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The great leveller: humanity's struggle against infectious disease

Henry Vandyke Carter

Colour illustration of a hand and leg affected by leprosyHand and leg affected by leprosyThe physician, microscopist and anatomical artist Henry Vandyke Carter (1831- 97) is, as the historian Ruth Richardson has forcefully pointed out, one of the unsung heroes of Victorian medicine. He had inherited the artistic talent of his father, the watercolourist Henry Barlow Carter, and provided the illustrations for the first edition of Henry Gray’s Anatomy, descriptive and surgical, which, rather than Gray’s text, made it a bestseller and a landmark in the history of surgical anatomy.

Carter was comparatively unusual among physicians in displaying a serious medical interest in leprosy. From 1858 until 1888, by which time he had become deputy surgeon-general, he was employed by the Indian Medical Service. Physicians in status-conscious colonial India ranked below the civil service and the military, and resources to further medical research were not plentiful.

The book from which the images in this section and the following one, entitled Later stages of leprosy were taken from, was the second of three which Carter wrote on leprosy, and was published during a period of momentous discovery in leprosy research. The illustrations show different aspects of  Carter’s skill as an anatomical artist from his illustrations for Gray’s Anatomy. They depict various stages of tubercular leprosy, based on Norwegian and Indian case studies.

It contains detailed descriptions of the clinical pathology and symptoms of the disease, based on case studies in Norway and India, and also considers the implications of Armauer Hansen’s research.

Colour illustration of an eruption of leprosy at a comparatively early stageEruption of leprosy at a comparatively early stageHansen, a Norwegian, had isolated the bacillus which was the causative agent of leprosy in 1873. Carter was one of the first medical scientists to be convinced by Hansen that the disease was contagious, and said that the leprosy bacteria were ‘the germs of a theory concerning leprosy which seems far more promising in results than others yet broached’.

Those who did not possess Carter’s skill in microscopy still doubted that leprosy was contagious. It is contagious, but is spread only by sustained contact, and so often occurs among members of the same family.

This had become far more than a scientific dispute; it had apparently grave political implications. Infectious diseases, such as cholera, had exacted a heavy toll on the British in India. They were not pleased with the discovery that there might be another such disease with which to contend. However, the leprosy scare of the 1880s and 1890s, which was based on the assumption that it posed as great a threat as cholera, was medically unfounded.

Carter was among those who advocated the segregation of lepers, a perspective which was based on his knowledge of the contagiousness of leprosy. After much hesitation, arising from widespread uncertainty concerning the nature of the disease, the colonial authorities decided to adopt a policy of segregation.   Although the cause of leprosy as a contagious disease had been identified, it did not follow that a cure was at hand.Colour illustration of an arm of a young male leperArm of a young male leper

The image at the top right illustrates an early case of leprosy (two years), with the ‘leper spot’ on the leg, and the hand, with the appearance of early nerve disease. This nerve disease is a characteristic of leprosy and eventually leads to facial immobility.

The next image, middle left, shows a patient at a similarly early stage, also with leper spots.

The final image, right, shows a Norwegian patient at an early stage of the disease. This case study was important in establishing that European and Asian patients were suffering from the same disease.

Images in the next section illustrate Vandyke’s depiction of the later stages of leprosy.

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