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AFT. No. 2
Abstract of Proceedings.
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1-SCIENTIFIC QUESTIONS.
The first of the preliminary questions was as follows:-"Ie choléra "Asiatique, susceptible de s'étendre (épidémique), ne se développe-t-il "spontanément que dans l'Inde, et est-ce tonjours du dehors qu'il "arrive quand il éclate dans d'autres pays? Ou bien revêt-il aussi le " caractère endémique dans d'autres pays que l'Inde? dans ce cas, quels "sont ces pays ?"
On the points involved in this question the Conference was in unani- mous agreement with that of Constantinople, that epidemic cholern has its origin in India, and exists permanently there in an endemic state; that it is probably endemic only in India, though there are some coun- tries bordering on India, concerning which sufficient grounds do not exist for a formal conclusion on this point; that it has never been observed in a really endemic state, (which of course must be carefully distinguished from an origin from secondary foci) either in any part of Europe, or in Turkey in Asia, or in the Cancasus, or in the north of Africa, or in America; and that, though the possibility of its becoming acclimatized in any of those countries is not to be rejected, ench event is to be held as extremely problematical.*
On the second question, "Le choléra est-il transraissible par l'homme ?" some discussion took place, not in reference to the main question, in which the Conference was entirely in accord with that of Constantinople, but on an exception taken by the German delegates to the wording of one of the conclusions of the Constantinople Conference on the subject.f With certain qualifications to meet this view, and which recognised the influence of localities, the Conference accepted those conclusions, thereby affirming that cholera is transmissible by the human subject coming from an infected locality; that the rapidity of its transmission is in correspondence with the activity and rapidity of human communi- rations; that the introduction of a single cholera patient may give rise to the development of an epidemic; and that there are facts which tend to prove that a single individual (und à fortiori several) coming from an in- fected place, and affected with diarrhea only, may be enough to give rise to the development of an epidemic of cholera, or, in other words, that the premonitory diarrhoea of cholera may be the means of transmitting the disease.t
On the points raised in the third question, "Le choléra pent il être
* Throughout this abstract I have given in fuil the conclusions as voted by the Conference. They frequently go beyond a mere categorical reply to the questions asked, and sometimes contain qualifications of the conclusions stated in the final "Relevé des Conclusions, &c." (Annex. III.) which should not be disregarded.
†The phrase objected to was "L'homme atteint de choléra est par lui-même le "principal agent propagateur do cette maladie." And the objection taken by Professor Pettenkofer was particularly to the words "par lui même." The view of the German delegation was thus formulated by Professor Hirsch :-"Je ne conteste "nullement la transmissibilitée du choléra par l'homme venant d'un milicu infecté ; "je considère l'homme seulement comme la canse spécifique, en dehors de l'influence de la localité infecté; en ontre, je te considère comme le propagateur du choléra, lorsqu'il vient d'un cadroit où le germe de la maladie existe déjà.”
It is apparently by an error, which escaped observation at the time, in the Procès- verbaux, that the proposal of the German delegation is therein stated to have been formally adopted, and to the exclusion of the Constantinople resolutions. Bat the fact was that the discussion showed that there was nothing really to dispute about: the conference readily and at once recognized the influence of localities, and most certainly the resolutions of Constantinople, modified on this point only, as I lave stated in the text, were adopted. I find this error in the Irocès-verbaux and Relevé des Conclusions, has been since noticed by other Members of the Conference. (See Bull. de l'Acad, de Med. 1874, p. 926.)
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Art. No. 2.
Abstract of
propagé par des effets qui, provenant d'un lieu infecté, ont servi à Pusage, et spécialement par ceux qui ont appartenu à des cholériques ?** the conclusions of the Constantinople Conference were unanimously Proceedings. accepted, viz., that cholera is transmissible by goods employed for per- sonal use coming from an infected place, and especially by such as have been used by cholera patients; and that there are even facts which show that the disease may be conveyed to a distance by such goods, if they have heen kept close and unexposed to free circulation of air.
The fourth question, "Le choléra peut-il-être propagé par des comestibles ? " was one which had not been considered at Constantinople. This question it was decided after a short discussion to divide into two, the one having reference to food, and the other to drink, especially to drinkable water. To the first branch of the question, “Le choléra peut- "il-être propagé par les aliments?" the answer given by a majority, after considerable discussion, was that the Conference having no con- clusive facts of the transmission of cholera by food, was not in a position to give a formal decision on the point. To the second division of the question, "Le choléra peut-il-être propagé par des boissous, particulière- "ment par l'eau 7" the reply was unanimously in the affirmative.
On the fifth question, "Peut-il-être importé par des animaux vivants?” the conclusion arrived at by a majority, after some discussion, was that there exists no proof of the transmission of cholera from animals to mankind, but that the possibility of it may reasonably be admitted.
On the sixth question, "Lo choléra peut-il-être importé par les « marchandises? "the conclusion of the Conference at Constantinople, that, while they were ananimous as to the absence of any proof of the transmission of cholera by merchandise, they must admit the possibility of such occurrence under certain conditions, was, after discussion, adopted by a majority. No vote was given against it, but several dele- gatious abstained from voting. As is evident from the wording of the resolution, it was only as to the concluding phrase that there was any difference of opinion.
On the seventh question, "Le choléra peat-il-être propagé par les 4 cadavres des cholériques ?" the conclusion of the former Conference, that though there was no conclusive evidence of the transmission of cholera by the corpses of cholera patients, it was prudent to consider them as dangerous, was unanimously adopted.
On the eighth question, “Le choléra peut-il se propager au loin par « l'atmosphère seule ?" the Conference adopted, with equal manimity, the conclusions of that of Constantinople, which were as follows: No fact up to the present time has shown that cholera can be propagated to a distance by the atmosphere alone, whatever the atmospheric conditions may be; and it is further a law, without exception, that no epidemic of cholera has ever been propagated from one point to another in a shortor time than was requisite for a human being to travel from the one point to the other. The surrounding air is the chief vehicle of the cholera- producing agent, but the transmission of the disease by the air is limited, in the immense majority of cases, to a distance very close to the source of infection. None of the facts which have been cited of transport of cholera by the atmosphere to the distance of one or of several miles is sufficiently conclusive.
The Conference assented also with unanimity to the answer which had been given at Constantinople to the ninth question, viz. "L'air frais arrivant du dehors aux agents donnant naissance ou propageant le “choléra, et les aérant, ou bien l'isolement de ces agents de l'air extérieur, "constituent-ils des éléments ayant on non une influence sur le caractère "contagienx du choléra ?” This reply was to the effect that in fresh air
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