King's College London
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The great leveller: humanity's struggle against infectious disease

Photo-set on leprosy

Mother feeding her baby through a small hole in her enveloping gownInfectious mother feeds her baby in NigeriaLeprosy, whose symptoms include painful skin disfigurements, can be spread only by sustained contact with another human, and it is therefore notas infectious as bubonic plague or cholera.

Unlike these two diseases, it has a long incubation period. Since the 1980s pharmacology has been able to halt, but not reverse, the progress of the disease. However, before any effective cures were devised, those who suffered from the disease were, for cultural reasons which stemmed from Biblical descriptions, stigmatised and ostracised.

Leprosy was often explicitly associated with supposed sexual depravity and it remained conventional opinion for centuries, in the words of the historian Sheldon Watts, that, ‘Lepers needed moral uplift even more than they needed medical care.’

Although such attitudes were widely held in Christendom and were reinforced by clerical authority, Islamic attitudes to leprosy were more ambivalent. When the British Empire tried to enforce the isolation of lepers in Africa this excited strong resistance, particularly in predominantly Muslim areas.

Mother feeding her baby through a small hole in her enveloping gownIssuing DAPDS pill in NigeriaThe ‘picture set’ from which the images here are from dates from the period shortly after the first effective treatment for leprosy was introduced in the early 1940s. This was dapsone, the administration of which is shown in the image on the left.

However, this proved to be unsatisfactory, as many patients developed resistance. Nevertheless, the tone of this picture set reflects not only the comparatively sudden ‘medicalisation’ of this disease, but also the imperial determination to demonstrate that British rule in the African colonies was benevolent, against mounting pressure from African nationalism.

The founding of the National Health Service in Britain in 1948 engendered a general mood of optimism concerning the future of medical care, which is reflected here. Tropical medicine was an important component of this exercise in persuasion. The task of establishing and maintaining ‘leprosaria’ in colonial Africa was generally left to missionaries, few of whom possessed medical qualifications.

This phenomenon arose for four reasons: the traditional reluctance of physicians to treat lepers, the general shortage of medical personnel in the colonies, the unwillingness of the colonial power to spend money and the eagerness of missionaries, who, disturbed by the increasing atheism of their own societies, found captive souls to save among lepers. Salvation for lepers was to be found in purposeful work in a self-contained community. These settlements at one and the same time intended to replicate indigenous African villages and to create new Christian communities.

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