REruKT OF THE ROYAL VACCINATION COMMISSION. 697 



Value of Isolation. 



We can see nothing, then, to warrant the conclusion that in this country 

 vaccination might safely be abandoned, and replaced by a system of 

 isolation. If such a change were made in our method of dealing with 

 small-pox, and that which had been substituted for vaccination proved 

 ineffectual to prevent the spread of the disease (it is not suggested that it 

 could diminish its severity in those attacked), it is impossible to contem- 

 plate the consequences without dismay. 



To avoid misunderstanding, it may be well to repeat that we are very 

 far from underrating the value of a system of isolation. We have already 

 dwelt upon its importance. But what it can accomplish as an auxiliary 

 to vaccination is one thing ; whether it can be relied on in its stead is quite 

 another thing. 



Even admitting fully the protective effect of vaccination, it does not, 

 in our opinion, diminish the importance of measures of isolation or dis- 

 pense with their necessity. We think that steps should be taken to secure 

 a more general provision for the isolation of small-pox patients than 

 exists at present. We have already called attention to the fact that 

 mischievous results are likely to follow the use as a small-pox hospital of 

 a building situate in a populous place. We think that wherever it is 

 placed it should have sufficient space around it to enable the sanitary 

 authority to add rapidly to the accommodation by the erection of tem- 

 porary buildings. 



Compulsory Provision of Isolation Hospitals. 



Sanitary authorities are now sometimes reluctant to provide isolation 

 hospitals. We think that, on a petition by a prescribed number of the 

 ratepayers in a sanitary district, the Local Government Board, if satisfied 

 that the hospital accommodation ought to be provided, should have power 

 to make an Order for such provision. 



Compulsory Notification of Small-pox. 



We think that notification of small-pox should everywhere be compul- 

 sory, and, whenever the disease showed a tendency to become epidemic, 

 a notice should be served by the sanitary authority upon all persons in 

 the neighbourhood who would be likely to come within the reach of con- 

 tagion, urging them to submit to vaccination or re-vaccination, as the case 

 might be, if they had not been recently successfully vaccinated or re- 

 vaccinated ; and attention should be called to the facilities afforded for 

 their doing so. Attention should also be called to the importance of 

 avoiding contact with persons suffering from the disease, or coming into 

 proximity to them, and of avoiding contact with any person or thing 

 which may have become infected. It is important to notice that, even 

 where vaccination has been neglected, there is great readiness to submit 

 to it in the presence of a threatened epidemic ; a large number of vacci- 

 nations are then obtained willingly and without opposition. Whenever 



