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 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/AA00006092/00010
 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: 1924
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: AA00006092:00010
 Related Items
Preceded by: Report of the Department of Health of the Panama Canal for the year ...

Table of Contents
    Front Cover
        Front Cover 1
        Front Cover 2
    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
    Tables
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        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
    Back Cover
        Back Cover 1
        Back Cover 2
Full Text









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W. P.


CHAMBERLAIN


Colonel, Medical Corps, United States Army
Chief Health Officer









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For additional copies of this publication address The Panama Canal, Washington, D. C., or Balboa Heights, C


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AF
S.


CONTENTS.


Page.


T itle ...... ....... :. ....... .. ...... ........... ......
Vital statistics regarding employees only.......... .. .. . .. ..
Vital statistics for the Canal Zone, employees and nonemployees.
Vital statistics for Panama City, employees and nonemployees...
Vital statistics for Colon, employees and nonemployees..........


M alara .... . . . .. . . . . . . . .
.. M osquito control......... .. . . .. ..
Garbage disposal and fly prevention. ......
Infant mortality. . . . .
Child health education and child hygiene...
Physical examination of school children . .
Diseases of animals.... . . . . . . . .


Quarantine Division. ..... .
Ancon Hospital. ..... .. ...
Corozal Hospital...........
SColon Hospital..... .. .. . ..
Santo Tomas Hospital.... ..
Pafo Seco Leper Colony......
Board of Health Laboratory..
Tables . . . . . . . . . .


* . .
* . .


. . . . .


* *~ .1


.


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H ..:.. ..
.. /


PANAMA


CANAL,


HEALTH


DEPARTMENT


Z., May


BALBOA HEIGHTS,


SIR: I have the honor to submit the following report tf the op

tions of the Health Department for the calendar year 1924..


Respectfully,


CHAMBERLAIN,.


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Chief


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LETTER OF


TRANSMITTAL


THE


Colonel M


WALKER,


Governor, The


Panama Canal,


Balboa Heights,


Canal Zone.




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HEALTH


DEPARTMENT.


OPERATION


AND


ORGANIZATION.


!The operation and


organization


Health


. bame as described in the Report for the. Calendar

PERSONNEL.


Department
Year 1923.


The personnel employed by the Health Department is the


that shown in the Report of the Calendar Year 1923,
ing exceptions:


same as


with the follow-


Col.


Weston P


Chief Health Offi


Army,


who


. Chamberlain, M
cer, replacing Col.


was relieved


from


medical Corps,
Henry C. F


duty


with


S. Army


isher
The


became


, Medical Corps,


Panama


Canal


effective June 22,


1924.


Surgeon Carlisle P


. Knight,


S.P.


, became Chief Quarantine


Officer


, replacing Surgeon


Rucker


who was re-


lived from duty with


Maj.T
intendent


om S.


Mebai


, Colon Hospita


The Panama Canal
ne, Medical Corps,


, replacing Maj


, effective Apri


Army


Thomas


1924.


became Super-
Leary, Medical


- Corps,
Canal,


Army


effective June 22,


The personnel of Santo


who was relieved


from


1924.
Tomas Hospita


duty with


Panama


The


Panama


ceased to be under


the jurisdiction of The Panama Canal,


effective September


1924.


. The internes at Ancon Hospital completed their internships in


June


and July


1924


, and were replaced by Dr


Edward Pevser


Eugene


G. Free, [
.Hewitt, [
- Dewey E.
- August 11


Norman


North


Spalding,


Westerman


Elmer J


Thomas


Wenaas


Arrasmith,


. Richard M.


and


The service of the l-ast named was terminated


1924.


The following physicians were employed during the year


by detai


from the Medical Corps of the Army or by selection through the Civ


Service


Commission


Maj


. Conger,


Maj


lliam


Murohv.


CaDt.


Frank W.


Romaine


. Cant


Pau


CaDDs.


a a . r


Harry


N


B 4


W




___________________~~~~~~~~.H H_________ _________ ___~_~


SUMMARY


VITAL


1 STATISTICS REGARDING


EMPLOYEES ONLY."


admission


rate


and


quarters,


from


cau


has been as follows:


Year.


Average
number
employed.


,547
,238
,890
,167
,802
,876
,893
,654
,329
,785
,176
,589
,520
,204
,673
,389
'447
,976
,625


Rate.


a--!~r


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From


disease alone


130.32, as compared


the admission


133.48


rate


to hospital


1923, and


139.47


1924
1922.


.was
The


total


admission


rate


to 'hospitals only


was


151.57


1924,


as corn-


pared with 155.90 in 1923, and 167.61 in


The death rate, frbm all causes,


1922.


has been:


Average
' number
employed.


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


Rate.


I -


The


hospitals


with


Year.


I ,,




jjri~wr..:. .
^,'i:,..-


- The death rate from.disease alone for 1924 was 5.51,as compared with
: 6.10 in 1923, and 6..13 in 1922.

The noneffective rate, from all causes, has been:


Years


1906
1907
'1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
'1921
1922
1923
1924


Average
number
employed.


,547
,238
,890
,167
,802
,876
,893
,654
,329
,785
,176
,589
,520
,204
,673
,389
,447
,976
.625


Rate.


The 6 diseases
with their rates,


causing the highest number of hospital admissions,
were as follows:


Ven r diseases . .... . .. ....
M alaria ...... . . . . . . . ...
Diseases of the eyes and their annexa
Bronchitis (acute and chronic).......
Tuberealosis (various organs)... ....
Nephritis (acute and chronic) ......


The 6


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


diseases causing


I . .


highest


Admissions.


Rate.


number


Admissions.


deaths,


Rate.


with


16.69
16.34
7.14
3.53
2.41
2.06

their


rates,


were as follows:


Tuberculouia (various organs)...
'- Nephritis (acute and chronic)..
Organic disease of the heart....
... 'Cancer (various organs) .. ...
. Pneumonia (broncho and lobar).


1923.


Deaths.


Rate.


Deaths.


-- F I


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8


SUMMARY OF VITAL STATISTICS FOR THE CANAL


AND


N,ONEM PLdYEES.


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From an average population of 33,723 in the Canal Zone, there wt&; Li
..n. .


72 0 of these were from disease


7.08 for 1i


, as compared
Tuberculobis


, as compared with 7.14 for 1923, and


and


0.64


1921


per cent of all deaths from disease during the year.


There were 694 live births reported during the year
te of 20.58. (See Table VII. Da e 51). Of these. 255'


a o ,


Of the total births reported


,giv
were


5 per cent were


Deaths among children under 1 year of age, from all caut
, of which 12 were white and 54 were black, giving an infan


Year.


1905
1906
1907
1908
1909
1910
1911


1913
1914
1915.
1916
1917
1918
1919
1920
1921
1922
1923


Popula-
tion.


1 rJ U t' I


Deaths.


1,047
710
410
343
328
286
247
242
236
254
253


number of live


123.01


births reported d
for black children


during
, anc


Sfor all ages, 22 per cent occurred amoi
and 37 per cent among children under


showing the death


Rate.


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cai"se" -.


*....1"... .S
tX .. .. :H"
ing a ti:ulrtKI .
white, a-,il
S:.: "
stilib i ."i


a ) . : ::.. ....
nes, thotalded;H!HH

'the year, ::


5 yeaws 0oH,
Il *U ,, ;


rates for the Canal Zone fro


F.i~i
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: ?r~:i~ItQ


..l


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S I


EMPLOYEES


anf


5 03 deaths during the year


rate of 8.01


1923


The death rate from tuberculosis was 1.01


0.74 for


1922


ra


439 were black.


rate


based


on the


47.06 for white children


average of 96.54.


Of the tota


death


under 1 year of age,
age.


Below is a
1905 to 1924.


table


from all causes


Ii


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f





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i


She- 6 diseases causing
es, were as follows:


noni (broncho and lobar). ....... ....
roulociB variousa organs) ...............
hea and enteritia includingg colitis).....
de diseaaee of the beart. ....... ......
sr Cri oi organs) ..................


he death rate from


the highest number


. . ... . .. . .

. . . . *


Deaths.


Rate.


Deaths.


tuberculosis was 3.20, as compared


1923, and 3.76 for 1922. Tuberculosis caused approximately
cent of all deaths from disease, as compared with 18 per cen<
3, 18 per cent in 1922, and 17 per cent in 1921.


"here


th rate of 35.95.
:hs.


* live births reported during the year, giving a
Of the total births reported, 6 per cent were still-


S. There were 296 deaths among children under 1 year of age, giving an
infant mortality rate, based on the number of births reported during the
year, of 138.06.

Of the total deaths for all ages, 25 per cent occurred among children
under 1 year of age, and 39 per cent among children under 5 years of age.
Below is a table showing the death rates in Panama City from 1905


to 1924, from all causes:


Ye


ar.


' 1905
1906
1907,.
1908'
1909
1910
1911
1912
1913'
, 1914
- 1915
4 1916
1917
1918
1919
1.. 920


=- :


Popula-
tion.


,984
,518
,548
,073
,801
,591
,555
,057
,172
,948
,373
,778
,074
,369
,369
,500


Deaths.


Rate.


deaths,


with


their


were 2,144


with 3.35


t in


I


w




-U L .. pi~Iit
*j .. :


SUMMARY


AND


COLON--


NONEMPLOYEES.


From a population of 31,285, there were 475 deaths during the')
these, 455 were from disease, giving a rate of 14.54, as comp
th 12.05 for 1923. and 13.41 for 1922.


The 6 disea


ses causing the highest


number of


deaths,


with


1


were as 'follows:


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


The death rate from


tuberculosis


Deaths.


wa


for 1923, 2.55 for 1922, and 2.30 for 1921


Rate.


1924.

Death.. I Ir


s 2.62, as compared with
. Tuberculosis caused app]


mately 18 per cent of all deaths from disease, as compared with 1i


cent in 1923, 19 per cent in 1922, and 13 per cent in 1921.
There were 690 live births reported during the year, giving a I


OF VITAL STATISTICS FOR


irth~


rate of 22.06. Of the total births reported, 5 per cent were stillbirths.
There were 79 deaths among children under 1 year of age, giving an
infant mortality rate, based on the number of live births reported


during the year, of 114.49. .
Of the total deaths for all ages, 17 per cent occurred among children
under 1 year of age, and 27 per cent among children under 5 years of age.
Below is a table showing the death rates in Colon from 1905 to 1924,


ca u ses


Popula-
tion.


Deaths.


Rate.


.I




A..






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S j.


* .. .111

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A


EMPLOYEES


of
Wi


rates,


from all


Year.


:.: .
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*..... .~ : :. :

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ear, :,,


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" :" .:" 11



MALARIA.


The admission rate of employees from malaria was


16 per


1,000 for


the year 1924.


While the figures naturally vary somewhat from time


to time, it should be noted


that there has been a practically constant


residual rate for this disease during the past 9 years, the only marked


deviation being a rise to 31


1,000 in


1919,


which occurence is ex-


plained


fact


that in


1919


many


infected


native


Panaman


laborers were imported into the Zone to take the place of striking West


Indian employees.


As in the past, much of the malaria developing in


the Canal Zone was contracted outside the sanitated areas of


the Zone.


The admission rate from malaria among employees has been:


Year.


1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924


Average
number
employed.


,547
,238
,890
,167
,802
,876
,893
,654
,329
,785
176
,589
,520
,204
,673
,389
,447
,976
.625


The admission rate from malaria was 18.00 for white employees, and
- 15.75 for black employees.


Two employees d
Dredging Division,
to unsanitated areas


lied


from


malaria.


Both


urere


employed


working at night in parts of Gatun Lake adjacent
. One was a colored West Indian, the other a white


A .ar- nn '


*I k r I ...nt r flrl


I, .1


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nt n SI


''*I **i l ** tIU* II *EU .I *U.j.*& *.* *I *rI-IJ *' ****I*


Rate.


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The death rate from malaria among eMployees hat ent .:i

.. *. . ... A


1906
1907
1908
1909
1910
1911
1912
.1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924


26, 547
39,238
43,890
47,167
50,802
48,876
50,893
56,654
44,329
34,785
33,176
32,589
25,520
i 24,204
20,673
14,389
10,447
10.976


I.
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*


The noneffective rate from malaria among employees ir


0.31


,as compared with 0.55 in 1923,


MOSQUITO


and 0.46 in 1922.


CONTROL.


There has been no slackening of efforts to reduce mosquito


Ditching of large swamps in


Hope and


year d
toward
board.


Gatun


rainage


the east wil


the cattle pastures'adjacent


has been pushed from


areas


between


both directions.


Canal


and


be completed from Gaturi to the Car


S.. ". ..:. .. '.
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tiM.A
I 1924
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OI
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*l


West of the Canal, in the northern district, much new work
done. The large main drainage ditch on "Fill 3" has been deeply
sea' level, the laterals have been cleaned and regraded, and a w
tension has been dug at the northern end for the purpose of inter
the run-off from the hills and discharging it directly into the old


Canal.


Boggy


streams


being cleaned


and


straight


teined t


as
a '


n...... .. .:':... ..."..
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Fre ,
oiii i

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'.v : .Y ;'AAsi^w. AlF~
_* Ll* A ***f^n *VW'






C:

V.5 ''
K Z H i


;.*;

I I

[. I.

;.4;


i : -,::
ii:i



Si,
I:


P'.:

4:.

Ii:.


I'


rr
":1 .
HJ bt.
i.1
4I',
:~i-I


. H .
SI


. .



H i3i formeso

Haty season


t.ite' extent of these swamps near the Atlantic end of the


even if only a


very small


percentage of


the


ry bred in them reached Colon and Cristobal,


becarne noticeable,


especially in


Fortunately the control in


e mosquitoes
nevertheless


the early weeks of each


these regions is a conipara-


tively simple matter of shallow spade wide ditches which permit flood


*.waters to escape and sea water to circulate freely through al
the low land.


In' the southern


district


, mosquito


part


breeding along the entire shore


line of Miraflores Lake and its numerous arms is now prevented by oil-


ing when necessary
ticed in only one sn


. Up to a few years ago mosquito control was prac-


ial


lying immediately behi


arm of this lake-the Pedro Miguel
ind the town of Pedro Miguel. In


River inlet
this arm all


vegetation was kept removed from the shallow margins and oi


mixed


with phenol-soap emulsion, was freely applied. A considerable force of
men, at a cost ranging between $600 to $750 a month, was almost con-


stantly employed on


shore line.


this limited area


More recently it has been


control the entire shore
over 25 miles in extent.


which had


found


barely


advisable


miles of


to keep under


ne of Miraflcrres Lake and its arms,


V


Through the use of oiling boats, from


ihich is
which


heated oil is sprayed upon the grassy lake margins, it has become prac-


ticable to prevent mosquito emergence


this greatly increased area


with a crew of 3 men and at a cost of less than $250 a month for


abor


and


materials.


The oil


heated


solely


to enable


it to


pass


readily


through the nozzles of the spray pump so that it will emerge in a finely
divided state-practically a mist-which creates an efficient film upon


the water.


The


shore line of Miraflores Lake is very shallow for


most part and in its grassy margins our most potent malaria


vector


Anopheles albimanus,


finds


ts favorite breeding place.


A considerable


part of the time of one man (a colored West Indian of long experience
- "and.training) is spent in searching these lake edges for mosquito larve,


both before.
discovered.


and after oiling. Oiling is carried out only when larvae are
This method of control has been found to be very efficacious.


.. In the vicinity of Corozal some large streams are being straightened
a..d the bottoms lined with nre-cast concrete sections of 14-inch width.


.


.


.




ip.


and a ful


formerly the


had


time sanitary inspector was placed in charge of it,


where


inspector in charge of mosquito control in Panama Ci


to give some of hi


sanitation


time to other duties connected with municip


As a result of this change it has been possible to inaug


rate within the new di
out in the Canal Zone.


strict a policy more in accord with that carii


A new limit has been established


of 1 mile from the farthest house in Bella Vista


standing water will be drained away


, ata distan'


, within which bound


the streams


will be


and much permanent work (concrete bottoms and tile) wil


train


be install


"'ii
: 1. . HJ



:j.."


Hi
tjr
In

ce

4:
d.4...,


as rapidly as may be practicable.


The change has made it possible to


to better advantage


the forces of


other Canal Zone sanitary .


inspectors


edition


for a
their


5515


tance


own


in this


districts


work during


permit.


such


During the


times


past


as the con-


years so


much work of a permanent nature has been done


in the southern dis-


trict of the Canal Zone that only one-third as many men are required


for mosquito control


accomplished
in which the


as was formerly the case


throughout


Canal


SPOSAL OF


those portions of


one authorities


WASTE AND


the same result can be
: Republic of Panama


are responsible for sanitation.


FLY


For some years past the garbage of Panama,


neighboring Army)


PREVENTION


Ancon


Balboa


and the


posts has been disposed of by burying in low swampy


ground east of Panama City


the management of th


dump being under


* *
I
A.

..



:4.
i
I. :i
i1


immediate


supervision


health


officer


Panama..


The


method
Health


E


which has been described in
department is successful ir


previous
i caring f


annual


reports
garbage


with


minimum of nuisance and expense


odors are not marked


rats are nrot


attracted


and


flies


breed


any


troublesome


extent.


The


situation as


fuel


surface of


regards flies


for the


the garbage


has recently


been improved by substituting.


arvacide formerly used to spray over the covered


besides


being


more destructive to fly larva


and


pupae,


the oil


is much cheaper.


New composting pits


have been constructed near the Panama gar-


S r / . ". r ,


:11


~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~-~~~~-~~~ ~~~~~~~---~-~~~-"~~ ~-"~ :1!: ...:',n3WUflPC~j


D


I I I_ I


1 ~I


d i




*. *1 *.1


.4r


6 4-nch layer of mud which is then sprayed with heated fue


During


the first two or three days thousands of maggots work their way to the


surface and perish


in the oil


the concrete curb prevents their escape


into the soil at the sides and ends.


Manure is sold from these compost


pits only on certain days of the week and as soon as the day'
removed the exposed face of the composted manure is again


sales are
plastered


with mud and oiled


. It has been found


that


manure of the type pro-


duced


Panama


City


, even


when


composted


as Ion


as 6


months,


still proves attractive


to flies when


exposed


weather in


piles.


Consequently


, gardeners are required to put the manure into theground


or to spread
purchase.


t in a thin top dressing within 24 hours from the


time of


INFANT


MORTALITY.


The


Panama,
follows:


death


and


rate


1.000


Canal


live
one,


births


the past


cities


Colon


and


6 years have been as


Colon.........
Panama.......
Canal Zone: -
White.....
Black.....


Total (whit


*.. . .. . .. .
. . . . . . . . . .
e Ind black)...........


34.36
130.00
95.09


39 28
73.95.


1922.


47.06
123 01
96.54


CHILD


HEALTH


EDUCATION


AND


CHILD


HYGIENE.


Prior to 1924 no organized child health movement existed on the Canal


Zone.


January,


1924


, Miss Sally L.


Jean,


Director of


the Health


Education Division of the American Child Health Association, and M


Julia W


. Abbott


Associate Director of that Divi


-. Zone at'the invitation of Governor J


Morrow


sion, visited
. These lad


I the Canal


studied


the conditions existing
mittee consisting of thd


here and


e Governor


made


recommendations


the chief health


officer


to a


com-


the chief


quartermaster, the secretary of the bureau of clubs and playgrounds,


the superintendent of schools,


and others.


The recommendations sub-


- ---~




u .. ".. *. .: ... :* f


H:.....


16

designed to arouse general interest in child hygiene, postcr
the clubhouses, and talks on health subjects delivered at the
or before the various organized societies of the Canal Zone.
On February 4th a.health center was inaugurated at the ;


house
age,
total


At first this was limited to children between 6 an


at in Apri


service was extended to those over 2 ye.


of 2,137 examinations were made on 721 children anm


mothers visiting the center was


293.


Forty-three


4
at
Eli


4IiC
NP


~t~.lii~1'



the mit#'HI


children


referred for dental treatment and 62 were sent to the various clinics.


*flXh I


Ancon


Hospital


18 corrective operations were secured.


similar center was organized at Cristobal.


officer


and Dr


Hearne, port quarantine officer


to give one afternoon a week to this work.
center was organized in connection with t


has been highly successful and


the work


Byrd
each


i]n .Crg*:"t
c~ity fi~i~i
volupee~1.


In April pre- and post-na" ".
the Colon dispensary. -TM&iiH
is carried on semiweekly by'tj


Levy.


A mothers


' club was organized in Balboa on Apri


Morrow was elected president


at the first meeting


was 103.


On April


. There were 75 charter


, and the total membership at th
21 a similar club was organized a


Hearne was elected president.


enrolled at the first meeting.


a meeting and


decided


There were 36


In May the women of I


to unite with


Balboa cl


1925 when they planned to organize their own unit.
Three May Day health pageants were held in co


American 4
Campaign.


on May


Health Association National


The pageant at


n


May


Balboa was given on


and in Cristobal on May 3.


attended these pageants.


Approxima


A health talk was one of th


pageant.
A public health and school nurse for the Pacific si


by the Health Department in August.


She immedial


natal course of instruction for expectant mothers.
The child hygiene campaign during the year 1924 w
n.I l- I ,,r nrnl -in tF n.,nrha c n'Tt n fl- 7 r oIMno I 9flfl i


11, and rs.Jj> iJs!
member, en"roflld M
e close of, tte'at4:
t Cristotsi ........


.. *. :
charter mt....- :.....
)edro Migud :4eW~g

lub until ear
-, .*. .. .. ** .I. .- ... :

junction wi" i
Day Health N sin'
Say i; pin Git i1
tely 2,5001 pe
.e features of e, ., .:
j- * -* X C

f , *... :.' :X


de was em yH
tely openeal a "

Sasmain2ly ........
ias mainly "mpo"


* *. .
HP. i.H
. . .. .
SI


31


of


A:




'i:n:" l" JuR~" FLI


.iM .. .:" M .
". .. *."
': I;
C.:


the children were examined with the clothing removed to the waist,
tbdibeing made possible because of the presence of a health department


nurse during the proceedings.


An invitation was extended each mother


tQ attend the examination of her child and approximately


15 per cent


pupil


examined


were


so accompanied


The


results


examination were as follows


Number of children examined. ..... ..... ....
Number of childrenn found needing medical treat-


nieri t. ........ .... .....
Defects found'rewuiring treatment:
SDiefective viamon.............
SDefetive hearing............
Defective naeal breathing.....


Hypertrophied tonsils....


2114


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


Defects found requiring treatment-(Continued):
Pulmonary disease........ .............


Cardiac disease ......... ....... ..
Chorea and other nervous diseases..
Orthopedic defects................


Malnutrition.......
Defective teeth.....
Contagious diseases


II. .II. .
. -. .


DIS


SES


AN IMALS.


The veterinary force of the health department carries


out the quaran-


tine inspection


Panama


and


animal


Colon


across the Isthmus;
slaughtered for food


entering
inspection


Canal


animals


the ante- and post-mortem


and


the inspection of


Zone or


transported
inspection of


dairies


, dairy


cities of


animals


herds


and


milk


handling.


Quarantine work in 1924 included the examination of 27,487


cattle


and 100 horses and mules
Panama and Colon, from
from other countries. TI


brought


into the Cana


Zone


or the cit


the interior of the Republic of Panama,


andi


tere were 7,563 cattle and 6,154 hogs inspected


for rail shipment across
Mount Hope abattoirs
made on 24,153 cattle,


were


condemned


ante-


Forty-o


account of extensive bru


ticemia,
i on ac


on account


:count


icterus


sthmu
and


which
ne of


ises al
of pr
.and


tuberculous cows came from


s.


post-mortem
) carcasses a
e carcasses s


Colon


Panama


examinations


Lnd
were


nd septic wound


leumonla,


2 on


on account


and


were-


726 edible parts
condemned on
account of sep-


account of Te:


tuberculosis


ocal dairies in Panama where


sas fever,,
is. The 2
they con-


tracted


pure


the (
bred


disease on


stock


premises presumably infected by importation


from


Europe.


Fortunately,


no tuberculosis has


.


1111111111111111111 242
111111111111111(111 21~


s, 3 on




*HiLl ~
.1 *rj'2 *.
H


troyed in


Panama.


Fortunately


post-mortem findings


that in only a few instances were the inroads of the disease
advanced to render the milk supply dangerous.


* ,H iim. :.
.H
H: :B'C

H.
4j'*'


Regular inspections of dairies are conducted to insure cleanlinessand


acceptable conditions.


at frequent


intervals


In addition to this, samples of milk are take


chemical and


which serves as a check on careless produce


the Zone and


cities of


bacteriological examination,
tion. The entire milk supply


Panama and


Colon


.'i
' 'x1
* .:. -
'* '* .a


pasteurizoiegl


before being delivered to the consumers.


Of 23,061
cysticercosis,


hogs


slaughtered,


119 on account of cholera


were condemned


on account f


, 21 on account of pneumonia,


2 on account of


Icterus,


9 on account of


pyemia,


12 on


account of


pyrexia, and 3 on account of tuberculosis.
from a lot fed on garbage collected at hotels


The tubercular hogs were


and restaurants.


Cholera


has been found among hogs slaughtered in Colon and


Panama to the


extent of nearly one-half of one per cent


this


er than the natural rate for the Republic of


account of holding animals in pens
tically does not exist in the interior


the
Thi


percentage i
Panama, or


during long period


'es


s. Ch


Cysticercosis has decre


ast 5 years from 15 per cent to 3 per cent of all hogs s
reduction is due to the work done by the Panaman G


assisted by the International Health Board,
the spread of hookworm disease of man. Tl


with a view to
ie decrease in c


has caused a saving of about $50,000 per year in the cost o


plied the cities


of Panama and Colon alone.


much high- :".
;umably 0n .
lolera pra-
ased within- .2
laughttered.,
overnmettt .
preventing: .
ysticetcosis '
f pork sup- :


None of


more dangerous


and


destructive diseases of


animals


exist on the Isthmus


at this time.


Anthrax has not occurred in cattle


for about 2 years,


and when present it was confined almost entirely to


wampy pastures of the Atlantic side.


Contagious abortion,


which


occurred several years ago has disappeared.


Foot and mouth diseases


and


rinderpest in cattle,


and glanders in horses and mules, have not


occurred here.
horses on the
mules, but str
---L -.. -


Maladiedu coit


Isthmus.


or dourine


Strangles was im


*ict quarantine and disinfect


,has never been found among
ported with a shipment f
tion prevented its spread to


T~~, - -- CL na


l\mlra nllC tn rnlnn Ef~kl~:


h.


I





"V.:
*VEI~ :**: ...l"

;r.4


QUARANTINE


S.xx.:::.... .
* ." "!H '


DIVISION.


P;. KN HT


United States


Public


Health


Service,


Chief


Quarantine Officer.


! ;: .i.,- arantine. policies for protection of the Canal Zone have been car-
.:dediput as heretofore. It is a notable fact that of 5,958 ships calling


.*asg.. p1 Zone


ports,


only


one


was


detained


on account


quar


: aghle. disease and


this vessel was


held


solely for the purpose


completing the number of days of incubation required for craft from
Sfllw ..fever ports.
S"The chief quarantine officer made two official trips during the year,


the first to investigate an outbreak of


yellow fever in San Salvador,


and the second to continue the policy of making inspections of foreign
ports and stimulating relations between sanitary officers.


.At the request of the President of Salvador


that country was visited


0nd a.study was made of the outbreak of yellow fever in the capital.


Qa. recommendation. of the chief


quaran tine officer


experts from


Rockefeller Foundation
October the disease had


took charge of


the campaign


been stamped out.


,placed against the ports of Salvador


A rigid


and was continue


in July


and by


quarantine was
led through the


1924.


All of the ports and some of the other towns


visited and contacts were made w
authorities of these two countries.
trip indicates that bubonic plague,
.on the west coast of South Americ
-Canal. Typhus fever also exists,
among the poorer classes it has not t
the Canal ports. On account of the


ith


of Peru and Chile were


the national


and


local


health


Information received during this
both rodent and human, is present
a, and is a constant menace to the


but owing to the restricted


travel


een found on any ship that entered
presence of foot and mouth disease


.qa arantine embargo
n ception of Colombia,


was


issued


Venezuela


again


t South


America


with


British Guiana and Dutch Guiana


:. t'Hthe close of the year these quarantine restriction


A maritime


quarantine


conference


west coast of South America,


February


February


was


, dealing with


held


Delegates


were still i
problems


n force,


the city of Panama f
were accredited from


the
from
the


" : :3C a
is ";-


year


n

















Disapproving the routine partial fumigation of ships. (4)

ing the periodic fumigation of ships only when free c

Recommending the placing of seaports in the best pos.


condition at the earliest practicable date.


Record


adoption of measures needful to prevent unnecessary or

delays-to ships on account of maritime quarantine.

The amount of fumigation for the elimination of rodi


somewhat over that in previous years.


Although cyan


gas has proved very successful for the destruction of rats

through experimentation that the ordinary time and do


rodents was not sufficient to kill all roaches


furthermoi


,f cargo. H
. U.. :. ....




im end in t":.

unwanantork
..a" .ii I

ents incea i i
ogen-chloride .::
... .. : ':x :.: : i:*::

,it was found.
. ..: ::1

sage usl fo
e, that to iI :.'d"


a ship entirely of roaches, it is necessary to repeat fumigation at short

intervals, since this gas, or any other used in fumigating ships, is not:


lethal for cockroach eggs.


A.


Very little loss has been suffered by ships through quarantine d.eten-


hion .


During the entire year there were but 3,000 ton-detention days


and 187 passenger-detention days, which shows that the cost to ship-

ping was practically nil.


Vessels inspected and passed.... ....
Vessels detained in quarantine.......
Vessels given radio pratique. .......


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


Vessels passed on sworn statement of Master......


Totals........... . ..... ,. .

Supplementary inspections of vessels.
Vessels fumigated for rats...........
Crew inspected and passed... ......


. . ..
... ...


Crew passed on sworn statement of Master .....
Crew passed by radio .... .......... ...........
Passengers inspected and passed .... ..... ....
Passengers passed on sworn statement of Master..
Passengers passed on radio pratique.............
Persons detained on board vessels on account of di


Persnns detained in quarantine ..... ................... ...
Persons vaccinated .. .. .. . .. . . . . . . . . . . . . .


',575
1
103
2,P27


19.
1,185.


SImmigration operations continued under the division of quarantine


as heretofore.


The number of persons dealt with was 2,752


ber excluded and deported was 992;


the nurmt-


the number detained at static o


on account of immigration laws was 762, and the number detained and

later landed was 128. "


4 1

S"
x'


!.;;.';d
I
...I
.'i :1


;il;a
r.,mrJ
'i
~ "... i
iit
a
:~I
.. ''j
u
it

I:..


?; iiil


ri ii 9

i:I
''

r


~~~-~~~~~~~~~ ~~~~~~~~~~"~~~~~~~~~~~~~"~"~~"~"~~~~~"~"


1111111111111111111111111111111111111111
IIIIIIIIIIII IIIIIIIII1ILII1II


IIIIII IIIIIII IIIIIIIIII III II
IIIIIIIIII I' IIII IIII III IIIIIIIIIIIIIIIIIII II!
IIIIIIIIIIIIIIIIIII 1111111 III





JC .I .

i . *
;.- i 21

' 'aftie weekly meetings of which the entire medical staff, including the
personnel of the board of health laboratory and the Ancon dispensary,


Stakes part.


Many visiting physicians attend these meetings.


$Surgical clinic.-During the year


minor operations
were performed-;


(including intravenous


1,386 major operations


injections of


and 5.684


arsphenamine)


3,384 cases visited the out-patient department


obstetrical


cases


were delivered.


Medical clinic.


,-There were .3.368 cases


treated


the out-patient


department


558 adults


were vaccinated


with


known


"takes;"


352 children,were vaccinated with 192 known
Eye and ear clinic.-There were 8,213 visits


"takes.


to the out-patient depart-


men t;


2.160


operations


were performed,


and 1,387


refractions


done.


Many new item


of equipment were placed in service


n this


clinic during


the year


the more important being


A treatment chair with incidental


equipment (making 3 now in use); an air compressor for the operation


.of sprays and forsuction treatmentof nose and


throat conditions


and


a new Halle's


universal bone surgery outfit.


Radiographic


clinic.-There


were


2,627


cases handled


which


6,452 ordinary films and 2,859 dental films were used.


During the year


.the following new equipment was received and placed in operation


'transformer unit for radiographic work


a Coolidge unit,


consisting of a


transformer


, regulator and stabi


izer


controlling the tube current;


an X-ray exposure timer with foot switch attachment


a corona-proof


overhead system


an XL


ray table with accessories for combined radio-


graphic and fluoroscopic work
out secondary radiations.


and a Bucky fluoroscopic grid to cut


Radio-therapy


clinic.--On


March


1924


, a radio-therapy clinic


was established


, the chief of which is charged with the supervision and


direction of radium therapy


ray therapy


and hydro-therapy


. Six


hundred and ninety out-patients and 268 hospital patients were treated


- -in this clinic.


The To


placed in service; 1
tubes each contain
containing 10 mgm.


owing initial new equipment


ube containing 50 mgm.


mgm.


of radium sulphate;


of radium sulphate


and an


was received and


of radium sulphate


5 needles


each


ray therapy appara-


+irc rlc'c;rrncir In Al,;ior 9f0ll (ll 1rnlt' tnrl r-i;t;n cr a nf tranfrmopr i nl._









23


an electric light cabinet, a continuous bath and a shampoo table
installed, but this unit has not been placed in operation as yet be
some of the equipment has not been received.


patients.-Six


hundred


and fifty-six


residence is outside the Canal Zone or the cities of
were treated in Ancon Hospital, and 47 in Corozal i
Operating expenses.-The following table gives th
the hospital for the past 'three years:


patients


Colon or
Hospital.


'1


Pa


i :i

** :::: : ,
*IH H3: ..!
:::
..." :. :ill. ""
,*. ,:. .::::::, .
i ":.i iiil
..*- .
. : :: .* .:. .. ": ii

.. .. :m... : :
::* *. ::.


: :4 : .
:!y'



a** .:.*...
whose.
fia.... : .t


*1


e cost of operiatt


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


Operating expenses '... ... *... ... -
Revenmue............................. .
N et co t. .. . . . . . . . . . . . . . .
Days relief furnished ... ...........
Coat per patient per day...............
Goet of subsistence supplies per patient pel
Operating expenses, Ancon dispensary.....
Revenue, Ancon dispensary..............


rday .
...... .


$525,584
312,713
212,871
112,
4
16,438
1.883


20,551.97
09,573.03
10,979.94
109,599
4.75
.34
17,952.78
4.113,.50


6558,5546a
342*41.719
21S'l3b.7S
119AMiP
t3)~
40
I7,2It.VS~
d4,OU .10


These figures do not include the salaries paid by the War Department to medical ofmoers of tie Arar.y es-
tailed for duty with The Panama Canal, which amounted to approximately 346,900 in 1922, 152300 in 1923 $5,.000
in 1924.


COROZAL

(Capacity


HOSPITAL.

400 patients.)


Capt.


HESNER


, Medical Corps,


Army


Superintendent.


Repairs and alterations.


-The second floor of ward


" which "cOn-


ted of small


custodial rooms


, has been remodeled by converting it into


a large dormitory


This change has added space for


15 patients,


and


building


better


ventilated


and


illuminated


, and


much


more


sanitary.


Routine


painting


and


repairs


woodwork


, plumbing,


steam line, etc.,


have been done wherever required by hospital artisasi


with the help of patients.


in the pasture has been commenced,


The laying of a new pipe line from a spring


with a view to furnishing a cheap


water supply for the refrigerating machines at
and for washing down the piggery and barns.


the dairy


and


kitchen


Trees and gardens.


-Two of the Hydnocarpus weightiana trees planted


a few years ago are productive and bearing at


this time a


heavy crop


Nonresident


.1 -


:j


mm





V...


li.
.4i


adtiitted was 139, as con
dis.charges and 23 deaths,


npared with 1
as compared


with


1923
113


There were


discharges


and


139-
32


Deaths last year.


There were no suicides


or deaths


due


to violence.


Of the


total


Cent) improved,


released


cent)
cent)


and


were


recovered


unimproved


, 62


. Of


(45 per


total


admissions,


55 were cases paid


Government of Panama,


a.nd theremainder were Canal Zone charity or private pay


the total number discharged


cases.


65 were deported.


Ofthe patients.


chronic medical or


-There were on


surgical


cases


December


(not


insane),


29 black and 3 white
as compared with 24


black and 3 white of this class at


the beginning of the year


. Eleven


were


admitted


died


were


discharged,


and


2 were repatriated.


All those capable of performing work are encouraged to do so.


Recreation.-Weekly


picture shows


and


band


concerts


have


been


continued


throughout


the year


amusements


provided


patients the greatest pleasure appears to be derived from the moving


pictures,
tainment.
back of t


which do not tire them as readily as do other form


of enter-


During the dry season, weekly picnics were held in a grove


hospital,


picnic


lunches


were served


and


baseball and


other sports were engaged in.


Treatment.


-Intensive specific treatment is given to patients suffer-


ing from syphilitic psychoses, these constituting about 20 per cent of


the'total admissions.


During the year


426 doses of arsphenamin were


administered intravenously, and 130


umbar punctures were performed.


The fact that the great majority of the patients are of low intelligence
and exceedingly illiterate, often makes it difficult or impossible to dis-
cuss their mental disorders with them from a physcho-analytic stand-


point.


However


, by teaching them to adapt themselves to their new


environment


, and by rendering their enforced sojourn


free


from


un-


pleasantness, it has been possible to relieve the mental stress in most


- casedg.


encouraged


engage


some


occupational


work


because it


is generally conceded


that


the mental redemption of many


cases


may


only


effected


through


diversional


employment.


The


work at


Corozal


Hospital differs


in many respects


from


that


average


occuDational


theraDv


deDartmen t.


ThPre


rnrns


I --- a - -


r..


*


A




* ../. :.* K I" i.f" f
... h- ." :'
... ...l
Hi:
H '!
I 'Hin


:: : ":: H :*?
H i:-"tEJE:::i .
Occupational instruction helps the patients in both a therapeutic .a.
L economic way, because most of them have no trade or pmnfessioa H..
It come from a class which depends upon unskilled day labor forp,:
*. .. *: ..:..ii :.i


livelihood. In many instances the


have


been


result of


precipitated


the hus


employment


poverty,


history


which


band being out of work and


which


result of treatment in


was


fitted.


shows


was


that


psychose.


brought about as a


the wife unable to final


Many


such


the occupational department,


patients,


oamaB


learn something


which not only may be of financial value to them, but also may become
a means of preventing a recurrence of mental trouble. .


The total receipts


from the occupational ward amounted to $6,251.34,


of which $4,523.84 was from the sale of brooms.


The money is utilized


huh
'nlj
..4u


I.. H .
N..


S.i" i...

'N..
'a. :
S. ... "..i




V ^ :!


for purchasing material required to continue activities in thip deptit-


ment and for providing the workers with pin money.


The value of the produce taken from the patients'


consumption amounted


garden for hospital


to $3,394.72.


Farm Department.-About 20 additional acres of land were cleared,


making a total of 100 acres under cultivation.
aggregated $4,118.64, and for manure $1,015


The receipts for produce


'.97.


Dairy.


-The


herd


consists


Jersey


cows,


and


calves; 8


Holstein cows and 10 calves


and 2 bulls.


There were 76,341 quarts of


milk prod u
Piggery.


iced


and milk sales during the year amounted to.$19,522,50.


-There were 397 pigs and 50 hogs remaining on December


. Fifteen acres were added to the hog pasture,


increasing the total.


to 60 acres.


The piggery has proven very profitable,


the gross income


derived from this division of the farm amounting


to $5,376.64 for the


year.


Cemetery.


was


necessary


to enlarge


the cemetery this year .by
4


clearing off about 3 acres adjoining it on the west.

COLON HOSPITAL.


(Capacity,


80 patients.)


Maj


ToM


MEBANE


, Medica


Corps,


Army


Superintendent,


an
bu


a




::'~ ,;' ,' I
'I

1' .


b'dvlantages and benefits of refractions and correction of minor condi-
tiois without the long trip to Ancon Hospital with consequent loss of
Sme.
.iw'*


portable


bedside X-ray apparatus


been


installed,


the. hospital for the first time to diagnose and treat properly


and other ailments requiring this apparatus.


enabling
fractures


Formerly it was neces-


sary to send all such cases across the Isthmus to Ancon Hospital.


Repairs.-The interior of


the hospital


and


exterior woodwork


have been repainted during the year.
I


SANTO


TOMAS


HOSPITAL.


(Capacity


500 patient


* Major E.


BoCOCK


, Medical Corps,


Army,


Superintendent.


During August the patients were moved from the old hospital


n the


.center


city


new


reinforced


concrete


building


in the


Exposition ground


The dedication ceremonies were held September


1924


on which


date,


decree of


President


of Panama


operation of the


hospital


was


taken


over


entirely by the


Panaman


Government.


The Superintendent,


two physician


chief


nurse, and


'two ward nurses,


who had


been


Canal


employees,


were


replaced


Appointees of


the Panaman


Government.


These


six positions


had


been filled by employees of


the Panama


Canal since


1905,


under an


agreement between


two


Governments which was entered into at


that time in order to afford


more extensive hospital


facilities


people


sthmu


and


to enable the Health Department


Panama
infection


hospital
promptly


Canal


to maintain close supervision


diseases
facilities


Panaman


on the


health


Isthmu


officer


terri tory.


Santo


of Panama al


over


There
Tomas


treatment


now


ample


Hospital report


notifiable


diseases;


- saving to the
results from


United


states


Government t


the new arrangement;


change-was made by the authorities


about


$14,000


year


consequently no objection
of the Panama Canal.


nnflAT


r' nrfl


rr' 'NT V


Lr *I IIU dI *U d SI


~4;


1T~nrn


- a




Ii; . *:;;;;; *. .1xi .** nfl:u: 25A


.. .:
n


lar type,


2 of the neural type, and: 7 of the mixed typ. Foear a


readmissions.


Two


these


readmiseons :were- of the mal typ4


still negative bacteriologically,
required additional treatment


but suffering from


trophic ulcers


both of these were again paroled late


in the


year


The other 2 readmissions


one of the


nodular type asd


one of ttl mixed type, were positive bacteriologically on reentry;bo0
had been paroled from the colony some years before the institution


specific


receive<
5 cc.


these
per c


treatment


doses.


with


patients died during the year.


Treatment.
acid in S cc.


Twelve patients received ethyl esters of cod liver


Three patients


injections,


5 cc.


5 per cent sodium chaulmoograte in intravenous


The chaulmoogric esters were administered


to most of these patients,


and


three times a week


weekly;


the maximum


quantity given to any one patient during the yeat was 1,021 cc.


greatest number of injections given any individual was


receiving 5 cc. daily


ing signs


1 of these died


,this cans


without show-


Five patients received no specific treatment:


and the remaining 3 were too oldt or


received


and


thymol for uncinariasis,


clinic at Ancon
violet light, and
cases were but s


was discharged


feeble to be subjected to treatment.


positive
injection!


mercurosal


Wassermann reactions, and 9-o:f


S


of


novarsenobenzol


patients


were


(0.9


treated


M mt~
. HE. .
with


all with beneficial results.


Hospital


esters


ethyl


esters


for treatments with


chemical


cautery,


chaulmoogra


X-ray


radium


ive
Wle


ultra-


Trophic ulcers in nerve type


.1n.
* .


werO


and


all capable of destroying tubercles, but fulguration with high frequency
current seemed to be the most efficient method for that purpose on
account of its penetrating power. ...
r;ltsral Y-rc Cre w rrannhls rn hIQIci P nhcnrntinn nf fhp tlhprclem.


* .:..
... ii. ... .....
1-
s .........
. ..



: :.J
.


. 4.
:i : *:

i. i ii
.. . : : ..
"n "i ..'l .






.it
H :A
... -X. "
. **.










.1 .. .
F ... .*












.i a
S....... H
.. :: . :: .
:* '. :% n



.



H X %






H'.'

....... . .


-Ninety-four patients were given esters of chaulmoogric


in intravenous and intramuscular injection


to others once


of overdosage.


, except Sundays,


for about 3 months


Eleven cases have shown


lose)


intravenous


Twelve


Thirteen patients were taken once a week to the radiotherapeutiti


[ high frequency current.


Injections


owly affected by the treatment.


electro-cautery


H .: ...HL'i
1H.

is
..r


.


\


I?"'




*. I. t
4. *. .
..n ..* 4

Sn- H.


* I.


4


nyiax


aluminum and frbber tubing)


60 minutes exposure to both


sides


of nasal septum, three exposures, caused absorption of leprous infiltra-


:fiinof mucous membranes of septum and turbinates,


but did not affect


the presence or number of orgfnisnmsin areas so


treated


Neither did


the ultra-violet rays (40 minutes exposure with curved quartz
pressure) affect the bacteriological picture of areas so expose


rod and


' Intra-neural injections into the fusiform swellings of ulnar and post-
tibia. nerves with esters of chaulmoogra were continued as of last year


with


beneficial results.


Exposure


filtered


rays


was capable of


causing


subjective


changes


in skin


sensation


along


areas


nerve


distribution and was very useful as an adjuvant in


trophic


the treatment of


ulcers.


The Von Pirquet test with old tuberculin was tried on 16 patients in


various stages and types of the disease.
as compared with the controls. The tim,


All showed positive reactions
e of appearance of the reactions


was delayed in most instances from 2 to 6 days. Smears taken from
nodules caused by the tuberculin were negative for B. lepre.
Lepra fever and eruptions were more numerous this year than last.


Attacks were mainly confined to new arrivals,
were also affected. A few of the patients had


sion at short intervals.


In none


however


though some old residents
several attacks in succes-
did the new tubercles so


developed


remain


long


after


fever


subsided


As in


previous


years,


these attacks occurred at period


of season change (about April-May


and November-December) when colds and


rrflUII


common


on the


Isthmus.


The effects of specific treatment for


C


were about the same as in previous years.


eprosy and
No attemr


its complications
)t is made here to


evaluate the use of the ethyl esters of cod-liver oi
moogra, as they were introduced only in the laj


1 or the soap of chaul-
st month of the year.


The cod-liver oil esters caused coughing spells similar to those occurring


when chaulmoogra is given by vein.


followed


Temperature


in practically the same manner as with


and local


reactions


chaulmoogra.


The


soap,


when given intravenously


, caused no coughing spells,


but in


stead


0 Cl1g4 t


-ra n


010ntt


I' 1-hP


ahrhAnm n


zrrrhi;r1


nrrllrrpr


LB. LzALaA& t.CLI~L L .A taL a t.A t.1 'n. atfk 1I1tt LLfEA AU1~1 LI It KL l~AA t. A~~ VT ** *Y.. A tUS~


rr~ m nl;~p


I n


r




:5
:ikii


r..

S.!


BOARD


HEALTH


LABORATORY


(Operated in connection with Ancon Hospital..)
I


BATES


, Chief of Laboratory.


typhosus.-Recovered in blood culture from 11 individuals;


4 from shipboard,


typhosus A


4 from Colon


paratyphosus B,


and 3 from the Canal Zone.


Paratyphosus C were not


, para-
recov-


ered at any time during the year from blood,


stool


or urine.


Typhoid carriers.-On December 31


under sanitary surveillance,


1923


and G.


, twotyphoid carriers were
H., both of Panama City.


Stool


specimens


from


each


were examined


monthly.


All specimens


were positive for B


typhosus.


No new carriers were discovered during


the year.
Bacillus


dysenterie.


-Dysentery


bacilli


were


recovered


from


the


tools


patients.


The


Shiga


organism were each recovered once,


baci


and


Type


and Type II organism


(Sonne)
(Flexner,


Hiss-


Russell


, etc.) was recovered from 16 patients.


Respiratory infections.


-In November quite a large number of people


on the


thmus


suffered


from


an acute


respiratory


infection.


This


infection
under as


was generally


;eptic


mild


precautions


in type.


from


Sputum


approximately


specimens


these


collected
persons


who had the severest attacks
were cultured and studied.


,and who were patients in Ancon Hospital,
The influenza bacillus was not recovered


from a single culture,


neither was the hemolytic


treptococcu


The


cultures contained only the ordinary mouth organisms.


Tonsil and adenoid examinations.


-The routine examination of ton-


and adenoids removed at operation was continued throughout the


year


Of 463 tonsi


removed alone


8or 1


.72 per cent were found to be


tuberculous


adenoids


removed


alone none were


tuberculous;


of 377


tonsils and adenoids removed together 9,


or 2.38 per cent were


tuberculou


Of thi


last 9


3 tonsils alone were tuberculous, 5 adenoids


alone were tuberculou


and in one set both tonsils and adenoids


were


- -- "


- *4


A~~r U UI IJ A -Z


Bacill


*.i
' ";: :"


and B.


.


r


m r




*. : 1*

*'i
* Inf


factor prohibited. so extensive a study.
was inaugurated, 520 rats have been thus
stained by Gram's method and examined


However, since September, wh


examined.


I microscopic


Smears of livers and


en this plan


spleens


were


Small pieces of livers and


spleens were macerated in sterile normal saline by means of a sterile mortor and pestle.
This suspension, prepared from the organs of not more than 10 rats, was then sub-
cutaneously injected into the abdominal wall of a healthy guinea pig. All pigs dying
inlaess than 7 days were autopsied, and those living 7 days were bled to death and then
aut6psied, their blood being used in the complement fixation tests. Gross inspection
and smears of liver and spleen were made in the examination of these animals. Thus
far no positive results for plague have been obtained." *


During the year 1924 the special


smear and animal inoculation work


referred to above wa


continued


Six hundred and fifty rats


were thus


examined


. No positive results for plague were obtained


. This was in


addition to the routine autopsy examination of 11,252 rat


A articles prepared and presented.-The following
at the Laboratory during the year:


papers were prepared


Studies in the Chemistry of


the Blood


Observations on the Creatinin of the


Blood, by Mr. lames E. Jacob.
Preliminary Report on Total, White and Differential counts of Bl
Healthy Individuals Dwelling in the Canal Zone, by Dr. W. C. Cox.
Preliminary Report on Investigation of Sugar Content of Blood
Tropics with Special Reference to the Canal Zone, by Dr. W. C. Coxanc
A Clinical and Bacteriological Analysis of the Bacillary Dysentery
Hospital during the Past 5 Years, by Dr. R. C. Connor and Dr. L. B.


ood


n Norma


(human) in the


IMr. J
Cases
Bates.


E. Jacob.
in Ancon


The first three of


these papers were presented at the


June meeting


the Medical Association of


Isthmian


Cana


one.


The fourth


was


read


International


Con ference


Health


Problem


Tropical America held at Kingston


Jamaica,


Jul


1924


Connor


was


also


publ


ished


International


Clinics


Vol.


, Thirty-fourth Series,


December


1924.


-In the investigation of the creatinin of the blood


it was found that the so-called creatinin reaction was not specific,


the substance giving this


and


reaction in some instances could be separated


into an alcohol-soluble and


an alcohol-insoluble


portion


Following


the presentation of this


work


in the paper noted above,


inves


tiga-


tion was continued along a different line.


An effort was


made to


estab-


lislj the presence of creatinin by the formation of the double compound


with zinc


chloride.


Contributors


to the discussion


creatinin


onepstion have rennrterl


nePrative resIlts alonnr


this


same


1 . ..-


hut as


Creatinin in blood.


p







*. .: :. ....:. ..... .
:l :: E E H





**:: : :. :* '
S:.. I::
.iEE i


: .:*
4: EE:E


During the year approximately 32,000 reports have bn

This does not include duplicates.


x. E .: ':


*.

q** "^ **^l
.
:" .


U


BACTERIOLOGICAL EXAMINATIONS.


JI iIii iaii |4 i ,


IBlomd su r. ....... .f ................... ...............
B. yph, os ......... .. .. .. ... .. .... ... .. .........
Pnevaocowwu Type IV................. .................
B. mu.ncosu apsbw .,.... .......... ...... ........... .

Stapklocomus albuws.... .............. ...................
Btapkhylteccus aureus. ................................
Stools cultured Icr typhoid-dysentery goup.....................
Positive stool oultures.............. ..... ......... ....... .
.yphagua ... .. .... . . . .. .. . . . . .... ....,..
p mi (irom e carriers)...........................

B. dztgenteriue vrnpi Z (Shi s ) ......... ... ...... .......
B. dyseterise MannieFermenter, Group II..............
B. dayenUerwe MmizeFPermerniq, Groul III.............
Bacillus of typhoid-dysentery group (not identified)......
Urine cultured for typhoid group.............................
trine positive fcr B. typhaosw........ ...... ...... ...... ...
Urines cultured fcr organisms other than typhoid group..........
Positive urine cultures (61 of these B. celi) ..................
Throat cultures fcr B. diphtheria........ ..... ... . . .......
Positive for B. dipMdheri .................................*
Nasal cultures for B. dip4therize ...............................
Positive for B. dip haeriase.......... ... ......... ......
Throat cultures for arganisma other than B. diphtherise......... ..
Spinal fluid cultures...... ................. .. ..........
Positive spinas fluid cultures ....... .... ...... .... ..
B. infl ue Ta.. 1 ....................................
Pnrumoreocus Type I .......... ......................
Pueromeoacus Type II................ .... .... ..

St ap ylueocs . u. re. ...... .. ................. .......


aso-ph rltpyuesl cult.s s...................................
Scul tu resi ....... ... . . . . . . . . . .. . . . .

Naultures -phar gel cultures ..... ..............................
CSpulture frures ... ..c .. .. ... ..... ...... .....
Culture from epin ochlesior glnd..................................


CuPletures of pus from various loction... ................ ......
AsCiti fid cul tu res................ ...... ............... ...
nee fluid cultures ,...... . . .. . . ... .... . . .. . . .
Ankle fluid culture ... .. .. . ..... . . . . .... . . . .
Cultures for Ducrey's cillua. ............................ ....
Cultures from skin lesio ns..................................... .
Cultures of pus from various locations. ............... .........
G land culture ...a.. .. . . . . . . . . . . . . . . .
Bile cultures .. ...
utopsiesr rom cultured. ....... ................ ....... ....
Organs, e uda tes, etc......... .. . . ....... ... .. ......
BSurg cal tissues cultured... .. .... ............ .... ...

Positive fcr Trep.nema paridum. .............................
Conjunctival smears..........................................
Smear from ulrer on jaw. ..... ........... ..... .......,..
Mouth smear (ulcers .e.. .r. t.. ........ ................
Sputum smears for B. tuberculosis................... ..............
Positive tr .tuberculosis..................................
Sputum examined for spirochaete. ............. .. ...........
Throat smea rs .. ............................................
Positive fcrfuifotrm bac\ius and spirinum of Vineenf' angina.
Smear from larynx (positive fcr B. tuberculois) ....................
Cervical abscemear for B. tuberculosia........ ...... ..... . ...
QW.. um C*A-. *MW. .UI I..."....


i; : :: :


: . ***, ,: .11 *,, ,:,,::
:. HE : .


......i... .. M .. .
*..





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.....H.ll H.E ........

... ......... .... .
: .::: E .. .. ::...'E E

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



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: i..iEE ::EE .
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* . . . . .. "......."........



.. .." .:::: .::::.
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... .............









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g . .E .H EEEH.
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S .:" "E:"." ": E;.; '.

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* II

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BACTElIOLOGICAL EXAMINATIONS--Con tinued.


fPusitive for Tertion malarial parasite........... ........
Positive for E. A. malarial paraites ....................
Positive for Quarto malaria prasites .. :...............
Pasteur treatment administered................. ........
trine examined for gonococcus ..............
Strapings from under finger nail for fungus ...................
ci.tel h contents examined for blood ............ ... .......
Water from Balboa clubhouse swimming pool................
Water from Balboa Army & Navy Y. M. C. A. awimpiag pool
Water from Arenal River ........ .... ... ........ ... ....
W after from beaches................ .....................
Water from well .................... ..................
Water from Hotel Washington swimming pool .................
Food stuffs examined:
Milk cultured for bacteria count........................
'Ice cream cultured for bacteria count...............
Pread examined for rope....... ....... ............
Culture of canned cherries ... ........ ...
Culture of canned vegetables........ ..... ..........
Culture of canned fruit salad..... ............
CaTlure of raw meat ................
Culture of salted cod fish. . . .. . . . . . . ... ......
Autoclaves tested.... . . . . . . . . . . . . . . . . .
Miscellaneous smears and examinations ...... ............


SEROLOGICAL EXAMINATIONS.


W assermann tests............... ................
Gonococcus complement fixation tests..... ...........
Agglutination tests.. .. ....... .... .... .. ...
Blood typing ftr transfusion. ..... ... ......... ...
Examination of blood fcr coagulation time ...........
Blood sera prepared by Swift-Ellie method for intraspinal


. ....................... .
. . ... .. .
. .. ..........................
. . . . . . . .
injeetian.. ... ... .


16.09,
18
51
32
314
14


ANALYSIS OF WASSERMANN TESTS.


A total of 15,445 Wassermann tests were performed on the blood of

10,624 persons. The results of these tests are summarized below:

TABLE SHOWING NUMBER OF PERSONS ON WHOM WASSERMANN TESTS WERE MADE AT
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1924.


Race, sex, and status.


White, civil, U. S. citizens:
M ales. . . . . . . . . . . .
Females.. .... .... .... ..
Children.....................
White, soldiers, males, U. S. citizens


White, other than U. S. citizens:
M ales ............................................
Fem ales.. .... ..................................
Children... .......... .............. ...........


Totals.. .....


Individuals
positive.


475


lndividuaia
lzegstivq.


5,125


Total
individuals.
tested.


1,694
262
42
3,602

5,600


852


I -I-


Per cenl of
individuals
positive.


9.03
9.16
2 38
8.25

8.48


15.85


15.85


I


852


TOt~lgllllllllllll


















In addition, Wassermann tests were made on 624 spinal fluids takerH

from 501 individuals, and of these tests 115 or 18.42 per cs2t .V.


positive.


PATHOLOGICAL EXAMINATIONS.


A utopsies.-A total

of Health Laboratory.

General Diseases:
Typhoid fever ................... ..
Mnlariml fevr Wb.f.lrvwnilamnnl


M easles .........................
Inluens, .... .................
Dysentery, bacillar ... .........
J eprosy. * : . . . . . . . .
epeticemia. ...................
Pellagra........................
Tubera lasis of the lungs. . .....
Acute military tubereulmie........
Tuberculsis of bones and joints...
R Joke rs, .. .. .. .. .. .

Syphilis, tertiary. ............. ...
Cancer of the buccal cavity......
Cancer of the it~mach and liver...
Cancer of the uterus.............
Cancer of the male genital organs.
Cancer of the suprarenal glands (hJ
DiSbetes ........................
Adi~n8disons, s dies .........

Leakemi a ....... ......... ... ..
Leukemia. lymphatic............
General amyloid degeneration.....

TOt:1] .....................


Diseases of the Nervous
Simple meningitis. ... ...........
Poeumonoceus meiemngitis.........
Locomoter ataba ................
Cerebral bemrrhage, apoplexy....
Softening of the brain............
General paralysis of the insan ....
Epilepey...... ................
Convulsions of infants............

Torsi .. . . . . .

Diseases of the Circulato
S Per icr e ditis .... ......* .. .... .
Acute endoearditis ...............
Malignant endo r litis. .........
Other organic diseases of the heart
Angna pectlnri ..... . . . . ......
Aneurysm ...................
Arteriose lero si ..................
mrircea ......................
Hemorrhage, postoperaie........


Total .

Diseases of the Res
Bronabopueumania.......
Lobar pneumonia.........
Pleurmisy .................
Emovema. ............


of 262 autopsies were performed at

The causes of death were as follow


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



. * . . . .

i . . . . . i




. i i. . . i
,. i .i,. ... i


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ipernephromai


* . . .. .. .


* .. .. m .
System
*.*. . ...
. . . . .

* . . . .

* . . . .






* . . . .

. . . . .


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


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


and

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


Orgai
*.*.. . .
* . . .



. . . .

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ns of
*.. ... .
. . . .


* . . .

* . . .


Special

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


em:


ipiratory System:


. . .


H. -
A ,,,, "

.. ::::::: 1

*H*H: I"

the Boar&

Hr ':
s:- .
"".. '......"l .

.. ...:
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..... r... i .i

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HA j f .... s h .i... ....S
'iilmmlb Aieee.

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Genit.-Urinary System: and Asnena:


a
10



18


m m. m:. .


. . .


. . .

. *


uDiease of. the Bones
. dfelomatofiB.... ..........
Adutte bilateral mastoiditia.....
al- a a m


and of the Organs of Locomotion:


. :. . .


....... .


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


:.. Malformations.:
S.Tql. .... . ....................... ..


.. Diseases of Early Infancy:
8 .I.tewaF aeatonarum......... ................... .....
.i Prem afiire:bira .. . . . . . . . .
.: "' Gon .o it debilirt. ...... ... ............... ..


;.. .Atass neoa torum .. ... .. ...... ......................
.. lriury at birth( erebml hemorrhage) .......... ...

'. l :. : . .. .

:,: Affections Produced by External Causes:

-S ..".u ade by drowning.................. ... .... ......
S: Agte ayenical, poimming .............................
I;:s lmieig .lpoisonipg, accidental....... .................
;' Sna (conftlgration excepted) .............. ..........
!'.' "' sirtioI of deleterious gases (conflagration excepted)...
..... . .e.lt. .i- ld.ow n in g ........ ... .... ... ... ... .....................
- .'I;.. _sanx ism by firearms.... ......... .... .... .. ... .. .
'.. T aum atisa byfall........ ... ...... .......... ......
Tiaumatism.by automobile accidente.................
.a.cture ofJ~I ynx (on. bicycle colliding with tractor).....
H. 'j1* atureo i4tlull thrownn from truck).. ...... ..... ..
...-. BrBi tr e.. ...... ..... ......... ..................
:. .:.... cide by rutting or piercing instruments ..........
~:. im", :nideby. btimutinstrumentin hands of unknown party
"... ~rnamatir. 5lb blowrceived in prisefight..............
:. .. litkiple.injuawie due lo.falling B.eijon of pipe...........
iiuinin by explosive.. ....................... ......
: :. . . . . . . . . . . . .

S... T otals ........ . ....... ......... ....... .... ..


h:


4. .
K 14 n^e


. . .. .. .




. . . . .
.. . . .


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


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I

a



B.
ft
S



as


. . .


5,


1
1


4

4






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: : .. H .
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TABLI SHOWING THE MORE RfEQENT C.AUEB O ARATH FOUND AT AIII I
BOARD OF HEALTH .LAOfATORY, 1O4O .. Y J H


TubcruloBl...........
External caue. ..... .
Ormic heart diseam....
Pneumonia, bronoho and
Cinoer...............
Bright~ disease (acute an
Sybphilin includingg genera
Malnutrition in infants..


....Ii


ChuS.a


H~ HH


V.

*9~rli2II


TABLE SHOWING THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOA
HEALTH LABORATORY, 1904 to 1924.


'NJ:
A1 Hj;
I!
ZWi H* .1


Totals.


1.022


1.088


60
27
46
26
52
41
23
21
6
14
8
5
6
3

4'
5
3
3

370


3
24
40
26
32
30
38
37
34
38
20
17
21
6
15
29
16
19
9
29


8
23
27
25
31
37
86
27
26
12
12
20
23
12
14
11
5


10


89
36
23
11
36
10
15
8
6
5
7
3


4
54
4


3
15
12
11
17
16
20
22-
26
27
14
10
18
8a
20
16
17
- 9
12
21

814


33.
58
14
11
10

6
a
5a
2

1
a
* * *



8

I


' 1'
.1

11-:,

SI
14
15
U
9
C.


' J

1

1*




U


Thia include. 32 caem of influenza.


V.~ ~ ...- ~ II
.Y-.

I'
: ':"~jXAjj,~iiiiH
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y InH



.X llH !i~W
... ...
Il.?



K~. E i .61i


SH"jj


b . h.
b *< :!


W
-. ., -. -
1 .: ...1
0 5 -r:ll:- X .
Q *.*A .1 .* -H
. . .. -.*^: .a "-...
4 .

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6. H.*. i:

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1. H. .........

-. .. = .
m ....* =S==:*-..
a ^ |A: ^l..j
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ft : -.j ;ttiHiH.:5
1- ~ ~ ~ "H a *vl*ti'i.Sj" t
__ U Sf-Jf ^ .11''*: SI:


W SA........f:SB


lob~~


Id chronic nephritie)..
rl ppreais) ............







KBli JBBBBX B "i Il i l:d "J" :. .* " A
*uu :.." r Is .u .: * -
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~ x ^ :,..:*.r *, * .1
S... . .
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JA: f Ta SOWING.NWMBER OF AUTIOPBIES PERFORMED REVEALING THE FOLLOWING DISEASES .
.. ..~.. PER YEAR AT BOARD OF HEALTH LABORATORY. 1904 TO 1934
.. * ~. :.: a ..
* . .. .
r, *,,,, *





.. .x :. ..~ *:*

:.. .. . .. .. * -_ _
:. .. .
....*. ... . .l .











*V *" k . ...*
S !:.' . . 3

.: P. ..L H A T. 0 O









s . . 4 .i
.. .. .
* S. h .. ..-.. w



'4 :". I n -"I I I _:I/o
i ,,,,,,,, -ii ,-
.. ,:...',.V .. C .
,.w I; .'.,, I-I I I I I-


1 907 .. .
.90ft....
199...
o....
1911.,;..,
1914....

1915,.. .
1 06....
91. ...
1 1 .-
": 19170...,
2019....
'o.,...i
. 1921....
1922 -...
1923.,..
1m24...


- 'Total.....


. . . .
2
2


* . . i *




. . . . .
3







23


I
1
* . . .
*. . . .


26


2
* . . .


. . .. .. *
* . .







20
* .i .

. . |.. *
* * .
*i i .
*' i i i. H i

* t .b. .e
,ng ii0


.. .. *

"~ i
* . . . .
I






4
2



m 1
.. .. I
* . . .


* 20
4

1





20


* . . . .

. . . . .



4
1
2
1
3
2
3
3
1
2
3



27'


* . * .

* . . .


* . . .



*.. *. . .


* . . . .


....oi.g
* . . ..







* H * * *
........
* . . . .




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






i... ....
iini.. is

,ii ii 3
* i . * *1i

*n*iiiil*i


SAll cases since 1905 ,ere imported ses.


Per cent autopsied.-Four hundred and three bodies (not including 6

Sdisinterred) passed through the laboratory; 263 or 65.3 per cent were

, aptopsied, one of these autopsies having been done at Santo Tomas

Hospital before receipt at the laboratory.

*Makria carriers found at autopsy, 14.

Slntestinal parasites found at autopsy.-Nineteen cases in the 263

autopsies or 7.2 per cent, showed one or more parasites or their ova,


as follows: ,


... Cronloidas.....,....,........................


Trichocephalu u.'.............. ...... ..........
Taena, saginata...............................


TABLE SHOWING CAUSES OF DEATH FOUTND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH
' LABORATORY, 1924.


7,066


m g









4 1.i
* vi: .*:


NlUiMBtWIe MWSQWeOAOQRWAMNJAiWNI' S 2


* a.... alan Sa.I


0218


a. *...nsnn.tI.nnnnnnnnHnns9
in. nix..
H
Miii .. .. n
.
2.. ~. ~~nn I
!..
4 H ri
. iH.n ME!
-9.. . Mni:2



EMUWE nvH~~~ ~


Eye, hgrowtk from ...... ...... ...... .........,
a oe r'om eyelids ........ ...................
N Msal i lx pe .. ... . .. . . . . . . .

Bpecimens.from nose, other thpa polyps.. ........
Ears, growths from.......... .. ........ .
Lip, specimens from .. . . . . . . . . .... .......
Mouth, tumors fro ...........................
Timsp from lower aventr proem........ ...,.....
Tongue, specimens fo .... .... . . . .- ....
Jaw, epuiiB from lowe.r... ... . . . . . . . . ..
Suum iry tumor... . . . . . .... ... ....
Tonaale, one. . . . . . . . . . . . . ..... ,... . .
TO silsB, pair. ..... .. .... .. .......... ............
Tonsils, pairs and adenoids ............. ........
Oyst from posterior pillar of tonsil..............
Adenoids. .. .. .. .. .. .. .. .. .. ... .. .. .. .. .. .. ..

Palate, soft, growth from.... . . . . ...... .
Parotid region, tumor of ........ ....... ...... .
SB mt nazill ry glands...... ..... . .. .. .. . .... .
Thyroid gland, portion of ................ .... ...
Thyroid gland. .... . . ..... . . . . . . . . . ..
Vocal cord, tumors from........................
Gland. from neck and jugular vein..... ..........
Neck, tumor from ........ ........................
r ym tn .........................................
Breast, m ale. . . . . . . . . . . . . . . . ..
Breast, specimens from ........ ..... ...........
I ver, tissue from ..... ........ .. ... .. .. ..... ...
Gall bladder ............................... ...
d leen .... . . . . . . . . .. . .. . ... . .
Peritoneum and momentum, specimens from........
K idney ..., .... ... .. . . .............. ....... ...
Herni ac, contents of.... ..... .... .... .......

Bladder, ecised specimen from..................
Prostate.... . .. ... . .. . .. .. ... .. ...... .
Prostate, seminal vehicles and part of each vam.....
Foreskin-......... . . . . . . . . . . . . ...
Peri-urethral tumor mass ....................
Penis, excised ulcer ofi ... ...... . .. ....... ....
T esticle . .. . . . . . . . . . . . . . . ..
Testicle, ord.and epididymip....................
Epididymis and vaa...... ... ...... ..... ... ....

Cord, small nodule just above epididymia.........

Uterus, and adnexa ........... ..... ............
Ituteu, adtiex and appendix ....................
Uterus, specimene from ...... .... .. ... ....
Uterus, placenta and child (with or without adneza
Uterine cervix, or specimens from ...............
Tube cr tubes.. .. .. . . ... .... .. .. ... .
Tube or tubes with ovary or ovaries......... .....
Tibeor tubswith other specuten ...............
Ovary or ovaries. .. .. . .... . ... . .. ..... ..
Ovary or ovies with other spenimens (kube exce
Other combinations of female genital organs.......
Specimens from external female genitalia .........
Stomach, specimens from... *.. .... ... ........
Intestine, rejected portion of, smal] ..... ..........
Appendices (including 31 removed with faale.pni
Transverse colon, specimen from.................
Rectum, specimens from . .................... .
Peri-recta! fistlous tract ............. ....
Anal htulrl tract.......... .............. ..
Pilonidal cyst, cocceygeal............. ....... .
Upper extremity, or specimens from .............
T.ninar nvyipmi.lt nr anAoimana fFrwnn


.

i .. -- -- :: - ---
.. ... ......... q.. .. .. H... .

*.* ..rA rnn.... .. ***:*
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. . .. . . . . . .* S . . . .-.. . *. * .. . h..*

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i.

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. . .. . . . I. .* . . . . S* . -. .. ,....-..y .j ;.n. i: E!!.n:
...*i!*......

. . . .. . . . . . . .. .4 55. .. *.. * ...... ..*.* **.: -:-

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. * .* .* * * . * . .* -. .. . . . ., *.'h-.. n. ..1




.. ............ . . . . . . . .......U .. ~ .*:E.


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. . . . . . . . . . . . . .U *U.U. . . *.q *.. A.. .ini--
. . . . . . . .. . .*............ ......U- * . . ..*. .*. *..- .

. . . . . . . . . . .* ... . .. .. .* *. . ... ~. .
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. . ... ,, ...,



























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H.




... ...... ~ ... ......~~* ~*~~ ~~~~ ..*.. 4..UU. . *.tki. .n ~. Mr.

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. . . ... . *... *.. ... H .




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.. . . . ..U . . . . . . . . *. U . .*. U. *.q. .. . n.* ...
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S. ..

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...... . .. .
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< .......... tumors cancerr.:
:.: "* :: ...::. ..... *.
.. :: *:*.



.* .:.... **i .. *
xsn. surgint specimens.-The principal Teions encountered



*g* **- *j ... . . . . ........ .. . . ... . . . . *
S :I* .. ** .



.. an d .e ar.... .......... ...... .. ... . .. . . ... .... . . .. .. .. . .. .. .


. *....."........
...... 1%di ate.ge.)
:" *... .' ... ...". ......... ... ..... ............ ........... ........ .... . .............. .
.... *. 4






"nait subut eou tissues..... ............ ..... . ... . .. .. .. .. ......... 4
.i."ne .. l .t. .... ........... .. .. ................. .. .. 4


"'r Tota: ................. ...
.behign tumors:
broma of eonjunmetivs...... ......
;Nasal'polyps...... ...... . . .. .
:Lymphomsa of roof of nostril.......
S. gioma of lip. ..... ...........
yapillonata of mouth.............
pillary..hemangioma of tongue. ..
.: asular fibroma of jaw ..... :.... .
.pibrous op t s............. .....
. yst front poserior pillar of tonail..
'." lxe tlmor parotidd region........
: pil 6f vocal cord ....... ..
.. tuio alnd colloid goiters.......
'' e oosnb nsor nodular goiter.....
.' Fibr-adenomata of breast.........
. bromama of breast ........ .. .....
... ~idea of breast .............
'. ,:.Hdenoma of brast ....... .. ......
: .ed edtnmor of peritoneum........
Papillary cystadenoma of mneentery
... ypertroahied, protate....... ....
,i rorl.es e..... . .... .. . . .
a eme polps' ..,. .................
. ffise b~tomyomstosin uteri. .....
ystie ovaries and ovarian cysts....
:... aden mat ous cy yt of ovary........
:ea id"eysteaof ovary ...........
S,: t..ian cysts.. ........'........
. ..:.. Pibroadenomao of buttocks .......
F bro-adenoma- of tre.. : .......
:' .. .teomaa,, great toe .......... ....

.:..... pi i au t .... .................
;: .. aole........... ....
* :.... .Eipit eliO cy M. ..................

. b.ocyest of sralp .. ......
-. oddtj piionidal) ..........
... ,emid cysat, cervical... .........
:.,: othgieendotheliomata (knee and 1
."t- .: ~tiDa {ckm......... ....
i.. :: ai nt cell arcamata.... ........... ...
:, Iupoma... .-.. ... ... ..............


'a.


4
I


*1
I
I


I
S

I
I



1

S


1
S'
a
I


1
I


5
I
I
I
S
3
I





.. r : .: *....: ... ..ii." :.... i ". i :... .... .....
i* a *. ** .. i *.
.." . H .

S. .I . .iiH
.K :" .. ** .....*n : ....



.L :" ... ., H ,:, .,; ,,* ,,H.
S :*. .. .c I.::* * .
S**,m: , , ,B| . a "":,,
** *.EE"*.:: E ".
Other requent" lesions" encou terd **. .'* ...t : *L. ..
* 4 .... H* ** ..
S. .. ..
Tnmor caused b Onhodera aoecutiea (fra a) ....





Asnotie retinae vith psnophthaha.itis). .... ......... ....... .... ..... . ....^. :- p. *IuI.i
Hypewtrophy of thyroid gland with one ad n ma iaas of oc i ,.?. H:
I : I = I"1 I I I I I I U l r 4" 4k I ik dl i 4







Axiluary ade from case of acute lymphatic sn. .>i..................... ........^ ^ i.. ...^ U::;i ii^Q
BJ.sto yn'ccai. of banud..**.**..*.. *................... **... -5* ..,*., *. f *9. .iApi
(Ot] er eitnare ofen **o *s **. t .': .... . .... . H ...:.





odraoina r a........ ......................................................... ... ..... .. .t
AiCllmiar nodes rom pe o aue3 lym .pli le..... .. . .. . .. ... .... .. . . ...... .. ... .





Early prenancy (ovum)a in uteu..I................................ ....................... .. ..


Ectopic tubal pregnancy (1 ruptured).*u *...*...~b.....S.....:....s....I .*.H
Bilate ral fbra.denamatous (7) growth of prximalend.of tube.. *******...*.. ... .... ...q. 1 i
t roed with tainh t.............. . a .. .a....... . . . - C - * C * : .. *::.. ..
. lesy pron () in i........ s ......ii.. ..i...... ......,............... .. .... .....i.. ...... ... ..
C olrm bis n spleen. . .*.. . . * * . * *. . . *. * . *.. * *.. . * . . *. . i *.... .: .



Ehtaitea pnephregn nc(1 ruptred) k e... ........ .............. ............ .........,.,.. ...








2 .!!!.. .. J
I ntan eeo. :*' .!":. ....
F uli term b m pregnant* . . . . . . . . . . . . . . . . . . . . . . . . . .. . ... ..

Earlyac ent a] b o dum . .t. u. . . . . . . . . . . .. . . . . .. ... . . .. .... . .... .... .... ...





Miscellaneous human examinations:ximal ends of b ......... .... ............... .



o -tal o_.......... ................................................ .................. ... .


Darkfleld examinations of liver..... .......
Differential blood counts.................
Blood counts, complete ............. ........
External description of human body.......
Blood fcr filaris survey..................
Differential] leucocyte count.............
Four-month fetus..... ..................
Three and one-half month fetus...........
Three-month fetus..... ... ....... .....
Ectopie gestation complete ...............
Fetus, placenta and membranes complete..
Examination of skin lesions .............

Total... .... ...

Animals (wild and domestic), b
Cultures from animal autopsies (cattle)....
Culture of pus from shoulder abscess (cow)


Total. . ....

Animals (wild
Guinea pigs (alter in
Rabbits........... .
Hens .......... ....
Dogs..... . . . .
Pigeon .. ........
Wild turakey.......


and domestic),
oculation). ........



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


a


. ."- J


.. . . . ., .. .. .. . . . . . . . . . .. .. . ... . . -. .*. ..... . ...4H *

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






:." .::d : .. f 4.
. . . . . . . i . .. . . . . . . .. . . . .i .. i i m . 4 .. x".... .- ,"l.t..

. .. . .- . . . .. . . . . .i .. . .. . . . . .- ... ......... . : .





Hi .
.* . . . . .** . . . . . ... . * . * * * .. * a i. *.. A S
.... '........ ...... .. ...





& l.. "".
.. i.






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



S. ... .. ...
.:*: '.h!*Z



- !!i.



:. .. : ...
........... ,. , ., ...,... ,, *. ** ,* .*....,.. *. :


. * *- x
4 : 4:4"

" I b .." " ....

.... ... ... ... ... ... .... IY~ .. .. .. .. .. ..+ + + .. .


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


*. ..... .
---- ,,,, < :j I


nwr1u \ w6&C u(ScF0 (uracGSfl4 wnsac&&cancuiw csxamIsns:s
Cattle tissues fortuberculosis (22positivefor B.tuberculosis).................
Dog's brain for rabies . . . . . . . .... .. . . . . . . . .. .. . . . . .. .. .
Guinea pig tissues for tuberculosis.... ...... ...........................
Tumer from lip of mule for histological examination................. ........


Rats examined. . . . ... . . . . . . . . .
M us m usculus... . . . ... ... ....... . ..
M us alexandrinus .......................
A us norweg icus...... ...... .... .. ...
s ratt . . . .. . .... .. .... ... .
Rat smear examined (from liver and spleeo)....


S .. . .
. . . S . . .
... ....... m

. . . . . . . .


,... ** + ii if
i ...
-. .. .... ..


.. .. .
.. *a t.


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f.. ...fl:,n


11111111111111111111


.* .


Total
~,,,~:,\


TO1B1~1IIIII




NI* H..:.

1*'t
: .4
.. I.X
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1!! .itia~~idh~~iud!oe


A
* .4.


CHEMICAL ANALYSES AND EXAMINATIONS.


r If ,


St : g'.. ." :I ...."

..I ..:i:" *.e. "r.as... t o... .....
.... .. ..............
.! .:- teanitroen 'determiaz

i,: itrhtgeni detrminationes..
:": aoc iddetmni htions ......
: l i. i :e ti: ".i. ,i.t0al. i.. .
: .! : : .UG O t )" ........





5 .. ...:: i b dioxide determinalign
:i;:' I : .= ..: i m oboride denterininatlo


.apoest determinations....


:mmi, a i determinations......


*;! .Irucatua....
b Ottodeeylc................

S' Slpeuoaeopice a.........'..
o s l e, ":;.. Killiyn ." .. i NatI*




H:tl:gH. lnd ihdeitealt ...........
..* .lboeralub.... ....
...: ". ; l'uo, dpen aiued. ...,... ...

. ,. *, Baa..-"jm S m *..............



- ": .]. "achin po W.Jo e..............
:... Alcobolic denaturede.......... .
: .. . Al ,cohoeub..... ... ...... ...


.i.:.n 'v a.bolic did, aude...........
d.ea iO=io . . . .. . .. . a...






0 -ad. OUnal i..................
' '. . e ,f ....a ....... ......... .....










'h.. ...a Ipteip a............
;. .Fo: s*tu s... .. .................




-^ :. B an,.,, a,.. ... . . . . . .
. Coe d .ed.....................













. :, ,. .3. . . ... .. .
M RE .r .o e ...... . .. . .
.iii Hi evaporated..........
:, Mil, c teerd's ......... ....



S- .I

.:. a..: O l mo... ..............
...' .. I t heicn.. ...... .......... ..
.. ,. powdered. ..................
"," t.nlo ir al specimens. ....... .
Kidney tumor (F).........
; Srpi gBfrR ee...........
S0e; .o...,................
.: .:.. G ,llowda examined...........
: ". :Co i dold.l o..... ....... ....,
:: ^ : amoninm aulpbata )..... .
.. henol.
f. ..::.. ,~~r~oGl u :-e..... .............. ..
.,,,,; .' Ure nitrog .. ... ............
i . ; r acid..... . . . . . . . .
r;. :. Cre:tinn..... ......... ... ..
i.3.:. *" T*. -.: exfn.n " ,.-., . .


tent. ....

.. .3. *s .

tions......

*...N .. ..
.. ...N.....
i . . . ..

5........
. . .. . . .


e.. .. . . .
. . . N i i i N


.. . . . .

. . . . . .

. . . .. .

.........

.........*
. N i i i | i . .





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. N. I
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I I. 3 I 3 I






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. . . . .


.. ... .. .
. l . . .
. . . N I

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5
1

1
I

244

S,"502

578
592
927
18
2
I
2
2

I
1
2




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1
I

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2

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2






3
.2
272
9

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546
530
512




5


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

. .... . .. ..

. ..................
. . N . . .
. . .. .., ..


1,026



p












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1
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3
99
1
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557








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e r .. ..--- . =-, .. ". .. :....... ..
Ritr ee. Ss.er aaa w m ........- .. ..., .. ., ,,- ... ....,. ,,* .... ,.,,,,,, ,-. ,, ,, ,,,

n ts a.. d. ....... .
..... ... .... ........ ... ........ ....- .. .... ...




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S(iHv er i, p e r, c .. .... .. ...... ...................... ,. '*Y ... ..., ,








atylDs of ool prepared, ltes.. .. ..-.....................,..... ;.,. ....;..---- -..h^^i i-il
Ethyl ester of oh. pepred, .......................... ............;..... ... ; .. ------
ND*IN * -


Gleam jj. .












_ h l Btrodi abal d... .. ... ^............. ,.,....,...........*............... aw ... .....:.. L.'.. ;,:l^
B d e c. .. ......... .... .... .... ...... . ...... ......,....a,,... *,... 9,, .- r,

II tEhB I *****i* ***. i**i** . *- A .








looedn red oi e . ........ ................ .......... ...... .............. ...... -. ,,.*. ;: Ill
Bodies hel. d hf .mI- ht-......-................... ........ ............................,....... ..
CIi...ueis e"eteuidz leat..r .. .... h... .. . . ...... . . ..... .. ....
h U t ofhn tmm I dithmosi d e d.e.. .. . ... ..... . . ....... ............ .** *...H...


Eulisigdelofromrdpr.......... .. ... .... .................................ifl*..
ad li er oi deed, e ..... ........... .. ....

jj tfb.*oh *. * "* .-









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..: ... : .:: :. : ....:


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,1Z8 PROM HOSPITALt, DEATHS, AND ND NTFEOTIVC AT hS
FOR EMPLOYEES.


~I .i :!S~HU:i!!
HSH..~jij -





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a.
H...


AeBaOLUTE Xl UMNB.


8,570

11,625


2,846
8,130


- 10.17


Dibscharpe.
fktn hospital.


o
F'


5837


544
971

1.515


1.465


ANNUAL AVUaIon PEa


3Eas. : sl.


tZotals


...White.....
faifp......


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


Tdh~lu.


. .


.. . . .
..... .*.1 .


190.84
137.57

151.57


1865.93
145.03


178.07
113.29

130.32


169.71
120.79

133.48


S
0
cn
S
U


3



39
; 208


Deaths.


19
65


-.a


Ore,


15,229
42,079

i7,308


14,301
40,899

55.200


41.72
115.28

157.00


39.18
112.05

151.23


1,000 EMPLOTErs.


12.77
24.28

21.25


22.43


6.65


'.. . . .


13.78


I.

I..
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.. Oman


.t-rDEATHS OF RESIDENTS AND DEATH RATES, OF THE CANAL ZONE AND THE CITIES
OF PANAMA AND COLON.


. ...
n.la.s.....
ra..........
.Zone. .. .

'otale.,....


i . . . .


Totals........


Popula-
tion.


59,635
31,285
33,723

124,643


59,635
31.285
31,793

122,713


Deaths.


Total.


1,948


1.752


Disease.


1,128
455
270

1,853


Annual rate per 1,000
population.


External
causel.


Total.


15.63


14.28


Disease.


14.87


18.08
12.05
7.14


13.71


External
causes.


.67
.64
1.04

.76


.47
.51
.82


SYear 1923:
S.'PanYaa.....
V Onion......
.." Canal Zone..


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TAmB VYI.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1924.


White employees from the United States:
Disease ............. ..........
.t terna l cau m ....................


White women and children from the United States:
D disease ...... ... : .. .. .. .. ..... . . .
External causes........ .... . .... . . ..


Annual
death rate
per 1.000
population.


6.02


White employees from the United States and their families:
D iseasel .... . . . . .. . . . .. .. .... .. . ....
Exte nal causes....................................


Number of American children born on Isthmus during the year...................................... ..
Deaths among American children under I year of age ............... .. ...... ... ...
Infant mortality rate among American children (number of deaths per 1,000 live births).............. .


TAme VII.--BIRTHS AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF


PANAMA AND COLO.N.


Place.


Year 1924:
Panama......
Colon.. .
Canal Zone...

Totals....

Year 1923:
Panama......
Colon........
Canal Zone...

Totale....


. . .
. ... . .


S. . . .


Popula-
tion.


59,635
31,285
33,723

124,643


59,635
31,285
31,793

122,713


Births.


Total.


3,727


2,163
748
623


Alive.


3 5.28


3,343


Rate per 1,000 population.


Total.


29 90


28.80


Alive.


35.95
22 06
20 58

28.30


27.24


TABLt VIII.--INFANT MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF
PANAMA AND COLON.


Place.


Live births.


Male.


Female.


Total.


Deaths among
children under
I year of age.


Number.


Rate per
1,000 live


1111111


~~11111111111111111111111111111111111111


Total; ..


Total. ...


Total .......




S


TABU IX.-TABLE SHOWING DISBCEAlGA AND JDATR IN NOfITABl;
PANAMA CANAL, .1924.


Nunaae


General dimes..


Typhoid fever.... .. .... .. . .. ...
Relapsing fever........ ...... ....
Malarial fever, Estivoautumnal.....


Malarial fever,
Malarial fever,
Malarial fever,
Malarial fever,
MaaIroil feCer


Tertian......
Quartan......
mixed ...
undetermined.
fliniral


Malarial fever, Cacbexia..........
Vaccinia... .. . . . . . . .
M ea les .. .......................
Scarlet fever . ... ....... .. ...
Whooping cough..............
Diphtheria and croup............
Croup . . .. . . .. . ....
Influenza.. ...... ............ .
Dysentery, Entamebic ...........
Dysentery, Bacillary .........
Dysentery, unclassified........
Leprosy . . .. . . . . . . .
Erysipelas ..... .......... .....
Dengue ............... .. .....
Chicken pox....... .......... .
German measles...... .. ..
M um ps..... ... .. .. . . ..
Hemoglobinuric fever, unqualified.
Filariasis ...... ... .
Other epidemic diseases..........
Purulent infection and septicemia.
Septicemia................
Tetan us . . . . . . . . . . .
Mycosis ...... .
Acti nomycos i..............
Pellagra . .. .. ... . . ...
B eriberi. . . . . . . . .
Tuberculosis of the lungs........
Acute military tuberculosie.......
Tuberculous meningitis...... ...
Abdominal tuberculosis..........
Tuberculosis of bones and joints..
Tuberculosis of other organs......
Tuberculosis of the skin.........
Tuberculosis of the lymph glands.
Rickets.. . .. .... .. . .. .


Syphilis, primary........
Syphilis, secondary .......
Sypbilis,'tertiary .....
Syphilis, cerebro-spinal.
Syphilis, hereditary......
Syphilis, period not stated
Gonococcus infection...
Gonorrhea...... .... ..
Gonorrheal arthritis......
Goncrrheal bubo ...... ...
Gonorrheal orchitis and ep


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.. .. .
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. . .. .


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145
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25
2
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3
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White.


32





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53


TABs ZK-.RNOWD(G DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA
CANAL, 1924-Conti nued.


Disesm .


General diseases.-Continued.


Other tumors (tumors of the female'organs ex-


So ptped)........... ... ...
Acute arncular rheumatism...
chronic rheumtism arid gout.

Arthritis deorans..........
Diabetes ... ...... .........
Exophthalmic goiter..........
Addien's disesee...........
. Leukemia lymphatic.........
HBodgkib's disease.........
Anemia, primary, pernicious..
Anemia, secondary, cause not i
"Other general diseases..... .
Alcoholism (acute or chronic).
Aldoholimn, acue.........
Alooholism, chronic..........
Alcoholic psychosis...........
Chronic lead poisoning...... ..
Other chronic poisonings......
Drug habit..................


. . . .

. . . . .

. . . ..
. .. ... .
. . .. . .
. . . . . .
. ............ ...
determined
. . . .
i . . ..
.. . .
. . . . . .
. . . . . .
. . . . .. .


.. . . .
. . .

... . .
. . .


Diseases of the nersouv system and of the organs of
.. spsecil sense.

Eneephalitia................ ....... ... ..
'Z .S simple meningiti ..... . .... ..............
Cerebro-upinal fever ..... ..............
SLocomnaotr ataxia ..............................
Otherdiseases of the spinal cord. ..............
Acute anterior polio-myelitis.. .....
Cerebral hemorrhage, apoplexy.............
Softening of the brain ............... .........
Paralysis without specific cause......... ....
General paralysis of the insane...............
Dementia precox ...... ..... ....... . ...
Manic depressive pay'ehosis ..................
j Toxic psrchousi ............................
Other forms of mental alienation.... ... .....
Epilepey ........... ........ ...... . ..
Convulnsions, nonpuerperal (5 ears and over) ..
Convusions of infants (under 5 years of age)....
:C horea .............................. . .
-H ysteria. ....... . .......................
N euralgi ....................................
N eurt is ...... ............... .... . . .
: Itbe cility. ...............................
-rganic disease of the brain.. ....... .. .
.N eure tHenia .......................... ......
S Other diseases of the nervous system. .... .
olio lar conjunctivitis............ ..... .. ..
Trachom a. .... . . . . . . . . . . . . . ....
Disia e of Cornea.... . ....... .. . . .
.D i me eof I ri, .................. .. ..........


o
--C,
Sc


2
1
3
7
5

4

9
13
74
9
4
28
13
3
10
1
35
2
36
7
2
34
S38
27
1
42
19
a '


0
*I
-a
-a
C
a)


I-I






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* . .



*


1
1
* .
I
I
I

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


*.




*.
2


. . . .
. .
.. ...


Employees.


White.I Black.


I




4

I
3

1



I
2





I
. .






1


1
2

. . .
I'

5
. .. .

2
9

16
8
n


Nonemployees.

White.


Army.






4
3
* . .

1I
.


I

1
1I
I
5
II
I
3


I






1
I
. ..
. .

. . .
. .. .
I
I
14
2


9
2
ft


Others


1

I
4
3
3
3

1
3
14
1
... .
6
5
1
5

9
1

3
1
13
13
2

I
1
I
1
n


Non-
residents.


Black. White.


'Black.


5
* .
I


17



I
I
2
13
.

.
3

1



. *



2
2
2

4
4
I
2
11
39
5
3
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I
6
1



I
3
4
1
6
5
8

11
6
0

PWII


S I





1 . .. *-*.. ,,SHc" :.::,. : *.. .
"* " * :: "..: .... .*

S. ... .. :* . H '*.






TiBau IX-SHOWING DISCRAQGE3 AND DEATHS IN HOSPITALS OWF Iftl PA* L dI,
r s r
... : .:



*A* fl *IIH.L.


Diseases of the circulatory system.-Continued.

Arterio-sclerosi ................ ... ... ... .
Other diseases of the arteries, atheroma, etc.....
Bemorrhoids.............. ................. .
Varioes............ ........ . ...
Varicocele ....................................
Phlebiti ....................................
Other diseases or the veins ..................
Lymphadenitis (nonvenereal)............ ...
Other diseases of the lymphatic system .......
Hemorrhage; other diseases of the circulatory
system . . . . . . . . . . . . . . .


Diseases of the respiratory system.


Adenoid vegetations..........
Other diseases of the nasal foes
Lary gitis... ..... .. ..... .
Other diseases of the larynx...
Diseases of the thyroid body..
Acute bronehitis......... ....
Chrronchiti ..........
Broneho-pneumonia.......'..
Pneumonia (unqualified)......
Lobar pneumonia ...........
Pleurisy. ...................
Empyema...................
Gangrene of the lungs........
Asthma .....................


. .. .. .
m. .. . .
..*. .... .
. . . . .
. . . . .
. ... . .


*... .... .
.. ... .. *
.. n... ..
. n. n.. .
........
........d


Other diseases of therespiratory system (tubercu-
losis excepted)....... . . . . . .... . ...
Abscess of lungs ....... .. ..... ..... .....


IMaeases of the digestise
Diseasee of the teeth and gume


Iyss'..


Storm atitis. . . . . . . . . . .
Other diseases of the mouth and anneza.......
Pharyngitis. . . . . . .. .. ..............
Follicular tonsillitis.......................
Other diseases of the pharynx..............
Foreign body in the esophagus...............
Ulcer of the stomach.. .......... ...... ....
Gastrectas is ....... . . . . .. .. ... . .. . .
Acute gastritis......... ..... ... ........ ...
Chronic gastritis.................. .........
Acute indigestion ................. ..
Other diseases of the stomach cancerr excepted)
Diarrhea and enteritis (under 2 years).........
C olitis.. ....... ......... ........ ...... ..
Diarrhea and enteritis (2 years andover)......
Colitis. .................... ............ ..
Ankylostomiasis............................
A ariasis ..... .......... ............... .
T eniaia s. .. . ... .. . . .. ........ .. .. .
Strongyloidosis .. . . . ...... . .. . . .
Other intestinal parasite................
Amitrl4 a ...ai rJmffI


.I
.4.
*'0
.0


121
6
1
9
235
13
38
1
36
39
4
. ...
32


U;


.4


"igm

. . .











,,S
mn mm


Employees.


White. Black.
.


2
. .


13

1 *
23
1
1......
I
5

. .
5


6
3
19
4

1
* . ...
1
4


.. . ..
"8

. . . .
. . . .

16
1
1


2
1
2


Noneplos~a


Wh~ite.


Armsy,


2

*. ..* .
al
3
. . . .

186
-6


I
59
1
1
I
* . .
43
4
2
.. .. .
"6
2
1

5

3


3
2
109
]11
'II

4.
I
1"
5
3
6
3

1
4
1
1
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1
- -- -


Other]



6
1


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1
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1 .

8
5


90
22
1
. . . .
"5"
.58
8
5
1
5
8
1

12

3
a ---


3
2
11
156
14
1
4

r -
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..~....
1
5
7
20
11
9
9
11
as:
1
3
50


17

9
1


1
19
S5


103
12

. .. .i.
3


70
3
41
1
27
6
1
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S &


w :".xx:iii
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.4


Taai IX.--SHOWING DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA
CANAL, 1924-Continued.


p ir


Dieseas.


Diseases of the digestive system.-Continued.

Other diseases of the digestivesystem (cancer and
tuber ulosis excepted) .....................
Nonunereaw diseases of the enito-urinary system
and anneza.
Acute nephritis,... ......... ...... ............
Bright'e\disease (chronic nephritis)..............
Ohyluria....................................
Movable klid.ey'. . . . . . . . . . . . . . . .
Movable kidney..............................
Pydo-nepbrosis...............................
Other diseases of the kidney and annexa.........
Calculi of the urinary passages.. ...................
C ysftis ...... ................ . . .........
Other diseases of the bladder...... .............
Stricture of the urethra, nonvenereal ...... .....
Vejco-vaginal fitula ................... ..... .
Other diseases of the urethra, urinary abscess, etc.
Chronic prostatitis ........................ ...
Hypertrophy of prostate...... ............. ...
Other diseases of the prostate............. ....
Nonvenereal diseases of the male genital organs.
H ydrocele...... .............................
Uterine hemorrhage (nonpuerperal). .<...... ...
Uterine tumor (noncancerous)...............
M etri tis.....................................
Other diseases of the uterus ...................
Cysts and other tumors of theevary...........
Salpingitis and other diseases of the female genital
orga ns ..... ......... .. ................ .
Benign tumor of breast.................... ...
Nonpuerperal diseases of the breast (cancer ex-
cepted) ..... ... ......... ... ........... .
The purperra stale.
Normal labor r............................... ..
Accidents of pregnancy........... ...... .....
Extra-iuterine pregnancy ................... ....
Hyperemesis gravidarum.......................
AbO tiOnl ....... ... ..... ... ...................
P t ier ner . he.or.r .age. . . . . . . . . . . . ..
Puerperal hemorrhage.........................
Other accident. of labor.......... .... ........
Puerperal septicemia...................... .
'Puerperal albuminuria and convulsions... .......
Eclam psia ................................. .
Following childbirth (not otherwise defined)......
Puerperal diseases of the breast................


. Diseases of the skin and of the ceua"r tissue.
G angrene. . . . .. . .. . .. . . . . . .
Raynaud's disease ..... ....................
Oa urdcle ..' ..... . . . . . . ..... .. . . . .
Carbuncle.. ..... . . . . . . . . . . . . .
Acute abscess. . . . . . . ..... ... . .
Phlegmon and cellulitis .......................
EWvimnnhk-tnm*


I.5I
--a






17



24
32
1
24

21
85
20
29

34
3
II
4
5
2
41
26
13
50-
1I
95
15

131
3

8


439
61
10
14
83
3
59
2
10
1
25
18


1
1
15
8
92
,81
In-


tli







I)








11


Employees.



White. Black.


1I



I


1

6
6
6
S2
6

1I


2

2


2
. . .

1
2 i
. .. ..



1
* .
I

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


. .. .
. . .
1
2
6
26
5


Nonemployees.


White.


Army. Others





5 4



4 7
1 t6
1
I
1 .
2 4
13 29
2 5
6 8
1
4

2

1 2
1 . .
9 4
b .
6

I
42
6

. 29
. . 29
9

4


. 182





. .. .33
. ... .... .

. . . .1
. . .. . .. .
* . 7


A


Non-
residents.


Black.I White. I Black.


I


I


S


. . .





*** :: I
.. *"." "* .:K*
S. i ....

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










SEmployes. N employee, rea ** *

:Diseae : Ihi .
*. ...*.
.H ..








3-g 1 White. Black. r Black. White.. Blauk. 'is:
S E Army. Others :




Other diseases of the bones (tuberculosis excepted). 50 1 6 3 28 6 7 .. '
. A nkyl ein. .. . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . .. . ... . ... .. .
Synov tia. .. ... ... . . .. .... . ... 4 .. . . . ..... 1 ... .. . . .......

Other diseases of the joints (tuberculosis and rheu-
matiam ecepted)... ..... ..... ... 11 .. .. 2 ..... 3 ...........
Am putations. . . .. 2 . .. . . . . 1 ...... .. ... ..
Other diseases of the organs of locomotion. .... 54 ." 15 11 9 8 6 6 ...... :
Malformations. ,=:>..
Congenital malformations (stillbirths notincluded) 9a 4 1 12 8 26 47 3 .,... ..
Diseases ofarly infancy. .
Newb orn child... .. .. 505 .. ... ... ... .. ... .... 224 281 ...... ...,.. '. '
Congenital debility, icterus, and sclerema .... 1 2 .. ... ..... ...... 1 2 ...... .......
I -em nature birth............... ... . .. ... I 14 . . . . 4 II ...... .. :
Congenital debility.. . . 3 ... ... .. 4 ..
M malnutrition . . .... . ...... ... ......... 13 9 . .. .. .. .. '5 16 1 .... .
Other causes peculiar to early infant y (including :
various conseq uences of label r.. . 9 ... .. .... . . 5 9 .. .. ."
.:i..
Old age. 1 1 .

Senility ...... . . ... . . . . . . . .. . 2 0 . . . . ,
Senile dementia . .. . . .... 2 ... . . . .. . .... 1 I .... .- .., .


H* :

Poisoning by food... .. .. 35 ... 6 4 8 7 1 ......
Venomous bites and stings... ... . . . . . . 2 . . . . . . .. 1 . . . 1 .. ...... ..
Snake bit es. . . . . . . . . . . . . . .. 1 . .. .
Other acute poisoanings.. . .... .... 8 1 1 2 1 2 2 ..... .
Conflagration..... .... .... .. . . . . . . . .. .... 1 ..
Burns (conflagration excepted) .......... 40 3 2 6 10 6 9 8 ,
Absorption of deleterious gases (conflagration ex- :..
repted)..... .. . ......... . ..... 6 1 1 2 1 1 2 .... .. .. .
Traumatism by firearms .. .. . ... 1 ... ..... 4 7 3 1 ..... .
Traumatism by cutting or piercing instruments... 24 .. ... 2 5 6 1 6 3 1|
Traumatism by fail... ........... 141 2 11 12 38 25 38 ... 1.....
TraumaLism by machines .. .. 19 ... . 2 6 4 ....1 6 .... .
Traumatism by other crushing. ..... ... 81 4 9 19 28 6 14 9 .... .
Injuries by animals ..... . . . . . . . . . . . . 2 4 . . . . .. . . ...
Starvation . . . . 3 . . ... . ... 1. . .

Fractures (cause not specid) .2 2 34 8 4: 21 6 .
Dis locations . .. . . . . . .. . . . . 5 2 1 1 .. ... ... .
Sprains. ... ... .... . . . .. ..... 6 1 5 .. . ............. ...... .. .... .. .
Other external violence .. ... .. .. ... 214 3 9 98 32 8 33 341 3. .

Ildefn ed organs disease.. 1 ... . 2 7 **

ll-desned organic disease .... .. .... 8 4 1 .. ... 10 ..... ... ... .
Cause of death. not specified r ill-defined.. .. .. 2 ...... ... ..... ..... 2 .... .. .. *...
Infections of undetermined riin . .... 53 1 4 8 7 21 7 ....... .





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-sf--
onoc


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H *



NJ ..


TaBLs XI.-NUTMBER OF DAYS HOSPITAL TREATMENT FURNISHED VARIOUS LASBSES
OF PATIENTS AND AVERAGE NUMBER IN HOSPITAL EACH DAY. 1924.


Clams of patient.


Ancon Hospital:
Employees........
Army and Navy.....
Panama Governmen t


Charity.......
All others.....

Totals....


. .


i.. i.. ....
.. .. i| M. ....


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

* . .1
*..... .


Corozal Hospital:
Employees.................... ,
Army and Navy.................
Panama Government............
C harity ........................
All otu her . .. . . . . . . . .
All others ................... ...

Total (insane).............

Cripples ...... . . . . . . . ....
Chronic medical and surgical cases....


Colon Hospital:
Employees .............
Army and Navy........
Panama Government ....
Charity...... .........
All others ..............


Totals.


Palo Seco Leper Colony:
Panama Government.


Charity.............

Totals ..........

Totals by classes:
Employees.........
Army and Navy.....
Panama Government


..


. . ,


..... .
. . .

.w n


. .j


. .. . ..


Charity, cripples, and chronic.
All others . .. .... . . . .


Grand totals.....


Number of days trew


Ameri-
can.


5,471
22,659

2,488
14.770

45,388


.. . i
1,.029
. . .
Ill
264


. . .
. . . .


6,209
25,732

3,395
17,251

52,587


[Foreign.


1.103

22
1,317
13,880

16,322


366

25,420
2.664


30,730


51

O
123
1,655


2,646
. . .


2.646


1,520

28,088
6,023
17,81.5

53.446


Black.


26,560

223
10,405
30,567

67.815


4,799

77,922
13,051
10,246

106,018


1,433

0
2,151
4.574


20,094
9,755

29.849


32,792

98,239
53,581
45,387

229.999


Total.


33,134
22,659
245
14,270
59,217

129.525


5,165
1,029
103,342
15,826
12,790

138.152


10.405


15.782


22,740
9,755

32,495


40,521
25,732
126,327
62.999
80,453

336,032


Average number in hospital eacday.


Ameri-
can.


14.99
62.08

6.82
40.47


124.36


.30
.72

3.84
. . .


1.5.87


17.01
70.50

9.30o
'47.26


144.07


Foreign.


.3.02
. . .. ..
.06
3.61
38.03


44.72


84.19


0
.34
4 54


4.17

76.95
16.50
48.81


146.43


Black.


72.77


185.79


13.15

213.49
35.76
28.07

290.47


3.93
. . . . .1

5.853
12.53


22.35


81.78


89.84

269.15
146.80
124.35

630.14


Total.


00.78
62.08
.6?
89.10
162.,

354.87


2.82
283.18.
43.06.
35.04


p 378.50

\ 26:50
28.51


6.09
5.60
0
8.41
23 14


43.24


89.03


111.03
70:.50
346.10
172.60
220.42

920.64


r These cripples require no medical attention.


HI'c
.1-i:i


*;.1i.





*" iH;

.1::i .'



H.:.,

*' H.r



I... HIY



'"ri






H:.. :I
H








jib

H.


4u S~


I


1




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rc.
C
CC


Dispenary.


Ancon.,.. ..
Balboa.....
Pedro Miguel.
. ltun. .......
Collm1.1 ,... .


iiiiiiiiiii


T'tIBoa. ...


Remaining
January 1,


Wbita,


Admitted.


Black.lWhite.I Black.


4

i3


20 2,913 1,395


_White.

. . .


S. .. .


Black.


Discharged.


White.


Tr~anuferred


Remaining
December
31, 1924.


SBlack. White.I Black. White.I Black-


181 19y
105 132
453 467

.2,890 1,.350


. . .


Dispensary furnishing treatment.


Anoon........
Balboa .......
Pedro Miguel.
Gatun........
Cok ,........

Totale....


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


Days treatment furnished.


White.


7,500


Black.


2,678
' 503
789
671
4,646


Total


16,787


Average number treated
in quarters per day.


White.


20.55


Black.


25 44


Total.


45.99


ALL CABES TREATED BUT NOT EXCUBED FROM WORK.


Dispensary


Ancon........
Balboa ......
Pedro Miguel.
Gatun........
Coln.a........

Totalhe....


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

* . . S S * S S * * * *.
. . . S *.... . . . . .
n ... ..m... .. .. 1nn
. . . . . . . . . . .

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


Employees.


White. I Black.


7,482
12,719
2,681
4,859
5,147


12,059
15,977
5,290
10,339
14,471


Total.

19,541
28,696
7,971
15,198
19,618


Monemployeas.


White. I Black.


5,128
17,686
3,790
3,543
6,596


10,151
5,432
6,915
4,916
12.,333


Total.


15,279
23,118
10,705
8,459
18,929


Wh~ite.


12,610
30,405
6,471
8,402
11,743


32,888 158,136 191,024 136,743 139,747 176,490 169,631


Total.

Black.

22,210
21,409
12,205
15,255
26,804

97,883


Total.


34,820
51,814
18,676
23,657
38,547

167,514


Tacm XII-REPORT OF DISPENSARIES, 1924.

mEoPL7IeBs TrETaED I QUArTERS.


111111111111111111111111111111111111111

1111111111111111111111111111(1111111111




I .H*.. A *j'ji *......~


60

*
TaBn XITI.-CONBOLIDATED ADMISSION RElOR'l HOSPITALS AND DISPENSARIEB, 1924.


All classes of patients.


Admissions to hospitals, excluding Corozal farm, cripples, and chronic ward,.
Admission of employees, to quarters.......... ...... ..... .... ..... ..


Total adminieiona to haupitaks and quarters. ... . *


Leas number of patients transferred between hospitals and from quarters to hos-
pitale, whose admissions are duplicated in the above figures.. .......


Net admissions to hospitals and quarters ..

Employees only.
Employees admitted to hospitals ..... ...........
Employees admitted to quarters.... .... ...


Total admissions nf employees.... ... .... ... ...... .......
Lees number transferred between hospitals and from quarters to hospitals, whose
admissions are duplicated in the above figure ..........................


Net admissions of employees..


Annual admission rate per 1,000 employees to hospitals and quarters


AVERAGE NUMBER OP DAYS IN HOSPITALS AND QUARTERS FOR EACH ADi


Hospitals:
Ancon...
Colon ..


Average for hospitals


Quarters:
Ancon........ .
Balboa..........
Pedro Miguel....
Gatun .... .. ..
Colon ........ .


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


.. ., . . . . . .. . .


. . .
. .
. . .

. . . .


.i l *. ..


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


White.

5,008
2,913

1,921


214

7.707


604
2,913

3,517

46

3,471

1.136.17


Black.

4,745
1,395

6,140


1,232
1,395

2,627

* 135

2,492


290.78


I-


IN, EMPLOY EE ONLY.


White.


10.77


Black.


21.37


4.78
9.32
12:77
5.21
9.03


-* .: *. .. .
. ..4... ::



.. r.
S 'r<. l

S:P
: *" .: ,. ..


.*IH :: :*'.: ....
4 g*.. *
.c .'....:: ..:..::

r Hi

E,, IJ,
** : :: : ...
: *"i i
<* ,. :*


Total .
9,5


*Hi!
-: k.-'

I..
4.

*1. 36 .. .


4,806w i ;'
I HI:

lsA.







5.16H
St. I
a0,5H




...




3.I.


Average for quarters.




. H.:
*Ii
H.....
.;
tH ..
I ..

II,
IH .'
Krh .



r.-


**i.


61


TAfl XIV.--BURGICAL OPERATIONS PERFORMED.


. Amputations:

Fo.ot. . .. .......... ........
1 Thigh..... .. .. . ........ .
Leg ...... ............. .
. H and ............. . .........
Digits, multiple..................
Operation. on bone:
Lakinectoly. ........ .... ... ..
.Resection of knee ..... .. ... .. .
'Wiring of fractures, simple.......
Plating of fractures, simple........
Open. operation of fractures..... ..
Open reduction of fracture........
Dislocation, reduction, compound.
Craniectomy, decompressive ......
Bone splint to fracture, simple....
Fracture reduction, simple.... ...
Adenectomny:
Cervi al.. .................... .
Inguinal, single .... .. .. .... ......
Inguinal, double...... ...... .....
Femoral. .. .. .. .. .. .. ... .. .. ..
A illary .......................
Heniotomy:
SInguinal, single.... . . ... .. ....
Inguinal, double .... ..............
Ventral ... .. .............
Strangulated.... ......... ...
Fem oral ... ............... .
Genito-Urinary tract:
Nephropexy.....................
Cystotomy.. ..... . .
Proatae1tomS ..................
Urethrotomy, internal ...........
Urethrotomy, external ............
Varicocele, radical cure........
Hydrooele, single, radical cure ..
Hydrocele, double, radical cure..
S Nephrectomy .......... .. .... ..
Orchidectomy.. .... .........
Epididymotomy .............. .
Amputation of scrotum..........
Curettage uteri..... .. . . .
Perineoplasty......... .........
Trachelhrraphy................
Vaginal puncture...............
Circumcsleion..................
.' Obstetrical:
lmrrian sia .inn abhdnminal


SAccouchement forceps................
High forceps... . . . . . . . . . . . . ....
Low farceps............................ .
Version. ... .................. .. .
Perineorrhaphy. .................. .......
Thoraa:
Excision of breast and axilla... .............
, Thoracotom y.............................
Rectum:
Hemorrhoids, radical cure...... . . . .
Fistula in ano. excision of.................


An con
Hospital.


Number.


1
2
I
3
2
2

3
1
6
I
3
2
1
2
1
15

5
127
40
U,
I
5

80
14
12
2
3

5
I
2
8
5
7
4
.. . .

6
63
I
200
31

4
279

6
2
2
9
6
36

41
13

66
5


Died.


1
.. .. .


Colon
Hospital.


Number. Died.


. *


1
4

I




2

I
. . .



2






.......


. . .
. .
,


1
. .. . .


I -




. .... *. . .. :r. a .
S ..,. .:..:" ,,:: *:.
V..it3


Laparotomy-Continued:
Gastro-enterostomy... .............
Gastrotomy ......... .... ....
Enterectomy. . . . . .....
Appendectomy...... ............
Appendectomy with local peritonitis...
Appendectomy with general peritonitis
Calostomy .... ........ ........ ....
Cholecystotomy ........ . .. ..
Cholerystoatomy ........... .....
Cholecy3tectomy. ....... . . .


Abscea of liver, laparohepatotomy...
Abscess of liver, thoracohepatotomy..
Pan-hysterectomy.................
Splenectomy.. ....................
Supravagina] hysterectomy...........
Hysteromyomectomy. ...............
Myomectomy .............
Salpingectomy, single................
Salpingectomy, double...............
Salpingo-oophorectomy..............
Ovarian e3stectomy.................
Oophorectomy.......................
Suspensio-uteri .....................
Ectopic gestation.. ....... ..........
Enterrorrhaphy. ......... ..........
Lateral anastomosis intestine by eutur
Cauterizations .... ... ..... . ..
Blood transfusion....... ... ........
Arspbenamin, intravenous...... .....
Salvarsan.. . . . . . .
-Novoarsenobenaol-Intravenous. ....
Major operations, various............
Minor operations, various............

T otals .............................


I


An

Number


Number.


tarn
pitaL


Died. I!
I I-


1
1


2








.......

















.n.mn. ..m.


19


U



















I.


Colon
n-q~ta'


(umber. .1
mi



6.9. ..


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

. .. . .U

. . . ..
I0 *.4

2 ...






*., . . . .
- . .. . .
I



....... .
9







2 ..

*... . . ..

"2 3 '^
. . U
'""2. ...

4 ....











123 ...


TaBmL XIV.--SURGICAL OPERATIONS PERFORMED.-C tianed.


.1


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S .:il


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.: ... ...

n *:
.. 1



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:I'


I,11

4.. H~hhj


S.21


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*;



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II.






i


63


TaaLa XV.--OPERATIONS IN THE EYE, EAR, NOSE, AND THROAT CLINICS.


Aneon
Hospital.


Eye:
Advancement.....:............
Capsulotomy...................
Cataract extractions-
Combined........ ........
Linear....... ..............
Chalasior., removal..............
Enueleation........... .........
Foreign body, removal .........
Hordeolum, inciaion.... . ......
Iridectomy .... .. ....... ....
Lachrymal operations-
Ddation of ducts ............
Lid operations--
Plastic..... . . . . .
Excision and draining of ante
-Needling ... . . . . . .
Pterygiumm.....................
Tenotomy ................ ....
Capsulectomy ................
Miner.... .. .. . . . . . . . .
Ear:
Furnucle, incision...............
Foreign body, removal...........
Mastoid operations-
.R;mnl.


Oasiculectomy.... ...............
Paracenteais.......... ... ... . .
Polypi, removal ................
Excision of cyst from ear..........
Others ...... . . .. . . . . . ....
Nose:
Cauterization .. .. . . . .... .
Foreign body, removal............
Polypi, removal .. .... .......
Rhinoplasty............. ........
Sinuses-
Ethmoid, simple..............
Frontal, simple. . . . .......
Frontal, radical...............
MaxilLry, puncture and irrigati
MaxilUry, radical...........
Maxillary, drainage...........
Submucous resection,.............
Turbineetomy ........... ........
S M inor.... .. . .............
Other. ,.. ... ..... .... ..
Pharynx:
Adenoidectomy...................
Peri naillar abscess, incision .......
Tonsillectomy... .................
Uvulectomy..................... .
Retropharyngeal abscess, incision...
M inner ...... ... ..
Larynxa:
Foreign body, removal............
Total minor...... . . . . . . . . . ...

Totals . ... . .. .. . ......

Refractions ....... ..................


. . . ......

ricr chamber
. . . . . .
. . . . . ..


. .
. .
. .
on
* .
. .
..
. .

.


. . . .


I

4
4

. 4
24
2
6
a

3

4
I
3
68
2
1
6

2
6

15
5
45
2
I
2

2
2
6
10

2

t
17
3
I
75
27
3
I

505
28
877
2
1
2

3
XI

2.160

1,387





.t .:. r
*< * j 4* *. *r


64


TamU XVI.--COOR&. BMOSPIAL, STAWEENT ONFrIUMMITMl


I~a~5t~L


First admission. ... . . . . .. . .. . . . .. .. .. ... .
Second admission .............. .... .......,,. ....... .. ..
Third admim on.. .... .... ..... ... . . * * *
fourth admission ..... ... ... .. ..... ............. ..........
Fifth iansion ........... ... .... .. .......... .. ...


Totals........


H:" j~i l K Wii flj:
.4 4r .... hFI
* :y -

.41.
lil. li ., .;
IHE V
2%i hAS m


H k-tji
*. : .Mii .
iiitp*.~

L~t:.' H


*ForaCanals but,


Male.i

i47v

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


52
w~mnd
|pmpm


-T-


.1
.2*
. .. .. .
i. ...-...


i *. .C..
SIy;..


1 1I..'.


S. .

'tAt
. i ...
-: ..: Ji ..


*-. a M.
**

.


-Ga.BmB


W eUl . . . . . . . . . .. . . . .
Improved....... . . . .. ...... ... .... ....
Unimproved .................................

Totals..................................


TaBrn XVII.-FORCE REPORT.


Chief Health Officer.......
Quarantine Service.. .......
Health Officer Panama.....
Health Office, Colon........
Aneon Hospital. ......... .
Colon Hospital..... .....
Santo Tomas Hospital......


Palo Seco Leper Colony.
Zone Sanitation ........
Coroal Hospital ........ ..
Line Dispenaries.......

To as .... ......


Decemb 31, 1024.


Total.


.3'
124

381
87~
* * S *
SB=
Ilie.
118
121'
-MS.


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