[Health service organization during the age of pestilence. 2]. / Excursus sull'organizzazione dell'assistenza in tempi di pestilenza. Seconda parte.

The author presents the history of the places where patients with epidemic pathologies were isolated. Since the study of medicine began, such places have been known as asclepiei, xenodochi, hospices, lazarettos, sanitary cordons, and quarantine stations and they contributed to controlling epidemics in Europe. Important not only in the context in which they were created, these structures expressed the medical culture and point of view of that age. Although very far from discovering the cause of the pathology due to their lack of scientific knowledge, the medical class sometimes knew how to effectively organize the isolation of patients. The history of such structures interweaves with the long history of Christianity and with the emerging nations of Europe and the city-states of the Italian Renaissance. Previously, in classical Greece and Imperial Rome there had also been "homes for the sick" to isolate patients. Today the world is periodically hit by epidemics. In such moments the medical profession uses its research ability and organizational capabilities but also historical memory to reduce epidemic contagion.

[Multibacillary leprosy in Tyrol]. / Multibazilläre Lepra in Tirol.

Five cases of multibacillary leprosy have been diagnosed in a period of 15 years (1987-2001) at the outpatient Department of Neurology of the University Hospital Innsbruck. All patients presented with dermatological and mild to severe polyneuropathic signs and symptoms. 4/5 patients recovered fully, whereas 1 patient with an initially severe polyneuropathy showed persistent polyneuropathy as long-term sequela. The prevalence of leprosy in the catchment area of the Department of Neurology, University Hospital Innsbruck (comprising the entire province of Tyrol--650,000 inhabitants) is to be calculated as 0.5/1 million. The incidence of newly diagnosed leprosy within this province of Tyrol is 0.04/100,000/year. The aim of the presentation of these 5 patients is--beside the epidemiologic aspect--to alert all neurologists and dermatologists that this disease still exists--despite decreasing prevalence and incidence rates on a global scale; this is of particular importance since neurological long-term sequelae can only be avoided by early diagnosis.

Fighting leprosy and other endemic diseases.

As part of its 100th-anniversary celebration, the Pan American Health Organization has named 12 persons as "Public Health Heroes of the Americas" in recognition of their noteworthy contributions to public health in the Region of the Americas. Over the course of this year, the Revista Panamericana de Salud Pública/Pan American Journal of Public Health will be carrying pieces written by or about these heroes. Como parte de la celebración de su Centenario, la Organización Panamericana de la Salud (OPS) ha distinguido con el título de Héroes de la Salud Pública a 12 personalidades que se han destacado por su valiosa contribución a la salud en el continente americano. A lo largo de este año, la Revista Panamericana de Salud Pública/Pan American Journal of Public Health publicará una serie de escritos de los mismos galardonados o acerca de ellos.

A policy for leishmaniasis with respect to the prevention and control of drug resistance.

At the moment no country has a policy designed to control or prevent drug resistance in leishmaniasis. The risk of resistance is high in areas of anthroponotic visceral leishmaniasis, for example North Bihar, India, where the rate in some areas is 60%. Post-epidemic Sudan is also at risk. Zoonotic areas in which HIV co-infection is common could also be at risk as sandflies can become infected from co-infected individuals. Many factors determine the choice of drug for the treatment of visceral leishmaniasis, and drug resistance may not be the over-riding priority. In anthroponotic areas reduction in transmission through public health measures will be important, but the use of two drugs in combination should be seriously considered. Pharmacokinetic and other features of the drugs available, relevant to their use in combination are discussed and tentative suggestions made concerning trials of possible combinations. These include miltefosine plus paromomycin and allopurinol plus an azole. Lessons may be learnt from the experiences of similar problems in malaria, leprosy and tuberculosis. Guidelines are offered for the introduction of policies to use drugs in combination, which differ between anthroponotic and zoonotic areas of transmission.

Healthy imaginations: a social history of the epidemiology of Aboriginal and Torres Strait Islander health.

It is difficult to imagine Aboriginal and Torres Strait Islander health without the powerful descriptors of epidemiology. The statistical imagery of numerical tables, pie charts, and bar graphs have become a key element in the public presentation of Indigenous public health issues. Such quantitative measurements of health draw on the authority of neutral, objective science and are thus rarely questioned in terms of their social meaning. This paper traces the history of this imagery through the 20th century, providing a social account of epidemiological description. Historical notions such as social Darwinism, assimilation, and dangerous other are all seen to be woven into the epidemiological text. The enormous rise in the epidemiological description of Indigenous health problems in recent years needs to be analyzed as a social phenomenon and, in particular, as an aspect of emerging forms of governmentality. Finally, it is argued that such analyses are needed in order to promote an anthropology of epidemiology and to avoid limiting medical anthropology to applications within epidemiology.

La política sanitaria de la ciudad de Caracas / The sanitary policy in the city of Caracas (1830-1857)

Propone estudiar la política sanitaria instrumentada por el gobierno de la ciudad de Caracas, durante el período 1830-1857, para prevenir y evitar la propagación de enfermedades como la viruela, paludismo, fiebre amarilla, lepra, cólera que afectaron en forma de epidemias a la población venezolana y a la caraqueña, produciéndose un considerable descenso demográfico y perjudicando el deteriorado aparato productivo. (AU)

Recent trends in leprosy in a large district of West Bengal, India, revealed by a modified leprosy elimination campaign (MLEC), 1998.

A Modified Leprosy Elimination Campaign (MLEC) in September 1998 in the District of Midnapore, West Bengal, covered a population of 8.1 million people and detected 8181 new cases. Available data from 7328 cases were studied to observe the trend for leprosy in this area. Data are presented on sex and age distribution, classification and the proportions of multibacillary (MB), paucibacillary (PB) and single skin lesion (SSL) cases discovered in a period of only 8 days. The large numbers of people examined in this district and the high total of new cases revealed are in keeping with experience in other parts of the State and in other parts of India. However, many cases were found in endemic areas and these will receive special attention in a second MLEC, planned for January 2000.

Leprosy elimination campaign, Amazonas-Brazil 1997.

A leprosy elimination campaign (LEC) was carried out in 15 endemic areas of Amazonas State, Brazil, in 1997. The LEC concentrated effort to detect leprosy cases during a multi-vaccination national campaign for serious public health problems other than leprosy, such as polio, diphtheria, hepatitis, measles, etc. The national campaign involved intensive population mobilization, giving a valuable opportunity to examine people for leprosy. The LEC personnel included 2964 individuals (municipal and state health workers and community volunteers), distributed in 688 health units and 53 reference health centres. As a result of the LEC, 74,814 person-to-person communications in the community were given; 10,297 clinical skin examinations were conducted, and 40 new leprosy cases were detected on the day of the campaign in urban areas of the municipalities. This total was low, compared to results in other states of Brazil, possibly due to the development of health education activities and regular community services in the state of Amazonas since 1987 and to the early implementation of WHO multiple drug therapy (MDT) from 1982 onwards. Despite the fact that the LEC was carried out only in the urban areas of the municipalities, the finding of no cases of leprosy in 7 out of 15 of them was surprising and may indicate that the prevalence of hidden cases of leprosy is not all that high, at least in these areas of the Amazonas State.

Skrljevo disease--two centuries of history.

Skrljevo disease, also called Rijeka (Fiume) or Grobnik disease, by some physicians was first identified in the village of Skrljevo in Croatia in 1790. From texts dating back to the beginning of the 19th century it is clear that it was a non-venereal (endemic) form of syphilis and represented a great calamity for the local people and a problem for the physicians. The disease was considered by some to be lepra, scurvy, scabies or others. The occurrence of the disease in the region around Rijeka was closely associated with the poor socioeconomic conditions present at that time in the region. It is interesting to note that many of the greatest physicians of the time such as Alibert, Frank, Hebra, Sigmund were acquainted with the disease and dealt with it in their writings. This paper gives a brief chronology of the major political events in the region since that time, underlying the measures used in fighting the disease.

Results of a 1 year Special Action Project for the Elimination of Leprosy (SAPEL) in poorly accessible areas of Akwa Ibom State, Nigeria.

This article reports the outcome of a Special Action Project for the Elimination of Leprosy (SAPEL), including the implementation of multidrug therapy (MDT) in difficult situations in Akwa Ibom State in Nigeria. Twenty-two fishing villages and five communities in areas of gully erosion participated in the project from August 1996 to September 1997. Seven new cases were detected and treated with MDT. Twenty-one out of 22 defaulters examined resided in the mainland part of the project area and not in the fishing villages. Considerable difficulties were encountered with regard to the exorbitant cost of transport, physical attacks on the teams and the lack of reliable information on population figures for the project area. The discussion includes attention to the cost-effectiveness of the SAPEL approach under the conditions described and the need to develop better monitoring of treatment and community participation in poorly accessible areas.

Leprosy control in the Northern Territory.

An epidemic of leprosy occurred among Aboriginal people of the Top End of the Northern Territory following its introduction towards the end of the 19th Century. The extent of this outbreak became apparent through community surveys conducted in the 1950s which revealed that one in 10 Aboriginal people in some areas were affected by leprosy. Initial control activities were outbreak-focused, directed at case finding and management. Case finding was by systematic community survey. Case management included appropriate rehabilitation and reconstructive surgery. Regular review of treated patients ensured early detection of relapse and detection and treatment of sequelae. Education and full participation of Aboriginal health workers in the diagnosis and management of cases provided local expertise at the hospital and community level. The case detection rate fell from 270 per 100,000 in the Aboriginal population in 1951 to four per 100,000 in 1997. Elimination of transmission is now the objective of the control program. Combining of the tuberculosis and leprosy control activities of the Territory Health Service in 1996 resulted in increased efficiency of the mycobacterial services.