1 c ^ SPECIAL NOTE. Mr. John Barrett, the Director of the Inter- national Bureau of the American Republics, an institution devoted to the development of comity and commerce among the American nations, and which acts incidentally as the office of the Inter- national Sanitary Bureau, presents his compli- ments to the readers of this volume, and, in expressing the hope that they will enjoy a perusal of its contents, desires to state that if they care for further information concerning the Latin- American Republics they can obtain it by ad- dressing him at the International Bureau offices, Washington, D. C. TRANSACTIONS OF THE THIRD INTERNA- TIONAL SANITARY CONFERENCE OF THE AMERICAN REPUBLICS a.-JTV^ HELD AT THE NATIONAL PALACE, CITY OF MEXICO, DECEMBER 2-3-4-5-6-7, 1907 PUBLISHED AND DISTRIBUTED UNDER THE AUSPICES OF THE INTERNATIONAL BUREAU OF THE AMERICAN REPUBLICS WASHINGTON, D. C. 1909 PRESS OF BYRON S. ADAMS, WASHINGTON, D. C. MEPMOOUCCO BY THE COLUMBIA PUtNOONAPH CO., WASHINGTON. 0. C. BANCROFT LIBRARY U lAPR 23 1940 INDEX. PAGE. Officers of the Convention 5 Officers of the International Sanitary Bureau of Washington 6 Convocation of the Third International Sanitary Convention 7 Program of the Third International Sanitary Convention of American Republics 11 Death of Senor Licenciado Don Jose Algara 14 Transactions of the Third International Sanitary Convention of American Republics : First day, Monday, December 2, 1907 Morning Opening session 15 Afternoon session 27 Second day, Tuesday, December 3 Morning session 33 Third day, Wednesday, December 4 Morning session 40 Afternoon session 51 Fourth day, Thursday, December 5 Night session 57 Fifth day, Friday, December 6 Morning session 72 Night session 81 Sixth day, Saturday, December 7 Morning session 86 Afternoon session 97 Appendix : Feasts and social functions in honor of the Delegates 115 Letter from the Convention to the President of the Mexican Republic. 117 Tribute of respect to the Chairman of the Convention, Dr. Eduardo Liceaga 118 Adherence of the Brazilian, Colombian and Uruguayan Delegates to the Convention of Washington of 1905 1 19 Subjects that will form part of the Fourth International Sanitary Con- vention 120 Resolutions adopted by the First, Second and Third International Sani- tary Conventions 121 Reports presented by the Delegates to the Convention : Brazil 137 Chile 139 Colombia 158 Costa Rica 160 Cuba 162 Ecuador 169 Guatemala 171 Honduras 173 Mexico 173 Salvador 188 United States 194 Uruguay 219 CALL FOR THE FOURTH INTERNATIONAL SANITARY CONVENTION. In accordance with the resolution adopted at the Third International Sanitary Convention, held in the City of Mexico, December 2-7, 1907, the date December 25, 1909, to January 2, 1910, has been fixed for the assembling of the Fourth International Sanitary Convention in the city of San Jose, Costa Rica. The following official correspondence in regard to the call and the provisional program of the convention are printed in the interest of the Convention. INTERNATIONAL SANITARY BUREAU, WASHINGTON, U. S. A. June 12, 1909. HON. JOHN BARRETT, Director, Bureau American Republics, Washington, D. C. SIR: In accordance with the resolution adopted at the Second International Sani- tary Convention of American Republics authorizing biennial conventions, and in accordance with the action taken at the last convention in Mexico City, De- cember, 1907, I enclose herewith a call for the Fourth International Sanitary Convention of the American Republics to meet in Costa Rica December 25, 1909, to January 2, 1910. In accordance with paragraph 7 of the resolutions relating to international sanitary police, adopted at the Second International Conference of American States in Mexico, January 29, 1902, I have to request that you take such measures as you deem advisable to make announcement of this call. It is also requested that the Bureau of American Republics in making this announcement also make representations to the government of Costa Rica in order that there shall be issued through its Department of Foreign Relations invitations to the several countries to be represented. Respectfully, WALTER WYMAN, Chairman, International Sanitary Bureau. FOURTH INTERNATIONAL SANITARY CONVENTION OF THE AMERICAN REPUBLICS, To BE HELD IN SAN Jos, COSTA RICA, DECEMBER'S, 1909, TO JANUARY 2, 1910. INTERNATIONAL SANITARY BUREAU OF THE AMERICAN REPUBLICS, WASHINGTON, D. C., June 14, 1909. In accordance with the resolution adopted by the Second International Sanitary Convention of the American Republics, which authorizes biennial conventions, and in accordance with the action taken at the Third International Sanitary Convention, it is hereby announced that the Fourth International Sanitary Convention of the American Republics will be held in San Jose, Costa Rica, December 25, 1909, to January 2, 1910. It is respectfully urged that every Republic of the Western Hemisphere be represented at this convention, both those that have been heretofore represented and those which have not taken part in the previous conventions. In accordance with resolutions adopted at previous conventions, there will be considered practical means for the adoption of measures intended to obtain the sanitation of cities and especially of ports. This subject has, therefore, been included in the provisional program, which has been prepared by the President- elect of the coming convention with the view to continuing the work of previous conventions. PROVISIONAL PROGRAM FOR THE INTERNATIONAL SANITARY CONVEN- TION OF THE AMERICAN REPUBLICS TO BE HELD IN SAN JOSE, COSTA RICA, DECEMBER 25, 1909, TO JANUARY 2, 1910. 1. Reports presented by the different delegates in regard to the sanitary regulations and laws adopted, and in force, in their respective tountries, since tKfe last meeting. 2. Special report by each official delegate regarding the manner in which the resolutions adopted in the three previous conventions have been put into practice, in their respective countries. 3. Reports in regard to sanitary conditions in ports, and measures pro- posed for the improvement of. such sanitary conditions (with special reference to the principal ports). 4. Reports relating to the registration of the movement of population and the rate of mortality in each country, specifying those of ports and principal cities. 5. Sanitation of cities and especially of ports. 6. Measures for the protection of passengers that embark in vessels from infected ports. 7. Discussion of measures against the introduction of diseases not included in the Convention of Washington of 1905. 8. Sanitary models or forms to be adopted by Nations forming part of this Convention. 9. Discussion on sanitary measures relating to Yellow Fever, Bubonic Plague, Tuberculosis, Malaria, and other diseases, in conformity to new dis- coveries, or experiences. 10. Discussion on measures relating to venereal diseases. 11. Discussion on the necessity of the adoption, by the European Nations, of the Convention of Washington and other sanitary measures subsequently adopted by this Convention with respect to such colonies as they have in America. 12. Discussion on new discoveries with respect to the transmission of yellow fever and malaria, besides the mosquito bite. 13. Organization in each country represented at this Convention, of a commission of three physicians or health officers to act as delegates of the International Sanitary Bureaus of Washington or Montevideo, and to form part of the International Sanitary Information Committee of the American Republics. By direction of the International Sanitary Bureau of the American Republics. WALTER WYMAN, Chairman. JUAN J. ULLOA, Secretary. As requested in the communication of Dr. Walter Wyman, Chair- man of the International Sanitary Bureau, the Director of the Inter- national Bureau of the American Republics has addressed a letter to the diplomatic representatives of the countries interested in the Convention transmitting a copy of the Call, and the Provisional Program, which has also been given to the press, and will be printed in the Bulletin of the Bureau. MEMBERS OF THE INTERNATIONAL SANITARY BUREAU OF WASHINGTON. DR. A. H. DOTY. United Statei. DR. JUAN GUITERAI, Cuba. DM. JUAN J. ULLOA, Costa Rica, Secretary. DR. WALTER WYMAN, United Statei, Preiidrnt. DR. EDUARDO LICKACA. Mexico. DR. EDUARDO MOORE Chile. DK. RHCTT GOODE, United Stalei. OFFICERS OF THE CONVENTION. President. Doctor EDUARDO LICEAGA, President of the Supreme Board of Health of Mexico. Vice-Presidents. Surgeon-General WALTER WYMAN, United States Public Health and Marine-Hospital Service. Doctor OSWALDO GONQALVEZ CRUZ, Brazil. Doctor RICARDO GUTIERREZ LEE, Colombia. Doctor JUAN J. ULLOA, Costa Rica. Doctor JUAN GUITERAS, Cuba. Doctor E. SOZA, Chile. Doctor J. H. ESTEVES, Ecuador. Doctor SALVADOR ORTEGA, Guatemala. Doctor Luis LAZO ARRIAGA, Honduras. Doctor GREGORIO MENDIZABAL, Nicaragua. Doctor RODOLFO B. GONZALEZ. Salvador. Doctor ERNESTO FERNANDEZ ESPIRO, Uruguay. Permanent Secretary. Doctor JUAN J. ULLOA, Costa Rica. Committee on Credentials. Senor Licenciado Don JOSE ALGARA, Mexico. Doctor RHETT GOODE, United States. Doctor SALVADOR ORTEGA, Guatemala. Advisory Council. Doctor EDUARDO LICEAGA, Mexico. Doctor WALTER WYMAN, United States. Doctor JUAN J. ULLOA, Costa Rica. Doctor E. SOZA, Chile. Doctor R. GUTIERREZ LEE, Colombia. Committee on Yellow Fever. Doctor JUAN GUITERAS, Cuba. Doctor R. H. VON EZDORF, United States. Doctor O. GoNgALVEZ CRUZ, Brazil. Doctor W. G. OWEN, United States. Committee on Bubonic Plague. Doctor P. LAUTARO FERRER, Chile. Doctor E. LICEAGA, Mexico. Doctor P. T. STRAUB, United States. Committee on Trachoma and Spinal-Cerebral Meningitis. Doctor JAMES GATEWOOD, United States. Doctor G. MENDIZABAL. Nicaragua. Doctor H. ROBERTS. Cuba. THIRD INTERNATIONAL SANITARY CONVENTION. Committee on Tuberculosis. Doctor H. L. E. JOHNSON, United States. Doctor J. AZURDIA, Guatemala. Doctor L. LAZO ARRIAGA, Honduras. Committee on Malaria. Doctor G. PAYAN, Colombia. Doctor R. B. GONZALEZ, Salvador. Doctor J. H. ESTEVES, Ecuador. International Sanitary Bureau of the American Republics, Washington, D, C. Chairman. Surgeon-General WALTER WYMAN, United States. Secretary. Doctor JUAN J. ULLOA, Costa Rica. Members. Doctor EDUARDO LICEAGA, Mexico. Doctor EDUARDO MOORE, Chile. Doctor A. H. DOTY, United States. . Doctor JUAN GUITERAS, Cuba. Doctor RHETT GOODE, United States. CONVOCATION OF THE THIRD INTERNATIONAL SANI- TARY CONVENTION. In accordance with the resolution adopted at the Second International Sani- tary Convention held in the City of Washington, October 9-14, 1905, the date of December 2-7, 1907, has been fixed for the assembling of the Third Inter- national Sanitary Convention in the City of Mexico. The Convention is held under authority of resolutions of the Second Inter- national Conference of the American States held in the City of Mexico in 1901-2, and of the Third International Conference of American States held in the City of Rio de Janeiro in 1906. The following official correspondence in regard to the call is herewith pro- mulgated : INTERNATIONAL SANITARY BUREAU, WASHINGTON, U. S. A., June 18, 1007. "MR. JOHN BARRETT, "Director, Bureau American Republics, "Washington, D. C. "SiR: In accordance with a resolution adopted at the Second International Sanitary Convention of American Republics, October, 1905, I enclose herewith a call for the Third International Sanitary Convention of the American Repub- lics to meet in the City of Mexico, December 2-7, 1907. "In accordance with paragraph 7 of the resolutions relating to international sanitary police, adopted at the Second International Conference of American States in Mexico, January 29, 1902, I have to request that you will take such measures as you deem advisable to make announcement of this call. "It is also requested that the Bureau of American Republics request the Department of State to invite the attention of envoys at this Capital, whose countries have not as yet ratified the Sanitary Convention ad referendum of Washington, to the desirability of doing so. and urge them to secure repre- sentation at the coming Convention in Mexico City. "Respectfully, "WALTER WYMAN, "Chairman, International Sanitary Bureau." "THIRD INTERNATIONAL SANITARY CONVENTION OF THE AMERICAN REPUBLICS, "To be held in the City of Mexico, December 2-7, 1907. "INTERNATIONAL SANITARY BUREAU OF THE AMERICAN REPUBLICS, "WASHINGTON, D. C., June 17, 1007. "In accordance with a resolution adopted by the Second International San- itary Convention of the American Republics, it is hereby announced that the Third International Sanitary Convention will be held in the City of Mexico, December 2-7, 1907. "It is respectfully urged that every Republic of the Western Hemisphere be represented at this Convention both those that have been heretofore represented and those which have not taken part in the previous conventions. "It will be remembered that the First Convention, held in Washington from the 2d to the 5th of December, 1902, was called in compliance with the 5th of the resolutions relative to Sanitary Police adopted by the Second International Conference of American States in Mexico. January 29. 1902. These resolutions were accepted as the basis for the work of the First Convention, which was of a character chiefly scientific, and resulted in the adoption of certain sanitary and hygienic principles and the establishment of an International Sanitary Bureau at Washington. "The Second International Sanitary Convention which was held in Wash- ington from the 9th to the I4th of October, 1905, assumed a more formal char- acter than the previous one, and resulted in the subscription to a "Sanitary Convention ad referendum," concluded on October 14, 1905, which codified all the measures destined to guard the public health against the invasion and 8 THIRD INTERNATIONAL SANITARY CONVENTION. propagation of yellow fever, plague and cholera. This Sanitary Convention ad referendum has been ratified by at least nine republics, and attention is respect- fully invited to the following paragraph contained therein : " The governments which may not have signed the present Convention are to be admitted to adherence thereto upon demand; notice of this adherence to be given through diplomatic channels to the Government of the United States of America, and by the latter to the other signatory governments.' "As will be seen below, the Conference at Rio de Janeiro in August, 1006, recommended the adoption of the same Convention by all the countries therein represented. "Resolutions adopted at Rio de Janeiro, August, 1906. "Following are the resolutions of the Third International Conference of American States at Rio de Janeiro in August, 1906, indicating, among other measures, matters for consideration by the Sanitary Convention to be held in Mexico City. The Third American International Conference recognizes the desirability of the Principles of International Sanitary Police which inspired the last Con- ference held in Rio de Janeiro, as applicable to a specific region, and the con- vention which was signed in Washington on the I4th of October, 1905, which is applicable to all sections of America, and therefore makes the following recommendations to the countries here represented: "i. That as a general rule, they should adopt said International Convention of Washington, adhering to the same and putting its precepts into practice. "2. The adoption of measures intended to obtain the sanitation of the cities and especially of the ports, as well as to obtain, as far as possible, a better knowledge and a better observance of hygienic and sanitary principles. "3. The desirability of having all American countries represented in the coming International Sanitary Conference which is to be held in the City of Mexico in December, 1907, and that the respective delegates to that Conference should be instructed to study and resolve the following points: "(a) Practical means for giving effect to the Second of the present recom- mendations. "(fc) The establishment and regulation in each of the American countries of a commission co.mposed of three public medical or sanitary officers, in order that, under the direction of the International Sanitary Office, established in Washington, they may constitute an International Bureau of Sanitary Informa- tion throughout the American Republics, with power to collect and com- municate all data relating to public health and such others as the Conference may consider desirable. "(c) The establishment and organization in the place in South America which the Conference may designate, of a Bureau of Sanitary Information which will furnish to the International Sanitary Bureau, already existing, the necessary data to comply with recommendations V. VI and VII, relative to sanitary police, which were adopted by the Second American International Conference. "(rf) The establishment of relations between the International Sanitary Bureau, now existing in Washington, and the 'Bureau Sanitaire International,' of Paris, in order to obtain the best information on sanitary subjects and to reach agreements that will facilitate the objects with which both offices are established. "4. In accordance with the provisions of paragraph c, article 3, the City of Montevideo is designated as the residence of the Bureau of Sanitary Infor- mation." "Provisional Program for the International Sanitary Convention in Mexico City, December 2-7, 1007. "The following program has been arranged to embody the sanitary principles considered by the previous conventions and in conformity with the resolutions adopted by the Conference at Rio de Janeiro: "ist. Each delegate will bring a paper relating to the nation he represents. This paper will cover the following points: "(o) A report on the existence of transmissible diseases which may prevail in its territory, especially with reference to bubonic plague, yellow fever, cholera. c , *. " 2 * O u O. .2 3 ^ ? ~ v - JOTS w SSoSe.^ w -S38g Q Q gS O i- CM ro w ^ H O S" e ^E*u'S w ' t " I |u|i QQQOQ Q THIRD INTERNATIONAL SANITARY CONVENTION. 9 malaria, beri-beri and trachoma. This report will give detailed information on the measures which have been adopted for the prevention of stamping out of any of the diseases above mentioned, if they are unfortunately present in the country represented by the delegate. (&) A report on the condition of the ports of his country, specifying the works which may have been executed therein, those in course of construction and those which are projected, as well as the manner in which the problem of water supply, of proper sewerage and of the connection of house drains with that system of sewers has been resolved, as well as the methods that have been employed or are proposed for the sanitation of the dwellings. ( seems to me that we have been of the same opinion. In the session of day be- fore yesterday, I said that it was necessary to omit the inspection, which shows that that is my personal conviction, and I shall so maintain continually; but, gentlemen, we have not yet reached that stage. If we had time enough to study, I would certainly adhere, without any restriction whatever, to what Dr. Fernandez Espiro has just said, but we have only two days at our disposal in. which to do our work. Now, can we make any modifications in two days ? DR. FERNANDEZ ESPIRO. Mr. Chairman, I have not advocated any modification whatever, and simply desired to make known my opinion on the subject. THE CHAIRMAN. I take advantage of this opportunity to repeat that I should not say the latest expression of science, but the last agree- ment, and this is the point upon which I shall insist. My opinion is that sanitary laws are behind the times, but if we can not make any modification at this moment, which of these two ways is the most acceptable? To accept something that is not the best, but which has already been accepted by 27 nations, or to introduce sani- tary modifications in two days, which is the only time we have at our disposal, which of the two ways is the most practical ? Fortunately we have already entered an epoch in which idealism has to submit to reality, however terrible the latter may be, and we are compelled to accept the current coin, that is to say, the Convention of Paris, which has been accepted by 27 countries, and we hope that the new conventions may improve, and they will surely improve, the sanitary laws. Let us accept said convention for the present the time will come when it can be modified because it is better to accept these interna- tional sanitary laws, however deficient they may be, than to have none. I beg to make a formal motion: That one of the resolutions to be voted upon at the session to be held on Saturday morning, be in the following terms : That the delegates of the nations here assembled adhere to the Convention of Washington of 1905, and that those countries which have already adhered to it, but whose adhesion has not been ratified by their respective Governments, pro- pose the ratification thereof. I request the Third International Convention to accept this resolu- tion. I also request that this proposition, like the former ones, be referred to the Advisory Committee. Let us now continue to consider the matter we were discussing, and which refers to the measures that should be taken to protect ourselves against trachoma, beri-beri, and other transmissible chronic diseases. O4 THIRD INTERNATIONAL SANITARY CONVENTION. In order to encourage the discussion on this point, I will read the following : The easy intercourse among men, either by land or by sea, has brought about two great benefits to mankind ; but since there is no advantage without some disadvantage the facilities which steamers and railroads afford for transportation have also their disadvantages. Men in traveling carry with them the diseases from which they suffer. The International Sanitary Police has earnestly tried, even to exaggeration, to pre- vent quickly developed transmissible diseases from being brought into ports, or border cities, or more accurately speaking, to render very difficult the transmis- sion of these diseases, keeping the patients of said diseases or those who are sus- pected of being stricken with them on the vessels on which they come, or in special lazarettos, but with regard to transmissible chronic diseases, legislators have not until now given any attention to them, and yet it is just as necessary to take precautionary measures against transmissible diseases that quickly de- velop as it is of those which develop slowly, and are called chronic. Now that Asiatic immigration encounters such great difficulties in entering the United States of North America, it has been directed toward Latin-America. Through the port of Salina Cruz there arrives in Mexico every month one or two steamers bringing Chinese immigrants and some of them Japanese. Our sanitary code prescribes that there shall only be allowed to enter the Republic such persons as desire to be transported to it as immigrants, when they have a certificate of health showing them to be in a perfectly healthy condition, issued by the proper authority of the place whence they come, and countersigned by the Mexican Consul. In accordance with the same code, the certificates issued two months prior to the date of arrival of the immigrants to our country are void. (Article 49 of the Sanitary Code.) But this measure was insufficient because the immigrants might have left their country having the diseases in incubation and arrive at our ports after the latter have developed. Attention should be called to the fact that our situation favors the transmission of diseases, because the vessels do not touch at any port, but come directly from the Orient to pur Pacific ports. In view of the above, rules have been issued referring to Asiatic immigration, a brief outline of which is as follows: Immigrants shall come provided with a certificate of health issued by a physi- cian at the place of departure, and countersigned by the Mexican Consul in such place, and in the absence of the latter, by the Consul of the United States of North America. Immigrants will only be admitted through the port of Salina Cruz when their number exceeds ten, but when in smaller numbers they are allowed to land at the ports of Acapulco, Mazatlan, Guayamas, Tampico, Veracruz, or Coatzacoalcos. All vessels with immigrants on board are received in accordance with the pro- visions of the Sanitary Code, the Maritime Sanitary Regulations, and such special rules as may be issued by the Superior Board of Health in each case, as circumstances may require. If no special circumstances exist, the healthy immigrants are allowed to land without delay, and are taken directly through a special wharf to the lazaretto reserved for them. There they are compelled to bathe, their clothes and baggage are disinfected, and subject to an inspection for ten days. If at the end of this period no disease develops among them, they are allowed to leave, the health delegate duly notifying the Superior Board of Health con- cerning the place of destination of each of the immigrants. Heretofore the foregoing measures have been sufficient to guard us against cholera, bubonic plague and yellow fever, but they were not able to prevent some patients of beriberi from entering the country. Inasmuch as this disease was entirely unknown in Mexico, and since, on the other hand, the patients had it only in an undeveloped stage in which it was not easy to detect it by the symptoms, which make it easily detected when it is in an advanced stage, there were several cases in Salina Cruz, Tehuantepec and Santa Lucretia, but only among the immigrants themselves. As soon as the sanitary authorities discovered these cases, they demanded that the patients should be re-embarked for their country, and that no person afflicted with beriberi should be allowed to land. The disease called trachoma was known in Mexico only by occulists, and it must THIRD INTERNATIONAL SANITARY CONVENTION. 65 have been so rare that physicians generally did not know of it, and much less the people. Dr. Lorenzo Chavez, a distinguished occulist, had occasion last year to note a small epidemic of trachoma in a government school, and called attention to the danger of the same being spread. This fact caused the sanitary authorities to think of the possibility of the Asiatic immigrants bringing trachoma and of the danger of their spreading said disease throughout the country; and as the dele- gates of the Board of Health at the ports were advised of said danger, they have commenced to enumerate the number of trachoma patients arriving in the Republic, a greater number arriving at Pacific than at Gulf ports. In one of these steamers there were 220 trachoma patients. Then the Superior Board of Health requested the Secretary of the Interior to prohibit the landing of such immigrants, and they were actually re-embarked for China, and thus the Depart- mental declaration that such patients would not be allowed to land in any of the Gulf or Pacific ports .was obtained. In order to prevent the introduction of the aforesaid diseases, the immigrants are thoroughly inspected before they embark at the port of Hong Kong, whence Chinese immigrants generally come. To this end a physician representing the Superior Board of Health was sent to said port, and he prevents immigrants afflicted with the bubonic plague, cholera, and other transmissible and quickly developed diseases from embarking there. A law is now under consideration to prevent patients afflicted with tubercu- losis, leprosy, scrofula, malaria (with visible symptoms), beriberi, cerebro-spinal meningitis, trachoma, and other transmissible chronic diseases from landing in our ports. Said law will likewise prohibit the landing of the insane, the aged, idiotic chil- dren, persons whose constitution has been greatly weakened owing to any previous disease or to rickets, the lame, the one armed, the humpbacked or crippled in any other way, who are unable to work, and all those who might become a burden to the State. We hope that if Congress enacts said law, which, as already stated, is under consideration, we shall not only be freed from some diseases unknown to us, but by not allowing them to be introduced in our territory, we shall guard our neighboring countries against them. I invite you, gentlemen, to suggest to your respective governments the ad- visability of taking similar precautionary measures to those we have already adopted, or rather to those which will soon constitute a part of our sanitary legislation. If all the people of America would form a true league in order to prevent the entrance of sick immigrants, or those unable to work, in the vast extent of our continent, we would contribute in a very efficient manner to improve both the social and sanitary conditions of our respective countries. I desire to add a word to what I have read. Immigrants are not like other passengers. I request very severe laws for immigrants, but not for passengers. DR. ROBERTS. As I had the honor to state when I read my report concerning Cuba, and which I submitted to you, the entrance of immi- grants afflicted with trachoma should be prohibited. Trachoma is not imported into Cuba from Asia by Chinamen, because the entrance of Chinese subjects in Cuban territory is absolutely prohibited, and there- fore, this disease can not be brought in by the Chinese. On the other hand, many European immigrants brought the disease to Cuba. The quarantine service of Cuba has physicians at the Spanish ports whose duty it is to examine persons afflicted with trachoma, and thus prevent their entrance to Cuba, and it is also their duty to vaccinate them, and thus comply with that requisite of the laws of the country, and prevent smallpox on board the ships, a disease which often occurs on vessels arriving in Cuba. Now, the mission of the physicians of the quarantine service in Span- ish ports, which send us a great current of immigration is, for many 65 THIRD INTERNATIONAL SANITARY CONVENTION. reasons, very difficult to carry out. In the first place, at the Spanish ports whence these immigrants come, young men embark who are un- willing to render military service in their country, and illegally obtain permits to embark, and as they have not been examined by any au- thority or physicians, nor identified by anyone, some of them who are not vaccinated may be afflicted with trachoma ; but in the Cuban ports the sanitary service endeavors to ratify the examinations made by the physicians residing in Europe and attached to the consulates, and they ratify also the diagnosis or observation they have made. When the health officers visit a vessel, the physicians of the port immediately proceed to vaccinate persons who have not been recently vaccinated, and while carrying out this operation, they examine the eyes of the immigrants, and if they detect in any of them an abnormal condition of the conjunctivas, they make a brief report without further examination, and address a communication to the special commissioner, who causes the immigrant to be thoroughly examined by a special commission of occulists whose diagnosis is considered final. If from this examination it should appear that the patient is afflicted with trachoma, he is re-embarked for the port of origin, but if he hap- pens to be a Cuban, he will be allowed to land. As to leprosy, I would state that it is one of the diseases subject to quarantine in Cuba. A leprous person is re-embarked for the place of origin, and care is taken to disinfect in the most thorough manner the place occupied by him. Immigrants afflicted with tuberculosis, if they are unable to work and are liable to become a burden to the State, that is to say, if they are in an advanced stage of the disease, they are re-embarked for the countries of origin. Persons afflicted with malaria or beri-beri are admitted, but are sent to hospitals for contagious diseases until they are cured. DR. FERRER. Mr. Chairman, the first case of trachoma in Chile oc- curred in 1902, and the case was discovered by Dr. Maximo Cienfue- gos, professor of ophthalmologic clinic, and since then, according to the detailed statistics of that same clinic, of 1,000 children afflicted with conjunctivitis, there were only 14 cases of trachoma, and therefore, such statistics are rather vague, but in spite of this fact, the necessary precautionary measures have been taken. There are physicians at Santiago, Chile, who carefully examine children. With regard to immigration, rules and regulations have been issued, which are now in force, and, besides, physicians have been sent to Europe, attached to the consulates, whose duties are to examine all passengers coming to our port, and, consequently, every immigrant coming to Chile is examined by immigrant physicians. Such immigrants are examined again in Chile, and therefore, by means of this system, I think we have the guarantee that trachoma will not develop among us, and I should add that the only cases that have occurred were among the Turkish or Arabian immigrants. Beri-beri is unknown in Chile. Two or three years ago a vessel arrived in Chile from the Fridge Islands, and the whole crew was ill with beri-beri, and all of them died, except a cook and his assistant, who were compelled to run the vessel aground on the Chilian coast. THIRD INTERNATIONAL SANITARY CONVENTION. 67 I take advantage of this opportunity to inform the delegates of a fact worth knowing. In the steamer that brought me from Valparaiso to Panama, a per- son afflicted with leprosy came on board at one of the ports at which the steamer touched, to the displeasure of all the passengers, and went into the dining room. He landed in a port of the same. Republic, and no precautionary measures were taken against him. When he landed. I inquired whether the bedclothes used by said person had been disin- fected, or whether any disinfection had been made, and learned that absolutely nothing had been done. I call attention to this serious case, because it should be borne in mind by the nations who had accepted the Convention of Washington. THE CHAIRMAN. If no one wishes to make any further remarks, I beg to suggest the following resolution to the Convention : It should be recommended to the Governments represented at this Convention to enact a law prohibiting the immigration of persons afflicted with trachoma or beriberi to each of the respective countries. DR. ROBERTS. By preventing the emigration of persons afflicted with trachoma from one country to another, we actually prevent the intro- duction of trachoma into any nation, and as we are here assembled for a common purpose for a Pan-American purpose it seems to me that we should, at the same time, devise means for diminishing the number of persons afflicted with trachoma, and to this end it would be very desirable to submit such patients to a special inspection by the local authorities, in order not only to diminish the number of said patients, but also to avoid the transmission of the disease to the other inhabitants of the town. THE CHAIRMAN. Does any of the delegates wish to make any re- marks on the subject? (No one desired to make any further remarks on the subject.) In accordance with the resolution adopted at the first session, it was agreed that if one of the subjects to be discussed at a certain ses- sion should become exhausted, we should proceed to discuss the next topic in the following session, and, therefore, I open to discussion the subject corresponding to Friday's session, namely, "Discussion on the Measures to Prevent the Transmission of Tuberculosis on Board of Vessels and in Railroad Cars." We may say that the subject of tuber- culosis is open to discussion the world over. If at the present sanitary convention it were possible for us to discuss the measures to pre- vent tuberculosis, it is evident that we would not have enough time at the sessions we have at our disposal not even if we should have a double number of them to exhaustively treat this subject. My pur- pose is simply to request the delegates here present, and to those who, like Dr. Roberts, have had great personal experience in the treatment of this disease, to help me in the study already undertaken, since we do not propose to introduce a novelty, but only to agree among our- selves as to the precise rules that should be put in practice in order to prevent the spread of said disease on board vessels and in railroad cars. We know positively that there are two ways of contracting the dis- ease, namely : through the respiratory apparatus, and through the 68 THIRD INTERNATIONAL SANITARY CONVENTION. digestive apparatus. We should not concern ourselves with the diges- tive apparatus because there are rules already established and well known to the delegates, as for instance, the taking of good food and good drinks. Therefore, it is not necessary to establish any inspection except on vessels where it is really of the greatest importance to in- spect the manner of preparing food for the purpose of preventing the transmission of tuberculosis. With regard to railroad cars, the means which have been proposed are many, but I beg to suggest some of them because they can be easily applied. I am going to show you an apparatus which was constructed by a countryman of mine, and which has the following advantages : It is a cuspidor made to be placed next to each seat in railroad cars. The cuspidor is small because they are to be used near the persons, but it is evident they could be made larger if desired. The principal fea- ture of the invention is that a continuous current of water passes through ; as soon as the cover is lifted and one spits into the cuspidor, an antiseptic liquid, such as a solution of carbolic acid, bichloride of mercury, lime water, or the like, commences to flow, and drops into an interior deposit in the car. Another colleague of mine suggested to me that perhaps it would be better to cause the sputum to fall on a heated metallic plate, heated either by steam or electricity. In this way, the sputum, being thrown on the plate, the liquid part thereof is evaporated while the solid part is consumed. I call the attention of the delegates to these suggestions because they may induce other persons to devise other means that have not occurred to me. Of course, we should not forget the recommendation to thor- oughly clean the cars, and allow only those persons to expectorate who have portable cuspidors, require the cleaning of seats, and not permit the dusting in cars as is done at present, not to improperly use the broom, and to clean the floor with wet rags, to disinfect the bedclothes used in sleepers, and periodically the coaches themselves. I would add that these measures have already been put in practice. Bedclothes are the most apt to transmit any disease, and a special recommendation must be made concerning this. In American and iMexican coaches, these blankets are placed between two sheets, so that the latter may be easily disinfected, but perhaps it is not so with regard to the pillow cases. These are the means which have been suggested to me, and I request the delegates to point out any other that might occur to them. DR. ROBERTS. Mr. Chairman and delegates: In accordance with the prophylaxis of tuberculosis on vessels, we have necessarily to divide the latter in two classes, namely, ocean and coastwise steamers. The latter, which constitute an integral part of the nation, should be subject to the prophylactic measures on tuberculosis imposed by said country, but with regard to ocean steamers, the difficulty for us is greater, for a very simple reason: each vessel has its rules and regu- lations imposed by the nation to which it belongs, and therefore, said vessel will not submit to rules prescribed by another nation. For in- stance, take an Italian, or the vessel of any other nation, having on board Italian immigrants, which is required to have on board a physi- cian for a giv^n number of immigrants, and to have on board a small THIRD INTERNATIONAL SANITARY CONVENTION. 69 dispensary with a special petitoric. This is done by Italy in order to protect its emigrants, but as we have no emigration, but only immi- gration, we cannot, therefore, demand, and it is almost impossible to expect others to submit to certain regulations, which would have to be prescribed by the nation to which the vessel belongs or to which the emigrants belong. There is no doubt that third class passengers are most liable to con- tract tuberculosis on board vessels, because they live in common, and it seems to me that it is especially in that part of the vessel where the severest measures should be enforced, causing the same to be dis- infected after the landing of the immigrants who occupied it. These immigrants, who are crowded on the vessel and poorly fed, are un- doubtedly those who are most liable to contract tuberculosis. DR. VON EZDORF. My idea on the subject of tuberculosis on vessels is that we cannot take any particularly extraordinary measures against tuberculosis in the traveling public ; but one measure I think we should take in regard to vessels, and that is the examination of crews, to pro- vide that crews at least should be free from tuberculosis. As for the other measures, of course there are always some laws or regulations adopted to prohibit expectoration in public places or places where people congregate, and there should always be regulations of that kind on a vessel. There have been a number of suggestions made in this connection, and one that I have thought would be applicable, is the use of paraffine paper spit cups that could be made in a very cheap form and might even be distributed by means of slot machines, where you could get them for probably a penny or two pennies, with printed directions on the machine how to use the cup and directions for its disposition after it has been used for some time. Provision could be made for the destruction of the expectoration and the cup at one time by fire, which is the best way to disinfect infected expectoration. I have one other proposition which I think would be a good one, and that is the screening of all the living quarters of a vessel. I believe that is practicable. It would tend to protect the vessel against mos- quitoes and flies. On vessels the dining and living quarters frequently swarm with flies come in contact with infected expectoration they may deposit some of the organisms or some of this matter in the food or the milk, or in any of the edibles, and I believe that is one way by which tuber- culosis may be spread. I therefore consider that the screening of all living quarters is advisable on board a vessel. I had some other points on this subject which I intended to present; I did not know it would be taken up this afternoon. DR. FERRER. One of the things that any traveler may observe on board a steamer is the fact that napkins are not changed every day. In some steamers they change them only on Sundays, and frequently the napkin which has been used by one person is given to another. It would be advisable to follow the custom observed in sanitariums, namely, to place the napkins in a waterproof cover with the name of the person thereon. In many cities it is quite a common thing to see signs prohibiting expectoration, yet, it was in one of the most progres- sive cities I have visited where these signs are used .and where fines 7O THIRD INTERNATIONAL SANITARY CONVENTION. are imposed for the violation of this rule that I saw the greater num- ber of people expectorating on the floor. It would be advisable to devise some practical means of compelling the observance of the rules referred to on these signs. Chilian railroads have made great progress so far as disinfection is concerned, but there is a custom which should be taken into considera- tion in the discussion of tuberculosis, and that is a war against the broom and the duster, which are in common use in our countries. The program only refers to measures against tuberculosis on steam- ers and in railroad cars, but I think we could go beyond said program and make some other recommendations, such, for instance, as the one proposed by Dr. Soza in his report, prohibiting the employment of consumptive schoolmasters. This has already been prohibited in some countries, but in many others there are consumptive schoolmasters who continue to teach. I have made these remarks in a brief manner because I was not prepared for this discussion. DR. GONZALEZ. On one of my last journeys, I observed something that suggested an idea to me. By chance I went to the quarters of the steerage passengers at the time the crew was at dinner, and noticed that all the members of the crew were crowded together, and among them was one who was evidently a consumptive, All of them took their dinner in tin pails which are washed in a basin of dirty water, and wiped with the same rag. Could we not devise some beneficial measure for the prevention of contagion, by ordering the disinfection of these utensils ? DR. ROBERTS. I simply desire to make an explanation which may, perhaps, be desirable. We cannot legislate concerning foreign vessels, but only concerning our own, and the danger does not lie in the latter, but in the former. DR. MENDIZABAL. With reference to the question of the prophylaxis of tuberculosis which is being discussed, I regret to say that we have been propagating panic to such an extent that at present people are afraid of a person simply because he expectorates or grows thinner, and in some places this fear has been carried to such an extreme that I know a town where persons are taken to the Police Court only be- cause they find themselves in the condition referred to above, and hotel keepers are fined heavily because they allow people in delicate health to stop in their houses, and, what is still worse, a fine of $50 has been imposed on some people who have expectorated in the street. There- fore, a kind of microphobia has been developed. I may perhaps be told that this fear is the waiting room of prophylaxis, but I would add that in my opinion it has become a real disease, because some persons seem to be even afraid of their own shadow. That does not mean, of course, that I am opposed to the adoption of measures in this case, because I am one of those who earnestly recom- mend cleanliness because I consider it the principal factor in life. It is right to prohibit expectorating on the floor, because it is dirty and vulgar to do so, but we should not frighten people, making them believe that simply because they pass near the sputum of a person afflicted with tuberculosis they will be infected. Those of us who have been practicing medicine for thirty or forty years have witnessed three evo- lutions : there was a time when we did not fear tuberculosis ; after- THIRD INTERNATIONAL SANITARY CONVENTION. /I wards we commenced to fear that the disease might be somewhat contagious, and we now know that it is highly contagious, but our fear has not increased to such an extent as to be exaggerated, because if through the sputum of a consumptive, real contagion should occur, many millions of human beings would have perished by this time. Our lives are full of fears, and we should avoid increasing them, besides, it is really very painful and sad to see society a victim of fear. A new doctrine is now being advocated, and seems to prevail in Europe, namely, that contagion cannot be acquired through the respira- tory organs, and lately Behring's works, and still later those of Clem- ent, have demonstrated that the greater number of infections have been acquired through the digestive organs. Therefore, we are now able to see that we should not fear an expectoration which the rays of the sun will destroy, and that we should not be so much afraid to stay in a railroad car where it will be sufficient to open the windows and let in the air and the sun in order to disinfect it in a more thorough manner than could possibly be done by all the antiseptics known in the world. Gentlemen : We all know; because we have traveled a great deal by rail in the United States, for instance, that the trains there lack light and air, which are without doubt the best disinfectants that we have, and which have been granted us by Divine Providence. Now, then, I, in the name of humanity, inasmuch as we are here assem- bled to discuss humanitarian questions, request you to be a little more humane and kind to those unfortunate consumptives. If they do not cause us as much harm as it is supposed, and if we know that the person who enjoys good health and is well fed has nothing to fear, because we have seen many healthy and strong persons who have been in close contact with persons afflicted with tuberculosis, why should we then entertain such fears? Would any of us tolerate, when trav- eling, accompanied by his wife, that she should be ordered to leave the train simply because she was supposed to be afflicted, or even though she was really afflicted with tuberculosis? Let us then be humane, and adopt all the measures proposed, which I cheerfully accept, but let us also avoid the spreading of panic, by putting before the people an invisible enemy which causes great fear. THE CHAIRMAN. The hour for adjournment, in accordance with the rules of the Conference, having arrived, should any delegate desire to make any remarks, he can do so at the next session. The session adjourned. 72 THIRD INTERNATIONAL SANITARY CONVENTION. FIFTH DAY, FRIDAY, DECEMBER 6. Morning Session. The session was called to order by the Chairman, Dr. Liceaga, at 9 a. m., the following delegates being present: Doctors Oswaldo Gongalvez Cruz, Ricardo Gutierrez Lee, Genaro Payan, Hugo Roberts, Juan Guiteras, Ernesto Soza, Pedro L. Ferrer, Juan Horacio Estevez, Walter Wyman, R. H. von Ezdorf, P. T. Straub, James Gatewood, Rhett-Goode, H. L. E. Johnson, Salvador Ortega, Jose Azurdia, Luis Lazo Arriaga, Gregorio Mendizabal, Rodolfo B. Gonzalez, Ernesto F. Espiro, and Juan J. Ulloa, Secretary. The minutes of the previous session being read and approved, the delegates of Costa Rica, of Uruguay, Brazil, and Chile, proposed, in the name of their respective Governments, the capitals of their respec- tive countries as the place in which to hold the next international sani- tary conference, and these propositions were referred to the Advisory Committee. THE CHAIRMAN. In accordance with the resolutions adopted at the last session, we will now continue the discussion of the measures con- cerning international sanitary police for preventing the transmission of tuberculosis on board vessels and railroad cars, and to that end Dr. von Ezdorf continues to have the floor, and will read an address which he did not have with him at yesterday's session. DR. EZDORF. I should like to conclude what I had to say in regard to the transmission of tuberculosis from individuals on board vessels. I mentioned yesterday the advisability of having paraffine paper cups provided on board ship and also the screening of the vessel, as practical measures. In regard to vessels carrying passengers, we have to divide the ships into two classes. We have ships that carry a large number of persons, immigrants, etc., and others that simply carry cabin passengers, first and second class passengers. We also have ships which make only short voyages, and other ships that make long voyages, so that we have to discuss each one of these separately. Now in regard to persons on board the ship that is carrying a large number of passengers : I think one of the first measures that we have to consider is that they should be educated to understand that the prac- tice of expectorating promiscuously in places frequented by others may be dangerous to their fellow men. I think every one will agree to that, that expectoration is a filthy habit. The second proposition is that all persons should be encouraged to use individual drinking cups, and also cheap paraffine paper cups might be provided for use as expectorating cups individual cups. Now, a point that I wish to make in regard to the third class pas- sengers, or steerage passengers, whom Dr. Roberts referred to as being the most dangerous individuals on board the vessels and more likely than the other classes to infect the living Quarters, because of lack of ventilation and lack of care is that the only provision we could make THIRD INTERNATIONAL SANITARY CONVENTION. 73 in regard to those passengers is to endeavor to have them understand that they must not expectorate any where except in the places provided for that purpose, and one of the most practical measures that I think could be adopted on board ship is the use of the paraffine paper cup al- ready mentioned, to be placed folded into a tinform which might hang along the sides of the bunks. As we know, these large steerage passen- ger vessels are very crowded, and the passengers are in bulks one over the other, sometimes in tiers of three. These cups can be used in cases of seasickness and for all ordinary expectoration. I think that is all we can possibly do with regard to that class of passengers. These cups could be destroyed by fire, or thrown overboard at sea. That is practicable for any vessel, whether a long-trip or a short-trip vessel. But with regard to a long-trip vessel where the passage is, say, two or three or four weeks, I think there should be a disinfection of those quarters or barracks of the steerage passengers at the end of each voyage. With regard to the short-trip vessels, where the passengers are in these steerage barracks for only two, three or four days, I think that periodical disinfection would be quite sufficient. Whatever measures we wish to adopt should be practical and easy of application, and these have occurred to me as the most practical and easily understood by the steerage passengers that we have to deal with. As far as the cabin passengers are concerned, I think they can under- stand instructions, wherever they may be placed in printed form about the cabins. I conclude this exposition with the following conclusions : 1. The traveling public should be educated to understand that the practice of expectorating promiscuously about in places frequented by persons may be dangerous to his fellow-man. Expectoration is a filthy habit and should be made punishable. 2. All persons should be encouraged to use individual drinking cups and cheap paper paraffined cups should be provided on all vessels for passengers. 3. Disinfection of vessels and furnishings of short-trip vessels periodically. Disinfection of steerage passenger barracks at end of each voyage if the voyage has been a longer one. 4. Notices should be posted in steerage quarters and living quarters enjoining passengers not to expectorate on floors. 5. Crews of vessels should be examined physically before being given employ- ment. 6. Screening as far as practicable the kitchen, dining rooms and all living quarters as a protection against flies. 7. Whenever paraffined paper cups are provided, printed instructions should be printed on cups as to use and destruction. DR. SOZA. Mr. Chairman: The Chilean Delegation, in accordance with the provisions of the provisional program, which requires that each delegate shall give his opinion as to the manner of preventing the transmission of tuberculosis on railroad cars and vessels, has deemed it advisable to submit to the consideration of this Conference the following recommendations: PROPHYLAXIS OF TUBERCULOSIS ON RAILROAD CARS AND STEAMERS. I. To avoid, as far as possible, in dormitories the use of fixed carpets and curtains. 74 THIRD INTERNATIONAL SANITARY CONVENTION. 2. To recommend the use of cuspidors which should be profusely distributed. 3. The periodical disinfection of cars or berths, including furniture, beds, etc. 4. The disinfection of dining room utensils. In the dining rooms of steamers where napkins are not changed after each meal, the napkins shall be kept in special envelopes. 5. The examination of the personnel and rejection of persons suspected of being afflicted with tuberculosis. 6. Notices posted in conspicuous places which shall read : TO SPIT ON THE FLOOR IS A FILTHY AND IMPOLITE HABIT WHICH OFTEN CAUSES THE SPREAD OF CONTAGIOUS DIS- EASES. DR. JOHNSON. Mr. President and members of the Convention: In accordance with the preliminary programme, I have the following com- ments to make with respect thereto : We recommend to the several American Republics that they take the necessary steps toward the codification of all the Health Laws and Regulations, both statute and police, and present the same to the Bureau of American Republics at Wash- ington. The ultimate object being the unification of all such laws and regula- tions. (This motion was referred to the Advisory Committee.) DR. LAZO ARRIAGA. I have heard with pleasure the opinion ex- pressed concerning the prophylaxis of tuberculosis on steamers and railroad cars. I think that all, or at least the majority of us, accept the means suggested for that purpose, and that the principal and almost the only one that could be put in practice is cleanliness ; but it seems to me that we should not put difficulties in the way of those afflicted with tuberculosis who desire to travel, or to prevent them from doing so, because, what would be said of a physician who would tell his patient, you can not be cured? What would be said of a physician who would say to his patient : You have such and such a disease ? It would be an injury to the patients, and yet that is just what we would be doing by excluding from steamers and railroad cars per- sons afflicted with tuberculosis. We were told yesterday that the greatest difficulty in transporting the sick was among second class and steerage passengers. I do not agree with this view of the matter. The poor afflicted with tuberculosis do not travel, not only because they can not afford it, but because they do not desire to do so, and those traveling as emigrants are look- ing for work and not for health. The sick who travel for the benefit of their health are the rich, that is to say, those who can pay first class passage, and they will have a physician on board who will sug- gest to them the necessary means not to endanger the health of the other passengers. As I said before, it is not proper to reject such passengers, but to subject them to the observance of certain rules, and to prevent them from knowing that they are seriously ill. With regard to steerage passengers, and I make this as a motion, I think the steamship companies should be requested to treat the sick as they are treated in hospitals. Many a time it is not poverty that abounds so much in the lower decks of vessels as it is filthiness ; people who are starving do not go there; the danger lies in filth, and the steamship companies might compel passengers upon receiving them on board to take a bath ; they might furnish them with a special dress THIRD INTERNATIONAL SANITARY CONVENTION. 75 for the voyage, cause their clothes to be washed and disinfected, de- livering the same to them at the place of landing. I believe this would be a beneficial measure both to the passengers and to the country. DR. AZURDIA. On board the steamer on which I came to this city with Dr. Ortega, one of the passengers had a hemoptysis which en- dangered his life. We had occasion to assist him, and we observed that the physician on board the steamer paid absolutely no attention to that very important disease. Fortunately, the patient recovered from the hemoptysis in spite of the indifference shown by the physician on board the steamer, but it seems to me that it would be worth while for the Convention to recom- mend to the different governments to require that the physicians em- ployed on board steamers be duly qualified, and to have, in addition, some knowledge of contagious and infectious diseases, and to be able to advise the necessary prophylactic measures that should be taken in order to protect healthy persons from all danger of contagion. Therefore, I believe that it would be worth while to recommend this matter to the Governments of the American Republics. THE SECRETARY. I am going to make a motion, in order to save time. Good scientific measures have been proposed, based on a knowledge of tuberculosis, and also on the experience of physicians, in order to prevent the spread of this disease on railroad cars and steamers. Fortunately almost all the delegates agree as to the majority of the measures submitted, and, consequently, I move that Dr. Soza, delegate of Chile, and a specialist in the matter, be requested to collect all the opinions and condense in one single proposition all the measures re- sulting from the different resolutions, in order to submit said proposi- tion to the -consideration of the Committee on Tuberculosis. DR. GUTIERREZ LEE. I entirely agree with all that has been pro- posed concerning the practical measures against tuberculosis, but it seems to me that it is necessary to do something more. I would advise as an additional measure concerning the prophylaxis of tuberculosis that on all newly constructed railroad cars and steamers, there shall be provided a special place for the accommodation of consumptives. At present we find that in ordinary cars two or three sick persons may travel, and if the cars that are to be constructed, because progress has to sanction modern sanitary measures, a special department should be established, that is to say, an infirmary for persons suspected of being afflicted with tuberculosis, I think good . results would be obtained. Formerly there were cars on which travelers were exposed to the inclemency of the weather, but at present we find that railroad cars have berths, dining rooms and sitting rooms. Therefore, I believe that it would be an easy matter to secure special cars for the accommo- dation of patients, since otherwise, if proper attention is not given to the unfortunate consumptives, we would revert to the usages of the Middle Ages when legislation was so severe that patients were seized in their own houses, and even their property was taken away from them. I have read in a certain book that when leprosy prevailed in England and Germany, those afflicted with that disease were not allowed to go into the street and their property was taken from them. In fact they did everything short of shooting them. I think that we should try to devise means of avoiding diseases, but 76 THIRD INTERNATIONAL SANITARY CONVENTION. in such a way that the patients may have such liberty of action as it would be inhuman to deprive them of. If a person afflicted with cachexy, for instance, a Frenchman or a Spaniard, residing in Vera Cruz, wishes to return to his country, he faces two propositions ; either the steamship company admits him in spite of his disease, or he is detained by the physician who acts as an .intermediary between the company and the people. In this way the patient is deprived of his desire to die in his country, or of the hope of being cured there. Should the steamship and railroad companies have a complete infirmary then the patient would be able to travel and the companies would be able to transport him. Therefore, we should not be inhuman ; science should be charitable, and should not deprive a person carrying the germs of a disease, the virulence of which we do not yet know, of his freedom of action. This would be equivalent to the provoking of a social revolution. THE CHAIRMAN. The motion made by Dr. Ulloa to the end that the opinions expressed heretofore be referred to Dr. Soza, so that he may make a summary of the same and submit it to the proper committee, is now under discussion. Does any one wish to make any remarks? Shall it be approved? The motion is approved. DR. MENDIZABAL. I have requested the floor simply to make some remarks, in addition to what I said yesterday, on tuberculosis. I am very glad that Dr. Gutierrez Lee approves the humanitarian measures I took the liberty to suggest, because I still believe that the most advi- sable means are the most efficient in case of a disease the transmis- sibility of which is comparatively small. Therefore, we should proceed with great circumspection and care, since otherwise I think the unfor- tunate consumptives would have to announce their advent by the ring- ing of bells, so that everybody could avoid them as they pass by. I desire again to call attention to the difficulties of the modern sys- tem of navigation, and the necessity and advisability of adopting a common sanitary law, since otherwise we would have to encounter the greatest of difficulties. I beg to mention an instance. On the large and good Chilean steamer in which I made my last voyage, there was a physician, a medical student, who knew nothing about medicine. There were many passengers on board, and the quantity of merchandise was such that it was stored in the quarters reserved for steerage passengers, and the latter mixed with cabin passengers. The steamer had touched at several places infected with bubonic plague, and, in spite of this fact, everybody was allowed to freely visit the vessel, and to come on board and sell their wares to passengers, such, for instance, as Panama hats, not stopping to think that perhaps some of those who came on board had slept in the same room occupied by a person afflicted with the bubonic plague. There was not on the vessel even a poor quality of vaccine to resort to in case of necessity. These dangers could be avoid- ed if we would .adopt a general sanitary law, since then everybody would doubtless take the proper precautionary measures. We arrived at a port in Ecuador, Guayaquil, where there was no lazaretto, nor any other suitable place for the isolation of the sick, and inasmuch as, for this reason, passengers were not allowed to land, it happened that several of them who were going to Peru were com- pelled to go to Panama and thence continue their voyage. These THIRD INTERNATIONAL SANITARY CONVENTION. 77 difficulties could be remedied by a law to which all of us would have to submit. The only law now in force is that of the Convention of Wash- ington. There is a maxim which says that the desire to obtain the best thing possible, some times prevents the attainment of a good thing. If we have something that is not very good, let us adopt that which is the best that we could possibly obtain, even though it may not be the best. With reference to tuberculosis, I said that traveling is becoming so difficult that it will be necessary to have special trains, such as they now have in the United States for colored people, who, because they have thick lips and kinky hair, it is believed that THE CHAIRMAN. I beg to remind Dr. Mendizabal that, in accordance with the rules adopted, the speakers can only have the floor for five minutes. DR. FERRER. The remarks made by Dr. Mendizabal concerning navigation on the Pacific are true. There is no sanitary service on board the steamers. I remember having been obliged to rise very early one morning in order to attend some passengers because the physician on board did not know what to do. As this is a question affecting the national honor, it is my duty to state that Chilean medical students are not to be found on all Pacific coast steamers. What is said of Ecuador concerning this matter, is true, as the rep- resentative of that country will admit, but it should also be said that there was a floating lazaretto at the port of Guayaquil, which lazaretto was wrecked, and a new one is now being constructed, though of a provisional character. Yesterday I mentioned the fact that some countries allow persons afflicted with leprosy to embark for foreign ports, but do not allow them to travel from one port to another within the country. DR. WYMAN. Mr. President and Members of the Convention: In accordance with the preliminary programme, I have the following com- ments to make with respect thereto: 1 have a resolution to offer not on this subject, however. I would like to inquire if it is pertinent or the proper time to introduce it. Whereas, It was declared by the Third International Conference of American States held at Rio Janeiro in August, 1906, that the Sanitary Convention should resolve upon the following, viz: The establishment of relations between the International Sanitary Bureau now existing in Washington and the Bureau Sanitaire de Paris, in order to obtain the best information on Sanitary subjects and to reach agreements that will facilitate the objects with which both offices are established, and Whereas, the said Bureau Sanitaire International de Paris, though not yet established, will be established in the near future. Resolved, That the International Sanitary Bureau at Washington is author- ized to take such measures as may be necessary to carry out the Instructions contained in the aforesaid resolutions of the Third International Conference of American States held at Rio Janeiro in August, 1906. THE CHAIRMAN. Let it be referred to the Advisory Committee. DR. GATEWOOD. Mr. President, I desire to present the following resolution, with a request for reference to the Advisory Committee : Resolved, That the Sanitary Conference recommend the establishment of sep- 78 THIRD INTERNATIONAL SANITARY CONVENTION. arate hospitals or special wards for the care or treatment of tuberculosis patients. DR. ROBERTS. I request the floor in order to present the two fol- lowing propositions: The undersigned states that, inasmuch as both the railroads and the steamers constitute an integral part of the nation to which they belong, such prophylactic measures as are adopted on said railroads and steamers to avoid the spread of tuberculosis, should be the same as those for hotels, boarding houses, etc., in the nation to which said railroads and steamers belong. Inasmuch as the object of the Conventions of the American Republics is to unite the quarantine processes in order to protect public health, causing the least possible injury to international commerce, and Whereas, owing to the lack of uniformity of the bills of health issued in the different American nations, it is difficult to form an exact opinion concerning the same, because they often fail to furnish all the necessary details, I, there- fore, beg that the following propositions be adopted: 1. That in the next meeting of the International Sanitary Congress the model forms of the documents to be used by the nations accepting the Convention, be discussed and approved in order to render uniform said documents. 2. That in every port open to foreign commerce, the sanitary authorities shall issue bills of health to all vessels applying for same, in accordance with model form adopted by the next Convention. THE CHAIRMAN. Let this resolution be referred to the Advisory Committee. DR. FERNANDEZ ESPIRO. In the brief exposition I had the honor to make last night concerning the International Sanitary Convention of Paris, or, in other words, to that of Washington, which has been based on the former, I expressed the opinion which I entertained regarding a certain clause of that International treaty. Therefore, in accordance with said views, I have thought that this Convention might do a good work on meeting again, if it should endeavor to make such amendments as may be deemed advisable at said Convention of Washington, with- out prejudice to recognizing the merit of its work, and the noble ends which have guided the persons who participated therein. I believe that a committee could be entrusted with the duty of formulating a plan of sanitary agreement of the Republics, and to submit the same at the next Convention. This opinion is shared by the delegate of the Republic of Brazil, and in the name of the country which has sent me here, I am going to make a motion to the Convention, hoping that it may be favorably received by the delegates. This brief motion is as follows: The delegates of Uruguay and Brazil propose: 1. That the Convention appoint a committee for the purpose of presenting a plan of an International Sanitary Convention of the American Republics to become effective upon the expiration of the Convention of Washington, said plan to be considered by the Fourth Convention. 2. The Commission appointed shall forward said plan to the Chairman of the International Sanitary Office at Washington, in order that said Chairman shall in turn, take the necessary steps so that it may be known in advance by the Governments of the American States. The latter part of the motion tends to overcome the inconveniences and difficulties encountered when the work is not made known before- hand to the Governments invited to attend these conventions. THIRD INTERNATIONAL SANITARY CONVENTION. 79 THE CHAIRMAN. The motion made by Drs. Fernandez Espiro and Gongalvez Cruz is referred to the Advisory Committee. In order to make the best possible use of the short time at our dis- posal, and in accordance with the agreement made at the first session, the consideration of the modifications made in the frontier ports and cities in the different countries, is now in order. We have a very short time now, so that the reading of any report concerning what the Mexican Government has done would take all the time of the session. In order that the reading may be as short as possible, and that it may be, at the same time, instructive, I have caused an album to be placed in the hall containing views of the drain- age and water supply works which have been constructed in the ports of Veracruz, Coatzacoalcos, Salina Cruz, Manzanillo and Mazatlan, as well as views of the sanitary stations in Veracruz, Salina Cruz, etc. On the maps placed on the blackboards will be found the complement of these works. I have only mentioned the improvement made at the ports, and if I had time I would call attention to those that have been made in the States of the interior of the Republic, whose authorities have sent here the plans and drawings of the works. These documents are on exhibition in the next room. I shall only read the report made by the Mexican delegation in which are set forth the expenses incurred on account of said works. (See Appendix, page 186.) DR. FERNANDEZ ESPIRO. I have listened with pleasure to the re- port just read by the Chairman of the Convention concerning the im- portant sanitation works carried out in the Mexican Republic. In conformity with the opinion of all the delegates, I beg to propose that the favorable impression which the perusal of said report has afforded us, be forwarded to the Government of the Republic of Mexico through the Chairman and Secretary of the Convention. THE SECRETARY. I second the motion of Dr. Fernandez Espiro. THE CHAIRMAN. I gratefully accept the suggestion made by the delegate of Uruguay, and seconded by that of Costa Rica, and shall take pleasure in making it known to the Government. DR. FERNANDEZ ESPIRO. I desire that it be by a vote of all the dele- gates, saying that the Convention hereby expresses the great pleasure with which it has listened to the reading of the report of Dr. Liceaga, and desires that said manifestation be made known to the President of the Republic. The motion was unanimously carried. THE CHAIRMAN. I once more thank you for this honor. DR. FERRER. Inasmuch as several motions have been presented con- cerning matters which should be submitted to the consideration of the next Convention, it seems to me that it would be advisable to appoint a special committee to make a report to-morrow on the matter, or that the committee kindly submit a complete plan so that we may have a basis in order to consider these matters at the next Convention. DR. GUITERAS. I request the floor in order to state that Dr. Ferrer's motion is of a dual character, and I believe this matter should be re- ferred to the Advisory Committee. 8O THIRD INTERNATIONAL SANITARY CONVENTION. THE CHAIRMAN. I agree with Dr. Guiteras, since there would be no time to appoint the committee suggested by Dr. Ferrer. Therefore, the matter is referred to the Advisory Committee. DR. MENDIZABAL. As I said in the previous session, I believe that the subject referring to syphilis and other venereal diseases, which cause such great ravages to mankind, should be discussed at the next convention. Therefore, I beg to make the following motion: Whereas syphilis and other venereal diseases wtiich at present may be called the modern plague, cause such great ravages to modern society, degrading the human race, predisposing to the contraction of many other diseases, the delegate of the Republic of Nicaragua submits to the consideration of the Convention, the following propositions: First. Let the question of the uniformity of the means of defense which each country should take in order to prevent the spread of syphilis and other venereal diseases be recommended to the consideration of the next International Sanitary Convention of the American Republics. Second. Let these diseases be included in the list of diseases like yellow fever, bubonic plague, cholera, beri-beri, etc., against which all nations are endeavoring- to protect themselves. THE CHAIRMAN. Let the motion of Dr. Mendizabal be referred to the Advisory Committee. DR. WYMAN. I beg leave to present to the Convention a report from Dr. A. H. Doty, of New York, in compliance with some of the features of the preliminary programme, and he has also transmitted photographs of the work that has been going on in Staten Island for the elimination of mosquitos by drainage of swamps. I will turn this in to the Secretary for such use as he may be able to make of the illustrations or of the articles in question. I would suggest that the photographs might be left on the tables for the members to examine. I also wish, Mr. President, to invite attention to some very inter- esting papers that have been transmitted by Dr. Samuel G. Dixon, Commissioner of Public Health of the State of Pennsylvania. They have come to me since my arrival in Mexico, and I have placed them on the table. They show the operations of the Department of Health of the State of Pennsylvania in its several divisions, with a number of photographic illustrations. Dr. Dixon asked me to kindly transfer these to Dr. Liceaga as President of the Superior Board of Health, after they have been ex- amined by the members of this Convention, and I trust that Dr. Liceaga, as President of the Superior Board of Health, will kindly accept them from Dr. Dixon. I move that the reading of that report be dispensed with at the present time. I think it would take quite a long while, and it can be included in the proceedings. THE CHAIRMAN. I beg to remind those present to be at 3 o'clock sharp today at the patio (yard) of the building of the Superior Board of Health where the automobiles which will take us to the Colonias de la Condesa, Roma, and Juarez will be in waiting for us. I again recommend the delegates to be punctual. The meeting adjourned. THIRD INTERNATIONAL SANITARY CONVENTION. 8l Night Session. The session was opened at 7 p. m. by Dr. Liceaga, the Chairman, The following delegates were present: Doctors Oswaldo Gongalvez Cruz, Ricardo Guiterrez Lee, Genaro Payan, Hugo Roberts, Juan Guiteras, Ernesto Soza, Pedro L. Ferrer, Juan Horacio Estevez, Wal- ter Wyman, R. H. von Ezdorf, H. L. E. Johnson, Salvador Ortega, Jose Azurdia, Luis Lazo Arriaga, Engineer Hilario Elguero, Doctors Gregorio Mendizabal, Rodolfo B. Gonzalez, Ernesto Fernandez Espiro, and Dr. Juan J. Ulloa, Secretary. The minutes of the morning ses- sions were read and discussed. DR. ROBERTS. Mr. Chairman : I have presented two propositions so that they may be taken into consideration at the next Convention, and I notice that only one of them is mentioned in the minutes. THE SECRETARY. Dr. Roberts is right. Owing to an involuntary omission, said proposition is not mentioned in the minutes, but it will be added to them. The minutes were approved as corrected. THE CHAIRMAN. The subjects to be discussed at to-night's session are the following: Reading of such papers as may be submitted, the object of which is to discover the germs of yellow fever; those the purpose of which is to determine whether there are other mediums of transmitting yellow fever and malaria, than the mosquito bite, and such other essays as may be submitted dealing on the improvement of the method of warring against mosquitoes. These are the subjects to be discussed, and if the Convention will permit, I will grant the floor to Dr. Soza, delegate of Chile, so that he may read a paper on the manner of combatting tuberculosis on board railway cars and steamers. . DR. SOZA. Mr. Chairman: I have the honor to submit to the Ad- visory Committee the following summary which agrees with the several motion made by the following delegates : Dr. Ricardo Gutierrez Lee, of Colombia; Dr. Hugo Roberts, of Cuba; Dr. R. H. von Ezdorf, of the United States; Dr. H. L. E. Johnson, of the United States; Dr. Jose Azurdia, of Guatemala, Dr. Luis Lazo Arriaga, of Honduras; Dr. Eduardo Liceaga, of Mexico, and the Chilean Delegation. 1. To avoid, as far as possible, the use of fixed carpets and curtains. 2. To recommend the use of cuspidors which should be profusely distributed. 3. The daily disinfection of cars or berths, including furniture, beds, wash basins, etc. All clothes, including napkins, should be disinfected before being washed. 4. The disinfection of dining room utensils. To avoid keeping napkins to- gether, or if so kept, each should be covered with an envelope of the same cloth, and to avoid the entrance of flies to the kitchen, to the cook's quarters, etc., by covering all openings with wire gauze. 5. The examination of. the personnel before employing the same, and dismissal from service should any of them be afflicted with tuberculosis. 6. All steamers and railway trains should be provided with a special and comfortable department for the transportation of consumptives, and upon trans- porting them projecting decorations, acute angles and holes that may favor the retention of dust, should be avoided. 7. The posting of notices in conspicuous places which shall re^ad as follows : "TO SPIT ON THE FLOOR IS A DIRTY AND IMPOLITE HABIT, AND IN MANY INSTANCES CAUSES THE SPREAD OF CONTAGIOUS DISEASES/' 8. Physicians on board steamers should be graduate practitioners. 82 THIRD INTERNATIONAL SANITARY CONVENTION. THE CHAIRMAN. As it was decided this morning, this proposition will be referred to the Advisory Committee for the proper considera- tion and- decision. Dr. Payan will now read the recommendations of the Committee on Malaria, so that they may be referred to the Advisory Committee. I beg Dr. Guiteras to kindly translate them into English. DR. PAYAN then read the following document : The Committee on Malaria of the Third International Sanitary Convention, after having considered the different motions made on malaria submitted by Doctors Azurdia, Lazo Arriaga, Guiteras, von Ezdorf, and Hugo Roberts, and after hearing the opinions expressed by the delegates who participated in the discussion of the same, has decided to submit to the Advisory Committee the following resolution: 1. To recommend to the governments represented at the International Sani- tary Convention that quinine salts, fine wire gauze to be used for protection against mosquitoes, crude petroleum, ready-made mosquito nets and material used in their manufacture, be exempt from customs duties. 2. To recommend that the governments, through their respective sanitary authorities, carry out the most active popular propaganda concerning a knowl- edge of the etiology, prophylaxis and treatment of malaria, and to encourage public lectures on said subject in the schools, shops, barracks, etc. 3. To recommend that there shall be established in such places as may be necessary, headquarters for the distribution, gratis, of quinine among the poor on medical prescriptions and for the prophylaxis of malaria. 4. To recommend to the governments to direct that the sanitary maritime au- thorities shall state in bills of health issued by them, the mortality caused by malaria. 5. To recommend to the International Sanitary Bureau permanently estab- lished in Washington, the sending of regular reports concerning the existence of malaria in the principal seaports. 6. To likewise recommend to the governments the publication of a handbook in which shall be compiled, in a brief, simple and practical form easily under- stood by the people, information concerning malaria, and afterwards to have an understanding with the Governments on the matter so that they may cause the handbook to be extensively distributed. The Chairman again read the subjects of the program open to discussion, and asked if any of the delegates wished to make any remarks. DR. GUITERAS. I have a short paper that I am going to read con- cerning the last subject of to-day's program, that is to say, the cam- paign against yellow fever and mosquitoes, but before reading it, I wish to refer to the second subject mentioned in said program, or that which has for its object the determining whether there are other means of transmitting yellow fever and malaria in addition to the mosquito bite. With regard to this matter, I wish merely to say that the constant experiments made at the ''Hospital de Las Animas," established in 1901, concerning this disease continue to show from day to day that there is no other medium for the transmission of yellow fever. The experiment to which I refer for the treatment of the cases which occurred in said hospital, taken from the focus where the disease originated, and since that year yellow fever has not spread to any considerable extent among those who are not immune. There- fore, I consider this an experiment which shows from day to day that there is no medium for the transmission of said disease. The report I am going to read is based on a tour of inspection to Cienfuegos. (See Appendix, page 166.) THIRD INTERNATIONAL SANITARY CONVENTION. 83 (On concluding the reading of his report, Dr. Guiteras was enthu- siastically applauded.) THE CHAIRMAN. Dr. Guiteras has just handed to the Chair the translation into English of the paper he has just read. Gentlemen: I have listened with great pleasure to the interesting report made by Dr. Guiteras. In this transmissible disease, yellow fever, the most important point lies in the detection of the first cases. When the sanitary authorities know the focus of infection, then it may be said that they have found the Ariadna thread, which was what happened in the instance referred to by Dr. Guiteras, and then it can be said that the disease is controlled. If the cases were not so numer- ous among the military force as among civilians, what Dr. Guiteras has just told us would be sufficient. In the case referred to by Dr. Guiteras, it was evidently possible to determine, as he has just said, that the mosquitoes which attack the military force came from the midst of civilians, and in this instance it was possible to extinguish the disease because the focus was found. Whoever has the good fortune to detect the first cases may be sure of success. We are fol- lowing the process that Dr. Guiteras has just set forth by means of the flying brigades (I don't know whether they are called by another name in other Spanish countries, but among us we call by this name the groups of men who go from one place to another to discover the occurrence of new cases). I wish to state in as few words as possible the process we tollow in our struggle against yellow fever. The first report is considered as the fundamental basis ; we have yellow fever spies everywhere who give us the alarm by saying: There is a suspected case in such and such place. As the towns are not far from each other, and as there are means of communication, such, for instance, as the railroads which cross the State of Veracruz, I receive the report by telegraph and by the same means I forward the information to the chief of the flying brigade so that he may immediately start to investigate the case. Then he goes to the place, provided with "all the elements of disinfection and for isolat- ing the patient. The isolation is made, steps are taken to find suspected persons, and afterwards the disinfection is made not only of the houses occupied by the patients, but also of those surrounding them. When this operation has been completed, the second follows, namely, the destruction of the larvae, so that they may be quickly exterminated. This process has given excellent results, and if I have taken the liberty to call attention to it, it is simply in order to ratify the views expressed by Dr. Guiteras. As to the difficulties for disinfecting the dwellings, we have not en- countered the great ones to which Dr. Guiteras has referred, because it is the houses of the poor that we have to disinfect, and they are scant- ily furnished, and whatever furniture they have is of little value, and if necessary we pay for it. Therefore, said houses can be readily dis- infected by simply covering the doors and windows. Should "it be impossible to do so, then the sheet referred to by Dr. Guiteras is ap- plied, which we call Victoria, after the city where Dr. Del Rio in- vented it, and I will now tell you the history of it because it is inter- esting. In 1903 we had yellow fever in the city of Victoria, capital of the State of Tamaulipas, and there we found a very intelligent person 84 THIRD INTERNATIONAL SANITARY CONVENTION. whom Dr. Guiteras knew, namely, Dr. Narciso Del Rio. He was a very active man, and for the treatment of and campaign against yellow fever, I imposed upon him the following conditions : "You must not leave until the town is disinfected." Dr. Del Rio made' many attempts at lisinfection, but, inasmuch as the disease reproduced itself continuously in the poor people's huts, which had poorly joined walls, or common reed grass which leaves large cracks between each other, and grass roofs, through which the mosquitoes escape and render the disinfection inefficient, he almost despaired of solving the problem of disinfecting the huts, or jacales, as they are called in Mexico. As I insisted that it was necessary to completely eliminate yellow fever from the City of Victoria, Dr. Del Rio first devised the idea of wrapping up the huts in a canvas sheet. He was led to devise this means by the knowledge he had of the fact that the mosquitoes upon smelling sulphurous acid fly out of the room to be disinfected, or from the hut, as the case may be, through the cracks through which light penetrates. You know the smallest cracks are sufficient for the escape of mosquitoes, as was shown by the ex- perimental study made by the same doctor, which consisted in closing a room air tight, leaving the key hole uncovered, and covering the lock with a funnel with the vertex closed ; introduce ten mosquitoes in the room where formerly there were none, burn the sulphur and then it was observed that of the ten mosquitoes seven had died and three of them had escaped through the lock of the door and were held prisoners in the glass funnel that had been placed there in order to prevent their escape. Therefore, the problem consisted in covering all the cracks and openings through which the light penetrates. The process invented by Dr. Del Rio to prevent the escape of the mosquitoes and which I described in Havana in January, 1904, during the sessions held by the American Public Health Association, is the following: Take a strip of canvas of regular width, nail it to the ground against one of the side walls of the hut; spread the cloth tightly against the wall until it reaches a point underneath the eaves of the roof; fix it there with a strip of wood attached to the wall by means of a support resting on the floor, continue spreading the canvas strip around the eaves of the house, and so on with the inclined plane constituting the roof; then draw it down through the other inclined plane of the opposite side; turn it under the eaves of that side of the hut until it reaches the vertical wall where it is fixed by means of a wooden cross beam or strip similar to that of the other side ; then the strip of canvas is caused to follow the wall into the interior where it is again nailed down. On this strip of canvas the following is placed overlapping each other, and on this layer another is placed, and so until the whole length of the hut is covered. Then the front and rear part of the hut remains to be covered. This is accomplished by sew- ing together other canvas strips, the extent and shape of which must be the same as those of the front of the hut to be covered, and the piece is united by means of a seam to the first of the strips already men- tioned. A similar operation is made with regard to the rear of the hut. Before closing the last part, the combustion of the sulphur is started, and the entrance door is closed. Then the hut is closed air tight within the canvas cover, as shown by the drawings which I have THIRD INTERNATIONAL SANITARY CONVENTION. 85 the pleasure to submit to this assembly. I again repeat that I de- scribed this model in Havana, in January, 1904. To be brief, I will say that the experience we have acquired enables us to advise, as Dr. Guiteras has just said that it hapened in his case, that it is necessary immediately to look for the focus until it is found, and to apply to every house or hut the aforesaid process by using the said cover, and then there is no danger of mosquitoes escaping through the openings. (Applause.) DR. GoNgALVEZ CRUZ. The struggle against yellow fever at Rio de Janeiro, by means of the fumigation of the houses covered with canvas, in order to prevent the escape of the mosquitoes, was tried' at different times. This process was employed in all houses of whatever con- struction and was adopted from the beginning of the campaign against yellow fever. THE CHAIRMAN. Does any other person wish to make any remarks ? In accordance with the rules adopted from the beginning of the sessions, we should proceed to discuss the following subjects, but those to be discussed in the morning session are of such a character that it would not be possible to discuss them in this one, since they are pend- ing decision in the Advisory Committee, and with regard to the sub- mission by each delegate of a paper concerning the organization in his country of a committee composed of three physicians or sanitary officials for the purpose of forming part of the International Sanitary Information Committee of the American Republics, although it would be the only subject that could be discussed, I would say that, so far as I am concerned, although the organization is already made, I have no official advice in the matter, and I think the same is true of the other delegates. At all events, I would request that the session be adjourned so that the Advisory Committee may have sufficient time to work, especially in view of the fact that the session will only last 20 minutes more. The session is, therefore, adjourned. 86 THIRD INTERNATIONAL SANITARY CONVENTION. SIXTH DAY, SATURDAY, DECEMBER 7. Morning Session. The session was opened at 9 a. m. under the presidency of Dr. Liceaga, the following delegates being present : Dr. Oswaldo Gon- galvez Cruz, Dr. Ricardo Gutierrez Lee, Dr. Genaro Payan, Dr. Hugo Roberts, Dr. Juan Guiteras, Dr. Ernesto Soza, Dr. Pedro L. Ferrer, Dr. Juan Horacio Estevez, Dr. Salvador Ortega, Dr. Jose Azurdia, Dr. Luis Lazo-Arriaga, Lie. Jose Algara, Engineer Hilario Elguero, Dr. Gregorio Mendizabal, Dr. Rodolfo B. Gonzalez, Dr. Ernesto Fer- nandez Espiro, Dr. Walter Wyman, Dr. R. H. von Ezdorf, Dr. J. Gate- wood, Dr. Rhett Goode, Dr. H. L. E. Johnson, and Dr. Juan J. Ulloa. The minutes of the preceding session were read and approved without discussion. THE CHAIRMAN. In the morning session of today the following matters will be taken into consideration: Discussion of pending mat- ters; adoption of the resolutions taken in the preceding sessions; pre- sentation by each delegate of a report regarding the organization in his country of a commission composed of three physicians or health officers for the purpose of forming part of the International Sanitary Informing Commission of the American Republics. THE SECRETARY. I will take the liberty to read the first resolution adopted by the Executive Committee : The Executive Committee has the honor to submit to your consideration the following report on the different subjects referred to it ist. To request the delegates from the Governments of Brazil, Colombia, and Uruguay, subject to the full powers with which they are invested, to adhere to the Sanitary Convention of Washington of 1905. THE CHAIRMAN. I beg to submit this resolution to the approval of the delegates and I would allow myself to request the Delegation from Chile to declare also their adherence, as Dr. Ferrer gave us yesterday the most pleasant news that the Government of his country has already under its consideration the ratification of said convention and has mani- fested its adherence. Therefore, I do not believe it necessary for said delegation to make its adherence by signature. DR. FERRER. I thank the President for his kind words, and beg to state that the Chilean Delegation will have the honor to affix its signa- ture to said resolution. THE CHAIRMAN. But as it was already adopted by the Chilean Dele- gation and signed by its representative, I said that we would take into consideration the words expressed by the Delegation of said Republic, stating at the same time it was not necessary for that Delegation to affix its signature to the resolution in question because the adherence had already been made. The resolution was adopted. DR. LAZO-ARRIAGA. In the name of Honduras, I will have great pleasure in signing. DR. JUAN J. ULLOA, OF COSTA RICA, Permanent Secretary; President-elect of the Fourth International Sanitary Convention to be held in San Jose de Costa Rica in December, 1909. THIRD INTERNATIONAL SANITARY CONVENTION. 8/ DR. GUTIERREZ. We accept and are ready to sign the adherence ad referendum. DR. FERNANDEZ ESPIRO. I also accept and with the greatest pleasure I manifest my adherence. Dr. Gongalvez Cruz, Delegate from Brazil, also adhered in the name of his country. THE CHAIRMAN. I am now going to have a copy made of this reso- lution in Spanish, English, and Portuguese, so that it may be signed by all. It is indispensable that there be a center and this is the Department of State of the United States. Therefore, one of the acts because this is an act will have to be sent to the Department of State of the United States and another will be formally filed with the Department, of Foreign Relations of this Republic. As the Secretary is going to withdraw in order to prepare the reso- lutions that were adopted last night by the Advisory Committee, I request Dr. Guiteras that he be kind enough to act as Secretary. Dr. Guiteras took the Secretary's chair. THE CHAIRMAN. As we will have to wait until' the resolutions of the Committee are ready, I move that another matter described in the pro- gramme be taken up, and that the Delegate from Brazil be kind enough to make the presentation referred to in Section 4. DR. GONQALVEZ CRUZ (Reading) : ORGANIZATION OF THE BRAZILIAN COMMITTEE TO FORM PART OF THE INTERNATIONAL SANITARY INFORMING COMMISSION OF THE AMERICAN REPUBLICS. The' Brazilian Commission will be constituted by the Chief of the Demographic Service of the General Bureau of Public Health, and of two assistant physicians from the same division. The organization of that service is already provided for in Section 18 of the Regulations of the Sanitary Services in charge of the Union. The Division of Demography publishes its reports in weekly, monthly, and yearly bulletins. The monthly and the annual bulletins will constitute the source of information that Brazil will furnish to the International Commission. DR. FERNANDEZ ESPIRO. I believe that no other delegate is in the same position as the Delegate of Brazil to present at this moment a report regarding the constitution of a commission of three physicians provided for in the programme. Therefore, I would make the follow- ing motion : That the Delegates of the different American Republics, upon arriving at their respective countries, manifest to their Govern- ments the convenience and urgent necessity of constituting a commis- sion of three persons, and that as soon as the Governments shall have appointed said committees, the International Bureau at Washington be notified. I believe that this is the most practical solution, as I un- derstand that none of us is empowered to propose which persons should constitute said committee. THE CHAIRMAN. I agree with the motion of Dr. Fernandez, but as I am authorized, as my delegation is authorized, I am going to read the report which it submits. I repeat that I am entirely in accord with the motion that such delegates as are not expressly empowered by their Governments may fulfill this provision of the programme in the manner suggested by Dr. Fernandez, and then his motion is placed before the Convention, reserving myself the right to read the report that I have. 88 THIRD INTERNATIONAL SANITARY CONVENTION. DR. LAZO ARRIAGA. I agree with the motion of Dr. Fernandez, be- cause, although I am authorized to designate the persons that would constitute the Committee in question, in accordance with the laws of my country, it is the Government who makes these appointments. THE CHAIRMAN. Gentlemen, Section 4 of the provisional programme of this Convention says : Each Delegate shall present a report regarding the organization in his country of a Committee composed of three physicians or health officers to form part of the International Sanitary Informing Commission of the American Republics, as is provided by paragraph 3 (b) of the resolutions adopted in Rio de Janeiro. As the intention of this provision is to create a center of information for all the American Republics, I believe that its purpose is carried out as regards Mexico, by appointing the Superior Board of Health as the Committee to form part of the Informing Commission, as it is a federal sanitary office which compiles directly the statistics relating to public health of the ports, border cities, and other important centers of the country, and is thus enabled to fulfill easily the purposes sought by the Rio de Janeiro Conference. But in order to conform with the letter of the provision in question the Superior Board of Health appoints as members of the Committee Dr. Eduardo Liceaga, Dr. Nicolas Ramirez de Arallalo, and Dr. Jesus E. Monjaras. Its organization shall be the same as that of the Superior Council of Health, which is the advisory board of the Government of the Republic. DR. FERNANDEZ ESPIRO. The Third Pan-American Conference of Rio de Janeiro provided that Montevideo should be one of the centers of information to be in communication with the International Sanitary Bureau of Washington, but I do not know that that Conference speci- fied which should be the Republics that should send their communica- tions to the International Bureau at Washington so that this center might in turn send its reports to Montevideo. Therefore, I would like that this point be decided by the Convention in order to avoid any future controversies which might hinder the routine of said reports. THE CHAIRMAN. I believe it would be wise to take into consideration the motion of the Delegate from Uruguay, for it is not sufficient to es- tablish centers of information. It is understood that the intention of the Rio de Janeiro Conference was to provide a speedy and efficient method of furnishing the data required, and to that end it established three centers in the world, one in Paris, another in Washington, and another in Montevideo. What is proper and logical is to adopt the following di- vision : From Ecuador towards the north to Washington ; from Ecuador towards the south to Montevidio ; these two centers might communicate with the center in Paris. This division seems to me the most natural one, and it is the resolution that I submit to the Convention, because this Convention, originated by the Rio de Janeiro Conference, should inter- pret such doubtful points as may exist in the resolutions adopted by the latter. DR. ESTEVES. As Ecuador remains in the dividing line I would like to know if it belongs to the northern or to the southern section. THE CHAIRMAN. According to my proposition, it belongs to the northern section. DR. GUITERAS. It seems to me that we ought not to limit ourselves to the Equatorial line, but that instead the countries near to Washington THIRD INTERNATIONAL SANITARY CONVENTION. 89 should establish communication therewith, and those farther south with Montevideo. DR. ESTEVES. It seems to me that Ecuador is farther north and it is nearer Washington than Montevideo. DR. GUTIERREZ. I believe that it is very easy for us, now that we are here assembled with brotherly purposes, to determine which should be the center to which we should address our reports. I believe that Brazil, Argentina, Uruguay, Paraguay, and Chile have their center in Monte- video; Ecuador, Venezuela, Colombia, and the Central American Republics, in Washington ; Peru, being more accessible to the Isthmus of Panama, should also address to Washington; furthermore, the official and commercial communications of this latter Republic are sent via Panama. Regarding the Colonies in the Continent, belonging to Holland, France, etc., such as English Guiana and others which are not included in our International Convention, I will say that we should take them into consideration, because in Cayenne, as well as in Georgetown, cases of yellow fever have been recorded ; this is a question upon which I would call the attention of the Convention in order that we may have connection with said Colonies as a whole, thus establishing sanitary relations with them. THE CHAIRMAN. Precisely. The remarks just made by the Delegate from Colombia show the advisability of establishing relations between the information centers of Washington and Montevideo and the central bureau of Paris ; but until an agreement is reached we will not be able to determine anything in regard to said colonies, for, although they are in America, they, are European dependencies, and it is not within our power to make any provisions in regard to them. The most proper and logical course is that indicated by Dr. Gutierrez. These colonies should send their reports to America because their sanitary interests are more closely related with the Continent than with Europe. I do not believe that we ought to decide this question but only outline it, be- cause this Convention cannot adopt a resolution as the previous one, for as long as the Chiefs of the three centers do not reach an agreement, whatever decision we might take would only be a theoretical one, and as all our resolutions should be highly practical and effective, I move that the Convention approve this matter. (Approved.) DR. GUITERAS. I take the liberty to remind the Convention that in one of the previous sessions I submitted a proposition to the effect that an agreement should be reached among the three centers of information in regard to said colonies. This resolution is now before the Executive Committee. THE CHAIRMAN. According to what Dr. Guiteras has just now said, we will wait for the decision that the Advisory Committee will now ren- der in which will be included both Dr. Guiteras' motion and mine. The session was suspended to wait for the report of the Committee. The session was reopened, and the Secretary read the decision of the Advisory Committee, a translation of which into English was made, and which is as follows: Delegates to the Third International Sanitary Convention: "The Advisory Committee has the honor to submit to your consideration the following report on the different subjects referred to it: 9O THIRD INTERNATIONAL SANITARY CONVENTION. 1. The representatives of the Governments of Brazil, Colombia and of Uru- guay are requested to adhere to the Sanitary Convention which was signed in Washington in 1905. 2. To the American governments represented in this Convention is recom- mended the codifying of all the sanitary laws and regulations of the respective countries, and as soon as this is accomplished to forward copies of them to the International Sanitary Bureau at Washington. 3. The Convention is recommended to authorize the International Sanitary Bureau of Washington to establish by means considered by them to be most convenient corresponding relations with the International Sanitary Bureau of Paris in accordance with the declaration made by the third Pan-American Con- gress held in Rio de Janeiro August, 1906. 4. That the Secretary be authorized to include in the publication of the pro- ceedings of the Third International Sanitary Convention a summary of all the resolutions adopted by the first and second International Sanitary Conventions held in Washington. 5. That recommendations be made to the American Governments of the con- venience of agreeing upon compulsory vaccination against smallpox. 6. That recommendations -be made to the Governments represented in this Convention of the convenience of declaring free from State taxes the sale of quinine, fine wire mosquito netting to be used as a protection against mosquitoes, crude petroleum, mosquito bars and material used for that purpose. 7. That recommendations be made through the medium of the respective sani- tary authorities that the Governments enter into a most active propaganda on the' etiology, prophylaxis and treatment of malaria and resolve upon the estab- lishment of public conferences on these subjects in schools, shops, barracks, etc. 8. That recommendations be made for the establishment of centers at neces- sary points for the free distribution of quinine to the poor in necessary quanti- ties for the prophylaxy of malaria. 9. That recommendations be made to the Governments that they order the maritime sanitary authorities to include in the public health reports which they issue the mortality occasioned by malaria. 10. That recommendations be made to the International Sanitary Bureau at Washington to furnish regular information in regard to the existence of malaria in the principal sea ports. 11. That recommendations be made to all Governments alike for the publica- tion of a pamphlet in which be compiled in a brief, simple and practical form, easily understood by the public, facts concerning malarial fever, for liberal distribution. 12. That recommendations be made to the governments that they prohibit the immigration of persons suffering from trachoma and beri-beri. 13. That recommendations be made to the various American nations for the legal and adequate steps in favor of the nationalization and centralization of sanitary authorities. 14. That to the American governments be recommended the following sug- ?jstions for the prevention of tuberculosis in railway cars and steamships: (a) o avoid, as far as possible, the use of carpets and fixed curtains, (b) To recommend the use of spittoons well distributed, (c) Periodical disinfection of cars and staterooms, including furniture, beds, washbowls, etc. These disinfec- tions should especially be made in the third class. All clothing, including nap- kins, should be disinfected before being washed, (d) Disinfection of dining- room service and the use of paper envelopes by the passengers for napkins ; also that the food be covered with wire screens at ports and that the windows of railway cars, staterooms and habitations on vessels be screened with fine wire nets to avoid the introduction of flies, (e) The examination of employes of vessels and passenger trains in order that tuberculosis subjects are not employed, (f) All vessels should have a special and comfortable department for the ac- commodation of tuberculosis patients, its construction not to admit of the re- tention of dust in any part, (g) The pasting of notices in public places con- demning the habit of spitting on floors, (h) Recommending that the physicians at the border not only be graduates in their profession, but, if possible, to have a special knowledge of the prophylaxis of tuberculosis. 15. That recommendation be made to the effect that the European Nations adopt the Convention of Washington of 1005, in their American colonies, specially in what concerns yellow fever. THIRD INTERNATIONAL SANITARY CONVENTION. QI 16. To recommend the American Nations that their bills of health contain the same kind of information. THE CHAIRMAN. The recommendation respecting the etiology of yellow fever has been stricken out. The resolutions just read are now before the Convention. DR. ROBERTS. I have presented a motion regarding the regulations to which ships should be subjected in order to protect the lives of passengers. I would like to know if it has been rejected. THE SECRETARY. The Committee will bear in mind the remarks of Dr. Roberts. DR. WYMAN. I have two resolutions that I think are important, and I suppose they may yet be considered by the Advisory Council and be reported on this afternoon, or they could be adopted by the Convention right now. Are we to have another report from the Ad- visory Council? These ate the resolutions: Whereas: The Third International Conference of American States, held at Rio de Janeiro in August, 1906, by resolution declared that the delegates to this International Sanitary Convention should resolve upon practical means for the adoption of measures intended to obtain the sanitation of the cities and, specially, of the ports, Resolved, that this subject be one for consideration also by the members of the next International Sanitary Convention to be held in Costa Rica, and that the International Sanitary Bureau in Washington be authorized to make inves- tigations and to take such other action as may be necessary to present this matter in satisfactory form at the said Convention in Costa Rica. Resolved, that the Sanitary Conference recommend the establishment of Sepa- rate Hospitals or Special Wards for the treatment of tuberculosis patients. Resolved, that a location be furnished by the Bureau of American Republics for the use of the International Sanitary Bureau. That a clerk is authorized to be employed and paid by the International Bureau. That expenditures be authorized and certified to by the same Bureau. That the Bureau of the American Republics be charged with the collection of the fund provided for by Section 7 of the resolutions concerning International Sanitary Policy adopted by Second International Conference of the American Republics held in Mexico in 1901-1902. That the Bureau of the American Republics is also charged with the custody of the fund and keeping of the accounts, I will say in submitting these post resolutions that I have prepared them, in conjunction with Mr. Yanes who represents the Bureau of American Republics here and that they meet with his approval. Dr. Roberts was given the floor. DR. ROBERTS. Taking into consideration the great advantages that result from enforcing sanitary measures as near as possible to an in- fected locality, not only to prevent the introduction of cholera, bubonic plague, and yellow fever into another locality, but also to protect the lives of passengers in ships sailing or leaving the said infected locality, I move : "That a resolution be passed in the next Convention prescribing measures to which should be subjected passengers, cargo, and ships leaving an infected port in order to give greater protection to the lives of passengers, preventing the occurrence of cases on board." (Ap-, proved.) THE PRESIDENT. I move that the motions of Dr. Wyman and Dr. Roberts be placed before the Convention, but as Dr. Fernandez Espiro has asked to be heard, I would request the Delegate from the United 92 THIRD INTERNATIONAL SANITARY CONVENTION. States to present his resolutions afterwards so that they may be voted upon immediately, as I have suggested. DR. FERNANDEZ ESPIRO. I agree with the propositions presented by the United States Delegation, especially the second one, as it refers to a question of great importance which will be adopted by the Fourth International Sanitary Convention of American Republics. This reso- lution of Dr. Wyman refers to the memoranda that should be presented by the different delegations in regard to sanitation works. I repeat that I consider this matter as one of high importance, and I believe that it should be specified with greater details so that the next Convention may become acquainted with all that has been done between the two meetings, and I think that what the Chair has done with respect to the proposition of the Chilean Delegation should be done in regard to that of Dr. Wyman, that is to say, it should be placed before the Convention immediately. The other point is this : The Delegations of Brazil and Uruguay had presented a motion providing for the revision of the Convention of Washington, at the Fourth Convention, on the understanding that this Convention of Washington had a fixed limit ; but since there is no such limit, the proposition presented by the Brazilian and Uruguayan Del- egations is not necessary. In the name of Dr. Cruz and my own, I move that said motion be withdrawn in order that it shall not appear in the report of the Committee. THE CHAIRMAN. I wish to explain to Dr. Fernandez Espiro the reason why we have adopted the proposition that persons suffering from trachoma and beri-beri be rejected. I consider it a very impor- tant question for us and for all the countries. The basis consists in the fact that both being acute diseases and that in yellow fever, it is possible to make the isolation, and all nations have undertaken the task of gathering together these patients and isolating them, assisting them until they recover; but such process can not be imposed in the case of prolonged diseases and when the cases are very numerous. I am going to give an instance, which I hope will convince the dele- gates. It is only four months ago that it was decided in Mexico not to admit to the country persons afflicted with trachoma and beri-beri. Now, during that period of time, about 500 persons afflicted with tra- choma have arrived in the country. What place or lazarettos sufficient to accommodate persons having trachoma, who at that rate would enter the Republic in a year, could we have? For this reason, we follow the rule that in case of acute diseases each nation must gather the patients and place them in the proper institutions in order not to compel them to return on the same vessel, but in the case of trans- missible chronic diseases it is not possible to do this. Dr. Fernandez has made an explanation concerning his vote, but I wish the Convention to know why the Advisory Committee has adopted this resolution. (The propositions formerly submitted by Doctors Wyman and Rob- erts were voted upon and unanimously adopted, and added to the reso- lutions approved and submitted by the Advisory Committee.) DR. ORTEGA. As Doctors Liceaga and Ulloa will call on the Presi- dent of the Republic, I take the Chair at the request of the former, and Dr. Guiteras will kindly act as Secretary. THIRD INTERNATIONAL SANITARY CONVENTION. 93 (Dr. Ortega having taken the Chair, the floor was granted to Dr. Azurdia. ) DR. AZURDIA. As to the point concerning compulsory vaccination referred to in a rule of the Convention, I would like that the following exception be made: The laws of Guatemala provide that vaccination shall be compulsory, and said law implies generally to all American countries. Therefore, I would like to have it stated that this resolu- tion applies only to those countries where vaccination is not compul- sory. DR. MENDIZABAL. I should like to add the following to this resolu- tion: That not only vaccination, but re-vaccination, which is already enforced in all countries of the world, should also be recommended. DR. GUITERAS. I wish to express my opinion concerning the first point. It seems to me that a general recommendation may be unneces- sary, in those countries where vaccination is already compulsory. As to the other recommendation, I have nothing to say. THE CHAIRMAN. Do the delegates agree to the amendments pro- posed by Doctors Azurdia and Mendizabal? DR. GUTIERREZ. I believe this is a question of phraseology. If the countries have already established vaccination in their laws, it is not necessary to allude to it in a new resolution. DR. AZURDIA. I second the proposition of Dr. Mendizabal in regard to vaccination. DR. ROBERTS. I believe that by using the words "vaccinal immunity" the question would be settled, and I make this suggestion for the sake of brevity. DR. GUTIERREZ. I thought it was sufficient to make that one recom- mendation, because the word vaccination is the common term, and re- vaccination is not a new term. But if we use the words vaccinal immunity they will be understood, but they will not have the exact meaning given them by the Government and the people, because the phrase is technical. Therefore, I think the word vaccination is suffi- cient, because, although re-vaccination is necessary after eight or ten years, I understand that the same is compulsory, because in case of an outbreak of smallpox the people themselves would request re-vac- ciriation. DR. AZURDIA. I completely agree with Dr. Roberts from a technical point of view, since we should be familiar with technical terms, and es- pecially concerning the administrative branch of the Government, but from the point of view of the layman, I believe that in order to under- stand the exact meaning of re-vaccination, that this familiar term be used. It is precisely for the purpose of obtaining the results suggested by Dr. Gutierrez that I insist in the use of said common familiar terms. We do not wish to specify that there shall be re-vaccination after eight or ten years, simply because if we are going to wait that long, because in an outbreak of smallpox said provision would be of no avail. DR. GUITERAS. The fifth recommendation reads : To recommend to the American governments the advisability of prescribing compulsory vaccination against smallpox. It seems to me that this fully covers the ground. 94 THIRD INTERNATIONAL SANITARY CONVENTION. DR. ROBERTS. Then, it behooves each country to prescribe in its laws the period of time that shall intervene from one vaccination to another. DR. GUITERAS. The Chairman requests me to ask whether article V shall be modified or remain as it now stands. DR. PAYAN. I move that the article remain just as it now stands. DR. GUITERAS. The Chairman understands that the majority of the delegates is in favor of said article remaining just as it has been drafted, and therefore requests that it be approved. (The article was ap- proved. ) Dr. Guiteras then read the following proposition made by the Chilean Delegation : Whereas, The international prophylaxis of tuberculosis so far as it concerns navigation and railway transportation, should be the result of the perfect interior organization of countries in their systematic struggle against said disease, the Third International Sanitary Convention recommends 'to the Governments of the nations here represented the general employment of the sanitary measures against the invasion of said disease. (The proposition was approved.) DR. PAYAN. I have requested the floor simply to give my vote to said proposition. It seems to me that a country can not demand sanitary measures from other countries until said country properly observes them itself. Therefore, in order to demand that international prophy- laxis be enforced at all ports, the country in interest should have the elements necessary to enforce said rules. Therefore, I approve said proposition. (At this moment Doctors Liceaga and Ulloa returned and took charge of their respective posts.) DR. WYMAN. Mr. President, I have received a telegram this morn- ing from Rome, Italy, from the American representative in Rome appointed by the Government of the United States to meet the other representatives from other countries, in order to form the International Sanitary Bureau of Paris. The International Sanitary Convention agreed to at Paris provided that later delegates should be sent to Rome to organize the Inter- national Sanitary Bureau at Paris. Among the delegates sent to Rome was one from the United States, Dr. McLaughlin, and in giving him his instructions I directed him informally to convey to the members present at that conference the resolutions passed at Rio concerning the intercommunication between the International Sanitary Bureau of Washington and the International Sanitary Bureau at Paris. I have a telegram from Dr. McLaughlin which I would like to read, showing that evidently the President of the International Sanitary Bureau of Paris is in hearty accord with the idea of intercommunica- tion between the two bureaus : Cablegram. Rome, Dec. 6, 1907. General Walter Wyman, American Em- bassy. Mexico. Resolution 3 D Rio Conference 1906 read here. President expressed pleasure of this Conference with same and stated no doubt existed that la Office International de Hygiene Publique dc Paris may communu -ate directly with Washington bureau as with Sanitary authorities of country adhering to Rome Convention. McLaughlin, Hitt. THIRD INTERNATIONAL SANITARY CONVENTION. 95 THE SECRETARY. The President desires to know if this Conference is in session yet at Rome. DR. WYMAN. They are meeting this month to form the International Sanitary Bureau ; they are probably in session now. THE CHAIRMAN. Gentlemen : The cablegram which Dr. Wyman has just read to us shows the solidarity existing at this moment in all the nations of the earth to accomplish a common purpose. In order to pre- vent an evil, the first thing to be done is to know what it is, and the only way to detect it is through the bureaus that are established in all parts of the world. The last convention established three bureaus in order to furnish the necessary information, namely, those of Paris, Washington and Montevideo, and if the Rome conference is still in session, I would suggest that our Convention cable it, through our Minister at that capital, manifesting the pleasure of the Third Inter- national Sanitary Convention in approving the purposes of that bu- reau, whose aims are identical with ours. (Applause.) Dr. Wyman has stated to me confidentially that the cablegram was not sent him officially, but I believe that it can also be said confidentially that the Convention has listened with pleasure to the reading of said cablegram. THE SECRETARY. As was said before, the proposition of Dr. Rob- erts was not, by a mistake of mine, included in the report. Dr. Roberts will now read it. DR. ROBERTS (Reading) : The object of the Conventions of the American Republics being to render uni- form quarantine regulations in order to protect public health, causing at the same time as little injury as possible to commerce, and Whereas, owing to the lack of uniformity in the bills of health issued by the different nations of America, it becomes difficult to fully understand the same because they many times lack certain details, the undersigned delegate proposes : 1. That at the next International Sanitary Congress the forms of bills of health to be issued by the nations that have adhered to this Convention be dis- cussed and approved, in order to verify the aforesaid documents. 2. That at all ports open to foreign commerce, the sanitary authorities shall issue bills of health to all vessels applying for them, and in accordance with such model form as the next Convention may adopt. THE SECRETARY. Inasmuch as owing to the short time we had at our disposal these resolutions were not considered by the Advisory Com- mittee, they will now be discussed. Shall they be adopted ? (They were approved.) The propositions submitted by the Chilean delegation and the last ones submitted by Dr. Wytnan were likewise approved, and these, as well as those of Dr. Roberts, were added to the resolutions adopted and submitted by the Advisory Committee. THE CHAIRMAN. The Secretary will now give an account of the visit we have just made to the President of the Republic, the object of which was to present the congratulations suggested by the delegate of Uruguay. THE SECRETARY. I take pleasure in reporting on the mission which, together with the Chairman of this assembly, was entrusted to us by the Congress at the previous session relating to the congratulations which said Assembly had decided to present to the President of Mexico for the important sanitary works that have been carried out in this g6 THIRD INTERNATIONAL SANITARY CONVENTION. country. General Diaz requested us to express his deep acknowledg- ment for this testimony of appreciation on the part of this Congress, and that all he had done in that respect was simply to second what Dr. Liceaga had recommended. During said visit the President of the Republic added that he would always keep as an inestimable memento the communication in which he was advised of the resolu- tion adopted by the Third International American Sanitary Conven- tion, and which the speaker, together with the Chairman of said Con- vention delivered to that high functionary on that occasion. The delegates proposed a vote of thanks to Dr. Liceaga for the great impetus he has given to the sanitation of the ports and of the capital of Mexico, and congratulates the administration of General Diaz for the most important works accomplished along those lines. DR. GUTIERREZ LEE. I beg to submit the following proposition to the delegates : Whereas the sessions of this Convention are about to close, and after hearing what the President of the Republic has said in praise of our illustrious Chair- man, I believe that all the delegates should present a token of our respect and admiration to the indefatigable scientific-worker, Dr. Liceaga, our present Chair- man. As you have already seen, his name is associated with all that progress, all those hospitals, all those centers of sanitation, not only of the Federal Dis- trict, but of the whole Republic, to which he has devoted his great learning. Therefore, I propose that this Convention present a testimonial of admiration and respect to the Chairman, who honors us with his presence on this occasion. (Great applause.) THE SECRETARY. I have the honor to second the proposition present- ed by the delegate of Colombia, and to say to the Convention that Dr. Gutierrez Lee, anticipated my wishes, as I had thought before to speak on the matter, and I have now great pleasure in approving the well deserved homage now rendered to our worthy Chairman. The proposition was unanimously adopted. (Applause.) THE CHAIRMAN. This testimony has deeply touched me, and be- cause of this fact I can not properly express my gratitude with words; but if what I have done, which is very little in comparison with what I should do, deserves your commendation, I declare that this is the greatest satisfaction that I have ever experienced. (Applause.) I re- peat my deep acknowledgment for this token of esteem to which I do not think I am entitled. DR. SOZA. Mr. Chairman: The Chilean delegation has the great honor to state that all the sentiments expressed by the gentlemen who have just spoken are shared by all, and like the delegate of Costa Rica were about to express them. I think we should all join in this testi- monial, since it is the opinion of all, and that we should sign a testi- monial on parchment in order that our Honorable Chairman may keep it as a memento. In this way we would unite our testimony in a graphic and tangible manner. (Applause.) The delegate of Uruguay as well as those of the Central American Republics cheerfully second this proposition. The delegate of Brazil also seconded said proposition. DR. WYMAN. The United States will yield to no one in its apprecia- tion of Dr. Liceaga's important work. We are 'his nearest neighbors, and have for many years witnessed his earnest and brilliant efforts in behalf of hygiene and public health. Nowhere has Dr. Liceaga greater THIRD INTERNATIONAL SANITARY CONVENTION. 97 admirers than in the United States, and we wish this statement to be appreciated in all that it applies, and we shall have the greatest pleas- ure in subscribing any document wherein said sentiments are expressed. It was decided to appoint a committee composed of Doctors Liceaga and Ulloa to deliver to the President of Mexico the communication referring to the resolution adopted by the Convention concerning his illustrious personality. DR. GUITERAS. The Cuban delegation approves with great satisfac- tion the sentiments just expressed. DR. ESTEVES. Following the example of my colleagues, I share the sentiments expressed, always admiring the Mexican colossus. THE SECRETARY, Dr. Liceaga gives me a mission rather difficult to fulfill. He says he is not able to answer as he should wish the sentiments expressed in his commendation because he is deeply touched, a fact which we easily realize, because all wise men are modest, and Dr. Liceaga can not be an exception. The Dr. Liceaga of the present occasion reminds me of the Dr. Liceaga whom I had the honor to meet at the Second Convention of Washington. On a certain occasion in which, at a dinner given to the delegates by the Cuban Minister, similar remarks were made regarding him, and all he was able to do was to stand up and manifest his apprecia- tion with tears in his eyes. Nothing could be more eloquent than those tears, which I remember very well, and can fully appreciate, what are now the feelings of our competent and beloved Chairman. (Applause.) Gentlemen-: Before the close of the session, I take the liberty to request the delegates to deliver a copy of the different essays presented at this convention so that they may be forwarded to the Bureau of the American Republics to be filed. Dr. Yanes would sincerely thank you for this attention. I also wish to call the attention of the official representatives of the Republics to the advisability of suggesting to their respective Governments to put into effect the provi- sions which have been approved before, to the end that funds be provided for meeting the expenses that said office may incur. This matter should be taken up at once because the work of publishing the long essays relating to the proceedings of this convention would require considerable expense, and that you should also take into consideration at once the proposition of Dr. Wyman concerning the office and em- ployees of the International Sanitary Bureau. I have a list of the nations that have already paid in full, of others that have paid in part, and of those that have forgotten to comply with this agreement. I shall not read the names, but the list is at the disposal of the delegates for their information. THE CHAIRMAN. I beg to remind the delegates that our last ses- sion will take place today at 3 p. m. The session adjourned. Afternoon Session. The session was called to order at 3 p. m. by Dr. Liceaga, Chair- man, the following members having been present: Dr. Oswaldo Gongalvez Cruz, Dr. Ricardo Gutierrez Lee, Dr. Genaro Payan, Dr. Hugo Roberts, Dr. Juan Guiteras, Dr. Ernesto Soza, Dr. Pedro L. 98 THIRD INTERNATIONAL SANITARY CONVENTION. Ferrer, Dr. Juan Horacio Esteves, Dr. Salvador Ortega, Dr. Jose Azurdia, Dr. Luis Lazo-Arriaga, Lie. Jose Algara, Dr. Gregorio Mendizabal, Dr. Ernesto Fernandez Espiro, Dr. Rodolfo B. Gonzalez, Dr. Walter Wyman, Dr. R. H. von Ezdorf, Dr. Rhett Goode, Dr. H. L. E. Johnson, Dr. J. Gatewood, and the Secretary, Dr. Juan J. Ulloa. The Secretary requested that the reading of the minutes of the pre- vious meeting be dispensed with and that he be authorized to prepare them later. This request was granted. In the course of the session said minutes were discussed and ap- proved. THE CHAIRMAN. Before commencing the discussion of the matters comprised in the program, the Secretary wishes to present a resolu- tion to this Congress. THE SECRETARY. I proposed the following resolutions, which were unanimously approved : 1. That a Committee be appointed to give, in the name of the Third Inter- national Sanitary Convention, a vote of thanks to His Excellency General Porfirio Diaz, President of the Mexican Republic, for his important co-operation in the success of this Convention. 2. That a vote of thanks be extended to the Vice-President, and to the Secretaries of State, of the Treasury, and of the Interior for the kind attentions shown us. 3. That a vote of thanks be accorded to the Superior Council of the Govern- ment of the Federal District, and to the Municipal Government of this city for the kind attentions they have shown us. 4. That we sincerely thank the committee of ladies who have so kindly waited on the wives and friends of the foreign delegates. 5. That a vote of thanks be given to the Superior Board of Public Health and to the Director of the Water Supply Works of this City for the valuable services they have rendered us, and 6. That we express to the Mexican delegates to this Convention our deep appreciation of the exquisite courtesy and the splendid manner in which they have welcomed us to their country. Dr. Wyman moved that the propositions made by Dr. Ulloa be unanimously adopted. The Chair appointed Drs. Johnson, Gutierrez Lee, Fernandez Es- piro, Ferrer, and Lazo-Arriaga, to convey to the President of the Mexican Republic the resolution approved at this session, and which refers to his distinguished person. THE CHAIRMAN. The selection of the place for the holding of the next convention is now in order. DR. GONQALVEZ CRUZ, the delegate of Brazil, moved that the next convention be held in Costa Rica. (ApprovedJ THE CHAIRMAN. Gentlemen: The decision that the convention has just made seems to me to be of the greatest importance; that the delegate of a country as important as is that of Brazil should have made this declaration, honors him who made it as much as it does the country from which he comes, and this is another proof that the aims of this Convention are entirely just and equitable. The most im- portant commercial and maritime nation is not selected, but, on the contrary, the smallest of our sister Republics. I accept the resolution proposed to the Convention. (Applause.) THE SECRETARY. Gentlemen: In the name of the Republic and THIRD INTERNATIONAL SANITARY CONVENTION. 99 Government of my country, I sincerely thank you for the great honor you have conferred on us. We are a small nation, but we shall see that our good-will meets the exigencies of an Assembly as important as this one is, and, above all, after conventions have been held in the United States and Mexico. Costa Rica, gentlemen, two years hence will receive you with open arms, and although we have no lesson to give you, you will find there a reception such as is accorded to true brothers. (Applause.) THE CHAIRMAN. This point settled, the selection of the Chairman of the Convention is in order. Permit me to suggest that Dr. Juan J. Ulloa, of Costa Rica, be chosen Chairman of the next convention by acclamation. (Approved by acclamation.) (Applause.) THE SECRETARY. I am overwhelmed with gratitude at the distinction of which you have made me the object. Although I am large in size, I am small in intelligence and scientific accomplishments, and, above all, when I am placed side by side with the giants Liceaga and Wy- man, who have preceded me in the honorable post to which you have called me. I appeal to your benevolence and earnestly entreat you to assist me in discharging the duties of such a difficult mission, in the fulfill- ment of which I can only offer my willingness and the true desire of my heart to do so. (Applause.) THE CHAIRMAN. The program shows that we should proceed to the appointment provided for in article 4 of the provisional program, but as this appointment was made this morning, we will proceed to the election of the chairman and personnel of the International Sani- tary Bureau of the American Republics. DR. FERNANDEZ ESPIRO. I move the Convention that the Chairman and personnel of the International Sanitary Bureau in Washington continue the same as it has been heretofore. (Applause.) This motion was unanimously carried, and, therefore, the personnel of said Bureau is Drs. Walter Wyman, Eduardo Liceaga, Juan J. Ulloa, Juan Guiteras, A. T. Doty, Rhett Goode and Eduardo Moore. THE CHAIRMAN. For my part I sincerely thank you for the honor you have conferred upon me in continuing: me as a member of that Committee. THE SECRETARY. I likewise desire to express my sincere thanks for this honor. DR. WYMAN. I also wish to thank you for the honor of having been again elected Chairman of the International Sanitary Office, and to express my deep gratitude for this honor. THE CHAIRMAN. This phrase has been placed in the program: "Designation of the authority which is to issue the invitations to that Convention." As we have already said a number of times in this Convention this reunion was born at the Pan-American Conference held in Mexico during the latter part of 1901 and the early part of 1902, and the 5th clause of that conference says: "V. The Second International Conference of the American States further recommends, in the interest of the mutual benefit that would be derived there- from by each of the American Republics, and that they may more readily and effectively co-operate one with the other in all matters appertaining to the subiects mentioned in the above resolutions, that a general convention of the IOO THIRD INTERNATIONAL SANITARY CONVENTION. health organizations of the different American Republics shall be called by the governing board of the International Union of American Republics to meet at Washington, D. C, within one year from the date of the adoption of these resolutions by this conference; that each Government represented in this con- ference shall designate one or more delegates to attend such convention; that authority shall be conferred by each Government upon its delegates to enable them to join delegates from the other Republics in the conclusion of such sanitary agreements and regulations as in the judgment of said convention may be in the best interests of all the Republics represented therein; that voting in said convention shall be by Republics, each Republic represented therein to have one vote ; that said convention shall provide for the holding of subsequent sanitary conventions at such regular times and at such places as may be deemed best by the convention ; and that it shall designate a permanent executive board of not less than five members, who shall hold office until the next subsequent convention, at which time the board shall be appointed with a chairman to be elected by ballot by the convention; that said executive board shall be known as the 'International Sanitary Bureau,' with permanent head- quarters at Washington, D. C." It has been customary for the Bureau of the American Republics to call the Convention, and that was the method adopted with regard to the first two conventions, and no objections were made, but since the Convention had to meet out of Washington, then the departments of foreign relations of all the Republics made the following objection: That there was no doubt as to the authority the Bureau of the Ameri- can Republics had to make the call, but that it seems an act of national courtesy that the Republic in which the convention was to be held should issue the invitations, and for this reason it will be remembered that the Mexican Republic issued the invitations to this Convention through its Department of Foreign Relations. Inasmuch as our purpose is that all our decisions shall be of a practical character, I would beg to request you that the Bureau of the American Republics make the call, and that, in addition, the Gov- ernment of the country where the Convention is to be held issue an in- vitation through its department of foreign relations to the several coun- tries represented. DR. WYMAN stated that this was the desire of the convention. DR. JOHNSON seconded the motion. DR. LAZO ARRIAGA. I entirely agree with the motion of the Chair- man, and would like for all of us to adopt it. THE CHAIRMAN. This matter having been decided, and as no one wishes to make any remarks to the contrary, I would like for the Convention to fix the date of the meeting of the next Convention. THE SECRETARY. I suggest, Mr. Chairman, that on considering the date the Convention is to be held and on deciding the same, a date as close to the 25th of December as possible should be chosen, because that is the best season of the year in San Jose, with the advantage that, after the work of the Convention is over, the delegates may enjoy the civic festivities which will take place in said city on the 3Oth and 3 ist of December, and the ist of January. THE CHAIRMAN. Inasmuch as the duty of this assembly is to fix only an approximate date, it devolves on the Bureau of the American Republics to fix the precise date, with the approval of the new Chair- man. I believe that the resolution could be worded in the following manner: "To be held in December, 1909." THIRD INTERNATIONAL SANITARY CONVENTION. IOI If no one wishes to make any remarks, we shall consider this reso- lution approved. It was approved. Let us now carry out the last part of our program. I have the pleasure, gentlemen, of announcing to you that the next person who is entitled to the floor is Dr. Gongalvez Cruz, delegate of Brazil, a very modest gentleman, whose merits I refrain now from stating, fearing that he would be embarrassed thereby. Still, I will say that in sanitary matters he occupies one of the first places in Brazil, and I have the greatest pleasure in introducing him to you, if such introduction is necessary, since he has an international reputation. DR. GONQALVEZ CRUZ. Mr. Chairman and delegates: On leaving you today, I feel it my imperative duty to express my acknowledgment to this hospitable and progressive country for the kind and fraternal reception accorded us. I congratulate myself and all my colleagues on the many advantages derived from the exchange of views that we have experienced here, and which all of us will carry with us to our native countries, con- tributing in this joint manner to a unity of views and agreement in all matters relating to sanitation. I shall always retain the most pleasant recollections of these few days, and Brazil is deeply indebted for the kind and courteous at- tentions of each and every one of the members of this assembly. Nothing could describe the eloquent and brilliant manifestations accorded the learned President of the Supreme Board of Health of Mexico, and to our esteemed Chairman I bring the homage of deep gratitude for the paternal, kind and able manner in which he has di- rected our work, and who has encouraged us with his example of untiring diligence. My esteemed colleagues, I bid you farewell. THE CHAIRMAN. I have the honor to introduce to you Dr. Ricardo Gutierrez Lee, representative of Colombia. He has been our com- panion in all our work of this kind. He is one of the most enthusiastic members in sanitary matters, and since he would not make any remarks, I did not wish to deprive myself of the satisfaction of inform- ing you that I have known him for a long time, not only as a distin- guished gentleman, but also as an able member of our conventions. At the same time I have the pleasure to introduce to you Dr. Payan, who is the Benjamin of this Congress, and who has already shown us his great ability in his report. DR. PAYAN. Mr. President and Delegates: I am deeply grateful for the kind words of the Chairman. In the name of my Government and in that of the Colombian Dele- gation, I have the great honor of expressing our deep gratitude to the Mexican Government and Delegation to the Third International Sani- tary Convention for the constant proofs of sympathy shown us, thus rendering more lasting, if that could be possible, the pleasant re- membrances which all of us shall keep of the pleasant days we have spent in this beautiful capital of this great Republic where we have seen a true progress and over which floats as a halo of peace, the illustrious figure of General Diaz. I would also express my acknowledgment to the distinguished Chair- man of our Convention for the kind manner in which he has treated us. We have seen this morning that the nations of the American con- 102 THIRD INTERNATIONAL SANITARY CONVENTION. tinent here represented gave him a testimony of their admiration, which he well deserves because of his great work in behalf of the progress of his country, and when the continuation of the Pan-Ameri- can Conventions was proposed, he pointed out the best way of uniting all the peoples of this Continent. Concerning this matter I believe that if we have not entertained a more favorable opinion of ourselves, it is because we have not known each other well enough. If we have not made ourselves understood mutually, it is because the isolation in which we have lived has not permitted us to banish the prejudices and discover the capability and good faith that obtain among us. By our mutual intercourse we dis- cover that from all points of view our opinions are not widely differ- ent, much less indeed than we suspect. A better understanding, and a greater and clearer conception of our mentality and moral purpose, is what those who aspire to the creation of Panamericanism, that is to say a true Pan-American solidarity, should endeavor to bring about. (Applause.) THE CHAIRMAN. I have the honor to introduce to you a person who needs no introduction to this assembly, Dr. Guiteras, of Cuba. The name of Dr. Guiteras is so closely associated with our work in the sanitary congresses, and with this Third Convention, that, as Presi- dent Diaz said, when I introduced Dr. Guiteras to him, "his name is well known in connection with the doctrine of the transmission of yellow fever." Indeed, if Dr. Guiteras has not so many qualifications which entitle him to the respect of the scientific world, and of the whole world, it would suffice for him to have associated his name with the great discovery which has completely revolutionized the knowl- edge we had concerning yellow fever. DR. GUITERAS. I am exceedingly grateful for the kind congratu- lations from Dr. Liceaga, and Dr. Roberts will take the floor to bid farewell to our colleagues. THE CHAIRMAN. I congratulate myself on my mistake, because thereby I will have the pleasure to say publicly what I have said in private. Dr. Roberts also deserves great credit; he is the Chief of the Sanitary Service of Cuba, and has shown us his great learning both in the part he has taken in our discussions, and in the propositions he has submitted, all of which are eminently practical. DR. ROBERTS. Mr. Chairman: It is the duty of every civilized man to do all that he possibly can in behalf of his fellow beings, and this being the mission that has brought about our meeting, we ought to be satisfied for having endeavored to contribute, with the greatest enthusiasm, in carrying out our great purpose. I sincerely wish that the ties of union established by this Convention among all the nations of America, to which Mexico has greatly contributed, may be closer every day, and that this union may prove to be the foundation of a fraternal feeling among all the people of the New World. THE CHAIRMAN. Dr. Juan J. Ulloa, another gentleman who is unknown to you, will now have the floor. This unknown gentleman is one of the veterans in sanitary works, from the time we earnestly undertook such work, and he has shown his constant desire that these conventions may not be given up, and, in addition to his scientific at- THIRD INTERNATIONAL SANITARY CONVENTION. IO3 tainments, and which he disowns through modesty, he possesses a proverbial kindness, and will therefore constitute a true bond of union for future congresses, especially now that he has been elected Chair- man of the next convention that will be held in San Jose de Costa Rica. THE SECRETARY. Before beginning my remarks, let me embrace my old friend and distinguished teacher, Dr. Eduardo Liceaga. Being about to leave this noble and progressive land where we have been shown so many courtesies, and where we have been treated in a royal manner, I, in the name of Costa Rica, and of its government, sincerely thank the government of His Excellency, General Diaz, I thank the learned descendants of the brave Aztecs, the government of the Fed- eral District, and our colleagues the delegates of this enlightened country. May the progress which has been so rapidly made in Mexico, con- tinue its forward march until the sister of which we are proud is lost sight of in the splendid horizon of the 2Oth Century. Farewell, my dear colleagues, until we meet again ; when you arrive in the bosom of my country, I shall have the pleasure of according you the most cor- dial welcome. (Applause.) THE CHAIRMAN. Gentlemen: Dr. Ferrer, delegate of Chile, has kindley consented to make some remarks. Though he is young, as you see, he has already attained eminence in his profession, and is well known not only in his country, but in all America, and I take great pleasure in introducing him to you as one of the prominent men of his Republic. DR. FERRER. Mr. Chairman and Delegates: The Chilean delega^ tion on taking leave of the Convention assures to the Mexican nation its most genuine and cordial support, and thanks His Excel- lency, General Porfirio Diaz, President of the Republic, for his kind and benevolent observations made concerning our country, and ex- presses to the Honorable Chairman of the Third International Sani- tary Convention of the American Republics, Dr. E. Liceaga, its most respectful and sincere sentiments of admiration at the excellent man- ner in which he has fulfilled his scientific duties, the discreet way in which he presided over the proceedings of this Convention, and, above all, at his goodness of heart and his spirit of fraternalism to each and every one of our colleagues. It is most gratifying to the Chilean Delegation to grasp the hands, on this solemn occasion, of its colleagues of the American Republics, manifesting to them the solidarity of our sentiments in our difficult tasks, and to acknowledge that the highest confraternity, the calmest discussion, and the most noble spirit of American union has always pervaded this atmosphere. THE CHAIRMAN. The representative of Ecuador, Dr. Esteves. I regret very much that I should not have had occasion to learn of his excellent attainments, but his innate modesty has constantly obscured them. Nevertheless, from private conversations had with him, I am convinced of his nobleness of spirit, and of his desire to carry the work of the Convention to a successful termination. DR. ESTEVES. Mr. Chairman: The Republic of Ecuador, which hastened to accept the invitation of the Mexican Government to IO4 THIRD INTERNATIONAL SANITARY CONVENTION. attend the Third International Sanitary Congress, has again mani- fested on this occasion its desire to offer its modest contingent to all that tends to more closely unite the American Republics, not only with respect to their political relations and diplomatic friend- ship and good-will between the Governments, but also in all that signi- fies progress, reciprocal usefulness, the interchange of views, and the application of general rules to the welfare of the Continent. You will remember that the first convention dealt almost exclusively with hygienic questions, and in this matter it is an honor for me to accept your authorized opinions for the purpose of proclaiming at your side the supremacy of hygiene over medicine notwithstanding our professional partiality as, even in the judgment of learned mili- tary leaders, the humanitarian provisions suggested with the object of regulating and civilizing war, and the generous efforts that civilized nations have made to avoid strife, are likewise preferable in matters relating to warfare. One of the positive advantages of sanitary congresses is that it can be said of them that all their members are of accord beforehand, and no essential difference can arise in the estimation of the methods that it is fitting to adopt, for the purpose of efficiently combating the most terrible and sanguinary enemies of the human species. Innumerable benefits having already been obtained in the union of 27 nations under the provisions of one Sanitary Code, and it being logical to hope that the fraternal, farseeing and redeeming propaganda is not to be stopped within the limit already reached, a day will come when un- just prejudices will be banished and difficult obstacles swept away by universal union under one flag the flag of Science for the Health and Life of Men that could easily cover all the countries of the earth as well as the realms of heaven. The eloquent examples that you have cited relating to the wonderful success obtained in Mexico in the extirpation of yellow fever, as well as a comparative review of the ravages of the plague in India, the almost barren results of the recent invasion of the cholera in Europe, and the prodigious effect of the antiseptic system used by the Govern- ment of the United States in Habana, show in the most conclusive manner how certain are the truths you have established as to the immense benefits of hygiene, and how much more efficacious is the sanitation of towns at the present time than was the ancient and odious regime of quarantines that will soon be abolished everywhere. We can now congratulate ourselves that the provisions of the Con- vention of Washington of 1905, which have been in force in Ecua- dor, should have been unanimously accepted, with slight modifica- tions, by this conference, and it only remains for us to desire that these provisions be the basis of a code of international sanitary police regulations in all the countries of the New World. I am pleased to acknowledge that the agreements of this Conven- tion are of undeniable importance and are worthy the high purpose that caused us to assemble here, and I promise that they shall be faithfully observed by the country that I represent. In conclusion I am deeply indebted to the Mexican Government and to you for the kind reception you have given me, and I now convey to the Government and people of the United States of Mexico, the THIRD INTERNATIONAL SANITARY CONVENTION. IO5 friendly greetings of the People and Government of Ecuador, and avail myself of this opportunity to publicly express the cordial feelings of admiration and respect which General Eloy Alfaro, President of the Republic of Ecuador, entertains for the illustrious General, Por- firio Diaz, whom the whole world admires for his statesmanship as well as for his civic virtues. THE CHAIRMAN. Dr. Azurdia is not only one of the most distin- guished physicians of his country, but also a well known poet, having shown his great attainments whenever he has had the floor; but what renders the presence of the Guatemalan Delegation of the utmost im- portance is the spirit of confraternity that it has constantly shown ever since we commenced to hold our sessions, and the great clearness of its views in the matters in which it has taken part. Therefore, I take pleasure in introducing to you Dr. Azurdia, who will now have the floor. DR. AZURDIA. Mr. Chairman and Delegates: We shall leave this Capital, but the memories of this Convention will remain indelibly engraved in our minds and hearts as an event of the utmost import- ance. In our minds, because of the comprehensive scientific work carried out in sanitary matters in the ports and cities of the Republic of Mexico. We had occasion to admire the General Hospital which can compare favorably with the best hospitals of the world, the water supply works of this city, expensive and magnificent, the important system of sewerage and drainage, and the institution devoted to the rehabilitation and moral improvement of criminals, namely, the beau- tiful penitentiary of Mexico. We have had also occasion to admire the means of communication, the great commerce, the wonderful industries developed at Rio Blanco in the weaving and spinning mills* the great general progress in all the spheres of human activity that is being carried out in the Republic. And, consequently, we have realized that such results obtained from science when applied to hygiene, have in Dr. Liceaga an untiring director, as those which the nation, as a whole, has obtained in com- plicated economic-administrative affairs, have their ablest representa- tive their alma-mater in the President of the Republic. On the other hand, thanks to the gallant courtesy of Dr. Liceaga, we have also been able to admire, not only the flowers which with immense profusion embellish these beautiful fields, not only the panoramic views of this unique valley, but also the fire of the eyes of the beautiful Mex- ican ladies whose magnetism has entirely fascinated us. And add to all this, gentlemen, the work of the Convention, which will doubtless be beneficial to all America, has shown us that the solidarity of the people of the New World so far as ideals, aspirations and sympathies are concerned is a possible and real fact. In a word, is it, perchance, necessary to speak of hospitality in a sister republic, wherein prevail the same tendency toward progress, advancement and education as those which obtain in my beloved Guatemala? Why should we speak of hospitality in a country like this universally known for its nobleness, beautiful because of the learn- ing of its men and the refinement of its social circles ? We will soon meet again, gentlemen. Tomorrow in August of next year we shall hold in Guatemala the Fifth Pan-American Medical Congress, IO6 THIRD INTERNATIONAL SANITARY CONVENTION. and, soon after, the Fourth International American Conference in Costa Rica. The Delegates of Guatemala do not say farewell, we give you a hearty greeting, humming an American hymn of loving confraternity to Dr. Liceaga, Chairman of this Convention, and to the President of the Mexican Republic. Gentlemen, we will not say adieu because the Government and people of Guatemala, who sent you their affectionate greetings at the begin- ning of your labors, anxiously waits for you to receive you with open arms. THE CHAIRMAN. I hope that Dr. Wyman, as representative of the United States, will favor us with some remarks. Indeed it is unneces- sary for me to introduce General Wyman, since no person is better known than he on the whole American Continent. The work he has undertaken, and which he has carried out in his country, the great benefits received not only by his native country, but by all the other countries of the American Continent, but the great knowledge he has in matters relating to public hygiene and the wonderful organization of the services he has rendered to his country, are really prodigious, and the progress made by the Marine Hospital Service is equally worthy of credit. These facts go beyond anything we can measure with ordinary understanding, inasmuch as the work he has accom- plished belongs to a century rather than to a short period of time. I take pleasure in expressing publicly on this occasion my admiration for Dr. Wyman, who will now take the floor. DR. WYMAN. In glancing over what ha's been done this last week, I believe that the International American Sanitary Convention has lost nothing of its vigor, purpose, and ability to do things, but that in all these things they have been increased by the deliberations of the Con- vention which is now about to close. The first Convention, which was held in Washington five years ago, announced some principles on which we all agreed, and also estab- lished feelings of good will among the delegates. All this prepared the way for the important event of the second con- vention, which was held two years ago, and furnished us with a con- crete proposition, namely, the Convention which was proposed to our respective governments. This Convention prepared some rules which should serve as a guide for all the republics in the treatment of bubonic plague and yellow fever, which have already been recognized as international diseases. Almost all of the Republics have adhered to this Convention by formal approval or ratification. And now at this Convention we have dis- cussed and prepared in concrete forms some additional sanitary pro- visions which being the formal and unanimous expression of all the republics ought to be of unquestionable value in the years to come, serving as the star which shall serve as a guide in the voyage of the several republics towards a perfect port of hygiene and sanitation. But again, in compliance with the instructions of the Third Confer- ence of the American Republics held at Rio de Janeiro in 1906, we have taken measures tending to establish a practical method of bring- ing perfect sanitation to our ports. We can not, at present, affirm that we have prepared a Convention which shall serve as the basis for the purpose in view, but we have authorized the International Sanitary THIRD INTERNATIONAL SANITARY CONVENTION. IO/ Office to take this matter into consideration, and in accordance with a resolution, all the delegates know that this will be one of the questions which will be taken up and considered % at the Fourth Sanitary Conven- tion, which will be held within two years in Costa Rica. An Interna- tional Convention concerning such sanitation of the port as would pre- vent the plague from spreading, a disease which after it is developed spreads through all the arteries of commerce, is, doubtless, a great sanitary step forward, which would be in consonance with the feelings of modern fraternity among nations. This week has been full of prac- tical lessons, which we have received from this glorious Republic of Mexico lessons both of humanitarianism and in matters relating to public health. We unanimously say, well done, Mexico, well done, Liceaga. From a social point of view it is very difficult for us to be able to express properly our gratitude for the great hospitality and exquisite courtesies shown us all this kindness and courtesies have left lasting remembrances in all our hearts, and in view of these pleasant enter- tainments, we, the foreign delegates, have been able to become better acquainted with each other, and have formed ties of friendship which will endure as long as we live. Mr. Chairman and gentlemen: It seems to me that this beautiful group of flags displayed behind the seat of the Chairman, showing the colors of all the Republics, conveys an exact idea of our present situa- tion with regard to our international sanitary conventions. Those flags are in a group the motto for which consists of two words : "Peace and law !" What a noble aspiration is expressed in these two words, and how well they harmonize with the purpose of our Convention ! The brilliant colors of these flags are a symbol of beauty and power. The white color is found in those flags to symbolize the purity and the absence of selfishness in our purposes; the red symbolizes the earnestness with which we endeavor to carry out our ideals; the blue reveals our loyalty and our constancy toward the observance of our principles, and all these colors are grouped to form one single flag or symbol. Such is our situation today. May it so continue for a long time. If the future sanitary conventions are inspired by the same fra- ternal feeling, and by the same harmony of action and aims that have been shown in the first and second conventions, and now in this third one, then I am sure that the American Republics and the whole world will have reason to congratulate themselves on the good results which will undoubtedly be obtained because of them. DR. GOODE. We have experienced gr^at pleasure during our brief visit to this great and beautiful city of Mexico. The Mexican ladies are as beautiful as they are kind, and the cultured gentlemen we have had the honor and satisfaction of meeting are perfect types of the Mexican race. Mankind will derive great benefits from the work of the Third In- ternational Sanitary Convention, and to our Chairman, Dr. Liceaga, we are indebted for the success of this Convention and the happy hours we have spent here. THE CHAIRMAN. Dr. Lazo-Arnaga, Delegate of Honduras, whose personal attainments I had occasion to appreciate during the short IO8 THIRD INTERNATIONAL SANITARY CONVENTION. moment which our official work left at our disposal, and whose per- sonality I greatly admire, will now address you. DR. LAZO-ARRIAGA. I want to unite my voice to the choir of praises concerning our dear and learned Chairman, and also to thank the enlightened Mexican Government and the distinguished representation of the city who have co-operated to the end that our stay in this beautiful Capital of Mexico may be more pleasant. If we ever had a reason for remembering a beautiful city, where, in addition to the work of man nature had prodigally contributed to its embellishment, and where to this is added the great beauty of her daughters, we would assuredly point to Mexico. Before saying farewell to you, I desire to thank each and every one of you both for the courtesies which, as representative of Honduras, you have shown me, and for having appointed as the place of meeting of the next Convention one of the Central American Republics. As a Central American I am deeply conscious and grateful for this honor. THE CHAIRMAN. Dr. Mendizabal, our countryman, is the represen- tative of Nicaragua, and I hesitate to say anything in his honor be- cause my love for him is such that it might be construed that anything I said about him was due to my friendship for him and not because of his real personal merit, but I am compelled to introduce him to you as one of our men of science who have worked most in the different branches of medicine, and who, at the same time has been not only the physician but the friend of all his patients, and who, on the other hand, has been one of the pillars of all the scientific works of the society to which he belongs. He is very well known among us and I sincerely wish he should be equally well known among you. DR. MENDIZABAL. Above all allow me to express my gratitude for the kind and affectionate words which I don't think I deserve of my dear friend Dr. Liceaga, inspired by a good and old friendship of 40 years of work and which can never be broken. Allow me also, gentlemen, since we have finished our task, to con- gratulate myself in the name of the Republic of Nicaragua, which I have the honor to represent here, and to congratulate ourselves for the success attained by this International Sanitary Convention, inasmuch as the work which has been done will bear good fruit and be beneficial to the future. Allow me also to thank the representatives of the Mexican Republic, its President and people for. the innumerable courtesies they have shown to all the delegates during our short stay in this country, and allow me also to congratulate this people, as has been done before, for their progress which we knew only by name, and which we are now practically acquainted with because we have seen pass before our eyes millions of dollars which the Mexican Government has spent in carrying out one of the most beneficent measures that concerning public health. For this reason, the Mexican Government is entitled to be further congratulated. Allow me also to fervently pray that Providence, who has endowed Mexico with a splendid government, may prolong for many years the life of its Chief Executive and may also prolong that of his right- hand man in sanitary matters. Dr. Liceaga has been wisely selected by General Diaz to direct all the men who will have to help him in his grand work of progress and peace. THIRD INTERNATIONAL SANITARY CONVENTION. IO9 I beg to congratulate all the delegates of the sister republics for the magnificent work they have brought to us thus pointing out to us and conveying an exact idea as to the work they have done and are doing in those republics, and how they have struggled in behalf of health and the preservation of life. We already know this because we have just returned from a trip to South America, where we had gone especially to call the attention of the Argentine Republic, Brazil, Chile, Peru, etc., to the great benefits to be derived from perfect hygiene. Some of these countries were not entirely unknown to us, and we have just had occasion to see that they follow the same course, the same methods, and that all of them are looking after the health of their fellow citizens. Finally, gentlemen, before we say farewell, for a short time, since we are soon to meet again, if life and health so permit, to express the desire that all my colleagues, upon returning to their respective coun- tries may find their homes as they left them where we are always happy and that they may reap the reward of their efforts. I pray that their countries may continue to prosper and progress, so that they may reach, without any obstacle, the goal of their greatness, which they doubtless will attain, inasmuch as the people of the world discov- ered by Columbus, seem to live in the land selected by God for the development of all the blessings of liberty. Be ready, gentlemen, to erect a throne (don't get frightened at this word which frightens many American nations), get ready to erect a throne to the great goddess before whom we all bow, the goddess before whom all civilized nations kneel down Hygiene. All the im- pulses of civilization come to us from the Old World. Let us work so that America may be the worthy throne of civilization sent to us by that Old World, and let us retain it here forever, lest disheartened, it may return again to India from whence it came. Gentlemen, I wish you much happiness, and that everyone of you: may be entirely happy in your homes. THE CHAIRMAN. Dr. Rodolfo Gonzalez, Delegate of Salvador, will make some remarks. Dr. Gonzalez is a countryman of ours, and has established himself in Salvador where his merits have been recognized, and where he has been given a high place in the army. He has had great experience in matters relating to public health. I mention this fact because I am proud of it. DR. GONZALEZ. Those who, like myself, knew Mexico 25 years ago, and return to it now, find that where ponds formerly stood are now streets of asphalt; that at points that were formerly foci of infection hospitals or sanitariums are now to be found ; that all the branches of public health are so well administered that if Mexico continues in this way, it will become, owing to the untiring energy of Dr. Liceaga, a place where good health will be epidemic. (Applause). All this, gentlemen, is due, undoubtedly, to the wise administration of General Diaz, and to the great ability of Dr. Liceaga, who is everywhere, who sacrifices himself, and who employs in work in behalf of mankind the hours which we devote to the family, to quietness and repose. With patriotic philanthropy and abnegation he never counts the hours of work, nor does he measure the hours of repose, because he devotes all his time for the benefit of others, even at the risk of sacri- IIO THIRD INTERNATIONAL SANITARY CONVENTION. ficing his own health and interest. I fervently pray to God, with the true faith of a believer, to preserve the life of men such as he who now directs the destinies of the Mexican Nation, and of all his illus- trious co-workers, including Dr. Liceaga, of course, in the Depart- ment of Hygiene, and which is an honor to the nation and a benefit to mankind. In the name of the Government of Salvador, I promise this conven- tion that I shall fulfill all the promises I have made here concerning hygiene. ( Applause. ) THE CHAIRMAN. Gentlemen: Uruguay is represented here by Dr. Ernesto Fernandez Espiro. It is only three days since we met him at least the majority of us and we have already discovered in him a man of lofty ideals, of deep learning, of much foresight concerning public health, all of which will not only be beneficial to his country but to all the American republics. DR. ESPIRO. Mr. Chairman and delegates: I must first express my thanks for the kind and unmerited words just spoken by Dr. Liceaga, as well as for the courtesies shown me since my arrival at this splendid and beautiful Capital, which progresses continually, solving without delay some of the most important and far reaching problems of hy- giene. I do not know whether it will be my good fortune to return here, I do not know whether I shall have the opportunity of again shaking the friendly hands that have been extended to me on this occasion, but be that as it may, I shall always retain a pleasant remembrance of the happy and tranquil days that I have spent under this beautiful sky and in the radiant light of the Mexican sun all those days in which I have shared with you the tasks of a common work, and in which we have united all our efforts and glory in the highest, the noblest, the most civilizing and humanitarian work. Friends, companions, and delegates, with the same affectionate and cordial words with which I had the honor to greet you on my arrival here, I now take leave of you in the hour of parting. THE CHAIRMAN. Delegates: The final part of our program re- quires me to say something in answer to your words of farewell, but I can not adequately reply. I took some notes during the meeting for the purpose of making a resume of, what has been said, because it seems to me that the Chairman of the Convention should do this, but in spite of this fact I can not fulfil this part of my duties. I tried to do so, and here is the raw material, but, I repeat, I have not been able to make the resume, because I have not had time to do so. I regret very much that the last part of the program can not be carried out. But if I was not able to do that which it was planned that I should do, I am going to take the liberty of reminding you of that which was formerly done. Common sense, which continues to be the guide of humanity at the present time, has caused purely theoretical conceptions of purely speculative ideas to pass into the realm of the practical. In former congresses, scientific as well as other kinds, the best aspirations, the most perfect ideals of humanity were discussed, but after the meetings were over, each delegate carried away the impressions of the beautiful phrases, of the lofty thoughts, of the superior intelligence of the ora- THIRD INTERNATIONAL SANITARY CONVENTION. Ill tors, but with the hope that that which had been considered could be realized at some future time. We also have good orators, as you have just heard, such as, for example, Drs. Espiro, Azurdia, Lazo Arriaga, Gonzalez and Mendizabal, and the only difference between the men of that time and those of today, is that the former thought properly but did not act, while the latter not only thought but acted properly. This is not optimism nor an illusion. It is not more than six years since the Second International Con- ference of American States met here, and during the last days of its sessions January 29, 1902 it approved a resolution on international sanitary police in conformity with the clause that I have just read. It was agreed that within a year from that date a Sanitary Convention composed of delegates from the sanitary bureaus of the American republics, should meet in Washington. The promise was fulfilled, the resolutions having been adopted on January 29, and the first meeting held on December 5, 1902. The results of the first meeting were very important, because then, for the first time in a scientific congress of an international character, very important declarations were made con- cerning the transmission of yellow fever, which was well known to the majority of physicians, but which, up to that time, had received no official sanction. Subsequently the first conference in Santiago de Chile could not take place, but the second conference was held in Washington from the 9th to the 1 4th of October, 1905, in which great activity was shown, resulting in the preparation of an international treaty because the Sanitary Convention (Treaty) of Washington, although identical with that of Paris, nevertheless, had to add the part concerning yellow fever, which was only announced in the Convention of Paris. I re- peat, six days were only necessary in which to celebrate an interna- tional treaty ! This work seems to me to be of great importance, as were the other resolutions which were adopted. The motion made by Dr. Wyman concerning the collection in a single book of all the reso- lutions adopted at the previous conventions, means that in future we shall have a Code which covers the better and larger part of the knowl- edge that has been acquired on public hygiene. The Third International Sanitary Convention was held in turn and in due time. It is flattering for me to say that the part concerning hygiene, and that contained in resolutions adopted by the Pan-Ameri- can Conference have been successfully carried out. The work we have now done can not be properly understood for some time to come, but matters which most interested all of us were treated, and have been put into effect with great precision. An interesting fact is that all the delegates who have come here were prepared by their scientific knowledge to inform us of the results of their experience. There have been resolutions such as those relating to tuberculosis, that when they were given to Dr. Soza he had only to formulate them because they had already been well studied. This proves that the work is bearing fruit, and that it is easy to do when there is a will to do it. For these reasons it can be deduced in an entirely practical manner, that the union of the American nations is being effected. 112 THIRD INTERNATIONAL SANITARY CONVENTION. This lack of discrepancy in all the matters that we have treated, this simplicity in the manner of discussing them, removing from them every aspect of ostentation and vanity, this persistence in arriving at cor- rect and practical conclusions is the most important proof of the benefits that meetings of this class bring, not only to the peoples of America but to all mankind. I congratulate myself that Mexico should have been selected for the holding of this Convention, and that her invitation has been accepted by 13 American Republics; I congratulate myself in my name and in that of my Government, for the courtesies that we have received from you, and I have no words with which to sufficiently express my gratitude. Gentlemen, let this proof of confraternity which is presented to the Third International Sanitary Convention of the American Republics, be a pledge that in future these meetings shall be more numerous, and that they will be attended not by a certain number of republics, but by all of the republics of the Western Hemisphere. I wish that in those pleasant impressions which you say you will carry away with you, and which is so gratifying to me, you will see the sincerity of the intentions that inspires the Mexican delegation. (Applause.) Among the resolutions proposed by the Secretary of the Conven- tion is one referring to the appointing of a committee to convey to- the President of the Republic the thanks of the Convention for his courtesies to it and for the valuable assistance rendered it. The com- mittee is composed of Drs. Fernandez Espiro, Wyman, Lazo Arriaga > Ferrer, and Gutierrez Lee. Gentlemen, farewell. The session adjourned. APPENDIX THIRD INTERNATIONAL SANITARY CONVENTION. FEASTS AND SOCIAL FUNCTIONS IN HONOR OF THE DELEGATES. The courtesy and splendor with which the foreign delegates were received in Mexico by the National and Federal District Governments, by the Supreme Board of Health, and by the Mexican Delegation to the Conference, were indeed most notable. In the afternoon of the 3rd of December we were cordially received in the National Palace by His Excellency General Porfirio Diaz, the President of the Republic. In the night of the 4th we were tendered an informal reception at the Department of Foreign Relations, at which occasion, on account of the illness of Seiior Don Ignacio Mariscal, the Department was represented by Senor Don Jose Algara, whose unexpected death we now mourn profoundly. After a delicious tea the delegates were presented with an artistic gold medal, representing the Pan-American Union and bearing the following inscription : "Third International Sanitary Convention, Mexico, December 2 to 7, 1907." At the same time Dr. Eduardo Liceaga presented each delegate with a gold Aztec calendar, with the Mexican colors in the pin from which it hung. On the night of the 2nd a magnificent banquet was given us in the Municipal Palace by the Government of the Federal District and the Supreme Board of the Municipality of the Capital. The abundance of flowers and lights with which the Municipal Palace was ornamented offered a most wonderful view. The banquet was presided over by Don Guillermo de Landa y Escandon, Governor of the Federal District, who delivered an eloqueut speech to which Dr. Pedro L. Ferrer, of Chile, replied in the name of the foreign delegates. In the morning of the 3rd we made a visit to the Penitentiary of the Federal District, where we were cordially received by the Director of the institution, Don Octaviano Liceaga. The conditions of safety, hygiene, comfort and disci- pline prevailing in the Penitentiary were justly praised by the delegates. In the afternoon of the 3rd we were tendered an automobile ride to the Castle of Chapultepec, where we had occasion to admire the exquisite taste displayed in the furniture and ornaments of the different apartments. After visiting this sumptuous edifice and taking a ride through the beautiful park that surrounds it, we stopped at the Cafe de Chapultepec, where a tea was tendered us, beauti- ful ladies of the society of Mexico honoring us with their company. In the afternoon of the 4th we visited the magnificent new Post-Office build- ing, which adds to its beautiful architecture all the necessary elements for the good administration of so important a branch of the Government. Engineer Don Norberto Dominguez, Director-General of Posts, received us most ^courte- ously and presented us with a luxuriously printed pamphlet describing the new building. After the sessions of the 4th we visited the offices and dependencies of the Supreme Board of Health; we had occasion to see the complete equipment of stoves, pumps, disinfecting, apparatus and other instruments used in the splendid sanitary service of the Federal District. Taking into consideration the recog- nized ability of Doctor Liceaga in sanitary matters, his progressive ideas, his indefatigable activity, the fitness of -his subordinate employees, and the well- merited trust that the Government of President Diaz has placed upon him, one can easily explain the great progress achieved in Mexico during the last years in all that tends to the improvement of Public Health. In the night of the 4th a concert in the Arbeu Theatre was given in honor of the Delegates. The theatre was beautifully decorated, and the attendance was large and select; the musical program was wonderfully executed by the artists that participated in the concert. The 5th was spent in an excursion to Xochimilco, where we had opportunity to admire the great Water Works, nearing completion, that will supply the city with pure water. We were received by Engineer Marroquin Rivera, Director of Il6 THIRD INTERNATIONAL SANITARY CONVENTION. the Works, thanks to whom we were able to appreciate that remarkable plant. From Chapultepec we were taken in an express train to Xochimilco. At I o'clock in the afternoon a splendid banquet was served in the open air and under an arch made of tree branches, palms and flowers. This banquet was rendered most charming by the presence of the beautiful ladies that attended it and by the melodies played by an excellent orchestra. Dr. Liceaga presided over the banquet and delivered a speech with the eloquence that characterizes him, and, at the request of the delegates, Dr. Azurdia, of Guatemala, thanked Dr. Liceaga in their name. At half-past two we sailed around the lake in big canoes that were richly decorated, and thus was ended one of the most pleasant excursions. In the afternoon of the 6th we took an automobile drive to the Juarez, Roma, and La Condesa colonies, as the new suburbs are called. In the same afternoon we visited the General Hospital of Mexico, a large and elegantly built institution which fills all the modern requirements. Its system of pavilions, the extent of its site, its good ventilation, perfect hygienic conditions, and magnifi- cent administration place it among the first in the world. Afterwards we went to inspect the Pumping Station and Sewer-cleaning plant, magnificent institutions which are classed among the best of the sanitary works of Mexico. On the 7th, at 8 o'clock in the evening, we were tendered a splendid farewell banquet by the Mexican Delegation, which took place in the "Salones Sylvain." This banquet was attended by the Assistant Secretary of Foreign Relations, rep- resenting the Secretary who was ill at that time, the United States Ambassa- dor, the Minister Plenipotentiaries of Spain, Italy and Belgium, the Charges d' Affaires Guatemala and Salvador, several foreign consuls, all the Delegates to the Convention, and several representative gentlemen. Dr. Liceaga offered the banquet with a well-worded toast which he closed saying: "I drink, gentle- men, to the personal prosperity and to the health of your chiefs executive, to the prosperity of the nations represented in this congress, and that the inhabi- tants of the whole universe may consider themselves as one single nation in all that relates to the preservation of human health, or to the achievement of uni- versal peace." Dr. E. Fernandez Espiro, of Uruguay, responded to the toast of Dr. Liceaga, in the name of all the. delegates, and closed his remarks drinking to the health of the President of the Mexican Republic and Doctor Liceaga. Then, Sefior Licenciado Jose Algara, Assistant Secretary of Foreign Relations, spoke in the name of the Mexican Government, and praised the progress of modern hygiene, the scientists that were honoring Mexico with their presence, and Dr. Liceaga. My colleagues of the Convention honored me with the pleasure of answering to the official toast of the Assistant Secretary of Foreign Relations. After^con- gratulating the Mexican Government for the progress achieved in the country thanks to its well-directed efforts, and the activity it had displayed in the work that now speaks so highly in its favor, and after making special mention of the remarkable impulse which had been given to sanitary works, in the ports as well as in important cities, principally the capital, I closed my remarks drinking to the health of President General Porfirio Diaz and his officials, who fully realized the importance of the improvement of public health ; to the welfare of the noble nation that had received us so splendidly; to the health of the Mexican Delega- tion, whose attentions to us had no bounds; and to the health of the illustrious Mexican, the eminent Doctor Liceaga, our chief, teacher and friend. Upon the closing of my remarks, I had the pleasure of fulfilling the mission with which my colleagues had entrusted me, placing in the hands of Dr. Liceaga a copy in parchment, signed by all the Delegates to the Convention, of the reso- lution in which is stated the appreciation and recognition that we all felt towards him for the most valuable services he has rendered his country, and in which a tribute of respect and admiration is paid to the distinguished hygienist of Mexico, glory of the medical profession of the American Continent. Finally, it is mv pleasant duty to express in the name of all the delegates our sincere appreciation for the many attentions that were accorded to us in Mexico, and to the persons who honored us with social functions, making special mention of Doctors Liceaga and Monjarras and their families. New York, November, 1908. (Signed) JUAN J. ULLOA. THIRD INTERNATIONAL SANITARY CONVENTION OF AMERICAN REPUBLICS. MEXICO, December 6, 1907. MR. PRESIDENT: We have the honor to inform you that at the session held yesterday by the Third International Sanitary Convention of American Republics the Honorable Delegate from Uruguay, Doctor Fernandez Espiro, made the following remarks : I have listened with great pleasure to the report that has just now been read by the President of the Convention, regarding the works of sanita- tion that have been carried out in the Mexican Republic, and, if all the delegates here present agree with the motion, I would propose, in their name and in my own, that a resolution be adopted expressing the gratify- ing impression that the reading of that report has afforded us, and that a copy of the said resolution be forwarded to the Government of Mexico, through Honorable Doctor Liceaga, President of the Convention. The motion having been seconded by the Delegate from Costa Rica, and ac- cepted by all the delegates, it was submitted to the Convention and unanimously aoproved. The Chairman of the Convention expresses his appreciation therefor, and stated that he would be pleased to transmit the resolution to the President of the Republic. We take advantage of the opportunity to renew the assurances of our most distinguished consideration. (Signed) E. LICEAGA, Chairman of the Convention. (Signed) JUAN J. ULLOA, Secretary of the Convention. To SENOR GENERAL DON PORFIRIO DIAZ, President of the United Mexican States, Present. THIRD INTERNATIONAL SANITARY CONVENTION OF AMERICAN REPUBLICS. In the City of Mexico, the seventh day of December, 1907, the Delegates to the Third International Sanitary Convention of American Republics assembled in the National Palace, expressed the feelings of esteem and admiration that they have for Doctor Eduardo Liceaga, Chairman of the Convention, by reason of the valuable services that he had rendered to Public Health in his country, and resolved, by acclamation, to pay a tribute of respect and admiration to the dis- tinguished hygienist of Mexico, glory of the medical profession in the American Continent. Signed by all the Delegates to the Convention. THIRD INTERNATIONAL SANITARY CONVENTION OF AMERICAN REPUBLICS. The Delegates from Brazil, Colombia, and Uruguay, to the Third International Sanitary Convention of American Republics, duly authorized by their Govern- ments, in the official capacity with which they are invested, state that: Deeming it useful and convenient to adopt for their respective countries the Convention signed at Washington the I4th of December, 1905, and in accordance with the Transitory Article thereof, they accept and sign ad referendum, in the name of their respective Governments, the said Convention signed at Washington the I4th of December, 1905. Signed in quadruplicate, two copies in Spanish and two in English, in the Hall of Sessions of the Department of the Treasury, National Palace of Mexico, on the 7th of December, 1907. OSWALDO GONCALVEZ CRUZ, Delegate from Brazil. GENARO PAYAN, RICARDO GUTIERREZ, Delegates from Colombia. E. FERNANDEZ ESPIRO, Delegate from Uruguay. SUBJECTS THAT WILL FORM PART OF THE PROGRAM FOR THE FOURTH INTERNATIONAL SANITARY CONVENTION THAT WILL BE HELD IN SAN JOSE, COSTA RICA, IN DECEMBER, 1909. In order to give publicity, for the information in advance of the different countries of America, to some of the important subjects that will be discussed in the next sanitary Convention, I take the liberty to publish herewith the reso- lution adopted by the International Sanitary Bureau of Washington in its session of October 4, 1908. Among other subjects, the program for the Fourth International Sanitary Convention of American Republics shall include the following: ist. Each delegate will present a report regarding the manner in which the resolutions adopted in the three previous Conventions have been put into practice in their respective countries. 2nd. Reports in regard to sanitary conditions in ports and measures pro- posed for the improvement of such sanitary conditions (with special refer- ence to the principal ports). 3rd. Reports relating to the registration of the movement of population and the mortality of each country. 4th. Sanitation of cities and specially of ports. 5th. Measures for the protection of passengers that embark in vessels leaving Infected ports. (Signed) JUAN J. ULLOA, Permanent Secretary. RESOLUTIONS ADOPTED BY THE FIRST, SECOND, AND THIRD INTERNATIONAL SANITARY CONVENTIONS. The following resolutions, adopted by the First, Second, and Third Interna- tional Conventions of the American Republics, are hereby published, in accord- ance with the direction of the last named Convention, held in the City of Mexico, from December 2 to December 7, 1907: RESOLUTIONS ADOPTED BY THE FIRST INTERNATIONAL SANI- TARY CONVENTION OF AMERICAN REPUBLICS, HELD IN THE CITY OF WASHINGTON, DECEMBER 2, 3, AND 4, 1902. REPORT OF COMMITTEE ON ORGANIZATION. Your committee respectfully report that to carry out the intent of this sanitary convention there should be 1. A president, who shall also be the chairman of the executive board known as the International Sanitary Bureau. 2. One vice-president from each Republic represented. The duties of the vice- presidents shall be, in the order named, to preside in the absence of the president. 3. A secretary. The duties of the secretary shall be to keep a record of the proceedings of the convention from day to day, with a view to their publication to be followed by the publication of specially prepared papers relating to the designated subjects. 4. An advisory council, to consist of six delegates. The president shall be ex officio a member of said advisory council. The duties of the advisory council shall be to prepare the programme from day to day, to examine and pass upon the papers which it is proposed to be presented before the convention, to con- sider resolutions that are presented in general meetings and report upon them to the general body with recommendation either for their passage or rejection, and to attend to such other matters as may be referred to it. The committee nominates the following officers to fill the positions named: For president: Surg. Gen. Walter Wyman, United States Public Health and Marine-Hospital Service. For vice-presidents: Senor Don Eduardo Moore, M. D., Chile; Seiior Don Juan J. Ulloa, M. D., Costa Rica ; Senor Don Juan Guiteras, M. D., Cuba ; Senor Don Luis Felipe Carbo, Ecuador; Senor Don Antonio Lazo-Arriaga, Guate- mala ; Senor Don Nicanor Bolet Peraza, Honduras ; Senor Don Eduardo Liceaga, M. D., Mexico; Senor Don D. Roman, M. D., Nicaragua; Mr. John Stewart, Paraguay; Dr. H. L. E. Johnson, United States; Senor Don Luis Alberto de Herrera, Uruguay. For secretary: Dr. Arthur R. Reynolds, United States. For members of the advisory council: Dr. Rhett Goode, United States; Dr. M. J. Rosenau, Unfted States ; Senor Don Juan Guiteras, M. D., Cuba ; Senor Don Eduardo Liceaga, M. D., Mexico; Maj. Walter, D. McCaw, U. S. Army; Senor Don Juan J. Ulloa, M. D., Costa Rica. Your committee further recommend that the International Sanitary Bureau shall consist of five members, one of whom shall be the president of this Con- ference, the other four members to be nominated to the conference by the advisory council, and the said council shall also recommend to the convention the time and place for the next annual conference. Respectfully submitted. Dr. CARLOS FINLAY, of Cuba, Dr. EDUARDO MOORE, of Chile, Dr. H. L. E. JOHNSON, of the United States, Dr. GLENDOWER OWEN, of the United States, Minister FELIPE CARBO, of Ecuador, Committee. 122 THIRD INTERNATIONAL SANITARY CONVENTION. I. Resolved, That the convention shall be governed by the resolutions agreed upon by the International Conference of American States held in Mexico in 1901 and 1902. II. Resolved, That the time of detention and disinfection at maritime quarantine stations shall be the least practicable time consistent with public safety and in accord with scientific precepts. III. (a) Resolved, That measures of prophylaxis against yellow fever shall be based upon the fact that up to the present time the bite of certain mosquitoes is the only proven natural means of propagation of yellow fever. (&) Resolved, That the Governments represented in this conference approve the measures employed in Habana for the prevention of the spread of the disease on land, for the isolation of cases and the fumigation of buildings, it being understood that said measures are based upon the principle enunciated in resolution (a). (c) Resolved, That the prevention of the importation of the disease by ves- sels wherein persons actually infected are found must conform to the methods employed on land, yet there are questions concerning the importation of infected mosquitoes that require further study before any decided modification of the quarantine laws can be recommended. (rf) Resolved, That the subject of bringing the quarantine laws to conform with the new doctrine of mosquito infection shall be referred to the International Sanitary Bureau of the American Republics for report at the next meeting. (e) Resolved, That an International Sanitary Committee at Washington shall be appointed, and constituted as follows: Surg. Gen. Walter Wyman, chairman; Dr. Eduardo Liceaga, of Mexico; Dr. Eduardo Moore, of Chile; Dr. Juan Guiteras, of Cuba; Dr. Juan J. Ulloa, of Costa Rica; Dr. Rhett Goode, of the United States ; Dr. A. H. Doty, of the United States. IV. Resolved, That the different Governments study, in their respective territories, the geographical distribution of the mosquito of the genus stegomyia, in order that said study may have practical application in subsequent conventions. V. Whereas bubonic plague and other diseases are spread by rats, mice, and other lower animals, which, to a great extent, find sustenance in animal and vegetable kitchen wastes commonly called garbage : Therefore, be it Resolved, That all organic waste or garbage shall be kept separately on the premises until it can be removed, unmixed with anything else, and destroyed. VI. Whereas typhoid fever and Asiatic cholera are caused by swallowing food or drink contaminated by the discharges of previous cases: Therefore, be it Resolved, That it be recognized by this conference that if all the discharges of every existing case of typhoid fever and Asiatic cholera were instantly disinfected, typhoid fever and Asiatic cholera would cease to be a menace to the world. VII. Whereas the Second American International Conference of the Pan-American States, held in the City of Mexico, October, 1001, to January, 1902, provided that a sanitary convention convene in Washington within one year from the signing of the resolutions on sanitation and quarantine, and shall elect an Inter- THIRD INTERNATIONAL SANITARY CONVENTION. 123 national Sanitary Bureau, with permanent headquarters at Washington, for the purpose of rendering effective service to the different Republics represented in this convention : It is hereby Resolved : (a) That it shall be the duty of the International Sanitary Bureau to urge each Republic to promptly and regularly transmit to said bureau all data of every character relative to the sanitary conditions of their respective ports and territories. (6) And to furnish said bureau every opportunity and aid for a thorough, careful, and scientific study and investigation of any outbreaks of pestilential diseases which may occur within the territory of any of the said Republics. (c) // is further resolved, That it shall be the duty of the International Sanitary Bureau to lend its best aid and experience toward the widest possible protection of the public health of each of the said Republics in order that disease may be eliminated and that commerce between said Republics may be facilitated. (d) It is further resolved by this convention, That it shall be the duty of the International Sanitary Bureau to encourage and aid or enforce in all proper ways the sanitation of seaports, including the sanitary improvements of harbors, sewage, drainage of the soil, paving, elimination of infection from buildings, and the destruction of mosquitoes and other vermin. (e) It is also recommended by this convention, That in order to carry out the above measures a fund of $5,000 shall be collected by the Bureau of American Republics in accordance with paragraph 7 of the resolutions of the Second International American Conference above referred to. VIII. Resolved, That a vote of thanks be extended by this Convention, for their cordial hospitality and valued assistance, to His Excellency Theodore Roosevelt, President of the United States; to His Excellency John Hay, Secretary of State; to His Excellency Leslie M. Shaw, Secretary of the Treasury; to His Excellency W. H. Moody, Secretary of the Navy; to His Excellency David J. Hill, Assistant Secretary of State; to His Excellency Sefior Don Manuel de Aspiroz, of Mexico; to His Excellency Sefior Don Gonzalo de Quesada, of Cuba; to the ladies who honored and favored this Convention with their pres- ence at the reception ; to the officers and members of the Metropolitan and Cos- mos Clubs; and last, but not least, to our distinguished president, Dr. Walter Wyman, Surgeon-General of the Public Health and Marine-Hospital Service. RESOLUTIONS ADOPTED BY THE SECOND INTERNATIONAL SANI- TARY CONVENTION OF AMERICAN REPUBLICS, HELD IN THE CITY OF WASHINGTON, OCTOBER 9-14, 1905. (Besides these resolutions, a Convention ad referendum was signed, in regard to preventive measures against cholera, bubonic plague and yellow fever.) RECOMMENDATIONS BY THE ADVISORY COUNCIL. The council recommends that the vice-presidents of the last Convention be continued in office, excepting when the representation to this Convention is different, in which case the new delegates are to take the place of the previous ones. In the case of the Republics which were represented at the last Convention and which are not represented at the present Convention no vice-presidents shall be appointed ; and the council recommends that the respective delegates from the countries which are represented at this Convention for the first time shall be appointed as vice-presidents also. 2. That the International Sanitary Bureau as constituted at the last meeting be continued. 3. That the resolutions presented by Dr. Guiteras concerning the printing of the 5,000 copies of the United States Pharmacopoeia be recommended for approval. 124 THIRD INTERNATIONAL SANITARY CONVENTION. 1. (a) Resolved, That the name of Surgeon-^General Wyman be presented to the convention as president for this meeting, and that the name of Dr. Eduardo Liceaga be presented to the convention as president of the next convention, and that Dr. Juan J. Ulloa be nominated as permanent secretary. (d) Resolved, That the convention be held every two years. (c) Resolved, That the next meeting be held in the City of Mexico in Decem- ber, 1907, subject to the call of the International Sanitary Bureau. () Several important improvements have been introduced in our ports of Limon and Puntarenas in order to improve their sanitary conditions. Their respective municipalities, efficiently aided by the National Government, have taken great care to improve the condition of their streets, their systems of water supply, the system of drainage of the town, and the sanitation of dwellings and public buildings. Maritime sanitation has been put in practice with proper precautions, and ves- sels and passengers coming from infected ports having been subjected to quaran- tine in the strictest manner, and in accordance with modern methods. The macadamized streets have been extended at Port Limon, the drainage sys- tem has been improved, as well as the water supply mains, and important improvements are now being carried out in both systems, one of which will be the proper connection of the drainage system of the houses with the sewer system by means of iron pipes. The National Government has provided both ports with fumigating apparatus of the Clayton type, which have rendered excellent service in the disinfection of THIRD INTERNATIONAL SANITARY CONVENTION. l6l houses and of some vessels. These apparatus are of the H type, and, together with their corresponding steam motor, are easily transported to the place where they are needed, by means of the wheelbarrows on which they are mounted. I have seen these apparatus in operation and am entirely convinced of their effi- ciency for the destruction of rats, mosquitoes, bedbugs, fleas, and other kinds of insects. The gas which they produce is trioxide of sulphur, which, before it penetrates the dwellings through the proper pipes, is cooled down through coiled tubes through which cold water circulates, which constitutes a part of the generating apparatus. This machine is a double action apparatus, and is used for extracting the air from dwellings and vessels before the sulphurous gas is introduced therein, and is also used to inject pure air after the disinfection takes place. It seems that said gas does not injure fabrics or furniture. At present these apparatus are used in several of the American countries, and I believe that they can be conscientiously recommended to those countries that have not yet adopted them. At Puntarenas, and especially at Port Limon, we have two quarantine stations which, though somewhat deficient, render good service. The Government which I have the honor to represent, proposes to construct at the Island of Uvita, situated opposite Port Limon, and about a half mile distant therefrom, the neces- sary buildings for establishing there a quarantine service, in accordance with the plans which I had the honor to submit last year, as a consequence of the Com- mission with which I was entrusted. A suitable installation for the quarantine service of the port of Puntarenas will also soon be made. (c) One of the most praiseworthy achievements of the present administration of Costa Rica has been the earnest support and efficient help which the National Government has rendered to the different municipalities of the Republic for the purpose of improving their sanitary conditions, and, more especially, for the laying of the systems of water mains for the potable water supply. Since the present administration has been in control, it has efficiently helped the construc- tion of at least ten water mains, and there are more under construction. The Government has promised to help other towns along these lines. One of the most important improvements about to be undertaken is the exten- sion and improvement of the water mains of San Jose, and the general system of sewers in the same city. These works will cost approximately $1,000,000. Lately the sanitary conditions of the capital of the Republic have been considerably improved, and the new boroughs that are being opened for the extension of the town, are put in good sanitary condition before buildings are constructed thereon. In the other principal cities of the country, important sanitary improvements have also been introduced. (d) Since the I4th of October, 1905, several sanitary police laws have been promulgated, as you will see from the respective appendices. The most important provision made in the sanitary branch of the Government was the ratification, by the National Congress, during its regular sessions of 1006, of the .International Sanitary Convention held in Washington on October 14, 1905, by the representatives of the governments which participated in the Second International Sanitary Congress, and which will be the law to govern in the important matter of sanitary police of the American Continent. Quarantine was declared against vessels coming from the port of Havana, on account .of the cases of yellow fever, which, unfortunately, occurred lately in Cuba, as well as inspection quarantine against vessels coming from San Francisco, Cal., owing to the bubonic plague prevailing in said city. Special measures have been taken against tuberculosis, syphilis and the morphine habit. 2. The practical methods which I beg to suggest in order to prevent the trans- mission of tuberculosis in traveling vehicles, are .those which are already known and accepted generally, namely : the proper disinfection of railroad cars and the staterooms and berths of vessels. The provision of portable cuspidors, punish- ment by heavy fines of persons who expectorate on the floor of cars, berths, etc., and the thorough and careful disinfection of all the utensils employed by con- sumptives or those who are suspected of being afflicted with tuberculosis. 4. The organization of a commission composed of three physicians, or health officers, intended to constitute a part of the International Sanitary Information Commission of the American Republics, may be entrusted, so far as Costa Rica is concerned, through the National Government, to the medical faculty, which l62 THIRD INTERNATIONAL SANITARY CONVENTION. is the advisory authority of the country, in matters relating to sanitary measures or sanitary* police. 5. It seems to me that the establishment of the Bureau of Sanitary Informa- tion of Montevideo, in accordance with the provisions of paragraph 3 (c) and paragraph 4 of the resolutions adopted in Rio de Janeiro, is very desirable. 6. I also consider very important the establishment of relations between the International Sanitary Bureau established in Washington and the International Sanitary Office of Paris. GENERAL REPORT PRESENTED BY DRS. HUGO ROB- ERTS AND JUAN GUITERAS, DELEGATES FROM CUBA. The provisional programme for this Convention, to which I have the honor of belonging, includes a memorial by the Delegate of each Nation, which shall contain a report respecting the contagious and infectious diseases prevalent in his territory, as also the conditions of the ports, the aid furnished by the Government to the Municipalities or States, and ,the Sanitary Police Laws promulgated after October 14, 1905. Allow me first to occupy myself with our sanitary organization, for once understanding what we might term its "anatomy," it is- much easier to interpret its functions and also to judge of its results. In Cuba, the superior sanitary body is the National Sanitary Board, composed of members of the Sanitary Administration, including a Lawyer and an Engineer, as advisers on technical questions. Not only does this Board exercise supervision over all sanitary matters, but it is also a Consulting Board for all hygienic questions ; its President is the Chief Sanitary Officer. On this basis, the service is divided into two important branches : the Quaran- tine Service or that of external defense, and the Interior Sanitary Service, whose object is to afford internal protection. QUARANTINE SERVICE. The object of this service is to compel the carrying put of the Quarantine Laws and Regulations, the same being in force in the United States of America at the time they were promulgated in Cuba; these, later on, were modified in order to adjust them to recent advances in science. In order to reap the great advantages obtained in taking all measures as promptly as possible, the Law provides what must be done by all vessels in an infected locality and also the measures to be adopted by the same at sea, should a quarantine case occur on board; and furthermore the requirements to be observed in Cuban ports, should sufficient precautions against the transmission of the epidemic not have been taken at the port of sailing. The introduction of all epidemic disease should be prevented, and especially those termed quarantinable, being the following according to our law: yellow fever, plague, cholera, small-pox, leprosy and typhus. Although this law does not make a final classification of vessels according to their sanitary conditions on sailing from or arriving at a port, still the standard accepted in Cuba, allows us to classify them under three heads : "Infected," "Suspected" and "Indemne." An "Infected" vessel is one on which no precautions have been taken on sailing from an infected port, thereby accepting the possibility of the existence on board of the pathogenic agent, which, until destroyed, might, at any time, infect some person on board. These vessels on arrival at Cuban ports are fumigated, and the crew and passengers detained for a time covering the incubation of the disease in question. A "Suspected" vessel is one which, though sailing from an infected port, by having observed the required precautions, the possibility of its having on board the pathogenic agent, cannot be entertained, nevertheless, some person on board might be in the incubative period of the disease acquired by infection during the stay of the vessel in the infected locality. Such ships are not fumigated in Cuba, but the personnel is detained in Quarantine during the period of incuba- tion of the disease; the said period begins to count from the last moment in THIRD INTERNATIONAL SANITARY CONVENTION. 163 which they were exposed to the disease, that is to say, from the time they left the infected locality. An "Indemne" vessel, in the true acceptance of the word, which means: "exempt from harm," is one on which the existence of a pathogenic agent cannot be entertained, and on which the passengers and crew could not possibly be in the incubative period of any disease, either because no quarantinable disease existed at the port of departure or because all proper precautions had been taken before sailing. It is therefore easy to understand that a ship changes from an "Infected" to a "Suspected" class by fumigation, and from "Suspected" to "Indemne," through the course of time; that the appearance of quarantinable disease on board a "Suspected" ship, immediately changes it or part of it into an "Infected" one, which may through fumigation again be turned into a "Suspected" ship. This was the opinion sustained by the delegates of Cuba to the Second Inter- national Sanitary Convention, held in Washington in October, 1905, and in conformity with said opinion, Regulations were made for our defense against Yellow Fever. On the 8th of last May, the resolutions adopted by the above cited Convention were promulgated and put in force by the Honorable Provisional Governor of Cuba; and, the requirements contained in Chapter i, Articles I, II, III and IV, by which it is obligatory to report not only the first appearance of confirmed cases of Plague, Cholera or Yellow Fever in the country, but also to remit a detailed account of the locality where the case or cases appeared, the origin and form of the same, etc., etc., were carried out by our State Department. There are twenty-three ports open to foreign commerce in Cuba, FIVE as Quarantine Stations, containing everything necessary to handle any ship, besides two fully equipped Stations (Lazaretos), one in Havana and the other in Santiago de Cuba, with Hospitals sufficient for any contingency which might arise. Each port has a competent staff available for its needs. There are FIVE doctors attached to the Cuban Consulates in foreign ports with which we have close commercial ties or which send us great currents of emigration. Vaccination is obligatory in Cuba. The Officers of the Quarantine Service vaccinate arrivals from foreign countries. This Service costs the Cuban Government about ONE HUNDRED AND THIRTY THOUSAND DOLLARS a year. Fumigations, Bills of Health, etc., are entirely gratuitous. There are no sanitary fees, and when any one is sent to the Quarantine Stations, his maintenance is supplied by the consignees of the ship, the State defraying all the rest of the expense. IMMIGRATION. The Immigration Department is a complementary branch of the Quarantine Service. This Department has charge of the physical examination of the immigrants, with the object of preventing the introduction into Cuba of persons whose immigration is prohibited, either because their habits might be the source of danger to the community, or because they may have some physical defect which sooner or later may oblige them to resort to begging or to apply to asylums for the poor, or, owing to their suffering from contagious or loathsome diseases, which are not necessarily quarantinable. In Havana this important mission is entrusted to the Immigration Department, and in the rest of the Ports of the Island, the Collectors of Customs perform the duties of Commissioners of Immigration, in which the Doctors of the Port co-operate. For the purposes of the Immigration Law, foreigners who come under any of the prohibitions or restrictions contained in said Law, may be divided into two great groups : to the one group correspond those whose habits or nationality bar them from immigrating; to the other belong idiots, insane persons, those suffering from loathsome or contagious diseases, such as Favus, Leprosy, Syphilis, Tracoma and Tuberculosis of the lungs. All immigrants who have physical deformities and who may therefore become a public charge shall be returned. Immigrants free from all disease or physical deformity who arrive in Cuba in a state of pauperism, are lodged in the Triscornia Barracks, until proper work is found for them. 164 THIRD INTERNATIONAL SANITARY CONVENTION. NATIONAL SANITARY DEPARTMENT. To this Department is intrusted the preservation of the Public Health within the nation. Under its supervision are all the branches of Public Health Service such as Hospitals, Sanatoria, etc. Each Municipal District has a local Sanitary Chief, with the necessary auxiliary Staff; the number of persons employed, and likewise the salaries of the officers, are fixed in proportion to the population of the district. The superior direction of the Department is vested in a Board composed of six members, among whom are included a Lawyer and an Engineer as advisers. The Chief Sanitary Officer is the President of the Board. This National Sanitary Board has general supervision over all matters con- cerning public health and sanitation in all the Republic. It makes sanitary investigation of the causes of diseases, especially those of an epidemic character; including diseases of animals; the cause of malaria, and the effects produced on the public health by localities, conditions, habits, liquors and medicines. It publishes the useful results obtained, and distributes popular instruction on these and other similar questions. It compels the enforcement of the Sanitary Laws, including the laws regulat- ing the admission to the practice of medicine and surgery, veterinary medicine, pharmacy, dental surgery, obstetrics, embalming, funeral agencies, prostitution, and also the laws regulating dangerous and noxious industries and occupations. It compels the carrying out of all measures throughout the Republic, respecting the water supply, sewers, garbage and street sweepings, adulteration of foods, liquids and drinks, and also those concerning the importation and treatment of the cattle for slaughter. It maintains in Havana a Biological, Chemical and Bacteriological Laboratory, fully equipped with apparatus and instruments, and with a competent staff to carry out bacteriological studies and to examine foods. Besides these, there are Special Commissions, who are oblige^ to examine, so as to ratify or rectify, all suspected cases of contagious disease which might become epidemic. Depending likewise directly on the National Sanitary Board are the dispen- saries and official sanatoria, the Central Bureau of Vaccination and the Special Hygienic Service. (This last has in charge all matters referring to prostitution, and has branches in different cities of the Republic.) Also depending on the National Sanitary Board, is the "Las Animas" Hospital, destined exclusively for patients suffering from contagious diseases; this estab- lishment is specially equipped for this object. And, lastly, the Maternity and Orphan Asylum, the Hospitals of Societies as well as private, are under the supervision of the National Sanitary Board. YELLOW FEVER. In the month of November, 1905, we were surprised by an outbreak of yellow fever in Havana, the more so, that from September 28, 1901, not a single autochthonous case had been registered, and, in order to avoid its introduction, all measures and suggestions taught by recent scientific discoveries, touching the transmission of the disease through the "Stegomya" mosquito had been stringently carried out. The spread of the epidemic, new cases arising before the necessary time had elapsed for the intrinsic and extrinsic incubation of the pathogenic agent proceeding from the original case, revealed the existence of an epidemic amongst us, very evidently proving that, either a group of infected "Stegomyas" had succeeded in entering this country, or that some infected person had formerly existed, notwithstanding pur efforts to discover him, and in spite of the thorough investigation carried out. The problem remains unsolved; the introduction of yellow fever into Cuba can only be hypothetically explained; and, as is natural among all these different hypothesis advanced to explain the fact, we must accept the one having the most probabilities. If we consider, that in the month of May, 1905, an epidemic of yellow fever broke out in New Orleans, of which we had no knowledge in Cuba until the latter part of the month of July, when defensive measures against that city were adopted, it is not unlikely to suppose, that during such lapse of time, some person being in the period of incubation and not being under observation, had THIRD INTERNATIONAL SANITARY CONVENTION. 165 landed in Cuba ; or that some ship from New Orleans had been allowed to move about freely, thus permitting infected "Stegomyas" to reach the city. From the time the first case appeared in the year 1905, until November 7 1907, 322 cases with 98 deaths have occurred in all the Island, and, if we consider the large non-immune population we have at present, it is easy to understand, that though it is true that the epidemic still exists, it has not reached the proportion that such epidemics usually acquire, owing to the tenacity with which it has been fought, notwithstanding the disturbed conditions of affairs. The means employed to check the epidemic are those that would logically occur to any one in view of the manner of its propagation. To ratify or rectify the diagnosis of every person who may be suspected of suffering from yellow fever; isolation of the patient, and disinfection of all places where the disease is liable to have been taken, and likewise those places which in their turn he may have infected during the contagious period of the disease. In infected localities, wherever it was possible to daily inspect npn-immunes, this has been done, and whenever a non-immune has changed his residence, the different Sanitary Officers have been notified so that the person may continue under observation during the probable period of incubation. Besides these precautions, all Quarantine as well as Public Health officers respectively, watch all routes by which an epidemic may be introduced, carrying out all the measures ordered, on the least suspicion, and immediately reporting to their superior officer, the President of the National Sanitary Board. PLAGUE. Notwithstanding the numerous vessels that daily arrive in Cuba from places infected by the Yersin bacillus, we have fortunately not had to lament the occurrence of a single case. Special care is taken to avoid the landing of rats from these vessels. Recognizing the importance that rats represent in the Sropagation of the plague, and their swimming powers being so great, the uarantine Service experimentally tried to estimate this faculty; therefore, six rge rats were thrown into the Bay of Havana, and their movements observed from a small boat. From this simple experiment the following was deduced: First. That rats are able to remain on the surface for a length of time varying from 35 to 45 minutes. Second. That they do not swim in a straight line, but forming irregular zig-zags, probably owing to the small horizon visible to them. Third. That if they happen to see any object, increasing their exertions, they steer for it, and if able to seize, they do not abandon it, unless obliged to by superior force. From these observations, the following practical results may be obtained : That it is sufficient to anchor the vessel, for fumigating purposes, at a distance of 50 meters, which rats do not cross, unless carried by the current or some floating object. That floats should be placed near the vessel so that rats on falling into the water may find refuge upon them and thus be easily despatched. MALARIA. In the Island of Cuba, as in all intertropical countries, malaria has been quite prevalent, and only through the constant sanitary work done, thereby avoiding as much as possible the propagation of the "Anopheles" mosquito, have we been able to diminish the number of cases. This work of Municipal sanitation was included in the "Sanitary Ordinances" which the Cuban delegates presented to the Second International Sanitary Convention. Moreover, the systematic campaign waged against the "Stegomya" includes the "Anopheles" also, and this has been the cause of greatly diminishing Malaria. The number of deaths owing to this disease has gradually decreased. In Havana in the year 1890, they reached 909, and last year 26 occurred. These numbers are the most evident proof of the success obtained in the sanitation of the city. TUBERCULOSIS AND TRACHOMA. The fact that a person suffers from either one of these two diseases is in itself sufficient cause to bar him from landing in Cuba, in conformity with the provi- sions contained in the Laws of Immigration. In order to contend with these diseases in our territory, as well as against others equally contagious and transmissible, the National Sanitary Department l66 THIRD INTERNATIONAL SANITARY CONVENTION. has adopted numerous and efficient restrictive measures, among which are, the prohibition to attend schools, colleges, workshops, factories, etc., to children, employees and workmen suffering from transmissible diseases or who come from houses where such a disease exists, or until they have obtained the proper discharge as cured. A special Sanatorium for consumptives is at present being built as an experi- ment, in a suitable place in the Province of Havana. There are negotiations pending for the purchase of a suitable property to which the "San Lazaro" Hospital will be removed after making the necessary repairs and improvements. This Hospital, where lepers are housed, mars the appearance and defaces the city, being besides very inconvenient for the purpose. And, finally, in many cities of the Island plans are being made for the building of aqueducts and sewers, which will contribute greatly to the sanitation of the different towns and cities, the most important being those of Havana, Cienfuegos and Santiago de Cuba. REPORT ON YELLOW FEVER. Extract from the report made to the Provisional Governor of Cuba by Dr. Juan Guiteras, Chairman of the Committee on Infectious Diseases, and Dean of the Faculty of Medicine. This report is based on a tour of inspection to the City of Cienfuegos, and to the central provinces of the Republic in the month of September of the current year. On the day of my arrival in Cienfuegos, on the ipth of September, it was apparent that the breaking out of the epidemic was rapidly yielding to the efforts of the sanitary authorities charged with combatting the same. On leaving the city on the 22d of said month, there remained only five cases, three of which had originated in the neighboring towns of Guaos, Caunao and Soledad. What happened at that time was in accord with our experience during the last few years, since the new outbreak of yellow fever in Cuba in 1905. It has happened ever since that the disease is under control in the centers of population where the sanitary organization can exercise prompt and efficient action, while in the country, on the contrary, the disease keeps dragging from one place to another, having an existence more or less unknown. This prevalence of yellow fever at places in the country is a very interesting phenomenon, which now occupies our attention with all the interest of a problem of great practical importance. But we should not regard it as a new thing. In former times, before yellow fever was eliminated from the Island, the authorities did not pay much attention to the prevalance of the infection in the city of Havana, and paid much less attention to cases in country places. The disease could easily spread from one place to another without attracting the attention of any one, unless it should encounter some observing person like Dr. Pedro Albarran, who had the good fortune and talent to photograph one of those peculiar rural epidemics among the native population. Whether any records existed concerning the wanderings of this disease, we have reason to suppose that they were not lacking, since such is the history of all epidemic diseases. Smallpox, scarlet fever, and cholera, have migrated from the centers of population to the rural districts, and from the latter again to the centers of population in the form of a small secondary epidemic, thus maintaining the conditions called endemic. This flux and reflux of the tide may be easily followed in the annexed drawing, which presents in synopsis the course of yellow fever since its introduction into Cuba in the fall of 1905. The cases which occurred in the cities of Havana and Cienfuegos are marked with black and red triangles, respectively, while those which originated out of the Capital are marked in red letters. There may be seen in said drawing how, during the administration of President Estrada Palma, the disease was extinguished in Habana in February, 1906; how the infection continued in the rural districts, and how Habana was again infected in June and August of the same year from said districts. The repeti- tion of the same events during the present administration, may also be followed in said drawing. The epidemic at Cienfuegos was also probably imported from the rural dis- tricts. At the end of the summer of 1906, the interruption of communication THIRD INTERNATIONAL SANITARY CONVENTION. 167 with Habana, brought about by the political disturbances and insurrectional outbreaks, impeded or delayed the detection and control of a small epidemic outbreak in Cruces, though this outbreak was eventually controlled by Capt. H. D. Thomaspn, and Dr. Claudio Delegado. However, we may presume that the rural territory extending from Cruces and Cienfuegos, have served, by means of sporadic cases, as a slow fire concealed in the explosions. We should, therefore, devote our attention more than we have done here- tofore, to rural districts. Active and experienced inspectors in the diagnosis of yellow fever should be kept traveling through the provinces. They will, of course, be under the orders of the Department for the purpose of investigating and reporting concerning suspicious cases that may develop in any place. While they are not obeying direct orders from the Department, they shall travel on their own initiative and consult the local authorities and physicians, examine the statistics of mortality in the several municipalities, and shall endeavor to inform themselves concerning the sanitary conditions, and the direction of the currents of working men and immigrants. In this second visit that I made to Cienfuegos, I was enabled to confirm the forecast which, together with Dr. Finlay, we had made during our previous visit in the middle of August, and I mention this fact merely because under the present circumstances it is proper to call especial attention to some points in the epidemiography of yellow fever. Upon our arrival at Cienfuegos in August, we found a very violent outbreak of the disease in the American garrison, which contrasted with very slow evo- lution of the infection among the civil population. Among the troops a group of fifteen men (soldiers of the sanitary corps) within a very few days had caused seven infections, while among the civil population of the city only three had occurred. In spite of this threatening aspect of the outbreak in the garrison, we were able to foretell that the infection would be rapidly extin- guished in that camp, and that it would cause a great deal of trouble in the city. The fundamental difference between the two outbreaks was the following: In that which occurred in the soldiers' camp we had reason to believe that we had to deal with an initial outbreak among the soldiers. The first cases had been detected and properly treated; we knew precisely where the troops had bcome infected; we knew that the infecting mosquitoes must have been in a recently constructed wooden barrack which was built as an extension to the building which they had been using as a military hospital a barrack which was occupied by the soldiers of the sanitary corps, in fact, we could almost tell the number of infected mosquitoes in the barrack. Therefore, it was to be presumed that a thorough fumigation of said barrack would terminate the out- break of yellow fever in the garrison, and so it was, in fact, because said outbreak came to an end just as suddenly as it began. On the contrary, in the city the situation was unknown. The three cases which had been denounced came from different wards of the city, and it was impossible to determine where the infection had been contracted. It was evident that other cases not detected had occurred before the denounced cases. Probably some of these had infected the mosquitoes of the aforesaid barracks, and at all events it was feared that a very active campaign would be necessary in- order to extinguish the infection. Such has been the campaign that is being carried out under the direction of Captain Thomason, with the co-operation of Dr. Claudib Delgado, in charge of the Department of Investigation and Diagnosis, and of Dr. Custodio, who has charge of the sanitation and disinfection works. The methods employed by Dr. Thomason are the same as those employed by Dr. Gorgas in 1901, which constitute the practical application of the Finlay doctrine. It is proper here to state that the rules which said doctrine imposes are two, viz.: 1. The treatment of the infecting material, that is to say, the patient and the infected mosquitoes. This is accomplished by isolating the patient under wire gauze against insects and by the destruction (fumigation) of such mosquitoes as have bitten the patient. 2. A general campaign in order to prevent the breeding of the stegomyas for the purpose of obtaining, even though only temporarily, the extinction of that specie in the locality. The discussion concerning the relative importance of these two rules seems useless. We must, of course, recognize as an incontrovertible truth, that either 168 THIRD INTERNATIONAL SANITARY CONVENTION. of the- two rules by itself would be sufficient to obtain the rapid extinction of any epidemic if our methods were perfect. However, it is proper for us to bear in mind what generally happens during a prophylactic campaign against yellow fever, and then it will be seen that, without doubt the purpose has always been to attend to two things at the same time ; but in the acute period of the epidemic, when the clamor of the people is heard in all places expecting and demanding immediate results, the general practice has been to devote the greatest energy to the treatment of the material infected, leaving as a secondary consideration the work of the extinction of the breeding of stegomyas. The material infected, the patient and the mosquitoes which have bitten him resemble somewhat the firing line of an advancing enemy against whom one hastens to direct his fire before going in a roundabout course and cutting off the communication of the enemy with his stores of ammunition. When the Government of Intervention took charge of the direction of our affairs in the fall of 1906, when we were in the midst of an energetic campaign against yellow fever, it happened that Major Keane, Sanitary Supervisor, demon- strated that the inspection of the water reservoirs, the destruction of the larvae, and the general campaign against the stegomya had been neglected. It then became evidently advisable that Major Keane should have imparted the necessary activity to that section of the sanitation work. The same happened during the recent epidemic at Cienfuegos, where the greatest possible attention has been given to the breeding places of mosquitoes, the strictest orders have been issued, which, however, there is no doubt that they had already been observing in some parts of the city; but some time was required before the people really understood what is required of them in the matter of deposits of water and breeding places of larvae. The doubts pre- vailing concerning the matter caused some delay in imposing of fines, which is the only way of securing the co-operation of all. A general inspector arriving in the midst of the campaign may, by devoting his attention to this part of the program, efficiently support the efforts of the chief in charge of the work. So far as the technique of the fumigation is concerned, Captain Thomason and his assistants realizing the necessity of modifying some details have tried new processes. There is no doubt whatever that by means of the system now employed, the mosquitoes are sometimes frightened away from the house during the preliminary preparation for the fumigation, either by the family taking down pictures, curtains, opening drawers and closets to take out anything that might be injured by sulphur, or by the fumigators themselves who shake in the air the strips of paper and the rolls used to cover the cracks and openings in the walls and ceilings. There is danger, especially as to the ceilings, in the mosquito remaining outside of the paper. In order to remedy this deficiency, Captain Thomason has attempted to close up the house from the outside, roof and everything else, with large canvas sheets. This method had been employed before in the disinfection of huts and barracks in Cuba as well as in Mexico, but continued experience is extending the application of the system to all kinds of dwellings and securing its use in practice. Captain Thomason has* also insisted on the advantage of concentrating the operations of a great number of workers in one single block of houses in order that all of them may. be fumigated at the same time, and to prevent mosquitoes from flying from one house into another. Something should be said in a report of this character concerning the general results obtained by the processes which are being employed in Cuba. It is of course quite natural for the mere lookers-on to become impatient, and to demand more rapid results, but the impartial opinion of experienced observers will recognize that the work which has been done in Cuba in order to combat yellow fever, both during the present administration and during that of President Estrada Palma has been highly satisfactory. During both epochs we have succeeded in preventing yellow fever from assuming, even remotely, the char- acter of extensive annual epidemic recrudescenses, which characterized them in times gone by, nor has it been allowed to assume the serious epidemic forms which recently prevailed in New Laredo, New Orleans and Pensacola. The differences, owing mainly to the comparative promptness with which the plan of campaign is established in Cuba, because the announcement of the exist