REPORT OF THE ROYAL VACCINATION COMMISSION. 693 



down to 1885, compared so unfavourably with the rest of the country, the 

 condition has since that date become so entirely changed ? We think it 

 is impossible to attribute this change to vaccination. There is no reason 

 to suppose that the position of the Metropolis in respect to vaccination 

 has, since the year 1885, become superior to the rest of England and 

 Wales : rather the other way, as the decrease in infantile vaccination has 

 been greater during the last few years than in the rest of England and 

 Wales. The change, therefore, must be due to some other cause. 



The hospitals which, in the opinion of the Commissioners, were 

 propagating the disease in their neighbourhood, were in operation 

 down to July 1882, when their Report was made. In 1877 and 1878, and 

 again in 1881, small-pox was epidemic in London to a considerable extent. 



We have stated in detail in paragraph 471 * the steps which were taken 

 by the Metropolitan Asylums Board in consequence of the recommenda- 

 tions of the Royal Commission. It will be seen that the intra-urban 

 hospitals still continued in use, and that complaints were made in 1884 that 

 they were spreading small-pox in their vicinity, although the number in 

 each of them was not allowed to exceed 50. In October 1884 this number 

 was reduced to 25. It was not, however, until 1885 that the system now 

 in operation was inaugurated, and all cases of small-pox were treated in 

 hospital ships. It is impossible not to be struck with the fact that it is 

 since the year 1885 that the Metropolis has presented so satisfactory an 

 aspect as regards small -pox mortality. The facts to which we have been 

 calling attention certainly seem to point to the conclusion that this has 

 been due to a system of isolation, well organised and administered, the 

 beneficial effect of which is no longer neutralised by a spread of the 

 disease from the hospitals in which the isolation is carried out. 



Upon the whole, we think the experience of London affords cogent 

 evidence of the value of a sound system of isolation in checking the 

 spread of small-pox. 



Stamping-out Si/stem 'in Anstrnlia. 



The experience of isolation systems in Australia is interesting and 

 worthy of special notice, because whilst in this country the quarantining 

 of persons who have come in immediate contact with those suffering from 

 small-pox has only been possible with the consent of the persons whom it 

 was proposed to subject to quarantine, in Australia their removal to a 

 place of isolation has been made compulsory. 



Australia, by virtue of its geographical position, and the consequent 

 separation by long sea voyage from infected ports, enjoyed for a long 

 time a sort of natural isolation. Thus, Hirsch, in his " Historical and 

 Geographical Pathology," vol. i., pp. 133-4 (1881), remarks : 



" The continent of Australia up to 1 838 had enjoyed an absolute 

 " immunity from small-pox ; towards the end of that year the disease 

 " appeared at Sydney, having been imported probably from China ; it 

 " lasted, however, only a short time, and remained absent from the 

 " continent until 18G8. In that year it was introduced into Melbourne by 

 " a ship, and again it spread only to a slight extent, and quickly died out. 



* Final Report. 



