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districts with which they are combined. This idea has been
suggested to us, as the result of the inquiry, how it has come
about that whilst the metropolis, in the decennium 1867-1876 and
again 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.
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, accompanied 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.
The question we are now discussing must, of course, be
argued on the hypothesis that vaccination affords protection
against Small-Pox. Who can possibly say that if the disease
once entered a town, the population of which was entirely or
almost entirely unprotected, it would not spread with a rapidity
of which we have in recent times had no experience, or who can