Resolutions Adopted by the Fourth International Sanitary Conference of the American Republics

Held in San José, Costa Rica, December 25, 1909, to January 3, 1910

CSP4.R1 - I. The IV International Sanitary Convention With respect to bilharziosis, hydrophobia, leprosy, typhus fever, ankylostomiasis, etc., this Conference suggests that recommendations be limited to requesting the various governments to take those measures of protection, which they believe necessary.

CSP4.R2 - II. (a) To recommend especially to the various governments that they employ all possible means at their disposal to secure the effective sanitation of seaports, to the end that the introduction of plague, cholera, and yellow fever may be prevented, and in the event that a case of either of these diseases reaches a port that it be promptly isolated and measures taken to prevent its spread.

(b) To recommend special ordinances for the proper construction of ratproof buildings, especially those designed for the storage of foodstuffs, suc as markets, granaries, abattoirs, stables, etc.

(c) To make obligatory the use of galvanized iron garbage cans with tight-fitting covers for the reception of refuse from houses, and to arrange for the daily disposal of such refuse.

(d) That properly equipped laboratories be provided at all seaports where the periodical examination of rats may be made so that plague can be apprehended before its appearance in human beings.

(e) That the crusade against the mosquitoes, "Stegomya calopus" and "Anopheles," be carried on vigorously along lines which have been shown to bring the best results.

CSP4.R3 - III. (a) That careful statistics on population, morbidity, and mortality be kept at every port, such data to be compiled at regular intervals of not more than one month, and also annually.

(b) Every port should be provided with a proper system of sewerage, an adequate supply of pure water, and paved streets.

(c) That all habitations be constructed with a view to furnishing fresh air and sunlight sufficient to maintain the health and vigor of the inmates, and that the character of the construction shall conform to local conditions.

(d) That in every port there shall be a sanitary authority clothed with ample power to vigorously enforce sanitary ordinances.

(e) That it be made obligatory in schools to furnish instruction in the elementary principles of hygiene and sanitation. This instruction should be objective, or by means of the publication of simple rules, or both.

CSP4.R4 - IV. (a) That it is the duty of owners and masters of vessels to rid their vessels of rats and to use all possible means to keep them free therefrom.

(b) That this should be accomplished by the periodical fumigation of holds of vessels with sulphur gas at periods of from three to six months and at times when advantage may be taken of the vessels being free from cargo or laid up for repairs; and at all other times vigilance should be exercised by the masters for the destruction of rats by such other means as they deem most effective.

CSP4.R5 - V. (a) That no person be allowed to embark who is suffering from a quarantinable disease, or from scarlet fever, measles, diphtheria, or any other communicable disease.

(b) For permitting the embarkation of passengers and crew who have been presumably exposed to infection where the above mentioned diseases exist there should be observed at the port of embarkation the following requirements:

Cholera, five days observation or surveillance; disinfection of baggage.
Smallpox in epidemic form, vaccination or other evidence of immunity.
Tyhpus fever in epidemic form, twelve days' detention or observation; disinfection of baggage.
Plague, seven days' detention or surveillance; disinfection of baggage.
Yellow fever, six days detention or surveillance; or immunity.

(c) Thorough cleaning of all portions of the vessel and prompt isolation of all cases of sickness which may occur on board. than one month.

CSP4.R6 - VI. The Fourth International Conference of tile American Republics recommends that Article IX of the convention of Washington be interpreted as follows:

Article IX. In order that a locality be considered free of contagion, it will be necessary to furnish official proof to the satisfaction of tile interested party.
- First. That there have been no deaths nor new cases of plague or cholera for five days after the isolation, death, or discharge of the last case of plague or cholera; in the case of yellow fever the period shall be eighteen days, but, each Government reserves the right to prolong this period against those countries where the measures for the isolation of cases, the destruction of mosquitoes, and the disinfection of foci are not observed.
- Second. That all measures of disinfection have been applied, and in treating, of plague cases that there have been carried out all measures for the destruction of rats, and in the case of yellow fever that the proper measures have been taken against mosquitoes.

CSP4.R7 - VII. To recommend that the Fifth International Sanitary Convention determine what constitutes immunity from yellow fever.

CSP4.R8 - VIII. To recommend to the Governments here represented the great importance of distributing, in all possible ways, instructions as to the best measures by which people may protect themselves against malaria tuberculosis, especially by the publication of rules to control these diseases and by making it obligatory on the part of employers of labor to supply such rules and to require their observance by their employees.

CSP4.R9 - IX. That the countries here represented adopt the models of sanitary documents herewith presented.

CSP4.R10 - X. To recommend to the Governments represented that for future sanitary conferences there be nominated delegates who have assisted at previous conferences; and when the delegations are composed of more than one member, that one of them shall have assisted at a previous conference, or that in any case the delegates shall be sanitary authorities in their respective countries.

CSP4.R11 - XI. To request of the Bureau of Information of Montevideo to forward a report to the International Sanitary Bureau at Washington of its transactions since the Third International Sanitary Conference.

CSP4.R12 - XII. With the object of perfecting the knowledge of infectious diseases in the tropics and to give to tropical medicine the scientific basis now held by the most advanced nations, this conference requests of the Governments of the American Republics that wherever these elements of progress are lacking they encourage every project tending to provide special information on parasitology and on pathological anatomy.

CSP4.R13 - XIII. To request also of the Governments of the American Republics that they favor the establishment in seaports and important cities of laboratories where not only diagnoses may be made in order to comply with the requirements contained in the resolutions of our sanitary conventions, but where also original investigations in tropical medicine and general pathology can be made along lines which the sanitary authorities deem practicable.