COMPULSORY VACCINATION IN BOMBAY----THE DANGER OF TUBERCULOSIS.
(APPENDIX to LEPROSY AND VACCINATION by WILLIAM TEBB)
Notwithstanding the proofs laid before the Royal Commission on Vaccination regarding the futility of the practice as a prophylactic against small-pox, its injurious consequences in spreading inoculable diseases, and the cruelty and injustice attending its enforcement, there are not wanting those who are continually plotting to extend the system, by means of coercive legislation, amongst populations who are known to entertain a widespread repugnance to vaccination, but who are without representative institutions. At a meeting of the Bombay Legislative Council (reported in the Times of India, February 24, 1892) held for the purpose of hearing the second reading of the bill to prohibit the practice of inoculation, and to make vaccination compulsory in certain districts of the Bombay Presidency, the Honourable Mr. Javerilal U. Yajnick moved certain amendments to the law. In the course of his argument, in which he points out the danger of transmitting leprosy and syphilis by means of arm to arm vaccination, he quotes the opinion of "an able and experienced medical gentleman," Dr. Bahadurjee, who in reply to an inquiry writes :
"In answer to your letter in which you ask me my personal opinion on the arm-to-arm vaccination method which is intended to be enforced by the new Vaccination Bill, I have no hesitation in saying that, besides its being not suited to the peculiar conditions which obtain in this country, on professional grounds the method is objectionable, and for these reasons :
1. Arm-to-arm vaccination obviously acts as a channel for the transference of some skin diseases, and affords a ready means for propagating such inherited constitutional taints as those of syphilis and leprosy. No doubt, special rules, with full details, will be framed for the guidance of the operators in their selection of proper subjects, with a view to avoid these mishaps; but, having regard to the class of men from whom the supply of district vaccinators is to be obtained, the detailed rules will be of as much use to them as the paper on which they are printed.
2. Syphilitic taint does not necessarily show itself in ill-health at the early age at which vaccination is practised and demanded by law. A child may be in fair health, and yet have inherited syphilis. Moreover, syphilis does not stamp itself on the face and arms, so much as on the back and legsparts not generally examined by the vaccinator, and thus apt to be overlooked Only yesterday I was asked to see a case of skin disease in a child. On stripping the child bare, I found him fairly healthy to look at, and could see no skin blemish on his person. But closer examination of the hidden parts revealed the presence of unmistakable condylomata (syphilitic). These condylomata unnoticed, I should have passed the child as a very fair specimen of average health, and a fit subject to take the lymph from. Syphilis, as betrayed in obtrusive signs, is not difficult to recognise, but when concealed, as is more often the case, it is by no means easy to detect it.
3. In the case of leprosy it is still worse. There is no such thing as a leper child or infant. The leper heir does not put on its inherited exterior till youth is reached. And it is by no means possible by any close observation or examination of a child to say that it is free from the leprous taint. Surely arm-to-arm vaccination will not help to stamp out leprosy. On the contrary, it has been asserted, and not without good reasons, that it has favoured the propagation of the hideous disease.
4. It is acknowledged that extreme care is required in taking out lymph from the vesicles to avoid drawing any blood, for blood contains the germs of disease. Extreme care means great delicacy of manipulation, and delicacy of manipulation with children is not an easy task, and requires some experience and training. Is this to be expected from the class of men who are going to act as public vaccinators in the districts? Supposing a district vaccinator to acquire it to some extent after considerable practice, what about the delicacy of manipulation of one newly put on?
5 Puncturing a vesicle with such delicacy as not to wound its floor and draw blood is one great difficulty. But the selection of a proper vesicle is another as great if not a greater difficulty. Products of inflammation are charged with the germs of disease, the contagion or contamination media, as much as the blood itself is. And the contents of an inflamed vesicle are quite as contaminating as the blood itself of a subject who, though charged with the poison of (inherited) syphilis or leprosy, has none of the obtrusive signs of the taint for identification. And out here inflamed, i.e., angry-looking vesicles are not the exception but the rule, as can be easily told by personal observation and experience, and equally easily surmised if the habits of our poor be duly considered. Thus, even if no blood be drawn, the danger of transferring constitutional taints by the arm-to-arm method is by no means small; remembering that leprosy which claims India, and not England, for one of its homes, does not admit of any detection on the person of a subject from whose arm lymph may be taken, and that syphilis is more often difficult to detect than otherwise, and remembering, also, that both these are often met with largely in some districts."
With regard to tuberculosis, the most deadly of all diseases in Europe, the following extracts from the translation of an article in the Gazette Hebdomadaire des Sciences Medicales, by Dr. Perron, Officier de la Legion dHonneur, which appeared in the Vaccination Inquirer and Health Review of December, 1890, may arrest the attention of the reflective reader. Dr. Perron says
"The possibility of conveying tuberculosis to man in the act of vaccination was long ago pointed out. Tuberculosis has, in fact, a special predilection for the bovine race which yields us our vaccine. There are few of these animals that escape its attacks; the calf, the heifer sometimes bear traces of it but a few weeks after their birth. It would then appear quite natural to suppose that the vaccine, taken from a bovine animal and inoculated by the skin, might thus convey tuberculosis to the vaccinated subject. It is by no means so, however; for it is demonstrated that the inoculation of tuberculosis by way of the skin is extremely difficult in itself, and that there is not the slightest fear of doing so by way of the vaccinal punctures. The direct conveyance of the tuberculosis contagion in this manner need not, then, be taken into account. If vaccination renders man more prone to contract tuberculosis, it is, in our opinion, by a method altogether different.
"We hold that we must, in this case, arrange our facts in accordance with the new theories of which we have spoken above; that we must, that is to say, consider, with respect to vaccination and the possibility of a tuberculous contagion due to it, the part which can be played in the organism by nocivity, or receptivity, in relation to micro-organisms.
"The cow, as we have said, is the tuberculous animal par excellence She is often the bearer of specific granulations, sometimes even along with the appearance of ordinary health. She is, therefore, a soil eminently favourable, and therefore very receptive, for the bacillus of Koch. But along with tuberculosis there is another acute malady specially attaching to bovines, for it possesses the property of arising spontaneously among them, namely, the vaccinal disease, which, as we all know, shows itself locally by the appearance, on the teats and on the udder, of pustules, whereof we avail ourselves for human vaccination. Thus, then, two acute diseases, tuberculosis and vaccinia, find always in the cow the soil most favourable for their evolution; and that clearly because the medium of cultivation is propitious both to the bacillus of Koch and to the micrococcus of vaccine.
"If, as announced by Professor Bouchard, the medium created by a vaccination can be destructive to one or several microbic species, we may add that, by the law of reciprocity, a medium of cultivation may at the same time be favourable to one or several microbes. That is exactly what happens with the cow in respect of tuberculosis and vaccinia, diseases between which the soil of cultivation establishes, as we see, a striking connection.
"This is the time to examine what happens when we inoculate a human subject with cow-vaccine. By that act we bring the human organism into a state of immunity, which is certainly bactericidal as against the microbe of variola; that is the benefit we seek, and which constitutes the vaccinal immunity. But here is the important point; at the very time when we have created in the man the vaccinal soil, we run the risk of having, ipso facto, established that humoral state (terrain humoral) which is favourable to the tuberculous genesis, that is, the medium of culture which is receptive for the bacillus of Koch.
"The first and the most grave result which follows from this interpretation is, then, that vaccination, besides the advantages which it offers us in our contest with variola, presents the danger of opening the way for the invasion of tubercle.
"If we now turn back and examine the events of the last century or so, we can show a constant increase of tuberculosis, a fact never hitherto satisfactorily explained. There was a time when this malady existed only as an exceptional thing; now, actually, in spite of the incessant progress in public and private hygiene, in spite of all the material improvements that have been made, it tends more and more to rise to the rank of a pestilence. It should be remarked that it strikes by preference at the young lives, that is, those who are, nevertheless, at the age when the physical resistance to morbific causes is the strongest. Now, a malady which originates in exhaustion, in vital poverty, should display its power in the inverse order, and should fall most heavily on the old. We are, then, compelled to believe that young folk offer, for some quite special reason, an exceptionally favourable soil for the implanting of Kochs bacillus.
"Side by side with this growing extension of tuberculosis, we see developing, pan passu, and in the same period of time, that is to say, since the beginning of the century, the practice of vaccination. We may ask ourselves whether in this double simultaneous evolution there is not a hidden oneness? If tuberculosis, in spite of all sanitary precautions, has multiplied its attacks during the last hundred years, it is, we submit, because vaccination has come to Create for it a propitious soil. That would explain, not only its advancing growth in all civilised countries, but also its special influence over the young subjects who are always more or less recently vaccinated, and consequently more receptive than the others in the presence of the bacillus.
"In all European armies, vaccination is the order of the day. On their arrival with their corps, the young soldiers are forthwith carefully revaccinated. Now, the military statistics of all countries show an enormous proportion of various forms of tuberculosis among soldiers, especially during the first and second year after their enlistment. Divers causes have been invoked for the explanation of the facts. First, the moral decline produced amongst young soldiers by their separation from their families. That might have been possible formerly, but it is not probable in our day when facility of communications generally permits the young soldier to remain in touch with his native country. Besides, in the army afloat, which is less favoured in this respect, we find no more cases of phthisis than in the army ashore. Nor can a bad hygiene be any longer pleaded, nor an inferior dietary, for the European States take the greatest pains to secure for their soldiers the best of material conditions, and succeed in doing so to a very satisfactory extent. Nor can over-work be alleged, for in time of peace the routine of the service requires, save under very exceptional circumstances, just as much exercise as goes to make up a healthy amount of daily exercise. To sum up, the young soldiers find with their corps material conditions of life, which, for a very large number, are superior to those of their native surroundings. Their life in the great towns, though evidently having an injurious effect, cannot by itself explain the numerous cases of tuberculosis of which we are speaking, for the barracks are in general well situated and looked after in accordance with the rules of health. Whence then can come these attacks of tuberculosis, so sudden, so numerous, upon subjects that, but a few months before, the council of revision rightly declared to be fit for service. Tuberculosis of the lungs, of the organs, of the joints, of the bones, etc., all these fatal evils show themselves in the garrisons of all countries with a frequency before which one might well despair. We believe that we must simply seek the reason for these facts in the revaccination which awaits the recruits upon their arrival at their corps, and which transforms them forthwith into a medium which is receptive towards those germs of tubercle which swarm in centres of population. This revaccination immediately upon enlistment is all the more regrettable and inopportune since just at that moment the young man, separated from his-family, his country, his familiar conditions of life, undergoes, without any period of transition, total and radical changes in his manner of life, and thereby finds himself less well equipped for resistance."
Referring to the efforts made by the Indian health authorities to escape the dangers of inoculated diseases by the introduction of animal lymph, the Calcutta Daily News of 9th February, 1892, says :" In trying to avoid the Scylla of leprosy, syphilis, and kindred evils, they fall into the Charybdis of tuberculosis and other equally fatal maladies. When doctors disagree, patients usually have the reverse of a comfortable time, and in the present situation the public may well look around in alarm, and cry to be saved from the dangers with which the whole subject of vaccination seems to be beset."