Lessons From the Wrong Isolation Policy Violating Human Rights for Leprosy in Japan.

Leprosy, caused by Mycobacterium leprae , is one of the so-called "neglected tropical diseases" and is found today mainly in Africa, Asia and South America. Although oral antibiotics capable of curing leprosy are now available, the disease is still misunderstood and feared by the public because of the unsightly deformities that it may cause. In Japan, leprosy has been present since the 8th century and was regarded as a hereditary disease; people avoided marrying into a family with a member affected by leprosy. At the beginning of the 20th century, the Japanese government instituted a policy of lifetime quarantine of individuals with leprosy to eradicate the disease, thereby purposely disseminating negative and inaccurate perceptions of the disease as deadly and highly contagious and fostering a long-lasting prejudice among the general public towards those affected. Even after effective treatments became available, the government continued quarantining patients until 1996. The government has since then apologized to the patients for violating their constitutionally guaranteed human rights. Children with leprosy and children born to parents with leprosy were also victims of the policy and prejudice created. We describe herein the history of leprosy-related policies in Japan to emphasize the importance of balancing public health policy with human rights.

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.

Effectiveness of Hot-Water Immersion Against Brevipalpus yothersi (Acari: Tenuipalpidae) as a Postharvest Treatment for Lemons.

Citrus leprosis is a destructive disease of citrus caused by several viruses (CiLVs) that are quarantine pests in the United States. Brevipalpus yothersi Baker (Acari: Tenuipalpidae) vectors the most virulent strain of CiLV. This mite is present in the United States and could facilitate the spread of the disease if CiLV reaches the country. Postharvest treatments could mitigate B. yothersi on imported commodities from areas where CiLV exists. The current study explores the effectiveness of hot-water immersion as a postharvest treatment against B. yothersi. Lemons were immersed in water at 21, 48, 53, or 63°C for 5, 10, and 15 min. Immersions at 53 and 63°C for all time schedules dislodged over 99% of adult mites. Lemon fruit quality and B. yothersi egg viability after hot-water immersion were also evaluated. Fruit quality significantly decreased in lemons treated at 63°C resulting in decay (grade 3, rejection), while at 53°C there was a quality reduction (grade 2, minimum acceptable market level) compared to lemons immersed at 21°C or nontreated controls (grade 1). None of the eggs hatched when the lemons were immersed in water at 63°C and an average of 1.5% hatched at 53°C for all time schedules. Immersion in water at 53°C for 5 min dislodged 99.71% and 57.14% of adult and immature mites, respectively, and resulted in 98.11% unhatched eggs without significant fruit quality reduction. Hot-water immersion could be a key component in a systems approach to control B. yothersi on imported citrus fruits from countries where citrus leprosis is present.

Humanitarian quarantine in practice: medicine, religion and leprosy in New Caledonia.

Medicine and religion worked in close synchronisation during the leprosy outbreak of New Caledonia (1890-1950). Once isolation of leprosy-affected people became mandatory doctors and missionaries came together to promote a particular form of medical practice that tied charitable zeal with cutting-edge medical research, developing a sophisticated set of medical practices that catered for the soul as well as the body. Such practices went hand-in-hand with ideas developed by doctors in the earlier stages of the epidemic about the way in which the disease had entered the Kanak (local Melanesian) population. Doctors and missionaries admitted that immoral colonial channels had upset the delicate balance of local social and biological rhythms. Yet they also believed that the highly contagious nature of the outbreak was linked to the inferior state of Kanak. This paper aims to highlight the way in which the leprosaria system in New Caledonia represented a double-edged moral high-ground within the French medical colonial narrative. It tracks the complex way in which emotionally charged arguments about contagion, science and spirituality constructed an ideology of humanitarian quarantine which was used to justify a highly aggressive form of medical biocontrol.

Historia de la profilaxis ante las enfermedades contagiosas. Medidas preventivas descritas en el Levítico / História da profilaxia contra as doenças transmissíveis. As medidas preventivas descritas em Levítico / History prophylaxis against contagious diseases. Preventive measures described in Leviticus

Introducción: Los capítulos 13 y 14 del libro de Levítico se centran en la actuación ante la lepra, enfermedad más temida a lo largo de la historia que enfermedades como la Peste Negra o la sífilis. El objetivo del presente artículo es analizar de forma exhaustiva las medidas preventivas de ambos capítulos frente a la lepra bíblica, sus consecuencias y su repercusión a lo largo de la historia. Método: Se examinaron los capítulos 13 y 14 del Levítico en tres versiones diferentes de la Biblia. Posteriormente se analizaron otros documentos de investigadores relacionadas con la temática y manuales de enfermedades transmisibles. Desarrollo del tema: Los hallazgos obtenidos destacan la utilidad de las medidas descritas para controlar la expansión de las enfermedades transmisibles, presentándose la cuarentena como la solución más óptima para promocionar el bienestar y la salud de la comunidad en aquel período, y la higiene era considerada un eje fundamental en este ámbito. Conclusiones: La aplicación de estas intervenciones ha producido beneficios notorios, especialmente en la reducción de la mortalidad, tanto en la población hebrea del período bíblico como en otras sociedades posteriormente, destacando algunas ciudades en durante la Peste Negra; y han instaurado pilares sobre las que descansa la epidemiología y salud pública actual (AU)

Introduction: Chapters 13 and 14 of Leviticus focus on performance against leprosy, most feared throughout history that diseases like syphilis Black Death or disease. The aim of this paper is to analyze thoroughly the preventive measures of both sections from the biblical leprosy, its consequences and its impact throughout history. Method: Chapters 13 and 14 of Leviticus in three different versions of the Bible was discussed. Later, other studies and manuals communicable diseases were analyzed. Development: The findings highlight the utility of the above measures to control the spread of contagious diseases, quarantine appearing as the optimal solution to promote the welfare and health of the community at that time, and hygiene was considered a cornerstone in this area. Conclusions: The implementation of these interventions has produced notable benefits, especially in reducing mortality in both the Jewish population of the biblical period and subsequently other companies, highlighting some cities during the Black Death; and they have formed the pillars on which rests the current epidemiology and public health (AU)

Introdução: Capítulos 13 e 14 de Levítico foco no desempenho contra a lepra, o mais temido por toda a história que doenças como sífilis Peste Negra ou doença. O objetivo deste artigo é analisar cuidadosamente as medidas de prevenção de ambas as secções da lepra bíblica, suas consequências e seu impacto ao longo da história. Método: Capítulos 13 e 14 do Levítico em três versões diferentes da Bíblia foi discutido. Mais tarde, foram analisados outros documentos e manuais de doenças transmissíveis relacionados com as doenças descritas na Bíblia. Desenvolvimento do tema: Os resultados destacam a utilidade das medidas acima referidas para controlar a propagação de doenças transmissíveis, quarentena aparecendo como a solução ideal para promover o bem-estar ea saúde da comunidade na época, e higiene foi considerado um marco na nesta área. Conclusões: A implementação destas intervenções produziu benefícios notáveis, especialmente na redução da mortalidade, tanto a população judaica do período bíblico e, posteriormente, outras empresas, destacando algumas cidades durante a Peste Negra; e eles formaram pilares sobre os quais repousa a epidemiologia atual e saúde pública (AU)

[Discussions regarding the reconstruction of the significance of leprosy in the post-sulfone period, Minas Gerais, in the 1950s]. / Discussões em torno da reconstrução do significado da lepra no período pós-sulfônico, Minas Gerais, na década de 1950.

From a historical viewpoint, all the elements surrounding a disease, from its name to the weight of meaning attached to it, are the result of "negotiations" in which many sections of society are participants. In the case of leprosy, the discovery of sulfones in 1941 made a significant contribution towards transforming our understanding of this disease, leading to questions being raised as to the measures adopted for its prevention and control, particularly the compulsory isolation of sufferers. On the basis of these assumptions, this article examines the debate which took place regarding the process whereby the old prophylactic procedures for the control of leprosy were replaced, in an important national journal, Arquivos Mineiros de Leprologia, in the 1950s.

Discussões em torno da reconstrução do significado da lepra no período pós-sulfônico, Minas Gerais, na década de 1950 / Discussions regarding the reconstruction of the significance of leprosy in the post-sulfone period, Minas Gerais, in the 1950s

Da perspectiva histórica, todos os elementos que envolvem uma doença, desde sua nomeação até a carga de significado que lhe é atribuída, resultam de "negociações" elaboradas por múltiplos atores sociais. No caso da lepra, a descoberta das sulfonas, em 1941, contribuiu de forma significativa para a transformação do entendimento dessa enfermidade, gerando um questionamento acerca das ações utilizadas para o seu controle/combate, sobretudo o isolamento compulsório dos doentes. Com base nesses pressupostos, este artigo analisa o debate que se constituiu acerca do processo de substituição das antigas práticas profiláticas para o controle da lepra, em um importante periódico de circulação nacional, Arquivos Mineiros de Leprologia, na década de 1950.

From a historical viewpoint, all the elements surrounding a disease, from its name to the weight of meaning attached to it, are the result of "negotiations" in which many sections of society are participants. In the case of leprosy, the discovery of sulfones in 1941 made a significant contribution towards transforming our understanding of this disease, leading to questions being raised as to the measures adopted for its prevention and control, particularly the compulsory isolation of sufferers. On the basis of these assumptions, this article examines the debate which took place regarding the process whereby the old prophylactic procedures for the control of leprosy were replaced, in an important national journal, Arquivos Mineiros de Leprologia, in the 1950s.

Beyond quarantine: a history of leprosy in Puerto Rico, 1898-1930s.

From biblical times to the modern period, leprosy has been a disease associated with stigma. This mark of disgrace, physically present in the sufferers' sores and disfigured limbs, and embodied in the identity of a "leper", has cast leprosy into the shadows of society. This paper draws on primary sources, written in Spanish, to reconstruct the social history of leprosy in Puerto Rico when the United States annexed this island in 1898. The public health policies that developed over the period of 1898 to the 1930s were unique to Puerto Rico because of the interplay between political events, scientific developments and popular concerns. Puerto Rico was influenced by the United States' priorities for public health, and the leprosy control policies that developed were superimposed on vestiges of the colonial Spanish public health system. During the United States' initial occupation, extreme segregation sacrificed the individual rights and liberties of these patients for the benefit of society. The lives of these leprosy sufferers were irrevocably changed as a result.

Politics of leprosy segregation in Japan: the emergence, transformation and abolition of the patient segregation policy.

The segregation of leprosy patients, a practice introduced early in the 20th century, was maintained in Japan after World War II. It locked in the viability of subsequent policy choices, and patients' isolation was sustained long after it was proven to be scientifically unnecessary. For leprologists and leprosarium directors, there was little opportunity to conceptualize and test the epidemiological validity and effectiveness of outpatient services as alternatives to the existing policy, since most of the patients were already hospitalized. Since leprosy was no longer a threat to the general public, bureaucratic officials, as well as legislators, lacked strong incentives to reformulate the overall policy. Within the Ministry of Health and Welfare, daily tasks were largely transferred to the section for leprosarium management, and the search for other options lost importance. For patients, long institutionalization elevated their dependency on life in leprosaria. These conditions must be emphasized as policy legacies, the results of past policies, since they posed obstacles to effective policy innovation in accordance with changing scientific knowledge. To make policies reflective of scientific knowledge, it is essential to understand and foresee the effect of policy legacy, when introducing and appraising public health policies.

Politics of leprosy segregation in Japan: the emergence, transformation and abolition of the patient segregation policy

The segregation of leprosy patients, a practice introduced early in the 20th century, was maintained in Japan after World War II. It locked in the viability of subsequent policy choices, and patients' isolation was sustained long after it was proven to be scientifically unnecessary. For leprologists and leprosarium directors, there was little opportunity to conceptualize and test the epidemiological validity and effectiveness of outpatient services as alternatives to the existing policy, since most of the patients were already hospitalized. Since leprosy was no longer a threat to the general public, bureaucratic officials, as well as legislators, lacked strong incentives to reformulate the overall policy. Within the Ministry of Health and Welfare, daily tasks were largely transferred to the section for leprosarium management, and the search for other options lost importance. For patients, long institutionalization elevated their dependency on life in leprosaria. These conditions must be emphasized as policy legacies, the results of past policies, since they posed obstacles to effective policy innovation in accordance with changing scientific knowledge. To make policies reflective of scientific knowledge, it is essential to understand and foresee the effect of policy legacy, when introducing and appraising public health policies.

[A brief discussion on ancient Chinese Infectious Hospital and setting down for the patients with infectious diseases].

The medical care and treatment of patients with infectious diseases began in the Yin-Sang dynasty is the earliest in Chinese character, indicating an idea of patients with infectious diseases kept in isolation ward. This character was found in Bronze inscriptious dated 3350 years ago. In the Spring and Autumn period, isolation ward for infectious disease patients was mentioned in Lun Yu. In the Qin dynasty, isolation ward for leprosy patients was mentioned by Qinjian from Yunmeng (Cloudy Dreams of Sleeping Tiger) in Hubei provice, which was called Liqiansuo. In the Eastern Han dynasty, infectious army hospital was set up --Yanlu. From the Six dynasties period to the Sui-Tang dynasties, clinical wards in the temples, and after the song dynasty--An Le Fang, An Ji Fang, Bao Shou Cui He Guan, Jiang Li Yuan, Yang Ji Yuan, Fu Tian Yuan etc, though not specifically set up for infectious diseases patients, all played an important role for the isolation, setting down and treatment of infectious diseases patients.

[The construction of epidemic station in Leipzig until the beginning of the present century]. / Der Bau von Infektionsstationen in Leipzig zu Beginn unseres Jahrhunderts.

Among three large medieval foundations: St George's Hospital (opened in 1212 as a shelter for the homeless and terminally sick), St John's Hospital (first mentioned as a leprosarium in 1278) and St James' Hospital (probably opened at the end of 15 c. as a shelter for the terminally sick) only St George's and St James' survived the changeable fortunes of Leipzig (though the latter was at a number of occasions destroyed and rebuilt at a different site). Particularly at the times of war and epidemics they were used as field hospitals. E.G. St James' since 1566 was used as a quarantine for the plaque victims. At the end of 19 c. Leipzig hospitals had practically no isolation wards. In 1871 as a result of small-pox, temporary building were constructed for infections patients moved later to St James'. The particular status of Leipzig as a trade, fair and transportation centre influenced a number of decisions concerning the prevention of epidemics whose introduction coincided with the state and land regulations dealing with observation of people suspected to be ill, isolating them and desinfecting objects of contact. The town archives disclose talks concering the construction of isolation stations at St James', in 1913 St George's was reopened. It had kept two buildings for the sick, mostly TB patients.

BC's "Island of death" marked a sad chapter in Canada's medical history.

Although the first case of leprosy in Canada was detected in 1815 in New Brunswick, the saddest chapter concerning the disease's history in Canada did not open until the late 1800s when leprosy was discovered among Chinese migrant workers on Canada's West Coast--a chapter that was not closed until 1957. Penelope Johnston relates the story of British Columbia's "Island of Death," where lepers used to be quarantined.