1616 



The scientific or experimental phase of preventive medicine — the 

 era of bacteriology — overlapped and followed the sanitation move- 

 ment. It provided the technical foundation on which sanitary water 

 and sewage disposal practices are still based, as well as for coping with 

 those infectious diseases which can be controlled or eradicated by 

 vaccination. 



Though all nations benefit from the health of their own citizens 

 and those of other nations, and health measures are generally accepted 

 throughout the world, present levels of international cooperation in 

 public health were not easily achieved and remain hard to sustain or 

 extend. In the early deliberations (1850-1900) the paucity and uncer- 

 tain authority of scientific knowledge left much room for debate 

 and for the convenient alignment of medical science with national 

 interest. Thus, the German members of the International Sanitary 

 Council of Constantinople made decisions of little consequence to 

 disease but calculated to expand the political dominance of Germany 

 or to weaken British commercial dominance; British physicians, 

 even with French scientists ridiculing their logic, supported British 

 shipping interests by downgrading the importance of quarantine 

 restrictions ; Turkey reportedly paid little attention to sanitary rules, 

 holding that the whole system was a tool of imperialist power poKtics 

 rather than one designed to protect Europe from invasions of 

 epidemics,^" 



EARLY INTERNATIONAL EFFORTS TO CONTROL DISEASE 



It is to the credit of diplomacy that under these circumstances 

 nations persisted in developing constructive plans and international 

 rules for controlling the spread of disease. It was a long step forward 

 when the French Government convened the first International 

 Quarantine Congress in 1851. Successive congresses were held in 

 Constantinople in 1866, Vienna in 1874, Washington in 1881, Rome 

 in 1885, and Venice in 1892. Three other agreements dealing with 

 cholera which followed in 1893, 1894, and 1897 were later combined 

 in a single International Sanitary Convention in 1903. In 1909, as a 

 result of a 1907 meeting in Rome of 12 nations including the United 

 States, a permanent International Ofiice of Public Hygiene was set 

 up in Paris. It continued to function through both World War I and 

 World War II, after which it was absorbed into the World Health 

 Organization (WHO), created in 1946. 



The first full-fledged international health organization, in the 

 sense of one which carried out sanitary policing action, was the Pan 

 American Sanitary Bureau (PASB), established in Mexico City in 

 1902. Further strengthened in 1924 when 24 nations of the Americas 

 ratified the Pan American Sanitary Code, the Bureau provided for 

 regional cooperation in public health which went beyond existing 

 European practices. Now known as the Pan American Health Organi- 

 zation or PAHO, it still exists as an autonomous international health 

 organization for the Americas; it serves additionaDy as the WHO 

 regional office. It brought extensive experience in the control of disease 

 to the process of designing the new WHO. It also played a strong role 

 in the adoption of a decentralized structure for WHO, which (with 



'*' Many similar examples could be cited. In 1898, for example, German provincial Inspections for trich- 

 inosis were designed as much to keep out American pork as to protect local populations. (See Huddle, 

 Science and Technology in the Depannient of State, vol. II, p. 137ti.) 



