CHAPTER 14: THE SEGREGATION OF LEPERS.
So far, I have said nothing concerning the growing demand for compulsory segregation of lepers. It is admitted on all sides that the forcible deportation and confinement of well-to-do lepers would be impracticable, and already there are too many laws which are cruel and oppressive to the poor, but which, by the wealthy, are easily evaded. So far as the well-to-do are concerned, the law of enforcing segregation of lepers at Molokai, as I have already shown, is an admitted failure, and the act of separation of the poor from their friends is the most heart-rending and painful experience which, in a tolerably long life, I have ever witnessed.
In the "Report on Leprosy by the Royal College of Physicians, 1862," I find the following:—" The Committee, having carefully considered the replies already received, are of the opinion that the weight and value of the evidence they furnish is very greatly in favour of the non-contagiousness of leprosy. The Committee can only repeat the statement made in their former report to the College, that the replies already received contained no evidence which, in their opinion, justified any measure for the compulsory segregation of lepers." Acting on this opinion, the Duke of Newcastle issued a circular to the Governors of the Colonies, stating "that any laws affecting the personal liberty of lepers ought to be repealed, and any action of the Executive Government in enforcement of them, which is merely authorised and not enjoined by the law, ought to cease."
Dr. George L. Fitch, formerly Medical Superintendent, Leper Settlement, Molokai, Hawaii, says :—" Segregation began in 1866 in Hawaii, and since that time has been followed out with a really brutal severity. At no time since the inauguration of the system has the proportion of cases segregated fallen as low as one-half, so far as I could find out, and I had the fullest opportunity to know of any one. The white population there are terribly in earnest, and, as they control the policy of the country, they have exercised every ingenuity in this matter, so that it may be considered certain that an average of two-thirds, at least, have been for the entire period under a restraint much more pronounced than is the case in Norway. Yet there is not the slightest evidence that the disease has decreased; at least, I know of no such evidence. From all I hear from there, the proportion of lepers continues as great, if not greater, than it has been for years. That the disease does not manifest as severe symptoms as formerly is certain, but I know of no reason to believe that the percentage of those afflicted has lessened at all. On the contrary, both the total number, and the proportionate number of cases, would seem to have steadily increased. . . . Of late years, so bitter a feeling has grown up among them in opposition to segregation, that in quite a number of instances the lepers and their friends have risen in arms to resist the officers sent to apprehend them. . . . Bring these three facts together. In India, up to 1815, lepers were buried alive to get rid of them; and still the disease persists. In Norway the disease is disappearing without segregation, for putting two cases out of five into hospitals, where they are allowed to carry on their handicrafts, and selling the products to those outside, cannot be called segregation. In Hawaii, where as thorough segregation as the Government, aided by public opinion, can enforce, is carried out, the disease steadily increases." — New York Medical Record, September 10, 1892. Art., "Etiology of Leprosy," p. 301.
Dr. George Thin, in his recent work on "Leprosy," though an advocate for the seclusion of lepers, shows himself alive to the difficulties of compulsion. In pp. 257-8 he says : —"A law enforcing the compulsory isolation of lepers can only be effective in any country where leprosy is common, if it is strongly supported by public opinion. Those who have little practical experience of lepers and leprosy must not forget that for a considerable time, and often for years, the stricken member of a family suffers comparatively little, requires little attention, is not specially repulsive in appearance, is as full of love for his parents and brothers and sisters, and in return is as much loved by them, as if he were not afflicted by the disease. To realise what compulsory isolation in an asylum of all the lepers in a country would mean, when such cases are considered, it is only necessary to apply in imagination the same law to consumptives when their disease runs a slow insidious course. What would the consequences be in England if a law were passed that every husband, or wife, or child, who developed a slight cough, attended with weakness, and in whom slight physical changes were detected in the apex of one lung, should, on the strength of what his probable fate would be several years afterwards, be immediately and forcibly conveyed from his family with no, or scarcely any, hope of’ ever again rejoining them? Imagine the evasion, concealment, and subterfuge that would be practised, and the difficulty, if not impossibility, of passing a law which would be effective! As a matter of fact, already, and with no compulsory isolation, in all but the very poor, leprosy is in most countries concealed as long as it is possible."
A medical practitioner who has resided several years at Honolulu and Molokai informed me that he personally knew of a number of well-to-do lepers, some occupying prominent positions, including several Europeans, who from political and other influences with officials of the Government were allowed to be at large, and it was not intended to disturb them. Nor is it considered possible to amend this partial method of dealing with the difficulty, especially as the natives do not believe in contagion. At the Leper Asylum in Ceylon, as also in the West Indies, I found that only the poor were segregated in the lazarettos, and in every country I have visited, the compulsory segregation of all lepers is considered impracticable. Moreover, the experience in Hawaii has been the reverse of encouraging. Mr. R. W. Meyer, agent of the Board of Health at the Leper Settlement, Molokai, in his report dated April, 1886, observes that segregation has now been practised for twenty years, and the result is that there are as many lepers as ever; more than at the commencement.
In an article in The Lancet, August 26, 1882, p. 318, commenting on a report on leprosy in Hawaii, and referring to the segregation of lepers, the writer says: "Nothing can, we think, call for action such as is described in certain parts of the report, and which has also called forth a protest by the Assistant Attorney-General of the kingdom. This gentleman describes how people supposed to have leprosy have been taken summarily from their houses by the police authorities, and have, without a moment’s preparation, been ordered into boats, and conveyed across to one of the island settlements, where, as he says, they, are practically doomed to death."
That compulsory segregation cannot be carried out save by setting aside every humane feeling is admitted by those who are familiar with its operation. Thus,. in his official report to the Board of Health, Honolulu, Mr. R. W. Meyer observes: "After the most careful consideration, I find that this is a question which involves a great principle, and which duty to oneself and his fellow-men alone should decide; a question which demands the absolute setting aside of every influence resulting from a feeling of sympathy with the unfortunate sufferers."
In the "Report of the Select Committee on the Spread of Leprosy in South Africa" I find the following:--
Q. 52. "Do you believe there will be much difficulty in compulsorily removing these people ?"—"Yes, there will be great difficulty They will do what they can to conceal cases. They will steadily deny that any one in the house is affected by the disease I have found the most undoubted and notorious cases denied. They have a great aversion to remove. Most of them are married, and, in addition to the natural repugnance at parting from their wives, their sexual passions are particularly strong—in fact, they become, both mentally and physically, a lower type."— Witness, Dr. H. C. Wright, June 27th, 1889, District Surgeon at Wynberg.
Q. 92. "Take the case of a respectable man, educated and intelligent, would you separate him from his wife and family and remove him from his home?"—" I am afraid there is no help for it."— Witness, Dr. Simons, District Surgeon of Malmesbury, July 4th, 1889.
Q. 192. "I think that husband and wife should be separated, and that is a hard case, but necessary."— Witness, Dr. Beck, of Roudebosch, July 4th, 1889.
LEPROSY REPRESSION ACT.
Under this heading, the Cape Times of April 22, 1892, gives the following :—
ACT OF 1884 TO BE ENFORCED.
The Government have decided to promulgate the Leprosy Repression Act of 1884, and as at present decided the enforcement of the provisions of the Act will take place during the ensuing month. This action has doubtless been suggested by the disclosures of the census of a year ago, when the number of lepers in the Colony and the Transkei was shown to be 625—at least double the number casually reported from the various districts of the Colony. Since the taking of the census the number of know lepers has been increased to 664, and the promulgation of the Act will therefore necessitate the immediate provision of accommodation for the large number of sufferers who are still at large. The following will show the distribution of lepers in and out of hospital at the date of the census, in April, 1891 :—
IN HOSPITAL.
The Colony proper, as constituted in 1875: European or white, 21 —I4 males and 7 females; other than European, 97 ;—77 males and 20 females.
OUT OF HOSPITAL.
The Colony, as constituted in 1875: Europeans, 30 ;—15 males and 15 females; other than Europeans, 256 ;—130 males and 126 females. Province of Griqualand West: Europeans, nil; other than Europeans, 17 ;—males, 12; females, 5. Transkeian Territories: Europeans, nil; other than Europeans, 204 ;—118 males and 86 females.
ROBBEN ISLAND.
A special report upon the lepers and accommodation for such upon Robben Island shows that, excluding the 54 coloured sufferers recently received from the Orange Free State, the number now on the Island is 162, of whom 16 are Europeans and 146 coloured persons. There are therefore over 500 lepers in the Colony, Griqualand West, and the Transkei still to be provided for. It is interesting in this connection to note that during the past year no fewer than 139 persons have voluntarily sought refuge within the leper wards of Robben Island Hospital. Of these 85 were males, 6 being European and 79 coloured persons. The European females admitted number 3 and the coloured females 51. During the same period 1 coloured male and 1 coloured female have been discharged from the island, whilst there have been 29 deaths, viz. Five European males and 16 coloured males, and 8 females, 1 white and 7 coloured. In view of the demand for accommodation, which will arise upon the promulgation of the Leprosy Repression Act, the wards at Robben Island are being largely extended, and we are informed that by the end of May the leper hospital will be completed and provision made for all the lepers known to exist in the Colony and the Province of Griqualand West. The Transkeian lepers, all of whom are coloured, will be centred at Engoobo, where a large asylum is now in course of construction.
The Leprosy Repression Act has since been promulgated in Cape Colony, and a systematic hunt for lepers has been carried on with the usual distressing concomitants—separation of parents from children, husbands from wives, friend from friend. A considerable number of lepers are in close concealment, carefully hidden by their friends. The well - to - do lepers have not been molested.