REPORT OF THE ROYAL VACCINATION COMMISSION. 689 



attempt to deal with small-pox in a similar fashion appears to have been 

 made until the last quarter of the eighteenth century. This was in all 

 probability largely due to the adoption of inoculation as the recognised 

 defence against small-pox, and the acceptance of Sydenham's doctrine 

 of epidemic causation may have exercised an influence in the same 

 direction. 



No writer appears to have suggested methods of isolation, disinfection, 

 etc., against small-pox prior to 1 763. In that year East of Lyons published 

 his " Reflections on Inoculation and Small-pox, and upon the means which 

 might be taken to deliver Europe from that malady." He maintained— 

 (1) That small- pox was not a necessary and inevitable malady ; (2) That it 

 arose only from contagion ; (3) That it resembled plague in most of its 

 features. His conclusion was expressed in these terms: "I say; that to 

 " deliver Europe from small-pox we must act upon principles directly 

 " opposed to inoculation ; far from multiplying the contagion, we must 

 " keep it away by taking the same precautions and employing the same 

 " measures against that malady as have proved so successful against leprosy 

 '' and the plague." 



The earliest account of the practical employment of such means is 

 from Rhode Island, U.S.A. Haygarth, on the authority of Drs. MofEat and 

 Waterhouse, states that for many years prior to 1778 small-pox had been 

 successfully prevented from becoming epidemic there by regulations for 

 isolation of the infected on a neighbouring small island specially used for 

 that purpose, and for quarantining infected vessels, destruction of infected 

 clothing, etc. Moreover, inoculation was discouraged at Rhode Island, 

 and those who wished to be inoculated had to go to some place away from 

 the Island, and were not to return until there was no danger of their 

 infecting others. 



A passage in Dimsdale's work on Inoculation, published in 1781, shows 

 that in some towns of England pest-houses were beginning to be used for 

 small-pox. In 1784 Haygarth, of Chester, published his " Inquiry how to 

 prevent the Small-pox," and in 1793 "A Sketch of a Plan to exterminate 

 the Small-pox from Great Britain." 



The great epidemic of smaU-pox at Chester in 1774, to which allusion 

 has already been made, was the occasion of Haygarth's first attempts at 

 organised dealing with epidemics of small-pox with a view to preven- 

 tion. In his " Inquiry " he combated Sydenham's doctrine that epidemics 

 are due to some occult condition of the atmosphere, and argued that 

 small-pox was always spread by infection only. He further maintained 

 that the variolous poison could be carried as an infection for a little 

 distance only through the air, and " consequently that the small-pox may be 

 " prevented by keeping persons liable to the distemper from approaching 

 " within the infectious distance of the variolous poison till it can be 

 " destroyed." These views led him, upon the return of an epidemic in 

 1777, to propose a plan for the prevention of the natural small-pox, and 

 in 1778 a society was formed to carry out the plan in Chester. The plan 

 consisted on the one hand of a general inoculation at people's homes at 

 stated intervals, on the ground that the inoculated small-pox was far less 

 fatal or injurious than the natural small-pox, and on the other hand of 



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