REPORT OF THE LEPROSY COMMISSION
:
CONTAGION. Dealing with the
contagiousness of leprosy, the Commissioners come to the important conclusion that, though they consider leprosy an infective disease caused by a specific bacillus and also a contagious disease, they are of opinion that there is not sufficient evidence that leprosy is maintained or diffused by contagion; indeed, under the ordinary human surroundings, the amount of contagion which exists is so small that it ma) be disregarded, and no legislation is called for
on
the lines either of segregation
or
of inter-
diction of marriages with lepers. In support of this conclusion certain arguments, derived main* ly from analogy are put forward together with some more particular evidence of a negative character. The Commissioners very properly commence the
chapter on Contagion by defining contagious and infective, but the "two instances of infective diseases which are by no means contagious "given by the Commission are not altogether appropriate, seeing that pueumonia the terms
js well known under certain conditions to become " contagious,and it has been proved that'? malaria
by inoculation. They also state their position in regard to the contagiousness of leprosy by quoting some remarks of FJiigge who says, '"The diffusion of leprosy by contagiop is exceedingly rare, and evidently can only take is communicable
Oct.
REPORT OP THE LEPROSY COMMISSION?CONTAGION.
1893.]
place
under
special
and
is
so
predisposing favourable that
much we
po^itive evidence
on
343
the
otner
side
cannot but consider the conclusions
conditionsto which the Commission add that arrived at by the Commissioners are unwarranttheir subsequent arguments will be guided by ed. As the proverb says, c< An ounce of fact is this dictum, and " that the more weight is worth a pound of theory." In this connection it attached to special favourable conditions, in fact should not be lost sight of that Father Damien what in clinical language is culled the suitable used to be cited as a strong instance of the non* nidus' the further contagion disappears into the contagiousness of leprosy in that he had lived practical purpoback-ground. Indeed, for among lepers, in close contact with them for many ses?and these are what the legislator or sanitary years without contracting leprosy. It will be reformer has to consider?it vanishes altogether." remembered how sadly this conclusion was upset This is a position which we are quite unable in the end. The illustration given by the Comto accept, for if both contagion and a suitable mission of the slight risk of the spread of thedisease nidus are necessary for the development of leprosy around a leprous community, viz., the condition of the existence of the one, viz., specially favourable at Tarn Taran, is not. a very happy one for conditions can scarcely cause the other, viz., things the reason that, as the Commissioners themselves contagion, to fall into the background. Given shew, the high mortality among lepers will naturan organism which, in virtue of hereditary prelead to gradual extinction of the leprous disposition, is a suitable nidus the danger of con- ally as the ratio of lepers tagion will become more and more real in propor- community. Consequently, is maintained, the disease is as likely to have tion to the predisposition and the absence of re- been caused by its spread to others than the striction of the sources of infection by isolation as by the causation favoured by original to lepers &c. The Commissioners have been unable the Commission. Reference is made by the Comshow except by more or less imperfect, analog) that leprosy germs flourish elsewhere than in the mission to their discussion of the question of asylums being possible centres for the diffubody and their views that the germs must have sion of the leprosv,* and they state that in all the a place somewhere whence they can always de asylums of the Punjab the lepers are allowed, novo attack the healthy organism is a vague on special days at least, to go out into the on no surer basis than specustatement, resting ^ 1 bazaars and the neighbourhood to procure food lation. The example of tuberculosis is singuor whatever they require, thus mixing freely with larly infelicitous as the evidence in favour of the -people. This mixing freely with the people contagion is growing every day. The observain the sense of contact does not, as a matter tion that " it is to be regretted that the modern of fact, occur, as no native will willingly advances of and animal inoculation ?
a
bacteriology
have tended to make not only the public, but also scientific writers disregard the evidence derived from clinical and epidemological experiments," is scarcely to the point, seeing that long before bacteriology was known or the leprosy bacillus was discovered the view as to
bring himself into contact with a leper. Even among relations this avoidance is the rule, and there is a voluntary self-effacement of lepers, lhe
tendency
which is
an
to
voluntary segregation of lepers, India, by which
undoubted fact in
become leprosy lepers
of their own free will social outcasts, leaving their homes and separating themselves from their friends, is contrary to the
being a contagious disease was almost universally held. The results obtained by bacteriology merely strengthened previous observations. The opinions of the Commission as to lepers mixing Commission's somewhat slighting reference to freely with the people. As regards the statebacteriological researches in this connection, is ment of the Commissioners that it is an almost hardly in keeping with their former views as universal opinion of scientific and intelligent expressed at page 100 when their de novo theory men in India that a spread of the disease has was introduced, for there they attach special never been known to take place from a leper importance to the teachings of modern advances centre to its neighbourhood, we would say that, even if this be in bacteriology and animal inoculation. accepted as correct, the question At the best, the evidence adduced by the Coramission in support of their thesis that leprosy is not contagious is negative evidence, and there
is
one
*
which has Report
never
of the
beer
thoroughly
investi-
Leprosy Commission, page 124.
344
?
INDIAN MEDICAL GAZETTE.
To settle this
gated.
leprosy occurring
question
every of an
of
case
vicinity asylum special inquiry into
in the
separate aud
would
months after the
ultimately on as
died
[oCT.
leper spots
1893.
made their appearance, and lie case can be relied
confirmed leper. This
a
correct.
perfectly
require 2. This case we cannot rely upon as well as the preits mode of origin and possible connection with ceding one, but it is very similar in its features. A young the asylum. Till this is done, it is impossible to overseer coming home one night met in the public road With reference to this we note a former remark of the Commission in connection with contagion. " Neither come to a
conclusion either way.
would it be
permissible
to be too much
guided
of medical observers in Iudia."* On the other hand, if we take individual facts,
by
the
opinions
there is stroug collateral evidence of such tensiou iu the
of those
who
lepers healthy people. of illustrating this point we case
intimate contact with
ex-
are
in
For the shall
a
black
When
woman
offering
with whom he had sexual intercourse. some money she told him to put it into
her
her mouth
as she had no hands. He then had lost her fingers, and on examining her found that she was a leper. This preyed
such
a
that he
degree
was never
perceived she carefully
more on
afterwards the
his mind to same
man,
upon this occurrence. Me soon lost all energy and courage, and about two years after he became a leper and died as such.
always thinking
Q. Q. Q., aged 35, white, born in England, whose
3.
family
never
left
Europe,
and who lived
comfortably,
co-
give habited with a coloured girl. After two years he found some recorded instances in favour of contagion. out spots on his body, which were declared by medical men In the summary of reports of leprosy in foreign to be leprous. lie had a child by this girl. He left for where he soon improved, the spots nearly disapcountries issued by the Honolulu Governmentf England He returned to the colony and renewed his conpearing. in 1886, Dr. ft.. D. Ghose, then Civil Surgeon nection with this girl. He soon, however, got bad again, of Rungpur, after referring to 33 cases in which and returned to Europe where he died a confirmed leper, the persons affected with leprosy had lived in '?'lie girl wms found afterwards to be afflicted with leprosy. the same house with other lepers before getting A sister of hers died of the same disease as also her child purpose
that in four of these 33 cases there was sexual intercourse with leprous individuals In one village he found six before the attack.
it, mentions
in different stages of the disease less related to each other. A woman got
A black boy belonging to parents who had for gene4. rations been sbives to a family, enjoyed perfect health, and was perfectly free from any disease as well as all the members of his family which was a large on e. This boy used and sleep witli another boy who was not known to
first from
to
individuals more or
leprosy
a
leprous husband
who lived
in another village. Her parents were not leprous. After her husband's death she came to live with
and, before
she
year in the house, he got the disease. In the course of six years three other individuals in the neighbourher brother
ing
houses
were
affected.
was
a
The oldest
individual
woman
village assured D'\ Ghose that before the returned home after her husband's death
lie had
not seen
in this
a
leper
in that
village.
also some remarkable cases reported by the British Guiana Commission as given in Dr. Hillis'e workj :? There
are
A yuunir Scotchman whose parents have never left and whose family were as healthy as could be desired, met
:
CONTAGION. Dealing with the
contagiousness of leprosy, the Commissioners come to the important conclusion that, though they consider leprosy an infective disease caused by a specific bacillus and also a contagious disease, they are of opinion that there is not sufficient evidence that leprosy is maintained or diffused by contagion; indeed, under the ordinary human surroundings, the amount of contagion which exists is so small that it ma) be disregarded, and no legislation is called for
on
the lines either of segregation
or
of inter-
diction of marriages with lepers. In support of this conclusion certain arguments, derived main* ly from analogy are put forward together with some more particular evidence of a negative character. The Commissioners very properly commence the
chapter on Contagion by defining contagious and infective, but the "two instances of infective diseases which are by no means contagious "given by the Commission are not altogether appropriate, seeing that pueumonia the terms
js well known under certain conditions to become " contagious,and it has been proved that'? malaria
by inoculation. They also state their position in regard to the contagiousness of leprosy by quoting some remarks of FJiigge who says, '"The diffusion of leprosy by contagiop is exceedingly rare, and evidently can only take is communicable
Oct.
REPORT OP THE LEPROSY COMMISSION?CONTAGION.
1893.]
place
under
special
and
is
so
predisposing favourable that
much we
po^itive evidence
on
343
the
otner
side
cannot but consider the conclusions
conditionsto which the Commission add that arrived at by the Commissioners are unwarranttheir subsequent arguments will be guided by ed. As the proverb says, c< An ounce of fact is this dictum, and " that the more weight is worth a pound of theory." In this connection it attached to special favourable conditions, in fact should not be lost sight of that Father Damien what in clinical language is culled the suitable used to be cited as a strong instance of the non* nidus' the further contagion disappears into the contagiousness of leprosy in that he had lived practical purpoback-ground. Indeed, for among lepers, in close contact with them for many ses?and these are what the legislator or sanitary years without contracting leprosy. It will be reformer has to consider?it vanishes altogether." remembered how sadly this conclusion was upset This is a position which we are quite unable in the end. The illustration given by the Comto accept, for if both contagion and a suitable mission of the slight risk of the spread of thedisease nidus are necessary for the development of leprosy around a leprous community, viz., the condition of the existence of the one, viz., specially favourable at Tarn Taran, is not. a very happy one for conditions can scarcely cause the other, viz., things the reason that, as the Commissioners themselves contagion, to fall into the background. Given shew, the high mortality among lepers will naturan organism which, in virtue of hereditary prelead to gradual extinction of the leprous disposition, is a suitable nidus the danger of con- ally as the ratio of lepers tagion will become more and more real in propor- community. Consequently, is maintained, the disease is as likely to have tion to the predisposition and the absence of re- been caused by its spread to others than the striction of the sources of infection by isolation as by the causation favoured by original to lepers &c. The Commissioners have been unable the Commission. Reference is made by the Comshow except by more or less imperfect, analog) that leprosy germs flourish elsewhere than in the mission to their discussion of the question of asylums being possible centres for the diffubody and their views that the germs must have sion of the leprosv,* and they state that in all the a place somewhere whence they can always de asylums of the Punjab the lepers are allowed, novo attack the healthy organism is a vague on special days at least, to go out into the on no surer basis than specustatement, resting ^ 1 bazaars and the neighbourhood to procure food lation. The example of tuberculosis is singuor whatever they require, thus mixing freely with larly infelicitous as the evidence in favour of the -people. This mixing freely with the people contagion is growing every day. The observain the sense of contact does not, as a matter tion that " it is to be regretted that the modern of fact, occur, as no native will willingly advances of and animal inoculation ?
a
bacteriology
have tended to make not only the public, but also scientific writers disregard the evidence derived from clinical and epidemological experiments," is scarcely to the point, seeing that long before bacteriology was known or the leprosy bacillus was discovered the view as to
bring himself into contact with a leper. Even among relations this avoidance is the rule, and there is a voluntary self-effacement of lepers, lhe
tendency
which is
an
to
voluntary segregation of lepers, India, by which
undoubted fact in
become leprosy lepers
of their own free will social outcasts, leaving their homes and separating themselves from their friends, is contrary to the
being a contagious disease was almost universally held. The results obtained by bacteriology merely strengthened previous observations. The opinions of the Commission as to lepers mixing Commission's somewhat slighting reference to freely with the people. As regards the statebacteriological researches in this connection, is ment of the Commissioners that it is an almost hardly in keeping with their former views as universal opinion of scientific and intelligent expressed at page 100 when their de novo theory men in India that a spread of the disease has was introduced, for there they attach special never been known to take place from a leper importance to the teachings of modern advances centre to its neighbourhood, we would say that, even if this be in bacteriology and animal inoculation. accepted as correct, the question At the best, the evidence adduced by the Coramission in support of their thesis that leprosy is not contagious is negative evidence, and there
is
one
*
which has Report
never
of the
beer
thoroughly
investi-
Leprosy Commission, page 124.
344
?
INDIAN MEDICAL GAZETTE.
To settle this
gated.
leprosy occurring
question
every of an
of
case
vicinity asylum special inquiry into
in the
separate aud
would
months after the
ultimately on as
died
[oCT.
leper spots
1893.
made their appearance, and lie case can be relied
confirmed leper. This
a
correct.
perfectly
require 2. This case we cannot rely upon as well as the preits mode of origin and possible connection with ceding one, but it is very similar in its features. A young the asylum. Till this is done, it is impossible to overseer coming home one night met in the public road With reference to this we note a former remark of the Commission in connection with contagion. " Neither come to a
conclusion either way.
would it be
permissible
to be too much
guided
of medical observers in Iudia."* On the other hand, if we take individual facts,
by
the
opinions
there is stroug collateral evidence of such tensiou iu the
of those
who
lepers healthy people. of illustrating this point we case
intimate contact with
ex-
are
in
For the shall
a
black
When
woman
offering
with whom he had sexual intercourse. some money she told him to put it into
her
her mouth
as she had no hands. He then had lost her fingers, and on examining her found that she was a leper. This preyed
such
a
that he
degree
was never
perceived she carefully
more on
afterwards the
his mind to same
man,
upon this occurrence. Me soon lost all energy and courage, and about two years after he became a leper and died as such.
always thinking
Q. Q. Q., aged 35, white, born in England, whose
3.
family
never
left
Europe,
and who lived
comfortably,
co-
give habited with a coloured girl. After two years he found some recorded instances in favour of contagion. out spots on his body, which were declared by medical men In the summary of reports of leprosy in foreign to be leprous. lie had a child by this girl. He left for where he soon improved, the spots nearly disapcountries issued by the Honolulu Governmentf England He returned to the colony and renewed his conpearing. in 1886, Dr. ft.. D. Ghose, then Civil Surgeon nection with this girl. He soon, however, got bad again, of Rungpur, after referring to 33 cases in which and returned to Europe where he died a confirmed leper, the persons affected with leprosy had lived in '?'lie girl wms found afterwards to be afflicted with leprosy. the same house with other lepers before getting A sister of hers died of the same disease as also her child purpose
that in four of these 33 cases there was sexual intercourse with leprous individuals In one village he found six before the attack.
it, mentions
in different stages of the disease less related to each other. A woman got
A black boy belonging to parents who had for gene4. rations been sbives to a family, enjoyed perfect health, and was perfectly free from any disease as well as all the members of his family which was a large on e. This boy used and sleep witli another boy who was not known to
first from
to
individuals more or
leprosy
a
leprous husband
who lived
in another village. Her parents were not leprous. After her husband's death she came to live with
and, before
she
year in the house, he got the disease. In the course of six years three other individuals in the neighbourher brother
ing
houses
were
affected.
was
a
The oldest
individual
woman
village assured D'\ Ghose that before the returned home after her husband's death
lie had
not seen
in this
a
leper
in that
village.
also some remarkable cases reported by the British Guiana Commission as given in Dr. Hillis'e workj :? There
are
A yuunir Scotchman whose parents have never left and whose family were as healthy as could be desired, met
