REPORT. In the name of the Committee chosen at the session of the 18th February, 1881, and consisting of the following members: MM. Outrey, Chairman; de Bille, Dr. Cbryera, Lowndes, Dr. Turner, Camporeale, and Bartholomew to embody in a formal document the conclusions of the Conference, Mr. de Bille, as reporter of the Committee, has the honor to submit the following report: In proceeding to give to the resolutions adopted by the Conference their final shape, your Committee lias not deemed itself empowered to go in any case beyond the limits imposed upon it by the votes recorded in the protocols. The decisions of the majority should be regarded as final, and, however much it may be desired to amend this or that resolution or to supply this or that omission, this cannot be done without reopening the discussion of questions already debated. On the other hand, your Committee has thought it to be not only within its power, but to be its duty, to deal with tire form and the order of the decisions of the Conference. By reason of the wide liberty left to the delegates of introducing propositions, and of having the vote of the Conference upon them, there are marked differences in the forms of the resolutions adopted, and the order of their adoption has depended less on their logical sequence than on the accidents of debate. 1 our Committee lias endeavored to bring out the logical relation of the questions dealt with by rearranging the resolutions adopted with reference to their subject-matter. Begin- ning with the general rules for an internal sanitary service, it lias placed next those relating to the forms of international notification, then those providing for the form, the delivery, the trustworthiness, and the gratuitous issue of bills of health, and, lastly, the recommendation of a measure for the scientific investigation of yellow fever. Of the propositions submitted to and adopted by the Conference, some were cleclara- rations of principles and suggestions couched in general terms. Others, on the other hand, with the view of exhibiting their whole scope, go into minute and exhaustive detail, giving even the drafts of conventions to be hereafter made. Your Committee hopes to have met the views, both of those who submitted the propositions and of the members of the Confer- ence, by removing this want of uniformity, which they have done by restoring to the resolu- tions their quality of generality and by embodying all details in an exhibit to accompany the resolutions. It has endeavored in this way to recast the resolution looking to the estab- lishment of a centralized international sanitary service, that relating to the form of bills of health, and, lastly, that providing for a temporary scientific commission for the study of yellow fever. In fact, that which has been adopted by the votes of the Conference on these questions is the general principle expressed in the propositions. There would have been great hesitation in accepting at this time as binding every clause of the drafts of Conven- tion or every phrase in the forms for sanitary documents, matters of detail which have been very little or not at all discussed in our sessions. In the two first resolutions, relating to the internal sanitary service of the different countries and their seaports, it has been thought convenient to make a slight transposition, which does not in any way affect the substance of the propositions adopted. The question has been raised whether there does not exist a contradiction between the third of the resolutions herein reported and one clause of the draft of a convention contained in the third annex. Your Committee is of opinion that such contradiction is, in any event, only apparent, and that there is no reason for submitting the question anew to a vote. In the hope that the Conference will approve the principles which have guided the la- bors of the Committee, your Committee submits to the Conference for adoption the following series of resolutions, with their respective annexes and appendices, and proposes that an instrument embodying them be signed by all the delegates, in the diplomatic order of the the States represented. 3 The International Sanitary Conference, assembled at Washington in the months of January and February, 1881, submits as the result of its deliberation to the favorable con- sideration of the Governments there represented the following resolutions, adopted respec- tively by the majority of votes specified at the foot of each paragraph: RESOLUTIONS. I. Each Government shall have such an organized internal service as will enable it to be regularly informed of the state of the public health throughout the whole of its territory. Yeas: Argentine Republic, Austria-Hungary, Belgium, Denmark, Spain, France, Hayti, Italy, Mexico, The Netherlands, Portugal, Russia—l 2. Nays: Chili, United States, Great Britain, Sweden and Norway, Turkey—s. 11. Each Government shall publish a weekly bulletin of the statistics of mortality in its principal cities and ports, and shall give such bulletins the largest possible publicity. Teas : Argentine Republic, Austria-Hungary, Belgium, Chili, Denmark, Spain, France, Hayti, Italy, Mexico, The Netherlands, Portugal, Russia—l 3. Nays: United States, Great Britain, Sweden and Norway, Turkey—4. 111. In the interest of the public health, the sanitary authorities of the countries represented in this Conference are authorized to communicate directly with each other in order to keep themselves informed of all important facts which may come to their knowledge; but nothing herein contained shall relieve them from the duty of furnishing, at the same time, to the consuls in their respective jurisdictions the information they are required to give them. Yeas: Belgium, Chili, Denmark, Spain, United States, France, Hayti, Mexico, Russia Sweden and Norway, Turkey—ll. Nays: Germany, Austria - Hungary, Italy, The Netherlands, Portugal, Argentine Republic—6. IY. A centralized international system of sanitary notification being deemed indispensable to the successful carrying out of measures for preventing the introduction of disease, it is advisable to create international organizations to be charged with the duty of collecting information in regard to the outbreak, spread, and disappearance of cholera, pest, yellow fever, &c., and of conveying such information to the parties interested. A draft of a convention to carry out this object (Annex I) has been voted by the Conference in the following manner: Yeas : Germany, Austria-Hungary, Belgium, Chili, Denmark, Spain, Hayti, Italy, Neth. erlands, Portugal, Argentine Republic, Russia, Turkey—13. Nays: United States, France, Japan—3. Abstained from voting ; Mexico, Sweden and Norway—2. 4 V. Bills of Health shall be in the form hereto annexed. (Annex II.) Yeas: Belgium, Denmark, Spain, United States, France, Hayti, Italy, Mexico, The Netherlands, Portugal, Turkey—11. Nays: Germany, Argentine Republic, Austria-Hungary, China, Russia, Sweden and Norway—6. VI. Bills of Health shall be delivered at the port of departure by the responsible sanitary agent of the central government. The consul of the country of destination shall have the right to be present at the examination of ships made by the representative of the territorial government under such rules as may be laid down by international agreement or treaty. Yeas : Germany, Argentine Republic, Austria-Hungary, Chili, Denmark, Spain, Hayti, Nays: Belgium, China, United States, France, Russia, Sweden and Norway, Tur- Italy, Mexico, The Netherlands, Portugal—ll. key—7. YII. Bills of Health granted in compliance with international rules should be issued gratis. Yeas: Germany, Austria-Hungary, Belgium, Denmark, United States, France, Hayti, The Netherlands-—B. Nays: China, Italy, Russia, Sweden and Norway, Turkey—s. Abstained from voting : Argentine Republic, Spain, Mexico, Portugal—4. YIII. A temporary and scientific Sanitary Commission shall be created by the nations most directly interested in protecting themselves against yellow fever, and by such others as may wish to take part in this arrangement, to be charged with the duty of studying all matters pertaining to the origin, development, and propagation of that disease. A draft of a convention to carry out this object (Annex III) has been voted by the Conference in the following manner: Yeas: Germany, Austria-Hungary, Belgium, Chili, Denmark, Spain, United States, France, Hayti, Mexico, The Netherlands, Portugal, Ai’gentine Republic, Tur- key-14. Abstained from voting : Italy, Japan, Russia, Sweden and Norway—4. 5 Annex I. The draft of a Convention mentioned in the Resolution IY is as follows : Article I. There shall be established in Yienna and Havana a permanent International Sanitary Agency of Notification. The respective Governments shall agree among them- selves as to the formation of those agencies. Art. 11, It will be the duty of the agency at Yienna to gather sanitary information from Europe, Asia, and Africa. The agency at Havana will extend its sphere of action to the American Continent and the islands belonging geographically thereto. This system to be subject to such modifications as may be rendered necessary by the state of telegraphic communication. Art. 111. The contracting Governments shall have the right to establish, if necessary, a third agency in Asia. Art. IY. The Governments agreeing to this system of notification will send their sanitary reports to that agency in whose jurisdiction it is. Every agency shall send its notifications to those Governments sending sanitary bulletins. The different agencies will exchange the information they receive among themselves in order that it may be made known to the respective countries belonging to the jurisdiction of each. Art. Y. There shall be no exceptions to this system, save in cases of extreme emergency. In such cases, however, a Government may enter into communication with an agency to whose jurisdiction it does not belong. Art. YI. In cases of doubt as to the correctness of the bulletins received, the agency is authorized to enter into communication with the respective Governments, who will be obliged to furnish as soon as possible the information asked. Art. YII. In those countries where international sanitary boards exist the agencies shall establish communication with them. Art. YIII. In those countries which have not a perfect sanitary organization, or which have not adopted the conclusions of this Conference, the consuls of the contracting powers shall meet in an International Sanitary Council in order to give to the said agencies the information which cannot be obtained from the local authorities. Art. IX. The Governments of Spain and Austria-Hungary shall fix the annual budget of expenses, which they will submit to the participating Governments. Art. X, The division of expenses between the different Governments shall be as follows : Half of the expense will be divided in proportion to the number of population, and the other half in proportion to the amount of tonnage of the merchant marine combined with the commercial maritime value of every country. Art. XI. The Governments of Spain and Austria-Hungary shall submit at the end of every fiscal year the final accounts to every one of the interested Governments. Art. XII. The present Convention is concluded for the space of ten years. Any Government, however, is at liberty to renounce the Convention after three years. The right is reserved to make such changes as any one of the Governments taking part shall designate. Annex 11. I) (the person charged to deliver the bill,) at the port of do hereby state that the vessel hereinafter named INTERNATIONAL BILL OF HEALTH. clears from this port under the following circumstances: 6 Name of vessel: Tonnage: Nature (vessel-of-war, ship, schooner, &c.);. Apartments for passengers, No. Destination: Guns; Name of Medical officer (if any): Where last from Name of captain Total number of passengers: Ist cabin,. . . .; Total number of crew : Cargo: 2d cabin,. .. .; steerage,. Vessel. 1. Sanitary condition of vessel, (before and after reception of cargo, with note of any decayed wood.) Note disinfection of vessel: 2. Sanitary condition of cargo : 3. Sanitary condition of crew:...... 4. Sanitary condition of passengers :. 5. Sanitary condition of clothing, food, water, air-space, and ventilation: Port. 1. Sanitary condition of port and adjacent country— a. Prevailing disease, (if any): I). Number of cases of and deaths from yellow fever, Asiatic cholera, plague, small- pox, or typhus fever during the week preceding— Number of cases of— Number of deaths from— Yellow fever: Yellow fever: Asiatic cholera: Asiatic cholera Plague : Plague: Small-pox: Small-pox Typhus fever : Typhus fever: c. Population according to the last census: d. Total deaths from all causes during the preceding month : 2. Any circumstances affecting the public health existing in the port of departure to be here stated: I certify that the foregoing statements are made by , who has personally inspected said vessel; that lam satisfied that the said statements are correct, and I do further certify that the said vessel leaves this port, bound for in Ix witness whereof I have hereunto set my hand and the seal of office, at the port of ? tliis day of ,188 , o’clock. [seal.] [Signature.] Annex 111. Article I. A temporary scientific sanitary commission will be established by the nations most deeply interested to protect themselves against yellow fever, and also by such nations as will adhere to these proposals. Art. 11. The duties of this commission will be— A. The study and ascertainment of the principal and permanent centres of the morbi- gene germs of the disease. B. The conditions which favor its extension, and also the etiology and circumstances which aid its propagation in the respective centres, and its diffusion to other countries. C. The means to be employed to circumscribe more and more its effects, or to eradicate 7 the disease entirely from the regions in which it originates, and from the countries lately attacked. D. How to prevent the transmission by vessels. E. The best and most practical method of disinfection of ships, their cargoes and pas- sengers. F. Also everything relating to the prophylaxis and treatment of the disease. Akt. 111. The countries which desire to concur in the organization of this scientific commission will agree between themselves as to the instructions to be given to their dele- gates in order to facilitate their labors. Akt. IY. After having studied on the spot the different questions submitted to its investigations, this Commission shall present a collective report indicating the most practical means to attain the end proposed. Appendix I. The special delegates to the Convention have agreed to recommend the adoption of the following proposition, which, because of its special and scientific character, they have not thought it expedient to submit to a formal vote of the Conference. Proposition. The Conference recommends the creation of twenty-two international sanitary posts for the study of yellow fever, to be established at Hew Orleans, Galveston, Yera Cruz, Panama, Maracaibo; one in each of the Guianas; two in Cuba; one in each of the following islands: St. Domingo, Jamaica, St. Thomas, Gaudeloupe, Martinique, Barbadoes; one in each of the following ports of Brazil, Para, Maranham, Pernambuco, Bahia, Bio de Janiero, and one in Senegambia. In each of these posts there will be at least two physicians,—one from the same country, and the other from the country with which the port or town is in the most constant communication. All other nations will have the right to send sanitary physi- cians to these posts. The expenses of each of these posts will be paid prorata by the nations which have appointed sanitary physicians. The number of posts will be increased or dimin- ished as the necessities of the case may require. The contracting nations will arrange be- tween themselves as to the number of physicians that each nation shall appoint, and for their distribution at the different posts, and the same process shall be used in the future for the increase or diminution of the posts. The physicians of these sanitary posts will not be allowed to practise their profession generally or accept any other employment, under pain of dismissal. They will only be allowed to accept the duties of physicians of the hospitals in which yellow fever cases are admitted. At each post there shall be 1. A laboratory, furnished with chemical and other instruments and material neces- sary for making analyses. 2. A cabinet, for experimental and histological studies, furnished with good micro- scopes for the necessary examinations. 3. A library, containing the most important works which have been published on yellow fever. The physicians of the sanitary posts shall 1. Keep themselves informed of the sanitary condition of the town in which they are, in order to know when the first case of yellow fever breaks out. 8 2. Follow the progress of the disease so as to know exactly when it decreases and ends. 3. Immediately inform the sanitary authorities of the country from which they are appointed of all the facts which can he of interest to them. 4. Study the meteorological condition of the town in which these posts are placed, and see what relation exists between this condition and the appearance, propagation, and gravity of the disease. 5. Study the telluric conditions of those towns with the same object as in No. 4. 6. Make frequent chemical and microscopic analyses of the drinking water used in these towns 7. Help the authorities whose duty it is to inspect the ships in order to see if any re- lation can he found between the condition of these vessels and the eventual appearance of yellow fever on board. 8. Study the sanitary condition of the town and endeavor to find out if any relation exists between an unhealthy focus and the development of the epidemic. 9. Frequently visit the hospitals where cases of yellow fever are admitted and study the progress of the disease from observation of the different cases. 10. Help to make the autopsy of the bodies of persons dying from yellow fever. 11. Making the anatomico-pathological and histological examinations of the humors and organs of these bodies so as to try and discover the nature of the lesions. 12. Make monthly report of what they have observed, and transmit it to the Govern- ments by which they are appointed. These reports will be published and distributed by all the Governments which have adhered to this institution. 13. Make an annual report, a copy of which will be sent to the Governments by which they are named and another presented to the conference of sanitary physicians. Every year there shall be a conference of medical sanitarians at which at least one member of each post shall assist. The first conference shall take place in Havana, and the places at which the others shall be held shall be designated at the end of each yearly conference, in such order that every year the meeting shall take place at a different, city. The conference shall last ten days, and the reports of the different sanitary posts shall be read and discussed. It is desirable that the Governments should send occasional inspecting committees to examine these posts. If an international commission on epidemics is created, as has been proposed, this commission should have the right to regulate the workings of those posts. (Signed) COUNT BETHLEN, EDWARD SEYE, 1)k. RAFAEL CERYERA, Hr. CARLOS FINLAY, Hr. IGNACIO ALYARAHO, Hr. F. J. YAN LEENT, J. J. da SILYA AMAHO. Appendix 11. Proposal presented by the undersigned delegates, having voted against Article YI, and destined to be submitted to the favorable consideration of the Governments represented in this Conference: Article I. In the countries where the regulations demand that the ships at the time of their departure should have a bill of health delivered by the local authorities, this bill of healtli shall continue to he delivered by the above authorities; but the captain of the vessel shall have the right to ask that this bill of healtli be vised by the consul of the country of 9 destination, whose duty it will be to give it with the least possible delay. This consul shall have the right to accompany his vise with such remarks as he may judge necessary. If the vessel is not subjected to the obligation of being furnished with a bill of health by the local authorities, the captain shall have the right to demand one from the consul of the country of destination, whose duty it shall also be to deliver it with the least possible delay. Aet. 11. In the countries where the regulations demand that the ships before obtaining a bill of health from the local authority be subjected to a sanitary inspection, the consul of the country of destination, or his delegate, shall always have the right, at the request of the captain, to assist at this inspection. If the vessel is not subjected to the obligation of furnishing itself with a bill of health delivered by the local authority, the consul from whom the captain shall ask such a bill of health, or his delegate, shall have the right to make the above-mentioned sanitary inspection according to such laws as shall be established by mutual agreement between the contracting powers, but in this case this inspection shall be made in conjunction with the consul of the country of the nationality of the vessel. Signed by the Delegates of BELGIUM, UNITED STATES, FRANCE, RUSSIA, TURKEY. Appendix 111. The delegate of Mexico to the International Sanitary Conference of Washington has presented to the Conference the following memorandum read by him in the sitting of Feb- ruary 18th, and a proposition thereto attached signed by him and other delegates. The necessary steps to obtain information of the state of the public health, as well as the sanitary inspections of the vessels, shall be made by the local sanitary authorities. Each Government signing this treaty shall, however, have the right to take part through its own agents in all the operations of the above-mentioned authorities. (Signed) Dr. J. ALYARADO, De. e. j. yan leent, STEPHEN PRESTON, JULIO CARRIE, J. J. Da SILYA AMADO. 10 lii witness whereof, the undersigned delegates to the International Sanitary Confer- ence at Washington, of the several Governments taking part therein, have approved the foregoing final record of their proceedings, and have affixed thereto their signatures. Done at Washington tins day of March, 1881. For GERMANY, For THE ARGENTINE REPUBLIC, For AUSTRIA-HUNGARY, For BELGIUM, For BOLIVIA, Fob BRAZIL, For CHILI, For CHINA, Fob THE UNITED STATES OF COLOMBIA, For THE ISLAND OF CUBA, For DENMARK, For SPAIN, Foe THE UNITED STATES OF AMERICA, For FRANCE, For GREAT BRITAIN, Foe THE HAWAIIAN ISLANDS, Foe HAYTI, Foe ITALY, Foe JAPAN, Foe LIBERIA, Foe MEXICO, Foe THE NETHERLANDS, Foe PERU, Foe PORTUGAL, Foe RUSSIA, Foe SWEDEN AND NORWAY, Foe TURKEY, For VENEZUELA, The President of the Conference: The Secretary of the Conference ; The French Secretary: