By 1924, all 21 American republics had joined in the work of the Bureau and that year´s Pan American Sanitary Conference attended by 18 countries took the significant step of adopting the Pan American Sanitary Code which was formally ratified as an international treaty by all 21 republics. The code was the culmination of a 12-year effort and is still in force today. The budget of the Pan American Sanitary Bureau in 1902 was $5,000, and by 1924 it had grown to $50,000. (When Fred Soper took over, in 1948, the annual budget was $1.3 million.)
