NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
NATIONAL LEPROSY FUND.
Memorandum on the Report of the Leprosy Commissioners,
as prepared by a Special Committee, appointed for the
purpose, and endorsed or annotated by Members of the
Executive Committee.
Your Committee, having been instructed to consider and
report to you upon the publication of the Report of the
Leprosy Commissioners in India in 1890-1, beg to submit
the following considerations.:—
I. They desire to place on record their sense of
the ability with which the Commissioners con-
ducted their investigations while in India, and
of the comprehensive and valuable nature of
their report.
II. The conclusions at which the Commissioners
arrived have been summarised by them at the
end of their report as follows—the evidence
upon which these conclusions rest being dis-
played at length in the earlier pages of the
Report :—
" (1) Leprosy is a disease sui generis ; it is not a form
of syphilis or tuberculosis, but has striking
ætiological analogies with the latter."
" (2) Leprosy is not diffused by hereditary trans-
mission ( I ), and for this reason, and the established
amount of sterility among lepers, the disease has
a natural tendency to die out."
" (3) Though in a scientific classification of diseases
leprosy must be regarded as contagious and also
inoculable (' -' ), yet the extent to which it is propa-
gated by these means is exceedingly small."
( 1 ) ( 2 ) Vide page 9.
4
LEPROSY COMMISSIONERS' REPORT.
" (4) Leprosy is not directly originated by the use of
any particular article of food, nor by any climatic
or telluric conditions, nor by insanitary surround-
ings ; neither does it peculiarly affect any race or
caste."
'• (5) Leprosy is indirectly influenced by insanitary
surroundings, such as poverty, bad food, or
deficient drainage or ventilation, for these by
causing a predisposition, increase the suscepti-
bility of the individual to the disease."
" (6) Leprosy in the great majority of cases originates de
novo, that is, from a sequence or concurrence of
causes and conditions, dealt with in the report,
and which are related to each other in ways at
present imperfectly known."
III. Thirdly, the Commissioners having been instructed
to report upon the practical measures to be
taken for the control or restriction of the disease
in India, have suggested the regulation of
Lepers and Leprosy by means of by-laws
framed by the various Municipalities, upon
which point they write as follows :—
(a) " The Commission are of opinion that the sale of
articles of food and drink by Lepers should be
prohibited, and that they should be prevented from
practising prostitution, and from following such
occupations as those of barber and washerman,
which concern the food, drink and clothing of the
people generally, quite apart from the dread of a
possible infection."
(b) " The Commission consider that the best policy in
dealing with the concentration of lepers in towns
and cities is to discourage it, and to this end
would suggest that municipal authorities be em-
powered to pass by-laws preventing vagrants
suffering from leprosy from begging in or
frequenting places of public resort, or using
public conveyances."
(c) " The large Presidency Towns and the capitals of
provinces in many cases already possess leper
asylums, which might be enlarged by municipal
funds or private subscriptions. Asylums should
LEPROSY COMMISSIONERS' REPORT.
5
be built near towns where they do not already
exist, and the authorities should have the power
of ordering lepers infringing the regulations
either to return to their homes or to enter an
asylum."
(d) " Competent medical authority should always be
consulted before action is taken under such by-
laws.""
IV. Upon the afore-mentioned conclusions of the
Commissioners, numbered I, 2, 3, 4, 5 and 6,
your Committee offer the following remarks :—
They accept Nos. 1, 2, 4 and 5.
They desire to express their disagreement with
the concluding words of No. 3—
" That the extent to which leprosy is propagated by
contagion and inoculation is exceedingly small,"—
not being satisfied with the evidence offered by
the Commissioners for this opinion.
They cannot concur in the views expressed in
No. 6,— namely that
( 3 ) " Leprosy in the majority of cases originates de
novo, that is, from a sequence or concurrence of
causes and conditions, dealt with in the report,
and which are related to each other in ways at
present imperfectly known,"—
being of opinion that the evidence adduced in
the report does not justify such conclusions.
V. The Commissioners, in the section of their
Report entitled
" Practical Suggestions,"
p. 452-7, as also in other parts of the Report,
have expressed opinions strongly adverse to
(3) Vide page 9.
6
LEPROSY COMMISSIONERS' RERORT.
compulsory segregation, either complete or
partial. For instance, they say on p. 258 :—
" No legislation is called for on the lines either of
segregation or of interdiction of marriages with
lepers."
And on p. 453—
" For India complete compulsory segregation may be
considered to be absolutely impracticable.
Neither do the conclusions given before as to the
nature of the disease justify any recommendation
for absolute segregation."
And on p. 454—
" It is impossible for the same reasons to advise
compulsory partial isolation. Voluntary isola-
tion is therefore the only .measure left for con-
sideration."
And on p. 456—
" In no case would the Commissioners suggest an
Imperial Act, especially directed against lepers
as such."
And again on p. 456—
(4) " In conclusion, the Commissioners believe, from the
considerations and arguments adduced in the
foregoing report, that neither compulsory nor
voluntary segregation would at present effectually
stamp out the disease, or even markedly
diminish the leper population, under the existing
conditions of life in India."
Your Committee, having already expressed their
inability to accept the reasoning, upon which the Commis-
sioners have based the above conclusions, are equally unable
to accept the corollary that segregation in any case of leprosy
in India is either impracticable or undesirable. They entertain
a precisely opposite opinion, and would be sorry if the
Government of India were encouraged by the Report of the
( 4 ) Vide page 9.
LEPROSY COMMISSIONERS' REPORT.
7
Commissioners to refrain, from taking the necessary steps in
the direction of such segregation of lepers as may be found
possible. Their opinions upon segregation are in accord with
those expressed in the following extract from a memorandum
by Dr. Vandyke Carter :—
MODES OF SEGREGATION. L. " By erecting plain asylums at certain
centres, each of which would be a refuge common to
several districts ; and a place of detention, under due
management and supervision."
IT. " By founding Leper Colonies, or village communities
mainly of the affected, who, while allowed more liberty
of movement, should yet be prevented from mingling
with the peasantry around : hence still the need of
strict supervision. Many spots would thus serve—
such as deserted forts, decayed villages, and places
now waste yet not far from other sources of supply,
or not without near resources easily resuscitated."
III. 'By requiring the strict isolation of leprous subjects
retained in their homes at express wish of friends.
Suitable separate lodgment would be indispensable ;
unsuitable shelter is even now sometimes supplied.
Joining of such home-isolation with more public
measures should not be overlooked ; for to it
experience in Norway seems to point as a means
essential to complete success within a moderate
period of time ; and in India it would have to be still
more largely resorted to."
IV. " For carrying out the above, in addition to funds, legisla-
tive authority is needed to take up the vagrant sick,
to remove the sorely diseased who is insufficiently
guarded at home, and at times to enforce continued
isolation of the infected until medical sanction of
liberty be granted."
VI. Reserving their opinions as expressed in the fore-
going paragraph and extract, your Committee
give a general approval to the minor re-
commendations of the Commissioners, numbered
above as (a) (b) (c) (d), for the regulation of
lepers and leprosy in India, which they consider
might with advantage be carried out ; though
8
LEPROSY COMMISSIONERS' REPORT.
they do not concur in the opinion that muni-
cipalities will be necessarily or universally the
best means of effecting that object.
Nominated by the GEORGE N. CURZON (Under Sec-
Executive Committee retary for India) Chairman.
of
the
National
Leprosy Fund
EDWARD CLIFFORD.
Nominated by the ( DYCE DUCKWORTH, M.D , LL.D.
Royal College of {
(With
the exceptions noted over-page.)
Physicians
( G. A. HERON, M.D., F.R.C.P.
NommateJ by the JONATHAN HÜTCHINSON,
Royal College
of
LL.D., F.R.S. (With the exceptions noted over-page).
Surgeons
N.C.
MACNAMARA, F.R.C.S.
28th April, 1892.
FERDINAND ROTHSCHILD
{Chairman of the Executive Committee).
F. LONDIN.
*ANDREW CLARK, M.D, F.R.C.P,
Members of * JAMES PAGET.
the Executive
*J. FAYRER.
Committee.
*W. GUYER HUNTER.
JONATHAN HUTCHINSON.
E. CLIFFORD.
ALGERNON BORTHWICK, Hon. Trea.
EDWARD LAWSON
„ „
J. R. SOMERS VINE, Hon. sec.
* These Members have signed a further Memorandum, which will be found on page u.
May 1st, 1893.
LEPROSY COMMISSIONERS' REPORT.
9
Independent or Dissentient opinions, etc., expressed by
Members of the Special Committee and of the
Executive Committee.
(1) " Leprosy is not diffused by hereditary transmission." I
do not think that this is proven.—J. FAYRER.
( 2 ) " Contagions and also inoculable" This is also un-
certain.—J. FAYRER.
( 3 ) "I understand the Commissioners to mean by the
expression " de novo " in reference to the origin of
Leprosy that they believe that the disease may begin
independently of" personal contagion and in con-
nection with climatic and dietetic causes. In that
belief I entirely share. I also agree in the main with
the rest of the statements in the Commissioners'
Report to which exception has been taken in our
Committee. I feel convinced that if Leprosy be con-
tagious at all it depends but to an almost infinitesimal
extent upon contagion for its spread."—JONATHAN
HUTCHINSON, LL.D., F.R.S.
Concurred in by J. FAYRER.
( 4 ) " I am in agreement generally with the recommenda-
tions of the Commission respecting voluntary isolation,
and the issue of Municipal By-Laws regulating the
habits of Lepers. I know of no trustworthy evidence
to prove that a leper in any community is a source of
greater danger than is a consumptive patient, and I
know that a person suffering from Syphilis is a real
and very positive source of danger anywhere. It
would therefore be absurd on the face of it to adopt
stringent laws for the leper, and to let the Syphilitic
person go free.
" The intelligent layman now imagines that because
bacilli are an essential feature of Leprosy, therefore
the disease must be readily contagious. This is simply
quite contrary to fact. The same thing holds good
exactly for consumption, and for some other disorders
in which microbes play a part.
" I think a well-empowered and vigorously supported
Government Medical Executive officer should be
appointed in every large town, and in certain districts,
10
LEPROSY COMMISSIONERS' REPORT.
to supervise the leprous populations and report
regularly upon them. It should be his business to see
that the local regulations are fully carried out, and
on his requisition only should any action be taken
when necessary.
" Suitable asylums should be provided, and those now
existing be sufficiently enlarged to meet the needs
that will arise under suitable by-laws.
" The project of Leper-farms is, I think, a good one.
More than this is, I believe, not within any practical
scheme for amending the condition of lepers, and for
diminishing the spread of the malady."—DYCE
DUCKWORTH, M.D.,
LL.D.
Concurred in by J. FAYRER.
( 4 ) " I am strongly in favour of the maintainance (by
Government or otherwise) of voluntary Homes for
Lepers, but do not believe that segregation would effect
anything in diminishing the prevalence of the disease.
Compulsory segregation would I think involve in-
justice, and entail much social misery. I believe
that our Commissioners' Report well expresses not
alone the opinions of those who have signed it, but,
in a general way, those of the educated classes of
the present day throughout India."—JONATHAN
HUTCHINSON, LLD., F.R.S.
Concurred in by J. FAYRER.
" I think the Report a most valuable and excellent one,
agreeing generally with the remarks of the Committee.
I concur in the objections made by Sir D. DUCKWORTH
and Mr. HUTCHINSON. I have also noted two
remarks, which I do not consider can be accepted
as proven.
" But on the whole I regard the Report as most excellent,
and, if the recommendations are acted on, one which
will prove of the greatest benefit to the population of
India. When Leprosy disappears, it will do so as a
result of improved hygienic and social conditions.
" In the meantime all that is possible—as suggested in
the Report—to be done, should be done to ameliorate
the condition of the sufferers, and I am glad to find
that coercive measures of segregation, or wild fear of
contagion, are not contemplated."—J. FAYRER.
LEPROSY COMMISSIONERS' REPORT.
11I
We, the undersigned Members of the Executive Committee of the
National Leprosy Fund, desire to express our approval of the
Commissioners' Report, which we regard as a very careful record
of well-observed important facts. We concur with their suggestions
of "the practical measures to be taken for the control or the
restriction of the disease in India." We dissent from the opinion
expressed in the body of the Report of the Special Committee
on the subject of the Contagion of Leprosy, and from the re-
commendations founded on that opinion. We believe that the
evidence of the spread of Leprosy by contagion is not sufficient
to justify the compulsory segregation of Lepers, though the
institution of Homes in which they may voluntarily reside may be
very earnestly advised. And we are of opinion that, although an
unusual susceptibility of Leprosy may be transmitted by inheri-
tance, and the children of Lepers may be more than others liable
to the disease if living in the conditions in which it generally
occurs, this does not supply reason sufficient for prohibiting the
marriage of the Leprous.
ANDW. CLARK, M.D., F.R.C.P.
W. GUYER HUNTER.
JAMES PAGET.
J. FAYRER.
JONATHAN HUTCHINSON.
INTRODUCTION.
I N April 1889 Father Damien de Veuster died of
leprosy at Molokai. Born in Belgium, he had
left his native country sixteen years before, and from
that time had devoted himself to the relief of the
Hawaiian lepers.
His martyrdom did not appeal in vain to humanity,
and a Committee was at once formed in England
to consider the best way of perpetuating his memory.
The first meeting of this Committee was held at
Marlborough House on June 17th, 1889, under the
presidency of H. R. H. the Prince of Wales.
An Executive Committee was next nominated,
which, at a meeting on June 30th, resolved on the
erection of a memorial to Father Damien at Molokai,
the formation of a fund for indigent British lepers in
the United Kingdom, the endowment of two Leprosy
Studentships, and finally the appointment of an Indian
Leprosy Commission.
Subscriptions were raised, and the sum collected
was further increased at a dinner, on January 13th,
1890, at the Hôtel Métropole. The chair was taken
by H. R. H the Prince of Wales, who, in proposing
the toast of the evening, gave an account of the
National Leprosy Fund and invited further subscrip-
tions.
viii
REPORT OF THE LEPROSY COMMISSION:
Subsequently a letter was received from the Gov-
ernment of India expressing their willingness to sub-
scribe to the fund, and to assist by appointing two
Indian delegates to act with the British Commis-
sioners, and by facilitating in every way the collection
of evidence by the Commission throughout India.
Three Commissioners were appointed by the Royal
College of Physicians, the Royal College of Surgeons,
and the Executive Committee of the National Leprosy
Fund respectively. A special Committee was also
formed to prepare instructions for the Leprosy Com-
mission. In accordance with these instructions the
Commissioners left London on October 23rd, 1890,
and arrived on November 17th at Bombay, where
they were met by the Indian representatives. A full
account of the further proceedings of the Commission
will be found in the diary.
It only remains to record the great interest shown
in the work of the Commission and the invaluable
assistance afforded by Their Excellencies the Viceroy
of India, and the Governors of Bombay and Madras,
by Their Honours the Lieutenant-Governors of
Bengal, the North-Western Provinces and Oudh,
and the Punjab, and by the Chief Commissioners
of the Central Provinces, Assam, and Burma.
For help in carrying out the more technical part
of the work special thanks are due to Dr. Rice, Sur-
geon-General with the Government of India, and to
Introduction.
ix
Drs. Pinkerton and De Fabeck, Surgeons-General
with the Governments of Bombay and Madras re-
spectively.
Finally, the Commissioners must express their
appreciation of the great kindness shown them
throughout the country by the Civil Surgeons and
Missionaries, who spared no trouble in rendering
every possible assistance. To the Managers of the
Railway Companies also the sincere thanks of the
Commission are due for their unfailing courtesy.
Method of Working.
The following plan of procedure was agreed upon.
The first aim of the Commissioners was to acquaint
themselves with the features of the disease as it ap-
pears in the Empire, directing their attention more
to æetiological factors than to purely clinical aspects.
This could only be done by travelling' from centre to
centre, and from asylum to asylum, and personally
enquiring into the histories of as large a number of
lepers as possible. It was, therefore, decided to take
full advantage of the cold season, and to spend about
five months in examining asylums and lepers in vari-
ous localities.
Subsequently the Commissioners
were to assemble at some hill station in order to sup-
plement their enquiries by pathological and bacte-
riological researches.
Numerous places were visited, and over two
x
REPORT OF THE LEPROSY COMMISSION:
thousand lepers were personally examined with a
view to eliciting certain data as to heredity, conta-
gion, and other points in the aetiology of the disease.
This portion of the enquiry occupied exactly five
months, and the remainder of the time was devoted
to bacteriological investigations at Simla, where the
Indian Government had built a laboratory for the use
of the Commission.
Questions were also sent through the Office of the
Surgeon General with the Government of India to all
Civil Surgeons with a view to obtaining their per-
sonal opinions, and gaining information regarding
the distribution and spread of the disease and allied
general questions
The Report.
The report is thus divided into two chief parts.
In the first the results of the enquiry by the Commis-
sion while travelling will be considered ; the second
part will give an account of their laboratory work.
The first chapter will contain a short diary, and
this will be followed by a description of the asylums
and districts visited, the number of lepers seen, and
other statistical information. Details of the distribu-
tion and spread of leprosy and its relation to soil,
climate, race, and other conditions will next be dis-
cussed, while the following two chapters will treat
of the all-important questions of heredity and con-
tagion.
Introduction.
xi
The sixth chapter will be devoted to such æetiolo-
gical points as food, syphilis, and defective hygiene.
A brief summary of the various methods of treatment
hitherto employed, and the deductions based.on the
enquiry of the Commissioners, will conclude the re-
port. In an appendix an account of the pathological
and experimental work done at Simla and Almora
will be given.
GENERAL REMARKS.
THE
ordinary clinical aspects of leprosy are too well
<W> known to require notice here. It will be sufficient to
state that in India, as in other parts of the world, three forms
of leprosy are met with, the tuberculated, the anaesthetic, and
the mixed. In the first the skin is primarily invaded by the
leprous growth, afterwards the mucous membranes and viscera.
In the second form the lesions occur chiefly in the peripheral
nerves, while the third is simply a combination of the other two
forms.
It has been suggested by some observers that tuberculated
and anæsthetic leprosy are distinct diseases. That they are
one and the same may be inferred from the fact that tubercu-
lated leprosy is nearly always associated in its later course with
anaesthesia, thus giving rise to mixed leprosy, and also from
the fact that the same bacillus is found in the two forms. Fur-
ther, Gerlach 1 has shown by a series of elaborate dissections in
a case of anaesthetic leprosy, that the primary growth takes
place in the skin around the peripheral ends of the nerves, ex-
tending afterwards up the branches to the main trunks. The
onset of the disease would thus appear to be the same in each
variety.
The following table shows the number of cases and the
percentage of each form of leprosy observed by the Commission
in the various places visited. These figures agree very nearly
with those worked out by Vandyke Carter for Bombay.
( 1 ) Untersuchungen über die Unabhängigkeit der Bildung anästhetischer Haut-
flecke von der Erkrankung zugehöriger Nerven be<w>der Lepra anästhetica Dorpat,
1890.
xiv
REPORT OF THE LEPROSY COMMISSION:
TABLE I.
Cases observed according to Form of Disease.
ASYLUM OR
LOCALITY.
Agra . .
Aligarh . .
Almora . .
Bangalore .
Belgaum .
Benares . .
Bombay . .
Burdwan . .
Calcutta . .
Calicut . .
Cawnpore .
Conjeeveram . .
Darjeeling .
Dehra Dun .
Delhi . .
D harm sala .
Fyzabad .
Gwalior . .
Gya . .
Hyderabad .
Jubbulpore .
Jummoo .
Kapurthalla .
Lahore .
Lucknow .
Madras .
Madura . .
Mandalay .
Meerut . .
Anaes-
thetic.
38
8
74
49
1
27
135
8
52
12
8
8
2
46
4
7
13
7
28
7
9
1
8
...
10
106
64
51
...
Tuber-
. cular.
1
1
2
2
2
1
87
1
6
1
...
2
...
4
1
...
1
...
4
3
...
...
2
...
...
19
9
21
...
Mixed.
15
1
32
4
...
4
35
12
30
13
2
6
1
38
6
5
3
6
10
11
6
...
...
2
3
57
36
102
...
Disease
not stated.
...
...
...
...
20
...
2
...
1
...
...
2
...
...
...
...
...
...
...
...
...
I
...
...
...
2
4
3
9
TOTAL.
54
10
108
55
23
32
259
21
89
26
10
18
3
88
11
12
17
13
42
21
15
2
10
2
13
184
113
177
9
REMARKS.
General Remarks.
xv
Table I—continued.
Cases observed according to form of Disease.
ASYLUM OR
LOCALITY.
Moulmein
Nagpur
Naini and Alla-
habad
Naini Tal
Patiala .
Peshawar
Poona
Prome
Purulia .
Rangoon
Rawalpindi
Sialkot .
Subathu .
Tanjore .
Tarn Taran
Thayetmyo
Trichinopoly .
Umballa .
Yerrowda Prisor
TOTAL
Percentage .
Anaes-
thetic.
12
94
48
1
7
1
14
4
57
21
37
27
34
9
103
23
.9
21
5
56.6
Tuber-
dular.
4
27
2
1
1
1
34
14
3
1
...
6
4
2
2
11
2
1
1
284
12.2
Mixed.
9
5 2
16
...
1
...
...
12
34
40
10
6
8
5
36
28
3
10
9
719
31 0
Disease
not stated.
1
...
...
...
...
...
...
...
5
...
...
1
...
...
5
...
2
...
...
5 8
...
TOTAL.
2 5
174
66
2
9
2
45
30
99
6 2
47
40
46
16
146
62
16
3 2
15
2,371
...
RFMARKS.
The age of the patient and the duration of the disease were
noted in nearly every case of leprosy examined by the Com-
mission. The patient's age at the onset of the disease was
thus easily calculated, and the results are given in Table II
arranged in quinquennial periods.
It will be seen from this table that most persons became