696 SUPPLEMENTARY APPENDIX. 



Suggested Stamping-out System tit the United Kingdom. 



We have no difficulty in answering the question, what means other 

 than vaccination can be used for diminishing the prevalence of small-pox ? 

 We think that a complete system of notification of the disease, accom- 

 panied by an immediate hospital isolation of the persons attacked, together 

 with a careful supervision, or, if possible, isolation for sixteen days of 

 those who had been in immediate contact with them, could not but be 

 of very high value in diminishing the prevalence of small-pox. It would 

 be necessary, however, to bear constantly in mind, as two conditions of 

 success : first, that no considerable number of small-pox patients should 

 ever be kept together in a hospital situate in a populous neighbourhood : 

 and secondly, that the ambulance arrangement should be organised with 

 scrupulous care. If these conditions were not fulfilled, the effect might 

 be to neutralise or even do more than counteract the benefits otherwise 

 flowing from a scheme of isolation. 



When we turn to the other branch of the inquiry, how far such means 

 could be relied on in the place of vaccination, we find ourselves -involved 

 in questions of a much more complicated nature. We have little or no 

 experience to fall back upon. The experiment has never been tried. 

 The nearest approach to a trial of it has probably been in Australia. But 

 even in the parts of that country to which we have alluded the population 

 has not been entirely unvaccinated, though there has been a large 

 unvaccinated class amongst it. Moreover, in applying the experience of 

 Australia to this country, two things must be borne in mind. In the first 

 place small-pox has only appeared from time to time, introduced from 

 without at one or other of the ports of the country, and the several 

 colonies of which Australia is composed are of great territorial extent, 

 with few large centres of population. In this country small-pox is 

 always present in some part of it. There has not been a single year 

 without several deaths from the disease. Large centres of population 

 are numerous, and the intercourse between them constant. In the several 

 colonies of Australia the number of ports is not great, the vessels which 

 enter them are comparatively speaking not numerous, and the ports from 

 which they arrive are many days' voyage distant ; and there are careful 

 arrangements for quarantining vessels to exclude disease. The shipping 

 which enters English ports is of vast quantity, and passengers are brought 

 in large numbers from the continent of Europe not only daily, but it may 

 almost be said hourly ; the voyage, too, is but brief. The other matter to 

 be remembered is, that part of the Australian system is the compulsory 

 removal to quarantine for 21 days of those who have been in the house 

 with the patient, in addition to the transfer of the patient himself to a 

 hospital. There can be no doubt that such a system, if completely carried 

 out, would be of the highest efficacy. But it is obvious that in this 

 country the practical difficulties of working such a scheme in the large 

 towns would be really insuperable, to say nothing of the difficulty of 

 procuring legislative sanction for it. 



