?fjc Ihtlmit JJlciiical ?ajcttc. JULY
1, 1871.
of politics, but of science. Among it, and in our own particular department, we find some of the brightest ornaments of British history; and I will not do you the injustice of supposing that there is any one among you who would not prefer the reputation of Harvey or the Hunters to that of nineteen-twentieths of the courtiers and politicians of the periods in which they lived."-SIR BENJAMIN BRODIE. "You have chosen the path, those who have preceded you in
not
VACCINATION AND SYPHILIS. A few months ago, we directed tho attention of our readers to the past condition, and future prospects of vaccination in this part of India; we urged that time only was required for tho further
development
protective
of the
advantages
influence of the vaccine virus
to be over
gained from tho small-pox ; never-
theless, while maintaining these principles, we are aware that the future of vaccination must depend to a great extent upon the method in which it is most
performed. Wo need hardly say, it is that the vaccine matter used should be as puro
as
in this country, we have difficulties of no ordi-
important possible, and,
nary nature to contend
against
in this respect.
Wo allude espo-
THE INDIAN MEDICAL GAZETTE.
1M
cially to the possibility of inoculating a healthy child with virus containing the organic infecting matter of syphilis, while puncturing his arm with the intention of vaccinating him. It is very remarkable, the perversity with which medical men at home have resisted the evidence in favour of the possibility of conveying
syphilis with vaccine lymph; not merely was the foi-eiga testimony bearing on this point rejected, but that afforded by the few and isolated cases in England, was also discarded; the truth, however, can hardly be resisted any longer, for Mr. Jonathan Hutchinson, at a late meeting of the Royal Medico-Chirurgical Society, brought forward evidence on the subject, which, we think, must force conviction upon There are few men even the most sceptical on this matter. whom the profession trust with greater confidence than Mr. Hutchinson; and we take the following summary of his communication to the Medico-Chirurgical Society from the Medical Times and Gazette of the 29th of April. A medical practitioner obtained an apparently healthy child to serve as vaccinifer; on the 7th of February, 1871, he vaccinated eleven young adults from this child. It was noticed at the time of the operation that on being punctured each vesicle on the vaccinifer's arm bled. Ten of the eleven persons took the vaccination, which ran through its normal course, the scales falling off at the end of the third week after the operation had been performed, but of
mass
about the termination of the fifth week, the cicatrices
on the of the persons vaccinated had become indurated, and subsequently ulcerated, the axillary glands were enlarged, arms
and
a
was observed over parts of the body. On it was discovered that the infant vaccinifer was a
roseolar rash
enquiry, healthy looking child,
with
no
apparent symptoms of syphilis,
but he had had an affection of the mucous membrane of the " " and a peculiar twang in crying in early the snuffles, nose, on close scrutiny, five small mucous patches were
infancy; found
near
the anus.
child's father.
The
There
pustules
was a on
suspicion of syphilis about the arm had run through
the child's
their normal course, and it is to be remarked that the first two individuals vaccinated from this child had regular vaccinia, and
syphilis; but of the remaining nine, all had chancres and eight of theso vaccinia also. The chancres were indurated, round, with thin glutinous discharge, speedily passing into fungous buttons. Some of these patients had headache and pain in the limbs. The conclusions Mr. Hutchinson drew from the facts of the case were, that this apparently healthy child was affected with latent syphilis, and that, under these circumstances, pure vaccine lymph may be drawn from a vaccine pustule formed on the arm of such a subject, that this lymph may also contain the syphilitic poison, but that it is probable the admixture of the blood of the child together with the lymph will give rise to syphilis in an otherwise healthy person, vaccinated from a subject of this description. This history together with the fact of the persons affected by syphilis, having come directedly under the observation of so able a surgeon as Mr. Hutchinson, effectually settles the question as to the possibility of vaccinia being a vehicle of syphilis; we can no longer doubt that syphilis may be thus conveyed from an apparently healthy child; but, admitting this fact as we do without reserve, it i3 surely unwise to rush into the no
opposite extreme, and endeavour to suppress vaccination and the inestimable benefits it is capable of affording mankind, because there ha\e occurred here and there a few instances of
injury,
from
imperfect
or
[July 1,
careless
operation,
or
even,
perhaps,
from
avoidable contamination through the means resorted to. we
must endeavour
to
1871.
follow out the rules laid down
un-
Rather
by
Mr-
Simon when discussing the circumstances of the case above related, and never vaccinate without the most careful enquiry as to the health of the vaccinifer, never draw blood, and never vaccinate from vesicles with inflamed areola, because inflammation i3
virtually a transudation of liquor sanguinis possibly poisonous bioplasts. These precautions cannot be too strongly insisted on in a country like India; we are all probably aware of the fact that syphilis is of very common occurrence among the lower orders, but, we expect, few of us to realize the extent of this evil; and yet the ordinary practice is to vaccinate our own "and patients' children from the arm of a native infant (usually of the lowest orders) brought to our door by a native vaccinator. Of the vaccinifer's previous history we know absolutely nothing, and we suspect, beyond a glance at the pustule on his arm, very few of us are in the habit of making a minute examination for marks of inherited syphilis on the child. If such be the case, we can only hope the instance above related from Mr. Hutchinson's practice, may bring the matter home to us, and make us more thoughtful and careful in these matters. At the same time, considerations such as these should impress upon those whose duty it is to watch the proceedings of native vaccinators in our rural districts, the responsibility of their office, for no amount of means or money will disseminate the blessing of vaccination among the people of this country, if an impression, grounded perhaps on facts, arises among them, that in vaccinating their
charged
with
children the operator may at the the
poison
of syphilis.
same
time inoculate them with
1, 1871.
of politics, but of science. Among it, and in our own particular department, we find some of the brightest ornaments of British history; and I will not do you the injustice of supposing that there is any one among you who would not prefer the reputation of Harvey or the Hunters to that of nineteen-twentieths of the courtiers and politicians of the periods in which they lived."-SIR BENJAMIN BRODIE. "You have chosen the path, those who have preceded you in
not
VACCINATION AND SYPHILIS. A few months ago, we directed tho attention of our readers to the past condition, and future prospects of vaccination in this part of India; we urged that time only was required for tho further
development
protective
of the
advantages
influence of the vaccine virus
to be over
gained from tho small-pox ; never-
theless, while maintaining these principles, we are aware that the future of vaccination must depend to a great extent upon the method in which it is most
performed. Wo need hardly say, it is that the vaccine matter used should be as puro
as
in this country, we have difficulties of no ordi-
important possible, and,
nary nature to contend
against
in this respect.
Wo allude espo-
THE INDIAN MEDICAL GAZETTE.
1M
cially to the possibility of inoculating a healthy child with virus containing the organic infecting matter of syphilis, while puncturing his arm with the intention of vaccinating him. It is very remarkable, the perversity with which medical men at home have resisted the evidence in favour of the possibility of conveying
syphilis with vaccine lymph; not merely was the foi-eiga testimony bearing on this point rejected, but that afforded by the few and isolated cases in England, was also discarded; the truth, however, can hardly be resisted any longer, for Mr. Jonathan Hutchinson, at a late meeting of the Royal Medico-Chirurgical Society, brought forward evidence on the subject, which, we think, must force conviction upon There are few men even the most sceptical on this matter. whom the profession trust with greater confidence than Mr. Hutchinson; and we take the following summary of his communication to the Medico-Chirurgical Society from the Medical Times and Gazette of the 29th of April. A medical practitioner obtained an apparently healthy child to serve as vaccinifer; on the 7th of February, 1871, he vaccinated eleven young adults from this child. It was noticed at the time of the operation that on being punctured each vesicle on the vaccinifer's arm bled. Ten of the eleven persons took the vaccination, which ran through its normal course, the scales falling off at the end of the third week after the operation had been performed, but of
mass
about the termination of the fifth week, the cicatrices
on the of the persons vaccinated had become indurated, and subsequently ulcerated, the axillary glands were enlarged, arms
and
a
was observed over parts of the body. On it was discovered that the infant vaccinifer was a
roseolar rash
enquiry, healthy looking child,
with
no
apparent symptoms of syphilis,
but he had had an affection of the mucous membrane of the " " and a peculiar twang in crying in early the snuffles, nose, on close scrutiny, five small mucous patches were
infancy; found
near
the anus.
child's father.
The
There
pustules
was a on
suspicion of syphilis about the arm had run through
the child's
their normal course, and it is to be remarked that the first two individuals vaccinated from this child had regular vaccinia, and
syphilis; but of the remaining nine, all had chancres and eight of theso vaccinia also. The chancres were indurated, round, with thin glutinous discharge, speedily passing into fungous buttons. Some of these patients had headache and pain in the limbs. The conclusions Mr. Hutchinson drew from the facts of the case were, that this apparently healthy child was affected with latent syphilis, and that, under these circumstances, pure vaccine lymph may be drawn from a vaccine pustule formed on the arm of such a subject, that this lymph may also contain the syphilitic poison, but that it is probable the admixture of the blood of the child together with the lymph will give rise to syphilis in an otherwise healthy person, vaccinated from a subject of this description. This history together with the fact of the persons affected by syphilis, having come directedly under the observation of so able a surgeon as Mr. Hutchinson, effectually settles the question as to the possibility of vaccinia being a vehicle of syphilis; we can no longer doubt that syphilis may be thus conveyed from an apparently healthy child; but, admitting this fact as we do without reserve, it i3 surely unwise to rush into the no
opposite extreme, and endeavour to suppress vaccination and the inestimable benefits it is capable of affording mankind, because there ha\e occurred here and there a few instances of
injury,
from
imperfect
or
[July 1,
careless
operation,
or
even,
perhaps,
from
avoidable contamination through the means resorted to. we
must endeavour
to
1871.
follow out the rules laid down
un-
Rather
by
Mr-
Simon when discussing the circumstances of the case above related, and never vaccinate without the most careful enquiry as to the health of the vaccinifer, never draw blood, and never vaccinate from vesicles with inflamed areola, because inflammation i3
virtually a transudation of liquor sanguinis possibly poisonous bioplasts. These precautions cannot be too strongly insisted on in a country like India; we are all probably aware of the fact that syphilis is of very common occurrence among the lower orders, but, we expect, few of us to realize the extent of this evil; and yet the ordinary practice is to vaccinate our own "and patients' children from the arm of a native infant (usually of the lowest orders) brought to our door by a native vaccinator. Of the vaccinifer's previous history we know absolutely nothing, and we suspect, beyond a glance at the pustule on his arm, very few of us are in the habit of making a minute examination for marks of inherited syphilis on the child. If such be the case, we can only hope the instance above related from Mr. Hutchinson's practice, may bring the matter home to us, and make us more thoughtful and careful in these matters. At the same time, considerations such as these should impress upon those whose duty it is to watch the proceedings of native vaccinators in our rural districts, the responsibility of their office, for no amount of means or money will disseminate the blessing of vaccination among the people of this country, if an impression, grounded perhaps on facts, arises among them, that in vaccinating their
charged
with
children the operator may at the the
poison
of syphilis.
same
time inoculate them with
