최근 5년간 나병의 병리조직학적 고찰

김지숙 ( Kim Ji Sug ),김명화 ( Kim Myeong Hwa ),최혜영 ( Choe Hye Yeong ),함정희 ( Ham Jeong Hui ),고영훈 ( Go Yeong Hun ) 대한피부과학회 2003 대한피부과학회지 Vol.41 No.8

N/A Background : In Korea, the prevalence of leprosy and the number of new indigenous cases has fallen. With this reason, the diagnosis of leprosy is not as easy as in the past and it became more dependent of the histopathologic features by skin biopsy. Object : The aim of this study was to document and analyze the clinical and histopathological features of leprosy in Korea. Methods : We carried out the clinical and histopathological studies on 90 leprosy patients who visited the Institute of Leprosy Control during the period from Jan. 1998 to Aug. 2002. Results : The results obtained were as follows. 1. Elongated granulomas which are frequently observed in the leprosy lesions, was not present in the 3 cases(18.7%) of T types, 2 cases(28.6%) of B types and 17 cases(27.9%) of L types of leprosy. 2. In the L type of leprosy, infiltration of foamy cells showed elongated(63.9%) or nodular(27.9%) patterns more than typical diffuse infiltrative pattern(8.2%). 3. Selective nerve involvement by lymphocytes was found in 2 cases of L types of leprosy. 4. In the B type and the L type leprosy, prominent nerve involvement and neural destruction was not found in 1 and 7 cases, respectively and sparse to mild infiltration of foamy cells was found in 71.4% and 34.4%, respectively. Conclusion : In the histopathological diagnosis of T type leprosy, elongated or even round granuloma, perineurial lymphocytic infiltration and nerve remnant in the granuloma was characteristic. As for L type of leprosy, we should know that in 1/3 cases, it can show only sparse to mild infiltration of foamy cells and there is no obvious nerve abnormalities. Therefore, these results suggest that many cases of leprosy can show atypical histopathological findings and we should take caution in the diagnosis of leprosy. (Korean J Dermatol 2003;41(8) : 1049~1056)

“나병은 낫는다”: “당신은 (이 사실을) 아십니까?” -잡지 『새빛』 수록 나병 계몽운동 자료 검토(1964∼1970)

한순미 구보학회 2019 구보학보 Vol.0 No.21

As we know, the Korean Hansen’s disease literature requires differentiated approaches from other types of literature due to the different historical, social, and political specialities that the lepers and Hansen’s disease experienced. Especially, literary works that emerged during the period of the leprosy enlightenment movement should be reviewed in the flow of leprosy enlightenment policy and movement. The purpose of this study is to examine the specificity of leprosy literature by reviewing the enlightenment materials in the magazine THE VISION published between 1964 and 1970, of course there needs more discussions in details. The full-scale study on the magazine THE VISION has not yet been made. it is not an easy task to examine the reality of the Enlightenment Movement, such as discussion, lecture, and advertisement. This was written in the process of thinking about how to approach the Korean Hansen's disease literature through the data of the leprosy enlightenment movement period. The magazine, THE VISION was published with the enlightening purpose to give a ‘new vision’ to ‘lepers’ in ‘the dark’. As the English title ‘Vision’ shows, the magazine began with the will to find hope in a desperate reality and to set a vision in the vision-less society. However, even under such a slogan of the enlightening movement, the social atmosphere did not change easily. It emphasized ‘enlightenment education’ to eliminate discriminative language and emotions, such as the term ‘Migama’[未感兒]. The social rehabilitation of lepers was still controversial. In this situation, leprosy enlightenment movement could go forward to the direction which was set originally? One thing to remember here is that the state of ‘ignorance’ about leprosy has become a standard for the boundary between Oriental medicine[韓醫學] and modern medicine, or traditional superstition and modern knowledge. Leprosy focused as the object of conquest and pioneering was not limited only to the problem of physical disease, and expanded to the problem of mental and cognitive dimension. Facing with the series of events caused by ignorance, the Enlightenment Movement presented medical common sense as an indispensable requirement to maintain a healthy life of daily life. The leprosy enlightenment movement has been made through mass media such as advertising, broadcasting, theater, movies, and public lectures such as medical classes and medical consultations since mid-1960s. The advertising included the ads such as “Do You Know (The Fact)?”, “Leprosy Heals”, and “Danger and Safety of Leprosy”. What we need to pay attention is that not only the leprosy but also disease were pointed as the ‘common sense of health’ that the public should learn. As the common sense of disease was regarded as the ‘knowledge’ to keep health, ignorance of disease was the object to ‘enlighten’. The characteristics and direction of Hansen's disease literature were decided according to the expert symposiums on leprosy, common sense lectures on leprosy, and ads of leprosy healing. ‘Leprosy Enlightenment Literary Works’[癩病啓蒙文藝作品], which the general readers participated in shows not only recognition change, but also the limitations of the public. It is expected that there will be followed further detailed discussions in the future. 알다시피 한국 한센병문학은 한센인과 한센병이 겪어온 역사적, 사회적, 정치적인 특수성으로 인해 다른 유형의 문학과 차별화된 접근을 요구한다. 계몽운동 시기에 나온 한센병문학은 당시 나병 계몽정책과 운동의 흐름 속에서 살펴야 한다. 앞으로 자세한 논의가 이루어져야겠지만 이 글의 목적은 우선 1964년부터 1970년 사이에 출간된 잡지 『새빛』에 수록된 계몽운동 자료들을 검토하면서 한센병문학의 특수성을 헤아려보는 것이다. 잡지 『새빛』에 관한 본격적인 연구는 아직 이루어지지 않은 상태다. 이런 상황에서 좌담회, 강좌, 광고 등을 통해 계몽운동의 실상을 살피는 작업은 결코 가볍지 않은 과제들을 안겨 준다. 이 글은 부족하게나마 나병 계몽운동 시기의 자료들을 통해 앞으로 ‘한국’ 한센병문학을 어떤 각도에서 다가갈 수 있을 것인가를 고민하는 과정에서 쓴 것이다. 잡지 『새빛』은 ‘어둠’ 속에 있는 ‘문둥이’들에게 ‘새빛’을 주기 위한 계몽적 성격을 표방하면서 출간되었다. 잡지의 영문 제목인 ‘비전(Vision)’이 지시하는 것처럼 절망적 현실에서 희망을 찾고 비전 없는 사회에서 비전을 마련하겠다는 의지를 안고 출발했다. 그러나 계몽운동의 구호 아래에서도 사회의 분위기는 쉽게 달라지지 않았다. ‘미감아’를 비롯해 차별적인 언어와 감정을 없애기 위한 ‘계몽교육’을 강조했으나 나환자의 사회복귀는 여전히 논란거리였다. 나병 계몽운동은 애초에 설정한 방향으로 나아갈 수 있었을까. 여기에서 한 가지 기억해둘 것은 한센병에 대한 ‘무지’의 상태가 한방의학과 현대의학, 전통적 미신과 근대적 지식의 경계를 나누는 기준이 되고 있는 점이다. 한센병은 단지 신체적인 질병의 문제로만 한정되지 않고 정신적, 인식적인 차원의 문제로 확장되었다. 무지로 인해 생긴 일련의 사태들 앞에서 계몽운동은 일상의 건강한 삶을 유지할 수 있는 의학적인 상식을 필수불가결한 요건으로 제시했다. 광고, 방송, 연극, 영화 등 대중매체, 그리고 의학교실, 의학상담 등 대중강좌들이 1960년대 중반 이후 나병 계몽운동의 한 축을 형성했다. 대중들의 인식을 개선하기 위한 방법으로 ‘대중강연’과 ‘광고’가 활용되었다. 광고 「당신은 (이 사실을) 아십니까」, 「나병은 낫는다」, 「나병의 危險과 安全」 등을 대표적으로 들 수 있다. 이 광고들에서 주의 깊게 보아야 할 것은 나병만이 아니라 질병을 대중들이 습득해야 할 ‘건강 상식’으로 초점화하고 있는 점이다. 질병에 대한 상식은 건강을 지키기 위한 ‘지식’으로 부상하면서 질병에 대한 무지함은 우선 ‘계몽’해야 할 대상이 된다. 나병 계몽운동 시기 전문가들의 좌담회, ‘나병 상식 강좌’, ‘한센병 치료 광고’ 등은 당시 한센병문학의 성격과 방향을 결정했다. 일반 독자들이 참여한 ‘나병 계몽 문예작품’은 일반인들의 인식 변화와 그 한계를 보여준다. 이에 관한 자세한 논의는 다음을 기약한다.

10년간의 의료기관 한센병 협력 진단 사업 성과 및 분석(2009~2018)

박진모 ( Jin Mo Park ),김희정 ( Hee Jung Kim ),김종필 ( Jong-pill Kim ) 대한피부과학회 2022 대한피부과학회지 Vol.60 No.2

Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. As leprosy has a long disease course, various dermatoses must be considered in the differential diagnosis. Objective: In Korea, due to the low incidence rate of leprosy and lack of doctors with experience of leprosy, it is difficult to make an early diagnosis. Therefore, we evaluated the importance of cooperation projects in the diagnosis of leprosy. Methods: A retrospective study was performed on 137 patients who were referred by other hospitals to the Institute for Leprosy Research, Korean Hansen Welfare Association, to make an early diagnosis of leprosy from 2009 to 2018. Results: Among 137 patients, 19 were diagnosed with leprosy, which accounted for approximately 37% of new cases of leprosy in Korea during the 10 years. By nationality, 15 were Korean, and 4 were foreigners. The most common type was lepromatous leprosy. All multibacillary patients were positive for phenolic glycolipid-1 antibody, M. leprae-specific gene polymerase chain reaction, and acid-fast bacilli stain. Among the four paucibacillary patients who showed both negative acid-fast bacilli stain and phenolic glycolipid-1, three were positive for polymerase chain reaction. Of the 55 skin biopsy specimens that were not diagnosed with leprosy, granulomatous skin disease was the most commonly diagnosed condition. Conclusion: In this study, we diagnosed patients with leprosy who were referred from other hospitals due to the suspicion of leprosy, which enables early treatment of leprosy. Finally, we believe that our project has public health significance in preventing the spread of leprosy in the community. (Korean J Dermatol 2022;60(2):75∼81)

한센사업에서의 재활사업에 대한 한센전문기관의 역할에 대한 분석

김종필,김연실,고영훈 대한나학회 2003 대한나학회지 Vol.36 No.2

Recurrent lepromatous leprosy in 68-year-old female

( Yong Se Cho ),( Jee Hee Son ),( Yun Sun Byun ),( Bo Young Chung ),( Hye One Kim ),( Hee Jin Cho ),( Chun Wook Park ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Leprosy is chronic disease by Mycobacterium leprae (M. leprae). M. leprae is gram-positive, intracellular, aerobic, acid-fast, rod-shaped virus well grows on 27-30 ℃ often found in tropical countries. There are five types; tuberculoid, borderline tuberculoid, borderline, borderline lepromatous and lepromatous leprosy. Borderline leprosy is most common and lepromatous leprosy shows symmetric nodules, plaques, thickened dermis, and frequently involves nasal mucosa resulting in nasal congestion and epistaxis, but, typically, detectable nerve damage is late. The prevalence and incidence rates in Korea were declined by active governmental management and multiple anti-leprosy agents. 68-year-old female presented with erythematous nodules on her forehead, both cheeks, and nose lasting for two year. Before visiting our department, she was erroneously treated with oral and topical steroid as granuloma faciale but had not been improved. In the interview, there was no specific past medical history. But, after diagnosis as lepromatous leprosy, we checked Korean Hansen Welfare Assocation (KHWA) and she has a past medical history of leprosy in 1968 which is treated with dapsone. We performed skin smear test, punch-biopsy with AFB stain from the nodule on her face and PCR for leprae DNA. Patient was diagnosed with recurred lepromstous leprosy. She was transferred to KHWA and treated with multi-drug treatment (dapsone, rifampicin, clofazimine)

나병의 병형에 따른 혈관신생

김보석 ( Bo Suk Kim ),박석돈 ( Seok Don Park ),김종필 ( Jong Pil Kim ) 대한피부과학회 2010 大韓皮膚科學會誌 Vol.48 No.4

Background: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. It has recently been reported that various clinical manifestations and treatments of leprosy are associated with increased angiogenesis. However, there are few reports on this topic. Objective: This study aims to examine the differences in angiogenesis according to clinical forms of leprosy. Methods: Thirty-three cutaneous lesions that represented the clinical spectrum of leprosy and 7 normal skins were selected for this study. Clinical forms of leprosy included in this study were 7 cases of tuberculoid (TT), 8 cases of borderline tuberculoid (BT), 8 cases of borderline lepromatous (BL), and 10 cases of lepromatous (LL) leprosy. A total of 40 sections of formalin-fixed, paraffin embedded tissues were investigated for Factor VIII-related antigen (FVIIIRA) expression using immunohistochemical staining. The number of FVIIIRA positive blood vessels in hot spot at a power of ×40 was observed by 2 independent dermatologists. Results: The number of vessels ranged from 4 to 12 (mean 8.43±2.64) in the normal cutaneous tissues, 23 to 38 (mean 28.86±5.46) in the TT, 46 to 71 (mean 56.50±8.68) in the BT, 49 to 77 (mean 64.75±9.82) in the BL, and 74 to 159 (mean 104.40±27.71) in the LL. The mean numbers of vessels in the BT, BL, and LL leprosy lesions were significantly higher than the mean number in the normal cutaneous tissues. Also, an overall increase was observed in the mean number of vessels from TT through BT, BL to LL leprosy lesions. Conclusion: We suggest that increased angiogenesis is associated with pathogenesis in leprosy. This study should prove helpful to future research into leprosy treatment. (Korean J Dermatol 2010;48(4):278~282)

S-100 염색 및 컴퓨터 보조 영상분석(Image Analysis)을 이용한 결핵양형 나와 유육종증의 감별

조영은 ( Jo Yeong Eun ),김명화 ( Kim Myeong Hwa ),최혜영 ( Choe Hye Yeong ),명기범 ( Myeong Gi Beom ) 대한피부과학회 2003 大韓皮膚科學會誌 Vol.41 No.10

N/A Background : Histologic evidence of destruction of a cutaneous nerve by granulomatous inflammation is a feature of tuberculoid leprosy. However, identifying remnants of the nerve in the granuloma may be difficult in some instances because of morphologic similarities with granulomatous dermatoses, such as sarcoidosis, lupus vulgaris, tertiary syphilis, etc. Object : The purpose of this study was to investigate the expressions of S-100 and EMA and to estimate area, thickness and density of nerves for differentiation truberculoid leprosy from sarcoidosis. Methods : Paraffin embedded tissues from patients of 11 tuberculoid leprosy, and 4 sarcoidosis were investigated for the expression of S-100, EMA and for the measurement of area, thickness, density of nerves by image analysis. Results : 1. S-100 staining in tuberculoid leprosy demonstrated fragmented, infiltrated, swollen nerves or the absence of dermal nerves(45.5%). 2. All of the detectable nerves were identified within granulomas from tuberculoid leprosy, but nerves from sarcoidosis were widely distributed over inside(33.3%) or outside of the granulomas, perivascular, and periappendageal areas. 3. There was no expression of EMA in skin lesions from leprosy, sarcoidosis, even in the site showing perineural thickening in S-100 stain. 4. The cross-section area and the thickness of nerves were decreased in order of tuberculold leprosy, sarcoidosis, and normal control group(p<0.05). 5. The density of nerves was decreased in order of normal control group tuberculoid leprosy, and sarcoidosis with statistical significance between tuberculoid leprosy and sarcoidosis. Conclusion : It is possible to differentiate tuberculoid leprosy from sarcoidosis by the observation of the morphologic changes with S-100 protein stain and the measurement of the cross-section area, thickness and density with image analysis.(Korean J Dermatol 2003;41(10 : 1332~1337)

최근 15년간(1992~2006) 대구 지역에서 진단된 나병의 임상 양상

김미혜 ( Mi Hye Kim ),신동훈 ( Dong Hoon Shin ),최종수 ( Jong Soo Choi ),김기홍 ( Ki Hong Kim ) 대한피부과학회 2010 대한피부과학회지 Vol.48 No.10

Background: The prevalence and number of new cases of leprosy have recently markedly decreased in Korea. Therefore, the concerns about leprosy have also gradually decreased. For this reason, making the diagnosis of leprosy is not as easy as it was in the past, and it is more difficult to find new cases of leprosy. Objective: The purpose of this study is to evaluate the epidemiologic and clinical features of recently diagnosed cases of leprosy in Daegu city, Korea. Methods: Fifteen patients were diagnosed with leprosy according to the clinical features, histopathologic findings and bacteriologic examinations at Yeungnam University Hospital from 1992 to 2006. The epidemiological and clinical features according to age, gender, the place of residence, the duration of disease, the location of lesions, the cutaneous findings and the type of disease were evaluated retrospectively using the patients` medical records. The patients enrolled in this study were divided by the Madrid classification: the lepromatous type, the tuberculoid type and the intermediate or borderline group. Results: Fifteen patients were diagnosed with leprosy during the past 15 years. The ratio of males to females was 1.5:1. Most of the patients (66.6%) were aged in their 40`s and 60`s. This shows that the rate of patients 40 years or older is on the increase. The male patients were younger than the female patients. The male patients were in their 20`s and 40`s, whereas the female patients` ages ranged from their 50`s to 80`s. The skin lesions showed various features and six (40%) of the 15 patients had sensory change. Eleven (73.3%) of the 15 patients were in the borderline group, followed by 3 patients with the tuberculoid type (20%) and 1 patient with the lepromatous type (6.7%). Conclusion: New leprosy patients have been persistently found and the findings of this study suggest that dermatologists play an important role in diagnosing and treating leprosy and they have to pay attention to diagnose new cases of leprosy. (Korean J Dermatol 2010;48(10):832~836)

메리놀 외방선교회의 동아시아 한센인 구호사업과 스위니(Joseph A. Sweeney) 신부의 활동

이민석(Lee, Min-Seok) 서강대학교 인문과학연구소 2021 서강인문논총 Vol.- No.61

메리놀회 선교사 스위니(Joseph A. Sweeney, 徐耀燮, 1895~1966) 신부는 1895년 9월 4일 코네티컷 주(Connecticut) 뉴브리튼(New Britain)에서 태어났다. 그는 1915년 메리놀회에 입회하여 1920년 2월 8일 대신학교를 졸업, 사제 서품을 받았다. 그리고 이듬해 중국 선교사로 파견되었다. 3년 뒤 1924년에는 평양 지목구 교구 설정 준비를 위해 한국으로 전임되었다. 스위니 신부는 1926년 비현 본당 주임신부로 부임하여 성당기지를 확보하고 교회 기초 작업에 힘썼다. 이듬해 다시 만주 푸순(撫順)으로 선교지를 이동하여 푸순 지목구 교구 설정 준비에 매진하였다. 1932년 푸순 지목구가 설정된 이후 스위니 신부는 1932년 메리놀회가 담당하는 광둥성 장먼의 한센인 구호사업의 담당 신부로 임명되었다. 그는 신후이 한센인 요양소와 하이먼 한센인 요양소(천국의 문)를 설립하여 한센인 구호 활동을 전개하였다. 그는 중일전쟁 기간에는 일본제국주의의 억압 그리고 1950년 이후에는 공산주의의 억압 속에서도 한센인 구호 활동을 계속하였다. 하지만 1953년 공산주의자들에 의해 억류되었다가 추방당하여 미국으로 돌아갔다. 미국으로 돌아간 스위니 신부는 본국에서도 한센병 연구와 한센병 구호사업에 열중하였다. 그는 1954년 한센병 치료에 공헌한 공로로 다미안 듀튼(Damien Dutton) 상을 받았다. 1955년 그는 평양교구장 서리이자 가톨릭구제회(N.C.W.C) 한국지부장 캐롤(George M. Carroll, 安, 1906~1981) 몬시뇰의 요청으로 한국에서 한센인 구호사업을 재개하였다. 그는 1956년 천주교구라회(Catholic Leprosy Service)를 창설하여 구호 활동을 전개하였다. 해방 후 한국전쟁을 거치며 총독부의 소록도 자혜의원을 통해 관리(강제격리) 되었던 한센인들이 ‘부랑나환자’가 되었다. 천주교구라회는 이들의 치료와 구호를 위해 힘썼다. 천주교구라회는 ‘나이동 진료반’을 조직하여 순회 진료를 하였다. 이를 통해 일제시기부터 해방 이후에도 계속된 한센인의 강제격리 치료가 재가(在家)로 전환하는 계기를 마련하였다. The Maryknoll Missioners Father Sweeney was born on September 4, 1895, in New Britain, Connecticut. He joined the Maryknoll Society in 1915, and was ordained a priest on February 8, 1920. The following year, he was sent as a missionary to China. Three years later, in 1924, he was transferred to Korea to prepare for the establishment of a parish in Pyeongyang. Father Sweeney was appointed as the head priest of the Bihyeon Cathedral in 1926, securing the base of the church and working on the foundation of the church. The following year, the missionary field was moved to Fushun of Manchuria, and prepared for the establishment of a parish in Fushun. After the establishment of the Fushun parish in 1932, Father Sweeney was appointed as the priest in charge of the leprosy relief project in Jiangmen, Guangdong Province, in charge of in 1932. He established a sanatorium for Leprosy in Xinhui and a sanatorium for Haimen, and carried out relief activities for lepers. He continued his relief work for the lepers despite the oppression of Japanese imperialism and the oppression of communism. However, he was detained by the Communists in 1953 and then deported and returned to the United States. After returning to the United States, Father Sweeney devoted himself to leprosy research and leprosy relief work in his home country. He was awarded the Damien Dutton Award in 1954 for his contribution to the treatment of leprosy. In 1955, he resumed the leprosy relief project in Korea at the request of George M. Carroll Monsignor, the head of National Catholic Welfare Conference(N.C.W.C) and the bishop of Pyeongyang. In 1956, he founded the Catholic Leprosy Service and carried out a leprosy relief project. After liberation, during the Korean War, lepers who were managed through the Sorokdo Jahye Clinic of the Government-General of Korea became ‘vagrant lepers’. The Catholic Leprosy Service worked hard for their treatment and relief. The Catholic Leprosy Service organized the Mobile clinics to provide medic al treatment. Therefore, the forced quarantine treatment of lepers, which continued from the Japanese colonial period to after liberation, provided an opportunity to switch to treatment at home.

나환의 기억과 서사적 욕망 : 맥락과 징후

한순미(Han Soon-mi) 국어국문학회 2010 국어국문학 Vol.- No.155

Leprosy holds severe complexity as a disease which should be considered in varied realms of the human body, the family, the ethnicity, the nation and self-others. Since lepers' pain and the history of leprous asylum pair closely throughout the history, individual experiences in leprosy are bound to sociopolitical and cultural-historical reflection which make the memories of leprosy have barely reproduced literary narratives. The article relates novels that appeared in 1960s in which medical research and enlightening movement for lepers, and the reclamation project in Omado for lepers' settlement took place. Paradise of Yours(1974-1976) by Chungjun Lee, The Island(1983) by Jungmo Yun and The Autobiography of a Ghost(2003) by Youngkook Ryu necessitate detailed pondering as they arouse political, ethical and historical issues by dealing with 'historical memory' of leprosy rather than simply taking leprosy as a mere theme. The differences among the processes taken for engendering leprosy narratives and the critical consciousness in them embody signs that require discrete analysis. The distinct ways three novels unwind "Norusanyang incident" indicate the differences among them, from which the writer's desire along with political and ethical foundation of the motif emerge. These novels address questions on destiny, community, history and otherness and contemplate the leads, maintaining slightly different approaches on 'stigma' of leprosy. The questions these novels face, however, are hardly settled and this explains why some narratives remain unfinished and have extended by-talks. However interpreted, these signs indicate the vacancy in historical memory and demand ethical rumination on the others in society. All these necessitate determined examination assuming various aspects on the novels dealing with the leprosy. Hopefully this study would be the ground-breaking work for them.