NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Hereditary Transmission and Predisposition.
237
Table IX—continued.
Condition of the Brothers and Sisters of Leprous Patients with a
" True" History of Heredity.
NAME OF ASYLUM OR
LOCALITY.*
Dharmsala
Gwalior
Gya
Jubbulpore
Jummoo .
Madras
Madura
Nagpur
Naini and Allahabad .
Patiala
Poona
Purulia
Rangoon .
Rawalpindi
Sialkot
Tanjore
Tarn Taran
Trichinopoly
Thayetmyo
Umballa .
TOTAL
No.
of patients
actually
born of
leper pa-
rents.
2
I
5
1
1
10
2
4
I
I
I
3
1
4
1
1
4
I
3
I
62
No.
of their
brothers
and
sisters.
5
5
12
1
3
28
6
7
2
1
1
7
1
11
4
4
10
6
8
3
156
No.
of these
affected.
I
...
I
8
1
1
1
2
1
...
3
...
I
21 =
13.4 per
cent.
REMARKS.
No statement.
No statement.
Ditto.
In some no statement.
No statement.
No statement.
No statement.
No statement.
* Bombay has been omitted on account of insufficient details, as in no case the number of
brothers and sisters was stated.
238
REPORT OF THE LEPROSY COMMISSION:
TABLE X.
Condition of Brothers and Sisters of Leprous Patients with a
"False" History of Heredity.
NAME OF ASYLUM, ETC.
Agra
Almora
Bangalore
Conjeeveram
Dehra Dun
Fyzabad
Jubbulpore
Madras
Madura .
Mandalay .
Purulia
Rangoon .
Rawalpindi
Sialkot
Subathu .
Tarn Taran
Thayetmyo .
No.
of patients
with such
history.
2
10
2
I
4
I
2
5
3
2
9
1
3
I
2
7
I
No.
of their
brothers
and
sisters.
3
29
4
4
16
2
8
13
8
5
22
1
4
1
2
1
No.
of these
affected.
I
5
...
1
...
...
...
3
3
...
8
...
1
...
2
6
REMARKS.
Bombay has been omitted
for the reason given in foot-
note, page 236.
Hereditary Transmission and Predisposition.
239
Table X—continued.
Condition of the Brothers and Sisters of Leprous Patients with a
"False" History of Heredity.
NAME OF ASYLUM, ETC.
Trichinopoly
Umballa .
«
TOTAL
No.
of patients
with such
history.
2
3
61
No.
of their
brothers
and
sisters.
8
6
No.
of these
affected.
I
...
31 =
20.6 per
cent.
REMARKS.
A glance at Tables IX and X might at first sight lead to
the belief that the children born of lepers or of parents who
became lepers at any time after the birth of these children
suffer more frequently from leprosy than do the children born
of people remaining free from the disease. To enquire into
the truth of this statement a Table, Xa, has been added to
show the condition of the brothers and sisters of leprous patients
born of parents healthy before and after the birth of such
patients. It has been found that 850 patients had 2,853
brothers and sisters, of whom 97, or 3.4 per cent., subse-
quently contracted leprosy. On the other hand, from Tables
IX and X, it will be seen that 123 patients with a history of
"true" or "false" heredity had 306 brothers and sisters, of
whom 52, or 17.0 per cent., subsequently became affected.
Does this prove a specific hereditary influence or predis-
position ? Now it is evident that from Table IX no conclusion
can be drawn as to the fate of the offspring of leprous parents
as a whole, for here only those families have been selected
where one parent and one child at least are lepers, and where
a specific hereditary influence may actually be assumed to
exist, the child in each instance being born of a leprous parent.
All those cases, however, have been omitted where a leprous
parent had absolutely healthy children. Table IX does not
240
REPORT OF THE LEPROSY COMMISSION:
therefore assert anything about all the children born of leprous
parents. How many of these become diseased has been con-
sidered in previous paragraphs. Selecting, however, those
families where, through the fact that one child is affected like
its parent, a specific hereditary predisposition is granted to
exist—and of such only a small number was found—Table IX
shows that contrary to expectation of 218 children with such
an inherited predisposition only 83, or 38 per cent., became
lepers. That this ratio should be higher than in Table Xa
simply amounts to stating that in these families the assumed
hereditary taint actually exists, but it says nothing as to the
number of children born of leprous parents who subsequently
become lepers. Table IX, therefore, clearly cannot be con-
trasted with Table Xa with a view of finding out the greater
predisposition of the offspring of leprous parents as a whole.
A similar objection must be raised when Table X is em-
ployed to prove the same assumption. For here only those
families are chosen where one child at least became a leper,
while those children which permanently remained healthy have
been excluded. To make the conclusion as to the offspring in
general a legitimate one, all the children born of such parents
who, though healthy at the time of birth of these children,
subsequently became lepers, should be considered. A com-
parison of Tables X and Xa can evidently only prove this,
that in those families where a parent becomes a leper after
the birth of his children, and where also at least one of these
children subsequently becomes a leper, the children as a whole
are more liable to suffer from the disease, just as a comparison
of Tables IX and Xa can only show that in those families
where at least one parent is a leper before the birth of his
children, and where also at least one of these children subse-
quently becomes a leper, the children as a whole are somewhat
more liable to suffer from the disease than the children in
those families where the parents are healthy, and remain so,
while at least one child is a leper.
Hereditary Transmission and Predisposition.
241
But clearly all this does not prove anything in favour
of a specific hereditary predisposition causally related to the
leprosy in the parent. In fact, it argues strongly for an
acquired predisposition both by the parents and the children,
and this in the case of the latter may have been facilitated
by some congenital abnormality not related to leprosy, but
inherited from the former.
On the other hand, it seems astonishing from a considera-
tion of Table Xa, that selecting those families where the parents
were healthy, but one child at least a leper, of 850+2,853 or
3,703 children 850+97 or 947 individuals, or 25 per cent.,
should have become lepers, though the parents, as far as could
be ascertained, were free from any family taint in the direct
line. The same percentages for Tables IX and X would be 37
and 43.6, respectively. It might now be well to compare these
figures with results obtained from a consideration of such fami-
lies where the parents remained healthy, and were confessedly
free from any family taint in the direct line, but at least two of
the children were lepers. It will be seen from Table Xb that
in such families 96 patients had 292 brothers and sisters, of
whom 111 were lepers : or that selecting these families, of 388
children 207, or 53.3 per cent., were diseased. This is very
instructive, as though here an hereditary specific predisposition
is excluded as rigorously as possible, yet the disease shows a
predilection for certain families.
It is only when examined in this light, that deductions re-
garding the offspring as a whole can be made with a view to
elicit the influence of a specific hereditary predisposition. Now
as individuals of alien blood, such as husbands and wives of
lepers who live with the family under similar conditions, suffer
to the extent of from 5 to 6 per cent., the above arguments are
strengthened. 19 Evidently all that can be argued from these
considerations is, that leprosy in a certain number of instances
( 19 ) Cf. Chapter on Contagion.
R
242
REPORT OF THE LEPROSY COMMISSION :
has a tendency to affect several members of a family, but that
this is not due to a specific hereditary predisposition.
TABLE Xa.
Condition of Brothers and Sisters of Leprous Patients whose
Parents remained Healthy.
ASYLUM OR LOCALITY.
Aligarh
Almora
Bangalore
Belgaum .
Benares .
Calcutta .
Cawnpore
Conjeeveram
Darjeeling
Dehra Dun
Delhi
Dharmsala
Gwalior .
Gya
Jubbulpore
Kapurthalla
Lahore
Lucknow .
Madras
Madura
Mandalay
Moulmein
Nagpur
No. of
patients
with such
history.
6
74
21
2
13
67
5
12
1
67
7
7
9
3°5
1
1
2
59
47
136
16
53
No. of
:heir bro-
thers and
sisters.
12
256
71
9
32
245
11
54
4
228
23
17
35
98
15
1
4
4
214
209
495
53
131
No. of
these
affected.
I
16
...
...
...
2
...
3
1
6
...
2
...
3
1
...
...
...
15
9
7
...
...
REMARKS.
It must be remarked, that
in several instances when
the brothers and sisters of
a leper were healthy, their
number had not been en-
quired into, or at tiroes no
mention at all made of
them. On the other hand,
whenever a leper had a
leprous brother or sister,
full information has always
been given. Taking due
consideration of this fact,
it is evident that the per-
centage at the end of this
table is too high.
Agra, Bombay, Calicut, Hy-
derabad, Subathu
and
Tarn Taran have been
omitted on account of in-
sufficient details. Omis-
sions, however, though
few, exist also in some of
the other stations. Making
due allowance for these, it
may be said that 2 per
cent. indicates the true
ratio.
Hereditary Transmission and Predisposition.
243
Table Xa—continued.
Condition of Brothers and Sisters of Leprous Patients whose
Parents remained Healthy.
ASYLUM OR LOCALITY.
Naini and Allahabad .
Naini Tal
Patiala
Prome
Purulia
Rangoon
Rawalpindi
Sialkot
.
Tanjore
Thayetmyo
Trichinopoly
Umballa .
TOTAL
.
No. of
patients
with such
history.
8
1
8
24
18
41
19
22
9
46
5
8
850
No. of
their bro-
thers and
sisters.
31
2
27
65
41
122
54
75
31
156
20
18
2,853
No. of
these
affected.
1
...
1
2
9
1
6
4
...
4
3
97 =
3'4 per
cent.
REMARKS.
TABLE Xb.
Condition of Brothers and Sisters of Leprous Patients belonging to
Families where the Parents remained healthy, but at least Two
Children were Lepers.
ASYLUM OR LOCALITY.
Agra
Aligarh
Almora
No. of
patients
belonging
to such
families.
1
1
13
No. of their
brothers
and sisters.
1
1
49
No. of
these affect-
ed.
1
1
16
REMARKS.
R 2
244
REPORT OF THE LEPROSY COMMISSION:
Table Xb—continued.
Condition of Brothers and Sisters of Leprous Patients belonging
to Families where the Parents remained healthy, but at least
Two Children were Lepers.
ASYLUM OR LOCALITY.
Calcutta .
Conjeeveram
Darjeeling
Dehra Dun
Dharmsala
Gya
Hyderabad
Jubbulpore
Madras
Madura .
Mandalay .
Naini and Allahabad .
Patiala
Prome
Purulia
Rangoon .
Rawalpindi
Sialkot
Subathu .
Tarn Taran
Thayetmyo
Umballa .
TOTAL
No. of
patients
belonging
to such ,
families.
2
3
I
6
1
2
I
I
12
9
6
1
1
2
7
\
5
3
3
8
3
3
96
No. of their
brothers
and sisters.
8
13
4
28
4
8
I
I
25
34
26
I
6
8
17
1
15
5
3
22
!
8
3
292
No. of
these affect-
ed.
2
3
I
6
2
3
1
1
15
9
7
1
1
2
9
1
6
4
3
9
4
3
111=
37.9 per
cent.
REMARKS.
Hereditary Transmission and Predisposition.
245
VIII.—Before giving a summary of this chapter, a few
remarks must be made upon a point which has an important
bearing on the question of heredity : what will be the risk of
increase to the leper population, assuming heredity to be a
more or less influential agent in the spread of the disease ?
This matter was thoroughly gone into by Drs. Lewis and
Cunningham, 20 who came to the conclusion that " taking all
the information attainable there appears to be no great risk of
increase to the leper population of Kumaun as far as the disease
is dependent on heredity for its multiplication."
Following their line of argument, it will be seen, by referring
to Table XI, that 2,915 children were born before or after the
manifestation of leprosy in the parent or parents. Almora and
Meerut have been left out of consideration, because the total
number of children could not be obtained in all instances where
both the parents were lepers.
Strictly speaking, only the children actually born of lepers
should be considered. However, as here the greatest possible
increase to the leper population is under discussion, and this
matter is simply a side issue to the question of heredity and of
practical rather than scientific value, all objections will be
waived, and all the children included. Thus the case will be
stated as strongly as possible. Besides, the fact exists that
whether the parent was a leper before or after the birth of his
children, a certain number of the latter suffer at one time or
another. Whether this is due to a specific hereditary influence
has been previously discussed, and for the present purpose it
will be best simply to accept the fact, and enquire what would
be the probable increase to the leper population.
In Table XI all those children who died in infancy have
been excluded for obvious reasons. Now 2,915 children have
been the issue of 1,564 marriages. These marriages have been
grouped together in Tables XII and XIII. Of these 71 were
contracted by individuals both suffering from the disease, so
( 20 ) Loc. cit., page 63.
246
REPORT OF THE LEPROSY COMMISSION :
that these would represent 142 lepers. This is not quite cor-
rect, as some patients married twice. But while facilitating
calculations, it will in no way affect the ratio, and moreover
will compensate for omissions among the other leper marriages.
These were contracted between a leper and a healthy person
and amount to 1,493. Thus 1,493 lepers must be added to
the above 142, which gives a total of 1,635. In the case of the
1,493 marriages between a healthy and an affected person the
fact that in a few instances the healthy individual subsequently
became diseased has been neglected, and thus matters will be
equalised.
The 1,635 lepers would be replaced by 2,915 children. A
few of the children have already died, but as this fact was not
consistently enquired into, it will be best to consider them all
to be alive. The 1,635 lepers therefore have contributed a per-
manent addition of 1,280, for 1,635 of the children must be
deducted as merely replacing their leprous ancestors. Now it
is certain that all the children would not become lepers. At
present only 78 of the children are affected, but this small
number may be due to the fact that many of them are still
young, and it may be reasonably expected that some of them
will show manifestations of the disease at a more advanced
age. Tables VII and VIII fully justify this suspicion. How-
ever, a certain proportion of them are adults and married and
have healthy children.
Taking everything into consideration, it is unlikely that more
than 5 per cent. of the 2,915 children will become lepers. This
would indicate that of the total number of children born up to
the present, 145 only are likely to become lepers through the
agency of heredity. Hence a leprous population of 1,635
individuals may be expected to transmit the disease to 145.
This latter number, as far as the statistical tables show, is too
high. It would appear probable from Tables VI, VIII, and
XI that about 80 of the children would become lepers through
the assumed influence of heredity.
Hereditary Transmission and Predisposition.
247
Thus there is no danger of a spread of the pest by heredi-
tary transmission and predisposition. In fact the figures show
conclusively that not only could there be no increase to the
leper population by means of this agency, but that all other
causes being removed, the disease must die out. It is, on the
strength of these data, not astonishing to find that the disease
should have been practically extirpated amongst a community
like the above-mentioned Norwegians, who forsook their own
country and wandered into fresh areas and surroundings,
apparently out of reach of the factors capable of originating
the disease. To this point, however, reference will be made
when considering the question of contagion,
TABLE XL
Children born Before and After Manifestation of Disease in
Parent or Parents.
ASYLUM OR LOCALITY.
A g r a
A l i g a r h
.....
B a n g a l o r e
....
B e l g a u m
....
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
Children born
before appear-
ance of leprosy in
parent.
5 2
30
52
7
59
201 (11)
28
66
28
Children born
after appearance
of disease in
parent.
5
20
2
5
10
5
12
20
Total
number of
children.
67
35
72
9
64
211
33
78
43
NOTE.—The figures in brackets indicate the number of children born before the appear-
ance of the disease in the parent or parents who became lepe¡s: 5S out of a total of 2,447,
or 2.3 per cent.
248
REPORT OF THE LEPROSY COMMISSION:
Table XI—continued.
Children born Before and After
Manifestation of Disease in
Parent or Parents.
ASYLUM OR LOCALITY.
C a w n p o r e
.
.
.
.
C o n j e e v e r a m
D a r j e e l i n g
.
.
.
.
D e h r a D u n
.
.
.
.
D e l h i
D h a r m s a l a
.
.
.
.
F y z a b a d
.
.
.
.
G w a l i o r
.
.
.
.
G y a
H y d e r a b a d
..
J u b b u l p o r e
.
.
.
.
J u m m o o
.
.
.
.
K a p u r t h a l l a
.
.
.
.
L u c k n o w
.
.
.
.
M a d r a s
.
.
.
.
M a d u r a
.
.
.
.
Mandalay
Moulmein
Nagpur
Children born
before appear-
ance of leprosy in
parent.
10
30
4
154 (4)
27
II
16
8
73
8
17(1)
2
9
12
208 (6)
137 (6)
127(1)
265 (2)
Children born
after appearance
of disease in
parent.
5
12
2
20
6
1
4
3
5
16
9
1
3
1
43
56
35
9
30
Total
number of
children.
15
42
6
174
33
12
20
11
78
24
26
3
12
13
251
193
162
24
295
NOTE.—The figures in brackets indicate the number of children born before the appearance
of the disease in the parent or parents who become lepers : 58 out of a total of 2,447, or 2.3 per
cent.
Hereditary Transmission and Predisposition.
249
Table XI—concluded.
Children born Before and After Manifestation of Disease in
Parent or Parents.
ASYLUM OR LOCALITY.
Naini and Allahabad
Naini Tal
....
Patiala
P o o n a
.....
P r o m e
.....
Purulia
.....
Rangoon
....
Rawalpindi
....
Sialkot
Subathu
Tanjore
.....
Tarn Taran
....
Thayetmyo
Trichinopoly
....
Umballa
....
Yerrowda Prison
T O T A L
Children born
before appear-
ance of leprosy in
parent.
57
...
6
47(0
27 (2)
172 (9)
62
40 (4)
53
37(0
14 (1)
151 (2)
50 (5)
1 (1)
57
17 (1)
2,447 (58)
= 2.3 per cent.
Children born
after appearance
of disease in
parent.
17
I
I
3
4
9
12
4
11
1
34
5
7
1
3
468
Total
number of
children.
74
1
7
47
30
176
71
5 2
57
48
15
185
55
8
58
20
2,915
NOTE.—The figures in brackets indicate the number of children born before the appearance
of the disease in the parent or pareats who become lepers ; 5S out of a total of 2,447, or 2.3 per
cent.
250
REPORT OF THE LEPROSY COMMISSION :
TABLE XII.
Marriages.
ASYLUM OR LOCALITY.
Agra
Aligarh
Bangalore .
Belgaum .
Benares
Bombay .
Burdwan .
Calcutta .
Calicut
Cawnpore .
Conjeeveram
Darjeeling
Dehra Dun
Delhi
Dharmsala
Fyzabad .
Gwalior
Gya
Hyderabad
Jubbulpore
Jummoo .
.
.
Kapurthalla
Lucknow .
Madras .
Madura
Mandalay
Moulmein
No. of
sterile
marriages.
8
...
9
6
4
72
7
30
2
2
1
...
2
2
5
4
11
5
1
...
1
6
13
18
26
6
MARRIAGES WITH ISSUES
Between
two
lepers.
...
..,
...
...
...
...
...
...
...
...
...
...
2
...
...
...
...
...
...
...
1
...
1
...
...
...
Between a
healthy person
and a leper.
10
3
12
1
4
10
2
7
12
3
6
2
8
...
1
3
1
3
6
5
1
...
...
21
24
15
5
No. of couples
the children of
which were
born before
the appear-
ance of the
disease in the
parent.
20
5
22
2
19
100
9
27
7
5
6
...
46
7
6
5
4
27
2
5
1
4
5
52
32
38
5
Total
number of
marriages.
38
8
43
9
27
182
18
64
21
10
13
2
71
9
9
13
9
41
13
11
2
6
11
87
74
79
16
Hereditary Transmission and Predisposition.
251
Table XII—continued.
Marriages.
ASYLUM OR LOCALITY.
Nagpur
Naini and Allahabad .
Naini Tal
Patiala
Poona
Prome
Purulia
Rangoon
Rawalpindi
Sialkot
Subathu .
Tanjore
Tarn Taran
Thayetmyo
Trichinopoly
Umballa .
Yerrowda Prison
TOTAL
No. of
sterile
marriages.
30
14
...
3
14
9
12
16
7
14
26
4
33
7
5
8
3
461*
MARRIAGES WITH ISSUES
Between
two
lepers.
...
1
...
...
...
...
7
1
1
...
12
...
...
...
26
Between a
healthy person
and a leper.
17
9
1
...
...
3
3
6
2
1
3
1
9
3
2
1
1
227
No. of couples
the children of
which were
born before
the appear-
ance of the
disease in the
parent.
90
30
3
22
8
63
19
16
21
13
5
52
20
1
20
6
850
Total
number of
marriages.
137
53
1
7
36
20
78
41
32
37
43
10
106
30
8
29
10
1,564
IX.—Again, the diminished procreative power of lepers and
the comparatively high mortality among their offspring operate
powerfully against the possible risk of increase in the leper
population. The latter point is well established, and Drs. Lewis
and Cunningham have drawn attention to it so prominently in
their report that it would be useless to enter into any further
discussion upon the subject. It may therefore be stated that
* Of these 45 were severally contracted by two persons, both lepers.
252
REPORT OF THE LEPROSY COMMISSION:
a certain number of children born of leprous parents would be
probably shortlived.
There is also no doubt that the reproductive power of
lepers is diminished. It is fully established through clinical
and pathological observation, that leprosy causes extensive
morbid changes in the sexual glands and disturbs the sexual
functions. That this applies to men has never been denied.
But that it is equally true of women has been proved by Dr.
Arning, 21 who also demonstrated the existence of a leprous
ovaritis. It has been shown from Table IV that the issue of
98 marriages between two lepers amounts to only 65. Again
Table XIII shows that of 85 couples no less than 55, or 64.7
per cent., were sterile. Hence, assuming all the 65 children
to live and grow up, according to these figures 168 lepers (cf.
Table XIII) would be replaced by 65 persons, that is, there
would be an actual decrease of 62 per cent. in such a popula-
tion. Assuming that 5 per cent. of the 65 children became
lepers, it seems that 168 lepers would be replaced by 3 or 4
lepers, or if the diffusion of the disease depended on heredity
only, there would be an actual decrease of almost 99 per cent.
in the leprous population. No doubt these figures are small,
yet they allow of the following conclusions :—(a) There is no
evidence that marriages among lepers in any way per se in-
crease the risk of diffusing the disease, as far as heredity is
concerned. (b) Even allowing the latter the fullest play and
setting aside all other causes of leprosy, the disease would
gradually die out in such a population as has just been consi-
dered. Intermarriages, therefore, amongst lepers cannot be
regarded as harmful to the community, or as calculated to
spread the disease, so far as this depends on hereditary trans-
mission or predisposition.
But how does the case stand when the marriages between
a healthy person and a leper are considered ? It is more diffi-
( 21 ) Journal of the Leprosy Investigation Committee : No. 2, Feb. 1891,
page 127.
Hereditary Transmission and Predisposition.
253
cult to acquire absolutely accurate information from the data
obtainable, and the following statements must be regarded as
suggestive only. In almost every instance husbands and wives
were healthy at the time of marriage, and one or other con-
tracted the disease some years later. It would evidently not
be fair to compare the numbers of children born before, with
those born after, the appearance of the disease in either hus-
band or wife, and then draw deductions as to the influence of
leprosy on the reproductive power. For, firstly, in a large
number of cases one person forsakes the other as soon as the
disease becomes marked, and, secondly, by the time the disease
manifests itself the age of the patient is often so advanced
that the loss of reproductive power may be attributed to
organic and functional causes.
Two tables have been prepared ( Tables XIV and XIVa )
to show how far leprosy may be said to influence the repro-
ductive power of the persons affected. Only such persons
have been chosen who cohabited for at least five years after
the appearance of the disease, and all patients over forty years
of age have been rigorously excluded. In this manner it may
be hoped to obtain a few suggestive facts.
In Table XIV such marriages where the husband only was
a leper have been grouped together, and it is found that of
296 couples 176, or 59.4 per cent., had no issue after the
appearance of the disease in the husband, while the progeny
of the 120 non-sterile couples amounted to only 249 indivi-
duals. That is, under the assumed conditions, the average
number of children to each couple amounts to less than one.
Again from Table XIVa it is seen that of 88 couples
where the wives only were affected, no children were born in
62 instances after the manifestation of the disease, the total
number of children born to the diseased mothers amounting to
49. Thus 70.4 per cent. of the women became sterile with
the appearance of the disease, and the average number of
children to each is considerably less than one.