El mundo tuberculoso de Maxence Van der Meersch / The tuberculous world of Maxence Van der Meersch

Resumen Maxence Van der Meersch (1907-1951) fue un escritor francés cuyas novelas exponían las desigualdades sociales de la época. Entre ellas se destacan las asociadas con la tuberculosis, enfermedad frecuente, que aquejó a miembros de su familia y causó la muerte del autor. Las narraciones refieren las formas de presentación del mal, los métodos de diagnóstico, las actitudes de los pacientes y de su entorno, cómo afectaba a su situación laboral, los medios de subsistencia familiar y los recursos y complicaciones de los tratamientos. Al desarrollarse el argumento durante la llamada "era sanatorial de la tuberculosis" se retrata el acaecer en un sanatorio público. Se destaca la similitud de sucesos de la vida real del escritor y su esposa con los que se describen en parejas imaginadas en las novelas. El éxito de Van der Meersch fue opacado en sus últimos años por el agravamiento de su enfermedad y por críticas formuladas a algunos escritos. Resaltan las del cuerpo médico de esos años, que objetaron la crudeza del lenguaje, la inexactitud en la descripción de técnicas y, principalmente, por promover un objetado régimen antituberculoso.

Abstract Maxence Van der Meersch (1907-1951) was a French writer whose novels encompassed social inequities of the time. Among them, those related to tuberculosis are of special interest. This was a common disease that affected his family members and ultimately caused his death. In his narrations, the author refers to the various signs of the illness, the diagnostic methods, the patients' behaviour, their environment, how it affected their employment situation, the economic difficulties, treatment resources and complications. As the novels' plots are developed throughout the so called "sanatorial age of tuberculosis", the author describes the events occurring in a public sanatorium. The similitude among the situations lived by the writer and his wife, and those of the imaginary couples in the novels are highlighted. During his last years, Van der Meersch's success declined due to the complications of his illness, and because of the harsh criticism towards some of his writings. Particularly, the critiques posed by the medical professionals of the time, who rejected the raw language, inaccurate technical descriptions, and, above all, the promotion of an objected anti-tuberculosis regime.

Thomas Mann y las enfermedades infecciosas en la primera mitad del siglo XX. Parte II: Tuberculosis, cólera, trasplantes / Thomas Mann and the infectious diseases in the first half of 20th. century: second part: tuberculosis, cholera and transplants

Resumen Con seguridad Thomas Mann es hoy en día un escritor olvidado, para los infectólogos y para todo el mundo, con apenas un selecto grupo de poquísimos lectores entre nuestros jóvenes colegas. No les hará mal, a éstos y a aquéllos, sin embargo, adquirir algún conocimiento de las ideas sobre las enfermedades infecciosas en la primera mitad del siglo XX, período en que Mann escribió las obras aquí comentadas: por el contrario puede resultarles particularmente útil si este conocimiento les llega a través de la visión muy personal del germano, quien pone el foco más en el espíritu -la voluntad, el alma en suma- que en el componente físico de la enfermedad, en la miseria corporal, ignorando de paso, desdeñosamente, a las bacterias causantes.

Surely Thomas Mann is today a forgotten writer, with only a little and selected group of readers between our young colleagues. However, perhaps could be useful for the others some knowledge about his vision of the infectious diseases in the first half of the twentieth century, when he wrote the novels here reviewed. Typhoid fever, meningitis, syphilis, tuberculosis and cholera are present in Mann's thematic from Buddenbrooks till Doktor Faustus, always with a personal focus, more on spirit -the will to live- rather than flesh and bones... or bacteria. One of his lasts and minor works let us throw an ironical glance over transplant, no so named, indeed, by Mann, who speaks of "exchange". In this second part we present tuberculosis, cholera and…transplant.

Del "armamento antituberculoso" al Sanatorio para Tuberculosos de Huipulco en la Ciudad de México, 1920-1940 / The road from the "antituberculosis armory" to the Huipulco Tuberculosis Sanatorium in Mexico City, 1920-1940

Resumen Este artículo estudia las diferentes propuestas y estrategias para prevenir los contagios de la tuberculosis pulmonar implementadas en la Ciudad de México a partir de la década de 1920, al comenzar la primera campaña de largo aliento contra esa enfermedad, y analiza las limitaciones y problemas a los que ésta se enfrentó hasta 1940. Se destaca por qué la contención de los contagios de esa enfermedad ocupó un lugar prioritario después de diez años de guerra civil; se presta atención a los modelos y estrategias implementados y se examinan los problemas por lo que atravesó la construcción y el funcionamiento del Sanatorio para Tuberculosos de Huipulco, sustento clave de la lucha antituberculosa desde tiempo atrás a nivel internacional.

Abstract This article discusses the various proposals and strategies to prevent the transmission of pulmonary tuberculosis in the City of Mexico from the 1920s decade onwards, when it was launched the first long-term campaign against the disease, and analyses the limitations and challenges faced until 1940. It looks upon the motives that led the need to contain the transmission of the disease to occupy a dominant role after ten years of civil war; it focuses on the models and strategies implemented, and examines the challenges faced by the construction and operation of the Huipulco Tuberculosis Sanatorium, a key component of the fight against tuberculosis at the international level since long ago.

Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden

Background. Many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms long after completion of tuberculosis (TB) therapy, often resulting in numerous hospital visits and admissions.Objectives. To describe the profile of patients with chronic lung disease (CLD) with or without a history of PTB, and their in-hospital outcomes. Methods. We conducted a retrospective review of patients with CLD admitted with respiratory symptoms to Dora Nginza Hospital, Port Elizabeth, South Africa, from 1 April 2016 to 31 October 2016. These patients were divided into two groups: CLD with a history of PTB (CLD-TB) and CLD without a history of PTB. Patients with current culture-positive TB were excluded. Baseline characteristics and clinical outcomes (duration of hospitalisation and in-hospital mortality) were compared between the two groups.Results. During the study period, a total of 4 884 patients were admitted and 242 patients received a diagnosis of CLD. In the CLD patient group, 173 had CLD-TB and 69 had no history of PTB. Patients with CLD-TB presented with respiratory symptoms a median of 41 months (interquartile range (IQR) 101) after completion of TB therapy. CLD-TB patients were predominantly male (59.5%), and compared with patients with no history of PTB were more likely to be HIV-positive (49.7% v. 8.7%; p=0.001) and had had more frequent hospital admissions before the current admission (median 2.0 (IQR 2.0) v. 0; p=0.001) and longer hospital stays (median 5 days (IQR 7) v. 2 (4); p=0.002). However, there was no statistically significant difference in in-hospital mortality between the two groups (17.3% v. 10.1%; p=0.165).Conclusions. In patients with CLD, a history of PTB is associated with numerous hospital admissions and longer hospital stays but not with increased in-hospital mortality. TB therefore continues to be a public health burden long after cure of active disease

La Tuberculosis a través de la Historia: un enemigo de la humanidad / Tuberculosis through history: an enemy of mankind

Introducción: La tuberculosis es una enfermedad infectocontagiosa causada por el Mycobacterium tuberculosis, la cual representa un serio problema de salud. Se evidencia, a través de la Historia, la lucha del hombre en su afán de contrarrestarla y los estragos que la enfermedad ha causado y provocado innumerables muertes sin importar razas, edad, clases sociales, aunque si afectando en mayor medida a los más desposeídos. Objetivo: Describir algunos aspectos generales que caracterizan la historia de la tuberculosis y su efecto negativo sobre la salud del hombre, precisar la lucha de las instituciones de salud a nivel mundial contra esta enfermedad y aspectos del programa de prevención y control utilizado en Cuba. Material y Métodos: Se realizó una revisión bibliográfica en el período comprendido entre mayo y junio de 2015. Se evaluaron revistas de impacto de Web of Sciencies (43 revistas) y revistas cubanas. Se consultaron las bases de datos de sistemas referativos, como MEDLINE, PubMed y Scielo con la utilización de descriptores como tuberculosis pulmonar tuberculosis Infection. Se incluyeron artículos en idioma inglés y español, y publicaciones de los últimos 5 años. Se obtuvieron 55 artículos, y se circunscribió el estudio a 27 que enfocaron estas temáticas de manera más integral. Conclusiones: La tuberculosis es una enfermedad muy antigua y a pesar del avance científico y social alcanzado, continúa siendo un inminente peligro para la salud. Constituye un compromiso político de todas las naciones mejorar y desarrollar programas y servicios de salud para el mejor desempeño en la lucha contra esta enfermedad(AU)

Introduction: Tuberculosis is an infectious-contagious disease caused by Mycobacterium tuberculosis, which represents a serious health problem. The man´s fight against this disease has been evidenced through history. He has demonstrated his desire to control it and the damage it has caused such as uncountable deaths regardless race, age, and social classes; mainly affecting the dispossessed. Objective: To describe some general aspects that characterize the history of tuberculosis and its negative effect on man´s health, specify the fight of health care centers worldwide against this disease, and present prevention and control measures used in Cuba. Material and methods: A bibliographic review was carried out during the period between May and June, 2015. Impact factor journals from the Web of Sciences (43 journals), and Cuban journals were evaluated. Reference databases such as MEDLINE, PubMed, and SciELO were consulted using some descriptors such as pulmonary tuberculosis, and tuberculosis infection. Articles in English and Spanish languages were included, as well as publications of the last 5 years. A total of 55 articles were obtained, and the study was limited to 27 ones that focused these topics in a more comprehensive way. Conclusions: Tuberculosis is a very old disease and, despite the scientific and social progress achieved, it continues being an imminent danger to health. The development of programs and health services for best actions in the fight against this disease is a political commitment of all nations(AU)

El control de la tuberculosis en Cuba desde fines del siglo XIX hasta 1930 / Tuberculosis control in Cuba from the late 19th century to 1930

Introducción: la tuberculosis es una enfermedad infectocontagiosa de evolución aguda, subaguda o crónica, conocida antes del año 1000 a.n.e. Sobre la existencia de la tuberculosis en Cuba hay noticias desde 1630; el conocimiento de los médicos cubanos sobre el mal se presentó en las publicaciones especializadas. Objetivo: presentar los principales aspectos de la historia del control de la tuberculosis en Cuba. Métodos: se siguió le método histórico-lógico, apoyados en la revisión documental. Resultados: en Cuba la lucha contra la tuberculosis se inició a finales del siglo XIX; se presentan las acciones tomadas hasta el año 1930. A finales del siglo XIX se creó la Liga Antituberculosa, la cual a principios del siglo XX tomó carácter nacional; se construyeron dispensarios para el tratamiento ambulatorio de los enfermos; en 1907 el primer sanatorio para el tratamiento internado de los pacientes. Pero después de la segunda década los trabajos de la lucha tuvieron un decrecimiento. En la segunda mitad de la década del 20 se creó una cátedra específica para su enseñanza en la Escuela de Medicina e instituciones que reforzarían, al menos en teoría, el trabajo dirigido hacia la mejora de la situación de la enfermedad en la población. Conclusiones: durante los primeros años del siglo XX, se organizaron los primeros servicios para el tratamiento de la tuberculosis, se inició un incipiente control sobre la enfermedad. Aunque los servicios y acciones fueron insuficientes, constituyeron un intento de mejorar la situación enfermedad en la población(AU)

Introduction: tuberculosis is an infectious contagious disease of acute, subacute or chronic evolution. Known before the year 1 000 B.C., news about its presence in Cuba dates back to 1630. Cuban doctors' knowledge about the condition appeared in specialized publications. Objective: present the main aspects of the history of tuberculosis control in Cuba. Methods: the historical-logical method was applied, supported by document review. Results: the fight against tuberculosis started in Cuba in the late 19th century. A description is provided of the actions taken until the year 1930. The Anti-Tuberculosis League was founded at the end of the 19 th century, and acquired nationwide scope at the beginning of the 20th century. Dispensaries were built for ambulatory treatment. The first inpatient sanatorium was founded in 1907. However, after the second decade, the fight against tuberculosis witnessed a decline. In the second half of the 1920s, a specific professorship was created to be taught at the School of Medicine and institutions which would reinforce, at least theoretically, the work aimed at improving the status of the disease in the population. Conclusions: during the early years of the 20th century, the first services for the treatment of tuberculosis were created and incipient control of the disease was started. Insufficient as the services and actions were, they constituted an attempt to improve the status of the disease in the population(AU)

La tuberculosis en Rosario. Aproximaciones a una historia sociocultural de la enfermedad / Tuberculosis in Rosario. Approaches to a sociocultural history ofthe disease

En el año del centenario de la inauguración del edificio propio de la Liga Argentina contra la Tuberculosis, este artículo analiza en una primera parte las razones de su localización en la ciudad de Rosario a principios del siglo XX; y en una segunda parte el discurso a favor de este proyecto desde las páginas de la Revista Médica de Rosario con el objetivo de mostrar la existencia de una particular forma de entender la atención de la salud.

At the year of the centennial inauguration of the Liga Argentina contra la Tuberculosis house, this article firstly analyzes the purpose of its location in Rosario city at the beginning of the twentieth century; secondly, the speech from the Revista Médica de Rosario in order to show a particular way of understanding the health assistance.

A clausura enferma: petições para a saída do Convento da Ajuda no Rio de Janeiro para tratamento de doenças contagiosas, c. 1750-1780 / Disease in the cloisters: requests to leave Convento da Ajuda, Rio de Janeiro, for the treatment of contagious diseases, c. 1750-1780

Resumo O artigo discute os pedidos de freiras do Convento da Ajuda para deixar a clausura a fim de curar doenças contagiosas. O padecimento dessas doenças era considerado uma das poucas exceções para permitir a saída das freiras. As ordens femininas guardavam estritamente a clausura, condição necessária para manter o recato de virgens consagradas a Cristo. A documentação contém detalhes sobre as causas e as formas de transmissão das doenças, bem como sobre os tipos de tratamento para combatê-las. Por fim, os processos esclarecem os procedimentos adotados fora da clausura para as freiras não colocarem em risco o recolhimento e a honra, quando iam buscar em locais distantes o tratamento adequado para aquelas doenças.

Abstract This article discusses the requests submitted by nuns from Convento da Ajuda (Ajuda Convent) to leave their life of enclosure to receive treatment for contagious diseases. Disease was one of the few cases in which nuns were granted permission to leave. The female orders were strictly cloistered in order to preserve their purity as virgins consecrated to Christ. Extant documents detail the causes of the diseases, the ways they were transmitted, and the treatments used to fight them. These processes shed light on the procedures adopted outside the cloisters so that the nuns did not jeopardize their reclusion and honor when they went to distant places in search of treatment.

The History of Tuberculosis in Morocco

Whether TB was already spread in Morocco before the French protectorate or was it brought by foreigners; is an interesting debate in the medical history of Morocco. It was common among practitioners who were first interested in the health situation of Moroccans. TB; and especially its pulmonary form; was rather rare in Morocco [3]. In the 19th century; a medical doctor (Despine) who lived in Essaouira; declared the absence of TB in this Moroccan city; which was open for trade with Europeans very early in history

Gênese da atenção domiciliária no Brasil no início do século XX / Génesis de la atención domiciliaria en Brasil al inicio del siglo XX / Genesis of home care in Brazil at the start of the twentieth century

RESUMO Objetivo problematizar as condições de possibilidade para o aparecimento da atenção domiciliária no início do século XX no Brasil. Método estudo de inspiração genealógica sobre a atenção domiciliária. O material empírico foi constituído por dois documentos legais sobre o tema publicados no Diário Oficial. A análise documental utilizou as ferramentas analíticas poder, poder disciplinar e biopolítica, inspiradas em Foucault. Resultados foram elaboradas duas categorias: “Vigilância no domicílio: as enfermeiras visitadoras e a tuberculose” e “Registros: o aparelho político e econômico”. Considerações finais A tuberculose, a nova profissão das enfermeiras visitadoras, os registros produzidos pela vigilância e a análise minuciosa das cidades conferiram à atenção domiciliária um caráter de vigilância, inspeção e controle voltado a conduzir as condutas dos indivíduos.

RESUMEN Objetivo problematizar las condiciones de posibilidad para el aparecimiento de la atención domiciliaria al inicio del siglo XX. Método se trata de un estudio de inspiración genealógica sobre atención domiciliaria. El material empírico fue constituido por documentos legales sobre el tema, publicados en el Diario Oficial. El análisis documental utilizó las herramientas analíticas poder, poder disciplinar y biopolítica, inspiradas en Foucault. Resultados fueron elaboradas dos categorías analíticas, “vigilancia en el domicilio: enfermeras visitadoras y la tuberculosis” y “registros: aparato político y económico”. Consideraciones finales la tuberculosis, la nueva profesión de las enfermeras visitadoras, los registros producidos por la vigilancia, y el análisis minucioso de las ciudades configuran la atención domiciliaria con carácter de vigilancia, inspección y control para mejor conducir las conductas de individuos.

ABSTRACT Objective to discuss the conditions that enabled home care at the beginning of the twentieth century. Method study of the genealogic inspiration on home care. The empirical material consisted of legal documents on the subject that were published in the Official Journal. The documents were studied using analytical tools, such as Power, Discipline and Biopolitics, which were inspired in Foucault. Results two analytical categories were established, “home inspection: visiting nurses and tuberculosis” and “records: political and economic apparatus”. Final considerations tuberculosis, the new profession of visiting nurses, inspection records and the detailed analysis of the cities grant home care a nature of surveillance, inspection and control to conduct the behaviour of individuals.

Discursos sobre a tuberculose: estigmas e consequências para o sujeito adoecido / Discourses on tuberculosis: stigma and consequences for the subject ill / Discursos sobre la tuberculosis: el estigma y las consecuencias para el enfermo

O adoecimento por tuberculose é um processo subjetivo, que afeta a busca pelos cuidados de saúde. Esta pesquisa objetivou investigar como discursos sobre a tuberculose afetam o sujeito adoecido em tratamento hospitalar. Utilizando a abordagem qualitativa, foram realizadas entrevistas, em 2009, no município de João Pessoa - PB, com 16 doentes, sendo a maioria do sexo masculino, com idade média de 37,5 anos e ensino fundamental incompleto. O material foi organizado no software Atlas.ti e tratado segundo o referencial teórico-metodológico da análise de discurso francesa. Observou-se que aposição discursiva dos doentes de tuberculose entrevistados remete a um lugar de passividade, devido às formações imaginárias que o significam como um sujeito sem direitos reclamados, sofrendo, assim, um processo de apagamento e interdição. Em conclusão, foi identificada a necessidade de serem desenvolvidos modos de desestigmatização do ser doente de tuberculose, mediante a problematização de discursos cristalizados, particularmente nas instituições de saúde.

Falling ill with tuberculosis is a subjective process, which affects recourse to health care. The objective of this study was to investigate how discourses about tuberculosis affect the subject with tuberculosis undergoing hospital treatment. Sixteen tuberculosis patients, most of them male, mean age 37.5 years and incomplete fundamental education were interviewed, on a qualitative approach, in João Pessoa, Paraíba State in 2009. The material was organized using Atlas.ti software and analyzed within the the oretical and methodological frame work of French discourse analysis. It was observed that the discursive position of tuberculosis patients refers to a place of passivity, due to the imaginary formations that signify themas subjects with rights that are not claimed, and who the refore suffer a process of erasure and exclusion. In conclusion weidentified a need to develop ways to end the stigma attached to being ill with tuberculosis, by questioning discourses thathave crystallized, particularly in health care institutions.

Enfermarse de tuberculosis es un proceso subjetivo que afecta el recorrer a la atención de salud. Esta investigación tiene como objetivo investigar cómo los discursos sobre la tuberculosis afectan al enfermo en tratamiento hospitalario. Hacien do uso de un enfoque cualitativo, se han realizado entrevistas en 2009, en la ciudad de João Pessoa -PB, junto a dieciséis enfermos, en su mayoría hombres, cuyo promedio de edad era de 37,5 años y que tenían educación primaria incompleta. El material se organizó en el software Atlas.ti y fue analizado de acuerdo con el marco teórico y metodológico de análisis del discurso francés. Se observó que la posición discursiva de los enfermos de tuberculosis entrevistados remite a un lugar de pasividad, debido a las formaciones imaginarias que lo significan como un individuo sin derechos reclamados, sufriendo así un proceso de invisibilidad y prohibición. En conclusión, se identificó la necesidad de desarrollar modos de desestigmatización del serenfermo de tuberculosis, mediante la problematización de discursos cristalizados, en particular en las instituciones de salud.

Rudolf Krauss, Giovanni Noe y una instantánea de las enfermedades infecciosas en el Chile de 1930 / Rudolf Krauss, Giovanni Noe and a flash of infectious diseases in Chile, 1930

When there were giants on the earth, two of them, Rudolf Kraus and Giovanni Noe, met at the ancient Bacteriological Institute of Chile, and founded together a journal representing the principles of the institution. A nostalgic glance over the papers published therein for these so named giants lets us know a little about the study of infectious diseases in the thirties, when tuberculosis and malaria were two of the biggest problems for the world’s public health... then and now.

Cuando había gigantes sobre la Tierra, dos de ellos, Rodolfo Kraus y Juan Noé, austriaco el uno e italiano el otro, coincidieron por un tiempo en el antiguo Instituto Bacteriológico de Chile. Tuvieron entonces la idea de crear una revista que representara los fines de la institución y el progreso de la microbiología. Una mirada nostálgica sobre los artículos publicados en dicha revista, nos permite saber un poco sobre el estudio de las enfermedades infecciosas en los años treinta, cuando la tuberculosis y la malaria eran dos de los mayores problemas para salud pública en el mundo... entonces y ahora.

La tuberculosis y el vals criollo en la ciudad de Lima de las primeras décadas del siglo XX / Tuberculosis and vals criollo in Lima city during the first decades of the 20th century

En la primera mitad del siglo XX, en la ciudad de Lima, los médicos poco o nada podían hacer frente a la tuberculosis, la enfermedad crónica más prevalente y con mayor morbilidad y mortalidad. En general, la muerte por enfermedad era un fiel acompañante de la gente, especialmente de los pobres. La expresión popular sobre el enfermar de tuberculosis y morir se reflejó en dos sentidas piezas del vals criollo: Fin de bohemio (Pedro Espinel Torres, 1937) y No me beses (El tísico) (Luis A. Molina, c1940).

In the first half of the 20th century, in the city of Lima, the medical doctors did little or nothing against tuberculosis, the most prevalent chronic disease and its highest morbidity and mortality. Death from disease was a constant companion of the people, especially the poor. The popular expression about sick and dying of tuberculosis was reflected in two sensitive pieces of the vals criollo: Fin de bohemio (Pedro Espinel Torres, 1937) y No me beses (El tísico) (Luis A. Molina, c1940).

Nursing care in Tuberculosis patients at a Spanish sanatorium, 1943-1975 / Cuidados de enfermagem em pacientes com tuberculose em um sanatório espanhol 1943-1975 / Cuidados enfermeros en portadores de Tuberculosis en un Sanatorio español, 1943-1975

OBJECTIVES: the objective in this study is to identify the profile of the nursing staff, the work conditions and to describe nursing care at a sanatorium located in Barcelona, Spain between 1943 and 1975. METHOD: historical study undertaken between 2008 and 2010, based on oral sources, five direct and one indirect testimonies, and the analysis of written documents. The data from the testimonies were collected through semistructured interviews. RESULTS: the nursing staff, mostly religious women, had scarce material and economic resources and no preventive measures to take care of the ill. The nurses undertook activities centered on the basic needs for physical and spiritual wellbeing. CONCLUSION: The study reveals how the nurses, despite working in hostile conditions, attempted to safeguard the wellbeing of the patients and accompany them during the death process. .

OBJETIVOS: o objetivo deste estudo foi identificar como era o perfil dos enfermeiros, quais eram as condições de trabalho e descrever os cuidados de enfermagem de um sanatório, localizado em Barcelona, Espanha, entre 1943 e 1975. MÉTODO: estudo histórico, realizado entre 2008 e 2010, a partir de fontes orais, cinco testemunhas diretas e uma indireta, e a análise de documentos escritos. Os dados dos testemunhos foram coletados através de entrevista semiestruturada. RESULTADOS: verifica-se que os enfermeiros, em sua maioria mulheres religiosas, dispunham de recursos materiais e financeiros escassos, e não contavam com medidas preventivas para o atendimento aos pacientes. As enfermeiras realizavam atividades voltadas para as necessidades básicas de bem-estar físico e espiritual. CONCLUSÃO: o estudo revela como as enfermeiras, apesar de trabalharem em condições hostis, procuravam salvaguardar o bem-estar dos pacientes e acompanhá-los durante o processo de morte. .

OBJETIVOS: el propósito de este estudio es identificar cómo era el perfil del personal de enfermería, cuáles eran las condiciones de trabajo y describir los cuidados enfermeros de un sanatorio ubicado en Barcelona, España, entre 1943-1975. MÉTODO: estudio histórico realizado entre 2008-2010, a partir de fuentes orales,cinco testimonios directos y uno indirecto, y el análisis de documentos escritos. Los datos de los testimonios fueron recolectados mediante entrevista semiestructurada. RESULTADOS: se constata que el personal de enfermería, en su mayoría mujeres religiosas, dispuso de escasos recursos materiales y económicos, y no contó con medidas preventivas para el cuidado de los enfermos. Las enfermeras realizaron actividades centradas en las necesidades básicas de bienestar físico y espiritual. CONCLUSIÓN: El estudio revela cómo las enfermeras, a pesar de trabajar en condiciones hostiles procuraron salvaguardar el bienestar de los enfermos y acompañarlos durante el proceso de muerte. .

Insights from paleomicrobiology into the indigenous peoples of pre-colonial America - A Review

This review investigates ancient infectious diseases in the Americas dated to the pre-colonial period and considers what these findings can tell us about the history of the indigenous peoples of the Americas. It gives an overview, but focuses on four microbial pathogens from this period: Helicobacter pylori, Mycobacterium tuberculosis, Trypanosoma cruzi and Coccidioides immitis, which cause stomach ulceration and gastric cancer, tuberculosis, Chagas disease and valley fever, respectively. These pathogens were selected as H. pylori can give insight into ancient human migrations into the Americas, M. tuberculosis is associated with population density and urban development, T. cruzi can elucidate human living conditions and C. immitis can indicate agricultural development. A range of methods are used to diagnose infectious disease in ancient human remains, with DNA analysis by polymerase chain reaction one of the most reliable, provided strict precautions are taken against cross contamination. The review concludes with a brief summary of the changes that took place after European exploration and colonisation.

Análise paleogenética da tuberculose e perfil paleoparasitológico de populações do período histórico do Rio de Janeiro / Paleogenetic analysis of tuberculosis and paleoparasitological profile of populations of the historical period of Rio de Janeiro

A cidade do Rio de Janeiro foi o principal centro comercial e capital do país durante o período colonial brasileiro. A chegada de centenas de milhares de colonizadores europeus e escravos africanos à cidade desencadeou um crescimento urbano e populacional desenfreado. O objetivo do trabalho é avaliar o cenário paleoepidemiológico da tuberculose na população do Rio de Janeiro entre os séculos XVII e XIX através da análise paleogenética do complexo Mycobacteriumtuberculosis (MTC), bem como da análise do perfil paleoparasitológico e da ancestralidade humana. A infecção por bactérias do MTC foi identificada na população enterrada nos sítios arqueológicos analisados. A frequência de infecção observada foi de 53 por cento e 25 por cento em cemitérios europeu e africano, respectivamente. Os parasitos Trichuris trichiura, Ascaris sp., Taenia sp. e Enterobius vermicularis foram detectados através de técnicas paleoparasitológicas e paleoparasitológicas moleculares. O nematoide T. trichiura foi o mais comumente encontrado nos sítios arqueológicos estudados, demonstrando uma frequência de infecção de até 70 por cento.Estes dois últimos representam o registro mais antigo dessas infecções no país. A ancestralidade humana revelou uma proeminente contribuição da população europeia na dispersão da tuberculose na cidade, e confirmou a presença da infecçãoem escravos africanos recém – chegados ao país. O cenário de infecção portuberculose na cidade, assim como por parasitos intestinais, é discutido...

The city of Rio de Janeiro was the main commercial center and capital of thecountry during the Brazilian colonial period. The arrival of hundreds of thousands ofEuropean settlers and African slaves to the city triggered unbridled population andurban growth. This study aims to evaluate the paleoepidemiologic scenario oftuberculosis in Rio de Janeiro population between the seventeenth and nineteenthcenturies through paleogenetic analysis of Mycobacterium tuberculosis complex(MTC), as well as examining the paleoparasitologic profile and human ancestry. TheTB infection was identified in the individuals buried in archaeological sites. Thefrequency of infection was observed in 53 percent and 25 percent in European and Africancemeteries, respectively. The parasite Trichuris trichiura, Ascaris sp., Taenia sp. andEnterobius vermicularis were detected by paleoparasitolgical and moleculartechniques. The latter two represent the earliest record of these infections in thecountry. The nematode T. trichiura was the most commonly found in archaeologicalsites studied, showing an infection rate of up to 70 percent. The human ancestry revealed aprominent contribution of the European population in the dispersion of tuberculosis inthe city, and confirmed the presence of infection in African slaves. The scenario ofTB infection in the city, as well as intestinal parasites, is discussed...

Aspectos subjetivos do paciente ao diagnóstico de tuberculose e adesão terapêutica: contribuição à educação médica / Subjective aspects of the patient at diagnosis of tuberculosis and adherence: contribution to medical education

O abandono do tratamento da tuberculose (TB) continua a impactar os desfechos clínicos e poucos estudos abordam pacientes, médicos e alunos visando compreender os aspectos subjetivos envolvidos no tratamento. O objetivo deste estudo foi abordar os aspectos subjetivos do paciente com TB quanto ao diagnóstico e adesão terapêutica e relacioná-los às concepções de médicos e graduandos de medicina. Foram incluídos na pesquisa 23 pacientes, em seu primeiro episódio de TB pulmonar, selecionados por critério de saturação e, por exaustão, sete médicos preceptores e 15 alunos do quarto ano de medicina, no período de novembro de 2011 a dezembro de 2013, no ambulatório de TB do Hospital Universitário Pedro Ernesto, Rio de Janeiro. Os dados foram coletados por meio de entrevista individual semiestruturada, grupo focal, observação participante e registros em diário de campo. O referencial teórico utilizado foi o Interacionismo Simbólico, tendo como abordagem metodológica de análise a Teoria Fundamentada nos Dados, na qual priorizamos o eixo Estratégias de Ação/Interação e suas interseções emergidas das falas analisadas. [...] A categoria central do estudo Vivência de adoecimento e adesão ao tratamento, obtida por processo interpretativo, revelou as ações e interações definidas por categorização dos discursos e suas interseções. Nas falas dos pacientes emergiram as categorias estigma, autossegregação, dificuldades assistenciais; e mecanismos de defesa como: negação, racionalização, isolamento; outros mecanismos mentais, como culpabilização, responsabilização e da interação social, como o encobrimento...

The abandonment of the tuberculosis (TB) treatment continues to impact clinical outcomes.Few studies seeking to understand the subjective aspects involved in the treatment addresspatients, doctors and students. The purpose of this study was to address the subjective aspectsof the TB patient regarding diagnosis, therapeutic adherence and relating them to theconceptions of physicians and medical students. Twenty-three patients were included in thesurvey on their first episode of pulmonary TB, selected by saturation criteria, and exhaustion,seven preceptors doctors and fifteen fourth-year medical students, from November 2011 to August 2013 at the TB outpatient ambulatory of the University Hospital Pedro Ernesto(HUPE) of the Rio de Janeiro State University (UERJ). The data was collected through semistructuredindividual interviews, focal group approach, participant observation and records ina field journal. The theoretical background applied was Symbolic Interactionism, with themethodological approach of analysis, the Grounded Theory, prioritizing the axis ActionStrategies / Interaction and their intersections, emerged from the speech analysis. [...] The core category of the study The experience ofbecoming sick and treatment adherence, obtained by interpretive process revealed the actionsand interactions defined by categorization of speeches and their intersections. In the speech of patients emerged the following categories: stigma, self segregation, care difficulties, anddenial, rationalization, isolation, other mental mechanisms such as blame, accountability andsocial interaction as concealment...(AU) The assistance strategy category was related to physicians’practice in order to favor adherence. In the medical obedience category, students scored thegender difference as interfering factor for abandonment...

La mortalidad por tuberculosis en Argentina a lo largo del siglo XX / Tuberculosis mortality in Argentina during the twentieth century

El objetivo de este artículo es realizar un análisis de la curva de mortalidad por tuberculosis en Argentina a lo largo del siglo XX, desde 1911 hasta 2007. A partir de los datos obtenidos de diversas fuentes de carácter oficial se marcan las etapas históricas de dicha mortalidad, generando dentro de éstas subperíodos, a fin de entender el comportamiento de la mortalidad por tuberculosis, dependiendo del momento histórico. De esta forma, se vincula el desarrollo de la enfermedad con los dispositivos que se generaron para combatirla. Se realiza un análisis del comportamiento de la mortalidad por regiones del país, partiendo del supuesto que el desarrollo de la misma fue diferente según condiciones económicas y sociales y desarrollo sanitario.

The aim of this article is to provide an analysis of the mortality curve for tuberculosis in Argentina throughout the twentieth century, from 1911 to 2007. Using data from various official sources, the mortality rate is divided into historical phases and sub-periods, in order to show how the behavior of tuberculosis mortality depended on the historical moment. Thus, the progress of the disease is linked to the methods that were developed to combat it. The fluctuations in mortality are analyzed by regions of the country, on the assumption that mortality varied according to economic and social conditions and the development of healthcare.

Research on tuberculosis: 75 years of IBIT contributions

In 1937, the foundation year of the Brazilian Institute for Tuberculosis Research, three questions persisted in the researchers' mind: "What is the real value of BCG? How to solve the problem of the chest register of large communities? When will we have a specific drug for the treatment of tuberculosis?"; Along with this line of thought, the author presents a list of the Institute's main contributions, by pointing out the following topics: different diagnoses between pulmonary tuberculosis and pulmonary schistosomiasis; innocuity of iodine salts in pulmonary tuberculosis; relative value of Weltmann and Takata-Ara's reactions, and of blood and lipase rates in bacillosis; the value of the bacteriologic diagnosis (method of precipitation, standardization of drug sensitivity tests; identification of non-pathogenetic germs not only in the sputum but also in gastric Broncho-Alveolar Lavage, playing an important role in the infection tropics; probable protective role of BCG in tuberculin positive individuals; increase in awareness of the value of tuberculin; comparative studies of several types of tuberculin; clinical and epidemiological importance of nontoxic drugs; tuberculin surveys in Salvador and Feira de Santana cities; proposed classification of clinical forms of pulmonary tuberculosis; increase in the value of selective miniature chest radiography; standardization of radiological shadows; and tests on the therapeutic value of the drugs. To SILVEIRA, IBIT'S contribution can be summarized in eight points: importance of bacteriology in the diagnosis and therapeutic procedures; increase in the value of tuberculin tests; selective miniature chest radiography; possibility of replacing the hospital by an ambulatory care center; BCG vaccination; wide and general indispensability of a well-done and well-balanced therapeutic scheme; simplified treatment; progressive shortening of the treatment program; no over optimism about the first victories in the bacilli therapy.