Protocols of the proceedings of a Committee appointed by the International Sanitary Conference, at its session held in Washington, H \ January 12, 1881. 3 PROTOCOL No. I. Washington, I). C., January 12, 1881. The Committee created by the International Sanitary Conference for the purpose of considering and reporting upon the various projets brought before said Conference, met at the State Department, Wednesday, January 12, at 1 o’clock F. M, There were present— Mr. Hermann A. Schumacher, Mr. Edouard Seyb, Dr. Raphael Ceryera, Dr. James L. Cabell, Dr. Thomas J. Turner, Mr. J. Hublby Ashton, Mr. Jambs Lowndes, Mr. Edward M. Archibald, Dr. J. C. Tache, Dr. Ignacio Alvarado, Dr. F. J. Yan Leent, Dr. J. J. da Silva Amado, all accredited delegates to the International Sanitary Conference. On motion of Mr. Sbve, the special delegate from Belgium, Mr. E. M. Archibald was elected Chairman, and Dr. Thomas J. Turner was elected Secretary. The Secretary placed before the Committee the following replies to the memoranda issued by the Hon. W. M. Evarts, Secretary of State of the United States, and dated Wash- ington, D. C., July 29, 1880, presented by Senor Don Simon Camacho, (the delegate from Yenezuela.) The projet of Senor Camacho, charge d’affairs of Yenezuela, was laid before the Com- mittee by the Secretary. It is as follows: Questions Answered hy Yenezuela.. I. Who should be the certifying officer or authority as to the sanitary condition of ports and places and of vessels ? Answer. Such a commission should be in charge of an instructed physician of good standing, appointed by the General Government, and field responsible. He will be aided in his investigation by a board of citizens of known honesty and patriotic interest, appointed by the municipal council of the place, who will likewise fix the number of members. This board to be presided over by the president of said council, and the responsible physician shall always form a part of it. 11. How can the certifying authority obtain trustworthy information as to the actual sani- tary condition of ports and places, and as to the presence of contagious diseases ? Answer. By residing in the port, taking note daily of the death certificates issued by the other physicians of the place and the city physicians, when there are any, ascertaining what sickness exists in the hospitals of the port or place, and by keeping in constant com- munication as to the sanitary condition of the ports and places of the Republic. In procur- ing all these data the responsible physician shall be actively assisted by the Board of Health, 111. When yellow fever or cholera exists at or in the vicinity of a port or place, what examination should be made of a vessel sailing therefrom to secure a trustworthy knowledge of her sanitary condition? 4 Answer. Every vessel about leaving port should, prior to receiving cargo, be visited by the sanitary authority, or by a physician delegated by the same, and submitted to the follow- ing precautions: It should be carefully inspected throughout, and orders given for all indis- pensable hygienic measures, as well regarding cleanliness as food and drink; the water and means of preserving it should be examined; likewise the clothing of the crew, correspond- ence, Ac. Passengers and crew should be examined, and no one should be allowed to embark who is affected by yellow fever, cholera, and other cases of contagious infective diseases. IY. To what extent, and under what conditions, should a clean Bill of Health be considered as affording satisfactory evidence that the vessel is free from danger of conveying infectious disease ? Answer. Ist. The certificates of the health physicians should be entitled to full faith, not only because of their position and standing, but also because of the legal responsibility they are under. 2d. As another guarantee, there should be required the certificate of the Consul of the nation having jurisdiction over the first port to which the vessel is bound. 3d. The health physician of the place where a vessel arrives, who will carefully inspect the condition of the same as to the salubrity, will be the third guarantee that no epidemic or contagious disease exists on board said vessel. 4th. The captains and masters should be charged with the duty of constant vigilance to keep their vessels during the passages always as clean and neat and in the other hygienic conditions they were in when leaving port of departure. Any omissions or violations on this point should be punished according to the penal code to be established by the future conference. Y. In what way can trustworthy information be obtained from ports or places which have imperfect or unsafe quarantine and sanitary regulations, and which may be unwilling or un- able to adhere to the proposed international system ? Answer. Ist. In the first place, every country or Government will instruct its Consuls in places that have not adhered to the Conference to notify those that have adhered, with the greatest care, precision, and promptness, whenever contagious or infective diseases prevail in such places. 2d. The adhered Governments and their health physicians will immediately notify each other whenever they learn in any way that in any of the non-adhered countries either of the sickness in question has made its appearance, or prevails in any of their ports or vicinity. YL Whether a schedule of graduated penalties could be fixed, to be exacted for various offences arising under the proposed international system? Answer. Yes; penalties should be imposed and the Sanitary Conference should approve a code, for which purpose every member should bear in mind the sanitary laws of his respective country. (Signed) SIMON CAMACHO. The Secretary also placed before the Committee the memorandum of the Hon. W. M. Evarts, Secretary of State of the United States, dated Washington, July 29, 1880, as follows: 5 Department oe State, Washington, July 29, 1880. Memorandum in relation to points proposed to \>e submitted to an International Sani- tary Conference : A joint resolution of the Senate and House of Representatives of the United States, approved May 14,1880, authorized the President “ to call an International Sanitary Con- “ ference, to meet at Washington, District of Columbia, to which the several Powers hav- “ ing jurisdiction of ports likely to be infected with yellow fever or cholera shall be invited “ to send delegates properly authorized, for the purpose of securing an international system “ of notification as to the actual sanitary condition of ports and places under the jurisdiction “ of such powers, and of vessels sailing therefrom.” This resolution has its origin in the practical difficulties which have been encountered in the administration of the regulations and rules recommended by sanitary experience and framed by the legislation of the country to the end of preventing the introduction and spread of yellow fever, cholera, and other contagious or infectious diseases in the territory of the United States. The extensive prevalence of yellow fever in certain parts of this country during the past two years, and the almost continual existence of the danger of the introduction of such contagious or infectious diseases as yellow fever and cholera by vessels coming to this coun- try from infected ports abroad, gave rise to such legislative measures, but the difficulty in their application lias been chiefly owing to the fact that in certain foreign ports where infec- tious or contagious diseases have existed, or were supposed to exist, the local authorities have shown some hesitation as to cooperation with the consular and medical officers of the United States in carrying out regulations deemed essential by this Government as a sanitary safe- guard. Moreover, in consequence of the vague and untrustworthy evidence obtainable in some cases as to the sanitary condition of suspected foreign ports, vessels coming thence to the United States have in some instances, as it lias afterwards appeared, been subjected to unneces- sary quarantine in the ports of this country. On the other hand, vessels from non-infected ports of the United States have been compelled to submit to like unnecessary and vexatious delays by the quarantine regulations of other countries, based upon imperfect knowledge of the sanitary condition of American ports. The joint resolution of Congress, quoted above, contemplates only securing “ an inter- “ national system of notification as to the actual sanitary condition of ports and places,” and does not touch on the broader and more intricate question of the preventive sanitary measures imposed in the ports of each country in conformity with its own laws and in proportion to the danger of outward communication and internal spread of epidemic disease at the port of introduction. The Government of the United States, recognizing the essentially local char- acter of quarantine requirements, and their adaptability to the sanitary conditions and risks in the districts where they are applied, would not seek to propose any international code of general quarantine laws, even did the system of State and Federal Governments in the United States favor bringing the sanitary precautions of the sea-board States from Texas to Maine, with all their varying conditions, under one governmental code. But the President is of the opinion that the great inconveniences and losses which the commerce of the world has been, and is now, suffering from the delays and obstructions caused by unnecessary quarantines can, to a great extent, he relieved by the establishment, as contemplated by the Congressional joint resolution of May 14, 1880, of an international system of notification as to the actual sanitary condition of ports and places likely to be in- fected with communicable or epidemic diseases ; and, following the authorization of the reso- lution referred to, he has, therefore, deemed it proper to submit to the Governments of the chief maritime powers the expediency of holding a conference at an early day, in this city, to consider the subject of a proper and applicable scheme of such international notification. The specific propositions which the President would desire to submit to the proposed Conference would include the following: 6 A. The establishment of a reliable and satisfactory international system of notification as to the existence of contagious and infectious diseases, more especially cholera and yellow fever. B. The establishment of a uniform and satisfactory system of bills of health, the state- ments in which shall be trustworthy as to the sanitary condition of the port of departure and as to the condition of the vessel at the time of sailing. The discussion of these points would involve, among others, the following questions: I. Who should be the certifying officer or authority as to the sanitary condition of ports and places, and of vessels ? 11. How can the certifying authority obtain trustworthy information as to the actual sani- tary condition of ports and places, and as to the presence of contagious and infectious diseases ? 111. When yellow fever or cholera exists at or in the vicinity of a port or place, what examin- ation should be made of a vessel sailing therefrom to secure a trustworthy knowledge of her sanitary condition ? IY. To what extent and under what conditions should a clean bill of health be considered as affording satisfactory evidence that the vessel is free from danger of conveying infectious disease ? Y. In what way can trustworthy information be obtained from ports or places in countries which have imperfect or unsafe quarantine and sanitary regulations, and which may be un- willing or unable to adhere to the proposed international system ? YI. Whether a schedule of graduated penalties could be fixed, to be exacted from vessels for various offences arising under the proposed international system ? The Secretary also placed before the Committee the memoranda presented by the dele- gates of the United States to the Conference at its session of this day, as follows: Nations have at present ample power to prevent, without any breach of their inter- national obligations, the introduction into their territories of contagious or infectious diseases. But there is often an omission to exercise that power when there is real danger or an un- necessary exercise of power to avert an imaginary danger. These mistakes arise from two sources ; Ist, ignorance of the real state of the facts in the country where the danger lies ; or, 2nd, the omission to communicate to other countries the knowledge which actually exists. Ist. That each Government should bind itself to obtain seasonable and accurate infor- mation of all facts bearing upon the public health in its territories. The remedies for these evils seem to be, in outline: 2nd. Each Government should bind itself to communicate promptly its information to the other parties to the Conference. 3rd. Each Government should bind itself to give to the consul or accredited agent of the others access to all hospitals and all the records of the public health. 4th. Each Government consents that its ships before and after taking in cargo may be subjected to an examination in port by the agent of the country of destination to meet the sanitary requirements of the country of destination. 7 sth. No clearance shall he granted without a hill of health signed by the agent of the country of destination in the accompanying form. In case of no such agency in any port of clearance, or non-attendance or disability of such agent, the absence of such bill of health to work no injury in the country of destination. 6th. Penalties may be inflicted under general laws at the port of destination for viola- tion of these rules or any declared offence against the public health. 7th. A Bill of Health granted in compliance with these rules shall be adequate evi- dence of the health of the ship at the port and time of departure. INTERNATIONAL BILL OF HEALTH. port of , do hereby state that the vessel hereinafter named clears from this I? , (consul, consular agent, or other officer empowered by law to sign,) at the port under the following circumstances Name of vessel; Tonnage: Nature, (vessel-of-war, ship, schooner, &c.): Apartments for passengers, No.; Destination: Guns; Where last from: Name of captain: Name of medical officer, (if any): Total number of passengers: Ist cabin, . . . .; Total number of crew: Cargo: 2d cabin, ... .; steerage, VESSEL 1. Sanitary condition of vessel, (before and after reception of cargo, with note of any decayed wood.) Note disinfection of vessel: 2. Sanitary condition of cargo: 3. Sanitary condition of crew 4. Sanitary condition of passengers: 5. Sanitary condition of clothing, food, water, air-space, and ventilation: POET. 1. Sanitary condition of port and adjacent country— a. Prevailing disease, (if any): h. Number of cases of and deaths from yellow fever, Asiatic cholera, plague, small- Number of cases of— Number of deaths from— pox, or typhus fever during the week preceding- Yellow fever: Yellow fever: Asiatic cholera : Asiatic cholera: Plague : Plague: Small-pox Small-pox: Typhus fever Typhus fever; c. Population according to the last Census : d. Total deaths from all causes during the preceding month: 2. Any circumstances affecting the public health existing in the port of departure to be here stated 8 I certify that the foregoing statements are made by. . , who has personally inspected said vessel; that lam satisfied that the said statements are correct; and I do further certify that the said vessel leaves this port, hound for in the In witness whereof I have hereunto set my hand and the seal of office, at the port of , this. . . - day of , 188 ~ . . - o’clock. [seal.] , Consul. The Committee then adjourned until 2 o’clock P. M., Thursday, January 13, 1881. The Secretary op’ the Committee: THOMAS J. TURNER. The Chairman of the Committee: E. M. ARCHIBALD. PROTOCOL NO. 2. Second day’s proceedings of the Committee appointed by the Inter- national Sanitary Conference, January 13, 1881. 3 PROTOCOL No. 11. The Committee met at 2 o’clock P. M. at the Department of State Washington, January 13, 1881. Present— Mr. H, A. Schumacher, Mr. Edward Seve, Dr. Rafael Ceryera, Dr, J. L. Cabell, Dr. T. J. Turner, J. Hubley Ashton, Esq., James Lowndes, Esq., Hon. E. M. Archibald, Dr. J. C. Tache, Senor Don Ignacio Alvarado, Dr. E. J. Yan Leent, and Prof. Jose Joaquim da Silva Amado. Mr. Ashton laid before the Committee the following proposition, which was read, as follows: The protocol of the last meeting was read and approved. It is proposed that the Committee take up and consider, in its order, each one of the propositions laid before the Conference by the delegates on the part of the United States. The Chairman shall ask whether there are any objections to such proposition. If none are stated, the proposition shall be recommended for adoption to the Conference. If any objections are made to such proposition, the delegate shall state them briefly in writing, when the Committee will proceed to consider them. After such consideration, a vote shall bo taken on the proposition. If it be not carried the vote shall lie reported to the Conference, together with the objections made to the same in the Committee without any recommendation, leaving to the Conference to determine whether or not the proposition shall be adopted or modified in its further deliberations. If the proposition be carried notwithstanding the objections, it shall be recommended for adoption to the Conference. Dr. Cervera submitted the following : The special delegate of Spain has the honor to present the following observations to the consideration of the Committee, charged to prepare the report which is to serve as a basis for the discussion of the principles of the International Sanitary Conference. In the first place he finds an important and noteworthy difference between the proposi- tions set forth in the memorandum submitted by the Government of the United States of America and those submitted to the Conference by the American delegates, and while ho admits that tire latter are derived from those set forth by the American Government, he begs leave to call attention to the curtailment or exclusion of the third and fourth, and to the limited development given to the four other questions submitted in the memorandum. It would have been better, in his opinion, to follow the suggestions contained in the memorandum, commencing the order of discussion with the para- graph designated A. Had this been done, a technical and thorough discussion of con- tagious and infectious diseases would have enabled us to agree upon the best and safest methods to be established in the international system which is sought; to return afterwards to paragraph B, and then to establish a uniform and satisfactory system of bills of health, as well as of other means which may lead to the same result. On this occasion the ques- tions numbered 1 to 6 in the memorandum, and some others that might be added at the request of the delegates, would be treated in their place with more or less fullness. Is not this desired, and is it not sought to meet the wishes expressed in the memorandum ? Why, then, forget the first proposition of the memorandum, which is perhaps the most important of all ? I desire to make the following observations to the propositions presented by the honor- able delegates of the United States, I must remark in regard to the first that it is too 4 general and insufficient. The Governments should, indeed, procure reliable and full in- formation as to the state of public health throughout their territory, but when such informa- tion does not come from men skilled in medical science it has no positive value. It is, therefore, necessary to add the establishment of a special medical corps in those countries where it does not exist, if it is desired to obtain credible information. Still more may be done. An international sanitary commission may be appointed in the various places border- ing on the Gulf of Mexico. Where this may be desirable, said commission to do, with re- gard to the yellow fever, what has been done in Eastern countries with respect to the cholera by the commissions of Alexandria and Constantinople, which were appointed for this pur- pose, and by the physicians who were sent long before by France to various Eastern cities- As a matter of course the first proposition being once accepted and properly drawn up, the second and third are but corollaries thereto, and may very well be accepted with some amendments. As to the fourth, while I have no serious objections to its spirit, I desire to ask what kind of an examination is to be made on board of a vessel before and after it has taken in cargo, and how such examination may bo made in order to satisfactorily meet the exigen- cies of each country, the object being to prevent contagious or infectious diseases ? The first portion of the fifth proposition may very well be accepted; but it is proper here to remark that the final paragraph of this proposition is too much at variance with the sani- tary laws of Spain for it to be accepted without any reflection. I here terminate my observations, adding nothing to the sixth proposition, which in fact- does not affect the essential part of the questions proposed, but as to the seventh I must also state that a bill of health, whatever guarantee it may furnish, is never a sufficient guarantee of the health of the vessel. Washington, January 13, 1881. The memorandum forwarded to our respective countries by the United States Govern- ment expressly marks out the points to be specially treated in the International Conference. The sub-committee will therefore have to take as basis of the report to bo rendered to the Con- ference the questions proposed by the United States Government, and not the projet presented by the special delegates of said United States. Dr. Alvarado submitted the following: It would at first sight appear indifferent to take as basis one or the other document, in- asmuch as the special delegates of the United States arc the representatives in the Conference of the Government of this Republic; but as the Honorable the Assistant Secretary of State expressly declared during the last session of the Conference, in answer to the interpellation made on this point by Mr. Outrey, the French Minister, that the projet presented by said delegates was to be considered as the private opinion of said delegates, and not as emanating from the United States Government, my opinion is that the sub-committee occupy itself with the direct examination of the questions contained in the above-mentioned memorandum in the order in which they are written thereon. Our respective countries will in this way respond to the invitation made to them, and this will not happen if we proceed otherwise. This does not mean that we dismiss the projet of the 'North American delegates; it will, on the contrary, serve as much in the fulfilment of our mission (being, as it is, a con- scientious study carefully prepared) as also the answers that several Governments have already given to that of the United States relative to the points in question. Wc will consider all those documents as private opinions which we will keep in mind in preparing our report, but not as the starting-point of our labors. Consequently I have the honor to submit to the judgment of the Committee the follow- ing proposition: “ The Committee of the International Sanitary Conference will occupy itself at once with the direct examination of all and each one of the questions contained in the mem- orandum of the 29th of July, 1880.” Mr. Schumacher submitted the following: There are in the papers before us three principal questions of entirely distinct character. 5 I. The establishment of a reliable and satisfactory international system of notification as to the existence of contagious and infectious diseases, says the memorandum and the pro jet. That each Government should bind itself to obtain seasonable and accurate information of all facts bearing upon the public health in its territories, and to communicate promptly its in- formation to the other parties to the Conference. Connected with this question is the other: In what way trustworthy information can be obtained from ports or places in countries which have imperfect or unsafe quarantine and sanitary regulations, and which may be unwilling or unable to adhere to the proposed inter- national system? That is, No. Yof the memorandum, and not mentioned in the projet. Being these questions of general and of chiefly diplomatic character, our Committee, com- posed only by consuls-general and special delegates, has, as it seems to me, to recommend to the Conference to consider them at once in pleno. 11. The establishment of a uniform and satisfactory system of hills of health, the state- ments in which shall be trustworthy as to the sanitary condition of the vessels at the time on sailing. At this system the memorandum refers in Nos. I, 11, IY, and YI, and the projet in Nos. 3, 4, 5, 6, 7. This matter, with all its details, appears to me as the principal held of our consideration; it combines questions of more or less technical character, and of the rights or duties of the consular service; it touches directly the shipping interests, especially of the countries the ports of which are not under the general obligation to ask from each vessel a bill of health. A discussion of these points may therefore be only possible for those members of the Committee who have yet received their instructions. I understand that some members are expecting them every moment. 111. Question 111 of the memorandum refers only to yellow fever or cholera, asking what examination in these special cases should be made of the vessels to secure a trustworthy knowledge of her sanitary condition. This point is entirely technical; therefore I believe that only the technical members of the Committee are able to give full answer. I therefore beg to propose that the Committee will begin its discussions with the question whether wre will accept the mentioned separation of matters as modus operandi. I think that the propositions of the delegates of the United States are generally accept- able to my country, and are even in consonance with the laws governing this matter. There are doubtless practical difficulties, but it is for the Conference to overcome those by an international agreement. Prof. Am ano submitted the following: As regards the two first propositions, I think that the best expedient is for all the countries represented at this Conference to pledge themselves to publish medical bulletins of medical statistics, whereby the sanitary condition of the principal cities and maritime ports may be accurately known. Such a publication, as is issued in this city, (National Board of Health Bulletin,) and at Brussels, Paris, Nancy, Havre, Marseilles, Copenhagen, Turin, Home, Lisbon, &c., would inform the sanitary authorities concerning the matters of interest to international hygiene. I find no objection to permitting consuls and other accredited agents to visit hospitals and to receive all necessary information in order that they may perform their duties well. This is according to the customs of my Government. Article 6of the Portuguese maritime health regulations requires the consuls of Portugal to inform themselves constantly concern- ing the sanitary condition of their districts, and to endeavor to learn whether there are any cases of plague, yellowT fever, cholera, small-pox, exanthomatic typhus, and other contagious maladies of an epidemic character, and also whether there is any epizooty or contagious typhus among horned cattle and exudative peri-pneumonia ; for which purpose consuls must be on good terms with the managers of the civil and military hospitals, the departments of public health, the most esteemed practising physicians, and finally with the directors of vet- erinary institutions. t It is the duty of Portuguese consuls to communicate to their Government in the most expeditious manner, without losing a moment, (such are the words of the regulation,) the appearance of any cases of plague, yellow fever, or cholera on land or on board of vessels 6 / incurred in Portuguese ports, and also any case of epizooty, stating the day or days on which the cases appeared, even if they have not proved fatal. The publication of the statistical bulletin which I propose will greatly facilitate the performance of this duty by consuls. At the Sanitary Conference held at Yienna, Mr. Dickson, the English delegate, stated that in the British Indies the custom-houses at the ports from which vessels sail issue bills of health, but the Sanitary Commission at the same time furnishes the necrological table of the preceding week, so that, to use the expression of this learned English physician, by this system information is obtained as to the sanitary condition by two means, namely, by statement and by fact. Our bills of health contain nearly all the propositions made by the delegates of the United States. They are even more minute than the French bills. I do not think that the signature of a consul is of the slightest importance as a guar- antee of the health of a vessel, if he is not allowed to examine it thoroughly. Our regula- tions make it obligatory upon captains and commanders to permit consuls and other health officers who need to examine them to go on board of their vessels. (Art. 11, Ho. 2.) It also renders it obligatory upon consuls to address to captains or commanders who ask for a bill of health, and to the crews and passengers on board of their vessels, all questions that they may think proper in order to learn the hygienic condition of the vessels, and to endeavor to visit and inspect the same. I simply reproduce the provisions contained in the general maritime health regulations, which took effect in pursuance of the decree of JSTovember 12, 1874. I therefore see no objection to approving the fourth proposition of the delegates of the United States if reciprocity as regards these measures is agreed to. There remains, however, the practical difficulty of rendering the examination of the vessel useful and of making the bill of health a reliable document. Among us the title of physician is, other things being equal, a recommendation for ap- pointment as consul, but in reality I think that very few physicians have availed themselves of this prerogative; and yet it is incontestable that some competency in medical matters is required in order to issue a bill of health properly. I think we can find the means of solving this difficulty in an international institution of health officers. Health officers residing in the country in which endemic or serious epidemic diseases prevail can assist consuls in their task of informing their Governments of all sani- tary changes which require precautionary measures, and they can also subject vessels to medical inspection. The Portuguese regulations provide that if a vessel brings no bill of health, and no consular certificate in lieu thereof, the chief of the sanitary police shall enable the captain to make amends therefor by telegraphic information derived from the proper officers in the ports or places from which he has sailed, informing him at the same time that he must pay a fine and also the cost of the telegrams. (Art. 66.) In the absence or disability of Portuguese consuls, vice-consuls and all the officers who legally supply their places, bills of health and vises may be issued by the consular agents of France, England, Spain, Italy or other nations on friendly terms with Portugal. (Art. 7.) Admitting that bills of health furnish in general sufficient evidence of the sanitary con- dition of the port and of the vessel at the time of the latter’s departure, the Portuguese regu- lations nevertheless allow one exception which seems to me very proper. It is when an epi- demic becomes developed a few days after the departure of a vessel; thus the consul in a port who had issued a clean bill, if it should happen that the cholera or yellow fever ap- peared in that port within five days after the departure of the vessel, or cases of plague in eight days, would be obliged to transmit the intelligence by telegraph to the Portuguese Government and to the heads of the health departments. In all cases of doubt the sanitary authorities of Portuguese ports must correspond by telegraph with the consuls in order to obtain all necessary information. Mr. Seve stated that, in his opinion, the first step would be to find out what had already 7 been done by the various sanitary conferences already held. He stated further that he had a work on the subject, which he would present to the Committee. It contained a history of these conferences, and the writer urges the establishment of a national health authority in every country, tire duty of this board being to study all the causes which affect the public health, and not epidemics alone. He also urges the formation of local boards in each country to act in concert with the national authority, and suggests the creation of an Inter- national Board of Health. Mr. Seve closed by saying he hoped this projet would be con- sidered by the Committee, and that he would be permitted to present a special report later on. Dr. Yan Leent stated that in Holland the magistrates gave the bills of health. Hr. Tache submitted the following : There are, in the broad, before the Conference two distinct propositions : a. The establishment among nations of a system of constant mutual notification of the general state of health of each country, and of the appearance and disappearance of infec- tious disease anywhere. h. The allowing by nations of a sanitary inspection being made of hospitals, ships, and their crews, passengers, and cargoes, by authorized agents of any one and all of the contract- ing parties, at ports situate within the jurisdiction of the other contracting parties, no matter the nationality of such ships, persons, and things. The first of these propositions, as easily perceived, has a twofold object—the mutual exchange of general information amongst nations in regard of sanitary matters, and the warning of any impending danger threatening some, several, or all countries in intercourse with each other. The second might be technically described as intended to be the prophylaxy of evils of which quarantines are the remedy. There cannot be two opinions, in a purely sanitary point of view, about the rectitude in principle and the practical utility of these two proposals, framed by the United States National Board of Health. Ho one can contradict to their intrinsic goodness. The difficul- ties in the mode of carrying them into practice come when they are confronted with the exigencies of nations’ supremacy in matters of that sort within each one’s territory and with the requirements of commercial and shipping interests of the various countries in daily communication one with another. There is, however, a very great difference in this respect between the two typical propositions of international notification and of international inspection. The difficulties attending the adoption and practice of the first, if there are really difficulties, are of a trifling and easily surmountable nature, while the intricacies of the second proposition are regarded by many as assuming a somewhat formidable character, which, nevertheless, cannot be considered as absolutely insuperable. Starting from that expose of matters as they stand, I beg permission to suggest that each of the said two propositions be taken up separately and decided upon as distinct, although intimately connected, subjects for deliberation. I would furthermore suggest that the questions be put in the form adopted by the United States delegates in their projet; that is, in the form of positive propositions to be adopted, amended, or rejected, as the Committee, first, and then the Conference shall see fit; and that every secondary proposition appertaining to each of the two separate subjects be taken up in two distinct series, so that the subject of international notification be definitely disposed of before entering into the consideration of the subject of international inspection. For example: On the subject of International Notification— Principle proposed for admission: It is the opinion of this Conference that it is highly desirable that an international mutual notification on sanitary matters, and on the appearance and disappearance of infectious diseases should be adopted amongst nations. Should tins be admitted, then sections 1 and 2, and possibly 3, of the United States 8 delegates’ projet would follow for deliberation and final decision, whether they be rejected, adopted, or modified by amendments receiving the acquiescence of the Conference. Then, and not till the subject of International Notification is exhausted, would come the subject of International Inspection again by deciding first, on the principle in the follow- ing words or others to the same purport: It is the opinion of this Conference that it would be advantageous to allow certain sani- tary inspection to be made by foreign agents in ports of various nations, subject to such regulations as are necessary for the safeguard of each country’s sovereignty and of each country’s commercial interests. Then, if such principle, with its mitigation, were adopted, would come the time to con- sider the 3d, 4th, sth, 6th and 7th propositions of the United States delegates’ projet. A strict adherence to such or similar proceeding, by serial order, would avoid the danger of further delay which are to the serious inconvenience and detriment of such mem- bers of the Conference as do not reside in "Washington, some of whom are most anxious about other public business entrusted to their care. Ur. I ache offered then the following resolution, which was read, considered, and agreed to : Resolved, 1 hat this Committee recommend to the International Sanitary Conference that it be admitted as an international principle of sanitation that it is highly desirable to adopt an international system of notification concerning sanitary matters and the appearance and disappearance of contagious or infectious diseases. Ur. Alvarado offered the following, which, after being read and discussed, was dis- agreed to: Resolved, That the details of discussion of this Committee be based on the memoran- dum of the Honorable the Secretary of State of the United States, under date of July 29 1880. ’ Ur. Tache submitted the following, which was read: Resolved, That it is the opinion of this Committee that it would be highly advantageous to permit certain sanitary inspections to be made by foreign agents in ports of various na- tions, subject to such rules as are necessary for the safeguard of each country’s sovereignty and of each countiy s commercial interests, and that the said opinion be expressed in the report of this Committee to the Conference. Mr. Schumacher moved that the words “ by foreign agents” be stricken out. The vote was taken, and it was decided in the negative. The question then recurred on the original resolution. Mr. Schumacher stated that he had not yet received his instructions, and would have to suspend his vote on the resolution. The vote was then taken, and the resolution of Ur. Tache was adopted. Then, on motion of Ur. Cabell the Committee adjourned until Friday, January 14, at one o’clock P. M. The Secretary of the Committee: THOMAS J. TURNER. The Chairman of the Committee: E. M. ARCHIBALU. PROTOCOL NO. 3. Third day’s proceedings of the Committee appointed by the Inter- national Sanitary Conference, January 14, 1881. 3 PROTOCOL Ho. 111. Session of January 14, 1881. The Committee met pursuant to adjournment. Present— Mr. Hermann A. Schumacher, Mr. Edouard Seve, Dr. Raphael Cervera, Dr. James L, Cabell, Dr. Thomas J. Turner, Mr. J. Hublby Ashton, Mr. James Lowndes, Mr. Ed- ward M Archibald, Dr. J. C. Tache, Dr. Ignacio Alvarado, Dr. F. J. Yan Leent, Dr. J. J. da Silva Amado. The reading of the protocol of the second day, January 13, 1881, was dispensed with. Mr. Edouard Seve submitted the following: [Translation. ] Proposed General Organization of Public Hygiene, hy Dr. Th. Belval, presented hy Mr. Edward Sere, Delegate of Belgium. Propositions Adopted hy the Medical Congress held at Brussels in 1875. Hygiene considered in an executive point of view should comprise two distinct parts: Ist. A national organization. 2d. An international organization. I. 1. The national organization would include the establishment by law in each country, and in all degrees of executive authority, of health and hygiene. 2. These would consist— A. Of a superior board near the governmental authority; B. Of a provincial (State) commission in each of the departments, provinces, pre- fectures, governments, cordes, or districts ; c. Of a local committee in each commune in which such an organization might be possible. In communes whose small size will not permit the establishment of a committee, sanitary circumscriptions should be established, comprising various communes or sections of communes taken together. 3. The surveillance (and in case of need the execution) of the measures recognized as being of public utility should be exercised: A. In a general way by the secretary of the superior board; B. Throughout each province by the secretary of the provincial commission; C. In each commune or group of communes by the secretary of the local committee in the capacity, respectively, of inspector, provincial inspector, and of communal or rural inspector of the health service. They could, if necessary, be assisted, or their places might be supplied in the perform- ance of this work, by a member of the board or of the commissions. 4. Reports would be published or issued annually by each branch of the service. 5. Independently of the communication which the three degrees of the hygienic service would maintain with their respective administrations, these branches of the service might maintain continuous relations with each other with regard to all questions within their competence. 4 6. The greater the independence and the authority of the various brandies of the sani- tary service in their sphere of action, the greater will he the advantages to public health. 7. The budget of each of these branches of the service would form part of that of the respective administrations to which they might be attached, as is done in the cases of the budget of public instruction and public charity. 11. The international organization would comprise— -Ist. The fiequent and regular exchange of communications between the superior hygienic boards of the various countries. These communications would bear principally A. a. Upon the means used to improve the sanitary conditions of the various localities and of their population; 1). Upon the hygienic measures adopted with a view to mitigating the effects of endemic diseases; g. Upon the precautions adopted for the purpose of preventing the importation of epidemic or contagious diseases ; d. Upon the opposition of foci or of endemic diseases; e. Upon measures adopted to combat epizooties. B. Upon the results obtained in each of these cases; Upon the statistical data collected or to be collected with a view to elucidatin'l, the problems of public hygiene. 2d. The’periodical meeting of International Sanitary Conferences, (such as, for instance, the Washington Conference.) A correct copy. Edouaed Seve. Mr. Lowndes submitted the following resolution, which was read, considered, and agreed to : That the Chairman submit the propositions of the American delegates in their order foi discussion and for a vote thereon, and that no resolution or discussion shall be in order but discussion and resolutions cognate thereto, until all of said propositions shall have been acted on. The Chairman stated that the first business in order under the resolution just adopted would be the propositions of the United States delegates, which would be read by paragraph for consideration. The preamble was read, as follows : Nations have at present ample power to prevent, without any breach of their inter- national obligations, the introduction into their territories of contagious or infectious diseases. But there is often an omission to exercise that power when there is real danger, or an unnecessary exercise of power to avert an imaginary danger. These mistakes arise from two sources: Ist, ignorance of the real state of the facts in the country where the danger lies; 2nd, the omission to communicate to other countries the knowledge which actually exists. On motion, the words “at present ample ” were stricken out, and the words “ an in- herent ” inserted in lieu thereof. On motion of Mr. Sohumaohee, the word “principal ” was inserted between the words “ two ” and “ sources ” in line 5. On motion, the word “ which,” in the 6th line, was stricken out, and the words “of facts 7 inserted in lieu thereof, and the word “ ascertained ” substituted for “ exists ” in the Bth line. Mi. fecnuMACHEE moved to strike out the last sentence entirely, beginning with “These mistakes.” & The vote was taken, and the motion disagreed to. 5 The preamble, as amended, was then adopted, Mr. Schumacher voting in the negative. Mr. Schumacher offered the following resolution, which, after discussion, was disagreed to : That the first two articles in the projet submitted by the United States delegates be not discussed by this Committee, hut that they he respectfully reported hack to the Con- ference for its consideration. The first United States proposition was then read, as follows: The remedies for these evils seem to be, in outline: Ist. That each Government should bind itself to obtain seasonable and accurate infor- mation of all facts bearing upon the public health in its territories. On motion of Dr. Cabell, the words “it is desirable that” were inserted before “each;” the words “bind itself to” after “ should” stricken out, and the words “ as far ae practicable” inserted before “seasonable.” On motion of Dr. Yan Leent, the word “dominions” was substituted for “terri- tories.” On motion of Dr. Tache, the words “of all facts” after the word “information” were stricken out. On motion of Dr. Cebveba, the word “scientific” was inserted after “accurate.” The first proposition as amended was then adopted. The 2nd United States proposition was then read, as follows: 2nd. Each Government should bind itself to communicate promptly its information to the other parties to the Conference. On motion of Dr. Cabell, the words “It is desirable that” were inserted before “each,” and the words “ binds itself to” stricken out. The 2nd proposition as amended was then adopted. Mr. Seve laid before the committee the following table : Societe Royale de Medecine Poblique do Royaume de Belgique. Province de. Arrondissement de. Commune de Statistique Medicale et Hygieniqne dressee par M. le Docteur. Mois de 18. . Exjpedie le (Signature.) Requ d Bruxelles le. Inscrit d V Indicateur sous le N°. Notes Explicatives. (a.) L’age des personnes decedees sera designe par jours pour les enfants de 0 a 1 mois par mois pour ceux ages de 1 mois a 2 ans, et par annees pour les individus ayant depasse deux ans. (h.) La profession des parents sera pour les enfants decodes; celle du mari, pour la femme sans profession.—Les ouvriers seront distingues des patrons par le signe Of qui precedera la designation du metier. Les enfants morts qui frequentaient I’ecole, la designation ec qui precedera la profession des parents. (c.) La qualification d’indigent sera reservee pour les personnes pauvres qui recevaient des secours de la charite ofiicielle. (d.) Toutes les fois que le medecin signataire aura constate dans I’habitation de la personne decedee une cause notable d’insalubrite, il en fera mention dans cette colonne. (e.) Pour designer les maladies causes de deces, on suivra autant que possible la nomenclature 6 et flamande, elaboree jadis par line Oommission officielie (MM. Beliefroid, Janssens et Theis,) portee en 1858 a la connaissance de tons les practiciens dn pays par circulaire de MM. les Gouverneurs, et approprie a I’etat actuel de la science, comme il est indique plus loin. (/'.) Les observations demographiques on medicates qui ne pourraiend tronver place sous les rnbriqnes precedentes seront inserees dans cette colonne. Le medecin devra y consigner, les observations meteorologiqnes, telles que; hauteur barometrique, emper- ature, pluie tombee, temps et vents, inclinaison, declinaison de Paiguille aimantee, etc., etc. Nota.—Les reponses aux indications ci-dessus demandees restent naturellement limitees a ce qu’autorise la conscience du medecins. DATE du AGE SEXE ETAT CIVIL ' ETAT d'aisance RESIDENCE CONDITIONS Hygicniques MALADIE OU ACCIDENT CAUSE DU DECES (A Consti- OBSKRVA TICKS. (/) OBSERVA- Deeds (a) Profession — (C De 1’Habitation Denomi- nation Marche Nature CAUSE tution TIONS Riche - id) — Epiddmique de Aisd Bonnes Maladie Durce Aigue End^mique Sporadique la Maladie S3 “bb o GENERATES Mois. C 3 .s 4> B E Pauvre Commune Rue Passables principale Subaigue Infectieuse ou de suj et 3 o jO Jour S < Mois Jours cS s 6 ‘