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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.
Of course, also, thorough disinfection, and measures
calculated to promote the public health, the prevention of
overcrowding in dwellings or on areas, cleanliness, the
removal of definite insanitary conditions, &c.
The latter part of the question is thus answered:—
(503)
We can see nothing then to warrant the conclusion that,
in this country, vaccination might safely he abandoned, and
replaced by a system of isolation. If such a change were
made in our system 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 contemplate the consequences without dismay.
To avoid misunderstanding, it may be as well to repeat
that we are very far from under-rating 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.
As outbreaks of small-pox have not unfrequently had
their origin in the introduction of the disease to common
lodging-houses by tramps, further control over such houses
and common shelters is recommended.