The Pan American Sanitary Code, 1924

Introduction

The presidents of Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, El Salvador, Guatemala, Haiti, Honduras, Mexico, Panama, Paraguay, Peru, United States of America, Uruguay, and Venezuela, being desirous of entering into a sanitary convention for the purpose of better promoting and protecting the public health of their respective nations, and particularly to the end that effective cooperative international measures may be applied for the prevention of the international spread of the communicable infections of human beings and to facilitate international commerce and communication, have appointed as their plenipotentiaries, to wit:

Article 1

The objects of this code are:

1. The prevention of the international spread of communicable infections of human beings.
2. The promotion of cooperative measures for the prevention of the introduction and spread of disease into and from the territories of the signatory Governments.
3. The standardization of the collection of morbidity and mortality statistics by the signatory Governments.
4. The stimulation of the mutual interchange of information which may be of value in improving the public health, and combating the diseases of man.
5. The standardization of the measures employed at places of entry, for the prevention of the introduction and spread of the communicable diseases of man, so that greater protection against them shall be achieved and unnecessary hindrance to international commerce and communication eliminated.

Article 2 Definitions:

As herein used, the following words and phrases shall be taken in the sense herein below indicated, except as a different meaning for the word or phrase in question may be given in a particular article, or is plainly to be collected from the context or connection where the term is used.

AIRCRAFT.-Any vehicle that is capable of transporting persons or things through the air, including aeroplanes, seaplanes, gliders, helicopters, air ships, balloons, and captive balloons.

AREA.-A well determined portion of territory.

DISINFECTION.-The act of rendering free from the causal agencies of disease.

FUMIGATION.-A standard process by which the organisms of disease or their potential carriers are exposed to a gas in lethal concentrations.

INDEX, AEDES AEGYPTI.-The percentage ratio determined after examination between the number of houses in a given area and the number in which larvae or mosquitoes of the Aedes aegypti are found, in a fixed period of time.

INSPECTION.-The act of examining persons, buildings, areas, or things which may be capable of harboring, transmitting, or transporting the infectious agents of disease, or of propagating or favoring the propagation of such agents. Also the act of studying and observing measures put in force for the suppression or prevention of disease.

INCUBATION, PERIOD OF.-For plague, cholera, or yellow fever, 6 days; for smallpox, 14 days; and for typhus fever, 12 days.

ISOLATION.-The separation of human beings or animals from other human beings or animals in such manner as to prevent the interchange of disease.

PLAGUE.-Bubonic, septicemic, pneumonic, or rodent plague.

PORT.-Any place or area where a vessel or aircraft may seek harbor, discharge, or receive passengers, crew, cargo, or supplies.

RODENTS.-Rats, domestic and wild, and other rodents

Article 3

Each of the signatory Governments agrees to transmit to each of the other signatory Governments and to the Pan American Sanitary Bureau, at intervals of not more than two weeks, a statement containing information as to the state of its public health, particularly that of its ports.

The following diseases are obligatorily reportable: Plague, cholera, yellow fever, smallpox, typhus, epidemic cerebrospinal meningitis, acute epidemic poliomyelitis, epidemic lethargic encephalitis, influenza or epidemic la grippe, typhoid and paratyphoid fevers, and such other diseases as the Pan American Sanitary Bureau may, by resolution, add to the above list.

Article 4

Each signatory Government agrees to notify adjacent countries and the Pan American Sanitary Bureau immediately by the most rapid available means of communication, of the appearance in its territory of an authentic or officially suspected case or cases of plague, cholera, yellow fever, smallpox, typhus, or any other dangerous contagion liable to spread through the intermediary agency of international commerce.

Article 5

This notification is to be accompanied, or very promptly followed, by the following additional information:

1. The area where the disease has appeared.
2. The date of its appearance, its origin, and its form.
3. The probable source or country from which introduced and manner of introduction.
4. The number of confirmed cases, and number of deaths.
5. The number of suspected cases and deaths.
6. In addition, for plague, the existence among rodents of plague, or of an unusual mortality among rodents; for yellow fever, the Aedes aegypti index of the locality.
7. The measures which have been applied for the prevention of the spread of the disease, and its eradication.

Article 6

The notification and information prescribed in Articles 4 and 5 are to be addressed to diplomatic or consular representatives in the capital of the infected country, and to the Pan American Sanitary Bureau at Washington, which shall immediately transmit the information to all countries concerned.

Article 7

The notification and the information prescribed in Articles 3, 4, 5, and 6 are to be followed by further communications in order to keep other Governments informed as to the progress of the disease or diseases. These communications will be made at least once weekly, and will be as complete as possible, indicating in detail the measures employed to prevent the extension of the disease. The telegraph, the cable, and the radio will be employed for this purpose, except in those stances in which the data may be transmitted rapidly by mail. Reports by telegraph, cable, or radio will be confirmed by letter. Neighboring countries will endeavor to make special arrangements for the solution of local problems that do not involve widespread international interest.

Article 8

The signatory Governments agree that in the event of the appearance of any of the following diseases, namely: cholera, yellow fever, plague, typhus fever, or other pestilential diseases in severe epidemic form, in their territory, they will immediately put in force appropriate sanitary measures for the prevention of the international carriage of any of the said diseases therefrom by passengers, crew, cargo, and vessels, and mosquitoes, rats; and vermin that may be carried thereon, and will promptly notify each of the other signatory Governments and the Pan American Sanitary Bureau as to the nature and extent of the sanitary measures which they have applied for the accomplishment of the requirements of this article.

Article 9

Information of the first non-imported case of plague, cholera, or yellow fever justifies the application of sanitary measures against an area where said disease may have appeared.

Article 10

The Government of each country obligates itself to publish immediately the preventive measures which will be considered necessary to be taken by vessels or other means of transport, passengers, and crew at any port of departure or place located in the infected area. The said publication is to be communicated at once to the accredited diplomatic or consular representatives or the infected country, and to the Pan American Sanitary Bureau. The signatory Governments also obligate themselves to make known in the same manner the revocation of these measures, or of modifications thereof that may be made.

Article 11

In order that an area may be considered to be no longer infected, it must be officially established:

1. That there has neither been a death nor a new case as regards plague or cholera for 10 days; and as regards yellow fever for 20 days, either since the isolation, or since the death or recovery of the last patient.
2. That all means for the eradication of the disease have been applied and, in the case of plague, that effective measures against rats have been continuously carried out, and that the disease has not been discovered among them within six months; in the case of yellow fever, that the Aedes aegypti index of the infected area has been maintained at an average of not more than 2 percent for the 30-day period immediately preceding, and that no portion of the infected area has had an index in excess of 5 percent for the same period of time.

Article 12

The international classification of the causes of death is adopted as the Pan American Classification of the Causes of Death, and shall be used by the signatory nations in the interchange of mortality and morbidity reports.

Article 13

The Pan American Sanitary Bureau is hereby authorized and directed to re-publish from time to time the Pan American Classification of the Causes of Death.

Article 14

Each of the signatory Governments agrees to put in operation, at the earliest practical date, a system for the collection and tabulation of vital statistics which shall include:

1. A central statistical office presided over by a competent official.
2. The establishment of regional statistical offices.
3. The enactment of laws, decrees, or regulations requiring the prompt reporting of births, deaths, and communicable diseases, by health officers, physicians, midwives, and hospitals, and providing penalties for failure to make such reports.

Article 15

The Pan American Sanitary Bureau shall prepare and publish standard forms for the reporting of deaths and cases of communicable disease, and all other vital statistics.

Article 16

The master of any vessel or aircraft which proceeds to a port of any of the signatory Governments is required to obtain at the port of departure and ports of call, a bill of health, in duplicate, issued in accordance with the information set forth in the appendix and adopted as the standard bill of health.

Article 17

The bill of health will be accompanied by a list of the passengers, and stowaways if any, which shall indicate the port where they embarked and the port to which they are destined, and a list of the crew.

Article 18

Consuls and other officials signing or countersigning bills of health should keep themselves accurately informed with respect to the sanitary conditions of the ports, and the manner in which this code is obeyed by vessels and their passengers and crews while therein. They should have accurate knowledge of local mortality and morbidity, and of sanitary conditions which may affect vessels in port. To this end, they shall be furnished with information they request pertaining to sanitary records, harbors, and vessels.

Article 19

The signatory Governments may assign medical or sanitary officers as public health attaches to embassies or legations, and as representatives to international conferences.

Article 20

If at the port of departure there is no consul or consular agent of the country of destination, the bill of health may be issued by the consul or consular agent of a friendly Government authorized to issue such bill of health.

Article 21

The bill of health should be issued not to exceed 48 hours before the departure of the ship to which it is issued. The sanitary visa should not be given more than 24 hours before departure.

Article 22

Any erasure or alteration of a bill of health shall invalidate the document, unless such alteration or erasure shall be made by competent authority, and notation thereof appropriately made.

Article 23

A clean bill of health is one which shows the complete absence in the port of departure of cholera, yellow fever, plague, typhus fever, or of other pestilential disease in severe epidemic form, liable to be transported by international commerce. Provided that the presence only of bona fide imported cases of such disease, when properly isolated, shall not compel the issuance of a foul bill of health, but notation of the presence of such cases will be made under the heading of "Remarks" on the bill of health.

Article 24

A foul bill of health is one which shows the presence of non-imported cases of any of the diseases referred to in Article 23.

Article 25

Specific bills of health are not required of vessels which, by reason of accident, storm or other emergency condition, including wireless change of itinerary, are obliged to put into ports other than their original destinations, but such vessels shall be required to exhibit such bills of health as they possess

Article 26

It shall be the duty of the Pan American Sanitary Bureau to publish appropriate information which may be distributed by port health officers, for the purpose of instructing owners, agents, and masters of vessels as to the methods which should be put in force by them for the prevention of the international spread of disease.

Article 27

Every vessel, carrying a medical officer will maintain a sanitary log which will be kept by him, and he will record therein daily: the sanitary condition of the vessel, and its passengers and crew; a record showing the names of passengers and crew which have been vaccinated by him; name, age, nationality, home address, occupation and nature of illness or injury of all passengers and crew treated during the voyage; the source and sanitary quality of the drinking water of the vessel, the place where taken on board, and the method in use on board for its purification; sanitary conditions observed in ports visited during the voyage; the measures taken to prevent the ingress and egress of rodents to and from the vessel; and the measures which have been taken to protect the passengers and crew against mosquitoes, other insects, and vermin. The sanitary log will be signed by the master and medical officer of the vessel, and will be exhibited upon the request of any sanitary or consular officer. In the absence of a medical officer, the master shall record the above information in the log of the vessel, in so far as possible.

Article 28

Equal or similar forms for Quarantine Declarations, Certificates of Fumigation, and Certificates of Vaccination, set forth in the appendix, are hereby adopted as standard forms.

Article 29

An infected port is one in which any of the following diseases exist, namely, plague, cholera, yellow fever, or other pestilential disease in severe epidemic form.

Article 30

A suspected port, is a port in which, or in the areas contiguous thereto, a non-imported case or cases of any of the diseases referred to in Article 23, have occurred within 60 days, or which has not taken adequate measures to protect itself against such diseases, but which is not known to be an infected port.

Article 31

A clean port, Class A, is one in which the following conditions are fulfilled:

1. The absence of non-imported cases of any of the diseases referred to in Article 23, in the port itself and in the areas contiguous thereto.
2. (a) The presence of a qualified and adequate health staff.
(b) Adequate means of fumigation.
(c) Adequate personnel and material for the capture or destruction of rodents.
(d) An adequate bacteriological and pathological laboratory.
(e) A safe water supply.
(f) Adequate means for the collection of mortality and morbidity data.
(g) Adequate facilities for the isolation of suspects and the treatment of infectious diseases.

Signatory Governments shall register in the Pan American Sanitary Bureau those places that comply with these conditions.

Article 32

A clean port, Class B, is one in which the conditions described in Article 31, 1 and 2 (a) above, are fulfilled, but in which one or more of the other requirements of Article 31, 2, are not fulfilled.

Article 33

An unclassified port is one with regard to which the information concerning the existence or non-existence of any of the diseases referred to in Article 23, and the measures which are being applied for the control of such diseases, is not sufficient to classify such port.
An unclassified port shall be provisionally considered as a suspected or infected port, as the information available in each case may determine, until definitely classified.

Article 34

The Pan American Sanitary Bureau shall prepare and publish, at intervals, a tabulation of the most commonly used ports of the Western Hemisphere, giving information as to their sanitary conditions.

Article 35

A clean vessel is one coming from a clean port, Class A or B, which has had no case of plague, cholera, yellow fever, smallpox, or typhus aboard during the voyage, and which has complied with requirements of this code.

Article 36

An infected or suspected vessel is:

1. One which has had on board during the voyage a case or cases of any of the diseases mentioned in Article 35.
2. One which is from an infected or suspected port.
3. One which is from a port where plague or yellow fever exists.
4. Any vessel on which there has been mortality among rats.
5. A vessel which has violated any of the provisions of this code.

Article 37

Any master or owner of any vessel, or any person violating any provisions of this Code or violating any rule or regulation made in accordance with this Code, relating to the inspection of vessels, the entry or departure from any quarantine station, grounds or anchorages, or trespass thereon, or to the prevention of the introduction of contagious or infectious disease into any of the signatory countries, or any master, owner, or agent of a vessel making a false statement relative to the sanitary condition of a vessel, or its contents, or as to the health of any passenger, or persons thereon, or who interferes with a quarantine or health officer in the proper discharge of his duty, or fails or refuses to present bills of health, or other sanitary documents, or pertinent information to a quarantine or health officer, shall be punished in accordance with the provisions of such laws, rules, or regulations, as may be or may have been enacted, or promulgated, in accordance with the provisions of this Code, by the Government of the country within whose jurisdiction the offense is committed.

Article 38

Clean vessels will be granted pratique by the port health authority upon acceptable evidence that they properly fulfill the requirements of Article 35.

Article 39

Suspected vessels will be subjected to necessary sanitary measures to determine their actual condition.

Article 40

Vessels infected with any of the diseases referred to in Article 23 shall be subjected to such sanitary measures as will prevent the continuance thereon, and the spread therefrom, of any of said diseases to other vessels or ports. The disinfection of cargo, stores, and personal effects shall be limited to the destruction of the vectors of disease which may be contained therein, provided that things which have been freshly soiled with human excretions capable of transmitting disease, shall always be disinfected. Vessels on which there is undue prevalence of rats, mosquitoes, lice, or any other potential vectors of communicable disease, may be disinfected irrespective of the classification of the vessel.

Article 41

Vessels infected with plague shall be subjected to the following treatment:

1. The vessel shall be held for observation and necessary treatment.
2. The sick, if any, shall be removed and placed under appropriate treatment in isolation.
3. The vessel shall be simultaneously fumigated throughout for the destruction of rats. In order to render fumigation more effective, cargo may be wholly or partially discharged prior to such fumigations but care will be taken to discharge no cargo which might harbor rats except for fumigation.
4. All rats recovered after fumigation should be examined bacteriologically.
5. Healthy contacts, except those actually exposed to cases of pneumonic plague, will not be detained in quarantine.
6. The vessel will not be granted pratique until it is reasonably certain that it is free from rats and vermin.

Article 42

Vessels infected with cholera shall be subjected to the following treatment:

1. The vessels shall be held for observation and necessary treatment.
2. The sick, if any, shall be removed and placed under appropriate treatment in isolation.
3. All persons on board shall be subjected to bacteriological examination, and shall not be admitted to entry until demonstrated free from cholera vibrios.
4. Appropriate disinfection shall be performed.

Article 43

Vessels infected with yellow fever shall be subjected to the following treatment:

1. The vessel shall be held for observation and necessary treatment.
2. The sick, if any, shall be removed and placed under appropriate treatment in isolation from Aedes aegypti mosquitoes.
3. All persons on board not immune to yellow fever shall be placed under observation to complete six days from the last possible exposure to Aedes aegypti mosquitoes.
4. The vessel shall be freed from Aedes aegypti mosquitoes.

Article 44

Vessels infected with smallpox shall be subjected to the following treatment:

1. The vessels shall be held for observation and necessary treatment.
2. The sick, if any, shall be removed and placed under appropriate treatment in isolation.
3. All persons on board shall be vaccinated. As an option the passenger may elect to undergo isolation to complete 14 days from the last possible exposure to the disease.
4. All living quarters of the vessels shall be rendered mechanically clean, and used clothing and bedding of the patient disinfected.

Article 45

Vessels infected with typhus shall be subjected to the following treatment:

1. The vessel shall be held for observation and necessary treatment.
2. The sick, if any, shall be removed and placed under appropriate treatment in isolation from lice.
3. All persons on board and their personal effects shall be deloused.
4. All persons on board who have been exposed to the infection shall be placed under observation to complete 12 days from the last possible exposure to the infection.
5. The vessel shall be deloused.

Article 46

The time of detention of vessels for inspection or treatment shall be the least consistent with public safety and scientific knowledge. It is the duty of port health officers to facilitate the speedy movement of vessels to the utmost compatible with the foregoing.

Article 47

The power and authority of quarantine will not be utilized for financial gain, and no charges for quarantine services will exceed actual cost plus a reasonable surcharge for administrative expenses and fluctuations in the market prices of materials used.

Article 48

Sulphur dioxide, hydrocyanic acid, and cyanogen chloride gas mixture shall be considered as standard fumigants when used in accordance with the table set forth in the appendix, as regards hours of exposure and of quantities of fumigants per 1,000 cubic feet.

Article 49

Fumigation of ships to be most effective should be performed periodically and preferably at six-month intervals, and should include the entire vessel and its lifeboats. The vessels should be free of cargo.

Article 50

Before the liberation of hydrogen cyanide or cyanogen chloride, all personnel of the vessel will be removed, and care will be observed that all compartments are rendered as nearly gas tight as possible.

Article 51

In order to better protect the health of travelers by sea, to aid in the prevention of the international spread of disease and to facilitate the movement of international commerce and communication, the signatory Governments are authorized in their discretion to license physicians employed on vessels.

Article 52

It is recommended that license not issue unless the applicant therefor is a graduate in medicine from a duly chartered and recognized school of medicine, is the holder of an unrepealed license to practice medicine, and has successfully passed an examination as to his moral and mental fitness to be the surgeon or medical officer of a vessel. Said examination shall be set by the directing head of the national health service, and shall require of the applicant a competent knowledge of medicine and surgery. Said directing head of the national health service may issue a license to an applicant who successfully passes the examination, and may revoke said license upon conviction of malpractice, unprofessional conduct, offenses involving moral turpitude or infraction of any of the sanitary laws or regulations of any of the signatory Governments based upon the provisions of this code.

Article 53

When duly licensed as aforesaid, said surgeons or medical officers of vessels may be utilized in aid of inspection as defined in this code.

Article 54

The organization, functions, and duties of the Pan American Sanitary Bureau shall include those heretofore determined for the International Sanitary Bureau by the various International Sanitary and other Conferences of American Republics, and such additional administrative function and duties as may be hereafter determined by Pan American Sanitary Conferences.

Article 55

The Pan American Sanitary Bureau shall be the central coordinating sanitary agency of the various member Republics of the Pan American Union, and the general collection and distribution center of sanitary information to and from said Republics. For this purpose it shall, from time to time, designate representatives to visit and confer with the sanitary authorities of the various signatory Governments on public health matters, and such representatives shall be given all available sanitary information in the countries visited by them in the course of their official visits and conferences.

Article 56

In addition, the Pan American Sanitary Bureau shall perform the following specific functions:

To supply to the sanitary authorities of the signatory Governments through its publications, or in other appropriate manner, all available information relative to the actual status of the communicable diseases of man, new invasions of such diseases, the sanitary measures undertaken, and the progress effected in the control or eradication of such diseases; new methods for combating disease; morbidity and mortality statistics; public health organization and administration; progress in any of the branches of preventive medicine, and other pertinent information relative to sanitation and public health in any of its phases, including a bibliography of books and periodicals on public hygiene.

In order to more efficiently discharge its functions, it may undertake cooperative epidemiological and other studies; may employ at headquarters and elsewhere, experts for this purpose; may stimulate and facilitate scientific researches and the practical application of the results therefrom; and may accept gifts, benefactions, and bequests, which shall be accounted for in the manner now provided for the maintenance funds of the Bureau.

Article 57

The Pan American Sanitary Bureau shall advise and consult with the sanitary authorities of the various signatory Governments relative to public health problems, and the manner of interpreting and applying the provisions of this Code.

Article 58

Officials of the National Health Services may be designated as representatives, ex-officio, of the Pan American Sanitary Bureau, in addition to their regular duties, and when so designated they may be empowered to act as sanitary representatives of one or more of the signatory Governments when properly designated and accredited to so serve.

Article 59

Upon request of the Sanitary authorities of any of the signatory Governments, the Pan American Sanitary Bureau is authorized to take the necessary preparatory steps to bring about an exchange of professors, medical and health officers, experts or advisers in public health of any of the sanitary sciences, for the purpose of mutual aid and advancement in the protection of the public health of the signatory Governments.

Article 60

For the purpose of discharging the functions and duties imposed upon the Pan American Sanitary Bureau, a fund of not less than US$ 50,000 shall be collected by the Pan American Union, apportioned among the signatory Governments on the same basis as are the expenses of the Pan American Union.

Article 61

The provisions of this Convention shall apply to aircraft, and the signatory Governments agree to designate landing places for aircraft which shall have the same status as quarantine anchorages.

Article 62

The provisions of Articles 5, 6, 13, 14, 15, 16, 17, 18, 25, 30, 32, 33, 34, 37, 38, 39, 40, 41, 42, 43, 44, 45, 50, of the Pan American Sanitary Convention concluded in Washington on October 14, 1905, are hereby continued in full force and effect, except in so far as they may be in conflict with the provisions of this Convention.

Be it understood that this Code does not in any way abrogate or impair the validity or force of any existing treaty, convention, or agreement between any of the signatory Governments and any other Government.

Article 63

The Governments which may not have signed the present Convention are to be admitted to adherence thereto upon demand, notice of this adherence to be given through diplomatic channels to the Government of the Republic of Cuba.

Made and signed in the city of Havana, on the 14th day of the month of November, 1924, in two copies, in English and Spanish, respectively, which shall be deposited with the Department of Foreign Relations of the Republic of Cuba, in order that certified copies thereof, in both English and Spanish, may be made for transmission through diplomatic channels to each of the signatory Governments.