Pierre Richet (1904-1983), fighting onchocerciasis and totalitarism.

While Eugène Jamot's name is associated with the combat against sleeping sickness, Pierre Richet is permanently linked to the battle against river blindness, which he first reported in 1936 in two neighboring households in Garango (Burkina Faso). Onchocerciasis remained a continuous interest, through his last article "The OCCGE and Onchocerciasis", written in 1983. Nonetheless over the course of these five decades, Richet's trajectory was far from that of a specialist dedicating his life to a single disease. After a decade essentially spent fighting trypanosomiasis, came a decade of war in which the specialist in endemism joined the Free French Army and put his organizational know-how at General Lerclerc's disposal, from Morocco to Indochina, via Germany. On his return to Africa in 1953, he extended the principle of mobile teams to the other major endemic diseases accessible to treatment and to vaccines. Richet organized first the combat against leprosy and launched vaccination programs. In 1955, he returned to the battle against onchocerciasis and deployed the first large-scale insecticide program in Chad. The intermediate term failure of this prototype fermented his scientific, interdisciplinary, and organizational thought, which flourished at Bobo-Dioulasso. At the dawn of the independence of French-speaking African countries, and against the political tides of the time, he obtained in 1960 the creation of a supranational organization, the OCCGE, common to 8 countries of West Africa, and he headed it for a decade. Drawing lessons from the past and in the absence of effective pharmaceutical treatment, Richet the physician played the entomological card with one hand, with technical support from Orstom (IRD); this detailed work enabled the development of a strategy. With the other hand, he played the multilateral card, which led in 1974 to the launching of the extraordinary Onchocerciasis Control Program (OCP). If it is Jamot who awakened Africa, Richet is the person who restored its view but also millions of hectares of cultivable land.

Lepra: doença, isolamento e segregação no contexto colonial em Moçambique / Leprosy: disease, isolation, and segregation in colonial Mozambique

Resumo A partir de documentação produzida entre a primeira metade do século XIX e a primeira metade do século XX, prioritariamente relatórios médicos, o artigo aponta as concepções vigentes na comunidade médica colonial e entre as populações locais sobre a lepra, suas manifestações e seu enfrentamento. Enfoca as tensões quanto à prática de segregação dos leprosos e suas implicações sanitárias e sociais. Para compreender as raízes dos discursos e estratégias no meio médico português e colonial, recupera-se a trajetória das definições de isolamento, segregação, lepra e suas aplicações, ou ausência de referência, na literatura de missionários, cronistas e médicos em Angola e Moçambique a partir da segunda metade do século XVII.

Abstract Drawing on documents produced between the early nineteenth and mid-twentieth centuries, mainly medical reports, this paper indicates the prevailing conceptions in the colonial medical community and local populations about leprosy, its manifestations, and how to deal with it. It focuses on the tensions concerning the practice of segregating lepers and its social and sanitation implications. To comprehend the roots of the discourses and strategies in the Portuguese and colonial medical environment, the trajectory of the definitions of isolation, segregation, and leprosy are traced, as are their use in or absence from the writings of missionaries, chroniclers, and doctors in Angola and Mozambique as of the second half of the seventeenth century.

Leprosy: disease, isolation, and segregation in colonial Mozambique. / Lepra: doença, isolamento e segregação no contexto colonial em Moçambique.

Drawing on documents produced between the early nineteenth and mid-twentieth centuries, mainly medical reports, this paper indicates the prevailing conceptions in the colonial medical community and local populations about leprosy, its manifestations, and how to deal with it. It focuses on the tensions concerning the practice of segregating lepers and its social and sanitation implications. To comprehend the roots of the discourses and strategies in the Portuguese and colonial medical environment, the trajectory of the definitions of isolation, segregation, and leprosy are traced, as are their use in or absence from the writings of missionaries, chroniclers, and doctors in Angola and Mozambique as of the second half of the seventeenth century.

Genome-wide comparison of medieval and modern Mycobacterium leprae.

Leprosy was endemic in Europe until the Middle Ages. Using DNA array capture, we have obtained genome sequences of Mycobacterium leprae from skeletons of five medieval leprosy cases from the United Kingdom, Sweden, and Denmark. In one case, the DNA was so well preserved that full de novo assembly of the ancient bacterial genome could be achieved through shotgun sequencing alone. The ancient M. leprae sequences were compared with those of 11 modern strains, representing diverse genotypes and geographic origins. The comparisons revealed remarkable genomic conservation during the past 1000 years, a European origin for leprosy in the Americas, and the presence of an M. leprae genotype in medieval Europe now commonly associated with the Middle East. The exceptional preservation of M. leprae biomarkers, both DNA and mycolic acids, in ancient skeletons has major implications for palaeomicrobiology and human pathogen evolution.

[History of human epidemic and endemic diseases in the southwest Indian Ocean]. / Histoire des épidémies et des endémoépidémies humaines dans le sud-ouest de l'océan Indien.

Smallpox has been known in the Mascarene Islands since 1729, and in 1898, the vaccinogenic and anti-rabies Institute of Tananarive, the future Pasteur Institute of Madagascar, was created to combat it. Cholera first arrived in the Mascarenes in 1819, but did not affect the Comoros Islands and Madagascar until the current pandemic. Bubonic plague has beset the ports of Madagascar and the Mascarenes since 1898. Girard and Robic developed the anti-plague vaccine in 1931 at the Pasteur Institute of Madagascar. The Mascarenes lost their reputation as Eden when malaria arrived in 1841, and this disease remains prominent in Madagascar and Comoros. Leprosy has been known in La Réunion since 1726 and is still very present in Mayotte, Anjouan, and Madagascar. Leptospirosis is a public health problem, except in Madagascar and the Comoros. Dengue, chikungunya, and Rift Valley fever are also present. HIV/AIDS is not a major concern, except in Mauritius, where it was spread by injection drug use, in the Seychelles and in Madagascar's largest cities. Madagascar is the principal site worldwide of chromoblastomycosis, first described there in 1914.

A viagem científica de Neiva e Penna: roteiro para os estudos das doenças do sertão / The scientific journey taken by Neiva and Penna: a blueprint for studies of diseases from the Brazilian hinterland

Analisa o relatório de Arthur Neiva e Belisario Penna , focalizando a contribuição dos autores ao estudo de uma das doenças endêmicas por eles encontrada ao longo de todo o trajeto percorrido, de longa data conhecida popularmente por 'mal de engasgo'. Observaram e descreveram com minúcia os sintomas apresentados pelos doentes e a associação frequente do mal de engasgo com outro mal endêmico conhecido por 'vexame' ou 'vexame do coração', que consistia em crises de palpitações. Os estudos epidemiológicos e clínicos de Neiva e Penna sobre o mal de engasgo muito contribuíram para o conhecimento dessa afecção e representaram um incentivo para todos os pesquisadores que se dedicaram ao seu estudo, especialmente quanto a sua relação com a doença de Chagas.

Analyze the report by Neiva and Penna, focusing on the contribution these authors made to the study of one of the endemic diseases encountered throughout their journey, which had been long known under the popular name of mal de engasgo (choking disease). They recorded their observations and detailed descriptions of the patients' symptoms and the association frequently encountered between mal de engasgo and another endemic disease, known as vexame or vexame do coração, characterized by bouts of palpitations. Neiva and Penna's epidemiological and clinical observations of mal de engasgo were crucial for all the researchers interested in the disease, especially its relationship with Chagas disease.

La lepra en la Almería de los siglos XVIII y XIX / Lepra in Almeria during XVIIIs and XIXs century

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Hanseniase no Estado do Espirito Santo: uma endemia em ascensao? / ?

Objetivo. Estudar a tendencia da Hanseniase no Estado do Espirito Santo e suas macroregioes de saude. Periodo 1980 a 2003. Metodo. Trabalho de delineamento descritivo, abrangendo analise de tendencia e estudo ecologico exploratorio. Populacao de estudo: o universo dos casos de hanseniase, registrados no Sistema de Informacao de Agravos de Notificacao da Secretaria de Estado da Saude do Espirito Santo. Realizou-se estudo de tendencia da incidencia global, por faixa etaria e por classificacao operacional, utilizando modelos estatisticos para series temporais. Os indicadores de avalicao da endemia foram analisados segundo parametros propostos pelo Ministerio da Saude. Resultados. Na Analise de Tendencia, as curvas de incidencia global e por faixa etaria, indicam tendencia de crescimento, menos pronunciado a partir do ano de 1996; tendencia de crescimento para os paucibacilares e de estabilizacao para os multibacilares. A avaliacao dos indicadores de acompanhamento da endemia revelou que o percentual de grau de incapacidade 2 manteve-se estavel em baixos patamares, media de 6%; percentual de casos em menores de 15 anos abaixo de 10%, com discreta tendencia ao declineo; altos indices de forma tuberculoide; percentual de abandono na faixa de 6%. A prevalencia encontra-se em declinio. Conclusoes. A tendencia da hanseniase no Espirito Santo no periodo de 1980 a 2003 e de crescimento, aparentando menos velocidade a partir de 1996. Esta situacao nao e homogenea. Na Macro3 - Norte, onde os indicadores socioeconomicos sao mais precarios, a tendencia e crescente. Tendencia de declinio da prevalencia, sugerindo influencia de fatores operacionais. Merecem estudos adicionais, os altos indices de forma T verificados no Estado, e a grande oscilacao dos dados da Macro2 - Sul

O estigma do pecado: a lepra durante a Idade Média / The stigma of sin: leprosy in the Middle Ages / Le stigmate du p éché: la l épre au Moyen-Âge

O percurso da lepra e dos leprosos durante o período medieval constitui um objeto privilegiado para o estudo do impacto de uma doença sobre determinada sociedade e dos mecanismos sociais envolvidos na percepção, delimitação e destino das doenças, pois ela atingiu o Ocidente medieval em um momento em que este se definia de forma excludente em relação à alteridade. Os dispositivos que a Idade Média criou para superar a desestruturação trazida pelo advento da lepra, excluindo os leprosos do convívio social e encerrando-os em um universo à parte, o qual despertava, ao mesmo tempo, medo, desconfiança e ódio, tiveram uma enorme aceitação social. Assim, a segregação e o confinamento que se cristalizaram em tomo dos leprosos, apareceram, por muito tempo, no tratamento que a sociedade ocidental dispen­sou aos seus párias; além disso, a própria medicina ocidental os incorporou como base da ação terapêutica, em que o isolamento dos doentes passou a ser uma via obrigatória para a cura...

The trajetory of leprosy and lepers in the Medieval period is a special subject to the study of the impact of a disease on a determined society, and of the social mechanisms implicated on the perception, delimitation, and destiny of the diseases, for it achieved the Medieval Occident in a time when it was defining itself in an excluding way in relation to a change. The mechanisms that the Middle Ages created to overcome the desestabili­zation caused by the forthcoming of leprosy, keeping the lepefs away from the social contact, and locking them in a world apart, that caused fear, suspicion, and hate at the same time, were very well accepted by the society. Therefore, during a long time, the segregation, and confinment that were fixed around the lepers appeared in the treatment that occidental society gave to its social outcasts; moreover, the occidental medicine itself incorporated them as base for the therapeutic action, in which the segregation of pacients became the compulsory way to cure...

Le parcours de la lépre et des lépreux durant la période médieval constitue un sujet privilégié pour l' étude d'une maladie sur une société determiné et des mécanismes sociaux engagés dans la perception, delimitation et destin des maladies, car elle a atteint l' occident medieval a un moment ou celui-ci se précise de façon à exclure tout changement. Les dispositifs que le Moyen-Âge a crée pour surmonter la destructuration apporté par l' avénement de la lépre, excluant les lépreux de la fréquentation sociale et les enfermant dans un univers à part, en éveillant, en même temps, peur, méfiance et haine, ont eu une énorme acceptation sociale. Ainsi, la ségrégation et le confinement qui se sont cristallisés autour des lepreux, se sont présentés, pendant longtemps, dans le traitement que la société occidentale a accordé a ses parias; de plus, la médicine occidentale les a incorporé comme base d'action terapeutique, ou l'isolement des maladies est devenu un chemin obligatoire vers la cure...

Importância dos focos lepromatosos no contrôle domiciliar da endemia de lepra - prevenção da lepromatose pela cura da lepra indeterminada

The importance of lepromatous foci for the domestic control of endemic lepra the prevention of leprosy by the cure of indeterminate lepra. Starning from the traditional concept established by Armauer Hansen in 1886 that lepra is a disease spreal through contagion within the family, the author suggests a prophylaxis system in accordance with irrefutable epidemiologic arguments and with an ecologic basis in the field of preventive medicine, to work as follows: a) periodic inspection of domestic foci by mobile Sanatary Units. b)Intensive treatment of the indeterminate group cases, so as to break the cycle of contagion and avoid their development into the lepromatous type, the majority of which evolve from the indeterminate type, the most frequent among Lepra incipiens. c) Higher efficiency and more facilities for sulfone therapy is diagnosed in its initial form. avoiding highly infective open lesions through intensive treatment. d) Extinction of compulsory isolation which, besides being extremely expensive for the campaing, brings about the hiding of foci; to assist advanced cases of the disease, the existing sanitaria should be maintained with an open door regime, the only condition compatible with selective isolation advocated by the VII International Lepra Congress (Tokyo - 1958). e) Transformation of preventories into polyvalent educational and assistential institutions for needy minors, so as to protect descendants of Lepra patients from the stigma of millenary tradition. f) Integration of lepra prophylaxy within the Public Health Service, to be coordinated as a specific unit in polyvalent organizations with sanitary, assistential and scientific aims, of official, state, or private institutions; thus, a close collaboration between clinicians, pathologists, and sanitarists specialized in leprology and the technical personnel of the Public Health Organization is obtained. In consequence, specific standards are raised and stigmas and anathemas, among which pop...