THE RESULTS OF THE DRESDEN CONFERENCE

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214 THE RESULTS OF THE DRESDEN CONFERENCE. THE Royal Commission upon Vaccination held another sitting on Wednesday last at the offices in Gleat George- street. Sir James Paget presided. Dr. Barry, of the Local (Government Board, concluded his evidence, after which Mr. C. Shattock and Mr. C. Watterer gave evidence in flavour of vaccination. MR. W. A. WILLS, M.D. Lond., has been appointed Lecturer I on Elementary Medicine at the Westminster Hospital Medical School. Mr. P. R. W. Santi, F.R.C.S., has been appointed a Demonstrator in Anatomy, and Mr. P. Macleod Yearsley, M.R.C.S., L. R. C. P., and Mr. H. H. Mills, M. R C. S., L.R.C.P., have been appointed Assistant Demonstrators in Anatomy in the same school. THE total amount received on behalf of the Hospital ’Saturday Fund for the present year, including the workshops’ collections, reaches nearly £ 10,000. THE RESULTS OF THE DRESDEN CONFERENCE. WE have now before us the complete record of the pro- ceedings of the International Sanitary Congress of Dresden, together with those of the various committees that were con- stituted to report on special points to the full Conference, and also the text of the Convention to which the following ’countries have adhered : Austria-Hungary, Belgium, France, Germany, Great Britain, Italy, the Netherlands, Russia and ’Switzerland; and it is hoped that Denmark, together with Sweden and Norway, will also adhere before long. On the other hand, Greece, Turkey, Spain and Portugal are not looked upon as very hopeful ; but it is at least satis- factory to note that the delegates of those countries for the first time spoke in an almost apologetic tone of the quarantine restrictions to which they still adhere, and some of them implied that the example of the Great Powers could hardly ’fail to have an important influence in moulding the opinions - of their respective Governments. We have so recently given a summary account of the principal conclusions that were arrived at in Dresden, that it is not necessary to repeat them. But we may point out that the conclusions range themselves under two headings, and ’ihat the success of the Conference has been in large measure due to this fact. In the first place the maximum restrictions that can be imposed as regards land traffic, sea traffic and goods are defined, and the contracting countries undertake ’, not to exceed these. In the second place, certain minimum restrictions are imposed on all alike. In this way agreement was possible as regards countries which differed somewhat in their views; one set could adopt the maximum, another - would be content to impose the minimum. And we need >hardly point out that the British delegation from the first anade it clear that the minimum only would be exacted by England, and their main trouble was to see that this minimum ,was not made too stringent. Of the contracting parties, Great Britain exhibited the most liberal mind ; then followed Germany, Belgium and Holland; Switzerland was hardly less liberal, except as regards some curious views, which her delegates ultimately withdrew, as to a danger from imported fish ; then came France and Russia, who seemed very generally to be in mutual agreement, and Austria-Hungary. But although we place France in the rear rank, yet it is clear that the Conference owed much of its success to her initiative and to the admirable way in which her technical delegates, MM. Brouardel and Proust, set out the subjects for discussion and made proposals as to the form cf the various conclusions. Above all, perhaps, England owes much to the French delegates for bringing into the Dresden scheme (and for insisting on its retention) the proposal which they originally made at Venice to the effect that, as regards shipping, vessels were not to be judged by the ports from which they had sailed but by their actual sanitary condition. So long as a vessel was deemed infected because she had sailed from an infected port all vessels coming from our Indian ports were to be dealt with as infected, but now that a vessel is never to be deemed infected unless she has had cholera on board within seven days of her arrival, English vessels will practically never come within the restrictions-even modified as they are-to be imposed on infected ships. Amongst the conclusions which most interest us are the following. Notification of the existence of cholera is to be given by a country to all the other contracting countries. Here, unfortunately, France has interposed a serious obstacle. She only consented to the obligation on condition that nothing short of a foyer was to be notified. We have already referred to the utter uselessness of such a notifica. tion and we repeat our objection to it. And we are glad to note that our delegates oppose tte limitation to a foyer. Mr. Farnall wisely urged that England had often procured relief from quarantine to British shipping became it was known that we make no secret as to even isolated cases of cholera in our port?, and because our denials as to the existence of that disease are accepted. The French expressed a contrary opinion, but it is by no means clear that they have ever adopted the principle of absolute openness with regard to every attack of cholera in their midst Dr. Thorne Thorne went so far as to declare his opinion that the introduction of the term foyer would only serve as a means of secreting cholera and of withholding the needed information ; but the British delegation did not further oppose because, as Dr, Thorne announced, whatever the conclusions of the confer. ence, Great Britain would continue her practice of at once making public every case of cholera occurring in her midst. Another point that led to some dispute had to do with the requirement that soiled-i.e., unwashed-linen should be disinfected at the frontiers. Nearly all the advanced nations opposed this view, which France had brought forward; and when the French delegates contended that France had met with considerable success in keeping cholera out of their country by the adoption of this practice, Dr. Thorne pointed out that there was nothing convincing in such an argument for England had had an equal success without carrying out any such practice ; and Mr. Farnall urged the conference to be content with disinfecting the unwashed linen of passengers when this was deemed necessary by the local authority. The French, however, would not accept this condition, and the? insisted on a vote being taken as to whether the practice should be obligatory, as they wished, or only permissive, and as the result of a lengthened debate they were defeated bya large majority. But meeting on a future occasion they apparently induced other Powers to agree with them, and their demand was acceded to, the proposal being opposed by the British delegates alone. We have referred to this incident at some length because the value of the consistent attitude of the British delegation was thoroughly rewarded, for when the matter came before the full conference at a later stage M. Brouardel finally accepted that which was, in effect, the British proposal-namely, that the obligation should be limited to such linen and other articles as were deemed by the local authority to be contaminated. In other word:. whatever other countries may be induced to do, the practice of our English local authorities will remain precisely what it has been. The only other point of any real importance on which a difference of opinion arose had to do with arrivals in infected ships, and in the case of such vessels the conference decide by a very large majority that persons still in health ;;:eret0 be placed under observation for a period not exceeding five

Transcript of THE RESULTS OF THE DRESDEN CONFERENCE

Page 1: THE RESULTS OF THE DRESDEN CONFERENCE

214 THE RESULTS OF THE DRESDEN CONFERENCE.

THE Royal Commission upon Vaccination held another

sitting on Wednesday last at the offices in Gleat George-street. Sir James Paget presided. Dr. Barry, of the Local(Government Board, concluded his evidence, after whichMr. C. Shattock and Mr. C. Watterer gave evidence in

flavour of vaccination. ____

MR. W. A. WILLS, M.D. Lond., has been appointed Lecturer Ion Elementary Medicine at the Westminster Hospital MedicalSchool. Mr. P. R. W. Santi, F.R.C.S., has been appointeda Demonstrator in Anatomy, and Mr. P. Macleod Yearsley,M.R.C.S., L. R. C. P., and Mr. H. H. Mills, M. R C. S.,L.R.C.P., have been appointed Assistant Demonstrators inAnatomy in the same school.

THE total amount received on behalf of the Hospital’Saturday Fund for the present year, including the workshops’collections, reaches nearly £ 10,000.

THE RESULTS OF THE DRESDENCONFERENCE.

WE have now before us the complete record of the pro-ceedings of the International Sanitary Congress of Dresden,together with those of the various committees that were con-stituted to report on special points to the full Conference,and also the text of the Convention to which the following’countries have adhered : Austria-Hungary, Belgium, France,Germany, Great Britain, Italy, the Netherlands, Russia and’Switzerland; and it is hoped that Denmark, together withSweden and Norway, will also adhere before long. On

the other hand, Greece, Turkey, Spain and Portugal arenot looked upon as very hopeful ; but it is at least satis-

factory to note that the delegates of those countries for thefirst time spoke in an almost apologetic tone of the quarantinerestrictions to which they still adhere, and some of themimplied that the example of the Great Powers could hardly’fail to have an important influence in moulding the opinions- of their respective Governments.We have so recently given a summary account of the

principal conclusions that were arrived at in Dresden, that itis not necessary to repeat them. But we may point out thatthe conclusions range themselves under two headings, and’ihat the success of the Conference has been in large measuredue to this fact. In the first place the maximum restrictionsthat can be imposed as regards land traffic, sea traffic andgoods are defined, and the contracting countries undertake ’,not to exceed these. In the second place, certain minimumrestrictions are imposed on all alike. In this way agreementwas possible as regards countries which differed somewhatin their views; one set could adopt the maximum, another- would be content to impose the minimum. And we need

>hardly point out that the British delegation from the first

anade it clear that the minimum only would be exacted byEngland, and their main trouble was to see that this minimum,was not made too stringent.

Of the contracting parties, Great Britain exhibited the mostliberal mind ; then followed Germany, Belgium and Holland;Switzerland was hardly less liberal, except as regards somecurious views, which her delegates ultimately withdrew, as toa danger from imported fish ; then came France and Russia,who seemed very generally to be in mutual agreement, andAustria-Hungary. But although we place France in the rearrank, yet it is clear that the Conference owed much of itssuccess to her initiative and to the admirable way in which hertechnical delegates, MM. Brouardel and Proust, set out thesubjects for discussion and made proposals as to the formcf the various conclusions. Above all, perhaps, Englandowes much to the French delegates for bringing into

the Dresden scheme (and for insisting on its retention)the proposal which they originally made at Venice to

the effect that, as regards shipping, vessels were not to

be judged by the ports from which they had sailed but

by their actual sanitary condition. So long as a vessel

was deemed infected because she had sailed from an infected

port all vessels coming from our Indian ports were to be dealtwith as infected, but now that a vessel is never to be deemedinfected unless she has had cholera on board within seven

days of her arrival, English vessels will practically nevercome within the restrictions-even modified as they are-tobe imposed on infected ships. Amongst the conclusionswhich most interest us are the following. Notification ofthe existence of cholera is to be given by a country toall the other contracting countries. Here, unfortunately,France has interposed a serious obstacle. She onlyconsented to the obligation on condition that nothingshort of a foyer was to be notified. We have alreadyreferred to the utter uselessness of such a notifica.tion and we repeat our objection to it. And we are

glad to note that our delegates oppose tte limitation to afoyer. Mr. Farnall wisely urged that England had oftenprocured relief from quarantine to British shipping becameit was known that we make no secret as to even isolated casesof cholera in our port?, and because our denials as to theexistence of that disease are accepted. The French expresseda contrary opinion, but it is by no means clear that they haveever adopted the principle of absolute openness with regardto every attack of cholera in their midst Dr. Thorne Thornewent so far as to declare his opinion that the introduction ofthe term foyer would only serve as a means of secretingcholera and of withholding the needed information ; but theBritish delegation did not further oppose because, as Dr,

Thorne announced, whatever the conclusions of the confer.ence, Great Britain would continue her practice of at oncemaking public every case of cholera occurring in her midst.Another point that led to some dispute had to do with the

requirement that soiled-i.e., unwashed-linen should bedisinfected at the frontiers. Nearly all the advanced nationsopposed this view, which France had brought forward; andwhen the French delegates contended that France had metwith considerable success in keeping cholera out of their

country by the adoption of this practice, Dr. Thorne pointedout that there was nothing convincing in such an argument forEngland had had an equal success without carrying out anysuch practice ; and Mr. Farnall urged the conference to becontent with disinfecting the unwashed linen of passengerswhen this was deemed necessary by the local authority. The

French, however, would not accept this condition, and the?insisted on a vote being taken as to whether the practiceshould be obligatory, as they wished, or only permissive, andas the result of a lengthened debate they were defeated bya large majority. But meeting on a future occasion theyapparently induced other Powers to agree with them, andtheir demand was acceded to, the proposal being opposedby the British delegates alone. We have referred to thisincident at some length because the value of the consistentattitude of the British delegation was thoroughly rewarded,for when the matter came before the full conference at a

later stage M. Brouardel finally accepted that which was, ineffect, the British proposal-namely, that the obligation shouldbe limited to such linen and other articles as were deemedby the local authority to be contaminated. In other word:.whatever other countries may be induced to do, the practiceof our English local authorities will remain precisely what ithas been.

The only other point of any real importance on which adifference of opinion arose had to do with arrivals in infectedships, and in the case of such vessels the conference decideby a very large majority that persons still in health ;;:eret0be placed under observation for a period not exceeding five

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215CHOLERA.

days after the occurrence of the last case of cholera. This

was objected to by the British delegation, and Dr. ThornEannounced that England could only accept the conclusion orthe understanding that the "observation" was in her caselimited to the supervision exercised in this country on peopleafter they had been allowed to go to their own homes. This

remained as a point of difference to the end, and at the

closing meeting of the Conference it was formally announcedby the British delegation that they still held to that view, andthat any adhesion of England to the Convention would be thuslimited. In short, England would decline to alter her choleraregulations in this respect, and it is generally understoodthat her acceptance of the Convention has been made sub-ject to a distinct understanding in this respect.There remains one other question that calls for note.

When the subject of dealing with rags and allied articleswas under discussion Dr. Koch and Professors Proust andBrouardel gave it as their opinion that there was no evidenceto show that rags, in the commercial sense of that term,had ever been known to have conveyed cholera. Thi wasassented to in so far as English experience was concernedand the final conclusion on this point, which seems to havebeen arrived at with unanimity, is to the effect that norestrictions ought to be placed on those articles deemed tobe rags which are imported in bulk and which are com-pressed in bales by hydraulic pressure and bear marks oforigin recognised by the importing country ; the same absenceof restriction is to apply to "shoddy" " and the Germanwools known as "Kunstwolle." In this single respectthe Conference were in advance of our country in so far asremoval of restrictions is concerned. Our present RagsOrders have reduced these restrictions to a minimum, but theacceptance of the terms of the Dresden Convention will pro-bably lead to a further relaxation in this respect.On the whole the Convention shows a very remarkable

advance in public opinion amongst the leading nations ofEurope, and England is well repaid for her consistent attitudein having invariably refused to sign a Convention whichcarried with it quarantine restrictions, although the durationof these was constantly diminished-from ten days at theConstantinople Conference in 1866 to seven days at Vienna inIB74, and again to five days at Rome in 1885. Now our

delegates have been able to sign a convention of agreementwith the Great Powers of Europe in the matter of choleraprevention without the need of imposing any quarantine,whilst leaving foreign countries free to follow in the coursewhich England has for so long held to be the right one.

CHOLERA.

CURRENT NOTES, COMMENTS AND CRITICISM.

WITH the exception of the Mecca outbreak the cholerepidemic has not up to the present manifested itself with anygreat severity this year. Detailed accounts of the outbreal

amongst the pilgrims to Mecca, so far as they have been published up to the present time, show that the loss of life habeen very great. The total number of pilgrims to Mecca isestimated at 135,000, and the mortality amongst them is stateèto amount to 10 per cent. An abstract of the report of Dr.Chaffy, the Egyptian delegate, addressed to the president ojthe Sanitary Council in Alexandria, which was published inThe Times of the 18th inst., gives a brief but graphic accountof the lamentable state of affairs brought about by the greatmortality amongst the pilgrims. The real object of all sanitaryinquiry is to arrive at a sound decision as to the work requiredto save life in the future, and there cannot be much doubton this head in regard to these pilgrimages. It is the neglectof Turkey to enforce even the simplest sanitary laws inArabia that has been the cause of this year’s frightfulmortality. Egypt is threatened with the introduction of

, cholera from two sides-from the returning pilgrims fromMecca on the one hand and from arrivals from the Frenchlittoral on the other. A French steamer, the Ncatal, axriveclrecently at Alexandria from Marseilles with a suspicious caseof illness on board. The passengers for Egypt were landedat the Mex quarantine station and the steamer went through.the Canal in quarantine.As regards Russia cases of cholera still continue to make

their appearance at Moscow and some cases have occurred at,Kieft. Cholera prevails in the government of Podolia, in Orel,Bessa,rabia, Kherson, Stavropol, Kursk, Pensa, Simvirsk,Vialkin, Saratoff and Kuban : but the disease, if widelydistributed, may be said to be smouldering, as it is not,

prevailing to any grave extent or with any epidemicintensity. Its sudden increase in Podolia and its reappear-ance in the government of Kherson are the main features.of interest.

According to the latest intelligence through Reuter’s

agency, the chief ravages of the epidemic are in the provinceof Podolia, where the last weekly official report announces309 cases and 90 deaths ; and it still prevails, though in aless degree, in the provinces of Orel, where there were93 cases and 41 deaths ; in Bessarabia, 26 cases and 8 deaths ;and in Saratoff, Viatka, Kursk, Tula, Kherson and Tobolsk,not to mention the occurrence of sporadic or suspicious cases.that have been notified from other provinces. There is no.cholera reported in St. Petersburg, but great activity is beingdisplayed in that city in inspecting houses and premises.suspected to be in an insanitary condition. As regardsMoscow the outbreak originated in a prison in the person ofa woman who came from Kieff. The disease is said to pre-vail almost exclusively amongst the poorer classes of the

population. The Director-General of the Central Adminis-tration of Prisons, on learning of the occurrence of choleraamongst the plisoners in Moscow, telegraphed instructions to.break up the jails and disperse the prisoners by removingthem to the jails of four other cities in the heart of theempire. The preferable course would surely have been tohave encamped the prisoners in the most open and exposedsites in the vicinity of Moscow, with military guards overthe camps.From Vienna and Budapest we learn that sporadic cases of

cholera have been reported from counties between the Theissand the Eastern frontier and in Northern Transylvania. It isconsidered probable by some that the outbreak in East andlorth Hungary may have been introduced from the Russianprovince of Podolia. Four cases are reported from the townof Szatmar in Hungary, and a few fresh cases have alsooccurred at Dees in Transylvania. The disease does notseem, however, to have so far firmly established itself any-where.There have been a few cases of suspected cholera notified

in Berlin, but they are probably not true cholera. Cases ofsummer diarrhoea are said to have been rare in Berlin this

year.As regards France, there have been a few fresh cases

of cholera at Toulon and in the South of France. Severalcases have been reported at Vallauris, in the AlpesMaritimes, and, according to the Lanterne, cases of choleraicdiarrhœa have occurred in the Clichy district of Paris.Sporadic cases have also been reported from a village on thebanks of the Rhone near Lyons, and fromHyeres ; but as faras official intelligence is concerned there does not appear tohave been any great prevalence of cholera in France this

year. Speaking generally, other countries have, however,imposed a short quarantine as a precautionary measure on allarrivals from Southern France and French Mediterraneanports.The amount of discomfort, or even hardship-to say nothing

of the interference with commerce-that may arise from anunreasoning fear of infectious disease and the rigid enforce-ment of quarantine regulations is well exemplified in the caseof the steamer Ferdinand de Lesseps, which arrived recently ats

Marseilles from the West Indies and Venezuela. Owing to arecent outbreak of cholera in France the vessel was refused)admittance to any harbour of Venezuela or the West Indies,

*

even under quarantine restrictions. The French authoritiesof Mmtinique also refused her access on account oftwo deaths which had taken place on board fromsmall-pox. The Venezuelan authorities at Porto Cabello,declined to receive any French emigrants or to allow anyportion of the cargo to be landed, and when the shipeventually arrived at Marseilles her troubles were not over,for she was ordered to Frioul to be quarantined. We cannot