Introduction
This essay examines M.K. Gandhi’s evolving discourse on leprosy and his extremely cautious use of media for advocacy. Gandhi engaged with leprosy through the course of his life, with two distinct narratives. One is more personal, built around interactions with leprosy patients whom he came across from time to time, in both South Africa1 and India. This is fairly consistent, his interactions have the same warmth and attitude of fearlessness to what was widely regarded as a ‘fell’ disease,2 with traces of mysticism and an overall disregard for the dangers of infection. There is another public health discourse which I discuss in this paper, which has been overlooked by scholars, which begins from 1925, when Gandhi began his visits to leprosy institutions in India. This narrative is altogether different, it contains a clear endorsement of modern medicine, it evolves continuously alongside medical developments and it is to be found mostly in Gandhi’s journals.
More than from any other source, the full range of Gandhi’s evolving discourse on leprosy, modern medicine and public health can be gauged from his media advocacy in YI and HJ . It may thus be termed a media discourse, with strategic messages on leprosy in the form of articles written by Gandhi or commissioned by him. These reflect the very latest, up-to-date medical positions, very much in the nature of health bulletins on leprosy. Well before the print media began to engage health correspondents, Gandhi took on this role.3 Leprosy was a sensitive issue with much public prejudice, both globally and in India, and Gandhi’s media pronouncements were carefully constructed and cautious. Those aspects that did not fit in with the perspective of modern medicine were excluded.
This public health discourse evolved over two decades with two broad phases. The first continued until 1934, during which time Gandhi was visiting missionary-maintained leprosy institutions and finding his way. Modern medicine had begun to offer a ray of hope for leprosy patients, especially those in the early stages of the disease and Gandhi’s responses were influenced by the nature of the missionary institutions where he first encountered it. The missionaries had a complex relationship with modern medicine, offering a humane and caring environment, very different from Gandhi’s harsh condemnations of medical institutions in HS . At the same time Christian missionaries persisted in holding onto biblical notions of sin long associated with leprosy, and held Christian teaching to be the major priority, which in turn prompted a very vocal Gandhian discourse on religious conversions. In the second phase Gandhi came into contact with the modern medicine for leprosy in a much more secular form, as advocated by the Indian Auxiliary of the British Empire Leprosy Relief Association (BELRA). This semi-official body was founded in 1927, a collaborative effort between the colonial state, medical missionaries and a great many Indian doctors and researchers in key posts, and its position was significantly different from the more harsh and coercive measures taken internationally against leprosy patients.4 The impact of BELRA was considerable. In 1920 the Christian missionary organizations were the major player in the field of leprosy care, with 4700 patients in residential care in asylums maintained or aided by them, from a total of 8850 patients in leprosy asylums.5 By 1940, BELRA was very much at the helm: of the 95 residential institutions accommodating 13,000 leprosy patients, about 25% were mission run, the rest by the government or civic bodies.6
These figures are indicative of the progressively greater role of non-missionary institutions. However the major thrust of the BELRA intervention was not on providing residential accommodation to patients. Their position was that all forms of leprosy were not contagious, that the disease was amenable to treatment in the early stages, and they initiated the process of entering into villages, making alliances with local bodies and offering treatment. Theirs was a humane, non-coercive policy on leprosy with a great emphasis on preventive aspects, including diet and improved sanitation.7 Much of this was close to Gandhi’s heart and he came to adopt more or less wholesale the BELRA position. Gandhi’s discourse developed further when in December 1944 he visited the Maharogi Seva Mandal, the first leprosy home and hospital run on Gandhian principles. The following year leprosy was included in the Constructive Programme and in 1946 in the activities of the Kasturba Gandhi National Memorial Trust (KGT). In the last years of his life Gandhi continued with advocacy on behalf of the leprosy affected, all of which was duly reported in his journals.
This discussion challenges many well-established notions on Gandhi, especially the view that throughout his life he retained an antipathy towards modern medicine, which following David Arnold is read as part and parcel of his rejection of both modern industrial civilization and colonialism.8 Studies on Gandhi and public health have continued to uncritically echo this view, reflecting what Faisal Devji has termed ‘a convention’ amongst Gandhian scholars ‘to spend some time tracing his intellectual and political antecedents And these have themselves become so conventional as to be rattled off for the most part without further analysis.’9 More recently Dilip Menon has called for renewed attention to ‘the genealogy’ of Gandhi’s argumentsand to ‘the diverse and now-forgotten fields of discourse that his positions were located in.’10 These comments are especially relevant to studies on Gandhi and health, where there is no reference at all to the bacteriological revolution or what modern medicine meant in the late nineteenth century. As a result there has been no reconsideration of conventional notions and discussions on Gandhi’s public health policy are confined to hygiene and sanitation.11 A major study by Joseph S. Alter, Gandhi’s Body: Sex, Diet and the Politics of Nationalism, does extend the scope of Gandhi’s public health policy by viewing this as an integral part of a larger political agenda, where ahimsa, fasting, vegetarianism, nature cure and sexual abstention are all parts of ‘a discrete, modern, scientific sociobiology.’12 However Alter too remains with the idea that ‘Gandhi was dogmatically critical of allopathic medicine and regarded biomedicine as dangerous.’13 Alter neglects to factor in Gandhi’s public health discourse on leprosy as well as Gandhian institutions such as the KGT, where alongside leprosy, modern medicine played a prominent role in midwifery and nursing.14 Another stumbling block is the scholarly discourse on HS , where major studies, including those of Partha Chatterji and Anthony Parell have neglected to provide any historical context to Gandhi’s critique of modern medicine and remain with conventional ideas on Gandhi and modern medicine.15 Recent influential studies such as the edited volume of Ritu Birla and Faisal Devji, Itineraries of Self-Rule: Essays on the Centenary of Gandhi’s Hind Swaraj, hold out the promise to ‘unsettle some tired views of Gandhi’s ideas about life, habit, violence, and virtue,’16 but we have a repetition here of HS as ‘a condemnation of modern “civilization” in all its violent technological proliferation.’17
Turning to leprosy, only Sandhya Shetty discusses this in relation to Gandhi, but her approach remains limited to Gandhi’s interactions with some few patients in South Africa and then a jump to Parshure Shastri. Shetty repeats prevailing notions about Gandhi’s ‘robust and radical’ critique of modern medicine, and in her study leprosy patients, outside of a historical context, are ‘shadowy subaltern objects of Gandhi’s nursing, who arrive unexpectedly and briefly.’18 Her discussion is without reference to the medical understanding of leprosy in South Africa, with harsh legislations in place, or the wholly different situation in India in the 1920s, when Gandhi interacted with Parshure Shastri, freedom fighter and leprosy patient. In this respect Shetty follows the approach of biographers, of which Rajmohan Gandhi is a representative example.19 Ramchandra Guha’s two-volume study is entirely silent on leprosy.20 The reappraisal of Gandhi which post-modern scholarship calls for has not yet extended to his complex relationship with leprosy and modern medicine.
The Impact of Bacteriology
During Gandhi’s childhood, colonial medicine regarded leprosy as a hereditary condition, with some speculation on other modes of transmission, a view reiterated by Sir Henry Vandyke Carter of the Indian Medical Service (IMS). He was invited in 1876 by the Kathiawar princes to investigate on leprosy in their territories.21 Gandhi’s references to childhood memories of Ladha Maharaj, a spiritual teacher who had leprosy, contain no suggestion of contagion.22 It was in 1873 that Armauer Hansen discovered the leprosy bacillus and fears of contagion rapidly increased. Hansen’s discovery took place in the context of wider developments within modern medicine in the second half of the nineteenth century which Michael Warboys has discussed, the process whereby earlier environmentalist theories were replaced with a bacteriological understanding of disease causation.23 In the case of leprosy fears of contagion reached a peak in Britain in 1889 following the death of Father Damien de Veuster, a Belgian priest who had elected to serve leprosy patients in Molokai. This was during Gandhi’s residence in London as a student (1888–1891). There was a huge public furore and fears of an epidemic led to the appointment of a Leprosy Commission for India (1889), with much media coverage including in The Times , read by Gandhi.24
‘A missionary has gone home to England from an Indian leper settlement to die of the terrible scourge contracted while carrying out his noble work in this country. Following the great example set by Father Damien … It was only after being medically examined by Sir Patrick Manson, the expert of tropical diseases, that the horrible truth was known as to his malady. Leprosy, it was pronounced to be, and for 8 months the Missionary is under treatment at the London School of Tropical Medicine.’25
Here leprosy is represented by Gandhi in terms of the bacteriological understanding of causation, transmission and diagnosis, and the reference to Sir Patrick Manson only underlines this. Manson was founder of the London School of Tropical Medicine, and author of Tropical Diseases: A Manual of the Diseases of Warm Climates,26 which enjoyed a canonical status in India.
Missionary Medicine
One of Gandhi’s first media statements on leprosy in India was in IO , 11 April 1908, whilst in South Africa, in an article titled ‘Lepers’ Blessings.’ He refers here to an ML publication27: ‘There is a place called Chandkhuri in India. There, Christian missionaries have established a lepers’ hospital to which they admit any Indian leper … It may well be that the British preside over an empire and prosper because of the blessings of these lepers while we live in misery because of their curses.’28 Gandhi’s introduction to the medical treatment for leprosy was mediated by the Christian missionaries and their institutions. The Mission to Lepers was founded by Wellesley Bailey in 1874, and it soon became the major care provider for leprosy in India. The missionary asylums for leprosy were not primarily medical institutions, though some did offer medical facilities.29 It is clear from the many missionary publications that the leprosy affected was not seen primarily as a patient but as a sinner in need of Christian teachings.30 This representation was so widespread that the missionaries have been charged with ‘retainting’ leprosy at a time when modern medicine was establishing a bacteriological understanding.31 Some of the issues raised by Gandhi here, on the proselytizing activity of the missionaries, or the need for Indians to take responsibility, would be reiterated frequently.32 What Gandhi does at this time is to deftly invert the missionary representation of the leprosy patient as a sinner to one who gives ‘blessings.’ Gandhi’s effort to de-stigmatize leprosy begins here, though elements of mysticism, evident in the title ‘Lepers’ Blessings,’ would be sanitized from his public health discourse subsequently.
‘I was told at Purulia that leprosy was brought under subjection by means of oil injections, especially in the initial stages. The Superintendent also told me that the cases that looked horrible-burnt up skin or burnt toes and fingers-were not contagious at all. In such cases the disease had done its work. There was no contagion and no cure. The contagious cases were those which neither the public nor the patient recognised as such. These are the cases that admit of complete cure through injections … The general reason assigned was unchaste living.’36
There are some inaccuracies in this article, such as ‘leprosy is on the increase’37 and the reference to ‘unchaste living,’38 all of which are indicative of Gandhi’s dependence on lay missionaries for information.39
Gandhi visited the Naini Leper Asylum in Allahabad on 16 November 1929, where his friend Sam Higgenbottom served as the Honorary Superintendent. The recent treatment data was very encouraging, with 7 adults and 18 children having been discharged as cured during 1928.40 Gandhi wrote in the Visitors’ Book: ‘I envied Mrs. Higgenbottom the love of the children to her as to a mother,’41 a reference to the Home for Untainted Children on the asylum premises. At the Naini Leper Asylum Gandhi encountered a contentious issue, the segregating of male and female patients, a policy endorsed by both the ML and The Board of Foreign Missions of the Presbyterian Church in the USA, which the Higgenbottoms chose to defy.42 Ethleen Cody Higgenbottom brought this to Gandhi’s attention during this visit, with reference to the separate accommodation for married couples, and Gandhi reverted to this some years later in HJ , 14 September 1935, in an article ‘Procreation among Lepers.’ Here Gandhi referred to his discussion with Mrs. Higgenbottom and invited Miller’s opinions on this policy, which Gandhi then published.43 The issue of sexual rights of the leprosy affected had never come up in the public domain, nor was it broached by the Indian elite groups, and several articles in The Pioneer on the Naini Asylum44 were completely silent on this. Gandhi’s HJ article in 1935 thus remains the lone voice calling for discussion on the sexual and reproductive rights of the leprosy affected, amid repeated calls for coercive actions, including threats of sterilization, both in India and internationally.
The Indian Auxiliary of BELRA
On 5 May 1934 Gandhi met with Dr Isaac Santra at the Sambalpur Leper Asylum in Orissa. This meeting with India’s first leprosy specialist of eminence, who played a leading role in BELRA, was surely a turning point in Gandhi’s discourse on leprosy. Following this meeting we get Gandhi’s most explicit endorsements of the position of BELRA. Dr Umapati Gupta is referred to as the ‘leprosy expert’ in HJ , 18 May 1934, in an article which contains Dr Santra’s survey undertaken in Puri.45 Santra’s expertise was in the area of public health and preventive measures and the leprosy survey conducted across India, which he headed, placed the figures of leprosy affected as at least a million persons. By this time BELRA placed greater emphasis on preventive measures and the importance of hygiene and diet. Within five years of operations BELRA had made enormous progress, entering into villages, establishing treatment centres, training over 5000 doctors in the latest treatments for leprosy and educating people about the disease.46
All of this was dear to Gandhi’s heart. From 1934, Gandhi’s media positions became closely allied to the BELRA position, and Gandhi invited medical experts and activists to write in HJ , a recognition of the authoritative voice of his own journals. Gandhi himself wrote an article titled ‘Leprosy and its Prevention’ in HJ , 7 September 1935, extending his endorsement to a recent and widely read BELRA booklet of Dr Ernest Muir, Leprosy: Diagnosis, Treatment and Prevention.47 Gandhi wrote, ‘I quote freely from the chapter on Prevention,’ and he provided a detailed account of Muir’s views on the exaggerated panic over contagion, the need to protect children, and for patients to maintain certain precautions.48 Gandhi’s media bulletins on health, as always, disseminated the most recent medical knowledge.
Gandhi also reveals an awareness of the need for missionary institutions to play a major role in the field of public health. Following a correspondence between Gandhi and his friend, A. Donald Miller, Honorary Secretary to the ML,49 a series of articles by Miller, ‘Letters to a Village Worker,’ addressed to a fictional village activist, appeared in HJ during June and July 1936.50 Miller’s affirmed this work to be the duty of ‘patriots,’51 and wrote from a public health perspective. By 1936, both Gandhi and Miller had adopted public positions which were very close to BELRA.52
By the 1940s the missionary institutions no longer set the agenda. BELRA, with Dr R. G. Cochrane as medical advisor, was very much in the lead role in formulating policy for leprosy.53 With the creation of Gandhian institutions for leprosy Gandhi’s endorsement of modern medicine developed in new directions. The Maharogi Seva Mandal (MSM ) was founded in 1936 at Dattapur, Wardha, under the inspired charge of Manohar Dewan. Gandhi refers to him in HJ , 20 October 1940: ‘Though an utter stranger to medicine this worker has by singular devotion mastered the method of treatment of lepers and is now running several clinics for their care … He has now published a handbook in Marathi for the treatment of lepers,’54 a reference to Manohar Dewan’s Marathi textbook on leprosy titled Maharog (1940), a compilation of several BELRA publications.55 When Gandhi included leprosy in the Constructive Programme, he referred to this institution and to Dewan with some pride.56 Another Gandhian institution to commit to leprosy work was the KGT, following Gandhi’s meeting on 8 February 1945 with Dr Cochrane, at the initiative of T.N. Jagadisan, India’s first leprosy patient turned activist.57 Gandhi shared the leprosy activities of the Trust in ‘Kasturba Leprosy Work,’ in HJ , 14 April 1946, sharing the latest medical perspective: ‘In Madavilagam village 18 definite cases of leprosy have been discovered out of 593 inhabitants. Four of these are infective and fourteen neural. Infection is spread by indiscriminate contact of infective cases with children.’58
The challenge of combating of stigma and educating people about leprosy required the support of eminent medical voices and there is a realization that Gandhi could not do it alone. Thus Sushila Nayar, personal physician to Gandhi, wrote in ‘Ignorant Legislation,’ HJ , 5 May 1946, of a news report in the Hindu of 1 April 1946, referring to a proposal before the Sind Assembly to sterilize male beggars.59 Gandhi followed this up in a letter to Dr Cochrane dated 11 September 1946, asking for ‘a well-considered medical opinion,’ signed by as many medical men as possible.60 Another article by Gandhi, ‘Leprosy and Contamination,’ HJ , 22 September 1946, was in response to a media report in the Hindu of Madras of 26 August 1946, on the proposal of the Bihar government to construct a separate jail for the leprosy affected in Govindpur, Manbhum.
Gandhi’s Legacy
Gandhi’s discourse on leprosy and public health had a great impact during his lifetime and his legacy continued to inspire after his tragic death. The Gandhi Memorial Trust, also known as the Gandhi Smarak Nidhi, formed on 17 February 1949, resolved to take up leprosy work as a major activity. Rajkumari Amrit Kaur, India’s first Minister for Health, acknowledged that the ‘national recognition of Leprosy as an important public health problem was given when Gandhiji … created the necessary enthusiasm among the leaders for the welfare and rehabilitation of people suffering from leprosy.’61
Alongside the public health narrative, Gandhi’s visits to leprosy asylums and interactions with patients continued, revealing a more personal dimension. The Superintendent of the Cuttack Leper Asylum wrote of his visit on 20 December 1927: ‘Although far from well, when last in Cuttack, he paid us a visit and also sent a basket of fruit and bunches of lovely roses … He gave cheery messages which in tone and interest and spirit were really Christian.’62 Dr Isaac Santra has related how after one such interaction with patients at the Sambalpur Leprosy Clinic, Gandhi declined the offer of disinfectant, which unfortunately has been read out of context as a disavowal of bacteriology.63 Perhaps the most widely shared and enduring image of Gandhi’s commitment to the leprosy patient is the support he offered to Parshure Shastri, freedom fighter and leprosy patient, when Shastri arrived at Sevagram. Gandhi’s uneasiness at the time is recounted by contemporaries64 but these find no mention in his public discourse. Shastri made a brief appearance in HJ , 15 September 1940, in a report of an ashram wedding wherein he officiated; for the very first time in the colonial history of India a leprosy patient was represented in the media without reference to deformity or disability, neither a sinner nor mendicant nor outcaste. This too is part of Gandhi’s legacy. Outside HJ , Gandhi continued to make reference to illness having its origin in the mind, though with great caution not to reinforce stigma. At prayer meetings in October 1947 he clarified that every illness was a consequence of ‘violating nature’s law,’ and leprosy was no different: ‘Leprosy is a skin disease … I believe it is a disease of the body and there is no difference between leprosy and cough.’65 The next day he added, ‘Hatred towards one’s fellow-beings … is worse than leprosy.’66
The secularization of leprosy was a complex process and boundaries were fluid. Scholars have noted that Gandhi frequently held multiple positions and cautioned about the dangers of homogenizing these. Viewed from a historical context, holding multiple positions was very much a characteristic of the times. A dual allegiance can be seen in Dr Cochrane’s conduct of a research study at Saidapet in the Madras Presidency, on the basis of which official policy was formulated. In an internal communication to ML, he refers to a public health objective, ‘to find an economical method of leprosy-control,’ but also to a second objective, ‘to give an opportunity for the indigenous Christian Church in India to demonstrate Christian service … we are anxious not to have to depend on non-Christian support for the scheme.’67 Gandhi, along with the missionaries, struggled with divided loyalties and HJ provided a space for diverse voices. Primacy was given to effectively taking the medicine to the people, which could include advocacy of quackery. Thus A.V. Thakkar, an eminent social worker and close associate of Gandhi, wrote in HJ , 23 November 1934, in praise of a missionary group in Kajaria, Sindh: ‘Father Elwin, though a Christian in the truest sense of the term, is not out for proselytization … the latest method of injecting chalmogra oil is being adopted for treatment. Brother Shamrao, though not a doctor, has learnt the treatment and is in charge of the Home.’68 There is little difference in this respect between the positions of Brother Shamrao and of Manohar Dewan, who explained the circumstances which made such a situation inevitable: ‘Being a non-medical man I had some hesitation to take up this work in the beginning. I started clinics, began to conduct an in-patient institution and published books on the subject not because I was better fitted for it but because nobody else was doing it.’69 Amid the diversity there were shared ideals which united Gandhi with Donald Miller, Dr Santra, T.N. Jagadisan, Dr Cochrane, Manohar Dewan and a host of others, who gathered at the first Indian Leprosy Workers’ Conference at the MSM in Wardha from 30 October to 1 November 1947. Donald Miller recounted his experiences of the Conference and noted, ‘How Wellesley Bailey would have rejoiced to look upon that company now gathered under the Chairmanship of Dr. Jivraj N. Mehta, Director-General of Health Services.’70
The Gandhian institutions for leprosy were also hybrid in nature, deriving from BELRA, from Christian missionary institutions and Gandhian ideals. What gave the MSM its unique status as a nationalistic institution was the adoption of Gandhian principles, including spinning for everyone, and Gandhi’s explicit endorsement. Nonetheless it was a product of the times and similar institutions emerged around the same time in response to local conditions. The Naba Kushta Nibas was one such, built in Purulia in 1937, a citizens’ initiative over concerns about the environment at the Purulia Leper Home, where ‘discriminations, and fear of conversion threw a large section of these lepers on the town.’71
The Gandhian vision for leprosy is positioned somewhere between the faltering secularism of missionary medicine, which had perforce to modify the religious agenda, and the more secular medicine of BELRA, shorn of religious metaphors, but not without its own contradictions. Gandhi’s discourse was rooted in a particular phase of colonialism where the state did not wish to commit resources for leprosy control and encouraged voluntary agencies to step in. In such a situation his choices were limited and historically determined. The Gandhian discourse must necessarily include his many associates who built institutions for leprosy, including Vinoba Bhave, A.V. Thakkar, Manohar Dewan and Baba Raghav Das, all of whom showed considerable independent initiative. Gandhi himself acknowledged Vinoba Bhave’s mentorship for Manohar Dewan, and when he visited the MSM on 12 December 1944, he went a step further and declared, ‘I am not the real Mahatma. Manoharjee is the real Mahatma.’72
There is a uniqueness to leprosy in Gandhi’s life, for with no other illness did he have such a long and sustained engagement. Clearly Gandhi’s relationship with modern medicine and public health was more complex than we have allowed for, and his sustained commitment to the modern medicine for leprosy calls for a rethinking of Gandhi’s discourse on health in general. His exposure to bacteriology dates to his student days in London, well before HS , and it appears much more likely that his critique of modern medicine in HS did not constitute an outright rejection of the basic premises of bacteriology. In the case of leprosy Gandhi chose to make of modern medicine an ally because it was beneficial to the leprosy patient, which shows in no small measure his spiritual heroism. Here nature cure failed him. In April 1942 Gandhi mentioned to Donald Miller of his attempts at nature cure treatment with Parshure Shastri: ‘I suggested treatment to him by fasting … It was a very severe fast; and in the end he could keep it up no longer; and as he took to nourishment again, so the signs of the disease reappeared.’73 But this was not a private confession. Gandhi went further, making public that on matters concerning leprosy he stood with the opinions of Dr Cochrane rather than of a naturopath.74 By 1947 Gandhi’s public position on leprosy was identical with that of modern medicine. His discourse had evolved through the course of his life, and it would be rare to find another instance where a discourse on public health is revealed entirely through media. Looking back at Gandhi’s 1908 article in IO on ‘Lepers Blessings,’ and the great distance he had come, we may perhaps see the ultimate triumph to be the secularization of leprosy.