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HIDE
 Front Cover
 Title Page
 Table of Contents
 Letter of transmittal
 Main
 Tables
 Back Cover


PCANAL



Report of the Health Department of the Panama Canal for the calendar year ...
ALL VOLUMES CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/AA00006092/00006
 Material Information
Title: Report of the Health Department of the Panama Canal for the calendar year ...
Physical Description: v. : ; 20 cm.
Language: English
Creator: Canal Zone -- Health Dept
Publisher: U.S. G.P.O.
Place of Publication: Washington
Creation Date: 1923
Publication Date: 1918-
Frequency: annual
regular
 Subjects
Subjects / Keywords: Public health -- Periodicals -- Panama -- Canal Zone   ( lcsh )
Sanitation -- Periodicals -- Panama -- Canal Zone   ( lcsh )
Genre: federal government publication   ( marcgt )
serial   ( sobekcm )
 Notes
Dates or Sequential Designation: 1917-
General Note: From 1918 published: Mount Hope, C.Z. : Panama Canal Press.
 Record Information
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 225670417
ocn225670417
System ID: AA00006092:00006
 Related Items
Preceded by: Report of the Department of Health of the Panama Canal for the year ...

Table of Contents
    Front Cover
        Front Cover
    Title Page
        Page 1
        Page 2
    Table of Contents
        Page 3
    Letter of transmittal
        Page 4
    Main
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 48-1
        Page 48-2
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
    Tables
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
    Back Cover
        Back Cover
Full Text




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artmen


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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
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ildren


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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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IIIIII


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Balboa Heights, Canal Zone.


SIR:


S0F


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1 have the honor to submit the following report of th op"
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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


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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,


...... ... ... . .
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iran.


Corrigan,


Sanitary


Inspector,


Ancon-Balboa


4


H
t
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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.


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


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.























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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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.


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A.


".," "


Rate.


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11%


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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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". : .c.i'^:;.H:s.


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
' '.
. .


Y


. *.. .- *
H.


I I ~~iiii 4


* T :, **1| .. -*
Ad. esic*s. R ate *.' Adjmi


28
134


,T~i-dj *


C 'Is


r


* H


.c.~I




Sr'"'Ci

-.. .. 4.


The


rates


6 diseases


were as follows:


causinIg fthl *highest Tumb
H -.il I C


S.:.. .:"


iPi


..:H::
.~ ;. Hr~~i~


A '*f. 4.


.: -" ," .....:::'n:
" . .LL


.a-
.n:v':r:


The noneffective rate for malaria in 1923 was 0,55


* 4


J


X


:x
..r.


!mru~


~D~D~;
('


I







U..

.x... .HL. '.


i::X:. ?:
"U~i


* x 'SE "...': "
:' E ^"! .: .s::!
I,:" :"::M i .
. H. Ei
.. .. H iN
: *.** A* .


S ..


C:: .


:i'| ii:
. .
:i'
HI.. ..
*:: .i .'
..: :*.


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


Iryees, as compared with 19.07 for black employes.


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


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



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

......H. of age
.. .... .. ..* ..
. . ..* ,
H ..... *. .



.1 . :r::.: .


9"~: ~0 :
%i~ i19&Jh

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







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TaBLE I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES


I ..----
rH
:~xn iij
9k..........
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'I, 'ft."
l.n?.7
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I
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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


1.193


1.457


I

I

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Deadu.,


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o


S;
DO
N8
CI
B*
*5


o'I


S
0


8


55.200


12,942
43,546.

560,488


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1tgsniiii


ANNUAL AVERAGE PEa 1,000 EMPLOYmsB.


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


17.22
24.23

22.42


17.69
32.02

28.14


6.65


I 6.89


6.73


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OF PANAMA AND COLON.


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Panam ...
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Caal Zone.


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Antigua.. ........

Autria ....... ...
Bahama Island..
Barbade. ........
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Chiea .... . . .
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France. ......... ,

Greece. .........
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Mexico...........


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Nicaragua.......
Panama.......
Peru ... .....
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Porto Rico.......
Riusia...........
St. Andrews ......
St. Kitt ... . .
St. Lucia .......
St. Thomas......
St, Vincent.......
pain............ .
Switzerland... ..
Triidad....... .
United States..:.
Venezuela....
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a VH.'-8T483TIC8 REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES.
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ti^NiaM tmn the United States:
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Annual
death rate
per 1.000
population.


5t"l" % iiW4'4,e s sand children from the United States:
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: i:r emoee frcon thqe United States and thdir families:
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....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
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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-




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59,635
31,285
31,793

122,713


60,068
31,393
31,098


122.559


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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
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Number.


Rate per
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MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA
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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 ............


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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







:1.
HC S
**H~F i.H Hli.: =


:



























* =. I~ *
~~.*:* qj
*~1hl~
I-....
.


:4. '-1
if
-


^i..:' .. . .. ^ **"*
*.:* w* **! . .
inIt


Iii i lb/a
-*!* s !s * .
;. *S .* *%




*** w as *


1.9





r


tnt
H~l


.:.H.1:


:F&. .| y


L%

*I


QeI! r

As
1Ei


4


- r~
SI..W


-S4~


h
. *


P *
mm


04"P *rt.-
A-.c


-CMI


*


YEQ~


'-4 0


-4 lC


wan P


O4D C'1e0
t


w .aQcqaO
*r


*
04 C~ *m
.04
*
-
*
*
*


'0~ l C C
1~ *010l
-r -to


oa Onco
- w-- *4
*


== I .. =


O1 la
a~~0


*aqI
ac


C .aok--
~rc 4


-- ..I I


* 4.


S


rAq o*.-l*
4O~
*r


a,
C &c


,r ~ '--
ehI1j
*
b~caa I a

At- M~
S. IrP ~ .fL

3-.:>.~P

A


@0


-* ..' --.':- w n- 1 1 II .


-I OOMCSIQ
*Cq r-
m .


. -.,- ,


C~ an n '


I. IiI l'' ~ I


Q CD CO


.-c.2t-


4.O 0041


00.-. N 04
rlrcn04
-r rla


*COCO
*eoooc Q
* O


* -4


*M
*taqow C


eIl~ .cl
-I


k-c mornr)


morn-9
eq~8
-S -


M o '""'
- .o n-,o


* Nt- ha
..oc cD


:.i *r =qc *ct -I rlNL
kC *CC CC .. ON 00

.' -. ', ~I ,


0 .fl-4
cCt@OG


- II


o *040


- N C**
*~ C^ O 0
-M^


.1 ,
*f


I:


~I __


I --- .. .. ... ~ -~ I


g


mm ammm


I


~IP~ N
I C4 ~ rl


10 N~


fo


r,, ,, ,











: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~ ** *
S
* . . .
4


::~ot~' 'k


* .. ii
* ...Hq* ~,p "s&7
* ha~.
814" t'~
V
glMpj.
1,0w rr
*. :i:as
4~48?
*1.8I5~

khV

*ti*ig
H
* .aasao~
miv 4fl.~
eq
I.IT :at.

*a
N.H






'$1


8,111

'Ii
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