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SPECIAL NOTE. 
 
 Mr. John Barrett, the Director General of 
 the Pan American Union, an institution devoted 
 to the development of comity and commerce 
 among the American nations, and which acts in- 
 cidentally as the office of the International Sani- 
 tary Bureau, presents his compliments 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 in- 
 formation concerning the Latin-American Re- 
 publics they can obtain it by addressing him 
 at the Pan American Union, Washington, D. C. 
 
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TRANSACTIONS OF THE FIFTH 
 
 INTERNATIONAL SANITARY CONFERENCE 
 
 OF THE AMERICAN REPUBLICS 
 
 HELD IN SANTIAGO DE CHILE, 
 
 NOVEMBER 5 TO 11 
 
 1911 
 
 f *&l 
 
 PUBLISHED AND DISTRIBUTED UNDER THE AUSPICES OF THE 
 PAN AMERICAN UNION, JOHN BARRETT, DIRECTOR- 
 GENERAL, WASHINGTON, D. C. 
 

 Press of Byron S. Adams, 
 Washington, D. C. 
 
 \ a 
 
INDEX. 
 
 PAGE. 
 
 Call for the Fifth International Sanitary Conference J 
 
 List of Delegates 5 
 
 Officers and Committees of the Conference 6 
 
 Officers of the International Sanitary Bureau of Washington 7 
 
 Officers of the Sanitary Information Bureau of Montevideo 7 
 
 Delegates of the International Sanitary Bureaus of Washington and Monte- 
 video and Members of the International Sanitary Information 
 
 Committees 9 
 
 Program of the Fifth International Sanitary Conference 10 
 
 Transactions of the Fifth International Sanitary Conference of the Ameri- 
 can Republics. 
 First day, Sunday, November 5, 1911 — 
 
 Afternoon — Opening Session 15 
 
 Second day, Monday, November 6, 1911 — 
 
 Morning Session 26 
 
 Afternoon Session 28 
 
 Third day, Tuesday, November 7, 1911 — 
 
 Afternoon Session 34 
 
 Fourth day, Wednesday, November 8, 1911 — ■ 
 
 Afternoon Session 36 
 
 Fifth day, Thursday, November 9, 1911 — 
 
 Afternoon Session 39 
 
 Sixth day, Friday, November 10, 1911 — 
 
 Morning Session 41 
 
 Afternoon Session i 47 
 
 Seventh day, Saturday, November 11, 1911 — 
 
 Morning Session 53 
 
 Afternoon — Closing Session 61 
 
 Appendix : 
 
 Festivities and social functions in honor of the delegates 67 
 
 Resolutions passed by the Fifth International Sanitary Conference.... 68 
 
 Reports of the Committees 71 
 
 Reports presented by the Delegations : 
 
 Argentine Republic 77 
 
 Bolivia 81 
 
 Brazil 87 
 
 Chile . . 91 
 
 Costa Rica 97 
 
 Cuba 101 
 
 Ecuador 107 
 
 El Salvador Ill 
 
 Guatemala 113 
 
 Mexico 117 
 
 Paraguay 119 
 
 United States , 121 
 
 Uruguay 153 
 
 Venezuela 159 
 
CALL FOR THE FIFTH INTERNATIONAL SANITARY 
 
 CONFERENCE. 
 
 In accordance with the resolution adopted at the Fourth International Sanitary 
 Conference, held in the city of San Jose, Costa Rica, from December 25, 1909, 
 to January 3, 1910, the date, November 1-12, 1911. has been fixed for the 
 assembling of the Fifth International Sanitary Conference in the city of San- 
 tiago, Chile. 
 
 The following official correspondence in regard to the call and the pro- 
 visional program of the Conference are printed in the interest of the 
 Conference. 
 
 International Sanitary Bureau, 
 Washington, D. C, May 10, 1911. 
 Honorable John Barrett, 
 
 Director General, Pan American Union, 
 Washington, D. C. 
 
 Sir: 
 
 In accordance with a resolution adopted at the Fourth International Sanitary 
 Conference, held at San Jose, Costa Rica, December 25, 1909, to January 3, 
 1910, and with the approval of the International Sanitary Bureau, I inclose 
 herewith a call for the meeting of the Fifth International Sanitary Conference. 
 A copy of the provisional program that will govern the deliberations of the 
 conference is also inclosed. 
 
 I have also to request that, pursuant to the provisions of Paragraph 7 of 
 the resolutions relative to sanitary police, adopted at the Second International 
 Conference of American States, you take the necessary measures to announce 
 this call and bring the provisional program to the notice of the governments 
 concerned. 
 
 It is understood that the proper representations will be made by your 
 office to the Legation of Chile, so that the invitations to the Conference may 
 be jointly issued by that Government. 
 
 Respectfully, 
 
 (Signed) Walter Wyman, 
 Chairman, International Sanitary Bureau. 
 
 FIFTH INTERNATIONAL SANITARY CONFERENCE OF THE AMER- 
 ICAN REPUBLICS, 
 To Be Held in the City of Santiago, Chile, November 1-12, 1911. 
 International Sanitary Bureau of the American Republics, 
 
 Washington, D. C, May 12, 1911. 
 Announcement is hereby made that, in compliance with a resolution adopted 
 at the Fourth International Sanitary Conference, the Fifth International Sani- 
 tary Conference of the American Republics will be held in Santiago, Chile, 
 November 1-12, 1911, under the presidency of Dr. Alexander Del Rio and the 
 auspices of the Chilean Government. 
 
 The attendance of representatives of every American republic is earnestly 
 desired, including those which have not taken part in previous conferences. 
 
 As stated in the Provisional Program, a number of subjects will be dis- 
 cussed at Santiago, which are of vital interest to all the nations of this con- 
 tinent, and it is expected that the deliberations of this Conference will be fully 
 as important and fruitful in results as the preceding ones. The provisional 
 program which follows is subject to amendment or revision, as may subse- 
 quently seem advisable. 
 
Provisional Program for the Fifth International Sanitary 
 Conference of the American Republics, to be Held in the 
 City of Santiago, Chile, November 1-12, 1911. 
 
 1. Reports by the several delegations in regard to the sanitary legislation 
 enacted in their respective countries since the last Conference. 
 
 2. Special reports relative to the means employed in the different countries 
 for the enforcement of the resolutions agreed to in the last Convention. 
 
 3. Reports discussing the vital and morbidity statistics of each country 
 during the last two years. 
 
 4. Special reports on the sanitary progress of the principal cities in each 
 country. 
 
 5. Discussion of measures relative to social hygiene, with special reference 
 to venereal diseases. 
 
 6. Determination of what constitutes immunity to yellow fever. 
 
 7. Discussion of hygiene of sea traffic, having in view specially systematic 
 measures for the deratization of ships. 
 
 8. Discussion of hygiene of tramway and railroad traffic. 
 
 By direction of the International Sanitary Bureau of the American Re- 
 publics. 
 
 Walter Wyman, 
 
 Chairman. 
 
 As requested in the communication of Dr. Walter Wyman, Chair- 
 man of the International Sanitary Bureau, the Director General of the 
 Pan American Union has addressed a letter to the diplomatic represen- 
 tatives of the countries interested in the Conference 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 Pan 
 American Union. 
 
DELEGATES. 
 
 I.-Argentine Republic } £ r - Gregorio Araoz Alfaro. 
 
 ( Dr. Fernando Alvarez. 
 
 2. — Bolivia Dr. Claudio Sanjines. 
 
 2 r r ^ zil | Dr. Ismael da Rocha. 
 
 { Dr. Antonino Ferrari. 
 
 4. — Colombia Dr. Alcibiades Vicencio. 
 
 5. — Costa Rica Dr. Fernando Iglesias. 
 
 6. — Cuba Dr. Hugo Roberts. 
 
 7.— Dominican Republic f Senor Tito V. Lizoni. 
 
 ( Dr. J. Ramon Campos. 
 
 8. — Ecuador Dr. Luis Felipe Cornejo y Gomez. 
 
 g tj nited States (Dr. Gregorio M. Guiteras. 
 
 \ Dr. J. C. Perry. 
 10.— Guatemala | Dr. Salvador Ortega. 
 
 ( Dr. JULIO BlANCHI. 
 
 11. — Honduras Senor Oscar Valenzuela Valdes. 
 
 12. — Mexico Dr. Jesus Monjaras. 
 
 13. — Panama Dr. Caupolican Pardo Correa. 
 
 14. — Paraguay Dr. Rojelio Urizar. 
 
 15. — Salvador Dr. Juan B. Miranda. 
 
 16_ Uruguay ^ Dr. Ernesto Fernandez Espiro. 
 
 ) Dr. Jaime H. Oliver. 
 
 17._Venezuela f Dr - Pablo Acosta Ortiz 
 
 ( Dr. Luis Razetti. 
 18. — Chile: 
 
 OFFICIAL DELEGATION. 
 
 Executive Committee. 
 
 Provisional President : Dr. Alejandro del Rio. 
 
 Secretary to the Delegation : Dr. Gregorio Amunategui. 
 
 Treasurer : Dr. Octavio Maira. 
 
 Members : Dr. Paulino Alfonso, Dr. Luis Asta-Buruaga, Dr. Mamerto 
 Cadiz, Dr. Lucio Cordova, Dr. Ramon Corbalan Melgarejo, Dr. Pedro Lau- 
 taro Ferrer, Dr. Eduardo Moore, Dr. Manuel Camilo Vial. 
 
 Members of the Delegation : 
 
 Dr. Vicente Izquierdo, Dr. Roberto del Rio, Dr. Ricardo -Davila Boza, 
 Dr. Francisco Landa, Dr. ALciBiADES Vicencio, Dr. Eduardo GarcIa Collao, 
 Engineer Jorge Calvo Mackenna, Dr. Conrado Rios, Dr. Ernesto Soza, 
 Dr. Waldo Silva Palma, Dr. Alberto Adriazola, Engineer Guillermo Illaxes, 
 Dr. Carlos Altamirano, Dr. Daniel Carvallo, Dr. Benjamin Manterola, 
 and Dr. Enrique Deformes. 
 
OFFICERS OF THE CONFERENCE. 
 
 President. 
 
 Doctor Alejandro del Rio, Chile. 
 
 Vice-Presidents. 
 
 Doctor Gregorio Araoz Alfaro, Argentine Republic. 
 
 Doctor Claudio Sanjines, Bolivia. 
 
 Doctor Ismael da Rocha, Brazil. 
 
 Doctor Alcibiades Vicencio, Colombia. 
 
 Doctor Fernando Iglesias, Costa Rica. 
 
 Doctor Hugo Roberts, Cuba. 
 
 Sefior Tito V. Lizoni, Dominican Republic. 
 
 Doctor Luis F. Cornejo y Gomez, Ecuador. 
 
 Doctor Gregorio M. Guiteras, United States. 
 
 Doctor Salvador Ortega, Guatemala. 
 
 Sefior Oscar Valenzuela Valdes, Honduras. 
 
 Doctor Jesus Monjaras, Mexico. 
 
 Doctor Caupolican Pardo Correa, Panama. 
 
 Doctor Rogflio Urizar, Paraguay. 
 
 Doctor Juan B. Miranda, Salvador. 
 
 Doctor Ernesto Fernandez Espiro, Uruguay. 
 
 Doctor Pablo Acosta Ortiz, Venezuela. 
 
 Secretaries. 
 
 Doctor Grecorio Amunategui, Chile. 
 Doctor Jaime C. Perry, United States. 
 Doctor Luis Razetti, Venezuela. 
 
 Committee on Credentials. 
 
 Sefior Paulino Alfonso, Chile. 
 Doctor R. Corbalan Melgarejo, Chile. 
 Doctor Vicente Izquierdo S., Chile. 
 Doctor Caupolican Pardo Correa, Panama. 
 
 Executive Committee. 
 
 Doctor Alejandro del Rio, Chile. 
 
 Doctor Fernando Alvarez, Argentine Republic. 
 
 Doctor Ismael da Rocha, Brazil. 
 
 Doctor Gregorio M. Guiteras, United States. 
 
 Doctor Jesus Monjaras, Mexico. 
 
 Doctor Ernesto Fernandez Espiro, Uruguay. 
 
 Committee on Plague. 
 
 Doctor Antonino Ferrari, Brazil. 
 
 Doctor Pedro L. Ferrer, Chile. 
 
 Doctor Luis F. Cornejo y Gomez, Ecuador. 
 
 Committee on Malaria and Yellow Fever- 
 Doctor Claudio Sanjines, Bolivia. 
 Doctor Hugo Roberts, Cuba. 
 Doctor Jaime C. Perry, United States. 
 
 Committee on Cholera. 
 
 Doctor Gregorio Araoz Alfaro, Argentine Republic. 
 
 Doctor Luis Asta-Buruaga, Chile. 
 
 Doctor Gregorio M. Guiteras, United States. 
 
 Committee on Sanitation of Sea and Frontier Cities. 
 
 Doctor Carlos Altamirano, Chile. 
 Engineer Jorge Calvo Mackenna, Chile. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Doctor Ricardo Davila Boza, Chile. 
 Doctor Eduardo Garcia Collao, Chile. 
 Engineer Guillermo Illanes, Chile. 
 Doctor Manuel Camilo Vial, Chile. 
 Doctor Jaime H. Oliver, Uruguay. 
 
 Committee on Prophylaxis of Acute Transmissible Diseases. 
 
 Doctor Francisco Landa, Chile. 
 Doctor Alcibiades Vicencio, Colombia. 
 Doctor Fernando Iglesias, Costa Rica. 
 Doctor Juan B. Miranda, Uruguay. 
 Doctor Pablo Acosta Ortiz, Venezuela. 
 
 Committee on Prophylaxis of Chronic Transmissible Diseases. 
 
 Doctor Roberto del Rfo, Chile. 
 Doctor Ernesto Soza, Chile. 
 Doctor Salvador Ortega, Guatemala. 
 Doctor Rogelio Urizar, Paraguay. 
 
 Officers of the International Sanitary Bureau of Washington, D. C. 
 
 Chairman. 
 
 Surgeon-General Doctor Walter Wyman, United States, deceased. 
 
 Members. 
 
 Doctor Alejandro del Rio, Chile. 
 Doctor Hugo Roberts, Cuba. 
 Doctor Oscar Dowling, United States. 
 Doctor Salvador Ortega, Guatemala. 
 Doctor Eduardo Liceaga, Mexico. 
 Doctor Luis Razetti, Venezuela. 
 
 International Sanitary Information Bureau of Montevideo. 
 
 Chairman. 
 Doctor Ernesto Fernandez Espiro. 
 
 Members. 
 
 Doctor JoAQufN de Salterain. 
 Doctor Julio Etchepare, Secretary. 
 
DELEGATES OF THE INTERNATIONAL SANITARY BU- 
 REAUS OF WASHINGTON OR MONTEVIDEO AND 
 MEMBERS OF THE INTERNATIONAL SANITARY IN- 
 FORMATION COMMITTEES. 
 
 fDr. Manuel Cuellar. 
 
 Bolivia \ Dr. ELf as Sagarnaga. 
 
 I Dr. Enrique Aranibar. 
 
 [Dr. A. Davila Boza. 
 
 ^ HILE i Dr. Pedro L. Ferrer. 
 
 I Dr. Lucio Cordova. 
 
 _ _ fDr. Carlos Duran. 
 
 Costa Rica J Dr . Elias Rojas. 
 
 [Dr. Jose Maria Soto. 
 
 fDr. Juan Guiteras. 
 
 Cuba j Dr. Enrique B. Barnet. 
 
 1 Dr. ArIstides Agramonte. 
 
 fDr. A. H. Glennan. 
 United States of America J j) r j y/ Kerr 
 
 LDr. John W. Trask. 
 
 _ fDr. Salvador Ortega. 
 
 Guatemala • • • Dr. Juan J. Ortega. 
 
 L Dr. Julio Bianchi. 
 
 TT fDr. Jose M. Ochoa Velasquez. 
 
 Honduras J Dn i GNACI0 Castro. 
 
 LDr. Juan Angel Arias. 
 
 fDr. Luis Debayle. 
 Nicaragua I Dr r ODOL fo Espinosa. 
 
 [Dr. Juan B. Sacoza. 
 
 -. fDr. Eduardo Liceaga. 
 
 Mexico j Dr. Jesus MonjarAs. 
 
 I Dr. Nicolas Ramirez de Arellano. 
 
 fDr. Luis Urriola. 
 
 rANAMA \ Dr. Alfonso Preciado. 
 
 LDr. Augusto S. Boyd. 
 
 c fDr. Tomas G. Palomo. 
 
 Salvador J Dr . Francisco Guevara. 
 
 LDr. Rafael B. Castro. 
 
 , r * fDr. Pablo Acosta Ortiz. 
 
 J Dr. Carlos Manuel de la Cavada. 
 Dr. Luis Razetti. 
 
Program of the 
 
 Fifth International Sanitary Conference of the 
 
 American Republics, 
 
 To be Held in Santiago de Chile From the 5th to the 12th of November, 
 
 1911. 
 
 1. Sanitary laws, regulations and measures adopted in each country since the 
 Fourth Conference. 
 
 2. Fulfilment of the resolutions adopted in the first four sanitary Conferences. 
 
 3. Report relating to the adoption of the Convention of Washington of 1905 
 and of the modifications of its 9th article by the 4th International Sanitary 
 Conference and the 4th International American Conference (of Buenos Aires) 
 (Note A). 
 
 4. Constitution and work of the reporting International Sanitary Com- 
 missions. 
 
 5. Sanitation of cities and specially of ports indicating the participation which 
 the National Government has had in the execution of these works. 
 
 6. Prophylactic measures taken against plague, cholera and yellow fever, with 
 special mention of the methods employed for the destruction of rats, flies 
 and mosquitoes. 
 
 7. Criterium by which the health authorities must be guided to determine 
 when a person shall be considered immune from yellow fever. 
 
 8. National and international protective measures relating to tuberculosis, 
 venereal diseases, small-pox, malaria, tracoma, leprosy and scleroma (Note B). 
 Legislation adopted against these diseases and the results obtained. 
 
 9. Monthly and yearly statistics of morbidity and mortality in the principal 
 ports and cities ; information in regard to the adoption of Bertillon's nomen- 
 clature. 
 
 10. Sanitary inspection of international maritime and terrestrial traffic in 
 case of communicable or quarantinable diseases; their specification. Regula- 
 tions relating to the retention or devolution of patients in such circumstances. 
 
 11. Sanitary laws on immigration. 
 
 12. Data on the adoption of maritime sanitary documents approved by the 
 4th Conference. 
 
 Note A. — Art. 9 of the Convention of Washington says : "Art. 9. In order 
 that a locality be considered free of contagion, it is necessary to furnish the 
 official proof: 1st. That there have been no deaths nor new cases of plague 
 or cholera for five days after the isolation, death or discharge of the last case 
 of plague or cholera ; in the case of yellow fever the period shall be eighteen 
 days, but each government reserves the right to prolong this period. 2d. That 
 all measures of disinfection have been applied, and in treating of plague cases 
 that there have been carried out all measures for the destruction of rats, 
 and in case of yellow fever that the proper measures have been taken against 
 mosquitoes." 
 
 The modification introduced by the Fourth International Sanitary Conference 
 (San Jose de Costa Rica, 1909-10), says: "This Fourth Sanitary Conference 
 recommends that Article 9 of the Convention of Washington be interpreted as 
 follows : Art. 9. In order that a locality be considered free of contagion it will 
 be necessary to furnish official proof to the satisfaction of the interested 
 party: 1st. That there have been no deaths nor new cases of plague or cholera 
 for five days after the isolation, death or discharge of the last case of plague 
 or cholera ; in case of yellow fever the period shall be eighteen days, but each 
 government reserves the right to prolong this period against those countries 
 where the measures for the isolation of cases, the destruction of mosquitoes 
 and the disinfection of foci are not observed. 2d. That all measures of disin- 
 fection have been applied, and in treating of plague cases that there have been 
 carried out all measures for the destruction of rats; and in the case of yellow 
 fever that the proper measures have been taken against mosquitoes." 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 11 
 
 The Fourth International American Conference, held in Buenos Aires, re- 
 solved to draw up Art. 9 of the Conference of Washington thus: "In order 
 that a locality be considered free of contagion, it will be necessary to furnish 
 official proof to the satisfaction of the interested parties, etc. (the rest 
 similar to the modification introduced by the Fourth International Sanitary 
 Conference). 
 
 Note B. — This new subject has been introduced: 1st. Because it is a disease 
 which has a tendency to extend from its primitive homes and become a scourge 
 which must be taken into account; 2d. Because there exist in America, aside 
 from sporadic cases, two well characterized foci, San Salvador and Chile; 
 3d. Because it is a theme for study recommended by the 1st Pan American 
 Scientific Congress (Chile, 1908) ; and 4th. Because its study constitutes to-day a 
 motive of world-wide interest, as shown by the resolution taken at the Sixteenth 
 International Congress of Medicine (Buda-Pesth, 1909), whereby a permanent 
 commission was appointed with that object, and of which are members, among 
 others, Doctors Freudental and Meyer, of the United States of America, and 
 Dr. A. del Rio, of Chile ; the formation of an international league with its 
 seat at Vienna, and the future meeting of a conference in said city for carrying 
 out this purpose. 
 
 Recommendations. 
 
 1. The Government of the American Republics are recommended that, for 
 future Sanitary Conferences, it is convenient to nominate delegates who have 
 assisted at previous Conferences ; and when the delegations are composed of 
 more than one member, that at least one of them shall meet the foregoing 
 requisite, or that, in any case, the delegates shall be sanitary authorities in 
 their respective countries. 
 
 2. Each delegation shall present a paper or report which shall deal precisely 
 and necessarily with the subject marked out in this program, and also a concise 
 extract of the same to be read within fifteen minutes' time at the sessions. 
 Each extract shall be printed in Spanish and English; that of Brazil in 
 Portuguese and English, and that of Hayti in French and English. 
 
TRANSACTIONS OF THE FIFTH 
 
 INTERNATIONAL SANITARY CONFERENCE 
 
 OF THE AMERICAN REPUBLICS. 
 
FIFTH INTERNATIONAL SANITARY CONFER- 
 ENCE OF THE AMERICAN REPUBLICS. 
 
 FIRST DAY— SUNDAY, NOVEMBER 5, 1911. 
 Afternoon — Opening Session. 
 
 At 2 o'clock in the afternoon there assembled in the Hall of Honor 
 of the National University of Chile, in the city of Santiago, the Dip- 
 lomatic and Consular Corps, the Delegates to the Conference, and 
 members of the Chilean National Congress, of the Courts of Justice, 
 of the Council of Public Instruction, of the Superior Council of 
 Health, of the various Faculties of the University, of the Board of 
 Benefkience, etc. Shortly after two o'clock, the President of the Re- 
 public, the Ministers of the Interior, of Foreign Affairs, and of Pub- 
 lic Instruction, the Presidents of the Senate and of the Chamber of 
 Deputies, the Rector of the University, the Provisional President of 
 the Conference, the Dean of the Faculty of Medicine, the Secretary 
 General of the University, the Secretary of the Chilean Delegation, 
 and the Aide-de-Camp to the President of the Republic, occupied the 
 places of honor. 
 
 The formal inauguration of the Conference was then begun in the 
 following manner: 
 
 The Minister of Foreign Affairs, Sr. Enrique A. Rodriguez: 
 
 The Republic of Chile rejoices on having as its guests the dis- 
 tinguished scientific personages who have gathered in this city for the 
 purpose of studying and solving the high and varied problems tending 
 to establish the best ways of preserving human life. And in behalf 
 of the Supreme Government, I have the honor to welcome the Dele- 
 gates of the Fifth International Sanitary Conference. 
 
 It is gratifying to note that these Conferences have been increas- 
 ing the number of adherences by the American Governments, and 
 Chile congratulates itself on this occasion for having been honored 
 with the attendance of the official delegates from seventeen Republics 
 of the three Americas. The Government expresses a national feeling 
 by extending to you, on this solemn occasion, its thanks for so high a 
 distinction, which it owes to those Republics as well as to their men of 
 science, many of whom have already brilliantly collaborated in pre- 
 vious Conferences. 
 
 These periodic Conferences, created by the Second Pan American 
 Conference (1901-1902), are inspired not only by an idea of preser- 
 vation, but also by an urgent spirit of altruism, because they are 
 beneficial to the American Republics and to humanity in general. The 
 meetings devoted to the interesting study of international and public 
 hygiene, define the measures of defense that the countries must adopt 
 in order to prevent the propagation, through their littorals and fron- 
 
16 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 tiers, of transmissible diseases, such as cholera, plague, and yellow- 
 fever, and at the same time they encourage Governments to check the 
 development of epidemics, by improving the interior sanitary condi- 
 tions of each country. 
 
 The scientific discussions that take place in these Conferences, the 
 exchange of ideas among the sanitary representatives, must neces- 
 sarily wield a positive influence upon the hygienic measures of our 
 Republics. Aside from its undisputed scientific merit, these meet- 
 ings also realize a generous international work, free from the con- 
 ventional forms of the Foreign Offices. The intercourse amongst 
 superior men who contribute efficiently towards the direction of the 
 intellectuality of the peoples of America, assures and strengthens fra- 
 ternal sentiments ; it creates special ties of friendship which concur 
 in the realization of the ideals of peace and harmony that might tend 
 to constitute their highest aspiration. It enables them to know with- 
 out any effort, the social structure, the mechanism of public institu- 
 tions, their economic force, the industrial, scientific and literary prog- 
 ress, and, in a word, everything that gives the stamp of civilization 
 and progress, and that marks the importance of civilization and prog- 
 ress in the New World. 
 
 Reviewing the work of the four previous Conferences, the first 
 two held in Washington in 1902 and 1905, respectively, the third in 
 Mexico, in 1907, and the fourth in San Jose de Costa Rica, in 1909, 
 we see what has been done in our continent in the interest of public 
 health. 
 
 It is thus that the conquests of science open up new ways. Public 
 health, one of the principal conditions for the vitality of nations, 
 should also be one of the principal aims of all governments. 
 
 Chile has been represented in all the previous Sanitary Confer- 
 ences, whose resolutions, reported to the Government by our Dele- 
 gates, have been made subject of special study and interest. It has 
 been the wish of the Government to submit to this assembly of emi- 
 nent experts a brilliant record of work done for improving public 
 health. But unfortunate circumstances, unavoidable and unforseen 
 catastrophies, such as the earthquake of 1906, the material damages 
 caused thereby it has been necessary to attend to first, have prevented 
 it from achieving its aspirations. 
 
 The water supplies established in all provincial and departmental 
 capitals, and the sewer systems that have been or are nearly completed 
 in ten cities of the Republic, constitute only a portion of the projects 
 that we are determined to carry out. New means of maritime and 
 land communication will facilitate the intercourse among our Repub- 
 lics and will put us in closer contact with Europe; but it is necessary 
 to devote our attention to the sanitary prophylaxis that such progress 
 demands, as a guaranty that must be offered by every civilized nation. 
 All nations are solidarily responsible as to everything that concerns 
 public health, and no good result can be accomplished without a com- 
 mon action. 
 
 The labor of every new Conference will have to be more arduous 
 and complicated, but, gentlemen, you may rest assured that to stimu- 
 late your work you may depend upon all governments directly inter- 
 ested in the success of the resolutions that may be passed. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 17 
 
 Messrs. Delegates : Your attendance in this Convention, and the 
 distinguished position that you occupy, are in keeping with the just 
 titles and merits conquered in the cultivation of science; I, therefore, 
 predict that your deliberations will be crowned by most brilliant re- 
 sults, and trust that Chile in particular will derive great benefits from 
 your enlightened advices. 
 
 His Excellency, the President of the Republic, has been pleased 
 to show you by his presence the importance that he attaches to the 
 tasks before you, and in his name I declare that the Fifth Interna- 
 tional Sanitary Conference is opened. 
 
 The Provisional President, Dr. Alejandro Del Rio: 
 
 Mr. President of the Republic, Messrs. Ministers, Messrs. 
 Delegates : The Fifth International American Sanitary Conference 
 which we inaugurate today under the high auspices of the Chilean 
 Government, will undoubtedly mark a memorable date in the develop- 
 ment of sanitary progress. Hygiene, a science which only a few de- 
 cades ago was in its incipiency, emerging from the crucible of the 
 experimental method, has become the great distributor of human 
 health. Its principles established in a definite form ; its investigation 
 methods, safer and more rapid from day to day, and the transcen- 
 dental efficiency of a result, are facts that already stand with an irre- 
 sistible force before the public conscience. 
 
 Exotic diseases — be they plague, cholera or yellow fever — being 
 known today by their causes and means of propagating, are now easily 
 controlled by the joint action of science and the will of man. Like- 
 wise, endemic or epidemic diseases, whether they be malaria, typhoid 
 fever or tuberculosis, disappear or diminish considerably in countries 
 subject to the influence of the present means of sanitation. Hygiene 
 nowadays means health and welfare of individuals and wealth and 
 prosperity of the nation. 
 
 For a long time and only until recently, a decisive importance — 
 undoubtedly exaggerated — was attached to international conventions 
 establishing more or less strict rules of sanitary police in the frontiers 
 of countries ; but these great hindrances to the means of communica- 
 tion among men and to commercial intercourse among countries, for 
 the sake of hygiene wrongly understood and applied, have now, for- 
 tunately, passed to history. 
 
 The great Pettenkofer, the founder of scientific hygiene, was per- 
 fectly right when he affirmed that no frontiers could be proof against 
 unhealthy germs ; this affirmation, though discouraging at first, has a 
 far-reaching beneficial effect, because it diverts the attention of science 
 and the action of governments from the useless and harmful chimera 
 of a complete frontier defense ; and because it concentrates such atten- 
 tion and action upon the only substantially fruitful object which 
 should be considered in this matter, to wit, the defense of the nation 
 "by means of the strength of her citizens and by the success of the re- 
 spective national methods of hygiene. 
 
 Without absolutely disregarding the usefulness of conventions, the 
 success of the sanitary defense of every country depends, in the first 
 place, upon the truth of the principles from which the legislators have 
 
18 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 derived their inspiration, and, in the second place, on the proper or- 
 ganization of the sanitary services. And I must add that under ordi- 
 nary circumstances these are the factors destined to eradicate en- 
 demic diseases and to reduce the permanent causes of unhealthiness. 
 
 In Chile we have passed slowly through the first stage of our 
 emancipation from colonial traditions and prejudices of ignorance. 
 Our geographic position and the obstacles opposed by nature to our 
 communication with the centers of culture, have produced a percep- 
 tible delay in the sanitation of our cities ; but the consciousness of this 
 delay has aroused in our souls a noble emulation that is already be- 
 ginning to be fruitful, and that will undoubtedly be still much more 
 so in the future. 
 
 During the sessions of the Conference we shall show the sanitary 
 works that we have carried out and the elements of various kinds that 
 have contributed towards its realization. We shall also show frankly 
 our failures and deficiencies, but at the same time we will exhibit the 
 projects for improvements, which do credit to our efforts and hopes. 
 
 Messrs. Delegates : I have the high honor of extending to you in 
 behalf of the Chilean Delegation, our most respected and cordial 
 welcome. You may be sure that the people of Chile, and specially 
 the capital of the Republic, honored by your presence, join us in 
 greeting you. 
 
 Various circumstances predict a brilliant success for the Fifth Amer- 
 ican Sanitary Conference. Yours shall be the honors. 
 
 The Secretary of the Chilean Delegation, Dr. Gregorio 
 Amunategui then offered the floor to one Delegate of each nation, by 
 alphabetical order. 
 
 The Delegate from the Argentine Republic, Dr. Araoz Al- 
 faro. Mr. President of the Republic; Messrs. Ministers; Mr. Presi- 
 dent ; Messrs. Delegates : It is with real pleasure that the Government 
 of the Argentine Republic participates in this high gathering of scien- 
 tific men, a conference initiated by our great sister of the north for 
 the purpose of finding the most perfect solutions to the great and 
 numerous problems that affect the health of the American countries. 
 
 By initiating this series of sanitary conferences, the United States 
 proved that that great nation is not only zealous for its own material 
 and moral progress, but also for the advancement of the whole Amer- 
 ican Continent, and it is only fitting that we should now pay that 
 country the homage of our gratitude for having placed under its high 
 patronage this international and permanent work. 
 
 Therefore, the Argentine Republic is gratified at taking part in this 
 task, and will contribute, through our modest collaboration, in the 
 study and solution of sanitary problems, so that America shall be, not 
 only an emporium of wealth and a garden of natural beauties, but 
 also the healthful, good, pleasant and generous continent, always open 
 to the fruitful activities of all industrious men of the world. But 
 however great may be the satisfaction of the Argentine Delegates for 
 associating in this noble work, it is not as great as their gratification 
 for being able to realize it now under the auspices of the Chilean 
 Government in this hospitable country, to which our people are bound 
 by ties so old and a most deep affection. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 19 
 
 Personally, the Argentine Delegates, already bound by affection and 
 respect to all the eminent men here assembled, and, very specially 
 to the Chilean physicians, hygienists and public men, express their 
 enthusiastic wishes that this Conference may produce not only new 
 ideas concerning sanitary questions, but also and above all, practical, 
 easy and efficient solutions tending towards the achievement of the 
 higher degree of welfare, health, and happiness in all the countries 
 of America. And we undertake the task with enthusiasm and energy, 
 in community of aspirations with the illustrious of all the American 
 countries, who we fraternally embrace under the egis of this wise and 
 progressive Government and in the midst of this strong, energetic and 
 intelligent people. 
 
 The Delegate from Bolivia, Dr. Claudio Sanjines. Mr. Presi- 
 dent of the Republic ; Mr. Minister for Foreign Affairs ; Mr. President 
 of the Conference ; Messrs. Delegates : Having been selected to repre- 
 snt Bolivia before the Fifth International Sanitary Conference of the 
 American Republics, it is my high honor to bring personally the cordial 
 greetings that the Bolivian Government and people send to the Chilean 
 Government and people. 
 
 And to me, personally, this occasion means the happiness of return- 
 ing, after a few years' absence, to this beautiful section of the Ameri- 
 can continent, the land where I spent the best years of my life, on a 
 mission of concord and affection ; to meet again my eminent professors 
 and my dear companions, with whom and together with the distin- 
 guished Delegates from the American Republics, we will now under- 
 take to solve the problems that affect the suffering humanity. What 
 a great work ! What a satisfaction to contribute in it ! 
 
 I believe that there is nothing nobler than to work for the dissemi- 
 nation of hygiene, for the eradication of epidermis, and to make of 
 each nation a healthful home, free from evils, and hereby capable of 
 progress upon the basis of health and strength. 
 
 I think that my Government in designating me as its Delegate to this 
 Conference did not have in mind the scientific training with which 
 every one taking a seat among you should be provided ; I believe that 
 I was selected merely because I pursued my medical studies here in 
 Chile ; and this is precisely the reason why I have accepted a mission 
 so difficult as well as honorable. 
 
 In closing, I make fervent vows for the success of the labors that 
 we inaugurate to-day 
 
 The Delegate from Brazil, Dr. Ismael da Rocha. Mr. Presi- 
 dent of the Republic ; Mr. Minister for Foreign Affairs ; Messrs. Min- 
 isters ; Mr. President of the Conference ; Messrs. Delegates : 
 The medical Delegates from Brazil, my esteemed colleague and 
 myself, here present, with the valued permission of Dr. Ferreira, our 
 Minister Plenipotentiary near this Government, rise to present you 
 the sincerest and most cordial greetings that we bring from the Presi- 
 dent of the United States of Brazil, Marshall Hermes da Fonseca, 
 and from Baron de Rio Branco, our beloved Minister for Foreign 
 Affairs, two eminent personalities, who now renew their salutations 
 through our medium, together with the expressions of the very old 
 friendship that bind the people of Brazil with the people of Chile. 
 In the name of Brazil, I also greet with the greatest consideration and 
 
20 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 esteem all the diplomatic representatives from the countries of Amer- 
 ica, Europe and Asia, and very specially the illustrious Delegates 
 from the American Republic. You may believe that my Brazilian 
 heart vibrates with the throbbings of extreme joy that I felt upon 
 touching the hospitable soil of Chile. 
 
 These Conferences, happily initiated by the United States Govern- 
 ment in Washington in 1902 and 1905, continued in Mexico in 1907 
 and in San Jose de Costa Rica in 1909-10, and now in Chile, assemble 
 the hygienists of North, Central and South Americas to study the 
 protection and prolongation of human life, by means of the supreme, 
 eternal and superhuman effort of medicine for the purpose of averting 
 death and desolation. These Conferences enliven and stimulate men 
 of science in that intellectual transfusion among men devoted to the 
 same labors and researches, collaborating in the great task of con- 
 ciliating the spirit of friendship among peoples ; in that necessary and 
 progressive international American fraternization. This is the idea 
 that brought us to this privileged soil ; which idea also inspires the 
 wise Government that guides the destinies of Brazil, "generous and 
 fertile soil, industrious and peaceful people," which entertains great 
 hopes from the pacific seeds planted for the future, "progressing 
 rapidly, without deviating from its traditions of liberation and without 
 violating the rights of others." "It is indispensable," said the illus- 
 trious Baron de Rio Branco in the Latin- American Congress of 1905, 
 "that before half a century, four or five, at least, of the most important 
 Latin-American Nations, following the example of our great sister of 
 North America, through a noble emulation, should rival the most 
 powerful States of the world in point of resources and prestige." 
 
 This Continent, whose territory stretches uninterruptedly from north 
 to south, from the Arctic Pole to the southern extreme of the world ; 
 this Continent, which from its extensive and endless coasts, both on 
 the Atlantic and the Pacific, overlooks an immensity of heaven and 
 sea, with an unbroken horizon, absolving from the framy waves and 
 inhaling from the echo of the mountain ranges and the balmy forests, 
 the pure sentiments inspired by nature; this continent, which has the 
 privilege of possessing the three greatest and most wonderful basins 
 of the Occident, formed by the Mississippi, the Amazon and the 
 River Platte, to-day fully opened to the world's commerce ; this con- 
 tinent, which with the religion of Jesus in all its nationalities, shows 
 sublimely and altruistically to the generations the Christ of the Andes 
 and the Statue of Liberty in the Port of New York ; this continent, 
 so vast, which without transposing its domains, finds the bear of the 
 Pole in the glacial zone and the butterfly of the tropics in the pic- 
 turesque gardens of the torrid zone ; this continent, with volcanoes 
 in its highest peaks, and flexible leaves in the virgin forest or in the 
 graceful palm trees growing near its placid beaches ; this continent, 
 which has gathered under varied climates different races in process 
 of transformation ; this continent, I say, this America of ours can not 
 retrograde ; it can not think of extermination nor death ; it must by 
 all possible means increase its strength, so that it may say to the 
 nations over the seas : Oh, glorious and beautiful Europe, we owe 
 thee everything, as a son owes everything to his parents ; we owe thee 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 21 
 
 our discovery, our first steps, our civilization and our commerce and 
 the industrial development of our resources. But thine children have 
 grown. Behold them, strong and powerful, and trusting on the peace- 
 ful struggle of the lofty ideals of humanity. Chile, which has given 
 the world this admirable example through its never-disturbed peace, 
 shall be one of the first countries on which that glory shall fall, in 
 addition to those which it has already won. And I have the greatest 
 pleasure in exclaiming, long live Chile ! 
 
 The Delegate from Colombia, Dr. Alcibiades Vicencio. Gen- 
 tlemen : The Republic of Colombia, in honoring me with its repre- 
 sentation, cordially participates in the labors of the Fifth International 
 Sanitary Conference. 
 
 The discovery of the continent in which we live was hailed as a 
 blessing to humanity ; a blessing of wealth because of the treasures 
 hidden in its soil ; a blessing of beauty because of the splendor of its 
 peerless nature ; a blessing of life because of its immense and fertile 
 territory. We are the lords of this privileged continent ; we are 
 Americans, and upon us falls the responsibility that our name implies. 
 The different countries here represented, upon uniting their effort to 
 defend life and insure the welfare of their citizens, giving the science 
 of medicine the leading part to which it is entitled in the social and 
 international movement of the peoples, prove the high degree of their 
 culture, and show that they feel strongly the close ties of solidarity now 
 binding men to each other. In the name of the Republic of Colombia, 
 I express the hope that, for America's good, success will crown the 
 noble effort that this Conference means. 
 
 The Delegate from Cuba, Dr. Hugo Roberts. Mr. President of 
 Chile ; Messrs. Ministers ; Messrs. Delegates ; Gentlemen : I have the 
 honor to greet you in the name of the Cuban nation. The Republic 
 of Cuba takes a deep interest in all sanitary matters ; in those belong- 
 ing to its interior regime as well as in those concerning its relations 
 with other nations; and it is our fondest desire that these Conferences 
 may strengthen the ties of union among American Republics, so that 
 we may love each other as true brothers ; and that they be also bene- 
 ficial to humanity in general. 
 
 Cuba hopes that the idea born in our minds may soon be converted 
 into positive facts. 
 
 The Delegate from Ecuador, Dr. Luis Felipe Cornejo y Gomez. 
 Mr. President of the Republic; Mr. Minister for Foreign Affairs; 
 Messrs. Diplomatic Representatives ; Mr. President of the Conference ; 
 Messrs. Delegates ; Gentlemen : Honored with the representation of 
 Ecuador before the Fifth International Sanitary Conference of the 
 American Republics, I fulfill the pleasant duty of greeting, in the name 
 of my country, the glorious Chilean Nation in the person of its illus- 
 trious President, His Excellency Dr/ Ramon Barros Luco, under whose 
 auspices this Conference is held. At the same time I extend my 
 respectful greetings to the distinguished members of the learned sani- 
 tary assembly here gathered. 
 
 In view of the highly humane purposes pursued by the Sanitary 
 Conferences that are being held periodically by the various countries 
 of America, it is to be hoped that the present one will be as the others 
 
22 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 preceding, plentiful in efficient and wise resolutions tending to the 
 welfare of each and every country of the Continent. 
 
 The Delegate from the United States of America, Dr. Gre- 
 gorio M. Guiteras. Mr. President of the Republic ; Messrs. Minis- 
 ters ; Messrs. Members of the Diplomatic Corps ; Mr. President of 
 the Conference ; Messrs. Delegates ; Ladies and Gentlemen : In the 
 name of the United States of America and of the Delegation of that 
 Republic, I have the distinguished honor of greeting Chile and its rep- 
 resentatives, as well as the other delegation of our sister Republics of 
 the Western Hemisphere. 
 
 Having arrived here a few days before this Conference was called 
 to order, I have enjoyed the opportunity of observing a little of this 
 country, and I can assure you that these observations have charmed 
 me and aroused my admiration for a country where human work has 
 overcome the obstacles presented by nature, originating by reason of 
 those very obstacles, the existence of a Latin race, virile and moral, 
 which for its civic spirit and culture can be favorably compared to any 
 other nation in the whole world. Unfortunately, the Chilean race is 
 not properly known in our country, a fact due mainly to the distance 
 separating us. If the people of both countries knew each other better, 
 they would like each other better, and I hope that the day is not far 
 when the ties of friendship now binding us will be closer for the good 
 of both Republics. 
 
 In the name of the United States, I thank you most expressively for 
 the distinguished and truly warm welcome accorded us from the 
 moment we landed on Chilean soil, at the port of Arica, until arriving 
 at Santiago, the beautiful capital of Chile. 
 
 The Delegate from Guatemala, Dr. Salvador Ortega. Mr. 
 President of the Republic ; Mr. President of the Conference ; Ladies ; 
 Messrs. Delegates : The Government of Guatemala, which has taken 
 a great interest in the International Sanitary Conferences of the Amer- 
 ican Republics from the time they were initiated, has entrusted us with 
 the honorable mission of representing it before this learned assembly 
 which, as in previous occasions, will solve many of the important sani- 
 tary problems that are to have a powerful influence on the welfare of 
 all the peoples of America. 
 
 The pomp and solemnity with which the sessions of the Fifth Inter- 
 national Sanitary Conference are being inaugurated are evident proofs 
 of the support that this prosperous country gives to everything that 
 means progress and advancement. May we be permitted on this solemn 
 occasion to present to His Excellency Sr. Ramon Barros Luco, the 
 worthy chief of the Chilean Republic, in the name of our President, 
 Sr. Estrada Cabrera, the fervent vows that President Barros' per- 
 sonal happiness, and to tender the fraternal greeting that Guatemala 
 sends to the heroic people of Chile. 
 
 Mr. President of the Conference ; Messrs. Delegates : The Delega- 
 tion from Guatemala presents you their respects, and wishes you the 
 best success for your important labors. 
 
 The Delegate from Mexico, Dr. Jesus Monjaras. Mr. Presi- 
 dent of the Republic; Mr. Minister; Mr. President of the Conference; 
 Messrs. Delegates ; Ladies and Gentlemen : It is a high honor and 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 23 
 
 a great satisfaction for me to greet the people and the Government 
 of Chile in behalf of the people and Government of Mexico. 
 
 Without hesitating, I accepted the invitation to represent my country 
 before this Conference, notwithstanding the necessity of separating 
 from my family and my interests, because I feel an immense pleasure 
 at finding myself once more among my friends, and as a guest of 
 this intelligent, noble and hospitable people whom I so love ; and 
 because of the satisfaction of contributing within my modest ability 
 to the realization of the matters that are to be studied here for the 
 purpose of securing rules for the uniformity and harmony of inter- 
 national sanitary measures, thus facilitating the progress of the peo- 
 ples constituting this vast continent, and providing easy and practical 
 means of avoiding the transmission of infectious diseases. 
 
 It is particularly gratifying for me to express on this solemn occa- 
 sion my sincerest wishes for the success of this Conference, for the 
 prosperity of this noble and great nation, for the happiness of His 
 Excellency the President of the Republic and Madame Barros Luco, 
 of the Delegates here present, of the Executive Committee, and of 
 the noble and distinguished Chilean ladies. 
 
 The Delegate from Panama, Dr. Caupolican Pardo Correa. 
 Mr. President of the Republic ; Mr. President of the Conference : 
 Messrs. Delegates; Ladies and Gentlemen: The Government of 
 Panama, a country which characterized itself by its efforts in behalf 
 of hygiene, stirring on account of the advance made and which has 
 placed it among the American countries that have become prominent 
 in this respect, has conferred upon me the honor of representing 
 it before the Fifth International Sanitary Conference, charging me 
 also with the pleasant duty of presenting its cordial greetings to the 
 Government and people of Chile, and to the Delegates from the other 
 Republics, its sincere best wishes that this Conference may be as 
 useful as the preceding ones, and it may contribute to strengthen the 
 ties binding us. 
 
 The Delegate from Paraguay, Dr. Rogelio Urizar. Mr. Presi- 
 dent of the Republic ; Gentlemen : From Paraguay, my country, I 
 convey to the noble and gallant people of Chile a cordial greeting of 
 confraternity ; to the Government the sentiments of friendship from 
 the Paraguayan Government; to the charming Chilean ladies, the just 
 admiration of a people that knows how to pay homage to grace and 
 beauty; and in the persons of my fellow delegates I greet the beau- 
 tiful American continent. 
 
 It is the first time that Paraguay takes part in the International 
 Sanitary Conferences, but I cherish the firm conviction that hereafter 
 its participation will be very active, since its climate and geographical 
 situation place under very favorable conditions for a prophylactic 
 campaign. 
 
 I could not but accept with true satisfaction this beautiful mission 
 of confraternity and scientific labor, which affords me the opportunity 
 of becoming acquainted with the native soil of my ancestors and of 
 meeting the medical authorities of this continent. 
 
 The important labor that assembles us here has already begun to 
 bear fruit, and when the railroads crossing the frontiers shall have 
 
24 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 at last united us, the laws formulated by these Conferences will be 
 the highest expression of our culture. 
 
 The Delegate from Salvador, Dr. Juan B. Miranda. Mr. 
 Minister ; Messrs. Delegates ; Gentlemen : An evident sign of culture 
 and progress is this gathering of scientific men now assembled here 
 from almost all countries of America for the purpose of discussing 
 and uniforming sanitary principles, to resolve and adopt hygienic 
 measures of international scope calculated to prevent the propagation 
 of contagious diseases of an epidemic, endemic, or pandemic nature, 
 and to forstall the deathly damages that such evils cause among the 
 inhabitants of this continent, for which a brilliant future is in reserve. 
 Nobly contributing to the realization of these beautiful ideals of 
 altruism, a civilizing task is performed, and the interests of the great 
 human family are best served. 
 
 In keeping with these noble and lofty purposes is the honor that 
 has been conferred upon me by the Government of the Republic of 
 El Salvador, designating me as its Delegate to the Fifth International 
 Sanitary Conference of the American Republics. To all this and to 
 his personal qualifications is due the marked interest which the Presi- 
 dent of Salvador, Dr. Manuel Enrique Araujo, takes in this assembly 
 and hopes for its success, he, himself, being a most distinguished 
 physician and a thorough Central-American. Not only does President 
 Araujo bind his warm affection to the happiness of the nation over 
 which he presides, but also to the welfare of Central America, of 
 that of the New World, which may be considered as the common 
 fatherland of all those who have had the honor of being born on 
 American soil. 
 
 The Government of Salvador adheres to the resolutions passed by 
 previous Sanitary Conferences ; it will adhere to such amendments, 
 changes or revisions that may be made thereto, and it will also 
 adhere to the new resolutions that are to be adopted by this Con- 
 ference. It shall lend its loyal support to everything that may be 
 resolved, and shall not omit any sacrifice that may be needed in order 
 to carry out efficiently all sanitary measures for the preservation and 
 welfare of humanity. 
 
 Therefore, in the name of the Government of Salvador, I have the 
 honor to perform a triple mission : First, to present my respectful 
 homage to His Excellency the President of Chile for the high 
 patronage to this assembly of public hygiene ; second, to congratulate 
 and applaud the President of the Conference, Dr. A. del Rio, and 
 through his medium, all the members of the Chilean Delegation for 
 the efforts they have displayed to secure the success of the Confer- 
 ence ; and, third, to send a cordial and affectionate greeting of pro- 
 fessional comradeship and solidarity to all my distinguished fellow- 
 delegates. 
 
 The Delegate from Uruguay, Dr. Ernesto Fernandez Espiro. 
 Mr. President of the Republic ; Mr. Minister for Foreign Affairs ; Mr. 
 President of the Fifth International Sanitary Conference : In the first 
 , place, the Uruguayan Delegation thanks the Chilean Government for 
 the kind attentions extended to us from the moment we arrived at 
 the beautiful land of a traditional culture. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 25 
 
 The participation of Uruguay in past Conferences, and the interest 
 showed therein by its sanitary authorities and those devoted to the 
 study of hygiene, account sufficiently for its alherence to the pur- 
 poses of this new Conference and its representation before it. 
 
 For us, who fulfill the pleasant mission of conveying to the Govern- 
 ment of this country the affectionate greetings of the Uruguayan 
 Government and our best friendly wishes, it is a source of true 
 satisfaction to attend this Conference, which enjoys the fortune of 
 gathering the representatives from almost all the American Republics. 
 Its success, which may already be assured, shall confirm once more 
 the good results of this periodic meeting and shall justify, at the same 
 time, the advisability of continuing them and of securing for the 
 future the attendance of all American countries, because everyone of 
 them should be equally interested in the deliberations of these Con- 
 ferences and the enforcement of their resolutions. 
 
 Gentlemen, Uruguay contributes to this meeting with the work 
 which it has carried out with regard to sanitation during the last 
 few years, and although it does not pretend to have solved all the 
 problems of sanitary science, it is in a position to say that it has 
 found a solution for many of them, and it will find it for other 
 problems, since that is the aim of the Government and authorities of 
 the Republic. The Uruguayan Delegation will have occasion during 
 this Conference to dwell further on its report and to explain the 
 organization and operation of the sanitary services of the Republic 
 and the enforcement of the recommendations of previous Conferences. 
 
 Meanwhile, it predicts that this new meeting will have the best 
 results, thanks to the ability and learning of our colleagues of this 
 country and of the other Republics here represented. 
 
 The Delegate from Venezuela, Dr. Pablo Acosta Ortiz. Mr. 
 President of the Republic; Mr. President of the Conference: We, 
 the Delegates from Venezuela, in fulfilling the mission which has been 
 entrusted to us, perform the duty of presenting, in the name of our 
 Government, a cordial greeting to the Government of Chile, and our 
 warmest wishes for the prosperity and aggrandizement of the great 
 Chilean nation, which now extends to us its courteous hospitality, 
 offering us the best bread from its granaries and the best wine from 
 its vineyards. 
 
 The honor has been conferred on us again of forming part of this 
 Conference, whose high deliberations tend to make the conquests of 
 modern sanitary science uniform and practicable, and upon congratu- 
 lating ourselves and our colleagues we trust that the definite resolu- 
 tions of this Conference shall take mutual respect as the standard, 
 and shall be inspired from equity and justice, the only elements which 
 render friendship permanent and sincere, and which make strong and 
 closer the ties binding the American nations. 
 
SECOND DAY— MONDAY, NOVEMBER 6, 1911. 
 Morning Session. 
 
 The session was called to order at 10:30 A. M., the Provisional 
 President, Dr. Alejandro del Rio, presiding, all the foreign Delegates 
 being present and nearly all the members of the Chilean Delgation. 
 
 The Provisional President. In accordance with the program, 
 this session is for the object, in the first place, of electing the President 
 of the Conference. By designation of the Supreme Government, it 
 has been my honor until this moment to have charge of the work, in 
 lieu of our bereaved and beloved President of the Supreme Council 
 of Hygiene, Dr. Maximo Cienfuegos. 
 
 It would be gratifying for me to surrender these high duties, be- 
 cause there are in this Conference distinguished personalities with 
 greater merits than mine. 
 
 Dr. Araoz Alfaro. In the name of the Argentine Delegation, and 
 believing that I am also interpreting the wishes of the other Delega- 
 tions here present, I move that a vote of applause be given to the 
 executive committee for its wonderful organization of this Conference. 
 And to signify this vote, I ask all Delegates to rise. (The motion 
 was unanimously carried and all the Delegates rose.) 
 
 I also move that Dr. Alejandro del Rio be made the permanent 
 President of the Fifth Conference. Nobody better than he, who 
 has been the organizer of the preliminary work, could discharge the 
 position with greater efficiency. This motion is also made to include 
 the confirmation of Dr. Amunategui as Secretary and the other Dele- 
 gates as members of the Executive Committee. 
 
 (This motion was carried by acclamation.) 
 
 Dr. Fernandez Espiro. I move that the Conference pay a tribute 
 to the memory of the eminent Dr. Cienfuegos, elected President of this 
 Conference, and to this end I have the honor to propose that the 
 Delegates rise in homage to our bereaved colleague. (The motion 
 was carried by acclamation and the Delegates rose.) 
 
 The President. I thank the Delegates most expressively for the 
 high honor they have conferred upon me by electing me as the Presi- 
 dent of this Conference. I must now refer to a slight irregularity 
 that might perhaps affect the resolutions we may pass now, although 
 such an irregularity is only a matter of form. 
 
 The credentials presented by the Delegates were delivered last 
 Saturday to the Under-Secretary for Foreign Affairs, who will return 
 them in a short while to have them referred to the special committee 
 that is to be appointed for the purpose of passing upon them. There- 
 fore, we will not be definitely constituted at this session. At this 
 afternoon's session we may give approval to our actions at this 
 session. 
 
 It is now in order to elect the Secretary. 
 
 Dr. Oliver. Dr. Araoz Alfaro already made a motion to that, 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 27 
 
 which was carried. This being the case, I think it is not necessary 
 to vote again. On the other, nobody better than the provisional Secre- 
 tary could perform those duties, because the transactions and all 
 documents must remain here. If necessary, I make a formal motion 
 to confirm Dr. Amunategui in that position. 
 
 The President. If all the Delegates agree, the proposition of the 
 Uruguayan Delegate will be carried. (General acceptance, and Dr. 
 Amunategui then takes possession of his seat as Secretary.) 
 
 The Secretary, Dr. Amunategui. I beg leave to thank my dis- 
 tinguished colleagues most sincerely for the honor they have bestowed 
 upon me. At the same time, I request the President to move that 
 one more Secretary be appointed, who should be one of the foreign 
 Delegates, as has been customary. I take the liberty to submit the 
 name of Dr. Razetti, who filled the same position in the last Confer- 
 ence. (The proposition of Dr. Amunategui was carried by acclama- 
 tion, and Dr. Razetti took a seat at the President's table, and thanked 
 the Conference.) 
 
 Dr. Fernandez Espiro. With regard to the designation of Vice- 
 Presidents, the rule followed in previous Conferences has been to 
 elect as such all the Delegates who had attended. If this procedure 
 is acceptable, I would move that it be followed also on this occasion. 
 
 The President. The list of Delegates will be read in case there 
 is any remark to be made. With regard to the proposition of the 
 Delegate from Uruguay, I think it is well to remember that several 
 Delegations are composed of more than one member. If the assembly 
 deem it advisable, in such cases only one of the members should be 
 designated as Vice-President. 
 
 (The motion of Dr. Fernandez Espiro, with the amendment sug- 
 gested by the President, was carried unanimously.) 
 
 The Secretary, Dr. Amunategui, then read the list of Delegates 
 which appears on page 5. He afterwards announced that Dr. Igle- 
 sias, Delegate from Costa Rica, and Dr. Valenzuela Valdes, of Hon- 
 duras, had not yet arrived. 
 
 Dr. Vial. As a Delegate from Chile to the last Conference, and 
 therefore in a position to know the procedure followed on former 
 occasions, I move that a third secretary be appointed, who should be 
 a member of the United States Delegation. I propose that Dr. James 
 Perry be appointed as such. (The motion was unanimously 
 carried.) 
 
 The President. In view of the decision of the Conference, Dr. 
 Perry is also designated as Secretary. There will now be read the 
 list of Delegates whose names are submitted as Vice-Presidents of the 
 Conference. (The list was read and the Delegates named elected as 
 Vice-Presidents by unanimous vote.) 
 
 The President. It is now in order to appoint the various com- 
 mittees. The Secretary will read a list that has been prepared for 
 submission to the Conference. I request the Delegates to make such 
 remarks as they may deem proper. 
 
 The Secretary, Dr. Amunategui, read the list referred to, which 
 appears on page — , as subsequently modified. 
 
 Dr. Fernandez Espiro. I have no remark to make to the list 
 
28 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 as read, with the exception that the President of the Conference be 
 added to the Executive Committee. (This motion was unanimously 
 carried.) 
 
 Dr. Ferrer. I would that the assembly appoint a committee of 
 three or four Delegates to study the list just read and in this after- 
 noon's session to recommend the addition of such names as were 
 not included — perhaps on account of lack of time — and who it may 
 be advisable to appoint on account of their particular specialities. 
 
 Dr. Fernandez Espiro. The just desire manifested by the Dele- 
 gate from Chile might be well met in this manner: That each com- 
 mittee, by its own action, should be enabled to decide which other 
 members of the Conference might be added to it. 
 
 Dr. Vicencio. Perhaps it would be more advisable to let the 
 Delegates join whichever committees they might be more interested in. 
 
 Dr. Ferrer. T believe that Dr. Fernandez Espiro's suggestion 
 meets the difficulty better. I accept it, so far as I am concerned, and 
 withdraw my motion. 
 
 Dr. Vicencio. This matter might go over until this afternoon's 
 session, and the committees as proposed by the President could be 
 appointed now. 
 
 Dr. Alfonso. Both propositions are compatible, so, I think, the 
 two could be accepted. 
 
 Dr. Araoz Alfaro. The motion of the Delegate from Uruguay 
 is conciliatory, and could be accepted right now. 
 
 (The motion of Dr. Fernandez Espiro was carried unanimously.) 
 
 The President. The program of this session is complete. 
 
 The session adjourned at 12 M. 
 
 Afternoon Session. 
 
 The session was called to order by the President, nearly all the 
 Delegates being present. With the President sat Dr. Araoz Alfaro, 
 of the Argentine Republic, and Dr. Sanjines, of Bolivia, in their 
 capacity as Vice-Presidents of the Conference. 
 
 The minutes of the morning session were read and approved. 
 
 The President. We should begin our labors with the reading of 
 the reports of the various Delegates. Following the alphabetical 
 order, the first place belongs to the Argentine Delegation. Dr. Al- 
 varez has the floor. 
 
 Dr. Alvarez. The delegation of which I am a member has pre- 
 pared four reports, which it has the honor of presenting to the Con- 
 ference. One deals with the defense against cholera ; another with 
 plague ; another with the campaign against malaria in the Argentine 
 Republic, and the fourth one with compulsory vaccination. 
 
 Dr. Monjaras. I deem it advisable that the order established 
 by the program should be followed. In this respect, in my opinion, 
 we should begin with the first subject of the program, which refers 
 to "the laws of sanitary police and sanitation measures adopted in 
 each country since the Fourth Sanitary Conference," and then continue 
 with the other subjects in their proper order. Afterwards, the report 
 should be open for discussion. 
 
 Dr. Guiteras. I agree with the Delegate from Mexico as to the 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 29 
 
 enforcement of the order established by the program. But I was 
 also under the impression, or at least such is the interpretation given 
 by the American Delegation, that each Delegation should present a 
 resume or abstract, destined to explain to the Conference the manner 
 in which the resolutions adopted in former Conferences have been 
 complied with, and that afterwards the reports on the special subjects 
 included in the program would be read. 
 
 Dr. Monjaras. The subject referred to by the American Delegate 
 is included in the program, but it is the second thereon and not the 
 first. It is true that the program that has been distributed among 
 us is merely provisional, but it must be followed until a permanent 
 one be adopted. 
 
 Dr. Araoz Alfaro. The Delegation of which I am a member has 
 not been able to bring a general resume because this is the first time 
 that the Argentine Republic takes part in these Conferences; but 
 instead, it presents various papers on special subjects included in the 
 program. As to precedence for the consideration of subjects, that the 
 Delegate from Mexico thinks is prescribed by the regulation of the 
 Conference, I understand that there is no calendar compelling the 
 assembly to postpone one subject for another one. If my under- 
 standing is correct, as I think it is, I will say that we are at liberty 
 to take up several subjects in such order as may seem to us most 
 advisable, or only a few of them and not all. 
 
 In this particular, the Argentine Delegation places itself entirely 
 at the command of the assembly. Therefore, if the Conference re- 
 solves to take up the resumes, this Delegation will gladly postpone 
 the presentation of its report until such time as may be set therefor. 
 
 Dr. Razzetti. We should bear in mind the second recommenda- 
 tion attached to the provisional program, which is as follows : 
 
 2. Each delegation shall present a paper or report which shall deal precisely 
 and necessarily with the sbject marked out in this program, and also a concise 
 extract of the same to be read within fifteen minutes' time at the sessions. Each 
 extract shall be printed in Spanish and English; that of Brazil in Portuguese 
 and English, and that of Hayti in French and English. 
 
 Therefore, when for the present session the reading is announced 
 of the reports of each Delegation, it is meant, of course, that the 
 assembly will hear and consider extracts or resumes and not the 
 report in full, whose reading could not be made in the space of fifteen 
 minutes. 
 
 Dr. Araoz Alfaro. I repeat that the subjects included in the 
 reports of the Argentine Delegation are in accord with the provisions 
 of the program announced for this Conference. Therefore, the only 
 thing to be decided upon is whether the papers that we have prepared 
 should be taken up at this session or at another one. 
 
 Dr. da Rocha. Acknowledging that the Delegate from Mexico 
 is perfectly right in his remarks, and that the Delegate from Vene- 
 zuela has properly and pertinently reminded us of an important point, 
 at the same time, I think that the Argentine Delegates have complied 
 with their mission most fully, because their papers are strictly con- 
 fined to the subjects assigned to this Conference. 
 
30 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Dr. Fernandez Espiro. I agree with Dr. Monjaras' view that 
 in the absence of a resolution to the contrary, which has not been 
 passed, the Conference should proceed in accordance with the provi- 
 sional program. But there is a decisive circumstance for not strictly 
 applying the regulations on this occasion. This circumstance has been 
 invoked and deserves the consideration of the Conference. Dr. Araoz 
 Alfaro has said that this is the first time that the Argentine Republic 
 participates in these Conferences, and, for this reason, its Delegates 
 can plausibly disregard the practice heretofore observed and the 
 existence of a program previously adopted. Those of us who have 
 attended former Conferences have borne in mind this antecedent, and 
 for this reason the Uruguayan Delegation has dealt with most of the 
 subjects prescribed, and has also made an extract of its reports so 
 that their reading may be limited to the time allowed. But the posi- 
 tion of the Argentine Delegates is different, and it seems to me that 
 the Conference could not dispense with the reading of the reports 
 they have prepared. As an act of courtesy, I would move that the 
 Argentine Delegates be given the floor so that they may read their 
 report. 
 
 Dr. Sanjines. The Bolivian Delegation finds itself in the same 
 position as the Argentine Delegation. 
 
 Dr. Soza. At a former Conference, in which I was present, there 
 was, as in this Conference, a provisional program indicating the sub- 
 jects. The permanent program is adopted by the Conference, if it 
 so deems advisable. 
 
 Dr. Araoz Alfaro. The reports of the Argentine Delegation 
 might be taken up after the other Delegations have read the extracts 
 they have made. The Argentine Delegation would be pleased to see 
 this procedure adopted. 
 
 Dr. Ferrer. In previous Conferences, the strict compliance with 
 the provisional program was not required. It is sufficient to glance 
 at the transactions of those Conferences to see that a great number 
 of the papers read were not adapted to the previous established 
 previously. Sometimes a report included all the subjects, and other 
 reports included only one or some of the subjects. This procedure 
 may not be quite regular, but for obvious reasons it should not com- 
 pletely be proscribed. 
 
 Dr. Fernandez Espiro. I think the point raised has been suffi- 
 ciently discussed, and I believe that the incident could be closed to the 
 satisfaction of all if we adopt the following motion which I submit 
 to the Conference: 
 
 The Delegations of the different countries participating in this Conference 
 are allowed to read their reports even if they are not strictly in accord with 
 the regulations of the Conference. 
 
 (A vote was taken and the motion unanimously carried.) 
 The President. I wish to ask the Conference a question. As 
 I believe to have understood it, the Mexican Delegate opines that the 
 subjects should be taken up independently and separately. That is 
 to say, that each Delegation will be given the floor to deal with the 
 first subject only. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 31 
 
 Several Delegates. No, Mr. President, there should be no 
 limitation. 
 
 The President. Very well. I will then give the floor to each Dele- 
 gation to read its report, whether it be complete or not. 
 
 Dr. Monjaras. I will give the President the explanation he de- 
 sires. If the complete reports are long, the Delegates should read 
 extracts, the reading of which shall not take up more than fifteen min- 
 utes. When the fifteen minutes are up, the President should grant the 
 floor to another Delegate. This, I think, is the order which should 
 be followed. 
 
 The President. As the regulations and the program are only of 
 a provisional nature, I request the assembly, if it should deem it ad- 
 visable, to give them a permanent status. 
 
 (This motion was unanimously carried.) 
 
 The President. Dr. Alvarez has the floor. 
 
 Dr. Alvarez read the report which appears on page 77 of the Ap- 
 pendix. 
 
 (On motion of Dr. Fernandez Espiro the Argentine Delegation was 
 allowed additional time to proceed with its interesting reports.) 
 
 (Another report of the Argentine Delegation, on compulsory vac- 
 cination was left over for a subsequent session.) 
 
 The President. I would like to know if the Conference wishes to 
 take up the immediate discussion of each report, or if it prefers to 
 leave it until after all the reports have been read. I move that the 
 latter procedure be adopted, because it offers the advantage of taking 
 up the discussion of a certain subject — malaria, for instance — after all 
 the reports thereof have been heard. 
 
 (This motion was carried, and, consequently, the discussion was 
 postponed until the reading of the reports was over.) 
 
 Dr. Roberts. Dr. Alvarez, in his report on cholera, stated that 
 there is in the Argentine Republic a corps of bacteriologists, and that 
 a suspected ship arrives the examination of the individual is made. 
 That examination, as I understand, is made during the trip and also 
 upon arrival at port. I wish to know if the physicians who make the 
 examination on board ship are employed by the Argentine Govern- 
 ment or by the respective navigation company. 
 
 Dr. Alvarez. They are employed by the Argentine Government. 
 
 Dr. Monjaras. I would like to know what do the bacteriological 
 examinations on board consist of. It is important to know if they are 
 bacterioscopical examinations of the baccilu, or if the examination of 
 agglutination is made. 
 
 Dr. Araoz Alfaro. They include both things. 
 
 Dr. Alvarez. I am at the disposal of Dr. Monjaras to furnish him 
 the details regarding the examinations. 
 
 Dr. Araoz Alfaro. I will advance the information that all neces- 
 sary means are employed in order to reach a diagnosis as rapidly as 
 possible. 
 
 The President. The Delegate from Bolivia has the floor. 
 
 Dr. Sanjines read the report given on page 81 of the Appendix. 
 
 Dr. Guiteras. I would like to know what disease is that upon 
 which the Delegate from Bolivia has reported under the name of 
 espundia. 
 
32 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Dr. Sanjines. It is Briebas bubo. Concerning this disease and its 
 treatment, I will say that I have treated with success some cases of 
 espundia in the legs, by means of rasping and cauterization. Those 
 afflicted with espundia in the fauces generally die of tuberculosis. At 
 present there are two physicians in Bolivia who employed the 606 in- 
 jections in the sections of the country infested with this disease. Ac- 
 cording to the reports they have sent to the Government they obtain 
 saisfactorily results with this treatment, except in causes where the 
 fauces are affected. I myself have employed the same injections with 
 similar results. 
 
 Dr. Razetti. In Venezuela we have recently began to experiment 
 the 606 injection with the same purpose. A soldier who had been 
 subjected to the treatment improved within 12 hours. In another case 
 the eruption disappeared immediately after the first injection. 
 
 Dr. Urizar. In Paraguay this disease, there known as buba, oc- 
 curs under some peculiar symptoms, and with no little frequency it 
 appears in the northern verba mate groves and in the Brazilian rub- 
 ber plantations, bordering with the Oriental regions of Bolivia. As 
 a general rule, the disease begins by affecting the hand or the foot, 
 through the bite of ticks, flies and other insects and worms, and is 
 then manifested by ulcerations with fleshy irregular borders, of the 
 size of a dollar. Many patients are cured by cauterization, or rasp- 
 ing followed by cauterization. In obstinate cases, after a period vary- 
 ing between three and four months, the disease attacks the soft palate 
 or the nasal fossae. It is the stage of specific localization, which follows 
 that of generalization. This stage of generalization is a rule short 
 and irregular. In some cases it is manifested by symptoms common 
 to septicaemia. In other cases those symptoms are accompanied by 
 the apparition of ulcerations in different parts of the body ; these latter 
 symptoms I know only from what I have read of them in descriptions 
 of the disease written by Argentine, Bolivian and Brazilian authors. 
 Of cases that have come under my observation, none have shown other 
 localizations than those in the nose and the soft palate. As to the na- 
 ture of the disease, I do not agree with the opinion of the Bolivian 
 Delegate. I have colored a great many preparations, I have innocu- 
 lated various species and cultivated in several forms, and I think I have 
 the assurance that it is not tuberculosis, as Dr. Sanjines opines, but a 
 disease due to an infection whose agent is still unknown and which is 
 probably transmitted through insects which bite men in those regions 
 (ticks and bot-flies). 
 
 The President. The Delegate from Brazil has the floor. 
 
 Dr. da Rocha. In behalf of the Brazilian Delegation, I submit to 
 the Conference several printed volumes, to wit: Historical sketch of 
 the public health services of j Brazil, specially in the city of Rio Janeiro, 
 during the century 1808-1909; Sanitary laws and regulations in force 
 in Brazil, Medical emergency service in Rio Janeiro ; Yearbook of 
 demographic-sanitary Statistics, published in 1910 by Dr. Casio Ra- 
 zende, of the General Bureau of Public Health ; and the Commemora- 
 tive Bulletin of the National Exposition of 1908. (Dr. da Rocha then 
 read the report appearing on page 87 of the Appendix.) 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 33 
 
 Dr. Araoz Alfaro. On behalf of the Argentine Delegation I wish 
 to congratulate the Brazilian Delegation for the splendid work it has 
 presented, which includes all the subjects of the program. At the same 
 time, and although the Brazilian Government has already been con- 
 gratulated for the sanitary works done, especially in Rio de Janeiro, 
 thanks to which yellow fever has been eradicated, I would ask my es- 
 teemed colleagues to send again a vote of applause to that Govern- 
 ment, I would also move that the Conference adopt a vote to place the 
 Brazilian physician Dr. Oswaldo Cruz among the benefactors of hu- 
 manity. (Unanimous demonstrations of acceptance.) 
 
 Dr. Monjaras. Being acquainted with Dr. Oswaldo Cruz's work, 
 I wish that it be expressly stated in the minutes that the Mexican Dele- 
 gation adheres to the vote proposed by the Argentine Delegation. 
 
 Dr. da Rocha. I request that special mention be made in the min- 
 utes of the deep appreciation of the Brazilian Delegation for this 
 courteous and honoring manifestations addressed to our Government 
 and one of the most eminent men of our nation. 
 
 Dr. Maira. I have been requested by the Director of the Sismo- 
 logical Institute, don Fernando Montesus de Ballore, to invite the Del- 
 egates to visit the Santa Lucia Observatory. 
 
 (The session adjourned.) 
 
THIRD DAY— TUESDAY, NOVEMBER 7, 1911. 
 Afternoon Session. 
 
 The Conference was called to order by the President Dr. Alejandro 
 del Rio, nearly all the Delegates being present. By invitation of the 
 President, Dr. da Rocha, of Brazil, and Dr. Vicencio, of Columbia, 
 sat at the presidential table in their capacity as Vice-Presidents of the 
 Conference. 
 
 The minutes of the previous session were read and approved. 
 
 Dr. da Rocha submitted to the Conference a map of Brazil show- 
 ing the sanitary ports of the Republic. 
 
 The President. Gentlemen, I have the honor to introduce to you 
 the distinguished representation of the Pan-American Union, Captain 
 Granville R. Fortescue, who honors us with his presence. I move that 
 he be admitted to the sessions. He will deliver in due time a greeting 
 from the Pan-American Union, of which he is the bearer. 
 
 (The motion of the President was unanimously approved.) 
 
 The President. I also have the honor to introduce to you the hon- 
 orable Delegate from Costa Rica, Dr. Fernando Iglesias, who, on ac- 
 count of difficulties in the transportation, was delayed in his arrival. 
 The ^Delegate from Costa Rica has the floor to deliver the greeting 
 from his country. 
 
 Dr. Iglesias. Gentlemen: It is an honor and a sincere pleasure 
 for me to send a warm greeting to the Government and the medical 
 profession of Chile. I come to this hospitable and generous land full 
 of faith and gratifying hopes. Now that I find myself in the midst of 
 this vigorous people, which is justly proud of having produced so 
 many eminent men and illustrious physicians, my admiration for it 
 increases. Debts of gratitude bind us to the Chilean Nation. Costa 
 Rica does not forget them. In the name of my country I greet you. 
 
 Dr. Iglesias, Dr. Roberts, Dr. Cornejo, Dr. Guiteras, Dr. Bian- 
 chi, and Dr. Monjaras read their respective reports, in the order 
 named (see the Appendix, pages 97, 101, 107, 121, 113, and 115, re- 
 spectively). 
 
 The President. A new list of the Committees has been drawn up. 
 The changes made in the list previously approved consist merely of 
 the addition of new members to some committees. 
 
 The Secretary, Dr. Amunategui. The Committees, with the new 
 members, are now constituted as follows. (See page 6.) 
 
 Dt. Guiteras. If I remember rightly, a Committee on Resolutions 
 was appointed for the purpose of considering the different motions 
 presented before submitting them to the Conference. I would like 
 to know if these functions are to be exercised by the Executive Com- 
 mittee. 
 
 Several Delegates. Yes, sir. 
 
 The President. It is understood that the consideration of the mo- 
 tions is to be made by the Executive Committee. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 35 
 
 Dr. Araoz Alfaro. It seems advisable that such reports as have 
 been read be referred to the Executive Committee, so that it may in 
 turn assign them to the proper committees. 
 
 The President. Are the reports to be submitted also, or only the 
 motions? I believe that the consideration of the reports would take 
 too much of the Executive Committee's time, and it may even be im- 
 possible. The chair would ask the Delegates having motions to sub- 
 mit, to send them in written form to the secretary. 
 
 Several Delegates. Very well, we shall do so. 
 
 The President. It is then agreed that the Delegates will present 
 the motions in the exact form in which would have the Conference 
 adopt them. 
 
 The committees will be called to-morrow so that they may begin 
 their labors. 
 
 (The session adjourned at 5.15 p. m.) 
 
FOURTH DAY— WEDNESDAY, NOVEMBER 8, 1911. 
 Afternoon Session. 
 
 The Conference was called to order by the President at 2 P. M., 
 nearly all the Delegates being present. By request of the President, 
 Dr. Iglesias, of Costa Rica, and Dr. Roberts, of Cuba, sat at the 
 presidential desk in their capacity as Vice-Presidents of the Confer- 
 ence. 
 
 The minutes of the previous session were read and approved. 
 
 The President. Yesterday, late in the evening, Dr. Jose R. Campos 
 and Sefior Tito V. Lizoni, received the credentials accrediting them as 
 Delegates from the Dominican Republic to the Conference. Those 
 credentials have been referred to the respective Committee. Mean- 
 while, following the rule established in other Conferences, said gen- 
 tlemen are temporarily recognized as Delegates. 
 
 Dr. Ferrer. Mr. President, I would request you to propose that 
 the name of Dr. Guiteras, the distinguished Delegate from the United 
 States, be added to the Executive Committee. I consider his presence 
 in that body as necessary in a large measure. He is fully familiar 
 with the subjects before this Conference and in direct touch with the 
 International Bureau of Washington with which will, undoubtedly 
 be related many of the resolutions to be passed by the Conference. 
 
 The President. I am really suprised to hear the suggestion of the 
 Delegate from Chile, as Dr. Guiteras' name was included in the list 
 that was prepared to propose the personnel of the various commit- 
 tees. It has simply been an omission in copying. I thank Dr. Ferrer 
 for the opportunity he affords me for amending the error. If there is 
 no objection, Dr. Guiteras' name will be added to the Executive Com- 
 mittee. 
 
 (The motion was unanimously carried.) 
 
 The President. To continue with the reading of the reports, I 
 will request the Delegate from Panama to take the floor. 
 
 Dr. Pardo Correa. Mr. President, I am sorry to find myself placed 
 in a necessarily difficult position, because I am wholly unable to fur- 
 nish any information in accordance with the program of the Con- 
 ference. The Republic of Panama had appointed another represen- 
 tative who was unable to leave in due time; but as the Government 
 did not want to be absent from this Conference, Panama having al- 
 ways taken an active participation in the previous meetings, and zeal- 
 ously tried to comply with its resolutions, succeeding in placing the 
 country upon an advantageous sanitary condition, requested me by 
 cable to assume its representation. Also by cable, I have received the 
 proper authority to take part in the proceedings and votes. I repeat 
 that I regret my inability to report to the Conference on the subjects 
 under consideration, I can, however, give the assurance that Panama 
 shall adhere to every measure, every resolution tending to benefit the 
 hygiene and health of the countries represented. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 37 
 
 Dr. Urizar and Dr. Oliver then read, in the order named, their 
 respective reports (see pages 119 and 153). 
 
 The President. The Delegate from Venezuela has the floor. 
 
 Dr. Razetti. The Venezuelan Delegation, in compliance with a 
 provision of the program submits a lengthy report and also a resume 
 or extract printed in English and Spanish. Besides in accordance with 
 that recommendation, this procedure seems highly useful, because the 
 mere reading of the report is not sufficient to give an exact idea of 
 the informations, plans and propositions advanced. Under such cir- 
 cumstances, many of the listeners can only obtain an incomplete and 
 passing impression, whereas a publication enables all to act with pre- 
 cision and to participate in the discussions and to vote in a manner 
 duly deliberated. (He then read the extract, and afterwards dis- 
 tributed copies thereof as well as several printed volumes containing 
 comprehensive information on the different subjects dealt within the 
 report. (See Appendix, page 159.) 
 
 The President. The Delegate from Colombia has the floor. 
 
 Dr. Vicencio. I have not as yet received the report that is being 
 prepared in my country, but I have requested that it be sent directly 
 to Washington, and I hope it will reach in time to be inserted in the 
 book containing the transactions of the Conference. 
 
 The President. The Delegate from Salvador has the floor. 
 
 Dr. Miranda. I am not in possession of complete data to report 
 upon the different subjects of the program. He then read several pa- 
 pers. (See Appendix, page 111.) 
 
 The President. Dr. Vial, a member of the Chilean Delegation has 
 the floor. 
 
 Dr. Vial. The report of the Chilean Delegation is not strictly in 
 accordance with the program in so far as the order of the subjects is 
 concerned, but all of them are discussed with the due attention and 
 with the all possible care. (He then read the printed report, copies 
 of which were distributed. See page 91.) 
 
 Dr. Cornejo y Gomez. I move that the Conference adopt a vote 
 of applause to the distinguished Chilean Delegation for the brilliant 
 and complete report which it has submitted. 
 
 Dr. da Rocha. Warmly applauding the motion just presented, and 
 as a compliment thereto, I request that record be left in the minutes 
 of the good impression that the Brazilian Delegation has experienced 
 upon visiting the Institute of Hygiene, and acquiring a close knowl- 
 edge of Chile's scientific medical service. 
 
 (These motions were carried by acclamation.) 
 
 The Secretary read the report of the Committee on Credentials. 
 (See page 72.) 
 
 Dr. Guiteras. In regard to that report, I would like to elucidate 
 one point. I would move that it be distinctly understood that Mr. 
 Fortescue is not a Delegate to the Conference. He has been granted 
 the privilege of the floor, but not as a Delegate. I understand that 
 Mr. Fortescue's admission does not in any wise alter the established 
 rule. 
 
 The President. A mistake has evidently been made in the report, 
 
38 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 which will be rectified. At a previous session I invited Captain For- 
 tescue to take the floor. I now reiterate the invitation, of which he 
 may avail himself at such moment which he may deem opportune. 
 
 I think it is now in order to have the committee constituted so that 
 they may start their work. I would request the Delegates to present 
 their motions so that these may be referred to the respective Com- 
 mittees to be reported upon and submitted to the Conference for dis- 
 cussion. 
 
 Dr. Guiteras. It being in order, as I understand from the invi- 
 tation of the President, to present now the motions or proposed reso- 
 lutions, I would like to know if they are to be presented to the Execu- 
 tive Committee. 
 
 The President. No, sir. The motions must be presented to the 
 Conference and they may drafted briefly. Then they referred to the 
 proper Committees. I believe this is the most practical way. 
 
 Dr. Guiteras. Then, in accordance with the President's statement, 
 and with his permission, I will submit a motion. 
 
 (Several Delegates read the motions they had prepared. See Ap- 
 pendix.) 
 
 A discussion followed as to the presentation, procedure and deliber- 
 ation of the motions, following rules being adopted by unanimous 
 vote : 
 
 1st. The Delegations shall submit their motion in writing to the Secretary 
 before the next session, or in the beginning of said session. They may draft 
 the motions briefly, reserving the right to submit lengthier drafts. 
 
 2d. The motions, according to this nature, shall be referred to the proper 
 Committees which shall report to the Conference, recommending the adoption 
 in the original or amended form, of the rejection or postponement thereof. 
 Motions not coming under the jurisdiction of any Committee shall be referred 
 to the Executive Committee. 
 
 3d. For the discussion of the reports submitted by the Committees, the Con- 
 ference shall follow the order of subjects prescribed by the program. Within 
 said, the motions shall be discussed in alphabetical order of countries repre- 
 sented. 
 
 4th. In the discussions, the limitation of time shall be strictly observed, as 
 established by the regulations, and the order of the program shall be followed. 
 
 5th. All motions, after having been discussed, shall be referred to the Execu- 
 tive Committee, which, after revising and confronting them, shall submit the 
 same to the definite vote of the Conference. The Executive Committee may 
 consolidate two or more similar motions into one single resolution, and 
 propose the elimination of repeated or inconsistent motions. The reports 
 from the Executive Committee shall not be subject of discussion. The votes 
 shall be taken by aphabetical order of nations. 
 
 The Secretary, Dr. Amunategui transmitted to the Conference an 
 invitation extended to the Delegates by Senor Joaquin Cabezas, Di- 
 rector of the Institute of Physical and Manual Training, to visit the 
 establishment. 
 
 (The session adjourned at 4.30 P. M.) 
 
FIFTH DAY— THURSDAY, NOVEMBER 9, 1911. 
 Afternoon Session. 
 
 The Conference was called to order by the President, Dr. Alejandro 
 del Rio, at 2 P. M., nearly all the Delegates being present. By re- 
 quest of the President, Dr. Cornejo, of Ecuador, and Dr. Guiteras, of 
 the United States, sat at the presidential desk in their capacity as Vice- 
 Presidents of the Conference. 
 
 The minutes of the last session were read and approved. 
 
 The President. I have the pleasure to grant the floor to the Do- 
 minican Delegation. 
 
 Senor Lizoni. In behail of the Dominican Republic, I have the 
 pleasure to wish this great assembly the best success for its important 
 labors. At the same time, I wish to assure you that the Government 
 of that nation will make it its duty to adopt and comply with the 
 resolutions that may be passed. I regret my inability to report upon 
 the subjects prescribed in the program, as I have received neither a 
 report nor sufficient data. 
 
 The President. The Chair has just received the credentials ac- 
 credited Senor Oscas Valenzuela Valdes as Delegate from Honduras. 
 Said credentials have been referred to the proper committee. Mean- 
 while, following the established procedure, Sr. Valenzuela Valdes is 
 temporarily recognized in his capacity as Delegate. As he is not 
 present now, I shall avail myself of the first opportunity to offer him 
 the floor for the customary salutation. 
 
 Dr. Ferre. In behalf of the Chilean Delegation, I submit a motion 
 which I do not doubt will be accepted by the Conference with pleasure. 
 The day before yesterday, there was inaugurated in Paris by the 
 French Minister for Foreign Affairs, the Universal Sanitary Confer- 
 ence. It is only natural that this American Conference should send 
 a greeting to that of Paris, in view of our affinity of object and pur- 
 poses. I move, therefore, that the President be authorized to transmit 
 in behalf of the Conference a message of greeting addressed to the 
 Minister for Foreign Affairs of France, or to the proper officer. 
 
 (The motion was unanimously carried.) 
 
 Dr. Guiteras. I wish to ask the Delegate from Chile if he is sure 
 that the Paris Conference has been inaugurated. I was under the 
 impression that that Conference had been postponed a second time. 
 
 Dr. Ferrer. It was inaugurated yesterday or the day before by 
 one of the members of the French cabinet. 
 
 Dr. Guiteras. Very well; I thank the Delegate from Chile for 
 his information. 
 
 The reading was then taken up of the different motions presented 
 by the Delegations, as follows : Argentine Delegation, 3 motions ; 
 Bolivian Delegation, 2 ; Brazilian Delegation, 1 ; Colombian Delega- 
 tion, 1 ; Cuban Delegation, 4 ; Ecuadorian Delegation, 1 ; United States 
 
40 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Delegation, 3 ; Paraguayan Delegation, 1 motion and 2 propositions ; 
 Uruguayan Delegation, 1 ; Venezuelan Delegation, 1. The Chilean 
 Delegation presented several motions, as follows : 5 signed by the 
 President, Dr. del Rio; 1, by Dr. Ferrer; 1, by Dr. Astaburuaga; 1, by 
 Dr. Soza; 1, by Engineer Illanes, and 2, by Dr. Amunategui. 
 
 Some of the Delegates took the floor for the purpose of formulating 
 their motions or explain their scope and significance. 
 
 (The motions were referred to the respective committees, and they 
 appear in the Appendix.) 
 
 Dr. Araoz Alfaro, in behalf of the Argentine Delegation, pre- 
 sented an extract of reports previously submitted to the Conference 
 by said Delegation. 
 
 The President. In accordance with the regulations, it is now 
 in order to undertake the discussion of the different subjects of the 
 program, in their numerical order. 
 
 (A short while after the consideration of the subjects was begun, 
 the Conference decided to abandon this procedure because it was 
 deemed of little advantage and that it was more useful to proceed 
 with the discussion when the motions were considered.) 
 
 Upon suggestion of Dr. Fernandez Espiro, it was decided that two 
 sessions should be held on the following day (Friday), one at 9:30 
 A. M. and another at the usual time, 2 P. M. 
 
 (The session adjourned.) 
 
SIXTH DAY— FRIDAY, NOVEMBER 10, 1911. 
 Morning Session. 
 
 The Conference was called to order at 10 A. M. by the President, 
 Dr. del Rio, nearly all the Delegates being- present. By request of the 
 President, Dr. Ortega, of Guatemala, and Dr. Monjaras, of Mexico, 
 sat at the presidential desk in their capacity of Vice-Presidents of 
 the Conference. 
 
 The minutes of the previous session were read and approved. 
 
 More motions were submitted by Dr. Monjaras, Dr. Roberts and 
 Dr. Manterola. They were referred to the respective committees. 
 (See the Appendix.) 
 
 Several committees reported upon the motions referred to them, 
 and the discussion of their reports was taken up in the order and 
 manner below stated. 
 
 The Committee on Chronic Contagious Diseases reported favorably 
 upon Dr. Urizar's motion on leprosy. 
 
 Dr. Corbalan Melgarejo. I believe to have understood that it 
 is recommended that the Governments adopt measures for the eradi- 
 cation of leprosy. If such is the meaning of the proposed resolution, 
 I would like to state my doubts as to whether this subject would 
 come under the jurisdiction of the Conference, because it is not a 
 matter of international sanitary police requiring the imposition of 
 quarantine or preventive measures. A patient arriving at a port, dis- 
 embarks or remains on board but the vessel is always received. The 
 matter is a subject for regulation only in so far as the policing of 
 immigration is concerned. Every country may defend itself against 
 leprosy or other contagious diseases in general, but with measures of 
 purely local nature. In Chile the passage of a law is contemplated 
 prohibiting the introduction of foreigners sufferings from chronic 
 contagious diseases, and ordering that they be returned to the country 
 of origin. 
 
 Dr. Urizar. I wish to explain the meaning and scope of my 
 proposition in view of the remarks by the distinguished Delegate from 
 Chile. The motion does not imply an international sanitary provision. 
 Its purpose is not to induce Governments to enact laws of that kind. 
 It is simply to advise the Governments of countries where leprosy 
 prevails to compile statistics for the purpose — quite natural and nec- 
 essary — of ascertaining the number of lepers, the places where they 
 live, etc., which data will help in devising the means conducive to 
 the eradication of the disease and facilitating the study of its etiology. 
 Undoubtedly, the prophylaxis of this disease has been and shall be a 
 matter of wide discussion, for the very reason that affecting chronic 
 patients it is difficult to prescribe that they be deprived of their liberty, 
 systematically. But the proportions that leprosy is assuming, justify 
 and render indispensable the recommendations that I propose, which 
 
42 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 refer to the internal legislation of each country, which could adopt 
 them, employing its means, according to its customs and capacity. 
 
 Dr. Guiteras. The measures recommended by the proposition in 
 question, are undoubtedly plausible enough, but I understand that all 
 countries have already adopted such measures. In the report of the 
 American Delegation, there is stated what the United States have 
 done in this particular. In my opinion, all the countries of the Amer- 
 ican continent have advanced enough to see the advisability of enforc- 
 ing measures of this kind. 
 
 Dr. Alvarez. Leprosy prevails in the Argentine Republic and I 
 accept the motion in view of the necessities of my country. We have 
 not complete leprosy statistics and have not yet enforced isolation 
 measures. It was only recently that it was decided to establish a 
 leper asylum in Entre Rios for the purpose of isolating there those 
 that have been at liberty. 
 
 Dr. Roberts. I will inform in regard to what is done in my coun- 
 try. Leprosy prevails in Cuba and we have leper asylums. Every 
 leper must be isolated in those establishments, unless it is proven that 
 he has the means to be isolated and attended in his own home in 
 such a way that it will not constitute a menace to society. A leper 
 having the means to do so, does not isolate himself properly, is forci- 
 bly confined. 
 
 Dr. Araoz Alfaro. I am going to supplement the information 
 furnished by my distinguished co-Delegate, Dr. Alvarez, by adding 
 some data. Although these statistics are very incomplete, it may be 
 established with certainty that there are more than three hundred cases 
 in the Argentine territory, located specially in certain districts of 
 Corrientes and Entre Rios. A year ago there was held in Buenos 
 Aires a National Congress on Leprosy, and among the measures pro- 
 posed by the Congress there is the establishment of a leper colony 
 in an island of the first-named province. In my opinion, the motion 
 in question might be amended, but I agree with the idea, and I 
 abstain from suggesting any amendments. 
 
 Dr. da Rocha. I agree with the proposition of the Delegate from 
 Paraguay, and I accept it. In Brazil we have in force measure*, to 
 that end, which in some States, as Sao Paulo and Rio de Janeiro, at J 
 very stringent. 
 
 Dr. Corbalan. In view of the explanations given by the Delegate 
 from Paraguay, and understanding now perfectly the meaning of his 
 motion, I shall give it my vote. 
 
 Dr. Monjaras. The motion now being discussed, comprises sev- 
 eral points of importance. The first refers to what the national gov- 
 ernments may do, and to this end the Fourth Conference adopted a 
 resolution which confines itself to recommending the different govern- 
 ments that they "adopt such measures as they may deem advisable." 
 To take into consideration a standpoint of greater importance, I will 
 say that the defense against leprosy has two aspects, to wit: the 
 defense within the country and the defense to prevent leprosy from 
 being introduced from any nation. In Mexico, Cuba and the United 
 States lepers are not admitted upon arrival at a port or at the frontier, 
 and likewise they are not permitted to leave the country. In this way 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 43 
 
 the international side of the question is disposed of. With respect to 
 the interior of each country, it is obvious that all governments can 
 adopt such measures as they may see fit. My opinion would be that 
 we merely refer to what was resolved by the Fourth Conference. 
 
 Dr. Urizar. My motion refers in the first place to the compilation 
 of complete statistics by each country, not only as a national measure, 
 but also for the purpose of ascertaining the extent of the propagation, 
 which is very important from the scientific standpoint. Therefore, 
 my proposition concretes and defines in a better way the recommen- 
 dation made by the Fourth Conference to the governments, and to 
 this end a mere reference to that recommendation would not be 
 sufficient. 
 
 (There being no more Delegates desiring to speak on the subject, the 
 discussion was ended at this piint. In accordance with the rules, the 
 motion was referred to the Executive Committee.) 
 
 The President's motion on scleroma was favorably reported upon 
 by the respective committee, and there being no discussion thereon, 
 it was referred to the Executive Committee. (See Appendix.) 
 
 Dr. Araoz Alfaro. This disease is unknown in many countries. 
 
 Dr. Roberts. It exists in Cuba, but the cases are few. 
 
 Dr. Ortega. It is very frequent in Guatemala, in comparison to 
 other acute diseases ; the same is true of Salvador. 
 
 The President's motion on the regulation of prostitution was favor- 
 ably reported upon by the Committee on Prophylaxis. (See Appen- 
 dix.) 
 
 Sr. Alfonso. It has been generally believed that the regulation 
 of prostitution is a scientific means of limiting the ravages of venerea] 
 diseases. But, as the Delegates know, eminent authorities on syphil- 
 ology have reached the conclusion that it is not worth while to adopt 
 such a regulation. I submit this idea to the consideration of the Con- 
 ference; in fact, this thesis, which offhand seems rather extravagant, 
 is worthy of being taken into consideration after one has studied the 
 reasons upon which its authors base their opinion. 
 
 Dr. Monjaras. In Mexico, the regulation of prostitution has been 
 in force for many years. There has been taken a statistical table of 
 the propagation of venereal diseases by registered persons, that is to 
 say by those whose names are recorded in the books kept for that pur- 
 pose — and by persons who in Mexico are called ambulantes (ped- 
 dlers), and that operate clandestinely. This table has shown in an 
 evident manner that the greater the clandestinity the larger the number 
 of cases. Well-to-do patients are asked how they contracted the dis- 
 ease, and through their answers the woman is looked for, and most 
 times we find that she also is suffering from the same malady. In 
 other instances we find that the disease has been acquired in a house, 
 and upon investigation it turns out that it was communicated by a 
 clandestine woman. As a rule the physicians have observed that the 
 regulation of prostitution is beneficial. 
 
 Dr. Bianchi. I do not think that it is not pertinent for me to 
 argue in favor or against regulation. I only want to say that the 
 regulation of prostitution in women is not sufficient. It would be 
 
44 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 necessary to include men in the procedure suggested by Dr. Mon- 
 jaras, because a man can at intervals transmit the infection. I think 
 that long as our customs do not permit the enforcement of a really 
 scientific regulation, it is better to confine the campaign to the popu- 
 larization of the methods of individual prophylaxis. At any rate, 
 this Conference, which is in a way something like the Supreme Court 
 of Hygiene in America, should not declare itself openly for or against 
 regulation until the great hygienists of the world shall have reached 
 an agreement on the subject. 
 
 Dr. Sanjines. In Bolivia, prostitution has recently been regulated 
 in some cities. In my opinion, the immediate isolation of the patient 
 should be required, and no patient should be allowed to trade until 
 she has been cured. I would add that strict persecution of clandestine 
 prostitution be recommended. 
 
 Dr. Araoz Alfaro. I believe that, as a whole, the proposition is 
 well termed. In the Argentine Republic the regulation has been in 
 force for a long time, and it may be said that it is so now even in the 
 smallest cities. In accordance with the opinion of Drs. Monjaras and 
 Sanjines, that regulated prostitution is less dangerous. As the manner 
 of the regulation, the Conference, in my opinion, should not pronounce 
 itself. In Chile they speak of isolation ; in the Argentine Republic 
 we have tried both systems, that is to say, isolating the patients or 
 letting them free, not to trade but to cure themselves in their own 
 homes. In accordance with the statement of the Delegate from Guate- 
 mala, it would be advisable, both from the moral and scientific stand- 
 point, that the investigation be made applicable to men also ; but, of 
 course, this is quite difficult from the practical standpoint. 
 
 Dr. da Rocha. In Brazil this is a question under consideration, 
 because we want to make the defense against the disease consistent 
 with individual liberty. Personal defense would perhaps be more 
 effective than a strict regulation. 
 
 Dr. Roberts. As stated in the report of the Delegation, regulation 
 is enforced in Cuba. Statistics show that venereal diseases are more 
 frequent where clandestine prostitution prevails. Oftentimes it hap- 
 pens that when a registered prostitute feels sick she undertakes to 
 operate clandestinely. The inspection of houses of prostitution is 
 made twice a week. A night dispensary has been established for the 
 treatment of men, as stated in the report. This dispensary is resorted 
 to by men who, on account of their financial situation, can not bear 
 the expenses of medical attendance, or who by reason of their occupa- 
 tion can not be treated in day time. 
 
 Dr. Manterola. I support the proposition of the Chilean Delega- 
 tion. Through investigations made by Dr. Astaburuaga and myself, 
 it has been ascertained that in this country, also, particularly in Val- 
 paraiso, what Dr. Monjaras has said is true, that is to say, that 
 clandestine prostitution causes more damages than public or regulated 
 prostitution. I believe, as the Guatemalan Delegate does, that regula- 
 tion should be extended also to men who communicate the infection. 
 At any rate, it seems to me that women should have the right to 
 demand the examination of the man who communicated the disease. 
 The mere fact that the man pays does not give him the right to 
 cause such a damage. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 45 
 
 Dr. Corbalan. I accept the motion proposed by the President. 
 Many times I have examined in my office men who contracted the 
 disease from women who traded with a clean bill of health. It is 
 therefore necessary that there be a competent, careful and honest 
 corps of inspectors. 
 
 The President. I am going to say four words in order to explain 
 the motive of my proposition. I am well aware that in every country 
 there are men who favor and others who oppose the idea of regula- 
 tion of prostitution. But the truth is that in order that regulation, 
 in countries adopting it, may be efficient, it is necessary that it be 
 enforced under certain requirements, and the necessity of such require- 
 ments should be emphasized, because if they are not complied with, 
 the regulation is then deceiving and dangerous. It is, of course, nec- 
 essary that the inspection should be made by competent physicians. 
 This suggestion may seem paradoxical, but the truth that such a 
 service should be in charge of specialists. In many cities in Chile 
 the examination of prostitutes is made at their own houses. Such a 
 commission is not in keeping with a physician's dignity, aside from 
 the fact that he can not be provided with the proper means for such 
 an examination. We all know that the diagnosis of syphilis is some- 
 times difficult. 
 
 For these reasons I have moved that it be recommended that the 
 inspection be made by specially prepared physicians, and in dispen- 
 saries or polyclinics. As in many cases it is necessary to make a 
 microscopical examination of the spirochaete and the gonococcus, 
 there should be a laboratory annex where it could be made properly. 
 
 Dr. Astaburuaga. In the regulations governing prostitution an 
 age limit is generally prescribed for women engaging in the trade, 
 which age is about eighteen years. But Dr. Manterola and I have 
 observed in Valparaiso that a great number of prostitutes there have 
 not attained that age, specially those who peddle in the streets looking 
 for clients. I consider that this point should be taken into considera- 
 tion and a solution given thereto. 
 
 The President. The Executive Committee will take up this sub- 
 ject and submit to the Conference in definite form. 
 
 (The motion under discussion was referred to the Executive Com- 
 mittee.) 
 
 Dr. Soza's motion on tuberculosis, having been favorably reported 
 upon by the respective committee, was then taken for discussion. 
 (See Appendix.) 
 
 Dr. Araoz Alfaro. In nearly all the countries there are anti- 
 tuberculosis leagues. In the Argentine Republic there is a very im- 
 portant, whose Director is Dr. Emilio Coni. Accepting the motion, 
 I would like to know if what is proposed is the appointment of an of- 
 ficial commission. 
 
 Dr. Soza. I have explained all my ideas on the subject in a pamphlet 
 that has been distributed among the Delegates. In many countries, 
 in France, for instance, there is a considerable number of associations 
 against tuberculosis, but as they operate without any concerted action, 
 they do not accomplish the results desired. They act as soldiers with- 
 out a chief. An eminent French author has said that the money is 
 
46 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 being thrown away without any profit whatever. The purpose of the 
 motion is, therefore, to make uniform the action of these associations 
 by combining the efforts. On the other hand, the Governments would 
 be free to act according to circumstances and in accordance with the 
 means of action at their disposal. 
 
 Dr. da Rocha. In Brazil, as in many other places, there are 
 leagues of that kind, but without a special jurisdiction over them. 
 This is a municipal matter in that Republic, but the Federal Govern- 
 ment renders financial help which sometimes exceeds 170,000 pesos. 
 A federal tax has been levied on banks, the products of which are de- 
 voted to that purpose. 
 
 Dr. Fernandez Espiro. I second Dr. Soza's motion, because in my 
 opinion it tends to overcome difficulties in some countries where there 
 are various organizations with the same purpose but independent from 
 each other. (He then stated what is done in Uruguay in this par- 
 ticular.) 
 
 Dr. Manterola. I also support the motion. 
 
 (The motion was referred to the Executive Committee.) 
 
 The motion presented by Dr. Razetti on malaria having been favor- 
 ably reported upon by the Committee on Malaria and Yellow Fever, 
 was then brought up for discussion (see Appendix). 
 
 Dr. Razetti. In an annex to the report of the Venezuelan Delega- 
 tion, the Delegates will find the conclusions reached by the Simla Con- 
 ference, in which a very complete and interesting study was made of 
 the means for the eradication of malaria, such as the destruction of 
 mosquitoes by draining lands, pouring kerosene oil, etc. The conclu- 
 sions of that Conference, which was attended by the most eminent 
 physiciansof England, will be of great service in intertropical countries 
 for a systematic campaign against malaria. 
 
 Dr. Araoz Alfaro. Malaria is so widely distributed throughout the 
 American Continent, that everything that refers to its eradication has 
 in my opinion a great collective interest. Therefore, I second with 
 enthusiasm the proposition of the Venezuelan Delegation; but as I do 
 not know in detail the conclusions of the Simla Conference, I shall con- 
 fine myself to outlining briefly what is done in my country. In the 
 Argentine Republic we have an area of nearly 400,000 square kilo- 
 meters — out of a total of 3,000,000 — affected by malaria, generally of a 
 mild nature, few acute cases occurring and without cachexia. The law 
 that is now being enforced provides for all forms of prophylaxis en- 
 forced in the most advanced countries, especially Italy, where, as we 
 all know, there are experts who advocate quinization only, and others 
 who favor the fight against mosquitoes. In my country the methods 
 in use are : Preventive quinization and curative treatment of patients ; 
 fight against mosquitoes (mechanical protection of patients; drainage 
 of swamps ; elimination of stagnated waters ; petrolization and mechan- 
 ical protection of waters ; fumigation and destruction of mosquitoes, 
 etc.) Besides, it is proposed to make anti-malarial education in the 
 schools as wide as possible. I would like to know if the proposition 
 of the Venezuelan Delegation includes something more. 
 
 Dr. Razetti. The measures outlined by the Argentine Delegate are 
 the basis, which, among others, may be adopted for the eradication of 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 47 
 
 malaria. The meaning- of the motion is confined to the fight against 
 mosquitoes — because it is not sufficiently practical to accomplish the de- 
 sired result. It is necessary to combine all means, and this is what the 
 Simla Conference did, which Conference has sanctioned the fight 
 against mosquitoes, education of the people, quinization, etc. We, in- 
 stead of devising the plan of campaign, should adopt what is already 
 done, recommending it to the interested Governments. This is the 
 object of the motion now under discussion. 
 
 Dr. Perry. Measures that may be applicable to a certain locality 
 might be impracticable in other places. Therefore, the adoption of 
 different methods would be advisable. The measures adopted in 
 Panama, in the Canal Zone, are the same as those in common use in 
 other countries. The procedure consists of attacking the chain at its 
 two ends, man and mosquito. A way of destroying mosquitoes, ex- 
 plained in detail in a publication that I have issued, is to catch the 
 insect in traps adequately arranged. This means facilitates the calcu- 
 lation of the amount of mosquitoes in a certain locality, which is a very 
 important data in determining the seriousness of the danger caused 
 by malaria at that point. 
 
 Dr. Sanjines. The measures recommended in the motion will be 
 of great interest in Bolivia, and, therefore, I accept it with much en- 
 thusiasm. 
 
 Dr. Guiteras. An important means of ascertaining the existence 
 and extent of malaria would be to provide that all cases that may occur 
 should be reported to the sanitary authorities. In report of the United 
 States Delegation mentio nis made of the States of the Union — still 
 very few — yhere it is compulsory to report all cases of malaria, typhus 
 and other communicable diseases. 
 
 Dr. Ferrari. In measures employed in Brazil to fight malaria, the 
 principal object is the destruction of mosquitoes, but it is not indeed 
 the means resorted to. For instance, four years ago the Municipality 
 of Rio Janeiro enacted measures of protection for laborers employed 
 in the canalization of waters, in order to prevent the apparition or in- 
 crease of the disease. The works of the Maderia Mamore Railroad 
 had to be abandoned because malaria used to decimate the laborers 
 employed in the construction. At present the work has been renewed 
 by an American Company, which applies preventive and curative 
 measures ; not only the destruction of mosquitoes, but also quinization 
 and other means which have been recommended as more efficient and 
 practicable. 
 
 (It being considered that the motion had been sufficiently debated, 
 it was referred to the Executive Committee.) 
 
 The President conveyed to the Delegates an invitation from the 
 Mayor of Valparaiso, to visit the water works of Pefiuelas. (The in- 
 vitation was accepted by the majority.) 
 
 The session adjourned at 12 m. 
 
 Afternoon Session. 
 
 The Conference was called at 3 :30 p. m. to order by the President, 
 Dr. Alejandro del Rio, nearly all the Delegates being present. The 
 
48 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 President requested Dr. Pardo Correa, Delegate from Panama, and 
 Dr. Urizar, from Paraguay, to seat with him at the presidential desk, 
 in their capacity as Vice-Presidents of the Conference. The minutes 
 of the previous session were not read, as they were not yet ready, but 
 the Chair was authorized to approve them. 
 
 On motion of Dr. Guiteras it was resolved that in discussing the 
 different motions only their authors and the Delegates wishing to ob- 
 ject to them be allowed to speak thereon. 
 
 Several new motions just delivered at the Secretary's office were 
 read and referred to the respective committees. 
 
 The Committee of Yellow Fever submitted its report on the motions 
 of Dr. Guiteras and Dr. Roberts, on yellow fever, without recommen- 
 dation. (See Appendix.) 
 
 Dr. Guiteras. At the present time, the opinion on the transmission 
 of yellow fever is very different from that of years ago. Formerly, it 
 was considered that when a person had suffered an attack, a repetition 
 would very seldom take place. Now it is said that a person may live 
 ten years in an endemic place, go to immune countries ,and contract the 
 disease a second time upon returning to. the endemic place. An emi- 
 nent English authority has made very interesting studies on the sub- 
 ject, and his investigations show that the mere fact of having resided 
 for ten years in an endemic locality can not be taken as constituting 
 sufficient immunity. 
 
 Another point: A place is considered as endemic even if very few 
 cases of the disease appear therein. Supposing that there occur in a 
 port only ten, or five, cases during one summer, in the tropics that 
 place would be considered as an endemic locality. It is possible to 
 consider that one can live for a long time in an endemic place without 
 coming in contact with the mosquito ; and it is also possible one can, 
 without taking any precaution, spend many years without contracting 
 the disease. Possessing the present knowledge on yellow fever, I 
 consider that a sensible person and therefore exercising some case in 
 order to guard himself can live quite confidently in an infected locality 
 without fearing the disease. By taking precautions one can avoid the 
 bite from a mosquito. Nowadays, exactly the same is true of yellow 
 fever as it is of cholera. One can live in a place infected with cholera 
 without contracting the disease ; all that is necessary to boil — or to 
 reach only a certain degree to kill the Koch baccilu — eatables and bev- 
 erages. I am really of the opinion that there should be no immunity 
 declared against yellow fever; but since the subject is mentioned in 
 the Washington Convention, we should take it into consideration. Of 
 course, we should take the most advanced point possible, as would 
 be case of fever reported by a competent physician who knows the 
 disease. 
 
 Dr. Roberts. The subject under discussion is quite simple, and un- 
 doubtedly all the Delegates have already formed an opinion. The ques- 
 tion at issue is merely to decide, for practical quarantine purposes, of 
 protracted residence in an endemic focus can be taken as constituting 
 indemnity, even if the individual has not suffered from the disease, as 
 is now the rule in Cuba, United States and Mexico. We must bear in 
 mind that the motion deals with the subject of the program, referring 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 49 
 
 to immunity from yellow fever from the standpoint of quarantine. It 
 is true that from a theoretical standpoint, immunity is something that 
 can not be conclusively assured. But in Cuba, where yellow fever has 
 been endemic for a long time, the statistics show that after six years 
 it is very seldom that one contracts the disease. Every foreigner, 
 when contracting the disease, acquires it before completing six years 
 of residence. And the same is true of natives contracting the borras 
 fever, which is etiologically considered as yellow fever. There is no 
 doubt, of course, that sometimes one may live in an endemic focus and 
 yet not acquire immunity; but the number of cases in which such a 
 thing might happen is so insignificant, that I do not believe there is 
 any danger worthy of being taken into consideration ; on this ground, 
 I ratify my motion in the sense that, for the practical purposes of 
 quarantine against yellow fever, a residence of ten continuous years 
 in an endemic focus can be accepted as constituting immunity. 
 
 Dr. Monjaras. What is the point under discussion? 
 
 The Secretary, Dr. Amunategui. It should be the report of the 
 committee ; but it happens that the committee has merely referred the 
 two motions to the Conference, without making any recommendations. 
 
 Dr. Roberts. The case is very easily explained. There were two 
 motions each favoring a different opinion, and as they had been sub- 
 mitted by two Delegates forming part of the committee, this body 
 deemed it proper to abstain from making any recommendations. 
 
 Dr. Monjaras. There being no recommendation, we must discuss 
 the proposition on the floor of the Conference. It is of vital impor- 
 tance to determine the question in one way or other, and this should 
 be made from a practical standpoint, and avoiding the obstacles of an 
 extreme attitude. Dr. Guiteras proposes that a certificate from a com- 
 petent physician should be required ; but such a procedure would pre- 
 sent a serious obstacle, because we must first know who is com- 
 petent. 
 
 Dr. Guiteras. I referred to the authorities, whose duty it is to 
 watch over matters pertaining to public health. 
 
 Dr. Monjaras. It is assumed that public health officers are com- 
 petent, even though in fact they may not be so. Perhaps a medical 
 certificate, duly authenticated, is sufficient, even if the physician issuing 
 it is not a public health officer. 
 
 Dr. Razetti. The idea that has just been stated there is a serious 
 practical inconvenience. The physicians do not certify as a rule. Then 
 again, the physician who attended a patient may have died, or absented 
 himself at the time when a person wants to obtain a certificate from 
 him. Or the patient himself may have changed his residence and is 
 thus unable to secure a certificate from his physician. The health 
 authorities of Porto Rico require the certificate. Thus, a person de- 
 siring to go there applies to any physician for a certificate stating that 
 lie has suffered from yellow fever. As a matter of fact, such docu- 
 ments, thus secured, are worth nothing. I believe that the fact of 
 having resided a long time in an endemic place is more worthy of con- 
 sideration. 
 
 Dr. Alvarez. But, such a man, such a passenger, does he constitute 
 a danger to the home where he intends to go to? 
 
50 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Dr. Razetti. I believe he does not. If he is taken sick with fever, 
 the sanitary authorities will isolate him. I do not believe that an in- 
 dividual should be refused admission into a country just because he 
 has not suffered from yellow fever. An individual who has contracted 
 syphilis is more dangerous. In a word, I do not attach any practical 
 importance to a certificate. 
 
 (The subject being considered sufficiently discussed, the motions 
 were referred to the Executive Committee.) 
 
 A report from the Committee on Prophylaxis of Acute Diseases, was 
 then read, it being upon a motion by the Argentine Delegation pro- 
 posing that the Governments be recommended to have school teach- 
 ers learn how to vaccinate. The report recommended that the motion 
 be rejected. 
 
 (There being no discussion it was referred to the Executive Com- 
 mittee.) 
 
 Another report from the same committee was read, recommending 
 the approval of a motion by Dr. Sanjines. (See Appendix.) 
 
 Dr. Vicencio. I would like to know if an error was made in the 
 report of the committee in stating that only Brazil and Chile had no 
 compulsory vaccination. 
 
 Dr. da Rocha. In some States of Brazil, as Sao Paulo, vaccina- 
 tion has been made compulsory; but it is not so in other States. 
 
 Dr. Guiteras. Compulsory vaccination in the United States exists 
 only indirectly. For instance, children attending school must be vac- 
 cinated. 
 
 (The motion was referred to the Executive Committee.) 
 
 A report was then read from the Committee on Sanitation of Ports 
 and Frontier Towns recommending the adoption, with slight modifi- 
 cations, of Sr. Ulanes' motion on water supply and sewer system in 
 towns. (See Appendix.) 
 
 (The motion was referred to the Executive Committee.) 
 
 Another report was read from the same committee, recommending 
 the approval of a motion from Dr. Vial. (See Appendix.) 
 
 (There being no discussion, the motion was referred to the Execu- 
 tive Committee.) 
 
 A report was then read from the Committee on Plague, recommend- 
 ing the approval, with slight modifications of four motions submitted, 
 respectively, by the Delegations from Bolivia, Cuba, and Paraguay, 
 and the Chilean Delegate, Dr. Davila Boza. (See Appendix.) 
 
 Dr. Roberts. In the motion by the Cuban Delegation, dessatization 
 is provided for indemne ships and not for the contaminated ones. 
 The program referred to the systematic dessotization, but not in case 
 of plague. The recommendation had already been made by the last 
 Conference, and experience has shown us that nothing is gained with 
 mere recommendations. 
 
 Dr. Sanjines. I accept with pleasure the amendment proposed by 
 the committee to the motion. I was aware beforehand that, as cus- 
 tomary, the assembly would word my motion in general terms. If a 
 had made particular references in my motion, regarding specially the 
 sanitation of the ports of Arica, Antofagasta and Mejillones, it was in 
 order to emphasize my point, because in my capacity as Bolivian Dele- 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 51 
 
 gate it is my duty to prevent the invasion of infectious diseases into 
 Bolivia. I am, therefore, pleased with the modification suggested by 
 the committee, and I hope the Conference will accept the motion. 
 
 Dr. Illanes. I wish to give some information regarding the sani- 
 tation works in the ports of Arica, Mejillones, and Antofagasta, which 
 bear relation to the proposition of the Delegate from Bolivia and the 
 report thereupon, because of the reference made in said proposition 
 to the ports I have mentioned. The Government of Chile devotes its 
 best attention to the improvement of those ports. 
 
 In the contract for the construction of the Arica-La Paz Railway, 
 provision is made for the laying of pipes for the conduct of the River 
 Caracarami waters, taking them from a point 140 kilometers away from 
 Arica. These waters shall be used, partly for the exploitation of the 
 railway, and partly for the supply of the city and port of Arica, it 
 being estimated that the capacity of the water supply will be 70 liters 
 daily per inhabitant. Besides, in the plans for public works now un- 
 der the consideration of Congress and which if passed would be oper- 
 ative next year, funds are appropriated for the sewer system and for 
 the water supply works in the same city, which funds, together with 
 those set aside for like works in the city of Tacna, will amount to 
 2,200,000 pesos. 
 
 In regard to Mejillones, the Supreme Government called for bids 
 on the construction of water supply works and sewer system, but the 
 proposals submitted were accepted because none of them met the re- 
 requirements prescribed. The Supreme Government continues to pay 
 attention to the construction of works of sanitation of that town. 
 
 In Antofagasta there is a water suppy system, owned and exploited 
 by a private concern, but the Government is now bent on improving 
 the service, by pranting new water concessions so that the supply 
 may be increased. In the same city the Government is carrying on, by 
 contract, the consideration of the sewer system and water supply for 
 public use, which works will soon be completed. 
 
 In the plan for public works, to which I have just referred, provi- 
 sion is made for the construction of very important port works in 
 Arica and Antofagasta which will contribute largely to the improve- 
 ment of public health in those ports. 
 
 I wanted to give this information, Mr. President, for the benefit of 
 the Delegate from Bolivia and by reason of the justified motives con- 
 tained in the motion under discussion. If the Delegate from Bolivia 
 should desire further information, I shall very gladly furnish him there- 
 with. 
 
 Dr. Sanjines. It is gratifying for me to state that I am highly 
 satisfied with the explanations courteously given by the distinguished 
 member of the Chilean Delegation ; I shall be pleased to transmit this 
 information to my Government. 
 
 (Without further debate, the motions were referred to the Executive 
 Committee.) 
 
 The motions and the committee reports thereon having been and 
 discussed, the debate was then taken up of the motions which the Ex- 
 ecutive Committee had decided to submit to the consideration of the 
 assembly. 
 
52 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 The Conference was first consulted as to two motions presented by 
 Dr. Amunategui. (See Appendix.) 
 
 The Delegates from Colombia and from the Dominican Republic 
 abstained from voting. The Delegation of Salvador voted in the nega- 
 tive. All the other Delegations voted affirmatively. The motions were, 
 therefore, approved. 
 
 Other propositions which were ready for submission to the Assem- 
 bly were unanimously approved. (See Appendix.) 
 
 A report was read from the Committee on Cholera recommending 
 the adoption of the resolutions appearing in the Appendix. 
 
 (There being no discussion, the motions were referred to the Execu- 
 tive Committee.) 
 
 Dr. Fernandez Espiro. As in to-morrow's session, the Conference 
 will select the seat for the next Conference, the Uruguayan Delegation 
 has the honor to propose the city of Montevideo for that purpose. 
 
 Dr. Roberts. In the name of Cuba I have the honor to propose the 
 city of Havana as the seat for the Sixth Conference. 
 
 The President. The board of Directors of the Medical Society has 
 requested me to invite the Conference to a special session that it will 
 hold this evening at which we will have the pleasure to hear the lec- 
 tures to be delivered by our distinguished colleagues, Dr. Araoz Alfaro, 
 of Buenos Aires, and Dr. Ferrari, of Rio de Janeiro, the former on 
 cito-diagnosis, and the latter on small-pox. 
 
 Dr. Araoz Alfaro. I beg to submit a motion recommending the 
 next Conference "the study of epidemic cerebro-spinal meningitis and 
 of anterior transmissible poly-mielitis." 
 
 (This motion was referred to the Executive Committee.) 
 (The session adjourned at 4.30 p, m.) 
 
SEVENTH DAY— SATURDAY, NOVEMBER 11, 1911. 
 Morning Session. 
 
 The Conference was called to order at 10 A.M. by the President, 
 Dr. Alejandro del Rio, all the Delegations, except the Hondurean, 
 being present. By request of the President, Dr. Ortega, of Guate- 
 mala, and Dr. Lizoni, of the Dominican Republic, sat at the Presi- 
 dential table in their capacity as Vice-Presidents of the Conference. 
 
 The minutes of the penultimate session were read and approved. 
 
 The Secretary, Dr. Amunategui, transmitted to the Delegates 
 an invitation from Sr. Justino Pelle to visit the model slaughterhouse 
 of Valparaiso. 
 
 The President. The representative from the Pan-American 
 Union, Captain Granville R. Fortescue, has the floor. 
 
 Captain Fortescue. Mr. President and Delegates : I bring warm- 
 est greetings from the Pan American Union in Washington and felici- 
 tations with best wishes for a successful convention from my chief, 
 the director general, Mr. John Barrett, than whom there is no more 
 loyal supporter of Latin American interests. 
 
 I come to you not as a North American, but as a Pan American. 
 
 Lack of technical education forbids my addressing you to-day along 
 the lines of the special and most important work which has called 
 you here ; that has been ably done by my esteemed colleagues, Drs. 
 Gregorio Guiteras and J. C. Perry, whom we have heard with interest. 
 
 As you are good Americans first and scientists afterwards, I shall 
 speak on a subject that should claim the interest of all Americans 
 be they born in Chile or Colombia, Argentina, or the United States, 
 Brazil, or Bolivia, or in any other of the sturdy nations of our hemi- 
 sphere. This subject is the Pan American Ideal. 
 
 Those who have given thought to the progress of civilization can 
 not but have been impressed with the rapid advance that has charac- 
 terized the cause of humanity during the last 10 years, an advance 
 which perhaps owes its greatest stimulus to the activity of the mem- 
 bers of your profession. No longer is the cruel doctrine of the 
 survival of the fittest tenable — now we advance the more humane 
 theory of aid to the weaker, and those who through adversity, mis- 
 fortune, or illness, find themselves handicapped in the struggle for 
 existence, are not trampled under foot but instead receive the kind 
 hand of brotherhood, which helps them to bear more equably their 
 burdens. No longer do we see in our neighbor's misfortune the 
 quickly to be seized opportunity for our own advancement. 
 
 The spirit of the age is what has been aptly called the Christian 
 spirit, which, liberally interpreted, means that we must meet all men 
 on the broad ground of unselfish consideration. Granting this gradual 
 change which is being brought about by the force of public opinion 
 
54 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 in the relations between man and man, why is it not a logical sequence 
 to apply this principle to the relations between nations? Nations are 
 but collections of individuals, having the same ambitions, passions, 
 emotions of the unit human being, and thus it should follow that 
 when the plane of thought of the members of society is brought to a 
 higher level, when the necessity of mutual interdependence is generally 
 recognized, the fellowship of nations should become a fact. 
 
 The fellowship of nations. That is the Pan American ideal. A 
 joining together in bonds of mutual understanding of all the Repub- 
 lics of this half of the world. How are we to arrive at this much 
 to be desired end? First, by promoting personal intercourse, by 
 becoming better acquainted ; and second, by letting the old hatreds 
 die. We of the northern Republic must make the opportunity that 
 will lead to closer relations with you of the Latin countries. This 
 we will do with the completion of the Panama Canal. The stimulus 
 to travel that is bound to follow this event can not but help leading 
 to an era of good feeling. We will learn of your glorious history, 
 your heroes, your magnificent resources, and your steady social and 
 economic progress, while you will meet Yankees who do not worship 
 at the shrine of the dollar. Not that I deprecate commerce; quite 
 the contrary ; commerce and comity are allied forces on the side of 
 mutual better understanding. 
 
 It is known that trade is one of the best mediums by which it is 
 possible to gain a correct appreciation of the other man's point of 
 view. As such an appreciation is absolutely essential in order to 
 combat the intolerance of ignorance, it is only natural that an institu- 
 tion which aims at the attainment of these ideal national relations that 
 I have depicted should bend its energies to the promotion of every 
 legitimate means of increasing commercial activity. And as a cor- 
 ollary to this trade movement there will be that most necessary work 
 which is the chosen field of you gentlemen. In your positions as 
 guardians of the health of the peoples it would seem that innumerable 
 opportunities would present themselves wherein it would be possible 
 to advance the Pan American ideal. 
 
 I may say here that without your aid, without the highest state of 
 sanitation in all our ports, it would be impossible to develop new 
 trade routes to their perfection. The fight against disease which you 
 are so successfully waging has opened the door to worlds heretofore 
 considered closed to the white man. The fever-stricken jungles that 
 had been given over to the occupation of wild birds and beasts alone, 
 will by the magic aid of sanitation develop into lands which will 
 support the countless millions of future generations. 
 
 Again, sanitation has reduced the perils from disease in traveling 
 to a minimum, it has raised the standard of cleanliness among all 
 nations, and it has made for an advance in civilization by promoting 
 the self-respect of those who practice its precepts. These are only 
 a few of the results of your labors, but they have been strong causes 
 in the promotion of the unity of nations. 
 
 The condition which I have placed as the second factor in bringing 
 about the perfect understanding among the western Republics is "to 
 let old hatreds die." It is a fact that our judgments of past events 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 55 
 
 as historically set forth have undergone many changes, and it is signi- 
 ficant, in my country at least, that we are revising our history books. 
 No longer is it considered necessary to breed bitter hate in the hearts 
 of our school children against England because the soldiers of King 
 George fought our forefathers. Again, the story of the four long 
 years of civil strife, which divided my people in acrid antagonism, 
 is now told with careful impartiality. Of course, the extreme partisan 
 still lives ; that is to be expected. But it is with a changed spirit that 
 we read of those incidents which were wont to arouse our suspicions 
 against all other countries, and made us look upon them as implacable 
 rivals. Suspicion is the parent of much misunderstanding. Let us 
 have done with it. The Latin American nations have a glorious his- 
 torical heritage. From the days of early discovery, when those who 
 came first suffered untold hardships, through the brilliant period that 
 led to independence, the American has given proof of high standards 
 of honor and bravery on many occasions. O'Higgins, Bolivar, San 
 Martin, Sucre, and Washington are names ever enshrined high among 
 the world's array of heroes. 
 
 But it is not only military records that spell the fame of the Ameri- 
 can Republics. "Peace hath her victories no less renowned than 
 war," as has been proved by the record of achievement standing to 
 their credit at The Hague Conference. 
 
 And if more proof were wanted to show that the Pan American 
 nations stood shoulder to shoulder in the front rank of the world's 
 peace movement, I would point to that monument which stands high 
 up above the clouds of Uspallata, "The Christ of the Andes." A 
 peace monument that puts before the world the unsurpassed example 
 of the forbearance, the moderation, the unselfishness of two great 
 nations. And there at the base of that statue is inscribed the words 
 that should be the inspiration of all countries: "Rather that these 
 mountains should crumble to dust than that nation should arm against 
 nation." That is the Pan American ideal. 
 
 Senor Alfonso. Mr. President, Messrs. Delegates : It is not every 
 day that we have the privilege of listening to such refreshing and 
 comforting expressions. The remarks we have just heard are phil- 
 osophy ; they are benevolence ; they are morality. There is an inferior 
 consciousness of own interests that leads us to compete by vexatious 
 methods with our supposed adversaries. But there is a superior 
 realization of those very interests that leads us to discover the great 
 harmonies that there may exist among the various interests of men, 
 and to unite our efforts in the struggle against hostile nature, against 
 vice, ignorance and error. This superior consciousness of human 
 interests enlightens first in the minds of great men and great nations. 
 What a great truth there is in that saying that "when the sun rises 
 it shines first upon the hills." 
 
 The scientists, monarchs of mind, without scepter nor crown, out- 
 line the courses to be followed by humankind, and the advanced gov- 
 ernments co-operate with them in the furtherance of the civilizing 
 activities. 
 
 The natural development of our life offers by itself enough misery, 
 trouble and pain, which we should not increase by antagonizing our- 
 
56 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 selves mutually ; on the contrary, such miseries, troubles and pains 
 should stimulate us in uniting our hearts, minds and wills for the 
 best sake of the welfare and improvement of humankind. 
 
 There is not an instant in the extensive history of the world in 
 which the idea of progress has not continued to realize itself, in 
 which the idea of progress has not been in execution in the midst of 
 all activities of life ; and of all progresses the most substantial and 
 important one is the moral progress that irradiated from a cross at 
 the hill of Calvary. As you have just heard, that moral progress 
 has erected on the Andes the monument to the Savior which sym- 
 bolizes the reconciliation and friendship of two sister nations. That 
 moral progress is the greatest comfort and hope of humankind. 
 
 Science contributes in a very large measure to that moral progress, 
 just as it sheds light upon our paths and guides our steps. Faith 
 is the lever of that progress ; I do not refer to a given religious faith, 
 but to that faith that invigorates the spirit upon the consideration of 
 all great ideals, and which creates heroic minds in the struggle for 
 welfare. All is harmony ; all is solidarity. 
 
 Material progresses that facilitate and improve life contribute 
 towards such harmony and solidarity. Through innumerable diffi- 
 culties, the Republic of our continent strive to consolidate their 
 thoughts, their feelings and their destinies. The nature of historical 
 events has accorded our great sister of the North an actual promi- 
 nence, the acknowledgment of which is no obstacle to other regards 
 and considerations, and it shall not be taken advantage of to the 
 detriment of the other Republics, but for the sake of mutual solidarity 
 and progress, specially when the titanic work of Panama shall have 
 untied the Isthmian knot and united both oceans. 
 
 We have heard words of logical ideality and progress which invite 
 us to rise of our hearts and minds. We are grateful for those words 
 on account of their own value and of what they mean to the future. 
 
 (Several reports from the Executive Committee on different mo- 
 tions were then read. The text of the resolutions adopted appears 
 in the Appendix.) 
 
 Dr. Araoz Alfaro. What was the outcome of the motion pre- 
 sented by the Venezuelan Delegation in regard to the prophylaxis 
 of malaria? 
 
 The President. The Executive Committee did not submit it to 
 the consideration of the Conference because it recommends the adop- 
 tion of the Simla Conference, the text of which that body has not 
 seen. Likewise, there are other motions which have not been ap- 
 proved by that Committee and have not been, therefore, submitted to 
 the Assembly. The Executive Committee has taken such action on 
 ground which it deemed sufficient. 
 
 We will now proceed with the designation of the place where the 
 next Conference shall be held. 
 
 The Secretary, Dr. Amunategui. Having consulted a large 
 majority of the Delegates in regard to this point, I have the honor 
 to move, on behalf of the Chilean Delegation, that the city of Monte- 
 video, Uruguay, be selected as the place for the next meeting. (The 
 motion is carried.) 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 57 
 
 Dr. Da Rocha. As I feel sure that I am voicing the desire of the 
 Delegates, I have the honor to move that Dr. Fernandez Espiro be 
 appointed President of the next Conference. 
 
 (The motion is carried by unanimous acclamation.) 
 Dr. Roberts. I am sorry not to have been able to secure the floor 
 beforehand. It was my desire to state that, having consulted the 
 other Delegates and having convinced myself that the majority of 
 them preferred to designate Montevideo, in deference to that desire, 
 I intended to move that that place be designated by acclamation. 
 
 Dr. Guiteras. The U. S. Delegation had seconded the motion 
 presented by Dr. Roberts to the effect that Havana be selected as the 
 place for the next meeting, I must now say that it is with great 
 pleasure that I accept the offer made by the Uruguayan Delegation. 
 
 The President. In view of the unanimous acceptance by the Dele- 
 gations, the city of Montevideo is designated as the place for the next 
 Conference. 
 
 Dr. Fernandez Espiro. The Uruguayan Delegation, in behalf of 
 the Government and in its own name, sincerely thanks the Conference 
 for the honor conferred upon our capital city. It also thanks the 
 Cuban Delegate, as well as the United States Delegate, for their kind 
 words. I also express our appreciation to the Delegate from Brazil. 
 The President. It is now in order to appoint the members of the 
 International Sanitary Bureau of Washington, and in this connection 
 I have the honor to move that the honorable General Wyman be 
 re-elected as the Chairman thereof. 
 
 (This motion was unanimously carried in the midst of prolonged 
 applause.) 
 
 Dr. Guiteras. In behalf of the United States Delegation, I wish 
 to thank the President and the Delegates for the honor they have 
 conferred upon my nation and General Wyman re-electing him as 
 Chairman of the International Sanitary Bureau of Washington. 
 
 I beg to add that General Wyman watches with the keenest interest 
 the progress of this Conference. He has it at heart; he wished to 
 attend it, but unforseen circumstances prevented him from having 
 that pleasure. 
 
 The President. As my motion has been carried with the unani- 
 mous acceptance so expressively accorded it, I shall have the honor 
 to advise General Wyman by cable. It is now in order to elect the 
 six members that are to constitute the Bureau. 
 
 The Delegates then went into conference, to agree on the names to 
 be voted upon, and upon returning, Dr. Araoz Alfaro presented the 
 following list, which was approved by acclamation : 
 
 Dr. Oscar Dowling, of the United States of America. 
 Dr. Eduardo Liceaga, of Mexico. 
 Dr. Hugo Roberts, of Cuba. 
 Dr. Salvador Ortega, of Guatemala. 
 Dr. Luis Razetti, of Venezuela. 
 Dr. Alejandro del Rio, of Chile. 
 Dr. Roberts. The Cuban Delegation thanks the Conference most 
 sincerely for the honor it has conferred upon me. But I must state 
 that there are in Cuba eminent scientists who can undoubtedly fill 
 
58 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 that position with greater ability than mine, particularly Dr. Juan 
 Guiteras, our Director of Health, whose name I had proposed for 
 the place. 
 
 Dr. Cornejo. Referring to a motion that I had the honor to 
 submit and which the Executive Committee did not see fit to report 
 to the Conference, I request that the following statement be read 
 into the minutes: 
 
 "The Ecuadorian Delegation submitted in due time a motion which, 
 I suppose, has been taken into consideration by the Executive Com- 
 mittee, because yesterday there was approved a motion similar to my 
 proposition which call the attention of the governments that signed 
 the Washington Convention the necessity of harmonizing the maritime 
 health regulations. But as neither in yesterday's session nor in 
 to-day's, which is the last one, has it been reported to the Conference, 
 I beg to state : That in submitting that motion, the Ecuadorian Dele- 
 gation only had in mind to inform the Assembly the extreme sanitary 
 restrictions to which the arrivals from Ecuador are subjected, to the 
 detriment of our commerce, and without regard to the Convention of 
 Washington. On the other hand, it is only proper that motions should 
 be reported upon, whethey they be acceptable or not. 
 
 Perhaps, the motion by the Ecuadorian Delegation might be re- 
 garded as partial, that is to say, as not being couched in general terms. 
 But in my opinion it is not so, because if the terms of said motion 
 have some reference to the present situation in Ecuador, it could have 
 been so worded as to meet the demands of the Conference. And a 
 simple suggestion from the honorable Executive Committee would 
 have been sufficient for the Ecuadorian Delegate to draft his motion 
 in more general terms." 
 
 I have diverted the attention of the Conference with this statement 
 in order to inquire if all the motions submitted, including mine, will 
 appear in full in the book that is going to be edited in the United 
 States, containing the transactions, resolutions and motions of this 
 Conference. At any rate, I repeat that I wish that the foregoing 
 statement be inserted verbatim in the minutes. Before closing, I will 
 request the President to state whether or not the motions submitted 
 by the Delegates are to be published in the transactions in their orig- 
 inal form. 
 
 The President. The Delegate from Ecuador desires the state- 
 ment he has just read to be inserted in the minutes. The Chair has 
 no objection thereto, and has the pleasure to so order it. 
 
 Dr. Cornejo. I request the President to tell me whether the mo- 
 tions will be published in their original form. 
 
 The President. Regarding that point, I must say that the mo- 
 tions approved by the Assembly in accordance with the rules and with 
 the practice constantly followed shall be promulgated in the shape 
 given the mby the Executive Committee when reporting them to the 
 Assembly. 
 
 Dr. Cornejo. I do not refer to the resolution of the Conference, 
 which, of course, shall be published just as they may be passed. 
 What I wish to know is whether the motions presented by the different 
 delegates are to be inserted in the minutes in their exact original form, 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 59 
 
 whatever the action taken thereon. In my opinion, such an insertion 
 would imply no inconvenience, but, on the contrary, it would serve 
 to give a full and correct idea of the subjects discussed, and it would 
 also help in the construction of the resolutions and other acts of the 
 Conference. 
 
 The President. With the explanation given by the Delegate, I 
 understand that his desire is that the original motions should be 
 inserted in the transactions as a matter of record, so they may serve 
 to give a true history of the transactions, discussions and votes of 
 the Conference. In that sense, the chair has no objection, but, on 
 the contrary, it makes it a duty to move that the motions submitted 
 be published in their original form in the transactions. 
 
 Dr. Cornejo. I thank the President, as I also thank the Execu- 
 tive Committee, which, although it abstains itself from submitting to 
 the consultation of the assembly the motion that I presented, and to 
 which I referred a few moments ago, it has approved it implicitly, 
 because it withheld it on account of a matter of form. 
 
 The President. Of course, the Executive Committee must see 
 to it that all motions are couched in general terms, that is to say, 
 that they should not have a local object in view and limited only to a 
 country or two. Otherwise, the idea contemplated in the Ecuadorian 
 Delegate's motion is within the strict observance of the Washington 
 Convention. 
 
 Dr. Cornejo. Exactly; and I so state it in the remarks I have 
 submitted in writing. 
 
 Dr. Araoz Alfaro. I move that General Doctor da Rocha be 
 designated to speak, in the name of all the Delegations, at the closing 
 session that is to be held this afternoon. He will interpret faithfully 
 our feelings and will express eloquently our appreciation of the 
 magnificent hospitality and kindness that have been extended to us. 
 
 (The motion was unanimously carried.) 
 
 Dr. da Rocha. Accepting the honorable commission with which 
 I have been undeservingly honored, to express sentiments of the 
 Delegations upon taking farewell, I request that special mention be 
 made in the minutes of the profound gratitude with which I receive 
 this additional proof of the Argentine Delegation kindness upon mov- 
 ing that I be designated for that purpose. 
 
 The President. We shall now proceed with the reading of the 
 lists of the information committees. I am sorry to say that the list 
 is not a complete one, because there still is lacking the Committees of 
 several countries. 
 
 The Secretary, Dr. Amunategui, read the list referred and stated 
 that the Committees of the Argentine Republic, Brazil and Paraguay 
 are missing. 
 
 Dr. Ferrer. It should be borne in mind that these appointments 
 are made ad referendum, as they are to be submitted to the approval 
 of the respective Governments. 
 
 Dr. Monjaras. The appointment of these Committees should be 
 made by the respective Delegations. It should be remembered that 
 the members appointed should be public officers. 
 
 Dr. Araoz Alfaro. I move that appointment of the Argentine 
 
60 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Committee foe left to the Government of my country, to which I shall 
 convey the desire of the Conference. 
 
 Dr. da Rocha. I make the same statement with regard to the 
 Brazilian Committee. 
 
 Dr. Corbalan. I am informed that several of the members ap- 
 pointed on the information committees have ceased to be public officers 
 and they should therefore be replaced. This is an important point, 
 because it is connected with the services of the different countries. 
 
 Dr. Fernandez Espiro. This same question has been discussed 
 on other occasions. Some Delegates stated that they were authorized 
 to make the appointments for the respective committees, while others 
 said that they were not provided with such authority. I was in this 
 latter case, and I suggested that the Delegates, upon returning to their 
 countries should take up with their respective Governments the matter 
 of organizing officially the Information Committees. It was so done 
 in my and other countries. I believe that this same procedure should 
 now be followed. That is to say, that the Delegations having full 
 powers from their Governments to make the appointments, may do 
 so now ; and those not having it should request their Government to 
 organize their own committees. 
 
 Dr. Guiteras. I believe it would be proper to notify the Interna- 
 tional Sanitary Bureau of Washington when the Committees now 
 lacking are duly organized, so that the names of the appointtees may 
 be published in the Transactions of this Conference. (General 
 approval.) 
 
 Dr. Ferrer. I take advantage of this opportunity to move that a 
 vote of remembrance be taken in honor of two gentlemen intimately 
 connected with these Conferences and their growing success. We 
 have already given a vote of applause to General Wyman by the 
 significant action of reappointing him once more to the Chairmanship 
 of the International Sanitary Bureau. I think it is also our duty to 
 send our greetings to Dr. Liceaga, of Mexico, President of the Third 
 Conference, and to Dr. Juan Jose Ulloa, of Costa Rica, permanent 
 Secretary of first Conferences, and President of the last one held in 
 San Jose de Costa Rica. The affectionate remembrance that I pro- 
 pose is for those two gentlemen. 
 
 (The motion was carried by general acclamation.) 
 
 Dr. Monjaras. I beg to submit the following votes of thanks : 
 
 1st. That the most expressive thanks of the Conference be tendered 
 to the people and Government of Chile, and specially to the President 
 of the Republic and the Minister for Foreign Affairs, for the numerous 
 and kind attentions extended to the Delegates from the nations here 
 represented. 
 
 2d. To the Santiago society for the attentions that we have received 
 from them. 
 
 3d. To the Argentine Legation near the Government of Chile for 
 the reception to which the Delegates were invited. 
 
 4th. To the Chilean Delegation, which so kindly has made so pleas- 
 ant the sojourn of the Delegates from the other nations. 
 
 5th. To the President of the Conference, Dr. Alejandro del Rio, 
 for the beautiful garden party which he gave in honor of the Dele- 
 gates in his residence, "Villa Maria." 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 61 
 
 6th. To the directors, administrators and professors of the scientific 
 and charitable institutions which have so courteously received us. 
 
 Dr. Razetti. The Venezuelan Delegation had drafted a resolu- 
 tion which I will not read because it is similar to that presented by the 
 Mexican Delegate. 
 
 Dr. da Rocha. I move that 'there be added a vote of thanks to 
 the press of this capital. 
 
 Dr. Monjaras. I propose still another vote of thanks, that is to 
 the Intendent and First Mayor of Valparaiso for the invitation he 
 tendered to the Delegates to visit that city and the Penuelas Water 
 Works. 
 
 (All the above motions were unanimously carried.) 
 
 Dr. Asta-Buruaga. In behalf of the Chilean Delegation, I move 
 that the Conference extend its thanks to the Bolivian Delegate for 
 the banquet which he gave in the Club Union. 
 
 Dr. da Rocha. I request the following statement be read into 
 the minutes : 
 
 The Delegation from the United States of Brazil wishes that record 
 should be left in the Transactions of the Fifth International Sanitary 
 Conference, of the successful results which, for the sanitary defense 
 of the Brazilian ports, have been obtained by the strict compliance 
 with the provisions contained in the Sanitary Convention of June 22, 
 1904, signed in Rio de Janeiro by the Plenipotentiaries from the 
 Argentine Republic, Uruguay, Paraguay and Brazil, respecting at the 
 same time the provisions of Washington Convention and amend- 
 ments. Santiago de Chile, November 11, 1911. Dr. Ismael da 
 Rocha. Dr. Antonio Ferrari. 
 
 The Secretary, Dr. Amunategui. To the closing session that 
 will be held this afternoon at four o'clock, the Delegates : and their 
 families and the Diplomatic representations of the American Repub- 
 lics have been invited. As this invitation has been made at a late 
 hour, the Delegates are requested to extend it to their respective 
 Ministers. 
 
 It being probable that ladies will be present at the closing session, 
 at which the resolutions passed will be read, I request the Assembly 
 to let that regarding prostitution to be read now. (Resolution X, ap- 
 pearing on page 68, was read.) 
 
 The session adjourned at 12 M. 
 
 Afternoon — Closing Session. 
 
 At four o'clock, assembled in the Hall of Honor of the University, 
 the Fifth Conference held the closing session, Dr. Alejandro del Rio, 
 presiding. To his right seated Dr. Fernandez Espiro, from Uruguay, 
 President of the Sixth Conference, and Dr. Acosta Ortiz, of Vene- 
 zuela. The Secretaries, Dr. Amunategui, Dr. Perry and Dr. Razetti, 
 also sat at the President's table. 
 
 The Secretary, Dr. Amunategui, read the resolutions passed by 
 the Conference (see Appendix, pages 68 and 69). 
 
 Dr. Fernandez Espiro thanked the Conference for designating the 
 city of Montevideo as the seat for the Sixth Conference, and the 
 
62 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Chilean Delegation for making, through Dr. Amunategui, the motion 
 to that effect. 
 
 Dr. da Rocha then took the floor and delivered the farewell speech 
 in behalf of the Delegates. He began by saying that the farewell may 
 be divided into three parts, to wit: to the American Delegates, to 
 Uruguay, and to Chile. With respect to the first he pointed out 
 the fact that the American Eagle bears this motto : E Pluribus Unum, 
 which means all united, and which amplified could be applied to sci- 
 ence, to progress, to hope and to force for 'the defense of national 
 honor whenever necessary. He then moved that a greeting be sent 
 to the American Nation, which gallantry wrote the words "America 
 for the Americans." As to Uruguay, he congratulated that country 
 for having been seleoted for the seat of the next Conference, a very 
 fitting selection, because it is the country with the smallest death 
 rate, that is to say, 15 per cent. He then repeated the phrase of 
 Francisco de Saca, an eminent Uruguayan, "Peoples must be learned 
 or else die." With regard to Chile, he quotes from a geography 
 written by his daughter, Miss da Rocha, a description of that country. 
 He closes, saying that the Brazilian Delegates will not return to their 
 country by way of the Andes, but by that of the Pacific around Punta 
 Arenas so as to become acquainted with its coast. 
 
 The President. Ladies and Gentlemen : I will occupy your atten- 
 tion for a short time only. I only wish to express in behalf of the 
 Chilean Delegation our sincere and affectionate esteem of yourselves, 
 whom we have learned to love during our common labors. 
 
 The friendship created on this occasion will serve, undoubtedly, to 
 facilitate the practical application of our acts and resolutions, taking 
 into consideration the high representation with which you are in- 
 vested and your influence near the respective Governments. A similar 
 influence will certainly serve to facilitate the action of the information 
 committees. It has been a matter of regret to Chile to appear before 
 this with a poor sanitary equipment, but we cherish the hope that 
 when we again have the honor of welcoming it, our situation will be 
 very different, and we will then present to the American Republics a 
 new example of what can be accomplished by carrying out the resolu- 
 tions of these Conferences. The problem that should now be solved 
 among us is far from presenting the difficulties which other countries 
 have had to overcome, and which, as evidenced by the reports here 
 read, have been successfully solved in practice. 
 
 The seat of the Sixth Sanitary Conference, the capital of the 
 Oriental Republic of Uruguay, the progressive city of Montevideo, 
 and the high merits and personal qualifications of the worthy President 
 of that Conference, our dear and respected friend, Dr. Ernesto Fer- 
 nandez Espiro, insure the greatest success of that meeting. 
 
 We wish our esteemed colleagues a happy return trip, and we 
 request them to convey to their respective governments the expression 
 of our esteem and our appreciation of the fact that they selected 
 representatives who have deserved our most cordial and respectful 
 welcome. I do not believe that I exaggerate when I say that, on 
 account of the number of nations herein represented, and of the 
 importance of its resolutions, this Conference is no less valuable than 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 63 
 
 the preceding one and that it marks a positive progress in the history 
 of these periodical meetings, which are so beneficial to the sanitary 
 betterment and to the moral and material prosperity of the American 
 Republics. 
 
 Dr Cornejo, at his request, was then given the floor. He delivered 
 a short speech thanking the Delegates for their attentions to him ; 
 praising the work of the Conference, and paying a high compliment 
 to its President, Dr. del Rio. 
 
APPENDIX. 
 
Dr. Alejandro del Rio, of Chile. 
 
 President of the Fifth International Sanitary Conference of American 
 Republics. 
 
 Dr. del Rio, unanimously elected by the Delegates to the Fifth Conference, to 
 preside over its sessions, is one of the most prominent hygienists of Chile, 
 having devoted many years to the public health service of his country. 
 He is a Professor of the School of Medicine of the University of Chile, 
 member of the Supreme Council of Public Health and administrator of the 
 Public Assistance. By his genial personality and exquisite politeness, the 
 distinguished President won the affection and respect of all the Delegates, 
 who unanimously gave him a rising vote of thanks. One of the most 
 brilliant functions held in honor of the Delegates was the Garden Party 
 given by Dr. del Rio, on which occasion the foreign delegates had an 
 opportunity to admire the beautiful and charming ladies of the beautiful 
 capital of Chile. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE OF THE 
 AMERICAN REPUBLICS. 
 
 FESTIVITIES AND SOCIAL FUNCTIONS IN HONOR OF 
 THE DELEGATES. 
 
 From the moment the foreign Delegates landed on the hospitable shores 
 of Chile, they were accorded a most cordial welcome and attentions 
 of every description were showered upon them by the Chilean Government and 
 people. At the very outset they were surprised and delighted by the arrange- 
 ments made in advance for their comfort and welfare. No expense was 
 spared by the Government to meet this end and no expense was permitted the 
 Delegates from their own purses, if it came within the legitimate requirements 
 of the work. The Delegates, once settled in their quarters, were invited by 
 officials and individuals to innumerable festivites. 
 
 On Saturday afternoon, November 4, the Delegates presented their cre- 
 dentials to the Under-Secretary for Foreign Relations, who afterwards intro- 
 duced them to the Ministers for Foreign Relations and of the Interior. An hour 
 later they were received by the President of the Republic, Dr. Ramon Barros 
 Luco. 
 
 At the conclusion of the opening session, on Sunday, the Delegates drove to 
 the course of the Club Hipico, which has one of the most picturesque race 
 courses on the American Continent, and attended the races as specially invited 
 guests. The inaugural day concluded with a magnificent banquet given by the 
 Chilean Delegation to the visiting Delegates in the Club Union. At this dinner 
 Senor Paulino Alfonso, on behalf of the Chilean Delegates, welcomed the for- 
 eign Delegates, in whose name Dr. Fernando Alvarez, of the Argentine Dele- 
 gation, answered in equally eloquent terms. After the banquet each Delegate 
 was given a beautiful and artistic medal as an emblem of the Conference, the 
 work of the famous French sculptor, M. Hippolyte Lefebvre. 
 
 On Monday, the 6th, at 5 o'clock, a garden party was given by the President 
 of the Conference, Dr. Alejandro del Rio, at Villa Maria, his beautiful country 
 residence, which occasion was the scene of the reunion of all the members of 
 Santiago's smartest society and gave the Delegates the opportunity of meeting 
 the charming and beautiful ladies of the Chilean capital. 
 
 At eight o'clock in the evening of Wednesday, His Excellency the President 
 of the Republic tendered the members of the Conference a complimentary 
 dinner, which was held in the State dining room of the Palacio de la Moneda, 
 the presidential mansion, which was also attended by the diplomatic represen- 
 tatives of the American Republics, the members of the cabinet and prominent 
 officials and individuals. 
 
 The following evening, the Argentine Minister gave a reception and dance, 
 a brilliant affair, which was much enjoyed by the Delegates in whose honor 
 it was given. 
 
 On Friday evening, the Bolivian Delegate. Dr. Claudio Sanjines, offered to his 
 colleagues a splendid banquet at the Club Union, to which the members of the 
 Faculty of Medicine of Chile were also invited. At the conclusion of the 
 dinner, Dr. Sanjines drank to the health of the Delegates after a brief and 
 eloquent speech, which was replied by Dr. Vicente Izquierdo, the Dean of the 
 Faculty of Medicine. Speeches were also delivered by Dr. Razetti, of Vene- 
 zuela; Dr. Vicencio. of Chile; Dr. Araoz Alfaro. of the Argentine Republic; 
 Dr. Manterola, of Chile ; Dr. Guiteras, of the United States ; Dr. Carlos Ibar, 
 of the Chilean Faculty of Medicine ; and Dr. Alvarez, of the Argentine Republic. 
 
 The great banquet offered by the Chilean Government in honor of the Dele- 
 gates, to celebrate the successful closing of the Conference, took place on Sat- 
 urday, the 11th, at 8 o'clock. The dinner was presided over by the Minister 
 of the Interior, Senor Jose Ramon Gutierrez, who spoke in behalf of the 
 Government. Dr. Guiteras, of the United States, answered in the name of the 
 members of the Conference. Captain Fortescue, the representative of the Pan- 
 American Union, also delivered a speech. 
 
68 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 On Sunday, Senor Francisco Subercaseaux extended the hospitality of his 
 country home, La Hacienda del Pirque ; and in the afternoon the Delegates 
 attended the Corso de Flores, or flower carnival, given in their honor in the 
 Parque Forestal. 
 
 Having been invited by the Intendent and the Mayor of Valparaiso, the Dele- 
 gates went to that port on Monday, the 13th, to visit some of its establish- 
 ments and institutions, such as the hospitals, the Pehuelas water-works, and 
 Vina del Mar, the fashionable summer resort of Chile. 
 
 When not in session the time of the delegates was occupied in visiting the 
 different hospitals, medical schools, model sanitary tenement houses, and other 
 institutions of this nature in Santiago. All the delegates were most enthu- 
 siastic in their praises of the hygienic institute, an institution which for com- 
 pleteness of detail and general perfection can not be surpassed. The visit to 
 the school of medicine and clinical hospital, where the delegates were most 
 hospitably received by Dr. Don Vicente Izquierdo, the distinguished Dean of 
 the Medical Faculty, was a most instructive one. The Delegates everywhere found 
 much to hold their attention — at the sanitary exposition in the beautiful "Palacio 
 de Bellas Artes," the Mixed Hospital of Salvador, the Woman's Hospital of San 
 Francisco de Borja, and at the dental school, where by special invitation Dr. 
 Gregorio M. Guiteras, of the United States delegation, made an address. 
 
 RESOLUTIONS PASSED BY THE FIFTH INTERNATIONAL SANI- 
 TARY CONFERENCE. 
 
 The Fifth International Sanitary Conference of American Republics, having 
 duly considered and studied all the subjects provided in its program, has, through 
 the intelligent and efficient co-operation of the Delegates thereto, passed the 
 following Resolutions : 
 
 Be it resolved : 
 
 I. 1st, that the appreciation of the Conference be conveyed to the Govern- 
 ments represented; 2nd, that the American Governments be requested to send, 
 whenever possible, delegates who are trained hygienists, or at least, who are 
 nationals of the respective country; and that at least one delegate should be a 
 high sanitary officer, or a person who has been a delegate to a former 
 conference. 
 
 II. That each Republic should transmit, regularly, to the International Sani- 
 tary Bureau at Washington, and to the Central Committee at Montevideo, all 
 documents and reports relating to sanitation in that country. These documents 
 should include demographic conditions in the chief ports and cities and the 
 data relating to all kinds of contagious diseases. 
 
 III. That it be recommended that the International Sanitary Bureau of 
 Washington shall study these resolutions, include in the program for the Sixth 
 International Sanitary Conference such amendments to the Washington Con- 
 vention as it may deem necessary, and submit the respective proposed amend- 
 ments. 
 
 IV. That it be recommended that each Government organize substantial and 
 practical courses in hygiene and sanitation, so that specialists might be de- 
 veloped in those branches, with specific diplomas if necessary, qualified to carry 
 out in future the work of sanitation. 
 
 V. That it be recommended to the nations which have adhered to the Sani- 
 tary Convention of Washington, that they formally comply with its provisions. 
 
 VI. That it be recommended that causes of death be certified to by physicians, 
 at least in cities and seaports, in order to secure accuracy in statistics. 
 
 VII. That the establishment be recommended of fiscal laboratories for the 
 analysis of food stuffs and drinks imported though the custom houses. 
 
 VIII. That nations wherein leprosy exists be advised to keep accurate and 
 detailed statistics of lepers ; to organize colonies for the isolation of the patients, 
 and to enact laws to ward off the disease. 
 
 IX. That it be recommended to the Governments of the American Republics 
 that they promote or facilitate investigation as to the prevalence, frequency and 
 contagiousness of scleroma. 
 
 X. That it be recommended that prostitution should be regulated in cities, 
 and specially in seaports, intrusting the sanitary inspection to physicians 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 69 
 
 specially prepared on the subject, discharging their duties in dispensaries or 
 polyclinics provided with all the necessary means; and that persons that may 
 transmit infection be confined in hospitals until cured. 
 
 XI. That it be recommended that the Governments establish in their re- 
 spective countries a "Permanent Commission on Tuberculosis." The Pan- 
 American Union of Washington shall, through the diplomatic representatives 
 of the different American countries, request of those Governments the organi- 
 zation of said Commission. The various countries should also exchange infor- 
 mation in order that all may be acquainted with the methods adopted and re- 
 sults obtained. 
 
 XII. That it be recommended to the nations adhering to the Convention of 
 Washington that they amend their rules of hygiene at ports and on frontiers 
 so as to agree with the terms of said Convention. 
 
 XIII. That it be recommended that upon arrival of a vessel, a bulletin be 
 posted advising the passengers on board as to the sanitary rules to which they 
 are subject, and as to the laws or regulations by virtue of which such rules 
 are enforced. 
 
 XIV. That countries taking protective measures against arrivals from other 
 countries be recommended to maintain on board such vessels sanitary physicians 
 possessing the necessary technical knowledge. 
 
 XV. That it be recommended that vessels conveying passengers or immi- 
 grants be provided with apparatus and other means of disinfection. 
 
 XVI. That it be recommended that the disinfection of ships be made always 
 in the presence of witnesses in order to insure the success of the disinfection. 
 
 XVIL That it be recommended that all ships conveying passengers be pro- 
 vided with room for the confinement of patients, for the observation of persons 
 suspected of infectious diseases, and for the isolation of confirmed cases. 
 
 XVIII. That the International Sanitary Information Committees of the 
 American Republics, besides the duties intrusted to them by former Confer- 
 ences, shall advise their respective Governments as to the obligations imposed 
 by the International Sanitary Conferences in which their countries have par- 
 ticipated, or resulting from special ratifications. 
 
 XIX. That in order to consider a person as immune from yellow fever, it is 
 necessary that be shall have suffered the disease, which fact must be proven 
 by a certificate from the sanitary authorities in the port of departure. 
 
 XX. That it be recommended: 1st, that the water supply and sewer system 
 of cities be constructed and operated by the State or by the respective munici- 
 palities, without regard to pecuniary profit; and, 2nd, that the selection of a 
 source for water supply should be made by hygienists or engineers, by common 
 accord, taking into consideration the condition of the soil and possibility of 
 pollution. 
 
 XXI. That each Government adhering to the Sanitary Conference, in carry- 
 ing out works of sanitation and hygiene, give special attention to those sea- 
 ports and cities where the presence of endemic and infectious diseases shows 
 clearly that the health of the world will be improved by the introduction in such 
 places of modern hygienic and sanitary water supply and drainage. 
 
 XXII. That we hereby renew the recommendation made by the Third Inter- 
 national Sanitary Conference of Mexico of 1907, to the effect that laws be 
 adopted enforcing vaccination and revaccination against small-pox. 
 
 XXIII. That all passengers coming from cholera-infected localities, or who 
 may incidentally have come in contact with cholera patients, shall be subjected 
 to bacteriological examination of their intestinal excretions and shall be under 
 sanitary surveillance if it be confirmed that they are carriers of the cholera 
 bacillus ; and that those suffering from an attack of cholera shall not be re- 
 leased from such surveillance, until it is shown that the bacillus has disappeared 
 from the excretion. 
 
 XXIV. That the sanitary report that each delegation must submit on its 
 respective country shall be delivered in due time to the secretary, in printed 
 copies to be distributed in the preliminary session. 
 
 XXV. That we recommend the Sixth International Sanitary Conference of 
 Montevideo to study epidemic cerebrospinal meningitis and transmissible ante- 
 rior polymilitis. 
 
 XXVI. That reiteration be made of the recommendations passed by the 
 previous conferences on prophylactic measures against plague, specially those 
 regarding the destruction of rats, both on land and on board. 
 
REPORTS SUBMITTED BY THE COMMITTEES. 
 
 REPORT BY THE EXECUTIVE COMMITTEE. 
 
 Messrs. Delegates : 
 
 Your Executive Committee, after studying the various propositions referred 
 to its consideration, recommends that the following be adopted, they meeting, 
 in the opinion of the Committee, the general requirements. 
 
 (The text of the resolutions appear on page 68.) 
 
 Respectfully submitted : E. Fernandez Espiro, Alejandro del Rio, G. M. 
 Guiteras, F. Alvarez, J. E. Monjaras, Ismael da Rocha. 
 
 The I Resolution was passed in view of a motion by Dr. G. Amunategui,. 
 of Chile; 
 
 The II. on motions by Dr. Guiteras. of the United States, Drs. Fernandez 
 Espiro and Oliver, of Uruguay, and Dr. Del Rio, of Chile; 
 
 The III, on motions by Dr. Roberts, of Cuba, Dr. Davila Boza, of Chile, 
 Dr. Guiteras, of the United States, and Dr. Razetti, of Venezuela; 
 
 The IV, on a motion by Drs. Araoz Alfaro and Alvarez of the Argentine 
 Republic ; 
 
 The V, on motion by Dr. Cornejo y Gomez, of Ecuador, and Dr. Mon- 
 jaras, of Mexico; 
 
 The VI, on motion by Dr. del Rio, of Chile; 
 
 The VII, on motion by Dr. Asta-Buruaga, of Chile; 
 
 The VIII, on motion by Dr. Urizar, of Paraguay; 
 
 The IX and X on motion by Dr. del Rio, of Chile; 
 
 The XI, on a motion by Dr. Soza, of Chile; 
 
 The XII, XIII, XIV, XV, XVI, and XVII, on motions by Dr. Monjaras, of 
 ^Lexico ; 
 
 The XVIII, on motion by Dr. Ferrer, of Chile; 
 
 The XIX, in view of the report by the Committee on Yellow Fever; 
 
 The XX, on a motion by Dr. Illataes, of Chile; 
 
 The XXI, on a motion by Dr. Vial, of Chile; 
 
 The XXII, on a motion by Dr. Sanjines, of Bolivia; 
 
 The XXIII is based on the report of the Committee on Cholera; 
 
 The XXIV, on a motion by Dr. Vicencio, of Colombia; 
 
 The XXV, on a motion by the Argentine Delegates ; 
 
 The XXVI, is based on the report of the Committee of Plague and on a 
 motion by Dr. Cornejo y Gomez, of Ecuador. 
 
 The Executive Committee also took under consideration the following mo- 
 tions, which were submitted to the Conference: 
 
 A motion by the Venezuelan Delegation proposing that it be recommended 
 that the Governments of America adopt the modifications to the abbreviated 
 Nomenclature of Bertillon's Classification, introduced by the Bureau of Sta- 
 tistics of the Venezuelan Department of Promotion. 
 
 A motion by Dr. Ferrer, of Chile, recommending the insertion of the reso- 
 lutions passed by the four previous Conferences in the Transactions of the 
 Fifth, and that the Pan American Union be requested to call the attention to 
 the necessity of complying with the sanitary agreements adopted. 
 
 A motion by Dr. J. E. Monjaras, of Mexico, regarding the diagnosis of 
 yellow fever. 
 
 A motion by Dr. Vicencio, of Colombia, recommending the establishment 
 of pediatria services 
 
 A motion by Dr. Lauda, of Chile, recommending the adoption of immigra- 
 tion laws in accordance with modern sanitation. 
 
 A motion by Dr. Manterola, of Chile, recommending the construction of 
 school houses according to the rules of school hygiene, and so built that they 
 shall be a guarantee to the life of the pupils. 
 
 A motion by Dr. del Rio, of Chile, recommending the publication in Spanish 
 of a text and atlas of school and administrative hygiene for use by officers 
 having charge of public hygiene. 
 
72 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 REPORT BY THE COMMITTEE ON CREDENTIALS. 
 
 Your Committee on Credentials has examined the Powers exhibited by the 
 following delegates : 
 
 Argentine Republic. — Doctores Don Gregorio Araoz Alfaro y Don Fernando 
 Alvarez. 
 
 Bolivia. — Doctor Don Claudio Sanjines. 
 
 Brasil. — General Doctor Don Ismael da Rocha y Doctor Don Antonio 
 Ferrari. 
 
 Colombia. — Doctor Don Alcibiades Vicencio. 
 
 Costa Rica. — Doctor Don Fernando Iglesias. 
 
 Cuba. — Doctor Don Hugo Roberts. 
 
 Dominican Republic. — Doctor Don Jose R. Campos y Senor Don Tito 
 Lizoni. 
 
 Ecuador. — Doctor Don Luis F. Cornejo y Gomez. 
 
 Guatemala. — Doctor Don Salvador Ortega y Don Julio Bianchi. 
 
 Mexico. — Doctor Don Jesus Monjaras. 
 
 Panama. — Doctor Don Caupolican Pardo Correa. 
 
 Paraguay. — Doctor Don Rogelio Urizar. 
 
 Salvador. — Doctor Don Juan B. Miranda. 
 
 United States. — Doctors Gregorio M. Guiteras y J. C. Perry, of the U. S. 
 Public Health and Marine Hospital Service. 
 
 Uruguay. — Doctores Don Ernesto Fernandez Espiro y Don Jaime H. Oliver. 
 
 Venezuela. — Doctores Don Pablo Acosta Ortiz y Don Luis Razetti. 
 
 Pan American Union. — Capitan Granville R. Fortescue. 
 
 And having found the said Credentials in due form, it recommends that they 
 be approved. 
 
 Santiago, November 8, 1911. — Vicente Izquierdo. — Kaupolican Pardo Correa. 
 — R. Corbalan Melgarejo. — Paulino Alfonso. 
 
 REPORT BY THE COMMITTEE ON BUBONIC PLAGUE. 
 
 Your Committee has studied the four motions submitted respectively by 
 Dr. C. Sanjines, of Bolivia; Dr. H. Roberts, of Cuba; Dr. R. Davila Boza, of 
 Chile; and Dr. R. Urizar, of Paraguay, and has the honor to recommend that 
 action as follows be taken on each of the said motions : 
 
 MOTION OF THE BOLIVIAN DELEGATE. 
 
 As all proposed resolutions should be equally applicable to all the nations 
 of the Continent and not limited to any given country or countries, this motion 
 is amended as follows : 
 
 Resolved, That reiteration be made to the Governments as to the necessity 
 of improving the sanitary conditions of ports in pursuance of the Washington 
 Sanitary Convention, and to signify to them the desire of the Fifth Sanitary 
 Conference that there should be undertaken as soon as possible the establish- 
 ment of experimental bacteriological laboratories, the destruction of rats, the 
 increase and improvement of sanitary stations in the principal ports, and other 
 prophylactic measures recommended. 
 
 MOTION BY THE CUBAN DELEGATE. 
 
 The Committee recommends that the motion submitted by Dr. Roberts be 
 approved in all its parts as follows : 
 
 1st. Every vessel engaged in navigation should be provided, besides other 
 sanitary papers, with a certificate from a competent authority, to the effect 
 that the vessel has been totally freed from rats, within a period not over six 
 months. 
 
 2nd. This document shall be deemed indispensable, like other health docu- 
 ments required by maritime sanitary authorities, and no ship that is not pro- 
 vided with the said certificate shall be allowed to engage in navigation. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 73 
 
 3rd. The nations participating in this conference shall allow a period of 
 
 not more than six months within which their respective ships shall comply with 
 
 this provision. 
 Your Committee further suggests the addition of the following paragraph: 
 4th. Said certificates shall be valid only for non-infected ships ; infected 
 
 ships shall be subject to disinfection and destruction of rats, as may be ordered 
 
 by the sanitary authorities of the port. 
 
 MOTION BY THE CHTLEAN DELEGATE, DR. DAVILA BOZA. 
 
 Your Committee suggests that this motion be modified so that it shall be 
 in the nature of a recommendation and not an amendment to the Washington 
 Convention. With said modification the motion would read as follows : 
 
 That it be recommended that the maritime sanitary authorities endeavor to 
 carry out the destruction of rats in ships before unloading, and if not pos- 
 sible, within 48 hours after; without damaging the merchandise, the vessel or 
 its engines. 
 
 MOTION BY DR. URIZAR, OF PARAGUAY. 
 
 Your Committee suggests that this motion be approved, not as a resolu- 
 tion, but merely as a recommendation, considering that the aseptic serum 
 from horses is not of a lasting effect. 
 
 Santiago, November 10, 1911. — Dr. Antonio Ferrari. — L. F. Cornejo Gomez. 
 — P. L. Ferrer. 
 
 REPORT BY THE COMMITTEE ON MALARIA. 
 
 Your Committee on Malaria has the honor to report as follows on the 
 motion submitted by the Venezuelan Delegation : 
 
 That it be recommended to the Governments in whose countries the malarial 
 epidemic prevails, that they adopt, as the fundamental code for the anti- 
 malaria campaign, the resolutions and recommendations passed by the Simla 
 Conference, as proposed by the said delegation, or any other regulations the 
 effectiveness of which has been shown in other countries and which may be 
 specially applicable to the American Republic. And that the Delegates shall 
 report upon the results obtained in the anti-malaria campaign in their re- 
 spective countries. 
 
 Santiago, November 9, 1911. — J. C. Perry.— Claudio Sanjines. — H. Roberts. 
 
 REPORT OF THE COMMITTEE ON YELLOW FEVER. 
 
 The Committee on Yellow Fever has the honor to report on the motions 
 presented by the delegates indicated, as follows : 
 
 With regard to yellow fever two different opinions have been submitted 
 as to what constitutes immunity from said disease for practical quarantine 
 purposes. 
 
 According to the United States Delegation, only those producing a cer- 
 tificate to the effect that they have previously suffered from the disease. 
 
 According to the Cuban Delegation, persons immune from the disease are, 
 not only those who have suffered from the disease, but also those who have 
 lived for over ten consecutive years in an endemic focus of yellow fever 
 without having contracted the disease. 
 
 Santiago, November 9. 1911. — J. C. Perry. — Claudio Sanjines. — H. Roberts. 
 
 REPORT OF THE COMMITTEE ON CHOLERA. 
 
 Your Committee on Cholera has studied the four motives submitted by Dr. 
 Roberts, of Cuba, Drs. Araoz Alfaro and Alvarez, of the Argentine Republic, 
 and Dr. Guiteras, of the United States, all of which agree in principles ; there- 
 fore, your Committee recommends that the following be adopted, which har- 
 monizes with the fundamental ideas : "Be it resolved that all passengers 
 coming from cholera-infected localities, or who may incidentally have come in 
 contact with cholera patients, shall be subjected to bacteriological examina- 
 
74 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 tions of their intestinal excretions and shall be under sanitary surveillance 
 if it be confirmed that they are carriers of the cholera bacillus; and that those 
 suffering from an attack of cholera shall not be released from such surveil- 
 lance, until it is shown that the bacillus has disappeared from the excretion. 
 Santiago, November 9, 1911. — Luis Asta Buruaga. — G. Araoz Alfaro. 
 
 REPORTS BY THE COMMITTEE ON SANITATION OF COAST AND 
 
 FRONTIER TOWNS. 
 
 I. Your Committee on Sanitation of Coast and Frontier Towns, having 
 studied the motion by the Chilean Delegate Sr. Illanes, recommends its adop- 
 tion, with this amendment : add after the word "respective" the following : 
 "by administration or by contract. — J. H. Oliver. — Carlos Altamirano — E. 
 Garcia Collao. — Manuel C. Vial. 
 
 MOTION BY ENGINEER ILLANES, OF CHILE. 
 
 Be it recommended that the water supply and sewer system of cities be 
 constructed and operated by the State or by the respective municipalities, 
 without regard to pecuniary profit; and, 2nd, that the selection of a source 
 for water supply should be made by hygienists or engineers, by common ac- 
 cord, taking into consideration the condition of the soil and the possibility 
 of pollution. 
 
 II. Your Committee on Sanitation of Coast and Frontier Towns, having 
 studied the motion by Dr. Manuel Camilo Vial, of Chile, recommends its 
 adoption. — Guillermo Illanes. — J. H. Oliver. — Carlos Altamirano. — E. Garcia 
 Collao. 
 
 MOTION BY DR. MANUEL C. VIAL, OF CHILE. 
 
 That each Government adhering to the Sanitary Conference, in carrying out 
 works of sanitation and hygiene, give special attention to those seaports and 
 cities where the presence of endemic and infectious diseases shows clearly 
 that the health of the world will be improved by the introduction in such 
 places of modern hygienic and sanitary water supply and drainage. 
 
 REPORTS BY THE COMMITTEE ON PROPHYLAXIS OF ACUTE 
 TRANSMISSIBLE DISEASES. 
 
 I. Your Committee on Prophylaxis on Acute Transmissible Diseases has the 
 honor to report upon the motion by Dr. Claudio Sanjines, of Bolivia, which 
 is as follows : 
 
 "Be it resolved that we hereby renew the recommendation made by the 
 Third International Sanitary Conference of Mexico of 1907, to the effect that 
 laws be adopted enforcing vaccination and revaccination against small- pox. 
 
 And we have the honor to recommend that it be adopted in full. — Alci- 
 biades Vicencio. — Juan B. Miranda. — P. Acosta Ortiz. — Fernando Iglesias. 
 
 Your Committee on Prophylaxis on Acute Transmissible Diseases has the 
 honor to report upon the motion submitted by the Argentine Delegates recom- 
 mending that vaccination be taught practically in normal schools. 
 
 Although the idea of the Argentine Delegates is worthy of applause, this 
 Committee does not deem it wise to recommend its adoption. It is a good 
 idea in particular cases, but it is not of general interest. On the other hand, 
 since vaccination is compulsory in most countries, the proposition might be 
 included in the laws or regulations of the respective nation, which legislation 
 must vary according to the topography, nature of the population, etc. — P. 
 Acosta Ortiz. — Alcibiades Vicencio. — Juan B. Miranda. — Fernando Iglesias. 
 
 REPORT BY THE COMMITTEE ON PROPHYLAXIS OF CHRONIC 
 TRANSMISSIBLE DISEASES. 
 
 Your Committee on Prophylaxis of Chronic Transmissible Diseases has 
 studied the following motions : 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 75 
 
 (1) MOTION BY DR. URIZAR, OF PARAGUAY. 
 
 Whereas leprosy is spreading in America and invading new regions, be it 
 resolved that nations wherein leprosy exists be advised to keep accurate and 
 detailed statistics of lepers ; to organize colonies for the isolation of the 
 patients, and to enact laws to ward off the disease. 
 
 (2) MOTION BY DR. DEL RIO, OF CHILE. 
 
 "Resolved that it be recommended to the Governments of the American 
 Republics that they promote or facilitate investigation as to the prevalence, 
 frequency and contagiousness of scleroma. 
 
 (3) MOTION BY THE SAME. 
 
 That it be recommended that prostitution should be regulated in cities, and 
 specially in seaports, intrusting the sanitary inspection to physicians specially 
 prepared on the subject, discharging their duties in dispensaries or polyclinics 
 provided with all the necessary means ; and that persons that may transmit 
 infection be confined in hospitals until cured. 
 
 (4) MOTION BY DR. S0ZA, OF CHILE. 
 
 That it be recommended that the Governments establish in their respective 
 countries a "Permanent Commission on Tuberculosis." The Pan American 
 Union of Washington shall, through the diplomatic representatives of the dif- 
 ferent American countries, request of those Governments the organization of 
 said Commission. The various countries should also exchange information in 
 order that all may be acquainted with the methods adopted and results ob- 
 tained." 
 
 We have the honor to recommend the adoption of the above motions, with- 
 out any amendments. — Santiago, November 9, 1911. — Roberto del Rio. — R. 
 Urizar. — Salvador Ortega. — Ernesto Soza. 
 
REPORT OF THE ARGENTINE DELEGATION, CONSIST- 
 ING OF DOCTORS GREGORIO ARAOZ ALFARO AND 
 FERNANDO ALVAREZ. 
 
 I. 
 
 SANITARY POLICE LEGISLATION AND SANITARY MEASURES ADOPTED SINCE THE 4tH 
 
 CONFERENCE. 
 
 As our country has not attended the preceding conferences, we deem it neces- 
 sary to submit a general sketch of our sanitary organization. 
 
 Ours being a federal system of government, our National Government does not 
 exercise any direct jurisdiction on sanitation, except in the capital and federal 
 territories, and on matters relating to ports and land frontiers. 
 
 The superior sanitary authority is called "National Department of Hygiene" 
 and is constituted by an "Advisory Board," consisting of 3 physicians who are 
 experts on hygiene, 1 veterinary surgeon, 1 member of the Army Sanitary Serv- 
 ice, and 1 president who has executive powers. This Department is under the 
 Ministry of the Interior and consists of the following sections: 
 
 Marine Sanitation, the service extending to all the ports of the republic. 
 
 Interior Sanitation, embracing the following sections : Vaccination, Malaria, 
 Social and Industrial Hygiene, Railways, Demography, Inspection of Pharmacies, 
 and 
 
 School Hygiene. 
 
 Under this Department the following sections are placed : 
 
 Chemical Laboratory, for analysis of foods, medicines, specific, etc.; 
 
 Bacteriological Laboratory, destined to the preparation of serum, aside from 
 hygienic examinations and investigations. A beautiful ample building is being 
 erected outside of the city limits, for this Laboratory. 
 
 Division of disinfection, embracing all sorts of disinfections by means of 
 formol and other chemical preparations, Clayton and Marot apparatuses for the 
 destruction of rats, etc. 
 
 The annual budget for the Department of Hygiene amounts at the present 
 time to about $1,400,000 gold, besides a sum of about $100,000 gold, destined by 
 law for the antimalarial campaign. The Government has requested for the next 
 fiscal year an additional $800,000 for the termination of the sanitary stations in 
 the principal provincial cities. 
 
 In the city of Buenos Ayres, having a population of about 1,200,000 inhabitants, 
 the local service is in the hands of the "Direction General of Public Beneficence 
 and Sanitary Administration" under the Municipality. This Direction General 
 controls all hospitals, asylums, and certain dispensaries, service of first aid; 
 dispensaries, etc., for children; inspection of prostitution, inspection of slaughter 
 houses, markets, and foods; vaccine, bacteriological laboratory, disinfection, 
 with several stations within the city, and special gangs for the killing of rats, 
 etc. This service is completed by those under the foundling and orphan asylum 
 and the Benevolent Society. 
 
 There is in each province a Board of Hygiene, whose functions and organi- 
 zation are similar to those of the National Department and Public Beneficence 
 established in all the important towns. 
 
 Our sanitary legislation consists of the following: 
 
 An act creating the National Department of Hygiene, amended last year, as to 
 organization. 
 
 Municipal and Provincial Orders, organizing the Division of Public Charities, 
 Boards of Hygiene, Disinfection, etc. 
 
 Regulations of the Land and Marine Sanitary police. 
 
 Law providing for compulsory vaccination and revaccination in the capital and 
 federal territories. Several of the provinces have also enacted similar legislation. 
 
 Legislation against malaria. 
 
 The provinces and municipalities have also enacted special legislation, regu- 
 lating the inspection of food, medicines, buildings, prostitution, etc. The Sani- 
 tary Direction of the Province of Buenos Ayres deserves all commendation be- 
 cause of its completeness. 
 
78 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 The General Direction of Sanitary Works, dependent from the Ministry of 
 Public Works is in charge of the construction and operation of the system of 
 potable waters and sewerage in the capital city and in such provinces as request 
 the aid of the National Government. 
 
 II. 
 
 RESOLUTIONS ADOPTED BY THE FOUR PRECEDING CONFERENCES. 
 
 Notwithstanding the fact that our country did not attend the four preceding 
 conferences, almost all the recommendations adopted by them had already been 
 enforced by us, even before such recommendations, as will be shown in the body 
 of this report. On the other hand, the Sanitary Convention of Argentine, 
 Uruguay, Paraguay and Brazil, signed at Rio de Janeiro in 1904 and still in 
 force, is based on the same principles as that of Washington in 1905. 
 
 Ill AND IV. 
 
 Not having attended the preceding conferences we cannot report on these 
 points, but we have no doubt that our government will lose no time in com- 
 municating with the Montevideo and Washington Bureaus. 
 
 V. 
 
 SANITATION OF CITIES AND ESPECIALLY OF PORTS, STATING WHAT THE NATIONAL 
 GOVERNMENT HAS DONE IN THIS MATTER. 
 
 Buenos Ayres, La Plata, Rosario, and Bahia Blanca, the principal ports of our 
 country, have enjoyed for a number of years a complete sanitary service, such 
 as an abundance of excellent potable water, sewerage and drainage systems, in- 
 spection, disinfection and deratization systems, etc. 
 
 Other ports of lesser importance in the south, as well as the river ports are 
 all being furnished with such systems by the National Government. 
 
 There has never been any endemic disease in any of our ports. As regards 
 the provincial towns, important works of sanitation have been undertaken with 
 the aid of the National Government, and in the poorer provinces by the Federal 
 Government alone. In all the capital cities, there are at present good systems 
 of pure, excellent drinking water and this work is being extended to smaller 
 towns in the province of Buenos Ayres in the campaign against typhoid fever, 
 due frequently to well water. Cordoba is now furnishing an extensive sewer 
 system, and Tucuman, Salta, Catamarca and Jujuy, towns where malaria was 
 prevalent, have almost completed their sanitary work under the Direction Gen- 
 eral of Sanitary Works of the Capital, and malaria has already decreased to a 
 remarkable extent. 
 
 We have the satisfaction of stating that a few years hence not one city will be 
 found in the republic without a complete sanitary service. In all the provinces 
 and federal territories there are in operation disinfection stations, with a special 
 personnel devoted to the work of deratization, this service being maintained by 
 provincial appropriations in the richer states and by the federal government in 
 the poorer states. 
 
 VI. 
 
 PROPHYLACTIC MEASURES ADOPTED AGAINST PLAGUE, CHOLERA AND YELLOW FEVER, 
 WITH SPECIFICATION OF THE MEANS EMPLOYED IN THE DESTRUCTION OF RATS, 
 FLIES AND MOSQUITOES. 
 
 Plague. Of all these diseases only the plague, which was introduced in 1900, 
 sporadically appears in some places in the republic, and once in a while a small 
 focus consisting of 8 or 10 cases is found. These cases have in reality no col- 
 lective importance, but serve to demonstrate the enormous difficulty of com- 
 pletely stamping out the disease, particularly in our country because of the im- 
 mense quantity of cereals and grains to be harvested, stored and exported every 
 year. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 79 
 
 The principal means adopted to fight the plague are : 
 
 Systematic deratization of all ships coming to port. In the port of Buenos 
 Ayres there are Clayton apparatuses on wagons, while in other ports both the 
 Clayton and Marot systems are used. Besides these methods there are special 
 devices used to prevent the landing of rats, over ropes, chains, etc. Gangs of 
 men are permanently engaged in the cities and in the water front in the destruc- 
 tion of rats by means of portable "Gubba" generators of gases. Neither the 
 serum nor the fluids from Europe have been successful. A certain number of 
 dead rats is sent from each batch for dissection and bacteriological examination. 
 Should any appear to be infected the houses are surrounded and the extermina- 
 tion made as thorough as possible. 
 
 There is an ordinance in force in Buenos Ayres providing for the rat proof 
 construction of all new buildings. Railway stations, stables, granaries, mills 
 and grain warehouses are subject to special vigilance for the extermination of 
 rats. So far as garbage is concerned for many years it has been kept and col- 
 lected by most approved methods. Large Backer ovens will soon be built for 
 the cremation of garbage, thus doing away with the obsolete system of burning. 
 
 Cholera. For many years we have not had a case of cholera in the cities. 
 One or two cases arriving in ships from abroad have been isolated and treated in 
 the Island of Martin Garcia. In the matter of prophylaxis against cholera, in 
 the last few years, especially because of the epidemics of Italy, and the cases in 
 Trieste and Marseilles, the country has been governed by the Sanitary Conven- 
 tion of Rio de Janeiro, which we have already mentioned as based upon the most 
 liberal principles. We desire to call special attention to the fact that our 
 Department of Hygiene has given for the last year considerable importance to 
 the investigations of the bacillus carriers, and that we have been lately able to 
 find in healthy passengers from Italian ports the cholera bacillus. We believe 
 that it is necessary to further extend the prophylactic measures in this respect, 
 and we will later have the honor to submit a resolution covering this point. 
 
 Yellow fever. It does not exist in our country and fortunately during the last 
 few years very few cases have arrived at our ports from Brazil. The provisions 
 of the Convention of Rio de Janeiro are enforced in these Cases. 
 
 VII. 
 
 As there is no yellow fever in our country, we cannot express an opinion on 
 this topic. 
 
 VIII. 
 
 NATIONAL AND INTERNATIONAL PROPHYLAXIS IN TUBERCULOSIS, VENEREAL DISEASES, 
 SMALLPOX, MALARIA, TRACHOMA, LEPROSY, AND SCLEROMA. LEGISLATION ON 
 THE SUBJECT AND RESULTS OBTAINED. 
 
 Tuberculosis has been for many years the object of an unrelenting and unin- 
 terrupted campaign by the authorities and by the Argentine League against 
 Tuberculosis, in connection with the International League. We have regulations 
 and ordinances prohibiting expectorating outside of cuspidores, receiving pa- 
 tients declared as suffering from tuberculosis in common hospitals, and pre- 
 scribing periodical disinfection of railways, tramways, etc., and the houses of 
 those suffering from tuberculosis or who have died from the disease. There 
 are special dispensaries and sanitariums, both in Buenos Ayres and Cordoba, 
 open air schools, special colonies, etc. 
 
 Against venereal diseases. There are in the capital and in all provinces regu- 
 lations relative to venereal diseases, such as those regulating prostitution, peri- 
 odical examination of prostitutes, identification cards, etc. There are also free 
 consultation rooms for those having secret diseases and a Social Hygiene Al- 
 liance has lately been established for prophylactic purposes. 
 
 For smallpox there is compulsory vaccination and revaccination, with animal 
 virus from an excellent and old National institute. During the past and in the 
 present year, there has been in certain portions of the country, Tucuman and 
 Mendoza principally, a slight epidemic of smallpox which has permitted the em- 
 ployment of the method of intensive revaccination. The epidemic has almost 
 disappeared. Immigrants are not allowed to enter the country unless vaccinated. 
 
 Malarial or paludic fever has been a source of preoccupation for all in our 
 
80 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 country because of our territorial extent (3,000,000 square kilometers), contain- 
 ing all sorts of climate. We have a vast malarial region of over 400,000 square 
 kilometers, mainly in the provinces of Tucuman, Salta, Jujuy, Catamarca and 
 the Territory of Chaco, and portions of Santiago and Cordoba. We have a law 
 against malaria, and we are now carrying on a most active campaign against 
 malaria, employing all known means, such as quinine as a cure and as a pre- 
 ventive, protection against mosquitoes, extermination of mosquitoes by means of 
 fumigation, petroleum, reclamation of swampy lands, and other means. In cer- 
 tain regions where it was necessary to have still water, as lakes or reservoirs, 
 for the use of men and beast, flowing wells are being built, so as to do away with 
 the old system. For this campaign against malaria the budget in force carries 
 an appropriation of about $100,000, gold, but there is a movement on foot to 
 increase this sum to about $1,000,000, gold. 
 
 Trachoma is a rare disease among us and not endemic. No person suffering 
 from trachoma is allowed to enter the country. 
 
 Leprosy is scarce in Argentina. Some years ago there was a great deal of in- 
 terest shown in this disease, resulting in a Congress of Leprosy being held in 
 Buenos Ayres, when a complete census of lepers was made. In the entire re- 
 public, having a population of about 7,000,000 the number of lepers does not ex- 
 ceed 300 odd cases, and allowing an ample margin for omissions we may say 
 they do not reach 500. The lepers are to be isolated either in a special hospital in 
 Buenos Ayres or in a leper colony on an island in the province of Entre Rios, 
 where there are a few cases as in Corrientes and Santa Fe. 
 
 Scleroma is unknown in Argentina. 
 
 IX. 
 
 MONTHLY AND ANNUAL VITAL STATISTICS OF THE PRINCIPAL PORTS AND CITIES. 
 REPORT ON THE ADOPTION OF THE BERTILLON NOMENCLATURE. 
 
 In the capital, as in the provinces, a complete system of statistics has been 
 kept for many years. Only a few of the provinces, the less wealthy, have no 
 complete system of statistics, but this will be remedied as circumstances permit. 
 As to mortality, it suffices to state, in general terms, that in Buenos Ayres, for 
 many years it has ranged from 16 to 19 per 1,000, notwithstanding the fact that 
 many persons from the interior towns come to Buenos Ayres to die, as in any 
 other large capital. 
 
 X. 
 
 PROPHYLAXIS OF INTERNATIONAL TRAFFIC EITHER BY SEA OR LAND, IN CASE OF 
 CONTAGIOUS AND QUARANTINE DISEASES. 
 
 Under Nos. I, II and VI we have stated how our prophylactic service has 
 been organized, and which are the principles adopted and fixed by the Rio de 
 Janeiro Convention in 1904, with Brazil, Uruguay and Paraguay. The spirit of 
 this Convention and general rules agree with the Paris Convention in 1903 and 
 that of Washington in 1905. We again beg to call attention to the great im- 
 portance of observing cholera carriers, whether convalescing from the disease, 
 or in good health but coming from infected districts. 
 
 XI. 
 
 SANITARY LAWS ON IMMIGRATION. 
 
 All we can say is that our laws prohibit the entry into our country of any 
 person suffering from chronic contagious diseases, especially trachoma and 
 leprosy. Persons unfit for work or over 60 years of age [except when they 
 have relatives in the country, under certain conditions] are debarred, as well as 
 adventurers or fugitives from justice. 
 
 XII. 
 
 ADOPTION OF MARITIME SANITARY PAPERS APPROVED BY THE FOURTH CONFERENCE. 
 
 Our country did not attend said conference. 
 
REPORT OF DR. CLAUDIO SANJINES, BOLIVIAN DELE- 
 GATE. 
 
 Mr. President and Messrs. Delegates : The Bolivian Government having been 
 invited to participate in the Fifth Sanitary Conference of the American States, 
 has appointed me its delegate. To comply with the provisional program of this 
 conference it would have been my pleasure to submit a special report on the 
 progress of sanitation in the principal cities in Bolivia. But unfortunately I 
 was appointed at the last moment and have not been able to gather other data 
 than that dealing with the general sanitary conditions of Bolivia, a few diseases 
 in the Colonias Territory, and some data relative to climatology and the sani- 
 tary conditions of La Paz. 
 
 Sanitary Organization. 
 
 The municipal organic law gave authority to municipalities to deal with all 
 sanitary problems ; this authority, however, was generally ineffective and in- 
 sufficient. In view of this fact Senator Andres S. Muhoz, a distinguished physi- 
 cian, without trying to abolish such authority, prepared a project of a General 
 Public Sanitary Law, in order to create a sanitary administration dependent on 
 the Executive Power, having the fullest authority, under a Director General, 
 directors of Departmental Sanitation and provincial physicians. This project 
 after being carefully considered by the Faculty of Medicine of La Paz, was 
 submitted to the National Congress, and has become a law of the republic. I 
 deem it an honor to have been the President of the Medical Association when 
 this law was under discussion. 
 
 The Government, with the advice of the Medical Association, engaged the 
 services of a specialist in Germany as Director General. Unfortunately the per- 
 son engaged, a member of the University of Freiburg, did not satisfy the wishes 
 of the Government, and was relieved from further duty. The National Con- 
 gress is at this moment discussing an appropriation for the reorganization of 
 the Service, with a competent personnel. 
 
 Compulsory Vaccination and Revaccination. 
 
 I believe, gentlemen, that if there are epidemic diseases hard to fight against, 
 this cannot be said any longer of smallpox, which besides making many victims, 
 leaves indelible marks on the skin, produces blindness, etc. To cope with this 
 loathesome and terrible disease, we have today a most powerful arm, vaccine 
 •virus. And I want right here to submit a motion to the consideration of this 
 Conference, and it is to recommend that the recommendation of the Third Inter- 
 national Sanitary Conference held in Mexico in 1907, in reference to compulsory 
 vaccination, be not ignored. Smallpox has also made its ravages in Bolivia in 
 former years, and the National Congress has passed a law which has been pro- 
 mulgated by the Executive, providing for compulsory vaccination and revaccina- 
 tion. In compliance with this law, the proper sanitary officers go from house to 
 house within the infected territory, to vaccinate all individuals. There are also 
 dispensaries where on certain days vaccination is performed. We are fortunate 
 to have in Bolivia in the "Sucre Medical Institute" a vaccine division, founded 
 in 1898. It is now progressing under the able direction of Doctor Nicolas Ortiz, 
 and producing a virus which has been most successful both at home and abroad. 
 I believe that in 1907, the president of the institute, Dr. M. Cuellar, had the 
 virus tested and the report stated that it ranked among the best of its kind pre- 
 pared in South America. The best proof of this lies in the fact that smallpox 
 has disappeared in Sucre. We are grateful for the excellent work of the 
 "Sucre Medical Institute." 
 
 Potable Water. 
 
 The Bolivian Government, fully aware that the principal factor in the sani- 
 
82 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 tation of a town is a supply of good drinking water, has been expending for 
 several years large sums for the improvement of the water system, by means 
 of modern piping and filtration plants. All municipalities have contributed to 
 this work within their means. Further reference to this subject will be made 
 later on. According to my information obtained from our Treasury Depart- 
 ment, during the last few years the Government has spent in the improvement 
 of the water system of the cities of Cochabamba, La Paz, Potosi, Oruro, Tarija, 
 Santa Cruz, Trinidad, Padilla, Capinota, Punata and Totora, the amount of 
 $3,346,449, including in this sum the works to bring water from Cajamarca 
 to Sucre. A large order for water pipes has been given lately to a German firm 
 for the cities of La Paz, Cochabamba, Trinidad and Caraza. 
 
 National Institute of Bacteriology. 
 
 This institute, only recently created, due to the initiative of President Ismael 
 Montes, is working satisfactorily in La Paz, under Dr. Nestor Morales Villazon, 
 who was sent by the Government to Europe to make certain special research. 
 The first work of the institute has been devoted to the bacteriological analysis 
 of the potable waters of La Paz showing the improvement attained by the use 
 of the new pipes and filters. For instance, the waters of Challapampa at the 
 time of the old system gave 6,818,000 bacterise per litre, and later 3,750,000 and 
 1,000,000, which translated into plain facts show an enormous number of in- 
 fectious diseases of the digestive organs, and typhoid fevers, particularly in 
 children. After the new system had been in use the examination of the water 
 showed first 1,278,000, then 700,000, then 145,000, and finally 63,000 bacterise per 
 litre, while typhoid has almost disappeared, and the infections of the intestinal 
 canal have decreased. 
 
 The species most frequently found are colicomunis, proteus vulgaris, fluoresens 
 putridas and fluoresens liquificens. At present the institute is engaged in the 
 examination of the waters of Milluni, which I believe to be pure as they are 
 taken at their source, sent to the filters and thence distributed through first- 
 class piping. 
 
 Dr. Morales' work with the Eberth bacillus is worthy of consideration. In 
 virulent cultures from Europe and isolated species in patients in La Paz, he has 
 found that the bacteria^ protoplasm, from the 2d and 3d culture, a degenerative 
 process, inoculated on animals give unimportant reaction. He has made 
 the same observation as regards the Koch bacillus. Inoculations on horses with 
 virulent European cultures and tubercular sputa, only show a rise in temperature 
 and decrease in weight, the horses having improved rapidly, all signs of inocu- 
 lation having disappeared. Dr. Morales believes that at an altitude of 3,630 
 metres above the level of the sea the defense of the phagocites is most powerful. 
 
 To investigate the popular belief that syphilis is found in the llama, several 
 have been inoculated with the virus, with negative results. The investigations 
 of Dr. Morales on blood from malarial patients from the La Paz creeks, have 
 shown the existence of the Laveran hematozoa in all forms, mainly as a rosette. 
 The foregoing suffices to show that the Bacteriological Institute is a powerful 
 agent in hygienics. 
 
 Malaria. 
 
 From the provisional program of the Fifth Sanitary Conference a special topic 
 has been omitted for the discussion of sanitary measures against malaria, not- 
 withstanding that the Delegate from Costa Rica to the Fourth Conference sub- 
 mitted a motion calling for the appointment of an international committee for 
 the purpose of preparing a handbook in plain language so that all may under- 
 stand it to fight against malaria, such work to be submitted to this Conference. 
 
 If malaria is only known in the northern portion of Chile, on the other hand 
 for the great majority of the delegates here present, this must be a topic of the 
 greatest importance, as malaria is endemic in tropical countries. I, therefore, 
 beg to suggest especially to such of the delegates as have a better knowledge of 
 the disease, to consider at this meeting how to make effective Dr. Rojas' motion. 
 It would be most important to me, and to Bolivia an invaluable service, if I 
 could take back to my country a complete report, not only of the modern theories 
 on malaria but also on the elements at the command of science to fight against 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 83 
 
 the disease. I feel sure that my suggestion will be acted upon when my col- 
 leagues learn of the ravages malaria has done in some sections of Bolivia. 
 
 Distribution of Malaria in Bolivia. 
 
 An examination of the distribution of malaria in Bolivia clearly demonstrates 
 that this endemic disease does not exist in cold countries and increases as a 
 warmer climate is approached ; that in the temperate regions it only makes its 
 appearance during the heated season; that malaria does not require a warm 
 climate merely, but also humidity and stagnant waters, developing especially in 
 low, undrained territory, in places where humidity is constant due to superficial 
 underground water; in places subject to inundation, and near rivers and par- 
 ticularly small streams. According to this, malaria is found in Bolivia as fol- 
 lows : 
 
 Department of Chuquisaca: Province of Tomina and basins of the Pilcomayo, 
 Churumatos and Oroconta; in Camataqui, a special type accompanied often by 
 hemorrhages and cirrhosis of the liver. It is very resistent to the quinine 
 treatment. 
 
 Department of La Paz: In most of its provinces. 
 
 Department of Beni: At the capital and a few other towns. 
 
 Department of Cochabamba: In some of its provinces, mainly in Mizque and 
 the swampy regions. 
 
 Department of Potosi: In some of its provinces, particularly the proximity 
 of the Pilcomayo river. 
 
 Department of Tarija: The Gran Chaco and Tarija. 
 
 Department of Santa Cruz: In some portions of this Department. 
 
 As may be seen, Bolivia is a prey to malaria. The ravages of malaria, of 
 course, are better checked at points in the vicinity of cities and towns. As I have 
 remarked, malaria is prevalent along the basins of the large rivers, in the 
 regions where rubber is extracted, and trade posts have naturally been estab- 
 lished. The distribution of malaria in Bolivia may be established in a general 
 way along the great rivers and all their respective affluents. The presence of 
 rubber in the northwestern portion of Bolivia, which naturally attracts trade, 
 and certain difficulties with the neighboring countries made necessary during a 
 few years the sending of troops to the frontier, which fell in great numbers the 
 victims of malaria. This is now a matter of history, because the sanitation of 
 those dangerous regions has been perfected to such an extent that there exist 
 now prosperous towns, among them some of the healthiest in Bolivia. Surgeon 
 General Elias Sagaruaga of the Bolivian Army, who went to that region with 
 the expedition in 1903, has submitted to the Supreme Government a set of rules 
 against malaria which it is expected will be placed in the hands of those living 
 in malarial zones. I shall not enter into a discussion of the disease, but will 
 simply state that malaria in Bolivia is present in all its forms. 
 
 Espundia. 
 
 I have nothing to add to the monograph submitted by my distinguished col- 
 league, Dr. Elias Sagaruaga, at the Fourth Scientific Congress (First Pan 
 American) held in this city in December, 1908, under the title: "Tropical 
 Pathology of Espundia." It is the Buba according to Breda, of Padova, Italy, 
 and may be confounded with the Pian and Frambesia. Breda believes to have 
 discovered the bacillus of Espundia, and has studied this disease in the laborers 
 returning to Italy from Brazil, and in 1907 published his work "La Bouba del 
 Brasile." It appears that Breda's theories are accepted by French dermatolo- 
 gists. The Breda bacillus cannot be cultivated, nor has it shown any lesions 
 when inoculated in the ear of a rabbit. Maiocchi and Bosellini have described 
 another bacillus. Castellani maintains that yaws, pian and buba are one and the 
 same thing ; that the tardy localization in the mucus membrane can be compared 
 to the manifestations of syphilis, and that the real pathogenic agent is a pro- 
 tozoa the treponema pertenue, spiral, belonging, because of its characteristics, 
 more to the spirochetes than to the treponemas, and similar to the schandin. 
 
 The characteristics of the pathological anatomy of espundia are the plasmatic 
 cells ; the lesions are both of the skin and the mucus membrane, very similar to 
 
84 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 frambesia. Breda maintains that pian and yaws are very different from buba, 
 and that this is more like frambesia and espundia. The matter has not been 
 definitely settled. As espundia is neither contagious nor easy to spread, the 
 prophylactic measures cannot be positive. It is better, however, to isolate the 
 patients. The employ of gaiters as a protection against insect bites and scratch- 
 ing is recommended. Gaiters may be substituted by puttees in damp places. 
 Malnutrition is another cause of ulcers. Besides the remedies known in La 
 Paz, Salvarsan or 606 has been used. While there has been a certain measure 
 of success, it cannot be compared with that attained in the treatment of 
 syphilis. I believe that improvement in a large number of patients has been 
 due to the use of arsenic. 
 
 La Paz is subject to atmospheric variations from one day to another and even 
 during the same day. These variations are productive of catarrhal affections.- 
 
 As the hospital records are generally used for statistical purposes as regards 
 prevailing diseases, and these have been kept without entering the name of the 
 place where the patients come from, many coming from the provinces, no 
 accurate data can be had. This will be remedied in future, thus facilitating 
 our statistical work. Death certificates should also contain this information. 
 
 The Municipality of La Paz will soon have a bureau for the collection of vital 
 statistics. 
 
 From incomplete statistical data on burials we find that from 1900 to 1910 the 
 number of deaths from fever (generally typhoid) was 1,490; measles, children 
 from 1 to 7 years of age, 2,020; from 8 to 15, 596; whooping cough, children be- 
 tween 1 and 7 years of age, 2,398; between 8 and 15, 928; gastro-intestinal dis- 
 eases, children from 1 to 7, 1,859; from 8 to 15, 259; smallpox, children between 
 1 and 7, 1,055; from 8 to 15, 281; from 16 to 21, 148; from 30 to 41, 40; dysen- 
 tery, 1,766 deaths; bronchitis, 753; grippe, 123; pneumonia, 1,702; gastro- 
 intestinal infections, 288; malaria, 22; heart disease, 728; pleurisy, 501; tuber- 
 culosis, 251, etc. 
 
 From the foregoing a fair idea may be had of the dominant diseases, especially 
 the infectious and contagious diseases. Lack of hygiene, and other habits par- 
 ticularly among the lower classes, is mainly responsible for this condition. Two 
 other factors are also important in this connection, atmospheric changes and 
 the habit of appealing to the hospital when the, disease is so far advanced that 
 there is hardly any possibility of recovery. 
 
 Fortunately for us neither cholera nor bubonic plague have so far visited 
 Bolivia. It behooves the sanitary authorities of Antofagasta, Mollendo and 
 Arica to do all in their power to prevent the introduction of these diseases, by 
 the proper sanitation of their ports. In case cholera and the plague should 
 visit Bolivia, the resolutions adopted by this conference will be carried into 
 effect. 
 
 Municipal Action. 
 
 The municipality of La Paz, in the discharge of its duties, is doing the utmost 
 for public sanitation. Its best work, however, is the damming up in a reservoir 
 the waters from the Choqueyapa, on which the city of La Paz is built, as well as 
 the waters descending from the glaciers of Huayna-Potosi and Chacaltaya. 
 The reservoir holds sufficient water to feed the other city deposits with a 
 constant flow of about 500 litres per second, night and day, at all times and in 
 all seasons. From the reservoir the waters are sent to the Achicola filters, 
 through two systems of steel pipes, one measuring 12,000 meters in length with a 
 uniform interior diameter of 500 millimeters, and the other measuring 100,000 
 meters, with same interior gauge. Now the inhabitants of La Paz have a daily 
 water supply of about 500 litres per head, twice as much as the daily water 
 supply of larger capitals per capita. Besides this supply from the Milluni we 
 also have that derived from Tembladerani, which has been rated as ideal, by the 
 Director of the Chemical Laboratory of Santiago, Chile. The Municipal Coun- 
 cil of La Paz is now engaged in the preparation of the necessary plans for a 
 sewerage system costing about $6,500,000, thus insuring the almost perfect sani- 
 tation of La Paz. 
 
 The Municipality has also charge of the hospital service; one for men and 
 the other for women, besides a lazaretto for both sexes for the isolation of such 
 patients as may require it. Plans for a model hospital are now under considera- 
 tion, to be erected on one of the best sites in the city. Conjointly with the 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 85 
 
 Hospital Service there is the public charity institutions with special sections for 
 the treatment of the eyes, children's diseases, medicine, surgery, gynecology, etc., 
 and a special section devoted to emergency cases. 
 
 The Bureau of Hygiene has a staff devoted to sanitary house to house inspec- 
 tion, reporting on contagious and infectious diseases, attending to the isolation 
 of patients, disinfection of infected rooms, analysis of potable water, drinks, 
 foods, etc., in accordance with the regulations. 
 
 The Municipality has also devoted special attention to the protection of society 
 against venereal and syphilitic diseases. There is now a regulation in force 
 regarding prostitution, prepared by Dr. E. Sagarnaga and myself. 
 
REPORT OF DOCTORS ISMAEL DA ROCHA AND AN- 
 TONIO FERRARI, BRAZILIAN DELEGATES. 
 
 I. The Sanitary Police regulations and 'sanitary measures adopted by Brazil 
 since the Fourth Conference, are the same as those in force in 1907, and sub- 
 mitted to the Third Conference. They have not been altered by new federal 
 legislation. To this wise legislation Brazil owes the extinction of yellow fever 
 in Rio de Janeiro, and the ever increasing success in its campaign against all 
 contagious diseases. 
 
 II. Brazil has complied with the resolutions adopted in the preceding con- 
 ferences, as shown in the publications we are distributing, and other official acts 
 which cannot be included in this report because of their extension. 
 
 III. Brazil has complied with the Washington Convention of 1905, and the 
 amendments to Art. 9, made by the Fourth International Sanitary Conference, 
 and the Fourth Pan American Conference of Buenos Aires. Our Brazilian 
 sanitary laws now in force, as shown by the evident good results obtained in 
 sanitation all over the country, lead to the attainment of the final results aimed 
 at by the convention and amendments. 
 
 IV. Nothing to report. 
 
 V. The sanitation of the city of Rio de Janeiro, capital of Brazil, and of the 
 cities and ports with which there exists an international trade and commerce, 
 has been completed in some instances and is being established in others, with the 
 aid of the Federal Government. The following works may be mentioned: 
 
 1. Port of Manaos : Work done under contract between the Federal Gov- 
 ernment and the "Manaos Harbour Corporation," estimated at several millions 
 of dollars. There have been in Manaos sporadic cases of yellow fever, against 
 the spread of which such sanitary measures have been taken as have proven 
 successful in Rio de Janeiro and Para. The port works are rapidly progressing. 
 
 2. Port of Belem (Para). The works contracted for by the National Govern- 
 ment with the "Port of Para Corporation," are progressing satisfactorily, at a 
 cost of about one million dollars. Port free from plague, yellow fever or 
 cholera. 
 
 3. Port of Sao Luiz (Maranhao). Works under the National Government, 
 wharves, dredges, etc. No yellow fever. 
 
 4. Port of Fortaleza and Port Camousin (Ceara). Healthy belt. Works done 
 by National Government to benefit commerce. 
 
 5. Port Cabedello (Parahyba). Healthy belt. Dredging done by National 
 Government. 
 
 6. Same remarks apply to Port of Natal (Rio Grande do Norte). 
 
 7. Port of Recife (Pernambuco). A colossal undertaking, costing millions of 
 dollars. Sanitary conditions most satisfactory. 
 
 8. Port of Bahia. The work progresses most actively. Splendid work, as good 
 as that of Pernambuco. Good sanitary conditions, and a fine port. 
 
 9. Port Victoria (Spiritu Santo). Work under way. Good sanitation. 
 
 10. Port of Rio de Janeiro. Under contract with Walker & Co. To be com- 
 pleted very soon. Wharves extending a long distance along the water front. 
 Mortality which not many years ago was about 56 per 1,000, now shows less 
 than 20 per 1,000. 
 
 11. Port of Nichtheroy, opposite Rio de Janeiro on the same bay. Sanitary 
 works progressing under contract. 
 
 12. Port of Santos (S. Paulo). Healthy. Works completed. A healthful, 
 flourishing city. Large trade. 
 
 13. Port of Paranagua (Parana). Healthy. Works of improvement pro- 
 gressing under contract. Estimated in several millions. Curityba, the capital of 
 the State, is a prosperous city. 
 
 14. Port of Florianopolis (Santa Catharina). Healthy. Improvements in the 
 smaller ports by the National Government. 
 
 15. Port of Rio Grande. Most healthy. Difficult navigation on account of 
 shifting sand banks. Works of improvement under a French Company. 
 
68 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 16. Port of Corumba (Matto-Grosso). A river port. Works under contract 
 and progressing. 
 
 VI. The prophylactic measures against plague and cholera are the same as 
 those contained in the report submitted to the Third Sanitary Conference of 
 Mexico by Dr. Oswaldo Cruz. As to cholera, it has not made its appearance in 
 Rio de Janeiro for many years. The sanitary police of ports is carried on, most 
 successfully, in accordance with the convention in force. 
 
 VII. It is very difficult to tell when a person may be considered as an immune 
 from yellow fever. As there is no serum against the disease, immunity may 
 depend on acclimatization. Two years may suffice if it is a contaminated zone, 
 but if the person goes to other countries, traveling destroys immunity if he re- 
 turns to the contaminated place. 
 
 VIII. The national and international prophylaxis of tuberculosis, venereal 
 diseases, smallpox, malaria, trachoma, leprosy, are shown in the tables we submit. 
 Scleroma is unknown in Brazil. 
 
 IX. Bertillon's nomenclature has been adopted in Rio, as shown in our sta- 
 tistics. The monthly and annual mortality in the city of Rio de Janeiro, is 
 shown in subjoined table covering the last 50 years, for periods of 5 years. 
 
 Years. Rate per 1,000 inhabitants. 
 
 1859-1863 58.43 
 
 1864-1868 49.03 
 
 1869-1873 49.12 
 
 1874-1878 44.40 
 
 1879-1883 34.71 
 
 1884-1888 30.40 
 
 1889-1893 38.20 
 
 1894-1898 33.16 
 
 1899-1903 27.86 
 
 1904-1908 26.08 
 
 The period of 1909-1912 is lacking, but the rate is lower than 20 per 1,000. 
 There was in 1908 a serious epidemic of smallpox, and only a few cases in 1909 ; 
 only 1 case in 1910, and in 1911, 3 cases, up to the day of our departure from 
 Rio de Janeiro. 
 
 As regards other ports these figures are for 1910. 
 
 igio. Rate per 1,000 inhabitants. 
 
 Manaos 35.15 
 
 Para 32.10 
 
 Nichtheroy 32.15 
 
 Santos (S. Paulo) 20.14 
 
 Paranagua 18.22 
 
 Florianopolis 22.69 
 
 Porto-Alegre 26.55 
 
 X. Brazil has adopted the sanitary measures recommended at former con- 
 gresses, including the convention signed in Rio, June, 1904, by the representatives 
 of Argentina, Uruguay, Paraguay and Brazil, and now in force, after due ap- 
 proval by the respective governments. 
 
 Nowhere in Brazil are patients sent back to their places of origin ; quarantine 
 was suppressed in certain cases and enforced against cholera, yellow fever and 
 plague. Attention has been paid to proper isolation of patients or suspected 
 cases, to sanitary vigilance, disinfection, vaccination, etc., according to the dis- 
 ease. Communication cannot be suspended nor vessels denied port for sanitary 
 reasons. Sanitary cordons are abolished. It has been fully demonstrated in 
 Brazil that the principles adopted in the convention referred to are ample for 
 the sanitation of any port. 
 
 XI. The sanitary laws on immigration are derived in Brazil from the general 
 sanitary legislation. Besides these regulations, there is in the island of Flores, 
 Rio de Janeiro, a modern, well-equipped, sanitary establishment for immigrants, 
 with an excellent medical service, and all sanitary conveniences. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 89 
 
 XII. The sanitary documents adopted in the Fourth Conference, do not alter 
 in any way the documents adopted and in use by Brazil. 
 
 An accurate idea of the mortality from yellow fever in Rio de Janeiro may 
 be had from the following table giving official figures : 
 
 Cases. 
 
 1901 299 
 
 1902 984 
 
 1903 584 
 
 1904 48 
 
 1905 289 
 
 1906 43 
 
 1907 39 
 
 1908 9 
 
 1909 
 
 1910 
 
 These figures are most eloquent. 
 
 As regards bubonic plague, a few cases break out in the spring of the year,, 
 which however disappear before the application of appropriate prophylactic- 
 measures. 
 
 In conclusion we beg to submit the following figures showing the present 
 population of Brazil : 
 
 Direction General of Statistics. Population of Brazil in 1910, estimated by 
 Municipalities. 
 
 States. Population. 
 
 Alagoas 863,522 
 
 Amazonas 421,702 
 
 Bahia 2,443,848 
 
 Ceara 1,001,929 
 
 Distrito Federal 914,610 
 
 Espirito Santo 331,269 
 
 Goyaz 303,851 
 
 Maranhao 614,893 
 
 Malto-Grosso 150.071 
 
 Minas Geraes 4,237,027 
 
 Para 581,317 
 
 Parahyba 623,472 
 
 Parana 530.228 
 
 Pernambuco 1,435.004 
 
 Piauhy 438,778 
 
 Rio de Janeiro 1,057.275 
 
 Rio Grande do Norte 317,199 
 
 Rio Grande do Sul 1,554,000 
 
 Santa Catharina 399.510 
 
 S. Paulo 3,427,312 
 
 Sergipe 452,544 
 
 Territorio do A ere 76,065 
 
 Total population 22,175,426 
 
REPORT OF THE CHILEAN DELEGATION. 
 
 Messrs. Delegates : In accordance with the program for this Conference, 
 the Chilean Delegation has the honor to submit a brief resume of the prog- 
 ress achieved by the country in public hygiene during the last few years, par- 
 ticularly the last two. 
 
 In connection with this paper an exhaustive report has been printed and 
 distributed, under the title of "Public Hygiene and Assistance in Chile," and 
 a sanitary exhibition has been installed, which will be shown to the Delegates, 
 presenting some features of our sanitary progress. 
 
 The backward state of our sanitary legislation and the defective organiza- 
 tion of our sanitary service, led us to concentrate our efforts during the last 
 few years into the radical modification of that state of affairs. 
 
 A Sanitary Code is now pending before the Chamber of Deputies, embody- 
 ing all the necessary reforms and providing for the required legislation on so 
 important a subject. It is expected that the bill will soon be made into law, 
 and that it will surely be productive of great benefits for the country. 
 
 The sanitation of cities and ports has been the subject of the Government's 
 best attention. Adequate water works have been built for the cities of Copiapo, 
 Vallinar, Coquimbo, Combarbala, Ligua, Quilpue, Casablance, San Jose de 
 Maipo, San Bernardo and suburbs, Carepto, Talca, Linares, Parral, Cobque- 
 cura, San Carlos, Chilian, Coelemu, Talcahuano, Concepcion, Los Angeles, 
 Nacimiento, Mulchen, Angol, Collipulli, Victoria, Traiguen, Temuco, Valdivia, 
 and Osorno ; 30 cities in all, with a population of over 350,000. The total cost 
 of these works, most of which have been completed, is £603,559. In all of 
 them allowance has been made for an increase in population of from 80 to 
 100 per cent, and the capacity is 150 liters a day per person. 
 
 There have been completed, or are nearing completion, the sewer systems of 
 Antofagasta, Taltal, Serena, Curico, Talca, Chilian, Concepcion and Valdiva; 
 8 cities in all, at a total cost of £594,553. 
 
 The sewer system of Santiago, the construction of which was begun on 
 July 10, 1905, and completed on December 20, 1910, serves an area of 2,500 
 hectares and its length is 370,000 meters. It has cost over 13,000,000 gold 
 pesos of 18 d. At present over 3.500 are connected with the system. All 
 these works represent an approximate expenditure of 30,000,000 gold pesos 
 of 18 d. 
 
 The present water supply of the capital being insufficient, additional works 
 are being carried on, which will cost nearly 12,000,000 gold pesos of 18 d. 
 
 In Valparaiso also additional water works are being constructed, the pres- 
 ent supply being inadequate. The cost of these works is estimated at 5,- 
 000,000 gold pesos of 18 d. Mention should also be made of the definite 
 paving of the streets of Santiago and Valparaiso, each costing £500,000 and 
 £50,000, respectively. Another important work is the reconstruction of Val- 
 paraiso, the cost of which has reached 57,500,000 pesos paper. 
 
 Among sanitary works of another kind we may mention the sanitation of 
 laborers' houses in Santiago and other parts of the Republic, with the indirect 
 support of the Government. The legislation on this subject is based upon 
 the law of February 20, 1906, which created dwelling boards in all Depart- 
 ments of the Republic. A later law authorized the Supreme Dwelling Board 
 to raise a loan of 6,000,000 pesos for the construction of model houses for 
 laborers. The said boards are empowered to carry on the sanitary inspection 
 of dwellings, to order the execution of improvements and to close unsanitary 
 houses. During the year 230 tenement houses, with 6,900 dwellers, were 
 closed on account of unsanitary conditions. During the same period, the 
 Supreme Board authorized the opening of 40 tenement houses with 2,500 
 rooms, costing 2,500,000 pesos. The same board has also inaugurated 100 
 houses for laborers in the town of San Eugenio, and is building many more 
 in different wards of the capital. The Mortgage Bank (Caja de Credito 
 
92 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Hipotecario) is also constructing 166 laborers' houses, at an expenditure of 
 1,700,000 pesos. The same institution has bought a large tract of land valued 
 at 1,053.335, for the same purpose. It is also going to build dwellings for 
 small farmers. 
 
 The government has already issued the call for bids for the construction of 
 the Valparaiso port works, the approximate cost of which will be 31,000,000 
 pesos gold of 18 d. 
 
 The construction of the port of San Antonio will soon be undertaken at a 
 cost of $1,175,000 pesos gold of 18 d. 
 
 The prophylaxis of the diseases enumerated in No. 8 of the program is not 
 carried on satisfactorily for the reasons above stated. 
 
 Tuberculosis. — The prophylaxis of this disease is carried on specially by the 
 anti-tuberculosis leagues of Santiago and Valparaiso, which have been in ex- 
 istence for some years and are subsidized by the Government. 
 
 In Santiago, besides the propaganda work done in different ways, and par- 
 ticularly to a special publication called The Social Hygiene Herald, there are 
 public dispensaries and a maritime sanitorium in Cartagena, two hours by 
 rail from the capital. 
 
 There is also in Santiago a special hospital for consumptives, with pro- 
 vision for 200 beds. In the other hospitals no cases of tuberculosis are al- 
 lowed. 
 
 In Valparaiso, the prophylaxis of this disease is principally in charge of the 
 Bureau of Propaganda against Tuberculosis. The city has also a dispensary 
 and a hospital for consumptives, with a capacity for 250 patients ; and the 
 "Edwards Sanotorium" in Los Andes. 
 
 In Peha Blanca there will soon be opened a sanatorium with 130 beds. 
 
 Small-pox. — Not having a law making vaccination and re-vaccination com- 
 pulsory, this disease prevails in an endemic form and appears with varying 
 frequency. From 1880 to 1907, that is to say, during 28 years, the statistics 
 record 144,000 cases with 73,528 deaths, or an average of 2,626 deaths per year. 
 During that period 7,401,900 vaccinations were made. 
 
 Serious epidemics were recorded in 1880, 1886, 1890, and 1905, the latter with 
 10,615 victims. In 1910 there were 1,929 deaths from small-pox, and in the 
 present epidemic at Santiago, 673 deaths have been recorded from January 
 to October. In 1910 312,645 vaccinations were made, of which 111,122 were 
 revaccinations. 
 
 For the preparation of animal vaccine we have an excellent institute, which 
 has recently been made a part of the serotherapy section of the institute of 
 Hygiene. In 1910 that section delivered to the Central Vaccination Board 
 78,380 tubes of virus. This body has charge of everything connected with 
 vaccination. 
 
 Malaria. — It prevails only in a small part of the northern end of the country. 
 Its influence in our demography is very insignificant. 
 
 Venereal Diseases. — The prophylaxis of these diseases is, by virtue of our 
 political constitution, in charge of the municipalities. 
 
 At the present time this service is organized in the ports of Arica, Iquique, 
 Antofagasta, Tocopilla, Taltal, Coquimbo, Valparaiso, Constitucion, Talca- 
 huano, Coronel, Valdivia, and Punta Arenas, and in the cities of Santiago, 
 Talca. Curico, Chilian, Concepcion, San Felipe, Quillota, Angol, Los Angeles, 
 Arauco, Rengo and Nueva Imperial. 
 
 The medical inspection of prostitutes is done bi-weekly, weekly or bi- 
 monthly, either in houses or in special polyclinics. The isolation of con- 
 tagious patients is not compulsory, but is enforced more or less rigidly in the 
 various cities. 
 
 In Santiago there are polyclinics and special hospital wards for the treat- 
 ment of these cases. In the national navy special attention is given to the 
 treatment of venereal cases, with very satisfactory results. 
 
 In the armv the rate of these diseases has been reduced from 25.3 per cent 
 in 1907 to 14.5 per cent in 1910. 
 
 Trachoma. — This disease was imported into the country in 1881, apparently 
 by a Spanish immigrant. From that year until 1889, 151 cases were verified in 
 the eye infirmaries of Santiago. The percentage of trachoma patients in the 
 total number of cases treated in the infirmaries of Santiago, has increased 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 93 
 
 from 0.5 per cent in 1895 to an average of 3.1 per cent for eleven years. The 
 percentage in 1910 was 8 per cent. 
 
 The measures now enforced to prevent the importation of trachoma cases 
 are confined to the medical examination of immigrants upon arrival. 
 
 Leprosy. — This disease does not exist in Chile. The only three cases so far 
 recorded have occurred in foreigners. At present the only case existing (a 
 negro from Jamaica) is isolated in one of the Santiago hospitals. 
 
 Scleroma. — Up to the present date 35 cases of this disease have been ob- 
 served in different parts of the country. 
 
 Yellow Fever. — This disease is unknown in Chile. 
 
 Plague. — It appears in an endemic state in the northern ports, from Arica 
 to Taltal, inclusive, since 1903. The first epidemic invaded Iquique (May, 
 1903) and successively the other ports, in subsequent years, as far north as 
 Arica and as far south as Taltal. 
 
 At various times there have been small epidemics in Valparaiso, and isolated 
 cases in Santiago. In both cities the focii were quickly destroyed. During 
 the last two years the plague has appeared in the north under a mild form. 
 In 1910 there were recorded in Arica, Pisagua, Iquique, Tocopilla, Mejillones, 
 Antofagasta and Taltal, 232 cases with 123 deaths. During the first five 
 months of 1911, in the same cities, there were 147 cases with 59 deaths. 
 
 The fight against this disease has been principally in charge of the Gov- 
 ernment, with the usual methods. In the campaign for the destruction of 
 rats, mention should be made of the activity displayed by the Iquique disin- 
 fecting station and of the good results obtained at that place with the azoa 
 virus. The Government, through the Institute of Hygiene, has distributed 
 free of charge large quantities of Yersin serum and Haffkine vaccine. 
 
 Asiatic Cholera. — During the last years the Government has enforced vig- 
 orous defensive measures to prevent the importation of this disease. Among 
 those measures we may mention the sending of a sanitary inspector to Re- 
 publics of the River Plate; the purchase of Docker barracks, field medicine 
 chests, and field laboratories for the rapid bacteriological examination of the 
 disease; the establishment of a sanitary station in Juncal for the sanitary sur- 
 veillance of the frontier traffic, etc. 
 
 For the prevention of the introduction of exotic diseases through maritime 
 ports there have been established a permanent sanitary station in Arica and 
 a provisional one in Punta Arenas, which will be made permanent. 
 
 Mention should also be made of the disinfection services in the principal 
 ports and of the twelve disinfecting stations in as many different places in 
 the Republic. 
 
 With regard to the tenth subject of the program, we may say that the gov- 
 ernment, besides the general supervision which it exercises over all sanitary 
 matters, has in case of an epidemic, the right to enforce for a definite period, 
 and the consent of Congress previously obtained, the Law of Sanitary Police, 
 passed on the 30th of December, 1896. By virtue of this law, the President 
 is empowered to close the maritime and land ports ; to prescribe quarantine 
 measures, compulsory disinfection of passengers and cargoes, and to adopt 
 such other measures which he may deem necessary for the eradication of any 
 of the epidemics specified in the regulations. The General Health Ordinance 
 of January 10, 1887, specifies the sanitary measures that may be adopted by 
 the authorities. 
 
 The General Board of Sanitation, which was created to advise the Govern- 
 ment in sanitary matters, and to study and submit health and prophylactic 
 measures, and the departmental boards of sanitation, were abolished on 
 May 23, 1900, and the Superior Council of Health was organized instead 
 thereof. The provincial councils of hygiene, established by decree of Jan- 
 uary 19, 1889, were also reorganized and subdivided into the present Depart- 
 mental Councils, which have been operating since the 10th of December, 1892. 
 The Law of Navigation, in force since June 24, 1878, and the Maritime 
 Health Regulations of February 18, 1895, prescribe the measures of a perma- 
 nent character that should be taken against epidemics ; the inspection of ves- 
 sels; the issuance of bills of health; the adoption of prophylactic measures 
 that should be observed before, during and after the voyage ; quarantine and 
 
94 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 examinations; sanitary stations, sanitary tariffs, and the duties pertaining to 
 sanitary authorities. On the other hand the government enforces as a na- 
 tional law the Sanitary Convention of Washington. 
 
 With regard to the information called for in the second subject on the pro- 
 gram, we beg to report as follows : 
 
 Convention of Washington. 
 
 Section 34 of the Convention of Washington reads thus : 
 
 Packet boats shall be subjected to special regulations, to be established by 
 mutual agreement between the countries in interest. 
 
 In Chile the ships of the Pacific Steam Navigation Co., of the South 
 American Steamship Co., and of the Kosmos Line are required by a govern- 
 mental decree to stop at Arica to be inspected by the Chief of the Sanitary 
 Station, and after complying with this requirement then allowed to proceed 
 south. 
 
 When the Sanitary Station is informed of a reappearance of plague in the 
 ports of Peru, in Callao to the south, the passengers and crew are inspected 
 and the ship disinfected with sulphur gas. 
 
 Article 35 of the Washington Convention reads as follows : 
 
 Without prejudice to the right which governments possess to agree upon 
 the organization of common sanitary stations, each country should provide at 
 least one port upon each of its seaboards, with an organization and equipment 
 sufficient to receive a vessel, whatever may be its sanitary condition. 
 
 What has been said in regard to the Sanitary Stations shows the manner in 
 which this article has been complied with. 
 
 With reference to Article 36 of the Convention of Washington we may say 
 that Chile has in all its ports a sanitary board composed of the maritime gov- 
 ernor, of the representative of the Army and of the port physician, which 
 boards have charge of the enforcement of the sanitary measures prescribed 
 by our maritime sanitary legislation, which dates from 1895. 
 
 The port physician inspects the crews and ships arriving at the port. 
 
 The sanitary condition of the population of the port is generally in charge 
 of the physicians of the city. 
 
 Conference of Mexico. 
 
 Resolution 2. In the Chamber of Deputies there is under discussion a bill 
 codifying the sanitary laws and measures of the Republic, amending and 
 amplifying them. 
 
 Resolution 3. In the same bill vaccination is made compulsory to all in- 
 habitants of the Republic. 
 
 Resolution 11. In Chile no immigrants suffering from trachoma or beri- 
 beri are admitted. 
 
 Resolution 12. The Sanitary Code which will soon become a law of the 
 Republic the sanitary legislation is centralized. 
 
 Resolution 13. The Government railroad have a sanitary department which 
 is in charge of the disinfection of cars, berths, cabins, etc., inspects the per- 
 sonnel, etc. 
 
 Conference of Costa Rica. 
 
 I Resolution. The Government prepares the anti-rabic vaccine and applies 
 it free of charge in the Division of Seroterapy of the Institute of Hygiene. 
 The Government furnishes free transportation to the capital to persons who 
 have been bitten by dogs infected or suspected of rabies. 
 
 II Resolution. Chile is carrying on its work of sanitation of ports. 
 
 Resolution VIII. In Chile there are several private associations or institu- 
 tions engaged in the fight against tuberculosis, and they are supported and sub- 
 sidized by the Government. 
 
 Said institutions also educate the public by means of lectures, publications, 
 etc., regarding the manner of preventing the disease. 
 
FiFTH INTERNATIONAL SANITARY CONFERENCE. 95 
 
 Organization and Work of the International Sanitary Information Committees. 
 
 The International Sanitary Information Committee of Chile was created by 
 Supreme Decree No. 579 of May 30, 1908, in pursuance of the resolutions 
 adopted by the Second International Conference of American States, held 
 in Mexico in 1902, by the First International Sanitary Convention, held in 
 Washington, December, 1902, and by the Third International Conference of 
 American States held in Rio Janeiro, August, 1906, which latter, by para- 
 graph b of Resolution 3, requests the Governments to "establish and regulate 
 in each American country a Committee composed of three medical or sanitary 
 authorities, under the direction of the International Sanitary Bureau estab- 
 lished at Washington as an International Sanitary Information Committee 
 with power to meet and interchange data referring to public health and for 
 any other purpose that the Conference may think proper." 
 
 In the Third Sanitary Conference of Mexico it was resolved to establish an 
 International Sanitary Bureau in Montevideo as a center for the Information 
 Committee of the Argentine Republic, Bolivia, Brazil, Chile, Uruguay and 
 Paraguay, the committees of the other Republics reporting to the Washington 
 Bureau. 
 
 The Chilean Committee was constituted on June 23, 1908, and through the 
 Department of Foreign Affairs its organization was communicated to the High 
 Contracting Parties. 
 
 The Government of the Oriental Republic of Uruguay informed the Min- 
 ister for Foreign Affairs the organization of the Sanitary Committee of Monte- 
 video, under date of May 11, 1911. 
 
 The Chilean Committee is composed of Dr. Ricardo Davila Boza, director 
 of the Institute of Hygiene, Dr. Lucio Cordova, ex-secretary of Supreme 
 Council of Hygiene, and Dr. Pedro Lautaro Ferrer, Sanitary Inspector of the 
 Republic. 
 
 With regard to the 9th subject on the program, we may say that in the 
 printed reports contain the demographic statistics for the principal ports and 
 cities, and that the Bertillon system has been adopted in the Republic. 
 
REPORT OF DOCTOR FERNANDO IGLESIAS, DELEGATE 
 FROM COSTA RICA. 
 
 Mr. President ; Gentlemen : When the Fourth International Sanitary Con- 
 ference of the American Republics adjourned in San Jose de Costa Rica, several 
 resolutions were adopted. I am happy to state that the Costa Rican Government 
 has complied with most of these resolutions, notwithstanding the difficulties 
 which have arisen due to the earthquake and destruction of the city of Cartago. 
 
 The Costa Rican Government, ever consistent with its established policies, has 
 given particular attention to hygiene, by the enactment of important measures to 
 prevent the propagation of contagious diseases, to decrease mortality, and the 
 sanitation of the ports and towns of the republic. The following sanitary legis- 
 lation has been enacted, some of a national and others of a municipal character. 
 
 (1) Surcharge of 5% on customs duties on goods imported by Puntarenas, 
 to be devoted to sanitation of said port. (August 17, 1910.) 
 
 (2) To compel physicians to report to the authorities and the Medical Faculty, 
 all cases of infectious diseases, or those suspected to be infectious, coming to 
 their knowledge in the practice of their profession. (August 17, 1910.) 
 
 (3) To invest the annual sum of $25,000 (colones) in fighting against anky- 
 lostomiasis. (September 30, 1910.) 
 
 (4) Erection of buildings. (August, 1910.) 
 
 (5) Introduction of potable water in cities and towns, taken directly from the 
 source. 
 
 (6) Decree of October 20, 1910, on sanitary service, creating the "personal ob- 
 servation card" for individuals coming into the country. 
 
 (7) Venereal prophylaxis. (Decree of November 25, 1910.) 
 
 (8) Closing the ports to steamers coming from Venezuela, Trinidad and Italy 
 during the plague and cholera epidemics. 
 
 (9) To vest upon the chiefs of Marine Sanitation and Hygiene the authority 
 of police officials. 
 
 (10) San Jose sewerage and drainage of a majority of the towns in the re- 
 public. 
 
 Fulfilment of the Resolutions Adopted by the Preceding Four Sanitary 
 
 Conventions. 
 
 On March 4, 1911, a law was promulgated on the sanitary campaign against 
 ankylostomiasis, whereby the annual amount of 25,000 colones is appropriated 
 to defray the expenses of the physicians engaged in the fight, distribution of 
 medicine gratuitously, etc. By this law, physicians are obliged to give monthly 
 lectures in each town on general questions of hygiene, both public and domestic, 
 and to explain the importance of the campaign against ankylostomiasis, pointing 
 out the means to resist and prevent the disease. 
 
 Gastro-intestinal parasitic diseases in Costa Rica have two fields ; among 
 children under five years of age, their mortality reaching the alarming rate of 
 52.3%, and among those afflicted with ankylostomiasis. Dysentery is another 
 disease which causes a large number of victims in Costa Rica. In view of these 
 facts, and of the provisions of Sec. 1, Art. 3, of the resolutions of the Fourth 
 Sanitary Conference, the Government and the Municipalities have directed all 
 their efforts to provide all cities and towns with sanitary water service through 
 a system of pipes, directly from the headwarters or source of the streams. 
 
 The sanitation, hygiene and vigilance of our ports has had special attention, 
 and the country has had no epidemics of a general or alarming character to 
 fight against. During the month of July there was a case of yellow fever in 
 Siquirres, and the Government, the Medical Faculty and the U. S. Fruit Com- 
 pany, all took energetic and efficient means to fight against the spread of the 
 disease. This was accomplished as well as the complete sanitation of the zone, 
 with excellent and positive results. 
 
98 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 By resolutions of May 20, September 5 and November 20, 1910, the ports of 
 the country were closed to all vessels from the island of Trinidad, and from 
 Venezuelan and Italian ports, and other suspected localities. The quarantine 
 service was performed by the Sanitary Police, and immigrants were submitted 
 to periodical observation. During the previous year 15 patients were sent to 
 the quarantine station on the Uvita island, and of these 2 were cases of typhoid 
 fever and 7 of malaria. The quarantine station has been thoroughly repaired. 
 A special department has been built for fumigation, and four rooms for isola- 
 tion; all doors and windows have been protected by wire screens, and a large 
 covered water tank was also built. 
 
 In Limon death rate among children is about one-third of the general mor- 
 tality. Malaria is prevalent, but has decreased, due to the use of petroleum. 
 All privies have been closed up, or connected with the sewers; 67 back yards 
 have been filled and all cess pools and swamps treated with petroleum. 
 
 On October 29, 1910, a decree (No. 5) was issued creating the "personal ob- 
 servation cards." By the provisions of this decree, every person arriving in the 
 country is under obligation to report every day, during one week, to the town 
 doctor, for examination; every other day, the second week, and every third day, 
 the third week. At present there are under construction in Limon the customs 
 warehouses, built of iron and cement, rat proof, as recommended by the Fourth 
 Sanitary Conference. 
 
 The report submitted by the Costa Rican Delegation to the Fourth Sanitary 
 Conference shows that deaths due to tuberculosis increase every year. Un- 
 fortunately, this increase still continues, and Dr. Cespedes in his last report 
 states "tuberculosis has had a remarkable increase, mainly among the colored 
 people." 
 
 There has been no epidemic at the port of Puntarenas. Malaria has almost 
 disappeared, due to cleanliness and removal of all stagnant waters. The Marine 
 Sanitary Service has always taken the precaution of examining every passenger 
 entering the country. 
 
 The Bacteriological Laboratory has given excellent results. During the past 
 year 4,407 analyses were made. 
 
 Death rate among children in the provinces was as follows in 1910 : San 
 Jose, 1,609; Alajuela, 1,101; Cartago, 1,040; Heredia, 463; Guanacaste, 393; 
 Puntarenas, 243 ; Limon, 241 ; a total of 5,090. 
 
 The causes of mortality among children, embraced in the principal groups, 
 according to the international classification, are as follows : 
 
 1909. 1910. Difference. 
 
 I. General diseases 557 408 —149 
 
 II. Diseases of the nervous system or other 
 
 organs 838 
 
 III. Diseases of the respiratory organs 497 
 
 IV. Diseases of the digestive organs 1,895 
 
 V. Other diseases 1,376 
 
 TUBERCULOSIS. 
 
 Provinces. 1909. 
 
 San Jose 104 
 
 Limon 47 
 
 Heredia 41 
 
 Cartago 26 
 
 Alaj uela 29 
 
 Puntarenas 18 
 
 Guanacaste 22 
 
 861 
 
 23 
 
 397 
 
 —100 
 
 2,142 
 
 247 
 
 1,333 
 
 —43 
 
 Cantons. 
 
 San Jose 82 
 
 Limon 47 
 
 19 IO. 
 
 Difference. 
 
 74 
 
 —30 
 
 51 
 
 4 
 
 49 
 
 8 
 
 33 
 
 7 
 
 30 
 
 1 
 
 27 
 
 9 
 
 24 
 
 2 
 
 52 
 
 —30 
 
 51 
 
 1 
 
no. 
 
 Difference. 
 
 20 
 
 —1 
 
 18 
 
 1 
 
 IS 
 
 8 
 
 12 
 
 1 
 
 10 
 
 3 
 
 41 
 
 —19 
 
 39 
 
 9 
 
 13 
 
 3 
 
 10 
 
 4 
 
 9 
 
 —7 
 
 9 
 
 —1 
 
 FIFTH INTERNATIONAL SANITARY CONFERENCE. 99 
 
 Cantons 1909. 
 
 Heredia 21 
 
 Cartago 17 
 
 Esparta 7 
 
 Puntarenas 11 
 
 Barba 7 
 
 Cities. 
 
 San Jose 60 
 
 Limon 30 
 
 Heredia 10 
 
 Esparta 6 
 
 Puntarenas 16 
 
 Liberia 10 
 
 The number of fatal cases of tuberculosis in the entire republic was 288. 
 
 MEASLES AND SCARLET FEVER. 
 
 There were no cases of measles, and but 3 of scarlet fever. 
 
 TYPHOID FEVER. 
 
 Provinces. 1909. 
 
 San Jose 48 
 
 Alajuela 15 
 
 Cartago 11 
 
 Heredia 6 
 
 Guanacaste 2 
 
 Limon 1 
 
 Puntarenas 
 
 Cantons. 
 
 San Jose 31 
 
 Alajuela 12 
 
 Heredia 3 
 
 Cities. 
 
 San Jose 14 
 
 Heredia 1 
 
 In the entire country there were 77 deaths from typhoid fever, or an increase 
 of 6 cases over 1909. 
 
 CHOLERA INFANTUM. 
 
 Provinces. 1909. 
 
 San Jose 159 
 
 Alajuela 114 
 
 Cartago 56 
 
 Heredia 31 
 
 Limon 1 
 
 Guanacaste 
 
 Puntarenas 2 
 
 Cantons. 
 
 San Jose 108 
 
 Alajuela 16 
 
 Cartago 25 
 
 Grecia 44 
 
 Alvarado 10 
 
 Atenas 11 
 
 Jimenez 14 
 
 1910. 
 
 Difference. 
 
 33 
 
 —15 
 
 26 
 
 11 
 
 8 
 
 —3 
 
 7 
 
 1 
 
 2 
 
 . . 
 
 1 
 
 
 
 
 
 
 23 
 
 —8 
 
 22 
 
 10 
 
 6 
 
 3 
 
 13 
 
 —1 
 
 5 
 
 4 
 
 1910. 
 
 Difference. 
 
 227 
 
 68 
 
 114 
 
 
 111 
 
 55 
 
 50 
 
 19 
 
 9 
 
 8 
 
 4 
 
 4 
 
 
 2 
 
 139 
 
 31 
 
 41 
 
 25 
 
 38 
 
 13 
 
 27 
 
 —17 
 
 22 
 
 12 
 
 20 
 
 9 
 
 20 
 
 6 
 
110. 
 
 Difference, 
 
 71 
 
 40 
 
 9 
 
 2 
 
 100 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Cities. 1909. 
 
 San Jose 31 
 
 Grecia 7 
 
 As shown by the preceding figures cholera infantum claimed in 1910 twice as 
 many victims as in 1909, in the city of San Jose. 
 
 Sanitary Department. 
 
 The Sanitary Department of San Jose has rendered great and important serv- 
 ices. During 1910, 910 water closets were built or improved, 191 drainage pipes 
 or sinks were built, 38 cess pools and 84 swamps were filled in or reclaimed, be- 
 sides all the work in connection with the sewers. 
 
 The "Clayton" machine is used in San Jose for disinfection, particularly in 
 cases of diphtheria, malignant dysentery and tuberculosis. In the disinfection 
 of sewers, sinks, etc., 60,000 kilograms of "kreso" were consumed in 1910. 
 
REPORT OF DR. HUGO ROBERTS, DELEGATE FROM 
 
 CUBA. 
 
 Mr. President, Messrs. Delegates: In accordance with the Program adopted 
 for this Conference, I have the honor to report upon our sanitary legislation 
 passed since the last Conference, that is to say, since the latter part of 1909. 
 I must call your attention to the fact that there is in Cuba a Department of 
 Health and Beneficence. The importance given to sanitary matters in my 
 country, made us feel the necessity of that organization, and since its creation, 
 everything concerning so important a branch is entrusted to that Department^ 
 not only as regards domestic sanitation, but also concerning foreign relations,' 
 that is to say, quarantine and immigration. 
 
 For the regulation of interior sanitation, there are in force the Sanitary 
 Ordinances promulgated in 1907 and reported to a previous Conference. For 
 this reason I shall confine myself to enumerating only the amendments thereto. 
 
 These amendments refer to foods and beverages; construction of buildings; 
 ventilation, drainage and sanitary works; hotels, lodging houses, cafes, restau- 
 rants, etc., schools, colleges, academies, seminaries, and other educational in- 
 stitutions; classification of obnoxious, sanitary and uncomfortable factories 
 and establishments; hospital, infirmaries,, lazarettos, and clinics. 
 
 New chapters have been added on animal sanitary police; professions (spe- 
 cially dental surgery) ; wet nurses and ophthalmia neonatorum. 
 
 Sanitary laws being completely uniform throughout the whole country, it was 
 found necessary to issue instructions to the 84 local health chiefs of the 
 various districts, as to the interpretation of the law and as to the adminis- 
 trative procedure to be followed in each locality. For that purpose official 
 instructions were printed, regarding not only the legal functions of the chiefs 
 and personnel under them, but also their relations with the General Bureau 
 and the Department. 
 
 As regards quarantine service or foreign sanitation, there are in force in 
 Cuba the resolutions adopted by the Conference of Washington, Mexico and 
 San Jose de Costa Rica. I do not speak now of the manner in which the 
 resolutions of the named conference have been complied with because I will 
 do so when reporting upon the second subject on the program. But I will 
 take the liberty to state that in the opinion of the sanitary authorities of 
 Cuba, the Washington Convention is deficient in some respects, particularly 
 in regard to cholera and to the classification of vessels. Thus it seems neces- 
 sary to revise the resolutions passed by that Conference. To this end I have 
 confidential instructions from our Director of Health, Dr. Juan Guiteras. In 
 this connection, I must point out to the fact that such necessity has been felt 
 not only in Cuba, but also in several European nations, because in the 
 Sanitary Conference that is about to be held in Paris they are going to revise 
 the conventions signed in that city in 1903 and from which the Washington 
 Convention has been copied. 
 
 I make these statements submitting them to the Conference should it deem it 
 convenient to take them into consideration. I must state also that in order 
 to prevent the introduction in Cuba of any person carrying cholera bacilli, from 
 European countries with which we maintain frequent relations, we resort to 
 the bacteriological examination by means of the rectal catheter, and only when 
 a negative result has been obtained is the free entry granted. 
 
 If it is important to fight the diseases that ravage humanity, it is no less 
 important to study and apply all means advised by science with regard to 
 reproduction, conservation and improvement of humankind, that is to say 
 Homiculture, a science recently constituted and unified, and which has for 
 its object, among other things, the prevention of morbinativity and mortinativ- 
 ity, infantile mortality and morbility and puerperal diseases. The Executive 
 has requested from the legislature an appropriation for the establishment of the 
 "Hernandez-Pinard Palace of Homiculture," which, as our Secretary of 
 Health puts it, "will serve not only in the case of women and children, but 
 also as a school for mothers wherein women shall be taught in a practical 
 manner the rules and cares that they should follow for the preservation of 
 their health and that of their children." 
 
102 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Upon the principles of homiculture, our Health Department is about to 
 undertake a special campaign against morbinativity and mortinativity, and in- 
 fantile morbidity, for which purpose, Dr. Matias Duque, former Sercetary of 
 Health, created a division of pediatrics in connection with the Bureau of In- 
 vestigations and Research of the Department. Drs. Ramos and Hernandez, 
 the originators of the idea in Cuba, have done considerable work on the sub- 
 ject, but it being too lengthy I shall abstain from speaking thereof. The 
 Delegates, however, will find all information thereon in the reports made 
 by those scientists. The importance of the work thus initiated is self-evident. 
 Its ends are the increase of population and the improvements of the race. 
 
 For the purpose of bettering the conditions under which laborers live, our 
 Government has built and is building "houses for laborers." These houses 
 are provided with adequate conveniences, and the laborers may acquire title 
 to them by the payment of a small monthly payment. 
 
 We are now free from quarantine diseases. Smallpox has been eradicated 
 from our territory, where it has not appeared for the last ten years. As a 
 whole, the sanitary condition of the Republic is excellent, as is shown by 
 our death rate, which was 13.03 per 1,000 in 1909 and 15.57 in 1910. 
 
 With reference to the second and third subjects of the Program, I shall now 
 enumerate what has been done by my Government in compliance with the 
 resolutions passed by the Fourth Sanitary Conference, held in Costa Rica (see 
 the text of said resolutions in the Appendix, Translations of the Fourth Inter- 
 national Sanitary Conference, page 105). 
 
 I Resolution. — The Department of Health is actively engaged in fighting 
 these diseases. Bilharziosis, in so far as we know, and exanthematic typhus, 
 positively, do not exist in the Republic. Leprosy and typhus are quarantine 
 diseases. 
 
 II Resolution. — Thanks to the centralization of the sanitary services of the 
 Republic, there is a great deal of efficiency in enforcing the measures recom- 
 mended by this Resolution, excepting plague, which disease has never threatened 
 us directly. Rigid inspection is kept over suspected arrivals, which are duly 
 disinfected. Educational propaganda has been carried out on the extermination 
 of rats, and at the Las Animas Hospital we are carrying on experimental 
 studies on the extermination of rats and fleas. 
 
 III Resolution. — The recommendations made in this resolution are complied 
 with by the Government of Cuba and it may be said that they are embodied in 
 our sanitary policy. 
 
 IV Resolution. — In order literally to comply with this resolution, it would 
 be necessary that all nations should come to an agreement. In Cuba it is 
 carried out to a certain extent, as vessels are very frequently treated in order 
 to rid them of rats, specially when they come from places infected or sus- 
 pected of plague. 
 
 V Resolution. — Cholera, small-pox and exanthematic typhus do not exist 
 in Cuba. As regards other contagious or transmissible diseases, such as measles, 
 scarlet fever, and diphtheria, etc., no person suffering therefrom is allowed to 
 embark, because our Sanitary Ordinances provide that such patients be con- 
 fined in special hospitals for infectious diseases, if they are not properly isolated. 
 
 VI Resolution. — This interpretation has always been sustained by the Cuban 
 Government. 
 
 VII Resolution. — This is the sixth subject on the program, and I shall, 
 therefore, speak of it at its proper place. 
 
 VIII Resolution. — This has been complied with in my country, and I shall 
 take it up at the point where I report upon the fifth subject on the program. 
 
 IX Resolution. — These models of sanitary documents were submitted by the 
 Cuban Delegation to the Fourth Conference and were adopted by the Govern- 
 ment immediately afterwards. 
 
 X Resolution. — In compliance with the resolution my Government has ap- 
 pointed me as its Delegate to the Third and Fourth Conferences held in Mexico 
 and Costa Rica, respectively. 
 
 XI Resolution. — It seems that the Information Bureau of Montevideo has 
 not as yet been duly organized. 
 
 XII Resolution. — The Government of Cuba strives to render the medical 
 profession most efficient for fighting any diseases liable to cause serious dis- 
 turbances in public health, and for this purpose, there have recently been de- 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 103 
 
 livered in the Las Animas Hospital free lectures on bacteriology of cholera and 
 other diseases, all physicians having been invited to attend. 
 
 XIII Resolution. — We have in Cuba a great number of public and private 
 laboratories where the work referred to in the resolution is carried on. 
 
 The fifth subject on the program requires a report on the sanitary progress 
 of the principal cities, in each country. 
 
 Havana, our capital, is now undergoing a great transformation which will 
 render better still its sanitary conditions and will embellish it remarkably. 
 During the last two years the sewer and paving works have been going on, 
 although at present not very rapidly in order not to interrupt public traffic. 
 In spite of the large quantities of earth that have been removed not one single 
 case of typhoid fever has occurred. 
 
 Large extension works are being carried on in connection with our magnifi- 
 cent aqueduct of the Alvear Canal, in order to increase the water supply and 
 carry it to every section of the capital. The works for dredging, draining and 
 filling the port has also been started, and likewise the construction of splendid 
 steel and cement wharves, which will facilitate the extermination of rats. 
 
 Cienfeugos, the second largest city in the Republic, is also nndergoing im- 
 portant changes. Sewer and paving works are now under construction. There 
 is a fairly good water supply which is being improved. 
 
 We have under consideration the building of an immigration station, and the 
 enlarging of the present floating quarantine station turning it into a land sta- 
 tion, to be provided with every necessity to meet the increased traffic inci- 
 dental to the opening of the Panama Canal. 
 
 In Nipe, a town on the northern coast and possessing the largest bay of the 
 Republic, we are planning to establish a quarantine and immigration station. 
 
 In Santiago, the capital of Oriente Province, we have rebuilt the Cayo Duan 
 quarantine station, and is soon to be completed, at a total coast between $65,000 
 and $70,000. An immigration station is also going to be built very soon. The 
 city has two aqueducts and another is being constructed. The sewer and pav- 
 ing works are about to be finished. 
 
 The Cuban Government, fully cognizant of the influence exercised by social 
 hygiene on public health, as well as of the decisive importance of the success 
 that may be accomplished in fighting the epidemics that ravage humanity, has 
 strived by all possible means to keep the public posted on the hygienic pre- 
 cautions that should be observed in order to ward off contagious diseases, 
 specially against those which, on account of their epidemic nature or the 
 number of victims that they may cause, should be more directly fought. 
 
 Our Sanitary Ordinances contain exhaustive instructions as to the manner 
 of preventing such diseases, but as they can not be properly understood by the 
 masses of the population, different pamphlets under the general title of "Popu- 
 lar Instructions" have been issued and widely distributed. Those recently 
 printed relate to rabies, tuberculosis, cholera, etc. 
 
 The "Popular Lessons on Tuberculosis" were awarded a prize by the Tuber- 
 culosis Congress recently held in Barcelona, Spain. "Popular Instructions on 
 Asiatic Cholera" have also been printed and distributed to prepare our public 
 in case that disease now prevalent in some European ports, should invade our 
 country. 
 
 With regard to venereal diseases, I have to say that prostitution is regu- 
 lated in Cuba, it being considered as a necessary evil. Therefore, women thus 
 engaged are subject to special regulations, which compel them to report at 
 Division of Special Hygiene in order to undergo a periodic medical examina- 
 tion ; those found suffering of such diseases are confined in a special clinic 
 exclusively devoted to their treatment. These regulations also refer to the 
 places where prostitutes may live, designating the districts set aside for the 
 purpose ; under them prostitutes are not allowed to occupy conspicuous places 
 in theaters, nor to drive in open carriages, etc. 
 
 Bearing in mind the important role played by man in the transmission of 
 venereal diseases, there has been established, as an annex of the Division of 
 Special Hygiene, a dispensary for men, where those resorting to it voluntarily 
 are properly treated. They are mostly laborers. 
 
 The seventh subject of the program refers to the "Criterion as to what 
 constitutes immunity from yellow fever." For practical purposes of quarantine 
 against yellow fever, those that may be considered as immune from yellow 
 fever, are : 
 
104 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 First. Individuals proving- by means of official documents to the satisfaction 
 of the authorities in the port of arrival, that they have suffered from yellow 
 fever. 
 
 Second. Those who have resided for a period of ten years in a district where 
 there has broken out yearly a focus of the disease during that period. 
 
 Considering that the ports and cities of the first and second class in the 
 Island of Cuba were yellow fever focii up to September, 1901, those who have 
 resided in said ports and cities for a period of not less than ten years prior 
 to that date, are therefore to be considered as immune from the disease. 
 
 The adoption of systematic measures for the extermination of rats on board 
 ships, is of vital importance since the discovery of the active role played by 
 these rodents in the transmission of plague. 
 
 In Cuba, all ships arriving from ports where there has been plague are sub- 
 jected "deratization," but it can be stated that such "deratization" has not been 
 efficient in all cases, because in the greater number of instances we have to deal 
 with ships completely loaded with merchandise which only make short stops in 
 Cuba in order to unload a small part of their cargo. For this reason it can 
 not be always guaranteed that the death-dealing gases reach every section of 
 the ship. In all nations where ships are chartered they require that for the 
 protection of passengers every vessel should observe certain conditions, and 
 be provided with the necessary means to meet any emergency, likewise, every 
 vessel is subject to periodic inspection. Now, then, the elimination of the 
 presence of plague rats on board should be included among the conditions re- 
 quired of all ships to protect the health of those on board and prevent the 
 spread of plague. In view of the preceding, I have the honor to move the 
 following be adopted : 
 
 "Every vessel should be provided, together with the papers issued by the 
 proper authorities, with a certificate also issued by a proper authority, to the 
 effect that it has been totally ridden of rats while in ballast, for a period not 
 exceeding six months. 
 
 "This document shall be indispensable, like all other papers with which a 
 ship must be provided in order to engage in navigation. 
 
 "Nations participating in this conference shall allow a period not exceeding 
 six months to vessels of their respective flags to comply the conditions wherein 
 prescribed." 
 
 With respect to ships arriving from any locality infected with yellow fever, 
 the Washington Convention specifies the treatment to which they shall be sub- 
 jected in order to eliminate mosquitoes. Vessels with flies on board may, 
 when necessary be subjected to the same measures, although these insects should 
 not exist in a ship where cleanliness prevails regularly. 
 
 Our sanitary ordinances contain a chapter dealing exclusively on hygiene of 
 railroads, street railways and omnibuses, because of the large number of per- 
 sons traveling on such vehicles. 
 
 The principal requirements prescribed by said chapter are those referring 
 to cleanliness in the transportation of passengers. 
 
 The last and ninth subject on the program refers to "monthly and yearly 
 statistics of morbidity and mortality in the principal ports and cities; infor- 
 mation in regard to the adoption of Bertillon's nomenclature." 
 
 Cuba can be proud of its death rate, which is one of the lowest in the world. 
 In order to give you an idea of this interesting subject, I shall quote some extracts 
 from the reports prepared by the Chief Statistician of the Health Department, 
 for the years 1909 and 1910. 
 
 A resume of the demographic-sanitary statistics for 1909 shows that there 
 were recorded during the year 70,167 births, 28,832 deaths, and 12,552 marriages, 
 which show an increase of 4,800, 471, and 394, respectively, over 1908. 
 
 As to the movement of incoming and outgoing passengers at all ports of the 
 Republic— according to statistics furnished by the Department of Finance- 
 there were 67,322 arrivals and 57,505 departures, or an increase in population of 
 9 817 persons. Comparing these figures with those of the preceding year, it is 
 seen that, although there was an increase of 3,506 in the arrivals, the departures 
 increased by 3,852, so that in the net gain there was a decrease of 346 
 
 The total population of the Republic has been duly estimated at 2,199,859 
 inhabitants on December 31, which, in comparison with the census of 190/ 
 shows an increase of 150,879 within the short period of two years. Examining 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 105 
 
 the rates given by each the mentioned demographic factors, we have that births 
 are represented by 135.10; deaths, 13.03, and marriages, by 51.32; which, com- 
 pared with those for the preceding year show the following increases: 9.57; 
 0.29, and 1.66; respectively. 
 
 I beg to call your attention particularly to the low total death rate of the 
 Republic, 13.03, which continues placing on a very high level among the coun- 
 tries publishing demographic statistics, and which render Cuba as one of the 
 most healthful countries in the whole world. On the other hand, these figures 
 serve to show the fallacy of the assertion as to the unhealthiness of the tropical 
 countries. The sanitary state of a country is measured, not by its climatic con- 
 ditions, but the application of the measures adopted in accordance with scien- 
 tific rules. Nevertheless, in spite of these gratifying figures, when analyzing 
 the causes that have produced them we can not but lament some hundreds of 
 deaths which could have been avoided if those scientific rules had only reached 
 the popular masses, through education. 
 
 The daily average of deaths during 1909 was 78.99, as against 77.49 in 1908. 
 Examining them with those of the preceding year, we have the following: 
 
 Increase — Disease of circulatory system, 9.40 against 9.31 ; bronchitis, bronco- 
 pneumonia, and neuromia, 6.29 against 5.92; rickets, 3.46 against 3.13; cancer, 
 2.69 against 2.46; meningitis, 2.70 against 2.11; malaria, 2.04 against 1.99; 
 Bright's disease, 1.76 against 1.67; senility, 1.74 against 1.53; cirrhosis of the 
 liver, 0.88 against 0.75; grippe. 0.85 against 0.63; measles, 0.30 against 0.17. 
 
 Decrease: Enteritis (children under one year), 9.44 against 9.52; tuber- 
 culosis, 8.89 against 9.61; pulmonar tuberculosis, 7.88 against 8.53; tuberculosis 
 in other organs and tissues, 1.01 against 1.08; tetanus neonatorum, 1.91 against 
 2.15; typhoid fever, 0.69 against 0.86; whooping-cough, 0.40 against 0.95. 
 
 Among the deaths due to non-pathological causes, but to accidental causes, 
 I must mention those produced by the sinking of the S. S. Nicolas Castanos; 
 those due to lightning or electrical currents, and those caused by typhoons and 
 storms, specially in the Eastern region of the Island. 
 
 With regard to the year 1910, there were recorded in the Republic 13,446 
 marriages, 76,706 births, 3,243 still-births and children who died before being 
 24 hours old, and 33,844. As compared with 1909, there is an increase of 894 
 marriages, 6,539 births, and 5,012 deaths, and a decrease of 147 still-births. 
 
 With respect to the movement of passengers arrived and departed, there were 
 in 1910 77,744 arrivals, and 57,924 departures, having a balance in favor of the 
 population of 19,820. Comparing those figures with 1909 we have an increase 
 of 10,422 in arrivals and a decrease of 419 in departures. 
 
 The population of the Republic for June 30, 1910, has been estimated at 
 2,161.671 inhabitants, according to the census taken by the Department of the 
 Interior. These figures show an increase of 38,188 over December of 1909. 
 The mortality in 1910 shows a coefficient of 15.57, quite higher than that of 1909, 
 which was only 13.03. (For an explanation of the causes of death and detailed 
 statistics, see Spanish Edition of the Conference.) 
 
REPORT OF DR. LUIS FELIPE CORNEJO Y G6MEZ, 
 DELEGATE FROM ECUADOR. 
 
 In the first place I want to express the deep regret of the Government of 
 Ecuador at having been prevented by unforseen causes at a last hour from 
 attending the Fourth Sanitary Conference, held in the capital of Costa Rica. 
 
 Our geographical position in the very heart of the tropics, has been the 
 principal source of the endemic diseases that have hindered the growth of 
 our population, and for this reason there has been aroused in our public a 
 strong sentiment for the sanitation of our cities, to which end the Congress of 
 the Republic has just issued a law approving the gigantic project for the sani- 
 tation of Guyaquil, which includes : the sewerage of the city and the paving 
 of its streets, water supply, extension of the embankment, and other im- 
 portant improvements, all of which constitute a colossal work in the execution 
 of which the enormous sum of 50,000,000 francs will be invested. A respon- 
 sible French firm has taken charge of this work, which will insure the sanita- 
 tion of the principal port of the Republic. 
 
 The sanitary legislation of Ecuador is of two kinds: (1) sanitary laws 
 and regulations, and (2) municipal ordinances on hygiene. The enforcement 
 of the former is in charge of the Public Health Service, and that of the lat- 
 ter, of the various municipal police departments. 
 
 The first sanitary institution we had in Ecuador were the health boards, 
 where organization was very heterogeneous, while on the other hand their 
 scope was limited almost exclusively to the defense of ports against quaran- 
 tinable diseases. 
 
 The aparition of plague in Guayaquil in 1908 initiated a new era in sanitary 
 measures, and by executive decree of the same year the Special Sanitation 
 Commission was created, which was later replaced by the Public Health Serv- 
 ice by law of November 3, 1908, enacted by the Congress of the Republic. 
 
 The Public Health Service is constituted by a General Bureau located in 
 Guayaquil and several sub-bureaus in the various provinces, under the gen- 
 eral Bureau for the purposes of administration, and under the Cantonal 
 boards, for purposes of financial management. 
 
 The General Bureau has issued the following sanitary regulations: (1) 
 Campaign against small-pox; (2) making vaccination compulsory in the city 
 of Guayaquil (this has been superceded by a law of Congress making vaccina- 
 tion compulsory throughout the whole country) ; (3) compulsory report by 
 physicians of all infectious diseases; (4) campaign against mosquitoes; (5) 
 isolation of confirmed and suspected yellow fever cases; (6) restrictions on 
 the removal of infectious cases from one place to another; (7) restrictions on 
 attendance of infectious patients in private, which is only allowed in excep- 
 tional cases; (8) special provisions for the removal of yellow fever or plague 
 patients to Guayaquil from neighboring points; (9) restrictions on the burial 
 of persons dying of plague or small-pox; etc., etc. 
 
 The maritime sanitary regulations are based upon the stipulations of the 
 Washington Sanitary Convention. 
 
 Other hygienic matters, such as the inspection of markets, groceries, etc., 
 street cleaning, removal and cremation of garbage, etc., etc., are entrusted to 
 the municipal governments. On the other hand, the police departments render 
 their valuable cooperation in helping the sanitary authorities enforce the sani- 
 tary laws and regulations. 
 
 Among other bills of a sanitary nature now pending in Congress, is one ad- 
 mitting the free admission of wire screens, crude petroleum, mosquito nets, 
 quinine salts, for the purpose of promoting the fight against malaria and yel- 
 low fever. 
 
 Although at present my Government is devoting its best attention to the im- 
 provement of the statistical service, this important branch is still deficient. Our 
 figures show that there is a marked difference between the demographic sta- 
 
108 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 tistics of the cities situated on the inter-Andean plateau and that of the coast 
 cities, the difference being in favor of the former, where, on account of the 
 altitude and cold climate, there is no stegomya, and the anopheles can not 
 breed. The same may be said with regard to tuberculosis in those cities. 
 
 The general death rate in the population of Quito, 80,000, is 2.37 per cent, 
 the most frequent causes being bronchitis, pneumonia, and dysentery. 
 
 The percentage of mortality due to tuberculosis, and other epidemic dis- 
 eases is as follows : 
 
 Per cent. 
 
 Tuberculosis 0.40 
 
 Typhoid fever 0.03 
 
 Malaria 0.01 
 
 Small-pox 0.02 
 
 In Guayaquil, the demographic statistics for 1910 show a death rate of 41.08 
 per thousand in a population estimated at 82,000. The principal causes of 
 death are as follows : 
 
 Per cent of general mortality. 
 
 Tuberculosis 13.79 
 
 Malaria 9.78 
 
 Yellow fever 4.61 
 
 Plague 8.58 
 
 It is true that the death rate in Guayaquil is high, but it should be taken 
 into consideration that this is due to the fact that there go to that port a great 
 number of patients from other points of the Republic seeking cure in the hos- 
 pitals of that city and that a large number of dead from neighboring places 
 are buried in Guayaquil and recorded as taking place in that city. We hope, 
 however, to materially decrease that death rate with the improvement soon to 
 be undertaken. 
 
 The campaign against yellow fever, which is carried on most actively, is 
 absolutely along the lines of the most modern theories and methods. It is 
 carried on not only in Guayaquil but also in the surrounding towns, particu- 
 larly in the railroad zone between Duran and Bucay, the largest focus of the 
 disease, which the greatest number of patients to Guayaquil lazaretto. A pro- 
 visional lazaretto will soon be opened in Duran for the isolation of the cases 
 from that zone. On the other hand, the public is being educated on the pre- 
 vention of the disease, by means of publications, posters, etc. 
 
 The campaign against plague is also carried on most actively in Guayaquil, 
 controlling in an efficient manner every new outbreak. The complete destruc- 
 tion of rats is, however, difficult on account of the nature of our wooden 
 buildings. A great improvement has been effected in Guayaquil, in the matter 
 of building, i.e., that practically all the old wooden gateways have been re- 
 placed for others of stone or cement, thus rendering them rat proof. We 
 will gradually do the same thing with the ground floors of the houses so that 
 no rats can live under them. The general sanitary condition of dwellings has 
 likewise been improved, and the campaign against the rodents is energetically 
 enforced. 
 
 The lazarettos are under the control of a medical director and a staff of 
 interns, composed of senior medical students. Besides the lazarettos for yel- 
 low fever, plague, and small-pox, which are managed by the Health Service, 
 this bureau has established and maintains an observation Hall in the General 
 Hospital, where all patients admitted to that institution are carefully examined 
 before being assigned to the respective wards. All the lazarettos have been 
 built along the most modern lines. In the plague lazaretto there has been 
 established a bacteriological laboratory for the verification of all cases and the 
 systematic examination of rats. 
 
 The small-pox lazaretto has been closed for the last two years, there having 
 been no new cases during that period. We may, therefore, consider this dis- 
 ease as having been definitely stamped out from Guayaquil. 
 
 The maritime health section is under the Port's Physician. 
 
 The Board of Municipal Charities has recently opened the Institute of Ani- 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 109 
 
 mal Vaccine, built in accordance with all modern requirements; it will furnish 
 the whole Republic with the virus as soon as the law of compulsory vaccination 
 shall have been passed by Congress. The great Municipal Chemical labora- 
 tory has also been recently inaugurated, and is in charge of the able German 
 physician, Dr. Robert Levi. 
 
 The municipal government of Guayaquil established several years ago two 
 crematories, which are regularly operated for the destruction of garbage. 
 
 There are in Guayaquil several modern hospitals, splendidly equipped. The 
 General Hospital is provided with clinical, chemical, bacteriological, electrical 
 and radiographic laboratories. 
 
 Through public charities under the initiative of the great philanthropist and 
 distinguished physician. Dr. Leon Becerra, there is maintained at Guayaquil 
 the Society for the Protection of Children, founded several years ago, with a 
 medical dispensary for children, where assistance and medicine are furnished 
 free to the poor. 
 
 For the public school there is a Bureau of School Hygiene, which is charged 
 with the inspection of the health condition of teachers and pupils, and issues 
 hygienic rules and advice as to the preservation of health. 
 
 The sanitation of other cities is also properly looked after by the respective 
 sub-bureaus of health. In Quito specially, the sanitary conditions have im- 
 proved considerably. 
 
 I have taken the city of Guayaquil as the basis of my report in order to 
 show the sanitary and hygienic improvements that have recently been effected 
 in Ecuador, and also to let you know what we are doing to accomplish the 
 complete sanitation of our principal port, which will soon be realized in view 
 of the success so far attained. 
 
 Now then, gentlemen, a country which thus strives to improve the hygienic 
 conditions of its ports, enforcing sanitary measures of inestimable value and 
 with evident success in order to save its own nationals and in order not to 
 constitute a menace to the health of others, deserves not to be excluded from 
 the benefits of the laws, wisely issued and jointly adopted by nearly all the 
 American nations. 
 
 Today Ecuador's commerce suffers considerably on account of the stringent 
 restrictions enforced against its principal port; there are no longer to be seen 
 the numerous ships of all nationalities that formerly promoted our national 
 commerce. The few vessels that are compelled to touch in Guayaquil moor at 
 a place separated by a distance of 2,000 meters from the commercial center, 
 which renders loading and unloading difficult, and hinders the passenge* 
 traffic. 
 
 On the other hand, the steamers plying between Panama and Valparaiso 
 have been obliged to do away with the stop at Guayaquil because their pas- 
 sengers in transit would be considered as coming from an infected port and 
 placed under quarantine for the mere fact that the steamer touched at a dis- 
 tance of over 2,000 meters away from the city and loaded and unloaded under 
 quarantine. 
 
 This procedure, which attacks directly our national interests and works to 
 the positive detriment of continental commerce, compels Ecuador to request 
 this Conference, through its Delegates, that the severe sanitary restrictions 
 imposed against the port of Guayaquil be attenuated and made to conform with 
 the reasonable prescriptions wisely stipulated in the Washington Convention. 
 
 As to the important subject as to what constitutes immunity from yellow 
 fever, I believe that if a person has lived for twelve years in a focus of the 
 disease without contracting it he may be considered as immune therefrom. 
 
 The defense against venereal diseases is a subject which demands the best 
 attention of all Governments. I believe that the regulation of prostitution is 
 the most effective means to prevent the spread of such diseases ; and at the 
 same time a propaganda should be carried on in order to educate the public 
 as to the evils therefrom and as to the manner of prevention. 
 
REPORT BY DR. JUAN B. MIRANDA, DELEGATE FROM 
 
 EL SALVADOR. 
 
 Mr. Presidente: Messrs. Delegates: The Republic of El Salvador, whose 
 Government has conferred upon me the honor of representing it before this 
 Conference, has, in so far as possible, complied with the provisions adopted by 
 the previous conferences. 
 
 The Salvadorean Government's constant aim has been and is to enforce in a 
 practical way all health laws and regulations tending to the sanitation of cities, 
 ports and towns and to safeguard the lives of their inhabitants. The Chief 
 Executive fully realizes that, by giving the best attention to all public sanitary 
 measures, he not only benefits the material interest of commerce, but also 
 renders a deserved tribute to the Science of Life, which is the unanimous 
 aspiration of humanity. 
 
 It is a well known fact that there is in force in El Salvador since 1900 a 
 Sanitary Code which contains all sanitary regulations and provides for all 
 measures that should be taken in case of an epidemic, whether imported or 
 originated in the country. It contains also hygienic regulations for railroads, 
 Hotels, barber shops, church, and other public places ; and for the sale of 
 liquors, beverages and foodstuffs. 
 
 Vaccination is compulsory, and medical inspection of schools and other edu- 
 cational establishments is periodically carried on. 
 
 Yellow fever, which was formerly rather frequent, has practically disap- 
 peared. 
 
 Malaria, which until recently used to cause numerous victims, has decreased 
 considerably; this endemic disease prevails only in the coast. The Govern- 
 ment enforces all measures recommended by science in order to fight the dis- 
 ease. 
 
 In order to fight tuberculosis, which is responsible for high death rate, there 
 have been organized associations, which are efficiently supported by the Gov- 
 ernment. 
 
 For the purpose of educating the people in matters of hygiene, popular 
 pamphlets are published and freely distributed, showing the methods of pre- 
 venting and curing tuberculosis and other infectious diseases. Large posters 
 are also fixed in conspicuous places for the same purpose. 
 
 The water supply of cities is also the subject of the Government's particu- 
 lar attention. 
 
 There is a Board of Health vested with ample authority to look after the 
 public hygiene of the Nation. 
 
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 REPORT OF THE GUATEMALAN DELEGATION, COM- 
 POSED OF DR. SALVADOR ORTEGA AND JULIO 
 BIANCHI. 
 
 Messrs. Delegates : In pursuance of the provisional program for this Con- 
 ference, we have the honor to submit the following report : 
 
 I. 
 
 Most of the sanitary provisions and regulations mentioned in the following 
 were enacted in 1908, but did not become effective until the beginning of 
 1909. This is the list : 
 Regulations governing bakeries. 
 
 barber shops, 
 butcheries, 
 street cleaning, 
 bathing establishments, 
 compulsory report of infectious diseases, and special 
 prophylactic measures for the prevention of small-pox, scarlet fever, diph- 
 theria, typhus, etc. 
 
 Bilharziosis is unknown in Guatemala. 
 
 Leprosy is comparatively rare, from twelve to fifteen lepers being treated 
 annually at La Piedad Asylum ; specially maintained for lepers. 
 
 One confirmed case of rabies was observed last year in the capital. The 
 regulation ordering the capture of all stray dogs and compelling owners to 
 keep their dogs muzzled has had a successful result. 
 
 Exanthematic typhus worked havoc during some time, principally in the 
 army. Thanks to the disinfection of all equipments and harnesses it has now 
 almost totally disappeared. 
 
 Anchylostomiasis prevails in the following places : Chocola, Chitalon, 
 Trapiche Grande, Ixtapaca. Various pamphlets prepared by the Faculty of 
 Medicine on the manner of contracting and preventing the disease have been 
 widely distributed among the farmers in those places. This disease, however, 
 has never appeared in considerable proportions. 
 
 II. 
 
 To improve the sanitation of ports Health Physicians have been appointed 
 in the principal ones (San Jose, Puerto Barrios, Livingston, and Champerico), 
 whose principal function is to prevent the importation of such diseases as 
 cholera, yellow fever, and plague. For the same purpose, Puerto Barrios will 
 soon be provided with Panama iron tanks, which are mosquito proof, and the 
 city is to be supplied with water from the Escondido River. 
 
 Through lack of bacteriological experts, there have not yet been established 
 any laboratories in the ports. 
 
 The crusade against mosquitoes is carried on most vigorously. By means of 
 pamphlets and posters, the public is being educated with regard to the trans- 
 mission and prevention of malaria and yellow fever. The customs duties on 
 quinine salts, formaline, mosquito nets, and wire gauze have been abolished. 
 
 In all public schools the pupils are taught how to guard against yellow 
 fever, malaria, and tuberculosis. Popular lectures with lantern slides are held 
 for the same purposes. 
 
 In all the ports of the Republic special care is taken to prevent the em- 
 barkation of persons suffering from infectious diseases. In Puerto Barrios, 
 our principal port, nobody is permitted to embark unless he produces a cer- 
 tificate to the effect that he is vaccinated and in good health. 
 
 Although plague and cholera do not exist in the Republic, publications have 
 been distributed showing the manner of preventing those dread diseases. 
 
114 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 In order to be prepared for an invasion of yellow fever or plague, several 
 Clayton apparatus have been imported for the destruction of mosquitoes and 
 rodents. 
 
 In order to comply with the recommendation regarding experts on para- 
 sitology and pathological anatomy, the Government has sent several physicians 
 to Europe who are now studying those subjects and bacteriology, with a view 
 to establishing in the country a Pasteur institute. 
 
 The Government has adopted the models for sanitary documents recom- 
 mended by the Conference of San Jose de Costa Rica. 
 
 III. 
 
 The movement of the population in the capital and its suburbs during the 
 last two years was as follows: 1909— births, 3,178; deaths, 3,667; 1910 — 
 births, 4,754; deaths, 4,188. 
 
 The principal causes of death were as follows, with numbers of death : 
 
 1909. 1910. 
 
 Intestinal worms 315 228 
 
 Pneumonia 302 
 
 Tuberculosis 325 230 
 
 Small-pox 216 
 
 Pulmonar catarrh 178 149 
 
 Dysentery 84 
 
 Whooping cough 10 
 
 Typhoid fever 17 
 
 The movement of the population in the whole territory of the Republic was 
 as follows: i909— births, 69,943; deaths, 52,160. 1910— births, 74,498; deaths, 
 35,077. Thus, the increase of population in 1909 was 17,783, and in 1910, 
 39,421. 
 
 IV. 
 
 June 8, 1906, may be considered as the starting point of the work to improve 
 the sanitary conditions of Guatemala, as on that date the Supreme Board of 
 Health was created. This body is governed by the Organic Code of Public 
 Health, which contains also all the provisions of the Washington Convention 
 of 1905. Besides the Supreme Board, there are the Departmental and local 
 boards. 
 
 To prevent the propagation of infectious diseases, we have a lazaretto and 
 a public disinfection station. 
 
 In the lazaretto, which is located in the suburbs of the capital, are confined 
 all cases of infectious diseases. This establishment renders important serv- 
 ices, as, for instance, in the small-pox epidemic of 1908-9 there were treated 
 1,380 cases, of which 31 per cent died. 
 
 In order to guard the nation against the invasion and propagation of this 
 dread scourge, which in the epidemics of 1883-84 and 1890-91 caused over 
 80,000 victims, the present administration ordered recently the establishment of 
 an Institute of A'.iimal Vaccine, thanks to which the epidemic of 1908 did not 
 assume alarming proportions. Since its creation and up to June 30, 1911, the 
 Institute has manufactured 1,314,689 doses of virus. During the year 1909, 
 there were made 1,783,365 vaccinations. When the Institute of Vaccine was 
 opened there had been already imported from abroad large quantities of virus. 
 This accounts for the fact that during 1909 alone there was more vaccination 
 than the number of doses manufactured in the country. 
 
 The epidemic that appeared recently in several departments of the Republic 
 was fought by 24 commissions of physicians and students, who were provided 
 with everything necessary for the organization of lazarettos and for proper 
 treatment of patients. 
 
 Among the inhabitants of the Republic we sincerely believe that there are 
 very few who have not been vaccinated, not only because vaccination is com- 
 pulsory, but also because the authorities and physicians have always cooperated 
 in order to carry out this most important measure. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 115 
 
 There is a well organized street cleaning department in the capital, which 
 is also charged with the removal of refuse and garbage from houses. All 
 the refuse thus gathered, as also all dead animals, are incinerated in the 
 Municipal Crematory, inaugrated in 1908 with machinery from New York. 
 It has a capacity for 15 tons of garbage per day. 
 
 One of the most important improvements in the capital has been the 
 repaying of the streets. The old sewer system is gradually being replaced 
 with a new one. The city is provided with an abundant and excellent water 
 supply, which will soon be further increased. 
 
 In other cities of the Republic sanitary improvements are being carried 
 with great activity. 
 
 V. 
 
 The old regulations on prostitution being deficient, new ones have been 
 drafted which fully meet all the requirements of modern hygiene. We can not 
 report upon them because the Government Attorney has them still under con- 
 sideration. 
 
REPORT OF THE DELEGATE FROM MEXICO, DR. JESuS 
 
 MONJARAS. 
 
 1. Laws of sanitary police and health measures adopted since the Fourth 
 Conference. 
 
 After the Fourth Conference, held in San Jose de Costa Rica, the President 
 of the Republic, by authority of Congress, issued the following legal pro- 
 visions : 
 
 (1) Declaring as infected certain ports which had been invaded by cholera. 
 
 (2) Providing that only Tampico, Veracruz and Progreso should be opened 
 to vessels coming from said infected ports, and that on othei ports on the 
 Gulf of Mexico should be closed to arrivals therefrom. 
 
 (3) Providing that Coatzacoalcos shall be opened only for the purpose 
 of unloading vessels. 
 
 To enforce the above provisions, the Supreme Board of Health issued per- 
 tinent regulations. 
 
 (4) Decree reorganizing the Mexican Red Cross. This institution has been 
 entrusted also with the assistance in cases of public calamities. 
 
 2d. — Compliance with the Resolutions Adopted by the First, Second and 
 Third Sanitary Conferences. 
 
 In the reports submitted by the Mexican Delegations, to those Conferences 
 an account is given as to the manner in which the resolutions of each previous 
 conference had been complied with. So that in the present report I shall 
 confine myself to the resolutions of the Fourth Sanitary Conference of San 
 Jose de Costa Rica. 
 
 With reference to the first of these latter resolutions, I have to state that the 
 measures of isolation and disinfection prescribed in the Sanitary Code and 
 its regulations, are applied to all cases of infectious diseases. With regard to 
 rabies, I will say that there are in Mexico several anti-rabic institutes, similar 
 to the Pasteur Institute of Paris, where all anti-rabic infections are duly 
 and carefully applied. The success of these treatments has been so complete 
 that not one single infection of the thousands of cases that have been thus 
 so far treated, has failed, and our statistics do not show one single case 
 where an individual treated has shown the symptoms of the disease. All cases 
 of rabies occurring in animals are duly verified by all known methods, and 
 whenever possible by the Negree process. On the other hand the sanitary 
 authorities capture all dogs in the streets ; dogs owned by residents are re- 
 quired to be muzzled and tied. 
 
 Concerning exanthematic typhus, there are now being carried on in Mexico 
 scientific investigations in order to discover the patogenic agent, the manner 
 of transmission of the disease, and its serotherapy. To this end the govern- 
 ment offers a prize of $50,000 for works leading to positive practical results. 
 This competition is open to physicians and scientists all over the world. At 
 the same time the Supreme Board of Health enforces energetic measures to 
 prevent the spread of this dread disease. 
 
 Speaking of the II resolution, Mexico has improved or is improving the 
 sanitary conditions of its first and second class ports, and of those which, by 
 virtue of the Washington Convention are the only ones where may be admitted 
 arrivals from localities infected from cholera, plague or yellow fever. Sani- 
 tary inspectors have been trained and laboratories established for the assist- 
 ance of passengers suffering or suspected of any of said diseases, including 
 such persons as may be bacillus carriers. Said ports are also equipped with 
 modern sanitary stations and lazarettos. There are in the capital of the 
 Republic fully equipped bacteriological laboratories, a pathological laboratory 
 and a parasitological laboratory. 
 
 With regard to par. (b) of resolution II, I must say that in Mexico in 
 order to construct a building it is necessary to obtain previously a permit 
 from the Supreme Board of Health, which sees to it that the plans conform 
 with all sanitary requirements. 
 
118 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 With reference to paragraph (c) of the same resolution, it is strictly com- 
 plied with in Mexico, and persons violating its provisions are liable to pun- 
 ishment as provided for in the Sanitary Code of the Republic. 
 
 The first of these answers covers what relates to paragraph (d). 
 
 Referring to paragraph (e), I will say that the campaign against yellow 
 fever and malaria actively carried on in Mexico throughout the year, along 
 the lines set forth in the report of the Mexican Delegation to the Third 
 Conference. (See pages 207 to 211 of the Transactions thereof.) 
 
 As to resolution III, I will state that its provisions are strictly complied 
 with; as also those contained in paragraphs (b), (c) and (d) of said reso- 
 lutions, which are included in the prescriptions of the Sanitary Code and its 
 regulations. 
 
 The requirements of resolution IV are strictly enforced in Mexico by virtue 
 of the Maritime Health Regulations. Besides, all vessels engaged in the 
 transportation of immigrants are equipped with Clayton or Marot disinfecting 
 apparatus, as also are some of the vessels for the transportation of passen- 
 gers. First and second class ports are likewise provided with everything that 
 is necessary for the proper disinfection of ships. 
 
 With regard to resolution 5, the Sanitary Code and the Maritime Health 
 Regulations contain provisions, which are strictly enforced, as to the require- 
 ments that should be observed before allowing passengers to board the vessel. 
 
 Concerning resolution VII, I will say that the sanitary authorities of Mexico, 
 in order to declare a person immune from yellow fever, require that such 
 person shall have suffered an attack of the disease. In this connection there 
 are being carried on experiments to ascertain the true condition of immunity 
 and prevention. 
 
 Reporting upon resolution VIII, I state that the Supreme Council of Health 
 has distributed thousands of pamphlets, and has held illustrated conferences 
 to educate the public in regard to the diseases referred to in the resolution. 
 
 As to resolution IX, the Supreme Board of Health has now under con- 
 sideration, and will submit to Congress, a bill amending the Sanitary Code 
 and its regulations, among which amendments are included the recommenda- 
 tions of this resolution. 
 
 Resolutions XI and XII have been covered in the answer to resolution II. 
 
 (5) Sanitation of cities and especially of ports. 
 
 This subject has been covered in the report of the Mexican Delegation, 
 which appears in pages 218 and 219 of the Transactions of the Third Sani- 
 tary Conference. 
 
 (6) Prophylactic measures against plague and yellow fever. 
 
 Mexico has continued to enforce the same prophylactic measures of which 
 report has been made to previous Conferences. 
 
 (7) What constitutes immunity from yellow fever? 
 
 This question has been answered in the paragraph relating to resolution 
 VIII. 
 
 (8) National and international prophylaxis of tuberculosis, venereal dis- 
 eases, malaria, trachoma, leprosy and escleroma. 
 
 This subject is covered in the answer to resolution I. 
 
 (9) Monthly and annual statistics of morbility and mortality in the principal 
 ports and cities. 
 
 Mexico uses since 1892 the nomenclature of Bertillon (now internationally 
 adopted). With regard to the monthly and annual statistics of the morbility 
 and mortality of the principal ports and cities, they are kept regularly. 
 
 (10) Sanitary inspection of international, maritime and domestic traffic with 
 regard to cases of transmissible diseases. 
 
 For the sanitary inspection of transmissible diseases, Mexico enforces fully 
 the provisions of the Sanitary Convention of Washington, as contained in the 
 Sanitary Code and its regulations. 
 
 (11) Sanitary immigration laws. 
 
 To answer this subject, I refer to the report of the Mexican Delegation to 
 the Fourth Sanitary Conference. 
 
 (12) Data on the adoption of the maritime sanitary documents approved 
 by the Fourth Conference. 
 
 This subject is covered by the answer to resolution XIV. 
 
REPORT PRESENTED BY THE DELEGATE FROM PARA- 
 GUAY, DR. ROGELIO URIZAR. 
 
 Gentlemen : The Republic of Paraguay, although heretofore absent from 
 these International Sanitary Conferences, has established its internal and 
 external defense in accordance with modern methods. Its external defense, 
 that is to say, its international sanitary police, is regulated under the agree- 
 ments signed, first at Montevideo, and later at Rio Janeiro in 1904, with the 
 Argentine Republic, Brazil, and Uruguay. Said agreements are copied from 
 the conclusions reached at the Paris Conference of 1903. 
 
 The interior defense of Paraguay may be said to be in process of develop- 
 ment. The republic being an unusually healthy country, the legislature has 
 found it unnecessary to give much attention to health matters, except when once 
 in a while some diseases appeared which required the enforcement of sanitary 
 measures. 
 
 Formerly, there was in the capital a Board of Medicine which was later 
 reorganized as a Board of Health, with more specialized duties. This Board 
 was composed of a president, a secretary and several members, two of which 
 were pharmacists. All were appointed by the Executive. The resolutions 
 passed by the board were, therefore, belated and inefficient. 
 
 Consequently, by a law of Congress the board was in 1900 reorganized into 
 a Department of Hygiene, something like a sub-Ministry of Public Health. 
 The Director of the Department of Hygiene is to-day the highest sanitary 
 authority in the country, and is under the immediate control of the Minister 
 of the Interior. If the Constitution of the Republic did not, as it does, fix the 
 number of cabinet officers, health affairs would by this time be under a new 
 executive department. 
 
 The powers and duties of the Director of the Department of Hygiene are 
 very ample, because he not only enforces the health laws, but also interprets 
 them and recommends the adoption of such new measures as he deems 
 necessary. 
 
 Under the Department of Hygiene are: (1) The National Institute of 
 Bacteriology, in charge of the preparation of serums and vaccines and of the 
 diagnosis of infectious diseases in the whole territory of the Republic, whether 
 endemic or epidemic, and whether human or animal. As a division of the 
 Institute there is a National Vaccine Conservatory which has produced enough 
 virus to vaccinate almost all the inhabitants of the country, including several 
 hundreds of Indians in the Chaco region. For the diagnosis in infectious dis- 
 eases, the Institute is provided with a complete laboratory, where there are 
 made cultures, inoculations, reactions, etc. Thus, Paraguay is fully equipped 
 to comply with the clause of the sanitary agreement requiring the immediate 
 notification and localization of foccu of infection. 
 
 (2) A section of the Department of Hygiene is also the division of disin- 
 fections and sterilizations, composed of a chief, six inspectors and several 
 companies of guards, whose number may be increased whenever necessary. 
 It is die duty of this division to: disinfect vessels; inspect and supervise 
 the cleaning thereof; destroy rats aboard and fumigate the said vessels, 
 and sterilize clothing, for all of which it is provided with the necessary appa- 
 ratus and instruments. It is also charged with the disinfection of dwellings, 
 utensils, churches, barracks, schools, theaters and other public buildings. 
 
 (3) The Division of Sanitary Inspection, under a physician of the Depart- 
 ment, with a personnel composed of the hygiene inspectors of the Municipality 
 of Asuncion. This division is charged with the supervision of drug stores. 
 
 (4) The Isolation Division, which has in the suburbs of the capital several 
 "houses of isolation," thus called to do away with the name "lazaretto," 
 which is feared by the people. This division is also provided with an ambu- 
 lance service for the transportation of patients. The use of these houses is al- 
 most exclusively devoted to the prophylaxis of plague. 
 
120 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 With the above described organization, the sanitary defense of the country 
 is effected under the following legislation : 
 
 (1) Law of compulsory vaccination, which has been in force for over 2 
 years. 
 
 (2) Law compelling physicians to report all cases of infectious diseases 
 coming under their notice. 
 
 (3) Law creating a permanent annual appropriation for the expenses of the 
 health service. 
 
 (4) Law creating the Department of Hygiene, and its regulations. 
 
 (5) Municipal ordinances in public buildings, vehicles, foodstuffs and 
 beverages. 
 
 Under these laws the Department is authorized to issue such regulations as 
 it may deem wise for the proper enforcement. 
 
 The prophylaxis of leprosy is a question that engages the best attention of 
 the Paraguayan Government, because where ten years ago there were only a 
 few cases imported from abroad, there are now entire families which are 
 veritable leper colonies. I believe that it is high time for the American Gov- 
 ernment to reach an agreement on the prophylactic measures against this, 
 dread disease so widely scattered the world over. And I take advantage of 
 this opportunity to move that the Fifth International Sanitary Conference 
 pass a resolution recommending the countries where the disease prevails to 
 collect minute and detailed statistics of the number of lepers in each country, 
 and to establish leper colonies, like those maintained by the United States 
 Government. 
 
 Like leprosy, tuberculosis was a disease almost unknown in Paraguay. But 
 the beneficial climate of my country attracts thereto every year a large num- 
 ber of consumptives, who have generously spread the germs of so terrible 
 a scourge. The Department of Hygiene is now exerting all possible efforts 
 in order to fight the disease. 
 
 The prophylaxis of venereal diseases is carried on under municipal regula- 
 tions, which tolerate prostitution. In the schools children are taught how to 
 abhor certain diseases and the manner of preventing them. 
 
 Malaria, which is frequent in damp places, is so mild in Paraguay that it 
 is usually cured by the single administration of a purgative. The chronic form 
 is not, however, unusual, but it is as a rule curable. Death on account of 
 malaria occurs only in the yerba mate plantations of the north and east, 
 where the disease is endemic. 
 
 Ankilistuniaris is one of the principal causes of the weakening of the race, 
 because as a rule it attacks the peasants living in places remote from towns 
 and who do not know how to cure or defend themselves. For the purpose of 
 educating the people with regard to the manner of infection and prevention 
 the Department distributes pamphlets on the disease. 
 
 Gastro-enteritis and tetanus neo-natorum were until recently two of the 
 greatest causes of death. In order to check the ravages of the former, the 
 Department of Hygiene maintains special dispensaries where mothers are 
 taught how to feed their babies, and while nursing they are kept under ob- 
 servation, and the children weighed and examined regularly. Tetanus neo- 
 natorum has almost disappeared since the municipalities provided for a suf- 
 ficient number of municipal midwives who are charged with the duty of 
 attending poor women. 
 
 Of the three worst scourges of humanity, cholera, yellow fever and plague, 
 only the latter has gotten a foothold in Paraguay, but only in a form so mild 
 that its death rate is very low. Only in two places of the Republic cases of 
 plague occur once in a while ; Asuncion and Conception. In this connection 
 and before closing, I must mention the good results obtained in Paraguay 
 with the anti-plague sero-vaccination, the use of which should be recommended 
 in epidemics. 
 
The Late Dr. Walter Wyman, Surgeon General, United States Public 
 Health and Marine Hospital Service. 
 
 President of the First and Second International Sanitary Conferences of 
 American Republics, and Chairman of the International Sanitary Bureau 
 of Washington. 
 
 He died suddenly on November 21, 1911. 
 
 We fulfill a painful duty upon paying from these pages a homage of respect 
 to the memory of Dr. Wyman, apostle of public hygiene in the Western 
 Hemisphere. His attractive personality, his incessant activities in behalf 
 of public health, and, above all, the sincere admiration and sympathy 
 which he always showed for the countries of Latin America, with whose 
 hygienists he co-operated efficiently, won for him the respect and affection 
 of the officials and other distinguished men of those nations, as well as of 
 all those who had the privilege of coming in contact with him. 
 
 Dr. Wyman was born in St. Louis, Mo., in 1848. After graduating from the 
 School of Medicine of that city, he joined the Public Health and Marine 
 Hospital Service in 1876. Since then, devoted to the solution of hygiene 
 problems, he soon attained a prominent position in the medical world. 
 Once at the head of the Service he reorganized it and broadened the 
 scope of its activities, to such an extent that it has now achieved a high 
 degree of efficiency and usefulness. 
 
 United States has lost one of its most valuable men; Latin America a sincere 
 friend, and his colleagues of the Sanitary Conference, the beloved brother, 
 the respected teacher. But in our hearts his memory shall forever live, 
 his remembrance shall guide the deliberations of our future conferences, 
 and his spirit, fervently invoked, shall preside over all sessions of these 
 gatherings initiated by his far-seeing mind. 
 
 May he rest in peace! 
 
REPORT OF DRS. GREGORIO M. GUITERAS AND J. C. 
 PERRY, DELEGATES FROM THE UNITED STATES OF 
 AMERICA. 
 
 The Delegation from the United States of America to the Fifth International 
 Sanitary Conference submitted the following reports in accordance with the 
 provisions of the Program of the Conference: * 
 
 SANITARY LEGISLATION IN THE UNITED STATES. 
 
 National. 
 
 Practically no new sanitary legislation has been enacted by the National 
 Congress since the Conference held in San Jose, C. R. One exception is the 
 provision made by the 61st Congress, 2d Session, whereby there may be 
 admitted to marine hospitals for purposes of scientific study, cases of con- 
 tagious and infectious diseases not to exceed ten in any one hospital at any 
 one time. This measure is an important aid in the conduct of investigations 
 already begun, and offers increased facilities for future investigations. Another 
 exception is the provision in the laws of 1910 appropriating $40,000 to enable 
 the President to check the prevalence of contagious and infectious diseases 
 among the Indians, five tuberculosis sanatoria exclusively for persons of the 
 Indian race having been erected in different parts of the country under this 
 provision. 
 
 Different attempts have been made to secure the enactment of laws con- 
 ferring further powers on the federal health organization, but none of these 
 attempts have so far been successful. 
 
 State Legislation. 
 
 Quite a mass of far-reaching health legislation has been enacted in the 
 last two years in the different States of the Union, the most important of 
 which is briefly abstracted here. 
 
 Health Organisation. — Considerable changes were made in the laws govern- 
 ing the sanitary organization of various States. Nevada, North Carolina and 
 Porto Rico revised their former laws with a view to strengthening the State 
 Board of Health, and increasing the efficiency of local health authorities. 
 In Virginia the powers of the State Board of Health were greatly augmented, 
 it being given authority fo appoint local boards of health; in Vermont the 
 sphere of action of local health officers was given more amplitude and that 
 of local boards of health diminished proportionally; in Wisconsin, further 
 duties were imposed on local health officers ; the State Board of Health of 
 Maryland was reorganized into a number of bureaus, a measure which is 
 intended to facilitate the .discharge of its duties; a number of specific powers 
 in regard to sanitation were vested in the State Board of Health of Kentucky; 
 in California the control of the State laboratory was definitely given to the 
 State Board of Health, power given to establish branch laboratories in different 
 parts of the State, and minor changes being made in the office force of 
 the Board. 
 
 Communicable Diseases. — The tendency in the last two years has been gener- 
 ally towards increasing the number of reportable diseases and facilitating their 
 control by the State health authorities. In New York a State laboratory was 
 created for the study of cancer. The State Board of Health of Iowa was 
 given far more latitude in the preparation of regulations governing quarantine 
 and disinfection. The State Board of Health of Virginia was empowered 
 to designate what diseases are to be reported in that State. A list of 11 
 diseases was immediately prepared by that board, and adequate instructions 
 was issued for *their control. The Sanitary Code of Texas was given force 
 
122 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 of law by the legislature, thus compelling compliance with its numerous provi- 
 sions relative to reporting, disinfection and quarantine of cases of the 25 
 diseases mentioned therein. Recent laws have added 10 diseases to those 
 already reportable in Utah, 7 in the case of California, 3 each in the case of 
 North Carolina and Rhode Island, 2 in the case of New Hampshire, and 1 
 each in the case of Iowa and Indiana, while in the exercise of their powers 
 the State health authorities have added 13 diseases to their previous lists in 
 Washington, 7 in Florida, 4 in Porto Rico, 3 in Pennsylvania, 2 in Idaho, and 
 1 each in Maine, New Jersey, South Carolina, Tennessee, and Wisconsin. In 
 addition, revised lists of reportable diseases were issued by the State Boards 
 of Health of Oklahoma (16 diseases), and New York (22 diseases), thus 
 making at present eight States which have under more or less effective control 
 20 or more diseases; namely, California (31), Louisiana (20), Massachusetts 
 (21), New York (22), Pennsylvania (.33), Texas (25), Vermont (24), and 
 Washington (22). 
 
 The unusual prevalence of some diseases or the realization by the public 
 of their importance forced action as follows : 
 
 Hookzvorm. — Made reportable in Virginia, Pennsylvania, and Washington. 
 
 Poliomyelitis (anterior) was made reportable in Florida, Iowa, Idaho, New 
 Jersey, New York, Massachusetts, Pennsylvania, Rhode Island, South Caro- 
 lina, Tennessee, Utah, California, Washington, Maine, Wisconsin. Investiga- 
 tions of the disease were also authorized by law in Rhode Island. 
 
 Pellagra. — Made reportable in California, New York, Pennsylvania, and 
 Washington. 
 
 Ophthalmia neonatorum. — Made reportable in Indiana, District of Columbia, 
 New Hampshire, North Dakota, Utah, and Tennessee, while provision for the 
 distribution by the State Board of Health of a prophylactic to prevent its 
 occurrence was made in Massachusetts and Vermont, thus making with New 
 York and Vermont four States in which such prophylactic is furnished at 
 public expense. 
 
 Rabies. — Made reportable in California and Florida, while provision was 
 made for the free administration of Pasteur treatment to indigent persons 
 in Kansas, Indiana, and Virginia. 
 
 Diphtheria. — Provision for the free supply of diphtheria antitoxin was made 
 in the laws of Connecticut, Delaware, and Iowa. 
 
 Venereal Diseases. — Both California and Colorado require in recent laws 
 the reporting of venereal diseases, this being the first action of this nature 
 in the United States, and perhaps in America. 
 
 Tuberculosis. — The last two years have been marked by more or less com- 
 prehensive legislation in practically all parts of the Union with respect to 
 tuberculosis. 
 
 In addition to the appropriations made for the support of sanatoria already 
 in existence, appropriations for new State sanatoria were made in 1911 in 
 Connecticut, Kansas, Montana, Nebraska, North Dakota, Texas, and West 
 Virginia, while Missouri made provision for the erection of district tuber- 
 culosis hospitals, and New Jersey and Wisconsin authorized the establishment 
 by the counties of such hospitals. Appropriations for the care of tuberculous 
 patients were made in California, Louisiana, and Porto Rico, and for educa- 
 tional campaigns in California, Massachusetts, Mississippi, New Jersey, and 
 Vermont, and for the acquisition of tuberculosis charts for use in the schools 
 in Mississippi. State commissions for the study and recommendation of the 
 best methods to combat the disease were created by law in Massachusetts, 
 Missouri, New Jersey, Minnesota, Rhode Island, and Vermont. 
 
 Laws relating to the registration of cases were enacted in California, 
 Mississippi, New Jersey (in this State a more satisfactory law being sub- 
 stituted for the old one), New Hampshire, and Rhode Island, while their 
 registration was also required in the new regulations issued by the State 
 health authorities in Virginia and Porto Rico; and the stipulation that the 
 records will be strictly confidential made in Wisconsin. 
 
 In Ohio a new departure was made by authorizing the establishment of 
 separate schools for children suffering with tuberculosis. A New Jersey law 
 forbade expectoration on the floors or walls or trolley cars; while in Wis- 
 consin expectoration in all public places was prohibited. 
 
 Drinking Cup. — An organized effort to suppress the promiscuous use of 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 123 
 
 drinking cups in public places was made with the result that during the year 
 1911 laws were passed prohibiting their use in Colorado, Connecticut, Idaho, 
 Illinois, New Hampshire, New Jersey, Massachusetts, and Vermont, while 
 regulations against them were also issued by the State Boards of Health in 
 Kansas, Louisiana, Michigan, Mississippi, Oklahoma, Oregon, and Wisconsin. 
 
 The use of roller towels was forbidden by laws in Connecticut and Wis- 
 consin, and by regulation in Kansas, and the use of suction shuttles in fac- 
 tories in Massachusetts. 
 
 Vital Statistics. — With a view to making the registration of births and 
 deaths more complete, modifications to the existing laws were introduced in 
 Alabama, Idaho, Illinois, Kansas, Kentucky, Massachusetts, Minnesota, Mon- 
 tana, Nevada, New York, North Carolina, Porto Rico, and Rhode Island. 
 The most important of these laws are those of Idaho, Kansas, Kentucky, 
 Montana, and Nevada, as their provisions will probably capacitate these States 
 for admission to the "registration area" of the United States. Only minor 
 changes were made in the laws of Massachusetts, Minnesota, New York, and 
 Rhode Island, States which already belong to the "registration area." The law 
 of North Carolina extends the collection of birth and death statistics to cities 
 over 500 inhabitants instead of 1,000 as formerly. 
 
 Occupational Diseases. — A fair start towards ascertaining the prevalence of 
 certain diseases in various occupations, and thus evolve remedies to avoid 
 their occurrence, was made in 1911, when laws requiring the reporting of 
 certain diseases of occupation was passed in California, Illinois, Michigan, 
 New Jersey, New York, and Wisconsin. These laws apply mainly to those 
 industries in which poisonous materials or other dangerous substances arc 
 handled by the employees. The Illinois law has the widest scope of all, as it 
 also requires that the employers shall provide approved devices and methods 
 for the prevention of the diseases in question. 
 
 Factory Sanitation and Hygiene of Employees. — Further protection to the 
 health of employees was provided by laws passed in Illinois, Maryland, Massa- 
 chusetts, New York, and Virginia, in which provision is made to secure the 
 safety and sanitation of various industries. In Kentucky, New York, New 
 Jersey, Massachusetts, Rhode Island, Maryland, Pennsylvania, South Carolina, 
 and Illinois, laws were enacted regulating the employment of minors and 
 women. 
 
 Poisons. — For the purpose of restricting the sale of poisons or narcotics, 
 laws were enacted in California, Illinois, Indiana, Massachusetts, Mississippi, 
 Montana, New York, Ohio, Oklahoma, South Carolina, and West Virginia. 
 
 Asexualization. — A law was passed in Iowa providing for the sterilization 
 of degenerate criminals, thus making four States (California, Connecticut, 
 Indiana, and Iowa) in which such provision is in force. 
 
 School Inspection. — A number of States passed laws for the medical inspec- 
 tion of children attending the public schools. These are Indiana, New York, 
 Rhode Island, Utah, Vermont, and West Virginia. 
 
 Hotel Sanitation. — Regular inspections by the health authorities and similar 
 establishments with a view to secure the maintenance of sanitary conditions 
 are provided for in recent laws of Georgia, Idaho, Mississippi, Oklahoma, 
 and Virginia. 
 
 Tenement Houses. — Regulation of the tenement houses which constitute 
 chiefly the dwellings of the poor is aimed at in legislation passed in California, 
 Connecticut, Kentucky, and New York, while the determination of insanitary 
 dwellings, and as such unfit for human habitation, is contemplated in a Penn- 
 sylvania law. 
 
 Plumbing. — Examinations for plumbers are provided in the laws of Mary- 
 land, Ohio, and Pennsylvania, while their examinations are placed under the 
 control of the State Board of Health in Massachusetts. 
 
 Nurses. — Laws establishing certain requirements for nurses and compelling 
 their registration were passed in New Jersey, Maryland, Vermont, Idaho, 
 and Wisconsin. 
 
 Pharmacy. — Changes in the laws governing the exercise of the pharma- 
 ceutical profession were enacted in Kentucky, New York, Indiana, Maryland, 
 Rhode Island, Utah, and Vermont. 
 
 Embalming. — The provisions for the licensing of embalmers and the exercise 
 of their calling were somewhat amended in Maryland, Vermont, and Wisconsin. 
 
124 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Water Supply. — A number of laws having for their object the prevention 
 of water pollution were passed in California, New Jersey, Illinois, Louisiana, 
 Rhode Island, and Wisconsin. 
 
 Milk Supply. — Provisions to prevent the contamination of milk were enacted 
 in Colorado, Idaho, Louisiana, Massachusetts, Montana, New Jersey, New 
 York, Pennsylvania, South Dakota, Utah, Vermont, and Washington ; laws 
 requiring the enforcement of the tuberculin test on cattle were passed in 
 Maryland and Virginia. 
 
 Food. — Various amendments to the food laws were made in Georgia, Illinois, 
 Indiana, Kansas, Massachusetts, Mississippi, Montana, New Jersey, Rhode 
 Island, South Dakota, Utah, Wisconsin, Wyoming, California, Pennsylvania, 
 and Vermont. The sanitation of food establishments, and the personal hygiene 
 of employees handling or selling food is required in the laws passed in New 
 Hampshire, Rhode Island, Illinois, and Utah (only in establishments selling or 
 handling meat or meat products). 
 
 FULFILLMENT OF RESOLUTIONS ADOPTED IN PREVIOUS CONFERENCES. 
 
 The delegation of the United States to the Fourth International Sanitary 
 Conference reported on those matters of special import relative to the manner 
 in which the resolutions of previous conferences had been put in practice. 
 It remains to report on the means employed in the United States and its 
 possessions for the enforcement of the resolutions agreed upon at the last 
 conference held in San Jose. 
 
 With respect to bilharziosis, no measures of protection have been taken, nor 
 were they necessary, since the disease is an exotic one and practically never 
 reported in the continental United States. 
 
 Rabies has been made the subject of special investigations, and certain defi- 
 nite measures have been taken for its control. 
 
 The disease prevails in many sections of the country, and it was one of 
 the subjects for consideration at a conference of State and territorial health 
 authorities held in Washington, D. C, April 30, 1910. As a result, there were 
 adopted certain specific recommendations regarding the measures necessary 
 for the prevention and eradication of rabies, which recommendations were 
 subsequently published and distributed to health officers throughout the coun- 
 try. The apparent increase of rabies in the United States rendered necessary 
 the placing of antirabic virus at the disposal of persons bitten by rabid 
 animals, and on April 29, 1908, there was undertaken the preparation and 
 administration of antirabic virus at the Hygienic Laboratory at Washington. 
 Treatments at this institution are administered without charge, and in addition 
 the virus is sent to State health authorities for final preparation and adminis- 
 tration by them. During the fiscal year 1910, 128 persons were treated at the 
 Hygienic Laboratory, and 777 treatments were sent out to the health authori- 
 ties of 14 States. Twelve shipments of the virus were made to the Canal 
 Zone. 
 
 Measures for the control of rabies, to be effective, must be State-wide in 
 their application, and there must be uniformity of executive action by con- 
 tiguous States if any lasting benefit is to be secured. 
 
 In the absence of federal law for the treatment and care of lepers these 
 duties devolve upon State and local health authorities. Lepers who arrive 
 at quarantine are, of course, amenable to the maritime quarantine regulations. 
 Any American sailor who may be afflicted with the disease is entitled to treat- 
 ment, but other persons are cared for by the localities in which they live. 
 Provision has been made by the national government, however, for continuous 
 and systematic investigations of leprosy, and these are being conducted at 
 the national Leprosy Investigation Station in Hawaii. The leprosy bacillus 
 has been grown in symbiosis and in pure culture. The disease has been trans- 
 mitted to lower animals, and attempts have been made to obtain not only a 
 vaccine but a curative serum. These attempts give some promise of success. 
 
 The continued absence of typhus fever from the United States has rendered 
 unnecessary the taking of any special measures against the disease. Realizing 
 its importance, however, and the possibility of its introduction, two officers 
 of the Service were sent to Mexico City in November, 1909, to study the 
 etiology and mode of transmission of the typhus fever prevailing there, and 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 125 
 
 to determine its similarity, if any, to Rocky Mountain Spotted Fever. These 
 officers found from their studies that the disease was not identical with Rocky 
 Mountain Spotted Fever, but probably identical with Old-World typhus fever. 
 They succeeded in producing the disease in two species of monkeys, and found 
 that it is not contagious in the ordinary sense of the word, but is conveyed 
 by means of the body louse. 
 
 Since the last international conference, important measures have been taken 
 in the United States for the prevention and eradication of hookworm disease. 
 The new-world type of this organism having been discovered by Professor 
 C. W. Stiles, in 1902, it has been the subject of continuous investigations in 
 the Division of Zoology of the Hygienic Laboratory since that time. At the 
 same time, a campaign had been carried on with the result that the public 
 was aroused to the importance of the disease, both from economic and public 
 health standpoints, and in October, 1909, a private citizen announced the gift 
 of one million dollars to be used for the eradication of hookworm disease. 
 The administration of this munificent fund was placed in the hands of a board 
 of trustees, and matters have been so conducted as to bring about thorough 
 co-operation between federal, State and municipal sanitary authorities, organi- 
 zations, and private individuals. The State is recognized as the unit of 
 organization. The board of trustees convinces itself of the existence of the 
 disease within a State, and the State board of health then appoints an officer 
 who takes general charge of the work of eradication and appoints assistants. 
 It will thus be seen that the actual work is carried on under the supervision 
 of the State health authorities. Funds are made available from the gift 
 mentioned above, and the federal government acts in an advisory capacity and 
 conducts investigations necessary to the success of the campaign. 
 
 Through public documents announcement has been made of the recommen- 
 dations of the last conference with respect to the employment of necessary 
 measures to secure the effective sanitation of seaports for the prevention of 
 plague, cholera, and yellow fever. A special bulletin was issued on the subject 
 of rats in relation to the public health, and special attention was invited to 
 the necessity of rat-proofing buildings. In other words, it was urged that the 
 rat must be builded out of existence. The extent of this work and the 
 results following it in San Francisco and elsewhere on the Pacific Coast will 
 be referred to in the special report on antiplague measures which is to follow. 
 In the above-mentioned bulletin, attention was also invited to the importance 
 of the use of properly constructed garbage cans. The providing of such cans 
 and the enforcement of regulations relating thereto devolves entirely on private 
 citizens and municipal authorities, and in San Francisco and adjoining cities 
 in which plague has prevailed in the past, such cans have been provided in 
 large numbers. 
 
 Properly equipped laboratories for the detection of plague infection among 
 rats have been maintained at the more important seaports on the Pacific Coast 
 and Hawaii, such as Seattle, San Francisco, Los Angeles, and Honolulu, and 
 arrangements are contemplated which will extend this laboratory service to 
 other ports as occasion may demand. 
 
 In the vicinity of some cities, such as New Orleans, active crusades have 
 been conducted for the extermination of mosquitoes, and in certain of the 
 States, as New Jersey, there exist statutes which provide for the determination 
 of mosquito breeding areas and their proper drainage. 
 
 The measures contemplated in the third resolution adopted by the last 
 conference are recognized by municipal authorities generally as being of fun- 
 damental importance, and in general they are already made the basis of 
 sanitary administration in seaports and cities of the country. 
 
 In conformity with the fourth resolution, and as had previously been decided 
 upon, there was adopted the following quarantine regulation : 
 
 "Vessels engaged in trade from ports infected with plague shall have such 
 measures taken as will free them from rats not less than once every six 
 months. This is best done by fumigation when the vessel is empty." 
 
 It is now recognized that rodents are the all-important agents in the trans- 
 mission of plague in international commerce, and that the most essential anti- 
 plague measure is the freeing of ships of rodents. Studies are accordingly 
 being made to determine the best method of accomplishing this without the 
 destruction of cargo. 
 
126 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 The provisions mentioned in the fifth resolution have long been embodied in 
 the United States quarantine regulations, and the edition of these regulations, 
 revised October, 1910, are entirely in conformity with the spirit of the 
 resolution. 
 
 The dissemination of information regarding sanitation and the public health 
 is a peculiar function of the federal government, and as such has been as 
 fully performed as available appropriations would permit. As an example, it 
 may be stated that during the fiscal year 1910 over 400,000 copies of sanitary 
 and public health bulletins were distributed by the Public Health and Marine 
 Hospital Service. Other bureaus and divisions of the government likewise 
 distributed pamphlets, some of which undoubtedly had an indirect bearing on 
 the public health. In order to discharge more fully this function, and to 
 conform in larger measure to the eighth resolution, representations have been 
 made for greater facilities for the publication and distribution of public 
 health literature. 
 
 The models of sanitary documents approved by the last conference and 
 mentioned in its ninth resolution have been adopted, and are used in quaran- 
 tine practice. 
 
 On account of the cholera situation, which during the past summer has been 
 acute, it was impracticable to conform to that part of the tenth resolution 
 which recommends to the government represented that for future sanitary 
 conferences there be nominated delegates who have assisted at previous con- 
 ferences. It may be stated, however, that the officers designated as delegates 
 on behalf of the United States to the present conference are sanitary author- 
 ities of the highest character and charged with most responsible duties in the 
 protection of the public health. 
 
 With respect to the twelfth and thirteenth resolutions encouragement has 
 been given by the federal government to original investigations in parasitology 
 and tropical medicine. Studies of the former subject are being made by 
 officers of the government, and systematic studies of tropical hygiene by private 
 institutions are being arranged or carried on. As an example, may be men- 
 tioned the contemplated establishment of a School of Tropical Medicine at 
 Tulane University, at New Orleans, La. 
 
 Finally, it may be stated that commendable progress has been made in the 
 United States during the past two years by sanitary authorities generally, not 
 only in the execution of necessary measures laid down by the last conference, 
 but by means of investigations into the causes, methods of transmission, and 
 measures necessary for the prevention and eradication of communicable 
 diseases. 
 
 ORGANIZATION AND WORK OF THE COMMITTEE IN THE UNITED STATES TO REPORT IN 
 CONNECTION WITH THE INTERNATIONAL SANITARY BUREAU OF WASHINGTON. 
 
 In conformity with the plan adopted at the Fourth International Sanitary 
 Conference, it became necessary to submit the names of three gentlemen who 
 would constitute a committee in the United States to act as delegates of the 
 International Sanitary Bureau of Washington, and to form part of the Inter- 
 national Sanitary Information Committee of the American Republics. The 
 names submitted by Surgeon-General Wyman were those of officers of his 
 Bureau who were then and had previously been engaged in the collection and 
 preparation of sanitary information for distribution. 
 
 In the absence of the Surgeon-General, and by reason of seniority, Assistant 
 Surgeon-General A. H. Glennan was at times in temporary charge of the 
 Bureau of Public Health. Assistant Surgeon-General J. W. Kerr has adminis- 
 trative supervision over all scientific research relating to public health ques- 
 tions, and Assistant Surgeon-General J. W. Trask has charge of the Division 
 relating to the collecting of sanitary reports and statistics. The work repre- 
 sented by these two latter Divisions are published in the form of Hygienic 
 Laboratory Bulletins. Public Health Bulletins, and Public Health Reports. 
 Copies of all of these publications, when issued, are furnished to diplomatic 
 representatives of the American Republics at Washington, copies are sent to 
 the Pan American Union, and access is had to them by the membership of 
 the International Sanitary Bureau of Washington. 
 
 It would appear that the plan devised and adhered to by successive inter- 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 127 
 
 national sanitary conferences to provide for the collection and dissemination 
 of information respecting health conditions in the Western Hemisphere is a 
 wise one and deserving of further elaboration. The plan contemplates a 
 committee of three physicians in each country to collaborate, and their efforts, 
 together with the regular discharge of duties of sanitary officials, should result 
 in the prompt collection of accurate data. 
 
 The names of the committees appointed by the several countries are included 
 in the report of the Fourth International Conference held in Costa Rica, and 
 it is hoped at this meeting in Santiago the work of these committees appointed 
 by the different countries may be systematized so that the reports may be 
 gathered regularly and transmitted, a part through the Bureau of Information 
 of Montevideo, and a part direct to the Sanitary Bureau at Washington. 
 According to the statement of President Ulloa at the Fourth Conference in 
 San Jose de Costa Rica countries north of Ecuador should report to the 
 Bureau at Washington, those to the south to the Bureau at Montevideo. 
 
 The United States, through its Public Health Service and the bulletins that 
 it issues, is able to disseminate pertinent information affecting its own country, 
 and many of these bulletins are sent to adjoining countries. 
 
 The Chief Sanitary Officers of any country here represented who is not 
 on the mailing list and does not receive the bulletins will be placed thereon 
 upon request. Many of these bulletins have heretofore been sent to the other 
 Republics through their diplomatic representative in Washington, but a direct 
 request from the Chief Sanitary Officer of each country would meet with a 
 favorable response for the regular mailing of certain of these bulletins. In 
 this connection mention should be made of the monthly bulletin of the Inter- 
 national Office of Hygiene of Paris published in the French language. They 
 contain most valuable information from all countries throughout the world. 
 The bulletins are now available to those countries which contributed to the 
 support of the International Office of Hygiene of Paris. The latest informa- 
 tion concerning health activities in the United States as well as in other 
 countries are contained in these bulletins. It would be well if each country 
 would become contributory to this office in Paris so that these bulletins would 
 be transmitted regularly to the principal sanitary authorities in each of the 
 Republics. 
 
 SANITATION OF CITIES AND SEAPORTS. 
 
 American cities enjoy the greatest amount of decentralization; and excepting 
 certain restrictions on taxation and indebtedness imposed upon them by their 
 charters or the general laws, they are sole arbiters in all matters pertaining 
 to internal improvements. There are of course certain sanitary requirements 
 which they must observe, as otherwise the State authorities are usually empow- 
 ered to intervene and take charge of the health administration, an action 
 which would hurt the business interests of the city, and to which all com- 
 munities are averse. In the case of epidemics, defective sanitary conditions, 
 or impure water supply, liable to cause disease, the State Board of Health or 
 the Federal Public Health Service sends on request experts to investigate 
 the matter, determine the exact conditions responsible for it, and suggest 
 remedies for their improvement or prevention. These requests are frequently 
 received from various parts of the country, and as a result of the reports 
 made by the officers conducting the investigation, sanitary works are often 
 undertaken by the cities with a view to securing better water supply, disposal 
 of sewage, etc. 
 
 Although the Federal Government purposely abstains from interference in 
 local affairs, the enormous amount of national property scattered all over the 
 country in the form of quarantine stations, marine hospitals, naval reserva- 
 tions, custom houses, army posts, post offices, etc., obliges the national author- 
 ities, outside of other considerations, to watch closely local health conditions, 
 and gives them at the same time an excellent opportunity to exercise a benef- 
 icent influence on the health affairs of most cities. This influence is due to 
 the high sanitary and hygienic standards maintained by the Federal Govern- 
 ment in the grounds or reservations under its control, and also to the fear 
 that if proper sanitary requirements are not enforced, such federal property 
 as is located in the city may be appropriated to other purposes. 
 
128 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 In a number of States, cities are required to provide such modern facilities 
 as sewerage systems, adequate water supply, drainage facilities, etc., the expense 
 to be met by taxes or bonds to be approved by the people at special elections, 
 or distributed, pursuant to the provisions of the law, between the public 
 treasury and the owners of the property benefited. Such improvements are 
 going on all the time in practically every part of the country. Vast work in 
 this line has been done in the most important cities, such as Baltimore, New 
 Orleans, New York, Seattle, and San Francisco. To further accelerate this 
 movement, laws have been passed in some States, as in Pennsylvania, requiring 
 all cities in the State to erect plants for the disposal of their sewage in a 
 fixed number of years. In those States with large centers of population hardly 
 a legislative session goes by without the enactment of some law aimed at safe- 
 guarding the water supply, compelling the adoption of scientific systems of 
 sewage disposal, or appointing commissions to study any existing unsanitary 
 conditions, and make recommendations for their amelioration. 
 
 As some cities derive their water supply from, or discharge their sewage 
 into, interstate or international waters, which are admittedly under federal 
 control, there is a strong probability that the national congress may adopt 
 measures to prevent the pollution of these waters, thus helping the cause of 
 the many communities which are now struggling so persistently for better 
 sanitary conditions. 
 
 On the whole there is steady improvement in the United States in the matter 
 of sanitation of urban centers, the results of which will undoubtedly be 
 reflected in lower morbidity and mortality rates. 
 
 PROPHYLACTIC MEASURES TAKEN AGAINST THOSE DISEASES SPECIFICALLY MEN- 
 TIONED AND PROVIDED FOR IN THE SANITARY CONVENTION SIGNED 
 
 ad referendum, Washington, October 14, 1905. 
 
 In conformity with the sixth topic contained in the provisional program, it 
 is necessary to review the present status as affects the United States of those 
 diseases specifically mentioned in the International Sanitary Convention signed 
 at Washington, October 14, 1905. These diseases are plague, cholera and 
 yellow fever. As is well known, both plague and cholera are making pandemic 
 invasions of the earth, while yellow fever, on the other hand, has receded until 
 it may be stated that it has been less prevalent during the last two or three 
 years than for any equal period in a quarter of a century. No detailed descrip- 
 tion will therefore be given of the measures taken against yellow fever, and 
 particularly since report is subsequently to be made on the broad subject of 
 immunity to this disease. 
 
 It remains to discuss both plague and cholera, which diseases within the last 
 two years have been of great interest, not only to the United States, but to 
 practically all other countries in the Western Hemisphere. The continued 
 advance of these diseases is sufficient to attest the wisdom of the action taken 
 at preceding conferences for their prevention, and to invite further interna- 
 tional co-operation for their eradication. 
 
 plague. 
 
 It was stated in the report of the Delegates of the United States at the 
 Fourth International Sanitary Conference that measures against plague were 
 being continued on the Pacific Coast by the Public Health and Marine Hos- 
 pital Service. These measures have been continuously carried on since that 
 report was made, with the result that no cases of human plague have occurred 
 in San Francisco since February, 1908, and no cases have been infected in 
 Oakland since July 17, 1908. Only four cases have occurred in this period, 
 and these were in rural districts. The last case of rat plague in San Fran- 
 cisco was found October 23, 1908, and in Oakland, Cal., December 1, 1908. 
 At Seattle, Wash., no case of human plague has occurred since October 25, 
 
 1907, and but two cases of rat plague have been found since September 26, 
 
 1908. These rats were found, one February 8, 1910, and the other August 
 26, 1911. 
 
 Anti-plague measures have been continued in these cities and are being 
 continued at the present time even though no cases of human or rodent plague 
 have been discovered except as above mentioned. The measures have been 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 129 
 
 continued for the purpose of determining whether plague had appeared or was 
 likely to reappear among rodents, and were made especially necessary in San 
 Francisco and the bay cities by the prevalence of plague among the common 
 ground squirrels of California, the first infected squirrel having been found 
 in Contra Costa County in August, 1908. Since the discovery of this squirrel 
 a continuous campaign of investigation and eradication has been carried on 
 for the double purpose of determining to what extent the infection has spread, 
 and to destroy infected squirrels as far as possible. 
 
 Squirrel-free zones have been maintained around the cities of San Fran- 
 cisco, Oakland, Berkeley, and Alameda, and have averaged from a mile or 
 two to several miles in width. Camps of instruction have been maintained 
 upon these zones for the purpose of instructing new employees in the methods 
 to be used in squirrel destruction, and also for the purpose of instructing 
 county authorities, ranch owners, farmers, and other individuals who desire 
 to avail themselves of the opportunities thus afforded. 
 
 The investigations as to the prevalence of squirrel plague have extended 
 over 45 counties of the State of California, and investigations have been made 
 in several counties of Nevada and Oregon as well. No infection has been 
 found in these latter named States. 
 
 During the past two years infection has been found among squirrels in 
 11 counties of the State of California. During the past year, however, no 
 infection has been found in 4 of the counties that were previously infected, 
 leaving 7 counties infected at present. 
 
 In September, 1910, a systematic campaign against squirrels was begun in 
 the following manner : A portion of the force was used in the maintenance 
 of squirrel-free zones and for the purpose of destroying known foci of 
 infection. Another portion was sent further afield for the purpose of deter- 
 mining to what extent the infection had spread, and for the discovery of 
 new and unknown foci of infection. This work has been practically com- 
 pleted for several months and a general campaign of squirrel eradication is 
 now being carried on. 
 
 On March 13, 1909, the Legislature of the State of California passed an act 
 which makes it incumbent upon property owners throughout the State to 
 begin in good faith the destruction of all squirrels on their property, and the 
 State Board of Health is authorized to make inspection to determine whether 
 squirrels are present or not. When the presence of squirrels is reported by 
 agents of the State Board of Health, notice is served upon the property owner 
 to begin work. If work is not begun within a reasonable time the State 
 Health Officer or the local Health Officer of the county in which the property 
 lies proceeds to exterminate the squirrels and the cost of this work then 
 becomes a lien upon the property. 
 
 The officer of the Public Health and Marine Hospital Service in charge of 
 plague suppressive measures in California has perfected an arrangement with 
 the State and county authorities by which a certain number of inspectors are 
 appointed by the latter. These county inspectors work in conjunction with 
 the employees of the Federal Government and are under the direction of the 
 Service Officer. 
 
 Quite a number of counties have joined this movement and have employed 
 inspectors, and as a result a joint Federal and County inspection is under way. 
 Much interest is being manifested in the work by all parties concerned and 
 favorable results are expected. 
 
 Since the report to the Fourth International Sanitary Conference 4 cases 
 of plague have occurred. All these cases were infected from ground squirrels 
 and no spread has resulted from any case. During the year ending July 1, 
 1910, 116,515 rats were collected and examined and none found infected. 
 One hundred and thirteen thousand six hundred and fifty-five were caught and 
 examined and 354 were found infected. During the year ending July 1, 1911, 
 127,948 rats were caught and examined and none were found infected; 126,125 
 squirrels were caught and examined and 55 were found infected. The reason 
 so few infected squirrels were found during the year ending July 1, 1911, is, 
 that the most of the work during the year was in the nature of a recon- 
 naissance to determine how far the infection had spread. Now that eradica- 
 tion work is fairly under way, it is expected that the number of infected 
 squirrels found will be materially increased. In fact, from July 1, 1911, to 
 September 2, 1911, 78 infected squirrels have been found. 
 
130 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 The fact that so few human cases of plague have occurred during the past 
 two years, considering the extent of the infection in California, is very 
 encouraging, as is also the fact that the extent to which infection has spread 
 is known. 
 
 A squirrel-free zone is being created at the present time on the border of 
 the infected area in order to check its further spread, and inasmuch as the 
 efficacy of these zones has been proven in the case of San Francisco and the 
 other cities there is reason to believe that the free zone in the rural district 
 will be equally efficacious. This latter zone was made necessary for the 
 following reasons : 
 
 As is well known the Sierra Nevadas are a large range of mountains which 
 traverse in a general northerly and southerly direction the eastern part of the 
 State of California; the common ground squirrel of California is found as far 
 up as 7,500 feet elevation, but does not extend to a higher point, the average 
 height of the mountains being probably 10,000 feet. These mountains were 
 therefore considered as more or less of a natural barrier. Later, however, 
 investigation has shown that there are several passes through these moun- 
 tains, the elevations of which are less than the 7,500 feet mentioned, and the 
 squirrels continue through these passes and connect with the squirrels on the 
 eastern side. Prior to December, 1910, the San Joaquin River had been con- 
 sidered a natural barrier to the spread of the disease among squirrels on 
 account of its size and on account of the fact that large and extensive swamps 
 are present on both sides of the river, but in December, 1910, infected squirrels 
 were found on the east side of this river at two points, so that the river can 
 no longer be so considered, and the establishment and maintenance of the 
 squirrel-free zone above mentioned was decided upon as the best means of 
 preventing the spread of the disease further to the east. 
 
 In order to prevent the further importation of plague into the United States 
 and to avoid all interruption of commerce, officers of the Public Health and 
 Marine Hospital Service are detailed to Guayaquil, La Guaira, and to ports of 
 Japan and China. These officers maintain a close supervision on all ships 
 bound for the United States, and at frequent intervals fumigate vessels bound 
 for the United States with sulphur for the destruction of rats and the other 
 vermin aboard. The quarantine laws and regulations of the United States 
 as revised in October, 1910, state in section 112, as follows: 
 
 "Vessels engaged in trade from ports infected with plague shall have such 
 measures taken as will free them from rats not less than once in every six 
 months. This is best done by fumigation when the vessel is empty." 
 
 With this regulation as a basis there has been inaugurated what is known as 
 a "rat quarantine," and all quarantine stations of the Service have been directed 
 to report to the Bureau at Washington the number of vessels which ply 
 between plague-infected ports and ports of the United States, and are directed 
 to fumigate these vessels for the destruction of rats and vermin at least once 
 every six months, and oftener, if practicable. 
 
 Experience of several years in the fumigation of vessels in the Philippines 
 has shown that if vessels are fumigated regularly at least once every six 
 months, rats and vermin will be maintained at a low minimum, due to the 
 periodical destruction of most of them, and also due to the fact that rats will 
 not board vessels so treated. 
 
 The progress of plague throughout the world has been carefully followed 
 during the last two years and necessary precautions have been taken to 
 prevent the entrance of the disease. The occurrence of several cases of 
 human plague in the county of Suffolk, England, the discovery that plague 
 is endemic among the rodents of that vicinity, and the discovery of plague 
 among rats in Wapping, a part of the port of London, are matters of interest 
 that are now engaging the attention of the Public Health and Marine Hospital 
 Service for the purpose of determining what influence or bearing these occur- 
 rences will have. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 131 
 
 CHOLERA. 
 
 The delegation of the United States to the Fourth International Sanitary 
 Convention of American Republics reported on the world distribution of 
 cholera and the measures which were being taken by the United States Public 
 Health and Marine Hospital Service against its introduction. That report 
 covered the period ending June 30, 1909, and it is now desired to review the 
 cholera situation from that time to the end of the fiscal year ending June 
 
 CHOLERA IN RUSSIA. 
 
 During the summer of 1909 cholera was distributed over a wide area, the 
 city and government of St. Petersburg and the southern governments suffering 
 the most. In St. Petersburg there were more than 6,000 cases and over 2,000 
 deaths. The disease prevailed in all parts of the city and cholera bacilli were 
 found in the water of the River Neva, from which the municipal water supply 
 is taken. With the approach of winter there was a subsidence in the disease, 
 and from January 29, 1910, to May 8, 1910, no cases were reported. When 
 the disease reappeared, the Bachmut province was first attacked, and from 
 that point cholera spread over European Russia, attacking 216,796 persons, of 
 whom 100,982 died, in the period from May 8, 1910, to February 4, 1911. 
 Cold weather again brought a respite from the disease until April 21, 1911, 
 when cholera again appeared in Russia. From that date until September 11, 
 1911, 1,045 cases and 579 deaths have been reported. 
 
 CHOLERA IN GERMANY. 
 
 An July 21, 1909, an American traveling in Europe died of cholera at 
 Konigsberg, Germany. In September of the same year a fatal case occurred 
 in Pakalisne. near Russ, in eastern Prussia. On September 22d, another fatal 
 case was reported from the town of Stolzenhagen, 25 miles north of Stettin. 
 In October, November, and December cases were reported at various places in 
 East Prussia, but on December 30, 1909, Germany was officially declared free 
 of cholera. Forty-four cases occurred during the outbreak. On June 23, 
 1910, a Russian immigrant from the Warsaw district died of cholera at the 
 immigrant inspection station at Ruhleben, near Berlin. On June 27th another 
 case occurred among immigrants, and in September cases occurred in Marien- 
 burg and its suburbs. The last cases reported from Germany occurred on 
 October 9, 1910, since which time no cases have been reported in that empire. 
 Thirty-three cases and sixteen deaths were reported during the 1910 outbreak. 
 
 CHOLERA IN SWEDEN. 
 
 On August 12, 1909, a case of cholera occurred at Stockholm, Sweden, in 
 the person of a traveler who had arrived by steamship from St. Petersburg 
 on August 10th. This is the only case which has been reported from Sweden 
 in the present pandemic. 
 
 CHOLERA IN THE NETHERLANDS. 
 
 Two cases of cholera were reported at Rotterdam on August 20, 1909. The 
 local health authorities immediately inaugurated vigorous measures to prevent 
 the spread of the disease. In all, thirty- four cases and fifteen deaths occurred 
 up to September 14, 1909, when Rotterdam was officially declared free from 
 cholera. In 1910, one case occurred at Rotterdam on board a vessel from 
 Russia, and since that time no cases have been reported from that city. 
 During the 1909 outbreak the disease appeared in sporadic form at many places 
 in Holland, and had it not been for the prompt and efficient measures which 
 were promptly taken at the infected places, a more serious outbreak would 
 have occurred. The wide dissemination of the disease may be accounted for 
 by the presence of cholera carriers, of which a number were found. 
 
 CHOLERA IN BELGIUM. 
 
 Nine cases of cholera with six deaths were reported between October 26 
 and 30, 1909, at Boom, a town of about 17,000 inhabitants, situated 10 miles 
 from Antwerp. Since that time no cases have been reported from Belgium. 
 
132 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 CHOLERA IN THE PHILIPPINES. 
 
 Cholera was present in the Philippines throughout 1909 and 1910, but a 
 determined effort was made to discover and isolate every case, and so vigor- 
 ously has this been prosecuted that no cases were reported, either from Manila 
 or the provinces for the first quarter of 1911. A case from Amoy, China, was 
 apprehended at the Mariveles quarantine station May 25, 1911. 
 
 CHOLERA IN ITALY. 
 
 On August 17, 1910, cholera was reported in Italy. The cause of the out- 
 break is alleged to have been the embarkation at Brindisi of a party of Russian 
 gypsies from Batum. They proceeded by rail to Trani, which appeared to be 
 the primary focus of the epidemic. The infection spread to various towns 
 and cities in the Provinces of Bari and Foggia, both in the region of Apulia. 
 In late September the situation became worse and cases of cholera were 
 confirmed bacteriologically and officially reported in Naples and Rome. By 
 October 1st the disease had been officially declared in the Province of Salerno 
 and town of Auletta, the Province of Sicily and towns of Palermo and Mon- 
 reale. Mid-October found the Provinces of Avellino, Caserta, and Campobano 
 also infected, and early November added the Provinces of Girgenti, Lecce, 
 Caltanisetta, Perugia and Trapani to the list. Cases continued to be reported 
 from Italy until February 4, 1911, from which time until June 8, 1911, when 
 there was a cholera death at Reggio di Calabria. Since that time to September 
 2, 1911, 10,397 cases and 4,123 deaths have been reported from no less than 
 seventeen different provinces. 
 
 CHOLERA IN AUSTRIA-HUNGARY. 
 
 On June 20, 1910, a case of cholera, apparently imported from Russia, was 
 reported at Padwolococzyska in Galicia. August 31st two cases were reported 
 at Vienna in persons recently arrived fiom Hungary. September 13th isolated 
 cases of cholera were reported in eight villages from Kressburg to Mahacs, on 
 the Danube. Later, cases were reported at Trieste, Laibach and Gratz, but the 
 disease died down and no cases were reported from December 17 to May 24, 
 1911, when it reappeared in several localities, the bulk of the cases occurring 
 at Trieste. 
 
 GEOGRAPHICAL DISTRIBUTION OF CHOLERA. 
 
 July 1, 1909, to June 30, 1911. 
 
 July 1, 1909, to July 30, 1910: 
 
 Asia. — Ceylon, China, India, Indo-China, Japan, Java, Korea, Manchuria, 
 
 Persia, Siam, Siberia, The Straits Settlements. 
 Europe. — Belgium, Germany, The Netherlands, Russia, Austria-Hungary. 
 
 July 1, 1910, to June 30, 1911: 
 
 Asia. — Arabia, Borneo, Ceylon, China, Federated Malay States, India, Indo- 
 China, Japan, Java, Korea, Manchuria, Persia, Siam, Turkey, Straits 
 Settlements. 
 
 Africa. — Tripoli, Tunis. 
 
 Europe. — Austria-Hungary, Bulgaria, Denmark, France, Germany, Italy, 
 Roumania, Russia, Servia, Turkey. 
 
 North America. — Canada,* United States.f 
 
 South America. — Brazil. 
 
 MEASURES TAKEN AGAINST THE INTRODUCTION OF CHOLERA FROM RUSSIA AND ITALY. 
 
 On account of the widespread character of the epidemic, particularly because 
 of the conditions prevailing in Russia and Italy, the enormous emigration from 
 these countries presented a quarantine problem which occupied the immediate 
 and serious consideration of the Public Health and Marine Hospital Service 
 of the United States. The measures instituted to prevent the introduction of 
 the disease may be divided as follows : 
 
 1. Quarantine measures enforced at foreign ports of embarkation. 
 
 2. Those enforced during the voyage. 
 
 *At quarantine. 
 
 fAll cases (except one at Auburn, N. Y.) were at quarantine. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 133 
 
 3. Those taken at the various quarantine stations in the United States. 
 
 4. Special inspections for the detection of cholera made by Service officers 
 engaged in the medical inspection of arriving aliens. 
 
 5. The immigration destination notification system. 
 
 QUARANTINE MEASURES ENFORCED AT FOREIGN PORTS OF EMBARKATION. 
 
 The measures enforced at the foreign ports of embarkation, so far as the 
 present cholera situation in Europe is concerned, date from July 14, 1910, when 
 a request was made through the Treasury Department for the resumption at 
 certain European ports of the detention for five days of steerage passengers 
 from the cholera-infected districts in Russia prior to their embarkation to 
 the United States. 
 
 The enforcement of the provisions of paragraphs 30, 31 and 32 of the Quar- 
 antine Regulations of 1903 (paragraphs 29, 30, and 31, revised regulations of 
 1910) by the consular officers at Hamburg, Bremen, Antwerp, Rotterdam, and 
 at continental and British ports dates from September 17, 1908, when the 
 prevalence of cholera in Russia made it necessary to provide for the deten- 
 tion of steerage passengers for five days in suitable barracks and for the 
 disinfection of their baggage at the ports of departure. 
 
 The regulations also provide that cabin passengers coming from cholera- 
 infected districts embarking at clean or infected ports should produce satis- 
 factory evidence as to their exact place of abode during the five days imme- 
 diately preceding embarkation. 
 
 On January 8, 1910, these restrictions had been temporarily removed on 
 account of the great diminution or almost complete absence of cholera in 
 Russia, but, as stated above, they were resumed on July 14, 1910. On account 
 of the steadily increasing spread of the disease a request, August 9th, that 
 the consular officers at the ports above mentioned detain for five days prior 
 to their embarkation steerage passengers from all parts of Russia, it being 
 considered impracticable, not to say impossible, for all the consular officers 
 to determine whether a given group of emigrants were from a district in 
 Russia not infected with cholera. 
 
 Finally, on account of the general prevalence of the disease throughout the 
 Russian Empire and the report of its appearance in Germany and in Italy a 
 request was made through departmental channels on September 2, 1910, that 
 the consular officers at the ports of Marseilles, Havre, and Cherbourg, in 
 France, and the Italian ports of Genoa, Palermo, and Messina be instructed 
 to detain steerage passengers from all parts of Russia and disinfect their bag- 
 gage prior to embarkation for the United States. 
 
 Medical officers of the Service are regularly assigned to duty in the American 
 consulates at Naples, Palermo, Genoa, Messina, and Catania, Italy, Marseilles, 
 France, and Libau, Russia. In addition officers were detailed to inspect ports 
 of embarkation in Italy, France, England, Holland, Belgium, Austria-Hungary, 
 and Russia, in order to include them in a huge and effective cordon sanitaire. 
 This outgoing quarantine work performed at the various foreign ports is 
 provided for by the "special regulations on account of cholera, foreign and 
 insular, paragraphs 24, 25, 26, 29, 30, 31, and 32. 
 
 Special attention is paid to the inspection of intending emigrants to deter- 
 mine the presence in their baggage or upon their persons of foodstuffs, bottled 
 water, etc., which might have been exposed to the infection, and to the destruc- 
 tion of such articles when found. This inspection is made before and after 
 the period of detention. 
 
 While the methods of procedure may differ to a certain degree at the 
 various foreign ports, a description of the routine at such ports as Libau and 
 Naples may be taken as a fair example of the work under consideration. 
 
 Emigrants are received until the evening of the sixth day preceding the 
 sailing of the vessel. They are there held for five full days prior to their 
 departure and subjected to a daily medical inspection. A personal inspection 
 of the vessel is made on the day of sailing. Each family or single person is 
 given a dated green card, termed a "quarantine" card, which states the name 
 and age of each individual, and the fact that said person is at the time free 
 from quarantinable disease. The card is stamped by the representative of the 
 Service at the time of the first examination. Then upon the day of sailing, 
 
134 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 five days later, the "quarantine" cards are again produced, attached to the 
 ship's ticket as a control, and after the examination of the passenger the 
 card is stamped with a date stamp marked "Second inspection." All emigrants 
 not having a quarantine card, those with the card not stamped and dated, or 
 those ill or suspected of being ill, are recommended for detention in the city 
 until the sailing of the next vessel, two weeks later. 
 
 MEASURES ENFORCED DURING THE VOYAGE. 
 
 Not only were the majority of the steamship lines furnished with copies 
 of paragraphs 46 to 52, inclusive, of the United States Quarantine Regulations, 
 but, in accordance with the general instructions therein contained, a general 
 order was issued to practically all of the trans-Atlantic lines running into 
 the ports of New York, Boston, Philadelphia, Baltimore, Montreal, Halifax, 
 and Norfolk to instruct the ships' surgeons to carefully inspect all passengers 
 and crews, and to particularly note their condition during the 24 hours prior 
 to their arrival at the ports above mentioned. 
 
 MEASURES TAKEN AT THE QUARANTINE STATIONS IN THE UNITED STATES. 
 
 Upon the arrival of vessels from cholera-infected ports or from ports from 
 which persons from infected districts embark, the vessel, together with the 
 personnel and passengers, are subjected to a careful inspection. This in- 
 cludes a personal inspection of the individual, an examination of any person 
 ill, and a bacteriological examination of the stools of any reported to have 
 suffered from any gastro-intestinal disturbance en voyage, or whose appear- 
 ance would so indicate, or who may have been in close contact with a person 
 or persons whose illness is considered suspicious. 
 
 The vessel is held in quarantine pending any examination thought warranted 
 by the circumstances. At this inspection the work performed at foreign ports 
 is checked up and failures to comply with the prescribed restrictions are 
 discouraged by appropriate measures. In cases of emergency an expert from 
 the Hygienic Laboratory is detailed to conduct the investigation at the port 
 or place where the suspected case is being held. 
 
 SPECIAL INSPECTIONS FOR THE DETECTION OF MILD OR PREVIOUSLY UNRECOGNIZED 
 CASES OF CHOLERA MADE BY SERVICE OFFICERS. 
 
 The medical officers of the Service engaged in the inspection of arriving 
 aliens have rendered invaluable aid by carefully endeavoring to detect cases of 
 cholera which on account of obscure symptoms might have passed the regular 
 quarantine inspection. The result has been that the medical inspection of 
 arriving aliens may be rightly classed as an important line of quarantine 
 defense. 
 
 When a death from cholera occurred July 20, 1911, at the Boston quarantine 
 station and three days later a death occurred at the New York quarantine 
 station from the same disease, specially qualified officers of the Service were 
 stationed at those ports to reinforce the quarantine inspection by special phys- 
 ical and bacteriological examinations. These prompt measures have thus far 
 resulted in the apprehension of the imported cases before their departure 
 inland. 
 
 THE IMMIGRANT DESTINATION CERTIFICATION. 
 
 It was thought that the measures above described were ample in scope and 
 effectiveness to meet the cholera conditions, and the quarantine problem caused 
 thereby, save in one particular, and that was in the case of "cholera carriers." 
 The fear of the "cholera carrier" from a quarantine standpoint arises from 
 the uncertainty as to the duration of the infectivity of the individual. While 
 the majority of observers assert that "carriers" lose their vibrios in 10 days, 
 certain authorities claim that the vibrios are carried for much longer periods, 
 even as long as 69 days. The average time elapsing between the beginning 
 of the period of detention of emigrants at a foreign port and the landing at 
 the United States port is about 17 days. This is 7 days in excess over the 
 commonly accepted period during which vibrios are carried and is a source 
 of much safety and confidence. But the "cholera carriers" of long duration, 
 however infrequently they may be encountered, presented a problem which 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 135 
 
 could only be met by the establishment of a system by which the services of 
 the local health officers throughout the United States could be utilized in 
 keeping under surveillance those localities wherein newly arrived immigrants 
 are domiciled. An arrangement was therefore effected at all the large immi- 
 gration stations by which the destination of each immigrant from a cholera- 
 infected country is recorded on a separate card. The cards are then segre- 
 gated according to the States to which the immigrant is destined and mailed 
 daily to the secretaries of the various State boards of health for further 
 distribution to the local health officers in each State. The facsimile of the 
 face and back of the card below will show the form in which the information 
 is sent. 
 
 (Face) 
 IMMIGRANT DESTINATION CARD 
 
 Port of.. 
 
 MONTH 
 
 Jan. 
 
 Feb. 
 
 Mar. Apr. 
 
 May 
 
 June 
 
 July 
 
 Aue. 
 
 Sep. 1 Oct. 
 
 Nov. 
 
 Dec. 
 
 DAY 
 
 2 
 
 3 
 
 4 
 
 5 
 
 6 
 
 7 
 
 8 
 
 9 
 
 10 
 
 11 
 
 12 
 
 13 
 
 14 
 
 15 
 
 18 
 
 19 
 
 20 
 
 21 
 
 22 
 
 23 
 
 24 
 
 25 
 
 26 
 
 27 
 
 28 
 
 29 
 
 30 
 
 31 
 
 Name of Immigrant 
 
 From what Country? ITALY RUSSIA 
 
 (Check indicates the country) 
 
 DESTINATION 
 
 
 Ala. 
 
 ! Cal. 
 
 Del. 
 
 Ga. 
 
 Ind. 
 
 Ky. 
 
 Md. 
 
 Minn. 
 
 Neb. 
 
 N.J. 
 
 N.C. Ok!a. 
 
 : r.i. 
 
 Tenn.l Vt. 
 
 W.Va. 
 
 STATE: 
 
 Ariz. 
 
 Colo. 
 
 D. C. 
 
 Idaho 
 
 Iowa 
 
 La. 
 
 Mass. 
 
 Mo. 
 
 Nev. 
 
 N.M. 
 
 N.Dak 
 
 Oreg. 
 
 s.c. 
 
 Tex. | Va. 
 
 Wii. 
 
 
 Ark. 
 
 Conn. 
 
 Fla. 
 
 111. 
 
 Kans. 
 
 Me. 
 
 Mich. 
 
 Mont. 
 
 N.H. 
 
 N.Y. 
 
 Ohio 
 
 Pa. 
 
 S. Dak 
 
 Litah Wash. 
 
 Wy. 
 
 Town or City Street and Number. 
 
 Initials of Inspector. 
 
 (Back.) 
 
 TREASURY DEPARTMENT, WASHINGTON, D. C. 
 
 On information received from the Commissioner of Immigration, this card 
 is sent to the State boards of health that they may be informed of immigrants 
 coming into the States from countries in which at the present time cholera 
 is prevalent, whether generally prevalent or only in certain districts. The 
 person named on the reverse has been subject to the quarantine regulations at 
 foreign ports, the quarantine inspection at the domestic port, and also the 
 subsequent immigration examination. Notwithstanding these precautions, it is 
 advisable to exercise surveillance over arrived immigrants from the cholera- 
 infected countries as named on the reverse, and to this end it is suggested 
 that this card be sent to the local health officer at the point of destination, 
 so that he may examine into any case of sudden or fatal gastro-enteritis or 
 diarrhea among immigrants to determine its actual nature, and if any doubt 
 exists, to report to the State Board of Health or to the Public Health and 
 Marine-Hospital Service at Washington. This card should not be confounded 
 with the information required by paragraph 67, U. S. Quarantine Regulations 
 
136 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 promulgated October 20, 1910, relating to immigrants who have arrived on a 
 vessel on which infection has appeared and whose destination after quarantine 
 detention and disinfection would be sent by telegraph or mail. 
 
 Surgeon-General, 
 U. S. Public Health and Marine-Hospital Service. 
 
 CHOLERA SITUATION DURING THE SUMMER OF 1911. 
 
 With onset of summer, cholera began to be reported in various places in 
 Europe and it was feared that cases would be exported to the United States 
 in spite of all precautions at foreign ports of embarkation. These fears 
 were realized when on June 13, 1911, the quarantine officer of the port of 
 New York reported that a steerage passenger from southern Italy who had 
 embarked June 2d at Naples had died June 6th of cholera while en voyage. 
 Fortunately some of his discharges had been saved by the ship's surgeon. 
 When these were examined at the Hygienic Laboratory in Washington the 
 clinical diagnosis of cholera was confirmed. On June 14th a second case was 
 reported, while on June 20th four cases were discovered at the port of New 
 York on an Italian steamship arriving from Genoa, Naples and Madeira. 
 On the same date a "cholera carrier" was discovered at the same port on 
 board a vessel from Patras, Greece, and Palermo, Italy. The "carrier" had 
 embarked at Patras. 
 
 A.s a result of the foregoing, all quarantine officers on the Atlantic and Gulf 
 coasts, and all officers engaged in the examination of alien immigrants both 
 at home and in Europe were warned that careful inspection was necessary 
 to detect atypical cases or bacillus carriers and concealed food. 
 
 On June 30, 1911, the immigrant destination notification system proved its 
 value in a signal manner. An Italian boy who arrived on the Italian steamship 
 on which four cases were found June 20th (vide supra), after being detained 
 for seven days at quarantine, went to Auburn, N. Y., where he sickened 
 June 30th and died the following day. A second case of cholera from the 
 same steamship occurred in an Italian woman who was taken ill in Brooklyn, 
 June 30th, and died July 4, 1911, at quarantine, where she had been sent. It 
 is probable that these two cases were "carriers," and to diminish the danger 
 from such cases the following additions to the United States Quarantine 
 Regulations were promulgated : 
 
 "All steerage passengers arriving at ports in the United States from ports 
 or places infected with cholera shall be subjected to bacteriological examina- 
 tion and shall not be admitted to entry until it has been determined by said 
 examination that they are not cholera bacillus carriers." 
 
 The above was in addition to the regulations contained in a circular issued 
 July 6, 1911, which provided: 
 
 "Cholera Bacillus Carriers. 
 
 "To diminish the danger from cholera bacillus carriers, steerage passengers 
 coming from ports or places where cholera prevails and arriving on vessels 
 upon which cholera has appeared, shall be detained ten days for observation 
 unless after five days' detention they are found not to be bacillus carriers. 
 
 "The same provision shall also apply to other persons arriving on said 
 vessels who for special reasons are deemed liable to be thus infected." 
 
 On July 29. 1911, the Canadian Government issued orders that "all steerage 
 passengers arriving at ports in Canada from ports or places infected with 
 cholera shall be subjected to bacteriological examination at the quarantine 
 station of the port and shall not be permitted to pass such station or to make 
 customs entry until it has been determined by such examination that they are 
 cholera-bacillus carriers." This measure acted as a protection to the United 
 States inasmuch as not infrequently persons from infected ports take passage 
 for the United States via Canada. 
 
 The protective value of the above-mentioned measures instituted by the 
 United States and Canadian Government was at once apparent. A cholera 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 137 
 
 carrier was apprehended at the Gross Isle Quarantine and from the time that 
 the examinations were begun at the port of New York, September 5th, twenty- 
 six carriers were found among detained passengers and crews. No case of 
 cholera has occurred in the United States since July 23d, and no case of 
 cholera has arrived at a port of the United States since August 18, 1911. 
 
 CRITERION OF IMMUNITY IN YELLOW FEVER. 
 
 By G. M. Guiteras, A.M., M.D., 
 Surgeon, U. S. Public Health and Marine Hospital Service. 
 
 The problem of immunity in relation to infective and contagious diseases 
 has a most important bearing on all branches of practical medicine, but in none 
 more so than in preventive medicine, which branch is the special and, in fact, 
 the only theme for discussion before this conference. And we may well feel 
 that in advancing the principles of preventive medicine we are doing an 
 altruistic and humanitarian service of which the medical profession may well 
 be proud. 
 
 Immunity is that condition of the body cells which make them resistent to 
 the invasion of a parasitic germ or to the toxin produced by it. 
 
 The fascinating study of how immunity is produced has made great strides 
 of late, due to the labors of such noted scientists as Metchnikoff, Ehrlich, and 
 others, but it is not our present purpose to deal with that phase of the subject, 
 but to confine ourselves to its practical side from the viewpoint of the sani- 
 tarian, and with special reference to yellow fever. 
 
 Immunity may be natural, that is, inborn in the individual, or it may be 
 acquired. When acquired, it may be the result of natural causes, such as a 
 previous attack of the disease in question, or it may be brought about by 
 artificial means, such as the injection into the body of an antitoxin, as in the 
 immunity conferred by the use of diphtheria antitoxin or antityphoid serum. 
 In either case, a change occurs in the cells of the body, making them resistent 
 to the invasion of the same pathogenic organism or its toxins. 
 
 The immunity conferred in the latter case as in the former is not absolute. 
 In diphtheria it lasts but a short time; in the exanthemeta, in typhoid yellow 
 fever, etc., the immunity conferred by a previous attack of the disease may 
 persist for a lifetime. 
 
 But even in the diseases just mentioned there are exceptions, that is, cases 
 do occur in which a previous attack of the disease fails to confer immunity 
 on the subject attacked, although it is well known that these exceptions are 
 rare. Many cases are cited, it is true, where a second or even a third attack 
 of yellow fever has occurred in the same individual, but human judgment is 
 so very prone to err that it is more than probable that in many of these cases 
 a mistake was made in the diagnosis either in the first febrile attack or in a 
 subsequent one. I think, that admitting the possibility of a second attack, in 
 so far as yellow fever is concerned, it may be considered sufficiently rare as 
 to be a negligible quantity for practicable purposes such as quarantine restric- 
 tions, and we are therefore within a reasonable limit of safety in admitting 
 that a previous well-authenticated attack of yellow fever may be accepted as 
 conferring immunity for quarantine purposes. 
 
 The next step, and a most important one, is to determine what we are to 
 accept as evidence of a "well-authenticated attack of yellow fever." This is a 
 difficult and delicate subject, because it necessitates a determination of the 
 professional ability and the probity of a brother physician. Unfortunately, we 
 have to admit that some of our confreres (a very small proportion, to be 
 sure) are at times willing to take a long chance in signing immune certificates, 
 and for friendship's sake or for pecuniary gain, to certify to that which is not 
 true. I would, therefore, insist that in order to accept a person as immune 
 as the result of a previous attack it should be necessary to present a certificate 
 from the attending physician stating that the person interested has had an 
 attack of yellow fever and was treated by him for that disease. Further, such 
 certificates should be accepted only from men of the highest integrity and of 
 recognized familiarity with the disease in question. 
 
 I am of the opinion that only under the above conditions should a certificate 
 of immunity be accepted for quarantine purposes. 
 
138 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 It has heretofore been the general custom and, in fact, is incorporated in 
 our quarantine regulations, that a ten years' residence in an endemic focus 
 of yellow fever is sufficient to confer immunity, and that a certificate to that 
 effect might be accepted by the sanitary authorities on sufficient evidence of 
 such term of residence. 
 
 It always has seemed to me that this is an error, that is, that it was 
 opening the door too widely and was a dangerous practice. For there are 
 localities even in endemic foci where one might live for years with but slight 
 chance of becoming infected, as for instance, where one is surrounded by 
 immune individuals. 
 
 This objection, however, is very much enhanced, since the determination 
 of the method of transmission of yellow fever, for it is quite clear that, at 
 the present time, an intelligent, well-informed and careful individual could 
 live for any number of years in an endemic focus of yellow fever and, while 
 susceptible to the disease, never contract it. It would be only necessary to 
 protect oneself against the bite of the mosquito, and this under ordinary 
 circumstances would not be difficult of accomplishment. Just as in the case 
 of cholera Asiatica one may reside in an infected locality and escape all danger 
 of infection from that dread disease by merely boiling or heating to the 
 required temperature everything taken into the alimentary canal, so also, one 
 may remain in a place infected with yellow fever and taking easily applied 
 precautions against the bite of the mosquito escape all danger of contracting 
 the disease. 
 
 I would therefore recommend that our present regulations be so amended as 
 to eliminate that proviso which accepts ten years' residence in an endemic focus 
 of yellow fever as evidence of immunity against that disease. 
 
 It is to be hoped that in the near future we may be fortunate enough to 
 discover the causative agent of yellow fever, and that as a result thereof we 
 may be able to prepare a serum that will confer either a temporary or rela- 
 tively absolute immunity against the disease, such as we now have in typhoid 
 or in variola. Under such circumstances travel from infected points would 
 be greatly facilitated, and the danger of infecting healthy localities reduced 
 to a minimum. 
 
 PROTECTIVE MEASURES AGAINST CERTAIN COMMUNICABLE DISEASES. 
 
 The diseases represented in this report are mostly those the gravity of which 
 is being more and more fully appreciated. The list is by no means complete, 
 but it is supposed that in future conferences time will be reserved for the 
 discussion of such diseases also as typhoid fever, pellagra, uncinariasis, amoebic 
 infections, ophthalmia meonatorum, infantile paralysis, etc., the importance 
 of which all sanitarians of all nations must realize, and in regard to which 
 considerable is now being done in the United States. 
 
 Tuberculosis. — The campaign against this disease which received such great 
 impulse following the meeting of the Eighth International Congress on Tuber- 
 culosis in the United States in 1908 has continued with unabated force. 
 
 The legislation enacted in the last two years has been reviewed in Report 
 No. 1. The Federal Government, which already maintained sanatoriums at 
 Fort Stanton for seamen of the merchant marine, at Fort Bayard for soldiers, 
 and at Las Animas for sailors of the navy, has added five more institutions 
 of the same character intended exclusively for the use of persons of the 
 Indian race. 
 
 The combined efforts of the various agencies engaged all over the country 
 in fighting tuberculosis have been effective in bringing the death rate down 
 from 173.9 per 100,000 of population in 1908 to 167.5 in 1909, and 160.3 in 1910. 
 There is good reason to believe that these encouraging results will persist. 
 The National Association for the Study and Prevention of Tuberculosis, which 
 is an unofficial organization has its headquarters in New York, and continues 
 a factor of the first importance in promoting both public and private enter- 
 prise aiming at the ultimate control of the disease. 
 
 The rapid extent and increasing force of the movement may be judged from 
 the fact that, as shown in the last Tuberculosis Directory published by the 
 above-mentioned association, there were in 1911, 342 dispensaries and clinics 
 for the treatment of tuberculosis in the United States, an increase of 324 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 139 
 
 over those existing in 1905 (18) ; the number of sanatoria showed a similar 
 augmentation from 111 in 1905 to 422 in 1911. The number of associations 
 for the prevention of tuberculosis rose from 18 in 1905 to 511 in 1911. With 
 the exception of Alaska, Idaho, Mississippi, Nevada, South Dakota, Utah, 
 Vermont, and Wyoming, such associations now exist in varying numbers in 
 every State, territory, and dependency of the United States. 
 
 The realization by the public of the dangers of this disease has proved of 
 sufficient strength to secure not only the enactment of laws for the registra- 
 tion of cases, creation of sanatoria, disinfection, etc., having as an object the 
 direct control of the disease, but also of others relative to sanitation and 
 ventilation of factories, regulation of housing conditions, abolishment of the 
 public drinking cup, suppression of promiscuous expectoration, medical inspec- 
 tion of schools, etc., which must necessarily be influential in bringing about 
 a general improvement of sanitary conditions, and a diminution of morbidity 
 and mortality rates. 
 
 Venereal Diseases. — The national immigration law excludes from admission 
 into the United States persons afflicted with a loathsome or dangerous con- 
 tagious disease. The regulations prepared by the Public Health and Marine 
 Hospital Service includes syphilis, gonorrhea, and soft chancre in the category 
 of loathsome contagious diseases, and therefore patients suffering from any 
 venereal disease can not obtain admission to the United States. 
 
 Syphilis and gonorrhea are by law declared reportable diseases in only two 
 of the States that form the Union, namely, California and Utah. Both of 
 these laws were enacted during the present year. 
 
 The employment in food-handling establishments of persons with venereal 
 diseases is forbidden in California, Illinois, Indiana (bakeries and confec- 
 tioneries only), Kansas (by rules of the State Board of Health), Nebraska, 
 New Hampshire, Pennsylvania (only in bakeshops), Rhode Island (only in 
 bakeries, confectioneries, and ice-cream shops), Tennessee, Utah (only in 
 meat-selling and handling establishments, and Washington (same as Penn- 
 sylvania.) 
 
 Various provisions have been made, forbidding the exercise of the barber's 
 trade to persons with syphilis, requiring sterilization of tools and knowledge 
 on the part of the barber of the most common manifestations of face and 
 skin diseases, etc. To avoid the propagation of this disease in barber shops 
 the above provisions are contained in laws of Colorado, Connecticut, Illinois, 
 Kansas, Louisiana (in regulations of the State Board of Health), Michigan, 
 Minnesota, Missouri, New Hampshire, North Dakota, Oregon, Rhode Island, 
 Texas, Utah, Washington, Wisconsin, and District of Columbia (by 
 regulation). 
 
 Hospital facilities for this kind of patients must be provided in Massa- 
 chusetts, while prisoners with syphilis must be isolated in the same State, and 
 retained in prison until cured, in both Massachusetts and Connecticut. 
 
 A law of the State of New York passed in 1910 requiring the detention of 
 diseased prostitute prisoners until cured occasioned numerous protests on the 
 part of women who complained of discrimination against their sex, and has 
 recently been declared unconstitutional by the courts. 
 
 A law providing for the sterilization of syphilitic patients kept in public 
 institutions was enacted this year in Iowa, and there is little doubt that the 
 asexualization laws in force in California, Connecticut, and Indiana could be 
 made to apply to such patients, although they are not specifically mentioned 
 in the statutes. 
 
 Marriage of patients while the disease is communicable is forbidden by the 
 laws of Indiana and Michigan. 
 
 Employment of persons suffering with syphilis, such as school janitors or 
 teachers, is forbidden by the laws of Indiana, and admission to school of 
 pupils with venereal diseases is prohibited in West Virginia, the fact to be 
 ascertained by annual medical inspections. 
 
 The use of barbershops or public bathrooms by patients is prohibited by 
 regulations of the State Board of Health in Kansas. 
 
 Dissemination by advertisement or otherwise of information regarding vene- 
 real diseases or remedies therefore is interdicted in Massachusetts, Minnesota, 
 and Ohio. 
 
 With a view to preventing the spread of syphilis and other diseases, the 
 
140 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 use of suction shuttles in factories is forbidden in Massachusetts, and the 
 promiscuous use of public drinking cups abolished by law or regulation in 
 sixteen of the States and a number of the most important cities ; while the 
 use of roller towels was stopped in Kansas and Connecticut. 
 
 Venereal diseases are specifically exempted by law from control as "com- 
 municable diseases" in Connecticut and Tennessee. 
 
 Power to issue regulations to prevent their spread is vested in the State 
 Board of Health of Utah. 
 
 The foregoing is a resume of the most important legislation relative to 
 venereal diseases enacted in the United States. The control of these diseases 
 is a subject that has attracted considerable attention in this country, especially 
 during the last few years. In the discussion of this problem a great disparity 
 of views prevails here as elsewhere, and many of the measures already adopted 
 must be considered as purely tentative. 
 
 A number of bills approved by the medical profession requiring medical 
 examination of aspirants to marriage have been introduced in several legis- 
 latures, but none have so far been adopted. 
 
 "Reglementation" in the European sense has been tried in at least two cities, 
 but general opinion seems to be against it. 
 
 A number of societies have been formed in several States to combat through 
 educational means the spread of venereal diseases, and several of them are 
 doing effective work. The national organization, the American Society of 
 Sanitary and Moral Prophylaxis, has especially, since its foundation, been 
 active, conducting a wise campaign of education, by means of publications, 
 public addresses, and otherwise. 
 
 Quite thorough studies of the social conditions that lead to the spread of 
 venereal diseases has been made by several commissions in some of the largest 
 cities of the country, namely, New York, Chicago, and Minneapolis, the result 
 of the investigations conducted being embodied in voluminous publications. 
 
 At the last meeting of the American Public Health Association, held at 
 Milwaukee in September, 1910, the matter received attention at the hands of 
 some of the leading sanitarians of the country. The committee appointed the 
 year before by the association rendered a report containing the following 
 recommendations : 
 
 I. The recognition, study and control of the prevalence of gonorrhea and 
 syphilis by the State boards of health, as with all other communicable pre- 
 ventable diseases, by securing reports from physicians of cases by number, at 
 first by request and later by legal requirements, in order to ascertain the 
 distribution of these diseases. 
 
 II. An educational campaign for parents of all social classes and children 
 of all ages and sexes. This teaching should be not only moral but also 
 medical in the widest sense. It will not do at present to rely on the moral 
 argument. 
 
 (a) Proper distribution of circulars, pamphlets and other literature by 
 State Health Departments through all suitable channels. 
 
 (b) State Health Departments to instruct all its local health officers in- 
 sexual matters and direct them to make a systematic effect to educate the 
 people in their respective communities. 
 
 (c) State Health Departments to make a definite and determined effort 
 to awaken and interest the medical profession in this fight against venereal 
 diseases. 
 
 (d) State Health Departments to send out especially trained paid teachers 
 and lecturers of their own, supported by exhibits and lantern slides, to address 
 special meetings of parents, health officers, medical men, teachers and others 
 in schools, colleges, churches, etc., on these and other preventable diseases. 
 
 (e) State Health Departments to encourage the organization of local 
 leagues or associations, whose purpose shall be the support of and control of 
 a crusade against the spread of all communicable diseases. 
 
 1. Said societies to include every profession and walk of life. 
 
 2. To depend preferably upon philanthropists for necessary funds, rather 
 than upon paid subscriptions for financial support. 
 
 (f) State Health Departments to interest and provide for the authorities. 
 having charge of the educational curriculum in public and private schools. 
 
 1. By introduction of biology into the graded course of all schools. 
 
FIFTH INTERNATIONAL SANITARY COXFEREXCE. 141 
 
 2. By introduction into the text books on physiology of the upper grades 
 instruction in reference to anatomy and physiology of the urinary and sexual 
 organs. 
 
 3. By special instruction to normal school students who are to become the 
 instructors. To impress upon the preceptors and teachers of these subjects, 
 presidents and deans of all colleges, the necessity of repeated instruction in 
 reference to the communicability of syphilis and gonorrhea, and to inculcate a 
 morale of protection among the college fraternities. 
 
 4. To utilize the public press for the proper occasional presentation of the 
 .subject and to discourage the display of advertising matter which encourages 
 
 the exposure to danger in these diseases. 
 
 5. To utilize churchmen's clubs, fraternal societies, trades unions, women's 
 clubs, and especially mother's clubs for the immediate instruction of parents. 
 
 (g) State Health Departments to recommend the enactment of laws for: 
 
 1. Registration, physical inspection and segregation of prostitutes. 
 
 2. Notification and report (by number if desired) of venereal cases. 
 
 3. Physical examination of men before marriage. 
 
 4. Penalizing and holding to a strict (perhaps money damage) accounta- 
 bility those knowingly responsible for the transmission of venereal diseases. 
 
 5. Keeping open free night dispensaries and maintenance of special dispen- 
 saries and hospitals for these diseases. 
 
 III. Advocacy of temperance on account of the relationship between alco- 
 holism, venereal diseases and insanity. 
 
 IV. Advocacy of personal cleanliness and venereal prophylaxis for those 
 whose carnal appetites can not be controlled by the agencies of moral 
 prophylaxis. 
 
 V. Advocacy of early marriages. 
 
 Smallpox. — The ravages of this disease having from time immemorial been 
 so marked and severe, the knowledge of its seriousness being so general, it is 
 only natural that the volume of legislation relative thereto should greatly 
 exceed that enacted for the control of any other disease. Smallpox is in every 
 part of the Union classed as a "dangerous communicable disease'' subject to 
 control by the health authorities. It is named as one of the six quarantinable 
 diseases in the United States quarantine regulations, persons arriving at ports 
 of the United States who have been exposed to the disease being required to 
 be vaccinated or quarantined not less than 14 days since last exposure. 
 
 General vaccination is, under certain restrictions, made compulsory in only 
 10 States, 2 territories, and the District of Columbia ; in two others it may 
 be made such whenever deemed necessary by the State Board of Health. In 
 seventeen more it may be enforced by local authorities. The vaccination of 
 exposed persons is required by the State Board of Health in four other 
 States, and recommended in two more. The attendance at school of unvac- 
 cinated persons is forbidden by law in fifteen States; and in Porto Rico the 
 adoption of this measure is optional with local school authorities, and in 7 
 other States, and can only be enforced during periods of epidemic in 7 others. 
 Compulsory vaccination is forbidden in the laws of 4 States, and in one it is 
 declared unlawful to make vaccination a condition to admission to school. 
 No reference is made to vaccination in the laws or health regulations of 
 5 States and Alaska. 
 
 The reports received by the Surgeon-General of the Public Health and 
 Marine Hospital Service indicate that there has been marked decrease in the 
 prevalence of the disease for the last ten years. There were 55,857 cases 
 reported for the year 1902, 42,950 for the year 1903, 25,106 for the year 1904. 
 Only 10,554 cases were reported for the year 1906, and 14,377 for the year 
 1907. During the fiscal years 1908, 31,200 cases; 1909, 24,657 cases; 1910, 
 25,084; 1911, 35,204 cases were reported respectively. The increase in the 
 number of cases for the last four years furnishes perhaps evidence of a 
 better and more thorough system of reporting cases rather than of an actual 
 increase in the occurrence of smallpox. 
 
 The unusually mild character of the type of the disease prevailing in the 
 United States is revealed in its extremely low mortality. The census reports 
 show a steady diminution in the death rate per 100,000 inhabitants, which as 
 3.4 for the quinquennium 1901-1905; 0.5 for the year 1905; 0.2 for the years 
 1906, 1907, 1908, and 1909; and 0.4 for the year 1910. The actual number of 
 
142 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 deaths was a yearly average of 1,119 from 1901-1905; 308 for 1905; 95 for 
 1906; 74 in 1907; 92 in 1908; 79 in 1909; 202 in 1910. The comparative high 
 mortality for the year 1910 must be attributed to several sporadic outbreaks 
 of local importance only, which, however, succeeded in bringing up the death 
 rate for the entire country. 
 
 The reports compiled by the Bureau of Public Health for the calendar year 
 1910 shows 30,352 cases of smallpox. The benignity of the disease can be 
 appreciated from the fact that there were only 415 deaths, that is, a death 
 rate of 1.63 per cent, while the mortality abroad is usually from 20 to 40 
 per cent. The State of Utah had the highest case rate, with 966 cases, that is, 
 257.32 for each 100,000 inhabitants. The next highest rates occurred in the 
 order indicated in North Carolina, Florida, Montana, Oklahoma, and Colorado. 
 The lowest case rates per 100,000 occurred in Connecticut (no cases) ; Mary- 
 land (0.46); New Jersey (0.86); Maine (1.07); Pennsylvania (2.18), and 
 New Hampshire (2.32). It is a noteworthy fact that the State of Utah, which 
 had also the highest case rate in 1909, namely, 507 cases for each 100,000, 
 has a provision in its statutes forbidding compulsory vaccination or to make 
 vaccination a condition to admission to school. In none of the other five 
 States in which smallpox was highly prevalent is compulsory vaccination thor- 
 oughly enforced while a systematic system of vaccination is practiced in the 
 six States with the lowest case rate. 
 
 A striking departure in the treatment of cases of smallpox was recently 
 made in Minnesota. Consistent with the scientific theory that considers vac- 
 cination the best protection against smallpox, the State Board of Health in 
 its rules does not require quarantine in cases of smallpox. A sign is, however, 
 placed on the house to serve as a warning to the public, and the patient 
 himself is not suffered to leave the house. This policy has also been adopted 
 this year by the State Board of Health of North Carolina with the avowed 
 intention of causing the people to adopt vaccination as the only defense 
 against smallpox. 
 
 Malaria. — A plan of campaign against malaria must of necessity depend on 
 the thorough enforcement of three measures: 
 
 1. Compilation of statistics showing the prevalence and distribution of 
 the disease. 
 
 2. Extermination of the agent that transmits the infection, the anopheles 
 mosquito. 
 
 3. Destruction of the malaria germ after it has gained admission to the 
 human organism. 
 
 1. There are only three States, California, Pennsylvania, and Vermont, 
 which require reports of cases ; in four others, Arizona, North Dakota, Okla- 
 homa, and South Dakota, the State health authorities are empowered or 
 required to take measures to prevent the spread of malarial diseases. There 
 are therefore no accurate data showing the prevalence of malaria in the 
 United States. The death rate per 100,000 inhabitants reported for the regis- 
 tration area was 3.9 in 1905, 3.5 in 1906, 2.8 in 1907, 2.5 in 1908, 2.4 in 1909, 
 and 2.2 in 1910, but as this disease seldom results directly in death and is 
 often reported under various names, the above information can hardly be 
 taken as a true index of the occurrence of the disease. 
 
 2. The problem of mosquito extermination has usually been considered in 
 the United States as one for solution by the individual community suffering 
 from this plague. Local action has been taken in several cities, such as New 
 Orleans, for the destruction of mosquitoes ; a section of Sanitary Code of the 
 City of New York requires the screening of water tanks to prevent the access 
 of mosquitoes ; in most localities the health authorities assume that "each 
 person is responsible for his own mosquitoes," and their interference is limited 
 to the circulation of educational literature, the results depending mainly on 
 the public spirit of the citizens. Of all the States, New Jersey has in force 
 the most thorough system of mosquito eradication, the laws providing for 
 surveys of swamp areas for the purpose of determining the places most 
 prolific of mosquitoes and the times when they are most likely to appear, 
 and also for State appropriations to aid those localities which are willing to 
 contribute to the anti-mosquito work. Enforcement of a number of measures 
 to prevent the breeding of mosquitoes in cisterns, tanks, barrels, buckets, 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 143 
 
 ponds, etc., is required in the health regulations of Louisiana and Hawaii ; 
 while screening of cisterns is required in the laws of Mississippi and Texas. 
 
 3. Contrary to the practice of several foreign countries, such as Italy, 
 Greece, Bulgaria, Algeria, etc., free distribution of quinine at public expense 
 is not practiced anywhere in the United States. 
 
 Trachoma. — A report on trachoma was presented by Surgeon-General Wyman 
 to the Third International Sanitary Conference in Mexico in 1907 (see page 
 217 of the Transactions). No new developments relative to this disease have 
 occurred in the United States, although a part of the medical press has recently 
 challenged the proof of the contagiousness of the disease. That it is con- 
 tagious there is no doubt. Abundant evidence to that effect can be adduced, 
 and the experience of the Public Health Service in its examination of over 
 1,400.000 persons since 1891 confirms this view. Furthermore, there is no 
 question regarding the wisdom of excluding trachomatous aliens from a 
 country. 
 
 Leprosy. — A report on leprosy was presented by the United States delega- 
 tion to the Fourth International Sanitary Conference at San Jose, Costa Rica, 
 in 1907 (see page 194 of the Transactions). No further report appears 
 necessary at this time. 
 
 MORBIDITY AND MORTALITY IN THE UNITED STATES. 
 
 One of the main purposes of this conference is the prevention of the spread 
 of disease from one country to another. This is accomplished in part by the 
 mutual institution of general sanitary measures. However, the first requisite 
 in the prevention of the spread of any disease, be it from one district or 
 province to another district or province, or from one country to another, is a 
 knowledge of its prevalence and geographic distribution in the districts, prov- 
 inces or countries. This knowledge can be acquired and made available to 
 those concerned only by the reporting of cases of sickness. The publication 
 of the exact status of disease in the several countries would assist in the 
 maintenance of a minimum maritime quarantine and, by making the prevalence 
 of diseases in the several countries comparable, would be a powerful incentive 
 to sanitary progress. It would give the sanitary authorities exact information 
 by which they could deal with actual specific conditions, instead of generali- 
 ties, and would render their work more effective for the same expenditure 
 of time and effort. 
 
 Morbidity. — Increased attention and consideration are being given by the 
 health authorities of the United Sttaes, national. State, and local, to the 
 reporting of cases of sickness. Its importance, as a basis of public health 
 work, is receiving merited recognition, as is evidenced by the many laws 
 being enacted by the State and city authorities. 
 
 Each State has jurisdiction in regard to the diseases which shall be reported 
 within its territory, and determines which shall be notifiable. The notifiable 
 diseases, therefore, vary to some extent in the several States. A list of those 
 diseases and the number of States requiring a report of cases follows: 
 
144 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Number of States 
 Diseases. requiring notification. 
 
 Actinomycosis 2 
 
 Anthrax 7 
 
 Beriberi 3 
 
 Cancer 1 
 
 Cerebro-spinal meningitis 22 
 
 Chagres fever 1 
 
 Chicken pox 13 
 
 Cholera (Asiatic) 35 
 
 Dengue 4 
 
 Diphtheria 37 
 
 Dysentery 1 
 
 Epidemic dysentery 2 
 
 Erysipelas 3 
 
 Favus 1 
 
 German measles 3 
 
 Glanders 8 
 
 Gonococcuc infection 1 
 
 Leprosy 20 
 
 Malarial fever 2 
 
 Measles 22 
 
 Mumps 3 
 
 Opthalmia neonatorum 16 
 
 Pellagra » 4 
 
 Plague 20 
 
 Pneumonia 6 
 
 Poliomyelitis 16 
 
 Puerperal fever 2 
 
 Rabies 5 
 
 Relapsing fever 1 
 
 Rocky Mountain (spotted) fever 1 
 
 Scarlet fever 37 
 
 Smallpox 42 
 
 Syphilis 1 
 
 Tetanus 4 
 
 Trachoma 6 
 
 Trichiniasis 3 
 
 Tuberculosis : 
 
 All forms 18 
 
 Communicable 1 
 
 Abdominal 1 
 
 Laryngeal 4 
 
 Pulmonary 9 
 
 Typhoid fever 23 
 
 Typhus fever 23 
 
 Uncinariasis 4 
 
 Whooping cough 17 
 
 Yellow fever 27 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 145 
 
 With the present active interest in public health matters, it is believed that 
 practically all the preventable diseases will be required before many years 
 to be reported in every State. This will not only afford information for the 
 immediate action of the local health authorities concerned, but will give a 
 knowledge of the geographic distribution and prevalence of the diseases 
 throughout the country, which will be of the greatest value in the study of the 
 epidemiology and the factors operating in the spread of these diseases. 
 
 Cholera. — From June 14 to August 18, 1911, six cases of cholera arrived at 
 the New York quarantine on vessels from cholera infected localities, and 
 twelve cases developed among passengers and members of the crews of these 
 vessels while under detention at quarantine. From June 30th to July 19th, cases 
 of the disease developed among recently arrived immigrants, or among those 
 who had come into intimate contact with them, at the following places : 
 
 Auburn, New York 1 case; 
 
 New York City 2 cases ; 
 
 Staten Island, New York 1 case; 
 
 Boston, Massachusetts 1 case. 
 
 The patient in each instance was isolated, all but the first named being 
 removed to the quarantine station, and no extension of the disease occurred. 
 The last case was taken sick July 19th, in New York City, since which date 
 no case has occurred in the United States, outside of those among the immi- 
 grants detained at quarantine. 
 
 Cholera bacillus carriers are as important to the sanitarian as are cases of 
 cholera, and can properly be classed with them. Measures enforced by the 
 Treasury Department for the detention of these carriers among immigrants 
 from cholera infected localities resulted in the finding of 26 carriers among 
 immigrants and members of crews arriving at ports of the United States on 
 vessels from cholera infected places. These were as carefully isolated as 
 the cases of the disease. 
 
 Smallpox. — Smallpox in a type so mild that it is at times recognized with 
 difficulty has been prevalent throughout the greater part of the country. 
 During the calendar year 1909 there were reported 24,099 cases with only 
 150 deaths. During the year 1910 there were reported 30,352 cases with 415 
 deaths, and from January 1, to June 30, 1911, 17,290 cases with 56 deaths. 
 The prevalence of the disease is undoubtedly to a large extent accountable by 
 its extreme mildness, many of the cases not being sufficiently ill to require 
 the services of a physician, or even to cause the patient to take to bed. 
 Because of this many cases were undoubtedly not recognized and other indi- 
 viduals were in consequence exposed to an extent that would not have occurred 
 with a more serious illness. 
 
 During the year 1909, and more especially during 1910, there were a few 
 isolated outbreaks of smallpox of a virulent type, and in these the mortality 
 rate varied from 16 to 54 per one hundred cases. The distribution of the 
 disease as reported in the several States is shown by the following tables: 
 
146 
 
 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 SMALLPOX, 1909. 
 
 Showing, by States, Cases Reported, Case Rates, Deaths Reported, and Case 
 Mortality Rates. 
 
 States. 
 
 1. Alabama 
 
 2. Alaska 
 
 3. Arizona 
 
 4. Arkansas 
 
 5. California 
 
 6. Colorado 
 
 7. Connecticut 
 
 8. Delaware 
 
 9. Dist. of Columbia, 
 
 10. Florida 
 
 11. Georgia 
 
 12. Idaho 
 
 13. Illinois 
 
 14. Indiana 
 
 15. Iowa 
 
 16. Kansas 
 
 17. Kentucky 
 
 18. Louisiana 
 
 19. Maine 
 
 20. Maryland 
 
 21. Massachusetts . . . 
 
 22. Michigan 
 
 23. Minnesota 
 
 24. Mississippi 
 
 25. Missouri 
 
 26. Montana , 
 
 27. Nebraska 
 
 28. Nevada 
 
 29. New Hampshire . 
 
 30. New Jersey , 
 
 31. New Mexico 
 
 32. New York 
 
 33. North Carolina . , 
 
 34. North Dakota 
 
 35. Ohio 
 
 36. Oklahoma , 
 
 37. Oregon . . 
 
 38. Pennsylvania . 
 
 39. Rhode Island 
 
 40. South Carolina . . 
 
 41. South Dakota 
 
 42. Tennessee . . 
 
 43. Texas 
 
 44. Utah 
 
 45. Vermont . . . , 
 
 46. Virginia . . . 
 
 47. Washington . 
 
 48. West Virginia 
 
 49. Wisconsin . . 
 
 50. Wyoming . . . 
 
 Total 
 
 Cases. 
 
 Case rate 
 per 
 
 100,000 
 inhabit- 
 ants. 1 
 
 102 
 
 (?) 
 (?) 
 
 120 
 
 180 
 345 
 3 
 (?) 
 
 24 
 
 3 
 
 266 
 
 (?) 
 
 2,135 
 
 1,363 
 
 825 
 2,197 
 
 390 
 
 1,409 
 
 36 
 
 26 
 
 14 
 
 1,175 
 
 1,430 
 
 76 
 
 221 
 
 685 
 
 109 
 
 (?) 
 
 2 
 
 88 
 
 (?) 
 
 762 
 
 1,733 
 
 204 
 
 1,328 
 
 1,434 
 
 252 
 
 25 
 
 (?) 
 
 19 
 
 13 
 
 680 
 
 752 
 
 1,854 
 
 73 
 202 
 
 310 
 26 
 1,208 
 (?) 
 
 24,099 
 
 44.33 
 .27 
 
 7.34 
 .41 
 
 38.31 
 
 50.74 
 
 37.12 
 
 131.67 
 
 4.87 
 
 2.02 
 
 .42 
 
 42.38 
 
 69.41 
 
 187.46 
 
 .46 
 3.56 
 
 8.52 
 79.45 
 36.72 
 28.14 
 90.41 
 38.65 
 .33 
 
 507.11 
 20.56 
 
 28.39 
 52.14 
 
 Deaths. 
 
 (?) 
 
 (?) 
 
 (?) 
 
 (?) 
 (?) 
 
 Case mor- 
 tality rate 
 per hun- 
 dred. 
 
 Remarks. 
 
 33.33 
 
 .37 
 
 .37 
 
 4 
 (?) 
 
 .18 
 
 3 
 
 
 1 
 
 4 
 
 14 
 
 (?) 
 
 (?) 
 3 
 
 (?) 
 
 (?) 
 
 7.143 
 .34 
 .98 
 
 .44 
 
 2 
 (?) 
 4 
 2 
 
 2.27 
 
 .52 
 
 .12 
 
 4 
 6 
 
 .30 
 .42 
 
 9 
 
 
 2 
 
 2 
 
 14 
 
 5 
 
 .29 
 .27 
 
 18 
 
 
 9 
 
 2.90 
 
 16 
 (?) 
 
 1.32 
 
 150 
 
 
 Incomplete; no available rec- 
 ord of cases for entire State. 
 
 Cases not reported. 
 
 1 death reported; reports in- 
 complete. 
 
 Incomplete; no available rec- 
 ord of cases for entire State. 
 Do. 
 
 No available record of cases 
 for entire State. 
 
 Cases probably incomplete. 
 Incomplete; 181 of these cases 
 
 were reported in Macon. 
 No available record of cases. 
 
 Incomplete; no available rec- 
 ord of cases for entire State. 
 Do. 
 
 Do. 
 Do. 
 
 Do. 
 No available record of cases. 
 
 Do. 
 
 Incomplete; no available rec- 
 ord of cases for entire State. 
 
 Do. 
 
 Do. 
 Incomplete. 
 
 Incomplete; no available rec- 
 ord of cases for entire State. 
 
 Do. 
 
 No reports received. 
 
 'Based upon the estimated population July 1, 1910, as given by the Director of the Census. 
 
 Poliomyelitis. — Poliomyelitis has been prevalent throughout the United States 
 for several years to a degree unusual for this disease. The authorities, how- 
 ever, have been taking active measures to ascertain the cause of its prevalence 
 and the reasons for its spread. The prevalence and geographic distribution 
 of this disease as reported by States for the calendar years 1909 and 1910 are 
 shown by the following tables : 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 147 
 
 SMALLPOX, 1910. 
 
 Table No. 1. — Showing, by States, Cases Reported, Case Rates, Deaths Reported, and Case 
 
 Mortality Rates. 
 
 
 
 Case rate 
 
 
 
 1 
 
 
 
 per 
 
 
 Case mor- 
 
 
 
 Cases. 
 
 100,000 
 inhabit- 
 ants. 1 
 
 Deaths. 
 
 tality rate 
 per 100. 
 
 Remarks. 
 
 
 616 
 
 
 '.?) 
 
 
 No available record of cases 
 for entire State. These 
 cases were reported in Bir- 
 mingham, Mobile, and 
 Montgomery. 
 
 
 (?) 
 
 
 (?) 
 
 
 Cases not reported. 
 
 
 (?) 
 
 
 (?) 
 
 
 No available record of cases. 
 
 
 106 
 
 
 (?) 
 
 
 No available record of cases 
 for State. These cases were 
 reported in Argenta, Little 
 Rock, Lonoke, and Fort 
 Smith. 
 
 California 
 
 177 
 
 
 1 
 
 
 Incomplete. 
 
 Colorado 
 
 1,096 
 
 136.23 
 
 7 
 
 0.64 
 
 
 Connecticut 
 
 None. 
 
 
 None. 
 
 
 
 Delaware 
 
 (?) 
 
 
 (?) 
 
 
 No available record of cases. 
 
 District of Columbia.. 
 
 96 
 
 28.89 
 
 
 
 
 Florida 
 
 1,286 
 
 169.50 
 
 12 
 
 .93 
 
 
 
 389 
 
 
 (?) 
 
 
 No available record of cases 
 for State. These cases were 
 reported in the city of 
 Macon. 
 
 Idaho 
 
 (?) 
 
 
 (?) 
 
 
 No available record of cases. 
 
 Illinois 
 
 730 
 
 12.91 
 
 (?) 
 
 
 
 Indiana 
 
 764 
 
 28.24 
 
 1 
 
 .13 
 
 
 Iowa 
 
 850 
 
 38.19 
 
 1 
 
 .12 
 
 
 Kansas 
 
 2,202 
 
 129.77 
 
 12 
 
 .54 
 
 
 Kentucky 
 
 (?) 
 
 
 
 
 No available record of cases. 
 
 Louisiana 
 
 860 
 
 
 5 
 
 
 Reports are incomplete. 
 
 Maine 
 
 8 
 
 1.07 
 
 
 
 
 Maryland 
 
 6 
 
 .46 
 
 
 
 
 Massachusetts 
 
 144 
 
 4.26 
 
 
 
 
 Michigan 
 
 2,585 
 
 91.66 
 
 121 
 
 4.68 
 
 
 Minnesota 
 
 1,002 
 
 48.18 
 
 9 
 
 .90 
 
 
 Mississippi 
 
 227 
 
 
 5 
 
 
 No available record of cases 
 for State. These cases were 
 reported from 7 cities. 
 
 Missouri 
 
 287 
 
 
 2 
 
 
 Do. 
 
 Montana 
 
 634 
 
 167.32 
 
 1 
 
 .16 
 
 
 Nebraska 
 
 51 
 
 
 (?) 
 
 
 No available record of cases 
 for State. These cases were 
 reported from Lincoln and 
 South Omaha. 
 
 
 (?) 
 
 
 (?) 
 
 
 No available record of cases. 
 
 
 10 
 
 2.32 
 
 
 
 
 New Jersey 
 
 22 
 
 .86 
 
 
 
 
 
 (?) 
 
 
 (?) 
 
 
 No available recoid of cases. 
 
 
 353 
 
 3.85 
 
 8 
 
 2.26 
 
 
 North Carolina 
 
 4,281 
 
 193.45 
 
 8 
 
 .18 
 
 
 
 306 
 
 52.51 
 
 2 
 
 .65 
 
 
 Ohio 
 
 759 
 
 15.88 
 
 10 
 
 1.32 
 
 
 Oklahoma 
 
 2,342 
 
 139.75 
 
 99 
 
 4.22 
 
 
 Oregon 
 
 164 
 
 24.18 
 
 5 
 
 3.05 
 
 
 Pennsylvania 
 
 168 
 
 2.18 
 
 6 
 
 3.57 
 
 
 
 
 
 
 
 No cases reported. 
 
 South Carolina 
 
 (?) 
 
 
 (?) 
 
 
 No available record of cases. 
 
 
 365 
 
 
 1 
 
 
 Report complete for April to 
 December, inclusive. 
 
 Tennessee 
 
 2,199 
 
 
 10 
 
 
 Incomplete. 
 
 Texas 
 
 2,925 
 
 74.72 
 
 67 
 
 2.29 
 
 
 Utah 
 
 966 
 
 257.32 
 
 2 
 
 .21 
 
 
 
 
 
 
 
 No cases reported. 
 
 Virginia 
 
 350 
 
 
 6 
 
 
 No available record of cases 
 for State. These cases were 
 reported from 8 cities. 
 
 Washington 
 
 583 
 
 50.46 
 
 14 
 
 2.40 
 
 
 
 (?) 
 
 
 (?) 
 
 
 No available record of cases. 
 
 
 443 
 
 18.94 
 
 (?) 
 
 
 
 Wyoming 
 
 (?) 
 
 
 (?) 
 
 
 No available record of cases. 
 
 Total 
 
 30,352 
 
 
 415 
 
 
 
 'Based upon the estimated population July 1, 1909, as given by the Director of the Census. 
 
148 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Table No 2. — Showing Cases Reported by Months. 1 
 
 
 Jan. 
 
 Feb. 
 
 Mar 
 
 Apr. 
 
 May 
 
 June 
 
 July 
 
 Aug. l Sept. 
 
 Oct. 
 
 Nov. 
 
 Dec. 
 
 Total 
 
 Colorado . . 
 
 Florida . . . 
 
 Illinois .... 
 
 Indiana . . . 
 
 Iowa 
 
 Kansas .... 
 
 Maine .... 
 
 Maryland . 
 
 Massa- 
 chusetts 
 
 Michigan . 
 
 Montana . . 
 
 New 
 Hampshire 
 
 New Jersey 
 
 New York. 
 
 North 
 
 Carolina. 
 
 North 
 
 Dakota. . 
 
 Ohio 
 
 Oklahoma 
 
 Oregon . . . 
 
 Penn- 
 sylvania. . 
 
 Utah 
 
 Washington 
 Wisconsin 
 
 82 
 50 
 170 
 189 
 122 
 441 
 ... 
 
 90 
 290 
 122 
 
 4 
 
 "si 
 
 877 
 
 46 
 104 
 238 
 
 36 
 
 14 
 706 
 181 
 120 
 
 39 
 
 3973 
 
 132 
 
 61 
 
 32 
 
 92 
 
 109 
 
 280 
 
 6 
 
 26 
 262 
 116 
 
 3 
 
 2 
 
 50 
 
 758 
 
 32 
 
 83 
 
 388 
 
 29 
 
 41 
 785 
 91 
 82 
 63 
 
 3523 
 
 179 
 213 
 
 88 
 104 
 
 97 
 256 
 
 5 
 
 356 
 
 68 
 
 1 
 
 69 
 
 429 
 
 107 
 60 
 
 390 
 29 
 
 40 
 
 581 
 
 112 
 
 60 
 
 66 
 
 3310 
 
 114 
 118 
 
 58 
 
 92 
 
 141 
 
 148 
 
 i 
 
 4 
 
 253 
 
 64 
 
 "(ii 
 
 317 
 
 14 
 
 77 
 
 475 
 
 12 
 
 8 
 
 228 
 
 79 
 
 78 
 
 33 
 
 117 
 
 180 
 
 74 
 
 98 
 
 68 
 
 304 
 
 1 
 
 3 
 
 10 
 
 370 
 
 70 
 
 3 
 
 55 
 
 249 
 
 22 
 178 
 214 
 
 12 
 
 22 
 
 199 
 
 64 
 
 54 
 50 
 
 2417 
 
 68 
 162 
 92 
 82 
 76 
 247 
 
 7 
 
 316 
 
 53 
 
 2 
 
 41 
 
 219 
 
 20 
 168 
 267 
 
 14 
 
 7 
 
 246 
 
 27 
 
 36 
 
 37 
 
 62 
 81 
 24 
 
 "23 
 
 43 
 
 1 
 
 2 
 
 104 
 
 33 
 
 2 
 10 
 
 115 
 
 6 
 
 46 
 69 
 
 23 
 42 
 21 
 15 
 32 
 
 754 
 
 14 
 
 28 
 
 16 
 
 6 
 
 17 
 20 
 
 65 
 
 8 
 
 3 
 
 10 
 
 91 
 
 38 
 
 4 
 
 51 
 
 4 
 17 
 11 
 
 4 
 10 
 
 | 417 
 
 39 
 17 
 8 
 1 
 9 
 9 
 
 32 
 15 
 
 4 
 1 
 
 45 
 
 2 
 
 8 
 
 65 
 
 12 
 
 6 
 8 
 
 42 
 
 7 
 
 12 
 
 342 
 
 73 
 11 
 52 
 2 
 12 
 66 
 
 101 
 
 18 
 
 3 
 1 
 
 197 
 
 3 
 11 
 46 
 
 7 
 
 32 
 
 35 
 
 5 
 
 14 
 
 689 
 
 112 
 
 107 
 
 84 
 
 53 
 
 50 
 
 211 
 
 1 
 
 339 
 17 
 
 "2 
 
 244 
 
 9 
 
 8 
 
 48 
 
 2 
 
 1 
 28 
 91 
 41 
 37 
 
 1485 
 
 104 
 258 
 32 
 45 
 126 
 177 
 
 97 
 
 50 
 
 3 
 2 
 2 
 
 740 
 
 7 
 
 12 
 91 
 11 
 
 2 
 
 53 
 212 
 
 81 
 50 
 
 2155 
 
 1,096 
 
 1,286 
 
 730 
 
 764 
 
 850 
 
 2,202 
 
 8 
 
 6 
 
 144 
 
 2,585 
 
 634 
 
 10 
 
 22 
 
 353 
 
 4,281 
 
 306 
 
 759 
 
 2,342 
 
 164 
 
 168 
 2,925 
 966 
 583 
 443 
 
 Total.. 
 
 2375 
 
 2187 
 
 23,627 
 
 Pellagra. — Pellagra is a disease which was not known to exist in the United 
 States, with the exception of an occasional isolated case, until the year 1907. 
 If cases existed before this time, they were not recognized. Since 1907, how- 
 ever, cases have been found in considerable numbers in many localities. It 
 continues to be prevalent to an unexpected extent, and an increasing number 
 of cases are being recognized as practicing physicians become familiar with the 
 symptoms of the disease. Its exact prevalence is not known, although it has 
 been found in more than thirty States. The disease is undoubtedly one which 
 is frequently not properly diagnosed. It is at present required by law to be 
 reported in only four States. 
 
 Leprosy. — Occasional cases of leprosy are found in the United States. They 
 are usually among the foreign born, although cases have been reported among 
 the native born. From January 1 to September 1, 1911, nine cases have 
 been reported from seven States and the District of Columbia. 
 
 Plague. — From July 1, 1909, to August 8, 1911, seven cases of plague have 
 been reported in the State of California. These occurred as follows: 
 
 October 26th 1 case 
 
 August 2d 1 
 
 September 24, 1909 1 " 
 
 June 5th 1 " 
 
 September 5, 1910 1 " 
 
 July 25, 1911 1 " 
 
 August 8, 1911 1 " 
 
 Beriberi. — Occasional outbreaks of this disease have been reported as follows : 
 In South Carolina, among negro convicts, at a camp ten miles from the 
 
 city of Charleston, seventeen cases, with eight deaths. 
 
 In California during the years 1907, 1908 and 1909, twenty-five deaths from 
 
 beriberi were reported. Of these, twenty-two were of Japanese, two of Chinese 
 
 and one of German nativity. 
 
 "This table includes only the States for which the cases were reported bv months. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 149 
 
 A series of seventy-one cases was reported among the patients in the State 
 Insane Asylum, Tuscaloosa, Alabama, during the years 1895 and 1896. Of 
 these twenty-one were fatal. 
 
 In 1907 over two hundred cases developed in the State Lunatic Asylum, 
 Austin, Texas. Of these, twenty were fatal. 
 
 MORTALITY. 
 
 The data available in regard to vital statistics refers mostly to the year 
 1909, the Bureau of the Census not having yet made public the bulletin con- 
 taining the mortality statistics for the year 1910. Through the courtesy of the 
 Chief Vital Statistician of the Census Bureau, some advance information rela- 
 tive to mortality rates of the most important diseases in the year 1910 is 
 also incorporated in this report. 
 
 The population of the "registration area" of the United States, which was 
 estimated to comprise in 1908 a total of about 45,000,000 inhabitants, was 
 increased in both 1909 and 1910 by the addition of further sections of the 
 country complying with the requisites of the Census Bureau. The percentage 
 of population in the "registration area" thus rose from 51.8 in 1908 to 55.3 
 in 1909 and 58.3 in 1910. Laws recently adopted in various States make it 
 very probable that this area will soon receive further substantial additions. 
 
 For the year 1909 the registration area of the United States included the 
 following States: California, Colorado, Connecticut, Indiana, Maine, Mary- 
 land, Massachusetts, Michigan, New Hampshire, New Jersey, New York, 
 Ohio, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, Wis- 
 consin, and 54 cities in non-registration States. Minnesota, Missouri, and 
 North Carolina (only cities over 1,000 inhabitants) were the States admitted 
 to the registration area in 1910. 
 
 The total number of deaths returned from the year 1909 was 732,538, and 
 for 1910, 805,412. The death rate for 1909 was 15 per 1,000 and 14.95 per 
 1,000 in 1910, a mortality which compares very favorably with that for the 
 year 1908 (15.4). 
 
 Of the deaths registered for the year 1909, 54.4% were deaths of males, 
 a rate practically identical with that for 1908 (54.3%). There was a slight 
 decrease in the proportion of deaths of children under 5 years of age, 26.8% 
 in 1909 to 27.5 in 1910, this being mostly due to a lower ratio of deaths of 
 infants under 1 year in 1909 (19.1) than in 1908 (19.7). The quinquennial 
 percentages up to and including 45 to 49 years are either the same for 1909 
 and 1908 or a trifle lower in 1909, thus making the proportion for the higher 
 ages greater in 1909 than in 1908. 196,534 of the deaths occurred in children 
 under 5 years of age, and 140,057 of these were of infants under 1 year. 
 
 The death rates of the larger American cities for the year 1909 vary for 
 the most part between 14 and 17 per thousand, and are about 2 or 3 per 1,000 
 lower than they were ten years ago. The precise figures are, however, sub- 
 ject to revision, as they are based on estimated populations: 
 
 jqo8 igog 
 
 New York 16.8 16.0 
 
 Chicago 14.0 14.6 
 
 Philadelphia 17.4 16.4 
 
 Boston 19.1 16.8 
 
 New Orleans 22.7 20.2 
 
 St. Louis 14.5 15.8 
 
 Pittsburgh 16.5 15.8 
 
 Baltimore 18.3 18.7 
 
 Washington, D. C 19.3 19.0 
 
 Detroit 15.6 14.0 
 
 Milwaukee 13.6 13.6 
 
 Indianapolis 13.5 11.4 
 
 Jersey City 17.8 16.8 
 
 Buffalo 15.9 15.2 
 
 Cleveland 14.2 12.9 
 
 Cincinnati 18.5 16.4 
 
150 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 The cities with the largest amounts of decrease in the actual number of 
 deaths returned in 1909 as compared with the year 1908 were Philadelphia 
 (987); Boston (696); Pittsburgh (687); New Orleans (575), and Cincinnati 
 (512). The continued decrease in the number of deaths in Philadelphia is 
 worthy of notice, the decrease for the year 1908 as compared with 1907 having 
 been 1,550. 
 
 CAUSES OF DEATH. 
 
 No. of deaths Death rate per wofioo 
 
 1909 19 10 1908 1909 1 010 
 
 Typhoid fever 10,722 12.673 25.3 21.1 23.5 
 
 Malaria 1,175 1,176 2.5 2.4 2.2 
 
 Smallpox 79 202 0.2 0.2 0.4 
 
 Measles 4,860 6,598 10.2 10.0 12.3 
 
 Scarlet fever 5,781 6.255 12.4 11.0 11.6 
 
 Whooping cough 4,906 6,146 11.0 10.1 11.4 
 
 Diphtheria and croup 10,358 11,521 22.3 21.2 21.4 
 
 Tuberculosis, all forms 81,720 86,309 173.9 167.5 160.3 
 
 Cancer 37,562 41,039 74.3 77.0 76.2 
 
 Rheumatism 3,633 4.004 7.9 7.4 7.4 
 
 Diabetes 7.024 8,040 13.9 14.4 14.9 
 
 Meningitis 7,853 7,619 19.8 16.1 14.2 
 
 Heart disease 65,971 76,178 133.3 135.3 141.5 
 
 Bronchitis 12,127 12,620 26.9 24.9 23.4 
 
 Pneumonia 70,033 79,524 136.0 143.6 147.4 
 
 Diarrhea and enteritis (inf.) 44,648 54,266 98.9 91.5 100.8 
 
 Appendicitis 5,768 6,128 11.7 11.8 11.4 
 
 Bright's disease 48,430 53,330 97.3 99.3 99.0 
 
 Puerp. affections 7,791 7.455 16.3 16.0 15.7 
 
 Suicide 8.402 8.590 18.5 17.2 16.0 
 
 Accidents (including violent deaths) 47,135 48,606 97.9 99.7 90.3 
 
 The twenty leading causes of death for 1909 in the order of the number of 
 deaths caused were : 
 
 Tuberculosis 81,720 
 
 Heart disease 65,971 
 
 Diarrhea and enteritis 52,516 
 
 Pneumonia 49,007 
 
 Bright's disease (and nephritis) 48,430 
 
 Accident 44,281 
 
 Cancer 37,562 
 
 Apoplexy 36,463 
 
 Broncho-pneumonia 21,026 
 
 Premature birth 18,286 
 
 Congenital debility 14,988 
 
 Old age 13,456 
 
 Bronchitis 12,127 
 
 Tvphoid fever 10,722 
 
 Diphtheria _ 10,358 
 
 Diseases of arteries 10,174 
 
 Suicide 8,402 
 
 Various diseases of stomach 8,171 
 
 Meningitis 7,853 
 
 Childbirth 7,791 
 
POLIOMYELITIS IN THE UNITED STATES.' 
 
 Cases and Deaths Reported During the Year 1910. 
 
 
 Jan. 
 
 Feb. 
 
 Mar. 
 
 Apr. 
 
 May. 
 
 June. 
 
 July. 
 
 Au E . 
 
 Sept. 
 
 Oct. 
 
 Nov. 
 
 Dec. 
 
 Total. 
 
 
 Stale. 
 
 O 
 
 1 
 
 o 
 
 s 
 
 ™ 
 
 | 
 
 CJ 
 
 1 
 
 U 
 
 | 
 
 « 
 
 1 
 
 O 
 
 _ 
 
 3 
 
 J 
 
 O 
 
 | 
 
 ™ 
 
 
 
 cj 
 
 | 
 
 !|I 
 
 J 
 
 | 
 
 Remarks. 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ■ No reports. 
 Do. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 13 
 
 4 
 71 
 
 2 
 
 io' 
 
 9 
 1 
 
 31 
 
 3 
 
 1 
 
 11 
 
 4 
 
 
 
 5 
 Mis 
 
 l.lii 
 
 1 
 
 32 
 
 1 
 
 15 
 
 December report not yet received . 
 Reports not completed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 I 
 
 IS 
 2 
 
 I 
 
 36 
 
 'i 
 
 
 2 
 
 2 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Do. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 113 
 
 11 
 
 20 
 4 
 
 2 
 
 IS 
 1 
 
 
 1 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 No reports. 
 
 from second week in September 
 to Dec. 15, 1910. there were 42 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 42 
 
 93 
 137 
 13.1 
 HIS 
 IS!, 
 
 1 
 
 1: 
 12 
 2!l 
 Mil 
 17 
 
 
 
 
 
 
 
 
 1 
 
 1 
 
 1 
 
 
 5 
 
 1 
 
 II 
 
 4 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 16 
 
 5 
 
 23 
 
 2 
 
 33 
 
 77 
 
 111. 
 
 18 
 II 
 32 
 
 52 
 611 
 ■13 
 
 10 
 11 
 IS 
 
 11 
 ii 
 
 i 
 11 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3 
 
 3 
 
 1 
 
 1 
 
 4 
 
 2 
 
 T 
 
 J 
 
 25 
 
 2 
 
 20 
 
 J 
 
 51 
 57 
 
 7 
 15 
 
 156 
 
 44 
 
 Wa- 
 
 39 
 
 
 
 Up to Nov. 20, 1910, 1S9 cases and 
 
 47 deaths. 
 Present— no reports. 
 No reports. 
 
 first six months of the year- 
 June and July 1910, 184 cases re- 
 ported; deaths not given. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 4 
 3 
 
 9 
 
 1118 
 
 7 
 89 
 
 III 
 
 2 
 13 
 
 ll 
 
 2114 
 
 10 
 
 77 
 
 3 
 
 4 
 16 
 
 7 
 
 575 
 
 10 
 
 55 
 
 6 
 
 2 
 3 
 
 5 
 
 54 
 
 9 
 6 
 
 3 
 
 1 
 
 
 
 35 
 
 588 
 
 43 
 227 
 
 28 
 
 14 
 09 
 
 
 8 
 
 
 1 
 
 
 2 
 
 
 3 
 
 
 8 
 
 
 
 
 21 
 
 7 
 
 5 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Reports lor year not complete. 
 
 January to June 1910, 36 deaths. 
 No reports. 
 
 Do. 
 Estimated cases 40. 
 No reports. 
 9 eases with 1 death during the 
 
 years 1909 and 1910. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 6 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 5 
 
 2 
 
 
 
 
 
 
 
 
 
 
 
 5 
 75 
 
 2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 75 cases during the year from 55 
 
 localities. 
 No reports. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 
 1 
 
 
 10 
 
 
 28 
 
 12 
 
 97 
 
 16 
 
 l:l 
 
 21 
 
 .::: 
 
 9 
 
 4 
 
 2 
 
 517 
 
 60 
 
 
 
 
 
 
 
 
 
 
 No reports. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ii 
 
 
 29 
 
 1 
 
 38 
 
 1 
 
 11 
 
 24 
 
 1 
 
 10 
 2S 
 
 2 
 
 1 
 
 
 Mil) 
 
 36 
 ,097 
 231 
 
 85 
 
 80 
 
 '4' 
 
 21 
 
 72 
 
 10 
 
 17 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Reports not complete. 
 
 January to August 1910, 5 eases 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Ore on 
 
 
 
 
 
 
 
 
 
 
 
 2 
 
 2 
 
 18 
 
 152 
 46 
 
 5 
 
 275 
 70 
 
 1 
 
 58 
 
 378 
 65 
 
 1 
 
 111 
 
 5 
 
 117 
 9 
 
 50 
 
 9 
 
 115 
 1 
 
 11 
 
 22 
 
 2 
 
 15 
 2 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 Reports for year not complete. 
 During the year a total of 231 
 
 Cases reported between May 21 
 and Oct. 15. 
 
 
 
 
 
 
 1 
 
 
 
 
 4 
 
 
 5 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 15 
 
 1 
 
 25 
 
 11 
 
 31 
 
 3 
 
 11) 
 
 2 
 
 5 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 No cases reported. 
 Do. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 2 
 
 1 
 
 
 
 2 
 13 
 
 357 
 
 254 
 
 1 
 2 
 
 2 
 
 49 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3 cases, 2 deaths, to Oct. 1; no 
 cases during balance of year. 
 
 Jan. 1 to Oct. 12, 1910. 326 eases 
 were reported. 
 
 Vi, inia 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 »30 
 103 
 
 15 
 
 318 
 
 
 
 
 19 
 20 
 
 1 
 9 
 
 12 
 
 8 
 
 1 
 
 6 
 
 
 1 
 
 
 
 
 
 
 
 
 7 
 
 
 24 
 
 1 
 
 40 
 
 1 
 
 
 51 
 
 17 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 22 
 
 27 
 
 Estimated there were 500 cases. 
 No reports. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 12 
 
 3 
 
 2 
 
 1 
 
 7 
 
 2 
 
 11 
 
 3 
 
 46 
 
 2 
 
 .'.7 
 
 7 
 
 465 
 
 44 
 
 ,117:1 
 
 82 
 
 
 
 04 
 
 76 
 
 177 
 
 11 
 
 05 
 
 3li 
 
 ,093 
 
 25 
 
 
 ,146 
 
 L71 i 
 
 
 
 
 I See Public Health Reports, Sept. 30. 1910, p. 1317, and Oct, 23, 1910, p. 1517 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 151 
 
 DEATHS BY SEX AND AGE. 
 
 Sex. Percentage. 
 
 Male 398,597 54.4 
 
 Female 333,941 45.6 
 
 Age. 
 
 Under 5 years 196,534 26.8 
 
 5 to 9 years 16,141 2.2 
 
 10 to 14 years 10,761 1.5 
 
 15 to 19 years 18,138 2.5 
 
 20 to 24 years 27,303 3.7 
 
 25 to 29 years 29,733 4.1 
 
 30 to 34 years 29,905 4.1 
 
 35 to 39 years 32,965 4.5 
 
 40 to 44 years 32,115 4.4 
 
 45 to 49 years 34,646 4.7 
 
 50 to 54 years 36,428 5.0 
 
 55 to 59 years 37,007 5.1 
 
 60 to 64 years 42,475 5.8 
 
 65 to 69 years 46,649 6.4 
 
 70 to 74 years 45,610 6.2 
 
 75 to 79 years 41,989 5.7 
 
 80 to 84 years 29,680 4.1 
 
 85 to 89 years 16,533 2.3 
 
 '90 and over, and unknown 7,925 1.0 
 
 OCCUPATIONS AND CAUSES OF DEATH. 
 
 An effort has been made to compile data relative to decedents in the regis- 
 tration area who were at least ten years old, and were reported to have been 
 engaged in some gainful occupation at the time of their death. Of the deaths 
 of males reported, 210,507, or 52.8%, were of persons engaged in some gainful 
 occupation; while in the case of females, 27,459, or only 8.2%, were of per- 
 sons gainfully employed. 
 
 In the absence of definite statistics (which are only available every ten 
 years) showing the number of persons employed in the different industries, the 
 data compiled by the Census Bureau regarding the relative mortality of various 
 occupations can hardly be called satisfactory, as more or less guesswork must 
 figure in all the comparisons made, and it is difficult to determine the whole- 
 someness of a given industry as shown by the death rate. 
 
 REGULATIONS RELATIVE TO INTERNATIONAL TRAFFIC WITH A VIEW TO PREVENTING 
 THE SPREAD OF COMMUNICABLE DISEASES. 
 
 The United States Quarantine Regulations outline the measures which have 
 been deemed advisable for the protection of the nation against the introduction 
 of communicable diseases in international traffic. These regulations were thor- 
 oughly revised in October, 1910, and conform strictly to the principles laid 
 down at the International Sanitary Conference held at Paris in 1903, and the 
 Conventions signed by the American Republics. Their application in the daily 
 practice was the subject of a paper by the United States delegation at the 
 Fourth International Sanitary Conference held at San Jose, Costa Rica, in 
 1909 (see page 196 of the Transactions). 
 
 The one matter of supreme importance in the revision of the regulations was 
 the adoption of a regulation relative to the destruction of rodents, which com- 
 mits the government to the policy of systematic fumigation of ships every six 
 months or oftener.* This matter has been brought to the attention of the 
 International Office of Public Hygiene at Paris, and it is expected that it will 
 be one of the subjects under consideration at the International Sanitary Con- 
 ference which will meet at Paris in October, 1911. 
 
 *This regulation is discussed in another part of this report, and a copy of the regulation 
 itself is also given there. 
 
152 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 SANITARY RESTRICTIONS ON IMMIGRATION. 
 
 The immigration laws of the United States exclude from admission : idiots, 
 imbeciles, feeble-minded persons, epileptics, insane persons, persons afflicted 
 with tuberculosis or with a loathsome or dangerous contagious disease, and also 
 persons afflicted with a mental or physical defect of such nature as to affect 
 the ability of the alien to earn a living. 
 
 Officers of the Public Health and Marine Hospital Service conduct the medi- 
 cal examinations of aliens, and pass upon questions of a medical character 
 arising in the enforcement of this act. The regulations prepared by this 
 Service define a loathsome contagious disease, and refer especially to those 
 essentially chronic in character, such as favus, ringworm, sycosis barbae, acti- 
 nomycosis, blastomycosis, frambesia, mycetoma, leprosy, and venereal diseases. 
 A dangerous contagious disease is taken to mean a communicable disease, 
 essentially chronic in character, which may result in the destruction of one of 
 the most important senses or loss of life, such as trachoma, filariasis, uncina- 
 riasis, amoebic infection, bilharziosis. 
 
 Cases which are considered to fall under the classification of "persons afflicted 
 with a mental or physical defect of such nature as to affect the ability of 
 the alien to earn a living" are such diseases as hernia, heart disease, defective 
 nutrition, defective development, chronic arthritis and myositis, nervous affec- 
 tions, malignant new growths, deformities, senility, varicose veins, defective 
 eyesight, cutaneous affections, eruptive fevers, anaemia, tuberculosis joint affec- 
 tions, and conditions such as pregnancy, and in general all diseases and defects 
 that may impair a person's capacity for self-maintenance, all defective and 
 diseased conditions of a more or less permanent character tending to require 
 institutional care or treatment, all physical conditions which require or are 
 likely to require medical treatment, and all cases of diseased, deformed, or 
 crippled children. 
 
 Many of the immigrants are inspected at foreign ports, but the chief reliance 
 is placed on the examination at the port of arrival. These examinations are 
 now conducted at 79 stations, 77 medical officers having been assigned exclu- 
 sively to this work during the fiscal year 1910. There were 1,280,957 immi- 
 grants examined, of which 30,780 were certified for exclusion by the immigra- 
 tion authorities. 
 
REPORT PRESENTED BY DOCTOR E. FERNANDEZ ES- 
 PIRO AND DOCTOR JAIME H. OLIVER, DELEGATES 
 FROM URUGUAY. 
 
 I. LAWS OF SANITARY POLICE AND HEALTH MEASURES ADOPTED SINCE THE FOURTH 
 
 CONFERENCE. 
 
 The following laws have been enacted since the Fourth International Sani- 
 tary Conference, held in San Jose, Costa Rica, in 1909 : 
 
 Law creating the Departmental Offices of Health Inspection, in lieu of the 
 Departmental Boards established in 1895 under the National Board of Hygiene; 
 there is one for each Department of the Republic, under competent physicians 
 appointed by the Executive upon recommendation of the National Board. 
 
 Law of National Public Assistance. Under this law, all national and 
 municipal establishments devoted to the care, protection and attendance of the 
 poor have been placed under the control of the Bureau of National Public 
 Assistance and the Board of Public Assistance, which latter is composed of 21 
 members. The former is under a Director-General. 
 
 Law of Pharmacies, which prescribes the conditions and requirements which 
 must be fulfilled for the operation of these establishments. No drug store can 
 now be operated unless it be under a graduate pharmacist. 
 
 Law of Vaccination and re- Vaccination, which compels every inhabitant of 
 the Republic to be duly vaccinated. 
 
 The Economico-Administrative Board of Montevideo has also enacted the 
 following health ordinances : Regulating the sale and distribution of milk ; 
 regulating the use of coloring matters in the manufactory of foodstuffs, papers 
 and cardboards. 
 
 II. COMPLIANCE WITH THE RESOLUTIONS PASSED BY THE FIRST FOUR CONFERENCES. 
 
 The Government of Uruguay has not overlooked the resolutions passed by 
 the Sanitary Conferences, since both the international and domestic laws of 
 the country are in accordance with the fundamental principles of said 
 resolutions. 
 
 In support of this suffice it to say that the International Sanitary Convention 
 of Rio de Janeiro has recognized the advisability of shortening the period of 
 detention of passengers and of the disinfection of baggage, in the same manner 
 as it was recognized by the second resolution of the First Sanitary Conference 
 of Washington of 1902. On the other hand, the National Board of Hygiene 
 has adopted the recommendations of the 6th resolution of the same conference 
 as to the immediate disinfection of discharges from cholera patients. The 
 same body has also taken into consideration the 2d resolution of the Third 
 International Sanitary Conference as to the codification of all sanitary laws 
 and measures, recommending the legislature of the Republic to appoint a com- 
 mission charged with the compilation of such legislation. The commission was 
 duly appointed and will surely have its work completed before the convening 
 of the Sixth Sanitary Conference. 
 
 With reference to the 5th resolution of the Third Conference, we have to 
 state that it has been complied with by the law of compulsory vaccination 
 referred to. 
 
 The 17th resolution of the same conference, recommending the advisability 
 of isolating consumptives, has been fulfilled by the Bureau of Public Assistance 
 by ordering that such patients be gathered in the Fermin Ferreira Hospital, 
 which has at present about 300 patients, and which will later have a capacity 
 for 700. 
 
 Paragraph (d), Resolution II of the Fourth Conference has been put into 
 practice with the order of the Bureau of Health of Montevideo, to the effect 
 
154 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 that rats be captured in different parts of the capital and examined in the 
 municipal bacteriological laboratory for the purpose of ascertaining the pres- 
 ence of plague. 
 
 Paragraph (d), Resolution III of the same Conference has also been com- 
 plied with, because the sanitary authorities in the port of Montevideo enforce 
 the medical inspection of ships at all times. 
 
 Resolution X has also been put into practice by sending to this Conference 
 a delegate who had participated in a former conference. 
 
 As to Resolution XI, we shall, in part IV of this report, state the reasons 
 why no information has been furnished to the International Sanitary Bureau 
 of Washington. 
 
 III. REPORT ON THE ADOPTION OF THE WASHINGTON CONVENTION OF 1905 AND THE 
 RATIFICATION OF ART. IX THEREOF AS RECOMMENDED BY THE FOURTH CONFER- 
 ENCE AND THE PAN AMERICAN CONFERENCE OF BUENOS AIRES. 
 
 When the Third International Sanitary Conference of Mexico took place, 
 the Uruguayan Delegate accepted on behalf of his Government and signed 
 ad referendum the Sanitary Convention signed at Washington in 1905. This 
 convention has been submitted to the Legislature for its approval. Therefore, 
 we expect it will soon be a law of the Republic, and likewise, Article IX thereof 
 as amended by the Fourth Conference. , 
 
 IV. CONSTITUTION AND WORK OF THE INTERNATIONAL SANITARY INFORMATION 
 
 COMMISSION. 
 
 The constitution and establishment of the Information Sanitary Bureau of 
 Montevideo had to be postponed through unforeseen circumstances, and it was 
 only in December, 1910, that it took place. The Executive appointed the fol- 
 lowing persons to constitute the same : Dr. Joaquin de Salterain, Dr. Julio 
 Etcharpe, and Dr. Ernesto Fernandez Espiro. Upon request of the Commis- 
 sion, the Minister of Foreign Affairs advised the Sanitary Bureau of Wash- 
 ington and the American Governments of the organization of the commission, 
 under date of May 2, 1911, but up to this date the Montevideo Bureau has 
 received no communications from the Washington Bureau. 
 
 This is the best opportunity to request the Delegates from the countries 
 interested to request their Governments to send the necessary information to 
 the bureaus of Montevideo and Washington. 
 
 V. SANITATION OF CITIES. 
 
 In the Third Conference of Mexico we stated that the Government had 
 issued a decree in July, . 1907, providing that studies and surveys be made 
 for sanitation works in rural towns and cities. Those studies and surveys have 
 now been completed, as well as the projects of the works that are to be 
 undertaken. 
 
 The purpose of the Government in this important subject has been to provide 
 those cities and towns with the best possible water supply and sewerage 
 systems. The total costs of these works will amount to $17,000,000 gold. 
 
 VI. PROPHYLACTIC MEASURES AGAINST CHOLERA, YELLOW FEVER AND PLAGUE. 
 
 These diseases are entirely exotic in Uruguay. Whenever any cases have 
 occurred, they were imported from abroad and always through the maritime 
 way. 
 
 The prophylactic measures enforced in Uruguay against palgue are in 
 accordance with the Convention of Rio de Janeiro of 1904, between the Argen- 
 tine Republic, Brazil, Paraguay and Uruguay, which has established as the 
 three fundamental principles in matters of international sanitary police, the 
 following: 1st. Not to interrupt communication with any country, by closing 
 ports or establishing sanitary cordons in frontiers; 2d. Not to reject any vessel, 
 whatever its sanitary condition; 3d. To enforce prophylactic measures, the 
 isolation of sick or suspected, the disinfection of ships and baggage, sanitary 
 inspection of vessels, sanitary surveillance, and preventive vaccination. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 155 
 
 There is the Isla de Flores, a well-equipped Sanitary Station, with a lazaretto 
 for the observation of sick and suspected passengers. 
 
 For the extermination of rats, there are enforced in Uruguay the general 
 provisions of the Rio de Janeiro Convention and of the Plan of Sanitary 
 Maritime Defense against Plague issued by the National Board of Hygiene, 
 which provides in Section 11 that when plague should appear in a maritime 
 port of the Republic, no vessel coming therefrom shall be allowed to unload 
 unless it has been previously rid of rats. In September, last, the Board of 
 Directors of the Port of Montevideo began the enforcement of a plan for the 
 systematic destruction of rats. The author of said plan is Dr. Jaime H. 
 Oliver, a Director of the Port. On the other hand, the municipal Government 
 of the Capital has a brigade of inspectors charged with the duty of inspecting 
 all buildings and destroying the rats therein. 
 
 Among the diseases classed as exotic by the Maritime Sanitary Regulations, 
 there is beri-beri, which does not exist in any section of our territory. The 
 only cases observed have come through seaports, and in accordance with the 
 said regulations, they have been confined and isolated in the lazaretto of the 
 Isla de Flores, where they were retained until the departure of the vessel 
 importing them. During the last four years only 64 cases have been recorded 
 in that lazaretto. 
 
 VII. PROPHYLAXIS OF TRACHOMA, LEPROSY, VENEREAL DISEASES, SMALLPOX AND 
 
 TUBERCULOSIS. 
 
 In the report presented to the Third Conference of Mexico, it was stated 
 that the cases of trachoma observed by the occulists in Uruguay, were isolated 
 cases which had not constituted i'ocii of infection, and that only in the 
 Foundling and Orphan Asylum of Montevideo there were some cases which 
 tended to disappear, thanks to isolation. 
 
 We will now state that almost all the children lodged in that asylum were 
 suffering from granular conjunctivitis. Energetic isolation measures were 
 enforced, and thanks to them no new cases have occurred. The disease would 
 have disappeared entirely had it not been for the fact that from time to time 
 new children are admitted who are afflicted with the disease. At present the 
 total number of trachoma patients in the asylum is 40. According to the obser- 
 vations of occulists, trachoma occurs with some frequency in Montevideo, and 
 also among foreign immigrants. 
 
 Leprosy is a disease rare in Uruguay. As all physicians are compelled to 
 report all cases coming under their observation, we have very complete statistics 
 of the cases of leprosy. During the period of 13 years, from 1898 to 1910, 
 215 cases have been reported, according to the records of the National Council 
 of Hygiene. 
 
 Venereal diseases. — In the year 1903 the National Council of Hygiene was 
 authorized to prepare the Regulations governing prostitution, the inspection of 
 which was under the control of the Department of Police. Prostitution is now 
 regulated upon the following basis : Elimination of districts, and, therefore, 
 toleration of disseminated prostitution ; compulsory registration of all women 
 engaged in the practice; medical inspection twice a week; use of a book of 
 identification, wherein are recorded all medical inspections and the sanitary 
 condition of each woman ; prohibition to attend cafes, bars, etc. 
 
 As a complement to the service of medical inspection, there is a Dispensary 
 for Prostitutes, at the head of which are two physicians. 
 
 The elimination of clandestine prostitution is entrusted to the Department 
 of Police. 
 
 Prostitutes suffering from venereal diseases are confined in the Doctor Ger- 
 man Segura syphylocomium, at the head of which is a Medical Director, with 
 an assistant, under the control of the National Board of Hygiene. Very soon 
 there will be a new building with capacity for 150 patients, costing $300,000, 
 gold. The medical inspection of prostitutes is made by seven physicians for 
 the capital ; two for the syphylocomium, and two for the Dispensary. 
 
 During the five years that the syphylocomium has been in operation the 
 following cases have been treated : 
 
156 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 1906. 1908. 
 
 Syphilis 95 Syphilis 60 
 
 Chancres 18 Chancres 26 
 
 Gonorrhea 266 Gonorrhea 379 
 
 Other diseases 29 Other diseases 42 
 
 1907. 1909. 
 
 Syphilis 75 Syphilis 34 
 
 Chancres 30 Chancres 44 
 
 Gonorrhea 211 Gonorrhea 191 
 
 Other diseases 54 Other diseases 47 
 
 1910. 
 
 Syphilis 82 
 
 Chancres 52 
 
 Gonorrhea 271 
 
 Other diseases 76 
 
 It should be noted that there are included in those totals women from the 
 various Departments of the Capital, in whose towns and cities inspection of 
 prostitutes is also enforced. 
 
 Smallpox. — To the prophylactic measures against this disease, mentioned in 
 the report to the Third Conference, there should be added the law of vaccina- 
 tion and re-vaccination above referred to. 
 
 During the period of 10 years, from 1901 to 1910, 421,707 inoculations have 
 been made by the corps of official vaccinators. The number of vaccinations is 
 really greater, because private physicians do a considerable amount of in- 
 oculations. 
 
 The vaccine used in Uruguay is manufactured by the Municipal Institute of 
 Vaccine, and obtained from tuberculine-tested heifers. The number of tubes 
 distributed by the Institute in 1910 was 236,240, as against 96,278 in 1909. 
 From 1901 to 1910, it has distributed 797,771 tubes. 
 
 Tuberculosis. — In addition to the measures set forth in the report to the 
 Third Conference, there are enforced the provisions of new laws, such as the 
 ordinance providing for the inspection of dairies, and the law of 1910 estab- 
 lishing the tuberculization service and animal veterinary inspection, under 
 the Bureau of Animal Sanitary Police. All milch cows are inoculated with 
 tuberculine. 
 
 In August, 1908, there was created the School Medical Corps, which, among 
 other duties, is charged with the individual examination of teachers, pupils 
 and students in normal schools. In this examination particular attention is 
 given to tuberculosis. Thus we have been able to find among 476 teachers 
 examined, 77 suffering from pulmonar consumption. All those found thus 
 afflicted are isolated until cured or retired. 
 
 Summer colonies are being organized, one being already in operation, for 
 sick children from the Foundling and Orphan Asylum and for those selected 
 by the School Medical Corps. This colony is giving splendid results in the 
 fight against consumption, as are also the new pavillions for consumptives in 
 the Fermin Ferreira Hospital. 
 
 Independently from the Government, there is an anti-tuberculosis league, 
 founded by Dr. Joaquin de Salterain, which has four magnificent dispensaries 
 in the Capital, specially built for that purpose. 
 
 The 31st of August, last, was designated as "tuberculosis day," during which 
 there were received voluntary subscriptions from all over the country amount- 
 ing to $85,000 gold. The league is now building an "Open-Air Cure Hospital" 
 on a large tract of land beautifully located in the outskirts of the city. 
 
 Malaria is a disease unknown in our country. It is very rarely observed 
 among foreigners. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 157 
 
 VIII. STATISTICS ON MORBIDITY AND MORTALITY, AND REPORT UPON THE ADOPTION 
 
 OF THE BERTILLON NOMENCLATURE. 
 
 The statistical data that we present before this Conference refer exclusively 
 to the contagious diseases which occur most frequently in the Republic. We 
 shall give below, by periods of five, from 1896, the statistics of cases and 
 deaths. Comparing this table, it is seen that the largest number of cases 
 belongs to tuberculosis, measles and typhoid fever, and that the largest of 
 deaths was caused by tuberculosis, measles and smallpox. 
 
 1896-1900 1901-1905 1906-1910 
 
 Cases. Deaths. Cases. Deaths. Cases. Deaths. 
 
 Measles 3,798 372 4,059 197 6,128 212 
 
 Diphtheria 1,422 614 1,216 281 1,545 229 
 
 Whooping cough 702 243 768 186 647 190 
 
 Tuberculosis 2,375 4,539* 5,965 4,785 6,158 5,958 
 
 With regard to the adoption of the Bertillon Nomenclature, we have to state 
 that it has been in force in Uruguay since 1901. 
 
 *The greater number of deaths is due to the fact that the reporting of cases 
 was enforced only from the second period of five years. 
 
 IX. INSPECTION OF INTERNATIONAL TRAFFIC BOTH BY LAND AND SEA IN CASES OF 
 
 TRANSMISSIBLE OR QUARANTINABLE DISEASES. 
 
 The supreme authority charged in Uruguay with the enforcement of the 
 provisions above set forth, is the National Board of Hygiene, created by the 
 law of October 31, 1895, and clothed with ample powers. It is composed of 
 seven members appointed by the Executive. Its chairman is the supreme chief 
 of the whole sanitary service of the Republic. In each Department there is one 
 Departmental Hygiene Inspector and a Departmental Board of Hygiene. In 
 Montevideo there is also a Bureau of Maritime Sanitary Inspection with a 
 Medical Director and three maritime physicians, whose special duty it is to 
 prevent the introduction of exotic and infectious disease. According to the 
 Maritime Sanitary Regulations, the diseases included in the former class are: 
 cholera, yellow fever, beri-beri and plague, and in the latter class, typhus, small- 
 pox, scarlet fever, measles and diphtheria. 
 
 The maritime sanitary regulations require that all vessels be provided with 
 a bill of health, and besides every ship is duly examined upon arrival by a 
 sanitary inspector. 
 
 Mention has been made of the Sanitary Station at Isla de Flores, provided 
 with a lazaretto for infectious diseases. This island is situated outside the 
 port of Montevideo, and is divided in two sections, one for healthy passengers 
 under observation, and another for sick passengers. The maritime sanitary 
 regulations provided that all passengers, when sick or convalescing from an 
 exotic or infectious disease shall be confined in Isla de Flores. 
 
 As regards our land frontiers, we have no inspection over the international 
 traffic, and only in case of an epidemic in a neighboring country do we enforce 
 prophylactic measures. 
 
 X. SANITARY LAWS ON IMMIGRATION. 
 
 The immigration law of Uruguay was enacted in 1890, for the purpose of 
 encouraging the introduction of immigrants into the country. Among its pro- 
 visions, there is one prohibiting the master of any vessel from admitting aboard 
 ship any person suffering from contagious diseases, or is poor, or over sixty 
 years old, or physically or mentally unable to work. The said law also prohibits 
 the immigration of Asiatics, Africans, Hungarians and Bohemians. 
 
REPORT PRESENTED BY DOCTORS PABLO ACOSTA 
 ORTIZ AND LUIS RAZETTI, DELEGATES FROM VEN- 
 EZUELA. 
 
 .Honored by the Government of Venezuela with its representation before 
 this learned Conference, we beg to report as follows upon the various subjects 
 of the Program: 
 
 I. Sanitary police laws and health measures adopted in each country 
 
 SINCE THE FOURTH CONFERENCE. 
 
 Organization of health services. By a presidential decree of January 6, 
 1910, there was created, a dependency of the Department of the Interior, the 
 Bureau of Public Hygiene and Health, which has charge of all matters relating 
 to maritime sanitary police, study of infectious diseases, sanitation and disin- 
 fection works, demographic statistics, leper colonies, insane asylums, etc. 
 
 The chief of this bureau is the National Director of Public Hygiene and 
 Health, who is chairman ex officio of the Supreme Board of Health and 
 Hygiene, whose principal function it is to legislate upon public health and 
 hygiene matters which may be referred to it by the Executive. 
 
 Under the Bureau of Public Hygiene and Health is the Technical Division 
 of Hygiene, divided into three sections, viz. : infectious diseases ; chemistry 
 and bacteriology; and statistics and demography. This division is equipped 
 with complete laboratory of hygiene, which is provided with everything neces- 
 sary for the manufacture of serums and vaccines, and for chemical and bac- 
 teriological analysis. A special department of the laboratory is exclusively 
 devoted to plague, both in men and in rodents. 
 
 Besides the section chiefs, the Division has medical sanitary officers, house 
 inspectors, sanitary policemen, sanitary squads, etc. 
 
 Special health tax. — By decree of the President, dated December 29, 1910, 
 a special health tax, of one per cent of the total value of customs duties 
 levied on merchandise imported. The Chamber of Commerce of Caracas, 
 constituted as Central Board of Public Health, administers these funds, which 
 are kept in the Bank of Venezuela, as a special account called "Hygiene 
 and Sanitation Funds," together with revenues derived from the inspection of 
 vessels, disinfections, etc. 
 
 Sanitary Organization of the City of Caracas. — The city of Caracas, capital 
 of the Republic, is divided into nine Sanitary Districts, at the head of which 
 is a Medical Health Officer. The personnel consists of two sanitary inspectors 
 for each district; one general agent of sanitary police, and five subordinate 
 agents who are at the head of the various squads, which are as follows : three 
 for petrolization ; four for drainage; three for destruction of mosquitoes, and 
 seven for destruction of rats and for disinfection in general. One corporal 
 has immediate charge of each of these squads. 
 
 There is also a special department of the Technical Bureau provided with 
 all necessary apparatus and instruments for disinfection, and with a personnel 
 well trained for the performance of its duties. 
 
 Sanitary Organisation of Ports. — The ports of Venezuela opened to foreign 
 traffic are : La Guaira, Puerto Cabello, Carupano, Ciudad Bolivar, Maracaibo, 
 Cristobal Colon, Puerto Sucre, Pampatar, and La Vela. In each of them 
 there is a Director of Health whose duties are provided for in the Maritime 
 Sanitary Police Regulation issued on June 4, 1909. 
 
 La Guaira and Puerto Cabello, the principal ports of the Republic, are each 
 equipped with a bacteriological laboratory and a disinfection station with 
 Clayton apparatus. Carupano and Ciudad Bolivar also have disinfection 
 stations. 
 
160 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 Although our sanitary organization is not as yet perfect, we believe that 
 we now have a solid basis upon which to build an excellent health service, 
 which will soon be accomplished through the keen interest the present adminis- 
 tration takes in matters of public hygiene. 
 
 II. Compliance with the resolutions passed by the first four confer- 
 ences. 
 
 The Government of Venezuela has, within the means at its disposal, complied 
 with the Resolutions of the Fourth Conference. Those of the first three it 
 has accepted in principle, they being of real benefit to the public health of 
 the American Continent. 
 
 III. Report on the adoption of the convention of Washington of 1905, 
 
 AND THE RATIFICATION OF ARTICLE IX AS AMENDED BY THE FOURTH SANITARY 
 CONFERENCE AND THE PAN AMERICAN CONFERENCE OF BUENOS AIRES. 
 
 Venezuela was one of the signatory nations to the Sanitary Convention of 
 Washington. 
 
 As to the amendment proposed by the Fourth Sanitary Conference and the 
 Pan American Conference of Buenos Aires, to Article IX of the Convention 
 referred to, we will take the liberty to make the following remarks : 
 
 1st. The text of said article should be carefully studied in order that it should 
 be clearly and precisely termed. The periods therein fixed to consider a 
 locality free from infection are not in conformity with every-day observations. 
 In places where yellow fever and plague are prevalent it is noticed that periods 
 of from one to more months may elapse without the occurrence of a single 
 case, only to reappear later, although all necessary measures may have been 
 enforced and continued to be enforced vigorously. Such disappearances and 
 reappearances show that the infected locality is still in that condition even 
 if no cases occur in man, that is to say, that it is not a passing epidemic, but 
 an endemic. Yellow fever in some American countries is epidemic, but entirely 
 endemic since time immemorial. Plague, except in very rare cases, such as that 
 of La Guaira, where it only lasted six months, is a disease most difficult to 
 fight, because the extermination of rodents, which are the main factor in main- 
 taining the state of infection, is an arduous task, requiring not only large 
 amounts of money but also a long time. 
 
 What can be the meaning of the "five days" prescribed for plague, and what 
 that of "eighteen days" for yellow fever, in order that a locality may be 
 considered free from infection of those diseases, when we all know that new 
 cases may appear after months have elapsed since the last case? An examina- 
 tion of statistical figures would show us how far from scientific accuracy is 
 the wording of the now famous Article IX of the Washington Convention. 
 
 2d. As regards the amendment thereto suggested by the Fourth Conference, 
 we notice that the words "to the satisfaction of the interested party," instead 
 of elucidating the text and of giving a precise meaning to the spirit of the 
 article, it makes its interpretation obscure and difficult. Which is the inter- 
 ested party when a country is unfortunate to have been invaded by an epidemic 
 disease? We suppose it is the neighboring country still free from infection, 
 or both, if the wording were to be "both interested parties." But then the 
 question arises, which of them is entitled to prescribe the extent of such 
 satisfaction? When are the parties to declare themselves as satisfied? We 
 know that plague epidemics are intermittent and last for some years in certain 
 countries, and that yellow fever is endemic in some American Republics. 
 
 For the above reasons we believe that Article IX of the Washington Con- 
 vention should be carefully considered and so amended as to be in accordance 
 with equity and justice upon which the relations between civilized nations 
 should be based. 
 
 IV. Constitution and work of the sanitary information committees. 
 
 The Venezuelan Committee is composed of Dr. Carlos M. de la Cabada, the 
 Director of Public Hygiene and Health, and Dr. Luis Razetti and P. Acosta 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 161 
 
 Ortiz, Delegates from Venezuela to the Fourth and Fifth Sanitary Conferences. 
 Organized in due time this Committee has performed its duties regularly. 
 
 V. Sanitation of cities and specially of ports. 
 
 The sanitation of the city of Caracas urgently calling for a good sewer 
 system, the Government of the Republic entered into a contract with an 
 English company, whose engineers have already arrived to make the necessary 
 surveys, and the actual work of construction will soon be started. The total 
 cost of the system is estimated over 20,000,000 francs. With its excellent 
 climatic and topographic conditions, a good sewer system and well paved streets, 
 Caracas will be one of the healthiest cities in the Continent. 
 
 VI. Prophylactic measures against plague, cholera, and yellow fever. 
 
 A. Measures against Plague. 
 
 Under the General Ordinance for the Defense of Caracas against Plague, 
 the campaign is conducted upon the following basis: 1st. Destruction of 
 rodents; 2d. Early diagnosis of the disease and compulsory declaration of 
 every case; 3d. Systematic isolation of all cases in a special station, and, 4th, 
 use of the Haffkine lymph and of the Yersin serum. The systematic and vig- 
 orous enforcement of these measures has produced satisfactory results, as may 
 be seen from the table given below, which comprises from April 18, 1908, 
 when the epidemic started, until this date. If we have not as yet succeeded in 
 eradicating the disease entirely, we have at least reduced it to a very limited 
 number of human cases. Indeed, 188 cases during 41 in a population of nearly 
 80,000 is not much for so ravaging a disease as plague. It is venturing to 
 assume that very soon plague will have disappeared from Caracas, just as it 
 did from La Guaira, where it has not occurred during the last three years, 
 neither in man nor in rodents. In making this assertion we base it upon the 
 fact that the disease in rodents has decreased from 0.66 per cent in 1909 to 
 0.32 in 1911. The destruction of rats in Caracas is rather difficult on account 
 of the topography of the land. 
 
 The table referred to, showing the number of plague cases in Caracas, is 
 as follows : 
 
 YEAR. CASES. 
 
 1908 78 
 
 1909 29 
 
 1910 39 
 
 1911 42 
 
 188 
 
 B. Measures against Yellow Fever. 
 
 Yellow fever is an endemic disease in Venezuela, one territory being within 
 the yellow fever zone. The stegomya callopus is one of the commonest insects 
 in our cities. Several learned Venezuelan physicians have made important 
 clinical investigations on the subject, and the First Venezuelan Medical Con- 
 gress appointed a commission to study the Venezuelan mosquito. 
 
 In the early part of 1910 was begun systematically the campaign against 
 yellow fever in Caracas, and in the beginning of 1911 the enforcement of 
 active and efficient prophylactic measures was started. This campaign is car- 
 ried on as follows : 1st. Compulsory declaration of all cases, both confined 
 and suspected; 2d. Rigid isolation of all patients; 3d. Systematic destruction 
 of mosquitoes and their larvae. 
 
 These prophylactic measures having been in force since not long ago, it is not 
 possible at this time to notice the results of the campaign, but, as the methods 
 adopted in Venezuela are copied from those so successfully tested in Cuba, 
 Mexico, Brazil, Panama, etc., it is only logical that we should expect to 
 achieve the same satisfactory results. 
 
 During 1910, 15,968 houses were inspected for mosquitoes, and 4,415 bottles 
 of petroleum used in destroying the insects. During the first eight months 
 
162 FIFTH INTERNATIONAL SANITARY CONFERENCE. 
 
 of 1911, 26,850 houses have been inspected, and 5,706 bottles of petroleum 
 used. During the same months 6,129 deposits were found with mosquito larvae, 
 and destroyed. 
 
 The cases of yellow fever reported to Bureau of Hygiene during 1910 and 
 1911 were as follows: 1910 — 122 cases with 39 deaths, or a death rate of 
 32 per cent; 1911 (January to August) — 100 cases with 52 deaths, or a death 
 rate of 50 per cent. 
 
 C. Measures against Cholera. 
 
 Our Martime Sanitary Police Regulations prescribe the manner in which 
 vessels arriving from cholera-infected localities should be treated, in accordance 
 with the provisions of the Washington Sanitary Convention. As soon as it 
 became known that an epidemic broke out in Italy, instructions were given to 
 all Health Directors at the various ports to make a more rigid inspection of all 
 vessels, specially those coming from Mediterranean ports. No suspected ships 
 have been allowed to enter our ports, and up to the present time we have 
 not had one single case, in spite of our considerable traffic with Italy. As an 
 additional preventive measures, all physicians are required to report all cases 
 of cholera nostras coming under their observation, and a careful investigation 
 is made of every case thus reported. 
 
 VII. What constitutes immunity from yellow fever. 
 
 Although in reality it has been scientifically and definitely established what 
 constitutes immunity from yellow fever, or when should a person be considered 
 as immune, it seems logical and natural to establish — even though temporarily — 
 that besides those who have suffered an attack, also those who have lived in 
 an infected locality for a long time without contracting the disease, may be 
 considered as immune. As regards individuals born in an infected locality it 
 is to be supposed that immunity is so easily acquired in youth. 
 
 VIII. Prophylaxis of trachoma, leprosy, scleroma, venereal diseases, 
 
 SMALL-POX, TUBERCULOSIS, AND MALARIA. — LEGISLATION AGAINST THESE DISEASES 
 AND RESULTS ACHIEVED. 
 
 Trachoma. — This is a disease which is very seldom noticed in Venezuela, and 
 the health authorities at the ports are very careful in the examination of persons 
 arriving at the Republic, never allowing the introduction of any person suffer- 
 ing from the disease. 
 
 Leprosy. — There are in Venezuela two leper asylums, one in Cabo Blanco, 
 in the Federal District, with a colony of 300 lepers, and another in Providencia 
 Island, State of Zulia, with 500 lepers. In Venezuela, the denunciation and 
 isolation of all cases of leprosy is compulsory. Recently we have been experi- 
 menting with "Nastin," but we are as yet unable to report upon the qualities of 
 this new remedy. 
 
 Venereal Diseases. — We have no special legislation on the prophylaxis of 
 venereal diseases. Prostitution is not regulated, but the Police Department does 
 not permit the public practice of the profession, and regulates the system of 
 passive tolerance. The women devoted to the profession do so clandestinely. 
 In our principal hospital we have a department of syphilis and dermatology. 
 There are also special clinics of ginecology and diseases of genital organs. 
 
 Small-pox. — Thanks to compulsory vaccination and re-vaccination, Venezuela 
 is almost free from this disease; only once in a long while some sporadic case 
 occurs. 
 
 Tuberculosis. — The white plague continues to occupy a high place in our 
 mortality statistics. In the Hospital Vargas of Caracas, special wards have been 
 established for the proper isolation and treatment of consumptives. There is 
 in the capital a private association called the Anti-Tuberculosis League which 
 renders most valuable aid through its dispensary, distributing freely among the 
 poor all necessary medicines and means, and holding periodical public lectures to 
 educate the masses. 
 
 There is now under consideration the establishment of a private tuberculosis 
 sanatorium in the outskirts of Caracas. 
 
FIFTH INTERNATIONAL SANITARY CONFERENCE. 163 
 
 Besides a special propaganda against the disease, there are enforced certain 
 measures of disinfection and sanitation of public buildings, theaters, schools, 
 barracks, and private houses which may be infected. 
 
 By decree of October 26, 1910, the following articles are allowed free of cus- 
 tom duties : 
 
 Calcium carbide, creoline, sulphur, formol, sulphate of iron, sulphate of copper, 
 Tersin's serum, Haffkine's lymph, disinfecting apparatus of all kinds, cultures, 
 so-called "kill rats" and "rat plague." 
 
 Malaria. — The prophylaxis of malaria is, in the opinion of the Venezuelan 
 Delegation, the most important problem affecting the welfare of the inter- 
 tropical countries of the Western Hemisphere. We therefore take the liberty 
 to call the special attention of the Conference to this subject. 
 
 In the work of general sanitation of the tropical countries of America, 
 malaria must necessarily occupy a prominent place, because that tenacious 
 malady, the most formidable endemic of our zone, is the worst and most power- 
 ful enemy of the progress of our countries. In Venezuela, for instance, malaria 
 kills every year from 8,000 to 10,000 inhabitants of all ages. 
 
 Since the Fourth Sanitary Conference, there was held in Simla, British India, 
 in October, 1910, a special conference for the study of malaria and its prophylaxis. 
 That meeting passed resolutions of inestimable value for the defense against 
 malaria. These conclusions we beg to recommend this Conference to adopt, as 
 constituting a code for the defense against malaria. 
 
 IX. Monthly and yearly statistics on mortality and morbility in the 
 
 PRINCIPAL PORTS AND CITIES. AND REPORT UPON THE ADOPTION OF THE BERTILLON 
 NOMENCLATURE. 
 
 Since all along the Venezuelan coast, malaria and dysentery still prevail 
 endemically, our mortality and morbility are quite high. The death rate is 
 represented thus: La Guaira, 33 per 1,000; Puerto Cabello, 42 per 1,000; 
 Maracaibo, 36 per 1,000; Cuidad Bolivar, 23 per 1,000; Carupano, 25 per 1,000. 
 
 Bertillon Nomenclature. — This nomenclature has been in force in Venezuela 
 since the time when we undertook the systematic study of demographic statistics. 
 Recently, the Government revised its blanks in accordance with the amendments 
 introduced in 1909 and with the New Abridged International Nomenclature; 
 but further increasing it in order to insert items which are indispensable in the 
 tropical countries. 
 
 Death certificates. — By decree of March 31, 1911, the Federal Government has 
 provided that the death certificates shall be uniform throughout the Republic, 
 and made upon blanks printed and furnished by the Government. In this 
 certificate is entered the immediate cause of death, the principal disease, and the 
 number belonging to it. To facilitate this, the nomenclature is reproduced at 
 the back of the blank. 
 
 X. Sanitary inspection of international traffic, both by land and sea, in 
 
 CASES OF QUARANTINE INFECTIOUS DISEASES. 
 
 With regard to the sanitary inspection of international trade, we are governed 
 since 1909 by the provisions of the Maritime Sanitary Police Regulations, drawn 
 in conformity with the needs and resources of the Republic, but based upon the 
 stipulations of the Washington Convention. 
 
 XI. Sanitary laws on immigration. 
 
 As the immigration into Venezuela is still very small, we have no special 
 legislation on the subject. At present we confine ourselves to a careful exam- 
 ination of all passengers arriving from abroad, rejecting those that may be 
 suffering of any infectious disease. 
 
 XII. Adoption of sanitary documents approved by the fourth conference. 
 
 We consider that the forms of bill of health approved by the Fourth Confer- 
 ence, being useful for their purpose, should be adopted by all countries of the 
 Continent, thus attaining a much desired uniformity. 
 
COLUMBIA UNIVERSITY LIBRARIES 
 
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 expiration of a definite period after the date of borrowing, as 
 provided by the library rules or by special arrangement with 
 the Librarian in charge. 
 
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P19 
 
 1911 
 pan American Sanitary Conference, 
 5, Santiago de Chile, 1911. 
 
 Transactions.