2 Danielssen, D. C. and Boeck, C. M. "Traitê de laSpedalskhed ou Elephantiasis de Grecs." Bergen: Ed.D. Bayer, 1847.

Darier, J. Compte rendu des travaux de la confer-ence internationale de la le.pre. Ann. Dermatol. Syph-ilogr. 7 (1897) 1149-1163.

FIG. 1. Gerhard Armauer Hansen.^FIG. 2. Daniel Cornelius Danielssen.

INTERNATIONAL JOURNAL OF LEPROSY^ Volume 62, Number 3

Printed in the U.S.A.

Reflections on the International Leprosy Congresses andOther Events in Research, Epidemiology, and

Elimination of Leprosy

THE FIRST ERATHE SCIENTIFIC ERA BEGINS

1873The scientific era of leprosy began in 1873

when Gerhard Armauer Hansen (Fig. 1)published his observation of Alvcobacteri-um leprue in materials from leprosy pa-tients) The principal opposition to Han-sen's view that leprosy was an infectiousdisease came from Daniel Cornelius Dan-ielssen (his father-in-law) (Fig. 2) and CarlWilhelm Boeck (Fig. 3) in "Trait& de la Spe-dalskhed ou Elephantiasis des Grecs" (Fig.

' Hansen, G. A. and Loft, C. "Leprosy." Bristol:John Wright, 1895.

4) 2 who considered it a hereditary disease.This book was the standard reference bookon leprosy from 1848 until the death ofDanielssen in 1895.

1897The I International Conference about

Leprosy was held in Berlin. 3 Rudolf Vir-chow (Fig. 5) is President; Hansen and Las-sar are Vice-Presidents. There were 180 par-ticipants at the Congress. William II,Emperor of Germany and King of Prussia,with the Empress, gave a reception at thenew palace at Potsdam, and both personallygreeted each member of the Congress. Thefirst resolution of the Congress was to createan international society against leprosy. Aresolution was put forth to follow the ex-perience of Norway in compulsory isolation

412

Fio. 3. Carl Wilhelm Bocck.

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Boeck.

FIG. 5. Rudolf Virchow.

of patients. Hansen explains that in 1856there were 2839 patients and following thepolicy of isolating known cases the numbersof patients had decreased to 321 by 1895.Leprosy is considered a disease producedby a microorganism; it is not hereditary; andit is possible to prevent it. 4 Schafer estab-lished that a leprosy patient, when speaking,sends up to 150,000 bacilli into his envi-ronment at a distance of 1.5 meters.

1909The II International Conference about

Leprosy was held in Bergen (Fig. 6). G. A.Hansen is the President. Segregation of lep-rosy patients is still recommended as wellas mandatory reporting of new cases. Mar-riage ofleprosy patients is allowed only aftervasectomy.

1923The III International Conference about

Leprosy is held in Strasbourg. The Presidentis Edouard Jeanselme (Fig. 7). It was feltthat the segregation of patients has to behumanitarian and has to allow the leprosysufferers to be near their families, if this iscompatible with an efficient treatment.

1926After long discussions on language pri-

ority, it is decided that a leprosy journal

4 Besnier, E. Role etiologique de l'heredit& et de latransmisibilit& dans la production de la l&pre. Rapportpresent& a la Conference de la Lepre, Berlin, Octobre1897. Ann. Dermatol. Syphilogr. 7 (1897) 1164-1172.

414^ International Journal of Leprosy^ 1994

,r^,„ II. INTERWIt.6J

0N9LE VIDE,SAPkIJCE LEPR9KONFEREINGE..71 BE R GEN IC, - 1$ /,,,usr 1909^Ernter reT 13AU Ai C7n1tv U.

FIG. 6. II International Congress, Bergen, 1909.

FIG. 7. Edouard Jeanselme. FIG. 9. Herbert Windsor Wade.

FIG. 8. Hans Peter Lie. FIG. 10. Pedro Luis Balina.

Editorial^ 41562, 3

,v■^COI^Attn:

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i.mix Du D;:uuttsuFIG. 11. Victor George Heiser.

AVE, ' HU/UW.3 DANS LE TEXTE

LT XII' Pl.:INCHES EN CUULEUBS HUHS.TEXTE

C.^11015f:DiTcrics

FIG. 14. Title page of 1934 Jeanselme book.

FIG. 12. Maximiliano Aberastury.

FIG. 13. Insignia of the newly formed InternationalLeprosy Association.

would be established, Lepra (Biblioteca Ia-teraationalis), and that it would be pub-lished in Manila (Hans Peter Lie and Her-bert Windsor Wade, Figs. 8 and 9,respectively) and also in London, New York

and Paris. Among the contributing editorsof Lepra was Pedro Luis Balina of Argentina(Fig. 10). A Societe Internationale de Lep-rologie is founded. The President is E. Jean-selme; the Vice-President is Victor GeorgeHeiser (Fig. 11). Among the ten HonoraryPresidents is Maximiliano Aberastury ofArgentina (Fig. 12).

1931The International Leprosy Association

(Fig. 13) is founded with new bylaws in Ma-nila. The President is V. Heiser: the Sec-retary is Robert Greenhill Cochrane.

1934"La Lêpre" by E. Jeanselme was the last

book of leprology which was predominantlyfrancophone (Fig. 14).

1938The IV International Congress of Leprosy

was held in Cairo (Fig. 15). King Faroukopens the sessions. Egypt is the country thatprovides the seeds of chaulmoogra, the onlytherapy ofleprosy for centuries. The Indian-

4-1

A

i. it.^.1^N S^•,,

416^ International Journal of Leprosy^ 1994

Oe_ - -De 4,1 .0e1 1), - 24/ - - -

FIG. 15. IV International Congress, Cairo, 1938. Included in this picture of some attendees arc the Argen-

tinians J. M. Fernandez (1), Mrs. J. M. Fernandez (2), Mrs. G. Basombrio (3), Mrs. P. Balifia (4) [in front andto her right, her son, Luis M. Balifia], G. Basombrio (5) and Dr. Migone (6) of Paraguay.

FIG. 16. Jose Maria Manuel Fernandez:

European classification faces the SouthAmerican classification with its indetermi-nate clinical form. The approved clinicalforms are LI, L2, L3, NI, N2, N3.

1939Jose Maria Manuel Fernândez (Fig. 16)

publishes the "Princeps" paper about BCG

in leprosy.' He recommends that leprosycontacts who are anergic to leprolin be vac-cinated with BCG in an effort to prevent thedisease. He points out that the Mitsuda re-action can be positive in individuals whohave not been exposed to M. leprae and, inthat sense, is not specific for leprosy.

1947Cochrane's first edition of "Leprosy in

Theory and Practice" becomes the standardreference book on leprosy (Fig. 17).

THE SECOND ERATHE AGE OF CHEMOTHERAPY

1948The V International Congress of Leprosy

was held in Havana° (Fig. 18). The Presi-

Fernandez, J. M. M. [Comparative study of theMitsuda and tuberculin reactions.] Rev. Argent. Der-matosifilogr. 23 (1939) 425-453.

6 Memoria del V Congreso Internacional de la LepraCelebrado en La Habana del 3-11 de Abril de 1948.

62, 3^ Editorial^ 417

OXFORD MEDICAL PUBLICATIONS

A PRACTICAL TEXTBOOKOF LEPROSY

BY

R. G. COCHRANEM.D., CI■^ D.T.M. A II. (LNG.)

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LONDON NEW YORK TORONTO1917

FIG. 17. Title page of 1947 Cochrane standard ref-erence book on leprosy.

dent of the Congress was A. Oteiza Seticn,and the President of the International Lep-rosy Association was H. W. Wade. With the

FIG. 19. Guy Henry Faget.

discovery of sulfones 7 by Guy Henry Faget,et al. (Fig. 19) at Carville, leprosy enters theage of chemotherapy. Stanley Stein (Fig. 20),The Star's founder/editor, starts a uniquecampaign at Carville to promote an edu-cated public opinion about Hansen's dis-ease (HD).

1953The VI International Congress was held

in Madrid 8 (Fig. 21). The President of the

' Faget, G. H., Pogge, R. C., Johansen, R. A., Dinan,J. F., Prejcan, B. M. and Eccles, C. G. Promin treat-ment of leprosy; progress report. Pub. Health Rep. 58(1943) 1729-1741.

Memoria del VI Congreso Internacional de Lep-rologia (Madrid), 1953.

FIG. 18. V International Congress, Havana, 1948.

418^ International Journal of Leprosy^ 1994

FIG. 22. Felix Contreras Doefias.

International Leprosy Association was H.W. Wade. The Coordinator of the localCommission was Felix Contreras Duelias(Fig. 22). Thiosemicarbazone appears as asecond chemotherapy agent. 13CG is rec-ommended. Leprosaria have to be replacedby outpatient clinics. The official classifi-cation which was approved is indetermi-nate, tuberculoid, dimorphous, and lepro-matous.

FIG. 20. Stanley Stein.

FIG. 21. VI International Congress, Madrid, 1953.

VII INTERNATIONAL 1 5 ''CONGRESS^ LEPROLOGY

62, 3^ Editorial

^ 419

FIG. 23. VII International Congress, Tokyo, 1958.

FIG. 24. Fernandez explains his theory of the in-terrelationship ofleprosy and tuberculosis at the TokyoCongress.

1958The VII International Leprosy Congress

was in Tokyo 9 (Fig. 23). It is necessary toend the practice of compulsory isolation ofleprosy patients and to avoid the institu-

FIG. 25. Charles C. Shepard.

tionalization of patients' children. J. M.Ferndridez, 5 President of the InternationalLeprosy Association, explains his early pas-sion for BCG and the inter-relationship ofleprosy and tuberculosis (Fig. 24).

1960Charles C. Shepard (Fig. 25) reports the

multiplication of M. leprae in the mousefoot pad. 1 °

10 Shepard, C. C. The experimental disease that fol-9 Transactions of the VIIth International Congress^lows the injection of human leprosy bacilli into foot

of Lcprology (Tokyo), 1958.^ pads of mice. J. Exp. Med. 112 (1960) 445-454.

420^ International Journal of Leprosy^ 1994

FIG. 26. VIII International Leprosy Congress, Rio de Janeiro, 1963.

1963The VIII International Leprosy Congress

was held in Rio de Janeiro" (Fig. 26). Lep-rosy is to be considered a disease like allothers. The term "leper" has to be elimi-nated. Social rehabilitation has to be donein the patient's home by an interdisciplinarymedical and paramedical team inspired bythe leprologist. John H. Hanks considers Al.leprae a challenge because Koch's postulateshave not been fulfilled.

" Memorias del VIII Congreso Internacional de Lepra(Rio de Janeiro), 1963.

1966Dennis S. Ridley and William H. Jopling

put forth a classification'' , 13 for researchpurposes: LL, LI, BL, BB, BT, TT (and In-determinate) or L.L., L.I., B.L., B.B., B.T.,T.T. (and Indeterminate).

12 Ridley, D. S. and Jopling, W. H. A classificationof leprosy for research purposes. Int. J. Lepr. 33 (1962)111-130.

" Ridley, D. S. and Jopling, W. H. Classification ofleprosy according to immunity; a five-group system.Int. J. Lepr. 34 (1966) 255-270.

FIG. 29. The armadillo (Dastpus novemcinctus).

Ninth h'entationalLepro ,;y Congress1968

IHRPH110111111FIG. 27. IX International Leprosy Congress, London, 1968.

FIG. 28. Paul W. Brand.

62, 3 421Editorial

EWA vialett.ft:sott#0`wW

THE THIRD ERAPHYSICAL, PSYCHOLOGICAL,

SOCIAL, AND ECONOMICREHABILITATION

1965Jacob Sheskin reports thalidomide is ef-

fective in type 2 leprosy reactions (erythemanodosum leprosum). 14

14 Sheskin, J. Thalidomide in the treatment of leprareactions. Clin. Pharmacol. Then 6 (1965) 303-306.

1968The IX International Leprosy Congress

was in London (Fig. 27). Paul Brand (Fig.28) made the point that physical rehabili-tation is now a "must" in leprosy treatment.In the field of psychological rehabilitation,Oliver N.V. Hasselblad points out that prej-udice is worse than ignorance. Thomas F.Frist performed exemplary work with SOR-

422^ International Journal of Leprosy^ 1994

FIG. 30. X International Congress, Bergen, 1973.

RI on labor, economic and social rehabili-tation while at Bauru, Brazil. Importantnews about the inoculation of ill. leprac inthe thymectomized and irradiated mouse isgiven by Richard J. W. Rees.' 5 Sheparcli°determines the efficacy of drugs and eval-uates therapies in the foot pads of normalmice.

1971The armadillo (Fig. 29) is reported to be

susceptible to disseminated infection withleprosy bacilli by Waldemar F. Kirchheimerand Eleanor E. Storrs.' 7

FIG. 31. Chapman Hunter Binford.

' 5 Rees, R. J. W. Recent bacteriologic, immunologicand pathologic studies on experimental human leprosyin the mouse foot pad. Int. J. Lepr. 33 Part 2 (1965)646-657.

16 Shepard, C. C. Considerations of the applicationof the foot pad technic in leprosy research. Int. J. Lepr.33 Part 2 (1965) 657-661.

" Storrs, E. E. The nine-banded armadillo; a modelfor biochemical research. Reprinted from: The Labo-ratory Animal in Drug Testing; 5th Symposium of theInternational Committee on Laboratory Animals,Hannover, 19-21 September 1972. Spiegel, A., ed.Stuttgart: Fischer, 1973.

1973The X International Leprosy Congress is

in Bergen's (Fig. 30). One hundred yearsafter the discovery of Al. leprae, the arma-dillo is presented as an animal model thatis affected more seriously than human be-ings (Storrs). With the introduction of ri-

' 8 Program of the X International Leprosy Congress(Bergen), 1973.

62, 3 Editorial 423

FIG. 32. XI International Congress, Mexico City, 1978.

LEPROSYINTERNATIONAL

I EPROSY CONGRESS

FIG. 33. XII International Congress, New Delhi, 1984.

FIG. 35. Mahatma Gandhi. FIG. 37. M. M. Gimenez.

fampin and clofazi mine, multidrug therapy(MDT) is born. And with thalidomide(Sheskin), type 2 leprosy reaction (erythemanodosum leprosum) now has an effectivetreatment.

1978The XI International Leprosy Congress is

held in Mexico (Fig. 32). The President of

424^ International Journal of Leprosy^ 1994

FIG. 34. Mother Teresa.

Leprosy

EDITED BY

Robert C. Hastings NU) 1'111)

Journal..) I ,imr, t 11E11,1^ni Me.11.,11c and A.Ilumt Proirss.r^ TuIane^C.,nwr,

Ncve Orleans. !mum., lt,lt

FOREWORD BY

Jacinto ConvitIltre.tur, Institut° N.Ion.1 Jr 171,1..1,, Cmacas. Vence.,

ririr]rimCHURCHILL LIVINGSTONEEDINist•RGII LONDON mliusouRNI: ANI) NEW YORK 1955

FIG. 36. Tide page for "Leprosy," edited by RobertC. Hastings.

1975Chapman Hunter Binford (Fig. 31) re-

counts a century of research for an experi-mental model for leprosy.

62, 3^

Editorial^

425

FIG. 38. XIII International Congress, The Hague, 1989.

the International Leprosy Association is Ja-cinto C. Convit." Leprosy, perhaps for thefirst time, is entering into the mainstreamof medical research. In immunology, for in-stance, viable BCG plus heat-killed IL lep-rae is useful for leprosy patients and theircontacts (Convit). The rights of the childrenof leprosy patients to have a normal life wasexpressed once more. 2°

1984The XII International Leprosy Congress

is in New Delhi (Fig. 33). Important Indianresearch work is recognized. The ICRC andthe "Mycobacterium IC' vaccines are prom-ising. Mother Teresa (Fig. 34) asks themembers of the Congress to cure patientsand to pray for them. Mahatma Gandhi (Fig.35) was very fond of nursing leprosy pa-

19 Convit, J., Aranzazu, N., Ulrich, M., Zuniga, M.,de Aragon, M. E., Alvarado, J. and Reyes, 0. Inves-tigations related to the development of a leprosy vac-cine. Int. J. Lepr. 51 (1983) 531-539.

20 Resolution of the XI International Congress ofLeprosy about children who are related to leprosy pa-tients and are still discriminated against.

FIG. 39. Michel F. Lechat.

tients. On one occasion he was invited tospeak at the inauguration of a new hospitalfor leprosy patients, and he expressed hisfeeling that he would be much happier if hehad been invited to the closure of a leprosy

426^ International Journal of Leprosy^ 1994

Buena Vista PalaceLake Buena Vista

Orlando, Florida, USA

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hospital. Now the Gandhi Leprosy Me-morial continues his work.

1985Robert C. Hastings's edition of "Lepro-

sy" becomes the new reference book to studythe disease (Fig. 36).

1987M. M. Gimenez (Fig. 37) and R.

Waisman 2 ' -24 report bacillemia in leprosypatients, contacts, and healthy medical andparamedical workers.

2 ' Gimenez, M. M. and Waisman, R. Bacteremia enlepra. Rev. Argent. Microbiol. (in press).

22 Waisman, R. Bacilemia e indice de infeccion sub-clinica. Actas Dermatosifilogr. Acad. Espan. Dermatol.78 Suppl. I (1987).

23 Gimenez, M. M. and Waisman, R. Comentariossobre la lepra preclinica. Paper which was awarded thePadre Fermin Arnau, Obra de San Lazaro, AcademiaNacional de Medicina Prize in 1988.

24 Waisman, R. Estudios de la bacilemia en pacientesde lepra bacteriolOgicamente negativos y en convi-vientes sanos. Bioquim. Chaquefia 2 (1991) 21-26, 28.

1989The XIII International Leprosy Congress

is in The Hague (Fig. 38). The President ofthe International Leprosy Association isMichel F. Lechat (Fig. 39). BCG is consid-ered a useful tool in the prevention andtreatment of leprosy, probably even moreuseful than in tuberculosis. There is a vastamount of experience with BCG, the vac-cine having been administered to 2 billionpeople worldwide. MDT is winning the firstbattles.

1993S. K. Noordeen, 25 Chief of the Leprosy

Section of the World Health Organization(WHO), reports that 4,600,000 patients havebeen treated with MDT from the pool of5,000,000 registered patients. These figuresare eloquent about the strategy that has beenchosen to obtain the goal of eliminating lep-rosy as a major public health problem by

25 Noordeen, S. K., personal communication, 1993.

62, 3^ Editorial^ 427

the year 2000. Elimination as a major publichealth problem is not eradication of the dis-ease, but is defined as maintaining a prev-alence rate (leprosy patients requiring che-motherapy) of less than 1 per 10,000inhabitants. The leprosy team is not to bedissolved, and we must not give up fightingthe disease.

1993The XIV International Leprosy Congress

is held in Orlando (Fig. 40). The Presidentof the International Leprosy Association isWayne M. Meyers (Fig. 41). WHO believesleprosy can be eliminated as a major healthproblem by the year 2000.

In summary, the International LeprosyCongresses are a useful and indispensableforum to provide an opinion of peers as tothe validity or fault of the results of studyand research in leprosy. There is no com-parable opportunity for a collective approv-al or disapproval of the results of one's per-sonal work in the field, especially anopportunity to discuss work that has beenpublished in those journals dealing predom-inantly with leprosy, the International Jour-nal of Leprosy, Leprosy Review, the Indian

Flo. 41. Wayne M. Meyers.

Journal of Leprosy, Revista de LeprologiaFontilles, and Acta Leprologica.

—Luis M. Baling, M.D., Ph.D.Professor of Dermatology

—Raul P. Valdez, M.D., Ph.D.Professor of DermatologyUniversity of Salvador

and Buenos Aires UniversityBuenos Aires, Argentina

Reprint requests to Professor L. M. Ba-lifia, Av. Alvear 1890, PB 1129 BuenosAires, Argentina.