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Most of the leprosy patients in Turkey live in the rural areas of Eastern and South-Eastern Anatolia. Those living in the suburbs of the big cities of the Western parts of the country have come there by immigration. Nearly all patients are very poor; they have no land, or only a small amount of soil for cultivation. The incidence of deformities in our patients is high, excluding them from regular employment and a source of income. In Turkey, it is obligatory to attend primary school, but after that education has to be paid for, and the poor families of leprosy patients find it difficult to continue the education of their children. As the 'Society for the Struggle Against Leprosy', based in the Istanbul Leprosy Hospital at Bakirköy, we have developed a project to enable patients to continue sending their children to school, whilst at the same time asking the mothers to seek advice and guidance on family planning. The outset objective of this project was to enable children and young people, who otherwise have almost no chance of continuing education, to pursue education at secondary, high school and university levels. It was envisaged that in the long term educated children would be able to find a job and provide effective care and support for parents and other members of the family. This paper describes the administrative and other measures adopted and the results of the project from 1995 to 1998, during which a total of 545 children have been supported at an overall cost of US$107,378. The scholarship project has so far been remarkably successful in Turkey and it is hoped that it may provide a model for similar approaches in other countries. An unexpected and extremely encouraging finding has been that females now exceed males in this project and are increasing at all levels, including university entrance.

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Dr. Hulusi Behçet was born on February 20, 1889 in Istanbul. He graduated from Gülhane Military Medical Academy in 1910 and then he specialized in Dermatology and Venereal Diseases. He served in the Edirne Military Hospital between 1914-1918 and then went to Budapest and Berlin to improve his knowledge. In 1923, he started at the Istanbul Medical Faculty as an academic staff and with university reform in 1933, he was appointed as a professor to Department of Dermatology and Venereal Diseases and continued his career there until his death in 1948. Three patients whom he had consulted for years and who shared similar symptoms made him suspect a new disease and a viral etiology which may play a role in the appearance of this disease. After several discussions and publications, medical literature had accepted Behçet's Disease as a special entity. Dr. Behçet published a total of 196 articles, 53 of which were published in prestigious international journals.

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Women in Turkey have many social, cultural and economical problems. Women with leprosy have problems in common with other women as well as those related to physical and social consequences of leprosy. There are 2,414 patients with leprosy in Turkey, registered to Istanbul Leprosy Hospital and 829 of them are females. The mean age and duration of disease of our female leprosy patients are high. Most women with leprosy were born in eastern part of Turkey where prevalence of leprosy is higher and most have moved to western regions. The proportion of women who have some kind of social security is very low. Their economic status is also not good and 79% of patients had stigma about their disease. Three fourths of these cases have been hospitalized some time, for different reasons. Most of them (97.2%) have inactive disease at present. Disability degrees of patients are high. Patients with disability degrees over one constitute 54% of total for eyes, 55% for hands and 51% for feet. High percentage of multibacillary form and long duration of disease, delayed diagnosis, insufficient self-care of patients due to low socio-economic and cultural status and failure of health personnel to control patients periodically may be among the reasons for such high ratios of moderate and severe disabilities. In the light of the data obtained in our study, some measures to alleviate the problems of patients resulting from their socio-economic, cultural and social status have been suggested.

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Lagophthalmos and corneal hypaesthesia are amongst the most frequently encountered lesions in leprosy and they can easily give rise to blindness. Many measures (such as eye drops, protective conoid shields, muscle exercises, surgical treatment etc.) have been used to protect the eyes under such circumstances and this paper examines the protective role of methyl cellulose and conoid shields in 41 patients. All of them had lagophthalmos (5 mm or more) and corneal hypaesthesia. They were divided into three groups. Group one had 15 leprosy control patients (27 eyes) who did not use methyl cellulose or eye shields. Group two had 16 leprosy patients (28 eyes) and they used methyl cellulose and eye shields when they felt discomfort in their eyes. Group three had 10 leprosy patients (17 eyes) and they used methyl cellulose and eye shields regularly. Statistically significant improvement was seen in group three. Further studies on larger groups of patients including the effects of different concentrations of methyl cellulose, on Schirmer test and tear break up time, may be of value.

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Leprosy is one of the leading causes of corneal hyposensitivity. In this article the corneal sensitivity of 143 leprosy patients was examined, and correlations between corneal hyposensitivity and anterior segment pathology were detected. Twenty four healthy volunteers were examined as controls. Various degrees of corneal loss of sensitivity were found in 46.2% of leprosy patients. Lagophthalmos, chronic lepromatous granulomatous uveitis, iris atrophy, and social blindness were found 4.5-16.6 times more frequently in eyes which developed severe corneal hyposensitivity.

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The intraocular pressures of a total of 286 eyes of patients with lepromatous and borderline lepromatous leprosy who never had regular ophthalmological care or local eye treatment were measured. The patients were categorised according to the type of leprosy they had, and the eyes were categorised as without or with chronic plastic iridocyclitis. In patients with lepromatous and borderline lepromatous types of leprosy the intraocular pressure was significantly lower in eyes with chronic plastic iridocylitis 10.1 (3.6) mmHg than in both unaffected eyes 11.0 (3.2) mmHg and control eyes 13.5 (2.5) mmHg. It has been shown that chronic plastic iridocyclitis which remains untreated for years results in a lower intraocular pressure than normal.

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A positive pathergy test in patients with Behçet's disease has been accepted as a diagnostic criterion by many authors, but in recent years it has been claimed that the test has a decreased positivity. We have examined the test in 92 proven cases of Behçet's disease, using 20G and 26G disposable needles and evaluated them after 48 h. Maximum positivity was found to be 65% when we used needles of size 0.9 mm (20G), but the reactivity was considerably less when 0.3 mm diameter (26G) needles were used. The disposable needles used nowadays are less traumatic to initiate the reaction than were the non-disposable ones used in the pre-AIDS era.

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84 Turkish patients with lepromatous and borderline lepromatous leprosy were investigated with regard to the presence of antibodies to a variety of tissue constituents and immunoglobulins. Thirty Turkish-born volunteers and two groups of patients with systemic lupus erythematosus and primary biliary cirrhosis respectively served as controls. No increased incidence of autoantibodies to smooth muscle cells, nuclei, mitochondria, striated muscle, thyroid microsomes and thyroglobulin was detected. A high incidence of rheumatoid factor and circulating immune complexes was found.

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Ocular complications of leprosy patients often develop insidiously and with few if any symptoms. This study involves measurement of the pupil cycle time (PCT) to evaluate the autonomic nerve system of the iris to determine the presence of subclinical intraocular involvement. The study included 19 lepromatous (LL), 19 borderline lepromatous (BL), and five borderline tuberculoid (BT) leprosy patients and involved 25 healthy volunteers, 10 patients with pulmonary tuberculosis and eight with Duhring disease. The PCT was measured in these groups. In all leprosy groups included in the study the PCT was higher than in the control groups. Moreover, the PCT of the leprosy patients without any intraocular involvement was higher than in the controls. These results show that in the ophthalmic examination of leprosy patients without any symptoms the fact that autonomic nerve system of the eye is affected by the leprosy can often be determined by measuring the PCT.

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Between 1983-1987, the Istanbul Leprosy Centre (ILC) organized in Van a leprosy education program for medical personnel and the local population, subsequently whole population surveys and case contact surveys were carried out independently in different regions. 66 new cases were detected during those years 56 (85%) patients were diagnosed by ILC teams at the field and at the hospital. In 49 (74%) of the 66 there was one or more close contact within the family, in 17 (26%) there was none, but old patients in the village or nearby. It is concluded that the education of the local medical authorities and the population is of utmost importance for the early diagnosis and patient-close contact surveys are the best for our country.

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In the last 12 years, we treated 427 Turkish patients suffering from Behçet's disease. We report on the frequency of symptoms as well as the modes of therapy in Turkey.

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During treatment of multibacillary leprosy with the combination rifampin (RMP) 600 mg, ethionamide (ETH) 500 mg, and either dapsone (DDS) or clofazimine (CLO) 100 mg, hepatotoxicity was observed in 4.5% of 596 patients. Hepatitis appeared after 5-186 days, with a mean of 93 days and a median of 76 days. Mortality was 26%. ETH and DDS or CLO were administered daily in all regimens in which hepatitis occurred. RMP was given either daily or daily during the first two weeks or eight weeks, followed by a once-weekly dose. It is concluded that the combination RMP + ETH is the toxic component. In some patient groups there was a high correlation of toxicity with age. A regimen in which RMP was administered only twice a week during three months was not accompanied by hepatotoxicity. Future studies should show if reduction of the daily dose of ETH or reduction of the duration of the administration of RMP + ETH might reduce the incidence of hepatotoxicity while conserving the efficacy.

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