Revising the 1912 International Sanitary Convention

At the opening of the International Sanitary Conference held in Paris in May and June 1926, Camille Barrère, French ambassador to Rome and veteran of many sanitary convention negotiations, claimed that, in the field of health work, ‘universal solidarity is unreservedly manifest’.Footnote ¹ In his welcoming address to the delegates assembled to revise the 1912 International Sanitary Convention, he praised the science and internationalism that allowed the world to be bound together in an ever improving sanitary safety net. Despite his optimism, the 1926 negotiations illustrated how the challenges to living up to Barrère’s rhetoric remained substantial. The 1912 agreement had laid out measures to control cholera, plague, and yellow fever, which had menaced nineteenth-century imperial trading routes. In the words of the Belgian secretary-general of the interior and health Otto Velghe, the 1912 agreement aimed to ‘safeguard Europe from pestilential disease coming from the East’.Footnote ² This agreement no longer suited the political or epidemiological realities of the 1920s.

The 1926 convention was a key document in the rethinking of international relations in an era that saw the dissolution of the great European land empires and a renegotiation of European power overseas. The framers of the new convention had to balance the traditional privileges of the maritime powers and the Paris-based Office International d’Hygiène Publique (International Public Health Office) with the geopolitical realities of the interwar period. Japan and the United States pushed for an agreement that was less Eurocentric than its predecessor and that recognized the growing international stature of their countries. Asia and the Americas had both negotiated regional agreements that they expected to be taken into consideration at the global conference.

The 1926 convention is notable for two reasons: the first is the increased reliance on epidemic intelligence rather than quarantine as the basis of international epidemic control, representing the maturation of a process that had begun at the turn of the century.Footnote ³ Second, despite the universalist rhetoric used to support the convention and epidemic intelligence, the intelligence networks that states entered into were based as much on political concerns as epidemiological factors. States and international organizations used their participation in information networks to assert their authority on a regional basis. Unlike the nineteenth century, when the debates over quarantine were framed in terms of trade and economic issues, debates over epidemic intelligence were framed in terms of international political arrangements and the growing importance of international institutions for great power politics.Footnote ⁴

The use of diplomatic conferences to create international agreements concerning disease control began at the 1851 international sanitary conference held in Paris, two decades after cholera had begun to menace Europe.Footnote ⁵ Despite regular conferences, states did not come to an agreement on maritime travel restrictions to control cholera until 1892.Footnote ⁶ Although trade interests shaped these discussions, Mark Harrison has shown how political issues, including the Crimean War and rising tensions in the Middle East, were equally important in steering the direction of the conventions.Footnote ⁷ The sanitary system began with conferences, mirroring the congress system of diplomacy, and aimed to create a series of conventions to regulate quarantine and data-sharing requirements.Footnote ⁸

As the congress system began to break down, international sanitary negotiators took inspiration from other aspects of international relations, beginning to formulate an international organization to oversee sanitary control. In 1903 in Paris, conference delegates emphasized the need to communicate epidemic information internationally while leaving states free from interference in their internal affairs; Patrick Zylberman has called this the height of the Westphalian sanitary system.Footnote ⁹ This shift in emphasis led the international community to create the Office International d’Hygiène Publique, known more commonly as the Office, in 1907, to collect notifications of infectious diseases of international concern and to revise sanitary conventions.Footnote ¹⁰ This article examines how the greater emerging political structures in the interwar period shaped the basis for the negotiation of the convention, in the same way that the conference system of the nineteenth century shaped the earlier conventions. Accordingly, new states and new international organizations are accorded as much space in the analysis as evolving understandings of incubation periods or cargo restrictions.

By the 1912 convention the pattern of international conventions had been set, and the Office provided a modest but consistent forum for discussion of contagious diseases. The 1912 convention continued the trend begun in 1903 of simplifying and solidifying rules about disinfection and quarantine. These provisions were left firmly in the hands of ports of arrival but limited to avoid unduly inconveniencing arriving ships.Footnote ¹¹

Revision of the code to incorporate new scientific knowledge and changing transportation technology had been planned for 1918, but the Office delayed the revision because of the war. By the early 1920s, an international consensus had developed that the 1912 convention was ‘absolutely out of date and in disagreement with all modern theory’.Footnote ¹² The League of Nations Health Organisation commissioner Norman White, returning from a tour across Asia and the Americas, commented that many of the officials he spoke to expressed the view that the document needed to be revised.Footnote ¹³ The American State Department reported, after consulting with the public health service, that ‘it is extremely advisable to have a revision of the existing sanitary convention’.Footnote ¹⁴ Most of these commentators took it as self-evident that the sanitary conventions were evolving documents, subject to regular revision, and so did not elaborate their specific issues with the 1912 text. Although earlier conferences had been particularly concerned about cholera and plague, a fear that remained in the public mind as evinced in Katherine Mayo’s 1927 Mother India, officials at the 1926 conference were more concerned with influenza and typhus, two diseases that had spread widely during the First World War.Footnote ¹⁵

New scientific research created discontent with the epidemic control measures in the 1912 convention. For example, that convention had devoted significant space to regulating cargo, but later work illustrated that cargo rarely harboured infectious material. By 1926, the state of the art suggested that rats were more important vectors, so the convention’s framers hoped to address the destruction of rats more fully in the convention, while lessening restrictions on cargo.Footnote ¹⁶ The greatest scientific controversy at the conference was over how to deal with healthy carriers of diseases such as cholera, provisions for which were largely left out of the convention because no consensus could be reached.

None of these changes were as fundamental as the increased emphasis on information sharing in the new convention. Such sharing of knowledge through bills of health had long been an important part of both formal and informal sanitary control networks. Neville Goodman has called this a period of transition from quarantine to epidemic intelligence. David Fidler argued instead that epidemic intelligence made quarantine more effective, because, by guaranteeing shorter quarantines in exchange for better information, states were more likely to share.Footnote ¹⁷ Rather than controlling the movement of contagious people using quarantine, the framers of the 1926 convention sought to facilitate the flow of information about contagious diseases. This system required states to open their records to increasing public scrutiny, and to trust the data of other nations. In general, despite that risk, states believed that the ability to anticipate infected ships before they arrived, and the potential to lessen quarantine because healthy ships could be allowed to proceed unencumbered, made increased information sharing a politically and medically attractive possibility. Propelled by trade interests and a growing interest in international exchange in the interwar period, states negotiated expanded international intelligence provisions into the 1926 convention.

Thus, what had changed more dramatically was not the scientific basis of the agreement but the political one. Changes were needed to accommodate the institutional and political underpinnings of the interwar international setting. Many of the empires that had signed the 1912 convention no longer existed; new states such as Poland had never formally adhered to the convention; others – particularly the USSR – had an ambiguous relationship to new international structures. Many of these states sought to define their relationship to the rest of the international community through the negotiation of a host of conventions on various topics. Additionally, the League of Nations and its supporters attempted to adjust the balance of power and basis of international agreements. The new convention had to contend with these realities.

Institutional politics had a profound effect on the convention, taking the form of disagreement between the supporters of the League of Nations Health Organisation and the supporters of the Office over which body would become the central organization in the new epidemic intelligence-sharing scheme. These tensions stemmed from larger geopolitical concerns, particularly the French desire to maintain international standing, and the British and American drive to limit the functions of the League of Nations. While supporters of the organizations had serious differences of opinion over the proper function of international organizations and the limits of international intervention into health affairs, they were also motivated by fears of losing prestige, and by petty bureaucratic rivalries. Despite paying lip service to the importance of objective technical decision-making in setting up scientific agreements, such as the international sanitary conventions, delegates (even those who did not receive direct instructions from their foreign ministries) usually followed the broad policy of their governments, meaning that seemingly petty concerns often masked larger philosophical or political motivations.

Debates over small sums of money, and over the time taken to fill out bills of health, likewise reflected deeper philosophical differences about the duty of care owed by international actors to others. The sums were small not because the issues were unimportant but rather because budgets for international health cooperation were small. While many captains and shipping lines complained about the cost and time of consular visas, debates over whether to maintain the older, paper-based system of bills of health were conditioned by new technologies and new attitudes to information sharing. Studying the negotiation of this convention reveals how shifting understandings of epidemic control, bureaucratic rivalries, and questions of grand strategic importance all shaped the international sanitary system.

Regional precursors

Although the framers of the 1926 International Sanitary Convention claimed to be creating a new global framework for international sanitary control, they really found themselves attempting to integrate regional blocks. Alison Bashford has observed that, in the interwar period, the sanitary system was built along regional rather than international lines. That is, global networks and concerns were secondary to more local structures.Footnote ¹⁸ Local epidemiological, political, and technological conditions meant that the international sanitary system under the 1926 convention was more a patchwork than a unified whole. Even strong advocates of the International Sanitary Convention supported regional agreements, which they believed would make the application of the global convention simpler and more responsive to local conditions. Regions were based partly on epidemiological conditions (including climate zones and trade routes) and partly on the limits of communication technology, but mostly on the attempts of states and organizations to solidify their presence in areas that they believed to be in their natural purview, or in partnerships that governments and organizations hoped would prove mutually beneficial.

Regional agreements in central and eastern Europe, Asia, and the Americas set the stage for the International Sanitary Convention by bringing practical issues to the fore.Footnote ¹⁹ International sanitary codes had cross-pollinated before, as when the 1905 Washington Sanitary Convention negotiated by the American states largely adopted the 1903 Paris Sanitary Convention.Footnote ²⁰ What was particularly notable about the 1926 convention was that the American and Asian agreements were negotiated first, meaning that international sanitary policy was no longer being driven almost exclusively by Europeans.

The first set of these new regional sanitary conventions was one of the newly created League of Nations Health Organisation’s greatest victories at the 1922 Warsaw International Health Conference. At that conference, which dealt mainly with eastern European typhus, many central and eastern European countries began negotiating sanitary agreements.Footnote ²¹ The Health Organisation’s guiding committee hoped that the sanitary convention between Russia and Poland, signed when memory of the Russo-Polish war was still fresh, would be ‘framed in such a manner as to allow of its becoming a standard instrument applicable to all countries in eastern and Central Europe’.Footnote ²² Other agreements followed: Germany and Poland published an agreement in March 1923;Footnote ²³ Serbia and Austria issued an October 1924 convention.Footnote ²⁴ These conventions required substantial reporting on diseases that went beyond those required in the 1912 International Sanitary Convention. They also included extensive rules for land traffic, owing to the geography of the region, which had been left out of the 1912 convention.

The most problematic region for the 1926 revision was Asia and its neighbours. The awkwardly named ‘Far Eastern Area’ included Japan, China, the Philippines, Indonesia, India, Australia, and parts of East Africa, and had been left out of nineteenth- and early twentieth-century health agreements. Formal, informal, and aspiring empires looked to the region to expand their influence. Only China and Japan were sovereign nations, and both had taken actions to assert sanitary authority.Footnote ²⁵ The Manchurian Plague Prevention Service was an extraordinary piece of medical politics, which, as Liew Kai Khiun writes, showed ‘remarkable autonomy’ because the Chinese-run organization managed to make inroads even into areas over which Russia and Japan had attempted to assert sanitary control.Footnote ²⁶ Japan more broadly used public health to assert political authority, using its control of the port city of Dairen (now Dalian) to illustrate its superior ability to administer Chinese territories.Footnote ²⁷ In various interwar sanitary fora, the Japanese advocated stronger representation in sanitary law, claiming that Japan faced special risks from its neighbours. They sought to revise the International Sanitary Convention, which Japan had never signed, to address its needs and in so doing amend what the Japanese government saw as one of the last ‘unequal treaties’.Footnote ²⁸

The British government remained interested in its dominions in the region, not to mention colonial outposts such as Singapore. By contrast, the United States, which had a strong naval presence near the Philippines and had recently declared a serious interest in the Pacific at the Washington Conference, remained uninterested in Asian sanitary matters, beyond reforming domestic public health in the Philippines. The Americans preferred to exert sanitary influence closer to their own borders, and away from the League of Nations.Footnote ²⁹ The reluctance of many of the powers to cooperate fully in sanitary exchange was indicative of limited cooperation more generally in the region.Footnote ³⁰ In short, Asia was a region in which geopolitical struggles frequently played out in the form of medical politics.Footnote ³¹

Like the rest of the international community, the League of Nations Health Organisation was slow to embrace formal cooperative work in Asia. In 1922 the Japanese delegate to the Health Committee, Mikinosuke Miyajima, proposed a Commission of Enquiry to investigate the epidemiological situation in Asia as a first step to increased work in the region.Footnote ³² The Health Committee attempted to avoid the expense by claiming that they could trust colonial governments to send back accurate information on the situation. Miyajima triumphed. In November 1923, the health section member Norman F. White was dispatched as a one-man Commission of Enquiry to the Far Eastern ports.Footnote ³³

White’s tour took him through China, Japan, and much of East Asia. His report on the mission encapsulated the challenges facing the international sanitary order in the interwar period: changing scientific beliefs, weak states, new transportation technologies, and inadequate conventions. White combined a universalist vision with a pragmatic localism. He began with the goal of studying ‘diseases of international importance’, such as cholera, smallpox and plague, their movement between Eastern Ports, and the quarantine and surveillance measures that were designed to stop them. He intended to develop uniform procedures across the ports to deal with these issues, which would in turn facilitate a regional sanitary convention.Footnote ³⁴

White’s hopes for a universal project were soon dashed. He quickly abandoned the questionnaire that had been laboriously designed by the Health Committee, because he found that the questions were not broadly applicable and risked obscuring important data about individual ports.Footnote ³⁵ He articulated the central problem of integrating Asia into a sanitary system as being that the public health infrastructures of most Asian countries lagged behind their European counterparts, meaning that assumptions that one could make about Western ports did not hold.

White’s monograph outlined two international projects to improve conditions in Asia. The first was for a Central International Epidemiological Intelligence Bureau for the Far East, which would receive and send information about epidemic diseases.Footnote ³⁶ His suggestion that the bureau be housed in ‘the gateway to the Far East’, Singapore, was taken up after the Rockefeller Foundation agreed to fund the venture.Footnote ³⁷ He also suggested that Asian governments should sign a regional sanitary convention that would serve as an entry point to the International Sanitary Convention. Although both suggestions were grounded in European practices, White advocated for them to be crafted in response to local needs. Both influenced the development of the International Sanitary Convention.

The Far Eastern Bureau for epidemiological intelligence created substantial international interest. The Health Committee was supportive. The Chinese, Portuguese, British, and Japanese agreed outright, and the Dutch and French in principle, although they expressed concern about the cost. Ludwik Rajchman, the Medical Director of the League of Nations Health Section, approached the Rockefeller Foundation, who had earlier expressed interest in European Epidemic Intelligence, claiming that, once the Eastern Bureau demonstrated its effectiveness, governments would be willing to carry the cost.Footnote ³⁸ To explore the project, the Rockefeller Foundation’s International Health Board agreed to pay US$5000 for a League of Nations-sponsored health conference in Singapore in February 1925 to help establish the bureau.Footnote ³⁹ The conference included representatives from British India, British North Borneo, Ceylon, China, the Federated Malay States, French Indochina, Hong Kong, Japan, the Netherlands East Indies, Siam, the Straits Settlements, and an observer from the Philippine Islands.Footnote ⁴⁰ H. F. Smith, the observer from the Philippines, noted ‘I think the President [of the conference] probably knows more about the attitude of my Government in regard to the Conference than I do myself, he having been in America since I was there and my not having received any detailed instructions’. He went on to note that he nonetheless expected a friendly relationship between the American government and the new bureau.Footnote ⁴¹ This disinterest contrasted with the attitude of the United States to domestic public health in the Philippines, which suggests that the American position probably arose out of hesitation about cooperating with the League of Nations.

The conference delegates agreed to open the bureau on a trial basis and confirmed the Singapore location.Footnote ⁴² The International Health Board offered a grant of US$25,000 (Straits$44,500, over US$300,000 in modern terms) annually for several years, to allow the bureau to prove its efficacy and attract government funding.Footnote ⁴³ The twelve attending governments agreed that they would cooperate administratively. Siam and the Straits Settlements both offered financial support of up to US$2,800 (Straits$5,000) annually for three years, while French Indochina and the Netherlands East Indies offered free wireless services, and North Borneo offered to carry the costs of telegrams internally, and in the case of an outbreak.Footnote ⁴⁴ The budget for the year was approximately US$40,000, split between the Rockefeller Foundation, the Health Committee, and local sources, and represented approximately one-quarter of the League of Nations Health Organisation’s annual budget.Footnote ⁴⁵ The Bureau opened on 1 March 1925.Footnote ⁴⁶

At the conference, the delegates attempted to come to a consensus on the purpose of the new bureau. That office was intended ‘to place important epidemiological information unreservedly and promptly at the disposal of all other countries and thus engender a spirit of mutual confidence that is essential to the negotiation and ratification of any satisfactory international code’.Footnote ⁴⁷ An extensive sanitary information exchange network already transmitted disease information among the consular representatives of Great Britain, America, Italy, Japan, and Australia. Consequently, the bureau had to improve data to prove its value. Simply creating a new body to transmit data already shared would be burdensome; cooperating states expected the bureau to standardize or otherwise improve the quality of the data.Footnote ⁴⁸ The conference discussed various ways in which the staff of the bureau could provide more useful information without putting excessive demands on states, which included sending telegrams or radio messages ahead of infected ships, and following them up with weekly letters explaining general port and ship health conditions.Footnote ⁴⁹

These discussions on standardizing information exchange led directly to White’s second contribution, his proposed regional sanitary convention. White expected this agreement to be a separate chapter in the International Sanitary Convention, modelled on the current practice for Hajj regulations, in order to harmonize and protect Asian countries from each other and to align practices with Europe.Footnote ⁵⁰ He suggested several differences from the practices in the International Sanitary Convention of 1912, the most important being a different basis for the sanitary system. In Asia, ports, rather than ships, were to be classified as infected or clean. Rather than inspecting each individual ship, any vessel coming from an infected port was assumed to be carrying infectious material (people, goods, or rats) and would therefore be subject to quarantine. If the ship came from a clean port, presumably there was no way for it to have become infected, so the ship was treated as uninfected unless the captain reported any illness during the voyage. This type of system, occasionally in practice in Europe, had been abandoned by the 1912 International Sanitary Convention because European health experts believed port classification encumbered healthy ships with unnecessary burdens that were more costly than inspecting each ship individually. The system also put the responsibility for a ship’s health in the hands of the staff of the port of embarkation; many nations did not want to give up that amount of control over ships that they feared might be bringing illnesses into their territory. White thought that port sanitation in Asia meant that the chance of clean ships emerging from infected ports was small, making the European practice ill-suited to Asia.Footnote ⁵¹ The Indian government objected strongly to this innovation, claiming that classifying ports would be unwieldy and would require ‘a degree of interference’ into civilian life that would be impossible, and costs that would ‘also react disastrously on the commerce of a country’.Footnote ⁵²

White’s proposed sanitary convention was controversial. The United States Surgeon-General, Hugh Cumming, was uneasy about creating a separate convention for Asia; he feared that ‘separate sanitary conventions for different parts of the world might imperil the international character of the work’, despite his involvement in the creation of an American regional agreement.Footnote ⁵³ The Japanese disagreed, stating that any universal convention would require special regional considerations for Asia.Footnote ⁵⁴ They preferred to negotiate a separate regional agreement for Asia, but were willing for the agreement to become part of the revised International Sanitary Convention.Footnote ⁵⁵ This proposal caused other problems, as many Asian nations, including China, were unsure about whether they wanted to become party to the larger convention.Footnote ⁵⁶ Other governments protested that they could be protected only by the full International Sanitary Convention. The Australian government feared the effects of the presumably lower standards in the Asian agreement.Footnote ⁵⁷ New Zealand claimed to trade so infrequently with Asian countries afflicted with plague, smallpox, or cholera that their interests might be better served by the International Sanitary Convention that governed their European trade partners.Footnote ⁵⁸ The conference ultimately decided that Eastern governments would wait to see the shape of the global revision before formally signing their own agreement.

Although the draft agreement was not ultimately officially incorporated into the text of the 1926 International Sanitary Convention, White’s draft shaped practices in Asia and around the world. Debates over whether the port of arrival or departure should have the responsibility for disinfection, the importance of information sharing, and the need to balance regional and global needs were particularly salient in negotiating both the American regional arrangements and the 1926 International Sanitary Convention.

The Americas presented a different set of challenges, having too great a public health infrastructure to be smoothly integrated into the international convention. Washington’s Pan American Sanitary Bureau was the world’s oldest international health organization. Created in 1902 by the Second International Conference of American States, it began as an information-sharing arrangement but soon took on the additional role of encouraging member states to improve their public health infrastructures.Footnote ⁵⁹ By 1924, all of the American states except Canada had joined.Footnote ⁶⁰

The sixth and seventh Pan American Sanitary Conferences (respectively in Mexico in 1923 and Havana in 1924) revised American quarantine and sanitary control measures, resulting in a new Pan American Sanitary Code in 1924.Footnote ⁶¹ The delegates who approved the convention remained committed to the older idea that ‘there shall be no invasion of the autonomy of any of the signatory Governments’, and that they were ‘left free to apply such additional measures of a local nature as may be required to meet special local conditions or peculiar circumstances’.Footnote ⁶² Information sharing became increasingly important in the Pan American Sanitary Code. Countries had to notify the first case of an extensive list of diseases, which went beyond the requirements of the International Sanitary Convention;Footnote ⁶³ the Pan American Sanitary Bureau was to become a central statistical clearing-house.Footnote ⁶⁴ The Pan American Sanitary Code adopted a mixed system of whether to declare ports or ships clean.Footnote ⁶⁵

The League of Nations sent White to the conference. He approved of the Pan American Sanitary programme; the conference delegates took seriously many of the issues that he had identified in Asia.Footnote ⁶⁶ Despite his approval of the direction of American public health initiatives, health cooperation between the League and the Americas was complicated. The United States continued to try to bolster their own position within the Pan American Sanitary Bureau and the Office, while maintaining an ambivalent relationship to the League of Nations and its proposed projects. Although the United States had a de facto representative on the League’s Health Committee, in the person of Hugh Cumming, who represented the Office’s advisory committee, Cumming and his country retained a closer relationship with the Office than the League.Footnote ⁶⁷

White was deeply concerned about Cumming. Although he described Cumming personally as ‘likeable and most kind and helpful’, his assessment of the Surgeon-General’s professional work was scathing. White claimed that Cumming had ‘no interest whatever in international public health beyond a constant care that no code or convention should in any way prevent the U.S. doing exactly what he judges necessary to the public health of his country’. Although the Surgeon-General’s office had prepared the draft Pan American Sanitary Code and the Havana conference’s agenda, White claimed that Cumming did not appear to understand them. He wrote that he believed that Cumming’s attitude to international work merely mirrored that of the uninterested United States State Department, and reflected broader US qualms about international cooperation.Footnote ⁶⁸

The attitude of Cumming and the State Department to international health work diverged from broader American foreign policy objectives. Although the United States, through initiatives such as the Washington Conference, was attempting to find a place in the global order, the International Sanitary Convention was of limited interest to the country, which had also largely sat out of the negotiations in Singapore.Footnote ⁶⁹ The United States understood immigrants to be the greatest threat to its sanitary security, and was resistant to any international attempt to limit national prerogatives in sanitary matters.Footnote ⁷⁰ Through the Pan American Sanitary Bureau, headquartered at Washington, it had dominion over its own sanitary sphere of influence. It also had the benefit of regional conferences and conventions with provisions better suited to the Americas: for instance, covering yellow fever well before the International Sanitary Conventions did.Footnote ⁷¹ The existence of the Pan American Sanitary Bureau was a mark of international prestige for the United States, and allowed a point of entry into international cooperation in health matters other than the League. Unlike the French and British, whose large maritime trading empires had made quarantine a vital issue of economics, the United States, buffered by two oceans and its own organization, was able to remain partially aloof from the debates in Singapore, and attended Paris in order to preserve that position. The US position seems to have resulted from their relative epidemiological isolation, and the desire to limit formal cooperation with the League of Nations, as much as from any belief about the efficacy of the convention. They ultimately signed the convention, albeit with reservations, although most of their formal cooperation took place under the auspices of the Pan American Sanitary Bureau and the Office. These regional fractures shaped the character of the conference, where delegates had to balance good science with good politics.

The 1926 International Sanitary Conference and Convention

By 1924, the advisory committee of the Office had worked out a draft revision at its regular meetings. This draft was notable for the number of times that the Office appeared specifically as the body to which information should be reported, a change from the 1912 convention and undoubtedly a power play.Footnote ⁷² The Office staff also tried to keep League of Nations staff, including White and Rajchman, in the dark in the earliest stages of their redrafting, delivering the draft to governments while Rajchman was en route to Japan.Footnote ⁷³ Although the League was hesitant to further antagonize the Office, or incur the costs of planning the conference, the League Council offered technical support.Footnote ⁷⁴

The conference, which convened in Paris in May 1926 at the invitation of the French government, was attended by more than sixty delegations. They included the United States and the USSR, new countries such as Poland, and representatives of colonial holdings, often as part of a metropolitan contingent.Footnote ⁷⁵ The League of Nations Health Organisation, the Office, and the International Labour Organisation also sent delegations. Most delegates were public health specialists, who did not have the full plenipotentiary powers to sign a binding treaty. In the main, they were interested in technical issues, and the question of who would oversee the system, rather than geopolitical intrigues. In contrast, many of the earlier sanitary conferences had been staffed by career diplomats.Footnote ⁷⁶

The conference received little publicity. Le Figaro, which described in depth many of the conferences meeting in Paris during this period, never mentioned the gathering, and the conference was also given little coverage in the major British and American newspapers. The French minister of labour, health, and social security had been so badly briefed that he did not even know how frequently the French had hosted the conference.Footnote ⁷⁷

At the first three conference sessions, delegates gave opening remarks that set out their nations’ positions. The Italian delegation advocated an expanded list of diseases, more definition of surveillance and observation, more emigration rules, and more actions taken at the point of origin.Footnote ⁷⁸ Matsushima of Japan discussed the special challenges faced by the East. He claimed that nations required complete control of definitions of infection, that information-sharing requirements needed to take into account infrastructure problems, and that the Singapore Bureau had to be able to accept data required by the convention.Footnote ⁷⁹ Witold Chodzko proudly noted that Poland was participating as an independent nation for the first time. He pointed to Poland’s post-war health experiences to show the importance of terrestrial as well as maritime agreements.Footnote ⁸⁰ In his opening address, Hugh Cumming made several requests that attempted to solidify America’s position, including that English become the second official language of the conference and that the Office maintain and even expand its role as coordinator of international health information.Footnote ⁸¹ The American delegation also wanted the Pan American Sanitary Code provision allowing states to create their own local regulations that exceeded the stringency of the International Sanitary Convention to be included in the larger agreement.Footnote ⁸² After the opening statements, subcommittees examined quarantine, deratinization, information exchange, and other key provisions of the draft. They debated three of the most important policies in interwar health: quarantine, preventive techniques that would make large-scale quarantine obsolete, and international epidemic intelligence sharing. These discussions led to a new emphasis on intelligence sharing for practical and political reasons.

Quarantine, the basis of older international sanitary conventions, was out of vogue for practical and political reasons. Determining who had been exposed on large ships was challenging, especially given that some of the aetiologies of the diseases in question were unclear. In some countries, quarantine was seen as a major intrusion on the part of government.Footnote ⁸³ By the early 1900s, it was divided into two practices – observation and surveillance – in order to decrease the inconvenience. Observation entailed keeping an infected ship’s passengers in public health custody, either on the ship or in port hospital, until the incubation period of the suspected disease had passed. In surveillance, passengers were only subject to periodic physical or bacteriological examinations for the same period.Footnote ⁸⁴

The International Sanitary Convention set maximum limits on practices, rather than mandating minimums, to protect people from unnecessary impingement on the freedom of movement. The text replaced ‘quarantine’ with the word ‘observation’ in most sections.Footnote ⁸⁵ Only in the section concerning the Suez did language referring to quarantine survive.Footnote ⁸⁶ In other parts of the world, in the instance of plague, isolation of the sick and their contacts was still allowed, and the contacts could be quarantined for six days, the length of the incubation period.Footnote ⁸⁷ Land and rail quarantines were left to local agreements between neighbouring states.Footnote ⁸⁸

The framers of the 1926 International Sanitary Convention looked to other techniques to supplement quarantine. One of the most contentious proposals was the use of vaccines, particularly anti-cholera vaccines for migrants. Vaccination was expensive, especially in the numbers needed for pilgrims and emigrants, and many still viewed it as an invasive procedure. Debates centred on the Hajj pilgrimage, which European health officials viewed as a significant cholera risk, because of the large movement of people to a crowded space with limited sanitary facilities en route. The political sensitivities of the region were mounting, with Egypt angling for more control of its own waterways and chafing under outside regulation. The convention declared the anti-cholera vaccine ‘a method of proven efficacy’ to lessen the spread of the disease, but only recommended the use of the vaccine in endemic regions.Footnote ⁸⁹

Even more contentious were regulations on how to fumigate and disinfect ships to kill rats and other vectors of infection, most importantly plague. Chemical fumigation was costly and poisonous, as well as controversial. Consequently, provisions regulating pesticides were vague. Under the convention, governments were required ‘to use all the means in their power to diminish the danger and to keep informed of the conditions of rats in the ports’. They were supposed to inform others of these conditions, and to perform regular bacteriological examinations of captured rats. These requirements were particularly strict for six months following the discovery of the last plague-infested rat.Footnote ⁹⁰ Ports were also required to attempt to stop the boarding of rats onto ships.Footnote ⁹¹ Countries were required to allow the disinfection and destruction of rats on plague-infected ships, although the technique had to limit damage to the ship and cargo, and no specific technique was mandated.Footnote ⁹² However, deratinization was required to take place in the way that would cause least damage to ship or cargo; no specific measure was named.Footnote ⁹³ Ships were required to undergo periodic deratinization, with certificates attesting to its validity for six months.Footnote ⁹⁴ In instances where rats, mosquitoes, or cholera had been found during inspections, ports were allowed to require the disinfection, deratinization, and fumigation of ships.Footnote ⁹⁵

The port suggestion that had caused White so much grief in the Far Eastern Agreement was even more controversial in Paris. White, who advocated port classification for the rest of the world as well, was at a loss over what he saw as a perfectly logical suggestion. ‘This apparently innocuous question’, he wrote, ‘is sometimes debated with all the fervour that one associates with important political and religious discussion’.Footnote ⁹⁶ He believed that classifying ports as infected might be a salutary form of stigmatization, encouraging those ports to clean up their acts.Footnote ⁹⁷ He thought that the focus on ship and port of arrival conditions in the Paris convention did not take into account the importance of rats in disease transmission, or the fact that many ports lacked the disinfection methods for a disease that might be imported.Footnote ⁹⁸ Many others supported the idea that disinfection at the port of origin was preferable; American studies, despite the desire of American public health officials to maintain control of sanitary determinations in their own ports, had found that disinfection at source was more effective.Footnote ⁹⁹ These decisions rested on whether or not countries agreed that the potential of improved processing times and fewer diseases arriving on ships were worth the risk of having to trust other countries’ medical staff.

The delegates settled on a mix of procedures. Ports of embarkation were required to stop sick passengers and all rats from entering ships, and emigrants had to be medically screened by their home country.Footnote ¹⁰⁰ Despite fears of slowing down commerce, the 1926 convention retained many end-of-journey provisions in order to preserve a last line of defence against contagion. As a counterbalance to screening on embarkation, it preserved the right of countries to make medical visits on all arriving ships.Footnote ¹⁰¹ Countries of destination also maintained the right to fumigate ships for rats on arrival.Footnote ¹⁰² Canada and the United States signed the treaty with the reservation that they could override the convention when ships they believed to be infected entered their ports. This revealed a divide between North America and the rest of the world, as well as the increased separation between Canada and the rest of the British empire, which did not request this exemption.Footnote ¹⁰³

Consensus grew that quarantine was best limited, and could be avoided through communication. Information sharing increasingly became the basis for epidemic control efforts, expanding on the short list of notifiable diseases in the 1912 convention. The 1926 convention added the requirement to notify other nations of epidemics of smallpox and typhus; these diseases, although still widely endemic, were believed dangerous enough when epidemic to make them worthy of international notification.Footnote ¹⁰⁴ More fundamental changes were affecting information sharing: with the advent of ship-based telegraph and radio, the possibilities for sharing information increased. Ships could send ahead their health status; ports could communicate to each other without the risk of sending messages through intermediaries who might themselves be contaminated. While these notifications were rarely allowed to replace more traditional methods such as the medical visit, they supplemented older methods when the technological and epidemiological conditions allowed.

As the world grappled with the technological possibilities of rapid disease notification, great discussion ensued over what to do with the current standard of notification: the bill of health. The bill of health was a certification by the captain, and sometimes a port medical officer at the beginning of the voyage, of the health conditions of the ship, which were often re-certified on arrival by the medical officer of the port and the consular office of the home state of the ship. Ranging from minimalist to detailed, the bill of health could be time-consuming for the captain to fill out, time-consuming to have verified and approved, and frequently inaccurate. The form used in the Straits Settlements, praised by Norman White for its simplicity, included the past history of the ship, the number of cases of plague, cholera, smallpox, and yellow fever, as well as other diseases and deaths, a full list of disinfection steps taken, and a listing of all infectious diseases in the port in both the past week and the calendar year, to be certified by the port health officer.Footnote ¹⁰⁵ The bill of health frustrated many shipping lines. In addition to its being time-consuming, paying ports and consuls for their certification was costly.Footnote ¹⁰⁶

In the 1920s, some hoped to abolish the bill of health, while others wanted to revise and standardize it. The International Shipping Conference believed that simplified or abolished bills of health could supplement radio and wireless messages, leading to increased efficiency and less burdensome paperwork.Footnote ¹⁰⁷ The British government favoured the suppression of bills of health, because the powerful and lucrative British shipping lines repeatedly requested that documentation burdens be lessened.Footnote ¹⁰⁸

Not everyone believed that bills of health were outdated. Although Britain led the charge against them, many British colonies appreciated the extra medical information that the bills provided, especially in epidemiologically active areas.Footnote ¹⁰⁹ The British sanitary administration in Egypt opposed the suppression of bills of health, calling the proposal ‘very radical’.Footnote ¹¹⁰ Thus, the British were caught between the demands of their shipping interests and their colonies. The 1926 International Sanitary Convention kept the requirement for bills of health, but their long-term survival remained unclear.

Careful management of information, no matter what its form, became an increasingly important issue in the international public health system. Who would manage that information was a major concern of the conference. Under the previous agreement, the Office collected notifications through the mail, making communication slow and essentially useless to non-European countries. Meanwhile, the League, through the Singapore Bureau and its Epidemiological Intelligence Service, had set itself up as a rival information-gathering body, upon the request of its members. Many delegations asked that the League take responsibility for epidemic intelligence, because of its early successes in the field. Before the conference, the British international public health representative George Buchanan related, with some trepidation, that international sentiment was ‘hardening’ in favour of Geneva.Footnote ¹¹¹ At the conference, the Japanese, whose nation had been geographically out of range of the older system, pushed hard for the League to be new centre. Failing that, they ‘insisted’ that the League’s Singapore Bureau be allowed to take notifications from Asian nations. The Italian and Polish delegations signalled their nations would prefer to send notifications through the League, as did the Latin American delegations.Footnote ¹¹²

Not everyone agreed. The Soviet delegation studiously ignored the League, reiterating that the Office was the only international health organization. Buchanan and the British announced that the Pan American Sanitary Bureau and League of Nations Health Organisation could best serve public health by supporting the Office’s mission. Hugh Cumming framed the US objections to League activities in terms of fears over the duplication of services, eliding the fact that the United States was not a member of the League of Nations. He also glossed over the fact that significant support for the League’s epidemic intelligence system had come from the American Rockefeller Foundation.Footnote ¹¹³

The pro-Office camp carried the day. The agreement was a compromise, which was amenable to the needs of states that had felt ill served by the old system. The ‘regional bureaux’ agreement allowed countries such as Japan to send their disease notifications to local bureaus, which would send the notifications on to Paris. Singapore, the Washington Pan American Sanitary Bureau, and the Alexandria Hajj station were all declared to be regional bureaus.Footnote ¹¹⁴ Negotiating the exact terms of the agreement was tortuous, and continued after the International Sanitary Convention had been completed. The French, British, and Americans did not want the League mentioned by name in the convention itself.Footnote ¹¹⁵

Despite the emphasis placed on information sharing, many of the reservations made to the signatures on the convention concerned that practice. Most were based on geography. China, India, portions of the British empire, and Japan all included reservations on Article 8, which required nations to notify the international community of all outbreaks of the notifiable diseases above a certain threshold. They stated that their internal public health structures were not adequate to the task. There were regions in their territory that did not have the staff, the laboratory equipment, or communications equipment to make notifications in a timely manner. They agreed to report internal epidemics as they became international threats.Footnote ¹¹⁶ Japan objected to language in the convention that required nations to telegraph information about epidemics, arguing that, by the time mail notification of rural, internal epidemics entered the city, the danger had often passed, and that the cost of a telegram was unnecessary.Footnote ¹¹⁷ Despite these concerns, the Singapore Bureau made Asia one of the most open information-sharing regions during its existence.

The new International Sanitary Convention could not be called a universal agreement. Non-European regions, particularly the Middle East and Asia, were dealt with in separate chapters, or even ancillary agreements, which were only hinted at in the main text. Africa was all but left out. White eloquently summarized the many practical and political impediments to a truly universal agreement, writing that there were ‘manifold’ reasons why people were hesitant to adopt a universal agreement:

Paradoxically, the acceptance of a model that took into account regional differences allowed for a more universal subscription to the convention.

Epidemic intelligence and regionalization after 1926

After the conference, epidemic intelligence sharing became another battleground for working out institutional and national differences. Despite the compromise that left the Office International d’Hygiène Publique as the centre of the required epidemic notifications, the League of Nations Health Organisation became Europe’s most important hub of epidemiological information. The Geneva office had more staff, a larger printing budget, and a wider purview of disease data collection, which allowed the League statisticians to produce more meaningful data. By January 1926, before the sanitary conference, Albania and Portugal were the only large European states not reporting to the League, although the convention was not ratified until 1929.Footnote ¹¹⁹ The German medical statistician Emil Roesle wrote that these ‘bulletins can be seen as proof of the increasing harmonious collaboration of all civilized nation in counteracting epidemics, and of the humanitarians aims of that section, which are being more and more appreciated’.Footnote ¹²⁰ As this information became statistically and strategically valuable in Europe, attempts were made to export the model around the world. Adapting the model outside Europe proved problematic because many regions did not have the capacity to produce comparable statistical notifications.

One region was able to create a sustainable local model. The Singapore Bureau, which began operating before the International Sanitary Convention was signed, had a head start on building a local information infrastructure. The first years of the Singapore Bureau were occupied with establishing its weekly report and creating a radio and telegraphic network for transmitting epidemiological intelligence. It achieved early success: within a year of opening, Gilbert Brooke, the director of the bureau, reported to Rajchman that ‘the bureau progresses famously’ and that the weekly bulletin had grown from reporting data from two countries to seven.Footnote ¹²¹

This early communication relied on telegraphs more than mail. Singapore had been chosen because of its strategic importance as a telegraphic site; but telegraphs had their weak points, as they could be very expensive. Singapore’s work was eased by the development of a telegraphic code, called the AA code, which decreased the length of telegrams, and therefore their cost.Footnote ¹²² Prior to the code being implemented, Brooke had estimated that cable costs would be Straits$30,000–$60,000.Footnote ¹²³ Even after the code was implemented, cables still cost the Bureau nearly Straits$25,000 (approximately US$14,000 of the US$25,000 of funding) per year, and was the second largest expense after staff salaries.Footnote ¹²⁴ Cable costs continued to grow until the end of the decade, despite attempts to economize, although the cost per port went down owing to these efficiencies.Footnote ¹²⁵ The telegraph was thus not sufficient to support a worldwide epidemiological intelligence network, given the financial restrictions of the 1920s.

Radio, or wireless telegraphy, seemed able to solve many problems, as radio transmissions were significantly cheaper than telegrams.Footnote ¹²⁶ This was because radio did not require a sophisticated infrastructure. The League had access to a radio transmitter in Singapore, which could reach Europe, the Indian Ocean, and most of Asia, and one at Nauen, in Germany, that could cover the rest of Europe, Africa, and the Americas. Using radio broadcasts, Singapore would only have to transmit each round once, saving time and money, because other stations would be able to pick up and relay the message further.

The plan to re-transmit the Singapore data from Germany was controversial and illustrated a major difference between how disease information was managed in Asia and in Europe. Different cultures of practice had emerged, despite a general acceptance of European public health principles. A. L. Hoope, of the British government, feared that Nauen broadcasts would open to public scrutiny diseases that might embarrass Eastern governments.Footnote ¹²⁷ However, in the East, where disease was to some extent assumed, and where there was a longer tradition of relatively free exchange, open sharing of information was regarded as the only way to maintain public health. In the West, there were fears that such data could cause embarrassment. The difference was so great that in the East much of the data was eventually available in newspapers, supplied by governments directly.Footnote ¹²⁸ From his earliest tour, White ‘was impressed by the fact that almost everywhere much more information of epidemiological interest and importance is available locally than is readily available elsewhere’, although the infrastructure in the early 1920s did not always allow for the significance of that data to be recognized.Footnote ¹²⁹ Ultimately, the Asian data was transmitted, but had limited effect on the types of information broadcast from European governments themselves.

Setting up the broadcast system proved difficult. Although by June 1925 thirty weekly returns reached the Bureau, most came in via telegram or letter.Footnote ¹³⁰ A complicated relay structure seemed poised to allow ports as far flung as those of Australia, Shanghai, Aden, Zanzibar, and Madagascar to receive broadcasts.Footnote ¹³¹ Broadcast remained at best a regional technology. Wireless had not yet expanded commercially to Africa, and the weather conditions made wireless impossible to use between 2 pm and dusk for most of the year.Footnote ¹³² The League continued to add wireless sites, but also relied extensively on telegrams.

Political factors shaped the region as much as technological limitations. Epidemiology and geography did not map neatly onto political power structures. Several health authorities attempted to connect informally to the Singapore Bureau because they were geographically part of the epidemic region but were politically connected to other organizations. The Canadian government wrote asking if Singapore reports might be mailed directly to Canada’s Pacific ports, because data being routed through Paris then to Ottawa was too slow to be useful, and the bills of health received from arriving ships did not give a comprehensive picture of epidemics brewing in the East.Footnote ¹³³ Carlo Chagas also asked for data to be sent directly to the Brazilian government, or at least relayed through Geneva, because of the number of Japanese immigrants coming to Brazil.Footnote ¹³⁴

Others, by contrast, attempted to limit communication with obvious information-sharing partners, illustrating the political stakes in the convention. White’s attempts to increase communication directly between the Singapore Bureau and the American government or the Pan American Sanitary Bureau, instead of through the Paris Office, were rejected because the Philippines Office had already been instructed to update the US about Eastern epidemics of interest, and additional reporting would only represent ‘a duplication of effort’.Footnote ¹³⁵ This tension over the role of the region continued even into the Second World War, when the League was in its dying days, and the Health Section member Yves Biraud attempted to have the Singapore Bureau reopened, emphasizing that the bureau existed primarily to serve the region and not the League, or the Office, or any larger system. He wrote that he found great scepticism about this view among representatives from the US government and the Office.Footnote ¹³⁶

Despite these difficulties, the bureau fulfilled its role as the Eastern regional office under the International Sanitary Convention, reporting disease data back to Paris. It also extended the scientific work of the League, running studies of indigenous disease and port practice, and facilitated exchanges of medical personnel in the east. With the successes of the bureau, the Health Committee believed that they had discovered a workable model for regional cooperation, even if all those involved acknowledged that regional divisions were naturally contingent.

The effective exclusion of African concerns from the 1926 International Sanitary Convention, coupled with the success of the Singapore Bureau, led to calls for the creation of a similar bureau for Africa. International health cooperation had proved difficult in Africa, because of a combination of geoepidemiological and imperial concerns. Mandatory governments were disinclined to cooperate with the League of Nations Health Organisation’s attempts to collect diseases statistics from Africa.Footnote ¹³⁷ Although health was a concern for many colonial powers, for economic and humanitarian reasons, governments rarely collaborated on issues of colonial health.

Africa had mostly been represented by its imperial and mandatory rulers at the 1926 sanitary conference. Only Egypt was represented by a native African, and the governments of Sudan and Egypt were primarily interested in questions relating to the control of the Hajj pilgrimage routes, rather than in the broader agreement. South Africa, although represented by its own delegate, Philip Stock, followed the rest of the British empire in often deferring to the British delegate.Footnote ¹³⁸ Like Australia and New Zealand, the government of South Africa believed that the country would be better protected by a strengthened general agreement than a possibly watered-down regional arrangement. Stock advocated the inclusion of influenza as a notifiable disease, and the decreasing stringency of bills of health.Footnote ¹³⁹ Rather than wishing to abolish the bills, however, he reported his government’s desire that ships’ captains rather than doctors should fill out the bill of health, because they could provide a longer record of illness, having less turnover than ships’ doctors. Aside from promoting the use of radio for notifications, which may have been because of their distance from other ports and the length of time that mail took to reach South Africa, Stock generally agreed with Britain’s representative.Footnote ¹⁴⁰ The close economic and political ties between the British colonies and Britain, and the fact that many of the most economically important health problems in Africa, including tuberculosis and sleeping sickness, did not travel along maritime routes, led to difficulty in developing an African health policy.Footnote ¹⁴¹

Following the success of the Singapore Bureau, and facing a continent-sized lacuna in epidemic intelligence, colonial governments and international public health workers began to explore whether such a solution might be a way to integrate Africa into the global public health network. Supporters argued that the bureau was necessary for the good not only of Africans but also of European powers. Improved health conditions in Africa would lead to improved economic outcomes for colonial powers. Lucien Raynaud, head of the Pasteur Institute’s laboratory in Algiers, was a passionate advocate of the importance of health work to the colonial project. He believed that Africa was at risk of depopulation through invasion, slavery, famine, and epidemics.Footnote ¹⁴² Europe, because of its use of ‘black labour’ and ‘coloured troops’, was at risk of importing ‘diseases which have hitherto been confined to the black races’ and, consequently, ‘Europe and all civilised nations are bound, in common humanity, to give a thought to the situation of these backward peoples who are being mown down by so many diseases and afflictions’.Footnote ¹⁴³ The rhetoric supporting the African bureau freely mixed economic, humanitarian, and imperial justifications.

The placement of the proposed bureau raised political and practical problems. Raynaud offered the use of his Algiers laboratory. He argued that the air, rail, and wireless connections from Algeria to the rest of Africa and across the Mediterranean ideally positioned his laboratory to handle the bureau’s heavy communications responsibilities.Footnote ¹⁴⁴ He estimated that the bureau would cost approximately FFr70,000 (US$2,200) a year for a doctor, stenographer, clerical and office support, printing, and postage.Footnote ¹⁴⁵ This sum was significantly less than that spent by the Singapore Bureau, probably because Raynaud did not include cable fees, assuming that the bureau would use the Pasteur Institute’s infrastructure.Footnote ¹⁴⁶ Although Rajchman supported Raynaud’s suggestion, Britain and its empire favoured locating the bureau in Egypt.Footnote ¹⁴⁷ However, empires were not necessarily of one mind on this issue. Perrier, the Inspecteur General du Service de Santé claimed that his office would prefer Dakar, another French colony, which he claimed was the natural centre of Africa.Footnote ¹⁴⁸ Other experts advocated a tripartite division of the continent, including a Mediterranean region centred on Algiers, and a Western and Atlantic bureau built in Dakar, with East Africa reporting to Singapore.Footnote ¹⁴⁹ The location proved impossible to agree on and, without a strong national advocate, the proposed bureau faltered. Although Raynaud attempted trial transmissions, his centre lacked the communications equipment to produce timely and significant information, and his experiment ended.Footnote ¹⁵⁰ Once again, a model created for one part of the world failed to translate to another for reasons of geography, technology, and politics.

Conclusion

The 1926 International Sanitary Convention was intended to be a truly global document. The European great powers, however, firmly illustrated that, while they said universal, they meant a document that responded to European needs, both within its borders and around its colonies. Political trends in the interwar period meant that this understanding of international sanitary cooperation had to change. With American and Japanese interests in play, the international sanitary system was becoming truly international, but not necessarily in the ways that the European deans of the system had intended. Proponents of the League of Nations also desired a more open and broadly based system, and their bureaucratic and ideological interests often put them at odds with partisans of the Office and the Japanese and American programmes. The convention illustrated that Europe was no longer the sole driving force in sanitary legislation: Asia and the Americas each offered models, influenced though they were by European and imperial concerns.

Regionalization was the most prominent response to this dilemma. Although geographic and epidemiological factors shaped these regions, as did trade routes and the limits of communications technologies, the regions of the world were highly artificial and dependent on political allegiances. Politically, they replicated traditional spheres of influence and, although Japan in particular lobbied for more independent control of its sanitary sphere of influence, Singapore’s Far Eastern Bureau was more attentive to British and French imperial concerns. Even information sharing, which was found to be a highly effective way of binding regions together, was often carried out along politically rather than technically expeditious networks.

At the same time, to write the convention off as so much politics ignores the important role that technical knowledge played, and the broad consensus reached in technical matters. The technical focus of the conference speaks to the rhetorical separation of diplomacy and science in the interwar period, a fictional separation that allowed work to continue despite the great geographic, epidemiological, and political differences among the framers of the convention. Studying these negotiations illustrates that world history is shaped nearly as much by budget disputes and questions of institutional pride as by grand geostrategic goals. Global systems, composed of so many local circumstances, are contingent and contested, and therefore reveal important insights about the intellectual, geographic, and political contexts that produce them.