GENERAL DEPARTMENT.
Bombay Castle, 5th March, 1884.
No. 756.—The following Memoir on Leprosy by Brigade-Surgeon H. V. Carter. M.D., is publish-
ed for general information in continuation of Govern-
ment Notification No. 4900,* dated 7th December
1882 :—
* Vide page 1002 to 1170 of Part III. of the Bombay
Government Gazette of 14th December 1882.
"Memorandum on the Prevention of Leprosy by Segregation of the affected
The following brief Memoir is the third I have
compiled for submission to the authorities of
British India; and, like its first predecessor, it is
based upon unique experience acquired through
the enlightened proceedings of the Government
of Norway.
By the kindness of Dr. G. A. Hansen, the able
Superintendent of the Leper Department, I am
enabled to offer the latest known statistical data;
and by the courtesy of the Director of the Civil
Medical Service in Norway, I have been supplied
with a series of Reports in continuation of those
described in my earliest communication to the
India Office, 1873. Since 1875, some changes in
these have been made ; and in future, only quin-
quennial Reports will be issued : the next being
due in 1885.
Considering afresh the information thus accru-
ing, I propose, in the interests of India, to
discuss : (1) The present state of the Leper-
question in Norway; (2) the probable explanation
of amendments noted; and, (3) Hygienic measures
suitable for India. An illustrated note on the
pathology of Leprosy is also subjoined.
PART I.
PRESENT STATE OF THE LEPER-QUESTION IN
NORWAY.
The methodical isolation of lepers has, during
the past 25 years, been carried on with unremit-
ting effort; the result being a decided diminution
of the sick throughout this period. On initiation
of the restrictive measures sanctioned, it was not
anticipated that marked effects would quickly
follow; and hence no dissatisfaction is expressed
at the moderate and gradual amendment which
has ensued. Recognizing from the first the
incurability of leprosy, the State limited its at-
tempts to opposing the hitherto continuous repro-
duction of disease; and such anticipatory sphere of
action admits only of radical rather than showy
achievements. How much longer these somewhat
costly measures may have to be maintained can-
not yet be said; but it has been learnt that
restrictive means ought, if possible, to be extended,
and could be remitted only at imminent risk of
renewed spreading of disease.
Registration of the affected being an essential
preliminary, I note that properly it includes,
besides an enumeration of the lepers, a due record
of their history and movements. In Norway
the district medical men have always been aided
under express injunction, by "all clerical and
secular officials and functionaries" of Govern-
ment ; and the peasantry not opposing, it might
be expected that the yearly register would be
fairly exact. In this matter, however, precision
is everything; and it has long been apparent that
so simple a result as a strictly accurate list of
lepers is hard to be obtained. Thus the
malady in question begins obscurely and proceeds
slowly; it seldom early disables; being at first
set down as a blemish, it is disregarded by
patients and their friends; and since, in addition,
many bad subjects purposely evade registration,
it results that of the " fresh additions " brought
to light year by year only 1 / 6 are "new cases" of
quite recent origin, whilst 5 / 6 are entered as
"overlooked" cases dating back 2, 3 or several
years to the beginning of illness. As to the
possible number of such latent residua, Dr.
Löberg, in 1870, liberally estimated them at 300
(vide my First Report, p. 17); whereas by the
adjusted Tables of 1880 it appears there must
have been then at least 500 unrecognised or
undetected lepers in the country, or one-quarter
more in excess of the 2,050 actually known.
This datum illustrates the difficulties of regis-
tration which are met with in Norway, and which
also, I may add, obtain in Western India; since
e.g., instead of the Census (1871) number of
158,I found there were at least 472 lepers existing
in Káthiáwár during 1876, most of whom had of
course been overlooked (vide Káthiáwár Report,
p. 65). The Norse Tables show separately the
number of Asylum inmates (duly known and
named) and of Home-dwelling sick (only approx-
imately ascertained); these combined numbers
furnishing a plain total, which, for convenience,
is added in column 10 of the statement below.
Such ordinary enumeration is not, however, of
more than very limited value; and in 1870 the
tables supplied an adjusted List of lepers, com-
bining in addition the numbers who, to judge
from their aspect and asserted duration of illness,
must for varying periods have been all along
living unregistered in the country districts.
Such numbers are still considerable—ex. gr.
On comparing the List below, column 3, with a
later one for 1881 I have been privately favoured
with, it appears that during this last year alone
no fewer than 74 " over-looked" cases were found
which had to be incorporated with the figures in
the preceding year's list at dates corresponding
with the beginning of illness as follows :—17 of
2 years' duration, 18 of 3 years', 10 of 4 years',
2 of 5 years', 4 of 6 years', 8 of 7 years', 3 of 8
years', 1 of 9 years', 1 of 10 years', and so on; 4
being referred back so far as 25 years. Besides
these, there were 16 strictty " new " cases brought
to light in 1881 : the total " fresh additions" (as
I here use the term) in that year amounting,
therefore, to 90. The latest issued Table in the
amended form is the one for 1880, which is
copied below in columns 1 to 9 inclusive ;—
B 1 1 1 1 —1