The People Only Death Will Touch
Leprosy has been the world’s most feared disease for centuries but this missionary went into Africa to find there’s no foundation for blind fear and that new drugs show promise of a cure
THE REV. ARTHUR PAYTON
I SHALL never forget Rosa.
She was very short and stocky and her clothes had been repaired so often it was impossible to tell which was patch and which original cloth. Her white hair contrasted sharply with her wrinkled black skin. She was about 70.
Rosa sold peanuts at the door of my house on an island in the Leeward group of the West Indies. She wouldn’t sell them to me, perhaps because I was a missionary. Every morning when I came out to begin my rounds she would bare her brown stumps of teeth in a grin and give me three or four nuts.
One day a friend saw me accept her gift. With a look of horror he knocked the peanuts out of my
“Never do that again,” he snapped.
I was startled and annoyed. “Why not?”
He lowered his voice. “Rosa is a leper.”
I was frightened stiff. I admit it. Like nine in ten who will read these words I thought of leprosy as something accursed and incredibly vile.
A few days later Dr. Ernest Muir, perhaps the world’s foremost specialist on leprosy, came to visit our island. I told him about Rosa.
He laughed at my fears. “There are two kinds of leprosy,” he said. “Infectious and noninfectious. Rosa has the kind that attacks the nerves and cannot be transmitted. But any case of leprosy, infectious or not, can be treated medically and soon we hope to be able to cure every one who has it, no matter how far it is advanced. Fear of it is simply a barbaric hang-over—a greater danger than the disease itself.”
Thus assured, I continued to accept Rosa’s nuts. It may sound like whistling in the dark, but I felt I was helping in a
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small way to show that there was no need to be frightened, no need to treat Rosa as an outcast. But, at the back of my mind I kept wondering: What had Muir meant when he spoke of fear of leprosy being a barbaric hang-over?
In time I found out.
It was in 1944 that I signed up for a five-year term with the British Empire Leprosy Relief Association. Two years after that I went to work in the field. My headquarters was the Uzuakoli Leprosy Settlement, in the Owerri province of southeastern Nigeria.
The settlement, begun in 1933, was caring for 1,600 in-patients and 23,000 out-patients by the time I arrived. Two doctors, one nursing sister, two lay workers and about 15 African helpers comprised the entire staff.
I was surprised at my first glimpse of Uzuakoli. It looked like a beautiful park. The sweet odors of magnolia, orange and tangerine blossoms mingled. But when I reached the settlement proper the prevailing odor was that of chaulmoogra, a heavy oily smell spiced with medicinal creosote. This oil, used for centuries in the treatment of leprosy, is injected into the muscles and under the skin.
The settlement was almost gaily colorful—terra cotta for the sun-baked mud huts and bright green for the palm-mat roofs. A mud church, seating 1,000 rows of long mud pews, was its core. Surrounding it was a school, a children’s feeding centre, hospital and recreation ground. Around these, spreading like a fan, were the homes of the patients: Women’s Town, Married Quarters, Men’s Town. It was all comfortable and pleasant; far cheerier than any native town.
A Diagnosis From Clay Pots
Soon after I arrived I met a young man of perhaps 30. He was a patient but he didn’t have the telltale leprous nodules or the clearly marked discolored patches on his skin. In fact, he didn’t to my then-untrained eyes look to be suffering from leprosy at all. But stretching from one shoulder to the other and down the small of his back was a horrible scar where he had been burned.
I asked Dr. Charles Ross, a big jovial Northern Irishman in charge of the settlement, why the man was there. Ross pointed to the edges of the scar. “Look,” he said. On the unburned skin, spreading outward, were faint patches of lighter-colored skin—the marks of leprosy.
“How did you get burned?” I asked the patient.
He shrugged, pretending not to understand. I persisted. Finally, glancing nervously over his shoulder, he told me that a witch doctor had treated him for Norio Ocha—Ibo for leprosy— by the use of fire. Deathly afraid of witch doctors and of juju, the pagan gods and religion of the Ibo tribe, he would say nothing more. Later, through bribing some of the patients with rice chickens to re-enact the witch doctor’s fire “cure,” I learned how it was done.
Our make-believe victim was a small boy of 11. His name was David. Once the others had agreed to re-enact the tribal custom for me they pitched in as if it were the real thing.
David’s parents took him to the chief and the headmen and informed them that their son had Norio Ocha. The chief, frowning, nodded and said
he would have to consult his private juju. This was two inverted clay pots on a tripod under a tiny palm shelter.
Everyone gathered around solemnly. The chief poured palm wine over the juju, mumbling incantations. He followed this by bleeding a cockerel to death over the pots. Then all were silent while the chief listened for “voices” to tell him what action to take. Finally he nodded. The “voices,” he said, had asked for the services of a certain witch doctor. The chief sent for
Cure By Flame
The witch doctor was a wizened pigmy, dressed in a postage-stamp cloth and nothing else. In a bag over his shoulder he carried his drugs and instruments. Slowly and solemnly he walked into the group, his eyes fastened on the boy. Fear showed starkly on the face of every native.
The witch doctor turned to David’s father. “You must pay me five pounds,” he demanded, “before I act.”
“Four,” the boy’s father offered.
The pigmy turned to stalk away.
He turned back. David’s father pretended to produce the £5 and the witch doctor set up his own juju—this time a single inverted pot. There were grunts, almost inaudible incantations and now and then a weird terrifying screech. He, too, poured palm wine and cockerel’s blood as an offering.
All this time the boy was being held firmly by two of the headsmen. The witch doctor turned to them. “Put the boy face down on the ground,” he ordered. They did so.
The witch doctor produced a white powder from his bag of tricks and sprinkled it over a leprous patch on the boy’s right shoulder. Then he snatched a flaming brand from the fire and, before I could move, he pressed it on the powdered patch.
“Stop!” I shouted. I knocked the brand away. I had found out what I wanted to know, but I hadn’t counted on the fierce little witch doctor throwing himself so realistically into his role.
Leprosy, like its sister disease tuberculosis, is caused by a germ. The disease was first recorded more than 5,000 years ago, but it wasn’t until 1874 that Dr. Gerhard Hansen, of Norway, discovered the lepra bacillus. Since then scientists have been trying, without success, to grow it artificially outside the human body.
They tried inoculation to transmit it from human to human. That also failed. For while it was once thought leprosy was “the touch of death” it is known today that healthy adults are normally immune to it. It attacks successfully only when physical defenses are weak through other illness or directly through an open wound.
Leprosy Does Not Kill
When the germ does invade it can land on two possible beachheads—the nerves or the skin. Nerve leprosy wastes, deforms, cripples and is usually noninfectious. The nerves are surrounded and strangled while on the surface of the body the signposts are blotches of discolored skin, without feeling or the ability to perspire. The bones are not properly fed and tend to shrink and waste away, especially the fingers and toes.
Skin leprosy, which is infectious, carries with it ugly nodules of thickening skin, under which the germs grow to a seething density unknown in any other disease.
It is important to remember that leprosy itself does not kill. It can cause racking pain, it can distort and cripple,
it can blind, but sufferers usually die from tuberculosis or kidney disease.
The classic treatment for the disease for centuries had been the oil of the chaulmoogra, a tropical nut, but with this cures were effective only in early cases. Advanced cases could be retarded and eased.
The greatest advance in the history of the disease came in 1941 when drugs of the sulphone family—including sulphetrone, an all-British development —administered orally or injected into the muscles were found to produce results so startling that some doctors believe they now have the means to cure almost any sufferer.
These drugs may eventually enable nine out of every 10 patients to return to their homes to enjoy a normal happy life. Of course, even though this sulphone news is far more hopeful than any of us dreamed even a few years ago, until doctors have cured their patients and checked on them for at least five years after the cure they will not say results are final and definite.
Doctors today do say this much though: No leprosy case is hopeless any more. But this is small comfort to the fieldworkers who know that only 10% of the world’s estimated 3 million sufferers can be treated with the resources now available. For, apart from Africa, leprosy is also common in Asia, South America, the West Indies, parts of the south Pacific and Europe. Even Canada has two lazarettos — at Tracadie, N.B., and Bentinck Island, B.C.—where eight patients are at present under treatment.
Leprosy is rarely passed on to a healthy European. Babies are never born with leprosy, but children kept in contact with leprous parents for more than six months are likely to contract it within a few years. In spite of popular myths it cannot be caught from a fur coat or a banana skin. People who go to work among leprosy sufferers—we are trying to burn the word “leper” out of the language— rarely become pariahs. They regularly go home on leave.
One of our major jobs at Uzuakoli is to find early cases of leprosy and persuade them to come forward for treatment. Sometimes this is difficult. In the Ibo tribe it is believed that if leprosy attacks a person it is because the juju is upset by him; therefore he is accursed. When he discovers signs of the disease on his body the victim tries to conceal it. Eventually one of the headmen is certain to find out. Then he calls the witch doctor who, in turn, will make one of two decisions.
He may demand money and promise a cure, a promise he cannot fulfill. Or he may confirm the belief that the victim has upset the local juju and cast him out from his home and village.
We are opposed to compulsory segregation or treatment. This tends to drive the disease underground. We have to use persuasion. Our method is to carry out surveys of an entire clan at a time.
My first experience of this was with a clan where we had done no previous work. We arranged to meet the paramount chief and his chieftains to discuss the possibility of making our survey. At first we met stolid resist-
Suddenly Dr. Ross had an idea. “I want to make it perfectly clear,” he said, “that we have come only to examine everybody for leprosy. We are not interested in taking a census for the tax department.”
A grin broke like a sharp new moon on the chief’s face. “That,” he said, “is different.”
To prepare for the survey our entire staff, African and European, set out with two trucks loaded with food and equipment. We then split up into twos : and threes, with at least one African in each party to act as interpreter. Every! one in the clan had been instructed ' to remain in his home until someone had examined him. We went into every compound and every hut. ■
We listed every case. To each we ! gave a chit of paper with his name written on it and told him to assemble at noon at our prearranged central ' meeting place. In three days we 1 examined 3,000 people. Seven in every 100 had leprosy. One fifth of the 210 ;
were contagious cases.
A Double Check With Blindfolds J
After the first part of our survey we 1 set up a field laboratory and re1 examined the cases by blindfolding them and, while touching various parts s of their bodies, asking them to indicate ( when they were touched. 1
When we touched a leprous spot they i could feel nothing. We took slides of i skin and nasal scrapings and scrapings \ from the lobe of an ear, numbered them 1 and packed them up to be taken back 1 to the settlement for microscopic tests. \ Then we reported back to the chiefi tains. We told how many cases we had r
found and which of them should come i
to live in the settlement. We also said i that we would need to provide treatc ment on the spot for the others: cleared land in a central location and materials 1 with which to erect on it a segregation s village for infectious cases. Nearby, we c asked them to build a clinic for nonr infectious patients. t
This was only a beginning.
We trained some of our more intelligent patients as male nurses so that c they were able to give chaulmoogra f injections and administer other treatI ments. Two went to live in the new 1 clinic. Others we trained as leprosy inspectors—these were healthy Afric cans, of course—one of whom would e live among the clan and constantly go i over the ground looking for new cases. v Once a month after this the doctor I called to check over the treatments and examine patients. c
This is slow work. With the manv power and money at our disposal we e have been able to cover only one fifth i: of Owerri Province. It is sad and I frustrating to realize that with enough of both we could probably kill the / threat of leprosy everywhere forever. a In Africa only one in 20 who has leprosy is being treated. I
Once a native woman was cast out from her home, her husband and her t four children. Alone she stumbled s
through 40 miles of deep bush to the gates of Uzuakoli. She asked to be admitted. “Sorry,” she was told. “There isn’t room for even one more.” And there wasn’t.
She refused to take no for a final answer. All that day she sat at the gates, begging everyone who passed to let her in for treatment. At sunset she shuffled hopelessly away.
Next morning she was back at the settlement; but this time she was brought inside. She was dead. A bush policeman had found her, hanging by the neck from a tree.
20 Minutes to Have a Baby
Heartbreaking? Of course. But the settlement just didn’t have the money to stretch its resources farther.
Tragic as many cases are, others help to balance the picture.
There are, for instance, the discharge ceremonies, when cured patients are given certificates of good health and allowed to go home. The atmosphere is like that of a college graduation. The entire settlement, patients and staff, black and white, turns out in its Sunday best. There are special seats for the departing patients and the doctor in charge presents them with their “diplomas.”
At one of these cermonies I saw a young married girl, one of the “graduates,” rise suddenly from her seat just before the presentations. Dressed voluminously in all the finery she owned she hurried toward the operating theatre. I wondered what was wrong.
Twenty minutes later she was back. In her arms, incredible as it may seem, She carried her newly born first baby. Joyfully she waltzed forward to collect her certificate, happy in the knowledge that if she had become a mother only a few short months before she would have been, for its sake, separated from her child.
Often at Uzuakoli I heard patients speak with fearful awe of a place they called the “Home of Leprosy.” It was located in the Niger Delta, which is made up of thousands of tiny islands. Almost everyone who lived there, so went the reports, suffered from leprosy. Later we found that, in cold fact, 60 % had it. These people, unlike others we worked among, took the disease fatalistically: if it had to be, it had to be. They did not cast out those who caught it or did they attempt cures. We knew it was a festering sore that needed cleaning out.
One day Dr. Ross and I drove from Uzakoli into Abua, about 100 miles south. There we were joined by one of our African public health workers, named Dunbar. He told us he had been to see the people of Amelego—the “Home of Leprosy.”
“They are most anxious for you to come,” Dunbar said. But Ross had a full schedule. Regretfully, he told Dunbar he would have to put it off for a later date.
Next morning at 6 a.m. Dunbar was on our doorstep. Without batting an eye he confessed he had sent drum messages during the night saying we would come. The people of Amelego had sent a canoe to fetch us.
Ross was put out, of course, but I could see he wasn’t going to be able to withstand Dunbar’s stubbornness. Sure enough, a little after 2 in the afternoon, into the 20-foot dugout canoe went Dunbar, Ross, six paddlers and myself.
We paddled down the river for hours. At 6 the sun went behind dark clouds and the breeze stiffened to a gale.
“We’re going to run into a tornado,” Ross said.
He had hardly spoken when it hit us. Rain in solid sheets. Thunder shook the earth and lightning bolts
played tag across the black sky. We were soaked to the skin. My pith helmet was limp as a rag.
We reached Amelego half an hour later. We were led into the town hall, a corrugated iron roof supported on stilts. In it were half a dozen cows of a breed immune to the tsetse fly and held in high reverence by the natives. The cows, used to having the free run of the village, objected to being turned out of the town hall into the fresh mud.
Then the chieftain set out three chairs for us and the entire village gathered under the roof to begin the powwow. We were tired, wet and hungry. Especially Ross.
“Get all those women out of here,” he thundered suddenly. The women got
“Now,” he said, “we need a fire.” In 10 minutes there was a roaring blaze in the middle of the town hall.
“Ah!” said Ross, and peeled off all his wet clothes. I did the same, to the fascination of the natives. They judge manhood by the number of hairs on one’s chest. I boast a round half dozen. One of the chiefs came over to
“Master, you be very small boy for Africa,” he said. “When you come from school?” He was only a year older than I, but, judging by his chest, he was indeed a man.
Then I Remembered Rosa
Ross, Dunbar and I each made a speech, repeating over and over again that they must take leprosy seriously. When we finished a young man in his twenties stepped forward from the crowd with a young woman.
“Will doctor look at my sister?” he asked.
“Sister“ is a term often used by a native when he means his wife. Ross examined her. “How do you live?” he asked.
“Together in a small house with our two children,” she said.
“Then you must live in a separate part of the house and not mingle with the children. You have infectious leprosy.”
Without another word the pair stepped back, tears streaming down their cheeks. As if by a signal, the crowd divided, leaving a wide path for them to walk through. Pathetic as it was, this was our first sign our talks had been taken to heart. I knew then we could count on co-operation in the “Home of Leprosy.”
I felt good about it. Suddenly, for no apparent reason, I thought of Rosa and the peanuts she had given me and of how terribly frightened I had been.
I couldn’t help looking back over the years and laughing at my ignorance. For here I was, in a district where six in every 10 living mortals had the disease.
I knew leprosy could be conquered and that there is no reason any longer to fear it.
No, I shall never forget Rosa. ★