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

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REPORT

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artmen

Panama

FOR

THE

CALENDAR

YEAR

1923

-I

FIS:

Colonel, Medical Cdrps, United States Army
Chief Health Officer

Canal

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For additional copies of this publication address The Panama Canal Washington D. 0., or albos Hei

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CONTENTS.

Title.....

:, operationn and
? N Feosnnel.....
:;. Vital statistics
SVital statistics
Vi~al statistics
Vital statistics
Malaria... ..

Page.
1

organization......

regarding employees only....... . . . . .
for the Canal Zone, employees and nonemployees
for Panama City, employees and nonemployees.
for Colon, employees and nonemployees.........

. .Mosquito control...... .
i ,.. Antiplague work.. ..... . . . .
:,; Fly prevention... . . . . . .
"'iTyphoid fever .....
. ifant mortality....... .
'. Physical examination of school ch
: Health Office, Panama City......
:. :Health Office, Colon-Cristobal...

.:Q rantine Division....
..Ancon Hospital........
,..Cbrozal Hospital......
: Colon Hospital.........
. Santo Tomas Hospital..
. Pal t Seco Leper Colony.
:Board of Health Laborat

craT~bles
.1

ildren

* . .. .. ..
* . . . . U .
* . . . U *
* . . . . .

* . . 9 .
* . . .
. . . . .
. . . . .
. . . . .

..U .. . .
. . ... .

orv. .

[, Discharges from hosp
flofyeJPPe s

itals, deaths, and

noneffective rates for em-

V.J W . . . . . . . . . . . . .. . . . .
Causes of deaths of employees by color, age, and length of residence on
Isthmus .........

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V.
VI.

VII.

xi.
SX.

X;
XI.
:XIl.
XIII.
::!

Deaths of residents and death rates of the Canal Z(
of Panama and Colon .. . . . . . . . . .
Deaths of residents of the Canal Zone, and the citi
Colon, by cause, sex, color, age, and residence.
Deaths of nonresidents by cause, sex, color, and ag
Deaths by nationality or nativity..... ... ... . .
Statistics regarding American employees and their

Births and birth rates in the Canal Zone, and the
C olon . . . . . . .. . . . . . . . . .
Infant mortality rates in the Canal Zone, and the
C olon . . . ... . . . . . . . . .. ..
Deaths of infants by cause, sex, color, age, and
Cases treated in hospitals. .... . . . . . . . .
Consolidated hospital and asylum report......
Number of days hospital treatment furnished v
tients and average number in hospital each
D isnensari es ...............................

H*ii*XV

citi

mne, and the cities

es of Panama and

;e, . . . . . . .

families. . . .
ies of Panama and

cities of Panama and

place of residence...

variouss classes of pa-
Sday . . . . . . .

...... ... . 88

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t.
H..

88

immm d

IIIIII

.

Balboa Heights, Canal Zone.

SIR:

S0F

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HE,.
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1 have the honor to submit the following report of th op"
. n .' .

nons or the Health Department for the year 1
'
923.

Respectfully

S.:H. C. Fa1

Chief HeaL

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District Dentists at-

Cristobal.

Gatun.

Pedro Miguel.
S"Ancon.

Balboa.

La. Boca.

Division of Sanitation-

Panama Health Office.
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HEALTH

OPERATION' AND

kDepartment operates under the direction of the Governor
ma Canal. It is maintained from funds designated for

Panama Canal appropriations, and revenues derived from

Ltions.

It exercises jurisdiction in health matters over the

mnd the cities of Panama and Colon, Republic of Panama,

operatess

with

Panamanian

her parts of the Republic.

zation of the health department consists of:

Health Office, Balboa Heights.

division of Hospitals and Charities-

Ancon Hospital, Ancon.

-Board of Health Laboratory.

Corozal.

Colon.

Tomas Hospital, Panama,

Santo

h iffl-re

DEPARTMENT.

ORGANIZATION.

Government

health

Corozal Hospital

Colon Hospital, I

R. P.

Palo Seco Leper Colony.

Dispensaries at-

Colon Hospital.

Gatun.

Pedro Miguel.

-Ancon Hospital.

Balboa.

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PERSONNEL.

HEALTH

OFFICE.

Balboa Heights.

Fisher,
. Curry
Fessler

J. S. Army, Chief Health Officer.
Assistant Chief Health Officer.
Office Assistant.

DIVISION OF HOSPITALS AND CHARITIES.

A necon Hospital.

Army, Superintendent.

S. Army,

Assistant to the Superinte

Earhart, Chief of Surgical Clinic.

, Assistant Chief of Surgical Clinic.

(December 31, 1923.)

Roland C.

William

Connor, Chief of Medical Clinic.
. Braithwaite, Assistant Chief of Medical Clinic.

Capt. Henry E. Keely

Army

,Chief of Eye,

Ear

Nose and Throat

Clinic.

Dr. Ivan E.

Leroy S.

Hix, Assistant Chief of Eye, Ear

Townsend

Chief of

Nose and Throat (

R4y Clinic.

Physicians.

Lieut.
Maj.
Maj.

Roger Brooke,

Henry L. Krafft,

Claude D.

Holmes

'II

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Army.

S. Army.

Army.

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CHIEF

Col.

Henry C.

Dr. Dalferes P

Mr.

Arthur L.

Col.

Lieut.
Capt.

Pyles,

James B. Anderson,

ent.

Troy W

Dr. Howard K. Tuttle

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Internes.

Dr. Cdric H.
Dr.i Ivyl C. B

Walter W

Dr. Mack M.

Otto A.

Nelson.
edwell.

Kostal.

Dr. Augustus H.

. Benton.
Shafer.

Foster

True P. Gottschalk.
Arnold L. Jenson.

Board

Health

Laboratory.

Dr. Lewis B.

Bates, Chief of Laboratory.

Capt.
Capt.

Virgil H

Wesley C.

Cornel

Cox

Army, Pathologi

Army

Bacteriologist.

James E.

Jacob,

Chemist.

Corozal Hospital.

Capt. George E.

Hesner

Army

Superintendent.

Dr. David G.

Sampson.

Capt.

Henry

Hayes,

Army.

Colon

Hospital.

Maj.

Thomas J

Leary

Army

, Superintendent.

Physicians.

Maj

H~.. *:
Hi:

Dr.
Capt.
Capt.
Capt.

Tom S.

iilliam

Walter F
George J.
John M.

Mebane
J. Levy.

. Hamilton

. Schirch
Tamraz.

Army.

Army

S. Army

Army

Santo Tomas Hospital (Panama).

Maj.

Edgar A.

Bocock

Army,

Superintendent.

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Cristobal-Colo 'ip'nsary.
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William

Levyi

Gatun

James A.

District

Physician.
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Dispensary.

Grider,

District Physician.

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Pedro Miguel Dispensary.

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William B.

Meares,. District Physician.

Wayne Gilder.

Balboa Dispensary.

Dr. Littleton O.

Harley G.

Julian R.

Keen

, District Physician.

Bickford.

Hunt.

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Ancon

Dispensary.

t.:
.:HC

Panama Heath Office.

Hen'ty Gbldthwaite, Health Officer

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Carppirow, Sanitary rhispector.

Irspectbri.

Inspector.

Morris M. Seeley, Sanitary Inspector.

Av Lewis

Vaccinator.

Dowd,

Walter

Olson

District

Physician.

Dr. George Eugene.

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DWIS~ONT

OF SANITATION.:

Mr.

James M.

Mr. Charles L.

Mr. Everett F:

PierCe; Sahi'tary

Qtiimby,

Dr. Henry

Sai.nitary

Vrederick F

Veterinarian and Meat InspG
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Ih, Sanitar Inspector, Northern District, Gatun.

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... lett, Sanitary inspector, Southern District,
.-L.Willett, Sanitary Inspector, Southern District,

...... ... ... . .
::': a

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Corrigan,

Sanitary

Inspector,

Ancon-Balboa

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Tolar, Sanitary Inspector (Relief)

Pedro Miguel.

DIVISION

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OF QUARANTINE.

Chief Quarantine Ofice.

Balboa Heights.
At

William C. Rucker,

. "
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S. "H.." .Al::.
: .

- Cristobal-Colon Quarantine, 'Cristobal, C. Z.

Dr. Charles A. Hearne, Quarantine Officer

Dr. William J. Burke.

Di. Francis L. Alexaitis.

"Dr. Ernest E. Nunnery.

Balboa-Panama Quarantine, Balboa, C. Z.

Dr. John..D. Odom, Quarantine Officer.

Dr. Philip Horwitz..

.iDr. Samuel S. Irvin. .

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Ancon.

District,

, Chief Quarantine Officer.

,......:....:.

.
....
....
.

Year.

1906
1907
1908
1909
1910
1911
1912
1913
1914.
1915
1916
1917
1918
1919
1920
1921
1922
1923

Average
number
employed

39,
43,
47,
50.,
48,
50,
56,
44,
34,
33,
32,
25,
24,
20,
14,
10,
10.

Rate.

1, 79
1,419
1.132.
887
905.
896
727
519
420
320
283
357
406
550
672
620
490
485.

admission rate to hospitals only was 155.90 in 1923, as

16.7.61 in 1922, and 211.20 in 1921.

The death ratefromall s.. .

.C ~ ~A z~A

Year,.

1906
1907
1908
1909
1910
1911
1912
1913
1914
1915

Average
number
employed

I --

,547
238
,890
,167
,802
,876
,893
,654
,329
,785

Rate.

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V.*

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For disease alone the admission rate to hospitals in 1*

as compared

with

139.47

1922,

and

180.35

19

A" .. ::..:

923 was 13* a
fh. .!

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The death- rate from disease alone for 1923 was
tb6..lai, 1922, and 5.70 in 1921.
The nnbofeetive rate, from aW causes, has been:

6.10, as

compared

:. . ...

........1910

" I1912
S191308
1909
19140
191
1912
1913
1914
1915
19162
1917
1918
4919
1920
1921
1922
1923

AvIenupe
number
e~iplo~ed.

,238
,890
,167
,802
,876
,893
,654
,329
,785
,176
,589
,520
,204
,673
,389
,447
.976

The admission rate for malaria fever has been

Year.

19084
1905
1906
1907
: 1908
1909
..:1910
wii
1912

: 1913

- 191
r 1916

I.-. t919

a

employed.

i,213

,547
,238
,890
,167
.802
,876
,893
,654
,329
,785
,176
,589
,520
,.204

Rate.

*l .4~

A.

".," "

Rate.

:ircii"i
Ic:
C.i
11%

::ii

I ,

1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923

0.46 in 1922

,213
,511
,547
,238
,890
,167
,802
,876
,893.
,654
,329
.785

,589
,520
,204
,673
,389
.447

and 0.33 in 1921.

2.66
5.57
7.45
3.51
1.37
.85:
.81
.84
.31
.30
,14
.23

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The 6 diseases causing the highest nuinber of hospital .ad..i.

with their rates, were as follows: *
S....... .... ... i.", :

Venereal disease s.. ... ...............
Diseases of the eyes and their annexa.
Bronchitis (acute and chronic)........
Nephritis (acute and chronic)......
Tuberculouis (various organ)...,..

4
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Y

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Ad. esic*s. R ate *.' Adjmi

28
134

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The

rates

6 diseases

were as follows:

causinIg fthl *highest Tumb
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The noneffective rate for malaria in 1923 was 0,55

* 4

J

X

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wn'r&te to hospitals and quarters for malaria was 20.03

Iryees, as compared with 19.07 for black employes.

.. ." r .
"_* .. ,"W E

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i""~ii .i...
... .... : **
HII-A _* B
W: ifi:"

: ate-.from disease .for

'ppjf

..::

. ASH

A,

.;faf. 14
!:r;I .. ...H...ftectea

Hi..l.. I.4i
: :. "I ". jG :: .: .: .:: ... . "" ...
eaths rfrom

:::::::: 18 J

i G' in :: ::.i:
.: ***...*' :: : m'.h
a..." ..:T'herew.

. :.. ..5. .

. ths.
i .. .. :. .. ** .
."' : :
...eaths.

i.".n .::: .. :" .::"
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::: ':: :U ": .J.:" e .
..., ohfc: w;. h

:: W:: a;, sed
I .Sr th. ..t

......H. of age
.. .... .. ..* ..
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I,1r I

2t3,463
34,095
*,4 036
67 146
76,900

, r, : *.i e;;; _e

FOR

NDD

THE

American

(white)

employees was

and 2.43 for 1921.

.CANAL

ZONE-EM PLOYEES

N' EMPLOYEES.

average population of 31

during the year

, as compared with 7.08 for 1922,

:h rate from tuberculosis was 0.69

0.64 for

1921

Tuberculosis caused

793 in.the Canal Zone

there were

, giving a

and 6.72 for 1921

, as compared with

0.74

10 per cent of all

disease during the year

3re 591

live births reported during the year

(See Table

re black.

VIII, page 77.)

Of these

Of the total births reported

xnong children under

1 9 were white,
on the number

white children

total deaths,

year of age,

giving a birth

206 were white

5 per cent were still-

from all causes totaled

and 34 were black, giving an infant mortality
;r of live births reported during the year, of

88.31 for black children, and a general average

per cent occurred among children

under

, and 32 per cent'among children under 5 years of age.

a table showing the death rates for
!3, from all causes:

Deaths.
A

1,700
1,708

.I1,025
1,251
" 1,385

1. 129

Rate.

F

*n 'A

I

Canal

Zone from.

.j. red with 3.27 fo1922,

of these were from disease

.... \

i

i

.14

.* : *.. ,," ..-.
* .:* *. .*. .H I
...
db...:.. ~ " ...

VITAL STATISTICS FOR PANAMA CITY

NONEMPLOYEES.

. mm

From an estimated oooulation

during the year.
18.08, as compared

The

rates,

6 diseases

59,635,

there were

1,106

Of these 1,078 were from disease, giving a .ra
with 20.66 for 1922, and 21.26 for 1921.. .
.;: ; r .rX

causing the

highest

were as follows

wi th i
-,, It :.
". -H

Tuberculosis (various organs)...............
Pneumonia (broncho and Jobar)......... *.
Diarrhea and enteritis (including colitis).....
Nephritis (acute and chronic). ............
Organic diseases of the heart...............
. Cancer (various organs) ...................

. . . . . .

Deaths.

Dedip~.

I.:

1:
;.J'. H f f j
;:Sr

The death rate from tuberculosis was 3.35,

for 1922, and 3.67 for 1921.

as compared wit.lif %

Tuberculosis caused approximately 18

cent of all deaths from disease, as compared with 18 per cent ini.19l

17 per cent in 1921

rate of 34.26.

infant

mortality

and 16 per cent in 1920.

Of the total births reported, 6 per cent

rate,

based

on the

number

of live

during the year, of 141.95.

total

26 per cent occurred among ci

year of age, and 39 per cent among children under 5 yi
Below is a table showing the death rates in Panama

to 1923, from all cau

ses:

..H I

r, giving a bzr*;
were stillbipt llhs;*
)f age, giFai
.. . ..i

S. births.
:i tl ^' J.L ^*!

.."". ...
weildre tillnUn&.i.

)ars of age.ii:H

City fro .]t)
births r *.........
......

Year.

1905
1906
1907
1908
1909
1910
1911

Popula-
tion.

I a

,984
,518
,548
,073
,801
,591
,555

Deaths.

,447
,142
,156
,292
,038
,446
,456
'An~f

Rate.

I o flfl IJ~

*. *:*'
v. :-. H.- ..
.L 'il.. .bi

:.H I::~

Hi *H:H I H
H
V.

,number ot

deaths,~i

There were 2,043 live births reported during the yeal

There were 290 deaths among children under 1 year c

deaths,

I

I

.fl.S.H : 'ar.:H~t *
iiP..
Hr. Hf:

K44~ k H H .1 ~

'ATISTICS

FOR

COLON--EMPLOYEES

AND

NON-

EMPLOYEES.

: w..on a population of 31,285;' there were 393 deaths during the year.
OIf these, 77 were from disease, giving a rate of 12.05, as compared with
3A1.4for 1922, -and 16.25 for 1921.
. 5 The" 6 diseases causing the highest number of deaths, with their
rates, were as follows:
mm a "id .V"

..:. beutosia variouss organs) ................
InDtinS. (bronco and lobar).. . : .... .
eplritis (acute and chronic).. .. ...... .. .....
nQrini diseases of the heart .............. ..
. .r hmmand enteritie (including colitis).... . .
nce (Vrious argna).. ...... .......... .. ...

* .::
. . . .

Deaths.

Deaths.

The death rate from

tuberculosis

was

1.92

,as compared with 2.55

for 1922,

and

2.30

1921.

Tuberculosis caused

approximately

per cent of all deaths from disease, as compared with

19 per

cent

1922, 13 per cent in 1921

SThere were
rate of 22.66.

, and 21 per cent in 1920.

709 live births reported during the year, giving a birth
Of the total births reported, 5 per cent were stillbirths.

There were 82 deaths among children under 1

year of age, giving an

.. infant mortality
during the year,

rate,

of 115.66.

Of the total deaths,

per cent occurred among children

under

year of age, and 29 per cent among children under 5 years of age..
Below is a table showing the death rates in Colon from 1905 to 1923,
from all causes:

Year.

*?- .. 4-. ....^ -
i%: *1996
-1908
t'. 1:: T
l'- .. to 8
-.' A. r 7
1%9 b

1. 910o
; .< .1911
?. r;F4

Popula-
tion.

I-t,1o76
13,651
14,549
15,878
17,479
19,535
19,947

Death.

.553
703
571
418
396
514
527

Rate.

.49.
51.
39.
26.
22.
26.
26.

based

on the

number

births

reported

r

I

Probable place
of ipetioan.

Canal Zane anitated
arnns..... . . . .
Cattle cam ps
-nd panptures......
Otjserrananitated
aeamin.Zone......
Colon...'. .- ......
Midiaelaneou. unman-
itated area out-
Bide Zo7.e .........

Annual rate per 1,000.

Rap lays~

Nunem~apalara

820 1,250 1,376
8.7911.76 12.27

HX
~i~diH

9T.1

'BC...

z White-Cases 57, rate 20.08.

* Military only-Caes 851, rate 91.87.

Black-Cams 15, rate 19.07.

Others-Cames 543, rate 87.

iiH
r. i:4:
:: :L.H!J

'Ca

Although the sanitated areas of the Zone are gradually being.
H

, principally

ditching

larger outlying swamps

ti

lands

* there has been a slight increase in the malaria rates.

among employees, yet the increase is not as large as might havtl
'C..

expect
poses,

ed. On opening the Zone to repopulation for agricultu
chiefly by former employees of The Panama Canal, ita i

that

, whatever benefits might. be derived

, there would surely)

tremendous infection with malaria, and that If spite of our preca4
in locating these settlers at a distance .of.a mile or more froi tlh i
e-..

Zone town

*~ThisQ

added
offset

s, our employees would necessarily be infi

has doubtless

percentage of

by the

improved

tekeni Uita case

irl'~oirsae in.stanci

malaria so incurred has: surely

economic condition

.the

ected foff

be "
pu been ...
popu.ltioi

chief reasons for the increase in the rate for employees can ri
:i .: *::
be laid to the facts that the Dredging Division has had exte eli'
jects under way in Gaillard Cut, necessitating night Work = i|
p : .,i.

contiguous

cattle

pastures

and

other

unsanitated
l:: *".

* Si -. .. - S.r

**
'a: jl

9.

!-"W^H

: ..ili
#,d:::::

'i" :

_A

",

m

..1

a

TO~t~18111111

d : ,

..a... ...
: *i... .. .. ". .

,,

..-:M& a te:.a
e fo::li ..
CI.. ,.j

i" . ": "..: ". ":' .
T heat e tel

i to the enlisted man's propensity for wandering about the

ill hours and seasons,

Naval

as well as

to the location

some

bases in-areas least favorable for sanitating.

w cases occurred among the commissioned personnel and
s. Many of the cases charged against the military popu-
ported as recurrent cases.

v-up

treatment given

by, the

physicians of The

Panama

i ': after the "clinical cure" of acute cases of malaria, to completely
lutre;r sterilize.them, is apparently efficacious in all forms of the disease,
.2:.arecurrent case being rare when the patient has taken the prescribed
"'treatment. This consists of administering 10 grains of auinine. nre-

'-

'-

A

ferably

liquid

form

children,

in proportion)

every

evening

* :before

the patient retires,

' fritn acute symptoms.

for a

period of 8 weeks following his

r

This treatment is practically compulsory

elief
for

employees of The Panama Canal and their families.

Upon others it is

.strongly urged.

While

t is difficult to state positively whether a case

is recurrent or a fresh infection

relatively few repeated

cases

the same individual make it certain that recurrence of an original infec-
ltion is rare, even in tertian malaria.
:-:.Thecombined death rate in the Canal Zone and the cities of Panama

- adi Colon from malaria has been

* "" 1906
' ...'-. 19 o8
... -1908'
19.09

","- = 9 -.
; ":1911:
1912
|;.:913-y

"" i915

I.....
H, ,,' 'A917

E "E : ".. .
,, ,,.

Popula-
tion.

I 73.264

. 120,097
135,180
151,591
156,936
146,510.
129,104
123,592
121,650
, 116,918
114,003
109,737

113,958
114,037
120,666

1

Rate.

9.49
5.37
3.36
2.07
1.89
1.82
1.64
1.32
1.27
.51
.21
..18
.18
.16
.08
.16

I-

iiUi

I

j -- --

~E~zi~.
.-r

Zetek, formerly entomologist of the Health Department f
Panama Canal, says: H
The big difference, and only one, .between it '(Tarsimaclata) and that s ..
- manus), is the broad white band on the palpus, thus making three white bands
Salbimnanus has but two. But this middle white band is often represented by oti
white scales, and from such a condition, by more and more white, until.the
tarsimaculata type is obtained. All such variations.may occur mina single. oto@
taken from the same place, and what is of greater significance, true anbimaust...
obtained from this same lot. This fact establishes the pint that tarsin .
can not be considered a distinct species, that at most it is only a variety of ..
There is, however, a preference for brackish water by arssa4
whilealbimanus will live in both fresh and brackish water.-"The Pacani,
Species of the Genus A noiheles," Proceedings af the Medical A ssocikdion .f ti iF
Canal Zone, Vol. XIII, p. 29. .. :..
The other seven (or eight) species of anopheles. -kibow t
-.. -.
in Panama (A. argyritarsis, A. pseudopuinncptipennis, A. spi
A. punctimacula, A, eiseni, A. neivai, A. nimba, A. hyltili
l g. ".. i..i... i
of relatively less importance. Although pseudopnchpan
A. argyritarsis have been expenimeptally infected withcmai&.
are not so numerous now min the vidnity of quarters, nor.d d ..
apparently enter houses so readily or Hy as far as theA.l4:
" :i : l" :" "::l'li

3I-E 3E

utP. na reus
*.I1o **. *" ." d *es-
: :.. : .. .. **
.......... .: :s:w it.
*"$'i e 1 ..". "

*Cii'.

.... :,.. ,,

p o:ce. practicable.,
SCta:d.., to divide x
iwc k. ulex, Stegoi
: all that were not (

JLUUSL

UZ1LL~

18 genera and 135 species.z

39 species.
Aedes and

the last

Ia list

9 (10?)

two.

ie mosquitoes

The

Culex are

But

days of

mosquitoes into only three classes for pre-

nd the first class in-
distinction whatever

abits of

ed,;

,tpid '-between

... *..y. H . It
.Bi ... ..limits

:::... .T I L
... ..1 i..c e ...
i..:B .."3C : " .. .
..... .. h
i::. * :: 'n .*.. ** "
il ". "" i iii ., ^
Indl:; inaicat
p... . .
H, Wi41
ri....t ..

ri'.""" ": : ". S..... .: . ..
Hatti, stra

..he.."Li a..'"

,,;.showed the pre
.UrEoaenia geon

arm of Miraflor

pheles
nail st

species

years,

anopheles

however

these mosquitoes,

reported

breeding

reams,

and

sexice only

with
and

albimanus

of A

erica) of which none were present in, the adult
Turning from the cattle pasture to an adjoining
res Lake, the probable source of the albimanus
Had the pasture been evacuated and oiled and

e been entailed

reports for the
pumped into it

nearest

because,

better

extension

pasture

by spoil

in the

appreciation
n of sanitati

areas

was

fairly

on

two miles and over from in-

these

effectively

anopheles
A search

as the

only

in hoof-

that

as greatly to impede access to it by a boat or otherwise.
* I t r3. i r r I 1

Thirty-one species of Wyeomyia

Anopheles.

re- harmful or especially annoying to man.

in the early

construction

nyia and Anopheles,

later

of control at that time, such distinctions were of little

'to areas one and even

it '" comes

necessary
9-

n order to sanitate economically
tion of this:

takl

minsector

e advantage
as well as e:

dawn and dusk catches in a Canal Zone town.

resultedd in the discovery and report that there was con-

in the
I the r

removed and

recommendd action

the' pasture oiled.

breeding-out

made

Further investigation

of hundreds of

pseudopunctipennis (associated

economic loss would havi

which has been described in our annual
4< -

has been rendered so shallow

i;

c.

In another instance

included

anopheles

Mount

Hope

4 ...* -E".. "i ";."" = .ggi
**** :..::* 'i
..* "":.. :: ::.
.. _. .. _j...: i* .
" ".x i i :
* .i i. .a : ::. : ....
at Mqunt Hope nthe adult mosquito .
fonly the. *pr" ".. ** a *l *.
Sonly t~he'p ure tarsmuacula i v=a iet :,

breeding as was occurring in the controlled areas furhnishf
.t" ". ........ i.... '":
and other less common species but no distinct arsmacuioa. itil
tinued search revealed that in a remote undrained corner of a. .H
.* *** .* i ... ".".

"S| A. H 3 W i
10 'Ifi
i lO lVhi

Anopheles tarsimaculata true to
This swamp is now being dr i

swamp in a former pasture,
breeding in large numbers.

which

of. the

district,

includes

swamps surrounding Cristobal and Colon at the Atlantic en

the Canal

we have continued

to extend

pasture lands south of Mount Hope.

the drainage system

The cattle have been

. . ....
. A **:il
*.: .:Fl: : '
"rHd-

from
from

the dairy

Silver

fresh and

sea-level

pasture of

City

brackish

channel

Gov.

negro

swamps

the old

Arcia

suburb
in this

French

, lying

between

Cristobal)

pasture have

diversion

and

been

on the

1r and '2n
the 16ow49
,A H

connected J
east-.anhd t i

French Canal on the west. Though these ditches may not achi'e
complete measure of success m dryng the lowest parts of the area;-.." .t b
~ ~ .* ,:. .. :i h :

will at least insure a free influx of sea water at each tide and favor: .
A : nf 11 X t :.r" "..
di tcl-- rib t-i n f\ the e p^r eai e~fcnt f eed-^^anin -mi nn-ro' ". l1

s r u o o v r s o ng n ows.

- - C -- - . :a gt",
In the Gatun district the completion of the drainage in the nor.th.
rt of the large hydraulic fill between the French Canal an*'t
... *.. ::a u

Chagres River has, been authorized.

original ditch, dug

and draining the southern

part,

is being widened and deep

level and a new ditch will be dug in the north end, interceptingH.
run-off from a low range of hills and draining intothe French Caniarl
-- - a a a

the north end of

the fill.

the entire length of the fill thro.

of the rainy season

to the year

the burden

ann -. nC

1919 this hll was inundated

Formerly this flood water had

ugh the first ditch, and iti.the:h'
was too great for its capacity. H P.,
H ,

throughout each rainy

and

produced

vast

quantities

- anopheles,

catch

anopheles

in quarters

many thousands a month.

Gatun

Now

varying

is rare

from

that

several hi
a single:

an dpt

is caught

these

same

quarters.

addition

valuable banana plantations, gardens and homes are'bein

H~yw

- - - -

pa

"ii "I

*

1--q

!i Ai! !! s Si ......- . . " .i
:** .. .:s *I*H HFU.:* * **
...** . ..
:, ,,:: **" ,
i. I i ". ii . "I I . H -
H."

: : Mi. i F* :::** : ... ::.
.. .. ... ... ... . ..
..** ** *. ,,, ,, .
,, ,,, ,,, . = -
.:i. .. ...moachment
el otranophbe1es
*4..1t tiat frequei

uI..I.an A. pseudopj
S.. top minnows are
, ",":, ,'-*
:,** *, *.::: ,*, : *
illi' .::. .. ,* ,,, ,, ,: ,

., spcime ons ofos i
'it il.urers of mosquito
H . : ,* :

Le small lakes surrounding

Pedro

Miguel is

With silting from the Canal and watershed

of vegetation into the
production have gradi
ntly throughout much

e, breeding

profusely

now
and

shallow waters, the areas
ally increased. It is re-
of the lake margins Ano-

while

in ditches

nail pools a short distance away, only
unctipennis will be found.

present in

suitable

sthmian waters

several varieties show them

larvae.

They

are hardy

s, hoof
argyvri-

and lab-

to be voracious de-

and survive in

almost

:.y kind of natural
as :/& ..the sole means

water

, but dependence can not be placed on them

mosquito

control

Many

forms

plant

: afford the larve adequate protection from these

: fo;oloesa, described in last year'
1*

fish.

The plant,

Chara

report as a favorable shelter for larvae

H and

.which

seemed

- -

spreading

to all

bodies

shallow

water,

practically disappeared with
surface of the water-but it

ast rainy season-at least from

s reappearance is expected as a result of

thedclearer water and more sunshine of the dry season.

.'Ona December 1

Dr. P

B uxton

of the London School of Trbpical

: .Mdicine, arrived at' Colon,

en route to the Islands of Samoa

to under

udies for the control of filariasis in those islands,

said to be due

mosquito Stegomyia

the chief health

pseudoscutellaris.

officer

to supply

him

had previously re-

with

a stock

.%. take

j" ... .
:1 ". I in

:'S-.. Sa
N...:
mm :. ,,,I :
iik.hio
jul11H--BLf** L kt

vs here, as he feared there were no suitable fish of that kind in the

toan Islands. On his arrival here
rninnows caught'in fresh and br
se have. been identified as Poec

Buxton was given about 450

ackish

ilia

water near

sphenops,

Mount

, a viviparom

Hope.
is fish

..''atm to "sa affinisin appearance and habits.
i H. :x, "",,,

In

Eny are vry effective against all kinds ot aquatic iarve.

; an aquarium
These were

aced on board the ship in .two five-gallon kerosene tins and started

thelonig journey.to the Antipodes via New Zealand.

.teir^^hardine

$ss

As evidence

Dr.. Buxton writes from Samoa:

te(

..

";.,..

'

i

propagation in

UrIIStODaL.

conditions have .improved

ancon ana

SalDoa, on me..

to such an extent that 1

sanitary inspector of those towns were shared with

ing most of

the year.

Being particularly proficiex

this inspector has been detailed to devote .half his. t

and building inspection in the city of Panama.

especially unfavorable for antirat work.

, dating from early Spanish days.

and materials are high in

year to year in

past times;

spaces in and between buildings;

cellar to

a population

roof with merchandise;

cost.

H

Much of

Building spa

Flimsy construct

tortuous narrow pass;

warehouses and
foodstuffs expose

- i A "1

the serv
Panama Ci
.. I.

.... .:

the town.i
***. E. .. .... -,,." .
:* .Y ^::"

ice is: at a:
on, adde..
ages. and, 0.n
storesp.. "
d everywh'e.'
MEO,. ..'i e"-*.t .J :

indifferent for the most part to sharing their he
* '% ."

possessions with

rats;

these present

but

editions as they once existed in Panama City

a faint picitue
While nmuIc te
.i ^ A- ~. %^c &.J

be done, an excellent start has been made and many of the w

editions corrected, especially in the methods of storing c

in shops and warehouses.

supervised
enforced.

and

New

compliance

construction

with

and repa

rat-proofing regular

n *- 'S - r~ yin n -.

H. ... .M..j
.: * .. *: .. ..: : :*::. *
i .. ~Ia
ion :.iH-
.* '... r .*...
**T "Sn.h.. .
.... 1 ..... .

r

...:

rainy

ES!SJ4Y

I:: .. C.
ft ion

an d

season

disposal

ir ot freeedom from fies.

tess

reeaol

garbage

and

occurs.
manure

ne care
mainly

TYPHOID FEVER.

typhoid fever were reported to the chief health

.4 HflH*' *-
4 '-
.... .. ~~
*r".e":ce y an r'
( -* : ...* ...
I*.:. :'. **. .,*
.I'u "" : :*. *. ".

were from the city of

who

had contracted

Panama

the

ive of the nonresident cases

lived) died.

8 from Colon

disease. elsewhere

, and
than

(including one white

Four of the cases in Colon were in one

icre was no apparent connection between the other cases that

H:.::M *c:':::: tally

flu .

b~~ii~
Ig~~t~~

In this family, one case

nedic

1 i
d.

a boy

years old,

:al attention until a few hours before death.

was

On being

"of the diagnosis the health -officer ordered the contacts ex-

and typhoid vaccine administered to the remaining 5

ra

raiily:

. ":" u.. L." .. .j "j
* H 45i were seit t
.n^A jfeese"t

ttes. that

......ed." c(S
^^~^iS~'"'* \
"Si""V~ ""'":" *. o^

members

The day following the administration of the vaccine,

brothers)

were found

o the hospital,
in each case.

SIt is

occur

have elevated

temperatures

where a positive diagnosis of

No other

cases followed in

this

typhoid

family

believed that carriers are responsible

here.

In every

case

ers .among the contacts resulted

the disease,

a careful

in no careers

se report of Board of.Health Laboratory,

being

page 52.)

.i

Lie CaaI;i. Zo

.. -

)!if
j" :
H. V

|h
liiii.
A "F

't: :".. :..:" .
,. ....

S. .
iijfi'
| UlLLa
::A*:;y~ ~iuyii 6 ^'
^*'^"^H^^^
..se* ~ ~ ~ ~ ~ 'Y iy. < Bs !**

:1
il*..

.. .* : .

*

INFANT MORTALITY.

mortality rates of the cities of Colon and Panama,
id "for the past 5'years have been as follows:

pI'r.S -**** ..

; .41d
. -. F*-'-

* 4 *. . 4*

* *. q.. .

I q *.- .

i. .

-r"

154.47

37.28
154.00
113.67

142.21
155.801

IsojoG
95.09

139.28
173.95
338.22.
134.73

139.66
147.23
41.32
120,27
93.62

i.:

Irri. *4l-ije'aa nlAhE'ahnt! (r n nrMaintl an 'hirt 1 rxralfar

*6fli.

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

t: cas. e

and

i':' ~.- -;- r' rrr::"

, 115.66
141.95

88.31
72.76

`,:~"-----c`

.

T

T
it w

A

as c

1916.
1917.
1918.
1919

.onar. lea ... ":
ho lelthoweea nism" r Oe.. ..--,1nos. ... . . . . .. . .* 'i "
- * . -. 1 . .. . C. . (ardiao disease. *.q . .i... . .... .... .
hose with defective teeth as only physical Chorea and other nervous dieasees.. .."
defect.. ..... ........ 354 Orthopedic defects.. ... .......:... .. .
a found requiring treatment: Malnutrition...................... ..... .. ..'.
delective vision. .. .1.......... ... ....... 35 Defeetive teeth..: . ... .. . ... ....... I
feective hearing . . . . . ...... .... 15 Contagious diseasm................ .. ..i

'he colored school children were also examined and all whoreqir
ere vaccinated against. smallpox..
I.:
: .:. *.:.i!.

HEALTH OFFICE PANAMA CITY. -Nt
C
DR. HENRY GOLDTHWAITE Health Officer. "I.
.* ** .. ... h ;
falaria.-The following is a table of the malaria cases reported
ontracted in this city during the years 1916 to 1923: .....

Number.I Rate Number 1.Rte"
Year. of per Year. of "pe ..
eases, thousand, e se .thoue.H:
**. "! ":" EEE':
....................... 123 3.87 1920 ........................ I 100 1-
... ......187 3.06 1921................... ..... 67 H .11
..................... 97 1.58 1922 .............-.. .... 106. .. t t
................ ....... 181 2.95 1923........................ 78 -.
______________________________________________I________________ '
.*-I.: .:: .
|1 -.-" :. ".----

t is probable that most of the cases were contracted in the en'r f '
he city or in the unsanitated areas beyond.. ... .
.... .".... .........:.....
)il has been used in antimosquito work during the past se e..
rs as follows: .. ... ..
.G.u I..: :..
Gallons. .hGll
................0 + .. '. .. . ................... ........... . "'"'

........................,828 1923 ................... ................. ..
9,365. .. ." ...
. .. 1. :....,#

'his saving of oil Cand labor) has resulted from the drainage o:
e swamps and other places once oiled freely, and the gradual lilting
>f the swampy areas in which the garbage from Ancon Bal
Panama is being buried. .

II

of t

yeai

T

larg

and

Ph: r V
H H ..S.
H..:.IH;I;

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

.... rte.could-
:: ..
i l ...
:.H,..H ..n'c.m=,rcairx s' V
uH

. h.. fine

..~' itAlse was
.: tessary"
H.bn.c ove

.H ross, an(
;. .. pl yed by

:ase in

this

rate

continues

a gratifying

manner

be much further reduced if economic conditions permitted
it of the regulations covering housing conditions.
fund, from which the wage of the public welfare or prenatal

paid, reached such a low figure in

to discontinue her services.

r and paid by the Cana

October last that

She has,

however

since

t was
been

Zone Chapter of the American Red

1 is performing practically the same

the Panama health office.

:" "year that she worked,

functions as when

During the

ten months

em-
the

she made 3,315 house visits, 1,654 women came

to the clinic for treatment, and 900 babies were brought there.

Diphtheria.-I n

July,

1922, owing to the increase in diphtheria,

started taking throat

cultures from all school children in

an effort

locate, any carriers;

9.927

cultures were taken in

1922

the work

....as completed in the early months of

1923

when 1.187

cultures were

taken, making a total of 1.1

,114 cultures taken in the city

almost

tirely

from

schools.

Thirty-seven

cases

were

found

harbor

virulent B.

diphtheria.

..* Tuberculosis.-The deaths from tuberculosis during the years 1914 to
1923 have been as follows:

S.1914.
191.::
1917.
1918.

.i .. .... ., . .
"i i i i i i i i.

Number
or
deaths.

Rate
per
thousand.

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

Number
of
deaths.

Rate
per
thousand.

It will be noted that there has been very

..rate-for several years, and

little change in this death

believed that there will be no rapid im-

.. provement in the situation until such time as the Republic of Panama

, constructs a sanitarium in a suitable location

of high

altitude.

Fines.-There were 604 fines imposed for violation of the sanitary

rules and

regulations

during

year,

and

$1,093

collected

.result thereof.

This money is held as

an "emergency fund,

to be used

fF

.

":

During the past year this office has taken up the ainte
all dairy herds tuberculin "tests. Forty .reactors hav beif't
negotiations are in progress to have the Republic of .PAIli W
S..reasonable valueto the owners for. be" nim
reasonable value to the owners for tubercdlar animals" ""o" """""-

killed.

this connection it is interesting to, state, that in

abattoir four native animals have been found with- t iberciuo

by the veterinarian;

it is commonly said here that none of

cattle have bovine tuberculosis.

HEALTH OFFICE

JESSE L.

COLON-CRISTOBAL.

Health 'Officer.

H

Malaria.-The following is a table of theinalaria'cases
having been contracted in Colon and Cristobal during thi

. ... .: S:::....
* .h

.1
..........................................................................................
'p.! ,

. .-..s :

:
r,, ,S1
- vv L **U i ,H E
,, ,hf ,, ,, ,,,,,,,,

to 1923

.. .

.. 1 ..

.i F
. .. *
dy A~g
I r ** d *
* fi

. +

.i ;,jE
i~~* Hi *H;,~ p~
* ii *'- cir.
.t:i.tt H

Mosquito

flights.-Several

comparatively

small

fli

1 L .. l..
C. : : ....... :' : """: .
:<" ..."" n"i ... .
"" : 2: .."::

were

noted

during

advent of

raiflly

season.

made on

A edes

flights.

the screens of

Occasionally,

along with the aedes.

within
certain

a radius of

that

Le Washington H(
found to be the

however,

a fe

As there is no anoph

over two

miles

from..

C

anopheles is actually flying

tel ..and Colono H"I
,, ,, ', ":. .
S . ..:: :::":...: ..
predorninati ..
w anopheis '..iii*
eles. breediig to: 1i
SC = IAJ i l =
** .....* * l
olon HornytalAtH1
".. .. ":" ::" .. ".
g a, dietmargqc e f

f..

taeniorhynchus was

Illlrllll: r

III II II II IIII IIIII I

iiiyrl(i.

rr

BltRD

:ulosis may

R#.rn~mI.

3e par

:ly aue

.42'
.. Hi EE.a
* I

K.;.

0iopv^ercrowded conditions in many of the tenement sections
. :.. i. x1 i :i F' .. .
iie... the repopulation pf the Zone, and to better living condi-

jsimg the laboring people.
l i ia y This rate shows a continued gratifying decrease

iM Hryears. The principal factors response
qitiHhave been the betterment in the econo
.... increased d
t-b" owing to.more employment, increased

L(principall
Hill:: H nditions in C
HA.... b b.i
l. .. th -
: .. .

F' ...The inf
........ ..... . ;f t

... ..
CfK A -K *-* **vC- ** --
H i. i . .

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

I. .: he: T he|infant mo

C-om prison (
S: realityy rate ol

k: is ~perbaps shove
oUne.'.': and E
Il;: x .. -. =

.H...ij. .. ying in crowde
..... ....t a" m 6
WeadIdyian
'E. .. -
*... .. .

* "" .. "
ri':; and oc c anpied in
i: "' . "" : .. . i
; .. ..
-Ii *- '' r n c* w de

im:::,..t.." be, &1:
-* fl: &3 : 1 U a.,

I:- :: l.;- F
r.' '
.... ..* ....
" SS- .. ^ ^ ..... . .. r... " ^ ^ ,
Hi *.. ....
. . 4.,.:: ..: .. : : . .. .. \
S-i. :E S, x .
W ":: ": .x ::; .: ** -. : ~X n H j ** *

y in
3lon.

the Canal Zone)

and

the advice and

ble for this improve-

status

agricultural

opera-

relief from overcrowded living

treatment afforded mothers

ugh the medium of the Cristobal Woman

ant death rates of Colon from 1917 to 1923,

245.14
186. 16
155.29
142.21

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

u. . .m.m.

)rtality rate for Silver City for 1923 was

's Club

Free

have been

* .

139.28
139 66
115.66.

88.5.

of the death rate from tuberculosis and the infant
f Colon in 1923, with those of Silver City, is of interest
iing graphically the results due to difference in envi-

~COfOnomx

conditions.

The

population

Colon

'anamanians and West Indians (especially the latter),
d tenements, and a great proportion of whom have no

Lent.

Silver City is a new suburb of Cristobal in which

ployees of the Panama Canal dwell in model quarters

Panama

1919;

Canal

style of

construction.

was

built

its population last year averaged 3,350:

* .
* . .
* *

rrsI

Woman's Club

Free Clinic.--Al

cases needing medical

LL a ~~~n .- q. ..nf

~*1

.4

*

IlrIl III Il I II III IIII ' '' ''''''''''''

k

Ir~7rC

r :Bilver. CitJi, 19%9.....,

Iti City. loat.............
IIII Illlrlrl.l'lill IrlrIl I
he per itWIO live birtbe. .....

L1 ~ r ~1~ s.

TT

* i:.Hi'jiii

Vaccinations.--The

number

of vaccinations

t" * .... l "

performed was ;3,S

The visiting nurse keeps a record of all births

and whenachl r"rchb

the age of three months it is vaccinated.. In this way the populatiqk H
will eventually become practically immune to smallpox. The ch6i IQ
method of vaccinating is used entirely and is unquestionably the mo .. .

satisfactory method in our hands.

Building

inspection.-Owing

to the

expiration

of leases on

number

of lots

belonging to the

Panama Railroad

Company, it has

been possible for this office to have the houses on these lots put: i,
proper sanitary condition before new leases were issued, and in. thi.i....
way many dark and poorly-ventilated tenements have been converted:. ..
into buildings fit for human habitation. .:.i&
A: '.:; :i H
A mi-plague measures.-"Build the rat out" is the motto of this office.
but as this is naturally and in some cases necessarily a slow Drocess ."..'.

r- t..

other methods

are deemed

bulky materials and

necessary adj uncts,

such

as the elev

food supplies on permanent storage r

properly spaced in order to facilitate inspection,

poisoning.
Panama Ra

many
tion.
.tobal

The

various

departments

road have cooperated in a

improvements

have

been made

The

cleaning,
; Panama

trapping
Canal

very satisfactory manner

through

their

hearty coo

The greatest improvement has been accomplished at the

stores and store yard

store yard
Garbage

been

the improved sanitary

condition

very gratifying.

addition

50-ton

unit

Hope incinerator has proved satisfactory in every way. The han
and disposal of garbage in this district is thoroughly satisfactory

would be difficult to improve upon.

conspicuous

by their absence.

amounted to 22,098 tons

There are so few flies that the

Garbage incinerated during the

, at a cost of $1.03 per ton.

The incine

is operated by the Municipal Engineering Division.

QUARANTINE

Surgeon

WILLIAM

Chief (

COLBY

DIVISION.

RUCKER

7huarantine Officer.

atioi
S .. ." i "l :

H s'
S. ...d :".i

,,,a
. i. ..." .i.. .
4... ... ".... "

t'*1d .
. :*.. m.: : k' is:

y anr e^==
Sr l .. ..

IIi

.a: .. t.: ::m

.ra t- .. i::,
ou nt' .... f" ":::

-.1
F,,, '
d li ........ HH

1: ** *

: :

disposal.-The

its .t- thLeir por

~s, MUc

:o assist anc

stimulate t

ie placing

H H

4!'r "" H'~~~

*~. H:. uatntine

g.'m -Honduras,
H.::: ade with-
tutr.ies. At th

ning of those ports

in such a condition as to prevent

centers for the -iJtribution of

communicable

diseases.

arantine officer made several extensive journeys during

te purpose of

division.

Salvador,

carrying into effect

the foreign policy

The Pacific coast ports of Costa Rica,

and

national

request

Guatemala

and
the

local

were

health

Surgeon

visited

and

authorities

General

Nica-
con-

f these
United

lttes'Public Health Service, and also in the interest of The Panama
;C"a:-"... al1 he visited the Caribbean ports of Costa Rica, Nicaragua, Hon-

~H.;". ."";"diu: 'ais, Gu;
H.:;i" Ed::n." .r."i i
. ....

S ...His repi
i.....i .. A H
.... ui anntir
i... ....
.i # H.. ": : .. ..

., fe.

atemala and British Honduras. Lat
in the Pacific coast ports of Ecuador

orts

indicate

e problem.

that

yellow

fever

. As a matter of fact

er he studied sanitary
. Peru and Chile.

has almost

ceased

, sanitary conditions

in the

re are such that there is no practical danger of the spread of

'er even
it when
r of C

though
yellow

olombia

it should

fever

was

, -the only

be introduced.

discovered
restrictions

This

bele

IS SO

Bucaramanga,

placed

on travelers

o" ,..iifm Atlantic coast ports of that country were that their temperatures
..".. tild be taken daily by the ship's surgeons and a record thereof be
l. .. :

ft.
* T"

H'::

ISA

1t
Hi
;:ir

nished

*the

quarantine

boarding

officer

and

port to the latter daily to complete six days.

i. order, to have their temperatures taken.
.; Th.e sanitary inspections of the chief q

lwe....rwer,

that

passengers

from port of departure

[uarantine

officer

indicate,

that bubonic plague on the west coast of South America is

~".,iery genuine: menace.

.As ..a result of the South American journey

martatida a conference to meet in Panama,
HX *

*the President of Panama

February 25-29,

1924

S.ihe..purpose of standardizing and rationalizing the maritime quaran-
:"..... .......:.....

. : .
i..... .......
i .., . ..
q::l.:" :...
"E:: .E:: :" "." ...

tins of the countries involved-Panama,
::it is .believed. that out of this conference
operation which will be mutually bene
. . : *
,eoopera
, .,rn r ,.

Ecuador,

will

Sficial

[row
to al

Peru and

Chile.

an international

1

countries

con-

~::: ::: ,i

::

a

.

ol

[

g

fairly good-sized lumps,

and when prepared in this war the

not come off rapidly enough to constitute a fire hazard,

process is

unduly

hatches it was

slow.

found

By hanging the .generators. j

that considerable time is saved.

diffusion
achieved

obtained.

satisfactory

have

by following this method that cyanogen

been

chloride

has tee
. " " "..
:, "*

made
rapid,

the standard
satisfactory

fumigant
fumigant,

of The

and

Panama

when

Canal.

demurrage

It isB a

losses

* .1 :'
c. a '
,.i .." "H
bE. HA'*I X *

sidered it is

the cheapest method,

costing less than half as .mulr

Iphur dioxide, and about fifteen per cent less than hydrocyanadt..E'
A radical departure from previous methods was made in Decenib
mmm a mm

1923

when

an order was

issued

requiring .that

quarantine deda

tions shall

be sworn

by masters and surgeons of

arriving

Quarantine offers

have

legal authority

'i

to administer oaths

for this

purpose have

guards the method.

declaration.

the powers of notaries. This adequately -sat:
The following is the text of the new quaraan.t,,.
CGj

THE

PANAMA

CANAL

HEALTH DEPARTMENT

QUARANTINE E

QUARANTINE

DIVISION

DECLARATION.

Instructions-This Declaration should be prepared but not signed prior to theentry of the vesl.toaCail
Itmust be sworn and subscribed to in the presence of the Quarantine Ofider .before pratique willbegranted.
vessel han received radio pratique, this declaration shall be signed and filed with the Quarantine Officer of
entry. To facilitate the entry of vessels, the Quarantine Bearding Officer should be given a listofpasengers

"::: pr -: *: : i::
t ..:. :5
n t.. *....

.he. ".." .
H.... .;M .l
r,.r!
I s .. .... ..
-Itt'. ..

the Canal Zone, in order that they may be given immigration inspection.

The undersigned,

which arrived from

Master and Surgeon of the S.

S ......... _.. .-

........... --- ------... ... on .....-.......-..................---------

(place)

certify that no case of Cholera,

us Fever

Yellow Fever

(date)
, Plague,

Small]

, Leprosy or other diseases that may become a daa

'. . .
:. : .: "-" ::
.do reI
: ":: .. ":EE

gerpr tok; t -a

Canal Zone or

Republic of

Panama

has occurred

Sboard- ., :|i
i .. .. . ....
.

vessel during the present voyage

that all on board

class,..

class

....... .. 3d

class

and ...

..-.... ..Officers

and.

P0Ifl

are in good health (except as noted on reverse hereof)i

.that there.,

. =1-

*.
* 1.;i

u

I:: ,

I ---,

1!!

' *. .. sss

N

I I .. ?

InCLtlBlng_,.-,.i~:~';r*$:

%

Ir

r r

::I rI

I.... ::. #:
-! :1.:: . -

attiC

LI

ingress

O0 rodents

out effectively.

-. i. .-- .--..i. -... ....- .-.... .... ......- . ..... M aster

'.l S BSc RIBED TO in my presence. .. ... --...... .................. ...... ......
: (date)

"Sn

Quarantine Officer.

tr.. '.
A.-,.

(Reverse.)

..,4b

10 fof Executive Order of February 6,

Hg...... ,..XV,of

ii tiII regulation
..n..am and C

Officers

hereby

1917

authorized

states:

to administer

oaths,

purpose they shall have the powers of a notary public."

Executive Order of March 31

s for the Canal Zone,
Solon, states:

and

1920

, regarding quaran-

the harbors of

the cities of

... K ... ... *;
U "nH n,

fi..ni .mt" .. .
.... .. Inst
. .. JU.. . X. ** -..
:r:: *.. : :* :: .* ..g
Ad ... .. .
. i .. .:. *' *: H..

.. . .** . ... .. '

.::. ... . ..I f '"' .. s h p
** ... H... 4 * "

**3- ** *E " ..*.. i".
: I m c :i. **". I
: *:* *" .i ..:! : . pn
.I. :dteCourt, in
u......s.H...

,. N........... K. .

3 :: : .. : . : .. *.*.
I: :..H. n t h

Holl
.hj"i" ""- ''f Y n
..... .... tt hraio

.p":" "' i. tt... fl ed nt
K'= .. .c inipr

*.. ...K ..

H...- H. t .
..... ^ ...t

n failing to observe the requirements of these regulations

ructions issued by the Governor of The Panama

with these regulations,

Canal

shall be punished by a fine not

hundred dollars, or by imprisonment in jail not exceeding
)r both such fine and imprisonment at the discretion of

conformity with the Act
of these regulations."

comes from a clean port and has a

Congress authorizing

clean

on is accepted and no inspection is made.

ratique is granted,
he quarantine office.

of health,

cases in

the declaration is signed at sea and
It is possible to do this with safety

secondary sanitary lines of defence in the Canal Zone,

false oath is not likely to occur
isonment.

it being punishable by

actions; have been made in the quarantine tariff.
e for the benefit of the Canal and the Republic

Quar-

h

hhe Panama: Canal to give its clientele as much services
Serefore the charges for night quarantine inspection were
Fthe osts of fumigation were reduced in order that shio-

111111

mm
a

rIYWIYi' j k.. m

Wi

.n~~~

The following is a compilation showing the diminishinglop

suffered

by ships through quaranti

at a basis for comparison,

the loss

ton-detention-day, and five dollars

Naval crew and vessel detention ar
4

Total tons
received.

9,717.452
10,779,529
17,793,683
20,232,456
20,898,873
37,313.867

ne detentions. In oder pto.

is arbitrarily set at ifty ".

per passenger-detention-daty ;
xx *^-' ,* !, :.. **,,,**-
e.not included in this table:.: ::. ....
::. i*, .: *,*...E:6;
S"! "*S'jL. r
___________ WN

Total ton
detention days.

154,176
161,376
48,172
80,786

Total pauses-
ger and rew
detention days.

38,169
18,570
33,436
14,161
113
330

Total is..
T 0l.lom
"-

2067,933.00.
173",538.(O:.
191,66,00.
111,.198.00 :
565.00
*2,887.00

QUARANTINE OPERATIONS, CALENDAR YEAR 1923.

Vessels inspected and passed. ......................
Vessels passed on certificate of ships' medical officers..
Vessels detained in quarantine.................. ...
Vessels given provisional pratique .. ......... .
Vessels given ratio pratiqdle. .. . ........... .. .

Total arriving vessels ......... .. ...... ...

Supplementary inspection of vessels ..........
Number of days vessels were held................
Vessels fumigated..... . .... ........ ... ....

Crew inspected on arrival ....... ........... .... .
Passengers inspected on arrival..................
Crew passed on certificate of medical officers ....
Personnel of Atlantic Fleet passed on certificate of
Passengers passed on certificate of medical officers.
Crew passed by radio pratique ..................
Passengers passed by radio pratique .............

Total persons arriving... .... ... .... ........

Cristobal. ]

3,475
'185
1I
1I
53

3,715

1,925
1
107
1QO 1"f

.... .... "....
I

. . . . . .

medical

Supplementary inspections of persons on detained vessels.
Persons detained in quarantine stations ................
Number of days detained in quarantine stations .........

Persons detained on board esasels ................... ..
Number of days detained on board vessels.... ....... .

Persons vaccinated ..... . .. .. .....
Number of rate found on vessels fumigated..

Persons detained for immigration reasons....
Persons deported under immigration laws....

. .. I

292.087

". .... .

a 2,250

21.7
252,

797
1,054

Balboa.

2,512
4..

2,644

17
*17
22

117,463

2,410
""". 466,

144.411

. 106000
6 863
75,581

3,8QD
',6,.000

. . ,-....-

.1886
814;

..!;. : .

":". ":" ":::
.. ii; M ::i.:
.. .- H
. H. ,,
..
u'^::.::: .3E
.. *x *" !
:: "* : *"i

" i* *

,,,5
I
,b

....
". *'

a,

... -

5, ,,
.49

...................,
. *

,,, ,, .
,:,

.: .%.::... ,
* '

-: 1,^

Immi

tember

a

- .

gration operations have continued as in the past. On.,~

13, 1923, an executive order was issued covering a"d"ii i'

- ,- -m - - i - -i .. ..:H.

i.l;0

" ,

'I'

o~cers
p~sm,:::::::::::::l

, l11AA s

....

I

ill

S : *" s.. *. . ... ... : ..:
Il ji i . ... ..... "" i ..
.=, H:O'-,-::" :, - -. ,:
"H*- . ^K i*f i' ::. =*.. .* . *! '. - . .
.- :... ....., .
l* i. : *.:. ."

!!!X .! *. ". :' : .
N.:: :.. : :::* .

: i *...
. .. . ...
.H .. N ....
.. N : .*
......
..... .. .... . .. . .

.ANCON

~1i~.'*VY ILL i-.

I

HOSPITAL.

PYLES, -U

Army

Superintendent.

N. H:.''. : .
'' ..:iu.ic" uung the year, 1,460 major operations and 4,377

riags kions (including intravenous injections of
..::.i: ,: : : , 1 ^

rnec,

cases

.: a ** *-
Srescriptinons were
'. were..
| ,* :, ~ ,,

visited

the out-patient

written, and

arsphenamine)
department for

244 obstetrical cases

were

I clni-.---There were 2,694 cases treated in the out-patient

'tuitm for. whom

.::, ...... :* .."*." .. %.. .:" i " .
yAatcipaed,
~....... .. :. . * *

.....I......th 115 kn
.;ych and ear clin
H 1 i55 '" i visttea the
i::.. .' ::. .-y: : '
:.. *. .... :. *' ...

...l w written; 1,5z
E ... .. -4.... .... ..

.I..,. 1 kand

F|I air cooled;
H cinic.i X-ray
Si:: 3,852 films,

!" *4.. ,* ...
1.* .
..H .. t hi

:P. *:: . " ". .* . .
.* . """. .. "

andof t*e yea
fx.. A -. *: T..: .... ... .... .. .n.

imthea remain t
i n. , ... .
"i..""" .. ," j"" .:' .e:"

L .. .. *.. ..

"Ia... ign on the
:... 9" ready f oir

It... ..
"'tai ecei v. hydor o-t
.HN n .. H ..
'"N'"'"o the yea
,.:" ." ...

f:iM ^ Beff: I .."

1.704

vith 256 known

)wn,

prescriptions

"takes;"

were written

adults

296 children were vaccin-

"takes."

ic..-Seven thousand nine hundred and seventy-four
ut-patient department, for whom 1,508 prescriptions

15 operations were performed, and

There

were

2,721

cases

handled,

, and 2,254 dental films were used

1,044 refractions
S

whom

1,133

215 treatments

the year.

therapy.-In December

following equipment

.e room formerly used as a waiting room

one quartz lamp,
a photo-therapy

addition

apparatus
room assign

water cooled

1

the ab
and a
red. for

eight,
)ove
supp

this

one quartz

a Universalmode;

which were' put into

there
ly of

was o
radium

equipment,

ordered

new

construction

and

it is

being

;s installation and use as soon as received.
-In the basement, a former storeroom was prepared

:herapy apparatus,

Lr:

control table,

the following being installed

shower

, perineal douche, and slop

ring equipment for this department arrived in non-
and until all the apparatus is received and installed,
ril not be put into service.
tesnt..- During the year 109,599 rations were issued

!'I
* I~ i

fCE

~,4V3

T

ivi
Hr ~:::i

Motor transportation.-During the year all

cars were

kept in
ft~~.ljp.-J.J,

state of repair

In addition to the work on hospital transport

the chaffeur-foreman also had immediate inspection of all motor -=ti'

portation

and

Department

bicycles

located in

belonging to

An con

the several

Corozal

units of

Pedro

the He,

Miguel

* i. ii I
.in"...

Panama

City

and made most of

the issues of

, gasoline

these vehicles.

July

a new Ford chassis was received for which .
wnlcn

ambulance

body

was

1-. .:l

L

service.

Grounds.-During th4
furnished by the Depart

locations.

Eugenia
spyros e

folia,

Quercus

pol

C'

, Litchi ,

Avocado itsama

1 Afanzgo

domeslicum.

sandersha
Fruits

hospital reservation for

Bananas (bunches) .....
Papayas ..... .
Bread fruit. ..... ....

Mangoes.......
Avocados......
Guavas. ......
Liwpes .. ..
Coconuts .....
Oranges ....
Sour saps......

... . .... ..
.............

.....................a*.. .
. . . a . . . a . . .

Tomatoes (pounds).
Pineapples......

I

These havematerially
Maintenance and repay
in the rear of the hospit
slide was estimated at

in the

slide was held

head of

the pow
in check

de broke the 1

1 1 _ 1 I ...--- _-

'nan....: 4-...,

n n *t C- r~t

n-ri

n.. 4

JUIAL UY Lilt: llUbplLdiI rI LIdlb aclILL JJLLL fl1U&Ma.-*
"" '" *:: I. :: **: *
X i::. .

e .year, fruit trees of the following varities"til
ment of Agriculture, were set out in perinnanet
,stachya, Quercus thomsoni, Quercus truncaa;^
aslanea diversifolia, Lagerstroemia, Coyo, D ,:.i
chinensis, Rhedia madruno, Macadamia ter
avocado panchoy, Avocado cancel, Avocado *imni H.i
, Phyllocarpus septentrionalis, and Lansiilit
and vegetables have been gathered from -the-'H
consumption by patients, as follows:. .

1921. 1922. 19233 1 .:: .....i
": """ :? EE.Ei:i
..................................... 502 377 .......: .

.... ....... ...... ........ ...... .. ... 2.835 2 600 ,-. ii
..... 846 214 .
. .. .. . .. .. . .4,100 1,150 .
..... .............. ..... ... .... ......... 3 24 "2 5 t" "
S11.:1 : :2 ; .:: YE3* 1:1
..................................... 9 2.. . . .. ..4- '...
10 ". *::: **n:*
... ... . l
.. .: .:::: :: .::::.

H .... ...
I::u " ::"
improved and lessened the cost of patients'di H.
\irs.-On October 9, 1923, a landslide occurred
*... .: :::::

.. ... : *" :***I". **S ::.::

by the power plant shop building, pressure at
light curtain wall in the rear of the bake shop;i: ";

Balboa

pini~er)

.benaster

rea r

..:......__

, ef~-~.,

A

* ~. a.

I *..:: . "

* :: ::: : ::. . *
*. i..
., ,* : . i: .,,'. "1
H :H ., **** .. .
"" 2.: ." ,

-Che !'; kge !ljf li
..... : : .

" .. "

engineering division,

immediately started to work and

6e slide material from the hospital buildings and grounds.
is of damage done tp the hospital consisted of: in bakery,

nor. wallstora~ge ruoni L4VtI mi,

Stiric.t motors put out of comn
Saother materials washed awe
:. '"'e electric motor put out
a, dt.e broken, and a consi
pse.es; in the isolation ward,
Seed with mud, machinery of p
: ered with mud and put out
:: .

"machine put out of
tiered unserviceable
covered with mud.

commission

and
Roads

roof caused to

Mission, and

Ly;

, two 3-horsepower

considerable flour,

in the carpenter shop, one

bread

7-horse-

of commission, window frames, doors
derable stock of hardware was rendered

, entire

ground

floor flooded

and

cov-

passenger and dumb waiters completely
of commission, motor of dish-washing

considerable

furniture,

and

floors

curbs were

hospital

and

walls

broken

property

ren-

basement

down

many

plates by

trucks

hauling

debris

, lawns

1,were

badly

scored,

and

several fine budded mango and avocado trees were lost.

Nonresident

Patients.-Patients whose

residence

is outside

Canal Zone

Colon

or Panama

City

were treated as follows

606 in

Ahicoqn Hospital, and 81 in Corozal Hospital

10 died in Ancon

Hos-

pital,

and

7 died in Corozal Hospital

total days treatment in Ancon

Hospital was 13,796,

and in

Corozal Hospital

1.8.055.

The following table gives the cost of operating the hospital for the

past

three years:

O.peOating e.pen,. ................ .. ....
.Oe awnue.i g expe a.. . . . . . . . . . . ....
.. ~ cot. ..... ............ ..... ............
. (Cost per patient per day ...... ..............
... Caet of subsistence supplies per patient per day.
. Oierati g expense, dispensary... ............
, ReLYenue, dispensary........... .... .... .. ....

(577,086.50
312,132.40
264,954 10
4.62
.39
18,518.85
572.50

.1922.

5525,585 44
312.713.70
212,871.74
4.67
.34
16,438.74
1.883.05

$520,551.97
309.572.03
210,979.94
4.75
.34
17,952.78
4,113.50

a C'-
r -.

-COROZAL

Capt.

GEO.

HOSPITAL
HESNER. U.

FOR

THE

Army,,

INSANE.

Superintendent.

Buildings.-An addition to Ward

(female ward) was erected at

)f $2;000, for the

purpose of housing

hydro-therapeutic ap-

j

A

r:

.

H.

i '

to roof

done

inspector

, thus making each Individual

hospital labor

pit fly-proof,

under, the direction

5qqlg

H~
A::...:

iii.. *.~H ~4~irk~~oJ~
hi H H..
.JL.!

district

-UI

-w

qn i:cflnji

at a cost of approximately $1,000.

platform and

boiler shed,

with

coal

Sn f.. r *co:n p .
refofor ed.'con

construction,

was erected

housing the new steam boiler

received,

reaction

this

work also

being done by hosDital labor under

.. "..,: S. ,..'"
the district sanitary inspector, at a cost of appr'"")a
"* *^" !

$600.

Hj
IN.

A storage tank of 4,800 gallons capacity was moved to ,the ho

inclosure and placed on

a concrete

tower

feet

high, at a coStH.*

$500.

C

This tank is to catch overflow from the refrigerating machine
Cl. -im l I' *1 .. l C -

an.o water thus collected willbeutilized in thelaundrystearn

The

partitions

between

porches

and

dining

rooms

man

female patients were renmo
each of these dining rooms,
to the comfort of the patiel

ved, thus adding 800 feet of floor spa
improving the circulation of air, and adi
r T j--

itrs.

repainted.

By the removal of partitions in ward

ing room to building No.

hne interiors of rnese rooms were g
. ....

and transferring opei
wing room), 150 feet

530 (laundry and se

floor space was added to the occupational ward.

Routine painting and repairs to woodwork, sco

line

have been

done

when

required,

S. ." : ,
U 1m a

reens, plum ing, ma
hospital artisans* "|
*. .'. *

the help of the patients.

4*.

Grounds.-Of

the various foreign

tropical plants,, received

courtesy

United

States

Department

Agriculture,

planted during the past two years within the hospital inclosure1, a

have

been budded with considerable success.

The following apj

to be thriving in the soil under local climatic conditions.:

Hydnocarpus weightiana

Litchi chinensis

Saigon mango

Kavas

Lansium domesticum
Garcinia livingstoniana
Garcinia mangostana

i;v t +n fI tb i- alnrr' nil rrinnra ni francM /r ruiahn a

Ji Patel mango

Rosa

Mango de

Amini mango,

- I . ...

'ii
:: ::. :*
H H .
ii.
.* :.. :. ...::' liii '
S ... .. .
::4 : ".H

oils.: ni. fin as ~ .kJn ~

.1. ~. H..

v:11:11

Kala Alphonse mango.

;I

:?'a

i'.. :.

iB.WRIMul"H:

------

x.K :::HA& -

i:
* .. *

*:: :: K. ..::::::: .S : : ** :" :: .
.:.* * .. :: :*
: *.. ... .. .. .....
. ...* *.
I^ "': "i.+.i i:
:* ".. .
'^^~li *'*; *' *i?.

S *K.::

** i .

* .

A':E; .i. .

X*:m "X m: .. .. .
* .* : .. *3:: ::
*.. * *. .... ..

16.:== -........................
....

,r". t .h i ,, "I
,%s ,, ::" : ,,:::
... .. "
HaI.
, K---.-. --

I* --:: .-x:II; ..v -
": :E.s:::. ":E.* "..."
KK.!.. .

K : a: a*:. :..
::.

| :.... .::. .
.:*: :: ... . .
i iiii ::: v -." *
"..!ir .KiiNrUi!

iia
.. .. x

:' : *: : f
I.: :

I. .. : . . ii.
:*. ** .... ... *.

..* .. .. :. *
:.

r" .i: xL..I.

...... .
: ':. *' Pa. I
... . * r

...r. :. .. .i
I- ,tQ 0

"iir -" * **
f....
1.. ---C ... t e

:. : .. .

i

-Kii'
ht';

wiIKHe xtade .to replace some

i to. England,

i i -

these

on December

with

species

which

. .prove successful as the results obtained with other
-a- lants. leads us to believe that most of these can be grown
underr local conditions.
..d .lns

5'and numerous flower beds have been maintained through-

,ear by the patients under the supervision of

I pounds and roads
'ed for, and grass cut,
ts.--The census of tl

are kept

with but

clean

hospital

*ompared with 389 on the same day of the previous year.

admitted was
who had bee

153, as compared

TI

transferred

with

surgical

toward the close of 1922,

charges and 32 deaths, as compared
is last year. Of the total released. 2(

r --

(49 per cent) were improved, and 32 (21
total admissions, 90 were cases paid for

1922

also

treatment

, hedges

an attendant.

flower

158 discharges and

6 (23 per cent) were recov-

8 per cent) unimproved.
by the Government of

, and the remainder were Canal Zone .charity or private pay
Fifty-four of the total number discharged were deported, 26

united States, 2
a. 1 to Mexico,

:otal of 72 per ceht of discharged patients
comparess favorably with the best institution

ted States.

-The great majority of

and have received little educati

discuss their

mental

disorders

i:"tic -standpoint. I ney are encour
" :.. I:: .. ."H. .. .
nationall work; they are furnishe

I lgph graphic concerts,. church services,

with

aged
d re

these patients are of low
on, making it difficult at

6 them
to do

ading,

weekly band concerts,

to Norway

Indies.
or im-

was
The
two

An con

bks in the vicinity of the hospital, and games such as indoor baseball,
Sticoet, picnic outings, etc.
i Special.treatrentis furnished patients suffering from specific organic

ord es.

great number of

mental

disorders

caused

'hilsand alcoholism. esoeciallv the

former

Intensive antisyphi-

.C.

trimmed

little expense to the hospital.

1923

were returned in 1923.

There were

to Germany
a

1 to the Philippines, and 21 to the West

recovered

U rf

for the insane in

from a psycho-
some interesting
moving pictures,

daily

J

. .: ..

as mental

disorders,

with

idea

assigning

patients

.*r. -3 "'
show! si
. '"r ** "!

higher intellectual capacity to the occupational ward, where

are taught woodwork,

of brooms.

ing,
and

both

IC

toy making, decorating, tin work,

The ferfiale patients are instructed in the arts of i

hand

and

various kinds of

on looms

needlework.

tional ward amounted to $4,818,66

ceived

brooms;

, embroidery,

crocheting,

The total sales from thl
of this amount $3,418.6

some of this is utilize

bunches

rnal

t
Ir

I

1,203
192
282
652
5.58
26,700
547
179
1,225
1,867

taken

ward. c

Pineapples....
Plantains ....
Sweet potatoes
Pumpkins....
Spinach.......
Squash.......
Tomatoes.....
Yams.. .....
Yucca........

in from

Ca

exce

and maldn

-ug wesav-".
basketl[":4
e occupa-..
:..i.:.ii:
0iO was *re9 .':ri
d for the
alt"k: .,.9

purchase of material required to continue activities in this departme

and the balance is turned in

for credit to the hospital.

A surplus

$350 was thus turned in during the year.

Some of
commodate

are sent

assigned to
apartment.

patients wh(
in account o

in agriculture, while
y, sewing room, and
laundering, with the

i in the occupatic
the fields to assis
tasks in the laun(
All of the hospital

sheets and nurses' uniforms, is done by the
these various undertakings between 75 and 81
are engaged in some form of work at all time
In order to encourage these patients to wo
sums of money with which they are able to
tobacco, confections, fruits, and commodities
discharged from the hospital they are given th

from

their

earnings.

Following

patients

Bananas. ............

Beans. string.....
Cabbage.......
Cucumbers......
Limes ..........
Mangoes .......

Okras ... .. .... ..
Oranges ............
Papaya..... .. .
Alligator pears......

The value

.... ...... .. .pounds.
................. pounds.
.............. .. pounds

* .. .
. .
...i.
..ll

............. each.
........pouneach.
........... pounds.
........ ...pounds.
... ............each.

of the

produce

garden

truck and

fr

patients. A
0 per cent of

:j*f *::..i
: ":.. .: :1
. .... *** ..*" ii

deOH..

of '

the patients

1..: :. "H5..
s ..": "...
rk, they are allowed small
purchase in the hospital,;::
of a like nature. Wheni .
Hr.* . h
e money they have saved
*""1
uit which were produced .I:

S..... ................. ..each..
............. . .. . a.ich.. 2 82, .
.. .pounds..
........ ............ ...po d .,*1 .
............. ....... ..pounds.. ....
. ............. .... ... jpounds.i 16 i.. ,
...... .... ....... ... pounds.. .1. .
*.. :::. .. .d4
. . . .. ..::.p..:* .1
a..t ..j:

the patients' garden for

from the sale of corn

the physically stronger male

a can not. be
f limited spa
the females

salvage
option of 1
is a result

is a list of

garden

..H:II
:* l

.. .. .."

.:

4%i..IHI..Il
II" l iH* H
*am:HNN :. .
H *

** : *...**L. ** i
*.. ...... ... ... .. ...
lat grar
i'
.-Z ......" ,
;l =H ,a1I=iwnts 'i
""!" 5, ...
i. i .. I. i .. ... .
i'. .. .. ."' . M i .." l
i':" :. .* H .l i
<: 1'*. i J.
:."" *g:" .*t a iii f n

f ying, and similar results are anticipated

with

the female

hen: the new hydro-therapeutic apparatus is installed.
trqno suicides or deaths due to violence among the patients.

e^ atpresent 24 black lnd 3 white chronic medical

(not insane
of the year
to do so.

..: ".. ws(one suffer
' .M. "a spinal cord,
S : .. .. .

and sur-

as compared with 2.1 black and 2 white at the
All those capable of performing work are en-

Some make

ring from ulcers of

bandages,

the leg,

and three legless men),

employed

ii

one with organic

making
lesion

and a number assist with the

ard. work. These men are paid a small amount f<
eiirform. During the year the output of the broor
:.creased by the installation of additional machinery

or the work they

n

plant

been

, so that the pro-

; Auction for the entire year has averaged more
.i.. 'week

Farm Department.-Twenty addition

than

acres of land

brooms

were cleared,

a part of which was planted in bananas, making a total of 80 acres now

.under cultivation.

We have

been able to plow

about

50 acres

and

With the modern farm machinery recently received,
carried on more effectively and extensively. Six m
: are used for farm work.

cultivation will be
lules and one horse

. Repairs

to fences were made wherever necessary

,and

rods of

new four-wire fencing was added

enlarging the dairy pasture by

acres.

... crop of

Twenty acres of

guinea grass is

been

being produced

cleared
on it.

of brush

and

a good

The hog pasture was

increased by

30 acres.

:There were 29 cripples on the farm at the close of the year

, pared with 30 at the beginning of the period
..." 'i

as com-

one having died during

-the year. One is under treatment in Ancon Hospital for tuberculosis,
:while..another was found guilty of selling liquor in the Canal Zone and

rwas deported by the police. 1
-z'ed by the farm in the garden,

The services of these cripples were util-

guinea pig warren (to supply

animals

Board

Health

Laboratory)

dairy,

piggery

and

cemetery;

one as a helper on the motor truck, one as a teamster, one as a fireman

at the steam plant, and others as helpers
.. i .. 9 . ,

n the kitchen.

There are five

w i r

r. ....

I

pas year amount to e;" ............ .
pa ea ::....... Hihir~

Equipment.-The following equipment was received and' -
..............................................=.....-= *..- ..
in this hospital: ..* ;
*.. .
n n *~l :. ,"Hl:. *

5H A
1 b. .ip obf r. .1.'. .
1n ho a............lf........ ,cl a ......... .... ..,........... ,-.. - ** ~:i. :
1 "* II. I.:I"* 1* "*** ** :m ...
pOdaon .lre .
1reFrigeratorplac tfor kithe.. ................. ..."..... .. ................. ..., ..
iblanksigrth'splortabfor Bte. ...........,.... ........,,.....-.......................;......... .

.. ... .. .. n. ,.. ., .*,, .:. .. ..... i.
1 blacoksmith's portable forge IIII :. :. lllll : ':: ::":.II IIIll llilll;119

.mo...m.chme .'." .'.::J......................................... ......
1 40-harsepowe retten-tuoe boiler '':teurisermlpartableankingmadrmeat. air.. : ""rlmild
Complete eet of hydr.-therapeutic. .,,... .. .. t.. . " '::... ......=
1 6- hoel balence frame oultivatta" .......... :...,.... '" :::..;.... ';i
ll~aweoll lliaaii moo fo pateui en potsl m mm in m m~impa m m m ~t:;j, :m :X m l =[ Zmg m aad=' i 'l dm1 ....:H" .

lii ll i:iliiii !* l":"" *i :: i< i
H* .. .
* LI ....... .....H .

*::* X:i ".. : ... * . .
k .. I '.:* i.. '. :: .. ...
H"*.:::4* ::4 .
: : ,
*H... : I;:I' 4 ::"

iir.. SI. *.. "
r
8~ 9FH
I -: !
'Iii TE;H.

~jj~A the inRk o.f't
i i: " "i " n aurse,

me*tili and: allo
..it dd the work

hee patients in the occupational ward

this has

who was able to devote only part of her
rs her toQ give more time and attention t

time

The

H.:.. H . I........i. . .
IH L."" ...J.... .. .
*:i ** ** A *
i:4 .. 4e! ... ... H"i ,"
.i:: *:i*":::" .: .: ::*" ..* : : I
... .......* : ...::.: ::K!!* ii --*. * .

rgijs a spe .
*,, :i *, .. *i ,, ,,, ..
i.:4, iey Hsary r
i........ *.:: .i .:* .*l
.t:;" f.t:an: Eg sc]
'"- "H'q. g
. i"" .. .
H. ii a sJ the attend
Hi il4i .:4 3l .. .. ., :4

_. ... . .
.. P. p er*tion am ion
:.E" .r:. .
.:! ": .a* .. *.:"
HH:4I H .:4:4
i :. **::4 A .* _

.: . : """
.!i': :. ...!h. : 4 . ..
H ". **" .. "

.bP .::.: !'"." t ne a *
. ..: .. i "
: .1 *' .. ."

: 7 iv lS erinitend en t,
: ... .Army

...:.... Hperioned to
. . :

I I. . ,p ,.a
.'V ... .. "*, "A

...H *-
pH.,'rtioned to

H;;.
wt .
II. IL.
*~I. H. I
I Al
~ I~.HV
Nor's.
....
I.
HIIIII .
.INI
IiSI!IIH.HJH 1
.i~.
I
N1
*~..IHSI~
n~. lEjI
II.

. w --.-

rks.-Ac training school

purpose

instructing

nd the care of the insane.

ase

prevails.

in Army

resulted.

and

employees

In addition

i course in hydro-therapy was given to those possessing

preliminaryy

qualifications.

hool an improvement

Since

has been

the organization

noted

idants and maids showing great interest in everything

ie welfare of
ig employees

COLON HOSPITAL

Colon

LEARY,

Army,

d Organization.-The hospital is rl
A*
I cooperation of the staff is excellent.
staff at present consists of 6 physici
all except one being detailed from t

reduced

Navy

The

unning

ward

smoothly

Medical

personnel

increase

Corps

There are at present no internes, as the hospital as at
ited is too small and the service offered too restricted

:ssary interne

this hospil

Physicians .on duty.
m- This hospital has a dual
ps ..y.and out-patient sel

:: dy ill. VWith the increc
:Atntic side of the Canal
ieal- consultation service

ii rough the
.: : *P"" E" .

training.

seriously

alI

function

to perform,

the
th(

i. e.,

two

internes

on the

shipping

Canal has increased the number of Public Health Service
* i ai .

: in th wards

ms6 obm ammn4ed since the creation of these new positions have demon-
tfurAthat th need for-themnwas an actualonne

, laundry, storeroom, etc.

silver
silver

attendants was

the regular

throughout the

the "patients, and a spirit

general

Superintendent.

'ans, including the

The loss of

number

rice, and hospitalization of the more seri-

providing dis-

an increased and active medical and sur-

i":x ===="

. I *i

42

physician

is without

such

help.

One

physician

is .assi;

colored dispensary and one to the. white dispensary.

to
pe

" .x . .: .*:: :: .......***
. .. H* .. .
" .H:. .. :i i i

. . :... ...i N
. N .. IiH
N. .

The problem that this hospital has been called upon to solve has be .
th i f ii i t" "i "..: "
give the maximum of service at a minimum expense, with tami
rsonnel, equipment and hospital space. That it has been faidy' I

successful is

evidenced by the improved regard of the Atlantic :side ri

Colon

Hospital

There has always been considerable dissatisfaction

on this side that sick or injured relatives must, in so many cases, be

transferred to Ancon Hospital for treatment,

due to lack of physici s.

trained in specialties,

lack of

the Atlantic side hospital.

necessary equipment,

This situation

can

and limited spa c
be improved to a

certain extent with the hospital continuing to draw on the Army Mfedi

Corps for its physician

specializing

in X-ray,

and laboratory work

eye,

As replacement

nose

and

throat

should be obtained

s are required, physician
, genito-urinary disease,

In addition to carrying on

5 .H
I .....
" .' '..

.. .
. * "a
"" : i

.:; .i i
'"Bii^Sa

the routine work of the hospital, these men would have an opportuit-:
ity to handle a certain number of cases in their speciality, particularly:

those requiring only

dispensary treatment.

By so doing the cost of

. :i :-ii
. .
:l.: ::'.ll
H .....
" .. .. .... '
H....
x. .. !-
":.A~

transportation

to Ancon Hospita

would be saved the government in

many cases,

and employ

would lose

time from their work :to

mention only a few of

nursing personnel
present needs.

important advantages of th

consists of

female nurses.

plan.

The:.

This is adequate fot:
mm "'tm a

Buildings.

-The

buildings

in excellent condition

e li.

with

ception of the part of the old hospital allowed

isolation
buildings,
too close

appearance of

ward

The

resurfacing

necessitated by ru

surface

hospital.

to stand for use as an.'.
S. ".
....

exterior

concrel

ting through of the reinforcements placed"

been completed and

The

painting of

adds much

hospital

bett

I!
* .H***^
* 'S::::::::5

..... ..I
I::... :
*: a.:**H
..
... ":! h K::L,
": ..... ...
...
t H
.N.....

continued

during the year

The work has

been done by the hospitaL

personnel as

they could be spared from other tasks.

. i r

SANTO

TOMAS

HOSPITAL.

,. S.
H

;
~~1hi~~t

I II : II jjll II I:I

re:.;.

.i""iii" Iy

RHRIMII..im

....

* **.. * ..:*' :... ..:* ...:: .. :.
**:. :4 *. **
.. . "" .* .

.. .: ::" :** :. .
:.*...... H.
. *:::. .
*...: *..... *

... .** ii

11m
... t.. o
...........Tonr 1k ik

approaching

Las Hospital,

date

policy of

inauguration

New

this institution during the past

* .WH: W~IhI.q.
fin. ... 1 -
rH..I
H".. ii. .
tnetl

~has

largely

been

devoted

iods previously in effect,

toward

intensifying

improving

enlarging and training the staff on hand,

'H.i -

Atnd generally raising to a higher plane the administration of the pres-
eti' institution.

By Presidential Decree

October

, the reorganiza-

tiont of the hospital

. .was

entrusted

in the (

capital towns of the provinces
Superintendent of Santo To

I

of the
nas

subject to the supervision of the Board of Directors of this in
.and since the date mentioned an active campaign of reorganize

been under way with the result that the close of

Repub-
lospital,

stitution,
:ation has

1923 finds five of the

provincial

hospitals

(Colon,

Bo

David) each having capacity of

ready to carry out
they are intended.

material

and

function

Month

equipment

and

cas
30
ns

Toro

beds

by month

genera

wel

, Santiago,
i equipped,

emergency station
, the accounting,
administration of

Chitre
staffed

ns

and
and

for which

supplying

these

subsid-

iary institutions is being improved

and it is

felt that within the coming

year they wil

be in all

Tomas Hospital, that v
A dministration.-On
of twelve nurses conc
training school. Aplr

respects credit tab
vill be inaugurate

January

luded t
'opriate

heir

1923

course

exercises

branches of

the New Santo

d about September

19

, the eighth graduating

e of
were

training

held

in the

and

24.
class

hospital
majority

of the graduates have been employed

of its branches.

either

in thi

hospital or

Particularly creditable seems the record of the

ing school from its inauguration in

"haVe been graduated,

and of this

nu

1915
Timber

since

that date 61

in one
train-
nurses

, 29 are now employed in the

Republic,
: republics,

18 have married,
and 3 have died.

have secured positions in neighboring

In several

departments it has

been

necessary

to secure additional

employees,

and invariably the vacancy has

- Panama when one was available.

been filled by a citizen of

Throughout the year

it has been

necessary to make increases in salary, particularly to the orderlies and

C -

S

a .-

1 _ ___ .- .--- - -.-

im:

r.

*.

a .

: .. ll .. . :: lflE::
"" "i ... ii
.. ." ..
.:. :
"" . d H. i"" .M
he.

on hand.

This amount will probably

be irtilized jn it

equipment for

new

hospital,

thereby bbviatin the

S

using old apparatus in the new buildings.

Steward's

department.

--During the year,

pared and issued at dn average cost of 31.8 c

During

been

edition

the year,

grounds and

given sufficient attention

until

necessary

sections,

new

to entirely

and student

hospital

renovate

nurses

; : '*:: :" ::
24,639 rationswekH
- .

tilt~s .per -r

buildings of

to maintain

is ready

the

lal

Quarters.

- ---I

them in
occupancy

)oratory, mo.
since these b

aflI:n Q r=
a ..... ." ..

y. It .:.i
rgue, ..ma *
""e; "-'<- ir
ung"we '
iifling wer "' .

very

bad

condition and

would

without considerable repair work.

keep for the buildings and grol

stand an additional year 'oE:
The average monthly cost of :lg

funds amounted to $475.18. "
professional work for the year has beent

successful and has shown marked progress over past years. The'in
. ..* *....: *,
ber of patients admitted was 9,769, as compared with 8,624 for the ym
1922; the average stay of patients in the hospital has been reduc~ted:l..,

9 days,

from 10 days as in 1922.

New diagnostic method

ids

have b..

introduced as promptly as proven

practicable in other

new medicines of value have been given a reasonable tri

system of filing records and statistics was instituted

th

... r" :1
.. . fu.....
hospitals;, i it
ial, and.a n!ii
ereby maid
S.. .:

these accessible for scientific papers that may be prepared by the,

pita

staff in

the future.

a,"'~

The medical service cared for

these
-

7,241

patients during the years... :"
*" H:: .!i

, a considerable number were infectious diseases, since a shlin A"
-S -~ il

epidemic of measles with a number of broncho-pneumqnia. cas

present in Panama during the latter months of the year.

The drug store,

in addition to furnishing all medicines and chenmi

the hospitals of

12,746 prescriptions.

the interior and

this number,

the National

3.221

Government ..

were issued free,

-. i

the remainder were charged to patients

referred by corporations

companies and to persons able to pay for their medicines. Practi
all drugs used were purchased in wholesale lots direct fromthe t*49
fac .u rers..
facturers. ". .. :: .,. ...

::m

:Ii HX*l

Professional

services.--The

"~: ,, lii:

I. r.

-. :.:V T??

'''

DL IZ.

..\.i *-.
iA: H. .*

B:l||rHosyear
I.. 4 lk in an enti

S... ..."een.. necessary

p |tqts,. withaonly
i.--that these'
o::s j ta at . . ..
: : ::.:........ : ..: .:... .: H a
ra i spita nation
'- '.! ,:,. .j ..i:::. h a v e :. *. "
I? raie nurses have

I .. : "i::: . .
: L ..aas
....... .* .=--*. H l d

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

..l":. E. ...: .: : .." ..* : .."...
H1.:* i-: ..' *1: ** *r

: E : :.:" .. ::. . ."J
:!!.. .'::. : .....: . .. .
H.......

e I =:. *r 4 .

S. ... . t

.f .. ." **..: .. 4 ". .

.' .CaatLfptients. 4
i *. .'V .. -.. W hite"

L .. .. ..... .. .... .. .

:: il. .. .' " : O ne: ~.
S...... ..1 p...
.... i' .. ...... ...H .. t..: r a di n
H .... e

... : : .. * A.. . f . ,
:" .. "* H .is :
| Wh*1 B * *iim:*
K $. .. q.* i T.. -*: *

H. .:,'I . * ... ..
'K ;: :n .. : -^ *.*

....----..u"*n r *.
::.:.::.: : . ......... ..l .....
.. .. J . -M .:
F H ........ ........ .*
HA .. -I Blean u Wahi

..... ....... ... ...

.... .........
*.. ..H" --
S* r .." .' . .: "
tL *... .h

iM'H

iIOna

s, a shortage of

care

White. Black.
I

-.1...... .

1

to carry

rely satisfactory manner has been experienced.

to maintain entire wards

, handling from 30 to

the services of internes and pupil nurses, and it

employees,

o give to the patients the class of

demands.

been

employed

notable

er available is

L0 SECO

ERICK D.

.IP HORWITZ, Attending Physician.

patients follow

making.

Black.

70

Admitted.

White.

Black.

3
- -. . .

Paroled.

Black.

S. . :.
. . ..

ijeonj. chinese.' 3 Two Chinese and 5 Panamans.

patients was as follows:

Deaths.

Plemoa

le. I

Black;

Male.

White.

- .. ...

Black.

"'* 1

Female.

White.

Black.

......11

several additional

improvement

not as yet sufficient to meet

COLONY

Remaining
Dec. 31. 1923.

White.

37
. . . .

Black.

48
26

74

White.

. .. .
* . .

Black.

. .. .
monaI

[y.I .

oI patients

amounted

competent

personnel

without

necessary

During the year

supervision,
service that

with

LEPER

TUCKER, Superintendent.

Black.

White,.

White.

Parolee.

Female.

6 i a

1

III III 1111111111

"1

.. ..

/..'

*ii

The
were:

plans

nationalities
33 British W(
4 Colombians

An average of

wage averaging $7.95

patients

est Indians;
: 2 Chinese

remaining

December

5 French West Indians;

1 Haitian

iH
ii~i i

:6.1
I.i~
Hi

35 Panama;i-

and 1 Ecuadorian.

patients were given employment,

their monthIl

each.

.iii:!
ii.:

A. .
%L ..ii

. :' ..' -...:" :: !
I .. ., ". . i r
SI"

"ii..:.ii
1.' ...

and
of t

cash allotments

patient,

totaled

, which vary according to the degree of disability

$1,557.50.

Thus

the total annual

income of

patients amounted to $4,205.43,

or an average per patient of $52.37

Total cash sales at the local store anmiounted to $2,938.55.

During

the year

pigs

from

there are 5 pigs remaining on

Weekly

were

greatly

perienced
During

movie"

exhibition

enjoyed by

local

the farm.

were continued

people.

Increasing

during

difficulty

year
was

an(
ex

in obtaining an operator for the moving picture machine.

year

concerts

5 vocal concerts by colored W

Chri

visited
cand v
visited

colored

West

Indian bands

are

est Indian choirs were given.

tmas week the Ancon Girl Scouts

the colony, sang Chri

the people.

stmas carols

from

the drug were given as follows

intramuscular injections to 67 patients.

injections to 41 patients.

and songs,

and di

stributed

Panama Rotary Clult

interest in the place and work

and have promised a radio receiving set for the colony

ocal carnival

13th of February

The visiting

the first
and was

physician

in our history

took place the 10th to th(

i tremendous success.

leper

report:

Specific

Treatment.

chaulmoogra acid

-The

was

for the preceding year

7,325 cc
10,205 cc
1.710 cc

n 1,465 weekly

,043 biweekly intravenous

in 342 triweekly

intravenous injections to 3 patients.

administrat

colony

ion of

make

the

following

ethyl

esters

; ....n i i...X ii.
."., *. ": ,iH

.. *iJ
ia ii iX:

..H
":" i .
: :. :: i ::::

N:!:
.::.* ":"*: :" !
I ",,,,,,,,
.:..: . :
..=:=..
....N.....
*=H-.iI
".. iii

S .i S
1 :"
," ,, ":,

. .. .. ..
>... .N.

f *3! iin ~i:. .

-.== ..." *.:i i iii'
N ...i .

HH. H....
N H..... "

Local products were purchased from patients to the amountof $143.61

farm were killed for food

A deputation

as is their annual custom

the colony and expressed great

26,375 cc of

followed along the general routine laid down

i;

~I .... *: .:* *
*:.. :**:: ::" "

- =" L "iz ==;** *=;" :H.:
.. *:.:: **. n H

ii. : .

..: *. *

SH. :
s n on r fed
i:,. :. H... r r --

Hif ajd.<~i 43*Au
... H ..H
; ..:.x. x
5 .. . : *UL
Npi 1 III* ruHf. t 1 n *

.:. .,. : "hn p e fo.
I ..... .

auction of dose or cessation of treatment for short periods.
did any alarming symptoms develop as a result of treat-

the esters.
*

C

bers given above as under treatm
of the colony, with the exception
o withstand the reactions following
ultimate recovery was considered nil

ent include the total
of 3 who were too old
injections, and whose
i.

C

Treatment of complications was given as follows:

1. Lues.-In several
the proper treatment f<
Wassermann reaction.
Wassermann reaction.
.ment. Seventeen cases
cases became negative
completing treatment,
2; Uncinaria.--Sixte
tiunr. All became nej
worms or ova.
3. Utcers.-Twenty
Among these, plantar
were ulcerations of the

C i

ase8

it was found that syphilitic infection

or leprosy. Eighteen such cases had show
Antilepric treatment had no effect i
These patients were, therefore, put on an
received 170 grams of Neosalvarsan in 189 i
after 103 grams in 114 injections. One
and 5 cases are still under treatment.

en

cases

interferes

n a positive
n modifyin
ti-syphilitic
njections. I
case died

were treated for uncinaria with thymo

1 with
blood
g the
treat-
Eleven
before

or chenopo-

native as was shown by repeated examination of stools for

pa

itients

perforatinE
fingers an

and forearms. The following' met
elevated position if edema was
solution; (c) Continuous applicat

were given

regular

treatment

trophic

g ulcers were most common; next in fre
d toes, and occasional shallow skin ulcers
hods were used: (a) Rest to affected memi
present; (b) Continuous application of I
ion of warm, sterile N. S. S. (d) Cauteriza

ulcers.
quency
of legs
ber-in
Dakin's
Ltion of

callous margins in

ai

by application of e
'chiulmoogra oil; i
.. injections. (vide A
.4. Local Lepric
types were given (

" '** :

I: -:
,,,H:"i

th chemical or
either Dakin's s
(e) Fifteen pat
LnnuaI Report

i

electro-cautery in ch
solution or 1 to 4 per

ronic indolent ulcers, followed
cent benzol chloride in crude

ients received 4,109 cc "Oscol" in 840 intravenous
1922.)

Conditions. Eyes.-Lepromata

mne-fourth to 5 per cent

eyes several times daily. Nasal ui
patients were discharging large a
they were subjected to periodic

" of benzol chloride in equal parts of
. In several instances injections of
absorption of the latter; chemical
the same effect. Nerves.--Intran
: f ulnar and peroneal nerves wer

the estel

lcers.-Owing to thm
umbers of bacilli (f
spraying of nasal c
crude chaulmoogra
the esters into nod

r(
a

Ul

eves

in nodular

rs in albolene d:
fact that the ma
om active nasal
cities with 1 to
il and albolene.
les resulted in tl

and electro-cautery was also capable

mixed

dropped into
jority of the
ulcerations)
2 per cent
Nodules.-
he complete

of producing

eural injections of the esters into fusiform swellings
e tried tith marked success for amelioration of

*

I~

HI*' I
HI:

H..~I~EIYI~&Y~1L ~T~r~l;~.r 8.. -. i :-

u-ia

1q I

Ernl' cm

IP ~YI

*hV

oC 09 0

Vf

H

ii

.i

H::: ** *.h:.. *. n* ".*.* **
.... *'..L .. : . *" .. ....
** * : ** : *. " :. .. ,: :,, .:

: ,,, .*, ,,,, i x: :"..: . :
.. . .. it. .. *' H
'* .* .::::.. :. .. : ::.. :.*.*:"
H ....

muscular injections of the esters. In aJanuary 192,.^ eaa .f -" ""
were negative, so patient was put on provoGati dsesa of K L ... ..........
to 40 grs. daily,. then developed .slight attacks of lepra fever and-.rupti ui&.
taken on the 3d of February, .1.922, from both sides of the. nassaluteptu.aiu'S
of right ear were positive for B. Leprae. K. ..was discontinued on tha. .Ial
February 14, 1922, patient wasgiven the esters.iatravenouslyt~rioueekly.d
to the intramuscular administrations. Intravenous doses were'mnadndly*W'.M

until maximum
trained up to Oc
reached on Apri
esters weekly.

of 14
tober
128,
On

Patient was again pu
following administrate
1922, proved to be p
intolerance to the larn
ent vomiting, eleva
discontinued on that
for chaulmoogra tre
weekly. On Januar

WC
. d.

Is

then put on

cc at a dose was reached on August S., 1922, .and .w'aa~
, *. ,:, ,*:: i ,:iii:
,1922, the.maximum of the intramuscular doses .h0&ij.
1922, .at 20 cc; thus, this patient received about.-..4 8'~,a '-
August 15, 1922, smears from nasal septum .we.re "g
t on K. I., 15 grs. daily. She developed no symptoms.tbia$
tion of K. I., but smears taken from nasal-septum .n ..S.
". .* *X .* . .
positive. October 19, 1922, patient developed 'rathi. ......
d f th-t-hih : s::d by""""** ..
ge doses of the enters, which was manifested by nausea. .
tion of temperature, and loss of weight; este*rs 't
date. October 26, 1922, collodial antimony .was s.bt.. i...l.
atment, and was given. in *5 cc doses intravenously " 'ti
.* : ***.... :**: :*" "!^
y 5, 1923, patient showed negative smears from nas:al .ti:.
gradually increasing doses of K. I. until maximum of .l.i'
^ ', ,"r i .u ... "^* i..:

was reached on April

these

doses

were

continued to date" tf

. : :.

Patient did not show any reaction following these large doses of K. I. and: -
examinations during this period from cauterized mucous:.membrane of nasat at
as well as skin of ears and old scars. of pigmented areas failed to reveal the pvea '
of B. Leprae. Clinically, however, patient showed no changes; there W..as s.
enlargement of both ulnar nerves, partial anesthesia of skin of extremit.. i.c ...
partial paralysis of terminal phalanges of little fingers. i "me .ii
4. Case No. 64. R. W.; male; .West Indian;, age 41 years.; timen. ..
years; nodular type; received a total of 1,317 cc of the esters via intramusutl|.
intravenous, routes; was paroled May 15, 1923. : *.
Patient was admitted to the colony April 19, 1911. '

Progress record: Although
nodular eruption in 1913, hih
was instituted here in August
disease with the exception of
organisms. During entire co
have become apparent with
swellings of lower extremities
of iodide of potassium given
patient January 155, 1922; at
daily. Several attempts to r

patient had an acute attack of lepra'fe.verti
: " ::.:

s lesions gradually cleared up when specifi ..
1921; patient presented .an almost arretedd state i
smears from lobule of left ear which have sho
urse of treatment another manifestations. of ithtn .
the exceptions of influimmnations on un tN
s following provocative administrations of ma4 .
to elicit symptoms, K. I. was first.. M
that time he could not tolerate doses higher. thaiC
epeat administration of K. I. during the
... ..u :"- .:. *Cii $. .

n

'"C.
HI:
E~.!df,-. .L.

was again put oh increasing doses of K. I.;

rtj well,

The largest, of K.

this time he tolerated the drug

was reached on March 31

, 1923-120 grs.

rMMg .this time he neither showed repetition of symptoms formerly produced by
Sd istcations of iodide, nor was the presence of organisms demonstrated in smears

rX tn et ear, skin, nasal mucous membrane, or other parts of the body.

l-l":;:: .." ""
S ..5
g..: .,
."^ T- *tk
H: ::=^ r a4 W

;C~e
antb;

male

Panamanian

46 years

received 210 cc of the' esters

time in colony,

via intramuscular route

year
was

p!Xl.ed Septenber 4, 1923. ,
. -'Tziq patient was admitted to the colony on

July

30, 192

never

had any

open ltsions or ulcers, and the only positive bacteriological finding was on

July

1921, in a crippled finger (ring finger of left hand) which was amputated for exami-

nation..

The report was as follows:

* "Microscopic Report: Atrophic leprosy (sparse number bacilli found in nerves
and subepithelial layer)."

Progress record:

Index finger of left hand having been amputated,

treated and healed in a short time.

Patient was placed on

Intravenous

stump was
injections of

coloidal antimony

three times a week

increased to 5 cc three times a week.

This usually caused a sharp rise in temperature followed by extreme weakness.
Smencing October 26, 1922, intramuscular injections of 5 cc of the esters w<
Q once. weekly in addition to the colloidal antimony twice weekly. On April

'colloidal antimony was discontinued, patient receiving
.*weeldy, intramuscularly; patient still presented con
condition had improved considerably, and on June 3,

as
4,

Corn-
given
1923.

ig but one injection of the esters
traction of both hands, but his

1923, he

was given provocative

.dmes of potassium iodide, 5 grains t.

.,and gradua

increased until the

maximum

Sof120 grains t.

d. was reached, which was continued for 14 days.

the:potassium iodide treatment did patient show any reaction.

At no time during
Smears taken from

., both sides of

nasal septum, from

lobules

of both ears, ani

from the discolorized

patches on skin, arm,
6. C6. ase No. 186.

proved to be negative for leprosy bacilli.

C. L.;

e; Panamanian;

age, 26 years;

time in colony, 71

years;

nerve type;

...... paroled December 2

received 241 cc of the esters via intramuscular route
2, 1923.

- Note:

Previous parole, February 7,

1920.

Readmitted February, 1920,

as clinic

. type. .He was discharged for insubordination and was readmitted because he could
S...-. not .ake a living outside. This case is of no clinical interest.

All" these patients were subjected

to the provocative ora

adminis-

I,.tration

y- accinations

potassium

.have

iodide

been

before

successfully

parole.

addition

performed

them

, smallpox

without

ii.:ausing any untoward reactions.

: (NOTE.--Vaccination

in active

cases

of leprosy has been

reported

cause

,:" very severe reaction.)
flaa. nan I~ na'. iF. ____Cl~ nnnn Cm nr -.n an I- rio ( nl + alt arI~ rrnc +r i-h0r~IP nrrr

Ii.g

..

No.. 310

inere type

was

s been completely destroyed. ." .. :'" I; "i:
.. [: .:: "" ." 5 *. :*
Eye lesions were found to be benefited by lo-il appicati -
ters in diluted form, especially when- combined witt: int

spray

or better still

ulcerated areas of

tamponss soaked in pure esters and appleid
S* ..:. 'S ::

the nasal mucous membrane.

It .is p 1

eye infections are the result of contiguity to" the intra-nasal co"

and that the organism is carried upward via the nasal duct.-
jEA
a.
.

.... : . .....*.::...
*. "" ..' '
- ..u :4.

BOARD

(Dr. L.

HEALTlH

BATES

i-

LABORATORY.

, Chief of Laboratory.

(Operated in connection with Ancon Hospital.

). :
)

There have been no epidemics to deal with during the:

Bacillus typhosus-Recovered in

blood culture from 13:
'C

S i.H iH.

I.
*. .ME::::...H
.' .: : 5 H
.. ..:. :... :** :
.. ...t. .... :. :" :
.. .. ,

4 from

shipboard,

from

Peru,

1 from Porto Rico, :aid

Canal Zone and Republic of Panama.

Pa~a~y~hiu&$vcsrjl

once in blood culture from a colored woman who lived-
..[: ::

.(Cristobal).

Typhoid Carriers.-On December

1922

,4 typhoid

nhdI~EL

...... .
4 ,,, ,":4,,

1:..

under

sanitary

surveillance

and

of Panaina

and C.

stool carriers.

de L. of

Colk

B.and(

- 4

a- C-' I

- .. .: '. ""I. ',''
^H^ ^P W ** I *** * :* A ***
> ~ ~ "' :" : .' ^',e .":^: E :* :: M:I f ifiiB
3. H. still remain positive- :.,
S1. .t .... .. a .... :' : .: .: .t:4.
/ r . ..._ ," : "::- J :4:."J l Y:: '. E :ei

ha

est

ii
-:

lb.

f

= === = = m

,r

---- w

r

w

Adenoid

routine, examination

noids removed at operation was continued throughout
"i. *::** "f. ov e w .
S: .Oi....i tonsil.ere veed alone, 5 or 1.6 per cent were found
1j :. l. usu ;.;of 17 adenoids removed alone, 2, or 11.8 per cent

-.. .er...e ;"
..: ,H":.* :*i.: r i.

r~.. H HH$,i tdeno.dc
=:^il^3 a a uni
.. .. lb * .. * **:: **
Hl.... HH were exa
.. .... ...... . . ._.

-., ~it'r: ........ ..er ps .
i*.. ** i . .: .. : . . .

.*H ::... . .. .* t
: .:: i .:*:. *
--'* .'... : :: ":. ss i ..,.:.. ..

of 322 tonsils and adenoids

Is

were found

t were:
nined,
resent.

ut none of

Cultures

noved

from

tuberculous.

652 cases in which

1.07

and

removed

together

The totals, considering
their tonsils or adenoids

cent in which tuberculosis

Mycotic fungi were frequently found in the

these .suggested actinomycosis

these

were

2 cases of

not made.

or other

Tonsi

and

phlyctenular conjunctivitis

One tonsil in one of these cases showed tuberculous

lidss in

(Tropical

the other case showed

laughing phagedena)

tuberculous foci.

-Thi

condition,

)ugh said to be common in the tropics, is very seldom seen
dl:Zotie... However, during the .year one typical case was

*****Ahn..Hospital. .A. C. W., No. 252596, white Am<
. :d to the hospital with large phagendenic ulcers on
|:. "".:. external maleoli.. He gave a typical te

:onset and progress of the condition.

erican

in the
seen at

was admit-

both legs over
Sxtbook history

He had been prospecting on the

i.: t:ani;a-Colombia border, goirg barefoot i
;. t.he lesieons showed enormous numbers o
-IH." I..f ito 15 hturnsand many fusiform ba(
It'I ti present but these immediately disa
....i.F.. tSle The spirilla and fusiform
. .:... H 1: t" "
H HHKI.ll.. 'JThe fusiform bacillus was rec
S*. i -: .
.... cnt erum agar, iicubated an mrobic
H. :.. .d er. atts'" method. Efforts to isolate tl
. .'d' .". ."" ." ... ". . .. < '1
S3 at.I oculauns were unsuccessful.
!**. aed ollwn the app'
p.. ..e Rats. Without Visible
Hb.j.ii ath. Reports," Vol. 38, No. 33
iP~r H" -.i -A -: V l 'No

most of the time.
f large coarse s

:11!!.

Smears from
pirille having

There were also staphy-

Appeared when treatment was

bacilli
coveredd

however

were

in pure culture

very
in 20

ally according to Krumwiede
he spirills were unsuccessful.

earance of an article entitled

Lesions"

"United

published August

States

1923

- S a

V

II.:...
:i:!

r' ,;;.n"

Exa~ziita~ions .--The

i

.

" 'Y' '' r

,rI~jH:::r

of not more than ten rats,

was then subcutanebotlly injected

abdominal wall of a healthy guinea pig.

seven days were autopsied,

and

All pigs dying in

those living seven days wei

.."".i:: .E" .:::
S" ". *" .: :: ":* "!
. ..* .. : ::
.. d .: .. ."
eiltSe h :.
'e bltedtn'H

death and then autopsied, their blood

fixation tests.
made in the ex<

being used .in the complemetJ

Gross inspection and smears of liver and .sple 'We
imination of all these animals. Thus far no vpi.itive^ eI
v ~ [ ", ^ ;:': .^ :":: ...:..* ** ***

results for plague have

been obtained.

The above is in additigx Ht

routine autopsy examination of 14,077 rats.

Swimming pool.-Periodic examinations of the water in

Swimming Pool were continued throughout the year.

Thi

the Balbo i
M C .flsi i..i:"
ese co.n..it .
-1>::x I1

of bacteria counts and examinations for B.

used for disinfecting the pool until

very difficult

coli.

Chloride of lime wasi

the last week in August

to get chloride of lime having

chlorine content, and

or no disinfection.
Canal Physiologist,

the deteriorated

On August
introduced

a satisfactory

product, of

course, g

Bunker

the chlorine

gas method of

T W lli. .
I". "'''
availablei A
ravelit .

..:::. : a ....
H I
... H
U~f..Z... H

ing the pool

modifying the method of introducing the gas to

requirements of the pool.

three times per week,
is added to the pool.

Ions.)
count

The pool is emptied,

scrubbed

ar

and each evening 2 to 3 pounds of chl
(The pool contains approximately 43(

The specimens for examination are taken in the morni:

now

properly

10 cc

is seldom above 100

distributed
quantities,

When

throughout the pool,

but when

added

the chlori

coli are seldon

those not skilled i

meet: th&.:

Lorinegits
..a... ::i
S* =. :: :..
*. :".=
ne. ...
oni p=resent:i
Sii .-. :...

in itue ...i ... ",..'.

the desired results are not obtained. I:Sc.l.
Library.-The laboratory library is well supplied with current tuixj i:S
.... .MCWSK^

cal journals dealing with

laboratory and closely allied subjects.

library is invaluable to the laboratory

profession

in general

always

been

staff.

Its use by the medi

encouraged.

The

.. .::::: :. .'a i

has seen a most noticeable increase in its use by the hospital staff.. H'H"
Embalming.-The embalmer-cremator has introduced a inaif
. i"..i....
tion to the routine method of embalming which causes a much -*aS
thnrnrrhnli fIvotlnn nF tbi 0i;ccc The rnrnl-rnn rhnci*ta *f at i.*..*M
J, IZ LI &U I :::..

H.H~

'sLBBS

* .:: ...

a

S.. ."

1... :.:Jng the year'approximately
". .! *" . :

H:LtSw not include duplicates.

llil. .. :-- *. *: BACTERIOLO(
. H:' HHEr.
Hill H H

UE .:. * .. __a. ..ul tee..,;;..-...... = .. .. .. ..... ..........
....:::* : :**
... :: H lA... M AJI-e
Ht ,,,:44
SH.:...i,:: ., , .-.
oos nC cua dpcae

*. :. *
H .
... .

r'.

I:;

11

Hf
* IIH:

1'I

I;'

^. ....p -.o.w. .............

B. cl ...................... ...

. ,sko~l rCcue ourue ............
slfhy.lo .s. a.bu ..............
Sitrponeaua no-&tmotyfic.......
d~s-. o.o.s idans. ............
S lured for Typhoid Dysentery

33,000 reports have been rendered.

.... S.
* . . I
. .... . .
. . . .
. .. . .
.. ... *
. .* . .

group.

.. r P itv e s topI culturea........ ... ..........
-. B .... iyphon e............ .. ..... .......
I. R -&. typhuosua on carriers (4 carriers)........
S. .. ".B. dsengrise Group I Shi). ............
S" B dfsenter.oe Mannie Fermenter Group II
S. B. dysantertieOraup III................
Binea culthued fortyphoid group.................
Pcimtive urine cultures..................
.. B a~ByphoAasue on carriers (1 carrier)........
TJdin. cultured for organisms other ihan Typhoid
SPaitive urine culture (53 of those B. coli)....
... dat cultures for B. diphLeriae ................
q .,., Poidtive for B. diph triue ..................
N'asl eidturep for B. diphheriae.......... .....
SCultuer from earfor B. dip.thcrie ...............
:- Thrst culture for organisms other than B. diphthei
Bar SIult..... .... ... .... . . .
hiMatoid cultures........ ................. . .

aop ...ha...ngea cul.ture.......................
Amflu e.lturej..............................
.." .;a fluid cultures ............................
..uemoeoccus Type I. .......................
i Brekpoeccw n Remolyicw...................
il fluid culture ............ . . . .. .
"Adw luid cultures ...........................
.Knee flid enltures.... .... .,. ......... ...
Cuftureu for Durey'e bacillus ................
. oitive for baillu of Duerep......... .....
.. ltures from.kin lesions .....................
1 a from suterior chamber, left eye .............
P fom perartieur abscess..................
froa abseee on lip ..... .... ........ ......*
Pi~e rom knee... ..... . . . . . . . . . . . . .

*.-":
. ;.f%. JWftrm faUopian tube. .....,...,........
Pus from sutum........ ......... . ... ....
I r :- 1P from left .tube.and ovwry...... .........
_..-.Pul froman bladder..............., .......
|~.: .. ... fs um .:.nkle joit.,... .... .............

..q" % ... Iro lhemo. .
''. .. %a Sm rem ee.. ......... ................
I.,"* ... A o .fiic ultn e e.,..'........ .......... .. ....

l ".... .. lo t ru aoe......... ..................
-* ""'-f-Is from edteig o left o..la...........

. .
. .
. .
. .

. .
. .
. .
.. .
* S
* .
* .
* .
* .

......

* .
. .. .

. .
. . .
group

. . .

.....

rice...
. . .

. ... .-

. . .

... . .

. . .

. . .

. . .
.. . .

... .

. . .
. . .

. . .
** . .

. . .

. .. .
.i . .
* . .

. .

I . I .

9
1
2
2
5
3
1
3
. .. . . .
100

9

go

. . . .
73

90

. .. .....
. . . .S.

. . . . - . . -
... ................................. .. .
. . . . . . . ... . . . .

.. . .................... ........- .....

. . . . ......................... . .... .

. . .................................. .... .......

. -............. ................ ....... ...
. . . . .. .. . .. .

. . . *. ... ..... .......................

. . . . . . . . . . S

S......... ~ ... ....... .......... . .S

190

8,176

2,884

I1s

2,125

88
1
I
6
a
7
7
5
47
64

18
3
112

11

1
1
1
I
3
1
I
4
I
1
1
2
2

1
2
133

9
1
1
2
133

0
I
i
2

;ICAL REPORT

" H".

I!..

H

a mm

56

BACTEROLOGICAL REPORT-Continued.

Drkfield e .mu.ioni..... ....*................
PositiveforTrsponema pa idum................
Darkfield examinations for 'aws.... . . .. . .. . .-
Suitum far dlarkfield ezamination.......... ..

Blood film a examined for malarial pa.ats. .......
Positive for Tertian Malarial Parsit ..........
Paitie for E. A. Maksrva Paraite.............
Positive for Quartan Malarial Parasuisa.... .....
Blood film examined for spiroeabete. of relapsing fever
Blood for red ceil count.......... ...... .... ...... .
Blood for white cell count ............ ..............
Blood for differential count........................
Blood for haemoglobin estimation.................
Blood examined for filaria ....... .... .. ......... .

I i* . * *. *t A...* * . J^f . f .j *^..
de d aPi H di I i m I ii i i m i iI a mdk m

| k a g dD | m H , ., | d g | *

.....[......

.. . . . .n .

i . .. . . .

Eye sm earse........... .... .... .................. ...........
Throat mhears.........y .....................................
Smears from nasal ulcer-................. ................... .
Urethral sm ears. . . . ....... .... . . . . . . . . . .. . .
'Vaginal sm ears... . . . .. . .. . .. . . . .. . .. ... .. . . . . .
Smears from venereal lesions........ ................. .......
Rectal sm ears... . . .... . . . . . ... .* *. . .. . ...
Smears for Leiahman-Donovan bodies..... . ...............
Feces examined for parasites and ova ..... .......... ..........
Stool for fermentation test........................ .... .. ....
Cell count of spinal fluids..... ...... .., ...... ........... .....
Rat virus cultured .... . .. . . . . . ........ .... ...... .. .....
Autogenous vaccines prepared........... .... .... .... .... ......
Water from Balboa Swimming Pool ... ....... ....... ......
Water from Panama Health Office for bacteriological examination.
Water from Colon Health Office for bacteriological examination...
Water from Fort Grant Beach..............................:
Water from Bella Vista Be-ach.................................
Drinking water for bacteriological examination..................

Food stuffs examined: -.
Milk cultured for bacteriological count ........
Mother's milk for culture....................
Dill pickle for culture................ .....
Hash for examination. . ....... ..............
Bread examined for rope...................
Bread examined for mold................ .....
Miscellaneous smears and examinations........ ....

SEROLOG

. . . . .
.. . . .* .

..- ... .. .
. ..*.... .

. . . . .

REPORT

. .. .. .. . . .. S '. *t|

. . . .. .. **. .. . .. *. .p
.* * * . * . ..

*.. . . * * .. . .. . ... .
.* . *. . S. *. .. . . . .

. .. . . . . . . .* *
. *.........* ... .4.... *.....

*................................ .. .
....-... ....... .......

.. l.l.. ll. .. l.. l .. ..l
i. .. l l. ll .. l. l . n
. .. . l.. .. l.. .. ..
. .l. .. l.. l.. . l.. l.. .. ..
.. . l . l .. .. l. . lll l
.l. .. . l.. .l ..l..l.. .. ..l..
. . . . .. . . l.. .. . .
.............. l..... p...
........................
... l ...................
.. .. .l... .... ... .. .. .
. ... ... ... ... ... ..
..l.. .n .l. . l l. . l . l l.
...... . .. l. . .. .ll. ..
... ..... I ll.. .. . .... l
..... ... .... ... ..l ll

..l . . l. . l.... .l l .. .l

. . . .
. . . .

S.. .
*. .*
.. . .

S
~H *....' H*Ii*ii.Hfl '** *fli*k
.1' .1....
H ES
*~* ..: --
iI~ N.: ,k *..~ .
.. .. .
4.. .. .. *i**L.*
A i.~ .~ .!*~* .S:~:j' I,
HE
.. .. 'I::
H
In

.5 H'~ H..:
A ...
i~1 ..
*
I ..j~ a
4.. 1 S
4*** *

H
* L ~ * .4 '~bquc~
'j. H hU~
42....

* . ... ... C.. **~~*.:
. *1-- -
. ~ -
too

b*... a..
* * i*~ * *4* *Ih
.1.
* h ~ ~ * *

* . . * . .
* . S *** .~* * .

. . I ~ * ~
~ * h U

* . . . C

* . U U ~ ~ ~ ~ . .
. . . . . *

* * . . . .

* . . . .
* . . * C ~ *

Lire'
* . .
* . .1.
I.
* . I
* . S
A.'

W asmermann tests ...................................................
Tuberculosis complement fixation tests................................
Gonococcus complement fixation tests..... ... ........ .... .........
B. mallei complement fixation tests. ......... . . . . . . .. . . . . . .
Agglutination testa............. .... .. ........................... . .
Blood typing for transfusion......................................... .
Examination of blood for coagulation time............................
Blood serum prepared by Swift-Ellis method for intraspinal injection......
Preparation of autogenous serum for asthma............................

. . . . .
... . . . . .

... ..... ....m a
... ... ... ... i

S..n n
* . .- .

* i . .
n n - n-

S
S
* 'WI
A',.

4-,:::..-.-..;WASSEkMANN REACTIONS DURING THE YEAR 1923
......... the.year 14,648 Wassermann tests were performed on 9,(
.i. ... ....
......... ...

I.H. .. .. ..
.. .. .
.. .:...*:... .. .. . . IiI I

H I . ".I
:... -- .." .. . a *

"'" .. .1+' I Pasitive. Native. Toti
I "ITotal,"

S: -, :. .

., .....
.. ... .. . ...
:.. .. P .-
r -.. .. .

m : j. ** 4**t .S ......
*. . 1-
....gmg am...........

." ... o

RII;SI S.... IIm umima i *ge m*m m *mu**m me m*g .*
.. . ...

:.. -......

-w ....*...-. T o..................................... .
... *.. .: .
X.. :H.L t L~

.. ::.1 " *

.. ... . -

.. . . i

.. ...* H H .
r 4. *
... :" .*.

.The figures in the above table are based
iN .Hals examined and not on the number of teE

n-adito. .. Wassermann tests were mad
. ........

. a... any individuals, and of these 113 or 17

PATHOLOGICAL.

uriigthe year, 205 autopsies were p

.jte alth ILaboratory. The cass-fd-t
.. .. ..H..

.** *** : .. *. *
aliymi:** 1S ***** -
....H ..
-, :.. :am"n'.:,m ."., D Kl'..... ... ..... .. . .. .. . . . . ..

...Hm..f_ hIc : .. u .. * * S. S.*. . . ........ . ..... . .. . . . .. .. . . . ..
.. . .
.. .... .. .....
J,,.u...,Bsih ry....*.::..

. :.. .".."... I idi e i o i ** i . . . . . .... . . . . . . . . . .. . . .. . .
i.....

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

612
294
'9

925

4,469

2,980

2,183
!.410
308

3,i05

i80
ng

I t
ire.

11. 69

28.03
20.76
6.20

23.68

31.66

16.85

on the number of individ-

sts made.

le on 631 spinal fluids from

.90 per cent were positive.

formedd at the Board of
rere as follows:

r -.iIi

243 1.688 1,931 !
19 140 159 1,
1 29 30
329 2,612 2,941 1

n,

Diseases of the Nervous System and of the Orga

i plme ningitis........................
Glioma (neural-epithelioma) of spinal eord...
Sarcoma of spinal cord ....................
Cdmbined sclerosis of the spinal cord........
Cerebral hemorrhage, apoplexy.............
Softening of the brain ................ .....
General paralysis of the insane.............
Dementia precozx......... . .. .. .. .. ..
Manic depressive psychosis.................
le y. .. . . . . . . . . . . . . . .
Im becility ..............................

Diseases of the Circulatory System:

Organic diseases of the heart.......
Sclerosis of the coronary artery.....
Aneurysm .......... ... .... ... ..
Arterio l s....... ...... ...
Embolism and thrombosis ..........

T ota.. .j. . . . . . .

Diseases of the Respiratory System:

Acute bronuchitis .........
Chronic bronchitis........
Bronchopneumonia.......
Lobar pneumonia.........
Pleurii.v ..... ........

. . . .. .
. .. . .

. .. . .. . .
..... . ......

. .. .
. . . .
.i *
* I w i n i

.i . .... .. i i" : ..." I

.i. H ........... :.. .
S**i ,,,,
I * * . ..j
:" ":. " !!" .

.: ": .'l

". : :: : :

i**..** ** *- * :*|.

-. HI......
-- -* H,

. . . . . . . . . .. . . . . i . .. . . .:

* . . . . . . . . .. * * . . l:

S......
,, ,, i i i

.-- .

.. - .

: .': ." ...x..*

Total ....
*"

I. ;

Diseases of the Digestive Systeim:

Tonsillar abeces, bilateral (Phlegmon and cellulitis). .. . . . . . . . . . . . ... . . . .. . . . ... .
Ulceration and gangrene of esophagus with perforation of left kn*onchus (aspiration pneumania).........
Diarrhea and enteritie (under two yeare)................ .... .............. .... ...................
0 0 1. sh e....... ... . . . ... ... .. .......... ... .... .... .... .... .. .............. ............

. .

Diarrhea and enteritis (two years and
Acute appendicitis ....... ........ ..
Operation for bilateral femoral hernia
Intestinal obstruction ...........
Acute yellow atrophy of the liver....
Cirrhosis of the liver............
Abscessm of liver .......... ........

. . . .. .
t operative

hemorrhage and simple peritonitis)..

* .
I *
. .
. ..
. .
. .

. . . U..
. U .. *...*
.. .. .. -.

.. . . . .

.*U.......
O1i| 1I1
1 1 1 i i'

, inI -~

Nonrenereal Diseases of the Genito-urinary System and Annexa:

Acute nephritis. ................ ...
Bright's disease chronice nephritis)...
Acute pyonephritis. ...... ..........
Pyelonephrosis....................
Rupt ed. urethra..................

Total..................

The Puerperal State:

Incomplete abortion.........
IAklk iii^ -c wen. 4 :n*

. .. .. ..
. . .. . .
. . . . U.

* U 1 1

.. ... ..*. .
. ..* .. .. .
. . . . . .

... ... .....
. . . . . .

*H li**j

1.
*11r~

:1..
-ii: 'Hi~
:4 I' :

. n :5.. l..l'
"H

:3 LEE
HI1 Ed

I
"":IHI

14tI

~E6T~.1
_ _ _ _ Hl II

:::yit'

*A ..:* ."..ai=-

. ... .. ... .. ... ... .....*. .. ....t. ... ..s. .i ...i n .

Total,,

Tbtal ,

H : 6. .. .. I.
Hi ... .

HI.

;.:..i : :. ..*:::, = * .
S i .. ....

e=", fasme of Early Infhncy:
........t.a birth. ..... ... ..... ........ .. .. ."* i....... ... ....

.. .. f .r ition ... ................ .. ................
."*Mon . .. ................. .. .. .

S................... ... . ............ . ......... . . . . . .
1 .. .. . .. n . . . . . . . . . . . . . . . .

. . . .
. .

Old Age:

baiIi.r. h .
To l I.................

Affections Produced by External Causes:

.Bmaa conflagrationn excepted).
Aeeidetal drowning.......
'um.tiam by fall. ..........
la.matiam by vehicle-......
Tziumatfim by landslides......

,.- T ota l-. ... . . . . . ...

ill-Defined Diseases:

2
1

Appendix:

t~i ni~b folwn fiIc. I iZ..

IhToaul ,I'oaI .

. .

I: '
.1
*1

The most frequent causes of death found at autopsy for the year

were:

:.,Sfalil (including general paresis)......
' &tf~~:i.r,;re

Cmi..,

Per cent
of
autopiei.

1

6
12
2

20

2

1
2
2
3
I

16
1

17

205

.::::::

::':::

mi~es~ea. ..
In~action of undetermined origin ................... .........

TOtOl~ I

1904 ......
1905 ......
1906......
1907 .....
1908. ... .
1909 .. . .
1910. . . .
1911......

C,
a

C -:

Table showing the more common. tcauses:pf

of HeaMlth aborator

1904....
1905...
1906..-.
1907..,.
1908....
1909....
1910....
1911....
1912....
1913....
1914...
1915....
1916...
1917....
1918....
1919....
1920....
1921....
3922....
1923...

Total.

4,

a~ -4

a Ma

fi9I -r I

ioou

1.055

a..
OIb

*0
: i

U

24 23
40 27
.26 25
32 .81
30 37
38 36
37 '27
34 26
38 12
20 12
17 I. 20
21 23
6 12
15 14

16 5
19 9
9 9

454 367

' This includes 32 cases of influenza.

autopsies

a

performed

revealing

I I I ; .: *.

,r...

. r ... .
It rj,.H .,f.1I1 .

ai atsuto ni*

a8 -] 'K *11.

15~~NH ,.a 1,
81~~. 25151

3.. .ao ft3 '.

S..5 4 t. .; ..! ii.H f:

;i.
.5 .ii

j S4H~ VjIJx

aM

*

4'

I.

Ii
1

t I "II. "

.. .ill.. .
I. H .I!l
S' .. : ::*........ H
*1 *J .i. "*X* i..i. .. .
6 : .. ..

.. > <.. ... .N., .-w J
2 6 I ...... .-- .

-.. ... : . *

50 1 5 4 ....-..~ ....- ... .
S. 0 ., i i: i i..

2 i. :7... :*.*.. .:
9 2 : ..i
S6. ...... 1 3 ... . .. -. ... - .. ..
361 .. 1. 2 3.:: ;: : : *:*:
.O 295 . . . . . . . . .. . .. . ... .- -k. - ::
451 2f . . . . -. . .. . . ... ... . .. . . .i..i
I 508 ........ 1 .1 ... .. * ........ ....
2 SH I .? : .
451 i " "" 'qI II I I'''I I"'w"I+" '+'I
... . ,, ,, .. '-
I l &! t

6
269
509
.496
361
295
451
508
425
460
375
328
323
330
253
324
334
289
262
205

Table

showing

number

diseases per year

5Ef

i?:ii:iei;C:ll

'bfae

*ss **, . :**9 '.>*X**
il -u l'slii :. .... -:": .=-" ." *"" ., -1 --i, ::-
H a:. .. .. X E ..: .*.
:iia:: .:..." : *e :* .. .,:: .. .. .. ." .
""" ". *::" ...: .. .H.. *. *. . : *:
.. ..... i .: ".:.-...... *: .0::-. . 1 . - .. .. ...i
... ** ::. .*: .. * ..* * ** ..
. 1 : 1. ... .
.. .. .. .. .. . ***. .
'.. ::n"** .. .... ...
........................................ .......... .. ....... .... ..........1
illii. Hihh.* .i ..19
Y" .i H" .* ...""-
..li i ."i"i.. ." :. ," .. . . .." ... . n. r m

iii". ; ... .... ....i... .
i ., ,: ,, ,
*AHL A1
[Hi e hundred a~nd twenty-tour bodies pasdthrough thiaboram-
ElE E. .E h. """"

~*Ait'tn the- year 1923;- 205 or 63.3 per cent were autopsied.
i . . . ..... . . : . . . .... .

I.. ...a .u at o sy... .. . . .. --... -... --... - - - ... - . ....1 8

.: ....i.There.were 50:cases in the 205 autopsies, or 24.39 per

* t whch responded either during life or at autopsy or both in a

P~itve-fimanner to the Wassermann test.

F"l" .tl..". Womsinan teat and pimitive for eyphilitic ion..............
i: irt:. ,-i .e:Wamermann utest and no definite syphilitic leuions.......... .....
S......ma. test a..nd. p tive for yphilitic l.on ......... .......
.: . i** .. . * *
MS-2 ***-f ** A

'r." .lnal"" parasites.- There were 29 cases in the
p :si"i .:: ^" :: * "* " "
! a ......

i ,.14.I per cent showing one or more forms of parasites
h ::" * *i *

..: ... ....,.. .... ... ... .. . 12 Oxyuria.......... ... . .
. ....... "*- 7Ti h m n ......... .
.I H ... .. H.5 ~
a : : ... . . .. -*,* * * *
. :: . .. .
Hq'f" :iu '.. "" " .

. . * . * * .* ..
. . . .* . . . . . .
* . . . .* . . . . .

205 autopsies, or

or their ova.

.. . . . . ..

H
if
I

",: 1 Lerosy.-There.. were
Ae" " :, "" A *
caises of death are give
.HiI! ... "; a se
4n.
LJH*" H
i=H.I H
id =!! !!! : '* :"
..::. :.. . .*** ..
' :u .. .r ;:. -
- ,,,, ,, ,
.T^^M id, 6 's Causfe of death.
H i.:o..::: **
: ,,,, ,,,i,,, "i .. l
IJSp :.- :* : *i7 r I' .. .- - *~ ^ - -----
. .^^^ ":"1 6g 4 Iepro y *.-........-.. .....
^W- g"" "" "" m'Ut T ^ ^
. .8 I.ep.....................
.. .o..i.. i Lenprosy....... ...... ... ....
..-.

H.P.
|. : 805 Iepray..... ... ......... ....
: *' ' 1'

1 :*. 1 .
Bg~Mlr ^ wcopic examinations and
; :X e.. *.-

.".::4 \; :* A ge i B.(p). .. .. . . . . . . . . . .
E *:.. .......if oa B ~..... .... ........ ...
... ey idat*
R::?: :p mefomxtrl a ms....... IId|

: *. : *..* g. ..u, ... .
::: \. l I n...... ...........
nB ahrB..... RI......

u. ::...* .o al.. cito . .... .:

: *. u...f. ro face..;..... -
: .." ...: h~ l e ".. .. . .

EB^" .:: '^(*ESis vett opal of neck-.....
..* .

.1!. SE:Hi: uimneC ~i'ifi'ozza t izeci d. ....***.. .... * **

": o. *q er extainaitios..... -.
.... ....Hih l owe.. w....... . .

Hilec^ siBtrifram
B I.'". ct' .pfz U .rN. ....t .S.S...
H HHawfroP lifr.I adj.ae. t ti... s.. .I
H. .. .

-...... ... ...... ..........
** *:h.9~ n~~ "fn m?1n i i m..- i i mim
".. ". 1 r mlag.gmmg~immm
. ......e t at. ... 4 ii i Dim d

... ... .... Ra a na..
.... ..... -mh o i a al .

i- - .. - - .---------

S4 lepers in the autops

Sin the table below:

y

Contributory causeD.

Chronic nephritis, psycheois, undetermined.
Tuberculosis, pulmonary.
Tuberculosis, pulmonary.
Chronic nephritis, pulmonary congestion and edema.

reports on surgical specimens:

i . . . * . . . . . . . . .

S. . . .. . . . . i . . . . . .
. .. ........... ....... ........

. . . . . . . . . . . i

. . . . . * . . . . S . S S*.**.
. . . . . * * . . . . . . i

* . ... S . . . . . . . *
. . . . S . * * * S * *
. .. . . * . * . . .. . . .
i i S S 4 * * i i i *

*. d. .. .. .. S**5 *. .. . .. .
ii* i S i h 5
. . . . . . * U * . . . .
ii.. .... .... .... .... ...
iiii i
................i... ii... i.. i i. i

series.

Their

.r* * ** : *a* : 4 **: ::..
S." '.*: i'" ..H **" .:::

.". ..." : .; .: :. .. ..
. ... : .ii:..

62

S* :....

Microscopic examinations and retorts on surgical secifrnes..---ContiuuL.. .

Specimens from rectum and anus..
Specimen from perineal fistula.....
Specimens from cysts of buttocks..
Specimens from skin (various locat
E yes.. ... .................... *
Submaxillary gland (salivary).....
Thyroid glands .... ............
rm ... ........ ............. .
Breasts ....... .*.... .... ..
Spleen . . . . . . . . . .
Kidney ....... .. ... ... .
Appendices (27 with female gentalh
Cervix uteri. .. . . . . . .
Uterusa .. .. ................
Uterus and tubes....... ........

Uterus, tube and ovary..
Uterus, tubes and ovarie

Tube and ovary (2
Tube and ovary..
'Tube.. ... . ....
Tube and ovaries..

Ovaries......
Prostate....
Testicles ...
Leg and foot.
Toe.........

Lymph
Lymph
Lymph
Lymph
Lymph
Lymph
Lymph
Fetus..

nodes,
nodes,
nodes,
nodes,
nodes,
nodes,
nodes,

ectop
. .
. . .
* .
. . .
. .
.

.

scalp. ..
submaxill
cervical..
axillary
mesenteri
inguinal
location n

. . . . .

ic pregnant

..ry and e.
. . . . -

* . . - -
. . . .

* . . . .

ary and cel

. . . . .

..ot

iot

stated
ot...her

other

. .
* .

'onus
* .

* .
. .
* *

a)..

. .

* .
cy>
. .

. .

* .

**--------------****

. . - n -

. .

rvrical.

. . . m
. .. -
. .. . ..... .......

.. . . . -

PRINCIPAL LESIONS ENCOUNTERED IN

SURGICAL SPECIMENS

THAN INFLAMMATORY

Malignant tumors (cancer)

rl ,

""" .. s.,
S ... .. .
OTHER H

** H

. il** i .
... ..

l m e i .i l l i i n n i l l i

Nose. .
Face (skin).....
Mouth, lips and
Jaw . . .
Neck (skin)....
Larynx. .....
Mediastinum .
Breast ........
Stomach......
Gallbladder...
Ovary.. ....
Uterus ........
Bladder..... .
Testicle .....

. . . .

... .
.~~ ~ *
tongue

nn...
. . .

..

........ .
* . .

. n..
i* . .

* . .
a.aaa.
. . .

* .

Epithelioma (location not stated)..... ..
Round cell sarcoma of gum .........
T.vmnnhmiurnrn. of axillarv LvmDh nodes.

ti.:::: :.r
.*** *.....................:...:"..; *. *I...iH...i
*.. ..*E .. .

. - *- - - - --* --- - - - --*- -:.- -- - --.K".:..:S.
......~..... . .... -- -- --..... .... -- --!-. .
.:

< .. ...I ..--

- - - - - - - - --. . .... .. . .
S . . . . . l . . . ..- . ..
- - - - - - - - - - - - - - - - - - -- - . . . .
*. .:* : **

- '*-- '"--- ---- ---- --- ---- ---" "" ** * --*".,** ** *- i ..... .
- - - - - - - - - * * - - * * * * * * .... :

Simcimenu fromeerotum............

Fetus and placenta....... .
Placentas . . .......
Autopsy sets of tissue from
Miscellaneous. . . . ...

Total .......

- i

-. -ait "H....i
m ... .m .. ....:

*- *h .. 1.

*- .. ..

H- : -. .
* * * ...:
t " :4: ... .

.- ":il.0
.. . ..i... ... .

. :, . S !
* **** A I .

.. - .* ... f. .
*-- . .. .Gn
* .. . 1 .
S.... .. *...

*H ~*.*. "i

S. .E ..
. . . '.

1-

. .ii..

: :.. 3.
. d .....
H ... ..
.

... : i..Si.of breast.... .. .
B l~i:::",i ,i|,, nf ......... ... ..
i : *ri". **............... ......

,,,.: ,asa css ............... ......
....' tdaca ova*y..........
S ..: .. ......
.ii i. ...

H.:::" .*s. *., ,.
S. :: . ....................
: :. ~"~ .4.

Be::** *' .;:: of ix.............'.

Hi ^abothian cyst. ................... ....
l cyst of labia majorntn.........

!!'.;.;g ir p* *...*om* buttock .......... ..... ..
I .. at. y . . . . . .

.amat of air ............ ..
....- ..:

S. Moles, warts, etc.....................
H- .' a taoma of -f cet.... ...
.... a n*so.
.ae:dt, .f.i ., 1r . . . . . .

Inthzmn, of foot. .. .... .. .. .. ... .. .

. .

Specimens showing tuberculosis:

STans l ... .. ...... ......................... .

HCervial lymph nodes.. .............. ........
SAsilary lymph nodes. .................. .......
. ... Inginal lymph nodes.... .....................
: .Igui~allymph nodes and fintulous tract.........
,.i Prmetal fistula... ........................
. Aappendi .r . ... . . . . . . . . . . . . .
i Inteatine (ileum) and mesenteric nodes... .....

;.. B tmr (wrst)...... ..........................
TberculosiB cutie (leg)............ ..........
.adoametritis and salpingo-oophoritis .......... ...
al.pimgo-oophoritis, bilateral....................
= *ehitia, epididymitis and funiculitis .............

-. T ote l. .i.... .... ....... ....... .. .. . .

Qfher infrequent lesions encountered:
*

Conjunctival follieusis (tumor of eyelid) ................. .
ScGiumna o.f tongue .................. ............. . ...
S. rCat of vocal cord.. . . ......... . . . . .... . . .
: ...Exo hthalmi goiter............. .............. .... ....
Aaceeuorv thyroid.. ............ ..... ........ ........... ..
. roncholit. .... . . .. . . . . . . . . . . . . . . . .
.. Lbrdenoms of male breast...... .. .......... ..........
, Nei~rolithiasis ................................... .... ..
*.. Ruptured malarial spleen (traumatic)............... ........
S... Caldfed msenteric node... ... . .. ..... ............ ..
":. App.mdikel fecalith ......... ......... ..... ....... .. .. .
Appeidiifeted with oxyuris vermicularis............. .
,ystadena o of ovary with pse.domyxoms of peritoneum. ...
. in in . ..
.Condylomata of vulva and anal region with entamebic invasion...
' :. Chronic phlebolecleroais and arterioeclerejs of leg and foot with ga

ngrene of footl

Miscellaneous human examinations:

aental blood films(one mitive for E. A.malria).....

. . .

I
4
2
1
52
1
3
1
33
.5
2
I
1
2
4
2
16
I

145
I4S

2
2
I
2

I
I
I
I
I
I
I
I
I

I
I
1
1
I
I
I
I
I
1
1
I
2
I
I'
17
+,

245

.....

:::':::

.,,.111111111 1 1111111 11111 '11 I III I 1I1 1111 111

.

TOtg~lLIIIIIIILII II I

. ... .... .. ..

The principal diseases encounter

domestic animals were as follows:

Cattle.-Tuberculosis; anthrax; blackleh

Guinea pigs.-Paratyphoid B infection.

Dogs.-Dochmiasis (canine uncinariasis)

Mlarmoset.-Fungus pneumonia.

Mule.-Sarcoma.
Rate examined... ..................... . .... .
M us Ml ............. ,.......................
M A a se uadr iin ja........ .. ..-.. .............
Mua arocua .................. ...... .... ........

Rat smeared examined (from liver and epleen). ........
Guniea pis inoculated (from 520 rata)........... ........

Microscopic slides prepared:
Surgical preparations (43 froen)..... ............. .....
Autopsy preparations (83 frozen) ................... .....
Animal preparations (5. froen) .............. .....,..

Photographs taken:
Lantern slides prepared........ .... ... ............
Photographs taken at Board of Health Lg boto ry.......
Photographs taken of lepers at Palo Seeo.........,.......

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

CHEMICAL ANALYSES AND

a * --U U-

... ....... . ... .......... . . . ..i .. ... "

S L' .:,!
.:* ** : ....
........ .
*, ..., *. : t ." **::"i" i
is
.. ." / *. ...Y:,

red that 'were important ''(

. . . .'
** ...:" : ....
.. .. :*E:
g. .
sl i i.ii

:' ,iM.., :,, i iH. h.
:. : .....!A. *!
Sten.asis; distemper. .Hii.i
:. *-:" *

I . . .j * ***.. .:: : *
i '* . : ..-. :

a i-'* .
. ".H" .-".. E
S. . . . . . . . . ,* * * ** .. x.. .i
.. . . . . . . ... . ... ... ,.... .. ... ..|:

-- .:,,

. . . . . . . ... . . .:.. ..; .., t ,. . . |

. . . . i . i . i .i . . .p i i. n I l l p .- : 'i : i

: *" I .... .i i .l .""
.*"... ,"" JE ,i- i ... i

S.. .1 .. -...
** :. :* :* :ii
...........-.. .... ...... m... . ...Ik 1 I"S

.. :: ***.
1; *;llm l =!:-^ "=" l ti H
""" .. ... T.. ........
.EXAMINATIONS MADE"." : .: "." H'..
S * .. ...* .. .. ".
Wj.,u ,4

Marmouet...............
Tmkey,........, .. ... :
Pig.. . . .. .

Total. ...

:1w.." .
"llliir!liw.':

UlSA J

flux.s

lA-MINATIONB MADE.--Continued.

meor e sa iane apparatus .

OjP... .@i u M e-. ... ...... ... .. *

lr ll.. fa mlthyl alcohol .
. .H...... p o w s . . . ..
:. ... ...'" . c,. .. .. .,
F :-... S..**.*-a..... .. E..I. .
1,r &, ohmiluld g. **.* *

Ii; .=H. **:., ^ ean m eal. -. . . . . . . .
d. .................. '

.. ,, ,, ,,*,m *. ........, **. .
'...la........ M jasth .* *.
,ni,1d . .e. .i. .

....', ..daiy. e water.....!''''''''''''''' i

S.. *.. f i evaporated .......... ..... .

|M ie vo r a d td t e.at i . . . . .* *.. .*. . .
fau. fuozdetectioof awap

;u.. .F. aish.,. .. . . .

1pml Si Luida neami.nd..a..... . . *

idal gold........

flH: *:.:. .-- ,

..G. a o .... .
C ij ig j j ....Lt e..JjJ .......

:. ... .r pi.e .. . . . . . .. .o . .

p* .:. i : d ete rm.ina.o i... ... ** -
: ...: ; u...ica in.eh.der ni. ide.......
... . .. imi-iiei ........' .. . .

|..... .. p u m............... ,

" "'.. iti a.deter iti........... ..

!-ed p a .
S. determination.. ...................

,. n., o~ne determinations.ol M....... .. ,
-.. a..in dee" naation.. ... 'ma ..m "**
.. ...

.. H Albm .- Sindetemnatio. .......

!!, :Ana deto nmi) io's....f.- ....... .
Sietne br ie determination.

S.de m nation..... .... ......
fc^'i I.' 1, u.dela g .............. .
, ,,, ,um mmIh m m

..B. l ""ation ..... ............ .

.....hm e k ...omnitu, .Mer..y n.t fou.

....~l. .....iatomachcne Chloalor

Ic : iik "El: ig~~i~a .".jtma nene ".me or R

." .

. . . .

. . . .

. . .

.* .

* . . .

*~~~ .

. . .
. . . .

.m e. .

* .

*v.ro.n* l .

. in . . . .m
. . . .

. n n . n . .
. . . .
" i n. . .
S . . i . .
******--**

- . . . i.

. i n . . .
. . n . . i

i . . .
* n . . i n
. i . . i
. . i . n

. n .
. . . .- .

. . . . .
. . i . i
11*******--

. . . . . .

. n . . .
i . . . .

m m . n p .

n n . i . i .

. n n . i m
. . .

n . m . n . *

.t .fo. ..d ...
. *******-
. ..****
. . i *

. . . I. .
. ****---
. . . . . -
- * - -
* * - *
1111111 1

""'11"1
111111 1
111 1 1
1 1 1
111-1 -
11mmme .

11mag1

t 1.11

. . -

. . -

. . . . ..
--.-.-. .

. . . i

* . . -
---------.

. . .

. * .
. .-
. . . . -
. . . . .
. . .
m.. .* .
. . .
. . .

. . . . .

-------.

.--. .

. . . .
* . .

* . . . .

.. ... *

-S-----.
.-------.

. .- ..

- . .

. . .

. . - -

-- ---. .

-. .. .
---. ... .

. . . .
* . .

**** .

. . .
* . . .

. . . *
. . .
found .
. . .
. .
. . .
S.. .
. .

. . .
. . .
. . .
. . .
. . .
. . .

found1

. .
. . .

. . . . .

I
I
1
2
2
4
22

I
1
1,

II
. .
. . .

2

2

1
2

. . .. . .

. . .
. . . . .
514
509
508

32
42
18
24
1

261
42

S
18

I
5
I
1
I
2

5
1
a

I
51

I
1

1

1
1

1
I
1
1

:::::::

-

i.iiiii.i
ii.,iiiD
Diin.iiii
i-iniiini
il.nili.
mmmmiDn
m.,mmmmm
mm.mmnnl
ilmm..mmn
minmmmmD
nmmmmnl
m nm.,im
.immm.
poisons
minm|nm
m|mimn
....-- -

TaBLE I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES

I ..----
rH
:~xn iij
9k..........
.1.~.*
'I, 'ft."
l.n?.7
H:X

zroaaiiw* .~

I
.1g..

aDEDLUrh 1IUMDUBB.

Year 1923:
White:....
Colored....

'rotla..

Year 192..
Wlhitd....
Colored.....

Totals.

.... . .
,...........m m

i-
Cd
.0

00

:Lb0

2,846
8,130

10,976

2,827
7,620

10.447

Discharges
from hospitals.

o
F-

1,179

1,711

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Year 1923:
White..
Colored

Totals.....

Year 1922;
White.........
Colored.........

Totals....

.........1

186.93
145.02

155.90

197.39
156.56

167.61

169.71
120.79

133.48

179.70
124.54

139.47

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Country.

.Afiriaa.....

n n

Antigua.. ........

Autria ....... ...
Bahama Island..
Barbade. ........
Canda ...........
Chiea .... . . .
C ilna............
Colombia.. ......
Costa Ri.a., ....:
Cubs... ..........
Deaerar....... ..
Dominica.........
Ecuador.........
Egypt...........
England..........
France. ......... ,

Greece. .........
Grnada.........

Guadeloupe.......

Ita.............
Jreand..........

*ta ... . . . .. .

Japan..... ......
Martinique. ......
Mexico...........

Monan~emrra

. m

Nauau..........
Nicaragua.......
Panama.......
Peru ... .....
Philippine Islande
Porto Rico.......
Riusia...........
St. Andrews ......
St. Kitt ... . .
St. Lucia .......
St. Thomas......
St, Vincent.......
pain............ .
Switzerland... ..
Triidad....... .
United States..:.
Venezuela....
Virgin Islads....
Unknown.......'.

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Total.......

* .
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. .
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Emjioyne

.Mal., j Female.

*. .. . . .
i1
i
15
. . . . . .

.... *....

2
. . . . . .

23

2
. .. . . ..i
i.. . .. .
S. *a ......

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. . . . . .
2
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23

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- . . .. .. 1

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. . . .. . .

1
2
*. . ... .

2

*. . .

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1 ~i"

3:
1

1
101

1
27
40

3
a
3
a
2
1
. . *. . .-

5

4
7
5
2*

*. *. .. *

183
1
16
.~4
6
1
1
323
10
1-
I

1
1
2t
14'

8
I

13
H
I
1

42
6
14

17
II

F~pngln.

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'3'

'70

4.
1

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82

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1
1
1
2
.5

1

1

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1

403
3
246
* . .

15

2
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7
. . ...

16
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a VH.'-8T483TIC8 REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES.
*4 1 ,

. .. .' .

-I-...

h i ..* ...* .: *
..::.:: " ".

ti^NiaM tmn the United States:
* H. .

**.YV ~ *:..? _l sl
m: i:.m l li l

i . i. i i i i i i i i i i i iii . .ii.....i....i....i.... n........... ii ii .

Annual
death rate
per 1.000
population.

5t"l" % iiW4'4,e s sand children from the United States:
** ** iF .S..n........................ .
S ..l i::"- ..: .... .S .......... ........ ...................................... .. ..............
I..

: i:r emoee frcon thqe United States and thdir families:
.. .j;* H i' .. ."* *.

S.... ... ............ ... ..... ..... .

*:!..:'* ... *
....HH ". I e ofAm. children on Sn dIsthmus du ing the ear 1923.i....... ............. .. ...... 123

i;:;... .'.m.talit. among America children. (number of.death per 1,000 live births) ....... ..... .. .. 32.52
:.*: I **... **.......

Wls vua.---sTH AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND-
o: :". .. ..... ...... ......... .....
Hil:l:.:! 7 h hld Births. Rate per 1,000 population.
";... " ,,:- Pop45a-

Hl.^:l .i. .- e ti8

m i :* i" :. . .
:: . .
........... .

.. '..... y " ""t "
...i... . n
g. ... : .: .... :." .: . ... ....
D*1*.-

* .. .
.. ., ;..U*.

a....

* .

S. .. C
i 4
.

59,635
31,285
31,793

122,713

60,068
31,393
31,098

122.559

:...::.. -* :.I i"Totas. ....... .. .

. ..H.a *.. ..
: iiii" ,, 's ,,
.r::. .... .' .i. ... ...*..... .

l..... .-.... .....
": *." : *,: : .. *.
*** .. -s* *.. .: *
-.i ... "- .. : .. ....... ..
.t . " "* .l i **:: .

.. ... :. . .
- -i* .: -
kuaA JX *UW M t"M ***A* I

r! *i 4 " "
.xH .. .
.. Hl H*

I : r .::*:*:: l." .H *b .
... . 7 ... .. .. **&

.a*.. ., ; . : .. . . . .. .
.I,,,,, :g,, ,

Total.

2,163
748
623

3,534

Alive.

120
39
32

191

TJotal.

36.27
23.91
19.60

28.80

30.14

Alive.

27.24

28.62

Live births.

his's.,

Female.

Total

Deaths among
children under
1 year of age.

Number.

Rate per
S1000 live
i births.

MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA
AND COLON.
S

n

1

I

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* . . .
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' General diseases.

Typhoid fever.......... ........
Typhoid bacillus carrier........
'T3phoid p.phylaxiS ......... .
Paratypboid ferer..... .......
Relapsing fever..................
Malarial fever, Estivoautumnal....
Malarial fever, Tertian...........
Malaria. fever, Quart. ........ .
Malarial fever, mixed.............
Malarial fever, undetermined.....
Malarial fever, Clinical ...... ....
mea poxle ... ... ... ........ .
Scarlet fever....................
Whooping Eough .................
Diphtheria and croup .............
Diphtheria bacillus arrier......
Influenza ............. ..........
Cholera nostras .... .............
Dymentery, entamebic..... ......
Dysentery, bacillary.............
Dysentery, unclasaified........
Plague............ ..... ..... ... .
Yellow fever ......... ..........
Lepro y. ..... ... ... . . . ..
Erysipelas... .. . .. .. .
Dengue.I.... . . . . . ...
Chickenpox.......... ........... .
M um ps .... .. . .. ... ... ... ..
Hemoglobinuric fever, unqualified.
Filariasis. . . . . . .
Acute infectious jaundice (Weil'e
disease)... . . . . . . . .
Other epidemic diseases..........
Purulent infection and septicemia..
Pyenia... . . . .. . . .. .. .
Tetanus .......... .. ..... ....
M ycoBis, ........... ...... ... .
Pell gra..... ........ .....
Beriberi. .................. ...
Tuberculosis of the lungs.........
Acute milary tuberculoi. ...... .
Tuberculous meningitis.........
Abdominal tuberculosin........
Pott' di sease...............,. .... .
Tuberculosis of bones and joints...
Tuberculosis of other organs......
Tuberculoui of the skin........
Tuberculosis of the lymph glands
Tuberculosis of the gemito-urin-
ary organs... ..... ........
Tuberculous absces ............

.. ... " "' ....B .. ": ":': :-" " -i' i^=

SEminployee. Nonenployes .^ tf
0 ,,, ,, ,,M- 3 ,,
.. W ite .. .. : I

SWhite. Black. Blck- -Whit Ba
R E Amy. Others .

.. .. ... :-. . :. :.:. w . ~.
"'...." .. ......::H
10 4 .. 1 2 *... ,.: it.

.. .. ...... .. ... ......*.... .. *.. h.. ."j

.... .......... 23 1 2 1 31 1 .. ..,
1 . . . . . .. . .t. . .......* .*. . ..*...
1 .... ..".*... . . i

2 1 7 :. . sp8

95 2...... 1 1 0 385
14 ."..".I. 1 .t t ." .". : "i i ." "".

4 11 1
*111 >1(11 -1111 *11i 2 1 ** * A A * ** * .* -: *'i ^ :!"^^

.. .. .. .. ..... . . . . *:* H
12 .!....: ...... 41 1 ... 3 51 ...... .. .

8 3 1 2 ..11. 6 ......
12 . : . .i: -..
0 ...... I' ... ..' ".... .'" "...T ".."- ..'" '""'" '" "
2 .... .. ..... .... 1 . "' 1 '" .l E S* i
1 . ****... ..

-. I . . .. .
1 1. ..... ... .. ...... 1.. .... .. ..... .... ,
so 9 I s I I' /a s I H .. l .
. . . .. .: .: .i -
11. l , . . .. .. .. '

...... A...... H....... .. r

S 3 1.. .. .
S4 in I a . .* ..

.-- H 2
3. ..... .. ..... .. ... ... ... .. ... * -. ."
1. .. ..... ... ..... *... .. ....... ...... ***.** rc...... .. wj.iIH:.i.
1 ...... J. 1 g ....1 ., *F1 .
8 ..... .... . ... 1 ...... . *. ... .. ...i

.. .- . . 1 . r : : :: t
._- . .. ...... ...
S ...... ..... ...... ...... ... ...... ....... ..
. . . . . . . . . . . . ./ .. . .. . *. s . *. ..... . .... ...

*. .... ,, ..... . ,*.. ... ...... ..... .... .... . .. .

.. 1 1 . .' .
......... I',.. ..... .. .. . .... . .' : I. .. ..l.:. ..'. :..:,,.-....
. . .. 1 1 ... . .. .* .. **1 . .... .. *.u *
1 . . ..-: l. .. .

.1W.

ti.

I. ... :7..
iti.:.
HI

:.b.:.
."

..HI
H.

TamLB Xi-CASES TREATED IN HOSPITALS, 1923.--Continued.

a,'-.~b

l disedaea.---Continued.

Gonocoecus infection-Continued.
Goncrbearl bubo...............
SGounarrheal ochitie and epididy-

oimaerhel ophthalmia.........
Soft chani are.................. . '..
Adenitis dbancroidal ..........
Cancer and other malignant tu-
more of the buccal cavity.... ..
Gianer and other malignant tumors
Sof the stomach andliver.... ..
Cancer andpther malignant tumors
of the peritoneum, intestines,
te tum .. ...... .........
SOUaeer and other malignant tumors
.of thefemale genital organs...
Chncerand other malignant tumors
of the breast. . .........
(aner and other malignant tumors
..- of'the akin... ................
Canes another malignant tumor
o. f other organs and of organs
.petifiod..... . a.
.-. Other tumors (tumors of the female
genital orgaiis excepted)......
Acute particular rheumatism.... ..
Chronic rheumatism and gout.....

Art

1mph

Anumi
Ohit
Ann"i

rtia deformans... ......
t.m i . . . . . . . . .
tnhi..lmic goitre ...... :......
EUkanial l m p h .. . . . . .
ia mphati...........
ta- chlorosi ................

ter nJ.ed ................
general dia6eeB...........
lrm (acute or chronic)....
boliasm, acute.... ........
li n, c ron ...........

ioead psoing.m.t.........
brai oecupabional poisoin-
Sha it........ .... ..... .
ighalic ...-... ....,....

Bum..a of te ,sewrsP~4n qata nd of
flu mg-. f sid Mule.

Panama Canal Hospitals.

43
0*

9
6
151
12

2

9

2

10

9

1

2

19
11I
6
2
19

13
5
. . .
.3
.. . .
I
"1

4
II1
9
g
11
5
4
2

1
1
. .... r

li&Iitim I '

a

'I-

. . . .

1

5

1

5

1
. . .5
. . .

I

5

1

I

. . . .

Employees.

White. Black

2

4
. . . .

3

29
2

Nonemployees.

White.

Army.

2

58
7

.....

. . . .

. . . .

Others

3
I

. . .3

3

I

3

3
2
1
1

3

.... i.

I

* n

enon-
residents.

Black. I W~hi teIBiack.

m. .
. . . .

. . . .
. m

Santo
Tomas
Hospital.

a
a,
0

4

3

1
I

6

.. ...

. . .

3 I......

--

m m m m

--

Dhueaamua f thu lruphat'ouystem. 14 [....... 8 .. ... .2 1' 2 I~.
Hemnorrhare; other LisLL of the .....: ..
circulatory aystem....... 9t E:I .... 1....
:ol e d ,.%~... . .... ., g.:
*** .jr r

H+:..A . *...
D i. oft.e".I......Zju....'m+

..,.. ..... 1,5 .+.. 0"1 :. *..Y : s. ..I H
Diteau, of the .aa.lf-- "....... 80 :...... 5 10 88 16..
.L.:mlrv"w: +.
r- n. .s a e
nlka ~ ~ + +iP..~ )Pi,,.I''' 1': i

Diseases of the naml foam. . . .. 80 . . . 5 10 88 12 1 :: 6 -... ., ..
*. ". . :::.. .:*
..................s... ....== =us... .humm:m =www=>",, .....=*"
thk.... &m.... nt the inewnw --- .. .:: . .--. 14

V

H.1

*d ****ath **d *** .**:.*

.~ i .. ...,...

. ~,.a'.: ......
: ..- l :**
a. ...... .
.-. ........

..: .*Llk1..Y- in taespags.

,,,4.: : ***

....'l ..lll.

a~i~i .bfthe .tam~a h ~an

**;Pof tahenteritia (under a

a { a), o..
.... ~...... ..........
deuteritis(2yrlearand

i . ... .... .

... ~basltim. ...............

,..nu
S,, -i. edi d),.......,
.... :mr,.,,.........,,... ...

.. t.- . ....... ......
.. ... . . *

4.1.p 3It. i t Phi ..*
.31 ita . . .. ... .
**ia *..*.. .....
*. . ... ... .. .

dbgfruotion. ...... .

... ..... ... .. .

..s1~ph of bh-,..

........ ......
...V45&Ulir d.hl...h......
.r. ..............

*. 2,*
pad -
...... .l.a..... .. .

* ..

- Panama Canal Hospitals.

79
31
31
.3
11
a

1

88
.......
109
10
6

1

1
2

.8

2l
-23
1

:
.8

'a
.4.
.1

0

1

. *

Employees.

White. Black.

I

4
... *.-
44
*. . . .

3

.i
1

a
4
1

*. .. ..

10
"io

15

6
1

5
2
S

. . i .
1
. . . .

1
5

1
J li

* . . .
*
2
22
1
. .
. ..*.i
1
4
-1
I

16
I

7
*. ... .
. . . .
*. . .. *
8
3

a
*. .. .
-37
* . . .
* . . .
14

- . ..

. . .
* . . .

2
. . . .
. . . .
1

?Jouemployeue.

WhiArmy. Other

Army.l Others

6

12
5
75
*. . .
.. .
1
* . .
I

a
3
a
2

. . .
. ...

25
... .. .
27
. . . .
3
3
. . . .
1
7
1

*. .. .

5
8.
* . . .
1

15
14
11
1

4
. . . .

22
30
80

3
I
8
. . . .

2*
* . ..

6 .
4
. .
2

ron-
realdenta.

Black.I White I Black.

2

2
2

1
. . . .

4
1

17 13
7 ......

..........
7 . .

" ... ... .. 4
8 7

...... 2 .
I I

Si . ...
8 a
. . *. . . .
19 15

5 1

2 . . 1
2 5

2 12

2
21 2

3 3
1 . .. .
4 1

*. .
I

n
.)

221
* . . .
na
6

132
3
. . . .

10
*.

*. ...

70

97
.
80

. . . .
119
971

283
*. .
177
. . . .
. . .
*. .. . .
56
. . * *

. . ...

11
21
. . . .

9
5

W

2
'a

S
S.

I......
* . ., ..

* . . .

1
. . ..

*.' .

5
. . .
. . . .
.. . .
. . . .
* . .

2

1
i
2
12

Sanrta
Toma.
Hospital.

on,..

|

I

I

~Y~Rita

T.aB. XI.--CASEBS TREATED IN HOSPITALS,, 193.-

Di-.ae

Nonveneral diseases of the gemilo-
urinary system and annao.-
Continued.

Diseases of the prostate... ... ..
Acute prostatitis.... ... .
Chronic prostatitis...........
Hypertrophy of prostate .......
Nonvenereal diseases of the male
genital organs. ......... ....
Hematocele.. . . ... ..
Hydrocele .......................
Uterine hemorrhage (nonpuerperal)
Uterine tumor (noncancerous).....
Other diseases of the uterus........
M etritis. . ..... ... .. . .. .. .
Cysts and other tumors of the ovary
Salpingitis and other diseases of the
female genital .rgans.........
Non puerperal diseases of the breast
(cancer excepted)......... ...
Benign tumor of breast.........

The puerperal state.

Normal labor ....................
Accidents of pregnancy ..........
lEtra-uterine pregnancy. ...... .
Hyperemesis gravidarum.... ...
Abortion .. .... . . . . . .. .
Puerperal hemorrhage .......... .
Other accidents of labor..........
Puerperal septicemia ...........
Puerperal albuminuria and con-
vulsions. .................. .
Eclam peia ... ........ .......
Puerperal phlegmasia alba dolens..
Following childbirth (not otherwise
defined)............ ......
Puerperal diseases of the breast....

Diseases of the akin and of the cefu-
lar flssue.

Gangrene. .... . . . . . . . .
Furuncle ................... .. .
Carbune le................ .. .
Acute abscess. ............. : ...
Phlegmon and cellulitis........
Trichophytosis ........ .... .
Scabies .......... . . . . . .
Pemphigus contagiosa...........
Elephantiseis...... ..... . .....

Panama Canal Hospitals.

ad
4-c
Cd

f-c

.. .i.
3
1

3

*
o
E-

......

Employees.

White. Black.

1
. . .. I

2

11
1
8

Black.1 Whi

6
. . . .
5
4
30
46
1
9

lNon-
ri

Black.

. . .. .

5
* . i .

1i

. .

.. .. .
1

4
. *. . ..
2

. . . .
. . . .

. .. .
......

0 theM

*Ss^ .::.N:.::
...HvI

Si* i:

a
gol

37..

210

65
. . .

ii,~r

66
2

I:

*:

- (.
* .. 't !F"
H *.11
.. . N

Ki 4.'I~ii
:H I

* .z
Hr
.:.. -
h* .*:.:
HC

*i ..:.q

iie

I.,.

*

..... 6 8 ...... ..... 1 .. ...

. *.V. . 5 2 .. ..* . .* ". : ::.
--i H ... H

.:.. ."

2 .. . ...
4 6 3 2 -.. .- l -i

9 2 24 6 3 138: .. l
0' 6 16 1 . .. .*..4. -
S1 . .. . .... .... .. ..'. ..
1 1 1 1 .. . .. ::i
... 1... ... .... .. ."..-... : 'j-

I
ii:

I

Nanemployeee.

Wbite

_

* H -Jr : '*. ta !.

kr

Hiir: iH

.I.
... H .,
-'4xI

85

TABtn XT.-CASES TREATED IN HOSPITALS, 1923.--Continued.

Newborn child ......... ......... ..
.Cngaital debility, icterus, and

, Congeaital debility.............

otherr causes peculiar to early in-
..,, fancy includingg various conse-
" =' anencd la a bnr)............

Panama Canal Hospitals.

82

52
I
9

11
2
38
a
3.

40

93

4 11
4

6
SI

5
I . . .

E-

I

. .. .
aI

I
1

.* ,
i i* *
* . . .

* .

.

1

9

19

7I

a

adp-y poisoning........... ...... 2 .
eifd . .. .. .. . . .. . . .. ... .
Badieby. food ............... 9 .....
ioaum.bhites and stings....... 1. .... .
ajiute: poioni ng..... .. 12
ae Mixt^Q ddelefarion gases
(eofiuation ecepted)...... 5 ..... .
mnastar by rearms....... 14 .
as ".tia csitting or piercing

Employes.

White.l Black.

4

3
2
' pl~

* . .
* .
* . .
* . .

. .

* . .
. .. .

* .
* .

* . .
2
6

. . .
. .
I

a

3

I

12

'3

PT

S* 3

Nonemployeea,

White.

Army.

15

2
* *

.
.

I

.

Others

12 j

1
1

1

5

Is8

191

4

2

2
i * l n

1

I
1
2
2

. . .

Non-
residents.
n

Black.I Whitel Black.

12
. . .

2
4

2
11-

11

58

220

3

34

11

5

a

2

5

2

1'

* . .

1
* . .

. . .
4
B

Santo
Tomas
Hospital.

2

35

15
3

3
* . .

* . .

27
3
11

28
23

35

975

15
3

*. . i

10
27

1'A

0
4I

'69

I

6

I

*

r

no memese .... ....... I. .. .

Feigned diamee. .... ., ......,...

. Totals.. . . . . . . .

7.781

582 1,194

].181

.. . .

* 1 .v .

r4.
h..i
A *l

*.ii~iH
.14

*::AH..:
I.
H*i' fii

II ..: i r:i

;d -i H.Er.

I i. E.::..
.M '' l
ii .....
flu.:
::p:iw'
. H H

IIIc
"'V I

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HC S
**H~F i.H Hli.: =

:

* =. I~ *
~~.*:* qj
*~1hl~
I-....
.

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if
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^i..:' .. . .. ^ **"*
*.:* w* **! . .
inIt

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;. *S .* *%

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1.9

r

tnt
H~l

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:F&. .| y

L%

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QeI! r

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1Ei

4

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. *

P *
mm

04"P *rt.-
A-.c

-CMI

*

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'-4 0

-4 lC

wan P

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t

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:88

'I.'

11'

.. TaPw XIII-NUMBER O DAYS B HOSPITAL TREATM5NT1fiB
OP.PATIENTS AND AVERAGE NUMBER IN HOSPITAL.
i ,,, *.,,, ,-. I

Chsuufwmptient.

Ancon Hompital:
Employees..... ,'......
Army and Navy.........
Panama Government.....

Charity..........
All others........

Corzal Hcpital:
Employees... .. ...
Army and Navy...........
Panama Government.......
Charity... . . .. .
All others,...... ... .....

Total (insane)..

Cripples ........... . .. .
Chronic medical and surgical cases

Colon Hospital:
Employees . . . . . ..
Army and Navy..... ... ......
Panama Governm ent............
Charity ...... . ... ..... ...
All others.. . ... . .. . . .

1alo Seoo Leper Colony:
Panama Governmenl.......

- . .

Totals......

Totals by classes:
Employees.................
Army and Navy.............
Panama Government .........
Charity, cripples, and chronies
All others............. . .

Grand totals....

Number of days treaeien

*Ajn4i

cap,

19,772
... .. .
2,500
11,222

37,402

2. . 6. .
278

* *

503
1,793

4,286

4,352
21,594

42.790

Foreign.

3,088

11,078

15,302

27,374
1.617
1,411

31,000

43
115
1,123

1,509

1.887

3,914

29,349
5,048
13,612

51,923

Bla4l

25,480

4,977
26,252

56.895

87,442
14.911

113,.823

9,434
8.297

5.356

17,542
0,884

27,426

30,504
12
it,529
49,035
39.223

224,303

*Ttal.

32.476
19,772
231
8,508
48,552

109,599

. 4,453
276
114,816
16,668
9.801

146.014

10,789'
9.167

1,841
1,558
402
2.150

14,223

I19.420

29,318

38,.70
21,606
134,878
57,226
86,625

319.105

,..::ixii Ut!.

2**i l* .,.,.
;APi ~~. .... .. .~i~~ii~

10-fl
14,17

102.47

.i76

.38
2.12

1.22
.4.24

1.3891
4.91

11.75

11.02
59.16

S37.78

117.48 I

S -

. 8.40,

'"^12i -

4ll2g

Itae.

- -<(r1
* *^ $A l Hi

~71 *.4.

155.10

_____..,i

75.00

. . -. .
.12
.32
3.08

4.14

5.17

10.72

80.41

142'.26

=... ..-'i^
... .fafri~i
^^^iiE^HxI1
1' ..
.t:f
.
.S.
*I
...

2 .Bi. .
40.856..
20.56

i 25i5~
22q78

48 .06
i 27.08

'83.57
.053
289.123
154.34
107 46-

6<4,.3

' These cripples require no medical attention.

~ei~-..III
H*::i

I*I. ** i
.. .. .....

A il

.... :I j .
* .. H,

,. 4...:" I i
:- ,, i,
::"* *:

TABLE XIV.-REPORT OF DISPENSARIES, 1923.

. .H, .,
Si,,,,:"

EWx.rOE TREnJ iAiD I QUTABB~E

Place.

Remaining
January 1,
1923.

Admitted.

Disohnzged.

Tram xac

I I

Ri lOit H~
4%ah~ -

I. . .. .

....B.B .. .

1111111111111

I

,;R

~pp~- i
I

TOt~BIIIIII

Totals,

ChariB.

... I

S.H. .-F:" 4 ... i ." .. .. .... ...

.rr "!"* "" i ." ..t urnihed quarters each day.
S *ite. Tota* ....t Bk .a l,
.. .. ..* ..I .
:." : .4. *. : : :B ** .. ..6 .5 0

560 1028 1,588 13 2 82 4.35

l'... 191 196 387 52 .54 1 06
.F .. .* .* .

.. Total.

:Bl.. :r ................... ........1 235 1105 22,310 11463 6,030 17493 .698 17,105 39803
...... ...... .... .. 3 3 10258 .031 353 5512 8865 7,126 15,70 22896

.y4miBh tetw. Days treatment furnshed, in quarters each day.

.44. r" .. White. Black. TotaL White. Black. Total.

.. .4..".. ............. .. ...... ... ...... ............. 1 813 2,548 4.361 4.g7 6.gg 11 a
S.H...a s 955 416 2371 5.36 1.14 6.50
So ................... ... 920 14,009 17 6,487 12,825 1,589.312 1.530,407 2.82 4.35241
... t ...- ... ... ..... . 2. 9 1 196 387 52 554 1 06
.....P... 1221 7 3.34 18 02 21.36

T.otal.... .......... .............. ....... 5,740 10,765 16.505 15.72 29.50 45.22

SP... aEmploye. employeey. Total.
S. White. Black. Total. White. Black. Total. White. Black. Total.

. ......................"... ................ .,39 i1,uoe 18,307 4,616 12,990 17,606 11-015 24.898 35.913
.. ........ ..... 11,235 11,075 22,10 11,463 6,030 17,4 22,698 17,105 39,803

.4 4 .......................... 3,773 10.258 14I031 3.353 5.512 8,865 7i126 15,770 22.896
+htvbal......... ........... ....... 3,920 14.000 17,029 6,487 12,825 10,312 10,407 26,834 37,241

l *:.... ..* m a a

Tat.L XV.--CONSOLIDATED ADMISSION REPORT, HOSPITALS AND DISPENSARIES. 1923.

All classes of patients.

Adnilsmion to hospitals, excluding Corosal farm, cripples, and chronic ward....
Itnjuiiaion of employees, to quarters..........................

*.. .--.. Total admissions to hospitals and quarters.....................
*.S number of patients transferred between hospitals and from quarters to hos-
F, pitals, whose admissions are duplicated in the above figures .............

Net admissions to hospitals and quarters...

Employees.
: employees admitted to hospitals . . ....... .....
Employees admitted to quarters...... .. .......

..... . . .

1 " Total admissions of employees ... ..................... .......
' eIi number transferred between hospitals and from quarters to hospitals, whose
II. .admissions are duplicated in the above figures.................... .. ..

..4, Net admissions of employees ................ .. .. .

r::'" A' nual admission rate per 1,000 employees to hospitals and quarters......... .

White.

6,267

2,784

978.21

Black.

5,915

5.462

2,665

312.05

Total.

12,386

657

11,729

5,321

484.78

~vuu.eu
l.a..
ItIL C
frH4!I S
...- *0~
Ill. -~.

NUMBER OF DAYbS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, EMPLOYEES.

I White.

Black.

p Total.

. 1an jn

tli~ tX .

" "'

e n TO

In I

Blod corpu ies...... ..., .. .. .... ., . ..... *. .. ... .
Sm and oo. .... .. ...... .. ...... . m. *.. .pm..*.*...* *mm
P. B and muh u., .. ... ....................... . .. .. .. *.....

Pun, blood and mucus..... ..,... ,..,. .... ,.....,... ,. .... -........... ..
. Guaiac test for occult blood............... .... ........... . ....... ..
-.Uriue exatiiii ationB (total).... .. ............................... .........*...... ,..

A ce. .. .. ............ . 1 .. .* "" "

: R . .. . .. . .. ......" ...*............. .'............ ........mI il mm

G3 aia1e r f0r Occult blood.,... ; .... .......:.... ... ........ ....... ... ,
S. ed im enta .......... . .. ... ... .. ..... .. . .. .... . . .... ....... . ... ,. ... .
Epithea5 cells..... .... *:** ****:
*. .
SB lile ..... .. . .. . . . .... . .. . ... .. . . . .. . . .. . . .
yaline i st u a........ -............... ...... .... .. *..'.. .. .".... .... ~ ...... -. ....
. l cellr ;. '- i- ... .. ..*.. 0,"
G ranullar ca t .. .....',;. ... .. . .. .. ... ... .. ... .. ..... ....:. .... . ... .. ., a.

Pu cas..t......... ...
IPIB ceJID... ..... . . .
Red blood corpuscles... ...
Pus and blood...... .....
Gonococ Ei ................
Tuberle bacilli...........
Hexin crystals...........
Functional kidney teats....
Sputum eauination (total)...
TUberDle bacli...........

S* . a

. . ... .
. .. .9 .

4 .* .* I
. . . .

.. .
. .. .p
... *m*
mmm*m*m

. .:h : j*. .

r 4 A "*

. .. .- .
..... *h .
m m e

m.. .

* *. .. S

. m
. .. m.

.

m mlll * l Siml 4 *

S :. .* ... . .
. . . ..' . 4
4 m N ma l

. ... . *.*.. .: *

* ~ . .
m. ... m ....

...lll... ..

ji *- b' *.q . *. 5..4 .

* . . S -... .
4.

. ... .... 4.:.* **
* ii.. ...
m * h m ... ,m

. .. m .. .m m m m mm I

. m m m *la l : M. m

. l.. . .-. . k .I I. .:

. ..p .1
.. .. .4...
* .. ...
N. q .."
* I. * ,
- *'-L S* ^*

* 4 ^*%*A
s......,

* :. q x4
-. .. ..

* ,
. 1 ..- I.:
. lil

. I
. ':5 .
4..
.*~. . ..
-S....
* .~.. *

t4k
. .*. .
.. tiS.- ih%*
* S I~ ** *
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* . . .
4

::~ot~' 'k

* .. ii
* ...Hq* ~,p "s&7
* ha~.
814" t'~
V
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1,0w rr
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4~48?
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eq
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8,111

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4*1

SHep t. o u s ., m m

B .
:** .Pneumococu ",, :
C ell counts... .... .. .' ." ..... .......... ...... ...... ...,.,"....- .,-..........*.=.. .:=

Urethral.--:. :.. : .. . . . . .. . . . *. . ..
Va' init*" "C: ^'.iB*"t S
__T i,~it -i.* .pi. . .... .* ,. *. : ..:*:* .U E

E es. ......... ................ .. ..........., ... " " '. .. .. . .: . . "j .".. .
mlsm i i . i m m i* -l l lI .
R m i. r. .. .*. ; "*... ** l^ %'_*.!i

Bpinal fluid examinations (total)....
Sears of sediment............

Fi.
~~;~I. .

!r.
'rK i
It~'I~iii i

*.g'.g l :c *''Am m m* *, ,m ** *, ,
i ,.. ... . . *

.a t..ji..B. m ltip... ..
misltojdigitB kmultiple....

. lnh la... ..S...q.S.S
manill. ...i.. I ....
h p . i . . i .
ractures saimple......
ra otres, compound..
y, ezplatoay. .....

, dobigle....
, double, *....

ra --.. 'ir elIZlq....s.

j Jfguinial. mingle..;.

H*H~ H * -ai-nf- -"-Un
Swam muactd

H. H...111H5-
.. . ..
H. H.. H..
: :. II. *

a Hi
IvlrI~i
HI

Ia:.,

'P IIH.

..V
H~iii

6wmj, internal..i

*.rmdiaaloure........
.1w nwo ~lr n~aI ir

S...lS.t4oe. double, radical cure.... -
.. 'rsde.tomy'......... .........
!! : ~Epididotomy.................
.lrlial t ieeetion of bladder.......
.ae tam .. . '" ... ...... .. ..
4;..ii:,Amputstiau:of erotoum..... .....
:.: Apuarwa on wf pedie.U............
:i..- ila"ut of penis and scrotum..
.. !:... Cf t ee uteri.. .. ..... ........
~ a.ie~t e ........ ........-

HY ih I Si.... .. .... -
....o-". ..... .... .....

I.. -tie:tbGcOa drainage of,

n aB ltioedn...... ............l.
5 foracep,...... .........,i.
' ,. . .... ,. .....,...
irogtL. '.:, ., . ." .. ... ... ; . . I.
.. .,*, ...,., ,. *...

.f. uu.. .ii& .he., .
I ,aMd. sils..

Anoon
Hasepital.

.: .....L.. .. ..

.. n ::- ..::. : .

Died.

Colon
Hospital.

Number.

3

3

. . . l

5

2
. . . .

Number.

7
1

I

16
2
I

39
177
28
7
4

89
9
9
2
I
1

. . .

9
1
7
8
21
2
8
88
1
I

9

157
24
2
4
12
7
248
. S S . .

5
2
6
. . . .
45

I
4
i,

Banto

HospitaL

Died. Number.

4
2

6
2
1
1
21
1

3

a5
2

153
25
7
2

11l
45
25
4
10

3.
'5
2
41
13
9
29
1
10
11
* . . -
4
4
7
1
107
7

*. . . i^
* - - -
~1
.*U
j

4

I

13
IS
2
3.

1
. ..... *

I

H 4. .

TaBs XVII.--luadRlOAL OPERATIONS PEBJORRMOED.-Cputinued.

General-Continued:
Plastic operations for tattoo remove
Plastic operations for effects of disea
Nerve stretching .................
8kin graft ................ .....
Laparotomy:
For general peritonitis....... .....
Intestinal obstruction...........
Exploratory.......... ...... .
Gastro-enterostomy...............
Gastrotomy ..... ...... ........
Entero-enterostomy ...............
Enterectomy .... ...........
Appendectomy.... .. ....... ... .
Appendectomy with local peritonitis
Appendectomy with general peritoni
Calostom y... ..................
Cholecystotomy..................
Cholecystoitomy. ...... ....... ...
Cholecystectomy ... .............
Choledochectomy.................
A bscess of liver, laparobepatotomy..
Abscess of liver, thoraoohepatotomy
Pan-hysterectomy .................
Splenectomy ...
Supravaginal hysterectomy ........
Hysteromyomectomy..............
M yomectomy ...... ..............
Salpingectomy, single........
Salpingectomy, double............
Salpingo-oophorectomy...........
Ovarian cystectomy...........
Oophorectomy....................
Plastic operation for chronic peritoni
Suspensio-uteri .. ..............
Ectopic gestation ...... .. ..
Enterrorrhaphy .................
Rupture of spleen.. .......... .....
Rupture of liver .............
Cauterizations ... ............ .

Ancon
Hospital.

Number.

I .
ae

5,824

Died.

. *. .. .

. . .

1
*"i.

. . .* .

Cole,
Hompit

Number.

mm,
* *. . . .
*. . -. ... I

1

.... ....
J2

12
4

13
* . . . .

1
*. . .

8
1

3
6
* . . . .*
* -... ..

"""i"

* . . *

8

12
* 6.1. . .

61
*. . .. . i

*. . . .

t61 .

1,021

*.:i .N

hi.i

O `TW~'HI. '.;

*id H *ti:.l

Hi.

.Tans.
fl.aata.J~I.ai
AMW4M"flYi HN
__ _ __ H H
III~- *llj.

*. . . .
11
II
1

I
3
5
4
2

1
150
33
9
1
1
10

3
5
4
8

56
8
3
12

'.'"20"
10
15
a

51
S7
4
12

110
2,637
12
1,469

2,846

-.. ...g
--

!:' .. .. a
S .. SS

. :.. ...
...

i: .. j

..
..: ..i

...i:

.1 .... I.
.p* .....: *
".. i

"".
S:: .

*"ai i.

:: K. :4.:E
E j. .. .
NJ ....

V .
N .ha

i ..: iFi

:: .. N** H:: "

.- *. 4

1.
29
17

* 1 1:
Is
" '46

: 8
&..
4..
2.
4
37.

S2
S
* .f .
SI
<36
11
50'
9
2.
go
90

.0..
108 -.

155
.; 82.
.

. 1. .
..8

* . . ...
S

. .. ....... .
* . .. i
59
. . .

..

. .
. .

. .

tiE.
*

*. .

.. .
* .

.. .
. .

. .
tis.

.. *
.. *

. .

. *
. ..

Arspbenamin, intravenous
Major operations, various.
Minor operations, various..
Salvarsan ....... .....

.....
... .
.. ..

.. .

I

....nemmn

Totals .

* .d. ". .. ...
-

N n n
:E= :n n *
n.. n . n .

ii.i

..fl~l.... -

Hi..

.I.
fliii -

r H~.
.flH. jE

H *.... ......
It,.

-.

n n.1n
HIn

TVIII-OPETIN I THE YE, EARNOE, AND TROAT CLINICS.
TABL XVIU-OPERATIONS IN THE EYE, EAR, NOSE, AND THROAT CLINICS.

.. ......... ......

. .. ..... .
*. . . . .. .
. . . . .. .
. . . . .

. . . . . .

. . . . . .
. .. ..............
.. .. .. . . .

3aBulotomy. ...............
ataract .extractiona-
SiS..e ....
Combine ed..................
inearz....... . . . . .
:halasion, removal ....... ....
ulterior chamber irrigtion.....
inlfeleation...................
foreign body, removal... ......
Iordeolum, incision ...........
omrneal ulcer-cirettement.......
ridectomy.......... .. .... .. .
Para cen teai .. ..................
.achrymal operations--
Dilation of ducts .... ......
Extirpation lachyrmal gland
1id operatious-
Excision of tumors........
Plastic ............ .......
'eedling. . . . . . . . .
Pterygium ...... ..........
future of lacerated eyebrow.....
renotomy.* . ... . . . . . .
minor ... . . . . . . . . . .

lruncle, incision ..............
becems, poet aural.............
Foreign body, removal..........
Maatoid operations-
Sim ple........ . . . . .
Radical... . . . . .
Parscenteaie ..................
Plasti.. ...... . . . . . .
Polypi, removal............. ..
Excision, mole, cheek ..........

Cauteriation .............
-:: -Foreign body, removal ........
Polypi, removal.': ...........
.. Rhinoplasty..................
j... -jt m . . . . .
.. Ethmoid, simple...........
:i. Frontal, simple ............
( ". Frontal, radical...........
Hllf Maxillary, puncture and irrii
.i Maxillary, radical .........
::;. .. Maxillary, drainage........
- -ubmucous resetion...........
-..; Turbinectomy..... ..... .....
M inbr eto. ... . . . . . . .

... Prip illi ab e, nion....
... ..: a d loectm y ................

** ..i .
la:::i.: oleotcy...... ....... ...
..ino. .... .. ... ...

SFreign body remove. ... .. .. .

f Exploratory operation of trost.

F:- foreign body, removal..........
ST ac l omy........... .......

Ancon
Hospital.

1

2
5
5
21
1
7
47
4
1
I
8
1

4
1

1
2
2
53
1

1

2
I
7

1
2
5
11

3
11
1
28
7
1
41
19
8

424
23
655
2
4

1
1I

1
I

Santo
Tomas
Hospital.

. i

. . . i

1
35
. . ..
3

1
. . .. .
I

* I. I

5
. . . .

.......

.. .i...

. . . . .

. ... . .
.......

.:::::

iiii'

PATb DnBD.

14" 1 8 ........ .... .......... ...7........
14" x I7"m.. ..a.................. .... ..

* . .
* . .
imm* .m.
im Mm mm

* *b
,...,.i *I.*.*4.*
a s m as mbl sa
Hi" i a idman | gm i d

'H.
u *'*
* r'r l y *.4 A

FiUm s:
I8" 10" ..... . . . . . . . . . . . . . ... .
140" 17" ..... ........ .., ... ... .. . . ...... ......., .. ..... .. .. ,. ,-......

Dental f1ms ....... .......... .. .... ...... .............. ............. ,.,. ,......,...,

TA~zw Xl-SANTO THOMAS HOSPITAL, STATISTICS, 1923,
PATfIlTBEs T a .
i i ^ *

Clase.

Pay es................... ......... .............
Chanty ase .. .. ......... ...... ..... .

I tal ... . . . . ... . . . . .. .. . . . . . .. -

Diest

~mdin~i aLl

White.

Black

i.. ..

*-;1 **:~:9.h~~LH m:;Pi

VI.'

I*UU...a:,.. Al

iii
I

S
sway

.mE..: ':'
HI.I:I.

hastCPi~i
Oi~x~H

~li~~H

I" H .~'!!f

.1 S.**i.s

* :*"" *r.. *.!. i

MIn~itatd

RPqjiniu
1, igay j
I -pt5

376J

Number
treated.

1,080
09,115

10.140

'''':
ii:..

Rv cseea ................. ....:.;...; ......... ;...,
Cbuity eaaee..

Tdsle

I
"'Z1OD~;i

NHII.. .. ii *
*IHH.***i*V
-lir I,
; ;;I.
.1

HOSPITAL, STATEMENT 01 00

AND DISCHARGES, 1923.

SCOMMITNMNTS.

| .1 a a mi.w.-n.- .. :.....,
4 M! ii .......i.......i

iCH 3i

'id .. i jp..,.
"Ti~i ~ VI2EH
Hi~
ti4 _

hH b.~..*.
,A,. -
h :.:
tr.&,.
Hi~L~~'I" ~

H .
KR .. Sie
St V

I..

3 .. .

I.n. . .
H .. *.* . .

: ,-**
H : 1%.
-. *t.~ d~i
.r. :. -1

(yKA

-1 --; :*r*-

i

. . M . .

*. .. . .... .. .. .

. . . .
. . . i
*......

SMale.

i i i i i i i n. .. . . . . . . . .i i i .i . . . .i i i. .

. . . . .i. . . . . . . . . . . . . . . . . . . . . . 43
~~. ,..

Female.

18
.. i

46 33
7 5
. .. .I

97 58

DZSCHAROUS.

of birth.

. .

..... .... .
. . .. . .

.i. .. ...... .

*.. . .....

* . ..
mmMMlMMHM
BelmUla
.....i...

. . i. . ..

Male.

. . . i
I

S L1

. 1.... .

Female.

2

2
3

4

13
li lll. l

i i i. .
llnmI
. N
B a i n. n

l' illS

Improved.

Male.

1
1
1
1

1
6

. . . .

1

1

1'
5
1

30

Female. Male.

1

'""13
* . .
* . .. .

1
*...... .
' '8

2
.. ..... .

2

1

6

I

.i.n..

28

Female.

4

TaBrn XXII.-FORCE REPORT.

December 31, 1923.

Gold.

4
. .. ..-.ii-

8
27
132
20
6
1
4
21
12

Silver.

22
146
71
220
34

36
02
89

Total.

4

31
151
86
347
57
6
35
94
104
17

Unimproved.

* -
II
IA
2' /.

:~

UNIVERSITY OF FLORIDA
311111 111111111111112086
3 1262 08896 2393

	Front Cover
	Title Page
	Table of Contents
	Letter of transmittal
	Main
	Tables
	Back Cover

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0	cached_data_manager.retrieve_item_aggregation
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0	sobekcm_page_globals.constructor.on_page_load
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