CHAPTER 8: LEPROSY AND VACCINATION AT THE INTERNATIONAL HYGIENIC CONGRESS.
IN the month of June, 1890, I presented before the Royal Commission on Vaccination certain facts tending to show the increase of leprosy in various countries which I had visited, and that this, increase was largely due to vaccination. In the following autumn I extended my inquiries to other countries, and discovered the same sinister results; and in the following April I published my conclusions in a pamphlet entitled "Leprosy and Vaccination," which has been widely circulated in the countries where the alleged cases of leprous invaccination have occurred. But no attempt was made to reply to the allegations until August, 1891, when Dr. Phineas S. Abraham, the Secretary of the Leprosy Investigation Committee, read a paper on the subject before the International Congress of Hygiene and Demography in London. The following is the report of his address, from the Lancet of August 22, 1891 :
"On the Alleged Connection of Vaccination with Leprosy. Phineas S. Abraham, M.D., read a paper on this subject. Accepting the bacillary theory of leprosy, and believing that instances have occasionally been reasonably demonstrated of its communication from one infected person to another previously healthy, Dr. Abraham has sought for evidence as to every possible means of inoculation, vaccination included. In this paper he gave a short account of the principal inquiries bearing upon the subject, and discussed the facts which have been alleged to connect leprosy with vaccination. The statements, or supposed cases, of the following observers were among others alluded to :Sir Erasmus Wilson, Sir R. Martin, Dr. Bakewell, Dr. Tilbury Fox, Dr. Castor, Dr. Ebden, Mr. Malcolm Morris, Dr. Bemiss, Dr. Hildebrandt, Dr. Arning, Dr. Mouritz, Dr. Rake, Archdeacon Wright, Professor Gairdner, Dr. Black, Drs. Swift and Montgomery, Surgeon Brunt Dr. Piffard, Mr. Hillis, and Professor Leloir. It was pointed out that the question had been in the minds of inquirers for many years past, and that the supposed instances brought forward were comparatively few. Even the most suspicious cases, such as those adduced by Professor Gairdner, Mr. Hillis, and others, were open to the objection that there was nothing to show that the subjects had never been exposed to any other possible means of inoculation or contagion, had never been in contact with lepers, or had never had to do with food or anything else which might have become contaminated by lepers; in short, we could not be sure that, having been born, or having lived for some time in a leper land, they had not been exposed to other pathogenic conditions of the disease. Dr. Arnings and some of the other observations were quoted in full because they had been much twisted, and false deductions have been drawn from them. The evidence from Scandinavia was significant; vaccination had been compulsory in Norway for many years, and largely practised from arm to arm in the leprous districts, and, as Dr. Hansen stated, no case of transferring leprosy therefrom had been hitherto known. Leprosy, indeed, was there steadily decreasing. In China, according to Dr. Manson, leprosy was common in the district where vaccination had been practised for the last sixty or seventy years; but, on the other hand, it was more common in districts where vaccination had only been recently introduced, and was practised to a very limited extent only. Some fresh facts and definite information on the subject were hoped for from Mr. William Tebbs late evidence before the Vaccination Commission. A great deal was, of course, made of the observations of Professor Gairdner, Dr. Arning, Dr. Castor, Mr. Hillis, and of some of the others alluded to above. One of them held the view that the spread of leprosy might be due to syphilitic vaccine lymph, and another had written a pamphlet on the subject which was full of inaccuracies. In point of fact, although a priori the possibility of an occasional accidental inoculation of the disease by vaccination might be admitted, up to the present time no absolutely clear and incontrovertible evidence connecting vaccination with leprosy had been forthcoming; and, in Dr. Abrahams opinion, anyone who said that vaccination was to any extent responsible for the spread of leprosy talked arrant nonsense. Nevertheless, from what was known concerning the introduction of bacillary diseases in man and animals, it certainly behoved medical men to be extremely careful in the selection of their lymph for vaccination; and in a country where leprosy was rife it seemed to him that it would be advisable to exercise particular caution, and, if possible, avoid, as was now being done in Hawaii, an indiscriminate arm-to-arm vaccination among the natives. The question of the possibility of transmitting leprosy bacilli by vaccine is receiving attention on the part of the Indian Leprosy Commission, and a paper on the subject by Drs. Bevan Rake and Buckmaster will appear in the next number of the Leprosy Journal"
In answer to this statement I sent the following to the Lancet:
LEPROSY AND VACCINATION.
(To the Editor of the Lancet.)
SIR,Dr. P. Abrahams address before the recent International Congress of Hygiene and Demography on the alleged connection of vaccination with leprosy, reported inthe Lancet of 22nd August, is hardly calculated to allay public anxiety in our tropical colonies where the disease is endemic. As he has referred to the evidence which I gave on this subject before the Royal Commission, I shall be glad if you will kindly allow me a short space for explanation. Dr. Abraham has furnished a tolerably large list of authorities who have either pointed out this particular danger or supplied particulars of cases where leprosy has in their opinion been invaccinated, but he adds that these cases are comparatively few. Allow me to observe that Dr. Abraham has omitted to mention that, of the distinguished medical witnesses, some have adduced several cases of invaccinated leprosy, and others refer to a "prolific," "serious," "alarming" increase of leprosy due to vaccination. Some of the cases are introduced with reluctance by practitioners, who know the damaging effect of these allegations upon a prescription lauded as "the greatest discovery in the history of medicine." Dr. Abraham quotes Dr. Hansen as stating that in Norway no case had been hitherto known of the communication of leprosy by vaccination. Permit me to say that this well-known pathologist has given his emphatic opinion, which I quoted before the Royal Vaccination Commission, that the chief means of disseminating leprosy is by inoculation, and that in Norway the greatest possible care is observed to prevent lymph being taken from leprous subjects. Dr. Abraham advises medical men to be "extremely careful" in the selection of their lymph, especially in countries where leprosy is rife, and to avoid arm-to-arm vaccination, "as is now being done in Hawaii." I beg to state that less than a year ago, as I know from personal inquiry, the bulk of the vaccinations in Hawaii were performed with humanised virus, it having been found that animal lymph produced excessive inflammation and many terrible cases of ulceration. In Ceylon, where leprosy is endemic, and, according to Dr. Kynsey, the Surgeon-General, increasing from some occult cause, arm-to-arm vaccination is principally in vogue, as it is also in the West Indies. If leprosy is spread chiefly by inoculation (and this source of infection is more generally accepted amongst dermatologists than any other), there is no mode of inoculation so widely prevalent as vaccination; and, having investigated the subject in all quarters of the globe, I attribute largely to this cause the alarming recrudescence of the disease which has taken place during the last thirty years in our colonies and most other leprous countries.,WILLIAM TEBB., Devonshire Club, St. Jamess, London, 5th September, 1891
This letter was refused insertion
It is clear by Dr. Abrahams mode of argument that leprous vaccination, as an important factor in the increase of the disease, is the last thing he will admit. All other possible sources of dissemination must be excluded before a theory so fatal to medical prestige can be tolerated. Any other of the numerous theories promulgated to account for new centres of leprous contamination the doctor is ready to consider, but vaccination (to use a classic phrase) "must be preserved from reproach," and the reputations of its distinguished advocates maintained. His opinions, however, do not seem to meet universal approbation, even amongst the medical profession. Commenting upon Dr. Abrahams address, the Hospital Gazette, London, of August 22nd, 1891, observes :" Dr. Abraham has gone to a great deal of trouble to prove, or attempt to prove, that, though leprosy is probably as susceptible of being conveyed by vaccination as is syphilis, there is no well authenticated case of the kind on record. It is admitted that quite a number of suspicious instances have been reported by competent observers, but Dr. Abraham rules them all out of court on the ground that other possible sources of infection have not been eliminated. This seems to be asking too much. Leprous vaccine is obviously only obtainable in countries where lepers are common, so that, theoretically, the victims must necessarily have been exposed to the special pathogenic influences. It has, we believe, been scientifically demonstrated that the disease can be conveyed by inoculation, and we shall require something more than this specious special pleading of Dr. Abraham before acquiescing in his conclusions."