The four numbers of the Journal issued by the Leprosy Investigation Committee contain a large amount of testimony from authorities in every part of the globe. A conspicuous feature, and one which has been commented upon in the press, is the confusion and contradiction of medical opinion, and this confusion is not restricted to theorists who have never visited countries where leprosy prevails, but is exhibited amongst superintendents of leper hospitals, well-known dermatologists, and eminent general practitioners. Most of the theorists are able to cite facts in support of their several beliefs, and maintain their conflicting opinions with equal confidence. Some of the most prominent of these views have been dealt with, but it would be beside the scope of this work to refer to them all. Beyond the general admission of the alarming increase of the disease, there is but one point upon which there is any approach to a consensus of opinion, and that is, that leprosy is a disease communicable by inoculation. Conversing with directors of leper institutions, experienced practitioners, and careful observers in countries where leprosy prevails, whatever their particular theories about it, I have found no one who denies that it is inoculable. In some instances, when pressing the logical issue of these answers I have said, "Then the disease is also communicable by vaccination," this has often been admitted, though sometimes with hesitation and reserve, and generally accompanied with the proviso that leprosy cannot be invaccinated if pure lymph only is employed and the operation be skilfully performed. Even if this were true, how pure lymph can be selected in tropical countries where the disease is generally of slow incubation, and does not manifest itself for years, and where the vaccinifer is never properly examined, is a mystery not explained. Moreover, while the State can enforce vaccination, it cannot compel the use of healthy vaccinifers, nor enforce careful operation. In nearly all leprous countries arm-to-arm vaccination still furnishes the chief sources of supply. The perennial cry of public vaccinators is that the lymph is "unsatisfactory." Animal lymph is often attended with excessive inflammation, and the practitioner is obliged to dilute it with glycerine, lanoline, and other substances, and its use is much more expensive. Moreover, a good deal of the so-called animal lymph in vogue is really only arm-to-arm vaccine, inoculated into calves, buffaloes, sheep, and donkeys, and partakes of the diseases both of man and of animals. Of the many cases of ulcerative and of fatal vaccination which have come under my notice during the past twenty years not a few have been due to the use of carefully-selected animal vaccine.

Dr. Robert Cory, Medical Director of the Government Calf Lymph Establishment, London, testified before the Royal Commission, November 17, 7889 (Q. 4390), that out of 32,000 cases there were 260 returned with sore arms, and 38 with eruptions. Then there were 16 cases of erysipelas, and nine of axillary abscesses, and (Q. 4392) eight deaths were reported to the Station .of children who had been vaccinated with animal lymph. The same witness testified (Q. 4369) that lymph taken from the cow leads to greater inflammation, and has a greater tendency to produce ulceration, than lymph which has been humanised.

Appendix  Index