Book reviews
Bergel, Meny. Metabolic Theory of Leprosy. Madrid: Institute of Leprological Research, 1998. Softbound, 214 pages. Order from: Prof. Meny Bergel, Institute of Leprological Research, Paraguay 1365-2, 1057 Buenos Aires, Argentina.
Prof. Dr. Meny Bergel founded the Institute of Leprological Research in Argentina over 50 years ago. With the constant financial support of his family, Prof. Bergel has studied leprosy extensively and concluded in 1960 that it is not caused by Mycobacterium leprae per se, but, rather, that it is a metabolic (auto-oxidative) disease and M. leprae are only incidentally present.
Most of Prof. Bergel's conclusions arise through a process of Socratic irony in which a question is put forth and a series of opinions or observations lead to his lack of acceptance of conventional explanations. He concludes that leprosy is a nutritional disorder associated with excessive auto-oxidation of organic lipids, and that treatment should consist of antioxidant diets. He considers M. leprae to be beneficial since they neutralize "pro-inflammatory hydro peroxides," and that they should not be killed.
These themes are repeated from somewhat different approaches throughout the book. There follows a list of 95 publications, including two previous books by the author, all dealing with the same theme of leprosy as a metabolic disease. Some 20 publications by other authors then follow which the author considers as supporting his views. The book concludes with a list of positions, memberships and honors of the author.
Unfortunately, the English translation uses "leper" extensively. I was unable to locate any original scientific data in the book. Note should be made that this book is privately published by the author's Institute of Leprological Research.
Obviously, Prof. Bergel is entitled to believe anything he wishes about leprosy. On the other hand, readers of this book may well be reminded of the advantages of peerreviewed publication.-RCH
Enarson, Donald A., Rieder, Hans L., Arnadottir, Thuridur, and Trébucq, Arnaud. Management of Tuberculosis; a Guide for Low Income Countries. 5th edn. Paris: International Union Against Tuberculosis and Lung Disease (IUATLD), 2000. Softbound, 84 pp. plus annex plus appendix of forms, black and white illustrations. ISBN 2-914365-00-4. Price not shown. For information on availability, contact: Editor, IUATLD, 60 Boulevard Saint-Michel, 75006 Paris, France.
"The Guide contains a description of tuberculosis and its identification. The treatment of tuberculosis and the organization and management of tuberculosis services and the structure within which such services can be delivered, even under the most stringent socioeconomic conditions, is outlined. The tuberculosis situation is evaluated, and the interventions designed to bring it under control are discussed. This fifth edition has been thoroughly edited. The order of presentation has been revised to provide a more logical flow of ideas. The new edition addresses issues that previously lacked explanation, most notably the resistance of Mycobacterium tuberculosis to medications and its impact on the management of tuberculosis.
"We hope this will be a useful guide for tuberculosis control for those who are valiantly shouldering the seemingly overwhelming task in remote rural areas and in overcrowded urban slums. It will also be of interest to health planners and coordinators as well as those in charge of training health workers."-Excerpt from the Preface by Prof. Dr. Josef Sayer, Executive Director, Misereor
Poriccha, D. Mycobacterium leprae Speaks with Grief. V. Ramesh, ed. New Delhi: Shriwal Advertising & Designing, 1999. Illustrated, 44 pp., RS. 75. ISBN 817525-123-9. Order from: Shriwal Advertising & Designing, 1812 Udai Chand Marg Near D.D.A. Market, N.D.S.E. Part-I, New Delhi, India, 110003.
D. Porichha, M.D., has had many years of experience in the pathology of leprosy. In a series of articles in the monthly bulletin on leprosy widely read by Indian field workers, Kusht Vinashak, he essentially translated the complex host-parasite interactions of leprosy into language that can be easily understood by field workers and laymen in general. And, in the process, he has masterfully injected enough humor to motivate the reader to read on. The captivated reader thus learns.
The story is told by M. leprae. The initial chapter, "The Entry," describes the perils of the bacillus making its way into the nasal tissues, of being able to get to the nose only by chance, clinging to a dust particle and happening to be in the air during inspiration. Then there are the perils of a sneeze happening before the poor bacillus can get comfortably into the nasal mucosa, and the chance of being swept away in mucus by cilia to ultimately die in the acid of the stomach after the mucus is swallowed.
With similar style the author then teaches the reader about inflammation, immunology, indeterminate, tuberculoid, and lepromatous leprosy (the last is the only chapter with M. leprae speaking with joy). The bacillus continues with descriptions of polyneuritic leprosy and concludes with treatment in a chapter called "From a Curse to a Cure." Throughout there are generous historical landmarks and personalities woven into this incredibly succinct narrative.
Dr. Porichha is to be congratulated on creating this masterful teaching tool and making it available for leprosy training.RCH
Ohtani, Fujio. The Walls Crumble; The Emancipation of Persons Affected by Hansen's Disease in Japan (a translation from the Japanese of The History of the Repeal of the Leprosy Prevention Law: Love Conquers, the Walls Crumble.) Tokyo: Tofu Kyokai Association, 1998. Hardback, black and white illustrations. ISBN 4-901097-10-5. Order from: Tofu Kyokai Association, Tsuji Building, 3rd Floor, 6-13-13 Shinbashi, Minato-ku, Tokyo 105-0004, Japan. Tel. 81-3-34320726; Fax 81-3-3432-0727. Our copy of the book was received with the compliments of Dr. Ohtani who dedicates his book to the International Association for Integration, Dignity and Economic Advancement (IDEA). The author indicates that the reader should make whatever contribution he/she feels appropriate to IDEA, and send to IDEA, P.O. Box 133, Oak Hill, WV 25901, U.S.A.
Ed. note: The Tofu Kyokai Association is a nongovernmental association established in 1952 under the sanction of the Japanese Ministry of Health and Welfare. The main objectives of the Association are to educate the public about Hansen's disease and to assist in the improvement of the life of Hansen's disease patients residing in sanatoria. It is also responsible for operating the HIH Prince Takamatsu Memorial Hansen's Disease Museum in Tokyo.
Fujio Ohtani, M.D., Ph.D., was born in 1924 in a farming village in Shiga Prefecture in the western part of Japan. He entered the University of Kyoto in 1941 to study medicine where he met Dr. Noboru Ogasawara, an assistant professor of dermatology. Dr. Ogasawara was said to have been the only person in all of Japan who was unyielding in his opposition to the official policies toward leprosy patients that resulted in their being involuntarily confined and sterilized. Dr. Ohtani had tuberculosis after World War II and was hospitalized for an extended period of time. In 1959 he began working in the Japanese Ministry of Health and Welfare where he rose to progressively more responsible positions, retiring as Director General of the Health Services Bureau in 1983. He is currently Chairperson of the Tofu Kyokai Association and Chairperson of HIH Prince Takamatsu Memorial Hansen's Disease Museum. He has written numerous books on public health in general and on AIDS, mental illness, and Hansen's disease.
In the author's notes for the English translation, he makes the point that when a person was diagnosed as having Hansen's disease in the past in Japan, others debased and hurt that person. The patients were treated as nonhumans and were forcibly confined and prevented from having chil dren. The author perceives this forced quarantine to be nothing less than an unjustified violation of human rights. The book is intended as a record of the effects on Japan of the Leprosy Prevention Law, through its several stages of amendments, and how it was ended.
In Chapter 1, there is a section dealing with Hansen's disease and medicine. The author feels that leprosy is essentially noncontagious, is now diagnosed early before any serious sequelae have developed, is rendered noncontagious within a few days of the start of treatment and modern treatment prevents any sequelae from ever developing. Perhaps this is true in modern Japan, but one must admit that approximately 600,000 new cases are detected annually on a global basis, many with significant disabilities at the time they are diagnosed.
A series of laws have been enacted in Japan dealing with leprosy. The first was Legal Ordinance No. 11 of 1907 (The Matter Relating to the Prevention of Leprosy). This underwent considerable revision in 1931 and became known as the (Old) Leprosy Prevention Law. The (New) Leprosy Prevention Law was enacted in 1953 and remained on the books until it was repealed in 1996. The author takes the position that the (New) Leprosy Prevention Law was unjust because it forced isolation of leprosy patients to sanatoria. The law delegates to prefectural governors the authority to confine patients who are diagnosed as having leprosy by a physician and "the patient is one for whom there is the fear of transmission of leprosy," In this the (New) Leprosy Prevention Law differed little from laws in various states of the United States at that time. In the section dealing with leaves from the sanatorium, leave can be granted by the sanatorium director for patients whose leave "will not be detrimental from the perspective of the prevention of leprosy. . . ." This is the same as laws in the state of Louisiana at that time. The law was generous regarding monetary compensation to the patients for any expenses they incurred as a result of their disease and, interestingly, provided for a prison term of up to one year and a fine of 30,000 yen ($83.33 at the time) for any sanatorium employee who breached medical confidentiality of the patients. The author takes the position medically that ". . . the incidence of Hansen's disease transmitted from one adult to another, is so low that it cannot really be called a communicable disease." From a human rights perspective, the author considers the law to be a violation of the human rights of a minority.
Some of the inmates of the leprosaria were afoul of the law before they were admitted, and they continued to engage in illegal activities after admission. In 1915, the Director of the Zensho Hospital, Dr. Kensuke Mitsuda, proposed that the directors of the sanatoria be given the authority to discipline and to restrain patients as needed and to create prison facilities in each of the leprosaria in order to contain the incorrigible patients. This authority was granted. It is interesting to note that the maximum period of confinement was 30 days. The author considers this a violation of the human rights of the patients.
In 1951 the National Leprosy Sanatoria Patients' Association was established as a democratic association of patients, the forerunner of the present day National Hansen's Disease Patients' Association or Zen Kan Kyo as it is abbreviated in Japan.
In most of the narrative and documents reproduced in the book the author uses his own records and experience, giving the book characteristics of an autobiography. To a casual reader the degree of detail is burdensome. To one intent on grasping all available detail on the history leading up to the repeal of Japan's (New) Leprosy Prevention Law the book will be rewarding. RCH