CHAPTER 5: LEPROSY AND RE-VACCINATION
THOSE who have studied the literature relating to the remarkable recrudescence of leprosy in tropical countries, or made personal inquiries where the disease is prevalent, must have been struck with the number of cases of persons whose family history has been shown to have been entirely free from all taint of this disease. In some instances the afflicted persons state they have never seen or come in contact with a leper. It is usual amongst the well-to-do classes to keep the malady a profound secret as long as possible; but a time comes when the disease discloses itself to the family physician or casual observer, and the friends are then led to inquire as to how the disease originated. Close inquiries reveal the fact that with them it is not hereditary, and the afflicted member is free from sore or abrasion of the skin. How, then, could the dreadful leprous poison have been contracted? The doctor then suggests the vague and much misunderstood word "contagion," or malaria, or diet, all of which theories are now rejected by leading lepra authorities. The unfortunate patient remembers that during a smallpox scare by the advice of his doctor he was re-vaccinated. Inquiries are made as to the vaccinifer, and it is not seldom discovered that the vaccine virus was taken from a subject in which the leprous taintthen not discerniblehas since fully disclosed the ulcerations of unmistakable tubercular leprosy. It will be said that this is a hypothetical case. From much conversation with intelligent observers in many countries where this disease prevails, including both English and native medical practitioners, public vaccinators, and army surgeons, I am convinced that this is by no means an uncommon experience. So strong is the belief in the existence of this danger, that soldiers in our tropical colonies, when subjected to vaccination, often resort to the practice of squeezing out the virus, if they can do so without observation, and use carbonate of soda, borax, and other disinfectants in order to neutralise the effects of the poison. This dread of vaccination is due to the knowledge amongst our troops, often born of bitter experience, that vaccination is not seldom the factor of disgusting and intractable diseases, the fatal cases of which are invariably registered under secondary causes, without disclosing the originating source of the malady. The leprous taint is more common in the army than is generally supposed. In my various inquiries I have heard of several soldiers being so affected. In his work on"Leprosy" (p. 71), Dr. Munro refers to the case reported by Dr. Liveing of a private soldier, a leper, in British India, who had several brothers and sisters all older than himself and all healthy. The same authority cites "the case of an officer mentioned in the Report of the College of Physicians, p. 241. Landre speaks of Dutch private soldiers being affected, while ladies never are, they never being exposed to contagion" (p. 45). If Dr. Munro had explained that ladies are not exposed to compulsory re-vaccination, he would have touched the solution of one source of infection. Dr. Sutherland, of Patra, says :" When serving with the native army, I found repeatedly that men who had in early life the character which I regard as a proof of the existence of a leprous taint, which I have already described, frequently had to be invalided in after years for leprosy, and subsequent observation and inquiry have led me to the conclusion that the opinion I have formed regarding what I have named a leprous taint was correct, and that this condition precedes the appearance of the disease in its aggravated form; and I think I am warranted in concluding, from the data given above, that this leprous taint exists in one out of every ten of the adult rural population of this district. In stating this, I am aware that my views will probably astonish persons who have not given the subject the attention I have."Royal College of Physicians Report, p. 188.
In a note, entitled, "Leprosy in Livonia," the British Medical Journal of August 20, 1887, p. 423, says:" The disease (leprosy) was introduced by a discharged soldier from Southern Russia." The same journal, in its issue of October 22, 1887, in a note on "The Spread of Leprosy," quotes M. Besnier, a member of the French Academy of Medicine, to the effect that, since the extension of the French Colonial possessions, soldiers, sailors, and missionaries, have fallen victims to leprosy in large numbers. The British Medical Journal, January 12, 1889, p. 93, in an article entitled "Transmission of Leprosy," mentions several cases of leprosy, including two young soldiers who became lepers. And the number for March 23, 1889, pp. 668-9, publishes the details of a case of mixed leprosytubercular and macularreported by Dr. 0. Caroll to the Royal Academy of Medicine in Ireland. The patient was an army pensioner, who had served in India and the Cape, "but he had not been, so far as he is aware, in contact with any leprous person." Again, on April 13, 1889, the same journal publishes a letter on "Leprosy in the United Kingdom," in which the writer says :"T. H., after a service of twenty-two years in India under the East India Company, returned home, and soon became a victim to tubercular leprosy." Another case of a soldier, formerly in India, who is now a leper in the wards of a large general hospital, is mentioned by Mr. C. S. Loch in the British Medical Journal, July 13, 1889. And in its issue of December 21, 1889, the same journal gives the fatal experience of this re-vaccinated part of the population, observing, on the authority of Dr. Olavide, of Madrid, that in the (leprosy) infected provinces of SpainJaen, Cordova, and Guadalura"most of the sufferers are missionaries or soldiers."
Madhub Chunder Ghose, Medical Officer in charge of the Leper Asylum, Calcutta, in a communication to the Hon. H. Beverley, dated Calcutta, 27th August, 1889, says :" It is well known that a distinguished officer of the Indian Medical Service became affected by leprosy during his residence in India."
These cases are too numerous to be explained by the theory of coincidence, and similar instances can be heard of by inquiry in every country where leprosy is endemic. In none of the foregoing instances does it appear that any inquiries were made as to re-vaccination being a possible source of the infection. No doubt the medical practitioners had their private opinions as to the causation of the cases examined, which, however, they have carefully withheld. In one of the cases a press reporter remarked on the reticence of the doctor, who, he said, "absolutely refused to give me any details beyond those which may be said to be available to any member of the public." He admitted, however, that the case was undoubtedly one of leprosy.
Soldiers, it should be observed, are picked men, living amidst healthy surroundings under superior hygienic conditions. They do not associate with lepers, but, on the contrary, carefully shun them. Nor can the disease in the instances I have cited be due to heredity. Re-vaccinated soldiers appear to be more liable to the disease than the European residents in countries where the disease prevails. However much opinions may differ as to other sources of causation, all authorities admit that leprosy is an inoculable disease and communicable by vaccination. Is it not probable, therefore, that the cases I have quoted are due to contamination at the point of the lancet in re-vaccination? Since the terrible disaster at Algiers in December, 1880, when 58 soldiers of the 4th Regiment of Zouaves were syphilised by re-vaccination from a Spanish child "of remarkably healthy appearance," I have made it a practice in all tropical countries which I have visited to interview soldiers and question them on the results of vaccination in the army. I could fill a long chapter of this book with details of disastrous consequences where soldiers; have been invalided at hospital with tumours, abscesses, and sometimes intractable maladies directly due to vaccination. Some have had their arms amputated and been discharged from the service, and others have sustained lifelong injuries. It must be noted that soldiers, when quartered in tropical countries where leprosy and syphilis prevail, are often obliged to submit to several re-vaccinations. In Capetown, a soldier belonging to the North Stafford Regiment, on duty near Government House, informed me (February 9th, 1892) that since he joined the army he had been vaccinated thirteen times. He was badly pitted with small-pox.
In an article on "Leprosy in the Baltic Provinces," by Dr. P. Hellat, dated St. Petersburg, in the Journal of the Leprosy Investigation Committee, December, 1891, the writer cites the following case which he considers speaks "very strongly for infection ":" A young man coming from a leprous-free district is called for military service, through which he comes to the South of the Empire to a leprous village, gets ill after two years with lepra tuberosa, returns home, lives with his mother, who after two years is attacked with lepra ancaesthetica." Dr. Hellat omits here to note that the first danger to which the recruit is subjected on joining the army is that of being inoculated with contaminated virus in the process of vaccination. All other risks, unless he has sores or wounds on his body (very improbable in a recruit who has recently undergone medical examination), are comparatively infinitesimal. For the serious risks incurred by re-vaccination our troops receive no compensating advantage in the way of immunity from small-pox, either of a sporadic or epidemic nature. According to the army medical reports, we find that among troops in Egypt in 1889 there were 42 cases and 6 deaths from small-pox. In the Bengal army in 1889 there were 71 cases and 8 deaths. In the Bombay contingent there were 49 cases and 3 deaths; and among the troops in Madras 32 cases and 6 deaths. In all, there were, in 1889, among this picked body of healthy re-vaccinated men, 202 cases and 23 deaths. How many cases of erysipelas, eczema syphilis, tuberculosis, and leprosy were due to re-vaccination is not stated, but we know that after every general vaccination order, a number of soldiers are disabled for a time, some more or less seriously. I produced evidence before the Royal Commission on Vaccination (Vol. III., p. 116) that in 1882 the Federal Government of Switzerland, owing to re-vaccination disasters, rescinded the regulation in the army, and in 1883 M. Weitzel, the Minister, of War for Holland, for similar reasons, issued an order to the effect that re-vaccination was no longer obligatory in the army of that country.