NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Distribution of Leprosy.
75
is said must merely be taken as suggestions worthy of future
consideration. It seems, however, that in those areas and
regions in which cholera is worst and endemic, the leper diffu-
sion is 'also greatest. 1 The facts concerning Lower Bengal,
Assam, and Burma, which are the worst fever districts of
India, and at the same time, taken as a whole, the most
afflicted with leprosy, may suggest that causes exist here which
lower the health and vitality of the population, and thus pre-
dispose it towards this disease. The special agents concerned
in the development of cholera.are manifold : climate, poverty,
overcrowding amongst them. But all these must contribute
to a bad hygiene and diminished resistance against infective
processes. It may be assumed that where cholera is worst the
hygiene and physical powers of the people are lowest. If this
be so, and Burma, Lower Bengal, Assam, and Orissa, on the
strength of this, considered hygienically the most unsound
districts, this fact may be accepted amongst others to explain
the great amount of leprosy in such districts as Burdwan,
Assam, and Burma.
A comparison of the leper distribution maps with the cho-
lera map will still further illustrate this matter. The dark
blue area in the latter represents those regions where the
disease is strictly endemic, while over the lighter areas the
disease is rather an epidemic than a constant feature. It will
be seen that the districts of Burdwan, Beerbhoom, Midnapore,
Moorshedabad, Darjeeling, Jalpaiguri, Rungpore, Sylhet, and
Cachar, in which leprosy prevails most extensively, are all
situated in the area of endemic cholera. And though the
statement is subject to exceptions, it may be said that more
or less the dark blue areas on the cholera map correspond
to those tinted other than red in the leper distribution maps.
An absolute harmony, even if this theory hold good, cannot be
expected, especially over those tracts where cholera is hardly
endemic, as here the conditions responsible for an outbreak
are not constant. Again, as will be shown later on, a famine
76
REPORT OF THE LEPROSY COMMISSION :
immediately before a census may possibly disturb the unifor-
mity of ratios. Thus perhaps it is fairest to argue from the
extremes only. These tend to show that, generally speaking,
in those districts which, on account of the endemic appearance
of cholera, certainly rank amongst the unhealthiest in India,
leprosy is very prevalent, while over those areas where there is
little or no cholera (which are represented in red) the leper
population likewise is smaller. As was explained above, a
causal connexion between leprosy and cholera is not hinted at,
but it is quite possible that the same noxia which cause one
district to be more attacked by cholera than another have
also a deleterious effect on the vital powers and general condi-
tion of their population in other directions.
Leprosy and Famines.
The great famine which raged over the southern provinces
of India no doubt effected grave changes in the population,
destroying thousands of lives and reducing the health of the
community. The famine extended over the years 1876 to
1878, and attacked especially the Madras Presidency, but
partly also Bombay. Taking the former first, according to
the Census Report of 1881, there were nine districts which
suffered, while the remaining thirteen were spared altogether.
But while among the non-famine districts a relative increase
of leprosy, according to a comparison of the first two censuses
can be established in eight instances, this is only possible
in two out of nine of the famine districts. Among the eight
unfortunate Bombay districts an increase could not be traced
in a single case, but, on the contrary, as in Madras, in the
majority of famine districts an appreciable decrease is ob-
servable. The loss of population for the southern presidency
amounted to 13 per cent, on the previous census, and the
population was 18 per cent, below what it ought to have been.
It is therefore possible that lepers under such unfavourable
conditions died in large numbers, for of twelve districts in the
Distribution of Leprosy.
77
Bombay Presidency, in which the leper ratios diminished,
seven were struck by the famine, while of nine similar districts
in the other presidency six were visited. It is of course im-
possible to estimate the actual influence of such distressful
conditions in this manner, as all the information required
regarding the number of lepers who died during those years
cannot be obtained, and the recent census throws but little
light on this question.
A table is appended to show the possible effect of the
famine on the leper population.
TABLE XIII.
Famine and Leprosy.
Presidency.
MADRAS
BOMBAY
District.
Nellore
Cuddapah
Kurnool
Bellary
North Arcot
Madura
Salem
Coimbatore
Pudukota
Broach
Ahmednagar
Poona
Sholapur
Satara
Belgaum*
Dharwar†
Kaladgi
Leper
Ratios after
famine
2nd Census).
3.2
1.8
3.4
2.6
6.3
37
2.2
1.4
2.8
2.5
10.1
12.0
6.8
11.0
3.3
1.8
2.9
Leper
Ratios before
famine
(1st Census).
3.9
2.9
3.6
37
6.2
2.9
2.8
2.2
3.0
5.3
14.0
12.0
11.9
11.8
10.0(5.1)
11.6
7.4
REMARKS.
* It appears from
the Census Report
(1872) that cases of
"white leprosy" were
generally
included
under the term "le-
prosy." The figure in
brackets
indicates
what is probably the
true ratio of lepers
for Belgaum.
† In Khandesh and
one or two other dis-
tricts of Bombay in
1881 "white leprosy"
was not rigorously ex-
cluded.
78
REPORT OF THE LEPROSY COMMISSION :
In estimating the value of these figures too much import-
ance must not be attached to a small increase or decr ease, but
ratios which differ, but little must be considered as represent-
ing a persistence of former conditions, since an increase or
decrease of less than one in ten thousand is practically inappre-
ciable, and moreover may easily be explained by unavoidable
errors in any large enumeration. In Madras, therefore, the
leper population can hardly be said to have changed. Here,
however, a famine occurred also in 1865 and 1866, and thus
matters may have been equalised. The difficulty of arguing
from census statistics must not be lost sight of, and due allow-
ance be made for errors in observation and enumeration.
Again, in the year 1866 there was a severe famine over
Lower Bengal. During this year throughout Orissa the average
price of rice, the staple food of the population, varied from
thirteen seers in January to five seers, and even less than five
seers, in August. The famine was confined to the districts
of Manbhoom, Singbhoom, Bankoora, Nuddea, Midnapore, and
the 24-Pergunnahs, in which it was less severe, and was most
intense in Orissa. The failure of the harvests for three suc-
cessive years, especially in Orissa and Tirhoot, and the high
price of food in consequence thereof, had made the distress
still greater, so that in some parts the poorer classes were
reduced to living on the seeds and berries of wild trees, grass,
and herbs. That understraitened conditions, as are implied
by a famine, the leper has but little chance of survival is highly
probable. Up to 1871, and even to 1881, the price of food
remained high over Bengal, so that the comparative health of
the people was kept at a low standard, and if bad conditions of
life have any influence on the development of leprosy, there
should be an increase in the leper ratios after they had pre-
sumably been greatly reduced by the severe famine of 1866.
Comparing the census returns for 1872and 1881, it is found
that in the first census after the famine the ratios were com-
paratively low, in any case, with the exception of Gya, lower
79
Distribution of Leprosy.
than in 1881, while in the latter year in many regions there
was a remarkable increase. One explanation which suggests
itself is, that the severe distress of 1866 and the previous years
decimated the lepers, while the unfavourable conditions during
the next ten years affected the population in such a manner
as to make it more liable to contract leprosy.
The following table gives the districts of Lower Bengal
which suffered from the severe famine in 1866 and the leper
ratios for the first two censuses. The difference in the ratios,
even allowing for imperfections in the enumeration, is remark-
able. With regard to Gya it must be remembered that some
parts of this district suffered much less than others, and that
the famine practically raged only in the western and southern
parts :—•
TABLE XIV.
Famine in Lower Bengal and its Effect on the Leper Ratios.
DISTRICT.
Bankoora
.
Bhagalpur
Champaran
Gya*
.
Manbhoom
Midnapore
.
Monghyr
Nuddea
Orissa
Sarun
Shahabad
.
Singhbhoom
.
.
Sonthal Pergunnahs
24-Pergunnahs
Leper Ratios
per 10,000
(1st Census).
29.9
3.1
2.1
9.8
5.4
8.3
3.0
97
2.4
3.3
6.0
.3
4.0
4.0
Leper Ratios
per 10,000
(2nd Census).
37.2
5.0
3.6
9.5
12..3
9.2
5.4
9.4
12.4
5.4
8.2
47
5.0
5.1
REMARKS.
* Only parts of Gya
suffered from the ia-
mine.
80
REPORT OF THE LEPROSY COMMISSION:
Discussing this question more generally, it will be found
that a famine, shortly before a census, apparently has a ten-
dency to reduce the leper ratio for such province, provided
that the census returns are considered sufficiently accurate.
The enumerations occurring only once in every ten years, it
is impossible to check the figures in anything like a satisfac-
tory manner. Hence in all arguments two courses are open,
viz., either to discredit the value of the ratios altogether, or to
concede to them a relative value of fairly sufficient accuracy.
If the former view be taken all the preceding and following de-
ductions are not worthy of consideration. If within certain
limits they are regarded as a more or less true comparative
statement of the leper diffusion, then it is necessary to explain
the differences in the ratios over different areas and in suc-
cessive censuses. For the present considerations and deduc-
tions, the latter more optimistic view has been taken, leaving
it, however, to the option of others to choose between the
two alternatives.
In the Central Provinces there was severe distress during
the years of 1868 and 1869, while in the period between the
first two censuses no scarcity occurred. It is found that in
1872 the leper ratio amounted to only 2 7, as against 6 5 in
1881, In the Bombay Presidency an intense famine raged for
two years shortly before the second enumeration, and the leper
proportion in 1881 was 2 4 per ten thousand less than in 1872.
In the North-Western Provinces a severe famine passed
over the districts in 1868 and 1869, and a less severe one in
1877 and 1878; and it is seen that the ratios remained low
and nearly equal for the two censuses, and the same applies
to Madras with its famines of 1865 and 1866, and 1876—1878,
respectively.
On the other hand, in Berar, where there has
been no famine, the proportions were high on both occasions,
especially so in 1881.
" The parts of the country which, from the abundance and
certainty of the rainfall, or from other conditions of climate, or
Reg. No. 486. Leprosy Com.—Sep. 91.—310.
Reg. No. 486 R., Leprosy Com.—Mar. 92.—1,004.
Litho., S. I. O., Calcutta.
8Ï
Distribution of Leprosy.
their geographical features, are exempt from the risk of drought
and consequent famine, are : (1) the eastern districts of Bengal
and Assam, which enjoy so ample and regular a rainfall and
such abundant river inundation as to ensure the safety of crops
in the driest years ; (2) Burma, which, like Eastern Bengal, is
never without rainfall or inundations more than sufficient for its
luxuriant rice crops ; (3) the narrow strip of country lying
between the Western ghats and the sea, and the tract imme-
diately eastward of the summit of that range ; (4) the upper
valley of the Nerbadda ; (5) Sind, in which, owing to the very
small rainfall, agriculture almost wholly depends on artificial
irrigation from the Indus, the supply of water from which never
so far fails as to cause a general loss of crop." 16
A map is appended to exhibit these tracts. These are
tinted red, while blue represents all those visited by famine
since 1860, the dark blue having suffered at least twice, the
North-Western Provinces alone having been subjected more
than twice to such distressful conditions since that time. The
numbers indicate the years in which famines visited the re-
spective regions.
The following table will assist to elucidate these points :—
TABLE XV.
Famine and Leprosy.
PROVINCE.
ASSAM* .
BENGAL PROPER
BERAR
Famines.
No famines
Very intense famine in
1865 and 1866
No famines
Leper
Ratios
¡per 10,000
(1st Cen-
sus).
6.8
7.8
6.4
Leper
Ratios.
per 10,000
(2nd Cen-
sus).
7.0
9.4
I4.0
REMARKS.
* As Assam includ-
ed certain districts
in 1881 which at
the -previous cen-
sus were incorpo-
rated with Bengal,
the ratio .6.8 has
been calculated on
an area equal to
that of 1881.
( 16 ) Report of the Indian Famine Commission, Part I, page 8.
c
82
REPORT OF THE LEPROSY COMMISSION :
TABLE XV.—continued.
Famine and Leprosy.
PROVINCES.
BOMBAY .
CENTRAL PROV-
INCES.
MADRAS
NORTH-WEST-
ERN PROVIN-
CES
AND
OUDH.
\
PUNJAB
.
Famines.
Very intense famine,
lasting for two years
1876 to 1878 .
Very intense famine,
lasting for two years
in 1868 and 1869 .
Famine in 1865 and
1866 .
Very intense. famine
from 1876 to 1878 .
Scarcity in 1860-61,
lasting one year
Intense famine in 1868
and 1869, lasting two
years
Scarcity in 1877 and
1878, lasting one
year
Scarcity in the south-
east in 1860 and
1861, lasting one year
Intense famine in the
south-east in 1868
and 1869, asting two
years .
Scarcity in the south-
east lasting for one
year in 1877 and
1878 .
Leper
Ratios per
10,000 (1st
Census.)
8.5
2.7
4.4
4.2
6.2
Leper
Ratios per
10,000
(2nd Cen-
sus).
6.1
6.5
47
4.0
3.6
REMARKS.
At first sight the Punjab appears to be an exception to
the above assumption that a famine before a census possibly
causes an appreciable diminution in the number of lepers. But
it must be remembered that here the first census took place
in 1868, so that the more intense famine worked its effect on
the leper population after the enumeration. This famine was
very severe in Hansi, Hissar, Rohtak, and Karnal districts,
Distribution of Leprosy.
83
and the distress was exacerbated by the " intensity of famine 17
over so great an area as that of Rajputana, which raised prices
to an excessive height and drained away the diminished food-
stocks ; while the influx of emigrants from those parts added
to the severe strain on the charity of the public. Distress
was so intense that 23,000 received gratuitous relief daily for
nine months at a cost of R4,250,000, and about three lakhs of
rupees of land revenue were remitted. The mortality was
greatly in excess over that of previous years." Of the
famine in 1877-78 the Report of the Famine Commission 18
says "that' the failure of the monsoon of 1877 was very
complete in the Punjab, but the autumn crop is less important
there than in any other part of India, and the rain of October
made it possible to sow the usual area with spring crops.
Moreover the preceding years had been very prosperous,
and the export of wheat, which had greatly increased in the
years 1876 and 1877, brought large sums of money to the
province.
The scarcity, however, became serious in some
places through the height to which prices had risen in conse-
quence of the famine of the south, and by reason of the influx
of starving people from Kashmir. The parts which suffered
most from the drought were those districts of the Delhi and
Hissar Divisions not protected by the Western Jumna Canal
which are always among the first affected, and the hill district
of Hazara, which had not been known to suffer in any earlier
famine. The distress was, however, nowhere intense ; the or-
dinary measures were taken to supply relief, and with the
rains of 1878 all fear of famine passed away. The mortuary
returns, however, which indicate an excess mortality of about
340,000 above the average during the year 1878, afford reason
for fearing that the high prices had a grievous effect on the
poorer classes of the population. " It will thus be seen that
the Punjab forms no exception to the opinion expressed above,
( 17 ) Report of the Indian Famine Commission, Part 1, page 15.
( 18 ) Ibidem, pages 20 and 21.
G 2
84
REPORT OF THE LEPROSY COMMISSION:
that a famine before a census may possibly affect the relative
diffusion of leprosy over a given area, and this point must not
be left out of sight in the study of the ætiology of the disease
by a comparison of the density of the leper population in
various presidencies or provinces. During seasons of distress,
such as it is perhaps only known in India, life is reduced to a
struggle for existence, and herein the leper must succumb
quickly, partly on account of his own miserable condition,
partly on account of the poverty of his fellowmen, which com-
pels them to withhold the helping hand. All these considera-
tions demonstrate the difficulties of an enquiry into the relative
frequency of leprosy in a country of such vastness as India,
subject to periodical calamities altogether unknown in Western
Europe, and capable of destroying large numbers of people in
a short time. And they also show that those who argue impli-
citly from census figures must not lose sight of any cause or
event which may materially affect such figures and thus
decrease their comparative value. Those who realise these
points will exercise forbearance with the Commissioners with
regard to the many shortcomings in the report, and especially
in this chapter, where India is discussed as an unit : they will
also understand why matters of great importance have only
been alluded to, and all arguments kept on the broadest lines,
in many cases being suggestions and hints rather than deduc-
tions.
To recapitulate : the purport of these considerations was
to show that it is not sufficient to compare two provinces of
different leper ratios and then, by a contrast of the physical,
economic, and other conditions of these provinces, suggest one
particular feature which is found in the area with the higher
ratio, as an ætiological factor. When such large tracts are
dealt with, the ratios alone are not sufficient to allow of deduc-
tions being made as to the proneness of a district to leprosy.
Firstly, the size of the Indian provinces demands great caution
in all conclusions and arguments. If it be remembered that
Distribution of Leprosy.
85
Bengal is almost as large as Spain, that the Punjab, and the
North-Western Provinces, respectively, occupy only 15,000
and 8,000 square miles less than the whole British Isles, and
that Bombay covers an area nearly twice as great as Great
Britain and Ireland, an idea may be formed of the difficulties,
it might almost be said futility, of drawing general deductions.
Secondly, districts must be selected where such interferences
as severe and intense famines can be excluded, and more or
less equally situated areas should be contrasted.
It now remains to examine how far the above statements are
borne out by the present census. Since the great famine in 1876
and 1878 no great distress has occurred in any part of India.
The conditions have changed much since that time ; railways
have been opened all over the country and inter-communication
is greatly facilitated ; a famine relief fund has been inaugurated
to prevent a recurrence of such disaster. Prices and wages are
being equalised all over India, and it is certain that the personal
condition of the population is bettering itself from year to year,
partly on account of increased commerce within and without,
partly on account of an improved hygiene. There can be no
possible doubt that thanks to the foresight and care of the Indian
Government a repetition of the disasters of 1866 and 1876 need
not be feared, and that the general conditions of people at large
are greatly ameliorated. Sir William Hunter 19 discusses this
question well in his usual eloquent style. He writes : " The in-
creased material prosperity of the people, the growth of foreign
trade, the inter-communications with town life, and the oppor-
tunities these give for better and more varied subsistence, must
have wrought beneficial changes in the population. Then again
the gradual spread of western knowledge, education, and sani-
tary reformation visible in all parts of the country must contri-
bute towards an improvement. The improvement in means of
communication, by the construction of railways and metalled
( 19 ) imperial Gazetteer, Volume VI pages 593 and 594.
86
REPORT OF THE LEPROSY COMMISSION:
roads, has directly developed internal, no less than foreign trade.
Facilities for rapid carriage tend to equalise prices, not only over
large areas of country, but also over long periods of time. As
wheeled carts supersede pack-bullocks, and as railroads super-
sede carts, the whole of India will gradually become one country
for the purposes of food supply. It is by this means alone that
a guarantee can be provided against the ravages of famine.
"The vicissitudes.of a tropical climate will always cause
local failures of the harvest, whether by drought or by flood,
which science, indeed, may learn to foresee, but which no prac-
ticable schemes of irrigation or embankment can altogether
avert. But India as a whole has never yet been unable, in any
single year, to yield sufficient food for her population. The real
problem of famine is a problem of distribution.
" In former times the inhabitants of one district might be
perishing of starvation, while plenty reigned in a district but a
hundred miles distant. In 1866 the people of Orissa were
decimated, not so much by drought or by inundation, as by the
impossibility of transport. In 1877 the distress in Madras was
alleviated by the importation of nearly one million tons of grain,
all of which was carried inland by two lines of rail in twelve
months. Supplies were drawn, not only from the seaboard of
Bengal and Burma, but from the most remote provinces. In
the year 1877-78 the Central Provinces exported grain to the
amount of more than three hundred thousand tons, and the
Punjab to the amount of four hundred thounsand tons, all of
which were conveyed south by rail. Trade has never known
such a stimulus as was afforded on this occasion when the carry-
ing power proved barely equal to the strain. If the famine had
happened before the opening of the railway it would have result-
ed in a loss of life without parallel, even in the annals of India.
" But the utility of local trade is not to be judged of only
at such a crisis. In normal seasons it tends alike to regulate
prices and to promote a higher standard of comfort. Within
the last twenty-five years the cultivators have learnt, for the