The scientific background of the International Sanitary Conferences Norman Howard-Jones h 4 "1 Formerly Director, Division of Editorial and Reference Services, World Health Organization WORLD HEALTH ORGANIZATION GENEVA 1975 HISTORY OF INTERNATIONAL PUBLIC HEALTH, No. 1 This study originally appeared in WHO Chronicle, 1974, 28, 159-171, 229-247, 369-348, 414-426, 455-470, 495-508. 0 World Health Organization 1975 Publications of the World Health Organization enjoy copyright protection in accord- ance with provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of WHO publications in part or in toto, application should be made to the Division of Publications and Translation, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Director-General of the World Health Organization concerning the legal status of any country or territory or of its authorities, or concerning the delimitation of its frontiers. The author alone is responsible for the views expressed in this publication. l1 CONTENTS Page Preface ............................... 7 Introduction ............................. 9 The first conference : Paris. 1851 .................... 12 The second conference : Paris. 1859 .............. ..... 17 The third conference : Constantinople. 1866 ............... 23 The fourth conference : Vienna. 1874 .................. 35 The fifth conference : Washington. 188 1 ............ ..... 42 The sixth conference : Rome. 1885 .............. ..... 46 The seventh conference . Venice. 1892 ............. ..... 58 The eighth conference : Dresden. 1893 ............ ..... 66 The ninth conference : Paris. 1894 ................... 71 The tenth conference: Venice. 1897 .............. ..... 78 The eleventh conference : Paris. 1903 .................. 81 The founding of the Office international d'Hygi8ne publique. 1907 ..... 86 The twelfth conference : Paris. 19 11-19 12 ........... ..... 89 The thirteenth and fourteenth conferences: Paris. 1926 and 1938 . ..... 93 Conclusion ........................ ..... 99 Bibliographical notes .................... ..... 101 Index ........................... ..... 105 ILLUSTRATIONS Page The facies in cholera. Vienna. 183 1 ...................... 10 Europe in 1851 .............................. 13 Berliner Cholera.Zeitung. 18 3 1 ........................ 14 Treatment of cholera by heat. 1831 ...................... 16 Cholera in Paris. 1832 ........................... 18 " A Court for King Cholera ". 1852 ..................... 19 Michael Faraday and Father Thames. 1855 .................. 21 Proceedings of the third Conference. Constantinople. 1866 ............ 24 Clot's " proof" of the non-contagiousness of plague. 1835 ............ 26 Filippo Pacini (1 8 12-1 883) ......................... 28 William Farr (1 807-1 883) .......................... 29 August Hirsch (181 7-1 892) ......................... 33 Max von Pettenkofer (18 18-1 901) ...................... 36 Opening of the Suez Canal. 1869 ....................... 41 Carlos Finlay (1 833-1 91 5) .......................... 44 Robert Koch (1 843-1910) .......................... 48 Sir Joseph Fayrer (1824-1907) ........................ 53 Sir John Burdon-Sanderson (1828-1 905) ................... 59 Sir Charles Sherrington (1 857-1 952) ..................... 60 Zum gegenwartigen Stand der Cholerafrage ................... 62 The first International Sanitary Convention to come into force .......... 65 Heat sterilization of faeces. St Petersburg. 1892 ................ 67 The Ka'ba. Mecca ............................. 72 The El Tor quarantine station. 1892 ..................... 73 Alexandre Yersin (1863-1943) ........................ 79 Albert Calmette (1863-1933) and Camille Gukrin (1863-1933) .......... 80 Ion Cantacuzino (1 863-1 934) ........................ 81 Adrien Proust (1834-1903) ......................... 82 EmileRoux(1853-1933) .......................... 83 William Crawford Gorgas (1854-1920) .................... 84 Coffins of plague victims at Harbin. 1911 ................... 94 Hideyo Noguchi (1 876-1 928) ........................ 97 AdrianStokes(1887-1927) ......................... 98 The first and last International Sanitary Conferences .............. 99 PREFACE It is almost thirty years since the nations decided that the World Health Organiza- tion should be founded as the single agency for directing and coordinating intergovern- mental health activities. Subsequent developments have been very fully documented in two WHOpublications respectively on the first and second decades of the Organization's existence and in the series of annual reports that started in 1948. But WHO did not come into being as a result of some process of spontaneous generation. As it exists today, it represents the culmination of over 120 years of strivings, at first with very limited objectives, towards intergovernmental cooperation in understanding and solving health problems. For theJirst four decades, international agreement was frustrated by lack of scientijic knowledge. Since then, every gain to knowledge won by medical research has increased the possibilities of fruitful international cooperation far the benefit of all mankind. In 1943 Sir Edward Mellanby wrote: " The work of Government Departments. of medical men . ., and of nursing staf in controlling disease can only be as good as knowledge allows it to be, and this know- ledge has come, and can only come by medical research." There is no more striking demonstration of Mellanby's assertion than that provided by the early history of international health cooperation, for which medical research provided the missing link. In the future, every advance made by medical research will facilitate the broadening of the scope of WHO'S activities. The present study is largely based on work done during the tenure in 1971-72 of an appointment as visiting scientist, National Library of Medicine, National Institutes of Health, Public Health Service, Department of Health, Education and Welfare, USA. The author wishes to acknowledge his indebtedness to Dr Martin M. Cummings, Director of the National Library of Medicine, and Dr John B. Blake, Chief of its History of Medicine Division, for having facilitated access to the superb historical resources of this great library. Introduction About two centuries ago Samuel Johnson, the proof of their real etiology and epidemiology. For English philosopher, wit, and lexicographer, said: some four decades these conferences produced no " Whatever ,makes the past, the distant, or the result, and it says much for the early pioneers of future, predominate over the present, advances us international health cooperation that they had the in the dignity of thinking beings." But, beyond tenacity to pursue their deliberations. But as the this, a study of the historical evolution of present etiologies of cholera, then plague, and then yellow scientific ideas and institutions helps to place them fever were unravelled, the pace of international in perspective, to measure the progress made, and, health cooperation quickened, leading to the by extrapolation, to predict future trends. foundation, one after the other, of the Pan American While it was not until 1948 that the World Sanitary Bureau, the Office international dYHygi&ne Health Organization came into being, it represents publique, the Health Organisation of the League of the culmination of efforts at international health Nations, and, finally, the World Health Organiza- cooperation that started almost a century before tion, which incorporated all its predecessors. when the first International Sanitary Conference The records of the International Sanitary Con- opened in Paris on 23 July l85 1. Ten such confer- ferences show not only how long and uphill was ences took place during the nineteenth century, and the road that eventually led to WHO but also how the seventh of them was the first to produce any scientific knowledge that has been painfully won tangible result. Nevertheless, these conferences may be forgotten and, decades later, rediscovered. provided a unique forum for the international Thus, in the 1960s the concepts of convalescent exchange of ideas between medical administrators cholera carriers, of mild or inapparent infections, and medical scientists of different nations and and of the gall bladder as a reservoir of cholera cultures. Their printed proceedings are of extra- vibrios were trumpeted as new discoveries. Yet the ordinary scarcity, as only a few copies were issued records show that all these concepts were universally for distribution to participating governments. Two accepted some sixty or more years ago. That they libraries-the library of the World Health Organiza- faded into oblivion for so long is doubtless because tion and the National Library of Medicine, cholera had been unknown for many years in the Bethesda, Md.-are probably the only ones in the countries where medical research and teaching world with the complete series, either in the form of were most advanced. The increase in the amount originals or photocopies. And the completion of the and speed of air travel has changed all that, and holdings of these two libraries was achieved as late public health authorities in all countries must now as 1971 by the mutual exchange of duplicates and be alert to the possibility that