(Distributed to the Council and the Members of the League) C .9 5 .M .35.1931 III.

LEAGUE OF NATIONS,

HEALTH ORGANISATION

EASTERN BUREAU.

Annual Report for 1930

-AND

Minutes of the Sixth Session

of the Advisory Council

held in Singapore,

December, 27th to 30th 1930.

c. A. RIBEIRO & CO., LTD., PRINTERS, SINGAPORE. TABLE OF CONTENTS.

PAGE.

Director’s Annual Report for 19)0 1

Agenda of the Sixth Session of the Advisory Council 14

Weekly Bulletin despatched by Cable in 1930 14

Infected Ships notified to next port of call in 1930 15

Act to prohibit the importation of yellow fever virus into the Philippine Islands 15

Circular letter regarding measures to prevent the introduction of yellow fever into India 16

Resolution passed by the 8th F.E.A.T.M. Congress in connec­ tion with yellow fever 16

Estimates for 1931 17

Balance Sheet and Yearly Accounts for 1930 18

List of Visitors 20

Minutes of the Sixth Session of the Advisory Council 21

First Meeting—December 27th 21

Second Meeting „ 29th 25

Third Meeting „ 29th 28

Fourth Meeting „ 30th 33

Resolutions adopted by the Advisory Council 37

Estimates for 1932 as approved by theAdvisory Council 38 DIRECTOR’S REPORT

ON THE WORK OF THE EASTERN BUREAU

FOR THE YEAR 1930.

1. R e s o l u t io n s o f t h e F i f t h Se s s io n . The Health Committee, at its 16th session, adopted the report of the Medical Director and at the same time approved the resolutions of the last Advisory Council session which were embodied in this report. Acting upon Resolution 2, the thanks of the Advisory Council were conveyed to the heads of the various wireless departments which had co-operated in broadcasting the epidemiological bulletins of the Bureau during 1929. In accordance with Resolution 3, the Secretary-General, on be­ half of the Advisory Council, tendered to the Governor-General of the Netherlands East Indies his appreciation of the hospitality shown to the members during the last session in Java. At the 11th Assembly, the "Rapporteur” on the work of the Health Organisation, Miss Susan Lawrence (British Empire), when referring to the development of the Eastern Bureau’s intelligence service, stated that the delegates of Australia and Japan had expressed the wish before the 2nd Commission of the Assembly that the activities of the Eastern Bureau should be further extended so that it could act pro­ gressively as a central agency for the League’s health work in the East. During the first meeting of the recently elected Health Com­ mittee, it was decided to replace the former Far Eastern Commission by a Sub-commission, to be presided over by Dr. J. Jitta, for the study of the budget and annual report of the Eastern Bureau.

2. E pidemiological I ntelligence . Information received by Cable.—This year, the position regard­ ing pestilential disease in Eastern ports has decidedly improved when compared with former years, the only unusual outbreak having been the occurrence of cholera during the summer in the main ports of the Philippine Islands. The bulk of information received by the Bureau shows therefore a notable decrease, despite further extensions in its intelligence service. In connection with the plan of reorganisation of port health administration in Chinese ports, Shanghai was taken over on July 1st by the newly created National Quarantine Service which has been placed under the directorship of Dr. Wu Lien Teh. This Service has been for­ warding to Singapore weekly telegraphic information on the incidence of cholera, smallpox and cerebro-spinal meningitis in Greater Shanghai, which is being supplied by the Public Health Commissioner of the Chinese Municipality, Dr. Houki-Hu. The latter has pointed out that the conditions of reporting in the area under his control were not yet such as to allow of exact figures being supplied ; we nevertheless wel­ come this first step which proved very valuable during the attenuated outbreak of cholera which occurred in September last in Shanghai. 2

Information from Amoy is now being regularly supplied, both by cable and letter, through the new Port Health Office under Dr. E. J. Strick. As Amoy will be taken over as from January 1st, 1931, by the National Quarantine Service, I wrote to its Director for the con­ tinuance of information as supplied under the previous regime. Since September, the Chief Quarantine Officer, Bushire, has been instructed by the Director of Public Health, Persia, to despatch to the Bureau a weekly informative cable regarding health conditions in South Persian ports. Referring to a remark appearing on page 39 of the Minutes of the last Advisory Council session on the possibility of my inquiring directly from the medical authorities in Abadan when immediate information was desirable, the Director of Public Health, Persia, drew my attention to the fact that only reports emanating from his Department should be considered as official. Since information is now regularly forthcoming re Persian Gulf ports, there exists no longer any reason for applying direct to Abadan. The Advisory Council having decided "that the speeding up of the receipt of the weekly information by 24 hours should be aimed at during the current year, without however altering the present arrangement until further discussion had taken place,” the time of receipt of this information in Singapore was checked over a period of 6 months and letters were then addressed in September to the Health Administrations of Madagascar, Kenya, India, Netherlands East Indies, Siam, Canton and Shanghai, whose messages had occasionally or regularly reached the Bureau after Wednesday noon during this time. The health authori­ ties of Kenya, Netherlands East Indies, Siam, Canton and Shanghai have declared that they would accede to this proposed alteration of time in the despatch of their weekly messages; the Director of Medical and Sanitary Services, Ceylon, through the intervention of Dr. A. L. Hoops as,Delegate of British Colonies and Dependencies, also agreed to comply with the new scheme. No intimation has so far been received from Madagascar and India; should their Health Administrations also find it feasible to advance the despatch of their weekly telegrams, steps could then be taken to adapt our wireless service to this new schedule. Information received by Post.—Returns received for the first time this year are the following:— Macao.—Boletim noso-necrologico semanal. Tanga (Tanganyika).—Weekly statistical return. Am oy.—Weekly return. Progress reports on the outbreaks of cholera in Shanghai and of plague in Inner Mongolia were incorporated in the Weekly Fasciculus. Broadcast in code.— As in previous years, the stations of Saigon, Malabar and Tananarive have broadcast our weekly coded bulletin, the average length of which has decreased from 51 words in 1929 to 46 in 1930, whilst the number of infected ports referred to in these messages was 1190 this year against 1448 last year. The number of failures in reception has fallen from 13 in 1929 to 10 in 1930 (India 6 times, Union of South Africa, Tanganyika, Japan, Hongkong, once each). It is no longer necessary for the Bureau to send a special cable to India when there is a failure in the reception of the broadcast in code, as the message in clear now answers the purpose. 3

As the Karachi broadcast was neither picked up by Iraq nor Persia, it was suppressed on August 8th on the suggestion of the Director of Wireless, India. Broadcast in Clear.—As the result of the generous offer of the Netherlands East Indies Wireless Service, Malabar Radio commenced on April 15th to broadcast daily our bulletin in clear on 15,600 metres wave-length. This message comprises the number of cases of pestilential diseases in Eastern ports; for the sake of brevity and economy, the number of deaths is not given, unless this is the only available data. In addition, information relating to important ports situated outside the Bureau’s area as well as quarantine notifications enforced or can­ celled during the week under review are included. The bulletin is com­ piled and sent out for broadcast on Friday morning; should any event of importance be reported to the Bureau in the course of the following week, a supplementary cable is despatched to Malabar and the informa­ tion added to our daily message, which is thus kept strictly up to date. Whilst in Shanghai, the difficulty experienced by Zikawei Radio in picking up Malabar in clear was demonstrated to me; it was owing to strong interference by the Saigon and Haranomachi stations. Although the Director of Saigon Radio kindly suggested that his station could cease emitting whilst our message was being sent out by Malabar, I thought the best solution would be to ask Malabar to broadcast simul­ taneously on 15,600 and 26.2 metres, as Zikawei was in a position to read easily the short wave message. The Director of Wireless, Bandoeng, having agreed to this, the connection with Shanghai has been regularly established on the short wave since May 22nd. In order to inform ship captains that our radio bulletin in clear was issued daily on two different wave-lengths by Malabar, a new circular letter was drafted in English, French, German and Japanese and despatched to the head offices of the main shipping companies, accompanied by personal letters to their Chief Medical Officers. In addition, I asked Mr. V. O. Bartlett of the League Office in London if he could have a list of the stations broadcasting our messages inserted in shipping publications. Mr. Bartlett consequently sent out a suitable article with the schedule of our radio services, to British shipping papers, chambers of shipping, principal medical papers, Radio Times, World Radio, etc. The same article was sent to leading newspapers in the East and has been extensively reproduced. Valuable information has been obtained from the post-cards filled in and returned to the Bureau by ship captains. It appears here again that Malabar PKX is strongly interfered with by Haranomachi Radio which renders the reception of PKX extremely difficult within 2,000 miles of Japan; further, Malabar is overpowered by Saigon, a state of affairs which has incited various ship operators to suggest that Saigon should also be entrusted with the diffusion of our message in clear. Another factor which caused some confusion in the picking up of Malabar at sea was the fact that on Sunday, and sometimes on week­ days at the request of the D utch Air Service, this station broadcasts our bulletin by means of its alternator PLA instead of its arc PKX. On inquiring from the Director of Wireless, Bandoeng, to whom I suggested the regular adoption of PLA for the sake of uniformity, I was informed that both broadcasts were made on the same wave-length and were always preceded by the necessary warning regarding the nature of the message. Owing to the wider range of the PKX transmitter, I thought it better to let the matter rest and have entered both call signals in our radio schedules. 4

The following table gives an idea of the working of our intelli­ gence service to ships which is on the whole very satisfactory:—

Percentage of Reception Station Reception Reception successful attempts. successful. unsuccessful. attempts.

Malabar 82 63 19 76 8% Tokio 33 30 3 91.0% Karachi 23 17 6 74.0% Madras 15 9 6 60.0% Hongkong 13 13 — 100 0% Shanghai 11 10 1 91 0%

Total 177 142 35 80.2%

It is gratifying to note that full use is made by ships of the infor­ mation facilities afforded by Malabar, as the message of this station is picked up not only on week days but even on Sunday, a fact which fully justifies the daily broadcast. Resolution 7 of the last session as well as the request for technical advice on the question of the selection of suitable hours for the broad­ casting of the Bureau’s bulletin (see page 45 of the Minutes of the 5th session) were forwarded to the Communications and Transit Section of the Secretariat which submitted both questions to its Advisory and Technical Committee; this body requested its Chairman to make the necessary arrangements for complying with the above request and in particular to consult the League’s Advisory Committee on Wireless on this matter. In the meantime a letter, from which the following extracts have been taken, was sent on August 22nd by the Secretary- General to the Directors of Posts and Telegraphs:— " The times for these broadcasts should be so fixed as not to clash with the long-distance European stations, for example, the press service, time signals, private telegrams for ships in the East, etc.; but to coincide, if possible, with the duty hours laid down by the Washington Radiotelegraph Conference for ships with one or more wireless operators With a view to supplementing the documentary material required for the study undertaken on these various points by the Communications and Transit Committee, I should be grateful if you would furnish as full infor­ mation as possible concerning the long-distance services in your country (particularly the services which the operators on board ship are obliged to pick up; for example, time signals, press service, private telegrams, etc.), which it is essential should not be in operation simultaneously with the issue of the epidemiological bulletin in clear.” It will be necessary to wait for the requested information from the Communications and Transit Section before any alteration can be made in our wireless schedule. But there is still another reason in favour of temporising : difficulties and delay have been experienced in the past in informing ships of even partial modifications brought into the time service of our broadcasts and, as an entire remodelling of this service is likely to take place shortly, it would be preferable to wait until a satisfactory schedule has been decided on before informing ships once for all. 5

I have also provisionally shelved the idea of requesting coastal stations to emit our messages on 600 metres after their weather report, owing to the traffic on this wave-length being extremely congested and on account of the reduction in range which such a modification would involve. Owing to the advance made by our broadcast service in clear, the question now arises whether it would not be advisable to suppress the service in code; this would make for uniformity, accuracy in trans­ mission and facility in reception, but would probably require an addi­ tional broadcast by Saigon Radio. I have unofficially approached the Director of this station regarding the possibility of passing over from the coded to the clear message and was informed that, should the Governor-General of Indochina be agreeable to this move, the radio company controlling this station would be willing to make the proposed alteration. In making the above suggestion I am aware of the objections which were raised at the last meeting of the " Office International d’Hygiene Publique ” against the principle of epidemiological informa­ tion in clear, but at the same time I am convinced that the motives advanced against such a procedure do not apply to the East where publicity of information is the policy adopted, a proof of which is to be found in the communications to the press made by the responsible Health Administrations of our weekly bulletins. A serious objection of a financial nature has however been advanced against the proposed alteration by the Director-General of Health, Australia, whose depart­ ment receives the coded message through a private wireless company against payment; a change over from the broadcast in code to clear would mean an increased annual expenditure to them of £130. Cables.— There has been no reduction this year in the number of weekly cables the Bureau is still obliged to despatch to health adminis­ trations which are not in a position to receive our wireless bulletin (see Annex 1 ), despite the following efforts made to incite some of them to pick up our short wave message: having gathered from the press that a new short wave receiving station had been opened in Teheran, I wrote to the Director of Public Health, Persia, asking whether Malabar PLO could be picked up there, but have had no reply so far. As Victoria Radio, Seychelles, was not equipped for the reception of the Tananarive or Malabar long wave, I suggested the picking up of PLO on 26.2 metres, but was informed that the receiving set could only be tuned on wave-lengths between 3 50 and 700 metres. The Port Health Officer, Aden, having mentioned in a letter the reception of the broad­ cast of the Alexandria Bureau which is sent out in clear on 21.7 metres, the suggestion was made to him that Aden might also try and pick up Malabar on the short wave, but this has elicited no reply yet. The aerial of the Berbera station has been under repair since September last, thus necessitating the sending of a weekly cable to the Health Administration of British Somaliland. Having gathered from the " Bulletin Quarantenaire ” of Egypt that Aden had been placed in quarantine <*n account of cholera by Persia in June last, an enquiry was made at Teheran after consultation with the Public Health Commissioner with the Government of India, as cholera has never occurred in Aden. It transpired that an error in transmission or decoding had occurred in the cable addressed by the Bureau to the Port Health Officer, Bushire. In the meantime the quarantine restrictions had been removed by Persia. 6

Infected Ships.— The number of ships reported to the Bureau as having had cases of major infectious diseases on board has fallen from 102 in 1929 to 63 in 1930, a very gratifying reduction; their classifica­ tion is as follows:— Plague 1 Cholera 8 Smallpox 44 C. S. Meningitis 8 Petechial Typhus 2

63

In 28 cases telegraphic advice of the prospective arrival of an infected ship was made to the next port of call (for details see Annex 2). As in previous years, minor infectious diseases having occurred on ships arriving in ports of British India were reported to the Bureau and can be classified as follow :— Measles 16 Chicken-pox 38 Mumps 6 Pneumonia 3 Scarlet Fever 1 Influenza 1 As I had reason to believe that there was overlapping in the matter of informing Aden on the arrival of infected ships coming down the Suez Canal, I asked Lieut-Col. Phipson, Port Health Officer, Aden, whether telegraphic notification of such ships by the Bureau was still desirable; Lieut-Col. Phipson informed me that 5 different notifications (4 by cable and 1 by wireless) had reached him regarding the landing in Port Said of one smallpox case from the s.s. " Mashobra ” on July 10th. I therefore replied that in future the Bureau would refrain from cabling information of this kind to Aden, as the Alexandria Bureau assumes this task in compliance with the special provisions for the Suez Canal and neighbouring countries included in the International Sanitary Convention of 1926 (Art. 78). The case of a cholera victim being buried at sea from a mail steamer near Moji, 5 miles outside Japanese territorial waters, was submitted to the Permanent Committee of the " Office ” at their October session by the delegate of Japan, with a view to an interna­ tional agreement being arrived at on the matter. It was suggested that the Japanese authorities should immediately put into force a regulation prescribing adequate precautions, but that a decision on the interna­ tional aspect of the case be put forward to the next session of the "Office” so as to allow a more detailed study. The Hedjaz pilgrimage was declared infected on May 23rd on account of cholera owing to the discovery of agglutinating vibrios (1/3200) in the stools of a pilgrim at El Tor; on May 27th a death attributed to cholera occurred on s.s. " Sassari,” bound from Jeddah to Massawa. Despite this, no further case of major infectious disease was reported on pilgrim ships returning from Jeddah to India, Malaya or Netherlands East Indies last summer. 7

3. I nternational Sa n it a r y C o n v e n t i o n . The Governor of the French Possessions in India has agreed to the territories under his jurisdiction being related to the Eastern Bureau for the application of the Convention. Resolutions 6 and 8 of the last Advisory Council session presented by Major-General Graham were considered by the Permanent Com­ mittee of the " Office ” at their spring meeting. Regarding Resolution 6, the Director of the " Office,” Dr. Abt, pointed out that the extension by the Eastern Bureau of its intelligence service to the hinterland of associated countries, as provided for in the agreement signed in 1927, had been dealt with. In this connection he thanked the Chairman of the Advisory Council for the valuable help afforded by the Eastern Bureau to the " Office ” in the carrying out of the latter’s mission. Dealing with Resolution 8, Dr. Abt pointed out that so far the " Office ” had notified diplomatic representatives only of the measures taken by Governments against arrivals from foreign ports. These measures, as far as they concern Eastern countries, could easily be cabled to Singapore, should the Permanent Committee of the " Office ” agree to such a move. It should however be borne in mind that the Govern­ ments do not regularly notify the " Office ” of the quarantine measures they enforce. The Advisory Council resolution raised therefore two important questions, namely: (1) Should the “ Office” forward the information received under Article 16 of the Convention to Health Administrations as well as to diplomatic missions in Paris? (2) Should the Governments be requested to keep the " Office ” informed of the measures they enforce against arrivals from foreign ports? The Delegate of the Netherlands proposed to refer these points to the Quarantine Commission for consideration; this was agreed to, but the President pointed out that meanwhile there would be no objec­ tion to the " Office ” forwarding information telegraphically to the Eastern Bureau re quarantine restrictions applying to countries in the East, as nothing calculated to facilitate the work of the regional bureaus should be neglected. At the autumn session of the " Office,” the Quarantine Com­ mission submitted a report on the application of Article 16 of the Con­ vention. After having declared that there was no reason for altering the present system of notifications to diplomatic missions only, the report further states that any Government desiring direct information under Article 16 could obtain it from the " Office ” on request. When how­ ever such information was of general interest, the " Office ” might at its discretion inform the Health Administrations. At the same time, it should be understood that measures enforced against arrivals from Far Eastern countries and notified to the " Office ” would be immediately transmitted to the Eastern Bureau. Dr. Ribot, Chief Quarantine Officer, Marseilles, having taken cognisance of the remarks contained in my last Annual Report regard­ ing the vaccination measures enforced by Marseilles against passengers from India, wrote to me that, although he was willing to cable to the Eastern Bureau information of this kind, he could not do so owing to lack of funds, and further that he would have to ask for the authorisa­ tion of his Government. I suggested to Dr. Ribot that a communica­ tion made by post to Geneva would meet our purpose, as the Health Section would then forward such information to Singapore by cable, this involving a delay of 24 hours only in reception. Dr. Ribot replied th at should general measures be enforced in Marseilles against foreign 8

ports, they would be notified to the " Office ” who would then inform Singapore; should however measures be applied to specific cases, he would endeavour to act according to my suggestion.

4. A n t i -C h o l e r a C a m p a ig n i n Sh a n g h a i . The proposals of the National Government of the Republic of China for collaboration with the League in health matters having been adopted by the Health Committee and approved by the Council, the Minister of Health requested the assistance of the Director of the Eastern Bureau with a view to establishing a programme of collaboration for the control of cholera in Shanghai between the Health Departments of Greater Shanghai and the two Foreign Concessions. A preliminary conference for devising a plan of campaign, at which the Medical Director was present, was held on December 28th, 1929. At a second conference on March 3rd, 1930, it was decided that May 15th should be " Cholera Day,” when an attem pt at mass inoculation should begin officially in the three municipalities. At a third conference held on May 9th, presided over by the Minister of Health, Dr. Heng Liu, and at which I was present, each Shanghai Municipality reported on the arrangements made to carry out the vaccination scheme. The International Settlement and French Con­ cession had appropriated 5,000 and 12,000 taels respectively for the work; each had organised travelling and stationary dispensaries and engaged additional Chinese medical officers with auxiliary staff to carry out the inoculations. In Greater Shanghai, six Chinese doctors had been specially trained, the sum of Mex. $10,000 having been allocated for this purpose by the Mayor of Shanghai. An exchange of views took place at this meeting on the question of vaccine concentration and it was decided that a uniform strength of vaccine should be used in the three municipalities; 2 injections (0.5 and 1 cc.) of a vaccine containing two milliard germs per cc. were finally decided upon, so as to avoid severe reaction. At the request of the conference I prepared a plan for the organisation of a Central Cholera Bureau to be created under the auspices of the Ministry of Health for the purpose of centralising all information re cholera and circulating it among the interested munici­ palities. The Central Cholera Bureau, which has been placed under the directorship of Dr. Wu Lien Teh, began functioning in July and kept the Eastern Bureau informed in an efficient manner of the development of the cholera situation in Shanghai during September and October. In addition, the Cholera Bureau has carried out since June a careful investigation of possible cholera carriers in various parts of the city. This examination yielded various kinds of cholera-like vibrios, but no true organism was discovered until August 28 th, when the first authentic cholera case was reported. During the outbreak, examina­ tions of possible carriers among contacts and hospital patients suffering from diarrhoea proved all negative but one. The cases of cholera which occurred this year were distributed as follow:— Greater Shanghai 87 International Settlement 26 French Concession 14 whilst the number of anti-cholera inoculations amounted to:— Greater Shanghai 404,675 International Settlement 66,338 French Concession . 66,021 9

It is noteworthy that cholera appeared at a much later date and showed a milder form this year than in the past five years. 16 deaths only occurred out of 127 cases, i.e. a lethality of 12.6%. How far the early precautions taken influenced the appearance and the course of this year’s outbreak remains to be seen. No case however was reported amongst the vaccinated. To meet the request of the Minister of Health, I drafted a scheme for an epidemiological study of cholera in Shanghai; this paper appeared in the October issue of the " National Medical Journal of China.” During my stay in Shanghai—April 28th to May 27th—I visited the laboratories where the cholera vaccine was being prepared, also the Infectious Diseases Hospitals in order to study the possibility of erecting a central isolation hospital common to the three municipalities, and I followed the work of the vaccinators in the different areas. On the occasion of a visit to Nanking, I delivered an address on the work of the Eastern Bureau before the staff of the Ministry of Health.

5. Y e l l o w F e v e r . In connection with the enquiry made last year from Eastern Health Administrations and Research Institutes, letters were received soon after the close of the Bandoeng session from Dr. A. H. Baldwin, Acting Director of the Australian Institute of Tropical Medicine, and from Dr. R. W. Cilento, Director of the Division of Tropical Hygiene of the Commonwealth Health Department, stating that no experiments with yellow fever virus had been or would be made in laboratories in Tropical Australia or its dependencies, the importation of any such virus being prohibited, unless with the written consent of the Minister of Health. Three eastern countries have taken steps to legislate during 1930 on the question of prohibiting importation of, and experiments with yellow fever virus. In the Philippines a law has already been passed, the text of which will be found in Annex 3. In India, two circulars were addressed in June and July last, one by the Director-General, I.M.S., to all Civil A.M. Officers and Directors of Laboratories, the other by the Secretary to the Government of India to all local Governments and Administrations; the latter is reproduced in Annex 4. In British Malaya an ordinance is being drafted providing for the absolute inter­ diction of research with, and importation of amaryl virus, which will extend to all territories under the jurisdiction of the Governor and High Commissioner. Resolution 10 of the last Advisory Council meeting was pre­ sented by Major-General Graham at the spring session of the Permanent Committee of the " Office.” The Delegate of the D utch Indies emphasized the need for complete interdiction of research work on yellow fever in non-contaminated countries and added that such pro­ hibition could only be efficient if generalised; but the President thought there was no reason for the " Office ” to interfere in the matter, as each Government could prohibit such research work, where deemed dangerous, and place an embargo on infected material. At the autumn meeting of the " Office,” a project for an inter­ national agreement regulating air traffic was discussed; the parts of this agreement which refer to aircraft from yellow fever infected districts will be placed before the members of the Advisory Council for their in­ formation, as Resolution 10(b) of the Bandoeng session alluded to the 10

" measures concerted by the ' Office.’ ” The latter has further suggested that special measures should form the subject of suitable arrangements between countries where yellow fever exists or can develop. The Far Eastern Association of Tropical Medicine, at its 8th Congress, passed a resolution regarding yellow fever (see Annex 5) directing the attention of all Administrations concerned to Resolution 10 of the last Advisory Council session.

6. C o - o r d in a t io n o f R e s e a r c h . Bacteriophage.— To meet the desire expressed by the Advisory Council, a review on the position of bacteriophage from a therapeutic point of view in the East has again been circulated this year. Dr, I. N. Asheshov having supplied me with a choleraphage he considered as polyvalent and active enough to authorise clinical and prophylactic attempts, I distributed this phage with his consent to the following laboratories and Medical Officers:— Singapore.—Municipal Bacteriological Laboratory. Singapore.—Medical College Bacteriological Laboratory. Kuala Lumpur.—Institute for Medical Research. Bandoeng.—Pasteur Institute. Manila.— Chief Quarantine Officer. Shanghai.— Commissioner of Public Health, International Settlement. Johannesburg.— South African Institute for Medical Research. together with 2 notes drafted by Dr. Asheshov on the testing of the activity of a bacteriophage culture and the use of bacteriophage for the prevention and treatment of cholera. Dr. Asheshov’s report on the Indian Bacteriophage Inquiry during the period September 1929 to September 1930 has just come to hand; it deals with the improvement of choleraphage, with the tech­ nique of its production on a large scale and with its practical application in the prevention of cholera. In connection with this latter point, reference is made to the experiment carried out in Puri during the Car Festival, which account will be circulated among the members of the Advisory Council. Pneumonia.—According to Resolution 9 of the last session, docu­ ments on the subject of Tropical Pneumonia have been assembled and a preliminary study of this disease from the clinical, bacteriological, etiological, statistical, therapeutical and preventive points of view was distributed to the members of the Advisory Council last November. As pointed out in its introduction, I had to refrain from addressing official requests for information to health authorities, as the above- mentioned resolution had not been approved by the Health Committee at the time I compiled the data. Since drafting this paper, further information re grouping of Pneumococci has been received from the Director, Pasteur Institute, Madagascar, and from the Deputy Director, Laboratory Services, Kenya. Plague.—Regarding the possibility of a meeting of the Plague Expert Commission, an exchange of views between the Chairman of the Advisory Council and the Medical Director resulted in the decision that the Commission should not be convened in December in Bangkok, during the 8 th Congress of the Far Eastern Association of Tropical Medicine. 11

The Bureau received the following papers contributed by Japanese workers on the lines of the Research Programme drawn up by the Plague Expert Commission in 1927:— Dr. T. Omoto (Metropolitan Police Board, Tokio). Study on domestic and wild rodents found in the City and suburban districts of Tokio. Dr. S. Y am ad a (Government Institute for Infectious Diseases, Tokio). Description of animals connected with plague dissemina­ tion in Japan. Survey of rats and rat-fleas in Kobe.— I. Dr. Y. limura (Central Sanitary Bureau). Study on plague epidemics in Japan. On the preventive measures against plague. Plague invasion into Osaka wharves in 1929 and pre­ ventive measures taken. Studies on certain plague-disseminating vermin in Japan. Oral Vaccination.—Dr. W. Kouwenaar, Director, Pathological Laboratory, Medan, has informed me that a suitable opportunity would arise shortly for a trial of vaccination per os against dysentery on a Sumatra Rubber Estate medically controlled by Dr. Doorenbos. The necessary polyvalent vaccine (Flexner and Y) would be prepared in Medan. This trial was to have been carried out in October last but, owing to the slump and the consequent cutting down of the labour forces, it was postponed to next January. An extensive oral vaccination experiment against dysentery is being carried out by the Prophylactic Department of the Tokio Metropolitan Police Board on children between 3 and 7 years of age in 4 suburban districts of Tokio City. Three pills containing 30 milligr. each of dried bacilli, but no bile, are given on 3 consecutive days on an empty stomach. 12,418 children have been vaccinated so far and the morbidity rate amongst them has been 2.8 per mille, against 11.4 per mille in controls. These results are provisional only, as the experiment is to be continued next year on a larger scale. Whilst in Shanghai, I discussed with the Director of the French Municipality and the Chief Health Officer the possibility of vaccinating per os against cholera the Chinese population of the French Concession, but was informed that a previous attempt made with " Bilivaccine ” had proved a failure, as the first tabloid may have been swallowed, but the others certainly were not. Dry Smallpox Vaccine.—The report of Dr. W. H. Kauntze, Deputy Director, Laboratory Services, Kenya, alluded to in my last Annual Report, has now come to hand; it refers to experiments made with dry lymph samples supplied by the Eastern Bureau from the Pas­ teur Institute, Bandoeng, and the " Institut de Vaccine Animale,” Paris. The results are extremely satisfactory, the average of taking in primary vaccinations ranging between 84.6 and 100%, after these lymphs had been kept 6 to 9 months at a shade temperature reaching sometimes 110 F. The report concludes that the power of resistance of dry lymph renders it ideal for stations where inaccessibility precludes the use of 12 glycerinated lymph, the only objection to its use being the difficulty of impressing on native vaccinators the necessity for care in the process of mixing. In the " Epidemic Diseases Summary ” issued by the Public Health Commissioner, India, attention is drawn to the note cm dry smallpox vaccine appearing as an appendix to the Minutes of the last Advisory Council session, and the opinion is expressed that " there is no doubt that the method is a great advance on that of the moist vaccine for use in tropical countries, where exposure to great variations of tem­ perature is unavoidable and long distances have to be traversed in transit.”

7. Q u a r a n t in e St a t io n s . The opinion expressed by the Advisory Council at the last session that the descriptive statements on Eastern quarantine stations collected and circulated by the Bureau should be printed by the League has not been acted upon for the following reasons:— (a) two statements pro­ mised by Eastern Health Administrations have not yet come to hand; (b) a description of Australian quarantine stations has been published meanwhile by the Commonwealth Health Department; (c) the last edition of the International Maritime Sanitary Year-book issued by the " Office ” gives a description of 11 of the Eastern quarantine services. In order to avoid overlapping, and in agreement with the Medical Director, I suggested to the Chairman of the Advisory Council that the information collected be passed on to the " Office,” who could use it at their discretion in the new issue of their Year-book. Dr. van Lonkhuyzen desires that the matter be placed before the Advisory Council for reconsideration.

8. L ia is o n i n L a b o r a t o r y W o r k . Freshly isolated cholera strains intended for vaccine preparation were sent to Australia at the request of Dr. J. H. L. Cumpston, Direc­ tor-General of Health. Cultures of B. Whitmori were sent to Dr. K. Sakamoto, Hygiene Institute, Dairen, for purposes of comparison, whilst typhoid and paratyphoid strains isolated in the Far East were collected for Dr. E. Grasset, Serologist of the South African Institute for Medical Research, Johannesburg, in order to allow an adapting of the con­ centrated anti-typhoid serum he prepares to Eastern antigens. Highly virulent plague strains from the Pasteur Institute, Bandoeng, were supplied to Dr. C. C. B. Gilmour to enable him to ascertain the degree of receptivity of Singapore rats to plague infection. I have already mentioned in my note on Bacteriophage the 124 cholera strains which were sent to Dr. Asheshov. White rats kindly supplied by Dr. Teding van Berkhout, Weltevreden, were sent to Dr. L. Anigstein, Kuala Lumpur, for his research work on tropical typhus.

9. A r t ic l e o n t h e E a s t e r n B u r e a u . At the request of Dr. G. V. Allen, Editor of the Malayan Medical Journal, I contributed to this periodical an article on the aims and achievements of the Eastern Bureau; a translation of this article into Japanese by Dr. Ouchi was sent to Dr. K. Nobechi, who had it inserted in four Japanese medical papers. 13

10. I n t e r c h a n g e o f P o r t H e a l t h O f f ic e r s i n t h e F a r E a s t . This study tour which was attended by 8 participants from 6 different countries and was conducted by Dr. C. L. Park, started in Singapore on June 27th and terminated in Tokio on August 19th, the ports of Batavia, Saigon, Hongkong, Canton, Manila, Shanghai, Kobe and Yokohama having been visited en route. As an account of this " interchange ” has already been submitted to the Health Committee (Document C. H. 910), there is no need for me to enter into any details, inasmuch as a full report on this tour will be compiled by Dr. Park when the expected contributions of the par­ ticipants have been received. Whilst in Singapore the party visited the Eastern Bureau and was given a demonstration of its working.

11. P l a n s f o r F u r t h e r A c t iv it ie s. At the last Health Committee meeting, the Medical Director was asked to frame a plan for dealing with the question of nutrition which had been formerly raised by the French Government; in this con­ nection it was decided that a special study of the rice problem in the Far East should be undertaken in consultation with the Eastern Bureau. Proposals for the constitution of an Expert Committee to go into the matter will be submitted at the next session of the Health Committee. Further, as a result of the survey on health conditions in the Pacific Islands carried out last year by Drs. H ermant and Cilento, it has been advanced that the Health Organisation of the League could advantageously arrange study tours in the Pacific in which the medical officers of the various island groups who have been so far somewhat isolated could participate. It was also proposed that travelling funds be provided for some of these medical officers so as to enable them to attend the F.E.A.T.M. Congresses. The study of these suggestions is to be entrusted to the Eastern Bureau, in consultation with Dr. J. H. L. Cumpston, Director-General of Health, Australia.

12. F i n a n c e . Our financial situation is satisfactory, as our total expenditure for the year has amounted to Str. $94,168, against an appropriation of Str. $99,108 (Annex 7). All contributions promised for 1930 have been received, either in Geneva or Singapore. Two contributions from the Federated Malay States Government have come to hand, covering the years 1929 and 1930. Besides the grants already pledged for 1930, a contribution of £275 was received from the Government of Hongkong. The Budget Estimates for 1931, as approved by the 11th Assembly, will be found in Annex 6.

13. St a f f . After four years’ connection with the Eastern Bureau, I would like, on the eve of my departure, to express my appreciation of my collaborators. The fact that the appointment of our Deputy Director, Dr. Ouchi, has been confirmed by the Secretary-General after one year’s probation, indicates the extent to which his services are appreciated. To Mr. Deutschman, our Statistician, who has been in office since the incep­ tion of the Bureau and who has now been nominated a member of the Health Section, Geneva, I express my sincere thanks for his unfailing 14

help. To the locally recruited staff, who have remained unchanged under my directorship and who have proved both willing and efficient in a task which requires accuracy and attention, I wish to convey my full appreciation of their loyalty and assistance.

AGENDA OF THE 6th SESSION OF THE ADVISORY COUNCIL.

1. Director’s Report for 1930. 2. The Bureau’s Wireless Service: (a) The question of advancing by 24 hours the despatch of the Radio­ bulletins; (/') The advisability of suppressing the Radio-bulletin in code. 3. Co-ordination of Research: (a) Bacteriophage; (!>) Plague and the F.E.A.T.M. Congress—further consideration; (r) Pneumonia— advisability of appointing an Expert Committee. 4. Yellow Fever: action taken in the East and in Europe on Resolution 10 of the last session. 5. Estimates for 1932. 6. Miscellaneous.

A N N EX 1.

WEEKLY BULLETIN DESPATCHED BY CABLE IN 193 0.

Average Particulars of Cost per Destination. No. of Remarks. message. word. words.

j S Saigon Full message 46 45 For broadcast

Weltevreden Summary in clear 87 35 For broadcast Western group of Resumed 11th Berbera 24 1 35 ports September Mahe (Seychelles) Do. 20 1 10 Aden Do. 23 1 . 10

Basrah Do. 20 1 05

Bushire Do. 20 1 00 Eastern, Central & Bangkok 16 .11 Southern groups Canton Eastern group 11 60

Amoy Do. 12 .60 Tientsin Do. 13 80

Vladivostock Do. 12 1 05 15

ANNEX 2. INFECTED SHIPS NOTIFIED TO NEXT PORT OF CALL IN 1930.

Date. Name of ship. Arrived at Infected with j From , Next port of call

January 2 Clan Macwhirter Singapore Smallpox Calcutta Suva Hoihow and 6 Kiungchow Bangkok Smallpox Swatow Hongkong L. Marques and 7 Ellora Mombasa Smallpox Bombay Durban 22 A n tenor Hongkong C. S. M. Shanghai Singapore 31 Fmp. of Australia Batavia Smallpox Colombo Singapore February 5 Pres. Mackinley Kobe Smallpox Shanghai | Honolulu Victoria (Brit. 13 Pres. Jefferson Kobe Smallpox Shanghai Columbia) 21 Sapphire Colombo Smallpox Bombay Aden Thursday Is. & 25 Sutlej Batavia Cholera Calcutta Fiji March 4 Glenamoy Colombo Smallpox Penang Port Said 4 Narkunda Colombo Smallpox Aden Fremantle 4 Pres. Cleveland Kobe Smallpox Shanghai Honolulu 6 I) Artagnan Port Said Smallpox Marseilles Colombo 7 Kiangsu Bangkok Smallpox Swatow Swatow 10 Pres. Fillmore Hongkong C. S. M. Shanghai Manila 10 Kwangtung Singapore Smallpox Swatow Bangkok 27 Hai Hing Singapore Smallpox Hongkong Hongkong April 16 Benedick Nagasaki Smallpox Taku Honolulu 16 Pres. Jefferson Kobe Smallpox Shanghai Honolulu May 8 Anhui Singapore Smallpox Swatow Hongkong 10 Tanda Sandakan C. S. M. Sydney Manila Singapore and 14 Baron Kinnard Calcutta Cholera Colombo Manila July 9 F.mp. of Asia Kobe Cholera Shanghai Vancouver 10 Mashobra Port Said Smallpox Tangiers Aden Djibouti and 17 C.hambord Port Said Smallpox Marseilles j Mombasa Sept. 23 Malwa Moji Cholera Shanghai Shanghai Dec. 9 Hopsang Hongkong Typhus Tsingtau Shanghai 27 Muncaster Castle Manila Smallpox Hongkong ; Macasser

A NN EX 3.

AN ACT TO PROHIBIT THE IMPORTATION INTO THE PHILIPPINE ISLANDS OF THE VIRUS OF YELLOW FEVER OR ANY SUBSTANCE WHICH MIGHT BE CONSIDERED INFECTED WITH THE CAUSATIVE AGENT OF YELLOW FEVER OR THE EXPERIMENTATION OF SUCH VIRUS OR SUBSTANCE IN THE PHILIPPINE ISLANDS.

8t h P h i l i p p i n e L e g is l a t u r e . Third Session, July 16th, 193 0. Section 1.— It shall be unlawful for any person, firm, corporation or other entity to import, bring or introduce into the Philippine Islands the virus of yellow fever or any substance which might be considered infected with the causative agent of yellow fever, or to experiment on such virus or substance in the Philippine Islands: Provided, however, That in case of accidental introduction of yellow fever into the Philippine Islands in the future, for the proper execution of the work of eradicating the disease, the Governor-General may suspend the effect of this Act. Section 2.— Any person, firm, corporation or other entity who shall violate or aid or abet in violating any of the provisions of this Act shall be punished by a fine not exceeding ten thousand pesos or by imprisonment not exceeding five years or both fine and imprisonment, in the discretion of the Court. Section 3.— This Act shall take effect upon its approval. 16

ANNEX 4.

Sim l a , the 21st July, 1930. From Sir F r a n k N o y c e , K t., C.S.I., C.B.E., I.C.S., Secretary to the Government of India.

To A l l l o c a l G o v e r n m e n t s a n d A dministrations .

Sir , I am directed to forward a copy of extracts on the subject of yellow fever from (1) the "Report on the session of the Office International d’Hygiene Publique ” held at Paris in October 1929, by Lieut-Col. E. S. Phipson, D.S.O., M.D., M.R.C.P., I.M.S., the Government of India’s delegate at the session, and (2) the " Minutes of the 5 th Session of the Advisory Council of the League of Nations, Health Organisation, Eastern Bureau,” held in Java in February 1930. 2. It will be observed that at both these sessions the necessity of taking all possible measures to prevent the introduction of yellow fever into India and the East was emphasised, and that it was held that grave danger attaches to the importation of yellow fever virus for purposes of research in laboratories into countries which are liable to infection with this disease but are at present free of it. The dangers involved in importing virus for such purposes are so real that, following the undertaking given by the delegates of other countries represented at the session of the Advisory Council of the League of Nations, Health Organisation, Eastern Bureau, the Public Health Commissioner with the Government of India, who presided at that session gave an assurance that no experiments with yellow fever virus would be conducted in this country. Steps have already been taken to prohibit the importation of virus into laboratories under the control of the Government of India or of the Indian Research Fund Association, but this action will only prove sufficient if private laboratories are subjected to a similar prohibition. In the opinion of the Government of India all import of the virus into India and all experimentation with it should be prohibited as soon as possible. ). Before proceeding further in the matter, the Government of India will be glad to know as soon as possible, whether any experimentation with yellow fever virus has been undertaken or is likely to be undertaken in any research laboratories located in and also whether would have any objection to the proposed prohibition. Other aspects of the problem, e.g. the question of prohibi­ ting air traffic between India and countries already suffering from yellow fever, are being separately considered. I have the honour to be, etc. (Sgd.) A. B. REID, For Secretary.

ANN EX 5.

RESOLUTION PASSED BY THE 8t h CONGRESS OF THE FAR EASTERN ASSOCIATION OF TROPICAL MEDICINE.

(B a n g k o k , December, 193 0.) The Eighth Congress of the Far Eastern Association of Tropical Medicine, having considered the present scientific position in regard to Yellow Fever, resolves:— (a) That the attention of all administrations concerned be directed to Resolution 10 of the 5 th Session of the Advisory Council of the League of Nations Health Organisation Eastern Bureau, dated February 22, 1930, with which it is generally in agreement. (b) That in view of the increasing dangers of introduction of the disease into areas of the Far East, stringent measures must be adopted against its importation, either through air traffic from infected or suspected areas, or through introduction of the virus for experi­ mental or other purposes. (r) That such measures may mean the interdiction of air traffic from certain areas until adequate protective measures are framed by the Office International d’Hygiene Publique and are in operation, or prohibition by law under severe penalty of the importation and possession of the Yellow Fever Virus. 17

ANNEX 6. ESTIMATES FOR THE YEAR 1931

AS APPROVED BY TH E 1 1 t h LEAGUE ASSEMBLY.

I. Staff Salaries- Str. $ Director Salary at 1,500 18,000 Deputy Director Salary at 1,000 12,000 Statistician Salary at 750 9,000 Financial Assistant Salary at 320 (260-20a-340) Alice. 20 % 64 4,608 Correspondence Clerk Salary at 260 (200-15a-260) Alice. 20% 52 3,744 French-speaking Steno- typist Salary at 185 (170-15a-245) Allce. 1 5 % 27 75 2,553 Two Clerks, Grade II Salary at 160 (100-10a-160) Alice. 15 % 24 4,416 Two Clerks, Grade II Salary at 150 ( 100-10a-160) Alice. 15 % 22 50 4,140 Two Peons Salary at 20 Alice. 15% 3 552 Liftman overtime allce. at 4 48

59,061 II. Travelling Expenses of the Staff and Expenses for the Co-ordination of Research 3,500

III. Cables and Postage— Cables 20,000 Postage 600 20,600 IV. Printing, Stationery and Equipment— Printing 2,000 Stationery 650 Weekly Fasciculus 3,600 Periodicals 800 Equipment 250 Books of Reference 300 7,600 V. Rent, Electricity and Telephone— Rent 3,000 Electricity 54 Telephone 166 3,220 VI. Travelling Expenses of Members of the Advisory Council 5,500

VII. Miscellaneous— Medical Attendance to Staff , 200 Audit fee 300 Miscellaneous 2,000 2,500

101.981 * n

L>r. Receipts and Payments Account for the Year ended 31st December, 1930. Cr. Estimate of Singapore. Geneva. Total. Expenditure Singapore. Geneva. Total. for year.

To Balance at 1st January, 1930 $ 8,174.10 $17,998.66 $26,172.76 $57,858.00 By Staff Salaries [5 5,465.95 $55,465.95 2,274.73 2,274.73 „ Contributions— 2.500.00 „ Travelling Expenses of Staff 5.500.00 „ Travelling Expenses—Advisory Dutch East Indies F 10,000 7,083.00 7.083.00 Council Members 5,221.83 5,221.83 19,600.00 „ Cables and Postage 19,304.95 19,304.95 Fed. Malay States for 1929. 2.750.00 „ Printing and Stationery 1,917.85 5 52.90 2,470.75 and 1930 6,000.00 6,000.00 3.600.00 „ Weekly Fasciculus 2,749.50 2,749.50 French Indo-China 900.00 „ Periodicals '469.87 53.45 523.32 Piastres 6,000 3.220.00 „ Rent, Electricity & Telephone 3,190.24 3,190.24 4,147.50 4,147.50 300.00 „ Audit Fee 300.00 300.00 Hongkong £275 2,367.71 2,367.71 200.00 „ Medical Attendance . 200.00 200.00 1.512.72 Japan for 1929 and 1930 2 200.00 ,, Miscellaneous Expenses 1,170.81 341.91 . 178.46 Yen 30,000 300.00 ,, Books of Reference 163.26 15.20 26,311.06 26,311.06 180.00 ,, Office Equipment 80.80 80.80 Philippine Islands 2,000.00 2,000.00 ,, Travelling Expenses of A. C. 3,105.54 3,105.54 Straits Settlements £3 50 Members paid in advance [ 3,027.00 3.027.00 ,, Rockefeller Foundation— 26,172.76 League of Nations Unexpended balance of 1929 26,172.76 S. F. 15,000 „ Remittances— 5.128.66 5.128.66 60,563.97 £ Eastern Bureau, Singapore 60,563.97 Rockefeller Foundation 1.729.73 „ A. Pelt— Advance £200 1,729.73 S. F. 15,000 5.128.66 5.128.66 ,, Travelling Expenses of A. C. Rockefeller General Grant Members — Excess amount due to meeting being held G. $10,000 17,718.71 17,718.71 at Bandoeng 3,470.20 3,470.20 Rockefeller General Grant 22,083.73 22,083.73 „ Travelling Expenses of Inter­ change Members 11,070.56 11,070.56 Bank Interest 299.79 362.99 662.78 „ Dr. C. L. Park— A /c. Inter­ Remittances— change 5,878.59 5,878.59 „ Dr. C. L. Park— A /c. Leprosy From Geneva 60,563.97 60,563.97 Commission 10,738.32 10,738.32 Remittance from Weltevreden 3,470.20 3,470.20 „ Balance at 31st Dec., 1930— At Mercantile Bank of Remittance from Geneva, India, Ltd. 3,179.37 3,179.37 A/c. Interchange 16,949.15 16,949.15 On Hand 51.75 51.75 Refund of Advance to Eastern Extension A. & C. Teleg. Co,, Ltd., A. Pelt, £200 1,729.73 1,729.73 Deposit 39.12 39.12 Remittance from Geneva, Municipality of Singapore A /c. Leprosy Commission 10,738.32 10,738.32 Deposit 18.50 18.50 At Geneva 1,791.28 1,791.28

$130,061.74 $91,221.20 $221,282.94 $ 99,108.00 $130,061.74 $91,221.20 $221,282.94

"The following transfers in the Kstimates for 1930 were found necessary and were made during the year In November $2,70 0 from " Travelling Expenses of Staff ” to " Cables;'* A »-» liecenibcr $15 0 f rom " Printing and Binding ” to " Stationery ■■ M i U t o f a n " ; -Ji 1 11 1 111 ■ i mi h n Dr. Income and Expenditure Account for the Year ended 31st December, 1930. Cr.

EXPENDITURE. $ cts. cts. INCOME. $ cts. $ cts. To Staff Salaries 95 By Contributions— Travelling Expenses of Staff 2,274 73 Dutch East Indies 7,083 00 „ Travelling Expenses—Advisory Council Members 5,221 83 Federated Malay States, for 1929 and 1930 6,000 00 „ Cables and Postage 19,304 95 French Indo-China 4,147 50 „ Printing and Stationery 2,504 60 Hongkong 2,367 71 „ Weekly Fasciculus 2,749 50 Japan, for 1929 and 1930 26,311 06 ,, Periodicals 523 32 Philippine Islands 2,000 00 „ Rent, Electricity and Telephone 3,190 24 Straits Settlements 3,027 00 „ Audit Fee 300 00 League of Nations, Geneva 5.128 66 66 ,, Medical Attendance 200 00 Rockefeller Foundation 5.128 17,718 71 „ Miscellaneous Expenses 2,174 12 Rockefeller General Grant „ Depreciation 650 19 Rockefeller General Grant 22,083 73 100,996 03 „ Balance being excess of Income over Expendi­ 662 78 ture transferred to Capital Account 7,099 38 ,, Bank Interest

$101,658 81 $101,658 81 BALANCE SHEET AS AT 31st DECEMBER, 1930.

LIABILITIES. $ cts. $ cts. ASSETS. $ cts. $ cts. C ash and D eposits:— C apital Accou nt:— At Mercantile Bank of India Limited, Singapore $ 3,179 37 On hand— Singapore 51 75 As per Balance Sheet 31st December, 1929 29,184 26 At Geneva 1,791 28 Deposits 57 62 Add— Excess of Income over Expenditure 7,099 3 8 5,080 02 T ravelling Expenses paid in A dvance: 3,105 54 36,283 64 Stock of Stationery on H and: 211 40 Deduct— Refund to Rockefeller Foundation of Bo o k s o f R e f e r e n c e : unexpended balance of 1929 26,172 76 As per Balance Sheet 31st December, 1929 412 81 10,110 88 Additions since 178 46

591 27 Less— Depreciation 295 63 295 64

O f f ic e F u r n it u r e a n d F it t in g s : As per Balance Sheet 31st December, 1929 1,692 04 Additions since 80 80

1,772 84 Less— Depreciation 3 54 56 1,418 28

$10,110 88 $10,110 88

We have examined the above Balance Sheet with the books and vouchers of the Eastern Bureau in Singapore and with returns from Geneva and hereby 20

ANNEX 8. VISITORS. 1930. 7 / 1 Med. Cdt. H. Mercier, Hanoi. 9 / 1 Dame Janet Campbell, Senior Medical Officer, Ministry of Health, London. 9/ 1 Dr. L. Rajchman, Medical Director, Geneva. 9/1 Dr. F. Boudreau, Health Section, Geneva. 28/1 Dr. E. Burnet, Health Section, Geneva. 5/2 Mr. R. Hebb, Pharmaceutical Dept., Baver-Meister Lucius, Leverkusen. 12/2 Mr. A. Pelt, Information Section, Geneva. 14 2 Dr. H. Morin, Institut Pasteur, Saigon. 17 2 Dr. P. Mitchell, Chief Quarantine Officer, Western Australia. ll / 3 H. E. Mr. Adatci, Ambassador of Japan, Member of the Council of the League of Nations. 26/3 Dr. S. Akiyama, s.s. Amazon Maru, O.S.K. 26/3 Mr. S. Nakagawa, Wireless Operator, s.s. Amazon Maru, O.S.K. 4 /4 Dr. O. Deggeller, Inspector of Hospitals, Weltevreden. 7/4 Dr. I. Idzumi, s.s. Suwa Maru, N.Y.K. 30/4 Dr. Khun Sribhishai, Siriraj Hospital, Bangkok. 5/5 Dr. C. Takeda, s.s. Kamakura Maru, N.Y.K. $/$ Dr. Y. Takeda, Medical Adviser to the Japanese Embassy, Rio de Janeiro. 5/5 Dr. K. Sato, s.s. Hakosaki Maru, N.Y.K. 12/$ Dr. T. Nikaido, s.s. Hakata Maru, N.Y.K. 19/$ Dr. Y. Habuto, s.s. Hakusan Maru, N.Y.K. 22/$ Prof. K. Fujiwara, Director, Municipal Hygienic Laboratory, Osaka. 22/$ Dr. T. Okubo, s.s. Hakone Maru, N.Y.K. 23/$ Capt. T. Taniguchi, I.J.N.R., s.s. Ceylon Maru, N.Y.K. 19/6 Dr. C. L. Park, Health Section, Geneva. 22/6 Dr. M. Umegaki, s.s. Malacca Maru, N.Y.K. 29/6 Dr. P. Brouwer, Medical Officer of Health, N.E.I. 29/6 Dr. E. Y. Ching, Ministry of Health, Nanking. 29/6 Dr. O. W. Chang, Medical Officer, Department of Health, Canton. 29/6 Dr. S. Chikamori, Medical Officer, Quarantine Station, Kobe. 29/6 Dr. M. Katsumata, Senior Medical Officer, Central Sanitary Bureau, Tokio. 29/6 Dr. Letonturier, Director of Sanitary Services, Cochinchina. 2 9/6 Dr. J. Portelli, Port Health Officer, Penang. 29/6 Dr. Luang Charn Vitivetya, Medical Officer, Health Department, Bangkok. l/ 7 Dr. S. Enokida, s.s. Ceylon Maru, N.Y.K. 14/7 Mr. J. Durand, Director, Cie. Française des cultures d’E.O., Saigon. 18/7 Dr. S. Kielbasinski, Chemist, Warsaw. 3/9 Dr. Noel Bernard, Institut Pasteur, Paris. 11/9 Mr. S. Kaihara, Wireless Operator, s.s. Katori Maru, N.Y.K. 12/9 Dr. H. R. O ’Brien, National Health Council, Siam. l$/9 Dr. K. Onukiyama, Govt. Institute for Infectious Diseases, Tokio. 8/10 Prof. A. Andreades, Athens. 8/ 10 Dr. N. Nagamine, Emigration Medical Officer, Kobe. 9/10 Dr. M. Nishio, Jikei-in Medical College, Tokio. 9/10 Dr. T. Shirai, s.s. Terukuni Maru, N.Y.K. l/ll Dr. L. Souchard, Institut Pasteur, Saigon. $ 1 1 Prof. J. R. Mez, University of Oregon. 6/11 Dr. R. Okada, s.s. Suwa Maru, N.Y.K. 6/11 Dr. T. Seki, s.s. Yamagata Maru, N.Y.K. 6/ll Dr. C. Ingi, s.s. Rangoon Maru, N.Y.K. 6/11 Dr. A. Kitahama, Emigration Medical Officer, Kobe. 26/11 Dr. O.Urchs, Pharmaceutical Dept., Bayer-Meister Lucius, Calcutta. 3/12 Dr. L. Otten, Pasteur Institute, Bandoeng. 3/12 Prof. M. Ota, Tohoku University, Sendai. 3/12 Prof. N. Ogata, Chiba University Medical College, Chiba. 3/12 Prof. S. Yamada, Govt. Institute for Infectious Diseases, Tokio. 17/12 Dr. H. Yaoi, Govt. Institute for Infectious Diseases, Tokio. 26 12 Dr. M. E. Wayson, Honolulu. 3l/l2 Prof. C. D. de Langen, Medical College, Weltevreden. 31/12 Prof. T. Matsui, Manchurian Medical College, Mukden. 31/12 Prof. S. Yokogawa, Formosan Medical College, Taihoku. 3l/l2 Prof. R. Kobayashi, Keio University Medical College, Tokio. 31 12 Prof. B. Nocht, Director of the Institute for Tropical Diseases, Hamburg. MINUTES OF THE SIXTH SESSION OF THE ADVISORY COUNCIL OF THE EASTERN BUREAU.

Held in Singapore from the 27th to the 30th December, 1930. Present:—

Dr. J. J. v a n L o n k h u y z e n (Chairman) Netherlands East Indies. Dr. F. H . G u e r in (Vice-Chairman) French Indo-China. Dr. A. L. H o o ps British Colonies and Dependencies. Major-General J. D. G r a h a m British India. Dr. S. C. Y in China. Dr. M. K a t s u m a t a Japan. Dr. K. Sh i m o j o Japanese Colonies. Dr. P h y a B o r ir a k s h V e j k a r Siam.

Dr. C . J. W il s o n (Observer)' Federated Malay States. Dr. S. B. G r u bbs „ Hawaiian Islands. Dr. R. W . H art Philippine Islands.

Dr. R. G a u t ie r Director of the Eastern Bureau. Dr. C. L. P a rk Director-Designate of the Eastern Bureau. Dr. T. O u c h i Deputy Director of the Eastern Bureau.

FIRST MEETING. Held on Saturday, December 27th, at 10 a.m.

(Dr. v a n L o n k h u y z e n in the C hair).

The C h a i r m a n , in declaring open the 6th session of the Advisory Council, expressed pleasure at the presence of so many of the previous participants as it was important for the continuance and evolution of the Bureau’s work that the unavoidable annual changes in representation should be limited to a minimum. Having welcomed the newcomers, he read out a letter from the Director-General of Health, Australia, regretting that conditions did not permit his Department to send a representative this year and conveying his greetings to the Council. In accordance with the usual procedure, the annual report was read and discussed seriatim.

1. Resolutions of the Health Committee. In connection with the creation of a new sub-commission of the Health Committee to study the Director’s report and the Bureau’s budget, Major-General G r a h a m wished to know whether this sub-commission would be entitled to interfere in other matters than the above. In reply, the D ir e c t o r

» Dr. Wilson did not attend the first meeting. 22 read out the minutes of the last session of the Health Committee relating to the appointment of this sub-commission, and Dr. P a r k explained that this new body had been formed to act as an intermediary between the Advisory Council and the Health Committee with limited powers.

2. Epidemiological Intelligence. The C hairm an expressed satisfaction with what had been achieved in Greater Shanghai and Major- General G raham hoped that in course of time complete information would be received from Chinese ports. The D ir e cto r said that accord­ ing to the Public Health Commissioner of Greater Shanghai, the figures supplied by his Department would approximately represent 80% of the actual cholera cases and 30% of the cases of cerebro-spinal meningitis, whilst smallpox would not be notified unless it broke out in epidemic form. It was however gratifying to note that the reporting of sporadic smallpox cases was now being made. In reply to an enquiry by the C h a i r m a n concerning Amoy, the D ir e c t o r stated that information re this port would be supplied as from January 1st, 1931, by the headquarters of the National Quarantine Service in Shanghai, where it was intended to centralize epidemiological intelligence from Chinese ports as soon as these were taken over. It was not anticipated that the change of regime would involve any delay in reporting. As regards Persian ports, Major-General G r a h a m believed that the Director-General of Health, Persia, had agreed to keep the Eastern Bureau informed re health conditions in the Persian Gulf ports and that no difficulty was anticipated, but, should any arise, the matter would have to be considered further. India had been cabling to Teheran the portion of the Bureau’s weekly bulletin which related to Indian ports and had also broadcast the coded bulletin weekly from Karachi, but had now ceased to do so assuming that Singapore was sending this informa­ tion direct; this was corroborated by the D ir e c t o r . The C h a i r m a n then brought forward for discussion the question of advancing by 24 hours the despatch of information by the various health administrations. Major-General G r a h a m pointed out that as far as India was concerned, it would be very difficult to forward such figures a day earlier, owing to the number of provinces from which returns had to be collected. He feared that a message arriving in Singapore before Wednesday noon would be incomplete, but he would however go into the matter further before replying officially. Dr. G u e r in stated that French Indo-China was in a position to send the required information a day earlier, but he considered that a complete message sent by the Bureau on Thursday should be adhered to. Dr. K a t s u m a t a informed the Council that Japan, Chosen and Kwantung Territory were agreeable to advance the despatch of their cables by 24 hours, but that the returns of some of the interior districts of Japan might not be received in time for the purpose. The C h a i r m a n said that the Netherlands East Indies were in a similar position to India, and that a message sent on Wednesday to comply with the new scheme would often have to be incomplete. He thought that owing to the present daily broadcast which was kept up to date by regular additional information from Singapore, the need for speeding up the weekly bulletin was not vital. The D ir e c t o r stated that he raised this question at the last session for two reasons:— firstly to bring up to date the Bureau’s intel­ ligence service, and secondly to meet a request from the Director of the " Office International d’Hygiene publique.” As regards the first reason, he fully agreed that the present functioning of the daily broadcast altered the position considerably; as to the second, the advance was intended to ensure the inclusion of the complete information in the weekly returns of the "Office,” the compiling of which closed on Wednesday evening in Paris. Information reaching Singapore later than Wednesday noon was cabled to Geneva, and inserted in the second part of the Weekly Epidemiological Record issued by the Health Section, the first part of which was the report of the " Office.” The C h a i r m a n remarked that the late information received in Singapore was published by the Health Section simultaneously with the " Office ” report, and therefore he could see no reason for altering the present policy. Dr.PARK pointed out that the first part of the Weekly Epide­ miological Record was the official intimation of the " Office ” signed by its Director, whereas the second part was a publication of the League of Nations, but the C h a i r m a n expressed the view that although the second part was not signed by the Director of the " Office,” it was nevertheless official information supplied in accordance with the International Sanitary Convention. Major-General G r a h a m and Dr. H o o p s agreed with the Chair­ m an’s views, and the latter proposed that the present system should remain in force for the time being. The Council thereupon decided that the present arrangement should continue, without prejudicing a further study of the question.

3. Wireless. The C h a i r m a n endorsed the suggestion contained in the Director’s Report to postpone any modification in the Bureau’s broadcast schedules until the Communications and Transit Committee had selected suitable hours for emission. Major-General G r a h a m was also of opinion that, as the Secre­ tary-General had approached the various Directors of Posts and Telegraphs on the matter, there was no alternative but to await the result of this inquiry. The Council agreed. In connection with the proposal to suppress the bulletin in code and to replace it by a broadcast in clear, the D ir e c t o r pointed out that the only difference between the two messages was the omission of the number of deaths from the bulletin in clear. He referred to Annex 1 of his Annual Report from which it could be seen that the message in clear to Weltevreden was twice as long as the message in code to Saigon. The Director of the Radio-Electric Centre, Saigon, considered however that such an increase in length was negligible from the point of view of his service. The C h a i r m a n drew attention to the discussion which took place at the last session of the "Office ” on the question of the confiden­ tial character of epidemiological intelligence and expressed the view that the policy of frankness and publicity of information that had been followed by the Advisory Council up to the present should be adhered to. There was no risk from the eastern standpoint in generalising the broadcast in clear. Major-General G r a h a m thought that the Advisory Council was on very solid ground regarding this matter, inasmuch as should any infor­ mation of a strictly confidential character have to be communicated, it could be cabled in code instead of being broadcast. In this connection he asked the Director whether during his 4 years in office he had had to deal with any such message; the D ir e c t o r replied in the negative. The C h a i r m a n having alluded to the objection raised by Australia for financial reasons against a wireless service entirely in clear, Dr. P a r k stated that the additional expense that would be incurred was regarded seriously by Dr. Cumpston, who pressed for a continuance of the mess­ age in code. Major-General G r a h a m suggested that the proposed alteration in the present mode of broadcast be postponed until the information from the Communications and Transit Section had come to hand, so as to enable a final remodelling of the Bureau’s schedules. The D ir e c t o r thought it advisable to approach all Administra­ tions that picked up the bulletin in code in order to ascertain whether they had objections to raise against the change from code to clear. Dr. K a t s u m a t a stated that Japan preferred the broadcast in clear as being more suitable for shipping, and Dr. Sh i m o j o shared a similar view on behalf of Formosa. Dr. G u e r in said that Indo-China agreed to the adoption of the message in clear; should it however be broadcast by Saigon, the question of the language to be used would have to be decided on. Dr. H a r t mentioned that the United States Naval Communica­ tion Service in the Philippine Islands would prefer the continuance of the broadcast in code, as it was feared that the reception of a message in clear would occupy too much time owing to its length. The C h a i r m a n , whilst considering that the objections raised so far against the suppression of the broadcast in code could be overcome, agreed that all interested Administrations should be asked to express their views on the matter. The Council decided that the proposed change from code to clear could be left to the discretion of the Director when he had satisfied himself that generally there existed no strong objections from the interested Administrations against such a change.

4. Cables. An exchange of views took place on the possibility of reducing the number of cables the Bureau was still obliged to send to health administrations which had no means of picking up the Bureau’s bulletins. The D ir e c t o r explained the action taken, but without result so far, to incite Persia, Seychelles and Aden to receive the short wave message. Regarding Aden, Major-General G r a h a m explained that this port was equipped with a naval wireless station of wide range which could pick up the Bureau’s bulletins. As promised at a previous meet­ ing, when in England he approached the Ministry of Health unofficially on the subject of the Aden naval station being asked to pick up, but the results of the conversations had so far been unfruitful. He hoped to renew them at a later date. In reply to Dr. H o o p s ’ enquiry as to whether the resumption of the cable to British Somaliland was to be permanent, the D ir e c t o r replied that the measure was only temporary, pending the repair of the Berbera aerial. Regarding cables despatched to ports in China and to Vladivostock, the D ir e c t o r pointed out that they were being sent as a matter of reciprocity and that for the present there was little hope of the Bureau’s wireless messages being received in these ports.

5. Infected Ships. The question of the overlapping of messages to Aden was considered, and Major-General G r a h a m expressed the view 25 that it was of such importance for a port to be informed beforehand of the arrival of an infected ship that overlapping of such information was immaterial. Dr. K a t s u m a t a brought to the notice of the Council the incident of the burial at sea 8 miles from Moji, of a cholera victim, i.e. 5 miles outside Japanese territorial waters. Owing to the existence there of a strong current, it was feared that the corpse would be washed ashore and as a result a considerable panic was caused at Moji which is a centre of fisheries. It was felt that it would have been preferable to bring the remains and all infected material to Moji where the necessary equipment to deal with such an emergency was available, especially as the steamer was within an hour’s run of the port. The D ir e c t o r then read the statement submitted on the matter by the Japanese delegate at the autumn session of the " Office.” Major- General G r a h a m said that according to Col. Mackie, who had attended this meeting as the representative of India, the risk was not considered very great; however the " Office ” was going into the question carefully from an international standpoint. Personally he was of opinion that if a corpse was properly weighted, as required by the Merchants Ship­ ping Act, there was no risk of its drifting. The C h a i r m a n could not see how any rule could be enforced on ships outside territorial waters unless by means of an international agree­ ment. He suggested that it should be recorded that the case had been brought to the notice of the Council, who were informed that it was in the hands of the " Office.” This was agreed to, and the Council adjourned at 1 p.m.

SECOND MEETING. Held on Monday, December 29th, at 10 a.m.

(Dr. v a n L o n k h u y z e n in the Chair).

6. International Sanitary Convention. The Council noted with satisfaction the recent inclusion of the French Establishments in India among the countries associated with the Eastern Bureau. Regarding the application of Art. 16 of the Convention, the C h a i r m a n recalled the incident in Marseilles which had given rise to the passing of Resolution 8 at the last session, and Major-General G r a h a m , who attended the spring meeting of the " Office ” when this resolution was presented, was asked whether he had any statement to make on the subject. Major-General G r a h a m said that he had little to add to what appeared in the annual report, but that, to make the position perfectly clear, he would ask the Director to read out the Minutes of the May 1930 session of the Permanent Committee of the " Office ” (pages 117-119). The attitude of the " Office ” towards the Advisory Council’s request for information regarding measures taken against eastern countries was such that the demand was an entirely legitimate one which should be met in future whenever possible. The fact that the " Office ” had not modified the present system of notifications to diplomatic missions should be interpreted as a desire to maintain the " status quo ” and did not preclude the desired information from being cabled to Singapore. The solution arrived at was therefore satisfactory from the Bureau’s point of view. i 26

The C h a i r m a n thought that the Eastern Bureau acting as a regional centre under the Convention, should be supplied with any information of interest to the East, thus enabling Health Administra­ tions to apply direct to Singapore, instead of having to incur the expense and delay which an application to Paris would involve. Major-General G r a h a m remarked that from the Minutes of the May 1930 session of the "Office ” it could be deduced that the general consensus of opinion there was in favour of communicating to the Singapore Bureau full information of interest to eastern countries. The C h a i r m a n , in summing up the discussion, considered that in view of the statements appearing in the available official documents, the Advisory Council was satisfied that the " Office ” would in future inform the Bureau telegraphically of the measures enforced against arrivals from eastern countries. He therefore suggested that a resolu­ tion be passed expressing satisfaction at the willingness of the " Office ” to meet the request contained in Resolution 8 of the last session, and quoting the statement made by the President of the Permanent Com­ mittee, namely, that ' nothing calculated to facilitate the task of the regional bureaus should be neglected by the " Office.” ’ Major-General G r a h a m thought it opportune to add that, in the interest of the health of the East, it was hoped that this would be interpreted in a very liberal way. The Council agreed to pass a resolution on these lines.

7. Director’s Visit to China. The D ir e c t o r gave a detailed account of his work in connection with the anti-cholera campaign in Shanghai. Major-General G r a h a m said that, when he heard the Director was proceeding to China, he could not see clearly what he proposed doing there, but since reading the annual report and hearing his state­ ment, he was satisfied that his presence in Shanghai had served an useful purpose. After congratulating the Director for his paper on the epidemiology of cholera, he pointed out that the work in Shanghai was of an international character and therefore in accordance with the spirit of the League. Dr. H o o p s expressed a wish that the Central Cholera Bureau would undertake similar studies on the cholera situation in other im­ portant ports, such as Amoy and Swatow, owing to the influx of immigrants into Malaya, Netherlands East Indies and Siam from these ports. In this connection, Dr. H a r t stated that his department was preparing a complete report on the epidemiology of cholera in the Philippine Islands, based on the observations made during the recent outbreak. The C h a i r m a n also wished to congratulate the Director for the efficient work done in Shanghai and for his valuable contribution to the study of the cholera problem. Although vaccination was carried out this year on only 20% of the Shanghai population it was nevertheless a marked success, and he hoped that by means of well organised propa­ ganda the number of inoculations would increase yearly.

8. Yellow Fever. The C h a i r m a n recalled the statement of the President of the Permanent Committee of the " Office,” appearing in the annual report, which defined the position taken by the " Office ” in regard to Resolution 10b of the last session of the Advisory Council. 27

It was obvious that each Government could legislate to prohibit impor­ tation of amaryl virus, but such a measure would only be effective if generally adopted. It had been thought that the " Office ” would be the proper body to bring about international co-operation in a matter which called for stringent action, and it was somewhat disappointing to note that the question had not been dealt with in Paris as fully as was anticipated. Dr. H o o ps and Dr. G u e r in also regretted that the " Office ” had not taken a more serious view of the matter. Major-General G r a h a m read out for the information of the Council, extracts from the report of the delegate of India on the May 1930 session of the " Office,” as well as parts of the minutes of the same session. The C hairm an expressed the view that, in the absence of an attempt at international understanding on the matter, eastern countries themselves should take action to prevent the risk of the introduction of yellow fever into the Orient. He was glad to note that three eastern countries had already taken steps to legislate thereon and wished to add that a law interdicting research with and importation of amaryl virus was under consideration in the Netherlands East Indies. In reply to a question whether the passing of a similar law in Indo-China would be possible, Dr. G uerin replied that the local Government had no authority to legislate in the matter, as this was the prerogative of the French Government. He would, however, endeavour to have the necessary steps taken in Paris with a view to gaining this end. Dr. Sh i m o j o , who intimated that Formosa was the only part of the Japanese Empire which yellow fever could invade, recalled the decision taken last year by the Formosan Medical Association at the suggestion of Prof. Horiuchi, its President, to refrain from experimental work with amaryl virus. Dr. Shimojo anticipated that in the near future a law prohibiting research on yellow fever and the possession of infected material would be passed by his Government, and he was ready to make all efforts to attain this. Dr. B o r ir a k s h said that in his report to his Government on the last session of the Council he drew attention to the subject of yellow fever. His report was placed before the Health Council, but no action was taken so far. At the request of the Chairman he agreed to raise this question again with the Siamese authorities. Referring to Resolution 10 of the last session, Major-General G r a h a m pointed out that the desire expressed by the Council was that the Health Committee, and not the " Office,” should bring this resolu­ tion to the notice of all administrations concerned; this may have been the reason why the " Office ” did not press the m atter more strongly. The D ir e c t o r was asked whether any action had been taken by the Health Committee as regards Resolution 10, and he replied that he had applied for information from the Health Section but had received no reply yet. Dr. P a r k , who was present at the last meeting of the Health Committee, had no doubt that they would look into the matter, as he was aware of it having been discussed favourably. On the suggestion of the Chairman that it would be advantageous to bring Resolution 10 of the last session to the notice of the Health Committee again, Major-General G r a h a m assured the Council that, should he attend the next session of the Health Committee, he would not fail to do so. Referring to the resolution passed by the Far Eastern Association of Tropical Medicine at their Bangkok Congress the C h a i r m a n said that it was encouraging to learn that a body consisting of not only public health workers but of the whole medical profession had taken note of and emphasized the views of the Advisory Council regarding the danger of yellow fever invading the East.. He suggested that the Council should express satisfaction with the resolution of the F.E.A.T.M. on this matter, and this was agreed to. The Council having perused the draft regulations for the sani­ tary control of air traffic, drawn up by the Permanent Committee of the " Office ” at their session of May 1930, Major-General G r a h a m read out extracts from a paper by Lieut-Col. S. P. James on the " results of recent researches on yellow fever in their bearing on measures for preventing spread of the disease.” The C hairm an considered that air traffic from the west coast of Africa constituted the main danger of infection, especially to India. Dr. W il s o n having remarked that yellow fever had not yet reached the East African coast, Major-General G raham stated that a regular air service would probably start functioning from 1st January 1931 between Cairo and Cape Town and that it would only be a matter of a short time before a trans-continental service was opened. The C hairm an emphasized that the danger was a real one which called for immediate action; it was therefore a matter of urgency that adequate sanitary measures should be framed by the " Office.” The Council adjourned at 1 p.m.

THIRD MEETING. Held on Monday, December 29th, at 2-30 p.m. (Dr. van Lonkhuyzen in the Chair).

9. Bacteriophage. Major-General G r a h a m wished to record his appreciation of the review drafted by the Director on this subject and to thank the Bureau for the assistance afforded to the Bacteriophage Inquiry by supplying an extensive set of cholera cultures from the Far East. As the question of bacteriophage was of considerable interest to workers in India, the Director’s paper was circulated among the par­ ticipants in the last Research Workers’ Conference in Calcutta. Papers on work carried out by Drs. Asheshov, Seranjam Khan and Lahiri (Bacteriophage Inquiry, Bankipore), Lieut-Col. Morison (Shillong), Lieut-Col. Taylor (Rangoon) and Major Iyengar (Coonoor), were placed on the table by Major-General Graham, who remarked that opinions still diverged as to the therapeutic value of bacteriophage and that further research was necessary before a final opinion could be formed. Considerable funds had therefore been reserved for the continuation of this work in India during 1931 under the auspices of the Indian Research Fund Association. The C h a i r m a n considered that the Director’s paper on bacterio­ phage should be given a wide circulation, as had been done in India, and that the collecting and recording of information on this subject should be continued. This was agreed to by the Council.

10. Pneumonia. The C h a i r m a n congratulated the Director on the elaborate document he had compiled on a subject of vital interest to all tropical countries. Referring to a statement in the annual report, 29 the Chairman wondered whether the approval of the Health Committee should be waited for before taking official action in a matter which dealt solely with documentation. The D i r e c t o r replied that he had always adhered to the policy of acting officially on the authority of the Health Committee only. Major-General G r a h a m thought that in the case referred to the procedure followed by the Director was probably cor­ rect, as Resolution 9 of the last session not only suggested the collection of information re pneumonia, but also envisaged the possibility of appointing an expert commission on this disease. It was therefore of importance to obtain the approval of the Health Committee on this latter point. The C h a i r m a n , considering the first part only of this resolution, pointed out that since the principle that the Bureau should act as a centre for documentation had met with the Health Committee’s agree­ ment, no further approval was necessary for action to attain this end, and the Director should accordingly be authorised to collect at his dis­ cretion from official sources information on subjects of interest to eastern health administrations. The Council agreed to this policy being followed in the future. Major-General Graham intimated that at the last Research Workers’ Conference held in Calcutta in November 1930, Lieut-Col. Acton, Director of the Calcutta School of Tropical Medicine, submitted a scheme for a comprehensive enquiry on respiratory diseases to be undertaken in India, special attention being paid to pneumonia. Major- General Graham informed that Conference that the Eastern Bureau was assembling documents on pneumonia and that an expert committee might be constituted for the study of this disease. He felt very strongly that the Advisory Council would be better advised to have the Director’s paper widely circulated among health administrations, research workers and even medical officers than to appoint an expert committee at this stage. The constitution of such a body could be considered at the next session when the results of the circulation of this document would be available. Meanwhile the Director should get into touch with workers for the purpose of collecting further information on the subject. Dr. Guerin was of opinion that the Director’s study would stimulate research on pneumonia and that it would be better to postpone for a year the question of appointing an expert committee. Drs. Katsumata and Shimojo shared a similar view. Drs. H oops and W ilson thought that the formation of this expert committee could with advantage be delayed a year or more and expressed the desire that the Director’s paper should reach the hands of all workers in the Straits Settlements and Federated Malay States. On the suggestion of the Chairman the Council decided that the document on tropical pneumonia should be widely circulated among eastern health administrations and research workers, and requested the Director to collect further documents on pneumonia to be tabled at the next session.

11. Plague. The C h a i r m a n intimated that the decision not to convene the Plague Commission during the F.E.A.T.M. Congress in Bangkok was arrived at mainly because the majority of the members could not be present. After consulting the Medical Director it was arranged that the President of the Plague Commission, Col. Mackie, should attend the Bangkok Congress and give at a sectional meeting an account of the work carried out in accordance with the research pro­ gramme framed in Calcutta in 1927. The Chairman pointed out that 30 the experience as regards expert committees in the East had not been very encouraging owing to the difficulty of bringing members together from long distances, also that leaving matters entirely in the hands of such committees yielded no practical results; he could therefore see no argu­ ment in favour of the continuance of the Plague Commission and thought that it was for the Advisory Council to decide whether it should be maintained or dissolved. Major-General G r a h a m stated that he had been anticipating the possibility of holding a meeting of the Plague Commission during the F.E.A.T.M. Congress this year; it would have been a favourable oppor­ tunity, which would not occur for another three years, to co-opt members of this Association for the purpose of a joint discussion on plague problems as had been done in Calcutta. The fact that only a few members of the Commission would be present in Bangkok had been advanced as one of the reasons for cancelling this meeting, but had it materialised, steps would have been taken to enable further members from India to attend. It was therefore regrettable that this opportunity had been lost. Referring to the programme of research, Major-General Graham pointed out that it had received a wide publicity and obtained the approval of the Health Committee; each country had carried out investigations along the lines which presented the most immediate interest to it, and the contributions of India and Japan had been placed on record at previous Advisory Council sessions. This year again he was placing before the Council the following papers:— 1. Plague Researches at the Haffkine Institute, Bombay, (1930-31), by Dr. Naidu and his assistants. 2. Rat Flea Survey of Rangoon (1930-31 ), under the Director of Public Health, Burma. 3. Rat Flea Survey in the Madras Presidency (1929-30), by Lieut-Col. King and Dr. Pandit. 4. Preliminary Investigation made on Plague Recrudescence in the Cumbum Valley of the Madura District (1930), under the Director of Public Health, Madras Presidency. It had been hoped that the work done in eastern countries in accordance with the research programme would in this way be cen­ tralised, compiled and circulated by the Bureau, but this was apparently not done and it was feared that these documents would be shelved. Major-General Graham was of opinion that unless the Commission met there could be no way of judging what it had accomplished, and he con­ sidered that it should not be terminated at this stage. The D ir e c t o r pointed out that when the Commission met in 1927 it was entrusted with a specific task, viz., the framing of a pro­ gramme of plague research, which was communicated to all interested health administrations in 1928. During the three years that lapsed the work had been proceeding and various contributions had been received by the Bureau. But to have convened a meeting of the Com­ mission for the mere purpose of discussing these papers, most of which had already appeared in medical journals, and in the absence of any definite item to be placed on the agenda, would in his opinion have had no practical value whatsoever. As regards the secretarial work entrusted to the Bureau, the Director wished to state that he had post­ poned compiling and summarising the available papers from India and Japan until the contributions expected from other countries participat­ ing in the scheme of research had come to hand. Experimental work could not be pressed, especially in the East and time should be allowed to enable the workers to obtain results. What really mattered 31

was that the work was still progressing ; the Commission should there­ fore remain in office to consider at some later date the results of the research carried out on the lines laid out by them. The Director would like to propose that the Bureau should approach the health administra­ tions who had agreed to participate in plague research but had sent in no results so far, with the object of compiling an up-to-date report on the work accomplished for circulation among the members of the Plague Commission and for presentation to the Advisory Council. The C h a i r m a n asked if there were any further arguments to be submitted for or against the Plague Commission. In the absence of any, he declared that the consensus of opinion was in favour of the Com­ mission remaining as such, but proposed that its constitution be liable to alteration as some of the members were no longer engaged in plague work; this was agreed to. Dr. H o o p s and Major-General G r a h a m having moved that the suggestion of the Director be adopted, the Council decided that the Bureau should assemble for documentation the work carried out in its area on the lines of the plague research programme and compile it in suitable form for circulation to the members of the Plague Commission and for presentation at the next session of the Advisory Council.

12. Oral Vaccination. Dr. G u e r in informed the Council that the anti-cholera trial he had mentioned at the last session was carried out on 5,000 children of the Cholon schools who were given " per os ” a vaccine prepared by the Pasteur Institute of Saigon. As no cholera case occurred either among vaccinated or controls, the trial was not conclusive. Alluding to the experiment planned in Bengal, Major-General G r a h a m said that, although a certain amount of bilivaccine had been distributed by the Public Health Department of this Province, no scientific results were available. The C h a i r m a n pointed out that the experience of three years showed that vaccination " per os ” was not a procedure which could easily be applied on a large scale in the East, where inoculation was still the preferred technique.

13. Dry Smallpox Vaccine. Major-General G r a h a m reported on the successful trials carried out in Delhi and in the Punjab with samples of dried lymph from Paris supplied by the Bureau, and said that he had called the attention of the Indian public health workers by means of the weekly Bulletin of his Department to the Director’s note on "Dry Smallpox Vaccine” submitted at the last session. The C h a i r m a n stated that in the Dutch East Indies dry lymph was stocked in ports for shipping to outlying island in emergency cases, but that the vaccination with glycerinated lymph was still the routine procedure on account of its lower cost. He expressed satisfaction at the role played by the Bureau in the co-ordination of research in this field.

14. Quarantine Stations. The C h a i r m a n intimated that on receipt of a letter from the Director suggesting that the documents assembled by the Bureau on eastern quarantine stations should not be published, but passed over to the " Office ” for inclusion in the Interna­ tional Sanitary Maritime Year-book at their discretion, he felt that this was a question to be placed before the Council for reconsideration. 32

Personally, he thought that, should the Administrations which had sup­ plied the reports agree, the information thus collected could be placed at the disposal of the " Office ” so as to avoid overlapping. The Council shared the same view, but with the reservation that the maps, charts and photographs which accompanied the reports should be retained by the Bureau for reference.

15. Liaison in Laboratory Work. The C h airm an expressed satisfaction at the help afforded by the Bureau to various workers; this was a branch of its activities which was worth developing. In this con­ nection the Director said that since drafting his annual report he had been able to supply sera for the grouping of meningococci, kindly sup­ plied by Dr. Saisawa of the Government Institute for Infectious Diseases, Tokio, to the Medical College, Singapore. Dr. Sh i m o j o stated that the Formosan Government Institute was carrying out a comparative study of the various typhoid strains used for vaccine preparation in eastern laboratories; he would be obliged to the members of the Advisory Council if they would forward him the strains of B. Typhosus kept in their respective institutes. The D ir e c t o r offered the help of the Bureau to this end.

16. Interchange of Port Health Officers. Dr. P a r k asked the members of the Council if they would arrange that the participants in this Interchange should send to the Bureau a copy of the reports they had submitted to their Governments, as he intended to draft a complete study of this tour after considering their views.

17. Plans for Further Work. Referring to the decision of the Health Committee that a special study of the rice problem should be undertaken in the Far East in consultation with the Bureau, the C h a i r m a n said he would like to have more details of this scheme, as the first intimation he received of it was in the annual report. Dr. P a r k stated that what was principally wanted at this stage was to get into touch with the institutes and workers specialising in the problems of nutrition so as to prepare a study on a specific point, viz., the best way to utilize the alimentary properties of rice. This study would then form the basis for a discussion in a limited committee com­ posed of experts from the Far East with the addition of two or three from the West. It was possible that in the course of this research a clinical study would have to be undertaken on groups of selected indi­ viduals for whom rice was the staple diet. Dr. H o o ps remarked that the question of rice had been com­ prehensively dealt with at the Singapore and Tokio Congresses of the F.E.A.T.M. in relation to beri-beri. It was then realised that it was impossible to take any international action to standardise the value of rice by regulating the milling. Dr. P a r k further explained that the scheme originated from a demonstration given to Dr. Madsen by Dr. Saiki of the methods he had devised for testing the value of rice, and that from this demonstration the question arose as to the most nutritive way of preparing it. For the moment all that was desired was to ascertain the views of the Advisory Council on the proposed scheme and to get from them the names of workers engaged in this line of research. The C h a i r m a n also having referred to the thorough way in which the rice problem had been dealt with by the F.E.A.T.M., could 33 see no use in the formation of an expert committee to deal with the limited problem of rice preparation. He felt that the Advisory Council had been placed in the difficult position of having to consider a scheme on which they had not been sufficiently informed, and he could not see how names of workers could be given unless their duties were more clearly defined. Dr. H o o p s suggested that the contributions of the F.E.A.T.M. to the study of the rice problem be referred to the Health Committee. The C h a i r m a n considered that the Council was unable to express any view on the scheme brought forward by the Health Committee until detailed information was available, and that the attention of the Health Committee should be directed to the work done on the question of rice under the auspices of the F.E.A.T.M. The Council agreed with the Chairman. On the suggestion of Major-General G r a h a m , the Council agreed in principle to the Health Committee’s proposal to organise study tours for medical officers of the Pacific island groups and to offer facilities to some of these officers to enable them to attend the F.E.A.T.M. Con­ gresses. The Director was asked to get into touch with Dr. Cumpston so as to hear his views on the matter.

18. Proposal for the N ext Meeting. The C h a i r m a n recalled that the idea of having periodical conferences including a larger number of delegates had been favourably received at the 3rd session in Delhi; he felt that the time had come to consider whether it would not be advis­ able to invite eastern countries related to the Bureau but not represented on the Council, such as, Ceylon, Macao, Hongkong, North Borneo, etc., to send observers to the next session which would likely be held in 1932; this would work towards acquainting a greater number of health administrations with the running of the Bureau, would stimulate interest in its work and give an opportunity to the Council to hear any comments or suggestions thereon. According to the Articles of Pro­ cedure each autonomous Government could send an observer to the Council meetings at its own expense, but the Chairman was of opinion that an exception should be made to this rule at intervals of 3 to 4 years to facilitate a larger representation, and that on such occasions the travelling expenses of these observers should be met by the Bureau. Should this suggestion receive the approval of the Health Committee, then the necessary provision could be made in the 1932 estimates to meet this additional expense. D r. H o o p s recalled that the original idea was that these large meetings should be held on the occasions of the F.E.A.T.M. Congresses, and such an opportunity had just lapsed. After an exchange of views, the Council agreed to the principle of a larger meeting being convened for the next session, as outlined by the Chairman, and subject to the approval of the Health Committee. The Council adjourned at 5 p.m.

FOURTH MEETING. Held on Tuesday, December 30th, at 10 a.m. (Dr. v a n L o n k h u y z e n in the Chair).

19. Finance. The D i r e c t o r , although not able to submit a complete statement of accounts for the financial year, was in a position 34 to inform the Council that the total expenditure of the Bureau for 1930 would amount to Straits $94,168, against an appropriation of $99,108. The contributions received for 1930 towards the Bureau’s upkeep totalled $34,775.42. The Estimates for the year 1932 were then perused by the Council. In this connection, Major-General G r a h a m announced that he had received a letter from the Medical Director intimating that Dr. Park would assume the directorship of the Bureau on Dr. Gautier’s departure, and that he would draw the same salary as Dr. Gautier, together with a house allowance. On enquiry from Dr. Park about this arrangement, Major-General Graham was informed that the Secretary-General had offered to Dr. Park the appointment as from April 1st, 1931, on a contract providing a salary of Str.$18,000 with an additional allowance of $2,150, making a total of $20,150. Dr. P a r k explained that the Medical Director had felt that this was an extremely delicate matter to bring to the notice of Dr. Gautier in view of the fact that his salary was different as compared with the one offered to himself. The Medical Director had therefore written to Major-General Graham asking him to bring the matter before the Advisory Council. Dr. Park wanted to state that it was not specified in his contract that the addition was an allowance, but that he had been offered the appointment at a salary of $20,150. Before being appointed, however, he had mentioned the difficulty of getting a suitable house in Singapore and the increase was probably the result. The C h a i r m a n said he was not prepared to consider the letter of the Medical Director to Major-General Graham as official. The proper way to have brought the matter to the notice of the Advisory Council would, in his opinion, have been either through the Chairman or the Director of the Bureau. Major-General G r a h a m , having read out the part of the Medical Director’s letter referring to the appointment of Dr. Park, stated that in his opinion the matter was outside the Council’s control; he would inform the Medical Director that he had brought to the notice of the Council, as requested, the question of increasing the Director’s salary in the 1932 Budget. The C h a i r m a n suggested the following means of settling the question under discussion:— (1) Leave the Director’s salary as it appeared in the 1932 Estimates, the amount to be altered in Geneva; (2) Leave the item open; (3) Enter the figure of $20,150. Dr. Y i n proposed a further solution, viz., to enter the additional amount under a special item, such as, " Provision for increase of Director’s salary.” The C h a i r m a n moved the adoption of Dr. Yin’s suggestion, and this was unanimously carried. Regarding the other salaries appearing in the 1932 Estimates, Dr. H o o p s considered the amount provided for the post of Medical Officer to be insufficient and suggested that it be raised to $900 per m onth; to this the Council agreed. Regarding the salaries of the locally recruited staff, the D i r e c t o r explained that the secretary and two clerks would have reached in 1931 the maximum salary of their respective categories; in order to enable them to obtain a further annual increment which he recommended, it had been necessary to promote them to the higher grade. Dr. H o o p s , who had been able to appreciate the work of the Staff whilst acting for the Director in 1929, supported this recommendation, which was agreed to by the Council. 35

Major-General G r a h a m having asked whether the locally re­ cruited staff could participate in the new pension scheme adopted by the last Assembly, the D i r e c t o r stated that he intended to bring this matter before the Secretariat. In reply to the C h a i r m a n who drew attention to the increase of $1,500 in the item " Travelling Expenses of the Staff ” as compared with 1931, the D ir e c t o r pointed out that this additional amount had been considered necessary as there would be in 1932 three medical men on the staff who might have to travel in connection with the co-ordina­ tion of research. Major-General G r a h a m proposed to increase the item " Printing and Binding ” from $2,000 to $2,500, as the reports compiled by the Bureau for purposes of documentation might have to be published, and this was agreed to. The other items having called for no comment, the Council passed the Estimates for 1932, amounting to $112,707 (Appendix 2).

20. Visitors to the Bureau. Dr. H o o p s having remarked that the majority of the Bureau’s visitors were from Japan, the D ir e c t o r said that this was on account of Dr. Ouchi’s presence in the office. Captains, Doctors and Wireless Operators of the steamers belonging to the N.Y.K. and O.S.K. lines frequently called at the Bureau to see the working of it and to enquire about sanitary conditions in the ports where they expected to call.

21. Comments on the Director’s Work. T h e C h a i r m a n wished, on the eve of the departure of the Director, to express the appreciation of the Advisory Council on the efficient manner in which he had administered the Bureau during his four years in office. Major- G en eral G r a h a m thought this appreciation should be placed on record and he read out a resolution he had drafted to this end which was seconded by Dr. K a t s u m a t a and passed by the Council.

22. Address by Dr. Grubbs. The C h a i r m a n having asked whether the members of the Council or the observers had any further statement to make, Dr. G r u b b s pointed out that in the discussion on1 yellow fever no allusion had been made to the Stegomyia index, i.e., the percentage of examined houses found to be breeding Aedes aegypti. Although there might be difficulties in taking this index in the East, he thought that this should be tried as a preparation for a possible advent of the disease and in order to train inspectors. On the subject of plague, Dr. Grubbs recalled that since 1924 surveys to determine the Cheopis index had been carried out in both Americas in the hope to devise a scale of infectibility and to find out why certain ports had never been infected whilst others had. A con­ siderable amount of work had been done in this field and a frequent exchange of views between the East and the West on plague problems might be of mutual value. The C h a i r m a n said he would bring Dr. Grubbs’ suggestions to the notice of the workers in the Netherlands East Indies.

23. Adoption of Resolutions. The final resolutions (Appen­ dix 1) were read by the C h a i r m a n and unanimously adopted by the Council. 36

24. Election of Office Bearers for 1931. The C h a i r m a n , after having thanked his colleagues for their friendly collaboration, asked them to proceed with the election of a President for 1931. Major-General G r a h a m expressed the view that owing to the fact that some of the senior members of the Council were unlikely to attend future meetings and to the change in the Bureau’s direction, it would be of great advantage if Dr. van Lonkhuyzen would be willing to remain in the chair for another year. Dr. van L o n k h u y z e n having objected for the reason that he might have to leave the East before the end of 1931, Major-General G r a h a m said he was satisfied that, should this occur suitable arrangements could be made by correspondence for another member to assume the chairmanship at the next meeting. He had therefore great pleasure in proposing the name of Dr. van Lonkhuyzen as Chairman for the ensuing year. Dr. H o o p s , in seconding this proposal, pointed out that the value of continuity in office had been demonstrated during Major-General Graham’s presidentship, and Dr. van Lonkhuyzen was unanimously elected Chairman for the year 1931. For the office of Vice-President Dr. B oriraksh proposed the name of Dr. Guerin who had acted as such during 1930, but Dr. G uerin remarked that he might have to go to Europe during the coming year; he therefore wished to move the candidature of Dr. Boriraksh as Vice- Chairman for 1931, which was seconded by Major-General Graham and unanimously carried by the Council. Major-General G r a h a m , on behalf of his colleagues, thanked the Chairman for the very able way in which he had conducted the Council’s deliberations in a language which was not his mother tongue. The C h a i r m a n declared closed the Sixth Session of the Advisory Council. 37

APPENDIX 1.

RESOLUTIONS.

1. The Advisory Council approves the Report of the Director of the Eastern Bureau for 1930.

2. The Advisory Council approves the Estimates of Straits $112,707 for the year 1932.

3. The Advisory Council notes with satisfaction the statement made by the President of the Permanent Committee of the "Office Inter­ national d’Hygiene publique” at their session of May 1930 that there would be no objection to the " Office ” forwarding telegraphically to the Eastern Bureau information regarding measures applying to countries in the East, as nothing calculated to facilitate the work of the regional bureaus should be neglected by the " Office.” The Advisory Council expresses the hope that in the interest of the health of the East this will be interpreted in a very liberal way.

4. The Advisory Council notes with satisfaction the fact that the Far Eastern Association of Tropical Medicine have recognised the danger of the introduction of Yellow Fever virus into the East, and, by the resolution adopted at their 8th Congress at Bangkok, have endorsed the views expressed by the Advisory Council in Resolution 10 of its 5 th Session.

5. The Advisory Council wishes to place on record, on the eve of the departure of Dr. Gautier on completion of 4 years’ work as Director of the Eastern Bureau, its appreciation of the excellent services he has rendered to the Bureau both by stabilising its organisation and by developing its role in connection with the prevention of disease in the area of the Bureau. 38

APPENDIX 2. ESTIMATES FOR TH E YEAR 1932. AS APPROVED BY THE ADVISORY COUNCIL.

Staff Salaries- Str. $ Director Salary at 1,500 18,000 Provision for increase of Director’s salary 2,150 Deputy Director . . Salary at 1,000 12,000 Medical Officer Salary at 900 10,800 Financial Assistant Salary at 340 (260-20a-340) Allce. 20% 68 4,896 Correspondence Clerk Salary at 280 (260-20a-340) Alice. 20% 56 4,032 French-speaking Steno- typist Salary at 185 (170-15a-245) Allce. 15 % 27.75 2,553 Two Clerks, Grade I Salary at 170 (170-15a-245) Alice. 15% 25.50 4,692 Two Clerks, Grade II Salary at 160 (100-10a-160) Alice. 15 % 24 4,416 Two Peons Salary at 25 Alice. 15% 3.75 690 Liftman, overtime allce. at 4 48

64,277 II. Travelling Expenses of the Staff and Expenses in connection ivith liaison with other Governments for the Co­ ordination of Research 5,000 III. Cables and Postage— Cables 20,000 Postage 600 20,600 IV. Printing, Stationery and Equipment— Printing and Binding 2,500 Stationery 650 Weekly Fasciculus 3,600 Periodicals 800 Equipment . . 250 Books of Reference 300 8,100 V. Rent. Electricity and Telephone— Rent 3,000 Electricity 54 Telephone 166 3,220 VI. Travelling Expenses of Members of the Advisory Council 5,500 VII. League’s Contribution towards the Pen­ sion Fund, 9% of Salaries (1931 ) . . 3,510 VIII. Miscellaneous— Medical Attendance to Staff . . 200 Audit Fee 300 Miscellaneous 2,000 2,500

$112,707