August 20, 1891^ 



NATURE 



;67 



Australasian conditions was described. The Conference rejected 

 ancient quarantine as a principle of action, and on account of 

 easy and daily interchange of population between the six 

 territories decided to regard Australasia as constituting one 

 epidemiological tract, and consequently to relinquish all 

 quarantine as against each other. Then, before adopting 

 resolutions which would affect others, they put themselves 

 in order hy declaring in a second proposition that quarantine 

 can yield protection commensurate with its costs only to countries 

 whose internal sanitation is good; and they recognized defects 

 inherent in all quarantine measures by declaring, in a third 

 proposition, that the function of quarantine is not to exclude in- 

 fection, but to lessen the entering number of foci of infection, and 

 thus made it clear that exclusive reliance was not placed by them 

 on quarantine as a defence against imported disease. Having 

 thus indicated what hhouid be refrained from, it proceeded to 

 say what should be done. Nations whose internal sanitary 

 organization was not perfect cannot afford to refer the observation 

 of suspects to the country at large. It was decided consequently 

 that limited quarantine should be employed against ships actually 

 carrying cases of exotic disease — that was, that vessels and 

 equipment should be cleansed forthwith and held for delivery to 

 owners at earliest possible date, but that the ship's company 

 should be detained in isolation for periods slightly in excess of 

 recognized clinical incubation periods. Medical inspection was 

 thus rejected as a principle of action not less than ancient 

 quarantine, but still not inconsiderately ; when imported disease 

 was one already familiar ashore, the circumstances were seen to 

 resemble England's, and then medical inspection must (not 

 might or could) be used. Accordingly, in case of scarlatina or 

 the like, patients were removed to ordinary isolation hospital 

 (not quarantine), the quarters cleansed, and the ship discharged 

 in the usual way after five or six hours' detention. These 

 principles were strictly adhered to by the Government of New 

 South Wales since 1884. If not quite so closely by the other 

 five Governments, the reason was probably political rather than 

 commercial or scientific. 



Dr. Rochard, of Paris (whose communication was read by Dr. 

 Jules Bergeron'i, said that the means of preventing the transmis- 

 sion of epidemic diseases, such as the plague, yellow fever, and 

 cholera, were threefold — namely, isolation, disinfection — and 

 sanitation. The first was the simplest and the most radical. 

 It was also the most difficult to use, because it required the 

 intervention of public enactments, and the existence of an entente 

 internationale. It was the system of quarantine and of the 

 sanitary cordons. The second was more modern, and was the 

 result of the development of contemporary science. The third 

 rested on the progress of urban hygiene. It was probable 

 that when we had sanitary towns we could brave epidemics. 

 England had spent five millions since the commencement of the 

 century, and it did not fear cholera during the last epidemic. 

 Some of England's resistance to the cholera must be ascribed to 

 its great distance from the source of cholera. M. Rochard next 

 proceeded to detail the means taken at the frontier by the French 

 authorities during the last cholera epidemic in Spain, and 

 expressed the belief that it was necessary to persevere in the 

 employment of those measures which responded to the neces- 

 sities of the moment and to our present knowledge, until the 

 future developed some better remedy. 



Dr. Stekoulis, of Constantinople^ after mentioning the methods 

 quarantine and inspection, detailed by previous speakers, said 

 that Turkey was like numerous other countries, one in which 

 sanitary organization had yet to be carried out. If cholera has 

 entered Turkey in these last years hy Basjorah (Persian Gulf) 

 and by Camaran (Red Sea) it was that the lazarets are not in 

 accord with the progress of sanitary science. The jjilgrimage of 

 the Mussulmans to Mecca is also a great source of danger to the 

 country. The lazarets of Turkey ought to be made sanitary, 

 and there would be a great danger removed. 



Dr. Hewitt, of Minnesota, U.S.A., said they had very little to 

 do in his State with disease properly called epidemic except that 

 of small-pox. Cholera had but once obtained something of a 

 lodgment, and then it came directly from the port of New York. 

 Small-pox came to them directly through emigration from the 

 ports of England, and most of it came through the Gulf of St. 

 Lawrence. Only the other day cascs came from Liverpool to 

 Minnesota. He mentioned one case in which infection was 

 irried in the clothing of a woman who did not have the disease 

 iierself, but had been exposed on shipboard to it. The epidemic 

 resulted in 300 deaths. For interior States like Minnesota the 



NO. I 138, VOL. 44] 



demand was that there .«hould be complete sanitary central organ- 

 I ization, with local organization in direct relation thereto, and 

 I that this organization should stand in direct relation to the 

 quarantine service, which should be bound to give notice to the 

 interior authorities of the presence of disease or infection, 

 and that they should all co-operate for its control. 



Dr. Simpson, of Calcutta, slated that the real source of cholera 

 epidemics in Europe was, in his opinion, from emigrants and 

 pdgrims coming over land and in ships to Mecca, where there 

 was a focus 2000 miles nearer Europe than any Indian port. 



Dr. Leduc, of Nantes, agreed with Dr. Cuningham as to the 

 need of improved sanitary conditions in our towns, but he 

 strongly disagreed with him when he proposed the suppression 

 of quarantine. Modern science teaches us that contagious dis- 

 eases are spread by wandering germs : isolation must therefore 

 be a preventive to the spread of the disease, and quarantine 

 presents us with the best means of isolation, so that to propose 

 the suppression of quarantine was to propose a measure at once 

 irrational and contrary to the principles of modern science. 



Dr. Thome Thorne, of London, spoke of the need of sanitary 

 reform in towns, and deprecated the so-called protection of a 

 country by means of cordons, quarantine, &c. The sixteen days' 

 quarantine decided at Constantinople in 1866 failed, the ten days' 

 quarantine decided at Vienna failed, and yet the five days' sug- 

 gested at Rome is to succeed. The contention is altogether 

 illogical. 



Prof. Stokvis, of Amsterdam, said that at the International 

 Medical Congress at Amsterdam there was a discussion on 

 quarantine, in which the same arguments for and against were 

 used as now. He then had no steadfast conviction. Now he 

 had, and it was, that the only way to prevent the spread of 

 epidemic diseases, and especially of cholera, was to make sanitary 

 improvements. He had arrived at this conclusion by the study 

 of the history of cholera in India, where cholera diminishes as 

 sanitation improves. In the Dutch Indian Archipelago, where 

 quarantine is of no consequence, the following figures show the 

 great diminution in the death-rate which ensued on sanitary 

 improvement. From 1864-78 the death-rate in the European 

 army was 15 per 1000. In 1878 artesian wells, &c.,were made. 

 In 1879-83 the death-rate fell to 6"4 per 1000 ; and in 1884-88 

 to 3*5 per 1000. These figures are very striking, and lead one 

 to hope that the saying of the late Prof. De Chaumont will come 

 true, that the time will arrive when cholera will only be an 

 historical curiosity. 

 j The following gentlemen also took part in the discussion: 

 Dr. Felkin of Edinburgh, Prof. Brouardel of Paris, Sir Joseph 

 Fayrer, Surgeon Major Pringle, Surgeon-General Cook, Dr. 

 Robert Grieve of British Guiana, Dr. Ruijsch of the Hague, 

 Brigade-Surgeon Staples, Surgeon-Generals Cayley, Ewart, and 

 Beatson, Seiior Vicente Cabello, and Brigade- Surgeon McGann. 



In the afternoon. Sir John Banks, K.C.B., in the chair, Dr. 

 Manson read an elaborate paper on " The Geographical Distri- 

 bution, Pathological Relations, and Life-history of Filaria 

 sanguinis hominis diurna and Filaria sanguinis hominis 

 Persians in connection with Preventive Medicine." The paper 

 was illustrated by numerous microscopical specimens. 



Dr. Manson said that the discovery of the blood-worms herein 

 named Filaria sanguinis hominis diurna and Filaria sanguinis 

 hotninis perstans suggests an investigation into their possible 

 pathological relations, and into their life-histories, with the view 

 to intervention in respect to them of preventive medicine. 



The facts that these parasites and the disease known as negro 

 lethargy, or sleepinii sickness of the Congo, are endemic in the 

 same region, the West Coast of Africa ; that neither can be 

 acquired unless in this particular region ; and that sleeping sick- 

 ness may declare itself many years after the endemic region has 

 been quitted, and that these filarije continue to live for many 

 years after the negro has left Africa ; suggest a possible relation- 

 ship between these parasites and this disease. 



A papulo-vesicular skin disease called craw-craw is endemic in 

 the sleeping sickness region, and sleeping sickness is often ac- 

 companied by a similar papulo-ve.-icular skin disease, probably 

 the same. O'Neil found a filaria- like parasite in the vesicles of 

 craw-craw. Nielly considers a disease he calls dermatose 

 parasitaire, which he found in a lad in France, the same as the 

 African craw-craw ; he discovered in the vesicles of the skin in 

 this case the same or a similar parasite to O'Neil's. Nielly, at 

 the same time, found an embryo filaria in his patient's blood 

 which was undoubtedly an earlier form of the skin worm. From 



