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:
September 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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PAGE 1

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REPORT OF THE HEALTH DEPARTMENT OF THE PANAMA CANAL FOR THE MONTH OF SEPTEMBER, 1917 ALBERT E. TRUBY, Colonel, Medical Corps, United States Army Chief Health Officer, Balboa Heights, Canal Zone WASHINGTON 1917

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CONTENTS. Page. Letter of transmittal.-------------------.----..5 General remarks. .5 Vital 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. .8 Board of health laboratory. 8 Chronic ward. 9 Colon Hospital. 9 Palo Seco Leper Asylum. 9 Santo Tomas Hospital. 9 Division of Sanitation: Canal Zone. 9 Panama. -. 10 Colon.11 Quarantine division .11 Statistical tables: Table I. Admissions, deaths, and noneffective rates for employees; deaths of residents of Panama, Colon and the Canal Zone. 12 II. Causes of deaths of infants by sex, color, age, and place of residence. .14 III. Deaths by nationality. 16 IV. Birth and infant mortality rates in the Canal Zone and the cities of Panama and Colon. 16 V. Causes of deaths of employees, arranged with reference to age and length of residence on Isthmus. 18 VI. Causes of deaths of civil population (employees and nonemployees) and military, by sex, color, age, and residence. .20 VII. Discharges and deaths m the hospitals of The Panama Canal. 26 VIII. Consolidated hospital report. 36 IX. Consoldated dispensary report. Report of contagious diseases.:. 38 X. Employees: Constantly sick and noneffective rates per 1000; number of days' treatment per admission, hospitals and quarters. 39 XI. Deaths of white Americans connected with The Panama Canal. 40 XII. Financial statement .41 XIII. Ancon Hospital. 42 XIV. Colon Hospital. 46 XV. Santo Tomas Hospital. 48 XVI. Sanitary work done in the Canal Zone, Panama, and Colon. 51 XVII. Quarantine transactions. 51 XVIII. Personnel report. 53 (8)

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LETTER OF TRANSMITTAL. THE PANAMA CANAL, CANAL ZONE, HEALTH DEPARTMENT, Balboa Heights, Canal Zone, October 11, 1917. Col. CHESTER HARDING, Governor of The Panama Canal, Balboa Heights, Canal Zone. SIR: I have the honor to submit the following report of the operations of the health department for the month of September, 1917. Col. D. C. Howard v as relieved from duty with the Panama Canal by War Department orders on October 4, 1917, and the undersigned was appointed chief health officer on October 5, 1917. Respectfully, ALBERT E. TRUBY, Chief Health Officer. GENERAL REMARKS. The health of employees and nonemployees of the Canal Zone and the terminal cities has continued good. No secondary cases of infantile paralysis have followed the case reported in August. The rigid measures taken in the Balboa district to reduce the prevalence of measles and diphtheria have produced excellent results, and the epidemic has practically subsided. The schools were therefore able to open at the scheduled time. Two cases of leprosy were discovered during the month; one, a native of Colombia, was returned to that country; the other was transferredto Palo Seco. One case of cerebrospinal meningitis and one case of tetanus were admitted to Ancon Hospital; both terminated fatally. VITAL STATISTICS. EMPLOYEES. The follo-ing statistics are based upon the total number of names Appearing on the pay rolls of The Panama Canal and the Panama Railroad Co. for the preceding month, which was 31,307. ~ Admissions to hospitals and quarters numbered 997, a rate of 382.15,1 as compared with 424.94 for the preceding month and 261.99 for the corresponding month of last year. 'All morbidity and mortality rates are computed as equivalent annual per 1,000. (5)

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6 Deaths from all causes numbered 24; of these, 19 were from disease, giving a rate of 728 from disease alone, as compared with a rate of 7.57 for the preceding month and 3.58 for the corresponding month of last year. The constantly noneffective rate was 10.75, as compared with a rate of 10.35 for the preceding month and 8.88 for the corresponding month of last year. Disease causing the highest admission rates to hospitals, in the order of their numerical importance, were: (1) Malaria, (2) venereal diseases, (3) influenza, (4) diseases of the pharynx, and (5) diseases of the eyes and their annexa. These five diseases caused 36 per cent of all admissions to hospitals, malaria alone causing 15 per cent and venereal diseases 13 per cent of all admissions. The admission rate for malaria, hospitals and quarters, was 28.36, as compared with 19.46 for the preceding month and 13.95 for the corresponding month of last year. The constantly noneffective, rate from malaria was 0.74, as compared with 0.58 for the preceding month and 0.67 for the corresponding month of last year. By race.-For disease only, the admission rate to hospitals and the death rate for white employees were 294.81 and 7.50, respectively, as compared with 273.85 and 2.47 for the preceding month and 222.33 and 7.94 for the corresponding period of last year. For black employees, for disease only, the admission rate to hospital and the death rate were 127.68 and 7.25, respectively, as compared with 132.96 and 8.44 for the preceding month and 69.94 and 2.89 for the corresponding month of last year. The constantly noneffective rates were 17.35 for whites and 9.55 for blacks. The admission rate to hospitals and quarters for malaria was 42.47 for white and 25.81 for colored employees, as compared with 17.27 for white and 19.84 for colored employees for the preceding month and 26.47 for white and 12 for colored employees for the corresponding month of last year. For American employees, the admission rate to hospitals, from disease only, was 255.38, as compared with 248.91 for the preceding month, and 180.34 for the corresponding month of last year. CANAL ZONE. The civilian population of the Canal Zone, based on the police census, taken as of June 10-30, 1917, is 24,038. From this population 28 deaths occurred during the month, 25 of which were from disease, giving a rate of 11.50 from disease alone, as compared with 15.47 for the preceding month, and 10.82 for the corresponding month of last year. Of the deaths from disease, 52 per cent occurred among children under 5 years of age, as compared with 39 per cent for last month. Sixty-one births were reported during the month, giving a rate of 30.45. Of these births, 23 were white and 38 colored. Eleven deaths occurred among children under 1 year of age, all colored, giving an infant mortality rate, based on the number of births reported for the month, of 0.00 for white and 289.00 for colored children, with a general average of 180.33 per 1,000 births.

PAGE 9

PANAMA. 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, 123 deaths occurred during the month, 117 of which were from disease, giving a rate of 22.88 from disease alone, as compared with 26.40 for the preceding month, and 30.01 for the corresponding month of last year. Of the total deaths from disease, 50 per cent occurred among children under 5 years of age, as compared with 52 per cent for the preceding month. The principal causes of death as compared with last month were as follows: August. SeptemTuberculosis (various organs). 23 31 Diarrhea and enteritis. 28 17 Pneumonia (including lobar and broncho-). 15 7 Two hundred and fifty-one births were reported during the month, giving a rate of 49.08. Forty-four deaths occurred among children under 1 year of age, giving an infant mortality rate, based on the number of births reported for the month, of 175.30. Of the total births reported, 9 per cent were stillbirths. COLON. The population of Colon, as shown by the health department census of June, 1917, is 26,078; in this population is included approximately 7,000 employees of The Panama Canal. From this population, 69 deaths occurred during the month, 68 of which were from disease, giving a rate of 31.29 from disease alone, as compared with 28.53 for the preceding month, and 31.10 for the corresponding month of last year. Of the deaths from disease, 37 per cent occurred among children under 5 years of age, as compared with 52 per cent for the preceding month. The principal causes of death as compared with last month were as follows: August. Betternber. Tuberculosis (various organs). 12 10 Diarrhea; and enteritis. 6 9 Organic heart disease. 5 8

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8 Eighty-nine births were reported during the month, giving a rate of 40.96. Eighteen deaths occurred among children under 1 year of age, giving an infant mortality rate, based on the number of births reported for the month, of 202.25. Of the total births reported, 8 per cent were stillbirths, DIVISION OF HOSPITALS. ANCON HOSPITAL. The average number of patients constantly in the hospital proper during the month was 534, as compared with 528 for the preceding month, and 470 for the corresponding month of last year. The average length of stay in hospital for each employee admitted was 17.41 days. The construction work on the new hospital is progressing rapidly. The administration building, kitchen and mess building, isolation building, and the nurses' quarters are all under construction; the first two named will be ready for occupancy about January 1, 1918. Twenty-four cases of measles were admitted as compared with 42 in August, 24 in July, and 48 in June. Twenty-two cases of diphtheria were admitted as against 7 in August. Ten cases of chicken pox were admitted in September, being the same number as for the preceding month. Three cases of leprosy were admitted, two of whom were nonresidents. One case each of tetanus and cerebrospinal fever, meningococcic, were admitted, and both terminated fatally. Seven cases of pneumonia were admitted as against 11 for August. Statistical charts are shown under Tables VII, VIII, and XIII. COROZAL HOsPiTAL. The average number of insane patients cared for during the month was 356, as compared with 361 for the preceding month, and 301 for the corresponding month of last year. During September, 11 patients were admitted, 5 died, and 12 were discharged. The admissions include one retransfer from Ancon Hospital. Among the discharges are included 8 patients who were deported to the United States. The general health of patients and cripples remains good. Statistical charts are shown under Tables VIII and XIII. BOARD OF HEALTH LABORATORY. With a view of determining whether or not the native hogs were immune from hog cholera, a Colombian hog was secured from the supply department, and allowed to eat a bit of intestine containing hog cholera ulcers. The animal gradually became weak and emaciated and died one month later with the t pical lesions of hog cholera. As the Panamanian hogs are probably of the mame breed as the Colombian, the former are in all probability susceptible to the disease.

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9 In addition to the above, three moribund Colombian hogs, also sent us by the supply department in Criotobal, during the progress of the above experiment, likewise showed lesions of hog cholera, but there was also a complicating verminous pneumonia. An examination of 10 horses upon the estate of Mr. Alejandro de la Guardia, on the Tapia River, showed that eight of them had trypanosomes in their blood, although only two of them were thought to be sick. These horses were kindly placed at our disposal by Mr. Guardia for the purpose of allowing us to carry out experiments on the treatment of murrina. The therapeutic action of several drugs recommended in other trypanosomiases of the horse is being investigated. A report of routine operations is shown under Table XIII. CHRONIC WARD. The average number of chronic patients cared for during the month was 33.33. Four patients were admitted to, 1 discharged, and 3 transferred from this ward during the month. COLON HOSPITAL. Fifty-five patients were constantly cared for in the hospital during the month as compared with 57 for the preceding month, and 33 for the corresponding month of last year. The average length of stay in hospital for each employee admitted was 8.32 days. Statistical charts are shown in Tables VII, VIII, and XIV. PALO SEco LEPER ASYLUM. An average of 66.56 patients were constantly cared for during tbo month, as compared with 65.61 for the preceding month, and 69.40 for the corresponding month of last year. During September, two patients were admitted and one disSANTO TomAs HOSPITAL. One thousand two hundred and fifty-six patients were treated during September, as compared with 1,325 for the preceding month, and 1,382 for the corresponding month of last year. The daily avera uuber of patients under treatment was 440, as compared with 467 for the preceding month,. and 447 for the corresponding month of last year. The total number of days' treatment was 13,648, as compared with 14,173 for last month. Seventy-eight deaths occurred at the institution during the month with (1) tuberculosis, (2) congenital debility, and (3) diarrhea and centers, the chief causes in the order named. Statistical charts are shown under Table XV. DIVISION OF SANITATION. CANAL ZON:. The following table shows the average monthly admission rate from malaria among employees to both hospitals and quarters for the month of September, the percentages being based on the ratio 20725-17-2

PAGE 12

10 of the number of admissions from each district to the total number of employees residing therein: Number of Number admisAverage of sons motly District. emfrom adpnsployees. malaria mon during rate. month. Balboa .2,668 2. 0.075 Ancon-Corozal. ....-------------------------------1,151 Pedro Miguel.-. 1,352 4 .296 Paraiso .995 2 .201 West of Canal.367:. Gatun. 1,136 6 .529 Cristobal-.-. 3,414 17 .498 Colon-.--. 7,115 14 .197 Panama. 8,383 1 .012 MiscellaneousI. 3,809 28 .735 Total..31,307 74 .236 1 Employees engaged in pasture and jungle clearing, etc., outside of above sanitated areas. PANAMA. An improvement which has been contemplated for some time is the construction of a new slaughterhouse. Plans are now under consideration by the municipal council, Panama, and it is hoped that the work of construction will begin shortly. A considerable decrease in the malarial rate is noted as compared with the previous month. This is probably due, in a large measure, to our present system of investigating these cases. Formerly Santo Tomas Hospital reported cases of malaria treated in that institution by simply giving the number of cases and the district to which chargeable. Names and addresses of patients were not furnished, so there was no way for our inspectors to determine definitely the probable source of infection. At the present time each malarial case treated in Santo Tomas Hospital is reported by card, giving name and address of patient, and from an investigation of the cases treated during September it appears that many of the cases became infected 'outside of the city. This speaks well for the efficiency of our antimosquito work. The past month has also shown a decrease in the number of cases of tuberculosis. Many cases were investigated during the month and home conditions noted. Our inspectors have been instructed to see that all obstructions of transoms over doors and windows be removed in order to permit of a better circulation of fresh air. In all new dwellings, for which permits are granted, we are insisting on larger windows and requiring shutters to be of lattice work in place of the tight board shutters that are now found in many of the tenement houses in Panama.

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11 As a large percentage of our .deaths among infants occurs among the poorer families of the city, who are ignorant of the proper care of babies, the work of our visiting nurse has been directed along educational lines. The Panamanian Red Cross are also working along similar lines in connection with their baby clinic. A pamphlet on the care of babies is now being prepared, and if approved, it is proposed to have copies distributed at the baby clinic at Santo Tomas Hospital, at the Panamanian Red Cross clinic, and by doctors and midwives attending the births of infants. COLON. There has been an increase in the malarial incidence during the month, due in part, no doubt, to the rigid enforcement of the law requiring physicians to report all malarial cases. The greater number of cases reported were found to be along the east side of Manzanillo Island, indicating that the source of infection was from the east. With this theory in view an investigation was made of the swamp to the right of Margarita Road, leading from Cocoanut Grove to the Fort Randolph Reservation, and extensive anopheles breeding was discovered. As this swamp is within three-fourths of a mile of New Cristobal, it is doubtless the source of infection. In the Mount Hope district a great reduction has been noted in the mosquito catch, the number of anopheles caught in the barracks at Mount Hope having been reduced from 300 to 2 or 3 per day in the past 6 weeks. The large open drain running across Swamp No. 4 was reopened during the month, thereby eliminating a probable source of breeding in this district. Work on the new fill to be made near the radio station, Colon, is expected to begin within a few days: QUARANTINE DIVISION. Reports from South America indicate that plague is somewhat on the increase, particularly in the cities of Callao and Lima, Peru. This is the time of the seasonal increase of both plague and yellow fever at Guayaquil, Ecuador, though up to the present time the number of cases has been lower than expected. General sanitary conditions in Buenaventura, Colombia, are reported as not as favor-able as in previous months, the sanitary work having been interrupted owing to a failure of supplies. We have had rumors that a resumption of the quarantine against the city of Buenaventura by the city of Cali, Colombia, is contemplated. Conditions on the Atlantic side have shown practically no change. One case of smallpox previously reported and held over from the preceding month at Balboa quarantine was discharged cured. During the month two lepers were brought to Cristobal, one from Colombia, to which country he was returned, the other from Bocas del Toro, Republic of Panama, which case, after bacteriological confirmation, was transferred to Palo Seco. With the exception of the two lepers; no cases of quarantinable nature arrived at or occurred upon the Isthmus during the month.

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12 The inspection of food animals for the month of September wap as follows: For supply department, ante 4nd pot mortem inspections: Cattle. ....,------------------------------------H ogs -. .274 For supply deparltment, quarantine inspections; Cattle. .----------------. .. H ogs .....---267 For outside interests, quarantine inspections: Goats ------Hides disinfected: At Cristobal slaughterhouse --------.---------1,576 By veterinarian, Panama health office. ..--------------1,281 Local quarantine inspections of cattle by veterinarian attached to Panama health office .--------------------88 One case of anthrax occurred during the month in an animal at the Cristobal slaughterhouse. Diagnosis was confirmed by board of health laboratory. Disinfection was carried out, and no other cases of a suspicious or positive nature have occurred. DEPORTATIONS. Ten deportations were accomplished by the hospital authorities during the month, 4 employees and 6 nonemployees, all suffering from disease. In addition to the above, 18 deportations were effected by the quarantine authorities during the month. TABLE I.-ADMISSIONS, DEATHS, AND NONEFFECTIVE RATES FOR EMPLOYEES. Admissions to Noneffechospitals. Deaths. .tive from sickness. P4 a)~~a 4)-4 a. W rn Z & September, 1917: White.-----------4,803 133 118 15 7 3 4 2,501 83.35 Colored. 26,504 353 282 71 17 16 1 7,594 253.15 Total.-. ---31, 307 486 400 86 24 19 5 10,095 336.50 August, 1917: White-----------4,864 128 111 17 1 1 0 2,544 82.08 Colored----------28,430 400 315 85 22 20 2 8,135262.41 Total-.33,294 528 426 102 23 21 2 10,679 344.49 September, 1916: White-----------4,534 100 84 16 4 3 1 1,860 62.01 Colored. 28,994 251 169 82 9 7 2 7,067235.57 Total.-.33,528 351 253 98 13 10 3 8,927297.58

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13 TAt t-.-ADMISSIONS, DEA'T'HS, AND NONEFFECTVE RATES FOR EMPLOYEES-Continued. PROPORTIONATE NUMBERS.1 Septelhber, 1917: White. 4,803332.29294.81 37.48 17.49 7.50 9.99 .17.35 Colored. 26,504159.82127.68 32.14 7.70 7.25 .45 .9.55 Total.31,301186.28153.32 32.96 9.20 7.28 1.92. 10.75 August, 1917: White. 4,864315.79273.85 41.94 2.47 2.47. .16.88 Colored.28,430168.84132.96 35.88 9.28 8.44 .84. 9.28 Total.3 294 190.30 153.54 36.76 8.29 7.57 .72. 10.35 September, 1916: White. 4,534 264.67 222.33 42.35 10.59 7.94 2.65 .13.68 Colored. 28,994103.88 69.94 33.93 3.72 2.89 .83 .8.12 Total. 33,528125.63 90.55 35.08 4.65 3.58 1.07 .8.88 I Annual average per 1,000 employees. TABLE I-A.-DEATHS OF RESIDENTS OF THE CITIES OF PANAMA, COLON, AND THE CANAL ZONE. Deaths. Annual average per 1,000 population. Population. Total DisExternal Total. DisExternal ease. causes. ease. causes. September, 1917: Panama. .61,369 123 117 6 24.05 22.88 1.17 Colon. 26,078 69 68 1 31.75 31.29 .46 CanalZone. 124,038 28 25 3 12.88 11.50 1.38 Total. 111,485 220 210 10 23.68 22.60 1.08 August, 1917: Panama. 61, 369 140 135 5 27.38 26.40 .98 Colon. .26,078 64 62 2 29.45 28.53 .92 CanalZone. 124,038 32 31 1 15.97 15.47 .50 Total. 111,485 236 228 8 25.40 24.54 .86 -September, 1916: Panama. 60,778 160 152 8 31.59 30.01 1.58 Colon. 24,693 67 64 3 32.56 31.10 1.46 CanaiZone. 31,048 34 .28 6 13.14 10.82 2.32 Total. 116,519 261 244 17 26.88 25.13 1.75 I Excluding military population.0

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14 TABLE IL-CAUSES OF DEATHS OF INFANTS BY BEX9 Sex. Color. +Iweek Cause of death. 1 week. -1 M. F. W. B. month. Malarial fever, estivo-autunnal.,. .1 1. Pyemia. .1 ..1 Septicemia. 1 .I1 Tuberculosis of the lungs. 1 1 -. 2. Tuberculosis, miliary. .1 .1 Tuberculous meningitis. 3 .3 Syphilis, hereditary. I .I Meningitis, simple. 1 ..1. Convulsions of infants. 1 Organic heart disease. .1 ... Acute bronchitis. 2 .2 Chronic bronchitis. 1 ... Broncho pneumonia. 2 3 -.15. Acute gastritis.I .. Acute indigestion. 1 1. Gastroenteritis. 11 14 2 23 .2 Colitis. .1 1 Intestinal obstruction. 1. .1 Nephritis, acute. .1. .. D uodenal ulcer. 1 .--. -I ---.1------. Congenital debility, icterus, sclerema.1 I 1 .2 2. Premature birth. 1 3 .I4 3 1 Malnutrition.-----. 1 Other causes peculiar to early infancy. 4 4 6 1 Total. 39 34 7 1661 11 7 Infant mortality rate, based on number of births reported for the month (death Percentage of deaths under one year of age to total deaths for month. 1 Yellow.

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COLOR, AGE, AND PLACE OF RESIDENCE. Age by months. Place of residence. 1-2 2-3 3-4-5 5-6 6-7 7-8 8-9 9-1010-1111-12 ~ Colon. Zone. Total. ma. .--.-.----1. ...1. ..1. ..1 --------..e --* .. 1 .1. .2. .2 .-...---* -~ ------m ------------3 = ......... ..-----------------.. .......1. ..I .1-. ...--. .------------.------......1. ...1 1. ....1. 1 .2 2. ......1 ---.....1. ....1. ..1 1 1 5 4 1 2' .1 1 1 2 158. 25 Z. .......1. .1 I1. .......1. .1 ....I .......1 1-= .....! ...-31 ----4 2 1 -. ....... 1 .......-..-.6 1 1 8 ----=w --1-*"e --. == -e'--______ _____ 7 8 10 10 3 2 11 5 4 2 3 44 18 11 73 under 1 year of age per 1,000 births) .175.30 202.25 180.33 182.04 ..-. 36 26 34 33 I

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TABLE m.-DEATHS, 13Y NATIONALITY. Employees. Nonemployees. Total. Gran Nationality. --Gal. Male. Female. Male. Female. Male. Female. Antigua ..1 .1 Barbados. 3 .14 19 17 19 36 Chile ---------------1 ...1 .1 China. .2 1 2 1 3 Colmbia. ..7 7 7 7 14 Cuba. ..1 .1 .1 Demarara. ...1 .1 1 Germany. ...1 .1 1 Grenada. .1 .2 1 3 1 4 Guadeloupe. .1 .-.-. 1 .2 .2 Jamaica.8. 30 21 38 21 59 Martinique. 2 .2 2 4 2 6 Montserrat.1 1 2 -.-. 2 Nassau. 1 .....1 Panama-. ..34 25 34 25 59 Peru.-. ..1 .1 .1 St. Kitts. ..1 .1 .1 St. Lucia. ..2 2 2 2 4 St. Thomas. ...1 .1 I St. Vincent. ..1 ...1 Switzerland. ..1 .1. 1 Trinidad. ..1 3 1 3 4 Syria. ..1 -. 1 -.1 United States. 6 .5 2 11 2 13 Venezuela. ..3 2 -3 2 5 Costa Rica. .I.1 1 Total. .24 .111 89 135 89 24 TABLE IV.-BIRTHS, AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Births. Rate per 1,00 population. Population. Total. Alive, born. Total. Alive. sil September, 1917: Panama. 61,369 277 251 26 54.16 49.08 5.08 Colon. 26,078 101 89 12 46.48 40.96 5.52 Canal Zone.-. 124,038 66 61 5 32.95 30.45 2.50 Total--. 111,485 444 401 43 47.79 43.16 4.63 August, 1917: Panama-. 61,369 245 225 20 47.91 44.00 3.91 Colon. 26,078 88 77 11 40.49 35.43 5.06 CanalZone. 1 24, 038 53 47 6 26.46 23.46 3.00 Total. 111,485 386 349 37 41.55 37.57 3.98 September, 1916: Panama. 60,778 298 277 21 58.84 54.69 4.15 Colon. 24,693 69 65 4 33.53 31.58 1.95 CanalZone. 31,048 54 52 2 20.87 20.10 .77 Total. .116,519 421 394 27 43.36 40.58 2.78 Exclusive of military forces.

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17 TABLE IV-A.-INFANT MORTALITY RATES IN THE CANAL ZONE AND' THE CITIES OF PANAMA AND COLON. Births. Deaths among Death Populachildren rates per tion. under 1,000 Male. FeTotal. 1 year births. male. of age. September, 1917: Panama. 61,369 137 114 251 44 175.30 Colon. 26,078 44 45 89 18 202.25 Canal Zone.1 24,038 37 24 61 11 180.33 Total. ..111, 485 218 183 401 73 182.04 August, 1917: Panama. 61,369 120 105 225 54 240.00 Colon. 26,078 36 41 77 25 324.68 CanalZone. 1 24,038 24 23 47 8 170.21 Total. 111,485 180 169 349 87 249.28 September, 1916: Panama.-.'. 60,778 161 116 277 59 213.00, Colon. 24,693 37 28 65 23 353.84 CanalZone. 31,048 28 24 52 14 269. 23: Total. 116,519 226 168 394 96 243.65 I Exclusive of military forces. INFANT-WELFARE WORK-PANAMA CITY. Station work: Total number of babies seen. 210 Instructions given to mothers, total cases. 173 Treatments given to babies, total cases. 60 Histories taken. .38 Examinations made. 291 Outside work: Total number of visits made. 1,267 Number of cases not located. 32 Number of cases moved to Colon and interior of Panama. 50 General: Number of breast-fed babies. 210 Number of bottle-fed babies. 27 Number of breast and bottle fed babies. 85 Number of babies on soft diet. 5 Total number of babies seen. 1,477 Number of destitute cases given assistance (by Red Cross). 3 Number of cases admitted to hospital. 10 Number of cases treated at Santo Tomas dispensary. .19. Number of cases treated by physician at station. 30: Defective conditions found: Skin rash. 9 Whooping cough. .2 Number of babies died. 11 20725-17-L-3

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18 TABLE V.-CAUSES OF DEATHS OF EMPLOYEES, ARRANGED WITH Color. Age (in years). Cause of death. W. B. 15-20 21-25 26-30 31-35 36-40 41-45 46-50 5&-65 Abscess of liver.1. .-....1 Abscess of spleen.1.1 .---..Apoplexy, cerebralhemorrhage .3 .-..---------2 Gastroenteritis, chronic. .1. .1 .. Heart, organic disease of. 1 1 .....1 1. Nephritis, chronic .1 1 .......2 Pneumonia. lobar. .2 ..1 1 .. Sarcomatosis, general. 1 .......1 Stricture of urethra. .1. .1 ... Syphilis. .2 ...-. 1 Tuberculosis of the lungs-------2 ...1 1 Rheumatism, acute articular. .1 ...1 External causes: Drowning, accidental. 3 1 1 ..1 1 1. Fracture of base of skull. 1 ..1 ...-. Total. 7 17 1 3 2 6 3 3 4 2

PAGE 21

19 REFERENCE TO AGE AND LENGTH OF RESIDENCE ON ISTHMUS. Length of residence on Isthmus (in years). A __ __ ___ __ ____ ___Unlj-Total. -1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-10 10-12 12-15 +15 ....-------------1 S .1 .1 -..2 ..3 .......-1. .....1 .....2 ......I 1 ..2 ...------------1 1 ...2 ...1. ..1 ..1 .1 .1. .-1 .-. 2 .....-1 ....2 ..........--------1 1 .-1 ...-....2 4 ...1. ..1 ...1. .1 2 .1 4 1 1 1 3 41 3 1 3 24

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TABiE V1.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEES PLACE OF Sex. Color. Age (in years). Cause of death. M. F. W. B. Y. -1 year. 1-4 5-10 General diseases. Typhoid fever. .1. ...-I Malaria.1 1. .. Malarial fever, estivo-autunmnal. 2 3 2 3 1 3 Diphtheria and croup.1. .1 ..1 Dysentery, entamebic. 1. 1 .... Pyenna. I ..1 .. Septicemia. 1. .. Tetanus .1 ..1 .... Pellagra. 3 .3 .... Tuberculosis of the lungs. 23 12 2 33 .2 .. Acute military tuberculosis. .2 1 .3 .1 1 Tuberculous meningitis. 3 ..3 .3 .. Disseminated tuberculosis. .2 .2 .... Syphilis, tertiary. 2. .2 ... Syphilis, hereditary. 1 .1 .1 .. Cancer and other malignant tumors of the buccal cavity. 1 ..1 ... Cancer and other malignant tumors of the peritoneum, intestines, rectum, etc. 1 1 .2 ... Cancer and other malignant tumors of other organs and of organs not spedfied. 1 .... Acute articular rheumatism. 1 ..1 .... Anemia, chlorosis.1 .1 .... Anemia, primary, pernicious. .I .1 ... Alcoholism, chromc. 1 ..... Diseases of the nervous system and of the organs of special sense. Simple meningitis.1. 1 ..... Cerebrospinal fever. .2 2 ..2. Cerebral hemorrhage, applexy.5. .5 ... Paralysis without specified cause. 1 1 .2 .... General paralysis of the insane. 2 ..2 .... Other forms of mental alienation. .1 .1 ... Convulsions of infants (under 5 years). 1 ..1 .1 .. Diseases of the circulatory system. Acute endocarditis. 2 .2 .2 Organic diseases of the heart .9 4 3 10 .1 .. Embolism and thrombosis.2 .2 .... Diseases of the respiratory system. Acute bronchitis-. 2 5 .7 2 5 Chronic bronchitis. 3 1 .4 .1 2 Broncho-pneumonia. 3 3 .5 1 5 1 Pneumonia (unqualified). .1 1 ...1 Lobar pneumonia. 3 6. 6 ..2.

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AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE, AND RESIDENCE. Age (in years)-Continued. Place of residence. Total. 11-20 21-30 31-40 41-50 51-60 61-75 76-100 Panama. Colon. Canal Zone. ..--................................-. 1. ...-. ... ..I .1. .14 1 1 *1 1 --------------. ...------1.-------........1 ....-.--.-----1 25 9 35 11 2. ...2. 3 ------------------3 ..1 2 -----. ----. .I .... ..1 ......2 .-.-...1. .-. ...1. ..... 11 .1. .-.....I .1. ...-... ----------1. .2. -. ...1 .....1. ....1 1. .... .1 .----------.1 -----. --. ---. -. 2 .2 ---. 1 1 4 2 1 1 4 2 ...-. .2. ...2 .....1 1. ....; ..............................1 2 ..12 42 31 1 .....1 .---1 1 ......2. .....2. ..2. ...... ---. .-. ........4 2 .6 2. ..2 3 1. 3

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TABLE Vt-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEES PLACE OF REStSex. Color. Age (in years). Cause of death. M. F. W. B. Y. -1year. 1-4 5-10 Diseases of the digestive system. Diseases of the mouth and annexa1...1Acute gastritis. 1 .1 .1 Acute ndigestion-.-.-1 .I.1 Diarrhea and enteritis (under 2 years). 13 15 2 26 .25 3Colitis ------------------------------.--1 .1 ---1. Diarrhea and enteritis (2 years and over) 1 ..1 .1------------Colitis. 1 ------1 .-1 Acute appendicitis. 1 .... Intestinal obstruction. 1 ..1 .1. Duodenalulcer. .1 .1 .1 Cirrhosis of the liver. 1 1 .2 Abscess of the liver, entamebic-------1 ..1 ... Abscess of spleen. 2. 2 .--.--. Simple peritonitis (nonpuerperal). 1 3 1 3 Novenereal diseases of the genito-urinary system and annexa. Acutenephritis.-------1 ..1 ..1. Bright's disease (chronic nephritis)---9 2 3 8 ..-1. Pyelo-nephrosis. .------------------1 ..1 Structure of the urethra, nonvenereal. 1 ..1. Uterine tumor (noncancerous)----------1 1 -Other diseases of the uterus -------------1 1 The puerperal state. Puerperal septicemia -----------------. 1 .1. Puerperal albuminuria---------------1 .1 .-. Diseases of early infancy. Congenital debility, icterus, and sclerema. .....-------------------------1 1 .2 .2. Premature birth. ..------------------1 3 .4 .4---------Malnutrition. ...---------------------6 2 .8 ---8--------Other causes peculiar to early infancy. 4 3 1 6 ..7--------Old age. Senility. ..---------------------------1 1 Affections produced by external causes. Suicide by asphyxia. ..---------------1 ---1 ------------------------Suicide by firearms.-----------------2 .2 --------------------Other acute poisonings-----------. ..1 .------------------Burns (conflagration excepted)----.1 ----1 -------------1----Accidental drowning. ..---------------6 .4 2 -----------------Traumatism by cutting or piercing instruments---------------------1 .1-------------------Traumatism by fall. ..----------------1 .1 ---------------Fractures (cause not specified)--------1 ..1----------------. Total.--------------------136 88 32 189 3 73 26 1 Stillbirths. .---------------------. 21 22 7 36 Grand total.---------------157 110 39 225 3 73 26 1

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23 AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR) AGE, AND DENCE--Continued. Age (in years)-Continued. Place of residence. Total. Canal 11-20 21-30 31-40 41-50 51-00 61-75 76-100 Panama. Colon. Cana l Zone. ....e.e. .........-ee. ...e. .............1 ..1 1 1 .......1 ..1 --------4. ........17 ..... ..1 .......1 1. 1 1 ------------------------1. .1 ..1. ....1 ---1 -------------------1----. .1 ....1 2 I .2. 2 1 2 .I .2 2 .4 1 ....I .....1. 1 .1 1 2 1 1 3 2 .2 7 2 11 .1 1. 1 .1 1 .1 .1 ..1 ..1 1 1 ......1 1. .1. .1 1.1 1 .......-I-----------------2 2 ..1 .4 3 3 2 8 5 1 1 7 ..1. 1. ..1 1 .1 1 2 .......2 2 1. .....1 ..1 .......1. .1 2 .3 1 ...2 .4 6 1. .1 .1 1. ....1 .1. ...1 10 29 34 22 17 8 4 123 69 32 224 26 12 5 43. 10 29 34 22 171 8 4 149 811 37 267

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24 TABLE VI-A.-DEATHS OF NONRESIDENTS.' Residence. Nationality Color. Sex. Age. Cause of death. David, Republic of Panama. Black. Male. 22 Pulmonary tuberPanama. culosis. Do.do ...do. 36 Cardiac insufficiency. Australia. British. White. .do. 21 Pye ia. Porto Bello, RepubPanama. Black.do. 52 Miliary, tuberculic of Panama. losis. Chiman, Republic .do. White. .do. 40 Acute nephritis. of Panama. S. S. Huasco. Chile.do. .do. 22 Accidental drowning. Taboga, Republic Panama. Black. .do. .22 Pulmonary tuberof Panama. culosis. Sona, Republic of .do. .do. Female. 45 Cancer of the utE Panama, rus. Interior of Panama. .do. .do. Male. 32 Malaria. David, Republic of .Jo. White. Female. 55 Myocarditis. Panama. I Deaths of nonresidents are not included in the statistical charts relating to the Canal Zone or the cities of Panama and Colon.

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-20725-17--4

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26 TABLE VII.-DISCHARGES AND DEATHS IN Employees. Discharges. Deaths. White. White. Diseases. Black. Black. M. F. M. F. M. F. M., F. M. F. M. Y. General diseases. Typhoid fever. .. Malarial fever: Estivo-autumna'. 2 .1 5 -35 1. Tertian.2.7. 7 Quartan.2 ...2 Undetermined. ....Measles.1. -. --2. Whooping cough. Diphtheria and croup. .2 1. Influenza. 5 2 1 -12. Dysentery, entamebic. .1. Leprosy. ....1. Dengue.1. Chicken pox. .... German measles. ....5 Mumps. ...1 2 .. Pyeira. Pellagra.-----. ...2. Tuberculosis of the lungs .1 7 .4 Pott's disease. .. Tuberculosis of other organs. 1. Tuberculosis of the lymph glands. Disseminated tuberculosis. Syphilis: Secondary. ..6. Tertiary ........25 .2 Period not stated. ...... Gonorrhea. 3 ..-. 11 Gonorrheal orchitis and epididymitis. .. Soft chancre. 2 ...8. Adenitis chancroidal. 1 .1 .3. Cancer and other malignant tumors of other organs and of organs not specified. ......Other tumors (tumors of the female gen tal organs excepted). 1 ..-.2. Other general diseases. 1 2 ------. 2. .. Alcoholism, acute.-. ..2 .1 I American.

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27 THE HOSPITALS OF THE PANAMA CANAL. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White Black. 00 M. F. M. F.M. F. M. F. M. F. M. F. M. F. M. F.4510 to 0 S .1.1 2. ..1. .......4 1 7-. 4 4513. ..1 .2. .....78 2 1 3 1 1 2 .17 .................... 3121.1 .........---------10. 333 S 2 1.1 1 2 1 ............2 -7 3 4 2. ..........19 5 4 2 31. .................I ...---------------------1 -.1 ....3. 1.;. ....2. -222. ......4 .....14. ............6 2 ...........5 ............1 ............1 ..... 2 1 2.1 ................ 1. ....1. ............2. ..........2. 11.-. 1 ..10. *2 1. 1 4~ 1.4.38 2 2. 1. .1. ..........6 .4. 1.4. .......... 51. ............ S ...........1 1 ....1 ........4 .............. ............ 2 Porto Rican.

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28 TABLE VIL-DISCHARGES AND DEATHS IN THE Employees. Discharges. Deaths. White. White. Diseases. Black. Black. '-4 M. F. M. F. M. F. M. F.M. F. M. F. Diseases of the nervous system and of the organs of special sense. Cerebro-spinal fever. Cerebral hemorrhage, apoplexy. ...---1 Paralysis without specified cause. ....1 General paralysis of the insane. ..... Other forms of mental alienation. ..... Dementia procox. ....1 Epilepsy.1 ... Hysteria. .... Neuralgia.-. 1 ...2. Neuritis. 2 ...1. Other diseases of the nervous system. ....1. Neurasthenia. 1 ... Diseases of the eyes and their annexa. 2 .... Diseases of the ears. .. Diseases of the circulatory system. Organic diseases of the heart.1 1 .8 .1--------Embolism and thrombosis. ... Diseases of the veins, (varices, hemorrhoids, phlebitis, etc.). 1 ... Hemorrhoids .4 ...3. Varicocele. ..1. .... Diseases of the lymphatic system (lymphangitis, etc.). 1 1 .1. Lymphadenitis (nonvenereal). 1 .1 .2. Diseases of the respiratory system. Diseases of the nasal fosso. 6 1. Adenoid vegetations.-Laryngitis. Diseases of the thyroid body. Acute bronchitis. .1 ---1. Chronic bronchitis. Broncho-pneumonia. Lobar pneumonia. .....2 Pleurisy. 1 ..6 -. Asthma.1. ....-.Other diseases of the respiratory system (tuberculosis excepted). ....

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29 HOSPITALS OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White. Black. P4 F. M. V. M. F. M. F. M. F. M. F. M. F. M. F. +4 + 5. -4 54 1 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ .....-.--.-.-.----------------i .............---------...--..-----.--------------g2 ..1 3 1 1 .--------------------------26 ---..-. ------.----------------.2 ....-----------------------2 2 .....-. -. ---1 ----------------------------91 1 ......-. .------------------------------2........5. .... ...----. .--------------------------------5-...--.--1 --------------------------. --.---. .--------------------------5 ...1 ---------------------.2 ....----------------------------0 ....1-------------.-.--------+ ---1 ......-....---.--------------------------2 --3 S ..--. -.------------------------------------E~4 .. ....--------------------------------2. 6 --1 1 1 -------------2 ----------------10 .1 2 ---. ----------------------------1 ..1 .--.------. -----..... ............ ..-------------------------------6 1 .........1 --------------3 11.---.-----------------------------------5 ........-....... 1 1 2. 1 .............1 5.1 24. .....2. .2--------------------2.--.--------------9.--.*.1. ......12 .1 2. .------------1---.----.-.1-----------------2 .----------. 5.

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30) TABLE VII.-DISCHARGES AND DEATHS IN THE Employees. Discharges. Deaths. White. White. Diseases. rA rV Black. 8 Black. M. F. M. F. M. F. X F.M. F. M. F Diseases of the digestive system. Diseases of the teeth and gums. 1 -----------1. Diseases of the pharynx. .. Pharyngitis.1. Follicular tonsillitis .1 1 -6. Ulcer of the stomach. Chronic gastritis. .. Acute indigestion. Diarrhea and enteritis (under 2 years). .. Colitis. Diarrhea and enteritis (2 years and over). 5 -. ......... Colitis. Ankylostoniasis. .2 Intestinal parasites. .1 1. Ascariasis. Acute appendicitis. ..1 Chronic appendicitis.1. Inguinal hernia. 2 2 7 Other hernias. .. Other diseases of the intestines. 1 2 .6 1. Constipation. Duodenal ulcer. ..1. Other diseases of the liver. 1 1. Abscess of the liver entamebie. ...1 Cholecystitis. .. Simple peritonitis (nonpuerperal). ... Nonvenereal diseases of the genitourinary system and annexa. Bright's disease (chronic nephritis). I ...4 .1 .1. Other diseases of the kidney and annexa. 1. ... Movable kidney. Pyelo-nephrosis. Cystitis. 2 1. 1. Diseases of the urethra, urinary abscess, etc. .. Stricture of the urethra, nonvenereal. 3 ..1. Vesico-vaginal fistula. Chronic prostatitis. 1. Abscess of the prostate. Nonvenereal diseases of the male genital organs. .1

PAGE 33

HOSPITALS OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. WbIte. White. Black. Black. White. Black. White. Black. -4 .Fi F. F. M. FI M. F. M. F. 4 ----------*-------------------------3 ...------------* ----------...... 5-. 3 9j 1 1. ,; -3 .-----: --------o-------------------es----------------------------* ----------------------------*-----------------9 ----r--------------------------------------------------------------* -----I. .........----------11 1 2---------*------------*--" --"--** -------"** -I ---.1 -** ------------------------------------...---------------------1 1 1.3. .I. 1-----------------------.7. 10. 3 113 1---------------1-.--.-.-.-.---------3 1 3 ..-.--------------.--.-7-.-. .-7-20 .1 -----------------------------------1 2------------------------------------------2 1 -4 --a ----------* I ----------** 2. .---------------------------------1 .---------------1-----------------------31 2---------------------------------.....-. .1 --.---------------------3 ---------------1 --------------31 1. ............ ---------------------------------1. ------------2 -.5. ............1 .--------.------.:. -------------. 1----------. --.-.--.--.---------12.

PAGE 34

32 TABLE VII.-DISCHARGES AND DEATHS IN THE Employees. Discharges. Deaths. White. White. Diseases. SBlack. Black. M. F. M. F. M. F. M. F. M. F. M. F. Nonvenereal diseases of the genitourinary system and annexa-Con. Hydrocele4. .....4 ....... Uterine hemorrhage (nonpuerperal). ............ Uterine tumor (noncancerous). ........ Other diseases of the uterus. ............ Cysts and other tumors of the ovary. .1. ......... Nonpuerperal diseases of the breast (cancer excepted). ...... Benign tumor of breast. .......... The puerperal state. Normal labor. ............ Accidents of pregnancy. ............ Hyperemesis gravidarum. ............ Abortion. ...... Puerperal hemorrhage. ........... Other accidents of labor. ........... Puerperal septicemia.----. -----------------..--------Puerperal albuminuria and convulsions. ........ Diseases of the skin and of the cellular tissue. Furuncle1. 1 .........-. ... Acute abscess. ..-----------------1 --------2 ....... Phlegmon and cellulitis. 2 ...... Scabies. ... Ulcer of the skin. ..3 .4 .-. ..-. ... Impetigo contagiosa. -........... Ingrowing nail. 2 ........... Other diseases of the skin and annexa. ....... Diseases of the bones and of the organs of locomotion. Diseases of the bones (tuberculosis excepted). 1 2 ... Caries (nontuberculous). 1 ........ Mastoid abscess. ......... Osteom yelitis. ........... Periostitis. .1 ......... Arthritis. ....4 ....... Synovitis. ...........-. Other diseases of the organs of locomotion.-. ..........-..

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33 HOSPITALS OF THE PANAMA CANAL-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. Wbite. Black. .Black. White. Black. White Black. D 2 1T1 M. F. M. F. PiM. F. M. F. M. F. M.1 F.M F. M. F. -...4 .1 .........1 .....3 ---------1 -------------3 1 ---------3. .....---4 1 ........... 4 .18 ...........23 .2 ..........2 ..14 .13 .............27 .1. ..I-------------------------------1. ...1 .1 ..........2. ..8 .1 .............9. ...5 .1 ............6 .1. ....1 ........... ...1 ............1 1 1 14.1.4. 1 3. 2 2 .3 .14. .......1 ......5 .............. ---.-.--.-.-.-.I3. .......10. 1 .............3 4 .............13. 2. .1 ..........8 ............1 .........-4 ~~~~~~. ..............6. .1 .........6 1 ......................................9 6 1 1i I ............-. ...

PAGE 36

34 TABLE VII.-DISCHARGES AND DEATHS IN THE Emplpyees. Discharges. Deaths White. White. Diseases. B; Black. M. F. M. F. M. F. M. F. M. F.MI. F. X.Malformations. Congenital malformations (stillbirth not included)1. .... XL-Diseases of early infancy. Newborn child. -.-. Malnutrition. Other causes peculiar to early infancy (including various consequences of labor). Affections produced by external causes. Poisoning by food 2--------------2------------. Other acute poisonings.------------------Venomous bites and stings -----.----------1. Burns (conflagration excepted)-.1 .1 .4--------------Traumatism by firearms. ----------2-------------------Traumatism by cutting or piercing instruments ------------------------1 14------------------Traumatism by fall.-------------2 .2 .4 .1-------------Traumatism by machines. ....2------------------Traumatism by other crushings (vehicles, railroads, landslides, etc .....1------------------Railroad traumatism ------------------1-------------------Injuries by animals.-----------1.--.... Fractures (cause not specified)-2 -----------4. .--------Dislocations. ....1-------------------Sprains --------------------------------.2. Other external violence. 3 ---1 .34-------------------Ill-defined diseases. Infections of undetermined origin 2 ...5---------------No diseased.ta. 81232 -. ..2. Grand total.-.-.-81 12 32 1 327 3 4--.---13

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:35 HQSPiTALS OF THE PANAMA CANAL-Continued. Nonemployces. Nonresidents. Dishbarges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White. Black. ::::::x::: ::: :-::-----:-:-------::----:---12 5 8 ----------*-------3---------*--29 ..-12 -8------.-.------------------------------------------------------13 ------------------------------------------------------------------------2 2. .. --------------------------------1 -.1 ------------------1 2 1 -----------------------------------------1 ----*1 -------------------------------------------------------------------------------------------------------------. ..2-2------------------------------------------2.3 7 ~~1-1-------------------------------5 ---------------------------------t----1 2 2-------------.1-----------------------------13 1 3 1 6 2 11-------------------2 1-----------------30 S1 5881 .-1-. 2 4 12 10 48 311 1 1127 46

PAGE 38

36 TABLE VIII.--CONSOLIDATED HOSPITAL REPORT. [A=White Americans; F=White foreign; B=Blacks.] Remaining Admitted. Died. Sept. 1. ch argued. A. F. B. A. F. B. A. F. B. A. F. B. ANCON HOSPITAL. Panama'Canalemployees. 16 8 103 58 11 145 2. 9 56 7141 Panama R. R. employees. 8 12 104 6 14 148 ..3 8 16147 Soldiers. 85 .185 .....190. Panama pay patients. .---.1 -----------------Other pay patients. 31 27 83 117 55 167 2 215112 49138 Charity patients. 25 8 21 53 11 36 1 59 12 35 Total. 165 55 312 419 91 496 4 2 28 425 84 461 COROZAL HOSPITAL. Panama Canal employees. .1 6 Panama R. R. employees. 1 .1. 1 Soldiers. 2 ..3 ....2. Panama pay patients. 4 48 204. 2 2 .3.3. 1 .1 Other pay patients. 1 6 3 .1 1. .2 1 3 1 Vharitypatients. 2 7 71. 1 1. 2 Total. 9 62 285 3 4 5 .5 5 4 3 Grand total. .174 117 597 422 95 501 4 2 33 430 88 464 COROZAL FARM (CRIPPLES). Panama Canal employees. 9 50 ..4 .....2 CHRONIC WARD. Charity patients. .4.2. ....1 COLON HOSPITAL. Panama Canal employees. 4 1 12 21 2 29 2 .1 17 1 23 Panama R. R. employees. 4 4 12 13 8 30 ...12 9 18 Soldiers. ..4 .....3 Panama pay patients. .1 2 .5 7 .2 1 ..1 Other pay patients. 10 10 3 21 23 25 .1. 19 16 16 Charity patients. 1.2 .2 ...1 Total. 19 16 29 61 38 93 2 3 2 52 26 59 PALO SECO LEPER ASYLUM. Panama pay patients-. .2 37 .1 .1. Charity patients. .1 27 ..1. Total. 3 64 ..2 ---.1. GRAND TOTAL. Panama Canal employees. 20 19 171 79 13 178 4 .10 73 8166 Panama R. R. employees. 12 16 117 19 22 179 ..3 20 25166 Soldiers. 87. 192 .....195 Panama pay patients. 4 51 244 .7 10 .2 4 .2 2 Other pay patients. 42; 43 89 138 79 193 2 3 17 132 68 155 Charity patients. 28 16 151 55 12 44 ..1 62 12 37 Total. 193 145 772 483 133 604 .6 5 35482115526

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37 TABLE VIII.-CONSOLIDATED HOSPITAL REPORT-Continued. [A=White Americans; F= White foreign; B=Blacks.) TransAverage number conferred. 30. stantly sick. A. F. B. A. F. B. A. F. B. Total. ANCON HOSPITAL. Panama Canalemployees. ..1 16 12 97 14.60 10.37 97.10 122.07 Panama R. R. employees. ..6 6 10 96 7.23 12.60100.34 120.17 Soldiers. 5 ..75 ..137.81.37 Panama pay patients. ..1 -----------. ---.17 .17 Other pay patients. ..1 34 31 96 33.87 34.20 91.26 159.33 Charity patients. .1 2 19 6 9 25.50 7.96 17.-37 50.83 Total. _. .,. 5 1 11150 59308162.57 65.13306.24 533.94 COROZAL HOSPITAL. Panama Canal employees. ....1 6 .1.00 6.00 7.00 Panama R. R. employees .....-..1.27 1.27 Soldiers. ...3 ..2.77 .2.77 Panama pay patients. ...4 49202 4.00 49.03 203.33 256.36 Other pay patients. ....4 1 .67 5.33 3.17 9.17 Charity patients. ....8 72 .93 7.03 71.90 79.86 Total. .., 7 62i282 8.37 62.39 285.67 356.43 Grand total. 5 1 11157121590170.94127.52591.90 890.36 COROZAL FARM (CRIPPLES). Panama Canal employees. 9 52 -. 9.00 52.73 61.73 CHRONIC WARD. Charity patients-.3.3 .33.33 33.33 COLON HOSPITAL. -Panama Canal employees. 3 .11 3 2 6 3.70 .70 6.50 10.90 Panama R. R. employees. 1 1 10 4 2 14 3.93 3.36 11.24 18.53 Soldiers. 1 ......16 ...16 Panama pay patients. .3 5. 1 2 ..33 .50 .83 Other pay patients. 2 7 7 10 9 5 9.36 8.60 5.70 23.66 Charity patients. .1 2 ...46 ..20 .66 Total. 7 11 34 19 14 27 17.61 12.99 24.14 54.74 PALO SECO LEPER ASYLUM. Panama pay patients. .1 38 .1.33 37.13 38.46 Charity patients.__. 1 28. 1.00 27.10 28.10 Total. ....2 66 .2.33 64.23 66.56 GRAND TOTAL. Panama Canal employees. 3 .12 19 24161 18.30 21.07 162.33 201.70 Panama R. R. employees. 1 1 16 10 12111 11.16 15.96112.85 139.97 Soldiers. 6 ..78. .84.30 ..84.30 Panama pay patients. .3 6 44 51242 4.00 50.69 241.13 295.82 Other pay patients. 2 7 8 z4 44102 43.90 48.13100.13 192.16 Charitypatients. .1 6 1 15151 26.89 15.99149.90 192.78 Total. 12 12 48 176 146 767 189.55 151.84 766.34'1,106.73 Number of employees remaining in hospitals: W hite. 65 Black. 272 Total. 337

PAGE 40

38 TABLE IX.-CONSOLIDATED DISPENSARY REPORT. EMPLOYEES TREATED IN QUARTERS. Re:ni AdDied DigTransRey-lst maing matted. dchrged. erred ma ing Days los. Sept. 1. Sept. 30. W. B. W. B. W.B.W. B. W. B. WJB.W. B.Total. Ancon ...71 ...7 ........1 3 ..3 Banbon---------71------71------------.1331 -3 Balboa.5.130 8 ..125 2 2 6 8 .323 13 36 Pedro Miguel. 1 .8 ...7 .2 ...2.Z -.26 Paraiso.-. 4 26 ..4 23 .2 .1 9 50 59 Gam boa. ...1 .....1 .....1 .1 Gatun. 2 .6 3 .3-1. .43 11 54 Colon. 7 37 73 226 ..77 236 .----. .-232 847 1,079 Total. 15 37 293 263 .-. 291 263 6 9 11 28 767 921 1,688 ALL CASES TREATED BUT NOT FXCUSED. Employees. Nonemployees. Total. W. B. Total. W. B. Total. W. B. Total. Ancon. .--.1,194 4,449 5,643 1,153 3,668 4,821 2,347 8,117 10,464 Balboa. 3,828 3,511 7,339 4,524 1,094 5,618 8,352 4,605 12,957 Pedro Miguel. 1,408 1,846 3,254 1,074 681 1,755 2,482 2,527 5,009 Paraiso. 872 2,242 3,114 831 856 1,687 1,703 3,098 4,801 Gamboa-. ---81 310 391 35 240 275 116 550 666 Gatun. 201 1,146 1,347 471 757 1,228 672 1,903 2,575 Colon. 2,395 6,600 8,995 .,718 2,582 4,300 4,113 9,182 13,295 Total. 9,979 120,104 30,083 9,806 9,878 19,684 19,785 29, 982 49,767 TABLE IX-A.-CONSOLIDATED HOSPITAL REPORT. White. Black. Total. Admissions to hospitals, excluding Corozal farm and chronic ward -----------------------------------616 600 1,216 Admissions of employees to quarters. .293 263 556 Total admissions to hospitals and quarters. -909 863 1, 772 Less number of patients transferred between hospitals, and from hospitals to quarters. 24 45 69 Net admissions to hospitals and quarters 885 818 1,703 EMPLOYEES. Employees admitted to hospitals -------------------133 353 486 Employees admitted to quarters-------------------293 263 556 Total admissions of employees. 426 616 1,042 Less number transferred between hospitals, and from hospitals to quarters, whose admissions are duplicated in above figures.-. 11 34 45 Net admissions of employees-----------------415 582 997 Annual average per thousand of admission of employees to hospitals and quarters-----------. 1,036.85 263.50 382.15

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39 TABLE IX-B.-CONTAGIOUS AND INFECTIOUS DISEASES REPORTED DURING THE MONTH. PanaColon. Canal NonresiTotal. ma. Zone. dent. Beriberi .2 1 ..3 Cancer ..2 ...2 Chicken pox. 9 4 6 .19 Diphtheria .11 7 15 .33 Dysentery. I .1 .-. 2 Gonococcus infection. .44 69 4 117 Hookworm .:. ..1 .1 L rosy .--. ...--.2 2 Malarial fever. 18. 30 87 4 139 keasies .1 7 19 .27 German measles ...3 .3 Meningitis, epidemic, cerebro-spinal. 1 ...1 M eningitis, tuberculous. 3 ..-.-. 3 Mump ..3 1 1 5 ]?efl .2 ...2 Pneumonia, acute. 7 1 ..8 Scarlet fever. 3 ...3 Syphilis ..4 36 .40 Tuberculosis. 26 3 6 3 38 phoid .1 .....1 W hoping cough2. 11 3 14 .28 TABLE X.-NUMBER OF EMPLOYEES CONSTANTLY SICK IN HOSPITALS AND QUARTERS. White. Colored. Total. Hospitals: Ancon Hospital. 45.80 204.71 250.51 Colon Hospital. 11.69 17.74 29.43 Total. 57.49 222.45 279.94 Quarters: Ancon.,. 4.43 .4.43 Balboa. 10.77 .43 11.20 Pedro Miguel. 1.17 .1.17 Paraiso. .30 1.67 1.97 Gamboa.-. .03 ..03 Gatun.-. 1.43 .37 1.80 Cristobal. 7.73 28.23 '35.96 Total. 25.86 30.70 56.56 taES Quarters. Total. Average number of employees constantly sick: White. 57.49 25.86 83.35 Black. 222.45 30.70 253.15 Total. 279.94 56.56 336.50 Average number of employees constantly sick per 1,000: White. 11.97 5.38 17.35 Black. 8.39 1.16 9.55 Total. 8.94 1.81 10.75

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40 TABLE X-A.-AVERAGE NUMBER OF DAYS IN HOSPITALS OR QUARTERS FOR EACH ADMISSION OF SICK EMPLOYEE. White. Black. Total. Hospitals Ancon Hospital. 11. 21 19.19 17.41 Colon Hospital. 8.83 7.95 &32 Quarters: Ancon. 1.87 .1.87 Balboa. 2.45 1.62 2.40 Pedro Miguel. .3.89-. 3.89 Paraiso. 2.25 2.00 2.03 Gamboa. 1.00 .1.00 Gatun. .5.62 3.67 5.09 Cristobal. 3.08 4.57 4.20 TABLE XI.-DEATH RATES AMONG AMERICANS ON THE ISTHMUS CONNECTED WITH THE PANAMA CANAL. Annual death rate per 1,000. White employees from the United States: Disease. .8.81 External causes. .8.81 Total. 17.62 White women and children from the United States: Disease. 2.37 External causes. Total. 2.37 Wbite employees and their families from the United States: Disease. 5.25 External causes. 3.93 Total. 9.18

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41 TABLE XIL-FINANCIAL STATEMENT AUGUST, 1917, DEPARTMENT OF HEAL4+H. August, Jul, August, 1917. 191. 1916. lion, general expenses: Cif health office.$ 507.71 $700.92 $567.28 Construction allotments. 661.20 2 16.70 Stoc~k. 11,962.45 124. 58. Suspense. 1175.24 212.36 Reserve for new tools. ..2,15~4.69 Total.1968.78 1,105.40 2,721.97 Hospital division: Ancon Hospital.3. 27,963.87 35,818.18 28,204.03 Corozal Hospital and farm.7, 435.05 9,054.65 6,216.38 Colon Hospital. 5,015.95 5,078.66 4,292.20 alo Seco Leper Asylum. 2,395.83 1,915.83 1,665.69 Santo Tomas Hospital. .4,900.56 1,129.67 4,136.48 Medical storehouse. i8070.40 1,167.18 653.16 Total .54,781.66 54,164.17 42,167.94 Sanitary division: Chief sanitary inspector. 50.00 50.00 50.00 Health office, Panama.*.5,296.59 3,788.34 3,654.-55 Street cleaning, Panama ..4,307.45 4,390.73 4,290.43 Health office, Colon.~ 3,185.06 3,214.41 2,987.65 Street cleaning, Colon .2,380.07 1,994.62 2,175.90 Zone sanitation ..11,909.65 8472.34 16,138.02 Total ....27, 128.82 21,910.44 29,296. 55 Dispensaries. 3,774.13 4,201.56 2,935.30 Quarantine division. 5,137.53 5,356.63 5,464.46 RECAMIULALTION. Administration, general expenses .1968.78 1,105.*40 2,721.97 Hospital division .54,1781. 66 54,164. 17 42, 167.94 Sanitary division .27,128.82 21,910.44 29,296.55 Dipnaries. .3774. 13 4,201.56 2,935.30 Quarantine division .5,137.53 5,356.63 5,464.46 Total. .89,853.36 86,738.20 82,586.22 1Credit.

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42 TaBLE XIII.-ANCON HOSPITAL. REPORT OF DAYS LOST IN HOSPITAL. American Foreign. Black. Total. Hospital: Panama Canal employees. 438 311 2,913 3, 662 Panama Railroad employees. 217 378 3,010 3,605 Army and Navy. .2,441 ..2, 441 Panama Government pay cases ...5 5 Other pay cases. 1,016 1, 026 2,738 4,780 13harity cases. 765 259 521 1,525 Total. 4,877 1,954 9,187 16,018 Asylum: Panama Canal employees. ..50 180 210 Panama Railroad employees .38 38 Army and Navy. 85 .83 Panama Government pay cases. 120 1, 471 6, 100 7,691 Other pay cases. 20 160 95 275 Charity cases. 28 211 2,157 2,396 Total. 251 1,872 8,570 10,693 Chronics. 1,000 C--pples 1000--------1,000 Cripples ..270 1,562 1,852 Grand total .5,128 4,096 20,339 29,563 Non-residents, hospital .406 Non-residents, asylum. 1,867 Average cost of subsistence per patient per day, $0.3462. WARD LABORATORY REPORT. Blood examinations (total number). .660 Estivoautumnal. 41 Quartan. .2 Tertian. 13 Differential counts. 24 Hemoglobin estimations. 183 Leucocyte counts. 120 Red blood counts. 2 Stool examinations (total number). 699 Ameba. 3 Ascans lumbroicoides. 13 Balantidium coli. 2 Cilitaed monads. .2 Entameba (hystolitica and tetragena). .2 Guaiac tests. 6 Pus and blood. --.--. 44 Strongyloides. 36 Tricocephalus dispar. 29 Uncinaria (ova). -----------.70 Urine examinations (total number). .-----------. 2,138 Albumen. 446 Bile. .23 Casts. 380 Ciliated monads. .2 Epithelia. 819 Guaiac tests. 84 Indican. 250 Pus and blood. 944 Sugar (positive 7, negative 698). .705

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43 TABLE XIIL-ANCON HOSPITAL-Continued. Sputum examinations (total number). 149 Positive for tuberculosis. 26 Smear examinations (total number). 63 Urethral. 56 Vaginal .---------------11 Eye. 2 Spinal fluid. Pleuric. SURGICAL OPERATIONS PERFORMED DURING THE MONTH. Number. Died. Amputations: Digits, multiple. 1. Operations on bones: Ostiectomy. .. Wiring of fractures, single. 5 Adenectomy: Cervical. Inguinal, single. 22 Inguinal, double. 9. Herniotomy: bhguinal, single .10 Inguinal, double. 7 .-. Ventral. 1 ----. Genito-urinary tract: Urethrotomy, external. 2 1 Varicocele, radical cure. 2 Hydrocele, single, radical cure. ;. 5 Epididymotomy. .8 Amputation of scrotum. .2 Curettage uteri. 10 Perineoplasty. Obstetrical: High forceps.1. Low forceps. Rectunm Hemorrhoids, radical cure .16 Fistula in ano, excision of. General: Thyroidectomy. 1 Excision of varicose veins. .2 Tenorrhaphy. Laparotomy: -For general peritonitis. 1 For intestinal obstruction. 1 Gastro-enterostomy. Appendectomy. .11 Appendectomy with local peritonitis.2. Supravaginal hysterectomy. 8. Hysteromyomectomy. 3 1 Myomectomy. 1 Salpingo-oophorectomy. .4. Ovarian cystectomy. 2 Suspensio-uteri. 9 Major operations, various .5 Minor operations. 225 384 3

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44 TABLE XII.-ANCON lIOSPITAL-Cm tinued. REPORT Or OPERATIONS, EYE A10 EAR CLINC. Tonsillectomy. ....23 Adenoidectomy ..13 Submucous resection. ..14 Pterygium ....4 Turb uectomy. ...4 Cataract extraction. .2 Minor operations. 8 Total .68 Refractions. 85 REPORT OF OUT-PATIENT DEPARTMENT. Clinic. Total New Pay eoripvisits. cases. cases. tis. Medical .232 163 40 177 SurgicaL. 301 138 6 43 Eye and ear. 550 204 .42 Total. .1,083 505 46 262 VACCINATIONS DURING THE MONTH. Number of adults vaccinated. 135 Number of "takes". .48 Number of school children vaccinated .9 Number of "takes". .-. 4 MONTHLY REPORT OF 13OARD OF HEALTH LABORATORY. Bacteriological examinations of: Blood cultures (2 positive, B. typhosus-1 new and 1 relapse; 1 staphylococcus aureus). 25 Throat cultures (31 positive for B. diphtheria; 57 positive repeaters). 341 Nasal cultures (4 positive for B. diphtheria). 16 Stools (58 from Corozal Hospital). .80 Urine (9 B. cohl, 1 streptococcus, 1 staphylococcus albus) .43 Autopsies cultures from. 4 Spinal fluids (1 meningococcus). .9 Inguinal gland culture.-.-. 1 Smears, various .9 Milk from Corozal Hospital farm dairy. 1 Bacterial counts of milk (29 Corozal farm and 7 Panama health office) 36 Steer's spleen culture (positive for B.'anthrax), Colon health office. 1 Sputums (9 positive, B. tuberculosis from Panama), all from Panama. 18 Lem on soda. 1 Chemical examinations of: Dairy milk from Corozal farm. 3 Dairy milk from Panama. 8 Urine. 39 Water, for salt determination. 3 Hide disinfectant (Panama health office). 1 Hide poison (Panama health office). 1 Rum (rou-claros). 1 Oil, petroleum. 1 Substance for identification (sanitary inspector, Ancon). .1 Corn meal. 1

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45 TA-iL XIII.-ANCON HOSPITAL--Continued. Chemical examinations of--Continued. BeveragesCocktail bitter 1.'. 1 Kola wine. 1 Peppermint.,. 1 Blackberry wine. 1 Spanish port.,. 1 Vermouth. 1 Pathological tissues prepared, paraffin (2 frozen). 423 Autopsies performed. 29 Tissues reported, surgical. 44 Autopsies, animal, performed (calves, 4; hogs, 3; horse, 1; goat, 1; dog, 1; monke, 1; deer, 1; kinkajou, 1). 13 Placent films. 34 Films, gonococcus (eye, 3; vagina, 1; urethra, 1). 5 Leprosy (3 positive). 4 Blood film, malaria. 1 Skin lesions examined. 1 Animal inoculations. 3 Cattle blood films. 4 Horse blood films. 24 Dog blood films. 10 Dog under observation. .1 Rats examined (Mus nuscuius, 971; Mus norvegicu, 35; Mus alexandrinu8, 15; Mu8 rattus, 225). 1,566 Undertaker: Bodies embalmed. 10 Interments at Corozal. 21 Shipped to the United States. 8 Shipped to Gatun. 1 Shipped to Colon. 2 Taken to Panama. 4 Cremations. 21 General: Wassermann reactions. ..1,007 Agglutination reactions. 5 Autogenous vaccines prepared. 4 Antityphoid vaccine administered. 1 Dark-field examination. 1 COROzAL HOSPITAL-STATEMENT OF COMMITMENTS, DISCHARGES, AN) DEATHS. COMMITMENTS. Male. Female. From Canal Zone, first admission. 5 2 From Panama Government, first admission. 1 13 1 One case has been transferred to Ancon Hospital for surgical treatment.

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46 TATLE XIII.--ANCON HOSPITAL-Continued. COROZAL HOSPITAL-Continued. DISCHARGES. Well. Improved. Unimproved. Male. Female. Male. Female. Male. Female. Barbados. .1. Colombia.1. ... France. .1. Martinique. ... Norway. ....-1 Philippines. ... Spain. U n it e d S t a t e s ...........................1 1 1 2---1 2 5 2 2. 1 Eight patients deported to United States DEATHS. Medical diagnosis. Mental diagnosis. Male. Female. General paralysis of the insane. G eneral paralysis of the insane. 1. Pyonephritis. Senile dementia. 1. Disseminated tuberculosis. Infection-exhaustion psychosis .. Degenerative encephalitis. Organic brain disease ...1 General paralysis of the insane. General paralysis of the insane. 1. TABLE XIV.-COLON HOSPITAL. REPORT OF DAYS LOST IN HOSPITAL. Class. AmeriForBlack. Total. can. eign. Panama Canal employees. 111 21 195 327 Panama Railroad employees. 118 101 337 556 Panama Government pay patients ..10 15 25 Soldiers. .5 Other pay patients.-. 281 258 171 710 Charity patients. 14 6 20 529 390 724 1,643

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47 TABLE XIV.-COLON HOSPITAL-Continued. LABORATORY REPORT, SEPTEMBER. Blood examinations. 293 Estivo-autumnal. 57 Tertian. 9 Red blood counts. 4 White blood counts. 17 Differential counts. 5 Hemoglobin. 9 Stool examinations. 44 Strongyloides. .15 Pus. 16 Ciliated m onads. 5 Red blood cells. 5 Uncinaria. 2 Urine examinations. 355 Album en. 42 Casts. ..30 Red blood cells. 3 Pus. 75 Sputum examinations .27 Positive for tubercle bacilli. 2 Smear examinations. .11 Positive for gonococi. 2 Autopsies. 6 SURGICAL OPERATIONS, SEPTEMBER. Operations of bones: Radical cure, hallux valgus, bilateral. 1 Herniotomy: Ingainal, signal. 2 Inguinal, double. 1 Strangulated. 1 Obstetrical: Perineorrhaphy. 1 Rectum: Hemorrhoids, radical cure. 2 General: Stab wound of soft parts, operation for. 1 Laparotomy: Appendectomy.:. 2 Minor operations, various. 8 Minor operations, various (dispensary). .156 Deliveries. 2

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TABLE XV.-A.NTO TOJAS HOSPITAL. RemainRemain. Class. I AdDied. Disi 1 ; mitted. charge. Pay patients. 27 98 2 83 40 Charity patients. 416 715 76 M1 414 Total. 443 813 78 724 454 Americans. Other nations. Number Class.treated. White. Black. White. Black. Pay patients. 125 1 0 48 76 Charity patients. 1,131 4 0 134 993 Total. 1,256 5 0 182 1,069 Number of days relief furnished patients. .13,648 Average number of patients constantly sick. 440 Average number of days treatment for each patient admitted. .10 Cost of subsistence per patient per day. .$0.56 DIsPENsARY REPORT. Class. White. Black. Total. Natives treated. 12 921 933 Foreigners treated. 21 299 320 Total. 33 1,220 1,253 DIsEAsEs TREATED. Malarial fever. 58 Diphtheria and croup. 8 Influenza .9 Dysentery. 4 Erysipelas. 1 Other epidemic diseases. 5 -Purulent infection and septicemia. 6 Beriberi .1 Tuberculosis of the lungs. 11 Tuberculosis of other organs. 1 Syphilis. 29 Soft chance .5 Gonococcus infection. 36 Cancer and other malignant tumors of the female genital organs. 1 Cancer and other malignant tumors of the breast. 1 Cancer and other malignant tumors of other organs and of organs not specified. 5 Other tumors 1 Acute articular rheumatism .2 Anemia, chlorosis. 2 Other general diseases.11 Alcoholism, acute or chronic .11 Other chronic poisonings. I

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49 TABLE XV.-SANTO TOMAS HOSPITAL-Continued. Paralysis without specified cause. 2 Other forms of mental alienation. 4 Epilepsy.-. 1 Neuralgia and neuritis. 1 Trachom a. 1 Other diseases of the eyes and their annexa. 15 Organic diseases of the heart. 14 Diseases of the arteries. 3 Diseases of the veins. 2 Diseases of the lymphatic system. 10 Diseases of the nasal fossae. 2 Chronic bronchitis. 4 Broncho-pneumonia. 1 Pneum onia .5 Pleurisy. 10 Diseases of the pharynx. 23 Diarrhea and enteritis (under 2 years). 9 Diarrhea and enteritis (2 years and over). 15 Ankylostomiasis. 48 Intestinal parasites. 13 Appendicitis and typhlitis. 7 Hernia, intestinal obstructions. 3 Other diseases of the intestines .3 Bright's disease (chronic nephritis). 11 Diseases of the bladder. 2 Nonvenereal diseases of the male genital organs. 9 Uterine tumor (noncancerous). 4 M etritis. 20 Other diseases of the uterus. 3 Salpingitis and other diseases of the female genital organs. 3 Nonpuerperal diseases of the breast (cancer excepted). 1 Normal labor .75 Accidents of pregnancy. 25 Puerperal septicemia. 1 Furuncle .1 Acute ab ess. 9 Other diseases of the skin and annexa. 26 Diseases of the bones. 3 Diseases of the joints. 4 Other diseases of the organs of locomotion. 1 Nurslings discharged from the hospital without disease. 72 Suicide by poisonmg. 1 Other acute poisonings. ..1 Burns. 2 Traumatism by cutting or piercing instruments. 9 Dislocations .1 Sprains. 2 -Other external violence. 11 Ill-defined organic disease. 1 Diseases not specified or ill-defined. 2 No disease. 19 Total discharges during month. 724 Deaths occurring among patients during the month. 78 Patients remaining in hospital at end of the month. 454 Total number of patients treated during the month. 1 256 SURGICAL OPERATIONS. Circumcision. 10 Adenectomj: Inguinal, single. 12 Inguinal, double. 1 Herniotomy: Inguiny, single. 5 F em oral. 1 Ventral. 2

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V0 -TABLE XV.-SANTO TOMAS HOSPITAL-Continued. Urethrotomy: Internal. .----------------------------------------------------3 External .--. 1 Hydrocele, single, radical cure.---------------------------------------. 2 Curettage uteri. ..........--------------------------------------------------7 Vaginalsection. .......---------------------------------------------3 Excision of breast. .........-----------------------------------------------I Hemorrhoids, radical cure. 1 Fistula in anus, excision of. 2 Excision of tongue.---------------1 Thyroidectomy. ...........-------------------------------------------------1 Mastoid ..........-------------------------------------------------------2 Tonsillectomy .----------------------------------------------8 Adenoidectomy. .........-------------------------------------------------2 Cataract ...........-------------------------------------------------------1 Incision of eye. ..........--------------------------------------------------3 Pterygium. ..........-----------------------------------------------------3 Iridectomy ------------------------------------------------. 6 Cyst of eyelid .2 Skin graft. ............-----------------------------------------------------17 Appendectomy .9 Cholecystotomy ...........-------------------------------------------------1 Hysterectomy. ..........--------------------------------------------------3 Supravaginal hysterectomy .----------------------------------------2 Salpingectomy: Single. --------------------------2 Double. ............----------------------------------------------------2 Salpingo-oophorectom y ..-.-. 5 Oophorectomy. .....---------------------------------------------------. .1 Suspensio-uteri. ...........-------------------------------------------------4 Major operations, various other. ......-------------------------------------5 Minor operations, various. .........-----------------------------------------55 Total. 189 LABORATORY REPORT. Urine examinations. .........---------------------------------------------634 Albumen. .............-------------------------------------------------157 Hyaline casts. ...........-----------------------------------------------40 Granular cases. ........----------------------------------------------33 Mucus and pus. ..........----------------------------------------------62 Blood. ...-----------------------------..-----------------------8 Epithelium cells -. '. .-------------------------------17 Phosphates. ............------------------------------------------------11 Sugar. ...........-----------------------------------------------------15 Stool examinations. .........---------------------------------------------881 Uncinaria. ............-------------------------------------------------117 Strongyloides .-------------------------------------------------3 Tricocephalus dispar ------------------------------------------1 Ascarides. ..-----------------------------------------------46 Ciliated m onads. 3 Mucus and pus. 7 Ameba. ............----------------------------------------------------2 Tenia solium. .-------------. .---------1 Sputum examination.-. --------------------------------------75 Positive for tubercle bacilli. 25 Blood examinations. ..........--------------------------------------------225 T ertian--. ...........7 Estivo-autumna.-------------------------------------37 W hite blood counts. ........-. ...14 Differential counts. .2 Wassermann reactions. .167 Positive. 55 Throat cultures---------. 73 Positive for diphtheria. ---------------10 Smears examined .--.---. 5 Positive for gonococci1. Blood cultures.0. 4 W idals reactions. 13 Surgical tissues.-.-------------------------------7 Autopsies performed. 48

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51 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. 840 .1, 640 Linear yards of ditches maintained .106,400 510 12, 520 Acres of vegetation removed. 84.91 28 58.5 Cubic yards of garbage removed during month. 9,863 2,743 13,790 Square yards of pools oiled .306,280 151, 435 81,900 Pit closets inspected daily. ..319 Closets disinfected during month. ..441 Water containers treated. .5,165 80,350 20,900 Containers with stegomyla larvae found ...6 Breeding places destroyed (mosquito). 205 30 27 Fly-breeding places destroyed. 51 .. Rats destroyed during month. 842 516 292 Notices served to abate nuisances. 212 478 Convictions for violation of Sanitary Code. 3 .. Private properties cleaned during month. 21 5,478 Houses disinfected or fumigated. 17 .24 Number of mosquitoes destroyed in dwellings: Anopheles. .3,630 1,708 Stegomyia. ..15 Culex. .815 4,427 Culex and mansonia ...2,577 Inspection of buildings. 3,783 8,335 5,232 Screening ..959 Sanitation. ..2,882 Mosquitoes. .238 Safety. ..3 Buildings-Construction and repair: Plans for new buildings approved. 6 4 Permits issued to repair old buildings. 81 39 Buildings condemned. Buildings demolished. .3 .. Food inspection: Dairies, milk venders, etc. .14 .. Bakeries, candy kitchens, ice-cream parlors, etc. 26 .. Bottling works, etc. 2 .. Hotels, clubs, restaurants, etc. 20 .14 Markets, miscellaneous etc 197 .55 Material used during month:. 55 Crude oil.gallons. 6,186 1,200 9,246 Larvacide.do. 318 314 357 Kerosene.do. 257 .630 I Cans. TABLE XVII.-CONSOLIDATED REPORT OF QUARANTINE TRANSACTIONS -AT THE PORTS OF BALBOA-PANAMA AND COLON-CRISTOBAL FOR THE MONTH OF SEPTEMBER, 1917. Vessels inspected and passed. 246 Vessels inspected and held in quarantine. 12 Vessels passed on medical officer's certificate. 1 Vessels inspected and transiting canal in quarantine. 7 Total vessels entered during month. 266 Supplementary inspections of detained vessels. 102 Total inspections of vessels during month. 368 Vessels fumigated on arrival. 16 Vessels fumigated prior to departure. 2 18

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52 TABLE -XVII.--CONSOLIDATED REPORT OF QUARANTINE TRANSACTIONS AT THE PORTS OF BALBOA-PANAMA AND COLON.CRISTOBAL-Continued. Bills of health issued. 241 Bills of health vis~ed. 152 Crew inspected and passed. 13, 7 1 Passengers inspected and passed. 3,864 Stowaways found on board of incoming vessels. 3 Total persons inspected on arrival. -. 17,618 Crew passed on medical officer's certificate. 800 Supplementary inspections of persons on detained vessels. 1. 832 Total persons inspected and passed. 20,250 Persons vaccinated in port on arrival. 276 Persons vaccinated in port of departure or en route. 1,354 Total persons vaccinated. 1,630 Persons detained at quarantine stations to complete period of incubation of I yellow fever and bubonic plague. 278 Persons detained in quarantine on board vessels. 1,701 Total persons detained in quarantine. 1,979 Persons arriving from foreign ports: Cabin. 768 Steerage. 400 1, 168 Persons arriving from coast towns in small launches and sailing craft .1,550 Persons departing for coast towns in small launches and sailing craft .1,409 Persons in transit passing through the canal. 11 Persons in transit for Pacific ports not passing through canal. .234 Persons in transit for Atlantic ports. 27 Immigrants rejected and deported. 18 IMMIGRATION REPORT FOR THE PORTS OF COLON-CRISTOBAL AND BALBOA-PANAMA FOR THE MONTH OF SEPTEMBER, 1917. FromCabin. Steerage. United States .507 69 Europe.-. 10. Cuba. 34 20 Porto Rico. 23 -. Jamaica and West Indies (not shown above). 13 181 Mexico. 2 Salvador.2. Costa Rica. -. 39 35 Bocas del Toro, Republic of Panama .49 271 Colombia. 101 88 Venezuela. 11 ----Ecuador.-. 12 1 Peru. 6 2 Chile.-. 5 4 Asia .-. .3 -817 671 1,488 Men. .799 Women. .452 Children. 1,488

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53 TABLE XVII-Continued. QUARANTINE TRANSACTIONS AT THE PORT OF BOCAS DEL TORO, PANAMA. Vessels inspected and passed.-. 18 Crew inspected and passed. 792 Passengers inspected and passed. .-. 194 Passengers, transit, inspected and passed.-----. 478 No quarantinable disease has appeared in this port, and the health conditions of the port and surrounding territory continue good. TABLE XVIII.-PERSONNEL REPORT. September 1917 August, Septemep 7 1917. ber, 1916. Gold Silver -Total Total Total employemployemployemployemployees. ees. ees. ees. ees. Chief health office .3 3 4 5 Medical storehouse. 4 4 8 8 8 Quarantine division. 13 35 48 48 46 Health office, Panama. 12 135 147 154 159 Healh office, Colon. 10 129 139 153 166 Ancon Hospital. 120 214 334 343 1 365 Colon Hospital. 19 27 46 48 42 Santo Tomas Hospital. 5 -.-.-. 5 5 6 Palo Seco Leper Asylum. 2 22 24 27 37 Zone sanitation. 6 130 136 142 126 Corozal Hospital and farm. 16 105 121 126 2 65 Dispensaries: Balboa .6 3 9 9 8 Pedro Miguel .2 2 4 4 3 Paraiso. 2 2 4 4 4 Gamboa.1 1 1 2 Gatun. 2 2 4 4 4 Total. 223 810 1,033 1,080 1,046 I Includes Corozal Hospital. 2 Corozal farm only. H 0

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