Citation
Report of the Health Department of the Panama Canal

Material Information

Title:
Report of the Health Department of the Panama Canal
Creator:
Canal Zone -- Health Dept
Isthmian Canal Commission (U.S.)
Place of Publication:
Washington, D.C.
Publisher:
U.S. G.P.O.
Creation Date:
December 1917
Frequency:
quarterly[1918-Mar. 1919]
Monthly[ FORMER <Nov. 1904>-1917]
quarterly
regular
Language:
English
Physical Description:
v. : ; 20 cm.

Subjects

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

Notes

Issuing Body:
Reports for <Nov. 1904>-Mar. 1914 issued by the Isthmian Canal Commission.

Record Information

Source Institution:
University of Florida
Holding Location:
Centers of Excellence at UF
Rights Management:
This item is a work of the U.S. federal government and not protected by copyright pursuant to 17 U.S.C. §105.
Resource Identifier:
29940569 ( OCLC )
ocm29940569
25402441 ( ALEPH )
Classification:
W 79. 12/5 ( sudocs )

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REPORT OF THE ALTH DEPARTMENT OF THE PANAMA CANAL FOR THE MONTH OF DECEMBER, 1917 ALBERT E. TRUBY, ri4. Colonel, Medical Corps, United States Army Chief Health Officer, Balboa Heights, Canal Zone WASHINGTbN 1,38

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N *N aa A& A.vA *n CE V "OL aZ

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VV CONTENTS. Page. Letter of transm ittal .:. .-. 5 Ge.nera emarks.m. 5 Vita1 statistics: Health of employees.------------------------------------------5 Health of residents of the Canal Zone. 6 Health of residents of the city of Panama.---------------------------7 Health of residents of the city of Colon. -----------------------. 7 Hospital division: Ancon Hospital----------. -------------------------------8 Corozal Hospital. ........------------------------------------------9 -Board of Health Laboratory. ...--------------------------------9 Chronic ward.--.----------9 Dolon Hospital .9 ~o~ou ospita-----------------------------------------------9 Palo Seco Leper Asylum.-.--. -. 9 Santo Tomas Hospital. ------------------9 Division of Sanitation: Canaj Zone. -------------------------------------10 -P am------------------------------------------------11 C o a n aL ............................................-...................1 2 Colon. .-------------------------------12 Quarantine division-.--.-.-...--------------13 Ststical tables: Table I. Admissions, deaths, and noneffective rates for employees; deaths of residents of Panama, Colon, and the Canal Zone. 14 IL Causes of deaths of infants by sex, color, age, and place of residence. 16 III. Deaths by nationality .18 IV. Birth and infant mortality rates in the Canal Zone and the cities of Panama and Colon. 18 V. Causes of deaths of employees arranged with reference to age and length of residence on isthmus .20 VI. Causes of deaths of civil population (employees and nonemployees) and military by sex, color, age; and residence.-. 22 VII. Discharges and deaths in the hospitals of the Panama Canal. 28 VIII. Consolidated hospital report. 40 IX. Consolidated dispensary report. Report of contagious dis-. eases. 42 X. Employees constantly sick and noneffective rates per 1,000. 44 Number of days treatment per admission, hospitals and quarters .--44 XI. Deaths of white Americans connected with the Panama Canal. --------------------------45 XI. Financial statement. 45 XIIL. Anon Hospital. 46 XIV. Colon Hospital. 50 XV. Santo Tomas Hospital. 51 XVI. Sanitary work done in the Canal Zone, Panama, and Colon. 55 XmLQarnie rascions .ii.w. 55 XVII. Quarantine transaction--------------5 XVIII. Personnel report.-----------------------57 -(3) MV -:M i

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A eA aA
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A 'A 9N. LETTER OF TRANSMITTAL. THE PANAMA CANAL, HEALTH DEPARTMENT, Balboa Heights, Canal Zone, January 11, 1918. HonI RNK FEUILLE, Ating Governor of the Panama Canal, Sxg: I have the honor to submit the following report of the operalions of the Health Department for the month of December, 1917. Respectfully, ALBERT E. TRUBY, Chief Health Officer. GENERAL REMARKS. The health of employees and nonemployees in the Canal Zone and -cities has continued good. The increased number of cases during the month of December, as well as during the other .pnth of 1917, as compared with the same months of 1916, was due entirely to the camps established by the supply department in pastures; this work has been very extensive throughout the Zpne, and the camps have been situated far from sanitated areas. actual number of malaria cases in December among employees She sanitated areas was lower this year than for any previous No diseases of a quarantinable nature originated on or were brought t% Ae Isthmus during the month. VITAL STATISTICS. EMPLOYEES. The'loilowing statistics are based upon the total number of names on the pay rolls of The Panama Canal and the Panama Company for the preceding month, -which was 29,685. (5) ..

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6 Admissions to hospitals and quarters numbered 781, gi a of 315.71,1 as compared with 401.65 for the preceding m, 327.91 for the corresponding month of last year. The constantly noneffective rate was 9.30, as compared with of 10.47 for the preceding month, and 8.86 for the co n month of last year. Deaths from all causes numbered 19; of these, 14 were from giving a rate of 5.66 from disease alone, as compared with a rate 4.42 for the preceding month, and 5.94 for the corresponding m of last year. Diseases causing the highest admission rates to hospitals, inh order of their numerical importance, were: (1) Venereal d (2) malaria, (3) tuberculosis, (4) bronchitis, and (5) lymphade These five diseases caused 34 per cent of all admissions to hosp veneral diseases alone causing 14 per cent and malaria 11 per cent all admissions. The admission rate for malaria, hospitals, and quarters, was 16.1, as compared with 21.31 for the preceding month, and 8.39 fr th corresponding month of last year. The constantly noneffective r from malaria was 0.63, as compared with 0.67 for the preceding month, and 0.28 for the corresponding month of last year. By race: For disease only, the admission rate to hospitals and t death rate for white employees were 218.63 and 0.00, respectively as compared with 262.95 and 4.92 for the preceding month, an 253.70 and 5.07 for the corresponding month of last year. For b employees, for disease only, the admission rate to hospital and death rate were 95.32 and 6.77, respectively, as compared With 115.84 and 4.33 for the preceding month, and 66.49 and 6.08 for th corresponding month of last year. The constantly noneffective rates were 15.62 for whites and 8. for blacks. The admission rate to hospitals and quarters for malaria was 9. for white and 17.42 for colored employees, as compared -with 24 for white and 20.67 for colored employees for the preceding mn and 22.83 for white and 6.08 for colored employees for the spending month of last year. For American employees, the admission rate to hospitals f disease only was 164.19, as compared with 259.37 for the precedg month. CANAL ZONE. The civilian population of the Canal Zone, based on the census taken as of June 10-30, 1917, is 24,038. From this pop 16 deaths occurred during the month, 13 of which were from giving a rate of 6.49 from disease alone as compared with 9.98 preceding month and 8.12 for the corresponding month of iasy Of the deaths from disease 38 per cent occurred among under 5 years of age as compared with 25 per cent for last 'Fifty-nine births were reported during the mouth, giving a of 29.45; of these births 18 were white and 41 colored. 'All morbidity and mortality rates are computed as equivalent annual

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A Z7 Two deaths occurred among children under 1 year of age, both ed, giving an infant mortality rate, based on the number of birtbs reported for the month, of 0.00 for white and 49 for colored children, with a general average of 39.90 per 1,000 births. Of the total births reported 3 per cent were stillbirths. PANAMA CITY. The population of the city, as shown by the Health Department census of June, 1917, is 61,369. In this population is included approximately 8,000 employees of The Panama Canal. From this population 136 deaths occurred during the month, 131 of which were from disease,-giving a rate of 25.61 from disease alone, as compared with 29.13 for the preceding month and 28.83 for the corresponding month of last year. Of the total deaths from disease 46 per cent occurred among .children under 5 years of age as compared with 50 per cent for the preceding month. The principal causes of death as compared with last month were as follows: NovemDecemher. ber. Tuberculosis (various organs).-----------------------------21 28 Diarrhea and enteritis. .----------------------------------32 19 Organi diseases of the heart. ..------------------------------11 15 Two hundred and forty-seven births were reported during the month, giving a rate of 48.30. Fifty deaths-occurred among children under 1 year of age, giving an infant mortality rate, based on the m7ber of births reported for the month, of 202.43. Of the total births reported 6 per cent were stillbirths. COLON. The. population of Colon, as shown by the Health Department census of June, 1917, is 26,078. In this number is included approximately 7,000 employees of The Panama Canal. From this population 66 deaths occurred during the month, 64 of which were from disease, giving a rate of 29.45 from disease alone as compared with 2:.93 for the preceding month and 25.76 for the corresponding uonth of last year. Qf the total deaths from disease 42 per cent occurred among clildren under 5 years of age as compared with 50 per cent for the ceding month.

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8 The principal causes of death, as compared with the.',, month, were as follows: NovemDcm ber. Tuberculosis (various organs). 13 Diarrhea and enteritis-. M5 Pneumonia (including broncho). -----------------------------8. Ninety-four births were reported during the month, giving a of 43.26. Nineteen deaths occurred among children under y of age, giving an infant mortality rate, based on the number of b reported for the month, of 202.13. Of the total births reported 2 per cent were stillbirths. DivisioN OF HOSPITALS. ANCON HOSPITAL. The total admissions to the hospital during the month numb 809 as compared with 936 for the preceding month and 744 for corresponding month of last year. The average number of p constantly in the hospital during the month was 449 as comp with 514 for the preceding month and 429 for the correspon month of last year. The average length of stay in hospital f( r each employee admit was 15.15 days. The following units of the new administration and clinics bud were occupied during the month: Superintendent's office, med clinic, eye and ear clinic, and drug store. The library waa moved and at present is housed in a storage room of the basem the library and reading room of the new building being as yet ready for occupancy. Those parts of buildings Nos. 234 and occupied by the above departments, were turned over to the ing Division to be razed. The X-ray department is the only',a ment remaining to be moved, which will be effected within k or ten days. Building 238, steward's quarters, was also razed by Buil Division for use aa field office and storehouse. New equipment.-The office floor of the administration bud was equipped throughout with steel desks and filing equipment, latter providing for the housing of all hospital charts, ap e standing on open wooden shelves. Transportation.-Ambulance body was removed from amb U. S. No.~305, chassis sent to Motor Car House for overld subsequent delivery to district quartermaster for placing r body on same. Thirty-nine cases of measles were admitted as compared November-19 of the cases admitted were received sb to December 26. Alo

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Sevencases of diphtheria were admitted as against 3 in November; nd caesof chickenpox as against 2 in November. Detaledstatistics are shown in Tables VII, VIII, and XIII. Gorozl ospital.-During the month 16 patients were admitted, 3 ie, and 6 were discharged. Among the discharges are included 3 ta deported. Average number of patients cared for during the month was -34, a copared with 341 for the preceding month, and 319 for the -coriesponding month of last year. Poard of Health Laboratory.-A report of routine operations is shownuner Table XIII. Chirpnic ward.-The average number of chronic patients cared for durngthe month was 26.45. Eleven patients were discharged or trasfrred from this ward during the month. COLON HOSPITAL. -A total of 196 patients were admitted to the hospital during the m~nh, as compared with 203 for the preceding month, and 139 for corresponding month of last year. The average number of pat8 constantly in the hospital during the month was 58, as cornprdwith 61 for the preceding month, and 44 for the corresponding moth of last year. Teaverage length of stay in hospital for each employee admitted,. as8.17 days. retailed statistics are shown under Tables VII, VIII, and XIII. PALO SECO LEPER ASYLUM. Teavejrage number of patients in the asylum during the imontli 0a 7. There were no admissions, deaths, or discharges during SANTO TOMAS HOSPITAL. A total of 880 patients were admitted to the hospital duriAig the monh, as compared with 850 for the preceding month, and 922 for thecoresponding month of last year. The average daily number of te in the hospital was 432, as compared with 438 for the premonth, and 440 for the corresponding period of last year. tydeaths occurred at the institution during the month, (ih1) tuberculosis, (2) organic diseases of the heart, and (3).darea and enteritis, the e f causes in the order named. Dtailed statistics are shown in Table XV. DIvIsxoN OF SANITATION. Following table Ehows the average monthly Amission rate fro maari among employees to bce~ hoepital5 and quarters for th onth of December, the percentages bemng based on the ratio .A A-8

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10 of the number of admissions fronf each district to the total of employees residing therein: Number of admissions A District. Number of from employees. malaria admi during month. Balboa. ...---------------------------------2,668 1 Ancon-Carozal.-----1,151---.. Pedro Miguel.-------------------.-. .1,352 Paraiso--.------------------------------995 1. West of Canal. 367 Gatum----------------------------------1,136. ., Cristobal. 3,414 8-.234 Colon. 7,115 1 .14 Panama. ....--------------------------------8,383 2 Miscellaneous1. 3,104 27. Total. 29,685 40 1 Employees engaged in pasture and jungle clearing, etc., outside of above satd areas. CANAL ZONE. During the month the usual sanitary measures have been ob Ih addition, a certain amount of new work has been done in districts, consisting mainly of laying tiling in seepage areas wher anopheles breeding has been found. The malaria rate for the reglarly sanitated districts has been very satisfactory, as shown by th fact that only 2 cases in employees have been reported, as cern pared with 7 for the corresponding month of last year. Th total number of malarial cases among employees reported for 1he month was 40, as compared with 24 for the corresponding monlh o last year; for the present month they were distributed as follows: Zone: From regularly sanitated areas, except CristobaJ and Toro Point -----------------------------------------From Cristobal and Toro Point. ..------------------------From miscellaneous camps, outside regularly sanitated areas. -2 From Panama and Colon. ..Total.-. 4 This increase in the totals for the month over that of ,a ya due to.difficulty in sanitating the district camps. .It has that anopheles are breeding extensively in the wet area& t pasture and land clearing camps and are evidently ob n abundant blood supply from the cattle, enabling them to more than under the former j ungle conditions when this blood was not available. While this available blood supply the tendency of these mosquitoes to make long flights in blood, it also tends to increase the propagation of anoplquitoes and the danger to employees who sleep in the ca

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AA A L AdA 11 etion of mosquito bars. The men in charge of the various pd make it their duty to see that every employee in their a camp-is supplied with and uses a mosquito bar. berculosis problem within the Zone is very satisfactory, case having been reported outside of Oristobal. T two cases of typhoid fever which occurred .in Gatum are g to be due to drinking water from seepage outcrops in the Areas. All other communicable diseases are lower than for the previous PANAMA. in reViiewing the work done by the Health Department in Panama r eiember, the large number of buildings inspected, and the "Aer of permits issued to repair old buildings are prominent e1. Practically all of the permits for repairs included proi for the installation of windows with stationary lattice blinds he purpose of providing the proper amount of light and fresh air -T g rooms and tenement houses. This necessary work has pushed continuously and already over 50 of the most insanihouses in the city have either been improved or the work of movement is now well under way. Tie ditching gang has made a good showing, and it is proposed to ne this important work during the coming dry season, espey iu that section of district No. I lying between Bella Vista and bnas police station. A systematic inspection of all hotels and restaurants was carried written. reports submitted. Comparisons were made with tons shown by a previous inspection several months ago, and a resul one restaurant was closed. A .The malarial rate for Panama. is sufficiently low to e no pecial comment. We still have a few cases originating city but each month there are, in Santo Tomas Hospital, a her of cases in individuals who become infected outside the Simits. SAL CASES OF MALARIA FROM CIVILIAN POPULATION AND EMPLOYEES LIVING IN PANAMA DISTRICT. A 1914 1915 1916 1917 .r ..................1 2 91 A, Fe ray ...19 127' 39 17 .111 67 16, 12 ..68 19 24 ..19 57 1 1 700 .194 50 91 14 137 50o 1 22 .179 71 30 10 A--. -.-. ..274 36 16 41 168 1 27 2 Se. ...:. ..168 '12 21 b. ..254 19 14 5 .167 20 20' 6 .121 28.19 4 A. .7 At

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16 T berculosis.-Antituberculosis measures havD been puh stantly and several additional educational articles have lished. One public talk has been given, and an ed. pamphlet on prevention of tuberculosis is now being p free distribution inwthe city. Beginning January 1, 1918, the health nurse assigned to this office will begin the work of visa and general supervision of all cases of tuberculosis reported. Infant welfare work.-At the close of the month the healthi turned over to the Panamanian Red Cross all baby welfare wrk. The infant death rate of 202.43 is the lowest in several months, and is a very creditable showing considering the present high cost of foods, including milk. Infectious diseases.-There has been a slight increase in the number of cases of measles reported. As several cases originated in ue t the public schools, an inspection was -made and all suspicious casee were sent home. The pupils were questioned as to history of coughs or colds and as to whether their eyes were sensitive to light. Besides this they were examined for nasal discharge or rash. COLON. The general health conditions continue to remain good in tha Atlantic Terminal city. Despite the fact that the public sc,"o have been in session several months the incidence of acute ifectiou8 diseases has not increased. All of the scholars were physically examined at Colon Hospital and with few exceptions were found tob in excellent health. Malaria.-The greater number of the cases reported were from the coaling station (night workers). Thorough inspection in this vicinity revealed anopheles breeding over the greater part of the south hal of the island, which has never been reclaimed. This is un4oubte the source of infection of employees in the coaling station and Camp Bierd section. Antimalarial work will be resumed in drains area No. 1, Margarita Road, on January 2,.1918. Tuberculosis.-The incidence continues to increase; 21 ca e w reported during the month with 13 deaths, as compared with nin cases for the previous month and five cases for the correspon month of 1916. It is thought that a rigid compliance with building regulations which provide for adequate light and ve tion is one of the best antituberculosis measures at our comm' da present. Each building from which a tuberculosis case has reported will be inspected and the owner of said building COmp d to provide adequate light and ventilation before it c occupied. As we carry out routine disinfection .of ti tuberculosis quarters, an educational campaign to enlig people to the dangers and outline ways and means to avoid ing this disease is contemplated. Diphtheria.-Only two cases were reported during the mon Mount JHope.--Several mosquito breeding areas were eliui e during the month, notably in swamp Nos. 2 and 4, by the inalt 4 drains and making several small fills.

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MM 13 ba,-Sanitary improvements were made at the abattoir gte month by concreting a part of the road between the hog slaughter pens and a general clean-up around the place. Result of an examination by the veterinarian six horses from Pnama Railroad stables and private stables were condemned disposed of in a humane manner. QUARANTINE DIVISION. 400nditions generally, along the west coast of South America, show Hry little change. An increase in plague cases has been reported m Guayaqmil, Ecuador, and a fresh outbreak of this disease in the Ioast towns in the Province of Manabi. The seasonal increase .of yellow fever in Guayaquil has apparently been lower than usual. During the month an American consular agency was established at Buenventura, Colombia, which also supervises outgoing quarantine es; this will probably bring about an improvement over the former method of clearing ships from this port. On the Atlantic side quarantine conditions in South and Central America show practically no change. 0a December 5 the supervision of the abattoir and meat inspection at Cristobal, which has been under the quarantine division, was tramsferred to the health office, Cristobal-Colon, in order to consolidte work of this character under one head. Reports of cattle inspection, ante and post mortem, disinfection of hides, etc., will be by that office. e quarantine inspector for Cristobal-Colon returned during the moth from escorting a number of insane patients to the Lesser A iIles, having left on this detail during the month of October. .his return voyage he stopped at Venezuelan ports, and was able make a report upon general sanitary conditions. His report indicates that La Guayra, Venezuela, particularly, is in an insanitary The repair work on cabin building, Colon quarantine, and fill of ,,quarantine reservation, have been continued in a satisfactory mner. Under Table XVII a statistical report of quarantine transactions .the month will be found. DEPORTATION deportations were accomplished by the hospital authorities d '::g the month, five employees and one nondmployee, 'all sufferfrom diseases. A edition to the above 60 deportations were effected by the Atine authorities. VA .I h;N

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14 TABLE I.-ADMISSIONS, DEATHS, AND NONEFFECTIVE A EMPLOYEES. ABSOLUTE NUMBERs. Admissions to Deaths. hospitals.s 944 4U) M) -4 4 "P December, 1917: White. .4,885 109 89 20 1 61 7. Colored ---------24,800 267 1971 70 18 14 4 6, 1. Total---------29,685 376 286 90 19 14 5 8,_64 276.25 November, 1917: Wbite.---. 4,8831 12O 107 13. 2 2' .,366 89 Colored -----------31 2411 14 9 5 7,4 Total.---------29, 8471 436 348 98 16 11 5 9,3 312. December, 1916: White-----------4,730 125 '100 25 4 2 2 2746 Colored---------29,597 252 164 88 6686 Total---------34,327 377 264 113 22 17 .5 9,4 3 PROPORTIONATE NUMBERS.1 December, 1917: White-----------4,885267.76218.63 49.13 2.46 .2.46. Colored----------24,8001129.19 95.32 33.-87 8.71 6.77 Total---------29,6851151.99115.61j 36.38 7.68 5.66 2.02. November, 1917: White-----------4883294.90262.95 31.95 4.92 4.92.---.Colored.---------24,964151.89115.84 36.05 6.73 4.33 2.40. Total----------29, 847 175.-29 139.91 35.38 6.43 4.42 2.01 December, 1916: White----------. 4,730317.12253.70 63.42 10.15 .07 5.07 Colored.---------29,597.102.17 -66.49 35.67 7.30 6.08 1.22.-. Total---------34,327131.79 92.29 39.50 7.69 5.94 .79. 1 Annual average per 1,000 employees.

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15 .-DEATHS OF RESIDENTS OF THE CITIES OF PANAMA, COLON, AND THE CANAL ZONE. Deaths. Annual average per 1,000 population. Population. NTotal. Disease. External Total. Disease. External causes, causes. er, 1917: -----61,369 136 131 5 26.59 25.61 0.98 Colon.-26,078 66 64 2 30.37 29.45 .92 Cnal Zone1. 24,038 16 13 3 7.99 6.49 1.z0 Total------111,485 218 208 10 23.46 22.39 1.07 mbr,1917:1 61,369 154 149 5 30.11 29.13 .98 26,078 53 52 1 24.39 23.93 .46 Zone 1 24,038 25 20 12.48 9.98 2.50 otal. 111,485 232 221 11 24.97 23.79 1.18 mber, 1916: Panawa. 60,778 152 146 6 30.01 28.83 1.18 Con. 24,693 58 53 5 28.19 25.76 2.43 Canal Zone. 31,048 26 21 5 10.05 9.12 1.93 Total. .116,519 236 220 16 24.31 22.66 1.65 NN1 EXClU1ive of military population. 4 A A

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16 TABLE 11.-CAUSES OF DEATHS OF IN Sex. Color. Cause of death. -1 wee'k.4 M. F. W. k Septicemia. .-------------------------------1 1 Tuberculosis of the lungs. 1 1 -2 .. Tuberculous meni gitis .-. 1 1 Miliary tuberculosis .1 .1.-----Disseminated tuberculosis-.-.------.1 -.1-------Anemia ------------------------------1. .. Convulsions of infants-------------.-.-.-.-.-. -1 ..1 1------Acute endocarditis. ....---------------------1 1 2------------Organic diseases of the heart ------------1. .1-----Acute bronchitis. 4 3 .7 .--Chronic bronchitis.-.------.-----------------1 ..-----Bronchopneumoma. 5 2 2 5--------------. Pneumonia (unqualified). .-----------------1 ..1-------Pleurisy.-----------------. 1 .1 -Acute gastritis .1 1 -------Diarrhea and enteritis. 817 15 --------Colitis. ....-------------------------------3 1 1 3. Acute hepatic congestion-.--.1 .1------Acute nephritis.-.---------------.--.1.----.-. Other diseases of the kidney and annexa 1.1. Pyelitis-----------------------------1---------1. Congenital malformations.----------------1 -----1 Premature birth.------------------------. 3 2 .5 4--Congenital debility.---------------------2 1 3 2 Malnutrition .-. 4 2 .6. 6 1---Other causes peculiar to early infancy.-.3 .-. 3 3 Total. ....--------------------------411 30 9 62 11 Infant mortality rate, based on number of births reported for the month (deaths Percentage of deaths under 1 year of age to total deaths for month---------AA

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x 17 9EJOOR, AGE, AND PLACE OF RESIDENCE. Age by.months. Place of residence. 4-5 5-6 6-7 7-8 8-9 9-1010-1111-12 Panama. Colon. Zone. Total. M. ........1 I .----------------------. ..1. .2 S .---------....--1---.. 1 ......1 ...1 .... ..... ..1 .....1 1 .2. .1 ..4. 7 .1.1 .1 .2 ..1 .1 .1 1 .7 .....4 ..1 ----------...2. ...1 .W ..--. .1 ...4 ......2 ..4 ..1. ..1 .......2.2 ,1. .....1 2. 1 ...1 .1. ..5 2 1 .... ......... --I-------2. .37 29 12 3 -8452-1844 2 7 10 1 431 0 1 q4 J.4 kk

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18 TABLE III.-DEATHS BY NATIONALITY. Employees. Nonemployees. Totals. Nationality. Gr. Male. Female. Male. Female. Male. Fe Barbados. 2 .15 11 17 11 Bermuda. ..1 1 1 1 M Canada. ..A Chile. ..3 .3 .r China. ..3 3 1 %A Colombia. I .2 7 2 A Curarao. ...1 Dominia. .1 ...1 .;. England. ..1. 0 .. Greee. ..2 .2 Grenada. 1. I. .1 2 2 Guadeloupe. I .1 1 1 2 India. .1. Jamaica. 4 .31 29 33 3 Martinique. 1 .3 1 4 'K Mexo .1 ..1 1 1 Montserrat. ..1 1 1 1 2 Nevis. ...1 1 Panami. 1 1 30 29 31 30 MI St. Lu3i. 1 1 2 1 St. Vincent. 1 ..N U, St. Thomas ....1 1 Spain. 1 .3 1 4 1 S Trinidad. 2 .1 3 3 3 United States. .7 2 7 U 2 Unknown. ....1 Total. 18 1 114 89 132 1 2 AL TABLE IV.-BIRTHS AND BIRTH RATES IN THE CANAL ZONE A.D THE CITIES OF PANAMA AND COLON. Births. Rate per 1,0 0 popuBirths. Population. Total. Alive. StillTotal. AIve. born.born December, 1917: Panama. 61,369 263 247 16 51.43 48.30 3. Colon. 26,078 96 ~94 2 44.18 43.26 .92 Canal Zone1. 24,038 61 59 2 30.45 29,45 J.Q Total. 111,485 420 400 20 45.21 43.06 2.1 November, 1917: Panama. 61,369 287 266 19 56.12 52. 4k.K Colon. 26,078 90 87 3 41.41 40.Q3 CanalZone1. 24,038 73 70 3 3#.44 34.94 Total. 111,485 450 425 25 48.44 45.7 December, 1916: 'Panama. 60,778 256 226 30 50.54 44.62 Colon. 24,693 94 90 4 45.68 43.74 CanalZone. 31,048 64 59 5 24.74 22. Total. 116,519 414 375 39 .64 38.

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TW.,;-A.-INFANT MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Births. Deaths among Death Populachildren rate per tion. Feunder 1,000 Male. Total. 1 year of births. age. eceber,1917:. Panama. 61,369 130 117 247 50 202.43 Colo,. 26,078 39 55 94 19 202.13 CanaiZone I. 24,038 26 33 59 2 33.90 Total. 111,485 195 215 400 71 177.50 November, 1917: 1anama. 61,3f69 129 139 268 66 246.26 Colon. 26,078 41 46 87 17 195.40 CanalZone1. 24,038 29 41 70 4 57.14 Total. 111,485 199 226 425 87 204.70 December, 1916: Panama. 60,778 109 117 226 61 269.91 Colon. 24,693 43 47 90 20 222.22 CanalZone. 31,048 32 27 59 5 84.75 Total. .116,519 184 191 375 86 229.33 I Exclusive of military forces. INFANT WELFARE WORK-PANAMA CITY. 8tatlon work: Total number of babies seen. 236 Instructions given to mothers, total cases. 125 Treatment given babies, total cases. ..46 Histories taken, total cases. 28 Examination made, total cases. 145 outside e work: Total number of visits made. 545 Number of cases not located. .38 l.Number moved to Colon and Interior. 61 SNu r iof breast-fed babies. 255 Nun-.ar of bottle-fed babies. .27 Xtumber of bottle and breast fed babies. .65 Total number of babies seen. .781 Nuber of destitute casesgiven assistance. 2 Numberof cases admitted to hospital.9 Number of cases treated at Santo Tomas Dispensary. 25 Number of cases treated by physician at station. .31 De conditions found: ikin disease (rash). ...9 couoop geoagh ..3 erofabies died. .10 4W

PAGE 22

20 TABLE V.-CAUSES OF DEATHS OF EMPLOYEES, ARRANEDWT Color. Age (in years). W. B. 15-2O 21-25 26-30 31-3536-441-4 Apoplexy .1. Other diseases of intestines. .I I ... Cirrhosis of the liver I. .. Heart, organic diseases of. .2 ....2 Intestinal obstruction.-. ....,. .1^ Nephritis, chronic. 1 ..1 Pleurisy. .I ... Pneumonia, lobar. .3 1 ..1 Tuberculosis of the lungs. .2 1 .1. Tuberculosis, disseminated. .1. Traumatism by fall. .1 Traumatism by vehicles. .1 ... Traumatism by cutting or piercing instruments. 1 1 .1 1 Other external violence. ...1 Total. 1 18 1 3 1 7 3 2" SS L

PAGE 23

4 24 NCE TO AGE AND *LENGTH OF RESIDENCE ON ISTHMUS. Length of residence on Isthmus (in years). A._ _ _ _ __ _ _ _ _ Total. -Un4-5 5-6 6-7 7-8 8-10 10-1212-15 +15 Life. n known. .......... e. .e. ..e............ ...........1 1 .............1 2 .e. ~e. ...e. .. .......1 .....2 ...e. .................... 1 1 1 .2 1 2 3 1 1. 1 41111 42 :1 ...1. ...1 3 ......1 2 ..1. ......1 ........1 ........12 .........1 1-1 2 1 1 1 1 11, 1 41 19 Aiit

PAGE 24

22 TABLZ I -CAUSES OF DEATHS OF CIVIL-POPULATTON (E Se Color. Age (in Cause of death. M. F. W. B. Y. -lyr. 14 General diseases. Malarial fever, estivoautumnal. 2 .. Purulent infection and septicemia. .2 1 1 .V V .. Septicemia. ..1 .-..... Pyemia and septicmmia, pneumococcic.1.-. 1 ..... Pellagra-. .4 .4 .... Tuberculosis of the lunes. 1916 5 29 1 2 1 .. Acute military tubererlosis. .I .1 .1 Tuberculous meninaitis. 1 1 2 .. Abdominal tuberculosis. 1 ..1 .... Disseminated tuberculosis. 3 1 .4 1 1. Syphilis, period not stated. 1 ..I .. Anemia, primary,.pernicious. I ..1 Alcoholism,chroic. .1 .1. Cerebral hemorrhage, apoplexy. 4 1 7 ... Epilepsy .1 ..1 ... Convulsions of infants (under 5 years of age) .1 Other diseases of the nervous system. 1 .... Diseases of the circulatory system. *Acute endocarfitis. 2 1 3 ..2 Organic iseases of the heart .14 9 3 18 2 1 Aneurysm. 1 .. Diseases of the respiratory system. Acute bronchitis.6 4 .10 .7 3 Chronic bronchitis. 3 ..3 1 2 Broncho-pneumonia. .7 4 2 9 7 4 Pneumonia.(unquahfied). 3 ..3 1 Lbar pneumonia. 5 1 2 4 .. Pleurisy. 1 ... Gangrene of the lungs. 1. ... Diseases of the digestive system. Acute gastritis.1 .1 Diarrhea and enteritis (under 2 years). 9 10 ..15 4 Colitis. 4 2 1 5 .4 2 Colitis.1 .1 .. Intestinal obstruction.1. ..I .. Other diseases of the intestines. ...V Acute yellow atrophy of the liver. .1 .. Cirrhosis of the I ver. .3 1 1 3. Other diseases of the liver. 2 .2 1. Abscess of liver (unqualified).1 .1 .. Diseases of the spleen. .1 ...1 Simple peritonitis.1 .1 .. Nonvenereal diseases of the genito-urinary system and annexa. Acute nephritis. .4 .1 3 .2 Bright's disease (chronic nephritis).7 1 11. Other diseases of the kidney and annexa. 1 .W1 .1. --'

PAGE 25

-23 EMPLQYW!S) AND MILITARY, BY SEX, COLOR, AGE, AND Age (in years)-Continued. Place of residence. Total. 21-3O 31-40 41-50 51-80 61-75 76-100 Panama. Colon. a T [on.Zone. 1 1 2 .2 .2 1. .1 ......1 ..........1 ....4 3 1 4 147621.23 10 '2 35 ..... 2. .2 ...12. ........I .. 2 ..........1 3 ... ............... ....-. 1 11 .......1 4 2 ..4 3 1 8 ......... 1 3 ..... ...... .....2 .3 .......1 .... .........1 1 ..... 1 .1. 1 .....1 ...6. .1 ...1. 1 P.51 2 1 1 4 ........1 .........1 ... .4 ....2 .,, s ..63. ..1 .~s~ .........,.*. ..~. ..s~ ..4 ..1 2

PAGE 26

24 TABLE VI.-CAUSES OF DEATHS OF CIVIL POPULAON (EML Sex. Color. Age (in Cause of death. M. .W. B. Y. -yr., I-. 51 The puerperal state. Puerperal dlbuminuria and convulsions.1 1. Eclampsia. .2 ... Diseases of the skin and of the cellular ti8sue, Elephantiasis. .. Malformations. Congenital malformations (stillbirth not included).1 .. Diseases of early infancy. Premature birth. .3 2 .4 1 5 Congenital debility. 2 1 .3 .3. Malnutrition.4 3 .7 Other causes pecuiar to early infancy. .3 .3 .0 .Afections produced by external causes. Other suicides. .1 Burns (conflagration excepted). 1 1. Accidental drowning. 1 Traumatism by cutting or piercing instruments.1 Tratmatism by fall. 1 ..1 Traumatism by other crushings. 2 ..2 .. Homicide by firearms. 2 .1 1 Homicide by cutting or piercing instruments. .... Homicide by other means. 1 Other external violence. 1 ... Ill-defined diseases. Sudden death.e. I .... Cause of death not specified or ill-defined. .1 .1. Total. 132 90 32 186 4 71 2 Stillbirths. .10 10 3 17 Grand total. 142 1io 35 203 4 71 1 *.W

PAGE 27

N.W. --n25. A NONEMPLOYEES) AND MILITARY, BY SEX, COLOR; AGE, ANID EIENCE-Continued. Age (in yearsy-Continued, Place of residence. Tota1 -0' 21-30 31-40 41-50 51-60 61-75 76-100 Panama. Colon. Canal Zone. a.~~. .9. ..1 1 ....1 2 1 .1. a,. ...5 2.1. 3 ....... .j.m. .... .....1.1 1. .... '*Uh-.7--e -----e 1.**. ... 1. ......1 SCC.a 11. .1. .CC. 2. .........1H. ...1 ..1. .....1 9*3*5*9 S .1 ...1 '2. ....1 1 *39* 1-. ....1.1 .~. ..1. ...1. ..1 5 129 42 27 14 8 3 130 66 20 222 -. ....I. ..16 2 2 20 4 29 42 271 14 1 8 3 152~ 68 22 242 18452-18--4

PAGE 28

26 TABLE VI-A.-DEATHS OF NONRESIDENTS.1 Residence. Nationality. Color. Sex. Age. Cause of Interior of Panama. Colombia. Black. Male. 32 Homiede by arms. Paja, Republic of English. White. .do. 46 Pulmonary tubrejPanama. lost. Colombia. S o u t h Colombia. Black. Female. 41 Dysentery. America. Bocas del Toro, ReJamaica. .do. Male. 57 Myocardial insumpublic ef Panama. ciency. Interior of Panama. Colombia. .do. Female. 49 Pulmonary tuberculosis. Las Santos, Republic Panama.do. Male. 72 Lobar pne. of Panama. Porto Bello, Repub._.do. .do. .-.do. 32 Accidental drowDlie of Panama. .nm. -Buenaventura, CoSpain. White. .do. 42 Organic heart dilombia. ease. Tapia, Republic of Colombia. Black. .do. 31 Pulmonary -tuberPanama. culosis. Interior (i Panama. Panama. .do. o. 40 Do. Nombre de Dios, ReJamaica. .do. .do. 34 Extensive bu r n public of Panama. arms and body. Bridgeport, Conn. U. S. A. White.do. 67 Organic diseaseoftbe heart. A *]

PAGE 29

*4 I* AA N A I N 1 xN -# s.aN

PAGE 30

28 TABLE. VIL-DISCHARGES AND DEATHS IN T Employees. Discharges. Deaths,. White. White. Diseases. Black. a a B10ak P4 M. F. M. F. M. F. M. F. M. F. F General diseases. Typhoid fever. .....-. ..... Malaria fever:3 Estivo-autumnal. 3 .3 .36 Tertian. 1 ..3. Quartan. ..1. .1 Undetermined ....... Measles ...1 .. Whooping cough. ....Diphtheria and croup. .1. Influenza. 5. .6 ..... Disentery: Entamebic. ..... Baill3ry. 1. ..... Unclassitied ..... Dengue. ..... Chicken pox. ..... Yaws. ...1. .... Purulent infection and septicemia. .. Pyemia and septicemia, pneumo....1. ... coccic. PellAgra. ...... Beriberi. ........ Tuberculosis of the lungs. 1 ...3 ... Pott's disease. ......... Disseminated tuberculosis. ..........2 Syphilis : Primary. .... Secondary ........ Tertiary .I .1 .17 1 ... Period not stated. ...... Gonococcus infection. .... Gonorrhea .1 .1 .14 .... Gonorrheal orchitis and epididy1 ...1 ... mitis. Gonorrheal ophthalmia. ....1 .... Soft chancre. ....6 ..... Adenitis chancroidal.1. ...3 .... Cancer and other malignant tumors ..1 of the stomach and liver. Cancer and other malignant tumors ....... of the female genital organs. Other tumors (tumors of the female ... genital organs excepted). Acute articular rheumatism. ..... A.=American.

PAGE 31

29 UO8PITALS OF TE PANAMA CANAL. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White Black. White Black. d C +.~ A. P.R.2 M. F. M. F. A.1 P.R.2 M. F. M. F. M. F. M. F. M. F. M. F. .1. ................3 2 1313 2 .1. I ..2 ......s5 1 8 ......----.-----.1. 3 1. ....1 6. ... .10 12 2 1 .........29 1. .-. ........... 2 2 2 1 .......-..-. ..-.8 3 ~ 2. 2. .1. ...........8 ..........o ....... ~~1. .....43 ...... ....... 4 .........--.....1. ..1. .1 1 ....2. ........2 ..2. 2. ........2 4 1 1 ..1 1 1 2 ..1 .....11 6 .1. .........1 2 ...2 2 2 ......-...2 3 .2. ............5 3 2 ..1 2 6 .....2 .......36 .............3 -.........-.2 .......2 .............-1 ~~ ................--2 --------1. .........I --.-. -. ....19 ..............6 -1 ., ~~~~~~~. ..........----2 R.POrtO Rican.

PAGE 32

30 TABLZ VI--DISCHARGES AND DEATJIN TH Employees. Discharges. Deaths. White. White Diseases. Black. Wi M. F. M. F. M. F. M. F. M.F. M. General diseases-Continued. Diabetes. ........ Olycosuria. ..... Exophthalmic goitre. ....... Other general diseases. ....... Alcoholism (acute or chronic). ........ Alcoholism acute. ...... Alcoholic psychosis. ......... Diseases of the nervous system and of the organs of special sense. Cerebral hemorrhage, apoplexy. ....... Paralysis without specified cause. ...... Other forms of mental alienation. ....* Dementia prwcox. .... Hvsteria. ..1. .. Neuralgia. .... Neuritis.2 1 Other diseases of the nervous system .... Neurasthenia. ... Diseases of the eyes and their annex Diseases of the ears. ... Diseases of the circulatory system. Organic diseases of the heart. ....3 Angina pectoris. 2 .... Hemorrhoids. ....3 Varices ........... Varicocele. 1. 1 Diseases of the Iym hatic system 3 ..... (lymphangitis, etc. Lymphadenitis (nonvenereal). ...4.4 Hemorrhage: other diseases of the .... circulatory system. Diseases of the respiratory system. Diseases of the nasal foss. 2 .. Adenoid vegetations. ... Mviasis of nasal fossap and sinuses. .. Diseases of the thyroid body. ...... Acute bronchitis. 4 3 .2 Chronic bronchitis ..1 I A.=American,

PAGE 33

PALS OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White Black. White Black. 0 1e .P.R.2 M. F. M. F. A.1 P.R.2 M F. M. F. M. F.M. F. M. F.M. F. 1 1 ...1 ....1 .............. -I ......, ...................1 4 ..1. ......5. a' .1. ....1 ..1 I .1. ......1. ......2 S 2. ...5 ..1. ...... .I. ..1. ........4 ..2. .......2 .........3 .a. ...... ...1.8. 4 .1 ...........;. ....3 .1 2 ............2 .............8 ...2 .1 .....-. ..........20 4' .............8 1 .........4 27 ......,. .....a. ...1 ...1 .....e. ......9 a. t. ..ae ses. eat C .1 ~ ..... ...at. ...aS ..t. 1 ** StaS I ** ~ aS.~ea ...6 t S.5teSC5* 1 1 4 5 1 4 ....a. 1 ....tea a. tee26 hu .W. .1 .at. te. ..s .e ........2 3. R.-.orto .can. Of*: 0**0

PAGE 34

32 TABLE VII.-DISCHARGES AND DEATIN T Employees. Discharges. Deat. White. White. Diseases. Black. B1Ai M. F. M F.M. F.M.F.M.F.M. 4 Diseases of tte respiratory sy'temContinued. Broncho-pneumonia. ......... Lobar pneumonia. ..2 .3 .Is Pleurisy 2 a. ............... Asthma Abscess of lungs Diseases of the digestire system. Diseases of the mouth and annexa. .......... Diseases of the teeth and gums ...2 om tis stomatitis ............ Diseases of the n~harynx .. Follicular tonsilitis. .3 --" Ulcer of the stomach. ........ Acute gastritis. .. Chronic gastritis. ......... Acute indigestion. .......... Diarrhea and enteritis (under 2 years) ........ Diarrhea and enteritis (2 years and over). .4 .3. Colitis.2 .. Ankylostomiasis. ..2 Intestinal parasites. .... Ascarasis. Teniasis. I ........ Acute appendicitis. 1 ....... Chronic appendicitis. ... Inguinal hernia. 1 ...8 Other hernias. ....I Intestinal obstruction. .1 .2.-.-.-.Other diseases of the intestines. 2 ...Constipation. .... Duodenal ulcer. .1 1 .... Cirrhosis of the liver. ........ Other diseases of the liver. I .... Cholecystitis. .... Simple peritonitis (nonpuerperal). .. I A.= American.

PAGE 35

33 PITALS OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White Black. White Black. m 4-1 m-7 .p .2 M. F., M. F. A.1 P.R.2 M. F. M. F. M. F. M. F. M. F. M. F. 48 ..........1 -..11. ...........3 ............. 1.1. .....---.3. ........ 5 .10O 18 1 4. -. ..--..-..-.44 1 ...1 ...-. --...-.-. .........2 .......I ....2. ..............-. -.... .................-. S. .2 .........4 ........1.--. ..7 2 ......-......2 2 ......3 ..1 .1 ..........-. 2 ...............7 S. ..............2 3 ...2 S 3 2 ......A --. ...-. .----.14 2 ..................2 S ......I .......16 ..............1 .........-. 2. PW .........................'00 wo 0 .........2 *; 2.i. 11. .........16 ... 1 4 .;J. ..2 ..........1-2 1 i ..1 .1 P. R.-PortoRIcan. *2r

PAGE 36

34 TABLE VIL-DISCHARGES AND DEATHS IN Employees. Discharges. Deaths. White. White* Diseases. Black. Bla r. M. F. M. F. M. F. M. F. M. F.o .i Nonvenereql diseases of the genitourinwry system anid annexa. Acute nephritis. ...... Bright's disease (chronic nephritis) 1 .-1 .3 .. Other diseases of the kidney and annexa. Caletli of the urinary passages. .. Cystitis. 1 .1 Diseases of the urethra, urinary abscess.et .... Stricture of the urethra,nonvenereal. .2 Acute prostatitis. ... Nonvenereal diseases of the male genital organs. ....2 Hydroele.2 ....2 Uterine hemorrhage (n-mpuerneral). Uterine tumor (noncancerous). Other diseases of the uterus. .1 Metritis. Salpinzitis and other diseases of the female genital organs. .1. Nonpuerperal diseases of the breast (cancer excepted). Benign tumor of breast. The puerperal state. Normallabor. Accidents of pregnancy. Extra-uterine pregnancy. H yperemesis gravidarum. .. Abortion. Other accidents of labor. Puerperal septicemia. Puerperal albuminuria and convulsions. Eclampsia. Puerperal diseases of the breast. Diseases of the skin andtle cellular tissue. Gaunrene. Furuncle. ... Acute abscess. 2 .... A.=-Americai.

PAGE 37

35 TALS OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Disharges. .Deaths. Discharges. Deaths. Wbite. White. Black. Black. White Black. White Black. -4 2 A .R. M. F. M. F. A.1 P.R.2 M. F. M. F. M. F. M. F. M. F.M. F. .2 ...1 ......3 1 2 ..1 ..-1 ..1----------. 8 2 ..2 1 1 ....1. ....51 S ........1 ....2 2 1 3. ........--.8 ......1. a. ............2. ...........-.-. -.........6 ............3 S1. ......... 1 .1. ..........4 -6 .4 ...........11 -I. ......1 7 .4 ...O a ..4. .......I ..1 ..1 .....1 4. ........I ..4 3 .1 ....---4 ......4 4q. ~ a .1 ...-.......4. ------1 -S. ...I. ..--.-. .1 .......1 .1 t *. ..2 ..... *.~. ,.1 ...~S. S *SC.----------1 -4 1 ....2. .......1 0 .s p. R.Porto Rican.

PAGE 38

36 TA&IRaiE VII.-DISCHARGES AND DEATH IN IN3 Employees. Discharges. Deaths. White. White. Diseases. Black. A Black. 00 ."AI -94 Pq N.' M. F. M. F. M. F. M. F. M. F M. F. Diseases of the skin and the cellular tissue-Continued. Phlegmon and cellulitis. 2 .4 Dhobie itch. Ulcer of the skin. .1 .5. Impetigo contagiosa. ...1. ... Urticaria. .. Other diseases of the skin and annexa.3 ..... Diseases ofthe bones and the organs of locomotion. Diseases of the bones (tuberculosis excepted). ....... Osteoimyelitis ....... Periostitis. ....1. Diseases of the joints (tuberculosis andrheumatism excepted). ..Arthritis. .1 .... Other diseases of the organs of locomotion.2. Malformations. Congenital malformations (still birth not included). Diseases of earlki infancy. Newborn child. Premature birth. Malnutrition. .. Affections produced by external causes. Poisoning by food .. Venomous bites and stings .1 ... Burns (conflagration excepted). 1 ..2 .... Absorption of deleterious gases (conflagration excepted)2. 2 ........ Traumatism by firearms. ....... Traumatism by cutting or piercing instruments. .2 .1 .21 ...1 .. Traumatism by fall. .1 ..7 ...... A .=Americani.

PAGE 39

37 A OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Disharges. Deaths. .Discharges. Deaths. White. Black. .Black. White Black. White Black. r 41 .R.2M. F. M. F. A.' P.R.2M. F. M. F. M. F. M. F. M. F. M. F. E1 -4 S 3, 2 ................1 ..................1. 2 .............8 3.1 ...............142 4 14 -3 ~. ................4. ...................1 .................1. 4 ..................1. 1 ..............w .....2 ---..-................2.4 .0 ..............442 M 1 1 --13--.-10.7. ......44............w. ....2.. A. .2 S. ..........2 >. .....s. 0. .......2 .1 1 ....2 .....19.P R.-Porto Rican. AA NJm R, % Mp %

PAGE 40

TABLE VIL-DISCIIARGES AND DEATH T Employees." Discharges.D White. White. Diseases. Black. I M rwji M. F. M. F. M. F. M. F.M. F.1 F Afections produced by external cause&-Continued. Traumatism by machines ....2 Traumatism bv other crushing, M (vehicles, railroads, landslides, etc.). Injuries by animals. .... Homicide by cutting or piercing instrments. ..... Fractures (cause not specified). ....... Dislocations. .... Sprains. ........ Other external violence. 3 ...35 .... Ill-defined diseases. Infections of undetermined origin. ......... No disease. .2 ...2 ....A. Total. 65 11 26 .264 3 1 A.=American.

PAGE 41

39 q V TALB OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Disebarges. Deaths. Discharges. Deaths. a White, White. Black. Black White Black White Black o 020 0 0 O APNR.2M. F.M. F.A. P.R. M. F. M. F. M. F. M. F. M. F. .................2 ...............12 1 .............-. ......2 f 1 1 -.1 .1. 1.9 ................. ...1 ..3 ...............41...1 ...........1 1 2 26 8 3.2.I131. 184 91 16458 104. 2 4 3 6 9 31 1 1 ..1 1,01238 2P. R.==Porto Rican. wA A. Kt

PAGE 42

40 TABLE VIII.-CONSOUDATED HOSPITAL REPORT. [A.=White Americans; F. =White foreign; B.=Blacks; P. C. .. P. R. R.=Panama Railroad.] Remaining Admitted. Died: Dec. 1. A. F. B. A. F. B. A. F.B.A ANCON HOSPITAL. Panama Canal employees. 16 10 72 41 18 103 Panama R. R. employees. 6 9 95 4 12 123 .5 Soldiers. 95 ..142 .2 ..2 Panama pay patients.1. Other pay patients. .24 38 82 103. 34 121 1 .I IOU Charity patients. 2 5 13 50 8 49. Total. 166 62 '262 340 72 397 3 1 2039 COROZAL HOSPITAL (INSANE). Panama Canal employees. 1 2 4. Panama R. R. employees. ..2 ..I Soldiers. 2 ..4 .. Panama pay patients. 4 48 201 .|. 3 .I I Other pay patients. .2 5 1 2. 1. Charity patients. .9 64 .1. Total. 7 61 26 4 1 12-. 12 Grand total. 172 123 538 344 73 409$ 3 2 229 COROZAL FARM (CRIPPLES). Panama Canal employees. 8 .I CEMONIC WARD. Charity patients W. D. .34 .... COLON HOSPITAL. Panama Canal employees. 2 .5 18 16. Panama R. R. employees. 2 3 17 7 423. 1 V 4 ll Soldiers. 4 ..6 .. Panama pay patients. .2 .4 8 .1 Other pay patients. 13 8 8 60 20 17 1 1 2 Charity patients. ..2. 4. 4 Total. 21 13 32 95 33 .3 PALO SECO LEPER ASYLUM. Panama pay patients.1 37. Charity patients. .1 28 .....* -~Total .21 65 ... GRAND TOTALS. Panama Canal employees. 1 920 132 59 24 120. Panama R. R. employees. 8 12 114 11 16 147. Soldiers.1. 1. .... Panama pay patients. 4 49 240 4 12. Other pay patients .37 48 95 163 55.140 12 2 9 Charity patiets. 26 17 139 54 8 8. Total. ...194 146 439 17 47 4 4

PAGE 43

41 TABLE VHI.--CONSOLIDATED HOSPITAL REPORT. .t Americans; F.==White foreign: B.=Blacks; P. C.=Panama Canal; P. R. R.=Panama Railroad.] TransRemainAverage number constantly ferred. jgSick. .red Dec.31. A. F.B. A. F. B. A. F. B. Total. ANCON HOSPITAL. amO Canal employees. ...1 6 18 66 12.97 14.61 62.64 90.22 a R. R. employees. 2 7i 8 82 6.65 9.94 84.16 100.75 ers. 4 ..48 ..71.33 ..71.38 paypatients. .....16 .16 ypatints. 1 6 11 24 80 20.58 28.25 86.25 135.08 C typatients. .2 31 5 25 20.71 5.93 24.51 51.15 Total. 4 1 12103 55253132.29 58.73257.72 448.74 COROZAL HOsPITAL (INsANE). anama Canal employees. .1 21 51 1.00 2.00 4.74. 7.74 P anamaR. R. empoyees ....3 ..2.77 2.77 ....4 2.35 ..2.35 anamapay patients. ..1 4 46 200 4.00 46.35 200.58 -250.93 er.pay patients. .2 6 .391 1.94 6.03 8.36 typatients. ..8 8.45 66.13 74.58 Total.1 9j 58283 7.74 58.74 280.25 346.73 Grand total. 4 11 13112113536140.03117.47537.97 795.46 CORDZAL FARM (CRIPPLES). maCanal employees. ..9 CHRONIC WARD. ty patients. ..10 23 ..26.451 26.45 COLON HOSPITAL. maiCanal employees .2 3 4 3 2 5 3.22 .80 6.10 10.12 an.R.employees. .2 7 3 ..9 3.03 1.74 10.87 15.64 .....2 ..1.80 .1.$0 pay patients. .2 4 ..2 ..43 1.73 2.16 rpay patients. .8 4 5 20 4 5 15.97 2.30 7.03 25.90 yts.1. 21 1.10 .19 1.00 2.29 Total. .10 1120 291 6 23 25.12 6.06 26.73 57.91 SECO LEPER ASYLUM. m pay patients. ...17 .1.00 37.00 38.00 --------28 .1.00 2&O00 29.00 .ry. .....2 65 .2.00 65.00 6 7.00 GdIAD TOTALS. a Iemployee&. 2 3 -51 10 31127 17.191 25.99 124.48 .167.66 R. R. employees. ..9 10 8 94 9.68, 11.68 97.80 119.16 ....54 .7553 ..53 tients. 8 2 4 47239 4 47.78239.47 291.25 y5 11 31 30 91 38. 33.09 99.31 169.34 .12 32 14147 21.811 15.57146.09 183.47 .14 12 4314113O898165.15134.1 7O7.151,006.41

PAGE 44

42 TABrZ IX.-CONSOLIDATED DISPENSARY REPORT EMPLOYEES TREATED iN QUARTERS. ReRemainA Die DisTransmainlug emitted. ien. charged. ferred. jug y Dec. 1. Dec.31. W. B. W. B. W. B. W. B. W. B. W. B. W. B T Ancon. 1 .70 ...69 ..2 174 Balboa. 6 1 135 24 ..135 17 3 6 3 2 288111 Pedro Miguel. ..12 10 ...2 .16 Paraiso. .36 9 ..5 11 1 1 11' Gamboa. ..1 1 ..... Gatun. .4 2 .4 2 ....14' Colon. 8 32 70 103 .77 120 ..-1. 126 742 8Total. 15 36 1298 139 .301 151 4 7j 8 17 630889 ALL CASES TREATED BUT NOT EXCUSED. Employees. Nonemployees. .Totj. W. B. Total. W. B. Total. W. B. jT Ancon. 1, 174 4, 173 5,347 1,862 2,837. 4,699 3,036 7,010 1 4 Balboa. 3,790 4,358 8,148 4,418 2,366 6,784 8,208 6,724 14, Pedro Miguel. 1,156 1,821 2,977 1,122 761 1,883 2,278 2 Paraiso. 491 2,023 2,514 536 757 1,293 1,027 2,1 Gamboa. 168 472 640 116 396 512 284 -1Z Gatun .342 1,242 1,584 530 815 1,345 872 2,057 2 Colon.1,425 5,644 7,069 750 2,470 3,220 2,175 8,114 10, Total. 1 9,546 19,733 28,279 ).,334 10,402 19,736 17,880 30,1N57, SA '.

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4 IX-A.-CONSOLIDATED ADMISSION REPORT. White. Black. Total. s to hospitals, excluding Corozal farm d Pronic 'ard .545 477, 1,022 A sions of employees to quarters .28 139 437 Total admissions to hospitals and quarters. 843 616 1,459 .nuher of patients transferred between hospiand from quarters to hospitals, whose admiss areduplicated in above figures. 26 33 59 admlssions'to hospitals and quarters. 817 583 1,400 EMPLOYEES. oyees admiitted to hospitals .109 267 376 yeesadmitted to quarters. 298 139 437 Totnt admissions of employees. -407 406 813 Les number transferred between hospitals, and from s to hospitals, whose admissions are duplic$edin above figures. 11 21 32 Net admissions of employees. 36 385 781 Annual average per thousand of admissions of employees to hospitals and quarters. 972.77 186.29 315.71 B IX-B.--CONTAGIOUS AND INFECTIOUS DISEASES REPORTED DURING TflE MONTR. Panama. Colon. Canal 1'konTotal. on. Zone. resident. ...7 cen pox. 4 1 2 .7 D rhe ...7. ...5 .5 .2 2 ..4 ery.4 1 1 3 9 cus infection. .15 56.71 okwr disease.9 .9 aria11ever. 4 1 53 3 61 .19 3 42 .64 tistiberculous .2 .2 tubI. ..I Map. .1 ...I alia, neonatorum. .1 I .2 ..2 ,acute.9 2 3 1 15 S ..2 14 .16 y ..1 1 21. 4 hpg cc h. 3 ...3 1

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7 I. a. ..0 .0a .a o a a .aa.aaov q fa .7 ao. ~Jg .....o ..a.IIxuV ~P00 ooIrniw ~.0.~T~ H.:m ff 2, SO tl P03 :sTdsoHo M0'U~O .9.004M 89 081 RZTL ..*.0. 0.UUIZ T1~1'T **. .. 9.tyfl 9N619 LT IJI .'I1NV0SN0 SaaLjridI'a seegl0u joMfijutnt iiaA j'jI

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45 EXI.-DEATHRATES AMONG AMERICANS ON THE ISTHMUS CONNECTED WITH THE PANAMA CANAL. Annual death rate per 1,000 population. t women and children from the United States: Disease. .-----------------------------------------------------4.65 External causes.---------------------------------------2.33 Total.-----------------------------------------------------6.98 Wbit. employees and their families from the United States: Disease---.......------------------------------------------2.57 External causes---------------.-------------------------------1. 29 -----. ....--.-.-. .-. .---.........-. 3 .86 TABLE XIL-FINANCIAL STATEMENT, DEPARTMENT OF HEALTH, NOVEMBER, 1917. November, October, November, 1917. 1917. 1916. Administration, general expenses: Chief health office.-------------------1,116.50 $664.53 $1, 282.84 Stock. ------------------------1256.40 1 2,436.25 $uepense.----------------------------192.56 185.12 Reserve for new tools. -------------------------------------2,176.75 Vacation pay-. .-------------------------. .2,743.69 Total.-----------------------------767.54 11,586.60 6,203.28 ilospital division: Ancon Hospital-----.---------------36,535.52 38,405.23 29,005.16 Corozal Hospital and farm-------------7,986.20 9,092.30 6,587.30 Colon Hospital----------------. 5, 783.35 5, 394.22 4, 378.52 Palo Seco Leper Asylum--------------2,530.13 2,221.84 1,627.35 Santo Tomas Hospital----------------1,200.16 1,052.00 865.00 Medical storehouse. --------------------1,216.87 993,38 698.68 TotaL.--------------------------55,252.23 57,158.97 43,162.01 a y division: health office, Panama----------------3,673.62 4,505.29 3, 549.60 eet cleaning, Panama. ,694.62 4,815.64. 3,870.82 ealth office, Colon-Cristobal----------3,112.12 2,864.10 2,676.67 $treet cleaning, Colon-Cristobal. 2,747.84 2,724.49 2, 040.94 Zpne sanitation.:. 10,988.35 11,009.42 1 38.00 Total.-.--------25,216.55 25,918.94 12,100.03 ies. 3,642.86 4,374.'02 2,630.76 tine division. 5, 452.42 6, 265.36 5,072.86 RECAPITULATION. tration, general expenses. 767.54 1 1,586.60 6,203. 28 I division.55, 252.23 57,158.97 43,162.01 division. .25, 216.55 25,918.94 12, I0Q.03 saries. 3,642.86 4,374.02 2,630.76 division. 5,452.42 6,265.36 .5,072.88 T.otal. .90,331.60 92,130.69 69,168.96 I Credit.

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C 46 TABLE XIII.-ANCON HOSPITAL. REPORT OF DAYS LOST 11t HOSPITAL. Class. American. 'Foreign. Black. Hospital: Panama Canal employees.-. 402 453 1,942 Panama R. R. employees. 206 308 2,609 Army and Navy. 2213 Panama Government pay cases -----.-. ..------------675 Other pay patients. ..638 Charity cases.----------------------642 184 761, Total. .-------------------------4,101 1,821, 7,991 Asylum: Panama Canal employees. -31 62 147 24 Panama R. R. employees.-. ..86 Army and Navy.-. 73 ----------Panama Government pay tases. 124 1,437 6,218. 7,77. Other pay cases. 12 60 i872 Charity cases. .,050 .42,.2 2 Total. .--------------------------240 1,821 8,688 1 Chronics .-----------------------------.----.--. .-820 Cripples. .266 1,581, Grand total.--------------------4,341 3,908 19; 080 21,3k Nonresidents, hospital. 1 Nonresidents, asylum. Cost of subsistene per patient per day, $0.2962. WARD LABORATORY REPORT. Blood examinations, total number. Estivoautumnal. 4 Quartan. Tertian.-iferntalcont----------------------------------Differential counts ..4 Hemoglobin estimations. Leucooyte counts. Red blood counts. Stool examinations, total number. Ameba. Ascaris lumbricoides.-.:. Balantidium coli Ciliated monads. Guaiac tests. Pus and blood. Strongyloides. Tenia saginata. Tricocepihalus dispar. I.-2 Unceinaria (ova). ----------------Urine examinations, total number.88 Albumin .. Bile. Casts. Ciliated monads. Epithelia. Guaiac tests. Heihin crystals. Indican. Pus and blood. Sugar (positive 12, negative 144).

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47 TABLE XII -ANCON HOSPITAL-Continued. Saminations, total number. ..403 4tive for tuberele ba2illl .44 m axaminations. total number. 35 Urt ra. ..17 agn .....;. 2y0 ... Spi alflu d. ........16 SURGICAL OPERATIONS PERFORMED DURING MONTH. Number. Died. Amputations: Digits, multiple. 1. operations on bones: Wiring of fractures; compound. 1. A omy: gnal. single.13. Inguinal, double. 4 Berniotomy: Ingu-al, singe .6 Gatro-urinary tract: .Urethrotomy, internal. 2 'Epididyotomy ..1 -. Amitation of scrotum.4-------Curettage uteri. 7 -. Perineoplasty. ..2 obstetrical: High forceps. L.ow foreeps. 2 --rmeorrh-apy. .1 Thoracotomy. 3 1 ~Rectum: Hemorrhoids, radical eure. 5. Fistula in ano, excision Of. 1. Geeral: Thyroidectomy. .I. Vmncose veins, excision of. 1. Tenorrhaphy..-. .1 Decision of surface neoplasms. .2. Plastic operation for congenital defect.2. ,batic operation for effects of disease.3. r general peritonitis (not traumatic or appendicial). 2 2 For ntestinal obstruction. 1 1 ppendectomy. 11 .. pede9tom with local peritonitis. 1 ginal y~sterectomy.3. Hysteromyomectomy.3. go-cophorectomy. 3 Spensiouteri. 3. Qr Ectopic gestation.1. or stab wound of abdomen.2 1 or operations, various. 95 Toal189 5 .W.0.18 REPORT OF OPERATIONS, EYE AND EAR CLINIC. y. ..37 tomy. ..30 S. 6 .transplantation. ..3 .. op ... To a1 ...........................t PAra4J"oWs.

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48 TABLE XIIL-ANCON HOSPITAL-Continued. REPORT OF OUT-PATIENT DEPARTMENT. m Clinic. Total New Pay visits. cases. cases. t Medical.--------------------272 205 41 A Surgical. ..-----------------------------294 1381 6 Eye and ear.---------301 1801 11 Total. .---------------------------867 523 48. jH REPORT OF X-RAY DEPARTMENT-CLASSIFICATION REPORT OF OASE FOR DECEMBER, 1917. FleuroDiseases. Injuries. TreatmJt. scopic. Tra Head.---------------------------12 4 -------Spine.-----------------------------------3 Chest---------------------------5 3 2 Abdomen----------------. 7 Pelvis----------------------. .9.-------------------Gastro intestinal. -----------------14 .----------------Dental.------------------.----11 ---------------------------'Upper extremities------------4 41 ---------Lower extremities. ---------------4 451 ------Total-----------------------66 96 21 T o t ....................:4 REPORT OF VACCINATIONS. Number of adults vaccinated. ....----------------------------------------Number of takes ---------------------------------------------------19 MONTHLY REPORT OF BOARD OF HEALTH LABORATORY, JANUARY 2, 1918. Bacteriological examinations: Blood cultures (3 positive B. typhosus; 1 positive B. coli)------. Agglutination reactions (1 positive B. typhosus)-----.--------. Throat cultures (7 new and 39 repeated positive for B. diphtheria).Stos----------------------------------------Stools .................-. .-Urine (3 positive Staphylococcus aureous and 3 positive B. coli) ---------. Sputum (4 positive B. tuberculosis).------------------------------Culture from surgical tissue (tonsils).---------------------------Spinal fluid. ........---------------------------------------------Fluid from knee.---------------------------------------Smears, vaginal. ------------------------------------------------Smears, eye. ....----------------.-----------------------------------Smears, urethral.--.---. Culture of pus from knee joint (positive Streptococcus)-. .:-.Blood, smear for malaria. ....----------------------------------Culture from organs of cow --------------------------------Smear of blood from horse .-..-.---Bacterial counts of milk.----------------------------------Culture from pus from abscess of cow (for autogenous vaccine) A Cultures of water from Balboa swmmng pool---------------. ...Examination of leper suspect (negative).

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49 TABLE XIIL.-ANCON HOSPITAL-Continued. examinations: D ilk from Corozal farm. 2 MiJk from supply department (Sheffield farm). 1 M o he 'sm ilk -.-----...----.-.--.---.-...2 28 Urin ....2 Porter, from Panama health office. ..---. sirup," from Panama health office .1 picklee" from Panama health office. 1 Ilaneous sausage. .1 ted lime from medical storehouse. 3, thological tissues prepared. --.70 Autopsies performed.-.-. 20 Tissues reported, surgical. 36 Autopsies, animal (chickens, 24) .24 Rats examined (mus musculus, 1,266; mus norvegicus, 251; mus alexan4rirns, 19; mus rattus, 135).-.-. 1,671 -------s .w -------.-w----------------.-.---------.....2 1 Buried at Corozal. Em balm ed ...7 Bodies shipped to United States .7 Taken to Panama. 4 sot to Colon. -------.---.---------------.2 MONTHLY REPORT FOR DECEMBER, 1917. Wassermann reactions. 791 Txboid vaccinations. .12 0 a. w pox vaccinations. 5 Autogenous vaccines prepared -. 2 HZAL UOSPITAL-STATEMENT OF COMMITMENTS, DISCHARGES, AND DEATHS. COMMITMENTS. Male. Female. m Canal Zone, first admission. 8 6 Government, first admission. 1 1 Total.9 7 DISCHARGES. Well. Improved. Unimproved. Male. Female. Male? Female. Male. Female. us raia ..-. ..... In i ......I. .;. .. ..... o P4. ....I UnPedStates. ...1 .1 Veneu I a ....... .2 .3 S1 deportatipn to Australia; 2 deportations to United States.

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50 TABLE XIII.-ANCON HOSPITAL-Continued. DEATHg. Medical diagnosis. Mental diagnosis. Me,.A Tuberculosis of the lungs. Dementia precox, catatonic. Imbecility. Imbecility--------------------1 Pellagra. Toxic psychosis. TABLE XIV.-COLON HOSPITAL. REPORT OF DAYs LOST IN HOSPITAL. Class. American. Foreign. Black. Panama Canal employees. 100 25 189 Panama Railroad employees. .94 54 337 Panama Government pay patients. .13 52 Soldiers-. 54 2 .-Other pay patients. 495 90 2i8 Charity patients. 34 6 31. Total. 777 190 827 1 794 LABORATORY REPORT. Blood'examinations. .I Esti o-autumnal. Tertian. Differential counts. 1 White blood counts. R ed blood counts. .....-. .-Hemoglobin estimations. Stool examinations. Oxyuris vermicularis. Strongyloides. Ciliated monads. Pus. Blood. lUncinaria duodenalis.Ameba. Urine examinations.-. Albumen.-.: Pus. Blood Casts.-.:. Bile. Sugar. Sputum examinations -Positive for tubercle bacilli. .. Smear examinations. .11 Positive for gonorrhea. Autopsies.

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51 TABLE XIV.-COLON HOSPITAL-Continued. SURGICAL OPERATIONS. on bones: y decom pressive. -.-. ...-. ....1 Lg periosteum of left tibia .1 ,sin gle .....-.---.----. .--. .-. ..--. .5 Inguinal, double. .........................2 Isingle---.-.----..-.-.-.-.----------g double.------------------------------------------------1 Gento-rinry tract: sgle, radical c ------------------------------------.3 dyrocele, single, radical cure------------------------------------1 Ryrcle oblrdical cure------------------------------------------13 Hyroel, gule, radical cure. 1 (urettage uteri. ..1 riab section, abdominal .--------------.------------------.-. -2 E ion of breast ----......-------------------------------------------1 Remorrholds, radical cure. --------------------------------2 Aneurismorrhaphy. ....-----------------.-----. ----------------------11 varicose veins, excision of.-------------------------.--------.------1 Laaotomy: Exploratory ..........-----------. .-------------.-------------------1 Appendectomy---------. ---------------------------------A dectomy with general peritonitis. .-.1 ...etomy, single.------------......---------------------------1 gectomy, double. .------------------.-----------------------1 Ovanacystectomy. .......-----------------------------------------1 -op-orectomy .---------------------------.-------------------2 Snspensiouteri. .....------------------.---------------------------2 Minor operations, various---------. .----------------------------14 i operation, various (dispensary)-----------------------------. 87 Nrmal deliveres. 4 TABLE XV.-SANTO TOMAS HOSPITAL. RemainAdRemainClass. Ing mitted. Died. charged. Ig Dec. 1. Dec. 31. aaes. .40 118 1 127 30 iases. 382 762 79 675 390 Tota. 422 880 80 802 420 Americans. Other nations. Number Class. treated. White. Black. White. Black. ys ....158 3 .--. 55 100 h. 1,144 2 132 1,010 .1,302 5 .187 1,110 relief furnished patient. ..13,415 tients constantly ick .-. .432 Ay= treatment each patient admitted .10 perptient per day.-.---------------. $0.56 11 died. 41.

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. 52 TABLE XV.-SANTO TOMAS HOSPITAL-Continued. 'DTSPENSARY REPORT. Class. .White. Black. Tm Natives treated. ..--------------------------------45 .275 .A. E Foreigners treated.-------------------------------. 2) 919 Total.-------------------5 1,194 -Nq. cass T yphoid fever-. .........M alaria .......-. .67 Measles. Diphtheria and croup. Influenza. .--------------------------------------------.------. Dysentery. ......----------------------------------------------------3 Erysipelas.----------------------------------------------------3 Other epidemic diseases. 2 Purulent infection and septrcemia. 4 Pellagra. .2 Beriberi. .........--------------------------------------.,.A., Tuberculosis of the lungs.--------------------------------------4. Syphilis. 2 Soft chancre.-------.-----------------------------------------"' Gonococus infection.-----------------------------------------Cancer and other malignant tumors of the peritoneum, intestines, rectum-. 2 Cancer d hr maliant tumors of the breast. Cancer and other malignant tumors of the skin.Cancer and other malignant tumors of other organs and of organs not specified. 2 Other tumors.------------. --------------------Acute articular rheumatism ......12 Peukema------------------------------------------------------Berikeria. .w. .. A nem ia, ch orosis. .......... Othe general diseases .Other chronic poisonings. Paralysis without specified cause. .Other forms of mental alienation..,.Epilepsy. .---------------------------------------------------. Neuralgia and neuritis. --. ------------------------------------------4 Other diseases of .the nervous system.rs .. Other diseases of the eyes and their annexa.1 Diseases of the ears. Organic diseases oftheheatt. ..------. Diseases of the arteries.---.-------------. Diseases of the veins. Diseases of the lymphatic system .----------------------------Hemorrhage other diseases of the circulatory system.----------------Diseases of the nasal fossae:. Chrole bronchitis.-----------------------------------------...-. Broncho-pneumonia. Pneumonia. .A Pleurisy. .. A sthm a ............Other diseases of the mouth and annexa. Diseases of the pharynx. O r i diseases of the heoatt-----.---w. .. OteDiseases of the sphtomchst-----------------------------------Diarrhea and eteritis Diarrhea and enteritis (2 years and over). ----------Ankylostom iasis. ..............................-7 Intestinal parasites. .......................N1 Ahronictsron typhlitis. .------------------------------.,. llroia inestia obstruction-----------------------------------Hneumson iaa s. ......., 1 Diseases of the anus and fecal fistula.----------------------Other diseases of theintestines .---------------------------.

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53 TABLE XV.-SANTO TOMAS HOSPITAL-Continued. No. cases. sisof the iver.-------------------------------------------2 diseases of the liver. ......----------------------------------------3 g 's disese (chronic nephritis).-.--...-----------------14 diseases of the kidney and annexa.-------. 2 :of the bladder -------. ..------------------------------------1 Ses of the urethra. .-.------------------------.-.-.-. 4 onvenerea1 diseases nf the male genital organs --.-----------------------4 .---------------* ----.-.-.-. -. .-------------------4 th r diseases of the uterus...-.-..8 pingitis and other diseases of the female genital organs.---------------7 npuerperal diseases of the breast. ...----------------.------------------3 r labor----. ..----------------------------------------------. 81 A ts of pregnancy. ...------------------------------------------19 -le------------------------------------------------------. .3 toabscess.-.-------.----.--.-.:--------------------------14 iseases of the skin and annexa ......-------------------------------28 s of the bones ...-------------------------.------------------1 as of the joints. ..--------------------------------------. .------2 Congenital malformations.-.-----------------------------------------4 Nprslings discharged from the hospital without disease.-------------------78 raumatism by firearms---..........-------------------------------------1 Traumatism by cutting or piercing instruments-. ----------------9 Injuries by animals --------.......------------------------------------1 S-----------------------------------------------------------------------1 ----tures. ...---------------------------------------------------10 tber external violence ...-----------------------------------------17 eases not specified or ill defined ......----------------------------------3 N isease .......----------------------------------------------------A1*oholism (acute or chronic)------......-------------------------------12 Total patients discharged during month--------.---------------02 s -among patients. ........------------------------------------------80 tents remaminig in hospital at end of month.-----------------------420 Total number of patients treated during the month -----------.---1,302 SURGICAL OPERATIONs. j dnectomy: nguinal, single. 8 Inguinal, double--------------------------------. 3 otomy: -nginal, single. 7 inal, double. .1 Ve t a ..!. 2 C omy,suprapubic-. ternal.-------------------------------------------------4 xternal. ..-. ......-. ........4 H ce e, single, radical cure. .2 vision -----------------------------------.------16-------etomy. .1. 1 ageuteri .7 Ssection.-. 2 of breast .--. 1 oh ids, radical cure.-. 6 .p.ul in sn, raxcal cure ..r. .6 i no, excision o-'1A 8ki gr ft .......1 omy.-. 11 coly .........11 Aoies cliver:-----------------------2 b atotomy r ..1 T r t tom y for. r e toto y for ....... yome tomy. .1

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54 TABLE XV.-SANTO TOMAS HOSPITAL-Continued. Salpingectomy: No. Single. .-------. Double ----------.---------------------A" Salpingo-oophorectomy.........-------------------------Qophoroectomy -------------------------------------------. Suspensio-uten Major operations, various other ---------------------------------Minor operations, various -----------------------------------------------Tonsillectomy .----------------Pterygium ----------------------------------------------------------4 Total--...............---------------------------------------------LABORATORY REPORT. Urine examinations.52 Albumen. Hyaline casts. Granular casts. Mucusandpus. Blood. .7 pu. S hosl ates. 7 Sugar. .19 Stoolexaminations. 80 ncearia. ongy Tricocephalusdispar. Ascaries. Mucus andpus. 4 Ciliatedmonads. Blood. Sputumexaminations. Positive for tubercle bac1ll. S 2 Blood examinations. .seran. Estivea. Throticutus ..I Myelocyte, leukemia. Phite blood counts. I Wassermann reactions. Positive .7. Throat cultures. a Positive for diphtheria .:. Widals reactions. Positive Smears examined. Positive for gonococci. .:. Blood cultures .w. .. Surgical tissues .z. Autopsies performed. 9 4W iLA

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55 TABLE XVI.-REPORT OF ROUTINE SANITARY WORK PERFORMED IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Panama. Colon. Canal Zone. Linear yards of new ditches constructed---------. .3,680 2, 985 -. Inear yards of ditches maintained. --30,583 Aores of vegetation removed. .----------------73.6 100. 4 Number of garbage cans emptied daily--------. --------------------4 685 Cubic yards of garbage removed during month. 9,745 3,839 Square yards of streets cleaned daily-----------. .600,000 125,829 $quare yards of alleys cleaned daily .------------600000 20968 t closets inspected during month.--------.-.--8 -s disinfected during month.-.-.-.-.---------.326 Number of water containers treated-------------9,628 110,91Number of mosquito breeding places destroyed 191 121 19 umber of containers found with stegomvia larvI.-.-. 1 r of mosquitoes destroyed in dwellings: Anopheles ---..-.-------------------..-------------345 896 Stegomyia ......----------------------------------------------230 Culx. .----------------------------------------787 5,399 oNmber of fly-breeding places destroyed-----------136 8 7 umber of rats destroyed .-.-. 1,197 378 1,060 rvate properties cleaned during the month.-----27 5, 520 umber of notices served to abate nuisances -----346 1,001 victions for Violations of sanitary code----------11 4 s-collected.-----------------------------------123 sos disinfected or fumigated. ------------------17 -.-. 41 Sq aeyards of pools oiled.293, 440 230,30 -----B iings sected.-----------------. --------5,636 10,880 5)530 Buligs, destruction and repair: Plans fonew buildings approved --------------4 -2 Permits issued to repair old buildings ----------97 50 Buildings dem olished:.-.-...3 -.---inspection: 1 Dairies, milk vendors, etc. .-------------1. 8 Bakeries, candy kitchens, ice-cream parlors 25 95 Bottling works---------------------------3 ,. Hotels; clubs, restaurants. ..--------------------------261 8 Markets, fi-uit stands, miscellaneous.-----------66 1,124 70 t.al used during the month: Crude oil, gallons .-----------------------3,800 3,167 5,894 Larvacide, gallons ....------------------------547 212 73 Kerosene, gallons ...-------------------------205 .429 TA XVII-CONSOLIDATED REPORT OF QUARANTINE TRANSACTON AT THE PORTS OF BALBOA-PANAMA AND COLONCrTOBAL. inspected and passed.--------.------------------------219 in quarantine-----------. .....-----------------------------3 inspected ana transiting canal in quarantine.-----------.----------7 passed on medical officer's certificate. 3 Total vessels entered. .232 utal inspections of detained vessels. ------------------------9 ntal inspections of vessels at docks. ....--------------------------69 it gated on arrival. .I. 15 s migrated prior to departure. 1 ealth issued. 200 B fhealtb vizded. 164 edon arrival. .9,007 inspeted on arrival.-. 3,362 Tota1 persons ispected on arrival. 12,369

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56 TABLE XVII.-CONSOLIDATED REPORT OF QUARANTINE T AN TIONS AT THE'PORTS OF BALBOA-PANAMA AND CUL CHRISTOBAL-Continued. Crew passed on medical officer's certificate. .-------------------. Supplementary inspections of passengers and crew.--Persons vaccinated in port on arrival .-. -Persons vaccinated in port of departure or en route .9Total persons vaccinated.----------------------------------1, Persons detained at quarantine stations to complete period of incubation of yellow fever and bubonic plague..-.-.--Persons detained on board vessels.Total persons detained in quarantine -,------------------------Persons landed from foreign ports: C ab in ........-.-. ..-.--S teerage ...--.-..-.-.-.--Total.-----------------------------------------------Persons arriving from coast towns in small launches and sailing craft.,Persons departing for coast towns in small launches and sailing craft. Persons in transit passing through the canal. ....-------------------, Persons in transit for Pacific ports not passing through canal on anrivbjg v essels. ....-. .--Persons in transit for Atlantic ports. Immigrants rejected ana. deported.-.-. IMMIGRATION REPORT FOR THE PORTS OF COLON-CRISTOA AND BALBOA-PANAMA. From-Cabin. 8 United States.-----------------------------------------. 531 Europe. 2 Cuba-. 9 Porto Rico.--------------.----------------. .--.--. 24 West Indies (not shown above) ----------------------------24 Costa Rica.-. 14' Bocas del Toro, Republic of Panama. .36 Nicaragua. Colombia. .613 Venezuela. .....-------------------------------------Ecuador. ---------------. Peru. ., ....---------------------------------1 Chile----.:--------------------------------------------1 Total---------------------------------------------71 M en e. .. W omen--. Children.------------------------------------. Total-----. ------------------------------------

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57 UARANTINE TRANSACTIONS AT THE PORT OF BOCAS DEL TORO PANAMA. % inspected and passed. 25 Inspected and passed. 838 inspected and passed. 164 rs,in transit, inspected and passed. 414 o quarantinable disease has appeared in this port, and the health conditions of the po ad surrounding territory continue good. TABLE XVIII.-PERSONNEL REPORT. I December, 1917. NovemDecentber 1917 ber 1916 Gold Silver Total (total (total employemployemployemployemployees. ees. ees. ees) ees. hfhealth office.3 3 3 3 d storehouse. 5 4 9 8 8 tine division. 13 35 48 48 46 elioffice, Panama. 14 143 157 151 152 oth ffice, Colon. 13 142 155 151 158 Hospital. 117 211 328 336 1370 Cospital. 19 26 45 47 43 Tomas Hospital. 6 .6 6 6 Seco Leper Asylum. 2 29 31 29 36 o sanitation. 4 158 162 149 121 or l pital. 18 100 118 116 268 .6 4 10 8 8 oMiguel. 2 2 4 4 3 .2 2 4 4 4 G oa. .i 1 1 1 at .2 2 4 44 TVotal.,. 227 858 1,085 1,065 1,031 I Includes Corozal Hospital. 2 Corozal Hospital included above. .100 WE **

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DIVERSITY OF FLORIDA 3 1262 08896 2237


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