Leprosy in Bombay - A Historical account by Aniruddha Malpani

LEPROSY IN THE BOMBAY PRESIDENCY, 1840-1897: PERCEPTIONS AND APPROACHES TO ITS CONTROL A Ph.D Thesis in History by Shubhada S. Pandya UNDER THE GUIDANCE OF

Dr. MRIDULA RAMANNA, MAHAMAHOPADHYAYA P.V. KANE INSTITUTE, ASIATIC SOCIETY OF BOMBAY, MUMBAI, NOVEMBER 2001.

LEPROSY IN THE BOMBAY PRESIDENCY, 1840-1897: PERCEPTIONS AND APPROACHES TO ITS CONTROL A

Ph.D Thesis in History by Shubhada S. Pandya UNDER THE GUIDANCE OF

Dr. MRIDULA RAMANNA, MAHAMAHOPADHYAYA P.V. KANE INSTITUTE, ASIATIC SOCIETY OF BOMBAY, MUMBAI, NOVEMBER 2001.

Name and Signature of the Guiding Teacher

Dr. Mridula Ramanna.

Name and Signature of the Student

Shubhada S. Pandya.

DECLARATION As required by Ordinances O.779 and O.771,

I wish to state that the work embodies in the thesis “Leprosy in the Bombay Presidency, 1840-1897: Perceptions and Approaches to its Control” forms my own contribution to the research of work carried out under the guidance of Dr. Mridula Ramanna, at the Mahamahopadhyaya P.V.Kane Institute, Asiatic Society of Bombay. This work has not been submitted for any other degree of this or any other University or Academic Body. Whenever reference has been made to previous works of others, it has been clearly indicated as such, and included in the “Bibliography”.

Shubhada S. Pandya Research Student

Dr. Mridula Ramanna Research Guide

ACKNOWLEDGEMENTS My thanks and gratitude go to Dr. Mridula Ramanna for being a guide in the full sense of the term. She not only introduced me to analysis in medical history, but suggested articles for reading and made constructive comments and suggestions. I was fortunate in being the recipient of two Heras Society Scholarships (1996-1997) and (1999-2000) . I am grateful to the Society for their generosity. I was also able to pursue some of the research work with the help of a short term Travel Grant from the Wellcome Trust in London in May-June 1997, which gave me access to the Library of the Wellcome Institute of the History of Medicine and the India Office Library. The help of the staff at the Maharashtra State Archives, the National Archives, and the librarians at the Mumbai University library, Asiatic Society of Bombay and the Heras Institute is gratefully acknowledged. I state with pleasure my debt to Shri Satish Kulkarni and the staff of Parkar Arts for expert help in formatting and printing this thesis. I say THANK YOU to my best friend, my husband Sunil Pandya.

Shubhada S. Pandya.

CONTENTS Page DECLARATION .............................................................................................. i ACKNOWLEDGEMENTS ............................................................................. ii TABLE OF CONTENTS .................................................................................. iii ABBREVIATIONS........................................................................................... vii

CHAPTER SCHEME

INTRODUCTION ........................................................... 1 CHAPTER 1. “The Aristocrat Among Diseases” ........ 24 SECTION A . Leprosy in Ayurveda and Western Medicine: Parallels ...... 25 in the Early Nineteenth Century. SECTION B. Leprosy in Western Medicine in the Later .................... 31 Nineteenth Century.

CHAPTER 2. Causation Controversies in India: the Leprosy Career of Henry Vandyke Carter....................................................................55

CHAPTER 3. Therapies, Therapists and Therapeutics ............................................ 78 CHAPTER 4. The Leper Censuses and their Uses ........ 110 CHAPTER 5. Laws and Lepers ..................................... 129 SECTION A . The Suicide of the Leper ...................................................... 130 SECTION B. The Leper and the Hindu Civil Law in Colonial Courts.. .... 137 SECTION C. Criminalising the Leper........................................................ 144 CHAPTER 6. Perceptions, Opinions and Anxieties ....... 156 SECTION A. British Attitudes.................................................................... 157 SECTION B. The Indian Press, Bombay’s “Intelligentsia” and the Leper.. 176 CHAPTER 7. The Leper in Person................................. 194 CHAPTER 8. Confine or Shelter? .................................. 200 CHAPTER 9. “Mr. Acworth’s Home” ........................... 250 CONCLUSION ............................................................... 289 BIBIOGRAPHY............................................................... 302

iii

Page FIGURES AND TABLES Fig. 1.1. D.C. Danielssen..................................................53 1.2 C-W. Boeck .........................................................53 1.3 G.Milroy ..............................................................53 1.4 G.A. Hansen.........................................................53 1.5 Decline of Leprosy in Norway 1856-1880 .........54 Fig. 2.1. Henry Vandyke Carter .......................................76 2.2. Grant Medical College, 19th Century.................76 2.3. J.J. Hospital in the 1860s ....................................76 2.4. Carter’s Map of the Leprosy-affected Regions of Bombay Presidency.........................77 Fig. 3.1. Madar (Asclepias gigantean) ............................104 3.2 Bauchee(Psoralea coryfolia) .............................104 3.3. Brahmi(Hydrocotyle asiatica) ...........................104 3.4. Cashew Nut (Anacardium occidentale).............104 3.5. Gurjon(Dipterocarpus laevis) ...........................105 3.6. Chaulmoogra(Teraktogenos kurzii)...................105 3.7. Tuvarka, Kadu Kavath (Hydnocarpus wightiana) ...................................105 3.8. J.C. Lisboa .........................................................106 3.9. F.J. Mouat ..........................................................106 3.10. Bhau Daji ..........................................................106 3.11. Sakharam Arjun ................................................106 3.12. Bhau Daji’s photographs of Dadajee Narayan .107 Table 3.1. Oil Therapies Tried out at the J.J. Hospital .......108 3.2. Sakharam Arjun’s Tabulation of Observations of Chaulmoogra oil Treatment, J.J. Hospital .....109 Table 4.1. Bombay City: Numbers and Categories of “Infirm” Persons enumerated in 1864 and 1872 ...................................................................124 4.2. “True Leprosy” in Bombay Presidency: Leper Census of 1867 ....................................124 4.3. “Prosperity” and Leper Ratios in Bombay Presidency in the three Censuses, according to the Leprosy Commission .............................125 4.4. Distribution of Leprosy in Bombay Presidency, 1881 ...................................................................126 iv

Page 4.5.

Approximate Numbers of Persons Afflicted with Leprosy in the Bombay Presidency and Native States, 1891 ...........................................127 4.6. Approximate Leper Rates, “British India” at each Census ............................................................ 128

Table

Fig.

Table

Fig.

Table

5.1.

Virulent & Severe type of Leprosy inviting Exclusion from inheritance................................155 6.1. Bhalchandra Bhatwadekar...............................192 6.2. Anna Moreshwar Kunte......................................192 6.3. Father Damien as a Leper ..................................193 7.1. Mortality Among 426 Lepers Bombay City, 1867 ...................................................................205 7.2. Urban Leper 1891 ...........................................206 7.3. Rural Leper in Kathiawar 1876 .......................206 7.1. Analysis of 426 lepers in Bombay City, 1867, showing Proportion of those Alive and Dying at each Decade of Age ....................................207 8.1. Statistics of the Rajkot Leper Asylum, 1875-1881 .........................................................239 8.2. Rajkot Leper Asylum: Number of Diets provided, 1876-1881.........................................239 8.3. Number of Lepers, J.J.Dharamshala, 1858-1895 .........................................................240 8.4. Sir Dinshah Manockjee Petit ............................241 8.5. Dinshah Manockjee Leper Asylum, Ratnagiri .242 8.6. Admissions, "Absenteeism", Deaths at the Leper Asylum, Ratnagiri, 1875-1884 ..............243 8.7. Leper Women and a Child at J.J. Dharamshala circa 1870 ........................................................245 8.8. Leper men at J.J. Dharamshala circa 1870......245 8.9. Archbishop Leo Meurin...................................246 8.10. Eduljee Framjee Allbless .................................246 8.11. Donors’ Plaque at the Eduljee Framjee Allbless Leper Asylum 1885 .........................................246 8.1. General Information about Dinshah Manockjee Petit Leper Asylum, Ratnagiri, 1883 and 1884..................................................247 8.2. Rations per person per day at the Leper Asylum, Ratnagiri, 1897..................................248 v

Page 8.3.

Fig.

9.1. 9.2. 9.3. 9.4. 9.5.

Table

9.1.

9.2.

9.3.

D.M. Petit Leper Asylum, Ratnagiri: Excess Contribution paid from Local Funds, and Savings Reverting to Government, 1887-1892 ........................................................249 H.A. Acworth .................................................282 N.H. Choksy ...................................................282 Nacoda Tank, where Lepers congregating alarmed well-to-do Citizens in 1889............283 Population Statistics of the Homeless Leper Asylum,1890-1897 .........................................284 Annual Income from the Sewage Farm at the Homeless Leper Asylum 1895-1898 .............284 Comparative Costs per Patient at the Homeless Leper Asylum and Other Civil Hospitals in Bombay 1891-1897 ...................................286 Comparative Cost of Maintenance of Beds at the Homeless Leper Asylum and Other Civil Hospitals in Bombay 1891-1897 ..................287 Weekly Dietary at the Homeless Leper Asylum 1890- 1897 ......................................................288

APPENDICES 1.1. Questionnaire on Leprosy Circulated by the Royal College of Physicians of London, 1862 ..315 5.1. Colonial legislation directly or indirectly bearing on the leper..........................................317 5.2. Act 6 of 1867 .....................................................321 5.3. Draft Leper Bill of 1889 ...................................322 5.4. Act 3 of 1898 ...................................................325 8.1. Number and Size of Leper Asylums in Bombay Presidency at end of 1897 ............332 8.2 Number of Lepers Treated in the Mofussil Civil Hospitals, Dispensaries and Leper Institutions in Bombay Presidency, 1896 ........333

ABBREVIATIONS Maharashtra State Archives, General Department............. MSAGD Maharashtra State Archives, Judicial Department............. MSAJD National Archives of India .................................................. NAI India Office Library ........................................................... IOL Report of the Committee of the District Benevolent Society of Bombay ............................................. RCDBSB

vii

INTRODUCTION (In this thesis the word “leper” is used solely in the interest of historical accuracy and is not intended to be derogatory to the person with leprosy.)

The

title of this thesis is “Leprosy in the Bombay Presidency

1840-1897: Perceptions and Approaches to its Control.” The “Perceptions” refer to understanding and intuitive recognition of “leprosy” the disease and “leper” the diseased, by various sections of Presidency society in the period under study. The thesis deals with this much-feared disease

period comprising almost six decades of the nineteenth century, and examines how it was perceived medically, legally, socially and politically, and how it was tackled in colonial Bombay Presidency. Leprosy is a disease whose chief home was -- and, unfortunately, continues to be -- India. So characteristic of the country was this disease considered to be, that an unnamed nineteenth century Viceroy reported to have remarked despairingly

was

"... one might almost as

readily undertake to rid India of its snakes as of its leprosy." 1 However, at the dawn of the twenty-first it appears that Indian leprosy is endangered. Global and national statistics suggest that although India has over 60% of the world's leprosy sufferers,

they currently number

just 680, 000 -- in marked contrast with the situation in 1984, when there were about 3.98 million lepers in India! 2 This gratifying situation has come about

chiefly due to the availability of effective modern

drugs. . Health agencies however caution that India still has a

very

long way to go before it can claim to have eliminated leprosy.

Times of India, 28/12/1889.

Status Report, 1998: Action Programme for the Elimination of Leprosy, Geneva, World Health Organisation, 1998; Report of the Special Meeting of the Leprosy Elimination Advisory Group, April 1999, Geneva, World Health Organisation, 1999; “Leprosy Trends, India 1985-1999,” The Bulletin of the Leprosy Elimination Alliance, 1: (2001) pp 7-10. Introduction

Leprosy is a chronic communicable disease of the nerves and skin, which develops when the germ, Mycobacterium leprae, interacts with a susceptible human being. Since most Indians are not susceptible, leprosy is not considered to be as highly communicable as tuberculosis or smallpox. Its importance, -- for the sufferer, the medical man, and the historian -- lies in

the

fact that the destruction of

the

nerves

leads to benumbing, paralysis and grievous mutilations of the face, hands and feet. In the absence of effective treatment, -- as was the situation in the nineteenth century, -- the disease shows itself in its full horror and may also be fatal. nineteenth

century

A fact which was well known to

doctors is that the

disease manifests in many

forms, some serious others relatively mild. The lay public in many societies has traditionally regarded leprosy as a disease of uniform ferocity, exciting pathos and terror in equal measure. Hence its seventeenth century European appellation was horridor morte -- “more horrible than death”, and its common Indian name was maharog -“the formidable disease”.

It was surely popular perception rather than

objectivity which prompted the authoritative Oxford English Dictionary in 1908, -- over a decade after the bacterial nature of leprosy was acknowledged, -- to define leprosy as “[a] loathsome disease which slowly eats away the body." 3

Stigma In many cultures, including Indian and European, the horror engendered by the physical disease of leprosy was transferred into the moral and religious spheres as evidence of sin and divine retribution. Probably it was not a great conceptual leap to presume that so grievous a bodily infliction must be just deserts for sinfulness; and that the sufferer deserved to be stigmatised and ostracised. The 3

J.A.H. Murray, (ed.), A New English Dictionary on Historical Principles, Vol .6, Oxford, Clarendon Press, 1908. Introduction 2

historian

of East Asian and European leprosy Olaf K. Skinsnes,

hypothesised that a socially stigmatising disease must show certain characteristics: firstly it must manifest on the skin, secondly it should start

insidiously

and

run

long course,

thirdly

progressively crippling and deforming, fourthly it must be

must be perceived

to be associated with "dirt" and uncleanness, and lastly it must be incurable. 4

To Skinses' list one might add one more characteristic,

namely that it must bears a resemblance to venereal disease and vicariously acquire an association with depravity and

heightened

sexuality. Leprosy satisfies these requirements eminently. In Judeo-Christian societies, the moral dimension of leprosy is said to have had its origin in Old Testament texts, which subjected the leprosy sufferer to civic penalties and disqualifications. 5 These have been extensively described and discussed medical

histories of the disease. 6

sufferer, along

with

others with

European

Hindu

physical or

social and

society the leprosy mental

disqualified from carrying out family and social duties

defects, was and lost

inheritance rights. 7 Another dimension of the socio-religious response 4

O.K. Skinsnes, “Leprosy in Society III: The Relationship of the Social to the Medical Pathology of Leprosy”, Leprosy Review, 34: (1964) pp 175-181. Other historical papers are: O.K. Skinsnes, “Leprosy in Society: Leprosy in Occidental Literature”, International Journal of Leprosy, 38: (1970) pp 294-307; O.K. Skinsnes, “Leprosy in Society: the Pattern of Concept and Reaction to Leprosy in Oriental Antiquity”, Leprosy Review, 35: (1964) pp 106-122..

The Bible, Book of Leviticus, Chapters 13 and 14, King James Version.

For example D.C. Danielssen and C-W Boeck, Traite de la Lepre, Paris, Balliere, 1848, pp 120-122. On mediaeval European perceptions and practices as revealed in the literature and histories such as Saul Brody, The Disease of the Soul: Leprosy in Medieval Literature, Ithaca, Cornell University Press, 1974; Charles Creighton, A History of Epidemics in Britain from A.D. 664 to the Extinction of the Plague, Vol. I, Cambridge, Cambridge University Press, 1891, pp 69-107. A discussion on the Biblical disease commonly thought to be leprosy, is in Stanley G. Browne, “Some Aspects of the History of Leprosy: the Leprosie of Yesterday”, Proceedings of the Royal Society of Medicine, 68: (1975) pp 13-21. 7

Ariel Glucklich, “Laws for the Sick and Handicapped in the Dharmashastra”, South Asia Research, 4: (1984) pp 139-151. Introduction

to leprosy in this country comes to light in the fact that the though the

shastras, -- a Hindu’s guide to rightful conduct--

frowned on

suicide, an exception was made in the case of a grievous illness, especially leprosy. Some colonial-era accounts, describe the various modes of suicide adopted by leprosy sufferers to end their miserable existence. 8 Such suicides were frequently assisted by relatives. Despite this, it is questionable whether civil and social penalties prescribed by the shastras or the Church were

invariably enforced in

the

respective societies. As this thesis shows, in India neither assisted suicide nor social banishment of the leper was the rule. Historians of medieval European leprosy too noted that the rules in some leper asylums were lax, and inmates were free to come and go at will. 9 What is not in doubt, however, is that the leprosy sufferer in both societies was liable to be marginalized domestically and socially.

Historiography of Disease-Colonialism-Medicine The history of medicine and disease

has in recent

experienced an expansion of scale and scope.10 There is a

years,

divergence

from the longitudinal perspective which held sway for decades, when medicine was depicted as “conquest” of diseases by great men and great ideas, independent of social and political contexts. Today medical history-writing of

domination

colonialism.

includes critiques of medical systems as tools

within The

social

triad

and

political

Health/Disease,

structures

such

Medicine,

as and

S.S. Pandya, “ ‘Very Savage Rites’: Suicide and the Leprosy Sufferer in Nineteenth Century India”, Indian Journal of Leprosy, 73: (2001) pp 29-38.

9 George Newman, “On the Decline and Final Extinction of Leprosy as and Endemic Disease in the British Islands”, in Prize Essays on Leprosy, London, The New Sydenham Society, 1895, p 66. 10

Roy Macleod, “Introduction”, in Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion, Roy Porter and Roy Macleod (eds.), London, Routledge, 1987. Introduction

Empire/Colonialism has been

examined from various angles in the

context of colonial India, addressing issues such as the marginalisation of indigenous medical systems, the medical imperatives of imperialism, the British-India medical

establishment’s public health

policies,

gender and medicine, responses and reactions of indigenous society to colonial medical initiatives and policies, medical politics, etc. 11

Such

attention as has been paid to the fortunes of individual maladies in India under colonial

dispensation, has focussed

on the great acute

epidemic diseases such as smallpox, cholera, and plague, or venereal disease. 12

Only a few medical and social historians have dealt with

major endemic chronic infectious diseases of India such as malaria

The following are examples: Deepak Kumar, “Unequal Contenders, Uneven Ground: Medical Encounters in British India, 1820-1920”, in Western Medicine as Contested Knowledge, A. Cunningham and B. Andrews (eds.), Manchester, Manchester University Press, 1997, pp 172-190; Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine, 1859-1914, New Delhi, Cambridge University Press, 1994; Maneesha Lal, “The Politics of Gender and Medicine in Colonial India: The Countess of Dufferin's Fund, 1885-1888”, Bulletin of the History of Medicine, 68: (1994) pp 2966; Mridula Ramanna., “Ranchhodlal Chhotalal: Pioneer of Public Health in Ahmedabad”, Radical Journal of Health, 11: (1996) pp 99-111; Mridula Ramanna, “Professional Reform: the Efforts of K.N. Bahadurji”, Journal of the University of Bombay, 54:(1997) pp 95-109; Mridula Ramanna, “Indian Practitioners of Western Medicine: Grant Medical College”, Radical Journal of Health, 1(new series): (1995) pp 116-135; Mridula Ramanna, “Indian Response to Western Medicine: Vaccination in the City of Bombay in the Nineteenth Century”, in Art and Culture: Endeavours in Interpretation, A.J. Quaisar and S.P. Verma (eds.), New Delhi, Abhinav, 1996; Waltraud Ernst, “Colonial Policies, Racial Politics and the Development of Psychiatric Institutions in Early Nineteenth Century British India”, in Race, Science and Medicine, 1700-1960, W. Ernst and B. Harris (eds.), London and New York, Routledge, 1999, pp 80-100; the contributions in B. Pati and M. Harrison (eds.), Health, Medicine and Empire: Perspectives on Colonial India, New Delhi, Orient Longman, 2001. 12

David Arnold, Colonising the Body: State Medicine and Epidemic Disease in Nineteenth Century India, Berkeley, University of California Press, 1993; Sanjoy Bhattacharya, “Re-devising Jennerian Vaccines? European Technologies, Indian Innovations and the Control of Smallpox in South Asia, 1850-1950”, in Pati and Harrison, Health, Medicine and Empire.; Ira Klein, “Imperialism, Ecology and Disease: Cholera in India 1850-1950”, Indian Economic and Social History Review, 31: (1994) pp 491-518; Ian Catenach, “Plague and the Tensions of Empire: India, 18961918”, in Imperial Medicine and Indigenous Societies, D. Arnold (ed.), Delhi, Oxford University Press, 1989; David Arnold, “Touching the Body: Perspectives on the Indian Plague 1896-1900”, Subaltern Studies. 5: (1987) pp 55-90; Douglas Peers, “Soldiers, Surgeons and the Campaigns to Combat Sexually Transmitted Diseases in Colonial India 1805-1860”, Medical History, 42: (1998) pp 137-160. Introduction

and leprosy, while tuberculosis has been totally neglected. 13 An oftrecited

axiom

colonial medical historiography

Western medicine was a handmaid deployed in the larger cause of domination of subject cultures.

has been that

imperialism, strategically

perpetuating the white man's

As a consequence, so the argument

goes, diseases that did not threaten imperial interests did not attract the vigorous state action

that was directed at diseases perceived to be

dangerous. 14

Historiography of Leprosy: Europe which was racked by leprosy in the Middle Ages, emerged largely

leprosy-free in the seventeenth century,

for

reasons

uncertain and much debated. In Britain only small pockets of the disease remained, particularly in the islands off the Scottish coast, these too became extinct

but

the early decades of the nineteenth

V.R. Muraleedharan, “Malady in Madras: the Colonial Government's Response to Malaria in the Early Twentieth Century”, in Science and Empire: Essays in the Indian Context 1700-1947, D. Kumar (ed.), Delhi, Oxford University Press, 1991; Sanjiv Kakar, “Medical Developments and Patient Unrest in the Leprosy Asylum 1860-1940”, Social Scientist, 24: (1996) pp 62-81; Sanjiv Kakar, “Leprosy in British India, 18601940: Colonial Politics and Missionary Medicine”, Medical History, 40: (1996) pp 215230. 14

Anil Kumar states that the British when "catapulted" to power in India, "trimmed, shaped and conducted the growth of Western medical science to attend, promptly and appropriately, to the callings (sic) of the Empire." Anil Kumar, Medicine and the Raj: British Medical Policy in India 1835-1911, New Delhi, Sage Publications, 1998, p 17. In a case study of bilharziasis in colonial Egypt, it was maintained that "[c]olonial medicine existed primarily to make the tropics fit for the white man to inhabit." John Farley, “Bilharzia: A Problem of 'Native Health', 1900-1950”, in Arnold, Imperial Medicine. . Radhika Ramasubban identified the priorities of the colonial medical establishment, in descending order, as maintaining the fitness of the army, European officials' and European health, with indigenous peoples' health last on the list. Radhika Ramasubban, “Imperial Health in British India 1857-1900”, in Disease, Medicine and Empire: Perspectives on Western Medicine and the Experience of European Expansion, R. Porter and M. Lewis (eds.), London, Routledge, 1988; David Arnold concludes that "Western medicine enjoyed an intimate association with the colonial power. Its first priority was the protection of the European community, and those interests and individuals closely connected with it." David Arnold, “Medical Priorities and Practice in Nineteenth Century British India”, South Asia Research, 5: (1985) pp 167183. Introduction

century. Hypotheses put forward for the posy-medieval disappearance of leprosy include steadily improving standards of nutrition and hygiene of the population at large, the segregation of lepers in asylums, laws against social intercourse with lepers, and the physiological interactions of

leprosy and

the plague -- the so-called “Black Death” -- which

ravaged Europe in the fourteenth century. The hypothesis of improved living standards appears to hold the widest appeal. 15 In

North America,

with

its large immigrant communities,

state and medical attention came to be increasingly directed at leprosy from the fourth decade of the nineteenth century. The been examined by historians. An that by Philip

work in this genre is

Kalisch, who studied North American leprosy not in

relation to the disease itself, societies when Kalisch

important

subject has

leprosy

but the responses of white Anglo-Saxon

sufferers were discovered in their midst. 16

compared official responses in two north American states,

namely

New Brunswick (Canada)

Massachusetts (USA) separated

the

period 1844-1880,

1904-1921. Though the

two periods were

by over three-quarters of a century, the

"lazaretto"

and

institutional

response involving isolation and incarceration of sufferers

was instinctive in both situations. Officials proudly claimed that twin policy of banishment and care arose from a religious spirit. Kalisch argues

that

such policies had their origin and stimulus in Biblical

precedent; he found the fount of leprosy stigma in the Old and New 15

For example Robert G. Cochrane, “The History of Leprosy and its Spread throughout the World”, in Leprosy in Theory and Practice, R.G. Cochrane and T.F. Davey (eds.), Bristol, John Wright and Sons, 1964. A modern supporter of the role of segregation in the extinction of medieval European leprosy is George Rosen, a historian of public health. George Rosen, A History of Public Health, Baltimore, Johns Hopkins University Press, 1993, p 41. The pros and cons of the plague hypothesis are discussed in Stephen B. Ell, “Plague and Leprosy in the Middle Ages: A Paradoxical Cross-Immunity?”, International Journal of Leprosy, 55:(1987) pp 345-350. 16

Philip Kalisch, “Tracadie and Penikese Leprosaria: a Comparative Analysis of Societal Response to Leprosy in New Brunswick, 1844-1880, and Massachusetts, 1904-1921”, Bulletin of the History of Medicine, 47: (1973) pp 480-512. Introduction

Testaments. In the Old Testament was the supposed association

the malady with sin and uncleanness, which came to be tempered by assurances of leper redemption in the New Testament. As acted out in the nineteenth century and early decades of the twentieth,

societal

responses indicated to Kalisch an "extraordinary reversion back to the medieval reaction to the disease." Zachary Gussow presents a larger history of leprosy in the in the continental United States and

its Hawaiian possessions in the

nineteenth century and first half of the twentieth century. 17 Notions of racial superiority, xenophobia

stereotypy of the leper, and

vis a vis

the "yellow peril"

white American

personified by

supposedly

leprosy-laden Chinese immigrants, are evoked by Gussow to explain the harshness of the policies for leprosy control in the United States. These policies included such measures as exile in secluded islands. Referring blames

the

heightened

Western world on the which made it

to leprosy stigma,

lepraphobia rise of

compulsory externment and this author

in the late nineteenth century

European and American imperialism,

convenient to

regard

leprosy as

one more

characteristic of "inferior" colonised peoples. Gussow cites examples from

around the world to challenge

intense

fear and shunning of

phenomenon being a

transcending

universal

apprehension diffusion of

another

the leper

assumption, -- that

is an ubiquitous cultural

geographic and ethnic barriers. Far from

response,

Gussow

maintains

that

[of the leper] is encountered, it is

"[w]here

related to the

Western fears and the Western practice of isolating lepers

from the community." (italics added) 18 Megan Vaughan's examination of the colonial encounter with leprosy in Africa in the early twentieth century,

focuses on

the

Zachary Gussow, Leprosy, Racism, and Public Health. Social Policy in Chronic Disease Control, Boulder, Westview Press, 1989. 18

Ibid, p 16. Introduction

strategies employed

Christian missionaries to

"understand" and

control the African leper. 19 She argues that a "leper identity" in the Biblical

mould was

engineered

for the

sufferer

"learned" to fit the missionary pre-conception of

that

the exemplary

"leper". Such a psychological construction enabled the development of Christianity.

The process involved a projection on to leprosy of "a

powerful Christian disease symbolism" [sin and salvation].

African tribe had no tradition of a specific fear and ostracism of the leper, missionaries saw it not as a sign of enlightenment, but of the tribe's "primitiveness". The tendency to implicate Biblical texts in the preservation and propagation of leprosy stigma,

does not

find

favour

with Sanjiv

Kakar, author of two studies of leprosy in colonial India. 20 avers that the Christian missionaries’ supposed

Kakar

role in promoting

leper segregation has been overstated, since the doctrine of isolation had contemporary medical backing. He further maintains that "there was a long tradition of persecution of Kakar's

paper

dealing with

leprosy patients in India".

patient unrest in leprosy asylums,

noteworthy for demonstrating that lepers were not passive when their perceived interests were threatened. The paper highlights some issues which sparked patient dissatisfaction. One was coercive religious preaching

in Christian institutions and insensitive handling of caste

prejudices. The other -- a demand for re-admittance into asylums -- was ironically fuelled by the success of new 1930s. The

discharge of

cured

leprosy treatments in the

lepers led to cuts in government

grants-in-aid to asylums. The cured, but still deformed sufferers who were set free into unsympathetic communities vociferously demanded re-admission into the safety of

asylums. Thirdly,

bad food and

Megan Vaughan, Curing their Ills. Colonial Power and African Illness, Cambridge and Oxford, Polity Press, 1991, pp 77-99.

Kakar, “Patient Unrest” ; Kakar, “Colonial Politics”. Introduction

attempts

enforce sexual segregation

in some missionary run

asylums were resented by the inmates. Infractions of the segregation rule, which

were "frequent",

were

viewed by

missionaries

with

Kakar's other investigation relates to "colonial politics"

and

disapproval. .

lepraphobia in late nineteenth century India,

and the medical role of

missionaries in leprosy asylums. Kakar argues that well- to- do Indian society collaborated with the colonial state in supporting segregation of the pauper leper. He further opines that the unwillingness of the colonial state to financially involve itself to any significant degree in the running of leper asylums,

resulted in the task falling into the

not-unwilling hands of Christian missionaries. References to leprosy in Anil Kumar's

"perspective of social

and institutional history" of medicine in colonial India, are fleeting, dealing only with the names and dates of some asylums. 21 In

two other wide- ranging

studies

the British Indian empire, leprosy gets the

respective

authors'

of disease, medicine and

mention only to substantiate

arguments. Mark Harrison,

cites

the

comments of a colonial medical observer vis a vis Indian classical knowledge about leprosy, to argue that Western medical men of the early 1800s grudgingly acknowledged that the "greater experience" of indigenous doctors in the treatment of indigenous diseases, profit Western medicine. 22

According

to David Arnold,

might

leprosy in

India was an exception to the "environmentalist paradigm" of disease pathogenesis

promoted

nineteenth

century

colonial

medical

commentators. Arnold's maintains that "leprosy was seldom seen [by them]

to be

determined by climate or environment", and that

unlike fevers and bowel diseases, 21

Anil Kumar, Medicine and the Raj, p 12.

Harrison, Public Health, p 42.

a non-epidemic (chronic)

disease

Introduction

like leprosy, was "seldom authors

in the

claim

among medical century. 23

earlier decades of the nineteenth

not borne out by

leprosy was creditably century

discussed in any detail"

discussed by

colonial medical men

causes, treatments and

the present thesis.

This

On the contrary,

at least three early nineteenth

with respect to

its

manifestations,

prevalence. 24

For a background study of leprosy in colonial India it is advantageous to consult work on another malady, namely insanity, intimately associated with institutionalisation of the afflicted. Like lepers, the insane were

traditionally marginalized by both European and

Indian society. Further, both lunatic asylums and leper asylums were peculiarly Western cultural imports into India, and nineteenth century colonial legislation on lunatic asylums was often commended by leper isolationists. 25 The institutional treatment of the insane under colonial rule in the pre- and post- 1857 periods has been investigated

Waltraud Ernst and James Mills respectively. 26

Arnold, Colonising the Body, p 29.

For example James Robinson, “On the Elephantiasis as it Appears in Hindoostan”, Medico-Chirurgical Transactions, 10:(1819) pp 27-37; Whitelaw Ainslie, “Observations on the Lepra Arabum, or Elephantiasis of the Greeks, as it Appears in India”, Transactions of the Royal Asiatic Society, 1: (1826) pp 22-24; E.J. Waring, “Statistical Notes on Some of the Diseases of India”, Indian Annals of Medical Science, April 1856, p 506. 25

The exotic origin of the lunatic asylum has been emphasised in James Mills, “Indians into Asylums: Community Use of the Colonial Medical Institution in British India, 1857-1880”, in Pati and Harrison, Health, Medicine and Empire. 26

Waltraud Ernst, “The Establishment of ‘Native Lunatic Asylums’ in Early Nineteenth Century British India” in Studies in Indian Medical History, G. J. Meulenbeld and D. Wujastyk (eds.), Groningen, Egbert Forsten, 1987; Waltraud Ernst, “Colonial Policies, Racial Politics and the Development of Psychiatric Institutions in Early Nineteenth Century British India”, in Ernst and Harris, Race, Science and Medicine; James Mills, “Reforming the Indian: Treatment Regimes in the Lunatic Asylums of British India, 18571880”, Indian Economic and Social History Review, 36: (1999) pp 407- 429. Introduction

Justification for the Present Thesis The above historiographic survey shows that there is a need for a comprehensive study of leprosy in the colonial period, based on social, medical, legal, and policy

perspectives, and which addresses

Indian anxieties and responses. The

Bombay Presidency

has been selected as a location for

three reasons. It was a microcosm of India. It was unique among the three Presidencies in that it was there that the capitalist system on which the British Indian empire was founded, produced number of

Indian commercial

introduction of Western education

the largest

magnates, -- the shethias. Also, the resulted in the rise of an articulate

and politically conscious English-educated professional class. Missionary involvement in leprosy was comparatively low key in this Presidency, being confined to running a few small asylums by the close of the century. 27 Thirdly, Bombay was the backdrop for

important medical

and therapeutic studies on the disease by Indian and British doctors, providing an opportunity to investigate their motives and biases. The period marked by leprosy. The

selected for study, namely 1840 to 1897, was

growing anxiety, activism years 1840 and 1897

and medical curiosity about are relevant in other ways. The

former saw the first colonial legislation directed at beggar, while in 1897

the

the urban leper

Government of India finalised the first

Lepers' Act -- which became law in the following year. That both pieces of legislation were directed at urban leper beggars says volumes about the colonial state's abiding concerns. In 1897 was held the First International Leprosy Congress which put the bacterial theory of origin of the disease on a scientific footing.

These are referred to in Chapter 8. Introduction

Historical Sources Consulted For this study a large number of

primary sources have been

consulted. The former include: official files, publications and reports in the Maharashtra State Archives; the National Archives in Delhi, the Indian Office Library in London, the Transactions of Medical amd Physical Societies of Bombay and Calcutta; prominent contemporary medical journals published in Britain and India; leprosy reports of the Royal College of Physicians of London and the Leprosy Commission in India; contemporary medical volumes on leprosy; publications of the British Government; reports of Indian and Bombay Presidency leper censuses;

law reports of

early

nineteenth century

criminal

cases

featuring leprosy in the Nizamat Adalat or Criminal Appeal Court in Bengal, civil cases before the Bombay High Court in the 1860s and

1870s;

leprosy

enactments of

the

Presidency and Imperial

Governments; contemporary newspapers especially Native Opinion and the Times of India, and accounts of lepers and leper asylums in District Gazetteers, Bombay Municipality proceedings; and lastly, the annual reports of civil medical institutions in the Presidency. Secondary sources include

histories of tropical medicine, histories of leprosy in other

countries, commentaries on Indian medicine and Indian medicinal plants, biographies of medical and

non-medical

personalities featuring in the

thesis, other standard works and modern studies of colonialism and medicine. Such an approach is admittedly open to criticism for ignoring the leper's own voice. Though most lepers were poor and unlettered, several

many sufferers came from educated and well-to-do families,

they left no personal testimonies dealing with their

leper-hood.

One

has to gauge the sufferer and his world through the eyes of his

Introduction

beholders. There being no scope to represent himself, the leper "must be represented". 28

Questions to be Answered The study hopes to address the following questions: (1) What were the points of contact between Indian and European medicine with regard to leprosy in the nineteenth century, and in what manner did colonial contact affect therapeutic practice in leprosy? How did the nineteenth century scientific revolution in European medicine reflect in perceptions about leprosy causation? How were European causation theories received in the colonial milieu of Bombay and India, and who were the persons involved, and what were their motivations ? (2) Did the colonial state have a leprosy policy; if so, in what manner was it manifested? (3) How did Hindu law perceive the leper and what were the religio-social practices towards him; what place did traditional law have in the â&#x20AC;&#x153;modernisedâ&#x20AC;? legal system fashioned by the British in the latter half of the nineteenth century? (4) What were Indian and British colonial societyâ&#x20AC;&#x2122;s perceptions about leprosy, especially in the last two decades of the century, and how did the wealthy and the educated classes in Bombay see their respective roles on the issue? (5) What was the nature

leper

institutions

Bombay

Presidency, and under what circumstances did they arise and how far did they fulfil their stated purpose?

Quotation from Karl Marx in Edward Said, Orientalism, London, Routledge and Kegan Paul, 1978.

Introduction

Chapter Scheme Chapter 1 entitled “The Aristocrat Among Diseases” examines in its first Section the early nineteenth century conceptual parallels about leprosy between traditional Indian, i.e., Ayurvedic, and Greekbased Western medicine

Both

gave pride of place to

fluid

substances, the humours or dosas, in the preservation of health and the causation of diseases including leprosy.

Heredity and

venereal

connections and various moral misdemeanours were some of

the

causation theories in both medical traditions, though the concept of contagion was less well developed in Indian medicine

than in the

European. Indian physicians recognised that leprosy occurs in mild and severe forms.

In addition, due to this

country’s

long acquaintance

with leprosy, they were fluent in the treatment aspects. In the second Section of this Chapter the focus is on coming to attention theories,

each

with

from mid-century. influential

causation theories in Europe The three main competing

supporters

were

sanitarianism,

hereditarianism and contagionism. The semantics of “contagion” and “infection”

are

examined.

Important developments

such as

application of the scientific method of enquiry to

the

leprosy, by

researchers in Norway, are also dealt with. That small Scandinavian country

was exceptional in Europe for being highly endemic for

leprosy. The country also produced outstanding scientists who held contrary views about leprosy causation. These were Danielssen and Boeck, who were supporters of the hereditary theory of causation and Armauer Hansen a proponent of the contagion theory, who discovered the microbe of leprosy in 1873.

The sanitary hypothesis

had its

strongest champions in Britain, the mother country of the nineteenth century

public health revolution. . The sanitarian bias of the Royal

College of Physicians of London Leprosy of

1867, which

is examined in their Report on

resulted in

diminishing

the

over-riding

importance given to leper asylums policies in some British colonies. Introduction

The

College’s

Report

was

admired

like-minded

medical

bureaucrats in India. For different reasons and with varying degrees of emphasis,

all

three

causation theories

saw

role for the leper

asylum in alleviating the problem of leprosy. Contagionists particularly were certain that the

Norwegian promotion of leper isolation

legislation enacted in 1856, resulted in the progressive

decline of

the disease noted in that country in the ensuing decades.

Chapter 2 entitled “Causation Controversy in

India:

the

Leprosy Career of Henry Vandyke Carter”, follows the three main European causation theories into India, anchoring them to the work of Henry Vandyke Carter an officer of the Bombay Medical Service. Carter’s interest in leprosy was spontaneous and he sustained it for the entire period of his career in India. His leprosy researches, which were

meritorious, spanned pathological studies, analysis of census

data, field studies in Kathiawar, and study visits to many countries, most importantly Norway. His contagionist decade and a half of study ,

were

discovery of the leprosy bacillus. advocate of

ideas evolved over a

cemented

by the Norwegian

He became an ardent and untiring

compulsory leper isolation in India, which brought him

into conflict with anti-contagionist sanitarians in London (Milroy at the Royal College of Physicians) and Calcutta. .. His chief adversary in this country was the powerful J.M.Cuningham the Government of India’s Sanitary Commissioner who prevailed upon the Imperial Government to pour disdain on the contagionist doctrine, and discount leper isolation as an instrument of control. The central Government’s opposition was inspired as much by anti-contagionist ideology as an unwillingness to involve itself formally in an expensive exercise. Neither could Carter convince an otherwise supportive Presidency Government to take the initiative in running leper asylums. The conclusion of this Chapter is

Introduction

that though Carter was one of the century’s most eminent

leprosy

researchers, his influence on colonial leprosy policy was negligible.

Chapter 3 entitled “Therapies, Therapists and Therapeutics” is concerned with leprosy treatments, including the roles of two Indian physicians in Bombay.

It shows that

British interest in traditional

cures for leprosy was manifest as early as the turn of the eighteenth century and continued for over seven decades of the nineteenth. The most significant colonial intrusion into the subject was the superceding of

traditional Indian medical empiricism and polypharmacy by the

Western

“rational”

experiment

method

assessing

therapies

planned

one at a time. The initiative was taken at Calcutta by

W.B.O’Shaughnessy. Indian medical students at the colonial medical colleges established in the pre-1858 period were trained in this method. Not only traditional Indian plant remedies, but some plants from other countries with favourable reputations, were imported with Government assistance. Encouragement was given to discover substitutes for exotic plant remedies Indian patients.

within

the country, and

trials were conducted

The main remedies examined in the 1860s and

1870s in Bombay Presidency were the oils of chaulmoogra, brahmi, bauchi, kowti, gurjun and cashew. Only the first showed promise, but none qualified as a cure. The political importance of leprosy therapy lay in

the fact

inexpensive

that the Government of India looked to it as an

answer to segregationist

calls for

leper asylums. The

chapter also examines how two Indian physicians’ utilised the Western experimental method for therapeutic

trials. Bhau Daji’s acceptance of

the Western ethos was incomplete. Though he fully appreciated the importance of sustained observation

before any remedy could be

endorsed, his secrecy about his medication, and his avowal of the traditional virtues of Indian physicians are proofs. Sakharam Arjun’s leprosy trials at the J.J.Hospital, on the other hand, demonstrate that Introduction

he fully identified with the spirit of Western medical culture as well as its personnel and institutions.

Chapter 4

entitled

“The Leper Censuses and their

Uses”

concerns the various Presidency and country-wide leper enumerations in the period under study. Figures from a partial census conducted in the Presidency were utilised by Carter in 1871, to theorise about leprosy in Indians. In common with colonial biases, he looked for the cause of leprosy in the Indian body itself as a consequence of cultural practices and the caste system. Leper enumerations were included in all

the Imperial censuses, despite the fact that

methodological

flaws

were

suggested that

India had hundreds of thousands

procedural and

apparent from the outset. The figures of lepers, but no

measures for control were ever mooted by the Government of India on the basis of the censuses.

The enumerations came to the aid of the

anti-contagionist Leprosy Commission which visited India in 1890-1891. Despite the acknowledged unreliability of the figures, the Commission used them to counter allegations of the contagionist alarmists about Indian leprosy rampant.

Chapter 5 entitled “Laws and Lepers” is divided into three Sections. These deal respectively with the legal aspects of sociallysanctioned

leper suicides in the pre- 1858

era, the

interplay of

colonial law and Hindu law in cases involving a leper’s from inheritance, and

exclusion

colonial secular legislation impinging

on the

leper. In the first Section it is concluded that early nineteenth century colonial were

judges, despite expressions of disapproval of the practice, as

condoning

prejudiced against the leper as were the shastras, in assisted

invariably handed

suicide

lepers.

Token

punishments

down to the relatives on the pretext

were

of non-

interference in a practice sanctioned in Hindu law. The Indian Penal Introduction

Code in 1862 criminalised suicide, and

religious suicides were de-

recognised. Hindu civil law excluded the leper, among other handicapped individuals, from inheritance. However the exclusion was based on the severity of

the disease. Three

judicial case studies demonstrate that

the colonial innovation of case law based on expert medical opinion, harmonised with shastric texts. The third Section showed that colonial secular

legislation dating from 1840 was characterised by intrusion

into the leper’s liberty on grounds of his supposed loathsomeness and public health danger. Only the Lepers Acts drafted in 1889 and 1895 were specifically directed at the leper. Other public health legislation, notably Act 6 of 1867

was deliberately made applicable to leprosy,

despite medical causation controversies. The intention of all legislation was the purging of urban areas of leper vagrants. Political exigencies in the country and their own disinclination to spend on

isolation of

hundreds of thousands of lepers, terminated whatever hopes the colonial Government might have entertained about leprosy control.

Chapter 6, entitled “Perceptions, Attitudes and Anxieties”, also divided into sections, deals firstly with the views of the official and non-official British, and secondly of

educated Indians about

leprosy, particularly during the panic associated with the leprosy and death

of Father Damien in Hawaii

The

examination of British

views, including those expressed in the Times of India, shows that they were not uniform, ranging from alarms about leprosy as an “imperial danger”, to denial

that

the disease was at all

important.

Similarly the sexual motif expressed itself variously as unfavourable as well as sympathetic comparisons of lepers with syphilitics, alleged injustice

to leper prostitutes, dangers to British troops from co-

habitation with leper prostitutes, and the sexual segregation of lepers in asylums. inferiority,

The

British

perception

leprosy

civilisational

was apparent in the sentiments expressed by sanitarians. Introduction

The intrinsic sinfulness of the leper and the prospect for salvation in Christianity were the pillars of missionary and clerical perceptions, as also their advocacy of leper isolation and asylums. Educated Indians in Bombay expressed their views in

the Municipal Corporation and the

Indian press. By and large they supported plans for putting leprosy beggars behind asylum walls,

but

lepers were excluded from these

were determined that

well-to-do

institutions. Medical professionals

such as Bhalchandra Bhatwadekar and Anna Moreshwar Kunte

who

were anti-contagionists, saw themselves as protectors of the leper from state high-handedness, educators of Indian public opinion and soothers of Indian leprosy panic. Kunte was particularly sceptical of the germ theory of disease, and disdainful of the contagionist opinions of Vandyke Carter. Chapter 7, entitled â&#x20AC;&#x153;The Leper in Personâ&#x20AC;? focuses

the

human being with leprosy. It reveals that outcasting or ostracism of the leper was

not the norm in Indian families.

was in the city

where outcast and vagrant lepers thronged, that both their physical plight and survival tactics were best seen. Most

city lepers were

outcast migrants from the coastal belt of the Presidency and from the lower social classes. Statistics from Bombay showed that men and women in the prime of life were maximally

affected and death rates

were very high due both to disease and privation. Suicides were not uncommon. The less ill lepers lived in groups by begging, sheltering in the J.J.Dharmashala or near water tanks, forming informal family and sexual alliances and even mediating themselves. The rural leper, in Kathiawar, on the other hand, especially if

continued to be fully integrated

his labour contributed to the community or family

economy. However, Carter noted deformed lepers were

instances

were even severely

treated with affection and respect by family

Introduction

members. Crude forms of segregation within the home or on outskirts of villages were also followed, but lepers were given food and clothing.

Chapter 8 entitled “Confine or Shelter?” points out that the leper asylum was a colonial import. The European concept of special institutions for lepers was of medieval provenance, and nineteenth century leper asylums are

the most tangible evidence of

encounter with Indian leprosy. By maintaining such

the colonial

institutions

the

Bombay Government hoped to demonstrate the benevolent face of imperialism, while establishing donors

leper asylums gained for the

shetia

the admiration of the public and their community and the

approval of the state. Four leper asylums coming up under different circumstances are studied in detail. The Rajkot institution established in 1850 was the result of British “persuasion” of the Kathiawar princes that a leper asylum was the answer to frequent leper suicides. The institution served as a leper shelter, the inmates resorting to it when they were

ill

during

times of

need

such

as famine.

The

J.J.Dharmashala at Bombay established in 1844 for all varieties of indigent persons,

was the

city’s

largest leper shelter for half a

century. It was an entirely voluntary institution, the Government grant being supplemented by

Parsi

and British donations. The

inmates

were paid a small amount for food and clothing. Those in need of medical help were sent to the J.J.Hospital situated nearby. In the later decades of the century the institution came in for severe criticism by contagionists

as a

hotbed of

leprosy

infection that could not be

tolerated. The Dinshah Maneckji Petit Leper Asylum at Ratnagiri, was established to

prevent the hereditary spread of leprosy by sexual

segregation. It was run from local body funds, with the Presidency Government keeping a tight leash on its own contribution. It failed as a leprosy preventive institution because of inadequate facilities to separate the sexes, and because lepers resorted to it only in times of Introduction

need. Lepers “absconded” from it when it suited them, till coercive legislation was Roman

introduced in the last decade of the century. .The

Catholic-run

Eduljee

Framjee

Albless

Leper

Asylum

Trombay in Thana district, though aided by Government,

was too

small and restrictive (25 male inmates) to have any pretensions as a public health institution. It was unpopular with non-Christian lepers, and escapes were frequent. For 5 years from 1885 it was the only leper asylum in the city.

Chapter 9, entitled “Mr. Acworth’s Asylum”, deals with an unique colonial leper institution established in Bombay city in 1890. Though envisaged as a temporary arrangement, it succeeded so well that it came to epitomise what could be permanently achieved by public

participation

and

cooperation

between

the

Presidency

Government and the Municipal Corporation. Nevertheless the purpose of the institution was an imperial one -- compulsorily removing offensive and “dangerous” lepers from the streets of the most important city. The founder

the “Homeless Leper Asylum”, the Municipal

Commissioner H.A. Acworth, leprosy as

infectious

controversies. He skilfully

persuaded the Government to

disease recruited

ignoring

declare

contemporary medical

the support of the shetias of

every community and the intelligentsia by emphasising the charitable and philanthropic aspects of the enterprise, All strata of British and Indian society willingly donated towards the buildings, while the support of the Indian leadership in the Corporation and of the Governor produced

the wherewithal for maintenance.

The medical attention

provided was also of good quality. Acworth took a personal interest in all aspects of the institution throughout his tenure as Commissioner. The inmates were vagrant lepers compulsorily behind

guarded

barbed

wire

fence.

committed

However,

for life

Acworth

was

sympathetic enough to accommodate their felt needs. There was no Introduction

attempt at rigid sexual segregation and religious freedom was ensured by the respective places of worship being donated by the public. An innovation

was the establishment of a sewage farm on the premises

which returned a profit for the institution.

Acworth looked upon

“his” institution as an example of the ‘civilising mission’ worthy of rank with the abolition of sati.

The

“Conclusion”

answers

the

questions

raised

this

“Introduction”. With reference to the medical aspect it shows that the germ

theory of

disease

and

the

nineteenth century had no tangible

bacteriological

revolution of the

echo in India. More effective in

rousing opinion to the contagionist cause was the leprosy of European Father Damien. Of colonial society’s ‘leper-is-loathsome’ proved action the

the

two chief perceptions,

to be more enduring and

productive of

than ‘leper-is-danger’. Lastly, the personalities and legacies of

medical

theoretcian

H.V.Carter

and

the practical administrator

H.A.Acworth are compared and contrasted.. Tables and Figures are placed at the end of relevant chapters. Other important information appears separately in the Appendices.

Introduction

Chapter 1 THE “ARISTOCRAT AMONGST DISEASES”

The problem of leprosy is not for the idle-minded. It is full of intricacy and difficulty.... However repulsive the disease itself in some of its phases may be, there is nothing whatever of that nature about its study. It is a sort of aristocrat amongst diseases, ... the history of its prevalence, increase and decline in different regions of our globe, is interwoven with that of civilisation itself. 2 Leprosy being one of the oldest diseases afflicting man, speculations about its cause and nature are to be found in the classical medical traditions of Europe and India. The considerations that went into the medical understanding of leprosy in the two traditions form the subject of this chapter. The material is presented in two Sections. Section A which is entitled “Leprosy in Ayurveda and Western Medicine: Parallels in the Early Nineteenth Century”, examines the similar theoretic bases of the classical Indian, i.e. Ayurvedic, and the Western traditions, which were reflected in some similarities in the etiologic theories about leprosy. The comments of early nineteenth century colonial medical observers on the subject are referred to. The Section covers the period before Western medicine was transformed from a Greco-Roman classical system to a scientific one in the later decades of the nineteenth century. Section B, which is entitled “Leprosy in Western Medicine in the later Nineteenth Century” focuses on the vigorous debates and controversies about the cause of this disease in medical circles in Europe as the century progressed. One of the pre-occupations of nineteenth century Western

Jonathan Hutchinson, On Leprosy and Fish-Eating. Statement of Facts and Explanations, London, Archibald Constable and Co. Ltd., 1906, p 1. Sir Jonathan Hutchinson (1828-1913), a President of the Royal College of Surgeons and a prominent skin specialist, was a doyen of the Victorian medical profession. Besides being a supporter of the fish hypothesis, he was a staunch opponent of segregation as a leprosy control policy . 2

Ibid. The Aristocrat Among Diseases

medicine was the elucidation of the causes of various diseases, in which the vindication of the germ theory played a crucial role. It achieved its success through the new science of bacteriology. This Section shows that the victory of germ theory and bacteriology in the case of leprosy was not automatic, but

protracted

and

hard won.

An examination of

the

nineteenth century European debates on the causation of leprosy enables assessment of the policies of

the colonial state in India during the

period. The subject of leprosy causation therefore features in more than one of the chapters which follow.. SECTION A : LEPROSY IN AYURVEDA AND WESTERN MEDICINE: PARALLELS IN THE EARLY NINETEENTH CENTURY

Kushta Treatises on individual diseases are not a feature of classical Indian medical texts. Rather, maladies are described in relation to various bodily systems e.g., skin, digestive, reproductive, etc. Skin diseases were generically referred to as kushta. Various types were recognised. For example in Caraka Samhita, probably dating from the third or second century BCE, it was stated that kushta “may be classified into seven kinds or eighteen kinds or

innumerable kinds.”

The seven kinds,

Quoted in R.E.Emmerick, “Some Remarks on the History of Leprosy in India”, Indologica Taurinensia, 12: (1984) pp 93-105. The distinction between the varieties of kushta was based on appearance, the discoloration of the skin, and the presence of itching, burning, pain, and ulceration. The seven main types mahakushta were: Audumbara: red and nodular like a ripe fig; Kapala: dry, rough, scaly spots like earthenware; Mandala: circular lesions; Rikshajihva: dark brown or coppery patches like a bear’s tongue; Kakanaka: patches dark in the centre, red at the periphery, like the seeds of kakanantika, (the plant abrus precatorius); Paundarika: a red and white rash resembling the lotus flower; Sidhma: Yellow coloured patches like pumpkin blossoms. Documenta Geigy, 1968, p 4; also C. Chakrabarty, An Interpretation of The Aristocrat Among Diseases

believed to be particularly destructive and dangerous varieties of kushta, were called mahakushta. The descriptions

mahakushta show that

leprosy has been resident in India from very early times. 4

The Nature of Leprosy The Ayurvedic compendia in which descriptions suggestive of leprosy are discernible are the samhitas of Susruta and Caraka, dating respectively from 500 BCE and 200 BCE.

As in the classical European

medical tradition, the basic tenet of Ayurveda was

humoralism. This

was the doctrine that health

consequences of

and disease were

equilibrium and disequilibrium respectively of certain bodily fluids or humours. The

three chief

fluids or doshas

whose

imbalance

was

implicated were Vata or wind, Pitta or bile, and Kapha or phlegm. The blood, known as Rakta or shonita also qualified as a humour. In Sushruta

Samhita was supposed to be the classified as a disorder of

Vata and Pitta, disturbed

while

in leprosy

Caraka was

postulated that the fluid

Rakta.

In Ayurveda

most

leprosy was

synonymously known as Vatarakta, Vatashonita, or Raktapiti. 6 Similar proximate causes were thought to result in leprosy in Greek medicine. 7 Ancient Hindu Medicine, Calcutta, publisher not stated, 1923, pp 363379. 4

More than one explanation was proposed for the appellation mahakushta for serious skin diseases. Sushruta (about A.D.500) maintained that it was the worst of all diseases (bad = kashta), while Vagbhata (about A.D. 625) asserted that the name kushta arose because the disease eats away the body (to eat away= kushnati). Anonymous, “Leprosy in Ancient India.”, Documenta Geigy, p 4. 5

Dominik Wujastyk, The Roots of Ayurveda, New Delhi, Penguin Books, 1998, p 104. 6

Dharmendra, “Leprosy in Ancient Hindu Medicine”, Leprosy in India, 12: (1940) pp 19-21. The Aristocrat Among Diseases

The well-known modern leprologist Dharmendra, considered Vatarakta to denote mainly the neural form of leprosy, in which numbness and

paralysis predominate.

characteristics of

Vata

According

and Pitta

Susruta,

the

chief

related diseases were kaunya or

paralysis of the hands, svaropaghata or hoarseness of voice, angulipatana or

falling off

of the fingers, and

destruction of the ear and nose. 8

karna-nasa-bhanga

This constellation of phenomena by

Susruta suggests to modern physicians that the disease was leprosy. Charaka too

gave

clear indications that leprosy was among the

disorders described by him, when he mentioned sparsha-hani or loss of touch sensation, ksata-sarpana or spreading ulcers,

ksate krimi-

sambhavah or worm infested ulcers, etc. in relation to certain skin diseases. 9 Causes of Leprosy Two early nineteenth century British commentators on Ayurvedic medicine listed the factors

which leprosy

had been ascribed

ancient Hindu physicians. Thomas A. Wise (d.1889), of the East India Company’s Bengal Medical Service enumerated some of them. The blood and seminal secretions of parents when tainted by leprosy, affects their offspring… It is believed to be communicable by contact, by 7

S.B. Ell, “Blood and Sexuality in Medieval Leprosy”, Janus. 71: (1984) pp 153-164. An analogous humoral conceptualisation of leprosy in classical Western medicine, was that by Oribasis of Pergamon in the 4th century A.D.: “The Elephantiasis originates from the blood burdened with black bile [melancholy]. But with time the quantity of black bile outweighs that of the blood, and then the ill produce an unusual bodily smell and appear horrible. Some produce also ulcers. It the black fluid is mild and mixes with the blood, a less severe, reddish elephantiasis is produced.” Quoted in Michael W. Dols, “Leprosy in Medieval Arabic Medicine”, Journal of the History of Medicine and Allied Sciences, 35: (1980) pp 314-333. 8 Emmerick, “Some Remarks”, p 98. 9

Ibid. The Aristocrat Among Diseases

breathing the same air, by eating together, by wearing the clothes, or ornaments, of a person labouring under the disease… speaking disrespectfully, or acting improperly, against his spiritual adviser (guru) or Brahmin; committing adultery with a Brahmin’s wife; killing a good man, or robbing a person of his estate. 10 The decidedly retributive and caste-ist tone of the above list is interpreted by the modern historian of Vedic and Ayurvedic medicine Kenneth Zysk, as the “Hindu veneer superimposed on a body of preexisting medical material.” 11 Even so, mention of tainted semen and leper contact as causes shows that the ancient Hindu physicians were familiar with concepts such as hereditary transmission and contagious communicability

diseases

and applied them to leprosy.

Similar

doctrines were enunciated in the classical Greco-Roman medical canon, to which early nineteenth century Western medical men in India subscribed. 12

Also

acceptable

to them

would

be the Indian

incrimination of dietary improprieties in the development of leprosy: … [e]ating and drinking at a similar period substances that do not assimilate, as milk and fish …. Exposure to fatigue after a full meal… the use of new rice, curds, fish, and of exceedingly salt and acid viands. 13 10

Thomas A. Wise, Commentary on the Hindu System of Medicine, Calcutta, 1845. Quotation in an anonymous review of Wise’s book in Medico-Chirurgical Review and Journal of Practical Medicine, 4 (new series): (1846) pp 411-419; also Thomas A. Wise, Review of the History of Medicine, Vol. 2, London, J. Churchill, 1867, pp 115-118. 11

A discussion on concepts of disease communicability in ancient India is found in Kenneth Zysk, “Does Ancient Indian Medicine have a Theory of Contagion?”, in Contagion: Perspectives from Pre-Modern Societies, L. I. Conrad and D. Wujastyk (eds.), Aldershot, Ashgate Publishing Ltd., 2000. 12

H. H. Wilson, “Kushta, or Leprosy, as Known to the Hindoos”, Transactions of the Medical and Physical Society of Calcutta, 1: (1825) pp 1-44. 13

Ibid, p 5. The mention of milk and fish in combination as lepragenic had parallels in Western medicine. Bernhard de Gordon, a 13th century teacher declared "comedere lac et pisces eadem mensa The Aristocrat Among Diseases

Thus Horace. H. Wilson (1786-1860), physician at the Calcutta Medical College and Sanskrit scholar, exposition of

elaborate and critical

ancient Hindu knowledge about leprosy published in

1825, found Indian dietary theories “less wild and unmethodical” than they sounded, since they harmonised with what “the most intelligent of our [Western] writers have given admission of ”, namely that there was a “connexion between the stomach and the skin.” 14 It is clear that in the early nineteenth century there were several points of contact between the two medical cultures both as regards the nature and the causes of leprosy. Treatment of Leprosy Indian texts listed a plethora of supposedly effective treatments and a large number of modes of administering them. The prescriptions were based solely on experience. This fact might be interpreted as implicit

acknowledgement that the disease was incurable.

Highly

elaborate regimens were prescribed, which Wilson faithfully -- though not

uncritically-- recounted. 15

However

the

accounts of leprosy

therapeutics in Caraka Samhita and Susruta Samhita do prove that the administration of drugs in Ayurveda was not haphazard, but predicated on the

stage and

type of

kushta,

and

the

associated

humoral

disturbance. 16 inducit lepram" – ingestion of milk and fish is thought to induce leprosy. Olaf K. Skinsnes, “Notes from the History of Leprosy”, International Journal of Leprosy, 41:(1973) p 226. 14

Wilson, “Kushta”, p 5.

Wilson’s critique of Indian therapeutics of leprosy is discussed in Chapter 3. . 16

Upon the first signs of the disease, attention was chiefly directed to the diet, and forbidden and recommended articles were listed. Meat was to be avoided; certain sorts of grain were preferred; vegetable The Aristocrat Among Diseases

ironic that the plant which proved historically to be

historically the most important in leprosy treatment into the modern period was not listed by Wise and Wilson despite its mention in Sushruta Samhita. Emmerick speculates that the omission was because the particular treatment “cannot have been regarded by them as having exceptional therapeutic value.” 17

The

coast of

plant

India,

was

under discussion, which

grows along

the west

tuvaraka (Hydnocarpus

Wightianai,

incorrectly called Chaulmoogra). 18

Sushruta Samhita

describes the mode of preparation: For a pious leper who wishes to live and [in] whom [other] methods of treatment have not been effective, the wise physician should treat him in the following manner: Ripe fruits should be collected, in the rainy season of the Tubara … tree which grows on the southern sea-coast… and whose branches are agitated by the wind, raised by the ocean waves; the kernel of articles were to include “leaves of Nimb, or marking nut plant, Madder ((sic) (Asclepia) , and Justicia (Adhatoda). An oily substance compounded from several plant sources (including Asclepias) was recommenced for external application. When the disease was of the formidable type, “the morbid humours” were to be cleared and purified by graded doses of emetics, purgatives and by bleeding. Juice of the brahmi plant (Mandukaparni, Centella Asiatica), compounded with infusions of other organic materials was considered to be of special efficacy at this stage of the disease. When the disease reached the marrow and bones, the case was “considered to be past the reach of medicine.” Wise, Review of the History of Medicine, pp 124-132. Wilson listed the following as constituents of Vajraka oil for external application in Kushta: Saptaperna, Karanja, Arka, Malati, Karavirajam, Snuha, Sirisha, Chitraka, Asphota, Visha, Langala, Vajrakhya, Kasisa, Ala, Manassila, Karanja seed, Triphala, Chavika, Rajani, Sidharta, Virenga, Prapunnara, all to be ground in cow’s urine and boiled in oil. Wilson, “Kushta”, p 28. 17

Emmerick, “Some Remarks”, p 102.

Dharmendra.. “Tuvarka of Ancient Hindu Medicine is Hydnocarpus wightiana and not Gynocardia odorata or Taraktogenos kurzii”, Leprosy in Indjia, 13: (1941) pp 51-53. The true Chaulmoogra is Taraktogenos kurzii, is a tree indigenous to north-east India; and like the oil expressed from the hydnocarpus seeds, chaulmoogre oil too was used for the treatment of leprosy till well into the twentieth century. The Aristocrat Among Diseases

the fruits is to be taken out, dried and made into fragments. And then they should be pressed in a mill like the sesame oil press, or the oil extracted in a basin as with the saffron flower. This should be put on fire (in a kettle) and when all the water has been evaporated from the oil, it ought to be taken out and placed (in a flask) in dried cow-dung for a fortnight. When the patient has been fattened by the treatment of oils, sweated by diaphoretics, cleansed (internally) by purgatives and emetics, then in a lunar auspicious evening, he should drink the oil, consecrated with the hymn that the essence of the kernel is the antidote of all poisons etc. The Tubara (chaulmoogra) causes the repeated evacuations of the toxin (of the leprous lesion) 19 through the upper and lower channels… The virtues of tuvarka in leprosy were rediscovered in Bombay in the middle of the nineteenth century. Tuvarka or hydnocarpus oil was the mainstay of leprosy treatment in India till the 1950s.

SECTION B LEPROSY IN WESTERN MEDICINE IN THE LATER NINETEENTH CENTURY Had Western medicine remained rooted in the humoralism

that

marked its theoretical base in the early nineteenth century, the dethronement of Ayurveda during British colonial domination -- noted by historians of colonialism -- could not have succeeded. 20 A characteristic of the scientific revolution that transformed Western m medicine in the course of the century, was

that systematic clinical observation

and the laboratory

provided the information to prove and disprove medical theories. Germ Theory A high point of scientific transformation of nineteenth century Western medicine was the experimental vindication of the theory that 19

Chakrabarty, Ancient Hindu Medicine, pp 373-374. The reference in question is Sushruta Samhita IV. 13. 8-9. Also the discussion in Emmerick, “Some Remarks”. Tuvarka is widely believed to be the “secret” remedy for leprosy used by Dr. Bhau Daji, discussed in Chapter 3. 20

Anil Kumar, Medicine and the Raj, p 10. The Aristocrat Among Diseases

infectious diseases are due to the agency of bacteria or sub-visible organisms. Though they were not originators of germ theory, the chief architects of its victory were Louis Pasteur (1822-1895) in France, and Robert Koch(1843-1910) in Germany.

Experimental

proofs

the

pathogenic power of micro-organisms in disease came thick and fast from the late 1870s.21 The most spectacular triumph of the germ theory was undoubtedly the discovery of the tuberculosis bacterium or bacillus, and proof of its indispensable role in that dread disease, by Robert Koch in 1882. 22

The germ theory had a profound implication, which

was that each disease was unique and specific. 23 This was a radical departure from the classical causation theories which postulated many unrelated factors in the production of a disease state. For example, in the eighteenth century the Dutchman G.G. Schilling authored a volume entitled De Lepra Commentatione (“A Commentary on Leprosy”), in which he listed the following as causes of leprosy: …[c]limatic conditions, eating habits, but above all poor living conditions of hygiene … but a “virus” is definitely involved in the ‘Aetiologia Leprae’ and in the transmission of the disease. 24 Specificity

implied a

particular, indispensable

factor for a

particular disease to occur. Germ theorists dismissed traditional notions of 21

Fielding Garrison, An Introduction to the History of Medicine, Philadelphia, W.B. Saunders Company, 1929, p 582. 22

C.C. Gillispie (ed.), Dictionary of Scientific Biography, New York, Charles Scribner’s Sons, 1974. 23

Kodell C. Carter, “The Development of Pasteur’s Concept of Disease Causation and the Emergence of Specific Causes in Nineteenth Century Medicine”, Bulletin of the History of Medicine, 65: (1991) pp 528-548. 24

Laszlo Kato, “Early Tractata on Leprosy”, International Journal of Leprosy, 55: (1987) pp 157-159. In pre-modern terminology the word “virus” denoted a poison or source of disease. The Aristocrat Among Diseases

“miasma” and non-living chemical poisons. Germ theory, and its handmaiden, bacteriology, provided the theoretic and practical means to demonstrate that the indispensable factors in disease production were specific living agents – in other words, one

species of bacillus

produced one specific disease. The practical consequence of germ theory lay in the sphere of containment and control..

Ideologies in Competition Like Schilling in the previous century, early nineteenth century physicians in Europe also attributed leprosy to diverse causes acting singly or in combination. Norwegian physicians, for example, blamed

“mal-

hygienic conditions and hereditary predisposition”, “insanitation and contagion”, “diathesis miasma”.

and

hereditary

taint”,

“endemic[ity]

and

By the middle of the century, the leprosy causation theories

could be roughly classified as three principal “isms”: sanitarianism, hereditarianism, and contagionism, with subsidiary ones implicating diet and terrain. Sanitarianism was the conviction among its proponents -- known as sanitarians -- that health was affected for better or worse, by the quality of

the man-made physical environment under which people lived.. It

mighthas been referred to as a variety Disease, was considered to be a debility of the system resulting from dirt, insanitation, stale air, impure water and poor living conditions. Sanitarians campaigned relentlessly for improvements in environmental cleanliness, housing, sanitation and supply of pure drinking water in Victorian England in the 1850s and 1860s, and 25

Gerhard A. Hansen, “The Bacillus of Leprosy”, Quarterly Journal of Microscopical Sciences, 20 (new series): (1880) pp 92-102.

”Diathesis”: a constitutional predisposition to a disease. “Miasma”: disease producing noxious chemical exhalations from rotting organic matter. The diverse views held by Norwegian physicians were discussed in Gerhard A. Hansen,. “On the Etiology of Leprosy”, British and Foreign Medico-Chirurgical Review, 55: (1875) pp 459- 489. The Aristocrat Among Diseases

their efforts resulted in a public health revolution, with dramatic reductions in water-borne diseases such as cholera and typhoid, typhus etc..

All this was achieved without positing germs or bacteria. Florence

Nightingale, founder of modern nursing, and leading Victorian sanitarian enunciated the philosophy pithily: … diseases, as all experience s h o w s , a r e a d j e c t i v e s , n o t n o u n s u b s t a n t i v e s … [ D i s e a s e s are] children of conditions, as a dirty and clean conditi on … [therefore] under our own c o n t r o l … 28 Not surprisingly, their comprehensive environmental and social perspective set sanitarianis firmly at odds with those whose conception of disease causation was restricted to one factor. Hereditarianism

was the

belief that some diseases, such as

leprosy and syphilis, were hereditary, i.e., transmitted from generation to generation. In the early decades of the nineteenth century the definition of hereditary disease was very loose:

medical

any disease which

was present in more than one generation of a family was labelled as hereditary. 29 When a supposedly hereditary disease developed in anyone whose ancestors were free of it, hereditarians

proposed that the

predisposition to the disease was inherited, which sooner of later turned into the disease itself. 30

Rosen, History of Public Health, pp 168-209.

Charles E. Rosenberg, “Florence Nightingale on Contagion: The Hospital as a Moral Universe”, in Healing and History: Essays for George Rosen, C.E. Rosenberg (ed.), Kent, Dawson, 1979, pp 116-136. 29

“Hereditary Transmission of Disease”, in. The Cyclopaedia of Practical Medicine, Vol. 2, J. Forbes, A.. Tweedie, J. Conolly (eds.), London, Sherwood, Gilbert and Piper, 1833. 30

C. Drognat-Landre, De la Contagione, seule Cause de la Propagation de la Lepre, Paris, Germer-Balliere, 1869, p 22. The Aristocrat Among Diseases

Contagionism,

was

the

doctrine

that

diseases

could

communicated from a sick to a healthy person by touching,

or via

non-living contagious material which had been in contact with the sick person such as bedding and clothing. Allied to contagionism, was the concept of infection, or the communication of disease by the agency of the atmosphere without contact. Such a view was exemplified in an early nineteenth century physician’s statement that “the small pox … does not propagate itself so much by contagion as by an infection of the air.

In practice, however,

many

physicians

made

distinction

between contagion and infection, regarding the difference only as a matter of semantics. A reputed medical lexicon complained: This word [contagion] and the term infection have been used very loosely, sometimes interchangeably, sometimes in contradistinction… some authors use infection to describe direct contact, others contagion. 32 Differences in interpretations continued into the last decade of the century, bedevilling the leprosy causation controversy In 1890 a retired Bombay medical bureaucrat, William J Moore, pleaded that it would remove considerable misunderstanding and not a little obscurity if writers on leprosy would confine their employment of the term contagiousness to its etymological import.33 Thus mutual incomprehension were built into

semantics and

usage. Sceptics of contagion (spread by touch) in leprosy, were wont to declare

that

the disease

sense of the term”. discoverer of

the

was

not

contagious, in the “ordinary

In 1890, a confirmed contagionist leprosy

bacillus,

G.A. Hansen, retorted

and the to

the

literalists: 31

Medical Journal 5:(1801) p 146, cited in Oxford English Dictionary, 1989. 32

The Lexicon of the Sydenham Society, Vol. 2, London, New Sydenham Society, 1882. 33

Times of India, 7 /10/1890. The Aristocrat Among Diseases

[My view] is that leprosy is contagious and nothing else. It is said that it is not contagious in the ordinary sense of the word; probably I do not know what the ordinary sense of the word is; but if someone should say communicable instead of contagious, I would not object.34 There were also subsidiary causation theories. The notion that a diet rich in fish, -- stale fish was especially suspect -- was implicated in leprosy had a hoary tradition in Western medicine. It dated to Greek times, and

was

reiterated

during the medieval

European leprosy

epidemic. 35 The stale fish theory resurfaced in Europe in the nineteenth century, In 1838 a Norwegian asylum regulation required that the food was to be purchased day by day.. "serving probably to check the consumption of stale fish etc". 36 “Endemicity” of Disease or Localism was a subsidiary theory based on geographic notions that categorized disease on the basis of

.Gerhard A. Hansen, “Leprosy in Norway”, Journal of the Leprosy Investigation Committee, 2: (1890), pp 63-66. The importance of etymology in leprosy causation theories was typified in the bias of the Indian Leprosy Commission’s Report. This is discussed in Chapter 4. 35

Galen (A.D. 131- 201), Greek physician and writer on medicine who lived in Alexandria, attributed leprosy specifically to salt fish and shellfish.. Anonymous, “Reports on Leprosy”, British and Foreign MedicoChirurgical Review, 55:(1875) p.299. 36

H.V.Carter, Report on Leprosy and the Leper Asylums in Norway, London, Her Majesty’s Stationary Office, 1874, p 29. Suspicions about fish-eating and the development of leprosy were echoed in India by colonial medical administrators. In 1859 Robert Haines the Registrar of Deaths in Bombay noted that “[t]he frequency of the disease[leprosy] in the class concerned with the catching and selling of fish is very remarkable…. This serves strongly to confirm the opinion long entertained, that an inordinate use of fish tends to produce the disease…” H.V.Carter, “On Leprosy, as seen in India: with Remarks on the Eruption and Anaesthesia”, British and Foreign Medico-Chirurgical Review, 31: (1863) pp 183-199. The Aristocrat Among Diseases

terrains. Certain regions were held to be inherently lepra-genic, while others were equally unfavourable to the entrenchment of the disease.

The Face and Features of the Leper A person with full-blown leprosy was easily recognised

laymen. A Mr. Huggins, indigo planter of Tirhoot in Bengal, -- a type of colonial resident given, it was said, to medical reminiscences "frequently of a sad and melancholy natureâ&#x20AC;? 37 --

produced

the

following vivid portrayal: A person attacked with the species of leprosy prevalent in India, is bloated in his face; his forehead, nose, lips, and ears swell out; his nostrils expand; his eyes appear sunk and very fiery; the tone of his voice is altered to a loud and somewhat nasal sound; no eruptions appear upon his body, but his skin is hard parched and dry, having lost its softness and moisture... his breath is fetid; his perspiration stopped.... After these primary symptoms, when the disease has become inveterate, the lepers' fingers are gradually eaten away, and drop off at the joints; his toes are affected in a similar manner, sores break out about his ancles (sic) and wrists. During the progress of these cancerous attacks no pain is endured by the leper, owing to that numbness which I have already stated as pervading his system; whilst the disease gradually proceeds ulcerating his flesh and dissolving his joints, till the vitals become affected.... In the last stage, his flesh gapes with long sores, his mouth, nose, and brain, dissolve before the leprous poison till death happily relieves him from such accumulated 38 miseries. 37

Calcutta Review, 8: (1847) p 380.

Lancet, 3-4: (1824) pp 149-150. Interestingly, Western medical men labelled leprosy eponymously from the afflicted person's fancied resemblance to real and mythical beasts., -- a legacy of classical Greek and Arabic texts. Thus the disease was variously known as Elephantiasis Graecorum, Lepra Arabum, Satyriasis, Leontiasis, etc. The term satyriasis also served as a label for the leperâ&#x20AC;&#x2122;s supposed lasciviousness. A succinct listing of the physical hall-marks of leprosy was presented by Francois de Sauvages (1706-1767), a French physician: Facies deformis, tuberibus callosis, ozoena, raucedo, cutis Elephantina, crassa, unctuosa, in extremis artubus anaesthesia, which translates as The Aristocrat Among Diseases

Medically however, many aspects of leprosy were nineteenth

baffling

century observers. One commentator pointed to its global

presence: C a n w e , … i ma g i n e e x t e r n a l c i r c u ms t a n c e s mor e u n l i k e than those which surround resp e c t i v e l y t h e l u x u r i o u s E a s t I n d i a n a n d t h e h a r d y I c e l a nder? Can countries be found w h i c h d i f f e r mor e t h a n r a i nless Egypt on the one hand, and h u mi d N o r w a y o n t h e o t h e r ? 39 Examples of the seemingly contrary features of the disease could be multiplied. Frequently the disease appeared to

hereditary,

developing in several members of a family, among direct as well as collateral descendants of lepers. At other times, it attacked only one individual while other relatives remained healthy. By and large lepers came from the lower social strata living in over-crowded, unhygienic conditions, and were ill fed.

Yet several lepers were of high social

class, who did not lack for nutrition, good housing, clean surroundings, etc. In appearance the leper resembled the person with syphilis, yet leprosy did not seem to be transmitted by sexual

contact with a

sufferer, as syphilis certainly was. Wives or husbands of lepers rarely became lepers themselves. Geographically, the disease was concentrated in some locales in a country other regions being free. It seemed significant that in the single most leprosy-ridden country in nineteenth century Europe, -- Norway -- lepers were concentrated

in the western

coastal regions where fisheries thrived and fish was consumed in large quantities.

“deformed face, hard nodules, a foul discharge from the nose, hoarseness, coarse greasy skin, and in the last stages numbness in the hands and feet”. Hutchinson, On Leprosy and Fish-eating, p 23. 39

Robert Liveing, “Elephantiasis Graecorum or True Leprosy”, The Goulstonian Lectures for 1873, London, Longmans, Green, and Co., 1873. p 70. The Aristocrat Among Diseases

Thus it can be seen that the multitude of characteristics of leprosy provided fodder for arguments and counter arguments about causation. Further, the answer to the causation question had practical import for control. Norwegian Leprosy and Hereditarianism Unlike many regions of Europe, the Scandinavian countries did not emerge leprosy-free from the Middle Ages. The worst affected was Norway, where an alarming increase in the disease was reported in the early nineteenth century – over 650

lepers were enumerated

in the

year 1836 around the western sea port of Bergen. A researcher Daniel Cornelius Danielssen (1815-1894) [fig.1.1] was appointed to investigate the disease at the Bergen leprosy hospital.

Systematic

studies were

conducted by Danielssen and his compatriot Carl- Wilhelm Boeck (18051875) [fig1.2] at this institution, resulting in the publication of an epochmaking treatise on Norwegian leprosy in 1847, which was translated into French the following year.

The treatise was hailed as the

“beginning of the modern knowledge of leprosy.” 41 The authors utilised emerging scientific disciplines such as biochemistry and epidemiology to ascertain the nature of the disease and propose a hypothesis about its cause. 42 Danielssen and Boeck concluded that leprosy was “decidedly hereditary”, since 88% of their patients had family members with the disease. In the remaining 12% who did not, they invoked the fish-rich diet, dampness and “telluric” or local 40

influences.

Their statistics

Danielssen and Boeck, Traite de la Lepre. Skinsnes. “Notes on the History of Leprosy ”, p 226.. Ibid.

Gerhard A. Hansen and Carl Looft, Leprosy in its Clinical and Pathological Aspects,. N. Walker (transl.), Bristol, John Wright and Sons, 1895, p 87. The Aristocrat Among Diseases

revealed that leprosy occurred among lepers’ relatives, it was more frequent in grandchildren than children, and in collateral relatives than lineal descendants. To Danielssen and Boeck this was strong proof of heredity. So convinced was Danielssen of this, and so great was his reputation, that he persuaded the Norwegian parliament in 1854 to consider male leper sterilisation and prohibition of marriage not only to lepers but their immediate descendants. Parliament narrowly decided against such measures.

Sanitarianism and the Royal College of Physicians of London In

the

early

1860s

the leprosy

causation

generating interest in London as well. In 1862

question

was

the Governor of

Barbados in the British West Indies drew the attention of the Colonial Secretary

to "the increase of this fearful malady in recent years", and

suggested that a full-fledged inquiry into the subject would be “widely beneficial”. On a request from the Colonial Office to the Royal College of Physicians of London,-- the 350 year old citadel of English medicine – a five member Leprosy Committee composed of Fellows of the College, decided that the inquiry should take the form of a questionnaire for medical officers in all British colonies as well as physicians in other countries. 45 [Appendix 1.1] The expectation was that the more widely 44

The proposal was defeated by civil libertarians and Norwegian physicians opposed to the hereditary hypothesis. Anonymous, British and Foreign Medico-Chirurgical Review, 21: (1858) pp 332-346. However, the authorities in Norway actively encouraged young patients to enter institutions, hoping thereby to minimise opportunities for procreation. This is discussed in Chapter 2. 45

The Royal College of Physicians of London was founded in 1518 by Henry VIII, with a “view to the :improvement and more orderly exercise of the art of physic and the repression of irregular, unlearned and incompetent practitioners of that faculty, in the tenth year of his reign.” The solicitations of Thomas Linacre, one of the King’s physicians were instrumental in the establishment of the College. William Munk, Roll of the Royal College of Physicians of London, London, William Munk, 1878. The Aristocrat Among Diseases

broadcast the questionnaire, the greater the amount of "authentic information"

which

they

could

base

their recommendations.

Sanitarianism was the dominant medical doctrine at the College in the 1860s and 1870s, and its strongest proponent was Gavin Milroy (18051886), [fig.1.3] a member of the Committee. 46 His influence was all the greater for being the only member who had seen leprosy in a tropical country. This was in the West Indies, while engaged on a cholera study in the 1840s. 47 Within a year of

launching the questionnaire, and with just

25% of the eventual number of replies in hand, the Committee hastened to inform the Colonial Office that on examination a very large majority of the reporters consider the disease to be not contagious or communicable to healthy persons by proximity or contact with the diseased. The replies already received contain no evidence that, in the opinion of the Committee, would justify any measures for the compulsory segregation of lepers… Thereupon the Colonial Secretary issued a decree that “any laws affecting the personal liberty of lepers ought to be repealed, [and] any action

Gavin Milroy studied medicine at Edinburgh University. His anticontagionist and pro-sanitation bias was apparent as early as the 1840s and 1850s, when he advocated abolition of quarantine measures against plague and cholera. He served with the Sanitary Commission in the Crimean War 1855-1856, and implicated poor sanitation as the cause of high mortality in the British army. Appropriately, in his will he left 2000 pounds to endow an annual lectureship at the College on the subject of State Medicine and Public Health. Lives of the Fellows of the Royal College of Physicians of London 1826-1925, G. H. Brown (compiler), London, Royal College of Physicians, 1955, pp 71-72. 47

The other members of the Royal College of Physicians Committee were: George Budd (1808-1882) a physician who had written about cholera, diseases of the stomach and diseases of the liver; Arthur Farre (1811-1887), obstetrician and microscopist; Sir William Gull (1816-1890), outstanding physician and physiologist; and Edward H. Greenhow (1814-1888), public health official and sanitation scientist. Milroy’s influence in India is mentioned in Chapter 2. The Aristocrat Among Diseases

of the Executive Authority not enjoined by the law, ought to cease.” 48 the final recommendations issued in 1867,

the Committee make no

bones about their ideological agenda: … that the hope of extirpating [leprosy] amid a people must rest mainly in the adoption of measures for ameliorating their general health and amending their physical condition, can scarcely admit of doubt.49 It disregarded its own admission, that many of the responses to the question of causation were vague and inconclusive, and expressed a “forcible” and “forthright” opinion that leprosy was

general

constitutional derangement, not a unique disease with a specific cause, nor that it could be controlled by segregation of the afflicted. “ It may be fairly said”, explained the medical journal Lancet, “that this conclusion was arrived at on the ground that leprosy had disappeared from Europe and other countries apparently as a result of an improvement in hygiene and the diet of the peoples among which it occurred; and it is hoped that leprosy will disappear from India as civilisation advances by similar causes.” 50 This was the sanitarian credo par excellence. Contagionism on the European Continent In the 1860s too, some continental European physicians were critically appraising the hereditarian conclusions of Danielssen and Boeck. The

year 1869

saw the appearance of a pamphlet authored by

Drognat-Landre of Amsterdam, who had made his own studies of the disease in

Dutch

Guiana.

dismissed

"worthless"

the

Report on Leprosy of the Royal College of Physicians Prepared for Her Majesty's Secretary of State for the Colonies, London, Her Majesty’s Stationary Office, 1867, p vi. 49

Ibid, p lxxiv. Lancet, 24/8/1872. Drognat-Landre, De la Contagione. The Aristocrat Among Diseases

Norwegians’ "proofs" of hereditary transmission, and pointedly

asked

how a disease which those authors appeared more frequently in the second generation than the first, in the fourth than the third, and in the collateral

than the direct line, could be labelled “decidedly

hereditary”! 52

Declaring that the Norwegian findings could only be

explained by contagion and predisposition, he answered potential objectors: We are asked, if leprosy is contagious, how is it that the contact so frequently proves harmless? I answer thus: Diseases are contagious only at certain periods of their working, and I have every reason to believe that such is the case with leprosy; and it may be that the infecting stage is of very short duration. On the other hand very few persons may be in a recipient condition. 53 Armauer Hansen (1841-1912) [fig.1.4] was a

young Norwegian

physician at the threshold of a career in leprosy, on whom DrognatLandre’s contagionist arguments had a decisive influence. was

a . son-in-law

the

hereditarian

Danielssen,

Although he Hansen

was

independent-minded enough to see a need for fresh studies. Another seminal influence on Hansen’s scientific development was the work and philosophy of Charles Darwin. 55 In 1868, apropos

his theory of

evolution, Darwin had discussed the utility of hypotheses in science:

Ibid, p 23.

Quoted in H.P.Wright, Leprosy an Imperial Danger, London,J&A. Churchill,1889, p 72. 54

L.M. Irgens, “Leprosy in Norway: an Interplay of Research and Public Health Work”, International Journal of Leprosy, 41: (1973) pp 189-198. 55

On his debt to Darwin, Hansen wrote: “Nothing I had previously encountered had so fertilized my thought and my work. My goal had become of researching as open-mindedly and honestly as Darwin had, to be as thorough, and at the same time, as cautious as he in arriving at my conclusions. My previous scientific experience had left me well prepared to accept his teaching.” Quoted in T.M. Vogelsang, “Gerhard Armauer Hansen (1841-1912): The Discoverer of the Leprosy Bacillus: His Life and Work”, International Journal of Leprosy, 46: (1978) pp 257-332. The Aristocrat Among Diseases

An unverified hypothesis is of little or no value. But if anyone should hereafter be led to make observations by which some such hypothesis could be established, an astonishing number of isolated facts can thus be connected together and rendered intelligible. 56 Hansen believed that his own “previous scientific experience” had left him well prepared to “accept” Darwinian teaching and apply it

theorisations

about

leprosy.

Hansen’s

scientific

experience included a period of training in Germany in 1870 in the laboratory of a well-known microscopist. In independent

1871

Hansen

began

investigations on the contagion hypothesis, spending two

summers travelling around

the leprosy- infested districts near Bergen,

examining and interviewing as many leprosy-affected families as possible. Simultaneously he pursued his microscopic studies at the research centre at Bergen. His findings were published in Norwegian in 1874 and in English translation in 1875 in a well-argued thesis that leprosy was a specific chronic infectious disease.

He contended that the contagion

hypothesis explained features about leprosy, e.g. a visitor from a nonleprous region falling victim to the disease after residence in a leprous district, as

also as the

curious

statistics

Danielssen and Boeck.

Recognising that the hypothesis required proof, in the final section of his paper Hansen

cautiously noted

that such a

proof

was “perhaps

attainable”. There are to be found in every leprous tubercle extirpated from a living individual--and I have examined a great number of them,--small staff-like bodies, much resembling bacteria, lying within the cells; not in all, but in many of them. Though unable to discover any difference between these

Charles Darwin, The Variation of Animals and Plants Under Domestication, second edition, London, John Murray, 1885, p 9. The first edition of this book appeared in 1868. 57

Hansen, “On the Etiology of Leprosy”, British and Foreigh MedicoChirurgical Review, p 489. The Aristocrat Among Diseases

bodies and true bacteria, I will not venture to declare them to be actually 58 identical. It was in such circumspect terms that the discovery of the leprosy germ was announced, and for good reason. Though the germ theory of disease was gaining ground following the experiments of Louis Pasteur and others, no human malady, and a chronic one at that, had yet been rigorously proved to be caused by a germ. Hansen therefore spent the next few years injecting rabbits and other experimental animals with germ-laden material from his patients, but without success The disease could not be transferred to any animal species. Despite his premonition that the bacteria were indeed genuine leprosy germs, the scientist in Hansen was compelled to admit a few years later that without experimental proof, "[he] could not decide whether these bacteria really were the virus which, introduced

into the system, produced the disease". 59

Attempts by other

workers were also not successful. In the face of failure, the scientific community’s acceptance of “Hansen’s Bacillus” as the agent of leprosy, remained contestable and a matter of belief, though. circumstantial evidence in favour was strong. The micro-organism was found in large numbers in bodies of lepers;

and never in non-lepers; it looked identical

whether obtained from lepers in Norway, Spain, Brazil, or India. 60 His field studies and discovery made Hansen a die-hard segregationist, the more staunch because leprosy appeared to be declining in Norway following enactment of stricter laws in 1856 for leper segregation and 58

The year of Hansen’s discovery was probably 1873. An account of the discovery is also found in H.P.Lie, “Armauer Hansen and the Leprosy Bacillus”, International Journal of Leprosy, 2: (1934) pp 473475. The influence of Hansen’s discovery in India is discussed in Chapter 2. 59 Hansen, "The Bacillus of Leprosy", p 101. 60

J.D. Hillis, 1881, p 144.

Leprosy in British Guiana, London, J & A. Churchill,

The Aristocrat Among Diseases

inducements to lepers to enter asylums. Hansen was convinced of a cause and effect relationship between segregation policy and disease decline, despite the fact that a minority of the lepers were segregated in asylums. [Fig.1.5]. By the early 1880s, the British medical press, while cautioning against

the “temptation” to “too readily accept a specific bacillus for

any special malady”, nevertheless acknowledged that Hansen’s discovery marked the beginning of a new epoch. … t h e e v i d e n c e [ i s ] t h a t w e ma y s a f e l y s p e a k o f a b a c i l l us l e p r a e … . P o p u l a r i n s t i n c t h a s a l w a y s regarded the disease as c o n t a g i o u s , b u t t h i s v i e w h a s not be e n f ully a c c e pte d b y th e p r o fe s s i on . T h e a cc u mul a t e d e v i d e n c e i n i t s s u pp o r t i s , 61 how ever, be c omi ng c ontinua lly str onge r … The

pertinence

the putative bacillus leprae

for

“our

Indian Empire” was not lost on the press, nor the role the state in India would be expected to play: …with the proof that this pestilential affection is due to the growth of a parasitic organism,… the time would seem to have come … when investigations on a scale which is only attainable by Government support … cannot long be delayed.62 Leprosy and Fish-Eating The most indefatigable nineteenth century champion of the “icthyophagic” theory of leprosy was the prominent British physician, Jonathan Hutchinson. His unabashed attempts to fit every

observation

into the theory eventually made him a maverick in the causation debates. He showed ingenuity in answering every objection of unbelievers. "Under the term "fish" let it be understood”, he said, “I include edible molluscs, crustaceans, and all living denizens of water, both salt and fresh". 63 He had 61

British Medical Journal, 29/7/1882.

Ibid.

Hutchinson, On leprosy and Fish-eating, p 11. The Aristocrat Among Diseases

a ready explanation for the fact that the disease did not occur in some heavily fish-eating countries. "We may safely hold that the absence of leprosy under conditions otherwise conducive to it may be explained by the abundance of salt", which prevented putrefaction and decomposition. 64 Racist clarifications of uncomfortable facts were produced. That leprosy appeared to be spreading along routes of Chinese immigration produced the explanation: "They [the Chinese] are skilful cooks, and they can make use of many things which no one else would look at; decomposing fish and potted fish are amongst the delicacies in which they deal..." 65

That leprosy

attacked the Brahmins of India who were strict vegetarians. Hutchinson explained away: "I have been assured by many persons who had enjoyed excellent opportunities in observation that a conscience for truth-speaking does not exist in the Asiatic mind..." 66 By the end of the century Hutchinson’s views were no longer taken seriously. More important was that

the obsession with diet made him a staunch anti-contagionist, who

regarded the utility of leper asylums as “illusory”. 67 Rudolf Virchow and Localism The German Rudolf Virchow (1821-1902), whose pioneering concepts and discoveries in pathology made him an outstanding figure in European medicine, undertook a study tour of Norwegian leprosy in 1859 n the invitation of Danielssen, and entered the leprosy causation controversy in 1863.

He opined that

Ibid, p xiv

Medical Press and Circular, 11/8/1890.

Ibid.

Hutchinson, Leprosy and Fish-Eating, p. 22.

in leprosy

"the idea of

E.H. Ackerknecht, Rudolf Virchow: Doctor, Statesman, Anthropologist, Madison,. University of Wisconsin Press, 1953, p 110. The Aristocrat Among Diseases

inheritance is inadequate".69 The point at issue, he felt, was not the reason for the recent

spurt in leprosy in

Norway, nor the large

amount of familial leprosy which had so impressed the Norwegian authors, but why the disease had declined precipitously in large parts of

post-medieval

Europe,

while lingering

in Scandinavia. The

phenomenon, Virchow averred, could not be explained "except on the basis of a special cause", which resided in the terrain or locality. The terrain

was

obviously hospitable to

the disease in Western

Norway, and hostile to it in the United States of leprosy had

America, where

failed to take root despite the immigration of several

Norwegian lepers in the past four decades. 70 He also dismissed the possibility of leprosy contagion, which he said was an "improbable … idea more and more [to be] abandoned…" 71 antagonistic to the role of bacteria

Virchow was generally

in disease, and came to terms with the

germ theory reluctantly.

Experiments --Human and Natural In the early years of scientific interest in the disease, Danielssen and others had injected discharges from lepers’ bodies into themselves and volunteers to determine if the malady could be transferred by inoculation. The experiments yielded negative results, which was one reason why Danielssen became an anti-contagionist. Following Hansen’s discovery 69

R.V. Virchow, “Die Krankhaften Geschwulste”, Part 1, G..L.Fite (transl.), International Journal of Leprosy, 22: (1954) pp 71-79. 70

W.L. Washburn, “Leprosy Among Scandinavian Settlers in the Upper Mississippi Valley, 1864-1932”, Bulletin of the History of Medicine, 24: (1950) pp 123- 148. 71

Virchow, “ Die Krankhaften”, p 77. The Aristocrat Among Diseases

medical attention returned to human experimentation. 72

The

most

publicised experiment was that conducted in Hawaii by an American physician Edward Arning on a convicted murderer. The

convict was

promised a reprieve if he agreed to be inoculated with leprous material containing bacilli. He consented; a leprous nodule was implanted into his forearm in November 1885. Three years later the President of the Board of Health in Hawaii certified that

the man "has become a tubercular

[nodular] leper". 73 Elation among contagionists was to be short-lived. A few months later it was discovered that some near members of the man’s family were lepers, hence his disease might not have arisen from Arning’s inoculation. A sceptic of contagionism drew attention to the flaw in Arning’s experiment, namely

that it was conducted

its a

leprosy-endemic country: … t h e i n o c u l a t i o n i n s u c h a [ l e p r o s y e n d e mi c ] c o u n t r y a s t h e S a n d w i c h I s l a n d s [Ha w a i i ] h a s l e s s v a l u e t h a n w o u l d b e t h e c a s e i f a suc c e s s f u l i n o c u l a t i on w e r e t o t a k e p l a c e i n a 74 country free from leprosy. Man's efforts failed to demonstrate the communicability of leprosy, but the same could not be said of one particular natural

occurrence,

which caused much excitement and panic in the western world and India in 1889-1890.

A Belgian priest, Father Damien de Veuster fell

These experiments were conducted between 1844 and 1875. Viktor Klingmuller, . Die Lepra, Berlin, Verlag von Julius Springer, 1930, p 131. Hansen himself performed a sensational - and illegal experiment in 1879, which cost him his position in the leprosy hospital at Bergen. Without obtaining her consent, Hansen inoculated into the eye of an unwilling young woman leper who had a mild form of leprosy, a quantity of infected material from a severe case. K. Blom, “Armauer Hansen and Human Leprosy Transmission: Medical Ethics and Legal Rights”, International Journal of Leprosy, 41:(1973) pp 199-207. 73

British Medical Journal, 19/4/1890.

Ibid.

Discussed in Chapter 6. The Aristocrat Among Diseases

victim to leprosy and succumbed to it sixteen years after serving in Hawaii

the leper settlement on

the

island

Molokai. 76

Contagionists in the medical profession and the lay public required no further proof of the strength of their case. The International Leprosy Congress, Berlin, 1897 This, the first international meeting devoted to leprosy, was organised by the most respected names in European medical science such as Virchow, who had by then accepted Hansen’s discovery, and Koch, whose innovations in bacteriology of the tuberculosis germ had helped in the study of Hansen’s bacillus too. The purpose of the Congress was to endorse Hansen’s discovery and set the seal of approval on views he had steadfastly held: (1) Every leper was a “danger” to his surroundings. (2) All causation hypotheses except contagion/infection were to be rejected.. (3) The bacillus discovered by Hansen in 1873 was the “real” cause of the disease. (4) The Norwegian policy of leper segregation and leper asylums was a model for other leprosy-affected countries. 77 Insanitation, and over-crowding acted only by providing greater opportunities for the spread of the leprosy germ. The presence of a leper exposed members of the family to the germ, giving rise to a seemingly hereditary transmission of the disease.

Gavan Daws, Holy Man, Honolulu, University of Hawaii Press, 1973.

Mittheilungen und Verhandlungen der Internationalen wissenschaftlichen Lepra-Conferenz zu Berlin im October 1897, Vol. 2, p 165. (Kindly translated by Dr. Katie Mody). The Aristocrat Among Diseases

Assessment Nineteenth century European interest in leprosy was aroused and sustained largely because of the presence of the disease in Norway.

Britain it was due to the colonial connection. Leprosy causation theories were several, reflecting the importance and significance attached by each school of thought to one or more of the variegated characteristics of the disease. The

British

sanitarians

were

nature antagonistic

contagionism and segregation policies for lepers, pinning their hopes on improved endorsement

environmental and

living standards.

The

of the bacillary cause of leprosy, though

eventual

based on the

discovery of the germ, was sustained by circumstantial evidence, rather than rigorous scientific validation. To contagionists the single most important proof of the communicability of leprosy was the steady decline in the number of lepers in Norway over the course of the century, after the peak in the early decades. Hansen had no doubt that this was the result of enactments in 1856 for leper segregation and asylums. But he turned a deaf ear to critics who pointed out that segregation in Norway was never either compulsory or universal. It was the also the case that lepers within asylums were discouraged from having children, so that hereditary factors could not be excluded. going and

Neither did he give credit to the on-

social improvements and rise in the standards of living, nutrition personal cleanliness among the Norwegian

period.

peasantry during

the

Modern analysis of nineteenth century Norwegian social and

agricultural indices and leprosy statistics points to improvement in the quality of life, especially diet, as a factor in the decline of leprosy; it also suggests that when the number of leprosy-affected families was large, as in the early nineteenth century, isolating the sufferers in asylums contributed partly to the later decline. 78

L.M. Irgens, â&#x20AC;&#x153;Leprosy in Norway : An Epidemiological Study Based on a National Patient Registryâ&#x20AC;?, Leprosy Review, 51: (1980) pp 1-130. The Aristocrat Among Diseases

The Next Chapter The next chapter examines how the main leprosy causation theories were perceived in

contemporary colonial

India, and

examines

the

personalities and opinions that influenced debates in Bombay and the capital, Calcutta.

The Aristocrat Among Diseases

Fig.1.1. D.C.Danielssen

Fig.1.3. G.Milroy

Fig.1.2. C-W. Boeck

Fig. 1.4. G.A.Hansen

The Aristocrat Among Diseases

Fig.1.5. The Decline of Leprosy in Norway, 1856-1880.* 3300 3000 2700 2400 2100 1800 1500 1200 900 600 300 0

Total

In Asylums

Year

* H.V.Car t er, “ M e m o r a n d u m o n t h e P r e v e n t i o n o f L e p r o s y b y S e g r e g a t i o n o f t h e A f f l i c t e d ”, B o m b a y G o v e r n m e n t G a z e t t e , 7/12/1882

The Aristocrat Among Diseases

Fig.1.1. D.C.Danielssen

Fig.1.3. G.Milroy

Fig.1.2. C-W. Boeck

Fig. 1.4. G.A.Hansen

Total

80 18

78 18

76 18

74 18

72 18

70 18

68 18

66 18

64 18

62 18

60 18

In Asylums

56 18

Number

3300 3000 2700 2400 2100 1800 1500 1200 900 600 300 0

Year

*H.V.Carter, “Memorandum on the Prevention of Leprosy by Segregation of the Afflicted”,BombayGovernmentGazette, 7/12/1882

Chapter 2 Causation Controversies in India: the Leprosy Career of Henry Vandyke Carter Vain! Vain!! The search for truth… Lepra for instance… Who knows the cause that rots these limbs, distorts that handsome face? Can any guess one atom of the laws that guide this horrid race of death with life? No! No!! 1

In this chapter the fall-out of the European leprosy causation controversies described in the previous chapter, is followed into India. The chapter is anchored in the life and leprosy work of Henry Vandyke Carter (1831-1897) [Fig. 2.1] , a member of the Bombay Medical Service. Carter’s studies of leprosy and lepers are traced over thirty years, as also his interactions relating to the subject with medical bureaucrats in authority in his home Presidency and in the colonial capital Calcutta. . At the end of the chapter as assessment is made of his legacy in leprosy control policy. Carter’s steadfast interest in leprosy and his several publications provide an insight into the evolution of his thoughts on the vexed question of causation. On a

personal

level,

the

academic and

administrative positions he came to occupy at the Grant Medical College (GMC) [Fig.2.2] and the Jamsetjee Jejeebhoy Hospital (J.J. Hospital) [Fig.2.3] in Bombay, brought him into contact with the Indian public, and Indians trained in Western medicine such as L.P. de Rosario, Sakharam Arjun and Anna Moreshwar Kunte. 2 However his leprosy work was not without controversy. His conflicts with medical

some

authorities in London and Calcutta about what constituted

“rationally founded

action” against

leprosy,

are

window on

contemporary biases and anxieties. -----------------------------------Anonymous, “The Leprosy Dilemma”, Indian Journal of Pharmacy, 1: (1894)p 107.

Examples of the effect and influence Carter had on the students at GMC are described in the present chapter and in Chapters 3 and 6. Causation controversy in India

Biographical Sketch Carter, a Yorkshireman, was born on May 22, 1831, the son and brother of artists. 3 He received his medical training at University College Hospital in honours in 1852.

London,

graduating

M.R.C.S. with

In 1853 he obtained a studentship in human and

comparative anatomy at the Royal College of Surgeons,

under the

famous zoologist Sir Richard Owen (1804-1892), and three years later became M.D of

London University. 4

Before he set out for India

in 1858, his artistic abilities had earned Carter a favourable reputation in London as illustrator of

a textbook of human anatomy,

the

legendary Gray’s Anatomy, familiar to generations of medical students. 5 A few months after arrival in India, -- his diary shows that he had equipped himself with “a Microscope

£ 12/=” -- he was

gazetted

Professor of Anatomy and Physiology at GMC, simultaneously serving as Assistant Surgeon at JJ Hospital. 6 From 1863 to 1872

he was

Civil Surgeon at Satara, where, as he found “my duties are not very arduous”, he was permitted to pursue further studies on leprosy. 7 In 1873 Carter returned to Europe on furlough, and obtained sponsorship from the Secretary of State for India for a study tour of Norway and leprosy-endemic

countries

the

Mediterranean

littoral. 8 The

-----------------------------------Carter’s obituaries in Lancet, 15/5/1897, and British Medical Journal, 15/5/1897.

A qualification held by about 30% of his peer group in the Indian Medical Service. Harrison, Public Health, Table 1.1.

Henry Gray, Anatomy Descriptive and Surgical; with Illustrations by H.V. Carter, the Dissections jointly by the Author and Dr. Carter, London, J H. Parker, 1858.

Diary entry for February 23, 1858, Carter Papers (Western Mss. 5809-5826), Wellcome Institute for the History of Medicine, London. 7

MSAGD, Vol. 8, 1870, p 353.

Carter, Report on Leprosy and the Leper Asylums in Norway; H.V.Carter, Reports on Leprosy (second series), Comprising Notices of the Disease as it now Exists in Causation controversy in India

researches of Norwegian leprosy scientists, described in the previous chapter, were much admired by Carter, and that country’s leprosy control policy based on leper isolation, made a deep impression as a most

“enlightened” one. 9 In

Bombay, in 1875, Carter obtained

permission from a sympathetic Presidency Government to conduct a field study of leprosy in the villages of Kathiawar. 10 In 1876 he was appointed

to the charge of the Goculdas Tejpal Hospital at

Bombay, partly to enable him to collate his findings. In 1877 Carter was appointed Principal of GMC and First Physician at JJ Hospital, and continued in this appointment till he left India. He was also President of the Medical and Physical Society of Bombay and Dean of the Faculty of the Medical Faculty of the University of Bombay.. He returned to Scarborough in Yorkshire in unappreciated.

1888,

unhonoured

though

not

Seven years after he left India, Behramji Malbari’s

Indian Spectator contrasted the then unsatisfactory state of affairs at the JJ Hospital with that in Carter’s days: [T]hings [ at the JJ Hospital] were better managed in Dr . Carter’s time: and although he is still abused by the jacks in office, for the way in which he hopped in here there and every where, unexpectedly examining the milk, the soup or the rice as it came in, or asking where it was when it failed to come in …. His old patients still bless his memory. Carter saheb was true ma bap to them and treated poor and rich alike as his children… 11

At the early age of 26 and well before he embarked on his Indian career, Carter wrote in his diary, “I positively dread idleness”. 12 His diligence and industry were noticed and appreciated by the --------------- ----------------------------------------------------------------------------------------------North Italy, The Greek Archipelago, Palestine, and Parts of the Bombay Presidency of India, London, Eyre and Spottiswoode, 1876. 9 Carter, Report on Leprosy and Leper Asylums in Norway, p 9. 10

H.V. Carter, Modern Indian Leprosy: Being the Report of a Tour in Kattiawar 1876, Bombay, Printed at the expense of the Chiefs of Kattiawar, 1876.

Indian Spectator, 10/3/1895, “Report on Native Papers”.

Diary entry for October 11, 1857, Carter Papers. Causation controversy in India

students at GMC. L.P.de Rosario who was a student in 1858, described Carter’s work habits: when not engaged in the lecture room or wards of the Hospital, he was seen to be earnestly busy with the microscope taking notes and making sketches of whatever he saw…. At other times he was found to be assiduously dissecting subjects of leprosy, in the anatomical room after College hours, up to a late hour in the evening13

Another former student, V.S.Trilokekar declared the debt he and other Indian students owed to Carter: I had the good fortune of working with Dr. Carter, and what I know at the present day about the microscope, and its use in medicine is due entirely to him. He was extremely anxious to create in his students a desire for research work into the causes of many diseases… 14

Two aspects of his professional outlook singled Carter out from his peers in the colonial medical establishment who by and large were content with daily routine. These were his constant endeavour to keep abreast of contemporary European medical science, and the attention aroused by his publications and career in Britain. Carter’s interest in leprosy was voluntary and sustained. He labelled the disease “one of the greatest plagues of

man”, and

unceasingly reminded those in authority that both noblesse oblige and shrewd practicality demanded its eradication from India under British aegis: …British rule in India would benefit itself and subject…. Intervention [is] to be recommended on both grounds of policy and humanity: that delay is to be deprecated, and that the present time is well suited for enlisting the cooperation of the people, who are tolerant only from an ignorance which it is our duty to dispel by open, and rationally founded action. 15 -----------------------------------13 Times of India, 18/3/1890. 14

V.S.Trilokekar, “Micro-Organisms and their Relation to Disease, with Special Reference to Malaria”, the Lord Reay Lectures, Indian Medico-Chirurgical Review, 3: (1895) pp 383-395. 15

H.V. Carter, On Leprosy and Elephantiasis, London, Eyre and Spottiswoode, 1874, p 211. On another occasion Carter reminded the Government of its “obvious duty of beginning a work in India which the progress of civilisation and common humanity seem… to earnestly call for … with our Indian empire…” MSAGD, Vol. 35, 1875, p 255. Causation controversy in India

Besides leprosy, Carter made important studies on many other Indian diseases. 16 His appointment as Honorary Deputy Surgeon-General and Honorary Surgeon to the Queen in 1890 were considered to be overdue recognition of his services. He died of pulmonary tuberculosis on May 4, 1897. Sir Ronald Ross, of malaria fame, regarded Carter as outstanding among the earlier generation of officers of the Indian Medical Service. 17

Leprosy, Causation and Remedy Carter’s interest in leprosy was sparked

soon

after

his

appointment as Professor of Anatomy at Bombay in 1858, not the least because the disease permitted him to use his skills in anatomy and illustration 18 His patients were the ill and dying lepers admitted in the Leper Ward at

the JJ Hospital, and the leper

Jamsetjee Jejeebhoy Dharamshala (JJ Dharamshala) which he visited frequently. 19

inmates of the situated

nearby

He was deeply moved by the lepers’

plight, and wrote feelingly on the subject. On the scientific aspect, he showed that he was well aware that such a study of

leprosy in

-----------------------------------These included Mycetoma (“the Fungus Disease of India”), filariasis (Elephantiasis), malaria, and, ‘relapsing’ or ‘famine’ fever. The last-mentioned study was conducted during the famine of 1876-1877 when large numbers of the ill and starving from the rural areas crowded into Bombay. The study earned Carter the Stewart Prize of £ 500/- of the British Medical Association. Though he made no bacteriological discoveries, he was the first to demonstrate in India, the organisms responsible for malaria, ‘famine’ fever, tuberculosis, the fungus of mycetoma, and of course, the germs of leprosy. 16

Ronald Ross, Memoirs: With a Full Account of the Great Malaria Problem and its Solution, London, John Murray, 1923, p 480. 18

S.S. Pandya, “An Anatomist in Leprosyland: On a Contribution from Mid-Nineteenth Century India“, International Journal of Leprosy, 65: (1997) pp 246-251; S.S. Pandya, “Henry Vandyke Carter, Medical Artist and Scientist”, Leprosy in Indis, 43: (1971) pp 19-23. Carter also communicated his pathological studies to the Royal Medical and Chirurgical Society and the Epidemiological Society of London; his papers were reviewed in the British and Foreign Medical and Chirurgjcal Review and Lancet. 19

The J.J. Dharamshala as a leper refuge is described in Chapter 8. Causation controversy in India

India was a pioneering venture, for although the disease was widely prevalent

and pitiably destructive

“attracted but slight powers,

[his]

attention on

profession”.

reason was that “it

in its effects, he said it

had

the part either of the ruling

Carter

shrewdly

guessed that the

attacks mostly the lower orders, and is but little

amenable to treatment…” He contrasted what he regarded as British colonial

disinterest

with the vigorous response of

British

society

against the disease in medieval times: … When the same or a similar disease devastated Europe during the middle ages, public asylums for lepers were raised and endowed, and the medical literature of the time teems with notices of leprosy… 21

his

first

publication

which appeared in 1862, Carter

declared that Indian leprosy was substantially different from the European variety. Pre-occupied

with pathology in 1863, Carter was

content to echo conventional wisdom on the causation question: “This disease is doubtless associated with well known hygienic conditions; but

nearly

has also a special diathesis, which, as it seems to me, approaches

the

syphilitic.”

However

quite

most soon

developed second thoughts, for in 1863, he retracted the syphilitic analogy, categorically rejected contagion, and became a supporter of the hereditary theory, espoused by Danielssen and Boeck. He cited reasons for his views: Leprosy in all its varieties is decidedly hereditary. 23 Neither fever nor syphilitic taint is common, but an hereditary predisposition is undeniable [because 50% of Dharamshala lepers had leprous relatives]… 24 -----------------------------------H.V.Carter, “On the Symptoms and Morbid Anatomy of Leprosy: with Remarks”, Transactions of the Medical and Physical Society of Bombay, 8(new series): (1863) pp 1-104.

Ibid, p 1.

H.V.Carter, “Case of Anaesthetic Leprosy, with Post-mortem Examination and Remarks”, Transactions of the Medical and Physical Society of Bombay, 7(new series): (1862) p 80.

Carter, “On Leprosy as seen in India”, p 184. Causation controversy in India

Propagation of the disease by contagion is not a tenable doctrine… [because] I have seen several leprous husbands with healthy wives, and vice versa; and in the immediate neighbourhood of the [JJ] Dharamshala, where lepers are constantly visiting, the disease is said not to have appeared. 25

During his leisure hours while Civil Surgeon at Satara, Carter painstakingly collated

the data from a

census of

8,220 lepers

conducted in the Presidency in 1867, and published his analysis in 1871. 26 [Fig.2.4]

He re-iterated

his

opinion that heredity was a

supreme influence in initiating and propagating the disease

expected in colonial discussions on endemic disease in India, Carter found the possible role of caste in transmission persuasive as well as convenient. .

The cause of leprosy was to be “sought for in the

people themselves”, and their practices. 27 [The] evident tendency [is] to confirm the impression that the hereditary transmission of Leprosy is decidedly favoured by the customs and observances… 28

Hereditary transmission by marriage and intermarriage of lepers, was rooted in the Indian custom of caste endogamy, according to Carter. The consequence was the disease’s wide distribution -- no caste was exempt -- and long persistence in the land.

Carter said his

theorisation was supported by the data showing that the highest rates of leprosy were to be found in districts such as Ratnagiri, where a --------------- ----------------------------------------------------------------------------------------------24

Ibid, p 192.

Ibid, p. 193.

H.V. Carter, “Report on the Prevalence and Characters of Leprosy in the Bombay Presidency, India, based on the Official Returns of 1867”, Transactions of the Medical and Physical Society of Bombay, 11 (new series): (1871) pp 74 – 248. The census data had initially been sent by the Presidency Government to Dr. Bhau Daji in view of his well known interest in the disease. No response was forthcoming from Dr. Bhau, and Carter’s offer to collate and compile the data was accepted by Government. MSAGD, Vol. 32, 1871, p 115. 27

Carter, “Report on the Prevalence”, p 89. Ibid., p 114. Causation controversy in India

family taint was most common. An inconvenient fact, but which did not deter Carter, was that the

majority

of the 8,220 lepers in the

Presidency as a whole had denied that they had leprous relatives. … it is impossible that leprosy should be excluded [from the hereditary category] though only about 20 per cent of lepers have acknowledged a taint. 29

In his view, such data pointing to the non-inheritance of leprosy, “is from the nature of the case, likely

to be apparent

rather than

real”,

explainable by the natural reluctance of lepers to admit to a familial taint. 30 On the possibility that leprosy could be spread by contact, i.e., by “contagion”, Carter circumspectly commented that there was a need for “special and precise information to thoroughly question”.

settle the

Sanitary preaching such as that in the Royal College of

Physicians Report on Leprosy of 1867, aroused Carter’s strongest ire: … it is not apparent that bad sanitation has such an essential connection with leprosy as it has with several acute or local disorders. [Also], it appears that poverty and leprosy do not pre-eminently stand in relation to cause and effect. 32 [Respecting the statement [by the Royal College] that improved hygiene has in some countries, and in past ages, led to the extinction of Leprosy, the reasoning seems to be defective:… and as regards the decline of leprosy in Europe… the most patent fact seems to be, not that of a general improvement in the diet and habits of the people … but rather that of the rigorous measures adopted for checking the progress of this … scourge… These institutions [leper asylums] were intended for the isolation of the infected… 33 (italics added).

Acknowledging that the laws for isolation and segregation of lepers in medieval Britain had been harsh, he argued that nevertheless they had been instrumental in ridding the country of the disease. They would be equally effective in India in the “enlightened” nineteenth century, he predicted, hoping that “no worthy or effective reasons will be urged -----------------------------------Ibid, p 134.

Ibid, pp 120-121.

Ibid, p 77.

Ibid, p 89.

Ibid, pp 78-79. Causation controversy in India

against a course which is clear in intent, philanthropic in design, and,… beneficial to the community.” 34

The alternative,, he warned, was

the

vague hope that improved living conditions in some distant future would somehow extirpate the disease. Carter deplored what he termed the “discountenancing”

leper asylums

by the Royal College of

Physicians in their Report on Leprosy four years before. 35

Carter’s

allegation evoked a strong protest from the dedicated sanitarian Gavin Milroy who had inspired the Report. Writing to the Colonial Office, Milroy asserted that the College had not “discountenanced” asylums, but recommended that they be “discontinued” as instruments of state policy for disease control. He insisted that he was not against asylums per se, “[a]ll who have seen the disease must recognise, I should think, the necessity for destitute lepers of such institutions…” 36

”The Enlightened Kingdom of Norway” Carter had long regarded Norway as a researchers.

Mecca for leprosy

In undertaking his study tour of that country in 1873,

Carter had two questions in mind: (1). “Is or is not the leprosy (Spedalskhed) of Norway identical with the True or Black Leprosy (Raktapiti) of Western India…?” His early researches suggested that were differences. (2) “Prior to the erection of asylums in 1856 what had been the progress of leprosy in Norway… and what are the results, … of the attempts made [by the state] to deal directly with this malady?” 37 --------------- ----------------------------------------------------------------------------------------------34

Ibid, p 83.

Ibid, p 77. The Report on Leprosy of the Royal College of Physicians of London is discussed in Chapter 1. 36

NAI, Home Department, Medical, April 1875, Proceedings 18 to 22. Carter, Report on Leprosy and Leper Asylums in Norway, p 6. Causation controversy in India

To the first question the answer turned out to be affirmative: Norwegian and Indian leprosy were indeed identical diseases. The answer to the second question

was especially gratifying to Carter,

already strongly pro-asylums and segregation. The

steady decline in

the prevalence of leprosy in Norway appeared to have started around 1856,

the

year

segregation and

when

stricter

laws

were

introduced

several asylums were established.

for

leper

To Carter it was

obvious that identical diseases required identical measures for control. The “novel and useful observations” were fully [are] singularly applicable to India, and will greatly strengthen the opinions of those who recommend State interference with the disease in the East. My own views, independently formed, are in remarkable accord with those of the chief advisers of the Norwegian Government… 38

He found the Norwegian asylum system to be largely a voluntary one. There was no compulsion on inmates either to enter or stay, but the majority who were old and infirm, never left the asylum. Reflecting the dominance of

the hereditary theory, Norwegian asylums

were

not

run on purely welfare motives. ….The cases which are judged most suitable for segregation are the young and active lepers of both sexes; the idea being that they should not be allowed to propagate their disease to offspring, and this idea was the dominant one leading to the establishment of asylums. 39

Carter

reasoned

anew

the

mechanism

which

segregation appeared to be instrumental in disease control in Norway. Specifically, he considered a special “agency” which

prevented

contagious spread. His hitherto strong hereditarianism appeared to be wavering:

--------------- ----------------------------------------------------------------------------------------------38

Ibid, p 3.

Ibid, p 15. Causation controversy in India

Now such influence must, I think, be either a capacity of infecting sound persons by contact or effluvia; or it must be one connected with the procreative faculty, by means of which a leprous progeny is introduced into the world…40

The year 1873 marked a sea-change change in Carter’s views. He showed himself willing to broaden his horizon, though he felt that contagion theory was irregular”, and

“not

without

difficulties”,

“seemingly most

“too recondite for general discussion”. 41

The reason

for shifting his stance was revealed in a footnote in the Report he wrote for his sponsor the Secretary of State for India: I take this opportunity of alluding very briefly to the latest investigations with which I have become acquainted, from their great interest and value. Dr. G.A. Hansen … is engaged in a series of inquiries which cannot but throw much light upon the origin and nature of leprosy. These point to the parasitic origin of the disease; and by Dr. Hansen’s kindness I have myself seen the minute organisms (a species of Bacterium) which are present in living leprous matter taken from the interior of a “tubercle.” Should these inquiries terminate in demonstration, it would be necessary to reconsider the topics I have just mentioned, for, as Dr. Hansen justly remarks, if leprosy be shown to be a specific disease … then its propagation by hereditary transmission must be very limited…. It is not, perhaps, impossible to understand most of the signs of supposed heredity on the ground of local infection or personal contagion. 42 (italics added)

Carter’s

modest mention of

Armauer Hansen’s discovery

“minute organisms … in living leprous matter” was the first indication to the English-speaking world that the germ theory of disease causation might

applicable

contagion/infection

leprosy. 43

The

practical

implications

in leprosy were not lost on him. Like his

Norwegian host Hansen, he became convinced that the sole reason for the ongoing decline

of leprosy in Norway was

contagion by isolation of

prevention of

lepers in asylums. However,

as had

happened during his enthusiasm for hereditarianism, Carter showed a blindness to inconvenient facts. -- he was unmoved, for example, -----------------------------------Ibid, p 24.

Ibid, p 6.

Ibid, p 27.

The discovery of the leprosy bacillus is discussed in Chapter 1. Causation controversy in India

when Milroy

reminded him that only one-third of Norwegian lepers

were actually isolated

in institutions, hence the prevention of leper

contact, could not be the reason. 44

Anti-Contagionism in India Carter went

Norway

supporter of the doctrine of

hereditary transmission; he returned to India strongly persuaded that leprosy might be a communicable disease. He reminded his sponsor, the Secretary of State,

that a leper asylum policy for India was of

“real and even urgent importance, … an essential item of the schemes of benevolence … due to the country from her enlightened rulers…”, which could no longer be disregarded without prejudice to British rule. 45 His

recommendations

for

leprosy control

India were wholly

inspired by Norwegian example: 1. That

Leper statistics be collected for the whole country, and

an annual leper census be held in India under medical supervision. 2.

That “without

delay” permanent Leper Asylums

established in heavily infested localities. 3.

That

systematically

Leprosy

enquiring into

the

Commissioner

be appointed

conditions under

for

which leprosy

arose and persisted. Carter broadly

hinted that

willing to fill this post. The

he was qualified, and more than Bombay government forwarded a

recommendation to the Government of India H.E. the Governor-in-Council … considers it very desirable that Dr. Carter’s work be made more complete by allowing him thoroughly to examine all the Districts in India where leprosy is most rife… [and] suggests that he be placed on Special Duty for a year… for this purpose….. H.E.-in-Council is confident that with the experience Dr. --------------- ----------------------------------------------------------------------------------------------44

Carter, Report on Leprosy and Leper Asylums in Norway, pp 14- 15

Ibid, p 30. Causation controversy in India

Carter has gained in other countries, his deputation in the manner proposed will be attended with excellent results… 46

Within

India

also Carter did

not lack for an influential

opponent -- none other than the head of the country’s establishment, the

“notoriously anti-contagionist”

medical

James McNabb

Cuningham (1829-1905), Sanitary Commissioner with the Government of India. 47

His

obituarist

described

Cuningham

being

“apt

throw cold water on strivings towards truth by local enquiry and clinical and pathological research… 48

Cuningham

acted true to form and

reputation by faulting all of Carter’s recommendations and theoretical premises. [Dr. Carter’s] opinion … rests on a very slender basis of evidence. By his own showing only about one-third of the Lepers of Norway were in Asylums at the end of 1870, and it is not probable that such a partial measure could have had very decided effect. Such segregation commends itself to those who believe that leprosy is in some way or other contagious, but it would appear that there is very little to support this idea.49

Advised by Cuningham, the authorities replied that even if leprosy could be “stamped out” by isolating the affected in the manner of medieval Europe and contemporary Norway, … the Governor-General-in-Council believes that it will be impractical to put Dr. Carter’s theory in practice in this country…. It may be said … there cannot be less than a 100,000 Lepers in British India. The Government could not undertake to build hospitals for all these people, and to keep up establishments for them, to clothe and feed them, and practically to turn them into sick paupers. To say nothing of the enormous cost which these measures would entail, the difficulties of attempting anything of the kind would be insuperable. 50 -----------------------------------MSAGD, Vol. 35, 1875, p 237.

Norman Howard-Jones, The Scientific Background of the International Sanitary Conferences 1851-1938, Geneva, World Health Organisation, 1975, p 74. Cuningham, an Edinburgh medical graduate, was an IMS officer of the Bengal cadre. He was Sanitary Commissioner with the Government of India between 1868-1884, and after the amalgamation of the two posts, held additional charge as Surgeon-General from 1880 to 1884. Harrison, Public Health, p 237. 48

Cuningham’s obituary in British Medical Journal, 15/7/1905.

NAI, Home Department, Medical Branch. March 1875. Proceedings 10-14A.

Ibid, p 22. Causation controversy in India

Thus the official

opposition to Carter

turned as much on the

“impracticality” and inadmissible cost of maintaining leper asylums, as

doctrinal

Commissionership

issues. Carter’s were

hopes

the

Leprosy

similarly thwarted by Cuningham on the

ground that the task was too large for one man, and being a “sanitary enquiry”, must necessarily

be conducted by his own

Sanitary

Department. By invoking this argument Cuningham ensured his own control dated

over any enquiry. By a Government 12th February

1875,

himself, the enquiry was

which

of India

was drafted

entrusted

Resolution

by Cuningham

to his Special

Scientific

Assistants Timothy R. Lewis (1841-1886) and David D. Cunningham (1843-1914). The coup de grace to Carter’s ambition was delivered when the Governor-General –in-Council was persuaded by the Sanitary Commissioner that … it would not be advisable for the Government to publish and circulate Dr. Carter’s paper, and thereby give it an authoritative character, as though the question of the specific origin of leprosy has been decided, which is far from being the case…51

Cuningham’s Critics The

powerful

Sanitary

Commissioner

was not without

his

detractors, nor was Carter without support. In London the influential journal Lancet deplored the “beggary economy of the Calcutta people” which bids

fair to put a stop to Carter’ researches. 52 . A

months later it repeated that it was which

the

aetiology

couple of

“sorry to discover the attitude

Government of India has assumed the question of the leprosy and

the general

management

lepers

-----------------------------------MSAGD, Vol. 50, 1876, p 20.

Lancet, 17/7/1875. Causation controversy in India

India”. 53 There was regret that Carter had been refused the Leprosy Commissionership, a refusal we can well understand from a red-tape point of view…. [It would elbow] Dr. Carter out of any participation in a matter upon which he has thrown great light by honest and admirable work.54

The journal shrewdly guessed that [p]robably, as Dr. Carter’s views in reference to the general treatment of lepers turn out to be not n accord with those of the Government, it may be convenient to deny him any facilities for prosecuting his enquiries any further. 55

Probably more was

irksome to Cuningham

the disdainful tone

the

views of Lancet,

of an editorial in the Indian Medical

Gazette, organ of the

Indian Medical

“medical instruction

the

than

members

Service, disseminator of

the

subordinate medical

establishment”. 56 The sting of the editorial authored by Kenneth Mcleod, Secretary to the Surgeon-General, was in its tail. We know not, and care not to speculate, who is responsible for having advised Government in this matter; but whoever did so must have known very little either of leprosy or of the civil medical service. Inept nibbling at great and weighty questions of sanitary science can only end in bringing sanitary science into contempt; and we hold that no scientific enquiry should be initiated unless a reasonable prospect of its successful prosecution exists, which is not the case in this instance.57 [italics added]

Cut to the quick, Cuningham protested

to the Government of

India that it was “most objectionable that articles of this nature… should issue under the avowed editorship of

Officer of

the

Government…are [subordinates] after reading it, more likely to aid in an important enquiry ordered by the Government, but which Dr. McLeod -----------------------------------Lancet, 25/9/1875.

Ibid.

Indian Medical Gazette, 1/5/1875.

Ibid. Causation controversy in India

… has told them is nothing but “inept nibbling?” 58 in the

It came about that

mid-1870s, two rival studies of leprosy were undertaken in

India: by Cuningham’s Scientific Assistants, and surprisingly, by Carter himself.

“No Uncertain Sound”—the Study of Lewis and Cunningham Lewis and Cunningham undertook fortified scientific

by J.M. Cuningham, justifications

for

their

their leprosy investigation

superior’s agenda, -- to present

anti-contagionist

Government of India might pursue.

policies

that

the

It was not surprising that the

author of the mandate to the investigators

was none other than

Carter’s critic in London, Cuningham’s ideological soul-mate, the sanitarian Gavin Milroy. … Dr. Gavin Milroy, [eulogised Cunningham and Lewis], who probably has a more extensive and accurate knowledge of the malady … remarks regarding the manner in which, in his opinion, the present enquiry should be conducted…[The investigators were to approach the subject] as if it were a tabula rasa, acquainting themselves … 60 with the circumstances and conditions which influenced its origin and spread.

The

venue of the study was the leper

Kumaon

hills,

established

Commissioner.

accommodated

about 80

was

the

1845

time of

asylum at Almora in the by

Sir

Henry

Ramsay,

the enquiry in 1876, it

lepers. The method adopted for the study

to question each inmate about personal and family history,

particularly the presence or absence of leprosy in ancestors, progeny and spouses. When the Cunningham and Lewis report was published, there was enough in it to enthuse the Sanitary Commissioner. -----------------------------------NAI, Home Department, Medical Branch,. February 1874. Proceedings 64-65.

A telling example of the ingrained anti-contagionism of D.D. Cunningham, is provided in J. Isaacs, “D.D. Cunningham and the Aetiology of Cholera in British India, 1869-1897”, Medical History, 42: (1998) pp 279-305. 60

T.R. Lewis and D.D. Cunningham, Leprosy in India: a Report, Calcutta, Office of the Superintendent of Government Printings, 1877, p 15. Causation controversy in India

The history of the Asylum gives no support to the doctrine that leprosy is a contagious disease, but strong evidence to the contrary…. [W]ith reference to the probable influence of heredity in the propagation of leprosy, the facts elicited and which may, we believe, be accepted as trustworthy, give forth no uncertain sound. There can, we think, be no very substantial argument … to contra-indicate the inference that hereditary taint exercises a most important influence in the transmission of the pest… 61

The authors referred to unnamed

“other serious and insurmountable

difficulties” in carrying out any scheme of mass leper segregation in India, which was a sentiment certain to be endorsed by their anti-leper asylum chief. “[I]t is evident”, they asserted, “that any attempts at stamping it [leprosy ] out by the segregation of leprous persons would prove wholly impracticable… 62

Carter in Kathiawar Although

deprived

the

Government of

India

opportunity for conducting further studies in ‘British India’,

the Carter

was able to fall back on the sympathy and high regard of the medical establishment of his home Presidency. There is no doubt that Dr. Carter is the greatest scientific man we have in the Service and his reputation is believed to be great over Europe. It would be a pity not to let him finish what he says alone remains for him to investigate, so that all that can be known about leprosy in this Presidency can be once for all recorded. 63

The strategy adopted by the Presidency government was to enable a study outside British territory, in the Western India Princely States which were under British political control. In late 1875, on a proposal submitted by the British Political Resident at Rajkot, the princes voted a sum of

Rs. 1,500 for three months, from January to

March 1876, for “aiding the enquiry into leprosy, as this disease -----------------------------------Ibid, pp 71-72.

Anonymous, “Reports on Leprosy”, British and Foreign Medico-Chirurgical Review, 60: (1877) p 141. 63

MSAGD, Vol. 35, 1875, p 435. Causation controversy in India

prevails in parts of the peninsula of Kattiawar… in its home or in the villages in which the lepers are born and reside , and where the causes are supposed to originate the disease…” 64 Carter’s hypothesis

intention

thrown

in undertaking this tour was to test the by

Hansen’s

work,

that

leprosy

communicable from person to person. Carter covered

was

about

six

hundred miles, visited fifty villages and hamlets and examined 262 sufferers. 65

He reported the

“noteworthy aspects” of his study.

… All leper-localities are connected, and they are universally arranged in groups or linear series…. I found no leper village to be isolated, but, on the contrary, that all such villages are connected with others immediately adjoining…. For myself, all these data may be said to point to transmission of the leprous disease by means of human intercourse. 66 [italics added]

If these inferences pointing to communicability of leprosy were correct, Carter concluded, it was legitimate to hope that

absolute

and entire segregation of lepers would, after a few generations be followed by diminution, if not

disappearance, of the disease from

India.

The Final Task Carter’s last efforts in leprosy were lobbying the Presidency government

leper

segregation.

Simultaneously,

his

scientific

interests continued to occupy him, but now they vindicated germ theory. In

1883, at

meeting of the Medical and Physical Society of

Bombay, he used the latest bacteriological techniques to demonstrate

-----------------------------------Ibid.

H.V. Carter, Modern Indian Leprosy.

Ibid,, p 67. Causation controversy in India

the bacillus discovered by Hansen. In a bid to “establish priority” in India, Carter also published photographs of the germs. 67 [see Fig]. The Presidency Government facilitated his scientific work, but his relentless advocacy of asylums, earned only theoretical agreement from the authorities, who balked at committing themselves to a comprehensive and open-ended, leper isolation policy:. …. His Excellency the Governor-in-Council fully recognises the desirability of establishing leper asylums in this Presidency…. But it is evident that provision cannot be made for all the lepers in the Presidency except at a very great cost – so great that however much His Excellency … may wish to alleviate the sufferings of lepers, he cannot undertake to meet the whole of the expenditure with due regard to other claims on the public revenues…. 68

Undeterred, Carter continued to keep the Government abreast of the latest leprosy statistics from Norway demonstrating the sustained decline of the disease in that country. Although he failed to bring the authorities round to his opinion,, one of his pronouncements was destined to become a plank for contagionists after his departure from India: … the direct communicability of leprosy is … a good working hypothesis…69

Assessment There can be no doubt about Carter’s humanitarian concern for the sufferings of lepers,

nor about

his scientific skills, nor indeed

about the prodigious effort he made to promote the establishment of -----------------------------------MSAGD, Vol. 92, 1883, p 73. The Medical and Physical Society of Bombay was established in 1838, its Secretary being Charles Morehead of the Bombay Medical Service. The quarterly Transactions first appeared in 1838. D.G. Crawford, History of the Indian Medical Service, Vol 2, Calcutta, W. Thacker and Co., 1914, p 457. Till the last decades of the nineteenth century, the membership comprised British colonial army and civil medical officers. 67

In 1879, for example, the Bombay Government turned down, on financial grounds, a request from the committee of the Sassoon Infirm Asylum, Poona, for construction of an Hospital for Lepers. MSAGD, Vol. 32, 1879, p 463. . 69 H.V.Carter, “Observations on the Prevention of Leprosy by Segregation”, Bombay Government Gaxette, 30/6/1887. Causation controversy in India

asylums to control leprosy in India. Due to the opposition his views generated in

powerful

quarters in England and India, his

leprosy

career holds up a mirror to contemporary medical controversies as well as colonial anxieties. While he regarded extirpation of leprosy as a colonial duty, the prudent and cost-conscious colonial

state was

resolutely unwilling to involve itself in leprosy control on the terms demanded by Carter. Carter’s scientific integrity was evident from his readiness to correct his opinions on the question of causation as new evidence, or new interpretations of old evidence, became available. However he was also prone to embrace these theories too enthusiastically. During the years when he supported the hereditary hypothesis, he dismissed the fact that most lepers said they did not have leprous relatives as evidence that Indian lepers were too ashamed to tell the truth. Similarly he attributed the decline of leprosy in Norway solely to leper isolation, and Cuningham that

saw no

merit in

the majority of

objections from Milroy and

Norwegian sufferers were not in

asylums. Carter was expend on

naïve about

the colonial state’s

willingness to

establishing leper asylums in India. On

acceptability of

the cultural

large scale compulsory segregation of lepers by

Indians, also, Carter showed a certain innocence. As brought out in Chapter 7, during the leprosy panic years of 1889-1890,

educated

and influential Indians in Bombay strongly attacked his contagionist and segregationist views. conviction that mass

Thus

Carter

proved

mistaken in his

leper segregation was so patently beneficial a

measure for leprosy control, that Indians would immediately see its benefits and support it. … the inauguration of a system … transparently adapted to the wants of the people would … be so directly appreciated that its bare proposal must call forth the approval of the

Causation controversy in India

enlightened Press and Native Opinion -- with the result , it might surely be anticipated, that local aid would unanimously voted… 70

Despite

the wide

admiration in

which his researches were

held, his lobbying for asylums had little influence on the colonial state in formulating leprosy legislation in the last two decades of the nineteenth century. History therefore judges Carter as an impractical theorist, and his vision of an India freed of leprosy by a benevolent and enlightened colonial government, as a pipe-dream.

The Next Chapter This is devoted to another aspect of the leprosy question in which the medical profession and the state played an important role, namely treatment.

-----------------------------------Carter, “Report on the Prevalence”, p 83.

Causation controversy in India

Fig. 2.1. H.V.Carter (Original photograph with the Trustees, Wellcome Trust, London); painting at right is at the Grant Medical College, Bombay.

Fig.2.2. Grant Medical College, Bombay.(19th Century Lithograph)

Fig. 2.3. The J.J. Hospital, Bombay, in the 1860s. (Original photograph in the Bhau Daji Museum, Mumbai).

Causation controversy in India

Fig. 2.4. Carterâ&#x20AC;&#x2122;s Map of the Leprosy Affected Regions of Bombay Presidency. Darker shading denotes high rates.* *H.V. Carter, On Leprosy and Elephantiasis, London, Eyre and Spottiswoode, 1874. Causation controversy in India

Fig. 2.1. H.V.Carter (Original photograph with the Trustees, Wellcome Trust, London); painting at right at the Grant Medical College, Bombay.

Fig.2.2. Grant Medical College, Bombay.(19th Century Lithograph)

Fig. 2.3. The J.J. Hospital, Bombay, in the 1860s. (Original photograph in the Bhau Daji Museum, Mumbai).

Chapter 3 THERAPIES, THERAPISTS AND THERAPEUTICS …diseases desperate grown By desperate appliance are reliev'd Or not at all. 1 State medicine failed, neem, gurjon, ichtyol, exhausted; ;;; arsenic, cashew, chaulmoogra, useless; sulphur, hydrarg [mercury], madar, tuberculin, blood-root, asclepias, lawsonia, thymus, suggested, tried, condemned and worthless seen… 2

This chapter investigates perceptions about leprosy by focusing on medical efforts to cure the disease, and the colonial state's expectations

from such efforts. The search for leprosy cures in

nineteenth century India provides an opportunity to investigates the utilisation of and responses to Indian treatments by the British. The chapter also takes advantage of the subject of leprosy cure to assess what

lessons

Indians trained

in the Western system believed they

had learned from such training. The historian of colonialism, David Arnold, has asserted that the prime concern of Western medicine in nineteenth century India was "the protection of

the

European community, and

those

interests ...

connected with it". 3 Leprosy appears to be an exception to Arnold's thesis. Although for the greater part of the century it was viewed as a misfortune of Indians, as this chapter shows, a

notable amount of

energy and some expense went into investigating its treatment. Not only did the colonial authorities evaluate also imported remedies patients.

indigenous therapies,

discovered overseas

but

for trial on Indian

Another point made by Arnold is that the deliberate

William Shakespeare, “Hamlet”, Act 4, Scene 3, in William Shakespeare: the Complete Works, P. Alexander, (ed.), London, Collins, 1968.

Anonymous, “The Leprosy Dilemma”, Indian Journal of Pharmacy, 1:(1894) pp 107-108. 3

Arnold, “Medical Priorities”, p 179. Therapies, Therapeutics,Therapists

dethronement of

the Indian medical

tradition and the dominance of

Western medicine was a consequence of "a ... conviction [on the part of British doctors] of medicine. Indian

indispensable element of

students

Bombay

the unique rationality" of their system of

the

this was the initiation of

new medical colleges at

Calcutta

and

into the rites and methods of the Western â&#x20AC;&#x153;rationalâ&#x20AC;?

therapeutics. The case of leprosy appears to bear out this argument. .

British interest in Indian Leprosy Treatments-- Late Eighteenth and Early Nineteenth Centuries The passing of the Middle Ages in Europe coincided with such a

striking

decline in the

leprosy "epidemic", that in the

eighteenth and nineteenth centuries. the average European medical man could claim no

professional

expertise in the disease. Colonial

expansion challenged the medical men serving overseas, by bringing home the fact territories,

that leprosy

still stalked

several of the subjugated

especially India. That country also had a

potentially

valuable traditional knowledge base for treatment of this disease. When

the

British

leprosy at the turn of

began

direct

attention

the eighteenth century,

Indian

they showed great

interest in the traditional therapies, though an incipient arrogance was already

evident. 5

1799,

keeping

with

its

Orientalist

commitment, the Asiatic Society of Bengal granted the hospitality of its journal Asiatic Researches to a communication from an Indian on

Arnold, Imperial Medicine, p 12.

M.N. Pearson, "The Thin End of the Wedge: Medical Relativities as a Paradigm of Early Modern Indian-European Relations", Modern Asian Studies, 29:(1995) pp 141-170.

Therapies, Therapeutics,Therapists

the subject of an

indigenous "cure for elephantiasis." 6

The author,

At'har Ali Khan of Delhi, a man "assiduous in medical inquiries", son of the physician to Nadirshah,

gave details of "a

prescription, the

ingredients of which are easily found, but not easily equalled (sic) as a powerful remedy against ... the Judham [the Arabic name for leprosy]" which had been brought to his notice by

"worthy and respectable

Maulavi". The remedy was "an old secret of the Hindu physicians... its efficacy [having] been proved by long experience." 7

The principal

ingredient of the medication was arsenic mixed with black pepper and made into pills. The editor of the journal urged with more than a tinge of condescension that this ancient Hindu medicine ... be fully tried under the inspection of our European surgeons, whose minute accuracy and steady attention must always give them a claim to superiority over the most learned natives; but many of our countrymen have assured me, that they by no means entertain a contemptuous opinion of native medicines, especially in diseases of the skin. 8 [italics in original]

George Playfair and James Robinson:

In the early nineteenth

century the plant with the best reputation as a leprosy curative was madar (Asclepias Gigantea, Calotropis Procera). [Fig.3.1] the most influential enthusiastic James Robinson,

reporters

In Bengal

were George Playfair and

the latter a Medical Officer at the "Hospital for

Insanes" at Calcutta. Playfair emphatically praised it as a “vegetable mercury”, specific in the cure of syphilis and leprosy. He maintained, I have found it very effectual, and in the Jagara or Leprosy of the joints, I have never failed to heal up all the sores and often have produced a perfect cure. 9 6

At'har Ali Khan, "On the Cure of the Elephantiasis", Asiatic Researches or Transactions of the Society Instituted in Bengal for Inquiring into the History and Antiquities, the Arts, Sciences and Literature of Asia, 2: (1799) pp 149-153. Till well into the nineteenth century, leprosy was synonymously known to Western medicine as Elephantiasis Graecorum or Lepra Arabum.

Ibid, p 153.

Ibid. p 151.

Robert Wight, “Observations on Mudar (Calotropis procera), with some Remarks on the Medical Properties of the Natural Order Asclepiadeae”, The Madras Journal of Literature Therapies, Therapeutics,Therapists

It was said that George Playfair’s favourable comments

the bark of the roots of madar as a remedy for leprous and other skin affections, had attracted

much attention in Europe. 10 Robinson

was more tempered in his praise. He agreed that the plant was useful, but reminded readers that benefits were seen only in the milder variety of leprosy, where it

succeeded when

the commonly used mercurial

preparations had failed: I ... tried everything that has formerly been recommended, and very largely, but in vain.... Where mercury has been used, but cannot be pushed any further safely, the mudar rapidly recruits the constitution, heals the ulcers, removes he blotches from the skin and perfects the cure… 11 In the more severe form of the disease, "the madar does harm, and is inadmissible." 12

Whitelaw

Ainslie (1766-1836):

Ainslie,

another

prominent

publicist of madar came to India in 788, and became a surgeon in the East India Company’s Madras Medical Service. A keen student of Indian therapies, his early reports on this subject originally appeared in 1813. 13 His definitive Materia Indica, or some Account of those Articles which are Employed by the Hindoos,

was published in 1826. 14 In this

_____________________________________________________________ and Science. Madras, published under the Auspices of the Madras Literary Society and Auxiliary of the Royal Asiatic Society, 2: (1835) pp 70-86. Robert Wight’s best known botanic work was Icones Plantarum Indiae Orientalis or Figures of Indian Plants. Madras, Franck and Co., 1850. Wight’s career in India (1819 to 1853) was spent in the Madras Presidency. 10 George Playfair, “On the Madar and its Medical Uses. Transactions of the Medical and Physical Society of Calcutta, 1: (1825) pp 77-102. 11

Robinson, "On the Elephantiasis as it Appears in Hindoostan".

Ibid, p 35.

Whitelaw Ainslie, Materia Medica of Hindoostan, and Artisan’s and Agricutlurist’s Nomenclature. Madras, Government Press, 1813. A review of this book from which the above information is obtained, appeared in the Edinburgh Medical and Surgical Journal 12: (1816) pp 347-349. 14

Whitelaw Ainslie, Materia Indica, or some Account of those Articles which are employed by the Hindoos and other Eastern Nations, in their Medicine, Arts, and Agriculture, London, Longman, Rees, Orme, Brown, and Green, 1826. In the same period Ainslie also wrote about leprosy, ascribing the disease to geography and uncleanliness. Ainslie, “Observations on the Lepra Arabum”. Rather Therapies, Therapeutics,Therapists

work,

Ainslie arranged his list of medicinal plants in alphabetical

order, and also included the synonymous appellation of each in Tamil, Telugu, Sanskrit, Persian etc., besides its scientific name in the Linnaean system. He devoted some attention to the merits “in the koostum of the Tamools Gigantea

(lepra arabum)”. of

which was

informants

the milk of

known to his

yeroocum pawl.

the plant

Asclepias

“Tamool vytians [vaidyas]”

By all

accounts

had

“extraordinary effect in purifying the habit, in cases of the loathsome of all diseases, lepra…”. 15 The favourable accounts from Calcutta and Madras about madar caused others in the country to try it. Experiments with the species of the plant indigenous to Carnatic did not tend to confirm the favourable accounts. The physician-botanist Robert Wight (d 1872), suspected, and proved by his studies that the curative effects of msdar were indeed species-specific. 16

Therapeutics Therapeutics is the branch of medicine concerned with the manner of treatment of disease. It was brought out in Chapter 1 that Indian medicine and its early nineteenth century European counterpart had much common ground in respect of Indian

leprosy causation theories.

therapeutics was systematic: The doses of medicines were

carefully and properly regulated by the age, sex, and temperament of the _____________________________________________________________ smugly he reported that he “[had] never seen it affect an Englishman". "This is comfort for John Bull", commented the reviewer of his work in British and Foreign MedicalChirurgical Review, 4:(1826) p 447. 15

Ibid, p 488. The age-old medical association of madar with leprosy cure in Indian medicine is also attested by the status of Calotropis (Asclepias) Procera as the sthala vriksha in the 11th century Chola temple at Suryanar Koil near Kumbakonam in Tamil Nadu. There is a legend that the sage Kalavar was cured of leprosy by propitiating Siva in a thicket of this plant. Neelakanta Sastri KA, The Cholas, Madras University Historical Series, Madras, Madras University Press, 1937. I am grateful to the leprologist Dr. G. Ramu for this information.

Therapies, Therapeutics,Therapists

patient, and the administration of remedies was guided by precise and minute rules.

Where the two systems diverged, and increasingly so

with the decades, was in their manner and style of evaluating therapies and administering them for maximum benefit. Indian

knowledge

leprosy “cures” was based entirely on spontaneous daily experience; Western physicians looked for answers from planned experience in the shape of experiment, observation, and conclusions drawn therefrom. This discrepancy the colonial medical establishment actively sought to remove by bringing subjecting Indian therapies to the discipline of their “rational” enquiry.

Horace Hyman Wilson (1786-1860): Wilson studied medicine at St. Thomas Hospital in London , and arrived in Calcutta in 1808 in the medical service of

the East India

Company. 17

His knowledge

chemistry caused him to be appointed at the Calcutta mint. His interest in Sanskrit earned him the secretary-ship

the

Asiatic Society of

Bengal from 1811 to 1833., and on his return to England in 1832 the Boden professorship of Sanskrit at Oxford, and high posts in the Royal Asiatic Society. With Sanskrit, it

his medical

background

and

knowledge

was not unexpected that Wilson selected

the ancient

Indian knowledge about leprosy and its treatment, as the subject of a contribution

entitled “Kushta or leprosy as known to the Ancient

Hindoos" in the Transactions of the Medical and Physical Society of Calcutta in 1825. 18 As explained in Chapter 1, Wilson found much to approve in the humoral

basis of

Indian etiologic theories

leprosy. He was also willing to concede that Europeans might profit _____________________________________________________________ 16

Wight, “Observations on Madar”, p 71. Dictionary of Indian Biography , C.E. Buckland, (ed.), London, Swan Sonnenschein and Co. Ltd., 1906. 17

Wilson, “Kushta”.

Therapies, Therapeutics,Therapists

from India’s long and extensive experience with treatments, albeit at the

cost of

knowledge

the of

“endurance of more enlightened practice:”.

leprosy,

though

wide,

lacked

Indian

refinement and

sophistication, and was he felt peculiarly suited to medical research by refined Western minds using Western methods. It was on the subject of Indian

therapeutics of leprosy, that Wilson’s scorn

and

dissatisfaction was more than obvious. He listed many prescriptions found in Ayurveda, bemoaning that they included "a prodigious number of the most preposterous and

ridiculous compounds". 19 Other British

students of Hindu therapeutics also thought that its great and besetting sin was polypharmacy, or the inclusion of several drugs

in one

prescription. Wight for example said the “very imperfect knowledge” of Indian physicians about the exact medicinal properties of madar led to “polypharmacy, “which induces them to combine into a single prescription the most heterogenous ingredients”. 20 An anonymous commentator on Ayurveda noted: that although Indian physicians knew about simples (single drugs), “they do not appear to have placed so much faith in them as in the heterogeneous and in the majority of instances inert and nauseating mixtures and potions.” 21

However Wilson reluctantly conceded that

however "absurdly blended" the Indian prescriptions, there was

alternative to native guidance, since the subject was one "with which we [British] are so imperfectly clarify

that the role

acquainted...". Wilson

native information

was

hastened merely

as a

preliminary to more scientific enquiries ... [The] advanced state of medical knowledge in Europe is a sufficient security, that the errors of these guides, imperfect as they undoubtedly are, will not lead us astray; whilst from their long experience, and accumulated observation,

Ibid, p 25.

Wight, “Observations on Madar”, p 75.

Calcutta Review, 8: (1847) p 426.

Therapies, Therapeutics,Therapists

it is possible that hints may be derived, which may lead us to an improved knowledge and classification, if not to a more successful treatment of the disease. 22

Therefore he was hopeful that something valuable might be retrieved from the "chaos". A "Rational" System of Therapeutics 23 Between

1835 and 1845

the

colonial

authorities

laid

the

infrastructure for removing what Thomas A. Wise, historian of Indian medicine, referred to as “the state of ignorance which now prevails over the whole of Hindoostan.”. 24 The first step was the establishment of British style medical teaching institutions in the three Presidencies. In Calcutta, where the first medical college was set up in 1835, "native" students

were

introduced

the

tenets

Western

medical

“rationalism", and a new "Indian" therapeutics was formalized with a Pharmacopoeia in mind. 25

Remarkably, the authors of the new

Pharmacopoeia, William Brooks O’Shaughnessy,

demanded

exacting standards of study and reporting than previously, even from Western doctors in India.. William B. O'Shaughnessy (1809-1889), as the first Professor of Chemistry and Materia Medica -- the branch of therapeutics dealing with the sources, physical characteristics, uses, and

Wilson, “Kushta”, p 3.

A nineteenth century medical dictionary defined “rational” as “a term applied to … treatment when founded on scientific principles, in contradistinction to empirical treatment , founded solely on experience.” Dictionary of Medicine Including General Pathology, General Therapeutics, Hygiene and the Diseases of Women and Children, R. Quain, (ed.), London, Longmans Green and Co., 1894. 24

Quoted in the review of Wise, Commentary on the Hindu System of Medicine, in Medico-Chirurgical Review and Journal of Practical Medicine. 25

W.B. O'Shaughnessy, The Bengal Pharmacopoiea, and General Conspectus of Medical Plants, Arranged According to the Natural, and Therapeutical Systems, Calcutta, Bishop's College Press, 1844 .

Therapies, Therapeutics,Therapists

doses of drugs -- at Calcutta,

enumerated

the

steps

that should

henceforth characterise entries in such a compilation: ... careful scrutiny of the claims to medical repute of native vegetable remedies: botanical identification of each plant, its accurate chemical analysis, preparation of its pharmaceutical extracts in sufficient quantities for clinical researches, and lastly, the researches themselves in Hospital practice. 26

Here was a major departure from the mainly descriptive approach of the early European writers on Indian treatments. O'Shaughnessy opined that even "the best" European work to date on Indian drugs, namely Whitelaw Ainslie's

Materia Indica,

several hundred plants, the practice by Indian

contained only a “catalogue of

products of which were used in medical

physicians.” 27 Although a great

number of the

plants had been identified and named, O’Shaughnessy felt that the work was

yet

incomplete, since hardly any had been subjected to

analysis, and

very

investigation.

The initiation of Indian medical students into the

scientific

aspects

few

O’Shaughnessy. Botany he

gave

had

been made

therapeutics was

twelve lectures

also

the object of

went

clinical

on apace

under

introduced at the Medical College and using

the Linnean system

plant

classification. 28 . So well did Indians learn the new system, that by 1867,

several

indigenous

drugs

obtainable at

native

drug

shops

and used by the Kabeerajes and Hakeems had been introduced into European practice in charitable hospitals and dispensaries, chiefly in Bengal. Western-trained Indian authors of pharmacopoeias now freely

Ibid, p 382

W.B. O’Shaughnessy, The Bengal Dispensatory, Chiefly Compiled from the Works of Roxburgh, Wallich, Ainslie, Wight, Arnot, Royle, Pereira, Lindley, Richard, and Fee, including the Results of Numerous Special Experiments, Calcutta. W. Thacker and Co, 1842, p. xiii.

M. Gorman, “Introduction of Western Science into Colonial India: Role of the Calcutta Medical College”, Proceedings of the American Philosophical Society, 132: (1988) pp 276298.

Therapies, Therapeutics,Therapists

adopted scientific nomenclature in plants

native

to north-east

(Chaulmoogra),

India,

such as

Gynocardia Odorata

Calotropis Gigantea (Akund, Madar),

Asiatica (Thulkuri, brahmi), [Fig.3.3] Such a

their catalogues and listings of

Hydrocotyle

Dipterocarpus laevis (gurjon). 29

development was considered entirely proper by the Calcutta

Review in 1879: The resuscitation of Indian medical science is a noble and useful work which ought to b e performed by educated Hindoos. It is perfectly true that Indian drugs ought to be largely studied as used by medical practitioners in this country…. Upon educated members of the profession … devolves this great and solemn duty, for it is they alone who can discharge it adequately and well. 30

Therapies Traditional

Indian remedies

and imported remedies of plant

origin were subjected to investigation by the Western experimental method in the following decades. The peak period of experiments on leprosy cures was

between

the 1854-1875,

with

several oils of

vegetable origin being subjected to clinical trial.. Chaulmoogra oil:

The physician responsible for bringing this

therapy to the notice of colonial medical academia was Frederic J. Mouat (1816-1897) [Fig.3.9] of the Bengal Medical Service. Mouat succeeded O’Shaughnessy as Professor of chemistry and material medica and became first physician at the medical college. In 1854, he presented for the European medical fraternity, "with considerable reluctance", -- because he had very little personal experience of its use -- "a few remarks upon the Chaulmoogra, [which appears] to have been long known to and prized by, the natives in the treatment of leprosy, and few of the fakirs traveling about the country are unacquainted with its

K.L. Dey, The Indigenous Drugs of India, or Short Descriptive Notices of the Medicines both Vegetable and Mineral in Common Use among the Natives of India, Calcutta, 1867. 30

Quoted in K.R. Kirtikar and B.D. Basu, Indian Medicinal Plants, Vol.1, Allahabad, Lalit Mohan Basu, 1933, p li.

Therapies, Therapeutics,Therapists

properties. 31

Mouat

testified

to the "remarkable and indisputable"

success from application of the oil of

this

plant in one

"well-

marked case of the worst kind of leprosy... that most loathsome and intractable of diseases".

The

plant was well-known among

indigenous populations of north-east India as a treatment diseases, as had been remarked by

the eminent

the

for skin

physician-botanist

William Roxxburgh,(1751-1815) in his Flora Indica.. 32 Mouat’s paper thus served to make respectable what Indians had known empirically for generations. Brahmi oil: The oil of

Hydrocotyle Asiatica or Centella

Asiatica, popularly known as brahmi or thulkuri, made its entry into the treatment of leprosy in the southern part of British India in the 1850s, from intimations that it had been extensively and successfully employed in the French possession of Pondicherry. 33 The French in India had in their turn, received the information from their island colony of

Mauritius, where a doctor

who

himself suffered

from

leprosy, had tried it with marked benefit. Accordingly it was prepared in India and given to 79 lepers in the asylum at Madras. Ir did not live up to its reputation. "The results", said the physician in charge

Mouat’s paper of 1854 reprinted in International Journal of Leprosy, 3: (1935) pp 219-222.

William Roxburgh, Flora Indica or Description of Indian Plants, reprinted literatim from Carey’s Edition of 1832, Calcutta, Thacker, Spink and Co., 1874, p 740. Roxburgh was educated at Edinburgh and came to India in 1776. He was initiated into Botany as Asssistant Surgeon, Madras Medical Service in charge Botanical garden at Samulcotta near Kakinada. He became the first Superintendent of the Botanical garden at Calcutta, and chief Botanist East India Company in 1783. As the author of Hortus Bengalensis and Flora Indica, he was the first to attempt a systematic account of the plants of India. Buckland, Dictionary. 33

A. Hunter, Report upon the Hydrocotyle asiatica. Medical Reports Selected by the Medical Board from the Records of their Office, Madras, Christian Knowledge Society's Press, 1855, p 356. It has recently been pointed out that nineteenth century colonial powers on the subcontinent, despite political rivalries, were not averse to sharing medical information. Mark Harrison, “Medicine and Orientalism”, in Pati and Harrison, Health Medicine and Empire, p 54.

Therapies, Therapeutics,Therapists

the asylum, "have not been quite so satisfactory in all forms of

leprosy,... still the benefits have been sufficiently marked in the majority of cases ... to entitle it to a place in the pharmacopoeia". 34

The Madras

Medical Board, which visited the asylum for an inspection was less impressed.

"It does not

exert any specific curative powers on the

constitutional taint of leprosy..." 35 Cashew nut oil: Another plant had a

longer run in India

origin.

The active

than

remedy

from overseas, which

brahmi, was of

South American

ingredient of the preparation, cashew nut oil,

came from Anacardium Occidentale, [Fig.3.4] a common tree of that continent. The remedy was initially kept a closely guarded secret by the discoverer,

Louis Beauperthuy of Venezuela. His claim of cure

was

confirmed

colony of Trinidad, who British Colonial Office. 36

British doctor from the British West Indies brought the treatment to the notice of the The Beauperthuy

method consisted in the

utmost attention to cleanliness and diet, and the application of the oil to promote blistering and subsidence of the leprous nodules. The Royal College of Physicians of London, when consulted by the Colonial Office, had recommended

that

more trustworthy evidence of the

oil's

efficacy than that provided in America, was required. Gurjon Oil: study

A British

investigator whose leprosy treatment

in 1873 was a model of the Western scientific experimental

method, was James Dougall, medical officer at the Andaman Islands penal settlement. Inspired by

the Beauperthuy

therapy, Dougall

selected for trial a tree abundant and indigenous to the islands and

34 35

Hunter, Report upon the Hydrocotyle asiatica, p 356. Ibid.

Correspondence Relating to the Discovery of an Alleged Cure of Leprosy. Presented to both Houses of Parliament by Command of Her Majesty, May 1871, London, Her Majesty's Stationary Office, 1871.

Therapies, Therapeutics,Therapists

north east India, viz., gurjon (Dipterocarpus Laevis). 37 [Fig.3.5] In his study Dougall

deliberately omitted to supplement his gurjon wood

oil regimen with the customary nutritious diet, so as to keep his enquiry free from all the complications ... because were the diets to be improved during the time the lepers were under this [gurjon] treatment it would have been difficult to determine how much of the improvement was due to increased diet and how far the gurjon oil had contributed to this improved condition...... I took up the subject entirely free from any theories regarding the origin, propagation or transmission of this disease, or the principles upon which a cure ought to be looked for.38

The oil, emulsified with lime water was

rubbed all over the

body after a daily bath, and also internally administered was reported by him to be so well accepted that

"although the lepers ... get half

ounce doses of the emulsion night and morning, they constantly ask for more" Six months of the gurjon oil treatment was "long enough to show that leprosy... cannot only be arrested, but the condition of the lepers can be greatly ameliorated; and men here who for years have not been able to do more than drag out a miserable helpless existence are now able and willing to work, and every sore is quite healed". 39 Dougall's found

much

enthusiastic report about the virtues of gurjon oil

favour with the Government of India, whose medical

adviser at the time was the well-known opponent of contagion theory and state-sponsored leper segregation, the Sanitary Commissioner J.M. Cuningham. 40

The President-in-Council in

1874

anticipated great

advantages in the gurjon oil treatment, not the least of which was Dougall’s claim that it was “not of an expensive kind”: 41

J. Dougall., Report on the Treatment of Leprosy with Gurjon Oil. Calcutta, Home Secretariat Press, 1874. 38

Ibid, p 7.

Ibid, p 14.

Cuningham’s reactions to contagionist demands are detailed in Chapter 2.

Dougall, Report on the Treatment, p 4.,

Therapies, Therapeutics,Therapists

The importance of this discovery to the natives of India, and not only to the natives of India, but to all the many who suffer from the disease in various parts of the world, can hardly be over estimatedâ&#x20AC;Ś. [T]he widest publicity may be given to Dr. Dougall's mode of treatment ... wherever opportunity offers and wherever the medical agencies at the disposal of government can be employed to assist the promotion of the object. 42

Undoubtedly Cuningham had seized on the gurjon oil "cure" as an unassailable

and

segregation from Cuninghamâ&#x20AC;&#x2122;s

suitably economical answer to demands for leper contagionists such

inspiration,

prophesied that

gurjon

useful agent which disease".

the

Vandyke

Carter.

Under

Government of India optimistically

oil :"bids fair to take its place

has yet been

as a most

employed for the cure of this

Accordingly inmates in several leper asylums, including

those in Bombay Presidency, were subjected to the rigors of the therapy, not always with the happy compliance of the subjects of the study. 44 Unfortunately, gurjon oil was also destined to disappoint. In 1877, following reports of lack of success from civil surgeons in various parts of the country, and his own further experience, Dougall retracted

his claims.

A prolonged experience of the use of gurjon oil in the treatment of leprosy in this Settlement has convinced me that the very hopeful prospect held out by this method of treatment of proving a permanent remedy in this disease has scarcely been realised ... 45

Leprosy Therapeutics in Bombay Presidency As befitted its

premier status, the J.J. Hospital at Bombay

was the location of investigations on several leprosy "cures" in the nineteenth century. The hospital had the best professional staff, while after 1862 the leper patients admitted in its "Ward for Incurables"

MSAGD, Vol. 30, 1874, p 33.

Ibid, p 35.

The response of the lepers at Rajkot to this regimen is described in Chapter 8. MSAGD, Vol. 33, 1877, p.55

Therapies, Therapeutics,Therapists

which was erected out of a donated by Rustomhee Jamsetjee Jejeebhoy, had

"the advantage

excellent

hygienic conditions, good and

sufficient food, air, and light, cleanliness,

regular habits and immunity

from privation", to maximise any benefits resulting from therapies. 46 In 1850s the medical attendant for leper patients was Jose Camillo Lisboa, ( d. 1897) [Fig.3.8] "an intelligent Graduate of the Grant Medical College"

deputed

the

first

physician

and

Morehead. (1807-1882). In the matter of therapy highest

confidence

Bauchee

principal

Charles

Lisboa placed the

(Psoralea Coryfolia). [Fig.3.2]

recounted several instances in which the drug had been administered with benefit. 47 Lisboa illustrates that the authorities at the institution encouraged drug trials on leprosy. Information about the Beaupurthuy cashew nut oil remedy reached the Bombay medical establishment in 1871 though Vandyke Carter, Civil Surgeon at Satara, well known for his deep interest in the subject of leprosy. Carter reminded the authorities that the

cashew

nut tree, Anacardium Occidentale, known locally as kajoo, abounded on

the Konkan coast, and

that

its oil could be easily procured

locally, so that "accurate trials might be made of it in government hospitals" in

the Presidency." 48

Between

1868 and 1876 a large

therapeutic trial -- involving 89 subjects -- was carried out at the J.J. Hospital

Sub-Assistant

surgeon

Sakharam Arjun

under the

supervision of the chief physician Henry Cook. [Table 3.1] The oils of chaulmoogra, kowti (Hydnocarpus inebrians), [Fig.3.6] bauchi, gurjon and cashew nut were used in the trial, the results of which are summarised

MSAGD, Vol. 30, 1874, p 106.

J.C. Lisboa, Transactions of the Medical and Physical Society of Bombay, 2 (new series): (1856) p 290; â&#x20AC;&#x153;Papers on Leprosy, read before the Grant College Medical Society, 1873â&#x20AC;?, Indian Medical Gazette, 9: (1874) pp. 269-270. 48

MSAGD, Vol. 32, 1874, p 243.

Therapies, Therapeutics,Therapists

in the Table. No "absolutely new"

remedy was tried

because the

object, as Carter declared, was "to test rather than invent." 49 All the oils

were cheap, abundant and locally available, except chaulmoogra

which had to be obtained from Calcutta. Trials with cashew nut oil were also carried out at the Ratnagiri Leper Asylum, but they proved disappointing. In contrast to anti-contagionists like Sanitary Commissioner Cuningham who pinned their hopes on leprosy cures for the control of leprosy, a distinguishing characteristic of contagionists was scepticism about curability of leprosy.

Carter

was no exception: he doubted

whether the [chaulmoogra] oil had "the power of so destroying the leprous material in the body as to effect a radical cure.. Doubts that chaulmoogra oil was efficacious in all cases and stages of leprosy were confirmed in the Bombay

trial.

The Surgeon-General

William Thom

reported to Government that the results at the J.J. Hospital proved the value of chaulmoogra oil as an ameliorative agent in leprosy,

whose

effect commenced in the early stages of the disease, but there was no satisfactory evidence that the drug was a “cure” for leprosy in the way quinine was for malaria. Carter’s therapeutic nihilism was enhanced by what he had learned about the disease

from his own pathologic

researches and the studies of Norwegian scientists. ... the more we learn of the natural history of leprosy, the less disposed we shall be, as I think, to laud the remedies hitherto tested.50

By the end of the decade hopes of ever curing leprosy were flagging, and by the end of the century, ironically at the “peak of European confidence in the superiority of Western medicine”, 51 there was a growing conviction that the disease was utterly intractable. This fact

Carter, Reports on Leprosy (second series), p. 33.

Ibid, p 34.

Arnold, “Medical Priorities”, p 178.

Therapies, Therapeutics,Therapists

emboldened contagionists measure which

to canvass the control of leprosy by a

had supposedly

worked

well in leprosy-ridden

medieval Britain, and was apparently working similarly in Norway, namely forcibly preventing social intercourse between leprous and nonleprous.

Therapeutic â&#x20AC;&#x153;Rationalismâ&#x20AC;? in Indian Hands The social historian of colonialism, Frantz Fanon, has written perceptively of the conditioning of "native" minds by the colonial experience. He asserts that among "native" doctors conditioning was manifested as ambivalence or even outright rejection of

indigenous

medical practices. The native doctor's behaviour with respect to the traditional medicine of his country is for a long time characterised by a considerable aggressiveness. The native doctor feels himself psychologically compelled to demonstrate firmly his new admission to a rational universe. This accounts for the abrupt way in which he rejects the magic practices of his people... 52

Leprosy therapeutics is used in the following pages to investigate the presence and extent of this characteristic in

two

nineteenth century

Indian physicians trained in Western medicine.

Frantz Fanon, Studies in a Dying Colonialism, London, Earthscan Publications, 1989, p 132

Therapies, Therapeutics,Therapists

Dr. Bhau Daji (1822-1874): 53 [Fig.3.10] Daji entered the Grant Medical College in

A native of Goa, Bhau Bombay in 1845, in the

first batch of students;, graduating with high honours in 1851. After a brief period in Government employ, he chose to become a private practitioner, and soon had a very large practice. Early in his medical career his personal qualities and professional success were the subject of a laudatory editorial in the respected English journal, the Lancet. Dr. Bhau Daji [found] that his own industry and abilities were quite sufficient to command practice.... From this time his career has been one of such prosperity and success as probably none of our first English physicians could boast of in the first ten years of their professional lives, and he now enjoys an amount of practice which notwithstanding the novelty of regular professional men and fees amongst the natives, and their aversion to pay for anything intellectual, a medical man of his age in England would be proud of.... In the midst of an engrossing, laborious and lucrative practice, Dr. Bhau Daji has always been one of the most active citizens and zealous promoters of public improvement and native welfare. 54

From

1853,

he was

assisted in his flourishing practice by his

younger brother Narayan Daji, also a GMC graduate. The leprosy studies of this important medical and socio-political figure of mid-nineteenth century Bombay commented on by many historians. 55

have been

described and

Bhau Daji’s interest in leprosy

Dr. Bhau Daji was a man of many parts. Besides his brilliant student career at the Grant Medical College and later fame as a medical practitioner, he played a prominent part in the Hindu social, educational and political movements in Bombay, being supportive of widow remarriage, female education and greater political representation for Indians in political decision-making. Between 1852-1856 he was President of the Students' Literary and Scientific Society which provided education for girls. From 1865-1873 he was Fellow of the Bombay University and a member of its Faculties or Arts and Medicine. He was also an early campaigner on behalf of the Bombay Association of Jagannath Sunkersett and later the East India Association of Dadabhai Naoroji. While engaged in the leprosy study, and in the midst of a busy medical career he was the first Indian Sheriff of the city. He was also an enthusiastic and talented Indologist and a VicePresident of the Bombay Branch of the Royal Society. His brother Narayan Daji was a keen photographer, and Bhau Daji was a founder member of the Bombay Photographic Society. Dictionary of National Biography, Vol. 2, S.P. Sen (ed.), Calcutta, Institute of Historical Studies, p 1973. 54

Lancet, 20/1/1855.

The definitive biography in Marathi by A.K, Priolkar, includes a well referenced, sequential account of Bhau Daji's leprosy studies, and also an interesting narrative of the author’s solution of the constituent of Bhau Daji’s secret Therapies, Therapeutics,Therapists

was charitable as well as medical, which explains to some extent his efforts to cure the disease.

His

patients

and

the

contemporary

Indian public alike looked on him as the ideal doctor, brilliant and compassionate, the more laudable because of his other attainments. His initial encounter with lepers was at the Nagdevi Charitable Dispensary where he and his brother offered their services gratis. It was a place to which the sick poor generally, as well as lepers, flocked. In his efforts to cure the disease, both "native as well as European medicines were tried, without any marked success….We have found the greatest difficulty in inducing the patients to take sufficiently long time". 56

medicine regularly for a

In 1867 he approached

the Bombay

Government for access to the patients in the Leper Ward of the JJ Hospital

to conduct experiments on a

new

remedy, the nature of

which he refused to divulge to the Hospital authorities. His motive in insisting on secrecy, according to his friend and apologist George Birdwood (1832-1920) was "to have his alleged cure tested [thoroughly], with the intention should its efficacy be thus established, of making it

public." 57

Bhau Daji’s request met with

short shrift from the

_____________________________________________________________ remedy. A.K. Priolkar, Dr. Bhau Daji - Vyakti, Kaal, va Kartutva. Chapters 25 and 26. Death Centenary Volume, Bombay, Mumbai Marathi Sahitya Sangh, 1971; another historian refers to "Dr. Bhau Daji's selfless devotion to the cause of Indian medicine, Indian drugs and Indian medical research..."; D. Keer, Dr. Bhau Daji Memorial Volume. Journal of the Asiatic Society of Bombay, 38 (new series): (1963) Another historian opines that "with this discovery [of the alleged leprosy cure] Dr. Bhau Daji's name must be included in the list of the great helpers of humanity who devote their lives for its betterment and for the reduction of its ills and miseries". T.G. Mainkar, (ed..), Writings and Speeches of Dr. Bhau Daji, Bombay, Bombay University Press, 1971, p 3. The subject continues to be discussed even in the lay press: J.P. Naik, Dr. Bhau Daji Hyani Lavalela Kushtarog Nivarak Aushadhicha Shodh (“Dr. Bhau Daji's Discovery of a Leprosy Cure”), Lokasatta, 20/10/1996. 56

“Report of the Nagdevi Charitable Dispensary from May 1852 to April 1860 and from May 1860 to April 1861”, Bombay, 1863, p. 16. (Quoted in Priolkar, Bhau Daji, p. 315 57

MSAGD Vol. 4, 1869, pp 11-12.. George Birdwood came to India as Assistant Surgeon in the Bombay Medical Service. He was Secretary to the Bombay Agri-Horticultural Society, and was associated with Dr. Bhau Daji in the Committee of the Victoria Museum.

Therapies, Therapeutics,Therapists

physicians of the JJ Hospital who objected "to any of the Hospital patients being treated with an

unknown

remedy or nostrum, as it

would be termed by the profession, because not ours, unknown". 58 Bhau Daji

thereupon

determined to

try

sufferer who approached him for

his "remedy" on any leprosy

relief .

There was no dearth of

suffering lepers who were willing to submit to the rigid dietary and therapeutic regimen required by Bhau Daji’s regimen. Several patients pronounced themselves benefited, and were not averse to publicizing the virtues of the doctor and his [undisclosed] remedy, and defending him against his critics. One grateful patient was the Reverend Vishnu Bhaskar Karmarkar of the Ahmednagar Marathi Mission, who developed leprosy around 1864. 59 It will be granted by all who possess a knowledge of the disease, and have made researches into it, that the time required to remove so terrible a malady, leading to frightful disorganisation internally and externally, and a source of misery to the patient as well as to those about him, is wonderfully short .... Should a person recover in three years from this disease I should not consider the time too long, especially as by this medicine the patient daily feels better and better and the diet and regimen are not severe.

Bombay's medical establishment was in full cry. against Bhau Daji's secrecy, which, they maintained, was

against the

precepts of their

medical canon. His actions had placed him beyond the pale -- out of the "arena of public discussion on the genuineness or otherwise, of his discovery". 60 They also scoffed when circumstantial evidence pointed to the secret remedy being tuvarka or kowti (Hydnocarpus wightiana), [Fig.3.7] a tree indigenous to the West coast of India, and mentioned in Sushruta Samhita. The remedy was

dismissed it as “nothing new.” 61

Ibid. Birdwood used the word "nostrum" in the sense of "of our own make". Concise Oxford Dictionary, 1976 59

Dhnyanodaya, 1/9/1868.

MSAGD, Vol. 8, 1870, p 341.

One bureaucrat at Calcutta sympathized with Dr. Bhau, remarking: “I confess that I rather sympathise with Dr. Birdwood and Dr., Bhau Daji. I don't think his medical brethren are giving the latter fair play; they first discredit his discovery as unlikely to be Therapies, Therapeutics,Therapists

The doctor himself steadfastly insisted that more time was required to ascertain the long term effects of his therapy before he could make it known, and insisted that his stand was in the true spirit of rational medicine. His defence of his actions became in effect a statement of his credo: ... it is of very little consequence, however, whether my remedies are quite new or not. If I succeed in showing that the formidable disease ... can be greatly alleviated and in most cases completely cured, I shall consider that I have accomplished all that either the medical profession or the public should desire.... The ... perseverance of Bhagiratha [is] required, and a Hindu physician and Hindu patients possess both in remarkable degree.... If I were to publish imperfect data -- half a dozen or even a couple of dozen cases treated even for a few months with tolerable success I should not add much to the knowledge of Medicine... Knowing the numerous fallacies that are liable to influence inferences drawn from observations imperfect in themselves, or few in number, I am collecting for the Profession ... data on a large scale (comprising three or four hundred cases) from which to make deductions with regard to cure, conditions of treatment... 62 [italics added]

Jim Masselos the historian of nineteenth century Western India has commented on Bhau Daji’s individualistic synthesis of Western and Indian medical praxis, illustrated in the Doctor’s academic contributions to the Grant Medical College Society. That Society was established in 1854 as a forum for academic discussions by Indian medical graduates in Western medicine. Masselos says Bhau Daji’s

"papers followed the

investigative procedures of Western medical science,

and were not

statements

about the relative merits of European and Asian medical

systems." 63

The

leprosy

studies

too

show

Bhau Daji’s deliberate

incorporation of the Western method, but also in the passionate defense of his secrecy, he explicitly extolled the patience and perseverance which _____________________________________________________________ true, and now say that it is true, but not new. If it is true and not new, more shame to them for not employing it before.” NAI, Home Department. Public Branch. 1871. Proceedings 19/8/1871. 62

MSAGD, Vol. 32, 1871, p 125.

Jim Masselos, “The Discourse from the Other Side: Perceptions of Science and Technology in Western India in the Nineteenth Century”, in Writers Editors and Reformers: Social and Political Transformations of Maharashtra 1830-1930, N. K. Wagle (ed.), Delhi, Manohar, 1999, p 123.

Therapies, Therapeutics,Therapists

supposedly informed the Indian healing art. Daji’s

personality was revealed

Another facet of Bhau

in the leprosy episode, namely his

shrewdness in exploiting expensive Western technology in the form of medical photography, to display the beneficial results of his therapy. Serial photographs were taken of patients to document the changes in their appearance over months and years, to buttress any future claims and presumably to silence the

disbelievers. [Fig.3.12] In the

decade after Dr. Bhau Daji’s death, the drug he re-discovered and probably

experimented

with,

tuvarka

or kadu kavath (Hydnocarpus

Wightiana) became better known to Europeans in Bombay Presidency as a leprosy treatment which gave “satisfactory results.” 64

Dr. Sakharam Arjun (1839-1885) [Fig.3.11] :

This physician’s

pre-medical education was at the Elphinstone Institution. He entered the Grant Medical College in 1858 ,and was awarded the “Licence to Medical Practice” in 1862. In 1863 he joined the staff of the College to teach botany, and was later appointed assistant under the First Surgeon William Guyer Hunter(1823-1902), the first Indian to be so appointed. Sakharam Arjun was for several years in charge of the leprosy sufferers at the "Ward for Incurables" at the J.J. Hospital, and in the 1870s was the physician who actually conducted the therapeutic experiments on chaulmoogra and cashew nut oils referred to above. 65 64

W. Dymock, The Vegetable Materia Medica of Western India, Bombay, Education Society’s Press, 1835, pp 71-72. 65

Sakharam Arjun’s pre-medical education was at the Elphinstone Institution. He entered the Grant Medical College in 1858, and was awarded the “Licence to Medical Practice” in 1862. In 1863 he joined the staff of the College to teach botany to the vernacular medical class. Later he was appointed assistant under the First Surgeon William Guyer Hunter (1823-1902), the first Indian to be so appointed. He also became Superintendent in the Vaccination Department of the Municipality. A progressive, he was deeply interested in women’s education. He was also a founder member of the Bombay Natural History Society in 1883. As a skilled botanist he published a catalogue of Bombay Drugs including a list of the Medicinal Plants of Bombay used in the Fresh State, Bombay, Examiner Press, 1879. Mohini Varde, Dr. Rakhmabai: ek arta, (in Marathi), Bombay, Popular Prakashan, 1991, pp 6-16. Therapies, Therapeutics,Therapists

His

superintendence of the Leper Ward

in the mid-1870s

brought

him into contact with Carter. It was Dr. Sakharam Arjun who acted as

interpreter

Carter’s

interviews

J.J.Dharmashala in the year 1875.

with

the

lepers

the

Sub-Assistant Surgeon's training and continued association with academic medicine at the Grant Medical College was reflected in the methodology in the five-year long drug trials. His plan of study, the style of recording observations, and the mode of analysis of

results

were modern, and showed

familiarity with the experimental method.

presentation and his

thorough

For example he ensured

that all the 89 "patients [were] placed under the same conditions and subjected to the same treatment", [italics added], which enabled him to compare results in various patients, and conclude that the oil was maximally beneficial when used for long periods and if the disease was in the early stage. 68 The type and duration and severity of leprosy was noted in each case, and periodic observations made of progress. A sample of his tabulation is presented in Table 3.2. _____________________________________________________________ 66

Clearly Sakharam Arjun was influenced by Carter both in respect of support for the contagion theory of causation, and the ‘danger’ from the lepers in the Dharmashala. At a meeting of the Grant College Medical Society in 1881, he read a paper on the nature, origin, causes and treatment of leprosy. He remarked that his experience at the Leper Ward made him believe that contagion had more to with the propagation of the disease than heredity. He described the deplorable conditions at the Dharmashala, where lepers with the aggravated form of the disease were crowded together. Segregation, he said, was the only means of “stamping out” the disease. Sakharam Arjun’s association with Carter was not confined to leprosy studies. In the investigation into “famine fever” in 1877-1878, Carter acknowledged the “extra-official“ and “willing and valuable assistance of Mr, Succaram Arjoon…”, who was thus no stranger to the scientific techniques of investigation. H.V. Carter, Spirillum Fever, London, J&A Churchill, 1882, p 31. Carter’s observations on the plight of the leper women in the J.J.Dharmashala are described in Chapter 7. 67

H. Cook, “Report on the Treatment of Leprosy in the Jamsetji Jijibhoy Hospital with the Chaulmoogra oil and on the Employment of Cashew Nut Oil as an External Application”, MSAGD, Vol. 30, 1874, pp 106-128

Ibid, p 110

Therapies, Therapeutics,Therapists

100

In the process of system, and on

imbibing the principles of

the strength of his long

European physicians at the J.J. Hospital,

academic Sakharam

the Western

association with Arjun

came to

identify fully with its ideology, personnel and institutions. In this perception , the "other"

was

decidedly the "native" practitioner who

had the temerity to stake a claim to cure leprosy, and the "we" was the colonial medical establishment.

In the month of March 1872,

the Principal of the Grant Medical College permitted a hakeem -despite Sakharam Arjun's expressed reservations -- to try a leprosy remedy

three

patients. The hakeem

declared

that

"in the

course of a month or so [of the treatment] the men were cured - but the doctor in-charge of the Lepor Arjoon", had "jealousy",

denied his and rejected

Sakharam Arjun

claim

(sic)

Hospital, Mr. Succaram

due to

"biased opinion" and

his requests for funds for further trials.

retorted that he considered

the hakeem to be

"nothing more than an ordinary quack pursuing his usual game". 69 ...I would take this opportunity of throwing out a few suggestions with regards to the treatment to be accorded to persons of the class of the present applicant, who profess to possess cures for leprosy and apply for permission to treat cases at the Hospital. Firstly - that acquainted as we are with the nature of true leprosy, it would be foolish and impertinent on the part of any person to ... induce us to the belief that a remedy could influence this disease in the least degree in the course of ten or twelve days or even two months. Secondly - that the treatment adopted by these men is likely to do material harm as was noticed in a case ... which I believe was produced from arsenical preparations invariably mixed by native quacks in their nostrums for skin diseases and particularly for leprosy. Thirdly - that I have reasons to believe from my knowledge of the quack practitioners in general that the men who were allowed the indulgence of treating cases in the Hospital might take an illegitimate advantage in misleading the ignorant masses of the people outside with regards to their supposed cures.... it is most likely that an idea will in time get abroad that the patients are being made the subjects of experiment by needy adventurers and the reputation of the institution be thereby injured. 70 [italics added]

Assessment 69

MSAGD Vol. 43, 1873, p. 153.

Ibid. Therapies, Therapeutics,Therapists

101

The British from early days, and long before fears that leprosy might pose a danger to themselves, showed a great deal of interest in the treatment of leprosy, and were quite willing to learn from Indian medical experience. Some of the interest was undoubtedly humanitarian. In the context of leprosy treatment, the main contribution of Western medicine was in the introduction of scientific experimental methodology. The effect of a single drug-- whose provenance was never a secret -- was systematically evaluated and recorded. An investigator such as Dougall even corrected for factors such as nutritious diet, which he thought could confound the results. British

interest in leprosy therapy also long antedated any

thought of using

treatment

as a strategy of disease control. That

hope began to be entertained in the early 1870s by a Government of India advised by its conservative, financially prudent and anticontagionist bureaucrats. The Government seized on the cure of leprosy with gurjon oil as a politic and inexpensive leprosy control measure to counter contagionist demands for universal leper segregation. . Western-trained Indian physicians adopted the Western experimental method readily, moving away from the empiricism and characteristic of traditional Indian therapeutics. The

polypharmacy

investigations into

leprosy treatments in Bombay showed that the two Grant Medical College-trained

Indian

practitioners,

namely

Drs. Bhau

Daji

and

Sakharam Arjun consciously incorporated the Western method of enquiry into their work. Sakharam Arjun was a government employee subordinate to the European physicians at the J.J. Hospital, while Bhau Daji was a successful independent medical practitioner, highly esteemed for

his

role in the social, civic and political life of the city.

Both

recognized that the treatment of leprosy was a long process. Sakharam Arjunâ&#x20AC;&#x2122;s tabulations of his years-long observations on the various remedies tried out under his supervision at the JJ Hospital would ring a familiar note with modern practitioners No record exists of Bhau Dajiâ&#x20AC;&#x2122;s Therapies, Therapeutics,Therapists

102

observations and notes, but it is significant that he did not hesitate to utilize photography, a Western technology, to document his results. Of

the two,

Sakharam Arjun

epitomises

Fanon's

colonized

"native" doctor, in his complete alienation not only from traditional methods of prescription, but in his utter contempt for traditional Indian practitioners. It is not surprising to learn that he was known by his friends - probably only half jocularly - as "Lord Sakharam Arjun". 71 Dr. Bhau Daji, on the other hand explicitly

glorified the perceived virtues of a

traditional Hindu physician, implying that he, Bhau Daji, possessed the requisite patience and perseverance that was required to pursue

his

therapeutic trial to a reliable conclusion. â&#x20AC;&#x153;Acculturation" is defined as the process of adopting the cultural traits of another group. In his steadfast refusal to divulge the nature and composition of his therapy, while simultaneously scrupulously observing the discipline of the Western experimental method, Bhau Daji's acculturation into Western medical praxis may be said to have been incomplete.

The Next Chapter The causation controversy had ramifications in India outside of H.V. Carterâ&#x20AC;&#x2122;s work and contagionist opinions. The Indian leper censuses and the findings of the Indian Leprosy Commission of 1890-91 are discussed in the light of their utility for anti-contagionists and eventual colonial leprosy policy. .

Varde, Dr. Rakhmabai, p 9. Therapies, Therapeutics,Therapists

103

Fig. 3.1. Madar (Asclepias gigantea, Calotropis procera)

Fig.3.3. Brahmi (Hydrocotyle asiatica, Centella asiatica)

Fig. 3.2. Bauchee (Psoralea coryfolia)

Fig.3.4.Cashew Nut (Anacardium occidentale) Therapies, Therapeutics,Therapists

104

Fig. 3.5. Gurjon (Dipterocarpus laevis)

Fig. 3.6. Chaulmoogra (Teraktogenos kurzii)

Fig. 3.7. Tuvarka, Kadu Kavath (Hydnocarpus wightiana)

Therapies, Therapeutics,Therapists

105

Fig. 3.8. J.C. Lisboa

Fig. 3.9. F.J. Mouat

Therapies, Therapeutics,Therapists

106

Fig. 3.10. Bhau Daji

Fig.3.11. Sakharam Arjun

Therapies, Therapeutics,Therapists

107

Fig. 3.12. Dr. Bhau Daji’s serial photographs from 1867 to 1870, of his patient Dadajee Narayan, who was reportedly greatly benefited by the doctor’s undisclosed leprosy treatment. (Originals at the Grant Medical College Library, Bombay)

TABLE 3.1 OIL THERAPIES TRIED OUT AT THE J.J. HOSPITAL, BOMBAY. *

Therapies, Therapeutics,Therapists

108

*H.V.Carter, “Reports on Leprosy (Second Series), Comprising Notices of the Disease at it now Exists in North Italy, the Greek Archipelago, Palestine, and parts of the Bombay Presidency of India”, London, Eyre and Spottiswoode, 1876, p 33.. COMMON NAME

ADMINISTRATION APPRECIAION

Chaulmoogra Outwardly and Oil. Inwardly (Teraktogenos kurzi)

f decided utility

Kowti Oil (Hydnocarpus wightiana)

Outwardly and Inwardly

A useful aid

Bawarchi (sic) Oil (Psoralea coryfolia)

Outwardly and Inwardly

Utility doubtful

Gurjon Oil

Outwardly and Inwardly

Utility not apparent

Cashew Nut Oil (Anacardium occidentale)

Outwardly

Utility Local and Temporary

Therapies, Therapeutics,Therapists

109

Table 3.2. Dr. Sakharam Arjunâ&#x20AC;&#x2122;s Tabulation of his observations on a Patient undergoing Chaulmoogra Oil Treatment at the J.J. Hospital, Bombay,1871-1873.*

MSAGD, Vol.1874, p 17. Therapies, Therapeutics,Therapists

110

Fig. 3.1. Madar (Asclepias gigantea, Calotropis procera)

Fig.3.3. Brahmi (Hydrocotyle asiatica, Centella asiatica)

Fig. 3.2. Bauchee (Psoralea coryfolia)

Fig.3.4.Cashew Nut (Anacardium occidentale)

Fig. 3.5. Gurjon (Dipterocarpus laevis)

Fig. 3.6. Chaulmoogra (Teraktogenos kurzii)

Fig. 3.7. Tuvarka, Kadu Kavath (Hydnocarpus wightiana)

Fig. 3.8. J.C. Lisboa

Fig. 3.10. Bhau Daji

Fig. 3.9. F.J. Mouat

Fig.3.11. Sakharam Arjun

Fig. 3.12. Dr. Bhau Dajiâ&#x20AC;&#x2122;s serial photographs from 1867 to 1870, of his patient Dadajee Narayan, who was reportedly greatly benefited by the doctorâ&#x20AC;&#x2122;s undisclosed leprosy treatment. (Originals at the Grant Medical College Library, Bombay)

TABLE 3.1 OIL THERAPIES TRIED OUT AT THE J.J. HOSPITAL, BOMBAY. * COMMON NAME

ADMINISTRATION APPRECIAION

Chaulmoogra Outwardly and Oil. Inwardly (Teraktogenos kurzi)

f decided utility

Kowti Oil (Hydnocarpus wightiana)

Outwardly and Inwardly

A useful aid

Bawarchi (sic) Oil (Psoralea coryfolia)

Outwardly and Inwardly

Utility doubtful

Gurjon Oil

Outwardly and Inwardly

Utility not apparent

Cashew Nut Oil (Anacardium occidentale)

Outwardly

Utility Local and Temporary

Table 3.2. Dr. Sakharam Arjunâ&#x20AC;&#x2122;s Tabulation of his observations on a Patient undergoing Chaulmoogra Oil Treatment at the J.J. Hospital, Bombay,1871-1873.*

* MSAGD, Vol. 30, 1874, p 17.

Chapter 4 THE LEPER CENSUSES AND THEIR USES How many lepers will a kingdom tolerate? 1

This chapter focuses on the leper enumerations carried out in Bombay Presidency and the county in the nineteenth century. It examines the circumstances under which they were carried out. It has been suggested that an important means by which the colonial state in India got to "know" its subjects was by classifying them at periodic intervals. 2

leprosy,

enumerating and enumeration of

sufferers was used by physicians to speculate about the Indian body as a reservoir of the disease. The leper censuses are

examined from

the perspective of the bureaucrats who conducted the operations, and the manner in which British medical men utilised the numbers obtained to promote their favoured preconceptions about the disease. Though

the nature and cause of

the authorities professed that leper enumerations

were necessary if leprosy was to be controlled, the censuses

were

never utilised in that cause by the state. Nevertheless, the decennial reports and tables stand as a valuable resource about a marginalized group in Indian society, as well as being a testimonial to colonial bureaucratic thoroughness. Lepers were first enumerated in the Bombay Presidency in 1867, it was also the first such exercise undertaken in the whole of India. The obtaining of leper statistics,

became progressively formalised in

the following decades, so as to add the requisite aura of objectivity, if not precision, to the enterprise, and to obviate vagueness. For 1

Kalisch, “Tracadie and Penikese Leprosaria”, p 480.

2 Bernard Cohn, “The Census, Social Structure and Objectification in South Asia”,. In An Anthropologist among the Historians and Other Essays, B. Cohn (ed.), Delhi, Oxford University Press, 1987, p 224. The Leper Censuses

110

example Charles Morehead, Principal of the Grant Medical College in 1860 could state only that “leprosy is common in India." 3

Censuses in Bombay Presidency The census of

Bombay city taken

in 1864, during the

governorship of Sir Bartle Frere who was appointed to that post in 1862. That enumeration was also notable because it

included a

category of citizens with “Infirmities”. Possibly this was an earnest of Frere's assurance to the assembled Indian “justices of the peace”, -- the city fathers -- that "the knowledge of the people that is sought for in a census conduces [among other things] to ... sanitary and social improvement." 4

The people with

census included

the “insane” (117 detected),

“blind” (543), and the “lame” (475),

"infirmities"

in a

tabulated

in that

the “dumb” (96),

total city

the

population of

816,562, indicating that handicapped individuals accounted for 15 per 10,000 of the population. Though there was no specific enumeration of lepers, it is quite possible that many were included in the returns for the 'lame'. A need for precise information on leprosy in the Presidency was voiced in the late 1860s. The very elaborate questionnaire on leprosy sent out by the Royal College of Physicians of London in the 1860s, which had elicited a large number of responses from India, but produced no local or countrywide figures on the scale of the problem. 5 However the College’s Report on Leprosy did contain an indication that obtaining leper statistics in India was not likely to be as straightforward as logical British statisticians might hope..6 3

Charles Morehead, Clinical Researches on Disease in India, Vol. 2, London, Longman, Brown, Green and Longmans, 1856, p 665.

A.H. Leith, Census of the Island of Bombay taken 2/2/1864, Bombay, Education Society's Press, 864. Sir Bartle Frere was initiated into sanitary reform by his association with and admiration of Florence Nightingale. Cecil Woodham Smith, Florence Nightingale: a Biography, London, Penguin Books, 1955, p 341.

The questionnaire is listed in Appendix 1.1. The Report on Leprosy of the Royal College of Physicians is discussed in Chapter 1.

One respondent, Dr. W.W. Hende, Civil Surgeon at Nagpur, described the difficulty: “... knowing as he [the European statistician] well does, how difficult it is in this country to conduct the simplest statistical inquiries with accuracy.... That this is not an The Leper Censuses 111

In the Collector

early months of 1866, A.K. Nairne the Assistant

of Ratnagiri

notice of the Collector,

district in the Konkan region, brought to the the pitiful condition of the

numerous lepers

in the streets of the main town. From an informal census conducted by him in fifteen of the larger towns and villages in the district, 233 lepers were counted, of whom as many as 103 were in such an advanced stage of the disease, that he, Nairne, describe

the loathsomeness of the appearance

could "scarcely the

unfortunate

creatures." 7 Nairne sought more information to confirm his impression that

Ratnagiri had more than its "fair share" of leprosy

the

Bombay presidency, if not the country, especially among the poor and ill-fed segments of the population such as the Mahars. 8 He suggested a more

extensive

enumeration

prior to

setting on foot corrective

measures. Nairne's suggestion was not only accepted, but the scope of the proposed enquiry was enlarged by the President of the Sanitary Commission, A.H. Leith, to

cover almost all the British-governed

regions of the Presidency, except Bombay.

Leith advised

that the

tabulation include details such as name, age, sex, caste, religion, and â&#x20AC;&#x201C; in deference to the hereditary theory -- the presence or absence of a blood relationship with another leper. It was stated that the object of the exercise was to collect [d]efinite data upon which to base measures, if these could be carried out, for the relief of the leprous, and possibly in due course, the protection of the community against the spread of the disease. 9 (italics added). imaginary idea, I may state that when it became known that the inquiry was to be instituted, nearly 200 lepers at once left the city, in consequence of a malicious report having been spread that, as some poisoners were about to be transported from this beyond sea, (sic), the Government wished to catch all lepers and ship them off by the same opportunity. Report on Leprosy of the Royal College of Physicians, p 86. 7

MSAGD , Vol. I, 1867, p.363.

Ibid.

Ibid. The Leper Censuses

112

Leith formulated a questionnaire to be filled in by local police authorities, in which caste, and blood relationship of lepers to other lepers formed the dominant theme. 10 This census preceded by half a decade the first Census of India in 1872. The mass of data collected in 1867, and collated and analysed by Carter in 1871, 11 has already been referred to in Chapter 2. Suffice it to say here that the inclusion of “race or caste or sub-division of caste” was not unexpected. It provided justification to British perceptions that the influence of such distinctions was all-encompassing in India, including even the transmission and endemicity of leprosy. Carter applied the necessary scholarly sheen to his sociological

and

comprehensive list of

etiological

theorising,

including

the castes and sub-castes in the Presidency,

prepared for him by the missionary John Wilson, who had an interest in this social feature. 12 On the geographical spread of the disease in the Presidency, Carter found that the worst form of leprosy, namely the “black” or nodular form, prevailed in western India, especially in the "Mahratta country" of Poona,

Ahmednagar,

Satara, and, --confirming

Nairne's surmise-- Ratnagiri. Khandesh was another region [Fig. 2.4 ].

In such

heavily "infested"

districts, the average ratio of lepers to

population was 1 to 500, twice that in the Presidency as a whole, and ten times that in the least affected region, Sind. [Table 4.2].

Ibid, p 362.

Carter’ major conclusions from this study have been examined in Chapter 2.

John Wilson ( 1804-1875) came to Bombay in 1829 as a missionary of the Scottish Missionary Society. A widely read man, and a prolific writer, he was President of the Bombay Branch of the Royal Asiatic Society from 1835 to 1842, and Vice-Chancellor of Bombay University in 1868. He Indian Caste in 1877. The Leper Censuses

113

The Indian Decennial Censuses A simple enumeration -- male, female and total - of four categories of infirm persons, namely the blind, deaf/mute, idiots/insanes, and lepers, was incorporated into the first general census of 1872. The inclusion of this feature became regularised and progressively elaborated in the subsequent decennial

censuses. 13

The tabulation of

infirmities in a

national census was not a nineteenth century colonial innovation. [Table 4.1] Blindness, deaf/mutism and insanity were included in the national censuses in several European and American countries at that time, including Italy, Britain, Argentina and the United States of America. 14

The addition of leprosy to the list of “infirmities” was

peculiar to India, and probably arose from two considerations, namely the

apparent ubiquity

the

disease,

and

its

supposed

easy

recognisability even by the poorly educated enumerators engaged in data collection. The utility of such information in a national census, was explained by J.A. Baines, the Bombay Presidency Census Commissioner in 1881 in health and economic terms: (a) "Physical", which indicated the relative influences affecting health, "either arising from local causes, or attributable either to heredity or personal habit". (b) "Economical", which indicated to the statistician the extra burden thrown on the community by unproductive infirm members.15 The focus on “influences” in the first point exposed the colonial obsession with the

supposed pathogenicity of the Indian

The practice was discontinued after the census of 1931. Despite the great importance attached by colonial officials to the sociological profile of Indians, it was not till the census of 1891 that "Infirmities" were entered on a religion, caste, or race classification. 14

J.A. Baines, Imperial Census of 1881. Operations and Results in the Presidency of Bombay including Sind. Vol. 1, Bombay, Government Central Press, 1882, p 96. 15

Ibid . The Leper Censuses

114

environment, modes of life, and social customs in a disease such as leprosy.

The Census of 1872:

Even though the disease had existed in

India for at least 3000 years, nothing was known of its distribution in various parts of the country, until the enumeration of 1872. It showed that in Bombay city, lepers constituted 3 per 10,000 of the population and 8.5 per 10,000 in the Presidency; the latter rate was the highest of the three presidencies in British

India. The findings of the 1867

census that the disease was frequent in the Konkan and the Deccan, and uncommon

in Sind, were also confirmed. 16

The Commissioner

recognised that errors existed in the data, due to confusion in the definition of "leprosy". There was initial confidence among colonial bureaucrats that "native" enumerators would easily distinguish between "black" or true leprosy

and

"white" leprosy or leucoderma. "[T]he

distinction”, he said, “is well known to the people everywhere, so there ought to be no difficulty on this point." 17 But Sanitary Commissioner Leith’s instructions to include only the “true” leprosy were not attended to, due to bureaucratic bunging, and sufferers from

both

diseases were returned simply as "lepers".

The Census of 1881:

The general census of 1872 had been

conducted piecemeal. In the first simultaneous country-wide census conducted in 1881, the high prevalence of leprosy in

the Deccan,

Konkan and Khandesh [Table 4.4] was once again noted. But this feature

did not impress the Presidency Census Commissioner J.A.

Baines, who had expected it to throw light on whether the body of 16

Lewis and Cunningham, Leprosy in India, pp 437-439.

Census of the Bombay Presidency taken on February 21, 1872. General Report on the Organisation, Method, Agency, etc., employed for Enumeration and Compilation, Part 1, Bombay. Government Central Press, 1875. The Leper Censuses 115

the Indian was lepragenic. "The distribution of leprosy", he declared, "is not a matter of much importance, if ... the disease is not local but personal in its development." 18 (italics added). Baines cautioned

against

unquestioning acceptance of the data, because, "[o]f all the particulars returned at the enumeration, there are none ... even

the

ages ... so

incomplete and vague as those regarding infirmities." 19

In the previous

census he had been optimistic about Indiansâ&#x20AC;&#x2122; ability to identify true leprosy, and blamed bureaucratic negligence for unreliable leprosy data. On

this

occasion,

blamed

native

ignorance, alleging

that

enumerators were unable to distinguish between true leprosy and leucoderma. 20 In addition,

alleged

Baines, errors occurred because

leprosy "is not recognised by natives until it is at an advanced stage." Baines certainly exaggerated the extent of public ignorance, considering the centuries long leprosy experience of

Indian society.

Carter

himself had been impressed by the acuity of popular discrimination of the disease: ... in India where cases are not seldom brought to the surgeon at so early a stage of the disease, that one is almost surprised at its quick detection; the existence of a family taint sharpens popular scrutiny. 21

Baines, Imperial Census of 1881, p 99.

Ibid, p 95.

The allegation is surprising considering that in western India there were colloquially distinct terms for the two diseases, viz., raktapiti for "true" or nodular leprosy, and korh for leucoderma. Rather it was English common parlance that designated the two conditions ambiguously as "black" leprosy and "white" leprosy. The association of leprosy with whiteness of the skin was ingrained in western consciousness. For example, in a contemporary dictionary the usage of the adjective "leprous" was illustrated with the Biblical quotation from Exodus Chap. 4, verse 6: "His hand was leprous as snow." J. Ogilvie, The Imperial Dictionary of the English Language. A Complete Encyclopaedic Lexicon, Literary, Scientific, and Technological, Vol. 3, Blackie and Sons, London, 1882. 21

H.V. Carter, Reports on Leprosy (Second Series) Comprising Notices of the Disease as it now Exists in North Italy, The Greek Archipelago, Palestine, and Parts of the Bombay Presidency of India, London, Her Majesty's Stationery Office, 1876, p 8. The Leper Censuses

116

The third source of inaccuracy in the leprosy census data was traced by Baines to Indian fears and suspicions about the purpose and consequences of census registration. Lepers' families were said to be reluctant to divulge information, because they feared

that the agent

would abuse the information acquired. The data about female lepers was regarded by officials as particularly suspect: only 30 or 40 women were registered for every 100 male lepers, which meant either that males were

naturally

likely -- there was

more prone to leprosy, or -- as seemed more

reticence

and

concealment about

women

sufferers. 22 Given these uncertainties, it was doubtful whether either of

Census Commissioner Baines'

expectations from the leprosy

census - "physical" or "economical" -- could have been fulfilled.

The Census of 1891 [Table 4.5] : This, the last Indian census of the nineteenth century, was also the first in which caste-wise and age-wise tabulation of infirm persons was attempted. It was also the census which focussed the attention of administrators away from the patent uncertainties of "How many lepers?" their tribe increasing?"

Interestingly,

the question "Is

the data in the

1891 census

suggested that the answer was in the negative, though the sceptical J.A. Baines, who was now Census Commissioner for India, found it "impossible to say for certain whether this disease is, in the whole, stationary or not."

He continued to be unsure about the relationship

between the caste, sex, or region-wise statistics and the geographical prevalence of the disease, and declined read more into the data:

Leprosy in India. Summary of Reports Furnished by the Government of British India to His Hawaiian Majestyâ&#x20AC;&#x2122;s Government, as to the Prevalence of Leprosy in India; and the Measures Adopted for the Social and Medical Treatment of Persons Afflicted with the Disease, Honolulu, H.I., 1886, p 15. The Leper Censuses

117

[Therefore] it does not seem advisable to enter into further analysis here in the case of a disease of which so little is known, and regarding which the returns are possibly inaccurate. 23

The Leprosy Censuses and the Indian Leprosy Commission The medical profession proved to be decidedly less inhibited about drawing conclusions from census data than the bureaucrats. As the then hereditarian Carter had done with the figures of 1867, late nineteenth century medical observers too utilised data

from Indian

leper census to serve their ideological agenda. This time it was not for the promotion of hereditarianism, but

for

the rejection of the

contagion theory of causation. One of the consequences of the panic generated in Britain on the death from leprosy of the priest Father Damien in Hawaii in 1889, was the establishment of a National Leprosy Fund with the Prince of Wales as Chairman. As one of its self-imposed tasks the Fund sponsored a three- member Leprosy Commission to India. 24

The two

Royal Colleges -- of Physicians and Surgeons -- each had one nominee on the Commission, while the third was selected by the Fund. 25 fact that

the Royal College of Physicians of London

The

was biased

against contagionism in leprosy has been emphasised in Chapter 1. In deciding its nominee on the Indian Leprosy Commission the College played true to form. Dr. Beaven Rake was Superintendent of the Trinidad Leprosy Asylum, the only member of the three with claim to

J.A. Baines, Census of India 1891. General Report, London, Eyre and Spottiswoode, 1893, p 227. 24

The other two projects undertaken by the Fund were publication of four volumes of the Journal of the Leprosy Investigation Committee 1889-1890, and the award and publication of four Prize Essays on Leprosy by British and European physicians. 25

Wright, Leprosy an Imperial Danger. The dynamic of the anti-leper hysteria of the late 1880s is discussed in Chapters 6 and 7. The Leper Censuses

118

first-hand leprosy experience. 26 Rake’s anti-contagionist credentials could not be faulted: he had earlier expressed himself not convinced that Father Damien's leprosy was proof that leprosy was contagious, i.e., spread by contact. Rake argued that Damien might as well absorbed the leprosy "virus" via

the food,

have

water, or air of

the

Hawaiian leper settlement where he worked. 27 The

mandate given to the Leprosy Commission was a broad

one -- to investigate leprosy in India, including its causation, and to recommend measures for its control and containment. The Commission toured the country for six months from December 1890 to March 1891, examining and questioning over one thousand lepers, and conducting laboratory experiments to cultivate the bacillus claimed

be the

investigations into

cause

leprosy.

After

which

contagionists

completing

their

several possible factors which could affect the

endimicity of leprosy in India, [Table 4.3] the Commissioners withheld their report to await the results of the 1891 census, which they hoped would vindicate their conclusions. The Damien episode had alarmed contagionists in that country. Doomsday scenarios were evoked by sober leaders of London’s medical profession, such as the Queen’s physician Sir Andrew Clark who was of the opinion that leprosy was a “real question”“. The evidence was conclusive, he said, that not only did leprosy exist in larger measure than in recent years, but new “germ centres” were springing up in various quarters, and the old centres were 26

Beaven Rake obtained a Licentiate from the Royal College of Physicians in 1880, and an M.D. from London University. The two other members of the Leprosy Commission were: George A. Buckmaster, a public health man, and Antunes A. Kanthack (18631898) who had been trained in bacteriology. They were assisted by two officers of the Indian Medical Service, A. Barclay and A. Thompson representing the Government of India’s Surgeon-General and Sanitary Commissioner respectively. The situation was reminiscent of the Royal College of Physicians Leprosy Committee in the 1860s where the only one who had seen leprosy was the anti-contagionist sanitarian Gavin Milroy -- discussed in Chapter 1. 27

The place of semantics in the causation debates is discussed in Chapter 1. The Leper Censuses

119

widening, and before â&#x20AC;&#x153;England and the civilised world there is looming a condition of affairs which might by growth threaten civilisationâ&#x20AC;?.28

The

Leprosy Commissioners were keenly conscious that leper numbers were the ammunition in the polemics of the increasingly strident leprosy debate in England: Those who speak of the great spread of the disease can evidently have no other support for their arguments than that afforded by census returns, and they must stand or fall by them... 29

They were also conscious of the fact that the trustworthiness of the leprosy census figures might, as had bureaucrats in previous years, be called into question. Therefore, even as they carefully professed that they were not unmindful of the flaws, the Commissioners pointed out that there was a saving grace: Though these decennial figures cannot be said to have an absolute value, are they altogether worthless? By no means, for they possess a high relative value, which is greatly enhanced as census follows census. 30 (italics added)

They acknowledged that in the first two censuses "the diagnosis was greatly at fault", but opined, contrary to Baines, that with the passage of time, "the diagnostic powers [to distinguish between true leprosy and leucoderma] of the people [had] improved." Further, geographic regions with the highest rates were the same in all the censuses, providing "a distinct confirmation

the

relative accuracy of the figures and

ratios...". The Commissioners accordingly calculated trends in leprosy prevalence in districts which had been enumerated in all three decennial censuses, and found that the national leper ratios per 10,000 worked out at 5.0, 6.0 and 5.0 [Table 4.6] respectively in

the

Times of India, 5/2/1890.

Leprosy in India: Report of the Leprosy Commission in India 1890-91, Calcutta, Superintendent of Government Printing, 1892, p 44. 30

Ibid, p 42. The Leper Censuses

120

decennial censuses of 1872, 1881 and 1891 respectively. 31 [Table 4.2] . The

results

were

highly

gratifying

since

they

enabled

the

Commissioners to conclude: that the evidence of the censuses excludes the idea of an increase of leprosy, and points rather to a gradual decrease at the present time.... Anyway an "Imperial Danger" leprosy has not become as yet, for the previous increase is more than counterbalanced by the present decrease... 32 (italics added)

For the Commission, the utility of the leper censuses was not confined to countering contagionist panic-mongers in Britain and India. The information the members themselves had gathered while questioning lepers, asylum keepers and government officials, combined with census data was used to justify preconceived notions about causation as well. After finding no significant relationship between

the leper rates and

climatic, dietetic, economic and demographic factors, the Commissioners concluded with sanitarian, anti-contagionist sympathies in full play. [The figures] clearly point to the influence of poverty and its accompaniments or consequences on the distribution of leprosy. 33

The minimising of contagion by the Commission in the transmission of leprosy was reflected in its recommendation that systematic leper segregation was unnecessary in India, and that marriages between and with lepers need

not be interdicted because leprosy was not

hereditary. The reception given to the recommendations by the Government of India is examined in Chapter 5.

Assessment This chapter has shown that the colonial Government in the Presidency as well as the country was ever anxious to quantify the leper problem, ostensibly to better plan the measures to 31

Ibid, p 56.

Ibid, p 58.

Ibid, p 131.

deal with it.

The Leper Censuses

121

However the information generated in the leper censuses was put to the greatest use not by policy makers but by medical men to validate ingrained biases about causation. The utility for medical speculations apart, it is necessary to ask why the colonial government went through the trouble of periodic tabulations of lepers. Census Commissioner Baines

routinely

blamed Indian society and

ignorant

Indian

enumerators for providing biased, faulty or false data, from which no reliable statistical or other conclusions could be drawn. The answer is probably that having once been set in motion in 1872, in emulation of the Western practice of quantifying nationally important physical and mental infirmities, it was sheer inertia – or bureaucratic optimism -- that carried the exercise through seven decennial operations, three of them in the nineteenth century. In only one aspect could the returns be regarded as roughly mirroring ground realities, namely in identifying the regions of the Presidency and the country where the disease was specially prevalent, and where it was almost non-existent.[Appendix 4]. About the actual number of lepers, the most that could be said was that it was very large. In the Bombay Presidency with a population of there were

lepers; in the country as a whole at least 105,000 in a

population of 210 million according to the 1891 census. The local Bombay Presidency leprosy census of 1867 provided fodder for Carter’s social-cultural speculations about Indian leprosy, based on the hereditary theory of causation which he at the time strongly supported. The Leprosy Commission which toured India in 1890-1891 was dominated by Beaven Rake, a self-confessed sceptic of

the contagion

theory. The Commissioners were fastidious about following a literal definition

the term

‘contagion’,

and

disproved

their

own

satisfaction the possibility that a leper’s touch might play any role in the communication of the disease. They also proved

to be less

fastidious than bureaucrats about utilising admittedly flawed census The Leper Censuses

122

returns in what they

regarded as the worthy cause of countering

alarmist rhetoric that Indian leprosy was raging and spreading. The anticontagionist, anti-segregationist report of the Commission which was based on census data and their own observations, had a long-term influence in India, since it was acceptable to a cost-paring Government of India. The Commissionâ&#x20AC;&#x2122;s

report

did

not contain any specific

suggestions for containment and control of leprosy. They

And placed

its faith in sanitarian transformation of the country. A report more at odds with Carterâ&#x20AC;&#x2122;s vision of colonial benevolence manifested in statesponsored leper segregation in leper asylums, could hardly be found.

The Next Chapter This and the previous chapters have largely dealt with the factors and processes which affected or were brought to bear on

medical

perceptions, anxieties and practices vis a vis leprosy. . The focus now shifts to the leper himself, and attempts at regulation through changing legal perceptions of him.

The Leper Censuses

123

TABLE 4.1. Bombay City: Numbers and Categories of INSANE

In 1864: 117

IDIOT Not Counted

DUMB

BLIND

LAME

LEPER

EUNUCH

543

475

Not Counted

206

230

881

629

209

In 1872: 9

325

“Infirm” Persons enumerated in 1864* and 1872.**

NOTE: In 1872 lepers comprised 1:3083 of the city’s inhabitants. * A.H. Leith, Census of the Island of Bombay taken 2/2/1864, Bombay, Education Society's Press, 1864. ** Census of the Bombay Presidency taken on February 21, 1872, Bombay, Government Central Press, 1875.

TABLE 4.2. “True Leprosy” in Bombay Presidency: Leper Census of 1867.* District Broach Kaira Thana Ratnagiri AhmedNagar Poona Satara Kaladgi Belgaum Dharwar

Region Gujarat “ Concan “ Deccan “ “ “ “ “

Popln./sq..mile 428 117 107 119 112 143 115 90 174 129

Lepers 554 77 733 1601 1467

Ratio 1:1000 1:2000 1:1200 1:428 1:840

M:F Ratio 7: 1 7: 1 2.7: 1 3.5: 1 5: 1

1077 1214 400 565 314

1:550 1:650 1:1400 1:1380 1:2500

4.5: 1 5: 1 3.9: 1 3.9: 1 4.2::1

*H.V. Carter, “Report on the Prevalence and Characters of Leprosy in the Bombay Presidency, India, Based on the Official Returns on 1867”, Transactions of the Medical and Physical Society of Bombay, 11 (new series): (1871) p 85.

The Leper Censuses

124

TABLE 4.3. “Prosperity” and Leper Ratios in Bombay Presidency

DISTRICT LEPER RATIO LEPER RATIO LEPER RATIO A: Poorest Districts Ratnagiri Kaladgi Ahmednagar Sholapur Satara Thans B: Prosperous

PER 10,000 (1872)

PER 10,000 (1881)

PER 10,000 (1891)

12.1 7.4 14.0 11.9 11.8 8.3

9.3 2.9 10.1 6.8 11.0 8.2

9.7 2.1 7.8 8.0 12.1 6.1

Districts

Kaira 5.2 2.4 1.3 Broach 5.3 2.5 2.2 Dharwar 11.6 1.8 2.0 Kanara 3.9 1.2 0.4 Khandesh 14.8 14.1 11.6 Ahmedabad 2.9 0.8 1.0 Belgaum 10.0 3.3 3.3 in the three Censuses, according to the Leprosy Commission.* NOTE: “Prosperity” was not defined; the Commission considered that density of population and revenue returns were important criteria. *Report of the Leprosy Commission in India 1890-91, Calcutta, Superintendent of Government Printing, 1892, p 106.

The Leper Censuses

125

TABLE 4.4 Distribution of Leprosy in Bombay Presidency, 1881* DISTRICT Khandesh Ahmednagar Poona Kolaba Satara Thana Ratnagiri Nasik Sholapur Bombay City Belgaum Kaira Surat Kaladgi Panch Mahals Dharwar Broach Kanara Upper Sind Frontier Karachi Hyderabad Ahmedabad Thar and Parkar Shikarpur

LEPER-RATIO/ 10,000 17.7 14.4 13.8 11.8 11.5 9.8 9.3 8.5 6.3 6.1 ( Cityâ&#x20AC;&#x2122;s Popln: 773, 196) 4.4 3.3 2.62 2.61 2.4 2.3 1.4 0.6 0.4 0.1 0.1 0.05 0.04 0 .03

*Compiled from (a) Report of the Leprosy Commission in India 1890-91, Calcutta, Superintendent of Government Printing, 1892, p 106, and (b) J.A. Baines, Imperial Census of 1881:Operations and Results in the Presidency of Bombay, Vol. 2, 1882.

The Leper Censuses

126

Table 4.5. Approximate Numbers of Persons Afflicted with Leprosy in the Bombay Presidency and Native States,1891. A. BRITISH TERRITORY DISTRICT

MALES

FEMALES

TOTAL

Bombay City Gujarat Ahmedabad Kaira Panch Mahals Broach Surat Konkan Thana Kolaba Ratnagiri Kanara Deccan Khandesh Nasik Ahmednagar Poona Solapur Satara Kanarese Districts Belgaum Dharwar Bijapur Sind Karachi Hyderabad Shikarpur Thar Parkar Upper Sind Frontier

234

135

369

69 105 55 49 161

27 15 18 28 81

96 120 73 77 242

366 298 800 13

193 166 283 6

559 464 1083 19

1324 312 555 827 488 1187

375 113 140 251 119 301

1699 425 695 1078 607 1488

285 185 245

53 29 86

338 214 331

24 40 46 4 11

31 18 28 3 4

55 58 74 7 15

2503

10,186

GRAND TOTAL

7683

B. NATIVE STATES Native State Gujarat Kutch Palanpur Mahikanta Kathiawar Rewakanta Cambay Surat Agency Konkan Jahwar Janjira Sawantwadi Deccan Bhore Akkalkot Satara Agency Kolapur Southern Maratha Agency Dangs Sargana Sind Khairpur

GRAND TOTAL

Males

Females

Total

19 54 52 302 222 5 36

8 41 13 124 97 3 15

27 95 65 426 319 8 51

26 61 30

10 18 5

36 79 35

113 19 72

30 4 18

143 23 90

724 176

232 51

956 227

3 6 4

1911

643

2554

The Leper Censuses

127

Table 4.6.

Approximate Leper Rates in â&#x20AC;&#x153;British Indiaâ&#x20AC;? at each Census.*

Total Population at Number Of each Census at which Lepers Leper Ratios were Calculated First Census (1867-1872)

Ratio Per 10,000

182,000,000 Second Census (1881)

1000,000

5.0

191,000,000 Third Census (1891)

115,000

6.0

210,000,000

105,000

5.0

NOTE: Only those districts and areas were selected by the Leprosy Commission which were enumerated in all Censuses. To facilitate calculation, round numbers were used, and the ratios were approximate only. It was assumed that the number of lepers in the Central Provinces had remained stationary. * Report of the Leprosy Commission in India 1890-91, Calcutta, Superintendent of Government Printing, 1892, p 56.

The Leper Censuses

128

TABLE 4.1. Bombay City: Numbers and Categories of “Infirm” Persons enumerated in 1864* and 1872.** INSANE IDIOT DUMB BLIND LAME LEPER EUNUCH

In 1864: 117

Not Counted

543

475

Not Counted

206

In 1872: 9 230 881 629 209 23 325 NOTE: In 1872 lepers comprised 1:3083 of the city’s inhabitants. * A.H. Leith, Census of the Island of Bombay taken 2/2/1864, Bombay, Education Society's Press, 1864. ** Census of the Bombay Presidency taken on February 21, 1872, Bombay, Government Central Press, 1875.

TABLE 4.2. “True Leprosy” in Bombay Presidency: Leper Census of 1867.* District Region Popln./sq..mile Lepers Ratio M:F Ratio Broach Gujarat 428 554 1:1000 7: 1 Kaira “ 117 77 1:2000 7: 1 Thana Concan 107 733 1:1200 2.7: 1 Ratnagiri “ 119 1601 1:428 3.5: 1 AhmedDeccan 112 1467 1:840 5: 1 Nagar Poona “ 143 1077 1:550 4.5: 1 Satara “ 115 1214 1:650 5: 1 Kaladgi “ 90 400 1:1400 3.9: 1 Belgaum “ 174 565 1:1380 3.9: 1 Dharwar “ 129 314 1:2500 4.2::1 *H.V. Carter, “Report on the Prevalence and Characters of Leprosy in the Bombay Presidency, India, Based on the Official Returns on 1867”, Transactions of the Medical and Physical Society of Bombay, 11 (new series): (1871) p 85.

TABLE 4.3. “Prosperity” and Leper Ratios in Bombay Presidency in the three Censuses, according to the Leprosy Commission.* DISTRICT

A: Poorest Districts Ratnagiri Kaladgi Ahmednagar Sholapur Satara Thans B: Prosperous Districts Kaira Broach Dharwar Kanara Khandesh Ahmedabad Belgaum

LEPER RATIO LEPER RATIO LEPER RATIO PER 10,000 PER 10,000 PER 10,000 (1872) (1881) (1891)

12.1 7.4 14.0 11.9 11.8 8.3

9.3 2.9 10.1 6.8 11.0 8.2

9.7 2.1 7.8 8.0 12.1 6.1

5.2 5.3 11.6 3.9 14.8 2.9 10.0

2.4 2.5 1.8 1.2 14.1 0.8 3.3

1.3 2.2 2.0 0.4 11.6 1.0 3.3

NOTE: “Prosperity” was not defined; the Commission considered that density of population and revenue returns were important criteria. *Report of the Leprosy Commission in India 1890-91, Calcutta, Superintendent of Government Printing, 1892, p 106.

TABLE 4.4 Distribution of Leprosy in Bombay Presidency, 1881* DISTRICT LEPER-RATIO/ 10,000 Khandesh 17.7 Ahmednagar 14.4 Poona 13.8 Kolaba 11.8 Satara 11.5 Thana 9.8 Ratnagiri 9.3 Nasik 8.5 Sholapur 6.3 Bombay City 6.1 ( Cityâ&#x20AC;&#x2122;s Popln: 773, 196) Belgaum 4.4 Kaira 3.3 Surat 2.62 Kaladgi 2.61 Panch Mahals 2.4 Dharwar 2.3 Broach 1.4 Kanara 0.6 Upper Sind Frontier 0.4 Karachi 0.1 Hyderabad 0.1 Ahmedabad 0.05 Thar and Parkar 0.04 Shikarpur 0 .03 *Compiled from (a) Report of the Leprosy Commission in India 1890-91, Calcutta, Superintendent of Government Printing, 1892, p 106, and (b) J.A. Baines, Imperial Census of 1881:Operations and Results in the Presidency of Bombay, Vol. 2, 1882.

Table 4.5. Approximate Numbers of Persons Afflicted with Leprosy in the Bombay Presidency and Native States,1891. A. BRITISH TERRITORY DISTRICT MALES Bombay City 234 Gujarat Ahmedabad 69 Kaira 105 Panch Mahals 55 Broach 49 Surat 161 Konkan Thana 366 Kolaba 298 Ratnagiri 800 Kanara 13 Deccan Khandesh 1324 Nasik 312 Ahmednagar 555 Poona 827 Solapur 488 Satara 1187 Kanarese Districts Belgaum 285 Dharwar 185 Bijapur 245 Sind Karachi 24 Hyderabad 40 Shikarpur 46 Thar Parkar 4 Upper Sind Frontier 11

GRAND TOTAL

7683

B. NATIVE STATES Native State Males Gujarat Kutch 19 Palanpur 54 Mahikanta 52 Kathiawar 302 Rewakanta 222 Cambay 5 Surat Agency 36 Konkan Jahwar 26 Janjira 61 Sawantwadi 30 Deccan Bhore 113 Akkalkot 19 Satara Agency 72 Kolapur Southern Maratha Agency Dangs Sargana Sind Khairpur

GRAND TOTAL

724 176 3 6 4

1911

FEMALES

TOTAL

135

369

27 15 18 28 81

96 120 73 77 242

193 166 283 6

559 464 1083 19

375 113 140 251 119 301

1699 425 695 1078 607 1488

53 29 86

338 214 331

31 18 28 3 4

55 58 74 7 15

2503

10,186

Females

Total

8 41 13 124 97 3 15

27 95 65 426 319 8 51

10 18 5

36 79 35

30 4 18

143 23 90

232 51

956 227

643

2554

Table 4.6.

Approximate Leper Rates in â&#x20AC;&#x153;British Indiaâ&#x20AC;? at each Census.*

Total Population at Number each Census at which Of Leper Ratios were Lepers Calculated First Census (1867-1872)

Ratio Per 10,000

182,000,000 Second Census (1881)

1000,000

5.0

191,000,000 Third Census (1891)

115,000

6.0

210,000,000

105,000

5.0

Chapter 5 LAWS AND LEPERS This chapter which is concerned with perceptions about leprosy and the leper

as reflected in Hindu

and British Indian

legal

systems, is divided into three Sections. The focus of Section A is the practice reported from certain parts of north India, of assisting in the suicide of lepers supposedly under religious sanction. The claim of post1858 colonial legislators to have successfully “extirpated” the custom is evaluated by referring to their responses to it in the early decades of the century. The evaluation ranges outside Bombay

Presidency,

with

citations of some cases of the practice coming up in the Bengal criminal courts. Section B

studies the fate of property and other civil disputes

involving lepers in

the colonial courts in Bombay Presidency,

examines claims by historians that the British initiated the

and

process

of “somatisation” of leprosy for legal purposes. Section C deals with the secular, -- including public health -- legislation enacted by the colonial authorities between 1840 and 1897, which was directed at the leper. . . The rigidly stratified social system associated with Hinduism through the ages formalised and codified Hindu society’s obligations to its sick and disabled members. The duties towards the sick were based both on concepts of humanitarian and moral action as well as on communal self-interest. The Dharmashastra texts, regarded as depositories of

the code of

moral

behaviour or

righteous

conduct,

contained

references to the civil rights and liabilities of the sick and handicapped, including lepers, in Hindu society. 1 The customary practices sanctioned in the Hindu personal law came under legal and judicial scrutiny during the colonial encounter in the nineteenth century.

Glucklich, “Laws for the Sick and Handicapped”. Laws and Lepers.

129

SECTION A: THE SUICIDE OF THE LEPER

On January 1, 1862 the British enacted the Indian Penal Code (Act 45 of 1860), one of the most important statutes in the modern legal history of India. The enactment was regarded by century

legal

commentators

as Britain’s

attempt to

nineteenth

modernize a

“primitive” ‘native’ criminal justice system which was based on “superstition” and arbitrariness. 2 Another justification for the Penal Code was to obviate the “undue” amount of judicial

discretion awarded to

colonial courts in the early nineteenth century, which had had to contend with three sources of law, viz., British Regulations, Hindu law and Muslim Law. 3 Looking back a quarter of a century on the effects of the Code, Sir Whitley Stokes, member of the Indian Law Commission, boasted in 1887 that …besides repressing the crimes common to all countries, it has abated, if not extirpated the crimes peculiar to India, such as … burying lepers alive … 4

The burial alive of lepers – their assisted suicide – is an opportunity to examine the claim. Also examined is the operation of the “undue” discretionary powers said to have been vested in the pre-1860 judiciary in their encounter with the practice.

Dharmashastra on suicide: The moral dilemma person afflicted with a grievous and incurable

whether a

disease should be

permitted to end, -- and even assisted to end, -- his/her

existence,

troubles modern societies. Dharmashastra texts and their commentaries 2

Discussion in D. Skuy, “Macaulay and the Indian Penal Code of 1862: the Myth of the Inherent Superiority of the English Legal System Compared to India’s Legal System in the Nineteenth Century”, Modern Asian Studies, 32: (1998) pp 513-557.

Ibid, p 519.

W. Stokes, Anglo-Indian Codes, Vol. 1, Oxford, Clarendon Press, 1887, p 71. Laws and Lepers.

130

suggest that such a predicament must have confronted Hindu society in historical times.. The morality of suicide in general was debated by many of the writers on Dharmashastra.

Taking

one’s

life

was

condemned as so reprehensible that obsequies and purification rights -- the elemental

filial duties towards departed ancestors -- were

recommended to be withheld from the suicide. The texts waived the injunction against suicide when incurable and painful disease made life intolerable for the sufferer. The sage Atri, for example was of the view that if … one who is so ill that no medical help can be given, kills himself by throwing himself from a precipice or into fire or water … mourning should be observed for him for three days and shraddha may be performed for him. (italics added) 5

In Manu-Smrti, according

to the commentator Medhatithi who

lived about 900 AD), “[s]uicide is regarded as desirable also in the case of persons suffering from leprosy…” 6 By resorting to suicide or samadh as the practice was known, whether by drowning, jumping off a cliff, burial or burning alive, the sufferer would entitle himself to the customary funereal rites and rituals, and also liberate himself and his family from the affliction in future births. Although there was no explicit sanction for it in the shastras, relatives and friends were known to assist such suicides to express their compassion for the sufferer and as acts of piety. The Early Nineteenth Century Colonial Gaze It is not known how frequent leper suicides were in practice in pre-colonial or early colonial times. Unlike sati suicides, of which 5

P.V. Kane, History of the Dharmashastra (Ancient and Medieval Religious and Civil Law), Vol. 2, Poona, Government Oriental Series, Bhandarkar Oriental Research Institute, 1974, p. 924.

G.N. Jha, (transl.), Manu-Smrti: The Laws of Manu with the Bhasya of Medhatithi. Calcutta, University of Calcutta Press, nd. p 106; J.H. Dave, Manu-Smriti. V-89, Bombay, Bharatiya Vidya Bhavan, 1978, p 18. Laws and Lepers.

131

the

East India Company administration

kept a count,

colonial-era

references to leper suicide are either couched in general terms, as reports of isolated incidents personally observed, or third party accounts. 7 Most

reports of religious leper suicide emanated from Bengal and

today’s Bihar and Uttar Pradesh, though Punjab, Rajasthan and Kathiawar in the Bombay Presidency were not exempt. 8

The practice was seen

among Muslims also, British judges alleging that this was, “under the influence of one of the many superstitions which the Moohammedans have adopted from

Hindoos”. 9 Customary leper suicide might be

placed in the category of sati. That practice was, after a period of politic tolerance by the East India Company administration, successfully legislated against in 1829. 10 Surprisingly, no such fate overtook the custom of religious leper suicide, despite it having none of the sociopolitical undertones of sati. The East India Company was at pains to maintain a semblance of continuity with the past

when it assumed the government of large

tracts of India. In the administration of criminal

justice the courts

were advised to be guided by the written “Mohamedan law” and the 7

A.D. Campbell, “ On the Custom of Burying and Burning Alive of Lepers in India”, Transactions of the Ethnological Sociaty of London, 7: (1869) pp 195-196; William Ward, A View of the History, Literature and Mythology of the Hindoos: Including a Minute Description of their Manners and Customs, and Translations from their Principal Works, Vol. 2, Serampore, Mission Press, 1815, p 313. A description of nineteenth century leper suicides is found in S.S. Pandya, “ ‘Very Savage Rites’: Suicide and the Leprosy Sufferer in Nineteenth Century India”, Indian Journal of Leprosy, 73: (2001) pp 29-38.

Reference to the custom in Punjab is found in E. Bosworth Smith, Life of Lard Lawrence, Vol. I, London, Smith, Elder and Co., 1883, p 173-174; in Rajasthan in C. Aitchison, Rulers of India – Lord Lawrence and Reconstruction of India under the Crown, Oxford, Clarendon Press, 1894, p 140; in Kathiawar in Carter, Modern Indian Leprosy, p 81. 9

W.H. Macnaghten, Reports of Cases Determined in the Court of Nizamat Adalat, Vol. 1 (1805-1819), Calcutta, Baptist Mission Press, 1828, pp 219-220.

“Regulation 17 of 1829”, The Days of John Company: Selections from the Calcutta Gazette 1824-1832, Calcutta, West Bengal Government Press, undated, p 354. Laws and Lepers.

132

fatwas of kazis appointed to assist the judges, and when Hindu religious texts were to be interpreted, by the vyawasthas or interpretations of the shastras produced by court pandits, “excepting cases wherein a deviation regulations

from it may have been of

the

expressly

British government.” (italics

authorized by the added). 11 In

clarification issued in 1821, judges were specifically directed not to exercise their prerogative in cases of assisted leper suicide, because such acts had “the sanction of the “Shastras”. 12

Illustrative Court Cases Four cases of assisted leper suicide came before the criminal appeal court of Nizamat Adalat at Calcutta in the first decades of the nineteenth century, of which two are detailed below as examples of the ‘privileged’ legal status accorded to the leper’s assisted death by colonial judges.. . In

”Vakeel of Government against Badul Khan” (1810), the

man had buried alive his mother-in-law, who being in extremis due to leprosy, had begged to be released from her torment. 13 The charge against the prisoner was that he had performed a burial without ascertaining that the woman was dead. The futwa of the kazis of the lower court was that the man be released since the accusation had 11

J. H. Harrington, An Analysis of the Laws and Regulations Enacted by the Governor General in Council at Fort William in Bengal, for the Civil Government of the British Territories under that Presidency, Vol. I, London, 1821, p 250.

The judicial forbearance towards crimes in connection with leprosy, was explicitly restated by the superior criminal court of Bengal in a resolution dated 25/6/1817: "They recorded ... their sentiments regarding the suicide committed by Hindoos in cases of extreme sickness... The subject was fully discussed by the Court and this description of suicide was considered to resemble, in principle, the female sacrifice of suttee. The Court remarked that although both are within the letter of Section 3, Regulation 8, 1799, “yet neither has been considered within the intention of that Section." IOL, Accounts and Papers (2) East India Affairs, Session 23/1 to 11/7, 1821, Vol. 18: 1821, p 25.

Macnaghten, Reports of Cases, Vol. 1, pp 218-219. Laws and Lepers.

133

not been proved. The judge of the lower court disagreed, and sent the case to the appeal court. However, while acknowledging that there was “a

clear and manifest intention of putting an

end to

the

existence of the sufferer”, the he nevertheless recommended that the prisoner be punished “slightly, for the sake of example” by just six months imprisonment. The Nizamat Adawlat agreed, and in view of “the peculiar circumstances of the case”, the judges did not deem it proper to sentence the prisoner to any further punishment than the six months confinement he had already undergone. In “Vakeel of

Government against Sohawun” (1810),

the

prisoner, a Rajput, was arraigned on the charge of assisting his father to bury himself alive. The father of the prisoner had been afflicted for some time with a leprous disease, from which he suffered so much, that he desired his son (the prisoner) to prepare a pit, and fill it with cow dung and other fuel, to which he was to set fire, that the deceased might cast himself into it and be burnt. The prisoner at first declined; but afterwards the father becoming still worse, prepared a pit, as he desired, and set fire to the fuel with which he had filled it. He then informed the father (the deceased), who repaired to the spot, and threw himself in; some time after which, the prisoner covered up the mouth of the pit. 14

On being consulted, the pandits of Nizamat Adawlat, cited the Puranas to show that no culpability attached to the son since he had promoted

the

spiritual

welfare

the

grievously

expediting his death. The judge of the lower court prisoner.

The

ill

father

exonerated the

appeal Court concurred in the acquittal, and directed

that he be discharged. In two other cases of assisted leper suicide similar judicial forbearance 14

was

apparent. 15

what

might

such

toleration

Ibid, pp 220-221.

In “Vakeel of Government against Sheoo Suhaee and Chotoo”, in 1814 the appeal court judges did not “consider the prisoners to be proper objects of punishment” and immediately set them at liberty. Macnaghten, Reports of Cases, pp 292-293. In “Government against Fukeera, Shubratee, and Nurkoo”, in 1820 the prisoners were sentenced to six months imprisonment. Machnaghten, Reports of Cases, Vol. 2, (1820), pp 18-19. Laws and Lepers.

134

attributed? The evidence suggests that British judges used excuses of non-interference in customary practices, and ‘native’ “superstition” as a façade for their own ingrained prejudices about leprosy. It was the common British perception that leprosy was a uniquely “loathsome” disease, therefore the life of

the sufferer was uniquely pathetic and

justifiably expendable. Thus

the judge of

the lower court in

Sohawun’s case opined, … I think it would be quite inconsistent with that spirit of toleration to punish persons, who, from the strongest motives of piety, have complied with the earnest intreaties of their parents, and have relieved them from an existence, which has become painful to them, disgusting to their friends, and useless to society. 16

Lord John Lawrence, who was Viceroy of India from 1864 to 1869, commented in similar vein on a case of burial alive of a leper coming to his attention when he was posted as magistrate in Etawah and Gurgaon in 1837-1840: Of all diseases that afflict humanity, the leprosy has always appeared to me the most loathsome and hideous…. [Referring to the incident] Punishment [to the relatives of the suicide] was, no doubt, necessary, though I am happy to say it was lenient…. I could not but think that they were to be more pitied than blamed and that, however revolting to our feelings was the manner of putting the unfortunate creature to death, in his [the leper’s] own words, “he had lived too long”. 17

Indian Penal Code The

enactment of

the

Penal

Code

1860

marked

the

secularisation of religious suicides, since suicide per se became a criminal act. Abetment to suicide was also criminalized as culpable homicide. The penalty for abetment was far stiffer than the “slight, for the sake of example”

which

marked

the

pre-1860

judicial

discretionary era. In 1864 the practice of consultation of court kazis and pandits was abolished.

1866

the

case of

Macnaghten, “Vakeel of Government against Sohawun”, p 220.

Smith, Lord Lawrence, pp 173 and 175.

the leper Purein

Laws and Lepers.

135

Singh of Jaunpur district in the North-West Provinces of the Bengal Presidency (today’s Uttar Pradesh), appeared in the police reports. He had been burnt to death by his relatives in a seven feet deep pit at his own request. 18

His seven “aiders and abettors”

were prosecuted

under Sections 300 and 306 of the Penal Code, and sent to prison for an extended period. 19

Assessment Hindu society

accepted that a person with advanced leprosy

was entitled to breach the shastric injunctions against suicide. Such a suicide was even encouraged by assurances that both leper and his family would benefit spiritually. While filial piety, affection, pity and a sense of duty

might have motivated some abettors, it

is possible that

sometimes lepers were ‘induced’ to do away with themselves by greedy or crafty relatives. The British judges, despite their protestations of superiority over Indian ‘superstition’ and ‘savagery’, showed ‘positive discrimination’ in cases of assisted suicide, by invariably sentencing the accused to light or token periods of imprisonment. They also frankly subscribed to the belief that the leper’s life in some circumstances was expendable. Whitley Stokes’ claims on

behalf of

the Indian Penal

Code were probably overstated. At least two other reasons might be proposed for the decline in incidents of assisted leper suicide in the post-1860 period: firstly the establishment of leper asylums with public, 18

private and

missionary

funds,

and

secondly,

and

Campbell, ”On the Custom”, p 196.

Indian Penal Code 1862. (Act 45 of 1860) Section 300: “Except in the cases herewith excepted culpable homicide is murder.. Exception 5: “Culpable homicide is not murder when the person whose death is caused, being above the age of eighteen years, suffers death, or takes the risk of death, with his consent.” . Section 306: “If any person commits suicide, whoever abets the commission of such suicide shall be punished with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine.” The Indian Penal Code 1860. Pocket Edition, Lucknow, Eastern Book Company, 1981. Laws and Lepers.

136

importantly, the “pull” factor of the prospering colonial cities such as Bombay,

where charity, shelter and medical facilities were

readily

available to ill and destitute lepers. Developments in Bombay in the last decades of the nineteenth century, which are examined in Chapters 9 and 10 illustrate these possibilities.

SECTION B: THE LEPER AND THE HINDU CIVIL LAW IN COLONIAL COURTS

This

section

deals

with the civil status

the leper in

Dharmashastra tradition, and examines whether, and in what manner, this was altered when the British set about their self-imposed task of “eliminating uncertainties and inconsistencies” in the traditional Hindu legal system. 20 The shastras for centuries governed the social and legal interaction between Hindus, not only in normal circumstances but when persons with

mental and

physical

handicap

and

incurable

disease

were

involved. Glucklich points out that ‘Hindu law’ -- as Dharmashastra was referred to by the British –- regarded the sick and handicapped as a “special class of legal subject”, sometimes specially privileged, at other times discriminated against. 21 lepers

and other objects of

civil

An example of privilege was that disabilities

were

entitled

“maintained or fed by their family, that is, by their brothers and the 20

R.W. Lariviere, “Justices and Panditas: Some Ironies in Contemporary Readings of the Hindu Legal Past”, Journal of Asian Studies, 48: (1989) pp 757-769.

Glucklich, “Laws for the Sick and Handicapped”, p 139. The privileges of the handicapped included exemption from pre-trial detention, special protection of their property, and immunity from law-suits. Discrimination took the form of exclusion from inheritance, and from testifying. The application of the latter to the leper was removed by the British in 1833: “The fact of a witness being afflicted with leprosy does not bar the admission of his evidence.” F.L. Beaufort, A Digest of the Criminal Law of the President of Fort William and Guide to All Criminal Authorities Therein, Section 390, Calcutta, British Library, 1850. Laws and Lepers.

137

rest.” 22

In view of the joint family structure of Hindu society, the

laws governing the rights and liabilities of the sick and handicapped -lepers

included --

were

incorporated

into

sections

relating

inheritance, ownership and transfer of property. The Leper and Inheritance of Property: Over the centuries two Hindu

personal

legal

systems

based

Dharmashastra,

gained

dominance in India. These were Mitakshara originating in the institutes of Vijnaneshvara and Dayabhaga

under the authority of Jimutavahana.

Mitakshara reigned in the Maratha regions of Bombay Presidency and south India, while Dayabhaga was mainly followed in Bengal. The provisions with respect to inheritance, -- more accurately disqualification from inheritance -- were similar in the two schools and directed at specific classes of handicapped persons including lepers. 23 After the British acquired control of India in the latter half of the eighteenth century, attempts were made to compile easily accessible digests of the Hindu personal law for use in the colonial civil courts. The most famous of the indigenous digests, brought out under the supervision of the judge and Orientalist Sir William Jones (1746-1794), was that compiled by the Benares Brahmin 22

Ibid.

The sage Nareda for instance said: “One afflicted with an obstinate or an agonizing disease, and one insane, blind, or lame, from his birth, must be maintained by the family…”. H.T. Colebrooke, A Digest of Hindu Law on Contracts and Successions with a Commentary by Jagannatha Tercapanchanana, Vol. 3, London, J. Debrett, 1801, p 303. Jagannatha's original consisted of texts compiled from the extant authoritative Dharmashastra literature on contracts and successions; with ample commentaries by the compiler. In its raw state it was not highly esteemed by the early jurists, who thought it "[abounded] with frivolous disquisitions as well as with the discordant opinions of different schools...". It was therefore derided as "the best law-book for a counsel, and the worst for a judge". T.C. Strange, Elements of Hindu Law, London, Parbury, Allen and Co., 1825, p xviii. “Exclusion from Inheritance: Yajnavalkya says [Mitakshara 360] “In impotent person, and outcast and his issue; one lame, a madman, an idiot, a blind man, and a person afflicted with an incurable disease, as will as others [similarly disqualified] must be maintained…”. Whitley Stokes, (ed.), Hindu Law Books: The Vyawahara Mayukha (translated by Borrodaile): The Daya Bhaga of Jimutavahans and The Law of Inheritance from the Mitakshara (translated by Colebrooke): The Dattaka Mimansa and The Dattaka Chandrika (translated by Sutherland), Madras, J. Higginbotham, 1865, p 107. Laws and Lepers.

138

Jagannatha Tercapancanana translating into

English

in the late eighteenth century. The task of

three important

reference

sources of

the

Hindu laws of successions, viz., Jagannatha's Digest, Dayabhaga and Mitakshara 24

was undertaken by another jurist and Orientalist, Henry

Thomas Colebrooke (1735-1867). According to Jagannatha, the sages had decreed that the person

to be excluded

from inheriting property

included One afflicted with an obstinate or an agonizing disease, and one insane, blind, or lame, from his birth… 25

Jagannatha clarified that the term “agonizing disease” referred to “leprosy and the like”. 26 The disqualifications in respect of inheritance and participation in the funeral rite of shradha belief that committed

leprosy was the result of in

birth.

followed from a

a non-specified

“original sin”

Significantly,

inheritance

disqualifications did not apply to all lepers, but only those suffering from the “incurable” ulcerous oozing severe type. A man afflicted with “slight

leprosy ... [retained] his right of inheritance". (italics added) 27

The criterion for civil disqualification of the leper was solely the physical manifestations of the disease, as illustrated in

Jagannatha’s

rendering of Bhavishya Purana: Hear, O priest! The enumeration of various sorts of leprosy, the last worse than the first: blisters on the feet, a deformity in the generative organs, cutaneous fissures, true elephantiasis, ulcers, coppery blotches, black leprosy…. … Among these the leper is the most vile, in respect of all religious acts, who is afflicted with ulcers on all his limbs, especially on his temples, forehead, and nose. 28

Colebrooke, Digest; H.T. Colebrooke, Two Treatises on the Hindu Law of Inheritance, Madras, College Press, 1822.

Colebrooke, Digest, p 303.

Ibid.

Ibid, p. 311.

Ibid, p 309. Laws and Lepers.

139

Interestingly, the shastras held that even the most afflicted leper was not beyond redemption: he could be rehabilitated by atoning for the original “sin” which had purportedly brought on the punishment of leprosy.

The leper thereafter became competent

“to inherit and to

perform acts of religion …when he has performed penance." 29 (italics in original)

Leprosy and the Colonial Civil Courts The historian Jane Buckingham has recently

discussed

the

“conceptual transformation” in the status of the leprosy sufferer wrought by British jurists and judges in their administration of Hindu law in the nineteenth century. 30 She notes that the British gave greater prominence to leprosy per se as an impediment to inheritance than the shastras,

in which the leper was subsumed

grouping of handicapped persons.

into a heterogenous

She argues that the colonial legal

transformation in the status of the leper consisted in “somatisation” or the application of physical criteria of eligibility for inheritance. Also that there occurred a dual process of “Brahmanisation” and “Anglicisation” of Dharmashastra by uniform application of its textual authority to all classes of Hindu society

regardless of their customary practices.

Buckingham appears to over-emphasise the alleged “somatisation” of leprosy by the British, and gives too little credit to the texts quoted above in Dharmashastra which show that the leper’s civil infirmities were already heavily grounded in the severity of physical disease. The British thus were able to utilise already

existing, socially acceptable

somatic criteria of disqualification to create their case law.

Ibid, p 314.

Jane Buckingham, “ ‘The 'Morbid Mark': The Place of the Leprosy Nineteenth Century Hindu Law”, South Asia, 20: (1997) pp 57-80.

Sufferer in

Laws and Lepers.

140

Cases involving lepers coming up before the Bombay courts in the nineteenth century show

that the British

applied

the physical

criteria enunciated in Hindu law faithfully. Judges insisted on proof of the type of leprosy, virulent or slight, in accordance with

the

shastric tenets contained in Jagannatha’s Digest. The case precedent was established by a Madras High Court judgment and facilitated the task in Bombay. 31 The case

Janardhan Pandurang (appellant) vs Gopal and

Vasudev Pandurang (respondents),

was heard before the Bombay High

Court in 1868 as a special appeal against the decision of the District Judge of Thana.. 32

Janardhan, a leprosy sufferer, sued his two brothers,

Gopal and Vasudev to recover possession of a third-share of the family property. The defence was that the plaintiff Janardhan, was not competent to claim his share because he was “an incurable leper.” The District Judge had opined that Hindu law "shows that leprosy though not incurable, disqualifies the leper from inheriting until he is cleansed from his leprosy." It was argued on behalf of the appellant Janardhan, on the basis of the Madras precedent, that in Hindu law only the virulent and aggravated type of leprosy invited disqualification from inheritance; but there was no

mention as to the nature of the

type of leprosy in

his

(Janardhan's) case. The High Court rejected the respondents' plea that the Vyawahara Mayukha -- the legal derivation

from Mitakshara

followed in Western India -- debarred the leper until he was cured. 31

The precedent was Muttuvelayunda Pillai vs Parasakti, decided in 1860, which involved a claim for inheritance of a share of property brought by a son of a deceased leper. The leper’s brother who was the defendant argued that that the deceased leper’s disqualification from inheritance passed on to the son (the plaintiff). The Chief Civil Court at Madras upheld the lower court’s decision in favour of the plaintiff that the deceased leper’s disease, not being of the serious type, did not disqualify from inheritance. Medical opinion was cited to base the judgement. Case cited in Buckingham, “ ‘The Morbid Mark’ ”, p 77. 32

“Reports of Cases decided in the High Court of Bombay 1868-1869”, in High Court Reports, C.F. Farran (ed.), Rajkot, 1915, p 145-147.

Bombay

Laws and Lepers.

141

Citing the same Madras judgement, it reversed the lower court decree, and remanded the case so that the type of Janardhan's leprosy could be ascertained. The same principle was illustrated in Ananta v Ramabai, which came up in 1876, the point at issue being whether the leprosy had to be congenital -- present from birth -- to disqualify the sufferer from inheritance. 33

The dispute involved possession of certain

land. The

Indian Subordinate Judge at Barsi had awarded only a moiety of the land to Ramabai, rejecting her claim for the other moiety, which was to be left

as a provision for Ananta the leper.

preferred by Ramabai the District Judge at Sholapur

the appeal awarded the

whole of the land to Ramabai, on the ground that the congenital leper Ananta could not claim a share in the land. Against this Ananta in turn appealed to the High Court, contending that it had not been ascertained that his leprosy was of the congenital kind. The High Court judgement delivered in February 1877 was a fluent harmonisation of shastric and case law. Their Lordships found that the ancient law giver Manu had been silent on the subject of disqualification for congenital leprosy. Citing Janardhan v Gopal and Pandurang, the judges observed that leprosy to disqualify had only to be of the "sanious or ulcerous kind", synonymous with the

"virulent or aggravated type of leprosy." The

District Judge was therefore directed to ascertain whether the leprosy of Ananta was of the virulent kind. Medical considerations and Hindu law were to the fore also in a dispute over conjugal rights. In Hindu law one of the circumstances which justified desertion was that the person suing for restitution of conjugal rights was suffering from a loathsome disease. 34 Premkuvar 33

Indian Law Reports: Bombay Section. Vols. I & II (1876-1878), Verbatim Reprints, Madras, Published by the Law Reports Office, 1914, pp 554-555. 34

E.O. Trevelyan, Hindu Law as Administered in British India, Thacker, Spink and Co., Calcutta, 1913, p 64. Laws and Lepers.

142

Bai v Bhika Kallianji a matrimonial dispute in 1868, was such a case. 35 The court applied not only the shastric criterion of virulence as laid out

Bhavishya

Purana,

communicability of leprosy

but

also

the

medical

one

to reject the leper husband’s petition. The

Judge opined that the "... the defendant could not live with the plaintiff without very great danger to her health", and behalf of the wife

that the man

was

that the argument

suffering from

loathsome

leprosy was “a good defence”.

Assessment Shastric texts were very clear that the civil disabilities suffered by the leper were predicated solely on the severity of his disease. The characteristics of virulent leprosy were so clearly listed in Bhawishya Purana that no medical man consulted by the courts would have had difficulty

giving

his

opinion on the type of case under

question.[Fig.5.1] British judges, in attempts to detach leprosy from its religious connotation of sinfulness and secularise it, had the benefit of the decidedly somatic blue-print stated in the Hindu texts. This cannot be called a “transformation” by “somatisation”, as alleged by Buckingham.

“Reports of Cases decided in the High Court of Bombay, 1868-1869”, p. 209. Laws and Lepers.

143

SECTION C: CRIMINALISING THE LEPER By what right do I deprive my brother of his liberty? Because he disgusts me… 36

Criminalisation by legislative fiat was a strategy adopted by the colonial regime in India to

control

those

objectionable elements in Indian society. In

considered the case of

leprosy,

legislative criminalisation was justified on two major considerations: firstly that lepers were too ugly to be publicly seen, secondly that they were threats to public health and well-being. These sensibilities may be respectively encapsulated as “leper-is-loathsome” and “leper-is-danger”. A common remedy was put forward to assuage both fears: legislation for the forcible removal of lepers from public view and their compulsory long term confinement in places set apart for them Of the two perceptions leper-isloathsome showed itself to be the more potent and durable. Central, Presidency or Municipal legislative activity against the leper was initiated in 1840, then languished for several decades before peaking steeply in 18891890, followed thereafter by several years of incubation of a Lepers Act, its finalisation in late 1897, and enactment in early 1898. From 1840 to 1897, the liberty of the leper in Bombay was affected by no less than eleven

pieces of specific or fortuitous, local and central, legislation of

varying degrees of stringency with various claims to success or failure. The legislation

listed

Appendix

5.1, 5.2,5.3 and 5.4

Four such

enactments are examined below.

Andrew Wingate, Bombay Civil Service, Collector of Nasik, commenting on the draft of the Leper Bill(which became the Lepers Act of 1898) in 1895. MSAGD, Vol. 61A, 1897, p 21.. Laws and Lepers.

144

City Legislation Three pieces of legislation enacted for promoting the health of Bombay City and ensuring the comfort of its citizens, are considered in the context of leprosy.. Act 22 of 1840: This, the first act affecting the leper’s freedom, followed on the large presence of deformed and disabled beggars in city streets. Lepers

being the majority of this group, were singled out as

especially offensive to urban colonial society’s aesthetic sensibilities. That perception had been voiced as early as the 1820s when the Bombay Courier complained about the large number of mendicants wandering about the streets of the Fort, among whom might be "some unfortunate leper…whom the

eye dreads to scan and who is rendered loathsome by sores and

filth…". 37 By 1840 the mendicant problem in Calcutta was stated to have become intolerable, and the Indian government resorted to Act 22 of 1840,

"...for the punishment of vagrants within the Town of Calcutta

extorting alms by offensive and disgusting exhibitions and practices".

A plea, which proved successful, was immediately made to extend its provisions to the "Islands of Bombay and Colabah". 39 The Act provided for one month’s imprisonment, rigorous or simple, for a convicted of

“extorting”

alms by

person

exhibiting a bodily ailment or

deformity. A second, and following offences invited two months hard labour. Very soon, however several complaints about official lethargy in enforcing the Act were heard, hinting that it was in danger of becoming a dead letter. In 1855 the Senior Magistrate of Police in Bombay defended his Department from the charge of inaction, by pointing to the

judicial difficulties under which his staff laboured.

Bombay Courier, 4/2/1826. The paper was a weekly founded by Luke Ashburner in 1790. Its contents consisted almost entirely of material selected from English papers. 38

The provisions of Act 22 of 1840 are detailed in Appendix 5.1.

Ibid. Laws and Lepers.

145

… Within the last few months hundreds of beggars have been arrested by the Police and placed before the Magistrates, but as very few could be brought within the provisions of the Act as offensively exhibiting bodily ailment and deformity ... all have invariably been discharged after a short detention... 40 (italics added)

But aesthetic outrage was not thereby allayed, and the Magistrate of Police sought to deflect criticism

invoking

the emotive leper-is-danger

excuse: It is] highly inexpedient and dangerous to health to place a large number of beggars in our public prisons which are already over crowded with persons convicted of heinous offences. 41 (italics added)

Undoubtedly he was gratified by support from the highest quarter. The Governor agreed that it would be "expensive and inexpedient to deal with the numerous beggars in Bombay by all

the forms of investigation,

conviction and sentence”. His Excellency recommended

that

Bombay

police needed to follow London’s example “of exhorting all persons and especially mendicants ‘to keep moving’ ”. His Excellency was confident that if his suggestion was followed, “the evil complained of will thus be remedied."

That fatuous hope was of course, belied; the Act of

1840 proved to be unenforceable, and did become a dead letter. Its demise showed that future legislation centred solely on the leper-isloathsome sentiment was not likely to succeed . City of Bombay Municipal Act of 1888:

The public health

sections of Bombay city’s municipal legislation were

enacted

for

preventing the spread of “dangerous diseases, such as cholera. 43 Section 424 of the Act for example permitted “ the Commissioner or any Police

MSAJD, Vol. 126, 1855, p 118 et seq.

Ibid.

Section 421 of the Municipal Act for example said “Dangerous disease means cholera and any endemic, epidemic or infectious disease which the life of man is endangered. ” Details of the relevant provisions of the Act are in Appendix Laws and Lepers.

146

official empowered by him…on a certificate signed by the executive health officer, direct or cause the removal of any person who is … without proper lodging or accommodation…and suffering from a dangerous disease, to any hospital or place at which patients suffering from the said disease are received for medical treatment.” The attempt to apply the legislation to leprosy in the late 1880s proved of no avail. The Education Inspector T.B.Kirkham initiated the attempt by informing the Municipal Corporators of the grave danger posed to their children by congregations of ulcerous lepers congregating near schools and colleges: : More than once I have seen with his own eyes, lepers scratching their open sores on the angular iron bars of the railing surrounding the Elphinstone High School and directly afterwards the boys of the School let loose from their classes, sitting on the same railings and rubbing their naked feet on the places just before used by the lepers.. 44

The

Municipal

Commissioner

E.C.K.Ollivant

agreed

that

“undoubtedly” leprosy was a dangerous disease, but pleaded helplessness because the existing Municipal legislation against epidemic diseases could not be sustained when lepers were involved. The Municipal Corporation proved equally unable to enforce sanitary legislation in other matters when lepers were the offenders. The case of

Rama Tookia, a leper

butcher,

caused

some

excitement in the city in July 1889, and illustrated the impotence of the law when dealing with even minor offences committed by lepers. The man was charged by Municipal inspectors with bringing meat unfit for human consumption into the city. The Magistrate fined him Rs.50, but did not imprison him. The Magistrate pointed out

that there was considerable

objection to sending Rama to jail, “as there was no means of segregating him from the other prisoners except by subjecting him to a good deal of hardship. If he were sent to prison, he would have to be incarcerated in the civil side of the jail for about fifteen days at the expense of Government,

MSAGD, Vol. 64, 1890, p.44 Laws and Lepers.

147

and at the risk of spreading the disease to the other prisoners. 45 It was a virtual re-play of the state’s admission of the law’s impotence put forward in 1855. As on the earlier occasion, the Police Commissioner in 1889 also bitterly complained that though lepers were "steadily on the increase", the existing legislation had proved infructuous because the Magistrates refused to convict. 46 “The scandal is as bad as ever. In the present state of the law the lepers are masters of the situation”, he asserted. " 47 In reality the state’s problem was not the Magistrates’ reluctance to convict, but the futility of applying quarantine measures and other public health legislation designed for short-lasting diseases like cholera or small pox, to a chronic disease such as leprosy. Hospitals for temporary admission sufficed for the former,

while subscribers to leper-is-danger

philosophy demanded nothing less than life-long quarantine – isolation -- of lepers. There were also persons in high places in India who questioned the supposed infectious-contagiousness of leprosy. To compound matters, though the

authorities

had

powers

to remove

lepers

supposedly

endangering the public health, they had none to detain leper offenders for an indefinite period of time. It boiled down to the fact that there was no place in the city constructed exclusively for the isolation of lepers arrested and convicted under public health laws. In effect in early 1889 the Presidency Government and especially the city fathers of Bombay found themselves under pressure from the leper-is-loathsome and leper-is-danger lobbies.

L.W. Michael, History of the Municipal Corporation of the City of Bombay, Bombay, Union Press, 1902, p 305.

About 430 lepers were enumerated in Bombay city in the census of 1881. T.S.Weir, the Municipal Health Officer, estimated that there were twice that number in 1889. 47

MSAGD, Vol. 64, 1890, p 239 Laws and Lepers.

148

Bombay Act 6 of 1867:

This Act is considered at this stage,

because in 1890 it was discovered that this legislation enacted almost a quarter of a century earlier “for the better sanitary management of Bombay”, showed great promise in the city’s drive against its leper beggars. The project, which proved successful, to bring the leper under the purview of the Act was the brain-child of H.A. Acworth, who was appointed Municipal Commissioner in June 1890. 48 Like the unsuccessful Municipal legislation of 1882, the Act of 1867 was a public health measure. There were however two crucial differences. The latter Act was designed to “check the spread of infectious diseases dangerous to life” (italics added) by forcibly removing affected persons from public places under pain of the provisions of the Indian Penal Code. 49

Secondly

the

Act of 1867

empowered the

authorities to notify places to serve as “sanitaria” or isolation houses under the Act to provide the necessary isolation for “infectious” persons. If the Act could be invoked, it would arm the Municipal Commissioner with the stick he needed to clear the streets of Bombay of offensive leper beggars, as well to notify a place or places to isolate them since they were suffering from “an infectious disease dangerous to life”. All that was required was to summarily declare that leprosy was such a disease. This was accordingly done by the Presidency Government, notwithstanding the controversy surrounding the cause of leprosy. At one stroke Acworth was able to subdue the twin

perceptions of leper-is-loathsome and leper-is-

danger. His strategy to establish a leper shelter in Bombay under the Act are examined in Chapter 9.

Chapter 9 is devoted to the efforts of Acworth to establish a place of confinement for lepers in Bombay. 49

Sections 269 and 270 and 271 of the Indian Penal Code are listed in Appendix 5.1. Laws and Lepers.

149

Central Legislation As the next chapter brings out, the period 1889-1890 was one of high panic about the danger of leprosy. Charges of official “dilatoriness” in moving against lepers compelled the Central Government in 1889 to come out with draft of leprosy legislation.

Draft Leper Bill to make Provision for the Isolation of Lepers and the Amelioration of their Condition: 50 The dual aims of the Bill reflected Calcutta’s awareness of the fact that the forcible isolation of lepers with penalties for offenders by itself would not be acceptable to Indian public opinion without the added humanitarian provisions. The Bill empowered a District Magistrate to “order the arrest of any person whom he believes to the 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…” While it permitted lepers to voluntarily isolate themselves in “retreats”, in effect the legislation was targeted specifically at leper vagrants and beggars. Anyone who escaped was to be re-arrested and returned to isolation. In the all-important matter of paying for enforcing the legislation, the Central Government adroitly laid the responsibility at the door of provincial and local bodies, cash-strapped as those bodies always were. Local funds were expected to maintain leper asylums out of scarce resources earmarked for hospitals, dispensaries and the like. Once a leper was admitted in an asylum, there was no hope of his ever being free again without the law's permission. The draft bill of 1889, however, was not destined to appear on the statute books. The beggar leper obtained a reprieve. Calcutta, pressed by London, decided to postpone legislation pending the visit of the Leprosy 50

The provisions of the draft bill of 1889 are listed in Appendix 5.2 The opinions of British and Indian colonial society on the proposed legislation are considered in Chapter 6. Laws and Lepers.

150

Commission to India in 1890-1891.

The visit and report of the

Commission have been referred to in Chapter 4.

The Lepers Act of 1898, drafted 1895: The Leprosy Commission of 1890-1891 had said that the attribution of the decline of leprosy in Norway to compulsory isolation was “completely erroneous.” The Commission’s “practical suggestion” was therefore for “the adoption of voluntary isolation [of lepers] as extensive as local circumstances allow”. Such a scheme could be counted on to win the support of the Government of India, who, as has been shown in previous chapters, never shown

much

enthusiasm for expensive leprosy systematic control measures. The stand of the

Leprosy Commission that leprosy

was neither contagious nor

hereditary was as expected, not challenged by the authorities in India. The Leprosy Commission interventionism – or at

provided the necessary rationale for the nonthe most

minimal interventionism -- always

favoured by the Government of India in the matter of leprosy.. The fact that the Lepers Act of 1898, “to provide for the segregation and medical treatment of pauper lepers and the control of lepers following certain trades” 51 was drafted in 1895, introduced into the GovernorGeneral’s Legislative Council on July 30, 1896, and enacted nearly two years later, illustrated that pressure on the Government of India from contagionists and other urban lobbies had eased in the post-Leprosy Commission period. The leper-as-danger anxiety having been shown to be untenable in the Commission’s report, colonial legislation reflected the more enduring leper-is-loathsome fear. As in the draft legislation of 1889, the Lepers Act of 1898 frankly targeted the poor and vagrant urban lepers who were the most visible – and in colonial society’s eyes, the most dangerous– manifestations of leprosy. In accordance with the recommendations of the 51

The Gazette of India, Part 4, 5/2/1898, Calcutta, Government Central Press, 1898. Laws and Lepers.

151

Leprosy Commission it also forbade leper bakers, butchers, dhobis, cooks, etc., from carrying on their occupations. 52 This appeared to be a curious throwback on medieval European anti-leper legislation

The

exclusion of the well-to-do leper from the purview of the Act owed a great deal to the political exigencies of the plague epidemic of 1897, which saw an

assertive Indian educated class demanding exemptions from

compulsory isolation. 54 In August 1897 Hindu newspaper of Madras had warned: We need hardly mention that any attempt at compulsory segregation of lepers of well-to-do families will be as vigorously opposed as the segregation of plague patients was… 55

In 1895, as a prelude to drafting the Lepers Act of 1898, a Resolution of the Government of India in the Home Department aired its responses to four recommendations of the Leprosy Commission. The first was that lepers be prohibited from carrying out certain trades. The Government agreed that the “object … to protect the public from dealing unwillingly (sic) with leper tradesmen…may be secured if prohibition is confined to Municipalities and the larger fairs….”. The second dealt with preventing mendicant lepers from thronging to the large cities. The Government stated that vagrant lepers ought to be dealt with in the same way as lunatics, i.e., by placing them in asylums. The third recommendation was that leper asylums be built “near towns”, which the Government declined to accept without “further consideration”. The fourth that competent medical opinion be consulted before branding any person a leper, was accepted. Times of India, 31/3/1895. It was revealing of the British attitude that “leper” for purposes of the contemplated legislation, was defined as someone with ulcerating leprosy. 53

“The Writ de Leproso Anovendo lieth, where a man is a Lazar, or a leper and is dwelling in any town and he will come into the Church, or amongst his neighbours where they are assembled, to talk with tem, to their annoyance and disturbance then he or they may sue forth that writ for t o remove him from their company. But it seemeth, if a man be a leper or a lazar, and will keep himself within his house, and will not converse with his neighbours, that then he shall not be moved out of his house. But there are divers manners of Lepers but it seemeth that the Writ is for those lepers who appear to the sight of all men that they are lepers by their voice, and their sores, and the putrefaction of their flesh, and by the smell of them. H.H. Scott, History of Tropical Medicine, Vol. 1, London, Edward Arnold, 1939, p 580. Proscriptions against going “into the bake-house or brew-house”, and handling “what is for the common use of men”, were other features of medieval anti leper laws. Newman, “On the History of the Decline and Final Extinction of Leprosy”, p 17. 54

The political strains of the plague epidemic are discussed in Catanach, “Plague and the Tensions of Empire”. . 55 Quoted in Lancet, 12/8/1898. Laws and Lepers.

152

As a further concession to Indian anxieties, medical and judicial safeguards were incorporated into the Lepers Act against wrongful confinement, and relatives were permitted to stand surety to care for a convicted leper. Unlike in the draft bill of 1889, life-long segregation and enforced celibacy were not made mandatory in Government-run or recognised asylums. Assessment Act 22 of 1840 was enacted solely on the leper-is-loathsome premise.

It became a dead letter because the colonial government

experienced difficulty in imprisoning them in common jails. Although attempts were made to bring lepers within

the leper-is-

danger agenda, as in the Bombay City Municipal Act of 1888, they were acknowledged to be total failures. The contagionist doctrine on which this legislation was based could not be applied in a chronic disease where the minimum requirement was seen to be life-long “quarantine” or isolation. Magistrates were also reluctant to send lepers offending against other public health laws, to jail because no facilities existed to isolate them from healthy criminals. The great merit of Act 6 of 1867, as the authorities saw it, was that it empowered them to notify certain places be they situated in Bombay city, or other regions of the Presidency. as isolation “sanitaria”

for lepers.

Despite the fact that

the

supposed

“infectious” nature of leprosy was not unanimously accepted in official circles in late 1880s India, the Presidency Government took it on itself to notify the disease as infectious and dangerous to life as required by the Act. Municipal Commissioner Acworth was thereafter able to proceed with his plan to rid the city’s streets of leper vagrants and beggars. This was an exquisite instance of the leper-is-danger argument in the service of the true anxiety, namely, leper-is-loathsome. With respect to central legislation, the draft bill of 1889 had some pretensions to leprosy prevention by isolating lepers and preventing leper Laws and Lepers.

153

procreation. The real nature of the legislation was

apparent in that

compulsion to enter an asylum was to apply only to leper beggars or those without means of support. The Government of India adroitly

laed the

responsibility for funding leper asylums at the door of local bodies. The Leprosy Commission’s discountenancing of the likelihood of leprosy transmission by contagion, gave the beleaguered Government of India a much-needed rationale for minimal legislative intervention in leprosy. The “practical suggestions” of the Commission that isolation be voluntary and compatible with local conditions was accepted. The anti-contagionist Commission’s baseless and quixotic suggestion that the sale of articles of food and drink by lepers and leper prostitution be prohibited was also accepted.

The Lepers Act of 1898 was not only directed against

the hardy colonial bug-bear, the leper beggar, but created paupers out of lepers who followed certain prohibited trades and callings. The interests of urban society were therefore considered to be paramount at all times. The rural leper beggar or butcher was left undisturbed. He did not intrude on the aesthetic sensibilities of

urban society.

One might legitimately conclude that colonial governments had no leprosy containment policy for India. Of the two dominant perceptions about the leprosy sufferer, leper-is-loathsome proved to be more durable and potent in framing legislation than leper-is-danger. Both Act 22 of 1840 and the Lepers Act of 1898 were directed at urban lepers who solicited alms by “exhibiting sores, wounds and bodily deformity…” 56

The Next Chapter The next chapter deals with the opinions and perceptions about the leper and leprosy among the British and educated Indians in the latter half of the nineteenth century.

Gazette of India, 5/2/1898. Laws and Lepers.

154

Fig.5.1. According to Bhawishya Purana, â&#x20AC;&#x153;That leper is most vile, in respect of all religious acts, who is afflicted with ulcers on all his limbs, especially on his temples, forehead, and nose.â&#x20AC;? H.T.Colebrooke (transl.), A Digest of Hindu Law on Contracts and Successions, with a Commentary by Jagannatha Tercapanchanana, London, J. Debrett, 1801, p 309.

Laws and Lepers.

155

Chapter 6 PERCEPTIONS, OPINIONS AND ANXIETIES This chapter utilizes sources related to leprosy legislation and newspaper reports to describe contemporary societyâ&#x20AC;&#x2122;s attitudes to leprosy and the leper. The focus here is generally on the years 1889 and 1890 when the leprosy panic which gripped Britain following the death of Father Damien, was exported to Bombay and India. 1 This event,

and a

series of local incidents in the period brought the problem of leprosy forcibly

to the attention of

Bombay society. The present chapter

contains two sections. The first section is devoted

to the

varied

perceptions of the official and non-official British in Bombay, and where relevant, in Britain and other parts of India. The official British were

the provincial civil service administrators and officers of the

medical service. The writings in the Times of India, the English language daily newspaper in Western India

premier

are also used to

examine non-official views. The opinions expressed are interesting in themselves, reflecting as they do the myriad faces that presented to late nineteenth century Western society. section

deals with the perceptions and anxieties of

the leper

The second educated and

influential Indians in Bombay as voiced in the Municipal Corporation, and in Indian newspapers by professional journalists and two wellknown local Western-trained medical men, Bhalchandra Bhatwadekar [Fig.6.1] and Anna Moreshwar Kunte [Fug.6.2].

The fact that Damien was a European (Belgian), aggravated the fear and panic.

Opinions, Attitudes, Anxieties

156

SECTION A: BRITISH ATTITUDES But what need is there for the laborious collection of such facts [that leprosy is not contagious because attendants of lepers do not get leprosy] when there is the grand object-lesson of Father Damien’s life and death before the whole world? 2

The three dominant determinants of British perceptions were medical causation theories about leprosy, the European Judeo-Christian heritage, and the imperial control over India. As Carter recognised, medical causation theories had wider ramifications: “Questions of science, and points of social and even of political import are concerned with this topic.” 3 Not surprisingly, the Biblical imagery associated with leprosy underpinned Christian missionary perceptions about the leper. 4

Other

British opinion owed a great deal to Victorian era perceptions that leprosy was a civilisational issue. The influential British Medical Journal expressed the

opinion that “the countries of Asia continue to be

infested by leprosy, to a greater or less extent, generally speaking, in

Morell Mackenzie, “The Dreadful Revival of Leprosy”, The Nineteenth Century 26: (1889) pp 925-941.

Carter, Modern Indian Leprosy, p 180.

The views of Wellesley Bailey the Protestant founder of the “Mission to Lepers in India and the East”, and Archbishop Leo Meurin, the Roman Catholic founder of the Eduljee Framjee Albless Leprosy Asylum at Bombay, are presented in Chapter 8. The chief motifs were sin/unclean-ness, and salvation/“cleansing”. The King James version of the Bible has the following Old Testament lines about leprosy and the leper: “And the leper in whom the plague is, his clothes shall be rent, and his head bare, and he shall put a covering upon his upper lip, and shall cry, Unclean, unclean.”. “He is a leprous man, he is unclean: the priest shall pronounce him utterly unclean; his plague is in his head.” (Leviticus 13:44-46) In the New Testament the outstanding anxiety is to free the leper of his “unclean” state. . “And there came a leper to him, beseeching him, and kneeling down to him, and saying unto him, If thou wilt, thou canst make me clean.”( Mark 1:40). “Then Jesus answering said unto them, Go your way, and tell John what things ye have seen and heard; how that the blind see, the lame walk, the lepers are cleansed, the deaf hear, the dead are raised, to the poor the gospel is preached.”( Luke 7:22). Opinions, Attitudes, Anxieties

157

proportion to the physical and moral

degradation of their

people.” 5

Within the above framework, the views of individuals and groups of non-official and official British were quite varied.

“Loathsomeness” and the Leper English vocabulary describing leprosy was emotive but limited, comprising one word, -- “loathsome’. Its

utility

for the user was

rather wide, serving to define the disease, the sufferer, as well as suffering. So

entrenched

was the word that well

his

after leprosy’s

infectious nature was universally recognized, a venerable

dictionary

persisted in defining the malady as “a loathsome disease which slowly eats away the body." 6

The word had an honorable provenance. In

Shakespeare’s play Henry VI, the Queen, aggrieved that her husband suspected her of involvement in the death of a favourite

courtier,

reproached him with the words: What, dost thou turn away, and hide thy face? I am no loathsome leper – look on me. 7

A the

Christian

missionary used “loathsome suffering” to evoke

revulsion and pathos with

which

missionaries endowed

the

disease. 8 As noted in the last chapter, a leper’s offensive appearance per se

was considered

legally, of course. Hence Commission, which 5

justification in

for putting him out of sight,

the wake of

the report of the Leprosy

was sceptical about the contagious spread of

British Medical Journal, 6/12/1862.

A New English Dictionary on Historical Principles, Vol. 6, Oxford, Clarendon Press, 1908.

William Shakespeare, “King Henry the Sixth.- Part Two”, Act 3, Scene 2, in William Shakespeare: the Complete Works, P. Alexander, (ed.), London, Collins, 1968.

John Jackson, Lepers. Thirty One Years’ Work Among Them. Being the History of the Mission to Leper s in India and the East 1874-1905, London, Marshall Brothers, 1906, p 32. Opinions, Attitudes, Anxieties

158

leprosy,

the

Government

India’s Surgeon-General W.R. Rice

claimed in 1893 that this was reason enough to remove him from the public view and isolate him: it is admitted on all sides, that leprosy is a loathsome disease and on this account those suffering from it should be segregated from the general public… 9

Leprosy as “Imperial Danger” The

possibility, increasingly considered a probability,

that

leprosy might be a communicable disease filled some British with foreboding. By 1889, following the death of Father Damien, [Fig.6.3] the

foreboding had turned to alarm. The

dreaded

“leper touch”

emerged from the mists of medieval British leprosy and came to be seen as a threat to British Indian life. Some were convinced that Indian leprosy was increasing by such leaps and bounds that it would soon invade “smiling England”10 At the height of the leprosy hysteria which engulfed urban society in 1889-1890, the Indian leper learned – undoubtedly to his surprise - that he could bring down the British empire if not Britain herself. Fears were freely expressed in London by a motley group of alarmists comprising medical men, a cleric, and an ardent anti-vaccinationist. The fears of Surgeon-Major Robert Pringle, retired from the Bengal Sanitary Department

were centred on

the

supposed sexual connection of leprosy, especially the sexuality of the woman leper. He thought it was his duty “to state distinctly, that the probable consequences [of the “increase” of leprosy in India], are very serious as regards the health

of the British soldiers in India…” 11

Morell Mackenzie(1837-1892) a London specialist in diseases of the 9

MSAGD, Vol. 69, 1893, p 25.

Times of India, 16/7/1889, quoting an epithet by a visitor to Father Damien.

R. Pringle, “The Increase of Leprosy in India; its Causes, Probable Consequences, and Remedies”, Transactions of the Epidemiological Society of London, 8 (new series):: (1889), pp 152-163. Opinions, Attitudes, Anxieties

159

throat, for his part was undeterred by the fact that he was intruding “into a region [leprosy] altogether foreign to [his] line of professional work.” 12

Leprosy was stalking the globe, he alleged, and millions of

lepers were “dying by inches.” Indian statistics of 135 000 lepers were too low, he felt sure, the real number being 250 000 and

growing,

he asserted using the authority of a missionary Edward Clifford. 13 These “facts” ought to discomfit the “mother of all nations”, continued Mackenzie, for besides an “unspeakable” amount of suffering, … they indicate a possible danger to ourselves. Leprosy has before now overrun Eu roe and invaded England, without respecting the ‘silver streak’ [English Channel] which keeps off other enemies; and it is conceivable that, under certain circumstances, it might do so again. It is well known that, in recent years, our countrymen whose lot is cast in places where the disease is indigenous have ceased to show the immunity from its attacks which was once thought to be their privilege… 14

The Reverend H.P. Wright struck the same fearful cord by declaring that one had only to see leprosy in its “virulence”, to know what the consequences for England would be: : Are Europeans Liable to Leprosy? Is England in Danger? I answer yes. Ere we are aware of it the fearful scourge may again be actively in our midst; and England who thought herself so safe, is with her closely packed population again in the field of its cruel ravages. 15 May God preserve my country from Leprosy, and move the civilised nations of this earth to combine for its banishment from man! 16

The paranoia of William Tebb, a layman, was primarily directed at smallpox vaccination. He made a determined attempt in 1893 “to bring 12

Mackenzie, “Dreadful Revival”, p 925.

Clifford was "a conscientious Protestant layman philanthropically interested in leprosy, comfortably off, and possessing some skill as an artist." Cliford came across an account of Damien in the magazine of the Soho girls club and decided to visit Damien on Molokai. He made the trip in 1888, after having visited leprosy centers in India. Clifford painted Damien and also scenes of Kalawao, where Damien lived. Daws, Holy Man, 14

Mackenzie, “Dreadful Revival”, p 931.

H.P. Wright, Leprosy and Segregation. London, Parker, 1885, p 168.

Wright, Leprosy an Imperial Danger , London, Parker, 1889, Opinions, Attitudes, Anxieties

160

together a body of evidence regarding the inoculability of leprosy and the evidence of its communicability by means of vaccination.” 17 All evidence was bent to assert his pet theory that leprosy was increasing in India, at least partly because of infected vaccination. He quoted freely from sundry sources to bolster his case. The Bombay Guardian had said: “If we have to choose between the danger of leprosy and small pox, let us by all means have the latter.” 18

Carter, “allowed to be one of the greatest authorities on

the subject, includes vaccination among the list of causations…”. 19

Hero-worship versus the Leper The disgust that many Europeans felt for leprosy was compounded when they non-white persons of subject populations with the disease. Therefore the white missionary or medical man who voluntarily went to serve or study victims of the disease, was automatically accorded an exalted moral status. The Times of India, was at the forefront of such a hagiographic exercise in its coverage of the last months of the life of

the Belgian missionary in Hawaii, Father Damien (1840-1889).

Followed of

the

with horrified fascination by its readers, the accounts told transition

Damien

the

leper

colony, initially

“uncontaminated in the midst of contamination,” through leper-hood, to martyrdom and death. 20

The reports were reproduced by the paper

from first hand accounts by Edward Clifford and others. They typified 17

William Tebb, The Recrudescence of Leprosy—Leprosy and Vaccination, London, Swan Sonnenschein and Co., 1893, p 9. 18

Ibid, p 184.

Ibid, p 189.

Damien, whose real name was Joseph de Veuster, went to the leper colony at Kalaupapa on the Hawaiian island of Molokai, in 1873. He experienced the first symptom of leprosy three years later, and was recognised as a full-fledged leper by 1885. Anwei V Skinsnes and Richard A. Wisniewski, Kalaupapa National Historical Park and the Legacy of Father Damien (A Pictorial History), Honolulu, Pacific Basin Enterprises, 1988. Opinions, Attitudes, Anxieties

161

the starkly different moral and aesthetic scales in which the Hawaiian leper and the European

missionary – even a

leprous

one --

were

weighed: … their [the Hawaiian lepers’] faces were seared and scarred: their hands and feet maimed and sometimes bleeding; their eyes like the eyes of some half- tamed animal; their mouths shapeless, and their whole aspect in many cases repulsive… On the threshold of the chapel door stood a young priest, “His cassock” says Mr. Stoddart, “was worn and faded, his hair tumbled like a school boy’s, his hands stained and hardened by toil; but the glow of health was in his face, the buoyancy of youth in his manner, while his ringing laugh, his ready sympathy, and his inspiring magnetism told of one…[who] is doing the noblest of all works.” … “Leprosy has done its work …. The poor father has suffered terribly…. If you could only see him as he lies on his bed of suffering! Tears would come to your eyes at the sight of that man.” 21

To enhance his saintliness, the paper recounted how, even with the shadow of death on him, Damien was “calm and resigned, and his anxiety was as to what would become of his poor flock when he had left it.” 22 Respect, if not reverence was also apparent in the Times of India’s references to Carter, another European who had voluntarily dealt with lepers and leprosy despite the possibility of infection. As expected, the paper considered Carter’s contagionist views to be sacrosanct. An Indian member of the Municipal Corporation, Bhalchandra Bhatwadekar, who had been so bold as to publicly question Carter’s dictum that “the direct communicability of leprosy is … [was]

good working

hypothesis”, earned a sharp rebuke for “extreme recklessness”. 23

Contagion, the Leper, and the Times of India It is curious that the single colonial society

event that convinced many in

the contagiousness

leprosy, was

bacteriological discovery made in distant Norway in 1873, 21

Times of India, 15/2/1889.

Times of India , 13/5/1889.

Times of India , 30/8/1889.

not

but the

Opinions, Attitudes, Anxieties

162

highly sentimentalised illness and death of Damien in 1889. 24

one stroke Damien’s leprosy gave Indian leprosy both reality and immediacy, and with the Times of India’s segregationist cause. The

influential

declaring

“should

that

Bombay.” 25

than

event

newspaper be

lost no time in

useful

warning to us in

It did its best “in season and out of season” to rouse

the citizens midst.” 26

the

help an impetus to the

Bombay to the danger that

was “always in their

In the two years 1889 and 1890, the Times published no less

eighty items on the subject of leprosy, including twenty five

editorials propagating its credo, “segregate and segregate.” Its strategy was multi-pronged, of which

the exaltation of Damien

described

earlier in this chapter was one tool. .Another tactic was to re-iterate untiringly

that

leprosy was incurable and that

lepers increasing in

number. It exploited the potential for public alarm when lepers were seen congregating

public

water tank

near

two premier

educational institutions: They [the lepers] scrape, tear, and scatter round them the proud flesh which they no longer feel, defiling the railing, and the very stones of the street, so that a school boy, suppose, who has just cut his finger in sharpening a pencil, runs the danger of inoculation by handling unsuspectingly, the polluted pebbles in play. 27

Its

access

information

about

developments in London enabled it to carry

happenings

and

prominently a report

from the London Times about the meeting presided over by the Prince of Wales to launch the Father Damien Memorial in June 1889. The august audience of lords and bishops at the meeting.. reportedly heard

with

“thrill of horror and

incredulity” the Prince’s

The discovery of the bacillus of leprosy is discussed in Chapter 1.

Times of India , 15/2/1889.

Ibid.

Times of India, 30/8/1889. Opinions, Attitudes, Anxieties

163

disclosure

that a leper was employed in the London meat market. 28

Another strategy adopted by the Times of India was to highlight incidents of Indians’ hostility to lepers to castigate the Bombay Government for its tardiness in initiating measures to remove lepers from public places: …every day brings a new argument against the apathy of the Government in this matter. In a village close to Poona, at the close of last week, two lepers in a very bad state were discovered by one of the villagers. The man sounded and alarm and the whole village turned out and drove the hapless wretches into the jungle where they were left to die in a ditch. 29

The Times of India however high, who

also

came down

heavily on any official

failed to show the required

respect for leper

segregation. A particular target of its ire was D..D. Cunningham, the Government of India’s medical adviser, who in 1875 had co-authored an anti-contagionist monograph on leprosy. 30 In 1889 Cunningham had declared his continued belief that the evidence then existing in regard to the communicability of leprosy “is still very imperfect, and …is opposed to the theory that it was readily communicable in any stage, or that even in the ulcerative

stage of the disease,

lepers are

source of

any

considerable danger to those with whom they associate.” 31 The Times of India fumed at a Government of India whose officials were apparently out of touch with Indian reality: The whole demeanour of the Government of India is hardly calculated to conciliate regard for its transcendent sagacity…. It may not be pleasant to the august circle who rule us from Olympus to discover how far they are behind the rest of the world. 32

Times of India,

8/7/1889.

Times of India,

17/4/1889.

T.R. Lewis and D.D. Cunningham’s monograph on leprosy is discussed in Chapter 2.

“Despatch Alluding to the Views of the Local Governments and Administrations on the Draft Bill of 1889”, Journal of the Leprosy Investigation Committee, 2: (1891) pp 30-31. 32

Times of India, 25 /8/1890. Opinions, Attitudes, Anxieties

164

… That such an opinion must have been dictated from Simla… or some arcadian retreat where lepers are not wont to congregate, and that the true position of our great Indian cities, with their concourse of lepers… 33

Sex and the Leper The sexuality of the leper was a frequent cause for comment by colonial observers, but for diverse reasons. The sexual connotation of leprosy had a

hoary tradition in European medicine: morbid

hypersexuality -- libido inexplibilis -- was characteristic of the disease.34

long considered

to be a

The sexual imagery was reinforced by

use of terms such as “venereal leprosy”, and .the apparent similarity between the facial features of a syphilitic person and the leper. 35 Thus in the District medical reports in 1874-1876, the “most striking” feature was stated to be that “… there is scarcely a civil surgeon but complain[ed] bitterly of the

spread of this taint [syphilis], and not a few

of them [did] not hesitate to connect it closely with leprosy.” 36 Such views were frequently claimed to be the result of deep study. In 1863,

the Residency Surgeon

at Indore, responding to the Royal

College of Physicians of London questionnaire on leprosy “ventured to predict,” because it required “a very large experience and very extended observations,” that “in all [instances], there is the episode of syphilis in the epic of leprosy.” 37 As proof of an instance of leprosy in a

his “bold assertion,” he detailed

girl of sixteen,

where he was able

Times of India, 18/11/1890.

M. Biett, “Clinical Lecture on Elephantiasis”, Lancet, 2: (1828-29) p 609.

The term “venereal leprosy” was used by the Bombay Government in the early nineteenth century to refer to ulcerous skin disease. MSAGD, Vol.22/25, (1821-23), p 185 36

Annual Administration and Progress Report on Civil Hospitals 1874-76, Government Central Press, 1876.

Bombay.

Medical Reports Upon the Character and Progress of Leprosy in the East Indies, being Answers to the Interrogatories Drawn up by The Royal College of Physicians, London, Calcutta., Foreign Department Press, 1865, p 219. The Report on Leprosy of the Royal College of Physicians have been discussed in Chapter 1. Opinions, Attitudes, Anxieties

165

establish a

syphilitic relation by

“pertinaciously hunting up the

environment of the case.” The alacrity with which the Surgeon assumed that

the leper

girl’s disease

Western presumptions

was

syphilis, reveal

unhesitating

about the leper’s promiscuity.

A girl aged sixteen, of the Brahmin caste [was] the subject of leprosy…. Her arms and legs were covered with a violet stained … eruption that instantly riveted my attention, being most suggestive of venereal antecedents. The Chief Native Doctor of the Indore General Hospital… informed me that when this girl was but eight years of age she had been treated by him for leprosy and cured…. Remark the date, eight years ago! … She was separated from her husband though not judicially, as soon as this disease [leprosy] became established one year and eight months ago; her manner was immodest and her look wanton …. On being kindly and privately interrogated by the Native Doctor the girl related how nine years ago (mark the date!) … she had been violated by a Brahmin … whose diseased [syphilitic] condition was well known…. I believe myself, if there were no syphilis … there would be no leprosy… 38

Sexuality

also

intruded

into

leprosy

supposed kinship with syphilis. In medicine to be

vicariously

the

disease’s

syphilis was considered

the archetypal contact, or contagious,

supposed similarities, leprosy

disease.

acquired

the

Because of attribute of

venereal contagiousness. Ironically, the comparisons between the two diseases resulted in startlingly differing conclusions depending on the ideological

bias

the

proponent.

In some alarmist

circles,

preventing venereal contact of a healthy person with a leper came to be regarded as a means of preventing leprosy. The most outspoken exponent of this doctrine was Robert Pringle, referred to above. He too sought to establish his credibility by claiming “twenty years of the closest study of this aspect”. 39

At a discussion on leprosy at the

Epidemiological Society of London in 1889, Pringle declared:: It is impossible to consider [leprosy] … without being struck by the remarkable resemblance … with constitutional syphilis; and all must feel that there is some terrible

Medical Reports Upon the Character of Leprosy, p 219. Pringle, “Increase of Leprosy in India”, p 156. Opinions, Attitudes, Anxieties

166

analogy between the two diseases, confined not only to some of the symptoms they exhibit, but extending also to a similarity in their modes of dissemination. 40 [italics added]

The syphilis

same

“remarkable

portended

prevention to

resemblance”

something

quite

William Moore,

between

different

leprosy and

vis a vis

leprosy

Surgeon-General with the Bombay

Government, who was a confirmed sanitarian. 41 . The features of resemblance between syphilis… and leprosy are so great that they cannot be ignored…. If leprosy is (as I hold it to be), … a latent syphilitic constitutional inherited taint, developed into activity… by surrounding unsanitary conditions, the means of preventing leprosy is not in reviving the antiquated system of leper asylums, but by measures against the spread of syphilis and by sanitation… 42 [italics added]

On the other hand the premise that similitude of

leprosy

and syphilis denoted a similar mode of spread, namely contagion, was interpreted 1887,

others

in a light

sympathetic

to lepers. In

the traditionally anti-contagionist Royal College of Physicians

argued that “if there be any elements of contagion in leprosy, they are not more to be dreaded than are those in the case of syphilis, which is not commonly considered to justify compulsory segregation of the part of those affected.” 43

The same sentiment was echoed by

members of

the Leprosy Commission, certain that the most dangerous public health problem in India was not leprosy, but venereal disease and syphilis.. As one member Alfredo A. Kanthack complained: To me it has always seemed inconceivable why we should be anxious to apply sanitary and preventive measures against tuberculosis and leprosy and allow an easily-resisted foe like syphilis to ravage undisturbed. 44 40

Ibid. Sanitarian ideology in leprosy is discussed in Chapter 1. Quoted in Tebb, Recrudescence of Leprosy, p 329.

“Leprosy Committee Report, communicated to the Royal College of Physicians, July 15, 1887”, Appendix 5, Transactions of the . Epidemiological Society of London, 8 (new series): (1889) p 149. 44

A.A. Kanthack, “Notes on Leprosy in India”, The Practitioner, 1: (1893) p 464. Opinions, Attitudes, Anxieties

167

Such a view was endorsed by a member of the Committee which evaluated the Commission’s report. He said he “knew” that a person suffering from syphilis was a “real and very positive source of danger anywhere…” and

therefore

that

it was

“absurd” to adopt

stringent laws for the leper and to let the syphilitic go free. 45 There was yet another aspect to sex, sexuality and the leper which coloured

British perceptions

which was avowedly curious

opposed

The same Leprosy Commission,

to the contagion theory, displayed a

illogic in recommending that lepers be prevented from

practicing

prostitution. 46

explicitly refused to

The

Government of India for its part,

interfere with

leper prostitutes

in the draft

“Lepers Act” which was circulated for opinion in 1895. para 8. As the Government of India abstain strictly from regulating prostitution, no bye-laws or Acts dealing with the prohibition against lepers following certain trades or callings should extend to that of prostitution by leper women”. 47

It was the implicit liberty

in the contemplated legislation, t

to the leper prostitute to pursue her trade that offended the Assistant Collector of Nasik. Labeling it as unjust and immoral, he conjured a scenario to make his point: Suppose two adjacent houses to be occupied by leper women. One is a sweetmeat seller and manages to support herself and possibly her children by honest labour, and we go to her and say: “You are a source of danger to the community; you shall not follow this calling, you shall be sent to an asylum and confined there.” Her neighbour is a prostitute and lives at ease on the produce of 45

Quoted in Tebb, Recrudescence of Leprosy,

Report of the Leprosy Commission, pp 419-420.

p 304.

In 1889, following its reluctant repeal of the much criticised Contagious Diseases Act, the Government of India had legislated the Military Cantonment Act for “the prevention of the spread of infectious or contagious [venereal] diseases” which implicitly permitted medical surveillance of prostitutes. However, under pressure from the Home Government, new legislation was passed in 1895, expressly forbidding medical inspection or compulsory treatment of prostitutes suspected of having venereal disease. Harrison, Public Health, p 75. Opinions, Attitudes, Anxieties

168

immorality and shame, and we say to her “you may remain and prosecute your calling because you are a prostitute and Exeter Hall [eponym for the Government of India] will not allow us to interfere with you.” Is there any morality in this? …. [The Government of India] is … is offering a direct encouragement to prostitution. A leper woman has only to make a practice of selling her body or at any rate to profess to do so, and we will not touch her though she communicates her disease to thousands while her neighbour who lives a life of chastity is to be removed from the sight of all her friends and sent to herd with others as unfortunate as herself…. Is the sin of honest labour to out weigh the virtue of prostitution or vice versa? 48

His Divisional Commissioner agreed, opining that “the public who wish to protect themselves from the leper [prostitute] must compensate her to start another occupation… 49 Another

sex-related

anxiety in some British minds

was

the

prospect of devitalisation of their soldiery by Indian leper prostitutes. The Times of India chided the authorities for countenancing “the existence of leper prostitutes, even close to the troops at Colaba [the military cantonment].” 50

Pringle, true

to form was

fearful

that

women lepers whose lives “British humanity” had saved from the savage Indian custom of live burial, would take at once to prostitution around European military cantonments. To prove this, I saw in a London hospital, a splendid young man, dying by inches [of leprosy] …. Now this was the result of this prostitution … 51

Such sexual anxieties found legitimacy and respectability in the hereditary theory of leprosy causation. Preventing the male leper from access to the opposite sex became

a major pre-occupation of

colonial administrators in leprosy asylums. The Sanitary Commissioner for Madras

firmly stated, “[Lepers]

MSAGD, Vol. 61A, 1897, p 41.

Ibid.

Times of India, 20/6/1890.

marry and beget children and

R. Pringle, “Communication”, Journal of the Leprosy Investigation Committee, 1: (1890) p 61. The burial alive of lepers and the British response to the practice of assisted leper suicide is examined in Chapter 5. Opinions, Attitudes, Anxieties

169

perpetuate the disease” 52 .

Pringle,

who regarded the subject of sex

and the leper very seriously indeed, demanded that any leper asylum “which does not strictly carry out this principle [of segregation of the sexes], should

once be closed…”.

[italics

original].

The

Government of India, sympathetic to such sentiments, declared in the preamble to its draft leper bill of 1889

that

no measure could effectively stamp out the disease which is stopped short of the absolute segregation of the sexes and the confinement for life of all affected by it, [and that ] strictly enforcing segregation of the sexes…[be observed in] every institution for the relief of lepers which receives a in from public funds… 54

The strategies employed by some asylum authorities to keep the sexes apart

were, walling off

the female ward – as

at Ratnagiri;

prohibiting even husbands and wives from cohabiting and locking up males and females in separate wards during the night as

at Madras;

and

building men’s and women’s wards at a distance apart as at Calcutta. 55 The doubts cast on the hereditary doctrine by the Leprosy Commission, and its opinion that interdicting marriages between lepers was unnecessary, took some of the wind out of the sails of doctrinaire sexual segregationists.

Leprosy as a “Filth” Disease In the demonology of nineteenth century sanitarianism the pride of place

was undoubtedly held

by “filth.”

Elimination of filth

consequently became a crusade for some colonial personnel. The promotion of environmental and personal

cleanliness

was an article

“Papers Relating to the Treatment of Leprosy in India 1887-1895”, Selections from the Records of the Government of India Home Department, No: CCCXXXI, Calcutta, Government Central Press, 1896, p 23. 53

Pringle, “Increase of Leprosy in India”, p 156.

Selections from the Records, Leprosy, p 11.

Ibid, p 1. Opinions, Attitudes, Anxieties

170

of strident moral conviction. In sanitarian eyes, cleanliness was not just next to godliness, it was godliness. That flout or disregard sanitarian

the

officials. 56

sanitary measures”

Indians appeared to

cardinal rules of sanitary behaviour outraged Indians’

“complete

abnegation

practical

even several decades after exposure to European

influence, was regarded as evidence of their incorrigibility,

especially

because it was “untenable for a moment to argue that we have not done much for the social and moral improvement of the natives…” 57 There was the occasional

optimist, such as the Civil Surgeon of

Patna, who thought that

eradicating a disease such as leprosy, so

extensively prevalent among “the lower orders,” “impracticable” task.

All that

was

was needed, he noted

was time and “the influence of a superior

European

not

patronisingly, intelligence

acting on a people by no means deficient in intelligence.” 58 It was entirely appropriate that Thomas G. Hewlett (1831-1889), Bombay’s Sanitary Commissioner, concurred with J.M. Cuningham, his anti-contagionist superior officer in the Government of India. 59 Hewlett saw sanitary measures as crucial to the control of leprosy and other diseases: The improvement of the hygienic conditions under which the mass of the people live is the only sure method of stamping out leprosy or any similar disease… the filth with which all the villages of India are surrounded is quite sufficient to prevent any hope of 56

A Municipal Commission described the condition of Bombay in 1861 monotonously in the strongest pejorative in the sanitarian lexicon:: “ Go into the native town and around you, you will see on all sides filth immeasurable and indescribable, and at places, almost unfathomable; filthy animals, filthy habits, filthy streets, and with filthy courtyards around the dwellings of the poor; foul and loathsome trades, crowded houses, foul markets, foul meat and food, foul wells and tanks and swamps, foul smells at every turn, drains unventilated, and sewers choked and the garbage of an Oriental city.” Scott, History of Tropical Medicine, p 98. 57

Army Medical Department. Statistical, Sanitary, and Medical Reports for the year 1862, London, Her Majesty’s Stationary Office, 1864, p 300. 58

Medical Reports Upon the Character of Leprosy, p 196. J.M. Cuningham’s anti-contagionism is discussed in Chapter 2. Opinions, Attitudes, Anxieties

171

success in combating the disease, which it is not difficult to foresee will prevail until such an objectionable state of matters is altered. 60

Another sanitarian widened improvements

the

to include virtually every

Bombay’s Surgeon-General

list

much-needed

aspect of Indian social life.

William J. Moore (18

), pinned his

hopes on [t]he influence and progress of sanitation in the most extended sense of the term … [including] the cleansing generally of villages and towns, drainage, ventilation, good water supply, the cheapening of salt, the prevention of scarcity, opposition to imprudent marriages, and measures for the prevention of specific disease. 61

The Sceptics There were some within the colonial administration in the last decade of the nineteenth century who regarded the large amount of press and official attention being directed at leprosy as disproportionate and contrived. The Acting Collector of Kolaba,

for example,

asked to

comment on the draft of the leper bill of 1889, denied that leprosy was increasing in his district, sserting that there were more urgent priorities than leprosy. When I have clean fresh water in my salt marsh districts to save the many lives lost there every year by almost endemic cholera and have got vaccination sufficiently popular to keep down the still more frequent plague of small pox, it will be time enough to think of a handful of lepers… in the meanwhile … public funds will be far better expended in combating these more flagrant scourges than in any interference with leprosy. 62

In the same protesting vein wee observations Service officers

about

the

draft

by other Civil

“Lepers Act” circulated

in 1895,

MSAGD, Vol. 39, 1878, p 303.

W.J. .Moore quoted in Leprosy in India. Summary of Reports Furnished by the Government of British India to His Hawaiian Majesty’s Government, as to the Prevalence of Leprosy in India; and the Measures Adopted for the Social and Medical Treatment of Persons Afflicted with the Disease. Honolulu, H.I., 1886, p 12.

MSAGD, Vol. 4, 1890, no numbering on these pages. Opinions, Attitudes, Anxieties

172

which placed the onus of maintaining leprosy asylums at the door of

local bodies,

There are many more crying public wants everywhere than leper asylums, and to throw a charge on local bodies for the benefit of an infinitesimally small proportion of the population when the whole community may be said to be in want of pure water and ordinary medical attendance seems to be hardly defensible…. 63

With the proposed targeting of the vagrant leper in the Lepers Act, the ground of state action, as the perceptive Collector of Nasik, Andrew Wingate noted, “shifted from contagion and danger

loathsomeness and beggary.” 64

The Indian Leper, the International Leprosy Congress, and Political Imperatives Nothing demonstrated the declining urgency with which leprosy came to be viewed in the closing years of the century, as the fact that the Government of India considered it unnecessary to send a delegate to the first International Leprosy Congress which

was

convened in Berlin in 1897. 65 Thus, a country in which according to the Times of India, “a quarter of a million of lepers roam[ed] about … polluting the life of a whole continent,” was not represented at the first scientific meeting dedicated to the disease. 66

The decision to stay

away from Berlin was criticised by the Times of India as “blundering indifference,” which underscored the Government of India’s “splendid isolation” on a subject which, said the paper, was of the greatest concern to India. 67 The Congress, dominated as it was by contagionists 63

MSAGD, Vol. 61A, 1897, p 7.

Ibid, p 21.

The main conclusions and recommendations of the Congress are examined in Chapter 1. 66

Times of India,

Times of India, 8/11/1897.

11/7/1889.

Opinions, Attitudes, Anxieties

173

and segregationists such as Armauer Hansen,

declared

that

“every

leper is a danger to his surroundings” 68 This was an opinion hardly likely

to commend itself to

the Government

of India, which had

chosen to accept the recommendations of

the anti-contagionist

Leprosy Commission in 1891. In the

projected “Lepers Act” drafted

in 1895, it

selective segregation only

had committed itself

“ulcerous” and

vagrant lepers

in large towns and cities. It was

resolutely unwilling on financial grounds to include within the scope of legislation “every leper who was [supposedly] a danger to his surroundings.” The absence of an official representative of the Government of India was a cause for comment among the delegates at Berlin. The sole apologist for

the Government of India’s

International Congress was

Phineas Abraham, a

views

the

dermatologist, and

former editor of the Journal of the Leprosy Investigation Committee brought out by the National Leprosy Fund. 69

Abraham’s

vicarious

defence of the Imperial Government contained the expected invective against Indian unreasonableness in matters of leper isolation. There was however

a significant shift in emphasis. In

criticism of

supposed

Indian neglect and

place of

the

usual

apathy towards lepers,

Abraham harped on Indians’ obstinate and irrational attachment to them,

which, he maintained, had

tied

the

hands

the

colonial

Government. India, he said, was a land, … where lepers are numerous, and their friends even more numerous, and not desirous of being separated from them, [hence] harsh measures of isolation and segregation become impossible…. If the Government had serious difficulties in enforcing simple 68

Ibid.

Phineas Abraham (born 1847) in Jamaica; took his medical training at St. Bartholomew’s Hospital, London and Trinity College, Dublin; specialist in skin diseases, was well known in dermatological circles in England and Ireland. He was Curator of the Royal College of Surgeons of Ireland, and also visited Norway to study leprosy. C.A. Cameron, History of the Royal College of Surgeons in Ireland, Dublin, 1916, pp 336-337. Opinions, Attitudes, Anxieties

174

sanitary precautions in the case of such an acute and fatal malady, as the plague in India, how much more difficult would it not be to insist upon harsh measures in the case of leprosy. 70

Not a word was of course said of the reluctance and refusal of the Government of India to initiate a scheme of leper segregation which was seen as a drain on imperial resources. This by itself suggested a waning of the leprosy paranoia that stalked India almost a decade earlier. By 1897 leprosy lost the status of “imperial danger”. There was one possible

reason for Abraham’s

invocation of

the

ongoing plague epidemic. The colonial state had discovered a new and potentially far more dangerous

“imperial danger” than leprosy

could ever have been. Assessment This examination

British views has shown that they were

neither uniform nor monolithic. causation

influenced

the

The

contagion

perceptions

theory of

several

leprosy

local officials,

which was often clothed in a sexual motif on analogy with syphilis. Frankly political fears of leprosy as “imperial danger” centered on magined threats to British

control by

the woman leper’s sexuality.

The draft legislation of 1889 too made sexual segregation in leper asylums an important provision. On the other hand, some British civil and medical officials, as well as the the sexual nuances of leprosy

Leprosy Commission interpreted

in a manner rather more sympathetic

to the leper. Sanitarianism and the colonial superiority complex contributed to the views of medical officials in Bombay that leprosy was evidence of an Indian

civilisational

social, dietetic, and

fault,

which only

drastic

purging

sanitary defects could correct. Similarly for the

lay British public in Bombay in 1889, it was not the discovery of 70

Times of India, 10/11/1897. Opinions, Attitudes, Anxieties

175

the leprosy bacillus

fifteen years earlier that

proved leprosy’s

infectivity, but the fact that a European priest had contracted the disease

after

associating with lepers.

aggressive harping

The Times

of India’s

the supposed increase of leprosy in India,

and the “danger” posed by vagrant lepers in Bombay, as also hagiology

Damien,

nourished

its

the fear of rampaging leprosy

which gripped the city. There the

leprosy

were sceptics in the Civil Service who did not share paranoia

emanating from urban

stated that the panic was perceived

exaggerated

centres, and

frankly

if not contrived.

Their

priorities were far removed from leper isolation, and were

centered on pure drinking water, public amenities and nutrition. One district

collector

perceptively

opined that

calls for leper

isolation

were predicated solely on aesthetic considerations. Lastly, by the closing years of the century, leprosy’s place as “imperial danger”

in the colonial imagination

was

usurped by

the

plague epidemic, which was a far greater threat than leprosy could ever have been.

SECTION B: THE INDIAN PRESS, BOMBAY’S “INTELLIGENTSIA” AND THE LEPER.

The historian Christine Dobbin showed that two groups of Indians, whom she categorized as the British-educated professionals or “the intelligentsia” and the merchant princes or shetias, wielded political and social influence in Bombay in the latter half of the nineteenth century. 71 This Section focuses on the perceptions of the 71

‘Intelligentsia` is meant as “all those in Bombay who received English education in the collegiate classes of the Elphinstone Institution before the founding of the University, and those who gained university degrees after that date. The term also comprises those who attended professional institutions, such as the Grant Medical Opinions, Attitudes, Anxieties

176

former class about the leprosy question, and examines their opinions and anxieties in the climactic years 1889-1890, when the problem came to a head. The responses, motivations and self-perceived role of the shetias are investigated in Chapters 8 and 9. which deal with leper shelters.

The Indian intelligentsia viewed the leprosy sufferer

with

repugnance, fear, and pity. In this they were of course not exceptional. Another characteristic with they shared with the British living in Bombay was their support for urgent legal action against the city’s vagrant lepers. When leprosy intruded into their own domestic sphere, however,

prudence

“respectable”

family would not deliberately draw public attention

to a leper

member. Unlike to-do

lepers

was their guiding

principle.

leper vagrants who were in the public eye, well-

preferred, or

were compelled,

to live in seclusion

within the home and not draw attention to themselves. Others might be

quietly

B.R.Nanda

cared for away from home. mentions that

His political

biographer

the nationalist leader Gopal Krishna

Gokhale's first marriage to Savitribai remained unconsummated due to her incurable leprosy. At his mother's suggestion,

and

Savitribai's consent", Gokhale remarried. Savitribai was

reported to

have been treated with “kindness”

by her husband

"with

and his second

wife, who arranged for her care till her death. 72 The passage hints that Savitribai, as a consequence of her disease, ceased to have any status in the Gokhale household. It also illustrates that lepers from well-to-do and educated Indian families led secluded lives, and kept

shielded

from public view. --------------------------------------------------------------------------------------------------------------College and the Government Law classes…”. Christine Dobbin , Urban Leadership in Western India: Politics and Communities in Bombay City 1840-1885., Oxford, Oxford University Press, 1972, p 28. 72

B.R. Nanda, The British Raj and the Indian Moderates, Delhi, Oxford University Press, 1977, p. 65. Opinions, Attitudes, Anxieties

177

The press, the Municipal Corporation, and medical meetings provided the stage for the expression of Indian views and concerns. There were several professionally qualified Indians, especially doctors and lawyers

in the Bombay

Municipality in the last two decades of the

nineteenth century. 73 Members were thus able to speak on a subject in professional as well as civic forums. Such was the case with Dr. Bhalchandra Krishna Bhatwadekar (1852 -1922), a prominent private medical

practitioner

trained at

the

Kaikhushroo N Kabrajee (1842-1904), Parsi

newspaper

Rast

Goftar. 74

Grant Medical College, and veteran

Both

men

editor of the

liberal

forthrightly

utilised

professional avenues and the Municipality for making known their views on the leprosy question.

The Indian Press The Indian press T

supportive

by and

large showed itself strongly

of removal of lepers from public places and their

segregation. From as early as the 1860s, when noticing the leper beggars in the city, the press highlighted

many

the health risks of

social intercourse with them. Most journalists had no doubt that the disease was catching, and

made frequent

demands for

official,

including police, action to prevent lepers from following trades and

Examples were Drs.. Cowasji Hormusji(1837-1920) and Accacio G. Viegas among the physicians, and Sorabji Shapurji Bengali and Pherozeshah Mehta among those trained in the law. Michael, History of the Municipal Corporation. 74

Bhalchandra Bhatwadekar who as a young man attracted the attention of Dr. Bhau Daji, established himself as medical practitioner in Bombay in 1885, and entered civic politics in 1889. Highly successful in both, he became Chairman of the Corporationâ&#x20AC;&#x2122;s powerful Standing Committee in 1898. He was knighted for his services in promotion and popularisation of vaccination. Gargi Bhatwadekar, Dr. Sir Bhalchandra Krishna Bhatwadekar,(in Marathi) Bombay, S.V. Parulekar, 1938. Rast Goftar, an Anglo-Gujarathi weekly was established by Dadabhai Naoroji in 1851. Kabrajee was its editor from the 1860s until the end of the century. Opinions, Attitudes, Anxieties

178

occupations which brought them into daily contact with the public. 75 They blamed the vagrants’ unrestricted freedom on the “ignorance” of the public which carelessly put themselves at risk of contracting the "abominable disease" 76

Arunodaya,

a Marathi weekly published

from Thana was unabashedly nostalgic about what it described as the old “effective” Indian custom of abandoning lepers in remote places. “Admittedly cruel” though it was, the paper claimed that it had kept down the numbers of diseased, it being "very bad to allow [lepers] to breed..." 77

The solution suggested by the paper for the vagrant

leper problem was certainly inspired by history -- transporting them to the Andaman Islands,

and preventing them from multiplying, so

that

both lepers and their disease would become extinct. In the panic of 1889-1890,

Bombay heard vocal sections of

Indian society demanding action against persons with the “most horrid and unsightly of all maladies”. 78 When the Government of India at last announced its intention to legislate on leprosy in 1889, the Bombay press, according to the Oriental Translator, received the news with "delight". 79

Indu Prakash

lauded

Education Inspector T.B.

Kirkham's demand in the Municipal Corporation for urgent steps to remove near the Elphinstone Institution and St. Xavier’s College, as an "excellent

beginning". 80

The Indian Spectator

edited by Behramji

Indu Prakash 12/4/1869, and Dnyan Prakash 26/4/1869, “Report on Native Papers”. Indu Prakash, an Anglo-Marathi biweekly was founded in 1862 jointly by Gopal Hari Deshmukh and Vishnu Parashuram Shastri Pandit. 76

Bombay Chronicle,

23/7/1882 and Bombay Samachar, 15/9/1882.

Arunodaya, 23/7/1882, “Report on Native Papers”. Thana. 78

Arunodaya waa published from

Ibid.

“Report on Native Papers”, 16/3/1889. The Draft Leper Bill of 1889 is discussed in Chapter 5. 80 Indu Prakash, 8/4/1889. Kirkham’s forebodings about leper vagrants in the city have been referred to in Chapter 5. Opinions, Attitudes, Anxieties

179

Malabari (1853-1912) used the leprosy issue to castigate the authorities for a recent increase in the salt levy. It contrasted

Kirkham's

“energetic crusade" to protect the public health with the Government of India's “platitudes of helplessness” when disease attacked

the

heavily taxed Indian ryot. 81 Not Kirkham’s

all

sections of

strident

the Indian

press were

impressed by

crusade for compulsory removal of lepers to

asylums. Phoenix, the

English language bi-weekly

Karachi, was apprehensive that the loathing and sensationalism and "noise" would

deprive the

published

from

horror generated by afflicted

of due

kindness and sympathy. 82 The Anglo-Marathi Native Opinion founded in 1864 by the scholar and jurist Vishwanath Narayan Mandlik(18331889), published from Bombay and edited by K.E. Khambata, opposed any legislation empowering the city authorities to forcibly segregate lepers "as it consider[ed] it possible that ... such powers might prove to be an engine of

oppression in

their hands". 83 It

recommended

that

segregation of lepers might be effected by "the establishment of a less coercive system, .where competent medical treatment and the provision of other flesh comforts might induce the lepers of their own free will to seek refuge.." 84 The Indian press followed the account of the Damien episode appearing in the Times of India with great interest. Indian editorial opinion also projected Damien poignantly. Like the Times of India, --------------------------------------------------------------------------------------------------------------81

Indian Spectator, quoted in Times of India 17/6/1889. Beramji Malabari (1853-1912), the editor, was also a social reformer. 82

Phoenix, 17/4/1889. The paper was edited by the Khoja Jaffer Kadu.

Native Opinion, 7/4/1889. This Anglo-Marathi biweekly was founded by V.N.Mandlik, and was at the time being edited by K.E.Khambata. 84

Ibid. Opinions, Attitudes, Anxieties

180

Damien’s leprosy was publicized as a cautionary tale

for

lethargic

and negligent Governments and local authorities. "[A]

laisssez faire

policy will be simply disastrous to the health of [Bombay's] teeming population",

warned the Gujarathi

The Government

and the

Municipality came in for scathing criticism from Kabrajee’s Goftar, for permitting

Rast

“lepers in our midst [going] about freely,

buying and selling, marrying and giving in marriage, and propagating the disease quite as they please.” 86 On the whole Indian editorial opinion subscribed fully to contagionist sentiment. It is well enough known in Bombay that constant and close intercourse of persons not yet infected, with lepers will also ultimately … cause them to fall victims to the terrible disease…. If retreats, asylums, or villages for lepers were to be established and multiplied, force alone could restrain them to remain. 87

It was the financial provision in the draft Bill of 1889 making leper

asylums a

charge on

local

dispensaries and hospitals

that

irritated Indians. Native Opinion labeled the proposal "robbing Peter to pay Paul", and predicted that it would work to the disadvantage of the general public

since a dearth of

asylums

due to shortage of

money would cause lepers to flock to general hospitals and "taint the atmosphere" 88

Hospital

patients would be

displaced by "poor

miserable specimens of humanity picked up from the roadside, [and] their money [diverted to] feeding and clothing their loathsome rivals". The Indian

press appropriated

British

colonial

vocabulary

leprosy an “evil”. Bombay Samachar insisted that as an

Gujarathi, 25/5/1889.

Ibid .

Native Opinion, 1/8/1889.

Native Opinion, 16/6/1889.

labeling "Imperial

Opinions, Attitudes, Anxieties

181

evil, Imperial in extent and depth", the cost of leprosy retreats be borne partly, if not wholly by the Imperial treasuryâ&#x20AC;Ś" 89

The Parsi Intelligentsia versus the Government In May 1889, Bombay was outraged and dismayed death,

in a police cart, of

Luximon Ganoo, a

having been turned away from the

pauper

by the

leper, after

J.J. Hospital. The Leper Ward

there had been closed by Government without assigning any reason. 90 That Ward had been donated by Rustomjee Jamsetjee Jejeebhoy(18241872), son of Sir Jamsetjee Jejeebhoy,

in 1863.

The

closure of

the Ward and the leperâ&#x20AC;&#x2122;s death put the Parsis in high dudgeon. 92 The incident

united

intelligentsia and

the liberal and

conservative Parsi

the shetia Jejeebhoy

family

press, the Parsi

in common

cause

against the Presidency Government. The closure of the Ward was described as highly arbitrary and objectionable. The conservative Jam e Jamshed, mouthpiece of the Paris Panchayat, sharply reminded the authorities that native hospitals had been founded by native charity, and urged the incumbent baronet Sir Jamsetjee Jejeebhoy to get the Government to re-open the Ward. 93 Rast Goftar took up

the subject

again in July of the next year, maintaining that the object of the donor Rustomjee

Jamsetjee

Bombay

has been frustrated

lepers,

which was

to provide a refuge

by Government's

for

unilateral

Bombay Samachar, 25/6/1889. The same argument was put forward by Indian Spectator, quoted in Times of India 17/6/1889.

The incident of the death of Luxmon Gainoo is described detailed in Chapter 7.

MSAGD, Vol. 13, 1862-64, p 227.

MSAGD, Vol. 64, 1890, p 230.

Jam e Jamshed, 21/5/1890 Jehangir B. Murzban.

This was a Gujarathi daily under the editorship of

Opinions, Attitudes, Anxieties

182

action. In the Corporation Kabrajee’s attempt to obtain priority for his notice of motion on the treatment of lepers in the J.J.Hospital was quashed by

the President, the segregationist Grattan Geary. 94

Meanwhile, another

outcast leper had died

the

streets. The

Coroner's jury ruled that lepers should not be “allowed” to die in public. "The pity of it is that there should have been an occasion for a jury to assert it", Rast Goftar commented wryly. Kabrajee pursued the question again in the Municipal Corporation in a motion pointedly drawing Government's attention to the dire straits into which homeless and ill lepers had been put Hospital. He asked for

the absence of care

the restoration

the J.J.

of the status quo

ante

forthwith. Other influential Parsis supported Kabrajee. On 14/7/1890 the President of the Municipality, the civil architect, Muncherjee C. Murzban addressed an official protest to Government, that the closure of the Ward, was "fraught ..with

the gravest consequences to the

sanitary conditions of the city, [besides being] in direct violation of the explicit condition on which the late Rustomjee Jamsetjee contributed Rs 80,000 towards its erection…" 95

In a speech

in the Corporation,

which Native Opinion termed "forcible", the redoubtable Pherozeshah Mehta flayed the Government's highhandedness. 96

"The

attitude

Government seems to have taken in this matter”, alleged Mehta, “appears to be somewhat like this: 'Never mind the endowment, we shall not give you any reasons why we have closed the Leper Ward' ". 97

Jam e

Jamshed made a last, futile attempt at reopening the matter in 1892. 94

Geary was the anonymous author of an article in the Times of India sharply critical of the crowding of lepers in the J.J. Dharmashala, and demanding their removal to an asylum.

Times of India, 5/7/1890.

Pherozeshah Mehta’s wider role in the Municipality on the leprosy question is discussed in Chapter 9. 97

Native Opinion, 14/8/1890. Opinions, Attitudes, Anxieties

183

By then, however, the Bombay Government was on stronger

ground

to defend itself. The success of Bombay city’s “Homeless Leper Asylum” established in November 1890 under joint Government and Municipal auspices was too patent to be denied. 98

Indian Medical Professionals The post-Damien leprosy

panic of

1889-1890 provided

two

prominent Indian graduates of the Grant Medical College, Bhalchandra Bhatwadekar and Anna

Moreshwar Kunte with an

opportunity to

utilize their familiarity with Western medical science, to question the purported evidence in favour of contagion. They also perceived that their access to Western medical knowledge gave them interpreting scientific information, moulding calming Indian fears and panic about Bhatwadekar and Kunte utilised

unique expertise in

Indian public opinion and

leprosy contagion. The avenues

for publicising their respective views

were the Medical and Physical Society of Bombay, and the pages of Native Opinion respectively.

Bhalchandra (later Sir Bhalchandra) Bhatwadekar (1852-1922): The

general

welcome extended

the Indian press to

the central

Government's draft bill of 1889, obscured the fact that the legislation was questionable from a public health point of view. The the disease continued to be a contentious subject in several

cause of medical

circles, despite the discovery of the bacillus and the Damien case. Bhatwadekar was a sceptic of contagion theory.

It was his considered

view that the raging leprosy panic in the city was artificial and without basis: “The scare of infection and contagion has spread so widely that the

The “Homeless Leper Asylum” is the subject of

Chapter 9. Opinions, Attitudes, Anxieties

184

public has been led into false beliefs.” 99 The need of the hour, he said, was

"a sober, quiet, unbiased and scientific investigation of the

disease.” 100 He was also of the view that the draft

bill of 1889

threatened the interests of the social class to which he belonged, namely the “well-to-do”. Quoting

chapter and verse from European and British

journals in the course of the debate he highlighted evidence from Norway to Syria, which appeared to negate the doctrine of contagionism in leprosy. He cited data nearer home on a leper census in the Presidency in 1882: “… it will not escape the eye of even a superficial observer, that very nearly seven-eighths of the cases given in it are hereditary and leave a very meager margin for other operating causes to work.” 101

He referred to the fact that neither Carter nor Sakharam

Arjun nor the attendants in the Leper Ward at the J.J.Hospital

had

contracted the disease Leprosy, he concluded, was a hereditary and non-contagious disease, and there was no need for public panic. Despite

this

forthright

conclusion, Bhatwadekar showed

ambivalence on the matter of leper segregation, admitting that "segregation of the lepers has been found to exercise some wholesome check on the propagation of the disease though not to the extent of stamping out the disease". There was also proclaimed

belief in

the

unconscious

inconsistency

non-contagiousness of leprosy,

his

and

the

advice he said he had given to anxious neighbours of a leper: I calmed their fears and told them that as the patient was kept in a detached portion of the house they had not to come into contact with him, and stood in no danger of catching the disease. 102 99

B.K.Bhatwadekar, “Leprosy in Bombay, in it’s (sic) Medical and State Aspects”, Transactions of the Medical and Physical Society of Bombay, 12(new series: (1889) pp 106-123.

100

Ibid, p 121.

101

Ibid, p 109.

102

Ibid, p 117. Opinions, Attitudes, Anxieties

185

Bhatwadekar, the Indian public’s preceptor, also saw himself as the leper’s protector. He cautioned the Government on the "engine of oppression" likely to be unleashed on the helpless leper by the powers given to the police in

the

proposed legislation.

One

provision

nevertheless “redeemed” the Bill in his eyes: the exemption of well– to-do lepers from compulsory admission into asylums. "It would be very unjust", he declared,

"[to]

interfere with

their

[rich lepers’]

liberty, as they do not show themselves ...and are not likely to prove dangerous".

Another

succinctly: the bill

participant

ought

the debate

apply only “in

expressed it more those cases where

natives as a class are filthy in their habits". 103

Anna Moreshwar Kunte (1844-1896): This graduate of the Grant Medical College, was the first M.D. of the University, and for many years a demonstrator in anatomy at his alma mater. He had assisted Carter in the investigation into “famine fever” in the late 1870ss, and was also familiar with that scientist’s papers on leprosy. During

what

he derisively called the “Bacteric-mania” of 1889, Kunte preferred to carry out his self-imposed task of public education anonymously as simply “a medical man” in the columns of Native Opinion. 104 wrote an

eleven part

series entitled “Leprosy from the Medical

Aspect” 105 In contrast to Bhatwadekar’s clinical or patient-oriented approach to public education, polemics

was

the

“Science

103

Ibid.

104

Native Opinion, 29/8/1889.

Kunte’s of

point of

Medicine”

entry into leprosy as

epitomised

105

His anonymous authorship of the series was disclosed in his obituary in Native Opinion, 19/7/1896. Kunte’s series appeared twice a week from 8/8/1889 to 15/9/1889. Opinions, Attitudes, Anxieties

186

bacteriology, and the leprosy researches of Carter. 106 Like Bhatwadekar, his aim was to counter the “alarmists” and

contagionist

“fanatics”

who he thought had seized the initiative in the leprosy debate. He proposed to

give readers “unbiased opinion based on facts”

bacteria, disease, and the pros and leprosy, to enable them

cons of

about

contagion theory in

to form their own opinions.

Despite

his

claim of impartiality, the first article of the series gave a foretaste of the direction in which Kunte wished to steer Indian public opinion: The relation between infection and micro-organisms [bacteria] is not yet sufficiently borne out by experiments so numerous as to be applicable to diseases… devastating and tormenting the human race… 107 [italics added]

If “scanty” experiments were relied upon, Kunte warned, one might well conclude that nearly every disease had an intimate relation to a micro-organism, and therefore all diseases could be eradicated by improved methods of segregation. “Having thus stamped out diseases from the human race, imagine the happiness the inhabitants of the earth will enjoy!!!” 108 Kunte’s discourse on bacteria illustrated that he was well read on the work of the premier scientists of the day such as Louis Pasteur, Robert Koch and discovery of a Equally

notable

Joseph Lister (1827-1912), and the

putative bacillus of was

his

leprosy

awareness

bacteriology, namely “Koch’s postulates”, in 106

107

108

by Armauer Hansen.

the

central dogma

enunciated by that scientist

1882. 109 Kunte pointedly emphasized that Koch’s work on the

Native Opinion, 8/8/1889. Ibid. Ibid.

109

“Koch ‘s postulates” stated that for an organism to be proved pathogenic for particular disease, it must fulfil four conditions: (a) the organism must be demonstrated in the diseased body; (b) the organism must be isolated and cultivated in pure form in the laboratory; (c) inoculation of the cultivated organism must produce the disease in an experimental animal, and (d) the organism must be recovered from the diseased experimental animal. Koch’s meticulous bacteriological Opinions, Attitudes, Anxieties

187

tuberculosis

bacillus had

been

confirmed by many bacteriologists,

“with [a] few exceptions”. This phrase was evidently designed to cast doubt in the minds of

Kunte’s readers on

the validity of

even

Koch’s work. We ask, why is this “with few exceptions,” a parenthetical clause, allowed still to remain, while the dubious result [that animals are not uniformly susceptible to tuberculosis] is acknowledged as a fact. 110

Kunte seized the opportunity to highlight that “Koch’s postulates” had not been fulfilled for the “leprosy bacillus” discovered by Hansen in 1873, and that there was a plethora of leprosy causation theories.. 111 The trend of

Kunte’s arguments was skepticism about contaagion

theory, not only in the matter of leprosy, but on the theoretical underpinnings of germ theory: It is clearly seen that the relation between a Micro-organism and its disease is very feeble, so far as is elicited by the experiments put forth; there is any amount of confusion in their results. 112

Kunte also did not shy away from ridiculing contagionists and those lobbying for anti-leper legislation: If the lower animals are capable of inoculation (sic) … then these animals ought to be subject to diseases equally with man. Amongst them must be diseases [communicated] from individual to individual. It is certainly necessary to apply the laws and regulation to them, just as in the same way as they are to be made applicable to human beings. Medical societies, laymen, and states, please take warning!!! Let this fertile source of infection be not lost sight of !!! Let us have asylums for rats, cats, mice, fouls (sic) &c !!! Having done this, segregation amongst them could be easily accomplished, we suppose !!! 113 …. Water again is a fertile source of [disease-producing organisms]. Dust, brickwork, woodwork, carpets, cloths… (Dollars, shillings, the poor Rupee of degenerate India &c) … --------------------------------------------------------------------------------------------------------------studies in tuberculosis exemplified his postulates. C.C. Mettler, History of Medicine, Philadelphia, The Blakiston Company, 1947, p 263. 110

Native Opinion, 11/8/1889.

111

The failure of experimental transmission in leprosy is described in Chapter 1.

112

Native Opinion, 8/8/1889.

113

Ibid. Opinions, Attitudes, Anxieties

188

come under the same category. We think we shall … control the waves and currents of water by some healthy legislation. Oh, Satan ! These micro-organisms are thy agents to be sure !!! 114 [italics in original].

His deepest scorn was reserved for Carter. He sarcastically referred to

Carter as “a

really a psalm”, because

medical Divine”, whose

“psalm -- it is

“it has no scientific basis” was that

“the

good working hypothesis.” 115

direct communicability of leprosy is a

He accused Carter of being the fount of other

falsehoods:

Many other assertions most contradictory in their essence, opposed to all facts and figures, devoid of science and fanatical in their after consequences and embodied in the voluminous out-of-the-way-literature have issued from this pathologist of Bombay. 116

Kunte

undertook

to “analyse” Carter’s investigations for the

benefit of his readers. His first pathological

studies

which

taunt was directed

had been based on

examination of

the a

mere “200 cases and 16 mortisections”: Sixteen post-mortems are the foundation of a good working hypothesis for the good of the population of India, consisting of about twenty millions of inhabitants under the scientific, civilised and Christian (sic) Government of Britain. 117

Hypothesis based on such meagre facts, opined Kunte, was a very

unsafe

guide for legislation.

Carter came

for further

unfavourable comparison when his observations differed from those of the Norwegians Danielssen and Boeck. Kunte patronisingly attributed the supposed “errors” to Carter’s “innocence” during the years before he became the darling of the contagionists in Britain and India. . The early researches of this pathologist were those of a timid inquirer…. Not yet contaminated by the idea that he was a great man, not yet contaminated by the observations of medical men, too idle to undertake researches, too careless to inquire for themselves,

114

Native Opinion, 22/8/1889.

115

Native Opinion, 29/8/1889.

116

Native Opinion, 1/9/1889.

117

Ibid. Opinions, Attitudes, Anxieties

189

and too much otherwise engaged, who styled him an authority on the subject—our pathologist always expressed his views by assertions most guarded. 118

After thus making short work of

Carter’s early work.

Kunte

closed his series with a dismissal of the later pathological researches also -- “they are nothing new”. 119

Assessment The late nineteenth century Indian intelligentsia in Bombay was active in civic politics, journalism and the professions of law and medicine. Throughout the latter half of the century, the Indian press decried the apathy of the authorities and mounted steady pressure to move against vagrant and beggar lepers on public health grounds.

this aspect they may be termed collaborators of the British alarmists who were in full cry in the post-Damien months. At the

same time

they were deeply anxious that the authorities not demean their role or their interests by arbitrary legislative or administrative actions. Hence the closing of ranks by the Parsi press, Parsi intelligentsia and Parsi shetias, in the matter of

the

closure of the Rustomjee Jamsetjee

Leper Ward. Hence also the anxiety of Bhalchandra Bhatwadekar and his colleagues that well-to-do lepers be exempted from compulsory isolation, a measure better suited to the Doctors Bhatwadekar and themselves as public educators

unwashed classes. .

Kunte, both anti-contagionists, saw who were

qualified to utilise

“scientific” facts for calming Indian panic. While citing verse from European medical

chapter and

literature, they shrewdly highlighted

such observations as cast doubt on contagion theory. . Of the two 118

Native Opinion, 8/9/1889. Danielssen and Boeck’s Lepre are discussed in Chapter 1. 119

observations in Traite de la

Native Opinion, 15/9/1889. Opinions, Attitudes, Anxieties

190

men, Kunte was the more academic and polemical. He threw cold water

on the germ theory of disease, and indulged

in sarcasm,

misrepresentation and personal attacks to dismiss Carter’s pathologic studies and contagionist views. Kunte accused contagionist and

segregationist views

Carter of basing his

“200 cases and sixteen

mortifications”, which was far from being the case. It was shown in Chapter 2 that the defining moment in Carter’s contagionist career was Hansen’s demonstration of the bacillus. Kunte’s tirade against Carter was curious, particularly since he was acquainted with the scientific method, and associated with Carter in

the painstaking work

“famine fever.” Not only did Carter acknowledge Kunte’s assistance, but both men

had

fallen victim to the disease

after

conducting

post-mortems on the fatalities. 120 Apparently the latter experience did not convince Kunte of the validity of the germ theory of disease.

The Next Chapter The next chapter concentrates on the person who was the object of colonial and Indian society’s anxieties, fears, charity, legislation and study -- the leper himself.

120

Spirillum Fever, p 31. Opinions, Attitudes, Anxieties

191

Fig.6.1. Dr. Bhalchandra Bhatwadekar

Fig. 6.2. Dr. Anna Moreshwar Kunte Opinions, Attitudes, Anxieties

192

Fig.6.3. Father Damien as a Leper.

Opinions, Attitudes, Anxieties

193

Fig.6.1. Dr. Bhalchandra Bhatwadekar

Fig. 6.2. Dr. Anna Moreshwar Kunte

Fig.6.3. Father Damien as a Leper.

Chapter 7 THE LEPER IN PERSON This chapter is devoted to the leper in person because the history of this disease can be better understood by studying its victim. The task is difficult. Due to the leprosy sufferer's lowly estate in Indian society, and the fact that he/she was usually poor and illiterate, it is hardly surprising that personal testimonies of ‘leper-hood’ are hard to come by in nineteenth century sources. The leper’s

social and personal

life, which are the focus of this chapter, have therefore been constructed from third person accounts and perceptions,

with the

attendant drawbacks of such an approach. As the following excerpt from the Times of India illustrates, prosperous colonial society in nineteenth century Bombay tended to view the leper in en masse and impersonal

terms, and was hardly

aware that he was a person in his own right, living by his wits in the prosperous metropolises, on the margins of mainstream society. They are to be seen ... along the Queen's Road and the Malabar Hill Road soliciting alms from Europeans; they are in the Bazar, at the Docks, in the Fort -- everywhere in short where there is a chance of begging a few pice ... in the meantime the public should understand that there are upwards of a thousand lepers in Bombay... In chawls in many parts of the native town and especially in Camateepoora lepers and healthy people are to be found living together in large numbers... 1

In this chapter the observations and remarks of medical men have proved especially valuable in giving a human face to the leper. Opportunities for observation by physicians were frequently available in the charitable institutions and hospitals in the larger cities of the Presidency, such as the District Benevolent Society’s J.J. Dharmashala, the wards of the J.J. Hospital and its predecessor the Native General Hospital at Bombay. 2 Lepers were admitted to a special ward at the 1

Times of India, 20/6/1890. The J.J.Dharmashala is described in Chapter 8. The Leper in Person

194

J.J.Hospital in the early years of the institution, but in the 1860s

the

space could no longer be spared due to the increasing needs of the Hospital. A ‘Ward for Incurables’ of

beds, including 20 for

lepers, was erected in 1864 from Rs. 80 000 provided by Rustomjee Jamsetjee Jejeebhoy. It was maintained by Government and managed by the staff of the Hospital. 3 The Urban Leper in Life A substantial number of the lepers in a city were not natives of it.

Ahmedabad the Surgeon in charge of the Huttee Sing and

Premabhai Hospital reported that most of the 72 lepers there had "come from distant provinces, notably Rajpootana and Kattiawar." 4

1855, J.C.Lisboa (d 1897), an Indian medical graduate who was

charge of the Leper Ward at the J.J. Hospital, estimated that over 50% were “born elsewhere”. 5 Several were from the fishing villages and small towns in the coastal regions of the Presidency, others came from as afar as the Deccan, Bengal and even Afghanistan. Though all communities were represented,

the majority of lepers

with substantial

“native Christians” as well.

numbers of

were Hindus, In the

absence of other provisions for his care, the leper's sole recourse was to "the peculiar views and feeling which the mass of the native community entertain in reference to the virtue of goodness of alms-giving (dharma), liberality". 6

[which] leads At

them to

any one time,

the exercise

indiscriminate

almost 100 lepers in the worst

MSAGD, Vol. 13, 1862-64, p 205. The consequences of the closure of the Ward in 1889 are described in Chapter 6 4

Carter, “On the Symptoms and Morbid Anatomy of Leprosy”, p 27.

J.C.Lisboa, “Observations on Leprosy; being extracts from a paper read before the Grant College Medical Society”, Transactions of the Medica land Physical Society of Bombay, 2 (new series): (1855) pp 290-300.

Anonymous, Bombay Beggars and Criers, Bombay, Family Printing Press, 1892, p 31. The Leper in Person

195

circumstances were lodged

and partly fed at the Dharmashala, while

others flocked to the Dispensary at the J.J. Hospital where 60 to 70 of the worst cases were admitted annually. The reports of Lisboa and Vandyke Carter indicate that the leper population comprised fishermen, farmers, field labourers, sailors, stone masons, housewives and young children, besides beggars. Several of the latter perambulating Bombay streets had seen better days as trusted servants and stewards in the homes of "respectable Hindu and other families". 7 Almost 40% of the Dharmashala

lepers

had leper relatives, while

among the Hospital

lepers, fewer acknowledged a "family taint", probably because their disease was not so advanced and they had

a greater hope that

medical treatment might be successful. 8 The personal histories of three Bombay lepers provided by Carter in the early 1860s give a sense of their social and personal circumstances. (a) Tah (sic) Mahomed, aged 53, was a J.J. Hospital patient, a pensioner from Nasik in Khandesh, who developed leprosy at the age of 50. He was in fair health, but had lost the use of one hand because of the disease. He was married, and had a grown-up family and grandchildren, who were all well. There was no familial 'taint' of leprosy, and the man had been an 'earning' member of his family when attacked by the disease. 9 (b) An unnamed ten year old Hindu boy from the Uran coast on the mainland was an inmate of the J.J. Dharmashala. His disease had appeared when he was five years old. His father had died of

Ibid, p 29.

Ibid, p 6.

Carter, â&#x20AC;&#x153;On the Symptoms and Morbid Anatomy of Leprosyâ&#x20AC;?, p 6. The Leper in Person

196

severe leprosy in the Dharmashala five years earlier, and the leper child was now an orphan. 10 (c) Changi, also a Dharmashala inmate, was a Hindu female aged 25 years from Bancote on the Ratnagiri coast. Leprosy spots appeared on her body when she was 13 years old. Her hands were numb and distorted, but she was otherwise in good health. Her paternal uncle was a leper in the Dharmashala; she was married, and had children, but her husband had driven her out on account of her disease. 11 Whether driven of his/her rural home by family, or leaving it of

his/her own accord, lepers who found their way to

joined the large fraternity of mendicants and vagrants

the city

begging for

scraps and pice by day, and sheltering in the Dharmashala or near public water tanks by night.[Fig. 7.2 ] Although many a leper was thus separated from his family, it sometimes happened that he abandoned

by his healthy spouse even in

was not

such dire circumstances..

She accompanied the sufferer to the city, devoting herself to his care, and living off his mendicancy.

A visitor to the Dharmashala in 1890

saw a healthy woman with a leprous husband, and a healthy man with a leprous wife and daughter, and exclaimed that "in such cases the love and devotion of the healthy one must be very real indeed". 12 Informal sexual alliances

and surrogate family relationships

also

formed

between "wifeless husbands and husbandless wives, children without parents and parents without children" Indian Medical

Service, when

Bombay, recalled that 10

K.R. Kirtikar (1849-1917) of the

officiating

Health

Officer

in the first 140 admissions at the Homeless

Ibid, p 12. Ibid.

W.C. Bailey, A Glimpse at the Indian Mission Field and Leper Asylums, London, The Mission to Lepers, 1890, p 9.

Ibid, p 3. The Leper in Person

197

Leper Asylum at Matunga in 1890, there were many instances of â&#x20AC;&#x153;free-will weddings, or matrimonial relations regardless of caste considerations." 14 Such liaisons generally were infertile; they were mainly formed from the mutual need for companionship in distress, or in the hope of nursing and care from the partner. Abandoned leper mothers such as Changi, whose story was cited above, had particularly unfortunate lives. In 1875, Carter "with the

kind cooperation

professional native gentleman who

particularly acquainted with the malady in question, and with the state of the afflicted in Bombay", personally

examined and interrogated

127 leper inmates of the Dharmashala.. 15 The most notable aspect of this study of

was

the

the woman leper.

attention he devoted to the special suffering Carter

found

women

all ages in the

Dharmashala. Significantly, they outnumbered the men. As

Carter

well knew from his researches, leprosy was almost 4 times more frequent in men than women, 16 which immediately suggested t him that women

lepers readily availed themselves of asylums if

offered the

opportunity. All the women interviewed by him had been expelled from their homes. Some were too disabled to leave the Dharmashala, but others less helpless, had found the yearning for home so strong as to be "uncontrollable". Carter reconstructed a poignant scenario of the reception a returning leper woman could expect in her village. The once expelled leper dare not again enter the precincts of her native village. Some described how they stood outside, and how then they did enquire in a loud voice from the passers by, of husband, children, friends and relatives. Never were the yearning women invited to enter their former homes; anxiously they came away without 14

MSAGD, Vol. 61A, 1897, p 173. The Homeless Leper Asylum is the subject of Chapter 9. 15

Times of India, 19/10/1875. The "professional native gentleman" referred to was almost certainly Dr. Sakharam Arjun, who was at the time in charge of the Leper Ward at the J.J. Hospital. His studies into leprosy treatments are discussed in Chapter 3.

Carter, â&#x20AC;&#x153;Report on the Prevalenceâ&#x20AC;?, p 92. The Leper in Person

198

any relief being offered them or hearing any expression of concern. Nay, worse treatment has been simply and uncomplainingly described to us, and that with every appearance of truthfulness on the part of the humble reciter of such unmerciful deed... No fewer than thirty six [of the married women] have living children now left at home... 17

Vagrant lepers in Bombay medication

were

to relieve the pain of

the

frequently

driven to self-

disease. They

empirically

discovered the soothing properties of opium, and some paid the price in opium addiction. 18

Leper Dying and Death in the City Much as its well-to-do citizens wished the living leper out of their sight, Bombay could not ignore him when he was dead or dying. [Fig.7.1] He was among the miserable objects in the very last stages of destitution picked up in the streets by the police, and brought to the Native General Hospital in the early 1840s or its successor the J.J. Hospital after 1845. Though lepers sought relief at such institutions, they did not always yield to the medical advice available therein. Instances were reported when a leper at death’s door due to his hands and feet being

riddled

with sores, steadfastly refused to submit to

amputation of the diseased limb.

Colonial

physicians

complained

about "the prejudices of the natives" which caused them to hold out against such surgery till it was too late and "the blood [had] become quite corrupted."

One leper who did consent to amputation of his

diseased leg, but on the table, his courage failing him, he was removed. Scurvy of a most severe character...supervened resisting all the remedies, and ... the patient died, after enduring the greatest suffering.. 19

Times of India, 19/10/1875.

N.H. Choksy, “The Opium Habit Among Lepers”, Indian Medico-Chirurgical Review, 1: (1893) pp 749-752. 19

“Annual Report of the Native General Hospital, 1841”, Transactions of the Medical and Physical Society of Bombay, (no volume no.): (1842) pp 19-33 The Leper in Person

199

Lepers formed one per cent of the patients dying in the Native General Hospital in the early 1840s. 20 from leprosy at the J.J. Hospital

The number of fatalities

averaged 12 annually; in

the

twelve years 1851-1863, Bombay saw a total of 543 leper deaths, 75% of

them men. 21

The

age at death in 426 lepers was

analysed by Carter in 1873 from the Bombay Mortuary Returns. About 70%

were between 21 and 50 years old when they died.

Particularly dangerous

for the woman leper were her reproductive

years (20 to 40 years). Leprosy was thus a disease of the prime of life. [Table 7.1]

High death rates among lepers were seen even

into the 1890s. 22 Of 1579 vagrants who were admitted into the Homeless Leper Asylum at Matunga between 1890 and 1896, as many as 670, i.e. 43%, had died by 1897. Of the 224 lepers who formed the first set of admissions, only 50% were alive 7 years later.

In Bombay city the life of more than one leper ended in tragedy. In May 1890, Luximon Gainoo, found unconscious in a verandah, died in a police cart because the authorities at the J.J. Hospital did not have any room for him. 23 More than one ended his life by suicide. In March 1889, the body of Poonaji Janoo, a fifty year old former mill hand,

expelled by his family, was

fished out of the Baboola

“Annual Report of the Native General Hospital at Bombay for the year 1838”, Transactions of the Medial and Physical Society of Bombay, (no volume no): (1840) pp 38-49. 21

Carter, “On Leprosy as seen in India; with Remarks on the Eruption and Anaesthesia”, British and Foreign Medico-ChirurgicalReview, 31: (1863) pp 183-190. 22

N.H. Choksy, Report on Leprosy and the Homeless Leper Asylum Matunga, Bombay, 1890-97, Bombay, British India Printing Works, 1901, pp 18 & 36. 23

Times of India, 21/5/1890. The Leper in Person

200

Tank in the

heart of

Coroner of Bombay,

the city.

Apropos

this incident, the

Dr. Thomas Blaney, revealed

in the Municipal

Corporation that every year he gave orders for disposing of the dead bodies of "ten, twelve, or fifteen" lepers. From his enquiries he found that some of them had died on the roadside, sometimes in front of the Elphinstone College [at Byculla], sometimes at one or other of the wells on the Esplanade. Some of them drowned themselves in the wells tired of life, neglected by the Government and the Corporation. 25

The Rural Leper in Kathiawar The pathos of the life and death of the city leper described above produces the

impression

that in India, families’ treatment of

their leper relatives was always characterised by hostility and indifference and outcasting. However such an outcome was neither invariable nor inevitable. The Leprosy Commission which toured all regions of the country in 1890, remarked significantly that while Indians feared the leper, they were not as judgemental about him as westerners were: “…. [t]he leper [is]

not really … such an outcast or deplorable

individual as European opinion considers him to be”. 26 As in the case of the city leper, so about the rural, Carter provides the largest amount of information. In making his case for leper asylums

Carter

was

ever

at pains to highlight the apparent

indifference of Indian society to the suffering of the leper, left to fend for herself, without medical attention of any sort. I have heard of harsh treatment [towards lepers] in the same locality [Sattara] : a bare shelter of sticks and leaves put up in the hedge-way amongst fields away from the village, where a poor creature lingered for four months before her death; and I doubt not the experience of almost every Indian official would enable him to call to mind similar instances.. 27 24

Times of India, 4/3/1889.

Times of India, 6/4/1889. Thomas Blaney 1823-1903), came to India in 1836, and studied medicine at GMC till 1860. He had a successful private practice, and was associated with the Bombay Municipal Corporation for almost 30 years. He was Coroner of Bombay from 1876-1893. 26 27

Report of the Leprosy Commission, p 290. Carter, Report on Leprosy and the Leper Asylums in Norway, p 24. The Leper in Person

201

On his return from the Norwegian tour Carter’s critical vision was strongly refracted though contagionist spectacles. His testimony is all the more valuable, because he was dismayed at the tolerant

manner of

rural Kathiawari society who did not shun the leper and segregate him as thoroughly as thoroughly as Carter wished, because he found no “sight… more affecting than that of a leper at home.” 28 This showed that stigmatisation and outcasting of leper relatives Indian society. In the three months

was not the rule in

that he spent in the villages of

Kathiawar, Carter observed the circumstances of 262 lepers, 44% of whom had the severe type of disease, living communities. In 25 year old

in their homes and

Duskrohi district of Bhavnagar state, he found a

leper who "eats the same food as others; lives in the same

room as his parents and the rest...". 29

In the same village, Carter came

upon a female of 30 years with well marked leprosy, who "[lived] in the common house, having a small space to herself..."

She mixed with

the other villagers and daily went to work in the fields “working as hard as she could from morn to eve.”

She was not permitted to

cook, but her husband brought the food to her.

In other villages Carter

found even deformed lepers to be active as farmers, barbers, grocers, merchants, fisher folk etc., without protest from others. As an example of what he deemed to be Indian fatalism and apathy, Carter described the acceptance extended by a family to a "perfect representative of the worst

form of the disease .... The

people [had] no objection to

admit lepers amongst them". 31 In Kundla distrct he met a touching ------------------------------------------------------------------------------------------------------------28

Carter, Modern Indian Leprosy, p 70.

Ibid, p 2.

Ibid.

Ibid, p 8. The Leper in Person

202

instance of filial affection for a

parent sorely afflicted with leprosy,

who Carter would have preferred to be consigned to an asylum. This 65 year old man was bed ridden, helpless and miserably lodged... lives alone in a straw hovel, close to a cattle shed and a few yards away from his old home; all these people are very poor, yet none want food, and the sons are very attentive to their aged leper father, who boasts to me that when he knocks with his stick three men run out to help him, and when he asks for a bit (sic), they give him handfuls to eat... a case well fitted for an asylum, yet it is more than doubtful if they would let him go. 32

When rural communities

segregated a leper member, it was in a

rough and ready manner by placing him/her in a verandah, or a hut some distance away, [Fig.7.3] or in the cattle stall, where he was fed and

given

necessary attention.

45 year old "Mussulmani"

leper

widow in Duskrohi lived with her six children, who prepared her food and fed her. She occupied a verandah separate from the common room, but moved freely about, "and [was] not much feared". Less tolerantly, though not unkindly treated, was a 26 year old woman leper in the same district,

who being deserted by her husband, returned to her

maternal home, living apart from them, "with Purbhu" -- with Godâ&#x20AC;&#x201D;as she told Carter simply and eloquently. Her caste people had

built

"decent hut" for her in their own quarter, and she was maintained by her brother. 33

When a family was unable to provide even a small place

apart, the only alternative was to permit the sick individual to remain in the household, living in the single room with the rest. Subsequently, if his presence became objectionable to the family, a "lean-to of mud and sticks" might be erected for the lodgement of the leper's cot.[Fig 7.1, Table 7.1]

Indian society in Kathiawar further alarmed Carter by its

disregard of precautions against the hereditary spread of leprosy. He ------------------------------------------------------------------------------------------------------------32

Ibid, p 16.

Ibid, p 57. The Leper in Person

203

wrote of "wretchedly diseased and

mutilated parents, continuing to

procreate.” 34

Assessment Medical men’s perceptions and observations have been the chief source from which a human face of the nineteenth century leper has been pieced together. The reports reveal that the sufferer’s suffering was most visible and severe in the city, where large numbers of outcasted lepers congregated and succumbed to privation and neglect. The leper wife and mother was particularly hard hit both in physical terms and when she was outcasted. As partners in distress in the city, it was necessary for lepers to adopt survival strategies such as selfmedication, formation of informal family groups and “free-will” marriages. These ensured that the benefits from mendicancy and association were widely shared. The frequent leper suicides reported by the Coroner of Bombay were an indication of the despair and despondency that dogged the existence of many. Carter’s disapproving pen and contagionist bias painted what he hoped was a deplorable and frightening picture of the Indian rural leper in his natural habitat. To the historian however, it shows systematic ill-treatment of an affected person was not the norm in Indian families and communities. Kinship structures, family affection, and the value placed on a leper’s contribution to the family’s or community’s economy, were the

factors retaining him/her within the household and society. It

would probably not have occurred to such families that locking up the leper member for life in a special asylum was a sign of enlightenment which promised great future

benefit

to them

preventing the

spread of leprosy.

Ibid, p 78. The Leper in Person

204

The Next Chapter The next two chapters follow the leper into the institutions which were established for him in Bombay Presidency.

Fig.7.1. Mortality Among 426 Lepers in Bombay City, 1867.*

% Dying

Males Dying

Females Dying

30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0 10

Decadal Age

*H.V. Carter, â&#x20AC;&#x153;Report on the Prevalence and Characters of Leprosy in the Bombay Presidency, India, based on the Official Returns of 1867.â&#x20AC;? Transactions of the Medical and Physical Society of Bombay, 11 (new series): (1871) p 101.

-------------------------------------------------------------------------------------------------------------

The Leper in Person

205

Fig.7.2. A Leper in a Colonial Metropolis. *

*J.L.Kipling, Beast and Man in India: A Popular Sketch of Indian Animals and their Relations with the People, London, Macmillan and Co., 1891, p 295.

Fig.7.3. A Rural Leper in Kathiawar.**

The Leper in Person

206

**H.V.Carter, Modern Indian Leprosy, being the Report of a Tour in Kattiawar, Bombay, Printed by the Chiefs of Kattiawar, 1876, p 97.

10 20 30 40 50 60 70 80

Living 0.67 7.87 22.35 30.57 26.79 9.84 1.48 0.03

Dying 0.3 7.8 20.6 25.5 21.2 12.1 9.8 2.6

MALES

Living 1.89 13.28 29.18 25.65 19.56 8.43 1.70 0.03

Dying 1.0 10.8 23.5 28.4 16.6 11.7 5.9 2.0

TABLE 7.1. Analysis of 426 lepers in Bombay City, 1867, showing Proportion of those Alive and Dying at each Decade of Age.*

FEMALES

The Leper in Person

207

Fig.7.1. Mortality Among 426 Lepers in Bombay City, 1867.*

% Dying

Males Dying

Females Dying

30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0 10

Decadal Age *H.V. Carter, â&#x20AC;&#x153;Report on the Prevalence and Characters of Leprosy in the Bombay Presidency, India, based on the Official Returns of 1867.â&#x20AC;? Transactions of the Medical and Physical Society of Bombay, 11 (new series): (1871) p 101.

Fig.7.2. A Leper in a Colonial Metropolis. *

*J.L.Kipling, Beast and Man in India: A Popular Sketch of Indian Animals and their Relations with the People, London, Macmillan and Co., 1891, p 295.

Fig.7.3. A Rural Leper in Kathiawar.*

*H.V.Carter, Modern Indian Leprosy, being the Report of a Tour in Kattiawar, Bombay, Printed by the Chiefs of Kattiawar, 1876, p 97.

TABLE 7.1. Analysis of 426 lepers in Bombay City, 1867, showing Proportion of those Alive and Dying at each Decade of Age.* AGE

MALES FEMALES Living Dying Living Dying 10 0.67 0.3 1.89 1.0 20 7.87 7.8 13.28 10.8 30 22.35 20.6 29.18 23.5 40 30.57 25.5 25.65 28.4 50 26.79 21.2 19.56 16.6 60 9.84 12.1 8.43 11.7 70 1.48 9.8 1.70 5.9 80 0.03 2.6 0.03 2.0 *H.V. Carter, “Report on the Prevalence and Characters of Leprosy in the Bombay Presidency, India, based on the Official Returns of 1867.” Transactions of the Medical and Physical Society of Bombay, 11 (new series): (1871) p 101.

Chapter 8 CONFINE OR SHELTER? A wall should be built separating lepers from infirms…each portion having a separate entrance … The North side will be preferable for the Leper Hospital as the prevailing winds would not then blow off the lepers on to the Infirms. 1

The concept of an institution specifically for

shelter

and

isolation of a special category of sick was a peculiarly European one. Leprosy asylums and refuges were the most tangible and long-lasting symbols of Western India’s colonial encounter. It is of interest therefore to examine the place and purpose of such institutions in the society of the time. One of the first leper homes in India was established by the Dutch at Cochin in 1728. 2

Probably the first institution established

under British aegis was that at Almora in 1835 by Sir Henry Ramsay (1816-1893),

later

Commissioner

Kumaon and Garhwal. 3 Such

personal and official acts served to bolster colonialism’s self-image as a caring system amidst apathetic and ignorant Indian society. 4 By the last quarter of the nineteenth century the leprosy asylum came to be regarded as an all-purpose solution to the anxiety, loathing and distress caused to well-to-do society by the sight of the leper. To hereditarians, an asylum was a place to ensure sexual segregation and prevent leper procreation they so feared.

To contagionists, it enabled isolation of

dangerously infected persons from society. To sanitarians

was a

place to re-invigorate the demoralised leprosy sufferer by providing him with a wholesome environment. 5

To Christian missionaries a leprosy

----------------------------------------------MSAGD, Vol. 92, 1883, p 111.

Mentioned without citation in Kakar, “Patient Unrest”, p 64.

Jackson, Lepers: Thirty-one years’ work among them, p 17.

For example Carter maintained that “… nothing has been attempted for alleviating the public, family and individual sufferings which are entailed by passive endurance of the leprous pest.. [italics added] . Carter, Modern Indian Leprosy, p 80.

For definitions of these terms see

Chapter 1. Confine or Shelter?

208

asylum

provided

Presidency’s provided and

the

best

scope for evangelisation. 6

For Bombay

moneyed Indians, founding of leper refuges and asylums

opportunities to perpetuate their and their family’s names

reputations.

Lastly, asylums

served to

remove

from

public

sight, -- and public mind -- “loathsome lepers” who were a blot on colonial pride in their prospering cities. To the sufferers themselves, the asylum was variously

place for medical treatment, a

refuge

from society’s fear and loathing, and a place to die in. Others patronised

asylums only

as temporary shelters, and

themselves

when they felt they no longer needed it.

removed

Such

persons

regarded forcible incarceration as an infringement on their liberty, and often demonstrated their determination to escape its restraints. With so many perceived advantages, it would be surprising indeed had such an institution not been introduced into India.

Leper Asylums

and the Decline of Leprosy in Medieval

England The

enduring power of

the public health role of

the leper

asylum in Western consciousness was remarkable, considering the fact that there was no consensus among historians on the reason for Britain becoming leprosy–free in the post-medieval period. Leprosy labelled “the

was

greatest disease of medieval Christendom” in a late

nineteenth century edition of the Encyclopedia Britannica. 7 However, it is almost certain that the estimated number of affected was inflated because many other diseases were mistaken for leprosy. After thriving in the medieval European milieu for about 250 years,

the disease

----------------------------------------------The entry of missionaries into the asylum undertaking led to a symbiotic relationship with the authorities. It was highly acceptable to the colonial government unwilling to involve itself in maintaining and running leper asylums, and was much desired for evangelical purposes by the missionaries themselves. Of the two major branches of the Christian church the Roman Catholics entered the asylum enterprise in Belgaum in 1863, ahead of their Protestant rivals.

Encyclopedia Britannica, Ninth Edition, Edinburgh, Adam and Charles Black, 1882. Confine or Shelter?

209

became extinct by the sixteenth century, though not before the leper asylum came to symbolise Christian societies’ response to the disease. The medieval Christian church,

which was at the forefront of

the

campaign to segregate and serve the leper, was inspired as much by the old as the new Testament precepts, stigmatisation as “unclean”, and isolating from society for “special” care. An excessively religious view was taken of this bodily disease. … it is a plague of leprosy: and the priest shall look upon him, and pronounce him unclean…. All the days wherein the plague shall be in him he shall be defiled; he is unclean; he shall dwell alone; without the camp shall his habitation be… 8

Despite the ubiquity of the leper asylum in medieval Britain – as many as 283 lazar houses were counted -- eighteenth and nineteenth century historians and Victorian physicians were not of

one mind

about the reason for the extinction of the disease. 9 Unlike Carter who unhesitatingly attributed it to strict segregation, others looked elsewhere for the answer. According to George Newman, a winner of a “Prize Essay on Leprosy” from the Father Damien National Leprosy Fund, ecclesiastical, not medical, institutions; refuges, not places for treatment; palliative, not radical, [therefore] useless as prophylactics... the decline and final extinction of endemic leprosy was due, not to segregation, but ... to a general and extensive social improvement in the life of the people... to agricultural advancement, improved sanitation, and land drainage. 10

Newman transformation

was not alone in giving pride of place to social rather

than institutions

for the extinction.

Charles

Creighton, author of A History of Epidemics in Britain even discounted the supposed high prevalence of the disease in medieval times. His explanation took account of hereditarian and sociological factors: It was a morbus miseriae of the Middle Ages, but on the whole not a very common’ and it was easily shaken off by the national life when the conditions changed ever so little. ----------------------------------------------Biblical sources on leprosy are given in Chapter 6, footnote 4.

W. MacArthur, “Mediaeval ‘Leprosy’ in the British Isles”, International Jjournal of Leprosy, 21: (1953) pp 218-230. 10

Newman, “On the Decline and Final Extinction of Leprosy”, p 66. Confine or Shelter?

210

It was all the more easily shaken off by reason of the facilities prohibition of marriage, and the monastic discipline. 11

Gilbert White

the famous late

historian of Selborne,

for divorce, the

eighteenth century social

linked the extinction to the rise of social

comfort: It must, therefore, in these days be, to a humane and thinking person, a matter of equal wonder and satisfaction, when he contemplates how nearly this pest is eradicated, and observes that a leper is now a rare sight. He will, moreover, when engaged in such a train of thought, naturally enquire for the reason. This happy change … may have originated and been continued from the much smaller quantity of salted meat and fish now eaten… from the use of linen next to the skin;;; from the plenty of bread… and from the profusion of fruits, roots, legumes, and greens, so common in every family…. 12

By the nineteenth century centuries,

but

their

response

Britain had been leprosy-free for to

Indian

leprosy

the British

instinctively drew on the association between lepers and leper asylums that was entrenched in their collective consciousness. 13

Traditional Institutions for the Indigent in India The medical texts of Susruta, Charaka and Vagbhata, compiled in the first to the sixth century A.D., are notably detailed on the signs symptoms and causes of leprosy. 14 evidence

The texts also abound in

that whatever be the religious attitude, Indian physicians

regarded leprosy as a disease to be cured or alleviated. However, the medical literature is surprisingly silent on the question of prevention of leprosy. 15

As for the Hindu leper himself, a moral taint as well

----------------------------------------------Creighton, A History of Epidemics, Vol.1, p 112.

G. White, A Natural History of Selborne: Letter XXXVIII., Vol.1, London, John van Voorst, 1877, p 205.

See the remarks by the missionary W.C. Bailey later in this chapter.

Some of these are mentioned in Chapter 1.

For example there is no mention of prophylactic measures in Dharmendra. “Leprosy in Ancient Hindu Medicine”, Leprosy in India, 12: (1940) pp 19-21; nor in Emmerick, “Some Remarks on the History of Leprosy in India”, Chakrabarty, An Interpretation of Ancient Hindu Medicine. Confine or Shelter?

211

as civil

disabilities

hung

over him, as

had over his

medieval

European counterpart. 16 In India the leper, was entitled to maintenance and care from his kin. Of course, generous family invariably shown, since

thousands of

children -- were expelled

spirit

was not

sufferers â&#x20AC;&#x201C; men, women and

from their homes to spend a

vagrancy, mendicancy and destitution. It

was for lepers in such

straits, as also for other indigent persons, dharmashalas were established

life of

that

shelters called

and maintained by communities, the

state and devout persons. Dharmashalas were

generally situated near

temples, holy places or in the larger towns and cities. Such institutions, therefore, traditionally

accommodated all

variety

needy

and

handicapped persons, there being no facilities, or even intention, to regard lepers as a special

class

indigent

requiring

Dharmashalas were used as temporary or permanent or night shelters for those who might

spend

isolation.

abiding places

their days begging for

alms. 17 Forts, Islands and Lepers in the Colonial Consciousness It was during the colonial period that thoughts of controlling leprosy began to be discussed; inevitably the control of leprosy became synonymous with controlling the leper. In Bombay Presidency in the late nineteenth century a

search was launched for secure places to

confine or extern the leper. It occurred to administrators that nature and history had provided a string of islands and forts along the coastal belt of the Presidency were ideally suited for the purpose in mind. On each occasion that a site was proposed, however, drawbacks were discovered in it, with the result that leper forts or leper islands

----------------------------------------------The status of the leper in Hindu civil law is considered in Chapter 5.

Anonymous, â&#x20AC;&#x153;Notes on Early Leprosy Institutions in Indiaâ&#x20AC;?, Leprosy in India, 12: (1940) pp 85-87. Confine or Shelter?

212

never became a tool of “control” in western India. 18 One of the first officials to canvass the merits of a

leper fort was A.K.Nairne,

Assistant Collector of Ratnagiri. ... it seems to me, that we have in the various forts along the coast of this Collectorate, places very admirably adapted for such seclusion, large enough to prevent any feeling of resistance. In the fort of Rutnagherry, for instance, there is ample room for building a whole village of small houses or huts, … while at the same time the steepness of the path up to the fort would alone prevent people in a bad state of health from going out of it... [S]uch a scheme as I propose would cost Government very little by way of outlay... 19

Leper islands were also a Western tradition, and interest along that line was sparked in Bombay by Damien’s death on the Hawaiian leper island of Molokai in 1889. The circulation of the draft leper bill in 1889

produced

some suggestions on that score. While

one

commentator, Dr. Edith Pechey (1845-1908) the first woman doctor in Bombay’s medical establishment, was of the opinion that the exile of lepers to islands was the “greatest cruelty”, she sought to sugar the “ cruelty”: with a compromise: … For this purpose it appears to me that an island might be selected so situated, and of so pleasant a climate as to afford a desirable retreat for such invalids from all parts of the British Empire.... It would ... be possible in this proposed colony to allow the admission of the families of those already married. 20

Nothing came of this proposal, but the island option was considered

again

the

following

year

the course

the

Government's search for a secure site for an asylum to be established ----------------------------------------------In 1889 following the “discovery” that there were several leper convicts in the penal colony in the Andaman Islands, the Government of India contemplated measures to prevent them from leaving the islands and segregate them from other convicts. Administratively the effort to create an internment camp within the convict colony proved to be unworkable. Sudratu Sen, Disclipining Punishment: Colonialism and Convict Society in the Andaman Islands, New Delhi, Oxford University Press, 2000, pp 238-239. In North America in the 19th and early 20th centuries, deserted islands were the chosen locations for leper asylums (lazarettos). Kalisch, ‘Tracadie and Penikese Leprosaria”. 18

MSAGD, Vol. 1, 1867, p 363. See also later Albless Leprosy Hospital”. 20

in this chapter “Eduljee Framjee

MSAGD , Vol. 4, 1890, no pagination. Confine or Shelter?

213

out of a donation from the Parsi magnate, Dinshah Manockji Petit. 21 "In speaking of an island," Governor Lord Harris clarified, I of course mean one that can only be reached by water-carriage, and which would be exclusively reserved for lepers... or so sparsely occupied as to cause little difficulty in removing the inhabitants..." 22

The merits of several islands were thereupon gone into, but fatal drawbacks were encountered in each: Harnai ("too small and the fort too dilapidated"), Deonar ("too close to the mainlandâ&#x20AC;Ś and not really an island"), Madh ("too large and too many inhabitants... acquisition and eviction of the present inhabitants would be too costly"), Arnala (" the Chemical Analyser ... pronounced one of the water samples brought from the

island 'unfit

for potable purposesâ&#x20AC;?). 23

Leper forts and islands

having been shown to be impractical, the colonial authorities had to resort to the second best option of a conventional structure on the mainland. In 1840, the

Presidency had

no institution for

sheltering

lepers, and no leper census had ever been made. Fifty seven years later, by

1897,

with a

leprosy population

over 10,000, 24

the

Presidency could boast of eleven asylums established through private Indian, missionary, or state funding. These are listed in Appendix 8.1. These included, in addition to the four institutions discussed below, asylums such as

the David Sassoon Infirmary at Poona, the Kagda

Peth asylum attached to the Civil Hospital at Ahmedabad, the Roman Catholic Asylum at Belgaum, the American Mission Hospital at Poladpur in Kolaba District, and asylums in the princely states

----------------------------------------------MSAGD, Vol. 82, 1891, p 45.

Ibid, p 34.

Ibid, pp 52-56.

According to the Census of 1891, the Presidency had 10,187 lepers. The census is discussed in Chapter 4. Confine or Shelter?

214

Sawantwadi, Baroda and Kolhapur. 25 between 20 and 300 lepers. 26 In of

confinement

well

They each

accommodated

fifty- seven years, the conditions

the

rhetoric

for

their establishment

changed under wavering medical doctrine and shifting socio-political compulsions. What remained constant was

the rulers' consciousness of

their 'civilising mission', and ‘superiority’ of the European Christian concept of special institutions for lepers. Four

nineteenth

century

leper refuges in the Bombay

Presidency, each with a unique origin and mode of functioning, are examined in the following pages. The success or failure of each institution is assessed on the basis of the stated purpose for which it was established. The institutions are: the Rajkot Leprosy Asylum, the J.J.Dharamshala at Byculla in Bombay, the Dinshah Manockji Petit Leprosy Asylum at Ratnagiri, and the Eduljee Framjee Leprosy Asylum at Trombay, near Bombay. The Rajkot Leprosy Asylum and J..J..Dharamshala dated from the pre-1858 period.

The Rajkot Leprosy Hospital:

The ‘civilising mission’ of

colonialism in the days of the East India Company was manifested in the campaigns for the suppression of sati, female infanticide and other Indian customs which the British found abhorrent. The response of the pre-1858 British to the socially sanctioned Indian custom of assisting in leper suicide has been studied in Chapter 5. Kathiawar

the

Gujarat

peninsula,

In the princely states in

leper suicides

were

not

uncommon, though there were no reports that rendering assistance in ----------------------------------------------Ibid.

The “Homeless Leper Asylum at Bombay, which is the subject of the next chapter, was the largest. Confine or Shelter?

215

such acts occurred. The mode of suicide favoured by Kathiawari lepers who were in despair or distress or destitute, was usually by throwing themselves off a cliff into the sea at holy places such as Gopnath on the Gulf of Kutch. The British Political Agent at Rajkot, Col. J. Lang confessed that the practice had been “little noticed” by the British initially. 27 The prevalence of

the custom of leper suicide by

drowning came to attention incidentally, rather than by design. 28 Lang wrote to London in 1849,

that he “found that this practice is much

more common than I had any idea of..." 29 The Rajkot leper institution was the outcome of his representation to the Kathiawar chiefs that "... the most effectual as well as most beneficial mode of putting an end to the practice of self immolation in consequence of leprosy will be found in the ... establishment of an Hospital for lepers at Rajkote." 30 In 1850 the public subscribed Rs. 8034 towards

a new Rajkot Civil

Hospital and dharamshalas for the "indigent and infirm", and the Chiefs, under the leadership of agreed

to pay a

the

Thakoresaheb

of Bhavnagar,

contribution of Rs 5278 per annum for a

leper

hospital. In its functioning, the institution was essentially a refuge for wandering or sick lepers

who had separated

themselves from their

families either voluntarily or under coercion by relatives. Carter’s estimation, it was not “an Asylum proper,” was

facility

for

long term segregation. 31

institution, who numbered

Thus, in

because

there

The inmates of the

between 38 and 50 in 1871-1876, were

----------------------------------------------IOL, Bombay Despatches E/4/1094, Political, 2/1/1852. Col. W. Lang was Political Agent in Kathiawar from 1845 to 1859.

Carter Modern Indian Leprosy, p 81

Ibid.

IOL, Bombay Despatches, E/4/1094, Political, 2/1/1852.

Ibid. Confine or Shelter?

216

superintended by a pensioned Hospital Assistant: evidence of cost-cutting and the fact that high qualifications were not regarded as necessary for the medical care of lepers. 32 Each inmate was given a ration of wheat flour,

dall,

rice etc, and

extras on special

occasions. The

hospital

followed the dharamshala principle in the sense that there were “no fixed

regulations whatever,”

effort

was made either to compel

admission into it, nor prevent inmates from leaving it whenever they wished. 33 In other words it was a poor-house for lepers. Almost 50% sought discharge “on their own request” every year. 34 The voluntary nature of the institution

is apparent from the graph below which

depicts the sharp rise in the number of inmates, and surprisingly, of voluntary discharges during the famine years 1877-1879. 35 [Figs. 8.1 and 8.2] Most deaths resulted from diarrhoea. The effects of the famine are apparent from Figure 8.2, showing the rise in the number of diets provided for the lepers Trials of new medications such as gurjon oil were conducted in the institution in the 1870s, but the leper subjects were

not

impressed by the effects. The physician in the Civil Hospital found that 26 cases came from the leper hospital to attend as out patients, “but at the end of 3 or 4 days they declined to

be subject to

cleanliness and the gurjon oil…[and] absented themselves in a body.” 36 The

Rajkot asylum

might be described as an institution to which

----------------------------------------------MSAGD, Vol. 39, 1878, p 273.

Ibid.

Gazetteer of the Bombay Presidency. Vol. 8, Bombay, Government Central Press, 1884, p 358. 35

“In 1877 the rainfall of Kathiawar was very scanty and much scarcity prevailed, while in 1878 the fall was so excessive that not only did the crops perish, but a most virulent fever prevailed through out the peninsula. The price of grain rose steadily and it was clear as early as the close of 1878 that much distress would immediately befall the poorer classes in the hot weather.” Ibid, p 311. 36

MSAGD, Vol. 50, 1876, p 391. Confine or Shelter?

217

the leper resorted during his/her own perceived need and convenience. The leper at the Rajkot hospital was an autonomous individual both in respect of his utilisation of the facility, and his attitude to being the subject of therapeutic trials. The establishment of the hospital did not immediately put an end to leper suicides. Carter, while on the study tour of Kathiawar villages in 1876, heard of a suicide which had occurred in 1867. 37 The practice appeared to have died out by the time of Carter’s visit. 38

The Jamsetjee Jejeebhoy Dharmashala, Bombay:

Also known

as the “J.J. Dharmashala”, this was the sole pre-1858

institution for

indigent people in Bombay city; it was to become the largest leper refuge in the metropolis for almost half a century. Bombay’s “District Benevolent Society” was started in 1838, on the initiative of the Bishop of Calcutta, on the pattern of similar institutions in Calcutta and Madras. Its small dharmashala situated at Bellasis Road near Byculla, was set up to “put a stop to mendacity” by accommodating “the

helpless and destitute, poor, the sick, the

maimed, and the blind, of every nation, and of every religion” 39

The

Society ran on donations, though from 1838, its funds were augmented by a monthly grant of Rs.300 from Government. In 1844, Jamsetjee Jejeebhoy (1783-1859), the wealthiest and most charitable Parsi of the time offered Rs.50 000 to the Presidency Government, and undertook to build a new spacious dharmashala on the site of the old for the Society,

on condition

that the Government doubled its monthly

----------------------------------------------Carter, Modern Indian Leprosy, p

Ibid, p 42.

Bombay Almanac Directory and Register for the year 1842. Bombay, Times Press, 1841, pp 40-41. Also Correspondence relative to the “Sir Jamsetjee Jejeebhoy Dhurrumsalla”, built by Sir Jamsetjee Jejeebhoy, Knight, and made over by him to government, for the District Benevolent Society of Bombay, Bombay, The Times Press, 1851, p 2. Confine or Shelter?

218

contribution to Rs. 600. 40 institution, which

The condition being accepted, the new

became known as the “J.J. Dharmashala”

function in 1847. 41

began to

A substantial portion of the running expenses of

the institution came out of the interest on the endowments by Jamsetjee Jejeebhoy and other philanthropists, amounting to almost Rs. 20,000 per annum. In 1855

the Dharamshala was described as

"a substantial

building... [but it is] capable of sheltering conveniently (sic) only about three hundred and fifty persons, and is consequently rather present." 42

As its

name

indicated it was

crowded

a poor house conducted

along traditional Indian lines for paupers

and disabled of all

categories, -- blind, halt, aged, destitute, orphans, and, not the least, lepers. There was no dearth of needy persons

thronging to

“city of gold” in search of alms and shelter. 43 inmates, especially the leprosy- affected, swelled public-spirited

persons

proved to be the most

were

the

The number of

year by year,

appealed to for donations. The

and Parsis

generous, followed by European individuals

and European mercantile firms; Hindu donors were few, noteworthy being the shetias Jagannath Shankarsett and Mangaldas Nathoobhoy. 44 The most generous donors to the Society were Parsis and Europeans. Of ----------------------------------------------Jamsetjee Jejeebhoy was born of humble parents, and made a vast fortunes in the China trade. In 1842 he became the first Indian to be knighted by the Queen. Of his numerous benefactions to Bombay, the most notable are the Jamsetjee Jejeebhoy Hospital (“J.J. Hospital”) and the Jamsetjee Jejeebhoy School of Art (“J.J. School of Art”). The J.J.Dharamshala of the District Benevolent Society still survives and is now an old age home. 40

Correspondence relative to the “Jamsetjee Jejeebhoy Dhara Dhurrumsall”, p 27.

Ibid.

The epithet for Bombay used by G. Tindall, Bombay, London. Temple Smith, 1982.

City of Gold – the biography of

Jagannath Sunkershet (1802-1865) a rich banker and public benefactor of the Sonar caste; member of the Bombay Legislative Council 1862-1865. Mangaldas Nathoobhoy (1832-1890) wealthy Kapol Bania banker and mill-owner; social reformer. In 1875, Nathoobhoy, on persuasion by Carter, showed an interest in funding the establishing a leper asylum for Bombay lepers. Carter, Personal Papers, Mss 5821. Confine or Shelter?

219

the Hindus, only Dr. Bhau Daji was munificent enough to be eligible for a

“Life Governorship,”

with

notable, though modestly generous

a donation of donors were

Rs. 1000.

Other

Drs. Vandyke Carter,

Narayan Daji and Sakharam Arjun, who were all leprosy researchers, and almost certainly used the leper inmates for their studies. The Dharamshala was managed by a five member Committee consisting of the chief donors; the day to day running was

by a

European, Thomas Hanna. An apothecary visited periodically to provide minor medical attention. The seriously ill

were

transported

at the

Society’s expense to the J.J. Hospital situated nearby. In 1889, the Managing Committee pointedly noted that its work was "being carried out chiefly for the benefit of Hindus, while at

the same time

there has been a marked decrease of late years in the number of subscribers ... belonging to that community". 45 They alleged that the preference for “indiscriminate alms giving by the native [Hindu] public, [made] street begging attractive and act[ed]

as a direct incentive to

vagrancy.” 46 Nevertheless, Hindu donations to the District Benevolent Society, modest in most years, dried up completely in the last two decades of the century at a time when the over-crowding was greatest. Leprosy sufferers were accepted at the institution almost from the inception of the District Benevolent Society. 47 Attempting a crude form of segregation, a portion of the building was railed off for the use of lepers, "who are kept separate from all the other inmates". While food and raiment were distributed to all inmates, lepers were given special consideration in alms. Every morning at about nine or ten o'clock the inmates are mustered to receive their daily allowances, which are as follows:- Blind and leprous adults receive three-quarters of an anna in money and a seer of rice; other classes of adults half an anna and the same quantity of rice. ... A supply of new clothing is distributed to them once a year, consisting ----------------------------------------------RCDBSB, 1888, Bombay, The Education Society's Press, 1889.

RCDBSB, 1884. Bombay, The Education Society's Press, 1885.

Bombay Courier,

6/6/1840. Confine or Shelter?

220

of a cumlee [blanket] and dhotee to each male adult, a cumlee and a sarree to each female adult, a dhotee to each boy, and a small sarree to each girl. 48

Their meagre allowance was pooled by the lepers and

any

family members accommodated with them who messed together. The inmates were permitted to go to the bazar

at certain hours in the

morning to purchase their little supplies. Many, of course

used the

opportunity to beg; if they were detected, the rules allowed only a small deduction in the money allowance by

way of punishment.

Enforcing sexual segregation was not seriously attempted. Married lepers who were separated.

accompanied

Females

who

had

by no

healthy spouses relations

were not

the Asylum, were

required, "whenever it can be done", to associate only with one another. 49 The leprosy-affected population of the Dharamshala in time became the largest single category of inmate. [Figs 8.2, 8.7, and 8.8]. In 1857, structural alterations had to be made for the enlarging the space set apart for lepers, the increase being considered absolutely necessary, "with a view to maintaining the general healthiness of the Asylum." 50 concern at

The Committee

periodically but vainly voiced its

leper over-crowding in the Dharamshala

due to the

absence of a separate and independent facility for the lepers in the city. … nothing seems as yet to show signs of a chance (sic) of seeing a Leper Hospital or Asylum founded in Bombay for the exclusive accommodation of those afflicted with this repulsive disease. 51 … A Leper Hospital is one of the pressing wants of this city… 52

Fig. 8.3 shows the category-wise statistics of the number of inmates of the Dharamshala over the years, the increase in the number of ----------------------------------------------Anonymous, “The Native Poor of Bombay”, The Bombay Quarterly Review, 4: (1856) p 239. 48

Ibid.

RCDBSB, 1857, . Bombay, L.M.D'Souza's Press, 1858

RCDBSB, 1871, Bombay, Education Society’s Press, 1872..

RCDBSB, 1884, Bombay, Education Society’s Press, 1885.. Confine or Shelter?

221

lepers and the steep decline after the establishment after 1890, with the establishment of the “Homeless Leper Asylum”, which is discussed in the next chapter. One of the most persistent voices for better isolation and care of the Dharamshala lepers was that of Carter. 53

Events in 1875 showed

that notwithstanding Carter’s touching account of their plight and his alarm about the Dharamshala as a fount of leprosy contagion, colonial unease about the disease had not yet reached a crisis level. As a memorial of the visit of the Prince of Wales to Bombay in year, a bronze statue

that

His Royal Highness subscribed by Sir

Edward Sassoon, found greater favour with the powers than Carter's hoped-for leper asylum funded by local magnates. 54 The Times of India was at the forefront in panic-mongering about the “horrors” of the leprosy-infested Dharamshala: Yet anyone who, gathering together all his resolution, can walk the narrow passage through the rows of closets in which these lepers drag out an existence, that sums up in itself what is most horrible and most repulsive in human suffering, would counsel an inexorable separation in mercy to future generations…. Men and women with their limbs wasted… or else swollen out of all form of limbs, sit or lie on either hand…. [W]e have hinted at the horrors in the narrow bounds of the Dharamshala, and have called attention to the appalling destiny reserved for those who are attacked by the most loathsome… of all diseases…in the hope of arousing attention to great suffering, and to what may be a great danger, in our midst… 55

An editorial alleged that the institution, established to prevent mendicancy, was actually encouraging it by turning away "slight" cases of leprosy, and in effect telling them to go and beg. During the closing years of the 1880s, and especially during the panic of 1889-1890, the British colonials viewed the leper as a potent threat to ---------------------------------------------------------------------------------------------------------53

Carter’s account of the plight of the women lepers inmates is reproduced in Chapter 7.

Donations had been pledged by wealthy Indians, such as Rs. 150,000 by Sir Cowasjee Jehangir Readymoney , Sir Mungaldas Nathoobhoy and Dinshah Maneckjee Petit. Carter, Personal Papers, Mss 5821, 55

Times of India, 19/10/1875. Confine or Shelter?

222

their health and power. 56 . In 1888, fuelling

the leprosy hysteria, the

paper published an extraordinarily vituperative communication Dharamshala

on the

and its lepers, by ‘Expert Correspondent.’

… it is a public duty to state, in the frankest terms, that the Dharamshala as it stands is a hideous anachronism, a monstrous shame, and a crying evil, for it is in a vital particular, a standing menace to the city’ s health… The question is no longer a lepers’ one. It is a question of contagion and concerns the body politic. Let any man consider the evidences pointing to leprosy as a contagious and frightful malady… and who will hesitate to proclaim that the nest of lepers who live, more, and propagate (sic) in the Dharamshala should be bundled, bag, baggage, root and crop out the city precincts… 57

The beleaguered institution came in for additional condemnation by

another category of olonial critic in the 1880s. To the Christian

missionary, the subject of leprosy belonged more to theology than medicine. The ambition of W.C.Bailey, 58 who visited the Dharamshala in 1886, was to appropriate the

Bombay leper so as to "spiritually

cleanse" him and "heal [his] sin-sick soul. “Is there no one in Bombay whom the love of Christ will

constrain to take up this work?” he

asked. The work “must be taken up by real Christians.”. 59 To this end he launched on a sensationalising description of the Dharamshala lepers.

[There were lepers] all huddled together in cells, 6 x 8 feet (these I measured with a tape), two people occupying one cell...Oh, the awful sights that one sees here! I could not bring myself to describe everything… One poor fellow was spotted all over like a leopard; another with great swollen hands, one of which he was having freely bled (to relieve the itchiness, he said) by a woman with an old razor. She was tapping the hand all over with the top of the blade, and the black blood was flowing freely... 60 ----------------------------------------------This perception has been discussed in Chapter 6.

Quoted in Times of India, 26/6/1890.

Wellesley Bailey (1846-1927) founded the “Mission to Lepers in India and the East” in 1874. As the “Leprosy Mission”, this organisation is today the largest of its kind in India and the world. 59

W.C Bailey, The Lepers of our Indian Empire. A Visit to them in 1890-91. Bombay, John F. Shaw, 1891, p 224; W.C. Bailey; A Glimpse of the Indian Mission Field and Leper Asylums in 1886-87, London, J. F. Snow Ltd., 1890, p 8. 60

Ibid, p 9. Confine or Shelter?

223

Particularly deplorable in missionary eyes was the absence of sexual segregation. If he was in charge, asserted Bailey, steeped in the Biblical notion of the ineluctable sinfulness of the leper, "... I should never allow marriages to take place in an asylum, as they do in the Dharmsala (sic) …” 61

Amid the gloom, Bailey found one reason

for gratification: he discovered

that

"[amongst]

the one hundred and

fifty lepers at present in the Dharmsala, there are about Christians who, we are told, exercise an influence for

twenty-five good on the

others." 62 By

1890, the half century old institution stood irretrievably

condemned as a hotbed of "danger" and horror, ironically as a result of its very success as a shelter for indigents.

The

Dinshah Manockji

Christian missionary accounts number of

Petit Leprosy

in the 1830s

Hospital,

Ratnagiri:

had hinted at the large

leprosy sufferers in the coastal district of

Ratnagiri.

Socially ostracised and in distress, lepers were reported to comprise a substantial number of the inmates of the "Asylum for the Aged and Destitute" set up at the small island fort of Harnai. 63

The problem

came to a head in 1866 with a communication from the Assistant Collector of Ratnagiri, A.K.Nairne, to his superiors, need for an

asylum

The

local government

stronger pressure to act when A.B. Leith,

suggesting the

was

President of

put

under

the Sanitary

Commission, reminded them that establishing an asylum for lepers would have

the additional virtue of preventing the spread of leprosy.

----------------------------------------------Ibid.

Ibid, p 13

“Report of the Hurnee Asylum for the Aged and Destitute for 1832-33”, Oriental Christian Spectator, 4: (1833) p 254

Confine or Shelter?

224

Thus was mooted for the first time a prophylactic role for a leprosy asylum in Bombay Presidency. … such an hospital is most desirable as a means of preventing the propagation and perpetuation of this hereditary disease by the removal of those affected with it to seclusion. The dread that the Natives of this country have of Leprosy would make them readily send their relatives suffering with it to such a refuge as the Leprosy Hospital should be… 65 [italics added]

The fact that

Ratnagiri had a large number of lepers

confirmed in the leper censuses of 1867 and 1872. 66

was

The rationale

for a leper asylum at Ratnagiri being unassailable, the only factor required to bring about this result was the wherewithal. Dinshah Manockji Petit (1823-1901) [Fig. 8.4] , the Parsi shetia and mill-owner who made huge profits during the American Civil War, was to prove

himself

most

lepers. 67

willing among his peers in

establishing asylums for

1873 he made an offer to the authorities, conveyed through

Vishwanath Narayan Mandlik (1833-1889), member of the Governor’s Council, and himself a native of Ratnagiri, of a sum of Rs.12000 for constructing and equipping a leprosy institution in the district. On learning that a further sum of Rs. 3500 would suffice to furnish and provide three wards, accommodating a hundred patients, Petit raised the total amount of his gift to Rs. 15500. 68

His offer being accepted, the

“Dinshah Manockji Petit Leprosy Hospital” was declared open in 1875, the first state leper institution in the Presidency to be established for the ---------------------------------------------------------------------------------------------------------MSAGD, Vol. I, 1867, p. 363. Nairne’s communication and the resulting leper census of 1867 have been referred to in Chapter 4. 65 MSAGD Vol. 1, 1867, p 364 64

Report of the Leprosy Commission, p 106.

Petit was a member of the committee which attempted, but failed, to establish a leprosy asylum in Bombay city to commemorate the visit of the Prince of Wales . In 1889 Sir Dinshah, as he then became, offered Rs. 100,000 for establishing a large leper asylum at Trombay, north of Bombay city, but again failed, in the face of the ready success of H.A. Acworth's "temporary" Homeless Leper Asylum at Matunga., discussed in Chapter 9 . 68

S.M. Edwardes, Memoir of Sir Dinshah Manockjee Petit (1823-1901) First Baronet, London, Oxford University Press, 1923, p 67. Confine or Shelter?

225

avowed purpose of leprosy prevention, and to be maintained out of public funds. [Fig. 8.5] It occupied a little over two acres at village Mouze Zadgam, amid

"barren

rocks",

Ratnagiri town. 69

the

safe distance

The administrative

philosophy

two miles from

underpinning state-

funded leper asylums may be described as relentless cost-cutting, and the Ratnagiri asylum’s construction, administration and maintenance were on Spartan lines. The building material was laterite clay – cheap, but absorbing damp during the rainy season. The three wards had accommodation sufficient

for

hundred persons, but

for less than half that number.

maintenance was

ensure

sexual

segregation, the women’s ward was enclosed by a wall, -- but it "[did]

not

sufficiently

separate

the male and female quarters." 70

Sanitation was also defective: there were only four latrines for the projected one hundred inmates. Night soil had to be removed

to a

special shed, as the rockiness of the site made trenching of waste impossible. The manure obtained from the human waste was offered to the local cultivators, but they were said to be "too

prejudiced"

to make use of it. The provision of arrangements for bathing overlooked walk

when the Hospital was built, so the lepers

some distance to a bathing tank. The lepers

similarly

to the

convicts in

clothing

was sanctioned

the

in special

Ratnagiri cases.

though

and

extra

Committee

Management consisted of thirteen District Local Board were generally prominent citizens,

had to

were clothed

jail, The

were

members, who

five ex officio members,

namely the Collector as President, the Deputy Collector, Civil Surgeon, Executive Engineer, and the mamlatdar. 71 ----------------------------------------------MSAGD, Vol. 26, 1874, p 219; also MSAGD, Vol. 33, 1877, p3.

MSAGD, Vol. 75, 1885, p 151.

MSAGD, Vol. 26, 1874, p 207. The mamlatdar was a civil officer in charge of a taluka. Confine or Shelter?

226

The

financial

arrangements

faithfully

reflected

the

Provincial Government's determination to control spending. The Local Fund contribution from which the asylum was maintained amounted to Rs. 2500 per annum, later reduced to Rs. 2000, and was to be deposited with the Provincial Service charges. It was further stipulated that the Government’s own contribution to the Provincial Service charge was not to

be drawn upon

expended. Any

until the Local

balance at

Fund

contribution

was

the end of the year was to lapse to

Government. [Table 8.1 and 8.3] Lepers hailing from Ratnagiri were maintained out of Local Funds, while the Managing Committee was compensated by Government for lepers sent to Ratnagiri from other districts. The latter moneys in turn came out of deductions at Rs. 99 per annum per head, extracted from the respective District

Local

Boards. 72 Cheese-paring was sometimes blatant, and put in doubt the official commitment to the undertaking.

For instance

government

declined to supply medicines gratis. 73 In 1895, alarm erupted in the Governor's advisory council at the discovery that in the three years between 1892-1895,

resulted in overspending

increase

in the number of

inmates had

by Rs. 350. The legislative member of the

Governor's Council, James Monteath stoutly argued that Government had no financial obligation beyond the guaranteed annual contribution of Rs. 2,000, and it was “quite Committee provided.” 74

stop

open to the asylum's

fresh admissions if

the

cost

Managing

could not be

In 1878, a recommendation from the Collector, that the

Civil Surgeon be remunerated by a horse allowance of Rs. 35 per month, for the "extra and responsible work" of periodic attendance at ---------------------------------------------------------------------------------------------------------72

MSAGD, Vol. 81, 1889, p. 65.

Leprosy in India. Summary of Reports, Furnished by the Government of India to His Hawaiian Majesty's Government, p 52. 74

MSAGD, Vol. 68, 1895, p 32. Confine or Shelter?

227

the

Dinshah Manockji

Government. 75 The

Petit

medical

Leprosy Hospital, was charge of the

rejected

leprosy hospital therefore

became, together with superintendence of the civil dispensaries, the jail hospital and the lunatic asylum, a routine duty A retired

of the Civil Surgeon.

medical subordinate was recruited to attend to

minor

medical matters, because no one else was willing to undertake the low paying job at Rs. 25 per month. 76 Table 8.1 demonstrates

that

savings were effected in running the institution each year,– though the amount decreased progressively -- which

were

duly

returned

Government. Lists of lepers willing in by the mamlatdars. were

to be admitted to the asylum sent

submitted

to the Civil Surgeon, whose

selection criteria amply reflected official cost-cutting priorities. First admitted were those sufferers able

maintain themselves, and

therefore "not likely to add much to the expenses";

those

with “slight” disease, so best suited as subjects "for curative treatment"; the least desired, ironically,

were the entirely destitute lepers. Thus a

class of the leper poor who might have been in most need of a shelter were not a priority with the officials. No doubt this was done in the interest of spending as little as possible on the institution. 77 The Ratnagiri asylum, like the one at Rajkot, was the venue of experiments with various leprosy treatments. On the recommendation of Carter, a major trial was undertaken using inunctions of cashew nut oil inunction in 1874-1976, on the lines of the Bearperthuy treatment, advantage being taken of the fact that the tree Anacardium Occidentale was indigenous to the coastal regions.

----------------------------------------------IOL, Bombay General Proceedings 1876-1878. No 3356. November 1878.

MSAGD, Vol. 89, 1889, p 127.

MSAGD, Vol. 33, 1877, p 3. Confine or Shelter?

228

The daily

diet per head recommended by the Civil Surgeon,

listed in Table 8.2, was said to be "good and varied, but fixed." 78 When on occasion, items such as fresh fish or milk were given out, they were in lieu of the quota of vegetables or dall. The monthly outgoings on diet and clothing per inmate was Rs. 8-4-0, or about Rs. 99 per annum. Despite such constraints, inmates found opportunities for autonomous actions. To the disapproval of the authorities

they

exchanged their rations with the contractor for tobacco, and preferred to cook their food separately in observance of caste rules. 79 The

original

expectation

voiced

by Sanitary

Commissioner

Leith in 1873, that the Hospital would serve to prevent the spread of leprosy by secluding lepers, was hardly matched by the reality. It was

obvious that

the inmates’ and

official

perceptions

about the

purpose of the institution differed radically. Lepers entered it during the rainy season, and left

it, or escaped from it with the advent of

the fair weather, to resume the free life of vagrants and mendicants. [Fig.8.6] In

1887, with the institution partly empty, the

Leper

Hospital Committee complained that “lepers are constantly absconding from the Hospital which has accommodation

and

provision of food,

bedding for more than the number of those who are actually

under

treatment. 80 In a bid to prevent lepers from absconding, the Committee ruled that the truants were not to be readmitted. Not surprisingly, such a policy was unsustainable, because … the lepers came back and sought readmission on account of the disease becoming aggravated, and in such a condition that it would have been nothing short of absolute cruelty to refuse them admission… 81

----------------------------------------------MSAGD, Vol. 75, 1885, p 151.

MSAGD, Vol. 23, 1877, p 79

MSAGD, Vol. 56, 1887, p 165.

MSAGD, Vol. 89, 1889, p 134. Confine or Shelter?

229

The Managing Committee complained that the existing legislation was defective,

because as the law then stood,

“no Magistrate or Police

Officer can compel a Leper howsoever dangerous he may be to the neighbourhood to resort to the Asylum.”

Section 269 of the Indian

Penal Code which empowered the state to punish the leper for “any unlawful or negligent act

likely

to spread the disease

Leprosy,”

happened to be silent on the matter of compelling him to live in a particular place. 82 have a

The Committee deemed it absolutely necessary to

separate Section in the Code empowering the headmen of

villages and district police to arrest and send absconded lepers back to the Leper Asylum as well as to compel vagrant lepers to seek shelter in the institution when their physical state was “dangerous” to the public. Adding to their sense of helplessness, the Committee of Management discovered

that

transported

to the Ratnagiri

their will" either.

had no power to compulsorily detain lepers

Such

their escape, sometimes particularly

asylum

from other districts "against

persons lost not

within a

time in making good

few hours of admission. After

disconcerting demonstration of independence by three

lepers transported from Poona who escaped on the very first night, Civil Surgeon McCalman bemoaned the resulting "waste of public funds," and pleaded that "some means should be taken to ascertain beforehand

themselves..."

the

lepers

In 1890

sufferers themselves

had

are willing to voluntarily McCalman

bemoaned

that

segregate while the

benefited from the Hospital, its ultimate

advantage to the community at large had been questionable,

and

its

original purpose of preventing leprosy unfulfilled. .

----------------------------------------------The relevant sections of the Indian Penal are listed in Appendix legislative aspects of leprosy are discussed in Chapter 5. 82

5.1. The

MSAGD, Vol. 89, 1889, p 135. Confine or Shelter?

230

All the experience goes to prove the continuance of leprosy by heredity and these conditions are undeniably fostered under the system which imposes no restriction on the leper's movements. 84

The Civil Surgeon, who unhesitatingly claimed that leprosy was not only "continuing” but “increasing” in the district, was correspondingly quick to dismiss

statistics

ground that the figures officials". 85

which belied had been

McCalman's

collected by "ignorant village

dissatisfaction

the greatest

his claim on the usual

apprehension

that

order within

the leprosy asylum was

echoed

the

growing

obstacle to effective segregation and the voluntary nature of the

institution. Just as the Government was powerless -- or at best limited in its capacity -- to enforce admissions to constrained in its power to compel

the asylum, it

was similarly

lepers to remain. The Ratnagiri

Hospital, like its counterpart at Rajkot, was resorted to by lepers at their convenience, e.g., They

during the monsoon or famine conditions.

had no compunction in absconding or leaving when the

institution had served their temporary need, and swiftly finding their way to holy places like Pandharpur to beg.

Their intolerance of restraint

was attributed by Bombay’s Surgeon-General W. J. Moore,

sceptical

of bringing order to the vagrant leper’s life, to the disease, which renders sufferers peevish, irritable and morose... It is evident that any legislative action interfering with the liberty of the leper would be most unpopular among the class, would be evaded in every possible manner, and could only be carried out forcibly. 86

In 1890, at the peak of the leprosy hysteria, the Dinshah Manockji Petit asylum was designated a "sanitarium” to interne cases of leprosy notified under Bombay Act 6 of 1867. 87 Lepers

compulsorily sent

----------------------------------------------MSAGD, Vol. 4, 1890, no pagination.

Ibid. The total number of leprosy sufferers in the district in 1867 and 1887 were as stated by Civil Surgeon McCalman was 1,599 and 1,254 respectively. 86

MSAGD, Vol. 56, 1887, p 175.

The Act is discussed in Chapters 5 and 9. Confine or Shelter?

231

there from other parts of the Presidency

could now also be legally

compelled to remain there. With this the authorities at Ratnagiri at last acquired the power they had long craved. The Presidency-wide famine which coincided with the travel restrictions

during the plague epidemic in the closing years of the

century created a problem authorities.

Whereas

the opposite kind for the asylum

in the 1880s, the Managing Committee

was

grieved that the Asylum was under-populated due to desertions and escapes, in 1897 they were faced with over-crowding and underfunding. In the absence of help forthcoming from the Provincial Government, only the generosity of enabled them to

feed and

clothe

Sir more

Dinshah

Manockji

than one hundred

Petit lepers

sheltering in the Hospital. 88 In conclusion, it appears to be highly questionable whether an asylum

ostensibly established to prevent

hereditary leprosy,

with

inefficient provision made for separation of the sexes, burdened by official tight-fistedness, plagued with from

frequent shows of independence

the inmates, and pathetically dependent on

critical times,

could

claim to have fulfilled its

private

charity at

stated purpose of

leprosy prevention. Eduljee

Framjee

Leprosy

Asylum,

Trombay:

Bombayâ&#x20AC;&#x2122;s

abandoned forts as leper asylums, were much on the mind of a Roman Catholic priest in the 1880s, when the leper beggar in Bombay was thought to be too close for the safety of ambitious

well-to-do society.

proposal was put to Government by the Jesuit Bishop Leo

Meurin(d 1895) [Fig.8.9] , that the premises of one of the old Forts - "Sion", "Matoonga", "Sewree" or "Worlee", be placed at his disposal with a view to converting them into the â&#x20AC;&#x153;head-quarters of a Leper ----------------------------------------------Times of India, 19/12/1897.

Confine or Shelter?

232

Colony or Village.” 89 The Bishop pronounced himself convinced that there was no possibility of successfully "grappling" with the leprosy problem, "than by complete segregation of all lepers," to which measure he

was “sure”

the

people of

India would not object. 90

the

Government granted him a dismantled fort and some cultivable land in its vicinity, the Bishop intended to

place

within it "by gentle,

attractive, and loving measures" lepers supported by the Paul charitable society which he headed, and

also

Vincent de such

non-

Christians as their co-religionists or Government were prepared to pay for. 91

In a few years,

favour with

said Meurin,

Government,

he hoped

if his "humble work" for

found

permission to transfer his

operations to the "ruined fort of Bassein, which, with its walls, might be turned into a regular Leper Colony on a large scale." None of the four forts were

found to answer the requirements,

Government's refusal of antiquarian interest" --

and

the

the use of Bassein fort, -- "an object of great

for a leper village,

compelled the Bishop to

lower his sights. 92 The

small “Eduljee

Framjee

Albless

Leprosy

Hospital”

accommodating about 25 lepers, came into being in 1885 as a result of Meurin’s acceptance of an offer of a spacious private bungalow at Trombay, six miles north

of the metropolis. The donors

the

'Albless Bungalow' were the heirs of Eduljee Framji Albless, a Parsi merchant [Fig.8.10] . Although the deed of transfer signed in October 1885, spoke of a “free gift”, one of the stipulations was that the asylum be open to lepers of all “races, creeds and nationalities.”

----------------------------------------------MSAGD, Vol. 98, 1884, p 301.

Ibid.

Ibid, pp 359 and 424. Confine or Shelter?

233

[Fig. 8.11]

His acceptance of the stipulation embroiled Meurin in the

nineteenth century Catholic church’s

power politics centred around the

Padroado question. 93 Objections were raised by a visiting Cardinal to

the

“unsectarian”

character

of the

proposed

institution, and

Meurin was ordered to give up the scheme. But in a compromise he was

permitted

[undocumented]

ahead,

with

the

insertion

some

changes in the rules.94 The “Rules Booklet”

of the

asylum demonstrated the biblical inspiration of the Christian missionary enterprise in leprosy: We have thought him as it were, a leper, ... as one struck by God and afflicted... 95

The

“Booklet” also illustrated that missionary strategy to involve

themselves in leprosy: was to condemn Indian society for its heartlessness when it outcast the leper, and condemn it also for apathy when it did not ostracise one considered by them to be

“struck by God and

afflicted”, besides harbouring a “dangerous” disease. By this means an opportunity was sought to be created for the exhibition of "Christian charity" by leper isolation and leper asylums: Christian charity steps in ... to alleviate the dreadful calamity of leprosy.... The poor leper sees himself shunned by his fellow men and considered by the vulgar even as an object of God's wrath... where lepers are not forced to sever themselves from human society, they must be induced to do so of their own free will. This may be secured, to a large extent, at least among the poorer classes, by offering them an attractive Home where they are compassionately received... with all due respect for ... their religion and their caste usages.. 96 [italics added]

Meurin's asylum was the first leper asylum near Bombay city, and for five years from 1885 to 1890, was the only institution to accommodate lepers arrested by the police. Government

provided

----------------------------------------------E.R. Hull, Bombay Mission History. Vol. 2, Bombay, Examiner Press, 1930, p 310.

Ibid, also J.H.Gense, The Church at the Gateway of India, 1720-1960, Bombay, St. Xavier’s College, 1960, pp 301.

MSAGD, Vol. 75, 1885, p 109 .

The biblical quotation is from Isiah Chapter 53.

Ibid. Confine or Shelter?

234

Rs. 1,500 monthly to the institution, which was

half the cost of

maintenance. 97 It did not accommodate more than 25 inmates, all males. With Father Damien as the precedent, Bombay’s British society harboured

ambitious hopes for the Albless Leprosy Asylum and its

founder:. We repeat... that for so fell a scourge as leprosy, there is but one treatment ... segregate and be kind to the leper... In the Catholic Home at Trombay, we possess the nucleus of a colony that might easily be made into another Molokai. 98

The

hopes

were

not

fulfilled,

because

Meurin's

failed an elementary test, namely its acceptability to the population it

asylum leper

purported to serve. It was not popular with non-

Christian lepers even the poorest, who formed

the vast majority of

the afflicted in Bombay. According to the anonymous

author of a

letter in the Times of India the twenty five inmates of the asylum belonged "not to the vagrant class," 99 and all were Christians. Lepers arrested for begging in

the streets

in the early months of 1890,

would not agree to be transported to the Trombay Asylum, preferring the

severely overcrowded J.J. Dharmashala.

100

The Managing

Committee of the Dharamshala complained: Although a Leper Hospital has been established at Trombay, the number of applicants for admission [to the Dharamshala] has not decreased. They are persuaded to apply at this establishment [at Trombay] but express a preference to remain here…101

As at Ratnagiri, some lepers entered the Trombay asylum at their own convenience, and left it at will.. 102 Its unpopularity with non-Christians was reflected in the statistics. In 1890 all twenty-four ----------------------------------------------Ibid, p 169.

Times of India, 15/2/1889.

Times of India, 26/6/1890.

100

Times of India, 26/2/1890.

101

RCDBSB, 1889, Bombay, Education Society’s Press, 1890..

102

Times of India, 6/5/1890. Confine or Shelter?

235

inmates were “Native Christians.

103

The composition was unchanged

in 1897, causing the Collector of Thana to remark other

castes

not

appear

that "lepers of

to appreciate the advantages of such

asylums. 104 The Managing Committee of the asylum, the apothecary and medical officer in charge were exclusively Roman Catholic. There was a sectarian ambience rules professed

the institution, notwithstanding that the

non-interference with inmates' religious beliefs.

The

establishment of the asylum was the result of Parsi generosity,

and

resentment against proselytising activity was expressed by the Parsi press. The conservative

Jam e Jamshed, the voice of the Parsi

Panchayat, wrote: The Leper Bill [drafted in 1889, but held in abeyance pending the visit of the Leprosy Commission] contains a considerate provision ... that the leper asylums to be opened hereafter shall not be allowed to receive any help whatever from Christian missionaries.... Notwithstanding this the native population of Bombay are left without the assurance that the Albless Leper Home is, and will be, kept in future free from missionary interference.... The Home would have been very popular with the class of persons for whose benefit it has been established, if [on the Managing Committee were appointed] a few eligible Native gentlemen of different persuasions... 105

Meurin’s asylum was in essence a shelter for Catholic lepers who were the only population size negated controlling the

who found

it acceptable.

Its small

Meurin’s proclaimed purpose of “stamping out”

and

spread of leprosy. His venture must be counted a

failure. He was no Damien and neither was his asylum of twentyfive male inmates, a Molokai.

---------------------------------------------------------------------------------------------------------103

Report of the Leprosy Commission, p 18.

104

MSAGD, Vol. 48, 1898, p 12.

105

Jam e Jamshed , 28/5/1890, “Report on Native Papers”. Confine or Shelter?

236

Assessment In

the period

before 1890,

leprosy asylums and

refuges

whether maintained by private or public funds, shared one feature -they were voluntary and looked upon by the lepers inmates, who were generally beggars or vagrants, as

convenient shelters, to be resorted

to only during hard times. There was neither any incentive for them to abide in the institution permanently, nor did the authorities have at hand any means to prevent escapes. Managements realised that punishing a leper by threatening attempting

expulsion

for

trouble-making

to escape was an unsustainable policy. Colonial

society's

morbid fear of the leper at large, as well as humanitarian feeling ensured that

an errant leper was received back into the institution.

The constant and substantial

number of escapes from the Ratnagiri

asylum suggests that there was no surveillance of asylum inmates. The J.J. Dharamshala, not only did not provide any barrier to social intercourse, but actually unlocked its doors for the inmates to go out into the bazar for daily purchases. Not to be forgotten is the fact that some of

the

leprosy-affected inmates of the Dharamshala lived

there with their families. By no means could any of the four establishments studied in this chapter

have qualified

either

Bentham-esque "panopticons", or Goffman-esque "total institutions". 106 ----------------------------------------------The 'Panopticon' was first proposed by Jeremy Bentham the English utilitarian in 1791. It was visualised as a structure of circular shape, having cells built round, and fully exposed towards a central 'well' whence the authorities could at all times keep the inmates under surveillance. Bentham considered that such a structure would be eminently suitable for prisons, hospitals, madhouses and lazarettos (leprosy asylums). J. Bentham, â&#x20AC;&#x153; Panopticon or the Inspection House: Containing the Idea of a new Principle of Construction Applicable to any Sort of Establishment, in which Persons of any Description are to be kept under Inspectionâ&#x20AC;?, in J. Bowring, (ed.), The Works of Jeremy Bentham, Part 3, Edinburgh, William Tait, 1838. The sociologist E. Goffman defined a "total institution" as a "place of residence and work where a large number of like-situated individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed formally administered round of life". Included in this category was the leprosarium. E. Goffman, . Asylums. Essays on the Social Situation of Mental Patients and Other Inmates, Middlesex, Penguin Books, 1961.

106

Confine or Shelter?

237

Lastly,

the

unwillingness

of the Government

to take on

the

maintenance of leper asylums, put paid to any claims that such an institution as the Ratnagiri asylum could prevent the spread of leprosy. The less than rigid separation of the sexes in that institution established for preventing hereditary transmission of leprosy was also a fatal defect. While medical

treatments were tried out, unfortunately with little

success, the four leper refuges were simply

poor-houses

for a

particular social underclass. It was shown in Chapter 5 that coercion was applied on lepers to remain within asylums in 1890, with the notification of the Albless and Petit asylums as

“sanatoria” under

Bombay Act 6 of 1867, for the “better sanitary management of Bombay [city].”

The Next Chapter The next chapter is devoted to the “Homeless Leper Asylum” which was established at Bombay in 1890 in the imperial cause of protecting and sanitising urbs prima in Indis.

----------------------------------------------------------------------------------------------------------

Confine or Shelter?

238

Fig. 8.1. Statistics of Rajkot Leper Hospital 1875-81 Patients

120 110 100 90 80 70 60 50 40 30 20 10 0

Died

Discharged on Request

1 00 87

58 38 27

71 67

45 23

59 53

*Gazetteer of the Bombay Presidency, Vol. 8, Bombay, Government Central Press, 1884, p 358.,

Fig.8.2. Rajkot Leper Asylum: Number of Diets Provided 1876-1881* 40000 30000 20000 10000 0 1876

1877

1878

1879

1880

1881

Year * Ibid.

Confine or Shelter?

239

Fig.8.3. Number of Lepers, J.J.Dharamshala,

1858-1895* Lepers

Blind, Lame, Orphans

Number of Inmates

300 250 200 150 100 50

18 83 18 86 18 88 18 90 18 92 18 94

18 71 18 73 18 75 18 77 18 79

18 67

18 61

18 57

Year *Annual

Reports of the District Benevolent Society of Bombay for those Years.

Confine or Shelter?

240

Fig. 8.4. Sir Dinshah Manockjee Petit,benefactor of the Ratnagiri Leper Asylum.

Confine or Shelter?

241

Confine or Shelter?

242

Fig. 8.5. The Sir Dinshah Manockjee Petit Leper Asylum, Ratnagiri.

Confine or Shelter?

243

Fig. 8.6. Admissions, "Absenteeism", Deaths at the Leper Asylum, Ratnagiri, 1875-1884* Total

Absented

Died

140 130 120 110 100 90 80 70 60 50 40 30 20 10 0

1875

1876

1877

* NSAGD, Vol.75,1885, p159.

1878

1879

1880

1881

1882

1883

1884

Year

Confine or Shelter?

244

Fig. 8.7. Leper Women and a Child at J.J. Dharamshala, circa 1870.

Fig. 8.8. Leper Men at the J.J. Dharamshala, circa 1870. (Original prints at the Grant Medical College Library).

Confine or Shelter?

245

Fig.8.9 Archbishop Leo Meurin, established the Eduljee Jramjee Allbless Leper Asylum, Trombay, near Bombay, 1885.

Fig. 8.10. Eduljee Framjee Allbless, benefactor of the Leper Asylum named after him.

Fig. 8.11 . Plaque at Eduljee Framjee Allbless Leper Asylum

Confine or Shelter?

246

TABLE 8.1. General Information about the Dinshah Manockjee Leper Asylum, Ratnagiri, 1883 and 1884.*

How it was supported; whether by Public or Private funds or both; if the Latter, in what Proportion

The Number of Lepers treated during 1883-1884 and the Results

YEAR 1883 Remained 44; Admitted 26; Total 70 Cured 0; Relieved 19; Absented 7; Died 6; Remained 38=================================

QUESTIONS

YEAR 1884

Remained 38; Admitted 29; Total 67

Cured 0; Relieved 16; Absented 9; Died 5; Remained 37

The Structural and Sanitary Condition and the Arrangements made for the Medical and Hygienic Treatment of the Sick

How Conducted

Three large double wards in separate blocks; verandahs all around; built of laterite; space for 100 beds affording 800 cu. ft space each. One ward occupied by females; wall running across enclosure separates male and female wards. Four double cook rooms and four latrines. Night soil removed as the site was rock for a long distance; no trench system possible. Bathing defective; one of the cook rooms being used for bath room. Well on premises. Clothing and rations sufficient; hospital two miles from station; visited twice or thrice weekly by Civil Surgeon. Much the same as a Dispensary. There was a Committee of which the Collector was President. Civil Surgeon had the interior control under supervision of the Medical Department.

* MSAGD, Vol. 75, 1885, p 190.

Confine or Shelter?

247

TABLE 8.2 Rations per head per day at D.M.Petit Leper Asylum, Ratnagiri, 1897. Rice

1 lb 7 oz (one seer) [~ 600gms]

Dall

4 " [~ 350 gms]

Ghee

Â˝ "

Vegetable

8 " [~ 700 gms]

Firewood

8 "

"Curry Stuff"

1 "

* MSAGD, Vol. 48, 1898, p 129.

Confine or Shelter?

248

Table 8.3. D.M. Petit Leper Asylum, Ratnagiri: Excess Contribution paid from Local Funds, and Savings which Reverted to Government, 1887-1892* YEAR

INCOME

EXPENDITURE

TOTAL

BALANCE

LOCAL BOARD

PROVINCIAL FUNDS

TOTAL

ESTABLISH- DIET AND MENT CLOTHING

1887-88

2500-0-0

2000-0-0

4500-0-0

993-8-0

294-12-1

3353-10-3

1146-5-7

1888-89

2000-0-0

4000-0-0

981-12-10 1959-14-4 377-0-4

3318-11-6

681-4-6

1889-90

2000-0-0

4000-0-0

1083-3-0

1715-10-1 248-7-7

3047-4-8

952-11-4

1890-91

2000-0-0

4000-0-0

1063-10-6

2154-6-5 308-8-6

3526-9-5

473-6-7

1891-92

2000-0-0

4000-0-0

1049-12-9

2259-2-3 291-4-11

3600-3-11

399-12-1

TOTAL

10500-0-0

10000-0-0

20500-0-0

5771-15-1

10154-7-9 1520-1-5

16846-7-11

3653-8-1

*MSAGD,

2065-6-4

OTHER

Vol. 68, 1893, p 147.

Confine or Shelter?

249

Fig. 8.1. Statistics of Rajkot Leper Hospital 1875-81 Died

Discharged on Request

100 87 73

67 45

187 7

59 53

1880

1876

187 8

188 1

187 9

120 110 100 90 80 70 60 50 40 30 20 10 0

187 5

Number of Lepers

Patients

*Gazetteer of the Bombay Presidency, Vol 8, Bombay, Government Central Press, 1884, p 358.,

1876

1877

17 73 6

10 80 3

20000

87 94

30000

22 40 6

40000

32 83 5

27 81 1

Fig.8.2. Rajkot Leper Asylum: Number of Diets Provided 1876-1881*

10000 0 1878

1879

Year

* Ibid.

1880

1881

Fig.8.3. Number of Lepers, J.J.Dharamshala,

1858-1895* Lepers

Blind, Lame, Orphans

Number of Inmates

300 250 200 150 100 50

18 83 18 86 18 88 18 90 18 92 18 94

18 71 18 73 18 75 18 77 18 79

18 67

18 61

18 57

Year *Annual

Reports of the District Benevolent Society of Bombay for those Years.

Fig. 8.4. Sir Dinshah Manockjee Petit,benefactor of the Ratnagiri Leper Asylum.

Fig. 8.5. Leper Women and a Child at the J.J. Dharamshala, circa 1870.

Fig. 8.6. Leper Men at the J.J. Dharamshala, circa 1870. (Original prints at the Grant Medical College Library).

Fig. 8.7. The Sir Dinshah Manockjee Petit Leper Asylum, Ratnagiri.

Fig. 8.8. Admissions, "Absenteeism", Deaths at the Leper Asylum, Ratnagiri, 1875-1884*

Number

Total

Absented

Died

140 130 120 110 100 90 80 70 60 50 40 30 20 10 0

1875

1876

1877

1878

1879

1880

Year * NSAGD, Vol.75,1885, p159.

1881

1882

1883

1884

Fig.8.9 Archbishop Leo Meurin, established the Eduljee Jramjee Allbless Leper Asylum, Trombay, near Bombay, 1885.

Fig. 8.10. Eduljee Framjee Allbless, benefactor of the Leper Asylum named after him.

Fig. 8.11 . Plaque at Eduljee Framjee Allbless Leper Asylum

TABLE 8.1. General Information about the Dinshah Manockjee Leper Asylum, Ratnagiri, 1883 and 1884.* QUESTIONS

How it was supported; whether by Public or Private funds or both; if the Latter, in what Proportion

The Number of Lepers treated during 1883-1884 and the Results

The Structural and Sanitary Condition and the Arrangements made for the Medical and Hygienic Treatment of the Sick

How Conducted

DINSHAH MANECKJI PETIT LEPER ASYLUM, RATNAGIRI Annual allowance from Government of Rs. 2000. From Local Funds Rs.2500. the first only available after grant from Local Funds was exhausted, and limited to maintenance repairs by Public Works Department at Government cost. YEAR 1883 Remained 44; Admitted 26; Total 70 Cured 0; Relieved 19; Absented 7; Died 6; Remained 38 ================================= YEAR 1884 Remained 38; Admitted 29; Total 67 Cured 0; Relieved 16; Absented 9; Died 5; Remained 37 Three large double wards in separate blocks; verandahs all around; built of laterite; space for 100 beds affording 800 cu. ft space each. One ward occupied by females; wall running across enclosure separates male and female wards. Four double cook rooms and four latrines. Night soil removed as the site was rock for a long distance; no trench system possible. Bathing defective; one of the cook rooms being used for bath room. Well on premises. Clothing and rations sufficient; hospital two miles from station; visited twice or thrice weekly by Civil Surgeon. Much the same as a Dispensary. There was a Committee of which the Collector was President. Civil Surgeon had the interior control under supervision of the Medical Department.

* MSAGD, Vol. 75, 1885, p 190.

TABLE 8.2 Rations per head per day at D.M.Petit Leper Asylum, Ratnagiri, 1897. Rice

1 lb 7 oz (one seer) [~ 600 gms]

Dall

4 " [~ 350 gms]

Ghee

Â˝ "

Vegetable

8 " [~ 700 gms]

Firewood

8 "

"Curry Stuff"

1 "

* MSAGD, Vol. 48, 1898, p 129.

Table 8.3. D.M. Petit Leper Asylum, Ratnagiri: Excess Contribution paid from Local Funds, and Savings which Reverted to Government, 1887-1892* INCOME

YEAR LOCAL BOARD

EXPENDITURE

PROVINCIAL FUNDS

TOTAL

ESTABLISHMENT

DIET AND CLOTHING

TOTAL

BALANCE

OTHER

1887-88

2500-0-0

2000-0-0

4500-0-0

993-8-0

2065-6-4

294-12-1

3353-10-3

1146-5-7

1888-89

2000-0-0

4000-0-0

981-12-10

1959-14-4

377-0-4

3318-11-6

681-4-6

1889-90

2000-0-0

4000-0-0

1083-3-0

1715-10-1

248-7-7

3047-4-8

952-11-4

1890-91

2000-0-0

4000-0-0

1063-10-6

2154-6-5

308-8-6

3526-9-5

473-6-7

1891-92

2000-0-0

4000-0-0

1049-12-9

2259-2-3

291-4-11

3600-3-11

399-12-1

TOTAL

10500-0-0

10000-0-0

20500-0-0

5771-15-1

10154-7-9

1520-1-5

16846-7-11

3653-8-1

*MSAGD,

Vol. 68, 1893, p 147.

Chapter 9 “MR. ACWORTH’S HOME” “…I have had the opportunity of seeing Mr. Acworth’s Home and hearing from him what is the experience of the disposition of the lepers to incarceration in it…. The lepers in Mr. Acworth’s Home are not only reconciled to the retention, but some are offering themselves voluntarily.”[Governor of Bombay, Lord Harris]. 1 “…it is equally distinctly to be understood that the Matunga Asylum was established only secondarily for the relief of the lepers; its primary object was the purgation of the city.” [Municipal Commissioner of Bombay, H.A. Acworth]. 2 This chapter continues the subject of

leper asylums with an

investigation of the founding and administration of an unique colonial institution which was established in Bombay in late 1890, in response to the lepra-phobia which engulfed the well-to-do citizens of Bombay in 1889-1890, their disgust at the destitute lepers roaming the metropolis and dismay when lepers died in its streets. 3 Although officially known as the “Homeless Leper Asylum”, a British official, Harry Arbuthnot Acworth (1849-1933) [Fig.9.1] was so closely associated with its birth and early years that he came to be regarded as its figurative proprietor. 4

[Fig. 9.1] However, Acworth’s plan to erect a leper asylum in the

MSAGD, Vol. 82, 1891, p 61.

Selections from the Records, Leprosy, p 319.

The leprosy panic of 1889-1890 is examined in Chapter s 5 and 6.

Harry Arbuthnot Acworth C.I.E. Educated at Oxford, was called to the bar in 1870, entering the Bombay Civil Service the same year. He held appointments in the Finance and Revenue departments, as well as Assistant Collectorships in various districts of the presidency. He was Bombay’s Deputy Municipal Commissioner in March 1890, before succeeding to the Commissionership. He retired in April 1890. On return to England, Acworth settled at Malvern, taking an active part in “Mr. Acworth’s Home”250

capital city would have come to naught without the

support,

participation and largesse of the Indian public. The institution

came to

be described as

the “best in India”,

and

cause

for official

“satisfaction in the fact … [of] having thus practically settled the vagrant leper question for the whole of the Indian Empire.” 5 This claim will

be evaluated, and reasons

will be proposed for the

apparent

success of an unique colonial leprosy institution. It

was

pointed out in Chapter 5 that

the leper’s perceived

“loathsomeness” was an abiding consideration in the way leprosy was tackled by the colonial authorities. Contagionists additionally harped on the public health danger supposedly posed by vagrant lepers. period 1889-1890, the official

discourse,

leper-as-danger

and the

Bombay, developed a strong

In the

theme dominated public

prosperous

and

and educated citizens of

“sense of the evil [of leper beggars

and vagrants] in our midst”. 6 The

presence of lepers in the city

was itself a consequence of their “natural gravitation towards a great city, that is, towards a convenient centre for begging”. 7 Groups of sick and deformed mendicant lepers became increasingly visible in the streets. Acworth in retirement in 1899, recalled the scenario of 1889: -------------------------------------------------------------------------------------------the local Conservative party and in education. He was fluent in Marathi. His publications included (in collaboration with Shankar Tukaram Shaligram), Powadas or Historical Ballads of the Marathas, (1891) and, Ballads of the Marathas Rendered into English Verse, (1894). Times of India, 12/6/1933; Who Was Who, Vol.3, London, Adam and Chas. Black, 1941; India Office Civil List, 1894. 5

Selections from the Records, Leprosy, p 319.

Times of India, 19/6/1890.

H.A..Acworth, “ Leprosy April 1899, pp 229-238; and 270-303.

in India”, Journal of Tropical Medicine,

“Mr. Acworth’s Home”251

… in every part of the city of Bombay lepers were, in 1889, more of less in evidence, in every stage of the disease, and exhibiting in the public streets every one of its hideous deformities… they crowded to the temples on the sea shore, lining the streets in scores and hundreds… 8 Europeans often blamed

the

rise in mendicancy

to Hindu

belief in alms- giving and charity. The result was that he who gave most died leaving behind the greatest number of beggars. Hindu … beggars of all classes are found in Bombay – Brahmans and Sudras, Mangs, Mahars, and Dheds, principally … the deformed, the leper … who prefer street begging because their gains are large..., and they have liberty to rove about … 9 The Law’s Infirmities In 1889, T.S. Weir, the Municipal Health Officer, estimated that that the city’s lepers had doubled in number from the 430 enumerated in the census of 1881. Weir feared that existing and public health legislation after serving the

was unavailing against lepers, because

light prison sentences awarded by Magistrates, or

paying the fines, the offenders were back habits.

anti-mendicancy

In the years 1889 and 1890

at their old haunts and

public

incidents

involving

pauper lepers led to soul-searching, guilt, and outrage among the wellto-do citizens. Instances of leper suicides in public wells and water tanks, [Fig.9.3]

roadside deaths of lepers for whom no medical care

was available, affronted members of the Municipal Corporation, and put the Government on the defensive on account of its arbitrary. closure of the Leper Ward at the J.J.Hospital. 10

Lepers came under a less

sympathetic glare of publicity in the civic body at Educational Inspector 8

.Ibid, p 232.

Bombay Beggars and Criers, p 1.

Parsi outrage at this action of the Government has been described in Chapter 6. “Mr. Acworth’s Home”252

T.B.Kirkham’s disclosure that that a colony of them had residence

at a public water tank

within

contagion-transmitting, -- distance of the

touching,

taken

-- implicitly

railings of the Elphinstone

High School and St. Xavier’s College, two

prestigious educational

institutions in the city. 11 In January 1890 the Provincial Government was besieged by demands from Municipal officials and the management of the Dinshah Maneckji Petit Leprosy Asylum at Ratnagiri, for powers to arrest and compulsorily

detain vagrant

lepers who they thought showed scant

regard for public safety and sensibilities. The existing

legislation was

thought to be unenforceable, for one reason, namely, that there is no separate accommodation in Jail for lepers and Magistrates will not convict under section 85 Act 13 of 1856. The same is the case with section 291 of the Indian Penal Code and as regards section 424 Bombay Municipal Act 3 of 1888 and Act 6 of 1867, the provisions cannot be carried out whilst no place exists for the reception of the lepers and for their detention pending despatch to the Asylum or other place appointed. 12 The absence of an asylum came to be seen as the crux of the leper problem in Bombay city. Even the potential of the most

promising

legislation, namely Act 6 of 1867 could not be realised in Bombay because no asylum existed to be notified as a “sanitarium” under the Act. 13

-------------------------------------------------------------------------------------------11

Detailed in Chapters 5 and 6. MSAGD, Vol., 64, 1890, p 230.

“ …. any person [such as a leper suffering from a “dangerous” disease] was bound to remain there [in the sanitarium] until one of the … Officers of Health certified that he might go abroad without danger to the public.” Acworth, “Leprosy in India”, p 234. “Mr. Acworth’s Home”253

Acworth, who became the city’s Municipal Commissioner

in May

1890, proudly claimed credit for the “discovery” that the Act could be used against leper vagrants and beggars. As an administrator, his watch-words were expediency and pragmatism. As he revealingly remarked, the Act originally meant for protection of the city from “dangerous

disease”,

was “useful, and

collateral purposes.” 14 undecided

[could be] used for other

At a time when

medical opinion was

about the communicability of leprosy,

the Provincial

Government’s action in notifying leprosy to be an “infectious” and dangerous disease under the meaning of Act 6 of 1867, was clearly questionable. When the Government of India asked for the “evidence on which the Bombay Government

had thus notified leprosy as an

infectious disease”, Bombay’s reply was suitably vague: four members of its medical

establishment had opined that

leprosy was such a

disease. 15 To purge the streets of lepers, it thereafter required only the setting up of a “sanitarium” for forcibly interning and detaining lepers who offended under the Act. Simple as it appeared theoretically, the actual process of establishing

a place of compulsory detention for

lepers involved complex negotiations and exposed tensions between the civic body and

the Presidency Government.

Sir Dinshah Maneckji Petit’s Offer On February 1, 1890 Sir Dinshah Maneckji Petit who succeeded to the mantle of premier Parsi sethia and philanthropist after the death of Sir Jamsetjee Jejeebhoy in 1859, offered Rs 100000 to Government, there being, he said, “a great need of a Lepers Home [in the city], 14

Ibid, p 233.

MSAGD, Vol. 64, 1890, p 40. “Mr. Acworth’s Home”254

where a good number of

these unfortunate beings, loitering about the

streets, can be comfortably accommodated.” 16 Sir Dinshah’s offer came burdened with

five conditions, of which the third

was

to prove

contentious. Petit’s conditions were, (1) Government to give, free of costs, suitable land for the Institution, (2) the amount of his donation to be used only for building purposes. (3) The Home to be “equipped and permanently maintained by those who are responsible by law for the maintenance and equipment of such Institutions”. (4) the Home to be called “The Sir Dinshah Manockji Petit Lepers’ Home.” (5) a separate ward to be set aside exclusively for at least 18 Parsee lepers and that if such lepers exceed that number, the additional lepers to be housed in other parts of the Home. 17 Wary as ever of committing itself to expenditure on maintaining leprosy asylums, the Government of Lord Reay

hastily passed on

Petit’s proposal to the city fathers, observing: that “it is for the Corporation to decide how to give effect to the third condition…” 18 The Corporation under the influence of that champion of municipal freedom Pherozeshah Mehta(dates} [Fig. 9.2] declined to admit that it had any legal liability in respect of leprosy asylums, but thought that Petit’s offer should

be accepted on his conditions. It said the

Corporation was prepared to do whatever was necessary under the Municipal Act

of 1882, but

“ventured to express the hope that

Government may see its way towards making a substantial contribution towards the expenses of the Institution.”

As a signal of official

Ibid.

Ibid, p 65.

Michael, History of the Municipal Corporation, p 306. “Mr. Acworth’s Home”255

acceptance

Sir Dinshah’s

offer,

the

Government

pressed the

Corporation to invite the Prince of Wales’ son Albert Victor, then on a tour of asylum at

India, to

Trombay

lay the foundation stone

near the

small

of the proposed

Roman Catholic-run

Eduljee

Framjee Leprosy Asylum, which was described in the last chapter. The foundation stone was duly laid on March 25, 1890. 20

Curiously,

it was not till two months after the ceremony that the Government officially accepted with thanks Sir Dinshah Manockji Petit’s offer, and

agreed to spell out the rights and duties of the municipality in

respect of

the leprosy asylum.

their own contribution to the

scheme, however, Government was deliberately vague. The Governor, Lord Harris [Fig.9.3] informed Petit that it was a matter “for future consideration.” 21 (italics added). Thus despite its royally laid foundation stone,

the absence of a firm commitment of financial support

for maintenance from the Government effectively grounded the Petit asylum project.

The Acworth Initiative It

was a letter

from a

Lady “A” -- revealed

to be Lady

Thomas Thompson, wife of a lawyer -- in the Times of India

The ceremony -- a high point of a royal visit which cost the city exchequer Rs. 30,000 -was publicised as affirming British royalty’s continuing concern for the lepers of India: “… his [Albert Victor’s] illustrious father has taken such a leading part in the efforts that have recently been directed both towards the amelioration of the condition of persons suffering from leprosy, and towards the control and eradication of that terrible disease. “ MSAGD, Vol 64, 1890, no pagination. In the previous year the Prince of Wales had presided over the Father Damien National Leprosy Fund, a British initiative, which led to the visit of the Leprosy Commission to India in 1890-91. 21

MSAGD, Vol. 64, 1890, p 126. “Mr. Acworth’s Home”256

June 1890, that

galvanised Acworth into action on Bombay’s leper

problem. By an eloquent plea for a leper asylum and

appealing in

turn to the humanitarian and self-preservative instincts of the Times’ well-to-do readers,

the Lady

succeeded in exciting the requisite

responses to the “loathsomeness” of vagrant lepers, the pathos of their existence, and the danger of their presence “in our midst’.. Any one passing along Queen’s Road at mid-day yesterday must have noticed … (and must have sickened at the sight) a large number of lepers collected near the Churney Road Station. They squatted in groups of six or seven families of all ages, from the old man with toeless feet to the … tiny, innocent but doomed baby at its mother’s breast. My object in writing to you is not that I felt horror at these hapless victims of a fell disease being en evidence, for it is well that the existence of leprosy in our midst should be … brought forcibly to the notice of the wealthier, more intelligent, and more responsible part of the community. My reason … is to ask – Can nothing be done … for these poor outcasts of society? Are they to be allowed to wander about homeless, penniless, and often friendless? Can no one devise the means to ameliorate their miserable condition? As far as money is concerned, I feel confident sufficient could be raised from the public to provide a temporary home till such time as the [Petit] Leper Home at Trombay is completed … … we must not shut our eyes to the fact that this real danger is in our midst. Lepers perambulate our streets, and rubbing against many an unconscious passer-by they cast their filthy rags on our roads… they pollute our wells and tanks by bathing in them. Can any one deny that the germs of their terrible disease are not by some one of these means disseminated, and who can tell which one among us may not in our turn become the victim of this awful scourge. Whatever view we take of the matter, whether philanthropic or selfish, our duty to ourselves or our fellow-man demands that a home now at once should be provided. [italics added] 22 She pledged Rs. 500/- if a subscription list was opened. The Times of India undertook to take charge of any donations forthcoming towards the establishment of a temporary home for lepers. As it made its offer, 22

Times of India, 19 /6/1890. “Mr. Acworth’s Home”257

the paper

re-iterated

its

demand

for

official

action on the city’s

leper problem: The present condition is at once a disgrace and a danger…. Surely the municipality can find some sort of temporary home for them. The public will supply funds readily enough if the municipal officers would only undertake to see that these funds are properly administered. 23 Within a week of Lady “A”’s appeal Municipal Commissioner Acworth went to the press with an estimate of the requirements for “dispos[ing] of the swarms of lepers who infest the city” to a temporary building. He favoured a site “in some distant part of the island” away from inhabited regions,

since he was under no illusion that the

lepers would all take kindly to forced asylum life. It would require about Rs., 50 000 to erect “proper and cheap accommodation” for about 200 lepers, while

for food, wages,

stores and medicines etc., a

recurring sum of Rs. 2000/- per month would be required. Acworth assured the Times’ readers that if these sums were raised or promised, the building could be up in less than a month, the city relieved of the existing nuisance and 200 of these miserable afflicted being provided for. 24 He proposed that a public meeting be convened in Bombay’s Town Hall, all sections of the people appealed to, and a committee appointed to collect and administer funds, and supervise the “temporary asylum.”

Indian Perceptions and Indian Support It was very soon apparent that to Lady “A” was supportive. 23

Ibid.

the Indian gentry’s response

Indians wrote to the Times of India

“Mr. Acworth’s Home”258

referring

contributing

the

possibility

and desirability

the

wealthy

“to really a very good charity.”[italics added] The word

“charity” underscored the fact that the Indian emphasis and support was to be based overwhelmingly on the humanitarian potential of the scheme,

rather than its supposed

mitigating potential.

“danger”

“nuisance”

The Indian press called for liberal benevolence

befitting the reputation of

the

city.

Native Opinion, for example,

commented that if an institution like that of our Pinjrapole [as asylum for old and ill animals, especially cattle] were founded on the most catholic basis, providing every requisite of life, we cannot see why the lepers may not be induced to find shelter there, when begging must be so heavy a strain upon their dilapidated constitutions. 25 In July 1890,

with the permission of

Sir Dinshah Maneckji

Petit, Acworth convened a meeting of the leading Indians citizens, European clerics and European officials at the magnificent Petit residence

at Malabar Hill, to discuss “housing

Bombay”. Those present included

such leaders of

the lepers of Indian opinion

and members of the “intelligentsia” as Justice Kashinath Trimbak Telang(1850-1893), the Nagar Brahmin politician Javerilal Umiashankar Yajnik, the Khoja reformer and lawyer Rahimtula Muhammad Sayani (1847-1902), and other elected members of the Municipality. From a purely pragmatic point of view, however, the most useful members of the gathering were the shetias and

magnates: Parsis such as

Dinshah

Naoroji Banaji(1837-1890),

Maneckji

Petit and

Muncherji

Gujarathi merchants such as Vandrawandas Purushottamdas, Ghelabhai Haridas, Harkisondas Narotamdas, Morarji Goculdas and many others. Mahomedan wealth was represented by Rahimtoola Maneck Khairaj, and the Khoja merchant Fasulbhoy Visram. That Acworth was able 25

Times of India, 25/6/1890. “Mr. Acworth’s Home”259

to obtain the attendance of Bombay’s most influential and moneyed Indian citizens to discuss the leper beggar, was as much a of aroused Indian sympathy, as implicit Indian

reflection

acknowledgement

British authority. At the start of the meeting

Telang made two

“business-like” suggestions which were unanimously approved. They were, firstly, that a public meeting to canvass support for the cause, as Acworth had

proposed, was unnecessary

considering that the people

at large were already well aware of the His

second proposal, which

importance of the issue.

was to prove far-reaching, was that

financially the fairest arrangement would be for the asylum to be constructed from public subscription, and for the Government and the Municipality jointly to undertake the maintenance of the inmates. The ensuing discussions and Indian perceptions

about

brought out the

nature of

the contrasting

British

the problem at hand.

The former regarded the leper question as a problem of power and law and order. The assembled Indians

were motivated

by the

charitable and humanitarian aspects of the enterprise. The Lord Bishop of

Bombay who presided,

stressed

that

compulsion

would be

necessary to retain lepers in the asylum which he envisioned as “a shelter to which homeless lepers could be removed and where they could be watched.”(italics added). Yajnik, on the other hand, referred to the current intolerable situation in which “lepers were suffered to die in public streets”.26 Yajnik dismissed the Bishop’s argument for compulsion as “not worth much”,

since it was likely that if lepers

were fed and looked after and cared for they would

voluntarily

remain in the asylum. Sayani too was confident that Bombay would assist the poor, and to do its duty towards them. Equally significant was the self-assurance of the assembled shetias that their influence and philanthropic example would ensure the

participation and charity

“Mr. Acworth’s Home”260

their

respective

communities. A

plea was therefore made for

fund-gathering sub-committees to be so organised “that members of each of them would have to work among the particular section of the native community to which visitation. 27

they belonged,”

by house to house

It was in the same cosmopolitan but communal spirit

that a Hindu, a Muslim and a Parsee representative respectively was voted to the administration of

a newly established “Homeless Leper

Fund”. Shethias such as Harkisondas Narotamdas, Rahimtoola Sayani, and

Muncherji

Banaji

were

Honorary

Secretaries,

himself and the city’s health officer T. S. Weir

while Acworth

completed the list.

Leading Roman Catholics later joined the Fund. Acworth’s plan “to relieve the city placed

of the existing

immediate

the firmest possible footing.

confident in their communal influence, were

nuisance”, The

was

wealthy

thus

citizens,

willing to pledge their

money and social influence for broadening the Fund’s financial and social base, while the acquiescence of the rate-payers was implicit in the acceptance of Telang’s suggestion that the Municipality play a role in the maintenance of the asylum.

The “Homeless Leper Fund” The Fund inaugurated in July 1890 at the Petit Hall meeting, was enriched enough by August for construction of Acworth’s “temporary” asylum to commence. A

sum of

over Rs. 12400

was

collected at the Petit Hall gathering itself, including a pledge of Rs. 1000

from

the governor Lord Harris. The enlargement

subscription list was

rapid,

thanks to

of the

the “irrepressible energy and

pluck of Mr. H.A. Acworth”, and the “munificent spirit”

the

-------------------------------------------------------------------------------------------26 Times of India, 19/6/1890. 27 Times of India, 4/8/1890. “Mr. Acworth’s Home”261

public. 28

Within six months of its launching Rs. 70000

had

been

subscribed; by May 1892 the Fund stood at Rs. 90500 and at the end of the financial year 1897-98

no less than Rs. 133000

had

been

subscribed -- a substantially larger amount than the Rs 100000 which been offered by

Sir Dinshah Manockji Petit in February 1890. 29

Acworth himself personally and unabashedly solicited money for his project, using the highly effective modus operandi of personal solicitation in every quarter, almost every home in the city. Lists of persons willing or likely to contribute wee made out from time to time, streets were taken in succession, and every precaution was adopted to pass by no house or shop from which, as the Times of India subsequently remarked in a leading article, “a ten-rupee subscription might reasonably be extracted”. 30 Bombay

mercantile firms were contacted by addressing the

city’s Chamber of Commerce. Nor were the princely States left out of the reckoning, and the Times of India

bluntly

“hoped that the

ruling Princes and the Chiefs [would] aid the cause.” 31 Large amounts were thereupon realised from the rulers of Baroda, Bhownagar, Cutch, and from the Ismaili Khoja chief Aga Khan. Acworth and the other honorary secretaries wealthy

and influential

in the

An appeal signed by also

mofussil, on

went out to

the

the justification

“equity and solemn duty” of the periphery towards urbs prima in Indis.

The Times of India touted the protection of the capital city

from the leper, as a scheme of vital importance.

Times of India, 23/8/1890 and 18/10/1890.

Choksy, Homeless Leper Asylum, pp 7-8.

Selections from the Records, Leprosy, p 313.

Times of India, 15/8/1890. “Mr. Acworth’s Home”262

There is no doubt that a large number of the lepers who infest the streets of Bombay, probably more than half, come from the Deccan, the Konkan, and Gujarat…. It is not just that the sole charge of housing and maintaining them should devolve upon the citizens of Bombay… Another and a more powerful [justification] is the interest which all parts of the Presidency must have in the sanitary condition of the Capital which is, a the same time, the greatest port in India…. The health, the wealth, and welfare of Bombay re-act and are re-acted upon by the health, the wealth and the welfare of the mofussil. 32 Ironically, the scheme for a leper asylum in Bombay was going from strength to strength at a time of raging argument about whether leprosy was, or was not, communicable. Contagionists were

pressuring

a frugal Government of India that lepers, like lunatics, ought to be locked up because they were a public danger. The were not convinced that medical opinion was unanimous

authorities on that

score. 33

Whatever might be the Government of India’s hesitation,

Acworth

himself

saw

administrative one , and

the

problem

he loftily distanced

purely

pragmatic and

himself

from the

vagaries of medical theorisation. Into that Serbonian bog, the question whether leprosy be contagious or not, it is superfluous as it assuredly would be on the part of a layman futile and presumptuous to enter. It has never been supposed by anyone responsible for the Matunga Asylum that the increase of lepers in the city was the consequence of the spread of leprosy by contagion…. Be the facts as to numbers, however, what they may, it is particularly noticeable as an indication to which medical speculation is apt to err on an administrative question…. It is no wonder therefore that the public of Bombay and those who were responsible for the health and safety of the city declined to await that immeasurably distant future when medical authorities are to be agreed upon the question [of causation]… 34 (italics added). 32

Ibid.

Times of India, 16/8/1890; NAI, Home Department, Medical, January 1891, Proceedings 35-38. 34

Selections from the Records, Leprosy, pp 318, 319. “Serbonian bog”: A difficult position with no way of escape. Concise Oxford Dictionary, 1976. “Mr. Acworth’s Home”263

The Corporation versus the Government The closing

years of

the 1880s were marked by increasing

friction between Government and the city’s Municipal Corporation whose undisputed leader was Pherozeshah Mehta.(1845-1915) 35

The

chief bones of contention was the respective legal obligations of the two authorities with respect to police charges, infectious diseases and primary education. 36 The leper question became an added irritant in the tense atmosphere. A keen sense of outrage and injustice was generated in the civic body in 1889, by the Government’s closure of the J.J. Hospital to persons suffering from “dangerous diseases” [and lepers were considered by the Hospital’s doctors to fall into this category],

thereby throwing the

financial responsibility for such

patients on the Corporation. Phirozeshah Mehta, the zealous guardian of Municipal prerogatives and financial interests, disagreed that leprosy came under Municipal public health legislation. At a meeting of the Corporation to discuss assistance for the leper asylum he said:. It is perfectly true that in Section 62 [of the City of Bombay Municipal Act, 1888] it is laid down to take measures to prevent or check the spread of “dangerous” diseases…. The words “dangerous” diseases as used in the Act were used in the sense of epidemic diseases such as cholera, small pox, measles, etc., which broke out suddenly in the city. Any other construction on those words would make it incumbent on the Corporation to establish sanitaria for all diseases which were more or less dangerous to health…. The Government seems to assume that it was the

-------------------------------------------------------------------------------------------35

J.R.B. Jeejeebhoy, Some Unpublished and Later Speeches and Writings of the Hon. Sir Pherozeshah Mehta, Bombay, The “Commercial” Press, 1918, pp 14-17 . 36

Ibid, pp 284-299. “Mr. Acworth’s Home”264

duty of the Corporation to provide for a disease of the character of leprosy… 37 Mehta nevertheless was at pains to show that despite his objections he was not a heartless man: [While] this Corporation do not acknowledge, that it is any portion of the legal duties cast upon them by law to establish or maintain homes, asylums, hospitals and sanitaria for lepers or leprous vagrants, … [yet in order] to alleviate human suffering, [the corporation] sanctions a grant, not exceeding Rs. 1000/- per month, temporarily maintaining the Leper Home being established by public subscription. 38 (italics in original). The Government, which had till then committed itself to little except activating Act 6 of 1867, came under increasing pressure to match

the

Corporation’s

offer.

The Times of

Government that the amount needed was a

India chided

“trifle”,

whereas

alleviation of leprosy in the city was a matter of provincial

the the

as much

as local concern. The present asylum [is an] outcome of charity…. They [Government] have not put a finger yet into the official pocket. … half the lepers of the city belong not to it, but to regions inhabited by the general taxpayer, the [Government] has given no help as yet…. * 39 With the concurrence of Governor Lord Harris who was a generous and early donor to the “Homeless Leper Fund”, the Bombay Government on 5th September 1890, resolved to pay a grant-in-aid of Rs. 1000 per month, calculated at Rs. 10 per head, towards half the maintenance of

200

inmates at the

Homeless Leper Asylum. 40

1891, when the need arose for increased accommodation in the asylum,

Times of India, 12/8/1890.

Ibid. Times of India, 11/8/1890.

.Michael, History of the Municipal Corporation, p 316. “Mr. Acworth’s Home”265

both Corporation and Government agreed to enhance their respective grants

maintain

100

additional

Corporation exploited the opportunity

inmates.

Nevertheless

the

to rake up the long-standing

political grievance of police charges. A special Committee which was convened to enquire into its obligations in leprosy -- Mehta was a member of the Committee – pointedly declared that the local body would be more generous to lepers

if it was “treated liberally by

Government in respect of Police charges”. 41

By 1893, for

various

reasons, one being the manifest success of the temporary Homeless Leper Asylum,

the proposed Petit leper asylum at Trombay

was

regarded as a lost cause, and the grants to Acworth’s “temporary” asylum were made permanent. Mehta and the Corporation continued steadfast

in their refusal to acknowledge that it was “any portion of

the legal duties cast upon them to maintain homes, asylums, hospitals or sanitaria for lepers or leper vagrants”.42

In 1894

the Municipal

Corporation discussed whether to accept an anonymous Rs.19,000

made to Acworth, for erecting a ward for sick lepers at

the Homeless Leper Asylum. Mehta’s implication Municipal

offer of

irritation flowed over at the

that the Asylum was a Municipal Commissioner

was

indirectly

institution. The

reprimanded

for utilising

Municipal channels for contracts and services to the asylum: “the Corporation [express] their strong disapproval of the accounts of

the

Municipality and of the Leper Asylum … being in any way mixed up.” 43

Ibid, pp 499-514.

Ibid, p 310. Ibid, p 320.

“Mr. Acworth’s Home”266

The Homeless Leper Asylum remained

a step-child

of Government

and Corporation. 44

Location and Construction of the Homeless Leper Asylum It was to the credit of Municipal Commissioner Acworth that he thought through all aspects of his asylum scheme, especially as regards its location and construction. It was to be situated within Municipal limits on a site safely removed from population centres, well-drained and unobjectionable from a sanitary point of view, yet within reach of the

supervisory municipal staff and

the public

wishing to inspect it.

About 11 ½ acres of uninhabited Municipal

and leased Government land in the village of Wadala was acquired in August 1890,, near the suburb of Matunga, two miles north of the Government House at Parel, and a mile or so from Dadar railway station, in a landscape dominated by vast stretches of rice fields and the Matunga salt pans. 45

The Times of India waxed eloquent about

its scenic virtues.

The Government and Corporation continued to share in maintenance till 1991, at which time the Acworth Leprosy Hospital became a fullfledged Municipal institution. 45

The “Government House” referred to now houses the Haffkine Institute.

“Mr. Acworth’s Home”267

The view that presents itself to one on entering the ground is quite a pleasant one. The ground is surrounded at some distance by paddy fields … and far in the distance are visible hills clothed with green, prominent among them being the Antop Hill …. Further down the East can be observed the Sewree Bunder and a part of the Bombay harbour and its shipping, and to the south lies in the distance the Parel hill with the late Mr. Narayan Dhabolkar’s bungalow perched on the top of it. A more suitable site could not well have been selected near Bombay. 46 It was confidently expected that the leper inmates would be pleased about the ample compensation for loss of their

liberty,

grounds [which were to be barbed-wire fenced all round]

“the

which are

so extensive as to permit of the inmates taking their ‘constitutional’ whenever they are inclined to do so.” 47

Matunga’s

as a hot-bed of guinea worm infestation in 1890 the

former notoriety

was no deterrence, since

nearby water main from Vehar lake could be tapped

for an ample supply of pure water for the asylum. 48

Most comforting

was the thought that the asylum Is completely hidden by arborage from the Matunga Road, one of the great roads leading north out of Bombay, from which it is distant in a direct line 520 feet, and no one passing along this road would have the least idea that the largest leper asylum in India was close to him. 49 With an eye on the impending arrival

in Bombay of the

Leprosy Commission from London in December 1890, Acworth was keen that the Homeless Leper Asylum should be opened by the early part of November. The technical expertise of Municipal consulting 46

Times of India, 20/10/1890. Ibid.

Michael, History of the Municipal Corporation, p 181; the Records, Leprosy, p 313.

Selections from

Ibid. “Mr. Acworth’s Home”269

engineers, architects and sanitary officials

was

freely utilised, with

Acworth himself personally involved at every stage, fully aware that he was

embarked on a

publicity.

The

financial

expected

prudence, and

dictated that

pioneering

enterprise in the full glare of

“temporary” the

low

nature of

the asylum,

social status of the inmates,

the Homeless Leper Asylum’s

architectural qualities be

serviceable rather than aesthetic. Accordingly, the military barrack rather than a conventional hospital was its inspiration. That the site had originally housed sepoys was of course a fortuitous coincidence. The plinths of their barracks still survived, and were promptly utilised for erection of sheds

for accommodation of the lepers [Figure 10.2].

Four parallel sheds of iron were erected, three of which were 100 feet long and 30 feet wide, the fourth 57 feet long and 30 feet wide for women lepers. The distance between the sheds was a generous 70 feet.

By 1895, with increasing demand for accommodation,

more sheds had been added, each 157 feet long. built

on rising ground for better drainage, had

two

The sheds were

gabled, thatched --

later Mangalore-tiled -- roofs 15 feet high, with ventilators above running along their entire length. The 8 foot high barrack walls were made of bricks, sand and gravel. No less than seven doors and 14 Venetian windows were provided on each side, and other open spaces ensured a free current of

air.

The Times of India’s reporter

pronounced them “nice and cool within even during the part of the day, and

… in

every

way

neat and comfortable.”

Each

shed

was

longitudinally divided by 8 foot high corrugated iron partitions, and housed

least twenty persons. Washing places and latrines were

housed separately in back-to-back rows. The urinals were constructed on the “self-flushing” water system much used in Bombay at the time.

“Mr. Acworth’s Home”270

cook-house,

dispensary, ward-servants’ quarters and apothecary’s

residence completed the ensemble of structures. 50 [Fig. 9.4] Acworth’s indefatigable solicitation of large donors permitted him in the next five years,

to add more sheds, improve sanitary

arrangements for the women inmates, build a hospital ward for sick and dying inmates, as

also

a school room for

children

with

leprosy. 51

Living in the Homeless Leper Asylum On November 7 1890, Acworth’s temporary “Homeless Leper Asylum” became a fait accompli. By invoking Act 6 of 1867 on specious grounds, about fifty vagrant and homeless lepers were forcibly rounded up from the streets by the Police, certified by the acting Municipal Health Officer Surgeon-Major K.R. Kirtikar to be suffering from the “dangerous” disease of “black leprosy”, and transported in special bullock carts known as reklas to the Asylum, into the care of the medical officer Dr. Nasarvanji Hormusji Choksy L.M.(1861-1939) 52 . [Fig.. 9.2]

Times of India, 20/10/1890; Selections from the Records, Leprosy, 315. 51 Choksy, Homeless Leper Asylum, pp 8-10.

Dr. (later Sir) Nussarvanji Hormusji Choksy , Superintendent of the Homeless Leper Asylum 1890-1897, was a distinguished graduate of the Grant Medical College and a prominent member of the city’s medical profession. In 1889 he was placed in charge of the newly opened temporary Municipal Infectious Diseases Hospital at Grant Road, from where he was recruited by Acworth for the leper asylum at Matunga. Later he held additional charge of the Arthur Road Infectious Diseases Hospital, where his services during the late nineteenth century plague epidemic were praised. He was President of the Bombay Medical Union, and associated with the Bombay Branch of the British Empire Leprosy Relief Association. Choksy edited the Indian Medico-Chirurgical Review 1894-1899, which was sympathetic to Indian attempts to breach the privileged position of the British-dominated Indian Medical Service. “Mr. Acworth’s Home”271

Their [the lepers’] condition was most abject and helpless. They were literally covered with rags … and their sores and wounds were in all stages of disintegration…. The first thing that was done on their arrival was to separate them according to their caste and sex…. Each leper was provided with a cake of carbolic soap and enough warm water for a good wash… and a clean suit of cotton clothing…. The patients were then taken to their respective wards and beds assigned to them. Their dinner … was served to them in plates, spoons being provided for those that had no fingers… 53 Within seven weeks of its opening, the population of the Homeless Leper Asylum swelled to 205, larger than the anticipated complement, and for financial reasons numbers had to kept at 300 for the next seven years. Women and children comprised one-third of the inmates. The population and mortality statistics for the asylum

from

1890 to 1897 are depicted in Fig. 9.4 The strikingly high mortality was witness to the

deprivation and

poverty of the lepers and

the dire

straits of some when they were picked up from the streets. It also confirmed the widely held belief in the utter incurability of leprosy.

Dietary: “native” civil demonstrate,

The

inmates’ dietary

hospitals in the city. However, as Tables 9.1 and 9.2 expenditure on the Leper Asylum was rigidly controlled

and remained unchanged over several increases

was modeled on the other

years,

in contrast

with steady

in maintenance costs in three other institutions. The

itself was planned for the day of the week, and

diet

there was a limited

variety, though it sufficed for ordinary requirements.[Table 9.3] It was supplemented by occasional gifts of fruit and sweetmeats from the general public, and were reported to be “greatly appreciated”.

Choksy, Homeless Leper Asylum, p 1. “Mr. Acworth’s Home”272

Discipline and Punishment:

Sceptics had predicted

that

the

leper inmates would be unruly and unmanageable, that escapes would be incessant despite

the fencing, and Acworth’s scheme unworkable

except by deploying a costly coercive staff. reported

that the reality

The asylum authorities,

did not prove to be so dire, though

obviously it was in their interest to play down difficulties. “It must be admitted,” said medical officer Choksy, “that considering all the circumstances, the patients have behaved extremely well and have been docile and amenable to discipline…. Nor [did] the patients quarrel amongst themselves, but [were] as a rule very gentle, and kind to each other.” About a

dozen escapes

occurred

intellect,” in despite the instance

“mostly

on the part of lepers of weak

twenty-four hour

was related of one “burly” Borah

police guard. 54

The

who was inclined to be

violent and abused the sirkar for the zoolum of forcibly imprisoning him in the asylum. He escaped the first night, but sought re-admission a few months later, “and became a well-behaved inmate.” Since the number of escapes was much smaller than expected, the police were dispensed with and replaced by chowkidars.

Even

the two strong

cells provided for solitary confinement of “refractory” and troublesome lepers

were only “infrequently” required.

If any patient persistently

showed defiance of authority, he was “expelled.” 55

Segregation of the Sexes: Bureaucrats agonised over the merits and demerits of sexual segregation in the Asylum. John Nugent, Secretary in the General Department, was torn

between the

need to make the

institution as “attractive” as possible so that lepers voluntarily entered and remained in it, and the perception that complete segregation was “best” 54

Selections from the Records, Leprosy, p 317. Choksy, Homeless Leper Asylum, p 6; Selections from the Records, Leprosy, p 317. 55

“Mr. Acworth’s Home”273

in leprosy. It was a good demonstration of the power that British officials wielded over the body of the leper beggar. Theoretically of course the barrack system [which was the prototype for leper accommodation], with more or less complete segregation of the sexes--the more complete the better--is the best as also it is the cheapest but I do not know how far it is practicable to adopt it rigidly would be to convert the institution into a prison. … The position of the enclosure where the female barracks were would then have to be walled or railed off from that part where the male barracks are. A wire fence would probably suffice as at night the women could be locked up in their dormitories and by day the attendants should be able to prevent any intercourse between the men and women. 56

At the outset Acworth, following the conventional wisdom, ordered

the sexes to be segregated. But

he soon came to the

conclusion that “if married lepers are allowed to live together, and lepers in an asylum allowed to marry, the amenities of such an institution will be greatly increased.”

Thereafter the authorities were

instructed to take a tolerant view of mixing of the sexes, and there was no check on association beyond the fact that men and women were housed in separate ward-sheds. 58

This

was an

a striking

innovation at a time when separation of men and women lepers was

a fetish

missionary-run institutions,

and

dogma in

high

official circles. 59 Lepers abandoned by their lawful spouses,

generally formed

informal alliances with fellow sufferers of the opposite sex, and the -------------------------------------------------------------------------------------------56

MSAGD, Vol. 82,1891,p7

Acworth, “Leprosy in India”, p 274. Choksy, Homeless Leper Asylum, p 5.

The opinion of Bailey quoted in Chapter 6, bears this out.. “Mr. Acworth’s Home”274

asylum’s

policy was partly based on the belief that unions between

lepers were not “fruitful” because lepers were not as a rule “prolific,” and only about 5% of lepers’ children fell victim to leprosy. Thus in nine years of its existence, only seven children were born

in the

asylum. Marriages between lepers were encouraged, it being recognised that such unions were entered into companionship

and

as much in expectation of

nursing care from the partner,

as for sexual

purposes. It is probable that the management’s relaxed and humane attitude

in an important matter,

contributed

the inmates’

acceptance of asylum life.

Religion

and

arrangement at

Religious

“Acworth’s

Observances:

Another

Home” was tolerance of

preferences and beliefs of the inmates.

Indeed

the

politic religious

it could hardly be

otherwise, considering that Bombay’s public of all communities had played a crucial role in the establishment of the institution. Maratha and low-caste

Hindu

lepers

were

housed

separately,

were

the

Mahomedans and Christians. Again the contrast was with missionaryrun

asylums,

such as the Roman Catholic Eduljee Framjee Leprosy

Asylum at Trombay which was unpopular with non-Christian lepers. 60 A Hindu temple, a mosque and Roman Catholic chapel were erected from

special

donations from the

respective

arrangements were made for attendance of

communities,

and

priests at these houses of

worship. Festivals and holidays of the communities were observed and small

amounts of money were provided for celebrations.

Similarly,

disposal of the bodies of lepers dying in the asylum was conducted in accordance with the religion of the deceased. The tolerant religious -------------------------------------------------------------------------------------------60

The Eduljee Framjee Albless Leprosy Asylum is discussed in Chapter

8. “Mr. Acworth’s Home”275

policy exposed Acworth to charges of “furthering the cause of idolatory”. For such criticism, Acworth said he “cared little”. The inmates of the asylum are, without having committed any crime, prisoners for life, and [I] feel it to be [my] clear and sacred duty to provide, so far as [I] can, for all their legitimate requirements; and [I] think, that the claims of a Hindu or a Mahomedan for a place of worship according to his belief is a requirement as legitimate as that of a Christian for a church. 61 The Asylum School:

Leper children under ten years of age

formed about 2.5% of the number “treated” (87 of the 3474 ) in the asylum in educate

the period 1890-97. A leper teacher was appointed to

them in Marathi, and

geography

in the school room.

grant-in-aid from the Joint regularly

the rudiments of

attend the

By 1897

arithmetic and

the school acquired a

Schools Committee.

Acworth

prize- giving functions, his

would

wife personally

raising subscriptions from her friends for gifts. 62 The Homeless Leper Asylum brought out in ample measure the paternalism

for

which

members of the Indian Civil Service were well-known.

Medical Facilities: of the

One feature which marked the high status

Homeless Leper Asylum

as compared to the institutions at

Ratnagiri and Rajkot, was that its Medical Officer N.H. Choksy was a respected and experienced city physician, rather than a low paid superannuated

hospital

assistant.

Under

his supervision, all

the

accredited forms of treatment of leprosy were tried out at the institution, including

chaulmoogra

unsatisfactory.

and the

gurjon matter

oil,

though

treatment,

the results

were

too, Acworth

accommodated to the lepers’ preferences. The proved impotence of -------------------------------------------------------------------------------------------61

Acworth, “Leprosy in India”, p 235.

“Mr. Acworth’s Home”276

the above

treatments, obliged

him to

permit trials with informal

drugs prescribed by local vaids and hakims if the drugs was divulged

and

the medications

nature of the

were shown

do no

The Sewage Farm of the Homeless Leper Asylum:

In a

harm.

pioneering experiment encouraged by against lepers Carkeet

Acworth,

social prejudice

was turned to the advantage of the asylum by

James,

early

enthusiast of sewage irrigation and sewage farming in India. 63

The

question of

the

Municipality’s

Drainage Engineer,

disposal of the asylum’s sewage became critical when

the overflow from the pits found its way into adjoining private land, placing the Asylum Committee at odds with neighbouring landowners. Faced

with the possibility of

injunction

restraining

Committee

them

litigation as well as a High Court from

“polluting”

private land,

the

bought up a large amount of land to the south of the

asylum, so that eventually the area irrigated by sewage was about 5.9 acres. As a result of James’ experiments on the best method of

sewage treatment and modification of the design of the latrines,

it became possible to start the operation of the sewage farm by 1895

using

receiving

open septic or

sewage “liquefying ” tanks capable of

19,000 gallons of human

fertility of the improved by

clayey and

kitchen sullage

moist soil was

per day. The

found to be

greatly

irrigation with sewage effluent. The irrigated land was

intensively cultivated, no plot being allowed to stand fallow for more than one month at a time. Six crops of fodder such as

lucerne and

guinea grass were harvested annually and sold at market rates to the -------------------------------------------------------------------------------------------62 Times of India, 4/3/1895. 63 C.C. James, Notes on Disposal of Sewage at the Matunga Leper Asylum, Bombay, Bombay, Times of India Press, 1901. “Mr. Acworth’s Home”277

Municipality for its stables. For the inmates’ consumption maize and jowar, with a rotation crop of legumes such as pulses or vegetables such as cabbage, carrot, turnips etc.

were

successfully planted.

Experiments were also conducted with bananas and other fruit trees. All lepers certified fit to do so were required to work, on the official claim that “their health is very greatly improved by the exercise. 64 The farm provided occupation for 25 to 50 lepers as malis or labourers. Males were paid two annas and women one anna per day, -- much below the ordinary rates of five annas and three annas respectively. ground that

The

the amount of

management justified this policy

on the

work they did was

proportionately less

farm achieved its

primary purpose of

than able-bodied coolies. While

the sewage

disposal of the asylum sewage, it was a costly enterprise, bringing in at first less than Rs. 500/-. A further year’s trial was decided on, with gratifying results. From that time, as Fig. 9.5 shows, the farm became increasingly successful, eventually more than paying for itself. At the end of the century, James recalled with some pride that the good results of the Matunga Sewage Farm go to show that with sewage in India much can be done beyond disposing of it without offence to the land. Such disposal can be made financially satisfactory with intelligent supervision even of the poorest soil. At Matunga the ordinary passer-by has no idea that the green plots he sees are being daily irrigated with 20,000 gallons of sewage effluent … 65 He might have added that the ordinary passer-by also had no idea that the said sewage effluent came from the body waste of lepers. -------------------------------------------------------------------------------------------64

C.C. James, Oriental Drainage, Bombay, Times of India Press, 1902, p 147. 65

Ibid, p 12. “Mr. Acworth’s Home”278

Assessment The

Homeless Leper Asylum at Matunga in Bombay, was a

unique colonial enterprise in its genesis and administration. It was due to Acworth’s drive and astute harnessing of the Indian public’s charitable instincts, and his unabashed use of Municipal facilities, that his project required just six months to become a reality. Acworth recruited

the city’s and Presidency’s wealthy and the “intelligentsia”

both as

exemplars and as intermediaries to reach the pockets and

the sympathy of the common citizen in an disclaiming

any

desire to

imperial cause.

Despite

venture into the “Serbonian bog” of

leprosy causation theory, Acworth showed no qualms in persuading the Government to invoke the provisions of a forgotten piece of legislation -- Act 6 of 1867 -- on the medically controversial ground that

leprosy

was

“dangerous”

public

health

problem.

The

participation of the civic body in the project, through the influence of Pherozeshah Mehta, and of the Government through Lord Harris, completed the legislative-financial-political tripod of essential support which Acworth required to carry out his scheme. Notwithstanding the aura

charity

associated

with

it in Indian minds, and the

shrewdly enlightened manner of its administration, the asylum was a nakedly coercive institution. . The success or failure of the Acworth’s

pet scheme asylum

might be evaluated on the basis of his goals, namely, evacuating the city streets of lepers and maintaining an institution in would not be unhappy to

which they

be incarcerated. Did Acworth succeed

in his goal of “purging” Bombay’s streets of leprosy sufferers ? The answer appeared to be “yes” in the early months, when wholesale sweeping up of lepers from the streets, and their forcible confinement in the asylum were the norm. The census of 1891, conducted within “Mr. Acworth’s Home”279

a few months of the founding of the Homeless Leper Asylum, revealed a diminution in the number of lepers in the city, but this could as well have been the result of an exodus to escape the police “zoolum”. The numbers swelled again as the wealth of the city continued to lure beggar lepers. In 1897, the Indian press complained that due to the lack of room in the asylum, lepers “are wandering all over the town.” 66 The sociology of mendicancy, the visible horrors of leprosy, and the ever increasing number of vagrants, ensured that the Homeless Leper Asylum could not permanently clear Bombay’s streets. Was asylum

life of

acceptable

quality

for

the

forcibly

incarcerated inmates? Two contrary prophesies attended the establishment of the Matunga asylum; first, that it would be so popular that it would soon become over-crowded; second, that it would be impossible to coerce the lepers into remaining there. The former appeared to be the correct prediction. from 200 to 300

The need to enlarge the asylum’s capacity

within a few years was

probably as

much

reflection of its acceptability to the lepers, as of the colonial state’s determination to use its coercive powers to incarcerate them. Unlike institution

the

lunatic

asylum -- another

imported into India -- where the

peculiarly

Western

colonial administrators

could look for guidance and precedents in corresponding institutions in Victorian England, of

there was no model for emulation in the case

the Homeless Leper Asylum. The combined carrot and stick

approach of Acworth was tailored to Indian custom and the lepers’ sensibilities. Some

reasons

might

therefore be proposed for the

comparative success of Acworth’s venture: a) the colonial

Government’s

prestige of the capital city,

over-riding anxiety to maintain so that

comparatively generous grant-in-aid 66

the

it was prepared to give a

of Rs 120/- per head annually

Times of India, 23/11/1897. “Mr. Acworth’s Home”280

for the Acworth asylum. This contrasted fistedness towards Ratnagiri,

the

for which

rural

Dinshah

only Rs. 99

sharply

with

Manockji Petit

its tightasylum

per head per year was deemed

sufficient. 67 Nevertheless, compared to other civil hospitals in the city, patronised by Indians of the poorer classes, the Homeless Leper Asylum was run on rigidly frugal lines. b) the adoption of a policy

permitting mixing of the sexes in the

asylum, and the encouragement of marriages between the leper inmates; c) tolerance of the religious sentiments and practices of the leper inmates of all communities; d) the

provision

creature comforts and medical aid of

good

quality under the supervision of a respected Indian physician trained in Western medicine, rather than a lowly paid hospital

assistant as at

Ratnagiri.; e)

the

support of

the press and

the socially and politically

influential sections of the Indian public. His unparalleled influence over the Homeless Leper Asylum gave Acworth ample scope for demonstrating the paternalism which marked the colonial civil servant. The leper came to acquiesce in his own incarceration behind an eight foot high barbed wire fence, and saw the sirkar as a benevolent but firm authority. In the year 1899, four years after his retirement from India, Acworth

spoke at a meeting on leprosy at London’s Royal

Society of Art, about the establishment of the Homeless Leper Asylum. Giving vent to his resentment that bureaucrats in Calcutta had denied him the recognition he considered was his due and “forgotten” his services to the cause of leprosy, “as if they had never been,” he nevertheless

ventured to weigh his part in the colonial

civilising

mission, and to predict that 67

This is discussed in Chapter 7. “Mr. Acworth’s Home”281

The future historian of India, will, in the category of India’s debt to England, place these measures for dealing with leprosy in the same rank as those in which Suttee and Thuggee were suppressed. But that historian will never know, … that the wise and humane policy … was born, its feasibility proved, and its efficacy established, in a little institution known as the Matunga Asylum. 68 For Harry Arbuthnot Acworth, the years 1890-1895

planning

and administering the Homeless Leper Asylum were his “finest hour”. The “Homeless Leper Asylum” officially became the “Acworth Leper Asylum” in 1905 in recognition of the founder’s signal services. It still survives as the “Acworth Municipal Hospital for Leprosy”.

.Acworth, “Leprosy in India”, p 275. “Mr. Acworth’s Home”282

Fig.9.1. H.A. Acworth

Fig.9.2. Dr. N.H. Choksy

Fig. 9.3. Nacoda Water Tank, Bombay,with St.Xavierâ&#x20AC;&#x2122;s College seen in the background and the Elphinstone Institution on the right : early 20th century. (Original photograph in the Bhau Daji Museum, Bombay).

Fig. 9.4. Population Statistics of the Homeless Leper Asylum, 1 890-97*

1 02

195

190 147

1 04

119

1 03 89

201

200

213

209

224

Deaths

240 220 200 180 160 140 120 100 80 60 40 20 0

Discharges

Admissions

Year

Fig. 9.5. Annual Income from the Sewage Farm at the Homeless Leper Asylum, 1895-98* 1400 1478

1200 1000

1103

800 600 400

489

200 0 1895-96

1896-97

Year

1897-98

TABLE 9.1. COMPARATIVE COSTS (Rs-As-Ps) PER PATIENT AT THE HOMELESS LEPER ASYLUM AND OTHER CIVIL HOSPITALS IN BOMBAY, (1891-97)*. Homeless Leper Asylum

Year

Per Diet Daily

Per Patient Annual

J.J. Hospital

Per Diet Daily

Per Patient Annual

Gocaldas Tejpal Hospital

Per Diet Per Patient Daily Annual

European General Hospital

Per Diet Per Patient Daily Annual

1891

0-3-0

60-7-9

0-3-8

394-0-0

0.3-0

445-0-0

0-9-1

1193-0-0

1892

0-3-0

65-11-9

0-3-8

423-0-0

0-3-0

458-0-0

0-9-8

974-0-0

1893

0-3-0

63-7-8

0-3-9

387-0-0

0-3-1

490-10-5

0-9-6

1089-7-5

1894

0-3-0

73-9-11

0-3-8

258-3-0

0-3-0

512-12-9

0-9-0

1055-7-3

1895

0-3-0

73-8-6

0-3-4

264-15-1

0-2-10

458-8-1

0-9-6

816-4-6

1896

0-3-0

81-2-4

0-3-7

273-6-1

0-3-0

0-9-6

1186-9-0

69-3-0

0-4 -3

341-9-4

0-3-10

0-12-6

1186-9-0

1897

0-3-0

506-13-3 515-1-9

* Annual Administration and Progress Report on the Civil Medical Institutions in the City of Bombay for the respective years, Bombay, Government Central Press.

TABLE 9.2. COMPARATIVE COST (Rs-As-Ps) OF MAINTENANCE AND

NUMBER OF PATIENTS IN HOSPITALS IN BOMBAY IN 1891.*

Institution

Average Daily Bed Occupation

Annual Expenditure

Cost of Maintaining each Bed

Homeless Leper Asylum

228.7

25,103-1-5

60-7-9

J.J.Hospital

393.4

1,55,112-0-0

94-0-0

Goculdas Tejpal Hospital

101.8

48,402-0-0

445-0-0

European General Hospital

63.7

76,004-0-0

1,193-0-0

*Annual Administration and Progress Report on the Civil Medical Institutions in the City of Bombay for the Year 1891, Bombay, Government Central Press, 1892. NOTE: The costs are only approximately comparable, since the institutions were not run on identical lines, e.g., the Homeless Leper Asylum did not have an Out-patient Department

Fig.9.1. H.A. Acworth

Fig.9.2. Dr. N.H. Choksy

Fig. 9.4. Population Statistics of the Homeless Leper Asylum, 1890-97*

224

Discharges

213

209

103

201

200

Deaths

195

102

190 147

104

18 97

18 96

Year

18 95

18 94

18 93

18 92

18 91

240 220 200 180 160 140 120 100 80 60 40 20 0

18 90

Number

Admissions

*N.H.Choksy, Report on Leprosy and the Homeless Leper Asylum, Matunga, 1890-97, Bombay, British India Steam Press, 1901, p 12.

Fig. 9.5. Annual Income from the Sewage Farm at the Homeless Leper Asylum, 1895-98* 1400 1478

1200 Rupees

1000

1103

800 600 400

489

200 0

1895-96

Year97 1896

1897 98

*C.C. James, Notes on Disposal of Sewage at the Matunga Leper Asylum, Bombay, Times of India Press, 1901, pp 8-11.

TABLE 9.1. COMPARATIVE COSTS (Rs-As-Ps) PER PATIENT AT THE HOMELESS LEPER ASYLUM AND OTHER CIVIL HOSPITALS IN BOMBAY, (1891-97)*. HLA**

JJH*** Per Diet Daily

Per Diet Per Patient Daily Annual

EGH*****

Year

Per Diet Daily

Per Patient Annual

Per Diet Daily

Per Patient Annual

1891

0-3-0

60-7-9

0-3-8

394-0-0

0.3-0

445-0-0

0-9-1

1193-0-0

1892

0-3-0

65-11-9

0-3-8

423-0-0

0-3-0

458-0-0

0-9-8

974-0-0

1893

0-3-0

63-7-8

0-3-9

387-0-0

0-3-1

490-10-5

0-9-6

1089-7-5

1894

0-3-0

73-9-11

0-3-8

258-3-0

0-3-0

512-12-9

0-9-0

1055-7-3

1895

0-3-0

73-8-6

0-3-4

264-15-1

0-2-10

458-8-1

0-9-6

816-4-6

1896

0-3-0

81-2-4

273-6-1

0-3-0

506-13-3

0-9-6

1186-9-0

1897

0-3-0 69-3-0 0-4 -3 341-9-4 0-3-10 515-1-9 0-12-6 1186-9-0 ===================================================================================

0-3-7

Per Patient Annual

GTH****

* Annual Administration and Progress Report on the Civil Medical Institutions in the City of Bombay for the respective years, Bombay, Government Central Press. ** Homeless Leper Asylum. (cost shared equally between Government and Corporation) *** Jamsetjee Jejeebhoy Hospital (Government) **** Goculdas Tejpal Hospital. (Corporation contributed Rs. 36,000/- annually). ***** European General Hospital (Government; for whites only).

TABLE 9.2. COMPARATIVE COST (Rs-As-Ps) OF MAINTENANCE AND NUMBER OF PATIENTS IN HOSPITALS IN BOMBAY IN 1891.* Institution

Average Daily Bed Occupation

Annual Expenditure

Cost of Maintaining each Bed

Homeless Leper Asylum

228.7

J.J.Hospital

393.4

1,55,112-0-0

Goculdas Tejpal Hospital

101.8

48,402-0-0

445-0-0

European General Hospital

63.7

76,004-0-0

1,193-0-0

25,103-1-5

60-7-9 94-0-0

TABLE 9.3. Weekly Dietary at the Homeless Leper Asylum, Bombay, 1890-1897.*

Monday

SUPPER

BREAKFAST

DINNER

Rice 3 ozs. (~110gm)

Patni rice or wheat 9ozs (~350gm)

Mild 4 ozs. (~120ml)

Toor dal 3 ozs. (~.110 gm).

Vegetables 4 ozs. (~ 150 gm)

Sugar ½ ozs. (~ 19 gm)

Vegetables 4 ozs. (~ 150 gm)

Curry stuff ¼ ozs. (~ 10 gm)

Ghee ½ ozs. (~ 15 ml)

Salt ¼ ozs. (~ 10 gm)

Sweet oil 1/6 ozs. (~ 5 ml)

Heeng 2 grains (pinch) Tea ¼ ozs. (~ 10 gm)

Mustard seeds 10 grains (~1gm)

Or Tea ½ ozs.(~ 20 gms)

Mild 2 ozs.(~ 60 ml) Sugar ½ ozs. (~ 20 gm) Baker’s bread 4 ozs. (~ 150 gm) Tuesday

Baker’s bread 12 ozs. (~ 500 gm) DO, + Mussoor Dal 3 ozs.

Chapatis 9 ozs. (~ 350 gm) Mutton 6 ozs. (~ 230 gm) Curry stuff ¼ ozs. (~ 10 gm) Salt ¼ ozs. (~ 10 gm)

Wednesday

DO, with Toor dal 3 ozs

SAME AS MONDAY

Thursday

DO, + Mussoor dal 3 ozs.

Toor dal 3 ozs. (~ 110 gm)

Friday

DO, with Toor dal 3 ozs.

Patni bread or wheat 9 ozs. (~ 350 gm) Curry stuff ¼ ozs. (~ 10 gm) Salt ¼ ozs. ~ 10 gm) Sweet oil 1/6 ozs. (~ 5 ml) SAME AS MONDAY

Saturday

DO, + Mussoor dal 3ozs.

SAME AS TUESDAY

Sunday

DO, with Toor dal 3 ozs.

SAME AS MONDAY

*N.H. Choksy, Report on Leprosy and the Homeless Leper Asylum Matunga, Bombay, 1890-97, Bombay, British India Printing Works, 1901, p 4. N.B. The average daily nutritive value of this diet is Calories-- 3808 Kcal; Protein—130.11 gm; Fats-- 49.8 gms; Carbohydrates—701.63 gm. This is an adequate diet according to a modern dietitian. (I am indebted to Ms. Shivani Kothare for this information).

CONCLUSION This thesis has attempted a multi-perspective study of Indian leprosy in Bombay

the nineteenth century, with particular reference to the

Presidency.

Perceptions have included the

political, legal, and administrative aspects

medical,

the “leper

socio-

question”

between 1840 and 1897. Where necessary the story of leprosy has been extended to other parts of the country and Britain. In the “Introduction” the following questions were posed for this study: (1) What were the points of contact between Indian and European medicine with regard to leprosy in the nineteenth century, and in what manner did colonial contact affect therapeutic practice in leprosy? How did the nineteenth century scientific revolution in European medicine reflect in perceptions about leprosy causation? How were European causation theories received in the colonial milieu of Bombay and India, and who were the persons involved, and what were their motivations ? (2) Did the colonial state have a leprosy policy; if so, in what manner was it manifested? (3) How did Hindu law perceive the leper and what were the religio-social practices towards him; what place did traditional law have in the “modernised” legal system fashioned by the British in the latter half of the nineteenth century? (4) What were Indian and British colonial society’s perceptions about leprosy, especially in the last two decades of the century, and how did the wealthy and the educated classes in Bombay see their respective roles on the issue? (5) What was the nature

leper

institutions

Bombay

Presidency, and under what circumstances did they arise and how far did they fulfil their stated purpose? Conclusion 289

Medicine Medical perceptions in one form or another intruded into many aspects of the leprosy problem,

hence the main medicine-related

developments form the subject matter of Chapter 1 (“The Aristocrat Among

Diseases”), Chapter

2 (“Causation Controversy in India: the

Leprosy Career of Henry Vandyke Carter”), Chapter 3 (“Therapies, Therapists and Therapeutics”), and Chapter 4 (“The Leper Censuses and their Uses”). It is seen

that there were indeed striking conceptual

parallels between the classical Indian, i.e., Ayurvedic, and the Greekbased Western medical perceptions about the disease in the early decades of the nineteenth century. In both

systems good health was

predicated on a balance of body fluids known as doshas in India, and humours in the West. In

both systems, too, disease, including

leprosy, was considered to be the result of humours, including the blood.

Both systems recognized

existed in more than one form, and agreed impropriety were

imbalance of

some

that leprosy

that heredity and sexual

somehow connected with it,

and

that diet and

digestion influenced skin disease. Leprosy appears to be an exception to the argument historians that

colonial

of some

medical priorities in India were centred on

diseases which threatened British health hence British political control. From the late eighteenth century till almost the last quarter of the nineteenth, lay British and colonial medical commentators paid a great deal of attention to leprosy, though in their perception it was quintessentially an Indian disease. Despite an ingrained sense of the superiority of their own medical heritage, medical colonials showed an interest in

traditional treatments, conceding that they – the West --

might have something to learn from Indian experience in this regard. Criticism was to be expected, of course, and it was directed at Indian medicine’s reliance on polypharmacy, -- the use of multiple drugs Conclusion 290

together. Also criticised was its empiricism, -- efficacy of a treatment postulated on the basis of

experience rather than experiment.

hallmark of the first colonial intervention in leprosy therefore, was the introduction of a “rational” system of evaluating remedies one at a time, by means of experiment, observation, and documentation. Colonial interest in, and optimism about, continued well into the 1870s,

the curability of leprosy

the regime showing

itself highly

receptive to Indian trials of reputed therapies from other countries as well. In the early 1870s anti-segregationist medical policy advisers at Calcutta vested great hopes in a

leprosy

containment

policy

predicated on leprosy cure. The vigour of the

debate in mid and late nineteenth century

Europe on the cause of leprosy, was evidence of the on-going scientific transformation of European medicine, especially the rise of germ theory and the science of

bacteriology. The

serious leprosy

problem in Norway in the early 1800s, as also its progressive decline in the later decades, proved to be of crucial importance to medical perceptions of causation. The three main competing causation theories which provided explanations for the decline were based respectively on heredity, sanitation, and contagion. Each

theory became elevated

to the status of dogma by their respective proponents, many of whom were

influential and powerful figures in nineteenth century European

medicine.

The semantics

“contagion” -- whether

leprosy was

transmitted through healthy skin, by touching the leper -- was also crucial to

disagreement Literalists, such as the Royal College of

Physicians Leprosy Committee, and the Leprosy Commission tended to be sceptical

of contagionism, while laboratory scientists

such

Hansen did not differentiate between “contagion” and “infection”. The minimising of contagion by the Leprosy Commission set the tone of colonial anti-leper legislation in India.

Conclusion 291

While European debates had an echo in India, they were moulded in transmission by personal bias and ambition of interested persons, and the imperatives of colonialism. Of the three main theories, two, namely sanitarianism and contagionism came to

dominate

arguments in India in the late nineteenth century, while hereditarianism found support chiefly in mid-century. wrought a

Sanitarianism, which

had

public health revolution in Victorian Britain without

recourse to germ theories, had its disciples in positions of power in the Indian medical bureaucracy and the influential Royal College of Physicians in London.

Under these circumstances it is not to be

wondered at, that the most important scientific event in leprosy, namely the Norwegian discovery of the bacillus in 1873, was not appreciated

British

India, and even

discounted.

Bureaucratic

suspicions at Calcutta about the Norway-returned contagionist Carter, who harboured

ambitions of a leprosy commissionership, resulted in

two rival investigations into the disease. Predictably sponsored one returned a non-contagionist,

the Calcutta-

anti-segregationist result;

Carter’s field visit to the rural areas in Kathiawar convinced him that indeed, human to human transmission was a distinct possibility in leprosy. . Similarly, bacteriological discoveries played no part in the panic-mongering of the Times of India in 1889-1890, which owed all to its sensationalising of the death by leprosy of Father Damien.

Colonial Leprosy Policy Did the colonial Government have a leprosy policy? If the phrase “colonial policy” is considered to mean a well-considered plan of

action adopted by

the colonial

Government to contain

leprosy,

the answer is in the negative. Two perceptions about the leper played a dominant role in official responses, namely ‘leper-is-loathsome’ and ‘leper-is-danger’.

The latter perception, which

had the potential to Conclusion 292

inspire

public health legislation

and action

to limit the spread of

leprosy, could not be sustained. The most important reasons were the state’s belief that establishing, maintaining and running leper asylums were a drain on imperial funds, and the determination of educated and well-to-do Indians that lepers of their own social class be excluded from compulsion to enter asylums. The sheer size of the leper problem in India was also a consideration. It

was shown in Chapter 3 that

till well into the 1880s,

leprosy was thought to be a misfortune essentially of people, and though of great medical interest, Westerners.

indigenous

not dangerous to

Even so, systematic investigations into leprosy treatment

were encouraged by

the authorities, and

carried out under

their

sympathetic eye by medical men who were guided by interest as well as humanitarian feelings. In Chapter 2 it was shown that the laissezfairism about leprosy control was challenged by the contagionist and segregationist Carter. From

the outset this

researcher argued that

building of leper asylums and enforcing leper segregation would be proof of a benevolent and paternalistic colonial state. The state’s response under the advice of the anti-contagionist Cuningham, was to refuse to acknowledge

leprosy as a particular danger,

reject

leper

segregation outright, and eulogise leprosy treatment as the basis of a containment policy. This, the first

“policy” statement from the

authorities, was a reactive, not pro-active response to the contagionists demand. The manifest incurability of leprosy put paid to the hopes of anti-segregationists. The

‘leper-is-danger’ perception was

to the fore in the

late

1880s in the wake of the Damien episode (Chapter 6, “Perceptions, Attitudes and Anxieties”),

and the discomfiting

presence of

beggars in the streets of Bombay and other cities. The authorities responded with

leper

colonial

draft legislation (Chapter 5, “Laws and

Lepers”) in 1889 to incarcerate vagrant lepers for life in asylums Conclusion 293

and sexually segregate them. Such legislation if passed, would have become a dead letter, since it was to be a charge on cash-strapped, and reluctant local bodies. In 1895, re-drafted legislation by the central Government, and enacted in early 1898. Its target continued to be the lower social class of leper, including the vagrant, the artisan and the petty

trader.

This

development

owed

much

the

Leprosy

Commission’s rejection of contagionism and hereditarianism. (Chapter 4, “The Leper Censuses and their Uses”, and Chapter 5, “Laws and Lepers”), and its quixotic recommendation that nevertheless leprous vagrants and artisans needed to be institutionalised. Thus the

'leper-is-loathsome' perception, proved to be more

durable and potent. It explained the rationale of the first colonial legislation against

leper beggars in 1840,

the draft legislation of

1889, Bombay Act 6 of 1867, and the Lepers Act of 1898. (Chapter 5, “Laws and Lepers” and Chapter 9 “Mr. Acworth’s Home”).

It must

be concluded that the prime and unchanging anxiety of the colonial state through the century was to purge urban areas of offensive leper beggars. The rural leper was left out of purview of legislation, presumably because he did not offend wealthy city dwellers. Thus unlike the

aggressive

contagionism and racism behind

compulsory isolation of lepers in the United States, Canada and Hawaii,

shown in the studies by the historians Gussow and Kalisch,

the official position in India was firmly against draconian measures against Indian lepers. At the International Leprosy Congress, Phineas Abraham declared in defence of compulsory universal politically

fraught

the Government of India,

leper segregation

to be contemplated

that

in this

country was too

seriously,

especially at the

time of the plague epidemic.

Conclusion 294

Hindu Leper Laws in Colonial Courts This was considered in Chapter 5, â&#x20AC;&#x153;Laws and Lepersâ&#x20AC;?. The shastras

discriminated

against

several