688 SUPPLEMENTARY APPENDIX. 



incidents fewer in number, and diminished hostility to the operation, it 

 may be that on the whole it would promote the cause of vaccination, and 

 secure, as its result, that the number of vaccinated persons would be 

 greater than at present. 



Means, other than Vaccination, for diminishing the Prevalence of Small-pox ^ 

 and how far such means could he relied on in place of Vaccination. 



Another question upon which we are asked to report is, what means, 

 other than vaccination, can be used for diminishing the prevalence of 

 small-pox ; and how far such means could be relied on in place of 

 vaccination. 



The means, other than the inoculation of small-pox or cow-pox, which 

 have been referred to by witnesses as being capable of diminishing the 

 prevalence of small-pox, are such means as have been employed against 

 infectious diseases generally ; they may be summarised as — (1) Measures 

 directed against infection, e.g., prompt notification, isolation of the 

 infected, disinfection, etc. ; (2) Measures calculated to promote the public 

 health, the prevention of overcrowding in dwellings or on areas, 

 cleanliness, the removal of definite insanitary conditions, etc. 



The principle underlying the practice of isolation with its accompany- 

 ing machinery is obviously the very opposite of that which recommended 

 the practice of inoculation ; it aims at exclusion of the disease, whereas 

 inoculation aimed at universal acceptance by artificially " sowing " or 

 " buying " the disease. Except in regard to the plague, our knowledge 

 and practice of measures of isolation and quarantine against epidemics is 

 of relatively recent growth. As the result of increased knowledge of the 

 mode of propagation of infectious diseases, of grea,ter sanitary activity, 

 and under the stimulus of legislation, organised effort, more or less, 

 thorough, is now, in this as in other countries, directed against the spread 

 of dangerous infectious diseases. Side by side with a vaccination system,, 

 means of isolation, etc., have been successfully employed to check the 

 spread of small-pox. They have also been sometimes so employed in 

 recent years in places where vaccination has fallen into disuse. 



It will be well to commence with a brief statement of the growth of 

 our knowledge on the subject of isolation as a means of dealing with 

 infectious or contagious diseases. We have already adverted to the fact- 

 that small-pox' is highly contagious, and that contagion from those 

 suffering from it is the means by which the disease is propagated. 



Although reference to infection appears in some of the Arabian writers, 

 the contagiousness of small-pox attracted little attention in this country 

 and in western Europe until the eighteenth century. Sydenham (1624-89), 

 though he refers to the contagiousness of small-pox, did not dwell upon 

 the matter, and did not regard it as so important an element in the spread 

 of the disease as some peculiar constitution of the atmosphere to which 

 he attributed epidemics. Boerhaave was the first, at the commencement 

 of the eighteenth century, distinctly to formulate the now generally 

 accepted doctrine that small-pox arises only from contagion. 



In 1720, Mead drew up an elaborate system of notification, isolation, 

 disinfection,' etc., in view of a threatened invasion of the plague ; but no 



