Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine.

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.

History of leprosy in Rio de Janeiro.

The record of the first cases of leprosy in Rio de Janeiro dates from the seventeenth century. The first local host of leprosy patients was created from 1741, and the first colonies hospitals were built in the early twentieth century, in order to avoid contagion of the population. The first structures dedicated to research also date from this time: the Leprosy International Institute, the Leprology Institute, and the Leprosy Laboratory of the Oswaldo Cruz Foundation, where the most prestigious leprologists of Rio de Janeiro worked. Currently, investigations are focused on the Oswaldo Cruz Foundation; additionally, leprosy patients are treated at municipal health centers and state hospitals, and former colony hospitals only accept patients with severe disabilities.

History of leprosy in Rio de Janeiro

The record of the first cases of leprosy in Rio de Janeiro dates from the seventeenth century. The first local host of leprosy patients was created from 1741, and the first colonies hospitals were built in the early twentieth century, in order to avoid contagion of the population. The first structures dedicated to research also date from this time: the Leprosy International Institute, the Leprology Institute, and the Leprosy Laboratory of the Oswaldo Cruz Foundation, where the most prestigious leprologists of Rio de Janeiro worked. Currently, investigations are focused on the Oswaldo Cruz Foundation; additionally, leprosy patients are treated at municipal health centers and state hospitals, and former colony hospitals only accept patients with severe disabilities.

Detection and strain typing of ancient Mycobacterium leprae from a medieval leprosy hospital.

Nine burials excavated from the Magdalen Hill Archaeological Research Project (MHARP) in Winchester, UK, showing skeletal signs of lepromatous leprosy (LL) have been studied using a multidisciplinary approach including osteological, geochemical and biomolecular techniques. DNA from Mycobacterium leprae was amplified from all nine skeletons but not from control skeletons devoid of indicative pathology. In several specimens we corroborated the identification of M. leprae with detection of mycolic acids specific to the cell wall of M. leprae and persistent in the skeletal samples. In five cases, the preservation of the material allowed detailed genotyping using single-nucleotide polymorphism (SNP) and multiple locus variable number tandem repeat analysis (MLVA). Three of the five cases proved to be infected with SNP type 3I-1, ancestral to contemporary M. leprae isolates found in southern states of America and likely carried by European migrants. From the remaining two burials we identified, for the first time in the British Isles, the occurrence of SNP type 2F. Stable isotope analysis conducted on tooth enamel taken from two of the type 3I-1 and one of the type 2F remains revealed that all three individuals had probably spent their formative years in the Winchester area. Previously, type 2F has been implicated as the precursor strain that migrated from the Middle East to India and South-East Asia, subsequently evolving to type 1 strains. Thus we show that type 2F had also spread westwards to Britain by the early medieval period.

Hospital de San Lázaro de granada: 470 años de historia, asistencia sanitaria y vida de los leprosos en el hospital / San Lazaro Hospital de Granada: 470 anos de história, saúde e vida dos leprosos no hospital / Saint Lazarus hospital of granada: 470 years of history, health and life of hospital lepers

El Hospital de San Lázaro fue fundado debido a que la pobreza y la enfermedad en esta época empiezan a ser consideradas como un problema de orden público y social, y la asistencia una labor del Estado. No obstante, la Iglesia seguirá manteniendo un papel importante. El objetivo del estudio es realizar una visión global del Hospital de San Lázaro de Granada desde el momento de su apertura hasta su cierre, prescribir la vida de los leprosos en el hospital y la organización asistencial, describiendo la figura de enfermería. El material y métodos utilizados han sido una exhaustiva búsqueda bibliográfica mediante recursos electrónicos y en formato papel. El método empleado consiste en recopilar documentación publicada desde el año 1996 al 2010, teniendo en cuenta variables como fechas de apertura y demolición del mismo, contexto histórico y social de la enfermedad de la lepra en la época, organización asistencial y vida de los leprosos en el hospital. Las conclusiones más destacadas son que el hospital fue el único fundado en Granada en el siglo XVI con función asistencial y de aislamiento como prevención de la lepra, la figura principal de la asistencia era el médico, dos enfermeros y dos enfermeras (AU)

The Saint Lazarus Hospital was founded. Poverty and diseases were seen as a problem of public and social order and medical assistance as a state’s task. However, the Church still kept an important role. The aim of this study is to present a general overview of the Saint Lazarus Hospital of Granada, from its beginning to its end, and to describe the lives of lepers in the hospital, the organization of health care as well as the role of nurses. The material and methods used in this study include an exhaustive bibliography of electronic resources and books. The method consists of gathering documents published from 1996 to 2010, taking into account variables such as the opening date, its demolition, social and historical context of leprosy, medical assistance and the lives of patients. The main conclusions are: -The hospital was the only hospital founded in Granada in the sixteenth century which took care of lepers and aimed at reducing the spread of the disease. -The main figure of the medical assistance was the permanent doctor and the nurses (AU)

O Hospital San Lazaro foi fundada por causa da pobreza e da doença nesta época começam a ser vistos como um problema de ordem pública e de assistência o trabalho social do Estado. No entanto, a Igreja continuará a manter um papel importante. O objetivo deste estudo é realizar uma visão geral do Hospital San Lazaro de Granada a partir do momento de abertura ao horário de fechamento, prescrever a vida dos leprosos no hospital e organização de saúde, descrevendo a figura de enfermagem. Os materiais e métodos utilizados têm sido uma busca exaustiva por meio de recursos eletrônicos e em formato papel. O método consiste em recolher documentos publicados de 1996 a 2010, tendo em conta variáveis como a abertura de datas e demolição do mesmo, contexto histórico e social da doença da lepra no momento, a organização dos cuidados e da vida dos leprosos em o hospital. As principais conclusões são que o San Lazaro Hospital foi o único hospital fundado em Granada, no século XVI e as funções de isolamento de cuidados, como a prevenção da hanseníase, a figura principal do atendimento médico foi a méica permanente e enfermeiros (AU)

Palomas blancas entre el amor y el dolor. El cuidado, las Hijas de la Caridad y el Hospital Gómez Ulla / White doves between love and pain. Medical Care, Daughters of Charity and Hospital «Gómez Ulla»

El cuidado, que ha existido desde los albores de nuestra humanidad, ha adoptado, conceptualmente, diversos significados a través del tiempo,al igual que lo han hecho la salud y la enfermedad. En dicho cuidado han estado secularmente implicadas las mujeres, en el interior delhogar, como prolongación de sus tareas de productoras y reproductoras de la vida, y lo han prodigado no solo a los niños y las niñas, sinotambién a las personas mayores, discapacitadas y enfermas. Además, desde siempre, mujeres de la más diversa índole trataron la enfermedadfuera de los límites de su casa, con mayor o menor preparación y asumiendo diferentes competencias hasta que, en la Baja Edad Media, seles negó autoridad y aptitud pues no se les permitió la entrada en las Universidades. El cristianismo había introducido en las conciencias losvalores de piedad, caridad y misericordia, afectando, especialmente, a muchas mujeres que pronto se dispusieron a mitigar las penas de losdesheredados y de los sufrientes entregando su vida por vocación de servicio a los demás. En el siglo XVII, en Francia, San Vicente de Paúly Santa Luisa de Marillac pusieron en marcha una sencilla organización: las Cofradías de Caridad, para canalizar la ayuda a los necesitadosde las parroquias parisinas. Poco después, ellas dieron a luz al instituto de las Hijas de la Caridad con características propias y con el fin deextender el servicio a los pobres y enfermos. Pronto, por su meritoria labor, las Hijas de la Caridad formaron parte insustituible de numerosasinstituciones: casas de expósitos, orfanatos, hospitales civiles y militares, cárceles, manicomios, leproserías… A España llegaron estasreligiosas en 1790 y rápidamente se extendieron por todas las provincias, mostrando mejoras en todo aquello que les era encomendado. Lossoldados heridos y enfermos fueron atendidos por ellas con todo celo en las numerosas contiendas del XIX: Guerra de la Independencia,Guerras Carlistas (AU)

Medical care, since the dawn of mankind, has conceptually adopted different meanings throughout the times, as well as health and sickness.Women have been involved for centuries in this medical care, at home, as an extension of their activities as lifegivers, and not only for childrenbut also for the elderly, sick and disabled. Moreover, women, from a wide range of origins, and more or less qualified, cared for the sick out oftheir own homes at different levels until the Low Middle Ages, when their aptitudes and capacities were denied as they were not allowed to enterthe Universities. Christianity introduced the values of mercy, charity and compassion, which were taken up particularly by many women whooffered their lives in service to their fellow men and women, mitigating the sorrows and sufferings of the unfortunates and dispossessed. In the18th century in France St. Vincent de Paul and Sainte Louise de Marillac started a simple organization, the Brotherhood of Charity to help theneedy in the Parisian parishes. A little later this originated the Daughters of Charity with their own characteristics and the objective to provideservice to the poor and sick. Due to their praiseworthy labor soon the Daughters of Charity became an irreplaceable part of many institutions:foundling homes, orphanages, military and civilian hospitals, prisons, insane asylums, leper colonies… These nuns arrived in Spain in 1790 andspread immediately all over the country improving everything they became responsible for. They were fully committed to taking care of sick andwounded soldiers in the numerous conflicts in the 19th century: Spanish War of Independence, Carlist Wars, African and Overseas Wars… Theycontinued their activities during the Spanish Civil War in field hospitals in the so-called national zone (AU)

A Fundação Paulista contra a Hanseníase e o processo de transformação dos Hospitais-Colônia de Hanseníase no estado de São Paulo / The Fundação Paulista contra a Hanseníase and transformation process of the colony hospitals of leprosy in the state of São Paulo

Uma história que começou silenciosa e ao mesmo tempo dramática. As pessoas iam sendo retiradas do seu meio, atônitas, quase sempre à noite, quando o nome "Lepra" era pronunciado, como uma espécie de senha. Tudo conforme havia sido projetado durante o regime de ditadura reinante no Brasil e executado com obstinação por agentes treinados para capturar gente. Asilos-colônia construídos no Estado de São Paulo iam aumentando o número de internações, não só de doentes, mas também de suspeitos da doença. Neste relato há que se lembrar do MORHAN, criado em 1981, movimento que passou a denunciar uma grave situação que estava sendo praticada em muitas colônias do país contra aqueles que recebiam altas, à revelia, sem terem para aonde ir. O livro detalha um importante registro por apresentar os fatos mais marcantes do papel do Estado, da participação da sociedade civil, trazendo ainda a importante presença da Fundação Paulista contra a Hanseníase, principalmente no processo de transformação dos hospitais-colônia, na atualidade.

A Fundação Paulista contra a Hanseníase e o processo de transformação dos Hospitais-Colônia de Hanseníase no estado de São Paulo / The Fundação Paulista contra a Hanseníase and transformation process of the colony hospitals of leprosy in the state of São Paulo

Uma história que começou silenciosa e ao mesmo tempo dramática. As pessoas iam sendo retiradas do seu meio, atônitas, quase sempre à noite, quando o nome "Lepra" era pronunciado, como uma espécie de senha. Tudo conforme havia sido projetado durante o regime de ditadura reinante no Brasil e executado com obstinação por agentes treinados para capturar gente. Asilos-colônia construídos no Estado de São Paulo iam aumentando o número de internações, não só de doentes, mas também de suspeitos da doença. Neste relato há que se lembrar do MORHAN, criado em 1981, movimento que passou a denunciar uma grave situação que estava sendo praticada em muitas colônias do país contra aqueles que recebiam altas, à revelia, sem terem para aonde ir. O livro detalha um importante registro por apresentar os fatos mais marcantes do papel do Estado, da participação da sociedade civil, trazendo ainda a importante presença da Fundação Paulista contra a Hanseníase, principalmente no processo de transformação dos hospitais-colônia, na atualidade. (AU)

Do Lazareto dos Variolosos ao Instituto de Infectologia Emílio Ribas: 130 anos de história da saúde pública no Brasil / From The Lazareto dos Variolosos to The Instituto de Infectologia Emilio Ribas: 130 years of history of public health in Brasil

O livro Do Lazareto dos Variolosos ao Instituto de Infectologia Emilio Ribas _ 130 anos de história da Saúde Pública no Brasil conta a vida de um hospital secular, fundado na época do Império e que se tornou referência na assistência, no ensino e em pesquisa na área de Doenças infecciosas e Parasitárias. (AU)

Centenario del sanatorio de Fontilles / Centenary of the fontilles sanitorium

Con motivo del Centenario de Fontilles, se exponen las circunstancias históricas de su fundación por los numerosos enfermos sin asistencia en la región valenciana, sobre todo en Alicante. La primera difícil etapa de 1909 hasta 1932 (año en que se produce la incautación por el gobierno de la República), la Guerra Civil y la devolución en 1941 a su propietario, el Patronato, encargando la administración a la Compañía de Jesús y el aspecto sanitario a la Dirección General de Sanidad, coexistencia que no funcionó y en 1943 vuelve a hacerse cargo el Patronato. Se comenta la evolución de la Colonia-Sanatorio hacia un hospital con función asistencial, investigadora y de formación, la aplicación de las sulfonas y posteriormente otros fármacos eficaces para la curación, el importante papel en la eliminación de la lepra en España, el ingreso en la Federación Internacional de Asociaciones de Lucha Contra la Lepra (ILEP) en 1969, los proyectos en países endémicos y la meta final de conseguir un mundo sin lepra (AU)

In recognition of the centenary of the Fontilles Sanitorium, we present some details of its history. The article discusses the foundation of the sanitorium by some of the numerous lepers with no health coverage in the region of Valencia, and Alicante in particular. After a difficult period between 1909 and 1932, the sanitorium was seized by the Republican government. After the civil war, it was returned to the board of trustees, who entrusted administrative tasks to the Compañía de Jesús while health care was overseen by the National Health Board. This coexistence was uneasy, and the board of trustees took over again in 1943. We comment on the transition from a sanitorium and colony into a hospital providing health care, research and training, and treatment with sulfones and subsequently other effective drugs. Also discussed are its role in the elimination of leprosy from Spain, admission to the International Federation of Antilepros y Associations in 1969, and its projects in endemic countries, with the ultimate goal of achieving a world free of leprosy (AU)

[Centenary of the Fontilles Sanitorium]. / Centenario del sanatorio de Fontilles.

In recognition of the centenary of the Fontilles Sanitorium, we present some details of its history. The article discusses the foundation of the sanitorium by some of the numerous lepers with no health coverage in the region of Valencia, and Alicante in particular. After a difficult period between 1909 and 1932, the sanitorium was seized by the Republican government. After the civil war, it was returned to the board of trustees, who entrusted administrative tasks to the Compañía de Jesús while health care was overseen by the National Health Board. This coexistence was uneasy, and the board of trustees took over again in 1943. We comment on the transition from a sanitorium and colony into a hospital providing health care, research and training, and treatment with sulfones and subsequently other effective drugs. Also discussed are its role in the elimination of leprosy from Spain, admission to the International Federation of Antileprosy Associations in 1969, and its projects in endemic countries, with the ultimate goal of achieving a world free of leprosy.

[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.

[An old document about hospitals, leprosy and pestilence houses in electorate of Saxony]. / Hospitäler, Lazarette und Siechenhäuser im Kurfürstentum Sachsen des 16. Jahrhunderts. Ein Fundbericht.

This paper presents a new, only recently identified source on Saxon hospitals in the Middle Ages, a list, compiled between 1553 and 1586 under the government of elector August (1526-1586), of the districts and towns with hospitals for old and poor people, sickly persons, lepers, syphilitics and patients with other infectious diseases. Run by the towns or, partially, in connection with monasteries and churchs, by the court of Dresden too, these institutions provided lodging, nourishment, clothes and physical care to the indigent inmates. A medical therapy in a stricter sense was the exception in that s time.

El Lazareto-hospital de la Boca del Riachuelo a fines del siglo XIX / The Lazareto-hospital of the Boca del Riachuelo by the end of the XIX century

Aborda sobre el patrimonio histórico arquitectónico que ya no existe: el Lazareto de la Boca del Riachuelo, patrimonio hospitalario de la Ciudad de Buenos Aires. Los lazaretos eran antiguamente hospitales destinados a leprosos. Luego se denominó así a los que se encontraban lejos de los poblados y se destinaban para realizar la cuarentena de viajeros que venían de zonas afectads por enfermedades contagiosas, o alojar enfermos en caso de epidemia.

El Lazareto-hospital de la Boca del Riachuelo a fines del siglo XIX / The Lazareto-hospital of the Boca del Riachuelo by the end of the XIX century

Aborda sobre el patrimonio histórico arquitectónico que ya no existe: el Lazareto de la Boca del Riachuelo, patrimonio hospitalario de la Ciudad de Buenos Aires. Los lazaretos eran antiguamente hospitales destinados a leprosos. Luego se denominó así a los que se encontraban lejos de los poblados y se destinaban para realizar la cuarentena de viajeros que venían de zonas afectads por enfermedades contagiosas, o alojar enfermos en caso de epidemia (AU)

[Hospitals, leper-houses and holy healers and in medieval Berry]. / Hôtels-Dieu, léproseries et saints guérisseurs dans le Berry médiéval.

Around the year 1000 many problems have been put throughout the beginning of urbanization, the increase of the country people, the pilgrimages and the spreading trade. The study of the medieval Charts allows to clarify how the sick were cured in the first hospitals-hôtels-Dieu- and how the lepers were isolated and kept outside the cities. When the recovery was impossible the intercession of saints was the only hope for the knight as well as for the peasants.

O que tem de ser tem força: narrativa sobre a doença e a internação de Pedro Baptista, leproso, meu avô (1933-1955) / The power of what has to be: a narrative on the disease and hospitalization of Pedro Baptista, leper, my grandfather (1933-1955)

Analisa a rede asilar paulista de combate à lepra, constituída como parte integrante de um projeto de políticas públicas no período do isolamento compulsório (1929-1967), tendo como foco principal a trajetória de vida de Pedro Baptista, internado nos leprosários paulistas entre 1934 e 1955. Apresenta a conceituação da lepra como doença infecto-contagiosa e a discussão sobre a política de isolamento dos doentes; esta política foi fundamentada através das resoluções aprovadas nas Conferências Internacionais de Lepra, ocorridas entre 1897 e 1958. Investiga ainda o estigma sobre a lepra e o leproso através da perspectiva histórica desenvolvida no decorrer do trabalho.

O que tem de ser tem força: narrativa sobre a doença e a internação de Pedro Baptista, leproso, meu avô (1933-1955) / The power of what has to be: a narrative on the disease and hospitalization of Pedro Baptista, leper, my grandfather (1933-1955)

Analisa a rede asilar paulista de combate à lepra, constituída como parte integrante de um projeto de políticas públicas no período do isolamento compulsório (1929-1967), tendo como foco principal a trajetória de vida de Pedro Baptista, internado nos leprosários paulistas entre 1934 e 1955. Apresenta a conceituação da lepra como doença infecto-contagiosa e a discussão sobre a política de isolamento dos doentes; esta política foi fundamentada através das resoluções aprovadas nas Conferências Internacionais de Lepra, ocorridas entre 1897 e 1958. Investiga ainda o estigma sobre a lepra e o leproso através da perspectiva histórica desenvolvida no decorrer do trabalho. (AU)

Reacercamiento 20 años Hospital Alemán-Nicaragüense Carlos Marx / Reacercamiento 20 years Hospital German-Nicaraguan Carlos Marx

En conmemoración de los veinte años de fundado el Hospital Alemán Nicaraguense Carlos Marx (HAN), la Direcciòn del Hospital organizó una Conferencia Internacional Reacercamiento 2005 Hospital Alemán Nicaraguense. Se exponen los resultados de la cooperaciòn para el desarrollo de los servicios brindados durante estos años, todos los departamentos clínicos del HAN presentaron los avances, retrocesos y limitaciones, se resalta el tema de Salud Pública. Se inicia con la historia, visión y misión del Hospital, asi como los servicios que se han ofrecido a la población nicaraguense durante estos veinte años, asimismo los logros, la escases de recursos humanos y limitaciones en cuanto a la infraestructura. Se discute opciones de un futuro apoyo por parte del Gobierno Alemán para mejoras del Hospital. En el acto de clausura la Ministra de Salud Lic. Margarita Gurdián otorga reconocimientos a los colaboradores y colaboradoras de muchos años

The evolution of the hospital from antiquity to the end of the middle ages.

The evolution of the hospital is traced from its onset in ancient Mesopotamia towards the end of the 2nd millennium to the end of the Middle Ages. Reference is made to institutionalised health care facilities in India as early as the 5th century BC, and with the spread of Buddhism to the east, to nursing facilities, the nature and function of which are not known to us, in Sri Lanka, China and South East Asia. Special attention is paid to the situation in the Graeco-Roman era: one would expect to find the origin of the hospital in the modern sense of the word in Greece, the birthplace of rational medicine in the 4th century BC, but the Hippocratic doctors paid house-calls, and the temples of Asclepius were visited for incubation sleep and magico-religious treatment. In Roman times the military and slave hospitals which existed since the 1st century AD, were built for a specialized group and not for the public, and were therefore also not precursors of the modern hospital. It is to the Christians that one must turn for the origin of the modern hospital. Hospices, initially built to shelter pilgrims and messengers between various bishops, were under Christian control developed into hospitals in the modern sense of the word. In Rome itself, the first hospital was built in the 4th century AD by a wealthy penitent widow, Fabiola. In the early Middle Ages (6th to 10th century), under the influence of the Benedictine Order, an infirmary became an established part of every monastery. During the late Middle Ages (beyond the 10th century) monastic infirmaries continued to expand, but public hospitals were also opened, financed by city authorities, the church and private sources. Specialized institutions, like leper houses, also originated at this time. During the Golden Age of Islam the Muslim world was clearly more advanced than its Christian counterpart with magnificent hospitals in various countries.