THE remarkable spread of leprosy during the past thirty years has excited much public attention. Having for many years been interested in the public health, I have been prompted to investigate the causation of this increase. My attention was first called to the growing ravages of leprosy during a visit to Asia Minor in the year 1884, and to one source of infection the extent of which is as yet imperfectly realised (I mean vaccination), by the perusal of the evidence brought before the Select Parliamentary Committee on Vaccination of 1871 by Dr. R. Hall Bakewell. In 1888-89, during a visit to the Virgin, Leeward, and Windward Islands, British Guiana, and Venezuela, I took the opportunity of investigating this serious allegation. In the course of my inquiries I obtained particulars of a number of cases of leprosy due to vaccination. These were furnished by highly respectable colonists, but were often coupled with the request that no names were to be published, either of the suffering families or of those who communicated the details. This reluctance, which is entitled to every consideration was due to the fear of exposing relatives, and damaging their social - standing in the community where they reside. Although the danger of communicating leprosy by vaccination has been admitted in official and other reports, I have on many occasions found it extremely difficult to get at the facts, copies of important documents having been repeatedly refused by officials both at home and abroad, and notably in the French Colonial possessions.

It is perhaps too much to expect that those who regard Jenner as one of the greatest of human benefactors will display much energy in bringing to light such cases as I have referred to.

Some of the obstacles in the way of independent investigation of this subject are alluded to in a communication, read before the Royal Vaccination Commission, from Dr. Charles E. Taylor, Secretary to the Legislative Council, Island of St. Thomas, Danish West Indies. Dr. Taylor states that during his 20 years residence at St. Thomas, D.W.I., he has known many cases of the communication of leprosy by means of the vaccinator’s lancet, but he adds that the sufferers or their families invariably decline to have the fact disclosed. One resident physician in Honolulu, who told me how the disease had been disseminated by means of vaccination in Hawaii, strongly deprecated making the details known, as he would not answer for the consequences. Despite these difficulties, however, a good many cases are recorded by medical men of high standing and wide experience, and some of them are here presented to the reader. Cases have come under my cognizance in which the reports of district surgeons, showing the spread of terrible diseases by means of vaccination, have been officially suppressed.

In June, 1890, I appeared as a witness before the Royal Commission on Vaccination, and gave evidence as to the results of my inquiries up to that date. This evidence will be found in the third report of the proceedings, pages 154-161.

At that time my investigations had been mainly limited to the West Indies, British Guiana, and Venezuela. Since then I have extended my - personal investigations to Norway, California, the Sandwich Islands, Ceylon, Egypt, New Zealand, Cape Colony and Natal in South Africa, and most of the Colonies in Australia, and have put myself in communication with superintendents of leper asylums and leading dermatologists in all other countries where leprosy is endemic. The results of these inquiries, with other collateral evidence bearing on the subject, are briefly set forth in this volume. While the pros and cons of the theories of heredity, fish-eating, malaria, and contagion, have been frequently dealt with by wellknown writers, this is, I believe, the first attempt made to bring together a body of evidence regarding the inoculability of leprosy and the evidence of its communicability by means of vaccination.

To physicians, superintendents of leper hospitals librarians of public institutions in Norway, Hawaii, the West Indies, the United States, and other countries, I am indebted for valuable official and other documents bearing on the subject, which I have freely quoted.

The British Medical Journal of July 3, 1886, p. 24, in a leading article on the investigations into the causation of leprosy, undertaken by Dr. Edward Arning in Hawaii at the instance of the Hawaiian Government, observes that this inquiry "is likely to have results of great importance both to science and to practical medicine." This prophecy is indeed likely to be fulfilled, but hardly in the manner anticipated by the writer. Amongst the most important of Dr. Arning’s discoveries is that vaccination has been instrumental in widely disseminating leprosy amongst the helpless and confiding population of that beautiful Archipelago.

Leprosy is one of the most loathsome as it is one of the most tissue-destructive diseases known, and when going through the wards of leper hospitals I have frequently noticed with pain the poor afflicted creatures bending their heads and covering their hands to conceal from strangers the sight of their distorted features and mutilated limbs. It is hardly possible to conceive, much less describe, the depth of human misery caused by the spread of this hideous and destructive disease; but some idea of its nature may be gathered from the following description of leprosy, which may well excite the sympathy of the philanthropist. It will be found in a recent work on leprosy by Dr. Thin, pp. 99-100. It is translated from Leloir, an eminent French authority on leprosy, and refers to the tubercular variety of the disease. "If the patient," he remarks, "does not die of some internal disorder or special complication, the unhappy leper becomes a terrible object to look on. The deformed leonine face is covered with tubercles, ulcers, cicatrices, and crusts. His sunken, disfigured nose is reduced to a stump. His respiration is wheezing and difficult; a sanious, stinking fluid, which thickens into crusts, pours from his nostrils. The nasal mucous membrane is completely covered with ulcerations. A part of the cartilaginous and bony framework is carious. The mouth, throat, and larynx are mutilated, deformed, and covered, with ulcerated tubercles. The patient breathes with the greatest difficulty. He is threatened with frequent fits of suffocation, which interrupt his sleep. He has lost his voice, his eyes are destroyed, and not only his sight but his sense of smell and taste have completely gone. Of the five senses hearing alone is usually preserved. In consequence of the great alterations in the skin of the limbs, which are covered with ulcerated tubercles, crusts, and cicatrices, the pachydermic state of skin which gives the limbs the appearance of elephantiasis, and of the lesions of the peripheral nerves which are present at this time, and by which occasionally the symptoms of nerve leprosy are combined with those of tubercular leprosy, the sense of touch is abolished. The patient suffers excruciating pains in the limbs, and even in the face, whilst the ravages of the disease in his legs render walking difficult and even impossible. From the hypertrophied inguinal and cervical glands pus flows abundantly from fistulous openings. In certain cases the abdomen is increased in size on account of the liver, spleen, and mesenteric glands being involved. With these visceral lesions the appetite is irregular or lost. There are pains in the stomach, diarrhoea, bronchial pulmonary lesions, intermittent febrile attacks, and a hectic state. The peculiar smell, recalling that of the dissecting room, mixed with the odour of goose’s feathers, or of a fresh corpse, is indicated, but badly described, by the authors of the Middle Ages, who compared it to that of a male goat."

Dr. John D. Hillis, formerly of British Guiana, says of the anaesthetic variety, that it is "known also as leuke of the Greeks, baras of the Arabians, joint-evil of the West Indies, sunbahirii of the East Indies, and dry leprosy, in contradistinction to the other form also known as humid leprosy; is characterised by a diseased condition of the nerves, and a peculiar eruption, the primary characteristic of which is loss of sensation, or anaesthesia; hence its name. After a time ulcerations form, a sort of dry gangrene of the limbs sets in, and joints drop off, and finally there is more or less paralysis. It would take a large volume to describe the signs or symptoms of leprosy, but the preceding account is -sufficient to show what an alarming affection we have to deal with."

In Mrs. Hayes’ little book, "My Leper Friends," is a chapter on leprosy, by Surgeon-Major G. G. Maclaren, M.D., in which the writer observes, pp. 123-4:   Acting on the strength of my own convictions as to the transmissibility and communicability of leprosy, I established the Dehra Dun Asylum on the principle already noted (the presence of a bacillus in the blood), and it has answered so far admirably; all its inmates living as happily as they can under their unfortunate conditions, and ending their existence contentedly! I have had, of course, ample opportunity of studying the nature of the disease, and its effects on the different organs of the body, and in many examinations I have made, post-mortem, I can testify that not a single organ in the whole body is exempt from the attacks and inroads of this dire and, loathsome malady. It invades the brain, spinal nerves, the eyes, tongue, and throat, the lungs, the liver, and other digestive organs. In addition, as is generally known, it maims and deforms the external parts of the body in a manner too revolting to describe. It is painful to witness the amount of deplorable suffering some of these creatures endure. True it is that many feel but little pain—one of the forms of the disease producing anaesthesia, or insensibility of the parts affected; but this is the case in a few only. The majority suffer in variously painful degrees, according to the organ or part implicated, and it is a mistake to think that their sufferings are little. Many, in the earlier forms of the ailment, lose their sense of sight, smell, and taste, and when their lungs or throat is attacked (a common form), their agonies are dreadfully distressing and painful to behold. The inroads of the disease are slow and gradual, which makes it all the more trying, and the painful and lingering death to which most are doomed is a condition that one dreads to dwell on."  It was the terrible nature of the disease that fostered the growth of the sumajh in India, the leper being accompanied to the grave with tom toms, where, in a sitting posture, he was buried alive.

In the West Indies, in British Guiana, in the Sandwich Islands, and in South Africa, when cases of invaccinated diseases were related to me, I was urged by the sufferers and by their friends to make known their grievances to English people and to the Imperial Parliament, and, if possible, to bring public opinion to bear upon a mistaken and mischievous system which, without doing the least good, has been the cause of such terrible and far-reaching consequences. Acting upon these entreaties, and upon others contained in communications from various leprous countries, I have presented to the public through the press, and to members of Parliament, such facts on this subject as came before my notice up to July, 1890. I now offer to the public further evidence and testimonies, on behalf especially of the afflicted population of our Crown Colonies and Dependencies, whose grievances have been so long and so flagrantly disregarded. Every attempt to introduce compulsory vaccination in the populous Island of Barbados, British West Indies, has been thwarted, owing to the widespread belief that leprosy and syphilis are communicated by the vaccine virus. In St. Thomas, Danish West Indies, and in Georgetown and other parts of British Guiana, it has, for similar reasons, been found practically impossible to enforce the vaccination law, and, in spite of severe compulsory enactments, entire districts remain unvaccinated by reason of this special danger; while, in the Sandwich Islands, a bill for the repeal of the vaccination law was introduced in the Legislative Assembly, July, 1890, by J. Kalua Kahookano, representative from North Kohala, Island of Hawaii.

Under the head of "The Legislature," the Daily Commercial Advertiser, Honolulu, November 9, 1892, publishes the recent report of the Sanitary Committee, as follows :—

"Hon. J. S. WALKER, President of the Legislature.

"SIR,—The Sanitary Committee report consideration of Bills Nos. 9,13 and 25, and Petitions Nos. 33, 152, and 206, relative to Vaccination.

"The object of all these bills and petitions is to repeal the law compelling parents and guardians to cause the children in their charge to be vaccinated.

"The complaints against the present system were very pronounced, and the repeal of the law making vaccination compulsory was strongly urged."

The committee met the Board of Health and conferred with them upon the subject, and under date of June 25th, addressed a communication to the Board, in which is the following :—

"Hawaiian Legislature, June 25, 1892.

"DAVID DAYTON, Esq., President, Board of Health. "SIR,—An effort is being made in the Legislature to repeal or amend the law relating to vaccination; the object being to leave vaccination optional with parents and individuals.

" The chief objection raised against the present compulsory system appears to be the belief of some that leprosy, and other diseases, have been propagated by means of vaccination.

"It is said that some of the vaccinating officers are careless in the use of vaccinating instruments, operating first upon one person and then another without cleansing the instrument; and that there is distrust of the quality of virus used, in some cases serious inflammation and illness following the inoculation.

"The petitions and proposed measures relating to the subject have been referred to the Sanitary Committee, and the committee desire the views of the Board upon the subject………

"Any suggestions the Board may be pleased to make will be appreciated.

Respectfully submitted,

WILLIAM O. SMITH, Chairman Sanitary Committee

The official report of the Honolulu Board of Health for 1892 shows that resistance to vaccination is spreading in many districts in these islands, and at the same time there is observed a sensible diminution in the number of lepers. In New Zealand, prosecutions for non-vaccination have for some time been abandoned. In the South African Colonies of Natal and Cape Colony the vaccination laws are enforced only during outbreaks of small-pox, and vaccination is everywhere regarded with mistrust. In the Transvaal and Orange Free State vaccination is entirely optional. In England there are about one hundred towns and poor law unions where the vaccination laws are a dead letter. In several of the Swiss cantons compulsory vaccination has been tried and abolished, and in no canton is there any penalty for non-vaccination. An attempt was made to pass a federal vaccination law in 1881, and was defeated in a Referendum by 253,968 votes against 67,820. In the Australasian Colony of Tasmania the compulsory law has been suspended by reason of its deleterious effects on the health of the people. In the Colonies of New South Wales. and Queensland, Australia, the people have successfully resisted every attempt to impose the hotly-disputed Jennerian dogma upon them. Dr. Manning, the medical adviser to the Government of New South Wales, reports that in 1891 vaccination was only partially carried out in thirteen Country districts. In ninety-two districts, no vaccinations were reported. The extent of the mischief already experienced will never be known, but sufficient is already admitted to arrest the attention of all who are seriously concerned for the public health and for the well-being of the community. Is it not, therefore, the duty of every medical practitioner to personally inquire into the matter for himself; and no longer to shelter himself behind the orthodox belief in the benign character of vaccination? For nearly a century Jenner’s prescription has been tried and found wanting. Each of the reports of the Royal Commission on Vaccination already published establishes the failure, mischievous effects, and injustice of the compulsory infliction of an artificial disease upon healthy people, while some of the most distinguished names in the profession have testified to its being the certain vehicle for the dissemination of leprosy. These names include Sir Erasmus Wilson (sometimes called the father of dermatologists), Dr. John D. Hillis, Dr. Liveing, Sir Ranald Martin, Professor W. T. Gairdner, Dr. Tilbury Fox, Dr. Gavin Milroy; Dr. R. Hall Bakewell, formerly Physician to the Leper Asylum, Trinidad; Dr. A. S. Black, of Trinidad; Dr. Edward Arning; Dr. Walter M. Gibson, late President of the Honolulu Board of Health; Professor H. G. Piffard, New York; Dr. A. M. Brown, London; Dr. Frances Hoggan, Dr. Blanc, Professor of Dermatology, University of New Orleans; Dr. Bechtinger, of Rio; Professor Montgomery, of California; Dr. Sidney Bourne Swift, late Medical Director, Leper Settlement, Molokai, Hawaii; Dr. P. Hellat, St. Petersburgh; Professeur Henri Leloir, Lille; Dr. Mouritz; Surgeon Brunt; Dr. John Freeland, Government Medical Officer, Antigua; Dr. S. P. Impey, Superintendent, Leper Asylum, Robben Island, Cape Colony;and many others.

On the subject of leprosy there are no higher authorities; therefore, considering that the evidence adduced in the following pages is founded upon an accumulation of facts and the testimony of eminent dermatologists, it is hardly open to doubt the intimate relation between the spread of leprosy and the increase of vaccination. May I not, then, urge that a concerted effort—by petitioning Parliaments, Legislative Councils, and other governing bodies, and by the powerful aid of the press—should be made to abolish the compulsory infliction of a disease fraught with such disastrous and far-reaching consequences to the human family? Until vaccination is disestablished and discontinued, and sanitary amelioration substituted for the inoculative experiments, drastic drug medication, and nerve stretching, practised in various leper asylums, I am convinced that this dreaded disease will march onward with accelerated destructive force, and its ultimate extirpation will be rendered well nigh impossible.

No one can be more conscious of the shortcomings of this treatise than the author; but if the painful facts herein disclosed should induce some able and independent pathologist to continue these researches in the interest of the public and regardless of consequences, the author will feel that his efforts have not been altogether fruittlss.