PAN AMERICAN SANITARY BUREAUPublication No. 193 March, 1943

THEPAN AMERICAN SANITARY CODE

INTERNATIONAL SANITARY CONVENTION

SIGNED AT HABANA, CUBA

NOVEMBER 14, 1924

WASHINGTON, D. C.

U. S. A.

FUNCIONARIOSDE LA

OFICINA SANITARIA PANAMERICANA

(OFFICERS OF TEIE PAN AMERICAN SANITARY BUREAU)

DIRECTOR

DR. HUGH S. CUMMINGSurgeon General (Retirad), U. S. Public Heal¿k Sergice

VICEDIRECTORDR. JORGE BEJARANO

Colombia

CONSEJEROS (COUNSELORS)

DR. VICTOR ARNOLDO SUTTER

El Salvador

DR. ENRIQUE CLAVEAUXUruguay

DIRECTOR AUXILIAR (ASSISTANT DIRECTOR)DR. EDWARD C. ERNST

Seicio ds Sanidad Pdblica dc los Estadoa Unidos

SECRETARIO (SECRETARY)DR. ARiSTIDES A. MOLL

R~dactor Cintifico, Boletín de la Oficina Sanitaria Panamricoana

VOCALES (MEMBERS)Representantes designados por las siguientes RIteplicas:

PARAGUAYHAITI BOLIVIAHONDURAS RIEPÚBI.ICA DOM3INIC.AN.\GUATEMALA PANAMÁ

MIEMBROS DE HONOR (HONORARY MEMBERS)Dit. Jo.io DE BARROS BARRETO, Presidente de Honor

Brasil

DR. CARLOS ENRIQUE PAZ SOLDÁNPeni

DR. MANUEL MARTiNEZ BÁEZMézico

COMISIONADOS VIAJEROS(TRAVELING REPRESENTATIVSB)

DR. JOHN D. LONGDR. JOHN R. MURDOCEDR. ANTHONY DONOVANDB. VERNON W. FOSTERDR. JOSEPH S. SPOTO

INGENIEROS SANITARIOS(SANITARY ENGINEERS)

SR. EDWARD D. HOPKINSSR. WALTER N. DASHIELL

ENFERMERAS (NURSES)

SRTA. KIATHLEEN LOGANSRTA. ANNE B. CACIOPPOSRTA. DOROTHY M. FOLEYSRTA. HELEN HOWITTSRTA. JOHANNA J. SCHWARTESRTA. MARTHA P. CATTELAINSRTA. ELLEN LORETTA ANDERSONSRTA. MARY E. STEHMANSRTA. AGNES ZACHARIOU

-a

THE PAN AMERICAN SANITARY CODEINTERNATIONAL SANITARY CONVgNTION SIGNED AT HABANA, CUBA. NOVEMBEB

14. 1924 1

The PreSidents of Argentina, Brazil, Chile, Colombia, Costa Rida,Cuba, Dominican Republic, Guatemala, Haiti, Honduras, Mexico,Salvador, Panama, Paraguay, Peru, United States of America,Uruguay, and Venezuela, being desirous of entering iinto a sanitaryconvention for the purpose of better promoting apd protecting thepublic health of their respective nations, and particularly to the endthat effective cooperative international measures may be applied forthe prevention of the international spread of the communicable in-fections of human beings and to facilitate international commerceand communication, have appointed as their plenipotentiaries, to wit:

The Republic of Argentina:Dr. Gregorio Araoz Alfaro.Dr. Joaquin Llambias.

The United States of Brazil:Dr. Nascimento Gurgel.Dr. Raúl Almeida Magalhaes.

The Republic of Chile:Dr. Carlos Graf.

The Republic of Colombia:Dr. R. Gutiérrez Lee.

The Republic of Costa Rica:Dr. José Varela Zequeira.

The Republic of Cuba:Dr. Mario G. Lebredo.Dr. José A. López del Valle.Dr. Hugo Roberts.Dr. Diego Tamayo.Dr. Francisco M. Fernández.Dr. Domingo F. Ramoa

The Republic of El Salvador:Dr. Leopoldo Paz.

PAN AMERICAN SASI'TARY CODE

The United States of America:Dr. Hlugh S. Cunirmming.Dr. Richard Creel.Mr. P. D. Cronin.Dr. Francis D. Patterson.

The Republic of Guatemala:Dr. José de Cubas y Serrate.

The Republic of Haiti:Dr. Charles Mathon.

The Republic of Hondiuras:Dr. Arístides Agraminonte.

The Republic of Mexico:I)r. Alfonso Pruneda.

The Republic of Pannama,:Dr. Jaime (e lade Guardia.

The Republic of Paragua.y:Dr. Andrés Gubetich.

The Republic of Peru:Dr. Carlos E. Paz Soldán.

The Dominican RIepublic:D)r. BI. Pérez Cabral.

Tlie Republic of V lrguiy:1 )r. Justo F1. G(inz;ltz.

I'lit t-nited SI :tes gtf Venezuela:!)i. EIIXiIle'l iejesa.

IVio havting l cl:ange tlheir fuill powers, found ini good and dueforn-. hxase agreed to adolpt, ad referendulir, the followiing

PaN AMERICAN SANITARY CODE

CHAP1 ER I. Objects of th/e Codc and Deflitiorns of Terms usedThere ;iARTICLE 1. The objects of this code are:(a) The prevention of the international spread of communicable

infections of human beings.(b) The promotion of cooperative lVeastres for the prevention of

the introduction and spread of disease into and from the territoriesof the signatory Governments.

(c) Thle standardization of the collection of morbidity aud mor-tality statistics'by the signatory Governmednts.

(d) Tlie stimulation of the mutual in terchange of information-whiclh may be of value in improving the public health and combat-ing tlie diseases of man.

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PAN AMERICAS SANITARY CODE

(e) The standardization of the measures employed at places ofentry for the prevention of the introduction and spread of the com-municable diseases of man, so that greater protection against themshall be achieved and unnecessary hindrance to international com.merce and communication eliminated.

ART. 2. Definitions: As herein used, the following words andphrases shall be taken in the sense hereinbelow indicated, except as adifferent meaning for the word or phrase in question may be givenin a particular article, or is plainly to be collected from the context orconnection where the term is used.

Aircraft: Any vehicle which is capable of transporting persons orthings through the air, including aeroplanes, seaplanes, gliders, heli-copters, airships, 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 thegorganisms of disease

or their potential carriers are exposed to a gas in lethal concentrations.Index, Aedes aegypti: The percentage ratio determined after ex-

amination between the number of houses in a given area and thenumber in which larvw or mosquitoes of the Aédes aegypti are foundin a fixed period of time.

Inspection: The act of examining persons, buildings, areas, orthings which may be capable of harboring, transmitting, or trans-porting the infectious agents of disease, or of propagating or favor-ing the propagation of such agents. Also the act of studying andobserving measures put in force for the suppression or preventionof disease.

Incubation, period of: For plague, cholera, and yellow fever, each6 days; for smallpox, 14 days; and for typhus fever, 12 days.

Isolation: The separation of human beings or animals from otlherhuman beings or animals in such manner as to prevent the inter-change 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.

CHAPTER II

SECTION 1. NOTIFICATION AND SUBSEQUENT COIMMUNICATIONS TO

OTHER COUNTRIES

ART. 3. Each of the signatory Governments agrees to transmit toeach of the other signatory Goverinments and to the Pan American

PAN AMEBRIOAN SANITARY CODE

Sanitary Bureau, at intervals of not more than two weeks, a state-ment containing information as to the state of its publie health,particularly that of its ports.

The following diseases are obligatorily reportable:Plague, cholera, yellow fever, smallpox, typhus, epidemic cerebro-

spinal meningitis, acute epidemic poliomyelitis, epidemic lethargicencephalitis, influenza or epidemic la grippe, typhoid and paraty-phoid fevers, and such other diseases as the Pan American SanitaryBureau may by resolution add to the above list.

ART. 4. Each signatory government agrees to notify adjacentcountries and the Pan American Sanitary Bureau immediately bythe most rapid available means of communication, of the appearancein its territory of an authentic or officially suspected case or cases ofplague, cholera, yellow fever, smallpox, typhus, or any other danger-ous contagion liable to be spread through the intermediary agency ofinternational commerce. **

ART. 5. This notification is to be accompanied or very promptlyfollowed 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, theAedes aegypti index of the locality.

7. The measures which have been applied for the prevention of thespread of the disease and its eradication.

ART. 6. The notification and information prescribed in articles 4and 5 are to be addressed to diplomatic or consular representativesin the capital of the infected country, and to the Pan American Sani-tary Bureau at Washington, which shall immediately transmit theinformation to all countries concerned.

ART. 7. The notification and the information prescribed in articles3, 4, 5, and 6 are to be followed by further communications in orderto keep other Governments informed as to the progress of the diseaseor diseases. These communications will be made at least once weeklyand will be as complete as possible. indicating in detail the measuresemployed to prevent the extension of the disease. The telegraph, thecable, and the radio will be employed for this purpose, except in thoseinstances 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

* The notification of cases of the diseases referred to in Article IV of the Pan AmericanSanitary Code should be considered as an obligation applying only to the first case or casesappearing in a country which previously has been regarded as free from these diseases.(lnterpretation, Eighth Pan American Sanitary Conference).

** By dangerous contagion isa understood all diseases of an epidemie character. and theobligation to notify "adjacent countries" means all of the American Republics. (Interpreta-tion, Eighth Pan American Sanitary Conference).

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PAN AMERICAN SANITARY CQ)E 5for the solution of local problems that do not involve widespreadinternational interest.

ART. 8. The signatory Governments agree that in the event of theappearance of any of the following.diseases, namely, cholera, yellowfever, plague, typhus fever, or other pestilential diseases in severeepidemic form in their territory they will immediately put in forceappropriate sanitary measures for the prevention of the internationalcarriage of any of the said diseases therefrom by passengers, crew,cargo, and vessels, and mosquitoes, rats, and vermin that may b~carried thereon, and will promptly notify each of the other signatoryGovernments and the Pan American Sanitary Bureau as to the natureand extent of the sanitary measures which they have applied for theaccomplishment of the requirements of this article.

SECTION 2. PUBLICATION OF PRESCRIBED MEASURES

ART. 9. Information of the first nonimported case of plague, chol-era, or yellow fever justifies the application of sanitapry measuresagainst an area where said disease may have appeared. *

ART. 10. The Government of each country obligates itself to pub-lish immediately the preventive measures which will be considerednecessary to be taken by vessels or other means of transport, pas-sengers, and crew at any port of departure or place located in theinfected'area. The said publication is to be communicated at onceto the accredited diplomatic or consular representatives of the in-fected country and to the Pan American Sanitary Bureau. Thesignatory Governments also obligate themselves to make known inthe same manner the revocation of these measures or modificationsthereof that may be made.

ART. 11. In order that an area may be considered to be no longerinfected, it must be officially established: ' *

1. That there has neither been a death nor a new case as regardsplague 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 lastpatient.

2. That all means for the eradication of the disease have beenapplied and, in the case of plague, that effective measures againstrats have been continuously carried out and that the disease hasnot been discovered among them within six months; in the caseof yellow fever, that Aedes aegypti index of the infected area hasbeen maintained at an average of not more than 2 per cent for the30-day period immediately preceding, and tliat no portion of theinfected area has had an index in excess of 5 per cent for the sameperiod of tirme.

* The measures referred to are to be applied to vessels from the infected area. (Inter-pretation, Eighth Pan American Sanitary Conference).

** This article refers to the scientific definition of an infected area. (Interpretation,Eighth Pan American Sanitary Conference).

6 PAN AMERICAN SANITARY CODE

SECTION 3. MORBIDITY AND MORTALITY STATISTICS

ART. 12. The International Classification of the Causes of Deathis adopted as the Pan American Classification of the Causes of Death,and shall be used by the signatory nations in the interchange ofmortality and morbidity reports.

ART. 13. The Pan American Sanitary Bureau is hereby authorizedand directed to republish from time to time the Pan AmericanClassification of the Causes of Death.

ART. 14. Each of the signatory Governments agrees to put inoperation at the earliest practicable date a system for the collectionand 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 byhealth officers, physicians, midwives, and hospitals, and providingpenalties for failure to make such reports.

ART. 15. The Pan American Sanitary Bureau shall prepare andpublish standard forms for the reporting of deaths and cases ofcommunicable disease and all other vital statistics.

CHAPTER III. Sanitary Documents

SECTION 1. BILLS OF HEALTH

ART. 16. The master of any vessel or aircraft which proceeds toa port of any of the signatory Governments is required to obtainat the port of departure and ports of call a bill of health, in duplicate,`'issued in accordance with the information set forth in the appendixand adopted as the standard bill of health. *

ART. 17. The bill of health will be accompanied by a list of thepassengers, and stowaways if any, which shall indicate the portwhere they embarked and the port to which they are destined, anda list of the crew.

ART. 18. Consuls and other officials signing or countersigningbills of health should keep themselves accurately informed withrespect to the sanitary conditions of their ports and the manner inwhich this code is obeyed by vessels and their passengers and crewswhile therein. They should have accurate knowledge of localmortality and morbidity and of sanitary conditions Which mayaffect vessels in port. To this end, they shall be furnished withinformation they request pertaining to sanitary records, harbors,and vessels.

* In view of special conditions attendant upon international aerial navigation the masteror other person in command or in charge of any aircraft shall be considered as having com-plied with Article XVI of the Pan American Sanitary Code when he has entered in his journey-log-book the essential sanitary information outlined in the model form of Bill of Healthcontained in the appendix of the Pan American Sanitary Code. (Interpretation, Ninth PanAmerican Sanitary Conference).

*" See page 19.

PAN AMERICAN SANITARY CODE

ART. 19. The signatory Governments may assign medical orsanitary officers as public health attachés to embassies or legationsand as representatives to international conferences.

ART. 20. If at the port of departure there be no c~nsul or consularagent of the country of destination, the bill of health may be issuedby the consul or consular agent of a friendly Government authorizedto issue such bill of health.

ART. 21. The bill of health should be issued not to exceed 48 hoursbefore the departure of the ship to which it is issued. The sanitaryvisa should not be given more than 24 hours before departure.

ART. 22. Any erasure or alteration of a bill of health shall invali-date the document, unless such alteration or erasure shall be madeby competent authority and notation thereof appropriately made.

ART. 23. A clean bill of health is one which shows the completeabsence in the port of departure of cholera, yellow fever, plague,typhus fever, or of other pestilential disease in severe epidemic formliable to be transported by international commerce. Provided, thatthe presence only of bona fide imported cases of such disease, whenproperly isolated, shall not compel the issuance of a foul bill ofhealth, but notation of the presence of such cases will be made underthe heading of " Remarks " on the bill of health.

ART. 24. A foul' bill of health is one which shows the presence ofnonimported cases of any of the diseases referred to in article 23.

ART. 25. Specific bills of health are not required of vessels which,by reason of accident, storm, or other emergency condition, includingwireless change of itinerary, are obliged to put into ports other thantheir original destinations, but such vessels shall be required to ex-hibit such bills of health as they possess.

ART. 26. It shall be the duty of the Pan American Sanitary Bu-reau to publish appropriate information which may be distributedby port health officers for the purpose of instructing owners, agents,and masters of vessels as to the methods which should be put in forceby them for the prevention of the international spread of disease.

SECTION 2. OTHER SANITARY DOCUMENTS

Awr. 27. Every vessel carrying a medical officer will maintain asanitary log, which will be kept by him, and he will record thereindaily: The sanitary condition of the vessel and its passengers andcrew; a record showing the names of passengers and crew whichhave been vaccinated by him; name, age, nationality, home address,occupation, and nature of illness or injury of all passengers and crewtreated during the voyage; the source and sanitary quality of thedrinking water of the vessel, the place where taken on board, andthe method in use ón, board for its purification; sanitary conditionsobserved in ports visited during the voyage; the measures taken to

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8 PAN AMERICAN SANITARY CODE

prevent the ingress and egress of rodents to and from the vessel;the measures which have been taken to protect the passengers andcrew against mosquitoes, other insects, and vermin. The sanitarylog will be signed by the master and medical officer of the vessel, andwill be exhibited upon the request of any sanitary or consular officer.In the absence of a medical officer, the master shall record the aboveinformation in the log of the vessel, in so far as possible.

ART. 28. Equal or similar forms for quarantine declarations, cer-tificate of fumigation, and certificate of vaccination set forth in theappendix are hereby adopted as standard forms.

CHAPTER IV. Classi#Cation, of Ports

ART. 29. An infected port is one in which any of the followingdiseases exist, namely: Plague, cholera, yellow fever, or other pesti-lential disease in severe epidemic form. *

ART. 30. A suspected port is a port in which, or in the areas con-tiguous thereto, a nonimported case or cases of any of the diseasesreferred to in article 23 have occured within 60 days or which hasnot taken adequate measures to protect itself against such diseases,but which is not known to be an infected port. i ,

ART. 31. A clean port, Class A, is one in which the following con-ditions are fulfilled:

1. The absence of nonimported cases of any of the diseases referredto 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 destruc-

tion of rodents.(d) An adequate bacteriological and pathological laboratory.(e) A safe water supply.(f) Adequate means for the collection of mortality and mor-

bidity data.(g) Adequate facilities' for the isolation of suspectp and the treat-

ment of infectious diseases.(h) Signatory Governmnents shall register in the Pan American

Sanitary Bureau those places that comnply with these conditions.ART. 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 whichone or more of the other requirements of article 31, 2, are not fulfilled.

ART. 33. An unclassified port is one with regard to which the infor-mation concerning the existence or nonexistence of any of the dis-eases referred to in article 23 and the measures which are beingapplied for the control of such disases is not sufficient to classifysuch i)ort.

* By existence of disease will be underatood one or more cases. (Interpretation. EighthPan American Sanitary Conference).

** This article refera to the standard prescribed by the Pan American Sanitary Codewhich the sanitary authorities should follow. (Interpretation, Eighth Pan American SanitaryConference).

PAN AMERIGIN BANITARY 0ODE 9An unclassified port shall be provisionally considered as a suspect.

ed or infected port, as the information available in each case may de-termine, until definitely classified.

ART. 34. The Pan American Sanitary Bureau shall prepare andpublish at intervals a tabulation of the most oommonly used portsof the Western Hemisphere, giving information as to sanitary con-ditions.

CIHAPTER V. Classiflcation of Vessels

AnT. 35. A clean vessel is one coining from a clean port, Class Aor B, which has had no cases of plague, cholera, yellow fever, small-pox, or typhus aboard during the voyage, and which has compliedwith the requireinents of this code. *

ART. 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 niortality among rats.5. A vessel which has violated any of the provisions of this code.Provided that the sanitary authorities should give due considera-

¡ion in applying sanitary measures to a vessel that lhas not docked.ART. 37. Any imaster or owner of any vessel, or any person violat-

ing any provisions of this code or violating any rule or regulationmade in accordance with this code relating to the inspection of vessels,the entry or departure from any quarantine station, grounls, oranchorages, or trespass thereon, or to the prevention of the intro-duction of contagioiis or infectious disease into any of the signatorycountries, or any master, owner or agent of a vessel making a falsestatement relative to the sanitary condition of a vessel, or its con-tents, or as to tlie health of any passenger or person thereon, or whointerferes with a quarantine or health officer in the proper dischargeof his duty or fails or refuses to present bills of health, or other sani-tary document or pertinent information to a quarantiiie or healthofficer, shall be punished in accordance with the provisions of suchlaws, rules, or regulations as imay be or may have been enacted orpromulgated in accordance with the provisions of this code, by theGovernment of the country within whose jurisdiction the offense iscommitted.

CHAPTER VI. The Treatment of Vessels

ART. 38. Clean vessels will be granted pratiqiue by the port healthlauthority upon acceptable evidence that they p)roperly fulfill the re-quiremients of article 35.

* A elean ship is one coming from a elean port of Class A or B, which, during itsvoyage, has not had aboard any case of bubonic plague (including rodent plague), cholera.yellow fever. small>,x. typhus fever. or any other diaease ,f an epidemic character, andwhich vessel has strictly complied with the reiiquiremnents contained in this code. (Interpreta-tion. Eighth Pan American Sanitary Conferencel.

PAN AMERIOAN SANITARY CODE

ART. 39. Suspected vessels will be subjected to necessary sanitarymeasures to determine their actual condition. *

AIT. 40. Vessels infected with any of the dliseases referred to inarticle 23 shall be subjected to such sanit.lry measuires as will pre-vent the continuance thereon and thec spread therefrom of any ofsaid diseases to other vessels or ports. The disinfection of cargo,stores, and personal effects shall be limited to the destruction of thevectors of disease which may be contained thlerein, provided thatthings which have been freshly soiled with huiman excretiotns capableof transmitting disease shall alwavs be disinfected. Vessels on whijchthere is undue prevalence of rats, mosquitoes, lice, or any othierpotential vector of communicable disease may be disinfected irre-spective of the classification of the vessel.

ART. 41. Vessels infected with plague shall be subjected to thefollowing treatment:

1. The vessel shall be held for observation and necessary treatment.2. The sick, if any, shall be removed andt placed uínder appropriate

treatment in isolation.3. Tbe vessel shall be simultaneously fuinigated thr.oughout for

the destruction of rats. In order to render fumigation more effec-tive cargo may be wvholly or partially discharged prior to suchfumigation, but care will be taken to discharge no cargo which mightharbor rats,1 except for fumigation.

4. All rats recovered after fulmigation shotuld be examined bacte-riologically.

5. Healthy contacts, except those actually exposed to cases ofpneumonic plague, will not be detained in quarantine. '* '

6. The vessel will not be granted pratique until it is reasonablycertain that it is free from rats and vermin.

ART. 42. Vessels infected with cholera shall be subjected to thefollowing treatment:

1. The vessel shall be held for observation and necessary treat-ment.

2. The sick, if any, shall be removed and placed lunder appropriatetreatment in isolation.

3. All persons on board shall be subjected to bacteriological exami-nation and shall not be admitted to entry until demonstrated freefrom cholera vibrios.

1 Explanatory footriote.-The nature of tlhe -ods .r nercliandisc likely to bfitbor rats(plague suspiclous cargo), shall, for purpose of this section, be demr.i(l to ( tiho following.namely: Rlce or other grain (exclusive of flllr) ; oil c.ike ini s:lksl: i ais i1 llliula orsacks; goods packed in erates with straNN or similar paeking m:nt',;ial: izo:ttiirg Inbundles; dried vegetables in baskets or c dasi,; dried and salted fish: peanuts In silcks:dry ginger; curios, etc., in fragile cases; copia ;,logse hemiup in bundles; coiled rope Insacking kapok; maize in bags; sea grass in bales; tiles, large pipes, and simitar articlee;and bamboo poles in' budleis.

* Consideration shall be given to the actual conditions found on the vessel in preferenceto conditions at the ports from which the vessel comes. (Interpretation, Eighth Pan AmericanSaRnitary Conferenice).

** There is no objection to the application of the measures which the local sanitaryauthorities may decide upon in each case in view of the special circumstances. (Interpretation,Eighth Pan American Sanitsry Conference).

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PAN AlMtICAN SANITARY GODE

4. Appropriate disinfection shall be performed.ART. 43. Vessels infected with yellow fever shall be subjected to

the following treatment:1. The vessel shall be held for observation and necessary treat-

ment.2. The sick, if any, shall be removed and placed under appropriate

treatment in isolation from Aedes aegypti mosquitoes.8. All persons on board nonimmune to yellow fever shall be ptaced

under observation to complete six days from the last possible expo-sure to Aedes aegypti mosquitoes.

4. The vessel shall be freed from Aedes aegypti mosquitoes.ARr. 44. Vessels infected with smallpox 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. All persons on board shall be vaccinated. As an option the

passengers may elect to undergo isolation to complete 14 days fromthe last pdssible exposure to the disease.

4. All living quarters of the vessels shall be rendered mechanicallycieán and used clothing and bedding of the patient disinfected.

ART. 45. Vessels infected with typhus shall be subjected to thefollowing treatment:

1. The vessel shall be held for observation and necessary 'treat-ment.

2. The sick, if any, shall be removed and placed under appropriatetreatment in isolation from lice.

3. All persons on board and their personal effects shall bedeloused.

4. All persons on board who have been exposed to the infectionshall be placed under observation to complete 12 days from the lastpossible exposure to the infection.

5. The vessel shall be deloused.ART. 46. The time of detention of vessels for inspection or treat-

ment shall be the least- consistent with public safety and scientificknowledge. It is the duty of port health officers to facilitate thespeedy movement of vessels to the utmost compatible with theforegoing.

ART. 47. The power and authority of quarantine will not be util-ized for financial gain, and no charges for quarantine services willexceed actual cost plus a reasonable surcharge fer administrativeexpenses aind fluctuations in the market prices of materials used.

* There is no objection to the application of the measures which the local sanitary au-thorities may decide upon in each case in view of the special circumstances. (Interpretation,Eighth Pan American Sanitary Conference).

1

PAN AMERICAN SANITARY CODE12CHAPrER VII. Funrigtion Standards

ART. 48. Sulphur dioxide, hydrocyanic acid, and cyanogenchloride gas mixture shall be considered as standard fumigantswhen used in accordance with the table set forth in the appendixas regards hours of exposure and of quantities of fumigants per1,000 cubic feet. *

ART. 49. Fumigation of ships to be most effective should beperformed periodically and preferably at six months' intervals,and should include the entire vessel and its lifeboats. The ves-sel should be free of cargo. 4

*

ART. 50. Before the liberation of hydrogen cyanide or cyan-ogen chloride, all personnel of the vessel will be removed, and carewill be observed that all compartments are rendered as nearly gastight as possible.

CIHAPTER VIII. Medical OfflCer8 of Vessels

ART. 51. In order better to protect the health of travelers by sea,to aid in the prevention of the international spread of disease, andto facilitate the movement of international commerce and communi-cation, the signatory Governments are authorized in their discretionto license physicians employed on vessels.

ART. 52. It is recommended that license not issue unless the appali-cant therefor is a graduate in medicine from a duly chartered andrecognized school of medicine, is the holder of an unrepealed licenseto practice medicine, and has successfully passed an examination asto his moral and mental fitness to be the surgeon or medical offlcer ofa vessel. Said examination shall be set by the directing head ofthe national health service and shall require of the applicant a com-petent knowledge of medicine and surgery. Said directing head ofthe national health service may issue a license to an applicant whosuccessfully passes the examination, and may revoke said licenseupon conviction of malpractice, unprofessional conduct, offenses in-volving moral turpitude, or infraction of any of the sanitary lawsor regulations of any of the signatory Governments based upon theprovisions of this code.

ART. 53. When duly licensed as aforesaid, said surgeons or medicalofficers of vessels may be utilized in aid of inspection as defined inthis code.

CHAPTER IX. The Pan American Sanitary Buremu

FUNCTIONS AND DUTIES

-AB. 54. The organization, functions, and duties of the PanAmerican Sanitary Bureau shall include those heretofore deter-

, This does not preclude the use of efficient methods of deratization other than fumigationnor the possibility that a vessel may actually be free from rats: it will therefore be under-s+ooi that among the similar documents referred to in Article XXVIII of the Pan AmeriearSanitary Code may be included certificates of deratization and of exemDtion from deratizationor fumigation, which may be issued in accordance with international forms. .Interpretatlon,Ninth Pan American Sanitary Conference).

· See page 18.

PAN AMERICAN SANITARY CODE 13mined for the International Sanitary Bureau by the various inter-national sanitary and other conferences of American Republics, andsuch additional administrative functions and duties as may be here-after determined by Pan American .sanitary conferences.

ART. 55. The Pan American Sanitary Bureau shall be the centralcoordinating sanitary agency of the various member Republics ofthe Pan American Union and the general collection and distfibutioncenter of sanitary information to and from said Republics. For thispurpose it shall, from time to time, designate representatives to visitand confer with the sanitary authorities of the various signatoryGovernments on public health matters, and such representatives shallbe given all available sanitary information in the countries visitedby them in the course of their official visits and conferences.

ART. 56. In addition, the Pan American Sanitary Bureau shallperform the following specific functions:

To supply to the sanitary authorities of the signatory Govern-ments through its publications, or in other appropriate manner, allavailable information relative to the actual status of the commu-nicable diseases of man, new invasions of such diseases, the sanitaryineasures undertaken, and the progress effected in the control oreradication of such diseases; new methods for combating disease;morbidity and mortality statistic§; public health organization andadlmiinistration; progress in any of the branches of preventive medi-cine; ahd other pertinent information relative to sanitation andpublic health in any of its phases, including a bibliography of booksand periodicals on public hygiene.

In order more efficiently to discharge its functions it may unlder-take cooperative epidemiological and other studies; may emplov atheadquarters and elsewhere experts for this purpose; may stimulateand facilitate' scientific researches and the practical application ofthe results therefrom; and may accept gifts, benefactions, and be-quests, which shall be accounted for in the manner now provided forthe maintenance funds of the Bureau.

ART. 57. The Pan American. Sanitary Bureau shall advise andconsult with the sanitary authorities of the various signatory Gov-ernmnents relative to public health problems and the manner ofinterpreting and applying the provisions of this code.

ART. 58. Officials of the national health services may be desig-nated as representatives, ex officio, of the Pan American SanitaryBureau, in addition to their regular duties, and when so designatedthey may be empowered to act as sanitary representatives of one ormore of the signatory Governnients when properly designated andaceredited so to serve.

ART. 59. Upon request of the sanitary authorities of any of thesignatory Governments, the Pan American Sanitary Bureau is au-

14 PAN AMERPCAN SANITAY CODE

thorized to take the necessary preparatory steps to bring about anexchange of prafessors, medical and health officers, experts or advisersin public health of any of the sanitary sciences, for the purpose ofmutual aid and advancement in the, protection of the public healthof the signatory Governmenis.

ART. 60. For the purpoee of discharging the functions and dutiesimposed upon the Pan American Sanitary Bureau a fund of nrotless than $50,000 shall be colleoted by the Pan American Union,apportioned among the signatory Govertwnents on the saile basis asare the expensesi f tFhei Pan Amnrican Union.

CuA~R X. Aircraft

ART. 61. The provisions of tbis convention shall apply to aircraft,and the signatory 4GoverEments agree to desi;nate landing places foraircraft which shall have the same status as quarantine anchorages.

CEHAPTER XI. Sanitary Convention of Wa.shinrgton

ART. 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, 49, and 50 ofthe Pan American Sanitary Conivention concluded in Washington onOctober 14, 1905, are hereby continued in full force and effect,except in so far as they may be in conflict with the provisions of thisconvention. '

CHAPTER XII

Be it understood that this code does not in any way abrogate orimpair the validity or force of any existing treaty, convention, oragreement between any of the signatory Governments and any otherGovernment.

CHAPTER XIII. Transitory Disposition

ART. 63. The Governments which may not have signed the.presentconvention are to be admitted to adherence thereto upon demand,notice of this adherence to be given through diplomatic channels tothe Government of the Republic of Cuba.

Made and signed in the city of Habana, on the 14th day of themonth of November, 1924, in two copies, in English and Spanish,respectively, which shall be deposited with the Department of For-eign Relations of the Republic of Cuba, in order that certified copiesthereof, in both English and Spanish, may be made for trans-mission through diplomatic channels to each of the signatoryGovernments.

66154-31-2

* See Appendix, page 16.

ADDITIONAL PROTOCOL APPROVED AD REFERENDUM BY 15

THE EIGHTH PAN AMERICAN SANITARY CONFERENCE

The ratification of the Pan American Sanitary Code shall be deposited

in the office of the Secretarv of State of the Republic of Cuba and the

Cubaln (;overnlilet shall comnimnicate these ratifications to the other

si.giato y States. which communication shall constitute exchange of

ratificatinms. The convention shall beconme effective in each of the

signatory States on the date of ratification thereof hv said State. and

shall renlain in force without limitation of time. each one of the

signatorv or adllerent States reserving the right to withdraw from the

convention hv giving in due fori- a \ear's notice in advanice to the

Government of the Republic of Cuba.

16 PAN AMERICAN SANITARY CODE

APPENDIX

TABLE I.-Quantities per 1,000 cubic feet

Sulphur dioxide ydrocyanio acld Cyanogen chioridemixture

Chemicalsmos- B Mos- Mos- Bed-qu Rats Lice qui- Rats Liceetoca ~~bugs bugsbugs

Lbs. Lbs. Lbs. Lbs. Oz. Oz. Oz. OZ . 0x. Oz. OZ. . Oz.Sulpbur -............ .2 3 4 3 ................. ..............Sodium cyanide .......- - - - -.............. 5 10 5 4 8 4Sulpburic acid..- --......-...... 5 10 5 ....... ........Sodium chiorate ..---... ........--.... ..- 2 4 2Rydrochloric scid ..--.. .... .........- ..- --. --... - 2V 17 34 17Water ........ --...... ......... 12 25 12 2 17 34 17

TABLE \II.-Hours of exposureSulpbur dioxide: Hours

Mosquitoes -.....-.........-.... ....... . 1Rats --....................---------------------....-------------------------Liece ..........................-----------------------------------------.. -Bedbugs - ..........---..-....--.......--.

Hydrocyanil acid:Mosquitoes - ------------...................... ..... -------------------------------------------------Rats ....-..-......-.............---------- - --------- aLice -------------------------..................... 2Bedbugs .......................-.. 2

Oyanogen chloride mixture:Mosquitoes ----------------------------------------------------------------- ...... .....................Rats ........-.............................................. 1MLice ....................-------------------------- ................................... 1Bedbugs ------.........-............................................... lH

Serial No.

-.....-.......................... ............... Health Servloe.-................. .... .Quarantine Station -..................---

CERTIFICATE oF VACCINATION AGAINST SMALLPOXName ............................-- Sex ..................Age .........-................ Date of Vaccination.......................Height .....-............... Date of Reaction .............................

Result:Immune Reaction.Vaccinoid.Successful Vaccination.

Signed ............................(Signature) Medical officer in charge.

-..................... ............ . ..... Health Service.

CERTIFICATE Or DIsCHARGE FROM NATIONAL QUABANTINE

-......................... .... Quarantine Station,Port of ........................-...........

, 192I certify that the ....................-........ of -............... , from ................

bound for ...........-..... , has In all respects complied with the quarantine regulations prescribedunder the authority of the laws of -................ , and the Pan American Sanitary Code, and that

(Country)the ve~sel, cargo, crew, and passengers are, to the best of my knowledge and belief, free from quarantinable

diseases or danger of conveylng the same. Said vessel is this date granted{provonalpratique.

1. Rat guards of an accepted design to be placed on all lines leading from the vessels.2. Gangways to be raised at night, or llghted and watched.3. Vessels to be furnigated after discharge of cargo.

Quarantine Oicer.

PAN AMBERWAN SANITARY CODE 17.... ....................-.. . H... Health Service

CERTMICATE 01 FUMIGSTION

(Not to be taken up by port authorities)

Port of .................-...-.................. , 192

This s s to crtify that the ....-........-................m--- ..--............--------. has beenfumigated at this station for the destruction of ..-............... as follows:

Grams or

.Guble Kilos or Gramsor ouncesc a paudity m,,.ao . oIcyanideCaPacty sulphur cyanide sodum

chlorate

Holds 1 ----------------------...................................... Date ............-------------------......2------- -------------------------- Duration of exposure.....3-..-............................... ......-....-..-.-. --.-..... .... - - - --.... . ..........

4-........-.......................-.-....-..-... ..... . .. Evidence of rats before fumi-5------------- ---------- ---------- gation .....

Engine-room and shaft alle........ Rats after fumlgation: living,Bunkers ................-... ......... ......... dead..........Forepeak............................. .........................Forecastle. .-.............. .......... - ...... i Ins'opection made by .....Steerage .......................- - - -Diniug saloon (first cabin) Opened by .....Pantry (first cabin) ..........-............ ....... Dunnage or other protection toGalley------------------ ........ _ rats; how treated prior toSecond cabin ....-.........-............ fumigation...........Second cabin pantry ---.................Provision storeroom ...........Living quarters ..............Staterooms ........ ......-.. .......... ..a..Smoking room ....... ------------..........

Total ................... -......-..- -. . ..............................

Quarantine Oficer.On the reverse side make a report of all compartments which were not fumigated, why they were not,

and give treatment. Also report any other pertinent information.

18 PAND AME~IOA SANITABY CODE

QUARPNT'INv DDCtLABATION

..................................... Quarantine Station......... ,192

Name of vessel ...... ........... ; destination ........-......; nationallty .................rig --.... . -......... -; tonnage .......-...... ; date of arrival ......--........... ; port of departure

-............. . .....; intermediate ports .-..................... ; days from port of departure-.......... . .......; days from last port ...........-.-. ; previous ports of departure and call .....

-......... . ......... .... . ; officers and crew ...-............ ; cabin passengers ......... ; steeragepassengers ..................... -;,total number of persons on board -............-.......... ;cargo .......-.................. ; ballast (tons) ....-..................... ; characterof ......-............... .; soure ................... ....... If waterballast, were tanks filled at the port of departure or at sea? ......................IDu ports of departure and call, did ves~l lie at wharf or at moorings in harbor or roadstead? ....... ...If vessel lay at moorings, how far from snore? .......................Was there communication with the shore? ..-.... ........ What changes in the personnel of the crew, it

- - --.. - - --..- --.--..-..-.--.--.-... . ......................................Sickness, cases of, in port of departure. No .....-..-...........; result.......................

in intermediate ports. No -............ ; result .....................at sea. No ....-...... ; result......................

Were the sick sent to hospital or allowed to remain on board? ..............................Was the bedding and clothing of those sick at sea frequently aired and washed? ..................Do you know of any circumstances afecting the health of the crew, or which render the ship dangerous to

the health of any port of .- If......-....-...............-.... ... If so, state them............(Country)

I certify that the foregoing statements, and the answers to the questions, are true to the best of my knowl-edge and bellet.

Master ..........---......... ----- ---------Ship's Surgeon ..-................-.. --..... -Vessel..-...........-...-....-...........

,Treatment of vessele ..l...............(kspectad and passed or detained)

disinfection of hold ..-.......... ; cabin and forecastle ........-....... ; beddlng, clothing,(Method) (Method)

etoe -------------------....................(Method)

Detalned-... days; sickness in quarantine .....-.......- ---....--(Number of cases and nature)

discharged in free pratique ................... ; port named In certificate of discharge ......................

Quarantine Officer

PAN AMEBICAN SAITABY C0DB 19

INTERNATIONAL STANDARD FORM BILL Or HRALT]

PFOBRMATION CONCERNINO TE VESSEL

I ........................... (offlcial tltle) -............... (the person authorized to~asue the bill, at the port of -)............. . ) do hereby state that the vessel herelnatter named clears

(or leaves) from'the port of .-...... ......-. t... under the follow54g clrcumstanoes: Name of veasel................ ; nationality ........-.. .. ; master -...-. . ..-.-. ; tonnage, gross ..... ;net -------- -; name o! medieal officer ---- ;- number of offlcera -s- ; ofcrew, includlng petty officers ....... ; officers' familes , pasengers destned or

---~at'ry 'o-'d~inti- ; embarklng at this port -..--...-..... . ..; first cabin -.......... ; second(Country o! destination)cabin -........-. . .; steerage -........ ; total number of passengers on board ........Ports visited wlthin preceding fotur months .................. . ...Location of vessel while in port-wharf -............ ; open hay ............... .; distanes from

shore .............lf any passengers or members of crew disembarked on account of sickness, state disease ---------Time vessel was in port (date and hour of arrival) -.......... ; (date sand hour o departure)

,Cheracter of communication with shore a .....-......-...-..-..---Sanitary condition of vessel. .. ...........----------------------------Sanitary measures, if any, adopted while in port .....-........... .. ' -.. --- -------Date of last fumigation for the destruction of rodents ...- ......................... -Number of rodents obtained .....-.....----.....--------..Port where fumigated ........- . ... and offlclais supervising the tuastlnon .................

Method of fumigation used (for rodents) .. .... ......................-- -(for mosquitoes) - .. ........------------------------------------------------------------------ ----

INFORMATION CONCEBNINO lTH POET

;8anitary conditions of port and vidcinity................. ... ..Prevailing diseases at port and vicinlty ... -- ---......----- ----------------------

Number of cases and deaths from the follUoing-named diseases durtno the twto teeks ecnding- .....o...

Number Number Remarks (any conditions affecting theDiseases of of public health existing in the port or

cases 1 deaths 1 vicinity to be here stated)

Yellow fever ...... ....-....Asiatic cholera....... ...... --- ---- ...... ..----------Cholera nostras or cholerine. ..........Smallpox................ ... .. ...Typhus fever ...............................Plague .............................Leprosy ....-.........-..................

I When there are no cases or deaths, entry to that effect must be made.

Health office of the port of -............ (when practicable this certificate should be signed by thehealth officer of the port).

Date of last case of:Cholera ----...-.-...--..---.---...-...-.-.---------------------------------------------------------Yellow fever .....................Human plague -----......... .....----------------------------------------------------------------Typhus ...-...-........------------------------- ---------....----------------------- ---------Rodent plague ..........................

Measures, if any, imposed by the municipality against rats during the last six months...............

Signature ol Port Health OfficerI certify that the vessel has complied with the rules and regulations made under the terms of the Pan

American Sanitary Code, and with the laws and regulations of the country of destination. The vesselleaves this port bound for .......-....... , via .........

Given under my hand and seal this - - day of -.........-. . 192 ....(Signature of consular officer) .. ..-............. --..-..

[SEAL.]Countersigned by

Medioal Officer.

PAN' AMERICAN SANITARY CODE

ANNEX-ARIcLE8 OF THE SANITAR1Y CONVENTION OF WASHINGTONTO CONTINUE IN FORCE

ARTICLE 5. The prompt and faithful execution of the precedingprovisions is of.the very first importance.

The notifications only have a real value if each government iswarned in time of cases of plague, cholera, or yellow fever and ofsuspicious cases of those diseases supervening in its territory. Itcan not then be too strongly recommended to the various govern-ments to make obligatory the declaration of cases of plague, cholera,or yellow fever, and the giving of information of all unusual mor-tality of rats and mice, especially in ports.

ART. 6. It is understood that neighboring countries reserve tothemselves the right to make special arrangements with a view oforganizing a service of direct information between the chiefs ofadministration upon the frontiers.

ART. 13. In the case of cholera and plague there is no reason toforbid the transit through an infected district, of merchandise, andthe objects specified in Nos. 1 and 2 of the preceding article if theyare so packed that they can not have beén exposed to infection intransit.

In like manner, when merchandise or objects are so transportedthat, in transit, they can not come in contact with soiled objects,their transit across an infected territorial area should not be anobstacle to their entry into the country of destination.

ART. 14. The entry of merchandise and objects specified in Nos.1 and 2 of Article XII should not be prohibited, if it can be shownto the authorities of the country of destination that they wereshipped at least five days before the beginning of the epidemic.

ART. 15. The method and place of disinfection, as well as themeasures to be employed for the destruction of rats, and mosquitoes,are to be fixed by authority of the country of destination, upon ar-rival at said destination. These operations should be performned insuch a manner as to cause the least possible injury to themerchandise.

It devolves upon each country to determine questions relative tothe payment of damages resulting from disinfection, or from thedestruction of rats or mosquitoes.

If taxes are levied by a sanitary authority, either directly orthrough the agency of any company or agent. to insure measures forthe destruction of rats and mosquitoes on board ships, the amountof these taxes ought to be fixed by a tariff published in advance, andthe result of these measures should not be a source of profit for eitherstate or sanitary authorities.

20

PAN AMERICAN SANITARY COI> 21ART. 16. Letters and correspondence, printed matter, books, news-

papers, business papers, etc. (postal parcels .not included), are notto be submitted to any restriction or disinfection. In case of yellowfever, postal parceis are not to be subjected to- any restrictions ordisinfection.

ART. 17. Merchandise, arriving by land or by sea, should not bedetained permanently at frontiers or in ports.

Measures which it is permissible to prescribe with respect to themare specified in Article 12.

Nevertheless, when merchandise, arriving by sea in bulk (vrac) orin defective packages, is contaminated by pest-stricken rats duringthe passage, and is incapable of being disinfected, the destruction ofthe germs may be assured by putting said merchandise in a ware-house for a period to be decided by the sanitary authorities of theport of arrival.

It is to be understood that the application of this last measureshould not entail delay upon any vessel nor extraordinary expensesresulting from the want of warehouses in ports.

ART: 18. When merchandise has been disinfected by the applica-tion of the measures prescribed An Artcle 12, or put temporarily inwarehouses in accordance with the third paragraph of Article 17, theowner, or his representative, has the right to demand from the sani-tary authority which has ordered such disinfection, or storage, acertificate setting forth the measurcestaken.

ART. 25. The sanitary authoritieM of the port inmust deliver to thecaptain, the owner, or his agent, whenever a demand foú it is made,a certificate setting forth that the measures for the destruction of ratshave been efficacious and indicating the reasons why these measureshave been applied.

ART. 30. Special measures may be prescribed in regard to crowdedships, notably emigrant ships, or any other ship presenting badhygienic conditions.

ART. 32. Ships coming from a contaminated port, which have beendisinfected and which may have been subjected to sanitary measuresapplied in an efficient manner, shall not undergo a second time thesame measures upon their arrival at a new port, provided that no newcase shall have appeared since the disinfection was practiced, andthat the ships have not touched in the meantime at an infected port.

When a ship only disembarks passengers and their baggage, or themails, without having been in communication with terra firma, it isnot to be considered as having touched at a, port, provided that in thecase of yellow fever it has not approached sufficiently near the shoreto permit the access of mosquitoes.

ART. 33. Passengers arriving on an infectdi ship have the rightto demand of the sanitary authority of the port a certificate showing

PAN AMERICAN SANITARY CODE

the date of their arrival and the measures to which they and theirbaggage have been subjected.

AtnT. 34. Packet boats shall be subjected to special regulations, tobe established by mutual agreement between the countries in interest.

ART. 37. Land quarantines should no longer be- established, butthe governmnents reserve the righlt to establish camps of observationif they should be thought necessary for the teinporary detention ofsuspects.

This principle does not exclude the right for each country to closea part of its frontier in case of necessity.

AR:r. 38. It is imnportanlt that travelers should be submitted to asurveillance on the part of the personnel of railroad(s to determinetheir condition of health.

ART. 39. Medical intervention is limited to a visit (inspection)with the taking of temperature of travelers, and the succor to begiven to those actually sick. If this visit is made, it should be com-bined as much as possible with the customhouse inspection to theend that travelers may be detained as short a time as possible.Only persons evidently sick should be subjected to a searchingmedical exarmination.

ART. 40. As soon as travelers conming from an infected localityshlall have arrived at their destination, it would be of the greatestutility to submit them to a surveillance which should not exceed tenor five days, counting from the date of departure, the time dependingupon wliether it is a question of plague or cholera. In case of yellowfever the period should be six days.

ART. 41. Governments may reserve to themselves the right totake particular measures in regard to certain classes of persons.notably -vagabonds, emigrants and persons traveling or passing thefrontier in bands.

ART. 42. Coaches intended for the transportation of passengersand mails should not be retained at frontiers.

In order to avoid this retention a system of relays ought to beestablished at frontiers, with transfer of passengers, baggage andmails. If one of these carriages be infected or shall have beenoccupied by a person suffering from plague, cholera or yellow fever,it shall be detached from the train for disinfection at the earliestpossible moment.

ART. 43. Measures concerning the passing of frontiers by thepersonnel of railroads and of the Post Office a.e a matter for agree-ment of the sanitary authorities concerned. These measures shoulldbe so arranged as not to hinder the service.

ART. 44. The regulation of frontier traffic, as well as the adoptionof exceptional measures of surveillance, should be left to specialarrangement between contiguous countries.

PAN AMERICAN SANITARY CODE 23

AaT. 45. The power rests with governments of countries borderingupon rivers to regulate by special arrangement the sanitary regimeof river routes.

ART. 49. All persons who can prove their immunity to yellowfever to the satisfaction of the health authorities shall be permittedto land at once.

ART. 50. It is agreed that in the event of a difference of interpre-tation of the English and Spanish texts, the interpretation of theEnglish text shall prevail.

o