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韓國癩病의 疫學 및 社會復歸를 目的으로 한 患者分類에 關한 硏究

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 Studies on the epidemiology of leprosy in Korea and the classification for their social rehabilitation. 
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[영문] Leprosy is rather endemic in Korea, where the disease has been feared and disliked by most of the people. In 1948, author, for control of the disease in shorter periods of time, proposed to utilize patients own labor capacity based on the medical aspects, their labor ability and sociological factors. So-called "Campaign for Hope Village Movement" which was launched that year under the leadership of the Korean Leprosy Association was based on author's proposal for "A Classification of Leprosy Patients by Labor Capacity". Thereafter in 1953, clinical use of sulfone derivative, D.D.S. (Diamino-diphenyl sulfone) was begun for the patients in all leprosaria in Korea. In 1958, curability of the disease with D.D.S. was internationally accepted with the recognition at the 7th International Congress of Leprology. In those days, under the Compulsory Segregation Law, leprosy patients in Korea were still forced to reside in leprosaria in spite of the fact that a considerable number of patients were in the state of cure with labor capacity for self-support. These circumstances, scientific and sociological progress in the field, made author devise "A Classification of Leprosy Patients for Their Social Rehabilitation" to let leprosy problem emerge out of the dark shadows of the past. This new classification was derived from "Classification by Labor Capacity" which was proposed in 1948. This new classification was based on clinical, bacteriological, epidemiological and sociological data which were derived from the results of survey by author under the direction of Dr. Joon Lew, Professor of Microbiology Department. Its value and usefulness in the field were discussed in detail in the following chapters. Chapter 1 Epidemiological Studies of Leprosy in 1948 Around 1945, after liberation of Korea from the Japanese administration, many wandering patients became a nationwide problem which demanded an immediate solution. At that time, considerable number of leprosy patients were isolated in several leprosaria; 6,000 patients in So-Rok-Do Leprosarium, 700 in Ae-Yang-Won (Yowsoo), 750 in Ae-Rak-Won(Taegu), and patients more than 600 were in Sang-Ae-Won(Pusan) which was once closed under the Japanese administration. These patients out-numbered the total patients during the Japanese administration. Yet considerable nuber of leprosy patients were wandering all around the country. In epidemiological point of view, certain measures had to be done for these patients. In these days, the Korean Government had not yet been established, budgets were totally inadequate to cope with the problem, and leprosy was considered an incurable disease. As a preliminary step toward the control of the disease, with the assistance of fellow-workers of the Department of Microbiology, author carried out the first extensive survey of leprosy patients to accomplish epidemiological studies of the disease. Materials and Methods Wandering patients were surveyed to outline their exact number and to obtain epidemiological data. In 1948, wandering patients were scattered in 19 places throughout the country. They had their own organizations, in which leaders governed them. Visiting these centers of gathering and having close co-ordination of the leaders, extensive survey was carried out. In the survey of instigutionized patients, those in So-Rok-Do Leprosarium, Ae-Yang-Won (Yowsoo), Ae-Rak-Won (Taegu) and Sang-Ae-Won (Pusan) were chosen for the purpose. Results This survey includes only that information which was verified. For that reason, the totals shown in the survey do not always match other totals, the differences being attributed to the subjects of the survey. (Ⅰ) Estimation of the total number of the patients in 1948: As the result of the survey wandering patients were 4,387 non-institutionized known patient 5,575 in number, meanwhile isolated cases in leprosaria were 8,350. Author estimated a total number of patients to be approximately 40,000. (Ⅱ) Other epidemiological studies: (1) Types, age and sex distribution study; Comparative studies were also carried out. (2) Occupation; Comparison was made between leprosaria patients and wandering patients. Occupational change before, at the time of, and after the onset was also discussed. (3) Distribution by provinces; By this study, high and low endemic areas in Korea were disclosed. Changes in addresses before, at the time of, and after the onset were also surveyed. (4) Age of onset; It was found that, among 3,296 cases in this survey, 926 cases (29.7%) in 16 to 20, 809 cases (25.5%) in 11 to 15,516 cases (15.3%) in 21 to 25,331 cases (9.7%) in 26 to 30 and 294 cases (9.3%) were in 6 to 7 years of age in order of frequency. (5) Incubation period; Out of 2,808 patients only 156 cases (81 males and 75 females), those who could definitely remember the contact with other leprosy patients prior to onset were selected. Detatiled analysis of the results was attempted. (6) Seasonal difference in onset; Spring (Feb.∼Apr.) was the highest with incidence of 456 (32.2%), 387 (27.3%) in autumn (Aug.∼Oct.) 304 (21.4%) in summer (May∼July) and 269 (19.0%) in winter (Nov.∼Jan.). (7) Initial symptoms and sites of onset; Comparative studies were carried out. (8) Religion; Changes in religion before, after and at the time of onset were surveyed. (9) Schooling; Comparative study was made between schooled and non-schooled group in various aspects. (10) Medical care in community at the time and after onset. (11) Various beliefs about the disease; Survey was made regarding their superstition and belidfs on the cause of the disease. (Ⅲ) Classification of leprosy patients for their labor capacity; Based on the above-mentioned epidemiological data and the sociological circumstances in 1948, the following classification was devised to utilize self-supporting labor capacities of those wandering patients. A total of 2,009 wandering patients were surveyed, analysed and classified into five groups according to thier physical capacity for labor. Group Ⅰ : Very light cases; physically capable for heavy labor as normal person were 761 cases (37.8%). Group Ⅱ : Those, capable for enduring ordinary labor were 375 cases (18.7%). Group Ⅲ : Those, only capable for light labor were 530 cases (26.4%). Group Ⅳ : Those, able to do self-care but physically unable for labor at all were 35 cases (1.7%). Group Ⅴ : Far-advanced, disfigured or old patients who need someone else for care in daily life were 77 cases (3.9%). Group "N" : Indicates those who pretended to be or thought to be leprosy patients but normal 231 cases (11.5%) belonged to this group. Total of 1,897(94.4%) out of 2,009 cases surveyed had the physical capacities for some kinds of productive labor. This indicated the possibility of utilizing their labor capacities for their economical welfare and self-support of those wandering patients when unused acres of the countryside were allocated for them. Meanwhile they could have properly regulated medical treatment with less budgets. Under the socio-economical circumstances in 1948, author proposed this self-supporting isolation colony system could be a key to proper solution in taking care of those wandering patients. So-called "Campaign for Hope Villages", which was organized and developed all over Korea under the active leadership of the Korean Leprosy Association was entirely baed on the data of this survey. Until June 1950 when the Korean Civil Conflict broke off, "Hope Villages Movement" was able to accomodate approximately 5,000 wandering patients in 16 Hope Villages. Table 1. Classification of 2,009 Wandering Patients by Their Labor Capacity. ━━━━━┳━━━━━━━━━━━━━━━━━━┳━━━━━━━━━┳━━━━ Group │ Labor capacity │ Number of case │ % ─────┼─────────────┬────┼─────────┼──── │ │ N │ 231 │ 11.5 ─────┼─────────────┼────┼─────────┼──── Labor │Heavy labor │ I │ 761 │ 37.8 ─────┼─────────────┼────┼─────────┼──── Group │ │Subtotal│ 992 │ 49.3 ─────┼─────────────┼────┼─────────┼──── │Mod labor │ Ⅱ │ 375 │ 18.7 ─────┼─────────────┼────┼─────────┼──── │Light labor │ Ⅲ │ 530 │ 26.4 ─────┼─────────────┴────┼─────────┼──── │total │ 1,897 │ 94.4 ─────┼─────────────┬────┼─────────┼──── Non-labor│Able for self-care │ Ⅳ │ 35 │ 1.7 ─────┼─────────────┼────┼─────────┼──── Group │Unable for self-care │ Ⅴ │ 77 │ 3.9 ─────┼─────────────┴────┼─────────┼──── │Total │ 112 │ 5.6 ─────┴──────────────────┼─────────┼──── Grand total │ 2,009 │ 100 ────────────────────────┴─────────┴──── Chapter 2 Epidemiological Studies and a New Classification of Leprosy Patients for Their Social Rehabilitation in 1962. In 1953, administration of D.D.S. (Diamino-diphenyl sulfone) was started to those in all leprosaria and in Hope Villages as a drug of choice, and it actually produced many cured cases as it was recognized at the 7th International Congress of Leprology in 1958. In spite of these facts, considerable number of those cured cases were still in the state of isolation as leprosy patients, though they should had been freed and emerged into normal community as normal person. Their rights as healthy individuals were denied and they were forced to remain in leprosaria consuming considerable amounts of national budgets. This paradoxical condition led author develope a new classification of patients, so-called "New Classification of Leprosy Patients for Their Social Rehabilitation" which was based on the clinical, bacteriological, epidemiological and sociological data acquired. Materials and Methods Total of 19,980 cases in all national and private leprosaria and Hope Villages were surveyed with co-operation of fellow-workers of Department of Microbiology, fellow members of the Korean Leprosy Association and Korean Army military physicians. Filling up the formulated charts through detailed individual physical examination, results were analysed. Standards of Classification Cases were divided into two main groups, one those with positive bacteriological tests, and the other with negative. These two main groups were then subdivided into five classes (Ⅰ-Ⅴ) based on labor capacity, general appearance as leprosy patients and other sociological factors. Class Ⅰ : Appearance of normal person with normal labor capacity. Class Ⅱ : Suspicious appearance of leprosy patient with normal labor capacity. Class Ⅲ : Definite appearance of patient but with moderately impaired labor capacity. Class Ⅳ : Advanced cases with capacity only for light labor. Class Ⅴ : Cases, far-advanced and needing care. Results Survey of 19,980 cases in the year of 1962 by new classification was shown in Table 2. Table 2. Classification of 19,980 Patients for Their Social Rehabilitation ━━━━━━━━━━┳━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Bact. │ Positive / Negative ├──────────────────────────── Institution \ Grade │ Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ ──────────┼──────────────────────────── National Leprosaria │ 590 1,006 968 835 361 956 880 778 1,228 646 ──────────┼──────────────────────────── Private Institutions│ 625 29 464 412 114 2,690 2,000 1,391 863 263 ──────────┼──────────────────────────── Total(%) │1,215 1,735 1,432 1,247 475 3,646 2,800 2,169 2,091 909 │(6.8) (8.7) (7.2) (6.2) (2.4)(18.2)(14.0)(10.9)(10.5)(4.5 ──────────┼──────────────────────────── Grand Total(%) │ 4,382(22.7) / 1,722(8.6)/ 8,615(43.1) /3,000(15.0) ──────────┴──────────────────────────── Through this survey, cured cases, non-infectious to tohers with negative bacteriological tests, were found to be 8,615 cases; 43.11% (Class Ⅰ, Ⅱ and Ⅲ with negative smear). Children from leprosy parents were 1,833 cases (9.17%) and non-leprosy cases, 428 (2.14%) respectively. As a conclusion, at least 10,876 cases (54.4%) could either go home to join their families as healthy person or could settle in somewhere else without any possible spread of the disease to normal communities. So-called "Campaign for Resettlement Villages" of Korean Government and of the Korean Leprosy Association was originated from the data of this survey. Chapter 3 Re-classification of leprosy Institutions Based on these data, re-classification of leprosy institutions was proposed. 1. Hospitals for bacteriologically positive cases (Class Ⅰ, Ⅱ and Ⅲ of positive patients). 2. Hospitals for disabled cases (bacteriologically positive and negative Class Ⅳ and Ⅴ). 3. Hospitals for corrective surgery cases (bacteriologically negative Class Ⅱ, Ⅲ or Class Ⅰ). After surgical correction, they are to be sent to Resettlement Villages. 4. Resettlement Villages for bacteriologically negative Class Ⅱ and Ⅲ. 5. Society for bacteriologically negative Class Ⅰ. The above-mentioned "Campaign for Resettlement Villages" made total of 10,007 cases gather and engage in self-supporting living in 65 Resettlement Villages in Korea. This campaign not only gave leprosy patients self-maintaining and self-supporting life but also reduced the national budgets considerably for the control of the disease. This resettlement projects are to be expanded more in near future and are to have attention of International Congress of Leprology.
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