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

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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:
1933
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_00016
System ID:
AA00006092:00016

Related Items

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

Full Text












REPORT

OF THE



Health Department


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'he Panama Canal

FOR THE

CALENDAR YEAR

1933


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



BALROA HEIGHTS, CANAL ZONE


THE PANAMA CANAL PRESS
MOUNT HOPE, C.Z.
1934






























































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






























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CONTENTS
Page
Title ___----------- ---------------- -------------- -------------- 1
Organization and activities ----------------------------------------- 5
Personnel ---------------------------------------------- -------- 5
Financial statements ------- -------------------------------------- 6
Patient days in hospital and asylum (see also table 9, page 83) ------------ 8
Vital statistics, populations of the Canal Zone, Panama City, and Colon ---_ 10
General death rates from all causes and from disease only ------------- 10
Canal Zone ------------ ------------- ----------------- 11
Panama City----------------r ---- ---------------------- 11
Colon ----------------- ------- ------------.------------- 12
Birth rates -.--------- ---------------------- ---------------- 12
Canal Zone----- --------- -- ----------------------------- 12
Panama City ------------------------------------------- 13
Colon .----------------... ----..-------------------------- 13
Infant mortality rates-- _------------------- ----------- 13
Principal causes of death ------------------------------------ 14
Acute transmissible diseases reported ----------------------------- 15
Vital statistics, Panama Canal employees ---.----------------.--------- 16
Death rates --_-----_----------- ------- -------- ----- -------- 16
Admission rates to hospitals and quarters -------- --------------- 16
Principal causes of admission to hospital --------------------------- 17
Noneffective rates, all causes ---------------- ------------------ 17
Admission rates, malaria -- --__-- ----------------------- 17
Deaths from malaria _----------------- ---------------------- 21
Division of Hospitals, Dispensaries, and Charities ----------------------- 21
Gorgas Hospital --_--------------------------------------------- 22
Board of Health Laboratory -------------------------------- 23
Colon Hospital ---------- ---__ -------.--- ------- --------------- 26
Corozal Hospital --_---_-- ----------------------------------- 28
Palo Seco Leper Colony ---------- ------------------------- 31
Division of Sanitation -------------- ------------------------ ------. 32
Health Officer, Panama City -------- ---- ----------------- 34
Health Officer, Cristobal-Colon ------------------------------- 37
Division of Quarantine ----------------------------------------- 39
District Nurse for the Pacific side _------------ --.-- ---------------- 40
General Tables:
1. Discharges from hospitals, deaths, and noneffective rates for em-
ployees---------__ _---------------- ---------------- 43
S 2. Causes of deaths of employees arranged with reference to color,
I age, and length of residence on Isthmus ------------------- 44
*







4


CONTENTS-Continued

General Tables-Continued: Page
3. Deaths and death rates of residents of the Canal Zone and the
cities of Panama and Colon --- ----_-..--_-.- -- _____ 46
4. Deaths of residents of the Canal Zone and the cities of Panama
and Colon, by cause, sex, color, and age ---------------- 48
5. Deaths of residents of the Canal Zone and the cities of Panama
and Colon, by place of residence; absolute numbers and
annual rates per 1,000 .------.---.....---------------_- 54
6. Statistics regarding American employees and their families -...... 60
7. Discharges and deaths in hospitals of The Panama Canal, abso-
lute numbers ------..-------------------..-----------.. 62
7-A. Discharges and deaths in hospitals of The Panama Canal, rates ,-
per 1,000 population --------------------------------- .. 72
8. Consolidated hospital and colony report --------------------- 82
9. Number of days hospital treatment furnished, and average num-
ber in hospital each day of the various classes of patients --- 83
10. Consolidated admission report, hospitals and dispensaries ---_---. 83
11. Report of dispensaries -------------------------------------- 84
12. Average number of days in hospitals and quarters for each ad-
mission, employees only ------------------------------- 84

























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REPORT FOR THE CALENDAR YEAR 1933

ORGANIZATION AND ACTIVITIES

The Health Department constitutes one of the five major adminis-
trative units of The Panama Canal organization functioning directly
under the Governor, and its organization and activities were some-
what comprehensively outlined in the annual report of the Health
Department for 1930.
PERSONNEL

'The only change in personnel assigned to important key positions
.was that of Chief Quarantine Officer, Surgeon Charles V. Akin, United
States Public Health Service, having been designated as Chief Quaran-
tine. Officer, The Panama Canal, on October 14, 1933, vice Surgeon
M. Flint Haralson, United States Public Health Service, relieved on
account of termination of tour of duty with The Panama Canal.
Total personnel in the service of the Health Department on Decem-
ber 31, 1933, was 1,025, a reduction of 22 in the white American (gold)
personnel, and 79 in the colored alien (silver) personnel, under the
previous year; total reduction 101. The principal reduction in per-
sonnel (70) occurred at Corozal Hospital for the Insane, and was
occasioned by the fact that in July 1933, 592 patients, the respon-
sibility of the Government of Panama, were transferred to the
Panamanian Government asylum for the insane. The remaining re-
duction in force, 31 in number, was distributed generally among other
Health Department units and resulted from necessary curtailment
in operating expenses to balance the budget.


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6

Total personnel in the employ of the Health Department, by units,
for each of the five years 1929 to 1933 inclusive, has been as is indi- *
cated in the following table:
FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER, EACH YEAR :K






ChiefHealthOfee....... .. 7 7 7 77 66 5
Gorgas Hospital.......... 176 299 475 167 267 434 159 243 412 162 252 414 157 249 406
Colon Hospital ......... 25 52 77 29 54 83 32 55 87 32 55 87 29 54 8u
Coroal Hospital ........19 144 163 22 141 163 21 138 159 21 139 160 11 79 go
.Linedispensaries1.........1 9 27 16 15 31 17 15 32 161 33 18 17

Health Offie,Colon.... .9 88 9 9 87 96 8 89 97 103 8 89 7

Total............... 282 8911,173 279 8471126 284 8261,110 275 8511,126 258 7721,025

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

The distribution of the gold personnel (white Americans except 3)8
on the basis of professional and other special qualifications, was as1
follows:

33 physicians, medical officers of 8 dispensary assistants
"the U.S. Army 5 pharmacists and assistant phar-
1 physician, surgeon of the U.S. macists
Public Health Service 2 chemists
27 physicians, civilian 2 general mechanics
1 dentist, U.S. Army 2 stewards and stewardesses
3 senior internes 2 dietists
7 junior internes 1 storekeeper
4 male nurses I dental hygienist
95 female nurses I carpenter foreman
2 district nurses I chauffeur foreman
26 clerks 1 physio-therapy aide
12 sanitary inspectors 1 electrician
I sanitary assistant 1 embalmer
1 quarantine inspector
4 veterinarians "
8 technicians
FINANCIAL STATEMENTS

Operating expenses for the Health Department as a whole were"
$159,286 less than for 1932; and comparable earnings were $93,326 less
Operating expenses and earnings by units are set forth in the following
table:.
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OPERATING EXPENSES AND EARNINGS OF THE HEALTH DEPARTMENT,
CALENDAR YEAR 1933


Chief Health Office ----------------
Gorgas Hospital -----------
Colon Hospital ---------------
Corozal Hospital .----------- --------
Palo Seco Leper Colony ----------
Line dispensaries ------------------
Medical store -------------------------
Quarantine service --------------------
Sanitation of Panama City and Colon ---.-
Street cleaning and garbage collection and
disposal, Panama City and Colon.
Canal Zone sanitation --.. ----__.........

Total --_--


'$29,065.09
2703,920.95
3150,595.56
4126,73 7.28
37,624.01
97,522.63
6,629.56
568,149.64
57,346.73
132,716.75

132,625.09


$328,555.38
83,762.33
105,754.80
24,666.75
36,790.17

17,881.46
9,799.76
117,581.79

49,769.02


61.542,933.29 774,561.46


* Includes Army pay of Chief Health Officer, which amounted to................................ 6,120.00
*Includes Army pay of Army medical officers on duty in this institution, which amounted to.......... 101,680.36
Also includes cost of operation of Board of Health Laboratory.
J Includes Army pay of Army medical officers on duty in this institution, which amounted to.......... 28,290.75
Also includes cost of operating Colon dispensary.
4 Includes Army pay of Army medical officers of duty in this institution, which amounted to.......... 11,425.41
Total Army pay of Army medical officers on duty in the Health Department.............. 147,516.52
sIncludes Public Health Service pay of Public Health Service officers acting as Chief Quarantine Oficer.. 5,078.45
* Includes Army and Public Health Service pay, which amounted to............................... 152,594 97
OPERATING EXPENSES OF THE HEALTH DEPARTMENT, CALENDAR YEAR 1933,
SHOWING AMOUNTS CHARGED TO VARIOUS ACCOUNTS


Gold pay roll (white employees):
Panama Canal pay_ ---------.------------- $567,975.61
Army pay -------------------------------- 147,516.52
Public Health Service pay ----- ---------- 5,078.45
Silver pay roll (colored employees) ---------------------------
Subsistence supplies _--_ ---- _---------------
Ice- -----------------------------
Hospital supplies and drugs ------------------
Equipment ---------------------------------- -------
Miscellaneous supplies --------- --------------
Laundry----------------_-----------
Telephones _-------------------------------------
Repatriation of patients physically or mentally disabled --------
Medical storehouse operation_ -- ----------------------
Marine Division, launch and bus service for boarding parties ---.---
Electric current ---- ------------------------------ ------
Electric:repairs and installations -------------------------
Water ....- ---------------. ---------- ---_-
Freight------------------------------------------- ------
Mechanical Division, repairs and miscellaneous work.---___----


$720,570.58
372,165.57
166,411.35
4,555.90
71,329.41
18,908.75
32,360.91
26,404.66
15,037.41
955.49
6,629.56
6,173.62
16,307.18
4,349.74
9,994.00.
13,751.f5
3,813.57


47%
56%
83%
66%
38%

26%
17%
89%

38%

50%







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8


Motor transportation charges (except for hospitals, quarantine : : ::
station, and dispensaries which operate .their own motor
vehicles). ---------------------------------------------- 47,325a 43 ::0
Repairs to motor vehicles of hospitals, dispensaries, and quarantine
station ------- -----------------------------------2,1a,84.,::
Rental of quarters.-----.------------- ---------------------- 555.82 ,
Construction Quartermaster, building repairs -------------------- 2,400.70 .:
Municipal Engineering Division, work --------------.... --....._ 2,852.70 .
Sale of buildings and surplus equipment, Corozal Hospital------ (6,446.12)
Miscellaneous expenses.-------------------------------------- '4,343.07

Total expenses ------------------------------------- 1,542,933.29

The extent to which the various units of the Health Department
have been self-supporting each year for the past 10 years is shown ip
the following table:


Gorgas Hospital.....................
Colon Hospital......... ...............
Corozal Hospital .....................
Palo Seco Leper Colony ...............
Line dispensaries ....................
Quarantine Division .................
Sanitation, Panaman and Colon.......
Street cleaning and garbage collection and
removal, Panama City and Colon....-
Zone sanitation ................. .. .
Health Department as a whole..........


Percent self-supporting
(Army pay included)
Calendar years-

1924 1925 1926 1927 1928 1929 1930 1931 1932 1931
52 53 51 57 54 52 49 46 47 41
41 39 37 44 44 52 59 52 51 I 51
81 82 80 85 76 88 86 89 94 81
40 45 38 46 41 46 55 44 65 Al
27 34 35 32 34 35 32 l1 43 31
38 46 53 35 38 49 35 32 24 2f
17 20 18 11 13 16 12 15 14 -
58 60 61 81 82 82 81 82 82 80
39 37 29 29 29 37 36 33 35 N8
48 50 49 53 51 54 52 49 51 50


PATIENT DAYS SPENT IN PANAMA CANAL HOSPITALS
NUMBER OF PATIENT DAYS IN HOSPITALS AND ASYLUMS


1929 1930 1931 1932 1933


Gorgas Hospital.........................
Corosal Hospital:
Insane patients.......................
Cripples and chronic medical and surgi-
cal cases........................
Colon Hospital........................
Palo Seco Leper Colony..................


184,506
209,794
27,623
30,755
36,568


163,975
228,862
28,923
41,158
36,102


165,050
228,327
29,883
41,508
34,947


149,812
253,240
31,802
35,379
38,543


149,292
172,41.
33,.96
31,378
34,4a


Total.............................. 489,246 499,020 499,715 508,776 421,01 .


The number of patient days spent in all Panama Canal hospitalsd!
was 421,201, representing a decline of 87,575 under the previous yeat.ag,:
The transfer in July 1933, of Panamanian insane to the Panamanuian:."
Government asylum accounts for 80,827 patient days of this reductions: i'|
the net reduction in patient days under the previous year being 6;7'ti,
The average strength of force in the employ of The Panama CanaI g .
1933 was only 277 less than in 1932, and the number of employee
patlerit days was 1,460 less (1932, 47,077; 1933, 45,617). There :; ,
a decrease of about 14,500 patient days in the group of patients d .rawn:.

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from families of U.S. Government employees, government contractors,
private patients, and others entitled to treatment. The number of
patient days chargeable to charity increased by about 5,300 (1932,
66,028; 1933, 71,379). During the past few years the military gar-
risons in the Canal Zone have increased materially (1928, 8,380; 1933,
9,817), and proportionately the number of patient days spent by
military personnel in Panama Canal hospitals has been much greater
(1929, 32,814; 1932, 50,674; 1933, 59,946)-about 10,000 more
patient days in 1933 than in 1932. The net decline in patient days
(6,748) is attributable to economic conditions (reduction in pay of
employees, and unemployment), reduction in activities of contractors
engaged in U.S. Government construction projects, and to some ex-
tent to an agreement made in October 1933, between the President
of the United States and the President of Panama, which provides
that hereafter no persons except U.S. Government employees and their
families will be entitled to treatment in Panama Canal hospitals,
except in emergency.
AVERAGE COST PER PATIENT PER DAY IN PANAMA CANAL HOSPITALS

Calendar years

1929 1930 1931 1932 1933
Gorgas Hospital:
Including total cost of Board of Health laboratory and under-
taking service ..... .............. .................... 5.08 5.40 5.07 5.03 4.71
Including only the cost of work done for this hospital by the
Board of Health laboratory and its undertaking service.. 4.87 5.16 4 83 4.76 4.47
Colon Hospital:
Including cost of Colon dispensary........................ 5.18 4.27 4.39 4.72 4.80
Including cost of Colon dispensary, also including the 5ost of
the work done for this hospital by the Board of Health
laboratory and its undertaking service ................. 5.55 4.55 4.65 5.04 5.12
Excluding cost of Colon dispensary, but including the cost of
the work done for this hospital by the Board of Health
laboratoryandits undertaking service ................. 4.84 3.96 4.11 4.39 4.47
Corozal Hospital:
Including cost of operation of dairy until December 1930; also
including cost of gardenesand cemetery .............. .90 .88 .70 ..65 .61
: Same as above, also including cost of the work done for this
hospital by the Board of Health laboratory and its under-
taking service ............................ ............ .92 .90 .72 .67 .64
Palo Beco Leper Colony:
Not including work done by the Board of Health laboratory
and its undertaking service ........................... 1.25 1.06 1.35 .96 1.09
Including -cost of the work done for this institution by the
Board of Health laboratory and its undertaking service... 1.26 1.07 1.36 .97 1.10

'NoT.-Owing to the multiplicity of f ons of the various units of the Health Department, the exact cost per
p.tihnt per day (in-patients) is impossible to determine. At Gorgas Hospital a large number of out-patients are treated
-;, the various clinic; also the Board of Health laboratory, including the undertaking establishment (which does the
eI:. alming and cremating, and handles the shipment of bodies, for all units of the-Health Department) is operated as a
pat of the hospital; the Board of Health laboratory does work for various divisions of the Health Department and for
i their departments of the Canal and for the Army. At Colon Hospital the dispensary is manned by hospital personnel
S an it isoperated as a part of the hospital; they have no undertaker, but furnish coffins and hearse service for the re-
I;:e. mra of colored patients dying therein.
i" I the foregoing table no effort is made to exclude the cost of any of the miscellaneous work of the hospitals from the
I l, o~ f eatingg for in-patiente, except that in the second figure shown of per-patient per-day cost for each institution an
If .. t has been made to include the proper percentage of expense of the Board of Health laboratory and its undertaking
i. ahble to such institution; also the cost of Colon dispensary has been deducted in the third figure of cost
iii pe-patit per-day for that institution, in order to make it more nearly comparable with Gorgas Hospital." The pro-
F. c;re: eia,."ps itheatpense of the Board of Health laboratory chargeable to eah institution was arrived at by a check of
f i: fmrik thelaboratory over a short period of time; on account of variation of the work it is more or less arbitrary.
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VITAL STATISTICS. "
POPULATIONS OF THE CANAL ZONE, PANAMA CITV-"
AND COLON-
The Health Department of The Panama Canal secures, analyze
and makes reports on the vital statistics (births, deaths, and disease;
rates) of three geographical units of the population residing on :the
Isthmus of Panama, namely, .the population of the Canal Zone, oftipe
city of Panama, and of the city of Colon. *:
Properly to interpret these statistics, it is essential that there be some .
understanding of the composition of the various units of the popula-
tion, their movement, and some of the special local factors involye4d
which usually are not encountered in stabilized populations in many. '
parts of the world. These special factors were discussed somewhat in.
detail in the annual report of the Health Department for 1930 (pages
12 to 15, inclusive) which can be obtained on request to the Chief,
Health Officer, Balboa Heights, Canal Zone.
The Republic of Panama takes a census every 10 years, the last '-
enumeration having been made in 1930. In Panama City, from 1920
to 1930, the population made an average increase per year of almost
exactly 1,500, and that figure has been used as the factor in computing
the population each year since 1920 by arithmetical progression. For
1933 the population is estimated to be 79,000 (arithmetical progression).
In Colon, from 1920 to 1930, the census figures indicate an average
decrease of 150 per year, and that figure has been used as the factor
in computing the population between 1920 and 1930 by arithmetical
progression. As there is some doubt as to the accuracy of the 1930
census of Colon, 30,000 was adopted for 1931, and continued since.
The population of the Canal Zone consists of white American ema'.
ployees and their families, colored alien employees and their families,
military and naval garrisons, representatives of shipping companies,";"
contractors, church and welfare workers, etc., and colored alien agt i'.
culturists who rent land under revocable licenses. A census of the".
Canal Zone population is taken each year and all figures for this grou ii~
are actual rather than estimated.
The term "employees" as used in Heah Department reports in- -:
cludes employees of The Panama Canal pr'er and the Panama Rail-
road Company, which is a corporation owned by the United States,
Government. :*
GENERAL DEATH RATES, ALL CAUSES, AND DISEASE ONLY
Death rates from all causes for all groups of the population ha4te .:.,&
been analyzed since the beginning of construction (1905) and thosi' ;:

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from disease only have been tabulated since 1913. Statistical tables
covering these data are incorporated in the annual report for 1931.
In this report (1933) the vital statistics incorporated will be limited,
as was done in the annual report for 1932, to a presentation and brief
discussion of death rates for the current year and a tabulation of rates
by consecutive 5-year periods to indicate general trend.
Health conditions for all groups (Canal Zone, Panama City, and
Colon) of the population were good; there were no epidemics; malaria
prevailed to a somewhat greater extent than is usual; morbidity and
mortality rates continued their downward trend and in some respects
declined to an all-time low point.
Canal Zone.-The death rate from all causes in the calendar year
1933 was 7.12 per 1,000 of population, the lowest of record (population
42,851, deaths 305). Deaths from disease only totaled 271 or a rate
of 6.32 per 1,000 of population, the lowest rate of record since 1913
except for the years 1930 and 1931, when comparable rates were 6.13
and 6.09 respectively.
The general trend of death rates in this group of the population of
the Isthmus during the past 20 years, both from all causes and from
disease only, has been very definitely a downward one as is evidenced
by the following analysis of rates for the past 20 years by 5-year periods.
CANAL ZONE DEATH RATES BY 5-YEAR PERIODS

1914-18 1919-23 1924-28 1929-33
Total death rates per 1,000 population................... 11.79 8.00 8.38 7 35
Death rates from disease per 1,000 population ............ 9.96 698 7.23 6.35

Panama City.-During 1933 the death rate from all causes was
14.95 per 1,000 of population (deaths 1,181, population 79,000), the
lowest of record (1905 to date). The death rate from disease, 14.30
per 1,000 of population (deaths 1,130, population 79,000), also was the
lowest of record. The trend in death rates from all causes and from
disease only has been continuously attaining lower levels during the
past 20 years as is clearly evidenced in the following tabulation of these
rates, by 5-year periods, since 1914:
PANAMA CITY DEATH RATES BY 5-YEAR PERIODS

1914-18 0919-23 1924-28 1929-33
.Toll death rate e 1,000 poplation.................. 28.45 20.20 18.12 17.04
Dema teas r disease, per 1,000 population............ 27.45 19.51 17.51 16.31

eo., sn-In. 1933 the death rate from all causes was 16.27 (deaths
S486, population 30,000) and from. disease: only, 15.63 (deaths 469,



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population 30,000). These rates are considerably in excess of the
comparable rates for any year since 1921, except for the years 1929
and 1930. The population figures for Colon have been held at the
constant figure of 30,000 since the 1930 census, as that census showed
no material change in the total population for the 10 years inter-
vening between 1921 and 1930.
The trend in death rates in Colon by 5-year periods for the past 20
years is shown in the following table which indicates that death rait
have been increasing during the past five years: :
COLON DEATH RATES BY 5-YEAR PERIODS

1914-18 1919-23 1924-28 1929-83
Total death rates per 1,000 population .................. 24.92 16.42 14.48 .1.1 "
Death rates from disease per 1,000 population............. 23.75 14.56 13.80 15.29


BIRTH RATES

Canal Zone (employees and nonemployees).-In 1933 the birth rate
for children born alive in the Canal Zone was 10.78 per 1,000.of popu-
lation (births 479, population 42,851). There were 17 stillbirths, rate
0.40 per 1,000 population, which, though slightly higher than for 1932
(0.31) is less than one-half the rate usually experienced in previous
years. The birth rate (total) for 1933 (11.18 per 1,000 population)
was less than for 1932 (11.69). The decline in birth rates for this.
group of the population has been continuous from year to year since
1924 when it was 21.65.
The persistent decline in birth rates for both groups of the popu-
lation-white and colored-can-be well appreciated by analyzing these
rates by 5-year periods for the past 15 years:
CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS, BY COLOR

1919-23 1924-28 1929-33

White Colored White Colored White Colored ,
Total birth rate per 1,000 of population............... 16.80 28.95 12.75 22.05 9.36 1 .03.
Lve birth rate per 1,000 of population.................. 16.31 27.30 12.26 20.66 9.13 14. .
Stillbirthrateper 1.000 of population ................... .49 1.64 .41 1.39 .23

As has been pointed out in previous annual reports, the low birth
rate in the white American population is influenced by the fact that the ,
unmarried military population amounting at the present time tbo:
about 10,000 individuals constitutes about one-half of this group. .: ..
The colored population is now a fairly well stabilized one. Th. 0'
total rate for this group in 1933 was 13.11 per 1,000 of population.. ..






13

_The decline in this group also has been persistent and continuous
S'since 1924 when it was 26.40. In the near future a considerable
proportion of the generation of the colored population born in the
Zone will have reached the age of reproduction, subsequent to which
time it may be anticipated that birth rates will increase.
Panama City.-In 1933 there were 2,607 children born in the city
of Panama, population 79,000 (rate 33 per 1,000 of population). Of
Sthe total births, 2,508 (31.75 per 1,000) were born alive and 99 (1.25
per 1,000) wern stillborn. There has been a continuous decline
in the rates for stillborn since 1930 when it was 1.80 per 1,000.
Incidentally it may be stated that in 1916 the rate for stillborn was
3.73. During the past 15 years birth rates have tended to decline
slightly as is evidenced in the following analysis of these rates by
5-year periods:
PANAMA CITY BIRTH RATES BY 5-YEAR PERIODS

1919-23 1924-28 1929-33
Total birth rate per 1,000 population........................ ............... 3739 34.49 34 00
Live birth rate per 1,000 population.................................... 35.24 32.74 32.47
Stillbirth rate per 1,000 population............. ......................... 2.15 1.75 1.53

Colon.-There were 851 children born in Colon (population 30,000),
the birth rate being 28.37 per 1,000 of population. Of the total births
809 were born alive, and 42 were stillborn (rates 26.97 and 1.40
respectively). The general trend of birth rates in Colon during the
past 15 years is shown in the following analysis of these rates by
5-year periods:
a COLON BIRTH RATES BY 5-YEAR PERIODS

1919-23 1924-28 1929-33
'Totalbirthrateper 1,000population ............... .................. 30.04 25.59 29.88
Live birthrate per 1,000 population............... .................. 28.38 24.21 28.46
Stillbirthrate per 1000 population................................. 1.66 1 38 1.42


INFANT MORTALITY RATES

Infant mortality (absolute numbers and rates per 1,000 of Jive
births) for the three groups of population involved were:

Cn.al Zone
Panama Colon
White Colored Total
I vetiirm (abds lBImorbers) ...................... 174 288 462 2,508 809
Daei. Sf ehldnre under one year of age(ablolute number) 6 29 35 295 93
i h lit rtE 'per l,Or ofrive births ................. 34 101 76 118 115


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Canal Zone ....: :
5-year period Panama ,
White Colored Average .
-1 2 ............................... 37.64 187.20 04.8. ....
14 :







1924-1928............................. 52.53 118.74 95.51 133.40i :
1929-1933................................ 3.19 101.13 78.69 130.18... : :.,i :" .::
---------------.--*---------* ... .....q ,*:";". ::.g'" t.
That considerable progress has been made during the past 15 a
in reducing infant mortality rates in all elements of the popu l
on the Isthmus is evident from the immediately preceding table

PRINCIPAL CAUSES OF DEATH

The principal causes of death for the past five years, for the three
groups of population involved, are set forth in the following tables:
SEVEN PRINCIPAL CAUSES OF DEATH FROM DISEASE. CANAL ZONE POPULATION, 19-403
(ABSOLUE NMsBERS AND RATEB PER 1,000) .

1929 1930 1931 1932 1183
Population.......................... 38,825 39,467 40,565 42,070 "42,89
Rate Rate Rate Rate BateB
Disease Num- per Num- per Num- per Num- per
be her 1,000 ber 1,00 her 1
Pneumonia (broncho and lobar)......... 27 .695 30 .785 23 .567 14 .333 34 .73
Cancer (various organs)............... 16 .412 15 .405 15 .370 18 .428 o .007
Tuberculosis (various organs)........... 34 .876 20 .507 19 .468 33 .784 21 .40 -
Diseases of the arteries............... ....... ..... ...... ...... 11 .271 ...... ...... 15 .5
Organic diseases of the heart............ 15 386 2 .557 ...... ...... 20 .475 14 .27
Apoplexy ......................... .. .. .. .. ...... ...... ... ...... 14 .333 12 .i2
Nephritis (aute and chronic)........... 23 .592 21 .532 18 .444 10 .238 12 ra

SIX PRINCIPLE CAUSES OF DEATH FROM DISEASE, PANAMA CITY, 1929-1933
(ABSOLUTE NUMBERS AND RATES PER 1,000): -


1929 1930 1931 1932 1933
Population............................ 73,000 74.402 76,000 77,500 "OIO
SRate Rate Rate Rate
Disease Num- Num- Num- Num- perNm
ber 1,000 ber 1000 ber 1 000 ber 1. 00
Tuberculosis (various organs).......... 204 2.79 208 2.80 218 2.87 203 2.62 S20
Pneumonia (broncho and lobar)......... 231 3.16 180 2.42 202 2.66 174 2.25 148 i
Diarrhea and enteritis, including colitis... 148 2.03 98 1.32 135 1.78 104 1.34 .
Nephritis(acuteand hronic)........... 114 1.56 113 1.52 64 .84 69 .89
Organic diseases of the heart............ 118 1.62 98 1.32 137 1.80 67 .86 ':
Cancer (various organs) ............... 67 .92 59 .79 62 .82 69 .89

SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 192-1933 08
(ABBOLUTE NUMBER AND RATES PER 1,000) )::;
------------------------ ----- ------ ..- ...:: .*.*,:*.-.. *..;... .;
1929 1930 1931 19338 198
Population......................... 29,850 29,765 30,000 30,000 S=iNS
---------------------____ -i-- --- --- --- -******.
Rate Rate Rate Rate ito
Nib_ IOD-r Nm Ol- Nob- No e 1 um-
.. ....o....r oo 1per0 w b p
1, b 1,0'N 1, 1,0w }


Tuberculosis (various orga)............
Pnemnonia (broho and lobar).........
Organic diseases of the heart..........
A .exy..... ..... ........... .....
ti (a and chronic)...........
Cane (various organs)...............


28
64


..:..


2.14
2.11
.94
.94
1.01


71
32
'4i1


2.39
1.65
1.08
1.38


90
81
32
23
24
,," .


3.00
1.70
1.07
.77
.80
... ..


74
46
30
a.
27
33
...,.. .


2.47
1.53
1.00
.90
1.10


i"H


105 8.5i0 :
51 1,70 .
34' l Im ,"
27 H:
22-


id4







15


Tuberculosis and the pneumonias continue to be leading causes
of death in all three groups of the population, maintaining first and
second places in the populations of Panama and Colon and first
rand third places in the Canal Zone population. The death rate from
tuberculosis in the Canal Zone population is less than one-fifth of
comparable rates in Panama and Colon; tuberculosis affects the
colored alien population of the Canal Zone to a far greater extent
than the white Americans. Deaths from degenerative conditions
of the arteries (arterio-sclerosis and apoplexy) are continuing to occur
with great frequency.

ACUTE TRANSMISSIBLE DISEASES

In the table appearing below is recorded the types of acute trans-
missible diseases which prevail in the Canal Zone and the cities of
Panama and Colon, and the frequency with which they occur in these
groups of the population (approximately 150,000).

CONTAGIOUS AND INFECTIOUS DISEASES-CASES AND DEATHS REPORTED TO THE
CHIEF HEALTH OFFICER DURING THE CALENDAR YEAR 1933

Residence 2
Outside the
e Panama Colon Canal Zone Zone and Total
Disease terminal cities
. New New New j New New
cases Deaths cases Deaths Deaths cases Deaths cases Deaths
Rabies ..................... ................ .......... ... 1 1
Chich enpo ........ 125 ........ 24 ........ 48 ........ 16 ........ 213 ......
Diphtheria........ 73 5 12 1 22 ........ 14 14 121 7
Dyentery, amebic... 78 9 6 2 1 1 164 10 249 22
Dysntery, bacillary
uinel sifid)... .. 1 ........ 1 ........ 3 ....... 1 1 6 1
"t tai............ 198 6 33 2 1,544 5 465 46 2,240 59
;Meslea. ............ 136 4 72 ........ 49 ........ 31 .... ... 288 4
Hangitui, f..eningo-
e u ...... ..... 1 I ........ ....... ........ .. .... ........ ........ I
........... 1 .. 2 8 ..... ....... ....... 11 ........
onia......... () 148 (') 51 () 34 () 50 ( 283
S.. ........ .. ...... ........ ....... ... 6 .......
.f .. .... ...... ........ ........ ........ 1 ........ 5 ........ 6 ........
v ...i ....... .. .......... ....... 4 ................ ....... 5 .......
S ........ 1 ................ ............... ........... .... ............
b s....... () 204 (9) 105 (.) 21 (.) 41 (9) 371
.mV ...... 11 5 6 ........ 4 2 14 1 35 8
W fvop.oou ... 5 ........ .. 34 ........ 35 ........ 5 ........ 79 ........
gt. .e ...... ............. ... !. .... ..... ...... ...... 1 ........ 2 ........
Reiun s guaratin-
IR O i qai di
Ch ta i, .. .......... ...... ....... .... ...... ............. .... ..... ................ ......
................ 7,4 ........ -
................... ......... .............. .....7 ........ 6 7......

tb i ... ... ..... a .... ........'... ........ ........ ........ ....... '........ 2 ... ......

1*4. A w U Imr sawe0 of umonia and tuberculosis. are not reported unless death occurs, this report shows only the
4 'gbeo death ftrom ese twao diseases.
l ;aores pher we are able to determine the plaoe of Ideetion fairly accurately, the place of infection instead
i tsd mKfb downB. It is usually impoeible to trace source of infection in amebic dysentery, but it is certain that
i .w m. eaa. wea uired in the seRitated area of the Canal Zone and the iies of Panama and Colon. A maloeity
alui of smladia shainr for the Canal Zone are believed to have been acquired in unsanitated areas.



.i;:"!. "... ;
'

II"0







16 .

VITAL STATISTICS, PANAMA CANAL EMPLOYEES .

To interpret properly vital statistics relating to this group iit s :
essential that one have knowledge of the conditions under which theyy:
are collected, their completeness, and other governing factors. Theei
factors were outlined in the annual reports of the Health Depat-
ment for 1930-1932 inclusive.
DEATH RATES, ALL CAUSES
The death rate for all employees (8.67 per 1,000 employees) was.
quite satisfactory (total deaths, 107; average number of employees for.;
the year, 12,344) being the lowest since 1924 (7.23). Ninety-seven
employees died of disease or at a rate of 7.86 per 1,000 employees, which"
represents the lowest rate attained since 1927 (7.82). -
The death rate from disease in the colored employees of The Panama
Canal was almost double that for white American employees, th
reasons f6r which have been discussed in the annual reports of the
Health Department for immediately preceding years. .
Death rates- in both white American and colored alien employees .
are gradually increasing, as is manifest in the following analysis of
such rates by 5-year periods, for the past 20 years: *
DEATH RATES OF EMPLOYEES, DISEASE ONLY, BY 5-YEAR PERIODS
1914-1918 1919-1923 1924-1928 1929-1933
White employees .................................... 4.51 3.20 4.94 5.38 .
Colored employees............................. ..... 5.93 7.36 8.49 10.02

The principal causes of death from disease in 1933 were: Tuber-
culosis, 15; pneumonia, 10; diseases of arteries, 9; syphilis, 8; cancer,
8; nephritis, 7; apoplexy, 5.
ADMISSIONS TO HOSPITALS AND QUARTERS
The admission rate to hospitals and quarters was 845 per 1,000
employees. As noted last year, this rate has been increasing each
year since 1926: 1926, 474; 1927, 502; 1928, 595; 1929, 602; 1930, 603iT
1931, 705; 1932, 725; 1933, 845. This increase is attributable t.:
gradual increase in the age of those employed (greater prevalence of
diseases of the chronic degenerative type).
The admission rate per 1,000 to hospitals for disease by race (whi te
and colored) has been as follows for the past five years: *
ADMISSION RATE TO HOSPITALS PER 1,000 EMPLOYEES. BY RACE (WHITE AND C OLOED)
White Colored
1929....................... ............. .. ....................... 273 1
1930............................. ...... ......... .288 180.........
1931 ......................... ...... .............................. .. 10 1
1932. ..................................... : ............ .............. .. 10 171
1933........... ......... ..... .... ... .... .................... .80







17

PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES TO HOSPITALS

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

1929 1930 1931 1932 1933
Disease Rate Rate Rate Rate Rate
Total per Total per Total per Total per Total per
1,000 1,000 1,000 1,000 1,000
Malaria (including the few cases treated
inquarters)....................... 337 21 410 26 276 19 177 14 328 26.57
Influen zs ......................... ............... ............ ...... 79 6 157 12.72
Diseases of pharyn and tonsils......... 184 II 136 9 153 10 97 8 146 11.83
Arteries lerosis ............... .. .. ..... ...... .. ... .. ... 124 10 120 9.72
Diseases of naal fossae ad annexa...... 153 9 .......... 270 19 ..... ..... 99 8.02
Diseases of eyes and annexa........... 113 7 ... ..... 131 9 81 6 68 5 51
Acuteabease ......................... 109 7 106 7 .... ..... 77 6 .... ......
Gonocoeeusinfeation................. 121 7 130 8 106 7 .... ................
Syphilis ............................. ...... ...... 150 10 114 8 ........... ...
Ankylostomiasis ..................... ...... ...... 113 7 ......... .. ....... .....


NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES

The noneffective rate for 1933 was 17.33 per 1,000 employees, the
highest recorded since 1912 (construction days).

ADMISSION RATES, MALARIA, EMPLOYEES (HOSPITALS AND QUARTERS)

As malaria is a most important cause of noneffectiveness in this
geographical area every effort is made properly to diagnose, treat,
make record of, and determine the source of infection in all cases
occurring in employees and other persons residing in the Canal Zone.
Since 1906 careful records have been kept of the incidence of malaria
in employees of The Panama Canal and its occurrence in this group
is shown in the following table:
MALARIA CASES, EMPLOYEES ONLY
Absolute numbers and rates per 1,000 employees

Average Number Rate Average Number Rate
Year number of per Year number of per
employed cases 1,000 employed cases 1,000
-.. ___i______ __-----_____ -----_____ I-- L -- -----___ -----______ -----_____ ______


1906 26,547 21,795 821 1920 20,673 401 19
1997 .39,238 16,637 424 1921 14,389 214 15
1908 43,890 12,372 282 1922 10,447 176 17
1909 47,167 10,169 215 1923 10,976 212 19
1910 50,802 9,487 187 1924 11,625 190 16
1911 48,876 8,987 184 1925 12,180 330 27
1912 50,893 5,623 110 1926 12,732 179 14
91. 56,654 4,284 76 1927 13,561 145 11
14 44,329 3,635 82 1928 14,260 203 14
S 34,785 1,781 51 1929 16,193 337 21
1 33,176 547 16 1930 15,524 410 26
S 32,589 473 14 1931' 14,597 276 19
5 25",520 472 18 1932 12,621 177 14
S 24,04 752 31 1933 12,344 328 27
E 3231-2


I.,


I,





4s
18

The rate per 1,000 employees for 1933 was, in round numbers, i l
(actually 26.57), the highest since 1925 when a rate of 27.09 was.bii-
tained. The malaria season for 1930, when a rate of 26.4 per.
employees was recorded, is comparable in many respects to da.
1933. .
Many factors, some known and some unknown, influence these wriaBJ
from year to year. The various factors which may possibly infueiti:i
the rate of prevalence of malaria are constantly under observatAi'it
and the results of such observations are recorded in the anal."i"
reports of the Health Department to which those especially interest
are referred. Marked annual variations in rates occur notwithsftan" ...
ing that continuously for many years the permanent drainage projects- 7
have been improved and extended and that extensive new drainar ~ ..
works have been installed.
The rate for 1933 (27) was in excess of those usually attained sin~ice
1916 (14 to 19 per 1,000) and was attributable to a number of facnlip -;
among which the following may be cited: .
(a) Continuation of large construction projects beyond the limits of '
so-called "sanitated areas."-Construction projects of this nature were'.
engaged in during 1925 (fortifications) and have been under way
since 1929 (road construction on east and west sides of the. Canal,
Pacific side, and construction of Madden Dam).
(b) Unusual prolongation of the rainy season.-Ordinarily the raii s
begin to taper off in late November and by the middle or latter part':
of December the dry season is well under way and small collections of
water suitable for anopheline breeding have dried up. In .1932 the
rains continued until the latter part of December, A. albimatnas
breeding places beyond the limits of the sanitated areas were abundant
until January 1933, and flights of A. albimanus into the sanitatedi
areas still were occurring. As a result, the malaria rate for the month": '
of January 1933 (annual basis) was 31.3 per 1,000 employees, which
is much higher than is usual (January 1932, 15.2; 1931, 23.6;, 1930, t;
20.3; 1929, 22.5; 1928, 6.7). Incidentally, it may be stated that ey
end of the rainy season in .1933 was quite similar to that iof 1934.:
and as a result the malaria rates for January 1934-when ,this '
report is being written-are unusually high (28.0 per 1,000). e: .W.i..
(c) Dredging Division projects.-In the early part of the dry senaS0CF
of 1933, the Dredging Division initiated a project including the:0al'LA
struction of a dyke damming up the Rio Grande and its tributaries i..:
the west side of the Canal just north of Balboa, with construction 4li1"
spillway at the upper end of the dyke. This area is to be used L: i
dumping purposes in dredging silt from the Canal. :Temporarily la.

2 1:.'. I
....:"









to enable the silt to settle solidly, it was necessary to bring the water
up to a high level. This level could not be lowered until some time
afterr the rainy season began and as a result a considerable amount of
fresh water accumulated in the tributaries emptying into the Rio
SGrande River. The areas were patrolled regularly and as soon as
breeding was found efforts were made to control it by oiling. It was
not possible, however, markedly to lower the level of the water until
about August or September. In the meantime the amount of breeding
was very greatly curtailed. Temporary drainage works have been
constructed in this area, the channel leading to the spillway has been
lowered, and we anticipate no great trouble, from it during the next
rainy season. A second Dredging Division project (fill) on the
Thatcher Highway in the vicinity of Farfan beach (west side of Canal,
opposite Fort Amador and La Boca) has not, as yet, settled solidly
and therefore is not adequately drained. The result was that during
the latter part of the rainy season A. albimanus bred so abundantly
as to necessitate dusting with paris green by airplane. The fill,
which consists of silt from the Canal, is still too soft to permit construc-
tion of permanent drainage systems. Fortunately, the area in the
vicinity of the Dredging Division projects has been depopulated and
there is but little opportunity for malaria-transmitting mosquitoes
to acquire infection except from individuals from the interior of
Panama awaiting ferry connections at the ferry slip on the west side
of the Canal at night. Sometimes the waiting period is a half-hour
or more.
(d) Aquatic flora, Gatun Lake.-Observations during the past few
years indicate that the amount of A. albimanus breeding in Gatun
Lake is increasing rapidly due to changes in the aquatic flora. This
problem was discussed in the Annual Report, Health Department,
Panama Canal, for 1932 (pp. 43-45) and further details are incorpo-
rated elsewhere in -this report. Evidence also in accumulating that
the dispersal flights of A. albimanus always noted at the beginning
of the rainy season, before rains are sufficient in volume to possibly
.result in breeding within the sanitated areas, are coming from the
Gatun Lake area. Anopheles breeding in the lake during April,
May, and June 1933, was materially greater than usual. Rains in
sitlicient volume to raise the lake level occurred much later than is
usual and:as a result the decline in the water level of the lake during
Sithe"dry season was approximately five and two-thirds feet rather than
thme sual five feet. Consequently materially more extensive areas of
s:atted decaying Chara were present on the surface of the lake than
i" aav re. fiou nd in its shallow parts. :As these mats afford ideal


.. "





.. ... .': :

20

food and shelter for Anopheles breeding, the amount of breeding-wa i:
much more extensive than usually is observed. There now appea.04
to be no doubt that the dispersal flights of Anopheles observ4~itd::;
throughout the Isthmus in May and June each year have their origiti";
principally in the Gatun Lake region and that the prevailing con': "
ception that A. albimanus has a short flight range requires revisitol, :'.
The flight from the lake to the Atlantic terminal is riot less than
four miles, and to the Pacific about 12 miles or more. .:'"
(e) Overhaul work on Panama Canal locks.-Overhaul of the locW
on the Pacific side was in progress from January 3 to June 9, 1933::
during which period several hundred laborers were employed on both
day and night shifts. Chronic carriers of malaria are common in
such groups. During the latter stages of this-overhaul when Anop.h-
eles flights were coming into the sanitated areas from the dredging
projects on the west side of the Canal, in close proximity to the Pacific
locks, and also from the lake area, abundant opportunity was offered:
the malaria transmitting mosquitoes to become infected through
attacks on labor forces engaged in night work on the locks. During'
the latter part of May and the first part of June the Special Seririce
Squadron of the Navy was at anchor in the basin off piers 15 and 16, -
Balboa, and for the first time in a number of years an unusually large
number of cases of malaria were undoubtedly contracted on board the
vessels.
(f) I'isits to the provincial districts of Panama.-Until recent years
but few sections of the provincial districts of the Republic of Panama
were easily accessible except by coastwise steamers, and opportunities
for employees and their families to visit these districts were greatly
restricted. This barrier greatly reduced opportunity to acquire
malaria. During the past 10 years the Public Works department"
of the Government of Panama has been actively engaged in the
improvement and extension of existing highways and the construction .....
of new ones. Tlje result has been that in increasingly large numbers,
the American employees of The Panama Canal are making automobile ,
trips to the provincial districts, building cottages in various coastal.:
areas for week-end and vacation use, and visiting with increasing fre- ..
quency interesting localities in the coastal and other areas. Not-?.
withstanding that employees are warned as to the possibility of con-
tracting malaria during visits to nonsanitated areas, and are urged to.'
safeguard themselves at night, most of them fail to do so. 'The.
result is that constantly increasing numbers of American employees *
and their families are contracting malaria through exposure in.non- .










sanitated areas. Conditions are such that it may be anticipated that
the numbers of individuals acquiring malaria from this source will
continue to increase.

DEATHS FROM MALARIA, EMPLOYEES


In 1933 two employees died of malaria, a rate of 0.16 per 1,000
employees. One of these deaths was that of an American employee
who contracted a malignant tertian infection at New Gorgona beach,
a coastal resort in the interior of Panama, had clinical symptoms for
several days before reporting to a physician, and when seen by a
Panama Canal physician was in a comatose condition. He was ad-
mitted to hospital immediately and died within three or four hours
thereafter. The second fatal case was that of a Panamanian laborer
employed at Madden Dam but living in one of the nearby nonsani-
tated native villages in the Republic of Panama. The patient was
treated for an estivo-autumnal infection in February 1933, readmitted
to hospital on April 3, 1933, and died of blackwater fever seven days
later.
Annual death rates from malaria in employees since 1906 have been
as is shown in the following table:

DEATHS FROM MALARIA AMONG EMPLOYEES ONLY
(Absolute numbers and rates per 1,000 employees)


1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919


Average
number
employed

26,547
39,238
43,890
47,167
50,802
48,876
50.893
56,654
44,329
34,785
33,176
32,589
25,520
24,204


Number
of
deaths

233
154
73
52
50
47
20
21
7
8
2
3
2
2


Rate
per
1.000
8.78
3.92
1.66
1.10
.98
.96
.39
.37
.16
.23
.06
.09
.08
.08


Year

1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933


Average
number
employed

20,673
14,389
10,447
10,976
11,625
12,180
12,732
13,561
14,260
16,193
15,524
14,597
12,621
12,344


Number
of
deaths

3


2
----------






1


2
----------


Rate
per
1.000

.15


.17



.06

.07

.16


DIVISION OF HOSPITALS, DISPENSARIES, AND CHARITIES

The units comprising this division and the scope of their activities
were outlined in the annual report for 1930. Brief reports of each of
thiee units for 1933 follow:





[ ":..: [ ,i" .. ": :




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

22

GORGAS HOSPITAL
(Normal capacity, 880 beds) '
Col. ORVILLE G. BROWN, Medical Corps, U.S. Army, Superinteiii
In addition to the routine work of maintenance and repair of bui i
ings and equipment by the hospital artisans during the year:, :: 'thf
following major plant improvements were made: .
1. The refrigerating plant and cold storage rooms of the hospiStl:.
main kitchen were completely overhauled and repaired at a .cost.
$3,350.
2. A new paint shop was constructed on a site adjacent to the
present shops building at a cost of $2,150. This activity was formerly
located under one of the ward buildings and, together with the storage
of inflammable material, constituted a fire menace which has now
been removed.
3. The old, worn-out galvanized iron pipes in Section "B".are being .
replaced with a new system of modern brass piping. The installati .. .
is now about 75 percent complete. All necessary material for thi ; .
work costing about $1,000 is on hand but, for reasons of economy, the
work is being accomplished only when the plumber is not otherwise
engaged.
4. The interiors of kitchen, mess halls, isolation building and section
"B" have been repainted throughout.
5. The parking site in rear of the Administration-Clinics building
was enlarged at a cost of approximately $900.
About $6,500 was expended during the year for new equipment and
replacements of worn-out or obsolete articles, of which about $1,900
was devoted to new equipment for the hospital subsistence department.
Cases treated.-There were 11,621 admissions during the year, with,
a total of 149,292 patient days. An average of 12.46 days in hospital
was spent by each patient under treatment as compared with 13.21
days per patient during 1932. The average number of beds occupied
daily during the year was 409.02. .
Surgical service.-There were 2,109 major operations (with 31t :
deaths) and 4,096 minor operations (with 2 deaths) performed during::
the year; 440 obstetrical cases were delivered, in which there wee :.
8 twin births and 14 stillbirths; 9,779 patients received treatment sn..
the out-patient service.
Medical service.-During the year, 6,216 patients were admitted ito -
and treated in the medical wards. In addition to the hospital service .:
.8,675 patients were treated in the out-patient service.
Eye, ear, nose and throat service.-There were 9,691. visits to the out-
patient department during the year; 1,610 operations were performed
and 1,065 refractions were done.








Radiographic service.-There were 7,505 cases handled, for which
4 8,472 films of various sizes were used, and in which 991 fluoroscopic
Examinations were made.
SDental service.-There were 5,088 sittings during the year; 1,360
o al examinations, 1,950 teeth extracted, 265 complete and 991
partial dental X-ray examinations.
Physio-therapy service.-Treatments were given as follows: 128
radium, 2,431 roentgen, 1,481 electro-therapy, 3,750 thermo-therapy,
3,688 actino-therapy, 4,262 massage and exercise, and 3,240 hydro-
therapy.
BOARD OF HEALTH LABORATORY
(Operated in connection with Gorgas Hospital)
Dr. L. B. BATES, Chief of Laboratory
Bacillus typhosus.-Recovered in blood culture from 13 individuals,
from the urine specimen of one other, and from four other cases at
autopsy. Six of these lived in Panama City, 3 in Colon, 3 were
transients, 2 from Madden Dam, 2 from Canal Zone towns, and 2
from Canal Zone unsanitated areas.
Typhoid carriers.-On December 31, 1932, there was only one B.
typhosus carrier, H.B., under sanitary surveillance. His stool speci-
mens were examined 10 times during the year and found positive
3 times. One new temporary carrier was found during the year.
SH.B. was the only carrier under sanitary surveillance on December 31,
1933.
SChagas' disease (Schizotrypansum cruzi).-The first case of this disease
St die in the Canal Zone or Republic of Panama, so far as is known,
was autopsied on August 7, 1933. A brief summary of the case is as
f allows: Autopsy No. 10, 203, F.B., age 3 months, 11 days; male;
tildck; residence, land license 1299 B.E., Chiva Chiva trail, Canal
Zone; place of death, residence as given above; time on Isthmus, life;
pHtcipal findings at autopsy: Schizotrypanum cruzi in myocardium,
:percarditis, otitis media, bronchopneumonia, right lower lobe, fatty
metainorphosis of liver.
: n : ake bite.-The fourth autopsy at this laboratory on an individual
J.ihg of snake bite was performed on November 2, 1933. P.B.,
.. colored, laborer, Colombian, age 25 years, was bitten October 28, 1933,
w: while obtaining a piece of sugar cane on Arinosa Farm, land license
:- Crifstobal-West. He died November 2, 1933. The snake was
Mi:,i~ i:by the victim but it was not recovered for identification. The
ii:stry : and autopsy findings were such that there was no doubt as to
J-0 &.' (death.'
: ... .* ..: .. .
"[E :E.:.... ......" .. ... ...

.." ... ...
. :T" I "...







24

SReports.-Approximately 38,900 laboratory examinations wi:re-
made. The volume and character of the work is indicated* in the i:
following summaries: '"
Bacteriological, protozoal, and miscellaneous examinations.--Ct-. t;
tures of blood, 213; cultures of stools (typhoid-dysentery), 946; cultures i
of urine, 1,266;cultures from nose and throat, 1,576; cultures of sputum, ,.
58; cultures of spinal fluid, 178; cultures of miscellaneous material
(eye, pleural fluid, skin lesions, pus,A bile, glands, autopsy tissues.
etc.), 189; darkfield examinations, 81; staining and examination of
smears conjunctivall, throat, urine, urethral, vaginal, sputum, etc.),- i
272; autogenous vaccines, 52; examination of lepers and leper sus-.
pects, 10; examination of urine for tuberculosis, 4; examination bf
spinal fluid for tuberculosis, 153; examination of feces for ova of
parasites and protozoa, 103; blood films for malaria parasites,
8,018; bacteriological examinations of water, 743; bacteriological
examinations of foodstuffs (cultures of milk, cream, ice cream, soft
drinks, etc.), 756.
SEROLOGICAL EXAMINATIONS
Wassermann tests ................... ........................................................... 18307
K ahn tests...... .................. .......................................................... 2,317
A gglutination tests........... ................. ....... ......................................... 210
Positive with B. tpho5us (Eberthella typhi) ................................... ........... 15
Positive with B. proteue X, ( Proteus sulgaris)........................................... 5
Fragility tests ........................................ ..................... .............. 4
Blood typing for transfusion ...................................................................... .
Examination of blood for coagulation time ........................... ............................ 4

Analysis of Wassermann reaclions.-There were 17,488 Wassermann
tests performed on the blood of 13,201 persons. The results are
summarized below:
TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1933
Total Percent of
Race, sex, and status Individuals Individuals individuals individuals
positive negative tested positive
White, civil:
Males................ .............. ............ 74 1,688 1,762 4,2
Females ............................. .......... 29 592 621 4.6
Children .............. ... ........... ........... 3 111 114 2.6
Total .. ..................... .............. 106 2,391 2,497 '. 4
White, military and naval:
Soldiers, continental United States................... 119 3,953 4,072 .9 *'
Sailors, U.S. Navy ................................. 21 270 291-. 6.8:
Total.................................... .. 140 4,223 4,363 3.8
Black and mulattoes: ':
Males......................................... 435 2,711 3,146 13.8
Females............................................ 245 2,646 2,891 8.1
Children ....................................... 14 230 244 6.7 "
Total..................................... 649 5.587 6,281 11.0
Chinese, males and females ............................. 4 56 60 6 '
Grand total .................................. 944 12,257 13,201 7.1
______________________________ _____ __o_ ,.__ \ r









In addition, Wassermann tests were made on 819 spinal fluids taken
from 612 individuals. The results are summarized below:
Individuals positive ........................................................................... 58
Individuals negative ..................................................................... 554
Total individuals tested ........................................................................ 612
Percent of individuals positive.................. ... .. .............. .......... ............ .... 9.48

PATHOLOGICAL EXAMINATIONS

Autopsies.-There were 3 I autopsies performed at the Board of
Health laboratory. The more frequent causes of death were as
follows:
Percent of
Cause of death Cases autopsies
External causes .................................... .... .......................... 44 13.88
Tuberculosis (acute and chronic)..... ............................................... 29 9 14
Organic heart disease (acute and chronic) .............................................. 26 8 20
Pneumonia (broncho and lobar) ................ .................. ......... ......... 25 7.88
Cancer.................................................. ..................... 23 7.25
Syphilis (including 4 general paralysis) ................. ........................ .... 20 6.30
Cerebral hermorrhage...... ....... .........................................14 4.41
Bright's disease (acute and chronic nephritis) ................. ...... ................. 8 2 52

Bodies autopsied.-The annual report for 1930, page 54, contains a
table showing the number of autopsies performed for the years 1904-
1930 in certain diseases that but rarely come to autopsy in this area.
The additions to this table for 1933 were as follows: Yellow fever, 0;
beriberi, 0; ankylostomiasis, 0; tetanus, 0; infectious diseases of
children, 1; plague, 0; smallpox, 0.
Five hundred and two bodies (not including 54 for storage only and
2 disinterred) passed through the laboratory; 317, or 63.14 percent
were autopsied.
There were 27 malaria carriers found at autopsy.
There were 30 cases of syphilis found at autopsy.
Three cases autopsied, or 0.94 percent, showed intestinal parasites.
Ascaris lumbricoides were found in each of the three cases; no search
for ova made.
Laboratory examinations of wild and domestic animals.-Cultures
* from guinea pigs, rabbits, etc., 36; autopsies and histological ex-
aminations of cows, hogs, parrots,. guinea pigs, rabbits, etc., 72;
examinations of rats for plague, 2,855.
Preparation of tissues for examination (slides), 8,864.
Chemical analyses and examinations.-Alcohol, 7; beverages, 16;
analyses of blood (nitrogen, urea, uric acid, creatinin, glucose, calcium,
Carbon dioxide, cholesterol, icterus index, phosphorus, sodium chloride,
etc., 2,311; analyses of foodstuffs, drugs, and chemicals, 616; gastric
:analyses, 532; spinal fluid, 854; drugs, for identification, 23; toxi-
cological examinations, 7; quantitative analyses of urine, 205.







26
4,
In addition to the more highly technical laboratory work ..
the Board of Health laboratory, the various sections of::*-
Hospital have laboratories in which routine clinico-pathologicalwqi
is done. The amount and character of work done by these unitaii*!
be judged from the following summaries of their activities: BIl !1:.
films examined for malaria, 13,898; red cell counts, 7,749; white i,':
counts, 9,127; differential counts, 9,030; coagulation time deterPtitia*"*' r::i .
tion, 18; Van den Berg tests, 45; sickletells, 51; qualitative naly. i :u a ::;
urine, 24,406; phenolsulphonephthalein test urine, 66; urethral smi ar.
107; vaginal smears, 170; prostatic smears, 315; stools for o.vai&.
parasites, 10,182; sputum for tuberculosis, 1,804; cell count spinal fluiily:
274; throat smears, 33; gastric contents for occult blood, 76. "
UNDERTAKING DEPARTMENT
Bodies received (including 2 disinterred and 54 for storage)........................................... S '
Bodies em balm ed ................................................................. ......... .
Bodies crem ated. .. ...... ... ........... ........................ ........................... ..... l :
Bodies buried on Isthm us ......................................................................... .i
Bodies shipped from Isthmus (including 2 disinterred) ............ ........ ... ... ..... ..... ... ..
s ..
Bodies buried at sea.......................................................................... ..

COLON HOSPITAL
(Capacity, 135 beds)
Maj. DEAN F. WINN, Medical Corps, U.S. Army, Superintendent, .
This hospital has continued to function essentially as an emergency
hospital although definitive treatment has been given to a wide range
of cases. Individuals requiring certain special examinations, for which::.;
equipment is inadequate, those with venereal and contagious diseases,
and mental and tuberculosis cases, were transferred to Gorgas Hospital
The utilities department has been active in preserving the appeatl-
ance of buildings and grounds and the upkeep of the various depart-
ments.
New construction.-The new nurses' quarters was completed add
occupied in April. This is a 2-story reinforced concrete building
with tiled roof, located just east of the inain hospital building tiaI-
facing Limon Bay. It affords commodious quarters for 16 nurs I::i::
including a suite of two rooms and bath for the chief nurse, anid '.
common bath and lavatory for each two rooms. On the second 0flSioi
there is an attractive lounge and on the first floor a reception haii:::
parlor and dining room. The kitchen and pantries are equipp iei
but have not yet been used for a separate mess. Bedrooms k:1:id%
living rooms have been equipped with new furniture. 'KI,
In August the old nurses' quarters was remodeled and cccupiei;:t
by the dispensary. The building is detached -from the main hospit ;;al
buildings. It houses the gold and maternity-pediatric clinic, t :i:t



A:.








silver clinic, laboratory, X-ray rooms, emergency dressing room, and
pharmacy. In addition, rooms are provided for the officer of the day,
dispensary office, and for temporary isolation. There are. ample and
Convenient suites of offices, waiting rooms and examining rooms for the
clinics. The laboratory is large and well lighted. The pharmacy
is well arranged and has adequate storage space. The building is so
arranged as to segregate completely white and colored patients.
In August a concrete and wood covered walk was constructed to
connect the new dispensary with the hospital. This has proven a
great advantage during the past rainy season.
In October the lower floor of the west wing of the main hospital
building was remodeled. This section, formerly occupied by the
dispensary, laboratory, X-ray department, and eye, ear, nose and
Throat department, has been converted into a ward containing eight
private rooms and a 6-bed ward. The west end of this section was
utilized for the construction of a suite of rooms for an eye, ear, nose and
throat clinic. An operating room for this department was constructed
by remodeling the existing porte coch6re.
A filing room for storing clinical records, etc., has been equipped
in the service building with steel shelving with a capacity of some
45,000 charts.
The shop and laundry facilities have been enlarged by the con-
struction of a covered area with concrete floor and a large insulated
drying room. This room is heated by an ingenious construction of
the flue leading from the fire box over which emergency laundry is
boiled.. There is no expense for fuel as only waste material, such as
old packing boxes, crates, etc. is used.
Movement of sick.-There were 4,160 admissions during the year with
a total of 31,378 patient days, the average being 7.5 days per patient.
Army personnel accounted for 8,305 patient days. There were 53,612
:' visits to the dispensary, including eye, ear, nose and throat and
surgical clinics, a daily average of 147. There were 19,384 white
Patients and 34,228 colored patients. The average number of beds
occupied daily was 86.
.< ?argical serrice.-There were 481 major operations. Included in
these there were: Appendectomy, 166; hernia repair, 48; hemorrhoid-
Sect.my,;, 4; hepatic abscess, 3; intestinal obstruction, 8; perforated
peptic. ulcer, 5; hysterectomy, 17; cesarean section, 6; uterine sus-
pension, 16; miscellaneous gynecological operations, 79. There were
S|lin2or operations; 177 fractures were treated.
r "i: ~qh0 .of new items of equipment were added. Among these
a :Iw. electric, dressing sterilizer, gas-oxygen anesthesia outfit,
and eIetinc cautery.


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







28 ...

Obstetrical senrice.-There were 368 deliveries during the year.,;
There were 17 sets of twins, 11 forceps deliveries, and 6 cesareat '
sections. An active well-conducted prenatal clinic is maintained.,
Medical service.-The general scope of the work has been satisfactory :.
in both volume and variety. No serious epidemics occurred during;
the year.
Eye, ear, nose and throat service.-This service was established in the
latter part of 1932. It has grown to be one of the largest and most -
important departments of the hospital and has filled a very definite.
need for the population on the Atlantic side of the Isthmus. During -
1933, 1,176 operations were performed; 9,503 treatments were recorded
for hospital patients and 5,713 treatments were given out-patients. *
Refractions numbered 698. The following abbreviated statistical.
report of operations is submitted as an indication of the scope of the.';
work performed: Mastoidectomy, 8; cataract operations, 20; ptery-
gium transplant, 94; trephine, 6; enucleation, 5; foreign body (cornea),
33; plastic of eye, 19; correction of ptosis, 3; correction of squint, 12;
submucous resection, 139; sinusotomy, 40; radical antrum, 7; radical .
frontal, 11; ethmoidectomy, 10; plastic (nose), 8; plastic (ear), 4;
cartilage inlay (face), 1; miscellaneous, 756.
X-ray department.-There were 1,349 examinations made during
the year. New and modern equipment was installed upon completion
of the new dispensary building so that this department is now able
to do a more satisfactory and varied type of work than formerly.
Laboratory.-Only routine work is done, serological and pathological
work being performed by the Board of Health laboratory, Ancon, C.Z.
The laboratory in the new dispensary building is well lighted and
adequate space for expansion is provided.
Dispensary.-The Colon dispensary is conducted as a department
of Colon Hospital. The combined gold and maternity-pediatric
clinic is under the direction of the district physician who is also in
general charge of the entire dispensary. Both white and colored
patients are cared for in this clinic but the hours and waiting and.
examining rooms are so arranged as to segregate the races. The' .;:;:
silver clinic is conducted by members of the hospital staff assigned ,.:
in rotation.
COROZAL HOSPITAL
(Capacity, 550 patients) ..
Maj. F. H. DIXON, Medical Corps, U.S. Army, Superintendent

Purpose.-Until recently this institution served to accommodate the
insane of the Canal Zone and of the Republic of Panama, the latter

:tI.








class of patients being cared for at the expense of the Republic at a
fixed rate of 75 cents per day. However, during June and July of
1933, all of the latter class, totaling 592 patients were transferred
to the Retiro Matias Hernandez, an asylum located on the Sabahas
road about five miles from Panama City, and erected during recent
years for this purpose. American or alien employees of the Panama
Canal, disabled by reason of injuries or chronic diseases, or enfeebled
by advanced age, who desire to enter the institution, are cared for in
Corozal Hospital.
As a result of the exodus of this great number of patients, six of the
old wooden structures were sold and torn down, and all male and
female insane patients consolidated in the new 2-story concrete
building completed in November 1931, while the cripples and chronic
patients are now quartered in the concrete structure formerly used
as a ward for insane women patients. To make these buildings
suitable for this purpose certain alterations were necessary, such as
removal of sliding doors and screens, constructions of new doorways,
installation of handrails along stairways, the erection of new walls and
partitions to separate the male from the female patients, and arranging
space for dining halls. These changes were all made by hospital
personnel under the supervision of the general mechanic. The
concentration of all insane patients in one building promotes efficiency
and also makes it possible to operate with more limited personnel.
At the same time, removal of the six wooden structures which were
no longer needed reduces the cost of maintenance for painting and
repairs. One building, ward "B," also of wood construction, being of
nore recent origin, was retained to provide for emergencies and will
accommodate about 160 patients.
A new cemetery tool shed to replace the old building, which was
too small for present requirements and in bad state of repair, is being
erected by hospital labor under the supervision of the general mechanic,
at an estimated cost of $350. This tool shed is more centrally located
than the old building, since the cemetery area has been enlarged and
new roads constructed in the 40-acre plot recently added. Con-
diderable work remains to be done in connection with the enlargement
of the cemetery, and it will be necessary to relocate the boundary
fence, erect additional gates and construct paths through the new
Section.
Routine, painting and repairs to woodwork, steel doors, window
frames, plumbing, boiler and steam lines, and filling and grading of
hospital grounds, have been performed by hospital artisans with the
help' of patients.







30 lI

Insane patients.-The census on December 31, 1933, was 178, a
compared with 748 at the end of the previous year. The nntuBe:
admitted was 247, as compared with 338 for 1932. There wre :8i
discharges and 3.1 deaths. There were 'no suicides, but one -de aiith'4:"
resulted due to altercation between two patients.
Other patients.-There were, on December 31, 73 black and 6 w ite" ':::i6
chronically ill or crippled inmates (not insane), as compared with 59'
black and 5 white of this class at the beginning of the year. Twet...:
four were carried on the pay rolls, employed as broom-makers, janitor,
and laborers. The broom-makers manufactured approximately 260 .
brooms per week.
Recreation.-Because of the reduction in the number of patients and"
the limited personnel, the weekly moving picture shows were di.-
continued in July 1933. However, band concerts through the courtesy
of the 1lth Engineers Band, Corozal, are provided about every other
week, unless Army maneuvers or other duties prevent. Refreshments.
in the form of candies, cookies, cigarettes, tobacco, etc., are distributed .
among the chronic and insane patients, the latter receiving tbis.0'
distribution in lieu of cash in case they are employed on the patients
pay roll. Church services were conducted once a week for the Cath- I
olic and Protestant patients. However, in view of the limited number
of Catholics remaining since the transfer of patients to Matias Her-
nandez asylum, such services have been discontinued since July 1933.
Treatment.-Intensive specific treatment was given to patients :
suffering from syphilitic psychoses. Three hundred and seventy-
three doses of arsphenamin were administered intravenously, and 219
lumbar punctures were made. At the end of the year there were 29
patients suffering from neuro-syphilis in some form; 25 of these were
males and 4 females.
Occupational therapy.-Because of the transfer of approximately ":
77 percent of our insane patients, the very limited number of remaining
patients and the need for economy, the occupational ward was d4iu.
continued and the services of the female nurse formerly in charg..t .
dispensed with.. .
In addition to the male patients engaged in the occupational ward::.
there were others employed in agricultural activities. The value .. .C'.
the produce taken from the patients' garden for hospital .consumptIop' .
amounted to $1,209. The more vigorous females were assigned to. ",
tasks in the laundry, sewing room, or salvage department. Aa,. ..
result of these various undertakings, between 75 and 80 percent of tit -.:
patients are engaged in some form of work. All of the hospita..'::i
laundering, with the exception of some bed sheets and. pillowca% '
and all of the nurses' uniforms, was done by the patients. ,:

':








Farm.-Repairs to fences were made, and pastures cleared of brush
P- during the dry season by cutting and burning pasture. There were
24 cripples employed on the farm and hospital at the close of the year
as.compared With 22 at the beginning of the year. These men are
employed in the garden, piggery, steam plant, cemetery, etc. Seven
(including two chronic patients) are tending plots of land in the farm
reservation, which they cultivate as gardens andthey are paid on an
actual production basis.
PALO SECO LEPER COLONY
Dr. EZRA HURWITZ, Superintendent
There were 106 patients at the Leper Colony on January 1, 1933.
Seven new cases were admitted, seven patients died during the year;
none were paroled and none absconded. At the close of the year 106
patients remained, 91 for the Republic of Panama and 15 for the Canal
Zone.
: Of the 7 deaths of lepers, all were autopsied at the Board of Health
laboratory and, in accordance with the preference of the Manual of
Joint Causes of Death of the Bureau of the Census, the cause of
death was recorded as leprosy in all cases; the contributing causes of
death .were as follows: One chronic glomerulonephritis; 1 amyloid
disease of the kidneys; 1 abscess, lower lobe, left lung, ruptured into
pleura; 1 pulmonary tuberculosis; tuberculosis of the vertebral column;
I peptic ulcer; perforated duodenum; peritonitis, acute, generalized;
in 2 cases no lesions other than those of leprosy were found.
Intramuscular administration of the iodized esters of Hydnocarpus
uightiana was continued as the routine treatment. Injections were
given twice weekly, and although attendance was not compulsory, all
patients except six reported with regularity for treatment:
In April the Municipal Division completed installation of the water
Sline from Balboa to the colony. The well, which has been the
p principal source of water (highly mineralized), but had never given a
sufficient supply during the dry season, has not been abandoned, but
will be kept in condition for use in emergency.
SIn June, electric equipment consisting of two ranges (replacing
the unsatisfactory oil-burning ranges), one stock pot and one water
Shelter were installed in the kitchen.
i., In July a graded road with a light surface of crushed stone was
""i.eed between Thatcher Highway and Palo Seco; and the launch
Pi:. ::Seco HI which had been used for transportation until then was
!!Eii ed' oer to e the Section of Surveys. The colony was provided
ti..ril:::lb~ance which is adequate for the present needs of the
qF4~lony







32

A number of patients W'ere permitted to visit.relati-es in Paniinl ij:
City, always attended by an officer of the Panama Health office,'ari':~'
one patient, with the permission of the Panamanian authorities: iwa: 's:
permitted to visit her aged mother in Los Santos. .*;:
It would be desirable to separate patients in their quarters accotding*:l
to the severity of infection. Under present conditions this is practiP.::
call impossible, as patients iA the same approximate stage of *: ii
fections are often temperamentally unfit to associate peacefully. ::Idi
planning future building at the colony, arrangement should,.be mhde'
for each patient to be quartered in a separate room.
With profits accruing out of the resale storeroom, the colony ptr-. .
chased a new projector for talking motion pictures. Three motion
picture agencies in Panama (Metro-Goldwyn-Mayer, Paramount, 1
and Radio-Keith-Orpheum) each furnish the colony with one show:
weekly, without charge. The excellent pictures shown have been a.
great source of pleasure and contentment to the patients.
The Palo Seco band received as gifts a saxophone from Mr. Danner,
of the American Mission to Lepers, and a clarinet from Dr. Barbour:
of Boston, Mass. Other donations received, were from Woman's
Auxiliary of Gatun Union Church, $10; Cristobal Women's Club, $5;
and gifts of clothing to each patient .were given through Father.
Lawler of St. Mary's Church.
The allowances made to the patients during the year was 11,896;"
$1,164.33 worth of farm produce was bought from 29 patients; 54:..
patients were employed in the colony and earned $3,110.73.

DIVISION OF SANITATION ,
The end of the dry season of 1933 was notable for an apparently .
unusually large invasion of anopheline mosquitoes into the sanitated
areas, the probable reasons for which have been discussed elsewhere ii
this report. The continued growth and spread of Chara and other'
aquatic plants in Gatun Lake contributed largely to the increase in
the numbers of anophelines. -
In the Rio Grande hydraulic fill west of the Canal near Balboa, I&:..
large drainage channel made in the soft mud by dynamite loweredii:!
the surface of the waters somewhat, but this area cannot be brouighti:,
under satisfactory control until the whole area of more than a squaree' *::
mile is filled to an elevation of several feet higher, or an additional '::
spillway, with its sill at a considerably lower elevation, is built. The!"
Rio Grande fill and spillway at first impounded a large lake of brackish-::':"
water with no outlet at low stages, simulating quite nearly the largij i
brackish swamps of the Atlantic sided and here, for the first time it.'.:.;:,;
*






33

our experience, Anopheles tarsimaculatus was found breeding on the
Pacific side of the Canal Zone. Adults were taken on the screens of
Nearby quarters and at Fort Clayton, two miles away.
The large hydraulic fill in the Thatcher Highway area developed, as
is customary in such fills, myriads of deep cracks during the dry season,
arid when the rains and run-off from the hills had filled these with
water they became prolific in breeding of Anopheles albimanus and
.,Aedes taeniorhynchus larvae. It was necessary on two occasions
S(November 20 and December 21) to dust this fill with paris green
from an airplane.' A five percent mixture of paris green with pulver-
ized clay was sufficient to destroy most of the A nopheles.
It was not necessary to use the airplanes in dusting the swamps at
Old Panama during the rainy season of 1933. Straightening of the
channel of the Rio Matias Hernandez through the western part of the
swamp improved the drainage of this part considerably and the fact
that cattle were not pastured in it as much as usual gave the swamp
vegetation a chance to krow and shade the area. Breeding occurred
only in small patches and was controlled by hand blowers dusting
with a one percent paris green mixture.
The new golf club building in the Sabanas northeast of Panama
City has proved very popular as an evening resort for its members and
guests, therefore it was necessary to improve the drainage of this area
to prevent mosquito breeding. The open streams were trained and
paved with 14-inch wide hemicylindrical precast concrete sections,
4,523 linear feet being so installed. At acute bends the banks of the
streams were rip-rapped with large stones. Also, 903 feet of subsoil
Stile were installed there. The golf club furnished part of the material
and the greater part of the labor for this undertaking.
SExperiments were begun with mechanical and animal traps to
catch adult mosquitoes, but the work has not sufficiently progressed to
"report results as yet.
Malaria surveys of employees of the Canal and contractors engaged
in large Canal undertakings in unsanitated areas were continued
throughout the year. All persons found carrying the plasrfiodia of
Snalaria were treated in an effort to reduce the number of carriers and
': clinical cases. It is believed that the results have justified the effort
i:. and expense.
!; : he enlarged new open grate incinerator at Summit, for the destruc-
;ii.n .of the garbage of Ancon, Balboa, and Panama City, was placed
;in 3o:pere'ation in April 1933. While during the dry season, with brisk
orth ..i s, the.garbage burns almost completely in 24 hours, it was
giwiauqt dusting was necessary on Ja uary 9, 1934

.......
'.ii"i:.: :....." :i ': i iE. ..: .




: L::. ..:!

34, !

found that during the season of rains and variable winds it reqit .
at times, nearly 72 hours for complete incineration. Theref~oreii
incinerator was trebled in size over its first design, allowing -grg:l.
.capacity for 3 days collection in serial order on the grate. "It disp .
of about 300 cubic yards of mixed garbage and rubbish, inclidt
large dead animals, daily. Because of its location in the ope^i til:::.
try 12 miles from Panama, the smoke.causes little or no nuisait&i.l:
The garbage is unloaded from a ramp near the city by motor d~. i
trucks, into chain cradles in specially constructed steel railroadt"'1 4
and hauled to the grate by rail. It is unloaded from the cars by...
crawler type tractor drawing out the chain cradles and emptying then.
on the grate, 15 to 20 cubic yards at a pull.
The grates of the incinerator are constructed of old railroad rails;
cut in half-lengths, and no trouble has been experienced from bucdift
of the rails as no fire or accumulation of ashes is permitted beneath;theb
grates. Comparatively very little fuel is used to burn the garbage.
The fires are started by small piles of scrap'wood, old railroad ti;,:
and rubber tires laid at intervals on the grates before the garbageis.
placed upon it. Once started, the fires burn through the. pile, within "a'
single stoker on hand to keep pulling unburned garbage over into 6thi.
burning piles. Wet manure from dairy and horse barns proved most
difficult to burn, the principal feed here, even in city stables, being....
green grass brought in from the country. This difficulty was o'v`',::..
come by dumping all manure into the sea, over a high sea wall, where
the tides effectually dispose of it without nuisance,
Notwithstanding that the breeding of various species of flies ap-
parently was under'careful control.at the garbage disposal dump in,
Panama City during the last three years of its operation, the change in
method of disposal-discontinuance of disposal dump and removal iof
all garbage from the city and its incineration at Summit-has resulted-
in a still further reduction in number of flies in Panama, more partie..-
larly those species which breed in decaying animal matter. :.
(See pages 18 to 21 for additional information on anti-malaria- wok

REPORT OF THE HEALTH OFFICER-PANAMA' :i..
Dr. JESSIE L. BYRD, Health Officer '
Dairy farm inspections.-All dairy cattle are tested 'once a yeai rf
T.B. reactors; any reactors found are either slaughtered or isolat
from the dairy herds. Three thousand one hundred fifty-two. dairyf
cattle were tested for T.B. during 1933, the intradermal test bfein:i'
used, and 264 reacted positively to the test. Ninety-one of th
'








actors were from two farms, the owners of which have never given
this department any cooperation in the prompt handling or disposal
of their reactors. .The other 18 dairy farms are practically free from
:.: T,.B. at present. All dairymen are improving their stock by the
importation of pure-blooded Holstein, Guernsey or Jersey cattle, and
by crossing them with the native stock. Most of the dairy farms now
have dipping vats and their cattle are almost free from ticks.
Milk inspection.-This work starts at the dairy farms, where the
inspector makes frequent checks on the sanitation of equipment,
methods of handling, technique of milking, etc. He collects samples
at the dairy, at the pasteurization plant, in stores and from delivery
trucks. All milk sold retail in Panama is pasteurized and bottled at
one of 4 pasteurization plants. While the consumption of fresh milk
in Panama City is increasing, and will, no doubt, continue to increase
somewhat, it is my opinion that fresh milk will never become a national
drink or food here to the extent that it is in other countries. The
present supply (about 1,300 gallons per day) is more than adequate
to supply the demand (about 5,500 bottles or 1,100 gallons). Only
about five percent of the population can afford to purchase fresh
milk and have iceboxes or refrigerators in which to keep it. Milk
-usually is sold in bottles containing one-fifth of a gallon. The present
retail price is 15 cents a fifth-bottle (75 cents a gallon). Five years
ago the the retail price was $1 a gallon. The fresh milk on sale in
Panama City is considered grade "A" pasteurized milk. However,
there are one or two dairy farms which could improve their product
and they*will no doubt do so when the new milk ordinance goes into
effect. It will allow us to grade raw as well as pasteurized milk, and
in that way will prevent the mixture of good and poor grade milk as
sometimes happens now.
;::Public health.-There have been no epidemics during the year. The
communicable disease rate remains about the same as last year, except
for amebic dysentery which shows a great increase during the past
seven months as shown by the following number of cases reported:
June, 14; July, 11; August, 26; September, 23; October, 25; November,
"41; December, 58.
The reason for this sudden increase in amebic dysentery is unknown,
but is probably due to better reporting on the part of Santo Tomas
Hospital physicians. The infection in more than two-thirds of these
i.t.as.e was.definitely traced to places in the interior of Panama, where
.*Mtajority of the patients resided. The deaths of residents of Panama
so::. !amiebic dysentery have been as follows for the past five years:
i;:, i930Q, 1; 1931, 3; 1932, 2; 1933, 9.
i .. :. : '....

D1:11aF"i I.t.
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M'i',:. .Er:':' .: .: '":::::: E. :: a : "it'." .';' ..::, .,,







36

Garbage collection and disposal, and street cleaning.-
tollected nightly in Panama City, Ancon, Balboa, and Alb ikA
an area of three square miles, and a population of appr
91,500 people, with the following equipment and force: Oneasil1
inspector (American); 2 foremen; 30 laborers; 7. trucksof itpti.
(one of which collects rubbish and manure during the day:) i
average a little more than 8 loads daily.
The following shows the gross cost of garbage collection, andi
posal of garbage and rubbish from Panama City, Ancon, Bab.8 u
Albrook Field, and Fort Amador, and of street cleaning in Panarnzti
during the year. The tonnage shown is considered fairly acurM
and was arrived at by the actual measurement of the trucks wjlh -ji
without top-load. The six night trucks average three cubic yard
without built-up sides and without top-load, and five and omejp
cubic yards each. with built-up sides and top-load. These Asp"l
check almost exactly with the yardage of the garbage cars whbid
known to be 75 cubic yards each. Three cubic yards are fipure4d
weighing one ton:
Garbage and rubbish collection, Panama City: ..K.4
Collected by Health Department -------------------tons ."29,41
Cost of collection-
Total.-----.------- -------------------------- 10010M39
Per ton ---------------------------------------- -------_ _
Per capital (79,000 population). ---------- .-- ------ -
Garbage collection, A ncon, Balboa, Quarry Heights, Albrook Field: (Rubbish n hig
places not collected by Health Department):
Collected by Health Department-------------------------tons-.. 64
Cost of collection-
Total_------------.---------------. ----------------- A16,3S
Per ton ----------------------- ------------------ --
Per capital (10,700)------------- ------------------------, fi t
Garbage disposal, Panama City, Ancon, Balboa, Quarry Heights, Albrook .Rdil#iu
.A mador:
Collected by Health Department-------------------------tons- 3
Delivered to railroad garbage cars by others ----------- -- tons -
Total garbage disposed of------------------------ --ton!s-, i
Cost of disposal-
Total.------.--.--_--_----------------- ------------ $252367
Per ton ----------- ---------------------- ----r------ --tf
^er capital (91,500 population)__ _......------------- ..
Rubbish disposal, Panama City, Ancon, Balboa:
Manure dumped over sea wall (October to December) ---ton
Delivered at dump by Health Department-- --------...----tons-
Delivered at dump by others ---.---,--t ---.-.. -tons 1
Total-------------- -- --------------- ------------tonsf.f Sl

.. .. ..

I.. .
I:*.* :-* .r -.




g :. .......


S. 37
*:". Ci::ty ... ;
: 1 tosa, Pana*a City, A con, Balboa-continued:
.Cost of disposal (salary of one man arid maintenance of road)-
S : tal --.--.-------------------------------------------- $988.00
"ii Per ton_.-------------- -- -- ------------------------- 07
I,: Per capital (88,700 population) ---------------------------- .01
b' STREET CLEANING-PANAMA
,l Total co .of street cleaning ------------------------------------- $22,771.63
I0 'Otf t street cleaning per capital (79,000). --------------------- .29
"'::n April 1933, the enlarged open-grate incinerator at Summit was
:;;t into operation, and since then all garbage from the Pacific terminus
hak been disposed of there; also, all manure from the city of Panama
rw*as'isposed of there from April until October 1933, since which time
i?: has been dumped over the sea wall on the edge of Panama City,
without creating a nuisance.
: The tow cost of collecting garbage is due to the system in effect.
which may be described briefly, as follows: The laborers are divided
into what is known here as pullerss or players," loaders and replacers.
The puller precedes the. trucks by about two hours in residential
districts and collects the garbage from each household can, placing it
into a large galvanized tub; when the tub is full he empties it into a
S.regulation garbage can and places the full can alongside the street.
,..he truck hs a driver and three loaders; two of the loaders ride on the
'-.unning board of the truck and when the truck stops for a can there
i;1is.no delay; the can is passed quickly to the loader on the truck who
empties it and passes it back, all in one motion. In the business and
i. tenement sections the pullers precede the trucks only about 30 minutes
.!: ;p ope hour so that cans will not remain on sidewalks to be upset by
iil.schievous boys and by dogs. This method permits rapid loading and
~*di uces truck hours to the minimum. The average round-trip time
Pe truck in the residential districts of Ancon and Balboa is about 60
iiu:ainutes; this-time is reduced to 50 minutes in Panama City where the
uilasity of population is much greater.

lPO$RT OF THE HEALTH OFFICER-CRISTOBAL-COLON
Dr. JESSE C. ELLINGTON, Health Officer
!emra k.-There were no epidemics during the year and the com-
ble. disease report. compares favorably with reports for previous
The general death rate of 16.27 is only slightly higher than the
average. The infant mortality rate of 114.96 is much higher
tI"rate for 1932, but only slightly higher than the average for
p.. 1927-1931. The infant mortality rate andthe tuber-
-trate of 3.5 no doubt reflect the poor economic conditions
.. t ..' .. ... ..
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fMt. Hope cemetery.-One thousand forty (1,040) square "yar
new road were constructed in the cemetery during the year by M 4
ipal Engineering Division forces, which greatly facilitates thrhi
dling of funeral processions. There were 493 burials, the recSi
amounting to $3,413. Miscellaneous receipts amounted to .$2i'2,.:
Street cleaning, garbage collection and disposal.-No changes wete
made in the methods of handling this work and the results wen
entirely satisfactory. Burning and burying of garbage and rubittWI
at the dump was carried out without fly breeding or other sanitary
nuisances.
i: .' '
Garbage and rubbish collection, Colon:
Collected by Health Department------------------------- tons-- 17,916
Cost of collection-
Total.--.-------.-------- ---------_ _----_ _----------_ $26,0304.
Per ton --------------------------------------- --- ------
Per capita'(30,000 population) ---------------------------------.

Garbage collection, Cristobal and Mount Hope: ..c





"." ." .
Garbage disposal, Colon, Cristobal, Mount Hope, France Field:
Delivered by Health Department ----------------------- tons- 18 107




Delivered by others-----------------------------------tons.. 254

Total---------------------------------------------tons.. 18,3f1
Cost of disposal-
Total_ ---------------------------___---------------- 11,57.4 i
Per ton -------------------------------- ----.--------- .3
Per capital (37,047 population).... ---------. -- -----

Rubbish disposal, Colon, Cristobal, and Mount Hope:, F ce Fel:
Delivered by Health Department---------------------- tons-. 2,8





Delivered by others----------------------------------- -tons 3,8
.'. ----










Total ----------------------------_ _------------ tons.. 6,628'
Cost of disposal-
Total .-----------------.--.----------------------,5---- $6500
Per ton --------------- ---------------------------.----
Per capital (36,247 population)--------.. ------.... ---- ---- -- -i

ureebb disposal, Colon ( not including New CriMtobal): ...."'.'
Delivered by Health Department .....-----------------..... ........... -, .
Delivered by others ---- ---- ---- ----- ---- )_---- _tons_- .



Total cost$---- -------------------- ---------t 6,.."
Per ton s,-etp------------------------------------
Per capital (36,247 population) J--.---------------

Street cleaning, Colon (not including New CriMtobal): ": ,: ..
Total cost------ ---------'-----
Cost of street cleaning per capital (28,000 population) ------- -.----.,









I ; Free clinic-Following is report of cases treated and other work
Done during the year:
Eye, ear, nose and throat (clinic visits) ---------------------------- 506
Prenatal and postnatal (clinic visits)_--. ---.----_------------ ---- 1,897
Babies (clinic visits) ----------------------------------------...... 2,230 .
Dental (referred to Dr. Doten) -----------------..----------------- 20
Formulae prepared---------------------------------------------- 8,741
Medical and surgical (clinic visits). -------------------------------- 131
Referred to hospitals ---------------------------------- -------- 125
Other work by district nurse:
Home visits ----------------------------.-- ----..-------------. 2,973
Vaccinations-----------------------------.------------------ ---- 3,109
Specimens to laboratory ------------------------------------------ 454
Mosquito and rat work.-Very few mosquito complaints were regis-
tered during the year, except during seasonal flights from points out-
side the city. Daily catches were made as an index.
Rat catching to serve as an index was also carried out throughout
the year and 4,704 traps were set, 1,152 rats caught, and 386 rats sent
to the laboratory for examination.
Inspection of food establishments.-Two hundred ard three permits
were issued to restaurants, hotels, dairies, milk plants, bottling plants,
soft drink places, etc., and 48 permits were subsequently canceled due
*to establishments going out of business. Inspections were made as
follows: Bakeries, 666; dairies, 196; milk plants, 421; bottling plants,
355; markets, 1,466; ice cream plants, 357; restaurants, 2,233;
soft drink places, 2,119. Samples of soft drinks, milk, ice cream,
caustic solutions and foodstuffs to the number of 592 were sent to the
laboratory.
Dairies were maintained in good condition and 1,979 cattle were
tested for tuberculosis. Five reactors were slaughtered.
Animal quarantine inspections.-Inspections were made as follows:
Cattle, 186; mules, 120; horses, 58; dogs, 18; monkeys, 15; guinea
pigs, 10; circus animals, 10; miscellaneous, 21.

REPORT OF THE DIVISION OF QUARANTINE AND
IMMIGRATION

Dr. CHARLES V. AKIN, Surgeon, U.S.P.H.S., Chief Quarantine Officer

The activities of the division show an increase over the year 1932,
most of the increase taking place during the closing months of the year.
No significant changes in quarantine procedure took place, but the
.:;closing month of 1933 saw a general tightening up in immigration
I;equiiireinents. Every effort will be made in the future to restrict




t.. "
' ..4 :"
I ".








40


admissions to the Canal Zone and to the Republic of Panamai: ti
such persons as give every guarantee that they will not become.pi*. 4
charges.
In addition to the duties incident to quarantine and immigr
procedure the Chief Quarantine Officer is assisting in reviszm %
sanitary code for the cities of Panama and Colon and in prozt
personal hygiene activities among the civilian employees of the.':
with particular reference to school groups.
The Chief Quarantine Officer also acts for the United States i
Health Service as medical officer in charge of medical rpliei
merchant seamen and other beneficiaries of the service. ,
The following table summarizes the activities for the year;.. .

Balboa Cristabel T


Vessels boarded and passed ....................... ............
Vessels granted pratique by radio.........................................
Total ..............................................................
Crew passed for quarantine...............................................
Passengers passed for quarantine...................................... ....
T total ................. ... ............................... ...........
Airplanes inspected and passed............................................
Crew of airplanes inspected and passed. ................. .................
Passengers of airplanes inspected and passed...............................
Total .................................................
Vessels detained in quarantine................... ..... ...... ..........
Crew and passengers detained aboard ship for quarantine ....................
Persons admitted to station on account immigration laws.....................
Number of detention days for the year..................................
Persons held for investigation and released...................................
Persons deported under immigration laws...................................
Supplementary sanitary inspection of vessels ................................
Vessels fumigated. ................. .........................
Box ears fumigated.......................................................
Deratization exemption inspections................... ..........
Revenues
Subsistenee........................... .... .... ... .......................
Night boarding of vessels....... .........................................
Fumigation of vessels...................................................
Fumigation of box cars...................................................
Deratisation exemption inspections ..................................... ...
Rations issued ...........................................................
Rats recovered after fumigation of vessels..................................


Numb
Averaj
Averaj


2,426
30
2,462
123,571
37,077
160,648
30


5 ,
.

4`01i
47 A 8

~.,8 ;


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i"


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129 3.331 8
2 2 ........... ,
735 .......... 3 :
985 ..........
5,698 .......... ..; .
8 42 S
438 490
745 2.740 ", i.
13 26 3.
91 34 12t
6 4 i. 4
$8,849.45 .......... ss, AtL:
2,550.00 3,850.00 6.40
890.50 1,205.10 2.SS
106.21 48.25 1
120.00 60.00 17aIfl


10,978 .........


*t[


REPORT OF THE DISTRICT NURSE FOR THE

PACIFIC DISTRICT ::

er of baby clinics maintained--.---------------------------- :.
ge number of babies enrolled per month-.--..------,---------,--
ge number ot babies visiting clinics per month -------------.---

U. ., : l
... ...., .



....... .. ....
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41

.Tntoal numbrier of visits to clinics -- ---------------------------- 4,553
Sta~ber of visits to cases of tuberculosis --------------------------- 56
iotal number of house visits ------------------------------------- 960

'. Rid Cross home hygiene classes were continued weekly at La.
Soc. a and Red Tank until the course was finished. At La Boca, 15
i" girls took the final test on April 27, and 14 received certificates from
Wi shington on June 24. At Red Tank, 11 girls took the final test
Son June 30, and 7 received certificates on August 18 from Washington.
The district nurse assisted with the examination.of school children
on the Pacific side, and with the tubeiculin tests which were started
late in the year and are still underway.
In December the baby clinic at Ancon was temporarily discontinued
and a baby clinic started at the Panama Health Office, Panama City,
Sat the request of the mothers in Panama who had been coming to
Ancon.









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GENERAL TABLES


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

ABSOLUTE NUMBERS
A


Year 1933:
White.............
Black.................

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

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


3,244
9,100

12,344

3.387
9.234

12,621


Discharges from and
deaths in hospitals


E-

1,153
1,873

3,026

1,113
1,821

2,934


1,070
1,593

2,663

1,050
1,583

2,633


83
280

363

63
238

301


ANNUAL RATE PER 1,000 EMPLOYEES


Year 1933:
White................. ........ 355.43 329.84 25.59 4.93 4.62 .31 ........ 19.49
Black................. ........ 205.93 175.16 30.77 10.00 9.01 .99 ........ 16.57

Total.................... 245.14 215.73 29.41 8.67 7.86 81 ........ 17.33
Tear 1982:
White................. ........ 328.61 310.01 18.60 5.02 4.43 .59 ........ 17.06
Black...................... 197.21 171.43 25.77 10 40 9 42 .98 ........ 17.06

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


. '*


Total deaths


is


5 -





23,072
55,026

78,098

21.151
57,666

78,817


I
-d



1
9

10

2
9

11


.5


15
82

97

15
87

102


E-

16
91

107

17
96

113


-C.

0


. 4


63.21
150 76

213.97

57 79
157.56

215.35


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46 ,' .


TABLE 3.-DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND TE CITI8 OPF
PANAMA AND COLON *
a':"i


Place



Year 1933:
Panama ................
Colon. ....... .. ..
Canal Zone ............

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

Year 1932:
Panama... .. ....
Colon...... ............
Canal Zone..............


Popula-
tion



79.000
30,000
42,851


Deaths
. ,


Total


1,181
488
305


Disease


1,130
469
271


External
causes


51
19
34


Annual rate n 1,000 ::'
populatd on


Total


14.95
16.27
7.12


Disease


14.30
15.63
6.32


151,851 1.974 1,870 104 13.00 12.31 1


77,500
30,000
42,070


1,232
433
307


Total .............. 149,570 1.972


1,171
405
272

1,848


61
28
35

124


15.90
14.43
7.30

13.18


15.11
13.50
6.47

12.35


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TABLE 6.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES,. 1l.


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

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


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Tan. 9.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED AND AVERAGE NUMBER IN
HOSPITAL EAGH DAY OFJTHE VARIOUS CLASSES OF PATIENTS, 193.

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


Garga Hospital:
Employees ......... ..........
Army............. ......
Navy ........................
Panamanian Government ........
Charity ......................
All others .......................


8,090
48,690
1,539
4
5,248
11,895


3,423

5
2,306
10,436


19,603

56
6,257
31,740


Total.................... 75,466 16,170 57,656


Corosal Hospital:
Employees....................
Army .................. .....
Navy ........................
Panamanian Government........
Charity .......... ...........
All others ....................
Total.....................
Cripples. ...... ..... .......
Chronic, medicalandurgical cases..
Colon Hospital:
Employees.................
Army.............. .....
Charity .......................
All others ...................
Total .....................
Palo Seco Leper Colony:
Panamanian Government........
Canal Zone Government........


226
3,059
6
675
2,136
6,102



864
8,197
738
3,101
12,900


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


Total by classes:
Employees....................
Arm y............... .........
Navy........... -.........
Panamanian Government........
Canal Zone Government, charity,
cripples and chronics........
All others...................
Grand total..............


9,180
59,946
1,545
4

6,661
17,132


197

17,077
4,190
6,591
28,055
1,095
1,836

25

288
1,751
2,064


9,355


90,327i
9,335
29,239
138,256
7,118
23,647

3,834
2,441
10,139


16.414 31,378


1,460 26,757
182 6,023


31,116
48,690
1,539
65
13,811
54,071
149,292

9,778
3,059
6
107,404
14,200
37,966
172,413
8,213
25,483

4,723
8,197
3,467
14,991


22.16
133.40
4.22
.01
14 38
32.59
206.76

62
8.38
.01
1.85
5.85
16.72



2.37
22.46
2 02
8.50
35.34


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6,205 .......


1,642 32,780 34,422


3,645

18,542
9,897
18,778


32,792

117,140
54,821
71,118


45,617
59,946
1,545
135,686
71,379
107,028


25.15
164.24
4.23

18.25
46.94


94,468 50,862 275,871 421.201 258.82


9.38

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6.32
28.59
44.30

.54

46.79
11.48
18.06
76.86
3.00
5.03

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.79
4.80
5.65

4.00
.50

4.50

9.99

50.80
27.12
51.45


53.71

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17.14
86.96
157.96

25.63

247.47
25.58
80.11
378.78
19.50
64.79

10.50
6.69
27.78
44.97

73.31
16.50
89.81

89.84

320.93
150.19
194.84


139.35 1 755.81


85.25
133.40
4.22 H
18
37.84
148.14

409 02

26.79
8.38
.01
294 26
38.90
104 02
472.36
22.50
69 82

12.94
22.46
9.50
41.07
85.97

77.31
17 00
94.31


124.98
164.24
4.23
371.74
195.56
293.23


1,153.97 '


TAsla 10.-CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1933

All classes of patients White Black Total

Admissions to hospitals, excluding Corosal farm (cripples and chronic ward)..... 9,189 6,855 16,044
Admissions of employees to quarters....................................... 3,646 3,882 7,528
Total admissions to hospitals and quarters............................ 12,835 10,737 23,572
Lea number of patients transferred between hospitals and from quarters to hos-
pitale, whose admissions are duplicated in the above figures ................ 250 338 588
Net admissions to hospitals and quarters. .......... ............ 12,585 10,399 22,984

Employes only
Employees admitted to hospitals........................................... 1,171 1,960 3,131
Employees admitted to quarters .......................................... 3,646 3,882 7,528
S Total admiione of employees........................................... .4,817 5,842 10,659

Cli mber transferred between hospitals and from quarters to hospitals, whose
S dmis ns are duplicated in the above figures ........................... 55 174 229

*. etadnimioMa of employees..................................... 4,762 5,668 10,430
S adiionratepr ,000employees to hospitlsand quarters.............. 1,467.94 622.86 844.94





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TABLE 11.--REPORT OF DWPENSARIES, 1933 8


EMPLOYEES TREATED IN QUBTBRS


SDispensary

I X4`


Remaining
January 1,
1933

White Black


Admit


Whe# ]


Ancon ........ 1 13 764 1
Balboa .. 3 1,516
Pedro Miguel....... ....... 342
Gatun.......... I .. : 139
Colon................... 8 26 874 1
Madden Dam.......... ...... 1 11

Total............... 15 43 3P646 3


Dispensary furnishing treatment


ted Died Discharged Transferred Deatembe : :
-- ----- ----- --- -- ---- "-;
31,, 1983i nl

Black Wlite Black White Black White Black White B] ikl

3 ...... ...... 735 1,140 29 62 '1 .g
771 .... ...... 519 774 ...... 2
450 ........... 342 446 ...... ...
226 ...... ...... 135 218 5 7 .....:
,124 ...... ...... 881 1,130 ............ .1
118 ...... .... 11 111 ..... 8 .

,882 ..... ...... 3,623 3,819 34 80 1 i.

Average number torqs.tt m
Days treatment furnished in qartes p ar .i;


S White Black Total White Black Tota


Ancon............................................. 1,851 5,930 7,781 5.07 10.25 .21,1
Balboa. ...................................... 4,9271 4,7151 9,643 13.50 12.92 4A. 4:
Pedro Miguel.................................... 9834 1,6771 2,661 2.69 4.60 7.29 0
Gatun.................. .... ................... 275' *1,0501 1,326 .75 2.88 3.& i
Colon................ ....... .... ... .......... 3,1401 10,0251 13,166 8.60 27.47 36s. :
Madden Dam............ ........................ 16 427 443 .04 1.17 1.21

Total..................................... 11,194 23,826 35,020 30.67 65.28 85.,9


ALL CASES TREATED


J.:

"..i
I'.i


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

Aneon.................... 7,222 17,204 24,426 7,217 16,138 23,355 14,439 33,342 47,781
Balboa.... ..............11,493 15,044 26,537 16,089 13,575 29,664 27,582 28,619 5,201:
PedroMiguel............. 3,826 7,898 11,724 6,509 15,999 22.508 '10,335 23,897 34,232
Gatun.................. 3,098 6,786 9,884 4,040 8,221 12,261 7,138 15,007 22,14.
Colon.................... 5,812 14,789 20,601 13,258 19,439 32,697 19,070 34,228 83;29
Madden Dam.............. '3,949 '6,926 10,875 31,208 '2,509 3,717 5,157 9,471 14.628 i
Total................. 35,400 68,647 104,047 48,321 75,881 124,202 83,721 144,564 228,:$5

I Includes 3,330 contractors' employees. Includes 4,897 contractors' employees. a Includes 1,043 members jF
families of contractors' employees. 4 Includes 2,093 members of families of contractors' employees.

TABLE 12.-AVERAGE NUMBER OF DAYS IN HOSPITAL AND QUARTERS FOR EACH ADMISSION
EMPLOYEES ONLY, 1933

White Black Total

Hospitals:
Gorgas................................. ................... ... 10.88 18.93 .5 ::
Colon ..................... ......................................... 6.59 9.13 8.51 I.

Average for hospitals............................................. 10.33 16.72 14.,:1j .

Quarters: r. '
Ancon ....... ........... ............ ..................... 2.52 5.24 At
Balboa.. ...................... ....... .......................... 3.25. .12 ,
Pedro Miguel. ................. .............................. 2.88 3.75 :8a. 0
Gatun....................................................... .06 4.80
Colon.................... ... .. ............................ .... 3.59 8.92
Madden Dam................................................ ....... 1.45 8.88 .

Average for quarters. .......................................... 3.10. 6.7 .4
"- __....._"__:_:" "--- ....


MR 39231-Panama Canal-&-21-34-1,000






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