are imposed for the violation of this rule-that I saw the greater number of people expectorating on the floor. It would be advisable to devise some practical means of compelling the observance of the rules. referred to on these signs.

Chilian railroads have made great progress so far as disinfection is concerned, but there is a custom which should be taken into consideration in the discussion of tuberculosis, and that is a war against the broom and the duster, which are in common use in our countries.

The program only refers to measures against tuberculosis on steamers and in railroad cars, but I think we could go beyond said program and make some other recommendations, such, for instance, as the one proposed by Dr. Soza in his report, prohibiting the employment of consumptive schoolmasters. This has already been prohibited in some countries, but in many others there are consumptive schoolmasters who continue to teach. I have made these remarks in a brief manner because I was not prepared for this discussion.

DR. GONZÁLEZ. On one of my last journeys, I observed something that suggested an idea to me. By chance I went to the quarters of the steerage passengers at the time the crew was at dinner, and noticed that all the members of the crew were crowded together, and among them was one who was evidently a consumptive. All of them took their dinner in tin pails which are washed in a basin of dirty water, and wiped with the same rag. Could we not devise some beneficial measure for the prevention of contagion, by ordering the disinfection of these utensils?

DR. ROBERTS. I simply desire to make an explanation which may, perhaps, be desirable. We cannot legislate concerning foreign vessels, but only concerning our own, and the danger does not lie in the latter, but in the former.

DR. MENDIZABAL. With reference to the question of the prophylaxis of tuberculosis which is being discussed, I regret to say that we have been propagating panic to such an extent that at present people are afraid of a person simply because he expectorates or grows thinner, and in some places this fear has been carried to such an extreme that I know a town where persons are taken to the Police Court only because they find themselves in the condition referred to above, and hotel keepers are fined heavily because they allow people in delicate health to stop in their houses, and, what is still worse, a fine of $50 has been imposed on some people who have expectorated in the street. Therefore, a kind of microphobia has been developed. I may perhaps be told that this fear is the waiting room of prophylaxis, but I would add that in my opinion it has become a real disease, because some persons seem to be even afraid of their own shadow.

That does not mean, of course, that I am opposed to the adoption of measures in this case, because I am one of those who earnestly recommend cleanliness because I consider it the principal factor in life. It is right to prohibit expectorating on the floor, because it is dirty and vulgar to do so, but we should not frighten people, making them believe that simply because they pass near the sputum of a person afflicted with tuberculosis they will be infected. Those of us who have been practicing medicine for thirty or forty years have witnessed three evolutions: there was a time when we did not fear tuberculosis; after

wards we commenced to fear that the disease might be somewhat contagious, and we now know that it is highly contagious, but our fear has not increased to such an extent as to be exaggerated, because if through the sputum of a consumptive, real contagion should occur, many millions of human beings would have perished by this time. Our lives are full of fears, and we should avoid increasing them, besides, it is really very painful and sad to see society a victim of fear.

A new doctrine is now being advocated, and seems to prevail in Europe, namely, that contagion cannot be acquired through the respiratory organs, and lately Behring's works, and still later those of Clement, have demonstrated that the greater number of infections have been acquired through the digestive organs. Therefore, we are now able to see that we should not fear an expectoration which the rays of the sun will destroy, and that we should not be so much afraid to stay in a railroad car where it will be sufficient to open the windows and let in the air and the sun in order to disinfect it in a more thorough manner than could possibly be done by all the antiseptics known in the world.

Gentlemen: We all know, because we have traveled a great deal by rail in the United States, for instance, that the trains there lack light and air, which are without doubt the best disinfectants that we have, and which have been granted us by Divine Providence. Now, then, I, in the name of humanity, inasmuch as we are here assembled to discuss humanitarian questions, request you to be a little more humane and kind to those unfortunate consumptives. If they do not cause us as much harm as it is supposed, and if we know that the person who enjoys good health and is well fed has nothing to fear, because we have seen many healthy and strong persons who have been in close contact with persons afflicted with tuberculosis, why should we then entertain such fears? Would any of us tolerate, when traveling, accompanied by his wife, that she should be ordered to leave the train simply because she was supposed to be afflicted, or even though she was really afflicted with tuberculosis?

Let us then be humane, and adopt all the measures proposed, which I cheerfully accept, but let us also avoid the spreading of panic, by putting before the people an invisible enemy which causes great fear.

THE CHAIRMAN. The hour for adjournment, in accordance with the rules of the Conference, having arrived, should any delegate desire to make any remarks, he can do so at the next session.

The session adjourned.

FIFTH DAY, FRIDAY, DECEMBER 6.

Morning Session.

The session was called to order by the Chairman, Dr. Licéaga, at 9 a. m., the following delegates being present: Doctors Oswaldo Gonçalvez Cruz, Ricardo Gutierrez Lee, Genaro Payán, Hugo Roberts, Juan Guiteras, Ernesto Soza, Pedro L. Ferrer, Juan Horacio Estévez, Walter Wyman, R. H. von Ezdorf, P. T. Straub, James Gatewood, Rhett-Goode, H. L. E. Johnson, Salvador Ortega, José Azurdia, Luis Lazo Arriaga, Gregorio Mendizábal, Rodolfo B. Gonzalez, Ernesto F. Espiro, and Juan J. Ulloa, Secretary.

The minutes of the previous session being read and approved, the delegates of Costa Rica, of Uruguay, Brazil, and Chile, proposed, in the name of their respective Governments, the capitals of their respective countries as the place in which to hold the next international sanitary conference, and these propòsitions were referred to the Advisory Committee.

THE CHAIRMAN. In accordance with the resolutions adopted at the last session, we will now continue the discussion of the measures concerning international sanitary police for preventing the transmission of tuberculosis on board vessels and railroad cars, and to that end Dr. von Ezdorf continues to have the floor, and will read an address which he did not have with him at yesterday's session.

DR. EZDORF. I should like to conclude what I had to say in regard to the transmission of tuberculosis from individuals on board vessels. I mentioned yesterday the advisability of having paraffine paper cups provided on board ship and also the screening of the vessel, as practical

measures.

In regard to vessels carrying passengers, we have to divide the ships into two classes. We have ships that carry a large number of persons, immigrants, etc., and others that simply carry cabin passengers, first and second class passengers. We also have ships which make only short voyages, and other ships that make long voyages, so that we have to discuss each one of these separately.

Now in regard to persons on board the ship that is carrying a large number of passengers: I think one of the first measures that we have to consider is that they should be educated to understand that the practice of expectorating promiscuously in places frequented by others may be dangerous to their fellow men. I think every one will agree to that, that expectoration is a filthy habit. The second proposition is that all persons should be encouraged to use individual drinking cups, and also cheap paraffine paper cups might be provided for use as expectorating cups-individual cups.

Now, a point that I wish to make in regard to the third class passengers, or steerage passengers, whom Dr. Roberts referred to as being the most dangerous individuals on board the vessels and more likely than the other classes to infect the living quarters, because of lack of ventilation and lack of care-is that the only provision we could make

in regard to those passengers is to endeavor to have them understand that they must not expectorate any where except in the places provided for that purpose, and one of the most practical measures that I think could be adopted on board ship is the use of the paraffine paper cup already mentioned, to be placed folded into a tinform which might hang along the sides of the bunks. As we know, these large steerage passenger vessels are very crowded, and the passengers are in bulks one over the other, sometimes in tiers of three. These cups can be used in cases of seasickness and for all ordinary expectoration. I think that is all we can possibly do with regard to that class of passengers. These cups could be destroyed by fire, or thrown overboard at sea. That is practicable for any vessel, whether a long-trip or a short-trip vessel.

But with regard to a long-trip vessel where the passage is, say, two or three or four weeks, I think there should be a disinfection of those quarters or barracks of the steerage passengers at the end of each voyage.

With regard to the short-trip vessels, where the passengers are in these steerage barracks for only two, three or four days, I think that periodical disinfection would be quite sufficient.

Whatever measures we wish to adopt should be practical and easy of application, and these have occurred to me as the most practical and easily understood by the steerage passengers that we have to deal with. As far as the cabin passengers are concerned, I think they can understand instructions, wherever they may be placed in printed form about the cabins. I conclude this exposition with the following conclusions:

1. The traveling public should be educated to understand that the practice of expectorating promiscuously about in places frequented by persons may be dangerous to his fellow-man. Expectoration is a filthy habit and should be made punishable.

2. All persons should be encouraged to use individual drinking cups and cheap paper paraffined cups should be provided on all vessels for passengers.

3. Disinfection of vessels and furnishings of short-trip vessels periodically. Disinfection of steerage passenger barracks at end of each voyage if the voyage has been a longer one.

4 Notices should be posted in steerage quarters and living quarters enjoining passengers not to expectorate on floors.

5. Crews of vessels should be examined physically before being given employ

ment.

6. Screening as far as practicable the kitchen, dining rooms and all living quarters as a protection against flies.

7. Whenever paraffined paper cups are provided, printed instructions should be printed on cups as to use and destruction.

DR. SOZA. Mr. Chairman: The Chilean Delegation, in accordance with the provisions of the provisional program, which requires that each delegate shall give his opinion as to the manner of preventing the transmission of tuberculosis on railroad cars and vessels, has deemed it advisable to submit to the consideration of this Conference the following recommendations:

PROPHYLAXIS OF TUBERCULOSIS ON RAILROAD CARS AND STEAMERS.

I. To avoid, as far as possible, in dormitories the use of fixed carpets and curtains.

2. To recommend the use of cuspidors which should be profusely distributed. 3. The periodical disinfection of cars or berths, including furniture, beds, etc. 4 The disinfection of dining room utensils. In the dining rooms of steamers where napkins are not changed after each meal, the napkins shall be kept in special envelopes.

5. The examination of the personnel and rejection of persons suspected of being afflicted with tuberculosis.

6. Notices posted in conspicuous places which shall read:

TO SPIT ON THE FLOOR IS A FILTHY AND IMPOLITE HABIT WHICH OFTEN CAUSES THE SPREAD OF CONTAGIOUS DISEASES.

DR. JOHNSON. Mr. President and members of the Convention: In accordance with the preliminary programme, I have the following comments to make with respect thereto :

We recommend to the several American Republics that they take the necessary steps toward the codification of all the Health Laws and Regulations, both statute and police, and present the same to the Bureau of American Republics at Washington. The ultimate object being the unification of all such laws and regulations.

(This motion was referred to the Advisory Committee.)

DR. LAZO ARRIAGA. I have heard with pleasure the opinion expressed concerning the prophylaxis of tuberculosis on steamers and railroad cars. I think that all, or at least the majority of us, accept the means suggested for that purpose, and that the principal and almost the only one that could be put in practice is cleanliness; but it seems to me that we should not put difficulties in the way of those afflicted with tuberculosis who desire to travel, or to prevent them from doing so, because, what would be said of a physician who would tell his patient, you can not be cured? What would be said of a physician who would say to his patient: You have such and such a disease? It would be an injury to the patients, and yet that is just what we would be doing by excluding from steamers and railroad cars persons afflicted with tuberculosis.

We were told yesterday that the greatest difficulty in transporting the sick was among second class and steerage passengers. I do not agree with this view of the matter. The poor afflicted with tuberculosis do not travel, not only because they can not afford it, but because they do not desire to do so, and those traveling as emigrants are looking for work and not for health. The sick who travel for the benefit of their health are the rich, that is to say, those who can pay first class passage, and they will have a physician on board who will suggest to them the necessary means not to endanger the health of the other passengers. As I said before, it is not proper to reject such passengers, but to subject them to the observance of certain rules, and to prevent them from knowing that they are seriously ill.

With regard to steerage passengers, and I make this as a motion, I think the steamship companies should be requested to treat the sick as they are treated in hospitals. Many a time it is not poverty that abounds so much in the lower decks of vessels as it is filthiness; people who are starving do not go there; the danger lies in filth, and the steamship companies might compel passengers upon receiving them on board to take a bath; they might furnish them with a special dress