CHAPTER 4: VACCINATION WITH REFERENCE TO LEPROSY
HAVING shown, on the authority of some of the most eminent dermatologists and superintendents of leper asylums, and from the testimony of those who have devoted special attention to the study of leprosy, that the disease is inoculable and spread by inoculation, we proceed to inquire whether there is evidence that this inoculation may be due in whole or in part to vaccination. When dealing with this question, I am aware that I am treading on delicate ground, inasmuch as vaccination has been lauded as an operation benign in its nature, free from peril, "the greatest discovery in the history of medicine," *
*Sir John Simon, late Chief Medical Officer to the Local Government Board, speaking of Jenner and vaccination in his "English Sanitary Institutions," London, 1890, p.123, note says :"I venture to predict that the new evidence [before the Royal Commission on Vaccination], so far as it may regard the merit of his discovery, will establish more firmly than ever that Jenner's services to mankind, in respect of the saving of life, have been such that no other man in the history of the world has ever been within measurable distance of him."
and, out of half-a-million prescriptions or so, the only one possessing such transcendent merits as to justify its universal compulsory enforcement. It is, moreover, considered by many ardent advocates to be impolitic to do or say anything calculated to discredit vaccination. It is hardly necessary to remind our readers that there has never been a scarcity of medical inventions which have held out similar promises. Smallpox inoculation, which, according to Dr. Moore, cost the nation millions of lives, was universally accepted by the profession for the best part of a century as a discovery "highly beneficial to mankind;" and it would not have been difficult, had it been originally an English discovery, to have obtained a munificent grant from Parliament, and possibly to have persuaded the Government to make it obligatory and universal. The practice of bleeding and cupping was in vogue for at least three centuries, and the use of huge doses of mixed and noxious drugs for nearly as long a period. Jenner received a reward of £30,000 from Government on his explicit assurance that vaccination would make an end of small-pox. The evidence brought before the Royal Vaccination Commission in London, by statisticians and able pathologists, abundantly shows that, while it has had no effect in diminishing either sporadic or epidemic small-pox, it has been a prolific source of the spread of inoculable maladies, such as skin disease, pyaemia, eczema, phlegmon, and, notably, leprosy and syphilis.
THE WEST INDIES.
One of the earliest medical practitioners to call public attention to the spread of leprosy by vaccination was Dr. R. Hall Bakewell, president of the Board of Health, Trinidad, who, as Vaccinator-General of that island and Visiting Physician of the Leper Hospital, possessed unusual opportunities for observing the effects of vaccination upon the health of the people. In a communication dated 31st December, 1870, Trinidad, to the Colonial Secretary, London, Dr. Bakewell says :" The question is not as simple as it appears. It is not a question of half-a-dozen minute punctures in an infants arm versus an attack of small-pox. It is a question of performing on every child that is born into the world, and that lives to be three months old, an operation sometimes, though very rarely; fatal; sometimes, but not frequently, attended with severe illness, always accompanied by considerable constitutional disturbance in the form of fever; sometimes, in an. unknown proportion of cases, introducing into the system of a healthy child constitutional syphilis, but suspected in the West Indies of introducing a poison even more dreaded than that of syphilisleprosy. And the parent is required by law to subject his child to these evils, most of which are only possible, but one of which is certain (the fever), for the purpose of avoiding the chance of an epidemic of small-pox, which, when it does occur, may or may not attack the child.
"It may be taken as proved that the syphilitic poison may be, and has been, introduced into the system of a previously healthy child by means of vaccination. But we know that leprosy is a constitutional disease, in many respects singularly resembling constitutional syphilis; like it, attended by stainings and diseases of the skin; like it, attacking the mucous membrane of the nose, throat, and mouth; like it, producing falling off of the hair, diseases of the nails and bones; and, like it, hereditary. Why should not the blood of a leprous child, whether the leprosy be developed or not, contaminate a healthy one?
"It seems to me not merely a popular opinion, but a medical one also. In returning to Europe in the spring of this year, I met several medical men from Demerara and other tropical countries, and they all considered that leprosy might be, and is, propagated by vaccination.
"Such cases as the following are difficult to account for, unless one adopts the hypothesis that leprosy is contagious (and, if contagious, a fortiori inoculable). The daughter of a colonel in the army, who held a staff appointment in one of our tropical colonies, contracted leprosy while in the colony. There could be no hereditary tendency, for both the parents are English, and it could not have arisen from bad diet. The young lady herself was a creole, but I was not able to discover whether she had been vaccinated from a creole or not. When I called in to see her in England, the disease was so far advanced that nothing could be done for her.
"Four cases at this moment in this colony are whites, both of whose parents are Europeans."Royal Gazette, Trinidad, March 1, 1871.*
*Since the above was written I have been informed by the father of one of the patients that Sir Ranald Martin, on being consulted after seeing the case, pronounced that the leprosy had been caused by vaccination.Footnote to Dr. Bakewells Report.
Dr. Bakewell was summoned on behalf of the Government to give evidence before the Select Vaccination Parliamentary Committee in 1871, and testified as follows (Answer 3563, p. 207 Official Report) : "There is a very strong opinion prevalent in Trinidad, and in the West Indies generally, that leprosy has been introduced into the system by vaccination; and I may say that, as Vaccinator-General of Trinidad, I found that all the medical men, when they had occasion to vaccinate either their own children or those of patients in whom they were specially interested, applied to me for English lymph; and that was so marked that in one instance a man, who had never spoken to me before, wrote me quite a friendly letter, in order to get lymph from England when he had to vaccinate his own child. It is quite evident that the only reason for wanting lymph from England must be that they consider it free from contaminating the system by leprosy; because, of course, there is an equal chance, and probably a greater chance in England, of the lymph being contaminated by syphilis."
Question 3564 and Dr. Bakewells answer (pp. 207-8) are as follows : Q." Have you had experience of any case in which Leprosy has been introduced by vaccination?"
A." I have seen several cases in which it seemed to be the only explanation. I have a case, now under treatment, of the son of a gentleman from India who has contracted leprosy, both the parents being of English origin. I saw the case of a child last year, who, though a creole of the Island of Trinidad, is born of English parents, and is a leper, and there is no other cause to which it is attributable. Sir Ranald Martin, who is a great authority on these points, agreed with me that the leprosy arose from vaccination." *
*Since the above evidence was communicated, twenty years ago, Dr. Bakewell has availed himself of opportunities for extending his researches into the causation of leprosy in New Zealand, which have served only to confirm and strengthen his previous conclusions. In a paper read before the Auckland (New Zealand) Institute, 20th July, 1891, and printed in vol. xxiv. of the "Transactions of the New Zealand Institute," Dr. Bakewell observes that the inoculation of leprosy by means of vaccination is now exciting much attention, and he gives the results of his more recent Inquiries into the subject of vaccination, citations from which will be found in the appendix to this volume.
In a State paper addressed to Earl Granville, consisting of correspondence on the subject of leprosy, presented to both Houses of Parliament by command of Her Majesty, May, 1871, Dr. Bakewell refers to a boy, aged 15, brought from Guadaloupe by Dr. Brassac at the expense of the French Government, in which the disease was attributed to vaccination from a leprous source.
No notice seems to have been taken of this startling testimony by the Select Vaccination Committee in their Report; and it was not until the publication of Professor Gairdners remarkable cases in the British Medical Journal, June 11, 1887, that further inquiry was attempted. In the same year Governor Robinson, of Trinidad, issued a circular to medical men in the Colony, referring to these cases. This letter contained the query, "whether the disease (leprosy) is communicable by vaccination, lymph from healthy vesicles alone being used." It is obvious that the form in which the question was submitted was, but little calculated to elicit the true facts. If "healthy vesicles" alone were used, it is clear that no disease, other than vaccinia, could result, and vaccination would be acquitted from a serious indictment, which was the evident intention of the experts who formulated the question. To discuss whether, and how far, impure lymph; or the arm-to-arm lymph in general use in countries like Trinidad, where leprosy is endemic, could convey leprosy, would have been to travel beyond the scope of the inquiry. To this circular twenty-seven replies were received, which may be summarised as follows :
(a) Upon the matters of experience, two of the witnesses, Dr. Alston and Dr. Chittenden, do not clearly indicate how far their experience warrants them in expressing an opinion upon the question. Of the remainder, four, Dr. de Verteuil, Dr. R. F. Black, Dr.R. H. Knaggs, and Dr. Bevan Rake, appeal confidently to their own practice. The others do not appear to have had sufficiently extensive experience to warrant a conclusion.
(b) As to the communicability of leprosy by vaccination, two of the writers, Dr. de Verteuil, and Dr. Bevan Rake, consider that leprosy cannot be inoculated by vaccination, if pure lymph be used. Dr. Black is of opinion that leprosy can be inoculated, though lymph from healthy vesicles alone be used. All the others express themselves with uncertainty and hesitation, or else disclaim having an opinion worth expressing upon the subject. Dr. de Montbrun, senr., says that leprosy would not be inoculable if every medical practitioner selected very healthy infants, born from healthy parents. and used only the lymph which exudes spontaneously after the puncture of the vesicles. Hardly any of the witnesses refer to the notorious difficulty, not to say impossibility, of ascertaining what families are leprous; concealment, for prudential reasons, being the rule, as admitted by intelligent inhabitants in all the leprous districts I have visited. Dr. Robert Francis Black, who has resided sixteen years at Port of Spain, Trinidad, informed me that his attention had been directed to the subject, and he had not the smallest doubt as to the invaccination of leprosy. He replied to the circular as follows:--
76 Queen Street, Trinidad,
July 16, 1887.
SIR,I have the honour to acknowledge the receipt of your confidential circular, No. 1818, dated 12th instant, and beg to state, for the information of His Excellency the Governor, that my experience of leprosy agrees with the statements of Professor W. T. Gairdner, of Glasgow, contained in your circular, and that I am of opinion that the disease in question is communicable by vaccination, lymph from healthy vesicles alone being used.
I myself have seen two or three cases of leprosy following vaccination, and have questioned the parents closely, but failed to ascertain or detect any family taint in either. Both the parents were respectively from Africa and China, the other was of creole parentage, but all the children were born here. With reference to these facts, I may mention here that, as far as I can recollect, the periods of incubation after vaccination were from two to three years; in fact, immediately after vaccination all were seized with obstinate cutaneous eruptions. As these were casual cases, I kept no memoranda, and as they did not return I lost sight of them, they probably concluding that it was hopeless to do so. I am also of opinion, for the reasons here stated, that arm-to-arm vaccination, at least in Trinidad, where leprosy is decidedly on the increase, is bad, as many very respectable families here are tainted with the disease, and nearly all the Portuguese have some member of their families actually diseased.
In conclusion, I may mention that I am also of the opinion that leprosy, like syphilis, tubercular phthisis, and cancer, is hereditary and contagious.
I have the honour to be, Sir,
Your obedient servant, R. F. BLACK,
Dr. C. B. Pasley, Acting Surgeon-General, etc.
Dr. Gairdners cases are reported in the British Medical Journal, June 11th, 1887, with the following title: "A Remarkable Experience concerning Leprosy; involving certain Facts and Statements bearing on the, QuestionIs Leprosy Communicable through Vaccination?" By W. T. Gairdner, M.D., LL.D., Professor of Medicine in the University of Glasgow :
"The time seems to have arrived when, without injury or offence to anyone concerned, it is possible to bring under the notice of my medical brethren some facts, and some inferences arising more or less directly out of the facts, in a case which occurred to me some years ago, but which I have found it necessary hitherto to deal with as involving matters of professional confidence not suitable for publication. Even now I shall deem it expedient to frame this mere narrative in such terms as shall not point to any definite locality, or to any recognisable person, among those chiefly concerned; although, by a formal certificate granted only the other day, I feel, as it were, absolved from the last tie that bound me, even under the most fastidious sense of professional duty, to reticence.
"Six or seven years ago, the parents of a young boy, fairly healthy in appearance, but with a peculiar eruption on the skin, brought him to me, and along with him a letter from a medical gentleman whom I had entirely, or almost entirely, forgotten, but who stated himself to have been a pupil of mine in Edinburgh considerably over twenty years before. It is unnecessary to enlarge on the particulars of this case, further than to state that, after more than one most careful examination, in which I had the assistance of my colleague, Professor MCall Anderson, we came to the conclusion which we announced to the parents, that the boy was suffering from incipient, but still quite well-marked, leprosy in its exanthematous form; a diagnosis afterwards amply confirmed. What struck me at the time as most peculiar was, that this case, coming from a well-known endemic seat of leprosy (an island within the tropics) and with a letter involving medical details by a medical practitioner of many years local experiencesent to me, moreover, for medical opinion and guidanceshould not have been more frankly dealt with by a diagnosis announced even to the parents, before they left the island. The father of the child was a sea-captain constantly engaged in long voyagesfor the most part between this country and the island alluded to. Both father and mother were Scotch, and there were several other children, all reported as quite healthy, as also were both the parents. Under these circumstances I wrote to the medical manwho in the sequel may be called, for brevity, Doctor X.simply stating the diagnosis arrived at, and indicating the line of treatment proposed. The parents were informed that it would be best for the child to live in this country, and his mother agreed to remain with him accordingly. And, as they appeared anxious to have every available suggestion and advice, I mentioned the name of Dr. Robert Liveing as having given much attention to the subject, and offered to write to him if they would take the boy to London, as they appeared desirous of doing. Although I wrote to Dr. Liveing, circumstances unknown to me led to a change in their plans, and, instead of going to London, they wont to Manchester, where I believe some physician was consulted, but I do not remember who he was. Ultimately, the mother determined for a while to settle in Greenock, and I placed her accordingly in communication with Dr. Wilson of that town, who for some time thereafter remained in medical charge of the case.
"Meanwhile, the course of post brought me in a few months a reply from Dr. X., not only entirely assenting to our diagnosis as communicated to him, but stating that he had been perfectly well aware from the first of the case being one of leprosy, but had deliberately chosen not to affirm the fact or even to allude to it in any way, either in his communications with the parents or in his letter to me. No reason was assigned for this (as it appeared to me) very remarkable reticence; but, as I did not wish to have the credit of having discovered for the first time what a gentleman so much more familiar with the disease might have been supposed to have overlooked, I took means to inform the parents of Dr. X.s reply, and of his having been all along of the same opinion with regard to the disease as we were.
"After this the matter passed out of my mind, and for several years I neither saw nor heard of this child except accidentally and in a way entirely to confirm first impressions. About three years ago, however, while engaged in lecturing on specific diseases, and among others, briefly, on leprosy, I made an effort to find out something more about this patient. The mother had removed to Greenock, and had brought over the whole family to Helensburgh, where, as I learned, they were visited by Drs. Reid and Sewell, and from the latter I now learned that the poor boy had gone steadily to the worse, and was extremely feeble, covered with sores, and in a most deplorable condition physically, but still receiving every attention and care that constant medical treatment, with the most faithful and loving maternal nursing, could afford to lighten his sufferings. I accordingly proposed, within the next few days, a visit to my old patient, as a matter of satisfaction to myself. Unhappily there was no other apparent object, either as regards diagnosis or treatment, for a visit which was, nevertheless, very gratefully accepted.
"The case was now in the most advanced stage of leprosy, proceeding to mutilation of the extremities, and accompanied not only by external sores, but presumably by internal lesions, which had reduced the patient to the last stage of emaciation. It was on this visit that the curious particulars now to be related were first brought to my knowledge by Dr. Sewell, and afterwards confirmed by the statement of the mother, showing very clearly, though, of course, upon second-hand information to a certain extent, that Dr. X. had a very special reason for his extraordinary reticence in the first instance. Her husband, who in his frequent voyages had opportunities of coming into communication with Dr. X., had remarked to him how very strange it was that, even in writing to a medical man about the case, he had given no hint of his opinion about it. The Doctors reply to this was, in the end, to the effect that he had kept silence because he did not wish to compromise a boy of his own, whom he (Dr. X.) believed to be a leper, and from whom he believed at the time that the boy he had sent to this country had become infected with the disease. He further explained that he had vaccinated his own boy with virus derived from a native child in a leprous family, and, as I understood (though perhaps not definitely so stated) that leprosy had declared itself in the native child after the vaccination; and, further, that (using his own child as a vaccinifer) he had vaccinated our patient directly from him. Before sending the last-named patient away with his parents, he had satisfied his own mind not only that his own boy was leprous, but that he had in this way become the source of the disease to another; but, the disease in his own child being in a very mild form, he was anxious not to disclose its existence. Meanwhile Dr. X. had died; his estate had passed into the hands of trustees; and I was informed that this reputed leper-boy had been, under the instructions of his father and his guardian, placed and retained at a public-school well known to me in this country, and that the boy was pursuing the usual course of a public-school education, in entire unconsciousness or the disease with which he was supposed to be affected.
"This information, so communicated, placed me in rather a difficult dilemma, namelywas I justified in taking steps to ascertain the truth of the story as regards Dr. X.s boy, either by personal investigation or, at least, by inquiries conducted so as to result in a well-grounded and scientifically exact opinion as to the facts? And, further, supposing that such opinion should turn out to be that Dr. X.s boy was a leper, was it a matter of duty on account of others to formally disclose the fact, be the consequences to the boy what they might? It was hardly probable that a boy generally known to be a leper would be retained permanently in any public school in this country, even had it been unquestionably a matter of medical doctrine that such a proceeding was quite safe. On the other hand, the boy was receiving the benefits of an English education at the express wish and on the responsibility of his father and guardian, and without (so far as appeared) any misgivings on the part of anyone. He was an orphan, and in what was to him a foreign land; his remaining under instruction might be, and probably was, a matter of the greatest possible importance to him. To bring him, therefore, even by an indiscreet inquiry, under the ban which in many or most countries still attaches to leprosy was certainly no part of the business of an outsider, and could only be justified at all by an overwhelming sense of duty to others.
"Under these circumstances I thought it well to consult, privately, one or two of those friends in London whom I believed to know most about leprosy, and among others Dr. Liveing, whom I was able to remind, at this stage, of my previous letter. These friends concurred in assuring me that, in the rather improbable event of their being personally consulted as to the retention of a leper in a public school (it being presumed, of course, that he was physically fit otherwise), they would have no hesitation at all in affirming that the other boys would not be endangered by such proceeding. As I happened to be very well acquainted with one of the medical officers (though not the ordinary medical officer) of the school in question, I communicated these opinions to him, and stated to him at the same time the extraordinary circumstances which had begotten, for me, such a lively interest in the son of Dr. X. In the course of a few days I was informed that an inquiry had been held by the medical staff; that the boy had been sent for and privately examined (though not ostensibly ill in any sense); and that it was, beyond all doubt, considered to be a case of leprosy. The medical authorities decided, however, that under the circumstances it was not their duty to sound the alarm, or in any way to disturb the boys education.
"From this time onwards (except the death of the first patient soon afterwards) I heard nothing more of these matters till a few weeks ago, when I was asked to see Dr. X.s son professionally on behalf of the school authorities; and, if so advised, to request Dr. Anderson also to give an opinion as to the present state of health of this young man, who happened at the time to be visiting some friends in Glasgow. It was represented to me that he had maintained, on the whole, fairly good health since I last heard of him through my medical friend, and had not been incapacitated from school work except on account of a contagious eczema which had been prevailing, and with which he had been affected in common with other boys. Apparently, however, the opinion had arisen that his general health was not quite so good, and that, in view of a cutaneous affection of this kind, apparently communicable, existing, it was no longer expedient that he should remain at the school. Indeed, I could not but come to the conclusion that his removal, on public grounds, had been practically settled; and with every desire to soften the blow as much as possible to the poor boy, it was felt to be necessary that his guardian, at least, should receive unequivocal and unbiased testimony as to the actual state of the facts and circumstances under which the decision was arrived at. Under these circumstances I saw and examined this boy, and made a report, along with Dr. Anderson, to the effect that the disease was evidently leprosy, though of a remarkably mild type, as shown by discolorations and cicatrices, and also by large , anaesthetic areas on the back of one limb. All breaches of surface, however, and all discharge had ceased at the time of our report, and Dr. Anderson felt still in a position to affirm that no danger to others could occur from the boys remaining at school. On this last point I did not feel able to give an unqualified assent to my colleagues opinion; but as regards the matters of fact and observation there was no doubt whatever, and our report accordingly on these was substantially as above."
In further explanation Professor Gairdner, in a letter to the British Medical Journal August 8, 1887, says : "In submitting to you some curious facts and statements which had been brought under my notice as bearing on the above subject ("Leprosy and Vaccination": British Medical Journal June 11, 1887)I was exceedingly careful not to obtrude any opinion of my own. It was clear from the first that the mere statement of such detail would waken up some old controversies, and would perhaps involve very serious practical issues; but these considerations did not appear to me to justify witholding the facts, but rather the public statement of them in as unbiased a form as was possible."
Referring to these cases, Dr. C. Burgoyne Pasley, Acting Surgeon General, Trinidad, observes :" The fact remains, that an unlucky boy, of undoubted European parentage, acquired a most loathsome disease, and died a miserable death as the result of vaccination, carefully or carelessly performed as the case may have been."Papers on Leprosy, Government Printing Office, Trinidad. 1890.
The same medical authority says :" If by accident I draw blood in puncturing the vesicle on the arm of any child, I invariably reject the child as a vaccinifer, no matter how healthy it may appear, or how abundant the supply of lymph may be, fearing to inoculate any constitutional disease, leprosy, syphilis, etc."British Medical Journa1p. 270, July 3oth, 1887.
A correspondent of the London Daily Graphic, writing from St. Kitts, 5th June, 1890, reports the following under the title of
"A SAD CASE."
"A sad case occurred here a short time ago, which shows the danger that arises from the practice of vaccination in an island where leprosy is treated as of no account. A few months ago a little girl, the daughter of the Rev. Mr. , a Wesleyan missionary, who came to the West Indies from England two or three years before, fell ill. On examination by the doctors it was found that the poor child had contracted leprosy. The only probable means of communication was by inoculation; and thus the parents, endeavouring to save their daughter from the very remote danger of small-pox, inoculated her with the horrible poison that will make her life a living death and herself a loathsome and repulsive, spectacle. Hoping that by returning to England he might get something done for his daughter, the missionary resigned his charge and made preparations for his departure. But a new trouble awaited him. The Royal Mail Companys steamers could not take a leper as a passenger; but one of Messrs. Scruttons vessels agreed to take the sorely distressed family to England. They got on board, and started on their voyage. But ill luck again attended them, for, while leaving the island, and when nearly opposite their old home, the, ship struck on a reef; and, although all on board were saved, the missionary and his family remain here, where they have been so sorely tried."
While in Trinidad, I made inquiries of a highly intelligent merchant, who has resided forty-three years in the West Indies, and has always been much interested in the public health. He says the belief is general in the islands that leprosy is being extensively disseminated by vaccination, and he furnished me with particulars of a number of healthy families where leprosy and other diseases have broken out after vaccination, of others who, in spite of. a law enforcing vaccination, have preferred to undergo the worry and penalties of prosecution to the terrible risks of this hideous and incurable malady. In some instances the children infected with leprosy have been sent by their parents to France and England, where, after treatment by some of the most distinguished physicians, they have either succumbed to the disease or returned to die at home; and in one case the mother died of a broken heart on seeing her eldest son come back a complete wreck, loathsome to the sight. All the victims described by my informant were in good circumstances,, and none were even sent to the Leper Asylum, where only the poor are interned. He says that had he kept a record he would have been in a position to have given details of very many cases, with all the attending circumstances, and adds, "I have come to the conclusion that we are indebted to vaccination for not only this (leprosy), but many other diseases, especially those of a scrofulous nature, as well as syphilis."
In a communication to the Lazaretto, St. Kitts, August 25, 1890, Dr. John Freeland, Government Medical Officer, Antigua, West Indies, says:--"In some of these islands leprosy has no doubt spread for the wantof precautions to separate the diseased from the healthy, from poverty, overcrowding, or decomposed food, and from, I fear, the system of arm-to-arm vaccination which now so universally prevails."
The following letters, read before the Royal Vaccination Commission, from Dr. Charles E. Taylor, of St. Thomas, Danish West Indies, secretary and member of the Colonial Council of St. Thomas and St. John, member of the Board of Health, etc., illustrate the difficulties which obstruct the investigation into this momentous suubject, owing to the dread which is generally felt by inhabitants of its becoming known that members of their family are tainted with this fearful malady, and probably also to an unwillingness to cast reproach on a prescription so extensively recommended by the profession as vaccination:--
St. Thomas, Danish West Indies
Virgin Islands, Jan. 2 1890.
DEAR Sir to your inquiry with reference to the
spread of leprosy in the West Indies, I beg to say that it is difficult to obtain
testimony with regard to this disease having been conveyed into families either by
vaccination or otherwise.
There is such a dread of the hideous fact becoming known, and though parents will talk about such and such a case, when it is pushed home to themselves, and their evidence requested for public purposes, even so important as a Royal Commission, they beg to be excused.
My own experience has compelled the conviction that leprosy has on numerous occasions been propagated by the vaccinators lancet in these islands. Children have been brought to me a year or two after vaccination who have shown unmistakable signs of leprosy, and whose parents assured me that such had never been b their family before. On the other hand, inquiry into the antecedents of the child from whom the lymph had been selected revealed the existence of leprous taint either on the paternal or maternal side.
My own experiences have been confirmed by Dr. Bechtinger, formerly a resident and practising physician here, whose extensive researches entitle his opinion to great weight amongst pathologists.
The belief also, in the British West Indies as to the conveyance of leprosy in this way is widespread, and forms one of the strongest grounds against compulsory vaccination that I know of.
In view of such a fact, and in face of such a terrible danger it is my conscientious opinion that every physician should hesitate before subscribing to such a doctrine.
I have the honour to be,
Yours very respectfully,
CHARLES E. TAYLOR, M.D., F.R.G.S., etc.
A later communication from Dr. Charles Taylor is published in the Public Opinion of Nov. 27th, 1891.
It is dated :
St. Thomas, Danish West Indies, October 20.
I have read the report of the evidence given before the Royal Commission on Vaccination in London with much interest, and with regard to the connection between vaccination and leprosy, an experience in these islands of over twenty years enables me to confirm the truth of this terrible indictment. On more than one occasion cases have come before my notice of leprosy in families which could only have been inoculated with the vaccine virus, none of the family having previous to vaccination been afflicted with this malady. Leading dermatologists in all parts of the world, and the most experienced physicians in the West Indies, are of the opinion that leprosy is spread most readily by means of inoculation, either through a wound or an abraded surface, and still more readily by puncturing contaminated vaccine virus into the arms of healthy persons. The reports of the medical officers of health and physicians to the leper asylums in the West Indies show that leprosy, which thirty years ago was stationary or subsiding, has increased. This, I have every reason to believe, and it is also the opinion of other competent medical men, is coincident with the introduction and spread of vaccination, for there are a number of islands where the disease was almost unknown previous to its inoculation in this way. Were it not for the reluctance which all physicians, have to expose families tainted with leprosy, they could give evidence as startling as the cases mentioned by John D. Hillis, of British Guiana; Dr. Bechtinger, formerly of St. Thomas; Dr. R. Hall Bakewell; and Dr. Black, of Trinidad. The possibility of spreading such a dire disease by means of the lancet is one too grave to be longer disregarded, and, it is needless to say, a serious matter for these islands, the most lovely in the world, where children, whose parents may be the most healthy, are liable to leprosy through arm-to-arm compulsory vaccination. May I venture to hope that the English Press will have the humanity and courage to speak out and compel colonial authorities to withdraw the vaccination enactments, which on these grounds alone are so dangerous to ourselves and our families. CHARLES E. TAYLOR, M.D.
So great is the dread of the invaccination of leprosy and syphilis, that when I visited the island of Granada in January, 1889, a gentleman connected with one of the public institutions of the island told me that he had two unvaccinated children, and, that rather than incur the risk of invaccinated leprosy or syphilis, he had sent them with his wife to a place of refuge in the mountains. He was not sure, he said, whether this ruse would succeed, as the authorities were very sharp.
When I visited Barbados in January, 1889, Mr. E. Racker, the proprietor of the Agricultural Reporter, Bridgetown, informed me of a case of leprosy communicated by vaccination, which he had personally investigated. Mr. Racker was intimately acquainted with the father, a member of the Legislative Council, and on one occasion, when visiting his house, noticed that his friends youngest child was afflicted with leprosy. The father said it was due to vaccination with lymph taken from a child subsequently discovered to be leprous. Though he believed in the benefits of Jenners discovery, he declared that there should be no more vaccination in his family. I may observe that so widespread is the belief in Barbados that leprosy and syphilis are communicated by vaccination, that every attempt to make it compulsory has been defeated. Nevertheless the advantage of vaccination is believed in by several men with whom I conversed, and there is a considerable amount of vaccination practised, to which I attribute no small share in the admitted augmentation of this disease before referred to. The hideous risk, attending the practice of vaccination is illustrated by the following letter of Mr. Racker, who writes .2nd May, 1890:" I know all about the case reported in the British Medical Journal by Dr. W. T. Gairdner. I am one of the executors to the will of Dr. J. C., but I had no idea that the boy was suffering from leprosy until I ,got a letter from the head master of Dollar, enclosing a letter from Dr. Gairdner.
"I think I told you how I once consented to have my children vaccinated, and how at the last moment I changed my mind, and would not allow them to be operated on, Well, that boy, Dr. J. C.s son, was the one from whom they were to be vaccinated. What a narrow escape I had!"
Mr. Alexander Henry, Vice-Chairman of the Council of the British and West Indian Alliance, and formerly editor of the St. Kitts Gazette, who has resided some years in the West Indies, and has devoted much attention to the spread and causation of leprosy, writing 12th June, 1890, says :" A medical officer of health cautiously admitted to me that leprosy was contracted by means of careless vaccination. Now, careless vaccination means vaccination from arm to arm, which is almost universal in these islands. I do not believe there is a doctor of any standing in the West. Indies who would deny that leprosy can be inoculated. It is admitted that owing to the slow incubation of the disease it is difficult to distinguish a leper; and when you take into account that medical officers are constantly complaining to the Government that they cannot get a supply of calf-lymph, and add to this the indiscriminate and careless yet vigorous manner in which they carry out the vaccination laws upon an ignorant and simple people, who have no means of asserting themselves, I think we may safely conclude there is a high probability that leprosy is spread by vaccination."
When or how leprosy entered this island is perhaps unknown. Certain it is, however, that the dread disease has recently been advancing by leaps and bounds. In proof of its increase here I quote the following passage from a recent quarterly report of Dr. Alfred Boon, one of the Government medical officers and acting analysts of Government statistics. Dr. Boon says :"The opinion that it is, as many hold, increasing in the island, is supported by the fact that in the four years 1885 to 1888 thirty-four such deaths were registered."
In a later communication received by me from Mr. Henry, dated October 8, 1891, he declares his conviction that vaccination is one of the chief factors in the spread of this fearful disease in the West Indies. After referring to the small-pox epidemic in Martinique, in 1887, and the consequent extensive re-vaccination propagated in St. Kitts, the writer proceeds :" But, you may ask, how did that affect the labouring class, who are known to have a strong prejudice against vaccination, and among whom the disease of leprosy is most common? This is the incident to which I wish to draw your attention. There is in force in St. Kitts (and in most of the other islands) a law to compel all boatmen and porters to take out a yearly license. Now, it so happened that, at the time when the boatmen and porters required to renew their yearly badge, the small-pox was raging in Martinique, with, of course, the usual panic in St. Kitts. The boatmen and porters were informed by the Inspector of Police, or by his authority, that no one could have his license renewed unless he had been re-vaccinated that year. I need not point out the unspeakable dangers which such a system of indiscriminatealmost recklessarm-to-arm vaccination exposed adults of the class among whom leprosy is rampant. In considering the medical aspect of the practice, you must bear in mind that the defence of the arm-to-arm vaccination by the medical officers is their admission that it is almost impossible to obtain pure calf lymph in the islands. Can you wonder, then, that there should exist a strong prejudice and an unspeakable dread of vaccination among the lower classes in the West Indies?" In support of this contention, that the majority of the West Indian islanders fear the practice of vaccination, Mr. Henry adduces the evidence of the medical officers themselves :" Dr. Gavin Milroy, in his Report on Leprosy and Yaws in the West Indies (House of Commons Command Papers, c. 729) states on pages 32, 33, In the frequent conversations which I subsequently had with many of these gentlemen (the medical officers in the West Indies) I learned the fact that the European and most of the higher creole families were always extremely anxious about the source of the lymph to be used in the vaccination of their children, from the dread of a leprous taint being thus acquired. None of my informants appeared to partake of this belief themselves, but all recognised the propriety of avoiding the use of lymph from children of families known or believed to be afflicted, especially as infants themselves rarely, if ever, exhibit any outward manifestations of the malady. "Dr. Milroy says that the Vaccinator-General, Dr. Bakewell seemed to give countenance to the popular belief as to the transmissibility of leprosy by vaccination."
Dr. de Verteuil, of Trinidad, in replying to the views of Dr. Bakewell, says (p. 34) that "it is necessary to take certain precautions. The vaccinifer should be healthy, and born of parents free from any syphilitic or leprous taint, and, as hereditary syphilis generally manifests itself after the age of four or five months, it would be as well to choose as vaccinifers children of five or six months and above." The only comment I need make on the "defence" of Dr. de Verteuils is to point out that it is well nigh impossible to take the necessary and certain precautions to know if the vaccinifers are leprous.
Dr. Bowerbank, of Jamaica, in pp. 34, 35, says:"I have frequently heard of a case of leprosy occurring in a family, alleged to have been the result of vaccination. I know of two instances in one family (a Jewish one), in which the parents and friends are thoroughly convinced in their own minds that such was the case. In Barbados we find a strong prejudice against vaccination, for Dr Browne writes:It has been a general rule not to vaccinate from the apparently unhealthy, or those of leprous taint, not so much from any opinion founded on fact of the possibility of conveying the disease, as from respect to the general prejudice prevailing. For the Leeward Islands, I refer you to a letter to the editor of the St. Kitts Lazaretto, 23rd August, 1890, by Dr. Freeland, Government Medical Officer of Antigua : In some of these islands, leprosy had no doubt spread from the want of precautions to separate the diseased from the healthy, from poverty, from overcrowding, or from decomposed food, and from, I fear the system of arm-to-arm vaccination, which now so universally prevails."
Mr. Henry says that the only point on which medical men seem to be unanimous regarding leprosy is that, whether it is contagious or not, it is inoculable; and, after citing various medical testimonies, showing the connection between leprosy and vaccination, he observes :" If ever a case was proved it is this one that there is a universal belief in the West Indies that leprosy is spread by means of vaccination. And I, for one, place far more reliance upon a popular belief of this kind, and especially upon this subject, than I place upon medical testimony, because the neighbours of a leper are far more likely to know when and how he contracted the disease: they know his pedigree, family history, and the whole condition of his life and its surroundings, whereas the medical officer simply pays a casual visit, and often does not hear or know of the leper till the disease manifests itself to such an extent that the leper becomes a burden and a danger to his relations and his neighbours.
"But what was the answer of the College of Physicians to the inquiry of the Chief Secretary of State for the Colonies, as to whether there was any ground for the belief that leprosy was spread by vaccination (in the West Indies)? On page 86, same Report, in their answers and advice to Lord Kimberley: The College of Physicians feel they cannot press too strongly on your Lordship the importance of enforcing the practice of vaccination for the protection of those who are too ignorant to protect themselves. As the people become a little wiser, .they will be able to protect themselves from the prejudice of the College of Physicians."
Leprosy is a disease of relatively slow incubation. Children pronounced perfectly healthy, and represented as approved subjects both for vaccination and for vaccinifers, may, in a few months, exhibit the unmistakable signs of leprosy. In a report by Dr. Edward Arning, dated Honolulu, H.I., November 14, 1885, presented to the president and members of the Board of Health, p. 52, this distinguished observer says:" The next point touches the vaccination question, with which I have dealt at length under the heading of experimental work. I would further urge that the medical examinations of school children, which have led to the elimination of quite a number of cases, should be kept up regularly and carefully. As an instance of their necessity, I may quote a case which has quite recently come under my observation. A little girl (native) belonging to one of our large schools passed my close examination a year and a half ago as healthy, but now presents initial symptoms of leprosy. We must not rely on general healthy appearance in these examinations, and on a furtive glance at hands and arms. I have found unmistakable marks of leprosy on the back of a child that held a recent health certificate. Moreover, we shall have to extend our examinations even to the very young children, in spite of Dr. Fitchs assertion that leprosy does not make its appearance before the period of second dentition. I have seen a child with clear signs of leprosy at three and a half years of age, and -know of another boy who was a marked case at four years old."
This eminent bacteriologist, in a letter before me, dated September 6, 1889, says:" During my stay on the Hawaiian Islands for the bacteriological study of leprosy, I was naturally drawn to a scrutiny of the question whether leprosy is transmissible, and had been there transmitted by vaccination; all the more so as there is. a general opinion prevailing on these islands that the unusually rapid spread of the disease about thirty years ago may possibly be attributed to the great amount of indiscriminate vaccination carried on about that period. And there is no mistake about the actual synchronicity of the spread of vaccination and of leprosy in the Hawaiian Islands; but many a mistake is possible as to the real causal relation between the two.
"I could trace the first authenticated cases of leprosy back to about 1830, but the terrible spread all over the islands did not take place until very nearly thirty years later, at a time when an epidemic of small-pox had given rise to very general and very careless vaccinations throughout the group ..attach far more importance to an instance of an increase of leprosy soon after vaccination on a much smaller scale, and during a much more recent period than the above. I have it on good authority that a very remarkable new crop of leprosy cases sprang up at Lahaina, on the island of Maui, about a year after most careless vaccination had been practised there."
The impossibility of detecting leprosy in its early stages is a matter of common notoriety amongst physicians, so that many who believe in the prophylaxis of vaccination refuse to incur the terrible risks involved by its practice in leprous countries.
Dr. E. Kaurin, in "Notes on the Etiology of Leprosy," in the Lancet, January 25th, 1890, observes :" We must bear in mind that the duration of the disease is much longer than is generally supposed. The patients, as a rule, take no account of the long prodromal stage, marked by indefinite subjective phenomena and temporary affections of the skin. The physicians themselves often overlook the early symptoms of the disease; indeed, it is sometimes impossible to form a diagnosis in the early stages. The whole period of the disease, from the onset to the time when distinct signs are noticeable, amounts to at least from three to four years."
Mr. H. A. Acworth, writing to me from the Municipal Commissioners Office, Bombay, July 29th, 1891, says:--"I have plenty of lepers in my hospital here who could not be identified as such, unless they were completely stripped and examined by a trained eye."
Dr. Mitra, in his Report on Leprosy in Kashmir, refers to the recorded statistics of lepers, and says that the enumerators "might have overlooked many cases in the incipient stages," whereupon the Lahore Civil and Military Gazette calls attention to the consequent dangers of communicating organic or other diseases by means of vaccination.
Dr. E. Arning says :-" When in Hawaii I attended a German boy, aged 12, who suffered from leprosy, from whom, when he was seven years old, several white families had been vaccinated."Journal of the Leprosy Investigation Committee, February, 1891, p. 131.
In the report of Dr. Webb, medical inspector, on the condition of the schools, April 1st, 1886, are recorded five-cases of incipient leprosy in the Royal School, and two in the Fort School, Honolulu.
Dr. F. B. Sutliff, of Sacramento, California, who has studied the disease as Government physician on the Island of Maui, says:" I very seldom visited a school without excluding some (children), while the spots just beginning to show in others made it only too probable that they would not long be doubtful cases. It did not seem to me a difficult task to read the fate of Hawaii in the little dark faces that looked up from their books." Occidental Medical Times, April, 1889.
In Dr. Arnings report, dated Honolulu, Nov. I4, 1885, p. 14, we read :" Closely allied to inoculation is the subject of vaccination. You are doubtless aware of the very prevalent opinion among medical men that the unusually rapid spread of the disease may possibly be attributed to the great amount of indiscriminate vaccination which has been carried on in these islands. If my information is correct, unquestionably new centres of leprosy have developed after vaccination was practised and several old inhabitants have told me how they themselves used no precautions whatever in vaccinating during a small-pox scare.
"To bring some light on this moot point I vaccinated a number of lepers. The vaccination only took in three cases, one tubercular and two anaesthetic. Both the lymph and crust of the tubercular case contained the bacillus leprae; in the anaesthetic cases I could not detect it."
Dr. Arthur Mouritz, then Resident Physician and Medical Superintendent of the Leper Settlement, Mobkai, in his Report for 1886 to the Board of Health, after alluding to contagious and hereditary predisposition, says:" The third cause to which I attach some importance, and which has undoubtedly spread the disease, is vaccination. I can bring forward no case personally, but I have reliable hearsay evidence that after the operation of vaccination had been performed on several white children, they manifested signs of leprosy, and finally developed the disease. Evidence on this same point is put forward by Sir Ranald Martin in India, and by Professor H. G. Piffard, of New York, both reliable authorities."
An Appendix to the "Report on Leprosy" addressed to the Legislative Assembly of Hawaii, in 1886, is an interesting account of Queen Kapiolanis visit to the Leper Settlement at Molokai, by the Princess (now Queen) Liliuokalani, in July, 1884. Amongst other incidents, the Princess refers to an interview with one, Kehikapau, in the presence of several persons. - Kehikapau called the Princesss attention to the circumstance of his having contracted the disease from vaccination. He also mentioned that, through the same agency, all his schoolmates had died of the disease, induced in this way.
According to the Report of Surgeon J. R. Tryon, of the United States Navy, leprosy has spread "from year to year in Hawaii, and has increased to a marked degree since the indiscriminate and careless vaccination practised during the severe epidemic of small-pox in 1853." Medical and Surgical Memoirs, 1887, vol. 2, ft. 1252, by Dr. Joseph Jones, President of the State Board of Health, Louisiana."
In a summary of reports furnished by foreign Governments to His Hawaiian Majestys authorities as to the prevalence of leprosy in India and in other countries, and as to the measures adopted for the social and medical treatment of persons afflicted with the disease (Honolulu, 1886), I find the following extracts, p. 238 and 239, from the New Orleans Medical and Surgical Journal, April, 1880.
After referring to the relation of leprosy with syphilis in the Hawaiian Islands, the author says :"Vaccination was also inquired into. Alarmed by an invasion of small-pox in 1853, a general vaccination of the whole population was ordered, and physicians being at that time very few on the islands, non-professionals aided in the work.
"It is charged by some that, as a natural result of the labours of the heterogeneous force so appointed, not only syphilis, but also leprosy, was greatly increased. In my last circuit trip in my district, I found very few adults who had never been vaccinated. This involves the question of inoculabilityin my opinion the main, if not the only, means of propagation other than inheritancethat is, like syphilis, it depends for its propagation upon the direct introduction of virus into the blood."
The fact that an increase in the practice of vaccination in leprous countries is often accompanied by an increase in the dissemination of leprosy is shown by the following evidence : Mr. George C. Potter the Secretary to the Honolulu Board of Health, writing to me on behalf of the President of the Board of Health, Dr. J. H. Kimball, in a letter dated Honolulu, H.I., June 1st, 1890, says :" It is an opinion among the laity and some of the profession that the extensive arm-to-arm vaccination that was practised in the years 1852 and 1868 during small-pox epidemics was a prolific cause of the spread of leprosy" In a report of the Board of Health to the Legislative Assembly of 1886, by the then president, Mr Walter M Gibson, I read, p 35, "There are two more causes which, in my judgment, have had a great effect in the propagation of leprosy, or diseases closely allied to it, although, medically, it be a disease sui generis. The first was the ignorance of some of the early and unqualified medical practitioners who were permitted to spread disease broadcast, and to do irretrievable injury before retribution overtook them; but the second and chief cause was the indiscriminate and, to my mind, careless vaccination that began about 1868
Dr H S Orme, President of the State Board of Health, California, in an able memoir on "Leprosy: its Extent and Control," says:" There can be no doubt that the lowering of the vital stamina of the race by the great prevalence of syphilis (at Hawaii) prepared them for the inroads of any disease that might threaten. During this period small pox also scourged the people, and in 1868 there began a general vaccination, in which virus was taken indiscriminately from human subjects. This reckless practice doubtless contributed greatly to the spread of both syphilis and leprosy."
In an article on "Personal Observations of Leprosy in Mexico and the Sandwich Islands," in the New York Medical Journal for July 17, 1889, the author, Dr Prince A Morrow, M A, says "Vaccination is believed by the natives, as well as by many intelligent physicians, to be a potent agent in the rapid diffusion of leprosy through the islands It must be remembered that until recently vaccination was performed by unskilful persons, human virus was used, and no distinction was made between a healthy person and a leper as a vaccinifer. The fact is incontestable that, after the general vaccination of the natives, numerous leprous centres developed in various parts of the islands where the disease had previously been unknown. Arning demonstrated the plentiful presence of bacilli in the lymph and crusts of vaccine pustules in lepers."
In the Archiv fur Dermatologie und Syphilidologie for January, 1891, we read that at the Berlin Medical Congress of 1890 Dr. Arning read a paper on "The Transmission of Leprosy," wherein he scouts the idea of hereditary transmission. He proceeds to ask the question raised by the late Dr. Hillebrand, "Has leprosy been spread in the Hawaiian Islands by means of universal vaccination?" And he declares: "There can be no doubt as regards the synchronousness of the diffusion of leprosy and the introduction of vaccination into the Hawaiian Islands.
"I am able to statehaving excellent authority for so doing, though, unfortunately, no statisticsthat a very remarkable accumulation of fresh leprosy cases took place in 1871-72, in a place called Lahaina, on the Island of Maui. This happened about one year after a universal arm-to-arm -vaccination, which had been most carelessly performed. About fifty to sixty cases occurred suddenly in this locality, which up to that time had been comparatively free from the disease."
Dr. Arning concludes :"Arm -to-arm vaccination should be prohibited in countries in which leprosy abounds."
When, during my visit to -Honolulu in October, 1890, it became known that I was seeking information concerning the spread of leprosy, in the interest of the public health, and not to support any medical theory or foregone conclusion, several gentlemen who had devoted much attention to these subjects called upon the, and others gave me introductions to those who were conversant with them. The President of the Board of Health, the Hon. David Dayton, and the Secretary, Mr. Potter, afforded me valuable assistance, and supplied me with copies of their various official reports relating to the introduction and dissemination of leprosy and the methods adopted for dealing with the scourge, which, with other European diseases, bids fair, unless arrested, to destroy the entire native race. They incidentally showed me copies, cut from the Press, of my own communications on the subject of leprosy and vaccination in the West Indies, thus illustrating their desire to inform themselves upon the subject by evidence from all quarters of the globe.
I have, in this monograph, made free use of the facts and testimonies contained in these important official documents, and I take this opportunity of expressing my thanks for the courtesy and information furnished by the gentlemen connected with the Board of Health, resident physicians, the Executive Officers at Molokai and Kalihi, and members of both Houses of the Legislature.
According to all the evidence which I have been able to obtain, leprosy was unknown in the Sandwich Islands until many years after the advent of Europeans and Americans, who introduced vaccination ; and there is no aboriginal word in the Hawaiian language for this disease. Mr. Dayton, President of the Board of Health, says that the natives, having no words of their own, used the Chinese words maipake ?" what is this disease?"
In Captain Cooks time (1770-79 ED)these islands were supposed to contain a population of 400;000 at the present time they do not number more than 40,000, and are rapidly diminishing. In all quarters, both native and European, lay and medical, among members of both Houses of the Legislature, I found the belief all but universal that leprosy was considered to be communicable, and that the propagation of the disease during the last twenty-three years was largely due to vaccination.
One medical authority told me that he had no doubt that the disease was inoculable and spread by vaccination, but he did not think it would be prudent to disclose the fact amongst the natives, as he would not be responsible for what they would do. He expressed his own convictions freely on the subject, which are confirmed by Dr. Edward Arnings inoculation experiment on the condemned convict Keanu, of whom he gave me a photograph, showing the development of the tubercular form of this disease. No other intelligent resident shared the fear of such an exposure, the incriminating facts having already been acknowledged both in the official reports and in various communications by medical practitioners to American medical journals. On the contrary, when it became known that I was there not to institute experiments but to collect facts in the interest of those afflicted people, I was urged by influential citizens, and particularly by members of the Legislature, to do what was possible to make known the evils under which they suffered, and to bring an enlightened public opinion to aid them in putting an end to a mistaken medical procedure, which had led to such disastrous results. One of the gentlemen who besought my intervention was Mr. J. Kalua Kahookano, a barrister-at-law, and representative of North Kahala, Island of-Hawaii (the largest in the Archipelago), who introduced a bill (July, 1890) in the Hawaiian Legislative Assembly to repeal the vaccination laws. This bill was supported by a petition from Mr. Kahookanos constituents, showing how leprosy, syphilis, and other diseases had been scattered broadcast in these islands by means of the vaccinators lancet, and new centres of the diseases thus established. The truth of this fearful indictment is now admitted by several medical practitioners of high standing, who have visited the islands to study the cause of the rapid spread of this destructive malady.
Amongst other old residents who kindly volunteered information was Mr. H. G. Crabbe, a member of the Upper House of Legislature, who had resided in the islands for forty-three years, and had always taken an active interest in the public health. He said it was time that the true facts concerning the propagation of this disease in Hawaii were made known, as the people were being decimated by leprosy conveyed to the blood by vaccinators. Mr. Crabbe detailed various facts in proof of this serious charge, and expressed the utmost anxiety that the truth should be made manifest in countries where public opinion was a potent factor for the wellbeing of the community. He had met with many cases of leprosy clearly traceable to vaccination in the islands, and the facts were admitted by those who, like himself, had taken the trouble to investigate them; but the evil was being perpetuated by those who ought to know better, partly through apathy on the part of the authorities, and partly through the ignorance of the natives, who accepted whatever kind of vaccine virus was most handy when wanted for use. Mr. Crabbe was a believer in vaccination as a prophylactic against small-pox, but considered that, as at present administered, it was a most cruel and mischievous infliction upon a confiding population.
In a statement handed to me by Mr. Crabbe, dated Honolulu, Hawaii, Oct. 22, 1890, the writer says:" In the year 1866 there was an indiscriminate vaccination of young and old amongst the natives; this vaccination was compulsory, but, thank heaven, I did not allow my children to be vaccinated with the common herd. From that time the leprosy cases became more frequent; many natives who had previously been healthy were afflicted with leprosy. The spread of the loathsome disease was more pronounced in the years following this indiscriminate vaccination. I can recall one case in particular of a native girl by the name of Kapeka, as healthy and as nice looking as tis possible for a native to be, who was forced to be vaccinated in the year 1866. In the year 1871 or 1872 Kapeka was sent up to the Molokai Leper Asylum by order of Dr. Robert MKibbin. In this particular case I have always contended that this girl was inoculated with the germs, not only of leprosy, but also of syphilis, from this fact. Long before she exhibited any signs of leprosy (some three years), if she hurt herself, so as to make an abrasion of the skin, the place would inflame and suppurate, and would take a long time in healing, presenting an appearance like a syphilitic sore. She died at the Leper Settlement."
The appropriation by the Government for the Molokai Lazaretto is £10,000 a yeara large sum for a poor and comparatively thinly populated country. During the past twenty-five years, about a million and a quarter dollars have been expended by the Hawaiian Government in making provision to benefit these afflicted people. It is, however, melancholy to reflect that one source of the dissemination of the disease, viz.vaccination, is still permitted, and, there is reason to believe, is encouraged both by the misguided Government and, notably, by certain official members of the medical profession. The latter have inherited such a deeply-rooted prejudice in favour of the merits of the Jennerian practice as to blind them to its destructive potency in countries where leprosy is endemic. The great majority of medical practitioners take their views from the medical journals, which most unfairly refuse to give their readers the adverse side of the Jennerian practice.
Notwithstanding the evidence of the disastrous results of vaccination in spreading and establishing new centres of leprosy, we are told in the "Biennial Report of the President of the Board of Health to the Hawaiian Legislature for 1888" (in which the depopulation of the islands, and the spread of leprosy, is frequently referred to) that "the work of vaccination has been pushed with vigour;" and, "The Board would recommend the passage of a more stringent law, imposing heavier penalties and giving the vaccination authorities all necessary authority."
In his remarkable work, "Traite Pratique et Theoretique de la Lèpre," p. 306, Professor Henri Leloir refers to the introduction and progressive increase of leprosy in the Sandwich Islands, and states that vaccination, compulsory and en masse, contributed to the spread of the disease.
Coincident with the activity with which vaccination has been extended in Hawaii, there have been several very severe outbreaks of small-pox. In the year 1881, according to official reports, 500 persons died of smallpox, a large majority of whom had been vaccinated. Each of these epidemics has been accompanied by a more stringent enforcement of vaccination, and has been followed by the development of new centres of leprosy and the more rapid spread of this destructive scourge.
In the pursuit of my inquiries in British Guiana in 1888-89, the public librarian, Mr. Rodway, expressed himself much interested in the subject of leprosy, which, considering the remarkable increase of the disease in that colony, has been neglected of late years. He called my attention to a work entitled "Leprosy in British Guiana," by a careful scientific observer, Dr. John D. Hillis, formerly Superintendent of the Leper Asylum in that country. Mr. Rodway said this was regarded as the standard work on the subject. From it I extract the following particulars of invaccinated cases
Case IV., p. 30.Confirmed Tubercular Lepra, supposed to have been contracted by Vaccination.Joseph Francis C, a fair Portuguese, born in Demerara, now aged twenty years. His parents are alive and healthy. He has been suffering for the last ten years from tuberculated lepra. He has a sister, aged eighteen years, at present (1879) an inmate of the asylum, suffering from the same form of leprosy. They were both admitted on July 30th, 1877, from Murray Street, Georgetown. They have three sisters and one brother, who are alive and well. Our patient, J. F. C, and his sister were vaccinated with lymph obtained from a member of a Portuguese family, ("It is within the knowledge of Dr. Manget, surgeon-general, and the author, that this family are at present afflicted with tuberculated lepra.") in whom leprosy was afterwards found to exist. They were the only members of the C family vaccinated with this lymph. Within 18 months of the performance of the operation by Dr. , a reddish brown spot appeared on the inner side of the right thigh, preceded, it is stated, by some constitutional disturbance. This spot was raised and tender, accompanied by profuse sweating all over the body, and remained for some time. Subsequently other spots made their appearance on the right buttock (which disappeared shortly after), between the shoulders, and on each cheek. They were all ushered in by more or less well-marked febrile symptoms. A red patch next appeared on the forehead, and epistaxis set in, periodically occurring to this day. Tubercules then made their appearance on the face, the other patches continuing to increase in thickness and roughness, and forming tubercular infiltration."
"The latter was removed by gurjun oil, under which treatment many of the symptoms were ameliorated." State and condition on November 30th, 1879 : "He has a light brown irregular patch on the front of his chest; this had been larger, thicker, and mahogany-coloured, and has evidently undergone partial absorption. There is a patch of tubercular infiltration on the back of the arms, and at the back of the elbows. The fingers are swollen, shining, and dark-looking, a solitary tubercle forming on the back of the hand. The swollen condition of the fingers and hands is very characteristic. There are two tubercles on each cheek the size of marbles; the lobes of the ears are thickened, and a tubercle is forming on the upper lip.
"There is no appearance of hair growing on the face. There are reddish-brown discolourations on the front and back of the legs. There are a few small scattered tubercles on the dorsum of the feet, and the lower parts of the legs are swollen and hard to the touch. There are tubercles on the scrotum, an ulcer on the leg where a tubercle has ulcerated, and the larger tubercles are slightly anaesthetic. This young man is one of the carpenters of the Institution; he is in hopes the treatment now being adopted may arrest the disease, which is, however, making slow but sure progress."
On page 191 of Dr. Hilliss book, a passage is cited from the work of Dr. Vandyke Carter (p. 178), one of the greatest authorities on the disease, in which vaccination is instanced as one mode of communicating leprosy. On page 192, we read :" The subject of leprosy was brought forward at the stated meeting of the New York Academy of Medicine, January 20, 1881, in a communication by Dr. H. G. Piffard, in which the author, who is not himself a believer in the contagiousness of leprosy, states : A review of the evidence bearing on the contagiousness of leprosy led the speaker to the conclusion that this disease, like syphilis, is not contagious by ordinary contact, but it may be transmitted by tile blood and secretions. Vaccination may transmit it."
A case in the speakers own experience was cited in proof of this." The Medical Record, February 19, 1881 p 212.
Sir Ranald Martin states :" The dangers to Europeans arise chiefly from vaccination and from wet-nursing. I felt that very early in my career in India and I took the precautions which are here recorded. I saw an English lady last year in a horrible condition (she said) from having been vaccinated from a leprous child." Leprosy in British Guiana, by Dr. Hillis, p 182.
On page 208 we read :" I have already given some cases in which there could be no reasonable doubt but that the disease was produced by vaccination with tainted lymph. Those of the brother and sister mentioned are conclusive on the point, and we have the testimony in favour of this mode of propagation from such men as Tilbury Fox and Erasmus Wilson. I will therefore conclude this chapter with a case from the work of a recent writer, Dr. Piffard, of New York ": "Case III.William T, aged 25 years, was admitted into Bell Hospital in May, 1864. He was of English parentage, but was born and passed his early life in British Guiana. After vaccination, performed when young, his arm became greatly swollen and inflamed, and large sloughs separated. Investigation revealed the fact that the vaccine virus had been taken from a negro whose mother was a leper. At the age of seven years some brownish spots appeared upon his back and arms; and at the age of eleven a blister formed on the palm of the right hand, followed by permanent contraction of the flexor tendons. A few months later he felt a tingling sensation around the nail of the right index finger, followed by a line of suppuration and loss of the nail. The finger soon healed, but the same morbid process separated itself in the other fingers of the same hand. After a few months, according to his statement, the skin of the distal phalanges split, and the flesh shrank away from the bones, leaving them exposed. The bones separated at the joints, and the stumps healed. These various processes occupied eighteen months or two years.
"The disease then affected the distal phalanges of the left hand in the same manner. After this it attacked the right foot, and a slough formed over the lower part of the instep. The great toe then became swollen, the skin split, and its distal bone separated; then, without much regularity, the remaining phalangal bones o fingers and toes necrosed and came away."Diseases of the Skin, p. 209.
"On examination," adds Dr. Hillis, "the patient was found to have macuae or other spots, and anaesthesia of the parts affected."
On the 31st March, 1890, I wrote Dr. Hillis, referring to the cases of invaccinated leprosy mentioned in his book, and asked if he could furnish me with any other facts, and whether he would be willing to give evidence before the Royal Commission. To this I received the following reply:--
134 Leinster Road, Dublin, 2nd April, 1890.
DEAR Sir,Yours to hand. I have no further reliable evidence as to the transmission of leprosy by vaccination than that contained in my book. These cases, however, may be relied on. I got the particulars from the medical man who performed the vaccination in question, and the parents of the children. I enclose a reprint from Timehiri.I am, Yours faithfully, -JOHN D. HILLIS.
Wm. Tebb, Esq
The British Medical Journal of November 5, 1887, contains a letter from Dr. Hillis, repeating his conviction as to the communicability of leprosy by means of vaccination. Dr. Hillis says he has had more than twenty years experience of the disease (leprosy), and half of this time he was superintendent of the largest leper asylum in the West Indies.In this remarkable work, Dr. Hillis quotes Dr. George Hoggan, whose testimony I have adduced, as an authority on the subject of leprosy, and few persons have had greater opportunities of studying the pathology of this disease.
In a recently published work by the late Archdeacon Wright, entitled "Leprosy an Imperial Danger" (Churchill, 1889) the writer, p. 85, reluctantly admits the danger of leprous vaccination. "Much, very much," he says, "seems to imply that leprosy can be communicated by inoculation, and is communicated by vaccination."
Dr. C. F. Castor, the Medical Superintendent of the Leper Asylum, Mahaica, British Guiana, in his report for the year 1887, p. 43, says :"Another manner in which the disease (leprosy) may be produced in the healthy with no taint is vaccination. This seems a most probable means of communicating the disease, nor can there be any doubt, I fancy, after reading the admirably recorded case by. Professor Gairdner, of Glasgow, in the British Medical Journal of the 11th June, 1887. Dr. Rake, of Trinidad, disputes the obvious conclusion of the professor, and marshals a number of facts that do not in any way, to my mind, overthrow the fact that in that case vaccination was the cause of introducing the disease in the child."
Again, in paragraph 86 of the same report, Dr. Castor says :" I have noted these points because I consider they are important, and as needlessly obscuring a palpable fact which should be made known far and wide in countries where leprosy is endemic and widespread, as with us, that there is every certainty of inoculation through vaccination."*
*Since the above was written Dr. Castor has given evidence before the Royal Commission on Vaccination (December 2nd. 1895), and in some particulars modified this opinion as to the danger of communicating leprosy by means of vaccination. In an article in No. 4 of the "Journal," December, 1891, in reply to my evidence on this subject before the Royal Commission, p. 4, Dr. Castor observes:---The opinion expressed that vaccination from a tainted source will produce the disease is, I believe, a true one." Surgeon Brunt,R.N., testified, March 2nd, 1892, before the Royal Commission, to actual cases of invaccinated leprosy within his own experience. Positive evidence and a body of unimpeachable facts cannot be set aside by wavering and contradictory statements like those of Dr. Castor.
The dread of communicating leprosy at Georgetown by means of vaccination is very general, and, as a consequence, the vaccination laws are, to a large extent, inoperative. Dr. Robert Grieve, Surgeon-General for British Guiana, in his report for 1887, referring to vaccination, p. 7, says :" In the beginning of the year vaccination, which had been carried on energetically in the latter part of 1886 in Georgetown, came practically to an end, owing to the unwillingness of the people to bring their children for the purpose."
On inquiry from both medical practitioners and intelligent residents, I found that this objection was mainly due to a wholesome dread of infection of leprosy, when the vaccination was performed with arm-to-arm virus, and of syphilis with various cutaneous eruptions, when imported lymph was used.
In the "Report on Leprosy and Yaws in the West Indies," by Dr. Gavin Milroy (House of Commons papers, C 729), the Surgeon-General of British Guiana says (p. 33) :" As far as my own opinion goes, I am inclined to believe in the possibility of such communicabilityi.e., of leprosy by means of vaccination. There is no objection in Guiana to vaccination, if the parties know the children from whom the lymph is to be taken." But against this there is the testimony of Drs. Hackett, Watkins, Stevenson, and Allison, who state that vaccination has hitherto been practised to a very limited extent among the lower classes in Guiana. Dr. Allison says that "this is principally, if not entirely, due to the difficulty of obtaining vaccine lymph ;" while Dr. Stevenson admits (p. 35) that "the prejudice of the lower classes against vaccination, on account of the supposed communicability of leprosy by it, was, until the recent epidemic of small-pox in Trinidad, insurmountable."
The origin of various recent outbreaks of leprosy in the United States is veiled in obscurity, only because medical men do not know where to look for it; though they have admitted that, since the discovery of the beth//us leprce, vaccination appears to be the most probable cause. Reluctant to impugn the Jennerian practice, and with opportunities at command, they have preferred to extend their researches in other directions.
Dr. H. S. Orme, President, State Board of Health, California, considers the ordinary explanations given to account for the dissemination of this disease inadequate, and observes:" Not heredity, nor syphilis, nor endemic conditions, could have given rise to the group of sixty cases in the village of Spain; to the outbreaks in New Brunswick and Cape Breton Island; to the sixteen cases at Charlestown between 1846 and 1876; to the forty-two now at New Orleans, or to the two at Galveston. It is often impossible to trace the source and mode of contagion, but the same is true with all the disorders whose contagiousness is disputed."---Leprosy: its Extent and Control, p. 29.
In the "Transactions of the Medical Society of the State of California" for 1890, vol. XX., Dr. Orme, referring to the general vaccination of the people of the Sandwich Islands in 1868 with human lymph, consequent upon an outbreak of small-pox, says:" This reckless practice doubtless contributed greatly to the spread of both syphilis and leprosy."
"At a meeting of the New York Academy of Medicine, June 6, 1889, Dr. Prince A. Morrow gave an account of his personal observations on Leprosy. Referring to his visit to the Leper Asylum at Molokai, he said he considered it probable that a number of the cases which had arisen in the Sandwich Islands had been caused by impure vaccine."British Medical Journal, Aug. 31, 1889.
Dr. T. B. Sutliff of Sacramento, California, has sent me the following narrative of a case of invaccinated leprosy, contracted in California : "Boy, native of California; never been out of this State; no family history of any constitutional disease; was well until about eight years ago; was then vaccinated. The arm became very sore, and was swollen in its entire length. An abcess formed in the axilla, and subsequently broke, discharging pus freely. Recovery ensued, the arm becoming well again. Soon after it was noticed that there were numerous patches of ringworm on the body. This condition continued for several months. Several persons, himself included, were vaccinated by the father directly from the boy. The father, and one other of the persons vaccinated, subsequently had ringworm. The father has since had tetter from time to time. One year after vaccination the boys ears became slightly enlarged. The nose was noticed to have become broadened, and tubercles formed on it and on other parts of the face.
"The ears are markedly enlarged, the nose broadened, and the alce are thickened. The hands show the disease quite plainly, the fingers being clubbed. There are a few small ulcers. There is a sore on the shoulder. The feet are beginning to be affected."
In the report of Dr. H. W. Blanc, Professor of Dermatology and the Chief Sanitary Inspector for the city of New Orleans, November 27, 1889, addressed to the President of the Board of Health for the State of Louisiana, where leprosy has been provokingly prevalent, it is stated that leprosy, syphilis, and tuberculosis are transmitted by vaccination. Dr. Blanc says that, "in his two-fold capacity of Dermatologist to the Charity Hospital of the city and Chief Sanitary Inspector of the city, he has had unusual opportunities for the study of leprosy and vaccination. During the past eight years he had observed over sixty cases of bona-fide leprosy (anaesthetic and tubercular). The disease is slowly increasing, it is inoculable and communicable by vaccination, and humanised virus should be avoided. Most of the vaccinations are performed by me and my assistants, and I will not on any account allow humanised virus to be used."
The Occidental Medical Times, Sacramento, California, of September, 1890, publishes "An Interesting Case of Anaesthetic Leprosy apparently following Vaccination," by Sidney Bourne Swift, Resident Physician, Leper Settlement, Molokai, H,I., and D. W. Montgomery, Professor of Pathology and Clinician for Diseases of the Skin in the Medical Department of the University of California. The writers say that "one of the most interesting points in this case is that Peke (the leper) had been vaccinated one year before developing symptoms of leprosy, and that the vaccination scar became anaesthetic. Might it not be that with the vaccine virus the virus of leprosy has also been inoculated?"
This question is answered by Dr. Chr. Uronwald, Chairman of the Sanitary Committee on Leprosy, Minnesota, Wisconsin, U.S., who says in the official report of the State Board of Health, "Vaccination has undoubtedly originated leprosy."
In a paper read before the California State Medical Society, in 1881, Dr. A. W. Saxe gives an instance of three children in Honolulu, born of American parents, who became lepers.
In consequence of the serious development of leprosy in Hawaii, there has arisen, during the past two or three years, a determined opposition to vaccination, to which the increase of leprosy is naturally attributed. The President of the Board of Health, the Hon. David Dayton, in the Report to the Board of Health, Honolulu, for 1892 (p. 27), says "that notices were inserted in the newspapers offering vaccination, but there were no applicants." In the same report (p. 67) Dr. R. B. Williams, Government Physician for Hilo and Puna, Hawaii, says:" There is among natives great prejudice and opposition to vaccination. . . . Hence voluntary vaccination is almost impossible." The existing law renders vaccination obligatory upon all the inhabitants of these islands, and has heretofore been enforced with great rigour, particularly during outbreaks of small-pox. During the past two years it appears to have been relaxed, and objectors have been humanely suffered to escape the dreaded ordeal. It is interesting and instructive to note the result. On page 41, the President of the Board of Health, observes : " On December 31st, 1890, there were 1213 lepers in the custody of the Board, that being the highest number ever reached; and on March 3 1st, 1892, there were only 1115, a decrease of 98 during the period." A recommendation is thrown out in the report, that the vaccination law should be amended, as the present laws are entirely unsuited to the times. In view of the evidence brought before the Royal Commission on Vaccination in London, showing the futility of vaccination as a preventive of small-pox, and its fertility in disseminating every inoculable disease, the only reasonable alteration in the vaccination laws that will be acceptable to an enlightened public opinion is their entire- and permanent abrogation.
Personally I have heard of many cases, which I have no doubt have been due to leprous vaccination. There is, however, it is to be regretted, manifest reluctance on the part of the profession to look for causation in this direction; it is generally pooh-poohed as soon as mentioned; and when it appears to be the only way of accounting for a particular case, the attending physician prefers to hold his peace rather than discredit a practice which he has been educated to believe is the greatest discovery in the history of medicine. Professor Gairdner, of Glasgow, introduces his cases of invaccinated leprosy in the British Medical Journal with an apology and evident reluctance.
It is generally admitted that, given the right conditions as to environment, temperament, or idiosyncrasy, all bacterial diseases are transmissible from one human being to another; and as no single authority that I have met with, since the discovery of Hansen, pretends that leprosy does not belong to this category, the danger of vaccination is obvious. I am aware that this objection is attempted to be met by the introduction of animal lymph; but animal lymph is admitted to be too active, especially in tropical countries, to be used direct; and in general, therefore, it is available only after one or two removes, when it carries with it diseases both animal and human, as has been shown in evidence before the Royal Commission on Vaccination.
An uneasy feeling is beginning to be exhibited in India on this momentous subject, owing to the accumulation of -evidence tending to show the sinister connection between the extension of the State-provided remedy against small-pox and leprosy. The synchronicity between the spread of leprosy and the extension of vaccination has given rise, in some districts, to such a dread of vaccination, that every device is resorted to by thoughtful parents to prevent their children being vaccinated. Attempts have been made to remove the dread of leprous inoculation by the substitution of cow, calf, sheep, lamb, and donkey lymph; various compounds (one described by the medical purveyor as the Madras paste, and another as Lanoline) have been introduced; and some of the leading journals now energetically demand a safer and better system of vaccination. Dr.N. Boral, Chief of the Vaccine Department in the Jubbulpore district, has come to the rescue of the Jennerian cultus in the columns of the Allahabad Morning Post, but he sees clearly the weight of the incriminating testimony, and admits that to deny- the possibility of vaccinal syphilis or vaccinal leprosy would be tantamount to denying the value of human testimony altogether.
The authorities in India are well aware of the widespread repugnance to vaccination in that country, and of the cause of this repugnance, in the mischievous results known to every vaccinator; but all mention of these evils is carefully omitted in their official reports. Now, however, that the dangers attending the most carefully conducted vaccination have been so fully disclosed in the voluminous evidence taken before the Royal Commission on Vaccination, the culpability of such reticence is inexcusable. The Statesman, of Calcutta, August 22, 1891, commenting upon the "Resolution on the Statistical Returns of Vaccination in Bengal for 1890-1," in the Calcutta Gazette, August 21, 1891, observes:" It has been stated that one of the greatest objections to vaccination among the natives of India, and other Oriental peoples, is that diseases such as leprosy, and other terrible blood diseases, have been inoculated with the vaccine virus. We think that some opinion should have been expressed under this head, and the omission of it is to be regretted in what is supposed to be a report given for the general edification of the Government as well as the public." And in a leading article, November 22, 1891, this same influential Indian journal, referring to leprous vaccination, observes : "There seems to be no possible room for doubting the reality of the very grave danger to which attention is drawn .. It is notorious that inoculation, that is, the direct introduction of the virus into the blood, is the chief, if - not the sole, means by which leprosy is communicated. Throughout the greater part of Europe, at least, and in all the principal British Colonies and Dependencies, including India, vaccination is not merely the most common means of inoculation, but in most of the countries in question it is a means which, practically, is universally adopted, and enforced by legal penalties. It seems, then, to follow, almost of necessity, that, unless special precautions are taken to prevent so terrible a calamity, leprosy, wherever it prevails in these countries, must inevitably, in a certain proportion of cases, be communicated through the medium of vaccination. . . . When vaccination from the human subject is practised, it is quite possible that, in a few generations, it might lead to an enormous multiplication of cases, and that without implying any want of ordinary care on the part of operators. For it should be rememberedand herein, it seems to us, lies the real gravity of the dangerthe disease is not one that commonly shows itself in infancy. The child from whom the lymph was taken might, to all appearance, be perfectly healthy, and yet its blood might be infected with this fatal and loathsome poison, and the operation thus make it a focus of contagion."
The Calcutta Daily News, August 7th, 1891, referring to the allegations that vaccination is responsible for the transmission of insanity, leprosy, and other diseases, observes :" The question is an important one; and while it is a great gain to humanity to even modify such a scourge as small-pox, it is largely discounted by the consideration that immunity from it may be purchased at the price of other diseases as bad or worse than that affliction itself."
The Bombay Guardian of April 6th, 1889, commenting upon the spread of leprosy by vaccination, observes : "If we have to choose - between the danger of leprosy and small-pox, let us by all means have the latter. The ghastly sights to be seen in every Indian public thoroughfare, of the scabious, handless arms, and footless legs of begging lepers, forbid any other alternative. Small-pox is bad, but leprosy is a hundred times worse."*
* The Indian Spectator, Bombay, December 27, 1891, in a leading article, calls attention to a strong reaction that has set in against vaccination, and points out that the opponents of the Jennerian method of preventing small-pox contend that vaccination is answerable for much of the spread of leprosy in recent times, and that this view, which has the support of men considered as high authorities on the subject, is of vital importance. The article concludes by observing that "The Leprosy Commission seem to have thrown away a fine opportunity in omitting to direct its researches into the alleged connection between vaccination and leprosy."
When similar charges have been made against vaccination in Europe, the usual course of the official propagandists is to ignore the terrible indictment as long as possible, and then, when questioned in Parliament, either to minimise its character and attribute the results to other causes, or to deny them altogether. Those who are concerned for the public well-being in India may study with profit the pages of the Third Report of the Royal Commission, to see what lengths the official supporters of vaccination are prepared to go in their advocacy of the Jennerian cultus.*
*On December 30, 1880, fifty-eight young recruits belonging to the 4th Regiment of Zouaves were vaccinated from a Spanish child at the Dey Hospital, Algiers. In a few weeks all the vaccinated developed syphilis, to which about one half subsequently succumbed. The Minister of War, General Farre, instituted an inquiry, but no report has been published. Five times questions were submitted in Parliament with a view of eliciting the facts. The President of the Local Government Board promised to institute inquiries through the Foreign Office, but, on receipt of a reply, excused himself from giving particulars by declaring that "the information was incomplete," and promised to make another application. Finally, on the 27th October, 1882, Mr. .C. H. Hopwood repeated his question, which was answered by Mr. Dodson (Lord Monk Bretton) by a categorical denial of the facts. At this time the Local Government Board were in possession of full details of this vaccine tragedy (supplied by a Member of Parliament), including the names of the unfortunate sufferers, their grade, matriculation numbers, and nationality, as furnished by a medical witness, after a personal and painstaking investigation of the facts at the Hopital du Dey.
A report of a " Scheme for obtaining a better knowledge of the Endemic Skin Diseases of India" has been prepared by Mr. Tilbury Fox, M.D., F.R.C.P., Fellow of University College, Physician of the Department for Diseases of the Skin at University College Hospital, London, etc., and Dr. F. Farquhar, Surgeon - Major, Bengal Medical Service. Under the title of Propagation these authors include inoculation and vaccination, and observe that there is by no means a slight body of facts which seem to show that the inoculation with matter from a leprous soreand this may occur in cohabitation and constant contact, and in vaccinationsmay give rise to the disease. The authors propound a series of fifteen questions, with the view of elucidating the presence and cause of leprosy in different- districts and individuals. It is noticeable that, while they allow that vaccination is a cause of the propagation of leprosy, inquiry on this point is not demanded. The Secretary of the Leprosy Investigation Committee, in his address before the International Congress on Hygiene and Demography, states that the cases of invaccinated leprosy are few in number. But, inasmuch as all the cases have cropped up accidentally and not as the result of research, it is impossible to estimate their number. An incalculable service to humanity will be performed when medical practitioners of high qualifications, not committed to any preconceived theory, will, in the interest of the public health, undertake this important investigation.
The British Medical Journal, Sept. 19th, 1891, reports an paper read at the meeting of the British Medical Association, on "Leprosy and Vaccination," by Dr. R. Pringle, surgeon-major, late of the Sanitary Department of the Bengal Army, who said "that of all charges which had been brought against vaccination, none approached in seriousness especially as it related to Indiathe charge that the present admitted increase of leprosy in certain countries was due to the increase of vaccination, which was stated to be not infrequently in those countries little else than leprous inoculation." Dr. Pringle, in recording this statement, fully admitted that in the main it rested on the evidence of medical officers of the, highest rank and authority in the West Indies, and that one Indian medical officer (Surgeon-General C. R. Francis) distinctly admitted, in an important public document, that this was not only possible but probable. Surgeon-General Francis, in the Journal of the Leprosy Investigation Committee, No. 1, August, 1890, had written that leprosy may be propagated by inter marriage and hereditary transmission is undoubted. I believe, too, in its propagation by vaccination or inoculation, but I am very sceptical as to mere contact being the cause. . . . I would advocate an investigation into the effects of vaccination, there being some who are still dubious on this point, though the statement made two or three years ago by Professor Gairdner on the subject would seem to be conclusive in favour of vaccination as a factor." The inoculation alluded to by Dr. Francis was stated by Dr. Pringle not to be inoculation by flies, as seen in ophthalmiaa fact which he remarked in passing was both recognised and dreaded by the Jews of old as one of the most certain and probable means of spreading leprosycontact, as pointed out, being to them a Levitical uncleanness, and not, therefore, necessarily risking the consequences of contagion. The inoculation alluded to by Surgeon-General Francis was small-pox inoculation, as practised in the Himalayas as a preventive against spontaneous small-pox. Dr. Pringle severely criticised the circumstances attending vaccination in the case recorded by Professor Gairdner in the British Medical Journal June 11th, 1887. It was hardly to be expected that the opponents of vaccination would fail to take advantage to the full of such damaging statements regarding vaccination in India as recorded by Surgeon-General Francis; but Dr. Pringle stated that Surgeon-General - Francis experience was entirely the reverse of his own. The main object of his paper was to point out the means available for subjecting these two conflicting experiences to the most searching investigation on the spot by the Leprosy Commission now in India."
Dr. Pringle proceeds to explain that for twenty years he had collected vaccine lymph in Tern, in the Himalayas, where leprosy was very gravely endemic, and used this lymph in districts where the population was 500 to the square mile. Over two millions of these vaccinations had been performed, and - he had never seen a case of leprosy traceable to vaccination. Dr. Pringle- omits to say whether he ever searched for such cases, or inspected the vaccinated subjects a year or two after the operation, or inquired whether those attacked with leprosy traced their affliction to vaccination. As Dr. Pringle urges upon the Leprosy Investigation Commission the importance of inquiry to test the validity of the charges now brought from all quarters, it would seem that he had not made this investigation himself.
Dr. Vandyke Carter, of Bombay, allowed to be one of the greatest authorities on the subject, includes vaccination among the list of causations, of which he says he has found recorded a few affirmative examples, at least, of each one method or means.Report on Leprosy and Leper Asylums in Norway, with reference to India, p. 178.
Mr. H. Brown, of Simla, writes to me Oct. 2, 1889:--"Experiments have proved - leprosy to be inoculable. There must necessarily be a dread of vaccination in India, since the subject from whom lymph is taken for the operation may be a leper. In India native village vaccinators are not over careful from whom they procure their lymph. In Malabar and various districts of the Madras Presidency, where I have lived hitherto, it has been no uncommon thing to see the lymph extracted from the arms of itchy native boys. Leprosy has increased- alarmingly since the introduction of vaccination. I know of some cases where perfectly healthy persons, whose parents also are healthy, and who have been accustomed to live in healthy localities, have been smitten with leprosy after vaccination. I can also quote cases similar where children have died, or have become very seriously ill, immediately after vaccination, from hideous eruptions and swellings. One lady, the wife of a respectable merchant in Cochin, assured me that vaccination and nothing else killed her baby. It was perfectly healthy until vaccination. The Surgeon-General, Dr. Brodie, in his report for last year on the Distribution of Diseases in the Presidency, declared that syphilis was on the increase throughout. This increase is coincident with the introduction of compulsory vaccination in a large number of municipalities, and with the more energetic action on the part of vaccination officers in the Madras Presidency."
Dr Chunder Ghose, in medical charge of the Leper Asylum, Calcutta, in a communication to the Secretary of the District Charitable Society of Calcutta, dated August 2 1st, 1889, states his opinion that leprosy is increasing in India, that it is communicable by vaccination, and that there is a dread of the operation on this account.
Dr. Roger S. Chew, of Calcutta, who was for six years in the Medical Department of Her Majestys Army in British India, and has devoted fourteen years to the study of leprosy in India and other countries, furnishes, in his pamphlet on leprosy, a table giving the results of his investigations into the causation of the 1034 cases which have come under his treatment. Of these, he says, insanitation is responsible for 105 cases, vaccination for 148, and 72 cases are due to other forms of inoculation. Dr. Chew has been kind enough to supply me with the following particulars from his case-book, in which, according to his diagnosis and careful inquiries, the disease is directly traceable to vaccination.
The cases here quoted are samples of a large number collected by Dr. Roger S. Chew, in which the connection between the onset of leprosy and a previous vaccination is well determined. With reference to this, I am advised by high medical authority that a secondary development of the results of an inoculation frequently coincides with a re-awakening of disturbance at the point of inoculation. Also, that when a secondary and constitutional disease first indicates its existence at the scar of vaccination, it may be taken as conclusive evidence that it is consequential to that vaccination. It will be noticed that, in almost all of these cases, the place of inoculation is first attacked, and in all of them it is affected.
Another point in the evidence adduced should be noted, namely, that it does not seem to matter whether the vaccination "took" or not for the secondary effects to be manifested in due course. The probability is that, if a vaccination is immediately "successful," a portion of the poison is discharged, and the rest retained. If there is no immediate result, the poison may still lie dormant for a variable period, concerning which practically nothing is known.Extracts from Memoranda in case book by Dr. Roger S. Chew, Calcutta, showing connection between vaccination and the commencement of leprosy
1."Jahoorie, aged twenty - eight. Married; no children.
Duration of leprosy, twenty years.
"There is no history of syphilis, either with himself or his relatives. - When he was about seven years old, he was vaccinated on his right arm. About six months after he- noticed a white patch over vaccine site; a similar patch appeared on his right buttock, and he soon after lost sensation in his left foot. The marks gradually faded away, broke out afresh in - other portions of his body, and again disappeared to reappear, et seq.; but wherever these marks appeared, they were accompanied by loss of sensation, which remained permanent throughout. About sixteen years ago he suffered from enlarged spleen, for which he was fired (i.e., burned with hot iron). Ten years ago the fingers of both hands began to be flexed on themselves.
"Present state :Perpendicular of ankylosed fingers is 1/8 inch on right hand, and 7/8inch on left. Fingers and thumbs of both hands much ankylosed, discoloured, and anaesthetic. Dry ulcer at inner flexion of right thumb. Open and entirely painless ulcer on tip of nose, extending 1 1/4-inch inwards. Amesthetic discoloured patches all over chest and abdomen. Two large (burn) scars over splenic region. Right foot has three large open sinuses, freely discharging a viscous, stinking, purulent fluid. On inserting little finger into the largest of these three sinuses, free vent was obtained, and the finger, striking against the astragalus, not only caused the patient a great deal of pain, but also brought away a quantity of foetid caseous-looking matter, due to caries of the bone. There are three discharging sinuses the largest one inch in diameter at the openingin the left foot also. Raw, ulcerated, and entirely painless stump, marking where middle toe of left foot has recently fallen off. Second toe of same foot has also dropped off, and on outer side of little toe of same foot is a peculiar blistered surface. Both shins largely covered with scaly and desquamating cuticle, with absolute loss of sensation. Hacking cough, and great pain in left thorax, with frequent and bloody sputa, beginning some two years ago, but aggravated during the last month. Caseous degeneration at extreme apex of right lobe of left lung.
2."Daidas, a male, aged forty-three; a native palki bearer. Duration of leprosy, twenty years.
"There is no history whatever of syphilis or syphilitic or leprous hereditation, nor are any of his relatives similarly afflicted. He was forcibly vaccinated about twenty-one years ago. The operation was not successful, but a year afterwards the vaccine pock grew rough, lost sensation, and gave place to a small crop of papillae, which spread, grew larger, and became entirely anaesthetic. He never had fever of spleen. About four years ago he used to get peculiar cramping sensations all along the course of the right ulnar (nerve) accompanied by extremes of cold and heat in fourth and little fingers. Contractions began to supervene, and these two fingers, entirely losing sensation and their power of grip, became permanently flexed on themselves. At this time his brows began to protrude and his upper lip to get thick.
"Present condition :Permanent and rigid ankylosis of fourth and little fingers of right hand, with total anaesthesia. Tumoid, discoloured, anaesthetic patches and papules all over hand and arm from finger tips to clavicular articulation. Large tumoid and anaesthetic patch, 5 X 4 in., on anterior aspect of right shoulder; another, 3 x 1 in., over vaccination site; and a third, 3 X 2 1/2 in., on elbow of same side. Upper lips very tumoid with paralysis of left side and partial anaesthesia of right. Uvula elongated and anaemic; fauces very anaemic. Sense of smell and taste are unimpaired. Left inguinal glands are indurated and slightly enlarged. Scrotum and prepuce elephantoid and anaesthetic. Posterior portion of scrotum is ulcerated. There are a few white spots over buttocks, whitish mark over left second toe, with loss of feeling. Ears are rather swollen. Features leonine, the supraorbital ridges being very tumoid and perfectly arnesthetic.
3." 1. Chundar Ghoral, a male, aged forty-two; a- Brahmin, and farmer by occupation. Duration of leprosy, twelve years.
"There is no history whatever of heredity, syphilis, impure living, or irregular habits. He was vaccinated seventeen years ago (the operation did not take), and five years afterwards a small rash broke out on that portion of his right arm where he had been punctured. This rash spread, ulcerated, healed, and left behind a thick warty lump, 3 1/2 in. long and 1 3/4 in. broad, which was utterly devoid of feeling. Similar excrescences appeared on various parts of his body, and about seven years ago he noticed some peculiar white patches appear.
"Present condition ;Open sinuses under ball of both great toes. Nodes all along course of lymphatics. Anaesthetic patches over several parts of body. Excoriation on left elbow. Leucoderma in patches of rather large areas in different parts of back and thorax. Features leonine and feet slightly swollen and oedematous. Knees swollen and marked with tubercular ridges. Complete loss of power and sensation n the fingers of both hands, but no ankylosis.
4." Rohim Bux, a male Mahomedan, aged twenty-five, a hackney carriage driver, stated on the 18th August, 1889, that, a fortnight after vaccination, which did not take, eighteen years ago, his parents noticed whitish patches occupying the site where the vaccine pits should have appeared, and remaining persistent for two years, after which they increased in size, coalesced, and steadily kept increasing to their present extent . . . On his forehead, half of right arm and hand, and on his right shin, are pinkish-white patches that do not itch; leprous ulcers on his right foot, implicating the great toe, the nail of which has sloughed off. A painless ulcer, 2 1/2 inches by 1 3/4 inches, occupies the surface of right hip joint. These ulcers are all perfectly anaesthetic. The ulcer on his hip joint is nearly three years old, scabbing, and breaking out afresh at irregular intervals.
5.-" Meer Mahomed, a Mahomedan male, aged thirty-four years, married, with eight children; a clerk by profession. His parents were quite healthy, and so are his wife and six of his children, but two daughters are lepers. On the 23rd August he showed bright silvery lines on the palmar surfaces of both hands, while on the dorsal surfaces were several small annular patches, together with three large crusted patches, the largest 1 in. by 3/4 in. First joint of left fourth finger had sloughed off, leaving a very angry stump. Running ulcers in right leg and thigh. Angles of mouth tough and thickened. Both ears nodular and tumoid (thickness, 1 1/4 in.). On chest and left arm were white patches, three of which formed a peculiar triangle which covered the vaccine pits, in which the disease first appeared. The lymph for the operation was taken from the arm of an apparently healthy native child. Patient has never had syphilis, nor does he know of any member of his family being afflicted with any blood disorder.
6.-" Bundaban Mullick, a Hindu male child of seven years, exhibited on the 27th August, 1889, several leprous ulcers on left wrist and at the angle of his mouth. On left arm was an oblong whitish-pink patch that entirely obliterated the vaccine pits. The boys father, who is perfectly healthy, says that two and a half years ago the boy was vaccinated, and about four months after the operation he noticed the puncture sites occupied by three small white patches, which in the course of one year extended and coalesced to form the single patch now seen. The ulcers appeared about a year ago, and refused to heal up.
7." A Hindu male, Bhaleshur, aged ten years. Six months after vaccination, three and a half years ago, a white patch appeared over his left clavicle and on vaccine site. Half of the patch on clavicle ulcerated, and the ulcer, finch broad and 3/4 inch long, refused to yield to either arsenic or mercury, both of which he had taken for two years. The clavicle is denuded of flesh, and plainly visible to the naked eye, while the ulcer itself is of a leprous type.
8." A Hindu female, Gowrah, aged nineteen, stated that she was vaccinated in her seventh year (as far as she remembers). The operation did not take, and, five months after, three whitish spots appeared on her right arm, where the vaccine pits should have been. These spots extended, coalesced, and, spreading downwards, disfigured her arm as far as the wrist. Her lips thickened, menses became irregular, and obstinate sores, which are still open, broke out on her feet.
9." Vincent DC., an East Indian clerk, aged thirty. A year after vaccination (six years ago) he felt a peculiar constant itching in the vaccine pits, and, a short time after, noticed on this left arm a curious rash, which subsequently gave place to obstinate ulcers, for which he was unsuccessfully treated by three different doctors. On his left arm are three irregular-margined annular patches, averaging 1 1/2 inches in diameter.
10." Da Singh, a Hindu schoolboy, aged twelve, told me (Dr. Chew) on the 11th December, 1889, that he had been vaccinated in his seventh year. About eight months after the operation, the vaccine pits ulcerated, and the ulcers spread and .coalesced, to form a large annular patch which has obstinately remained open. On same arm (right), a little above the elbow joint, appeared a long pinkish white patch, which gradually enlarged, and now occupies a space, 9 1/2 x 3 1/4 inches wide, running over flexor aspect of portions of both arm and forearm. .
11.-" Francis G, an East Indian male child, aged three; admitted on 21st December, 1889, has eczema of the scalp of three months duration. He was vaccinated when only eleven months old. The operation did not take, and a month afterwards the whole of that left arm became perfectly anaesthetic. An annular patch of the size of a rupee occupies the left angle of his mouth, and close by this annular patch are two small anaesthetic tumoid ridges.
12." Ameer Hoosein, a Mahommedan lad, aged fifteen, was vaccinated in his seventh year. The operation took, but in his eighth year the vaccine pits turned into little ulcers, which enlarged, scabbed, cleared, and finally coalesced to form one large annular patch on his left arm. Smaller annular patches exist on left shoulder, right hand, and right foot.
13." Doorie, a male, aged 18, is a leper, and attributes his disease, from which he has suffered for the past nine years, to impure vaccination. The vaccine pits are badly ulcerated, and he has an anaesthetic patch covering the entire elbow joint of the same arm. Both lungs are implicated.
14." Kasmini Bibi, a married Mahommedan female, the mother of two healthy children, deposed, on the 29th December, 1889, that she was vaccinated on her right arm in her thirteenth year. The operation took, but five years afterwards the pits ulcerated, and these ulcers remained obstinately open. At this time crops of paapillae accompanied by total anaesthesia, began to show themselves on her chin, right breast, right thigh, and right knee. About one and a half years ago a tiny white spot appeared in the centre of her forehead, and this spot has now increased to a circular patch the size of a shilling piece.
15." Goolburee, a married Mahommedan female, aged forty-seven, with pemphigus (five blotches on right foot) of one and a half years and leprosy of thirteen years standing. The latter disease she attributes to improper vaccination. She has been five times vaccinatedthe last occasion when thirty years of age. Four years after this the leprosy manifested itself. There are nodosities in both ears, in her nose, on her left arm, and along the left sternocleido-mastoid; one ulcer, 1 1/2 x 1 1/4 inches, on right ankle, and another twice this size covers last vaccine site on right arm.
16." Mabel P, a Scotch lassie, aged seventeen, and a leper for the last eight years, was brought by her mother, who stated that she was vaccinated when she was seven and a half years old. About six months after the operation, which was successful, symptoms of leprosy began to develop, and she flew here and there to every medical practitioner that money could procure to save her child, but to no avail, .as the disease kept increasing. The girls present condition is :Ears tumefied, and 2 1/2 inches thick. Face marked with ridges like cooled lava (volcanic). Sores on hands and feet and angles of mouth. Eyesight impaired. . . Tonsils indurated. Uvula ulcerated.
Ankylosis of little and fourth, fingers of both hands. Ulcer in left nostril, the right being entirely blocked, arid external nares flattened out. Lips protruding, thick, and hardened. Slight contraction of right knee, and anaesthesia well marked everywhere.
17." M. T, a Eurasian female, aged fifteen, whose father stated that three years agoat the time of the great scare caused by an expected epidemic of small-poxhe had his daughter vaccinated. The operation "took," but a year after the pits ulcerated and refused to yield to treatment. At the same time a few white spots appeared on her back, her sides, the nape of her neck, and over her face. Those on her face grew larger, till, impinging on each other, they finally coalesced to form one large blotch of pinky-white, which, contrasting against her olive brown complexion, terribly disfigured her.
18." A. An, a Chinese carpenter, aged forty-three, married, and the father of four healthy children, deposed on the 22nd December, 1890, that four months after vaccination, eleven years ago, the vaccine pits broke down into ulcers, which are still open. His ears are tumoid (1 1/4 inches) and perfectly anaaesthetic. Tubercular deposit, and. welt marked anaesthesia in patches all over body.
19." Imrato J. Ghose, a Hindu male, aged twenty-eight years, stated, on 14th Feb., 1891, that he had been three times vaccinated, in infancy, at six years, and at twenty-one years of age, at each of which times the operation was very successful. Fifteen months after the last vaccination his leprosy showed itself. His body is covered with hypertrophied anaesthetic patches of various sizes and contiguous to each other. Mercurial foetor of breath. Ears tumoid., Alae nasi partially affected, and anaaesthetic. Brows very slightly leonine; pains in loins in rising, and drawing up the legs; ulcer on ball of great toe of left foot, freely discharging serum. Vaccine pits are badly implicated in the hypertrophies on left arm.
20." Sibhoo, a Hindu male, aged forty, and a widower, stated on the 14th March, 1891, that he was vaccinated when thirty-six years old. A year afterwards the vaccine pits ulcerated (ulcers still open). He has never had syphilis in any stage; his people are healthy; his body is well nourished, with patches of discoloured (whitish) hypertrophied and anaesthetic cuticlethe smallest 4 x 5 inchesscattered all over. Black anaesthetic patch over surface of lower half of left "tensor vaginm femoris." Little toe of left foot has dropped off. Both ankles are much swollen and inflamed; there is entire loss of sensation in fingers, feet, and ulcers. Under the balls of both great toes are running ulcers.
"21.William J. C, an East Indian male, aged twenty-one, admitted on 31st August, 1891, was vaccinated three years ago, and a year afterwards noticed some pimples break out in vicinity of the pits, on back of hands, and on his back. These at first itched a great deal, but, breaking down into pustules, became devoid of feeling, and extended to various portions of his body. The left, fourth, and little fingers are also anaesthetic.
22." Khyroo, a Mahomedan male, aged fifty, applied for treatment on the 20th October, 1891. Has been married twenty years, and has four male and two female children, all healthy. Leprosy showed itself nearly a year after he was vaccinated. Prior to this be was always hale and hearty. Had small-pox eight years ago (i.e., four years after he was a leper). Present condition :Ears are slightly tubercular, their hypertrophy measuring about 1/32 inch, while their long and short diameters are normal, without sore or abrasion, and with slight anaesthesia. Face marked with small-pox pits, hypertrophy over malar ridges, angles of mouth and bridge of nose, the aloe of which are thickened, and tubercular anaesthesia is well marked. Arms covered with patches of tubercular deposit and vesicles, with well-marked anaesthesia.
"HandsThumb, ring and little finger of right hand permanently flexed; burn on thumb and forefinger, proving anaesthesia; nails deformed and splitting up; tubercular infiltration. Left forefinger much swollen, and a small ulcer on back of first joint, which is bent. Little finger also swollen and flexed on itself; fourth finger slightly flexed. Anaesthesia well marked in all the fingers, and in the palms and wrists. Small patches of tubercular growth all over wrists and dorsal surface of hands.
"Body, legs, and feet all show well-marked developments of tubercular leprosy, with anaesthesia.
23." G. DR, an East Indian of thirty years, admitted 3rd January, 1892, stated that one year after vaccination his disease appeared. Present condition :Ears wrinkled and elongated, with irregular nodes. Features leonine. Brows tumoid and tubercular, malar ridges hypertrophied and anaesthetic. Tubercular deposit at angles of mouth; nose flattened out, anaesthetic, and depressed at bridge. Tubercular deposit and anaesthetic patches along the entire length of both arms. Fingers contracted, ulcerated, and anaesthetic. Body also affected. Right leg elephantoid; the left anaesthetic. Feet well marked with the disease, being ulcerated and mutilated.
24." R. B. M, a Brahmin of thirty-eight years of age, stated that three years subsequent to vaccination the pits ulcerated and became anaesthetic. Features leonine, angles of mouth hypertrophied and anaesthetic. Arms ulcerated, with hypertrophied cuticle: ankylosis of elbow joint of left arm. Fingers of both hands badly ankylosed. A few patches of leucoderma on his back, and one on thorax. Large anaesthetic sinus under ball of great toe, of both feet.
25." Ishar Ghosal, a male Hindu, forty years of age, admitted 3rd January, 1892, deposed that he was vaccinated when twenty years of age, and five years afterwards the pits ulcerated. The ulcers healed, their site entirely lost feeling, and the anaesthesia spread till it implicated the entire length of right arm. Present condition :Features slightly leonine; face shows scars of old sores; hypertrophy and anaesthesia of malar ridges and angles of mouth. Besides the anaesthesia of right arm, there is a large whitish patch (5 x 2 1/4 inches), just above elbow. Ankylosis of fourth and little finger of both hands. Large patches of leucoderma on back, and one large white patch covers the entire thorax. The interspaces are hypertrophied and anaesthetic. Feet badly ulcerated, the ulcers being anaesthetic and discharging freely."
Dr. A., Mitra, Chief Medical Officer, Kashmir, says: "I have on three occasions searched for bacilli. In one instance I found them in lymph from a vaccinated leper."American Journal of Medical Sciences, July, 1891.
In the year 1888 the Government of India adopted and issued a series of resolutions on the subject of leprosy, admitting the increase of the disease, and acknowledging the impossibility of dealing with it in any effective manner. No word of warning was then, or has been since, uttered as to the inoculability of the disease, now so generally admitted by medical authorities, and the consequent dangers of its dissemination at the hand of the public vaccinator, nor is it likely that this source of infection will be officially condemned until the people in India, as in many parts of England, stand upon their parental rights, and refuse at all costs to imperil the health and lives of their offspring by this irrational and disease-engendering rite.
Some medical authorities, while admitting that leprosy is inoculable, and disseminated by vaccination, insist, for the credit of the Jennerian practice, that such cases are very rare, and are due entirely to the carelessness of the operator, and that, therefore, it is unreasonable to throw discredit on so beneficent a discovery on this account. This mode of reasoning may satisfy, the unreflecting; but if it be once allowed that leprosy is transmissible by vaccination, who can estimate the extent of the resulting mischief? Vaccination is practised in all the colonies and dependencies of our empire, and in all countries -where leprosy prevails. The disease is usually of slow incubation, and, until external indications of the malady are exhibited, a child may be, and often is, used as a vaccinifer without inquiry. Here, then, in leprous countries, are all the conditions necessary for inoculating the germs of leprosy into the blood of present and future generations. The late Dr. George Hoggan, of Beaulieu, France, who devoted many years to the study of leprosy, has examined many lepers in Europe, and he attributes the disease in nearly all cases to vaccination.
The following letter explains Dr. Hoggans view on this part of the subject : .
Beaulieu, Alps Maritimes,
December 29th, 1889
DEAR MR. TEBBUpon the connection between vaccination and leprosy I hold a very strong opinion. Apart from the opportunities which I have had in Egypt, Palestine, and elsewhere of studying leprosy in the mass, I think that my extensive researches into the minute pathology of the disease, as evidenced by the papers published in the "Pathological Transactions" for 1879 and "Archives de Physiologie" for 1882, warrant me fully in expressing a firm conviction on the subject. At pages 88 and 90 of the latter work I refer to the relations between vaccination and leprous infection, only, however, to show the difficulty of connecting the two in the history of the case. Taking all the factors into consideration, I hold that, in the cases of leprosy I was then investigating, the disease was conveyed through vaccination. I further believe that, in the majority of cases of leprosy developing in children, the leprous infection is transmitted along with the vaccine virus. In adults, on the contrary, I have had evidence that leprosy is often conveyed along with syphilis; and this, taken in connection with vaccinal infection in the young, had led me to suggest the following explanation of infection in leprosy :Hitherto all untainted evidence has shown that leprosy cannot be inoculated per se into a healthy body. *
*Dr. Hoggan, no doubt, refers to the negative results mentioned by Leloir in "De La Lépre," p. 237, where a doctor inoculated twenty healthy persons with leprous pus, blood, and tubercle, and to Profetas inoculations (p. 238) of twelve persons, including himself, with blood and pus from leprous ulcers in wounds made by scarification and surfaces laid bare by blisters, and to his subcutaneous injections of matter from leprous tubercie. He overlooks, however, the numerous- recorded cases of accidental leprous inoculations. Failures in intentional inoculations in countries free from leprosy cannot be set against cases of inoculation through abrasions of the skin or when the leprous poison is introduced into the blood by means of the vaccinators lancet.
Combined, however, with the virus of small-pox, syphilis, or other diseases, it seems to be easily transmissible into the system, and it is in this direction that future investigations should be pursued.I am, dear sir, yours faithfully, GEORGE HOGGAN, M.B.
In page 74 of the "Report of the Royal College of Physicians on Leprosy," dated 1867, is the following important suggestion:
"The question alluded to in the communications from Dr. Erasmus Wilson and Sir R. Martin (vide Appendix to Report) as to the transmission of leprous disease by vaccination and wet-nursing, is one of special interest to Europeans resident in India and other tropical countries, and calls for searching examination."
The cases referred to areCase 1, p. 235Elephntiasis tuberculosa; duration of latent period, two years; total duration, five years; no pains; febrile attack, simulating rubeola; vaccinated from a native child:
"A young gentleman, age 16, with fair hair and complexion, and somewhat more youthful in appearance than might be expected of his age, has been afflicted with the tubercular form of leprosy about five years. He was born in Ceylon, is the son of European parents, and one of six children, all of whom are healthy. His father and mother have always enjoyed good health, the father having resided in Ceylon for twenty years, the mother since her marriage. He was nursed by his mother, but vaccinated from a native child."College of Physicians Report.
Page 239, Case 9Elephantiasis anaesthetica following vaccination (given in Dr. Erasmus Wilsons work, 1867, pp. 620-2).:
"A lady, aged 26, the wife of an officer in the Indian army, became affected with elephantiasis in 1861. She was born in Calcutta of European parents, and brought to England when two years old. She returned to India in 1853; was married in 1855; has been eight years married, and has now (1863) revisited England for medical treatment. In 1861, then being in Oudh, she, was vaccinated from a native child, and shortly after vaccination "a slight spot came oil her cheek, and increased in size to the diameter of a shilling." It was hard to the touch, a little raised above the level of the surrounding skin, and of a dull red colour, without pain or tenderness. The swelling was painted with iodine, and afterwards blistered several times, and the blister kept open; but although somewhat reduced in size, the prominence was not removed. About six months later dull red flat spots appeared, dispersed over the greater part of her body. Her hands and feet became swollen, and she had pains of some severity in her joints and feet."
The same author gives the following on p. 650 (p. 86 of the Leprosy Committee Report):--
"Dr. Bolton, of Mauritius, mentions the case of a boy of fourteen, afflicted with leprosy from the age of seven, the son of British parents, whose father ascribed the origin of the disease to vaccination. . . . Several medical men, who have had the opportunity of watching the disease closely, expressed their belief that leprosy may be conveyed to sound persons through the medium. of the discharges of ulcers."
Referring to the series of papers which he reports, Dr. Erasmus Wilson says (" Royal College of Physicians Report," 1867, p. 234) :" Our cases also favour the suppositions of the existence of other modes of transmission (transmission by generationsupra), namely, by lactation, by vaccine inoculation, and by syphilitic inoculation. The first of these methods of contagion lies beyond the reach of remedy; the others are preventible."
In the December number of the Nineteenth Century for 1889, p. 929, Sir Morell Mackenzie, in an article entitled "The Dreadful Revival of Leprosy," says : "There is, or was quite lately, a boy in a large public school, in whom there are the strongest grounds for suspecting the existence of leprosy in the early stage; the disease is supposed to have been communicated by vaccination in the West Indies. It is beyond question also that there are many other cases in this country at the present moment, which are carefully concealed from the knowledge of every one but the medical adviser. Nearly every skin specialist must be able to attest this fact."
Dr. Suzor, of Mauritius, stated in the Progrès Medical, No. 14, that "in one instance two children of healthy parents became lepers, apparently as the result of having been vaccinated with lymph taken from a child belonging to a leprous family," and he thought the cases furnished conclusive proof of the communicability of the disease by vaccination.
In the British Medical Journal for Nov. 29, 1890, there is given a tolerably full report of the discussion on "Vaccination Eruptions" at the annual meeting of the British Medical Association held in Birmingham.
The discussion was opened by Mr. Malcolm Morris, M.R.C.S. (Edin.), who presented a formidable classification of vaccinal eruptions, including constitutional diseases of the most serious character, amongst which he included leprosy.
Dr. A. M. Brown observes in his pamphlet on "Leprosy in its Contagio-Syphilitic and Vaccinal Aspects," 1888, pp. 12, 16, 17: "When we come to note a recent medical disclosure bearing on this point (inoculation of leprosy by vaccine virus) and which has been allowed to pass unheeded for the reason, I presume, that it tells against the Jennerian and Pasteurian theory and practice, the necessity for strictest caution will be obvious. Hypothesis and specific bacilli apart, the observations of Arning, and alas, of too many who do not care to confess it, prove that vaccination is capable of actually transmitting lepra from the leprous to the non-leprous. The fact is unmistakable, and our duty is to make mankind and the medical profession dearly comprehend what this implies. . . . The unanimity and persistency with which vaccination in markedly leprous countries is charged with propagating and disseminating the malady, the well confirmed coincidence of leprous centres with vaccination centres, and the discovery of the specific bacilli in those leprously vaccinated, ought to satisfy all who are capable of weighing evidence, or of rational reflection, that controversy on the question must, and will, ere long, be silenced."
In a communication which I received from Dr. Brown, June, 1891, he refers to the communicability of leprosy by vaccination, and the attitude of the medical profession as a body towards the ever-increasing weight of evidence. "The fact of leprosy being communicable by inoculation is clearly shown by evidence to be beyond cavil or question. Medical men, seriously interested in their profession, who fail to see this are unfortunate, and their position must be charitably attributed to indifference to the whole question of leprosy, or a dread of the overthrow of some pathological doctrine to which they are practically pledged. The evidence of the fact that leprosy is communicable through vaccination is rapidly accumulating, and the force of its importance on the medical mind, as exhibited in its special journals, is anything but welcome. The fact of the exclusion of numerous well-known cases of invaccinated leprosy from the published papers of the Leprosy Investigation Committee, though most regrettable, is not surprising; the still ignoring of experimental data by inoculating bacillo grafters is quite as little so. It is certainly amazing to find that probably the chief factor in the dissemination of leprosy in the present dayJennerian vaccination should have been practically set aside by the Indian Commissioners. Considering the amount of conclusive evidence now before us, many, like myself, must have felt appalled to find that this was so. Still, we may feel perfectly assured that such a performance can no more score than the proverbial Hamlet-play where the leading role has been left out."
The Hospital Gazette, London, Oct. 1, 1890, contains the following, under the heading, "Leprosy and Vaccination ":" We know now that it is possible to transmit leprosy by inoculation, and it therefore behoves those who practise in countries where the disease is endemic to be very careful whence they take their vaccine. Leprosy is about as frightful a disease as any that poor man is exposed to, and beside it syphilisthe vaccinators bugbearsinks into comparative insignificance. A contemporary recalls the case of a native of the Sandwich Islands, who developed leprosy a year after vaccination, and seems disposed to raise the question as to whether the vaccination might not have been the means of conveying the infection."
Dr. Bechtinger, of Vienna, who has devoted thirty years to the study of leprosy in many countries, says : "No scientific man will deny that leprosy, like all bacterial diseases, is inoculable;" and he attributes the present increase of leprosy to the vaccinators lancet.
Dr. W. Munro says :"I am decidedly of opinion that by careless vaccination, bloody matter being taken with the vaccine lymph, leprosy can and most certainly would be propagated. .... . I decidedly consider that leprosy can be inoculated."Leprosy an Imperial Danger, by Archdeacon Wright p. 72.
Referring to an alleged case of infection by means of vaccination, the British Medical Journal, October 25, 1890. says:"Remembering Arnings important observations of leprosy bacilli in vaccine lymph taken from a leper, it is not to be denied that such inoculation may be occasionally possible." Perhaps this admission from the editor of a journal which has defended vaccination against all attacks and organised a powerful medical opposition against any modification of a most stringent and cruel law goes as far as could be expected. Mr. Ernest Hart has not thought it expedient, however, to submit the extraordinary statements in his "Truth Concerning Vaccination" to the test of cross-examination before the Royal Commission.
"Chambers Encyclopedia," 1891, vol. 6, page 585, says :" Evidence has recently been adduced which seems to show that it (leprosy) may be communicated by vaccination from a leprous child."
In the appendix to his work on "Leprosy," p. 274, Dr. George Thin has the following :"In the Monats. f. Prakt. Derm., Vol. XIII., No. 1, the report of a case is extracted from the Occidental Medical Times, of a leper who was vaccinated in 1878, who a year afterwards became leprous, and who at present has a large anaesthetic scar at the point of vaccination. This man had healthy parents, and of two brothers and three sisters, one had died of tubercular leprosy. He is twenty-five years of age, and has mixed with lepers all his life."
In his work of 280 pages on "Leprosy" (Percival & Co., .1891), Dr. Thin devotes four pages to "Vaccination in Relation to Leprosy," and refers to Dr. Gairdners cases. "The presumption," says Dr. Thin, that the disease was conveyed to the second and third child in the vaccine lymph is strong, but the case is by no means proved." Amongst others, Dr. Thin, p. 194, quotes the following from Dr. Daubler "Monats. f. Prakt. Derni.," Vol. VIII., p. 123), who relates two cases of leprosy at Robben Island, in South Africa, in which he believes it to be proven that the disease was conveyed by vaccination" :"The first case is that of a woman, H., thirty-six years old, married, and the mother of a healthy child of twelve. There was no leprosy in the family. Several years previously, on account of an epidemic of small-pox, she was re-vaccinated, the first vaccination having been effected when she was two years old. In the course of the two months following the re-vaccination, she experienced attacks of shivering and fever three to five times weekly, was frequently thirsty, but passed less urine than usual, and whilst the points of vaccination swelled and became brown, she grew dull and weak. She had been vaccinated on both arms over the insertion of the deltoid. No pustules formed, and when she saw the medical man two months after the vaccination, the parts were swollen. The swelling had begun three days after the insertion of the lymph, and reached its greatest extent eight days afterwards. At this time the parts became yellowish, and within fourteen days of the vaccination on each point there was a raised, discoloured skin, of a yellowish brown colour, and as large as a two-shilling piece. These swellings gradually increased, and, ten weeks after the vaccination, her physician found the skin of the arms and upper third of the forearm brown in colour and uneven. The brown spots extended lower down, when, after three more weeks, in which she was feverish and ill, the spots became swollen and smaller, but the skin did not resume its normal colour. In the fourteenth week after vaccination she had a violent rigor, repeated twice within the following week. Subsequent attacks of fever were at longer intervals, and not so severe. At and shortly after the severe rikors, brownish spots developed on the cheeks and forehead. Eighteen weeks after the vaccination leprous tubercles developed on the brow and on the cheeks. Two years later the woman was sent to the leper asylum at Robben Island, where she was seen and photographed by Dr. Daubler, tubercular leprosy being fully developed.
These cases have been carefully investigated, and their description in the "Monats. f. Prakt. Derm." is accompanied by photographs. On my visit to Robben Island, February 10th, 1892, I met Dr. P. Travers Stubbs, who is much interested in the leprosy question, and believes that the disease is inoculable and spread by vaccination. Dr. Stubbs was at that time acting as locum tenens for one of the medical officers at the Leper Settlement, and has since been kind enough to furnish me with the following further details concerning these remarkable cases of invaccinated leprosy :
NOTES OF THE TWO CASES OF LEPROSY ON ROBBEN ISLAND,
AS REPORTED BY DR. DAUBLER.
____________Elizabeth Hart, aged39.
European. Born at Cape Town.
Date of admission26th April, 1887.
RaceEnglish. Came from Wynberg (i.e., eight miles from Cape Town).
When contractedWhen small-pox was prevalent at the Cape in 1885.
Particulars as taken from the Case-book, Medical Department, Robben Island.
The patient says :"I was quite healthy until vaccinated at Wynberg by Dr. Silke in 1885. I was living with my husband in good circumstances, and had never come in contact with leprosy. About a year after vaccination a large livid patch began to appear round the vaccination mark. A few months later a creeping sensation on both sides of the face, worse on the left. Soon after this the face gradually began to, swell."
Present Condition, May 3rd, 1890.
Tubercular condition of both sides of face and earsthe left more so; loss of eyebrows; some loss of hair. Tongue a little affected in front. Both hands rather swelled and tender. Infiltration of forearms and upper arms up to shoulders. Legs same as arms. Ulceration about both ankles. There is no marked anaesthesia. No special indication at seat of vaccination on left arm, which, patient says, ran its usual course.
Has been under treatment about six months. First, iodides; gurjun about four months. The appearance of patient has much improved; also general health.
February 10, 1891.
Elizabeth Hart, aged 39, married 16 years. Occupation, housewife. One son born one year after marriage. No miscarriages. Menstruation irregular. Last unwell three years ago. Her husband is still living; also the son; both at work. Her father diedthe result of an accident. Mother died of phthisis, aged 40. No sisters. Three brothersone living, healthy; two deadone of dropsy, other found dead.
She states she was healthy until one year after vaccination, when her attention was drawn to a peculiar lividness of her left arm around the vaccination scar, which is still visible, and skin around quite healthy. There is no infiltration around the scar, which is of ordinary size and clearly visible. She consulted a doctor about this lividness, and then she went to the new Somerset Hospital, and attended for some six months, taking medicine all the time. She had pains in her legs at this time. She had no rash over her body. No sore throat, tongue, etc. Her nose, fingers, and hands became affected two years ago, 1888. Her hair began to fall out before she went to the hospital; eyelashes before she was admitted to the Robben Island Leper Asylum.
At present she has very little hairno eyelashes and eyebrows. Her nose is very much disfigured by old ulceration. Tongue nothing abnormal seen. No affection of her shoulder or elbow joints. Both her wrist joints are swollen, painful, and infiltrated.
There are small ulcerated spots about the size of a threepennypiece, which are beginning to discharge; are not deep, nor are the edges undermined. The palms of both hands were sound. The last phalanges of all the fingers and thumbs were destroyed, and the finger nails are cracked and shrivelleds No anaesthesia of fingers. Her legs from her knees downwards were in a similar condition. No periostitis of tibim. No, enlargement of glands (occipital).
In my opinion, this woman has leprosy, plus evidences of syphilis, but I am unable to find out when the latter was contracted or how.
P.B. TRAVERS STUBBS.
Ellen Wangell, 16 years.
Admitted November I, 1889, from Old Somerset Hospital.
Has lived in Cape Town and Clairmont all her life.
Contracted about 1885 at Clairmont.
Parents and brother healthy.
Tertiary rupial sores.
Patient says :" I was quite healthy till re-vaccinated at Clairmont in 1885 by Dr. Murray. I was living with my mother. We were in pretty comfortable circumstances. We were living by, ourselves. I had never seen anyone with leprosy to my knowledge. I first noticed my nose begin to swell, and afterwards the rest of my face. I was taken to New Somerset Hospital in July, 1889, for what, Dr. Eaton said, was leprosy in my legs. Afterwards to the Old Somerset Hospital ; then brought here."
Present Condition,9th May, 1890.
Symmetrical enlargement of face; right ear more than left; left cheek, large scar of ulceration, which broke out soon after admission, but soon healed; some infiltration and thickening of tongue; fingers of right hand numb, another contracted; left hand comparatively free; some remains of infiltration in forearms, but this has much diminished; some infiltration about the ankles, which are at present suppurating. Infiltration extends nearly as far as knees. Body free; no special indication at seat of vaccination. Has been under treatment since admission. First, iodide and oil gurjun from date of admission, then gurjun alone. General health much improved. Condition of arms and legs much improved.
As copied from case-book.
P.B. TRAVERS STUBBS.
Dr. S. P. Impey, Medical Superintendent, Leper Settlement, Robben Island, South Africa, says :" I wish to draw your attention to one very serious matter in respect to the spread of leprosy. It is contagious, and can be communicated from one patient to another by inoculation. In South Africa the reprehensible practice of arm-to-arm vaccination is carried on to an enormous extent. I have always held very strong opinions on this subject, and consider that many loathsome diseases are spread by means of the vaccinators lancet. No medical man would take lymph from a patient in whom the disease is visible; but in how many of these cases is it not latent? For years I have not vaccinated except with animal lymph, and, think that some means should be adopted to stop the dangerous practice of vaccinating with humanised lymph; rather allow the patients to have small-pox, where there is a chance of recovery, than force leprosy upon them. It is a noteworthy fact that, since the introduction of the art of vaccination, leprosy is spreading with rapidity. I am a firm believer in the efficacy of vaccine, but consider the arm-to-arm vaccination is a most dangerous practice and one which has led to untold misery."Extract from Special Report on Leprosy, from Robben Island, for 1891, in Reports presented to both Houses of Parliament by command of His Excellency the Governor of the Cape of Good Hope, Capetown.
Dr. Alexander Abercromby, of Cape Colony, writing from Capetown, April 20th, 1892, says that, if a drop of blood gets mixed with the vaccine lymph in the operation of vaccination, then the disease (leprosy) may be transmitted in this way, but he is of opinion that, without the blood, there is no danger. So far as the transference of syphilis and other deadly diseases is concerned, we know that this can be done with lymph of unimpeachable quality and without admixture of blood. In the January (1890) number of the "Archives of Surgery" Mr. Jonathan Hutchinson records several fatal cases, and another fatal case in July, 1890 (p. 23), all following vaccination. Mr. Hutchinson observes : " There is not the least reason to suspect any want of care in the vaccination or defect in the lymph." On July 6th, 1881, Dr. Robert Cory, Superintendent of the Calf Lymph Department, London, succeeded experimentally in transferring syphilis to himself with lymph free from admixture of blood.
Rev. Canon Baker, formerly. Chaplain at the Leper Colony, Robben Island, writes to me, June 1st, 1892:--"I have not met with any medical man who has been any considerable time in this Colony who affirmed that vaccination, from arm to arm especially, was not attended with danger in the direction of your inquiry."
Dr. P. Hellat, the leader of the movement for stamping out leprosy in the Baltic Provinces, Russia, writes to me from St. Petersburg, May 1st, 1892, that at the time when he published the result of his investigations into the spread of leprosy, he had omitted to take into account "what might be ascribed to the spread of vaccination." The matter "was of great importance, and one that cannot be considered an open question." Dr. Hellat says that in Russia no one is admitted to school without the marks of vaccination. Re-vaccination is resorted to on the occurrence of serious small - pox epidemics.