02225nas a2200217   4500000000100000008004100001260001700042653001100059653002600070653001100096653001200107653001800119653004000137100001600177245005000193856008800243300001200331490000800343520164200351022001401993       1986                            d  c1986 Jul-Aug10aHawaii10aHistory, 20th Century10aHumans10aleprosy10aUnited States10aUnited States Public Health Service1 aSoviero D J00aThe nationalization of a disease: a paradigm?  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477738/pdf/pubhealthrep00182-0061.pdf  a399-4040 v1013 a<p>The early history of the Federal involvement in Hansen's Disease reflects the history of the Public Health Service itself. As a young and aggressive institution, the Public Health Service sought out contagious, infectious diseases that threatened the public health. National resources and national coordination were needed to fight the likes of malaria, hookworm, or smallpox. The customary attack would consist of a field study, determination of the etiology, the method of transmission, and, then, perhaps, preventive measures. An eradication campaign would follow. Leprosy fit perfectly into the model--a disease of unknown etiology, an unknown method of transmission, thought to be highly contagious, and no known cure. The United States launched a major investigation in Hawaii, where the disease was prevalent and its victims conveniently segregated. The investigation failed. The Public Health Service then turned toward segregation and isolation as a way to fulfill its public health role. A bureaucracy was established around the idea that victims of leprosy must be incarcerated for the good of the public. The institutionalization of the Public Health Service and the philosophy upon which its treatment of leprosy was based proved difficult to change when researchers in the field made major scientific breakthroughs in the 1940s. The realization that the disease was only feebly contagious, activities of patient organizations, and pressure from the media and the Congress did not achieve as dramatic results as the sulfone drugs did. The Public Health Service moved, but slowly. What are the lessons in all of this?.</p>  a0033-3549