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Leprosy at the Cape

The subject of leprosy engrosses such a considerable share of public attention at the Cape at the present time, that I am prompted to avail myself of the leisure which a cruize in the Mozambique Channel affords me, to append a brief statement of the case in this place.

Somewhere about the year 1827, this disease appears to have first engaged the attention of medical men in the colony, or perhaps it would be more correct to state that about this period the first public Institution for the treatment of persons afflicted with the disease was established at the Cape. This institution which received the name of "Hemel en Aarde", (Heaven on earth [actually: Heaven and earth]) was formed as a Colonial charity, and put under the care of missionaries near Caledon in the western district, where for a long time previously, Hottentots affected with leprosy, were put under quarantine in huts, and supported by funds raised in the Swellendam district, where the scattered race of aborigines had been collected by some missionary people.

There is every reason to suppose that the disease existed among the Hottentots long prior to this date, although it was not until the period referred to that it appears to have first arrested public attention. And the inveterate nature of the complaint is pretty well evidenced by the fact that then, as now, these wretched people were not acquainted with any means of curing, or alleviating, the disease. Persons labouring under the disease, in all its various stages, mixed indiscriminately with the healthy portion of the community; and thus the hereditary taint (the only known origin of the disease) was transmitted from one generation to another, and this disgusting looking malady perpetuated. Whether these people believed that the compliant was thus engendered admits of doubt, in as much as it has been known sometimes to remain dormant in one generation and reappear in the next. And moreover as it appears (upon authority) to select the period of puberty for its development.

But if these people were aware of this fact, and merely regardless of it, the authorities at the period we refer to were equally so. For the Lazaretto at "Hemel en Aarde" appears to have been conducted from first to last without any regard to a proper seclusion of its inmates. At the institution were to be found many (one third of the whole it has been said) who were not affected with the disease; consisting of the families of those labouring under it. Such freedom of intercourse of course negatived in a great measure any good that might have resulted from proper medical attendance. But while it unquestionably placed no check upon its hereditary transmission, it afforded a very good opportunity of proving that the disease is not contagious, as it was not communicated to any of the healthy inmates, who all, more or less, acted as attendants.

The following sketch of the disease, as it appeared at this period, is quoted by the late Dr Murray, Surgeon to the Forces, upon the authority of the medical attendant of the institution of Hemel en Aarde.

"The disease attacks different parts of the body, but particularly the joints of the extremities, and face. It commences with a numbness and insensibility of the parts, followed by an eruption of copper coloured, tubercular spots, roughness, glossiness, and scaliness of the skin, falling off of the hair, & often without any material affection of the general health and spirits.

"When it attacks the limits, foetid, virulent ulcers form, the parts sphacelate [become gangrenous], and joint after joint falls off. When it affects the face, the alae [lateral cartilage] of the nose become swelled and scabeous [scabby or scaly] , the lips & lobes of the ears tumify [swell up], the skin of the cheeks & forehead grows thick, and forms large prominent rugae [wrinkles, folds], the hair of the head and eye-brows fall off, and the countenance becomes hideously disfigured, whence the disease got the appellation of Satyriasis, and Leontiasis from the supposed resemblance of the patients to a satyr, or lion. The progress of the disease is generally slow, continuing for several years, without injuring the patients general health, and their sufferings do not seem to be great, as one of its characteristics is that the sensibility of the parts becomes very obtuse, or totally abolished, and even pinching and puncturing gives no pain.

"Towards the close of the disease, the lungs become exceedingly oppressed, & the dyspnoea [difficulty in breathing] is so great, that the patients die as if suffocated."

In this sketch we have a tolerably full, although condensed exposition of the rise and progress of a disease the proper designation of which is "Elephantiasis Grecorum, or Tuberculata", together with the scales which more particularly characterise the true lepra. It may also be said to be closely allied to the disease so ably described in Dr Holland’s "Pellagra of Lombardy"; which infests the high, sheltered but swampy districts of that country; where, notwithstanding the productiveness of the soil, the diet of the peasant is miserably poor. But there are no symptoms recorded, or other evidence to show that the Elephantiasis Arabum, or Barbadoes leg, was observed in any case. That they were not found combined we might be prepared to expect from the distinctive pathological characters of the two diseases. But it is not improbable that a more extended experience on our part will show that this inveterate disease exists in all its various forms amongst the aborigines of South Africa. It is more than probable also in the present advanced state of medical science, with all the advantages which chemistry now gives us in a host of new & valuable medicines, that a greater attention to treatment in the early stages of the disease would materially alter the prevailing opinion of its incurability. But little however could be expected from an institution where the medical attendant was nonresident, and his "visits" compulsory only once a week. The general management of the institution at Hemel-en-Aarde was so bad, and the medical attendance so defective (people dying of erysipelatous, pulmonic, and dysenteric affections in the intervals of his visits) that it was finally closed upon the unanimous recommendation of the Medical Committee, and an asylum established at Robben Island instead, in 1845. The reason assigned by the Committee in support of the conclusions arrived at in their rapport - which has date 3 years prior to their recommendations being carried into effect – are as follows. 1st The non-residence of a medical officer. 2nd The low, damp, unhealthy locality of the institution. 3rd The want of proper seclusion of its inmates from the healthy portion of the community. And lastly, the heavy charge on the Colonial funds without any adequate good resulting to the patients or the public at large. By the establishment of a leper asylum at Robben Island, on the other hand, all these & many other objects conducive to the welfare of its inmates were attained. The sick were properly secluded in a healthy island, within reach of sea bathing & every necessary refreshment, and placed under the care of the resident surgeon of the general Infirmary already established there. The Infirmary now comprises three departments, one for chronic sick, one for lunatics, and one for lepers. The latter is completely distinct form the others – in the dietary, service in the Church – and other respects. In fact no intermixture whatever is permitted.

The asylum comprises four large rooms capable of containing 24 patients each, and is well found in every necessary requisite. There are now 63 inmates – therefore room for 33 more.

The following Return which has been called for by the recent discussions on the subject of leprosy at the Cape, and in Cape Town in particular, will exhibit the working of the present institution from its establishment to the present time. Drawn up by Mr Birtwhistle, Surgeon Superintendent of the Asylum.

  Europeans* Africanders Hottentots Negroes Kaffirs Malays Children belonging to lepers Total
  M F M F M F M F M F M F M F M F
Received into the Asylum from 15th Decr 1845, to 30th September 1853 6 1 11 5 76 38 17 4 3 1 1 0 12 6 126 55
Children of lepers discharged, sent to Genandal & other places, having no appearance of the disease                         3 2 3 2
  6 1 11 5 76 38 17 4 3 1 1 0 9 4 123 53
Died during the same period 3 1 7 5 55 20 11 3 2 0 1 0 4 1 83 30
Remaining in the asylum, 1st October 1853 3 0 4 0 21 18 6 1 1 1 0 0 5 3 40 23

* 3 born in England; 1 Frankfort on the Maine, Germany; 3 in Cape Town of European parents.

Various medicines were resorted to in these cases without the "slightest influence", but "cleanliness, good and comfortable bedding, & clothing, with the full dietary system allowed by government, and a liberal supply of medical comforts was found to conduce materially not only to the amelioration of the disease, but the prolongation of life." Although at first sight of the above table we are astonished at finding that not one single cure is recorded, our surprise immediately vanishes when we are told no previous history was obtained in any case, and that the patients were all in "the last stage, both wretched, filthy, and loathsome to the sight". And while it appears to be no respecter of colour, attacking black & white indiscriminately, the proverbial want of cleanliness and poorness of diet of the Hottentot race would seem, however, to have marked them out more particularly as its victims. This fact tends to support the opinion that the "poor living, want of cleanliness, mendicant misery, & exposure to cold & damp" – which is said to be "too constant attendants of this dreadful malady" must indeed "tent to generate and keep it alive".

The want of any power to seclude persons affected with leprosy without their full consent, will always make Robben Island, what it has hitherto been, a lagerhouse for chronic, incurable cases. Some auxiliary public charities for the out door treatment at least of incipient cases are therefore wanted. And much good may also be expected to result from the discussion which has been carried on, by directing the attention of the proper authorities to those hygienic measures which the condition of some of the humbler classes in Cape Town appears to demand. Many of the colored inhabitants, it is said, are "living in crowded, unventilated tenements, abounding in filth of the most disgusting kind, with animal & vegetable matters festering, fermenting and putrefying together, from which there is a constant emanation of offensive vapor, poisoning the atmosphere, alike destructive to health, and predisposing to every species of disease."

In the present state of the question then we may be excused for withholding our assent to the opinion of the hopelessly incurable nature of the complaint, and I shall conclude this brief sketch by instancing a case where amputation of the limb was followed by the happiest result, and in which a relapse would, in all human probability, have been warded off, if proper medical attention could have been secured to the patient.

I amputated a black woman’s leg, a little below the knee, for this disease, at Sierra Leone in Decr '47 or Jany '48 [when Loney was serving in Amphitrite; her log shows that she was at single anchor off Sierra Leone between 16 December and 9 January]. The limb from the middle of the calf down was one disorganised mass, with scarcely any distinction of tissue; and there was a tubercle over the great trochanter [protuberance on upper part of thigh bone, for attachment of muscles] of the same side also. The wound healed favourably, the tubercle disappeared, she gained flesh, and - to use her own words when I saw her in March ’52 [by which time Loney was serving in Hydra, en route for the Cape; her log shows that she touched at Sierra Leone from 28 February to 2 March] - she never enjoyed better health that she did for two years afterwards. She then began to have occasional slight illnesses, and latterly the other leg had begun to manifest signs of the disease. Hopeless as her case now was, she would still over & over again express her gratitude for having relieved her from such a lumbering, festering mass as the other leg was. Nor should I hesitate to pursue the same course under similar circumstances, notwithstanding the ultimate, unfavourable issue of this case.

HMS Hydra,
Mozambique Channel
1st Feby 1854.

Wm Loney M.D. Surgeon

Note: Leprosy is now known to be caused by the slow-growing bacterium Mycobacterium leprae, an organism discovered in 1873 by the Norwegian G.H.A. Hansen, and related to that responsible for tuberculosis. The first effective therapy was discovered in 1941; although a prolonged treatment is necessary, cure is now routinely possible. Although not highly contagious, infection does result from physical contact with an infected person. Susceptibility to the disease is probably genetically determined, and this fact will have led to the Victorian idea that it was hereditary. Damage to sensory nerves, and the resultant insensitivity to pain, is responsible for much of the malformation resulting from infection.

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