With this issue the International Journal of Leprosy is available on-line, beginning a new phase in its long and distinguished career. At such a juncture it is worthwhile to reflect briefly on the origins of the International Leprosy Association and this JOURNAL, to consider where we have come from as a guide to where we are going.
At the JOURNAL's birth in 1933, its founding editor, Dr. Wade, was working in what today would be considered near isolation, in the large leprosarium at Coulion in the Philippines, where more than a thousand patients lived. The JOURNAL was edited there for many years—without air conditioning, computers, telephone communication, or the internet. Leprosy was an incurable disease greatly feared even in medical circles, and the men and women who worked with patients and struggled to understand this disease were a dedicated lot indeed. Such isolation also meant a scarcity of information about recent developments in medicine, which had to wait long months while books and journals traveled by sea, then overland (often part of the way on pack animals) to reach the isolated hospitals. When Dr. Wade started the JOURNAL, its explicit mission was to alleviate this dearth of current information.
Then, as now, those who worked on leprosy would not be motivated by the more conventional desires for fame, fortune, or power, since leprosy work is a pursuit most unlikely to lead to any of these. Rather, the many persons who have dedicated major portions of their careers to work on this disease and its victims, and whose names can be found within the pages of this JOURNAL over the last seven decades, have been motivated by mixtures of altruism, burning curiosity, religious zeal, and just plain stubbornness in pursuit of this disease. (As those who have attended the International Congresses will attest, the ILA contains a collection of very colorful characters.)
These factors matter, because the attributes of altruism, curiosity, etc. are likely to be characteristic of those who carry this work forward in the 21st century, as well, even with improved treatment and better understanding of this disease.
During the middle decades of the 20th century the JOURNAL played an important part in disseminating important medical and scientific information about leprosy to those in the field as well as to scientists in research laboratories around the world.
Dapsone was discovered to cure this disease, giving health and hope to thousands upon thousands of patients around the world.
Terminology became more standardized, with the concept of an immunopathologic spectrum of host response at its epicenter, enabling effective communication between physicians and scientists everywhere.
An increasing number of scientists in endemic countries were trained, who were then able to take basic research to the bedside.
Surgical and rehabilitation techniques were developed that enabled patients to live more productive lives.
M. leprae were discovered to proliferate in the footpads of mice, leading to major advances in the testing of potential new therapeutic agents.
Scientific tools became more sophisticated:
Experimental infections of armadillos, and the resulting mass production of bacilli in armadillo colonies, enabled laboratories far removed from leprosy clinics to study, for example, the morphology, biochemistry, immunology, physiology, and ultimately the genetics of M. leprae, and to examine immune responses to its antigens with animal models and cloned cells.
Monoclonal antibodies and recombinant cytokines were applied to studies of human lesions as well as animal models.
Application of molecular technology has made the identification of M. leprae DNA in clinical specimens a feasible, reliable adjunct to diagnosis in difficult cases, and a further tool for epidemiologic research.
All experienced readers of this Journal will add many examples to this list and many other contributions to each category. Some of these developments have been reported directly as original papers in this Journal, and the others have been abstracted in its Current Literature section. Today, advanced research in leprosy is the subject of reports in the most prestigious medical and scientific journals in the world, employing technology and terminology beyond the wildest imaginings of Dr. Wade and his colleagues in the 1930's. Leprosy work has come a long, long way from its days of only supportive treatment and dogged research in isolated, under-equipped hospitals.
Leprosy is certainly not conquered, however, and a great deal of work remains to be done. This was emphasized in the ILA Technical Forum published in the JOURNAL one year ago, in the Resolution of the 16th International Leprosy Congress published in the last issue, and in the forums and seminars of the Congress that will be reported in more detail in this and subsequent issues, as well as in the discussions of the WHO Expert Committee that met in Geneva recently.
Those who undertake leprosy work today also face substantial information challenges, however, albeit of a very different kind. Medical and scientific information is now abundant, instantaneous, and overwhelming. Sorting it out, understanding the sophisticated techniques being used to dissect the pathogenesis of leprosy at the molecular and genetic levels, and learning how to apply this knowledge to the patient in the clinic are formidable challenges. A goal of the JOURNAL in the years ahead is to assist in these tasks. We will continue to do this through the familiar features of the JOURNAL—its Original Articles, Current Literature, and Correspondence—and we hope to add features to further assist readers in the compilation and comprehension of the surfeit of medical and scientific knowledge that bear on our work. The availability of the JOURNAL on-line, in a format that facilitates immediate access to cited papers in other journals, will continue to make it a prime resource for reliable, authoritative information about all aspects of leprosy.
As this is written the new web-site for the ILA is being completed. Please visit our site at www.leprosy-ILA.org. This provides the most convenient access to the JOURNAL on-line. You can also renew your membership, or join if you are not already a member of the ILA.
—DMS