A lepra e os novos referenciais da medicina brasileira no final do século XIX. O Laboratório Bacteriológico do Hospital dos Lázaros / Leprosy and the new frames of reference of the Brazilian medicine in late XIX century. The Bacteriological Laboratory of Hospital dos Lázaros

Procura destacar o papel do Laboratório Bacteriológico no cenário médico da segunda metade do século XIX, instituindo-se não só como um espaço de pesquisa sobre a lepra, como também um pólo dinâmico e precursor de consolidação da medicina pasteuriana no Brasil.

A lepra e os novos referenciais da medicina brasileira no final do século XIX. O Laboratório Bacteriológico do Hospital dos Lázaros / Leprosy and the new frames of reference of the Brazilian medicine in late XIX century. The Bacteriological Laboratory of Hospital dos Lázaros

Procura destacar o papel do Laboratório Bacteriológico no cenário médico da segunda metade do século XIX, instituindo-se não só como um espaço de pesquisa sobre a lepra, como também um pólo dinâmico e precursor de consolidação da medicina pasteuriana no Brasil.(AU)

Horto Oswaldo Cruz: histórico e projetos futuros / Horto Oswaldo Cruz: history and future projects

Enfoca a criaçäo do Horto Oswaldo Cruz, proposta pelo Dr. Arthur Neiva, que assume a direçäo do Serviço Sanitário do Estado de Säo Paulo em 1916. O objetivo do horto botânico seria o cultivo de plantas de importância médica e o fornecimento de recursos à medicina, orientaçäo do público na cura de moléstias e açäo contra o charlatanismo.(AU)

[Hansen's disease in the laboratory]. / A hanseniase no laboratório.

A physical doctor with a PhD in Pathology, Euzenir Nunes Sarno studies the immunology factors of Hansen's disease, one of the oldest chronic infections and that is an exclusively human disease. Staff member of an ambulatory that has become a reference on the disease in Brazil with 220 to 250 new patients per year, Euzenir emphasizes that the fact one cannot cultivate Mycobacterium leprae brings about some everlasting questions in relation to the transmission of and the sensitivity to the disease. There are also many epidemiology questions that remain unanswered. Estimates show that, among those who have contact with multi-bacilli patients, 90% are infected but only about 8% get sick. The high infection rate of those who live with multi-bacilli patients but never fall sick shows that just a small number of individuals are sensitive to Mycobacterium leprae. This is one of the questions immunology has not been able to answer. Why do some people resist to it and some don't? The figures are even lower when compared to those who are in contact with patients that are paucibacillus-infected, i.e. a manifestation of the disease with few bacilli. Hansen's disease is known as a skin malady. But, according to the specialist, its first damage is to the nerve, when the area becomes insensitive. Besides damaging the sensitive skin nerves, the disease can lead to motor disability and irreversible deformities, which sometimes lead to the amputation of limbs and protruded parts of the body. Mycobacterium leprae was one of the first pathogenic bacteria whose genome sequence has been entirely mapped. Only now we have the capacity to have more precise assessments. The disease is not inherited, and only in 1986 health services in Brazil began to take the responsibility for both the disease and its patients. During the twenty-year military dictatorship the country underwent, the health system was dismantled. In 1991, the one-year treatment with three drugs - Dapsone, Rifanpicine and Clofazimine- was introduced in our country. Just 30% of the cases get to negative results after the treatment. according to the interviewee, whereas tuberculosis is a highly virulent multi-bacilli disease, leprosy bacillus is not virulent, is a 'lazy' germ at the end of its evolutional process. One third of its genome does not work.

[Revealing a history of exclusion: the experience at Hospital-Colônia Itapuã Data and Research center]. / Desvendando uma história de exclusão: a experiência do Centro de Documentação e Pesquisa do Hospital-Colônia Itapuã.

Inaugurated in May 1940, in Viamão Municipality in Rio Grande do Sul, Hospital Colônia Itapuã was meant to shelter Hansen's disease patients. Built in order to work as a small town, the hospital was the stage of several life and work histories. The fragments of these collective and individual experiences have been recovered since 1999, when Centro de Documentação e Pesquisa (Cedope/HCI) was first implemented. It is through the center activities that we propose a comparative study of the history of the hospital and the history of those who lived and those who still live in it.

History of medicine: the metamorphosis of scientific medicine in the ever-present past.

Hippocrates (460-370 BCE), the father of medicine, developed principles for medical diagnosis and treatment together with a code of ethics. When the first Ptolemy ruled Egypt, he created a great library of 700,000 rolls at Alexandria, which became a repository for the works of Socrates, Plato, Aristotle, Hippocrates, and all the writings of the known world, but it was destroyed by a great fire. Galen of Pergamum (129-216), who lived 500 years after Hippocrates, was well educated and studied anatomy, surgery, drugs and Hippocratic medicine. His ideas influenced medical thinking for the next 1500 years. The Arabic physician Ibn Sina (Avicenna) wrote a great medical work entitled Canon of Medicine. After the Dark Ages (500 to 1050), academic medicine was reestablished in Europe, especially at Salerno, Bologna, Padua, Paris, Montpellier, and Oxford. The greatest medical disaster of the Middle Ages was the Black Death. Other diseases of note were leprosy, smallpox, tuberculosis, typhus, measles, diarrhea, meningitis, and colic. As interest in human dissection increased, the study of anatomy became popular. With development of the printing press, medical knowledge became more widely disseminated and technical advances in science flourished. Advances in medicine occurred in concert with developments in technology. These included the microscope, the stethoscope, anesthetic agents, discoveries in bacteriology, a carbolic acid spray to reduce infection during surgery, the clinical thermometer, blood transfusions, electrocardiography, X-rays, and the sphygmomanometer. Johns Hopkins University was established at the end of the 19th century to train scientifically knowledgeable physicians. The first faculty included Welch, Osler, Halstead, Kelly, Mall, and Abel. Graduates of the new school carried scientific medicine to universities throughout America. More medical advances have been made during the 20th century than in all the other centuries combined. Advances in medical knowledge have resulted not only from developments in technology but from increased access to current information provided through libraries such as the National Library of Medicine in Bethesda, Maryland.

[Sanitary battles and scientific clashes: Emilio Ribas and yellow fever in Sao Paulo]. / Combates sanitarios e embates cientificos: Emilio Ribas e a febre amarela em Sao Paulo.

Emilio Ribas, an administrative physician and sanitarian from Sao Paulo, was an advocate of the microbiological conception during the long period when he directed the Servico Sanitario de Sao Paulo (1898-1917). This article offers a brief analysis of his stance in the flight against yellow fever during the early 20th century, considered a highlight of his career. The scientists and professionals linked to this sanitary agency in Sao Paulo found themselves in a tense, unstable work environment, where experimental proof played an important role in corroborating new medical-sanitary conceptions and practices. The article takes a close look at the medical experiments on yellow fever directed by Emilio Ribas and conducted at Sao Paulo's Hospital de Isolamento in 1902-03. It examines these same studies in an effort to better understand how the significance of yellow fever was transformed and to explore its implications regarding the history of public health in Sao Paulo.

Research ethics--a brief historical review to 1965.

Most discussions on modern research ethics--particularly the formation of research ethics committees (institutional review boards)--focus on the revelations of the dreadful practices in the Nazi concentration camps at the Nuremberg trial after the second world war, with the subsequent production of the Nuremberg and Helsinki Codes. In fact, however, these trials were not pivotal: there was a long history of such concerns, going back at least to the 1830s, when William Beaumont introduced a contract with his patient Alexis St Martin, as well as the later part of the century when the celebrated leprosy worker Hansen was prosecuted in Bergen for having experimented on a patient without her consent, losing his post as a result. Probably, had it not been for the entry of the USA into the First World War, public indignation at the growing number of reports of unethical experimentation in public hospitals would have resulted in regulations, while official codes were introduced in Prussia at the turn of the century and in Berlin again in 1931. Nevertheless, the impetus for modern developments came principally from the furore aroused by the proselytising of two physicians: Henry Beecher, an anesthesiologist at Harvard, and Maurice Pappworth in London, whose respective books Experimentation in Man and Human Guinea Pigs, documented case histories of egregiously less than ethical research practices that went largely unquestioned by other clinical research workers. Here I shall discuss the reactions to and influence of some of these episodes, as well as more recent developments.

Cincuenta años de investigación en México / Fifty years of research in Mexico

Contiene un conjunto de investigaciones realizadas por el Doctor Alberto P. León, premio Eduardo Liceaga, donde se abordan los diversos trabajos que ha logrado sumar, a lo largo de su carrera, en cuestiones de investigación sobre diversas enfermedades. El libro contiene los siguientes capítulos: I. Antígenos II. Brucelosis III. Difteria IV. Investigación V. Lepra VI. Meningococcus N. Intracelularis VII. Proteus y proteosis VIII. Salmonella y salmonelosis IX. Shigelosis, shigella y otras enfermedades de origen hídrico X. Streptococcias y streptococci XI. Sulfalumin XII. Sulfargenta XIII. Tifo y rickettsia XIV. Tuberculosis y BCG(AU)

The contribution of medical missionaries to tropical medicine. Service-training-research.

Medical missionaries, historically the pioneers in introducing Western medicine into many tropical countries, are today responsible for a significant proportion of health care in several of those countries. Illustrating his theme with references to personal experiences in the former Belgian Congo, the author enlarges on the organization of a church-related comprehensive health care programme based on a chain of rural health centres and satellite dispensaries that brought curative and preventive medicine to the whole population within the area covered. Trypanosomiasis was eradicated, yaws and tuberculosis controlled, cerebral malaria eliminated, worm-loads reduced and nutrition improved. Leprosy was treated within the integrated service as soon as the sulphones became available. Medical auxiliaries and nurse-midwives were trained practically to tackle the local problems. Students from many missions over a wide area went into government, mission and company employ after training. Research concentrated mainly on the solution of pressing local problems, such as onchocerciasis and leprosy, but incidentally investigated interesting clinical phenomena.