4
to tlie more practical points, there are doubtless modifications to be made which would be suit-
able for circumstances in India ; nor need too much be attempted at once. It may be suggested,
also,' that an asylum should take the form of a walled enclosure or village, where occu-
pation could be found for the segregated ; there would be, too, separate buildings for those
entirely disabled. The questions of maintenance and regulations of asylums need be
discussed only when it has been resolved that a firm effort shall be made to deal with the
unchecked and unabated evil, whose presence in the community has now been made sufficiently
manifest ; and I would repeat my conviction that the peasantry of Káthiáwár are fully
capable of understanding, and gratefully appreciating, such measures for their benefit as the
one herein suggested ; and in particular, nowhere, perhaps, is the authority of the ' Darbár '
better exercised and better recognised than in the quarter so often named, namely, the
Bhávnagar State. The first consideration I take to be, separation of the infested from the
healthy ; and to a certain extent this might be done at home, were distinct orders issued on the
subject. Thus, it should be made incumbent upon those families, who, being in fair circum-
stances, desire to keep their lepers with them, that these sick be altogether separately lodged,
having bed, board and clothing quite apart, the object being to isolate them so far as
is possible. Too often, however, such regulations would be futile, on account of the
poverty of the sufferer and his connections, who would not be able to provide the required
separate accommodation. I do not suppose that any other obstacle than expense would arise
in attempting to enforce this isolation of the sick at their own homes, but even this tolerant
measure, when practicable, would need to be maintained by authority ; and such being the
case—namely, that legal provision is necessary—it becomes a question if it were not better
at once to deal with the subject comprehensively. The two main objects being understood
to be the protection of the community, and the due care of the sick—objects which in practice
become unique—I would suggest first, that a convenient refuge be offered to all vagrant
lepers, whose further wanderings should then be interdicted ; next, that a similar asylum
be open to the poorer classes of peasantry, whose compliance with the wishes of the State
is to be insisted upon ; and thirdly, that those persons who are willing to provide separate
maintenance for their leprous sick should be permitted to do so on]y upon the condition
that the isolation proposed be practically an efficient one. Segregation of the sick becomes
an inevitable resultant, because it would be impossible to furnish individual separation for all ;
and hence, a common home for the large majority of lepers would be required."
In his " Reports on Leprosy (Second Series), comprising Notices of the
Disease as it now exists in North Italy, the Greek Archipelago, Palestine, and
Parts of the Bombay Presidency of India " published in London under the orders
of Her Majesty's Secretary of State for India in 1876, Dr. Carter thus dwells
on the same subject with special reference to Western India :—
" Lastly, no provision here exists for mitigating the sufferings of lepers and for checking
the spread of their disease. Hence the obvious inference that an occasion is presented for
rauch useful work. It is true the people are very ignorant and prejudiced, but still they
have confidence in their present Rulers, and I feel assured they would regard measures of
relief as a blessing. The suitable segregation of pauper lepers in one or two asylums,
or villages of refuge, and the dissemination through the land of right ideas upon the subject
of the home treatment of lepers, represent the earliest of such measures ; and if
it be said they cost time, effort and money, yet one may reply the investment in so
humane a work of these expensive agencies may be recommended as likely to prove
highly remunerative from even a material point of view ; and surely, the responsibili-
ties and duty of authorities everywhere, in whose hands rests the welfare of a poor and in-
dustrious multitude, become more strikingly obvious when viewed in a higher aspect than
a material one."
He concludes the Report with some remarks on leprosy in Europeans in
India, from which it would appear that the disease in this Presidency is not con-
fined to Natives. The following is an extract from this portion of the Report:—
"As regards Bombay, I note that, amongst the thirty to forty patients under treatment in
the ward for incurables in the J. J. Hospital, there are usually two, three or four
European lepers; at present there are three men, latterly one went to England in search of
medical aid, one died, and one has lately come. This useful refuge for the helpless is now
wholly occupied by the leprous ; it was intended for Natives, but there being no other public
accommodation for European lepers, such poor sufferers have necessarily been admitted
here, notwithstanding the evident undesirability of treating European sick under the same
rules as are intended for Natives. It is known that there are other European lepers living at
their own homes in Bombay, but naturally some difficulty exists in ascertaining their exact
number. "Without in any way pushing enquiry in this direction, I have myself lately seen
three well-marked instances, viz., of a boy at school, a young woman and an adult military
man. Bombay still harbours in a crowded locality a leper colony of most wretched subjects
men, women and children ; and it is at least curious that the above three cases reside
not far from this focus of loathsome disease,"