A Retirement TributeThe face of leprosy research has undergone a complete transformation fr om the grey days of the 1920's and 30's, when leprosy was of all diseases the most isolated fr om the main stream of medicine and of no appreciable interest to medical research workers as a whole.A small but highly dedicated company of leprosy specialists did, however, keep the flame of research alight, and British leprosy workers were prominent among them, fo stered over many years by the British Leprosy Relief Association.Leonard Rogers, Ernest Muir, John Lowe, Gordon Ryrie and Robert Cochrane were all well-known pioneers in the specialty .Rogers' and Muir's Leprosy was the standard textbook for over 20 years from 1926.This group, in common with international colleagues from across the world were almost all of them first and fo remost clinicians, as were their immediate successors.While able to bring highly sensitive powers of observation to clinical and pathological aspects ofleprosy, they were in the very nature of things unable significantly to penetrate the fundamental mystery at the heart of the disease, namely the precise nature of the leprosy bacillus and its behaviour in the human body in relation to the body's defences.By the 1950's things were changing.The science of microbiology was expanding rapidly.Cochrane's Practical Textbook of Leprosy, published in 1947, and still more, the first edition of his Leprosy in Th eory and Practice published in 1959 presented leprosy in a manner entirely in line with current thinking in general medicine, so robbing the disease of its isolation and awakening the interest of specialists in other disciplines to the fa scinating problems posed by almost every aspect of leprosy .It was at this opportune moment that the decision was taken to add a leprosy unit to the existing celebrated tuberculosis department at the National Institute for Medical Research at Mill Hill, London.Equal wisdom and fo resight were displayed in the decision not to introduce a specialist leprologist fr om overseas, but instead to give responsibility to Dr Rees, a brilliant member of the scientific staff of the Institute since 1947; an expert in the microbiology and pathology of tuberculosis.Dr Rees was thus able to approach leprosy problems both with an entirely open mind and against a firm background of general medicine.It quickly became.apparent that a new star had arisen in the leprosy firmament, and one of first magnitude.Under Dr Rees' leadership the leprosy
The 54th Annual Report of Lepra, presented at the Annual General Meeting in June 1978, covers the year 1977.It condenses into 20 pages the interest and concern for sufTerers fr om leprosy felt by many people in ali walks of life in Great Britain.1977 was a record year for income.The total of .f551,376was achieved by Broadcast appeals, house to house collections, flag days, exhibitions, donations and an astonishing range of social events involving much generous and sacrificial service and often a great deal of enterprise and ingenuity.This is
This report comes fr om the West Africa Leprosy Secretariat, P.O.Box 673, Freetown, Sierra Leone, following a Conference in July 1977 at which the participating countries were Ghana, Nigeria, the Gambia, Sierra Leone, Liberia and Togo.Workshop groups consisting of about 12 members, dealt with the fo llowing subjects-"Treatment and Control", "Health Education and Rehabilitation", "Training", and "The Role of Surgery", and the Report shows that they did this in a commendably practical way, giving every evidence of people talking about a problem, and about countries, which they know extremely well at first-hand.Under the first of these headings, it is heartening to see a section devoted to "The Follow-up of Patients Crossing Borders", with emphasis on the importance of a Transfer Certificate and the need to make treatment fr eely and easily available by International Agreement in the 6 countries concerned.Another heading which catches the eye is "How to Attract Indigenous Doctors to Work in Leprosy" and this is fo llowed up, in the Section on Training, with a detailed consideration of the "Future for Leprosy Workers", conc1uding that "recruitment of special staff for Leprosy Control, if required, should be at the same levei as that required for parallel cadres in the general health services" and that more attention should be fo cused on a career structure for leprosy staff.In the light of current concern about dapsone resistance, perhaps one of the most interesting paragraphs is on page 3, under " Suggestions for Combined Treatment".It is advised that multi-bacillary leprosy should be treated with combined treatment, dapsone being given in fu ll doses in all cases, together with another drug, but, unfortunately, as set out here, it is not c1ear if this should be rifampicin ar c1ofazimine, or both at the same time.The next sentence is remarkable: "Drug resistance is not a major problem but is present in West Africa-in a relatively small percentage of patients".The participants inc1uded a number of experienced observers, and the statement contrasts strangely with the concern that is currently being expressed by workers in, for instance, Ethiopia, and by WHO.
The 54th Annual Report of Lepra, presented at the Annual General Meeting in June 1978, covers the year 1977.It condenses into 20 pages the interest and concern for sufTerers fr om leprosy felt by many people in ali walks of life in Great Britain.1977 was a record year for income.The total of .f551,376was achieved by Broadcast appeals, house to house collections, flag days, exhibitions, donations and an astonishing range of social events involving much generous and sacrificial service and often a great deal of enterprise and ingenuity.This is
The 53rd Annual Report of Lepra, The British Leprosy Relief Association, covers the year 1976 and continues the story of dedicated service to the cause of the eradication of leprosy which has characterized Lepra from the beginning.The Report gives the main guidelines of policy pursued by Lepra and for which support is encouraged as : Leprosy research and the dissemination of information.Prevention and cure of Ieprosy, particuIarIy in children.The training, provision and support of indigenous medicaI staff workers.Assistance to Governments, WHO and other organizations in support of effe ctive Ieprosy work.Integrated controI schemes providing domiciliary treatment.In March 1976 Lepra became a ful! member of The InternationaI Federation of Anti-Leprosy Associations (ILEP), and is participating in the policy making and programme of this most important Organization.The control work undertaken by Lepra tends to be concentrated in certain areas, notably, Malawi, where Lepra is the co-ordinator for alI Ieprosy work ; Sierra Leone, with grants in aid to controI projects in Zambia, India and Uganda.The involvement of Lepra in leprosy research is important, with grants for individual projects at several centres, in addition to that undertaken at Oxford by Lepra's ClinicaI ConsuItant, Dr A. C. McDougal1.The encouragement of work among children has always been important to Lepra.In 1976 The Children's Fund brought help to 30,470 children with leprosy, 26, 149 of them in India.The encouragement of training for leprosy workers at ali leveIs is also basic Lepra policy, and this has actively been pursued.Support for Lepra from within the United Kingd om has greatly increased in recent years, and in 1976, for the first time total income exceeded i500,000.Substantial aid was given to anti-Ieprosy work in 18 countries; i208,000 was spent on leprosy control projects, i58,000 on treating children, nearly i22,000 on research, and i5300 on training personnel.
The 53rd Annual Report of Lepra, The British Leprosy Relief Association, covers the year 1976 and continues the story of dedicated service to the cause of the eradication of leprosy which has characterized Lepra from the beginning.The Report gives the main guidelines of policy pursued by Lepra and for which support is encouraged as : Leprosy research and the dissemination of information.Prevention and cure of Ieprosy, particuIarIy in children.The training, provision and support of indigenous medicaI staff workers.Assistance to Governments, WHO and other organizations in support of effe ctive Ieprosy work.Integrated controI schemes providing domiciliary treatment.In March 1976 Lepra became a ful! member of The InternationaI Federation of Anti-Leprosy Associations (ILEP), and is participating in the policy making and programme of this most important Organization.The control work undertaken by Lepra tends to be concentrated in certain areas, notably, Malawi, where Lepra is the co-ordinator for alI Ieprosy work ; Sierra Leone, with grants in aid to controI projects in Zambia, India and Uganda.The involvement of Lepra in leprosy research is important, with grants for individual projects at several centres, in addition to that undertaken at Oxford by Lepra's ClinicaI ConsuItant, Dr A. C. McDougal1.The encouragement of work among children has always been important to Lepra.In 1976 The Children's Fund brought help to 30,470 children with leprosy, 26, 149 of them in India.The encouragement of training for leprosy workers at ali leveIs is also basic Lepra policy, and this has actively been pursued.Support for Lepra from within the United Kingd om has greatly increased in recent years, and in 1976, for the first time total income exceeded i500,000.Substantial aid was given to anti-Ieprosy work in 18 countries; i208,000 was spent on leprosy control projects, i58,000 on treating children, nearly i22,000 on research, and i5300 on training personnel.
Leprosy is unique among infective diseases in the intensity and persistence of its emotional content. Every leprosy patient is a person under stress, and the doctor's acceptance of this and sympathetic reaction to it underlie any success we may achieve in dealing with this disease. The psychological aspects of leprosy thus need to be thought of in relation both to the patient and the doctor himself.
Self-healing forrns af le prosy account for a considerable proportion af patients suffering frorn diagnosable forrns of the disease arnong the deeply-pigrnented people of Africa.These lesions are described clinically; they are bacteriologically nega tive to standard rnethods of exarnination, and the histopathology is non-specific or frankly tuberculoid.The frequency is unsuspected unless whole-populatian exarninations are regularly undertaken.
A detailed study of the nose in cases of leproma tous leprosy was undertaken at Victoria Hospital, Dichpalli, India and the results correlated with the general clinicaI findings.The histological details of the study will be presented elsewhere.The signs and symptoms of nasal involvement are described and it is stressed that this involvement occurs early in the disease processo The importance of all leprosy workers being aware of nasal involveme nt is pointed out and it is recommended that facilities for local care of the nose in leprosy should be established wherever the disease is treated.Possible mechanisms whereby leprosy ma y be transmitted are discussed.
During the past hundred years, The Leprosy Mission has played a significant role in ali the major advances in the treatment of sufferers from leprosy.Sympathetic custodial care was at first the only way of helping the individual and of alerting the conscience of Christendom and of govemments.Workers of The Mission have been foremost in the use of modem medication, reconstructive surgery, domiciliary treatment schemes, rehabilitation, and vocational training, and have made important contributions to the literature of leprosy.The emphasis throughout has been compassionate caring for the individual afflicted by lepro s y.
The Director of one of the most efficiently run leprosy control projects in India, reviewing progress over a 17-year period, said recently, "Arter a few years work by survey, education, and treatment methodology, the decline in incidence comes to a halt, suggesting a new ecological balance between the host and the infective agent.Even though the quantt!m of (Ieprosy) infection is reduced, new cases go on appearing in almost equal numbers every year.This static condition may give way if more potent drugs and modified methods of work are discovered" (Nilakanta Rao, 1973a).This experience is shared by many other workers in Inclia.Indeed, Dr K. C.
Dr Duff behind the scenes.As sub-editor, Dr Duff brought to the Leprosy Review a lifetime of experience in medicai journalism , and the technical excellence of the Revie w has been due in large • -measure to his meticulous attention to detail.We offer him our sin cere gratitude, and best wishes for his retirement.At this moment in time it is perhaps appropriate to declare once again the reasons for the existence of this Journal.The Leprosy Review carne into being in 1930 to articulate and publ f ciie the basic concerns of the British Leprosy Relief Association ; namely, (a) the stimulation of research in leprosy, (b) the fostering of responsibility for the eradication of leprosy and the best possible care of those suffering from it, (c) the encouragement• of those actually engaged in leprosy control work, through communicating advances in knowledge and the sharing of experience relating to common problems.These basic concerns still stand, an d ali need to find expression in the pages of the Leprosy Review.On the research side the Leprosy Review has a distinguished recordo There are few substantial advances in leprology in recent times tl1at did not have their first notice in this Journal.It is fundamental that significant original work should be published without delay.There was a time when publication was possible within six weeks of the arrival of a contribution at the editorial office, as the writer knows from personal experience.Nowadays, printing and publication problems demand a minimum of two and a half months between the receipt of an article and its uItimate appearance in print.This period cannot appreciably be shortened, but in normal circumstances it need not be greatly exceeded .It wilI be our firm policy to' offer publication of original work acceptable to the Editorial Board with an absolute minimum of delay.The past 15 years have witnessed enormous advances in our scientific knowledge of leprosy.Not only has My co.leprae been rehabilitated.Its unique properties have captured the interest and imagination of bacteriologists and ímmunologists at many centres, and its ongoing study is in the mainstream of
