International Leprosy Association -
History of Leprosy

  • International Leprosy Association -
    History of Leprosy


    Dr P Kapoor

    Status Physician
    Country India


    Dr P Kapoor, ‘An Autobiographical Sketch’, from S S Naik (ed) The Indian Leprologists Look Back. Bombay, 1990. pp. 77-81.

    I was born a healthy baby in the early hours of October 3, 1921 in Amritsar. I won the healthy baby competition award! When I was hardly 5 years old my father migrated to Calcutta and became a permanent resident of Calcutta. I studied in a Bengali school with English medium. I was a good athlete in school days. was more interested in sports than studies. In Class IX, I was a mediocre student but a good athlete. While in Class IX (pre-matric) I became interested to become a doctor and therefore had to study more to get high marks to get admission in a good science college and thereafter in medical college. The studies were done more regularly but not at the cost of sports. I played most of the outdoor games, basketball, football and cricket and hockey. I passed the Matric examination in the First Division, and joined St. Xavier’s College, Calcutta. I passed the Inter Science examination and stood 49th in the University. I got admission in the Calcutta Medical College in 1940 and passed the MBBS examination in 1945. For two years I was the recipient of a merit scholarship. I was always a good student. I played hockey for Mohun Bagan in the First Division. I was a member of the Medical College team in cricket, football and rowing.

    I had a few good friends who were very studious. They revised the subjects in my presence. This helped me intensively. My study hours in the holidays were 10 p.m. to midnight. Sports taught me about losing the game gracefully, coordination and cooperation. These qualities helped mc immensely in my professional career in later years.

    I was interested to do post-graduation in skin diseases. After graduation……I was house physician in 1945 in Pediatrics for 6 months. Later I applied for a house job in the skin department and was selected. Dr. Dharmendra was at that time the Head of the Department of Leprosy, School of Tropical Medicine, Calcutta. BELRA (HKNS) was granting a scholarship of Rs. 250/- to doctors interested to learn leprosy and willing to work in leprosy.

    Dr. Dharmendra was a family friend of my brother-in-law, and I used to meet him frequently. One day in mid-1947, when the post against the scholarship fell vacant, Dr. Dharmendra casually asked me whether I would be interested to join the leprosy department and learn the subject. After a few days he asked me to write an application for the same. No conditions were attached for the selection. I was free to continue work or not in the held of leprosy after the tenure. I applied as suggested by Dr. Dharmendra and was selected as being the only applicant. I joined the School of Tropical Medicine in October 1947. The scholarship was initially for one year - it was extended by another year. So for 2 years I was at the School of Tropical Medicine under Dr. Dharmendra and, Dr. S. N. Chatterjee, the 2 giants in the field of leprosy those days. During the 2 years of my work in the School of Tropical Medicine I learnt leprosy in all its aspects from Dr. Dharmendra. Dr. S. N. Chatterjee and Dr. N. Mukerjee.

    Dr. Chatterjee was looking after the clinical side, and Dr. Mukerjee was looking after the laboratory side of the Leprosy Department. He was also helping Dr. Dharmendra in the publication of Leprosy in India as Dr. Dharmendra being the Editor.

    This period was of Chaulmoogra treatment. That was the time when the patient of leprosy was always a patient of leprosy. There was too much of stigma attached to leprosy. Not only the leprosy patients were ostracised, but also those working in the leprosy field.

    At the school of Tropical Medicine I came in contact with Dr. P. Sen and Dr. K. R. Chatterjee. The miseries of leprosy patients were not effectively visible in the OPD of the School of Tropical Medicine. I had the opportunity to work for a good time in the Leprosy Asylum, Godhra. Calcutta. The miseries of Leprosy patients were seen there. I was very much moved by their sufferings particular chronic ulcer and painful neuritis, and their sufferings at the hands of friends and relatives. This reminds me of the great novel “One Who Walks Alone”.

    This period was also of great historical interest in leprosy. Sulphones were being tried in the treatment of leprosy…. Promin by the intravenous route, Sulphetrone tablets, Sulphetrone injections and in 1949 Dapsone. I was associated with these therapeutic trials. Working with Dr. Dharmendra and, Dr. Chatterjee and Dr. Mukerjee made me research-minded. I came to understand what research work was. I would be failing if I do not express my gratitude, if I don’t mention that Dr. S. N. Chatterjee taught me the clinical side of leprosy, the methods of examination, writing the notes, periodic examinations etc. etc. He taught me not only by words and lectures, but by practical demonstrations in the beginning, and by correcting my notes on patient cards later.

    I learnt from him, “One hand, for the patient, and the other for oneself.” With this technique there was no need to wash hands frequently. I mentioned earlier about the stigma in, and the ostracism of those working in leprosy, because I feel the fears of those who did not like to work in leprosy. I have never felt ostracised nor have I seen anyone working in leprosy having been ostracised.

    Principal Contributions…

    I feel that my principal contributions are

    (1) To introduce the treatment of leprosy patients in all Government and Municipal Hospitals, Dispensaries, Primary Health Centres in Maharashtra. It was no easy task. I had to face many obstacles for its success. I would not have been successful if I did not have the full support or active encouragement of the higher-ups, ministers, secretaries, the Surgeon-General, Director of Public Health, later the Director of Health Services, and also the sympathies of the Professors of Medicine, Surgery and also the Civil Surgeons.

    The maximum opposition came from some of the senior dermatologists. But by divine grace and patience, hard work and determination I was successful, and Maharashtra could boast of this achievement.

    (2) The second contribution may be said to be the preparation of the “Guide to Leprosy Control” by the Ministry of Health. The guide was prepared by a team of experts headed by Dr. Dharmendra. I was a member of this team along with other specialists, some of them being Dr. Wardekar, Dr. Ekambaram and Dr. Khoshoo. My main contribution in this work was regarding the forms, registers and patients’ cards.

    (3) The third contribution was in the study of the epidemiology of leprosy. I worked out the Taluka-wise, district-wise prevalence rates of leprosy in Maharashtra. I also studied the sex ratio, lepromatous rates, infection amongst contacts of lepromatous and non-lepromatous patients.

    While studying these features it was observed that places with higher leprosy prevalence rates and had lower lepromatous rates and vice versa. It was also observed, that the child prevalence rate was higher in the high prevalence rate districts. Other interesting observations were that leprosy was most unevenly distributed not only in the State, but within the Taluks also. In the low endemic area there were pockets of villages, of high prevalence rates, pockets of no leprosy case villages in the high endemic areas. The reason for this could not be studied. The mystery remains unsolved even today.

    The other contributions were in the field of sample survey techniques for monitoring the on-going programmes and the methods of planning. Maharashtra state had the unique distinction that voluntary organisations in leprosy work in full cooperation and coordination with the Government. A healthy relationship can be seen between the two even today.

    As I look back upon the achievements stated above, I feel that, that was possible became of the understanding I had developed with all social workers. Here I must record my gratitude to all those particularly Drs. Figueredo, Wardekar and great social workers, Shiwajirao Patswardhan, Diwanji and Baba Amte and S. D. Gokhale. Today I do not remember the others though there were many more.

    The other major contribution is writing a small practical book Guide to Leprosy and Leprosy Control with the cooperation of Dr. J. M. Mehta, President of the Poona District Leprosy Committee, and Mr. M. S. Mehendale, The third revised edition is published. The book has been very well received all over India.

    Professional Life as a Leprologist……

    I feel this question is redundant as far as I am concerned I was not only a leprologist but also an administrator and a planner. My work was not in any one institution and not in any one aspect of leprosy. Right in the beginning of my service career as a State Leprosy Officer I was tuned and trained by the Surgeon General of Bombay to be a Public Health Administrator. I was given many tasks by the Surgeon General which had nothing to do with leprosy. I did all these with great pleasure and dedication. This brought me in contact with all those who worked in the medical department and also those in the Public Health Department. This gave me an opportunity of seeing leprosy as one of the many health programmes. It needed attention only because it was a neglected subject. I successfully integrated leprosy in to the total health program in me to a great extent. With leprologists I was a leprologist, and with others I was a technical public health administrator. I got the best out of both worlds.

    I was a member of the leprosy expert committee of the Indian Council of Medical Research. Twice I was a member of the expert committee on Epidemiology and Leprosy Control of the International Leprosy Congress in 1973 and 1984. I feel I played a useful and constructive role in the proceedings of those committees.

    During my tenure as the President of the Indian Association of Leprologists, a seminar was organised on the Classification of Leprosy, a much debated subject, a subject where unanimity is not possible. For the first time a Consensus Classification was adopted in it as it is followed these days.

    Changing pattern of Leprosy……

    I am associated with leprosy work since 1947, when the sulphone drugs were not the main line of treatment. It was only being tried on an experimental basis. In the early 1950s, I introduced sulphetrone tablets in all leprosy hospitals in Maharashtra. Most of the medical colleges were also supplied sulphetrone tablets. In the middle of the 1950s leprosy subsidiary centres were started as a National programme. The work was on a trial basis. The drug to be used was dapsone. The response from the patients was very good… And before an evaluation of the Leprosy Subsidiary Centre was done, a rapid expansion of the LSCs started coming up. During this time dapsone tablets were introduced in all leprosy hospitals, medical colleges, and some civil hospitals in Maharashtra State. I was a member of she expert committee of the Government of India and also the member-secretary of the rehabilitation committee of the Government of Maharashtra. I was always one of the active members of all committees to suggest ways and means to improve the working of SET centres, LCUs etc., and therefore associated with all changes in all fields of leprosy work. I feel I was the first person to introduce rapid survey methods to detect leprosy cases. The rapid survey method is now one of the accepted methods of case detection. This has helped in the detection of very early cases of leprosy. Whether these early cases require treatment or not is a different matter, and difficult to assess.

    When I retired from Government service in October 1979, I felt that ostracism of leprosy patients had almost disappeared from rural areas in Maharashtra. The stigma to the disease however remains. It was felt that some of the leprosy social workers and senior dermatologists did not want the stigma and ostracism to be removed. Long back now that active leprosy work is done in the urban areas the fear about leprosy has almost disappeared. Voluntary reporting of early cases has considerably increased. I was inspired by the dedication of the late Shri S. K. Patwardhan and the living legend Baba Amte. Others who helped me indirectly were Dr. Cochrane and Dr. Paul Brand. There must be a few more but I am unable to remember them.

    All my colleagues know very well my ideas about integration of leprosy. The sooner the vertical programme of leprosy eradication is given up the better it will be for the patients and the community. Vertical programme for the detection of early cases of leprosy and their treatment act as speed breakers.

    Must we spend large amounts of money and other resources on detection of early cases which in all probability are self healing in nature? Self healing of leprosy is well documented but not much attention is given to it. The effort is to detect large numbers and make them disease-arrested or released from control early. Is this necessary? Many a time I had discussions with other experts but to no effect.

    Present hobbies……

    .... Homeopathy and medical astrology. I learnt homeopathy in 1963 at the instance of one of she great surgeons of Bombay. I developed an interest in astrology in 1984. I don’t know what made me take to this subject. I think it was divine grace. I feel that astro-remedies can help us along with modern treatment of leprosy and many other so-called chronic diseases. I am now so much engrossed in this subject that I have practically given up other hobbies.

    The tape received on October 17, 1988.

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