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

MISSING IMAGE

Material Information

Title:
Report of the Health Department of the Panama Canal for the calendar year ...
Physical Description:
v. : ; 20 cm.
Language:
English
Creator:
Canal Zone -- Health Dept
Publisher:
U.S. G.P.O.
Place of Publication:
Washington
Creation Date:
1920
Publication Date:
Frequency:
annual
regular

Subjects

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

Notes

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

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 225670417
ocn225670417
System ID:
AA00006092:00009

Related Items

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

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tbal Health Office.


lepitBI....... ... .
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:: ato Tas opital. .....
: P" l.See Leper Asylum....
Berd of Health Laboratory
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:::. i Admisuion rate per 1,000 eml
2 Death rate per 1,000 employ
.. 3 Noneffeotive rateper 1,000 e
S4 Malarial fever--Admisson n
.." 5 Malarial fever-Death rate 1
S... Malarial fever-Death rate
: ." *itieb of Panama and Col
!,ablea:
. : L. Disachars from hospitals, d

~I.: Causes deaths of employee

Canal Zone.. .....
SIV. Deaths of residents of the (
":. by cause, sex, color, age, 4
SIV.-A." Deaths of nonresidents...
.'.. V.. DeSths by nationality or nal
VI. Statiti' re American empl(
:: VII. Birth and birthrates in the
::::. VI Infant mortality rates in the
.". IX. Deatheof infantaby cause, a
S X. Di'harges and deaths in
S*. XI. Consolidated hospital and a
..:-.. .. XII, Cnsolidated dispensary rep
:::.. XIII. Coisolidated admission rejp
:.. ." XIV. Number of employees coanst
.. XV. Aver~A number of days in
r;}" :p1 ... ? ..oye... h p.
:..." .: .. .XVYL. Number days hospital t


ployeus, all causes......
see, all causes.........
mployee.............
ite per 1,000 employees
ner 1,000 employees....
per 1,000 population in
on-Employees and not


* a ... *
....... ...
i i


. .. ..i


the Canal Zone and the
lemployees............


deaths, and noneffective rates for employees.....
B by color, age, andlength of residence on Isthmus.
ith rates of the cities of Panama, Colon, and the

Janal Zone and the cities of Panama and Colon,
and residence. ... .. .. .. .. .... ..


tivity. . .
oyees and their families..
Canal Zone and the cities


of .Pa and Colon. .
ofPanama and Colon.


Canal Zone and the cities of Panama
rex, color, age, and place of residence.
the hospitals of The Panama Canal.
sylum report. ... ....... ...

rt. . . ... .. .. .
intly aick in hospitals and quarters...
Hospital or quarters for each admina

mtment furnished various classes of pa


and Colon






ion of sick


ktients.


Page.
1
6
7
10
13
23
26
27
33
38
40
41
43
44

63
64
65
66
67

68

69
70

72

74
84
88
89
90
91

94
110
112
113
113

114
114


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LETTER


OF TRANSMITTAL.


THE


PANAMA


CANAL,


HEALTH


DEPARTMENT,


BALBOA


HEIGHTS,


March


1921.


ht;
h..



V.


Col..jA J. MORROW,
Governor, The Panama Canal,


Balboa


SSR: I have the honor to submit the following report of the opera-
tions of the health department for the year 1920.


Respectfully,


FISHER,


Chief


Health Officer.


Heights, Canal Zone.


'




















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-;;::' *** th::
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Col. H. C."Fisher, U. S. Army, Chief Health Officer.
Dr D. P: Curry, Assistant Chief Health Officer.
, :*


DIVISION OF 'HOSPITALS AND CHARITIES.


-A ncon


a


Dr.
Dr.


.L.
T.
W.
R.

A.
T.
L.


I


Hess, U.
Earhart,
Hubbarc
Connor,
'. Braithw
Ryan, Cl
Odineal,
Townsen(


Hospital.


S. Army, Superintende
Chief of Surgical' Clinic
d, Assistant Chief of Sur
Chief of Medical Clinic.
raite, Assistant Chief of
lief of Eye and Ear Clin
Assistant Chief of Eye
. Chief of X-rav Clinic.


- -J


nt.

gical Cli

Medical
iLC.


inic.

Clinic.


and Ear Clinic.


Physicians.


Dr.
Dr.
Dr.
Dr.


George Eugene.
H. G. Hambleton.
L. S. Chapman.
M.A. V. Smith.


D. L. Hollis.


c.
H.
P.
Jar


D. Briscoe.
K. Tuttle.
G. Pomero'


nes


B urrow.


- Internes.


Dr. H, S. Liggett.
SDr. F. E. Hyde.
Dr. R. L. Ross.


Board of


Dr. J. G. Stoelzle.
Dr. H. G. Campbell.


Health Laboratory.


---. r
.
---


Dr. L.
.. xDr H.


B. Bates, Chief of Laboratory,
C. Clark. Pathologist.


V.


-- m'l-


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S..Panama Halth. Office.


..s.
.1.
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0r:
i.,

SI'
.1

h.


Dr.
Dr.


Dr i
flr.H


Henry. Goidthwaite,


Carpprow, Sanitary Inspector/
Pieree, Sanitary Inspector.
Anderson, Sanitary Inspector.
, Searcy, Sanitary Inspector.
Quinby, Building Inspector.
.Lewis, Vaccinator.
. T. Eisenman, Veterinarian an
SL. Casey, Veterinarian and M


Byrd, Health


C.H. Bath, Sanitary Inspector.

Tb A. Leathley, Sanitary Inspector.
M, M. Seeley, Sanitary Inspector.
SE. K. Turner, Sanitary Inspector.
Geo. Campbell, Sanitary Inspector.
.W. S. Chidester, Sanitary Inspector.


Emil Becker, Sanitary Insl
Dr. I. C. Mattatall, Super
Dr. W. F. Gross, Veterinai
Dr. F. F. Dowd, Veterinar
Can

E. F. Quimby, Sanitary I
I. W. Pickett, Sanitary In,
Geo. L,. Willett, Sanitary
5I John P, Corrigan, Sanitary
E J. L. Tolar, Sanitary Inspec

I DIVISI

i. Chie


Surgeon C. Rucker, I.
*
". Cristabal-Coo
B....:. n r .
i~i


pector.
vising Vet
rian and
:ian and Mi


Hlpz rns


Health


Officer.


d Meat Inspector.
[eat Inspector.


Officer.




t


:erinarnan and I
Meat Inspector.
IA n 4 1n I n tr


LaQ L .1 Ri A L's e


' r.


Inspector.


al Zone Sanitation.
inspector, Gatun District.
spector, Pedro Miguel District.
Inspector, Ancon-Corozal District.
r Inspector, Balboa District.
:tor (Relief).

[ON OF QUARANTINE.

f Quarantine Office.
Balboa Heights.


Chief


Quarantine Of


licer.


On11r2 nwi ne Oflfiwrsr


H.1
1K?:l
A).:
H.~


Health Office.


Pn Quarantine, Cristobal, C. Z.


Colon


Meat


























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t. -n.I


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







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of. 9
.L ..... 0


S.rate to -hospitals anddeath rate from disease, for
:were .267.06, and 3.63 respectively, as compared
I..-1 for black employees.
n:rate to hospitals a -id quarters for malaria was 20.05
iyees, as compared with 19.21 for black employees.


rate from disease for Americans was 3.32,
9: 1t9, 19and 3.;38 in 1918.


CANAL


as compared


ZONE.


EMPLOYEES AND NONEMPLOYEES.


roma an average population of 27,469 in the Can
a total of 242 deaths during the year. Of these, 2
ra disease, giving a rate of 7.68 as compared with
:969 for 191$.


tuberculosis was


and


1.02


1.84 for-'1918.


al
11


Zone


there


deaths were


7.81


1919


, as compared with 0.83
Tuberculosis caused 13


cett of alldeaths from disease during the year.
here were 631 live births reported during the year
-of 22.98. (See Table VII.) Of these 231 were


e black.
deaths
led 60,


(


M the otal births reported,


Irst.1 V


I1


5 per cent were


among cmmren, unaer i year ot age,
of which 8 were white, and 52 black;


from


, giving a birth
white, and 400


stillbirths.


causes,


giving an infant


tality rate, based on the number of births reported for the year,
4.36 for white, and 130 for black children, with a general average
5:09 per 1,000 births. "
if the total deaths, 25 per cent occurred among children under 1
r of age, and 38 per cent among children under 5 years of age.
lelow is a table showing the death rates for the Canal Zone


from 1905 to 1920, inclusive, from all causes among both employees


I" : ; I1
V.. :, -
q J !E :. .: ," P.p u l a r .
H. .. Y.


*..." .. .. 234 3 828,
I .. -. I .. '
"-H..:K.jA. .E. S... .-. 1 2 8
'. 19B.....i... 3.096 1.70
.. ..- 67, 1 1,273
/.... ...;.. .; 'm. 1 02


Rate
per
1,000.


1913.
1914.
1918;.
1916.
1917.


. .. .. .
* E


Popula-
tioan.


Deaths.


Rate
per
1 ,ao.


'.. .' .. -'


'he death rate from
the'preceding year


Year.


~I


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......r.H
*H* ace.
SI.


I H
itt. -I
*., (seat.L


H .I.LE ..: .
p.: .
:1: ';
H. H..ltb Fe


.itiR Qnaluding colitis)..

.a : chro.). ... ..... .
r ,Bd broa.ho)..........
thwartt ............


I'U......


S. .
...-.'.


4
. U 1 U U


Sratse from tuberculosis was 4.18,
diang year, and 4.45 for 1918." O
erculosis caused 21 per cent.


1920.


as compared with 3.87
f the total deaths from


:.There were 962 live births reported during the year, giving a birth
ate qf 38.& Of the total births reported, 5 per cent were stillbirths.
Thee were 137 deaths among children under 1 year of age, giving
an infant mortality'rate, based on the number of births reported dur-
g.. the year, of 142.41.
OTf the total deaths, 25 per cent occurred among children under
Sar of, age, and 35 per cent among children'under 5 years of age.
..' Below is a table showing the death rate in Colon from 1905 to 1920,
Sicimsiy t, froix all causes among both employees and nonemployees:


fl ~.r fl7
A


Year.


.w..* ^
a- ---
Slt).
urn-r


. .
*...* a


*. .... .
*,J *. .*.


Fopula-
'ion.


11,
13,

15,
17,
19,
S20,


-Deaths.


5.53
703
571
41i
394
514
527
493


Rate
per
1.000.


Year.


1913-.
1914..
1915..
1916..
1917..
19Ls..
1919..
1920..


. .. .. .
a a .
. *1
. .. ... .


II. .


. .* a. a


Popula-
tion.


20,
23,
29,
24,
I- 25,
26,
26,
26.


Deaths.


489
590
640
696
667
8616
573
554


Rate
per
1,000.


: 1 GEN

SX x.ala.ie --The number
,"Rartf s&.hows a gratifying
...... .. "I.PATT STATEMENT OF
::. "" "" ... DURING THE
, .. ::. .
,, i,,:,,'
: : :


ERAL


REMARKS.


of admissions for malaria to hospitals and
g decrease from that of the previous year.
TOTAL NUMBER OF MALARIA CASES REPORTED
CALENDAR YEARS 1919 AND 1920.


Employees.


Nonomployees.


,Total.


canA I *crnn na ,-aaa


1..~"'~Y
(Y11


inrn


rAnh


1II~A


rA, a


rnrrr




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'1ti previous year). was blocked, and the river
"" shallow, -widespread, meandering- stream.
discharging into the stream were choked with silt,
Sinorp1hous xnateriM completely filled the rock and tile
t iot of P araisohill, necessitating its removal.
undone, in' a few weeks, practically all of the excellent
u .... e. in' a. the
t previousyear in this area by the district sanitary inspec-
iiw "ing thewithdrawal of the hydraulic dredge, the Dredging
frnilhed, the sanitary inspector a gang of men who cleaned
o the ditches and did what was possible to restore the
,system, but without being. able .to restore its former
v.Wnor will it be practicable to do so if, as seems likely, this


t:. a.bto oi e used again as a dumping ground for spoil from the Canal.
z'*dei present conditions, only temporary expedients and costly
!': a::nce can be attempted. The Chief Hydrographer has
? l e plan for raising this arm of Miraflores Lake to the height
..of. tun LIke (from 54 to 85 feet, approximately), thus giving the
:.. f't an increase of depth of over 30 feet, and a considerably larger
S.eae .While this has been proposed mainly because of its effect on
l .: the iater supply of Gatun Lake and the surges in the cut affecting
shipping, it would greatly benefit the sanitation of Pedro Miguel,
Stkhroiugh the conversion ,of a large, wet area into a deep lake with
fa. ly clean, steep banks.
In the. Ancon-Corozal. district nearly 10,000 feet of permanent
S forctcovered and open concrete ditches were constructed. The
latter type of construction-that of the open half-round, sectional,
Dotwrete ditch bottom, as described in the report for 1918, of which
S.sev.ral thousand feet have been installed, has not been found as
sa.t.sactory as was at first hoped. In the jungle, where there are
many large deciduous trees casting their foliage, these drains easily
:, a.,f frequently b..ecorme blocked, allowing the formation of many
: small collections of water, and requiring to be cleaned frequently.
S. though. more easily swept and maintained than open earthen
, --it : the constant care necessary to prevent breeding during
H:t' t: slight precipitation makes them a constant source of danger
ew.:. e nse; therefore most of the ditches qf this type are being
:::.. sn. by sectional cast covers and broken rock. In future con-
rction practically all permanent work will be done with 6. or
4'* cnrete -tilemade ky this department, and covered with
..a a..stone.. O(n in the Mount. Hope district, where there are
,*tiea 3 u, ioat. alu marshes, and where there is a scarcity of
:... .. .. ...... ..,. ., .. .. .. ,4** IY




















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... F the c.nsro1 of mor
ttifis fbhat, as part of
aits purpose, drains and


.* i .


1920.


1.12
47.38


1919.


2.43
54.37
1


iglas


66.037


squito breeding the Army sanitary inspector
the permanent work with the allotment for
fills were made by him as follows:


-r


,
.. ^i


S~tatiou.


i. *;
*0E


. eraif...
.. 1 F~ChemT.. '.:.
..Porm .platon.-
r'uusat
PM%9!El*DUI.B


. .


. i .


. I.


. .


S..,. *
. 1fto...


.I I:


- .

..* -

* I i*


'Dit
drahm.


,295
135
,200
,000
,223
,734
.436


62.203


Concrete
drains.


Feet.
1,902


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


1.902


Rock and tile.


6" tile.


Feet.
2,095
428


2


I I..I.. .. .
I I I I I I I I


8' tile.


Feet.
.. .. .. ..


. 575


5.314


Fills.


Cu. yd.
665
200


1,350
* i i Sl i *


3.21


flp id finer-There were 36 cases of typhoid fever, of whom 9
di. Five employees, 11 none'mployee residents of the Isthmus,


am 9 .:.nonresidents had the disease. Of these,;

I n:-; .. ..iloyee (black), and 5 nonresidents (4
"."..e fiottaSidents were all ill upon arrival on sl
t ti| necd upon the Isthmus. The cases dev
i. ,except for 4 cases in one family from a
...y. ne r Patanal City. No other cases
l. i ty after the discaoery of.the infection.
.! k *.. .

.. H" .....l case w af fully investigated a
*ate minamined bacilli, resulting
MIt i. ,rf.lft.... 1ftf east in the Army an
**:: a ** .
:gh .. .. .*: ,* *. i I .... .. ..


3 employees (black),
)lack, 1 white) died.
lips and did not be-
reloping locally were
L small pueblo in the
developed in that


s to its origin; com-
g in the discovery d
d the other a patieAt




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h ithe laboratory, to which all rats, alive or
NtiZ W decomposed) are sent for examination. No
itiata kave been found...
.oSltil, .barium carboyiate has proved most effective.
jf p:treprig thepoisoned baits' were tried, in addition
e riethodes of nixing with meal, flour, or chopped fresh
a dd.cnmiemsary storehouse, the powder sprinkled on a
mie caused the death of 24 rats in one night. The health


:.iSl .':C'ir~.. orts the best results, as well'as facility in handling
Vbifom mnxitng the barium carbonate in proper proportions
Srit baking as a loaf of bread. Split cucumbers, with the
#nie prinekld inside, also proved alluring to the rodent appetite.
*l'. Isattenipted to catch rats by means of a viscous, slow-
Siititshs-spread on baited metal plates, hoping thereby to
" tci aot::only fthe rats, but their fleas as they left the dead bodies.
ethEdproved more efficacious in catching mice, as the rats
wet neraly too wary to become entangled in the varnish. It was
"hown, however that once a rat stepped upon the plate his death
l certain. .
iAfsgeg disposal.-The new incinerator at Colon was completed
Stently to place it ...in-operation in September.
S.'At this inciner tor is destroyed all the garbage of the cities of Colon
Sad Cristobal. Previously the garbage had been burned in the open
o. di mps, and later, dn a temporary, unsheltered, rail incinerator.
.During the rainy season especially .it was very difficult to destroy the
: .grbtage by these methods; flies were bred abundantly and numbers
of rats were attracted and fed. Following the. beginning of opera-
Stiens by the new incinerator the fly infection of the two cities was
k tably decreased and now the district is as comparatively free


S., u: eas Cab be expected.
Wh :incinerator on Gavilan Island, destroying garbage from

S* ia ima Ancon, .Balboa, Amador, and other places at the Pacific
"jiinaif the Canal, was closed for repairs in December, necessi-
I:^ titig,:i"r. "e" time being at least, other methods of handling the.
S.* The Health Officer of Panama undertook to dispose of this
!"' iEothe: dump near the beach just outside the city. Each
".. 'et.. ..tiqn wastbrciight out in the morning, beginning very
: Evey liad as. it arrived and was dumped as thoroughl
wMithWa solution of larvacide (crude phenol, lye, resin soap
t iest r adult files and as iany larve as possible. After
S...:. A .rnnntn-in .Eli. it O the arh"a w"a o r


... :.












i...
.' S .... : .'. ... M en." "
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S L::....* .::. ,* ;*..., .. ..* *. *
-* ** X *** 4 I ** ** i *q I
.p. ..uaetlir ... ..e..... ...... .... -.. .... 37 r

.. .: s. N ** S..* .... .. *. .:. .*
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... ........ ..... .. .. .... "....... 340

.a ...st Niivy e positive, 261 negative, 26 doubtful,

to he .i nfecte, this figure is conservative and

e. It is also ralized that of the 60 apparently cure
*iiambetnay remain infectious, because of the known d
tEn ** ....






#nd also from the fact that the women usually take a chemical
Wire :coming. to the clinic for examination. Three success.
ti~ smears are, required before the case is discharged.
Average number of visits of inffected ien to the clinic
Staio bthat butinittle benefit could be expected from the a tr
Given Not a man ever completed the course of ant isyphilit
si ent ... The. chief progress was achieved, with syphilitic
tist of whom, being compelled to come xto the clinic.
m ; ha .... ,. could b.


sufficient treatment t
leat.,
The Panama venere,
Tomas Hospital has
Spysician and two nl
became necessary to a
average of 30 or 40 p
1. iOa dayi menr and T
The fee for service


Women.

364
256
60


r cent of
probablyy
ed as a
d" cases
difficulty
ications,
I douche
ve nega-

c was so
eatment
ic treat-
women,
received


3 render them noninfectious for the present at


al cliic.-The
been especially


work of this
valuable.


clinic
At first


urses were employed, but as the w(
Add a second physician to the staff.
patients daily, the number, has grove
women coming on separate days.
in the clinic is 10 cents for each


ar

vn


at .Santo
but one
k grew it
From an
to over


applicant


,.. .gitered. .This purchases an admission ticket vhich thereafter
Sentitles the holder to entrance to the clinic. Drugs or prescriptions
.to: be taken to the patient's home are sold at actual cost and patients
thtT are absolutely unable to .pay are given free medicine. No
ihar is. made for medicines or dressings used in the clinic. For
x-i We~nrmn teststhe fee is $2 when the'patient is able to pay, but it
;a E isS"fen without charge to the poorer patients. Salvarsan is sold at
i. !~t prices; to patients who are well able to pay, $5 per dose
.. W idv patients unable .to pay full price,... but capable of con-


P'' ""' ~';" "~-~ "~ ~ ~" u- ---~-----~~-


- ..-. ------




I~












.ta. yeTereal disease is of little coi
- fi fsble at the present time to c
ac plis more than.a limited amoi
.. thMhoped'o for no is to spread
a 'as possible and to attempt to, educ
lHweit 'a litt le later, laws. may be enacti
: .... 7 H. S th aboition of commercial prostitution.
|....s a.well asithe popuilace are against any a
I-.en' tly it would be futile even to think


sequence, that it is
irry on a campaign
unt of good results.
1 as much favorable
:ate the people to a
ed which will bring
At present the law-
ttempt at abolition;


of ac


S d- the present government. However, by cai
:a onal work in a vigorous manner for a few yean
uniltmiiately. be possible to secure the passage
.... teliminaterecognized prostitution from the city
: tnin m the incidence of venereal disease.
i; : Fem.aot of school children.-The annual physic
"1 4: f sbh It children of the Canal Zone was made, start
7 : The results for the white children were as follows:
j.: ; nne of childreBn. i.............. i .... [ i .. ............

". .. .er fouiu. needing treatment ...
:. .:hm er with,.defetive teeth aaonly defect............................
f. ,..i ib' with defects other than teeth only.............. .. .. ....
,::.- .D ef e.s found ... \ . ... ....................... .........
,u* r I .
."" ......:... = s.. .... .. ........ .... .. ....

a

SNl i.. ... .... .
".. h pe d. e o d e S *. ..... . . -
S i. . .



.... ..
:-' -The parents were notified in each case when defect
advised as'to proper treatment either by the district
anama..Canal. hospital, or by a dentist. Of the to'
fiund, biate.221 were reported .as having been treated.
i epted as an accurate figure, however, as treatment
S ly-given in may cases, but not reported to the dis
made the original, physical examination. No r
So the di tsfound in the colored children, but pro
Stiyt tihe.t itn of examination by ethe district physi
|...=. .... or byadnit.OYh o


complishing it
rrying on the
s, it is felt that
of laws which
and limit to a

al examination
ng in October.


was found
physician
tal 935
rhis can
was un'


id,


860
398
462
935
519
143
12
33
167
4

11
3
10
28
193
and


n, in a
defects
not be
doubt-


strict physician
record was kept
per advice was
cian.




















e .:.., andit is a constant fght. u .
id. a iries.-The' milk situation continues to improve.
.e'!....or iss flexible standard of 300,000 bacteria per cubic centi-
,.. rtr raw milk has been set by this office, and the present bacterial
!." hows many samples having considerably less than 100,000
.. ..b ...cic centi meer, With the passage of time, the dairy
i: "':'y them, It is but a repetition of the history of all cities
I w ere supervision of the milk supply has been attempted. Possibly
rI... hav had less trouble than in any place in the United States
Sof sdiilar sie,flnainly for the reason that the orders from this office
.re mandatory, and there is practically no appeal therefrom./
: ei. eceia Central," or central plant to which all milk'from
te various dairies is sent, was opened for servicee in January, 1920,
i.. which time no milk has been sold in the city except that which
mis.pasteurized at this plant. The lecheria is owned and operated by
the ..dairymen's association. A limited quantity of clean, fresh butter
'is also produced by the plant. As soon as an adequate supply of
bottles of the standard size (1/5 gallon) -can be secured it will be
,: eired that all mil-ka be also bottled at the plant and that no loose
r: $ibe sold.
F'ines.-There were 1,425 fines imposed for violation of sanitary
Sregslations.and $2,684.50 collected as a result thereof.
.' O .iarge disposal.-A t the time this report is written we are burying
:I Iarge froznthe City of Panama and the terminus of the Canal,
owi .g th thinecessity for extensive repairs on the Gavilan Island
;. ieirator. his method of disposal is' being done at an approximate
0 of $ 1,2.65 per month for the total work, as against a 3-year
|^ S4 1064 per month for incineration of the garbage from
.1b Ct Panama alone.
'll Ysenteasesu.-During the year 395 cases of syphilis were
ap' t.prt4s to 1 this ffice and 1,111 cases of gonorrhoea; 'this. by rio
........r dsents.the A.ctual total, as it is almost an' impossibility
-.:: :-!d!" .., 'H'he,. City o Panama th. trn oh














S fl... bi-ds oii ':during the entire year.
[. ik$ h ugh. .y with the other ingredients
S*.:sd.nme, baked itt the ordinary loaf was found
at...' ethod of usrng this p ison.

Sre r rk for private ,parties in Colon.
.... .such w oWrk during 920
.. .... ": ..... .'. .*. : 4, -. *

... *...*..:- *. .....', ...,
.: ..G. .. : *. .I...*.. ...'."* i..t .: *'.. .w. .. .. .. .. *-***
... .. mortem nspe tion:

ir ..
SS ... .. *
.
.. *.kis.. a ttb. .. ..... S........

S.. :: .. ....... ................... .............. .--
". a. "::" .. -- .. I.... *
S't
!i. ." S S ". ". '
S' P" ..f.ri L'.
. .. '.*. -' ...- S ^ l -. i S .%. -
.... a.. *.. ..... i. .... ..*.. .. . .
.." .. .. .A r :." m mm.m a m m amm gim m o n m u a m m ..
: .f. .. :* . . ........
... tS .
t n f 25 f l d 10 II nl r


"t" .l L IJJcUL1LUIi UI Ul L.3 I tIL L U1 LdSLLIC: dllU 1'
S..per head is made against-the Colon abattoir. The col
- work since this charge was authorized (August 10, 1
StI98205.a ..
* ;:: Jood inspection.-.During the.past 2 months one sal
'"Ws assigned to food inspection only. The results
gratifying as shown by the improvement in the gen


Barium
of bakers'
to be the


aborers to
e collected


29,159
..... 10,876
.... 30,771
..... t10,731
..... 35


150
1,200

162
354


1,350

516


ifrc hnri nn


elections for this
920) amounted


unitary inspector


haw
eral
C


Been very
cleanliness


..... nd amnary conditi.on.o bakeries, dairies, ice cream parlors, restau-
:..,i~ kts, ..hotels, messes,. etc. The following establishments are now
:. r' receiving regular and systematic inspection by the food inspector:
: ::0 h ot0ts, 37, restaurants, 3 messes,. 18 bakeries, 5 bottling works, 8
.:. .Iarsk'ets, 48 vendors, 14 ice cream parlors and soft drink stands,' 6

SMaiudt.H.n iope district.--As conditions warrant, antimalarial work
..Mount. ope district has been gradually extended; 30,242 linear
A""!: asf .qpen drains were installed during the year. The installation
Sve ry. narow drains in low swampy areas is being tried out exten-
: .il y. in this district and they have proved very satisfactory.
Hi T.:..,he antimalarial work in the'district has been effective this year,
I::. shown by the low malarial rate compared to former years.
tl."ontemptplat-d to install an extensive system of tile drains
.. ,. t lllaIt the dnistfrint dilrinro the nPxt drv pnesnn in nrder to reduce




I~




































policy :o the quarantine service.
p free of quarantinable disease, and
is -of bringing this about for their o
aim of quarantine should be the al
ourselves in against outside danger


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



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

H




". .
." '
C'*
.:' "'

in:" ..i ... -;'
i. i.
rj' .
e ,
.., .. *.


I


".: .u imat; tour of inspection was made of the western ports of South
J Sret. The following quotations from 'Doctor Grubbs' report
idca the results accomplished:
* : .


. N tisns are attached hereto in the form of notes on the ports visited,
:i$ditin, aa trip was made' to Quito to express to the President of Ecuador and
ath.r efc4a. the interest and appreciation felt for the radical manner in which
ys fer rehas. been eliminated 'from Guayaquil, to assure them that we are
ti tte protdptly recogn such work by modifying our quarantine procedure
at4Lt agebt that similar steps be taken against bubonic plague.
-, i~n a similnecal was made, at the suggestion of the American Ambassador,
Sitheraamnt to express our interest in the extensive sanitary campaign he
BiUtSi u ed tin Paern and especially in the efficient work now being done in the
'imnce of Piura.


i4

Uid


:thee: js no yellow fever at Guayatiuil, and the city is probably noninfectable
, it is evident that the quarantine against persons from that port should
azy" "reioded so l.onglas such conditions are maintained. This action will be
mCest possible incentive to. have the present conditions maintained. As
im po..r. of Ecuador were always infected from Guayaquil, their quarantine
similarlyy be tdt. d The fumigation of all freight from Paita should be stopped
tir .. t ba all lighters at that port fumigated whenever used for
S.oiur ships, and for the fumigation of all dried hides, which are the only
ft.l.atf carryy .ate. As Paits is'frg from yellow fever and from etegomyia
to sal thesquarantine officers, in their discretion, to count such
e... have biet setit i t Pait or Talara as against the quarantine period of


..*,i I ~v:I *;,


i


I~ I*


.:..:














ICI'::<:s
r ,,
!.Hl5 ..:A
X' J ..": .


Hr:
'........., "... "

........"" *


ire
4.
H:..:i ,..":...
i:,: : ., .
... C' !
;:'i. ,.: :.::.
E*x" :x "..:*H

.:.:Lx...................
..i ':" :; :
.::..:* > '

ss. J.
,,,K, ,":{A *


,, ,,J ,, *_*
,,.H '"t '*




*a; *' "r1


C::n .
.4


Ii~
Ho'3


a :-,e pi nswuDai was aerauea to maKe an
... .Mand Tumaco, Colombia, with a view to
quarantine restrictions should be enforced
ie fdtdwing excerpts from that officer's report


a: The rainfall is about' 400 incites annually and is well dis-
lout the year.' The tide enters the lower levels of the town, and
Iis ani qpotantsfactor in keeping the town in a habitable condition.
E-butdidraot encounterr any mosquitoes. The water containers are
IThis I the port for Call, Manizales, and other places. In my
ia, bee nao yellow :fever here since 1915 and then the infection was
hcetd from Guayaquil.


-. Its. itBaiinended:' .
..:. i atthe qiuarantine be lifted, provided that within 3 montl
mrirLte campaign be underway.
-a 2 Tat the COlombian- Government finance this campaign and
biatfu;of the gm-ernment direct the work.
:.~3, Itr. suggested that in carrying out the work,. the sanitary
cooperation Sad assistance of Mr. Walsh, the American Consul.
'4. That'-Qur attitude at the end of 3 months depend on the
th:e:. ove .e.omuendations are carried out, as shown by reports
:aWthdr oinplince with suggestions offered by him.
Ti'uemacs: This towns 537 milesfrom Balboa and issitgiated in


hs an active anti-

that the sanitary

officer secure the

manner in which
from Mr. Walsh,


the southwestern


' oaoriertf Colombia. It has a population of 6,000 and is located on an island which
- is about $ feet above sea level. The soil is sandy and no water remains after the
wins, except that collected in screened tanks and barrels. The sanitary conditions
are the best I have seen in any of the smaller towns of Latin America. There is no
trace of quarantinable disease having occurred here for at least 15 years. It is
earnetly recommended that the quarantine be lifted at once.


...Following the
.wreisnMed"


receipt


this


report


following


instructions


H "' the Quarantine Officers, Cristobal and Balboa:
.. The 6-day detention period for passengers in
ippg required.
2 The 6-day, detention period for passengers in
.... is prisionally lifted.


good health from Tumaco is no

good health from Buenaventura


S: D u.ing .the year the general quarantine instructions have been
entirely revised afd amendments relative to night quarantine service
: have been. prodmulgated. On February 5, 1920, the quarantine regu-
i:: tatdons were extended to include influenza and similar diseases as
ma ritime quarantinable diseases.

S The: following instructions relative to vaccination have been
.. ... -olowed throughout the year:
.:. -:Tb ~uarntinte Offcers: In order to facilitate travel aqd to avoid unnecessary
:...'.... w a ation of passengers Who are amply protected against smallpox, quarantine
e a.inthorized -to issue a certificate of vaccination which will be good for 5
;.. :, : erthey have vacciated an individual and have personally observed either




















Lu%.H:.n
...............;' H *..

Hp.:. A. H' .
......... Hj;'.. H. *


'iA : V
H.
""' i bH.


1Ir2.. *


:vea swere.ltheld in quarantine...
,rni iectis of vuT s.. .. ... ..


* *. *. .i ..
* *.-. b .


, C ... ... .. .. .. .. .. .. .. .. .
S s. .. Cd .


Na n...... ... ..
SO, and Na Cn........


2,363

6
1,575

18
7
6
49
2
25


... .. .. .. .. .. .. 118,136
S. . . . 43,657
. .. . . 43,618
. . .. . . 10.814


a '1!otm11 a
o a... . .. .. ..* .. *


216,225


:.: apl:..ary inspections of persons on detained vessels.
P.. esna ataiued in quarantine aption...................
Snibeof day held...............................


* ..- .


* . .


4,612
1,725
3.452


I. mletgrotin.--The inspection of
previous years.
.-


ANCON


immigrants has continued as in


HOSPITAL.


(Col. L.


HESS,


S. Army, Superintendent.)


1w4.,V.

II!:'~t


1..:..::,


i:i:? P1 :X
II..


;' --p


IHH: -E..


Buildings and grounds.-A 2-story addition was built to the power-
last building; on the ground floor is the new carpenter shop,


*..". mm $ "
d., ttich
sidter,
--M


. .. .


as large as the former one.


and


on the secoi


nd floor are


the


shop and miscellaneous stores of the electrician, carpenter,
and plumber. Following the change, the hospital bakery
dsferred from the kitchen-mess hall building into the portion
*e-tplant building formerly used as plumbing and carpenter
d tbeh &ner bakeshop was occupied by the general me-


m.


department


$IE .. *d- A.m a a we


* U* 4 tn. ni- n ..


S.. -.. U

impe td on oiml. ......,.............
ea opted on-arrival.................
paged on ertifitate of medical officer......
aem pae ed on ertifoate of medical officer.


it:


wiok as *si and storeroo
Storage a receiving.rom


undertaker's


4 SW- -c -


ri~l'~ll rrr


Iiillriirli


IrE1Se:


a


I


. .




I~















*. .."* y i ^ S&: 4 m:* ea/>'^ *'
.. :, I ,*. *"* ,. *.. ,,
il; Ir taii ..! *, : *. ** : : :
S**I .* *
i.:. .. .: .. .
.1 .5A, ,* .. *..*..* *.* .*
.1 *E .* .* I
.: h > "i." ** :* .. *.




a- I '
H I:I ..*::. :* .


.. :.: : ....* ** :.. *. .
*...: i,. ...*.*.6_. .: .. I *. m .... a s .
*. .. n.. ...r : r e .
... .. :F .

.. .. .. .. .: ..... .
* p .. 4| ., .. .

:..O -...... ... .

%* H*** ," ,*,



": .. "" .. MO* grOFT

. ". ... *.** *
.
.. F .. .. .. .. .. .. .


. .


* "L .



1920..


.Toital number.treated.
* ... _


Coroat
Hospital.


Total.


350
581
939
1.304


.-874.
510
`"883
hri; 25~O


a PATIENT PER DAY


.
J *
, **


* Ir
** *4* *5.. U.. U *


*U..C... *. r.
* ** *. ***


U/au. U





* .
* U Um* *


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


S. .
* U U


CON HOSPITAL ONLY).

.. ... ....... *0.463
.... .... ..: .. .3495
. .............. .315

...... ..... .. .2522
.... ... .. .2372
............. .. 253


ENTS, NONRESIDENTS OF CANAL ZONE.


Died.


Ancon
Hospital.


7
- 9
19
16


Corozal
Hospital


- .. I.

.1~ *~* F I .1


* J


,* ...1
I:, Chronic patients
." aToa .mber

:.. Avr ge num



^: "2 p m.bu
I:.. .*. .. kA:e n-
r.. -dA -w n !
S'uumZrlrs
.~l t tPa


Oito~


:IIIasr2t*


treated.. ... .. ...
of days treatment.......
lr of patients per day....


ta coat. ..... .
r patients:
adlumiozil.....
days& relief....
constantly sick.


l


1920.


833
S. '9,626
. .26
. $0.315


. ...... 860
.. 15,134
.... 41.35


9,783
170
7
12


S9.972


Total.


1919.


34
9,710
27
50.2654

1,392
22,217
60.90

10,503
151
8
17


10.679


Days treated.


Aneon
Hospital.


5,101
7,667
15,434
24.418


191'5.


38
8,603
26
$0.2602

4,165
49,067
134.49

12,153
229
13
39


12.436


Corozal
Hospital.


21,396
20,431
17,245
15.979


1917.


63
9,836
27
50.2520

2,469
33,494
91.76

10,880
191
45
54

11,170


Total.


26,497
28,089
31,779
40,397


1916.


52.
9,174
2*5
30.2400'

1,937
28,519'
78.13.

911.
*225-
26.
59-


9,426-


a. ........ *U**** .i.
.'. U.{ U *
*.

*... U U
*a
11111(

man*
hI


I


I













YE.!I


i '
ffnf


Sno,: smutable


means' of


out-door


! navmg
exercise


-uDer-
i now


.. ""I
S..s i:r. hqulde *. rade for a sanitorium at some suitable
.i theCanal Zone.for the treatment of tuberculosis, with a.
"L"-' this class of patients. Under present conditions,
S ase sent. into Ancon Hospital, for -segregation in the
.i.n which. not- well adapted nor of sufficient size for

ti^ t: ag rge t-nsi courts and a swimming pool should be con-
Sh..te use of gold personnel in close proximity to the
!iu4arters. Some form of exercise is absolutely necessary in
tIte to:maintain hospital employees in the state of physical
Idemndedby their duties.
.. a nurses' quarters at the present time do not provide
sauflileat quarters far the nursing staff; it has been necessary to
dqi uy ins few rooms,, and for others to be quartered elsewhere.
iTke nfes home provides quarters for only 70 nurses, while 78 are
:.d "Suceongestion is not-conducive to the best interests of
S :'isfiesom and provision should be made so that each nurse will
**g y *.:.Foom .
gq :sxt sBion-Section.- Build an addition (basement and two
toriioes.) to rear of service section. This addition is needed so that the
?U*. t ooms in a portion of this section will have an outside corridor
. "i''to :'that of the other private .rooms. At present these rooms.
. desirable'for use of private patients on account of the sun
.....n.g directly into the rooms during the days when it shines and
Hi". 4 .ginclement weather the windows have to be kept closed,
Cwhcht- renders the rooms stuffy, and is a source of constant com-
l it. friom private pay patients. Also, such an addition would give
etoom for the diet kitchen which at present is entirely too small
fwp6per and efficient service of patients' diets. Further, it would
i-drd ore comimwdious reception rooms on first and second floors
Sf viitore'and incoming and 'outgoing patients, and in the

...used for experimental and diagnostic work


W. 0eatf-prole altcheckinaboratgry are kept iroe rooms which are
Srfoa separate, suiet-able building for an animal house. At pres-
.tanma as en used for experimental and diagnostic work
totoe &t-dsreepiLabo ntory are kept in rooms which are
omacngad possibe, the odor therefrom is















a t384patiens the 8rst day of the year.; 10 were admit-
2,- add 145 were discharged or transferred, leaving 377
i atLthe. end of the year.. We have endeavored to deport all
I Iwh. uid be sent back to thefr homes; the total deportations
U:.. ibefatrr fnhbered 80. patients. .
: ** Ttic upatioward, which was established in the early part of
..,.49 ...a 4proverr--a great success. Nearly- 40 patients are in this
'... rtmtt making various articles, -whereby they spend their
ttun a: cogenial manner which produces a beneficial effect upon
:: H 'tir Stental condition. Owing to the lack of accommodations, our
S'cfional undertakings are scattered in various parts of the
S.hospimtal .grounds; however, we have succeeded in finding some sort
.. ': work to employ about 80 per cent of the female patients and 60
Percent. of the males. An- open, spacious, well-ventilated building
|:>i ",:; where more patients could be brought during the ddy to be instructed,
would increase the efficiency of the occupational therapy and benefit
is dthe patients to a greater extent. Over $4,660 worth of produce was
. ...taken from the patients' garden and utilized for their own mess.
^ Undertakings. of this character do not entail any expense to the
H Health Department and yet are a material benefit to the patients
'themselves.
!:.' Broom-making machinery arrived recently and steps have been
i.:, taken whereby some of the insane patients, and some of the chronic
1:i who were transferred from Ancon Hospital, will be induced to make
br ooms. Several chronic have already taken up this kind of work
|,. and-.are earning a little money in order to enable them to purchase
i'i small luxuries and other articles.
,, : : The.grounds in the hospital inclosure have been kept in order by
patients detailed for that purpose.
= paiat etiedfr ht=upoe
.IH.


Gi'" a i
K -x
:.. "
4. ,..
=:. =v

I: .. *.

.nE ;.
Ni:,* ..


FARM


DEPARTMENT.


Gencral.-The number of cripple employees has beep reduced from
SO.to 29, by obtaining employment more remunerative for them
tht their work on the farm warranted us in paying. This, with
the reorganization of the farm, has reduced its running expense to a
great extent.
D i"ry.--Our herd consists atpresent of 59 Jersey and 16 Holstein
awa4s4, 2 Jersey bulls, 1 Holstein bull, and 25 calves. With the regular
atval of feed from the United States and. the pastures being in
i f St;'S t w 'a .. J n* .> f I I r>




I~












H..






H' H
*.~ ""
.3

:.5
f M~~*:,*
fr: 1
*~
1'" "~**


H.
a'
.9.
.3

H..
I
I..
ii
a..'
V

'I'
H


q.
H:


H.
v ..I.
I:.- -
.:-


*w,~;~". .. ** *. ** .*1*'S:*
rm:...."4$.H.Hi i
*HV:L."l'l::


. *

A. Bococ,
m y e ,


U. S.


Army,


Superintendent.)


.. ..to tmas Hospital. is notentirey under the jurisdiction
is, more or less, intimately associated wi
h..-Hiepartment by virtue of the agreement between t
j I .of PPgarma and The Panama Canal dated October 1
tjI reafas as tfolows:
e affairs of Santo Tomas Hospital will be administered
.y:.i board of Directors of five members, three of whom will
.'"N pinted.by the President of the Republic of Panama and
tlr by the Governor of the Canal Zone. Of the three directors
appointed .by the President, one shall be the Treasurer of the
IHpspial, and one the Secretary of the Board. The Chief
Health officer of the'Canal Zone, thereupon, will be the Presi-
dent .of the Boaird of Directors. The Superintendent, two
.internese and three graduate nurses shall be appointed by the
Governor of the Canal Zone and their salaries paid from the
i, fiids ofthe Canal Commissioni."


on
th
he
.7,


..... Under the provision of this agreement, Santo Tomas Hospital has
continued to operate under the joint administration mentioned and
under the direct supervision of the Chief I Health Officer of The
Panama Canal.
Tl year 1920 has been a particularly successful one for the hospital
. .i.. iany, ways. The auditing and property accounting department,
: i: called in 1919, has been perfected and enlarged with use, until it is
npow functioning efficiently and satisfactorily. All outstanding debts
of the institution, have been canceled and current monthly bills
:are now paid as soon as received. The revenues of the past year
..ihrave amounted to $245,414.96, while the actual operating expenses
; "have been $231,939..97, leaving a balance of $13,474.99 available
': for use.-.An excess of approximately $1,000 of revenues above
: expenses is now being shown monthly.
.. i. .eort has been made to _improve the purchasing department
of the hospital to the point where the best possible supplies and
". equipment can be obtained for the least expenditure of money.
:H" Wast.and extravagance have been lessened and economy and
Hif:.jn every department advocated and enforced.
The buildings, many of which are very old and practically falling
S:,dowa,have enx erypaired, repainted, and rendered habitable until
i: e construction of the new Santo Tomas Hosnital shall be conmnleted.






























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: ;B the yearthe asylum buildings wererepainted, both exterior
and ittior, byiy the patients. Trees and hedges were set out, lawns
maaked out and graded, and gravel connecting walks put. in. The
"task f altering. te baths and toilets of the nine quarters buildings
sc peted a -ventilator was built on the' office-commissary
:: bding; a vegetable storeroom and a carpenter shop was put in
.atd tthe fronts of two quarters were changed, doing away with the
long and dangerous front steps. A new panga was built. All repairs
to buildings, furniture, plumbing, etc., were made by our own labor.
-. rass and bush cutting and sanitary work also were kept up.-
One new building was completed by outside labor and occupied
Sduhiing the year, to be used as a detention ward for mental and unruly
cases among the patients.
.Weekly moving picture exhibitions were given as usual; several
dances were held and entertainments were given by some local talent,
others by Girl Scouts, the Penn State Quartette, etc. National
holidays were celebrated, and, thanks to the great generosity of
frierids on the Isthmus and in the States, our Christmas was a real
on., .with 'i tree, ice cream, cake, turkey, and presents. A small
a -..


::. .organ given by States friends contributed greatly to the success o1
. these times.
.During the year 11 patients were admitted, 5 died, 2 were repatri-
S'. atd, 1 ..mental case was transferred to Corozal Hospital, and 6 cases,
i after:-exhaustive examinations, were discharged. Patient popula-
i.. j tion December 31, 1920, was 74.
.A monthly average of 30 patients were employed, the .-payroll
.. averaging $193;.21 per month. The value of products purchased from
..,. t e..patients-for the asylum for the year was $811.02. Total cash
S.saleat the local store, operated by the asylum, amounted to

i t*696.28. ."
.- The oral administration of chaulmoogra oil was continued this

.Hl ySaf with rather more willingness on the part of the patients, due
S o the fact .tht several cases were discharged in 1919 "apparently
catd'" or at least in whom there were no active lesions or bacteriolog-
.rfnzltI" fl n" A A n..qi k ,ann '. g a flL:.S






























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B*xao cu.ttrea-
T.tal number of blood cultures....
Positive blood cultures.........
QrJ`nifz? covered in blood cultures:


I~il
R".... .


1:.3y ..


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I.
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i ? ..
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44, HJAJL /^Ut UtiI l X JY, LlIb U KI p lLILI Wll a

H *t R..I mcreasie. positive cases, seems to be about
S4aivi.ed between influenza and noinfluenza patients.
lp : .eEna.in our fatal influenza cases-seem to have been
Variety oft organisms. In no instance were the lungs

1ai ax id in most cases some of t9Ja organisms found in the upper
'' tr tct were also found irr the consolidated lung tissue.
t oughpdiikient about offering any:opinion on account of the
lntteness: f. our. work we quote the. following paragraph of
C wig as. stating our views at present: "The whole clinical
ad ..t olog cal picture becomes intelligible if we can postulate a

.irtty etiological agent actifig locally upon the respiratory surfaces
%.e. oally through its toxic products in such a manner as to
prepare the Way for invasion by the prevailing respiratory flora."
.itring the year the pathologist reviewed sinusitis, otitis media and
m.astdiditis in the 3,376 autopsies which had been performed by him
this laboratory. Much valuable data is collected in this paper and
:the .1920 number of, the Proceedings previously referred to will
contain this article in full. -
.The :entomologist prepared an article upon the Panama Canal
.species of the Genus Anopheles, bringing synonomy up to date,
and treating particularly upon the taxonomy of the species and
-the collection and care of material for study. The article with 13
illustrations has been printed by the Health Department as a mono-
graph, and will also appear in the Proceedings.
At various times.throughout the year blood films showing malarial
parasites, smears, cultures, intestinal parasites and ova and other
laboratory specimenshave been forwarded to medical schools
requesting them.


BACTERIOLOGICAL REPORT.


B.itphAsw (a5 cases). .....


- Pno. o.uu. .. ......
.'Typ.e !... .oo.... ...... ..
.. P.L, ...
.. T pe .: -...... .. .

Tre-' pe" i de.... .. ,....
LSi~F~~i~~C Tvnp IV


Aesmo~aywiw
*5...:..


* .


... . . . I I .t *
* i i. S i i* n i S i i* i ih i* ia i n i i*


. . .


.... ... .. .. ... .. ... ... .
* a. n S a i i p n m i n i i a m*m S n i 5i a S S n a i n S H m i i S 2



m u m n S i. i n i S i n i i 6
n".@ n m is i U i n m a m ai m m i ai gi gna nm nmmimn m i i n |m i i


*. a U S S S S S S S . a 12
..-.. .. .. .12.. .
-i a S S S S 5 S S


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.-.""-" :... : *- h. 5 .
. ..
.** .* .*. ....
:.. ..... ...

-... ,,,, ..- i. *.
ss.t pa lvaaa I mva


ad organs, en dateu, etc,


i.S .... i*- --*.
.*:*:. *. ...
.'': .' ..." "mkl,*,@- a d.D m m d i d w e m I me

.~~~~ .... .' ..; .. **.
""" i i" ." .. ... .. .. ..%. .. a

w.., ,- ,, ,,.-,-.. for B. ... ..r.. l.ui....,
."i****. .. ,.:g eu ,, m a.. ... ,
*... ..:" ". .1 .*


...


*ii j::i:.:Ltif bq~i*S. & B.. LwuuIa....
... .......... .....*



*d ....
:4". i-fn t.....sf .. ..- .. ........
*...:. .Co d...li o ..m* *







*!.."...!* gi~idvacoiue ..
nof tropical .
*.:~ ~ ~~~.' .... WhHggaWMA

~.of.. -AO tspg .....j-g ...


.w at 5,. ., i. .. ... ..... ... .....
.... .u ..i tipt. ..i .* .

K. LI* a". .
"Jih i ad bateiiogil count..
.*-.. .. ..


h ... .. .


"' ..iice re7port:(animals)

U: !.- :Cftlh ears (.19.5 pitive for B. anthbracis).
ide lt dorB. anthraia. ..... .. ..


537)l. -


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ill in lln11


. .


icilustyphoasms was recovered in blood culture from 25 individuals;

oftiiw cases were from shipboard and 13 from the Canal Zone
tie-:t Rblic f' Panama. The -two cases from which Bacillus

tjha A. wee recovered were from shipboard; the two ships
S~r *




111































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g ..-r s ". ..... r...... ..n... ...... .
:. .. .. U *** a





4 t*'T it.. . .. ..... .. .. .
Sn ... ..*. ... ... .. .
l ,. *... .. .. a

aI el.s of bone and ints................

e'.. .".. .... U ..
~.~. t..... .. .... ...........
S Canerof thestomaPh and liver (eophagus).....
.l Cani tubreaot.u ..................a...un..




::" acerf. other organs................. ."......
lH.M A a dinias dsry, nause not t determined........

|. ": l..--. -. .ag i. ... ........ .. ...... .
..1'su,.pizTelrh.... ..a". ....- -... ... ..
1, |-


3
1
2
2
17
9
2
1
2
1
23
2
3
2
1
1
4
1
1

123


Diseases of the nervous system and of the organs of the special senses,
S.* *.


4 3I*-.* .
Enoephalis. .................
S0i0plel ,...,...

y8... .. .....- .v .....
.eiaemRorrhage, apoplexy.
"ioe.muf th:e brain.. ,......
GiiraL tparuiyd of the inaeane.
w j6 5te s... .. .. .


. .. a . S S .




* .k. S U b .. .. S
* U n n -* ...a,..,a.
n ~ n n m ~ i | 1i i m
mn | l~i | | mmgI
~~~~~~~~~~~ LI I n inn


: i .."
: :... .... .. ., ..l .*

" ^:r ..nt *1,, J.'reiiIi ne 1Jl4M *in


2
4
4
. 1
6
2
8
1
2

30


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: ....... ................... .......
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32 95 t
.... .H
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r. ......... -. h.... ... .. ... ... .. .... .. *.. 11 ".4
.-. ..W........,-...............................*.... 10 2.

"* ":"* O w~ amw e~ w ha e~ = II Im t a i I.
I ~~~~~~~~ ~ 1 2.a*9'mtaaH~gMmgABM~~ HMHBAHA
-m -- =-- .-e


causes


dleatl/


autopsy


the-:


Health Laboratory.


be
*1"


24
40
26
ta-az
30
38


8
.23
.27
25
31

36


j


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3
'15
12
11
17
*16
20


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frojia m ba tok.........

L ~iom of external genital .
ma fr omP petWW and anu.....
From akn of upper extremity.
f from akin of lower extremities.
wf-rom akin of chest and abdomen,


from intestines..
rom rectum...,
from stomach...
from larynx and
dil


Thyeoid. ymnd...........
pe. mn ro brai...
:Sai:y glands..........
Uterua and apipendages...
X uterei..i.........
Tubes nd ovarie.......
pn paled from or





.Bladder, dmens from..
. .roetat glzaxds.........

nu.*M*ii l tL IS1L*_-*


.


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i


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~ns:~ft


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uterine



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nljiga

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." A. pua ted lower e-rm itie.. ..: .................... ...........................
!" Apated paper extremities.............. ..... ... . ...................



|j7 s aBj ftStejl myu ffrom ....... .. . .- . ... .*
S. .,u ,am ury.m .of....................... .....................................,-
S. erical......... ........ ....... .... ...
.. .. ade, su raelvicular..... . ... .. .. ... .. .. ....
". ia submarillary....... .......
l'.* .ot m e de ua x l a .. .. .... .- .> a


E:3:7i1*3n, cng "icn a......l i......... .......... .................
......u :iI- u. _d uupr-acasz... r .... .. .. . .. .. .. .. ... i... .. ..
. l.i.:. eaa .r.... .... ........................ ..... ...
. H .us, a...r....uw..... ,l flf l..

,, ",, ,,- ,,, ~ % :


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8
13
7

174
m
6
14
2
2
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2
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2
51
II
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2
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.41


I


f -1 .
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. i.iaro n .. .. .... ...

n andlegd ampatataed.
Ran uaannhiu


.4~~


eIa (Ist. from -eternal aditory
StouyrgoeiS.........,,... ........
im of an inguinal'lymph node......
kimn diue.ae ........... ....... ...
ai of ididymis and lymph node.
i of an auinal iap node.. -..


* .C..
a .






canal)
* S *

* a .

* a *


I. .a...
. iII


SI*Ii i i
I


, ,* *. ., -

.1 .fi'"...iges t on so. .. ...... ...... .. ... .. .. ............. .. .. ... .. 1
*btna peuhated in pelvis 14 years............... .. .. . .. .. I

I"i. ........ ..... ... .. ...... ....... .. ......... ... ..
: che. ... ..... .......... ...... ..... 1

l :-:.i o .torpic.pra (two at full term in. broad ligament and tube).......... ........... 6
H ..... a *... .. .. .. .... ... .. ..... .. .. .. 2
...^.it. iBd rth oxy is', veTwnucularis parates ...........,.. ....... ......... ..
H.r:* .:%f ....^ _



4 .review af the meningitis autopsy records during the years
t.: t tS~ 1920, intRusive was made and the following table was. com-
i ig Bacteriological examinations were conducted at autopsy.
tlutntion off the recovered organisms was carried out but* no
m n mm a m


H i H

































...ara.yfOhonsS B. (tuinea pis)..
: .... septicemia (three hogs).
44: ,44"J" ,,," ,, : :" :.. : """ .* S .
".. my e iss (one calf).


... :. *. *~i *

***"*..... J'4:1 .. .." .. ... ..
x. ** *


. ... Ar .t. ..t.
................... ..... ........
.....:. ..". . . .. ... . .
ii. :. .. :4 .
.. .. *
Sai expritation.

i. .,...i g experiments with the deer and cattle ti

Spii ped on either animal -as a host. Deer piropla
r;t. .a alf and cattle piroplasmosis was given a faw

iMy. n each case the infections were light as shc
Blin sos. Work is to be continued.
i**:.. ::::: :: ,: .. ..

1:;L: .; ae .miscellaneous examinations, human:
:.... ** .. *

p..iS:: '!m from the maternal surface of placentae (8 were positive
a. 3aa. ..
Biwdfil'., _m_ i ied for mal-ria................... ..............
.* *. .. .** ** **
t .. .. m:4fo Bwd pssgs ..**...*...............

a..'*:u tej fm"'' ..r..u..'.. n .... ... .. ..... .. .. .. ..


Ji]i":4 ,,!. ., lee .ia .topeied u.......................
jmn h A* *J m ** l .. .
... on .. V. ... ,. .. .
*: ** .. .* **I*



.;^;:i^.. .. .Dgr p r a...'. .. .. ... .. .. .. .
I8... .........'.. .... ... .. .. .. .. .* .. ., .. .
::: :: :.. *: : ::




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


*S... ".. 1*fi .- .. *


2,508
3.521


cks.


Both


types


Lsmosis was given
!n raised in cap-
)wn by blood film


for malaria, 2.8
*a a..S b S .
* S *S b a Su *
* S ** *= SSU*S* *S *


. i *b i C *t


* I.. .


* .* .. a .
*. S *. .
gliaie M ei g
. ~ ~ ~ ~ .. ... .. .


. i i a. *.I


* a i.**a i..*


284
9g2


.6,140

1.608


11.182a


IlllrtllllrlCIl


* J


















1.:.. C:ee~i~~. .. -


ri. *. .. .- K.

;:r*;D ......i


i 1*b


.| .. :.:.: . .
.il *". ." ........
*.. ..:t. .. .... ... .
.. rII .. -. i l Ir ..... d .i .. .. .
* .. *.
... mm .
p -.

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


***i** h
........
i;iW:.. ..bwf *:" .e" ,a.lue1tif1.......
*. .. i e, n or .s u c,....,. ,


i .



.Wa.hi* from milk botttle......


* tL


** Um *

S* -
* *. k. .* S Sq


I I I I I I Ir r 11


.. ...... ................i. .... .. .64

i i




U .. .. .. .. . 11


n S U S S *.* S *.S **iW* ... 3


i S *
i Sm*Sm m l
#mnninmu


. i. n. n n n n* i n n n


i..

I..

F.-,.








I:.
I::


: The work of the chemical laboratory during the year 1920 has
onisted mostly of routine analytical work, which is given in the
j.bo0 e tabulated form.
,." The working out of a method for the utilization of two shipments of
S.:utde, carbolic acid received at the larvicide plant consumed con-
.., durable time. While conforming to specifications as to "'tar acid"

: intent and specific gravity, these two shipments differed from the
crude carbolic acid received heretofore in somg manner yet not
thonaughly understood, and were not capable of being worked into a
i.' satisfactory larvacide by the method which has been in use at the
SIarnidde plant .for .several years. In all our previous experience
S* th thAe manufacturee of larvicide no crude carbolic acid similar to
bhese two shipments has been received, and no trouble has ever
b*iore been experienced in the manufacture of larvicide. After con-
be...experimental work in the laboratory it was found that
slforation of the crude carbolic acid by treatment with concen-
a .d sulphuric acid and heat would so alter its deportment in the
-laal process of. manufacture as to produce a .satisfactory larvicide.
iTi .iethod was tried at the larvicide plant on a larger scale and

H.. *tpoduce a good larvicide. The whole of the two shipments
....::.~ .ccarbe.lic acid were made into larvicide with this additional
H,.. ...X... ,.S ". ._.. L...--


Hi
IH.


'''' I` -''









































hH ,. -~. ... S. 35
.1.:


iilS41
liii i +m: ::,"--.-













.. H"d 0m mI tti lt.i I.*d.e.
...Id j. + .. 6 ,oi




:;etio sextenamg ALLJs~ohL auu'ltt mosquiitoes recelvea. ior
S.. ... .. .. ... .. ,.* 1 r






'Nrixdtwr kept of thfe ~e numberr of lots received
,,,, ~ *~ S4 ,I, ,




~~'a' *6 Qjs'quito lanro came from Panama Cit~y and
::i .: .V.. -i i sidere tat practia: each: lot meant a
.. ... : ....- .... v rwl..




.iiryWt~'lfd'.te lglia~eorthe-Health.
-F:..* ':*. 114 s .. of sam
H i an. "







.hntin iehh tat a o* *l~era .le 0
''* ti~t a amount ofmosq uito
octiri he lty i t Ar regu nations were 4
:..:.................t.....aarchtospectore rmmove4. T large percentage
A. u.. aa aIS a --......... t d' :, ni:,'.. .. a.....t L .l & aea. ot













"''''o- : .. ere~ kepre of the number os eeved
" "* .*. ,, *
.8.... *. .. .. .. ,. .* ... .,.

~~R.:*... _..ry e! o r ,..
qutolracme fromg Panamrga, Cumnd
*" pnbidrthathontderacble..acamount o mosqntoa
.

*:"*". .....'.".. ". i tob d* l" hat a.on ""al ".a ."ut o m o q u t -
..... i cty" "ff .the Amnerica.n regulations were
....,.. .. ityinspectos .rtkmoved, The large per'centage-
.....' ...." .hdwri~in :.tihe above table beig those of the yellow fever








































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CART NO. 37 '


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m a 4


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"U


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i d


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I


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I I


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H~t.'r .


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4 n. 'I.I


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:.:: Wike. :.'....
S.Cof d.....
*p. *
Total......


yar 9i9:t
White...
Colred..


Toal.


*. .


......*.. rl
.. .. .. .


S. '...t


.Urti'


Lien. DiSK.


.. U.i... NUUIBIEIR .

Ambolun Numnans.


4,688
15,985

20.673


4,523
19,681

24,204


Dieshare frm :
hospitals and deaJtas.


1,393
3,183

4.576


1,271
3.834


5.106


1,252,
S2,550i

3.802


1,141
3.121


4.262


I,
S

a
3
Ne
rz


,* APIL


INEFFECTIVE RATES


DeathS.


E-
* 'r

22
158


I


180

153


8
1428

150I


27


.2
23


Nonesfective
from sickness.


~I-

S31,775 86.81
; 80,760220.65

112,535 307.46


27,338 74.90
98,891270.93


251126.229.345 83


*i,
*PROORTIONATE NUMBERS."
!


year* 1920:
v.it ..
.Colored..


s *


Total.......


Year, 1919:
hite.....
lored .


- TotaL


41,688
16,985

2Ofl6731


4,523
19.681

24.294


297.14
199.12


267.06
159.53


221.351183.91


281.011252.27


210.92


176.09


30.08
39.59


37.44


28.79
36.23

34.83


1.06
1.37

1.30


0.44
1.17

1.03


. .


. .


18.52
13.80

14.87


16.55
13.77

14.29


* Annual average per 1,000 employees.


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un-
known.


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Pama


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4
1



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29






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1
1
5
1
169
8
5

2



1
I



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18




4


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11


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Pan-
ama.


* U U
*. ...U


Colon.


i i ia


6
1
0
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1


Canals To
Zone. taL


Place of residence.


I


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I _-


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I.::
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S* U' *
*. *.I...U


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2
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Place of residence.


Pan-
ama.
I


n i *


Colon.


r-


30
7
17


19.
3


2 .. .
1 3


1 .
19

1 6
152 43'
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Zone. Ilt


1 1.......


9
1
1
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II


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61-75 1. 76-100


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S.'. g*.A*. :

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known.


1


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1


1 5

3 5


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3 1,297


* ~ 4.


F~COSS ldeClPciln


l J.Colon. ne.Tot I


2,093.


111


.-/


1





















* ..S.I:':
* .... I...
f i: x


Age 0uPyears).


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; : i.. ..s .. ... ..* : ...
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** 75


1




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* U n H. U t
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known.


. .
-


Total.


5
7
8
1
3.
1
27
1
4
3
2
























lb. -;" KH~~: .r -
p:: ~:\;:lu~~liC.1':
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2

1


a'


Ae (in year).


I 21-30


* a...*


* .
* i .





* *
U. .* *

1


3


4
aga e

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1
-a


31-40


41-5 0


l1-60O


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11 ir
* U

I.....
a *

**U *.

* U U *


61-75


Orer


amem@ I
* .. .
. .. .
* *

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m U *

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*,

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* *
*m. *

- a U *

* g l .

* U m* m U

* U *

* .
* *

* *

* U *


Un-

known


p* .
* a .

* U

p* i U

* U a

* U I *

p* U *U

* U U

* U *

* U U

ft* .

* U* U

* U U

* f

* *


* .

* U U *


Total .


re nct taken up in the statistical charts relating to Panama. Colon, and the Canal Zone.


4.,



ii.
*
I
IL -





















:.' ." :.
* ".:/ j
* .. ** .


...::l




H ...~
"? ..
II" .


Annual
death rate
per 1,000
population.


::X A..

.l:n :. ..


:'!' :.



i..


.. ".


....loh fr the United Stats:
* a. .. .. .
a e .. ..... ..


**. ,


*.b .


. .I


Wteien and children from the United States:
itfllaaa_- -a


ti.tal . .
~rEalruie....... ......


* .
. .


. S *
* ..* .


* ... i i i i i i .
*i. .i. i g. *i* .i* .. .. a


1Total........


..... .. .


I..


. White ployes from the United States and their families:


aI~Mme


External caule.......


. .


i. a..I ..
* U U .


* U U ..


3.80
.72


4.52




3.69
.82


Total...


Ij;.


number


erican children born on the Isthmus during year 1920..


Deaths among American children under 1 year of age.................. ..........
: Infant mortality rate among American children (number of deaths per 1,000 births)...
iii i. .


205
10
48.78


he:
A.
Sr .."
ei", ,


L I I I i iai


'~ '' '''


*r


L rllll


111111111111


m


..















A 5
i
* H~i
:n,.. .. ..


wR


TAt


' RATES IN THE CANAL ZONE AND THE CITIES


/--O AXWAMA AND COLON.


. ...* ::. ". ** .w /


S.... .......'..... *.. i.
... n.. ,-. :,, ,: .
::: .: ..., ,



S...I .




r m 4 -
. ". .. .. ,
..... Tot



,, A,


." "


'1".
V.


Ph Cor..


....... .


.n. *


Pt.


aM9v. ...


atrO


i*nni..nII

*.*


i i U .
i....d i ..i.... i
..... ..... ....


.i. i. .. .


: on .'T....
"Ca taZone.

- Total...


Average
popula-
tion.


60,500
25,.078
27,459

114,087


61,369
26,078
26,511

113.958


iBirths..


Male.


Fe-
male.


1,150
503


2.001


1,190
479
355


2.024


1,226
459
283


1,968


1,024
429
340

1.793


Total


2,376
962
631


3,969


'2,214
908
695

3.817


Deaths


among
children
under 1
year of


Death
rate per
1,000
births.


155.30
142.41
95.09


142.61


154.47
155.29
113.67

147.24


.t.'
**.*I


X,, H .. **


1;" '"'
i
i"


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3-4


SAge (fr months)..


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1*

1












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..* .


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1
* .










1











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ft* .* *


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* .












13
* .f. .

....
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2

R* U
* ft I


4 5--6 67

* *


7-8


8-9


1 S F i


-I


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* *



2

2


* U *
* *
* .. .
* .


24
I

* ....
* *


* *



2


m.. I


I11-I2/


Place of residence.


2

2

6
1
6
1
1
1
1
.3
1
1
1
1
1
2
1
1
9

" 43

3
2


U..... i
1
9
1
119
8



1
2'
7

2 2,
a


Colon. Zanal
Zone.


3





* .. ..
* .


2


1
33.
2
2
1




1


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4









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' n i
6 0N


Total.


V.


1


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1 *


I


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42
11
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1
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M. F.

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M.F.


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M. F.


* .
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