6

scientific character. Everything they conceive must be practical. We have always seriously doubted this, and we have great pleasure in seeing that one publisher at least has had the courage to attempt to cater for the profession on these subjects, and we wish Professors Humphrey and Turner every success in their new and arduous undertaking. The first volume of the new series of their Journal of Anatomy and Physiology' contains, indeed, many interesting papers, and promises well for the future. Amongst the more important ones in the first part may be mentioned those of Mr. Gulliver, on the white and red blood corpuscles, and of Mr. Hair on the arrangement of the muscular fibres of the alligator, the amusing as well as learned disquisition of Professor Rolleston on ancient and modern domestic cats, the excellent paper of Mr. Mivart on the osteology of the Insectivora, and the contribution to the anatomy of the pilot-whale, by Professor Turner: whilst the second contains a suggestive essay by Drs. A. Crum Brown and Fraser, on the connection between chemical constitution and physiological action, an account of certain American crania by Professor Huxley, an interesting paper by Dr. Beigel, on the nature and action of Indian and African arrow poison, and a carefully drawn up account of the myology of the Orycteropus capensis and of the Phoca communis, by Professor Humphry, besides more than twenty other shorter communications. Each part contains also capital reports on the progress of anatomy by Professor Turner, and on recent English and foreign physiology, by Drs. Rutherford, Fraser, and Gamgee.

REVIEW VI.

1. Procès-Verbaux de la Conference Sanitaire Internationale, ouverte à Paris le 27 Juillet, 1851. Tomes I et II. Folio. Pp. 396 and 412. Paris, 1852.

Proceedings of the International Sanitary Conference opened at Paris, 27th July, 1851.

2. Procès-Verbaux de la Conference Sanitaire Internationale, ouverte à Constantinople, le 13 Fevrier, 1866. 4to. Pp.

762.

Proceedings of the International Sanitary Conference opened at Constantinople, 13th February, 1866.

3. Rapports faits à la Conference. 4to. Pp. 379. Pp. 379. Constantinople, 1866.

Reports made to the Conference.

In this article we purpose to give a summary of the principal contents of the proceedings of the late International Conference held in Constantinople on the subject of epidemic cholera, in order that the profession may be enabled to form their own opinion of the practical conclusions which were then adopted, and of the evidence on which these conclusions are based. The two volumes in which the proceedings are recorded are as yet very rare in this country, so that few persons can have an opportunity of examining them for themselves. It is the more necessary, too, at the present time, that a connected analysis of their contents be laid before the reader, as not only several of the topics discussed and opinions expressed by the Conference are occasionally being commented on in the press and at medical meetings, but also, more than once, reference has been made and questions asked in the Legislature as to what our Government propose to do in respect of the recommendations which have been officially made to them. But, before proceeding to our immediate task, it will not be unprofitable to take a retrospective brief notice of the sister work, the first on the list at the head of this article. It was undertaken now seventeen years ago for a similar object, and under similar circumstances; yet, strange as it may seem, its contents have (as far as we are aware) never been made known to the profession in any medical journal down to the present day. The truth is that, although printed as an official document, it was not published or circulated, in this country at least. The Conference of 1851 was more comprehensive in its scope than that of 1866; for it undertook to discuss and determine the whole subject of quarantine, in respect not of cholera only, but of other diseases, more especially of yellow fever and the plague. Delegates, medical and consular, were appointed to attend it by the governments of France, Great Britain, Russia, Austria, Piedmont, Tuscany, the Papal States, Naples, Turkey, Greece, Spain, and Portugal. The medical members were Drs. Melier, Sutherland, Rosenberger, Menis, Bo, Betti, Cappello, Carbonaro, Bartoletti, Costi, Monlau, and Grande. The conference sat for eight months, and held forty-three meetings. We shall confine our notice of their work to what has reference to the subject now in hand.1 The delegates differed much in opinion as to the necessity for any

1 A full analysis of the proceedings of the Conference will be found in a paper by Dr. Milroy in the 'Transactions of the National Association for the Promotion of Social Science,' 1859.

stringent quarantine in respect of cholera. The French, British, Austrian, and Piedmontese members were decidedly opposed to "measures of rigour." On the other hand, the Neapolitan and Papal members urged their necessity as much for the cholera as for the plague; the island of Elba and many places in Italy had been, it was alleged, preserved intact by the segregation or exclusion of all suspected arrivals. The Spanish and Portuguese members-while admitting that it is mainly by adopting sanitary measures on board merchant vessels, and also in sea and river ports, that the spread of the disease can be checked-contended that, until these measures were universally carried out, quarantine must be continued. Russia, it was stated, had not come to a definite conclusion on the question; she awaited further inquiry. On two points, however, experience seemed to her to be conclusive, viz. (we quote from Dr. Milroy's analysis)—

"That the disease, when occurring only in sporadic and occasional cases, is certainly not importable by intercourse; and, secondly, that the only fomites or articles capable of transmitting the cholera poison are bed or body clothes fouled with the excreta of the sick.

"The final decision of the Conference, as carried by a majority of votes, was that all arrivals whatever from a place where cholera exists should be liable to a quarantine of observation of five complete days, the voyage being included in this period, before free pratique is granted.

"If a case of the disease occurred during the voyage, the quarantine to date from the arrival of the vessel; and, if during the performance of quarantine, a fresh detention to be imposed from the date of each such occurrence.

"With respect to cargoes, it was decided that they shall never be required to be disembarked into a lazaret, or be subjected to any other measures of purification except free ventilation on board, and due attention to the cleanliness of the vessel itself.

"These remarks apply to arrivals from countries actually infected with the cholera. A shorter quarantine of observation, namely, for three days only including the voyage, might be imposed on arrivals from countries which a local board of health should consider to be compromised, either by proximity to an infected place or otherwise, although the disease may not yet have manifested itself."

To make assurance doubly sure on the side of presumed safety by these precautionary measures, it was determined that, even after the certified cessation of cholera in a place, an interval of ten days should be required to elapse before clean bills of health should be permitted to be issued therefrom. It need only be added to this short notice of the Conference of 1851 that the

convention, which was drawn up in accordance with the views of the majority of the delegates, was accepted only by France, Piedmont, Portugal, Tuscany, and Turkey. Our Government declined to accede to it, on the ground of the proposed restrictions upon freedom of intercourse, from the apprehended risk of importation of the several diseases, being deemed extreme, and unnecessarily oppressive. Within a year or two afterwards, the quarantine regulations of some of the States represented at the Conference were more rigorous and severe than they had been previously.

The Conference of 1866 was of larger dimensions, although the scope of its inquiry was more limited, than that of its predecessor. The governments represented at it were seventeen in number; and the number of delegates who attended was in all 35, of whom 14 were diplomatic, and 21 were medical. France was represented by Dr. Fauvel; Britain, by Drs. Goodeve and Dickson; the Netherlands, by Drs. Van Geuns and Millingen; Prussia, by Dr. Muhlig; Austria, by Drs. Sotto and Polak; Russia, by Drs. Lenz, Pelikan, and Bykow; Spain, by Dr. Monlau; Portugal, by Dr. Gomez; Greece, by Dr. Maccas; Italy, by Drs. Bosi and Salvatori; the Papal States, by Dr. Spadaro; Sweden and Norway, by Dr. Hubsch; Turkey, by Salih Effendi and Dr. Bartoletti; Egypt, by Dr. Salem Bey; and Persia, by Dr. Sawas. Belgium and Denmark were represented only by diplomates; and the United States of America, which had been invited to join, did not send any delegate. The first meeting was held on February 13th, and the last on September 26th, 1866.

The Conference was opened by an address from the Minister for Foreign Affairs of the Porte. No sooner was this over and business commenced, than the French delegates (Count Lallemand was the diplomatic member), with an autocratic energy which characterised them throughout the proceedings, moved the immediate appointment of a committee to determine what precautionary measures should be forthwith urged upon the Ottoman Government for adoption, in the event of cholera again appearing this year among the pilgrims assembled at Mecca. The scheme recommended by France was nothing less than the total suspension of all maritime communication and intercourse whatever between any part of the Egyptian coast in the Red Sea, and all ports on the Arabian coast, as long as the disease continued among the pilgrims, and for fifteen days after the occurrence of the last case among them. Until then, the pilgrims should be required to remain in the Hedjaz, unless they preferred to proceed on their return journey by caravan along the desert ;-whereby the disease was invariably, Dr. Fauvel asserted, got

effectually rid of. To carry into effect these measures would of course require, among other means, the posting of ships of war at various parts of the coast of the Red Sea, so as to bar the approach of all vessels to the infected points, and prevent the possible escape of any of the pilgrims to Egypt by sea. As to the pilgrims returning to India and other lands to the east of the Red Sea, they might possibly be allowed to embark at some port considerably to the southward of Djeddah; although it would be wiser on the whole, it was thought, to subject all pilgrims without exception to one general rule until all trace of the disease among them had vanished.

This proposition at once gave rise to much controversy. Mr. Stuart, the British diplomatic member, took exception to it as at variance with the very terms of the original invitation, addressed by the French Government to England and other states in respect of the Conference, whose object was professed to be

"De réchercher les causes primordiales du cholera-d'en étudier les caractères et la marche-d'en déterminer les points du départ principaux-enfin elle aurait à proposer les moyens pràtiques de le circonscrire et de l'étouffer à son origine;"

the ultimate and great object being to prevent, if possible, the recurrence of epidemic visitations of cholera in Europe. The present proposal was, he contended, "beginning with the end;" and, moreover, the consequences, maritime and commercial, involved in its adoption would manifestly be so very serious, that he declined to take any part in its consideration, without first consulting his Government. The Turkish and Persian delegates pointed out the disastrous results that might ensue from the sudden enforcement of measures of such extraordinary rigour, and this too, without any previous intimation to the tens of thousands of pilgrims that would soon be assembled at Mecca.1 Dr. Pelikan contested the necessity of the alleged urgency for immediate action, on the ground that the past history of cholera proves that

"the pestilence, always proceeding from India, has never followed two years in succession the same route in reaching Europe, the reason doubtless being that the epidemic development of the cholera is not explicable solely by its transmissibility.”

Moreover,the wide dispersion of cholera-infection already through

1 In 1865, the number of pilgrims was unusually great, not less, according to Dr. Gianelli, than 200,000. The majority arrived at Djeddah by sea. In that year, between 18,000 and 20,000 returned to Suez by sea. The total number of pilgrims this year, 1866, would probably be considerably over 100,000.