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BOOKS FOR YOU TO READ AND DOWNLOAD
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Copyright © 2004
M. S. Thirumalai
LANGUAGE AND POLITICS OF LEPROSY IN INDIA -
AN UNENDING CIRCLE
M. S. Thirumalai, Ph.D.
AN ANCIENT DISEASE WITH ANCIENT PERCEPTIONS
Leprosy is one of the ancient diseases still currently prevalent in India. The ancient perceptions about this ancient disease are also, unfortunately, still intact. Earlier last year, the President of India proposed a six-point plan for the eradication of leprosy in India. Indians are known for their great prowess for planning. The Union Government has declared that leprosy will be eradicated from the entire country in 2005.
UPROAR IN THE PARLIAMENT
In the Indian Parliament, the young and energetic Minister of Health Dr. Anbumani (himself a medical doctor) from the South, was trapped into a protracted discussion on whether leprosy is a communicable disease or not. He declared that it is a communicable disease, whereas the Chairman of the House declared it to be not a communicable disease. A senior member of the Opposition, who herself was a former Union Minister of Health, even remarked, according to the proceedings, "What sort of Health Minister he is?". Another member declared, "It is not a communicable disease...(Interruptions)...The hon. Minister should know about it." Murali Manohar Joshi, a well-respectd and admired doyen of the BJP leadership, came down heavily in favor of the position that this is not a communicable disease.
Perhaps sensing the emerging political divide on the issue between the North and the South, and between the ruling UPA and the Opposition NDA, and also perhaps between the upper castes of the North and the Sudra castes of the South, a member from the South tried to intervene saying that the Minister was a medical doctor and that he knew what he was talking about and that he (the Minister) should be allowed to speak. But the Chairman curtly addressed him citing his name and told him that "this House is not meant for you. Mind it..." Most of the emotionally charged discussion was in Hindi, and so it was good for Dr. Anbumani that he could not be bothered about such strong words!
Leprosy became a political issue! But this was not the first time leprosy would assume such a role.
LEPROSY ERADICATION - AN INTEGRAL PART OF OUR FREEDOM STRUGGLE
Since leprosy eradication was an important action that Congressmen and the patriots of all political complexions were involved in during the freedom struggle, a change of heart that leprosy is not a communicable or contagious disease is firmly established itself in the country among the politically conscious people. Then, to say, of all places in the Indian Parliament, with members having long memories of their hoary past, that leprosy is also a communicable disease was something that none would accept. Language and politics of yesteryears relating to leprosy repeated itself.
LEPROSY IN ELITIST HINDU SCRIPTURES AND OTHER RECORDS
Leprosy is referred to in one of the four Vedas. The disease is well recorded as a great curse in religious books and scriptures of many religions around the world. It is seen as a curse that re-appears again and again in families because of their moral deficiency, failure to propitiate gods, excessive indulgence and carnal desires, etc. Karma is also cited as a reason why one gets leprosy. There is also a theory that the disease originated from India and spread in Europe through the soldiers of Alexander the Great when he returned from India. Investigators have also pointed out that it might have originated from East Africa or Central Asia.
MORE PEOPLE AFFLICTED WITH THIS DISEASE IN INDIA THAN ELSEWHERE
Whatever be the place of origin of this ancient disease, the fact of the matter appears to be that there are still more people afflicted by leprosy in India than elsewhere. It should also be mentioned that the incidence of leprosy in India has come down heavily in the last few decades mainly because of the multi-drug therapy. At the same time some regions of India seem to be more affected even now by this ancient disease than other regions. For example, the southern states of India claim that they have eradicated leprosy, something day-to-day phenomenological knowledge will reject as true, while an official was quoted as saying, ""India has not been successful in eradicating leprosy as the healthcare infrastructure is poor in states like Bihar, Uttar Pradesh, West Bengal, Chhattisgarh, Jharkhand and Orissa. Delhi and Chandigarh, too, are not yet free because of migration of people."
THE USE OF MIGRATION AS A SAFE ROUTE FOR SURVIVAL
Migration was the frequently resorted means adopted by people afflicted with this dreaded disease. Shunned by their family members, caste members and society at large with which they were familiar until they were afflicted with this disease, there was no way that they could live in their familiar environs. Most eating-places for the public had sign boards prohibiting the people afflicted with this disease from entering their premises. People of great means were able to provide for themselves with seclusion in separate homes or apartments and were able to live and die alone, with very few contacts with the outside world. (In my high school days I knew two persons in my small town in south India who were closeted in this manner.) People of poorer means, not just the very poor, would leave their homes and go to other places. Often in the past no person afflicted with this disease would be allowed to enter villages. Many were killed and buried in villages.
ANONYMITY IN THE CITIES - A HELPFUL MEANS OF SURVIVAL
The anonymity of the cities continues to be a safeguard for these people. Movement of the people afflicted with this disease often transcends the ethnic, linguistic, and geographical boundaries. I've seen and heard many people afflicted with this disease speaking Tamil in cities like Kolkatta, Delhi, Chandigarh, and Bhubaneswar. They all seem to pursue some anonymity as a way of escape from the social compulsions. Their psychology is yet to be investigated, although we do have excellent records of their inner workings in the hands of some Indian writers.
19TH CENTURY INDIA AND LEPROSY - LEGALIZING SEGREGATION, CARING FOR THE ABANDONED
In 19th century India, eradication of leprosy was one of the hotly debated issues in the public. Secular as well as religious organizations, especially Christian missionary organizations, devoted a lot of their energies in bringing remedies to these unfortunate people. The concept of secluded or segregated asylum for those afflicted with the disease was developed and implemented.
Along with this, the question of the status of the disease as a communicable disease was also raised, especially when the rehabilitation and restoration of the families of these persons became part of the process in Christian missiology in India. Should the children of the patients of leprosy be allowed to be with their parents? How serious would be the effect of co-habitation? How would we train the patients in doing their daily chores, and in gaining some skills for earning their livelihood? What would we do to combat the negative views of leprosy prevalent among the people of India? Evangelization of the afflicted persons also became a hotly debated issue among the Christian missionary circles in the 19th century.
One may criticize the policy that led to the enactment of the Act of 1898. However the policy of segregation initiated asylums where people suffering from leprosy could be taken care of and trained in some skills. It provided some health care and food. And it certainly was superior to the treatment these people received from the society at large at that time.
REHABILITATION - AN EARLY RECORD
Wellesley C. Bailey, a missionary from the Church of Scotland, who was a leader of the Mission to Lepers in India, wrote in his book The Lepers of Our Indian Empire : A Visit to Them in 1890-91 / by Wellesley C. Bailey. London : John F. Shaw,1891,
There are many places where but little has been accomplished as yet, and where the results are but meager; but taking the Indian Empire as a whole, remembering that it is a continent, and not a country, that its population of more than 250,000,000 is made up of nations and peoples, that it has nearly 300 different languages and dialects, these being spoken by Hindus, Mahommedans, Buddhists, Sikhs, Jains, Parsis, Jews, Brahmos, and numberless Devil Worshippers; and that Caste, Degradation, and Enforced Seclusion of Women, Cruelty to Widows, and Child Marriage, are still giants in the land; remembering, I say, all these things, and taking into consideration the smallness of the force put into the field, one stand amazed at the results that have been achieved.
I have visited twenty-six places, where I have seen in all 1425 lepers. There are a few important institutions which I have not seen, such as Rutnagari, Mangalore, &c.; but all told, I do not suppose that more than 5000 poor sufferers are being provided for throughout the whole of the Empire; and if it be true that there are 500,000 lepers in India, how little of that vast aggregate of human suffering is being reached in any way! The irresistible conclusion that one comes to is, that sooner or later something must be done to put a check upon this open sore of India. "Legislate," says someone. Yes, by all means; but in the meantime what are you going to do with your half million of lepers? that is the question. Homes, or Retreats, or Asylums, or whatever you like to call them, should be spread all over the country; and in this great work the Government of the country, enlightened philanthropy, and Christ-like sympathy, must all go hand-in-hand. The Government, through its Local Governments, and the Local Governments through their District Committees and Municipalities, should gradually gather in all the floating leper population into homes or asylums. This must be done rather by persuasion than coercion. Lepers must not, as in old times, be found "guilty of leprosy" and treated as criminals. It must always be remembered that they have rights as well as other men and women, and that their rights ought to be respected. (Italics by M. S. Thirumalai) That they can be persuaded to enter asylums has been proved beyond any manner of doubt by the experience of the Mission to Lepers in India. We can, of course, deal with vagrant lepers as such, and with them compulsion might perhaps be used. All Christian and charitable institutions for the benefit of lepers should be encouraged by the Government. Grants in aid should be given to such institutions, and every facility to obtain sites for the building of such institutions should be afforded.
LEPROSY ACT, 1898
The British India Government was persuaded to enact the leprosy act (Leprosy Act, 1898) that aimed at effectively segregating the persons afflicted with leprosy into asylums, following the models then prevalent in Europe.
William C. Bailey's book published in 1891 narrates the run up to the enactment of the Act in 1898. Although the Act was repealed by the government of free India as socially discriminating against persons afflicted with leprosy, the repeal has not resulted in any great remedy for the people with this disease.
W. C. Bailey wrote further,
It has been the first in the field with Homes for the untainted children of lepers. This new development of work amongst lepers is a most important one. It must by no means be taken as proved that all children of lepers have the disease of their unfortunate parents transmitted to them. Medical authorities are not as yet agreed on this matter; and even if it were proved, experience goes to show that if children, as yet showing no marks of the disease, can be removed in time from all leprous surroundings, they will in all probability be saved from falling victims to the sad fate of their parents. Sir Morell Mackenzie, in an able article in the Nineteenth Century for December, 1889, says, 'Hereditary contamination has now been shown to be a quantité négligeable.'
Dr. Munro, an acknowledged authority, and a man of deep research, says, "Summing up, therefore, leprosy is not always, but only very rarely, transmitted from generation to generation, has never been proved to be transmitted without contact, is not constantly transmitted even when both parents are diseased, seldom affects more than one child in a family, and those only successively, independently of age, sometimes the youngest first, after contact, and goes back form child to parent when in contact. From all I have learned of the disease, I can find no proof of even the hereditary predisposition allowed to exist by Virchow, but feel much inclined to believe with Landré, the contagion is the only cause of its propagation."
POLITICS OF ETHNICITY AND LEPROSY
Bailey also found Europeans afflicted with this dreaded disease who have left their homes in Europe in his tours in India. He wrote,
I have been much struck on this tour by the number of European lepers one now hears of in India. I myself have met and conversed with several, and it becomes a growing conviction with me that the time has now come when a large central home should be established in some healthy part of India, where such sufferers from amongst our own kith and kin might find a refuge and a retreat. I know of some very distressing cases at present which might at once be placed in such a home. One poor fellow, writing to me lately, says, "God grant that your Mission may see their way to opening out such an institution for the benefit of their own countrymen, for up to this it is only natives who have been provided for to the exclusion of Europeans, who have been left out of all calculation." Such a home once started would become, I believe, to a great extent self-supporting, as in many instances European lepers would be able and quite willing to pay for their own board. Should this meet the eye of any one who would like to help on such a noble institution, I hope they will write to me on the subject. It is a work in which Europeans in India would, I believe, gladly help.
It is amazing to read that India was a preferred destination for some of these unfortunate Europeans. It is also amazing to read how people could think in terms of ethnicity and rehabilitation even in dire circumstances.
DEBATING THE LEPERS ACT OF 1898
The Lepers Act of India was hotly debated, and it revolved around the issues of communicability of the disease. There was, however, some agreement about the need for segregating persons afflicted with the disease. It suited the world view of both the British rulers and the Indian elite.
A draft of the proposed Act is given below. I was not able to get the actual act as it was finally passed by the British for enforcement in India. However, from the sub-title given to the proposed act, it is clear that the goal was primarily two-fold: making provision for the Isolation of Lepers and the Amelioration of their Condition.
Bailey (1891) also presents an interesting report on the meeting of medical practitioners as regards leprosy.
First the proposed bill for the act of 1898 is given below. This is followed by the report on the discussion among the medical practitioners in Bombay about the provisions of the bill and the nature of the disease itself, pursued on on August 2nd, 12th, and 19th, 1890.
COPY OF PROPOSED LEPER BILL FOR INDIA.
A Bill to make Provision for the Isolation of Lepers and the Amelioration of their Condition.
Whereas it is expedient to make provision for the isolation of lepers and the amelioration of their condition, it is hereby enacted as follows:
1. (1) This Act may be called The Lepers Act, 1889.
(2) It shall extend to the whole of British India, and
(3) It shall come into force at once.
2. (1) In this Act, unless there is something repugnant in the subject or context,
(a) "leper" means a person with respect to whom a certificate that he is suffering from leprosy has been made by a medical practitioner having from the Local Government general or special authority, by name or in virtue of his office, to certify as to the existence or non-existence of the disease in any person alleged to be suffering therefrom;
(b) "retreat" means a place for the time being approved by the Local Government as suitable for the accommodation of lepers; and
(c) "District Magistrate" includes a Chief Presidency Magistrate, and any Magistrate of the first class whom the Local Government may, by name or in virtue of his office, invest with the functions of a District Magistrate for the purpose of this Act.
3. (1) "Any council, board, committee, corporation, or other body of persons having authority over any municipality, cantonment, or other local area may, notwithstanding in any enactment with respect to the purposes to which the funds or other property of such body may be applied,
(a) establish or maintain, or establish and maintain, or contribute towards the cost of the establishment or maintenance of the establishment and maintenance of a retreat,
(b) with the previous sanction of the Local Government, and subject to such conditions as that Government may prescribe, appropriate any immovable property vested in such body, and either retain and apply it, or transfer it by way of gift or otherwise, as a site for or for use as a retreat.
(2) Any moneys placed by any enactment for the time being in force at the disposal of a Local Government for the purpose of the establishment or maintenance of hospitals, dispensaries, lunatic asylums, or other institutions for affording medical relief, may, notwithstanding anything in such enactment, be applied to all or any of the purposes mentioned in sub-section (1), clause (a).
4. (1) Any person knowing or believing himself to be suffering from leprosy who desires to be admitted into a retreat may apply orally or in writing to any Magistrate for admission thereto and for detention therein, either for life or for a term of years.
(2) On receiving such an application the Magistrate, upon proof that the applicant is a leper, may, with the concurrence of the person in charge of the retreat and, where he is not himself the District Magistrate, with the previous sanction of the District Magistrate, record an order authorizing the admission of the applicant into the retreat, and his decision therein for the time mentioned in the application.
5. A District Magistrate may order the arrest of any person whom he has reason to believe to be suffering from leprosy, and who is found asking for alms or wandering about without any employment or visible means of subsistence, and may, upon proof that the person is a leper, commit him to a retreat with the concurrence of the person in charge thereof, to be there detained, subject to the provisions of this Act.
6. The Local Government, or a District Magistrate, or any person having from the Local Government general or special authority in this behalf by name or in virtue of his office, may, subject to the provisions of any rules under this Act, at any time order the discharge from a retreat of any person detained therein under either of the two last foregoing sections.
7. If a leper detained for life under Section 4, or detained in pursuance of an order under Section 5, leaves a retreat otherwise than in accordance with an order of discharge under Section 6, or if a leper detained for a term of years under Section 4 so leaves a retreat before the expiration of that term, he may be arrested and brought back to the retreat by any police officer or by the person in charge of the retreat or any person acting under his direction.
8. The Local Government may make rules with respect to all or any of the following matters, namely:
(a) the inspection of places used or proposed to be used as retreats, and the powers which may be exercised by an officer making such an inspection;
(b) the management of retreats;
(c) the conduct of lepers in retreats maintained wholly or in part by the Government, or by any such body as is referred to in section 3, subsection (1);
(d) the exercise by District Magistrates and other persons of their authority to discharge lepers form retreats under section 6;
(e) the restrictions, and the deprivations of indulgence, to which a leper may be subjected by way of punishment for misconduct in a retreat, or for leaving a retreat in circumstances which justify his being brought back thereto under section 7; and,
(f) generally, the carrying out of the purposes of this Act.
9. A place shall not be approved as suitable for the accommodation of lepers unless such provision has been made for the segregation of male and female lepers from leprous or other female and male persons respectively, as the Local Government deems sufficient, nor shall the appropriation of any immovable property by any such body as is referred to in section 3, subsection (1), be sanctioned for either of the purposes mentioned in clause (b) of that sub-section except on the condition that such provision as aforesaid either exists or shall be made, and shall be maintained.
10. No leper shall against his will be sent under section 4 or section 5 to any retreat where attendance at any religious observance, or at any instruction in religious subjects is obligatory on lepers accommodated therein.
A MEETING OF INTELLECTUALS IN MUMBAI
EXTRACTS FROM PRINTED ACCOUNT OF MEETINGS
Held by the Bombay Medical and Physical Society
on August 2nd, 12th, and 19th, 1890.
Brigade-Surgeon W. Gray, President, in the Chair.
Dr. Balchandra Krishna, at the end of a very able paper on "Leprosy in Bombay in its Medical and State Aspects," sums up as follows: -
After a careful consideration of the facts and figures given above, I feel that I can safely draw the following conclusions: -
- That leprosy is prevalent throughout India, but satisfactory statistics are wanting to show both the increase and decrease.
- That it is endemic.
- That the weight of evidence is in favor of its hereditary transmission.
- That of the three forms of the disease, the non-tuberculated or anęsthetic form is most prevalent in India.
- That the weight of evidence is not in favour of the contagiousness of leprosy generally, and particularly of the anęsthetic form, and the tuberculated and mixed forms in their early stages; but there is some evidence in favour of the latter two being communicable in the ulcerating stage by inoculation of the pus on an abraded surface, either directly from the patient or by the stained clothing or other articles contaminated by the secretions of the leprous sores.
- That it is not communicable by aerial infection in the same way as small-pox or other exanthemata are.
- Granting that the tuberculated and mixed forms are contagious in their later stages, still it does not follow that every case of leprosy, indiscriminately, is contagious.
- That the diagnosis of the disease is not always easy, especially in its early stage.
- That no satisfactory treatment of leprosy has yet been discovered.
- That segregation of the lepers has been found to exercise some wholesome check on the propagation of the disease, but not to the extent of stamping it out.
- That the present excitement or the scare which has taken possession of the public mind is groundless.
- That a sober, quiet, unbiased, and scientific investigation of the subject is an absolute necessity, which will help the medical profession and the State to grapple with the problem more effectually.
Viewed by the light of these conclusions, "The Draft Leper Bill" circulated by the Government of India for the opinion of the Local Government seems to be a desirable measure in so far that, when it becomes an Act, it will serve pre-eminently to calm the public mind, which has been excited to the highest pitch, because it will be the means of removing vagrant lepers from the public gaze; but whether it will serve to stamp out the disease I am not sure. In its present form, however, in my humble judgment, there are some objectionable features in the Bill which, if allowed to remain, will defeat the object of the Government: -
- It is assumed in the Bill that every case of leprosy is contagious.
- The diagnosis of leprosy is left to medical men of all descriptions, whether qualified or unqualified, to pronounce a correct opinion.
- A powerful engine of oppression will be left in the hands of the police. (Italics by M. S. Thirumalai)
- The Bill seeks to treat lepers are criminals.
As regards the first objection, I have mentioned that the non-tuberculated form is not contagious, nor the tuberculated and mixed forms in their early stages; but they may be so, perhaps, in their ulcerating stages, and that the non-tuberculated or the anęsthetic form is most prevalent in India. Hence every case is not contagious, and some modification is necessarily required in the use of the word "Leper" as used in sub-section 1 under the definition of the Bill. The second objection is graver still: in sub-section 1, under "definitions," the term "medical practitioner" is used; this apparently includes medical practitioners of all kinds. I have discussed the question at length under the heading of Diagnosis. What hardship will then be entailed upon helpless people? A poor person may thus be confined, although not suffering from true leprosy, and simply through the mistake of a medical man. As regards the third objection concerning the police, who will be empowered to collect and guard lepers, persons not suffering from leprosy might be arrested for the purpose of extorting money, and the reverse might take place with the same object. They will then drag poor people into custody, and carry them many miles away before they will be seen by the proper authorities and liberated. It will be remembered that lepers are not criminals; they are unfortunate and miserable beings, and they are to suffer for their misery and not for their crime. Would the State be justified in doing this? Sir William Moore, late Surgeon-General to the Bombay Government, has discussed these points in a very able, practical, and elaborate paper on leprosy. He says that the measure may indirectly diminish leprosy in India, but he does not believe in the segregation of the sexes as a measure for stamping out the disease, for it remains latent for some years and then breaks out. He believers in advancing civilization and sanitation as the only means by which the disease will gradually diminish. It is a redeeming feature of the Bill that it does not propose to interfere with the liberty of rich and well-to-do lepers. It proposes to deal only with vagrant lepers; but some people, and among them I might mention the Municipal Commissioner and the Health Officer of Bombay, recommend that the rich should be dealt with in the same way as the poor. This would be very unjust, because it would necessarily interfere with their liberty, as they do not show themselves so as to attract the attention of the public, and are not likely to prove dangerous. I am not one of those who would say that there is necessity for asylums for a helpless leper covered with innumerable and loathsome ulcers, disabled every way, whose sufferings we might put an end to in a short time, who cannot earn his livelihood because of his disabled condition, not to speak of his hideous aspect.
DR. TEMULJI BICAJI NARIMAN: As for the provisions of the draft Leper Act, I agree in the main with my friend, Dr. Balchandra. I would like the poor leper to have a home to shelter him, and where he could get food and medicine; but I do not think segregation ought to be compulsory for those who can afford to lie in their own beds. Segregation would not only tend to spread leprosy, but would do an injury to those only partially affected, because we know that lepers have been cured by isolating them partially. These affected lepers are put amongst advanced lepers, and they thus stand a serious chance of having the disease increased rather than of having it cured. Government should be very careful how they put this Act into force.
DR. D. B. MASTER: The former speakers have fully touched upon the various headings discussed by Dr. Balchandra in his paper, regarding the causes of leprosy, I will refer only to one question, and that is fish diet, which is spoken of as one of the causes of leprosy. My idea is that fish diet, and more particularly putrid fish diet, cannot cause leprosy any more than any other unwholesome diet. Perhaps a man living entirely on fish diet may so weaken his system that he might become subject to leprosy if exposed to it. Besides that I do not think fish diet can give rise to leprosy. Then there is the hereditary tendency. Out of four cases I know of, I have not found any hereditary taint. Of course want of evidence is no proof there was no heredity. But I certainly failed to get any history of it. The first case was one in which a middle-aged Parsee was suffering from the tubercular variety. His mother and his wife and daughter lived with him, but none of them suffered from it. The second case was one in which a Parsee boy suffered also from the tubercular variety. I failed to find any trace of the disease, either on this father's or mother's side. The third case was a similar one, in which there was no trace of heredity. The fourth case was of the anęsthetic variety, in which a woman has been suffering from the disease for the last three years. In this case also I failed to get any trace of heredity. So, although hereditary tendency is admitted to be one of the causes of the disease, there are cases in which we fail to find any trace of hereditary taint. As to contagion, I agree with those of my friends who have said that it is not an easily communicable disease; but still I should be very reluctant to spread the belief amongst the public that mere contact with lepers was absolutely without danger. We have not sufficient evidence to show as yet that the disease is not communicable by simple contact; but if that belief were spread amongst the public, it would tend possibly to do more harm than good by creating a sense of security for which there is far no sufficient foundation. The students of two schools near the Nacoda Tank, where many lepers congregate, are exposed to germs of the disease with which the tank cannot fail to be contaminated. I would ask those of my friends who argued so strongly that the disease was not contagious, if they would drink out of that tank, or if they would even care to wash their hands in that water? No, they know very well the germs are there, and they are afraid. Still, many hundreds go there, drink the water, bathe in it, and wash their clothes in it, without contracting the disease. You might, basing your argument on that fact, say the disease is not contagious. As regards the conclusions drawn by my friend Dr. Balchandra regarding the scare, I agree with him. Now I come to the objections Dr. Balchandra has raised to the Draft Act. If this Bill is to be applied to all classes, whether rich or poor, I would certainly object to it, and very strongly too. For, if the Act is to apply to the rich as well as to the poor, it would inflict a great hardship on many; but if it is meant to apply to the wandering beggars only, it would be a boon to them, and I think no harm would be done, but good. Therefore, I think there ought to be no objection raised on that point. Then again as to Dr. Balchandra's second objection regarding the diagnosis of leprosy. He is afraid it would be put in the ands of quacks; but Government has laid down that no such authority would be given to quacks, or to any who knew nothing about it. Government will take care to entrust it to the proper authorities. A third objection is that it would tend to oppression if left in the hands of the police. The same objection was raised to the C. D. Acts, but the complaints were very few and far between. Of course in working an act of that kind, there is some oppression. The Police Act, for example, contains certain clauses which certainly prove annoying sometimes to respectable parties; but then we must for the good of the general public, just put up with it. As regards the fourth objection of Dr. Balchandra, as to the treatment of lepers as criminals, certainly there must be some check put upon them. There surely is not much hardship in that.
DR. N. N. KATRAK: Medical opinion a few years ago was that leprosy was not contagious, and I began my practice with the idea on my mind. I can remember some two or three years ago I was traveling on a train car near Crawford Market, when a poor woman was ordered to get down from the car. Her look was suspicious, to say the least of it, and suggested to me that she was a leper. But, poor creature, she was so weak, she had hardly strength in her to get down, nor would any gharry take her. I thought to myself, "Can this be the nineteenth century we are living in?" The chief point in connection with the treatment of lepers is the great injustice, or rather sheer tyranny, inflicted upon these poor and unfortunate sufferers. Ever since then I have tried conscientiously to study the question of leprosy as a contagious disease, and the conclusion I have come to is, from the evidence we as medical men possess, that it is not contagious. To say the least it is at best very doubtful; and as we in most cases give the benefit of the doubt, the benefit must be given in this case. It is the contention of most of us that most diseases are caused by what are called insanitary conditions. Well, then, the fulfillment of the provisions of the Act will not free you from the risk of taking leprosy. Our treatment, therefore, ought to be in taking general measure for improved sanitation. Leprosy is not contagious in the sense of ordinary contagious diseases. Taking one-eighth of the Bombay cases to be contagious will bring the number down to fifty or at most a hundred. Even of these hundred cases only one or two per cent can have been communicated by inoculation. Do we, therefore, require compulsory segregation? Who would support a measure that would so deprive others of liberty of action. One, two, or three cases is no proof of the case, or any warrant for compulsory confinement. How can one make out that compulsory segregation is not a hardship? Contagion, I have said, may be possible, but possible to a very slight extent. Leprosy is, for our practical purposes, not contagious. As regards curability, I have no experience, and will leave that topic for others to speak upon. The diagnosis of leprosy is a very important point. Many gentlemen have given their opinion as to how uncertain is the diagnosis. I know of four or five cases in which people were declared to be suffering from leprosy by a number of medical gentlemen; but ultimately the mistake was found out. Side by side with the proposal to segregate there ought to be some measure which would tend to diminish the disease, and then I believe the Bill might, to a certain extent, be of some advantage. There is one objectionable feature in this Draft-Act. I am not against segregation, though I believe there is some force in what has been said of it, that it may only help to increase the disease. But the character given to these asylums is something of the character of a gaol. Instead of having them made attractive in the Bill, they have been made actually repulsive. No man in his senses would go into these asylums unless compelled. I believe our Municipal Act is in itself sufficient, for there is a clause in it by which lepers can be prevented from wandering about the streets. Why not take advantage of this measure, and if it fails we might then think of something else? Have these measures been given a fair trial? All I would add is, that the present scare is a dangerous one, and it certainly is the duty of the Society to give to the public an expression of opinion in some tangible and definite shape?
DR. HUGHES: I have been very much struck during this discussion with the prominence that has been given to heredity as a cause of leprosy. Well, leprosy is, perhaps, hereditary, but it is not as hereditary as syphilis, or even as gout or rheumatism is. We must recollect that children of lepers live in an endemic locality. A good deal of the hereditariness of leprosy depends upon the hereditary bad health that is transmitted to them. This bad health predisposes them to contract leprosy in the same way as they might contract any other disease which may happen to be endemic. In 1873, when at Kolhapur, I made some investigation into the matter, and questioned 125 lepers. There lepers, I may mention, came from the Ghaut district, and were attracted thither by the number of wealthy and charitable persons to be found there. The result of this little investigation was that among those whose parents were affected, I only found seven out of 125, while grandparents had only been affected to the extent of 7.4 per cent, which give only about 8 per cent altogether. The principal cause of leprosy seems always to have been some ulcerating disease. The disease, I believe, is contagious. It also is infectious, I think, in the same way as typhoid fever is infectious. It can be taken in with food or water. The form of disease that is most infectious is the ulcerated tubercular variety, form which the bacilli are washed away in comparatively large quantities. This bacillus gets into the drinking water, and people who live in endemic localities are liable to be affected. Comparatively strong and healthy people may escape it for a certain length of time. I know a case where a man, whose father and mother were lepers, who lived for twenty-two years before showing symptoms of the disease. Having these views regarding the hereditariness and contagiousness of leprosy, I do not think it would be necessary in segregating lepers to separate the sexes. If a leprous couple chose to remain together, then let them do so, on the understanding, however, that the offspring of such a union be removed form the endemic area in which they were born, for whatever may be the sanitary measures, and however perfect they may be, there is a risk of the child receiving some leprous matter from the persons of some of the affected people. Having regard to the contagiousness of leprosy, I should say that not only should all paupers be segregated compulsorily, but all those in any way concerned with the preparation and distribution of food should be dealt with in the same way. It might also extend to those who have to do with the handling of clothes, though that is not so important. The well-to-do and more intelligent classes might have special provisions made for them.
DR. COWASJEE HORMUSJEE: From what I have heard and read of Dr. Balchandra's address, I see that there is a consensus of opinion that leprosy is in a certain form contagious, and that therefore the proposed Leper Bill ought to be accepted with certain modifications. I have all along thought that leprosy at a certain stage, particularly the ulcerated form of tuberculated leprosy, is contagious, and is dangerous when lepers, whether vagrants or not, are allowed to associate with other people; not only that, but it may be communicated to those who have no hereditary taint or are otherwise affected by that disease. I think there are many medical gentlemen in Bombay, whose long experience of thirty years and more would go to show that leprosy in that form is a dangerous disease, and the people suffering from it ought to be segregated. Therefore I think it is the duty of this Society, composed as it is of scientific medical gentlemen, to assist the noble effort of the Government of India by accepting the draft Bill.
DR. KIRTIKAR: Leprosy is to my mind a constitutional disease of a contagious character. It is contagious, not only in that stage which Dr. Balchandra has so well described, but it is contagious in that stage where in the anęsthetic form there are those deep ulcers that burrow through the limbs, and through all the body. These are contagious, and they are practically the more contagious because they escape our observation. A man may come to us with symptoms of anęsthetic leprosy, and with perhaps no other symptom; but when you proceed to examine him carefully, you may find a little sore. If this man is a cook, or an attendant on the sick, or does anything for others, he infects others without knowing it. That is one reason, I think, why all lepers should be segregated, whatever stage the disease is in. With reference to the social position of the leper, I think it is an admitted fact, having in view the contagiousness of the disease, that a leper has always been a man case out of society. He is degraded in the extreme. Even by an old Hindu law the leper becomes a social outcast, more to be shunned and abhorred than to be treated as a man. If we consider the plans of our Government, if we look at the Leper Bill from these points of view, I am sure there is no man, believing in contagion or not, but will have to admit that the lepers must be helped. Will we then not help them? I hope some of the gentlemen who spoke at the last meeting will grow wiser. They will find Government will be in a position to help those people if none come in the way, and poison the public mind by saying that Government is harsh. Government wants to give them shelter. I say it is our bounden duty to support the working of the Act, or I should say the passing of the Act in the first place. There will be, some are of opinion, practical difficulties in the working of the Act. Dr. Balchandra is afraid there may be a great deal of difficulty in poor lepers being dragged by a police sepoy before a magistrate, in order to procure the necessary certificate. I do not see where there is any practical difficulty. Then in the earlier stages, as it has been pointed out, there may be difficulty in diagnosis; but at any rate, diagnosis will not be such a terrible bar, as some have tried to make out, in the direct working of the Act. We all know there is an Insanity Act, and how the civil surgeons of the mofussil deal with the insane who may be found wandering about the streets, or even found in a house. What is done then? The magistrate of the district is applied to, and he refers to the civil surgeon, who signs a certificate after a careful examination of the patient; then the man is sent to the lunatic asylum. A similar process, if adopted with regard to leprosy, will not interfere with the civil rights of the individual himself. Not only that, but the civil rights of the surrounding people will be maintained, because Government must look to the interests of those who are healthy, and protect them from contagion. Under these circumstances it is our duty to unanimously express our approval of the present draft Bill. I do believe that instead of inflicting any punishment upon the poor lepers, this Act will enable our local authorities to give the neglected ones a shelter, which we, be it said to our shame, have so far neglected to offer to them.
DR. WEIR: I have very few remarks to make beyond giving you a few statistics. I think, whatever difference of opinion there may be amongst us, we are unanimous in thinking that our friend Dr. Balchandra has given us a very interesting paper. I would like, before giving you one or two experiences of my own, to examine, to a certain extent, the fact placed before you; and previous to entering upon that even, I think it is necessary to remind you that our position as medical men in Bombay is different to our professional position at home. I do not think it has been referred to yet, but I must remind you that the question of the segregation of lepers has already been disposed of by the people of India. There are gentlemen here who know and who have seen, as well as I have seen, that in some villages and different places in India lepers are excluded. Now, as the people have settled the question for themselves from a common-sense point of view, and from experiences extending over ages, if we professional men bring contrary evidence, even though it be proof as conclusive as their experience, they will not receive our testimony. They will lose faith in us. The public come to us for advice and for help. They ask, What we are to do? I do not think it is sufficient for us to say that certain things should not be done. We must give our views distinctly to the public, and either tell them that they are to do certain things or that they are not. There is another point in which our position is totally different to the profession at home. It is this. We have a much more credulous people to deal with than professional men in England have. Is it sufficient to explain to a man in scientific language that he has certain maladies, when your opinion is expected? We know perfectly well that in India people attach very little value indeed to a mere scientific statement. What they want is to be cured. Our position here today should be either to show to the people that we known more than themselves, or to admit we do not. I would not attach too much importance to one case of inoculation as sufficient to establish a disease as contagious.
THE PRESIDENT: Before Dr. Balchandra replies, as of course he has a right to do, I think it would be useful were I to put before you, as briefly and as plainly as possible, what I consider to be the result of the debate. To take the subject according to the headings we agreed upon there is first the cause. Well, as regards heredity, I think the opinion in favour of that as a mode of propagation is overwhelming. A great many of the speakers are certainly in favour of it. As regards contagion, which is the main bone of contention-in fact, it is the point upon which the whole discussion chiefly turned, and upon which the proposed legislation is based-I think the majority of the speakers are contagionists. I have counted them up, and out of fourteen speakers eleven are clearly contagionists. But every one does not agree as to the degree of contagion. We have varieties of contagionists. Of the anti-contagionists, I take it Dr. Temuljee is one of them, but at the same time he appears somewhat in doubt. Dr. Khory is the only one who spoke strongly as an anti-contagionist. He regards leprosy as not contagious at all. On the question of curability, those who touched on the treatment of lepers left that unmentioned. I think you will all agree with me that no cure has so far been discovered. Then as regards social position and social treatment, no one has alluded to that point except Dr. Kirtikar, and he tells us that the old Hindu law made vagrants of lepers. Whether the leper population is increasing, not one has been able to give us any proofs. We have no statistics or leper census. As regards Bombay, it is the opinion of most people that there are a larger number of lepers in the city now than there were some years ago; and the main cause of this is the existence here of a number of wealthy and charitable-minded gentlemen; for lepers, as you know, will flock to where they will or can hope to get charitable relief. Then as to whether lepers are a public danger. I think the general consensus of opinion here is that they are not a public danger-at least, not a danger in the sense that the public themselves view it. The public are in a state of panic on the subject, both here and at home; but we all know that the public are sometimes in a condition of panic, simply because they do not understand anything about the subject. Then as regards the provisions of the Draft Leper Act. Nobody, so far as I can recollect, has touched on the details of the Act, except Dr. Balchandra himself. But it seems to me that the general opinion of the meeting is in favour of the Act. I think, at any rate, every speaker is to some extent in favour of the Act.
Thus ended the meeting with a recommendation in favor of the Leper Bill. The issues discussed were wide ranging, and many insightful thoughts were expressed relating to social and religious attitides toward leprosy. It is also significant to note the reason offered as to why Bombay attracted a good number of migrants with this dreaded disease:
... the main cause of this is the existence here of a number of wealthy and charitable-minded gentlemen; for lepers, as you know, will flock to where they will or can hope to get charitable relief. Then as to whether lepers are a public danger.
The participants felt that the question of segregation is already approved and practiced in India, and as such the proposed Leper Act was simply buildt around the existing social attitudes but with a support and training base for the unfortunate people.
CURRENT TRENDS IN THE LANGUAGE AND POLITICS OF LEPROSY
Unfortunately the question of human rights, the rights of the so-called lepers as human beings, so courageously voiced by W.C.Bailey (quoted earlier in this article) was significant by its absence.
The word leprosy is still used in English, but a trend had become evident that used more and more the Indian terms to refer to the disease and persons afflicted with this disease. And yet, while the pejorative nomenclature derived from caste names for certain professions such as barbers could be re-designed in modern Indian languages, a sufficiently less pejorative term could not be coined easily for referring to leprosy in Indian languages. Most Indian languages continue to use kushT to refer to the disease. The term kushT is emotionally charged with fear and revulsion. There is a need to change this term and use something else in its place. Take for example, Barber Shops are now redesigned as Hair-dressing and beautifying shops, not any more connected with the barber caste. Indian languages need to switch to this strategy. In Tamil, the word kushT is almost given up in deliberate writing, and a Tamil word that refers to the cause or fixture of origin is more and more used, mainly because of the effort to write everything using Pure Tamil! Curses still abound with references to this disease in our talk.
THE QUESTION OF LEPROSY AND THE STUDY OF SOCIETY, DIAGNOSIS AND TREATMENT: THE OVERARCHING ELITIST APPROACH
The question of leprosy, thus, goes well beyond the condition of the disease, and it embraces a range of issues of importance relating to human rights, methods of diagnosis and treatment, social values, the power of the ruling classes to regulate their surroundings to their own advantage, etc. In no way it is a simple management of a visible condition. Benign members of the Indian Parliament as well as the Union Health Minister simply re-enacted the old scene. And the Indian public may not buy the theories about the origin and spread of the disease, but it will be continually frightened by the visible marks of the disease, and will seek an explanation in the familiar grounds of religion. Meanwhile, well meaning individuals and organizations such as Baba Amte and his family will devote their lives for the betterment of individuals and families afflicted with this disease,and be still criticized. Some others such as Graham Staines and his children, working to bring solace and skill to those suffering from this disease, may be burned alive. Ultimate victory will be achieved only when science could help arrest the spread of the disease. When visibility of the disease in the body is reduced or totally eliminated, the hearts embedded in age-old notions as cause for the affliction will be changed. I do believe that the time is not far off for this to happen.
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