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

REPORT

OF THE

Health Department

OF

The Panama Canal

FOR THE

CALENDAR YEAR

1932

J. F. SILVER
Colonel, Medical Corps, United States Army
CHIEF HEALTH OFFICER

BALBOA HEIGHTS, CANAL ZONE

TE PANAMA CANAL PRESS
MOUNT HOPE, C.Z.
1933
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For copies of this publication address The Panama Canal, Washington, D.C., or Balboa
Heights, Canal Zone.

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CONTENTS
Page
Title..-------. --------------------------------------------------- 1
Organization and activities. ----------------------------------------- 5
Personnel-------- .---------------.--------------------------------- 5
Financial statements .--.-------------- ---- ------------------ ------. 8
Vital statistics, populations of the Canal Zone, Panama City, and Colon - .. 11
General death rates, all causes, and from disease only ----------------- 12
Canal Zone ----------------------------------------------- 12
Panama City -------------- ---------------------------- 13
Colon. --------------------------------------------------- 13
Birth rates ---------------------------------------------------- 14
Canal Zone---_-------- ------------------------------------ 14
Panama City_---------------------------------------------- 15
Colon----------------------------- ----------------..-- -- 16
Infant mortality rates, Canal Zone, Panama City, and Colon---------- 16
Principal causes of death --------------------------------------- 18
Canal Zone-------------.---------------------------- 18
Panama City -------------------------------- ------------- 18
Colon-----__------------------------------------ --------- 19
Acute transmissible diseases reported -------- ---------------------- 20
Vital statistics, Panama Canal employees_ ----------------------------- 21
Death rates, all causes ------------------------------------------ 22
Death rates, disease only------- ------------ -------------------- 22
Admission rates to hospitals and quarters -------------------- ----_ 24
Principal causes of admission to hospital ..-------------------------_ 24
N6neffective rates, all causes-- ----------------------------------- 25
Admission rates, malaria ------- --------------------------------- 25
Death rates, malaria----------------------------------_---------- 27
Division of Hospitals, Dispensaries, and Charities_ ---------------------_ 27
Annual Report, Gorgas Hospital --------------------------------- 28
Annual Report, Board of Health Laboratory ----------------------- 28
Annual Report, Colon Hospital ------------------------------------ 35
Annual Report, Corozal Hospital.---------------------------------- 36
Annual Report, Palo Seco Leper Colony ------_-------------------- 38
Division of Sanitation----------------------------------------------- 40
Special projects undertaken in 1932__ __- __-------------------- 40
Medical care of the population in the Madden Dam area---------- 40
Drainage projects_ --__------------------_------------------ 40
Malaria in settlers (colored alien) living in the Canal Zone-------- 41
Seasonal mosquito pests-------------------------- ---------- 41
Mosquitoes common to the Isthmus-------------------------------- 42
Trypanosomiasis in animals--------------------------------------. 45
Annual Report, Health Officer, Panama City---------------------------- 45
Annual Report, Health Officer, Cristobal-Colon-------------------------- 47

4

COTENENTS-Continued

Annual Report, Division of Quarantine--------------------------------
Annual Report of the District Nurse for the Pacific side_ ------------_---_
Medical examination of school children_----__---_---__----.------_ -_

General Tables:
1. Discharges from hospitals, deaths, and noneffective rates for em-
ployees--------------------------- --....------
2. Causes of deaths of employees arranged with reference to color,
age, and length of residence on Isthmus ----------------
3 Deaths and death rates of residents of the Canal Zone and the
cities of Panama and Colon_---------------------_____ -.._
4. Deaths of residents of the Canal Zone and the cities of Panama and
Colon, by cause, sex, color, and age --------------------
5. Deaths of residents of the Canal Zone and the cities of Panama
and Colon, by place of residence, absolute numbers and
annual rates per 1,000-- .--------------------------
6. Deaths of nonresidents by cause, sex, color, and age -- ------
7. Statistics regarding American employees and their families .--...
8. Discharges and deaths in hospitals of The Panama Canal, absolute
numbers_---------------------------------
8-A. Discharges and deaths in hospitals of The Panama Canal, rates
per 1,000 population_.--._ -------.
9. Consolidated hospital and colony report_ --_ --------------
10. Number of days hospital treatment furnished, and average num-
ber in hospital each day of the various classes of patients. -
11. Consolidated admission report, hospitals and dispensaries-------
12. Report of dispensaries- _------------------------------------
13. Average number of days in hospitals and quarters for each ad-
mission, employees only-------------- ---------------
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CALENDAR YEAR REPORT, 1932
HEALTH DEPARTMENT

General economic conditions are such at present that drastic curtail-
ment of the scope of this report is necessary. It will therefore be
confined very largely to a presentation of such statistical tables and
analyses of vital statistics as will permit public health. workers to ob-
tain statistics for 1932. Vital statistics for all previous years of record
and illustrative graphs to show trend, are incorporated in the annual
report for 1931 and antecedent ones.
ORGANIZATION AND ACTIVITIES
The Health Department is one of the five departments of the Panama
Canal organization functioning directly under the Governor. It is
charged with sanitation and the control and prevention of transmissible
diseases in the Canal Zone and in Panama' City and Colon, the treat-
S ment and hospital care of United States Government employees and
their dependents, and others entitled to such care, the enforcement
of quarantine regulations, and the compilation of vital statistics for the
Canal Zone and the cities of Panama and Colon:
' Its activities are conducted under the four principal divisions indi-
cated in the organization chart on the following page.
The administrative functions and activities of the various divisions
were described briefly in the annual report for 1930.
PERSONNEL
The principal change in personnel assigned to key positions in the
Health Department organization during the year was the assignment
of Col. O. G. Brown, Medical Corps, U.S: Army, as Superintendent,
Gorgas Hospital, vice Col. A. M. Whaley, Medical Corps, U.S. Army,
relieved on account of termination of tour of duty with The Panama
Canal.

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The total personnel in the service of the Health Department on
December 31, 1932, by units, as compared with the strength for pre-
ceding four years, is shown in the following table:
FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER. EACH YEAR

Chief Health Office........ 5 ....
Gorgas Hospital......... 166 259
Colon Hospital ........... 24 38
Corosal Hospital'........ 21 126
Line dispensaries ......... 14
Palo Seco Leper Colony 1 37
Quarantine service........ 12 25
Health Office, Panama.... 10 125
Health Office, Colon ...... 85
Zone Sanitation........... 5 124
Total............. 266 828

1928 1929 1930

0 0
E- 0

1,094 282

E-

299 475
52 77
144 163
9 27
36 38
23 33
1281 139
881 97
112 117
891 1,173

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167 267
29 54
22 141
16 5I
1 28
II IIH
9 87
6 11I
279 847

1931

7 7.... 7
434 169 243 412
83 32 55 87
163 21 138 159
3 17 15 32
29 1 28 29
31 12 20 32
129 11 1181 129
96 8 89 97
123 6 120 126
1,126 284 826i1, 110
1

NoTE.-"Gold" are white American employees, with the exception of two white aliens and one colored alien.
"Silver" are alien employees, principally West Indians (colored).
Includes inmates paid for services rendered.
V

The distribution of the gold personnel, on the basis of professional
or other qualifications, was as follows:

33 physicians, medical officers of
the U.S. Army
1 physician, surgeon of the U. S.
Public Health Service
29 physicians, civilian
1 dentist, U.S. Army
9 internes
9 male nurses
101 female nurses
2 district nurses
S 35 clerks
11 sanitary inspectors
1 sanitary assistant
2 quarantine inspectors
4 veterinarians
8 technicians

7 dispensary assistants
5 pharmacists and assistant phar-
macists
2 chemists
2 general mechanics
2 stewardesses
3 dietists
1 storekeeper
1 dental hygienist
1 vaccinator
1 carpenter foreman
1 chauffeur foreman
1 physio-therapy aide
1 electrician
1 embalmer

The increase in force is an apparent rather than a real one. There
was a reduction of nine in the gold force. The increase-in the silver force
was due to readjustment of working hours, principally in street cleaning
and garbage collection and disposal gangs in Panama City and Colon,
to relieve unemployment. Heretofore a considerable number of em-
ployees worked on a 7-day week basis; this was reduced to a 6-day
week, wakes adjusted accordingly, and additional men employed to
cover the activities without additional expense.

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252 414
55 87
139 160
17 33
28 29
19 31
105 116
95 103
141; 147
8511.126

FINANCIAL STATEMENTS

OPERATING EXPENSES AND EARNINGS OF THE HEALTH DEPARTMENT,
CALENDAR YEAR 1932

Operating expenses Earning

Gorgas Hospital -------------------------- '$753,460.10 $352,808.75
Colon Hospital --------------------------- 167,132.29 85,359.59
Corozal Hospital (for the insane, chronic and
cripples)_----------------- ---------.. 3185,612.69 173,362.00
Palo Seco Leper Colony ------------------- 36,899.94 23,891.25
Maritime Quarantine Service--------------- s70,911.71 17,186.31
Sanitation of Panama City and Colon..----- 67,337.03 9,503.26
Street cleaning and garbage collection and dis-
posal, Panama City and Colon---------- 138,516.02 113,622.79
Canal Zone sanitation--------------------- 141,140.04 49,635.03
Line dispensaries. __ ----- ---------_--_ 96,510.09 41,055.20
Medical storehouse ...------------------- 6,957.16-------------
Chief Health Office and miscellaneous.------ 437,741.91 1,463.17

Total---------------------_----- 61,702,218.98 867,887.35
s Includes Army pay of Army medical officers on duty in this institution which amounted to ..-------- 118,908.74
Also includes cost of operation of Board of Health Laboratory.
- Includes Army pay of Army medical officers on duty in this institution which amounted to ---.---. 24,637.90
Also includes cost of operating Colon Dispensary.
SIncludes Army pay of Army medical officers on duty in this institution which amounted to-...-----. 14,697.96
'Includes Army pay of Chief Health Officer which amounted to.----------------------------- 7,200.00
Total Army pay of Army medical officers on duty in Health Department --------------- 165,444.60
SIncludes Public Health Service pay of Public Health Officer acting as Chief Quarantine Officer, which
amounted to--......------------------------- ---------------------------- 5,232.10
6 Includes Army and Public Health Service pay, which amounted to ------------------------- 170,676.70

OPERATING EXPENSES OF THE HEALTH DEPARTMENT, CALENDAR YEAR 1932,
SHOWING AMOUNTS CHARGED TO VARIOUS ACCOUNTS

Gold pay roll (white employees):
Panama Canal pay------------------------ $612,378.80
Army pay--------------------------------- 165,444.60
Public Health Service pay ------------------ 5,232.10
Silver pay roll (colored employees) -----------------------
Subsistence supplies ---------------------------------------
Ice--_-----------------------------------------------
Hospital supplies and drugs _-----_--- ----------------------
Equipment _ ----------------------------------------....
Miscellaneous material and supplies_---------------------------.
Laundry------------------------------------------
Telephones__---------------------------------------------
Repatriation of patients physically or mentally disabled......-----------
Medical storehouse operation -------------------------------
Launch service--------..--.........................----------------.............--
Mechanical Division repairs, oxygen, etc. -----_ --------- ----
Electric current.--_----------------------------..----------..
Electric repairs and installations---------------------..........................-----

$783,055.50
428,307.64
188,212.50
4,921.20
70,864.21
10,280.83
61,753.59
31,049.85
14,585.84
2,128.56
6,957.16
5,131.51
3,205.91
15i310.S5
1l668.33

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Water --------------..--------------------------------------.
Freight-.---------------------------------------------------
Motor transportation charges (except for hospitals, quarantine
station, and dispensarieb which operate their own motor vehi-
cles)-----------------------------------------------
Repairs to motor vehicles of hospitals, dispensaries and quarantine
station -----------------------------------------
Rentals of quarters------------------------------------------
Miscellaneous charges_-----------------------------------

$12,449.56
2,489.06

49,326.96

1,777.49
1,210.48
7,532.25

Total expenses--------- ---------------------------- 1,702,218.98

The funds for the operation of the Health Department consist
of direct appropriations from Congress and earnings from various
sources. The extent to which the Health Department has been self-
supporting during the calendar years 1923 to 1932, inclusive, is shown
in the following table:

Gross operating E s Percent
expenses Earmngs self-supporting
1923. ................................... 31,415,944.19 $685,596.02 48
1924 ......................................... 1,476,385.27 703,337.81 48
1925................................... ..... 1,430,484.91 721,005.34 50
1926 ......... ............................. 1,542,473.15 755,843.70 49
1927....................................... 1,628,376.14 860,926.35 53
1928.......................................... 1,821,696.73 937,469 38 51
1929........ ... ......... ..... .............. 1,902,222.27 1,022,940 76 54
1930........... ........................... 1,910,689.69 995,733.57 52
1931 .......... ... ......... .......... .... 1,827,845.00 894,809.11 49
1932............................................ 1,702,218.98 867,887.35 51

The extent to which the various units of the Health Department

were self-supporting during the years
following table:

1923-1932 is indicated in the

Percent sel-supporting
(Army pay included)
Calendar bears-

1923 1924 1925 1926 1927 1928 1929 1930 1931 1932
Gorgas Hospital.................... 50 52 53 51 57 54 52 49 46 47
Colon Hospital....................... 39 41 39 37 44 44 52 59 52 51
broaal Hospital ..................... 82 81 82 80 85 76 88 86 89 94
Palo Beco Leper Colony............... 39 40 45 38 46 41 46 55 44 65
Linedispensaries ..................... 31 27 34 35 32 34 35 32 31 43
QuarantineDivision................... 60 38 46 53 35 38 49 35 32 24
Sanitation, Panama and Colon.......... 13 17 20 18 11 13 16 12 15 14
Street cleaning and garbage collection and
removal, Panama City and Colon..... 51 58 60 61 81 82 82 81 82 82
onem anitation........................ 43 39 37 29 29 29 37 36 33 35
Health Department as a whole.......... 448 8 50 49 53 51 54 52 49 51

SThe average cost per patient per day for hospital care and treatment

in the various Panama Canal hospitals during the calendar years 1928
to 193i has been as is indicated in the following table.. These costs
include operationss, maintenance, and full salaries (that is, including

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the Army pay of Army medical officers assigned to the various hos-
pitals), and the cost of operating the Board of Health Laboratory.
Capital charge for construction, interest on physical plant values, and.
amortization charges are not included:

Calendar years

1928 1929 1930 1931 1932
Gorgas Hospital:
(a) Including cost of Ancon Dispensary until September 1929;
also including cost of Board of Health Laboratory...... 4.66 5.08 5.40 5.07 5.03
(b) Including cost of Ancon Dispensary until September 1929,
but excluding cost of the Board of Health Laboratory
chargeable to other divisions and outsiders............ 4.44 4.87 5.16 4.83 4.76
Colon Hospital:
(a) Including cost of Colon Dispensary...................... 6.43 5.18 4.27 4.39 4.72
(b) Including cost of Colon Dispensary; also including the cost
of the work done for this hospital by the Board of Health
Laboratory ...................................... 6.96 5.55 4.55 4.65 5.04
Corosal Hospital:
(a) Including cost of operation of dairy until December 1930;
also including cost of operating gardens and cemetery.... 1.00 .90 .88 .70 .65
(b) Same as above, also including cost of the work done for this
hospital by the Board of Health Laboratory ........... 1.03 .92 .90 .72 .67
Palo Seco Leper Colony (a) .................. ................ 1.39 1.25 1.06 1.35 .96
(b) Including cost of the work dole for this institution by the
Board of Health Laboratory..................... 1.40 1.26 1.07 1.36 .97

Gross operating expenses for the Health Department as a whole for
1932 were about $125,500 less than for the previous year and $208,500
less than for 1930, the peak year. Earnings for 1932 ($867,887) were
$27,000 less than for 1931 and $155,000 less than for 1929 when they
attained the highest point of record ($1,022,940). The brunt of the
reduction in earnings has fallen on Gorgas Hospital. The earnings of
that unit reached a peak of $486,000 in 1929, since which time they
have gradually been declining. In 1932 they were $352,808-$133,000
less than in 1929.
Notwithstanding the marked decline in gross operating expenses
and earnings during the past three years the number of patient days
spent in Panama Canal hospitals has gradually been increasing and
in 1932 reached the highest peak attained (508,776) since completion
of the Canal.
Two general classes of patients are cared for in Panama Canal hos-
pitals, namely: Those suffering from acute ailments in which the
turnover is rapid and large (Gorgas and Colon hospitals) and those re-
quiring domiciliary care, most of whom remain in hospital until death
(Corozal hospital for the Insane and Palo Seco Leper Colony).
The number of patient days spent in Gorgas and Colon hospitals
(acute cases) in 1932 was 21,000 less than in 1931, whereas patient

days in Corozal Asylum and Palo Seco Leper Colony .were 30,425 more
than for 1931. Reductions in patient days and admissions to Gorgas
and Colon hospitals is attributable in part to reduction in force of
about 2,000 employees in 1932 (1931, total force, 14,597; 1932, 12,621).
Lepers and insane chargeable to the Republic of Panama are cared for
at the expense of the Government of .Panama, the charge per patient
per day being 75 cents, which about covers cost of operation and
maintenance and does not include interest and amortization charges
on capital investment in buildings, "etc. (approximately $700,000).
Practically all other patients in Corozal Hospital and Palo Seco Leper
Colony are cared for at the expense of the Health Department.
Data on patient days in hospitals and numbers of admissions to
hospitals for the past five years are included in the following table:
NUMBER OF PATIENT DAYS IN HOSPITALS AND ASYLUMS
1928 1929 1930 1931 1932
Gorgas Hospital .... ....... ......... 184,945 184,506 163,975 165,050 149,812
Corozal Hospital:
Insane patients. .......... ....... 200,735 209,794 228,862 228,327 253.240
Cripples and chronic medical and sur-
gical ases...................... 25,459 27,623 98,923 29,883 31,802
Colon Hospital......................... 21,342 30.755 41,158 41,508 35,379
PaloSecoLeperColony ..... ..... .... 38,001 36,568 36,102 34,947 38,543
Total............................... 470,482 489,246 449,020 499,715 508,776

VITAL STATISTICS-POPULATIONS OF THE CANAL ZONE,
PANAMA CITY, AND COLON
The Health Department of the Panama Canal secures, analyzes, and
makes reports on the vital statistics (births, deaths, and disease rates)
of three geographical units of the population residing on the Isthmus
of Panama, namely, the population of the Canal Zone, of the city of
Panama, and of the city of Colon.
Properly to interpret these statistics, it is essential that there be some
understanding of the composition of the various units of the popula-
tion, their movement, and some of the special local factors involved
which usually are not encountered in stabilized populations in many
parts of the world. These special factors were discussed somewhat in
detail in the annual report of the Health Department for 1930 (pages
12 to 15, inclusive) which can be obtained on request to the Chief
Health Officer, Balboa Heights, Canal Zone.
The Republic of Panama takes a census every 10 years, the last
enumeration having been made in 1930. In Panama City, from 1920
to 1930, the population made an average increase per year of almost
exactly 1,500, and that figure has been used as the factor in computing
the population each year since 1920 by arithmetical progression. For
1932 thepopulation is estimated to be 77,500 (arithmetical progression).

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In Colon, from 1920 to 1930, the census figures indicate an average. :
decrease of 150 per year, and that figure has been used as the factor ",
in computing the population between 1920 and 1930 by arithmetical
progression. As there is some doubt as to the accuracy of the 1930.
census of Colon, 30,000 was adopted for 1931, and continued for 1932.:
The population of the Canal Zone consists of white American em-
ployees and their families, colored alien employees and their families,
military and naval garrisons, representatives of shipping companies,
contractors, church and welfare workers, etc., and colored alien agri-
culturists who rent land under revocable licenses. A census of the
Canal Zone population is taken each year and all figures for this group
are actual rather than estimated.
The term "employees" as used in Health Department reports in-
cludes employees of the Panama Canal proper and the Panama Rail-
road Company, which is a corporation owned by the United States
Government.

GENERAL DEATH RATES, ALL CAUSES, AND FROM
DISEASE ONLY
Death rates from all causes for all groups of the population are avail-
able since the beginning of construction (1905) and those from disease:
only are readily available since 1913. These data are incorporated
and shown graphically in tables appearing in the annual report for 1931.
In this report the data presented will be limited almost entirely to a
presentation and discussion of the death rates for 1932 and a tabulation
of death rates by consecutive 5-year periods to show trend. Those F
interested in the rates for previous years are referred to the annual
report for 1931.
Population, Canal Zone.-The death rate from all causes during the
year 1932 in the Canal Zone population was 7.30 per 1,000 of population
(pop., 42,070; deaths, 307). Deaths from disease only were 272 in a
population of 42,070 or a rate of 6.47 per 1,000. The general death .:;
rate (7.30) was the lowest of record (1905-1932) except for the year ::
1930 (7.14). The death rate for disease only (6.47) was about 6 percent
higher than for 1931 (6.09) which was the lowest of record.
During the past five years the trend in death rates, both general and :
for disease only, has been a downward one as is evidenced by the "'".,
following comparison of rates by 5-year periods since 1913:
CANAL ZONE DEATH RATES BY 5-YEAR PERIODS

1913-17 1918-22 1923-27 192-32 .
Total death rates per 1,000 population .................... 13.91 8.10 8.28 7.69
Death rates from disease per 1,000 population ............. 11.90 6.82 7.19 Bi6 .
V

The population in the Canal Zone is only now becoming a somewhat
stabilized one. The new factor now beginning to influence the vital
statistics in this population is the advancing age of the employees with
a greater prevalence of diseases of the chronic degenerative type, par-
ticularly in the colored population.
It may be anticipated that death rates for a few years will have a
tendency to increase pending complete stabilization of the population.
Panama City.-Death rates from all causes (1905-1931) and those
for disease only (1913-1931) are incorporated in statistical tables and
presented graphically in the annual report for 1931 (pages 13 and 14).
The general death rate for 1932 was 15.90 per 1,000 of population
(pop., 77,500; deaths, 1,232) the lowest of record. The nearest approach
to this low'rate was attained in 1923-17.28 per 1,000 (pop., 64,000;
deaths, 1,106). The death rate for disease only was also the lowest of
record, 15.11 per 1,000 of population (pop., 77,500;deaths, 1,171). The
trend of these rates is shown in the following analysis of rates by 5-year
periods:
PANAMA CITY DEATH RATES BY 5-YEAR PERIODS

1913-17 1018-22 1923-27 1928-32
Total death rates per 1.000 population ................... 30.56 21.06 17-55 18.06
Death rates frm dipesea per 1,000 population............. 29.32 20.35 16.97 17.34

iIncrease in rates for the last 5-year period over those for the imme-
diately preceding'one resulted from excessively high rates for the years
1928 and 1929, 20.06 and 19.36, respectively, for all deaths and for
deaths from disease 19.44 and 18.37. Rates for the three remaining
years of the period were: All deaths, 1930, 17.57; 1931, 17.64; 1932,
15.90; deaths from disease only, 1930, 16.81; 1931, 16.76; 1932, 15.11.
For purposes of comparison it may be said that the general death rate
S for Manila, P. I., was 25.61 in 1931, for New Orleans, it was 17.7 in
1929, for Atlanta, Ga., it was 15.7 in 1929, and for New York City it
was 11.3 in 1929.
Colon.-In 1932 the death rate from all causes in Colon was
14.43 per 1,000 of population (deaths, 433; pop., 30,000) and for disease
.only 13.50per 1,000 of population (deaths, 405; pop., 30,000). The death
rate from all causes is the lowest of record save for the years 1922, 1923,
1925,: and 1927 (14.40, '12.78, 13.17, and 14.03) and that for disease
only is the lowest of record except for the years 1923, 1925, and
1927 (12.26, .12.45, and 13.40).
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Death rates from all causes and from disease only by 5-year periods
have been as follows:
COLON DEATH RATES BY 5-YEAR PERIODS

1913-17 1918-22 1923-27 1928--2
Total death rates per 1,000 population.................. 25.08 18.48 14.08 15.82
Death rates from disease per 1,000 population............. 23.85 17.40 13.41 15.01

It is.evident that the general trend since 1913 has been a downward
one though the rates for the last 5-year period (1928-1932) are some-
what higher than for the 5-year period of 1923-1927.

BIRTH RATES, CANAL ZONE, PANAMA CITY, AND COLON

In analyzing birth rates it is important for many reasons to have
knowledge not only of the total rate for the new born, but to know also
the rate of those born alive and of the stillborn. The data necessary-
for such tabulation are available since 1916 and were incorporated in
the annual report for 1931.

BIRTHS, CANAL ZONE POPULATION. (EMPLOYEES AND
NONEMPLOYEES)

In 1932 the total number of births in the Canal Zone was 492 in
a population of 42,070, or a rate of 11.69 per 1,000 of population. The
birth rate in the population in the Canal Zone has been decreasing every
year since 1924 when it was 21.65 per 1,000 of population. In 1932 the
rate per 1,000 of population for babies born alive was.11.38 (number,
479; pop., 42,070) and for the stillborn, 0.31 (number, 13; pop., 42,070).
The rate for the stillborn was much the lowest of record, only about
one-third of that usually experienced.
The striking decrease in birth rates in the Canal Zone since 1916 can
best be appreciated by comparing the average rates by 5-year periods"-
CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS

1918-22 1923-27 1928-32
Total birth rate per 1,000 population ................................. 23.69 18.73 13.23
Live birth rate per 1,000 population................. ............... 22.54 17.76 12.49
Stillbirth rate per 1,000 population.............. ................... 1.15 .97 .74 .

The marked decrease in birth rates during recent years is attribut-
able in large measure to the following factors: Advancing age of the
employees who entered service during the construction period; and a
large proportion of generation born in Canal Zone has not yet attained
maturity and married.

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That the increase in maternity welfare activities during recent years
is bearing fruit is evidenced by the gradual decline in the rates for the
stillborn.
The population of the Canal Zone is made up of two quite different
elements, (a) white American employees and their families, Army and
Navy officers and their families, Army and Navy enlisted personnel,
and (b) colored alien employees and agriculturists and their families.
The large number of unmarried enlisted personnel of the Army and
Navy (approximately 10,600 during 1932) results in an abnormally low
birth rate among the white population.
Since 1921 birth rates have gradually declined in both groups of the
Canal Zone population (see annual report, 1931, for details). Compar-
ing birth rates in 1932 with those of 1921 there has been a decline of
60 percent for white Americans and 54 percent for the colored popu-
lation. The rate of decline in both groups can best be appreciated by
comparing average rates by 5-year periods:
CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS

1918-22 1923-27 1928-32

White Colored White Colored White Colored
Total birth rate per 1,000 population........ 16.91 30.41 13.36 23 42 9.71 16.04
Live birth rate per 1,000 population......... 16.37 2&.65 12.89 22.01 9.39 14 96
Stillbirth rate per 1,000 population ......... .54 1.76 .47 1.41 .32 1.08

The average rates for the last 5-year period show a decline of 43 per-
cent for white and 47 percent for colored births compared with the
period 1918-1922. It may be anticipated that birth rates, particu-
larly those for the colored group of the population, will begin to increase
in the near future unless a considerable proportion of the younger
generation now beginning to attain maturity seek employment else-
W.here than in the. Canal Zone.
Panama City.-The birth rates per 1,000 of population for Panama
City for 1932 were: Total births, 32.32; live births, 31.01; stillbirths,
1.31 (pop., 77,500; total births, 2,505; born alive, 2,403; stillborn,
102).
The total rates for Panama City have been fairly stationary for the
past 12 years, with a slight tendency to decrease for the period as a
whole (see annual report, 1931). Increasingly larger numbers of pros-
pective mothers are now -admitted to hospital for confinement, and it
? is estimated that at the present time, of all births in Panama City, about
50 percent are born in Santo Tomas Hospital. The midwives, during
recent years,. have .been more closely supervised, and during the past

I- '' . .

.... ".. .... ....... .......

16

three years their work has been under the constant supervision of a '
visiting nurse with special training in midwifery. During 1932 a visit-
ing nurse service was established in Panama City, a supervising nurse
having been brought down from the United States to inaugurate this. ;
service and to train the groups of Panamanian nurses selected for this
duty. That these measures are beginning to show results is evidenced : :.
by the downward trend in the stillbirth rates which has been contin-
uous for the past two years. The rate for stillborn during 1932 was
the lowest of record. The trend of total birth rates, live birth rates,
and stillbirth rates is shown in the following averages of rates by
5-year periods for the past 15 years:
PANAMA CITY BIRTH RATES BY 6-YEAR PERIODS

1918-22 1923-27 1928-32
Total birth rate per 1,000 population................. .................... 38.72 34.03 31.60
Live birth rate per 1,000 population.......................................... 36.41 32.24 2.99 -
Stillbirth rate per 1,000 population.......................................... 2.31 1.79 1.61

Colon.-The birth rates for the city of Colon for 1932 were: Total.
births, 30.77; live births, 29.33; stillbirths, 1.43 (pop., 30,000; total
births, 923; born alive, 880; stillborn, 43).
The general trend in birth rates for Colon during the past five years i
has been to increase. Considering the rates by 5-year periods for the
past 15 years, the average for each period is as follows:
COLON BIRTH RATES BY 5-YEAR PERIODS

1918-22 1923-27 1928-32
Total birth rate per 1,000 population.............. ..................... 31.78 25.12 29.88
Live birth rate per 1,000 population .............................. ........ 29.89 23.70 38.1& .
Stillbirth rate per 1,000 population................ ........................ 1.89 1.36 1.42

INFANT MORTALITY RATES, CANAL ZONE, PANAMA CITY,
AND COLON .

The infant mortality rates per 1,000 of live births for the three...
groups of population concerned, Canal Zone, Panama City, and Colon,
for 1932 were as follows: :
Canal Zone:
Live births (absolute numbers)-
American (white), 147; alien (colored), 332; total, 479.
Deaths of children under 1 year of age (absolute numbers)- .
American (white), 3; alien (colored), 31; total, 34.
Rate per 1,000-- ..
American (white), 20; alien (colored), 93; total, 71.

Y '

Panama City:
Live births (absolute numbers), 2,403.
Deaths of children under 1 year of age (absolute numbers), 311.
Rate per 1,000, 129
Colon:
Live births (absolute numbers), 880.
Deaths of children under 1 year of age (absolute numbers), 61.
Rate per 1,000, 69.

The better to visualize any results being obtained in the reduction
of infant mortality rates in the three groups of the population con-.
cerned, the average rates for each group by 5-year periods are tabu-
lated below:
INFANT MORTALITY RATES FOR 5-YEAR PERIODS, CANAL ZONE AND CITIES OF
PANAMA AND COLON

Canal Zone
Period Panama Colon
White Colored Total
1918-22 ............................... 33 04 131.73 96.08 162.28 153.81
1923-27................................. 44.02 111.87 88.87 131.68 116.95
1928-32 .................................. 48.48 106.25 86.97 136 32 100 97

Canal Zone.-Infant mortality rates in the white American popula-
tion of the Canal Zone have been quite satisfactory, ranging between
18 and 59 per 1,000 live births for the years 1917 to 1932, inclusive,
except for 1928 when the rate was 94. For the colored population the
variation during the same period has been between 88 and 180 (see
annual report, 1931). The rates in the colored group were consider-
ably in excess of 100 (107 to 143) during the years 1926 to 1929,
inclusive, and since then have been consistently below 100 (93 to 96).
Efforts are being made to lower these rates through a visiting nurse
service. As a result of the low rate in the white American population
(20) .the general infant mortality rate for the Canal Zone for 1932 was
unchanged from the record low rate of 71 set in 1931.

Panamd City.-Considerable progress has been made since 1917 in
reducing infant mortality rates in Panama City. The rates for the
5-year period 1918-1922 averaged 162.28 per 1,000 live births, whereas
S for the 5-yfear periods 1923-1927 and 1928-1932 they had been reduced
to 131.68 and 136.32, respectively.

i.* Coln.-Excellent progress has been made in reducing the infant
Snortality rates in Colon. For the 5-year period 1918-1922 the rate
averaged 154, whereas for the.period 1928-1932 it had declined to 101.
MR 3S9SS-

i,!"7: ."*... : ". :

PRINCIPAL CAUSES OF DEATH, CANAL ZONE,
PANAMA CITY, AND COLON

It has been customary in the Health Department annual reports of
recent years to report the six principal causes of death from disease in
Panama Canal employees and in the populations of the cities of
Panama and Coldn. Commencing with the 1930 report, comparable
data for the entire population of the Canal Zone have been included.
The statistics for the past five years for the three population groups
involved, Canal Zone, Panama City, and Colon, are being included in
this report.
Principal causes of death, Canal Zone population.-The data on this
subject are incorporated in the following table:
SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE. CANAL ZONE POPULATION, 1928-1932
(ABSOLUTE NUMBERS AND RATES PER 1,000)
1928 1929 1930 1931 1932
Population.......... ............ ... 37,056 38,825 39,467 40,565 42,070
Rate Rate Rate Rate Rate
Disease Num- per Num- per Num- per Num- per Num- per
ber 1,000 ber 1,000 ber 1,000 ber 1,000 I
Tuberculosis (variousorgans). ... ..... 25 .674 34 .876 20 .507 19 .468 33 .784
Organic diseases of the heart............ II .297 15 .386 22 .557 ...... ... 20 .475
Cancer (various organs)...... ...... 16 .432 16 412 15 .405 15 .370 18 .428
A poplexy.... ....... ..... ...... ...... .. ...... .. .. ... ... ...... ...... 14 .333
Pneumonia (broncho and lobar)......... 36 .972 27 .695 30 .785 23 .567 14 .333
Syphilis.......... ... ..... ... .... 11 .297 11 .283 10 .253 11 .271 10 .238
Nephritis (acute and chronic)............ 19 .513 23 .592 21 .532 18 .444 10 '.238
Diseases of the arteries... .. .... ..... .. ....... .. ........ .... ...... 11 .271 ...........

Tuberculosis and pneumonia have usually taken the greatest toll of
life in the population of the Canal Zone; in 1932 tuberculosis was again
in first place, but pneumonia dropped to fifth place, being replaced by
organic diseases of the heart. Diseases of the chronic degenerative type
are being noted with greater frequency as principal causes of death.
It is of special interest to note that deaths from apoplexy and diseases
of the arterial system have occurred with such great frequency during
the past two years as to have become one of the six most frequent
causes of death (diseases of the arteries in 1931 and apoplexy in 1932).
Tuberculosis and the pneumonias affect the colored population to a
far greater extent than the white.
Principal causes of death, Panama City.-The six principal causes of
death in the population of Panama City for the past five years are
shown in the following table:
'*

SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE. PANAMA CITY, 1928-1932
(ABSOLUTE NUMBERS AND RATES PER 1,000)
1928 1929 1930 1931 1932
Population.......................... 71,500 73,000 74,402 76.000 77,500
Rate Rate Rate Rate Rate
Disease um- per Num- per Num- per Num- per Num- per
er 1,000 ber 1000 ber 1,000 ber 1,000 ber 1,000
Tuberculosis (various organs)........... 227 3.17 204 2.79 208 2.80 218 2.87 203 2 62
Pneumonia (broncho and lobar)......... 248 3.47 231 3.16 180 2 42 202 2.66 174 2 25
Diarrhea and enteritis, including colitis.. 117 1.64 148 2.03 98 1.32 135 1.78 104 1.34
Cancer (various organs)............... ............ 67 .92 59 .79 62 .82 69 .89
Nephritis (acute and chronic).......... 115 1.61 114 1.56 113 1 52 64 84 69 .89
Organicdiseasesof the heart............ 105 1.47 118 1.62 98 1.32 137 1.80 67 .86
Syphilis .............................. 48 .67 . ....... .. . .... ..
Tuberculosis and the pneumonias continue to be the leading causes
of death. Death rates from these two diseases are much higher in
Panama City than in the population of the Canal Zone. The death
rates from tuberculosis in the Canal Zone ranged between 0.51 and 0.88
per 1,000 population for the years 1928-1932, whereas comparable
rates in Panama City ranged between 2.62 and 3.17. The differences in
rates are attributable in large measure to housing conditions in Panama
City and the economic status of the populations affected.
A similar disparity will be noted between death rates from the pneu-
monias in Panama City and the Canal Zone. The very high rates in
Panama City as compared with the Canal Zone are attributable to the
factors cited in the case of deaths from tuberculosis.
Principal causes of death, Colon.-The six principal causes of death
in the population of Colon, for the years 1928 to 1932, are shown in the
following table:
SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 1928-1932
(ABSOLUTE NUMBERS AND RATES PER 1,000)
1928 1929 1930 1931 1932
Population............................ 30,000 29,850 29,765 30,000 3(1,000
Rate Rate Rate Rate Rate
Disease Num- per Num- per Num- per Num- per Num- per
ber 1,000 ber 1,000 ber 1,000 ber 1,000 ber 1,000
Tuberculosis (various organs) ........... 63 2.10 64 2.14 71 2.39 90 3 00 74 2.47
Pneumonia (bronoho and lobar)......... -68 2.27 63 2.11 49 1.65 51 1.70 46 1 53
Nephritis (acute and chronic)........... 23 77 30 1.01 41 1.38 24 .80 33 1 10
Organic diseases of the heart............ .......... 28 .94 32 1.08 32 1.07 30 1.00
Apoplexy ............ .......... ..... 19 63 28 .4 ..... .... 23 .77 27 .90
Diarrhea and enteritis, including colitis... 27 .90 31 1.04 34 1.14 26 .87 18 .60
Syphilis........... ..... .................. .................. 26 .87 ...... .. ... ......
Cancer (various organs) ................ 26 .87 ............ . ... ...... ... ...
It will be noted, as was the case in the other groups of the population
of the Isthmus, that the leading causes of death are tuberculosis and
the pneumonias.
The most interesting point to be noted is that the death rates from
both tuberculosis and the pneumonias are very materially lower in
Colon than in Panama City, the higher rate for tuberculosis in Colon
in 1931 being an exception. The average rates per 1,000 population
per annum for two 5-year periods from 1923 to 1932 are as follows:

AVERAGE DEATH RATES PER 1,000 POPULATION PER ANNUM, FOR S-YEAR PERIODS. 193-1937,::
AND 1928-1932, FROM PNEUMONIA AND TUBERCULOSIS
Panama C oln"
2. .... ...: .

Pneumonia, 1923-1927................... ............................. 2.89 1.
Pneumonia, 1928-1932............... .................................... 2.78 "::::
Tuberculosis, 1923-1927................................................. 2.96 2.38
Tuberculosis, 1928-1932................................................ 2.85 2.42
The factors responsible for this difference are not known with cer-
tainty. On the average, housing conditions in Colon are better tha' .,.
in Panama City. The rates for Panama City are artificially high due :
to the fact that the principal Panamanian Government hospital. ..
(Santo Tomas) is located in Panama City and patients treated in that
hospital who actually reside in the provincial districts not infrequently :
give a Panama City address as their place of residence. Efforts are
made to eliminate this factor of error, but so far they have not beenii '
completely successful.

ACUTE TRANSMISSIBLE DISEASES REPORTED IN 1932 '
Beginning with the annual report of 1929, a table was introduced
showing the number of cases of transmissible diseases reported to the
Health Department of the Panama Canal. The reports for the Canal
Zone are quite complete, but for Panama City and Colon they are not,
especially for the less serious diseases such as whooping cough, mumps,
etc. The cases reported during 1932 are incorporated in the following
table:
CONTAGIOUS AND INFECTIOUS DISEASES-CASES AND DEATH REPORTED TO THE
CHIEF HEALTH OFFICER DURING THE YEAR 1932
-- -- -- -- - *------- -- -- *- - *----------- .i .'**.. .. .
Reported place of infection
Outside the .
Panama Colon Canal Zone Zone and Total
Disease_ terminal cities__
New New New New New
cases Deaths Deaths cases Deaths Deaths e Deaths
Chiekenpox ......... 124 .. .. 29 ........ 47 ....... ...... ..... 220 ........
Diphtheria .......... 48 4 12 ........ 23 1 18 1 101 0
Dysentery, amebic... 11 2 2 1 3 2 11 4 27 9
Dysentery, bacillary
(unclassified).... 3 1 1 ........ 6 1 3 1 '13 3.
Malaria............ 72 2 23 1 719 1 431 31 1,245 3
Measles............. 113 9 173 ........ 88 1 16 2 390 ; iI
Meningitis, meningo-
coccus ... ............ .................. ......... ....... .. .. ......... .. .
M umpe.......... 2 ............... ....... 8 ........ 1 ........ I 11 ...
Pneumonia......... (,) 174 ( ) 46 (,) 14 (*) 39 () 278
Poliomyelitis ........ 1 ........ 4 ........ 2 2 ........ ........ 7 2
Relpasingfever...... I .... .. .... .. ..... ............... 2 .... ... .........
Scarlet fever........................ 3 .. 7 1 1 .... .. 11
Trachom a.................. .... ..... ......... ... ................. .. ... . .. .....
Tuberculosis ........ (a) 203 () 74 () 33 (*) 9 (
Typhoid fever....... 2 1 3 ....... 4 1 9 4 18 i
Paratyphoid fever....................... . ........ .. ... .. ..... .. ............ .. ... .. .. ... .
Whooping cough..... 12 3 13 ........ 39 ........ 7 ........ 71
Maritime Quarantin-
able diseases
Cholera............ ..................................... .....
Leproy.. ......... 7 3 ........ ........ 2 7 1 14 7 ......:
Plague ....... ...... ............ ..... .. ... ........... ...... .. ..... ......... ... ....
SY llpoxf. .................. .. .... ...... .. ............ ... ....... .. ... ... .
Typhellow fever........ ...3 ......................... ............. ................. .
Typhusfever .........'3
A As many cases of pneumonia and'tuberulosis are not reported until death occurs, this report shows oly the "'
number of deaths from these two diseases.
SSporadic cae which in some respects resembled clinically mild typhus as it occur in the Uited StaW (iil
disease), giving positive Weil-Feli reaction.
1 "::.. ,: .

This table gives one a definite conception of the type of transmissible
diseases that are most commonly encountered in this region. In
general terms the data show the following facts so far as the populations
of the Canal Zone, Panama City, and Colon are concerned.
The so-called intestinal group of diseases (typhoid and para-typhoid
fevers and the dysenteries) are of rare occurrence. The fatality rate
in diphtheria is very low. While measles is of not uncommon occur-
rence it is but seldom complicated by pneumonias and the fatality rate is
low. Scarlet fever and meningococcus meningitis but rarely occur and
usually a considerable proportion of the few cases of meningitis en-
countered are confined to military personnel, the disease having been
contracted in the United States (recruits en route to foreign service).
In cities so closely surrounded by a large rural population heavily in-
fected with malaria the difficulties in deciding as to the place of infec-
tion with malaria parasites are obvious. Evidence collected indicates
that the cases of. dysentery reported from Panama and Colon are con-
tracted in the provincial districts of the Republic. Pneumonia and
tuberculosis are very common, with high fatality rates.

VITAL STATISTICS, PANAMA CANAL EMPLOYEES
Statistics covering this particular group of the population are quite
complete. Force reports showing total number of employees are con-
stantly available, and when time is lost on account of illness, record is
made of that fact. Reports of diagnosis of cases in quarters on account
of convalescence after hospitalization or on account of minor complaints,
ordinarily are not recorded in morbidity reports, except in the case of
malaria. Malaria constitutes the most important cause of noneffec-
tiveness in employees and all clinical cases requiring treatment by a
physician (hospital or quarters) are made the subject of a special report
and included in the statistics on malaria, in data relating to admission
rates to hospitals and quarters and in noneffective rates.
In August 1930, a new policy was put into effect that should have a
tendency to reduce the malaria rates among employees. In large
construction projects in nonsanitated areas, much of the labor is drawn
from nearby villages, sometimes as high as 50 percent, and a consider-
able number of the laborers from such sources are carriers of the mala-
rial parasite but have no clinical symptoms. Formerly, not until these
laborers became ill, and upon being sent to the District Physician were
found tb have malaria, did they receive treatment for it. The new
policy consists of making .routine monthly malaria blood surveys of
laborers engaged on such projects, and administering quinine regularly
to those found to be positive, irrespective of the fact that no clinical

symptoms were noted. It can be assumed that a certain proportion
(just what proportion we do not venture to estimate) of the individuals
so treated would, if not treated, come down with subjective or ob-
jective symptoms of malaria at one time or another. The individuals
found positive for malaria in this group, practically all of whom are
residents of native villages and employed temporarily by the Panama
Canal, are not included in the Health Department malaria statistics
unless they become ill and lose time from their work on account of
malaria.
It should also be pointed out that statistics relating to employees are
not representative of a homogeneous geographical group of the popu-
lation. The American white employees of the Canal reside in the Cainal
Zone under hygienic and environmental conditions that are quite
satisfactory. The Panama Canal, however, employs approximately
9,200 colored alien individuals only about one-third of whom live in
the permanent towns of the Canal Zone, the remainder, with their
families, living in Panama City, Colon, and elsewhere, under much less
favorable hygienic conditions.
In the interpretation of statistics relating to employees, it is there-
fore necessary to give consideration to the factors outlined above, as
well as to those mentioned in the introductory paragraphs on vital
statistics in this report.
EMPLOYEES, GENERAL DEATH RATES, ALL CAUSES
The general death rate for employees for 1932 was 8.95 per 1,000
employees (number employed, 12,621; deaths, 113) the lowest since
1926.
Since 1921, the general tendency has been for death rates for employ-
ees to increase, the rates for 1931 and 1932 having been exceptions,
The rates during the early construction period were high (1906-1910,
18.63). After completion of the Canal when the population became
stabilized and the employees were still comparatively young, the death
rates attained their lowest ebb (1921-1925, 7.23).
During recent years the average age of this group has gradually
increased, a larger proportion of individuals are becoming disabled with
and dying as the result of diseases of the so-called chronic degenerative
type, and the general death rates are gradually increasing (1928-32,
9.24).
EMPLOYEES, DEATH RATES, DISEASE ONLY
Death rates from-disease only for all Panama Canal employees and
the racial distribution of these rates (white and colored) are incorpor-
ated in the following table:

EMPLOYEES, DEATHS FROM DISEASE ONLY
ABSOLUTE NUMBERS AND RATES PER 1,000, WHITE, COLORED, AND TOTAL

Number of deaths Death-rate per 1,000,
Number of employees from disease only disease only
Year
White Colored Total White Colored Total White Colored Total
1906.... 6,106 21,441 26,547 '19 1,024 1,043 3.72 47 76 39.29
1907 ... 10,604 28,634 39,238 97 848 945 9.15 29 62 24.08
1908... 12,383 31.507 43,890 90 291 381 7 27 9.24 8.68
1909... 11,662 35,505 47,167 75 281 356 6.43 7.91 7 55
1910... 13,021 37,781 50,802 64 317 381 4.92 8.39 7.50
1911.... 12,251 36,625 48,876 72 30 374 5 88 8.25 7.65
1912.... 12,553 38.340 50,893 58 266 324 4 62 6.94 6 37
1913.... 11,943 44,711 56,654 43 254 297 3 60 5.68 5 24
1914... 7,024 37,305 44,329 47 265 312 6.69 7 10 7.04
1915... 4.719 30,066 34,785 15 126 141 3.18 4.19 4.05
1916.... 4,552 28,624 33,176 15 137 152 3.29 4 79 4.58
1917.... 4,814 27,775 32,589 22 165 187 4.57 5.94 5.74
1918.. 4,408 21,112 25,520 16 166 182 3.63 7 86 7.13
1919.... 4,523 19,681 24,204 8 142 150 1.77 7.21 6 20
1920.... 4,688 15,985 20,673 17 136 153 3.63 8.51 7.40
1921.... 3,855 10,534 14,389 10 72 82 2.59 6 83 5.70
1922 ... 2,827 7,620 10,447 10 54 64 3.54 7.09 6 13
1923.... 2,846 8,130 10,976 15 52 67 5.27 6.40 6 10
1924 ... 3,055 8,570 11,625 13 51 64 4.26 5.95 5 51
1925 ... 3,123 9,057 12,180 9 85 94 2.88 9 39 7.72
1926... 3.121 9,611 12,732 IS 77 95 5 77 8 01 7.46
1927.. 3,197 10,364 13,561 19 87 106 5.94 8 39 7 82
1928.. 3,308 10,952 14,260 19 112 131 5 74 10 23 9 19
1929 3,505 12,688 16,193 23 128 151 6 56 10 09 9.33
1930.. 3,589 11,935 15,524 27 148 175 7 52 12.40 11 27
1931.... 3,551 11,046 14,597 21 96 117 5.91 8.60 8 02
1932... 3.387 9,234 12,621 15 87 102 4.43 9.42 8 08

Americans only.

The death rate for white employees in 1932 (4.43) was the lowest
since 1925. For colored employees, it was well below the average of
the latest 5-year period, but higher than the 1931 rate.
The above table discloses an interesting point. During the 27-year
period, death rates for white employees were lower than for colored
without an exception, and markedly so in many instances. This
difference is further emphasized by comparing the average annual
rates by race, by 5-year periods:

Year 1913-1917 1918-1922 1923-1927 1928-1932
White employees ............... .................... 4.30 3.00 4.82 6.06
Colored employees......................... .......... 5.62 7.61 7.70 10.22

The average death rate for colored employees for the last 5-year
period was 69 percent higher than for white employees. The compara-
tively low rates in white employees are attributable to many factors
favorable to such employees, among which may be mentioned: Rates
of pay, scale of living, physical stamina, intelligence, education, hygiene
and sanitation in the home and immediate environment, and return
to the United States after becoming disabled. Another important
factor is that while in both racial groups the average age has gradually
increased to such an extent that diseases of the so-called chronic
degenerative type are becoming more common, they are affecting the
SI

24
."" l "" ::
colored employees proportionately to a greater degree than white em- :::iiif
ployees, and increasingly larger numbers of colored employees are .i
dying of such diseases while still in active service. .
It is to be noted that in recent years death rates in both groups of ';.
employees are attaining higher levels, although the 1931 and 1932 rates
are notable exceptions. The diseases which caused the greatest mor-
tality in 1932 were: Tuberculosis, 17; organic diseases of the heart and
arteriosclerosis, 9 each; syphilis, pneumonia, and nephritis, 8 each. .
Tuberculosis, arteriosclerosis, organic diseases of heart and disease of
coronary arteries caused more deaths in 1932 than in 1931, whereas
syphilis, pneumonia, nephritis, and cancer proved less fatal, especially
pneumonia.

ADMISSIONS TO HOSPITALS AND QUARTERS

The admission rate to hospitals and quarters was 725 per 1,000
employees. This rate has been increasing each year since 1926 (1926,
474; 1932, 725) and is attributable to gradual increase in the age of
those employed (greater prevalence of diseases of the chronic degenera-
tive type).
The admission rate per 1,000 to hospitals for disease by race (white
and colored) has been as follows for the past five years:
ADMISSION RATE PER 1,000 EMPLOYEES, BY RACE (WHITE AND COLORED)

1928 ......... ................................. ........................... 240 128"
1929 ......................................... ........................... 273 154
1930 ............ ...... .... .. .... ......... ................. 288 180
1931...... ... ........... .. .. .. ... ........................... ...... 310 187
1932 ..... .. .......... ..... .. ....................................... 310 .171

PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES TO HOSPITALS

The six diseases causing the greatest number of admissions of em-.
ployees to hospitals during the past five years are incorporated in the
following table:
EMPLOYEES, PRINCIPAL CAUSES OF ADMISSION TO HOSPITALS

1928 1929 1930 1931 1932
Diseases Rate Rate Rate Rate Rate
Total per Total per Total per Total per Total pe
1,000 1,000 1,000 1.000 1O000
Malaria (including the few cases treated
in quarters).............. ...... 203 14 337 21 410 26 276 19 177 1X
Arteriosclerosis ....................... .... ...... ...... .... ... .. ...... ...... 4 10
Diseases of pharynx and tonsils......... 121 8 184 11 136 9 153 10 97 8
Diseases of eyes and annexa............. 103 7 113 7 ............ 131 9 81 6
Influenza.... ............. ............ ...... ..... .... .... ... .......... 79 .6 . :
Acute abscess ...................... ... ...... 109 7 106 7 .... ..... 77
Diseases of nasal fossae and annxa....... 49 4 153 9 ............ 270 19 ........ '. i
Gonococcus infection................. 94 7 121 7 130 8 106 7 ...... ...
Syphilis............. ................ 70 5 ............ 150 10 114 8 ........ ..
Ankylostomiasi.................. ............ ......113 7 .... ....

.. .. i::ll.:

..": ". :;;:

NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES

The noneffective rate for 1932 was 17.06 per 1,000 employees. This
rate is gradually increasing, the rate for the 5-year period, 1923-1927,
having been 13.39 per 1,000 employees, as compared with a rate of 15.46
for the 5-year period, 1928-1932.

ADMISSION RATES, MALARIA, HOSPITAL AND QUARTERS, EMPLOYEES

Malaria is the most important disease prevention problem in which
the Health Department is engaged. Every effort is made to diagnose
and report in morbidity statistics all clinical cases seen by Panama
Canal physicians. Statistical records of cases of malaria occurring in
employees are the most accurate and complete that are compiled for
any special group of the population residing in the Canal Zone, except
military personnel, as employees absent from dufttnust secure a cer-
tificate from a physician to cover absence on account of illness in
order to be paid for time lost.
The admission rates per 1,000 per annum for all employees for the
years 1906 to 1932, inclusive, are incorporated in the following table:
MALARIA CASES, EMPLOYEES ONLY
Absolute numbers and rates per 1,000 employees
Average Number Rate
Year number of per
employed cases 1.000

1906 26,547 21,795 821
1907 39,238 16,637 424
1908 43,890 12,372 282
1909 47,167 10,169 215
1910 50,802 9,487 187
1911 48,876 8,987 184
S 1912 50,893 5,623 110
1913 56,654' 4,284 76
1914 44,329 3,635 82
1915 34,785 1,781 51
1916 33,176 547 16
1917 32,589 473 14
1918 25,520 472 18
1919 24,204 752 31
1920 20,673 401 19
1921 14,389 214 15
1922 10,447 176 17
1923 10,976 212 19
1924 11,625 190 16
1925 .12,180 330 27
1926 12,732 179 14
1927 13,561 145 11
1928 14,260 203 14
1929 16,193 337 21
1930 15,524 410 26
1931 14,597 276 19
1932 12,621 177 14 I

In the annual report for 1931 the local situation with respect to
malaria, the influence on its occurrence of large construction projects
in nonsanitated areas, and the control measures instituted in construc-
tion camps, were discussed somewhat in detail.
The malaria rate in employees, when normal conditions obtain and
when no large construction projects beyond the so-called permanently .
sanitated areas are under way, varies from about 14 to 19 cases per
1,000 employees per annum, dependent on the character of the malaria
season. Occasionally it happens that during the season of rains natural
conditions are such that great curtailment in the breeding of mosqui-
toes occurs with a consequent enormous reduction in density of the
mosquito population. When nature interposes these barriers the -
malaria rates are abnormally low as was the case in 1927, when it was
only 11 per 1,000. In 1930 the situation was apparently reversed and
the rates rose to i, though more than half of the increase was attribut-
able to the occurrence of malaria in employees engaged in large con- _
struction projects outside the protected areas.
In 1932 the rate was only 14, this notwithstanding that large labor
gangs were engaged in road building (Thatcher Highway) and-con-
struction activities (Madden Dam) outside the protected areas and
that with the opening of highways into the interior of the Republic of
Panama, increasingly larger numbers of American employees and their
families were exposing themselves to and contracting malaria through
.week-end and other visits to resorts in the provincial districts of.
Panama.
There is but little doubt that had conditions in 1932 been the same
as in 1927 (lack of highways into the interior of Panama and no large
construction projects beyond the sanitated areas) the rate would have
been as low as and probably less than in 1927 (11 per 1,000) which is
the lowest of record. The probable correctness of this statement is
supported by the following data:
Excluding from consideration the cases of malaria occurring in em-
ployees engaged in field projects outside the permanently protected
areas the rates for the following years were as follows: 1925, 16.5; 1926,
14.1;1927, 10.7; 1928, 13.7; 1929, 13.7; 1930, 18.5; 1931, 16.1; 1932, 13.0.
In 1932 the malaria rate in white employees was 20 per 1,000 and in
1931 only 18. Comparable rates in colored employees were: 1932, 12;
1931, 19. The increase in rates in white employees in 1932 over 1931
was undoubtedly due to exposure to infection in nonsanitated areas,
most of which was unnecessary and against which employees had been ,,.
warned. Our records show that in 1932, 69 white American employees
had attacks of malaria. Of this number, the history of the movements

..... [
:s

of the individual prior to the appearance of clinical symptoms indicates
that 56 contracted the disease through exposure to infection outside
protected areas. In 1931 and 1932 a number of employees built more
or less substantial houses in a village on a beach about 60 miles from
Balboa (Pacific coast) with a view to using them during vacations and
for week-end visits. The Health Department was not consulted as to
health conditions in that particular locality. It is known to be a par-
ticularly undesirable location from the viewpoint of malaria. One
malaria blood survey of a representative sample of the native popula-
tion of the village (New Gorgona) made in the fall of 1932, showed an
infection rate of 56 percent (number examined, 76; number positive for
malaria, 43). Our malaria records for 1932 show that 14 white Ameri-
can employees and 13 members of their families (total 27) contracted
the disease at this one place (New Gorgona Beach).
Incidentally it is worthy of note that one employee who contracted
the disease at New Gorgona during the Christmas holidays in 1932
died of malaria in January 1933 (treatment not sought until in a coma-
tose condition).
Analyses of malaria rates in this area and investigations of the sources
of infection, extending over a period of many years, emphasize that one
must be most conservative in attributing seasonal reductions or in-
creases in rates to one factor or another. Many factors must be given
consideration, some of which are known and others unknown, and it is
difficult to evaluate the importance of each. Extended observations
indicate that the breeding habits of the malaria transmitting mos-
quitoes, variations in amounts and spacing of rainfall, and changes in
local flora, influence greatly the density of the mosquito population and
that these factors vary greatly from year to year. It also has become
evident that dispersal flights of malaria transmitting Anopheles as well
as other species of mosquitoes, at the beginning and end of the season
of rains, extend over wider areas and for greater distances than were
thought to be the case some years ago. All these factors are being
studied continuously.

DEATH RATES, MALARIA, EMPLOYEES
The death rates from malaria, Panama Canal employees, 1906 to
1931, were tabulated and shown graphically in the annual report for
1931. No deaths of employees from malaria occurred in 1932.

DIVISION OF HOSPITALS, DISPENSARIES, AND CHARITIES
The units comprising this division and the scope of the activities
undertaken by them were described in the annual reports for 1930 and

28

1931. There was no change in the number or activities of such units :
during 1932. Brief reports of certain of these units follow:

GORGAS HOSPITAL
(Normal capacity, 880 beds)
Col. ORVILLE G. BROWN, Medical Corps, U.S. Army, Superintendent :.
During the year, there was no new building construction. The
routine work of maintenance and repair of buildings and equipment was
performed by hospital artisans.
Cases treated.-There were 11,330 admissions during the year, with.a
total of 149,812 patient days, making an average of 13.22 days spent
in hospital per patient. The average number of beds occupied daily
during the year was 409.05.
Surgical service.-There were 1,996 major operations (with 29 deaths)
and 4,201 minor operations (with 4 deaths) performed during the year;
482 obstetrical cases were delivered, in which there were 10 twin births
and 19 stillbirths; 9,544 patients received treatment in the out-patient i
clinic.
Medical service.-During the year, 5,381 patients were treated in the
medical wards. In addition to the hospital service, 8,300 patients were
treated in the out-patient clinic.
Eye, ear, nose and throat services.-There were 10,933 visits to the
out-patient department; 2,122 operations were performed and 1,543
refractions were done.
Radiographic service.-There were 6,672 cases, for which 16,360 films
of various sizes were used, and in which 894 fluoroscopic examinations
were made.
Dental service.-There were 5,622 sittings during the year; 1,595 oral
examinations and surveys, 2,364 teeth extracted; 318 complete and
918 partial X-ray examinations.
Physio-therapy service.-Treatments were given to 1,604 out-patients
and 1,087 hospital in-patients, during the year.

BOARD OF HEALTH LABORATORY
(Operated in connection with Gorgas Hospital)
Dr. L. B. BATES, Chief of Laboratory

Bacillus typhosus.-Recovered in blood culture from 11 individuals :
and from stool specimens of 1 other; 4 of these lived in Colon City, 3 ::
were transients, 2 lived at Madden Dam, 1 in Panama City, and 1 in
La Boca. In addition, B. typhosus were recovered repeatedly from stool -.,A
.H:.:i'

29

specimens of a 22-month old colored infant who ran a typical course of
typhoid fever. This child lived on leased land in the Canal Zone away
from main settlements.
Typhoid carriers.-On December 31, 1931, there was only one B.
typhosus carrier, H. B., under sanitary surveillance. His stool speci-
mens were examined nine times during the year and found positive three
times. No new carriers were found during the year.
Typhusfever.-G. T., Gorgas Hospital number 338407, age 33, white,
female, lifetime resident of Panama, ran a fairly definite course of ty-
phus fever, in the hospital. On the tenth day of the disease her blood
serum, in a dilution of 1-320, agglutinated B. proteus X1g. Four days
later her blood serum, in a dilution of 1-640, completely agglutinated
a culture of Xis.
C. de la O., Panama Hospital number 24572, age 12, white, female,
lifetime resident of Panama, also diagnosed typhus fever, gave a three
plus positive Weil-Felix reaction in a dilution of 1-160 and a one plus
reaction in a dilution of 1-320 and 1-640.
M. H., Panama Hospital number 24575, age 50, white, female, life-
time resident of Panama, diagnosed typhus fever, gave a positive Weil-
Felix reaction first in a dilution of 1-20 and seven days later in a dilution
of 1-160.
Reports.-Approximately 40,500 reports not including duplicates
have been made.

BACTERIOLOGICAL PROTOZOAL AND MISCELLANEOUS EXAMINATIONS
Total
B lood cultures ................................................................................... 247
Positive for B. typhou (Eberthela yphi)....... ......... ............ ...... ... ....... 10
Positive for B. pratyphsus B (Salmonlla schot.mullei). ................. ............ I
Positive for Staphylococus areuus......... ........... ............................... 10
Positive for Streplococcue iridans .................................................... 3
Positive for Peumococcus (Diplococcus pneumoniae)... ................................. 1
Positive for B. coli (Genus Eacherichia)................................................ I
Stools cultured for typhoid-dysentery group............................................................. 1.017
Positive for B. iyphosua (Eerihella tphi) on patients...................................... 23
Positive for B. gyphosau (EbLhells lyphi) on carriers..................................... 3
Positive for B. dysenteris, Group II (Shigell paradysenteriae).............................. 13
Urines cultured for typhoid group.......................................................... ...... 626
Positive for B. lphos erthella yphi) ................................................ 3
Positive for B. parafphoa B (Salmonella seotmulloen )....................... ...........
U rines cultured for orgams other than typhoid group.............................................. 593
Positive for B. c (Genus Escherichia)................................................. 160
Positive for B. coli and gram poitie cocci ..............................................
S Positive for Stapphylocca cusa ...................................................... 12
S Positive for Staphylococcus ares. ..................................................... 4
Positive for SretocoEua (emolytic).......... ......................................... 1
Positive for Streptooccus anhaemoyicus ................................................ 1
Positive for B. pyoynews (Pseudomonas aerginoa) ................................... 2
: Throat cultures for B. diphtheriae (Corynebacterium diphtheria) .............................. ........... 1,140
S itive for B. diptheriae (Corynebaderium diphlheriae).................................. 90
N a taltures for B. dip heriae (Corybacterium diptheriae)......................................... 561
ve for B. di phherie (Coraynebaotrium diphthriae) .................................... 43
That eutarea for gnim other than B. diphtheria (Cornebaterim diphtherie) ...................... 2
PeiAdve f S~1P eow aurm..........................................................
P .liJ Sefr o sea ridans....................................................... 2
; b Bli tw-fr (hoa m d ) ..................................................... 4
li*a feuti i...................................................................................... 19
.1ceus t .........................................................
PabvAf&o Bbe u ( .swwl..................................................... 3
obn i t (Gnuas sh ).................................................. 1

.ii

30

Total
E ar caltures......... ........... .. .. . ..... . ................... ........... 4
Sputum cultures .......................... ........ ................ 33
Positive for Streptococcus viridana ....................................................... 2
Positive for Pneumococcus Type IV (Diplococcus pneumoniae, Type IF)..................... I
Spinal fluid cultures .............. ...................................... .. ....... ......... 12
Positive for Pneumococcus (Diplooccus pneumoniae) ........ ............................. 4
Positive for Pneumacoccus Type I (Diplococcus pneumonia Type I)......................... 2
Positive for Pneumococcus Type Ill (Diplococcus pneumoniae Type 11) ...................... 1
Surgical tissues cultured .................. .................................................... 2
Pleural fluid cultures... .................................... ...................... ..... ... .. a
Positive for B. tuberculosis (Mycobarterium tuberculosis) .................................. 1
Knee fluid cultures. ........................................ ... ............................ 24
Gland cultures..................... ... ....... .... ................................. 2
Cultures from skin lesions ............................................................. ........ 16
Positive for Staphylococcus aureus....... ....... ................. ...... ........ 5
Cultures of pus from various sources.................. .................................. 23
Positive for Staphylococcus aureus............................ .................... 2
Autopsies cultured................. .................... . .................................. 40
Organs, exudates, etc............. .................................................... 38
Bile cultures ........................................................ .......... ............
Darkfield examinations .............................................................. .......... 3
Positive for Treponema pallidum............ .................................. 2
Darkfield examinations for yaws................... ................................................
Conjinctival smears........... ... .............. ......................................... 61
Positive for Gram negative intracellular diplococcci......................................... 10
Ear sm ears....... ........... .................................................. ... ...............
Cervical gland smears ................. ............. ...... .......................... ........ .3
T hroat sm ears............... .................................... ................. ........ 59
Positive for fusiform bacilli and spirilla of Iincent's angina (Borrelia vincenti and Fusiformis
dentium)...... ........................................................... 10
Sm ears from venereal lesions................................. .. .................. .............. 1
Positive for spirilla similar to those found in Vincent's angina ............................... 1
Rectal smear ...... .. .. .... .. ..... ...................................... 1
Positive for Gram negatire'intracellular diplococci........................................... 1
Urethral smears .................................................................. ......... 35
Positive for Gram negative intracellular diplococci......................................... 4
Vaginal and cervical smears ........................................................ .............. 13
Vaginal sm ears..... ........ ...... .. ............... ..................... ................... 50
Positive for Gram negative intracellular diplococri........................................ 12
Sputum smears for B. tuberculosis (Mycobacterium tuberculosis)........................... ......... 48
Positive for B. tuberculosis (Mycobaclerium tuberculosis)................................... 13
Urine for B. tuberculosis (Mycobacterium tuberculosis)................................................ 10
Spinal fluid for B. tuberculosis (Mycobacterium tuberculosis)............................................ 78
Positive for B. tuberculosis (Mycobacterium tuberculosis) .................................. 2
Cell count of spinal fluids.... .......................................................... .. ..... 2
Examination of leper suspects .................................................................... 18
Positive for B. leprae (Mycobacterium leprae).................................................... 9
Pure nerve type, negative for B. leprae (Mycobacterium leprae)............................. 2
Clinically leprosy................. ................................................. 1
Examination of lepers previous to parole................................. ............... ........ 1
Examination of paroled lepers..................................................................... 4
Positive for B. leprae (Mycobacterium leprae) ........................................... 2
Autogenous vaccines prepared..................................................... ............... 43
Feces examined for parasites and ova........................................................... 118
Positive for Endamoeba histolytica......... ............................................... 3
Positive for ova of Taenia nana......................................................... 1
Positive for ova of Trichuris trichiura.......... ....................................... .. 5
Positive for ova of Ascaris lumbricoides..... ........... ............................ 1
Positive for ova of A caris lumbricoides and Triehuria trichiura............................. 1
Positive for ova of Uncinaria. Ascaris and Trichuris trichiura .............................. 1
Blood platelet counts............................................ .... .... ..... ..... .... 7
Differential counts................... .. ......................................................... .
Red blood counts............................................................................
White blood counts................................................................. ......... 2
Hemoglobin estimations.......... .......................................................... 1
Blood films examined fof malarial parasites.......................................................... 411
Positive for Tertian malarial parasites................................................. 159
Positive for E. A. malarial parasites.................................................... 154
Positive for Quartan malarial parasites ....................................... ......... 5
Positive for Tertian and Quartan malarial parasites combined ...............................
W ater.... ............... .... ....... ............................. .................... 1,121
Ice examined for bacterial count and B. coli......................................................... 6
Washing powder "Swift's Pride"............ ...................................................... 1
Foodstuffs examined:
Army emergency rations.................................... ......................... .... 9
Cream cultured for bacterial count............. ....... ............... ......................... 5
Ice cream cultured for bacterial count....................................................... 90
Milk cultured for bacterial count (dairy) .............. ......... ............................ ........ 649
Sausage cultured for food poisoning organisms.............. ................................ 1I
Soda water cultured for B. coli and bacterial count.......... ... ................... .. 198 ".

SEROLOGICAL EXAMINATIONS

W aaermano tests .......... ............................................................ ........
K ahn test ......................................................................................
Agglutination te ts ....................... ...................................... .................
Positive with B. fyphoss (EbertheUa lyphi) ................................ .............. 4
Positive with B. paralyphosus A (Salmonela schottmuleri) .......... ..................... 1
Positive with B. proleus X, (Proteus vulgarial.................................... ... 6
Fragility tested .... . ................................................ ..... ................
Blood typing for transfusion................. ...................................................
Examination of blood for coagulation time.................. .......................................
Examination of blood for bleeding time ............... ............................................

Total
18,827
1.519
246

14
53
4
I

Analysis of Wassermann reactions.-17,979 Wassermann tests were
performed on the blood of 13,569 persons. The results are summarized
below:

TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1932

Individuals I s Total Percent of
Race, se, and status Individuals Individuals individuals, individuals
positive negative tested positive

White, civil:
Males........... .. .................... 83 1,885 1,968 4.2
Females. ................. ........ ........... 27 511 538 50
Children................... .................... 2 37 39 5.1
Total........ .............................. 112 2,433 2.545 4.4
White, military and naval:
Soldiers, continental United States ................... 165 3,769 3,934 4.2
Sailors, U.S. Navy................................ 21 208 229 9.2
Total...................... ................. 186 3,977 4,163 4 5
Black and mulattoes:
Males......................................... 537 2,955 3,492 15.4
Females............................... .......... 333 2,743 3,076 10.8
Children....... ................................. 12 204 210 5.6
Total....................... ............... 882 5.902 6,784 13.0
Chinese, males and females............................ 8 69 77 10.4
Grand total.................................. 1,188 12,381 13,569 8.8

In addition, Wassermann tests were made on 848 spinal fluids taken
from 562 individuals. The results are summarized below:

Individuals positive....................... ........................................ .......... 71
Individuals negative................... .......................................... ......... 491
Total individuals tested............. ........................... ........................ ....... 562
Percent of individuals positive........... ............... .................... ................... 12.63

pi..

"*S

32 e

THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH
LABORATORY, 1904 to 1932 *

SMI.

5 -
Year "1

1904 ....... 6 1 1 .... .. ... ... .. ..... .... ... ....... ...... . ....... ... .... ..
1905 ........ 269 60 9 27 3 8 5 3 9 ...... 2 .......
1906....... 509 11 22 50 24 23 39 15 33 ....... 2 .....
1907....... 496 156 35 27 40 27 36 12 58 4, 4 1
190....... 361 59 63 46 26 25 23 14 ..... 7
1909........ 295 55 37 26 32 31 17 ... 1 5 .......
1910....... 509 191 220 5 2 30 37 3 16 130 6 4
1911........ 49608 83 102 41 38 36 19 20 1 11 .......
1912........ 425 53 76 23 37 27 15 23 2 6 7 1. 2
1913........ 460 47 8 21 34 26 3226 5 23 12 1 5
1914....... 375 36 78 6 38 12 6 27 5 14 3 4
1915......... 328 83 102 41 38 36 1 20 12 5 12 15 1
1916........ 3 23 25 81 8 17 20 7 10 6 9 1
1917....... 330 47 89 21 31 23 3 18 1 3 12 11
1918........ 253 38 68 6 6 12 27 5 14 35 -
1915......... 324 28 55 31 25 1 4 3 20 3 10 10 9
1920......... 323 2 5 81 8..... 219 I 5 16 ....... 15
1921........ 289 14 537 4 16 5 8 17 2 4 7 2
1922........ 22 14 29 5 19 9 4 9 3 6 10 145
1923........ 205 6 55 3 9 9 5 12 2 1 11 M
1924........ 263 14 33 3 29 10 4 21 1 3 13 15
192.......... 306 1 34 7 38 11 3 17 1 3 16 14 7 2
1926........ 282 14 32 5 32 9 2 .....3 6 13 2
1927........ 358 27 22 10 35 17 39 1 2 1 21
1924.........263 14 33 3 29 10 4 21 1 3 13 12
1925.........306 15 34 7 38 11 3 18 1 3 16 17
1926.........282 14 32 5 32 9 2 11i ....... 5 13. 25
1927.........358 27 22 10 35 17 3 19 2 1 21 28
1928........ 436 45 40 8 40 20 3 13 2 10 19 46
1929........ 453 40 44 6 48 21 5 10 4 11 23 37
1930........ 375 26 40 2 45 26 1 23 3 1 15 48
1931........ 388 31 34 11 68 16 3 20 1 10 17 41
1932........ 348 12 41 4 39 8 4 29 1 1 16 28
Total... 10,012 1,232 1,375 423 828 505 266 457 194 160 286 411

This includes 32 cases of influenza.

The annual report for 1930, page 54, contains a table showing the
number of autopsies performed for the years 1904-1930 in certain
diseases that but rarely come to autopsy in this area. The additions
to this table for 1932 were as follows: Yellow fever, 0; beriberi, 0;
ankylostomiasis, 0; tetanus, 1; infectious diseases of children, 4; plague;
0; smallpox, 0.
Percent autopsied.-575 bodies (not including 47 for storage only and 7
disinterred) passed through the laboratory; 348, or 60.52 percent were
autopsied.

Malaria carriers found at autopsy.................................................................. 31
Syphilis found at autopsy (cases)............................................................ ........ 39

Intestinal parasites found at autopsy.- 13 cases in 348 autopsies per- .
formed at the laboratory, or 3.74 percent, showed one or more parasites
or their ova, as follows:

Asearis................................... 9 Endamoeba histolytio .............: ......... 1
Uneinaria ................................. 3 Oxyuris vermioularis......................... 1
Trichuris ......... ................... 2 Triehoeephalu ............................
Trichuris trichiura .......................... I

33

S: Multiple infections occurred as follows:

Iuneinaria and trichocephalus. .............. .......................................... ..........
SAsaris, Trichuris and Uncinaris ............. ........................................................ 1
Asearis, Trichuris trichiura and Oxyuris vermicularis ..................................... ............. 1

WILD AND DOMESTIC ANIMALS
iBateriologieal:
Blood smear from horse (negative for B. antracis) ................................................. I
Lung culture from calf ...................................... ......................... ....... 1
Spleen culture from horse negativee for B. anthraci) ................................................ 1
Spleen cultures from guinea pigs.... . ............... .... ............................ 35
Spleen cultures from rabbits................................................................ 37
Agglutination tests.................... ........................ ............... ... 6
(Serum of 6 cattle with B. abortua, 3 weakly positive 1-40)
T otal............ .................... ................................... ............... 81
Autopsies:
Guinea pigs....... ............................... .. ....... ..... .. ................ .. .... . 33
Rabbits. ..................................................................... ....... 36
Total .................................................................. ........... 69
Histological examinations:
Autopsy tissues from cows ........................................................... .... 32
Positive forB. tuberculosis .............................................................. 32
Total................................................................... 32
Rats examined:
SMus musculue....... ................................... ...................... .... 1,541
Mus oaleandrinuae ............................................................ ...... ..... 59
Mas noegicu......................... .......................................... 108
Mu ranhas................... .................... ................. .... ..... ........ 1,489
Total....................... .................................................... 3,197
MICROSCOPIC SLIDES PREPARED
Surgicaltissue preparations (51 frozen) ...... ........... ..... ................. .. .... . 2,998
Autopsy tissue preparations (3 frozen)................ ............................................... 6,373
Animal tissue preparations........................................................... ........... 141
Total....................................................... ................... ......... 9,512
PHOTOGRAPHS
J.W.., Gorgas Hospital No. 345230-pellagra.................................................. ... I
1.P., Gorgas Hospital No. 343446-lupus erythematosus disseminatus................................. 4
Total............................................ ................................ ...... 5

CHEMICAL ANALYSES AND EXAMINATIONS
Alcohol analyses ............. ....................................................... ..... .... .
Asit fluid-bile pigments.......................................................................... ..
Beverages...................... ................................................................ 11
Beer.......................................................... ...................... 1
Rum. I
Vo v ............................................................................... I
Whink. ................... ........................................... . ..........
W ine................................................................................ 4
Bl ods ........................................................................................... 2,241
Nonprotein nitrogen determinations................. ................................. 1,895
Urea nitrogen determinations................ ..................................... 336
Uric acid determinations....................................................... .... 123
Creatnin determinations.............................................................. 553
Glucose determinations.......................... ... ................................... 2,085
Calcium determinations............................................................. 14
Carotin determinations............................................................. 1
r eatine determinations.......... ................................................. 2
Carbon diodedeterminations .................................... .................. 6
Cholesterol determinations............................................................ 3
Sodium chloride determinations........................................................ 14
SPhosphorus determination ............................................................. 1
Vl terus index ... ...... .... .................... ................ .... ...... .... ...... 112
Van den Bergh reaction ......................................... ........................ 13
Albumin-globulin ratio....................................... ........................ 1
Protne; serau. ................................................................. .. 4
Lactic acidia equine blood...................... .. .................................. 19
S MR 35955---3

..:

.' ".!.i

34

34 ,

Calibrations-sphygmom nometer ................................................................ .
Calibrations- flask, volumetric ......................................... .. ... ..................
Cube root, rotenone determination ..................................................................
Drugs and chemicals ...... ......................................................................
Carbolic acid, crude .................................................................. 4
Cattle dip, arsenical ................................................................... 8
Larvicide. .................... .. ......................................... ......
Opium extract .............. ............ ........................ ........ ... ...... 1
Soap dye .............................................. .. .... .......... .............
X ylol ....................................................... ........................
Foodstuffs ....................................................................................... .
B utter ............................................................................... 4
Cream, fat determination.............................................................. 5
Ice creams ......................................................... ............................. 78
Lard com pound ...................................................................... 1
M margarine for mineral oil ......................................................... 1 .
M ilks, dairy .......................................................................... 618
Determination of acidity ................................................ 3
M ilks, evaporated ..................................................................... 3
Milks, mother's.............. ....................................................... 2
Sugar cane juice ...................................................................... 1
Sugar cane syrup .......................................... ................ .........
G astric analyses ................................... ......... ....................... ..... ...... ... 48
Ores, iron determination........................................................................
Seasone, free chlorine ...................................................................... ..
Sea water, detection in rugs....................................................................
Soda solution, washing ...................................................................... 8
Spinal fluids. .................................................................... .......... 0
Colloidal gold ....... ......... ... ............................................ 836
Globulin tests .................................................................... 86
Glucose determinations .................... ......................................... 61
Stains on shirt ......................................................................... .
Substances for identification ............................................................ 5
Cocaine ............................... ............................... ....... . 1
Cocaine and adrenaline................... .............................................
Opium........ ......................................................................
Powder, cleaning ...................................................................... I
T oxicological ............. ............... ............................................. .......... .
Bones (dog food) (negative for poisons)................................................. 1
Brain (negative for alcohol).................. .......... ............................ ...
Stomach contents (negative for alcohol) ................................................
Stomach contents and urine (positive for cresol)........................................ I
Stomach contents and urine (urine positive for veronal).................................... 1
Stomach (negative for alkaloids and heavy metals)........................................ I
Urine................................. .................... ....................................... 330
Albumin .............................................................. ......... I
Blood..... ......... ............................................................... I
Blood and bile pigments.............................................................
Fat (negative)..................................................................... I
Glucose. ................................................ ........................ 47
Hemoglobin.......................................................................... 3
Lactose.............................................................................. 1
Lead determinations (92 positive)............ ................ .............. ......
M ercury, negative ............. ........................................ ............ .
Phenol, negative......... .. ........................................................... 2
Sugar identification................................................................ .
Routine analyses....................................................... ........ .. 168
Vomitus (negative for poisons) ...................................................................
Water, sediment.............................................................................
Water for chlorides .............................................................. ..............
Water for phenol detection........................ ...................................... ...
Acetone, recovered ............... ... .................... ..................... ters..
Alcohol, butyl, recovered.................................................................itera. 3
Alcohol, ethyl, recovered ............. .......................................... ......liters. 212
Benzol, recovered .......... ............ ..................... ..................... liters.. 32
Creosote, recovered ........................................ ............................ ter.. 0.1
Chaulmoogra esters prepared .................................................liter.. 28.5
Dakins solution prepared................ .. ................................................ liters.. 47

UNDERTAKING DEPARTMENT

Bodies received (including 7 disinterred and 47 for storage)............................................
Bodies embalmed ......................................................................... ....
Bodies cremated ..................................................................... .......
Bodies buried on Isthmus.................. ................................................. .......
Bodies shipped from Isthmus (including 7 disinterred)................................................ 77

".5
N .i?

4

COLON HOSPITAL
(Capadity, 120 beds)
Maj. DEAN F. WINN, Medical Corps, U.S. Army, Superintendent
This hospital has continued to function essentially as an emergency
hospital although definitive treatment has been given to a wide range
of cases. Individuals requiring certain special examinations, for
which equipment is inadequate, those with venereal and contagious
diseases, and mental and tuberculosis cases, were transferred to Gorgas
Hospital.
On August 15, 1932, an eye, ear, nose and throat service was es-
tablished. An average of 750 out-patients per month have visited
this clinic. It has filled a definite and long-felt need for people on the
Atlantic side of the Isthmus. There were 301 operations performed,
classified as follows:
Tonsillectomy and adenoidectomy, general anesthesia ------------------ 123
Tonsillectomy, local anesthesia --------------- ----------------- 106
Nasal operations_------------------------------------------------- 27
Cataracts------ ----------------------------------------------- 12
Eye, miscellaneous_------------------- -------------------------- 25
Ear, miscellaneous..--------... ------.---- ---------.------ --------- 3
Mastoidectomy -------------------------------------------------- 5

The building for the new nurses' quarters is nearing completion. A
new transformer layout has been installed and housed in a small con-
crete.building. This new installation obviates the dependence upon
a single line for power and light. The hospital kitchen has been reno-
vated throughout. Gas cooking ranges have been replaced by elec-
tric ranges and an electric stock kettle installed. The utilities depart-
ment -ias been active in preserving the appearance of buildings and
grounds and the upkeep of the various departments. The construction
Sof the new ward in the present dispensary section and the remodeling
of the old nurses' quarters to house the dispensary was not begun as
contemplated. This work, however, will be started early in the coming
year and should be completed by mid-summer. Supplemental
approved plans will provide a covered passageway between the dispen-
sary and the main hospital, and the construction of a suite of rooms in
the west end of the new ward for waiting rooms, examining and treat-
ment rooms, and an operating room, for the eye, ear, nose and throat
department.
Movement of sick.-There were 4,130 admissions during the year,
with a total of 35,379 patient days, an average of 8.8 days per patient.
There were 56,406 visits to the dispensary, 360 house calls and 18 ship
calls. Army personnel accounted for 7,744 patient days.

36

The average number of beds occupied daily during each month was
as follows:
January- ---------------- 98 July------------...-----.---- 8
February------... ---------- 99 August--_----------------- 92
March ------------------ 102 September ----------------- 98
April------------ ------- 98 October .....------------. 104
May --------------------- 99 November--------- ------- 102
June---..-------.---------- 89 December--- ------------- 192

Surgical service.-There were 521 major operations and 647 minor
operations. These afforded an interesting variety of surgical pathology
and active emergency service. In addition this service gave definitive
treatment to 139 fractures.
Obstetrical service.-There were 457 deliveries during 1932. An
active, well conducted prenatal clinic is maintained.
Medical service.-The general scope of the work has been satisfactory
in both volume and variety. No serious epidemics occurred during the
year.
X-ray department.-There were 1,257 examinations made during.
the year. New and more satisfactory equipment will be installed in
this department during the coming year.
Laboratory.-Only routine work is done, serological and pathological
work being performed by the Board of Health Laboratory, Ancon, C.Z.
Nursing staff.-It has been necessary to increase the number of
nurses from 15 to 16 to provide for the eye, ear, nose and throat clinic.
Dispensary.-The Colon Dispensary is an integral part of the hospi-
tal. Its professional staff is frequently interchanged with that of the
hospital proper. The gold clinic and maternity-pediatric clinic have
been combined in order to conserve personnel. Daily attendance dur-
ing 1932 averaged 155 patients. There were 22,621 white patients
and 33,785 colored patients. These figures include out-patients visiting
the eye, ear, nose and throat clinic.

COROZAL HOSPITAL
(Capacity, 835 patients)
Maj. F. H. DIXON, Medical Corps, U.S. Army, Superintendent V

Purpose.-This institution cares for the insane of the Canal Zorie
and the Republic of Panama. It also cares for alien employees of the
Canal Zone disabled by reason of injuries or chronic diseases who desire
to-enter the institution.
Approximately 1,456 square feet of floor space was added to the:.
workshop and storage room in the basement of the kitchen building,.-I

*. .

Due to limited space on the female side and the rapid increase in the
hospital census, 50 female patients were transferred on April 13, 1932,
to building 535 (Ward '"D," formerly designated as ward "C").
A new bungalow-type detached cottage was completed by the Con-
structing Quartermaster in June 1932, for occupancy by a member of
"the staff of physicians.
The sterilizer and 15-hp. boiler formerly located at the hospital dairy
were transferred to the main steam plant and set up under one roof in
the same shed with the 40-hp. boiler. This should prove to be very
economical in case of breakdowns or necessary repairs. Both boilers
are the oil burning type.
Routine painting and repairs to woodwork, steel doors, window
frames, plumbing, boiler, steam line, etc., have been made by hospital
artisans, with the help of patients.
During the latter part of December 1932, leveling and grading was
started by the Municipal Engineering Division in connection with a
system of roads in the new extension of the cemetery, an additional
area of 39.37 acres. This extension will suffice to meet the needs of the
communities on the Pacific side for many years. Considerable grading
and road building.will be required; funds are available to cover imme-
diate requirements and the necessary work will be completed in the
early part of 1933.
Insane patients.-The census on December 31, 1932, was 748, as com-
pared with 649 at the end of the previous year. The number admitted
was 338, as compared with 297 for 1931. There were 197 discharges
and 42 deaths. There were no suicides or deaths due to violence
or altercations. Of the 197 discharged, 55 were considered as cured,
83 as improved, 59 as unimproved; 91 of the total released were
repatriated. Six patients were transferred to Gorgas Hospital for
treatment; 4 of these were returned to Corozal (also 2 who remained
under treatment December 31, 1931), and 2 died. Of the total admis-
sions, 100 were chargeable to the Government of Panama, and the re-
mainder were Canal Zone charity cases or private pay patients.
Other patients.-There were on December. 31, 1932, 59 black and 5-
white chronical medical and surgical cases, not insane (in addition to 5
out on pass), as compared with 47 black and 3 white of this class (in
addition to 9 out on pass) at the beginning of the year. Twenty-four
were admitted, 1 repatriated to Martinique, 1 died, and 3 were trans-
ferred to insane status; of the 29 patients transferred to Gorgas during
the year, only 20 were returned. All those capable of performingwork
were encouraged to do so. Twenty-five were carried on the payrolls,

.. '.. .: ..,

38

employed as broom makers, bandage rollers, janitor, laborers, ifa,,
helpers. The broom makers manufactured approximately 242 broom::is)
per week. :
Recreation.-Weekly picture shows and band concerts every po0theris:^
week are forms of entertainment which continue to please the pagtioIa.
Picnics, as in the past, were held twice a month. Church services w.qv:,
conducted once a week for the Catholic and Protestant patients..
Treatment.-Intensive specific treatment was given to patients s0ffer-:.' .N.
ing from syphilitic psychoses. Four hundred and ninety-six doses oQ.f..,:;,
arsphenamin were administered intravenously, and 317 lumbar pun.::.,i
tures were made. At the end of the year there were 60 patients
suffering from neuro-syphilis in some form; 41 of these were male and
19 female..
Occupational therapy.-Occupational therapy was continued in 1932
along the lines indicated in the annual report for 1931.
Farm.-Repairs to fences were made, and pastures cleared of brush
during the dry season.
There were 22 cripples employed on the farm at the close of the year,.
as compared with 24 at the beginning. During this period, 3 were ad;
mitted, 3 quit, and 2 died in Gorgas Hospital. These men are employed.:
in the garden, piggery, steam plant, cemetery, etc. Six (including one ;
chronic patient) are tending plots of land in the farm reservation, which,
they cultivate as gardens and are paid on an actual production basis.
Their average earnings per month amount to $38.92. Subsistence was
furnished them free of charge. The receipts for produce sold aggre.^
gated $3,301.69, and for manure, $462.50.
There were 135 pigs, 95 hogs, and 4 boars on hand December .31,
1932. Net deficit during the year amounted to $116.50; the gross
revenues were $1,935.29. '
Transfer of Panamanian insane.-The Panamanian Government-has:.
declared its intention to take over the care of the Panamanian patients.s.:
beginning in May or June 1933. :, ::
In the event this transfer is accomplished the remaining in.ss .':..
patients, superannuates, chronically ill and cripples can be housed:. in-.,:::
our permanent buildings after certain alterations in structure are imade.. ::
and practically all of the frame buildings now housing patients can e.:,:
demolished.
PALO SECO LEPER COLONY '
Dr. EZRA HURWITZ, Superintendent
During 1932, 38,543 days of treatment were furnished. There wO*e.irX
99 patients in the Colony on Janaury -1, 16 new cases were admitted-L::`
2"" ?'a" "
.. "h i
.. ~ ~.9,:",i.: :

7 patients died, 1 with leprosy arrested was paroled, and 1 eloped,
leaving 106 patients under treatment at the end of the year. Of
these, 87 were for the account of the Republic of Panama, and 19
were Canal Zone charity cases.
Intramuscular administration of the iodized esters of Hydnocarpus
wightianaa was continued throughout the year in the same manner as
during the previous several years. During October, November, and
December, mercurochrome 220 was given intravenously in one percent
solution to 70 patients. The average dose given was 10 cubic centi-
meters once weekly. This treatment has been of apparent benefit in
two cases with lepra reaction, but while improvement in general health
has been noted in a few cases, there has been no marked change in the
condition of leprosy in any case.
There were two marriages. Cecilio Tejada, male Panamanian, 23
years old, and Solidad Ruiz, female Panamanian, 18 years old, were
married January 14; and Rafael Munoz, male Panamanian, 30 years
old, and Elida Delgado, female Panamanian, 23 years old, were married
October 5. Both couples were furnished with married quarters.
There was one birth. Toribia Rivera Quesada, female Panamanian,
30 years old, who was admitted to the Colony September 11, 1918, and
married Jose Quesada, male Colombian, December 9, 1930, gave birth
to a female child at the Gorgas Hospital, September 27. The child
was cared for at the hospital, apart from its mother, until October 14,
when the grandmother was permitted to take the child to rear. It was
reported to be in good health January 31, 1933.
Since August 1919, a monthly allowance in cash ranging from $1 to
$2.50, according to the disability of the individual, has been paid to the
.patients in lieu of clothing, tobacco, toilet articles, etc. Money for
this purpose is obtained by the sale to the patients, through the Colony
sales storeroom, of supplies secured from the regular supplies of the
Institution. Because for several years, only subsistence supplies were
transferred from the Asylum stock and run through the resale store,
and also because the patients were spending less of their money for
such supplies than they had in previous years, there was a steady dimi-
nution in the cash made available for distribution in the monthly
allowances. To offset this, the allowance to the patients was decreased,
until in August a totdl allotment of only $100 was distributed among
108 patients. In September, with the approval of the Chief Health
Officer and the Auditor, we discontinued the cash allowance, and in-
stead, established a credit system whereby each individual inmate is
given a credit of $1.50 per month which he can use for purchasing
: necessities at the resale store. This method gives him great freedom
6 S

40

in manipulating his budget to suit his individual needs, andat:thes.aiie*
time is an assurance that the allowance is'spent for the purpose 4::.
tended, and that the total allowance circulates through the rea"t;'
store..
The total allowances made to the patients during the year -was
$1,657.50. Twenty-three patients who cultivate small areas on ....
reservation sold a total of $557.91 worth of produce to the Commissaryi
Forty-one patients received employment in the institution during the
year and earned $2,150.73.
On three occasions amateur brass bands of Panama entertained the
patients at the Colony. The 1932 carnival season was one of the
happiest ever experienced at Palo Seco. Throughout the year weekly"
motion pictures, the radio, phonographs, and billiard and pool tables
were a source of pleasure to the patients.
DIVISION OF SANITATION
The plan of organization and principal activities of this division,
which were outlined somewhat in detail in the annual report for 1939
(pp. 73-77) were continued without change in 1932. The usual
routine activities (see annual report 1931, p. 50) were continued.
SPECIAL PROJECTS UNDERTAKEN DURING 1932
Medical care in Madden Dam area.-Construction of the Madden
Dam, which will involve the expenditure of several millions of dollars
and will require about four years to complete, was begun in October
1931. The construction camps are large ones and it was necessary to
provide a special organization to minister to the sick and injured and
to assure the highest degree of protection practicable against malaria.
The scope of the activities involved and the organization provided to
carry them into effect were described in the annual report for 1931, pp.
50-52. This organization functioned satisfactorily in 1932. Malaria.
control measures instituted gave satisfactory results. The annual
malaria rate per 1,000 persons employed by the contractor was 46.3
(average number employed, 625; cases of clinical malaria reported, 29).
All factors considered, this is a very low rate. During the period of,
construction of the Panama Canal, 1907 to 1912, the annual rates
ranged between 110 and 424 per 1,000 employees, and in 1906, the .:
first year-of construction, the rate was 821.
Drainage projects.-A step was taken this year toward the drainage
of a part of the vast coastal swamps extending 30 miles or more eastward,- i
from the ruins of Old Panama. The part selected was, naturally,'th 4!
one nearest the areas already drained which lie tothe west 6f the ruidt

41

A meandering river, the Matias HernAndez, flowing through the
:westernmost portion of the swamp, was completely straightened for
about three-fourths of a mile of its course; the lower reaches of the
river, through a half mile of dense mangrove swamp, were freed of
fallen trees, logs, and other obstructions. The result was by no means
all that could be desired. These swamps are but a few inches or feet
above the high spring-tide levels and are almost absolutely flat, so
that run-off is slow. The hoofs of dairy cattle punch the miry soil
into countless depressions, rendering passage by human feet most diffi-
cult and fatiguing, and furnishing myriads of small breeding places for
Anopheles albimanus Wied. and A. neomaculipalpus Curry during the
height of the breeding season. Even after the-work on the river was
completed it was necessary to dust, at intervals, the adjacent portion
of the swamp with paris green from an airplane, as was described in
the annual report for 1931.
West of the Pacific entrance to the Canal, in the vicinity of the new
landing for the ferry across Balboa harbor, and the recently opened
Farfan bathing beach, tile drains and concrete sections are being in-
stalled in the drainage ditches.
A large hydraulic fill on the west side of the harbor, used as a dump
for spoil pumped from the Canal in cleaning operations, will require
unusual attention for some years to come. No permanent drainage
system can be installed in this fill so long as it is used as a dumping
ground, and efforts are being devoted principally to the prevention
of mosquito breeding by the installation of shallow ditches where these
are indicated and feasible.
Malaria in settlers (colored aliens) living in the Canal Zone.-This
problem was discussed somewhat in detail in the annual report for 1931
(pp. 56-59). Depopulation has been adopted as a general policy and
on account of economic conditions, which preclude wholesale action
within a short period of time, this policy is being accomplished gradu-
ally by cancellation of licenses for cause. In the fiscal year 1932 a
total of 142 licenses were canceled. The number of licenses in force
at the end of each fiscal year since 1923 has been as follows:

; Seasonal mosquito pests.-There are four species of mosquitoes com-
mon to the Isthmus that may be classified as pests because of their

42 '"'*

biting habits, namely: Aedes taeniorhynchus Wied., Mansonia tie i.tW||j
Walk., Culex quinquefasciatus Say, and Aedes egypti Linn. The A.iin ;
taeniorhynchus is by far the worst of the lot because of its widespr ad.::
dispersion during the season of its activities (June to August), its longer
range dispersal flights (10 to 30 miles or more), impracticability of coniw :'.
trolling breeding, which occurs many miles beyond the areas underi::.:::;:
control, and the viciousness with which it attacks human beings as well":,'.i
as animals. k**'
There are marked variations from year to year in breeding conditions; '
and hence in distances and density of dispersal flights. In 1931 hordes ,:::
of this species invaded the Canal Zone, an enormous flight having':.
occurred on June 9. A similar flight occurred on the night of Juneo. 10,.'
1927. In 1932 no large flights occurred and the seasonal prevalence of:i:.
this species was characteristic of a normal season. .:'.:
Mansonia titillans and, in lesser numbers, other species of this genuas
also attack man and at times become a pest, particularly in.the Mira-
flores Lake area. As the larvae develop under the surface of the water,: :
securing their oxygen supply through the rootlets of aquatic plants, '
their elimination is difficult. Destruction of aquatic plants on the-:
borders and headwaters of the Miraflores chain of lakes is impracticable.
because of the expense involved. During the past year or so it has
been demonstrated that emergence of adults can be controlled mate-..
rially by extra heavy dosing with the larvicidal oil.
Culex quinquefasciatus breeds in large numbers in the storm water
sewers in Panama City and elsewhere during the dry season as a result
of isolated collections of water in sections that have sunk below grade. t
This source of breeding is controlled by flushing the sewers and placing
oil in the water at the end of the flushing thus leaving a film of oil on:
the residium of water.
General breeding of A edes egypti is kept at a very low index by
routine inspections of premises and the enforcement of building regula:::-
tions which forbid the installation of roof gutters. A large proportion '
of A edes egypti breeding on the Isthmus occurs in houses occupied t..i: i
human beings and is found in small collections of standing water-'within:...:
the house (flower vases, ant guards under the legs of tables, drip pa..S:i:ii,,
under refrigerators, etc.).
MOSQUITOES COMMON TO THE ISTHMUS
For many years the personnel of the Health Department have been' "'
studying the species and breeding habits of mosquitoes indigenous to;
this region, more particularly the anopheline group. The result. o.:
these investigations and improvements in control measures are puhifb4,
:A:!!
...ai

lished from time to time in technical journals and the more important
ones, from a practical point of view, are summarized in. the annual
reports of the Health Department.
SIn the report for 1931 (pp. 52-54)-was included a table of the species
of anophelines known to be indigenous to this region and notes on new
species recently observed, breeding habits of some of the more impor-
tant species, and gradual changes in the aquatic flora in the Gatun Lake
region which is now influencing and doubtless will in the future have
still greater influence on the prevalence and density of certain species
of anophelines in this region and on the incidence of malaria.
During 1932 these studies were continued and it has become increas-
ingly apparent that appreciable numbers of Anopheles albimanus Wied.,
the one really important vector of malaria in Panama, periodically
invade the sanitated areas of the Canal Zone from the vast hordes of
these mosquitoes breeding in the more remote parts of Gatun Lake.
Naturally, the flora and fauna of this recently made lake (completed
and filled in 1914) are undergoing constant development and change,
the most notable feature in the floral development being the enormous
amounts of chara now growing (mostly submerged) over vast areas of
the shallower portions of the lake. There has been observed a definite
relation between the amount of this plant exposed at the surface of
the water and the surface elevation of the lake.
The maximum permitted elevation of the lake is 87.5 feet above sea
level, which elevation is reached in the months of November and De-
cember to provide water for the operation of the locks and the hydro-
electric plant during the succeeding dry season. During the four
months of the dry season the lake gradually falls and recedes, receding
,sometimes as low as 81.4 feet above sea level before the rains again
Begin to fill it in late April or May.
When the lake reaches its lowest level there appear at the surface
vast carpet-like areas of matted Chara, among which are to be found
the usual tropical microscopic vegetable and animal organisms on
whichh the mosquito larvae feed. These mats also prevent ready access
to the larvae by fish and other predators which otherwise would destroy
them. At such times the mats of Chara shelter inconceivably great
numbers of the larvae of A. albimanus. It is not unusual to dip up as
many as 100 larvae of various stages of development at a single dip
with a 4 by 8 inch bread-loaf pan. The total numbers of adult mos-
quitoes emerging from such places over the entire lake (165 square miles
Sinarea) must be incalculable.
-Just before the real rainy season begins there is usually a period of
S:some days or even weeks in which the weather is characteristic. High
fc;..~:.' : ..

44

temperatures and humidity, coupled with a cessation of the 'trati.
winds, hardly even a breeze stirring the air, render the days and .ia.
nights peculiarly oppressive. Occasional local showers may-'hae
already occurred, but the parched ground has absorbed the moisttire ..:,,
like a dry sponge. Intensive search reveals no sign of new Anophles
breeding places in stream or ground pools or elsewhere; only the
above described lake areas are teeming with larvae.
It is at this period the flights of Anopheles albimanus appear in the
Canal Zone towns and Army posts. Simultaneously they appear over
the whole Isthmus. Even at Balboa Heights, as many'as a dozen or
more may be taken in one evening by the police officer at his post at
the entrance of the Administration Building. Colon, Cristobal, Silver
City, and Gatun on the Atlantic side receive their visitation too. It
would seem that not only are conditions on the lake then conducive to
more intensive breeding, but something in the state of the weather or
season has stimulated the mosquitoes to greater activity, and a sort
of periodic dispersal flight is on.
The malaria rate responds promptly to this influx of A. albimanus.
Within a month's time, from all parts of the Isthmus increased numbers
of cases are reported. In previous years, before the brackish tidal
swamps on the Atlantic side of the Isthmus in the vicinity of Colon and
Cristobal were drained, periodic invasions of those cities by hordes of
A. tarsimaculatus Goeldi were not followed by any appreciable increase
of the malaria incidence, even though this Anopheles could be counted
on the outside of window screen panels by hundreds.
It has been noted that in these lake areas A. albimanus breeding is
markedly greater in patches of Chara in the vicinity of dwelling houses.
In some parts of the lake, where bladderwort ( Utricularia mixta)
occurs with the Chara, A. albitarsis Lynch Arribilzaga predominates
markedly, occurring with A. albimanus in the proportion of more than
three to one. At times a few A. bachmanni Petrocchi and A. strodoi
Root are taken in the bladderwort and Chara. In areas where Chaf~i
alone exists, only an occasional albitarsis larva is taken among hundreds
of albiinanus. Of these, only albimanus is considered to be of impor-
tance as a malaria carrier here.
Similar conditions in the small Miraflores Lake group near .Pedo
Miguel are controlled by oil sprays. In Stillson's pond, the small in-
let of Gatun Lake from which the water supply of that town is taken 1
the Chara is dragged out of the water before it reaches the surface;
this is done by the filter plant personnel to obviate the use of larvicidal:
sprays upon the water. But over the great areas of Gatun Lake in- V
tested with Chara no form of control seems practicable within economic -'I
limits.
*Tf'

The distances involved in these flights are much greater than are
usually ascribed, to the Anopheles. Gatun Lake comes no nearer than
12 miles to the Pacific terminal cities and not within 4 miles of the
Atlantic side cities. By far the greater portion of the surface patches
of Chara are much farther away. The conclusion that these periodic
long flights of albimanus come from such distant sources has been ac-
cepted only after long and patient investigation over a number of
years. There are no other sources of Anopheles albimaus of any magni-
tude within a less distance of the terminal cities at the times the flights
appear-after the long dry season and before the rainy season actually
begins. It is hoped that a series of observation traps can be arranged
another year at this season in order to obtain still further evidence
regarding these flights and their magnitude at varying distances from
the lake.
TRYPANOSOMIASIS IN ANIMALS
In the annual reports for 1930 and 1931 the occurrence of trypano-
somiasis in animals was discussed somewhat in detail. During the
first few months of 1932 a few sporadic cases occurred in the Canal
Zone but from a practical point of view it does not at present con-
stitute a menace.
It still prevails in certain provincial districts of the Republic of
Panama and appears to be extending northward toward Costa Rica.

REPORT OF THE HEALTH OFFICER-PANAMA
Dr. JESSE L. BYRD, Health Officer
Sanitary inspection.-The force engaged in this work is composed of
2 sanitary inspectors (Americans), 10 sanitary patrolmen (Panamanians
and West Indians), and 1 rat catcher. The work includes routine
inspections of houses, yards, alleys, and other properties; the location
and elimination of nuisances, such as fly, mosquito, and rat breeding
and dirty premises. The city is divided into 8 inspection districts with
a sanitary patrolman in charge of each district, which he covers every 5
to 7 days in a thorough manner. This system has been in force since
October 1, 1930, and has proven satisfactory. Owing to the depression,
nonpayment of rent, rent strikes, etc., many properties in Panama
City had the water service cut off from time to time during the year.
This resulted in a substantial increase in the inspection work, for such
properties were inspected twice a day as long as the water remained cut
off, in order to insure their cleanliness. Whenever' such property
became insanitary or an actual nuisance resulted from the lack of water,
the house was immediately condemned for occupancy and closed by the
Health Officer.

A %::::.
.i .. .

46

Building inspection.-This work is done by a sanitary intwa ,t
(American). It consists of approval of all plans for buildings 0:ij
structed, altered, and repaired within the city limits; the follow .
inspections of such structures during the process of construction, Ai:!vIi
their final inspection together with the issuance of occupancy pern~ita:l
This inspection is limited to the sanitary features of the building, su,: .
as rat-proofing, lighting, ventilation, plumbing, and drainage. ,
Rodent control.-All new buildings and existing buildings undergoing i
repairs are rat-proofed in accordance with the sanitary regulation$i.;"'::i
Eventually all buildings in the city will have been rat-proofed. During ..
the dry season, rats were reported as present in large numbers frat~
time to time in storm or combination sewers throughout the tity --
Investigation gave sufficient evidence that the reports were more .'.
less true, and in order to eliminate them a rat-poisoning campaign waqWg.:.
decided upon. It was decided to use white arsenic in the following
formula:
Arsenic -------- --- ---------------------------------------- 18 s
Fresh frozen meat sawdust------ ------------------------------ 72 parts..'
Cornmeal --..--....--- ------..----.-----------------------..... 5 par'
Flour--- ------------------------- ------- .--- ------------ 5 part
This was well mixed and put up in small packages, about one tea
spoonful to a bait, and wrapped in a square of paper. Six baits were:
placed in each manhole, and 55 percent of all the baits were taken with-
in 24 hours. A few dead rats and many dead roaches were found on
inspection the following day. Evidently most of the dead rats were
washed out to sea.
Instructions to sanitary patrolmen.-In order to improve the sanitary "
inspection service, a course of instruction having to do with the life
and habits of the most prevalent local mosquitoes, and a few of the
common flies, was given at the Health Office by one of the sanitary .
inspectors. The patrolmen showed a great deal of interest in this work..::
and are now able to identify several species of mosquitoes and flies, andi
know where to look for their breeding.
Vaccinations.-A vaccination campaign from house to house was
started in July 1932. Up to the end of December 1932, 19,141i
persons were vaccinated, and approximately 50 percent of .the city:::
had been covered. Most of the vaccinations observed at this ofcfi::e
showed immune reactions, a very few vaccinoids, and still smaller
number of vaccinias.
Dairy inspection.-A veterinary surgeon is in charge of this woiQ!
Pasteurization is compulsory. All dairy herds are tested for tuberMtf
losis annually and reactors are either slaughtered or isolated. Of the:

1
4 .::

cattle tested during the year, 3.15 percent reacted to the tuberculin
test. In order to prevent the introduction and subsequent spread of
tuberculosis in the cattle throughout the Republic, and the tremendous
financial losses resulting therefrom, the Panamanian Government
should prohibit the sale or disposal otherwise of tuberculin reactors,
except by slaughter.
Food inspection.-This work is under the direction of a veterinary
surgeon who makes frequent inspections of markets, bakeries, restau-
rants, lunch counters, ice cream parlors, soft drink stands, etc. All
such places are required to have a permit from the Health Officer be-
fore they are permitted to operate. The Panamanian Government
took over the ante- and post-mortem inspection of meat at the local
slaughterhouse on November 1, 1932, and employed a retired veterin-
arian of The Panama Canal for this work. This office continues the
supervision of this work.
Garbage collection.-The consolidation of the collection forces in
Panama City and the Ancon-Balboa district, which was effected on
February 9, 1932, has greatly facilitated the work and resulted in a
slight saving.

REPORT OF THE HEALTH OFFICER-CRISTOBAL-COLON
Dr. JESSE C. ELLINGTON, Health Officer

General.-There were no changes in personnel nor methods of ad-
ministration during the year. Health conditions were excellent and,
aside from two epidemics of a mild type of measles, communicable
diseases decreased from the previous year.
The general death rate of 14.43 per thousand was the lowest since
1927, while the infant mortality rate of 69.32 per 1,000 live births was
the lowest ever recorded.
Mt. Hope Cemetery.-During the year there were 470 burials and the
receipts from burials were $3,663, with miscellaneous receipts of $447.
Building inspection.-All construction work and repairs to buildings
were followed up throughout the year to see that all sanitary regulations
regarding rat-proofing, light, ventilation, toilets, etc., were complied
with. Fifty-six plans for new buildings and major repairs were ap-
proved and 864 permits for minor repairs were issued.
Street cleaning and garbage collection.-No changes were made in the
system of street cleaning, as it was satisfactory throughout the year.
Garbage and rubbish is collected daily and disposed of by burying and
burning at the dump. Fly breeding and obnoxious odors were not
troublesome during the year. Garbage and rubbish disposed of

48

amounted to 29,074 tons, 22,194 tons from Colon and 6,880 tons froit :;I
the Canal Zone. The cost of collection per ton in Colon was $1.36:
and the cost of disposal, 50 cents per ton.'
Meat inspection.-There were 7,383 cattle slaughtered, of which 7,343:
were passed and 40 were condemned as unfit for food. The number of.l::
hogs slaughtered was 4,250, of which 3,977 were passed and 273 con-.,:
demned. The 40 cattle were condemned because of extensive bruises,:.
tuberculosis, and septicaemia. There were 508 livers, 5 heads, and 15' ..
quarters condemned due to parasitic or other infections. The 273
hogs were condemned due to cholera, cysticercosis, emaciation, and a
few for other pathological conditions. Meat to the amount of 6,353
pounds was condemned at Mt. Hope and in Colon during the year.
Foodstuffs, in addition to fresh meat, were condemned as follows;
Ham, 170 pounds; cherries, 841 tins; pork snouts, 20 boxes; onions, 500"
pounds; chewing gum, 60 cartons; eggs, 9,000; apples, 18 cases; lob-
sters, 200 pounds; shrimp, 20 pounds.
Certificates for 4,831 hides from this district were given.
Inspections of food establishments.-The following number of inspect
tions were made Ice cream parlors, 431; bakeries, 486; dairies and milk'
plants, 483; bottling plants, 362; ice cream plants, 305; markets, 829;
restaurants, 1,225; soft drink places, 1,468. All food establishments
met the requirements of the Health Department and there were very
few prosecutions during the year. Monthly samples of all milk, ice
cream, and soft drinks were sent to the laboratory for bacteriological.
examination and chemical analysis.
All dairies were maintained in good condition and 1,782 cattle were
given the tuberculin test. Six reactors were found and slaughtered.
Animal quarantine inspection.-Inspections were made as follows:?
Horses, 52; steers, 3,791; mules, 18; cows, 107; hogs, 5; birds, 26;.
monkeys, 9; baboons, 2; dogs, 10; others, 20.
Free clinic.-The infant, preschool, and prenatal hygiene work was
carried on throughout the year in the clinic as follows:
Formulas prepared for infants ------ ------------------------------ 9,356
Infants and preschool children (clinic visits) ---------------------4,912
Prenatal cases (clinic visits)-------------------------------- 7784
Cases referred to hospitals or physicians__ _--------------- ---------- 445.
Adults, treatments given ---------------.... -----.----------------- 589
Smallpox vaccinations ------------------------------------------ 2,383.
Typhoid immunizations-- ------------------------------------ 23
Home visits of nurse--------------------------------------------- 4,094 '..
Specimens sent to laboratory ---------------------------------- 303"

* ...
..-.:

49

Mosquito and rat work.-All mosquito complaints were investigated
promptly and any breeding places found were destroyed. Daily
catches were made at several points as indices and through the sanitary
patrolmen in Colon and the larva hunter in the Zone all mosquito
breeding was eradicated as soon as possible. During the year, 3,798
traps were set for rats and 829 were caught.
S Swimming pools.-The two swimming pools in the city were under
observation throughout the year and two water samples were taken
weekly from each for examination. On one occasion it was necessary
to close one pool while repairs were made to the filter.

REPORT OF QUARANTINE TRANSACTIONS, CALENDAR
YEAR 1932

Cristobal Balboa
Vuesb inspected and passed... .................................................. 2,935 249
Vessels granted pratique.................. . .......... ........... .... 111 38
Vessels passed on certificates of masters ........... ............ ................ 14 1,868
Vessels issued provisional pratique.................... .............. ...................
Total........................................ ................. ........... 3,060 2,155
Crew inspected and passed............. ............................ .......... ...... 8,163
Crew passed by radio (Navy) ......... ................. .................. 24,476 7,944
Crew passed on certificates of masters................... ............ ........... 137,080 99,878
Passengers inspected and passed................................ .............. 63,535 5,652
Passengers passed by radio....................... ......... ........ ................. ......... 6,711
Passengers passed on certificates of masters ........................................ 18,607 16,252
Total........................................................... ............ 243,698 144,600
Airplanes inspected and passed ...................................................... 378 9
Crew of airplanes inspected and passed.......................................... 1,297 25
Passengers of airplanes inspected and passed............... .... ................. 1,397 21
Total.................................... ........................... 2,694 46
Vessels detained in quarantine.................................................................... ..
Crew detained in quarantine on board ship........... .. .... ....................... ...... .........
Passengers detained in quarantine on board ship.................................... .......... ..........
rew admitted to station account of quarantine regulations ............................ ..........
Passengers admitted to station account of quarantine regulations.................. ...... ................
Persons admitted to station account of immigration laws......................................... 944
Number of detention days for the year.................................. .................... 5,275
Persons held or detained for investigation and released.. ............................... 72 9
Persons deported under immigration laws........................................... 509 403
Supplementary sanitary inspection of vessels ........................................ 2,515 650
Vessels fumigated..... .. .......................................................... 37 9
Box ears fumigated .............................................................. 51 94
Deratisation exemption inspections............... ......... ........................ ....... 4
Meals served to cabin passengers....9............................................. .......... 490
Meals served to steerage passengers................................................. ......... 4,785
SMeals served to gold employees ................. ...................................... ........ 402
Meals served to silver employees ........................................................... 5,459
Total meals served................... ........................................... .......... 11,136

REPORT OF THE DISTRICT NURSE FOR THE PACIFIC
DISTRICT

; Number of baby clinics maintained----------------- ---------------- 6
Average number of babies enrolled per month----------------------- 465
Average number of babies visiting clinics during month. -------------- 208
MR 35955--4 ,

Total number of visits to clinics---------.--.---------------------- 4,038
Number of visits to cases of tuberculosis-------------------------- 62
Total number of house visits ------------------------------------- 1,067
Number of talks given in schools--_---- ---.------------_------- S

Interest in the baby clinics continues, although attendance was lower
than last year. Instructions as to diet and hygiene were continued
and pamphlets and other reading matter were distributed as seemed
necessary.
A clinic was opened at Gamboa at the request of the mothers in that
place.
Classes in home hygiene and care of the sick for colored girls were
organized in La Boca and in Red Tank. These classes were not finished
at the end of the year.
A class was also held weekly from June to November at La Boca
for housewives on preparation of inexpensive and well-balanced diet,
hygiene and general health measures.
All cases delivered by midwives were visited as soon as possible after
babies were born, and on the whole the work of the midwives seems
satisfactory.
The District Nurse assisted with examination of school children on
66 mornings. Saturday mornings are usually spent in visits to Bureau
of Statistics, to get names of new born babies, and in visits to the
maternity wards in Gorgas Hospital tobecome acquainted with mothers
of new born babies.

MEDICAL EXAMINATION OF SCHOOL CHILDREN
When school opened in October a full-time physician was put on
examination of school children. It was necessary, however, to assign
him to other work at various times, and the examination was not com-
pleted until the spring of 1933. A full report of the examination will
be made in our next annual report.

GENERAL TABLES

TaBaL 1.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES
FOR EMPLOYEES
ABSOLUTE NUMBERS

Year 1932:
White................
Black .................

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

Year 1931:
W hite................
Black .......... ......

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

C,

3,387
9,234

12,621

3,551
11,046

14,597

Discharges from and
deaths in hospitals

E-

1,113
1,821

2,934

1,201
2,440

3,641

.9

1,050
1,583

2,633

1,102
2,069

3,171

v3

_S

63
238

301

99
371

470

Total deaths

EU
I

- N t

113

27
106

133

15
87

102

21
96

117

11

6
10

16

ANNUAL RATE PER 1,000 EMPLOYEES

Year 1932:
White......................... 328.61 310.01 18.60 5.02 4.43 .59 ........ 17 06
Black........................ 197.21 171.43 25.77 10.40 9.42 .98 ...... 17 06

Total................ ..... 232.47 208.62 23.85 8.95 8 08 .87 ..... 17.06

Year 1931:
W hite................. ........ 338.21 310.33 27.88 7.60 5.91 1.69 ........ 17 63
Black................ ....... 220.89 187.31 33.59 9.60 8.69 .91 ..... 14 75

Total.................... 249.43 217.23 32.20 9.11 8.02 1.09 ....... 15 45

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225.48

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22,849
59,450

82,299

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TaBLEt 3.-DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF
PANAMA AND COLON

Death, Annual rate per 1,000
Deatha population
Place Popula- ____
tion External Eternal -
Total Disease cause Total Disease au9se

Year 1932:
Panama................. 77,500 1,232 1,171 61 15.00 15.11 .79
Colon.................. 30.000 433 405 28 14.43 13.50 .93
Canal Zone............... 42,070 307 272 35 7.30 6.47 .83
Total ................. 149,570 1,972 1,848 124 13.18 12.35 .83
Year 1931:
Panama................. 76,000 1,341 1,274 67 17.64 16.76 .88
Colon.................... 30,000 482 457 25 16.07 15.23 .83
Canal Zone............... 40,565 305 247 58 7.52 6.09 1.43
Total................ 146,565 2,128 1,978 150 14 52 13.50 1.02

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70

TABLE 7-STATISTICS REGARDING AMERCIAN EMPLOYEES AND THEIR FAMILIES, 1932

Annual
death rate
per 1,000

White employees from the United States:
Disease ....................................................... ........... ..........
External causes .................... ..... ...... ............. .......................
Total........... ..... ..........................................
Families of white employees from the United States:
D isease..................................... ......... . ................ ..............
External causes...... ..... ....... .. .. .. .........................................
Total........... ... .. .. ... .. .................. ....... .... .............
White employees from the United States and their families:
Disease ............................ .. ......... ..... .............................
External causes.... .. .... .. .. .......... ...................................
Total...................................... ........ ...........................

4.78

4.78

3.18
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3.1-8

3.73

3.73

211
3
14.31

Number of American children born on the 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)...................

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93

TaBLs 10.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED AND AVERAGE NUMBER IN
HOSPITAL EACH DAY OF THE VARIOUS CLASSES OF PATIENTS, 1932

Number of days treatment Average number in hospital each day
Class of patients Amedr- Ameri-
can Foreign Black Total can Foreign Black Total

Gargs Hospital:
Employees.................. ..
Army......................
Navy......... .............
Panamanian Government.......
Charity ........................
All others....................
Total ...... .. ...........
Coroal Hospital:
Employees .....................
Army......................
Navy.......................
Panamanian Government........
Charity........................
All others............... ....

7,2d5
39,934
2,053
2,366
14,159
65,717

134
2,996
165
3941
1,286

2,846

29
1,923
12,968
17,766

401

34,387
3,848
6,840

21,553

246.
5,775
38,755

31,604
39,934
2,053
275
10,064
65,882

19.69
109.11
5.61
6.46
38.69

66,329 1149,812 1 179.55

8,774

154,794
8,587
30,634

9,309
2,996
165
189,181
12,829
38,760

Total...................... 4,975 45,476 202,789 253,240

Cripples............... ........... .
Chronic medical and surgical cases....
Colon Hospital:
Employees................. ..
Army............... ...... .
Charity........................
All others.....................
Total ..................
Palo Seco Leper Colony:
Panamanian Government........
Canal Zone Government.........

938
7,744
696
3,477
12,855

.37
8.19
.45
1.08
3.51
13.59

7.77

.08
5.25
35.43
48.54

58.89

.67
15.78
105.89
181.23

1.09. 23.97
........ ........

93.95
10.51
18.69
124.25

422.93
23.46
83.70
554.07

1,241 7,544 8,785 ........ 3.39 20.61
1,115 21,902 23,017 ........ 3.05 59.84

129
277
1,467
1,873

........ 1,095
........ ........

Total............ .............. 1,095

Total by classes:
Employees.....................
Army..... ..................
Navy..........................
Panamanian Government.......
Canal Zone Government, charity,
cripples, and chronies............
All others.......................
Grand total...............

8,277
50,674
2,218

3,456
18,922
83,547

5,097
3,451
12,103
20,651

30,539
6,909
37,448

3,376 35,424

35,511
8,404
21,275
68,566

185,579

6,164
7,744
4.424
17,047

35,379

31,634
6,909
38.543

47,077
50,674
2,218
221,090

2.56
21.16
1.90
9.50
35.12

22.61
138.45
6.06

54,168 66,028 9 44
81,492 121,689 51.70

.35
.76
4.01
5.12

2.99

2.99

13.93
9.43
33.07
56.42

83.44

102.32

9.22 96.79

97.02 507.05

22.96
58.13

356,663 508,776 228.27 187.34

148.00
222.65
974.49

86 35
109.11
S5.61
.75
27.50
180 01
409 32

25.43
8 19
.45
516.89
35.05
105.90
691.91
24 00
62.89

16 84
21 16
12 09
46.58
96.66

86 43
18.88
105.31

128.62
138.45
6 06
604.07
180.40
332.48
1,390.10

TansL 11.-CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1932

Al classes of patients White Black Total

Admissions to hospitals, excluding Corozal farm (cripples and chronic ward)..... 8,385 7,443 15,828
Admissions f employees to quarters....................................... 3,102 3,208 6,310
Total admiagions to hospitals and quarters.............................. 11,487 10,651 22,138
Lems umber of patients transferred between hospitals and from quarters to hos-
pitals, whose admission are duplicated in the above figures ................ 220 240 460
Net admissions to hospitals and quarters............................. 11,267 10,411 21,678

Employees onl
Eimployeeeadmittedtohospital. ......... ............... .......... 1,139 1,919 3,058
Employee admitted to quarters.... ................................ 3,102 3,208 6,310
Total admlsions of employees......................................... 4,241 5,127 9,368

Lea number transferred between hospitals and from quarters to hospitals, whoee
admimion are duplicated in the above figure........................... 56 156 213
Net admissionsof employees................................... 4,185 4,971 9,156
Annal adlmiaion rate per 1,000 employees to hospitals and quarters............ 1,235.01 538.34 725.46

94

TaEaL 12.-REPORT OF DISPENSARIES, 1932

EMPLOTEES TREATED IN QUARTERS

Remaining Remaining
January 1, Admitted Died Discharged Transferred December
Dispensary 1932 31, 1932

White Black White. Black White Black White Black. White Black White Blsk

Ancon................... 4 9 749 926 ...... ...... 724 877 28 46 11 1I
Balboa ................ 4 6 1,190 565 1 ...... 1,188 568 ...... ...... 5 a
Pedro Miguel............ ..... .. 3 291 383 ....... 1 291 380 ...... 5 ...........
Gatun..... ............. ... ... ... 151 210 ............ 150 210 ...... ...... I .....
Colon. ... ........... .. 3 25 693 1,027 .... ...... 688 1,026 ...... ...... 8 6
Madden Dam ............ ..... .... 28 97 .. 1 28 96 ...... ........... ....

Total............... 11 43 3.102 3,208 1 2 3,069 3,157 28 51 15 41

Average number treated
g t t Days treatment furnished in quarters per day
Dispensary Furnishing treatment ______ _______
White Black Total White Black Total

Ancon. ........... ........................ ....... 1,814 4,994 6,808 4.96 13.64 18.60
Balboa..... ............. .......................... 3,321 2,737 6,058 9 07 7.48 '16.55
Pedro Miguel.................................... 1,175 2,194 3,369 3.21 5 99 9.20
Catun ................. ......... .............. 461 1,072 1,533 1 26 2.93 4.19
Colon............................... .............. 2,679 9,726 12,405 7.32 26.57 33.89
Madden Dam....................................... 48 286 334 .13 .78 .01

Total.................................... .. 9,498 21,009 30,507 25.95 57.40 83.35

ALL CASES TREATED

Employees Nonemployees Total
Dispensary
White Black Total White Black Total White Black Total

Ancon ................... 6,415 17,520 23.935 7,345 18,860 26,205 13,760 36,380 50,140
Balboa.................... 10,255 12,746 23,001 15,613 12,631 28,244 25,868 25,377 51,245
Pedro Miguel............. 4,577 8,139 12,716 8,521 15,375 23,896 13,098 23,514 36,612
Gatun................... 3,705 5,686 9,391 4,893 7,874 12,767 8,598 13,560 22,158
Colon ................. 8,858 13,823 22,681 13,970 19,744 33,714 22,828 33,567 56,395
Madden Dam............. '4,998 '7,740 12,738 12,381 41,698 4,079 7,379 9,438 16,817

.Total................ 38,808 65,654 104,462 52,723 76,182 128,905 91,531 141,836 233,367

*Includes 3,923 contractors' employees. Includes 5,728 contractors' employees. Includes 1,890 members of
families of contractors' employees. 4 Includes 927 members of families of contractors' employees.

TABLE 13.-AVERAGE NUMBER OF DAYS IN HOSPITAL AND QUARTERS FOR EACH ADMISSION,
EMPLOYEES ONLY, 1932

White Black Total

Hospitals:
Gorgas...... .................. ............... .... .. ........... 10.78 21.80 17.24
Colon................................................................ 8.27 12.05 11.17

Average for hospitals............................................ 10.49 19'.53 16.09

Quarters:
Ancon....................... ... ................................. 2.42 5.39 4.06
Balboa..................................... ........................ 2.79 .4.84 3.45
Pedro Miguel............................. ..... ................ 4.04 5.73 5.00
Gatun............................... ...................... 3.05 5.10 4.25
Colon.................. ........................................ 3.87 9.47 7.21
Madden Dam...................................................... 1.71 2.95 2.67

Average for quarters .................... ................. ....... 3.06 6.55 4.3.

O

MR 35955-Panama Canal-1-3-34-1.000

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UNIVERSITY OF FLORIDA
3 1 2II2 ll08ll9 l5llt lI I II I 11111111111111
3 1262 08896 2567

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MILLISECOND	CLASS.METHOD	MESSAGE
0	sobekcm_page_globals.constructor
0	sobekcm_page_globals.constructor	Application State validated or built
0	sobekcm_database.verify_item_lookup_object
0	sobekcm_page_globals.constructor	Navigation Object created from URI query string
0	sobekcm_database.verify_item_lookup_object
0	sobekcm_page_globals.display_item	Retrieving item or group information
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0	sobekcm_assistant.get_entire_collection_hierarchy
0	cached_data_manager.retrieve_item_aggregation
0	cached_data_manager.retrieve_item_aggregation	Found item aggregation on local cache
0	item_aggregation_builder.get_item_aggregation	Found 'all' item aggregation in cache
0	system.web.ui.page.page_load (ufdc.page_load)
0	sobekcm_page_globals.constructor.on_page_load
0	html_echo_mainwriter.add_style_references	Adding style references to HTML
0	html_echo_mainwriter.add_text_to_page	Reading the text from the file and echoing back to the output stream
89	html_echo_mainwriter.add_text_to_page	Finished reading and writing the file