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105-673: The main character of the stories is Thomas Covenant, an embittered and cynical writer, afflicted with leprosy and shunned by society but fated to become the heroic savior of the Land , an alternate world. In ten novels, published between 1977 and 2013, he struggles against Lord Foul, "the Despiser", who intends to escape the bondage of the physical universe and wreak revenge upon his arch-enemy, "the Creator". The story Gilden-Fire first appeared as an independent novella (illustrated by Peter Goodfellow), but

210-520: A "Gravelingas", or a Rhadhamaerl which also refers to the craft of stone lore. Stonedownors are typically dark-skinned, squat and muscular, though this is not always the case. Trell and Triock are both unusually tall for Stonedownors. During the Second Chronicles, their leaders are known as Gravellers, and sacrifice members of their village to use the blood to call forth the power of the Sunbane. Sunder,

315-689: A Forestal oneself. Hile Troy was willing to pay that price, to save the army under his command from defeat and destruction. The Giants are a race of extremely long-lived (but nevertheless mortal) humanoids of unusual height and strength. Giants are known for their stone lore (similar to but not identical with that of the Stonedownors), their skill at seamanship, their good humour and their love of story-telling. A common Giantish interjection is, "Stone and Sea!" Giants are resistant to cold and cannot be harmed by ordinary fire. Fire does, however, cause them intense pain, which they use to cure themselves of grief in

420-450: 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. 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

525-618: 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 one of

630-508: A concept which appears to do duty for both these beliefs: it is impossible to determine whether the sound used for this is "Worm", "Word" or "Weird", as it comes out in a blurred form sounding something like "Würd". In the Thomas Covenant stories, Donaldson takes several terms from Sanskrit that are significant in Hinduism and Buddhism and reassigns them meanings in the Land. For example,

735-799: 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. 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

840-486: A game he called "Clench Racing", wherein players each open a volume of the Chronicles of Thomas Covenant to a random page; the winner is the first to find the word "clench". Lowe describes it as a "fast" game – "sixty seconds is unusually drawn out". In 1995, scholar W. A. Senior published a full-length study published by Kent State University Press entitled Stephen R. Donaldson's Chronicles of Thomas Covenant: Variations on

945-529: A hardy race of warriors living in the Westron Mountains, west of the Land. The Haruchai shun the use of weapons or magic, taking pride in their own physical prowess and the purity of their service, which is never given lightly. They have the ability to communicate amongst themselves via telepathy, and each can access the combined memories of their entire race. Outwardly stoic, even seemingly emotionless, they could also be considered arrogant in their beliefs. It

1050-495: 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

1155-606: A person who seeks such a mount must travel to the Plains of Ra and offer himself to the horses for consideration. If a Ranyhyn accepts a rider, it is loyal to that rider until death. All of the Bloodguard (apparently) are accepted by the Ranyhyn, but not all Lords have been deemed worthy. The Ranyhyn also have a limited ability to perceive the future; these horses can "hear" when their rider will need them, hearing their calling days or weeks before

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1260-452: A phone call from his ex-wife Joan when he falls and hits his head, waking to find himself back in the Land, in the chamber of the Council of Lords of Revelstone. Angered by the fact that he has been transported away from "reality", Covenant nevertheless believes he is once again experiencing a dream or delusion due to his head injury. His hypothesis is supported by the fact that the Land has seen

1365-711: A proud and gifted race, they were led into self-hatred and despair by the Ravers. They were eventually destroyed by the Council of Lords, under High Lord Loric "Vilesilencer". The Waynhim are another race of creatures spawned by the Demondim that closely resemble the Ur-viles, though smaller and lighter in color. Like the Ur-viles (who are their long-standing nemeses), the Waynhim were made rather than born. However, they do not share their cousins' self-hatred, and have dedicated themselves to serving

1470-622: A remote region of the Earth called Elmesnedene, accessible only by ship via a narrow fjord called "The Raw". Although other people are welcome to visit and even stay in Elmesnedene, time flows quickly there and even the long-lived Giants grow rapidly old and die. In their own perspective the Elohim constitute the animating principle of the Earth and the history of the Land is the manifestation of events in their own consciousness. As they regard their own domain as

1575-485: A ritual known as caamora . In return for a favor performed for the mysterious Elohim long ago, the entire race of Giants are endowed with an innate ability to speak and understand all languages. The Giants' own language is very florid and verbose, and they find human speech to be rather curt and inexpressive. The Giants of the Land are sometimes called the Unhomed since they were separated from their homeland long ago. Although

1680-423: 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

1785-587: A state of pure consciousness. Donaldson has commented on his website that moksha, samadhi, and turiya are ways the Ravers describe themselves, while their other names are given by others. The first volume in the series was included in David Pringle 's book Modern Fantasy: The 100 Best Novels . Conversely, in 1986, David Langford published an essay by Nick Lowe , in which Lowe suggested "a way to derive pleasure from Stephen Donaldson books. (Needless to say, it doesn't involve reading them.)" This proposal involved

1890-437: 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

1995-630: 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

2100-436: 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. Several different approaches for classifying leprosy exist. There are similarities between the classification approaches. Leprosy may also occur with only neural involvement, without skin lesions. Leprosy may cause

2205-452: Is called a Hirebrand, or a lillianrill ( Lillianrill usually refers to the craft of wood lore). They are typically fair-skinned, tall and slender. During the age of the Sunbane, in the absence of permanent trees, woodhelvens became villages of wooden huts. In Donaldson's fiction, Andelain is a focal region of the Land, where the Earthpower is especially strong. In the Second Chronicles it

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2310-536: Is charged with protecting the ancient forests of the Land from the Ravers. Wildwood awakens the forest, totally destroying Foul's army, and personally garrotes Fleshharrower. The victory is a Pyrrhic one, however: the Lords' army is nearly obliterated, three Lords besides Elena have been killed, and Hile Troy has sacrificed himself as the price for the Forestal's aid, becoming Wildwood's immortal apprentice. The war thus ends in

2415-411: 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

2520-471: 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 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

2625-492: Is indistinguishable clinically from M. leprae . M. leprae is an aerobic , rod-shaped, acid-fast bacterium with a waxy cell envelope characteristic of the genus Mycobacterium . M. leprae and M. lepromatosis are obligate intracellular pathogens , and cannot grow or be cultured outside of host tissues. However, they can be grown using research animals such as mice and armadillos . Naturally occurring infection has been reported in nonhuman primates (including

2730-464: Is known as leprology. 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

2835-404: Is manifested by his extremely well orchestrated and even cautious long-term plans throughout the chronicles. The Ramen tend to the needs of the Ranyhyn (see below). The Ramen's life-work is to serve the Ranyhyn, whom they hold in very high esteem. Traditionally they do not ride or otherwise subjugate the great horses, and can grow resentful of those who do. The fact that the Lords of Revelstone and

2940-646: Is never addressed in the books. There are, however, other languages extant: for example, in Lord Foul's Bane , Atiaran tells Thomas Covenant that a different language was spoken in the age of the Old Lords. (However, this appears to be contradicted in Fatal Revenant , when Linden Avery and Berek Halfhand converse together in English.) Non-humans also have their own languages, for example the barking speech of ur-viles and Waynhim,

3045-413: 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

3150-513: Is now most widely available as a part of most versions of the Donaldson short story collection Daughter of Regals (1985). It was set during the action of The Illearth War , and covers an episode from the doomed mission to contact the Giants. Gilden-Fire is told from the point of view of Korik, the senior Bloodguard on the mission. It describes Korik's selection of the mission's Bloodguard, then narrates

3255-591: Is reserved for the trees of the One Forest of old, and their loathing of the Earthpower and all good things has led them to become Lord Foul's willing servants. The Despiser is somehow able to enhance their abilities when he pleases, but can prevent them from possessing individuals he deems too powerful (They were not allowed to possess Thomas Covenant, for instance, because his ring would make them too powerful for Lord Foul to control). This possession can be, and in some cases needs to be, facilitated by some external power. In

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3360-501: Is revealed on several occasions that the Haruchai are a deeply passionate race, capable of swearing a lifetime's worth of service if sufficiently moved. The Insequent are a mysterious race of people who dwell to the west of the Land. Each Insequent has a unique and very focused skill that can seem magical or superhuman. These skills range from invisibility, virtual invulnerability or even time travel. They have an almost dismissive disdain for

3465-413: Is safe and easy to use under field conditions because of it is available in calendar labelled 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

3570-448: Is spread between people, although extensive contact is necessary. Leprosy has a low pathogenicity and 95% of people who contract or who are exposed to 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

3675-627: Is the most commonly used name for the ancient enemy of the Land, given to him by the Council of Lords. He is also called 'The Despiser', the 'Gray Slayer' (his name in The Plains), 'Fangthane the Render' by the Ramen and 'a-Jeroth of the Seven Hells' by The Clave. According to Roger Covenant, he also called himself 'a-Jeroth' during the time he served on Kevin's council. He is described as "the wicked son or brother of

3780-520: Is the one place immune from the Sunbane, as it is protected by the Forestal Caer Caveral. Languages: Human inhabitants of the Land (together with Giants, Cavewights, and the human inhabitants of other regions of the Earth) all appear to speak modern English, though their style of speech is usually rather formal and archaic. The strange commonality of language between Covenant and the Land's inhabitants

3885-531: The Elohim they were created by the One Forest itself using knowledge from another Elohim imprisoned within the Colossus. The Forestals actively protected the remaining forest from destruction by encroaching mortals. They were more numerous in the distant past but few survived into the era of the New Lords. By the time of the Second Chronicles, when the remnants of the ancient forest (with the exception of Giant Woods in

3990-540: 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

4095-472: The "most unlikeable supposedly sympathetic protagonist". In 2013, Tom Shippey , writing in The Wall Street Journal , declared that, "in time "The Chronicles of Thomas Covenant" will be seen as one of the self-defining works of the third millennium, our equivalent in scope and ambition of earlier epics and fantasies, from Virgil's " Aeneid " to Tennyson's " Arthurian Idylls " and Tolkien's " Lord of

4200-512: The 'Illearth War' the Ravers were only able to possess their giant 'hosts' when they worked in harmony with the power of the Illearth Stone. They often serve as leaders in Lord Foul's armies, or as spies among his enemies. Stonedownors are humans descended from the Land's original inhabitants. They are known for their knowledge of stone lore and live in stone huts. A master of stone lore is called

4305-459: 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

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4410-646: 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

4515-675: The Ardent, although both the Vizard and the Auriference are believed to be deceased. The Lords are the leaders and stewards of the Land, also known as Earthfriends. The standards for Lordship are high, so they are generally few in number. In order to become a Lord, a person must master the martial arts and the theory and application of magic. These skills are called the Sword and the Staff respectively, and together form

4620-547: 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

4725-452: The Bloodguard often ride the great horses is a major point of contention, but the Ramen tolerate this in deference to the Ranyhyn, who choose to give their service. When defending the Ranyhyn from Kresh (large wolves in service to the Despiser) or other predators, the Ramen frequently use ropes as garottes to break the attackers' necks. Ramen are organised into three "ranks": Manethralls who are

4830-404: The Creator's heart" and is the source of all evil in the Land. He is a being of pure spirit, although capable of taking on human form, and is apparently immortal: he cannot be killed, but his power can be reduced to near insignificance. On occasions when this has happened he has always been able to restore and regenerate his power. His desire to bring suffering to the earth and the Land in particular

4935-515: The Fantasy of Tradition . It situates the Chronicles in the context of the fantasy tradition and argues that "Donaldson has created an important contribution to the canon because of his serious intent and adult concerns, his powerful mythopoesis , and his manipulation of the conventions of epic fantasy." In 2009, James Nicoll said that Thomas Covenant would win a "special lifetime achievement award" for

5040-511: The First Ward of Kevin's Lore, an ancient repository of knowledge. A student who masters both parts of the Lore – and does not opt to become Unfettered in order to pursue a private vision – is invited to join the Council of Lords at Revelstone, also known as Lord's Keep. The Lords carry special staffs that allow them to channel their power, and are easily identified by their sky blue robes. Lord Foul

5145-582: The Giants love children, they are becoming infertile, and their numbers are dwindling. Kevin Landwaster entrusted them with the first of his Seven Wards before the Ritual of Desecration. They sometimes address (and are addressed by) humans as "Rockbrother" or "Rocksister", in honor of the ancient alliance they made with High Lord Damelon Giantfriend. Saltheart Foamfollower is a Giant. The Griffins are winged lions. They are sometimes ridden by ur-viles. The Haruchai are

5250-561: The Giants' florid and ornate language, and the native tongue of the Haruchai . In the Second Chronicles it is explained that the Giants received "the gift of tongues" from the Elohim as a reward for the telling of a simple tale, and the Bhrathair , a people who live on the edge of the Great Desert, also speak their own language, which is described only as sounding "brackish". Worm/Word/Weird. In

5355-464: The Graveller of Mithil Stonedown, manages to use the power of Loric's Krill to summon forth the power of the Sunbane without shedding blood, and learns to manipulate the Sunbane for his own purposes. Ur-viles are blind yet highly magical creatures of jet black color and are constructs of an extinct race named the Demondim. One of their most distinctive abilities is that when assembled in a wedge formation,

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5460-577: The Haruchai and a bitter and long-standing rivalry with The Elohim , which has not yet been fully explained. They rarely reveal their true names, but prefer to be identified by their titles. So far only four Insequent have appeared in the stories: The Mahdoubt, the Harrow, the Theomach and the Ardent. A fifth, the Vizard, is referenced by several other characters, and a sixth—the Auriference—is mentioned briefly by

5565-643: The Indian doctor Sushruta 's Compendium , originally dating to c. 600 BC but only surviving in emended texts no earlier than the 5th century. Symptoms consistent with leprosy were possibly 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

5670-469: The Land and the Earthpower according to their own peculiar ethical system, the Weird of the Waynhim. Like the Ur-viles, they fight in a wedge formation with a loremaster at the apex. The Woodhelvennin are humans descended from the Land's original inhabitants. They are known for their use of wood lore and living in tree-top villages called "woodhelvens". The village elders are called Heers . A master of wood lore

5775-404: The Lords have lost their strongest and bravest allies in the fight against evil. Nevertheless, the Lords resolve to meet the enemy on the battlefield. Hile Troy is a genius in military tactics who developed a mystical form of sight when hurtloam, a magical mud with miraculous curative properties, was used to try and "heal" his lack of eyes. (The hurtloam used to heal Covenant's head injury also has

5880-659: The Lower Land) were long dead, the last remaining Forestal lived in Andelain. His name was Caer-Caveral, though he was originally Hile Troy, a man from Covenant's world who had once been Warmark (commander-in-chief) of the Lords' army. As described in The Illearth War , a mortal may in a desperate situation ask for the Forestals' help by singing the Forestals' own song ("I am the forest...") - but anyone who does that must pay by becoming

5985-586: 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: 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

6090-713: The Rings "." 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

6195-475: The Staff of Law lost again. Covenant is able to save himself and his Bloodguard by using the power of his white gold ring, again without understanding how. Meanwhile, Hile Troy has been forced into a desperate retreat by the superior force of the Raver's army to the edge of a dangerous, forbidding forest known as Garroting Deep. In desperation, he and Lord Mhoram beg the aid of Caerroil Wildwood, an immortal Forestal who

6300-591: 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

6405-525: The Viles. They had a semi-corporeal nature, and could only achieve physical presence by animating dead bodies. They were not originally wholly evil, but their inherent self-loathing was used by Lord Foul to gain their allegiance. They spawned two other races, the Waynhim and the ur-viles. The Elohim are a "faerie" people with god-like powers. They appear (to mortal perceptions) as beautiful men and women and are capable of dazzling physical transformations. They inhabit

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6510-405: The age of the Sunbane they leave the Land altogether. They are protected by their human servants the Ramen. The Ranyhyn are akin to normal horses, but are larger, always have a star and are in some indefinable sense enhanced by the Earthpower of the Land, so that their speed, endurance and intelligence outstrip those of a standard horse. The Ranyhyn can be ridden by individuals they deem worthy, but

6615-550: 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. In countries where people are frequently infected, a person is considered to have leprosy if they have one of the following two signs: 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

6720-515: 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. 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

6825-566: The cosmology of the Land, the Earth's core consists of a coiled-up serpent called the "Worm of the World's End". When Covenant attempts to sever a branch of the One Tree by using the power of the white gold, he risks rousing the Worm (which is not fully asleep, but merely resting) and thus destroying the Earth. The Waynhim and Ur-viles believe in a principle of ethics or destiny called the "Weird". The Elohim have

6930-452: 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,

7035-444: 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

7140-439: 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

7245-418: The effect of "curing" his leprosy.) While Troy leads the army to confront Fleshharrower's attacking force, Elena and Covenant go in search of the Seventh Ward, a repository of ancient magical power which Elena believes will ensure victory. Covenant, Elena and their two Bloodguard protectors journey through the remote mountain region on the western frontier of the Land to the hiding place of the Ward. Elena gains

7350-401: The evil Lord Foul has assembled a massive army, with which he now threatens the people of The Land. For forty years, the Lords have dedicated themselves to the study of Kevin's Lore, training new students at the school at the tree city of Revelwood. Only Mhorham remains from Lords of the council during the quest for the Staff of Law, but seven new Lords have taken their seats, having mastered both

7455-427: The first leprosy-specific vaccine available. 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. MDT

7560-399: The first species of pathogenic bacteria identified. The Illearth War The Illearth War is a fantasy novel by American writer Stephen R. Donaldson , the second book of the first trilogy of The Chronicles of Thomas Covenant series. It is followed by The Power that Preserves . Several weeks after returning to his world from The Land , the leper Thomas Covenant is taking

7665-415: 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

7770-447: 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

7875-472: 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

7980-493: 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. Not all people who are infected or exposed to M. leprae develop leprosy, and genetic factors are suspected to play

8085-513: 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

8190-487: The humans of the Land). They are described as having "long, scrawny limbs, hands as huge and heavy as shovels," plus "a thin, hunched torso, and a head shaped like a battering ram." Drool Rockworm is a cavewight. The Creator is the mysterious being who created the Land and the universe in which it exists. This universe is referred to as "the Land" but is clearly a different reality than Covenant's world. The fundamental structure of

8295-462: The leader (or loremaster ) at the apex wields the combined power of the entire group, without weakening any of their kin in the rest of the wedge. The ur-viles initially served Lord Foul, but later turned against him by creating the creature Vain (from which the new Staff of Law was created). In The Runes of the Earth , the ur-viles have actively joined the side of "good", though their motivation remains unclear. Because they were made rather than born,

8400-514: The leaders, Cords who assist the Manethralls while training to become Manethralls themselves, and Winhomes who perform domestic supporting duties. Two other ranks are mentioned in The Runes of the Earth , Keepers and Curriers, but their placement within the Ramen hierarchy is not known. The Ranyhyn are the great horses of the Land. In the early books these horses live on the Plains of Ra, though in

8505-524: 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. 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

8610-440: The magical and martial arts. The horse-tending Ramen have been enlisted to patrol the frontier near Foul's dominions. The Warward, the army of Revelstone, is full of battle-ready volunteers and is led by Hile Troy, who came to the Land from Covenant's world. An attempt was even made to attack Lord Foul directly, via a commando raid on his lair at the Land's eastern edge; although the raid, led by Lord Mhoram, failed, valuable knowledge

8715-424: The mission's passage through Grimmerdhore forest, where they defeat an ambush of ur-viles and kresh (wolves). The narrative ends as the mission leaves the forest. According to the author's foreword, Gilden-Fire was originally part of a larger, planned section of The Illearth War that followed the mission to the Giants in "real time", but was cut due to space restrictions as well as point-of-view inconsistency with

8820-559: 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

8925-419: The only "real" place in the Earth, they rarely dabble in outside events. However, if they perceive a grave threat to the Earth, one of their number is "Appointed" to attempt to avert the threat – and to bear the cost of failing. Forestals are beings who serve the forests of the Land, the remnants of the One Forest, the great sentient wood which once covered the Land. They are human in appearance, but according to

9030-522: The passing of forty years compared to the few weeks that have passed in his own world: the High Lord of the Council is Elena. Much later he learns that she is his daughter, born of his rape of Lena. Due to the trauma, Lena has disassociated from life and reverted to a childlike mentality, fully dependent on her family. Elena is now Covenant's summoner and shows no ill will towards her biological father. She and Covenant become close friends. Elena explains that

9135-471: The person exposed have been associated with developing lepromatous or tuberculoid leprosy. 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

9240-458: The population in which the cases have occurred, again at a given point in time. 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

9345-522: The power, but foolishly uses it to summon the long dead High Lord Kevin from his grave, and send him against Lord Foul. This act breaks the Law of Death, the barrier preventing the souls of the dead from interfering in the world of the living. Kevin's spirit is easily defeated and then enslaved by Foul wielding the Illearth Stone, and commanded to destroy Elena. The two High Lords engage in a battle of magic, in which Elena and her Bloodguard are defeated and killed, and

9450-693: The rest of the Chronicles . The events during the trek through Grimmerdhore are not mentioned in the published narrative of The Illearth War , and some information shared here on the origin and motivation of the Bloodguard does appear in other contexts in the published Chronicles . The rest of the mission after the Grimmerdhore passage was included in the Chronicles , via the narrative device of Bloodguard messengers. Cavewights are dimly intelligent subterranean creatures skilled in metal working and mining. They are weak-willed, and are easily intimidated by Lord Foul into serving him (though they once traded openly with

9555-554: The rider makes the call. Thus, when the rider summons his Ranyhyn, it appears shortly thereafter, regardless of the distance between them. Ravers are bodiless evil spirits with the ability to possess and control some lesser creatures, and most humans as well. Giants and Bloodguard are typically immune to this power, and there are no known instances of a Raver possessing a Ranyhyn. There are only three Ravers, ancient brothers who each have many names but are commonly called Turiya Herem, Samadhi Sheol, and Moksha Jehannum. Their greatest hatred

9660-470: 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,

9765-441: The stigma surrounding leprosy may help improve outcomes for people with leprosy. 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

9870-485: 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

9975-451: The term moksha , which in Sanskrit refers to liberation from the cycle of sorrow, is given as the original name for a creature of depravity and evil called a Raver. Another Raver, Satansfist, is called samādhi , which in Sanskrit refers to a state of mind in which one achieves oneness with the object of one's concentration. The third Raver, Kinslaughterer, is called turiya , Sanskrit for

10080-467: 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. Leprosy is classified as a neglected tropical disease . World Leprosy Day was started in 1954 to draw awareness to those affected by leprosy. The study of leprosy and its treatment

10185-499: 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

10290-535: 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

10395-417: 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

10500-460: The universe, the Arch of Time, prevents the Creator from intervening directly in events in the world of his creation, and he never appears in physical form within that world. He can, however, manifest himself in the "real" world—he appears to Covenant and Linden as an old man in an ochre robe—and guides those who attempt to make contact between the universes. The Demondim are a now-extinct race spawned by

10605-505: The ur-viles loathe their own bodies and often redirect this rage towards other targets. They also do not die, except when killed, or reproduce naturally, although they do retain the lore required to construct more of their own kind and the Waynhim—however, their motivations for doing so are unlike those of natural creatures. Viles are an extinct race who spawned the Demondim. They were non-corporeal, but nonetheless very powerful. Initially

10710-403: 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. Early detection of

10815-413: 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

10920-455: Was gained about Foul's forces. The commander of Foul's army is one of three brothers of the race of Giants, a people previously thought incorruptible. With the aid of the powerful Illearth Stone, the Ravers, Foul's non-corporeal servants, have possessed the three brothers, now renamed Kinslaughterer, Fleshharrower, and Satansfist. In shame and despair, the other Giants offer no resistance as Kinslaughterer murders them all in their home city. Thus,

11025-540: 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

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