Views & Reviews Past Caring

All together now

BMJ 2008; 336 doi: (Published 24 January 2008) Cite this as: BMJ 2008;336:220
  1. Wendy Moore, freelance writer and author
  1. wendymoore{at}

    In celebrating the 60th anniversary of the World Health Organization this year, it is humbling to reflect that for most of human history international cooperation has been notable by its absence.

    Early races and cultures were more likely to persecute each other as the perceived carriers of lethal diseases than to join forces in mutual opposition. The Mongols pioneered germ warfare when they catapulted plague-ridden corpses into the besieged Black Sea port of Caffa in 1347, thereby launching the Black Death on its devastating sweep through Europe. When syphilis was first observed in 1495, each successive nation of sufferers named the scourge after their closest enemies, so that the French called it “the Neapolitan sickness,” the Italians “the French sickness,” the British “the French pox,” and, after 18th century explorers imported the disease to Tahiti, it was inevitably dubbed “the British disease.”

    The contempt of cholera for the niceties of border control finally brought countries together in the first serious attempt at international partnership in 1851 when 12 nations, mostly European, met in Paris for the first International Sanitary Conference (ISC). It was an inauspicious start.

    Each country brought two delegates—a physician and a diplomat—but as both were allowed a free vote their views often cancelled each other out. It mattered little, since neither doctors nor diplomats had any idea of the nature of cholera or its method of transmission. So although the delegates could agree that bubonic plague and yellow fever were both contagious, there was no such consensus over cholera.

    The British medical delegate insisted that cholera was “purely epidemic”—or subject to local environmental and climate conditions. An Austrian member argued that cholera was a divine punishment on the lowest levels of society so that the only effective weapons were courage and faith. The Turkish delegate turned up 10 weeks late and demanded a two-day adjournment in order to catch up on his reading.

    A seven-strong committee charged with debating quarantine controls concluded that it was “humanly impossible to do anything useful or efficacious against such a scourge” and that quarantine measures were therefore ‘‘illusory” and “even dangerous.” This view was overturned by the full conference, which voted for limited border controls. When the summit ended after a full six months, the French foreign minister commended its delegates for their speedy deliberations, but since none of the countries implemented the agreed measures its end effect was zero.

    Undaunted by this seemingly disastrous beginning, there were nine more international sanitary conferences that century, of which only one produced any useful decisions. By the time of the 14th and final ISC in 1938, there were three distinct organisations competing to provide an international forum on health: the Office International d’Hygiène Publique, the Pan-American Sanitary Bureau, and the Health Organisation of the League of Nations. The outbreak of the second world war put paid to the rival altruism, which led ultimately—and somewhat perversely—to the creation of a single global partnership for health with the founding of the WHO on 7 April 1948.


    • Sources for this article are: Roy Porter, The Greatest Benefit to Mankind (HarperCollins, London, 1997), p 123; Claude Quétel, History of Syphilis (Cambridge, Polity Press, 1990); Milton I Roemer, “Internationalism in medicine and public health” in W F Bynum and Roy Porter (eds), Companion Encyclopedia of the History of Medicine (Routledge, London, 1993), pp 1417-35; Norman Howard-Jones, The Scientific Background of the International Sanitary Conferences, 1851-1938 (WHO, Geneva, 1975).

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