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Cholera is one of the major public health problems in the state of Odisha, India since centuries. The current paper is a comprehensive report on epidemiology of cholera in Odisha, which was documented from 1993. PubMed and Web of Knowledge were searched for publications reporting cholera in Odisha during the period 1993-2015. The search was performed using the keywords 'Odisha' and/or 'Orissa' and 'Cholera'. In addition, manual search was undertaken to find out relevant papers. During the study period, a total of 37 cholera outbreaks were reported with an average of >1.5 cholera outbreaks per year and case fatality ratio was 0.3%. Vibrio cholerae O1 Ogawa serotype was the major causative agent in most of the cholera cases. The recent studies demonstrated the prevalence of V. cholerae O1, El Tor variants carrying ctxB1, ctxB7 and Haitian variant tcpA allele associated with polymyxin B sensitivity and these variants are replacing the proto type El Tor. The first report of variant ctxB7 in Odisha during super-cyclone 1999 predicted its emergence and subsequent spread causing cholera outbreaks. The prevalence of multidrug-resistant V. cholerae at different time periods created alarming situation. The efficacy trial of oral cholera vaccine (OCV, Shanchol) in a public health set-up in Odisha has shown encouraging results which should be deployed for community level vaccination among the vulnerable population. This paper has taken an effort to disseminate the valuable information of epidemiology of cholera that will influence the policy-makers and epidemiologists for constant surveillance in other parts of Odisha, India and around the globe. [ABSTRACT FROM AUTHOR]

The famous Moroccan traveller Muḥammad b. Baṭṭūṭa, who left Tangier in 1325, claims to have made a journey that took him across most of the then Islamicate world. The country in which he recounts having stayed the longest was India, where he says he remained from 1333 to 1341/1342, mostly in the Islamic Sultanate of Delhi. A long section of his Riḥla is dedicated to the sub-continent and modern historians of this region ascribe to it an important documentary value, although it has been argued that Ibn Baṭṭūṭa may have borrowed – not to imply copied – information from other sources in other parts of the work. As concerns India, Ibn Baṭṭūṭa speaks of two epidemics and one deadly disease that occurred in 1334–5 and 1344. Some scholars have referred to them as cholera, while others have suggested it was the plague – thus supporting the hypothesis that the medieval plague pandemic had struck India before reaching the Middle East. How did this confusion arise? What exactly does Ibn Baṭṭūṭa's Riḥla relate? Do Indo-Persian sources confirm these epidemics? Do they and/or Ibn Baṭṭūṭa's Riḥla allow us to discount the presence of the Medieval Plague in India, or rather do they assert it? In order to answer these questions, this paper analyses the information on the Indian epidemics in Ibn Baṭṭūṭa's Riḥla and compares the text with its translations in the principal European languages and with Indo-Persian chronicles. These analyses reveal something of a lexical muddle which, in my opinion, has contributed to some errors and misunderstandings regarding the diseases in question. But another question arises: is it possible to read the information provided by Ibn Baṭṭūṭa and the Indian chronicles in a consilient way, that is, taking into account not only the analysis of written documents, but also the recent and current findings in genetics of plague, and in particular on the Black Death? Finally, an attempt is made to answer a question that has to be asked, particularly in light of the criticism often levelled at Ibn Baṭṭūṭa. Considering that in one of these events he claims to have witnessed the epidemic, is there any reason to suppose that he did not? Regarding the other two events that he did not claim to witness firsthand, is there any cause to doubt his claims? [ABSTRACT FROM AUTHOR]

This paper investigates global dynamics of an infection age-space structured cholera model. The model describes the vibrio cholerae transmission in human population, where infection-age structure of vibrio cholerae and infectious individuals are incorporated to measure the infectivity during the different stage of disease transmission. The model is described by reaction–diffusion models involving the spatial dispersal of vibrios and the mobility of human populations in the same domain Ω ⊂ ℝn. We first give the well-posedness of the model by converting the model to a reaction–diffusion model and two Volterra integral equations and obtain two constant equilibria. Our result suggest that the basic reproduction number determines the dichotomy of disease persistence and extinction, which is achieved by studying the local stability of equilibria, disease persistence and global attractivity of equilibria. [ABSTRACT FROM AUTHOR]

This article provides new evidence on how access to finance affects technological innovation and establishes the role of labor practices in shaping this relation. We exploit a unique setting, pre-Civil War America, where staggered adoption of free banking laws across states encouraged bank entry, and variation in the use of exploited workers in agriculture generated differences in producers' demands for labor-saving technologies. Results show that access to finance spurred innovation; the positive effect on agricultural innovation diminished with labor exploitation. We establish the causal role of labor exploitation using the 1850s cholera pandemic and the influx of Irish immigrants. [ABSTRACT FROM AUTHOR]

In October 2010, the Haitian Ministry of Public Health and Population (MSPP; Port au Prince, Haiti) reported a cholera epidemic caused by contamination of the Artibonite River by a United Nation Stabilization Mission camp. Interventional studies of the subsequent responses, including a descriptive Methods section and systematic approach, may be useful in facilitating comparisons and applying lessons learned to future outbreaks. The purpose of this study was to examine publicly available documents relating to the 2010 cholera outbreak to answer: (1) What information is publicly available on interventional studies conducted during the epidemic, and what was/were the impact(s)? and (2) Can the interventions be compared, and what lessons can be learned from their comparison? A PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA) search was conducted using the parameters "Haiti" and "cholera." Studies were categorized as "interventional research," "epidemiological research," or "other." A distinction was made between studies and narrative reports. The PubMed search yielded 171 papers, 59 (34.0%) of which were epidemiological and 12 (7.0%) were interventional studies. The remaining 100 papers (59.0%) comprised largely of narrative, anecdotal descriptions. An expanded examination of publications by the World Health Organization (WHO; Geneva, Switzerland), the Center for Research in the Epidemiology of Disasters (CRED; Brussels, Belgium), United States Agency for International Development (USAID; Washington, DC USA)-Development Experience Clearinghouse (DEC), and US National Library of Medicine's (NLM; Bethesda, Maryland USA) Disaster Literature databases yielded no additional interventional studies. The unstructured formats and differing levels of detail prohibited comparisons between interventions, even between those with a similar approach. Only two (17.0%) interventional studies included any impact data, although neither commented whether the intervention improved health or reduced incidence or mortality related to cholera. Agreed frameworks for guiding responses and subsequent reporting are needed to ensure reports contain sufficient detail to draw conclusions for the definition of best practices and for the design of future interventions. Miller J , Birnbaum ML . Characterization of interventional studies of the cholera epidemic in Haiti. Prehosp Disaster Med. 2018;33(2):176-181.

This paper seeks to balance the regional and thematic focus of cholera historiography by examining maritime quarantine in Busan, as it was devised and implemented by Japanese officials and doctors during the pre-colonial period. It also places the relationship between Korea and Japan in the context of relations with China, Russia and Britain. This paper shows that quarantine measures in Busan and other Korean ports reflected the rise of Japanese imperial power and the increasing desire on the part of the Japanese to establish an effective borderline for their regional empire.From 1879 Japan began to impose maritime quarantine in Busan, where Japanese influence was very strong even before the colonial period, though at that time Japan was unable to perform quarantine in its own ports independently due to the objections of Western powers, particularly Britain. Victories in the Sino-Japanese and Russo-Japanese wars established Japan as a regional power on equal terms with the West, and as the dominant power in Korea and Eastern Asia. With the acquisition of the right to impose quarantine in its homeland, Japan strengthened and extended the range of quarantine from Japan to Korea, China and Russia. Now quarantine screened Japan from potentially harmful agents – pathogenic and political – and its functions diversified further as modernisation and imperial expansion gathered pace. The reliance which Japan placed upon quarantine in maintaining its empire explains why it was increasingly out of step with other powers regarding international sanitary precautions. The Japanese maritime quarantine in Busan during this period therefore shows many aspects of Japan’s ‘national empire’. [ABSTRACT FROM PUBLISHER]

We conducted a matched case-control (MCC), test-negative case-control (TNCC) and case cohort study in 2016 in Lusaka, Zambia, following a mass vaccination campaign. Confirmed cholera cases served as cases in all three study designs. In the TNCC, control-subjects were cases with negative cholera culture and polymerase chain reaction results. Matched controls by age and sex were selected among neighbours of the confirmed cases in the MCC study. For the case-cohort study, we recruited a cohort of randomly selected individuals living in areas considered at-risk of cholera. We recruited 211 suspected cases (66 confirmed cholera cases and 145 non-cholera diarrhoea cases), 1055 matched controls and a cohort of 921. Adjusted vaccine effectiveness of one dose of oral cholera vaccine (OCV) was 88.9% (95% confidence interval (CI) 42.7–97.8) in the MCC study, 80.2% (95% CI: 16.9–95.3) in the TNCC design and 89.4% (95% CI: 64.6–96.9) in the case-cohort study. Three study designs confirmed the short-term effectiveness of single dose OCV. Major healthcare-seeking behaviour bias did not appear to affect our estimates. Most of the protection among vaccinated individuals could be attributed to the direct effect of the vaccine. [ABSTRACT FROM AUTHOR]

In the incidence patterns of cholera, diphtheria and croup during the past when they were of epidemic proportions, we document a set of cycles (periods), one of which was reported and discussed by A. L. Chizhevsky in the same data with emphasis on the mirroring in human disease of the ~11-year sunspot cycle. The data in this study are based on Chizhevsky’s book The Terrestrial Echo of Solar Storms and on records from the World Health Organization. For meta-analysis, we used the extended linear and nonlinear cosinor. We found a geographically selective assortment of various cycles characterizing the epidemiology of infections, which is the documented novel topic of this paper, complementing the earlier finding in the 21st century or shortly before, of a geographically selective assortment of cycles characterizing human sudden cardiac death. Solar effects, if any, interact with geophysical processes in contributing to this assortment.

In 1961 the seventh global cholera pandemic, El Tor cholera, broke out in Indonesia. Between 1962 and 1964, El Tor infected the southeast coastal areas of China. This pandemic occurred at a time of significant reorganization for both the rural medical and health systems and the people's communes following the failures of the Great Leap Forward. This paper explores how local governments led rural medical practitioners, health care workers, and villagers to participate in the campaign against the spread of El Tor cholera despite the readjustment and retrenchment of the people's communes as social, administrative, and political units. I argue that, during this period of flux, the local government strengthened its control over rural medical practitioners by institutionalizing their daily work practices and reducing their freedom of movement, whilst simultaneously providing incentives for health care workers to join the vaccination campaign. The people's communes and the household-registration system after 1961 put further restrictions on population mobility. This cellularization of village society greatly facilitated the vaccination, quarantine, and epidemic-reporting processes, and contributed to the formation of an epidemic-prevention system and eventually a response scheme for managing public health emergencies in rural China. This process reflected the complexity of the mutual interactions between the political and medical systems under socialism. [ABSTRACT FROM PUBLISHER]

Along with the establishment of the Department of Public Health in 1912, the implementation of public health policies became an integral part of city management in Republican Guangzhou. Yet the cholera outbreak of 1932 fully exposed the weaknesses of the medical and sanitary infrastructure of the city. Due to the Guangzhou government's inaction, the Fangbian Hospital, a local charitable hall founded in response to the bubonic plague of the 1890s, involuntarily took over the major responsibility for providing medical services for cholera patients in the early stage of the epidemic. Only after the death of hundreds of patients and Guangzhou being described as a ‘world of horror’ in the local press did the government-run hospital start to take a more active role. Epidemics have always served as catalysts for change in public health perceptions and practices. This paper attempts to explain how the cholera epidemic of 1932 changed the role of public health in the urban administration of the city. Emphasis is placed on analysing how the people of Guangzhou began to fight for a supply of clean drinking water once they came to realize the link between water and the spread of the fatal cholera epidemic in 1932. Clean water, which used to be seen as a commodity enjoyed by the privileged few, was now increasingly regarded as a citizen's right. [ABSTRACT FROM PUBLISHER]

Since 1977, Vibrio cholerae O1 has been isolated from the Australian aquatic environment and periodically cholera cases have occurred following exposure to these environments. To study the relationships between clinical isolates and environmental isolates from rivers and aquatic life, widely distributed throughout the country, a wide range of molecular typing methods were employed. In this paper we report the analysis of the 180 Australian isolates (10 clinical and 170 environmental) using ribotyping. Seven ribotype patterns were observed among the Australian inaba isolates, 2 of which included all clinical inaba isolates and 84% environmental inaba isolates collected from 9 rivers and creeks in eastern Australia during an 8-year period. Isolates from epidemiologically related clinical cases, asymptomatic household contacts and sewage were indistinguishable. The ogawa isolates were more diverse, with 9 ribotypes observed among 24 isolates from 8 rivers during the same period. Ribotype patterns were not shared between the serotypes with the exception of one ogawa isolate which could be distinguished using PFGE. Ribotyping has been useful in confirming an association between epidemiologically related clinical isolates and the aquatic environment and the persistence of several clones of the O1 serovar in the Australian environment during an 8-year period.

Following an outbreak of cholera in Hamburg in 1831, Amalie Sieveking founded the Weiblicher Verein für Armen- und Krankenpflege (Women's Association for the Care of the Poor and the Sick). This was the first Protestant religious voluntary society in Germany organized and led by a woman. Sieveking's conception of the Christian life of faith and the contemporary needs of the kingdom of God convinced her that Protestant women needed to assume a more active role in German society. The Women's Association visited the homes of those who were sick or in other difficult personal circumstances. They attempted to promote the comprehensive well-being of those whom they assisted by providing food, clothing and other necessities of life, paid employment, housing and opportunities to cultivate their spiritual life. [ABSTRACT FROM AUTHOR]

This paper presents the hypothesis that some cases of cholera might be due to effluent discharge from aircraft. The theoretical case is borne out by inspection of data on the physical conditions pertaining between high altitudes and ground level. A study of the distribution of isolated outbreaks and single cases of disease and their relation to major airline routes showed a reasonable correspondence. Sporadic outbreaks of cholera in Europe between 1970 and 1975 were found to lie within the flight paths of regular airline services from Calcutta, where cholera is endemic, to the Northern Hemisphere. Laboratory studies on the stability of Vibrio cholerae to conditions likely to be encountered in droplets falling from high altitude to the ground suggested that significant numbers of organisms might survive. It should be noted that in this study no account was taken of the effect of ultra-violet light on viability and it is known that at high altitides the ultraviolet light component of solar radiation is much higher than at ground level. Results of experiments where small numbers of organisms were inoculated into relatively poor media showed that rapid growth ensued and that sufficient organisms were produced to give an infective dose of Vibrio cholerae in 1-10 ml/fluid. It could be concluded that human infection could easily occur by ingestion of fluids such as milk or soup which had some time earlier received a fortuitous but slight contamination from the air. Investigation of one disinfectant (chloramine T) showed that it reacted rapidly and in a complex manner with peptone. One effect of this reaction was the elimination of bactericidal activity and it seems likely that, as at present employed, chloramine T is of doubtful value in aeroplane hygiene. One important conclusion that arises from this work is that if cholera can be spread, even only occasionally, by effluent from aircraft then close investigation should be made of the possibility of other bacteria and viruses being spread in a similar way.

From the mid-nineteenth century, seamen were increasingly identified as vectors of epidemic diseases such as cholera. The rising acceptance of the germ theories of disease and contagion and the transition from sail to steam at this time increased the fear of the rapid spread of contagious diseases through these mobile people. This article examines how the British naval authorities, ship surgeons and the medical and municipal authorities in the Calcutta sailortown sought to improve maritime health and hygiene to prevent the spread of cholera among and by British seamen. Nineteenth century Calcutta is an ideal context for this study on account of its epidemiological notoriety as a disease entrepot and the sea route between Calcutta and British ports was one of the most closely monitored for disease in the Empire. The article argues that a study of cholera among British seamen can generate important insights into the relationship among disease, medicine and colonialism and in doing so shed light into a neglected aspect of the history of nineteenth century cholera, the British anxiety regarding disease dispersion, practice of hygiene and sanitation and British seamen's health. [ABSTRACT FROM AUTHOR]

This article revisits the origins of internationalism in the field of health and shows how the cholera epidemics of the nineteenth century, much like the current coronavirus crisis, brought global differences such as social inequalities, political hierarchies, and scientific conflicts to the fore. Beyond drawing parallels between the cholera epidemics and the current crisis, the article argues for combining imperial and social histories in order to write richer and more grounded histories of internationalism. It explores this historiographical and methodological challenge by analysing the boardrooms of the international sanitary conferences, Middle Eastern quarantine stations catering for Mecca pilgrims, and ocean steamships aiming to move without delay during a worldwide health crisis. [ABSTRACT FROM AUTHOR]

In 1817–21, the Indian subcontinent was ravaged by a series of epidemics which marked the beginning of what has since become known as the First Cholera Pandemic. Despite their far-reaching consequences, these epidemics have received remarkably little attention and have never been considered as historical subjects in their own right. This article examines the epidemics of 1817–21 in greater detail and assesses their significance for the social and political history of the Indian subcontinent. Additionally, it examines the meanings that were attached to the epidemics in the years running up to the first appearance of cholera in the West. In so doing, the article makes comparisons between responses to cholera in India and in other contexts, and tests the applicability of concepts used in the study of epidemics in the West. It is argued that the official reaction to cholera in India was initially ameliorative, in keeping with the East India Company's response to famines and other supposedly natural disasters. However, this view was gradually supplemented and replaced by a view of cholera as a social disease, requiring preventive action. These views were initially rejected in Britain, but found favour after cholera epidemics in 1831–32. Secondly, in contrast to later epidemics, it is argued that those of 1817–21 did little to exacerbate tensions between rulers and the ruled. On the rare occasions when cholera did elicit a violent reaction, it tended to be intra-communal rather than anti-colonial in nature. [ABSTRACT FROM AUTHOR]

This article argues that ideas of health and disease in the Assam tea plantations of northeastern India exceeded instrumental logics of bodily disorder, medical ‘objectivity’, and preventive cure. It looks at cholera, kala-azar (or black-fever), and malaria—the three main killers in these estates—to show that imperatives of private capital and law conditioned and constrained parameters of well-being, mortality, and morbidity in these plantations. It therefore suggests that epidemiological theories and praxis emerged from a simultaneous—but expedient—reading of three versions of the labour body: the pathological, the productive, and the legal. The overlaps between commerce, law, and pathogens provide for a unique, if not exceptional, social history of health in colonial India. [ABSTRACT FROM AUTHOR]

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The legalization of world politics is often celebrated for reducing impunity for those who contribute to humanitarian crises. This may sometimes be true but the opposite is also true. In 2010, United Nations peacekeepers unwittingly brought cholera to Haiti and sparked an epidemic. Nearly a million people were made sick and 8,500 died. Legal activists have sought to hold the UN responsible for the harms it caused and win compensation for the cholera victims. However, these efforts have been stymied by the structures of public international law--particularly UN immunity--which effectively insulate the organization from accountability. In short, the UN is empowered, and the cholera victims disempowered, by legalization. The Haiti case powerfully illustrates the dangers of legalism, which have been largely overlooked in discussions of international law, and suggests that law alone is an inadequate arbiter of responsibility in international politics. [ABSTRACT FROM AUTHOR]

US cholera surveillance offers insight into global and domestic trends. Between 2001 and 2011, 111 cases were reported to the Centers for Disease Control and Prevention. Cholera was associated with international travel in 90 (81%) patients and was domestically acquired in 20 (18%) patients; for one patient, information was not available. From January 2001 to October 2010, the 42 (47%) travel-associated cases were associated with travel to Asia. In October 2010, a cholera epidemic started in Haiti, soon spreading to the Dominican Republic (Hispaniola). From then to December 2011, 40 (83%) of the 48 travel-associated cases were associated with travel to Hispaniola. Of 20 patients who acquired cholera domestically, 17 (85%) reported seafood consumption; 10 (59%) ate seafood from the US Gulf Coast. In summary, an increase in travel-associated US cholera cases was associated with epidemic cholera in Hispaniola in 2010-2011. Travel to Asia and consumption of Gulf Coast seafood remained important sources of US cholera cases. [ABSTRACT FROM AUTHOR]

Two community-based density case-control studies were performed to assess risk factors for cholera transmission during inter-peak periods of the ongoing epidemic in two Haitian urban settings, Gonaives and Carrefour. The strongest associations were: close contact with cholera patients (sharing latrines, visiting cholera patients, helping someone with diarrhoea), eating food from street vendors and washing dishes with untreated water. Protective factors were: drinking chlorinated water, receiving prevention messages via television, church or training sessions, and high household socioeconomic level. These findings suggest that, in addition to contaminated water, factors related to direct and indirect inter-human contact play an important role in cholera transmission during inter-peak periods. In order to reduce cholera transmission in Haiti intensive preventive measures such as hygiene promotion and awareness campaigns should be implemented during inter-peak lulls, when prevention activities are typically scaled back. [ABSTRACT FROM AUTHOR]

The emergence of epidemic cholera in post-earthquake Haiti portended a public health disaster of uncertain magnitude. In order to coordinate relief efforts in an environment with limited healthcare infrastructure and stretched resources, timely and realistic projections of the extent of the cholera outbreak were crucial. Projections were shared with Government and partner organizations beginning 5 days after the first reported case and were updated using progressively more advanced methods as more surveillance data became available. The first projection estimated that 105 000 cholera cases would occur in the first year. Subsequent projections using different methods estimated up to 652 000 cases and 163 000–247 000 hospitalizations during the first year. Current surveillance data show these projections to have provided reasonable approximations of the observed epidemic. Providing the real-time projections allowed Haitian ministries and external aid organizations to better plan and implement response measures during the evolving epidemic. [ABSTRACT FROM AUTHOR]

Determinants of anticipated acceptance of an oral cholera vaccine (OCV) were studied in urban and rural communities of Western Kenya. An explanatory model interview administered to 379 community residents assessed anticipated vaccine acceptance at various prices from no cost to full-cost recovery, socio-cultural features of cholera and social characteristics. Nearly all (99%) residents indicated willingness to accept a no-cost OCV, 95% at a price of US$ 0·8, 73% at US$ 4·2 and 59% at US$ 8·4. Logistic regression models analysed socio-cultural determinants of anticipated OCV acceptance. Prominence of non-specific symptoms for cholera was negatively associated with acceptance. A cholera-specific symptom (thirst), self-help referring to prayer, income and education were positively associated. In the high-cost model, education was no longer significant and reliance on herbal treatment was a significant determinant of vaccine non-acceptance. Findings suggest high motivation for OCVs, if affordable. Socio-cultural determinants are better predictors of anticipated acceptance than socio-demographic factors alone. [ABSTRACT FROM AUTHOR]

Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were US$32 and US$47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between US$28 and US$206, depending on hospitalization. Patients' cost of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective. [ABSTRACT FROM PUBLISHER]

The article discusses the epidemiology of smallpox epidemics in early modern Japan, reflecting on the disease's legacy and its impact on modern Japanese public health. It explores various responses to smallpox, noting the role of religion and local customs and suggesting that households and villages played a larger role than domains or the Japanese state. The author explores disease management in isolated areas, commenting on the strategies of fleeing and quarantining. The influence of smallpox epidemics on responses to later cholera epidemics is explored.

In this note, we study deterministic and stochastic models for the spread of cholera. The deterministic model for the total number of cholera cases fits the observed total number of cholera cases in some recent outbreaks. The stochastic model for the total number of cholera cases leads to a binomial type distribution with a mean that agrees with the deterministic model. [ABSTRACT FROM AUTHOR]

This article analyses the proceedings of eight International Sanitary Conferences which were convened between 1851 and 1894 to address the danger that cholera epidemics posed to Europe. These conferences are examined in the context of the intellectual and institutional changes in scientific medicine and in the light of the changing structure of internationalist endeavours that took place in the second half of the nineteenth century. The article shows that the International Sanitary Conferences were as much spaces of co- operation as they were arenas where differences and boundaries between disciplines, nations, and cultures were defined. Furthermore, it seeks to shed light on a broader tension of the period. On the one hand, the fact that the world was growing together to an unprecedented extent due to new means of transportation enabled Europeans to establish and expand profitable commercial and colonial relations. On the other hand, this development increased the vulnerability of Europe — for example to the importation of diseases. The perception that the world was becoming increasingly interconnected was thus coupled with the need for controllable boundaries. The conferences attempted to find solutions as to how borders could be secured without resorting to traditional barriers; like semipermeable membranes they should be open for some kinds of communication but closed for others. [ABSTRACT FROM AUTHOR]