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Making Refugees in India

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.  .  . 

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.  .  . 
Making Refugees in
India
RIA KAPOOR
1
3
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Acknowledgements
The first incarnation of this book was a DPhil thesis, and so my first major
research project. Its existence owes much to the kindness, camaraderie, and
advice of more people than I can count.
The first of many thanks is to the archivists in Geneva, New Delhi, and
London, who gave invaluable advice and kind direction as I researched. The
first inklings of this project came during my time working as an intern with
the Archives team at the UNHCR, and I am especially grateful for their
advice and friendship—and a further thanks to Heather Faulkner is due
here, too.
My greatest debt of gratitude is to Faisal Devji, supervisor and teacher par
excellence. He has carefully read every single iteration of this project, from its
existence as a single page to messy early drafts to this latest version. At every
stage, he has encouraged me to push my intellectual boundaries, with
kindness, good humour, and patience.
Shruti Kapila and Samuel Moyn, who examined my dissertation, gave me
incisive feedback and the courage to think more expansively. Every conver-
sation I have had with Yasmin Khan, whether an exam, email, or in passing,
has been rich in good recommendations and kind words.
The transition from dissertation to book would have been impossible
without my fantastic mentor and even better friend, Elisabeth Leake. This
book made it across the finish line because of her intellectual generosity,
careful reading of particularly knotty draft sections, and some much-needed
encouragement and support in a year of upheaval and transitions. Jonathan
Saha, Amar Sohal, and Smriti Sawkar have kindly and painstakingly read
draft chapters. Patricia Clavin has been very generous, and I thank her for
opportunities to reflect and to teach that influenced the shape of this work.
Many offered advice as reviewers, listened to early versions of these ideas
at conferences and seminars, and made generous suggestions in casual
conversation. They have all helped bring blurry, newly formed ideas into
more decisive forms. This project was also supported by a Clarendon Fund
Scholarship, a grant from the Beit Fund, and by Lady Margaret Hall’s
Santander travel fund.
vi 
I am so grateful to dear friends who were on their own academic journeys

alongside me. Béa, Amar, Smriti, Lynn, Lucie, Dom, Priya, Vanya, Vânia,
and Haya have spent time in Oxford’s many libraries (and outside them) as
I worked on the project. The Radja and Kearney-Mathur families made sure
I never felt like I was too far from home. Ben has been patient and
compassionate as I tackled this cherished undertaking, even as he sailed
tumultuous waters of his own.
My grandparents set out to write down their own memories of being
refugees in case I should ever need it, and I am stunned and thankful for
their enthusiasm. Ira has provided her own special brand of sisterly affec-
tion, even from afar. My parents, Lalit and Rajni, have inspired me and
cheered me on not just as I wrote and researched but always.
This book is dedicated to my family, whose own history on the move has
shaped mine.
Contents
Introduction 1
1. The Refugees’ Imperial Past: The Search for
Self-Determination in Empire 17
2. Resisting an Alien Invasion of Principles:
The Second World War and the New World of the UN 54
3. Refugees to (Re)Build the Nation: Partition and the
Humanitarianism of Developing the Postcolony 94
4. A Nation-in-Exile in the Age of Non-Alignment:
Rights for the Tibetan Refugees in India 138
5. Ten Million Reasons for Self-Determination:
The 1971 East Pakistani Crisis and Its Many Solutions 180
Conclusion 222
Bibliography 231
Index 251
Introduction
In 1948, aviator and plane manufacturer Antonius Raab and his wife Hilda
were deported from India, despite their status as subjects of the princely
state of Baroda.¹ They had arrived in India in 1941, classified within the
subset of ‘Balkan Refugees of Various Nationalities’ who came to India from
the ‘Mid-East’. They had been sent onwards to the subcontinent from Cairo,
as many dissident or politically inconvenient evacuees from Europe were.
Antonius was noted in British records as a German with a Costa Rican
passport, while Hilda is recorded as being of Czechoslovakian origin. Within
the larger bureaucratic category of refugee, British officials managing such
movements of people considered them ‘suspects’ as nationals of an enemy
power.² Raab’s Costa Rican documents—and the principle of nationality
arising from the husband’s status that would extend to Hilda—were disre-
garded by British officials in both Egypt and in India.³ Despite their well
recorded anti-Nazi sentiments and Antonius’ Costa Rican documents, the
Raabs were treated like the bulk of Axis power nationals.⁴ By 1942, Antonius
was officially identified as a ‘non-Nazi’.⁵ Under the orders of V. Shankar of
the Government of India, Raab was subsequently declared an ‘alien friend’
rather than an ‘alien enemy’.⁶ And yet, the Raabs found themselves leaving
for Italy in 1948 despite their desire to stay in the country.
India’s first home minister, Sardar Vallabhbhai Patel, explained to the
Constituent Assembly in 1948 that the decision to remove the Raabs from
¹ ‘Deportation of Antonius Raab, a Baroda State Employee’, Official Report of the

Constituent Assembly of India (Legislative) Debates, Vol. 6, 1948, pp. 575–7.
² National Archives of India (hereafter NAI) Digitised Public Records, Home Political, EW,
1941, ‘The Question of Accommodating Certain Balkan Refugees of Various Nationalities from
Mid-East’.
³ NAI Digitised Public Records, Home Political, EW, 1941, ‘The Question of Accommodating
Certain Balkan Refugees of Various Nationalities from Mid-East’.
⁴ NAI, Digitised Public Records, Home Political, EW, 1941, ‘The Question of Accommodating
⁵ NAI, Digitised Public Records, Home Political, EW, 1941, ‘The Question of Accommodating
⁶ NAI, Digitised Private Papers Sardar Patel, ‘Baroda 1948–49’.
Making Refugees in India. Ria Kapoor, Oxford University Press. © Ria Kapoor 2022.
DOI: 10.1093/oso/9780192855459.003.0001
2    
India under the Foreigners Act of 1946 had been made by the previous,
wartime British government.⁷ After the Second World War, new British
policies dictated that all foreigners who were ‘enemy nationals’ should be
refused visas and any extensions. Refugees, on the other hand, were to be
referred to the (British) government of India, who would make any decisions
on this front.⁸ In 1945, the British Indian government had decided that the
Raabs should be ‘repatriated’, even against their will if necessary.⁹ Antonius
is hardly the sort of figure traditionally thought of as a refugee, particularly
not in the latter half of the 1940s in India—a skilled aircraft manufacturer of
German origin, employed by an Indian prince. Yet, he had occupied that
category, within the subset of enemy alien, in the Indian subcontinent. His
position underlined that such humanitarian categories were hardly static or
consistent, and utilised in arbitrary ways that aligned with the movements of
people across imperial outposts.
Rather than providing clear answers, the Raabs’ story complicates the
category of the refugee in India. Even as the Raabs were challenging their
deportation by the British Indian government, a nationalist, Indian-led
government would take the helm—and this latter government oversaw
their departure. The Foreigners Act of 1946 that the Raabs were removed
under was vague about the circumstances of the foreigners themselves,
uniting all aliens in being non-Indian despite their reasons for being in
India. In the midst of this, the category of refugee shifted in the Indian
vocabulary from the internationally recognised refugees, internees, and
evacuees of the war to mean solely those displaced by the mass migrations
of the subcontinental Partition in 1947. The Raabs’ deportation points to a
changing idea of the refugee, an inconsistent refugee policy, shifts from the
colonial to the postcolonial, and also highlights questions of belonging in the
independent state. The case is a microcosm of the many currents that
governed India’s larger refugee policy in the years to come, perched on the
transition from colonial to independent. The colonially created ‘refugee’ was
folded into the undifferentiated category of foreigner by the officials of the
new Indian state, under a law inherited from colonial predecessors. How did
⁷ ‘Deportation of Antonius Raab, a Baroda State Employee’, Official Report of the

Constituent Assembly of India (Legislative) Debates, Vol. 6, 1948, pp. 575–7.
⁸ NAI, Digitised Public Records, Home Political, E, 1945 NA F-10-16, ‘Post-War Policy Inn
[sic] Regard to the Admission and Control of Foreigners’.
⁹ NAI, Digitised Public Records, Home Political, EW, 1941, F-24-7, ‘Missionaries originally
Intermid [sic] at the Central Internment Compound their Subsequent Transfer to A Parole
Centers or Family Camp Reunion of German Internees With their Families’.
 3
this relate to the progress and development that had been promised with the
achievement of the independent sovereign state? It is here that the consti-
tutive and destructive powers of the category of the refugee become clear.
India never signed the 1951 United Nations Convention on the Status of
Refugees, nor the 1967 Protocol that widened its geographical mandate. In
the seventy years since independence, India has provided sanctuary to
millions of refugees, beginning with those of Partition and extending to
the Tibetans, Afghans, and Sri Lankan Tamils. The modern refugee, who
crosses international borders seen as integral to sovereignty and who has lost
the protection of his own state, had been defined as such by Europe well
before the independent Indian state came into existence. The origins and
conditions governing refugees thus had their origins away from subcontin-
ental peoples’ experiences. India’s stance on refugees has recently seen a
shift, with the recent Citizenship Amendment Act’s naming of particular
religious communities and geographies as well as the expulsion of the
Rohingya Muslims. Despite the seeming change, it lies within the longer
history of India’s relationship and understanding of the category of refugee
in ways other than those prescribed by international consensus. That
choice had everything to do with an understanding of the refugee that
simply could not align with India’s own experiences, and a vision for
what self-determination meant for the Indian people.
The ‘problem’ of the refugee became institutionalised in the twentieth
century, starting with the displacements in Europe as a result of the First
World War. The first High Commissioner for Refugees, Fridtjof Nansen,
would be appointed by the League of Nations to deal with the largely
continental question of displaced White Russians and Armenians in
Europe. The Great Powers who held sway over the contemporary inter-
national order after the First World War had created the model of the
modern refugee, but one that privileged the European experience. While
that idea would evolve into the UN Convention and subsequent Protocol,
present-day practices surrounding the refugee have never shed the core
ideas derived from early twentieth-century European experiences.
Those who have had a greater say in international law, organisations, and
practice—often actors from Europe and North America—have obviously
had a greater influence on the prevalent international idea of the refugee.
Buying into international instruments would thus acknowledge their under-
standing of the refugee experience as universal, even if it obscured the
realities of mobility, displacement, and vulnerability for those who were
not from or of the so-called West. As Valentine Daniel has pointed out, the
4    
refugee is a discourse upheld by a manufactured infrastructure and categor-

isations that have the power to legitimise and verify the truth of the refugees’
experiences. Any study needs to account for how localised experiences
reflect wider global prejudices.¹⁰ To further borrow from anthropologists,
refugees are a product of the national order of things, and need to be
understood within that longer history—and so within that national order’s
relationship to the international order, and to colonial experiences.¹¹ In the
case of India’s approach, its leaders’ understanding of the construction of
universal principles and their relationship to Indian experiences within the
British Empire made the internationally created refugee suspect.
Much of this had to do with India’s colonial past, and the racial, social,
and other limitations on Indian colonial subjects in that British imperial
polity. An analysis of the clinical legalese surrounding refugee policy and
justifying its limitations, particularly in the former imperial metropole,
demonstrates these measures are really the product of a racialised thinking.
This rhetoric has been sanitised over time, erasing the language of difference
in favour of that of illegality.¹² These discriminatory hierarchies were clear to
Indian political actors when they had been colonial subjects engaged in anti-
colonial struggle, and they were quick to recognise their continuation in new
guises. Therefore, understanding personhood and refugeehood needs to
extend beyond an idea born in a world of imperial hierarchies. The core of
this study is to understand India’s needs and responses to these global
prejudices. India’s ‘strategically ambiguous’, ad hoc approach to refugees
thus has a startling ideological consistency when viewed in tandem with the
longer question of anti-colonial self-determination and its postcolonial
afterlives.¹³
¹⁰ E. Valentine Daniel, ‘The Refugee: A Discourse on Displacement’, in Jeremy MacClancy

(ed.), Exotic No More: Anthropology on the Front Lines (Chicago: University of Chicago Press,
2002), 280.
¹¹ Liisa H. Malkki, ‘Refugees and Exile: From “Refugee Studies” to the National Order of
Things’, Annual Review of Anthropology 24 (1995).
¹² For a significant attempt to understand the coloniality underpinning Britain’s present-day
refugee policy see Lucy Mayblin, Asylum After Empire: Colonial Legacies in the Politics of
Asylum Seeking (London: Rowman & Littlefield, 2017). The book draws on the ‘myth of
difference’ outlined in B.S. Chimni, ‘The Geopolitics of Refugee Studies: A View from the
South’, The Journal of Refugee Studies 11, no. 4 (1998).
¹³ The characterisations of India’s regime are borrowed from Sarbani Sen, ‘Paradoxes on the
International “Regime” of Care: The Role of the UNHCR in India’, in Ranabir Samaddar (ed.),
Refugees and the State (New Delhi: Sage Publications, 2003), 398 and B.S. Chimni, ‘Status of
Refugees in India: Strategic Ambiguity’, in Sammadar, Refugees and the State, 396–442.
 5
The process of making refugees in India drew on the principle that the
individual’s enjoyment of rights rested on the larger Indian collective’s
rights. Partition has been regarded as the defining moment in India’s refugee
policy, even its very foundation as a sovereign, independent state. But prior
to 1947, Indians had been subjects of the British Raj, and these experiences
coloured most of their postcolonial institutions, whether with surprising
continuities or obvious disruptions. The 1946 Foreigners Act remains the
primary legislation (subject to amendments) that deals with aliens in India,
from displaced persons to tourists, and predates Partition. The 1948
Foreigners Registration Act cemented this earlier law’s dissolution of cat-
egories into the larger one of ‘foreigner’ in associated documents, while the
1920 Passport (Entry into India) Act remains in force to this day too.
Indians had written a uniform policy of asylum out of the story even prior
to the creation of the new state. It points to Indian refugee policy’s origins in
the colonial past rather than beginning abruptly in 1947. The story
begins with the prospect of the nation-state rather than its ultimate realisa-
tion, as citizens of empire realised their status was a veneer for a limited
subjecthood.
Beyond international definitions, philosophy and theory have understood
the refugee in ways that cannot explain this Indian practice arising from that
region’s particular colonial experiences. Hannah Arendt famously observed
that it was not the loss of rights but the loss of a theatre in which to exercise
them that afflicted refugees—that is, the loss of citizenship.¹⁴ Within refugee
studies too, those occupying the category are acknowledged to be a casualty
of the system of nation-states.¹⁵ As Giorgio Agamben points out in his
reading of Arendt, refugees serve to remind us of the limits of human rights,
for their experiences disprove that such rights are inherent—for they should
otherwise exist even where the nation-state could not protect them. His
recommendation, that of the ‘perforation’ of the nation-state and an extra-
territorial recognition of rights in light of these failures, would not come as
¹⁴ Hannah Arendt, The Origins of Totalitarianism (San Diego: Harcourt Brace & Company,
1976), 295–9.
¹⁵ Emma Haddad, The Refugee in International Society: Between Sovereigns (Cambridge:
Cambridge University Press, 2008); C.B. Keely, ‘How Nation-States Create and Respond to
Refugee Flows’, The International Migration Review 30. no. 4 (1996); Aristide Zolberg, ‘The
Formation of New States as a Refugee Generating Process’, The Annals of the American
Academy of Political and Social Science 467 (1983).
6    
news to the Indian state as revealed in Chapter 4 of this work.¹⁶ These

conceptualisations, often consciously based on a Western experience of
receiving refugees, cannot apply worldwide. All see the early twentieth-
century break-up of European empires and the rise of the nation-state
form that failed to protect minority citizens as the start of the refugee as a
‘problem’. And so, all these understandings rest on the basis of what could
not be true for India in the first half of the twentieth century—that citizens
had a certain set of rights.
The process of making refugees in India began alongside the country’s
anti-colonial nationalists’ realisation of the revolutionary, ‘worldmaking’
potential of self-determination that gave rights (via meaningful citizenship)
to those who had been denied them in an imperial world order.¹⁷ The
nation-state form as it tends to be recognised was born of Western thought
and experience, always tracing its antecedents to Westphalia. It globalised in
the twentieth century with the so-called ‘Wilsonian moment’. The version
espoused by the anti-colonialists of the world was closer to Lenin’s revolu-
tionary vision of self-determination rather than Wilson’s, which tried
to walk back the concept from the precipice of such a revolution.¹⁸
Jawaharlal Nehru, India’s first Prime Minister and architect of much of the
anti-colonial nationalist Indian National Congress’ programme, famously
believed that securing Indian independence was a necessary precondition
for a more equal world. Through his vision of One World which viewed
the atomic age of the Cold War as destructive beyond the science of the
bomb, he sought to eradicate the vestiges of an equally disastrous imperial
order. The rights that leaders like Nehru called for challenged the effects of
imperialism, colonialism and the world order these processes had built.
Human rights as we understand them today were thus not the same rights
that anti-colonial nationalists were campaigning for. Prior to the worldwide
uptake of this more individualised idea of rights in the 1970s, anti-colonial
¹⁶ Giorgio Agamben, ‘Beyond Human Rights: A Potential Politics’, in Pablo Virno and
Michael Hardt (eds.), Radical Thought in Italy: A Potential Politics (Minneapolis: University
of Minnesota Press, 1996), 159–65.
¹⁷ I borrow this term from Adom Getachew, Worldmaking After Empire: The Rise and Fall of
Self-Determination (Princeton: Princeton University Press, 2019). While her framework focuses
on the Black Atlantic, there are parallels with the Indian project, particularly the Nehruvian one.
¹⁸ A term popularised by Erez Manela, The Wilsonian Moment: Self-Determination and the
International Origins of Anticolonial Nationalism (New York: Oxford University Press, 2007).
For Lenin’s conception of self-determination, see V.I. Lenin, ‘The Right of Nations to Self-
Determination’, in Bernard Isaacs and Joseph Fineberg (trans.), V.I. Lenin Collected Works vol.
20 (Moscow: Progress Publishers), 393–454. Also available at https://www.marxists.org/archive/
lenin/works/1914/self-det/ [accessed 22 June 2020].
 7
movements focused on collective rights—notably self-determination as the

right from which all others stemmed.¹⁹ Decolonising states developed their
own relationship with individual human rights, contributing to their world-
wide realisation even as these states’ leaders measured them against the
notion of sovereignty and self-determination.²⁰ The Indian state was
attempting to seize for its people the promise of liberal universalism, finally
weeding out the racial and civilisational superiority that had previously
barred them from equality within the empire and the international order.
The idea of the nation-state, which could guarantee such rights, had been
decided by certain powers long before some parts of the world were admit-
ted to the club, along with international organisations that could govern
their behaviour. The League of Nations certainly did not represent all of the
peoples of the world, let alone in an equal way. Nor was the nation-state a
foregone conclusion in the 1940s, with many visions of what access to
citizenship, sovereignty, and their benefits could look like.²¹ India’s own
journey towards the territorial form was governed by external facing con-
cerns of international representation. Internal diversity and difficulties of
belonging posed by a substantial diaspora further complicated the realisa-
tion of the postcolonial nation-state.²² Self-determination also had to reign
supreme for another reason, that of altering the very nature of supranational
forums—prior Indian experiences with international agencies had made
clear that the transformation of international organisations also required a
decolonisation of their methods and goals.²³ Humanitarianism often had
(and still has) political motivations, and certainly political implications, that
could not be allowed to threaten newly acquired collective rights where they
¹⁹ Samuel Moyn, The Last Utopia: Human Rights in History (Cambridge, MA: Belknap Press
of Harvard University Press, 2010).
²⁰ To understand the relationship between human rights, anti-colonialism and cultural
relativism, see Roland Burke, Decolonization and the Evolution of International Human
Rights (Philadelphia: University of Pennsylvania Press, 2010).
²¹ A recent reminder of this is to be found in Frederick Cooper, Citizenship in between
Empire and Nation: Remaking France and French Africa, 1945–1960 (Princeton: Princeton
University Press, 2017).
²² Itty Abraham, How India Became Territorial (Stanford: Stanford University Press, 2014).
²³ Sunil Amrith, Decolonizing International Health: India and Southeast Asia 1930–65
(Basingstoke: Palgrave Macmillan, 2006). For an understanding of how UNRRA failed to do
so, see Manu Bhagavan, ‘Towards Universal Relief and Rehabilitation: India, UNRRA and the
New Internationalism’, in Dan Plesch and Thomas G. Weiss (eds.), Wartime Origins and the
Future United Nations (New York: Routledge, 2015), 121–35. For an example of India’s
transformation of this world order as an actor from the so-called Global South, see Alanna
O’Malley, ‘India, Apartheid and the New World Order at the UN, 1946–1962’, Journal of World
History 31, no. 1 (2020).
8    
had so far been absent.²⁴ Refugee history has moved beyond institutional
histories of international world order and the Office of the United Nations
High Commissioner for Refugees (UNHCR). The refugee has been recog-
nised as an important player in the story of the nation-state and its citi-
zens.²⁵ This widened historiographical field has paved the way for an Indian
view of the ideas and practices surrounding refugees.²⁶
Immigration and asylum regulations tend to prioritise the needs of the
receiving nation-state, in particular governed by concerns for a hazily
defined ‘national security’. A conventional understanding of such hospital-
ity, whether to immigrants or to refugees, sees it governed by a condition-
ality so as to prevent the host becoming a hostage to these guests.²⁷ I contend
that this understanding does not account for experiences of states like India.
Self-determination had brought with it the potential to change the world,
and this needed to be jealously guarded—but not from the refugee. The
relationship between host and guest in India does not meet the standard of
hostility implicit in this conditionality either.²⁸ It was not the guest or the
refugee who threatened the Indian state so much as the afterlives of an
imperially created international order that India strove to transform. The
refugee was familiarly human rather than a dreaded intruder. That latter
role, of hostage-taker, was played by an international order that placed
burdens on former colonies rather than alleviating them, and so restricting
the hard-won rights of the Indian people.
²⁴ Michael Barnett, Empire of Humanity (Ithaca: Cornell University Press, 2011); Davide
Rodogno, Against Massacre: Humanitarian Interventions in the Ottoman Empire 1815–1914
(Princeton: Princeton University Press, 2012). A recent work contributing to the idea of the
human and stranger underpinning humanitarianism is Keith Watenpaugh, Bread from Stones:
The Middle East and the Making of Modern Humanitarianism (Oakland: University of
California Press, 2017).
²⁵ The creation of the refugee as a ‘problem’ is best understood through the work of Peter
Gatrell: Peter Gatrell, Free World: The Campaign to Save the World’s Refugees 1956–1963
(Cambridge: Cambridge University Press, 2011); Peter Gatrell, Making of the Modern Refugee
(Oxford: Oxford University Press, 2012). For ideas of the place of refugees in the history of the
nation-state, and the need for histories of refugees, see Philip Marfleet, ‘Refugees and History:
Why We Must Address the Past’, Refugee Survey Quarterly 26, no. 3 (2007); Philip Marfleet,
‘Explorations in a Foreign Land: Refugees, States and the Problem of History’, Refugee Survey
Quarterly 32, no. 2 (2013).
²⁶ The first book-length work is Pia Oberoi, Exile and Belonging; Refugees and State Policy in
South Asia (New Delhi: Oxford University Press, 2006).
²⁷ Jacques Derrida and Anne Dufourmantelle, Of Hospitality (Stanford: Stanford University
Press, 2000). For an argument against universalising the hostility supposedly inherent in
hospitality, see Anne Norton, ‘Democracy’, in On the Muslim Question (Princeton: Princeton
University Press, 2013), 118–40.
²⁸ For a theorisation of hostility inherent in hospitality, see Jacques Derrida, ‘Hospitality’,
Angelaki 5, no. 3 (2000).
 9
The story of the refugee in India is also one of the tensions of progress and
the individual enjoyment of rights within the sovereign nation-state. ‘Awake
[ning] to life and freedom’, as Nehru promised in his famous midnight
speech on India’s Independence Day, was hardly an equal proposition, and
the progress of the larger community could dispossess its component groups
and individuals. Even those acting out authoritarian forms of government in
the postcolonial world did so in the name of the people.²⁹ The Indian state’s
revolutionary promise, and its approach to a democratic participatory
politics, was not always a guarantee of all Indian peoples’ rights when it
came to a vision for the nation’s progress and the greater good. Nehru
himself was aghast that student protests in the 1950s would use methods
of anti-colonial agitation against the postcolonial state, despite acknowledg-
ing the importance of dissent in a democracy. In granting popular sover-
eignty, the Nehruvian postcolonial state had created citizens that it had a
direct relationship with. Nehru thought it obliged them to this state rather
than choosing to act independently from, or even against, it.³⁰ The freedom
of Indian people, and the Nehruvian belief in its subsequent worldwide
emancipatory potential, came at a price.
This project is obviously adjacent to those histories of social and eco-
nomic rights that the framers of India’s constitution never codified in a
binding way in the constitution, lest dictating the methods of development
and distribution cut against cherished democratic principles. Thus, the
Directive Principles remain a guideline despite their inclusion in this docu-
ment. By not codifying such rights, enacting social and economic protec-
tions themselves created a lesser, ‘undeserving citizen’ who needed help
from the state rather than exercising the reciprocal obligation of rights and
duty outlined in the constitution.³¹ The Constituent Assembly debated
social and economic rights, and in making them non-justiciable placed
them in a second-tier category to civil and political rights. Just as the
question of equality for individuals who belonged to historical socio-
economically disadvantaged minorities was mediated through their group
identity, so too was the progress of the individual subjugated to larger Indian
²⁹ Barry Hindess, ‘Citizenship and Empire’, in Thomas Blom Hansen and Finn Stepputat
(eds.), Sovereign Bodies: Citizens, Migrants and States in the Postcolonial World (Princeton:
Princeton University Press, 2005), 241–56.
³⁰ Dipesh Chakrabarty, ‘ “In the Name of Politics”: Sovereignty, Democracy and the
Multitude in India’, Economic and Political Weekly 40, no. 30 (2005).
³¹ Niraja Gopal Jayal, Citizenship and its Discontents: An Indian History (Cambridge, MA:
Harvard University Press, 2013), 109–35.
10    
progress. The Assembly had decided that correcting backwardness and

uplifting the state as a whole were its main goals, but in practice progress
towards that modernity could dispossess these vulnerable groups further.³²
Projects like the dams that Nehru had cast as the ‘Temples of New India’
brought with them massive internal displacement, submerging entire vil-
lages or affecting the livelihood of local residents for miles around. The state
rarely compensated these people, instead justifying an (unwilling) sacrifice
for the greater good, often made by the same groups whose circumstances
had necessitated other sorts of protections.³³ In making such rights unen-
forceable, the state dispossessed and displaced persons while creating a
rhetoric of the failures of these citizens to dutifully contribute to progress,
instead needing state assistance to lift them out of poverty. The absence of a
welfare state in India allowed for inequalities, even those perpetuated in the
name of progress, to be addressed in the language of charity rather than
rights.³⁴ The history of refugees is a similar history to those of socio-
economically oppressed communities, of minorities and of what was owed
to the postcolonial state.
Indians needed the vehicle and protections of the nation-state in order to
challenge the inequalities in so-called universal principles, making the figure
of the refugee difficult to reconcile. Protecting refugees certainly upheld the
liberal idea of rights, but their crossing of national borders left open the door
to another threat. In being a subject for universal concern and international
governance (and possible intervention), the refugee became a threat to
the sovereignty of the democratic nation-state governed for and in the
name of the Indian people. Understanding the challenge posed by the
internationally defined refugee requires rejecting the individuality associated
with the refugee, as the bounds of personhood extend far beyond this to
³² For a discussion on backwardness and the constituent assembly, see Jayal, Citizenship and
its Discontents, 136–62.
³³ For the speech from which the phrase ‘Temples of New India’ is taken, see Jawaharlal
Nehru, Selected Works of Jawaharlal Nehru, Second Series, vol. 26 (New Delhi: Jawaharlal
Nehru Memorial Fund, 2000), 130–4. For an overview of displacement caused by projects like
dams and the loss of rights and displacements from 1951 until recently, see Smitu Kothari,
‘Whose Nation? The Displaced as Victims of Development’, Economic and Political Weekly 31,
no. 24 (1996); Biswaranjan Mohanty, ‘Displacement and Rehabilitation of Tribals’, Economic
and Political Weekly 40, no. 13 (2005); Arun Kumar Nayak, ‘Big Dams and Protests in India:
A Study of Hirakud Dam’, Economic and Political Weekly 45, no. 2 (2010).
³⁴ A connection examined in the case of Partition’s refugees in Joya Chatterji, ‘Right or
Charity? The Debate over Relief and Rehabilitation in West Bengal’, in Suvir Kaul (ed.), The
Partitions of Memory: The Afterlife of the Division of India (Bloomington: Indiana University
Press, 2001), 74–100.
 11
relationships, communities, and societies. Instead, clarity lies in appreciating

both where the refugee has come from and what this means for those
receiving them.³⁵ India treated incoming groups in accordance with their
potential to either fit into or assist the national project in defiance of the
Manichean terminology of the Cold War that divided the world into com-
munist and Western democratic camps just as the new state was finding
its feet.
Outline
This work writes the postcolony into histories of refugee-related humani-

tarianism by examining India’s voluntary exclusion. Looking at refugees in
India is an exercise in understanding the interaction of universalisms like
human rights, nationalism, and the experience of the individual. The refugee
was caught between India’s stated commitment to both human rights and a
better world order, while needing to defend the national sovereignty that
gave it a voice to argue in favour of both these universalisms. India accepted
human rights as legitimate, but kept asylum fluid to deal with this contra-
diction. Indian policies might seem ad hoc, but this opportunistic stance was
a product of the evolution of India’s understanding of the relationship of the
international order with the countries of the mid-twentieth-century wave of
decolonisation, and of the differences between human and citizen in the
postcolonial state.
Inequalities experienced by Indians in empire were clearly based on a
racialised hierarchy, which begs the question of whether the new Indian
government was reacting with a similarly racialised thinking. I do not
believe the majority of leaders of the newly created Indian state were
thinking in racial and ethnic terms so much as about who they shared a
common past with. In that context, the government was establishing who
was to benefit from the development promised by the acquisition of this new
state. Its mistrust of the European refugee was more of a reaction to the
exclusions of transnational whiteness and the nation-states that rested on its
discriminatory practices, rather than an idea to be emulated in reverse.³⁶
³⁵ Daniel, ‘The Refugee’, 278.

³⁶ Marilyn Lake and Henry Reynolds, Drawing the Global Colour Line: White Men’s
Countries and the Challenge of Racial Equality (Cambridge: Cambridge University Press,
2008).
12    
Chapter 1 is set in the early twentieth century and serves as a prehistory of

the refugee under colonial rule in India. It primarily examines the interwar
years, with some reference to earlier events. Its focus in on the place of
Indians in the transnational British Empire even as the nation-state-based
order of the League of Nations came into being. Looking at these side-by-
side brings issues of citizenship within the empire, including the place of
minorities, into tension within the prevailing international norms for bur-
eaucratic categories like refugees and their relationship to sovereign terri-
tory. In particular, it emphasises a lack of sovereign power for a people, and
the resultant lack of equal rights for Indians. Layering issues operating at
various geopolitical scales helps to understand how imperially created
categories—in an international order where empires held sway anyway—
could affect how the refugee was understood as the transnational empire
gave way to the postcolonial nation-state.
Chapter 2 is set in the 1940s. In this decade, the world transitioned from
the Second World War to a new peace, and India went from colony to
independent nation-state. India declined to join the International Refugee
Organization (IRO) and had withdrawn from its predecessor, the United
Nations Relief and Rehabilitation Administration (UNRRA), both prior to
the mass migrations of Partition. The only law codifying the presence of
aliens in India, though subject to future amendments, was passed in 1946.
The chapter places India’s idea of refugees within the international moment
in the immediate aftermath of the Second World War. Examining the anti-
colonial nationalists’ challenges to the liberalism that underpinned both
empire and the international order of the League makes clear the decolo-
nised nation-state’s moves towards a new internationalism that protected
the rights of its population that had been denied them in empire. They rested
on a certainty that despite their victimhood, interventions on behalf of
European refugees threatened the worldwide equality—both economic and
otherwise—that the new nationalist government aspired to for its Indian
citizens-to-be. The iron grip of the idea of the nation-state, and membership
of this state as the sole guarantor of rights pushed Indians towards rejecting
international norms. It is thus the point at which India’s alternative geneal-
ogy of human rights, including that of asylum, diverged from those of the
international order.
Chapter 3 will look at the refugees of Partition, specifically how they were
understood in relation to the secular, democratic, development-oriented
state envisioned by Nehru’s government. The aim is to understand how
those empowered to shape refugee policy—the Nehruvian elite and their
 13
critics—approached the displaced millions alongside the other problems of

the newly independent, decolonising state. Uplifting an economy that had
been ravaged by colonialism, the crises of the princely states of Kashmir and
Hyderabad, and the clash of the secular ideal of India with a Hindu
nationalist vision all intertwined with the rehabilitation of Partition’s refu-
gees. In the new Indian narrative of citizenship, the term ‘refugee’ was used
deliberately to define those whom the state felt it owed something to.
Everyone else, if at all in receipt of government assistance, was subject to
the kindness and charity of a government already stretched to its limit
building the new nation. Refugees were not allowed to ‘wallow’ and become
a burden, with the government machinery encouraging them to become
proactive citizens of the new nation. Their discontent with this situation
formed the beginnings of a resistant politics. While the government tried to
soothe dissent to bring the refugees in line with the Nehruvian vision of the
state, opposing voices co-opted the refugees to push their own vision of
the state. The refugees of Partition became a snapshot of the domestic
ideologies of the Indian state, demonstrating the blurry line between sub-
jecthood and citizenship that carried on into the postcolony. To build the
refugee was to build the state. In this context, the more Eurocentric vision of
the host as different from the guest was completely shattered because the
refugees were part of the national self. Instead, refugee rhetoric aligned with
that of Indian progress, and the many versions of what that could look like.
Chapter 4 looks at India’s approach to refugees who were recognised as
such by the international regime versus the new state’s treatment of a
returning diaspora who were part of the fallout of decolonisation. The
circumstances of Tibetan refugees in India in the 1960s attracted inter-
national attention. The question of providing them asylum provoked
domestic debate about India’s relations with China and had implications
for India’s vision of non-alignment, particularly regarding how human
rights and self-determination would be brought together in the changing
postcolonial world. Ultimately the Indian government led by Prime Minister
Nehru would focus on the Indian state’s right to grant Tibetans asylum and
assistance with limited involvement from the international community, with
public opinion calling for the group right to self-determination in Tibet.
Simultaneously, the Nehruvian vision of non-alignment was undergoing a
change from its immediate postcolonial form to one which actively
responded to Cold War currents. This was in stark contrast to the returning
Indians from Burma, who were termed ‘repatriates’ in the early 1960s
despite being treated similarly to the refugees of Partition. The term ‘refugee’
14    
no longer implied belonging to the Indian state as it had in the first fifteen
years of its existence. The Indian government tried to draw a clear line
between those displaced by India’s own decolonisation and Partition, and a
crisis that was a thorn in the side of Sino-Indian bilateral relations in the
bipolar world of the Cold War. The 1960s can therefore be seen as India’s
reframing of the term ‘refugee’ to reflect its own interests both domestically
and internationally.
Chapter 5 examines India’s approach to the influx of millions of East
Pakistanis into its territory in 1971. Early in the crisis, India had appealed to
the international community for assistance. To India’s mind, the project of
Partition was complete, and it was not prepared to accept a massive influx
from the Bengal borderland in the vein of Partition’s refugees. India’s
representatives insisted that these were Pakistani citizens entering Indian
territory, rather than a last migration from the Partition of India premised
on religion. This chapter aims to understand the place of 1971 in India’s
relationship with refugees who did belong to the subcontinent but not to
India, at least not any longer. It also highlights India’s relationship with the
United Nations High Commissioner for Refugees, the international com-
munity’s primary channel of engagement with the subcontinental crisis.
India reframed the crisis away from Partition, insisting that the international
community assist it in achieving a complete refugee return rather than
buying into a religious logic to the influx. Effectively, India was attempting
to understand where humanitarian impulse met realpolitik, in a total rever-
sal of its attempts to depoliticise the Tibetan refugee presence.
This book starts with migrations within empire and how they correlate to
a lack of equal rights. It finishes in 1971, with the project of Partition finally
deemed to have come to a decisive end with the East Pakistani refugees seen
as disenfranchised citizens of Pakistan rather than Hindus or Muslims
belonging to either state born of the Raj. It argues that India’s refugee
story predates Partition. The Indian state had achieved its intended
secular-democratic form in a victory against the two-nation theory, held
by the Muslim League and Hindu nationalists alike, that saw Hindus and
Muslims as separate, distinct cultures and therefore called for separate
homelands. This Nehruvian architecture is subject to change as the present
government’s re-conception of the Indian state has brought up the relation-
ship of citizen and refugee once again through amendments to India’s
citizenship law.
My work is a study of deviations from European experience-based notions
of the refugee and hospitality, and how they are manipulated in this new
 15
context. Indian leaders’ idea of rights, like that of self-determination and the
nation, was in conversation with global discussions. They were conscious of
the origins of this discourse in other parts of the world, and that it did not
follow the same sequence as these places in its arrival and evolution in India.
Awareness of how similar ideas applied differently to different contexts also
explains that the conception of the refugee relies on the moments in which it
found application in India.
The term refugee meant different things to the Indians at different points
in time, and these meanings were tied to how groups of displaced people
related to the sovereign Indian state. I look at how those empowered to
design India’s refugee policy understood and shaped this concept with
relation to the international order. This was done in response to domestic
concerns but largely remained in the hands of the Nehru-Gandhi family and
those who worked closely with them. The timeline for this project corres-
ponds roughly with the Indian National Congress elite’s hold on the state,
prior to the fuller realisation of political society in the 1970s and 1980s and
the simultaneous rise of more pragmatic electoral politics.³⁷ Even as the
Congress-led state was establishing this ad hoc relationship between citizen
and refugee as the mainstream version, other ideas of this relationship
developed too. Religiously defined notions of citizenship and refugee rights,
which are in vogue today, bubbled under the surface. Their proponents
engaged with these larger conversations on self-determination and rights,
even as a state-led secular-democratic rhetoric papered over these prejudices
in the first decades of the republic.
All of this points to the notion of two ideas born in the West being
transformed in this theatre. The first was the notion of the nation-state and
self-determination, while the second was human rights. I suggest two oper-
ations at work: one was maintaining independence from an international
order based on Eurocentric experiences; the other was the state’s relation-
ship with the refugee populations as an object of policy that acknowledged
its impact on citizenship. The Indian state’s granting of asylum would then
make refugee groups subject populations rather than necessarily sharing in
the sovereign power of the state, made possible only by the situation of
citizenship in flux in the decolonising world.
³⁷ For an understanding of the idea of ‘political society’, see Partha Chatterjee, Politics of the
Governed: Reflections on Popular Politics in Most of the World (New York: Columbia University
Press, 2004).
16    
Indian resistance to an umbrella refugee definition and associated uni-

versalising practices reveals the realities obscured by such an artifice of
terminology. Underneath legal language and the prevalent notions of
migration—in which some people should settle for a flimsy ‘safety’ over an
enjoyment of the simplest of rights of citizens—that dominates the news, is a
weaponisation of the category of the refugee. The legacies of empire and its
attendant hierarchies still govern the worldwide conversation on migration
and the fear of unassimilable minorities. Assessments of these peoples’
situations are far more ad hoc and flexible than the static, absolute norms
that today’s immigration regimes and associated propaganda would have us
believe. Like B.S. Chimni, I reject the idea that refugees from the Global
South are something different from those, mostly European, refugees who
came before so much as those receiving them classifying and filing them
differently.³⁸ India serves as an example with its open and frequent redef-
initions of the bureaucratic category of refugee and of migrant, and therefore
the larger self-determined collective, that so clearly operate elsewhere. This
global history of a postcolony offers insight into what is, essentially, a
worldwide postcolonial problem.
Concealed in Indian practice, as so much of India’s political thought is, is
a clearly stated theory of the refugee that sees this category as both consti-
tutive and destructive of citizenship and therefore self-determination. Born
at the pinnacle of Nehruvian India’s worldmaking ambition, it offers a
version of the refugee that is not Eurocentric. Instead, a close look at the
Indian conception also has the effect of understanding the current inter-
national refugee regime as but one version of the relationship of citizenship
(or the loss of a meaningful version of it) and rights. At every turn, India
challenged the meaning of the refugee, preserving self-determination as the
right from which all others stemmed, even as the promise of its revolution
dimmed in the 1970s.
³⁸ Chimni, ‘The Geopolitics of Refugee Studies’.

1
The Refugees’ Imperial Past
The Search for Self-Determination in Empire
In 1927, Brussels played the unlikely role of host to anti-imperialists from all
over the world. Belgium was still reeling from the revelation that King
Leopold’s humanitarian organisation that had ruled the Congo Free State
had in truth mistreated and mutilated residents of the Congo, who had been
forced to labour in rubber production. The shame of the scandal had made it
easier to persuade the authorities in Brussels to permit a World Congress of
Oppressed Peoples. In the avenues of a city that had flourished from the
spoils of colonisation and subjugation, representatives from Asia and Africa
mingled with European and Russian trade unionists and even members of
British Labour. Any event of this magnitude was bound to be of concern to
the Great Powers, and spies infiltrated the ranks of the attendees.¹ Brussels
became a site for the solidarity of anti-colonial movements, and what would
eventually become the Third World.²
Jawaharlal Nehru, a member of the anti-colonial nationalist Indian
National Congress, had been travelling in Europe in 1926, having escorted
his wife Kamala to a Swiss sanatorium. Aside from winter sports and improv-
ing his French, he filled his days socialising with exiled Indian dissidents.
Berlin was a natural point of convergence for radical thinkers and commun-
ists, and where he first heard of the gathering at Brussels. Nehru immediately
wrote to the Indian National Congress, suggesting that he represent their
interests at the event. Its leaders acquiesced, and Nehru was off to what would
become the founding of the League Against Imperialism.³
Nehru, who would go on to be independent India’s first Prime Minister,
made a credible debut on the world stage at Brussels and articulated
¹ Nehru recalls the story of a French spy who dressed in blackface to mingle amongst the
delegates as an African representative. Jawaharlal Nehru, An Autobiography, 3rd edition (New
Delhi: Oxford University Press, 1982), 164.
² This introduction to Brussels in 1927 is drawn from Vijaya Prashad, ‘Brussels’, in The
Darker Nations: A People’s History of the Third World (New York: New Press, 2007), 16–30.
³ Nehru, An Autobiography, 161.
Making Refugees in India. Ria Kapoor, Oxford University Press. © Ria Kapoor 2022.
DOI: 10.1093/oso/9780192855459.003.0002
18    
the tenets of India’s internationalism that would dominate its politics in the
following decades. Heading the first nationalist Indian delegation to the
United Nations, his sister Vijaya Lakshmi Pandit would recall his words
from this maiden outing:
The Indian National Congress stands for the freedom of India; freedom for
the poor and the oppressed from all exploitation . . . We realise that there
is much in common in the struggle which various subject and semi-
subject and oppressed peoples are carrying on today. Their opponents
are often the same, although they appear in different guises. The means
employed for their subjection are often similar . . . As our great leader
Mahatma Gandhi has said, our nationalism is based on the most intense
of internationalism. The problem of Indian Freedom is for us a vital and
urgently essential one; but at the same time it is not merely a purely
national problem. India is a world problem and, as in the past, so in the
future, other countries and peoples will be vitally affected by the condition
of India.⁴
Nehru introduced India’s freedom from British colonialism as an essential

precondition for the transformation of the imperial world order. His social-
ism became more moderate in the coming years, but the internationalist
core would remain. The very name of the organisation born at Brussels, the
League Against Imperialism (LAI), implied criticism of the imperial associ-
ations of the premier world organisation of the time. Nehru saw India as a
poster-child for all oppressed peoples and declared that the Indian problem
‘affects a large number of countries directly, and the world indirectly, in
the sense that it affects the most powerful imperialism of our time’.⁵ His
experience with the LAI gave Nehru a wider understanding of imperialism
which saw class and anti-colonialism as intertwined, and which allowed
for a conflation of India’s status with other, similar resistances.⁶ Nehru’s
⁴ Vijaya Lakshmi Pandit, The Scope of Happiness: A Personal Memoir (New York: Crown
Publishers, 1979), 220. For the full text of Nehru’s speeches at this conference, see Jawaharlal
Nehru, Selected Works of Jawaharlal Nehru (New Delhi: Jawaharlal Nehru Memorial Fund,
1979), vol. 12, 270–6.
⁵ Nehru, Selected Works, vol. 2, 275. For a detailed study of how Nehru’s nationalism and
internationalism developed in tandem against wider currents, see Michele L. Louro, Comrades
against Imperialism: Nehru, India and Interwar Internationalism (Cambridge: Cambridge
University Press, 2018).
⁶ Louro, Comrades against Imperialism, 19–64.
  ’   19
internationalism, and by extension that of the Indian National Congress,

critiqued the sort of imperialism inherent in the League of Nations inter-
national order. A world community that supported the broader exclusion
of an exploited South Asian diaspora from white men’s nations despite
their status as British subjects was symptomatic of colonialism and imperi-
alism at large.
The roots of India’s departure from international norms for refugees lie in
its experiences within a transnational empire. Within the subcontinent and
beyond it, India was subject to British concerns. They affected the move-
ments of Indian people within the empire, shaped political considerations of
refugees and humanitarianism, and, as Indian nationalists discovered, cre-
ated a racially unequal international order. Additionally, the end of the First
World War and the solidification of the homogeneous nation-state as the
successor to heterogeneous empire within Europe meant an exclusion of
minorities from a full national belonging. The problem of the refugee is
commonly understood, as famous in the writings of Arendt, as marginal-
isation and exclusion by the nation-state that acts as the guaranteed plat-
form for rights.⁷ The question of minorities and associated restrictive
immigration policies played important roles not only within Europe but
also for the intra-imperial Indian diaspora. There were similarities between
these citizens of empire and those European ‘refugees’ who came to the
subcontinent—often prisoners of war from imperial armies or dissidents
who were not accepted by the new nation-states created by the war. But once
any migrant group reached India, and resettlement rather than repatriation
became the call of the hour, those people were subject to immigration
conditions similar to those that applied to Indians in the empire. There
was one crucial difference, as these refugee Europeans did not have to pay as
much to migrate away from the subcontinent to the white settler dominions
in the empire. Examining the movement of Europeans to and from India,
alongside those of Indian migrants within the British Empire, reveals the
extent to which British officials used internationally accepted definitions—
‘migrant’ or ‘refugee’—in what were essentially imperial exercises of moving
people between British-controlled regions. The juxtaposition illuminates a
double standard, with the application of the category of refugee to
non-subject Europeans seemingly justifying policies of movement that
excluded Indian subjects on grounds of race. In turn, this exploration also
⁷ Emma Haddad, ‘The Inter-War Perspective’, in The Refugee in International Society,

99–127; Arendt, The Origins of Totalitarianism.
20    
highlights the circumstances in which the internationally created refugee,

born of the same imperialist internationalism that Indian leaders decried,
would never be accepted by Indian people.
Indian understandings of and policies towards ‘refugees’ were fundamen-
tally shaped by experiences of empire and internationalism in the first half of
the twentieth century. On one hand, the treatment of the Indian diaspora
across the British Empire reinforced a sense of community and Indianness, a
tangible (rather than imagined) community whose unequal treatment
brought Indian nationalist attention to issues of mobility and the uneven-
ness of migration and settlement. On the other hand, Indian engagement
with liberal internationalism, as embodied by Wilsonian self-determination
and the League of Nations, turned Indian nationalists’ attention to the issue
of citizenship, but through the lens of the minority. Together they forced
new considerations of what a future independent India might look like—
could it be a federation, a single nation-state, or a community of national-
ities? Engaging with the League brought forward the tensions of empire and
imperial citizenship, while also forcing Indian nationalists to think about
their own non-majority populations, whether religious and ethnic minor-
ities or the handful of refugees hosted in the subcontinent. This had its own
tangible consequences that intertwined with pre-existing community prac-
tices. These issues all set the stage for what would come during and after the
Second World War.
Indian Movement within Empire
Indians born in the directly British-controlled territories of the subcontinent

were considered British subjects, all of whom were theoretically equal across
the empire. However, towards the end of the nineteenth and beginning of
the twentieth centuries, there was a tension between the envisioned uni-
formity of this citizenship (used interchangeably with subjecthood by this
time)⁸ and the nationalist states in the colonial white settler dominions.
Immigration and movement within the empire would expose this tension,
with racial exclusion limiting the experience of British citizenship for the
⁸ Mark R. Frost, ‘Imperial Citizenship or Else: Liberal Ideals and the India Unmaking of
Empire, 1890–1919’, The Journal of Imperial and Commonwealth History 46, no. 5 (2008),
889–90.
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Mental disorder increases; headache becomes more violent, and
sometimes more localized; amblyopia tends to advance to complete
blindness, with marked swelling of the papilla, or special disorders of
vision, such as hemianopsia, occur; palsies, ataxia, convulsions,
contractures, rigidity of limbs, altered reflexes, local spasms,
anæsthesia, hyperæsthesia, paræsthesiæ, neuralgias, appear
according to the extent and location of the growth. Certain special
phenomena, according largely to the seat of the tumor, may also
appear, such as disorders of hearing, taste, or smell, polyuria,
diabetes, albuminuria, polyphagia, or dysphagia.
In the third or terminal stage paralysis, anæsthesia, convulsions, etc.

become more profound; mentality sometimes decreases to nearly
complete imbecility, although in many cases a fair amount of mental
power is preserved almost to dissolution. Involvement of the bowels
and bladder becomes a distressing symptom, involuntary
evacuations adding to the torments of the patient. Bed-sores,
acquired or trophic, appear; the patient's limbs are painfully
contractured; great emaciation is usually present. With agonized
head, often blind or deaf, with torturing pains in anæsthetic,
paralyzed, and wasted limbs, covered with painful sores, filthy
involuntarily, imbecile or demented, death comes as a thrice-happy
relief.
Cases have been reported in which intracranial tumors of

considerable size were discovered on autopsy, and had evidently
been present for years without their presence having been
discovered or even suspected; but these are extremely rare. In
general terms, however, it may be said that every case of brain
tumor must give rise to symptoms. These symptoms may be few or
many, slight or severe, brief or protracted, constant or paroxysmal,
according to circumstances. Our experience and study of the
literature of the subject lead us to the conclusion that the
pathological character of the growth would have some influence as
to the severity and prominence of symptoms. Gliomata—which are
sometimes hard to distinguish from the brain-substance, particularly
the soft gliomata, producing comparatively little pressure—when
located in certain so-called latent areas of the brain might escape
detection during life; so might also very small tumors of any kind
situated deeply in the substance of the brain.
The position taken by Obernier, that individuality has much to do with

the activity of symptoms of brain tumor, has some strength. He refers
particularly to the psychical response to the irritation caused by brain
tumors, which differs very much in different individuals. The fact,
which has been pointed out in the article on Hysteria, that hysterical
symptoms are often present in cases of brain tumor as well as in
other forms of organic disease, is also sometimes the cause of
mistake by the diagnostician. The cases of Hughes Bennett and
Eskridge will be referred to in this connection under Diagnosis.
When the subject of local diagnosis is considered farther on, those

regions which are most active and those which hold an intermediate
position in the production of particular and distinctive symptoms will
be more particularly discussed.
The possibility of the existence of multiple tumors should never be

overlooked. These are of comparatively frequent occurrence, and
sometimes give rise to a puzzling symptomatology. In our search
through the literature of the subject for cases we met with many
examples of multiple tumors. In preparing our table multiple tumors
were usually omitted. They give sometimes symptoms and signs so
conflicting as to make a local diagnosis impossible, and even to
confuse the expert as to general diagnosis. In other cases, however,
one growth of larger size or in an active region takes command of
the situation, and leads clearly to its diagnosis in spite of other less
significant tumors. This was shown, for example, in one of our cases
(Case 14). From the symptoms not only was the presence of the
larger tumor diagnosticated, but its exact location was indicated
during life. Post-mortem examination, however, showed a smaller
tumor at the inferior angle of the right lobe of the cerebellum, and
also some basal meningitis with effusion which had not been
suspected. The first tumor was one of the ascending frontal
convolution, extending into the fissure of Rolando. Its presence and
location had been diagnosticated by the right brachial monoplegia
and paresis of the leg, which later increased to paralysis of the limb,
with right facial paresis, ptosis, partial anæsthesia of right side of
face, and slight clonic spasms of the right arm. At the present time,
when the question of operating for the removal of brain tumors is so
prominently before the profession, and is now generally regarded as
justifiable for growths in this one location, the cortical motor area, the
possibility of the coexistence of another tumor should be carefully
weighed. In this case, owing to the clear diagnostic indications, the
question of operation was considered at the time of consultation, but
fortunately—in large part because the patient was almost in extremis
—it was decided not to operate. The operation would have been
futile, the autopsy showing that the probable immediate cause of
death was the basilar effusion which accompanied the cerebellar
growth.
In another case reported by one of us3 three gummata were found in

three different locations: one in the prefrontal region, another in the
retro-central fissure, and a third in the supramarginal convolution.
The general symptoms of brain tumor were present in this case, but
no localization was possible.
3 Arch. Med., viii. No. 1, August, 1882.
The following are other illustrations of multiple tumors and of tumors

with other lesions out of a large number which we have collected:
M. 44.—Several severe falls on the head. Recent chancre with

secondary symptoms. Six months before death headache which
grew worse; most severe in right supraorbital region, and also
obstinate vomiting, vertigo, hiccough, insomnia. Some loss of power
on both sides. Slow in answering and indisposed to talk. Choked
discs. Involuntary evacuations. Some improvement under treatment,
and then relapse. Complete blindness. Polyuria. Specific gravity of
urine as low as 1003 and 1005. Appetite at times ravenous. During
last few weeks of illness head inclined to the right side, probably
from spasm. Intense thirst throughout the illness.
(1) Large sarcoma in the white substance of the right parietal and
frontal lobes, involving ascending parietal convolutions. (2) Softening
and abscess of the right temporo-sphenoidal lobe and posterior base
of the right anterior lobe. Softened mass size of a hickory-nut in the
upper portion of the right ascending frontal convolution. (3) Small
cystic tumors of the choroid plexuses.4
4 J. T. Eskridge, Trans. of Philada. Path. Society, for 1878-79, vol. ix. p. 119.
M. 5.—Convulsions, beginning either in right foot or in right face; not

unconscious during fits. Right-sided hemiplegia. Double optic
neuritis, followed by atrophy. Gradual increase in size of head, with
gaping sutures. Later, rigidity of right arm and leg. Shortly before
death the following symptoms suddenly set in: headache,
convulsions of right side with unconsciousness and retraction of
head, rigidity of right arm, and tremor of right leg. Later, both arms
flexed, with constant tremors of left arm, spreading over whole body.
Right sterno-cleido-mastoid was stiff; almost opisthotonos.
(1) Enormous tubercular tumor of left cerebral hemisphere,

extending from depth of Sylvian fissure and eroding skull. Corpus
striatum soft and diffluent. Weight, over eleven ounces. (2) Tumor,
double size of pea, in lower part of middle lobe of cerebellum.5 This
case was especially interesting for the onset of the cerebellar
symptoms late in the case, caused probably by a late appearance of
the cerebellar tumor.
5 Hughlings-Jackson, Med. Times and Gaz., London, 1872-73 (2), p. 34.
M. 2.—Screaming fits. Vomiting. Paralysis of left side of face,

including corrugator and orbicularis palpebrarum. Winking in both
eyes suspended. Paralysis of external rectus muscle. Agitation and
contractures of right arm and leg. Later, unsteady movement of head
and right arm and jerking of right leg.
(1) Small glioma in left hemisphere of cerebellum, and (2) a similar

tumor projecting from left lateral half of floor of fourth ventricle at
common nucleus of the abducens and facial nerves.6
6 W. H. Broadbent, Proc. Clin. Soc. Lond., v. 66-68.
F. 45.—Epileptiform attacks for fourteen years. Vertigo, occipital

headache, disordered vision, intolerance of light, sleeplessness,
excitability, constipation, with paræsthesia of left side. Retraction of
head, vomiting. Very late, convulsive movements of right eye and
right side of mouth; then general clonic spasms, coma, and death.
No paralysis. For twenty-six years there had been an induration of
one breast, which toward end of life had a somewhat scirrhous
appearance.
(1) Glioma in right hemisphere of cerebellum 1¾ inches in diameter.

(2) Glioma in centre of middle lobe of left hemisphere of the
cerebrum ¾ inch in diameter. Surrounding nervous tissue softened
and broken down.7
7 William L. Bradley, Tr. Conn. Med. Soc., 1880, p. 39.
M. 65.—Sudden attack of spasm of left arm, with paresis and

coldness and numbness. Headache and staggering. Wandering in
mind. Not unconscious. Twitching in eye. Two days later violent
convulsion in entire left half of body, with vomiting; not unconscious.
After convulsion left hemiplegia, with left deviation of tongue. Head
and eyes turned to right; vertigo. Partial anæsthesia of left face,
body, and limbs. Paræsthesia; painful nervous shocks through
affected limbs. Sounds in back of head. Later, mind cleared up and
many symptoms ameliorated. Very late, convulsion and coma.
Cheyne-Stokes respiration, involuntary evacuations. Duration, seven
weeks.
(1) Tumor in ascending parietal convolution at junction of upper and

middle thirds. (2) Large tumor occupied entire occipital lobe, but did
not present on surface, reaching to convexity of descending cornu of
lateral ventricle.8
8 W. H. Broadbent, Tr. Clin. Soc. Lond., v. 233-236.
Headache is the most frequent and positive symptom of brain tumor.
It is rarely absent; in most cases it has peculiar characteristics. Its
usual type might be described as continuous pain, sometimes of
persistent severity, but generally with exacerbations or paroxysms of
great violence. No suffering can surpass that which some of the
victims of intracranial neoplasms are compelled for months or years
to endure. It is only equalled by the torture produced by malignant
growths in the vertebral axis, the throat, or the bones of the pelvis.
The pain is not, however, always of this character. In a comparatively
few cases it is described by the patient as dull or moderate, or he
simply complains of distressing sensations of weight, pressure, or
constriction. Usually in these cases, however, the pain increases and
becomes less and less endurable. In 100 cases the headache is
described as agonizing, violent, severe, or torturing 20 times; as
moderate or dull, 26 times. It is simply mentioned 20 times, but here
presumably it was of the ordinary severe type. Thus in 66 cases, or
66 per cent., headache of some type was recorded. No mention was
made of headache at all in 29 cases, in some of which, however, it
was doubtless present. In only 5 cases was it stated not to have
been present: 3 out of these 5 were said to be gliomata, and of the
other 2, one was probably gliomatous, and the other a cyst in the
brain-substance. Tumors of this kind, which exert comparatively little
pressure and which are not connected with the membranes, are
probably those which are least likely to cause pain. In several
instances the patients complained spontaneously of the pain being
greatest in the region of the head nearest the seat of growth. With
reference to cerebellar tumors, it somewhat generally supposed that
occipital pain is usually present. It sometimes is and sometimes is
not. In 15 cases of tumor of the cerebellum and of the fourth ventricle
the pain was described as occipital twice, as fronto-occipital three
times, and as cervico-occipital once. Callender has noticed that
cortical lesions are more frequently accompanied by localized pains
than lesions of deeper parts.9 Some of our cases would seem to
bear out this view, although the data are not numerous or complete.
9 St. Bartholomew's Hospital Reports, 1869, and Ferrier's Localization of Cerebral
Disease, p. 99.
In a few cases percussion of the head elicited or intensified pain in
the region corresponding to the location of the tumors. We believe
that percussion of the skull may afford valuable aid in localizing
encephalic tumors, particularly when they are meningeal or cortical.
Ferrier10 holds that percussion often elicits pain over the cranial
region beneath which a lesion is localized, and Alex. Robertson of
Glasgow11 has also directed attention to the value of percussion of
the skull in the localization of disease on the surface of the brain.
10 Brain, January, 1879.
11 Abstr. Internat. Med. Congress, 1881, p. 85, and Journal of Nervous and Mental
Disease, April, 1882.
Vomiting is of frequent occurrence, although it does not usually come

on as early or remain as persistently as headache. It is more likely to
be paroxysmal, with longer or shorter intervals of relief. It frequently
occurs at the time of the exacerbations of the headache, and
between the paroxysms of vomiting, nausea, slight or great, is often
present. It probably occurs in about 50 per cent. of all cases of brain
tumor. It is recorded as having been present in 34 out of 100 cases.
It was comparatively infrequent in antero-frontal growths, occurring
only twice out of 10 cases.
A case reported by one of us (Case 70) was a remarkable example

of persistent cerebral vomiting. For four weeks before her death the
patient vomited almost incessantly. The tumor in this case involved
the middle cerebellar peduncle and the adjacent region of the right
cerebellar hemisphere, and had grazed and superficially softened
the floor of the fourth ventricle.
We incline to agree with Ferrier12 that the majority of cases of

cerebral vomiting can be ascribed to irradiation of irritation by the
nerves of the cerebral membranes or to the physical effects of acute
pain. The nuclei of the trigeminus and of the vagus are in close
anatomical relationship in the medulla oblongata. Irritative
impressions conveyed from the cerebral membranes, and
particularly from the dura mater, to the trigeminal nuclei in the
medulla are transferred to the vagus and give rise to vomiting. In
tumors of the cerebellum the vomiting may be brought about through
the affection of the centres of equilibration and the concurrent
vertiginous sensations (Ferrier), or it may be due to direct irritation by
contiguity of the floor of the fourth ventricle. In general, the tumors
situated farthest forward in the brain appeared to be the least likely
to give rise to vomiting.
12 Brain, July, 1879.
Vertigo was noted in 31 out of 100 cases. Under this general

designation dizziness, giddiness, reeling, insecurity in the erect
posture, etc. have been included. The vertigo can be explained in
several ways besides by the view which refers it to an affection of
centres of equilibration in the cerebellum. Like headache and
vomiting, it seems sometimes to be the outcome of pure irritation of
the cerebral membranes. Alterations in the intracranial circulation
produced by the growth of the tumor is another probable cause.
Experiments have demonstrated the existence of a communication
between the arachnoid cavity and the labyrinth, and consequently
the increased intracranial tension present may result in pressure on
the labyrinthine fibres of the auditory nerve, and thus occasion
vertigo.
The importance of ophthalmoscopic examinations in suspected

cases of brain tumor can scarcely be overestimated. They will often
serve to clinch the diagnosis in favor of tumor. Of the 100 tabulated
cases, choked discs were recorded in 8; optic neuritis or neuro-
retinitis in 18. These results serve to show the importance of the
examination of the eyes. It will be seen that with Allbutt, Norris, and
others we make a distinction between choked disc, papillitis,
congestion papilla, or ischæmia of the discs, and descending or
interstitial neuritis. The differences between these two varieties of
inflammation of the interocular ends of the optic nerve are well
presented by Norris in a previous volume of this work,13 which will
make it unnecessary for us to describe the conditions present in
these cases. An examination of the tabulated cases will show that
true choked discs were present in tumors situated in all portions of
the encephalon. They were not infrequently present in tumors of the
convexity. Descending neuritis would seem most likely to occur when
the tumors are so situated that inflammation set up by them can
readily extend by anatomical continuity along the membranes to the
optic nerves. The lymph-space theory best accounts for the
occurrence of choked discs in cases of tumor situated remotely from
the base. In choked disc the appearance is one of intense swelling
and engorgement of the optic papilla. In descending neuritis, as
described by Graefe and Norris, there is rather a dull-red suffusion of
the disc. Some of the cases reported as neuritis may have been
choked discs, and the reverse, as physicians often do not make any
distinction.
13 Vol. IV. p. 771 et seq.
Several practical matters should be borne in mind in connection with

this subject of the condition of the eye-ground. In the first place, sight
is not always impaired in cases of even somewhat advanced choking
of the disc, so that when other symptoms and indications lead to the
suspicion of a brain tumor, unexpected confirmation may be obtained
by ophthalmoscopic examination. Some remarkable cases of this
kind have been reported, and doubtless have been observed by all
ophthalmologists and neurologists of large practice. In some cases
of growths of large dimensions also careful ophthalmoscopic
examination has shown neither choked disc nor neuro-retinitis to be
present. In two of Seguin's cases, for instance (Cases 28 and 29),
these appearances were absent. In one he reports no neuro-retinitis,
but only some fulness of the veins. In the other, a large sarcoma of
the centrum ovale, ophthalmoscopic changes were absent. The
absence of disturbance of vision, therefore, should not lead the
physician to overlook making a thorough ophthalmoscopic
examination; nor should the absence of ophthalmoscopic
appearances lead him to make up his mind that serious intracranial
disease was not present. The presence of double choked discs is in
the highest degree significant of a brain tumor.
Observations on the temperature of the head have been made in a
few cases of tumor of the brain. Full accounts of such observations
in two cases (1 and 3 of Table) have been published by one of us.14
It is not within the scope of the present paper to review the general
subject of cranial or cerebral thermometry. We will simply, in passing,
recall the labors of E. Seguin,15 Broca,16 Gray,17 Lombard,18
Maragliano and Seppilli,19 and Amidon.20
14 Philadelphia Medical Times, Jan. 18, 1879, and New York Medical Record, Aug. 9,
1879.
15 Medical Thermometry and Human Temperature, by E. Seguin, M.D., New York,

1876.
16 Progrès médical, 1877.
17 New York Medical Journal, Aug., 1878.
18 Experimental Researches on the Temperature of the Head, London, 1881.
19 Quoted in Archives of Medicine, 1879.
20 Archives of Medicine, April, 1880.
L. C. Gray21 has recorded some observations in cerebral

thermometry in one case of tumor of the brain. The tumor, a soft
jelly-like mass the size of a hazelnut, was found between the
horizontal branch of the Sylvian fissure and the first temporal fissure,
while the whole of the right occipital lobe was converted into a
colloid, extremely vascular mass, which gave way under
examination, this degeneration also extending anteriorly to the tumor
as far as the fissure of Sylvius. Microscopical examination showed it
to be a typical glioma.
21 N. Y. Medical Journal, August, 1878.
The temperatures at different stations were as follows:

Left. Right.
Frontal 96.75° 98.33°
Parietal 95° 99.75°
Occipital 96.75° 100.50°
The average of the left side was 96.16°; of the right, 99.52°; of the
whole head, 97.84°.
In a case of frontal tumor (Case 1 of Table) the average

temperatures of the different stations taken were as follows:
Middle frontal station 96.5°

Middle occipital station 95.5°
Right frontal station 95°
Left frontal station 94.7°
Right parietal station 94.7°
Left parietal station 94.4°
In another case, reported in full by one of us22 (Case 94), a gumma

involved the basal termination of the corpus callosum, the peduncles
of the corpus callosum, the lamina cinerea, and anterior perforated
spaces; and the average temperatures at the different stations were
as follows:
Right frontal station 97.1°

Left parietal station 94°
Right occipital station 97°
Left occipital station 94.5°
Right anterior vertical station 97°
Left anterior vertical station 94°
Right posterior vertical station 96.6°
Left posterior vertical station 94.3°
22 New York Medical Record, Aug. 9, 1879.

In a gumma in the cortical motor zone of the right side the head-
temperatures, taken once, were found to be for the right parietal
region, 97.2°; for the left, 96°. In another tumor of the right motor
zone the right frontal region gave a temperature of 98°; the left, of
96°. In a tumor of the left occipito-parietal region the temperatures
were for the right parietal region, 98°; for the left, 97.8°. Although the
temperature of the head was only taken once in each of these three
cases, the observations were carefully made with tested
thermometers.
J. T. Eskridge, in a case of a tumor of the cerebellum with monocular

hemianopia (Case 76), made the following temperature
observations:
Axillary R. 98.6°; L. 98.6°

Head:
Anterior frontal station R. 98.4°; L. 98.4°
Posterior frontal station R. 98.5°; L. 98.6°
Superior frontal station R. 98.4°; L. 98.4°
Parietal frontal station R. 99.2°; L. 98.6°
Rolandic frontal station R. 98.8°; L. 99.1°
Occipital frontal station R. 99.4°; L. 99.1°
Posterior central station 99°.
Anterior central station 99°.
The normal average temperatures, as determined by Gray, were as

follows:

Right frontal station 93.71°
Left parietal station 94.44°
Left occipital station 92.66°
Right occipital station 91.94°
Left side of the head 93.83°
Right side of the head 92.92°
The whole head, exclusive of the vertex 93.51°
Motor region of the vertex 91.67°
The whole head, inclusive of the vertex 92.66°
We conclude that in brain tumors the average temperature of the

whole head is elevated several degrees above the normal, and that
the elevation of temperature is usually greatest at the station nearest
the seat of the growth.
Mental disturbance of some description was present in about one-

third of all the cases studied. Doubtless they were not recorded in a
large number of cases. Obernier says: “If the psychical qualities of a
patient suffering from cerebral tumor be analyzed, and a careful
comparison made of the former with the existing mental condition,
certain symptoms of mental disturbance will be discovered in most
cases where the tumor is a growing one.” The disturbances may be
in any sphere of the mind—in intellection, volition, emotion, or
perception. Mental slowness and uncertainty, inability to fix the
attention, impossibility of continuous mental action, apathy, or
stupidity, with hesitation or slowness of speech, were strikingly
exhibited in cases of tumor of the antero-frontal region. In Case 1 the
patient's mental condition was studied with great care, and in the
detailed report of the case23 the following facts were noted: The
psychical manifestations were among the most important features of
the case. Although comparatively uneducated, he had been when in
health intelligent and energetic. He had never during his illness had
the gay humor or delirium of grandeur seen in the general paralysis
of the insane. His condition, on the whole, was one of intellectual
slowness and uncertainty. He seemed to have great difficulty in
receiving mental impressions and in directing the movements of his
body. His faculty of attention was, in great measure, destroyed. It
could only be fixed, and then but partially, by distinctly and
vehemently repeating a question or command. He could hear, but it
was necessary to make a tremendous external impression on his
sense of hearing in order to call out a mental response. He
sometimes appeared to me like a man dazed by a great catastrophe
which he could not understand. He was not aphasic, although he
manifested certain striking peculiarities of speech, or, rather, of the
manner of speaking. What he said, either spontaneously or in
answer to questions, was spoken clearly and distinctly and in a firm,
loud voice. His sentences were short, but complete; neither words
nor syllables were omitted; and he made no mistakes in articulation,
enunciation, or pronunciation. In answering he did not seem to be
able to retain for any length of time a hold upon the same idea or to
follow a particular train of thought. He did not wander from one
subject to another, but he would suddenly stop speaking, as if unable
to go farther. Often on being questioned he would try to reply, and
after a sentence or two would sob and burst into tears like a violently
hysterical woman. He would at times have what might be termed
volcanic outbursts of speech. When all was perfectly quiet in the
ward he would suddenly explode with a sentence or two, and then
again subside into stillness. Exclamations of this kind might be
repeated at intervals of a few minutes for hours together, or they
might recur only at intervals of hours. Sometimes what he said would
be connected with some past events of which he seemed to have a
vague recollection; often it would be a demand for something to eat
or drink; and often, again, it would be a paroxysm of profanity.
23 Philadelphia Medical Times, Jan. 18, 1879.
Impairment of will is not uncommon in antero-frontal and other

cerebral tumors, and failure of memory, depression of spirits, and
even acute mania, occur. Many of the patients are emotional,
excitable, and irritable; they often sob and cry, apparently from the
great pain. In some cases, however, emotional conditions are
present which seem to be dependent on some special localization of
the tumor. Hallucinations were noted in two of our tabulated cases.
In one case, a tumor of the motor zone, the patient had delusions
that some one was about to take him away. There were also illusions
of fear or persecution. In another the patient had visual
hallucinations.
Speech-defects of various kinds occur in connection with intracranial

growths. Ladame, quoted by Rosenthal, has cited forty-five cases of
disturbances of speech in which the tumor occupied the most varied
regions of the brain. Peculiar disorders of speech from special
localizations will be treated of under Local Diagnosis.
Local spasms, which go under various names, as cramps,

twitchings, epileptoid attacks, athetosis or athetoid movements, are
common symptoms, particularly of growths which involve the cortical
motor area. They are of great diagnostic value. They are commonly,
although not invariably, accompanied by paresis, which is usually
most marked in the part most affected by the spasm. These local
spasms, beginning in one extremity, in a finger or toe it may be, often
spread toward the centre, until they involve to a greater or less
extent the whole limb, the side of the face, or one-half of the body.
Sometimes instead of this they recur with the same definite
movements over a long period. They are the expression of irritation
of cerebral centres or tracts connected with the muscles or groups of
muscles affected by the abnormal movement. They should always
lead the physician to carefully consider the great probability of a
lesion in some way involving the motor area.
Tumors of the cerebellum, pons, and medulla oblongata sometimes

give rise to general convulsions which closely simulate attacks of
grave epilepsy. These convulsions or general spasms are among the
most important symptoms of intracranial neoplasms. More than
paralysis, they may be regarded as general symptoms, as they are
more likely to occur from tumors situated in different and distant
regions of the brain than paralysis. They are by no means confined
to cases in which the lesion is situated in the so-called motor area of
the brain or in the cerebellum or pons-medulla region. Both
physiological and pathological experiments have shown that
convulsions violent in character, but having certain special
characteristics, may originate from severe irritation of the dura mater.
According to Duret,24 irritation of the sensory nerves of the dura
mater cause reflex spasms or contractures of the muscles of organic
life. These spasms or contractures may occur in the face, eyeballs,
neck, trunk, or limbs, and sometimes on one side and sometimes on
the other. They tend to diffuse and invade neighboring groups of
muscles. “They have never the localization, the measured and
purposed character, of the contractions which belong to the lesions
of the cortex. They frequently become transformed into permanent
contractures.” The application of these facts and conclusions to brain
tumors is evident. As neoplasms are so frequently connected, either
directly with the dura mater or with the fused membranes, it is
evident that the convulsive attacks from which the patient suffers
may occur from tumors located anywhere within the cavity of the
skull.
24 Sur les Traumatismes cérébraux, par H. Duret, chapter iii., summarized in Brain.
vol. i., 1878, p. 47.
General convulsions, as well as local or unilateral spasms, are

present in many tumors of the motor cortex; but if their method of
origin and their progress are closely watched they will usually be
seen to begin with local twitchings.
A glance at the table will show examples of convulsion in almost

every region of the brain.
Contractures—conditions of tonic spasm which continue more or

less persistently—may be either early or late symptoms. They may
occur in one or several limbs, in the face, or rarely in the neck. They
are probably due in some cases to persistent irritation of the dura
mater, in others to comparatively slight but continuous irritation of
motor centres, and in still others to advanced degeneration of the
motor tracts.
Choreas and choreic movements are not frequent, unless some of

the forms of local spasm are regarded as local choreas. In one of
Petrina's cases, a glioma involving the substance of both frontal
lobes, choreic movements of the right arm were present, and in this
same case tremor in both arms was also a symptom. Tremor
simulating that of paralysis agitans or multiple cerebral sclerosis is
occasionally observed, and sometimes a tremor which is nervous or
hysteroidal in character is one of the results of the great suffering of
the patient.
Paralysis or paresis is of course one of the most frequent evidences
of the existence of an intracranial tumor. The palsies of cerebral
tumors are chiefly unilateral, but the loss of power may be in one or
both limbs, in one side of the face, or in the entire one-half of the
body, according to location and extent. Tumors of the cortical motor
zone usually begin their paralytic manifestations with paresis of one
member or one side of the face, which goes on, as the growth
increases in size, to more or less complete hemiplegia.
The paralysis which results from brain tumor is due either to

pressure or to absolute destruction of tissue. In the latter case the
destruction is brought about not only by the simple displacement of
brain-substance, but also through the obliteration of blood-vessels
and the consequent softening.
Peculiar forms of paralysis occur as the result of neoplasm growing

in special locations, as will be more clearly shown under Local
Diagnosis. Thus we have the alternating paralyses from tumors of
the crus cerebri or of the lower part of the pons, and paraplegia, or
perhaps what might be better called double hemiplegia, from multiple
tumors which affect both sides of the brain. In rare cases paralysis of
all four extremities has resulted from a growth in the middle line of
the base of the brain. Some form of paralysis is recorded to have
been present in 20 cases out of 100.
Apoplectiform attacks sometimes take place suddenly during the

progress of cases of brain tumor. A patient who has been suffering
for months with the general symptoms of tumor, and who may or
may not have had some paresis of the limbs or face, has an attack of
unconsciousness, from which he arouses after a time, and is then
found to be almost completely hemiplegic. After such attacks, in
some cases, the symptoms of brain-irritation, particularly the
headache and vomiting, subside or greatly improve. Such attacks
may be explained in several ways—from the occurrence of
congestion with œdema, of intercurrent hemorrhage, or of softening
from obliteration of blood-vessels by the advancing growth; and the
temporary subsidence or more permanent disappearance of the
headache and other symptoms is probably, in some cases at least,
owing to the diminution of tension because of the breakdown of
tissue in the neighborhood of the growth. Sometimes the seizures
which occur during the progress of the case are both epileptiform
and apoplectiform in character.
Sometimes in cases of intracranial tumor there are present in the

cranial nerve-trunks and the muscles supplied by them the changes
known as the reactions of degeneration. These changes are
characteristic of the peripheral palsies, and indeed sharply
distinguish them from paralyses of central origin. The exception to
this rule in cases of intracranial growths is, of course, only apparent
and not real, because these palsies, when caused by the pressure of
a tumor on a nerve-trunk, even within the cavity of the skull, and not
upon their proper centres or intracerebral tracts, are as much
peripheral as though the injury was caused by compression of these
nerve-trunks outside of the skull. These reactions of degeneration
are briefly as follows: The nerve-trunk gradually, sometimes rapidly,
loses its response to both the galvanic and faradic currents. The
muscle loses its response to faradism coincidently with the nerve-
trunk, but to galvanism it is apt to exhibit first increased excitability,
then gradually lessening excitability: and with this lessening
response it puts on the so-called qualitative changes. These consist
of the serial alterations—i.e. the negative pole, instead of exciting the
more active reaction at closure, gives a less response than the
positive pole at closure, and also calls forth a response at opening
which may be greater than the opening contraction of the positive
pole, which may be abolished. In health the positive pole causes
often an active response, and the negative pole none, or almost
none, at opening. Finally, occur modal alterations in the affected
muscles, which consist of a slow, lazy contraction instead of a quick,
lively one as in health, and a tendency in the muscle to remain
contracted (tetany) while the current is passing. The many
modifications—or, better, the partial exhibitions of these changes and
the conditions underlying them—are to be sought in detail in special
treatises. It is sufficient to say that they have been reported in a
number of cases of brain tumor, and that the nerves in whose
distributions they would be especially seen are the motor oculi, or
third, the abducens, or sixth, and the facial, or seventh. It is doubtful
if a very exact electrical examination could be made of many
muscles supplied by these nerves, except in the case of the facial,
and possibly the elevator of the upper eyelid. It is in the case of the
seventh nerve that the recorded observations have been made. It
will be noticed, by reference to the table, that the third, sixth, and
seventh nerves are frequently involved in tumors of the crus and
pons-medulla region, and that the paralysis is usually on the side of
the lesion. These are the cases which would exhibit the reactions of
degeneration. It has been said that in ordinary hemiplegia, and also
in paralyses from tumors of the brain high in the motor region, the
affected side exhibits simply a qualitative increase to electrical
excitation; and this may be explained by the increased excitability to
all stimuli of the lower or spinal-cord centres when cut off from the
brain. The statement, however, which has been made, that in tumors
of the cerebellum the sound side exhibits a quantitative decrease,
sounds like a paradox, and requires further tests before being
accepted as a fact in electro-diagnosis.
Ataxia has been observed in cases of brain tumor situated in various

locations. The symptom described as ataxia, staggering, or
staggering backward, is more particularly observed in cases of tumor
of the cerebellum, pons, and corpora quadrigemina.
Changes in the state of the reflexes are somewhat frequent. Usually

the skin and tendon reflexes will be increased on the side opposite
the lesion, although some striking exceptions, probably due to the
positions of the growth, occur.
Atrophy of the limbs is sometimes present, but usually in brain tumor,

as the lesions are above the nutritive connection of the nerve, true
atrophies do not occur.
True neuralgias are frequent, particularly in the distribution of the

trigeminal. Trigeminal neuritis also undoubtedly occurs in lesions
involving this nerve at its origin, in its course, or in the Gasserian
ganglion.
Anæsthesia, either in the form of local or hemianæsthesia, was
observed in about 20 per cent. of the cases. It is rarely present as an
isolated symptom, but frequently accompanies unilateral paresis. In
a partial or variable form it most frequently is seen in connection with
tumors of the Rolandic region. It is a marked symptom in postero-
parietal growths and those involving the posterior part of the internal
capsule. It may take the form of loss of sensation to pain, touch,
pressure, temperature, etc.
Hyperæsthesia occurs so commonly as to be almost regarded as a

general symptom of brain tumor. Sometimes it is confined to the
head; sometimes it is generally diffused; more frequently it is present
in the limb or limbs affected with the paralysis. With hyperæsthesia
the patients often complain of spontaneous pain in the limbs.
Diplopia or double vision is a somewhat frequent symptom, occurring

most commonly, of course, when the ocular nerves are involved
directly or indirectly by the tumor; hence tumors of the floor of the
skull, of the crus cerebri, of the pons, or of the cerebellum are most
likely to give rise to this symptom. A close study of the character of
diplopia and of other symptoms which go with it will usually enable a
local diagnosis to be made. Diplopia, however, does sometimes
occur in tumors situated remotely from the base, either because of
pressure, because of general nervous weakness, or possibly
because of involvement of cortical oculo-motor centres.
Ptosis is another symptom, generally unilateral, and most frequently

present in connection with strabismus, diplopia, and dilatation of the
pupil from involvement of the third nerve. Dilatation of the pupil and
contraction of the pupil may be present as general symptoms of
tumors. The latter is most probably due to meningeal irritation.
Hemianopsia is another ocular symptom sometimes present in cases

of brain tumor, as it may also be in other forms of encephalic lesion.
It was present in 5 of 100 cases. Norris25 gives a full description,
brought well up to the present time, of this symptom, and a
discussion of the lesions upon which it depends. Seguin26 also
discusses this subject. Starr27 has collected a large number of cases

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Making Refugees in India (Oxford

Historical Monographs) Ria Kapoor

Making Refugees in India

OXFORD HISTORICAL MONOGRAPHS

.  .  . 

I am so grateful to dear friends who were on their own academic journeys

¹ ‘Deportation of Antonius Raab, a Baroda State Employee’, Ofﬁcial Report of the

2    

⁷ ‘Deportation of Antonius Raab, a Baroda State Employee’, Ofﬁcial Report of the

4    

refugee is a discourse upheld by a manufactured infrastructure and categor-

¹⁰ E. Valentine Daniel, ‘The Refugee: A Discourse on Displacement’, in Jeremy MacClancy

6    

news to the Indian state as revealed in Chapter 4 of this work.¹⁶ These

movements focused on collective rights—notably self-determination as the

8    

10    

progress. The Assembly had decided that correcting backwardness and

relationships, communities, and societies. Instead, clarity lies in appreciating

This work writes the postcolony into histories of refugee-related humani-

³⁵ Daniel, ‘The Refugee’, 278.

12    

Chapter 1 is set in the early twentieth century and serves as a prehistory of

critics—approached the displaced millions alongside the other problems of

14    

16    

Indian resistance to an umbrella refugee deﬁnition and associated uni-

³⁸ Chimni, ‘The Geopolitics of Refugee Studies’.

18    

Nehru introduced India’s freedom from British colonialism as an essential

  ’   19

internationalism, and by extension that of the Indian National Congress,

⁷ Emma Haddad, ‘The Inter-War Perspective’, in The Refugee in International Society,

20    

highlights the circumstances in which the internationally created refugee,

Indian Movement within Empire

Indians born in the directly British-controlled territories of the subcontinent

In the third or terminal stage paralysis, anæsthesia, convulsions, etc.

Cases have been reported in which intracranial tumors of

The position taken by Obernier, that individuality has much to do with

When the subject of local diagnosis is considered farther on, those

The possibility of the existence of multiple tumors should never be

In another case reported by one of us3 three gummata were found in

The following are other illustrations of multiple tumors and of tumors

M. 44.—Several severe falls on the head. Recent chancre with

M. 5.—Convulsions, beginning either in right foot or in right face; not

(1) Enormous tubercular tumor of left cerebral hemisphere,

M. 2.—Screaming fits. Vomiting. Paralysis of left side of face,

(1) Small glioma in left hemisphere of cerebellum, and (2) a similar

F. 45.—Epileptiform attacks for fourteen years. Vertigo, occipital

(1) Glioma in right hemisphere of cerebellum 1¾ inches in diameter.

M. 65.—Sudden attack of spasm of left arm, with paresis and

(1) Tumor in ascending parietal convolution at junction of upper and

Vomiting is of frequent occurrence, although it does not usually come

A case reported by one of us (Case 70) was a remarkable example

We incline to agree with Ferrier12 that the majority of cases of

Vertigo was noted in 31 out of 100 cases. Under this general

The importance of ophthalmoscopic examinations in suspected

Several practical matters should be borne in mind in connection with

15 Medical Thermometry and Human Temperature, by E. Seguin, M.D., New York,

16 Progrès médical, 1877.

17 New York Medical Journal, Aug., 1878.

18 Experimental Researches on the Temperature of the Head, London, 1881.