Report of the Health Department of the Panama Canal for the calendar year ...

MISSING IMAGE

Material Information

Title:
Report of the Health Department of the Panama Canal for the calendar year ...
Physical Description:
v. : ; 20 cm.
Language:
English
Creator:
Canal Zone -- Health Dept
Publisher:
U.S. G.P.O.
Place of Publication:
Washington
Creation Date:
1918
Publication Date:
Frequency:
annual
regular

Subjects

Subjects / Keywords:
Public health -- Periodicals -- Panama -- Canal Zone   ( lcsh )
Sanitation -- Periodicals -- Panama -- Canal Zone   ( lcsh )
Genre:
federal government publication   ( marcgt )
serial   ( sobekcm )

Notes

Dates or Sequential Designation:
1917-
General Note:
From 1918 published: Mount Hope, C.Z. : Panama Canal Press.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 225670417
ocn225670417
System ID:
AA00006092:00005

Related Items

Preceded by:
Report of the Department of Health of the Panama Canal for the year ...

Full Text










OF-THE
4 L T E ....A... '...... T- T









THE PANAMA CANAL




FOR THE
S .. -. .. ..:.' F ;





-'R POIT ',









...... .., CALENDAR YEAR "







McOAAC 1 .. .T.. **.
.IS.. T EARTHUR T. : .Mc O R


















7 '^ .,,'-., .. Lieutenant-Colonel, Medical Reserve orps, United States Army ...
J4 -













-. "".: .,, ,-* ""..: .Chief Health Officer .. .







Gift of the Panama Canal Mae


STHE PANAMA CAAL PRESS
SMOUNT HOPS, C. Z.
,'.. .: ..,1' :1919 ..
A41P
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3.t MUcCORMACK


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:.*: i i...i i* i* i i.


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SSi'. Employeeu.......
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t..b ,i(nI oone......"......
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^ per asy mn.. .ses. ..im a ...,-/e.. ... -., .- .. ... .... .........g


a*g n *. ie A. u .e a .. .. .a. .*
sl^iticw on Eniployees: l .-
*i lalion rate pet 1,000 employees. Al causes...... .............
S&; h rate per 1,000 employees. All causes ,,.........

I effetiveo rae. per 1,00:0 employees. ..... .. ...-. ....
IE l fever. Admission rate per 1,0QQ employees...............
P- .f fever. Death rate per 1,000 employees.................
I ?l"W W fever. Death rate per 1,000 population in the Canal Zone and
i itiesof Panama and Colon. Employees and nonemployees. .
*: .':. : .* *


p.i.tges,.deaths,. and noneffective rates for employees.... .-......., .. .5 5.
letIfoemployees by cause, color, age, and length of residence on Isthmus : 5
atMa orfeddente.of the cities of P (, Colon, and the Cabal Zone... ..
civiJ population employeee and nonemptoyees),by eause, .,
i..r. age1 a niid p la ce of residence .. .q .*.. .. ....-...- ... -. 5. .
.. .. .. .: ..

Feat s .fnon.e ni.s. ,....,,............,.. .... ..... ... ,.,.,.
C.., ioInKaLty or nativity... ,,., .. ...., : .. .., -... ..
:JiBE re:Andiesan employees and their failimes............ ....... 71 .
ih u id: "rh r.aes in the Canal Zone and the itiesof aPanama a :n:d:
BS*i *:.* .** m ..^ ,^ .,..,,,. ; ,.*, : ,. ,-. ,. .. *' S : '. '

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.. ... .. .. .i .rage, lad placeofre den e .. ... .. i. :.. :
t w. a destnd in thel.spit of The Panam Cana. i by ,. :.. *
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PANAMA


HEALTtH DEPARTMENT;


BALBOA HEIGHTS,


Z., January


15, 1919.


SHARDING,
|al. The Panama Canal,


SBaloa Heights, Canal Zone. ,

: the honor to submitthe following report of the opera-
eatth department for the vear 1918.


...: ." Respectfully,
i'. ARTHUR
.. ., :


McCORMACK,


Chief


Health Officer.


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V.
HHhH:! H., s
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GENERAL


REMARKS.


MALARIA.


tinues to be the


principal preventable disease against


,. ary. work is directed. During the -past. years it has
*t]ated,as might have been reasonably expected,. that the
litafitn in the rigid antimosquito work will be followed by
4 response in. at first a gradual and then a rapid increase


bf malaria..
i ..malaria cases among employees for
as follows:


i i.. .: .. ..
i **. *..* -
Sof th C l Z nd the two tie *
Slleeea- of the. Coanl Zene and'the two cities.


texcraioa into the figle, interior points, etc


. M M -
I..ill .II
.y dl & &
H W* -*JJ
L *B~w JC a


the past three


S1916


505
42
- .
V
A7.


lit 918' total are 32 carrtf 1: found inaa an o


"' 204
473
38


lolaS


200a
S30
*


iclearing
~A ;-rn'.


.i
S. ..
". ." :* .


i. y J nf


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iw.i i...... ..
..: P*, ": .**


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i. .'*
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-:
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the 1.5th Naval District have
the necessity for a sanitary


road frdin .Emili
tinmous .swamp,
Field, Coco Solo
importance that
The sanitary


ano Hill to
and is the s,
Navy Base,
this fill be m
fill along t


urged upon their respetii
fill along.the east sideo.-f
Coco .Solo, near ColmE. ",
source of 'all of the mosql
and Fort Randolph.
iade without delay.
,,I ,','
.." :, "" UB


:he Ancon-Lorozal


roan


- sidered completed. On account of settling, additional
made where necessary. -
Excepting Coco Solo, Pueblo Nuevo and Las* *:.
of. Panama, have been the .most prolific source of .
in Panama but .among our employees and other
drive through them. A careful topographical sait H
.been ordered with a view to sanitating this.extenswq
breeding area in the same comprehensive way 4
areas of the Zone. .


.4


*I.
:t a!"
C~I


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I* i
* H
- 'M


h
pr '


S *i r a .. r


I;


uneQairnueattu -, 1311, rauy
.. .-:.tlH.erelH. .. ,!. .: .RE .. s. 1
Withe umtteda 'fl:.jJl
.o..t nt ai .ni to.... .. ... ... .. ......
vised body .etf;taniawyh iHisp ectosH
Approach the .attr .. .. ...... '.
The encroachmentt of h cattle, indastt .o 6
==. l r<. O* ti e .. *.. "::" .i .

- military reservations and :civil sef elements s:.ii
anopheles breeding results in all wet areas. whet:-.
found: ad this increasesss 'dangr of: flights to: q
it.t will be necessary to direct that no cattle be ailH I
nor -during the wet season at all,. within a.: ,'i
inhabited areas./ .
The health department has strongly r-ecommnendel
nor, the General commanding the Departmentan


ffiKsS


; i

























S- i. ueaty with Dakizi's -solution and spayed h
.and all but three gradually cleared up; these tth ..
Shipped as caitiers. Very large and frequently repa
;" r injectiosof Fiexners Serui after clinicaldiagnosis,e ai
; citures are positive, are.of curtive value -in tmen :.
= .* rapidly fatal type.of the disease which confronted. .lii..
..- ease@s tlt -had died had been ill less than 30 hours.
.1-t, *. ".. / E E EA L DISEASEB .- .- ,- .;,..
A, ..il:< < tihe iiu 1e ir.Ocupation ur i s tatistics sho w A:-.::-E:=V;^


.. admssin -at~e to aesptas aend quarters of 2penty
.; disease acualy *treated in theNaERal Zone by A":il



:: "This p"le hs given usmoer greatest concern, T
i..... ..t. .. ma.tter. T.e alarming increase of the.B
.:arol.dt:r -forced the general :Iommanding he 1 de. r i



nl l Orre der 26t, whic in effect was a qrtsantsinem
nal cities on account of vene ea i seas es; a ". ..p ir.




Ies Shabit-fnomce 1904 there have heeo 27,633 asese4
S.. disease actaly treated in thee Canal Zonae by Ame.el.




..... ".. '.. .... U.. *. .U...
....i ..h 4 .
:.." :.- .-. :..". ..
t. .. ci f:estifathe Sadmol ld oa nen in thieetiusive sanitary si
** **. .** ** -* **. '.. :.L f*A





th..: e United States and the police jurisdiction ofPaaa
".. .. .. .it .. the matter. Te alarming increase of these4 ..




'"" 2 .. Hspta ..EeA st "a iOfc Panama, .a jIA.


A:... : .. ., "* I."; ; "

Ii..;............. ... .".. of.the iner schaoos were uening, thsdimtes"" ,show"

.. *: srn t nr flicm nfll twwtw ao ... -n -a













i.eirigtad w with fixed latie
bronght- vigorous prOtest from property owners,
"f, s '!, ." ;': :: ^ ^
r u-k pr e,.- ad.lits benefits became evident,

SI -id C:Ox with the active support of the former
rs, ha4 added an anti-tuberchdosis campaign to the
*l child-welfare. work. ey had been doing, The
the President of Panama and the constant and
Sand. supervision- of thee honorary President of the
l eross, brought to this- work the sympathetic assistau ce
jn"falanana interested in its welfare, At the suggestion
of: -.work was approved, his oringal suggestion being
,a sto briag it. in .lie with the best approved work in the
S. ... -:
u *s *
I]TU BERCULOSIS CAMPAIGN OF -THE PANAMA RED CROSS.
l fet- is the most frequent cause of death in adults in
anc:taused by a. germ or seed called the tubercle bacillus.
A:re found in the fluid coughed up by victims of the
when so coughed up, they are spread from the sick one-
4mfants and small elildren,.and adults weakened by other
"" -r by -vice, are especially liable to the development
germss when exposed to persons having the 'disasease:
4g- tuberculosis are too sick. to work efficiently, and are
Sg*upon their families or upon the public treasury. :
ie cf a.national antiturberculosis. campaign is.:
i. .a Ntreat existing advaficed cases so as to .arrest. the:'
PW disease in as many :o them ::as.possI. -. ... :
t *atically examine the well or .those showing even 'thte
iops sition .so as to detect .uberciilosis in .its hiptent
:fl6tay bentgrely relief ... :. ti
twnsit the di semiuation of the germs or seed of the disease
..e l .,: ..:. .:"..
.a. .t ,to .the. well.. ,. g. *- .:4..
s-kiiaiexisting Cases of ill-health aand remove existing daises
I.4 t nil .ap average .in&d vidu rektance, to disea ..
i.. ".. ". "" "" .. .* "i": "" .
aIoa o advanced case-i adequate hospitals is the :et
"S ptead t. the die...and tbtreby .these.
.... tvtrtn. .nurnl'trxo % n l a 1 ..our ati
= .. ,....,,
% .L


"*


::.il

* .I


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i I
:4."iiilf












A.~r H.I. ..
:t'.E:HV
t" ...3


'*:uvgjs^&t^ utatu


tion fir moar


I m,: ahitenanc.:
".andl"sp won


than.; *.....0.. s *A .
i :. a ....G. |...

d.. ci $u-562n5Or .ryiefra* agji.".. 'e
1d :ftr.ioessay ei-trava re-f .....""


- *. ." .'. '. .:.:x i
-The spread of the disease can be p .renve.t.d br "i.
1. inningg out where the :pati6&s fn, &4iak t'hS
avision,- andfl = teachfi n iem haw, and then -obliging tI
mf a'*r .* .. .. s ^ -. T


.certain .precatitOns which will minimize the di&et,
S2.- Teaching those who live in the same house wit
way to prevent contagion, so tthqt the necessary'ptre
. ., taken.-. .. :., :. .


3. 'Exacting vigilance so that the precautions.ar#l.i
carried out with strict punctualitv and that they iead i


-. ---" -'
iticrease their power of resistance. This work, propi
should be executed ;by dispensaries located in differed,
rtac+ n ni T- +h1 rnvrwinrcn : i


or immunity


c~n.


-, X:i


H.,


SsA LALeO al II 1 l. JJ V .c LeLs.f.


* "The- ..ower .of
essential parts:


resistance


" -1 .


Removal of any other existing cause of ill-health.


intestinal infections.
2.- Good nourishment.


>3.


Good housing with adequate fresh air and within


C.':,;q
- ::!;:


Abstinence from all vices.


.-..., 2 !:


Avoiding fatigue by adopting work which will not,


strength .of .the patient.


' "The first part of this program would involve systedf
tion of the blood of ill the sick for malaria and of th


r:: r.-a


" charges; for intestinal infections,


prompt and effective relief of either;


either parasitic or I


when found.


I
The'


. =would be.to teach that good nourishment is then the"tl


that luxuries are. unnecessary


and amusements should


ary place.


The third part


would ,be to


anres for proper light and ventilation
art.. would deal with the establish rent


implant the -n
qf "all d"glHig
..IrB f u.. X


cation; !the prohibition of opening drinking: salooioa*
supnression of canteens knRt'bv. women.;: ltuies' ats


-r. a.a-.


the .schoolroom,


S.evexn"i


: .and: applying i
. ,,',o..va d_ -__ -?_ .i. _


.. ".: .$'


eventually aholishiu
i orouslv the law as


its. S.


- J


..X-


V


...


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anedwbhen governmental .or scientific. icnpositions have
0M interests.hby want of knowledge of existing conditions
hennew'rules are established.
..mpaign, 'accordingly, should be established on the following
.t. .first .f all, the Directorate General of the Antitubereu-
S:paign: composed of one of the Secretaries of State (Hacienda


".n) w 'ith t
*sAtgna Red

a "Red Cross.
wresentative o


he two Presidents of t
Cross, the Treasurer
d the Director of the
This would create a
if the Government, thr


he Executive. Committee
and theSecretary of the
Tuberculosis Clinic of the
Directorate composed of
"ee prominent members .of


World and two doctors, one of whom is the Chief Health
...i The Panama Canal. They would develop:.
,necessary" dispensaries. Two in the city of .Panama
frtbe:one already established in thp Red Cross building, Two
B.*of Colon. ..One for the principal town of each province
Au h lic I
asgnatoriums with accommodation for 500 patients or more
fi. heilimits. ofthie city..of Panama, and the other in a place.
.,.sitons. of altitude, climate, and means of communication
.ind the bestin the Republic. ...
insarie would have the following.personnel.: Tn Panama
iry a doctor, a nurse, and one assistant doorkeeper,
S..of ..the. three clinics, and the necessary public health
t*ud& go into:the .homes of the people. with. istruction.
stratioas;:.each clinic to. be: -:opened ,two daysa.: a..wak .fa
'l oa:h day, ftirthe exami nation of the patients. I.I the aethr
ro. would be- :adequate .to -the local: roqiub.ai'.: '
lI .ay1 will keep a minute clinical..report oifevt:rytratit.
cut wibevisited..daily by-nutrse who wil sdiuppl Mry
*ii. .ia u..hanidkerchiefa waterproof bag n. .11 these -
:i i ii's.iBd'W li # .*:- -- ** 1..^n ...; a< M ."* "'*i =. ..* .. s t- -- t :' ... i. *' *. .._.r :..*_ .:.. .* "=ia. < -- *< **


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IOPS I


L JWL l f* ** *VBH
awa namovesssr "' *H t
al ;u -


g' *h e.a .. ,* .' ,. ... '""""::"
During the year.in connection wit the few phtQS.-.
:- : ,. .. ".... ." ". 4 % ..::.".. :" :. .
systeimn withal employees, a, pvi. cal xaminatioao .E
ploye.. was undertaken for the first .ti As
S. . ... "
s15o000 and 20,o000 of then. tisinvolved a conr
S" .. .. ." ..
work slight defects were discovered. in these-
dr into the hospit al for opera tion or treaty t:" ..lt ..
.whith ought not td be at work were sent to Corozal a


Svatio and lighter work


1
*'"
."I


d


This systematic examina7il


ployees should be repeated
extended to their families.


each


year


apd


should


VITAL


STATISTICS.


* -.:
- :w
w..


";.:1I,.:..i
*I.I


EMPLOYEES.


The average number of employees on the rollsof The Pan


and the Panama Railroad


32,589 for 1917,


, for the year was 25,520, as coni


and 33,176 for 1916:


i H.


w
H,::::
I-.


The total admission rate to hospitals and quarters wa&s


compared with 356.75 in 1917, and 282.76 in 1916.


For..die


the admission rate to hospitals was 136.60, as compared .t.i
in 1917, and 103.72'in 1916. The total admission rate t.


only was 163.17, as. compared with 160.85 in 1917, and 14QO
The total death rate was 8.11 as against 7.09 in 1917, &


in 19"15, and


7.04 in


1914.


, as against 5.74 in 19,17


noneffective


rate


and 5.7.7


alone was 7.13


The


constantly


The death' rate .fr.n
,and 4.581 n 19i6; :
from all causes. M


.compared with 9.65 for 1917, and 9.20 for 1916.. .-. .. :
: The admission rate for malaria, to both hospitals and qnl
. sa -as compared with 14;51 for '1917, and 16.49 kw


noneffective rate. for malaria
. 1917, and (59 for. 1916.


was


1.13,


ascon


:.iiii.El


aphred -'
.. .. *
.. ..... .... :r .. .


- .he admission rate for typhoid fever was 0.24, as cf
0.18 for ,917, and 0.66 in 1916. No deaths fromfitypli


employees oecurripd during the year,


C .*


.r.. *


U6


r:


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A


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EH#IEY~ Ha.:.. E
H..
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E':i; il~c ;ii iEH..
H EfrY.
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4 H~YY "


*. : *


J .. .
: i .: f ** .K q j
. .
L, .. .


.. 9 .
t U *


1*917
*:~~J -,:ll


'Deaths.


38



22
8


Rate.


l1 AM


AC4~


: ..

.,Deats. .Rai..::.-
.
*.


46
2S
* 19

16
6


.24


.-r! .*


|::46 deaths ,from

ie36.in 1917. an


... a
........
i :,, :,::.I..
.3rt.1 e.
:: *. ::.: .
i.i .

*q *...


r!


tuberculosis among


3 ibm


employees in


I19O;


1918


Profit


employees,

neu moriia


Sas, compared


EFFECTS OF RACE,


with 29 in


H : .
.. i .
.. ...
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S..
-:


, w,


to hospitals and death rate from disease,;for
nn rhf > 1 S 4 A a


379,and(3/6, as .compared ih /1&3
Slate .tg hospitals and quarters foar malaria ws-47
Mi.ard :with l947 for blacks* o _
:"~it'f^~ ..y ,.^'vi' i ..t ,Tii '' r m i':lti 13F5- 1- i T 7..
^E^Eii1~~~~~~~~~~~~ .~.L : .lo lci LJUUUd tlS U:i iillLWA ..U


. .: *" i 0 -
ciute: t hospitals for disease for Americans as21&5:
*i i. *
i ;ate : rom 'disease 3.38, ". "..


H.:

*.EHEllS4.


population of
,,..:!!! I : :** ** .:' .





." :h. i: .'. "" '


p'n't .xrotn tuoalet osi s ear Wi
.. : .. *: .. H*,. .
. ,:: .. ," : .. .. .." .. .. .. '::


. .. : .


" I


AND


NOEYgMPFLOVXBSi


22;290 :in the Ca

e.year.. Ofitese

as. om aredwit


ri n


* '*


iaF Zoe. thee:..

216 dath s."
.l-6 dfefb". "pfi "; .
fc^.^.l^.lp^:


** ,: ", : ,* ** *
. .... ** : .
Sompared -Wt .
rrv to.... M .

... l:.i i .. .


:rS
*EE'rI.:P
.*EE.HEil
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CANAL ZONE.


;, EMPLOYEES


-t teieuls. s.wa 1., 4,- as
." '" : :" :- .. .. "* *


uBmhiirr


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2~e~iiI


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... asyisu .. are.t.ow nusy *int-t C.;.ens..- WienYI U l g;
o t *e e . .." . .. ". ...- **
pity that this fo'trm of:therapy -canobiu
.o ula~iton. of. the.'tropic '. -. .: '..,:,.:.. -:. <..:'
.. .' .. I .." .. "* .. :. "" '
.. \ 7 :. ,A .: ." .. ." .. ... "
"" $ '. ". *l': !..


~a ;wu WaJ


~Hi


Ti


.. i" 1*-

.The daidr is conducted entirely by cripbled.:and
It is a profitable 'investment and furnishes .relia
lqntt milk which is sold through the coniassary::o
children. The raw milk of this dairy rarely has;, a
).tiigher than. 500 and the pasteuriznd product has nii
hisis duto the edae cooling, ** *" ::
som ue uto the. intnediate coohng, pasteurlza-tl0 a.


the milk. '".. .
Piggery.
J *

We. have continued the slop feeding of hog
insane hlkbor, developing a very profitable indu
.plant most of the slop from the Pacific end of
cotiverted into food in this plant.


Poultry.


With the .development of the modern poultry
.Dewtrtmdet.t at Sunnmmit the necessity for the c
plant by the health department ended.. This pl
cl V nrl re o 1ri nonn nirgLduc tve


. y, Ap .,,


GENERAL ]


* ,: I. .
..As previously recommended,.
ihonid be erected, on a plan simil
SU.ited States,. whereby ..we could
Spatiqnta and give them better care.'
bui. ing.where the patients could be


Soomd,..brushes, flippers,
thie 'handling of tEe patiei
*. *: .S: *.. P **


moshine
H
mops, ,is
a-


* ..




v:..,
Str 4.i
.y.n
th& .I~e
..
I;


- .* -- =.: f.: -:. :,
:* :: ,i": *":
.. .....
.* :....:..
*:::..:'
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"* <," i-< :^M '
*X :" .... v si
u.l..|
otidhag
a*n.
^^t^~.*t't1mif
Lam, Jp^


." :* :

REMARKS. : ''
.t t:i.




improve @n t^il'
S. ** :.. .






: : j r *i' i
*t...* ... i .
"e; "cildi n." li"
: ..::. *E:E .


S. .. i ...
.OcII .. .. *.m

la : t


at., a:xiU en UD: .~t. l .
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w. .rln-r j p ifili.anua.u:. bnw uurgicai u.ipsairzew are
it a nd upo: several occasions every available
l been. oc upied..
aside the recent influenza epidemic with the
o 2^2 soldiers from the transport Kilpatick is to be noted.

ial side the monthly average has been in the neighbor-
er.operatfons. C
itn of4 e hospital with .the Colon prophylactic station
ii .the red liglit district is of especial interest.. In
s tp.e of afHietion, one must first. get at and remove
Co Without this preliminary step all treatment is useless
iti continually taking place. This was proven by
frigmtstt the prophylactic station in coinparing the cases..
l.i. operated and those upon whom section had not been

Sirterest to note that these people may have existing
i nlfed-ovaries, and large walled-off abscesses and stii
Sito without any apparent discomfort.
w.rwas. performed upon 60 women. There were"n.
fi^ages varied from 14 years up. The average stay in the
kiom i0 -to 20 days, the majority being discharged on
Ithday. Practically every nationality was represented.
riMtnentt consisted in enemas and douches and be-
attat alf cases were pus, cathartics were not resorted
eratively. It was noted that where this procedure
ence was much shorterand that the post-operatir

Sall ..diseased tubes, ovaries, and the appendix were
iver practicable hysterectoayy was performed.
3.. *.... ... i ... a ""'*: 4
SH.leuterus was retained, especial attention was. pad
..ern the round. ligaments that the uterust would
f. .,..:..H. :.. .. .. :.. '*"' 1 ": ii...- .
H. .. *". .
..i i H. A. : : ::.
.. B .. .. I m *. d
dceswas drainag resorted to. Due t* ** r


ii. .t .. t r t. ... ..
-... .4. .. .. ... Ed ..
S .
treatmea~ ~ i''.:. ,. wsmsc d.


it


H

. t H


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.... *
S... .
:*. .... .
. .K ,**: *
.1
.1.:. ....






: ..... Np =


: ...-. ..: .. f .f!
.. ":
*- T *** *H H. : i ..
.. ... ". ".H.:H



disappeared. .Tw& cases of mahlria w rem ord, .D
tie Spanish iif uwa -outbreak 7' tiemsad
.mild...attacks, but soon responded to treatment 4.
During the year there were .*21 admissions, 4..
escape), p deaths, with 76 patients reninait
De ner ............ ..... ...........
At the cldse of the year 72, or 94 per cet, of .


syto Ia y cs :,. 'H... .
H.H.. .. : : .

S. PANAMA HEALTH OFFICE.
....*ta but::o:. *:* r
._.p... .* !.... ..:-
D m l er 3!-"' :' s".. .
Malaria.-The following table shows the cas of m4
able to the city of Panama in., the years 1914 to 191,:
h-14....... *. tSe: th...
S.. **" .... *
: ": .l: E


0184.... *14. a*. *. ** **: :a..I.'i .
.It. .. ,. 4,; "i
h- -
t9.4 :. .*.::
I f ~~~~~~~~~~l Q~~~~~~ ,, "- > 3 ^. ..;. B


Sthe table only proves that malana is a matter ot *bii.
control,. being simply a question of constant and. "al
Thwe has been continuous endeavor to mpovet. H


ditiors, eliminating all unnecessary drains, many of ii7
filled and oth&s straightened out, This has be
additional expense as to labor and with a very iai
expense in the consumption of oil. *
A survey has been made recently of all ditchcii
be termed the Panama District and it totals -....
Sth.is was done to.cornet former erors. and to *iw
." I ;. ,.
yardage. ...i
The serious problem confronting this: oiffe ao
is.,the condition of that portion of the eririrs
known as "Las Sabanas.", Cases-of malaria fr& u
district and. will .continue to do :so, so long askt
properlyy isanitated. It sees a uisekessnpenp
-, m -. r ,- g "". : ,*-, : n. .- .


HY::


I





-















gp at pe-n"y.respBwomse iqr ..pesnower naumer ox
.... .. .. H a 1 Ww census'. "ade: of the


Iaeit .. ationa ther~raAcmal measure in regard
b "'iev) -'will have a mrkcd effect upon t
* "* ** *.... .. *' e f e* .. .
it frsom tuer culosis, but upon hea4th. conditions
i of PanamI.a,. aLnd -that is that each. humJan. being

It ka"t SON cubic feet of .air space, and it is proposed ;to
Sopeiaing into every room in .each tenement house. in
.1.. with th cubical contents thereof and cordfinriethe
S"a"oowr to the required space; this can be done
rtitg regulations and would have. been done long ago
bgildiing inspector attached to this office. S
udiwF this. heading might be shown the large decrease
d: of infant mortality. The following table for the past


* a.
"H.,.?'i


s.ow the practically stationary condition.from 1914
We, and the marked decrease for the year 1918:.


"'I. .. i.. ..... .

: ..*: ... ..
;.. = : .
..": ." ,* *. -* -.
ite l.N- .^.


.pr thousand inannt mortality
.:0.
. *W **a S*SC**d C **C ** .


* ii..


* *.1 isa-


4 *


* L "
:x


~P.ini

- 188.27


ilt .:ate, together with that from tuberculosis, could
t's'd i' if= the absolutely indigent members of the popula-
ished .with sufficient ,and nutritious foo. .
Is Established in two or: possibly three sections of t#he
f at b eneit, .provided. some. scheme c.ouldbe....:
41:tHeb food did not go into unworthy hands: howev er,
.. .i" > ." f -"'
at tdtailN.and can and should .be worked out., Medit
* :Hbmi are cheap ...and- the..omibinatio. woutd-g..o f ao
4 th e p"se t.ondition;.providedthfund
... ...t *... K : ** *
*. ... .. .. .: .... .
.' t c *ase of smallpok was reported on July' *10;
.a. .. w.


I


S. pere ware iutcarntases. .It.aevepea, wevr
i.e a p io .I. ti.
a ':,ci(.. ..,,. ,. .. '... .. : .H... : ... ,H., : .
. ..-vidwl .cages -willt appear... ..n.i to
ai..tM intf pl'tio will b.I. :t


~iii
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.: .'. -, '. .. .. .. : :" : .:" *... "." : ..'-' ",? *': :: .. .
... ias.t nl.f ..:i ..
.. ...a. s.~so. a ,e....a.b.t his .....

inamtter,, all schools: within tbi. ls cir 1' i sf:
tm... doased ati account of:- orcrow in -' :
.* ."' : .*" : .. l .." .. .i "'*
Stasbs Tht old question of stabsicnseinconnetio
*. .. .. .. .. .... .
has roai ep many times .since thefrte ofMayn*
intention, -tn.. have all stables with the t.eeptiotb j i..
Repablic.of Panama and thi Panaa. Rair d..:cse
owners showed 'heir books and the large sums of i
buildings: and. yards under the direction and with.a.
previous health officer, it did not look reasonable, f
able that they should all be required to be k I
having but little trouble now from fly-breedinsg s as r
conditions, and it is- hoped by the beginning of nait
there will be no fly-breeding places in the tity, and
sufficient fines will have been imposed to force owi
stables but:,of hotels, restaurants, clubs, stores,
the fact that cleanliness is cheaper than dirt. --;
Man--All manure from the. stables within-. i
being disposed of at Pfena Prieta--fiing in; this, whbi.
cost to this office, is a'great, waste .of valuable mats
system should be devised wherebyt'his very .e
eould be disposed of to the gardens around the city .
'- '" M-" .. .. .* "':' ::. :?l : : i
Examination of food kandeZs.--Three hundreds
butchers, cooks,-waiters, and food handlers, barbersed.av
were examined, 348 of whom were.given a license t&
work and 37 ordered to Santo Tomas Hospital.for t
,. t reet ceanin g.- This work has been well and effih
inspector in charge andhby the men under him a.dti
14 the sot creditable manner, as the genal. cni
j : ". ...' :" '. ," .
o J'the city of Panama will compare favprihl.lw
.of. iMi r.size anywhere. .. ..


G47b"ge ,olict.n and...disposale The cuta t .
change frQmn.horse to. .motor coareyawnce.f.
red action i cost and increased efficie y ..
U': :... thie 1st of f December, with tliwk .";
'" ",' "," .'i: -l,'^ c "n I, I,.," ., :"" .n ."n, : S. "JI "IUh:1:E.J [















* .
Ebbul
I
.. V


~phylt
i~imcd 4


.0.h ofP:ecmIxr.this office was directed by they
i.dH.c.ntjiflue ,.is miethod-for t'he. season that the
tto -used Andshould be utilized for that pur-
iitber li tha management of the ininci;tor plant:
the diretironi of thli's office,: under orders from the:


i .xf. -
in fun


*1.


-Under Dec
Le 28, 1918,


ree No. 12 gf the Municipality
this office assumed direction of


pihhylaxis problem, establishing a..prophylactic sta-
4i eth Street. and attempting to conine. all prostitutes
| within a 'give n area. During the.period Irom.:July
i5 i:.there- were examined at the prophylactic station,
which number 4,1.92 returned to' the station.for prophy-,
te : During the same period there were registered at
.Hospital 539 women. The .following statistics on
d treatment of prostitutes at Santo Tom as Hospital,.


: : .
*:.. *. L* *. .
*

a aons,. JuIy 15
i!Art~ treatments, *


.1
|Eifia .taken, Ju

..o h tspitl l

*l rea ted in.
,gI, iea, 7 4,,
reportedd I
2ionf :ectiontl
.H..4 .a: .
E': i: t ,,
B ,, ,, ,, 1 ,,
, i ,* '* "


to December 31........ .,....
July 15 to .December 31,.....
uly 15 to December 31 ........
ly 15 to December 31....... .
to December 31...............
July 15 to December 31.... ..


Si .. .
4 T. .


- 2,694
568
. 178
.959.
5:,514
9M'gB


hhe hospital,. 152 were treated forsyphilis arid
ving 'been treated for both .diseases. ....
Sphysicians .in the city of Panama 82 icaes.
and 25 cases of syphllis.
i ,, ', ,


LTON


HEALTH OFFICE.


fIt- ^^opewts.--Many permanent inpt~vemn
:e sainithtion: have been- ma~di duririg thJS "ear, .\
^dfailic filling of the large swanrtps along the a
., ,j: /h. .. .** ^ .i : 3 ." ,^: : C Ift. ^"
ndoi~rrlri: 4ro'ad ouhrk*iihi/'tairo o^aof -h-(ri


4ents

L*iti[l
dAugS
dghtn~


.1-


"asa "..A Aakto Field, and FrAnce Fieldd t f iJ i
athp!- gritid: between Ctlon Ho pita and te RAd
e: i i6"g c t e' swampy area: soutt o Fiffteenth' .
...' ". ". *.. -'... ...
de andfthe erqction of a moern ..abattbir oft same...
..C... eipm 'e larg6 swamp nctto Nirh* $t
Cdal w d:Q Streeit is b............


.' .'..


?111;1;


.. i 'i'iii















I ..
. .. ...
* A .


. ..
":.'' :i .. "



* q.


w tsi`a as r i. 5 .& r S AAi .tI"iI" "'" t. .i
. ". ".. ... :. ". """ ..' : : r" W... .. ." : t .

... ..... .. -i rl .. ..

I -. l ...: -. .. .
to e.-. t ..tt -.dist .h-a
i .. ." ? *. .. ..., ".. I "i ..1" '" .. ." .it
i, .. ... I 1..

Fort Sherman -have .s...e.d o. rom mat t
.F. t,, :. ,..., .' .- ...: -'' .,.I' F 1 ";"" ';"" "" 'l.


Ti,- ...... o -
:- Th "n ,of... .. ite ..d gh d


.,wh ,ic- i. we -' "'. ..
Tgareusiois. -'Eheb number of ;cases of' tetio


the calendart year was 1
Shouies t4he discharge Of


I06~


The adag6sted


.. .... "ii
..............


uncured cases fromtE
1X LItLlLtS' AKUl A. Lifti


oF rodn and .thee eonomie status -of ..the "pphii
Cotewnianke it a very difficult problem to detlwi :
arsani-tarirmn for the 'isolation of all cases of tuberc.iio.
;* ~~.. ** ..*


need and would -go far in- solving tbe problem
a .-


Uther.


communicable


diseases


reported


.. .


t~o bec~lorrre epidemic, )
:T'fre t:ypfioi d ~as re s ~F~vare ~jmbablgr dak to ~iag


; abs~dse ca~t~iers.


Slsgsp~a~bhng.-~bi irdrk: f;cPs beensarr.~

~Ilei-~Isioa-oi a s;L~~ta~ insFYe~o~ I3~Ub~JL1~6~F~


I PA~~EljaiE ~t~ree~s di'Lt-m~ ti2e; ~yea~t.


r
cr
:il


- I:%s


F~tsli~i~-u impro~e~t~atn~ ihe expe~e ~%~EC~)!F;s:f~i~t~

~itth ~tT~e No. (I, SanStary R~u~anri; i
~$4%r~ numt~t~er of strajr and-dise~sed c~i-s~ine*9~


re~uc~d dpring t:
r* sji~:, ~i~~ rC i~- ~irC


~fiii~z~


~e~l


*k,


--


' .:' i


R!:j


S:i:.


~5~
~liii~j


~ u;


: :i~mi:
:::': 'i:::
i.:, i ::


r.


:: 4~1E3i~~ U~ ~irlLliCi UC;~PI~YI~Z~ Ui~tl.lii~~i~: L~C iYF;&tly i(;~i:l :::: '1.
Ij~ss~'-T~e 9t~tema~em, p~m~;p
? j ii
.li ~. L, i'.... "'; '' P;'x:i~i


-*


p


tj~hols;
me9i~i~iit


chicRe4-pQx,


i pneu monla,


whoopkp;


~ough,


~3~2fMPS,


O


Ilprtihalltnia, 4;. te~inus, .. ~r' smallipox, B~S, triber
~m~l~ox.-~Five casfs of~ smallp;C)ix wei~ ~e:


to 31:.


14;1I ~ere in same locality and alI from sa~ ~i
IU53and' Peo~le in Co;l.on have b~en


, .. -h


~t-~2ire~


m


; the


i


*. I


,& r I


mon~hs.


past 3


The~;':h~s been no epidemic of srqr sort:
snmallpar cases orjginated in Panama: Cityaad as-:Reail'
in Calo~~~iad~pratiousIy been vaccinated,'~lrere PiF"41~~~D












.i a. i... .. ...
.i. 'ofiep ..- ostitutes, 90 er cent of them
ae.al-: infection s.. Te' last emxmination shows tihat
"u"ectedat'present" Two.of.cers and eight enlisted
: a Corps were plina charge of tli venereal
tions. -- O r one hundred doses of asphinemnnn
tfintc. Minor operations and treatment of chronic
"j.do in" "ru tze.lm. .- .
District was reduced from six square' blocks, tout ,
".:.i. .. ..=... .. a
nwas placed .at each, corner of said block night and
iedld enter the district, without a pass issued by the.
in .-order to secure said pass the applicant wopld.
t.to aq. examination for the purpose of disclosing the
bence ..of' venereal. infections. If found infected he was
' tment for sain and instructed to report to some pri-
flfor treatment.
g.ia, Coldn lies been. satisfactory,,and much good
omnplished. Colon was made un rofitable .for aprs-
tradee in And .as a result .many left the country.
institution was reduced markedly.
:T general. sanitarir conditions in the entire: district
.an ever before and with the completion .of the many
n..ovenents now. :under way,.theoperatins of this
o t. becoming yearwilibe greatly facilitated..
... ..............* *. ,
.. QUARANTINE. .-
iWin 6X protecting the Canal from imported disese retimaias
ia me as the preceding years for two major diseasens,
ge an4d yellow fewer. In additionn theexclusiok of
nengiti:a and infuenza haveretquiired an enlargement
.. ..
. been. xeporte or is staspect to exist a g: prctica
* wst.coast ofSo.uth America, except gth souther part-
-M rdittritag-~.year enhde:d:alonwig t;I coast nonhrta rd
Sl intQ --the interior aid. no adequate eazsuzn ar9
Sth at ed or threatened- districts;
rprs .jt fretteatly -omitted acall.
.wAi-m coqwlt -of unsatifatory samiturYHCGifns
...... ... ...le etade from these ports .ceiard.it eina i'


H "




















ecoughy fumigated, steerage and crews 'quarters washed
lii 'steam, followed by bichloride, and allowed to proceed
from all members of crew were reported negative.
! ll.quarantine station not being sufficient, the adjacent
1l the Mafiana Club, and the Chinese detention barracks
.cA small hospital for the care of the active cases was


nhgrattnres of all patients were taken twice daily, and all
e sprayed morning and evening with a 5 per cent solution
.i.-T. From 150 to 200 cultures were taken daily,
ebfIfg that ech. patient had at least ore culture every three
6,.i. as a positive culture was obtained .the patient'was at
di in tents and maintained there until three negative cul-
Sbitained,.or developed active meningitis, in which case he"
i^.Bsferred to the hospital. Happily no cases developed
&tire time of quarantine. Patients isolated with posi-
Swre.. cultured daily, and given a spray every three
" i...":;_.. ,
situation was handled by a gang of 24 Japanese
Sis.. gang attended to the grounds and the cleaning of the .
Tihjwere recruited from a mong the steerage passengers.
i spenary was established to attend the minor complant.
S tigers. his' was opened one hour daily and had an
0l:patients daily.
.. .: .'* o ..
I&t of the situation was enhanced by the fact that over
of the patients Wire. Asiatics, and there was a lack of
I strict isolation was maintained from the beginning,
jitthe spread of the disease outside of the quarantine

optioneption of the cases of smallpox aleady mentioned in
.* f maritime quarantinable' disease arrived at Zone
Sred. on thie Isthmus during the year .
. i :,:;.. : :.*:* .. *"... *" .. : '
..*.i : :"* : *..,.,":, ,,1,. ,:. *.. *.
...:.:. ." .. CONCLUSION. ..
* i.:' ": ":. :* *"if ::" "* > :" ..


III'


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Ir:


*..2


39238


47)~67


"
i 60808b
- *-




i: ..785
48816.










i .
iii 89






3 .*8
ia3176
m i


' -25


.9 250


41 am


~s~o 6


10.64


11,02 ___i


B.ISS






1 .04 _

5710 ___


8.11


2


tL


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is: I:' 3.'


I


11r
h I '* : i


--c~


a


m m m























.V

* ...
p
.ME".


.. .. i
:. HH **. "


28.49


1~908


1909


3S10
Jr

JJini


I wnem


345890


*4717


50802


48818


125.09


1 :7


1~~


24.S7


I r



i.







.


. *** \ H.


A2.46


50893


21.11


1912






1914


S.1915I


1916 ,


-91"7


,, ,


86654


44529 .










52589
--- _


25520


15.97


1L.22 ~


10.28







.9.65


113.19


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LA:


125


lTes1.


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I 3923~


43s90


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... 47167


'0 0a902


CI


648870


"iil
.:K **
",E::: .... ...


* A ,. ,,
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,. w *7 .
... *, 5 *
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fi: ." ..c


.614


821


424














184


s110
***--- **









76
a mm a



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A. "


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li .. :: ... **.
f *:* *. x:..: ..* *.


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..50893


.- Si 5A6AA
,, a m ==m
== ==
mmm mm= mm


44$329'


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:'


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-u


*. -i *
. & ,, *,- *.


if,.


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w5,57




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~Na f~!ntlionai iW


*p *-*-*- .* .



Awtris...- ...i.. -

Argednin.......

Barbados:........


* -~ '4

* I *


B~E~ui~a~.1*ft


* a' a


British Guiana...

Bouds del Toro .


Chile.-..*..

China-.....

OdImbia...

Cst Rica..


. .


. ...

. -


. -i


. -. .


Onraa. ........ -..
u a ao. .. ,,..


Demierara ,... .......

Domainica...........

E _uador ..... .....


ag~d.....

FoPtune Island.

France. .......


Germsxny..


Greee... ..

Grenada.......


. *


. .


Guadeloupe. .......

Grand Cayian Island.

Honduras....... ...

Haiti....'. .. .


4-:.


i. .. --


Holland ...

Ireland ....





~n~d~: .:6


I. S.


H::. Montse at............




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r Ma r t i n i q u. .. -






. ." ".- .. .


i; .. te r ra . .
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. :.= .
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:..... : .. Salv ador........ .




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li:" :". .
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5

1 .

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252

1

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1



277

2


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44

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228


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i.om the' United States:


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Hs ..,l. i we a
:. ..... .*** .
Kiii .... i'
(q..,:- : ** v
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H:::: : ..:: .'. .a .




...r.. 't *e United States and their families:

. *i *. *. ** .
, i* ** .


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S.... .....
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at eaildren born on Isthmus during year 1918..... ... ....

aMii children under 1 year of age...... ... .........,. ....

Ste.amitong Ameiican children (number of deaths per l,000brths)


.:: '.:x::: : :: *:* .* .'
*1u "* ... *I*
^XI ? .. .

I :X ,::,'.. .. .

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:-; ; =- .... ..-.


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: .!* *........ "

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a.*:..... .. : ..:. .: : :: *** :. *
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.. .... .. .. .. ..
. ..... :... ..... r.


death iste

pert1,O00

4pop tion-.


2.38

Let


4.4



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5J7


...... .10

. ... ~~

iii~ejm WW


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.


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: OC lonf:l..:.......

Canal Zoie...


4 j. A



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4. p a


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I.'


p i a.

-rL


Total .. ....


YWlar, 191.71
Panama. ..


.C~nlCoone ....

'..Canal Zone....


This!I


* ..s
'


. a C


"''. ."""*1


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: <: :-* -.. .. .


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:61. 69,

2607S"

22.,290



109,737


61,074

25,386

*27,&43


114.003


1'~ s' ,rfH
I.
I..


725


L8~28


2,728

895


.,4280


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it,:, L **Ii


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l .
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STota..


2,472

801


.4,103


2,943
" 6


4~6h1


* Exclusive of military population.


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aii ..
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.



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.........


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81,369

26,.078
22,290


109,737


6;1,O74

25.,386

27,543


114,003


*1' I


- BirtfhB.


**

'Male.

.


1,205.
r.1..


1,976


1,418.

446


2,.13


unle.


1.0


J1,852.


1,354

462

320


2,136


-Totr!.


2,308

-70 5::


3.;828


2,772


.4,349.


I. 'Death'

aqgngi
Children

under 1

*year of

Sage.


667


85


Death

rate per

.,000
births.


1i'


a. H,

Hi
11i


. 179.18
..1. 11.,,








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h

S241.:3.

245.14
i 10.88


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M:alaia fever e vltna -.-. a .

Peniii*ios uuilaria. .. -..* *-.. b

**-* *- *- *-- *
*m co gh-.. -.. -, ...,.-

0ip~ttteiria-..; ---.--.,,,.-.- ,'...-. ,:.. .
Inftuea. za.. s :r .-.-.. .-

Baeatery ~..-/-a-..,,.... *........;..p...-... .

Pulent infections and septieaemjia ............... .
flgus.j01v -. -a --..a *





'ubeur -t.s. .nlNlarr........ ... ... .. ... .

Sept*emia ..... ..

Tblr*mosis, military .U..*-a* ia

Tubterculo~is ienengitbe.....s.........
Tutbermldosoai of the otber organs ....,...,,,*...

Dissemiinated tuberculouis;. :., :.u ::-..,;..-: .z

Palmonary tibeicilosis. -.. .............

Rickets *****S*..,*qS : I:*. : -- I

Syphs, pmrmanery ....;.e ,-..,w-... .,..,-,.-

hereditary .....-. .. .. .,.,,. .* .,,

period not stated..*....*....: ::- -....::

Leuhaezia.. ....... .................*....

Meniineis, timple.n- n.. .s........ ...... a.... .
1eiiiij,.R lIIO OC I *. *













Mtam. .meumococcic ..,......' .......u.....

Ioeninegits, ierebrsapinml .. -..,-.,....m-.m. .--


EpI~ i~epr. a..*. *......... *..... ...-..i*- ..- .

o nulsions of nfants.... -. .. -.., -. ..

Clhorea \ -., -,,,...,...,.,,..
Diseses i*"













Disease bjoit~t eyes and their annexa..............

Abice endciarditisg..... ..*...-.**..,.,... .. .-, .
O(rganie heart diese ..... .....................

Disease at ;te lymphatic system .,...., ,...

Hemorrhage; other diseases of the circulatory system.

Acuti~e broinch~itis.. i ......,. :.-.,.. .....,,.,,.,.

Chronic .onchitis ..... : ^

Btroaho pneumonia .,....,-...- ^ -.... ..-...--,'.'
1Bita prenimaia.. ........ ............... .....
-.pl e e a w a .. S *


Elupuitn Pierf~Jiod no -t- te. *. a a .. .. U .U U .

















Pneumonia tmijmaified. ................... ........ .

ilmnjnar ongestio -- ...,.. .. .. .. ....

a j a *. *. .-* .- .. ..*e ,,
--
-* ..











Qther a..ease. <. the respiratorysysten.i.............
a a.- U* ** *. .. .. *a *.* .a .. *... *..












*a. e- o t phary x........ ........ .

Diue ases ofj es..,d,. e .r............. .. .
.. .^ -- -* ,' j ^


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caOsef ao D4ta


gCongenia mualfJrmatian

Newbo. child. ..'. ...1
.Congenitl debility, icter

P l iatura birth...,.

.Cmngental debility -....

SAtophj of iatanta.....

Malnutrition..-........-


s ....... ..a*,.


us, and scleema... .


. a* a*


kx. .rr.
.1

V..


. .-a *.


. -.
...:.M


. .


Other.canes peculiar to early infancy.....

it.era.al violence ,............. ..... ..

Cause netpecified w ill-defined........


> Total ..... ..... .... .**. .


. ...


vim.... :.nn
HF j P
[.i


I6>


327


C..

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jj: *:: j& 4,( dl ^
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Dieaae


OGneral diseases-Contianed.


Tuberculosis of the lungs..
Acute military. tuberclosis.
Tubedulous tmeningitisn...
Abdominal tuberculosis....


Potis disease. ...-.....


- -1


Tuberculosis a bones and joints..
Tuberculosis.of other organs......
TuberculoBeaspf theuskin.. ....
Tubereulois bf the lymph glandtt


Thlerculoess


genito-urinary


orans.... ... ... ..
Tubemr ous absess.. :......
Diseminated tuberculosis......


Syphilis:
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econdary.. ......
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Other tumors (tumors of the female
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Acute trtioular rheumatism. .......
Chronic rheumatism and gout........
Arthritis deformans................


Scaurvy .....-..
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SB8imp:iemeningitis........... .




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Dijsees-of the ears...... .. ..


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Diseases of the digestive system--
Continued.

Intestinal obstruction..... ......
Other diseases of the intestines...
Constipation...... ......... .....
Duodenal uleer............. ......
Hydatid tumor ot the liver........
Cirrhosia of the liver.............


**.. *..
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Simple peritonitis (nonpuerperal) ....
Other diseases of tbe digestive system
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Bright's disease chronicc nephritis)...
Other 'diseases of the kidney and an-


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Pyelo-~ieBphrosis...'.... ........
Calculi of the uiinary passages.
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Absceas of liver unqualifiedd)..


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Nonewtal diseases of Le genito-
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Other diseases of the uterus..........
M eriris ..... ...... ..............
Cyste and other tumors of the.ovary.
Salpingitis and other diseases of the
female gpnital urgans....... ....
Nopuerpmcal diseases of the breast
(cancer excepted).. ..... -.......
Benign tumor of breasts. ....


The puerperal state.


ts of pregnancy....


Extra-uterine pregnant


ey:...


.rypremesis gravidarum ....... .... .
Abortion........... ..... .....
Puerperal hemorrhage, .............
Other aeuidents of labor. ..........
Puererpral eptimia ....i.... .....
Puerperal albuminmria and coivuNiones
Eclampisia., -.... ...I-. ...*..*.


Puerperal phlegmasia alba dolens,,
Sembolus, dtiden death... ... ..
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Diseases of the skin and cellUlar tissue.
Continued.


Prickly h at ... .....
Ulcer of the ]kin.... .
Impetigo contagiosa....
Urticaria....... ,......


. ...


Ingrowing nail.......,..... ......
Other disease of the skin and annexa.


Diseases of the bones and of the organs
of locomotion.


Diseases of


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excepted.... .... ..
Caries (nont tuberulous)
Mastdid abscess.......


(tuberculosis 1


, Osteomijelitis :. .. . .
teriostitis ,, ...
Diseases of the joints (tuberculosis
and:rheumatism excepted).......:..

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S Synovi s. ... . .
Other -diseases of the organs of loco-
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Afections produced by external causes.

DSuicide by paoisoning................
Suicide by firearms........... ..
Suicide by cutting or piercing instru-
m ent -. ... .. ... .. .. .. .
Poisonia by food.......... .......
Other acute poisonings.. ...........
Venomeneubites and stings... .......


Conflagration ........ ....
Burns (aon tgrationa excepted)


.


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Mauatiamn bw firearms ......
Trim t" .m b.y cutting or piercing
2I1tEm tIl fltU .... ... ... .. a......:
''rauinatiin fall.e. s.. ..........
TraiamAtiii Iby ma1hinee.S...........


Traumatism by other crushing,.
aurtadt traumatism. ........


Dynm it traiumaism... .....
Tram by landslides .. -
l naes byti aniina.. ..........
StLyatiOn... .....,.-.....-,.


1ffeat of heat...., ,a,.. i.
Me00t ef.hes .. ...............
Heat eiiiutien .. ....
Lightning ..-U ... .. .-
Ele tirrty (lightning excepted)..
lomiuide by .frdarass, ...... .


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-~ c
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f~rs

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I H


S.'


u;
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4
.$


-- =I ;


*


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II


I 'I


























HH~
r
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EU.
-~ I


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,~.tH H ...

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r:* -


4. :*: v .
I* -
Lu*". **..


.1


;.I

i~;
IA--..
Fl);:


iv-~


. .


A.r

'H 5r
W-
.1









I.... *


p.



5
H~i.*i

iLmi
IpS::




*i.


V


Deati


White


I I


-S .

:f. ,. I I. : .


*A* 4* *


Black







I.
m.- 7 .


-I-


. .


i i


. .


NTnmrdentf.


Dimeharges.


White.


a


. d* *


S i.


I


- 1


.r -


....


SB m


* .


. .


f *.


Black,


Deaths.


-


White


-I--


. m


I d


i *r a


S- m


*P#
Sr il


L I:~


4?


. n ..


.4

';rI


.*i*
;i*4;


I.. AL..
- N...


I '.. H


.~H~j~iiidI







i.E


* ..'


: .~.4. 1.
H c


Ili~
8;iEI





II


Blsalr;


I ,.


-


S .


|



















r~cafl


'U 1~1DWaa3nnps'


- I


. .


m?...

. ..









: :... i
!i':.' /:.

il::. *l.
*H.H
Hr "


:it" :'^
^*- .


Total,....


Corosal Hospital (insane):
Employees..,.........
Soldiers .... ...., ....
Panama: pay patients....
Other pay patients.......
Charity patients........

Total.. ..... ,.......


V j


Grand total...


Corozal Farm (cripples):
,.. Employees.. .* *.,.

Chronic wardi
.clarity at ients...,.


S, residents:
SH pital ...

sylhum... ,


* *


C olon hospital:
". employees.
S ld~iu;,


I., ~
r
A

it
*


* ..4 .


* .AJU. LL .s. .... .. ...
Pan- af pay patients.
Other pay patip.,nt....
..i. ariy patieita......

m., : ot ];.. m .... ...


Pi h Seco- Leper. Asylum:
P* anT.Tm. ne i. fiL Veci


Re..Remain :
*. : ....I g '

:,
'" lhJ'


.. -~J


Admoi~tk~e


S .


S..757
4,124
.. .
1,324


6,541


. .
DR~1R


J


927


* 0

6
5;


6191 r


"i:. .. 'H .
I, )' Ji:
m li
* .I


..A",t *.*


'* .


---I


S.. .H- I H

- 1
* .. H
:a-




3 "- M:...
Sd .. .
*iH





Vi2. ^2BW44


i5 Pt



Al Ir
5.. ... .


- -ix i:


i. 1 ",


:iiH










KI




:U..
*i
eHj:
441:i


I t


1,458
,. ,484

4,685


16

85
13
27


4,826


. *


~ 38~
50'
11


18!


'F


I :


479




58~


iI 12'


m ..


Ancon Hoepital: -
SEmployees....... ...
S oldi ers....... ..... .
Paniam pay patients
Other pay patients...,
.-. Charity patients,,.-..


2081 2,:739


, <


:.


.


- .


~~' S'~UB'l~wE



















0li^EfSES1iri 'LREPORT.-Continued.

*.au ut mB)Boas mawfArr B)=Bs


Sr ,emain-"
; rasn- ing
fre.... Deeminer

S. .1, 1918.


A. B A. IB.
2-5-1I3 92



2 -5 .31 "23 9 225


.1g..
L iI.

H:: .!:VL -:


I. .


I -.
.:
I!


HI4: **
1w rr
:d ', S


* .


*. .


a. :


p .


I* ". I: *


.....
*HXfl : -
.IM .i. *.
S..... .
SEi ".
:i .. ..:. .
....' ... ..


.. .


i li.....l ****


.flfl.JinrA ***.. ..


* 1 -. .. .
E **-: "*
H :: .
."X::: :: .
*:* *. .


. .


Si *.. '.


. .


S. q .I t .


. i.4 .. t ... .

.*. I .* .. *
:.- .. ..



.I .S .



. .I*...*
".. -. .." ... .
: .... .. .



.. .... .
' .. *. :. *


I .


..i. .


m mi


i" I


EL : .
..: C.. C

... i
%... *a.


--.1--


1 .I
-3 .

3 61 1 8


-i


471289


... 13


13 77


192 124
----*


-
-


f* iJ 4 *



1 3 ..-.
58- -
- .-


3 .-.. a *
.-
- -



7 141 -1

L I... 7

58: 3g .9
2 14
S-a -
.80 225 21:
-


- I 1 .


,.


Average number con-
stantly sick.


S- -J


146.21 140.99


. ..I i .


275..s 07.29
3a.983 24 .78


177.70 233-28


K


'0~.-l


210.48
4.84
69. 00


294.43


577,71



*40.551


30.75


*-. .
.1
. .




. 15)05


2.05
14.47.


A i


L Cf a... S


Total.


308.39
127.59
.22
129.:6
S42 .0


608.30


I3.87


265.07_
8.84-
179.32


374.21


982,. 41



47.08
.



30.:
g ti
. *




- I
"* "



" i

h". Hi "..


: 2.35
0.2 5



d if
30.25 a


a: .yg:




. *.' wa on


t."


*



.
.


S. 1.
..... .. *:...



... .: IIB ,


pti
^tients,.
lhafieat.- ..


~


r i.r ilrrllr


: ::I


.


i


...




















I .. .
i", *"
a. ::. *





I'. ..: .
.*::


S::.:** : *
H. .
l :. -* .
t: : '** *


.Hv .




.. .

S .



.' : .. .
:. ". ". .



. .
" .. ...=










i* :" .
". 'v
...i .


f W; :A
~~I:I j


""1


.. .-:, *'. *;** .
/ : ^ 4. ^ .


K


Ancn.


. '' *


ioa *. --.;


Paniao (i .
Gamin (*E)


Gatuh; *-..
Oristwal ..


.1
'* .


'U


w
I


-N-. *

* *

b. q .
* ..4 *.


TutIL....


.4: ...E. ..:H t

Ire .. *. ..
I'. .' .I??) ."
*i .
Ad- 'I -r i .. *I i\.



ol. :2~ :;''



*. 4.




4t: ?'


1 'jgj.




*.. .. .v' -1' ..? Ci U..
54P Si..1... 129 50 .34*::2i:.i
rL ". S814? I.~~z..l. sll~'~o



'I
I __ __ __ _


Au./L"'CASs TmEED Br NKoQT ErXCSD.


.11.


-;i

4..~~.~ .^ .~ V,9
1.*. *~ *~~e.*Ii 6P




IiK: .. .. .ssutgxa. *.1 .... fh40
*8:~ BSD~.1O ....b...F 46152





I.I


.I~rH, I *. A ldfl

,.....V .
z..' .. ... .1
.. .~


hj*'

..!
I. q.. ..
s r.. .
Hr......ii ..
N.H..~' ** .H
a .*A.M
S. *
H P .ii I I. .


~mp~oyeas.


I


43.,743.
31,.785
24,570
8286
2,571
10,747'
48. .A *


* !'


Total.


771,937
-42,214
11,315


&2,985


20,978


.NOnemployees.


1I,1944
41,639
15,3277
1,98?
250
6,117
15,385
4

02,W9O


insekd,
dc:esq


23,990
20, 941
15,200



7,758


Total.


188~3ia~


*4C -=p
...

.. .. h

. -- =": ""
7* h. **
"H HH


*I .:. .. e
.* H: | i ':i.

.*"* ...
* : l.' .. ':: i


.. ~PiH..
A*H jI1


-4
ectina M"i"14, l 4



S..". .
.f. "i ..
.. ". .' .i .h
*** : *.' ** :: ". Ki i.

*, :..l :*i.*r'-*^ q
:- .. S f


;I


i


SI. ''::.


*


1 .






















.K H ::a p.:
itM": J jki'


M tl nhtstals and quarter.


2. ...
I..: : ...:. .


* ..i -i


- '.4


. i *.


S..
.IV X~~-


1.:


L i."'


I F7:r .;
.5 &


*" ..'>.


\.* *, Mi


iT i S p *, V> Q


quartet.


-


.~ .. S**


I. .
.... .. *
.os employee ,.. ,,........ .......

*:iR .s t. *.pl

b-i-theuuand-Anpleyees to hospital.


.i .." .


. .. a a .i *. .


~ ~C: ... .l .. -.
!S!P.


. .. .. a


i i .


*. *.318* *

.4,505
... *.
13~,823



415

.I,408




;..187
.. 4505

5,692


;5,514


1,254...21


'D~lisk.


* I.i.



347S,'~





7,1


3.,268
1,778

5,046
i


47'.57


231.06,


TGEal.


15,251
6,283

21,534





30,i68.


.I


p ': i


A..
ILd






*Hi;

'ii


4AISH.
6.283


10,788


10.,271


405.-fl


Feitd between hospitals ,and
wheoa.dmisions:are dupli-


Sew mpaoyeein...s .... .. ......i
red betwkeo, hespitals and from
3 ..whose adaisions are .duplicated
.* .-** '*