NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Hereditary Transmission and Predisposition.
221
Table 11a—continued.
Analysis of Cases where a Family Taint in the Direct Line could
be traced through more than One Generation.
03)
(3)
Father=Leper (His FAMILY HISTORY WAS CLEAR
AND HE BECAME A LEPER AFTER
HIS SONS AND NEPHEW WERE
AFFECTED).
(4)
(5)
(6)
(2)
Son I = Leper.
Son II = Leper.
Son III = Leper. Son IV= Leper.
Four daughters
= all healthy.
One child=healthy. Fourteen children
and one of them = Leper.
Six children between the two and one of these=Leper (1)
(WAS AFFECTED BEFORE ANY OTHER
MEMBER OF THE FAMILY).
One child=Leper (BORN BEFORE DISEASE APPEARED IN
FATHER).
One daughter=Leper. Two sons=healthy.
One child = healthy.
Seven children=healthy.
Remarks.—In each case the offspring was born long before the disease appeared in the
parent. Six members of this family were examined individually and separately, and an absolute
uniformity of statements obtained. The figures in brackets indicate the order in which the
disease appeared in the various members of this family. The father acquired leprosy one year
or so before his death and was an old man at the time of his death.
(14)
Mother=Leper (HER OWN FAMILY HISTORY WAS CLEAR).
Two sons = healthy. One daughter= Leper (ACQUIRED THE DISEASE LONG BEFORE HER
MOTHER).
Two sons=Lepers (BORN AFTER THE MANIFESTATION OF THE DISEASE
IN THEIR MOTHER).
The whole family was seen and questioned.
(¿) Tarn Taran: (15) Father and Mother=Lepers (THEIR OWN FAMILY HISTORY WAS
CLEAR AND THEY ACQUIRED THE DISEASE
AFTER ALL THEIR CHILDREN WERE BORN).
Three sons=Lepers.
One daughter= Leper (SHE MARRIED WHILE HEALTHY
AND SEPARATED FROM HUSBAND AS
SOON AS THE DISEASE APPEARED IN
HER).
One child=Leper (DIED AT THE AGE OF 12 YEARS AND
WAS BORN SEVERAL YEARS BEFORE
THE MOTHER BECAME AFFECTED).
Four members of this family were seen and questioned.
(16)
Father=Leper (His OWN FAMILY HISTORY IS CLEAR).
Son I=Leper.
Son II = Leper (BOTH BORN LONG BEFORE APPEARANCE OF LEPROSY
IN THE FATHER).
One son=Leper (ALSO BORN LONG BEFORE APPEARANCE OF DISEASE IN HIS FATHER).
The whole family was seen and examined.
222
REPORT OF THE LEPROSY COMMISSION:
Table 11a—concluded.
Analysis of Cases where a Family Taint in the Direct Line
could be traced through more than One Generation.
(17)
Father=Leper (His OWN FAMILY HISTORY WAS CLEAR).
Son I=healthy.
Son II = Leper (BOTH BORN AFTER THEIR FATHER BECAME A
LEPER).
One daughter=Leper.
(k) Thayetmyo : (18) Mother=Leper
(HER OWN FAMILY HISTORY WAS CLEAR).
Seven children and one of them = Leper.
Two children and one of them = Leper (DIAGNOSIS EXTREMELY
DOUBTFUL).
Here no statements were made as to date of appearance of leprosy in the parents.
Even allowing that in a certain number of cases the patients
knew little of their grandparents, if heredity exercised any
appreciable influence on the spread of leprosy, it should have
been possible to obtain a far greater number of cases where
the disease could be traced through two generations at least.
As, however, all the doubtful cases have been included, the
figures may be assumed to represent the truth as nearly as
possible. Accepting even all the eighteen cases the ratio
would still be less than 1 to 100. Now in a disease like le-
prosy it may be urged that in most leprous families the grand-
children would have knowledge of the condition of their imme-
diate ancestors. Again this analysis shows the necessity of
a careful enquiry in each case into the time at which the parent
or parents became leprous, for it would evidently be absurd to
consider Case 13 an instance of hereditary transmission, as
here the grandchild actually acquired the disease before the
common ancestor.
In Cases 1 and 14 the child also became
affected before the mother. In such instances it obviously
cannot be a specific predisposition based on the existence of
leprosy in the parent which has been transmitted to the off-
spring. If a predisposition has been transmitted to the child,
it must have been the physiological or anatomical conditions
which have rendered the ancestor a favourable subject for the
Hereditary Transmission and Predisposition.
223
de novo acquisition of the disease, but it is certainly not a
legitimate inheritance of a leprous predisposition. For whatever
the child inherited it would have inherited, whether the parent
subsequently became a leper or not.
And excluding conta-
gion it may be quite possible that in all the members of the
family the disease started de novo, the necessary predisposition
having been acquired. To allow such cases as proofs of an
inherited specific predisposition would obviously be a " post
hoc ergo propter hoc " argument.
III.—From the fact that leprosy occurs often in several
members of a family, authors have argued the existence of a
specific hereditary predisposition. That such an argument
cannot hold good may be seen from the fact that instances oc-
cur where two or three brothers or sisters simultaneously suffer,
although they are not aware that they had any leprous ances-
tors. Leloir lays special stress on this point; and doubtless if
it can be shown with sufficient frequency that several children
become affected, while the parents remain healthy, this fact,
coupled with the small percentage of direct family taint, found
in the present enquiry, would still further diminish the import-
ance of heredity as a cause of the continuance of the disease.
It would tend to show that individuals habitually exposed to
the same conditions are liable to be affected in the same man-
ner. And as often years elapse between the appearance of the
disease in two children of the same family, it reduces the import-
ance of heredity still further. The fact of the parent being a
leper before the birth of the child does not alter this statement,
for it has been found in many cases that the son of a leprous
parent contracted the disease long before his younger brother
destined subsequently to become a leper, was born.
Enquiring into this matter, it is found that in 101 instances
or in about 4.5 per cent. of the cases examined, two or more
children became lepers, while their parents were perfectly
healthy, and in most of these cases no other relative was affected.
The correspondence of this ratio with the above is remarkable.
224
REPORT OF THE LEPROSY COMMISSION:
In this case heredity can of course have played no part, as it
is impossible to look to atavism for support, for the reasons
assigned above. The conclusion is strongly suggested that
though the disease in a small proportion of cases appears to
run in families, this cannot be ascribed to a specific inherited
predisposition.
A table is given showing the distribution of these cases
amongst the various asylums and places visited.
TABLE III.
Instances where two or more Children were Lepers but their
Parents healthy.
NAME OF ASYLUM OR LOCALITY.
A g r a
A l i g a r h
........
A l m o r a
........
B o m b a y
........
C a l c u t t a
........
C o n j e e v e r a r a
.......
D a r j e e l i n g
........
D h a r m s a l a
........
D e h r a D u n
........
G y a
H y d e r a b a d
.......
J u b b u l p o r e
M a d r a s
M a d u r a
........
M a n d a l a y
........
P r o m e
........
P u r u l i a
........
R a n g o o n
........
R a w a l p i n d i
.......
No. of
instances.
I
I
7
2
3
1
1
6
2
1
1
12
9
6
2
7
1
5
Hereditary Transmission and Predisposition.
225
Table III—continued.
Instances where two or more Children were Lepers but their
Parents healthy.
NAME OF ASYLUM OR LOCALITY.
S i a l k o t
S u b a t h u
T a r n T a r a n
.......
T h a y e t m y o
.......
U m b a l l a
........
TOTAL
No. of
instances.
3
3
8
3
3
101
IV.—Perhaps the best method of studying the influence of
heredity is to enquire into the condition of the children born of
leprous parents, the latter having been lepers since their mar-
riage. As will be seen from the subjoined table, 98 leprous
couples had 65 children, and of these three became lepers.
Two cases were so exceedingly doubtful that they may justly
be excluded. Thus it is found that 4.6 per cent., or accepting
the doubtful cases, 7'6 per cent. of the issue of leper marriages
have contracted the disease. Some, though very few, of the
children were still young, and one or two of them may subse-
quently develop leprosy. These figures therefore lead to re-
sults almost identical with those of Tables I and II. Yet here
the most favourable conditions for the full play of inheritance
existed, and nevertheless, the actual percentage of hereditary
cases is less. If a specific hereditary transmission exercised
any considerable influence, a much greater number of the 65
children should have become affected. And in order that no
misapprehension may exist regarding the value of the figures
given in Table IV, particular attention is drawn to the fact
that the majority of these cases of the issue of leprous parents
Q
226
REPORT OF THE LEPROSY COMMISSION:
are adults, perfectly healthy, some married and with healthy
children. A certain number, on the other hand, died healthy.
These figures, therefore, give little support to the view of a
legitimately inherited predisposition to the disease.
TABLE IV.
Cases where Father and Mother were Lepers at the Time of
Marriage.
NAME OF ASYLUM
OR LOCALITY.
Almora
Belgaum
Bombay .
Dehra Dun
Kapurthalla
Lucknow
Madras .
Mandalay
Meerut .
Nagpur .
Patiala .
Rangoon
Rawalpindi
Sialkot .
Subathu .
Tain Taran
Umballa
TOTAL
No. of
couples.
22
I
3
4
2
2
I
I
6
1
1
1
14
14
2
22
I
98
No. of persons
these couples
represent.
43
2
6
7
4
4
2
2
12
2
2
2
26
26
4
42
2
188
No. of
children.
21
2
3
2
...
...
...
I
...
10
3
5
18
...
65
No. of children who
became lepers.
T
...
...
...
I (??)
...
...
...
...
...
I(??)
2
...
...
3 or 5 = 4.6 per cent.
or 7.6 per cent.
V.—The only decisive way of disentangling the influence
of heredity and external conditions would be to imitate the
Hereditary Transmission and Predisposition.
227
experiment of the emigrant Norwegian lepers, and to remove
the offspring of lepers not only from their parents but also into
an area where leprosy is not endemic. Placed under such con-
ditions, with good food and hygienic surroundings, heredity
would have full and absolute play. There are two asylums
in India where children born of leprous parents are kept apart
from them and tended with great care ; this is done at Almora
and Purulia. The latter unfortunately has not been sufficiently
long in existence, hardly more than two years. The Almora
Orphanage, however, is much older and thus capable of afford-
ing very valuable information. The children born of either one
or two leper parents are removed from their surroundings and
carefully attended to in the Orphanage. Endemic influences
cannot of course be excluded. Drs. Lewis and Cunningham 18
say in their report: " There are at present (1877) in the
Orphanage of Almora 12 children of lepers now or formerly in
the Asylum. The total number of such children who have
been admitted into the Orphanage is 14, but of these 1 died,
and another, a girl of 22, has now left the Orphanage, is married,
and has children healthy to all appearance. Of the 12 remain-
ing 7 were born in the Asylum of two leprous parents ; 5, the
offspring of one leprous and one healthy parent, were born in
the villages to which their parents belonged. Their ages
ranged from 19 to 5 years ; their health and general condition
is excellent, and as yet they show no signs of leprosy."
The Commissioners were able to ascertain the correspond-
ing facts with regard to 23 inmates of the Orphanage. Of
these three were born before the manifestation of the disease
in the parent, their ages being 31, 28, and 19, respectively, and
five were under 10 years, their ages ranging from 7 years to 6
months (7, 7, 4, 3, and 1/2 years, respectively). All these eight
individuals were up to date in good health. This leaves 15
cases, and of these, as will be seen from Table V, only 1 has
( 18 ) Loc. cit., page 67.
Q2
228
REPORT OF THE LEPROSY COMMISSION:
contracted the disease, all the others having remained perfectly
well, or having died free from leprosy in adult age. The
number of children is certainly not a large one, and deductions
should naturally be made with care, but the figures, especially
if compared with the other ratios obtained, tend still further to
diminish the importance of heredity. For omitting the eight
cases, for the reasons mentioned, an assumed hereditary trans-
mission was traceable in 6.6 per cent.
TABLE V.
Almora Asylum Orphanage.
No.
I
2
3
4
5
6
7
8
9
10
11
12
13
M
15
Sex.
Female
»
„
"
Male
Female
"
"
Male
Female
Male .
Age.
28 years
28 „
27 ,.
25 „
24 „
22 „
21 "
20 „
18 „
17 „
15 „
14 „
13 „
12 „
Condition of
parents at birth.
Father
and
mother lepers .
Ditto
Ditto
Father healthy ;
mother leprous
Father
and
mother lepers .
Father healthy ;
mother leprous
Ditto
Father
and
mother lepers .
Ditto
Ditto
Father healthy;
mother leprous
Father
and
mother lepers .
Ditto
Father leprous;
mother healthy
Father
and
mother lepers.
Period
spent with
parents.
2 years
2 „
1 year
8 years
2 months
1 year.
7 months
2 years
2 „
1 year .
5 years
6
„
1 year .
10 years
2
,,
Period
spent in
Asylum
previous to
admission
into
Orphanage
2 years
2 „
2 ,,
6 „
3 ,,
1/2 year.
2 years
4 »
2 „
1 year.
3 1/2 years
2 years
2
,,
Period
spent in
Orphanage
16 years
15 „
24 „
11 ,,
20 „
20 ,,
19 „
11 „
15 „
16 „
81/2 „
9 „
11
,.
1 year
10 years
Present condition.
Healthy at 20 years
of age.
Healthy up to date.
Ditto.
Healthy ; died of
diarrhoea.
Healthy up to date.
Ditto.
Healthy ; died of
phthisis.
Leper for last 4 years.
Healthy; died of
epilepsy.
Healthy up to date.
Ditto.
Ditto.
Ditto.
Ditto.
Ditto.
Hereditary Transmission and Predisposition.
229
VI.—In the fourth section the condition of children born of
two leprous parents was enquired into. Here the condition of
all the children born after the manifestation of the disease in
one or other parent will be considered. It must be remarked
that in many cases the children could not be personally exam-
ined by the Commissioners, and in these cases the parent's
statements had to be accepted. Doubtless this is a source of
error and due allowance must be made. It was found that
amongst 500 children of all ages born of either two leprous
parents, or from one leper parent and one healthy parent, 21,
or 4.2 per cent., became lepers. In eight of these the existence
of the disease was extremely doubtful, while in some others no
statements were made as to the condition of the parent or
parents at the time of the child's birth. Even if 19 be accepted
as the actual number of the offspring attacked, the ratio yielded
very nearly approaches the truth. But as some children were
still young it may be objected that they had not yet reached
the age at which leprosy generally shows itself, and it is desir-
able to re-arrange the offspring in two classes—(a) all those of
ten years and over, and (b) all those of sixteen years and over.
Taking ten as the minimum age, it was found that there were
150 individuals born after the appearance of the disease in the
parent or parents, and of these 10 had become lepers, or 6.6 per
cent. Again, taking sixteen as the minimum age, there were 82
individuals born of leprous parents, of whom six subsequently
contracted the disease, or 7.31 per cent. Making all allowances
for errors, in diagnosis and inaccurate statements, it will be
apparent that the figures correspond closely with those of
former tables.
230
REPORT OF THE LEPROSY COMMISSION:
TABLE VI.
Condition of Children born after Manifestation of Disease in
Parent or Parents.
NAME OF ASYLUM OR LOCALITY.
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 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
.
.
.
.
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
.
.
.
.
Jummoo »
Kapurthalla
.
Lucknow .
No.
of
children.
15
5
29
20
2
5
10
5
12
20
5
12
2
20
6
1
4
3
5
16
9
1
3
1
No. of
children
affected.
...
T
I
...
...
2
...
...
...
2
I
...
...
...
I
...
...
...
I
...
REMARKS.
All young.
Very doubtful diagnosis.
101/2 years old.
8 1 / 3 years old.
All under 10 years.
101/2 years old.
Under 6 years.
Very doubtful diagnosis.
All under 6 years.
Under 12 years.
91/4 years old.
From 111/3 years old,
6 years old.
Aged 25 ; very doubtful diagno-
sis.
Hereditary Transmission and Predisposition.
231
Table VI—continued.
Condition of Children born after Manifestation of Disease in
Parent or Parents.
NAME OF ASYLUM OR LOCALITY.
Madras
....
Madura
.
Mandalay
....
Meerut
....
Moulmein
....
Nagpur
....
Naini and Allahabad
Naini Tal .
Patiala
....
Prome
....
Purulia
.
.
.
,
Rangoon
....
Rawalpindi
Sialkot
....
Subathu
....
Tanjore
....
Tarn Taran
Thayetmyo
....
Trichiriopoly
Umballa
....
Yerrowda Prison .
TOTAL
No. of
children.
43
56
35
3
9
30
17
1
1
3
4
9
12
4
11
I
34
5
7
1
3
500
No. of
children
affected.
3
2
...
1
...
...
...
...
1
...
2
2
...
...
...
1
...
21
= 4.2
per cent.
REMARKS.
2 very doubtful.
All adults.
Very doubtful.
Very doubtful.
No statement made.
All adults ; no statement made.
Under 5 years old.
Very doubtful.
All under so years old.
18 years old.
Under 7 years old.
232
REPORT OF THE LEPROSY COMMISSION:
TABLE VII.
Condition of Children born after the Manifestation of the Disease
in the Parent or Parents, taking 10 years as the Minimum Age.
NAME OF ASYLUM.
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 l g a u m
.
.
.
.
B e n a r e s
.
B o m b a y
C a l c u t t a
.
.
.
.
C a l i c u t
.
.
.
.
C o n j e e v e r a m
D e h r a D u n
.
.
.
.
H y d e r a b a d
J u b b u l p o r e
.
.
.
.
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
.
.
.
.
M a n d a l a y
.
.
.
.
M e e r u t
.
.
.
.
N a g p u r
.
.
.
.
N a i n i a n d A l l a h a b a d .
P a t i a l a
.
.
.
.
P r o m e
.
.
.
.
P u r u l i a
.
.
.
.
R a n g o o n
.
.
.
.
R a w a l p i n d i
S i a l k o t
.
.
.
.
No. of
children.
3
1
23
4
t
3
2
1
10
1
6
2
2
3
1
4
17
10
3
12
7
1
1
3
1
4
4
No. of
children
affected.
...
...
I
...
...
I
...
...
I
1
...
1
...
...
...
...
...
I
2
2
REMARKS.
Very doubtful diagnosis.
12 years old.
Very doubtful diagnosis.
Hereditary Transmission and Predisposition.
233
Table VII—continued.
Condition of Children born after the Manifestation of the Disease
in the Parent or Parents, taking 10 years as the Minimum Age.
NAME OF ASYLUM.
S u b a t h u
.
.
.
.
T a r n T a r a n
T h a y e t m y o
.
.
.
.
U m b a l l a
.
.
.
.
TOTAL
No. of
children.
4
13
2
I
150
No. of
children
affected.
...
...
10
= 6.6
per cent.
REMARKS.
TABLE VIII.
Condition of Children born after the Manifestation of the Disease
in the Parent or Parents, taking 16 years as the Minimum Age.
NAME OF ASYLUM.
A g r a
.
.
.
.
A l m o r a
.
.
.
.
B e n a r e s
.
.
.
.
B o m b a y
.
.
.
.
C a l i c u t
.
.
.
.
D e h r a D u n
H y d e r a b a d
K a p u r t h a l l a
M a d r a s
.
.
.
.
M a d u r a
.
.
.
.
M a n d a l a y
.
.
.
.
M e e r u t
.
.
.
.
No. of
children.
2
I
2
2
5
1
3
3
6
8
3
No. of
children
affected.
1
I
...
I
...
...
...
REMARKS.
Ages 19 and 16.
Very doubtful diagnosis.
234
REPORT OF THE LEPROSY COMMISSION:
Table VIII—continued.
Condition of Children born after the Manifestation of the disease
in the Parent or Parents, taking 16 years as the Minimum Age.
NAME OF ASYLUM.
Nagpur
....
Naini and Allahabad
Prome
.
Purulia
....
Rawalpindi
Sialkot
Subathu
....
Tarn Taran
,
Thayetmyo
....
Umballa
....
TOTAL
No. of
children.
7
7
1
3
1
4
I
6
2
1
82
No. of
child 1 en
affected.
...
...
...
I
...
2
...
...
...
6
= 7.31
per cent.
REMARKS.
Very doubtful diagnosis.
19 and 16 years old.
18 years old.
VII.—Lastly, the influence of an inherited specific predis-
position may be studied by the selection of cases in which a
family taint in the direct line can be traced, and by an enquiry
into the condition of the brothers and sisters. Now, as was
shown above, in many instances where there is evidence of a
family taint, the patients were born at a time when their
fathers and mothers were absolutely healthy though they after-
wards became lepers. These cases might be termed instances
of "false heredity." Again others were actually born of a
leper parent or parents. If new tables be constructed with a
view to showing how many of the brothers and sisters of lepers
with a "false" hereditary history have become lepers in com-
parison with the number of brothers and sisters of lepers with
a "true" hereditary history who have become lepers, addi-
Hereditary Transmission and Predisposition.
235
tional light will be thrown upon the influence of heredity.
For, in the former case, the predisposition cannot have been
legitimately inherited, and, if hereditary, must be related to
general non-specific conditions of the parent. In the case of
patients actually born of leprous parents great care has been
taken to ascertain that their brothers and sisters were also
born after the manifestation of the disease in the parent or
parents. In some cases no statements were made, and it is
quite possible that some of the brothers and sisters were born
at a time when their immediate ancestors were healthy. In
other cases, with regard to the patient himself, whose brothers
and sisters form the subject of the present enquiry, no state-
ment was made as to whether he or she had a true or false
history of heredity. These cases have been entered as though
they were instances of true heredity, and thus errors in statis-
tics are more or less counterbalanced, and the statistics placed
in a more favourable light from the heredity point of view.
It has been found that 62 patients with a true hereditary
history had 156 brothers and sisters born also, as far as could
be ascertained, after the manifestation of the disease in their
fathers and mothers; and of these 21 became lepers, or 13.4
per cent.
On the other hand, 61 patients, with a history of false
heredity, had 150 brothers and sisters, and of these 31, or 20.6
per cent., were lepers. This is certainly a most surprising result,
and, if coupled with the number of instances of several children
becoming lepers while their parents remained healthy, removes
the importance attributed to a specific hereditary predisposition.
The figures are certainly somewhat small, but yet allow of
decisive conclusions being drawn from them. Now, even if the
cases with insufficient statements be excluded from Table IX,
and added to Table X, the ratio would still militate against the
influence of an actual heredity. For, in spite of making such
allowances, the ratio could not be reduced below 15 per cent.
or 20 per cent. This appears to be a strong argument against
236
REPORT OF THE LEPROSY COMMISSION :
inheritance, for if this agency had much influence the ratios
should not only be reversed, but the percentage of lepers in
Table IX ought to be much greater than that of Table X.
The only inference to be drawn from these tables, and from
the fact of children being often affected though their parents
remain healthy, is that leprosy appears to have a tendency to
attack several members of a family, but that a legitimate specific
hereditary transmission cannot be regarded as the cause. In
another place it will be shown whether contagion can explain
this fact. It should never be forgotten that a disease due to
extraneous agents and conditions, such as leprosy seems to be,
may at any time affect people living in similar surroundings
and possessing similar constitutions. And it is precisely
amongst the members of a family that we get such conditions
and relations. However this will be dealt with more fully in the
chapter on Contagion.
TABLE IX.
Condition of the Brothers and Sisters of Leprous Patients with a
" True" History of Heredity.
NAME OF ASYLUM OR
LOCALITY.*
Agra
Aligarh
Almora
Bangalore
Belgaum .
Benares .
Calcutta .
Dehra Dun
No.
of patients
actually
born of
leper pa-
rents.
I
I
I
3
1
1
2
4
No.
of their
brothers
and
sisters.
2
I
7
2
2
4
9
No.
of these
affected.
...
...
...
...
...
...
I
REMARKS.
Doubtful.
No statement.
* Bombay has been omitted on account of insufficient details, as in no case the number
of brothers and sisters was stated.