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

MISSING IMAGE

Material Information

Title:
Report of the Health Department of the Panama Canal for the calendar year ...
Physical Description:
v. : ; 20 cm.
Language:
English
Creator:
Canal Zone -- Health Dept
Publisher:
U.S. G.P.O.
Place of Publication:
Washington
Creation Date:
1925
Publication Date:
Frequency:
annual
regular

Subjects

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

Notes

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

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 225670417
ocn225670417
sobekcm - AA00006092_00014
System ID:
AA00006092:00014

Related Items

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

Full Text











REPORT

OF THE



Ith, Dparten
:. OF

The. Panama -aa

FOR THE

CALENDAR,,YEAR
S19A25











W. P. CHAMBERLAIN
Colonlel, ed clCorp, United States Army
4, Chief Health Officer
Dr. D. P. CURRY
'Assistant Chief Health Officer




THE PANALMA CANAL PRES
AtMOUNT HOPE, C. Z.
1926
m1








-. ,. ..""It.... .:. ... .::': ,,.'.. ". --< *
":rE .:. :"" ." .: ".' .
: : '^ : *: :^, ': J

-- "' .
*.: ~ : .. ".. .
.....* : : :: .









"': .- "" """"
..... ::li






:~~~ ~~ ...:.::* *^* "
''.. .: .J'* .


S. ::".,..




*~ ~ ~ :: : ".**'?
S.H



~~:.~ .
III










S '. :..:.

i i....




I: .
... "


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







CI




.::...



a

,, ,::,:!


: .


: -' ,,'^ ;.
.#* .. .. :.






6 .. .... ... ; ..



" ". "'" "."
.. ".* ::. -:'. .:. ....




pe: t io an orga. ........ ........
















j a i'tt"f... state ent- ... .. .. ........ -...... ............ ......................... ...........
1'. of tal statistics for Colon-Employees and nonemployees..........










.i....eral remarks on health conditions on the Isthmus................ .... ...
w lfare w ork ..... _......... ................................................. ..... .. ..




i. V erinary i spections-......--- .- ..- .................. ..... ...... ......... .. ..







iviso of Quarantine-.... ......... ...... .. .............. ... ...... ........... .... .

'l^ ^ oitozal Hospital..................................... .. .. .....~. .. .
:.-S o L eper C ol ny ........................... ............... ..... ..... .. ..........
Srd of He alth La o a ry ... .' .................................................... ..
t m Dischargs trom hospitals, deths, and noe r s fr em-
,S. of.vitalstatistics for Canal Zone-Employees and nonemployees ...


...i..... 4. ury of statistics regarding malaria-......................................
tAtus of the m. malaria problem and mosquito control---.........
VE t ira! remarks on health conditions on the Isthmus .................
........ .. ..........................ww.. .... ................................. ..............
SVetrinary ifispection ..s-y...... ......................
S'ymS w .of Quarantine .....---------- .---------------------- --d n .......
a.i: .o H ospital.................. .. ................... ....................
tI: ,corozal Hospital ............... ..........................

,, o.0Seco Leper Coln y ................................ .......................................
Ujrd9:. of Health Laboratory ............... ...................... .............................

I. Discharges from hospitals, deaths, and noneffective rates for em-


S ployees -- -......................................................... ........................
..-... IIf. Causes of deaths of employees arranged with reference to color,
.. age, and length of residence on Isthmus...............................
': :. Deaths of residents and death rates, of the Canal Zone and the
cities of Panam a and Colon.....................................................
IV. Deaths of residents of the Canal Zone and the cities of Panama and
Colon, by cause, sex, color, age, and place of residence ..........
; 7:. V. Deaths of nonresidents, by cause, sex, color, and age. ..................
VI. Statistics regarding American employees and their families ...........
S VII. Births and birth rates in the Canal Zone and the cities of Panama
and C olon ......... ........ ........................ ..................
II, .Infant mortality rates in the Canal Zone and the cities of Panama
and C olon......... ........... .... ..... ..................
::;iX Discharge and deaths in hospitals of The Panama Canal...
I 2.:;".' Consolidated hospital and asylum report...... ........... .....................
S 1"-. :Numuber of days hospital treatment furnished various classes of
patients and average number in hospital each day ...............
I & port of dispensaries... ... ............. .........................................
Ij slidated admission report, hospitals and dispensaries..............
F IZ C itozal Hospital, statement of commitments and discharges..........
c port ..... ------------ ......................................................................
|:. ..... .. .... .... ,.
3

:.... ..... A


.: -:. ::. v


Page.

4
5
5
5
6
9
10
11
12
13
21
23
24
24
25
26
29
30
30


41





























Colonel M. L. WALKER,
Governor, The Panama Canal,
Balboa Heights, Canal Zone.

SIR: I have the honor to submit the following report of the operPt
tions of the Health Department for the calendar year 1925.i
Respectfully,
W. P. CHAMBERLAIN ,' .
Chief Health Offiei.:,

i T.
: ..,1













A'
... : 1::]) 1
4 ": N .





i ".ME. i!X
.... ..t...







S :..:
.," :.. E,::,.; .Eh::s






n .E: .'.:: :' .:::".. :. :: :






..... ....
U ; HEALTH DEPARTMENT.

OPERATION AND ORGANIZATION.

i ? operation and' organization of the Health' Department is the
Sl ias described .in the .report for the calendar year 1923, with the
jl -that Santo Tomas Hospital, in the city of Panama, R. P.,
eiA|pedj to be under the jurisdiction of the Health Department, Sep-
er 1,4924.
Sc PERSONNEL. ,

Thlbere has been no change in the higher supervisory personnel except
: ...it.Maj. John Wallace, Medical Corps, U. S. Army, relieved Maj.
S :.% S. Mebase, Medical Corps, U. S. Army, as Superintendent of
. C. oa Hospital effective January 24, 1925. For total force employed
S:the .Health Department, see Table XV. On- December 31, 1925,
e ." yirere 224 white employees and 761 colored. The white force was
4HI"e as follows:

physicians, medical officers of the 11 sanitary inspectors. .
S. Army. 2 quarantine inspectors.
physicianan, Surgeon U. S. Public 4 veterinarians.
SHealth Service. 7 technicians.
S;n .VPTysicians, civilians. 8 dispensary assistants.
Si:.nf;ternes. 3 pharmacists.
:7 'i'le nurses. 13 miscellaneous-storekeepers, chemists
ilfemale nurses. stewardesses, carpenters, foremen
Clerks mechanics.

FINANCIAL STATEMENT.

The:.;! funds for" the operation of the Health Department are derived
lfm a specific appropriation made annually by Congress and
'fy fro6 the earnings of the department, which at present slightly
the apprtopriation. The. accounts "of The Panama Canal are
by fisc years and thf figures shown at top of next page are a
ry for the fiscal year ending June 30,1925:




...
m : :. .





6

TOTAL EXPENDITURES OF HEALTH DEPARTMENT.
Gold pay roll (white employees).--...-.............-........................... -$464,
Silver pay roll (colored employees)........................... ........----------------------------- 341, 540 92!
Subsistence supplies ........ ................. .................... 16. Bi
Ice.............................-.-------.-----.- -.-........ --.- ---....... ...... ,-----------8
Hospital supplies and drugs .. ..... .............. ..:".... .... .... __..... ............ 2 41
Equipment........ ............................... ...... -- ..... ... ....--.... 2 ''Sl--- 820 .
M miscellaneous supplies .............. .... ......... .. ... ; .. .i i, t
L laundry. .. ....- ...........-.......................... ................ .................. 2
Telephones...................... .......... .. .................. 12, 6 ......
Deportation of patients physically or mentally disabled--....-. -.--..... 3., ft
Medical storehouse operation..................................... S.I-I---rB
Launch service............................ ..................... ---..-.-- -4------. -
Electric current................... ............... .
Electrical repairs and installations ..... ....... ........ ...". 9... .
W after ........... ... ..... ................................................................... ............... 43
Operation of garbage incinerator, Colon.............- .......................... 24,2 -3$;8::;::
Motor transportation (except for hospitals) and repairs.-.-..-.....- 51,601.96
R entals .. ............................. .... ..... ............................................. 795.9
Miscellaneous charges for sei vices of other Panama Can aldepart mentse 11,.3188
T otals ............................................................ .. ......... .. ....-......... .... .. ., IUZO.....-
EXPENDITURES AND EARNINGS OF SUBDIVISIONS OF HEALTH DEPARTMENT. W

Subdivision. Expenditures. Earnings. T

Ancon Hospital, 1,200 beds.................................... $567,500 $339,100 .60%
Colon Hospital, 80 beds.......... .............................. 91,000 44, 500 49%
Corozal Hospital for the Insane, 480 beds..-..-.__. 136,500 117,300
Palo Seco Leper Colony, 100 beds................... 40,900 18,200 45% i
Maritime Quarantine Service ................... .... 74,000 37,000 :' '-"0% ".
Sanitation of the cities of Panama and Colon.... 76,000 15,000 20 ,
Street cleaning and garbage collection and dis-
posal, cities of Panama and Colon .............. 122, 000 73, 100 -
Canal Zone Sanitation ....................................... 126,000 46,300 i
Line Dispensaries.... .. ............... ...... ........ 47,550 16,000 ::
M medical Storehouse ................ ........ ... ........... 8,250 ............-' .
Chief Health Office and miscellaneous ............... 30,640 1,000 .
Totals......................... .... ........................ 1,320,340 $708,400 S

SUMMARY OF VITAL STATISTICS' REGARDING i- .
EMPLOYEES ONLY*
The admission rate to hospitals and quarters, from all coitttsig
has been as shown in Chart No. 1 at top of opposite page: .
*All rates throughout this report are computed as annual pe .i r, r
Includes all employees of The Panama Canal and the Panamsa aioad on the latfinusi thhtd ng!
in the Canal Zone. and cities of Colon and Panama. e.
Active sanitary work in the Canal Zone and in the cities of Colon aqd Panama tw*n ft1eti
by the United States soon after the control of the proper y F th ftncb CaNlt COlOs'"
taken over in May, 1904. Tables are therefore carried as ftir bak toward that date as figures. i i
available. to give a comparison of the results of work done silne.;



a '..
11" bs
SUMM RY F VTAL TATSTIS R GARDNG :: : ; ':::: ,,











TCiBART A. 1.


.. ." : nm. er Rate.

9 6.547 7 .1,779
: '39, 238 .- .





79 890 1 132

SV919 48,86 896
192 250,893 727
1914, ::: 1 :4,389. 6 3 4 0
: .: ..:.4,785 .320
Ab.



C C T NO. I.














1911 2,64,204 8550
1.21 144,389 620








:- The ttl admission rate to hospitalswas 60.8 in 1925, as compared
S rate to hospitals in 1925 was 140.64, as compared with 130.32406





S' 24, and 133.48 in 1923.






g; 'The death rate, from all causes, has been as follows:
rIW8 _________- 905
S12 1 14,389CHART O. 2.














AAM.age
922 10,447 4490
.923 10,976 485

















)43,890 13.01
9 48,87625 11.02
19'2 50,893 59.18




















2 56,754 8.35
1 ,785 5.37
-192512,189 51.09
The total admission rate to hospitals-was 160.84 in 1925, as compared
..itb 151.57- in 1924, and 155.90 in 1923. From disease alone the
aM'ilssion rate to hospitals in 1925 was 140.64, as compared with 130.32
w aa -1924, and 133.48 in 1923.
The death rate, from all causes, has been as follows:

F" :CHART No. 2.
















"14,389 ,6.46
ar. number Rate.
eaployed.

39,238 28.74. I
0 47,167 10.64,
.: 0,802 10.98
..... ... 4.8, 7'6 11.02. .
41; 1 92 50,9 9.18s
1.:913 56,454 8.35
:, ,,i15 3,785: 5.77
.,16 33,176 6.03 S

24,2!04 7.23, f
14;-.8W9 6.6,-.7
16;1 447. 6.89 n




OY.. .
":,. a --;








-. :".. 1.::.IF:

The death'rate from disease,alone for, 192.5 was 7,72, a coi~.i
with 5.51 in 1924, and.6.10 in 1923.
The noneffective rate, from all causes, has been as follows:.
__ CHART No. 3.
Average ..
Year. number Rate. : .. i '..::....,.
employed. .. ...
1906 26,547 28.48
1907 39,238 25.09
1908 43,890 22.31 ...
1909 47,167 21.93 .
1910 50,802 24.37 ...
1911 48,876 24.46 '. '
1912 50,893 21.11 .4 25 ;. .i
1913 56,654 15.97
1914 44,329 12.22 ______________ i'
1915 34,785 10.28 ...
1916 33,176 9.20 .
1917 32,589 9.65 .
1918 25,520 11.19 ..; ,,i:
1919 24,204 14.29
1920 20,673 14.87 :
1921 14,389 13.96 1
1922 10,447 14.81




The 6 diseases causing the highest number of hospital admissionsl.j::
with their rates, were as follows:
1924. 1925. "
I 1 -r.-- *:: .- ,
Admissions. Rate. Admissions. Rats. 2
Malaria.. ........ 190 16.34 330. 27 9 :i1
Venereal diseases. ........... 194 16.9 18 .
Diseases of the eyes and their annexa.. .............. 83 7.14 71 A
Bronchitis (acute and chronic).......... ..... .... .. 41 3.53 :4
Influenza ...... ................ ......... 34 2.92 31
Tuberculosis (various organs)............................. 28 2.41 25i JA

The 6 diseases causing the highest number of deaths, with their ,m ,tes.';.,
were as follows: .
S1924. 1 CAM
th ther rates, we ... .. .. .: : .::...'M
D. '..4 I te. Deaths." .
Organic diseasesof the heart ............... .......... 6 .52 14.
Tuberculosis (various organs). ................. ... 12 1.03 I
Pneumonia (broncho and lobar) ............ ........... 5 43
Apoplexy......... ......... ............. 5 .43
Nephritis (acute and chronic) ......................... .60 ,
Cancer (various organs). ................................. 4s 52

The admission rate to hospitals from disease, and death rate i
disease, for white employees, were 206.85 a'nd 2.88, respectively.. t:..
compared with 117.81 and 9.39 for black employees.
The death rate from disease for American (white) implo4ees
2.57, as compared with 4.14 for 1924( and 4.87 for 1923.
134 of these admissions were from Bruja Point, where a gang of men was doing construction work ii atempn*i
camp, three miles beyond our sanitated areas. The rate, excepting these cases, is 16.09



Tstte d .L-rA:
~ 1. "~i .;.." ':, l 1,ilh,:li
diseseforwhie eploeeswer 20,.8 ah 2.8, espe..fveli} '.:i::! ;
compared ith 117.8 and 9.3 forblackemployee. "'. :.: :'..!:











I IMARY OF VITAL STATISTICS FOR THE CANAL ZONE-
EMPLOYEES AND NONEMPLOYEES.

ro aaaverage population of 34,840 in the Canal Zone, there were
Sid. eaths during the year; 241t of these were from disease, giving a
jiiate: f6.92, ias compared with 8.01 for 1924, and 7.14 for 1923.
S Aemii tefrorrltuberculgnis was 0.89, as compared with 1.01 for
9 .S9 4.9 9 fir :1923, 0.74 for 1922, and 0.64 for 1921. Tuberculosis
cu!e:ii' 13 per cent of all deaths from disease during the year, as com-
.. wedwt. 1t3:percent.in 924, 0-per cent in 1923, 10 per cent in 1922,
S:.$d per cent in 1921.
*::':Th.ere were 616 live births reported during the year, giving a birth
r"at ..of 17.68.. (See Table VII, page 51). Of these, 193 were white,
: and 423 were black. Of the total births reported, 5 per cent were
stillbirths.
S" Deaths among children under 1 year of age, from all causes, totaled
48,oftwhich 7 were white and 41 were black, giving an infant mortality
.:r rate, bas6d on the number of live births reported during the year, of
36.27 for white children, 96.93 for black children, and a general average
of 77.92.
Of the total deaths for all ages, 16 per cent occurred among children
mder I yeaIof age, and 27 percent among children under 5 years of age.


Below is a
t.. 1905 to 1925,


'Vear. Popula-
tion.
1' ~. 905 23,463
',1906 '34,095
-.. 1907 54,036
~7,.: .,146
S1909 76,900
: 1910 86,465
:,-1911 -90,434
,. 912 79,279
.19 61,700
S.191 4 46,379
S,1915 31,496
S-1916 31,447
7v.-M1917 33,044
: 1918 3 3,803
.i91::'. 9 .32,366
S .120 27,459
.. 92. 31,377
31,098
i1; :923 31,9793
.'. 33 723
1925 34,840


chart showing the death rates in the Canal Zone from
from all causes:
CHART No. 4.


Deaths.


828
1,700
1,708
1,273
1,025
1,251
1,385
1,129
1,047
710
410
343
328
286
.247
242
236
254
253
305
'297


Rate.


35.29
49.86
31.60
18.95
13.33
14.47
15.32
14.24
t16,97
.15.31
12.83
10.91
9.93
8.49
.7::63
8..81
7.52:
8.17
7.96,.
9.05
V 8.53


. 1 -----


I-:<: '%: "'- :
k''.: ".
. .. ... .,.

a p:.-A:- *'


I


- ---- ---


I
'






.
... -; ..... e. .. .:


SUMMARY OF VITAL :STATIfST. CS P.OR10.
EMPLOYEES AND NONEM1PLOVIEES.i.:--' :I::
From an estimated population of 59,635, there were ,:69 d0#t
during.the year. Of these, 1,126 were from disease, giving : 7iO: i l
18.88, as compared with 18.92 for 1924, and 18.08 for 1923: .
The. 6 diseases causing the highest number of d &4ts, withl '
rates, were as follows:'
,:' ..:.. .... : ....
1 1 4. .......
~-----------------------------924--------'*---- i~
Deaths Rate teiaeii.
Tuberculosis (various organ) ............................ 191 3,2 1
Pneumonia (broncho and lobar)......................... 237 3. 150".
Nephritis (acute and chronio)............... ..... .... 83 1.39
Diarrj ea and enteritis (including colii ......... ......... 104 .T4 "
Organic disease of theheart...:................. 77 1.29 t I
Cancer (varioum a organm)................................ 60 .84 a *.
The death rate from tuberculosis was 3.67, as compared w.itt;S
for 1924, 3.35 for 1923, 3.76 for 1922; and tuberculosis caused ap.iea-~s
mately 19 per cent of all deaths from disease, as compared: w*i i!:.
per cent in 1924, 18 per cent in 1923, 18 per cent in 1922, andltper 1:
cent in 1921. "
There were 2,220 live births reported during the year, givigsfta tbth.
rate of 37.23. Of the total births reported, 5 per cent were stillbirthAs...
There were 260 deaths among children under 1 year of age, givig an.6 .
infant mortality rate, based on the number of live births reporteddiag:l"'
the year, of 117.12. ..- .. ..- .. :.
Of the total deaths for all ages, 22 per cent occurred among chil]4,ei
under 1 year of age, and 32 per cent among children under 5 years of age:iX
Below is a chart showing the death rates in Panama City from 1905;l
to 1925, from all causes: CAR No. 5.
CHART No. 5.:
Year. Popula- Death. Rate.
tion.
"_ 5 .. ....
1905 21,984 1,447 65.52 f
1906 25,518 1;142 44.75 .
1907 33,548 1,156 34.45
1908 37,073 1,292 34.83 '. "
1909 40,801 1,038 25.44
1910 45,591 1,446 31.72
1911 46,555 1,456 31.27
1912 47,057 1,380 29.33 .
1913 47,172 1,507 31.95 kf 1
1914 53,948 1,863 34.53 fEf
1915 60,373 1,810 29.98

.: .. .* ..% ,V V F
1916 60,778 1,765 29.04 .... :
1917 61,074 1,714 28.06
1918 61,369 1,314 21.41
1919 61,369 1,211 19.74 .
1920 60,500 1,297 21.44 .
1921 60,500 1,336 22.09 1
1922 60,068 1,279 21.29 ..
1923 59,635 1,106 18.55 .....:
1924 59,635 1,168 19.59 .::
1925 59,635 1.169 19.60 S .

S.. ...... ,
0'. ". ; : "":





A'A




,W M.MARY ~F.VITAL STATISTICS FOR COLON-
EMPLOYEES AND NONEMPLOYEES.
: i;Trom an estimated population of 31,285, there were 401 deaths dur-
y .::j ar;. of these, 379 were from disease, giving a rate of 12.12, as
jspp e.wit h 14.54 or 1924, and 12.05 for 1923.
2. 4'be 4 diseasee ceaing the highest number of deaths, with. their
tn...t.a wre a.s follows:
S .. 1924. 1925.
SDeaths. Rate. Deaths. Rate.
-(V wl .d ario ran) ......... ... .. .. 82 2.62 63 2.01
.la (i ron oand lobar) ........ 56 1 79 38 1.21
: (n aktea d chronic). .............. .. 36 1.15 29 .93
Ib, d enteritia includingg colitis) ....... ... 37 1.18 27 .86
ii 22 .70 23 .73
NO .a .. b e.. ..... .. ..... ..
ipmip.as..dieasofthe beart...... .. ..... ... 38 1.21 20 .64

S'he death rate from tuberculosis was 2.01, as compared with 2.62
for 1924, 1.92 for 1923, 2.55 for 1922, and 2.30 for 1921. Tuberculosis
i..- sieAplunir lately 17 per cent of all deaths from disease, as com-
: pared with'18 per cent in 1924, 15 per cent in 1923, 19 per cent in 1922,
Sand 13 per cent in.1921.
'There were 769 live births reported during the year, giving a birth
rate f 24.58. Of the total births reported, 4 per cent Were stillbirths.
:There were 90 deaths among children under 1 year of age, giving an
: infant mortality rate, based on the number of live births reported dur-
: -ing'the year, of 117.04.
;. Of the total deaths for all ages, 23 per cent occurred among children
':. under year of age, and 31 per cent among children under 5 yzars of age.
SBelow is a chart showing the death rates in Colon from 1905 to 1925,
From all causes:RT N. 6.
CHART NO. 6.

.. .. ar. p eatha. Rate.

"1'176 553 .."49.48.
1900M 13,651 73 54.42
'0 14,549 571 39.24
S.1909 17,479' 396 22.65
1."0l 19,535 514 26.31..........
.t 11 1947 527 26 .
4r112 10,74 493 z344
913 ,20,232 489 24 7
1914 :23,2( 593 2.3

1916 24,693 -696 28
191 25,386 667 26.27
1918 26,0718 616 23.62
..1919 26,078 573 .21.97
.41920 26,,078 55$4 21.24
1921 28,.789. 497 17 .26
1922 31,393 445 14.17
.1923 31,285 .393 12.56
924 31,285 475 15'18
4925 $1,28 401 12.82


; .






















follows: ..

CHART No. 7.. .

Average "' :.'.l.
Year. number Rate..
employed. .. ,
-4 : ',: '' .. s.I.
1906 26,547 821
1907 39,238 424 :.:;;
1908 43,890 282
1909 47,167 215 ':- ....
1910 50,802 187 .,:*
1911 48,876 184 *
1912 50,893 .110 .
1913 56,654 76 '..
1914 44,329 82 IM '
1915 34,785 51 .
1916 33,176 16 U -
1917 32,589 14 ....
1918 25,520 18 ':
1919 24,204 31 w -. ".;
1920 20,673 19 : ...
1921 14,389 15 U '
1922 10,447 17 .. :::: :::I;
1923 10,976 19 M
1924 11,625 16 W
1925 12,180 27 m (Only 16,.omitting cases from Bruja Po61t.I :


Excluding the 134 cases from Bruja Point, the admission rate f om *.
malaria was 24.66 for white employees and 13.14 for black envploy ...,
(See page 16.)
There were no deaths from malaria"among employees .durgi.ng 't
year, 1925.
The death rates from malaria among employees. from i906t:,to 16M.
are shown in Chart No. 8 at top of opposite page:





--or


.. .. .. ..
., .,: ;......?;.. ,,:ii.i.:.. q; :iaii
--------------------------------------- 4.:'
:! ~.. j3 e.'.a... M,.: a: f:..:,










, .. ., C.A..T No. S:


Ser: i IateI.


3 25 .. 1mmm .
91,2 .81 m
.84
,893 .31 IM
7 ; 5 ,654 -.30
4-29 .14.
.34.,785 .23i
19t16 33,176 .06 E
i; 32,589 .09 W
I ::.: .'. .25,520 -.08 U
. .. 24,204 .08 U
0 92 20,673 ..15 K
S1921 14,389 .00
.192.2 10,447 -.00
1923 0,976 .00'
AA Ai.6..5 .17.
9":.- *i : ;12,5180 .00

P RESENT STATUS OF THE MALARIA PROBLEM AND
MOSQUITO CONTROL.

mosquito situation.-There are about 135 species of mosquitos on
.: the Isthmus, but most of them breed and spend their lives in the jungle,
tzrely, if ever, attacking man. Only a few species are of sanitary or
.-:eco rimic importance and these, for the purpose of mosquito control,
i-may conveniently be divided into three general classes.
(a) Mosqui(pes which transmit malaria, viz., anopheles of a few species. On the
SIsthimus the principal offenders are A. albimanus and A. tarsimaculata. These two
.. species breed in natural collections of water, pools, streams, ponds, etc., and under
it:'favorable'conditions fly to and enter houses at distances as great as a mile or more
I:. from their place of origin. They bite at night or near dusk, rarely by day except
iii i.ey deep shade.
bi:. .( Mosquitoes which transmit yellow fever and probably dengue fever, viz., Aedes
pi: lgyti, formerly designated as Stegomyia fasciala. A. aegyptiis essentially a domestic
O;.ldquiqto; laying its eggs in artificial collections of clean water provided by receptacles
:.such as, cisterns, jars, bottles, tin cans, sagging gutters, ant guards, vases, unused
P e. tpg ;s, etc 'These mosquitoes for the most part breed in the house or yard and
yiijI very short distances. If a well-screened house contains many specimens of A.
a : s gyflit is almost certain that breeding is taking place within the house itself. This
S" es bt..s costly by day, :particularly in the afternoon, and is very annoying.
::pantinud efforts to maintain a low A. aegypti index are made by the Health
!i?"t. z t iin. the towns of. the Zone and in the cities of Panama and Colon. These
i:e:itos arwe t .as energetic as would be the case if yellow fever were an imminent
:i.yxSr., but are sufficient.to reduce the number of houses in.which any breeding can
I&..: t:h ae ~rno us annual ifeporte, this chart showed a death rate of .09 for 1923, representing
death ,1 emlploye. Upon recent investigation it is revealed that this was an error, the man in
.lceraiate hi rvice.more than two months before his death. After his discharge
S.....ptei.e iet ina the intridot. wHere he contracted his malaria and died.
J ." ::: I"H.:: ;. ., ... ..
,, I "...: .:.,. :. :'.
"Jj :, : ;;:": .': : -
I ~i,,:: -.:. .,. : .., .. ..






S* .. ... ...
'. .. .. ...A.. i*
***" i:. -M -s" : ."*::. i i B
be found topless than one per tcent rFta-itl kt i a.aiit*o
both Panama and Colon. Where breeding ccvrrei i t t ip
vases or other small containers. It. has been. estimated 1by.oert

and under some conditions VV" to & sug: .: 4:~.~
ters for the development of an.epidemic if case e l. er .rit
a town and neglected as regards sanitary pre iuth '.
In view of the scarcity of yellow fever-carrying- ntmgg 4iS IA t he I'f. ii
.the practical disappearance of the disease in the WeWil.n -"Ie isc:r
vigorous maritime' quarantine maintained by The Panias Canal .ttIeat
ment, it is felt that a rec-udescence of this scourge on the Isthllt.u : i
virtually impossible. -. :..::' : ..
(c) Mosquitoes which cause annoyance only. In additionri6 those mentid i
there are many genera and species of mosquitoes which canuasannoys I.
bites but which are not known to convey disease, except that one specfie
more) transmits filariasis, a disease which has never been a factor of ....
the Isthmus. One of the most troublesome mosquitoes in this group 6i th4i
taeniorhynchus, which breeds to a limited extent in bracdish swamps adi. ~i.: i
pools among rocks but develops most prolifically in the deep craecs w .te l.f.
on hydraulic fills during the dry season and become water, containers .itli
rains. This insect can fly for many miles, perhaps as much as 30 or 40. The eSrd'
of annoying mosquitoes is of somesanitary importance here, partly. beca. th
actual irritation they may cuise add partly with a. view to the morale of the .pthlam
public which now considers sanitation neglected whenever any mosquitoes. aP st.,
Until recently much annoyance has been caused in Balboa and Amon d .*Y4b
first part of each wet season by A. taesiorhynckus moequitoe9*hic briedA hj ii i
numbers on the San Juan fill, west of. the Canal; By rearranging..the sch eei0q
the dredging division so that mud could be pumped onto the filled area just
the rains began, this nuisance was almost entirely abated in 192S and.. again ~ni'4
Fortunately it is not necessary to eliminate the last disease
mosquito, or the last human carrier of mosquito-borne patrsr' ujS
order to prevent or practically prevent the spread of mnipp
diseases. Out of each 100 anopheles mosquitoes,, if malaria i. rel4 t
scarce, only a few will have a chance to bite a patient during tlie 44i.
in which his blood contains malarial parasites in the effect
Of those which do so bite, only a limited number will he the :12.'ii
necessary for the malarial organism to reach its full devel 'pen.
insect, and of these some may die before they have an oppoflrt
bite a susceptible person. The same principles apply wjtlh.g sti.
force to yellow fever. Consequently, as regards the epidemic
disease, there are interrelated critical points' in t1the lumber 5hi.i47
quitoes susceptible to infection with the parasite iin quesdao
the number of human carriers of that parasite. Bot. bactoR..
rise above those critical points if there is to be an epi5efii U! fl
number of both susceptible mosquitoes and infected persons
these critical points, then sporadic new cases eof the disease w
in decreasing numbers as one or both factors are still further b ..

.. ........ :.. :. ....: .. ,
,,
9. '-4; :.- ;;: St







M .. .. .. ... ...

ii~| elinaieationUf anopheles mosquitoes in the
tDe~ of s ad window is-les necessary than
d' o actually aes few screened houses in the cities of
ni v l in the pt suburb of the former city. It is not
-si Wr eher we dould do away with screening on the
witut having a rise in the incidence of malaria. At any
-.iaaay collateral comforts such as the exclusion of
.ati. 'ied ~a scorpions, tarantulas, reptiles, etc.
i te;~ts -have sometimes been made to the effect that
~~ie been eradicated from the CanafZone. These statements
us To free the entire Canal Zone from malaria would
p" i 4. of eSfirt backed by millions of dollars. No attempt has
gR^cl i..de to d. Wfis. -As compared with yellow fever, malaria
p .i.*tl .offers a far more-difficult and expensive problem to the
ai frthe following reasons: First, the anopheles mosquitoes
ilaPre rural breeders,. developing in swamps, brooks, ponds,
i U!ijes.e very great areas, and often flying considerable dis-
'i, a. mile or more, to obtain the blood meal necessary for the
^gatior of theirspecies Second, the indigenouspopulation of the
hUts oataiie of the sanitated towns, is-to a large extent chronically
p4 with latent malaria, thereby affording abundant opportunity
iuhtlyi:hatched xasquitoes.to acquire the parasites when they bite
a4detted individuals. The policy adopted in 1922 of permitting
W4i mostin negroes, to settle on the vacant lands of the Zone
i',Wiirasd the opportunities for infection of mosquitoes. Third,
sil Whentract malaria may remain infective indefinitely even when
ualy tireatid with quinine for lengthy periods, and they can not
ii~istL~t spin a screened room as is the rule with the yellow fever
iit.ing :h*is brief 3 days of ihfectivity. Fourth, one attack of
I 'cO fesfrr no immunity to subsequent attacks. Fifth, there is an
i t dPt esira amtng many persons to leave the sanitated areas at
~~~die nid C i other purposes and this desire has been stimulated
bi.'tielst few year by the extension of good roads outside the

#itle.:. to stibj in the program of expanding and improving the
sij tyhi'iE~oqaito breeding is controlled, just when the expense
nli. .lkE n ot b tifed by the gain in malarial prevention
it~~Haid te reduction of upkeep costs-these ques-
|i s:W v2.M ^ Thework is still progressing, but the malaria
.;f' io 'the Canal is not now correspondingly de-
jti y 'tthe ict that an indeterminate but consider-
...M g .f e a which develop among those living in sani-


... :..... : :.. ..... ... : :: I : .... .... ....





tated towns actually acquire their infection when outside the saailtS
ted areas after. sundown. The increasing number of automobiles litt!
the rapid extension of hard-surfaced highways are bound to augWt
this danger each year. Military.maneuvers and mapping expedite
are important factors in raising the rate in the Army, in spite of.l W ,.i
phylactic doses of quinine. An incident taking place in .3925:$( '
a good indication of what would happen if the sanitation of our tOwa;'i:
should be neglected. A gang of workmen; averaging 226 in nufi s
was installing large guns at Bruja Point, which-is located about triar.;>
miles beyond our sanitattd areas. The white men lived in screen 4
houses and the colored men,. constituting most of the..forcei, ^,
under mosquito nets and presumably took prophylactic doses of-qi .:;qi:
nine. Yet in a period of five months 122 of thedt men suffered ar attack i
of malaria. This area has since been drained by the Army authorities:'
and few cases now occur. That the Isthmian malaria has not lost its
pristine powers is shown by the fact that pernicious types, particularly :
the cerebral and algid forms, not infrequently occur and sorpetimeSb.
result fatally.
Recent new drainage work in and about Panama City.--It should
be remembered that tlie cities of Panama and Colon, although not.in.
the Canal Zone, were placed by treaty under the complete sanitary .':
control of the Health Department of The Panama Canal. Their satm-.
tation is paid for by The Panama Canal, except as regards street.:
cleaning and garbage handling, for which the Republic of Panama
pays approximately half the cost. Sanitary control in each of these
cities is effected through the agency of a full-time 'health officer wh6 Ip':,
an American physician employed by and acting under the immediate.
jurisdiction of the Chief Health Officer of The Panama Canal.
UntiL recently the mosquito control measures carried out by .h.-:e
Health Department in and around the city of Panama had not been:..
consistently applied for a distance greater than half a mile from the
borders of town, indeed hardly that far from the outer parts of.the new.::
suburb of Bella Vista. Practically no permanent work had been d one,:,
by the Health Department, even in the large vacant areas local .4,
within the built-up sections of the city, control being effected by rmn-:
lined open earth ditches and by oiling. .
In October, 1924, a new policy was adopted. (See Report for yea:.l;
1924, p. 13). The area of control was promptly extended to a distanKir.
of at least a mile from the city borders, including in those borders a e'
most easterly houses in Bella Vista. (See map No. 1.) Furthermdr
immediate steps were taken to replace all trained streams and unlinei:

S. .


a .-


-1W

















. ... .... .N









LIMON ..























S0 ,










E E PANAMA CANAL
DEVELOPMENT OF ANrrTATIO
ATL4.nc TNRINUS

MAP Now L,
















































































































I




h-

' .. .. '. "a




narfth ditches by subsoil tile or by concrete bottomed open drains
bhe subsoil method was unsuitable owing to lack of grade or other
t~tn tnces. With the amount of funds which could be made
S.s a able by the Health Department during the last two years it has
ek possible to push the program rapidly. By June 30, 1926, not
:, 'ly hitd mosquito control been entirely effected over the enlarged
:,esbutall open earth ditches within the city, as well as most-of those in
S duridounding area, had been replaced by permanent drainage, and
WS ,s were developed for further extension, particularly eastward along .,
he, Sabanas road toward the Golf Club. These improvements in and
a .bout P-anama have been accomplished by the installation of 12a
miles of ubsoil tile drainage, 2t miles of open concrete bottom drains,
nd 1 miles of new open earth ditch not yet tiled, the total cost being
V, 987.1 The first result of these changes is an increased degree of
protection from anopheles mosquitoes--particularly in and about
ali'donla, Bella Vista, and the Exposition Grounds. The second result
Siiila be a saving in upkeep sufficient to pay for these permanent im-
Srovements in a few years; or, if the same amount of money is
expended annually, it can be largely devoted to further extension of
Spernianebut work rather than used up solely in current maintenance.
Recent new drainage work ien the Canal Zone.-Permanent drainage
wdrk in the Canal Zone has been speeded up during the 'last year,
rtculary at the Pacific end in the o area between Paraison and Ancon
Large installations of subsoil tile or concrete bottomed drain have been
8de west of the Canal near the Pedro Miguel and Miraflores Locks,
oth of Paraiso, in and about Coroal, along the west side of the Cor-
inxduRiver, and on the hydraulic fill between Balboa Heights and
Corozal.e Most of this permanent work replaced temporary earth
wrk i n thesh Cach had been inexistencea considerable time. During the last
L:years a total of 4 miles of tile and 2 miles of concrete bottomed

drain has been placed, and several areas of considerable size have been
filled,'at a total cost of $18,982.86.' The high cost per mile, as com-
Spared with the 6ost of the work referred to in the preceding paragraph,
Sis due to three factors: First, there was a much larger proportion of
S.concrete bottomed open drain, this being far more expensive to install
!than subsoil tile; second, the.work entailed more than the average
Amount of excavation; and, third, a large part of the sectional bottom
il wa placed in very difficult swampy sites where it had to be underlaid
i:, boards in order to maintain grade.
T. his work.was done during the period from Jan. 1, 1925, to June 30, 1926.
-.This work was done during the period from July 1. 1924, to June 30, 1926.
MR 2343--2
I : : : :' .. .
ai"
';I~.





*..



As a result pf the work done by the Health Department of The
ama Canal, supplemented by the work of ihe Army at "ort
and Camp Corozal, the entire area from one mile northnStof,
down through Culebra, Paraiso, Pedro Miguel, Red TankcFci
ton, Corozal, Balboa, Ancon, Fort'Axador, Panama, and BelatW
to the Pacific Ocean has been sanitated, most of it by ueaus ofi!
manent drainage. This represents-a protected area over 13 dle Ie
and ranging in width between a mimimum of 1 mile at sbme po
and a maximum of 6 miles at its oceanextremity. (See map
On the Atlantic side there has been equal recent activity in eelKte
the areas of sanitation. Nineteen and a half miles of new eatli" '':i
and 21 miles of subsoil ille drainage have been iinstalled during .the I.
two years.' The work has been made as permanent as poesibhI.ct'.i
owing to the character of a large part of the terrain-flat, swampy 1i ;:
only a few inches above sea level-it has been impracticable to ia i
much subsoil tile or concrete bottomed drain except in and arc fi :
Gatun. Seven years ago Gatun and Cristobal-Colon were each '.:'i:
rounded by sanitated zones extending less than 1 mile from thect i:w :0
limits, while an unsanitated region occupied the interveiin.:g .:
miles and bred enormous numbers of anopheles mosquitoes. T..19fi:'
Fort Davis was completed on a swampy site located not far f 1 'il' 7
Gatun. The malaria menace compelled the Army to underta&'atAi:
once an antimosquito program for the protection of the garirfbi\
Then the Health Department of the Canal initiated the plan of :sat"
tating the intervening stretch between Fort Davis and Colon. .. .. -2
work is now nearly completed. (June 30, 1926.) The draii~th
program carried out to the east of Manzanillo Bay by the..HiIt;.
Department and by the Army, primarily for the protection of FoCiII
Randolph, France Field, and Coco Solo Naval Base, has gr~leaSf~ti
improved the mosquito situation in Colon. At present the area iidet?
control to the south and east of Limon Bay is about 11 mites in teigW;,t
and varies in width from 2 to 4 miles. Extensive permanent A"iii
semipermanent drainage works completed by the .Army on the l .. lt;.
Sherman reservation, to the west of Limon Bay, have addedi4 ;.t.i. .;
protection of Colon on that flank. (See map No. 1.). -:.:
In many instances the new work done during the last, two ye.raii.
represents not an actual increase in the controlled area, but a. subsfit :
tion of permanent installation for temporary earth ditches. To ap:rii
ate what has been accomplished on the Isthmus by permanent draq
and by filling is impossible unless one was familiar with the daiii..
before these improvements were undertaken. Great aiosquito-bremei
* This work was done during the period from July 1. 1924, to June.30, 1926. .. 4 .

4 ..
,..: ,,.
: .. ::* *-* .
f* 1
: -: ** ,,** *,"' .j :j,:: ::. .'









i~ ct of rBct pe ezr.--In .l o t r
:I:-special effort has been made to reduce the chances of o -
l : .. 19

havelb been limminated for all timrne and have become lawns, gardens,
sii" or- harm!e3s grass and jungle land.
i.?.'::t. andcost of recent permanent work.-In all of the recent subsoil
l!aton -special effort has been made to reduce the chances of ob-
5 M tii o of the tiles by silt or roots. The plan for contemplated work
Sis ..... caefully laid out on profile paper with the aid of a level so as to
i~i : t th:ebewt available grade for the entire system, thereby securing
i- ."m: mt scouring action within the tile for eliminating silt. Wherever
:grae. per-its, tile is put at such a depth that its top is at least 24
inc hI es below the soil surface and the trench to a depth of 24 inches is
iI. :.d with broken rock. Placing the tile at such a distance below the
riaee-reduces the likelihood of grass roots qbstructing the lumen and
Ji .i mentally lowers the ground water level, thereby favoring rapid soil
..drying after rains. Except in rare instances all of the tile now used has
Ian interior diameter of 6 inches and is made of concrete, in sections
.1 foot long.
For several years all- open concrete bottomed drains have been
constructed by the sectional method, using precast sections 21 feet
l ongi of semicylindrical shape, with a channel 14 inches across and with
:.a befl at one end to receivethe plain end of the next section. These
i also.are laid strictly to a predetermined grade.
S. Both tile and sectional bottom are manufactured by the Health
SDepartmeht in its own plant at a cost which has now been reduced to
approximately 4 cents per tile and 50 cents per section. Broken rock
: :for covering tile drains costs $1.25 per cubic yard at the crushing plant.
Tn many instances rock is obtained near the job and broken up with
.. sledges by our own gangs at less cost. Labor is paid 21 cents per hour.
SThe average cost of 112,251 feet of completed permanent work recently
installed, about one-fifth of which was concrete bottomed and four-
Sfifths subsoil tile, has been 51 cents per linear foot. As a rule, tile is
i"uchlt less expensive to install than concrete bottom. Naturally
the depth of excavation necessary and the length of haul for material
Decidedly afftc-t costs so that no definite average can be given which is
Applicable to all projects.
I; ums spent for antimosquito sanitation by the Health Department
.:f fTe .Panama Canal.-In recent times the Health Department of
The Panama Canal has had available annually about $1,400,000 to
:.spen.d on its activities including hospitalization, outside medical
..service, cemeteres, and charities for the Canal Zone, and sanitation
na,. miritirnequarantie 'for the Canal Zone and for the cities of
Panamaand dCoI.-. Of thissum approximately the following amounts



... :










have been spent -each fiscal year for the strictly antimosquito
the Health Department:
119.... .. ....... $140,000 1923........ ... .
9120................ ... 140,000 1924...... ..... ... .i
1921....... ........... 105,000 1925... ................ t
1922................... 80,000 '1926 ......... .... ..
In addition to the sanitary program carried out by- the Health
apartment of The Panama Canal, the United States Army authorities
do a large amount ofantimosquito work at a cost qf appjoximat1'K"
$50,000 annually. This sum is entirely distinct from the funds'of tl,
.Health Department of The Panama Canal and is expended inder tie
direction of the Department Surgeon for the purpose of furnishi*'it
protection to the military stations, many of which were located subse; l:
quently to the Canal towns and beyond the areas sanitated by T. >y
Panama Canal. The money is mainly devoted to work.on the military,,. |
reservations, though some of it is spent on adjacent territory whet
necessary for safeguarding the garrisons. The operations df.the Ar"my:a:
and of the Health Department are coordinated by mutual agreementt
so that there is no conflict and the programs are linked together for
the better development of general protection. A large part of the origi-
nal drainage installations put in by the Army authorities was of.a per'i :
manent character. Their sanitary forces are now engaged in replacing:'
some of the earlier earth ditches with concrete bottomed drains..
Advantages of permanent work.-The increase in Health Departmenti :'"3
antimosquito expenditures during the last 2 years has resulted mainf l..
from the intensive program of permanent drainage work, and a a .s--aw~i,
investment these expenditures will pay dividends either in decrease I
future maintenance charges or in control of a much larger .area at t:i;:.
former figure. With reference to the permanent work recently installed ,;::.:
within and about Panama City, it has been estimated that the saving
from reduced cost of upkeep will easily pay for the improveme nt:
together with interest at 3 per cent on the original cost, in abouts
years; in addition, the area and degree of control during these 5 .
years will be much greater than they formerly were.
Unlined earth ditches require to be frequently cleared of siltm ".i
rapidly growing vegetation. This is a difficult and expensive procet;i .::
Even when clean and kept to grade, unless the grade is steep, tif'
frequently hold some water which, at time of infrequent rains, isr'a
flushed out and often furnishes breeding places unless regularly oile i
Subsoil tile requires no upkeep except an inspection once ot twic :
year, which consists of merely walking along the line to see that
a This has nothing to do with house screening. ".


,~
S *. A .:.




wN'- ,.: ,

rii i '" ... .

21

ie :P.rbstructed anywhere. If the tile- is obstructed, water will be-ap-
trei:: t on the surface. Open concrete bottomed.drain, like the unlined-
't:: t h ditch, requiresto be cleaned of debris and vegetation growing on
i. alnks, but this procedure can be carried out very quickly, and to a
i ~Ige-extent is accomplished by merely dragging along the channel
g:... i tlsoaked mop made of old rope. This "whale," as it is called,
m.. i ves debris and at the same time leaves a film of oil over any
remainingg water. After the installation of subsoil or concrete bottomed
Strain, the probability of complete control in a given area is materially
reasedt

: GENERAL REMARKS ON HEALTH CONDITIONS ON
THE ISTHMUS.

"In considering general health conditions and mortality rates on the
Isthmus, it should be borne in mind that in Panama City 78 per cent
of the population consists of negroes and mestizos, in Colon 85 per
cent, and in the Zone 50 per cent.' The negroes are in large part,
SWest Indians who were brought here during Canal construction days,
:'and their descendents. The negro population is greatly overcrowded in
Panama and Colon, Charts 4, 5, and 6 (pages 9, 10, and 11), show the
death rates in the cities of Panama and Colon, Republic of Panama,
and in the Panama Canal Zone during the years in which these areas
h;:.-ave been under the sanitary control of The Panama Canal. The
housing conditions for the negroes are better in Colon than in Panama,
wf'hich fact probably accounts in part for the more favorable showing
!i i that iity.
h e death rate in Panama City has been reduced from over 65 per
S1,000. ip 1905 (the first year of American sanitary control) to less than
i20 per 1,000 for each of the last 3 years. During the same period the
7 death rate of the city of Colon has fallen from 50, or over, per 1,000
4 t. 12.,6 in 1923, 1518-in 1924, and 12.82 in 1925. The Canal Zone rate
has dropped from a maximum of nearly 50 per 1,000 in 1906 to an
v. average below 8.5 per 1,000 for the past 9 years. It is interesting
I:to. compare the above figures with the death rates in some of our
American cities, particularly the more southerly ones, which are shown
is" :table at top of next page.
S... t e p~pnlatioit the Zone for 1925 includes approximately 27 per cent American (white) employees and their
Sint as itatedrsreas, 39 per ceat negro employees and their families living in sanitated areas, 22 per cent
i d (w )ii) Ihi sant stated area 5 per cent employees u(motly negroes)Jivmg in unsanitated areas, and 7 per
o stl aa theirfamilie (mostly negroe) engaged in farmin in unmanitated areas. This latter clam'
B. beemn i.s Ifst e only Mine 1921 and may be expected to act unfavorably on the morbidity and mortality rates.
O; 3123 whitemploeesiad925, about 450 were female. Most of the white male employees are married and have their
:. aand ehiMe withthheman the one.


M-L : :. ":.... ,




4 .' ::..; '
*; ... : .' ", ,: ',. : ...






CRUDE DEATH RATEISIN CEfTAIN AM"BEICGAN OTIE.. P1f OP .. ..:
S 1922., 1923. 12,
Atlanta............................ 16.3 19.2 B Ilimu re ........................... l fl
Biri m ......... ............ 13.4 D l ...................... .. 4.
Louivil...... ............... 14.1 46.2 New Q l L ......... ........ ..... .. 7.
h ond ................... 14.1 15.6 W a hi on ................. ........ 4
Albany ....... ........ ..... 13.2 13.4 Boston ............................... 23.
Bu e............................ 13.5 13.5 Chica ge..... ........... .......... ..... I .'
Cipeiati........................ 13.7 14.7 Fall Ri r r............... ..... ........ .
udiaa pi lia ....... ............. 12. 14.1 Kansae City................. .....
M neapoli e........... ......... 9.8 10.0 New York........................... .. 3.
P a l pl i ............ .......... 13.3 14.1 Pittelb r ..........................:. ... ..
San Antonio...................... 16.1 15.7 St. L rita.. ....................... ...... 1l ':
W aint o ................... .... 12.6 13.4 GSa ran.acieo ........................v 1:.. U I T. 'i

The death rate from disease among American (white) employe&ett,
The Panama Canal is shown on page 51. In evaluating these figurel....
one should bear in mind two factors: First, the employees must pass' a:iii'
fairly rigid physical examinatioit before coming to the Isthi i.
SLcnd, many Americans suffering from chronic diseases, or incapav:.;l,:
tate i by reason of old age, return to the United States to die. In ....
of these facts, the four diseases causing the highest number of dsqt il; .
in 1923, 1924, and 1925 among American employees were, all cbros 1,n||
maladies and were, in their order of frequency, as follows: Heartdi"ai;4,
cancer, tuberculosis, and apoplexy. Chart No. S shows that as a. cape i
of death malaria has become an insignificant factor. There have b i '4i
no deaths from this disease among employees of The Panama. .Ca.ma!wii
whether white or black, during the last five years, except 2 in 9Z4 ;::
The diagnosis of typhoid fever and of malaria in the Canal i ~' i3
or in the cities of Panama and Colon is rarely based on clinics e$li^ ..
deace alone. .In the past, however, in many tropical countries th<4j':i
has frequently been confusion between these two diseases. Fol ..ih;;
reason the typhoid fever statistics of the Health Department atoi d:
special interest. It will be observed that typhoid fever has cometolb.: .i
trivial factor in the morbidity and mortality figures, as is shown bJ 1 ;iyii.,
," ... .* : .. ... ..I ,
TYPHOID FEVER IN PANAMA CITY, COLON, AND CANAL ZONE.' z :

Probable oriwn d inetom ..
Year. Panan. City. Colon'. Cal= Z0. T..l b
Cases. Deotbs. Cases. Deahe. Case. DJtp. Ca"w. D r
1907.......... ................... 24 0 ) 30 ') 599 (') 658 : .i
19o 8......... .................... 22 ( ) 14 a) 245 6 W '
1909............. ............ 10 () 16 ') 221 (' 4?
1910......................... 12 f) 24 (0 93 ( 12
1911 .................. ........ ... & ) 13 ') 77 (
191 ............................ 10 3 ) 48 (
1913............................. 1 ( 4 (i) 50 ( ) .:
1914.................. ............ 8 a 2 s3 ; ; i;
1915.......... ...... .......... 15 5 5 2 5 ......
1916 ............................ 23 3 5 1 1 4 : '
1917.. ................. ........ 10 2 .. ....
1 918 ............. ... ........... 8 6 ..i...
102 ............................... 10 ...... .. 4 3 1 I */
119 ................... ..... 8 2 7 1 0 '2 *.
1ga ............................ .. 7 3. .:
K B JE .. ......................... ." W:::;." ::
1924 .................. ..6 1 1 1 ... .
1925................ ....... .... 5 2 4 ........
SPopulateo figure will be found in Charts 4, 5, and 6. .. "',
Pro-btWe morgi nletn of inetio asen that died up to 1913 not readily a ...i "-" :
I :h:: :'7. "0
.. ,. .- : .',. "'r ,.i:'.;., ..^'











Sdeath rates of infants per 1,000 live births in the cities of Colon
"Aftama and in the Canal Zone for the past 7 years have been as
,. ...'. -






1919. 1926. 1921. 1922. 1923. 1924. 1924.

S. 155.29 142.21 139.28 139.66 115.66 114.49 117.04
S ............ .... 154.47 155.9 173.96 147.23 141.95 138.06 117.12
.37. 44.36 33.22 41.32 43.69 47.06 36.27
S... 130.00 134.78 120.27 88.81 123.01 96.03
1 (tbit:apbllack.. 114.07 95.09 96.65 92.62 72.76 96.54 77.62

CHILD WELFARE WORK.
Stealth centers for children'and infants were maintained during the
Ssartat AsDsn, I3albwo and Pedro Miguel. Under the direction of the
i i nn ,ra, many of the mothers of the Pacific side have taken great
-iifitak in these centers.. Six hundred and seventy-five visits have
u t mdidtn4i by .infants or children to these health centers and the
visiting i urse madi 1,034 calls at the homes.
tbe Cristobal Woman's Club Free Clinie in the City of Colon, is
qpg ated jointly by the Cristobal Woman's Club and the Health
S |ucaxrtmfnt. The Health Officer of Colon is the director and the
is utui Department supplies the nurse in charge. The clinic has con-
t. ii ite work to infant welfare, prenatal, dental, and eye, ear, nose,
an&d throat work. Milk is prepared and feedings for one day are
provMied for approximately 25 babies daily.. The following table gives
m rs number of eases treated during the year:
: e (~. eludes all cases under 5) .... .. ... 9,314
ietl .. .. ................ ... .. .. .. 1,619
U.. s. ........................ .... 227
:, ye, ear, nose, and throat ..... ....... 2,346
eTial annual examination of ll children in the schools of the
:a wia ma de by Panama Canal physicians, assisted by trained.
a n the w white choisel 1,983 children were examined, among
. .... .... .
i ,hom the following defects were found:
ieiiid tekh, .............. 342 Othopedic defects....... .. .. 15


Saldefects...... ........... 8 Sin dieaseas ........ .... .... 4
Defective vision...... ....... 180 Nervous disorders.:...... 6
ef eibveai nhg.............. 22 Defects of genitalia.... ...... 5
rdcdsease. .......... 24
ftji sat.t of uitritkri of feach child was recorded and the use of the
w.~b~bt i noted. Parents were notified in every case of any defects


......
:"" N:

: ~.. : .. 1,61







24

found and efforts were made to have remediable. defects.cred-
.. The visiting nurse made weekly inspections .of the schools i
the Pacific end of the Zone. She also assisted. in the examination i
school children of the City of Panama and in the work of the i
Clinic of the Panama Red Cross.-
VETERINARY INSPECTIONS.
The veterinary force of the Health Department carries out the qiA :
antine inspection of animals entering the Canal Zone or the '.,
of Panama and Colon; the inspection of animals transported by rtail :
across the Isthmus; the ante and post-mortem inspection of: ahnima
slaughtered for food; and the inspection of dairies, dairy herds, .and.:..
milk handling. : ;
Quarantine work in 1925 included the examination of 25,363 cattle:
and 43 horses and mules brought into the Canal Zone, or the cit dfKAEi :
Panama and Colon, from the interior of the Republic df'Panamkta :;
and from other countries. There were 4,102 cattle and 6,3223 hg;,: r
inspected for rail shipment across the Isthmus. At the Colon; Panarmi ;
and Mount Hope abattoirs ante and post-mortem examinations were.
made on 25,995 cattle, of which 30 carcasses were condemned. 'Fift ee .i
of the carcasses were condemned on account of extensive bruises; 4''.4l ::::
septic wounds, 7 on account of septicemia, 3 on account of pndumbi .hi .. .-
2 on account of anthrax, 1 on account of actinomycosis, and 2 beiaus il.*.
of their dying condition upon arrival. :
Regular inspections of dairies were conducted to insure eleailin .eli
and acceptable conditions. In addition to this, samples of'milk iwier:
taken at frequent intervals for bacteriological "examination, as a c *
on careless production. The entire milk supply of the Zone andrA~fth::'
cities of Panama and Colon is pasteurized before being delivered to'E:
consumers.
Of the 23,596 hogs slaughtered, 788 were condemned on accoitmt of:
cycticercosis, 103 on account of cholera, 15 on accountof -pne;umoani .
25 on account of exhaustion, 2 on account of pyemia, 1 on acconiit ..
pyrexia, and 1 on account of emaciatior. ".. .i
During the year the Health Department supervised the disinfeetiaf0 ,
of 19,237 hides which were to be shipped to the United States.:

DIVISION OF QUARANTINE. ..
Surg. C. P. KNIGHT, U. S. P. H. S., Chief Quarantine Officer. : +:

The only quarantine embargo continued throughout -the .year m i
Was that imposed in December, 1924, for foot-and-mouth, : 'i;



:.. '. !2 "....
.' ::"[i" : :f' ::: ".
.. .. : ...: .. :* .:..:* ..... A ::;::!!* *i




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


.2&

api: inst all countries of South America, except Colombia, Venezuela,
a" i:dpiDutch and British Guiana. The quarantinL on account of yellow
fe; ve,.which was placed against the ports of El Salvador and the Stamm
Crei ;C k District of British Honduras in 1924, was lifted during the year

It is worthy of note that out of a total of 5,549 vessels inspected,
: only three were detained in quarantine, one for 1 days to complete
1; th. e prescribed six days after leaving a yellow fever port, and two U. S.
Navy ships for one day and three days, respectively, because of the
Presence of acute meningitis aboard.
Vssels given radio pratique ..... .... .... ....... ...... 179
i Vesselsinspected and passed.... .................... .. 3,898
Vessels passed on sworn declarations.............. .......... ..... 1,869
VeIsels detained in quarantine .. ............... ... ...... 3

Total..................... ...... .... ... .. 5,949

SV ssels fum igated.................. ..... ........ ..... ....... 126
Supplementary inspection of vessels....... ..................... .. 5,006
S Persons detained in quarantine station.. ....... ................. .. 90
S Persons detained on board vessels in quarantine ................... 1,521
Crew inspected and passed ......... ... .. ...... ..... 224,655
SCrew passed on'sworn declarations ........... ........... ..... 93,316
Crew granted pratique by radio.................................. 35,165
Passengers inspected and passed ............... ......... .. ....... 93,831
Passengers granted pratique by radio ...................... ...... 3,132
Passengers passed on sworn declaration........................... 25,818
Supplemientary inspection of persons on detained vessels ........ 220
Persons vaccinated. 1,097
Persons vacnatedi ............ .................... 1,097

Immigration operations continued under the division of quarantine
: s. heretofore. Eight hundred and fifty-two persons were deported
and 1310 were detained at the quarantine station on account of the
S immigration laws.

...... .. ANCON HOSPITAL.

(Capacity, 1,200 patients.)

^' Lieut. Col. W. L. PYLES, Medical Corps, U. S. Army, Superintendent.

.Administration.-The practice of holding periodic meetings of the
: entire staff, and monthly meetings of the head nurses, has been con-
tinued with beneficial results in efficiency of operation and coordina-
:iton of effort. The Clinic and Journal Club, established last year,
i.a.popiular and vahiabl feature of our hospital work.
ip,, "U

m vt))mmm










Professional services.-Duriing the year 1,443 major 't
and 5,186 minor operations, including intravenous injectio i
phenamine, were performed; 3,960 cases visited the out-patte tsi l
cal department; 330 pregnant women were delivered. There'
3,171 cases treated in the medical out-patient department; 554 adia t
and 433 children were vaccinated. There were 10,989 visits to thetajib 0
ear, nose, and throat out-patient department; 2,147 operatii .w:.h ".
performed and 1,156. refractions donL. There were 3,212 taseaae handlt*d
in the radiographic clinic, for which 7,532 ordinary fimu aof arnaw
sizes and 3,223 dental films were used. During the year 387 out.-piatini: F
and 406 hospital patients were treated in the radio-therapy iij4 i
which is charged with the administration of radium therapy, Xnt "I
therapy and hydro-theiapy; 745 radium therapy treatments, 1,9
X-ray therapy treatments and 7,070 physio-therapy treatmentswe rl
given. A total of 40,338 patients were treated by the physicians. 6f".:
Ancon dispensary which is attached to Ancoh Hospital for administra-i i:,
tive purposes. .
Nonresident patients.-Six hundred and eleven patients tiig:
outside of the Canal Zone and the cities of Colon or Panama, weiiI:.-
treated in Ancon Hospital during the year.
Operating expenses.-The follow ing table gives cost of operatMia.
Ancon Hospital (exclusive of dispensary) for the past three crale nd r ..:.'i
year -4:
-~~~~~~1 ------ ---- -,. ^ ^;
1923. 1924. 1925, ;:

Operating expenses'. ................... $520,551.97 $558,593.46- $539,610 :.:43
Revenues ............................ 309,572.03 342,461. .7 349,.4$Q 93 .
Net cost............................. 210,979.94 216,133.75- 1941 .5Q4 \
Days relief furnished.............,...... 109,599 129,525 14t429"
Gross cost per patient day............... 4.75 4.31 -4 4
Cost of subsistence supplies per patient *. ..- .. :i..
day....................... ..... .34 .40 .44
tire--------purposes--'*-------- '-s-, '"i^"- *.. ::^








SDoes not include the salaries paid by the War Department to medical officers of the Army detailed for duty
with The Panama Canal, which amounted to approximately 532,300 in 1923, $5DQO in 1924 and 878,600 in 19 :*

COROZAL HOSPITAL, :

(Capacity 450 patients.) i

Capt. G. E. HESNER, Medical Corps, U. S. Army, SuperintendeitCi

Pyrpose.-This institution cares for the Insane of the Caeal tZIEi","
and of the Republic of Panama, being reimbursed for the latter idaA-I

.. ... .. .. .

S.. .... ,: .
:4 ..5- .. .:.




- -.' "q 'L -------------

D... ... 2.


l age"ts by the Republic at the 'fixed rate of 60.75 per day.
i.~ti*casl E for Canal Zone employees disabled by. reason of injuries
i!i OI roni:' disease and.who desire to enter the institution.
N:- :i.' :4al, jeraJmoa.--The layingof a new pipe line from a spring
r:"; g lhi ide was completed and water is now being supplied from
S i iw for the refrigerating machines and for washing down the
.:pi.,Mand terw. This results i considerable reduction of water bills,
k. ia*tionsl were tarn down in Ward "C," eliminating the small
I W II B moa which were poorly ventilated and converting the
I upprF o into a dormitory with full size windows, thereby increasing
SthawJed capacity and greatly improving conditions generally.
PMi have i.been completed for the erection of a modern ward of
i parete co.3truction accommodating 104 female patients. This
S sildipg w s -designed that it may be converted into a hospital
. accommodating both male and female patients in the event that re-
re.wl of the Panamanian patients reduces the population of the
Sa imtiaa6n. Work will begin in May, 1926.
Qe~Wi ds.-The mangosteen trees which were brought during the
prviouPs year from Jamaica are growing sturdily; also the cinnamon
-. a :.a nutmeg trees. A row of imported oaks (Quercus fenestrata) was
pintnad along the roadway to the cemetery
a P. Aiccsu.--The census on December 31, 1925, was 389 as
Scompatred with 375 on the same day of the previous year. The number
,admitted was 153.. There were 110 discharges and 23 deaths. No
S k.ijde or death from violence occurred. Of the total released, 31 (28
Super tet) were recovered, 52 (47 per cent) were improved, and 27 (25
'ft eoat) were unimproved. There were 14 patients transferred to
Ancon Hospital for medical or surgical treatment during the year; 8
::.: o Ithesek e w returned to Corozal, 4 died, 1 was discharged, and 1
tf ist sil in Ancon Hospital at the end of the year. Of the total
a ,r isios, 77. were cases paid for by the Government of Panama,
:.. and the remainder were Canal Zone charity or private pay cases. Of.
t:. e 4.. discharged, 41 were deported.
:. nltenaiepecific treatment was given to patients suffering from
phii'tic psychoses, about 20 per cent of the total population. Four
SIt.unided and samIteen.doses of arphenaamin were administered in-
I tnavenBmuly, and 63 lumbar punctures were performed.
I Du~r ti the, yea, work has been continued in the treatment of
F puetite aurt~yphiAiscasus by the induction of malaria. Twelve patients
w::.. :..ere inoculated with tertian parasites according to the Wagner-
JWI xgIiE"UItI ". allowed, to hi w. from 10 to 12 paroxysms, and then
: tinh with. quttiaif The results were disappointing; only two cases

A21... 7 r.: .. '
R,.: : 1.. .. .
-M&'... .. :. .
AN.i i k:i .:".. :





.



showed improvement mentally and physically, and very little ci
was noted serologically. All of the patients treated-.by this reth'
were well-advanced paretics when admitted to this hospital. 0 "J
to inoculation all had received an intensive course of antis fhilitk_
treatment, somehaving received as many as 25 doses of neosalvarsa .a
Eight cases of epilepsy were recently started on the ketogentic'dWti
treatment. One obstacle encountered in the treatment of epileptI5
in the tropics is their disinclination to eat-a high fat diet. .S
Gratifying results were noted with the use of brewer's yeast as a dail
article of diet in the treatment of patients suffering with pellagra. i
Other patients.-There were on December 31, 30 black and 3 whit' :I
chronic.medial or surgical cases (not insane), as comparedwith9~';
black and 3 white of this class at the beginning of the year. :Ninewee'
admitted, 5 died, 1 was discharged and 2 were repatriated. Thi '".
capable of performing work are encouraged to do so. r,
There were 30 cripples (not insane) in the institution on Decemb~ie..:. I?..
31, the same as at the beginning of the year. Two were admitted dfi .-':f.
ing the year, 1 was discharged, and 1 was transferred to the chronic
ward. All but 5 were employed in some capacity by the institotionh :i
their services being utilized -in the garden, guinea-pig warren, d airy .:,.
piggery, ar cemetery, on the motor truck or teams, and in thestea~drf
plant. The five who are not employed by the hospital are each ?'
assigned a plot of land to cultivate individually and are paid for wihat'f!::,
they produce. Under this plan they are able to earn more than the-y :;;::r
would at a fixed wage and the method encourages industry, giving the.ri"': -.:i:
a greater incentive to apply themselves to their task; their aveag:::;
earnings per month amounted to $51.24, and subsistence was furnisih.~:.
them without charge by the hospital. :
Recreation.-Weekly picture shows and concerts have been codt. !:;
tinued throughout the year. During the dry season, picnics.were:h".i ..t
on Saturday in a grove back of the hospital, where lunch was servedti.-: .
and baseball, handball, and other sports engaged in. '""
Occupational department.-The total receipts from the occupationtt I
ward amounted to $5,919.43, of which $4,295.96 was from the sale'o.;
brooms. All of the brooms are made by the chronic patients (not i :t.,'
sane). Money derived from occupational work is utilized for purechasit>i5':"
material required to continue activities in this department arnd for":;
providing workers with tobacco, candy, or other luxuries. The valtuIe.i
of the produce taken from the patients' garden for hospital consumijp1i 'E -:
tion amounted to $5,380.
Dairy and farm department.-Approximately 50 acres *ave be .N .l
added to the hospital pastures through changes in fetce lines -A trt:ilii:


** ..: .'. ,i .

.... :..:.:. *.:. AN .
:ir : **^ "~ ii:*^ : ;:





--- .I ..:: ..* --. ... ;: .

: .29

'ailIibeen cut along the boundaries, and the pastures cleared ot brush.
tis;planned to have the entire hospital reservation enclosed within a
ipermanent fence during the coming year.
i:: in the dairy barns 100 individual concrete mangers were constructed.
:: iOh: n hundred individual automatic drinking cups for use of cattle were
i! .-:Sceived ,. of which 75 have been installed. During the latter part of the
i yeay 1'3, Costa Rican cows wer9 purchased and added to the herd to
k.-ep iLke those butchered because of advanced age or nonproductiveness.
i: The h rd now consists of 41 Jersey cows and 18 calves; 20 Holstein
Sfg03d'grade) cows and 10 calves; and 2 bulls. There were 45,375 quarts
*1f infilk produced and milk sales during the yearamounted to $14,582.35.
.The. receipts for farm produce aggregated $4,285.54, and for manure
1,003.50. There were 269 pigs and 50 hogs remaining on December
31. .The piggery continues to be an important source of revenue, and
%he gross income from this division of the farm for the year amounted
to $7,054.02.
: COLON HOSPITAL.

(Capacity 80 patients.)

iaj. JOHN WALLACE, Medical Corps, U. S. Army, Superintendent.

Purpose.--Colon Hospital is operated largely as an emergency
hospital and dispensary for the benefit of the Atlantic side of the
S-" thmus.
:* ;?. professional work.-During the year, 199 major and 97 minor opera-
" tions were performed. There were 625 administrations of arsphena-
-mine. Three hundred and four pregnant women were delivered.
STh-e dispensary physicians made 267 house or ship calls and 41,605
adttiets visited the out-patient clinic. The eye, ear, nose, and throat
: lnic-was operated in conjunction with the regular white clinic, there
..-being no physician for assignment to this special clinic exclusively.
'" There-were 221 refractions and 119 operations performed. The X-ray
:j. clinic .wa in operation only about 4 months during the year, due to
Ute .e worn-ouit condition of the equipment. A new portable bedside
Snithas been purchased and is due to arrive in the near future.
S..Repairs and. replacements.-A new obstetrical delivery room was
k c:qn structed for colored patients during the year. Practically all of the
Kit7.: ralfurniture and. equipment has been repaired and painted. A
I :i- set of dishes and adjustable bedside stands were purchased for the
Swit: e feinafe arde. Routine painting and repairs to woodwork have
bee a done as r uied.


.... ... : .. ... .. .
:-ii t :5:' :. ..'.- "/
aii --b:-'?:'.!:., ". .: rry" ...:




... 4: mpc-;





PALO SECO LEPER COLONY. .
(Capacity 100 beds.) .

Mr. FRED D. TUCKER, Superintendent .
Dr. PRILIP HORWITZ, Attending Physician. ,

The patient population reached a maximum of 100 at one time d
the year 1925. There were 94 patients at the beginning of theyea
12 new cases were admitted, 1 was discharged, and 8 died, leanv&a
total of 97 at the close of the'year. The discharged patient ,a iniegr
26 years of age, born in British Guiana, was returned to the land af..her'
nativity. She had been a patient in tht. Colony for 8 years ,.dwi:;
apparently cured at the time of her departure.
The new well, dug in 1924, has proven capable of supplying lteiij
Colony with pure water throughout the year and has relieved serious ..
deficiency. The stratum of fractured basalt underlying Palo Seco::
is not water-bearing and in previous years efforts to obtain a deep s6tpply:; :
has failed. The new well, was dug 20 feet deep in the outcropping f ~'.".
seepage of a hillside and has supplied what water was actually needed'. -
even through the pastrunusually dry season. ..v
A new infirmary was built this year, at a cost of approximately :
$10,000. It is of concrete and frame construction and contains two. '.
wards accommodating 12 bed patients, a commodious operating roori
and a drug room and dispensary. The basement floor will later i ..'
utilized for offices, commissary, and storerooms.
The old infirmary building has been remodeled into quarterslfio ill
patients. When the new offices and commissary are completed, 'th;;i!
old offices and commissary will also be remodeled as patients' quarter l :.i
By these increases in space it will be possible to relieve the.congepsta f i
which now obtains and, to isolate from positive cases the ciaid ic k
negative patients who are awaiting parole.

BOARD OF HEALTH LABORATORY.
(Operated in connection with Ancon HospitaL).

Dr. L. B. BATES, Chief of Laboratory.

Bacillus typhosus.-Recovered in blood culture from 9 individ i
6 were from shipboard, and 3 from Panama City. 'B. fowltdyj*di'4j.
and B. paratypkhoss B, were not recovered at any time during the yS't..
from blood, stool, or urine.

.:. :.:*.- '

........ .. .'.....:.:;......;...,S,




.'. 'a.:: : .. :', .. ". "
-^'- --- -- ----------


1!:.. 1

: Tyiheid c, airs.--rlOn December 31,.1924, two typhoid carriers were
SviKtdr -eanitary surveillance, H. B. and G. H., both of Panama City.
stsi ool ecinens from H. B. were examined monthly and from G. H.
q' up to September when he left the city. All specimens examined were
positive for B. typhosus. No new carriers were discovered during the
.- year
i Tasil and adenoid examinations.-In August of this year a 6-year
i: tu d of all tonsils and adenoids removed at operation was completed.
S Specialaatt atiori has been given to the incidence of tuberculosis. The
totaltninber of specimens examined in this period was 3,685 of which
.Al per cent showed tuberculous lesions. The greatest incidence was
S in cokared children-of 3 to 6 years of age and 80 per cent of all positives
Were from colored children under 14 years. In the white cases prac-
tically alT positives were between 15 and 34 years of age. Two-thirds
of all specimens from cases suffering with phlyctenular keratocon-
/ jitnctivitis were tuberculous. Cervical adenitis was the next most
.important associated lesion.
,Fatal cases of snake bite poironing.-Two patients suffering from
snake bite died in Ancon Hospital, one on October 31, 1925, and one on
November 25, 1925. From the available records it appears that these
two are the only fatal cases of snake bite on record in Canal Zone
: Hospitals. An autopsy was performed in each case. Below is given
a. "a short synopsis of each case.
Autopsy 7320.-G. B., male, black, 40 years cf age, residence Frijoles, was bitten
Over the upper third of right tibia and over internal malleolus of iight ankle on
: October 29th about 7 a. m., when on the trail on his way to work. He was admitted to
.eacon Hospital, nacenscious October 31st at 11.05 a. m. There was a history of
h.beorrhage from mouth and nose immediately after receiving the bite. He died two
Sand a half hours after admission. At autopsy, in addition to the wounds from the
.fingv, there was found extensive hemorrhage in subcutaneous tissues and fascia of
right leg ard ankle, extensive extravasation of blood in right retroperitoneal region,
hemorrhage inand about the right kidney and ureter, hemorrhages in the intestinal wall,
S terebralad meniageal hemorrhages and blood in the middle ears and mastoid antra.
i.: Autopsy 7343.-W. R., male, black, 55 years of age, residence Frijoles, was bitten
.I. -on the dorsal surface of the left foot by a small snake, on November 23d about 8 a. m.
An incision made at the site of the bite bled persistently. He was admitted to Ancon
S: Hospital. November 24th at 3 p'. m. He complained of pain in the left foot and said
S-hat he had.,been spitting up blood. The wound was still oozing blood. He died
November 25th at 5.45 a. a. At autopsy no gross lesions of importance were found
other than, moderate artedioEclerosis. 'Histological sections of the basal ganglia,
medulla, pons and cord all showed marked degenerative change. in the ganglion- cells
S The snake was-killed in each case. However, efforts to get the snakes
for purposes.of identification met with failure. In the first instance the
i snake was thrown into Gatun Lake because of a local superstition that
Sif a snake that has bitten a person is killed and thrown in to the water


RIF







32

the bite will prove harmless; in the second iiistaxice'the patieniIC;
thL snake in the yard while he went into a hut to dress his woun d a:
when he came out he found that the chickens in the.yard had e
the snake.
Mariahuana.-In conjunction with other branches" of the H
Department, the Police Department and the Plant Introductidn-Gi t
dens at Summit, an inquiry was made as to the identity and local t -
of the plant commonly known on the Isthmus as "Mariahuana."
plant was grown from seeds at Summit and lafer identified as Ca .sa..,!i
sativa L. by Paul C. Standley, Associate Curator of the SmrithsoniliL
Institution. He stated that the terms Cannabis indica and Ctnnab ": 1;,
americana are synonyms of Cannabis sativa. The plant grows wild". V 42"
the Canal Zone and in the Republic of Panama and is found :uithM
widely distributed. Its use for smoking purposes seems to be restriiesd: Q>
almost entirely to soldiers. It was not possible to form any apprWxi,
mate estimate as to what extent it is used by them. Smoking ex peir i
ments were carried out with the leaves and tops of both the wild ';'a::::^
cultivated mariahuana plants. The ordinary pharmacological effect R
of the drug were obtained to a moderate degree but these were n :ot
accompanied with any tendency to mania, violence, or disorderliness : j
The evidence tended to indicate that the drug as used here is not halb:it,:
forming in the generally accepted sense of that term. i
Ethyl Esters from Chaulmoogra Oil.-During the past year theii:i
preparation of the ethyl esters of the fatty acids of chaulmoogra'Q : o. :!
has been continued as in previous years. Attention has been directed 'l::i
to the problem of maintaining the content of free fatty adds in.t:4e2t
finished product at the lowest possible point. Esters have been prt-".
pared with very low free acidity, and such esters have been giv ..
intravenously with much less disagreeable effects than usually fdldois::,
the administration of esters with a relatively high content of. fatit .:i,2 :
acids. The study of the esters and their action is being continue" ....
along the lines indicated by this observation. :
Reports.-During the year approximately 40,000 reports have b- :::
rendered. This does not include duplicates. .

BACTERIOLOGICAL EXAMINATIONS .. ::
Blood cultures.... ..................... ........ ..................... ............ ......... ... i '
Positive for B. fyphonwu ........... ...... ......... ........... ......................... ....
Positive for Pnum cccum Typ: 1..................................................... 1
Positive for Pmunmaocu i Typa IV................... .... .. ............... ... ... ..
Positive for Strseplcccus wirdan .............................................. ........ 6 ...
Positive for Stre apcoccus, on-hemdol ic.................................................. I
Positive for B. cEli .................................................. ..... ..... ....
Positive for B.m uc us a prulatuar ......................................................... .
positive for Staph lac cs awr s ................. .................... .... .... ........ .
fbritive fB iaphllocwcusalbws .......................................:........,. i, .
*i. i.- '..:. ,
':.. :,: "..:"i"

EE ..... "...""





r:;::" '..:" "





33

BACTERIOLOGICAL EXAMINA'tIONS.-Continued.

. Eiiultd for typbid-dsentery group. ...................... .............................. 2,186
r i o D .typhe TO ................... ....................................... .... 17
rfir a. typho~ (from 2 arrines).................................................. 16
fE : L f dpnSlofe ia a nitle 'meer, Group ..................................... 38
S Bi .diynt r iae, ManairFermenter, Group III................................. 7
S f t se dys er lsf d...................................................
Sfortypoid grop. a.................................................. ....... 1,5
mttyphoid grq.oup 1.586
f -ot. B. t.i........... .. ..... ....................... ........ ........... 0
a l tItedibf rgisime other than typhoid group ............................................. 361
1 ..12f8 l .... ........... ...... .. ........ ............... ... ........ 123
fltw h afi.r owaureml. .;......Z ............................................. .3
t i t ef B .cr_ i .cu si a albt sd ...................................................... ... 93
Boph eutl ~fofr. iepnaietesi.. .... ........................................................
S Iat'We for B. ionuRsM ap ulate .............. ..........................................
T l O d ult f B dip f a.............. ..................................................... 1 15
iti farB. diphtuenriae ....................................................... 1
t drl for B ................................................................ 1
fE stiff rB. ri .................................................. 21
ultu esofB. dp therias tested for virulence .............................................. 2
.M tulseb ofB. di pthriae tested for virulence................. .................... ........ 2'
S culttinm for organisms other thin B. dip.hAriae ............................................... 25
Sp nal l dd uuirese ...................................................... ...................... 56
Positive foreB. inu.enws............................................................... 1
: Po:itive for PSernutocccus T .
w i. vi:tde futr. ......l.o .. I ................... ............... ...................... ........ 2-
Positive or P eumoo us Typ...... I... .................................... ................... I

si ti resr e ..................... ....................... ........................ .. ......
I turiea c.......u ........ ................... .. .................................. .......... .. ..
t It 'rPe...e .. ............................................................................ 13
Sstai d culture s ........ ............. ........ ...... .... ..... ... .. ............. 3
t i cultures ................... ...................................... ................ 12
d oult ur. s ............. ......................................... ............... 6 1
* f du lta ree.... ....... .......................... ........... ..... .. ............... .
: ~" ~a it cul tures ......... ................... ............... ..... ........ ................... 1
itd cultureur...........................e .
ids clul1urs0es e. ,e................................... ..... ............ 1
S li lture .. ............................ ....................... ....... ...... .
t"h m skin lesions ................................................... .................
i a ur pus from various locations................ .......... .... ..... ... ... .... 19
S Culture tor Ducrey'e bacillua......................................................... ..... .
: a s tured d. ..................................... .. .. .. .. ..... .... ...
eudatea, etc., from above autopes. ... ..... ............... .......... ... .. 247-
F .* wa c te Sz t S raed............................... ......... ....................................
S tfed.Mexamnatios........... ................................. .... .. ....... .. 319
S Positive for Trepemarpaidum .. ... ............ .. ... .... ..... ......... 32
; G ti ialam eaG r ....................... .......................... ..... ..... ... .... .. ... .. 1 2
Sm e rs........ .... .... ............ ....... .... ....... .......... .. ..... ...... ... ........... 378
*. -'ltiw f fawusifrrm bare lus and- pii lum of Vincent'a ang.ina.............................. 173
Smlaironai grapnlois for Leishmania (Positive I).............................. 2
S- a .1 l thre foitfr thr h ............ ..... .......................................... .......
S SpatBme msa.rri ato lmerclis................... ............................. .............- ---. 5-
S Posi iefo B.lu erculm isa .......... ......................... .......... ... ..... 21
$nw m .vocaleerde for B. uberciihsa.. .................... ..............................
jBi 'lud faor BAm sWarculoqs........................ .............................. ...... .... ..... '
S. P sitive f rB tuber Mulos i .................................................... ...... 2 ,,
Si.m e ined:fB. tubetrclous................. .. ............................... ..... ......... .;
FPtd am p joint enxmined for B. urculdari...................... ................. ............
Sti return examined for B. culi ............................... ..........................
S r i examination for pirochaete ...................................................... 12
m on ve ro eal le. onm. ............................... ................................... ... ..
c Pi a tiv. e w fifor bacilliand spirila similar to tho.efound in 'incrnf'a angina .............. 16. .
mP Pani .. ................... ... % ................ ... ....................... .61
emear ....................................................................................
r ....i.n.aa..s.n. ...................... ..... .. .. ....... 10
Scount f pin uids. .......... .. ..... ................... ........... ................... 12
................ ................. ........ .........................
oeFive fo B praes............................................................ 3
S Ato ouru oprle.I e.. a........ ..................... ................... ............. ....... .
E E o vacaio ova. ............................................ .... ....... ....... ... ..
Se ea..n .ov... ............... ............... .... .................... ... .. .. 159
fi s frielapnge fever spirill .................................................................
a B filmftin ealmariaperasiles .................................6. ....0... .......... 33
tf.fliw efat i ma rl pa r1iaL ..te.......................................... .......... 11
malaril prasites.. ..... .................................... 107
iv "tive tfoie puartano maurial palarasites .................................... ...... .......
Positive fo maral parasites, type undetermined ................................. ..... 4
ri nee..for..ococ a...:................ ............................................. 2
4 bloodoea pua ecounts......... ........... ...... ...... .. ....91........ ........... .91
D" f e t c le ountl. .. .......nt.................................. ... .... 88
....ount .. .......... ............................. ....... .. .. ............ 96
H" Hembindbinetimatione........ ...... .... ..... ............................ .... ...... :
MR 2343--3



,: ::;







N ..... .... '.." ,.. .
$ 4*:,: .- .-*' 1..



B4CTERIOLOQICAL uX AMA"Q
Water from Balboa clubhouseswimming pool......... ....... .. .. ..; *.
Water from Balboa Aimy and Navr Y. M. C. A. wiminug pool.......... ,. .. .. .
Water from Arenal River ...................................... ...
Water fro Health Office, Panama............................." .,, ..;...
Water from Washington Hotel swimming pool............................... ,,,....,
Water from Rio Abajo J P**.... .......................... ............ .......... ....... ;. .i
Water from etFo rtVe, on ..." ". .
Water fom Fort Clayton.... ........................ .......... .......:*** ..* I e.*.- I -
Water from Corosal swimming pool.................................... ................. -., .
Water from Pla eo Iland ell ...................................
W water from hin mi8 Beao. ..................................... .............................. ..- ,: :. ..::!.: i
Water from Bruni Point....._
Wat.r from orajaeom ........................................ d .................... A.
W after from CocoSolo............... ............................................ ..... .,
W after from beach............................................ .................... .....
Auto bave tested .. ....... .... ........................................ ..... ..... ... .. ,
Food turffs examined:
Mdk cultured.for beteria count.. .................h............................,r,. ... .... .i::; -:L
Crndy utured........................... ............... ............. ...... .
Ham ntu r .. ............................................................... ...... ..
Food from Coco Solo, lot.. ................. ........................... .
Micellaous smears and examinations..........................................
SEROLOGICAL EXAMINATIONS. i : .-.
W a erann im tests ................................................................... .. ...
Gonococcus complement fixation teets................... ...... .... .......... V .... *-S:
Tuberculosis complement fixatio. test ...................... .. ............
Blood typing for tra sfusion.............................................................. .....
Examination of blood for coagulation time................................................
Blood sera prepared by Swift-Ellis method for intraspinal injections....................................:
Agglutination tests... ........ ......................................... ..... ........ ....
Blood fr Van den Bergh t ............................................................

ANALYSIS OF WASSERMANN REACTIONS.

A total of 17,116 Wassermann tests were performed on the 1:A.oo4i

.. :. .. '.
10,958 persons. The results of these tests are sumrm.arized beI.w. ..
TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSBBUMANN TEST uBrnflkI|t
BOARD OF HEALTH LABORATORY AND RESULTS OF TESBT. 1985. '


Individuals Indlvi ."
Race, se. and status. ,poiti -ni .w,,. ..

White, civil, U.S. citizens:
M al ............ ......................... .. 22.9 1... I .~
Females ...................................... 15 25.
Children.......................... ........ ............ 25 2 .
White. soldiers. male, U. S. citizens ................... .. 445 2,991 .J


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


6890 18 ., i1


. t ,i .. :


White, other than U. 8. citiseao:'
M ales.............................. ........... 78 6 .
Female......................................... 21 185 M 2
Children.............. ......................... 2 9 11i -
Totals....................... ............... 101 557 4 SM:'' *;rl f
Blanks and Mulattoes:
Males ........................................ 586 1,763,S m
Females..................... ................. 3 1,51I4 Z8
Children .................. ......' 27............... 182 0
Totals.................................. .......... 076 3,459 A .436
Chinese, males and females............... .......... 10 34 4t -
Grand totals.................................... 1,776 9,182 .10


The figures in the above table are based on the number of ii
examined and not on the number of tests made. :;i1.
', '. *.... *...: :... ..
.:. .. ..


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

... : '




K "1: : ..
1. ." ... : .....




35
.. ..

SIn addition, Wassermann tests were made on 513 spinal fluids taken
Si" mi 398 individuals, and of these tests 65 or 12.67 per cent were posi-
fve.

PATHOLOGICAL EXAMINATIONS.


Alutopsies.-A total of 305 autopsies were performed at the Board
of Health Laboratory. The causes of death were as follows:

0 p, .: s Diseases of the respiratory system:
Pit..tphoid feror (B. Pph.r, m, B). 1 Chronic bronchitis ...................... I
;a M i, edivoutumnal .................. 7 Bronchopneumonia ...................... 6
Diphtheria........................... 1 Acute hemorrhagic bronchopneumonia....... 1
aentery, cillary...................... Lobar pneumonia.................... 8
..Lm Ir................................ 3 Gangrene of the lung...................... 2
teria r polioaaliti................ Acute respiratory infection.......... .. 2
Min"ngoo menigitis ................ I
Tabereuld i ofthe uage ................. 29 Total................................ 20
d miwgti .....................
S be eritoniatims............. 1 Disaaes of the digestive system:
Ismeinatuted tuberulosis, mute........... 1
Dibseminated tuberculosia, chronic.......... 2 Ruptured pyloric ulcer .. ............... ..
S Ttiary syphis .................. 5 Perforated duodenal ulcer ............... I
Ce16brolpmal i.... ................... Duodenal ulcers with hemorrhage........... I
S ry ............... ......... 2 Enteritis and colitis (under 2 years)......... 3
Pemia and sept iamp................. 2 Enterocolitis (2 years and over)............ I
ptiiia .P...............erforted gangrnou appendi............
&dermoid arcinoma of the tongue........ 2 'Intestinal obstruction ....................
Carcinoma of the ................. Intestinal intussusception .................. I
Carinma of the eo ................ Atrophi cirthois of the liver..............
-oma of the stomach.................. 5 Cholelithiasis..........................
,. oftheiver............ Acute peritonitis.....................
frulmym sam of tb liver.............
Sof the ervi uter.............. Total.................. ............ t
Byperephroma of the kidney............. I
Ci~ inoma f the bladder................. Nonvenereal diseases of the genito-urinary system
asigaati...I........................ and annex&:
Sa................................ 5 Aeute nephritis ....................... 5
l perglyo i.. ..... ............. ..... .. 1 Chronic nephritis......................... I
DiAbetee mellitue ......... .......... I Py it....................... nep.... 3
A ooli p oni secidental............... 1 Pyelonephrouis........................... I
'" sWE, = ip ...............-..... I Strictures of the urethra .................. 1
falnorhaediseae of the newborn......... 1 Hypertrophy and absoess formation of pa
tate............................ I
S Total............... ............... 90 Prol us ueri........................... i
... ihe iof tie nevus system and of the organs of Total............................. 23


pecial samue:
a. meais gitis ....................
S'emorrhage ...... ........ ,.....
'Ctlfielluar hembrrhag. .................
Cturarldysisof theminsane..............
p paecox... ....................:....
Cimn softeningh.......................


1
6
2
8
1
2


Total................................ 20

l .MMs of the e.ilnmtory system:
Acute pereatisu....................... 2
S Acuteendocarditis....................... 4
hfdaeirditis and myocarditis .............
S geotoari.s ..... ..................... a
S.. im tos .........................
n moearditis with hert block........ 1
ChruBit e odsearutii...................... 3
rdias hyprtrophy and diltattion with de-

P sawi... ..... .; ........ ........ ...
Ituptured aid*e anewr m..................
Aneurum aitbnominate arlary............. 1
Arturfisdneii ...........................
S....... ... ............. 29
S- aR fraeddat Sa to TIaIs 9e0pit1L


The puerperal state:
Ruptured tubal eltopic pregnancy.......... 1
Hyperemeis gravidarum ...................
Hydatidiform mole (and uterine hemorrhage) 1
Ufceration of the perineum rdlowing third
degree laceration.................... ..
Gangrenous metritis, puerp ua ............. I
P peperal septicemia...................... I
Puerperal eclampia ....................... I
Total ............................ 7

Diseases of the skin and of the cellular tissue:
Gangrene ofthe left foot and leg............ I
Gangrene of the fauces ....................
T otal ........................ ... .

Malformations:
Congenital circulatory anomalies ............ 3
Ceonenitally oystic kidneys.............
Malormation of the Il .................
Total ................................










.../ ... l


PATI)LOGICAL EXAMINATIONS. f Conftil I ,'
Diseases of early infancy: .. Afection srodued by edxerna i~pe ;
Hemorrhajc icteres he toum.. ......... 2 Traumiatim bly ob ad fa uii.d .
Malnutrition............... ............ 5 Traumatic rupture of the atas i ,itlhs:
Premature birth..............., 10 orrhage r """ o'
Asphyzia neonatorum pallida............... 1 Triaumatie brpture ofiteinteStie.....;
Infection of the umbilius ................... Tramati suppurative mqya it., ,.., ,
Total.............................. 19 Total....................;. ... "

41fectons produed by external cause: Ildefined disease: ..
Suicide bj drowning...................... ........:.; ... ....,ei
Suicide by fiream............................. Acute undetermined nfetion.
Snake bite............................ ". .' .................. .,..
Acute phosphorus poisoning ............... l ..
Accidental burns due to hot fuid........... 2 Appendix:..
Accidental drowning...................... 8 Stillbirth (accident of preg~n any).. ,
Traumatism by firearms, accidental:........ 3 Stillbirth (accident of labor)..:.::..
Traumatism by fall, accidental............. 2 Stillbirth (resulting from disease of mn6ot '.
STraunatimn by railroad, accidental......... 2 Stillbirth (causeundeter ned) ...
Traumatism n automobile accident ........ 1 Stillbirth (due to abnormality of hd). : .
Traumatism by falling tree............... I
Traumatism by a mule.................. 1 Total....... .................
Homicide by firearms................... 4
Traumatism by fall, homiidal............ 1 Grand total.................,., ji
TABLE SHOWING THE MORE FREQUENT CAUSES OF DEATH FOUND AT AU .TOPBt N
BOARD OF HEALTH LABORATORY, 1925.


Cause of death.


External causes ....... ...... ......... .................... ; ..... .... ........
Tuberculosis (acute and chronic) ....... ..... ...... ........ ....... ......... .........
Organic heart disease (acute and chronic) ...............r................................
yphilis (including general paresis)......... ... ............................
Bright'e disease (acute and chronic nephri) ........... ...........................
Caner. ............. ..................... .... ... .................. .
Pneumonia (broncho and lobar).......................................................
Prem nature birth .................................................. ................


TABLE





Year.


1904 ....
1905....
1906.,..
1907....
1908....
1909.. :.
9101....
Soll....
1912 ....
1913...
1914....
1915....
4916....
1917....
1918.:..
J919....
1920....
1921....
1922....
1923..
924...
2925.,..
W


SHOWING SOME


509
496
361
295
451
508
425
460
375
328
323
330
253
324
334
289
262
205
263
306


7,372


a
C
S

I


Cases. 1*
-*. lutoaiw.1


* 34
17 1
16
15 4
10


- "r.,


OF THE MORE FREQUENT CAUSES OF DEATH FOUND AT
BOARD OF HEALTH LABORATORY, 1904 to 1925:


cI
0P
C


27
50
27
46
26
62
41
23
21
6
14
8
5
6

4
5
3
3
7


'd
-US
IA
oB
s


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


J.

.......

8
23
27
---- 25
31
37
36
27
26
12
12
20
23
12
14
11
5
9
9
10
11


I-
'all
i -



. 5
39
36
23
11
36
19
15
8

7
3
3
5.
4
5
4
a


.5. I* I I I I I


1,037 1.122 377


SThis includes 32 case of influenza.


521
--------------- 1


388


ci


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


"






*) .*I 2 y
1






's C :a


10 96 4. :,

5 8 .. 2



... ... .. 10; -:5 |E
5 14 i



2 1 .. .


a r1


1 s -12 1::j
Q P ;:: a, ::i
...3 ...,... a -.v-.& :i,:






'"" '*":"." :i::.:l!
o. .7. i
5 ,, ... 5 ...; ..j l .
1 8 ~ j

1i ~ ; ;;




|": .u :. '' .."
S,'" r' :*




l,: 37

-i' dE T SHOWING NUMBER OF AUTOPSIES PERFORMED REVEALING THE FOLLOWING DISEASES
: PER YEAR AT BOARD OF HEALTH LABORATORY, 1904 TO 1925.
~SIAN ~:~(


j;l


t;;.,
,k .

4?:':


-'.-Per cent autopsied.--Four hundred and' twenty-two bodies (not in-
luding 2 disinterred) passed through the laboratory; 306 or 72.51
er cent were autopsied, one of these having been done at Santo Tomas
Hospital before receipt at the laboratory.
Malaria carriers found at autopsy, 12.
'. Syphilis found at autopsy (cases), 43.
Intestinal parasites found at autopsy.-Thirty cases in the 305
Autopsies performed at the laboratory, or 9.8 per cent, showed one or
more parasites or their ova, as follows:
noinaria........ ........................... 19 Strongyloides.......... ................... 2
: Trichoephsalu ................... ........... 8 Oxyuris... .. ........
AM ris .:.......... .......................... 7 Trichomona. ................. ...........
SMultiple infections occurred as follows:
i .in ar i, trickoeephalue and asearis............ 1 Ascaris and trichocephalu. .................... 3
citatria and trichocephalus ................... 1 Strongyloides and trichomonas .............. I
,Bgnarim and aecari ......................... 1
'IABLE SHOWING CAUSES OF.DEATH FOUND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH
LABORATORY, 1925.


aP Cause of death. Contributory causes.

7153 Leprosy..................
7200 Ler ..................... Multiple ulcers of skin and subcutaneous tissues and acute suppurative
arthritis, left shoulder.
; A0 Pu.nonary tuberculosia....... Leprosy; empyema, right.
:7218 Pulmonasy tberculeois...... Leprosy;. pleurisy, right, tuberculous.
7284 Chronic endocarditis........ Cardiac hypertrophy and dilatation; leprosy.
S1859 Leprosy.................... Bronhopneumonia; paychosis, undetermined.
'


since 1905 were imported oaes.
er.


19M .- ............................. 269 12 7 7 2 ........ 1 ........
.............. ............... 509 1 5 4 ........ ........ ..... .......
. .... .... .. .. ..... 496 ........ 1 2 1 .
Year. 'U .






361 ........ 1 2 3 .. .
"





9 ............................... 295 2 ........ ........ ............. .. .........
10.. .................... ..... 451 2 ........ ........ ........ ........ ........ ... ....
19 ..... ...... ........... .. .. 508 ........ ...... ........
1.1 ................................... 425 .. .... 1 .. ......... ......


3.. ........................ .. 400 ........ ...... 2 3 1 ... ................
4.... ............. .. ... 375 .. ..... ......... 4 2 ... .. .......
5....... ...... ..... 328 3 1 ........ 2 1 ...... ..... ..
1 9f ....... ..... .................. 323 ........ 2 ........ ........... ........
117........................... 330 ........ 7 ........ 1 2 ...............
98 .. .................... ... 253 ....... ........ 2 3 3 ........ .......
s1 4 ............................ 32 2 ........ ........ ......4
61 0 ........... ................ ..... .. ..... 1 ..... ........
191i .... .............. 289 ........ ........ ......... 2 ........
1 ................................. 2 ........ ..... ........ 1 3 ....... ........
191 3..................... ..... 205 ................ ..... ... ..... ..... ........
tB. i....3 ......34... ...... ...................... 3.............


. .......................................... 3 ........ .. .... ........ ...............
194................................ 2 3 ..........2............... 1
1 .s............. ...... ......... 30 ........ ........ ... ............. ........
Totals......................... 7,372 23 26 20 20 30 3 3
*1


::'


F.



I- '':


"All caso ,
*Seaerese



f :.. .. .
-. ;' i .:i r ."
I!li:: ..


!,




w


38


NUMBER OF MICROSCOPIC EXAMINATIONS AND REPORTS ON' SURG L AL. BIfOM ati P 4

Eye enucleated......... ..... ........ 5 Intraabdainal pregnanyretu and i". I
elid, specimen from ................... ..... I Uterine services or aptimenfrome .. ...
Nose specimens from......................... 2 Tube or tubes......................, ....
Ear, specimens from ................ ......... 6 Tube or tubes with ovary or ovaries.
Lipe, specimens from.......................... 6 Tube or tube with other specimen .......
Mouth, specimens from ....................... 6 Tubal ecthpies...............
Tooth and surrounding tissues............... ... I Ovary or ovaries and specimens frose ...e
Tongue, specimens from..................... 6 Ovary or ovaries combined with other epesa
Epu ...................................... I ubef ea exce pted)................... ...
Throat, specimen from.................... I Specimene from external female genitalia......
Parotd with tumor............. ............. Jejunum and diverticulum............ .. .
Tondla, pairs................................ 407' Appendices (including 58 removed with femal ~i
T'Eailamone..................... ......... 3 genitalia).................... .... .... .. .
Tonsils, pairs, and adenoids..................... 386 Rectum, specimens from.....................
Adenoids. ................ ................ 8 Rectaland analfistulae.................
larynx, specimens from .................... .. 4 Appendiceal epiploica. ..............,. .. .. : ...... .
Neck, specimens from ........................ 3 Ileum, portion of, cecum and appendix. ....
Thyroid cartilage, specimen from............... 1 Anus, and analregion, specimens from....... i;
Thyroid glands and specimens from same..... .. 11 Cest, cocygeal.. ................... .
Breasts.................................... Upper extremities, amputations of prtiona o
Breast, specimens from..................... 18 (specimens of).......................
Pritoneum and momentum, specimens from....... 2 Lower extremities ........ ............. I'."
Gall bladders............................... 4 Skin and subcutaneous tissues, speoimens frm.
liver, specimens from....................... 3 Skin and subcutaneous tissues, tumor o.......
.. .............................. I Bones specimens of...... .. ..... .. .. ...
ne s, and specimeas from Jamen............. 5 Joints, specimens from..................... ...
adder, specimens from ..................... 6 Muscle, specimens from......................
Fogtates................ ................ 6 Tendon, specimen from............................ ,i
Combined external male genitalia............... 2 Lymph nodes, cervical........................
Cni specimens from............. ......... 3 Lymph nodes, axillary....................... .
Edrocele sac.............................. I Lymph nodes, inguinal ................ ..... ,-
aarotum, specimens from ..................... 2 Lymph nodes, femoral.........................
Testes.................................... 5 Lymph nodes, inguinal and femoral............. I
Epididymes................................. 4. Lymph nodes, mental and mesenteric.......... .I
Cord. umbilical ....... ............... ..... I Lymph nodes, miscellaneous, and locations not
ruaina .............................. 4 given..............................
leri....... ........................ .... 9 Placentae................... .. .... ... 2
Utri and adnexa .................... .... 77 Colon Hospital autopsy sets of tisses. (54 tissues, 18' -
Uteri adns and appendices... ............ 30 Tissueindefinitely located.................... .,
Utari specimens from ........................ 30
Ud and appendices..................... ..... 2 Total................................... 1,B ,i


Lesions in surgical specimens.-The principal lesions encountered 'o
in surgical specimens other than inflammatory, were as follows:

Malignant tumors (cancer): Benign tumors-Continued:
Eye and adnexa. ..................... Epulis ofjaw ............ .... ........... *'-
Up .................................. Papillomas of throat ............ .......
M outh .................................. 1 Laryngeal polyp........... ........... ..
Tongue La...............y l .............. 4 Lary ne papillomata ..
Parotid .................................. Colloid goiters.............. ........... .
Tonsil (capsule)... .............. ...... Reidel's trum ............... ........... .
rynx............... Cystic goiters.......................... ;
Breast ..................... ento..............11 Aberrant thyroid tissue........ ..:...
Liver.................................... 2 Cysts of breast.......... .... .............. :
Kidey........... Chronic adenomatoid mantitits......... .. 1.
Prostate ................... ............. Intracanalicular fibroadenomata of brae nt....
Penis................... .............. 4 Fibroadenomat of beat......... ...
iUterue ...... .................... ,4 Aberrant breast tissue........... .. :
Cervix ......... ............. I Papilloma of bladder........... ...... .. i;."I
ovary.. .............: ...I ypertrophiedproat................... I...
External female genitalia ................. 3 Fibromyomata uteri .......................
Appendix.................. ........... 1 Uterine polyps....... .... ....... ...
Skin and subcutaneous tissue ............. 13 Cervical polyps ..........................
Bone .................................... IRNabeide' cystu s ......................... V
Bone .....Naboth.an cyts..................... .. .:.
Lymph nodes (adenomyosarcoma) ........ I Papilloa of ovary. ..................... .
node (gliosarcoma)................. Fibroma of ovary.........................
node (myxocarcinoma).............. Corpus luteum cysts........ .. ......
Lymph node (carcinoma) .................. I Cysti ovaries............................
r ne ........ Ovarian cysts, simple....................
Total ................................ Dermoid cysts of ovaries .................
Chocolate cysts of ovaries................. ..
.. ,4 Pavari-an cysts.e........................ t. ....:..
Benign tumors: Papillomata of female genitalia ........ 0.. .. .. ...:-.
Staphyloma of eye ................... 1 Epithelial cyst of oot...... .........
Aural polyps.... ......... ......... 2 Fibroemangiomata of kin.. ..........
Mucous cyst of lip...................... 1 Papillomat ofskin........... ..........
tithelialcystsof lip......... ....... 2 Nevi of skin.. ............... ..,.
,. .......... ... J:i

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




&. A- .:,
Choclatecyss oforan ....... ........... 'i;. ...


I













tIll4Uibare-Cu flfnuld: -
.....:-isof b ralsted uas f tifiu ..... 2







:of kin and subiatianeous ties. I
h feidot1sliia of subcutaneous



oS3,
..s.. .l ..........o .. .. .. 2
m:..., w..l 1




qomts nodes abdom ina l. 1
IO: :: ." .i ..... a d n l W ...... ...........



S.. 1e ..a..... ..................... 22
;...' ad.. sP-.tiim*if i tintei lriln n um.. 4





:Uand adenads ..... ........ ......
odra cervial.................... ..
DDde, Im inguaa. ...................... 1

Snodea. arilliary.................... 1
2 sodesminnfllo.anef e........ .o.... I
e ,. ...............................
j region ....................
........... .. .. ...........
Sindrlution ofrib..............
S t.s. ............................
m d l ......... ...... ..............
te tea and both epididymea....... 1
uld e.n ............................


WILD AND DOB

aepe ltured for B. anhracis....... I
S Ibeeirs cultured for B. atArocis (Positive
S.. .................................. 3
Gittl pmears -anemined for inroplasma bige-
aminum (Peitivel)................... 18

rT- 'Ikit .............................. 22


pig ..................... ..... 18
olnti ............ .. ............... 2
D gm .................................... 3
W ild'te rkey .............................. I
Rabbit .................................. I
Chickeae...... .................. ....... 2


Duck...... .............................
M: key.................................
.. Jd ......... ...... ............
sto inal, examinations:
Ba it's liver.. ........................
S'eliver..........................
T m frm saw (5 tisnes) ................
i I lm oDm stag ..........................


1
1
29

1
1
1
1


Specimens showing tuberoulosis-Continued:
S9in. ................... ................ 2
Tube, ovary and appendix .................
Ovary..... ............................. I
Nasal cartilage ................... ....... I
Total ................................

Other infrequent lesions encountered:
Blastomycosis of dorsum of hand and wrist ..
Fungus (epidermophyton peneti) in'le lluceg 1
Gaueber splenomegaly .....................
Leprosy of finger ................... ..... 1
Lymph node from acute lymphatic leukemi. 1
Ova in ekin from soles of feet............... I
Gangrene of testicle from torsion of acod in
infant .................... ......... 1
Hemorrhagic encephalitis (Colon Hospital an-
topsy tissue) .......................... I
Intact intra-abdominal pregnancy, past term. I
Supernumerary digit of hand of newborn..... I
Appendiceal epiploica strangulated by torsion 1
Intussusception of jejunum with diverticulum
at proximal end .... .......... .. I
M osy foot ............................... 1
Total.......... ...................... 1
Miscellaneous human examinations:
Placentae.......... ..... ............. .. 329
External description of human body......... 1
Larvae from ear for identification........... 1
Total............ ................ 331


IESTIC ANIMALS.
Histological examinations-Continued:
Eyes of sea lion.........................
Cattle tissues for tuberculosis.............
Calf's lung.............................
Mouse's lung............................
Uler of mule's ear......................
Bony tumor of fish.......................
Total...... ... .....................
Miscellaneous examinations:
Dogs held under observation for rabies......
Mosquitoes examined for malarial parasites..
Trypan blue solution prepared for intravenous
injection, lot ......................
Identification of spinous rat...............
Blood smears from cow for piroplasmosis....


I
8
1
I
1

I

15
1
1
1
1


Total............................ 36
Rats examined:
Mus muswdu .......................... 3,334
Mus alerandrins ....................... 139
M ua norn gicu ........................... 116
M ul rally ..................... .......... 1,54
Total .................. .... ....... 5,134


MICROSCOPIC SLIDES PREPARED.
i:. R peBmparations (4 fromn)............................ ...... ...................... 5,641
nto peparations (10 fr en)*................. ............................................. 3 266
A Apara o .......;.......,.................................. ....................... 264
T ir,. i l................................................. .................. .............. 9 ,131


PHOTOGRAPH.

bhotograstitakenatBoardof HealthLaboratar................................................ 12
Et.ipasl taken of leper at Palb Seo (taken t Dr. Philip Horwits) .................. .............. 91
101




o. ,:


..: ** .:: :*< ... .: ..





CHEMICAL ANALYSES AND EXAMINATIONS. .
l* ~ : ** *^


Abdominal fluid, urea determintion............................ ........ ..... .
ir analyses, alveolar................. .......... ....... ......... ...... .. .. .. ..
ascitic'fluidrtea determination................................................; .. .. ...
B&vi ges.. ................................... ........ .......................... .... .. ....
Beera, alcohol determination .................................. ...................
Poncha Crema, alcohol determination.......................... '.................... 1 4
Rum, alcohol determination ........................................................ .
Soda water, detection of sccharine..................................................
S Soda water, detection of salicylic acid... .............................................. 9
Whisky, alcohol determination ................................ .................. .
Blood analyse ........ ........ ........................... ........................... .. ....
Noiiprotein nitrogen determinations............ ........................ .......... 61.
Urea nitrogen determinations .................................. ..................... 878
Uri6 acid determinations...................... ................................. 777
Creatinip determinations ........................................................... '87
Gliucoe determinations...................... ................................... 1,191
Albumin-globulin ratio determinations....... ...................................... S
Calcium determinations.............................................................. 17
Carbon dioxide determinations..................................................... 1
S Cholesterol determinations........................................................... .-
Phosphorus, inorganic determinations................................................ 4
S Hemoglobin-orygen combining power............. .............................. 8
S odium choloride determinations.......... ............... .... .................. 18 ,
u us, biliary.................. .. ........... .. ..... ........... ..... ... .......... ......... .
aluld. urethral. ...................... .......................... ........... ......
Calibrations................ ... ............................................. ... .. .
-. Haldane apparatus. ..................... ........................................
Magnesiuphygmo sulpanometerso..l...........................................................
Drugs and chemical .................................................................... ..
o bholt. .... .. ............................................................... .. 4
Bay Rum, denaturapt..................................................................
Cattle dip...................................................... ......... ........
Magnesium sulphate solution ............................... ...................... ....
Parafic, melting point .............................................................
Food jtuff e ....... ... ........ ............................................. .....
Baking powdere...... .......... ........ .................................
Butter .......................... .... ......... ..................................... .
emAkson duic, .aii .. ........................................... ............. 31
Lime juice, acidity ...................................... ....................... .... 1
Milks, evaporate i............................ .................. ...
Milks, condensed. ................................. ......... ........... -. ........-
Masticanalyensed............................... ......................... .. .. .
M ilks, dairy .. ........................................ ... .......... .............
Milks, mothers.................................................................... .. 4
M ilks, pH determination..................................................... -
Viegars .............. ............. .. ......... ...................... .... -
astric analyses. ................ .......................... ........ ... ..... ....... ...
erum rom blisters, urea determination. ................. .......... ..... ...... .... .. .... 18 -
Spinal flu ids.........en .. ...... .... .................. ..................... ....
BColloidal goldte sts ............... ................................... ..... ..
CAmonium sulphate tests ...... ........................................... 47
Phenol tests ......................................... ................. 4 18
Gluose determinations. ................... ............................. '' 5
substances foridenticeat rion ... ..... .............................. ....................... ........
Barium sulphate in stomach contents................................................. 1-
Cocaine hydrochlooride ... .. .... .............................................. 12




Stomach contents for phosphorus .............................................
Sugar for mercuric chloride........................................ .....................
Suspected poison .......................................................... ..... 1.
Viscera for lead................................... ................ ......... .. ......... -
Urine examinations ............................................................
Acetone bodies determinations ..................................................... 4
S Albumin determinations .......................... ..... ............... ...... ........ 11
Ammonia determinations...................... ................ ................... 1
Blood, occult ................................................ .................... 1
Chloride determinations .......................................................... .. 20
Glucose determinations. ................. ..... ....... ................. ...... 30 4
Lead detection ............................................................ ..... 14
Nitrogen determinations. .. ............ ..... .... ..". ................... .30
Routine analysis...... ........ .................................. ......... 187
Water, free chlorine detection ......................................... .... ........ .........
Water, sodium chloride determinations .................................................. .......... ...
Alcohol, absolute, recovered, liters... ....................... ........................ .. .. ...
Alcohol, 95 per cent, recovered, liters ................. ... ........... .....
Aniline oil recovered, liters....................... ...................................... ........ ..
Ethyl sters of chaulmoogric acids prepared, liters...... :..................:..:.. .... ......


1 % ..








.' .. ..I.....j
i' i














h .











I0
...... ;
S '** ".- :. .:

*" .: ."









z t .:A*:il


















P ..;. .


40L


.. -:!


i



C1.


j












41


UNDERTAKING DEPARTMENT.


^ i reB~d dismterred)"................................... ................................ 42
1 4 bSV md(........................................................... ..................... 71
.crem atmed .7.............................. ... .. .. .. ........................... 11,
ji.. buried ou the Isthm us ....................................................... .. ........... 25
a l u e from Isthm us............................................ ............. ............ 5


..

,,
....
;.t


it



r


.' :


GENERAL TABLES.

Ta I.--DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES
FOR EMPLOYEES.

&BSOLUTH NUMBER.


Discharges
from hospitals. Deaths.




Io i I l .0





Year 1925:.

W)ite................ 3,123 707 646 61 13 9 4 16,266 44.56
Black.................. 9,057 1,252 1,067 185 96 85 11 44,957 123.17

Totals............ 12,180 1,959 1,713 246 109 94 15 61,223 167.73

Year, 1924:
White................ 3,055 583 544 39 19 13 '6 15,229 41.72
Black............... 8,570 1,179 971 208 65 51 14 42,079 115.28
I-E-





Totals............. 11,25 1,762 1,515 247 84 64 20 57,308 157.00


ANNUAL &. ERAGa PER 1,000 EMPLOYEES.


Year 1925:
White........................ 226.38 206.85 19.53 4.16 2.88 1.28 ........ 14.27
Black....................... 13824 117.81 20.43 10.60 9.39 1.21 ...... 13.60

Totals.................... 160 84 140.64 20.20 8.95 7.72 .23 ........ 13 7

Tear 1924:
White........................ 190.84 178.07 12.77 6.22 4.26 1.96 ........ 13.66
Blackl................ ........ 137.57 113.29 24.28 7.58 5.95 1.63 ........ 13.45

Totale........... .. ........ 151.57 130.32 21.25 7.23 5.51 1.72 ........ 13 51


r

la
i






1
;
I

::

.;

;'.

i:.
i


~ -


. I


,

....













i.1
ceem ,fl ;~
::~~~ 'joel ii


I"a O wI4' w N "*
is lJAnO I


-4....rn.


. *,=- .... .. rr -4., ,.:.
. ,. .' q P ....* !.
: : : : : : : : : ; ., [. .:


..8. .. .. .. I . .. .. :.,:',
8 ---. . . .. .. .. V '.,.



.. ......'. "
^ *. ': '. \ \ \ \ \ .: .* . r ...
... . .. .. . = ,,t
S. : : ": : : : : : : : : : : : : : : : : : : : : : : i' :,
... .. .................... .. ;. .

o_ --_____ .. . .. ... : : .. .. ^ .^ .
.... ... o ,l i .

.. o . i : o : ; : ; : .


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


. .i.i .i i i. i.i.i.i.i. 4


. . . .. ...

.. ... ... ... ... ... T...


L9 \ \ ; : : : : : : : : : : : : : : :: : : : :: : : : : : : :. :.


-------m~ r ---- -:----------------- --- -: -------- -:- -'-:-:- -:- -;- -:- -1 --- -' i 1


-4 ~. C


OP- l H' : : : : .:,,- :,,, : : ; : : : : : : ^ | ':,:.,*
o .e .- : : : : : : :I : : -w .::,:


-~ ~ ~ .*2 0


-" .. .. :
. o ...


. .._ .o .. ...


SE-IZ


T!C4- CO


- m Ir m N 4


. ,* .


04.0


CM4N C4 CD


- ~ ~ m~ eq-~-.2,q04 R Oeq0 cqC,4cq0 04I..4fl


o a. ... *

F 1

'.8.


:1

:cs
:g. .f


=' 'r ^ :. ." ":.":
*

-' : :' ::9:
" S *' i ''r
1:.J-''

d. --rca:r:.


e q


-nfl


*at Lq nB* p
... Mun*


..fl. *


gI-Oo '0"4


i-c


-Un t : :


-S-IS .


. . .. ,
.t *. .. .


I OZ--




"eqleap
11101


. . . r- l
*'. *


I-,
: : : : : : : : : : : : : : : : : .1-*; : !


:, :: : ; :. ;r ;; ; ;r ;rl; ;~i 4


.I_ ....**.... ... .... .... .. .. ... ,...
.. .. .,. ....,
,r' -.


4.. :(
c't: **^ .$


--


- --~~~


OCqlrlI I a l 'r'l 'Y -4 -4 C4 14


:i i i i j i


I.r.


, .- .. .. .






E..: ", ..,I .,; ,. ... o ,4

a.E.. .. .... .


43



OF PANAMA AND COLON.





STotl. Disa :ee. Total. Diseasena aU
|ii ** i .:,.' _-- ----- --__-- i -----__ -----__ ---- -__ ---- ---- -

S........ 5 116 1,12 43 19.60 18.88 .72
............... 31.285 401 370 22 12.82 12.12 .70
mio. a ........... 34,840 20 241 56 8.53 6.92 1.61

T e.,............. 125.760 1,867 1,746 121 14.85 13.89 .96


Panamx................. 59,635 1.168 1,128 40 19.59 18.92 .67
Con: ................. 31,285 475 455 20 15.18 14.54 .64
maisuam ................ 33,723 305 270 35 9.05 8.01 1.04

Tb.la................ 124,63 1,48 1,858 95 15.63 14.87 .76




..*




'i,


















:" .


i* .:" "
..

k:.: ; ,t
;'.,: ..
hi


", -." .
;!" *:: .. o ..

. .::' .. :.


i,:.? ..- : ::' -. .
[; .- :.: --
!.. ?? ; ,. .
:i: .


i ; :* : :... ..- < : .: .:- .
il lu .. .: .. .. .
:E : ..... .:.:: I" : .;l :.

i ': '; :. :::. n, .
::E..]r, ::" "


*


"b


: ~::












44


Sm


I I


*. :f 'f 4 ";"
o


c4-4I


4- i
.' .. .:^

*". ". : :'


," : ; ; .. : -', .*: -:... .


.4. H-HHA.fO. l 9, .4o :q C4 IQ


-,- 1.- 4I .


.3
0



'4







g
















0
sc









.4
0

0



0
Q
54







I
b
0




o

a
12







r'











E








o



rs


I

w
0


I
0












0f

0
0

U '

.4

'4
'4


S : : : o'. : : .. ... : ..


C
C
eg


@3-


:CO


.44o- .H4


' :4-1 ::4 : 4


VqI


4 . ..-. .





__: ::___:.I.. .: ,
I ~ N ~~rr ~ ~O ~N cr ~ :EJg.


.. ... .

:; : "; : : ; ;r : : .


i .,- .4.4 .- ,- -^ c
-4


*.q~ *i0 .~0-. .-i ..- .


.4.4 c~noo4.- r'm c-.-.4eqt C04


. :; : : : :


m


. '. o *. f.


. i


- t-f~~l.4~ .ii


.e t H.0 4 .-O.01. CC 4k. @S.C13.C


|
"I


-C


c c. ..
.4


.. ".H


: 's = :: .:
: : : : : :.






,c :3- :
.C3 0 !R


* ".. ..


nt'.:


'!- ...


0 *d
*0 '"' l


H..: :j
*11i


. ... .. ... 1


-


-- -


S- -- E -, -:-:-: "-: -, W : : : : :- c '
- I : : : : : : : : : :. : :


`"


~"" ""Y


I-- '~
C~~g.. .cr ~,i~

.. P-:


, -:- ... .... ;


i -


Ng


'' '


. .'

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


-'N


: mit


"' :


P-C~Cr) ~rl rlC~ -dl~d~N rlh


7"


~rP





-t


", .:,* .: ;". ....
.;!V : *,:" ;: .." .' ,
? : *,

.
." "
n: i .: "


S


": 4 .. .. :: S i : : : : : : : : : : : :
--.. : -.' : : : : : : ,-. ,- : : :

:'...' .... .. :-----------------: *.----- r ---:- .
.. .
i;:;:" ..t 4 Q .'": goe'c m w : : c "


.: .: : --. .. .






: : : : :*:: : : :.: ... .
4 46.4 t C4 _. .eq C4 I* C4 Do -W *0W








,"' : : ;: : .:". .. . : : : : : : : : : : : : : : : .. .









'"* .* .* eq..a .1 Cw '* '^0* *4 1
/ .. .. .


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







P .4 m e. .. eC .4 o
. .






S .. ... ..a
"" i f t ,. .
S' : ... : *: : : : : : '.CIS ~ CV CS '* .: : .I.. .
,, ...
5 .. ": i: ; : : : : : : : : : : : : : : : : : ; : : : : : :
,
n . .. . .
"' W : a .: 'y ~ .. . .. .
:. ; M : :. : : : -.: : -: ,., ., ,.






















.: .: : : : : ; : : .
:.. .. .. .
'...:' a .c ~ .. ... ..... .... ..... .........


--' 80~ 4-4- 4..j~~ C~I ..---l 1
4 14 e


ccl ..q..eqceqa~n~~equeqe


S: t-o .. .. .. J .



eq ceq c

.. .- q .
.e.q em I 4C 9 eq .ac-cl q :eq- A- .-. .a .


45. 52-4 O m coe s-S3 -I -- C -4.4-52


; .....-. M'-* .-


toNN~l~~ -r e


'a


a







'I


'C
fl


.9


1-1044e


I


i; ;





w w r"E'~i


UN


Ag


(4qfl


(rc "I


-O .-. ..~ C.'
U- dUB


cm


a e00900CrCeq -,peC -r4
O e qc
*- o 041-


. .... ..


I o .. "








:g : :4 m : : :. .,.,::.. : -:i
S* I *M'f






S; ; ; ; ::

S ... 4.,..,.,: :


I_ :_ 9 K.

:: : : : ...^




.. ..... .,.v.;** ,:*I-
..6 .. ... c'.:
o _4*# .: :

---- ... .--------- ., ... : ,....--- : -- -- ? **



.. u ,,'.3. : ,:,
..- ....i .
1 -4c fl 4:'m.. '.

:e : : : .: : '. ,I'.



. :. ..

.. 1 .. (.:- J,,, : if' : *



.. --- ".. .._ :' ,,::.-
C4 M cc. M..,:. : ::.,:








QQ N. .O. .. ..c i :0, ,: :, 0
~~ 4 r


arc


OADlerowowcq
on -m cI


mS9P


AI jr. "qCm4- : Bcmrr ecP- MiD


S eq an
EC,


: .~ :,
KS


I a'
3 71>




1-,
S: I
.a ::
i. .
* ..fl'i
Ss


~ ~ ~ i .: i ;;.' t : ii ...


... .: ...

46


... "
r :, ?


;'";"~;''"


ir : f. f ':IS .' .




_ ~


E!i








: F




;
E. 4.


















4..














i':


:1
St A.l; ;:





flc .i1f


.4- 4 *- 4 5n1


ai i a- gg I-- -- -a--------
.l e .. -


*Mt, rS*-i 0.- c, e aBgtcc.u i1 1 ICe .eq





m: .: .: : S: : : : : .-: -S c

eq . . .
a ".:. C .O.. ... ... :
















S:" .M.4 .. 11. 4 e : .
rr 4 ,Y CIv)I ,- .4 l .


do


,*, 4
-. ,' .; .




; ;. ..



^ *r ? 1 .




S. f : .1 : :
; c m.. .- ..
'



f, : -;...,....






*i
!i. "













F'.
,, ,a ^-,M ',,, ,. r,,




: if i ** *
||- i e-,
'. .


s .










o a
OGD ., W W,,I W, -


-v
41


- Sb .
80 C4 Cc ~ EI
0 CIWM-41q- c....q- .g-n -s
g o I


e-- g e4q4






















-i auC eg fl4 COi
i



























-4CCO CO Cit C






C.,..:..

":::







.,1




i l




*


0 a ..- r ~ r


- cq
P41














go
a



































III'


PI-



e-I












C4



c-

I.
C
.0
IA




a


Im


Sa






a


- ; ; :'^-.: '.,,, ." .. .


JR : i I i .





:i1





ti~ma--ii <,


I


i,-i
11 -,,a

















:













d a
9s


CO I1 o0 go


- 04 *:


3


UN|_
g -* m *
42


A.


.3 004.
'-4 r04 04


o *-'oU- *Y-40-~


4r


Y


04





lxi




ci
z:
4
'4





14







m


ci

4
4
4









I-
C,



ci


I0


CI
04


.04- .4


*" ".... a:" :l ? ,ii




.. .1t
:I I -* *** : :Ill











.*1
: : : : .: .:..' .







. .- i : :, .- '..:

:` :': e"'


...... =,,
: :


04045404- .04-Ufl04v


' *- '


O -I .0 -- .C -~ r
'I
o oj .5 5 .).. *


: > : : : ..... : .. -' t t
m. .. ..... : .; "

04. ...:
-: : :

S: c L m : : : : L: : : : : : : .



... o. .... ..r.

,- -4 .. '.. .4 ..
04 D W:' f "
.. . : ...

N g : : : : : : A :.





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

.~.ioZ : . .. ... .... .-.
SR0 ...
: : : : : : : :,:" .: -: ; ;. .: 1 :";







a "" .., ,: '"


b:b. ., ..El. : U 4* h .i. -i



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


I.








sj m N -
CD I :e m : ': s


4


-e --


i-,


i i i j i i i


iiii


I .










49





'* I : .;. '.."
S, ..



S...... ......
C, . ... .






,,,n : : : : : : : '1









: : : : : : : : .
g .
S. .









4q '


0 ... ... .B. .. . .

c* 0 4 -.i- *1 q -I. --- C--------------. C` *3C 4 .
S.. ........... ...... .

..- 'cc 7 M -.. -.... .. .










m : : : : : : : : :










:::: .... i
Or, -. i : : : ; : : i. i. .




S. ., ; ". : : : : .. .: :I:
S: | : : : : a :. : .
Spe








ii..',, i


*. . ..
.. .. .
: : : : : : : : : : : : : : : ; : ; : : : : : : i ;:;


r : : : : : :: : : : : : : : : : : : : : : : : : : : : I: : :
[* : : : :. '. .
:S *.. ... ... .. .... .



* ...





c 8 : .: : : : .:::: : : .:: :: : : : d
S : :: : : : ::


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


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





__ ........................

7 7 .. . .








'2 ___0:__ic- c&








-- q --- 4- .- *
phdc --- --*..'--.-.--; ---i--cq-,-----
E .S _________________^ __


.4S


:ma
a

.OC


v-I


1 '.. .:".- .
* i,







: i 4












. ..." i .
: ..:



































S. ..: i ....
W..





































.. *: v I4 !




r I
'. ii






























































.:S:
:: .': .:











S51


T.m VI.-WTATIBTICB REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1926.

Annual
.death rate
per 1,000
.. population,
t :: .li yees from the United States:
e.............................. ................................................ 2 57
i... i. i.a .Gal a ee........ ........................................... .. ... ... .. .73
T otal.... .. ......... ....................... ... 3.30

.... l,:ii. obwhite employees from the United States:
: .................................... .................. .. 4.2
.. .... : .ia ............................ .......... .. ... ......... ..... 5
S Totl.......................................................... ... .12

'.* W mlei uea from the United States and their families:
i.a.s... e.......... ...... ... .. ............. ... 3.81
... t causes. ............................... ... ... ...... 81
S al..................................... .... .. ...... .... .. 4.45

Number of American children born on the Isthmus during the year ........... .. .. 156
Dethe amon American children under I year of age ...... .................. ..... 7
Wnantmartau y rate among American children (number of deaths per 1,000 live births) .... 44.87

S TAam VII.-BIRTHB AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF
S, PANAMA AND COLON.


ia. FarOas:
Panama............ ...
o ilon .......... ...
O naa) Zoe.......... ..

S Totals ........... ....
:tar 1924:
PNam..................
iP lon ...... ............
qa Zone...........
Totals................


Births. Rate per 1,000 population.
Popula-
*; Place. tion.
Total. Alive. Still- Total. Alive. Still-
born. born.


59,635
31,285
34,840
125.760

59,635
31,285
33.723

124,643


2,339
800
651
3.790

2,271
726
730

3,727


2,220
769
616

3.605

2,144
690
694

3,528


39.23
25.57
18.68


37.23
24.58
17.68


185 30 14 28.67 1.47
185 1 _


127
36
36
199


38.08
23 21
21.65
29 90


35.95
22 06
20.58
28.30


2.13
1.15
1.07
1.60


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


Deaths among
Live births. children, under
1 year of age,
Place. ---
Rate per
Male. Female. Total. Number. 1,000 live
births.

ear 1928:
Panama..... ................................ 1095 1,125 2,220 260 117.12
C lon ......................................... 391 378 760 90 117.04
Canal Zone ................................. 337 279 616 48 77.92
Totab .................................... 1,823 1,782 3,605 398 110.40

a a ................................ ...... 1,120 1,024 2,144 296 138.06
n. .... ...................... 344 346 690 79 114.49
OCaalZone.................................. 369 325 694 67 96.54

Tolph.............. ................. 1,833. 1,695 3.528 442 125.28


I.


I




4::'" .... .. .. "
I!;:: ":;.:** :: A .l.r .?.'.' .:!::i; *.. ,.. "


I,




L







is:
'IK


V


i
i:
I"


'
'


~i





w. r
S. .. ... .






5 N P A.....

Taa. IL-DIscHAaRGs AND DEATHS I LH HOSPITAL 07THE PAMAMA 0.4.1*4 i~


D e flmployees. Nonemplayes.
a
Diseases. White
E White. Black Black
S. Army. Other


Epidemic, endemic, and infectious diseases.

Typhoid fever............ ..... ..............
Typhoid and paratyphoid clinical...............
Malaria, eativoautumnal................... .
M alaria, tertian ...............................
Malaria, quartan ......................... ..
M alaria, mixed ................. .............
M alaria, clinical ..............................
Hemoglobinuria, malarial ....................
Sm allpox ...................................
M easles .................. ............... ...
Scarlet fever ................................
Whooping cough ........... ... .......
D iphtheria.......... .................. ..
Diphtheria bacillus carrier ..................
Influenza with pulmonary complications specified.
Influenza without pulmonary complication speci-
fied............. ....................
Mumps... ...... ............ ................
Asiatic cholera.................... .........
Dysentery, amebic...........................
Dysentery, bacillary.........................
Dysentery, unclassified.......................
Plague, bubonic..............................
Yellow fever............. .................
Leprosy ....................................
Erysipelas....................................
Acute anterior poliomyelitis..................
Lethargic encephalitis........................
Meningococcus meningitis.....................
Chicken pox................................
German measles. .............................
Other epidemic and endemic diseases ..........
Tetanus. ...... .....................
M ycoses...... ................... a ........
Tuberculosis of the respiratory system...........
Tuberculosis of the meninges and central nervous
system ..... ........ ........ .......
Tuberculosis of the intestines and peritoneum....
Tuberculosis of the vertebral column...........
Tuberculosis of the joints ...................
Tuberculosis of the skin and subcutaneous tissue.
Tuberculosis of the bones vertebrall column ex-
cepted) ............ .....................
Tuberculosis of the lymphatic system (mesenteric
and retroperitoneal glands excepted)........
Tuberculosis of the genito-urinary system........
Tuberculosis of other organs than the above....
Disseminated tuberculosis, acute...............
Disseminated tuberculosis, chronic or unspecified.
Primary syphilis..............................
Secondary syphilis...........................
Tertiary syphilis.............................
Cerebrospinal syphilis............... ........
Hereditary spyhilis...........................
Other forms of syphilis .......................
Soft chancre................... ..............
Chancroidal lymphadenitis.....................
Gonocoecic urethritis ........................
Gonococcic orchitis and epididymitis.............:
Gonococcic arthritis .........................
Gonococcic ophthalmia......................
Gonococcic vaginitis..........................
Gonococcic bubo............................
Gonococcic salpingitis..........................
Other gonococcic infection..................
Pyemia and septicemia..................
Pygnia....... .... ............


11
2
498
174
.14
2
33
2
0
136
1
4
16
3
4

65
16
0
13
11
6
0
a
O

3
7
8
2
1
42
3
13
1
1
66

2
9
1
2
2

3

6
2


1
13

23
78
30
7
49
91
16
177
7
10
5
12
I
2
2
.2


2






0










3
1






0

0









-32

5
1


54
26


6

.... ..










2



1
. .






4
.. .


183
25
I





I9













1
... ..


... ..


27
25
6

2


9"
1


7
13









2
7
1
5






1
6i'


2 1
...... ...... .. ....
...... ...... 2 1

...... ...... ...... .I ....
3 ....... ..
2 ...... ...... ......
1 ...... 2 2.
...... 2 3 10
4 3 35 2
3 2 9 7
I. ..... ... ... .....
1 2 23 ......
...... 2 29 25
...... ...... 5 3
..... 3 56 49
...... .. .. 2 1
...... ...... 2 4
....... ...... ......


.. ... ..... .......
2 ... ...... ....


, 3
-2
42
27
1
3
1

123

1
6


15
2
2
6
3


1
5
6
1

2
4.




2











2-
2
1





2
I





2.

19


L I


4
......
187
65
6
2
11
. 1

2

.3
9
2
1
o10



5
1




2






33 :

6





S
1






a.
2
4

33

21

1
1
2




21







4
12


r. r ..;:




7 i







.... .... .... :..; ...







"1 9'*
2 .
.. .. ... .:;.

I ,,.

., -. .;:::.;
1 ..






.. ::i .:..




~ .i' .:
10 *. *.:: : :" i
..: ..
".'. : !: iH C!: : :: A






'' .., ::



.. ..... ..



4 .





4 XIW,
..... .....

... ..'.. :.. ...
,..... : : .ii r :[





.. .. :: : :.:..
: "' .i x :' .,
::
2 ... :..< ': '.






..... ~. .. ... ..'.::. "E.
.. ... ".. .." .









i l :
, .. :
i? .;::!:.
.- ,'4!ri::E::E
: ., ::


.. .. .


":. 'i!'-,
N,
y

." :. .. ,. .* :' .:." ..:% :-
: *. ". I
...::% .: '


T .


I










53

S .Et-DISCHABr6 dE AND DEATHS IN HOSPITAL OF THE PANAMA CANAL, 1925.- continued.
'. _____ _______

Employees. Nonemployeee. residen.
i'*-l-. _, *:0 Al nuzpzSy~dS n-y-l. --ruidenta.
Diseases. White.
*' White. Black. Black. White. Black.
S.= Army. Others

S. piieme, endemic, and infectious
*. : disease.-Continued.

i ..... .......... ............ ..... 2 3 3 1 ..... .
S............ .......... .......................... 2...... 2
Pliii ....... .......................... 2 ...... .. I.. ....... .........
Otri eti diseae............. ..... ...... .... .....
Gemra dise ses tno included in the above d&as.
Cancer and other malignant tumors of the buccal
cavity......................... 2 2 ..... 2 1 1
Caneertd other malignant tumors of the stomach
audliver................ .......... 6 8 .. 7 .... .. 6
Cancer and other malignant tumors of the peri-
toneum, intetine, and reetum............ 3 1 1 ..... 1 1
Canmeand other malignant tumors o the female
genital orga ........................ .. 28 5 .. 7 25
Canar and other malignant tumors of the breast 9 ...... .......... ..... 1 5 3
Cammer amd other malignant tumors of I he skin.. I ...... ......... ...... I
cOaeer and other malignant tumors of other or
pecied or ........ ........... .. 8 3 ...... 6 3 1 .
Benign tumors and tumors not returned as malig-
ant.... .. ......... ................... 44 ..... 4 9 9 18 3 ...
A terheumatiefever................ ..... ..... 1 1 1 6 2
Chronic rheumatism, osteoarthritis, gout......... 7 ...... 2 ...... 1 2 .. 2 .....
Pellgra .................................... 3 6 ...... 2 ..... 1 6 .........
SBenrberi ............................... ...... 2 1 .. .
Bikt ................................. ... .... ...
Diabetes melliau ............................. 19 1 1 3 .. 3 10 3 .
SG Gbr euria........... ...... ....... 2 ...... ...... ...... ..... I
Perniious anemia........................... 2 2 ..... ............. 3 ... 1 ...
Other anemias and hlorois .................. 3 ..... ...... ... I 1 .
Disease of the pituitary gland .............. I 1 ............ .......... ..... .... .....
Ezophthalmia goiter .................. ..1 ... ........... .....
Other diaes of the thyroid gland............ 13 ..... 1 1 8 1 .....
.Diseese of the thymus gland ................. 1 ............ .... ...... ...... ...........
Diseases of the spleen....................4...... ... ... ... 1 2 .........
Leukemia..... .......... ........ ....... I ...... ...... ...... .
.Aautealcshollam....... ....... ........... 28 1 2 ...... 12 9 3 3.
Chronic alchoolism ....................... 10 ...... ...... ...... 3 6 1
Al foholi psychosis ................. ... ...... 5 1 .... ..... 1 2 2 1
Alcohol p aoning...... ..... .............. 2 1 ...... .. I
c leadpoisoning .................. 5 ...... 2 3 ........ .........
Other chronic poisoning by mineral ubtanes.. .. ........... .
Dralhabit .................................. 3 ......... 1 2
Othergenealdiseases........................ 35 2 1 .......... 1i 17 3
Diases of he nsrous system and of the orgas of
special sesee.
Bhnple meningitis...... ..... ............... ... ..... 3 .... ...... ...... 3
Nonepidemic cerebrospinal meningitis.......... ...... I ...... .......... 1
Tabes dorsal (looomotor ataia) .............. 3 ...... ... ..... I .
Otherdiseases of the spinal oord.......... .. .. 2 .. 2
fCerebral hemorrhage ......... .. ......... 8 12 2 8 ..... 2 7 I
lHea iplegia...... ............................. 10 .... ...... 1 ... 7 2 .
Other paralysis without specified cause ........... I 7 ........ .. 4 1 ..
Geneapralparalysiof the inane................ 7 8 ...... 4 .. 3 8
Demetia precox........................... 51 1 ..... 1 14 13 20 4.
S M ie.depresive pychosis.................... 21 ... ... .... 2 I 9 9
'T o ic e hoasi .......... ....... ........... I .. .. ... ...... .1 ...... ....
So h i .. ....... .......... 2 ..... 1 .. .. ... ... .. .. 1 .
ter forms of mental alienation............... 6 5 1 1 4 25 19 13 3 i
lep y ...... .. .. .. ...... ............ 1 2 I 1 3 7 .
Convl s (non-puerpal; 5 years and over)... 3 ...... ... .. .
Infantile onvulions underr 5 years of age)...... A 3 .......... ....... 3 6
S ................................ ....... .
Neuritis................ ... ........ 21 ...... 3 4 3 4
er ......... .. ....... ...... 27 ...... 1 1 9 3 10 3 .
Otherneuralgia .. .. .... ......... 13 ...... 2 4 2 3 2 .







*.. ... ..


54 il

TAua IX.-DISCHARGES AND DEATHS IN HOSPITALS OF P MB PiANAMA l ANAT i


S employee. Nonemployees. reid"
_._ _..... "ru .,":.ru :MS m


S- White. Black. Black Whites
E Army. Of.ther


Disease of the nervous system and of the organs of
special sense.-Continued. ......

Softeningof the brain........................... 1 2 ..... ............ .. 2 1 ......
Imbecility ................... ........ .. 4 ..... ..... 3 1 ... 3.
Neurasthenia.............................. 20 .... 5 2 8 3 ..i. :".:;
Other diseases of the nervous system............ 20 1 ...... 2 8 3 6 .. ........
Follicular conjunctivitis ....................... 21 ...... 3 2 6 1 9 ..... 'i- ii
Trachoma... ....................... ..... 4 ...... ..... 2 ... 1 1 .... ..
Disease of cornea ....................... .... 53 ... .. 12. ...... i ,16 ,
Disease of iris ........................ .. 28 ...... ...... .11 9 2 a ..
Diseaseoflens...... ............... ... .. 25 ...... 6 2 3 11
Disease of funds .............. .......... 12 ...... 1 6 4 1 ...... ..... ...
Other diseases of the eye and annexa..... 70 ..... 8 14 22 8 20 8 ~
Diseases of the ear ..................... 112 ..... 7 3 S3 26 15 .
Diseases of the mastoid process............ .. .... 1 ...... 2 5 1... ',*
Dieases of the circulatory system m.
Pericarditis. ..................... ..... .... 6 3 ...... .... .... ..... .. .,. ** i
Acuteendocarditis..... .................. 6 5 ........ I- ...: .2 i
Acute myocarditis ................... .. 1 ..... .. ...... ...... 1 ..
Angina pectoris ........................ .... ....... ... .... ..
Other diseases of the heart ................. 52 12 8 II 5 14 24 2 ,.... ..
Aneurysm. ......... ... ... .. 3 4 ... 3 ...... ....... 5.... .. ..
Arteriosclerosis... .... .. 32 4 3 16 ...... 2 13 2 ..; .... i
Other diseases of the arteries... ...... 5 ........... 1 1 2 1 ..... ,. :::i..:
Embolism and thrombosis (not cerebral) .... .. 1 ..... 1 ...... ................ .
Hemorrhoids... .... ..... ..... .87 .... 11 15 31 9 14 .
Varices...... .. ....... .... .. .... 10 ...... 3 3 1 1 1 .
Varicocele................. ................ 3 ...... ..... 1 ...... ... .. .
Phlebitis ....................... ...................... .... ... .. .. ... .. I ......::
Thrombois ................................. I .. .............. ........... ...... 1 I ....
Otherdiseases ofthe veins............. ......... 2 .... ..... 2 ...... ...... ..... ... .. ...
Lymphangitis............. ...... ... .... 12 ...... 2 3 1 4...... ..
Lymphadenitis, aonvenereal.................. 87 ...... 7 10 25 S 21 14 : ..i.
Lymphangiectasis.................. ........ 1 ... ..... ...... 1 ....... .
Other diseases of the lymphatic system.......... 7 ...... ...... 1 .... 2 1 3 ..
Hemorrhage without specified cause (not cerebral l 4 ..................2 1 1 '.. ....::...
Other diseases of the circulatory system...... 6 ... 1 .... 4 1 ; ,i
Diseases ofl he respiratory system. '
Diseases of the nasal fossae................... 160 ..... 26 5 81 27 S13 ..
Diseases of the nasal fosme annexa .. .. 49 9 9 15 8 1 1 ....
Diseases ofthe larynx .............. .. 13 ...... 2 1 2 4 4 .....
Acute bronchitis ......... ................. 165 24 18 18 55 40 ,
Chronic bronchitis ....................... ... 9 1 3 1 1 2 2; 1 .. :.. :
Bronchopneumonia..... ............ 38 6 1 4 2 6 ,31
Lobr pneumonia. ....... .............. 44 16 ..... 11 7 31 4
Pneumonia, unspecified...... ....... ...... ... ...... ...... ..... ... .. ......... ...
Pleurisy ............................. 44 ..... 2 10 8 4 1. :
Empyema........ .. ......... ... ..... 9 ............. I.. 4I 4
Other diseases of the pleura. ................. ........... ...... .. .. 1 ... ...
Gangrene of the lung........................... 1 ..... ...... ...... 1:
Asthma ..... ...... .......... ............ 34 ...... 3 4 3 10 13 1
Other diseases of the respiratory system (tubereu- .".:"::?1
loss excepted)....... .. ........ .. 4 ...... ......4 2 1
Diseases ofthe digeuisie system. .'
Diseases of the teeth and gums. 4 .... .. 3 ...... 17 9 12 3 :.. :
Stomatitise............. ... ...... .... .... 4 .. .. ...... ... ... .......f .::
Other diseases of the mouth and annexa.......... 9 .... ..... 2 1 3 2, .
Adenoid vegetation .......................... 173 ... ..... .. 12 4 .
Other diseases of pharynx and tonsils............ 896 ..... 81 47 169 220 34 :. :.:.
Diseases of the esophagus..................... 2 ..... .... .... 1 ......
Uler of the stomach ........................ 16 1 2 6 1 1 .. ,.



.. ".
..:. .




S w w w

.:)




S55


T: 'r m .IX.-DISCHALGES AND DEATHS IN HOSPITALS-OP THE PANAMA CANAL, 19825.--motlnad


Iii


Diseases.


p
*I:
|S,,
:


t.:


is

I*
:I ....*



':.:. .i. ; ;.:* ii...
I....c ...' ;. ;.-"'.


* 4.
- S

elP


-
S


Employees.


White. Black.


4
8
4





12
8






15







2
.9
6
lb


: i iigVle| effVl digesaive eystem.-Continued.
* it~ia duodenum.....................
th............................
on....... ........................

Sof the stomach (cancer excepted).
1 .S olitia s or entero-colitis (under 2 years).
mu i oiiiiitozication (under 2 years) .....
pot e ti~slor entero-colitis (2 years and over)
.auti. itoication (2 years and over)....
.. .... .... ... .... ... ...... ..
i (idatido of the liver ecepted) ........
ledtis better than ankylostoma) ...........
OQU iraiteS, pecified .....................
raiiote lt t specified ............... .....
Ag ite "i d .......: ................... .
AtAppen~~.diitie...................
hnaitiobeo......................................
"lttiol obstruction. .............. .. .....
Othm diseases of the intestines ................
Cirrhoi of -the liver not specified as alcoholic ...
B Biiiary ilculi. .. .............

C h es .tis.......... ....................
lOter essftheliver...................
Dissesoat the pancreas......................
S Pbtofit s Irithout upeifled cause (except puer-
~ a, p ). ..................................
Sases of the digestive system (cancer and
S l loaisi excepted) .......... ...........

Kens imW diseass of the genit-urinary system
and ainrea.

A: te nephritis (including unspecified under 10
years.of age) .............................
Cihonie nephritis (including unspecified 10 years
and over) ...............................
ron ......................
Pmeei d~~...........................
.... .. ... ... .... ....... ... ..

ii ...............................
ovb he kidney.............................
OtBerdiloeses of the kidneys and annex (puer-
Spedl ophritia excepted)..................
: C'alcliJ f the urinary passages................
Iseareaof the bladder.......................
.Stristure of the urethra.......................
SOther. diseases of the urethra..................
Amatepft.statiti ............................
hronie toatitis...................... .......
Abaeea of the prostate.......................
ofthe prostatet...................
... ..... .........................
.. .'.'oe le. '............ .......... ...... .

SB. novenes'eal diseases of the male genital
aans, under this title....................
Jgs' a nd other benign tumors of the ovary......
: mSalpgiti and pelvic abscess (fmale)...........
Be Bsia umon s of the'uterus....................
amterine 1nmorrhaige............'.
lea ......... .. ...................
D be ...i ... ............................
Ei dm irit=a.................................
sung& maW. em ... ................ 1...... ...
m ai rlo ... .................. .............


8
3
35
I1
22


5
5


4

14






1
9
3
20
2
1
I

3

9.


8

S2


Nonemployeffl.


White.

Army. Other'


9

9
13
9
15
I
3
_ 8
7




61
54
29
1
27

3

7
7
I

2

5






4

3
11



2
3
8
6





2'


10


2

5
2
3
13
16
16
14
32
5

1

23
27
17
6
15

4

4
6



1




5

19
I
6
28
2


5
15
8
5


2
2


Non-
residents.


Black.White.I Black.


5

10
5
3
5
II
4

12
10
1
2
6
1
9
6
20
4
28

I

7
5


5

2




15

34
3
9
36



5
4
8
6
5


3

.4


8
17
74
43
5
1
3
6
14
.... i"


1

2
1

11i
1
I
ii
3
i
1
5

A
Is
18

11
."ii

1
4
6

1






2
2

5







I
I
. .




1
1
S J
2

5


I
6
""i


3

2

1
2


.-


.,....
..i








.
.....,.

.~.,..,


.*1


--


I---I I--I----1----I ----l----l--l-i


6


3 1









3 ..
2 2
6
... 6.
I
. .. ...


S 8
8
1 2

2
4
...... 1

I 1
I 1



6
.. .



...... ..
2 1



2

.. ... ....











56:


S ..


T4e~B IX.-DISCHARGES AND DEATHS IN HOBPITALB OF TiHEPANAMA Oilri. SI.-Ao
.%' -


Disease.'


Nonsenreal diseases of the petnlo-urinary system
sad anUnex.-Continued.
Prolapsus uteri ...........................
Lacerations, old or recent, of cervix and perineum
Benign tumors of the female genital organs (ex- .
cept of uterus)...........................
Other diseases of the female genital organs.......
Nonpuerperal diseases of the breast (cancer ex-
cepted)................................

The puerpral Pate.

Abortion (miscarriage, premature birth, etc.)....
Ectopic gestation..........................
Other accidents of pregnancy ................
Puerperal hemorrhage.......................
Cesarean section ................ ......... .
Other surgical operations and instrumental delivery
Other accidents of labor....................
Puerperal septicemia .......................
Puerperal albuminuria and convulsions .........
Following childbirth (not otherwise defined)......
Puerperal diseases of the breast ...............

Diseases of the skin and ofthe cellular tissue.

Gangrene ...................................
Furuncle .................... ..... ..... .. ...
Acute abscess.......... ........ ......
Trichophytosis.......... ..... ..............
Scabies......................... ............
Dhobie itch.................................
Prickly heat.................................
Ulcer of the skin.. ... ..................
Oriental sre (Leishmaniasi ................ .
Tropical ulcer. ............. .............
Ulcerating granuloma of the pudenda...........
Impetigo contagiosa....... ... .......... ....
Impetigo simplex .. ....... .....
U rticaria ............... ...................
Eczem a.....................................
Ingrowing nail.. ..........................
Other diseases of the skin and amexa..........

Diseases of the bones and of the organs of locomotion.

Osteomyelitis ..............................
Periostitis ....................................
Other diseases of the bones (tuberculosis and sinu-
sitis excepted) ..........................
A pkylosia.................. ................
Arthritis....................................
Synovitia. ....... ............................
Other disease of the joints tuberculosiss and
rheumatism excepted)................
Other diseases of the organs of locomotion.......

Malformations.

Congenital hydrocephalus....................
Congenital malformations of the heart...........
Other congenital malformations............'..

Early infancy.


Congenital debility...........................
Icterus of the newborn...................... .
Malnutrition .. ...... ..................
Premature birth (less than 1 year only)..........
Injury at birth (less than 3 months only)........
Other diseases peculiar to early infancy.......... .


Fl


21 .. ....
7 ......


4
1
43
8

13
67


3
2
94


2

13
1
1
10


Emiployes.


White. Blak.


1 ... ...:


1
1
3



3
3




2
1
I


4
20










2




1
1






I.
6
4










3
13


. 1


1
1











3
2
23

1
2
3







5



2
3



5

1
14.
,,.....
,.....
























..

14..


. ...... 1 I .2
1 .... 3 9 1 25


2
2
6
11
... ..
. .i1


Nonempirye.

White.

Ar- 1he Black.
Armny.Othere


3
22
5








3
2
9





1

1

4
20


1
20




89

22
4
4
10
.10
2
1
2


23


5
3
3
1
I

1
2
6
1
3

II


3





23
1
II


...... .. ..


4
14


1

48



44
7
16
I.

12
11
3
9
12
10


S 1
3
623
.3
1
2
1
12



1
2
2
5
.14


10
2
I
1
1
1


4



2

57


S 4
1
14
9
1
9


: .
.: ..


on


. i. .^ -
d"p2l.


..4 !
,.

.1i









"... .. .....
1 ". :
..... ",

.4 ... ...



.. .
W. M




4 .
.i.
S .. ....... ..
.. .4. ., ...
......i .'P '.
..... ., I. .



S .. ..... ,'
.... ::






1 .
-. ---~ l I. I ...Pi" : 4. r





....
....... ...' ....












''!
. ... : ..:.




8 ) .
2 : ""

.... ...: : ;!




....





..4."
..- .... ... ; : t '
". ..". .. .
: ... .. : ." .... .
.. "., .













.... ... ": .' ..::.ii ::
,. v :" .. ":.: : :i;; i


H .* ".r
**. ^ :
.* .>*'"


I


t




w mm car >~ w


.....*.... ..:. :% T'! y
:" ". : x:. f:'. *" *
:: ":. E : EE,. : *' .
T .

"!A .; .
'" .'-


TalI-IMOBCHARGiS AND DEATHS I1




SDiseases.








~.h eral causes.
k!il




: : .





T.. .

lt .u ide by corrosive substance........
ebyiream ..........................
Sfood.............................
be- Tomous animals.............
o e accidental poisonings (gas excepted)..
ttbu.a. (conflagration excepted) ....
d ab l tbrption of irrespirable, irritating or
4. pos us sgoa ............. ...............
Aeaeidaltraumatiam by firearms..........
Agidental traumatiam by cutting or piercing in-
s um ents.......... ...................
Acidetal traumatism by fall..............
Aeidental traumatism m quarries .............
Asidatal trimeatiam by machine............
ai oad ident ...........................
Clt ear accident............. .... .......
Automoile aidents ........................
Aeoplane and balloon accidents....... ........
Motorh eIe ad6idents.........................
Iaury by other vehicles.......................
landslide, other crushing....................
.hura by animal (not poisoning) ........... .
(deprivation of food or water)........
Z host................................
Accidental electric shocks .....................
Hmicide and attempted homicide by firearms...
-Homicide ly other means................


. ertera violence ..............

1 Defined diseases.

lnddendeath................ ...
Il-defned........................ .
Not speeifd or unknown................
Infection of undetermined origin....... ....
Feined disese.............. .. .
urgical operation and hock...........

Normal physiological conditions.

SNrmnsaIprgnane. y................ ..... .
Normal labor .
rfal.bC.. :I....... ..................
Lentating breaste................... .......
Newborn child.................... .. .
No disease (companion, observation, etc.). ..


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


57.


SHOSPITALS.OF THE PANAMA CANAL,1925.-Cootinued.

Non-
S Employees. Nonemployeee. residents.

Ic White.
SWhite. Blars, Black. White. Black.
Army. Others


2

191
4
24
187


I
28

43
1
3


41
507
16
580
330

9,539


I



1
2
I
5

1
1


3




1



1
I
... ..


334


1

6




I
1

6





2"
1


I

2




17



8
2


15
707


7

1

4
11

6
5
6


1
2
1




46
1
4
94
I





6







13

1,252


16
16
2
4
3

8

10
16
I
3

1
3

3
1
1
5

1

3

42'
3
10
14



4
1
8




i.


37

1,456


1





1
1

1

I
1

9



8



I




19


10



11
8
2



14
178
9
207
144


1





5
2
26

5

7
34
1.
2

9


4





44
5
42



2

16
1




26
326
7
369
68


2.334 3.447


I

8


1
1
3





12



2
I
2






1
3
4
150

640


.....



i





[2
2
2


r 3

37


II.


i:











r *
E:.







i .. ..


"' "N"i i


t .















!nl EU. o':~


.. .. .:.
* .. :




1 i:.


.& .j.a: I.| I ,
*a


0204 0062


o th--
C *h-d-
1- -


030m20


aek- mc


.E hO


:1


... n ... ,. I. .,, ...... .
3 o "= c- ___, __ -


-03..f.

to as 0m CD co W *

w M m Ni cq m roco r


n _I_ B Ic_ i I _
4 ..co a .c
=I 040 :.a 0200.-I C



bD C40 *a .

|Dr004 0-n0 t1 1",
-. r P' II '3*


M CDN .


-c
eq


. a_ cna -- T o *<. .- ,1 mc c

cc 6 m m 4o C- C.- I C a :. *


.... *




N ** 4
,Ifl


Sg
mc -


S: : ...



.a Io 00 -O







i.s
4 Q oU HPq


U ~S!


-ca


t-r ~p
-c p


.0410o


03I 4-H


SI j t<1 t ,H
: r _. ." : 11 .*' :" "". r'..,,.
. .. ."_. ". .. .i _._.*,_ ". ._ U .., : ,'... '...]* :..-^ .- i


0


cr0
eq 10.0
*00
CO


C13co o


a2 -40c
cc .0


.-i 0-4


l IC 4


I


..


il


l


gy1 .


LM


~s~f~


low :













Tam. XX-I~ NUMBER OF PAY8 HOSPITAL TaWa F Nb T EMBNISED VARIOUS CLASSES
OF PATIENTS AND AVERAGE NUMBER IN HOSPITAL EACH DAY, 1925.

NumbW of dda mtoamt. Average number in hospital eaoh day.
Clm of patient, Ameri- I A ri- Black. Tota
a. -Fr-. Bl-k. Total--a-.- Fm-ei Black.Total.
P~in Blin ~ Tn. otal


AMon Hoapital
EmiopM ..................
pslufiP w= uo oat ...........
A lr d ...... ..............
AH o th ....... .......... ..
Tofdsa........... ...... .
Comrl Haepital:
Ai.uya a. .........

nd ,asdye....... .. ....



plt i ge .... ................... ..
G"o 06m1di1 and su tical eases.:..


AB and Na....r..............
usra Govearment..........
charity.: ......... ....... ..
A l other .......... .........
.l d.......... ..........
S..... .. ... .. .
Paitimaa Governmtent.. ...



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


. gd Na v ...:
T- b s. Bt.o... ..........
.."dann Government. ..........
-'t.fif. edolse, and c.rn. s.. .
All others ............. ....


Grand totals .. ..


5,032
23,870

2,735
14,049
46.586


921
197
276

1,304


975
1,683
767
1,542

4,967


6,907
26.474

3,699
15,867
52,947


1,821
51
1,421
3,434

16,727

365
27,082
2,792
4,619
34.858

945
1,117

22

131
1,334

1,487

2,882


28,054
300
9,478
33,281
71,116

4,742
77,662
10,680
13,157
106,241

9,988
10,473

1,512

1.950
5,392

8,8.54

21,108
10,273


35,807
23,870
351
13,684
60,767

134,429

5,107
921
104,744
13,669
18.052
142,493

10,933
11,590

2,509
1,683
2,848
8.268

. 15,308

23,990
10,273


2.882 31.381 34,263 ..


2,208

30,015
6,406
19,387
58,016


16.25
65.40
7.49
38 49

127.63


2.52
.54
76
3.82




2.67
4.61

2.10
4 23

13.61


34,308 43,423 18 92
26,474 72.53
99,070 129,085 ..
52,842 62,947 10.13
51,833 87,087 43.48

238,053 349,016 145.06
1


4.99
.14
3.89
36.81
45 83

1.00
74.20
7.65
12.65

95 50
2 59
3 06

.06

.36
3 65
4.07

7.90

7.90

6.05

82 24
17.55
53.11

158.95


' These cripples require no medical attention.


76.86
.82
25.97
91.19
194.84

12.99

212.77
29.26
36.05
291 07

27.36
28.69

4 14

5.34
14 78

24.26

57 83
28.15

85.98

93.99

271.42
144.77
142 02

652 20


98.19
65.40
.96
37.35
166.49

368 30

13 99
2.52
286.97
37.45
49.46

390.39

29 95
31 75

6.87
4 61

7.80
22.66
41 94

65.73
28 15

93.88

118 96
72.53
353.66
172.45
238 61
956.21


i



*
..
~...


t









.0.
.t .. .....


T-. Tam XII.-REPORT OF DISPENBA2IES 19L5

MWLOTEBB 'afaI-m DI QUAXIS


Dispensary.


Remaining
January, I
1925.

White. Black.


Admitted.


'Died.


Discharged.


Transferred.


Ancon ................ .. 3 943 776 ...... ...... 914 730 25 42 it
Balboa .................. 4 ...... 1,239 75 ........... 1,241 74 ............. 2
Pedro Miguel............ ...... ..... 142 203 ...... ...... 139 198 1 5 2 .......
Gatun ......................... 1 108 154 ............ 106 151 1 4 1 .;. .
Colon ............ ............ 17 371 487 ...... ... 371 494 ...... ...... ... 10

Totals................ 4 21 2,803 1,695 ............ 2771 1,647 27 51 9 51


Average, number teat&ed
Days treatment furnished* in quarters gr dray.
Dispensary furnishing treatment. ___Da_ trea ue in q
White. Black. Total White. Slak. Total.

Anon................ .............................. 2,161 3,858 6.019 5.92 '10.5. 16.4
Balboa.............................. .............. 3085 639 3,724 8.45 1.75 10.20
PedroMiguel ........................... .......... 165 385 550 .45 1.06 1,6s
Gatun.............. .... ... ........ 508 686 1,194 1.39 1.88 3.27
Colon.................................. ........ .... 1,232 5,081 6,313 3.38 13.92 17.30

Totals......................................... 7,151 10,649 17,800 19.59 29.18 48.1


ALL CAEs TREATED.


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

co................ ...... ........ 7,763 14,590 22,353 5,755 12,230 17,985 13,518 26,830 4,au3.
Balboa.... ................... 14,221 16,074 30,295 18,259 8,432 26,691 32,480 24,506 56,98
PedroMiguel...................... 3,018 5,710 8,728 4,778 9,601 14,379 7,796 15,311 23,107
Gatun.............................. 3,288 7,708 10.996 3,911 4,962 8,873 7,199 12,670 19,868
Colon............................. 4,394 18,544 22,938 4,956 13,711 18,667 9,350 32,255 41,005

Totals......................... 32,684 62,626 95,30 37,659 48,936 86,595 70,343 111,562 181,80


9~~


'Hil


White. Black. White. Blok. White. Black. White. Black. White. Bi


A'N


o : "" i:.:':





: ...: ::":.










::
i, 'i










.. ... :, %
,I:


~
; r

'I"
,.*;.



.,
;i
;;
i
r~



i ;



"'"


i''



I-jf~
;"
":






;


:


lik~ !I




i4., .. '..S







I ait XIL--NSOLIDATED .ADMISSION REPORT, HOSPITALS AND DISPENSARIES, 1925.

A :lla esof patients. White. Black. Total.
to hospital, exmluding Caroal farm eripples and chronic ward)...... 5,287 5,061 10,348
:. A aF p oyee, 9to quarters ......................................... 2,803 1,695 4,498
S ..l: 7- s dB Wons to hospital and quarte......... .................. 8,090 6,756 14,846

Snumber of Datients transferred between hospitals and from quarters to hos-
: pitalsa whose admissions are duplicated in the above figures ............. 197 323 520
..'. I ad mio aonspitalsandquarters............................... 7,893 6,433 14,326
Employees only.
E 'lplyeeb admitted to hospitals........................................... 719 1,280 1,999
lBialoye admittedtoquarters............................................ 2,803 1,695 4,498


otl adMimsions of employees .........................................
Lal number transferred between hospitals and from quarters to hospitals, whose
.adjiions are duplicated in the above figures.........................

Nedadmissions of employees ........... .......................
" Aa l adission rate per 1,000 employees to hospitals and quarters............


3,522


,3.47
1,112.71


2,975


2,851
314.78


6,497
171
6,326
519.38


*AVERAGE NMRB OF DATY IN HOSPITAL AND QUARTBh FOR EACH ADMISSION, EMPLOYEE ONLY.

White. Black. Total.
Hspitak:
Ann................. ............................. ........... 12.60 23.51 19.71
'Colon............................. ............................. .... 7.17 7.34 7.27
Avrageor hospitals .................. ........... .......... 11.65 21.18 17.78

SAne.on................ ..................... ........... ......... 1.89 3.85 2.78
B l oa. ........... ............ .. ............. ................... 2.38 9.07 2.76
SPedroMignel........... ......... ............................ ... 2.88 4.46 3.81
S Gatun ...................... ........... ..... .. ....................... 5.23 4.68 4.90
S 'Col u. .... ............. ....... ....... ...... ... ......... ....... 3.57 11.04 7.83
Average for.quarters. ................................... ........ 2.51 6.32 3.95


I,
& ..e ,,


'4


I








1'

63


TaM& XIV.-CltMOAL RWIM.TA1. fAT W .. A
mui"m f."n """a. H
~noyan..........


FnW Canal Som. Ia Pumi "-.

Male. Femal. Male. lFeal .

First adm n................................... ......... 40 22' 32 W.
Second admion................... ............ ........ ......... 4 4
Third admission.............................................. ........ 1 1 .......
Fourth admision ......... ................................... .. .. ... .. ... ... .
Sixth admission ..................................................... ..........

Total.............................................. 4 27 37 40


DII|CKAZGUS.S


Male. FDmale. T ,al


W ell ......... ...................... .......... ........... ........ 12
Im proved.............................................................. 32 14
Unim proved ............................. ......................... ....... 21 13 3

Totals ....................................... ...................... 65 45 119



TAbaB XV.-FORCE REPORT.

December 31, 1925.
S1924. 1923. .
Gold. Silver. Total.

Chief Health Office .................................. 5 ........ 5 6
Quarantine Service................................. 11 23 34 34 : 8:
Health Office, Panama.............................. 9 124 133 124 IS
Health Office. Colon................................ 7 65 72 64 78-
Ancon Hospital ................................. 135 208 343 331 352
Colon Hospital ................................... 22 35 57 57
Santo Tomas Hospital.............................. ........ ........ ..... ........ .
Palo Seco Leper Colony........................... 2 34 36 8 37
Zone Sanitation....................... ............ 5 161 166 118 96
Corosal Hospital................................... 16 103 119 121 -10:
Line dispensaries .... ............... ................. 12 8 20 19 2B,

Totals....... ................................ 224 761 985 912 -8s
.51


,: k AN M R
: i:.;;?".i" :'





":TM.








jr.
L ...:i
i,;



ph





".': : 'i':.

.,: i.;:: 5,.,.' iii',i:
K i',,]










ii......:.:.
,*1.. ;i.: i
K. #.1"::: .


;"' ,t !.


' /' i.!!


.. .!..






... : .::A.:









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

S'' -;


MR 2343-Panama Canal-2-12-27-1.000


":'





.. w




























* .,C,







.r






(It




























































































h



e



*a












"1


.5
:*






... ii.,'i. ."



"- : "o.." : ." 'I...:." .
S..... .... ...: : .:^i:'






'4 -* s.
I, ." .... .. .. :. "" .: :'.;.:! :,.,,. :;l,.u i,.
.' .. .. : ,,":.. ; ,.:,iii






., **.. ,... % *... ..':'
i'El
.'1 ..' :. E .. .':: '
........ .'.




)~* *







:- IA.
..* :: .. .: v ..'. "... .. :
..... r ..:31






't




;.' : >* *.'FI; ,*:*:*;i;




S..
:... : .. N ., ...




: ..:. : .:."g
": ". "; '11
















j


.. .* .. I .'.



*N *'*N.s
'. \ .: ;'.. *: :..
"' :" .- .. ::. ..., r i..



























: ". :. ."
:.... : i: ," : i::,
,";. ,' :- ; .^ .: : : ii H I
: .'i :-... : '".!










'I
-tf
;A
,. .:;: "i':^,:ii
i::'.!:';ii' 5'[



















... .. .*: ...* M l
i












'4







: iii.s
.. .; :::i!M


































N'
trd
: .. ; : ..... .



























iS
:.. .. ..::: : J :
'." .
i.;


r...'Eir ..
% :' i;
: .. :...:H:'

... ::" '.~: '.2:/
: ,-':iil;i

.,. .. .c~~%
...


i : :.%
:.: :

I :i; c


:;' "" 'E L

1C ;: i;: ::"1

i
i:: ;o; .-







UNIVERSITY OF FLORIDA
Iltl 11111111 lill 11111 I II Ill1111 111
3 1262 08896 2690