in
is an evident the results which the Commissioners claim to have attained and their ancestors. of
source
This,
itself,
fallacy and explains
their divergence from the results obtained elsewhere. Every one much acquainted with
leprous
families is
aware
of the reticence of the
affected regarding their family history, and the reluctance with which any such admissions are made. Dr. Hillis of Demerara, remarks similar difficulties encountered in the West Indies where
dudian JjfUdiflHl USasqttq. SEPTEMBER REPORT
OFaTHE
no
1893.
LEPROSY COMMISSION
:
and
hereditary
motives for concealment existed.
ourselves have experienced the same difficulty in eliciting information from patients
HEREDITY.
The Commissioners
religious
Dr. Valence of Mauritius, mentions how it took him 15 years to trace out some of his cases ; the medical men in the Hawaian Islands, in fact wherever leprosy prevails, tell the same story, we
approach the question ofregarding their parents leprosy, not so much other reliable sources to
transmission of
whom
we
knew from
be well-marked
lepers. from the scientific side as from a consideration It is curious that it did not strike the Commisof the social results, which may possibly accrue sion that an enquiry such as theirs, extending at should leprosy be proved to be hereditary. most over a few months and in a country like Owing to this evident tendency to prejudge the India, where and
question,
too much stress is at times laid
on
one
intelligence
veracity
the
among
lepers they permitted to see are not set of facts to the exclusion of others which jwe conspicuous might readily lead to conclusions not cannot but consider of at least equal importance. in consonance with those of men who have deIn a scientific enquiry it is most essential to voted their lives to the investigation. It apconsider the facts in all their bearings, and come pears to us that apart from this there is a general
to conclusions
independently
of outside consi-
tendency
were
in the
report
to
derations which may appear harsh and so warp sufficient data and to give the judgment. For this reason the introducevidence.
dogmatise without
scant
consideration
to
Probably this is unintenantagonistic tion into the argument of possible necessity of the value of the report from but it detracts tional, enforced separation of husband and wife or The very important conclusion at which the Cominterdiction of marriage is to be deprecated. mission have arrived that "leprosy in India canThere is also a want of precision in the terms not be considered an hereditary disease,?and which are used in the report. The words " acwould even venture to say that the evidence they " " quired and " contracted the disease can only which exists is hardly sufficient to establish ah mean manifested or evidenced the disease, beinherited specific predisposition to the disease by cause, if the former terms are to be taken in their the offspring of leprous parents to any appreciliteral sense, then the Commission at times as- able degree,?" is one which requires the most sume that which ought to be proven. Nor do careful scrutiny. It is unnecessary to enter into we think that the Commission, in dealing with the argument by which the Commissioners contend this section of the report, have sufficiently ap- that both hereditary transmission and hereditary preciated the difficulties under which they were predisposition, as held by Liveing Dauielsen and labouring in their enquiry into hereditary inCarter and fluences
the 2,000 cases of leprosy they The short time which they had to
affecting
examined. devote to the
investigation
has
already
luded to. Then there is the undoubted leprosy is considered by the Hindus as
been al-
fact,
that
a divine visitation for heinous crime more particularly incest, and consequently there is in all cases a
repugnance
to
attribute any such disease
to
Lewis
Boeck, Virchow, Vandyke
existence ; but Cunningham it will be sufficient here to remark that the deduction drawn the Commission from the fact that and
have
uo
specific
by
leprosy occasionally skips a generation, namely, that it speaks strongly in favour of a more general than specific form of inheritance, and hence also for the possibility that a nou-tubejs
"
40
INDIAN MEDICAL GAZETTE.
310
cular may
OL*
lion-leprous
cause
sary
the
for the
leprosy,
as
the
condition
predisposition
of the
in the child
parent neces-
development of tuberculosis or case may be," is one with which
[Sept.
the number and proportion of blood relations and found that about 20 per cent, of lepers acknowledged a family taint. In 14-5 per cent, of these, however, the taint was in the collateral included in these 14*5 it may be submitted that with so much admixture of alien blood little can be deduced line.
As cousins
entirely disagree, inasmuch as the well-known laws of reversional heredity fully explain these percent., we
phenomena. It is to be noted that this same fallacy of completely setting aside reversional
1893.
are
I from the figures/' Thus in referring to the table the Commissioners heredity underlies the whole of their argument make the curious mistake of quoting not Dr. The way in which the 011 heredity in leprosy. Carter's ascertained results from that Commission dismiss Atavism as not worthy of Vandyke that 64'2 per cent, of hereditary lepers notice is a serious error in their investigations. table, viz., showed heredity in the direct line, 145 per cent, that the Comhave
We should hardly
expected
mission would have relegated the well-established facts of reversional heredity to the province of "biological speculation." Probably they would
line, and 21*3 per cent, in the line of brothers and sisters ; but they
in the collateral
co-equal
statement made
Dr.
Vandyke Carplace lepers in place the Atavistic appearance of haemophilia in the that Bombay Presidency, only in the same class. The Commission state that a general about 20 per cent, of lepers acknowledged the a child at the time of case was never seen leprous taint. They are also in error in stating that of birth or so shortly afterwards that it ought ,14*5 per cent, showing a collateral heredity are fairly be considered a congenital case. The included in the 20 per cent. These statements Commission have evidently overlooked the inso are utterly misleading that we think it stances given by Dr. Hillis, who quotes the Lepon us to append the table in incumbent of Physicians, question rosy Report of the Royal College the error into which the Commissioners to show in which are particulars given page 70, No. 32, have fallen, and which, in our opinion, invalidates of a child born of leprous parents having tubertheir conclusions. cules at birth. Again, in the same report (p. 102), Number and proportion of blood relations likewise affected another case is given of a child in arms born of who were mentioned by 1,561 individual lepers. a Direct Line. leprous mother and having tubercular leprosy. Number. Per cent. Other instances are given by Dr. Hillis of chil684 Father and others 43 8 "
"
quote the
/
dren with
well-marked symptoms
at two years of
by
with reference to
ter in another
...
...
Mother and others... Parents and others Grand parents
age. After
...
...
...
claiming to have settled the question of congenital leprosy in the negative, the Commissioners proceed to enquire into the frequency with which it is possible to trace a family taint
jn the direct line from parent to offspring, stating as a premise that if the facts available with regard to family taint in the direct line be not sufficient to establish inheritance then d. fortiori arguments from collateral relationship must be altogether without force. We shall show, however, that the facts available are amply sufficient
to establish inheritance in the direct line. In of their the argument Commissioners pursuance
....
197 70 53
1,004
12-6 4 4 34 64-2
Collateral Line. 226 &c.
14-5
Co-equal Line. Brothers and sisters 331
21-3
Uncles, aunts,
...
...
...
1,564
100-0
We must urge the conclusion to which this table leads with regard to family taint in the di-
line, and point out that a percentage of 64 is large as to afford ample and convincing proof
rect so
of direct of
heredity, being
as
it is
the outcome
careful and exhaustive
analysis of over 1500 acknowledged cases of hereditary leprosy. With refer to the results obtained by Dr. Vandyke regard to Tables I and II, these results would be Carter in Bombay in the following words: satisfactory if only the statements of lepers, uuwho collected Vandyke Carterf, informa, supported by other evidence, could be relied upon. tion from all parts of the Bombay Presidency, We have already stated that Hindus invariably gives a most careful and exhaustive table showing deny leprous taint. That the statements are not a
is an evident the results which the Commissioners claim to have attained and their ancestors. of
source
This,
itself,
fallacy and explains
their divergence from the results obtained elsewhere. Every one much acquainted with
leprous
families is
aware
of the reticence of the
affected regarding their family history, and the reluctance with which any such admissions are made. Dr. Hillis of Demerara, remarks similar difficulties encountered in the West Indies where
dudian JjfUdiflHl USasqttq. SEPTEMBER REPORT
OFaTHE
no
1893.
LEPROSY COMMISSION
:
and
hereditary
motives for concealment existed.
ourselves have experienced the same difficulty in eliciting information from patients
HEREDITY.
The Commissioners
religious
Dr. Valence of Mauritius, mentions how it took him 15 years to trace out some of his cases ; the medical men in the Hawaian Islands, in fact wherever leprosy prevails, tell the same story, we
approach the question ofregarding their parents leprosy, not so much other reliable sources to
transmission of
whom
we
knew from
be well-marked
lepers. from the scientific side as from a consideration It is curious that it did not strike the Commisof the social results, which may possibly accrue sion that an enquiry such as theirs, extending at should leprosy be proved to be hereditary. most over a few months and in a country like Owing to this evident tendency to prejudge the India, where and
question,
too much stress is at times laid
on
one
intelligence
veracity
the
among
lepers they permitted to see are not set of facts to the exclusion of others which jwe conspicuous might readily lead to conclusions not cannot but consider of at least equal importance. in consonance with those of men who have deIn a scientific enquiry it is most essential to voted their lives to the investigation. It apconsider the facts in all their bearings, and come pears to us that apart from this there is a general
to conclusions
independently
of outside consi-
tendency
were
in the
report
to
derations which may appear harsh and so warp sufficient data and to give the judgment. For this reason the introducevidence.
dogmatise without
scant
consideration
to
Probably this is unintenantagonistic tion into the argument of possible necessity of the value of the report from but it detracts tional, enforced separation of husband and wife or The very important conclusion at which the Cominterdiction of marriage is to be deprecated. mission have arrived that "leprosy in India canThere is also a want of precision in the terms not be considered an hereditary disease,?and which are used in the report. The words " acwould even venture to say that the evidence they " " quired and " contracted the disease can only which exists is hardly sufficient to establish ah mean manifested or evidenced the disease, beinherited specific predisposition to the disease by cause, if the former terms are to be taken in their the offspring of leprous parents to any appreciliteral sense, then the Commission at times as- able degree,?" is one which requires the most sume that which ought to be proven. Nor do careful scrutiny. It is unnecessary to enter into we think that the Commission, in dealing with the argument by which the Commissioners contend this section of the report, have sufficiently ap- that both hereditary transmission and hereditary preciated the difficulties under which they were predisposition, as held by Liveing Dauielsen and labouring in their enquiry into hereditary inCarter and fluences
the 2,000 cases of leprosy they The short time which they had to
affecting
examined. devote to the
investigation
has
already
luded to. Then there is the undoubted leprosy is considered by the Hindus as
been al-
fact,
that
a divine visitation for heinous crime more particularly incest, and consequently there is in all cases a
repugnance
to
attribute any such disease
to
Lewis
Boeck, Virchow, Vandyke
existence ; but Cunningham it will be sufficient here to remark that the deduction drawn the Commission from the fact that and
have
uo
specific
by
leprosy occasionally skips a generation, namely, that it speaks strongly in favour of a more general than specific form of inheritance, and hence also for the possibility that a nou-tubejs
"
40
INDIAN MEDICAL GAZETTE.
310
cular may
OL*
lion-leprous
cause
sary
the
for the
leprosy,
as
the
condition
predisposition
of the
in the child
parent neces-
development of tuberculosis or case may be," is one with which
[Sept.
the number and proportion of blood relations and found that about 20 per cent, of lepers acknowledged a family taint. In 14-5 per cent, of these, however, the taint was in the collateral included in these 14*5 it may be submitted that with so much admixture of alien blood little can be deduced line.
As cousins
entirely disagree, inasmuch as the well-known laws of reversional heredity fully explain these percent., we
phenomena. It is to be noted that this same fallacy of completely setting aside reversional
1893.
are
I from the figures/' Thus in referring to the table the Commissioners heredity underlies the whole of their argument make the curious mistake of quoting not Dr. The way in which the 011 heredity in leprosy. Carter's ascertained results from that Commission dismiss Atavism as not worthy of Vandyke that 64'2 per cent, of hereditary lepers notice is a serious error in their investigations. table, viz., showed heredity in the direct line, 145 per cent, that the Comhave
We should hardly
expected
mission would have relegated the well-established facts of reversional heredity to the province of "biological speculation." Probably they would
line, and 21*3 per cent, in the line of brothers and sisters ; but they
in the collateral
co-equal
statement made
Dr.
Vandyke Carplace lepers in place the Atavistic appearance of haemophilia in the that Bombay Presidency, only in the same class. The Commission state that a general about 20 per cent, of lepers acknowledged the a child at the time of case was never seen leprous taint. They are also in error in stating that of birth or so shortly afterwards that it ought ,14*5 per cent, showing a collateral heredity are fairly be considered a congenital case. The included in the 20 per cent. These statements Commission have evidently overlooked the inso are utterly misleading that we think it stances given by Dr. Hillis, who quotes the Lepon us to append the table in incumbent of Physicians, question rosy Report of the Royal College the error into which the Commissioners to show in which are particulars given page 70, No. 32, have fallen, and which, in our opinion, invalidates of a child born of leprous parents having tubertheir conclusions. cules at birth. Again, in the same report (p. 102), Number and proportion of blood relations likewise affected another case is given of a child in arms born of who were mentioned by 1,561 individual lepers. a Direct Line. leprous mother and having tubercular leprosy. Number. Per cent. Other instances are given by Dr. Hillis of chil684 Father and others 43 8 "
"
quote the
/
dren with
well-marked symptoms
at two years of
by
with reference to
ter in another
...
...
Mother and others... Parents and others Grand parents
age. After
...
...
...
claiming to have settled the question of congenital leprosy in the negative, the Commissioners proceed to enquire into the frequency with which it is possible to trace a family taint
jn the direct line from parent to offspring, stating as a premise that if the facts available with regard to family taint in the direct line be not sufficient to establish inheritance then d. fortiori arguments from collateral relationship must be altogether without force. We shall show, however, that the facts available are amply sufficient
to establish inheritance in the direct line. In of their the argument Commissioners pursuance
....
197 70 53
1,004
12-6 4 4 34 64-2
Collateral Line. 226 &c.
14-5
Co-equal Line. Brothers and sisters 331
21-3
Uncles, aunts,
...
...
...
1,564
100-0
We must urge the conclusion to which this table leads with regard to family taint in the di-
line, and point out that a percentage of 64 is large as to afford ample and convincing proof
rect so
of direct of
heredity, being
as
it is
the outcome
careful and exhaustive
analysis of over 1500 acknowledged cases of hereditary leprosy. With refer to the results obtained by Dr. Vandyke regard to Tables I and II, these results would be Carter in Bombay in the following words: satisfactory if only the statements of lepers, uuwho collected Vandyke Carterf, informa, supported by other evidence, could be relied upon. tion from all parts of the Bombay Presidency, We have already stated that Hindus invariably gives a most careful and exhaustive table showing deny leprous taint. That the statements are not a
