The subject of leprosy is a large one, and it is not proposed to carry this study of it further at this time. On return to India, the author hopes to continue the study of leprosy in Poona District, and to make an effort to place the control of the disease on a better footing. From study of the land and the people, their habits, their diseases, their mental equipment, their means of subsistence, and the public resources available, some more satisfactory method of control of leprosy may emerge. The present position is in the highest degree unsatisfactory. For thousands of lepers in the District there exists one Leper Asylum and a few clinics, and only some 300 lepers at most are under control.
ROGERS, 1931, animadverts against compulsory
segregation as failing to stamp out or materially to reduce
the prevalence of leprosy among backward races within
a reasonable time. MUIR, 1932,(160), believes that
segregation in India could not possibly be carried our for
frightening patients "underground," and because of lack of
finance. On the other hand, we have seen the success which has attended strict measures of isolation and control
in Norway, (40) Withoug going further into the matter,
it is enough to emphasise that in Poona District segregation
of lepers has never been tried, strictly and efficiently, nor probably in any part of India, .and one would be better convinced of the truth of the opinions of ROGERS and of MUIR in this respect, if segregation or isolation had been tried. There is at least enough evidence, of its value to expect that one should "move heaven and earth," at least to give it a proper trial. Further, the problem of leprosy looks staggering when considered for the whole of India, but if one adopts a District as the unit of campaign, it does not look so hopeless. If one imagines the position of a state in
India, small, independent, caring for no man, which determines to essay the proper control of leprosy within its
borders, one cam visualise even success. Some degree of
ruthlessness in the control of the liberty of the subject,
and in the control of frontiers, and in the enforcement
of anti- leprosy laws, and in the expenditure of money,
would be demanded, but Norway has taught us that it can be done. Of course there are many difficulties:, but in India
it has never been tried.
In Poona District we have not even enough accommodation for the ordinary cure of the lepers who come to us. We are forced to treat 70 lepers in a clinic, because there is no room for them in a proper leper hospital. This position at least should be remedied, and if a modern leper hospital to contain 1,000 persons were built in Poona District, one is convinced that it would find occupants.
Finally, one would like to suggest the anti-leprosy
measures which need to be developed in Poona Districts:
(a) All measures to spread general education and literacy.
(b) Specific education about leprosy, among the people
and among the existing medical personnel.
(c) Increase in medical anti- leprosy staff.
(d) Visiting every town and village in the District, and enumeration of lepers by careful and even bacteriological methods of diagnosis; at the same time carrying out propaganda and instituting treatment centres.
(e) Building adequate leper hospitals: lepers require a great deal of ordinary medical care which at present is not possible, and there is a vast field in leper sugery alone.
(f) Concerting of measures which aim at the 'bonification'
of the people, as improvement of agriculture, housing, water supply, control of diseases, spread of knowledge of dietary and the like.
(g) If enough courage and enough money be obtainable,
securing in the end strict control and isolation
of all known lepers.