Treatment of erythema nodosum leprosum (ENL, type 2 lepra reaction) with thalidomide is an effective alternative to steroid therapy, but Ministry of Health, Labour and Welfare (Japan) has only approved thalidomide (Thaled^® Capsule, Fujimoto Pharmaceutical Corp.) for the treatment of multiple myeloma under the Thalidomide Education and Risk Management System (TERMS^®) 2008. Then thalidomide was approved for ENL in 2012 by Ministry of Health, Labour and Welfare. Use of thalidomide for patients with ENL has already been established by various studies in other countries, but limited experience in Japan has hindered application of this medication to domestic patients. This led us to devise a guideline on the usage of thalidomide to treat ENL in Japan. Based on TERMS^®, we suggest that administration of thalidomide for ENL should be started at 50-100mg/day p. o. before going to bed and then the dose should be adjusted according to the patient’s symptoms, while not exceeding the maximum recommended dose of 300mg/day.

　ハンセン病はらい菌による感染症であるが、伝染病ではなく、むしろ宿主の免疫状態や反応によって病像が決まる「免疫病」とされる。同時に、「遺伝病」ではないが、宿主の遺伝的素因も大きく関与する。本稿では、免疫異常の病態を2つの「免疫ベクトル」で二次元的に展開し、筆者がこれまで経験してきたサルコイド様肉芽腫性病変を伴う原発性免疫不全症、遺伝性自己炎症性疾患であるブラウ症候群、鑑別が重要なサルコイドーシスなどとともに、類結核型とらい腫型のハンセン病をその平面上に位置付けることにより、これらの対比を明確にした。確かにハンセン病は先進国では消えゆく疾患であるかもしれないが、免疫学にかけがえのないモデルを提供し、その進歩に大きく寄与した。免疫抑制剤の進歩による再帰感染のリスクという新たな問題も出現し、現代においてなお、「古くて新しい」この疾患の存在意義は大きい。

  Mycobacterium leprae, the causative agent of leprosy, possesses unique features including inability to proliferate in vitro. In the cellular components of M. leprae, the fate of intracellular metabolites, assumed to be associated with such physiology, remain largely unknown. In this study, we found that amino acid species are significantly accumulated, while most of intermediates related to central carbon metabolism markedly decreased, in the intracellular metabolite fraction of M. leprae, as compared with that of other mycobacteria. Our results show the unique metabolite dynamics of M. leprae for the first time and these insights might contribute to understanding the physiological characteristics of leprosy.

　ハンセン病問題には多様な意見が存在しますが、それはハンセン病が社会的にも医学的にも非常に複雑な問題であることに起因しています。ハンセン病問題の理解には「ハンセン病問題の構図」を、サルファ剤であるプロミンに始まる一連の化学療法の時代以前・以後、日本と世界などの状況の違い、近代医学や公衆衛生政策の歴史、入所者や回復者の記録に併せて療養所関係者、政策担当者などの記録などを明瞭にした上で、各問題を考察する必要があります。このような前提から、ハンセン病資料アーカイブズには、資料の収集に加えて、これらの資料を時代や各予防法ごと、分野の違いなどで整理し、俯瞰的に、客観的に情報を提示するプロセスが重要です。また、ハンセン病資料アーカイブズには、多くの人々に情報を提供できること、学術的にも総合的 (多分野的) であり、偏向が少ないことも重要であると考えられます。このようなアーカイブズの試みとして「近現代ハンセン病資料アーカイブズ」^注) 事業を紹介し、その利点のみならず課題も提示し、今後のハンセン病アーカイブズ構築の一つの形 (Web公開学術データベース) として話題を提供したいと思います。

　医療は疾病、医療者、患者の三者が構成し、医療の史料にはそれぞれのエージェントや、それらがかかわった社会と文化的な関係が刻み込まれている。この小論は、昭和戦前期の精神医療の症例誌の分析を通じて、そのような症例誌の利用の形を提示するものである。症例誌の構成や、そこから疾病、警察、家族の影響などを読む事例が提示される。

  This paper explores the current status of preserving medical/patient records in Japan and providing them for public use, focusing in particular on issues relating to the medical records preserved in Hansen’s disease sanitaria, as per Japan’s present laws concerning official documents (in particular, the “Public Records Management Act” enacted in 2009) and those on personal health information. First, I introduce the basic approach to archival practice developed as a global standard—including the difference between “institutional archives” and “collecting archives”—as a theoretical background for the preservation and application of the medical/patient records and materials kept in Hansen’s disease sanitaria in Japan. Second, I explain how around the world scholars of the social history of medicine increasingly recognize that the demand for medical/patient records and their value is both the basis for and evidence of the growing trend for research into the “history of patients”. Medical/patient records that have been made and stored in each sanitarium in Japan would have many potential users if they became properly available for historical research and other activities. Lastly, this paper proposes some solutions to the problematic points of using medical/personal records for historical research—issues concerning privacy, research ethics, and reproduction of stigma—that are applicable to medical/patient records of Hansen’s disease sanitaria in Japan.

  This essay presents an overview of the collection, management and uses of historical documents at Kikuchi Keifūen, one of National Sanatoriums of Hansen’s Disease. It also suggests that the creation of a regional archive for the documents will encourage both academic research and societal use of the documents.

  Since its opening in 1909, Kikuchi Keifūen has amassed a large number of documents. So far about 30,000 historical documents have been collected at the Social Exchange Hall and History Museum.

  Some materials have been used in academic works by historians. Others have been used in educational outreaches. A particularly important outreach was organized in 2016 as an educational workshop for four students of Kumamoto University. The students read historical documents, conducted oral interviews with the residents, and finally replicated a scene from one of the court cases in which the patients were involved. This scene was exhibited at Kikuchi Keifūen from the winter of 2016 until the summer of 2017.

  The academic studies of the documents and the uses of the historical materials suggest that the idea of the regional archive, in which the historical documents will be kept and managed at the site of the life of the patients and ex-patients, is a good starting point. The idea will secure the resources easily and will develop further interactions, which will establish monuments for the lives and the memories of the ex-patients.