DR. R. H. BAKEWELL ON THE RISKS OF VACCINATION.
(APPENDIX to LEPROSY AND VACCINATION by WILLIAM TEBB)
In a paper read before the Auckland (New Zealand) Institute, 20th July, 1891, and printed in vol. xxix. of the "Transactions of the New Zealand Institute," Dr. R. Hall Bakewell, formerly Vaccinator-General and Medical Officer of Health for the Colony of Trinidad; author of the "Pathology and Treatment of Smallpox;" Fellow of the Royal Medical and Chirurgical Society of London, etc., says :" The permanent change in the blood is quite another matter. I commenced, but have never completed, some microscopical investigations into the conditions of the infants blood before, during, and after vaccination. It is evident that a fertile field for inquiry is open here; and without a series of well-conducted examinations, extending over children of different races, and in different climates, no positive conclusions could be arrived at. But of one thing we are quite certain, as it does not need the aid of a microscope; there is a large destruction of the red corpuscles during the febrile stage of vaccinia, followed by an anaemic condition. How long this anaemic condition lasts we have no trustworthy observations to tell us; and how far it extendsthat is, what is the actual loss of red corpusclesis, as far as I know, in the same state of uncertainty. Of course, we often find parents complaining that children who were perfectly healthy before vaccination have lost colour, strength, and flesh after it, and have never recovered their previous good health. But these complaints, tinctured as they evidently are by a strong prejudice against compulsory vaccination, must be received with caution. Still, there is such a mass of evidence of this kind that it ought to be allowed some weight.
So much for the inevitable results of vaccination. The accidents of vaccination may be roughly classified under the following heads:--
1. Inflammatory: including erysipelas and other septicaemic diseases; glandular swellings; phagedaena, sloughing, or mortification at the points vaccinated.
2.Eruptive diseases, mostly of a pustular character, occurring with or immediately after the vaccine eruption; eczema, herpetic eruptions, ecthyma, and impetigo.
3. The inoculation of constitutional diseasessyphilis, leprosy, tubercle.
Now, as regards the inflammatory diseases, there are some vaccinators of large experience who assert that they have never seen any ill-results of this kind arising from vaccination. Well, some people are very lucky, but they have no right to argue from their limited experience that such accidents never occur. I have been very fortunate in my midwifery cases; I have never lost a case in my own practice for thirty-five years; but for all that I do not deny that women die in childbirth. I have seen erysipelas more than once or twice, or a dozen times. In the West Indies it used to be common. The inflammation that followed the vaccination of coloured children was very intense, and the number of insects attacking the unfortunate children no doubt contributed to carry the germs of erysipelas to them. Glandular swellings, particularly in scrofulous children, are not rare. I had myself a case in which each vaccine vesicle was followed by mortification of the skin beneath it, and a phagedaenic ulceration which required very vigorous measures to stop it. This was in a young woman during the epidemic period in Trinidad. I am not sure whether it was a primary vaccination or a re-vaccination. The latter, as is well known, causes very severe inflammation, pain, glandular irritation, and erysipelas in the majority of adults, besides severe and most oppressive febrile disturbance; at least, this is the case at the time of epidemics, when re-vaccination is most practised.
Post vaccinal eruptions are so very common amongst the children of the poorer classes in England that they form one of the stock arguments against vaccination.
The inoculation of constitutional diseases used to be laughed to scorn in my younger days. It was said in my hearing by Sir John Simon, K.C.B., then Mr. Simon, the Medical Officer of the Privy Council, that no such inoculation could take place without gross carelessness or unskilfulness on the part of the vaccinator. I used to be of the same opinion ; but a case I saw some sixteen or seventeen years ago convinced me that an infant might look perfectly healthy, and yet be the subject of unmistakable hereditary syphilis. The evidence that syphilis has been communicated by vaccination is simply overwhelming. I may refer to the report of the Committee of the House of Commons on compulsory vaccination; the third report of the Royal Commission on vaccination now sitting in London; the work of Mr. Jonathan Hutchinson, F.R.S., late President of the Royal College of Surgeons of England, on syphilis, in which he devotes a chapter to the description of vaccinal syphilis; and my own experience in this colony and elsewhere. I have seen three cases in this colony alone.
"On my return to Trinidad I had to encounter an epidemic of small-pox which spurred us on to vaccinate right and left, and to revaccinate all who would submit to the operation. But so firmly fixed was the belief of the people that vaccination from a child of a leprous family would be a possible cause of the vaccinated persons becoming leprous, that not even the fear of such a terrible epidemic of small-pox as was then going on would induce them to allow themselves or their children to be vaccinated from any vaccinifer in whose family any member was a leper. And then, to my astonishment and dismay, I found that there was hardly a Creole family in the islandwhite, coloured, or blackfree from the taint of leprosy."