NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
280
REPORT OF THE LEPROSY COMMISSION :
alone, a little reflection will show that, selecting such a com-
munity as is implied in the tables, the disease would die out
after a few generations. Has this not been entirely confirmed
by the history of the Norwegian emigrants ?
In the chapter on hereditary transmission and predisposition
it was seen that the disease has a predilection for certain fami-
lies. It was further shown that heredity cannot justly be consi-
dered the cause thereof. It may be asked, whether this fact be
not explicable on the theory of the contagiousness of leprosy.
From a casual inspection of Tables IX, X, Xa, and Xb of
Chapter IV, it might appear as though this were really so. Fur-
ther consideration will prove, that even assuming the spread of
leprosy within a family to be due to contagion, yet the danger
of a general increase of the disease throughout the country on
this account is exceedingly slight. Firstly, amongst all the
families of which one member at least was a leper, in only from
5 to 8 per cent. at the most can the disease be said to have
spread within the family. Secondly, this diffusion within the
family is very slight. For as Table II of this chapter shows, of
1,691 persons who came into close contact with lepers, only 95,
or about 5 per cent., became affected.
Comparing Table I of Chapter IV with the present table,
there seems at first sight to be a great discrepancy. From
the former it might appear that in 264 out of 2,371 families, or
in 11.1 per cent., the disease had attacked more than one
member, that is, spread more or less within the family ; while
according to the latter only 95 out of 1,691 individuals living
with a leper in a family became affected. The difference in
the figures is due to the fact that in the enquiry into an here-
ditary taint, the evidence afforded by the patient's immediate
ancestors naturally was fully considered, as well as that afford-
ed by his own children, while for the construction of Table II
of this chapter, only the latter and the history of husbands
or wives were taken into account. If the tables had been
constructed on equal lines, no doubt many more instances of
Contagiousness of Leprosy.
281
an assumed contagion might have been added. But, on the
other hand, a far greater number of cases would have been
found where such a possible infection could not be claimed.
For there are many instances where a leper confessed to
having lived with his parents and brothers and sisters without
infecting them. Again, in a discussion of heredity it makes
no difference whether the leprous ancestor was separated from
his family or not. In Table I of Chapter IV, therefore, all
the cases have been considered where the children had been
removed from their parents, or developed the disease many
years after their death. Finally, of the 264 lepers with an
hereditary history, several were members of the same families,
so that if the table is to be used as an argument for a spread
by contagion within a family, evidently certain deductions will
have to be made.
Making every allowance for these differences in the con-
struction of the tables, it is evident that the discrepancy is only
apparent.
Table I of Chapter IV, therefore, as it stands cannot be
applied to prove or disprove contagion. It can only show,
that taking all the families in which one individual at least is
a leper, in considerably less than 11.1 per cent. another mem-
ber of the same family becomes affected. To apply it to the
subject under discussion, all instances in which contagion can
be positively excluded must be omitted and each family taken
as a whole. As the cases mentioned in Tables IX and X of
the same chapter are comprised in Table I no further comment
is necessary regarding them. The deductions from Table Xa
are strong arguments in favour of the views expressed in this
chapter, while the cases selected for the construction of Table
Xb are too special to permit any general conclusions being
drawn from them.
The discrepancies are, therefore, only on the surface. To
study the possible influence of contagion within a family, all
the members of such family must be considered—wives and
282
REPORT OF THE LEPROSY COMMISSION :
husbands as well as children—and it must be demanded that
the individuals had actually exposed themselves to the risk
of infection' by intercourse with lepers, that is,—separation and
segregation must be absolutely excluded. All these condi-
tions have been fulfilled in Table II of this chapter.
TABLE III.
To show in how many Cases a Supposed Contagion can be traced
from Husband to Wife, or vice versa.
NAME OF ASYLUM, ETC.
Agra
.
.
.
.
Aligarh
.
.
.
.
Almora .
Bangalore
Benares .
Bombay .
Burdwan
Calcutta .
.
.
.
Calicut
.
.
.
.
Cawnpore
Conjeeveram .
Darjeeling
Dehra Dun
Delhi
.
.
.
.
Fyzabad
Gwalior
.
.
.
.
Gya
.
.
.
.
Hyderabad
Jubbulpore
Lucknow
No. of
couples of
which one
individual
was
affected
with le-
prosy for
at least
five years.
4
9
10
7
26
9
24
11
4
7
1
9
5
6
5
8
6
5
2
No. of
instances
in which
disease
spread
from one to
the other.
1 ( 1 )
...
1
2
...
3( 2 )
...
...
...
...
1 ( 3 )
...
...
1
...
...
REMARKS.
( 1 ) Husband was a leper at time
of marriage and died three years
later. Fourteen years after his
death the widow was attacked.
Wife a leper sixteen years after
death of husband.
( 2 ) In one case the husband was
a leper; twelve years after his
death the widow was attacked by
leprosy.
( 3 ) Husband was a leper for four
years and then died ; two years
later his widow was affected.
Contagiousness of
Leprosy.
283
Table III—continued.
To show in how many Cases a Supposed Contagion can be traced
from Husband to Wife, or vice versa.
NAME OF ASYLUM, ETC.
Madras
....
Madura
....
Mandalay
Moulmein
Nagpur
....
Naini and Allahabad .
Prome
....
Purulia
....
Rangoon
Rawalpindi
Sialkot
....
Subathu
....
Tanjore
....
Tarn Taran
Thayetmyo
Trichinopoly
Umballa
TOTAL
No. of
couples of
which one
individual
was
affected
with le-
prosy for
at least
five years.
25
41
34
2
26
8
11
9
1
1
4
3
17
7
5
1
381
No. of
instances
in which
disease
spread
rom one to
the other.
1
3( 4 )
...
...
3( 5 )
...
4
1
...
...
...
...
4( 6 )
...
...
25
REMARKS.
( 4 ) In two cases the diagnosis was
very doubtful.
( 5 ) In one case husband and wife
affected at the same time.
( 6 ) In one case wife acquired le-
prosy three years after husband's
death, who had had leprosy for
six years.
It will be seen from this table that there were 381 couples
of which one member became a leper and continued to live
with the other for a certain period. Or, expressing it in other
words, 381 healthy persons lived intimately with an equal
number of individuals, exposing themselves to all possible risk
of contagion, and of this number only 25 subsequently became
284
REPORT OF THE LEPROSY COMMISSION:
affected, or 6.5 per cent. Six of these cases may fairly be
subtracted, so that of 381 people living with an equal number
of lepers only 19, or 4.9 per cent., became diseased, accepting
the doubtful cases, two in number, as trustworthy.
Only those cases have been chosen where couples had
been married for at least five years, the average time being
from seven to ten years. There can be no doubt that an en-
quiry into the condition of people married to lepers is the best
mode of ascertaining how far contagion influences the diffusion
of the disease. As Drs. Lewis and Cunningham said in their
report : 18 " The means which most naturally suggests itself
for enquiring into the theory that leprosy is a contagious
disease is an examination of the history of all the married
lepers, for were the result of this to show that the wives or
husbands, as the case might be, of lepers suffer frequently
from the disease this would be some evidence in favour of
contagion." From the above table it will be seen, that even
allowing a long incubation period, the ratio of people affected
is too small to warrant a belief in contagion as a factor of
much importance. If it be remembered that the married
people lived in endemic areas, the possibility of a de novo de-
velopment of the disease must undoubtedly exist.
In Table II the evidence afforded by whole families is given,
and it is at once seen that these two tables correspond in every
respect. However, do instances of a possible contagion exist
amongst people who have been married to lepers for less than
five years ? There were only five such cases, two at Bombay,
two at Madras, where each individual after having lived with a
leper husband for three years developed the disease, and one
at Tanjore. Here two people had been married for sixteen
years, and then the husband became a leper and was left by
his wife, who, within six months, was said likewise to have been
attacked by the disease. The woman could not be examined)
( 18 ) Op. cit., page 56.
Contagiousness of Leprosy.
285
and the diagnosis was highly questionable. But even allowing
the latter to be correct, it would seem probable that this is not
an instance of contagion, but that in these two people the
disease was the effect of the same causes.
A table will now be added, giving the number of people
who have been married to lepers, and who have lived with them
for less than five years, for periods varying from six months to
four years, three years being the average, since the manifes-
tation of the disease, and stating in how many instances leprosy
occurred.
TABLE IIIa.
To show in how many Instances Persons married to Lepers for a
Period of less than Five Years subsequently became Lepers.
NAME OF ASYLUM, ETC.
A g r a
....
A l i g a r h
....
A l m o r a
....
B a n g a l o r e
B e n a r e s
....
B o m b a y
....
B u r d w a n
....
C a l c u t t a
....
C a l i c u t
....
C a w n p o r e
C o n j e e v e r a m .
D e h r a D u n
D e l h i
.
F y z a b a d
....
G w a l i o r
....
G y a
.
No. of
couples of which
one individual
was affected
with leprosy for
less than five
years.
9
1
9
4
2
27
3
5
4
1
2
12
1
1
1
5
No. of
instances of
possible con-
tagion.
...
...
...
2 ( 1 )
...
...
...
...
REMARKS.
( 1 ) In one case a woman
married a leper. He died
two years later and four
years afterwards the wi-
dow became a leper.
286
REPORT OF THE LEPROSY COMMISSION:
Table IIIa—continued.
To show in how many Instances Persons married to Lepers for a
Period of less than Five Years, subsequently became Lepers.
NAME OF ASYLUM, ETC.
Hyderabad
Jubbulpore
Lucknow
Madras
....
Madura
....
Mandalay
Moulmein
Nagpur
....
Purulia
....
Rangoon
Rawalpindi
Tanjore
....
Tarn Taran
Thayetmyo
Trichinopoly .
Umballa
....
TOTAL
No. of
couples of which
one individual
was affected
with leprosy for
less than five
years.
2
1
1
24
16
22
7
22
5
15
1
1
7
9
1
1
222
No. of
instances of
possible con-
tagion.
...
...
2
...
...
...
...
...
1( 2 )
...
...
...
...
5
REMARKS.
( 2 ) Husband and wife ac-
quired leprosy within
six months of each
other.
It follows from this table that there were 222 couples of
which one individual became a leper and continued to live with
the other for a period of less than five years, and of the latter
only five became tainted, or 2.2 per cent. The Tanjore case
can perhaps hardly be included, so that the ratio would be
reduced to '9 per cent. It may be assumed that a certain
number will at a future date become affected. But in any
case the two Tables III and IIIa taken together are strong
arguments against an amount of contagion worthy of serious
Contagiousness of Leprosy.
287
practical consideration, as they plainly show that husbands or
wives of lepers do not frequently suffer from the disease. The
fact that in Table III a greater percentage of husbands or
wives became affected may be explained in other ways than by
mere prolonged contact with lepers. For it must not be for-
gotten that in almost every instance, at the time of marriage
both individuals were healthy, and that subsequently one of
them became affected, that is, all these people must presum-
ably have lived under conditions favourable to the appearance
of the disease. The further facts that they all have lived in
endemic districts, and that leprosy is a highly chronic disease,
make it less surprising to find a higher ratio of lepers in Table
III.
TABLE IV.
Enumeration of Cases where Persons resided with Lepers for Longer
or Shorter Periods, coming in constant and close Contact with
them, without being attacked by the Disease.
These may be classified as—
(1) Hospital or asylum officials.
(2) Persons detained in asylums for some time on
account of mistaken diagnosis, or voluntary in-
mates.
TABLE IVa.
Evidence afforded by Asylum Officials.
NAME OF ASYLUM.
Agra.
= 5 Officials.
Capacity of Official.
(1) Hospital As-
sistant
(2) Cook .
(3) Water-carrier
(4) Sweeper
(5) Six Dressers
Term of
Office.
14 years
30 „
15 ,,
15 ,,
1 year
Condition.
Healthy
,,
died
Healthy
,,
,,
REMARKS.
Does not live at asylum but
visits it twice or. thrice a day.
Did not live at asylum, but
cooked there all day.
Lives at asylum with wife and
family,
These men had to rub lepers with
gurjun oil, and did so for one
year. They left two years age,
and are quite healthy.
288
REPORT OF THIS LEPROSY COMMISSION:
Table IVa—continued.
Evidence afforded by Asylum Officials.
NAME OK ASYLUM.
Almora.
= 3 Officials.
Calcutta.
= 10 Officials.
Calicut.
= 3 Officials.
Dehra Dun
— 5 Officials.
Dharmala
— 4 Officials.
Capacity of Official.
(1) Resident Su-
perintendent
(2) Asylum Assist-
ant .
(3) Asylum Assist-
ant
(1) Washerman
(2)
(3) Porter
(4) Dresser
(5)
(6)
(7) Sweeper
(8)
„
(9)
(10) Water-carrier
(1) Cook
(2) Ward-cooly .
(3) Sweeper
(1) Keeper .
(2) Sweeper
(3)
„
(4)
,,
(5) Gardener
(1) Compounder
(2) Gardener
(3) Keeper .
(4) Sweeper
Term of
office.
20 years
25 „
17 ,,
20 years
14 ,,
7 »
15 „
9 ,,
1 3/4 ,,
7 n
4 ,.
4 „
17 ,,
30 years
12 „
23 ..
12 years
,,
,,
6 years
13 years
1 year
3 years
1 year
Condition,
Healthy
,,
,,
Healthy
,,
„
,,
,,
,,
Healthy
,,
Leper for
two years
Healthy
,,
,,
,,
,,
Healthy
,,
,,
,,
REMARKS.
Aged forty-two years, is married
and has had eight children,
varying in age from eighteen
to one and a half year. Whole
family live in asylum com.
pound, and are healthy.
Have to wash clothes of the
inmates of the asylum.
All the servants at the asylum
have to change their clothes
once a day, and the dressers
twice. All have to tike a
daily bath.
His cousin is also a leper.
All live on the premises of the
asylum.
Lives on the premises in a de-
tached bungalow with wife
and family. All healthy.
Cf. note about gardeners under
Tarn Taran.
Contagiousness of Leprosy.
289
Table IVa—continued.
Evidence afforded by Asylum Officials.
NAME OF ASYLUM.
Madras
= 9 Officials.
Naini
= 1 Official.
Rawalpindi
= 3 Officials.
Sialkot
= 5 Officials.
Subathu
= 5 Officials.
Capacity of official.
(1) Dresser .
(2)
„
.
(3)
„
(4)
„
.
.
(5)
„
(6)
„
.
.
(7) Tailor .
(8) Washerman
(9) Cook
(1) Attendant
(1) Dresser .
(2) Messenger
(3) Cook .
(1) Compounder .
(2) Water-carrier .
(3) Sweeper
(4) Washerman
(5) Gardener
(1) Messenger
(2) Carpenter
(3) Compounder .
(4)
(5) Missionary
Term of
office.
13 years
12 „
10
„
9 „
3 ,.
3 ».
12 „
8 ,,
15 ,,
Many
years.
25 years
13 1/2 ,,
25 ,,
22 years
12 „
2 „
2 „
2
,,
12 years
15 ,,
8 „
3 ..
4 »
Condition.
Healthy
,,
,,
,,
,,
,,
,,
,,
Leper
Healthy
Healthy
Doubtful
Healthy
Healthy
,,
,,
,,
11
Healthy
,,
,,
,,
REMARKS.
Has to mend the clothes of the
lepers (over 200 in number).
Has to wash the clothes of the
lepers.
Was treated for leprosy before
he joined the asylum (cf.
Table 1).
Lives at the colony.
Fingers and face look a little
suspicious, but there is no
anaesthesia.
His mother was a leper in the
asylum. He was brought up
there, and afterwards engaged
as cook.
The former water-carrier left
after being at asylum four-
teen years. He is still alive
and healthy.
All these officials live on the
premises.
U
290
REPORT OF THE LEPROSY COMMISSION :
Table IVa—continued.
Evidence afforded by Asylum Officials—continued.
NAME OF ASYLUM.
Tarn Taran
Capacity of Official.
(1) Keeper
(2) Gardener
(3)
,,
(4) Water-carrier
(5)
(6)
(7) Sweeper
(8)
„
(9)
,,
(10)
„
(11) Compounder.
Term of
office.
3 years
13 ,,
6 „
4
,,
1/2 ,,
7 ,,
6 ,,
5 ,,
1
,,
2 „
Condition.
Healthy
,,
,,
„
,,
,,
,,
„
,,
REMARKS.
Lives at asylum with his wife
and family,
They, like all the servants, live
on the premises. They use
the excreta of the lepers for
gardening purposes. Their
families also reside here.
They clean out the tanks where
the lepers bathe, and while
doing so are in the habit of
having a bath themselves.
From this table it will be seen that of sixty-nine asylum
officials only three were affected with leprosy. Of these one
had the disease before he entered the service (Madras), and a
second case is doubtful (Rawalpindi), so that actually only
one out of sixty-nine had become tainted, or 1.5 per cent.
Including the doubtful case a possible contagion can be traced
in only 3 per cent., a fact which, even on the assumption that
some of the attendants may subsequently develop leprosy,
nevertheless gives little support to the view that leprosy is
spread by contagion.
TABLE IVb.
Enumeration of Instances where Persons other than Officials resided
in the Asylums with Lepers.
(1) Almora.—In the asylum there were eleven people, blind, lame, and
imbecile. Of these, two inmates, aged forty and forty-five years, respectively,
had been there for twenty-eight years. Two, aged sixty and forty, had lived
there for eight years, and another, aged forty, for seventeen years. The other
Contagiousness of Leprosy.
291
six had resided at the asylum severally for eleven, five, three, three, two, and
one year. All these were examined by the Commissioners and found to
be free from leprosy.
(2) Calcutta.—Here there were two cases.
(a) A Native Christian, seventy years old, who has been in the asylum
twenty-five years, lives in a ward with lepers. He eats and drinks with them
and often consumes what they have left, or what they give him. He drinks
out of the same vessels and smokes the same hookah. He was found to be
suffering from multiple molluscum fibrosum, but otherwise quite healthy. He
will not leave the asylum, as he finds it comfortable.
(b) A woman, who suffers from hysteria and eczema, has been in the
asylum for twelve to thirteen years in close contact with four leper inmates
She is quite free from leprosy.
(3) Lucknow.—(a) A man and his mistress were admitted on July 7th,
1876. He was a leper, she was healthy and lived in the poor-house with
him and the other inmates until June 9th, 1881, when he died. Their child
is now twelve years old. He and his mother remained in the poor-house
with the lepers, so that she has been there fifteen years and—
(b) her boy, twelve years. Both are quite healthy.
(c) A woman was admitted July 5th, 1878, under the supposition that she
suffered from leprosy. She married a leper in the poor-house, but had no
issue. A son of a former marriage, sixteen years of age, came to Lucknow
and has remained there with her, so that she and—
(d) her son have lived amongst lepers for thirteen years without becoming
tainted by the disease.
(4) Madras.—A boy, an Eurasian, seventeen years of age, had been in the
leper asylum for two years. He was admitted on account of a wrong diagnosis
and was very reluctant to leave. He was quite healthy.
(5) Subathu.—(a) A man, who up to the present time is free from the
disease, has lived at the asylum for seven years, sharing a room with a leper,
and eating and drinking with him.
(b) A woman, whose husband was a leper and died at Subathu, has lived
there for eight to nine years. She is quite healthy and has remained at the
asylum to help the female lepers.
(c) Another woman was admitted from motives of charity, and has lived
among the lepers for ten years, being at present free from the disease.
(d) A third woman has voluntarily lived among the lepers for three- to
four years, and has remained healthy.
(6) Tarn Taran.—(a) A woman married a leper at the asylum and lived
there for ten years. They had two children. She and —
(b and c) her two children are healthy.
(d) A drover's wife, after her husband's death, had frequent intercourse
with the lepers of the asylum for the last twelve years, giving birth to three
children. At present all these are over eight years of age. She and —
(e, f and g) her children, have resided there and are absolutely healthy.
(h and j) Two children were seen, ten and twelve years of age, respec-
U 2
292
REPORT OF THE LEPROSY COMMISSION:
tively, who were born at the asylum of leper parents, and being orphans, have
been maintained there. They showed no signs of the disease.
(k) A woman, twenty-five years of age, was examined. Both her parents
were leper inmates of the asylum when she was born. Her father died when
she was two years old, and her mother when she was twelve years of age.
She was then taken care of by a female leper in the asylum and has married
a leper there. She has three children now, all over four years of age.
She and—
(l, m and n) her children are perfectly healthy.
These cases will now be given in a tabular form.
NAME OF ASYLUM.
Almora
= 11 Cases
Calcutta
= 2 Cases
Lucknow
«=»4 Cases
Madras
= 1 Case
Subathu
«=4 Cases
.
Condition on Admission.
ÎT3
%%
S S
cu -
\
gl
> ni
<u ~~<
(1) Molluscum fibrosum .
(2) Hysteria .
(1) Healthy woman
(2) Son of (i)
(3) Healthy woman
(4) Son of (3)
Eurasian boy, free from
leprosy.
1
(1) Healthy man
1 (2)
„
women
(3)
„
(4)
..
1
Present Age.
40 years
45 »
40 „
60 „
60 „
40
„
30
»
55 ..
20
„
20
„
20
,,
70 years
About 50 yrs.
About 30 yrs.
12 years
About 30 yrs.
16 years
17 years
Adult .
»
•
*
ij
•
•
Term of resi-
dence at the
Asylum
28 years
28 „
17 „
11
,.
8 „
8 „
5 „
3 ,,
3 .,
2 .,
1 ,.
25 years
12-13 „
15 years
12 „
13 ,,
13 >.
2 years
4 years
8-9.»
10 „
3-4 »
Present Con-
dition.
Healthy.
»•
' »
j»
i>
H
i)
>i
a
Healthy.
Healthy.
»
>»
Healthy.
Healthy.
o
>>
H
Contagiousness of Leprosy o
293
Term of resi-
preset- To
NAME OF ASYLUM.
Condition on Admission.
Present Age.
deuce at the
¡Í .
Asylum.
dltl0n *
,
|
Tarn Taran
= 13 Cases . (1) Healthy woman
. Adult .
. i o years
. Healthy.
(2) \
( Under 10 . Since birth
,,
, \ > Her two children I <
(3) 3
' I
»
>•
(4) Healthy woman
. ¡ About 40 yrs.
12 years
,,
(5) ")
\(
Since birth
,,
,,» ( Her three child- ) All over 8
v ren (4).
\ j years.
"
"
(7) )
|C
(8) Healthy child .
. | 12 years
. 12 years .
„
(9)
»
!»
•
i° 1»
. 10 „
,
„
(10) Healthy woman
. 25 „
. 25 „
.
.,
(ix) ~\
f All over 4 Since birth
,,
, \ I Her three child- \
(12) ( / ren>
:j years.
(13). ;
(.
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In this table are thirty-five cases, all well authenticated
and personally examined by the Commission, where people
were exposed to the dangers of contagion, and yet escaped
the disease. Adding these thirty-five cases to the previous
sixty-nine cases of Table IV¿z, it will be seen that of one
hundred and four persons, living under conditions highly favour-
able for contracting a communicable disease,, only one, or
Dossibly two, have become lepers ; that is, i or 2 per cent.
TABLE V.
Evidence in Favour of Contagion afforded by Persons Eating and
Drinking with Lepers.
ASYLUM OR
CENTRE.
Agra . .
No. of
Lepers.
5
No. of
persons
eating and
drinking
with them.
I I
How many
of these are
affected.
3
REMARKS.
In one case two brothers u se d to eat
and drink together : one of them
became a leper, and fifteen years later,
the other. In another case a leper
father and his two daughters used to
eat together. He died, and some
years later the two daughters became
diseased at the same time.