[Medico-historical monuments in Hungary from the times of Matthias Hunyadi]. / Hunyadi Mátyás uralkodásának hazai orvostörténeti emlékei.

Author attempted to collect all available medical data of the period of the reign of Mathias Corvinus (1443-1490) who ruled Hungary for 32 years. First part of this article outlines the general medical history of this era. In the 15th century the flourishing Kingdom of Hungary was inhabited by 3-3.2 million people. Under the rule of King Matthias epidemies were frequent visitors, plague e.g. was registered 11 times, while sudor anglicus once (in 1485). The ca. 120 hospitals of the era were founded mostly in towns and market-towns. At the same time 12 leprosories worked throughout the country. Strikingly many dates and details could be collected concerning medical doctors and surgeons working in Hungary. A list of 69 medical doctors and surgeons (60 physicians and 9 surgeons) of this era known by their names is attached to the article. The second and third part of the treatise is a medical history of King Matthias of his relatives and of his court. We can read here a report on the illnesses and death of Janus Pannonius and of Joannes Vitéz who both played an important role in Hungarian culture. Author's further inquiry is focused on diseases and death of the king. Cause of his death was--according to contemporary sources and our present-day knowledge--a cerebral apoplexy. On 6th April 1490 Matthias died suddenly but not unexpected, since his health had already been deteriorated critically during the previous two years, and he had long been crippled by gout. The king's condition had been worsened probably as an effect of factors caused by visceral form of gout. These factors were cardiovascular and renal damages and hypertension, which resulted the fatal cerebral apoplexy causing the king's sudden death.

Integrating leprosy control into general health service in a war situation: the level after 5 years in eastern Congo.

South Kivu Province of the Democratic Republic of Congo, plagued by a turbulent civil war, started a process of integrating leprosy into general health services in 1995. A questionnaire survey was carried out in September 2000 to assess the level of structural and functional integration, after 5 years of the integration process, in nine of its 14 health districts. The survey revealed that a total of 76 clinic nurses remained of those trained in leprosy since 1993. In all, 33-6% of the total 226 health facilities had a trained nurse, but according to the district supervisors who filled the questionnaires, nurses in only 28.3% of health facilities could diagnose leprosy. Less than 40% of the total 226 health facilities were structurally integrated with MDT and other leprosy services. Functionally, the clinic nurses were involved in dispensing MDT drugs and keeping leprosy records in 90.8 and 81.6%, respectively, of the integrated facilities, and diagnostic activities in 43.7%. The degree of involvement put health facilities into four grades of functional integration: 1) fully-functional integrated, 2) semi-functional integrated, 3) semi-integrated (structural but not functional), 4) not integrated (vertical). On this scale, 80% of 107 health facilities reported by the supervisors had some form of integration and 20% were not integrated. Treatment activities were significantly more functionally integrated than the diagnostic and POD activities, which require more skills. The presence of a trained nurse in a health facility made no significant difference to the involvement of clinic nurses in dispensing MDT drugs and performing POD activities, but significantly affected their performance of diagnostic activities and records keeping. The endemic districts had higher levels of structural integration, were not more likely to be functionally integrated. The levels of structural integration after 5 years are considered low in South Kivu Province, and reflect the significant negative effect of civil conflicts on integration of leprosy programmes in Africa.

The cost of tuberculosis to patients in Sierra Leone's war zone.

OBJECTIVE: To evaluate how the extreme poverty of the patients and the poor salaries of the staff combined to increase the cost of treatment to patients within the subsidised national tuberculosis programme in Sierra Leone. DESIGN/SETTING: From September to December of 1994, semi-structured interviews were conducted with 72 patients and 17 staff of the National Leprosy and Tuberculosis Control Programme of Sierra Leone, a screening and treatment programme funded by international donors. RESULTS: Although some extra costs were indeed incurred within the subsidized national tuberculosis treatment programme, they were much lower than those incurred during the pre-programme period when the patients sought intermittent help from a wide range of traditional and biomedical sources within the plural healing continuum. The national politico-economic crisis, and the consequent poverty of most patients, impeded compliance with and sustainability of treatment, even within the formal subsidised treatment programme. CONCLUSIONS: More money was spent by patients on treatment in the months/years preceding entry into the national tuberculosis programme. Many factors retarded entry, including poor communications, misinformation, malpractice by health professionals, and displacement resulting from chronic internal warfare. The war intensified all factors that predispose to tuberculosis and retarded access to treatment. Supra-programme cost, or 'corruption,' was minimal due to the poverty of health professionals, with a few salient exceptions.

[Vicissitudes of treating leprosy handicaps in Kapolowé, Zaïre]. / Vicissitudes du traitement des handicaps hanséniens à Kapolowé (Zaïre).

In 1990 Kapolowé was, without a doubt, the site of the only surgical centre in Zaire dealing with handicaps which developed in as an after-effect of leprosy. It would be useful to explain the hazards involved in such a venture for reasons which do not pertain to medicine but, rather, to particularly trying socio-political circumstances. The best surgical expertise was thrown out for political reasons. Insecurity and economic hardships practically halted movement and, consequently, the wider application of such expertise. During a mission in 1994, there was a partial resumption of activities. The surgical team was reinstalled and made operational. It had been possible to state that multidrug therapy (MDT) had always ensured that the disabled leprosy patients, living in groups, and treated before 1990 under regular supervision, did not experience serious relapses. That fact corroborates earlier information relating particularly to surgical decompression. Although most of them were able to resume a certain measure of professional activity, social factors must still be borne in mind and the concept of partial permanent disability must be applied.