CHAPTER 9: VACCINATION IGNORED IN OFFICIAL LEPROSY REPORTS.

 Now that evidence is accumulating in all directions regarding vaccine virus as a propagator of leprosy, attempts are made to minimise the effects of this evidence on public opinion, by alleging that the instances of such infection are few in number, and of no account when put in the scales against the enormous benefits arising out of the application of Jenner’s great discovery. This is not the place to enter into the pros and cons of this much-vexed question, but those who wish to study the facts may do so advantageously in the reports of the Royal Commission on vaccination; in the article on vaccination by Dr. Charles Creighton in the ninth edition of the "Encyclopedia Britannica"; in the able monograph, "Jenner and Vaccination," by the same author, and in Professor Crookshank’s instructive treatise, "The History and Pathology of Vaccination." My own views on this subject—the results of a lengthened experience—may be found in the Westminster Review for December, 1888, and January, 1889. While I do not admit with Dr. P. Abraham, Dr. George Thin, Dr. Beavan Rake, and others, that the cases of leprosy due to vaccination are few in number, it should be borne in mind that the subject has never been submitted to searching and impartial investigation. In 1862, by request of the Government, a Committee of the College of Physicians prepared a series of seventeen interrogatories which were sent to lepra specialists in all parts of the world, but all reference to vaccination as a possible or probable factor was strictly excluded.

In consequence of the rumours of the spread of leprosy, by means of vaccination, in the Island of Trinidad, Governor J. R. Longden felt it his duty to call the attention of the English Government to the subject, and on the 4th March, 1871, he addressed a dispatch to the Right Hon. the Earl of Kimberley, then Secretary of State to the Colonies. In confirmation of this serious charge against vaccination Governor Longden referred to the report of Dr. Bakewell, the Vaccinator-General of Trinidad, and to certain cases of invaccinated leprosy, and to Sir Ranald Martin and other eminent physicians as authorities for his statements, and added, "This part of Dr. Bakewell’s report appears to me to be deserving of your Lordship’s attention in connection with the increase of leprosy, which I fear must be admitted to have taken place in the last few years." In paragraph 13 of the dispatch Governor Longden says: "The danger of introducing disease into the system of a previously healthy child by vaccination is possibly a real one, and it is very important, as regards tropical colonies at least, that it should receive the attention of the medical profession." In paragraph 14, Governor Longden pertinently observes that the special danger of spreading broadcast the seeds of leprosy would be worse than the perpetuation of small-pox. Governor Longden’s dispatch was referred by the Colonial Department to the Royal College of Physicians, who were anxious to get rid of the most damaging indictment yet preferred against vaccination. This they, sought to accomplish, as far as possible, by ignoring it altogether.

That learned body nominated, Dr. Gavin Milroy, F.R.C.S., who arrived at Georgetown, British Guiana, on the 22nd July, 1871, and prosecuted inquiries mainly as to the contagiousness of leprosy in that Colony, and on the 17th October, 1871, he submitted to the Earl of Kimberley a report confirming the conclusion of the College of Physicians, as given in p. xix. of their report as follows :—" The all but unanimous conclusion of the most experienced observers in different parts of the world is ‘quite opposed to the belief that leprosy is contagious or communicable by proximity or contact with the diseased." Dr. Milroy adds :—" My personal observations and inquiries in the Colony all tend in the strongest manner to the same result" No question as to vaccination was submitted for consideration. On the 25th October, 1871, Dr. Milroy reached Barbados, and from thence proceeded to Antigua, and later on visited Trinidad, Dominica, and Jamaica. On reaching Trinidad in November, 1871, he discovered that Dr. R. H. Bake-well in his report had given "countenance to the popular belief as to the transmissibility of leprosy by vaccination," and, with the consent of Governor Longden, inserted an additional question to the Interrogatories for circulation in that’ Colony. This question, then submitted for the first time, elicited answers abundantly confirming Dr. Bakewell’s contention. These answers will be found cited in the communication from Mr. Alexander Henry, and elsewhere, in this volume.

Dr. Milroy’s report on this part of the subject is mainly directed to answer and, if possible, disprove Dr. Bakewell’s allegation, which, if unanswered, might prejudice the continuance of vaccination. Dr. Milroy says, "What is contended for is, that pure, genuine, vaccine virus, unmixed with blood, cannot be the medium of any contagion but cow-pox:" conditions, as every public vaccinator knows, impossible of fulfilment. At this period the transference of syphilis by means of vaccination was publicly acknowledged, but Dr. de Verteuil of Trinidad, in his reply to Dr. Bakewell, observes: "It is an illogical deduction that, because syphilis is inoculable, leprosy is, or might be, inoculable, the diseases being essentially different." Dr. Browne of Barbados, one of the witnesses, has misgivings on the point, and writes to Governor Rawson, November 8th, 1871, as follows:

"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 disease, as from a respect for the general prejudices prevailing." Public opinion, as shown by. Dr. Bakewell’s evidence, was even at that time in advance of medical opinion regarding the danger attending vaccination. Dr. Reade, the Colonial Surgeon of Singapore, cautiously observes (Dr. Gavin Milroy’s report, p. 36):

"There is a possibility that the disease (leprosy) may be transmitted from children hereditarily tainted with leprosy, and I strongly advise the continuance of importing lymph from England by every mail, and carefully selecting only healthy children as vaccinifers."

The testimonies elicited by this inquiry as to the communicability of leprosy and syphilis seem to have had no practical effect on the College of Physicians. In a letter from that body on "Vaccination and Leprosy," dated London, August 17, 1871, and addressed to the Earl of Kimberley, it is stated that, while it is admitted that in a few instances syphilis has been transmitted by vaccination, "yet with reference to leprosy it must be observed that there is no evidence adduced beyond the merest presumption that this disease has ever been transmitted by vaccination." And so far from cautioning the public against this fearful danger, and petitioning Parliament to repeal a law which had been productive of so much mischief, the College of Physicians reaffirmed their belief in the benign character of vaccination, and declared "that 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, and it would be a grievous wrong to forego so great a public benefit on the mere speculative grounds advanced by Dr. Bakewell."—Report on Leprosy and Yaws, p. 86.

The next inquiry emanated from the India office, and is entitled "Scheme for obtaining a better knowledge of the endemic skin diseases of India," prepared by Tilbury Fox, M.D., F.R.C.P., and T. Farquhar, M.D., 1872. Two chapters in the report of this inquiry are devoted to leprosy. The authors here furnish a list of twelve questions for elucidation in regard to the presence and cause of leprosy in different districts, and three questions for leprosy in individuals. In none of these iseither inoculation or vaccination specified.

The alarming increase of leprosy in Hawaii, which took place after the introduction of vaccination by the missionaries, once more called public attention to the subject, not only in that group of islands, but throughout the civilised world. In 1885 the Department of Foreign Affairs in Honolulu instituted the most extensive inquiry made up to that time into the causation of leprosy, and the means of its treatment and prevention. The deplorable position of affairs is briefly stated in the introduction to the official report, entitled, "Leprosy in Foreign Countries: Summary of Reports furnished by Foreign Governments to His Hawaiian Majesty’s Authorities, as to the prevalence of Leprosy in India and other Countries, and the measures adopted for the social and medical treatment of persons afflicted with the disease." . . . "It is about thirty years since leprosy first attracted any serious attention in the Hawaiian Islands. In the year 1866 the dread disease had gained such a deadly hold upon the native race, that the Hawaiian Government began to attempt to stamp out the scourge by segregation, for it had become a contest for the preservation or destruction of the aboriginal race. To judge by the number of cases in proportion to the population, the disease appears to be more virulent and malignant in the Hawaiian Archipelago than elsewhere on the face of the globe. What has been attempted and accomplished in this twenty years struggle with a great national calamity appears elsewhere."

"His Hawaiian Majesty’s Government being anxious to provide every possible means for the treatment and understanding of the fearful malady, His Excellency Walter M. Gibson, His Majesty’s Minister of Foreign Affairs and President of the Board of Health, addressed letters of inquiry to the Secretary of Legation at Ceylon and to the diplomatic and consular representatives of the Hawaiian kingdom in various parts of the world where leprosy was known to exist, making inquiry in respect to the character and treatment of the disease." It is stated that the response to these inquiries has been most generous, more especially from governments of dependencies of Her Majesty Queen Victoria. This interesting document gives reports from every section of the vast Empire of India and its dependencies, from Ceylon, Hong Kong, Siam, the Netherlands and their colonies, the Canary Islands, Norway, Spain, Mexico, Chili, and Guatemala, and an extremely interesting and valuable report from the famous Leper Institution of Tracadie, New Brunswick, Canada. The report from the Secretary to the Government of India being so comprehensive and voluminous, it has been considered expedient to separate it from the other reports.

"In grateful recognition of the sympathy of other afflicted nations, this collection of reports, together with the sad history of its own affliction, is presented to the world by the Hawaiian Government in the devout hope that the Almighty, in his great mercy, may ere long permit suffering humanity to find the means of mitigating the terrible scourge."

From this little known compilation I have made extracts on various matters dealt with in this volume.

In this important inquiry, although at that time the facts had become known throughout the Hawaiian Archipelago as to the spread of leprosy by vaccination, yet such was the reluctance to bring so grave a charge against a practice proclaimed far and wide as "the greatest discovery in the history of medicine," that it was thought expedient to make no mention of vaccination in the interrogatories, and to specify only those points drawn up by the Committee of the College of Physicians in 1862.

Owing to the increase of leprosy in South Africa, inquiries by Select Committees of the Legislative Assembly were instituted in 1883 and 1889, but the interrogatories relate chiefly to the spread of the disease, and to its contagious or non - contagious character. The questions were submitted viva voce, and vaccination as a possible factor in the dissemination of leprosy is carefully ignored.

An important report by Dr. S. P. Impey, Medical Superintendent of the Leper Settlement, Robben Island, on the dangers of spreading leprosy by means of vaccination, was in June, 1891, sent to the Colonial Office, Capetown. Of this report I have attempted, by repeated personal applications at the Colonial Office, Capetown, and at the Stationery Department of the colony, to obtain a copy, but without success.*   (*An extract from this report, through the intervention of a correspondent in South Africa, has since been obtained).

In the "Report of the Leprosy Inquiry Commission" for the Colony of Mauritius, published 26th October, 1888, I find the following request in the circular of instructions sent to medical practitioners :—"We would be glad to obtain any facts bearing upon the question of its heredity or contagiousness, upon the conditions favouring its diffusion, upon its treatment, and, finally, upon the best means of preventing its spread in the community.—T. LOVELL, Chief Medical Officer," etc.

Nothing is said as to the inoculability of the disease, nor is there any inquiry suggested as to vaccination, which has been the means of spreading leprosy in this colony.

The Royal College of Physicians published another report on leprosy in 1889, concerning which the Lancet, April 20th, 1889, says :—" A report from the Leprosy Committee was read. It stated that the documents forwarded by the Government on the subject of leprosy since 1887 did not contain much, if any, new information. In view of the fact that there is increasing evidence respecting the communicability of leprosy, the committee repeated ‘with greater urgency’ the recommendation made in 1887, that the Government should institute a full and careful scientific investigation, which would entail expense and require considerable time. The adoption of the report was moved by Dr. Symes Thompson, who said that the disease was spreading very much among communities in South Africa, and was seconded by Dr. Handfield Jones, who thought that the College should express more definitely its opinion of the contagiousness of the disease and the need for compulsory segregation. This view was not accepted by other speakers, but all concurred in the urgency for a thorough scientific investigation, and it was referred to the committee to draw up a statement respecting the scope of such inquiry, for submission to the Government."

This report was, founded upon official and other documents collected up to that date and forwarded by the Government to the College of Physicians. Of these documents I have been unable to obtain copies or even permission to inspect them. The report is signed, "James Risdon Bennett, Chairman," and is dated April 5th, 1889. It was then four years since the disastrous effects of vaccination in Hawaii had been published by Dr. Edward Arning, and two years since Professor Gairdner’s remarkable cases of invaccinated leprosy had been made known in the British Medical Journal. These and other facts showing the danger of invaccinating leprosy had been laid before the Dermatological Congress of Europe by eminent specialists. And soon after the publication of Dr. Gairdner’s cases, Sir William Robinson, Governor of Trinidad, issued a confidential circular to about 30 medical practitioners of that island, containing the question as to whether leprosy is communicable by vaccination, "lymph from healthy vesicles alone being used." Dr. A. S. Black, a well known practitioner, gave particulars of several cases in his own experience, and stated that leprosy was increasing in the island. In his report to the Surgeon General for 1890, p. 34, Dr. Beavan Rake says :—" Some thirty or more Trinidad doctors to whom the same circular was addressed returned negative replies." Dr. Rake omits to state that those who doubt or deny the risk qualify their answers by remarks such as that there is no danger "if pure lymph only is used, and precautions taken in the selection of the vaccinifer and the examination of the pustule," "if there be no admixture of blood" and "healthy lymph is used," "provided the lymph is clear" and "the vaccinifer is free from hereditary taint," "if bovine virus is selected," "with perfect cleanliness of the lancet," etc. Dr. Woodlock mentions that he takes the precautions of constantly importing fresh certified lymph from England. Dr. D. de Montbrun "dreads vaccination on the ground that syphilis and other cutaneous diseases have been transmitted by it." He also states that nearly all the families in Trinidad strongly object to vaccination with lymph taken from the children of the island, from fear that leprosy may be thereby communicated. Dr. Chitterton says :—" Vaccination is performed in Trinidad in a very unsatisfactory way." It is obvious that the value of the answers is seriously vitiated by the form in which the question is worded. The use of clean lancets and healthy vaccinifers without hereditary taint, however much insisted upon, cannot be made compulsory; and the people are obliged under severe penalties to submit to whatever vaccination is offered, which is chiefly of the leprous and syphilitic variety, collected from miscellaneous native vaccinifers by perfunctory public vaccinators. Indeed, as I have found by personal inquiries in the West Indies, South Africa, and Hawaii, all the precautions admitted to be indispensable for the safe performance of the official rite are habitually disregarded.

The latest inquiry is due to the extraordinary amount of public interest awakened by the published reports of the labours, devotion, and death of the late Father Damien in the Sandwich Islands, and to the accumulation of evidence from many English and French Colonies showing conclusively the increase of this frightful malady. The first meeting was held at Marlborough House, June 17th, 1889, under the presidency of H.R.H. The Prince of Wales; and a dinner in aid of the National Leprosy Fund was held at the Hotel Metropole, London, on the 13th January, 1890, at which also the Prince of Wales presided. A highly influential Committee was subsequently appointed, with Dr. Phineas S. Abraham as secretary. The following letter, with a view of eliciting suggestions, was published in the Lancet of the 31st May, 1890, also in the British Medical Journal and in the first number of the Journal of the Leprosy Investigation Committee:—

SIR,—With the object of eliciting by correspondence as much information as possible on the subject of leprosy, it is proposed as a preliminary investigation to address a series of questions to the officers of the various leper asylums and to others who may be able to throw some light upon the matter. I am requested to ask you to allow me to invite the co-operation in this inquiry of those of your readers who, from their knowledge of the disease, may be in a position to offer suggestions as to matters of, inquiry and as to points of elucidation. Any observations with which the Committee may be favoured will be gladly received and incorporated in the "Journal of the Leprosy Investigation Committee," of which the first number will be shortly published.—I am, sir, yours faithfully, P. S. ABRAHAM, Med. Sec. May 26th, 1890.

Dr. Abraham further explains that "although all information bearing on leprosy will be deemed of interest, it will be desirable for observers to direct particular attention to questions relating to the cause or causes and propagation of the disease, as well as to those referring to remedial measures." "It is to be noted that this ‘Journal’ is published for the purpose of obtaining reliable scientific information on the subject of leprosy, and that it will not be carried on in the interest of any one particular theory. Views from all sides will be admitted; and that the truth may be arrived at, full and free discussion is invited."

Nothing could be fairer, more explicit, or more promising for establishing public confidence and support than these announcements. Realising the importance of the subject and the limitations laid down by Dr. Abraham, I addressed to him, as Secretary of this Inquiry, the following brief communication on the principal point referred to—the causation of leprosy :—

Rede Hall, Burstow, near Honey, Surrey,
    June 10th, 1890

SIR,—Observing your note in the Lancet of the 31st tilt., requesting suggestions as to methods of inquiry, and as to points of .elucidation, with regard to the remarkable spread of leprosy, I beg to point out that amongst the questions which it is proposed by your committee to issue to the superintendents of Leper Hospitals, .dermatologists, and others, that of the connection of the disease with vaccination should be included. That there is a connection is now admitted by some of the most eminent authorities of the day, including Professor W. T. Gairdner, Dr. Liveing, Sir Morell Mackenzie, Dr. John D. Hillis, Dr. Edward Arning, Dr. Armaur Hansen, and others. Some of these writers admit that not only is leprosy communicable with the vaccine virus, but that new centres of contagion of this hideous disease have been created by vaccination, with most disastrous and far-reaching consequences. Trusting that this important feature of the question will not be overlooked by your committee, and awaiting the favour of a reply, I am, sir, yours faithfully,  WILLIAM TEBB.

Dr. Phineas Abraham, National Leprosy Fund, Adam Street, W.C.

To this letter the following reply was received :—

2 Henrietta Street, Cavendish Square, W. July 2nd, 1890.

DEAR SIR,—I must apologise for not answering your letter before this. With regard to the alleged connection with leprosy, this question will certainly be one of the points to. which special attention will be directed on the part of the committee, and an attempt will be made to sift the evidence in an impartial manner.—I am, dear sir, yours faithfully,
PHIN. S. ABRAHAM, M.D.

W. Tebb, Esq.

This correspondence, implicating vaccination, and pointing out a much-neglected source of danger, is absolutely ignored in the Journal of the Leprosy Investigation Committee; while communications from all parts of the world, in which the most diverse and conflicting theories are advanced by persons whose opportunities for observation and inquiry have necessarily been of a. very meagre description, have found insertion in its pages.

In a notice of a recent able work, "Leprosy," by G. Thin, M.D. (London: Percival & Co.), in No. 4 of the Journal of the Leprosy Investigation Committee, p. 71, no mention is made of the cases of invaccinated leprosy introduced by the author, which occupy several pages of the work. On the other hand, three articles against the theory that leprosy is spread by vaccination are inserted. It is also to be observed that, while numerous communications, pointing out the dangers of vaccination in countries where leprosy is prevalent, have, since the Leprosy Commission was appointed, appeared both in the home and colonial press (some of the writers citing cases of the disease disseminated in this way, and others furnishing the results of their painstaking investigations), no notice of such communications has been taken in the Journal of the Leprosy Investigation Committee. Three pamphlets dealing with the subject—two of them by medical writers—have been treated in a similar fashion. What amount of confidence the public, who have subscribed largely to the National Leprosy Fund, will ,place on an inquiry so manifestly one-sided, remains to be seen. It is certain that those who have looked for the impartial treatment of this serious phase of the question at the hands of the Leprosy Investigation committee will be grievously disappointed. Counsel holding a brief for the perpetuation of the Jennerian cultus could hardly have exhibited a less judicial attitude than disclosed by the official documents relating to this latest leprosy inquiry.

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