2. The medical perspective
3. The Indian perspective
3.1. Religious background
3.2. The “leper“ in public opinion
4. The British perspective
4.1. Governmental interests
4.2. The missionary enterprise
5. The leprosy asylum: Hospital or prison?
Even to modern scientists, certain aspects of leprosy1 such as its exact mode of transmission and point of onset remain a matter of research. How much greater the confusion in regard to leprosy must have been in colonial times, when Western medicine as we know it today was just beginning to evolve, is easily understood by looking at the many different, even contradictory attitudes towards the disease and the ways of dealing with its sufferers in British India. Using the example of the main institutions designated for the housing and the care of India’s “lepers“, the leprosy asylums, the many different motives and ideologies partaking in the medical, public and political discourse on this ancient disease shall be identified and discussed, seeking to show the many interconnections between colonial interests, public pressure, medical perspectives and missionary agenda. Did colonial intervention root in medical or rather pragmatic considerations? What religious ideologies nurtured the wish for the confinement of “lepers“? How much influence did Indian public opinion exert on the way leprosy was dealt with? This paper thus attempts to reveal the inner workings of the colonial state by looking at the many agents taking part in public health decisions and policies.
Academic literature offers a vast array of studies and articles concerned with the meaning of leprosy and leprosy asylums in the British Empire with a special look at the Indian context. Relevant information lies scattered about, and it is a goal of this paper to collect them and bring them in coherent form. Jane Buckingham provides perhaps the most comprehensive work of the social, political and medical implications of leprosy in the Indian context. Although her focus lies on the Madras Presidency, she presents a general picture of health politics in the colonial era, the case of leprosy therein occupying a special place. Sanjiv Kakar’s studies allow an in-depth look into the evolution of the leprosy asylums and the affected persons‘ response to it, while Lauren Wilks‘ article on missionary medicine focuses on the motivations behind and the impact voluntary Christian efforts exerted. Rod Edmond’s monography places the Indian case in the context of the rest of the British empire, revealing the country‘s leading role in terms of leprosy management.
This paper first takes a look at the medical perspective on leprosy throughout the 19th and early 20th centuries in order to provide the scientific framework within which to place and comprehend the subsequent sections. It will be shown that even medical opinion was not immune to external influences and manipulations. Afterwards, the Indian and the British attitudes towards leprosy and its sufferers will be dealt with by looking at their potential origins and consequences for the establishment and nature of the asylums. Lastly, the leprosy asylums themselves shall be looked at pertaining to the question if their functions and the conditions they provided for the patients respectively prisoners reflected the complex entanglement of factors discussed in the above sections.
2. The medical perspective
For a long time, the definition and description of leprosy was not consistent. Any particularly severe skin disease, be it in appearance or resistance to treatment, would be commonly termed as a form of leprosy2. James Dalton, a physician working in the Madras Presidency, first identified the distinctive characteristics of leprosy in 1811, decades before Danielssen and Boeck provided the foundational works on the disease in the 1840s3. While leprosy was thought to be a hereditary condition at the beginning of colonial reign, its contagiousness was recognized by the end of the 19th century.
However, the survey conducted by the Royal College of Physicians in the 1860s found that neither was leprosy transmitted via contagion nor was it likely to expand beyond racial and geographical barriers4. Compulsory segregation would thus not be justified. Its concluding report explicitly names the work of Danielssen and Boeck as its basis, thus blending in with the dominant medical perception concerning the hereditarian cause of leprosy prevalent in the mid-19th century5.
In line with then-current debates concerning the etiology of leprosy there was an ever-transforming handling of its sufferers in British India. Many colonial scientists assumed the cause of leprosy to be inherent in the Indian population, either because of certain rites and habits or because of the Indian blood itself. Convinced of the heredity of the disease, Henry Vandyke Carter6 argued that leprosy incessantly spread within certain castes due to the Indians‘ adherence to caste rules such as endogamy and exclusivity and was only present in the Caucasian sections of the population due to various historical events7. This “pathologizing of the Indian body“8 attests to Carter’s view on the Indian population through the prism of race and caste, doubtlessly shared by many of his colleagues9.
It was only the discovery of the Mycobacterium leprae in 1874 that set the ground for the acceptance of leprosy‘s bacterial causation and the abandonment of earlier exclusively environmentalist10 and hereditary explanations. Armauer Hansen’s groundbreaking discovery along with the acceptance of European vulnerability to the disease led to the increase of anxiety and ultimately to the perceived need for isolating its sufferers so as to prevent contamination11. After Father Damien succumbed to his leprosy infection in 1889 which he had contracted in a camp on Hawaii, the contagionist theory swiftly gained momentum both in the medical and lay perception. With this alarmed attitude towards leprosy came the popular demand for segregation and confinement of its sufferers, a demand only satisfiable by institutionalisation.
Finally, the International Leprosy Conference of 1897 held in Berlin12, comprising leading scientists from all over the Empire, supported the contagionists‘ stance and declared isolation of “lepers“ as the only means to prevent the spreading of the disease in order to ultimately extinguish it13.
“Every leper is a danger to his surroundings, the danger varying with the nature and extent of his relations therewith, and also with the sanitary conditions under which he lives. Among the lower classes every leper is especially dangerous to his family and fellow workers, but cases of leprosy frequently appear in the higher social circles.“14
This statement contains several important issues: First of all, it demonstrates the medical conviction that “every leper“ poses a threat, albeit to varying degrees. Moreover, it is acknowledged that poor sanitary conditions aggravate the danger. Lastly, the lower classes are deemed especially dangerous, although the existence of leprosy in higher classes is also acknowledged.
Contradictory to its widespread practice in both Western and Indian set-up institutions, confinement was not advocated, even argued against in the conclusions of the major medical investigations given that “under the ordinary human surroundings the amount of contagion which exists is so small that it may be disregarded, and no legislation is called for on the lines either of segregation, or of interdiction of marriages with lepers.“15 With these remarks the Indian Leprosy Commission, appointed in the wake of Father Damien’s death, truly did not have the finger on the pulse. General outcries and voices of rejection of certain sections of the report’s conclusion revealed the prevalent and deep-rooted belief that only by segregating and confining the “lepers“ their disease could be kept in check16.
Although no proof existed to corroborate this belief, Western medicine furthermore clung to the heightened contagiousness of leprosy sufferers in advanced stages until the beginning of the 20th century17 ; the fact that it was considered even higher when the patient suffered from open ulcers probably arises from instinctive revulsion, attesting anew to the not-always neutral medical view.
During the first decades of the 20th century, another major shift took place in the medical perception of leprosy; not only was the cause accepted as being of bacterial nature, but a promising treatment was developed that could possibly defeat the disease in an early stage. Thus, “the focus moved from confinement of patients in advanced stages to offering medicine to patients in the earliest stages.“18 On the eve of Indian independence medical authorities conceded that compulsory segregation had failed in its objective to help eradicate the disease from within the borders of the Empire. Indeed, this method even proved counter-productive in some instances, and could never, in the light of staggeringly high numbers of recently estimated cases, serve as the sole measure of control19.
Over time, “Western medicine had tacitly accepted the separation of leprosy from other illnesses, and its removal to the asylum, so that the asylum was able to develop as a medical site.“ By leaving religious notions of prohibiting sexual relations among “lepers“ unchallenged and agreeing to segregatory practices both through institutionalisation and sexual separateness within the asylums, the influence of Christian and public arguments becomes apparent20. Hence, the medical attitude was substantially subjected to non-scientific opinions regarding treatment of both the disease and those suffering from it.
3. The Indian perspective
3.1. Religious background
The dharmaśāstra contains several directions for the handling of those afflicted with leprosy. However, these directions, as is śastrik law in general, is only of relevance to the miniscule section of Hindu society, the Brahmins, who themselves would more often than not adhere to custom rather than Hindu law21. Manu’s code of law gives a detailed description of girls and women either recommended for marriage or to be avoided; among the latter are named those who come from families prone to leprosy22. In Hindu culture, leprosy was “still firmly believed to be the result of ‘sinful taint‘, the mark of bad action in a previous life.“23 The dichotomy of ritual purity and pollution is one of the defining aspects of Hinduism. In line with this, leprosy was perceived as evidence of severe pollution which greatly impacted the diseased’s social interactions on the family and community level. Hindu śastrik texts render those “lepers“ exhibiting ulceration quite vulnerable to social marginalisation as they prescribe outcasting and, along with that, loss of inheritance. Supposed ritual impurity, marked by caste affiliation, did not correlate with leprosy incidence of course; rather, it was the low economic position these castes most often than not find themselves in that rendered them more prone to the disease24.
Muslim law on the other hand appears in stark contrast to Hindu law as it is by far less exclusionary, yet it also required the family to support their leprous relative25. However, in the Sahih al-Bukhari26 (no. 5707) it is said that “one should run away from the leper as one runs away from a lion.“
When leprosy was actually perceived as a “divine blight“, medical treatment as provided in the asylum and the confinement within its walls itself would be deemed insufficient by the patient27. This might in turn have resulted in resistance to institutionalisation, yet to what extent remains unclear.
Evidently, there were instances of self-immolation by way of burning and burying alive of leprosy sufferers in Rajasthan28. Notwithstanding the Hindu belief that suicide constitutes a sin, leprosy seems to have been considered an exception29. Since only a few cases are reported, this practice appears to not have been widespread and thus does not necessarily reflect the Indian perception of leprosy, although its openness suggests a long tradition30.
3.2. The “leper“ in public opinion
Truth is, though, that these ancient Hindu prescriptions were rarely followed. Self-sufficient lepers received a much different treatment than the vagrant ones who resorted to begging as a means of survival; neither were they forcibly confined and separated nor shunned by the community. Even marriage contracts are known to have been forged between healthy young women and diseased older men, a practice that a British observer noted with disgust31. As soon as physical impairment rendered economic productivity impossible, the sufferer became an outcast. Socio-economic considerations thus weighed much more heavily than ancient prescriptions in Hindu law texts.
“In India is found an especial reason for denial in the stigma which attaches to an unmarried woman and to her parents – a fact which may partially explain a marked sex disproportion in the leprosy returns of the last three enumerations.“32
Whether it was precisely the disease or the stigma itself that prevented these women from marrying must stay an unresolved question. The social status of leprosy sufferers anyway varied widely among caste, region, sex, occupation and age.
Public opinion as represented by the masses is barely distinguishable from that of the elite, namely the middle and upper classes of society, seeing as the latter usually acted as spokespersons also on behalf of the former. Fact is, though, that they were quite vocal about their thoughts regarding leprosy, especially when the leprosy hysteria reached its peak in the 1880s and 1890s. Apart from publicly complaining of the presence of leprosy sufferers in the streets, though, they were also actively engaged in the construction of asylums from the 1870s onwards. There would not have been a single motive among Indian elite groups for supporting the establishment of leprosy asylums; some might have felt threatened and disgusted by the presence of leprous beggars on the streets, whereas others might have considered their placement in asylums an act of charity and goodwill. In view of their tradition of medical and charitable engagement, the Parsis of Bombay and elsewhere could be regarded as possibly having acted on the latter incentive. Nevertheless, academic literature apparently considers the first set of motives to be most common among the Indian elites. A pronounced class consciousness among Indian elite groups furthermore prevented a more balanced and, in today’s terms, fair treatment:
“Those of the lowest socio-economic level were perceived as having the least claim to liberty, those who were employed in menial, domestic or shop work as having greater claims and those who had sufficient wealth and status to remain in the home, away from public view, the greatest.“33
Even though they would object to the religious restrictions and the lack of observance of caste boundaries, Indian elites mostly accepted the nature of leprosy asylums as run by the British34.
Even in the few decades before independence, opinion by now established in medical circles could not dissuade the Indian public and the elites from adhering to the common misconception that those affected with leprosy posed a considerable threat35. Their influence becomes obvious when regarding the fact that British authorities were always heedful of the way political decisions might be taken by them. Such is expressed in the wording of LeFanu, a collector in Madras, who argued that “in the present state of public opinion“ it was “impolitic to extend the measure further so as to bring lepers of all classes within [the 1889 Leprosy Bill’s] provisions.“36
1 For the sake of decency as well as historical accuracy, this paper contains both the less laden word “leprosy sufferer“ and its 19th century counterpart, “leper“, although throughout written within quotation marks.
2 Buckingham, 2002, p. 8.
3 These two Norwegian scientists did pioneering research in the field of leprology. Their study “Om Spedalskhed“ (“On leprosy“, 1847) shaped the medical view on leprosy to a great deal throughout the 19th century. Norway in fact had been the only European country in which leprosy persisted on a large scale.
4 Cf. Edmond, 2006, p. 19.
5 Ibid., pp. 58f.
6 Chief medical officer in the district of Satara in the Bombay Presidency, 1831-1897.
7 Pandya, 2004, pp. 310f.
8 Ibid., p. 310.
9 Within this assertion resonates the belief in the superiority of “white races“ over “dark races“ of the tropics prevalent in this epoch. Only this would explain the lack of horror in the face of Norwegian leprosy compared to that generated by the existence of the disease among non-Europeans or those of non-European origin (cf. Pandya, 2003, p. 163).
10 Environmentalism is based on the assumption that bodies and diseases are inherently different from each other depending on the climatic conditions they stem from.
11 Cf. Edmond, 2006, p. 19.
12 Interestingly, British India had not sent a representative to partake in this conference. This puzzling circumstance might have been due to the replacement of leprosy as the “imperial danger“ with the plague that had entered into India from China a few years prior (cf. Pandya, 2003, p. 174).
13 Edmond, 2006, p. 19.
14 Isadore Dyer (1865-1920, American physician) reflecting the consensus reached at the Berlin conference, as cited in Robertson, 2009, p. 489.
15 Leprosy in India. Report of the Leprosy Commission in India 1890-91, 1893, p. 265.
16 Kakar, 1996, p. 219.
17 Kakar, 2006, p. 205.
18 Ibid., pp. 204f.
19 Rogers, 1946, p. 825.
20 Kakar, 2006, p. 194.
21 Buckingham, 2002, p. 31.
22 Manu, 3.7.
23 Buckingham, 2002, p. 104.
24 Ibid., p. 26.
25 Ibid., p. 31.
26 This collection of hadith belongs to the most highly esteemed works of Islamic tradition.
27 Kakar, 2006, pp. 200f.
28 Campbell, 1868, passim.
29 Jacob & Franco-Paredes, 2008, p. 1.
30 Campbell, 1868, p. 2.
31 Cf. Buckingham, 2002, p. 32.
32 Madras Census Report, 1911, p. 143, as cited in Buckingham, 2002, pp. 24f.
33 Buckingham, 2002, pp. 168f.
34 Kakar, 2006, p. 197.
35 Ibid., p. 206.
36 LeFanu as cited in Buckingham, 2002, p. 163.
- Quote paper
- Nejla Demirkaya (Author), 2014, Motives and Ideologies behind the Leprosy Asylums in British India, Munich, GRIN Verlag, https://www.grin.com/document/293784