한국 나병의 관리 및 추세

Abstract

[한글]

[영문]

The origin of leprosy is lost in antiquity. Although the term is used freely in translation of the Old Testament, most leprologists do not belive the Hebrew word "zaraeth'" has been correctly interpreted. Certainly some of the lesions described

by Moses do not suggest leprosy as it is known today. Greek records of about 500 B.C. indicate a knowledge of the disease which was called "elephantiasis graecorum."

Various historian would consider India as being the cradle of leprosy. From the shores of the Indus, this dermatosis, according to tradition, spread itself out by the earth to entire Asia and to Egypt, whence, through the sea, Phenicians brought it to almost all countries of Occident.

Hippocrates (460 B.C.), the Father of Medicine, studied it and named it "Phoenicians" disease.

The earliest record of leprosy in Korea gose back to around the end of 13th century. By the end of World WarⅡ, under the Japanese administration, about 8,000 leprosy patients were institutionalized under the concept of segregation. By 1968,

a total of known, registered leprosy cases in Korea sums 37,571, among which 7,479 are institutionalized and 30,092 are being treated as domiciliary patients either at home or in settlement and in resettlement villages.

The modern western medicine was introduced to this country in early 20th century.

In 1909 Rev. Drs. W.H. Forsythe and R.M. Wilson founded the first private leprosarium in Kwangju and this was the very beginning of introduction of modern medicine into the treatment of leprosy patients in this country.

Dating the past two and a half decades, many significant progresses have been made in the treatment of leprosy. The greatest advances was the discovery that sulfone drugs were effective in leprosy. The sulfone drugs were introduced in this

country in 1953.

Since significant progresses have been attained in recent year in Korea.

In 1955, a leprosy out-patient clinic, and in 1957, a leprosy mobile clinic were started.

In 1963, the over-all compulsory segregation law abolished, and this resulted in a great shift from the previous compulsory institutionization of the patients, and leprosy out-patient akin clinics and University hospitals have been engaged in the treatment of domiciliary patients.

Following the initiation of leprosy mobile service by Catholic Mission in 1955, additional government or voluntary mobile teams have been established and these haute been actively participating incase finding, treatment of home-patients and publicity campaign in rural areas.

In response to sudden increase in the number of beggar leprosy canes appeared on the streets from hiding, due to loose administrative control in 1946, after the end of the World WarⅡ, the Korean Leprosy Prevention Association, the forerunner of

the present-day Korean Leprosy Association, was organized in 1947 by enthusiastic, volunteers, J. Lew, S.W. Bang and their collegues. This laid the fomndation social rehabilitation of cured ex-leprosy cases in this country. By 1968, Government and

Korean Leprosy Association have rehabilitated a total of 10,865 ex-leprosy cases in 68 resettlement or settlement villages.

By 1968, there existed six leprosy institutions, i.e., three of national leprosarium with 5,800 patients and three of private cripple institutions with 1,779 patients throughout the nation.

In this study, a series of studies i.e., extensive review on historical background of leprosy in Korea, analyses of the leprosy control and evaluation of clinical epidemiology and socio-economical aspects and the trends of leprosy in Korea for the past 21 years, i.e., soon after the liberation of this nation in 1948 up to the 1968 were carried out in order to define the future plan of operation and policy for control of leprosy in Korea.

Materials and Methoeds

A. Analyses of the leprosy control based on the governmental organization, policy making, budgetary allocation and effectiveness, governmental and private leprosy institutions and changing their status, activities by out-patient clinics and

mobile teams and rehabilitation of cured exleprosy cases.

B. Analyses of clinical epidemiology and the trends of the leprosy on the basis of data obtained from total number of known, registered cases, classification of type of disease, bacteriology, lepromatous rate, positive rate, present age and the age of the onset of the disease and relapse rate during the period of full 21 years from 1948 to 1968.

Results and Summary

With these extensive review on historical background of leprosy in Korea, author attempted to can out a series of analyses of the leprosy control, evaluation of clinical epidemiological survey and socio-economical aspects of leprosy in Korea during the period of full 21 years from soon after the liberation of this nation in 1948 to 1968 in this studies and hoped to clarify the recent trends in the epidemiology and to reevaluate the previous reports and to uncover some of hitherto unknown aspects in epidemics of leprosy in Korea.

The control of leprosy, there existed five national and three private leprosy hospitals until 1967, but two of national leprosariums were transformed into resettlement villages in 1968 and number of in-patients also reduced. There were 18,307 patients in leprosariums and colonies by the end of 1961, but only 7,479 patients remained in the leprosy hospital in 1968, 10,894 negative cured ex-leprosy cases have keen resettled in 62 villages during the past year.

The leprosy mobile teams, out-patient skin clinic and local health centers have been actively engaged in the case finding and treatment of domiciliary patients, thus economically more efficient and will have no problem of social rehabilitation and 19,092 cases are receiving domiciliary treatment in 1968.

Reconstructive surgery have been performed since 1962, and total 863 cases have received corrective surgery for deformities in leprosy.

Since 1960, the gradual and significant increases in the number of new leprosy patients are detected and registered to the authorities. This increses in the number of cases indicated that the public understanding on leprosy itself has been greatly promoted year by year.

The epidemiological studies, the classification of the disease types revealed that the lepromatous type occupied predominantly 80.5%: tuberculoid, 18.7% and indeterminate group, 0.8% in 1968.

The number of patients of lepromatous type leprosy has increased year by year and has become greater than that of tuberculoid type of leprosy. Bacteriological examination of the in-patients showed that 15.2% positive in 1968. This fact is

interpreted as that the epidemicity of leprosy in Korea has been decreasing, and that the effectiveness of chemotherapy and general immunity in community against leprosy has been lowered.

Survey on the age of the onset of the disease established that the peak shows between 15 and 19 years of age, also peak of present age group shows between 50 and 54 years of age. The peak of these delay will certainly provide a significant progress in the control of leprosy in Korea.

Throughout the studies, the leprosy problem in Korea is under controlled and it became more evident that early diagnosis and treatment of early cartes at the out-patient clinics and leprosy mobile teams are distinctly effective in the control of leprosy in Korea.