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A summary of the treatment of people with leprosy in late 19th-century India, from the Medical History of British India collection.

In 1881, an estimated 120,000 leprosy patients existed in India, while the 1921 census estimated the total number of leprosy patients at 102,000. However, these figures are not representative of the actual number of leprosy sufferers, as throughout the colonial period the vast majority of leprosy sufferers remained outside institutional support and treatment.

Class distinctions

Leprosy is a chronic bacterial infection caused by ‘Mycobacterium lepraz’. It attacks mainly the superficial tissues, the skin and the peripheral nerves. If untreated, it can result in physical deformity such as muscular weakness and decay, and ulceration. Unlike other diseases which formed the focus of government legislation, leprosy was an endemic disease. The British Indian state’s involvement in regulating leprosy sufferers was marked not merely by concerns to prevent the spread of leprosy, but also by a desire to maintain social distinctions by preventing continual encounters between the British and Indian upper classes and leprous beggars.

Leprosy and segregation

Although the exact mechanisms for the communication of leprosy are still unknown, it is believed that the principal mode of transmission is by coughing and sneezing. In the early 19th century, it was believed that leprosy was transmitted principally by inheritance, though contagion was also seen as a possible means of transmission. G A Hansen’s discovery in 1873 that leprosy was caused by a bacillus, and the belief that leprosy could be transmitted by contagion, brought to the fore the issue of containment and confinement of leprosy sufferers as a means of managing the disease in colonial India. In India, H V Carter of the Bombay IMS, supported by the secretary of state, rose to prominence as the authority on leprosy. Inspired by the Norwegian experiment, Carter advocated similar legal and institutional measures to control leprosy in India. On the basis that leprosy may be transmitted by both methods, Carter advocated both the isolation of leprosy sufferers from society and segregation of the sexes. He proposed the establishment of a network of asylums in India similar to that in Norway which he so admired, and suggested that, in order to make isolation and segregation effective, legislation may be needed.

The discussion instigated between the provincial and central government in British India by the 1889 Leprosy Bill had ended in the decision by the centre that legislation to segregate all leprosy sufferers was not justified by the tenuous nature of the information leprosy transmission. The National Leprosy Fund was established on 17 June 1889 in recognition of the work of Fr Damien – a Belgian priest who cared for the victims of leprosy in Hawaii – by the Empire. The executive committee of the Fund appointed a Leprosy Commission to investigate leprosy and its contagiousness afresh in 1890. The commission reported that leprosy was not easily or efficiently transmitted. The extent to which leprosy was propagated by contagion and inoculation was found to be ‘exceedingly small’.

Restraints on sufferers

These findings were debated by authorities in India. Despite central reluctance to legislate the segregation of leprosy sufferers, provincial demands for such legislation were strengthened when the Bengal government passed an act for the segregation of paupers with leprosy, preventing leprosy sufferers pursuing particular employments and facilitating funding for maintenance of leprosy asylums. In response to these demands, the central government passed the Lepers Act of 1898, which provided legal provision for forcible confinement of leprosy sufferers in India. Implementation of measures restraining the employment of leprosy sufferers and their use of public transport and water facilities were left to the discretion of provincial governments.