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prompt notification, isolation of the infected, disinfection, &c.
2. Measures calculated to promote the public health, the prevention
of overcrowding in dwellings or on areas, cleanliness, the
removal of definite insanitary conditions, &c.
Isolation.
The principle underlying the practice of isolation with its
accompanying 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 greater
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, &c.,
have been successfully employed to check the spread of smallpox.
They have also been sometimes so employed in recent
years in places where vaccination has fallen into disuse.
Evidence bearing on the same point was given by Dr. Thorne
before the Royal Commission which in 1881-2 inquired into the
subject of small-pox and fever hospitals in London.
Speaking of hospitals for infectious diseases generally, he said,
"The evidence is so abundant that I could occupy you for hours
"in telling you of instances in which epidemics have evidently
"been prevented by the isolation of first cases of infectious
"disease."
Dr. Thorne says: " It is really more striking as regards small"pox
than any other disease, because small-pox can be more
"easily isolated ; the friends of the patient, and they themselves
"being so much more willing to submit to isolation, than when
"suffering from any of the other specific fevers." He adds,
however, that "efficient vaccination must be considered as a
" probable influence in contributing to the results."
It is to be observed, too, that Dr. Thorne expressed the opinion
that after an outbreak of small-pox had proceeded a certain way,
the influence of a hospital for good upon the population would
be very small indeed, that it would be good so far as concerned
the individual house from which the patient was removed, but
that it often had but little influence upon the general body of
the epidemic.
Notification.
Passing now to a consideration of the effect produced by a
notification of cases of small-pox and the steps taken to isolate
them, we naturally begin with Leicester. The method there
employed in dealing with small-pox has attracted much attention,
and is often spoken of as the " Leicester system."
As some discussion has arisen as to the exact procedure under
the Leicester system, it will be well to briefly state in what it
consists. On the receipt of a notification at the Health Office, a