrient media and quite often do not show themselves for many years.

The incubation period of the disease delayed for 15-20 years, due to characteristic features leprosy. Leprosy microorganisms by themselves are not capable of causing tissue necrosis. This means that the vital activity of microorganisms must be activated by some external factors, for example, malnutrition, secondary bacterial infection, poor living conditions or polluted water.

What forms of leprosy exist

Different forms:

• lepromatous, in which the pathogen has to act mainly on the skin;
• tuberculoid, in which the disease, for the most part, is able to affect the peripheral nervous system;
• border- with a tendency to develop into one of the two key types of the disease.

For several centuries, against leprosy preferred use chaulmug oil, but in modern medicine it is customary to treat leprosy sulfonic drugs, which are able to stop the development of infection and have a general strengthening effect on the entire body. In the case of a lepromatous type of infection, it is customary to use clofamysin.

In case of mild forms of the disease, leprosy goes away in two or three years. For severe leprosy treatment is delayed for 7 or 8 years.

Little country

We drive for a long time on a high-altitude snow-covered road. For kilometers around - not a single dwelling. The Terek leper colony is lost in the mountains of the Stavropol Territory. It was created one hundred and seven years ago by a local priest, among whose parishioners there were many lepers. Since then, it has grown into a whole village with its own customs and traditions.

The leprosarium is divided into three parts - residential buildings, hospital and administrative courtyards. It was about him that the famous book by Georgy Shilin "Lepers" was written, over which our grandmothers still cried. Contrary to the ordinance prohibiting contact between healthy people and infected people, the author lived here at the beginning of the last century. Little has changed over the century: only new, modern buildings with gas and sewerage have grown, and two monuments to Lenin and two to employees of the leper colony who have not returned from the war have appeared.

In total, there are 32 houses in the village - five-story buildings and hospital buildings. Here is your Kindergarten attended by thirty children. There used to be a school, but then it was closed. Now village children are taken to study in the nearest city - Georgievsk. The teachers there do not have leprophobia - they are used to it. Yes, and kids are not dangerous - now in the village under forty years old no one gets leprosy.

The village also has its own psychiatric hospital, where six patients are kept. There are bars on the windows, the door is locked. For the whole Soviet Union the psychiatric department for "pranksters" was only here, and everyone was brought here. After the collapse of the CIS countries, they demanded: "Give back our patients." They gave it away, only specialists of this profile remained only here.

Today, about a thousand people live in the Tersk leper colony. Of these, only one hundred and twenty suffer from leprosy. The rest are doctors, attendants and just people who have nowhere else to live. Some of them have spent their whole lives here and have no idea what is beyond the border of the village.

We are from local

The head physician of the leper colony, Mikhail Gridasov, is both the head of the administration and, in fact, the "president" of this small country.

We have our own ambulance, - he says, - fire and gas service, it remains only to put up four towers, raise the flag, come up with an anthem - and the state is ready. (By the way, in "Lepers" one of the patients also voiced the idea of ​​​​creating a state of leprosy patients. After some hundred years, his idea was practically realized.)

I ask the director how he got here, how he dared to lose a full life by isolating himself in a leper village.

Yes, I myself am from the locals, I was born here and grew up, - Mikhail Ivanovich admits smiling.

You... your parents... were ill with leprosy, I finally dare to ask what I'm thinking about.

No, - the head physician is not offended by the question, - my parents settled here after the war, in 1947, my father was offered a job. To be honest, when I studied at the Kharkov Medical Institute, I carefully concealed from my fellow students that I grew up and lived on the territory of a leper colony. Having married, I wanted to settle in Georgievsk, but they gave me housing here, and I stayed.

Together with patients - even after death

Together with Mikhail Ivanovich, we descend to the hospital yard, located below the main part of the village. The air here is so clean that it makes you feel dizzy. Accompanying us is 60-year-old Stepanida (the names and surnames of the patients have been changed for ethical reasons). You can't tell from her that she's a leper. A blooming motor granny in galoshes on her bare feet and an open coat talks aloud about what nasty men have become and now there is no one to find for the soul, so you have to treat "bitter" sadness. “But honestly, I quit,” she crosses herself, looking faithfully at the head physician.

Stepanida is a chronic alcoholic. Under all sorts of pretexts, they are already trying not to give her a pension in cash, because she drinks everything down to the penny, and immediately exchanges it for groceries at a local store.

There is no clear boundary between the administrative and hospital yard, as well as the line separating the healthy and the sick here. We pass the building of a modern cinema. The cemetery is left behind. For one hundred and seven years it has grown greatly, both the healthy and the sick were buried there.

Our doctors, even after death, are not separated from their patients, - the head physician jokes sadly. - Each of them should be given a monument for devoting their lives to these people, not being afraid of the black aura surrounding leprosy. Everyone with whom they have to communicate outside the village, having heard about the leper colony, immediately runs in a panic to wash their hands. Only representatives of medical dynasties work here: they replaced their parents, grandparents at the post. Here the head nurse Maria Ivanovna has worked for 46 years. There are four generations of doctors in the family of nurse Galina: her grandmother, mother, Galina herself, and now her daughter has returned home after her studies. All my life - with the same patients, but come on, try to endure all their claims and whims! By the way, we have the highest life expectancy of leprosy patients in Russia.

armless artist

The first buildings of the leper colony have long been dilapidated and now serve for household needs. Six buildings of modern hospital buildings have grown nearby.

Hospital rooms are more like dorm rooms or regular apartments. People here live (more precisely, live) for years, therefore, as they can, they arrange their life. Each room has a TV, carpets, portraits and icons on the walls, neat curtains, cabinets decorated with porcelain figurines.

Everywhere in the corridors hang huge, beautifully painted oil paintings. They were created by a local artist. He painted with brushes tied to the stumps of his hands. If not for the disease, he would have received an education worthy of his talent, perhaps he would have become famous artist. But now his works, completed shortly before his death, are known only in the leper colony, and the main connoisseurs of his genius are those with leprosy.

He is not alone, all here are people who have failed in society. They did not have time to discover and apply their talents. Those who came here at a more advanced age have memories: one was once a virtuoso pilot, the other was a journalist. Somehow a Negro was treated - a well-known radio host.

Forsworn brand

The clinical symptoms of leprosy (translated from Spanish as leprosy) are described in the Bible. Nevertheless, the most ancient disease is still one of the most poorly understood. It is said that leprosy is retribution for the sins of the ancestors. Scientists have also established that the Genza wand, the spreader of the disease, is transmitted by airborne droplets during prolonged contact, but only if a person has a genetic predisposition to this disease. That is, if one of his relatives suffered from it.

The first signs are a loss of tissue sensitivity, a person can scald with boiling water without feeling pain. Then skin manifestations, trophic ulcers, "lion's face", loss of limbs and blindness. A person, as it were, dies in parts, rots alive.

Since the dawn of mankind, lepers have been persecuted. Herodotus wrote about this in the fifth century BC. They were brutally killed or, provided with rattles and bells, they were escorted out of the camp of the living to certain death.

Even in Soviet times, treatment in leper colonies was more like a lifelong isolation of patients from society. And in our days, this disease is accompanied by an ancient, genetic fear that is difficult to overcome.

Previously, there were fourteen leper colonies in Russia, now there are only four - the rest were closed as unnecessary. Half of them are located in the Southern Federal District.

When you communicate with leprosy patients, a mixed feeling arises: curious, pitiful, and scary. Many of them could live outside the Terek leprosarium, but the disease does not just let them "free". They are feared, everyone has a negative experience of a free life behind them, associated with bullying and curses. They are hiding here not from illness, but from ordinary people.

They are not forbidden to have children, no contraceptive measures (as is practiced in relation to mental patients) are applied to them. In the vast majority of cases, children are born healthy. Previously, they were forcibly separated from their parents and sent to a special orphanage.

Husband left for another

Most of the inhabitants of the leprosarium create families among themselves, having become widows, they converge on a new one. Korean Boris once infected his wife, which did not prevent them from making nine children. He now has fourteen grandchildren. He buried his wife, now he lives in a leper colony with another woman, a widow. They do not consider it necessary to sign, they simply while away their old age.

Margarita Mikhailovna is under 70 years old. Like most patients, she has no eyebrows and eyelashes, a "lion's" mask froze on her face, part of the fingers on her hands turned into stumps.

Nevertheless, she knits herself warm clothes, wove pretty rugs, embroidered pillows in a way that a healthy person could not.

Her whole life is a complete tragedy. When whitish spots began to appear on the body of a young girl, she was sure that these were the consequences of terrible pictures of the war: in front of the girl, the Nazis killed people. They tried to treat her for malaria and syphilis for a long time. When they found out what kind of illness it was, a family tragedy also became known: at the age of two, Rita was taken to be raised from an orphanage. The real mother of the girl turned out to be leprosy, she died immediately after the war.

For ten years Rita lived in a leper colony, she was treated and discharged. But life outside the leprosarium did not work out: it was impossible to find a job, "kind-hearted" neighbors tried to burn her apartment, filled it with disinfectant. And it also happened - the driver stopped the bus in which Margarita was traveling and declared: “Everyone, you’ve arrived, get out,” and put her out without listening to complaints.

So Margarita Mikhailovna returned to live in the leper colony. She got married here for the second time. But then the husband went to another, also leprosy. It’s unpleasant to see them every day, but I also don’t want to return to the city: she is haunted by the constant fear that someone will see her legs, eaten up to her knees by leprosy, prostheses instead of feet.

"Why are we hated and feared?" she asks me. rhetorical question. “After all, our disease is not from drunkenness or drug addiction, not from fornication.”

Only deputies are not afraid of them - lepers are the same electorate. Local politicians are happy to come to campaign.

old-timers

Baba Marusya has been here the longest. She is 82 years old, of which 65 she has lived here since 1939. The leprosy did not spare her grandmother: she was blind for a long time, four decades ago, her nose was depressed, monstrous scabs disfigured her whole body. But she does not lose heart: she serves herself, erases and cleans.

Alla, who lives in the next room, also recently buried her husband, but she is doing well. She is neatly touched up, uses face creams. The woman is happy to be photographed, coquettishly hiding her hands, on which the leprosy has left its mark. It is immediately obvious: this person is an optimist and no life troubles can lead him into a stupor.

At the age of eight, Alla scalded her legs without feeling pain. Her mother also had leprosy, so the diagnosis was obvious. Alla ended up in a leper colony, within whose walls she grew up. She left for the first time with her husband already in adulthood - to visit her son, who lived in an orphanage in Labinsk.

The son grew up and from the only light in the window turned into a constant nightmare for his parents. If he came, it was to collect his pension, and during his last visit he stole money. Alla's husband quarreled with his son and slapped him for the first time, and after that he fell ill and soon died. The son did not even come to the funeral, he disappeared altogether. Alla worries about the unlucky child (who, however, is already under forty years old), misses, at the same time, she cannot forgive him for the theft that caused her husband's death.

She gave birth on her own head, she sighs. Nobody needs me now. - A friendly smile on her face is suddenly replaced by a grimace of suffering, tears flow from under glasses with large optical lenses. “And no one needs us ourselves, we don’t live here, but live out, we suffer ourselves and torture others ...

I am shocked silent, and the nurse quickly takes me out of the room.

Are we in danger of leprosy?

At present, leprosy has entered the category of exotic diseases - syphilis, AIDS, and tuberculosis are much more dangerous. Nevertheless, today in the world, according to various sources, from 3 to 15 million people suffer from this disease.

Recently, residents of other states entering our country for permanent residence have been tested for leprosy. And this is right, the employees of the leprosarium believe, it cannot be let out of control: "If you release the leprosy, bells will appear again."

According to the observations of leprologists, its distribution is greatly influenced by the socio-economic factor. Through the incubation period - an average of 10 - 15 years - after the wars, various cataclysms across the country, there was an increase in the incidence of leprosy. In such traditionally unfavorable areas as the Volga and Astrakhan, new cases of leprosy are noted annually. This year, after a long break, leprosy has been registered in central Russia.

In the Rostov region, last time a terrible disease manifested itself twelve years ago. However, no one can guarantee that tomorrow there will be no new outbreak of leprosy caused by the economic upheavals of the early 1990s. As even leprologists say: "The leprosy was born with humanity and will also die with it."

Probably, no one needs to explain who a leper or a leper is. These are people with leprosy, a severe infectious chronic disease, which affects the skin, nervous system, eyes and some internal organs. This word came to Russian from late Latin, where it sounds like leprosus, which is consonant with the Latin leprosorium.

In medical terms, a leper or leper is a patient who has chronic granulomatosis caused by the microbacteria Mycobacterium lepromatosis and Mycobacterium leprae.

History of leprosy

The named disease has been known since ancient times and is mentioned in the Bible. Hippocrates wrote about leprosy, but he probably confused it with psoriasis. IN ancient india also knew about leprosy. And in a lot of leper colonies appeared, as the disease passed into the stage of an epidemic. So, in the XIII century, according to Matthew of Paris, an English historian, Benedictine, chronicler, in Europe the number of lepers was 19 thousand people. The first well-known leper colony was Saint Nicholas in Harbledown, England.

In the Middle Ages, a leper or a leper is a society doomed to death in terrible agony. Such a person was placed in a leper colony, as if to be cured. But in fact, it was a quarantine, from which few people managed to get out alive. The fact is that leprosy is transmitted through discharge from the mouth and nose during frequent and close contact with people. And in the leprosarium, contacts are more than close and frequent.

Leprosy in the modern world

In the 90s of the last century, the number of lepers in the world decreased from 10-12 million people to 1.8 million. Leprosy mainly spreads in tropical countries, where nature has created suitable conditions for the life of microbacteria. And although the incidence of the disease has decreased, this disease is still quite widespread in India, Nepal, parts of Brazil, Tanzania, Mozambique, Madagascar and the west. Pacific Ocean. The World Health Organization in 2000 published a list of countries with outbreaks of the disease. Burma ranks third in terms of the number of infected, Brazil is second, and India is first.

It is important to know that the incubation period for leprosy is very long, on average 4-6 years, and sometimes it drags on for 10-15 years. The duration of drug therapy, depending on the degree and severity of the disease, can last from 3 to 10 years.

Book "Lepers"

People suffering from this disease also became heroes of literary works. So, in 1959, Georgy Shilin's novel "Lepers" was republished. The book describes the life of a leper colony. It should be said that the author himself repeatedly visited this institution, visiting a sick friend there, and even lived there.

"Lepers" is a story about the fate of various people who ended up in one place - in a leper colony. Each story touches and shakes to the core. There are a lot of heroes, but the character of each is unique - it's hard to get confused in them. Thus, the head doctor of the leper colony, Dr. Turkeev, belongs to a rare type of people who are not interested in either fame or money, and who give their all to serving their chosen cause. Free of charge (unfortunately, a now forgotten word). Shilin's style is beautiful, emotional, bright, expressive.

In Poland, in 1976, the film "The Leper" was filmed. This is a love story of a simple girl and a noble nobleman who will not leave anyone indifferent.

Finally, we note that lepers, whose photos can be found in sufficient quantities on the Internet, are affected by this disease to varying degrees, and sometimes it is not clear from a person that he is sick. Therefore, be careful to avoid close contact with people who are suspicious, especially if you are on vacation in tropical countries. Be healthy!

Jewish spiritual teachers say: "Leprosy (tsaraat) — disease of the soul. An evil tongue, gossip, a desire to harm people lead to leprosy ... The only cure for leprosy at all times was repentance, and the treatment was very long. Retribution always came quickly - in the form of isolation from society and shame, because everyone who saw a leper understood that this person had sinned " (http://www.evrey.com/sitep/nedglav/ar...)

The topic brought to the attention of the reader is not new. But it has no statute of limitations, so it can and should be repeated, repeated, repeated ... so that millions of people understand what kind of world we live in.

Gundarov: leprosy has gone through the political elite...

The name of Doctor of Medical Sciences Professor Gundarov thundered eight years ago, when the head of the laboratory of the State Research Center for Preventive Medicine of the Ministry of Health of Russia diagnosed President of Ukraine Viktor Yushchenko.

He explained: an incomprehensible "crust" of pockmarks and acne, disfiguring the politician's face, is a medieval leprosy disease. Leprosy, from which, without treatment, amputation of arms and legs occurs, and the face changes beyond recognition. Lepers were hung with bells around their necks and driven out of the cities, later they were locked up in leper colonies for life...

The scandal was forgotten until February of this year, when Yulia Tymoshenko was taken to the revolutionary Maidan. The bright beauty disappeared: a woman with a swollen face was sitting in a wheelchair, on which familiar features were almost invisible ...

The audience shuddered, a joke began to circulate on the Internet: “Yulia Tymoshenko on the Maidan was played by actor Sergei Bezrukov”, - and then Dr. Gundarov came on the stage again. And said: "I warned you".

Igor Alekseevich, are you sure about the diagnosis? How can you say such things?

I'm one hundred percent sure. With Yushchenko - one hundred, and with Tymoshenko - ninety-eight: there, after all, one can assume some kind of blood problems ... I will say this. I've been a professor twice, it doesn't happen that often. If, after publication, colleagues respond and prove that I am wrong, I will tear both my diplomas in front of everyone.

From the medical history: "on the night of September 5-6, 2004, presidential candidate Viktor Yushchenko is having dinner at the dacha of his friend, deputy chairman of the SBU. In the morning, the politician begins to complain of severe headaches, he vomits, neuropathologists are invited to the patient. On September 7, Yushchenko's eyes swell. September 8 journalists arrive: they celebrate unnaturally pink color the candidate's face and indistinct diction, Yushchenko himself complains of severe back pain, on the 9th, facial paralysis is added to this. The patient is urgently sent to Vienna, to a private clinic, where doctors discover a total lesion of the gastrointestinal tract: multiple ulcers, acute pancreatitis, gastritis, colitis ... The skin begins to change, but the skin is not the main thing: Yushchenko has severe back pain. The nature of the pain is incomprehensible, the patient can no longer walk, cannot get out of bed. Anesthetize with opium substances, as after a major operation, thanks to which the politician is conscious."

Later, cysts and ulcers will cover the whole body, they will fester and hurt, the poor politician will have to change three or four shirts a day so that his jacket does not get wet ...

One can only bow before the courage of Viktor Yushchenko, who in such a state (with a catheter in his back, on drugs) is participating in the election race. And one can only marvel at the short-sightedness of the Ukrainians, who elect a rotting man alive president.

I am familiar with leprosy theoretically and practically: I conducted examinations of patients in the Tersk leper colony for my Ph.D. thesis “Electrocardiographic changes in patients with long-term leprosy”, sometimes I had difficulty figuring out how to take a cardiogram if an arm or leg was missing ... I traveled until my wife knocked fist on the table: “I don’t want to get leprosy in twenty years!” This disease has a long incubation period...

What Yushchenko fell ill with, I immediately assumed. Leprosy is a neuroinfection: it lives in the nerve trunks. The affected nerves thicken, and where they pass through the bone channels, the holes become narrow for them, compression causes severe pain: such that the patient thinks of suicide. Moreover, the leg may hurt, or the arm may - depending on which nerve is damaged. Gastritis, pancreatitis, various paralysis and loss of sensation in leprosy are also classic manifestations, not to mention lepromas on the skin ...

All the doctors who treated Yushchenko noted the atypical course of the disease, could not come up with a common cause for such different symptoms. But once you think about leprosy, everything becomes typical. Like a textbook.

From the medical history: "Lepra is caused by Hansen's mycobacterium and is transmitted by talking. Hundreds of thousands of bacteria swarm around the patient and infect those who come closer than one and a half meters. A person can become infected, but not get sick. Or he can get sick, but in twenty to thirty years, when the fateful meeting already erased from memory. All this time, a healthy carrier and a leprosy patient in the incubation period will be the spreaders of the infection. "

Leprosy has many faces: a person will be treated for a hernia in the spine for five years and not guess that it is leprosy. Or complain about a sick stomach, swallow intestines and cereals - and this will again be leprosy. Leprosy is a great imitator, its symptoms are the symptoms of various diseases. For example, the author of this note has a numb hand, and it may be leprosy. Leprosy is invisible: it is not found in the blood and in half of the cases is not found in the affected tissues. That is, a third of leper colony patients have never had leprosy in their analyzes. Until recently, it seemed that the disease was defeated: now only six hundred people are kept in leper colonies in Russia. Scientists argue whether leprosy is curable: the disease is well stopped by drugs, but a relapse can occur even after decades. Leprosy doesn't kill: it just makes life miserable.

Igor Alekseevich, in fact, Yushchenko was diagnosed with dioxin poisoning.

It's not even worth talking about. This is a well-conceived version for the election campaign, to give the candidate the aura of a martyr. I have a photograph where Viktor Yushchenko, with his face slanted to the right, speaks from the podium of the Rada: “You know who this killer is. The killer is power!" - and according to the photo, paralysis of the left facial nerve is clearly diagnosed, which is typical for leprosy ...

But in order. When information about the poisoning was spread, the Vienna clinic where Yushchenko was treated issued a refutation. The doctors said that the poisoning version is not true! Later, they changed their minds - but the head physician of the clinic did not change. He was fired for refusing to sign the report on Yushchenko's poisoning, sued the clinic over this, and was reinstated.

Further: dioxin appeared in the tests only three months after the onset of the disease, before that the blood tests were clean. It is impossible to establish where he came from, who added the poison and whose blood samples were generally, since Yushchenko categorically refused to do tests at home in the presence of independent experts, even as part of a criminal case. For years he did not appear for interrogations, although he was a victim!

The concentration of dioxin in Yushchenko's blood, even if those controversial analyzes are to be believed, was only three or four Russian norms: it is higher in infants in Chelyabinsk ... Five or six parliamentary and medical commissions in Ukraine came to the conclusion: there is no evidence of poisoning, all this unfounded.

But you are also accused of lack of facts. You make a diagnosis on TV, which is unscientific and unethical.

I make a diagnosis based on video and photography, as well as medical documents. Ethical or not ethical, but due to political publicity, Yushchenko's medical record, his tests and examinations ended up on the Internet. I do not need to examine the patient, excellent professionals did it for me!

You can't be sure of the authenticity of the documents...

I know the deputies of the Verkhovna Rada, who thoroughly checked everything. I can be sure of the testimonies of doctors that they gave in court, I can be sure of the published reports of the commissions ... Besides, sometimes just photographs are enough!

In medicine, there is the concept of "stigma": this is a sign that occurs only with this disease. Only with leprosy does the face change beyond recognition. It inflates, the superciliary arches increase, the nasolabial folds cut sharper, the nose thickens ... In medicine, this is called the "lion mask" - the mask of leprosy patients, which even erases racial differences. Compare the photo of Yushchenko and the portrait of the patient from the textbook: they are almost identical. Only leprosy affects the earlobes: they increase, resembling a plum. Why are surveys here, everything is absolutely clear. I appeal to all doctors: well, colleagues, admit the obvious!

Only leprosy deforms the ear cartilage. Normally, the pattern of the auricle is specific, like fingerprints, hence the mass of assumptions about Yushchenko's double. People compare and write: it's not him!

Only leprosy affects the branch of the facial nerve, which is responsible for the movement of the upper eyelid. The whole nerve - please, but one branch - only trauma and leprosy. I have a photograph: on Yushchenko's left eye - like a thorn. It's because eyeball when blinking, it rolled up, but it’s gone back - the nerve does not work ...

In the case of Yushchenko, I would teach students what tubercular leprosy is. He even has an orange peel on his face, even rashes around his nose in the form of butterfly wings ...

If everything is so obvious, why is no one supporting you? Yushchenko's attending physicians sharply denied this version.

They bluntly refused to discuss it. Yushchenko's attending physician, cosmetic surgeon Olga Bogomolets, said that leprosy has been going on for decades, while Yushchenko, they say, developed the disease in a few days. It's just that she didn't read his outpatient card, but I did. Viktor Yushchenko had been ill for ten years by 2004!

Gastritis, damage to the entire digestive system, dermatitis, the nature of which the doctors could not establish, erysipelas, short-term paralysis. Viktor Yushchenko was the most frequently ill employee of the Ukrainian government! In 2002 - sixty-five visits to the doctor, seven per month! And this is not some hard worker who does not have enough money for good nutrition. It's the prime minister!

Yushchenko's back pain was such that he could not attend a meeting of parliament where the issue of his resignation was discussed: he went to the Institute of Neurosurgery, where the nerve was released from bone compression.

I'll tell you more. Thanks to my diagnosis, Yushchenko was treated.

Is there evidence?

The director of one of our leather institutes received a call from Ukraine, asking him to come and consult Yushchenko. He refused, then he was directly asked: "Could it be leprosy?" - "Yes, it could be leprosy"- and this conversation was just after my speeches.

Another indirect proof: it is known that from the very beginning Yulia Timoshenko told her colleague: "Get plastic surgery, remove that pokemon mask". Doctors in Switzerland tried to operate - and unsuccessfully: the tissues do not heal, they spread, as they are stuffed with mycobacteria, and then I read that Yushchenko had several dozen operations, and I see scars in the photographs instead of bumps, and this is only possible thanks to powerful antileprosy therapy .. .

I'm surprised otherwise. For ten years I have been knocking on all doors: I was at the FSB, at a reception with leading scientists, wrote open letters to Yushchenko, met with the speaker of the Verkhovna Rada, Moroz. No reaction! A serious consultation never gathered and did not even discuss the problem! But in epidemiology, there are clear rules for what to do when a patient with leprosy is found. And most importantly among them: it is necessary to take into dispensary records all those who communicated with a leper...

That's it. And that's why all the colleagues I turn to say: "Don't Climb". I gave materials to many of our leaders from health care, they: “No, I didn’t read, I don’t see!”- because if you read it, this is a 100% diagnosis, then you need to take action!

But it's about public health. Young guys who have been in contact with the affected tubercle leprosy are not taken into the army! The risk of infection is small, only three percent, but this is Russian roulette... And, in the end, there are already victims. Victim...

From the medical history: “Yulia Tymoshenko, who repeatedly hugged and kissed Viktor Yushchenko on the Maidan in 2004, was arrested in August 2011.
And almost immediately she declared that she was ill: bruises the size of a palm appeared all over her body. Yulia Vladimirovna is famous as a woman with peculiar notions of morality, so no one believed in the malaise (later the Ukrainian Iron Lady confirmed her bad temper, saying that she was beaten by the guards). The bruises and bruises were photographed, appearing and disappearing over time."

At the same time, Tymoshenko began to complain of back pain: the prisoner was transferred to the ward and filmed with a hidden camera, although doctors invited from abroad confirmed that Yulia was not a malingerer. A couple of months later, the body of the non-simulant was covered with a rash.

Igor Alekseevich, you said in your first interviews about Yushchenko many years ago: “It’s a pity if the beautiful features of Yulia Tymoshenko, the closest associate of the president, are distorted by a terrible disease ...”

How he croaked! But in fact, the seven years that have passed from “dioxin poisoning” is the standard incubation period for leprosy (lasts from five to thirty years. - Ed.). Arrest - the strongest stress. Yushchenko, after all, also got out of stress, during the elections ... I empathized with Yulia as a human being. The woman screamed: "I'm sick, save me"- and the authorities did not move painfully. She was examined in Kharkov by doctors known to me, I asked: you separate the identity of the politician and the symptoms. There is a rash, check it out!

Further, German doctors from the Charité clinic began to visit Yulia, they found that she had Schmorl's hernia, which eighty percent of older people have, as well as a systemic lesion of the nerve trunks. Most often this happens with three diseases: lues (syphilis), lupus (lupus erythematosus), leprosy ...

They led her to the court by the arms, and there you could see how swollen her face was. It is already different. Then they said: prison, they say, does not paint anyone. But Tymoshenko was not in prison, but in a first-class hospital, in a separate ward, with good nutrition and the best Western doctors...

Now Yulia Vladimirovna looks almost the same as before. She was photographed in a store in Germany: walking with her daughter, light, in a white dress...

This means that the exacerbation has passed and remission has come, or the doctors have begun anti-leprosy treatment. Leprosy is well docked modern drugs. It used to be that in leper colonies everyone was fingerless, legless - and now the problem is to identify the disease. Just think: Yushchenko and Tymoshenko have been destroyed for years in front of their colleagues! European doctors forgot the leprosy clinic, mistakenly attributed this infection to completely defeated ...

Now let's talk about ethics. We have the right to discuss the possible infection of a particular person with a dangerous infectious disease or not. Who has more rights: a person to his secret identity - or society to the safety of people's lives?

Did the US congressmen have the right to know that a Ukrainian was speaking in front of them, whose entire body under the suit was covered with oozing ulcers, presumably leprosy? Yushchenko's attending physician, Bogomolets, writes about this in an enthusiastic feminine way: they say, members of Congress would know how painful it is for the person who stands in front of them on the pulpit. But congressmen who constantly measure sugar - did they subscribe to such a risk? What about their wives and children?

Well, maybe the US knows the truth: Yushchenko's presence of American advisers was never hidden. What about ordinary Ukrainians? There was no president who kissed the people as much as Viktor Yushchenko!
Here we can recall the atypical behavior of patients with diseases rejected by society, such as syphilis, cancer. “Why am I the only one suffering? Why am I punished like this?" - and go, and infect, to share the pain. This mentality is broken...

Yulia Tymoshenko donated blood for ATO fighters in July: it's terrible... A leprous leadership is a leprous country... Or maybe leprosy also affects the brain? And this explains the current explosion of Russophobia in Ukraine?

This is a stretch: no effects of the bacterium on the central nervous system have been described. The point is different. Symptoms characteristic of leprosy began to appear in politicians in other countries. Unexplained bruising and bruising, changes in facial features, back pain, deformity of the ears...

One prominent opposition leader completely disappeared from the screen two years ago, I began to find out: it turns out that he had left-sided facial paralysis, like Yushchenko, he was treated unsuccessfully twice, recovered a year later, but traces remained. Has he ever met the former president of Ukraine?

No, I haven't met.

And who did you meet? With Boris Nemtsov, who visited Maidan in 2004.

Simple logic says that both of them should be tested for leprosy. Here it is important not to go too far, but also not to miss the danger.

Or Hillary Clinton. Obama fired her from the post of US Secretary of State a couple of days after the sudden defeat of the stomach and intestines with dehydration. Dehydration is just uncontrollable diarrhea and vomiting, it is treated with a drip in any rural hospital, and, of course, simple poisoning could not be the reason for the resignation of a second person in the United States. So Hillary was told it was a lifelong illness...

Leprosy went to the elite. Nature decided to punish the political elite. It's a slow but epidemic.

Have you informed suspected patients, those you suspect?

Necessarily. I took an oath as a Soviet doctor and consider it my duty to warn of danger.
But people still think that dysentery, hemorrhoids or leprosy cannot happen to a high-ranking official. As a result, we and all over the world do not have a mechanism for diagnosing top political figures. Remember Yeltsin with his ischemic brain disease: this is not a harmless condition. It is enough to pat such patients on the back, laugh at their joke - and get anything in return, up to the disarmament of the army ...

Therefore, the evidence-based opinion of the expert community is extremely important today. If it publicly confirms: yes, Yushchenko has leprosy, then all the politicians who met with the patient will run to be checked themselves.

And this is our salvation.

FIGURE: According to the World Health Organization, 800,000 new cases of leprosy are diagnosed every year. There are about fourteen million old treated patients who can relapse on earth.

APPENDIX:

"Leprosy is a disease of the soul. An evil tongue, gossip, a desire to harm people leads to leprosy ..."

Article announcement:

"God's Chosen or God's Cursed?!"

Now only heard from different sides: "Holy Land - Israel!" . Praise Israel and Jewish priests in synagogues, and Christian, reading prayers in the temples of Christ. But the ancestral home of the Jews has never been a holy land! On the contrary, it was the land of people cursed by God, whom the healer and prophet Moses once brought out of Ancient Egypt.

A careful study of the Torah and the Bible leads to an unequivocal conclusion: the people who left Egypt under the leadership of Moses suffered from terrible skin diseases. One of them was leprosy. Leprosy (leprosy) in ancient times was considered a disease sent as punishment by God. That's what they called her: "God's Curse". The Jews, brought out by Moses from Ancient Egypt, were sick with it.

Now it is customary to tell a fairy tale about how Moses led his people through the desert for 40 years. And for what purpose he led those unfortunate people through the desert - a mystery shrouded in darkness! Religious figures of Judaism and Christianity, and Islam too, do not want to admit that at the source of all three Abrahamic religions is the feat and hard work of the prophets to save leper villains: to treat their souls, minds and remove God's curse from them!

Today, it is customary to keep silent about why not to someone else, but to the Jews, Moses handed over the first "law of God" - the ten commandments: "Thou shalt not kill!", "Thou shalt not steal!", "Thou shalt not bear false witness!" etc. But, if you think about it, the mind should tell any person the answer to this question.

Moses brought these to the Jews ten Commandments, carved in stone, for centuries (!) that they originally lived robbery, theft, murder of people , and at the same time they also testified falsely against those whom they robbed, robbed or killed ...

When Christ came to the sinful land of the Jews, he tried to continue the work of Moses in the treatment of the mentally and physically sick. Jesus justified his coming to the Jews with the following words:“It is not the healthy who need a doctor, but the sick; I came not to call the righteous, but sinners to repentance.” (Luke 5:31-32).

The uncontrived fact that the ancestors of modern Jews were punished in ancient times with leprosy for their many crimes against God and humanity, explains, for example, why modern Jews have such a "rich" heritage of genetic diseases. What kind of inheritance is this, says an article published on a Jewish website www.sem40.ru

"I am the Lord, your God, a jealous God, for the guilt of the fathers, punishing children to the third and fourth generation"(Deuteronomy 5:9).

"There were also many lepers in Israel under the prophet Elisha, and not one of them was cleansed, except Naaman the Syrian"(Luke 4:27).

Genetics

Many genetic diseases are specific to specific ethnic groups or nationalities.

For example, 25 percent of Jews whose ancestors come from Eastern Europe turn out to be carriers of certain genetic diseases that can be passed on to their children. If one of the partners is a carrier of a genetic disease, then there is a 25 percent chance that the spouses will have a sick child. There is also a 50 percent chance that the child will be a carrier of the defective gene, like the parents, and only a 25 percent chance that he will not inherit it at all.

Fortunately, very accurate methods have been developed to determine whether a fetus has inherited genetic diseases or not. This can be either an amniocentesis, performed at 15-18 weeks of gestation, or a hornal villus analysis, usually performed at 10-12 weeks of gestation.

Jews who are about to become parents will benefit greatly from learning about the genetic diseases that are common among Ashkenazi Jews. These diseases include:

Bloom syndrome. Children suffering from this rare disease are born very small and rarely grow above 1.5 meters. They have red and very sensitive skin on their faces; various pathological disorders; they are more prone to respiratory and ear infections and have a higher risk of getting certain types of cancer. The carrier is about one in 100 Ashkenazi Jews.

Canavan syndrome. This disease usually appears in children between the ages of 2 and 4 months, and they begin to forget previously learned skills. Most children die before the age of 5. The carrier of this disease is one in 40 Ashkenazi Jews.

cystic fibrosis. Cystic fibrosis causes the body to produce thick mucus that accumulates mainly in the lungs and digestive tract, causing chronic lung infections and stunted growth. The carrier is every 25th Ashkenazi Jew.

hereditary dysautonomy. This disorder affects body temperature control, motor coordination, speech, blood pressure, stress responses, swallowing, the ability to produce tears, and digestive juices. Occurs in every 30th Ashkenazi Jew.

Fanconi syndrome - type C. Fanconi syndrome is associated with short stature, bone marrow failure, and a predisposition to leukemia and other cancers. Some children may have hearing problems or mental retardation. The carrier is one in 89 Ashkenazi Jews.

Gaucher syndrome - type 1. Every 1,000 Ashkenazi Jews suffer from this disease. Its symptoms usually appear in adulthood. Patients suffer from pain in the bones and joints, are sensitive to fractures and other pathologies associated with the skeletal system. Subject to anemia, bruising and poor blood clotting. This disease in currently can be effectively treated with enzyme replacement therapy. Every 12th Ashkenazi Jew is a carrier.

Mucolipidosis IV (ML IV). ML IV is one of the recently discovered genetic diseases of the Jews. It is caused by the accumulation of harmful substances throughout the body. Individuals with ML IV suffer from various progressive motor and mental deficiencies beginning at about 1 year of age. Early signs of the disease may include corneal clouding, strabismus, and retinal dystrophy. At the moment, patients with ML IV are known at the age of 1 to 30 years, but so far there is no data on the life expectancy of these patients. The percentage of people who are its carrier is also unknown.

Niemann-Pick disease - type A. Niemann-Pick disease is a neurodegenerative disease in which harmful amounts of fat cells accumulate in various parts of the body. Symptoms include loss of brain function and enlargement of the liver and spleen. Average duration the life of children suffering from this disease is 2-3 years. Every 90th Ashkenazi Jew is a carrier.

Tay-Sachs disease (children's type). Tay-Sachs disease is the most famous Jewish genetic disorder, affecting approximately one in 2,500 newborns. Children with Tay-Sachs disease develop normally until 4-6 months of age, after which their central nervous system begins to degenerate due to a lack of an essential hormone. Affected children lose all motor skills and become blind, deaf and dumb. Death usually occurs at the age of 4 years. Late manifestation of Tay-Sachs disease is less common, then the disease progresses more slowly and the symptoms are less pronounced. The carrier is every 25th Ashkenazi Jew.

Ideally, all parents who wish to have a child should be tested to determine if they are carriers of one of these diseases. In most cases, at least one of the parents will test negative, and their children will be born without these diseases. If the test results of both parents are positive, then they should contact the doctors to look for a solution to this problem.

It may be helpful to consult a rabbi before a difficult decision ahead. Many orthodox communities are pushing for pre-marital testing to cancel the wedding of two carriers of genetic diseases.

Sephardic Jews, whose ancestors come from Spain, Portugal, North Africa and parts of the Mediterranean, also suffer from certain genetic diseases. These include: beta-thalassemia, familial Mediterranean fever, deficiency of glucose-6-phosphate dehydrogenase, and glycogenosis type III.

Although these genetic diseases are usually not as bad as those that Ashkenazi Jews suffer from, they can cause serious health problems and require treatment.

The beta-thalassemia gene is found in one in 30 Mediterraneans, while one in five to seven Jews from North Africa, Iraq, Armenia and Turkey carries the gene for familial Mediterranean fever. The type III glycogenosis gene occurs in 1 in 35 North African Jews and can only be inherited if both parents have it.

Unlike other Sephardic genetic diseases, glucose-6-phosphate dehydrogenase deficiency, the most common enzyme deficiency disease in humans, which affects about 500 million people worldwide, is transmitted from mother to son. There is currently no carrier test.

Translation by G. Charushnikov for

24/12/2012

Moscow epidemiologist Igor Gundarov assures that leprosy is spreading among the heads of state - and if you continue to "ignore the epidemic", then in a few years it will break out of control.

FROM too close to Yushchenko

The epidemiologist believes that Viktor Yushchenko is sick with leprosy (the modern name for leprosy), Yulia Tymoshenko was infected from him. The professor also found signs of illness in Vladimir Putin. Online812 decided to find out if there could be a grain of truth in this.

Incredible at first glance, the version was voiced to the Russian media by the doctor of medicine, Moscow professor Igor Gundarov. He is an epidemiologist by profession and has worked extensively in Asia and Africa, where leprosy is still widespread. According to Gundarov, Vladimir Putin contracted leprosy from former Ukrainian President Viktor Yushchenko, who also infected former Ukrainian Prime Minister Yulia Tymoshenko. The incubation period for this disease is 10 years on average. Therefore, it is not surprising that it began to manifest itself in those infected quite recently.

Professor Gundarov has been talking about the fact that Yushchenko has leprosy for a long time. He considers the official version of dioxin poisoning to be ridiculous, deliberately fabricated by the US State Department for political purposes. According to Gundarov, Yushchenko literally has all the signs of lepromatous (the most severe and contagious) form of leprosy on his face. Gundarov saw the same symptoms first in Yulia Timoshenko, and now in the President of Russia.

Firstly, these are cyanotic (sometimes, on the contrary, whitish) spots on the face and body. They appear in the initial stage of the disease.

Secondly, pastosity (pale puffiness, puffiness) of the face and eyelids. (The Internet, which found these symptoms in Vladimir Putin, attributed them to the effects of cosmetic surgery).

Thirdly - a symptom inherent only in leprosy - deformation of the cartilage of the auricle. Some believe that Putin's "before" and "after" ears look different.

Fourth, vague back pain. Yulia Timoshenko also complained about them, and the fact that the Russian president suffered from the fact that he “pulled his back” is almost officially recognized.

According to Gundarov, Yushchenko's disease was not immediately recognized, it was launched, which is why it acquired such an ugly and noticeable form. The doctors of the other VIPs caught on in time, and the condition of the patients improved on anti-leprosy drugs. The professor believes that if we continue to “ignore the epidemic”, then in a few years leprosy will break out of control and a world panic will arise.

Monkey of all diseases

For comments, Online812 turned to the director of the only FGBU "Research Institute for the Study of Leprosy" in Russia, located in Astrakhan, Viktor Duiko.

According to him, the problem of leprosy is very relevant today, and the complete victory over the disease is still far away. Every year, up to half a million (!) New cases are registered in the world. The most disadvantaged countries for leprosy are India, China, Vietnam, Brazil, Sri Lanka. In Western Europe, about five thousand patients are registered, in Russia - about 400 people.

We are the leading institution for leprosy, there are four leper colonies in Russia in total. The country is divided into four zones, and assistance to the sick is provided according to the zonal principle. We supervise the Astrakhan and Volgograd regions. The Astrakhan region gives about 50% of all registered patients, so here in 1948 an institute was organized on the basis of a leper colony. Further, the main foci are the North Caucasus, the Stavropol Territory - there is the Terek leper colony. Another one is located in the Krasnodar Territory, and near Moscow - the Zagorsk antileprosy clinic. She oversees the North-West, the central part of Russia, Siberia and the Far East. We have more and more cases of imported leprosy. It is distributed, for example, by students from Asia and the African continent. Abroad - migrants from countries where leprosy is an endemic disease, - explains Viktor Duiko.

The doctor does not directly deny that Viktor Yushchenko could have contracted leprosy.
- At first glance, this is so. And they even called us, tried to give it a political color. But, firstly, a self-respecting doctor should not make a diagnosis on TV. Secondly, despite the fact that we live in the 21st century, leprophobia still exists. This disease is feared. And therefore, in order to make such a diagnosis for a person, it is necessary to conduct a complex of examinations very accurately. Only with all positive tests plus clinical picture leprosy can be diagnosed. Yushchenko's disease is a little like her, but there are a lot of chronic ones similar to her skin diseases. However, leprosy can imitate other diseases, for which it is called the "monkey of all diseases." This is her deceit, - says the director of the leper colony.

According to him, the first symptoms of leprosy are the appearance of spots on the skin. If it is not recognized at this stage, the process will progress. There will be rashes, impaired sensitivity, swelling. Pain can appear anywhere, as leprosy sticks develop and multiply in cells nervous system. The main route of infection transmission is airborne.

To get sick, you need contact with the sick and some kind of hole in the immune system. Leprosy is an immunodeficiency disease. But it is less dangerous and a hundred times less contagious than, for example, tuberculosis. Tuberculosis is much easier to catch than leprosy, says the doctor.
The disease is chronic infectious diseases. It can be cured, but only in the early stages.

The so-called tuberculoid type of leprosy - when only spots appear - is completely cured. And even the patient is treated on an outpatient basis, he does not need to be hospitalized. The lepromatous type and advanced cases are difficult to treat and, for almost their entire lives, patients must take maintenance doses of drugs. They live in anti-leprosy institutions and are fully supported by the state. There good conditions, increased nutrition. Today, these institutions are close not to some kind of reservation, but to sanatoriums. There is no strict isolation of patients there, - says Viktor Duiko.
Without leper colonies in Russia, according to him, it is not enough yet.

Leprosy in St. Petersburg

On the last Sunday of January, the world celebrates World Leprosy Day. Since 1948, it has been officially called leprosy or Hansen's disease, recognizing that the word "leprosy" (available, by the way, in all languages) humiliates patients.

Petersburg doctors and epidemiologists admit that the danger of leprosy is underestimated.
- Well, of course we met with her in St. Petersburg! The last case was registered about five years ago, and there were several more patients who had it in the past and were observed by us, - says Olga Gaivoronskaya, head of the organizational and methodological department of the St. Petersburg city KVD.

According to her, the patient was a Petersburger who often traveled to India for work. Unfortunately, he was diagnosed with leprosy late. The disease has gone far. The man was sent to the Astrakhan leper colony. An employee of the First Medical Institute suspected a rare diagnosis, and only then the patient began to be specifically examined for leprosy.

It took him a long time to be diagnosed. We thought about something else. Many diseases in the initial stage can have the same clinical manifestations. They simply didn’t remember about leprosy, says Olga Gaivoronskaya. - We forget about this disease. And we lose our focus. Therefore, later forms are revealed, and not the initial ones. In principle, it is not difficult to diagnose it. Usually we take a scraping from the nasal mucosa. If this is not enough, we do some research. The main thing is that there are specialists who can carry out the analysis. Today, those who remember what he looks like, there are not so many left.

Olga Gayvoronskaya refused to comment on the illness of “Yushchenko-Tymoshenko-Putin”.
“We don't have such official information that Yushchenko had leprosy,” she said.

Epidemiologist at the Clinical Infectious Diseases Hospital named after Botkin, Oleg Parkov told Online812 that he “heard about Putin and Yushchenko,” but also declined to comment.
- I will leave this without comment, because I do not have exact data.

Is such an infection possible at all?
- In general, it is possible to get infected, leprosy is quite a contagious disease. But "it was" or "it wasn't", I don't know. Moreover, we are talking about the first persons. Well, how can you comment on this!

According to Oleg Parkov, he has never encountered a leprosy in his entire 30-year practice.

Numbers

Of the 228,000 reported cases of leprosy in 2010, 126,000 (about 55%) were in India. This country ranks first in the number of cases. In 2011, the world started talking about the leprosy epidemic in India.

In Russia, the maximum number of cases - more than 2,500 people - was registered in the early 1960s. In 2007 there were about 600 of them. In 2012 - about 400

Saved from lazy death by the Inquisition

Leprosy has many names: Hansen's disease, hansenosis, leprosy, Phoenician disease, mournful disease, krymka, lazy death, St. Lazarus' disease. This is the oldest of known to man infectious diseases.

Leprosy has been mentioned in Indian and Egyptian mythology since the 15th century BC. e. There are many stories about her in the Bible. It is believed that the first leper colony appeared in Europe in 570. TO XIII century there were already 19 thousand of them. For the leper and his relatives, special rules were officially legalized. As soon as the disease was discovered, the person was taken to a religious tribunal, which "condemned him to death." That is, the patient was taken to the church, they put him in a coffin, served a funeral service, took him to the cemetery, lowered him into the grave and threw several shovels of earth on him with the words: “You are not alive, you are dead for all of us.” Then he was pulled out and taken to the leper colony. For everyone, he was considered dead. It was allowed to leave the leper colony only in special clothes - a gray cloak with a hood and a bell around the neck.

Some researchers believe that the Inquisition helped curb leprosy in Europe. The main sign of the witch was considered the "seal of the devil" - a special spot on the skin, insensitive to pain. This is one of the leading symptoms of leprosy.

The causative agent of leprosy was discovered in 1873 by the Norwegian scientist Gerhard Hansen. It is a small bacterium in the form of a straight or slightly curved rod.

Outside the human body, it can last up to seven days. The incubation period of the disease can be up to 20 years. It begins asymptomatically. Over time, a person's eyebrows fall out, the face is disfigured. Due to damage to the nervous system, sensitivity is lost. There are cases when the fingers and ears fell off in patients, the nose fell through. And completely pain free.

Until 1941, St. Petersburg-Leningrad had its own leper colony - Steep Streams. In 1893 it was built in the Yamburg district. According to the official version, all patients were evacuated from there before the arrival of German troops. According to unofficial - they shot, either ours, or the Germans.