AFP. No, 2.
A Detract of Proceedings.
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the generative principle of cholera rapidly loses its morbific activity, b) that under special conditions of confinement of air such activity might be preserved for an undetermined time; that it was under these con- ditions of confinement of air that, (as already stated in reply to question 3), cholera might be transmitted even to a distance by goods employed for personal use; that great deserts were a very efficacions barrier against the propagation of cholera, and that there was no example of that disease baving ever been imported either into Egypt or Syria across the desert by caravans coming from Mecca,
The two remaining preliminary questions of the programme gave rise to long and animated discussions.
Question 10 was, "Quand il y a contagion, quelle est la durée de "Finenbation?" The resolutions of the Constantinople Conference on this point had been as follows:-"In almost all cases, the period of incubation, ie, the time which clapses between the moment at which "the individual receives the cholera infection and the commencement of "the premonitory diarrhea, or of the confirmed cholera, does not exceed "a few days [elsewhere more precisely limited by the words, 'a week " at the outside."] All facts which have been cited of a longer incubation relate to cases which are inconclusive, either because the premonitory diarrhea has been included in the period of incubation, or because the infection might have taken place after the person's "departure from the infected locality. Observation shows that the "duration of the choleraie diarrhoea which bas been termed premonitory, "(which must not be confounded with every diarrhoea met with at "cholera times), does not exceed a few days. The facts which have been cited as exceptional do not prove that the cases of diarrhoea "prolonged beyond this period are really choleric, and are susceptible "of transmitting cholera when the individual suffering has been with- drawn from all sources of infection." After a very long debate, the Conference of Vienna assented to these conclusions by 13 affirmative votes to 1 negative, four delegations abstaining from voting.*
The 11th and last question was this: Connait-on des moyens ou des "procédés de désinfection grâce auxquels le principe générateur ou con- "tagieux du choléra peut sûrement ou avec quelque chance de succès être détruit ou perdre de son intensité ? Dans le cas affirmatif, quels sont "ces moyens ?" A short preliminary discussion made it evident that it would be desirable to take separately the opinion of the Conference as to the existence of means of disinfection which might be relied on with certainty, or only of means for the probable success of which there was good evidence; to separate, in short, the "strement" from the "quelque chance de succès." The known existence of any means of disinfection, absolutely certain in its operation, was denied by 12 delega- tions, and affirmed by none, seven delegations abstaining from voting.
*The difference of opinion, at least between the delegations which voted in the affirmative and those which abstained from voting, was, I apprehend, more apparent than real. I did not gather from the discussion that it was at all disputed by the latter that in the immense majority of cases (perhaps the expression "almost all " might have been felt by them a little too strong) the period of inenbation does not exceed the limits stated in the resolution. Their objection attached rather to the too small importance, which, in a prophylactic point of view, the resolution seemed to attach to the exceptional cases, of which the most reasonable explanation consisted in aduitting a longer period of incubation. As Professor Fettenkofer pat it, the question was to be regarded from a prophylactic not a clinical point of view; adding, that from the latter "il accepterait la thèse d'une courte durée.” On the other hand it was by no means intended, as the limiting word "alnost" shows, by those who supported the resolution to deny the possible, nor the probable, existence of a longer period of incubation in some cases, nor that dangers might, though rarely, arise therefrom.
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APP. No. 2.
On the other hand 14 delegations asserted, while four denied, the
existence of means of disinfection, of the successful application of which Abstmet of there was reasonable probability. The vote on this latter question, Proceedings. however, must be interpreted by reference to a further discussion to which it gave rise, which showed that the objection on the part of the delegations which had voted in the negative, to admit the probable efficacy of disinfectants, bad arisen chiefly, or at least in great part, from the influence they conceived an affirmative answer to the question would have in leading to a reliance being placed on disinfectants, to the pre- of judice of the precautions (which they deemed much more important) simple hygiène. This had certainly been the furthest possible from the intention of those who had given the affirmative vote. A resolution, therefore, which should remove all ambiguity on this point was proposed, and unanimously adopted, as follows (I give the exact words of the resolution itself): "La science ne connait pas encore de moyens désin- «fectants certains et spécifiques; en conséquence, la Conférence "reconnaît une grande valeur aux mésures hygiéniques, telles que "aëration, lotions profondes, nettoyage, &c., combinées avec l'emploi "des substances regardées actuellement comme désinfectantes."
No attempt was made at the present stage of proceedings to specify the various means of disinfection (49 required by the last clause of the 11th question), the subject being held to belong in its details more properly to question 22 of the programme.†
Four sittings of the Conference had been occupied with the determi- nation of these preliminary questions. The conclusions arrived at were, it will have been seen, essentially of accord with those arrived at by the Conference of Constantinople. At the last of these sittings the course to be adopted in considering the second part of the programme, the practical It was determined questions relating to Quairautine, was also disenssed, that the questions relative to Land and River quarantines (questions 12- 16) should be entertained in full Conference, but that the subject of Maritime Quarantine (questions 16-22) shouldd, in the first instance, be referred to a committec, and discussed on the committee's report. It was further resolved that the questions relating to the establishment of an international sanitary commission (Part III of Progranime) should also, in the first instance, be referred to a committee. And the committees for the respective purposes were nominated.‡
IL-QUESTIONS OF QUARANTINE.
The mode in which the questions connected with Quarantine were submitted for the consideration of the Conference differed from that which had been taken with regard to the scientific questions. The
* In the Procès-verbaux the votes are recorded as 13 affirmative to negative; M. Schleisner's vote, which was affirmative, having been erroneously entered as negative.
In point of fact no enumeration of disinfectant substances, or recommendation as to special means of disinfection, was ever made by the Conference. The com- mittee on Maritime Quarantines (see postea) in the Réglement attached to their report, suggested certain means as applicable to ships, and to passengers by ship, their clothes, and effects, bat on discussion it was felt that the best course was to leave the choice of means of disinfection to the competent authority of each country. 'The committee on Maritime Quarantines, as first uominated, consisted of Messrs. Hirsch (Germany), d'Alber-Gianstätten (Austria), De Ring (France), Polak (Persia), and Seaton (Great Britain); but MM. De Ring and Polak declining, for reasons stated by them respectively, were replaced by MM. Seramola (Italy), and Van Cappelle (Holland). The committee on the subject of an luernational Commission consisted of MM. Lenz (Russia), Catinelli (Hungary), Marcovitz (Roumania), Kierulf (Norway), and l'olak (Persia?,
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