NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
320
REPORT OF THE LEPROSY COMMISSION:
essential to health, that when they are not present in proper
proportion nutrition is affected, as is shown by certain forms of
scurvy : the peculiar dependence of proteid qualities on the
presence of salt is proven, but beyond this very little is
known. " 18 Klein and Verson also have shown that a total
abstinence from salt causes an appreciable loss of weight,
that is, disturbances in the animal metabolism.
The best authorities on dietetics prescribe a daily allowance
oí 300 to 460 grains of salts, but this includes the sum total
of all saline matters necessary for nutrition. 19 Hence 100 to
200 grains of sodium chloride might be considered a fair daily
allowance. The prison allowance of salt for adult labouring
prisoners in the North-Western Provinces and Oudh is 100
grains daily, being at the rate of 4 3/4lb per annum. In the
Punjab the allowance is a quarter of an ounce, or 5.7lb per
annum. In Bombay, the Central Provinces, Burma, and Assam
the allowance is half an ounce, or about 11 1/2lb per annum, while
in Bengal and Coorg it is 14 1/4lb per annum. In Madras, final-
ly, the daily rate varies from half an ounce in the district prisons
to an ounce in the Central Gaols, undoubtedly an unnecessarily
large allowance. The scale varies with the diet of the prison-
ers, being highest in the rice-eating provinces, where also the
consumption of salt by the population outside the prisons is
largest. In the North-Western Provinces and Oudh, where
the allowance is 4 3/4lb in the prisons, the consumption of salt
per head throughout the province is about 8ib per annum, and
it is much the same in the Punjab. And it is remarkable that
though in the former provinces the price of salt has since 1871
decreased about 50 per cent., yet the annual consumption per
head has remained almost stationary. The non-criminal popu-
lation includes, it must be remembered, a large number of
children, and allowance being made for these, the consumption
( 18 ) M. Foster : A Teal-book of Physiology : Third Edition, 1879, page 420.
( 19 ) M. Foster : op cit., page 411.
Reg. No. 458, Leprosy Com.—Sept. 91.—315.
Reg. No. 458 R., Leprosy Com.—Mar. 92.—1,004. Oct. 92.—1,000
Photo litho., S. I. O., Calcutta
Reg. No. 458, Leprosy Com.—Sept. 91.—315.
Reg. No. 456 R . Leprosy Com.—Mar. 92. -1,004. Oct. 92.-1,000.
Photo-litho., S. I. O., Calcutta
Sanitation, Diet, Disease,
etc.
321
per head of adult population in most districts is very much in
excess of the prison allowance which experience has proved to
be ample.
Now, as it has been shown that 9 annas, even when the salt
is most expensive, will buy the native all the salt he requires for
his own personal use during the year, it cannot be said that
the high price of this article debars him from obtaining his
necessary supply of salt. So, if there be any causal connexion
between salt and leprosy, there is no reason why the native
should go without his salt, as a few pence will procure his an-
nual demand for it.
The best mode of showing that such a connexion between
leprosy and the price of salt does not exist is a comparison of
the leper returns for the three censuses of 1872, 1881, and
1891 side by side with the prices of salt during the decennial
periods preceding the enumeration. This is done in Table
II.
Under " A " all those provinces and divisions are given
where, with the exception of the north-western division of the
Punjab, the price of salt has steadily diminished, while under
" B " those districts are found where the conditions are reversed.
It will be seen that the figures do not establish any causal con-
nexion between a high price of salt and leprosy, since from the
statistics no relativity can be established. The want of salt,
therefore, cannot, in the opinion of the Commissioners, be held
responsible for the origin or maintenance of the disease.
To illustrate this statement more graphically two maps have
been constructed. In the former the districts where the price
of salt has risen have been coloured red, blue indicating a fall
in the rates. Similarly, in the other map, red denotes an in-
crease in the leper ratios since the first census, and blue a dimi-
nution. If there were any actual connexion between the price
of salt and leprosy, the colours in the two maps ought to
correspond. It will, however, be seen that they almost replace
each other.
322
REPORT OF THE LEPROSY COMMISSION:
TABLE
Relation between Leprosy
A
Province.
Assam
.3
Bengal
North-West-
ern Prov-
inces.
Oudh
Punjab
. <
r
Central Prov-
inces.
Berar .
Division.
Surma Valley .
Brahmaputra Valley
Eastern .
Deltaic .
Central .
Northern
Orissa
Chota Nagpore
Behar, South .
Behar, North .
Eastern .
Central .
Western .
Sub-montane .
Southern
Northern
.
Southern
Central .
Sub-montane .
North-Western
Western
Western
Central
Eastern .
Berar
Salt
(from
1861—
o) No
f seers
per
rupee.
7'9°2
-07
8-i8
876
8-39
771
9'45
6-i6
8-31
775
6-8
6-88
7-36
7-08
6-50
678
7*99
8-25
9"5O
25-86
10-67
7"°Q
5-56
6-71
9*26
Propor-
tion of
lepers
per
10,000
( ensus
1872).
M
3'2
6-1
l6"2
7-8
2-9
2'5
5'9
2-6
2-4
3'4
2'5
2-9
7-0
6-9
5'2
4*i
8-8
6-4
2'2
4* 1
17
3'6
6-4
Salt
(1871-
81) No.
of seers
per
rupee
8'41
7-24
8-2O
8-84
8'54
7-69
9-81
6'95
8-io
7-69
773
9-32
9-67
8-49
7-90
7-89
9"34
8-92
9-88
23*18
IS'04
8-82
777
7-58
8-85
1
Propor-
tion of
lepers
per
10,000
Census
iSfli).
7"3
7-0
5'5
7-1
ig'o
11-8
12-5
5*3
77
4'5
3'i
3'5
2-4
4'3
3"3
3'5
27
2-4
4-6
3-6
i"3
8*5
4'5
77
14-0
Sa)t
(1881—
go) No.
of seers
per
rupee.
10*69
9'6o
10-59
11-28
11-13
1078
1172
9-07
10-90
I0'Ô2
10-04
"'43
irSo
11*04
10-31
10-65
11-66
11-86
13*57
22-S6
21-49
10*27
9-67
9-04
10-36
Propor-
tion oí
lepers
per
10,000
[Census
iSsi).
13*2
II7
4'3
5"2
i6"o
5-8
11-2
4-4
5-6
3-6
2-6
2"2
2'I
3-6
3'8
3-9
17
'9
2*5
20
'5
) Returns
V not
I received
)
12*7
Sanitation, Diet, Disease, ete.
323
11.
and the Price of Salt in India.
B
Province.
/
Burma
\
Raj putaña . J
Central India.
(
Bombay
. <
\
Sind and Ba-
luchistan.
Nizam's Ter-
ritories.
Madras
. [
Mysore
Coorg .
Division.
Tenasserim
Pegu (deltaic) .
Pegu (inland) .
Upper Burma (Man-
dalay) .
Arakan .
Eastern .
Western .
.
Indore,
Neemuch
Cantonment, and
Gwalior
Konkan .
Deccan .
.
Khandesh
Gujarat ,
0
Kathiawar (Rajkot) .
Kurrachee, Hydera-
bad,
Shikarpur,
Upper Sind Fron-
tier, Quetta .
Secunderabad, Bola-
ram
Malabar Coast
South, Central
Central .
East Coast, North .
East Coast, Central.
East Coast, South
Southern
Mysore, Bangalore .
Coorg
Salt
(from
1851 —
70) No.
ot seers
per
rupee.
39*12
22-82
3i"34
48-32
...
16-85
i5'9S
13-0
I7-94
...
36-45
12-51
18-37
15-86
13-16
18-82
19-07
ig'O2
18-
I3-4
'3"57
t'ropor-
lion of
lepers
per
10,000
Census
1N72).
12*3
14-2
11-8
9
...
8-6
io-S
13-1
5'4
...
1'3
• • «
6-6
2'5
3"4
4-0
37
5-8
2-9
4"9
4-8
Salt
(1S71-
So) NO.
of seers
per
rupee.
29-82
24-14
23'39
...
35"i
23-48
48-47
T
"
/
I4-88
I4-2O
I2-7I
I2-9O
16-5I
50-69
31-33
g-88
14-23
14-26
I5-44
14-61
iS'93
15-82
15-69
10-82
9"47
Propor-
tion of
lepers
per
10,000
Census
18S1).
4'2
9-6
6-9
at*
2*3
...
7-6
6-7
I 1*2
2-8
2-2
I'l
...
6-3
2-8
2-5
4-9
3-6
5-9
4'1
2-6
2'4
Salt
(1881—
go) No.
of seers
per
rupee.
2O'2I
21-63
I4-19
19-03*
30-48
I2"46
15-93
11-32
12-04
11-65
I3-19
13-72
40-06
12-83
9-86
13-62
14-09
13-46
12-8
13-9
14-24
15-5
9-96
9'9
Propor-
tion ( f
lepers
per
10,000
(Census
1891).
2-6
8-1
6-5
I5'9
27
•7
23
7"5
6-8
8-8
i'9
i"5
7
...
5-6
•8
rl
4-8
2-7
4-2
2-1
3'4
i'3
* Average of period from 1SS7 to iSyo.
Y 2
324
REPORT OF THE LEPROSY COMMISSION:
Lastly, water has been considered to be the vehicle of the
leprosy bacillus, and thus a means of infection. In some parts
of India this is a popular idea, and according to Boinet 20 a
similar opinion is held in certain parts of China. The theory
seems, however, highly improbable. For whether it be assumed
that leprosy bacilli contained in the water enter the body by
the mouth or through the broken cuticle, on such hypothesis
the disease should be much more generally diffused throughout
the empire than it actually is. The tanks in India, filled with
more or less stagnant water, are frequented by all classes of
people, and the leper is by no means everywhere prevented
from bathing with the rest, or filling his lota side by side with
a healthy person. He also attends " Melas," and bathes in
the company of other pilgrims. Any one who has witnessed
the life around the tanks will easily conceive that a disease, if
spread by means of water, should be diffused to an alarming
extent and at a great rate, especially if such disease be
endemic and always present.
It seems, moreover, very improbable that the leprosy bacil-
lus is capable of multiplying outside the human body. It is,
however, quite possible that, like the tubercle bacillus, it
remains dormant for a long time after leaving its host. But
the above considerations point strongly against the supposition
that it exists in ordinary water in this condition. Besides the
bacillus has never been found in water, and the observations of
the Commissioners were absolutely negative in this respect.
They examined water from the tank at Tarn Taran, which is
supposed to be beneficial to lepers, and is, therefore, always
thronged by them. Yet, as will be seen from the Laboratory
Report, although a large number of microscopical specimens
were prepared, in not a single instance could the leprosy
bacillus be detected. Water, therefore, can hardly be held
responsible for the propagation of leprosy.
( 20 ) E. Boinet : La Lèpre à Hanoi (Tonkin). Reyue de Médecine. X, No. 8.
Sanitation, Diet, Disease, etc.
325
Enquiry has been frequently made from intelligent native
gentlemen, as well as from patients, as to certain habits and
influences which might be concerned in the origin and propa-
gation of leprosy. No instance of the transmission of the
disease from an animal to man. was met with. Leprosy must
be considered exclusively a human disease, and it does not
attack domestic or other animals, as is the case with tubercular
disease. 21 The effects of premature marriages and the con-
sumption of opium, alcohol, and other stimulants were also
enquired into, but with entirely negative results. And indeed»
though undoubtedly certain classes indulge to excess in opium,
tobacco, the various forms of Indian hemp, alcoholic prepara-
tions from sugar, " mhowa," and the toddy palm, etc., the
races of India must be regarded upon the whole as decidedly
temperate.
Leprosy and Antecedent Diseases.
The question of the effect of syphilis was also considered.
It seems that when syphilis first appeared it was thought by
many to be a new form of leprosy, a modified leprosy. The
reason for this belief was the fact that syphilis appeared in
Europe about the same time when leprosy began to die out.
The leading physicians of that time, however, strongly contest-
ed such views. The people were so convinced of the errone-
ousness of this theory that the lepers refused to admit syphilitic
patients into their hospitals, and the latter had to build special
hospitals for themselves. 22 " And as leprosy became more
and more an unknown disease, partly speculation, partly the
observation of certain endemic syphilides, led some physicians
back to the ancient supposition." 23
At the present time some authorities have propounded the
converse theory that leprosy is an effect of syphilis, a modified
( 21 ) Cf. Journal of the Leprosy Investigation Committee, No. 2. February 1891,
page 130.
( 22 ) R. Virchow : op. cit., pages 500 and 501.
( 23 ) Ibidem.
326
REPORT OF THE LEPROSY COMMISSION:
syphilis. There can be no doubt that syphilis pathologically is
nearer related to leprosy than any other affection. 2 * This,
however, is no justification for the more modern theory. In
fact, as far as local changes are concerned, an almost greater
resemblance exists between lupus and leprosy. 25 Yet no one has
ever ventured to identify these two affections with one another.
Sir W. J. Moore's name is closely associated with what
might be called the syphilis-hypothesis. He considers leprosy
a phase of inherited syphilis. 26 In the opinion of the Commis-
sioners this view cannot be supported for the following reasons :
(a) the history of this hypothesis, as briefly alluded to above,
is entirely against it ; (b) there is at most only a resemblance
or analogy traceable between the two diseases ; (c) certain
clinical facts absolutely disprove the theory, unless the present
views on syphilis be entirely modified or in part given up„ The
fact that people contract syphilis after having become affected
with leprosy, is quite irreconcilable with the theory under con-
sideration that leprosy is a phase of syphilis : and it matters
little whether it be congenital or acquired. Of 154 individuals
who confessed to having suffered from syphilis, 12 had been
thus affected after the appearance of leprosy. At a few
asylums every leper was consistently interrogated with a view
to obtaining a more or less reliable ratio of syphilis amongst
lepers. Out of 458 lepers examined 88, or 19.2 per cent., were
found at one time or another to have suffered from this disease.
This percentage may appear high, but too much importance
must not be attached to the figures as they stand. In the first
place, the ignorance of the informants rendered it impossible
to be sure that the disease they described was truly syphilis,
and undoubtedly a certain number of cases must be deducted.
Yet many of these lepers had the unequivocal marks of tertiary
( 24 ) R. Virchow : op. cit., pages 500 and 501.
( 25 ) Ibidem.
( 26 ) Journal of the Leprosy Investigation Committee, No. 1, August 1890,
page 27, and "Lancet," May 17, 1890.
Sanitation, Diet, Disease, etc.
327
syphilis on their bodies. Again, no figures are obtainable show-
ing the extent to which syphilis and venereal diseases prevail
amongst the general population, though this is known to be very
large. Lastly, it may be objected that in those instances where
syphilis had been contracted subsequent to the development of
leprosy, the ignorance of the informant rendered it difficult to
decide with certainty as to which was the prior event. These
concessions must naturally detract a great deal from the value
of Table III. However, three authentic cases were seen by
the Commissioners, where there could not be the slightest
doubt that syphilis was contracted subsequent to the disease.
These were all seen at the asylum in Madras. Two were young
men who had suffered from leprosy for the last four and five
years respectively : each of them had a typical roseolar second-
ary eruption, the characteristic appearances of the tongue,
tonsils, and fauces, and moreover one of them presented the
remains of a true Hunterian sore, while the other had lost the
fraenum praeputii and showed an unmistakable scar. The
third case concerned a low caste Hindu, twenty years of age,
who had suffered from tubercular leprosy for the last twelve
months and at the time of examination actually had a primary
sore on the glans penis. These three instances alone are suffi-
cient to destroy the syphilis-hypothesis.
TABLE III.
Relation of Syphilis to Leprosy.
ASYLUM OR LOCALITY.
Agra .
Aligarh .
Almora
SYPHILIS CASES.
Before
Leprosy.
6
1
7 1
After
Leprosy.
I
TOTAL.
6
1
8
REMARKS.
(1) Three cases contracted
syphilis at about the same
time they became lepers.
328
REPORT OF THE LEPROSY COMMISSION :
Table III—continued.
Relation of Syphilis to Leprosy.
ASYLUM OR LOCALITY.
Bangalore
Belgaum
Benares
Burdwan
Calcutta
Calicut .
*
Dehra Dun
Delhi .
Dharmsala
Fyzabad
.
Gya
Jubbulpore
Kapurthalla .
Lucknow
•
Madras
Mandalay
.
Moulmein
Nagpur
Naini and Allahabad
Naini Tal
Peshawar
Prome .
.
.
Purulia
.
Rawalpindi
Sialkot «
Tanjore
SYPHILIS CASES.
Before
Leprosy.
I
2
3
5
10 2
1
5
1
4
3
11
2
I
2
2
21
4 3
22
I
I
2
64
4
1
1
I
After
Leprosy.
I
...
...
...
2
• ••
2
...
...
...
...
...
...
...
I
...
2
...
...
...
...
...
TOTAL.
2
2
3
5
12
I
7
1
4
3
II
2
I
2
2
22
4
24
I
I
2
6
4
1
1
1
REMARKS.
( 2 ) One
case
contracted
syphilis at the same time
he became a leper.
( 3 ) One
case
contracted
syphilis about the time he
became a leper.
( 4 ) One case contracted sy-
philis about the time lepro-
sy began.
Sanitation, Diet, Disease, etc.
329
Table III—continued.
Relation of Syphilis to Leprosy.
ASYLUM OR LOCALITY.
Tarn Taran .
Thayetmyo
Trichinopoly .
.
Umballa
,
.
TOTAL
Before
Leprosy
2
6 5
1
2
142
SYPHILIS CASES
After
Leprosy.
...
3
...
•••
12
•
TOTAL.
2
9
1
2
REMARKS.
( 5 ) One case contracted syphilis
about the time he became a
leper.
Again, even allowing that a certain number of the 154
cases specified in Table III were instances of gonorrhoea, does
not the fact that the remainder contracted syphilis at all—and
many of them had undoubtedly done so—militate against Sir
W. J. Moore's theory? For as these men became lepers they
must have been born in the particular phase of congenital
syphilis. How, then, is it to be explained that many of these
men presented the typical signs of tertiary syphilis concurrently
with those of leprosy ?
Lastly, it has never been shown that syphilis passes into
leprosy, or vice versâ. Nor does syphilis ever modify the
progress of the local changes in leprosy ; and the converse
also holds good. 27 In conclusion, all that has been said on
heredity may be used as arguments against this hypothesis.
It is, therefore, impossible to regard syphilis as having
any real or specific influence on the production of the disease,
or as acting otherwise than by lowering the general tone of
the system, and thereby rendering it more liable to attack by,
or hastening the progress of, leprosy.
( 27 ) R. Virchow: op. cit., page 501.
33°
REPORT OF THE LEPROSY COMMISSION :
Other diseases have been considered the possible cause
of leprosy, as malaria or scrofula. It is, however, so plain
that there is no scientific evidence for such assumptions that
mere mention of these hypotheses will suffice.
Summary.—The Commission have come to the conclusion,
after full consideration of the circumstances of life of the aver-
age native of India, that neither the form of diet, nor the
sanitary environment of the individual, have any specific
action in the causation of leprosy. But, as will be seen from
what has been written, sanitation in this country is far from
satisfactory, and leaves very much to be desired in the way
of improvement. And it is probable that bad hygienic sur-
roundings, deficient or improper food, poverty, exposure, and
such diseases as syphilis, are all factors of great importance in
reducing the vital powers of the organism and rendering it
more susceptible to attack. All such indirect and non-
specific causes are specially operative in the case of the
offspring of lepers, who are commonly beggars, and living
under the most unfavourable conditions for health. Nothing
has struck the Commission more forcibly during this enquiry
than the improvement in the general health of the sufferer
which follows residence in a well-conducted asylum, where
cleanliness, regular diet, and sanitary principles are insisted
upon and maintained.
The Treatment of Leprosy.
331
CHAPTER VII.
The Treatment of Leprosy.
D URING the stay of the Commission in India little op-
portunity occurred of personally investigating the effect
of treatment on leprosy, for only a short time was spent in
any station except Simla, and the latter place was too far from
a leper asylum to allow of systematic observations being
made. Information as to treatment had, therefore, to be
drawn from Indian and other Government reports, from various
works on leprosy, and from replies of officers in charge of
leper asylums, and of Civil Surgeons who had treated the dis-
ease in district hospitals and dispensaries.
It has already been pointed out that the incurability of
leprosy by any means yet known is unfortunately certain.
The following remarks must, therefore, be understood to apply
to palliative treatment.
This may be conveniently considered under three heads—
1. Hygienic.
2. Medicinal.
3. Surgical.
Hygienic.
The amount of hygienic treatment possible naturally varies
with the circumstances of the patient. What may be practic-
able for the rich man will be unattainable by the poor one.
This is a truism for all diseases, but it is peculiarly applicable
to leprosy. For example, it has been found beneficial in some
cases of leprosy to remove the patient to a temperate climate
where leprosy is not endemic. This proceeding is, of course,
inapplicable to the great majority of Indian lepers, and can,
therefore, be dismissed at once. Similarly, if all the lepers of
India could be made to wash regularly, to live in roomy and
33 2
REPORT OF THE LEPROSY COMMISSION:
well-ventilated houses, to eat only fresh and nourishing food, to
engage in gardening or other healthy outdoor occupation as
far as their crippled state would permit, and to observe the
greatest care with reference to drainage and sewage dispo-
sal, there is no doubt but that their disease would run a much
milder course. For this reason, apart from any question of
segregation on other grounds, the establishment of voluntary
asylums under careful supervision throughout India would do
much to lessen the sufferings of the leper, for in them he
would be taken away from his usual insanitary surroundings.
The difference between the condition of the lepers exa-
mined by the Commission in well-organised asylums, and that
of outcasts, in many cases without home or friends, collected
by the civil authorities, was sufficiently striking.
Medicinal.
Many drugs have been used in the treatment of leprosy
and widely different opinions have been expressed as to their
utility. The many secret remedies employed from time to
time may be at once dismissed, for they cannot concern a
scientific inquiry. Nor would space permit a dissertation on
all the known medicines which have been given for leprosy.
Only those will be discussed which have attracted attention,
or which have appeared to be of some value.
The oils of India may be conveniently considered in the
first place. Dr. George Watt 1 mentions the following oils as
having been used in the treatment of leprosy—
1. Albizzia Lebbek.
2. Anacardium occidentale.
3. Cynometra ramiflora.
4. Dipterocarpus turbinatus.
5. Gynocardia odorata.
6. Hydnocarpus Wightiana.
7. Hydnocarpus venenata.
8. Pongamia glabra.
9. Psoralea corylifolia.
10. Semecarpus Anacardium.
( 1 ) Dictionary of the Economic Products of India, Vol. IV, page 309; Vol. V,
Part I, pages 462 and 463; Vol. V, Part II, page 354.
The Treatment of Leprosy.
333
Dr. Vandyke Carter 2 also says that the oil of Arachis hy-
pogæa, the ground-nut, has been used, but that its utility is
not apparent.
Of the above eleven oils only four need be discussed at
length. They are Anacardium occidentale, or Cashew-nut oil,
Dipterocarpus turbinatus, or Gurjun or Kanyin oil, Gynocardia
odorata, or Chaulmoogra oil, and Hydnocarpus Wightiana, or
Kowti oil. They will be referred to in the order in which they
occur on the list.
ANACARDIUM OCCIDENTALE.
This oil played an important part in the plan of treatment
adopted by Dr. Beauperthuy at Cumana in Venezuela. Sev-
eral cures having been alleged, Dr. Bakewell was deputed
to examine and report on the cases treated. His official report
was presented to both Houses of Parliament in 1871, and
spoke highly in favour of the results obtained by Dr. Beauper-
thuy.
The main features of the treatment are these—
1. Hygienic Rules.
The patient must have pure air and nourishing food, in-
cluding a moderate amount of fresh meat daily, with a sufficient
quantity of fresh vegetables. He must abstain from salted
meat or fish.
2. External
Applications.
Frictions over the whole of the skin with cocoanut oil or
olive oil are to be employed twice a day. These are to be
followed by soap and water baths. The oil of cashew-nut is
then applied by means of a small piece of sponge to the
( 2 ) Reports on Leprosy, Second Series, page 33.