Beggars, metaphors, and stigma: a missing link in the social history of leprosy

Students of leprosy stigma are at odds over its sources, intensity, and current presistence. On the basis of a study of leprosy in Thailand that combined an archival survey with anthropological field-work, the present article offers a different thesis on these issues from those that have been proposed thus far. The thesis suggests that prior to the discovery of a cure for the disease, its sufferers encountered ambivalent rather than severly stigmatizing reactions. Yet the public's selective exposure-mainly to beggars with the disease-paved the way to the perception of leprosy as the epitome of stigmatization and to its transformation into a metaphor for degradation. Progress in the medical treatment of the disease significantly improved patients' social acceptance but also allowed them to keep their illness a secret. Their consequent disappearance from the public eye turned the figurative use of leprosy in the spoken language into the main source of shaping its image. This development contributed to the irrefutability and perpetuation of the negative image, and even to its intensification to the extent of utter divorce from concrete reality. After expounding this thesis, the paper discusses its potential contribution to resolving the disputes over the roots, severity, and persistence of leprosy stigma on the international level.

Les Aliénés voyageurs: how fugue became a medical entity

Dissociative fugue was first treated as a distinct psychiatric illness in Bordeaux in 1887, and was taken up by Charcot as automatisme ambulatoire in 1888. Charcot held that fugue episodes were caused by latent epilepsy; his opponents maintained an hysterical origin. The diagnosis flourished in France for more than a decade but, like the superordinate diagnosis of hysteria, had faded by 1910, although it was exported to Italy, Germany and Russia (but not the anglophone world). It was closely associated with vagrancy as a social problem, and military doctors tried to define the illness in order to protect deserters from punishment. Fugue was a companion to multiple personality, especially in respect of gender - most multiples were women, most fugueurs were men. Dissociative fugue provides a cameo illustration of how a psychiatric entity comes into being and then disappears.

[Development of immersion therapy in Mongolian medicine]

Being a tropical therapeutic measure, immersion therapy of Mongolian medicine includes mineral therapy, sebsu therapy, medical bath, liquid spraying and others. They have a long history and were recorded in Chinese or Mongolian medical works. Its provenance is closely related to the nomadic culture of the Mongolian plateau.

[Itinerant medicine in Fujian-Taiwan in early Qing dynasty and Zou Jie Hui Xin Lu]

By itinerant (zou jie), it refers to the physicians from southern Fujian and Taiwan who possess some special medical characteristics. They are TCM physicians. By chance, this author found a book, Zou Jie Hui Xin Lu, and explored its author and his native place, analyzed the historical background of the appearance of such physicians and their lofty medical morality during the Ming-Qing dynasties. Conclusion has been reached that the so-called itinerant medicine accumulated rich experience, emphasized an overall idea. However, it was also restricted by geographical area and the divorce of theory with practice.

The medical care programs of the Farm Security Administration, 1932 through 1947: a rehearsal for national health insurance?

At a time of renewed interest in universal health insurance, an examination of earlier periods when society grappled with the link between socioeconomic status and health is fruitful. Between 1935 and 1947, the federal government sponsored a comprehensive medical care program for low-income farmers, sharecroppers, and migrant workers under the auspices of the Farm Security Administration (FSA). Despite the strong opposition of the American Medical Association, humanitarian and economic concerns at the local level often promoted physicians' participation in the program's group prepayment plans. Many FSA leaders clearly saw the program as a model upon which national health insurance might advance. However, in the wake of World War II, the FSA program declined as physicians' income improved, the rural population declined, and traditional ideological objections to federal intervention in medical care resurfaced. The FSA experience illuminates the complex ideological, economic, and humanitarian motivations of American physicians in the face of health care reform.

[Coffee tree cultivation and the social history of onchocerciasis in Soconusco, Chiapas state, Mexico]

Due to the social and ecological changes that have taken place in the region of Soconusco, Chiapas, Mexico, the coffee tree growth economy (established in the latter part of the last century) has been an important factor in the transmission of onchocerciasis. The optimum ecological conditions for the growth of the coffee tree coincide with those of the disease's growth rate vector; the mobilization of migrant workers for the cultivation and gathering of coffee beans, plus changes in the natural environment, are elements which explain the disease's distribution in the different regions. The origin of the disease in Chiapas may be due to the migration of coffee plantation workers from Guatemala in search of land in which to settle. Social changes occurring after the Agrarian Distribution (land distributions that occurred in 1918 and 1940) caused an intensification and modernization in the areas of cultivation which in turn caused a decline in the disease's growth rate vector. This, together with standard of living improvements and control measures against the disease, explain why the problem in these regions has decreased considerably. The use of ivermectin as a new therapy paves the way for better disease control in the future. Nevertheless, in the smaller locations occupied by middle and poor class farmers, where coffee bean cultivation is just commencing and still in a rudimentary form, onchocerciasis and other diseases continue to present serious health problems.