In December 1930, the "Special Society for Leprosy" of the Society of Nations meets in Bangkok. On the day’s agenda is the internationalisation of the fight against leprosy by adopting common rules of action and standardising therapeutic practices. A worldwide network of research centres are being created. Four cities are already equipped : Calcutta (India), Culion (The Philippines), Honolulu (Hawaii), and Rio De Janeiro (Brazil). Tokyo is being considered.
Marchoux*, with the support of F. Sorel*, Inspector General of the Colonial Health Services, succeeds in convincing the French government of the necessity of setting up an organism to take care of lepers. "The Central Institute of Leprosy" is created in 1931 and, after the death of Marchoux, it is named after him. It is placed under the direction of Robineau*.
The establishment of the Institute in Bamako is justified because the town is in the very centre of the AOF, above Niger and the principal roadway and at the terminus of the Dakar-Niger railway line which was inaugurated in 1923. Built between the 1st October 1933 and the 1st November 1934 on a very fertile alluvial terrain of 250 hectares, it will be inaugurated in 1935 by Governor Brévié and the Chief Physician L’Herminier*.
THE TRIPLE VOCATION OF THE INSTITUTE
– A regional centre for combating Leprosy,
– A centre for clinical and therapeutic research as part of a worldwide network,
– A centre for the training and specialization of staff.
- Regional centre for combating Leprosy
The Marchoux Institute has a dispensary where numerous lepers living in the Bamako region are treated. (In 1980, there were still 1 700 registered lepers).
It has the responsibility of organizing and coordinating anti-leprosy projects in the whole of French Africa. In practice, the Institute does not hold these responsibilities for long. They are handed over to the SGHMP from 1946, at the moment when chemotherapy becomes available.
During this decade (1935-1946), the number of known lepers increases, evidence of the growing efficiency in detecting the disease. But the treatment with chaulmoogra oil is difficult to continue, not very effective, and has little attraction for those who know they have contracted leprosy and wish to avoid living in isolated leper villages.
It is only after an extensive use of sulphones, at the beginning of the 1950s, that detecting becomes really efficient and the endemic begins to decline. This decline becomes spectacular with the advent of additional chemotherapy about 1980. From being 200 among 10 000 inhabitants, the number of lepers falls in forty years to 5 in 10 000. Meanwhile, 800 000 patients have been detected and treated by the Colonial Health Service or the organisms that have succeeded it.
- Centre for clinical and therapeutic research
The only people admitted to the "hospital compound" with wards are 140 patients whose condition justifies hospitalization. Nursing nuns supervise the nursing staff. The originality of the Institute consists also in the fact that patients are admitted with their families who reside in "The compound for patients" where there are water supply points, dressmaking and basketry workshops and land to cultivate. Epidemiological and sociological studies are conducted there.
The institute is particularly useful for testing new medicines and perfecting methods of treatment.
It is there that Stevenel* identifies phytosterol (the active principal in chaulmoogra oil) in gorli oil, whose efficacy had been demonstrated in the 1930s by Rivoalen* and then by Tisseuil*, and which permits the treatment of lepers during the world wars when the provision of chaulmoogra is interrupted.
With the advent of sulphones, it is at the Institute that methods of treatment are decided on, notably by Laviron*, Lauret* and Jardin*.
Later, new medicines become available for the treatment of leprosy :
– Long-acting sulphonamides, studied by Languillon* from 1958, are just as effective as sulphones but may provoke incidents of intolerance.
– Rifampicinum, used since 1968, an extraordinarily effective bactericide, has transformed prognosis but its cost justifies controlled prescriptions of the medicine.
– Clofazimine, an expensive and toxic substance, is used since 1972 as an anti-reaction remedy; Thalomidine, Fluoroquinolones...
The establishment of these methods of treatment owes much to the work of successive teams at the Marchoux Institute and to their directors, especially, Laviron*, Kerbastars*, Languillon* and Saint André*.
Leprosy surgery has greatly benefited from the work of the surgeons of the Colonial Health Service, following the efforts of Carayon* in Dakar and Bourrel* who, at the request of Languillon, introduced reparatory and therapeutic surgery to the Marchoux Institute.
- Centre for the training and specialization of staff
All the personnel of the Colonial Health Service who are appointed to combat the great endemics follow a specialization course at Bamako. This training period is variable depending on whether the participants are physicians, surgeons, chemists, nurses, prosthetists, physiotherapists, pharmacists. Foreigners from different continents come there regularly.
THE INSTALLATIONS
At the beginning, the Central Leprosy Institute is established with a technical compound and a hospital compound :
– The technical compound has a central building with administrative services and bacteriology laboratories. The other buildings consist of a library, an assembly room, the pharmacy and its shops and lodgings.
– The hospital compound has wards for the hospitalization of patients who suffer from rhinitis or open lesions and residence quarters for non-contagious lepers.
– All around the hospital compound, there is arable land which can be used by the patients for cultivation or for breeding animals.
At present, the activities of the Marchoux Institute have been extended to the care of those suffering from tuberculosis and AIDS. It is now named CNAM (Centre National d’Appui à la lutte contre la Maladie), but it is likely to be called the Marchoux Institute for a long time to come.
For further information :
– Nébout Guy-Michel : L’Institut Marchoux ou 50 ans de lutte contre la lèpre en Afrique Noire. Thèse 1984 Université Paris VII.