Book review
La Lèpre. H. Sansarricq, Coordinator. Paris: Ellipses, 1995. Softbound, 384 pp., 87 figures, 47 color photographs, 29 tables in French. 280 French francs. ISBN 2-7298-9575-2. Available from: Ellipses-Edition Marketing, 32 rue Bargue, 75015 Paris, France.
The objective of La Lèpre, as stated in the Preface, is to establish an acceptable position between the heightened hopes and unresolved serious questions created by multidrug therapy (MDT) for leprosy. These questions revolve around several concerns: 1) that antibacterial therapy alone, without a vaccine, will not eradicate leprosy; 2) that prevention of disabilities will not receive adequate attention; 3) that the influence of HIV infection on leprosy is unknown; and 4) that research on all aspects of leprosy has an uncertain future. This reviewer is sympathetic toward these thoughts in view of what is perceived by some as a headlong rush toward MDT to the neglect of other aspects of the disease.
This work is intended to inform students, general physicians, public health workers, researchers and teachers about leprosy, especially those working in endemic countries.
The book is the product of 36 authors, and contains 39 chapters (plus 3 subchapters) that appear under six divisions: I. Introduction, II. Epidemiology, III. Clinical Aspects and Diagnosis, IV Immunology, V. Patient Management, and VI. Leprosy Control. Most authors are authorities well known to the worldwide community of leprosy workers, and all are widely known to French-speaking leprologists. A modest number of the authors are nationals of endemic countries.
This textbook covers the etiologic agent, clinical aspects, treatment, rehabilitation and control of leprosy in a clear and authoritative manner. The photographs, both color and black and white, are well chosen but of variable quality. Diagrams are clear and useful. The index, while short, will prove helpful.
In the nitpicking category there are a few minor points: 1) the reviewer is not aware of reports of naturally acquired leprosy in Dasypus hybridus (page 47); 2) there seems to be convincing evidence for the intrauterine transmission of leprosy but this is not mentioned; 3) Hayashi, in all probability, made the first observations on the lepromin reaction, rather than Mitsuda (page 159) (see IJL 21:370-372 and 347-358, 1953); 4) differential diagnosis should include streptocerciasis, especially for the benefit of francophone West and Central Africa (page 176), and 5) special mention of sexual promiscuity in leprosaria hardly seems warranted (page 194). As for the cover and binding, while rather sturdy, I wonder if they will long endure rigorous tropical climates.
It is indeed a pleasure to see a new book in French on leprosy in all its aspects. The reviewer recalls from his years as a leprosy specialist in the francophone countries of Central Africa the relative dearth of affordable up-to-date didactic resources in French. Thus, I am pleased to recommend this presentation by the eminent leprologist, Dr. H. Sansarricq, and his experienced collaborators. It is gratifying to note that the publishers, as a part of' the collection of the scientific publications of the "Universités francophones," are making the book available in some countries for as little as 25% of the original cost.
Much of this book, although intended for French-speaking audiences, carries a universal up-to-date message on the broader questions of leprosy that are accruing as we reach the year 2000. Occasionally the author's writings bear the earmarks of prophesy. I offer, for example, in free translation the book's final paragraph by Dr. Sansarricq: ". . . Certainly there will still be leprosy patients at the beginning of the 21st century. Perhaps even the elimination strategy will leave in its wake some foci that are difficult to eradicate. Without any doubt, there will be a real need for new diagnostic tools, new prophylactic methods, indeed new therapeutic regimens, for which only research can provide the answers. In view of these needs, support for basic research in leprosy must continue." - Wayne M. Meyers, M.D., Ph.D.