686 SUPPLEMENTARY APPENDIX. 



these it is a question of resemblance and not of identity with which we 

 have to deal. 



Only a few items of the evidence produced before us appear to require 

 special notice : among these, the most prominent is what has been known 

 as the " Leeds case," upon which we have heard the evidence of Mr. 

 Ward, Mr. Littlewood and Dr. Barrs. The witnesses named regarded it as 

 a case of syphilis, conveyed by vaccination, but all of them admitted that 

 the course of events was most unusual. We have carefully investigated 

 this case, and notwithstanding the opinion formed by the witnesses, there 

 appears good reason to doubt whether it was one of syphilis. The case was 

 made the subject of careful inquiry by Dr. Barlow on our behalf, who 

 shared the doubt we have expressed. The view taken by the medical 

 inspector of the Local Government Board who in the first instance in- 

 vestigated the case was that it was a case of hereditary syphilis. It seems 

 certain, however, that the parents of the child whose death was in question 

 were not in any way affected with syphilis. The vaccinifer also appeared 

 to be free from any taint of that disease, and its family history confirmed 

 this view. The co-vaccinees from the same lymph also exhibited no trace 

 of syphilis. These facts of themselves make out a strong case against 

 that having been the nature of the disease. Coupled with the fact that 

 it could not have been communicated by the vaccinator himself, they seem 

 to render it practically impossible that syphilis was the cause of death. 

 If the symptoms exhibited had in all respects corresponded with those 

 which are known to characterise syphilis, the proper inference might have 

 been that there was some error in ascertaining the facts of the case. But 

 it is beyond question that the course of events was very different in some 

 respects from that experienced in undoubted cases of syphilis, and we 

 think the true conclusion is that it was not a case of that disease. It may 

 probably be classed with a few others as examples of gangrene and blood- 

 poisoning, the direct result of vaccination, which are not to be explained 

 by supposing the introduction of any syphilitic or other poison. Fortu- 

 nately, such cases are extremely rare so much so that the witnesses 

 concerned knew of no case precisely parallel. 



The evidence offered to us would lead to the belief that, whilst with 

 ordinary care the risk of communication of syphilis in the practice of arm- 

 to-arm vaccination can for the most part be avoided, no degree of caution 

 can confer an absolute security. The rejection as vaccinifers of young 

 infants, say below four months of age (in whom congenital syphilis may 

 be as yet undeclared), and of adults (in whom the disease may possibly 

 have been recently acquired) are precautions which would probably shut 

 out almost the whole of the risk. The outbreaks of syphilis in connection 

 with vaccination which have been mentioned to the Commission (all of 

 which had been previously published) have occurred chiefly in arm-to-arm 

 vaccination amongst soldiers, or from the use as vaccinifers of young 

 infants the offspring of parents whose history was not known to the 

 vaccinator. It must, however, be admitted that neither the examination 

 of the vaccinifer if taken alone, and without a knowledge also of the 

 parents, nor the most scrupulous avoidance of any visible admixture of 

 blood with the lymph, are in themselves, however valuable, sufficient 



