2
amount of their leper-population :* this statement
being based upon Indian Census-returns, and
from my own enquiries in Káthiáwár I learnt
that much less than the whole truth may so
appear—vide Part 1 of former memorandum,
page 1.
In such matters as this some error arises de-
viously through prejudice, the sick hiding their
complaint, and families and communities screen-
ing their sick members ; the result usually being,
without doubt, a considerable distortion or else
defect in formal enumerations of the afflicted.
Moreover, there are direct obstacles to be en-
countered, if measures at all approaching to
effective isolation be attempted. So has been
and is now the experience in Europe—the harsh
old edicts against lepers I purposely pass over—
and so difficult has it proved to overcome preju-
dice or to interfere with the liberty of the sub-
ject, that, for example, only in June 1885 did the
Norse Parliament consent to Dr. Hansen's pro-
posal that the sanitary officials in the country
districts be authorised to inform the leper-sub-
ject he must take satisfactory measures against
. risking the infection of other people, if he be
allowed to live at home
and if he will
not apply such means, the sanitary authority may
order him to enter an asylum
the
authorities are not compelled to do anything, but
if they choose they may intervene
As regards
general sanitary measures (which the peasantry
are now being instructed in), improvement must
chiefly depend upon the co-operation of the people
themselves
Upon these few passages,
offered as sample, I need not now venture any
comment, as to their applicability to India ; the
restrictions imposed being a sequel of prior re-
gulations, and but part of a practical system of
segregation. It may, therefore, be enough to
remark that, other considerations apart, one ad-
vantage to all leper-infected countries which the
example of Norway by her sagacious and patriotic
legislation presents, consists in their being now
enabled beforehand to deliberately count the cost
as compared with the benefit of similar measures ;
for mutatis mutandis there seems no valid reason
to mistrust the efficacy anywhere of ' isolation,' as
a principle.
As to the rationale of ' segregation ' or ' iso-
lation,' it is to be noted that these two methods
are practically alike. There are more reasons
than one that the leprous had best be kept apart.
From a medical point of view, ideas have of late
changed, tending now to revert to the older pre-
ference for complete isolation. Thus, at the
initiation of legislative interference, the Norwe-
*Note.—Owing to differences in the definition of ' infirmi-
ties,' the two late Census-returns of the Bombay Presidency
do not afford the means of estimating the advance or decline
of leprosy here between the years 1872 and 1881. On the
last occasion it was intended that only instances of ' black '
or ' true ' leprosy should be enrolled, and the total then seems
to have been 10,095 ( Vide Table XVII, or 10,248 by au enu-
meration at page 100 of the text). The local distribution of
the disease being, as usual, highly varied, there were most
affected in the Deccan Division, viz., 5,774 lepers, of whom
4,015 were found in three of the six districts composing this
Division. In the text of the Census-returns, no special al-
lusion is made to the example of Norway ; and the ' Pellagra '
of Italy seems to be regarded as the analogue of leprosy in
that country. The distinction between these two maladies is
marked, and was pointed out in my second India Office
Report—the part published in a handbook of skin diseases
for use in India.
gian physicians regarded leprosy as a disease
kept up by hereditary transmission, and therefore
recommended as sufficient the segregation of the
sexes apart ; whereas the present official Super-
intendent works with a conviction that more
probably this malady is propagated by contagion,
and hence he inculcates the desirability of isolat-
ing the individual of either sex. Neither of these
opinions, I might add, has influenced the collec-
tion, nor need either bias the interpretation, of the
statistical data under review.
While it is not my intention here to discuss
these fundamental topics, I may offer the follow-
ing remark s as not unserviceable or out of place.
According to the doctrine of ' pangenesis,' here-
dity itself may be due to a kind of infection. The
discovery by Hansen of the bacillus leprœ, inclines
strongly to the side of contagion as the effective
agency ; both abstractedly, and by analogy with
the admittedly similar affection of tuberculosis,
in which the known infective agent is a similar
pathogene tic organism—see the drawing in my
Bombay Memoir. At the present day, most
physicians would hesitate to advance the view of
a wholly spontaneous, climatic, dietetic or mal-
hygienic origin of tubercular disease ; and such
a view of the origin of leprosy might, on the
same grounds, also be questioned. A hiatus,
however, exists here ; for whilst the conta-
giousness of tubercle (suspected in the
human subject) can be demonstrated by experi-
ment on the lower animals, no such proof as
regards leprosy has yet been certainly attained.
Dr. Hansen, indeed, writes that he has seen
specimens of this disease derived from inoculated
rabbits, and that he has the subject now under
confirmation. He remarks it appears of great
importance that the material employed in ex-
periment should be perfectly fresh—' the vitality
of the bacilli seems to be less in old leprous
nodules;' and, besides, a period of several months
must elapse before the results of inoculation can
be surely verified. The milder form (so-called
' ansesthetic ' or nerve-leprosy) presents the
characteristic organisms ; and as regards the
severer ' nodular' form, Dr. Hansen finds these
bacilli in wandering cells amidst the epidermic
scales surrounding the ' true leprous ulcer ;' they
are always present in the skin there. The inter-
nal organs of the frame may also be the seat of
these organisms.
There is, I may further observe, a third form
of disease strongly resembling the leprous, which
like the latter is peculiar to man, and which
has already been made the subject of special
legislation, being now regarded as truly conta-
gious at all its stages. Yet I note as regards its
later manifestations, which alone are those com-
parable to the eruptions of leprosy, it is within
the memory of living medical men that non-
contagion was not only asserted, but held to bo
proved by direct experiment. Considering,
therefore, the medical history of tuberculosis and
of syphilis, in connection with what modern
research has revealed of leprosy, there would a
priori seem, despite many plausible negative ob-
jections, ample grounds for suspecting the fell
scourge under notice of being transmissible as
are the two others. Deliberate experiment on
man (the surest test) being impossible, valid
evidence must be sought for comparatively, or