NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Loeal Notes :—Burma.
31
the adjoining native city of Lashkar, to be one hundred and
twenty-two. Many lepers were engaged in selling food in the
bazaar. At the time this census was taken the population of
Gwalior was 80,000, so that one in 655.7 of the population
are lepers. ' Analysis of this number showed—
Hindus .
Muhammadans
•
•
•
•
Male.
63
25
88
Female.
2 –
7
34
Thirteen lepers were examined. Ten of these were Hin-
dus, among them one Brahmin, and the rest other castes
[betel-sell er, Chamar, Tamoli, Ahir (cow-herd), Kachi (gar-
dener) ]. Nine were married. The total number of children
born was eleven, eight before and three after the appearance
of the disease : this gives 1.2 to each marriage. No leper had
been vaccinated or inoculated. Enquiries about fish were made
in seven cases, and three patients denied that they had ever
eaten fish or meat.
Burma.
MANDALAY.
In Burma lepers and others afflicted with loathsome di-
seases are regarded more with pity than aversion, but never-
theless they are outcasts, and must live in villages by them-
selves or else associate with beggars and pagoda servants.
They usually frequent the pagoda steps, and on feast days
they receive abundant alms, a handful of rice or a copper coin
being dropped by the worshippers into a basket or platter
placed in front of each leper. One hundred and eighty lepers
were examined at Mandalay ; one hundred and thirty-three of
these were Burmans. There were also thirty-five Muhamma-
32
REPORT OF THE LEPROSY COMMISSION :
dans and eleven Hindus ; among the latter two Brahmins.
Seventy-nine were married. The number of children born was
one hundred and sixty-two, or 2.0 to each marriage. Eleven
lepers had been vaccinated and four inoculated. Three cases
examined were not leprosy.
MOULMEIN.
Among twenty-six cases seen here twenty-five were lepers,
and of these eleven were Hindusand eleven Burmans. Sixteen
were married, and the number of children born was twenty-four,
or 1.5 to each marriage. Seven lepers had been vaccinated.
PROME.
A house-to-house enquiry was instituted at Prome, and
thirty lepers were examined here. With the exception of two
Chinamen, all the cases were Burmans. Twenty were married,
and the total number of children was thirty. Four patients
had been vaccinated and two inoculated. Two other patients
who were not lepers were also seen.
RANGOON.
There is no Leper Asylum in the whole of Burma. Lepers
for the most part are vagrant beggars, and a number of them
may generally be found grouped around the entrances of the
pagodas. Sixty-six cases were examined in Rangoon, collect-
ed from the Shway Dagohn Temple and in the town. A certain
number were seen in the Central Gaol. Forty-eight of the
above number were Burmans, and four were not lepers.
Forty-one were married. The total number of children to
these marriages was seventy-one, giving 1.7 to each marriage.
Eleven cases had been vaccinated and twelve inoculated.
Loeal Notes:—Native States.
33
Thirteen had suffered from small-pox. Specimens of nga-pi 7
were obtained at Rangoon for subsequent examination.
THAYETMYO.
Sixty-five cases, which were chiefly Burmans, were ex-
amined in Thayetmyo. One patient was an Eurasian. Thirty
lepers were married. Number of children fifty-five, that is,
about two to each marriage. Twelve lepers had been vacci-
nated . and eight inoculated. Three cases on enquiry were
found to be free from leprosy.
Native States.
HYDERABAD.
Among thirty patients collected for investigation at Hyder-
abad twenty-one were lepers. Notes of thirteen of these were
taken at the house of a charitable native gentleman, and eight
additional cases were seen among the native troops and also
in the Central Gaol. Six or seven lepers were also to be found
begging in the Mecca Musjid. Among twenty-one cases twelve
were Muhammadans and nine Hindus. Thirteen were married,
and the number of children born to these was twenty-four.
It was noticed that a large number of lepers also suffered from
syphilis.
The number of lepers in and around the city was small
according to the census of 1881. For the city it amounted to
one per ten thousand of the population, the ratio being twice as
( 7 ) In Burma a putrescent preparation of fish is largely eaten, called nga-pi. It
is prepared as follows : " A quantity of semi-putrid fish is put into a jar some salt,
and suffered to rot until it is crowded with maggots. It is then baked, worms and
all, over the fire, and potted for after use. The Burmans can no more live vvithou
nga-pi than others without fish." (Fenwick) Art. Fish, 296. Diet, of Econ. Prod,
of India; edited by G. Watt.
D
34
REPORT OF THE LEPROSY COMMISSION:
large for the suburbs. The Hindus suffered more from the
disease than the Muhammadans. The following table gives
the percentage of lepers on the total population of the city
and suburbs :—
H i n d u s
.
....
M u h a m m a d a n s
.....
C h r i s t i a n s
......
T O T A L
City.
•009
•007
...
•016
Suburbs.
•013
.007
...
•022
There was in 1881 for the city one leper to every six thousand
one hundred and eighty-three of the population, and for the
suburbs one to every four thousand three hundred and sixty-
three.
Mysore.
BANGALORE.
There is a small colony of lepers here which occupies a
building attached to the Lunatic Asylum. At the commence-
ment of 1890, there were twenty-five inmates, fourteen males
and eleven females. By November of the same year, eleven
additional cases, six men and five women, had been admitted.
Twenty-three cases were examined in the Asylum and forty in
a compound adjoining the Civil Hospital. Forty-three lepers
were married. The total number of children born to these was
seventy-two, or 1.6 to each marriage. Thirteen cases had
been vaccinated.
The records of the Asylum show that in no single instance
has any inmate of the Lunatic Asylum ever contracted leprosy.
Elephantiasis was associated with leprosy in one case that was
examined. An extensive trial of various modes of treatment
Loeal Notes:—Kashmir.
35
for the disease has been carried out by Brigade-Surgeon
McGann in the Asylum. These include the employment of
Hoangnan, Gurjun, and Chaulmoogra oil, and Unna's treatment
with Ichthyol and Resorcin.
A census made in 1890 showed the total number of lepers
in Mysore to be five hundred and seventy. The following table
gives the number in various districts of this State :—
Bangalore
Kolar
Tumkur
Mysore •
•
189
105
23
192
Shi moga
Kadur
Chitaldroog
Hassan
•
•
2
»9
31
8
Kashmir.
JUMMOO.
This city and the surrounding area appeared almost free from
leprosy. Only two cases were examined here ; both were
Hindus, married, with three children free from disease. One
of the lepers had been vaccinated.
With reference to leprosy in Kashmir it has been noticed
that the neighbouring Native State of Punch supplied many
inmates for the Asylum at Rawalpindi. Quite recently a Leper
Asylum has been established at Srinagar. A leper census, show-
ing the prevalence of the disease in the valley of Kashmir for
1890, is given in the following table :—
Srinagar .
A nanti nag
Kamraj .
Muzaffarabad
TOTAL
Men.
25
23
57
62
167
Women.
II
4
13
6
34
Muhamma-
dans.
36
26
69
66
197
Hindus.
I
I
2
4
36
REPORT OF THE LEPROSY COMMISSION :
CHAPTER III.
Geographical Distribution of Leprosy in India and its Relation to
Climate, Soil, and Raee.
I N an enquiry into the leper population of India many diffi-
culties present themselves. The only source of informa-
tion is found in the Imperial Census Reports. The census was
instituted some twenty years ago, so that at present three sets
of figures regarding the population are available. The lepers
were enumerated on all three occasions. But since the diag-
nosis as to what constitutes a leper is as a rule left to unpro-
fessional enumerators, the figures cannot possess an absolute
value. There can be no doubt that in the censuses, especially
in the first two, many cases of leukoderma have been included
under the heading of leprosy and, on the other hand, many
cases of leprosy must have been omitted in all three enumera-
tions. 1 It is more than probable, that especially in the case of
women, the returns are very faulty and imperfect. No doubt
men surfer more than women, but it would be erroneous to
argue exclusively from census returns, for the " purda" cuts off
all possibility of verification.
Though these decennial figures cannot be said to have an
absolute value, are they altogether worthless ? By no means,
for they possess a high relative value, which is greatly enhanced
as census follows census. It may be assumed that the errors
for each particular occasion are more or less evenly distributed
over the country, so that one census by itself fully justifies
comparative considerations. When, however, means exists to
check one set of figures with an other, the value of such
( 1 ) To obtain an estimate of the amount of errors that do occur, reference
should be made to the appendix to this chapter " Census, 1871, Bombay." Here
for a few districts two sets of figures are given, one for true and false leprosy
without distinction, and another for the true disease only. The differences are
remarkable.
Distribution of Leprosy.
37
considerations is greatly increased. When, for instance, it
is found that the specific leper population for Sind was very
small in 1872 and likewise in 1881 and 1891, and when the
different conditions under which the census was taken on the
three occasions are taken cognizance of, it must be regarded
as established that here leprosy is not prevalent. Again, when
a district or division periodically returns a high percentage of
lepers, no reasonable doubt can exist as to the frequency of
the disease over such area. Could enumerations take place at
oft-repeated intervals, the figures would well nigh be of abso-
lute value.
On the other hand, how does the case stand, when such
questions as the increase or decrease of leprosy from year to
year or from decade to decade, are raised ? Here the difficul-
ties are still greater and under the existing conditions the
greatest care must be exercised. For from three sets of figures
arguments can only be deduced with caution, especially if these
figures have merely a more or less relative value. Therefore
all that will be said regarding this point must be taken rather
as suggestions which gain in value as the figures approach
the standard of correctness. The Commissioners have felt
all along the insecurity of the ground invaded, and this chapter
shall point out how various are the factors which possibly may
have an influence over the leper population, and that before
the alarming statements of the rapid increase of leprosy over
India are accepted, the most critical and scrupulous tests must
be applied. Leprosy has been called an " Imperial Danger,"
which as such deserves the fullest attention of the Government
of India. Imperial, no doubt, leprosy is, for no part of India
is free from it, but a danger it can only be, if it be shown to
increase at such a rate as to undermine the health and life
of the general population. Those who speak of the great
spread of the disease can evidently have no other support for
their arguments than that afforded by census returns, and they
must stand or fall by them : for them the value of these figures
is absolute. This matter, therefore, as to how far leprosy is
38
REPORT OF THE LEPROSY COMMISSION :
an " Imperial Danger," and as such of the greatest importance
to the empire, will be fully considered.
When in the following pages allusion is often made to
the uncertainty of the figures, this will bear testimony to the
great doubt with which the Commissioners approached many
questions and the hesitation with which they venture to sug-
gest certain lines of arguments or personal opinions regarding
a country of which they know but little and which to Western
Europe at present is almost a terra incognita, so far as those
points are concerned which may be said to be of setiological
importance in the causation of disease. Comparisons between
Indian and European life are only too readily made, and in the
study of a disease the Western standard applied to all condi-
tions alike. The ignorance and want of education of the popu-
lation, often called the " Indian People," not to speak of the
vastness of the empire, are altogether lost sight of. Then
again there is the Oriental indifference which is encountered
everywhere and the eagerness of the Indians to agree with any
suggestion made by the enquirer. " Especial care will always
be requisite in collecting statistics of this kind to guard
against the incurable proneness of ordinary natives to report
as the result of any investigation whatever in their opinion their
immediate superior wishes the result to be." 2 Those who
most fully appreciate these differences between Western and
Eastern conditions will best understand the great diffidence
with which the Commissioners have ventured to express their
personal opinions on many questions discussed in this chapter.
Geographical Distribution of Leprosy.
I.—The following remarks apply in the first instance to
British India, as less accurate data are obtainable regarding
the Native and Feudatory States, and as these are of less
interest in a strictly imperial question, being outside the pale
( 2 ) Report on the Census of Oudh, Vol. I, page 151.
Distribution of Leprosy.
39
of the Government. Three maps are appended showing not
only the distribution but also the prevalence of the disease
over the country. The maps have been compiled after the
leprosy-map of Drs. Lewis and Cunningham, 3 and all three
may be regarded as fairly accurate representations of the
relative amount of leprosy existing in the different parts
of India. The Commissioners consider it their pleasant duty
here to acknowledge the assistance they have obtained from
Colonel Waterhouse, Assistant Surveyor-General of India.
A glance at the maps shows that leprosy is found in all
parts of British India, and it is known that it also occurs in all
Native States.
The latter were enumerated in the recent
census under the supervision of the Imperial Census Commis-
sioner, and have been in part included in Map III. The
prevalence of the disease, however, varies in the different
presidencies and provinces. To clearly demonstrate this point
various tints have been employed : red representing the lowest
ratios, and brown, yellow, green, blue, and black the amount of
leprosy according to the census figures or the various districts
in an ascending order.
It will also be seen that the relative prevalence varies
within certain limits for each of the three decennial periods.
Thus, in 1872, "leprosy prevailed to an extraordinary extent
in Beerbhoom and Bankoora in the Burdwan Division of
Lower Bengal, in the Kumaun Division of the North-Western
Provinces, extending across the southern range of the Hima-
layas ; and in the Deccan and Konkan Divisions of the
Bombay Presidency. The latter area, considered as a whole,
does not show such an extreme prevalence as the two others :
leprosy is, however, extremely prevalent, and in some districts,
such as Barsi, Sowda, and Rajapur, abounds to a degree as
great as is manifested in Beerbhoom, Bankoora, and Kumaun." 4
" Of the three presidencies, Madras, though not contamino-
( 3 ) Leprosy in India. A Report by T. R. Lewis, M.B., and D.D. Cunning-
ham, M.P.
( 4 ) Lewis and Cunningham. Op. cit., page 3.
40
REPORT OF THE LEPROSY COMMISSION:
the fewest lepers, taking the absolute numbers, presents the
lowest ratio, vis., forty-four to a hundred thousand, whereas
Bombay presents a proportion of leprous population nearly
double that of Madras, eighty-five lepers to every one hundred
thousand, although the absolute number of lepers in the Bom-
bay Presidency is slightly fewer. 5 The presidency of Bengal
furnishes an intermediate proportion ; very considerably lower,
however, when the whole presidency is considered than that of
Bombay. One of the divisions in Bengal—Burdwan—contains a
greater proportion of lepers, and absolute numbers almost as great
as those of the whole of the Bombay or Madras Presidency." 6
According to the census of 1881, of the three presidencies
Madras again presents the lowest ratio, viz., forty-seven to a
hundred thousand, while Bombay, though containing the fewest
lepers in absolute numbers, holds an intermediate position, show-
ing a proportion of sixty-one to a hundred thousand ; Bengal
just exceeding this. As in 1871, the disease is found to be
most prevalent in Bankoora and Beerbhoom ; next in the Simla
District, Dehra Dun, in Kumaun (especially in the Almora Dis-
trict) : the number of lepers in every one hundred thousand
varying from one hundred and sixty-one to three hundred and
seventy-two. There is very little change with regard to the
Deccan and Konkan Divisions of the Bombay Presidency as
compared with 1871, but according to Mr. Baines's Census
Report for 1881 " leprosy is probably returned in greater
number than it should be, owing to the inclusion of cases of
the false or discolorative disease."
Finally, the present census of 1891 shows a general decrease
of leprosy all over India. The leprosy-map is also more com-
plete, as Hyderabad, Rajputana, Upper Burma, and other areas
have been included in the general enumeration. Unfortunately
the Central Provinces, the greater portion of the Central India
Agency and the Feudatory States had to be omitted, as at the
( 5 ) In the Bombay Presidency, however, no distinction was drawn between
" white " and " black or true " leprosy, so that the figures for the area are too high.
( fi ) Lewis and Cunningham. Op. cit., pages 3 and 4.
Reg. No. 498, Lep. Com.—Feb. 92.—1,004.
Reg. No. 420 R., Lep. Com.— Oct: 92.—1,306.
Photo., S. I. O., Calcutta.
Reg. No. 493, Lep. Com.—Feb. 92.—1,004.
Reg. No. 420 R., Lep. Com.—Oct. 92.—1,415.
Photo., S. I. O., Calcutta.
Reg. No. 420, Lep. Com.—Nov. 92.-2,300. Photo., S. I. O., Calcutta.
Distribution of Leprosy.
41
time of writing the necessary returns were unobtainable. All
the statistical figures relating to these tracts had to be dispensed
with. This fact will not affect the arguments as to the possible
increase or decrease of leprosy in the slightest, but the Com-
missioners greatly regret that through waiting several months
for such returns much valuable time has been lost and the ap-
pearance of this Report unnecessarily delayed.
In the British territory the highest ratios once more are
found in Bankoora and Beerbhoom, the number of lepers in every
one hundred thousand amounting to about three hundred and
fifty. Burdwan, Simla, DehraDun, and Kumaun again show a
comparatively great prevalence of the disease. Altogether the
remarks on the previous censuses apply to the present one—a
distinct confirmation of the relative accuracy of the figures
and ratios—and it is therefore not necessary to discuss the
matter further, especially as the maps will give a better and
more complete idea of the changes that have taken place in
the leper population than any description or comments in words.
Two tables will now be given to show the number and pro-
portion of lepers in the three presidencies, and the most affected
districts according: to the three censuses.
TABLE I.
To show the Changes in the Number and Proportion of Lepers in
the three Presidencies according to the three Census Returns
{British Territory only).
PRESIDENCY.
Bengal
Madras
Bombay .
Lower Bur-
ma
Upper Bur-
ma
GRAND
TOTAL IN
BRITISH
INDIA
Total
popula-
tion (1st
census).
134,245,128
30,835,577
16,228,774
2,747,148
...
184,056,627
Total
number
of
lepers.
70,698
13,847
13,842
3,203
...
101,590
2 8
Proportion
Per 10,000.
.
5.2
4.4
8.-5
11.6
5.5
Total
popula-
tion (2nd
census),
146,752,868
29,916,629
16,489,274
3,736,771
196,895,542
Total
number
of
lepers.
92,181
14,088
10,095
2,589
...
118,953.
proportion
Per 10,000.
1
6.2
4.7
6.1
6.9
6.0
Total
popula-
tion (3rd
census).
147,399,804
34,336,196
18,901,123
4,658,627
2,946,550
208,242,300
Total
number
of
lepers.
76,079
11,967
10,187
2,960
3,504
104,697
§ 8
Proportion
Per 10,000.
5.1
3.4
5.3
6.3
11.8
5.0
REMARKS.
For 1891 Andaman
Isles and a few
railways and can-
tonments have
been
omitted,
and also the Gen-
tral
Provinces.
These omissions
naturally do not
considerably
affect the leper-
ratios. The re-
turns for Bengal
are
incomplete
(of.
Appendix
to this Chapter).
TABLE I-a
To show the Changes in the Number and Proportion of Lepers in the three Presidencies according to the three
Census Returns inclusive of Feudatory States).
PRESIDENCY.
Bengal
Madras
Bombay
Lower Burma
Upper Burma
Mysore and Coorg
GRAND TOTAL FOR
INDIA
Total
population
(1st census).
135,294,838
31,152,272
23,863,187
2,747,148
5,223,724
198,28l,l69
Total
number of
lepers.
71,287
13,944
18,794
3,203
1,579
108,807
Proportion
Per 10,000.
5.2
4'4
7.8
11.6
• • •
3.0
5.4
Total
population
(2nd census).
154,106,069
31,170,631
23,301,30
3,736,771
4,364,490
216,679,331
Total
number of
lepers.
98,017
I4,525
12,382
2,589
...
576
128,089
Proportion
Per 10,000
6.3
4.6
5.3
69
...
1.3
5.9
Total
population
(3rd census).
155,818,269
38,471,281
20,900,42 I
4,658,627
2,946,550
5,116,659
233,971,807
Total
number of
lepers.
80,426
13,771
12,741
2,960
3,504
837
114,239
Proportion
Per 10,000.
5.1
37
4.7
6.3
11.8
1.6
¡
i
4.8
REMARKS.
In this table besides the returns
for the areas mentioned in the
previous remarks (Table I),
also those for the Central
India Agency, Hyderabad,and
Rajputana have been omitted.
For a complete comparion
the appendix to this chapter
should be consulted.
The returns for Bengal (of.
Appendix to this chapter).
REPORT OF THE
Distribution of Leprosy.
43
TABLE II.
To show the Changes in the Number of Lepers of the Districts
which contain the largest Proportion of Lepers according to the
three Censuses.
PRESI-
DENCY.
/
BENGAL \
DISTRICT.
Akola .
Amraoti
ßalasore
Banda .
Bankoora
Beerbhoom
Burdwan
Cachar
Cuttack
Darjeeling
Dehra Dun
Ellichpur
Garhwal
Goalpara
Jalpaiguri
Kangra
Manbhoom
Moradabad
Moorshedabac
Nagpur
Pooree .
Rawalpindi
Rungpore
Simla .
Sylhet .
Wardha.
PROPORTION OF LEPERS PER
10,000 IN
1st Census. 2nd Census. 3rd Census.
5.3
6.8
?5
13.1
29.9
41.2
22.6
47
2.9
10.0
19.0
5.6
24.0
7.3
4.5
18.0
5.4
57
13.1
3.9
3.3
10.4
10.7
•
347
10.0
6.8
17.0
l6.2
13.7
12.2
37' 2
32.7
29.5
7.8
11.2
11.8
19.9
13.4
18.1
11.5
12.9
14.5
12.3
11.6
12.7
12.1
13.6
5.0
14.9
28.6
7.3
12.9
15.8
I 4.2
12.0
6.3
3 6 3
35.2
21.5
11.6
8.6
TS
20.5
16.5
16.9
19.3
9.9
10.8
12.3
5.3
8.2
*
3.6
6.8
288
13.5
t
REMARKS.
All Feudatory States have
been omitted, and also
those districts which
were not enumerated on
all three occasions.
* Returns not received.
t Returns not received.
44
REPORT OF THE LEPROSY COMMISSION :
Table II—continued.
To show the Changes in the Number of Lepers of the Districts which
contain the largest Porportion of Lepers according to the three
Censuses.
PRESI-
DENCY.
MADRAS
AND
BURMA.
BOMBAY
\
DISTRICT.
Amherst
Bassein .
.
Chingleput
Madras City .
Northern Ara-
kan
Rangoon Town
Shwegyin
Thayetmyo
Toungoo
Ahmednagar .
Belgaum
Dharwar
Khandesh
Kolaba .
Poona .
• •
Ratnagiri
S atara .
Sholapur
PROPORTION OF LEPERS PER
10,000 IN
1st Census.
14.7
12.3
6.1
10.5
28.4
10.5
17.6
10 8
31.5
14.0
10.0(5.1)
11.6
14.8
12. 0
12.0
I2'I
.0
11.8
11.9
2nd Census.
4.5
10.8
10.0
10.7
165
6.0
79
6.4
7.9
10 1
3.3
1.8
14.1
11.3
12.0
9.3
11.0
6.8
3rd Census.
2.5
8.4
6.0
7.6
28.0
37
4.8
6.5
5.9
78
3.3
2.0
11.0
9.1
10.0
97
12.1
8.0
REMARKS.
Only in Belgaum, Panch
Mahals,
Kurrachee,
and Hyderabad distinc-
tion was drawn in 1872
between "white" and
"black" leprosy, so
that the ratios given in
the first column are too
high. The figure in
brackets signifies the
ratio of true lepers for
Belgaum. In 1881 again
it appears probable that
in Khandesh and one or
two other districts of
the Deccan and Konkan
Divisions cases of white
leprosy have been in-
cluded with the true
disease.
In Table II some of those districts are given in which
leprosy is most prevalent, and such tracts of the country have
been selected which in any one census showed a proportion of
at least one in thousand. By also noting the proportions for