NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Distribution of Leprosy.
99
endemic nature of this affection. A disease can only be en-
demic in an area where all the conditions leading to its acqui-
sition exist. Leprosy is an infectious disease, but besides the
contagium vivum a certain disposition of the individual is ne-
cessary to produce the disease in the latter. Therefore it can
only be endemic in areas where besides the virus, those factors
also exist which are held responsible for the special disposition
in the individual.
This virus will probably be found in the resting stage of the
bacillus lepr
, but as yet the living microbe has not been found
outside the human body. Assuming that, since the disease is
highly prevalent, this virus is widely distributed throughout
space, and that special conditions of an area largely predispose
its population, it is evident that every facility is offered for an
acquisition of the disease de novo, that is, an acquisition of
leprosy apart from contagion. Indeed if the virus is widely
distributed, contagion may be practically neglected, since all
measures directed against the latter could be of no avail in
stamping out the disease. Tetanus, to give an example, is
no doubt a contagious affection, the specific parasite, however,
in some form or other is so widely distributed, that the risks
of acquiring this disease through contact, direct or indirect,
practically vanish when compared with the chances of an
independent infection from the soil or dust, an individual thus
acquiring the disease de novo.
It is not intended to imply by the term de novo that the
parasite is of no 
tiological importance, but that the microbe
may reach the body and set up the disease quite apart from
contagion if only the required disposition exists. At the pre-
sent time it is an only too common practice to consider any
disease, dependent on a specific organism, contagious under
all conditions alike and without allowing degrees of conta-
giousness. The conditions under which a disease becomes
contagious are often regarded as unimportant, and it is these
which actually lead to the establishment of a predisposition.
H 2
100
REPORT OF THE LEPROSY COMMISSION:
Modern bacteriological research has disclosed many facts which
clearly indicate that contagiousness is an extremely relative
term. This will be more fully considered subsequently, and
here only a few points will be mentioned in proof of how easily
general causes, such as poverty, famine, and precarious living
may lead to a special disposition towards a disease—may, in
fact, cause such disease to be endemic over a certain area.
It has been shown that dogs of one colour are more susceptible
to anthrax than those of another ; pigeons and hens, normally
resistant against the same disease, are easily infected, if allow-
ed to starve. Again rabbits, naturally more or less refractory
to quarter evil, lose their immunity through fatigue and over-
exertion ; and Hankin has shown that a meat diet increases the
resistance of ordinary rats against anthrax, while a milk diet
causes them to be susceptible to this disease. These few
facts—and instances might easily be multiplied—show how
readily a disease, originally non-contagious for a certain class
of animals, may be rendered contagious. The virus has re-
mained unchanged all the time, but an alteration in the
organism of the individual has taken place.
An endemic area, then, would be one where (a) the virus
in some form or other is present, and where also (b) such
conditions exist as are calculated to exercise a special pre-
disposing influence on the population, thus enabling the para-
site not only to enter the body but also to grow and thrive in
the same. It has been seen that there are districts in India
where leprosy is exceedingly prevalent, and has been so at all
three enumerations. These districts agree chiefly in the follow-
ing points, viz., the existence of poverty, insanitary conditions,
over-population, unhealthy or moist climate. Whether the virus
is also abundant in these districts cannot be proven, so long as
bacteriology is almost ignorant regarding the life history of the
leprosy bacillus. As the disease has existed in India since
antiquity, it is highly probable that the bacilli in a resting
stage are widely distributed, ready to encounter the susceptible
Distribution of Leprosy,
101
individual, and with the experience gained from the aetiology
of tuberculosis, it is quite legitimate to assume so It may be
objected that the assumption of a dormant condition of the
bacillus lepr
 outside the human body is a mere hypothesis.
This hypothesis, however, explains all the facts in the diffusion
of leprosy, and is, in reality, also accepted by those who believe
in the spread of the disease by means of contagion, when they
attribute the acquisition of leprosy to such acts as the washing
and wearing of lepers' clothes, and so forth. Again, there are
similar cases in bacteriology, e.g., tetanus, where the specific
organisms no doubt exist in the soil or dust, in the form of
spores, and yet have never been demonstrated microscopically.
At the present time no one denies the necessity of a
special predisposition in the case of tuberculosis. " It is esta-
blished beyond doubt that for the development of the latter
disease there must exist a certain ensemble of unhygienic and
bad or poor conditions of life, often perhaps transmitted from
the parents and ancestors. Thus the importance of general,
social, as well as hygienic, conditions is, eo ipso, acknow-
ledged." 30
Leprosy is not more frequent in some parts, as Bankoora
and Assam, because the people are more careless here in
their intercourse with lepers, but because the conditions here
are more favourable to the origin and spread of the disease,
just as the greater prevalence of tuberculosis among the in-
dustrial classes, as compared with the agricultural population
in England, is not accounted for by the assumption that the
former expose themselves more recklessly to the risks of con-
tagion. How much heredity and contagion contribute to the
spread of leprosy will be discussed in Chapters IV and V.
The consideration of the fact that even in those districts
where leprosy is extremely prevalent but little changes in the
affected population have taken place during the last thirty
( 30 ) Dina Sandberg. * Eitschrift fur Hygiene IX, page 376,
102
REPORT OF THE LEPROSY COMMISSION:
years points rather to the existence of general conditions lead-
ing to a specific disposition. For there is no evidence to
justify the assumption that the native is more careful in his
intercourse with lepers now than he was a generation ago.
Yet the disease remains stationary : indeed probably is slightly
on the decrease. It is asked, "What is this due to?" A
comparison with what has happened in England in the case of
tuberculosis will most readily appeal to those less familiar
with leprosy.
According to English statistics 31 there has been since 1858
a steady decrease in the mortality from phthisis both in the
agricultural and industrial population, and this decrease has
taken place much more rapidly than the decrease of mortality
from all causes during the same period. Again the decrease
of mortality from phthisis in the industrial population has been
proportionately greater than that in the agricultural classes.
From these facts this follows, that the decrease in the general
mortality establishes that a gradual improvement in the vital
condition in England has taken place, and that this improve-
ment accounts for the still greater decrease in the phthisis
mortality. As Dr. Sandberg 32 writes : " The steady decrease
of the phthisis mortality in England argues strongly for a
general development of sound hygienic principles throughout
the various classes of the population and for the benefit arising
from sound hygienic measures."
In England, then, the conditions leading to a general or
individual disposition have been, and are, constantly counter-
acted, with the result that phthisis is on the decline. Now if
the decrease in the leper population according to census sta-
tistics is an actual one, does it not seem more reasonable to
assume that this is due to the improvement in social and
hygienic conditions which undoubtedly has taken place during
( 31 ) W. Farr : Vital Statistics, 1885, pages 267, 268. Fr. Oesterlen : Handbucn
der med. Statistik, pages 405, 406.
32 Loc. cit.
Distribution of Leprosy.
103
the last quarter of a century ? If such decrease, however, be
not accepted, may it not be expected that by means of such
improvement the leper population, instead of remaining station-
ary, will gradually diminish ? It must be the chief aim of the
reformer to counteract the agents which are responsible for
the fact that leprosy is endemic in India. It is impossible to
attack the virus itself, but it seems not only possible to battle
against the predisposing causes, but to do so with fair hope of
eventual success. There is in India a tendency towards a
decrease of the disease, and this is assuredly due to the rapid
progress of the social, economic, and hygienic conditions all
over the empire. With a further and continued improvement
of these, it may be hoped that in India leprosy will cease to be
an endemic disease.
Density of Population in Relation to the Diffusion of
Leprosy.
The health and wealth of a population is closely con-
nected with the density of the population, and for any other
country it might fairly be assumed that the masses would
always crowd to the richest areas.
However, when it is
remembered that the Indian ideas of the standard of life and
comfort are very low, and that the people aim simply at
subsistence in contradistinction to maintenance, it is neces-
sary to exercise great care in forming an opinion as to the
wealth and well-being of the population. The fixity of occu-
pation and of condition, the great rigidity of domestic relations,
necessitate a keen indisposition in man to disperse, and thus in
some parts of the country there is no organised emigration as
yet, while in other parts the people have gradually accustomed
themselves to abandon their homes. ' A local congestion is
thus easily established, all the more as the requirements of the
masses are so moderate and the desire to increase them so
weak. Now as a population tends to increase faster within a
fixed area than the land yields food for it, and as according to
104
REPORT OF THE LEPROSY COMMISSION :
the principle of diminished return from land after the soil has
been worked to a certain extent, the application to it of addi-
tional labour or capital ceases to bring in the same proportion-
ate return as it did at first, and this decrease in productiveness
is continuous, it is clear that the density of population is no
index of the wealth of a district, and that the comparative
wealth of the various areas must be estimated in a different
manner. 33
Yet it seems proper to enquire into the relation between
the leper diffusion and the density of population. The append-
ed table shows clearly that no law exists between the two,
whether famine districts be excluded or not. Bengal, Bombay,
Madras, and the Punjab have been chosen, and these four
provinces may suffice. Examples demonstrating the truth of
the above statement might easily be multiplied.
TABLE XVIII.
Density of Population and Leprosy.
[Census 1881.]
DISTRICT.
BENGAL.
Burdwan
....
Bankoora
....
Beerbhoom
Midnapore
Hooghly
....
Howrah
....
TOTAL BURDWAN DIVISION .
No. of
persons per
square mile.
516.06
397.46
452.40
495.44
828.10
1,334.83
533.67
Lepers per
10,000 of
population.
29.5
37.2
32.7
9.2
5.6
19.5
REMARKS.
( 33 ) J. A. Baines : Operations and Results in the Presidency of Bombay, Chap-
ter II.
Distribution of Leprosy.
105
Table XVIII—continued.
Density of Population and Leprosy,
[Census 1881.]
DISTRICT.
BENGAL—continued.
24-Pergunnahs
Suburbs
.
.
.
.
Calcutta
.
.
.
.
Nuddea
.
.
.
.
Jessore
Khoolna
.
.
.
.
Moorshedabad
TOTAL FOR PRESIDENCY
DIVISION .
Dinagepore
Rajshahye .
.
Rungpore
.
.
.
.
Bogra
.
.
.
.
Pubna
.
.
.
.
Darjeeling .
.
.
.
Jalpaiguri
.
.
.
.
TOTAL FOR RAJSHAHYE
DIVISION
Dacca
Furreedpore
Backergunge
.
.
Mymensingh
.
.
.
TOTAL FOR DACCA DIVISION
No. of
persons per
square mile.
771.78
10,932.13
54,152.37
592.79
692.99
519.96
572.20
682.09
367.74
566.98
601.83
490.23
710.19.
125.75
201.65
44376
756.65
719.78
520.93
485.44
580.06
Lepers per
10,000 of
population.
5'1
6.0
5.4
9.4
4.0
2.7
12.7
6.8
7.4
4.6
14.9
67
6.4
11.8
12.9
9.2
5.6
4.0
2.5
8.4
5.6
REMARKS.
106
REPORT OF THE LEPROSY COMMISSION :
Table XVIII—continued.
Density of Population and Leprosy.
[Census ISSI.]
DISTRICT.
BENGAL—continued.
Chittagong
.
.
.
.
Noakholly
.
.
.
.
Tipperah
.
.
.
.
Chittagong Hill Tracts .
TOTAL FOR CHITTAGONG
DIVISION
TOTAL FOR BENGAL PROPER .
BOMBAY.
Ahmedabad
Kaira
.
.
.
.
Panch Mahals
Broach
.
.
.
.
Surat
.
TOTAL FOR GUJARAT DIVISION
T h a n a
.
.
.
.
K o l a b a
.
.
.
.
R a t n a g i r i
.
.
.
.
TOTAL FOR KONKAN DIVISION
K h a n d e s h
.
.
.
.
N a s i k
.
.
.
.
A h m e d n a g a r
P o o n a
.
.
.
.
S h o l a p u r
.
.
.
.
Satara
TOTAL FOR DECCAN DIVISION
No. of
persons per
square mile.
44I'II
50017
609·93
18·75
294·94
505·57
224·10
500·
158·38
225·
369·55
281·3
2I4I2
255·11
254·22
236·7
124·41
131·51
112 69
168·40
I28·84
212·98
144·1
Lepers per
10,000 of
population.
4·3
2·6
4·9
...
4·2
9·4
•8
2·4
2·7
2·5
6·2
2·8
8·2
11·3
9·3
9·2
14·1
7·5
10·1
12·0
6·8
11·0
10·8
REMARKS.
Distribution of Leprosy.
107
Table XVlll—continued.
Density of Population and Leprosy.
[Census 1881.]
DISTRICT.
BOMBAY—concluded.
B e l g a u m
.
.
.
.
D h a r w a r
.
K a l a d g i
.
.
.
.
K a n a r a
.
.
.
.
TOTAL FOR WESTERN KAR-
NATIC DIVISION
Kurrachee
.
.
Hyderabad
Shikarpur
.
.
.
.
Thar and Parkar
Upper Sind Frontier
TOTAL FOR SIND DIVISION
City and Island of Bombay
TOTAL PRESIDENCY
MADRAS.
Ganjam
.
.
.
.
Vizagapatam
Godavari
.
.
.
.
Kistna
.
.
.
.
Nellore
.
.
.
.
Cuddapah
.
.
.
.
Kurnool
.
.
.
.
Bellary
Chingleput
North Arcot
No. of
persons per
square mile.
194·68
110·90
107·85
148·8
33·9
33·3
85·2
15·9
58·0
50·3
33,662
*132·6
484
515
273
183
140
128
91
121
345
251
Lepers per
10,000 of
population.
3·3
r8
2·9
I'2
2·4
r8
I·2
•8
·5
1·3
1·1
5·5
6·1
4·0
47
5·8
4·0
3·2
1·8
3·4
2·6
10·0
6·3
REMARKS.
* Or excluding Sind
and Bombay Island, 174·1.
108
REPORT OF THE LEPROSY COMMISSION:
Table XVIII—continued.
Density of Population and Leprosy.
[Census 1881.]
DISTRICT.
MADRAS—continued.
South Arcot
Tanjore .
.
.
.
Trichinopoly
Madura .
.
.
.
Tinnevelly .
.
.
.
Salem
.
.
.
.
Coimbatore
Nilgiris .
.
.
.
Malabar .
.
.
.
South Canara
Madras City
TOTAL FOR THE BRITISH
DISTRICTS OF MADRAS
Pudukota Territory
TOTAL FOR THE PRESI-
DENCY,
INCLUDING
PUDUKOTA
TERRITORY
No. of
persons per
square mile.
372
583
341
258
315
209
211
95
410
246
249
274
250
[Census 1891.]
PUNJAB.
Jullundur*
.
.
Amritsar*
Sialkot* .
.
.
.
Gurdaspur
.
Delhi
.
.
.
.
Hoshiarpur
Ludhiana
.
.
.
.
Simla*
.
.
.
.
633·34
620·04
562·45
499·69
495·10
450·82
446·47
437·66
Lepers per
10,000 of po-
pulation.
6·6
5·0
4·0
37
47
22
1·4
6·3
5·1
9·4
10·7
47
2·8
4·6
REMARKS.
2·3
1·5
1·4
1·7
1·2
3·2
1·8
28·8
* An asterisk denotes a
district with an Asylum.
Distribution of Leprosy.
109
Table XVIII—continued,
Density of Population and Leprosy.
[Census 1891.]
DISTRICT.
PUNJAB —continued.
Umballa* .
Gujrat
Gurgaon
....
Rohtak
Lahore
....
Peshawar
....
Karnal
....
Gujranwala
....
Ferozepore
....
Rawalpindi*
Hazara
....
Jhelum
....
Hissar
....
Muzaffargarh
Mooltan
....
Shahpur
...
Bannu
Montgomery
.
.
Kangra*
...
Jhang
Kohat
....
Dera Ghazi Khan
Dera Ismail Khan
TOTAL FOR THE PUNJAB .
No. of
persons per
square mile.
375·24
370·97
337·16
328·53
292·38
287·95
280·21
228·76
206·10
183·15
172·61
152·45
150·30
III 36
103·87
101·98
96·77
86·81
79·69
74·40
73·3 2
72·07
51·50
188·55
Lepers per
10,000 of
population.
3·2
2·5
2·6
1·1
·4
•8
1·3
•5
1·5
3·6
3·0
23
1·7
1·1
·4
·7
•8
•6
10·8
•5
•6
"7
·3
2·0
REMARKS.
* An asterisk denotes a
district with an Asylum.
To gain an idea of the relative population of the areas in
question it may be well to mention the specific population of
no
REPORT OF THE LEPROSY COMMISSION:
more familiar countries. Thus, for Belgium, according to an
enumeration made in 1879, it was four hundred and eighty-six
per square mile, for England and Wales in 1881 as much as four
hundred and forty-five, while for Norway and Sweden it was as
small as fourteen and twenty-six, respectively, for the censuses
of 1877 and 1878. if a proof be required to show the truth of
the statement that a relation between wealth and density of popu-
lation is not a matter of necessity, this will best be found in Sind.
Being near the frontier, with a good sea-port, it has for a long time
been the resort of traders from the north and west. In the interior
are one or two large trade centres rapidly increasing under the in-
fluence of established lines of railway. Prosperity has grown under
good harvests and improved means of transport to market. Al-
together Sind must be considered as being greatly above the aver-
age as regards its wealth, and yet it is but scantily populated. 34
Predisposition of Races.
" The people of India proper, by which term is meant the
whole of the Western Peninsula and the plains west of the
Brahmaputra consist of a number of races and tribes of most
diverse origin, and owing to the restrictions of caste which
rigorously prohibit intermarriage, they have not amalgamated
to form a nation or even a number of nations as, for instance,
Celts, Saxons, Danes, and Normans have done to form the
English and Scotch of to-day. Religious and sectarian differ-
ences have added to the original differences of race, so that at
the present day as well as throughout her whole past history,
while India has always been a collection of many countries, no
one of these constitutes or has ever constituted a nation in the
European sense of the term." 35 " The population of India pro-
per consists of the dark aboriginal races, descended from the
original occupants of the country at the time of the first Aryan
invasion; (2) the fair or at least lighter-tinted descendants of
( 31 ) J. A. Baines. Op. cit., Chapter II.
( 35 ) H. E. Blandford. Op. cit., page 36.
Distribution of Leprosy.
111
the Aryan and Scythian immigrants, who entered India from
the north-west ; (3) mixtures of the two in all degrees of pro-
portion ; (4) immigrants from the coasts, such as Parsis, Jews,
Arabs, and lastly the English, and other Europeans ; and
(5) Eurasians, the mixed descendants of Europeans and other
races." 36 “ The population of Burma is more uniform ; it includ-
es several distinct tribes, but the great majority of these are of
the same or nearly allied races, and the absence of caste dis-
tinction allows of their amalgamation to a greater extent than
in India, at least in those parts of the country that are settled
and civilised." 37
Now leprosy affects all these ethnic elements, though
severally to a different degree. It does not spare the European
of unmixed blood, and the Commissioners during their personal
enquiries met with five cases representing three nationalities,
German, French, and English.
Eurasians suffering from
leprosy are frequently found. These facts, however, are so
well-known that it is hardly necessary to delay any further over
them. It may be interesting to mention that since 1860 from
the European army (Bengal, 1860-69, and India, 1870-89),
two soldiers have been invalided on account of leprosy, one
from the Bombay Army in 1879, and the other from the Madras
Army in 1887 ; and two have been admitted for the same cause.
For the following details the Commissioners are indebted to
the Statistical Medical Officer with the Government of
India :—
EUROPEAN ARMY.
(Bengal, 1860-69 and India, 1870-80).
Total invalided
Invalided for—
Venereal diseases
Phthisis
Leprosy
Admissions for leprosy
•
a
•
55.858
2,829
3,968
2
1 in Bengal Army in 1877,
2 1 in Madras Army in 1886.
( 36 ) H. E. Blandford. Op. cit., page 35.
( 37 ) Ibidem, page 36.
112
REPORT OF THE LEPROSY COMMISSION:
On the other hand, the admissions on account of leprosy
from the Native Army during the period of ten years, from
1879-1888 amounted to two hundred and twenty-nine, as will
be seen from the subjoined table :—
NATIVE ARMY.
Admissions for Leprosy.
YEAR.
1879
....
1880
....
1881
....
1882
....
1883
.
1884
1885
....
1886
1887
.
1888
.
TOTAL
No. admitted.
34
35
25
25
20
18
8
19
20
25
229
RE MARKS.
1 death.
2 deaths.
3 deaths.
It is impossible from a comparison of the two armies to
deduce a racial predisposition, as the conditions under which
the British soldier lives are entirely different from those of the
native. The former is exceedingly well looked after and cared
for, and resides for a limited number of years only in the coun-
try, while the native passes perhaps a lifetime in an endemic
Distribution of Leprosy.
113
area, and his mode of living does not in the least change after
he enlists. In contrasting statistics, great caution must be
exercised as to equality of the concomitant variations, a diffi-
culty which has confronted the Commissioners over the length
and breadth of this chapter.
There are in India no favoured races which are exempt
from the disease, and it can only be want of experience which
prompted one observer to remark : " I have never seen or
heard of a case of leprosy in a pure European." 38 And it
seems assuming too much that the fact of an Eurasian suffer-
ing should be explained as an inheritance through the native
stock. 39
It is difficult to estimate to what extent the various races
suffer. Arguing from general impressions, as accurate statis-
tics are not obtainable, it would appear that the native element
is undoubtedly more prone to the disease, and the unmixed
European least ; but accurate figures cannot be given. The
difference, however, may well depend on the inequality of social
rather than racial conditions, the native ranking lowest in
such a scale, while the Eurasian occupies an intermediate level.
The Commissioners are therefore of opinion that, per se, no
one race is more liable to contract leprosy, and that given
equal and favourable conditions, all will be affected alike.
These few words must suffice on this subject.
Leprosy in Relation to Religion and Caste.
I.—Examined by religion the Kabirpanthis show the highest
proportion for 1881. The Buddhists" show very high leper
ratios throughout, the Aboriginals, on the other hand, low ones.
The proportion for each religion is best stated in tabular
form.
( 38 ) A Medical Report upon the Character and Progress of Leprosy. Royal
College of Physicians, page 118..
( 39 ) C. N. Macnamara. Leprosy : A Communicable Disease. London. 1889.
page 20.
114
REPORT OF THE LEPROSY COMMISSION:
TABLE XIX.
Proportion per each Religion on Ten Thousand.
[Census 1881.]
RELIGION.
Kabirpanthis
Buddhists .
Nat worshippers
Hindus
Christians .
Muhammadans .
Satnamis
Parsis
Aboriginals
Jains
.
Sikhs
Lepers per 10,000 of
same religion.
7.7
7.0
6.0
6.o
5.6
5.o
4.3
3.9
3.3
2.2
1.9
Ratio of followers of
same religion per
10,000 of entire
Indian popu-
lation.
14
135
6
7,402
73
1,974
16
3
253
43
73
REMARKS.
“ Under ' Aboriginals ' those have been grouped together
who, not having been converted to Christianity or to Islam
or the Hindu belief, retain, if they have any religion at all, the
primitive cult of their forefathers, adoring nature under the
various forms or images they have chosen to select as re-
presentative of Deity. There can be no doubt that in such
an estimation errors have occurred when the difficulty of defi-
nition and elasticity of the designation ' Hindu ' is considered,
but the main inaccuracy resulting from mistakes will probably
be found in an under-estimate of the Aboriginals and Jains,
many of the latter being returned as Hindus." 40
For such general matters as are discussed in this chapter
such deficiencies are of little importance. Table XIX conveys
the fact that leprosy does not spare any religion. The Bud-
(40) Imperial Census Report for 1881, pages 17 and 23.