The history of leprosy in south India not only provides a fascinating insight into an endemic disease. It offers a context for the detailed examination of the political, economic and social life of south India in the nineteenth century and the exploration of global issues such as the stigmatism of disease, the development of scientific medicine, the articulation of class distinctions and the nature and functioning of colonial power.
The common beliefs, both refuted by Gussow, that leprosy was stigmatized equally in all cultures and that modern leprosy stigma is part of a continuous tradition, are further questioned by the indigenous and British response to leprosy in south India. In indigenous culture there was a disjunction between the degree of stigma associated with leprosy in the textual religious and legal tradition, particularly the vulnerability of the leprosy sufferer to loss of inheritance and outcasting, and the practice of ostracism which targeted only the poor with leprosy. Many Indian leprosy sufferers continued to live and work among family and community without hindrance. Municipal legislation in Madras, intended to restrict the activities of leprosy sufferers in specific areas of employment, was rarely used. Similarly, both the Madras Public Health Act of 1939 and the Lepers Act of 1898 made little actual impact on the working lives of leprosy sufferers. Within the textual tradition itself there was also disagreement over the precise degree of ostracism appropriate to leprosy sufferers. Further, while leprosy sufferers were often abhorred by the British in south India, many British medical officers perceived leprosy in medical rather than moral terms and emphasized that the old stereotype of the leprosy sufferer as dissolute was not born out by observation.
The exploration of fundamental questions concerning the nature of leprosy and the response to leprosy sufferers in nineteenth-century south India thus contributes to the understanding of the history of leprosy stigma in global terms. Similarly, discussion of the medical and legal aspects of leprosy in south India provides insight into the broader relationship between colonized and colonizer and the nature of power as it functions in the imperial context.