NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Distribution of Leprosy.
115
dhists are found chiefly in Burma, nine-tenths of this popu-
lation being followers of Gautama, while there are not two
hundred thousand to be found over the length and breadth of
the continent of India. The Nats are entirely restricted to
Burma. The Jains exist in numbers in the presidency of
Bombay and in Rajputana only, the North-Western Provinces
coming next in order. Their scruples respecting the destruc-
tion of animal life or touching animal food are well known,
and this. is important with regard to a theory of the origin of
leprosy which is based on the consumption of fish. The Jain
community is greatly commercial in character, and as a rule
in easy circumstances, and in some districts, at Gujarat and
Ahmedabad, with considerable or predominant influence. 41
This may to a great extent account for the small amount of
leprosy found amongst them.
"The Satnamis, who include a large number of agricul-
tural Chamars within their body, are found almost exclusively
in Raipur and Bilaspur. The true Satnamis abstain from
tobacco, intoxicating liquors and drugs, animal food, and from
certain vegetables. They are of taller physique, fairer and
better made than the other inhabitants of the country. Their
food consists of the produce of the fields, of which they always
have plenty, the virgin soil yielding a copious outturn for com-
paratively little labour. Their abstinence from animal food
(which in a country so hot as Chhattisgarh works more harm
than good), and from all sorts of intoxicating drinks and drugs,
and their agricultural pursuits give them health. Their ideas
of cleanliness are capable of much improvement ; they sleep in
a hovel without windows, with an array of children of all ages
around them, squatting on the floor, on which the veriest
apology for a coarse mattress is sometimes spread." 42
The Kabirpanthis, amongst whom relatively the largest
number of lepers is found, are also chiefly recorded in the
( 41 ) Imperial Census Report for 1881, page 42,
( 42 ); Ibidem, pages 43 and 45.
l 2
116
REPORT OF THE LEPROSY COMMISSION:
Central Provinces, though they undoubtedly exist also in other
parts of India, as Benares, Bengal, and as far as the Deccan.
They do not touch any spirituous liquors or flesh. In their
social relations, habits, and superstition they differ but slightly
from the Satnamis. 43
The Sikhs, who have less lepers in their ranks than any
other religious body, are found mainly in the Punjab, the only
instance in which they appear in any strength outside the
Punjab being in the adjacent province of Sind. But they
are met with scattered about in small groups all over Hin-
dustan and in some parts of the Deccan. Although composed
of different ethnic elements they form a race with as marked
features as any other in the Peninsula. 44 They have preserved
their ancient talent for war, and they supply a contingent of
picked men to the Anglo-Indian army. They are altogether
perhaps the manliest and finest set of men in the empire.
Tobacco smoking is strictly prohibited, but they do not abstain
from spirituous liquors and animal food, the flesh of the cow
only being a forbidden dish.
These few remarks may suffice. The Sikhs and Jains are
undoubtedly most exempt from leprosy, and the Parsis approach
them closely in this respect. These three bodies are more
or less select, the Sikhs representing the physically finest class
of men, while the Jains and Parsis stand commercially highest,
and belong to the wealthier portion of the community. The
healthy life of the Satnamis has been alluded to. Excluding
the Aboriginals, leprosy is least found in these four sections,
and this may perhaps be explained by their social or physical
superiority. That, however, an abstinence from animal food
by no means prevents a diffusion of leprosy is well illustrated
by the Kabirpanthis. Among the Buddhists and Nats much
leprosy is found, but it is well known that the social and
personal conditions of the Burmans are low, and in many parts
( 13 ) Imperial Census Report for 1881, pages 45 to 48.
( 44 ) Barth : The Religions of India.
Distribution of Leprosy.
117
deplorable. Table XIX thus seems to imply that where the
religious belief is coupled with bad social conditions the leper
ratios are highest, while, when favoured by exceptional surround-
ings, the proportion decreases considerably. Intermediate are
the Hindus, Christians, and Muhammadans, and these may
be said to represent the average population of India as regards
personal and hygienic conditions.
II.- At the recent enumeration the lepers were arranged
according to caste, since a classification based on the various
forms of religious belief becomes more and more uncertain,
as time and enlightenment advance, and is thus open to
criticism. Drs. Lewis and Cunningham, as far as opportunities
were offered, enquired into the relation of caste to leprosy.
Their investigation, however, was confined to Kumaun only.
They write in their report as follows : "As the inhabitants of
Kumaun virtually consist of two classes only—Rajputs and
Domes, the former representing an Aryan population, the
latter the Aboriginal people, whilst other classes are only very
sparingly represented—the evidence, such as it is, is in favour
of impartial distribution of the disease."
The Commissioners can assert with confidence, from
personal experience and enquiry, that no caste is exempt.
It remains only to examine to what degree the various classes
are affected, and whether one or other body is relatively more
liable to suffer from leprosy.
Unfortunately it was impossible to obtain statements of
the lepers arranged according to castes from the various
provinces or presidencies. Accurate details could be obtained
from the Punjab only, and the following remarks therefore
apply exclusively to this province. As far as general impres-
sions go, however, the conclusion derived from the statistical
evidence of the Punjab leper population may be taken to
represent the state of affairs in India generally.
In the following table the lepers have been arranged ac-
cording to castes, the latter being again subdivided as to their
118
REPORT OF THE LEPROSY COMMISSION:
material prosperity into three classes, viz., rich, moderately
prosperous and poor. A classification of this nature no doubt
involves great difficulties and cannot be altogether without
inaccuracies. It has, however, been prepared as carefully as
possible after due consultation with British officials and
educated natives most versed in this matter. No European,
and perhaps even no Indian, possesses a perfect knowledge of
the caste systems, and hence the following remarks must be
accepted as suggestions merely.
From the following statistics it appears that the least amount
of leprosy is found among the wealthy or rich castes, the ratio
being less than one per ten thousand, while the disease is most
prevalent among the poorer castes (3 . 05 per ten thousand)
This suggests the fact that leprosy like tuberculosis has a
certain predilection for people living under bad and more or
less miserable conditions. It is greatly to be regretted that
on account of the unavoidable want of statistical data at the
time of writing, statements regarding other parts of India were
unobtainable, because the evidence afforded by one province
can hardly be considered sufficient, when a question of so
difficult a nature is under discussion. In future, however, the
degree to which the richer and poorer castes respectively are
liable to suffer from leprosy should demand attention. It has
already been shown that the poverty-stricken districts present
higher ratios than the wealthier ones, and if the distribution
of leprosy among the different castes should also establish
this connexion between the disease and bad social or hygienic
conditions, the importance of an individual predisposition is
placed beyond a doubt. The further investigation of this
matter must, however, be left to others who are more familiar
with Indian social matters and who are in possession of all the
statistical evidence obtainable The few facts at the disposal
of the Commission clearly point to the influence of poverty
and its accompaniments or consequences on the distribution
of leprosy.
Distribution of Leprosy.
119
TABLE XX.
Abstract showing Lepers by Castes for the Punjab.
[Census 1891.]
Class.
I.-Rich .
II.—Moder-
ately weal-
thy.
CASTES.
Arora
Bánia
Bhabrá
Bohrá
Kaith
Kalál
Khatri
Khojá
Mahajan (Páhari)
Parsi
Súd .
Total Class I.
Arain
A wán
Baghbán .
Bishnoi
Brahman .
Muhial
Daudpotrá
Dhund
Dogar
,
Gakkhar .
Ghirath .
Gujar
Total of caste.
667,197
442,495
18,137
3,433
13,593
48,913
447,933
95,887
20,700
526
21,804
1,780,623
896,314
608,051
18,537
8,213
1,111,838
10,871
19,269
48,415
69,712
28,771
170,348
711,800
Number of
lepers in
caste.
33
43
1
1
3
10
48
3
2
1
5
150
161
92
2
2
439
1
1
3 2
15
19
192
195
Propor-
tion per
10,000.
•84
REMARKS.
The Feudatory
States are in-
cluded in the
totals.
120
REPORT OF THE LEPROSY COMMISSION:
Table XX—continued.
Abstract showing Lepers by Castes for the Punjab.
[Census 1891.]
Class.
II.—Moder-
ately weal-
thy—contd.
III.—Poor.
CASTES.
Ját .
Kamboh
Khattar
Khokhar
Mughal
Pathan
Pujári
Rajput
Rathi
Ror
Saini
Shekh
Sunár
Tarkhán .
Thakkar .
Ulmá
Total Class II
Aheri
Ahir
Barwálá
Batwál
Bawariá
Bazigar
Bharái
Bharbunjá
Total of caste.
4,631,283
151,160
9,773
139,964
130,760
970,466
3,004
1,790,359
100,929
43,212
125,352
366,973
176,400
664,260
27,180
43,086
13,076,300
16,552
197,649
63,847
23,488
26,431
17,174
67,537
8,105
Number of
lepers in
caste.
715
16
2
14
37
126
9
462
245
10
22
87
26
103
28
4
3,057
2
26
18
7
9
2
11
3
Propor-
tion per
10,000.
2'3
REMARKS.
Distribution of Leprosy.
121
Table XX—continued.
Abstract showing Lepers by Castes for the Punjab.
[Census 1891.]
Class.
III.-Poor
— contd.
CASTES.
Bhat
Bhatiárá
Biloch
Chamár
Changar .
Chhimbá
Chuhrá
Dabgar
Dagi and Koli .
Daoli
Darzi
Dhanak
Dhangri
Dhobi
Dumná
Faqir
Gadaria
Gaddi
Gagra
Garri
Ghosi
Hadni
Hazara
Hesi
Hijrá
Jaiswará
Jhinwar
Total of caste.
38,098
18,707
416,802
I,l88,Ol8
36,391
144·835
1,224,967
794
169,767
2,289
39,530
73,562
2,199
158,876
68,971
313,201
23,354
22,861
1,862
1,619
3,278
4,177
226
6,308
631
•
6,809
473,094
Number of
lepers in
caste.
37
6
29
334
2
21
109
1
291
2
9
9
2
19
137
81
11
62
1
1
2
2
1
8
1
1
113
Propor-
tion per
10,000.
REMARKS.
122
REPORT OF THE LEPROSY COMMISSION:
Table XX— continued.
Abstract showing Lepers by Castes for the Punjab.
[Census 1891.]
Class.
III.—Poor
—conld.
CASTES.
Jogi and Rawál .
Julaha
Kanet
Kanjar
Kashmiri .
Khanzadá
Kharral
Khatik
Kori
Kumhár
Kunjrá
Kurmi
Labaná
Lilari
Lohár
Machhi
Mahtam . ,
Mali
Mallah
.
Maniar
Megh
Meo
Mirási
Mochi
Nai .
Naik
Nat .
Total of caste.
91,937
670,345
363,359
3,138
225,307
3,471
52,029
17,446
12,010
540,759
6,481
1,897
56,154
27,597
352,780
201,307
56,984
201,189
93,858
12,787
50,201
120,578
245,214
407,634
383,017
701
9,963
Number of
lepers in
caste.
31
l61
673
4
52
I
3
5
2
116
1
2
9
6
89
22
3
39
15
5
2
29
62
59
97
1
3
Propor-
tion per
10,000.
REMARKS.
Distribution of Leprosy.
123
Table XX—concluded.
Abstract showing Lepers by Castes for the Punjab.
[ Census 1891.]
Class.
III.-Poor
—concld.
CASTES.
Native Christians
Nungar
Od .
Penja
Qassáb
Rahbari
Raj .
Rangrez
Rawat
Rehar
Saiad
Sansi
Sarerá
Tamboli
Tanaoli
Teli
Thathera
Thori
Thavi
Turk
Total Class III
I.—Rich castes
II.—Moderately
wealthy castes
III.—Poor castes
Total of caste.
19,176
18,919
23,670
15,489
120,799
3,768
12,527
16,265
18,437
1,095
289,449
23,647
11,475
817
58,027
308,955
5,021
8,207
3,230
6,191
10,040,316
1,780,623
13,076,300
10,040,316
Number of
lepers in
caste.
28
4
3
1
16
1
3
1
3
10
52
1
8
1
8
53
2
2
3
2
3,064
150
3,057
3,064
Propor-
:ion per
10,000.
3·05
•84
2·3
3·05
REMARKS.
124
REPORT OF THE LEPROSY COMMISSION:
Asylums and the Distribution of Leprosy.
I.— There being no segregation in India, it may be asked
whether on the hypothesis of contagion the practice of collect-
ing lepers at one centre might not become a source of danger
to the community. In all the Asylums of the Punjab the
lepers are allowed, on special days at least, to go out into
the bazaars and the neighbourhood to procure food or whatever
they require, thus mixing freely among the people. If by this
means the disease were liable to be spread amongst the
population, an increase should be noticeable in the leper ratios
of each district from one census to another, all the more as the
number of inmates is steadily increasing from year to year.
Such increase, however, cannot be traced, as the following
table will show :—
TABLE XXI.
Asylums and the Spread of Leprosy-
ASYLUM AND DISTRICT.
Amritsar
Jullundur
Kangra
Rawalpindi
Sialkot
Simla
Umballa
Ratio per
10,000 ( st
Census).
6.3
6.5
18.0
10.4
6.4
34.7
Ratio per
10,000 (2nd
Census).
4.4
3.0
14.5
5.0
3.8
28.6
4.9
Ratio per
10,000 (3rd
Census).
1.5
2.3
10.8
3.6
1.4
28.8
3.2
REMARKS.
The ratios are cal-
culated on 10,000
of the population.
It will not be necessary to delay any further over this
matter as the above statistical details are sufficient evidence
against the assumption of the spread of leprosy around an
Asylum as a possible centre of infection. The three censuses
point clearly to a decrease of leprosy in the respective districts,
Distribution of Leprosy.
125
and this can in no way be due to segregation, as such is by
no means enforced in any of the Institutions mentioned in the
table. The same applies to all other Asylums, but it is not
necessary to devote more time or space to this matter.
II.—Again the increase in the number of inmates of an
Asylum has been used as an argument that leprosy is rapidly
spreading in India. Alarmists especially make use of the
returns of Asylums and dispensaries to prove an increase of the
disease. Such arguments are illogical and incapable of show-
ing what they are intended to do. Dispensaries and hospitals
alike were unpopular in India but a short time ago, and the
Asylum to the leper especially distasteful. By gradual and
slow education they came to understand the blessing of such
philanthropic Institutions and learned to seek an abode in
them. All therefore that can be deduced from such figures is
an increased popularity of such homes. But it is not legitimate
to draw deductions from hospital returns as to the increase
or decrease of leprosy. In all such matters the education of
the people is of great importance. It might, to take a more
familiar example, be thought that adenoid vegetations of the
nasopharynx were becoming commoner in England, because
patients recognise the advantages of treatment more fully now
and appear oftener at the hospitals to be operated on, while
formerly they simply neglected their condition. These growths
have always been common in England, but the affected did
not seek relief. So it is with leprosy, and it may be hoped
that the people in India will be still further educated to recog-
nise the advantages of Asylums and palliative treatment. It
is well known to all Civil Surgeons that the native has an
abhorrence of a ward and does not seek admission into a
hospital for chronic diseases, though he has great faith in
practical surgery, and its more obvious and striking successes.
This form of argument from dispensary and asylum returns is,
however, reduced to an absurdity when the Matoonga Asylum
at Bombay is quoted to establish the increase of the leprous
126
REPORT OF THE LEPROSY COMMISSION:
population in India. 45 For into this Asylum all the lepers of.
Bombay and its neighbourhood, as far as room could be
provided for them, were crowded and retained under a Muni-
cipal Act, and admission at the inauguration of the Institution,
at least, could by no means be considered voluntary. Nor was
there an option given to the inmates to leave the Asylum at
will. In fact, the whole management of lepers in Bombay
being placed under the Municipal authorities, a police guard
was stationed at the entrance of the Asylum at the time of the
visit by the Commission. That the procedure was for the good
of the lepers who lived in clean and comfortable quarters,
tended by a skilled physician, there can be no doubt, but to
say " that many applicants were refused admission and that
this is a proof of the great number of lepers, or of the increase
of the pest in India," challenges open criticism.
III.—The presence of an Asylum in a district often attracts
numbers of lepers from neighbouring regions, and this is a
point which must not be left out of sight when an enquiry
is made into the leper density of a district. This applies
especially to such localities as border on native or feudatory
States, for in such cases immigration is not at all uncommon.
The lepers finding more congenial conditions under the British
rule leave their own State. Moreover, it has been pointed out
in the Census. Reports, that such migration of people of all
classes from native into British territory is by no means un-
common—a silent testimony to the excellence of the European
government.
In Kumaun the percentage of lepers is very high, and it
was found by Drs. Lewis and Cunningham 46 that the portions
of the district which are specially affected, are near the Nepal
frontier, and there is no doubt that many of the unfortunate
people cross the border to find more favourable surroundings.
( 45 ) Leprosy and Vaccination, by W. lebb.
( 46 ) Op. cit.
Distribution of Leprosy.
127
That they should gravitate around Almora with its excellent
Asylum is not surprising. Again the leper ratios for the Simla
district are very high. Simla lies embedded amongst feuda-
tory States, and has an old established Asylum at Subathu.
The total number of lepers registered in the Census Reports
for this district is only a little above the actual number of
inmates at the Subathu Asylum. From information, kindly
supplied by Dr. Carleton, it was gathered that a large number
of the patients admitted come from Garhwal, but the largest
number migrate from Kangra, and many seek admission from
the native States. It is evident, therefore, that the ratios for
Simla given in the three censuses (34.7, 28.6, and 28.8, re-
spectively) by no means represent the actual amount of leprosy
for the district. It was found that of forty-seven patients at
the Rawalpindi Asylum fifteen belonged to Kashmir or Punch
and two to Afghanistan, while at Sialkot, of forty lepers,
thirteen had obtained admission from distant districts, and of
these, four from Jummoo and Patiala. " At the Dehra Dun
Asylum," Dr. G. B, Ruttledge writes " of one hundred inmates
only twelve belonged to the district itself, eighty-two having
sought admission from native States, and six from neighbouring
districts." The same is true of other frontier Asylums, and
there can be no doubt that a constant flow from outlying dis-
tricts, and especially from native States, takes place. These
points are especially worthy of consideration with regard to
the hill tracts. Though undoubtedly leprosy prevails greatly
in these regions, the ratios in many instances are increased by
immigration. Whenever, therefore, a district shows a dense
leper population, one of the points of enquiry must be, whether
an Asylum exists in the locality, and how many of the inmates
of such Asylum have immigrated from outlying regions.
Leprosy and Vaccination.
It has been maintained that " the synchronicity between
the spread of leprosy and the extension of vaccination has
128
REPORT OF THE LEPROSY COMMISSION:
given rise, in some districts, to such a dread of vaccination
that every device is resorted to by thoughtful parents to prevent
their children from being vaccinated." 47. The history of lep-
rosy of India by no means bears out the assertion that such
" spread or recrudescence of the disease has taken place
during the last thirty years." It will be shown in the follow-
ing lines that, apart from the fact that the above dictum re-
garding " the connexion between the extension of the State-
provided remedy against small-pox and leprosy " involves a
serious petitio principii, a dread of infection through vaccina-
tion does by no means exist in India, and no uneasy feeling
is exhibited on this account and also that there is no reason to
fear a spread of this pest by such means.
It is true that in certain localities hostility to the opera-
tion is met with, but this is due chiefly to the inherent suspi-
cion of an uneducated and ignorant people of any proceeding
of which the reason is not understood, and also among
Hindus to quasi -religious motives. Were this hostility to the
operation based upon observance of its confirmed results in
spreading leprosy or other diseases, the opposition should have
come at some time subsequent to the introduction of the prac-
tice. As a matter of fact, however, it is only at first that
this is observed, and as time wears on, vaccination becomes
more and more readily accepted by the people. In not a
single instance did a leper accuse vaccination as the cause of
his misfortune, although the Commissioners enquired in every
case into the theory a patient might offer for the development
of his disease. As enlightenment and education advance, the
native becomes more and more awake to the benefit conferred
on him and his children by vaccination. Such statements as
those quoted above can only delay the progress of the work
inaugurated by a philanthropic prince by calling up groundless
fears and anxieties in the mind of an uneducated people.
( 47 ) W. Tebb, Leprosy and Vaccination, page 13.
Distribution of Leprosy.
129
This whole question deserves fuller consideration. Since
vaccination is said to diffuse leprosy in India, the first point to
be enquired into is the method employed. Anti-vaccinationists
are accustomed to speak of the danger of spreading the disease
by means of vaccination, as though the method of protective
inoculation were uniform, and as though vaccination were ex-
clusively practised from arm to arm with human lymph, or from
arm to arm.
If leprosy be transmissible in this manner, it can only be
by vaccination with human lymph or through the use of un-
clean instruments. Now in the city of Bombay calf lymph is
exclusively used, at the present time at least. In Madras the
Government has also determined to introduce as rapidly as
possible a complete system of vaccination involving the use of
animal vaccine to the entire exclusion of human lymph, and
similar steps are taken in other parts, as in Bengal, Assam,
and Burma. There is also no doubt that calf lymph is et pre-
sent extensively used all over India. Hence in calculating the
chances of spreading purely human diseases by means of
vaccination allowance must be made for the fact that a consi-
derable number of persons by being vaccinated do not expose
themselves to any such risk, for the danger of an infection by
means of unclean instruments is infinitesimally small, and can
therefore be disregarded. Such an event presupposes that the
person undergoing the process of vaccination is a leper, and
this in the case of infants and children, to begin with, must
be an extremely rare occurrence, and hardly more frequent in
the case of adults. Again, it is more than probable that in the
event of a confirmed leper offering himself for vaccination, the
most neglectful operator would be roused to the most careful
performance of his duty. Finally the person vaccinated from,
or after, a leper must be in the proper state or predisposition
to be infected by leprosy. The simultaneous occurrence of
all these concomitant conditions is hardly conceivable.
It is impossible to state in figures to what extent animal
K