International Sanitary Conventions

CONVENTIONS, international sanitary, special international agreements concluded between various countries with the aim of adopting more or less uniform measures to combat the most dangerous diseases. Epidemic outbreaks of earlier times, the frequent importation of various epidemics from one country to another, and the great economic damage suffered by individual countries in connection with these epidemics have long given rise to the practice of applying so-called quarantines (see), i.e., a peculiar system of anti-epidemic measures at borders to combat the introduction of these epidemics from one country to another. This system, which in its most extreme form boiled down to the complete closure of borders to the movement of people and goods, naturally led to economic difficulties, frequently paralyzed all trade and transport, and brought about major losses. Furthermore, the lack of coordination in adopting various restrictive measures at borders constantly endangered individual states, and these very measures often became an instrument of political and economic struggle and coercion, especially on the part of stronger states in relation to weaker ones. All these circumstances contributed to the fact that already from the middle of the 19th century, attempts were made to regulate this issue on an international scale, with the goal, on the one hand, of finding more or less uniform measures of sanitary border protection based on the data of modern science, and on the other hand, of alleviating and reducing the aforementioned restrictions on international trade and transport. In 1851, the first international sanitary conference was convened in Paris, aiming to develop international measures to combat cholera, which, as is well known, produced a major epidemic outbreak throughout Europe in 1848–50. The second conference in Paris in 1859, followed by conferences in Constantinople in 1868 and in Vienna in 1874, also had the purpose of combating cholera, with the question of preventive measures along the routes of cholera introduction from the East into Europe being raised for the first time at the Constantinople conference, and the question of quarantine rules being discussed in detail. However, all these four conferences did not create any obligations of an international character. In 1884, the fifth international conference took place in Washington, which discussed measures for border protection against another dangerous epidemic, yellow fever. Next followed two more conferences on cholera—in Rome in 1885 and in Venice in 1892. At the latter conference, all preceding resolutions were definitively revised, and as a result, the first sanitary convention of 1892 was adopted, which was subsequently ratified by the governments of the interested countries. Simultaneously, the previously existing Egyptian Maritime Sanitary Board was reorganized, structured as an international body with the aim of sanitary supervision of ships traveling to Europe from the East. Russia also participated in a number of the enumerated conventions and (like other countries) ratified the 1892 convention as well, thus recognizing its binding nature for itself. Following new outbreaks of cholera in Europe in 1891–92, two new international conferences took place: in Dresden in 1893 and in Paris in 1894. At these conferences, international measures for protecting the routes of cholera introduction were expanded, and a series of measures were established to institute a special sanitary regime for the ports of the Red Sea and the Persian Gulf in relation to the movement of Muslim pilgrims present there (to Mecca and Medina). The corresponding resolutions of these conferences subsequently acquired the force of an international agreement. Major outbreaks of plague, beginning in the late 1890s in India, again caused a series of restrictive measures and served as the occasion for a new conference to combat plague (the Venice Conference of 1897). At the beginning of the 20th century (1903), the Paris Conference consolidated all previous agreements into a single general sanitary convention; this convention is known under the name of the 1903 Convention (ratified by Russia as well). Finally, right before the war, a new Paris Conference of 1912 established a new text of the convention, which remained in effect everywhere until 1926. This latter 1912 convention was already ratified by the Soviet government and published in the USSR in 1926. All these conferences, which resulted in their work leading to the single international sanitary convention of 1912, had as their general goal the fight against three infectious diseases of an exotic character, introduced into Europe: plague, cholera, and yellow fever. All these diseases had their usual foci in non-European countries—India, Africa, South and Central America. Therefore, the main participants of the sanitary conventions, i.e., European countries, in the aforementioned 1912 convention established two groups of measures aimed principally at protecting Europe (and subsequently North America) from these dangerous imported epidemics. On the one hand, this is a system of measures for the mutual notification of all countries about the first cases of the appearance of any of these diseases on their territory, followed by reports on the course of the epidemic; and on the other hand, this is a system of those sanitary measures at their borders in relation to arriving passengers and goods that may be applied by one government or another upon the outbreak of an epidemic in neighboring countries. The forms and scope of these measures are strictly limited by the corresponding articles of the convention. Since the main danger of importing these infections was associated with maritime routes, the main measures of the convention ensured precisely the protection of maritime borders, and only partially the protection of land borders. The convention defines the measures permitted for application in ports and on ships, and the conditions under which ports or merchant vessels may be considered infected or suspected of infection. The convention finally abolished the system of quarantines, introducing instead methods of isolation of the sick, observation, and medical surveillance for periods corresponding to the incubation period of each of the three diseases listed in the convention, for those persons who came into contact with the sick, and finally the method of medical inspection of all passengers. At the same time, all these measures may be applied according to the convention only in relation to those 'provenances' (i.e., people and goods) arriving from a genuinely affected locality, strictly limited by the course of epidemic outbreaks; the convention does not permit the application of these measures in relation to the entire country as a whole on whose territory infection foci exist. Furthermore, in regard to the disinfection of goods and baggage, certain rules are established, consistent with modern data of hygiene in this field. Finally, all these measures are precisely detailed in relation to each of these three diseases: plague, cholera, yellow fever. The second part of the 1912 Convention provides a clause-by-clause regulation of the special regime of the Red Sea and its ports, the activities of the Egyptian and Constantinople sanitary boards, and the regime of the Persian Gulf. The application of the 1912 Convention, like preceding conventions, introduced a definite order into international border protection practice and eliminated a number of old restrictive measures. However, the World War of 1914–1918 sharply re-posed all issues in connection with massive outbreaks of various infections. At the same time, in the early post-war years, proposals began to arise again in certain circles about introducing so-called sanitary cordons at borders with countries affected by epidemics. New infections—smallpox, typhus, and Spanish flu—spread sharply. As a consequence, in 1922, the so-called European Sanitary Conference was convened in Warsaw, chiefly to clarify issues concerning epidemics in Eastern Europe. This conference was convened by the League of Nations; representatives of the USSR also took part in it. At the same time, the work of the International Office of Public Hygiene, created by agreement in Rome (1907) and having taken over the entire business of preparing, revising, and the daily international practice of applying sanitary conventions, continued. This Office of Public Hygiene (Paris), taking into account the experience of the war, the growth of new infections, and new epidemic data, revised the 1912 convention, and on the initiative of the French government in 1926, the twelfth international sanitary conference took place in Paris, with the participation of 57 states from around the world, including the USSR. The work of this conference served as the material for drafting the text of a new convention, which now, after its ratification by the majority of participating states of the conference, has entered into force, repealing the 1912 convention, under the title 'Sanitary Convention of 1926.' The government of the USSR ratified it on January 9, 1929. Its text was published in the 'Collection of Laws and Decrees of the Government of the USSR' dated March 22, 1929, under No. 19 (in Russian and French). The 1926 Convention differs significantly from the 1912 Convention. First of all, two additional diseases—smallpox and typhus—were introduced into the scope of this convention. The application of international measures against these diseases is limited and made dependent on their epidemic development, rather than on the appearance of the first cases of these diseases, which is the case in relation to cholera, plague, and yellow fever. In the corresponding articles of the 1926 Convention...

(articles 1-9) give more detailed instructions on the technique and procedure for notifications of the appearance of these diseases, with the reinforcement in this regard of the role of the Office International d'Hygiène Publique (see Office International d'Hygiène Publique). The exact text of the main articles of this section of the Convention reads as follows: Article 1. "Each Government is bound to notify immediately to the other Governments and at the same time to the Office International d'Hygiène Publique 1) the first recognized case of plague, cholera, or yellow fever discovered on its territory; 2) the first recognized case of plague, cholera, or yellow fever appearing outside the limits of a territory already infected; 3) the existence of an epidemic of typhus or smallpox." Article 2. "Simultaneously with the notifications provided for in the first article, or very soon after them, detailed information shall be furnished: 1) as to the locality where the disease has appeared; 2) as to the date of its appearance, origin, and form; 3) as to the number of confirmed cases of the disease and deaths; 4) as to the extent of the infected area or areas; 5) in the case of plague, as to the presence of plague infection or unusual mortality among rodents; 6) in the case of cholera, as to the number of bacillus carriers when such have been found; 7) in the case of yellow fever, as to the presence or relative abundance of its vector Stegomyia calopus (Aedes aegypti); 8) as to the measures taken." In addition to these requirements, the Convention establishes the obligation for periodic inspections in ports for the presence of plague-infected rats, with subsequent reporting to the International Office; the latter is also authorized to conclude necessary agreements with other international health authorities for information purposes (referring to the Health Section of the League of Nations, the Pan-American Sanitary Bureau in Washington, etc.). Articles 10-23 of the 1926 Convention establish the general conditions for the application of measures to "provenances" of infected territories, their exact definition, as well as general rules for the disinfection of goods, their importation and transit. Regulations concerning emigrants are specially stipulated. The following articles of the 1926 Convention (24-57) formulate the measures in ports and at maritime borders in relation to each of the five established diseases separately. The periods of observation, if applied, are set for plague at 6 days, for cholera at 5 days, for yellow fever at 6 days, for typhus at 12 days, for smallpox at 14 days. Compulsory deratization (once every 6 months) is established for all vessels; preventive inoculations are introduced as compulsory measures in smallpox and cholera. Measures at land borders are elaborated in greater detail (articles 58-66), where the main requirement of Article 58 states: "observation must not be established at land borders." Only persons presenting symptoms of the diseases specified in the convention may be detained at the borders. An exception is made for persons who have been in contact with patients suffering from pneumonic plague (observation of 7 days). Articles 67-90 of the Convention generally repeat the previous rules regarding the regime of the Red Sea ports and the organization of supervision in the Suez Canal; articles 91-168 establish the sphere of activity of the Egyptian Sanitary, Maritime and Quarantine Board. It should be noted that from the text of the 1926 Convention, those "special regulations for the countries of the East" which were present in previous Conventions have largely disappeared; the corresponding subheading of Article 54 of the 1912 Convention, which defined this special regime, has also disappeared. Even earlier, special measures for international sanitary control in the Strait of Constantinople disappeared; independent Turkey has now freed itself from this control, taking the entire matter of sanitary supervision in the strait directly into its own hands. Article 156 of the 1912 Convention, which spoke of the special quarantine board in Tangier (North Africa), has also disappeared. At the 1926 conference, attempts were also made by Persia to free itself from the special regime in the ports of the Persian Gulf; however, these articles, albeit in a mitigated form, were retained in the new 1926 Convention (Article 90). The countries of the East are thus freed from international guardianship in sanitary matters, creating their own sanitary institutions. In this regard, the position of the USSR at the 1926 conference was directed towards the liquidation of all these special sanitary regimes for individual countries and the establishment of uniform sanitary rules for all countries. Thus, the 1926 Convention introduced a number of important new additions to the previous Convention. In pursuance of its enactments, the Office International d'Hygiène Publique currently publishes informative data on the first cases of epidemic diseases and on the movement of epidemics in countries around the world (an agreement with the League of Nations, in its epidemic bulletins), has published a "Sanitary Directory" on the ports of the whole world and their sanitary equipment, has established forms for ship deratization certificates, elaborates questions on the rights of ship doctors, etc. In connection with the development of aviation, a draft of a special sanitary convention for air routes has now been drawn up in the International Office (preliminary consideration took place during the autumn session of 1929).- All communications with other countries, as well as with the Office International d'Hygiène Publique, are carried out through the appropriate diplomatic agencies (in the USSR through the People's Commissariat for Foreign Affairs); all misunderstandings that arise are considered in the International Office. Both the central health authorities of each country and all border health authorities, and especially the health organizations of ports and sea-going vessels, must be thoroughly acquainted with all the requirements of the Convention. Usually, for the correct application of the requirements of the Convention, local instructions and rules are drawn up. In the USSR, in connection with the 1912 Convention, the All-Union Law of 1926 is in force ("Regulations on the Sanitary Protection of Borders" of 1926 and "Rules for the Application of these Regulations" of July 29, 1928).- In addition to the general 1926 Convention, individual states usually conclude separate separate Conventions among themselves, having local significance. Such were the agreements of old Russia with Austria-Hungary (1895) and Germany (1905). After the revolution, sanitary conventions were concluded with Poland (1924), Estonia, and Latvia (1924). Such further is the corresponding sanitary convention of the American republics among themselves, i.e., the so-called Pan-American Sanitary Code ("The Pan-American Sanitary Code"), concluded at the Pan-American Conference in Havana in November 1924, ratified by the United States of America in 1925 (18 American states participated). Such are also the agreements of the small countries of the Middle East on the question of pilgrims (Palestine, Iraq, Syria, Egypt) in 1929.