The first International Sanitary Conference

Cholera had swept across Europe's borders since the 1830s, and governments had never acted together on quarantine. In 1830 severe quarantines and sanitary cordons in Russia, Prussia and central Europe had failed to stop the disease, and many blamed restrictive measures for harming trade. France reformed its own sanitary code in 1847 and 1849 and posted resident physicians in Turkey and Egypt to report on health there and to issue bills of health to departing ships. It then invited other governments to Paris.

The International Sanitary Conference met in Paris in 1851 with 12 nations, mostly European. Each sent two delegates, a physician and a diplomat, and since both had a free vote they often cancelled each other out. Neither the doctors nor the diplomats knew what cholera was or how it spread. The delegates agreed that plague and yellow fever were contagious but reached no consensus on cholera.

The convention it drafted included special provisions for the East: a health council at Constantinople with as many European delegates as Ottoman officials, and 26 European doctors stationed in the region, with a central doctor at each of Constantinople, Smyrna, Beirut and Alexandria to study local diseases, inspect their districts and report. Only France, Portugal and Sardinia joined the treaty that came out of it, in May 1853.

Nine more conferences followed in the 19th century, and only one of them produced useful decisions, according to the writer Wendy Moore in the BMJ. By the 14th and last, in 1938, three bodies competed to lead international health: the Office International d'Hygiène Publique, the Pan American Sanitary Bureau and the Health Organisation of the League of Nations. The three diseases debated in Paris in 1851 were still the only ones subject to the International Health Regulations in force in 2005.