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

Material Information

Title:
Report of the Health Department of the Panama Canal for the calendar year ...
Creator:
Canal Zone -- Health Dept
Place of Publication:
Washington, D.C.
Publisher:
U.S. G.P.O.
Creation Date:
1917
Publication Date:
Frequency:
Annual
regular
Language:
English
Physical Description:
v. : ; 20 cm.

Subjects

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

Notes

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

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
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:
225670417 ( OCLC )
ocn225670417
25402926 ( ALEPH )

Related Items

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

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This item has the following downloads:


Full Text








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REPORT


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THE


PANA


CANAL


FOR THE


CALENDAR-


1917


ALBERT


TRUBY


Colonel, Medical Corps, United States Army
Chief Health Officer


II. .,* HI
I ,i-.


YEAR




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District d
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employees. ... ......
residents of the Canal Z
residents of the city of:
residents of the city of I
spitals;
lspital ,...........

I of health laboratory .
pital..................
Leper Asylum ........
nas Hospital.........
Lrepsariez.- .........---------
nitation:


na. one...........
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I.-Admission rate per 1,000 employees................
II.-Death rate per 1,000 emplovees.....................
III.-Noneffetive rate per 1,000 employees .... ........-.
IV.--Malarial fever, admission rate per 1,000 employees..
V.--Malasrial fever, death rate per 1;000 employees.. -...
VI.-Death rate per 1,000 population, employees and
_ ployees.................. .....................


Statisticaltables:
Table No, I.


Admissions, deaths, and noneffective rates for e
deaths of residents of Panama, Colon, and the C
Deaths of infants by cause, sex, color, age, an
residence.....................................
Deaths among children under 1 year of age, in
Zone and the cities of Panama and Colon, by
month of death..-.---...m.m.........-....


NBUB...-

* ...a*. ..
*... .....S
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employees;
anal Zone.
d place of

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cause and
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IV.. Deaths by nationality....................................
V. Deaths of employees, arranged with reference to cause,
color, age, and length of residence on Isthmus...........
VI. Death rates among Americans on the Isthmus............
VII. Deaths of civil population (employees and nonemployees)


VIII.


IX.


XI.
Xli.

DIn.


and military, by cause, sex, color, age, and place of
residence ... ..... .............
Deaths among civil population (employees and nonem-
ployees) and military, in the Canal Zone and the cities of
Panama and Colon, by cause and month of death......
Discharges of employees from hospitals, showing cause of
admission and month of discharge ... ...............
Consolidated hospital report .. ...........................
Consolidated report of employees treated in quarters......
Consolidated hospital and employees treated in quarters
reIport. ..... .. .............. .. ..... ........ ....
Number of employees constantly sick in hospitals and
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TTER


TRANSMITTAL.


BALBOA


HEIGHTS,


CANAL ZONE,

January 28 1918.


IWNG,

'anama Canal.

nor to submit the following report of the opera-

Lepartment for the calendar year 1917.


ALBERT E. TRUBY,

Chief Health Officer.





PERSONNEL.


S' There have been many changes in the organization of the depart-

ment during the year. Before the declaration of war in April, 1917,
there were 12 officers of the Medical Corps of the Army on duty

with the health department. All but the present chief health

officer have been relieved by War Department orders, and in addi-

tion four civilian physicians and three other employees of the

department were commissioned in the reserve corps and ordered
i:. t the United States. The medical officers relieved were:
S' .- Col. Deane C. Howard, chief health officer.

SMaj. E. E. Persons, assistant chief health officer.

i Maj. F. F. Russell, chief of laboratory.

Maj. Wm. A. Duncan, chief of X-ray clinic, Ancon Hospital.

1. Maj. Guy L. Quails, surgical staff, Ancon Hospital.

Maj. Thomas D. Woodson, superintendent, Corozal Hospital.
Capt. T. J.-Leary, superintendent, Colon ,Hospital.
i .:. Capt. Win. E. Hall, chief eye and ear clinic, Ancon Hospital.
"-: OCapt. Charles E. McBrayer, health officer, Colon-Cristobal.

Capt. D. W. Harmon, chief sanitary inspector.
('Jpt. H. P. Carter, health officer, Panama.
ti,..---------------------------------------------------- I I iA it y fl' I *




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'well as all other "contagious disease of childhood are in variab ly
.m~ld'i. on the Isathmous, and recovery israpid and practically without
I:P ..
.:: ;." ;*. .%7
:***:.: *0
--well as all other contagious disease of childhood, are invariably
unild on the Tetlirue, and recovery is rapi n rcial ih u
complicationctandllyequtlae.


complication and sequelse.
S.. In the tertninal cities the death rates for
momnia in the colored race, also the high in
matters for careful consideration. The cau
rates are mainly economic-high, cost of
The cost of food has advanced greatly since t


Cited in great hardships,
are usually small, and th
>le and insufficient. The
particularly noticeable
The high rates charged
making these people sec
unsanitary; it also prod
often have but one sm


especially
e food the
results of
in cases
in Panan


ek quar
luces o
all rooI


te


has resu
incomes
unsuitab
food are
babies.
result in
usually
families


tuberculosis and pneu-
fant niortality rate, are
ses for these high death
food and high rentals.
he war started, and this
y for the blacks; their
?y are able to buy often
deficient and improper
of tuberculosis and in
la and Colon for rooms
rs which are small and


vercrowd
n becauE


afford to rent more or better ones. This depart
measures to improve the sanitary condition
requiring the owners of the buildings to incr
windows and ventilating spaces, and making
An educational campaign on tuberculosis
visiting nurse has been assigned to assist in
cases of tuberculosis. It is urgently recoj
quarters for silver employees be constructed
relieve the overcrowded conditions of Colon


* were done it would improve c
overcrowded condition of the
charged for rent.
The Panama Red Cross has d
zation, and is doing splendid
welfare work. The chief health
organization, and is therefore ,
are most urgent and important.


,ment
n of
3ase t


oti
has
this
mm
on
an


conditions in two
cities and rzduc


ing, and
e they cs
has taken
such plac
he size of


'a
4
C
.1


whole
Ln not
active
es, by
lattice


ler i m proveme
been started.
work and to v
ended that n
the Canal Zon
d Panama; if
ways-relieve
e the high pr


nts.
A
rsit
lore
e to
this
the
ices


developed into a very active organi-.
work along economic lines in baby
h officer is one of the directors of the'
ible to indicate what lines of work


CENSUS.


A census of
in June, 1917
forces-) of 24,03
and Colon, sho
these being sli
of December.


the Canal Zone was taken b3
, and showed a population
(8. Censuses were also taken
)wing a population of 61,074 a
ght increases over the numb
Q1.Di


-t .r. A -


* the police department
(exclusive of military
of the cities of Panama
nd 25,386, respectively,
er shown by the census




















Tubereulosis in its various forms caused 468 deaths amon aii&:'.
population of the Canal Zone aad the cities of Panama and Coloua
in 1917, giving a rate of 4.11 1 per 1,000, as compared with a rAte ...
1.41 in the registration area of the United States in 1916. .
Pneumonia (including broncho-pneumonia) was responsible ferr;.
343 deaths in 1917, giving a rate of 3.01, as compared with 137 ini
the registration area bf the United States in 1916. 4.. f
Diarrhea and enieritis caused 425 deaths in 1917, giving a rate 0ii
3.73, as compared with 0.79 in the registration area of the -Uiftd.r
States in 1916. .
Diseases of the heart.-The deaths from heart diseases (ozanic
diseases of the heart and endocarditis) numbered 161 or 1.41 per
1,000 population, as compared with 1.59, the rate. for the registation.
area of the United States in 1916.
Bright's disease (acute and chronic nephritis) caused 178 dethu
in 1917, giving a rate of 1.56, as compared with a rate of 1.05 for the
registration district of the United States in 1916.
Cancer and other maliqnant tumors were responsible for 39 death
in 1917, giving a rate of 0.34, as compared with the rate of 0.8. iw
the registration district of the United States in 1916.
INFANT MORTATIr'Y. "'".
The high infant mortality rate noted in last year's report
continued. That this excessive rate is chiefly caused by.por;i
ignorance, inadequate housing facilities, etc., may be seen
comparison of deaths among children of American families on
Isthmus with those of natives and West Indians for the year 191'
..... ..* "" i i. M:.:
i:






!''
.ini
.3!' ..



Ii!
I:r


S9

Of the 9 deaths occurring among American children, it is a
significant fact that in 5 instances (the mother in 3 of these cases
was Latin-American) the parents resided in Panama City or Colon.
Of the four remaining deaths, where the parents resided in the
Canal Zone, all were due to causes of early infancy, the oldest of
the four children being only 2 days of age at time of death. Such
a record speaks well for health conditions on the Isthmus for chil-
dren, where they have proper nourishment and care.


BIRTHS.


Births and stillbirths together
rate of 41.06 per 1,000 population
preceding year. Of the total bi
stillbirths, the same percentage as


numbered 4,681, giving a
, as compared with 37.65 fo
rths reported, 7 per cent
for the preceding year.


birth
r the
were


PERMANENT BUILDINGS.

Construction work on the new buildings for Ancon Hospital is
progressing rapidly. Two large ward groups and quarters for the
superintendent will be erected in 1918 the plans for these buildings
are practically finished. This will complete the building program
and will provide this community with a thoroughly modern con-
crete hospital. It will have a bed capacity of about 700, and will
compare in every respect with the best of such institutions in the
United States.
VITAL STATISTICS.
EMPLOYEES.


The average
Canal, the Pan
Panama Canal,
for 1916, and 34
The total ad]
as compared wi
alone the admi
103.72 in 1916,
hospitals only
186.17 in 1915.
The total de:


number of employees on the rolls of the Panama
ama Railroad, and contractors doing work for the
for the year was 32,589. as compared with 33,176
L.785 for 1915.


[

i



a


mission rate to hospitals and quarters was 356.75.
th 282.76 in 1916 and 320.20 in 1915. For disease


ssioi
anc
was

Lth


I


1 rate t.o hospitals was 124.80, as compared with
143.82 in 1915. The total admission rate to
160.85, as compared with 140.43 in 1916, and


rate was 7.09, as against 6.03 in


1916, 5.77 in


1915. and 7.04 in 1914. The death rate for


r disease alone was 5.74.































lenra mes. were zs 0ows: a'


1916. 19127.

**
-i :






Tuberoulosis (various organs)............. 36 LO 36 H
LobarDeaths. Rate. Deaths. Rat


Organcdiseases oftbeart....... 12
Nephritis (acute and cbronic)........... 20 .60 21 .6.
Cerebral hemorrhage.............. ... 9 27 .24


There were 36 deaths from tuberculosis among employees, being

the same number as in 1916, as compared with 27 in 1915. Fom H
pneumonia 29 deaths occurred among employees in 1917, as corn-
H biii
pared with 31 in 1916 and 25 in 1915.
I m I l .ll
E R .
EFFECTS OF RACE. .. ..
.. H
*,,,,,
mmI mm,,m

The admrnissionrate to hospitals .and' death rate from disease, for
white employees, was 280.02 and 4.57, as compared with 97.89 and
5.94 for black employees. ."
The admission rate to hospitals and quarters for malaria wa,
26.80 for whites, as compared with 12.39 for blacks.. .




Hr:.

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ii i : "t .
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* .: .
:.. ., *.:.. ..
*.. i .
......"
I" :::":::


CANAL ZONE


EMPLOYEES AND NONEMPLOYEES.


From an average population of 27.543 in the Canal Zone. there


was a total of 313 deaths during the year.


Of these. 273 deaths


were from disease, giving a rate of 9.91. as compared with 9.22 for
1916, and 11.30 for 1915.
The death rate for tuberculosis was 1.31. as compared with 1 .30


for 1916.
all deaths.


Deaths from tuberculosis this year were 11. per cent of


There were 669 births reported during the year, giving a birth
rate of 24.29. Of these, 225 were white, and 444 black.
There were 85 deaths which occurred among children under 1
year of age, 4 white and 80 black, giving an infant mortality rate,
based on the number of births reported for the year, of 17.77 for
white, and 180.80 for black children, with a general average of


125.56 per 1,000 births.
Of the total deaths, '_


per cent occurred among children under


1 year of age, and 37 per cent among children under 5 years of age.


Of the total births reported, 6 per cent were stillbirths.
Below is a table showing the death rates for the Canal Zone from


91 05 to 1917, inclusive,


including deaths from all


causes among


both


employees and


nonemployees:


Year.


1905.
1906.
1907.
1908.
1909.
1910.
. 1911.


I

- I
- I
m n nm-m
ammmnmm


Popula-
tion.


Deaths.


Rate
per
1,000.


35.29
49.86
31.60
18.95
13.33
14.47
15.32


Year.


1912........
1913........
1914 .. .. ...
1915. .......
1916.......
1917. .. .


Popula-
tion.


Deaths.


Rate
per
1,000.


14.1
16.
15.3
12.
10.


1 Average population for the year, excluding the military for the last six months,


PANAMA

EMPLOYEES AND


CITY.

NONEMPLOYEES.


- A


-- --






































both employees and nonemployees: pr


u rRate ioivriet s.rs




Ood6.....c... o, 51t hat .. 44. 5 .. ... .... ..' ... ...7

1907...-.... 33 548 1,186 34. 45 1914.......-. 1,, i4 18,
The..... deat rate fro tuerulsi was.8 531.22. as comar i:







H OYeth. topulda-teahs. per Yeteccr.e Pmopul cidrentuhde








1 rf....... 40, d801. .0 er ce a.o,4 4191e........ 47,$0 15 e a I of.i
1925,5817 1,142ivn 44.75in 1913..th.. 47,172l 1,507s 31n.6




1908....... 215484 1,156 34.83 19125....... 0,373 i,103 .

1O5t....... 40',801. .1,48 ..25.44 .1916........ 80,778 1,765 ..
1910........ 456591 1,446 31.72 1017........ 61,074 1,714
1911.......... 46, 555 1,456 31.27 ..

CO...
: *:i iiii
.. .
CoWN.*










. 1916 1917
i. *


I*Tuberculosis (various orgnas)........ ......... ......... ..... 91 113
l Pneumonia lobarr and broncho). ..-.... ..... -- -. ...- 117 95
.. Diarrhea and enteritis (including colitis).. 48 74
SNerphritis (acute and chronic) .... .........--*.---... 80 61
Bronchitis (acute and chronic). .........., ... -. ----. .. .-.- 61 55


The


deatb


3.69 for 1916


Irate from tuberculosis was 4.45, as compare
, being 17 per cent of the total deaths this year,


pared with 13 per cent for
There were 908 births r
rate of 35.77.


There
giving a


were zz
m infant


deaths
mortality


d


with


as com-


1916.


reportedd


among
rate,


during the year


children


based


reported for the year, of 244.49.
Of the total deaths, 33 per c(


1 year of age, and 43 per cent among cl
Of the total births reported, 7 per cen
Below is a table showing the death


19Th"


inclusive


, including


deaths


under


on the


giving a birth


year


number


ent occurred among children


I age,
births

under


children under 5 years of age.
t were stillbirths.


rate


from


in Colon
1 causes


from


among


1905


both


employees


and


nonemployees:


Year.


* S -
* S S
* Si *
- S S -
- -- S- S*


Popula-
tion.


Deaths.


Rate
per
1,000.


Year.


Popula-
tion.


* .
* S -
- .
* S *
* S I
* S S


Deaths.


Rate
per
1,000.


DIVISION


ANCON


HOSPITALS.


HOSPITAL.


The


total admissions to


the hospital


10,880, as compared with 9,116 for
average num her of nat.ients ennsts


1916


Lmt.lv in


during the year numbered
. and 10.652 for 1915. The


thet hosnital during t.he


i




























e emn anto mess in ing Is .Irapi y approach
tion., -
The isolation building for contagious diseases is also
completion. and
The passageways connecting section "A" and section "B i with ..
the administration building, were practically completed. e"n
The nurses' quarters was ready to receive roof. ..
Work was commenced on site to receive section "C-" of the new
hospital.
OLD BUILDINGS EVACUATED.. ."
*E
.. w.. ..-..ereautdnMrha
Building 237, wards 5 and 6, were evacuated in March and t.rne
over to the building division, which used same as field office, ta-
room, and carpenter shop, in connection with construeotino :1
the administration and clinics building and kitchen and mess
Building 238, section "B," wards 8, 9, 10, were evacus. ...,
in April and turned over to the supply department for razing a4
reerection at Pedro Miguel a silver quarters. The new kite 1
is being erected on this site.. iii"
Building 246 was also evacuated, cut in two, and moved ont th
4-n1 nl nn nn ,4,n 1A 5 c 4A wl ,n 4s InnmnaA .In- .-.t..- ... :m1:.







15

Building 2U5, section "C," wards 11 and 12, was evacuated in
September; building razed; site to be used for new nurses' quarters,
active construction of which has progressed as before mentioned.
Building 224, ward 15, was turned over to the building division
for use as storeroom and field office. Building 237, wards 5 and 6,
at present so used, to be razed in the immediate future.
As soon as building 240, operating room, can be evacuated, the
permanent ground improvements, such as walks, roads, lawns, etc.,
will be immediately undertaken.


SURGICAL CLINIC.


During the year 1,668 major operations and 1,775 minor opera-
tions were performed. There were 301 obstetrical cases delivered.
Three thousand one hundred and eighty-four cases visited the out-
patient department, for whom 560 prescriptions were written.


MEDICAL


CLINIC.


There were 3,184 cases treated in the out-patient department, for
whom 2,806 prescriptions were written.


EYE


AND


EAR


CLINIC.


There were 856 operations performed, 1,108 refractions done,
and 5,426 treated in the out-patient department, for whom 522
prescriptions were written.


X-RAY


CLINIC.


There were 2,205 cases treated during the year,
340 dental films taken, and 57 treatments given.


4,930 plates used,


DISEASES.


No new cases of sma
the latter part of 1916.
nated with 410 know
known "takes."
In January there wau
undetermined (with c
adenitis and neritvehl


llpox developed from the three cases treated
During the year 1,699 adults were vacci-
n "takes," and 62 school children with 37

3 an epidemic of an acute intestinal infection,
,r without as the case may be) mesenteric
itis.
























'emovetom car oo. o, e nr wit a earm
rebuilt from surveyed horse-drawn conveyance. The parent
hearse U. S. No. 301 is to be refitted with ambulance body and-
transferred to a line station for district physician's use.
-* H:r i.
COROZAL HOSPITAL I-NSANE)...
Hil.
During the year, 193 patients were admitted, 30 died, and 129 .
were discharged. Among the discharges are included 8 patients
who were deported or transferred to other institutions for further
treatment. .
The average number of patients constantly under treatment .i.
during the ,ear was 343, as compared to 290 for 1916.
Buitldins.-.-During the year the following changes were made in .
the buildings: The old Ancon admitting office was reerected in-!
the garden at the farm, and will be used as an office for the farin
manager and sleeping quarters for the watchman. A new vegetable
:and implement house and a breeding house for guinea pigs :and.
rabbits were built at the garden.A dipping vat, 1,590- ao
capacity, was built at the dairy to eradicate ticks. Thre:,AM
Proved a great success in getting the cows in better physical ....
S-tion and increasing their milk production. The fire exit. on te .: H~
wards were fixed by parmis3ion of the fire department so tt
they can be of more use during a fire.
Hospital department.-The hospital has shown a.gradual increa
Sn ;nn 0 .,C i# +La Unn+ .aran ianf A anarnl+oan fib -.:.




ii *!.. v'
:i. '*:.


I! -. 17
hii



II
.t:.' ?
*


3r,
H'7""
H:
3em4
H


to th
of th
been
from
larly,
test.
Wa M


e hospital
e stock,
increased
good mill
and one
The aua


a. 11"


i t is practically
1.5 to 2 per cei
Piggeel.-A
immunized pe
we will save
enable us to r
worked out wi
is hoped this w
Poultry yard
States were fo
fected were se;
this disease am


s of
)ut
. A
king
cow
lity


--- --


the department.
by more careful
n effort has been
mothers. The
was condemned
of the milk coni


y free from
nt above tl
process is
rmanently
the expen


aise ma


bacteria


he
un
ag
se


legal
der w
ainst
of a


a, :
rec
ray
ho
Im


ny more pigs


Iereby hog cholera se
rill make the piggery*
.-The Rhode Island
und .to be suffering
)arated and are being
long the healthy chic


Garden.--The garden has e
income, although the expense
granted cripples, and increase
General.--With increase of
crowded, and steps will have
room. Several cripples have


ihown


more interest in the occupation ward. Aside
they are being taught to crochet, and to make
the patients to distract their attention from the
Some of the male patients are allowed to cultiv
within the hospital inclosure under the supervisi
This has proved successful, producing about $
attempt is being made to teach some of the mal
rug making as done by the female patients. Alth
in not having a hydrotherapeutic room, an eff<
to carry out this treatment on the wards. In
patients' surroundings more pleasant, several
been added to the lawns, providing cut flow
A neurological clinic has been established a
where cases not requiring hospital treatment
staff of Corozal Hospital.
Farm department .-Dairy.-The demand for I
has increased so that at present we are s,upplyin
daily to sick adults and children, aside from t


Corozal farm milk
g about 200 quarts
;he regular suDnlv


There has been no increase
feeding the milk output has
made to raise all heifer calves
tuberculin test is made regu-
after positive reaction at last
tinues to be of high standard.
and the fat content runs about
luirement.
whereby all our pigs will be
g cholera. With this method
ministering serum, and it will
than before. A plan is being
;rum will be manufactured; it


pay for itse
Red hens
from tuber
killed off t


kens.
an increase


If.
imported
culosis.
Prevent


pro<


!has increased due to incr
d number of cripples.
patients the wards are
Sto be taken to provide a
had their claims settled


from the
Those in-
spreading


duce and
eased" pay


becoming
Additional
and have


from making hats,
rugs. This helps
ir morbid feelings.
ate a truck garden
on of an attendant.
125 monthly. An
e patients hat and
rough handicapped
ort has been made
order to make the
flower beds have
ers for the wards.
t Ancon Hospital
may consult the


-- I -- --























5.
adult
addit
of thE
An
sites,
wild
lecte(
of th
labor
Th
estab
in NT
were
cattl
Film!
* ined




Brain.
Marrow'

Th
brain


The focal degenerative arthritis found at autopsy in yfrng .
a offers the gross pathologist, in the opinion of the writer, somfe
ional presumptive evidence of syphilis and the application .
Laboratory tests for the disease are indicated.
attempt has been made to enlarge our knowledge of the psra
particularly those occurring in the blood and muscles, otf both
and domestic aniinals in Panama. The pathologist has col-
d for publication in the Proceedings of the Medical Association
SIsthmian Canal Zone the observations thus far made at the
atory on this subject.
e presence of Texas fever in this locality was first definitely
lished by the finding of B. bigeriina in the blood of sick cattle.
november, 1916. During 1917 further studies on this disease e
carried .out. Twenty-nine poorly nourished, tick-infested
from the Miraflores pasture were submitted for autopsy. .
s from the blood, spleen, bone marrow, and brain were exam-
for the piroplasma with the following results:

I..,
S Positife. Negative. Positive. Neptive. i.
," ,," e*.,t v

10 19 Bd.3 .


us it is seen that films made from crushed graj matter of the.
yielded far better results than blood films. An examination
L n n..n at 10K a i i,11... 1, nt an,.4d-1 ni. -' nln uun, 1 mi 4.ae.*






I
Il!!'"
j..n
'i.:


ii.


show a high mortality. Experiments ]
immunizing imported nonimmune cattle
large dose (20 cubic centimeters) of the I
after their arrival and not turning them
have passed through their mild attack of
By cultural methods it was shown ti
Panamanian beef cattle carry in their bl
The morphology of the trypanosome wa
and, as ordinary blood films were unife
method was developed to demonstrate t
in the peripheral blood. The freshly dra'
laked with distilled water and centric
sediment usually showed a few trypano
cattle inoculated into laboratory animal
young calf showed numerous trypanoso
inoculation. The trvpanosome agrecs


mes
with


s4


Trypanosoma thcileri in morphology, in size,
multiply in other hosts than cattle, and in thi
readily grown in artificial culture media. W
that the trypanosome of Panamanian cattle
organism is regarded by most authorities as b<
During the examination of the sediment of lak
centrifugation, filaria were frequently encounth


were practically always
Spirochaetes were enc
fore, that Panamania
dium; that most of th
them have filariasis;
th.ir blood.
Murrina has caused
the Sabanas between
conducted some field
in a few horses; life \
the treated horses surn


in carrying
examination
mat.a were
equine piro
Canal Zone
site occurs i


* out fourth
n of the bl
encounter


s present
rounterec
1 cattle a
Lem are
and that


even days after the
the descriptions of
in its inability to


e fac
e th
is Tr
?ing
ed c:
?red.


in films made from tl
in two instances.
I1 harbor B. bigrmina
barrierss of Tr. thIcicr
a few of them have


t that it can be
erefore decided
. thicleri. This
nonpathogenic.
battle blood after
Sarcosporidia
he heart muscle.
It seems, there-
and sarcospori-
i, and many of
spirochneles in


heavy losses during 1917 among the horses in
Panama City and Chepo. The laboratory
experiments on the treatment of the disease
ras prolonged in most instances, but none of
rived. The experience gained will be useful
er experiments in the future. During the
ood of the horses for trypanosomes, piroplas-
ed in several instances. An acute case of


plasmosis in an American horse was encountered in the
by Darling in 1913. It has been shown that the para-
.n Peruvian and Panamanian horses in this locality, and


it is probably quite prevalent.
Hog cholera has continued during 1917 at Corazal farm in spite
of the useof ho-rcholera serum It. has been established byv autnnsv


have been begun toward
by injecting them with a
)lood of native cattle soon
out to pasture until they
the disease.
hat a large percentage of
ood a large trypanosome.
s variable in the cultures
)rmly negative, a special
*he trypanosomes directly
wn blood was defibrinated,
fugated; smears from the
somes. The blood of the
s yielded negative, but a


























Blacks and mulattoes:
aemales.. .......................... a 1 238 2,44 3174 1
Irlaems~e.,.. ... ...~- 191 558 749 4
Children... ....................... .. 10 1 174 .

1,4t39 3, s2. 4,109) ]. r
(IsS, IIIs.* 4 9 13 1
Grand total..-..... ........... 2,1 078 7,483 9,561 *

In addition Wassermann tests were made on 214 spinal nuid. fro d
many individuals, and of these, 47, or 22.8 per cent, were poi-
tive.l1
B. typhosus has been recovered in blood culture 25 times. Seven
of these cases came from shipboard (six different ships, two case
were recent arrivals from the United States, and the rest w#e0
sporadic cases from six different towns. None of the paaypi.i
oanism were encountered during the year. ".i- .:.
The following were also recovered in blood culture: t. Bee
sBctxrentocotos..,.n..... -..-... .. -- ---. --. N.on.. o th--e- .. ptI..
Stamp. rylochclus aurenus....e....-.- ...... .-....-....- .. ..-..-...e--.-.... .. ... .. -...
Staheyloiooges eblreo........i...............e....... ...-.
B.Sta loos us....... ......... .................. o.................. .
. dsenter (Feotype).... .. ......,






a 21


tions made of insects belon


pal lines of investigation that ]
ment were in connection with
tidns have also been made alor
and general entomology, as thk
There were 240 lots of mosqi
and identified. Several samp]
attacking stored products. O
position habits of Culex and A
made on the house fly, Musca
interesting data regarding the
secured which will be report
tions on the life history and
calcilrans, are also being made
on regarding the insect transm
disease of horses, to determine
hosts. A number of adult r


received during th
Anopheles previous
covered this year.
which undoubtedly
of Bromeliaceous pi
have been foumd on
reported from this
humerale, was found


man as a hosi
Work on tU
hand catches
military post
completed in
ent year thai
examined an<


Anopheles
Anopheles
Anopheles
Anopheles
Anopheles
Anopheles
Mansonia
Mansonia
Mansonia


ants
the
local
on a


as well as
te census ol
in quarters
s, etc., wh
February,
t this work


g to a


. Specimens
Isthmus, whi
Ility-one of
tortoise; the
various wild
f the adult m


i
1


identified


albimanus..
tarsimaculant
punctipenni
malefactor..
s apicimaoula
eiseni.......
citillans.....
ni ricans....
fasciolatus...


a..
s...


11 orders. Although the princi-
been conducted in this depart-
.cal entomology, many observa-
lines of agricultural, economic,
s o'n the laboratory demand.
arvae received during the year
flour were examined for insects


observations were made on the ovi-
edes mosquitoes. Studies are being
domestic, in Panama, and new and


hal
ful
,bit
In


e year for iden
y unreported fr(


)its of oviposition have been
ly at a later date. Observa-
3 of the biting fly, Stomoxys
vestigations are being carried
of Murrina, the trypanosomal
ng insects act as intermediate
toes of various species were
Ltification. An adult female
m the Canal Zone, was dis-


of two new species of ticks
ch have not been previously
these species, Amblyomma
other, Ixodes ricinus, accepts
and domestic animals.
mosquitoes taken in the daily


and barracks at the various line stat
ch was continued throughout 1916,
917. During the two months of the
was carried on. 20.835 mosquitoes


Of thi number there were:
Of this number there were:


* ..I* ** ~ *


- .. ... .. ...... .. .. .. .. ... ...
. ... .. .... ..... ... ..... ..... ..... .....
*.. ........ *. m********-**** ***.****s-****
.. .. .. .... .. .- .. ..


Aedes (Stegomyia) calopus.
A edeomira squanmipennis. -
Lutzia allostigma...........
I esticocampa................
U' frnAm nn


ions,
was
pres-
were


1,108
2
53
10
1
4
5,021
342
916
14
4
1
16
An


This is Anopheles hylephilus, the larvae of
live in the water held at the bases of the leaves


1111111111111111
I














IH










on the water lettuce explain the history and ibution qf the
plant, a description of the plant, information regarding its pmp
gation and development, suggestions for its control, and notes ..
the insect enemies of the plant. Additional studies on the watr .
lettuce will be carried on from time to time with the view i;
discovering an economical and practical method of eradicating
a g g a"EE:....EEEEEi
the plant and its associated mosquito. s..t.. i
Evidence has been received which leads tothe suspicion t: t
ticks are possibly concerned in the distribution of the eggs of D...er
matobia hominis XDermatobia cyaniventris). Studies have been :'
made in connection with this infestation of the larvae of tlif n 's
and a report has been prepared for publication which contain the .ii
evidence submitted and the finding- of our observations. .
Extensive studies on the i uana tick, Amblyomma dissimile, ..
common ecto-parasite of snakes toads, and iguanas min Paj~s. 4
were completed during the year and an article on the subject
pared for publication. This pa er deals with tire descnptioi l4 ..
the diterent stage of the tick, te periods of attscihment, moltb
preoviposition, oviposition, and its attacks. on reptiles and ba. ..
chians. .. **
Pi 1m ..... : ':H.
The study of the snakes found in the Canalr Zonpe and t
was continued during the year and a number of specimens w ..




















:: :: ::

...........H..


. .....:....





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





TX



H..
.!, ... "


1q1 ..
HH
.11 i.
I:::rii:


.. uI .... ...
..r-1 Hi..
.... "*:" : ..* .**
:. :. .... **. ** ..
* : : .. .. *
T :*:*:.. i .
. I*..::*.
. H


"."' ..'..f.. 'Ydtlow-bellied sea snake," Hydrus ploturus,
'"" .."c": ... measured 26 inches in length, ra inches
:j* t:t!. ...i. *r n 1 inch wide doteally, was allowed to bite a
I pgrug weighing 425 prams. Its action in biting was very sim-
.I': th* ctsaln- ake,n E9laps fulvius. 'The act of biting lasted
j Iijondap and :a -chewing motion of the jaws occurred throughout
iHHttftt od mThe: pig evidenced no symptoms until four. minutes
teriithfe bite, when it suddenly fel over on its side, the respiration
": g33 to short weak gasps, and two minutes later the pig was
.Sm .. i Inexperiments with thevenom it was found that0.0015 gm.
.:: liquid venomnd iluted with 1 c. c. of normal saline solution and
c-ected .iubcutaneously. into a guinea pig weighing 508 grams,
aud paralysis in 10 minutes and death in 14 minutes. One ex-
Staction of venom from this snake produced 0.0038 gm. of liquid
veonm. While securing the venom it was noted that as soon as
te. snake began biting on the edge of the extraction dish the venom
was ejected from the fangs in fine streams of minute volume. The
fresh venom is quite viscid, but entirely colorless like water. It is
neurotoxic in effect. Animals that were bitten by this snake or
Received injections of the venom manifested no swelling, discolora-
tion, or other changes at the.site of the bite or infection, and the
autopsies showed no gross pathological changes. We find that the
Hydrus platurus is the most highly poisonous of any of the Panama
Smsnakes we have studied' to date. This species lives in the Pacific
and Indian Oceans, where it may be encountered in large numbers,
s sometimes being found in schools numbering thousands of indi-
viduals. It is commonly known among the natives of Panama as
the "Toboba" and is very common along the Pacific coast of
Panama and the adjacent islands. It is rather sluggish in dispo-
.tion and does not appear to be very vicious.
Experiments were also made with the venom of the "Fer-ce-
; lance,'' Bothrops atrox. This snake was 4 feet and 2 inches in length;
the body was rather stout, being about 11 inches in diameter and
with a ridge along the median dorsal line which gave somewhat of
.. a triangular appearance. The head was 2 inches long, 1I inches
.' ide at its broadest part, and rather flattened, being about three-
-.fonrth- of an inch thick and ending in a pointed snout. The tail
Shich was about 7 inches in length, tapered finely to a small tip.
This snake was allowed to bite a guinea pig weighing 410 grams.
It struck the pig with great rapidity and the bite lasted less than
Sthire seconds. Owing to being confined in small quarters the snake
was handicapped in its striking and but one of the fangs entered the
.i*L tnt in nert trnfntn. Thin wan a.t. thP rvioht fnrn anlldn1r Thn


:'




I~





S*. .. ... .2 ... .-.
S:: :*X : :*w* *. ". ... **** .. .* P a n *.

: .. .. ..... .....A. ... .. .
I ... .. .. -. -. i *. ... .. .. ..:a
e.... ... ... .t ntantly cared for during.te
S.' .tei. were 66 patients under treatment at the
i.-...lpya ;.f '. were admitted, 7 died, and 3 were dis-
.^ j7 ,6 remaining in the asylum at the end of the
Mcon story hit, 28 by 72 feet, containing 6
IBi.by lI feet, an 2 bathrooms, 2 toilet, and front and
t.i.disa. the length of the structure, was completed
H1,, ,,trA the -work on this building,'with the excep-
'41S0 ee riering, was done by patients of the institution.
iig is ued as quarters for6 male Wert Indian patients,
A 4 ~relieve he present congested conditions. The chapel
wuitrnved a distance of 35 feet and placed on a direct line with
Sbt ilding.. The space formerly occupied by the chapel was
reaaidd planted with grass and flowers.
p'.ahc- year the municipal engineering division made water
'..:..; *..t.. from.. the asylum pump to the military substation and
Swas erected by the forticationdivisionof 50-barrel capacity
|Hf the use f the'military substation. Water was supplied to this
....tBo commencig mi May, continuously, with the exception
Mubou.. thrw, weeks when the well at the asylum appeared to be
.iiU dry. The plunger and casing were lowered 50 feet,
*ni.i midg the total lift of the pump 138 feet:
S A foundation of rock and stones was laid during the year as a
.:w sate for the laundry, placing this building on a direct line
i ;:other buildings. Minor repairs were made on all buildings
. ".I..i. .the year by patient labor, who also built tables and benches
::a::. o aasylum-use. .
:bout 35 acres of land were under cultivation during the year
: patients; and all products were sold by them to the asylum.
i wimste 9,000 pounds of yam3, -1,400 pounds of yucca, 800
Sdd .pumpk, 500 pounds cucumbers, 600 pounds tomatoes,
o pounds okra, 500 doze ears of green corn, 12,000 plantains,
weeen ddgs were purchased from the patients at a total cost

'......ls. to theamount of $1,509.48 were sold from the commissary
..... ..ent during the year. All articles are sold at cost, and at a
t to .ithe_ department, as the cost of transportation and handling
..ti.l. extra supplies required to be-carried in stock amount to
II per cent, and it is recommended that authority be obh
.BeEfinsI e4a timar in. aif nI knn nmn nar, wn aflo *nU-t ntabn an 1enhe
'":' :10 pe ent d. d that a thority :c it.is recommende e .ob-







*H H 4... .... =::: :.. ..*:.. *.. : :*. .:*
S'*' = ": *.... .. A* ; *
*H*.. .. *. ':".
.. : .:W. *
::::: ..: *..i *Hi. ..

.. ...
: : '. .r .. :' *
** "'d....'.*l" *
:'.:...'* :'.: 'E*:. *..': "': : : *. P: .:".: ..

B ,... .
HI : :.. *

,.--,
.:I I i i ii. j H** *


27


*: ": mi~hi. ll' ,:**** i~ : .:. .'.- .=" ". "-
:gqi..B. .- *-thin thoe of teeth mly 58
~ iC;k; s. : &.l )i-i,-.! .ili..i i .i m Il i.; ..... ...i:1.... i !ii !!!iii!
S............... .................
:.1** 79
*." *...*. *. .... .... g aa **Fa.. ***: ...: .*.*.. .* a.
*H* H*.Au :0*:: .I*** ** a7

~ij~...:..:: ..il;:i#i ., .. .. .. .i.... IlIIi! ,i I iIIIIIlIi
*::**,****:. v. ..* :-:::. Pm. : .4 ***.n 3
H*** *., g
ii .. H 1**-I ** s.

H... ... 1 3 1 1.a .... .......................... .....-............. 167
H ,,,H:" ,, S ,, X ,
.*:. .*. .i....- .. .. *. *.,.
:.: 14* .... *.-*......* -*..... ---. *-- -- *
:*....s ... ................... -................... *.eaa.............. .


i.E~? "*3:*"..i. gla ds _.p
.* .* : :I H. *


**~~ ~ ~ raed n ramn ::.ri***,....*m*wammmeeempored..gammmmmemmmmmemmmmmmmmmme 16
::: T ,;. ..... li" gi,..:.." .*-
iF..... .. .................................
."H" ..... .




litiC



gvn were ..~s m istmpe.t "1i
,. ,...,* ...** ...-. .... .* -*..-..--- -.. ..... .. .. .- -- -
** :...... :*: .*...s e ee *e e e m m m mmdm m mm m1.emm m mm m
.. .. I '." ".s.
T at',i h i o s ul 9 1sae m raton me nrep e.
*. .. *
... .. H.... ...


-, =.,. ......--s u a i a io so t d8
". nh umber found, needing treatment includes all children in
there was even a suspicion of a diseased condition. The
*.:: .~.. Xzg ds a ..gax~s ....-.-.-.... -.-........2
rI'I.........n*~ 't"eated tonde fac



stiP: mber of cases reported as treated is not complete,dutohefc
~that many notices were.. ignored .by. parents, and many slips to be
..." etuned tm the exam tngrphyam can, showing that treatment was

+;( iven, were lost or misplaced.
I:. -- Th




,. H $h .children in the colored schools were also examined. and
*.*"- rentment recommended where necessary.


.. i "*.

a.".
* : ::

IH ':
". "
HI H
:9....*


HI.


- I


DIVISION


ZONEs


SANITATION


SANITATION,


The zone sanitation activities have been directed chiefly toward
malaria control and antimcsquito work. The infrequency of other
diseasesn of a communicable nature, within the limits of the zone,
has been such that no extra effort has been required of this depart-
::meot during the past year.
: .. iThe extensive activities of the supply department in clearing
eand for pastures.and plantations which-have made necessary the
establishment of numerous camps outside of the regular seanitated
areas has been responsible for 173 of 473 cases of malaria among
: employees reported during the year 1917. Of the remaining 300,
177 -were from Colon-Cristolal and Panama, leaving 36 for dredges,
-.etc and 87 for.the zone proper.
* 7 presence of the cattle in pastures which have limits extend-
btowithin the distance of maximum flights as determined for
tnn hAel mnsnaitn a, intrndrne a n w nrnhl nm in mnanuitn enn-


L::"i




I~




I..: *...;
.. .. ...;
I.H:. i H
.. .7


d~:~l~n T.1:::


unt aove-ll Rothem, poverty and the
.Iff lntitatin in the tenement houses of
: te.d.ang is due, of course, ti both low wages
-" : ....: ." ,


.. rs whae been taken to improve the living condi-
e n -eent houses by notifying owners to install lattice
t ot dark roomb, and ae such other changes as .are
iri pt" rove the preset poor system- of lighting and'
Sorty-fur different houses had undergone such
nte up to December 81, 1917.
better antitabereuloeje measure would be the building
mk an silver quarters on the Zone for the housing of the
owbtea. iding infantma. This would reduce the popu-
e.ity .greatly and there would then be room enough to
overcrowding among the remainder of the inhabitants.
ent"s would also result.
.Iovember and December several educational articles on
:r .J .
entio of tuberculoi" .were published in the local press,
A :' 'pbds were completed whereby, beginning with the New Year,
cot tuberculosis in the city would be visited and instructed
a b.ic-health nurse attached to this office.
H' H;H:i..I we;are work.--Late in 1916, because of the high infant
..:.'.:....r. ate, -a public-health nurse was added to the porFonnel of
.Pauna m|halt l.Pfice, and by the beginning of 1917 her work
.::well underway. During the year she made 14,165 visits and
'*ii instructions to 700 mothere in the care of their babies.
* : -the. firsthalf of the year there was no appreciable difference
E +, the ubual number of infant deaths, but in the latter months the
....:,etse ..was efficiently marked to indicate that results were
! :....i.. : areOd. -
...e-.a.tma National Red Cross Society, a native organization,
"- ""ok u.p this Work early in 1917 and conducted it along the
bjB linea as or iginally outlined by the visiting nurse attached to
4 Ti. iBy t re end of the year .their work was so well organ-
:..at it was decided to turn over to the National Reod Cross
Somety all intfut-welfare activities in Panama, which was done
,*. DOewer .31, 1917.
'Tlaagh the infant mortality rate is slightly higher than it was
.' ago it would doubess have been very much higher if no
St Welfare work had been done because of the increased cost
im Mi lk as well as practically all foods.












which is then burned. However, during the
of heavy rains, these fires die out and many
to finish their cycle of development in the
I, the1 manure piles.
Milk, dairies, bakeries, bottling works, can
restaurants, etc.--After the resignation of the
spector in August the inspections of these
carried on by district inspectors 'and the v
the circumstances it is not possible to make a
this work, or to give tables, but an effort w'
keep the hotels, restaurants, and bakeries in
at all times.
Building inspection.-Because of the increase
the number of new buildings has not been la
of old buildings and the work of supervising ri
on regularly. During November and Decem
unusual activity in this branch of our work d
of an extensive antituberculosis campaign.
Sanitary nuisances abated.-The total nu


abated for the year was 3,440. Fines amou
imposed. As many nuisances were commi
a policy of great leniency was followed, and
were minimum. A very effective way was
of $5 and then suspend it pending the subs
of the offender, and it was seldom found nc
fine.
Street cleaning.-This work has been carri,
by street sweepers with push carts under th
foremen in the various districts. By the prei
are kept in excellent condition.
Garbage collection and disposal.-Practical
elected during the morning, and throughout
been disposed of at the city dump. However
the new year all this material will be burned
which is now completed. No special comic
posal are necessary, as the work has been c1
way as for the previous year.


nt


night,
of the
ground


or in times
larva- escape
surrounding


idy kitchens, hotels,
food and dairy in-
various places were
veterinarian. Under
t complete report of
as made to at least
a sanitary condition


ed


cost


of materials


rge, but inspections
epair work has gone
ber there was most
ue to the beginning

mber of nuisances
;ing to $497.55 were


tted b
fines,
to imp
;equent
Scessar*


y poor people,
when imposed,
'ose a fine, say,
; good behavior


Y


to collect


ed on, as in the past,
e supervision of street
sent system the streets


ly all garbage is col-
the entire year it has
, after the beginning of
at the new incinerator,
nents on garbage dis-
arried on in the same


CO LON-CRISTOBAL.


Large permanent
during the past ye
LT a- 1 -


improvements ha
Sar. The principal
--1-t-- .. LI U. ..


ve been made in the district
1 one was the completion of
-- nLnaJ. tie .C AL..


I


I



















bull
01
been
on t
Mou
Th
atati
the
cond
will
local
long
lapi(
poli<
01
for t
furti
TI
and
elim
from
Be
Rivi
stati
nece
vici
in tl
press
effec


111


..................................................................................................il
ding sites.
her of the swamps farther south toward Gatun have dtl""
killed or drained until the radius of filing extends.
lie average at least one-half mile from the setth pt
nt Hope. ...H
e Ponton Beach water front in Colon, west of the ra
on, has been filled in and is being used as a-railroad
buildings adjoining the beach on the north side have gl bl
Iemned and removed, with the exception of one group whieh.'.:
soon be demolished likewise. Other improvement in h H **--
lity are expected to eliminate the rat infstation
centered there. The buildings had become old nd
dated and were not built in conformity with the rat proiH
nv of our present re'ulations.- ..
Ld Pier No. 4 of the Panama Railroad has been demoliubedH.
he most part and reconstructed for the remainder, h
her reduces the rat problem. ,,,
he beach at Battery Morgan has been completely trmnsf i:n*4.
the long-standing unsatisfactory conditions there en tw a ld
inated by filling in and building a sea wall there exeJ
the battery up to Fifth Street. .
because of the crease of population on the east saide of
er, the development of Fort Randolph, the plans for an H
on, and the submarine base at Coco Solo, it has beenh i
sssry to grapple with the problem of mosquito breeding in a.
nity. Work was commenced on draining some of the a
he latter art of the calendar year and is being continued at
ent. Hydraulic filling of a large part of these swamps isb i
ted now. .. .....






33

I side of glass plates coated with gum and placed on the west shore
of Folks River.
It was established by repeated inspection that the anopheles
Were not breeding anywhere in Colon or on Manzanillo Island. It
IH was proved that the mosqi itoes flew across the Folks River and the
necessity of eliminating the breeding grounds around Coco Solo
was demonstrated.
SOn the initiative of the chief health officer, persons living in un-
screened houses in Colon were reqp ired to be provided with mos-
[ quito nets, which m st be r-sed under penalty to isolate all infected
cases not being treated in the hospital.
Tuberculosis.-There has been an increase over 1916 in both the
I number of cases reported and deaths resulting from tuberculosis.
This high incidence is suggestive of conditions demanding im-
provement. One of these is the overcrowding in the old wooden
tenement ho-ses of Colon, many of them three stories high, on
, both sides of an alley only 3 feet wide. This office is engaged
in plans for a graded scale for widening alleys in proportion to the
height of b. ildings, which it is proposed to put into effect when
these bt ildings are condemned and replaced. It is believed that
the poorer classes of the population are not getting eno: gh of fats
and oils in their food, and a campaign of publicity on the subject is
intended.
The dampness of the lower p trts of these tenement ho--ses during
the rainy season is also a contributory ca'- se, and this will in part bo
remedied by better drainage of certain alleys and the raising of the
floors of these older buildings. The g neral cong. stion in the tene-
ments will be hard to relieve under existing economic conditions,
since the laboring classes are oblig d to pay between $4 and $10 for
a single room and consequently cl b tog other to reduce the expenses.
The best measure to remove these conditions permanently wo: ld
be the opening of a good road from Colon into the interior east-
wards, to enco rage the population to live out in the open and so
remove the congestion due to the limited b-ilding area on Man-
i zanillo Island, while this road wo-Id be a means of improving the
general business conditions of Colon, of increasing the prodt action
of food, of raising the standard, and lowering the cost of living. It
is recommended that the construction of this road through t.he
Canal Zone territory to the Panama boundary line be included in
plans for the Atlantic Terminal of the canal as soon as practicable.
Diphtheria.-There were 23 cases of diphtheria during the year,
a decrease of one as compared to the preceding year. A diphtheria
E carrier was located and kent in the hospital for several weeks until








































lies.--The close of the year witnesses an almost i
minimum in fly incidence in Colon. In the early partlof .
an effort was made to economize in the use of lanroaeci ck*e.
custom of using a mall quantity of larvacide on mnecesibteiq
and crevices in the cleaning of patios and premiisswas t
discontinued, with the result of an increase in the numbr i
to the extent that it was decided to resume the use of
before, which soon got rid of the ithe again. This use of
both destroyed adult flies and prevents fly breedapg in is i
d c e t rise i- s
before, which econ got rid..of the Sim again. This us of
both detroys adult flim and*prevents fly breeding in plus M
*9 "W a 41 wr *Me i Aiush .h *.h



An::.: .1
1:3'


35.


course of the year. The elimination of the old buildings on the
water front, the filling in of holes in the coral rock on other beaches,
which are a harboring place for rats, and the constant killing and
poisoning have reduced the rat infestation in the district, and it is
believed that the reduction is much faster than the increase, with
the probable outcome that Colon and Cristobal may be completely
free from rats when the prospective improvements are completed.
On the completion of the modern cold storage plant at Mount
Hope, the rat-infested plant now in operation at Cristobal will be
eliminated and the building used for other purposes, after it has
been freed from rats by the demolition of Dock 11, which is the
source of rodent breeding in Cristobal. The new cold storage plants
will probably be completed within the next eight months.
Hotels, cafes, and markets.--A new and modern concrete hotel was
built and put into commission in Cristobal during the year, replac-
ing the old wooden building which has been a subject of frequent
complaint of late years. A large new concrete hotel for Colon is
nearing completion at Bolivar and Eighth Streets, which will be a
decided improvement in the accommodations of that sort in the
city.
Continuing the policy of bringing cafes and restaurants up to a
high standard, upon which the health office has been working
steadily since the completion of the canal, several of them were
closed and others made to conform with the regulations. A num-
ber of improvements were made in the public market in Colon, but
it is probable that additional market facilities will have to be pro-
vided for that city before long, and it is desirable that this should
be located on a water front.
Piers and docks.--Pier No. 7 was completed and put into com-
mission during the calendar year. Pier No. 6 is well on the way
toward completion. Pier No. 11 is in the same unsatisfactory con-
dition as previously reported, but it will doubtless be remodeled
as soon as conditions permit. Pier No. 4 has been remodeled and
made available for the use of the schooner trade.
The docks are inspected thrice weekly, and the work of catching
rats is carried on daily, although the improved condition of the
piers has reduced the rat catch to almost a negligible point.
Building operations.-The three large areas devastated by fire
within the last two and one-half years have been almost completely
rebuilt with concrete structures, with the exception of a part of
one block,in front of the Government Palace. In addition to this
many vacant lots in various parts of the city have been improved
.2J, a 4,.., an j. L, a, n, A. -, a, 4 1\ A na C rrt alq S a n a i











PH ii
I:


tH
f: == :*


QUARANTINE


TRANSACTIONS.


A r6sum6 of the quarantine operations for the year just ended
shows that the quarantinable diseases of plague and yellow fever
have not materially changed, with particular reference to Central
and South American ports. Along the west coast the first part of
the year plague conditions were bad, particularly in Guayaquil,
with a high mortality rate. An ,extension of the disease has
occurred in Ecuadorean ports north of Guayaquil, which has been
made the subject of reports from time to time, and requires very
careful consideration from the standpoint of a farther northward
extension to Colombian ports, which would make the disease
relatively a very short distance from the Canal Zone. So far as
we are aware, however, this disease has not made its appearance
in Colombian ports up to the present time.
In Peru and Chile, general plague conditions have shown little
variation. The infection is very generally disseminated, and no
measures of any special benefit have been carried out for its eradi-
cation.
Yellow fever on the west coast has been more prevalent in
Guayaquil, Ecuador, than elsewhere, though the seasonal increase
of this disease at that port, looked for in the last few months, has
not been as extensive as expected.
In Buenaventura, Colombia, toward the latter part of the year
a consular representative, who also looks after the matter of fumi-
gating ships, has been stationed, which arrangement will be more
satisfactory from the standpoint of shipping between the canal
and this port.
Smallpox has been quite prevalent in Chile and Peru, and has
been reported as having a higher virulence than usual. Since
the first of the year, and even earlier, considerable trade has
developed between Ecuadorean ports and Panama, carried on in
small schooners. Careful watch is being maintained of this traffic,
in order to guard against yellow fever, smallpox, and plague, and
when considered necessary these vessels are detained and fumi-
gated.
On the Atlantic side plague is reported in Brazil, and we suspect
its presence in Venezuelan ports also.
Yellow fever is reported from time to time as being endemic in
certain places in Venezuela, and the shipping calling at Venezuelan
ports is watched on account of both this disease and the possibility
of plague being present. Yellow fever has also been reported in
Brazil and from some of the West Indian Islands. This disease


















forces of the canal have given material assitace in the p1 .

able class were rejected and deported.
of the law. During the year 360 U migmants falling in the m d ..................................................

The work of the veterinarians in connection with quarantine *~j'
ante and post mortem inspection of food animals, has been eid..
out in a very careful mainer, with particular reference to tnat.
During the month of March, 1917, a total of 15 deaths from mntihrn 'z'.
occurred among cattle belonging to'the supply department. Oun
of these cases occurred on the Ioor of the Cristobal abattoir 4n
was made the subject of special report. The statistical reports ..
the quarantine and ante and post mortem inspection of food a- .i H
male, and disinfection of hides by immersion in 1-1,000 biehloride ...
.... iii#





solution for 24 hours, are as follows: :" ..
Quarantine inspections:
Cattle. -- -....-..-.. -. ... -.-- ...-.-.--. ....-.-. .. I-.. *. -. 28. 675
Swine ......,,, -- -- -- --- -- -- -- ,...,-,, -,,.,,, -
Sbeep .. V" .".ijjlJ.





-- -p ,,. a -- ---. a--- ,, -. -- .. ... .- -.. ,--- a-.... -
0 oats. ...... .. .. .. .. ....-. ... -..-....*.a. -. *... I ..
ante and post mortem inspections:
Cattle. *-*. -.. -*. ...-** **- *- -----.- -. ... -- .- .. -. -.. ---- .. 17, clI
Swine.. ---- - .... .. ... 531..
Hides d isin fcted..- -.. .. .... -. ..- ...- -- --- -..... -" .. ...... .... ,
The supervision of veterinary work was transferred to the health.ix .
officer of Cristobal-Colon on December 5, 1917, in order to conhWi iH
date this work under one head. On November 21, 1917, governor t
circular 700-1 was issued, requiring application of tuberculn tat .ii!
to all cattle and hogs imported into the Canl Zone for d atr a m....
breeding purposes, and to such animals arriving in Canal r onrts. O
ports for transhipment to other points when considered neesry,.i
unless such animuale are accompanied by a health cert
including tuberculin test chart executed byan inspector of -th
United States Bureau of Animal Industry. This req uremeutzwsu.
H.........








for the purpose of preventing the introduction of tuberculos@is 1.
uamonti domestic animals on the Cn...al Zone. Th..e.ex.ami..ti.....
amog omstc nial o te anl on. heexmiaton h





HiI.!.u
ibi!!'
ll '/ DEOTTOS

"iiH""" "I:iiil.

H::*
~39
*:, ,,, *.



H *..i



.:1, DEPORTATIONS



|| Sixty-six employees were repatriated to their homes during the

Year, 57 of whom were incapacitated by mental or other diseases,

and the remaining from injuries received in the course of their

: employment. Thirty-four nonemployees were also repatriated, all

| of whom were suffering from disease excepting 2.
In addition to the above deportations accomplished by the

hospitals, 360 passengers on incoming vessels were detained and

fl deported by the quarantine authorities.
I *. 43016-18---6
Ii..






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/906 26S47 4/. 7J
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/907 93S38 *&.74








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DEATH


NO NPi.L OYCS.


cot. Ott


F ~ vL f~



































































Year 1916: -i
White..... 4, 552323. 59 67.35 56.23 5.27 3.29 ....... 17.76
Colored... 2417 0 33.61 6. 15 4.79 1. 3 ....."...3


Total.....3 54 ,7 ,1 31 187 447 11., 4.. 1
Year6 1140.














6n-1.. ".i

1 Annual average per 1,000 employees. ... 2'..7........5.:8......7..




:
.. .
h.43.62.... H. .....8'....
....*. ..,,,gi

-.. "... .'

i- ..G.. ..... ,..
** ~::* *




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IiiL ..
.. iiiiHp:
,,,,,,,,,,,,
=.i~ii ==. .
==* = .: ii :i

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











TABLE I-A.-DEATHS


IN THE CANAL


ZONE


PANAMA AND COLON


AND THE CITIES OF


Year 1917:
Panama...
Colon.....


....g....
*.. J. .


CanalZone.. .


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

Year 1916:
Panama..... .....
Colon............
Canal Zone....... -

Total...-........


Aver-
age
popu-
lation.


61,074
25, 386
127,543

114,003


60,778
24,693
31,447

116,918


Deaths.


Total.




1,714
667
'313


2,694

1,765
696
343


Dis-
ease.



1,661
642
273


2,576


1,702
662
290


Exter-
nal
causes.



53
25
40


Annual average per
1,000.


Total.


. Dis-


ease.


-~-- 2


28.06
26.27
11.36


23.63


29.04
28.19
10.91

23.98


27.19
25.29
9.91


22.60


28.00
26.81
9.22


22.70


1 Military forces stationed on Isthmus not taken up in population,
among same not included for last six months of year.


and deaths


43016-18--7


Exter-
nal
causes.


























S1IIeroulot xeziiiiitis ........ .....a ii:! 7 *
Abominl tuberculosis .................-. I.- 1 1 .. ...*.... -.
Disseminated tuberculas.. .......... ...... 81 3 ...- 4 ...-. -
4,~..
Syphilis, hereditary .................. ....... 1 1 8 5 2 -iH
Soiiv 5 ...... ........ .......**...- ......- I.- ii.
Stcarvy.".'".".. ... ""..... ". "... "".. .".--.'. "'i" 1 .... 1 ...... 1.
A nemu ....................................... 1 ... .... -.............. :
S. .... H.
1mpleme...net...... H........................ 2" .. .
Cerebro-spinal fever."". 1'"""" "" ["" ........ ..
Pneumococce eningitis ............ ........ 1
-- "" -" "" """ "" "". """"a"". """ "H, ". =
epileagV --..-._ _...... ......................... 2- 1- 1 ---...... -..... ..,
Eopilsopa p1.............................. 2 1 ". .
ConvalsionspfDZ mfants,..-.,,,,.,,,,. 11 1 2 10 6 1-
Acute endoArditis 2 1 2 1 ........ 1
Organic diseases of the heart....... ......... 1 4 I--..1 5 .....
D- 4A
~.sraixoejsoteasoy n pheat-nsy stem -.. . 1 .*. --. ......... .
Diseases of the yymphatic system............ 3 1 1 3 ..." .....
Acute bronchitis.............................. 24 25 4 45 3 3
SChronic bronchilis:...-...... .......... 13 11 1 23 ..-...
BronCho-pneumo -...... ......... 70 54 15 1109 1 1
Pneumonia (unqualified)................... 8 7 3 12 ........ ........
aO pnemoma. ..... ,,, .. .. 5 '58 2 11. H..
Ple1yr ........................................ ... .". ."'....a *.a. '" ... *
~11m
Bmpyerna. -. ... .,,, .. ..***.*
Pilmonarj y con gesti ......................... 1 ... 1.1
Aoute somuatitis... ......................a...... .4 "'....-..- -
.A.c31e g .stritis. *.......- .".. .5- 4 3 1
Acteo indigestion. .. ............ .... ... .... 2 .-.. 5...... ..
Diarrhea and enteritis. 1................. ..... 50 122 28 2344 7 1 1
cities. ................. ........ .......... ... 3. 37 65 1 ....
intestil obstructions....:- ....-..........- I..... 5 7 ... t.
Other iseeses of the intestines ....... ...... ... 2 I 1 .. .
Congestion of liver................. ...... ..-....... 2 2- .... 4 ..... ... ... .
Peritonitis............ ....... ................ 1 21.-.. 3 1
A,.t. nep.ritis -.. .. ....... ....... 8 2. ... .. ..
Chrom.ic nephritis .... ... ............-.. 1 1 ....-- 2 ................
Other diseases of the kidney and annexa....... 1 1.... 3 ...............
Pyelonephrosis................................ 4 ..... 4 ...............
Altti.nonitn 1 t I








tin





;1*.





hi
SEX, COLOR, AGE, AND PLACE OF RESIDENCE.

SAge by months. Place of residence.
__________-_______----__ ---~ ----i.,I. IT o

S1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 Pa Colon. Zoanal tale





i ... "'" ..... .. 1 4
1... .. .. .. .. .. .1. i ..2.. .. 1 3


.... 1 ... I .... ... 1 1 1 I ...... 3 ....... 4 7
2 .... 1.... 2 ........ 1 1 2 10 1 .... .... 11
.... 1 2 1 .... .... 1 1 ..... 3 1 7 1 2 10
.... 1 1 .... 3 1 .... 2 ..... 1 1 9 1 ....... 10


1





1
.... -


2



5"
1
12
3
*







2"

"40"
6
4
1



2
.... C

2
*.a. C
..3.
4..


1
1







1
1

2

19

2



19


30
12
12


1
*i"


1
3
6
2
2


i.. .
.ma e D


1


2

1
1


..~....


1
1
8
4
* -C


1
16
4


2
3
9


.9
1

3
1



9


4
34
1
70
1

15
8




8
2
205
64
6
1
4
2
7

2
1


. i..
--....


12
21
43

4'
1


1


1
1
2


2

















+++I.








Abdominal tubersulou sr-;..:.-: : :c:: :z:::: :::: :: : :z .- -- :: zx zz:
Diss.... ted tuberculosis........ ++.............. I

Syphilis, hereditary -..-... --....-.......-. .. -...- -.-- ---.... ...* 2 --. -...-.
S* ***.*-- .. --. .- -
Anzerriia, primrxwv, Ter11131J31J5 ---- -.~..- .-...I.-. -a--.. a.- d.:
Simple meningitis... ,:::::::::::11
Pneumococcus meningitis.......-...-...-.... 1 I-.**..... ....
Cerebral hemorrae, apopexy..........-...- .-...-.--- --..- -..--. 1
Epile asv. -. .........-- ..... ........ .. -- -. '.. --"-
Convulsions of infants (under 5 years of sge)........ ........ 2
Hi.*



Acute endocarditis. .- .. ..... .............. - ..H
Organic diseases of the heart.................. 1...........
Lymphadenitis (nonvenereal).... .......... .......
Acute bronchihts .......... ... ....... .-... 4 6. 6 1'"H'."
Cehrone bronchitis... po.. ... ........... ......! .... 1i" ....
C i lr~~ e broncl.lti .. -. -. *. I 1 .. 1 -.. -. ... *!. i


Broncho-pneumoa ......n.nde a.. ... ..... 12 11 2 7
Pneumoia un usli.ea.... .--..... .. ..... I.........
Lobar pneumonis ... ....... ....... --..... .. .. ...--- ----- -- .-
letprisy.. ...... -.. ...................... .....
EA yema ... -
Diseases of the mouth and an.exam ... .... ..-.- ....-.-..-... 2
Sto .tite. ...... ...-.- ....... .. .......... .. ....-a........... .-
Chroniutec gastritis. 1I. .:
ABcute digeston.. 12.... ....

Diarrhea and enteritis (under 2 years)...-..... 20 12 .13
Colitis ... ... ..... ..... .... ..... ..... 1.6
Hernm'.,mintestinal obuctions.... .... ....q ... m. m... ..m. -----
eIntisiainal obstructions.. .... .. .-. I ..
Duoenal ulcer..... -- -.- .- -- .- ---- i

Acute yellow atrophy of the liver.......-.. I ---!-
Other diseases of the iver ..... ....... ... .----.i 1 -. .- -.-...-.....aa... ...
Diseases of the suleen d.............,............. .......... ..... ................
Simple peritonitis.......... ..... ...... 2
Acute nepristis. ....i.-.. -. -. .
Chronic nephritis.-...- ............. ....... ...H.. .... 6.1.......
Other disease of the kidney and anexa.... 1 ........ .













51



IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON,
MONTH OF DEATH.


May.


..a....
*..... -
..... a
-..- -


... .. a
... ...


.- i -


..i i.-





*Wia ai*
* a
* .. .a
* a-

- --
* --


me.aa en
in- -mia a


June.


a.i a
i*a. a


.i. .a


July.


a... a...
II IBIl





iil~Iliil
*...a .. -
* a... .- a
* aa --


*......*
..a- -
-.a .na
*i-iaato
- a aaia


13
3
2


... .. -
* -e a










-.. .a a



...a a..
* .aa -
Sa a.- a


August.


i..a-i


ii.aai

..aa .a*i



..l i.i
- anaa ai
wiain- *


* iD.Dea
* a -- ai


iio....


1


- 1


Septem-
ber.


1



1
1





2


..a...- a


- -. -a *

Sa.a a


.....* a


- a a- -i
* .- -i


1
m -a- e
i a a B


October.


2


* ina i


-i ia i a


* *-*
* a- Sa


. .. ... .


a a ..n
i lii- a i


*wa i-w -i
ia in i- li


Novem-
ber.


iam i.m.a


-.a.-. a
- -.a a

















* a .


.. -...a




* a a a



- -- a


I.-.* *

..a.a -


* a.. -


-I



*.....


15

4
. .... a a


1
1


2
U i m i


1


eem- Totl.
ber. Total.


3
4
1
1
I
1
I


II
10
10
2
4
9
1
I
5


3

2
2



12



124
15


I


1


1


272
67
1
5
I
1
1
5
1


11
2
3


:(:::::::::I~ ::


[ -


I


I


m




























Colomba '-; _..:::"::: ii 1: 761 90 61. m1.
Costa Rica........... ... ...8 4 8 4 A ,
CubIa... ..... ......... 2... --.-.-1 a 1 7 1 S,
Curacao ... .......... .......... ....- 4 1 4 1 5 !r
Demerara.........a. 1 -....-... 7 4 8 4 13 H.
*Dominioa...... .. ... 2 -- ..- -- .. 3 2 3- '5
Employms. Naepo s. Toa .








Fnte isa. .............. .. --...a..... ...... 1 ..... .. 1
Brbai:.....: ......:1 47 .... 1..:5...- i 15. i :

French ooias.............. 1 ......... 7 61 W 61.. 1,:
German.................... ........ 1 1
Gree e -...a.. .. .. -- --. -.- .-- 9 3 9 3. *..
Grenada. -...--...-.-.. 4 ........! 281 19 32 19 ';
Guadeloupe........ .. 6 ......I 13 4 19 4 3 ,iii
Haei........ ......... 1......... 1 2 4-,
Iollandi.... ....... ........ ........ ........ ....... 2
Honduras. d 1---- ---1-..- ... ..--- .......- .... 1 .....
India...............- 1 31...................... 7 .....9..... 1
Italy ...----------- .--- 11 3 11 3 U4 }
Jamaica......-...-. -.. 76 ..a*a...318 301 394 301 05 .
O .. ~i~



LBeria.......-.......................l.......- I : 2....-..- 1 a! .-i
Martinique............ ......... 38 47 501
Hexico................ 1........ 4 3 5 3 8 :
H 13O".



Montserrat.:..-........ 1........I 7 5 8 5 1-:Hi
Nasssul.. I I I... I!i I I iii IIi ," i","..i_ I 1 1 1 "' ..dal
Nie:i2sP. ..a.- ....:7 : *.aa i '- i I 1.- 1i

Peru.....-.-.-........ 1........2 10 1 11 .. 2 .
.oPnulra. ............ ........... 1 "........ I .....-.. 1 "
Iodio m.o.................. ........, 4 ........ 7 ........ 7 ..,,-






Siaeia Leon............ ..... ........ ..... 1 ........ .'.
Salvadora -q........-.... 1.2 ..-.-.....-... 7 10 -...-.. I







~1
it
b.












ii.


I:

U:
I..





















Alcoholism, acute and chronic...,...
Aneurysm..... ...... .............. ...
Apoplexy (cerebral hemorrhage)......
Arterio-sclerosis ................ ...
Brain, abscess of ......-..... --, .....
Brain, softening of.....-.............-
Caroinoma of the stomach...........
Dysentery ...................-.-... .
Endocarditis-....-.....-..- ......
Fever, malarial, estivo-autumnal......
Gangrene. ..........................
Gastroenteritis, chronic...............
Heart, organic disease of..............
Hemorrhage, pulmonary..............
Hemorrhage, due to ectopic pregnancy
Hemorrhage ........ ......---......
Hernia, strangulated ................
Hodgk 's disease................ .. ..
Intestinal obstruction.................
Intestines, other diseases...............
Liver, abscess of ... .................
Liver, cirrhosis of........--..--.. -.. -
Lungs, abscess of............. ......
Lymphosarcomatosis-.................
eenimgitis, pneumococcic.............
Meningitis, streptococcus...... ........
Nephritis, acute-.. ....................
Nephritis, chronic...-..........-.......
Oesophagus, epithelioma of...........
Pancreatitis, acute gangrenous ........
Peritonitis, simple..-----.......--....-- ..
Pericarditis... ........ .....-.......
Pneumonia, lobar... ....... .......... .
Pleurisy ....................----.........
Pyemia -.........-----------------..
Prostate gland, hypertrophy of........
Rheumatism, acute, articular.........
Sarcomatosis. general ......-.....-...-


! 7
8
1
1
1
1
I

*
1
2
2
1
1
1
1
1
--i.
I
1
1I
1
3
3
1
I
1

16
2
1
2
.29
1
1
1
1
.- -.


.. I..!


1
4I


[:1 .. '"A
I -
I..r: Cii
?~111 ."H:.I
1. ...
.:: jf j.
tH
---


I


111





I'U5


WITH REFERENCE
ISTHMUS.


TO COLOR, AGE, AND LENGTH OF RESI-


Age in years-Con.


Length of residence on Isthmus (in years).


t-
,I
R e^




II
. .I -
.. ...

'i' '."


I
Grand
total.





I
1
\ 1
8
8
2
1
2
2
1
3
3
2
1
22
2
1
1
1
1
3
1
1
3
II3
1
1
1
20
2
1
1
'~2
29
1
1
1
1
1
1
20
2
1
I
2
29
I
I
1
1
1










































*e e* s .... ...C..S... -.. ... ....*.- .a.....a**-- b *:..

rnnn tiarn ais 11 2 t l*:*..
va ous. .... .... .... .... .... .... .. .. .!..


Suicide by firearms.............
Suicide by railroad traumatism
Other external violence........


.....

.....
meimi
riOQi


a......-.

-in.....i
immieilmmm


a.TotaLs. .. m.m.. ...a.-..-. ....a m....-a a m.*. ....


IE











*.. 4..:1




H.:


- ... H H::




..%



5'

WITH REFERENCE TO COLOR, AGE, AND LENGTH OF RESI-
I STHMUS-Continued.


Age in years--Con. Length of residence on Isthmus (in years).




--- -- --- --_ ---- --- --
SGrand
1 a s so a total.













2 1 1 1 1 ,
<6 1 1 1



6 3 1 .. ... 1 .. 1 .. ... 1 1 3... 1 .. .. ... 312 15
--
I... ... .. .. ... ... .. ... ... .. ... .. .. .. .... .... .. ....





TABLE VI.-DEATH RATES AMONG AMERICANS ON THE ISTHMUS.

Annual
average
per 1,000
popula-
tion.
White employees from the United States:
Disease............................................................. *.31
External causes1.........-. ....................... ....... .. 91

Total............................................................. 6.22
White women and children from the United States:
Disease............................................................. 4. 25
External causes ............ .................... ................. ......... .67

Total .....................................................********... .......... 4.92

White employees and their families from the United States:
Disease. ................................. ......................... 4. 28
External causes.................................................... 1.27
STotal............................................................ 5.55
i..
I ,
H! '.


















*. .."* .... .= =..:*:: M..
I I I

Cause of death. Les.........
m. F. W. B. Y. than 1i -4 54 0 .
1 year.
*.....


i*j
Hii






4jj







H.
''
I'H'



A
H H




'i

I ".


General diseases.

Typhcrid fever...-.-. -- ...-- .
Malaria .-------------.-----.
Malarial fever, estivoautumnal


M leasles...........
Whooping cough..
Diphtheria and crc
Dysentery........
Entamebic ....
Bacillary......
Unclassified...-
Purulent infection


S..n

ulp
. .-S.
-m -


and septi


n0


Pyemia. ............... .
Septicemia. ----. -...-..
Pyemia and septicemia, pi
coccic-- -
Tetanus-. -----... .. .-.
Pellagra ...................
Beriberi..- ...............
Tuberculosis of the lungs..
Aiute mniliarv tulhberplnosis


.... -. ..
-..-.-. -.
*. -....- .
* .
* .m
* mm- m -
* -.- -. -
cemia.
.. -. -
* S *
eumo-
*m- m- mm. -
- *m m
- -
* -


Tuberculous meningitis .......-...
Abdominal tuberculosis.. ..... ...
Pott's disease -...-...............
Tuberculosis of bones and joints..
Tuberculosis of other organs......
Tuberculosis of the genito-urinary
organs ..-..... .. -- ........
Disseminated tuberculosis........
Syphilis:
Tertiary -......... ...........
Hereditary --.. -----..-.-..--
Period not stated............
Gonorrheal arthritis .....-.........
Cancer and other malignan
tumors:
Of the buccal cavity .........
Of the stomach and liver.....
Of the peritoneum, intestines,
rectum........-...-.-......-..
Of the female genital organs.
Of the breast .. .... ........
Of other organs and of organs
not specified......... ..,..
Other tumors (tumors of the


t


1
22

8
12
4




3
6

1


4 .
4


- -. -
2
. .


4
19
3
133
12
7
5
1
1






2
1

1
1



5

4
11
4

* -


2
27
2..
7


1
3


5


1


--- 1
1
1
I


----..


. ...
..-.-. -


*. .....-
* S ..-.


- -


-. a
.


....-..
-.- --
.....
S....t
* -.


.A. -
* --


I.x
H.i H~lII


|


* I


i I I


I


I


*


I




H.:::. *:
*1":
Hr
ii!:



!ii*"* :.
.911


:: *
vs.: EE 59


SEE8 AND NONEMPLOYEES) AND MILITARY,' BY SEX, COLOR, AGE,
OF RESIDENCE.


11-20





2

. ...


1
1
1
I8
32

S2

1


S.i


.....
*m -


21-30


I
- -




I 3

I 1





- -
1
1


1
15
1
127
8

1i
iI




)mmemm
""7"




I *~ ~ .



1

1
"'4'




i-



-


31


Age (by years).



1-40 41-50 51-6-


"3'
I




2
"~ T




1

" '3
3



101
5
"i1,


3


2 .


1


2
1



. I
* *I
- *


0 61-75 76--160


2'



-i


'2

i 1

49 22


11
1 ;
S. -1 .


*-


::1.
- -


SS -i -I --


- S .*
I

II
1



i
6 i




I
I
-I

'I


..'.I

I
.
* S *


- *i*


2


5


- -


Il


---- s


..-.-I
iii~ii


I
I
2 1


. S....
-am m



---------------


.. -


Pan-
Colon.
amal


I--


2
2
9 0


Illij


I ij


*


.


(32

I
3


.


.


1


11



1


1
10

2
1
1




I
4



1
2

2


I .,

rri



) ..
(


Irl



/..~....~/

Iir


3






1


I


Place olresidence.


A ge
UI1
kPo\~n.


2



1
1




1

2

1

1

1

19
3
2

1


Total.


Canal
Zone.


Ilj

I
II

1



2


d












































Other diseases of the spinal cord... 1 4 1 4 I....-........ H
Cerebra 1 hemorrhage, apoplexy.... 33 30 7 55 1 2 ...-. E 1
softeuing ofthe brain.... ........ 3 2 1 4 ... *.... *. h'
S.W **bS ..a1 *

Paralysis without specified cause. 3 5 3 ..... .H. E.
General paallysis of the insane.... 5 1 1 5 .. .... ......-
Other forms of mentelalienation.. 1 1 2 ....... -. -.. ....
Ch oni ... ... .... ... ... ..a 3- ..


Epilepsy....--------------....: :.
Convulsions of infants (under 5
years of age)...--- ,-.-....-...
Choreas... ... .... ........ .
Other diseases of the nervous sys-
tem .- ...... .-..-.-.. .........
rericaraditis -...........---..-....
Acute endoosarditis...............
Malignant endocarditis............
Organic diseases of the heart......-
Angina pectoris..................
Diseases of the arteries, atheroma,
aneurysm, etc...................
Aneurysm.-. ...................
Arterio-sclerosis.....-..-........
Embolism and thrombosis....-...
Diseases of the lypiphatic system
(Iymphadenitis, etc.)............
Hemorrhage; other diseases of the
circulatory system.. -...........

Diseases of the respiratoJry yatem.

Diseases of the nasal fossae.......


1
13

1

3

2




1


1
1


"2'

-6
3
46
2

1
.2
4
2

1

1


I.. .I..


2

m ea


3

1
16
--. ..

- *.. .
1
1


2
.6
14
6
122
3

2
14
11
3

3

2




1


3

"""5
I~II Il


I .-ii

- -


4


---U-


1



3






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







S S

-* a -
.. .
....~i



. ...


.- -S -
*1


:.


* ::ii:.i*.i
H.:. ..y
* :.:y*
* .*......*
x.: :::: :: :.
. *..:* *:: :* ::::
Hi...........
Hi: : hi! :
... .
.. :!::: .: .
E
...........................................................................................I*H

...* 1. ..
.... .
T "**. J.. -----


* "

.*1.

i .H ii
..
: H... i

.** II


.. :


3


II


L


I













EES AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE,
OF RESIDENCE-Continued.


Age (by years).


11-20


1






1
1
1
1
.C i
- C -
1"i
1


2
*1
... -


gagmm

* C -


21-30






1




i





1
- C C












5

1





1



2
2
2
19



1
....- -
- mm -

- n -


31-40 41-50 I 51-60


2
2


1
1




22
1
2
21
2






1
amm m


2
3
a


3
2


1
"2"










'"2'
13
1
2
1
1


1
1
1
30
1


7


1


I......


- -




* wI
nI w
-I


1
3
1
24
* -


61-75


-..- C
-n. .
* C C


C....C.C



26
1I


1 1
4 --...

C Cw C -W

n C n I -


76-100


1


4

2
- C *








* S
* n -


*
- -. C


6
* nwC


..CC .. .
* .. .. C
3
. -..C.C -

* m.. m- C

* m. C


Age
un-
known.


* CC *
* CC -


1


* ..C-. C
. .- C

C .C w. n-


Place of residence.


Pan-
ama.






2
2
3




1
9
2
5
4

34
3
6
5
1
5

9
1

2
3
13
4
80
3

1
3
8
2


mrmmmage
-mC m -I
* C *W .


1
1


Colon.









2




1


1


1
23
2


. ... .


3
. n -


3
4I

46





2
- C



* C *


* C m -


Canal
Zone.


1






2




6
2




1
1
I





1







3
17


1



21







1 !
1
i
--1

-~ -


Total


1


i .


















































+- -
Duodenalue ...
Acute yellow atrophy of tbeliver.. 1 J 1 ... 2 .*.. .I... ..


Cirrhosis of the liver-.. .......-...--
Other diseases of the liver .....- -.
Abscess ofliver (unqualified)... ...
Abeess of liver, entamebic. .....- -.


Diseases of the spleen..
Abcess of spleen... -----
Simple peritonitis......
Other diseases of the
system...............


digestive
- m .. 0.


NoIanenereal diseases of the genito-
orinary system and annera.

Acute nephritis......... ... -....-..
Bright's disease (chronic nephritis)
Other diseases of the kidney and
annexa.. ..............-..--- ....
pyelo-nephrsis......-----...---
dfT..L.J.!"..5-


12






19
52

2
1
1


4







1


2
*. -


II
.
11
3

3
3
I II


---


t


I


*


rr
2






I'U..:"..

.iiP.. 63 -




" EES AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE,
:. OF RESIDENCE-Continued.


11-20


a i2
* ....


* a....





-.-.-.. a
2

*.S....
-......


21-301 31-401 41-50


... .-. I..
......- ...
i g ii i i DID
BaIa
Iillr m


1
1
1




am






1
2











ii-Y







13
20
3


*.a.... -


1
1
1
1
1
*..... .






5
1
* a*. a a
2

2
7


,.... -
1...a..


2










""4"
2
.....a.a
... ...




1
*......



4











4
28








1
1
1
*..a....
*......


*......




4
28


1
1


51-60




















"2"


""2

""2





""3'
1
2











2
26
....-.-a
*.-.a.. -
a..a .. a







2
*....a.a

*.... -
2a





a 3 a
1


a..... -



..... i






2
20


78-100


61-75
































""6'















"'5'


i
i
......
..... a
.-.a.a a
*..... a
-a...-.. -








*....a. -





*.... ..
- -6 a

* a.- a
*..a.-.. -
* -~ a
*..a.a. a


*..a.... a




- .1.


Age
un-
known.


i- i. -
fiBae *


.iiiiiiii






..iiii....



... .....


Pan-
ama.


1
1

2
10
2
3

244
80

2
6


9
1
6


1
2



2

146
.7







3
2
2
""14"







31
61

8
5


Colon.






3




1

1

65
3

3
3










'"4"
3
1
1
"'2'
10
4


1



10


15
46

4
1
2


Canal
Zone.


1
1
1


1
1


1

2


2




1


3
22


2


Total.








3
1
2


Ago (by years).


Place of residence.


*O a a -
- a a
----4-


I I


|











I


Puerperal albuminuria and cnm- ....
-- H....'am --., ........ EL..
nEclampsia-r ...n7........... 16..... 7 1 6 ...
Puerperal inseanity3 .....-.... -- -- .- --,, I ..- --.. --....-.. .
Diseases of the kin and of the celiZu-
sr tissue.,,,
angrene. -- ..-...- .. .. .... 3 ---. 1 2 -- -....-.---.. -, N,,,,
Phlengom and calllltis------ 1 .1 .. ---......-.-..-. .,,,,
ElepbazLtiasii- -................... .. .-.. 1 0.....* 1 *- -.****- *-- *
Other diseases of the skin -and
annexa. ..............- .. 2 -""
Mizlformatiosa.
Congenital malformations (still- |
birth not iclded). ....... 6 es. ,, ,,,H H



Diseases of early infancy. .n ..-...
Newbo................. ........ 1 1......... 1 ....... ,
COngenital debility, icterus, and
sclerema. ..... 7 4 3 8. 11
Premature birth..*..-*..** 39 37 3 71 2 76 .-.. **-.,
Congenital debility-- ..., 19 11 3 27.... 30 ..
A trophy ofinfats..-............ 1 ..... .... 1 *1 ---. '- *- *
M442 32 1 3 65 9 .
inanly (Incluing various c(snl- l




birthot nf larde 1 1 1 8 0 L i
ODe age. e.
snity ...................... ..... 4 3 ... .......... ....
j ,... E ..".. : .i:i .i
Oterfue ipii ii ii ir to iiq mrly i i i..i "ii i i .














EE8 AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE
OF RESIDENCE--Contnued.


11-20 121-30131-40


S.....l 1

* ...i

1 4

i i
1 5


I....IIII


* ***a
* .-.



a..a.


.... a


a.---I
IIIIII



a.---I


1
I I






1



1











aa

-a .e.



..... a
I ae* -I
...i. a


* -a


41-50


III.I*
1










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










*......
Iiiill

II iro
IOa aoa


* a a



* a aa a
* a.a om

* i.a -e



* a Ia.i


51-60


61-75







ni. a a
aaima a
-wie- i
*ia a o a
Iia a-i-


a..... a.a....


IIIaIa I




* aI-II-


... a a
a--...


I IIII




* a -- a


- ...
a..--.



I


76-100
I


iiIII


Iiirii
.Iaa a









a. ....
- -. i.


ea le


a.a....


Age
un-
known.


..aIa aI
-I- III


IIIIaIaa





IIIIaaII




IIIIIIII


*.... ....
IIIIIII
IIliiII


Place of residence.


Pan-
ama.


1





5







6
47
24

45



30




5


Colon. Canal


2







1
25
3
1
12
1 1


8
1


1
2
- aI I. a~


1





2




1

4
4
3

I 17
*
I

6
a--a-.


'Total.


Age (by years).


I


I


I

























om i: ,:N "



Iins .ii.ts.- ----.- 4 2 .- ..:....




Ho umsism by oteurtl oe...-... .. 2 .. .................. 2...il


Frahictes, "ce n .. 4 ....... ... .. 4 1 1 .
ere te m al v le e*........*. 5 .5:.. :.: --- *.....-... .:: .-..*
Affeciious produced hr alerzi -.. .
Ilausee-Continued. t HF




S "," H ::::
ramajMtISm by macSBrhin es.. .a. ............. ...e... n. i=
Traumatism by cutting or piero- 2
S Istru.. ................... ........ 2
-* i lH.i ".1
Traamatism byf all...... ....... 1 2 131. 1 1 ..... ......
Traumatism by machines 31

Traumatism bn ther crushing 1 2 *:..
vehicless, etc.). ... .......... .. -95 3 4 8 .. .1 ..t 1...
RIroad tra Iaumatisn. 5 .... 1 4 ...I. i *. 1.i i. .1 ...
Electricity (lightning excepted)... 2 1 1 H.... .H-H
o 1 1 H..........

Homicide by cutting or piercing .i.



Oiier external violence..". i


I
*t *


Ill-defiHed organic disease.........
Sudden death.-.-........-..-- .........
Cause of death not specified or ill-
defined ....-....................
Infections of undetermined origin.

Total- .. .... .. .. ...-- .....
Stillbirths...... ---..-.........

Grand total.............-...


1
1

9


1,.587
182

1,709


13 5
...- -....
-I
1,107 329
150 40

1.2571 369


-i
1

2,921
292

2,013


--S.--
.......


......



Ir~~
.ee at

-....n-


:i "
I \ I
III;
I

**.." ...
S ..:
.1




Hli
-3
: H H




x ...:: :.
* :
i S.'
rfV *:H


I

..I
.




p :.*


.

67


EES AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE,
OF RESIDENCE-Continued.


11-20 I91-30


s.-.-
-ia..

----a
Iiiig


..... a
..... a

....... -
a.... a

87
..... .8

87


1
* a a. -


31-40


2
a. a- a


1
a a i a -


2
a a i i


380 377


380 377


41-50 51-60


3
1

2


1
I* a a -


1
1









1


245


215


. .. *


2
.*. .* .a


*. a .-.
2
BI ii



i-a i ii
. a .
* *a ai


1


1


176
m. a a a a


61-75


.a.. a a- .
t a a .e
i* a a -
i a aai-


105


78-100


i .ii-I
iI.. .i
ii. .i .


Iliil
- a a a .
Sa. a a a -


Age
un-
known.


i a a a a ii
i a a a -


......
S- a a .e
e ai*a -e


3


Place of residence.


Pan-
ama.


1
5


2
2
5
3



1
1

15


1,714
216

1,930


Colcn.


S i i .


2
1


42


ilim
* n d i a





. a a .
* a -


5


667
73

740


Canal
Zone.


2

1
3
1

3
3
1

2


2
1

313
43

356


Total.


1
1

22
1

2,694
332

3,026


Ago (by years).
























Whoopin-. cH EEh 1 1.
WDjiph)fflh r iC indiao ... .................. *.a..... N.. .....I *.***. :apa.. r.. r
Diphtheri. and croup ................ .... ...
i Senitenry nm -- -n-- ....- I. I- h
Dysernterv::
_: ..n. -,- v- ,., ,...... ,....:4:4,

Flurr lout hifeetion and eepticeuuiia...,...... 1 1 ***.,,I.:,,,
iii*i : 4:m44
Fl 10mbi W WHUB.,.... ........ ...... .... .. '. .. :.:44444

Pveimis and septicemif upnnooic *n.. .... .......
T e t sn u s. .m -e m-e- -*--e m- m--m- -mm m me m mm mm-mm- a-- -- I .
P ...,,...........2...2................ 21 2
UPer macemem mmmmmmmmm emmmm emme memmesemm ese .m .5.. ,
Tuberulteis o -- .1. .ndsp e 40 25 32 oil
**: ....: : .:lllllll
# W m m m m m mEEmm m m ,:M.EE::EEEN



Aeute mil'ry tuberculosis ....................... 3 3 1 .
Tuberer bmus pneniwcitis1 3 2 2 '44
--* -*- -*- -S *--: -H'El
.. .H. EE.E
Abdominal tubercu loss '-. --....... -.. -- 1
Pott's dissanH
ltrtiar hb .... ""


Hereiar .. on e ,.,, ..... ...,. ... .......
Tuberlosi of other orrens. -- 1* *
'uberel isj of the enito-urlaz.y organs.

Byphilis:
'T1ertioei... iii-iii 1 -ii ai. ..



--------- --- -eioem --cum -.. .... .,. .... .. 2 -- -- a,.
Of ~~~~~~~~~~ ~ ~ ~ ~ :, ,,:4, :4:4:4:4 :n. ...,,.,, .,,..,..., .,.,..
HE..:.:EEEEE






Pl er o ... st....... 1 1
Gonorrieai u.liiti -. .- -.--s a a .--. a a .- -. -.II
Cancer and other manlinant tumors: H
O~f thebIu ocalcayvity a---------------------- -H



Ofhe theor fem91e nit seal geia.ogn
Oe f the r 1oxr1h and f er...... ........... ......a ..............
raerromos etcaumo-rsof- o. em- ail. r--a-a4 :4-.


pt-d) 1-H H
0 iieibeiit.:4.:4










Acute otiul *ry.:. reuHatis 1 "

0 urv. jbl..................a......a...*..... a...s.. a....... ai .~..a.;.
Ao csl ar io hr rho. uiratis .. xi .-.- .-. .- .- *.1. ..
1 a a..iii~ ii. 'iiii
1:4d4 1:1: 44












Anemia:I4
Thior os l xiso- the bones------ -n oi t. .. -- .......... ...::.:44.4.:::4-444....1 ..











i H
Pbrmary I%.r uof other o,- 4.




L I"











fc AND NONEMPLOYEES) AND MILITARY,! IN THE CANAL ZONE,
B CUSE AND MONT OF DEAT.














I1' ay, June. July. Aug. Sept. Oct. N'ov. Dec. Total.
'" *
*.69


...AND NONEMPLOYEES) AND MILITARY,' IN THE CANAL ZONE
6-BY CAUSE AND MONTH OF DEATH.




.. May. June. July. Aug. Sept. Oct. Nov. Dec. Total.


1


....a a.a a





1













3
1
24
........ .








1














I6



2
is. ...... -

















1












2

"""2'
....aa i"
.a...a.... .






24




1





2


S a .


1


....--a.... a
* a S a sa-
..aa...-a ...
* a a a1 aa aa


a -*- a


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


2


*.n..a.








*.. |.. a



NO- a a


* a a a a -


a.....


a.....

*.-...
a
OQrri


1



1
a.... ... -
.........-



2
-.. ... a

3

2
4






2


""'4'

... .....
aa aa1


-.-..a....
....*. a a
-.aa aa
....... a
.a .aa a a


..a .aa. -a









1


1










"""2'
1











"""28'

4

"""3'

1




"""3'










2


1
1
2
1
r.......- -





1









1
1





1


I

5

. a-i
a..a.


- a a -
....a ... -


-.-.-a.a -



-.a.a..a a


...... -


1.


1
Sa a a a aaa



a-- i 1 a


* --.......
- -a a -a

- aaa.a3


2



.... ...


2










1


4
....a ..a.-. -
-.a.a a .a a


-.a.a. -

-.a... -

-..a *



-..- a

- ---..
- *. a


2
2





2
1
1
*.-. -.a-.a
..a. a a-.a


.....


* a a aa -


-ac-a....
- a a .. a.
n .~ -


a..a..


1
* a a a


--a---a-
st


I











































Other diseases of the nervous system ..-" .. .
Oter csdits...- ............-.....-.-2

'lil
4 .:...........
.... .



















+Dtezeaaaof the eu.tog a-f.. .
I ..........
4-":'- "i ... ..... .
4 *
Dianaea of" the circstnfory system '



Acuitis O'e"c''dt
------
.: .' ...
Angii~a ectois. ... 1. *** -F







Iiessraesoftoather iseasher oma anerysmlete.1 ------- -..
An teurym....--- 1 ... ...
A .L........ n
Jkru.lmccrala. 7,.q E
Mbols-i s tm end thrdm sb. eui". ........*... 1. ""."1........ .. ".=...:.
eOrganic do ease of the heart ... ........ ...... 6- 1 "H
Angina pectoris ..........-.. .............. 1 .



isse of tmateries.,theom...... ......... aneurysmet. ...... i......
Henouraygeot.e .......................-..--.. 11

leysemo.. -----...-.. .... ....,,,....... -
nitl. etc.)....-..........---...-.....I............ 1. 1. 1. ..

y........ ........ ,...
.. .


,et'" "
Diaecea of the respiratorn agemate
.*
S-S 3~*Eb~~3 .. .. *... H .
luernso..hens..................................... ..... -. ..
r isease.-- of thec thyrozu body ..

t j. .* .H --H

Broneho-pn umoniach. .:..-....... --.-.-...- 29 14 13 .. .
Pneum.iiiruiia (unqualified)- ... ...- m m m m I i 3 1 2. ii.
Lobar neum noa...I ..................o 7 12 a>.
ij~ si iiurii~i.- -- -* **- -* -** .'r--
P~leur nsyeu. on. ........f d..................... ......... .-. .... ......H.... .H

-my m -..... -a -.-.-.-.-...-........ ..- 1 .. :..Y.. .
Gangrene of the lungs....... ... ............-. ........ 1 2 ......
m *" iiiii

Phil I YtW~hPW Pm95 fWlR a ...H:*.
.. ......
I n wrtc wm, mnh nR i ',,,",,' "
.... ,, .:EE'E: .... ....




lH.. H : .*:: ': *:.. ....:.. .. *."
,, .* .:*. .. *. ? ....


. *** i** i ** -. _
..* ...... ..... ....
:. .ah ,. .. .. 1 i
." :: ...: .. .... : .. .

. : ... .* .

..: i ... .. ..... "4 *
...ir...... ....... :..-
:. .. .ii : H .

i B" AND MILITARY IN THE CANAL ZONE

*K M E AN3 MC f OF DEATH-Continued.


Yuiyg


m.. .a


*




#.
a.....
mamman




.a-aaa
a.....


I I
I .*..... .. 1

S*..' 11 10 13
1 ......... ........
* .........i. ...... .. 1
. .1 2 3





| i. .........
I : ..

H.! 1m
..... .




i!"i:: .
" | 1 "
I. 4
. 9 4



-.. I 1 17 20
r::.* 7. m4 20'


18 12
*:::**i ..m 1 2
*' .. a.

fl r : 7 .a* I
--. .1 1

i *..


Ang.


* .

* ---


*i mBea i
ime..a


2
18
*ia m. -
i a mii .i


* memme.. -
* ....e ..


I ........


a.-...-
a.-----
* .. i
semenem


Sept.


. *


-a a a
* ... .


* ia*
a I e


me-m.m-m-


a. -i*"


*a
ma.mm.. -
-a *..13 -
.- a .. e *


oo.. a. -..
alii. ia a
messe*Wee


*iai.i
* a a.
|| |iai
meemm I


I


Oct.


-a.-..

















meem-a *


2








I




ma ...... .















10
68
22
2
12
sam-aasei


Wa. a
- e a -m* a
I1


Nov.


3







7
* .. .a. *
* am.m* a
* a -m. --


1











1
15
* a .
* aseme .


*..a.a....-
* aeame a *
am* mama


iwmillie


111111
* e ..
...m...
m..e...


Dsc.


O
*.-.. ..
C


a


i a


1







1




1









*23


- ..aa
* ea


* a.sa


* a a


seemen



1



1





* -.. i


-m*m..


Total.


i
i


I










!'j '.': HE "i..*
Al~:b V .. .. .a.
Mn:. ~ ..V. k. ll.1 *-
~:91! I' :. .J.




A F..

i.:.


:s.WD I T TARY- IN THE CANAL ZONE

OF PDEATl-Oontited.


..~ -
H.-
N ..k 4
~ Vlll*14..


ixlb"
ViX..







*V.. *..
4i ..














I::.' ,
















N; ..:'...
LHi-



Ic'




Pt..

S.a::


ri~.ii~qU i

I.I


r;::P *





*. ~X





I.


*;:~


ii'.1
i.:n ai



11





III

,2
4i


VlI~CI


K
C
*
mw-n



ItII


*
L.




.,*a -


1 W
M


'Sr
--a,.A


~rim


r '*











U .- -.


--S.r

|06|||


i l l. i i i


-


JRw.


W *IWW-i.


a. -a

* ... S

-a--.




1*5**S


5**S**

S...--

.... a


*


1


1
.1

.. .
l "


f Aug.


I. I i i
*--. -

-a---.


----S.

* .. -


WWWiWi
.. i--

- S..-


o -. de

*mm ii

* |.- O


.--- m mm


-I


Sept.


- ......
- S -

* ..



....i .














4


* i n- i


.m. w imnm
g m ll C


Oct.


iii.i-



* .

-----


-i-i-




11111

...-



-S...
S....

S..-.


Nov.


..i .


, eS-5
* .

* i i


.......*. **......


a.. S...**. 25t* S


.i ...I.I-


---- --- 1


Dec.


Total.


i


I


i


Fr~iJrr









H:"'!^ ir::* HillI:.*:.' **
S :.. :: *. :. :. .:. *:
."". **. .
i.8f::. .'" .::" **. *
P i*. ..* .. q.
: :... :* *. ** .. ,


i..i..i i..j..i.x. ...


hr


4..
-.5.


:1:

ii:. HI














Bn.1



A.,:












Hii..-.


.n:


1.

Ii



.3


-"p.- -.


a...1


1
1







1.........

1


h~1)S...
p.i-
I.r lr
li* *.r S


it111
Si
8
2
.OS


1.
1




1
-5.-C----i



2
1

*.... .i.


a-..-.

.. -S.
U
a*
---S.

*5 r a


,-.".. S..
a


? MILITARY, I N THE CANAL ZONE


~7a1ti~


12



4

2
I.'i



-C p-nSn


* *a C
~a*5aS*
- .
* .. C-


- ..... i.
- S h ......
... ......

.... -5- .
a a S. ... .
1*
- a a ...


"""3'


*.a- ..- *-S1*
...i!~' CI .0 5 1.qa


*5
-a


Aug.


a








1


......-.S
""3'
Hi D I


"'"2'
- .*5 -*


II I



iIII
.i..-.-

[*".. -


. .g .,


Sept.


..... p...a
-m
2
4
......... -

8"

7




K 1


1



1


5



1
...a...i"


* .. --
- .. ..5-
. S ** S -
- U i- i -
* a- SS
* .....
. ..--

* .... ..


\ 220


Oct.


1
4
2

11


5


a
i.i ..i i


2


Nov.


1
2
6




4
Ce a ..


.. a


""'"5"

....... _
-. ... a

1


5

*.r.. B.
......- -


253


Dec.


........
5
3


7


a
S* ... S


* ....
* .. S
- S a *


1
1








..a .a i. "







.... ..1


Total.


1
22
1
1

2. G4


A.


till Lrll


)rYr
rrrC




I~




S. h M. .... .. .... .. m
..* H* H...* .
*** *:
..... ..H ... .. : .. -
.. ..
.n .
C. **
..... .... .. :... ...
N .. I .. ..H ... .
NIH.... *
.. .. .*.. ..
--" :--s j -




:: : : :
"E ,: 1 "i ....** **. : : *. ..
.... .. .4.. .... .... .
II.. .....E..E1 ."::-E : E:... .... "-p. ...- E '.. .E:... .. -. .. .
.. .. .: .. .. -
t.....-- ept. Oc..

i .*. .. *.. :
=. *.n ,. .** .. .. *........


.-.





lH I.m* *
: :.. ..: V.
***.. 5 : : :* :










i i i i=.: ... ... --
:::. E.-." ". .: -








3 .4 IS 4 24 6 7 7 36 9 47







11 2
::::.:.....: .. ._ 1 7.... ..


..r::. : :." ." :. 2 1
.* ** *.. ... 1 1 2 1
r 11' 8 2 6 56 812 4 7







fl 14





il .~~ .-.. 2 11 2; i-. 2.. 2.. -:. ... .... I.
HI.. .-. ..:*2 2
E. 3l .z ': ... : ...E .. 1 1." .. I















*.1: 1. h* C *.. .....





*.. .
i. In .I ii ...... .. .n i~ i. :. i i.I i. i i i ii. i .























.... 6..."


...*:. ...." : "- 1..
: : -




















", ..I I : /I
.. i .5- .
.. : .
tr









S III
... ... /
". .. IM w # #1W W w 1a me m e mee 1 a I 1
.:



,.. e .- "-.1- -- ]t/t,

L, *-: .. "

: iA pd ... "W~ i m lI imu mem m I I iml mII I Im l e I
...... :.I II .11 11 2
p .::: *:

.-.! .I -/. l*! .. ....


8 ,- 5..--7 7...I.3-.1 318


ag,,,: i\ .1[: I i* 1 "1---i /-I I l /-


** ** .,. 1, ... .. .. .... .. ... .. .. .. .. 1 .


I I / l. I
. _. .....
I" ,] n,:[ lsl
,,
III III II III i ii iI I ii I II n i


.aNaB OF DISCHARGE.


Nov.


D.c,


II-I I- I 3 i -


Total.


5
* -

31
1
2
3


3

i2
3


"47"

6
13
1
1
1
1
1
4
48
1
1
2
8
6
4
1


Grand
total.










H, 79
,: '79


ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE-Ccntinucd.


May.


W. B.
-


June.


I


July.


Aug.


B.I W.


Sept.


Oct.


Nov.


Dec.


Total.


5



8
2



1

3
40

23


2

3
6


4

1
1




1
2
3
2
9
1
6

-2
13
4
4

7
--.




1
G8


1
3
4

2
32

6
-


Grand
total.


1


I








II


rmuu nopzeizzozia. a...... .. -. . . -s TI ....
WWflrmeem.Ibemawt..am im w tat wa..nmumfli.Am MA 1
Lobar peummia.. -...-......-.- .. ...-. .. .. 2 .. 2 .... -
..... .. .

Other diseases of the respiratory system...--. .... .... ... .--. -. .


bScess f luns..,.. ........ .............~..... I.... .-... 1..-. .-...... 1 .... .
Diseases of the digeatine agatem. 2 :
Diseases of tb e th and enexa. -. .- ... .. ... 1. .
Diseases of hie teth ud grim-....-.......... 1 1 1 *.. .a w
Btiatii -. . .-.. ... -- .- .-. ... ...
Diseases of the pharyni.......:.....:. .... .... : : .: : -: -...- -. ... -
rbharynlgitis..- .- --.. ..a..-. .... ... ..... .-. .. ... 1 -..--. .
Policular tonsilltis. ........--....---.. :3 1 1 1 3 6 1.
lIcer of the stomach.......... ..-.-.......-... 1 1 .... 1 L ...
Other diseases of the stomach (cancer ex-"
canted)..... -.....(....f... ...-.... .. 1 .. .! 1 ...- ..|. .
Acu te ge3stritis -. -.... -.... -..-- .-..- --.. -
Chouial gastritI -....- ........- .......... -... .. ...-. ... .... .- .. ..-. ....
":""": E: F "








Diarrhea and enteritis (2 years and over)..... .... 1 .... 2 1 2 A.... .
lob war lm em m e mm m e meemmeumomla s Ie mam m I emm /m I | g [ 8| ....
V IL :":EEE:








I I / -......-
In teost ialpaasits .. ... .........., ....... ..... .... ..... ... ... ... .
Inrosss.io .apn...e.i..i -. 1 1 1 --.
Ienuiisya ..r.ia-... -.--- .... .. *....... 6
Appendicitisand typhtis. .......... 1,,.,,,,
Sn .". l "
Ocute rsndestss ....ei..t...t........ .....s I 1 1 .. I 6 -. 1 1
Chronic apendicitis .....,................... 1 .. 1 1....1 I 1 2 ..
bu rsllun 6. -......... .TI ........ .
therhernigS ............... .......... 1 .... .. ...... ........ ....
Other dineass of the intestines............. 8: 3 3~ 2I 6~ 2 11-1 ~il i i Ill- f:-
C'ira ion .oe......i..v...................... .... .... :

DOther disen es of the hliv d ner ... .- .-*. .... ..-. 1 1 1 1 .
Abseosse of liow te (unqu ieI). ........... .... -.. ....... -.-. ..*.. ... :.
T'horyn sitis F....,, I..,., I,.1,,.-1 /. !~ 1.1 /11 I I -! b'









r.mple peritonitis I31(nonpueper/I)......... .. i i :j 1 ..
Ulcer ofthestomath II I011 1/ I 1/ 1.! .I..' l.*."


Other diseases of the digestive sttemner .e.... .. .I.I./. I I. I .-








81 .

ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE-Continued.


May.


June.


B. W.


July.


132W


Aug.


131W) ~


Sept.


W. IB.


Oct.


Nov.


W.A B.I


Dec.


W. B.


Total.


38
6
1
2
4
9
5
1
2



5

3
2
33
9

7
5
3
9
10
7
5
3
4
1
24
10
41
3
1
51
5
G
1
2
7
1
3
1
1


__ Grand
total.
B.




49 87
11 17
2 3
1 3
45 49
37 40
2i 31
2 3
..... 2


4 4
10 15
2 2
4 7
1 3
35 68
2 11
H
3 10
4 9
3
..... 3
2 11
3. 48
10 17
16 21
1 4
4
..... 4
..... 1
4 28
2 12
89 130
8 6
1
..... 1
42 93
12 17
2 8
..... 1
..... 2
5 12
2 3
2 5
..... 1
1 2



































Metsntis her tilmore o.....h..o.... ............ .... .... .... .... .... .... ..
Cysts and other tumors o the o 'arv".....
Balpinaitis and other diseases of the female ... '
gem"t.l organs ... .......... .............. .... ........... ..................... i ...
*t

The ptLerperal shte. "

a -
: : :EEEE"
Extra-uterine pregnancy -
.... *......-*. .. ..... ..
Abortion .- 1
tt
.H *=
Dieamst of the skirt and of the cellular tissue. 9 .

,Furuncle 1, 4 1 1 1F
,I,. .. 1'
Acute abscess EH 2 3 I 4 1 5 8
Phlenon oe.nd clulitis s ....... ............ 4 7 3 3 3 6. L 5H


Dhobie itch.."-.- -. .--..--- 1 1 2 1 "' 1"
IlUcer of the siin 2....... ...... ...... .. 1.. 2 2.... 2 1 3 H 1

i mpe tino ......o................... .... .. 1 ..... *. ..*. ............
UrboticeIiai 1 "ninn
....... ..* ...-.
SH......... ,




Other disems of the skin and annexa........ .... 1 2 4 5 .5-

Diseases of the bones and of the oTgIms of mo- -. : >::L.H
motion..
Wt t2, ,,,,L:,::HN:::,,,,






*. ..: 1
Dseasesofthe bones(tuberculosisexceptod).. 2 1 *...* f." ..* '.....
Caries (non tu berculous).. .... 1 .. ... .. .-.
Ostoomyeithis ........ .........."1 .
Periostils .... .. .. ................. .. .. *...... ... ...-
Diseases oT the joins (tuberoniosis and rh .......
- A a iI I ." .. ... ,











ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE-Continued.


May. June.


W. B.I W. B.


. .-


July.


Aug.


W. B.


- I -


Sept.


Oct.


W. IB. IW.


Nov.


Dec.


2
1
3
1
2

10
3

6
1
1





1


7
1
21
32

5
6

3
1I
11
33



17
1
.... .


B.





10
25



26
32
2
2
1
1

5


2



12
1
39
50
1
1
5
34
1
2

1
32



16
1
3
5


Grand
total.


Total.



















Aooncio prbyeod.by ...na. cau.s........,
ii::::::::::* : ..:::::i=
Buieide by poisoning........................ .... .. ... ........
Poisoning by food......................... ..... 1"" 4 3"1 1" 1
Venomonsb*sanftingu:n...:..n:n.. ::: :::: cx: :::: .: ::i:z : ...2


tion ercpteosnd) .... ................ .. ..... .. I.I:..::. ..'. ::.. .'.:*
Ao mldental drownin ..... ...... .............. ." '. .. 1... ... .
raumatsmbyfirearms................I 1. H.



'lraumatism by cutting or piercing iqstnru-:
S a ire usbites a a a a a a -. I .a *


me1ts.:..... ... 1 1 10 11.
Traumatsm b wationerllept)............... 2 I 8 .... 5 1 'IH'
Absorption or deleterious gas(oes nfiagra- .
s* *S*****.* S *::*:*:
Aecideznital. dro wning -. -. ... 1. ......................

Traumatism by marear hmes.. .... ..... ."-". "... "" T1 -. 2 1
Traumatism by other r crush pier g gs.....i.... 1 10 st 1 r -
Raii1road trau1m0tism......... .......... 2 1
unamite tram by falml.............. 2 8.... 4 5 1
T raurmatismninmines an d qunarrih. ... ... ... . ................... 1

Traumatism by landslines.................. 1 1 1 5 1 II 2 4


Effects ofheat........... .......... .............'....,..... ['"';::' ''
Treat euhatisn by other crushing........................... 1 1 0 1 6 4 5 .... 7.
RaElectrociad trau(iahtnin ex. t . .. .. .. 1 3 . 1 ... 1


Homicide by euttinp: or pieremng instruments, .1""t "i
Fractures (cause not speei ed).. ....I....... 4 11 [1 6
pn rase amalis:...h....s.................. ...... 1 2 I. .. .*
erexternal volene..................... 9 35' 10...
Heat echaUStiOn .. *.* .... ......** .... 1 .... .... .~....... *-.. ....





IL .fiem 3 discrrses. ,
Electricity (IIb tning excepted) ........ ... ......... ....
H omicide by cuttmns or piercing instruments. .... ... -.. ... n.... fl** *... .e--:


FrIna cturions (aof ndetermnet d o i. ....... 4 1 16 3 1 .. 3 3 8'
D~islocationis......... ................b.* a... 1 .... *i.... A 1 ..


No dise.se........-.......... ...... .....--.....-. 3 .. -. ... .. 9 -1H
Otherexternalviolence.................... 5 34 945 35 10 42

l-2eflned diatasee. diiHI
)I-de~ined ortnacadouse.........a-..--.... .... .... 1 ... .... .-. a.... *.. .
Inlect ions ofunmdetermined origIn............. 2 2 .... 3 ....4 1 1 .

*.* .: ..............


139 ZI [lii AJV lSj i4~...::it[l
IT I 1 W 1..*- .. -.II#
.;!!!1.11








85


ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE--Continued.


May.


3 7
2 10


.5.27
11*2S2
150 272'


June.


July.


3 134


2 4 ....
2 2 1

144243 122
1


Aug.


W. B.


3 34


111 309


Sept.


4 134


126,330


Oct.


7 150


Nov.


W.




1

1







2
1




1











8



"4
2
... -
-.. -
1~m
*ge S




1 S


1

8



4
2


127355 123


Dec.


W. IB.


I...
1

1



2



3
1


3
*.-.. S
*mu -
* -m-


102 267
I.- ;


Total.


2

1

16
12

10
13
3
- S -


28
1
4
74



1
18
12

1,488


25

2
1
"37'



10

123
79
1
29
53
16
1
2
5

1
1
1.
56
11
18
438



39
14

3,325


Grand
total.




1


1


2
1
11

139
91
1
39
66
19

2
7
1
1
1
1
84
12
22
512



1
57
26

4,813


















iADTii
.I :l a:I..
W. C. W. C. W. c. W. O. W. C. W
a wa.-. .... :*

::
AxNcox HosPrrALa. ..
I"E....n:*:* EE

Panama Canal employ- a
ees..-.................. 42 1301,0371,852 16 751,061,800 3 41 :6
Panama Railroad em- 1 21
ployee...... 1 52 1911, 124 3 53 1831 21
Panama pay cases r..... 1I.. 5 1.-... ..-. ... 5 0 .'
Other pay cases....... 9 564,17 620 37 1564,1131,415 8 ..
Charity cases.......... 12 3 485 391 5 32 452 327 4 30 36 25

Total.... ... ...... .154 2625, 888 4, 992 61 317 5, 7844, 562 3012 l1a .25

(inane). t ..Ir
:" m* m:.



Panama Canal employ- 0
0s3.... .. .- -- .... i7 ... -. .. 8 .. _. -
Panama Railroad em-
ployees ...... ......... 1.... 6-.... -.. ....- 4.. ., .... a H.
Panama paycases...... 37 188 2 64 3 1 9 28.... 5 5.
Other pay cases......... 7 2 35 17 1 6 33 7 2.... .
Charity cases........... 13 62 4 32.... 1 9 23 .... 1 .

........... 57 259 67 126 4 26 51 70 2 6- 67
Co0221 5778.

-. ... ....- .- .. ........ 9H... --- "-
ChrTo ic ward. *
II



COLON HOSPITAL. .
Panama Canal employ-
ees..... ......... 6 8 19 341 2 13 164 253 31 78 9 5 .:
Panama Railroad em- -I
a ......

ployees............... 1 8 125 359 2 14 106 242 15 107 2 .L
Panama pay cases.m.... 1 27 101 5 12 8 25 14. 6I .*
Other pay cases......... 12 1 620 159 10 11 507 100 44 5 ii
Charity cases......... 1 0 65 34 1 4 57 16 7 12 1..:
__. ___ ____ ________ __ ___ ___ __ _____ ____. ...
Total.............. 20 181,042 994 20 54 842 636 165 2991 5:3 M
PALIO 8ECO LEPER :
ASYLUM..
S H Hi i l i










TABLE XI.-CONSOLIDATED REPORT OF
IN QUARTERS.


EMPLOYEES


TREATED


Stations.


Ancon.......
Balboa.......
Pedro Miguel.
Paraiso.......
Gamboa......
Gatun........
Colon... .....


Remain-
ing Jan.
1, 1917.


5
1


2

.9


Admitted. Di
I

W. B. W.


1 004 7....
1,804 125....
168 13.....
94 131.....
12 13....
146 59....
1,104 2, 140.....

4,3322,488'....
I,1


ed.


Dis-
charged.


W. B.


996 7
1,776 72
153 11
86 116
11 10
1391 57
1, 105 2, 142

4, 266 2, 415


Trans-.
ferred.


Remain-
ing Dec.
31, 1917.


CONSOLIDATED REPORT OF DAYS LOST IN QUARTERS BY EMPLOYEES.


Station.


Ancon......
.A.xlcon .. .
Balbo......
Pedro Miguel
Paraiso......
Gamboa.....
Gatun.......
Colon........


White.


10,132


Colored.


10,934


Total.


21,056


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


Total. ...... .. ....
I:































--*-: :
TotalD.... l -- .. *-.' .A'Lj 70001fl ai .4 d ID 1 M .,
.-.... H...
.* ...:* ...:


White. Colored. H"..
il : l


Total admimsionn to hos itals, excluding Corosal --
farm and chronic warJ r. ... .. .. .... .. .. ... 6, iB 6, 12 1 4 i
Total'-ndinaiasns of employees to quarters........ 4,M32 2,4188 6, W0
S* ............
A. .E



Total admissimtio mpoye to hos itals, exldn Cbrozal H,52 ,8 5 8

Total admissions employees to qarter&.......... 4,332 .2,488 6 .EE.E
3 8 610 :.

.Lep Lun er of ipaiients brred from 1,3 8q6ar0 es
t to hospitals, and between hospitals, whoe
admissions are duplicated in the above Agure.. 327 .0 73TEE

Net admissions to hospitals and quartort.. 11,057 8,10 .P1C

EMPWOYES8...

Total admiionsofemployeesto hospitals....... 1, 552, 68 5.241 .
Total 0 admissions of employees to quter.-.... 4, 332 2,48 6,) M..... ...
I~ tai... - -....,12 I,.......










Lss number employees transferred from
teo to hospitals, nod between hospitals, wose ali
nadmissions are duplicated in the above figures.. 116 319 43
1...E:I"H8E..
H: ."EEE.J:
A m e m e m m m m m e ama m e m mi....me m m.: :J..:E














't.i


CONSOLIDATED DISPENSAEY REPORT OF ALL CASES TREATED BUT NOT ExCusn. ..
.....*-. .t


i Employees. Nonemployose. TotaL .
S.t a t 1 -.
Station I ,a I es I I ... 1. ... I











TABLE


XIII.-AVERAGE NUMBER OF EMPLOYEES
SICK IN HOSPITALS AND QUARTERS.


CONSTANTLY


Hospitals:
Ancon Ho
Colon Hos


Total -.


spital ............... ....... ... .....
pItal -'..-.---- -..-..-..-....a ..-


Quarters:
Ancon ....-...-
Balboa..........
Pedro Miguel..
Paraiso.... ....
'GOi.boa...-..--
Gatun.. --.......
Colon-..........

Total ........


n.-.-..


Average number of employees constantly
Hospitals ..... .........-....-...-..
Quarters..........- .......-. ......


y
- -
a-


ick:
..-. .. -


Total.....


Average number of employees constantly
1,000:
Hospitals ---- .----.a---- a-
Quarters ..'am- m-- --- -..a .* a


ck per


*..... -
*m-m-e -


Total. -.......0.. ...--.........------


White.


49.99
7.54

57.53


5.55
11.55
1.12
.92
.09
1.34
7.19

27. 76


57.53
27.76

85. 29



11.95
7.17


Colored.


181.45
17.76


199.21


.07
1.10
.17
.91
.07
.57
27.07

29.96


199.21
29.96


229.17


Total.


231.44
25.30

256.74


57.72


256.74
57.52


314.46


17.72
8.25


TABLE XIV.-AVERAGE NUMBER OF DAYS STAY IN HOSPITALS OR
QUARTERS FOR EACH ADMISSION OF SICK EMPLOYEE.


SHosital ospals:
Ancon Hospital.-. -....-.-..-....-.---... -.-
Colon Hospital.........................-.....
Quarters:
Ancon..... ....~ .............................
Balboa ...... ............ -....-..........
Pedro Miguei .- ....... ......-..... ---.....-- .--...-
Paraiso .......... .... ..- ........-.. ......
Gam boa .................. -.....-..........
Gatun ..... .........-. ..-...... .....-. ......


White.


14.65
8.60


.- -.


Colored.


21.75
9.23


.i -


Total.


19.74
9.02



































ies o emp ayee ', I...,i...:.
Army and Na. patients 2, 604 35,2942 69,IOI$, H: I. "
Pubc-health ser e patientsVA........TO......... .26,..1 5,216 ....

rai tl..-.-....- ....-....-.--....- ........ 5,Z4 I4,8 w." ..

r Grand toty p. .. ....... ............. 2,a W 5s, 2,.02557 5 4
-H- H.
"" .:i i" "
..... ...' "" q4. .


TABLE XVI.-SURGICAL OPERATIONS PERFORMED IN ThOON ADH:
COLON HOSPITALS. + ..
H!".
Ia ,. .;,:i--



Ancon Hoe- Colon Hom- Total. ...I*. NH:
pita!. pita!. i;


:- *: :I q*:j. :..
m iHi
**.**:**: :::*



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








.po. .*Ancn **os- ....Colon Hos-" .". 1 a....
.... ....................... ....... .. .........
I .. i.
Nigi.-.- D .. N 2- .....
I~eg ** ** ** ** -* *5 H --* MiH.



......................................................................._....... ... 1r.. ............................................
.. .1 5*
S,, ,i,,

.Foot .


d: ::,.... r EE....,......:. : .

I -:* H*
.*"*.*Ili ii:iW







...ni .to ...ex por.toY... 1 -. -.... 1 .. *



Tam innh do.m w1 .
Operations on"bon.s:"",,,,,,
Grnetm, eomrs-- -'"j
I I = I "1 "I I I i> i l ,
Hranieto e'lrao1+
Ta miwarwam w1 1' ? 1 1 i.: :=I














TABLE) XVI.-SURGICAL OPERATIONS PERFORMED IN ANCON
COLON HOSPITALS-Continued.


AND


Ancon Hos-
pital.


Num-
ber.


Herniotomy:
Inguinal-
Single ......... .......
Double ............
Ventral .
VentLraI.... ............... -

Strangulated...... .....
Genito-urmnnary tract:
Nephrotomy .... ......-....
Nephrectomy... ....
Nephropexy........ .......
( ystotomy .... ......-..-
Urethrotomy-
Internal. .-.. .
Extertil ............. I
Prostatectomy............. -
Varicocele, radical cure....
Hydrocele-
Single, radical cure ....
Double, radical cure.. -.
Orchidectomy........
Epididymotomy........
Amputation of the scrotum:
Amputation of the penis...
Curettage uteri ....
Perineoplasty..... ..... ....
Trachelorrhaphy.........
Vaginal punctures.. ......
* Undescended testicle,
double.........
Obstetrical:
Caesarian section, abdomi-
nal .................. .
Accouchment force. .......
High forceps... .........-. .
Low forceps ...............
Version....-.......... ......
Perineovrhaphy ...........
thorax:
Thoracotomy.... ..........
Pneumothoracotomy --...--
Excision of breast -........
Excision of breast and
.axilla- ... ..


1


,Died.


rrii
.....





. -
. *-
1iil
iilm
Iirii
1ii.
*i-. i


1 .


.a. ..
a... -
S...a
* -...a
a.a.-. -




* -... -


Num-
ber.


2
1


. 2
2


Died.


....i


.mime
...me
...i.
.Ri.e
. .
- -
* a
* -
- .-

- --


'I


. .
--.....


Num-
ber.


Died.


..a. .*
. .....



.......

- ..-
- -. .
. a .

* .


. a .


3

i.ii-...
..i.. l..

* a ..
a. ~ a a .


."a i*ai


Colon Hos-
pital.


Total.


I I




















+ U.- a a .+ -+-a+
















Appendectoumy -. .5- 104 .. .""". 50 ".---- 154I .. .
Appendectomy with local:
peritoxtis.i .-.-- 20 -7--.. 27 H:
Appendectomy with gen:
eral peritonitis. 2
Cholecystotomyp f... ........ A3 A....... 3
Cholecystostomy .-..... 1 .. .-... ....-. I
Cholecystectony.......... 5---...... .-..-- 6
Abscess of Liver-- o"
Lpartohepatiotomyfor 1 1 1 2 1 -
Thoraco-hepatotomy
Exlraoy15,~.. 6.... 2.... 1 6





Pan-hysterectomy- ......- 1 ....... 1 .
.+" .. .."






''"upravaginahyttm y 82 1 2 .. w 84 1 H
Hystero omycomeouy ...... 42 1 2 **.... 44 ....1>Il.
Adpohetomy............ .1......... .......-..... .. 1 ......
Salpmgo-o:"
Rvhniaannrw-.* .'..






Bin slw.....J. ........ 7 -....... 27 ....
)ouble -- ~- ..- --- -1,... --... :x:: :8
SAlpingo-dophorectony. -n- 30 -...... 2 a 32
*- -- -- -". *
Ovarian cysteontomy..... ... .- 1 3 .. .:. HT.
pholetotomy.... 1 ......-.. .. 1........ .,. ..a.-
Ioaoo- oheationt fr f
Sspen- io-sterecom......3 ....... --
uPrast ginal hopera t omny 0 r ......... 84



Ovarian cysteetomy....... 8 ........ 3 ........ 11 ........
Oophorectomy............. 2 ........ 3 ......... 5 ........
ii" ...Hill
I ""I "iii'""
Plastic operation for .




I





93


TABLE XVII.-OPERATIONS PERFORMED IN EYE, EAR, NOSE, AND
THROAT CLINIC--ANCON HOSPITAL.


Adenoidectomy........
Adenoidectomy and
tomy................
Cataract needling......
Chalazion ..............
Evisceration ....
Excision of chalazion...
Expression, both eyes..
Extraction of cataract..
Fracture of nose, reduct
Iridectomy. ...........
Lachrymal sac, inci
drainage -. .........-
Mastoidectomy .......


Number.
..... 145
tonsillec-
......... 90
... ... 1


nion


and
- .. .. -


Plastic on eyeball.........
Plastic, nose..........-....
Pteryglum, transplantation
Removal of nasal polyp...
Submucous resection of
septumi... ...-.......
Tonsillectomy. .............
Turbinectomy .............
Trephine of schlera.........
Urlectomy ..........-......
Various minor operations..


Number.

. .... 3
... .. 71

nasal
209
.....- 183
...... 47
... 5


-I -


Total- -. .. -.
Refractions......................


43

856
1,108


TABLE XVIII.-WARD LABORATORY REPORT-ANCON
HOSPITALS.


AND COLON


Blood examinations..........
Estivoautumnal......
Tertian ------ -......-- ...-
Mixed tertian and estivoa
Quartan ................
Differential blood counts.
Leucocyte counts. .. .-..
Red-blood counts ......
White-blood counts......
Hemoglobein estimations


Filaria......... ..........
Stool examinations...........
Uncinaria ova............
Ascaris lumbricoides .....
Trichocephalus dispar....
Strongyloides intestinalis.
Ameba ...... .... -....
Entameba -
Ciliated monads..........
Bilharzia.m..-.- --m-..
Pus and blood...........
Bilantidium coli .-......
Entameba, histolytica, an
Guaiac tests-.. ....-..
Cercomonas, intestinalis..
Tenia saginata dispar .....
Oxyuris, vermicularis. ...
Uncinaria (parasites) (ova
Trrin. n xn.minntinne


*. i i .
utumnal.
i S i i -
. *.

- --. *. .


*. .. S .
.. .


S.. ... ......


.... ...
* .


.....m....


ragena..
- .



.m.......
.....r..
* -
*.-. ..S.-.* -


Illil
a-mmi"
*. .. .

i l .. *


Aneon.


8,251
447
188
2
15
345
1,085.
92
116
2,867
12
7, 151
347
98
233
249
51
3
67
3
704
8
14
252
28
12

119
on inl


Colon.


....


- .



.. I.


....


1,468
204
39

1
48

31
141
62

483
8


33
2

38

'134

1


I


Total.


9,719
651
227
2
16
393
1,085
123
257
2,929
12
7, 634
355
98
233
282
53
3
105
3
838
8
15
252
28
12
16
120
"7 iea






































































SD ie ". :*: .S ." ..........

ingmJin- I Ad-SS zi DHi....

LIJ mitted. charged. 31
I i.H "E..
: ... ........
1 1917: ,..ii P-
.. "* .... .i: .
g

I H.
H-...
-.H E J


.. ..: ...
Pa :p ~i~t. ." ::::: 115 1,451101 341 1,451052' 3!O: "I ".JIHi

Chantyp tients........ .. 416 9,450 990n 8e.. 14c..


umoiotal. ... ..431 101551 190 .........'



N r.o.,.. rel.. f.n ....int ... ... ........ .. 4 .
*j.i. ""*





Aveagenuberof ay' teaten r atentad~itsd~ -- .- .- --. 13 H .:5|
Nb od sefr hd* .. H... .*
vr fi--..et-. e..
.& "* -*::;= .. .... :



ilaiets -.-.- *- -10 646 =-4.-:
***:*. .:: .1 ..-
.. ..j i
..."..-. .....
..:w :. ..........




: : :
A~..~ *.HIii







--
.--
.- ":. "
H *. .
I iH..
qI,. H.



.. : .: .E

S.".. H....:... ..-
/ "1 ,".:..m..




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PAGE 1

.5+ !1 -.. tvt .44 74 ,NA 4E4 elt RR ITa ;i ofie 'AA 'At jgL, ++ w

PAGE 2

t~ ct +V ++ AN V44 *. W*,0 .IfRO ". E Q 1 Y OF EA P g1R,1,V x7 xV hVh ,A NO ON .: 1 4WIR : |.4 Rs ". Re+ pe o J-V AM ; jiml %e cl e*i M.WW [ :7 .UP %onc .1 m Il -j'T 1' RI .I 4 e4 : x & an 'A T A F 4, e L: 1 z 10;r41 xxNY C g 'i E C

PAGE 3

NOTICE. Beginning with the year 1918 reports of, the Department of Health, The Panama 4Canal, will be issued quarterly instead of monthly. 43016

PAGE 4

4 4 q4 4 46 44 e -TA : -H .1 4". 404 RM

PAGE 5

-x. x s a =.1. xm. x

PAGE 6

x --i. -x .: : .x: .---.x a x -x .x xT x 4 E.

PAGE 7

REPORT OF THE HEALTH DEPARTMENT OF THE PANAMA CANAL FOR THE CALENDAR YEAR 1917 ALBERT E. TRUBY Colonel, Medical Corps, United States Army Chief Health Officer WASHINGTON 1918

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CONTENTS. Page. Letter of transmittal .5 Personnel. .5 General remarks. 6 Vital statistics: Health of employees. 9 Health of residents of the Canal Zone ..11 Health of residents of the city of Panama. 11 Health of residents of the city of Colon. 42 Division of hospitals: Ancon Hospital. 13 Corozal Hospital. 16 Board of health laboratory. 17 Colon Hospital.-. 24 Palo Seco Leper Asylum. .25 Santo Tomas Hospital. 26 District dispensaries. 26 Division of sanitation: Canal Zone .27 Panam a. 28 Colon. 31 Quarantine Transactions. 37 Deportations. 39 Chart No. I.-Admission rate per 1,000 employees .40 Chart No. II.-Death rate per 1,000 employees .41 Chart No. 11.-Noneffective rate per 1,000 employees. 42 Chart No. IV.-Malarial fever, admission rate per 1,000 employees .43 Chart No. V.-Malarial fever, death rate per 1,000 employees .44 Chart No. VI.-Death rate per 1,000 population, employees and noneinployees. 45 Stat isticaf tables: Table No. I. Admissions, deaths, and noneffective rates for employees: deaths of residents of Panama, Colon, and the Canal Zone. 46 II. Deaths of infants by cause, sex, color, age, and place of residence. .48 I11. Deaths among children under 1 year of age, in the Canal Zone and the cities of Panama and Colon, by cause and month of death. 50 IV. Deaths by nationality .52 V. Deaths of employees, arranged with reference to cause, color, age, and length of residence on Isthmus .54 V1. Death rates among Americans on the Isthmus. 57 VTI. Deaths of civil population (employees and nonemployees) and military, by cause, sex, color, age, and place of residence. 58 V* II1. Deaths among civil population (employees and nonemployes) and military, in the Canal Zone and the cities of Panama and Colon, by cause, and month of death .68 IX. Discharges of employees from hospitals, showing cause of admission and month of discharge .76 X. Consolidated hospital report. 86 XI. Consolidated report of employees treated in quarters. 87 XII. Consolidated hospital and employees treated in quarters report. 88 XIII. Number of employees constantly sick in hospitals and quarters. -89 XIV. Average number of days stay in hospitals or quarters for each admission of sick employee .89 XV. Patients other than employees treated in hospitals and revenue received from their treatment. .90 XVI. Surgical operations performed in Ancon and Colon hospitals 90 XVII. Operations performed in eye, ear, nose, and throat clinic. 93 XVIII. Ward laboratory reports, Ancon and Colon hospitals .93 XIX. Santo Tomas Hospital. 94 XX. Board of health laboratory. 95 XXI. Quarantine transactions .97 XXII. Report of routine sanitary work performed in the Canal Zone and the cities of Panama and Colon. 98 XXIIT. Personnel report .98 (3)

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LETTER OF TRANSMITTAL. BALBOA HEIGHTS, ('ANAL ZONE, Javnrary 28, 1918. Col. CHESTER HARDING, Governor, The Panama Canal. Sin: I have the honor to submit the following report of the operations of the health department for the calendar year 1917. Respectfully, ALBERT E. TRTPBY, Chief Health Officer. PERSONNEL. There have been many changes in the organization of the department during the year. Before the declaration of war in April, 1917, there were 12 officers of the Medical Corps of the Army on duty with the health department. All but the present chief health officer have been relieved by War Department orders, and in addition four civilian physicians and three other employees of the department were commissioned in the reserve corps and ordered to the United States. The medical officers relieved were: Col. Deane C. Howard, chief health officer. Maj. E. E. Persons, assistant chief health officer. Maj. F. F. Russell, chief of laboratory. Maj. Win. A. Duncan, chief of X-ray clinic, Ancon Hospital. Maj. Guy L. Qualls, surgical staff, Ancon Hospital. Maj. Thomas D. Woodson, superintendent, Corozal Hospital. Capt. T. J. Leary, superintendent, Colon Hospital. Capt. Win. E. Hall, chief eye and ear clinic, A neon Hospital. Capt. Charles E. McBrayer, health officer, Colon-Cristobal. Capt. D. W. Harmon, chief sanitary inspector. Capt. H. P. Carter, health officer, Panama. The vacancies caused by the return of these officers to active service have been filled for the greater part by officers of the Medical Reserve Corps. As stated in the monthly report for August, these changes made it difficult to carry on sanitary work in the Zone and terminal cities at the highest standard of efficiency. These Reserve Corps officers are well qualified physicians, but necessarily lack experience in administration and tropical sanitation which is essential to secure the best results. It is gratifying to state that all of them have shown great interest in their new duties, and that they are doing their utmost to maintain the standards set by their predecessors. (5)

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GENERAL REMARKS. Health conditions on the Isthmus during the year have been excellent. Except for one case of smallpox and two cases of leprosy brought to the Isthmus, no cases of maritime quarantinable disease have originated on or been brought to the Isthmus during the year. No cases of yellow fever or bubonic plague have occurred on the Isthmus during thd year 1917. The last case of yellow fever occurred in November, 1905, and the last case brought to the Isthmus was on December 10, 1915. The last case of bubonic plague contracted on the Isthmus occurred in August, 1905. No cases of smallpox have been contracted on the Isthmus since 1907, except two cases in November, 1916, which were contacts from an imported case. The one case of smallpox brought to the Isthmus in 1917 appeared at Balboa quarantine on August 22 in the person of a passenger from Bolivia who arrived on the steamship Aysen; all passengers and members of the crew were vaccinated, fumigation carried out, and the bedding used by patient destroyed; patient had been isolated aboard the ship immediately on the appearance of the eruption; it is probable that the disease was contracted in the interior of Bolivia, where smallpox is knowii to be more or less prevalent; the case recovered and was discharged on September 23, 1917. INFANTILE PARALYSIS. X case of infantile paralysis was admitted to Ancon Hospital from Pedro Miguel district on July 31, 1917. The patient was a child 3 years old, without history of contact with any previous case of the disease. The child had not been out of the Pedro Miguel district for two years. This was evidently a sporadic case, similar to the two cases appearing in the Balboa district in December, 1916, which also were without history of outside contact. The patient was isolated, the
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7 well as all other contagious disease of childhood, are invariably mild on the Isthmus, and recovery is rapid and practically without complication and sequelae. In the terminal cities the death rates for tuberculosis and pneumonia in the colored race, also the high infant mortality rate, are matters for careful consideration. The causes for these high death rates are mainly economic-high cost of food and high rentals. The cost of food has advanced greatly since the war started, and this has resulted in great hardships, especially for the blacks; their incomes are usually small, and the food they are able to buy often unsuitable and insufficient. The results of deficient and improper food are particularly noticeable in cases of tuberculosis and in babies. The high rates charged in Panama and Colon for rooms result in making these people seek quarters which are small and usually unsanitary; it also produces overcrowding, and whole families often have but one small room because they can not afford to rent more or better ones. This department has taken active measures to improve the sanitary condition of such places, by requiring the owners of the buildings to increase the size of lattice windows and ventilating spaces, and making other improvements. An educational campaign on tuberculosis has been started. A visiting nurse has been assigned to assist in this work and to visit cases of tuberculosis. It is urgently recommended that more quarters for silver employees be constructed on the Canal Zone to relieve the overcrowded conditions of Colon and Panama; if this were done it would improve conditions in two ways-relieve the overcrowded condition of the cities and reduce the high prices charged for rent. The Panama Red Cross has developed into a very active organization, and is doing splendid work along economic lines in baby welfare work. The chief health officer is one of the directors of the organization, and is therefore able to indicate what lines of work are most urgent and important. C ENS US. A census of the Canal Zone was taken by the police department in June, 1917, and showed a population (exclusive of military forces) of 24,038. Censuses were also taken of the cities of Panama and Colon, showing a population of 61,074 and 25,386, respectively, these being slight increases over the number shown by the census of December, 1915. GENERAL MORTALITY. Deaths in the Canal Zone and the cities of Panama and Colon numbered 2,694, as compared with 2,804 for the preceding year, giving a death rate of 23.63 per 1,000 population, as compared with 23.98 for 1916. Deaths from the more important diseases.-The table below gives the number of deaths occurring from certain groups of diseases causing the highest mortality rates, as compared with the two preceding years. 43016-18---2

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8 1917 1916 1915 Tuberculosis (various organs). 468 445 353 Diarrhea and enteritis. 425 415 442 Pneumonia (including broncho-). 343 373 315 Diseases of early infancy. 237 211 287 Nephritis (acute and chronic). 178 208 179 Organic heart disease (including endocarditis). 161 139 151 Bronchitis (acute and chronic). 116 115 154 Cancer (various organs). 39 48 36 Total population. ...---------------------------114,003 116,918 121,650 Rate per 1,000, all causes.-----------------------23.63 23.98 23.51 Tuberculosis in its various forms caused 468 deaths among the population of the Canal Zone and the cities of Panama and Colon in 1917, giving a rate of 4.11 1 per 1,000, as compared with a rate of 1.41 in the registration area of the United States in 1916. Pneumonia (including broncho-pneumonia) was responsible for 343 deaths in 1917, giving a rate of 3.01, as compared with 1.37 in the registration area of the United States in 1916. Diarrhea and enteritis caused 425 deaths in 1917, giving a rate of 3.73, as compared with 0.79 in the registration area of the United States in 1916. Diseases of the heart.-The deaths from heart diseases (organic diseases of the heart and endocarditis) numbered 161, or 1.41 per 1,000 population, as compared with 1.59, the rate for the registration area of the United States in 1916. Bright's disease (acute and chronic nephritis) caused 178 deaths in 1917, giving a rate of 1.56, as compared with a rate of 1.05 for the registration district of the United States in 1916. Cancer and other malignant tumors were responsible for 39 deaths in 1917, giving a rate of 0.34, as compared with the rate of 0.81 in the registration district of the United States in 1916. INFANT MORTALITY. The high infant mortality rate noted in last year's report -has continued. That this excessive rate is chiefly caused by poverty, ignorance, inadequate housing facilities, etc., may be seen by a. comparison of deaths among children of American families on the Isthmus with those of natives and West Indians for the year 1917: Death% Number Number rate per of of births. deaths. American. 261 9 34.48 Native and West Indian .4,088 967 23.55 'All rates are computed as equivalent annual per 1,000.

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9 Of the 9 deaths occurring among American children, it is a significant fact that in 5 instances (the mother in 3 of these cases was Latin-American) the parents resided in Panama City or Colon. Of the four remaining deaths, where the parents resided in the Canal Zone, all were due to causes of early infancy, the oldest of the four children being only 21 days of age at time of death. Such a record speaks well for health conditions on the Isthmus for children, where they have proper nourishment and care. BIRTHS. Births and stillbirths together numbered 4,681, giving a birth rate of 41.06 per 1,000 population, as compared with 37.65 for the preceding year. Of the total births reported, 7 per cent were stillbirths. the same percentage as for the preceding year. PERMANENT BUILDINGS. Construction work on the new buildings for Ancon Hospital is progressing rapidly. Two large ward groups and quarters for the superintendent will be erected in 1918: the plans for these buildings are practically finished. This will complete the building program and will provide this community with a thoroughly modern concrete hospital. It will have a bed capacity of about 700, and will compare in every respect with the best of such institutions in the United States. VITAL STATISTICS. EMPLOYEES. The average number of employees on the rolls of the Panama Canal, the Panama Railroad, and contractors doing work for the Panama Canal, for the year was 32.589. as compared with 33,176 for 1916, and 34,785 for 1915. The total admission rate to hospitals and quarters was 356.75. as compared with 282.76 in 1916 and 320.20 in 1915. For disease alone the admission rate to hospitals was 124.80, as compared with 103.72 in 1916, and 143.82 in 1915. The total admission rate to hospitals only was 160.85, as compared with 140.43 in 1916, and 186.17 in 1915. The total death rate was 7,09. as against 6.03 in 1916, 5.77 in 1915. and 7.04 in 1914. The death rate for disease alone was 5.74, as against 4.58 in 1916, and 4.05 in 1915. The constantly noneffective rate from all causes was 9.65, as compared with 9.20 for 1916 and 10.28 for 1915. The admission rate for malaria, to both hospitals and quarters, was 14.51. as compared with 16.49 for 1916, and 51.20 for 1915. The noneffective rate for malaria was 0.48, as compared with 0.59 for 1916, and 1.19 for 1915. The admission rate for typhoid fever was 0.18, as compared with 0.66 for 1916, and 0.11 in 1915. No deaths from typhoid fever among employees occurred during the year.

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The five diseases causing the highest number of hospital admissions, with their rates, were as follows: 1916. 1917. AdmisRate AdmisRate sons. Rsions. Venereal diseases. 521 15.70 634 19.45 Malaria. 502 15.13 461 14.14 Influenza. 94 2.83 179 5.49 Tuberculosis. 107 3.22 137 4.20 Diseases of the eyes and their annexa. 122 3. 68 109 3.74 The five diseases causing the highest number of deaths, with their rates were as follows: 1916. 1917. Deaths. Rate. Deaths. Rate. Tuberculosis (various organs). 36 1.09 36 1.10 Lobar pneumonia. 31 .93 29 .89 Organic diseases of the heart. 12 .36 22 .67 Nephritis (acute and chronic). 20 .60 21 .64 Cerebral hemorrhage. 9 .27 8 .24 There were 36 deaths from tuberculosis among employees, being the same number as in 1916, as compared with 27 in 1915. From pneumonia 29 deaths occurred among employees in 1917, as compared with 31 in 1916 and 25 in 1915. EFFECTS OF RACE. The admission rate to hospitals and death rate from disease, for white employees, was 280.02 and 4.57, as compared with 97.89 and 5.94 for black employees. The admission rate to hospitals and quarters for malaria was 26.80 for whites, as compared with 12.39 for blacks. The admission rate to hospitals for disease for Americans was 264.35, and the death rate from disease 4.31. EFFECTS OF SEASON. The highest death rates for disease occurred in the months of July and August, and the lowest in April and November. The highest admission rates to hospitals for disease were in August and October, and the lowest in February and March.

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11 CANAL ZONE. EMPLOYEES AND NONEMPLOYEES. From an average population of 27,543 in the Canal Zone. there was a total of 313 deaths during the year. Of these. 273 deaths were from disease, giving a rate of 9.91. as compared with 9.22 for 1916, and 11.30 for 1915. The death rate for tuberculosis was 1.31, as compared with .30 for 1916. Deaths from tuberculosis this year were 11t per cent of all deaths. There were 669 births reported during the year, giving a birth rate of 24.29. Of these, 225 were white, and 444 black. There were 85 deaths which occurred among children under 1 year of age, 4 white and 80 black, giving an infant mortality rate, based on the number of births reported for the year, of 17.77 for white, and 180.80 for black children, with a general average of 125.56 per 1,000 births. Of the total deaths, 27 per cent occurred among children under 1 year of age, and 37 per cent among children under 5 years of age. Of the total births reported, 6 per cent were stillbirths. Below is a table showing the death rates for the Canal Zone from 1905 to 1917, inclusive, including deaths from all causes among both employees and nonemployees: Rate Rate Year. tio Deaths. per Year. PoulaDeaths.1 per tio1,00 tion. 1905. 23,463 828 35.29 1912. 79,279 1,129 14.24 1906. 34,095 1,700 49.86 1913. .61,700 1,047 16.97 1907. 54,036 1,708 31.60 1914. 46,379 710 15.31 1908-. 67,146 1,273 18.95 1915. 31,946 410 12.83 1909.76,900 1,025 13.33 1916. 31,447 343 10.91 1910. 86,465 1,251 14.47 1917. 27,543 313 11.36 1911. 90,434 1,385 15.32 1 Average population for the year, excluding the military for the last six months. PANAMA CITY. EMPLOYEES AND NONEMPLOYEES. The population of the city, as shown by the health department census of June, 1917, is 61,369. From an average population of 61,074, there was a total of 1,714 deaths during the year. Of these 1,661 were from disease, giving a rate of 27.19, as compared with 28 for 1916, and 28.97 for 1915.

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The principal causes of death, as compared with last year, were as follows: 1916 1917 Diarrhea and enteritis (including colitis). 342 332 Tuberculosis (various organs) -.313 319 Pneumonia lobarr and broncho)-.-. -. -203 213 Nephritis (acute and chronic). 106 92 Organic diseases of the heart. 68 80 The death rate from tuberculosis was 5.22 as compared with 5.15 for 1916, being 18A per cent of the total deaths this year, as compared with 171 per cent for 1916. There were 2,772 births reported during the year, giving a birth rate of 45.39. There were 668 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of births reported for the year, of 240.98. Of the total deaths, 39 per cent occurred among children under 1 year of age, and 50 per cent among children under 5 years of age. Of the total births reported, 7 per cent were stillbirths. Below is a table showing the death rate in Panama City from 1905 to 1917, inclusive, including deaths from all causes among both employees and nonemployees: Rate Rate Year. iPoPulaDeaths. per Year. n Deaths. pe 1,000. 1,000. 1905. 21,984 1,447 65.82 1912. 47,057 1,380 29.33 1906. .25,518 1,142 44.75 1913. 47,172 1,507 31.95 1907. 33,548 1,156 34.45 1914. 53,948 1,863 34.53 1908. 37,073 1,292 34.83 1915. 60,373 1,810 29.98 1909. 40,801 1,038 25.44 1916. 60,778 1,765 29.04 1910. .45,591 1,446 31.72 1917. 61,074 I,714 29.06 1911. 46,555 1,456 31.27 COLON. EMPLOYEES AND NONEMPLOYEES. From an average population of 25,386, a total of 667 deaths occurred during the year. Of these, 642 were from disease, giving a rate of 25.29 from disease alone, as compared with 26.81 for 1916, and 20.59 for 1915. The principal causes of deaths, as compared with last year, were as follows:

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13 1916 1917 Tuberculosis (various organs). 91 113 Pneumonia (lobar and broncho). 117 95 Diarrhea and enteritis (including colitis). 48 74 Nephritis (acute and chronic). 80 61 Bronchitis (acute and chronic). 61 55 The death rate from tuberculosis was 4.45, as compared with 3.69 for 1916, being 17 per cent of the total deaths this year, as compared with 13 per cent for 1916. There were 908 births reported during the year, giving a birth rate of 35.77. There were 222 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of births reported for the year, of 244.49. Of the total deaths, 33 per cent occurred among children under 1 year of age, and 43 per cent among children under 5 years of age. Of the total births reported, 7 per cent were stillbirths. Below is a table showing the death rate in Colon from 1905 to 1917o inclusive, including deaths from all causes among both employees and nonemployees: Rate lRate Year. PopulaDeaths. per pYear.aDeaths. per tion. pe Yedon. 1,000. -1,000. 100 1905. 11,176 553 49.48 1912. 20,174 493 24.44 1906. 13,651 703 51.42 1913. 20,232 489 24.17 f'907. 14,549 571 39.24 1914.23,265 590 25.36 1908. 15,878 418 26.32 1915. 29,331 640 21.82 1909. 17,479 396 22.65 1916. .24,693 696 28.19 1910. 19,535 514 26.31 1917. .25,386 667 26.27 1911. 19,947 527 26.42 DIVISION OF HOSPITALS. ANCON HOSPITAL. The total admissions to the hospital during the year numbered 10,880, as compared with 9,116 for 1916, and 10,652 for 1915. The average number of patients constantly in the hospital during the year was 483, as compared with 449 for 1916. PERMANENT BUILDINGS. The board of health laboratory was occupied in February. It contains laboratories for the director in research work, the bacteriologist, pathologist, chemist, entomologist, and undertaker; also offices, autopsy rooms, photographic studio, library, museum, and a basement for animals.

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14 The crematory, housed in a separate building immediately adjacent to the laboratory, was connected with the board of health laboratory building by a concrete walled and roofed passageway. Section "B," the second ward unit of the new hospital, was occupied in April and will accommodate more than 100 patients. The section contains 37 private rooms, 7 small wards, 2 cells, and necessary service rooms. The admitting office and dispensary building was occupied in May. This building has on the first floor, offices, waiting and examining rooms, and drug store for both gold and silver patients; and on the second floor, two suites of dental rooms, and quarters for the staff. The administration and clinics building, being practically completed, was occupied in December. The administrative offices and file rooms, on second floor, the medical clinic and eye and ear clinic on first floor, and drug store in basement, were housed in the building at the end of the year. The remaimng parts of the building, X-ray clinic on first floor, library and reading room on second floor, and entire third floor to be occupied exclusively by the surgical department, will be completed in the near future. Nonreceipt of building material and equipment due to shipping congestion being the cause for the delay. The kitchen and mess building is rapidly approaching completion. The isolation building for contagious diseases is also nearing completion. The passageways connecting section "A and section "B" with the administration building, were practically completed. The nurses' quarters was ready to receive roof. Work was commenced on site to receive section "C" of the new hospital. OLD BUILDINGS EVACUATED. Building 237, wards 5 and 6, were evacuated in March and turned over to the building division, which used same as field office, storeroom, and carpenter shop, in connection with construction of the administration and clinics building and kitchen and mess hall. Building 238, section "B," wards 7, 8, 9, 10, were evacuated in April and turned over to the supply department for razing and reerection at Pedro Miguel as silver quarters. The new kitchen is being erected on this site. Building 246 was also evacuated, cut in two, and moved onto the fill below new section "A," and the site it occupied -used for the new isolation building. The halves were connected, new connections made with sewer, light, and water, and continued in service for occupancy by patients. Building 232, steward's quarters, was razed in December, as also were buildings 234-236, which housed the drug store, clinics, and library, and the site is being used for new section "C." Building 334, admitting office and dispensary, was razed in May. All mat erial of value was sent to Corozal Hospital for future use. Building 335 was taken over by district quartermaster for married quarters.

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15 Building 2165, section "C," wards 11 and 12, was evacuated in September; building razed; site to be used for new nurses' quarters, active construction of which has progressed as before mentioned. Building 224, ward 15, was turned over to the building division for use as storeroom and field office. Building 237, wards 5 and 6, at present so used, to be razed in the immediate future. As soon as building 240, operating room, can be evacuated, the permanent ground improvements, such as walks, roads, lawns, etc., will be immediately undertaken. SURGICAL CLINIC. During the year 1,668 major operations and 1,775 minor operations were performed. There were 301 obstetrical cases delivered. Three thousand one hundred and eighty-four cases visited the outpatient department, for whom 560 prescriptions were written. MEDICAL CLINIC. There were 3,184 cases treated in the out-patient department, for whom 2,806 prescriptions were written. EYE AND EAR CLINIC. There were 856 operations performed, 1,108 refractions done, and 5,426 treated in the out-patient department, for whom 522 prescriptions were written. X-RAY CLINIC. There were 2,205 cases treated during the year, 4,930 plates used, 340 dental films taken, and 57 treatments given. DISEASES. No new cases of smallpox developed from the three cases treated the latter part of 1916. During the year 1,699 adults were vaccinated with 410 known "takes," and 62 school children with 37 known "takes." In January there was an epidemic of an acute intestinal infection, undetermined (with or without as the case may be) mesenteric adenitis and perityphlitis. There was an increase in the number of measles and chickenpox cases treated. STEWARD'S DEPARTMENT. Necessary upkeep repairs were made on equipment and plant. Gold mess pantry was remodeled and a new steam table installed, the table replaced being transferred to the silver mess, heretofore not so equipped. There were 181,453 rations issued to hospital patients, and 61,581 to personnel entitled to same; a total of 243,034 rations, at a net cost of $81,902.08. 43016-18--3

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There were 28,682 rations issued to pay boarders at-the mess. There were 268,968 pounds of bread baked from 204,031 pounds of flour, at a cost of $13,141.41. MAINTENANCE AND REPAIRS. The usual routine work was performed by hospital artisans, and the plumbing material, lumber, locks, etc., salvaged from the several buildings razed. MOTOR TRANSPORTATION. During the year all cars were overhauled or in process of being overhauled mechanically, and the following changes made: Touring car 109 was remodeled into an ambulance, new No. 307. New bodies were made for trucks 501 and 502. Ambulance body was removed from car U. S. No. 305, to be refitted with a hearse body, rebuilt from surveyed horse-drawn conveyance. The present hearse U. S. No. 301 is to be refitted with ambulance body and transferred to a line station for district physician's use. COROZAL HOSPITAL (INSANE). During the year, 1.93 patients were admitted, 30 died, and 129 were discharged. Among the discharges are included 8 patients who were deported or transferred to other institutions for further treatment. The average number of patients constantly under treatment during the year was 343, as compared to 290 for 1916. Buildinqs.-During the year the following changes were made in the buildings: The old Ancon admitting office was reerected in the garden at the farm, and will be used as an office for the farm manager and sleeping quarters for the watchman. A new vegetable and implement house and a breeding house for guinea pigs and rabbits were built at the garden. A dipping vat, 1,500-gallon capacity, was built at the dairy to eradicate ticks. This,. has proved a great success in getting the cows in better physical condition and increasing their milk production. The fire exits on the wards were fixed by permission of the fire department so thatthey can be of more use during a fire. Hosloital department.-The hospital has shown a gradual increase in patients in spite of the fact that frequent deportations to the British West Indies have been made. With a staff of physicians and nurses trained in this line of work, it has been our aim to run this hospital like up-to-date scientific hospitals in the United States. So far we have met with success. All cases are classified according to their mental disorder, by the aid of thorough histories, case notes, and laboratory findings, thus each case is afforded proper individual treatment. Various forms of amusements, such as motion pictures, concerts, and games on the wards, are the forms of recreation given the patients, as well as daily walks in the vicinity of the hospital. The patients are beginning to manifest

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17 more interest in the occupation ward. Aside from making hats, they are being taught to crochet, and to make rugs. This helps the patients to distract their attention from their morbid feelings. Some of the male patients are allowed to cultivate a truck garden within the hospital inclosure under the supervision of an attendant. This has proved successful, producing about $125 monthly. An attempt is being made to teach some of the male patients hat and rug making as done by the female patients. Although handicapped in not having a hydrotherapeutic room, an effort has been made to carry out this treatment on the wards. In order to make the patients' surroundings more pleasant, several flower beds have been added to the lawns, providing cut flowers for the wards. A neurological clinic has been established at Ancon Hospital where cases not requiring hospital treatment may consult the staff of Corozal Hospital. Farm department.-Dairy.-The demand for Corozal farm milk has increased so that at present we are supplying about 200 quarts daily to sick adults and children, aside from the regular supply to the hospitals of the department. There has been no increase of the stock, but by more careful feeding the milk output has been increased. An effort has been made to raise all heifer calves from good milking mothers. The tuberculin test is made regularly, and one cow was condemned after positive reaction at last test. The quality of the milk continues to be of high standard. It is practically free from bacteria, and the fat content runs about 1.5 to 2 per cent above the legal requirement. Pigqeb.-A process is under way whereby all our pizs will be immunized permanently against hog cholera. With this method we will save the expense of administering serum, and it will enable us to raise many more pigs than before. A plan is being worked out whereby hog cholera serum will be manufactured; it. is hoped this will make the piggery pay for itself. Poultry yard.-The Rhode Island Red hens imported from the States were found to be suffering from tuberculosis. Those infected were separated and are being killed off to prevent spreading this disease among the healthy chickens. Garden.-The garden has shown an increase in produce and income, although the expense has increased due to increased pay granted cripples, and increased number of cripples. General.-V'ith increase of patients the wards are becoming crowded, and steps will have to be taken to provide additional room. Several cripples have had their claims settled and have been deported to their native country. Many others are awaiting settlement of their claims. With the reduction of this force the garden will become self-supporting. BOARD OF HEALTH LABORATORY. On February 27, 1917, the laboratory staff moved into their handsome new building where excellent workrooms and a very complete equipment are provided.

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18 The pathologist has continued during 1917 the examination of the large joints at all autopsies, and has published his results, which were summarized as follows: 1. Gross lesions of arthritis were found in 15.6 per cent of 1,100 consecutive autopsies and less than 1 per cent of those showing the lesions were considered "arthritis suspects." 2. All but two of the individuals showing arthritis were hardworling adults belonging chiefly to the negro race. 3. A chronic degenerative type of arthritis included 129 of the cases, while 43 cases were well known acute types of arthritis or some ill-defined acute and chronic types combined. 4. Chronic vascular disease (syphilis and arterio-selerosis) and employment at hard labor are considered important etiological factors in the production of chronic degenerative arthritis. 5. The focal degenerative arthritis found at autopsy in young adults offers the gross pathologist, in the opinion of the writer, some additional presumptive evidence of syphilis and the application of the laboratory tests for the disease are indicated. An attempt has been made to enlarge our knowledge of the parasites, particularly those occurring in the blood and muscles, of both wild and domestic animals in Panama. The pathologist has collected for publication in the Proceedings of the Medical Association of the Isthmian Canal Zone the observations thus far made at the laboratory on this subject. The presence of Texas fever in this locality was first definitely established by the finding of B. biqegrtina in the blood of sick cattle in November, 1916. During 1917 further studies on this disease were carried out. Twenty-nine poorly nourished, tick-infested cattle from the Miraflores pasture were submitted for autopsy. Films from the blood, spleen, bone marrow, and brain were examined for the piroplasma with the following results: Positive. Negative. Positive. Negative. Brain. 29 0 Spleen. 8 21 Marrow. 10 19 Blood. 3 26 Thus it is seen that films made from crushed gray matter of the brain yielded far better results than blood films. An examination was then made of 125 healthy beef cattle at the Panama slaughterhouse, and all of them were positive for B. bigcmina. A similar series of 150 beef cattle at the slaughterhouse in Cristobal showed 90 per cent positive. Since the cattle examined came from all the different Provinces of the Republic of Panama, it is safe to assume that the parasite is practically always present. These results were obtained from the brain films, blood films being negative. It ie thus definitely established that, for this locality at least, the brain film is far superior to the blood film for diagnosis at autopsy. Panamanian cattle must be regarded as healthy "carriers of the disease; imported nonimmune cattle quickly acquire the acute disease and

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19 show a high mortality. Experiments have been begun toward immunizing imported nonimmune cattle by injecting them with a large dose (20 cubic centimeters) of the blood of native cattle soon after their arrival and not turning them out to pasture until they have passed through their mild attack of the disease. By cultural methods it was shown that a large percentage of Panamanian beef cattle carry in their blood a. large trypanosome. The morphology of the trypanosome was variable in the cultures and, as ordinary blood films were uniformly negative, a special method was developed to demonstrate the trypanosomes directly in the peripheral blood. The freshly drawn blood was defibrinated, laked with distilled water and centrifugated; smears from the sediment usually showed a few trypanosomes. The blood of the cattle inoculated into laboratory animals yielded negative, but a young calf showed numerous trypanosomes seven days after the inoculation. The trypanosome agrees with the descriptions of Tryjpanosoma theileri in morphology, in size, in its inability to multiply in other hosts than cattle, and in the fact that it can be readily grown in artificial culture media. We therefore decided that the trypanosome of Panamanian cattle is Tr. thcileri. This organism is regarded by most authorities as being nonpathogenic. During the examination of the sediment of laked cattle blood after centrifugation, filaria were frequently encountered. Sarcosporidia were practically always present in films made from the heart muscle. Spirochaetes were encountered in two instances. It seems, therefore, that Panamanian cattle all harbor B. bigcmina and sarcosporidium; that most of them are carriers of Tr. heilcri, and many of them have filariasis; and that a few of them have spirochaetes in thnir blood. Murrina has caused heavy losses during 1917 among the horses in the Sabanas between Panama City and Chepo. The laboratory conducted some field experiments on the treatment of the disease in a few horses; life was prolonged in most instances, but none of the treated horses survived. The experience gained will be useful in carrying out further experiments in the future. During the examination of the blood of the horses for trypanosomes, piroplasmata were encountered in several instances. An acute case of equine piroplasmosis in an American horse was encountered in the Canal Zone by Darling in 1913. It has been shown that the parasite occurs in Peruvian and Panamanian horses in this locality, and it is probably quite prevalent. Hog cholera has continued during 1917 at Corazal farm in spite of the use of hog-cholera serum. It has been established by autopsy findings that Colombian hogs are susceptible to this disease. During the year 12,543 Wassermann tests were performed on 9,561 persons, as compared with 8,633 tests on 6,728 different persons during the previous year. The results of these tests are summarized in the following table.

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20 Wassermann reactions during 1917, based on the number of individuals examined and not on the number of tests made. Positive. Negative. Total. Positvn White, civil: Males. 193 1,323 1,516 12.7 Females. 20 144 164 12.2 Children. 5 17 22 22.7 White, soldiers, males. 273 2,214 2,487 10.9 Total. 491 3,698 4,189 11.7 Spanish and white natives: Males. 127 426 553 22.9 Females. 15 81 96 15.6 Children. 2 11 13 15.3 Total. 144 518 662 21.5 Blacks and mulattoes: Males. 1,238 2,536 3,774 32.8 Females. 191 55S 749 25.5 Children. 10 164 174 5.7 Total. 1,439 3,258 4,697 30.6 Chinese, males. 4 9 13 30.7 Grand total. 2,078 7,483 9,561 21.9 In addition Wassermann tests were made on 214 spinal fluids from as many individuals, and of these, 47, or 22.8 per cent, were positive. B. typhosus has been recovered in blood culture 25 times. Seven of these cases came from shipboard (six different ships), two cases were recent arrivals from the United States, and the rest were sporadic cases from six different towns. None of the paratyphoid organisms were encountered during the year. The following were also recovered in blood culture: Times. Streptococcus. 0 Staphylococcus aureus. 8 Staphylococcus albus. 1 B. co h .8 B. dysenteria (Flexnotype). 1 During the year 1,576 cultures were examined for B. diphtheria, and 300 positive cultures were obtained on 102 different individuals. One patient was detained in the hospital 71 days before negative cultures were obtained; 30 cultures taken during this time were positive. The meningococcus was encountered in four cases during the year. In two cases the diagnosis was made by. smears only, no growth being obtained in culture media. In the entomological department work has been carried on in all branches of entomology throughout the year, and identifica-

PAGE 27

21 tions made of insects belonging to all orders. Although the principal lines of investigation that have been conducted in this department were in connection with medical entomology, many observations have also been made alorg the lines of agricultural, economic, and general entomology, as the calls on the laboratory demand. There were 240 lots of mosquito larvae received during the year and identified. Several samples of flour were examined for insects attacking stored products. ObLservations were made on the oviposition habits of Culex and Aedes mosquitoes. Studies are being made on the house fly, Musca domestica, in Panama, and new and interesting data regarding their habits of oviposition have been secured which will be reported fully at a later date. Observations on the life history and habits of the biting fly, Stomoxys calcitrans, are also being made. Investigations are being carried on regarding the insect transmission of Murrina, the trypanosomal disease of horses, to determine if biting insects act as intermediate hosts. A number of adult mosquitoes of various species were received during the year for identification. An adult female Anopheles previously unreported from the Canal Zone, was discovered this year. This is Anopheles hylephilus, the larvae of which undoubtedly live in the water held at the bases of the leaves of Bromeliaceous plants. Specimens of two new species of ticks have been found on the Isthmus, which have not been previously reported from this locality-one of these species, Amblyomma humerale, was found on a tortoise; the other, Ixodes ricinus, accepts man as a host as well as various wild and domestic animals. Work on the census of the adult mosquitoes taken in the daily hand catches in quarters and barracks at the various line stations, military posts, etc., which was continued throughout 1916, was completed in February, 1917. During the two months of the present year that this work was carried on, 20,835 mosquitoes were examined and identified. Of this number there were: Anopheles albimanus. 1,108 Anoph cles tarsimaculata. 2 Anophe es punctipennis. 53 Anophelns malefactor. 10 Anopheles apicimacula. 1 Anopheles eiseni. 4 Mansonia titillans .15, 021. Mansonia nlricans. 342 Mansonia fasciolatus. 916 A edes (Sterromyia) calopus. 14 A edeomiva squamipennis. 4 Lu tzia allostigma. 1 Lesticocampa. 16 WV1, eomyia. 40 Ctilex and allied genera. 3,358 A complete report of this mosquito census has been prepared for publication. This report describes the habit of adult mosquitoes in entering habitations, explains the practical value of hand catching as a prophylactic measure against malaria, and the method of hand catching. Observations on the screw worm fly, Chrysomia macellaria (cochliomyia desvoidi), were continued during the first half of the year

PAGE 28

22 and an extended report on this obnoxious and dangerous fly was completed and read before the Medical Association of the Isthmian Canal Zone. This report consists of notes on the early history of the fly, its distribution throughout North, Central, and South America, its life history in Panama, including copulation and oviposition, its manner of attacking man and both wild and domestic animals and the injury caused by such attacks, the effect of sunshine, water, heat, and cold on the immature stages, the habits of the larvae in burrowing into the ground to pupate, the depth necessary to bury carcasses to prevent the breeding of this fly, the lethiferous effects of various drugs and chemicals on the larvae, and preventive and control measures against this pest. This very complete report required extensive observations on this fly. Studies on the lake mosquito, Mansonia titillans, and its host plant, the water lettuce, Pistia stratiotes, were continued at intervals during the year, and an article on the subject prepared for publication. This article consists of data regarding the corresponding increase of both the mosquito and water lettuce with the formation of Gatun Lake, the habits and development of the different stages of M. litillans, the prevalence of the adults and their attacks on man, their manner of biting, and seasonal prevalence. Data on the water lettuce explain the history and distribution of the plant, a description of the plant, information regarding its propagation and development, suggestions for its control, and notes on the insect enemies of the plant. Additional studies on the water lettuce will be carried on from time to time, with the view of discovering an economical and practical method of eradicating the plant and its associated mosquito. Evidence has been received which leads to the suspicion that ticks are possibly concerned in the distribution of the eggs of Dermatobia hominis (Dermatobia cyaniventris). Studies have been made in connection with this infestation of the larvae of this fly, and a report has been prepared for publication which contains the evidence submitted and the findings of our observations. Extensive studies on the iguana tick, Amblyomma dissimile, the common ecto-parasite of snakes, toads, and iguanas in Panama, were completed during the year and an article on the subject prepared for publication. This paper deals with the description of the different stages of the tick, the periods of attachment, molting, preoviposition, oviposition, and its attacks on reptiles and batrachians. The study of the snakes found in the Canal Zone and Panama was continued during the year and a number of specimens were secured by gifts from individuals and by purchase from natives. Two species of venomous snakes were added to our collection during the year, of which we have not had specimens heretofore. Of the number secured alive during the year, three were poisonous species of which we have not previously been able to secure living specimens. The possession of these three venomous species afforded us an opportunity to experiment with their venoms in continuation of our studies on the toxicity of the venoms of the serpents of Panama. The first of these three species was a fine

PAGE 29

23 specimen of the "Yellow-bellied sea snake," Hydrus ploturus. This specimen, which measured 26 inches in length, 11 inches thick laterally, and 1 inch wide dorsally, was allowed to bite a guinea pig weighing 425 grams. Its action in biting was very similar to the coral snake, Elaps fulhious. The act of biting lasted 40 seconds and a chewing motion of the jaws occurred throughout the period; The pig evidenced no symptoms until four minutes af ter the bite, when it suddenly fell over on its side, the respiration changed to short weak gasps, and two minutes later the pig was dead. In experiments with the venom it was found that 0.0015 gm. of liquid venom diluted with 1 c. c. of normal saline solution and injected subcutaneously into a guinea pig weighing 508 grams, caused paralysis in 10 minutes and death in 14 minutes. One extraction of venom from this snake produced 0.0038 gm. of liquid venom. While securing the venom it was noted that as soon as the snake began biting on the edge of the extraction dish the venom was ejected from the fangs in fine streams of minute volume. The fresh venom is quite viscid, but entirely colorless like water. It is neurotoxic in effect. Animals that were bitten by this snake or received injections of the venom manifested no swelling, discoloration, or other changes at the site of the bite or injection, and the autopsies showed no gross pathological changes. We find that the Hydrus platurus is the most highly poisonous of any of the Panama snakes we have studied to date. This species lives in the Pacific and Indian Oceans, where it may be encountered in large numbers, sometimes being found in schools numbering thousands of individuals. It is commonly known among the natives of Panama as the "Toboba" and is very common along the Pacific coast of Panama and the adjacent islands. It is rather sluggish in disposition and does not appear to be very vicious. Experiments were also made with the venom of the "Fer-delance, Bothrops atrox. This snake was 4 feet and 2 inches in length; the body was rather stout, being about 11 inches in diameter and with a ridge along the median dorsal line which gave somewhat of a triangular appearance. The head was 2 inches long, 11 inches wide at its broadest part, and rather flattened, being about threefourths of an inch thick and ending in a pointed snout. The tail which was about 7 inches in length, tapered finely to a small tip. This snake was allowed to bite a guinea pig weighing 410 grams. It struck the pig with great rapidity and the bite lasted less than three seconds. Owing to being confined in small quarters the snake was handicapped in its striking and but one of the fangs entered the pig to inject venom. This was at the right fore shoulder. The other fang ejected its venom over the hair of the pig on the outside, consequently the venom of but one fang was received by the pig. Within 15 minutes after being. bitten the pig began to show signs of pain and excitement. At the end of 25 minutes the shoulder that was bitten became greatly discolored and was so badly swollen that it was apparently helpless. This swelling and discoloration, accompanied by the sloughing of the hair and skin with profuse oozing of serum, gradually increased until 3 hours and 15 minutes after the bite, when the death of the pig occurred. It was autopsied 43016-18--4

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24 and much discoloration with extensive hemorrhage into the tissue was found in an area surrounding the right fore shoulder and extending across the breast and involving the left fore shoulder. A considerable amount of serum was present between the skin and the muscular coat. A guinea pig weighing 415 grams which was injected with 0.0130 gm. of liquid venom from this snake died iu 9 hours and 40 seconds. The amount of liquid venom ejected f one bite by this snake was 0.0728 gm. This venom is hemorrhigc in action and, although not extrEmely rapid in its action, is very lethal in effect. This species belongs to the group known as pit vipers, all of which are highly poisonous. A specimen of a second pit -iper was also received alive. This was a Bothrops lansbergii, 19 inches in length and seven-eighths of an inch in diameter. The bite from this snake killed a large mouse in a very few minutes. CHRONIC WARD. An average of 27 patients were constantly cared for in this ward during the year, at a daily per capita cost of $0.252. COLON HOsPTrAL. There were 2,036 patients admitted to this hospital during the year, as compared to 1,700 for 1916, and 2,129 for 1915. The average number of patients constantly in the hospital during the year was 50, as compared with 37 for 1916. The new garage, recently completed and turned over for use, is occupied by quarantine, Colon health office, and hospital ambulances, with quarters above for respective chauffeurs. There is a fourth space to take care of an additional ambulance for Colon Hospital. The quarters for doctors and internes were completed in April and turned over for occupancy. They are satisfactory in every way. With the completion of the morgue and addition of the new autopsy table we were able to have the old morgue and chapel torn down. It was found necessary to retain the stables to house the mule ambulance. The new quarters for nurses are rapidly nearing completion and should be ready for seri ice in about two months. The finishing -of the nurses' quarters will allow the tearing down of the remainder ,of the old hospital, which is not only unsightly but obstructs 0a breezes to the hospital. In April a dry fill and grade of the hospital grounds was made and since then much has been done to improvQ them. The plants and shrubs recently obtained frcm Ancon have been set out and give promise of thriving nicely. Early in the year a concrete sidewalk with curb and gutter was constructed on Second Street from Coconut Alley to sen ice road. The increase in personnel in 1917 was as follows: Internes, 2; nurses, 3; artisan, 1.

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25 PALO SEcO LEPER ASYLUM. The average number of patients constantly cared for during the year was 65.69. There were 66 patients under treatment at the beginning of the year; 11 were admitted, 7 died, and 3 were discharged, leaving 67 remaining in the asylum at the end of the year. A new building, one story high, 28 by 72 feet, containing 6 rooms; each 12 by 16 feet, and 2 bathrooms, 2 toilets, and front and back porch extending the length of the structure, was completed during the year. All the work on this building, with the exception of the electric wiring, was done by patients of the institution. The building is used as quarters for male West Indian patients, and helps relieve the present congested conditions. The chapel was moved a distance of 35 feet and placed on a direct line with other buildings. The space formerly occupied by the chapel was graded and planted with grass and flowers. During the year the municipal engineering division made water connection from the asylum pump to the military substation and a tank was erected by the fortification division of 50-barrel capacity for the use of the military substation. Water was supplied to this substation commencing in May, continuously, with the exception of about three weeks when the well at the asylum appeared to be running dry. The plunger and casing were lowered 50 feet, making the total lift of the pump 138 feet. A foundation of rock and stones was laid during the year as a new site for the laundry, placing this building on a direct line with other buildings. Minor repairs were made on all buildings during the year by patient labor, who also built tables and benches for asylum use. About 35 acres of land were under cultivation during the year by patients, and all products were sold by them to the asylum. Approximately 9,000 pounds of yam3, 1,400 pounds of -yucca, 800 pounds pumpkin, 500 pounds cucumbers, 600 pounds tomatoes, 200 pounds okra, 500 dozen ears of green corn, 12,000 plantains, and 300 dozen eggs were purchased from the patients at a total cost of $616.49. Articles to the amount of $1,509.48 were sold from the commissary to patients during the year. All articles are sold at cost, and at a loss to the department, as the cost of transportation and handling of these extra supplies required to be carried in stock amount to about 10 per cent, and it is recommended that authority be obtained to charge 10 per cent above cost price to cover this loss. Authority was obtained from the governor in October for the expenditure of $1,400 for the building of a new launch, 7 by 28 feet, and a work request was placed on the mechanical division October 26. This launch at the close of the year was 95 per cent completed. All rocks and stones around all patients' quarters and in the park in front of the administration building were removed during the year, and the ground graded and planted with grass by asylum labor.

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26 4 Motion-picture shows were given weekly until June, when due to the fact that boat service was uncertain, it was impossible to secure an operator to run the machine; and to return the reels to the Y. M. C. A. at a fixed time. Reels were furnished the asylum by the bureau of clubhouses, and this division also gave the asylum 70 books of fiction. At the motion picture shows, ice cream and cake are served to the patients. Services for the Protestant patients were held weekly during the year by the chaplain from Ancon Hospital. Occasional services for the Catholic patients were held by priests from Panama and the Canal Zone. At the close of the year 63, or 94 per cent, of the patients were taking chaulmoogra oil. Marked improvements in a number of case is shown and accurate records of the results of the treatment are being kept. The general health of the patients remains good; three cases of malaria occurred during the year, two among patients, and one in a new employee. Antimalarial work continued during the year. SANTO TOMAs HOSPITAL. Ton thousand five hundred and fifty-one patients were admitted during the year, as compared with 10,831 for 1916, and 11,283 for 1915. The average number of patients constantly in the hospital was 440, as compared with 447 for 1916. DISTRICT DISPENSARIES. Seven dispensaries, including those at Ancon and Colon hospitals, have been maintained during the year. At Ancon Hospital, the new admitting office and dispensary was occupied on May 8, 1917. It is a two-story concrete building with offices, waiting and examining rooms, drug store, and dentists' rooms. Quarters for the physicians, druggist, and attendants are provided on the second floor. A new concrete dispensary building was also erected at Pedro Miguel, which was occupied on December 31, 1917. It provides offices for the district physician, district sanitary inspector, and district dentist, and on the second floor has living quarters for the gold employees of the dispensary. A new concrete dispensary building is under construction at Gatun, and will be completed during the coming year. This will provide for up to date offices for all our district physicians with the exception of Paraiso, which in time is to be abandoned; and at Gamboa, which does not require a resident physician. The annual physical examination of school children of the Zone, conducted by the district physicians, was begun in October, 1917. The following table shows the result of the examination of the white school children: Number examined. .303 Number found needing treatment. 679 Percentage of those examined needing treatment.per cent. 52 Number with defects of teeth as only defect. 341

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27 Number with defects other than those of teeth only. 338 Defects found. 79D r elective vision. 77 defective hearing. .i1 T efective nasal breathing. 32 Hypertrophied tonsils. 167 Pulmonary diseaso. 5 Bronchitis. 3 Chorea or other nervous defects. 4 Orthopedic defects. 3 Malnutrition. 2 Defective teeth. 441 Contagious disease. 5 Enlarged cervical glands. 27 Cardiac disease. 13 Number of cases treated and treatment reported. 164 Number vaccinated. 159 Number of successful vaccinations reported. 89 The number found needing treatment includes all children in which there was even a suspicion of a diseased condition. The number of cases reported as treated is not complete, due to the fact that many notices were ignored by parents, and many slips to be returned to the examining physician, showing that treatment was given, were lost or misplaced. The children in the colored schools were also examined, and treatment recommended where necessary. DIVISION OF SANITATION ZONE SANITATION. The zone sanitation activities have been directed chiefly toward malaria control and antimcsquito work. The infrequency of other diseases of a communicable nature, within the limits of the zone, has been such that no extra effort has been required of this department during the past year. The extensive activities of the supply department in clearing land for pastures and plantations which have made necessary the establishment of numerous camps outside of the regular sanitated areas has been responsible for 173 of 473 cases of malaria among employees reported during the year 1917. Of the remaining 300, 177 were from Colon-Cristotal and Panama, leaving 36 for dredges, etc., and 87 for the zone proper. The presence of the cattle in pastures which have limits extending to within the distance of maximum flights as determined for anopheles mosquitoes, introduces a new problem in mosquito control. Will the anopheles feed exclusively on the blood of cattle, or will they only feed sufficiently to encourage propagation and then seek their choice meal of human blood and thereby intensify their efforts in spreading malaria? The observations during 1918 will probably furnish data on this point. The amount of permanent improvements of a sanitary nature, and a torps of sanitary inspectors of a very high grade of efficiency, will mean a still greater reduction in the malarial rate for the coming year. Methods of reducing the cost, without reducing quality and quantity of new work, have been submitted; if approved,

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28 they will facilitate the improvement of even the pieseni high standards of sanitation on the Canal Zone. The hydraulic fills In the Ancon-Corozal district are nearly completed, and should show a reduction of mosquitoes in the areas affected. The general health conditions of the zone have been good throughout the yeir, with the exception of the epidemic of measles in the Balboa district. PANAMA CrrY. Malaria.-In years past malaria has been one of the great santary problems in Panama, and for that reason it is here mentioned first. As a matter of fact, this disease no longer presents any great problem, as its control simply means a matter of drainage ditches and oil. The year 1917, with a total of 187 cases as against 2,154 cases three years ago, shows how effectively the problem has been attacked. With the extension of new ditches and the work of making permanent ditches out of those already constructed, even the amount of oil necessary is much less than in former years. Approximately 10,000 linear feet of new ditches were constructed during the year, so that now our drainage system totals about 160,000 linear feet. Over half of the ditching work for the entire year was done during November and December. How effective our measures have been is shown by the following table: Cases of malaria chargeable to Panama. 1914. .2,154 1915. 614 1,416.;. 235 1917. 187 Tuberculosis.-While malaria has steadily and .very rapidly decreased from year to year, tuberculosis has slowly but steadily increased, until at the present time over one-sixth of the total deaths from all causes are caused by this disease. The total number of deaths from tuberculosis for the past four years is submitted: Number of deaths from tuberculosis. PulmoRate per nary Other Total 1,000 Year. tubercuforms. deaths popul!losis. tion. .206 23 22 3.82 1)15. 210 35 245 4.0% 1 .16. 242 71 313 S. W 1317. 253 66 319 5.22 A survey of economic and building conditions was made during the last four months of the year, and in so far as it is possible step have been taken to remedy the principal conditions believed to.' be responsible for our high tuberculosis death rate.

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29 Two glaring features stood out above all others, poverty and the overcrowding and lack of ventilation in the tenement houses of the city. The overcrowding is due, of course, to both low wages and high rents. Already measures have been taken to improve the living conditions in the tenement houses by notifying owners to install lattice windows, cut out dark rooms, and make such other changes as are necessary to improve the present poor system of lighting and ventilation. Forty-four different houses had undergone such improvements up to December 31, 1917. A still better antituberculosis measure would be the building of sufficient silver quarters on the Zone for the housing of the employees now residing in Panama. This would reduce the population of the city greatly and there would then be room enough to prevent overcrowding among the remainder of the inhabitants. Lower rents would also result. During November and December several educational articles on "Prevention of tuberculosis" were published in the local press, and plans were completed whereby, beginning with the New Year, all cases of tuberculosis in the city v ould be visited and instructed by a public-health nurse attached to this office. Infant welfare work.-Late in 1916, because of the high infant death rate, "a public-health nurse was added to the personnel of the Panama health office, and by the beginning of 1917 her work -was well under way. During the year she made 14,165 visits and gave instructions to 700 mothers in the care of their babies. For the first half of the year there was no appreciable difference in the usual number of infant deAths, but in the latter months the decrease .was sufficiently marked to indicate that results were being secured. The Panama National Red Cross Society, a native organization, also took up this work early in 1917 and conducted it along the same lines as originally outlined by the visiting nurse attached to this office. By the end of the year their work was so well organized that it was decided to turn over to the National Red Cross Society all infant-welfare activities in Panama, which was done December 31, 1917. Though the infant mortality rate is slightly higher than it was a year ago it would doubtless have been very much higher if no in ant welfare work had been done because of the increased cost of milk as well as practically all foods. Infant mortality for past three years. 1915-221.00 per 1,000 births reported. 1916-236.86 per 1,000 births reported. 1917-237.73 per 1,000 births reported. Hookworm infection in emplcyees.-Examinations were made in November to determine the percentage of hookworm infection among our silver employees. As a result of these examinations it was shown that over 40 pre cent were positive. Because of this high percentage of infection among about 130 laborers, and with

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30 the knowledge we have concerning the decrease in efficiency this disease occasions, more extensive examinations of employees will be made. Principal infectious disease occurring in Panama during 1917. Diarrhea and enteritis, including colitis (deaths). 332 Pneumonia, lobar and broncho(deaths). 213 Chicken pox. Pertussis. 71 Measles. 52 Diphtheria. 38 Scarlet fever. 7 Typhoid fever. 7 Vaccinations.-The total number of vaccinations for the year was 1,447, and these were all done during June, July, August, and September. Regulation of midwives.-In 1916 a section was added to the sanitary regulations requiring the licensing and supervision of midwives by the health office. At the present time there are over 60 women in this profession registered in Panama in accordance with this requirement. However, as there is no penalty clause provided, births are not infrequently attended by unlicensed midwives. As most of-thEse wcmen have failed to meet all the requirements, there should be a provision 'whereby such incompetents could be eliminated. Wcrk cf the wtaivcrian.-On June 9, 1917, a veterinarian was added to the personnel of the Panuma health cff ce. Eccarse of the goverrment regulations requirirg the disinfection of hides, and a requirement that all hcgs and cattle shipped through Panama be inspected, such an official was found to be necessary. The veterinarian has divided his time between the supervision of hide disinfection, the inspection of animals, and meat inspections in the local markets. Since August, 1917, he hag also devoted as much time as possible to food and dairy inspections, in addition to his regular duties. The following is a brief report of the work done by the veterinarian from June 9 to December 31, 1917: Bides disinfected. 12,481 Goatskins, deerskins, etc., disinfected. 2,124 Hogs and cattle inspected. 10, 146 Inspections of markets, etc. .647 Diseased animals treated.-. 9 Horses condemned as unfit for service. 5 Dairies ins pected. 76 Hotels and restaurants inspected. 85 Bakeries inspected. .92 Stables.-Several stables were abolished as-sanitary nuisances, and those still remaining are maintained in 'sanitary condition. Manure is removed daily to the city dump, so that there is no fly breeding at the stables. Dispoial of manure.-All manure remaining within the city is taken care of at the dump. It is placed in piles about 6 feet high and 20 feet in diameter. The sides and edges of these piles are covered Mwith paper, shavings, or other inflammable material,

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31 which is then burned. However, during the night, or in times of heavy rains, these fires die out and many of the larv, escape to finish their cycle of development in the ground surrounding the manure piles. Milk, dairies, bakeries, bottling works, candy kitchens, hotels, restaurants, etc.-After the resignation of the food and dairy inspector in August the inspections of these various places were carried on by district inspectors and the veterinarian. Under the circumstances it is not possible to make a complete report of this work, or to give tables, but an effort was made to at least keep the hotels, restaurants, and bakeries in a sanitary condition at all times. Building inspection.-Because of the increased cost of materials the number of new buildings has not been large, but inspections of old buildings and the work of supervising repair work has gone on regularly. During November and December there was most unusual activity in this branch of our work due to the beginning of an extensive antituberculosis campaign. Sanitary nuisances abated.-The total number of nuisances abated for the year was 3,440. Fines amounting to $497.55 were imposed. As many nuisances were committed by poor people, a policy of great leniency was followed, and fines, when imposed, were minimum. A very effective way was to impose a fine, say, of $5 and then suspend it pending the subsequent good behavior of the offender, and it was seldom found necessary to collect the fine. Street cleaning.-This work has been carried on, as in the past, by street sweepers with push carts under the supervision of street foremen in the various districts. By the present system the streets are kept in excellent condition. Garbage collection and disposal.-Practically all garbage is collected during the morning, and throughout the entire year it has been disposed of at the city dump. However, after the beginning of the new year all this material will be burned at the new incinerator, which is now completed. No special comments on garbage disposal are necessary, as the work has been carried on in the same way as for the previous year. COLON-CRISTOBAL. Large permanent improvements have been made in the district during the past year. The principal one was the completion of New k-ristobal, involving the filling in of about one-half of the large swamp between G Street and the beach and INinth Street, as well as the fill immediately behind the wireless station, the latter being of very practical utility since it eliminated a long standing source of possible anopheles mosquito breeding which had to be kept oiled all the time. The open ditch along G Street has been converted into a concrete storm sewer into which the remaining part of the swamp is drained. The sewer system in this part of ( olon was changed and carried out in the bay in front of the quarantine station, thus affording a clean beach in front of New Cristobal. 43016-18--5

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32 The area at the corner of Ninth Street and Broadway was also filled in and made ready for building sites, eliminating another bad mosquito-breeding ground. The shore front on the southern extremity of the large swamp near the south end of Broadway is now being filled in for the erection of a new slaughterhouse and a garbage incinerator. This will eliminate one of the worst and most unsightly parts of the city. The pond at the southern extremity of old Cristobal near the electric substation has been completely filled in. The elimination of breeding places around Mount Hope has been extensively carried on, the areas in front of the printing plant and next to the canal stables having been entirely filled and made available for building sites. Other of the swamps farther south toward Gatun have either been filled or drained until the radius of filling extends practically on the average at least one-half mile from the settled part of Mount Hope. The Ponton Beach water front in Colon, west of the railroad station, has been filled in and is being used as a-railroad yard; the buildings adjoining the beach on the ncrth side have all been condemned and removed, with the exception of one group which will soon be demolished likewise. Other improvements in this locality are expected to eliminate the rat infestation which has long centered there. The buildings had become old and dilapidated and were not built in conformity with the rat-proofing policv of our present regulations. Old Pier No. 4 of the Panama Railroad has been demolished for the most part and reconstructed for the remainder, which further reduces the rat problem. The beach at Battery Morgan has been completely transformed and the long-standing unsatisfactory conditions there entirely eliminated by filling in and building a sea wall there extending from the battery up to Fifth Street. Because of the increase of population on the east side of Folks River, the development of Fort Randolph, the plans for an aviation station, and the submarine base at Coco Solo, it has been'found necessary to grapple with the problem of mosquito breeding in that vicinity. Work was commenced on draining some of the swamps in the latter part of the calendar year and is being continued at present. Hydraulic filling of a large part of these swamps is being effected now. Malaria.-This calendar year has seen the lowest malarial incidence in the history of the district. There was a slight rise in the malarial rate in the latter part of September, and a thorough investigation was made into the conditions responsible for it. It was established beyond all doubt that anophieles mosquitoes flew across Folks River from breeding grounds in the swamps between Coco Solo and Marajal (or Manawa). Very extensive breeding grounds were found in that area, the waters being alive with larvae and pupae of the anopheles, while adults were caught in the vicinity in boats anchored off shore and were found on the east

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33 side of glass plates coated with gum and placed on the west shore of Folks River. It was established by repeated inspection that the anopheles were not breeding anywhere in Colon or on Manzanillo Island. It was proved that the mosqitoes flew across the Folks River and the necessity of eliminating the breeding grounds around Coco Solo was demonstrated. On the initiative of the chief health officer, persons living in unscreened houses in Colon were regi ired to be provided with mosquito nets, which must be u-sed under penalty to isolate all infected cases not being treated in the hospital. Tuberculosis.-There has been an increase over 1916 in both the number of cases reported and deaths resulting from tuberculosis. This high incidence is suggestive of conditions d( manding improvement. One of these is the overcrowding in the old wooden tenement ho ses of Colon, many of them three stories high, on both sides of an alley only 3 feet wide. This office is engaiged in plans for a graded scale for widening alleys in proportion to the height of bildings, which it is proposed to pit into effect when these b ildings are condemned and replaced. It is believed that the poorer classes of the population are not gAting enogh of fats and oils in their food, and a campaign of publicity on the subject is intended. The dampness of the lower p irts of these tenement ho--ses during the rainy season is also a contrib story case, and this will in part be remedied by better drainage of certain alleys and the raising of the floors of these older buildings. The general congestion in the tenements will be hard to relieve under existing economic conditions, since the laboring classes are oblig Dd to pay between $4 and $10 for a single room and consequently club together to redil ce the expenses. The best measure to remove these conditions permanently would be the opening of a good road from Colon into the interior eastwards, to encourage the population to live o0-t in the open and so remove the congestion due to the limited b--ilding area on Manzanillo Island, while this road would be a means of improving the general bu siness conditions of Colon, of increasing the prodaction of food, of raising the standard, and lowering the cost of living. It is recommended that the construction of this road thro gh the Canal Zone territory to the Panama boundary line be incl ded in plans for the Atlantic Terminal of the canal as soon as practicable. Diphtheria.-There were 23 cases of diphtheria during the year, a decrease of one as compared to the preceding year. A diphtheria carrier was located and kept in the hospital for several weeks until cured. As a preventive against this and similar diseases the cantinas and other shops dispensing lig-ors and soft drinks were reqired to install rAnning water facilities with which to wash all their vessels, instead of using pails and other containers as had been the custom previously. This improvement was carried out with favorable res Its thoghout the city. Typhoidfever.-There were five cases of typhoid fever, an increase of two over the previous year. These cases originated on the steam-

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34 ship Advance. The last case was reported on December 11, and it is believed that the disease from that source is completely under control. Anthrax.-At present the sale of meat infected with anthrax is prevented by measures instituted during the last calendar year. Every animal slaughtered has its spleen examined for the anthrax bacillus. All animals imported are inspected by the veterinarian and killed and their carcasses incinerated if found infected. Some of the pastures now being used are known to be infected with anthrax: while the measures taken will probably preclude the danger of human infection, it is recommended that whenever the infection of a portion of a pasture with anthrax may be defined, that portion be fenced off and withdrawn from use. Mosquito incidence.-The mosquito catch in C olon-Cristobal and Camp Bierd has indicated a fall in the mosquito incidence. During the middle of the rainy season there were noticed a number of flights of anopheles and culex which originated across Folks River and caused a temporary rise in the malarial rate as well as much annoyance in the northeastern part of Colon. Steps are being taken soon to reduce the mosquito breeding in the region from which these flights came. There has always been considerable breeding of tineorynchus in the swamps in east olon, especially in the numerous crab holes there. It has not been practicable to eliminate these crab holes mosquitoes by oiling methods. although oil has been used to reduce the amount. The progressive tilling of these swamps will probably eliminate this source of annoyance. There has also always been a certain amount of breeding of aedes calopus in the containers at the garbage dump in Colon: the method in use there has made it impossible to eliminate all this breeding except at prohibitive expense. The building of the new incinerator, however, will put an end to this source of the stegomyia, and there ought not to be thereafter any more of these mosquitoes in the district. Flies.-The close of the year witnesses an almost irreducible minimum in fly incidence in ( olon. In the early part of the year an effort was made to economize in the use of larvacide and the custom of using a small quantity of larvacide on inaccessible cracks and crevices in the cleaning of patios and premises was temporarily discontinued, with the result of an increase in the number of flies, to the extent that it was decided to resume the use of larvacide as before, which soon got rid of the flies again. This use of larvacide both destroys adult flies and prevents fly breeding in places where mechanical cleaning can not be made thorough. -The effort is to reduce the number of these places by requiring buildings to be kept in repair and by a complete reduction of defects in concrete work, but until this is brought to a very high standard of perfection a limited use of larvacide is highly advisable. One thousand gallons of larvacide per annum will probably almost eliminate flies in the city, in addition to the present stringent regulations applying to stables and corrals. Rats.-Many old buildings in Colon have been brought up to the requirements of the regulations in reference to rat proofing in the

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35 course of the year. The elimination of the old buildings on the water front, the filling in of holes in the coral rock on other beaches, which are a harboring place for rats, and the constant killing and poisoning have reduced the rat infestation in the district, and it is believed that the reduction is much faster than the increase, with the probable outcome that Colon and Cristobal may be completely free from rats when the prospective improvements are completed. On the completion of the modern cold storage plant at Mount Hope, the rat-infested plant now in operation at Cristobal will be eliminated and the building used for other purposes, after it has been freed from rats by the demolition of Dock 11, which is the source of rodent breeding in Cristobal. The new cold storage plants will probably be completed within the next eight months. Hotels, cafis, and markets.-A new and modern concrete hotel was built and put into commission in Cristobal during the year, replacing the old wooden building which has been a subject of frequent complaint of late years. A large new concrete hotel for Colon is nearing completion at Bolivar and Eighth Streets, which will be a decided improvement in the accommodations of that sort in the city. Continuing the policy of bringing cafes and restaurants up to a high standard, upon which the health office has been working steadily since the completion of the canal, several of them were closed and others made to conform with the regulations. A number of improvements were made in the public market in Colon, but it is probable that additional market facilities will have to be provided for that city before long, and it is desirable that this should be located on a water front. Piers and docks.-Pier No. 7 was completed and put into commission during the calendar year. Pier No. 6 is well on the way toward completion. Pier No. 11 is in the same unsatisfactory condition as previously reported, but it will doubtless be remodeled as soon as conditions permit. Pier No. 4 has been remodeled and made available for the use of the schooner trade. The docks are inspected thrice weekly, and the work of catching rats is carried on daily, although the improved condition of the piers has reduced the rat catch to almost a negligible point. Building operations.-The three large areas devastated by fire within the last two and one-half years have been almost completely rebuilt with concrete structures, with the exception of a part of one block in front of the Government Palace. In addition to this many vacant lots in various parts of the city have been improved during the year, the most notable of which has been the one at Broadway and Third Street, where a handsome row of cottages has been erected. There has been considerable deterioration in the case of many of the older wooden buildings in the Slifer Park section of Colon, and it is probable that some of these buildings may have to be condemned during the next year. Schools.-Schools and school children in the district are periodically inspected. There is an annual physical examination of all pupils in the Zone schools made by the office of the district physician. Children in the Panamanian and private schools are

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36 not subject to the same examination and it is planned to have this done through the cooperation of the Panama Government. All school children in the district have been vaccinated against smallpox. There has been no epidemic in or traceable to the schools in the past year. The construction of the new concrete Cristobal school building has been of marked benefit. Its location in a quieter part of the district than the old schoolhouse ought to reSult in better health in the pupils and teachers. The exposure of small children to the heavy rains in going to and from the public and private schools in the rainy season is not the most desirable from the point of view of their health. It is hoped that some system of reducing this exposure can be worked out. General sanitation.-Control over the bringing of infectious diseases into the district from points on the coast of the Republic of Panama will be facilitated by concentrating the schooner and cayuca traffic at definite piers provided for that purpose, and it is desirable that these piers should be provided with ample facilities for the temporary storage, the inspection and handling of produce brought into port in these small vezEels. It has sometimes happened that stegomyia mosquitces are brought into Colon by these vessels, while infected persons from interior points may sometimes also get into the city in like manner. A more satisfactory and comprehensive manner of dealing with this branch of sanitation here ought to be worked out before the traffic assumes such proportions as to magnify the difficulty of handling it. Veterinary department.-The ante and post mortem inspections of all food animals is an important factor in the maintenance of public health, as it not only assures the consumers a wholesome meat supply but it also protects them against those diseases of animals that are transmissible to man. An important change during the past year is the present separation of the handling of edible and inedible products, or the removal of objectionable processes from the rooms where edible products are handled at the time of slaughter to distinctly inedible rooms. During the coming year it is hoped to extend the scope of this work so that the handling, salting, curing, and preparation of all meat products shall be under the observation of acompetent employee of this department whose duty it will be to see that all meat and meat products are handled in a sanitary manner from the time of slaughter until ready for delivery to the consumer. The employee will give especial attention to the cleanliness of products entering into the manufacture of sausage, lard, and cooking compounds; the cleanliness of equipment, the sanitary condition of employees' clothing, and see that meat of all kinds are stored and held under reasonably sanitary conditions. We also recognize the necessity of improving the conditions under which meats are handled in Colon, especially in the slaughterhouse where the handling of edible parts on clean tables will be a great improvement over that of the present method of using the floor. For the production of anti-hog-cholera serum on the Isthmus, a number of hogs have been selected and given the simultaneous treatment, with the end in view of using them within a short time for hyperimmunization.

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QUARANTINE TRANSACTIONS. A r6sum4 of the quarantine operations for the year just ended shows that the quarantinable diseases of plague and yellow fever have not materially changed, with particular reference to Central and South American ports. Along the west coast the first part of the year plague conditions were bad, particularly in Guayaquil, with a high mortality rate. An extension of the disease has occurred in Ecuadorean ports north of Guayaquil, which has been made the subject of reports from time to time, and requires very careful consideration from the standpoint of a farther northward extension to Colombian ports, which would make the disease relatively a very short distance from the Canal Zone. So far as we are aware, however, this disease has not made its appearance in Colombian ports up to the present time. In Peru and Chile, general plague conditions have shown little variation. The infection is very generally disseminated, and no measures of any special benefit have been carried out for its eradication. Yellow fever on the west coast has been more prevalent in Guayaquil, Ecuador, than elsewhere, though the seasonal increase of this disease at that port, looked for in the last few months, has not been as extensive as expected. In Buenaventura, Colombia, toward the latter part of the year a consular representative, who also looks after the matter of fumigating ships, has been stationed, which arrangement will be more satisfactory from the standpoint of shipping between the canal and this port. Smallpox has been quite prevalent in Chile and Peru, and has been reported as having a higher virulence than usual. Since the first of the year, and even earlier, considerable trade has developed between Ecuadorean ports and Panama, carried on in small schooners. Careful watch is being maintained of this traffic, in order to guard against yellow fever, smallpox, and plague, and when considered necessary these vessels are detained and fumigated. On the Atlantic side plague is reported in Brazil, and we suspect its presence in Venezuelan ports also. Yellow fever is reported from time to time as being endemic in certain places in Venezuela, and the shipping calling at Venezuelan ports is watched on account of both this disease and the possibility of plague being present. Yellow fever has also been reported in Brazil and from some of the West Indian Islands. This disease has also shown considerable prevalence in Mexican ports, particularly in the vicinity of the Yucatan Peninsula; the vessels, however, sailing from these ports to the canal are inspected by public health service officers, and as a rule consume more than six days on the voyage to the canal. From time to time the question of modifying our quarantine regulations against ports on the Colombian coast, particularly on the Atlantic side, has been brought up, but due to the condition of these ports and the inability to get complete and accurate data,

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38 it has not been considered advisable to further reduce our quarantine which is believed to be already the minimum procedure consistent with safety. In February, 1917, the new immigration law was made effective, which is embodied in governor's circular 601-61. Governor's circular 714 charges the division of quarantine with the duty of carrying out the above-mentioned executive order relating to the exclusion of undesirable persons. The application of this law has done much to remove from the Isthmus and to prevent the landing upon the zone of undesirable persons. The police and customs forces of the canal have given material assistance in the application of the law. During the year 360 immigrants falling in the undesirable class were rejected and deported. The work of the veterinarians in connection with quarantine and ante and post mortem inspection of food animals has been carried out in a very careful manner, with particular reference to anthrax. During the month of March, 1917, a total of 15 deaths from anthrax occurred among cattle belonging to the supply department. One of these cases occurred on the floor of the Cristobal abattoir, and was made the subject of special report. The statistical reports of the quarantine and ante and post mortem inspection of food animals, and disinfection of hides by immersion in 1-1,000 bichloride solution for 24 hours, are as follows: Quarantine inspections: Cattle. .8,675 Swine. 5,874 Sheep. 76 Goats. 4 Ante and post mortem inspections: Cattle. 17,094 Swine. 6,531 Hides disinfected .24,806 The supervision of veterinary work was transferred to the health officer of Cristobal-Colon on December 5, 1917, in order to consolidate this work under one head. On November 21, 1917, governor' circular 700-1 was issued, requiring application of tuberculin test to all cattle and hogs imported into the Canal Zone for dairy or breeding purposes, and to such animals arriving in Canal Zone ports for transshipment to other points when considered necessary, unless such animals are accompanied by a health certificate including tuberculin test chart executed by an inspector of the United States Bureau of Animal Industry. This requirement was for the purpose of preventing the introduction of tuberculosis among domestic animals on the Canal Zone. The examinations by the health department veterinarians have shown that this disease practically does not exist among the domestic animals of this locality, while on the other hand its prevalence among domestic animals in the States is very high. The method of administering the test is outlined in the circular, and is subject to change from time to time in the discretion of the chief health officer.

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39 DEPORTATIONS. Sixty-six employees were repatriated to their homes during the year, 57 of whom were incapacitated by mental or other diseases, and the remaining from injuries received in the course of their employment. Thirt y-four nonemployees were also repatriated, all of whom were suffering from disease excepting 2. In addition to the above deportations accomplished by the hospitals, 360 passengers on incoming vessels were detained and deported by the quarantine authorities. 43016-18-1--

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40 LDIYS$/OA' RATE P R 1000 erT P. YEES Yeor v eooy 6 /,906 6547 /77S /07 J0238 /419 /306 4326 //J2 ~ ~~/903 47/67 887 -/9// 4676 86/1/.e 50893 727 9/13 56654 S19 13/4 44J29 420 /9I 347 6 20 ~~ //6 3/76 283 /9/7 3?589 357 CHAR-T

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41 DEA TH R ATE PER 1000 EMPLOYEES ALL CAUSfES Year ,,y ,Rte C4 /906 2 6S47 41/73/907 J9238 28.74 1/98 43890 /3.0/ -/909 47/67 /.64 /4O 60902 /0.98 /9// 43876 /102 /9/2 50893 0.18 9/ 56664 8.35 19/4 44329 704 /V9A 3'4785 S. 77/9/6 J3176 6.03 19/7 32589 7 ,9 CHART 2.

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42 NONEFfTC r/ VE RATE PEI? 4000 41%P1. 0 YEES Yea,||S4Pote 4 J" 26547 2.48 /,907 39238 .09 /908 4J890 2Z.31 /909 476 7 Z13~ /9/0 60802 Z43 /9// 48876 Z9.46 /$9* 60893 2111 /9/J 6664 /5.97IS/4 44Je9 22~ /9/5 J4785 10.28 /9/6 JJ76 9.20 19/17 32589 9.6s CHART 3. ('Note correction // /9/6 rate, 9.20)

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43 XAL ARIAL FEVER DLMAf/Ss/aA' R4TE PEI? /,000 4MvPLOyEES --_" 104 623 / 6b h9' /crs// S/4 /906 26547 82/. /9c7 3J9J38 424 /$209 436?9o 262 /A90 47/67 2/5 /9/O 50802 /87 /9// 48876 /84 /9/2 64893 //0 /9/3 S6664 76 /19/4 44329 82 /9/5 4 786 3/ /9/6 33/76 /6 /9/7 32589 14 CHART 4.

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44 NALARIAL FEVER DEAT11 A9A7E PrR I000 E/IPLOYES YRar ate /904 62/3 2.66 '/90 /65// 5~57 -_ .906 %6547 74/907 39238 3. ___-/ /908 438so 1.37 /90s47/67 .86 /910 60802 .8/ IS/I 48876 .04 / 52 0893 .3 19131566s4 .3~ 914 4W4329 .4 19/ 34785 .23 1016 .3J176 .06 7 37559.AR CMA RT 5.

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45 /*rA 44 R IAL rf VCER DLFA TH lA Te PER 000 PoPuiL A rION /1v TNE CAN44 ZO4kC ANi, rH Clrt.5 Oi P41VAAIA ANID 0O0LOM -E kfPL 0 YCZ-eS AiNO NLWPZ. Y0yE'eS ea 0/ 'Ie 1$06 7J264 9.4 9 IS07 102/J3 eZ.37 /9067 /e0097 3.36 /&09 /JSO 2.O7./81/ /6930 1.82 /*/g /465/0 1.64 /9/j /9/04 /32 /9/4 /2359 /.2t /9/3 /e/6 60 .6/ /9/6 //69/6 .21 /917 1140 .48 CHART 6. (Note correction ;n 1.9/6 rate, 0.21)

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46 TABLE I.-ADMISSIONS, DEATHS AND NONEFFECTIVE RATES FOR EMPLOYEES. ABSOLUTE NUMBERS. Admissions to Noneffective age hospitals.Deaths from sickness. ber Conof emDe ExterDisExter-, Days stantly ployTotal. ease. nal Total. s nal treated. nonefecs. causes. causes. festive. Year 1917: White .4,814 1,551 1, 3481 203 32 22; 10 31, 132 85.29 Colored. 27, 775 3,691 2, 7191 972 199 165 341 83,648 229.17 Total. '32, 589 5,242 4,0671 1,175 231 1871 44 114,780 314.46 Year 1916: White. 4,552 1,473 1,217 256 24 15 9 29,513 80.86 Colored ..28, 624' 3, 186 2, 224 962 176 137 39 82, 116 224.36 Total. .33, 176 4, 659 3, 441 1, 2181 200 152 481 111,629 305.22 PROPORTIONATE NUMBERS.1 Year 1917: White .4,814 322.181280.02 42.17 6.65 4. 57 2.08 .17.92 Colored. 27,775132.89 97.89 35.001 7.16 5.94 1.22. 8.25 Total. 32, 589 160.85 124.80 36.05 7.09 5.74 1.35 .9.65 Year 1916: White. 4 552!323.59267.35! 56.23 5.27 3.291 1.98 .17.76 Colored. 28 624 111.31 77.70 33.61 6.15 4.79 1.36-------7.84 Total.33,176140.43103.721 36.71 6.03 4.58 1.45. 9.20 1 Annual average per 1,000 employees.

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47 TABLE I-A.-DEATHS IN THE CANAL ZONE AND TIIE CITIES OF PANAMA AND COLON. I)eaths. Annual average per 1,000. Aver1 i$ Di'ExlerD ExterTotal. nal Total. nal causes. causes. Year 1917: Panama. 61,074 1,714 1,661 53 28. 06 27.19 0.87 Colon. 25,386 667 642 25 26.27 25.29 .98 CanalZone. 127, 543 1313 273 40 11.:36 9.91 1.45 Total. 114,003 2,694 2,576 118 23.63 22.60 1.03 Year 1916: Panama. 60, 778 1, 765 1 702 63 29.04 28.00 1.04 Colon. 24,693 696 662 34 28.19 26.81 1.38 Canal Zone. 31,447 343 290 53 10.91 9.22 1.69 Total. 116,918 2,804 2,654 150 23.98 22.70 1.28 1 Military forces stationed on Isthmus not taken up in population, and deaths among same not included for last six months of year. 43016-18-7

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48 TABLE IL-CAUSES OF DEATHS OF INFANTS BY Sex. Color. I week Less and less Cause of death. than 1 than 1 M. F. W. B. week. month General diseases. Malarial fever, estivoautumnal. 3 1 2 Whooning cough.2 2 .4 Pyemia. 1 Senticemia. 1 1 2 ..1 Tetanus.1 1 1. Pellagra. 1 Beriberi. 5 2 .; ..1 Tuberculosis of the lungs. 4 7 .11 Acute miliary tuberculosis. 4 6 .10 Tuberculous meningitis. 7 3 2 8 Abdominal tuberculosis.1 1 ---2. Disseminated tuberculosis. 1 3 .4. Syphilis, hereditary. 8 1 1 8 5 2 Scurvy. .1 .1 .1 Anemia.1. Simple meningitis. 2 2 2 2 Cerebro-spinal fever. 1 ..1 Pneumococcic meningitis. 2 1 1 2 Metiingealhemorrhage. 2 .1 1 Epilepsy. .2. Convulsionspf infants. .11 1 2 10 6 1 Acute endocarditis. 2 1 2 1 Organic diseases of the heart.1 5 Diseases of the lymphatic system.3 3. Acute bronchitis. 24 25 4 45 3 3 Chronic bronchitis. 13 11 1 23 Broncho-pneumonia. 70 54 15 109 1 Pneumonia (unqualified). 8 7 3 12 Lobar pneumonia. 5 8 2 11 Pleurisy.1 ..1 Empyema. 1 1 .. Pulmonary congestion.1.1. 1. Acute stomatitis. .4 .4 Acute gastritis. 5 4 3 6. Acute indigestion. 2 3 .5 Diarrhea and enteritis. 150 122 28 244 7 Colitis. 30 37 j 2 65 1 5 Intestinal obstructions. 5 2 .7.-. Other diseases of the intestines. 2 1 Congestion of liver. 1 2 12 .4 Peritonitis. 1 2 .3. Acute nephritis. 8 3 2 9 .. Chronic nephritis. 1 1 2 Other diseases of the kidney and annexa. 2 1 .3 Pyelonephrosis. 4. 4 Acute cystitis. 1 .1 Diseases of the skin and annexa.1. 1 Congenital malformations. 6 3 1 8 2 2 Atrophy of infants. 1 Malnutrition. 35 28 1. 62 6 3 Other causes peculiar to early infancy.:::. 27 18 5 40 40 3 Lack of care. .. External causes.1 1'. 2 1 Cause of death not specified or ill-defined. 5 5 4 6 3 Congenital debility, icterus and sclerema. 7 4 3 8 6 1 Premature birth. 35 35 3 67 57 11 Congenital debility. 23 13 2 34 22 3 Total. 533 441 96 878 163 55

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49 SEX, COLOR, AGE, AND PLACE OF RESIDENCE. Age by months. Place of residence. --.--__Pa --Cana -'r 1-2 2-3 3-4 4-5 5-616-7 7-8 8-9 9-10110-11 11-12 PanColon) Canal tal. ama. Zone. .2 1 12 ....3 ... --1 ..........1 1 ..1.2. .... .........1 -I' 1 1 .--. 4 7 2 1. 2.1 2 10 1. 11 2 .3 1 2 10 1 21 1 7 I 1 1 ..3 1 2 .1 1 9 1 .10 I. 1.1.9 2 .1 S. 1 .2 2 .4 .........9 --. ...... 1 ....... 1 ........1 ...2 ....1. .....1. .1 1 ....3 ..3 1. .....2 ..1 ...1 2 2 1 2 ...2 .3. 21 1 1 .........2 1 .3 .1 1 2 ..4 .3 .5 1 2 1 ........4 ..4 5 7 9 3 3 4 4 6 1 .1 34 12 3 49 1 5 2 1 1 2 4 3 3 1 1 1 21 2 24 12 20 19 12 10 11 7 11 6 6 8 70 43 11 124 3 1 2 .2 3 1 2 1 .15 .15 2 .1 2 11 2 .4 8 4 1 13 .....1 ...1 1 ........1 ... .......1 1 ......1 1 2 1 4 2 2 1 ..1 2 ...8 1 9 2 .1 1 1 2 1 2 5 40 39 30 19 17 20 19 17 18 17 16 205 56 11 272 12 5 8 2 4 6 1 5 4 64 2 1 67 4 1. ..1. .6 7 ....1 ..2 1 ....1 .-.--4. .-. .4 1 ........1 ...2 ...3 2 1 .1 .1 2 1 7 2 2 11 .........1 ..w. .291 .........2. .3 ..1. .1 .1 1 4 ....1 .4 .-1 ...11. 2 .1 ..5 21 2 9 .~~ ~~ ........... 4 8 4 2 5 2 40 14 63 2 .....31 45 1 .........--. .1. ......1 .2 1.1. 1. ..1 2 .5 3 2 10 1 2 ......1 ..6 1 4 11 1 ..1. .....48 18 4 70 6 2 2 1 .......23 10 3 36 98 109 97 64 59 58 54 68 52 48 49 668 222 84 974

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50 TABLE III.-DEATHS AMONG CHILDREN UNDER 1 YEAR OF AGE, BY CAUSE AND Cause of death. a. FebruMarch. April. Malarial fever, estivoautumnal. .... Whooping cough. .1 .1 Purulent infection and septicemia ..... Pyernia. Senticemia.-. .... Tetanus. Pellagra. Beriberi. 1 1 2 Tuberculosis of the lungs. .4. Acute miliary tuberculosis ..2 1 1 Tuherculous meningitis. .1 1 2 Abdominal tuberculosis. Disseminated tuberculosis. Syphilis, hereditary. Scurvy ..1 Anemia, primary, pernicious .. Simple meningitis. .1 Pneumococcus meningitis. .1 2 Cerebral hemorrhage, apoplexy Epilepsv. Convulsions of infants (under 5 years of age). 2 Acute endocarditis ....1 Organic diseases of the heart. 1-Lymphadenitis (nonvenereal). .1 -----Acute bronchitis. .-. .4 6 6 Chronic bronchitis. 1 1 Broncho-pneumonia. 12 11 17 Pneumonia (unqualified). 1 2 3 Lobar pneumonia. 3 Pleurisy. Empyema. Diseases of the mouth and annexa ..2Stomatitis.1. Acute gastritis. Chronic gastritis. Acute indigestion. Diarrhea and enteritis (under 2 years). 20 12 13 17 Colitis.6 1 3 Hernia, intestinal obstructions. .. Intestinal obstructions. 3 Other diseases of the intestines. Duodenal ulcer. Acute yellow atrophy of the liver. 1. Other diseases of the'liver. .1. Diseases of the s leen. Simple peritonitis. 2 ------1Acute nephritis. 2 Chronic nephritis. 2 Other diseases of the kidney and annexa .. Pyelonephrosis. Cystitis. Other diseases of the skin and annexa. .. Congenital malformations (stillbirth not included). Congenital debility, icterus and sclerema.41 Premature birth. 6 5 5 4 Congenital debility. 2 4 5 6 Atrophy of infants. Malnutrition. 2 5 4 2 Other causes peculiar to early infancy ..3 6 1 7 External causes.--. .1. Cause of death not specified or ill-defined. Infection of undetermined origin. Total. 75 57 73 66

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51 IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, MONTH OF DEATH. June. A t Septem.October. NovemPecemTotal. May. uy. A ber. ber. ber. 1 2 3 1 ..1 .-. ..-4 ..1 .1 .---. 1. ...1. ..I ...... 11 2 2-4 121 ................. 2. ... 1 1 21 10 ..3 ..1 10 ....2 .~~~. .....1 1 ..1 3 .1 ..2 .. 1 1 j ..... 3 ..-.......3 -. 1151,2 .--. ....--.--.---------2 1 ....1 ..12.-..2 2 1 2 1 2 1 1 12 .-. 2 3 .. 1 3 ~~~1I. ..-------------.13 3 1 6 4 2 7 2 7 49 198 1 3 1 5 3 1 24 212 13 10 13 12 7 124 1 2 3 -.-. .I-I I 15 11 1 ..4 .....--------....1. ....... 4 1~ 1 1 21 1 ...---------------.1 1. 1.3. 1 6. 1 4 169 31 ----3732 25 27 24 15272 2 13 13 3 1 8 9 4 67 --------......--. .-.--. ......-.10 -------.J--------------'-2 -....---------------......-.---------------. ------. ------------........1. ....... .........-.......3 I .2 22 -..11 ~~~~1. ........------.2 ...13 ..30 .....-. .--------3 64 9 115 37 7 0 7 9

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52 TABLE IV.-DEATHS BY NATIONALITY. Employees. Nonemployees. Total. Nationality. ---Grand total. Male. Female. Male. Female. Male. Female Antilles .1. ..1 .1 Antigua. 17 13 20 13 33 Austria. .1 ..1 Barbados.' 47 .207 158 254 158 412 Bermuda .1 .1 1 2 i3 Bolivia. ...I Canada.-. ...2 .2 2 Chile. 2 .6 1 8 1 9 China. ..381 38 5 43 Colombia. 12 .78 61 90 61 151 Costa Rica. .I 2 4 3 4 7 Cuba. 2 .1 7 1 8 Curacao. ..4 1 4 1 5 Demerara. .1 .7 4 8 4 12 Dominica.2. .3 2 3 5 Ecuador. ..3 2 3 2 5 England. .4 1 4 1 5 Fortune Island 1 ..1 .1 France. ..3 2 3 5 French Guiana. ..1 .1 .1 Germany ......1 1 Greece. .9 3 9 3 12 Grenada. 4 .28 19 32 19 51 Guadeloupe.-.-. 6 .13 4 19 4 23 Guiana, British. ....1 .I Hayti. 1 .1 2 2 2 4 Holland. ...2 2 .2 Honduras. ..1 .1 .1 India. 3 ..7 .7 Italy. 3. ..11 3 11 3 14 Jamaica. 76 .318 301 394 301 695 Japan. ..2 .2 2 Liberia. ..1 .I1 Martinique. 12 .38 27 50 27 77 Mexico.--.4 3 5 3 8 Montserrat. 1 7; 5 8 5 13 Nassau. .1 2 2 2 4 Nevis. ..1 1 2 Nicaragua. .1 .1 1 1 2 Panama. 9 1 404 385 413 386 799 Peru. 10 1 11 1 12 Philippines. ..L .1 1 Porto Rico. ..2 .2 .2 Sierra Leone --1. .1 .I Salvador. 1 ..1 St. Kitts. ..1 4 -1 4 5 St. Lucia. 5 .9 24 24 24 48 St. Thomas. ..4 7 4 7 11 St. Vincent. 2 -. .7 5 9 5 14 Spain. .2 18 20 9 29 Switzerland. .3 .3 .-. 3 Syria. .-.1 1 1 Toboga. ..1 1. 1 Trinidad. 4 1 18 22 10 32 United States. 25 1 37 17 62 18 80 Venezuela. ..12 4 12 4 16 Unknown. 4 3 5 3 8 Total. 228 3 1,359 1,104 1,587 1,107 2,694

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x a s 4 4 4 x s 4

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54 TABLE V.-CAUSES OF DEATHS OF EMPLOYEES, ARRANGED DENCE ON Color. Age In years. Cause of death. Diseasesv. Anemia, secondary.1. Anemia, undetermined.1. .. Alcoholism, acute and chronic.Ii. .... Aneurysm. 1 7 ..i Apoplexy (cerebral hemorrhage). .8 .1 .. Arterio-sclerosis.1 1. ... Brain, abscess of. .I ..1 Brain, softening of. 1 1. ... Carcinoma of the stomach. I I. ... Dysentery .I. .. Endocarditis. 1 2 .1 1 Fever, malarial, estivo-autumnal. 1 2 .1 2 Gangrene .2. Gastroenteritis, chronic.21 .. Heart, organic disease of .21 ..6 3 Hemorrhage, pulmonary. 1 1 Hemorrhage, due to ectopic pregnancy. .1. .1 Hemorrhage. .. Hernia, strangulated.1 .1 Hodgkin's disease.1 .1 Intestinal obstruction.1. Intestines, other diseases. .1 1. Liver, abscess of. .3 Liver, cirrhosis of ..3 1 1 Lungs abscess of. Lymphosarcomatosis. ..1 Meningitis, pneumococcic.1. .. Meningitis, streptococcus.1 Nephritis, acute. 1 Nephritis, chronic. 4 16 .1 3 4 Oesophagus, epithelioma of ..2 .. Pancreatitis, acute gangrenous. 1 ....1 Peritonitis, simple. .1. 1 Pericarditis ...2 .1 Pneumonia, lobar ..29 2 4 7 3 Pleurisy. ... Pyemia.1. .1. Prostate gland, hypertrophy of.1. .. Rheumatism, acute, articular. 1 ...I Sarcomatosis. general.1 Septicemia and pyemia. .1 2 .1 1 Septicemia, penumococcic. .2 .1 Spleen, abscess of .1 ..1 Syphilis, tertiary .4 ...2 Toxemia, following thyroidectomy .1. I .1. Tuberculosis, disseminated. .14 1. 6 4 Tuberculosis, miliary, acute. .1 1. Tuberculosis, pulmonary.20 .6 5 0 Urethra, stricture of.2 .1 1 Undetermined.1 ...

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55 WITH REFERENCE TO COLOR, AGE, AND LENGTH OF RESPISTHMUS. Age in years-Con. Length of residence on Isthmus (in years). Grand o r= 1 to 10 ;_ total. S to e coo -. .-~ I I 0 "-' o to O 4 C9 C11 NV LID < ---1 ---..... ---ij. ---------2 -.. .1 2 T ---------...2 .2. 2-.2 ----.---..2 ........---1 ... .1 ..-...2. 1~~~ ..... 11 1. 1 ..2 -1. .I 1 -1-------.-4 21 .1 132 ...2 .1 L.I.IIKIII 1. ... .....1. -!1 -. -------1 1 1 1 --------.------. .---. ..1 S. .1--------------. .. .......-----1. ....1 --....------.... 3 2 1 4 2 .1 1 .2 2 2 1 1 20 .............2 1 .......... -.-----------. ...--.2 5 3 1 3 1 ..1 1 4 3 4 2 .1 5 .2 1 5294 -----4 "' i~ ---J ----............... ----------. -----.~~~~ ~ ~ ~ ~ ...............1 ...... .... .....-------------------------1 1 ...... J. .2 .......--------. .. 1 ........ 2. .2 .......1 14 .~ ~ ~ ~ ~ .....-! 1 -i. ....--------2 ....1 !. 2 1 2 1 .2 5 2 1 1 2 20 1 ...........2 ..................1

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56 TABLE V.-CAUSES OF DEATHS OF EMPLOYEES, ARRANGED DENCE ON Color. Age in years. Causes of death. External causes. Drowning, accidental. 3 13 1 1 3 3 Homicide by firearms. .2 1 .. Traumatism by railroads. 1 3 1 Traurmatism by firearms. 1 Traumatism, various.4 Suicide by firearms. 1. 1 1 Suicide by railroad traumatism. I .. Other external violence .3 .2 Total. 32 199 6 31 42 33

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57 WITH REFERENCE TO COLOR, AGE, ANI) LENGTh OF RESII STHMUS-Continued. Age in years-Con. Length of residence on Isthmus (in years). Grand -T A0 C i total. fit C 912 coto kf "_4 Cq M 'n olac 1 ...2 ..... 3 1 ...1 3 1 1 3 1 ..........1 2 39 30 17 12 17 4 7 5 4 14 25 14 19 9 25 39 21 18 3 38 231 TABLE VI.-DEATH RATES AMONG AMERICANS ON THE ISTHMUS. Annual average per 1,000 population. White employees from the United States: Disease. 4.31 External causes. 1.91 Total .6.22 White women and children from the United States: Disease. 4.25 External causes. .67 Total. 4.92 White employees and their families from the United States: Disease. 4.28 External causes. 1. 27 Total. 5.55

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58 TABLI VIL-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYAND PLACE Sex. Color. Age (by years). Cause of death. Less M. F. IV B. Y. than 1-4 5-10 I year. General disgeuls. Typhrid fever. .3 1 1 M alaria .--. .-. 2 1 1 .I -----Malarial fever, estiveautumnal .1. 14 5 11 8 .2 Measles. .I 1 Whooping cough. 2 3 .5 4 1 Diphtheria and croup. 1. 1 Dysentery. 1 1 2. Entamebic. 4 ..3 I Bacillary. .I Unclassified. .1. l'urulent infection and septicemia. 6 2 7 1 .1 1 Pyemia. .6 .1 Septicemia. 3 2 1 4. Pvemia and septicemia. pneumoSec ic .........1 2 .------1--. Tetanus. 2 4 2 4 .... I'ellagra. 9 -28 1 -. Beriberi. 10 3 2 10 1 7 Tuberculnsis of the lungs. 231 133 27 323 14 11 11 3 Acute military tuberculosis .12 29 .10 10. Tuberculous meningitis .1 7 15 .10 9. Abdominal tuberculosis.5 5 .10 2 Pott's disease. 1 1 .2. Tuberculosis of benes and joints. 1 .2 .2. Tubercuklsis of other organs. 1 ..I .-Tuberculosis of the genito-urinary organs .-. ..1 1 .1 Disseminated tuberculosis. 22 15 3 34 .4 4. Syphilis: Tertiary.S 2 .10 .-. Hereditary. 12 1 2 11 .9 4. Period not stated. 4 1 2 3. Gonorrheal arthritis. 1 .... Cancer and other malignant tumors: Of the buccal cavity .3 .1 2. Of the stomach and liver. 6 5 3 8 ---. Of the peritoneum, intestines, rectum.1 4 --Of the female genital organs. .11 5 6 Of the breast ....4 4 4 ---------Of other organs and of organs not specified. 4 .1 3 Other tumors (tumors of the female genital organs excepted). 1 ..-.--Acute articular rheumatism. 2 1 .3 -Scurvy. I .1. Diabetes. 1 2 2 1 Hodgkin's disease. 1 ..1 Anemia: Chlorosis. 1 2 .3 Primary, pernicious. 1 2 .3 Secondary, cause not determined. .2 2 .-. Other general diseases. 1 -. 2--------------I Deaths among military forces on the Isthmus included for the first six months only.

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59 EES AND NONPMPLOY-ES) AND MILITARY,1 BY SEX, COLOR, AGE OF RESIDENCE. Age (by year,,). Place of residence. --A --e ---1 l'Total. 11-20 21-30 31-40 11-50 51-60 61-75 76-100 known. Colon. Canal m[ Zone. 2 ....2 ....2 ..2 .1 I1 4.1 2 .. ....... ....................,.4 ............... 1 2 3 .1 2 2 --2 .4 21 1 1. 3 1 1 5 2) 1 1 1 3 S. ..3 .6 1 15 5 4 1 .17 1o 1 2S 1. ..9. .-4 13 32 127 101 49 22 6 2. 3 ,2 19 3164 -1 ---3 29 2 1 .19 1 2' 22 1 3 1 1. 7 .10 1 11 ..2 ....4 --. .1 2 ...----. ...... 1 j 3 2 2 ...4. ..1 ...2 11 1. ...16 1 2 1 1 .1 2 10 S. 4 ..1 1 2 23 22I 1 ...1 1 ......2 ...2 ................3. ........ .1. 221 ..4 .....1 -----..2. --.---. ....1 1 2 3 ..1 ..I ...K. ..3 1. .~ 1. ...

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60 TABLE VII.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYAND PLACE Sex. Color. Age (by years). Cause of death. Less M. F. W. B. Y. than 1-4 5-0 1 year. General diseases-Continued. Alcoholism: Acute or chronic. 1 1 Acute. .2 .2 Chronic. 3 Diseases of the nervous system and of the organs of special sense. Encephalitis.1 1 1 1 Simple meningitis. 7 6 7 6 5 2. Cerebro spinal fever ..3 1 2 ------2 Pneumococcus meningitis. 4 1 2 3 .3. Locomotor ataxia. .1 .1 Other diseases of the spinal cord. 1 4 1 4 Cerebral hemorrhage, apoplexy. 33 30 7 55 1 2. Softening of the brain. 3 2 1 4 Paralysis without specified cause. 3 5 3 5 General paralysis of the insane. ..5 1 1 Other forms of mental alienation.! 1 1 .2. Epilepsy.3 4 7 2 1 1 Convulsions of infants (under 5 years of agel -. 12 1 2 11 12 1 Chorea. 1. Other diseases of the nervous systemr. 2 ..2 Pericarditis. Acute endocarditis. 11 6 3 14 3 3 Afalignant endocarditis. 4 3 1 6 Organic diseases of the heart. 97 46 16 122 5 5. Angina pectoris. 1 2 .3 Diseases of the arteries, atheroma,I aneurysm, etc. 1 1 .. Aneurysm. 13 2 1 14. Arterio -sclerosis..9 4 1 11 1 ----Embolism and thrombosis. 1 2 .. Diseases of the lymphatic system (lymphadenitis, etc.)-. 3 1 1 3 4 Hemorrhage; other diseases of the circulatory system. 2 1 1 2 .j. Diseases of the respiratory x 8tem. Diseases of the nasal fossae.1. Laryngitis. 1 ..1 --1 Diseases of the thyroid body .. Acute bronchitis. 36 38 7 66 1 49 22 Chronic bronchitis. 23 18 1 40 24 9 1 Bronchopneumonia. 105 89 24 168 2-! 124 55 4 Pneumonia (unqualified). 19 17 6 29 1 15 10 Lobar pneumonia. 76 36 12 100 13 11 1 Pleurisy. 1 .. Empyema. 1 2 2 1 Gangrene of the lungs. 4 1. 5 Asthma. 1 3 .3 1. Pulmonary emphysema. .-1-. 1 Other diseases of the respiratory system .3 ..1 3 ..... Abscess of lungs.3 .. sysem.

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61 EES AND NONEMPLOYEES) AND MILITA RY, BY SEX, COLOR, AGE, OF RESIDENCE-Continued. Age (by years). Place of residence. Age InTIotal 11-20 21 30 31-40 41-0 -60 knwn. P olon. 31-0 1-3 6-00ama. (oo.Zonei 1. I ....2 ..2 2 ....2. .2 1 ...2 21 ......1 ....32 .........---1 22. 1 .2 2 ..2. .9 2 ... 1 ..... 22 2 1 .1 ...........2. .5 ~1. ......2 ..I 1 S 313. ...5 11 5 22 13 101 6 4 .34 23 6 63 --2---1 1 2 1 ..3 2. I .1 2 1 2 2 .6 .2 S 2 1 2 1 .5 .1 6 ......1 2 S. .5 1 7 .9 3 1 13 1 1 .2 .-. .-.2 2 2 11 ...3 3 .6 -2 2 3 1 3 ...13 4 ...17 1 2 2 1 1 .-1 -.-. 4 .3 7 19 32 30 24 26 6 1 so 46 17 143 S. ...... 1 7 74 -1 ..5. 1 2 3 1 1 ....35 15 3 2 33 -------1-2 1 12 .2 29 1-1 3 -4 ..4 1. ..1 .2 3 1 1 ..1 -... 1 i. ..1.1 1--1 -2. 0 Z0 4 74 1 1 2 ...2 -. I .4 35 2 41 2 2 ..2 3 2 ..115 64 15 194 1 2 3 1 1 2 ..33 2 1 36 9 19 21 16 12 7 3 .-.65 29 18 112 .................----............---. .-...--. ..I --1 --. ........2 ..1 3 1 3 .I ......3 2 ...5 1 .........4 .-.4 ......1 ....1 .i.1 ....1 2 ....2 1 .3 1 1 1 ..2 ...2 i 2 1 5

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62 TABLE VII.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYAND PLACE Sex. Color. Age (by years). Cause of death. Less M. F. W. B. Y than 1-4 5-10 1 year. Diseases of the diqevtivc syiem. Diseases of the mouth and annexa. .3 3 .2 Diseases of the teeth and gums. .1 -. 1 Stornatitis. ..-. .-.-. 2 ..1 1 2 --Other diseases of the stomach cancere cepted). 1 2 1 2 .1 1 Acutegastritis. -6 5 3 8 .9 2 Chronie -sl vitis. 1 .2 Acute in-iesion. 3 3 .-. 6 5 -I Dia-rhea and enteritis (under 2 years). 178 147 31 293 1 274 51 Colitis. 34 50 3 81 .65 19. Diarrhea and enteritis (2 years and over)-. 3 3 6 .2 1 Colitis. 6 4 2 7 1 .1 1 Ankylastomruasis.3. 3 Acute apnen Ii -itis. 2. .1 Iferniainlesinalobstructions. 5 4 .9 .4 Other he-nias --. 2 ... Intestinal oWstruction. 2 1 .1 Other diseases of the intestines .-. 2 1 1 .1 Constipation. ..Duodenal u c-.-. .1 2 1 2-Acute yellow atrophy of the liver. I 1 1. 2 .;--. Cirrhosis of the liver. 14 8 4 18. -. Other diseases of the lier .4 .10 4 1. Abs-ess of liver (unqualified). .3 1 1 3. Abeess of liver, entanebic. 2 1 .3. Diseases of the spleen. -. 1 1 ..2 1 Abeess of spleen. 2 .. Simple peritonitis. 14 12 5 2 Other diseases of the digestive system.I---I.--. Nonv cll rc' distsxc of the (ienitoMrnuin) m'T 4teMr 0ind tf1n p1. Acute nephritis. 30 19 6 42 1 11 6 2 Bright's disease (chronic nephritis) 77 52 19 109 1 3 7 Other diseases of the kidney and annexa. 10 2 2 10 .3 ; Pyelo-nephrosis. .1 ;. 3 2 Cvstitis. 1 1 2 .----Diseases of the urethra, urinary abscess, etc.2. 2. Stricture of the urethra, nonvenereal. Hypertrophy of prostate. 1 .I Uterine hemorrhage(nonpuerperal). 1 .1 Uterine tumor (noncancerous). .1 1 Other diseases of the uterus ..3 1 2 ----. Cysts and other tumors of the ovary ..1 1 ..

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63 EES AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE, OF RESIDENCE-Continued. Age (by years). Place of residence. Age unTotal. 11-20 21-30 31-40 41-50 51-60 61-75 76-100 known. PanColon. Canal ama. Zone. .........3 .3 1. ..1 .1. .....o .1 3 .........o. 2.10 1 11 2. .2 -. .244 65 16 325 ....80 3 1 84 1 1 2. ..1 .2 3 1 6 .1 1 2 2 1 1 .6 3 1 10 1 1 .....3 ..1 ...1. 1 1. 2 .1 .2 .1 .9 .9 12 ...I .1 2 1 2 .1 2 .o. 6 ..1 7 1 ........2 ..2 ..I ....o. ...1 .0. I .1. .1 1 1 3 .I ..1 .2 .2 .3 5 4 3 6 1 .16 4 2 22 1 .1 2 1 .7 3 .10 1 .1 2 ...3 1 .4 1 2 ..2 1 .3 1 .2 2. 2 2 ..2 2 4 7 7 4 1 1 ..14 10 2 26 1. 1 1 .13 11 4 2 ...31 15 3 49 2 20 24 28 26 15 4. 61 46 22 129 .3 3 1 1 1 ...8 4 .12 ..1 1 .1 .5 1 2 8 1. ...2 2 ......2 ..2 .2 .2 1.1. .1 S .....1 1 I.1I 2 .....1 2 .3 .1

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64 TABLE VIL-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYAND PLACE Sex. Color. Age (by years). Cause of death. Less M. F. W. B. Y. than 1-4 5-10 1 year. The puerperal state. Accidents of pregnancy .1 ..1. Etra-uterine pregnancy ..1 .1 A bortion. .1. I. Puerperal hemorrhage. .3. ... Puerperal septicemia. .6 .6 Puerperal albuminuria and convulbions. 4 1 3. ... Eclampsia. 7 1 6. Puerperal insanity .1 1. .. Diseases of the skim and of the cellulhr tissue. Gangrene. 3 1 2. Phlegmo m and cal1ulhtis. ...1. Elepantiasis .1 1. .. Other diseases of the skin and annexa. 1 1 .2 .1 Milformations. Congenital malformations (stillbirth not included). 6 3 1 8 .9 Diseisei of early infancy. Newborn child. 1. ... Congenital debility, icterus, and sclerema. 7 4 3 8 .11 Premature birth. 39 37 3 71 2 76. Congenital debility. 19 11 3 27 .30 Atrophy of infants. .1 .1 Malnutrition. 42 32 1 73 .65 9. Other uses peculiar to early inancy (including various consequences of labor). 27 17 5 38 1 44 Lack of care.1 .1. Old age. Senility. 1 4 2 3 .. Affections produced by exterwil causes. Suicide by hanging or strangulation. .... Suicide by drowning. .1 1. ... Suicide by firearms. 5 1 1 4 1 Other suicides. 1 1 2. .. Other acute poisonings. 1 5 2 4 Burns (conflagration excepted). 4 1 1 4 ..3. Absorption of deleterious gases (condawration excepted). 2 2 .. Accidental drowning .19. 1

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65 EES AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE OF RESIDENCE-Continued. Age (by years). Place of residence. A ge unTotal. known. PanCanal 11-20 21-30 31-40 41-50 51-60 61-75 76-100 ama. Colon. Zone. .......1 .1 .......1 .1. 1. ....1 1 2 ..3 3 1 4 1. ..4----------1 1 1 1. ..1 2 1 4 1 5 1. ..2 3 2 7 1. ..1 .....2 1. ..2 1 3 .1.1 ..1. ...1 ...1 2 ........242 2 0 ......a ......... .46 1 4 11 .......1 ..472 47 ...4 2 4 36 ..2. ......2 .....1. 1. ......6 .44. ...8 6 .~~~~ ~ ~ .4. ...5. .I .I ....4.1. .1 ........1 1 .1. ...1 6 2 .....41 1 2 2 2 2. ....6. .06 1 1. ....3 .2 5 I. .1. ..1 1 .2 1 8 9 5. I. .2 8 2 10 26

PAGE 72

66 TABLE VIL-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYAND PLACE Sex. Color. Age (by years). Cause of death. Less M. F. W. B. Y. than 1-4 5-10 1 year. Affections produced byi external causes-Continued. Traumatism by firearms.2. 2 ..... Traumatism by cutting or piercing instruments. 2 .1 1 Traumatism by fall. 13 1 2 11 1 1 .. Traumatism by machines. 3 .1 2. Traumatism by other crushings (vehicles, etc.). 9 3 4 8 ...1 Railroad traumatism. 5 .1 4 ... Injuries by animals. 1 1 ..... Ele.tricity (lightning excepted). 2. 1 1 .... Homicide by firearms. 7 1 2 5 1 ... Homicide by cutting or piercing instruments. 4 .2 2 .... Homicide by other means. 2 ..2 1 Fractures (cause not specified). 4 1 1 4 ... Other external violence. 5 ..5 .. Ill-defined diseases. Ill-defined organic disease. 1 ..1 .. Sudden death. .1 ..... Cause of death not spe-ified or illdefined.a. 9 13 5 17 .9 8 Infections of undetermined origin. .1. Total. 1,587 1,1071 329 2,321 44 974 287 21 Stillbirths. 182 150i 40 292 ... Grand total. 1,769 1,257 369 2,613 44 974 287 21

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67 EES AND NONEMPLOYEES) AND MILITARY, BY SEX, COLOR, AGE, OF RESIDENCE-Continued. Age (by years). Place of residence. -A ge nTotal. 11-20 21-30 31-40 41-50 51-60 61-75 76-100 known. PanColcn. Canal ama. Zone. 2 1 1 .......2 2 1 1 .1 1 2 .4 4 3 2 .5 6 3 14 1 1 1 ....2 1 3 1 4 3 2 .1 ..7 2 3 12 1 1 2. .1 1 3 5 1 .1 1 S 1 .1 .2 .2 1 61 .....2 4 2 8 3 .1 .2 2 .4 ..1 .2 .2 ..2 2 .1. 5 .5 3 .1 1 ...3 2 .5 1 .1 .1 1. .1 .1 .1 2 1 1 .15 5 2 22 1. .1 87 380 377 245 176 105 39 3 1,714 667 313 2,694 .216 73 43 332 87 380 377 245 176 105 39 3 1, 930 740 356 3,026

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68 TABLE VIII.-DEATHS AMONG CIVIL POPULATION (EMPLOYEES AND THE CITIES OF PANAMA AND COLON Cause of death. Jan. Feb. Mar. Apr. General disease. Typhoid fever. .1 1 Mplaria ... MpIiripI fever, estivo-autumnal. 1. 2 Measlos ... Whoopinq cough .. Diphtheria and croup. ... Dvsentery .1. Dysenterv: Fntamebic. .. Bacillrv. .. Unelassified. .. Purrlint infection and septicemia. 1 1 Pyemia. .1 1 Septicemih. Premia and septicemia, pneumococcic .1. Tetqnus. Pellacra. 2 2 2 2 Beriberi. 1 1 1 4 Tubercublsis of the lunos. 40 25 32 20 Acute military tuberculosis. 3 3 1 3 Tubererlus meninitis. 1 3 2 2 Abdominal tuberculosis. ..1 Pott's disease ..... TubercrlI wis of the bones and joints. Tuberculosis of other organs. Tubercrlsis of the venito-urinary organs. .. Dizserninated tuberculosis. 2 2 7 1 Syphilis: Tertiarv. 2 1 1. Hereditarv. .1 .2. Period not stated.1. .1 Gonorrhea1 arthritis. Cancer and other malignant tumors: Of the buccal cavitv. Of the stomach and Ii er. .1 i Of the peritoneum, rectum, etc. .I1. Of the femrle genital organs. ...1 Of the breast. .1 Of other organs and of organs not sneci 'ed ...1 Other tumors (tumors of female genital organs e xcepted). :. Acute articular rheumatism. ..1 Scurvy. Diabetes.1 Hod in's disease. ..1 Anemia: Chlorosis. .1 Primary, pernicious. Secondary, cause not determined. .1 Other Leneral diseases. .. Alcoholism: Acute or chronic. Acute. Chronic. 1 ..1 'Deaths among the military included for the first six months only.

PAGE 75

69 AND NONEMPLOYEES) AND MILITARY,1 IN THE CANAL ZONE BY CAUSE AND MONTH OF DEATH. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 1. ..1 ...4 .1 1 .2 .2 1 5 3 3 2 19 1 ........1 2 .1 .5 ....1 .m. 1 .....2 ..1 .1 .1 .4 1 ..1 ..I .....1 1 2 .2 8 .1 1 .6 ..I 1 1 1 .1 5 ...1. ..1 3 1 2. 1 1 1 .6 3 2 2 1 3 1 4 4 28 1 2 .1 2 .13 24 40 31 28 35 26 28 35 364 .1 3 4 3 3 4 1 29 11 2 .3 3 2 2 22 .1 4 3 .1 10 .I ..1 .2 ..2 .........1 ...1 3 2 -3 2 2 3 4 37 2 3 ..2 .10 .1 4 1 1 1 2 .13 ....2 1 5 .:. .1. ......1 1 1. ......3 2 2 .2 .1 2 .11 ...1 2 .1 .5 2 2 .1 .4 1 .11 ...1 ....2 ....4 1 ..1 1 ...4 ....1 .1 ......1 1. .o. ..3 ....o. ........I ....1 .3 .....o. ........1 -. .....3 ..1 .1 .1 3 ..1 ..1. ..2 .....2 ...1 1 ...2 1 ....2 1. ...1 1 6

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70 TABLE VIII.-DEATHS AMONG CIVIL POPULATION (EMPLOYEES AND THE CITIES OF PANAMA AND COLON, Cause of death. Jan. Feb. Mar. Apr. Diseases of the nervous system and of the organs of special sense. Encephalitis Simple meninzitis. 2 2 .1 Cerebrospinal fever ..I .. Pneumococcus meningitis. I ..2 Locomotor ataxia. .... Other diseases of the spinal cord. ...1 Cerebral hemorrhage. apoplexy. 4 7 5 2 Softening of the brain ..1 1 1 Paralysis without specified cause. .1 .1 General paralysis of the insane .. Other forms of mental alienation. .. Epilepsy. 1. Convulsions of infants (under 5 years of age)-. ..2 1 Chorea ..... Other diseases of the nervous system. .. Diseases of the circulatory system. Pericarditis .2 ..I Acute endocarditis ..1 1 Malignant endocarditis. .1 .. Organic diseases of the heart. 6 4 5 7 Angina pectoris .I .1 r iseases of the arteries, atheroma, aneurysm,etc. 1 ... Aneurysm. .1 Arteriosclerosis. 3 4 1 1 Embolism and thrombosis. Diseases of the lymphatic system (lymphadenitis, etc.).1 1 1 Hemorrhage; other diseases of the circulatory system. 1 1 Diseases of the respiratory system. Diseases of the nasal fossoe. .. Laryngitis. ...I Diseases of the thyroid body. .... Acute bronchitis. 5 7 7 3 Chronic bronchitis. 1 2 ..2 Broncho-pn3umonia. 29 14 13 15 Pneumonia (unqualified). 3 1 2 4 Lobar pneumonia. 9 7 12 14 Pleurisy. .... Empyema. 1 .i Gangrene of the lungs. 1 2. Asthma. 1 1. .. Pulmonary emphysema. .. Other diseases of the respiratory system. ... Abscess of lungs.2 2. Diseases of the digestive system. Diseases of the mouth and annexa. ... Diseases of the teeth and gums. ... Stomatitis. .. Other diseases of the stomach (cancer excepted). 2 .. Acute gastritis. ... Chronic gastritis. ..1 Acute indigestion ....1

PAGE 77

71 AND NONEMPLOYEES) AND MILITARY, IN THE CANAL ZONE BY CAUSE AND MONTH OF DEATH-Continued. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 1. .1 ..2 .......2 1 1 1 3 .13 2 1 1 3 1 1 ..1. ..3 1. .5 ---------..1. ......1 5 6 4 7 5 3 7 8 63 ...1. .1 .5 S. ..2 .8 1 1 2 2 1 ..I .1 .7 2 1 2 1 2 1 1 13 ..2 1. ..2 .6 1 .......6 2 2 2 2 2. 1 3 17 1. 1 2. 7 11 10 13 18 13 18 15 23 143 1 ......3 1. ....2 1 2 ..1 3 1 15 3 ..1 .13 ...2. ..3 .......4 1. ......3 1. ..1 1 1. ...... 4 710306 74 1 9 4 4 4 6 5 3 41 16 17 20 16 6 22 15 11 194 7 4 5 3 1 2 1 3 36 12 6 12 8 6 12 8 6 112 ...1 1 1 3 ...... ....4 ......I .....3 1 ...5 ....3 I ...1 .1. ....2 1 3 .6 .1 1 2 .e. e.e.1 ...2 111 2. .6

PAGE 78

722 TABLE VIII.--DEATHS AMONG CIVIL POPULATTOW (EWPLOYEEF AND THE CITIES OF PANAMA AND A.LO. Cause of death. Jan. Feb. Mar, A Diseases of the digestive system-Continued. Fiarrhea and enteritis (under two years) .28 16 16 20 Colitis. 6 2 3 a ] diarrhea and enteritis (two years and over). .I .. Colitis. .1 2 .. Ankylo3tomiasis .1 1. Acute appendicitis. Hernia, intestinal obstruction. 3 1 1 Other hernias. ... Intestinal obstruction%. .1 1 Other diseases of the intestines. ... Constipation. .. ] uodenal ulcer. .. Acute yellow atrophy of the liver. 1 ... Cirrhosis of the liver.1 4 1 Other diseases of the liver. ..2 Abscess of liver (unqualified). .i Abscess of the liver, entamebi. I ... Diseases of the spleen. ... A bscess of spleen. .. Simple peritonitis. 2 2 1 3 Other diseases cf the digestive system (cancer and tuberculosis excepted). ..1 Nonvenereal diseases of the genito-uninary system. Acute nephritis. 2 3 6 2 Bright's disease (chronic nephritis). 14 16 5 11 Other diseases of the kidney and annexa. 1 2 4 Pyelo-nephrosis. 1 Cyst itis. .... Diseases of the urethra, urinary abscess. ... Stricture of the urethra, nanvenereal. Hypertrophy of prostate ..... Uterine hemorrhage (ninpuerperal). Uterine tumor (noncancerous). .... Other diseases of the uterus.2. Cysts and other tumrs~of the ovary ..1 .. The puerperal state. Accidents of pregnancy. ...I Extra-uterine pregnancy. ..1 Ahartion. .. Puerperal hem-rrhage.!. .I Puerperal septicemia. Puerperal albuminuria and cnvulsions,. ... Eelampsia. .2 Puerperal insanity. 1. Diseases of the skin and of the cellular tissue. Gangrene. .*. Phlegmcn and celiulitis. .. Elephantiasis. .... Other diseases of the skin and annexa ...-WO. Malformations. Congenital malformaticns (stillbirth not Inlued). ..2

PAGE 79

73 AND NONEMPLOYEES) AND MTLITARY, IN THE CANAL ZONE BY CAUSE AND MONTH OF DEATII-Continued. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 21 36 53 36 28 28 24 19 325 2 17 16 3 1 11 11 6 84 1 ..1 1 .2 .6 1 2 ..1 1 1 1 10 .--------------I .----. ....3 ..-.....I ..1 .2 .2 1 1. ..... 1. ...2 1 7 ....I ...1 2 .-. 1 1 ...3 ........2 1 1 1. 3 2 3 1 4 22 2 1 2 ...2 10 1. ..1 ..1 4 .--.----. ---------------1 .1 ..3 1 ...1 2 -....2 ...2 2 .6 .4 2 3 1 26 M 2 1 8 6 1 6 8 4 49 14 9 8 9 11 10 10 12 129 1 1 1 12 2 ..2 1 2 8 ....2 -----. ..2 I --...............2 ....1 .....1 .1. .1 ........3 -1. .1. ...... .......1 .1 4 ---. -------1 ...1 2 7 I. ....3 *.----.-. ----. ..1 1 -------.-.......1 1 ...a. ..1 ---. ...2 1 1 ...3 1 9

PAGE 80

TABLE VII-DEATHB AMONG CIVIL POPULATION (EMPLOYEE. AND THlE CITIES OF PANAMA AND COLON, Cause of death. Jan. Feb. Mar. Apr. Diseases of early infancy. Schild. .. Congenital debility, icterus, and scierema. 4. premature hirth. 6 5 5 10 Congenital debility. 2 4 5 A trophy of infants. ... Malnutrition.3 5 0 Other causes peculiar to early infancy (including varbaus consequences of labor). 3 6 .7 Lack of care. 1 1 Old age. Senility. ... A Actions produced by external causes. Suicide byhanging or strangulation. ... Suicide by drownng. ... Suicide by firearms.1. .2 Other suicides. ... Ot her acute poisonings. ..;. Burns (conflagration excepted). .1 A bsorption of deleterious gascs (conflagration excepted). ..1 1 AccidentaI drowning. 2 4 3 1 Traumatism by firearms. 1 Traumatism by cutting or piercing instruments. .... Traumalism by fall. .3 12 Traumaism by machines. 1 TrCumaeism by othdr crush ags(reMicls, landslidcs, ec.). 2 4 1 1 Railroad traumatism. injuries by animals. ....1 Electriety (ihtn g exepted). 2 Homicide by irearm. .1 1 3 fl omide by cuti ing or piercing instruments. .1 1. Aomiheby other means. .. Fractures (cause not specified). ... Other external, violence. .... 117-defined diseases. Sudden death. .. Cause of death not specified or ill-defined .1 .2 11-defined organic disease. 1 .. Infections of undetermined origib. ..:. Total. 232 193 19 185 Stillbirths. ...27 21 23 28 Grandtotal. .259 21 219 213

PAGE 81

75 AND NONEMILOYEES) AND MILITARY, IN THE CANAL ZONE BY CAUSE AND MONTH OF DEATH-Continued. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 1 ....1 1 2 2 1 11 6 8 12 9 4 4 2 5 76 3 2 .3 .2 6 3 30 ... 3 9 4 9 8 11 6 774 3 3 2 1 7 5 4 3 44 ....2 1. 1 1 2 ..5 .......1 1. ......1 1. ..1.6 1. .....2 1.3 1. .6 1.1 ..5 1 2 1 .f ..5 ...26 1. .....2 1 1 2 .1 2. .1 2. .12 1. ..1 .3 1. 1. ...1 1 12 1. ....6 ........ .........1 3 .....0. ..... ....2 .5 1 1 ...1 f 5 ........1 1 2 5 22 ........_. .0. 1 1 .......1 205 246 278 236 220 253 232 218 2.6c.4 16 26 33 3 43 3 25 20 332 221 272 311 273 263 286 257 238 3, C26 162r33 33 52 3

PAGE 82

76 TA nLZ JX.-DISCHARGES OF EMPLOYEES FROM HOSPITALS, lan Feb. Mar. Apr. Cause of admission. W. D. W. B. W. B. W. B. General diseases. Typhoid fever.1 .2 .. Relapsing fever. ..1. Malariil fever: Estivoitunal. 9 12 3 7 7 4 3 6 Tertian. 5 5 2 6 3 4 1 4 Quartan. ..... Undetermined. ..... Measles. .... Diohthera and croup. .. Influenza. 9 4 6 5 9 5 6 2 Dysentery: Entamebic. ..... Bacillarv. ..... Unclassified. .....1 Lepros jr. 1 Erysiielas. ..1 1. .. DIengu. ..... Chickeupox .-. 9 1 11 .3 3 German measles. ..... Mumps. .. Yaws. 1 ..... P urulent infection and sapticemia. ........ Septicem ........ P vemia and s3pticemia, pneumococcie. ... Tetanus. ... Pellayra. ...1 Tuberculosis of the lImgs. .5 2 4 2 1 Pott's dis3as. .... Tuberculosis of bones and joints. ...1 Tuberculosis of other organs .1 Tuberculosis of the Jvmph glands. .3 .1 1 1 .1 Tuberculosis of the genito-urinary organs. .1 .1 Tuberculous absness. ...1 Diss3minated tuberculosis. ....... Syphilis: Primary. 1 Secondary. 2 9 2 3 2 2 V 9. Tertiary.1 9 1 11 1 11 1 5 Hereditary. ...... Period not stated.1 1 .1 1 .. Gonoocus infection. .... Goaorrnea. 1 9 2 8 4 3 3 9 Goaorrheal arthritis. ...-....1 Goaorrheal bubo. ... Goaorrheal orchitis and epididymitis. 1. 2 .. Gonorrheal ophthalmia. ........ Soft chAncre. 36 4 10 1 8 Adeaitis chancroidal.2. .2 2 Cancer and other malignant tumors: Of the buccal cavity .. Of the sto.nach and liver .I .1 Of the s in. ...1 O f other organs and of organs not s >eeifled. ..1. .1 .. Other tumors (tumors of female genital organs excepted). I .I ...2 Acule articular rheumatism. 3 .... Chronic rheumatism and gout. ...1 .... A.

PAGE 83

77 SHOWING CAUSE OF ADMISSION AND MONTH OF DISCHARGE. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Grand total. W. B. W4 B. W. B. W. B. W. B. W. B. W. B. W. B. W. B.* .1 .2. 2 4 4 8 1 ..1. 3 3 5 4 6 13 4 24 6 29 7 36 9 47 6 30 6 36 71 248 319 4 2 5 3 12 7 3 7 2 7 2 g 2 1 1 3 42 57 99 .2 1 1 .2 .1 .3 .I 1 10 11 1 .2 1 ...6 1 2 1 5 1 .6 14 20 ....I .1 2 .1 1 1 1 3 4 7 11 ...1 1 2 1. 1 1 .1 4 5 9 21 14 17 9 8 2 6 5 8 12 4 7 5 11 5 6 104 82 18 2 .....1 1. .1 1 .2 1 6 3 9 .............11 1 .......2 2 ......1 .1 .......3 3 ...............2 2 ........1. ....1 5 .2 1 2 2 2 .4 .3 .2 .1 4 47 51 ....21.5. ..2 6 8 ..1 ..1 8 1 2 .2 1 ...3 13 16 ......-. ......1I 1 1 2 ......1 .1 1 1. ..1 ..........1 1 2 ..............1 1 1 ...............-. -. ........1 .2 ......4 4 .12 3 1 .3 1 .1 7 4 .6 1 3 11 48 59 ............1 ...1 1 ...............1 ..............2 2 .....1 ...1 ...1 8 9 S ....1 ...6 6 ......1 ...2 ....4 4 ...........1 1 ....................2 1 1 2 3 .6 .1 3 .2 1 6 .2 ....9 43 52 1 16 1 21 3 28 3 22 .25 3 27 3 19 2 18 19 212 231 ....1. ........2 2 11. ...1. 1 ..1 2 ..5 6 11 ....1 .......1 ..2 2 3 13 5 7 3 7 .13 3 11 3 18 2 7 2 14 31 119 150 2 .4 1 2 .1 ..li. 1 .1 13 14 1. .........2 2 4 .1 1 2 1 3 .I .I .5 1 1 3 17 20 2 .1 .3 3 1 8 .6. 2.12. 2. 2 7 .6 18 92 110 S. .1 ..2 3 2 1 2 2 1 3 9 15 24 1. ...11 1. ......1. 1 2 3 5 .................1 .1 ...1 3 4 1 .2 1 .1 2 .7 4 11 ...........3 1 4 ...1 .1 1 2

PAGE 84

78q TABLE IX.-DISCHARGES OF EMPLOYEES FROM HOBPITAL, SHOW Jan. Feb. Mar. Apr. Cause of admission. W. B. W. B. W. B. W.B. General diseases-Continued. Diabetes. 1. ... Exophthalmic goiter. 1. ..... Anemia secondary, cause not determined. .1 1. Other general diseases.1 2 .1 3 1 Purpura hemorrhagica. ..... Alcoholism: Acute. .1 .1. .. Chronic.2 .1 .1 ... Alcoholic psychosis. .... Chronic lead poisoning. ..... Other chronic poisonings. ..... Diseases of the nervous system and of the organs of special sense. Other diseases of the spinal cord. ....... Cerebral hemorrhage, apoplexy. ........ Paralysis without specified cause. .......1 -General paralysis of the insane. ....... Other forms of mental alienation. .1 ...1 Dementia precox. ......... Epilepsy. ...W H ysteria. Neuralgia. ........ Neuritis. 2 1 3 1,. 1 2 2 Other diseases of the nervous system. ....2 1 Neurasthenia. ........ Diseases of the eyes and their annexa. .5 3 10 5. 7 2 6 Trachoma. ....... Diseases of the ears.1.1 Diseases of the circulatory system. Pericarditis.I. ... Organic diseases of the heart. .5 .8 1 8 2 10 Angina pectoris. ...... Diseases of the arteries, atheroma, aneurysm, etc. Aneurysm. ..... Arterio-s-lerosis. ....... Diseases of the veins (varices, hemorrhoids, etc.). .....1 Hemorrhoids. 4 3 6 1 .1 3 Varices. ..... Variconele. .1 .3 ..I Phlebitis. ........ Diseases of the lymphatic system. 1 .1 1 1 Lymphadenitis (nonvenereal). 2 2 5 2 7 2 4 Hemorrhage; other diseases of the circulatory system. ..1 .... Diseases of the respiratory system. Diseases of the nasal fossa. 4 1 6 .1 .6 2 Adenoid vegetations. ... Diseases of the larynx ........WKDiseases of the thyroid body. ... Al

PAGE 85

79 ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE-Ccntinued. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. __ ___ Grand total. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. .1 1 .1 ......1 1 ...4 2 6 ..1. .........1 ...1 .1 S .2 ............1 3 4 i 2 2 .2 .3 .2 .14 6 20 .1 .........1 .1 .1 .2 1 .1 .3 4 7 ....1 .1 .........6 6 .................1 1 ..... ......1 ..1. ........1 ..2 ..1. .........1 4 ......1. .1. ...2 2 1 .1 ...2 1 ....2 9 9 ......1 .1 .1 1 2 ...1.2 1.1. ..2 6 8 .1 1. ..2 2 *2 1 2 3 3 .5 1 4 1 .1 2 1. 1 1 2 3 3 .27 13 40 ..1 .2 _. 1 ..1 .2 ....6 4 10 2 2 9 ...12 4 16 3 4 2 9 2 8 1 4 2 6 .4 2 4 2 7 24 74 98 ....1. ..1 .1 I ..2 2 ...1. 1 1 1 1 51 7 12 ..................1 i 7 1 2 .3 1 6 2 8 .4 .4 .3 8 68 76 ...2 .2 2 ............ .2 .*. .........3 3 ....3 ..1 ..1 ..1 4 5 1 .....1. ...3 2 5 3 2 1 .6 5 4 6 4 3 i6 7 3 1 .3 40 32 72 ...............0 ...1 ..2 .12 3 .4 .2 .2 1 4 1 1 1 23 6 29 ................ ..I I ....2 1 .2 2 1 3 .12 5 17 6 .6 2 9 1 5 2 2 2 4 3 5 .4 18 57 75 .......1 ..1 2 1 3 2 1 3 .7 .4 1 7 .9 1 12 .2 1 63 7 70 ...1 ...1 .....2 2 .1 ..........1 1 2 ........1 ....1 1

PAGE 86

80 TABLE IX.-DISCHARGES OF EMPLOYEES FROM HOSPITALS, SHOW Cause of a Jan. Feb. Mar. Apr. W. B. W. B. W. B. W. B. Diseases of the respiratory system-Continued. Acute bronchitis. 5 6 1 2 .1 3 5 Chronic bronchitis. .3 1 2 ..1 Broncho-pneumonia ... Pneumonia (unqualified). 1. Lobar pneumonia. .2 2 .1 .8 Pleurisy. 1 6 .5 .1 1 2 Asthma. 1 2 .3 .4 .4 Other diseases of the respiratory system. .... Abscess of lungs.1 .1 Diseases of the digestive system. Diseases of the mouth and annexa. ..... Diseases of the teeth and gums. 1 1 ...1. Stomatitis. ...... Diseases of the pharynx. .1 .....I Pharyngitis. ...1 Follicular tonsillitis. 3 2 2 2 1 3 6 1 Ulcer of the stomach. .1 1 .1 .I Other diseases of the stomach (cancer excented). 1. Acute gastritis ...3 2 .. Chronic gastritis b. ..... Acute indizestion. 4 1 ..1. Diarrhea and enteritis (2 years and over). .1 .2 1 2 .3 Colitis. .....1 Ankvlostomiasis. 1 1 1 1 1 1 Intestinal parasites. ... Teniasis. 1 ..... Appendicitis and typhlitis. 1 ...... Acute appendicitis. 7 1 1 .I .1 1 Chronic appendicitis.1 1 .1 1 2 Incuinal hernia. 6 8 3 4 6 6 1 4 Other hernias.1 .1 ..1. Intestinal obstruction. ...... Other diseases of the intestines. 8 3 3 2 6 2 3 3 Constipation. ..1 2 .1 2 .2 Duodenal ulcer. 1 ...... Acute yellow atrophy of the liver. ......1 Cirrhosis of the liver .... Other diseases of the liver. 1 1 1 1 1 Abscess of liver (unqualified). .... Cholecystitis. .... Simple peritonitis (nonpuerperal). ....... Other diseases of the digestive system. ....I .. Nonvenereal diseases of the genito-urinary system and annexa. Acute nephritis. ....... Bright's disease (chronic nephritis). .2 1 2 .2 Chvluria. ..... Other diseases of the kidney and annexa.1.1 1 Pvelo-nephrrotis. .1 .. C6lculi of the urinary passages. ..1 ..1 Diseases of the bladder. ...1 Cystitis .1 1 .1 ..

PAGE 87

ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE-Continued. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. ___ __ Grand total. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. 2 13 4 7 1 3 2 3 1 1 5 3 7 3 7 2 38 49 87 1 2 2 1 ..1 ..1 .1 1 ..6 11 17 S1 .......1 2 3 .1 .1. 2 1 3 2 3 .2 .4 .6 .6 .3 .a 2 3 4 45 49 5 2 .2 .4 .5 1 6 .1 1 1 .2 9 37 46 1 4 1 .2 1 12 1 .1 .1 .3 5 26 31 .1 1 ..1. ..1 2 3 ................2 .2 .1 .2 .4 4 3 1 .2 ..1 1 .2 .2 5 10 15 ............2 ...2 2 ........1 1 .I ..3 4 7 ...I .1 .2 1 3 3 1 2 .1 1 3 5 2 6 3 6 4 5 3 3 33 35 68 1. 1 .1 .1 1 2 .9 2 11 3 1 2 ..1 .1 .7 3 10 2 .1 .1 5 4 9 1 .1. .1 .....3 .3 2 .I .1 1 .9 2 it 18 2 1 .5 .6 .5 1 2 1 .4 3 10 38 48 1 3 .1 .2 3 1 2 .2 7 10 17 .2 1 .I .2 .3 .4 .2 5 16 21 1.11 .1 ..3 1 4 1.1.I .1. 4 .4 ....1 .1 2 .4 4 2 .1 1 .1. 1 .24 4 28 ..2 ...1 ...1 10 2 12 2 6 3 7 2 14 6 8 4 7 3 8 4 9 1 8 41 89 130 1 .......1 ..3 3 6 1. .1 .1 6 1 5 3 3 844 3 7 7 4 .42 51 42 93 1 2 .I .1 .1 ...2 ..1 ..5 12 17 1 ..1 .1 ...1 1 6 2 8 ..1 1 .1. I ....1 .2 .2 1 1 2 .1 1 .7 5 12 .I .1 1 1 2 3 1. 1 .,. .1 1 .3 2 5 1 .1 1 ........1 1 2 1 1. 1 1 2 .1 .6 1 2 .6 1 4 1 2 .6 2 3 6 41 47 .2 .2 2 2 .1 .1 .2 1 .1 8 3 11 I. ...1. 2 5 7 ....1 .......5. 5 .............1 2 3 .3.1 1. 1 .3 1 19 9 12

PAGE 88

82 TABLE IX.-DISCHARGES OF EMPLOYEES FROM HOSPITALS, SHOW Jan. Feb. Mar. Apr. Cause of admission. W. B. W. B. W. B. W. B. Nonvenereal diseases of the qenito-urinary system and annexa-Continued. Diseases of the urethra, urinary abscess, etc. 1 1..1 .3 Stricture of the urethra, nonvenereal. .5 .1 .1 .3 Diseases of the prostate. Acute prostatitis. Chronic prostatitis. 1 Nonvenereal diseases of the male genital organs .1 .2 2 1 3 .5 Hvdrocele. 1 3 .1 2 1 .1 Uterine tumor (noncancerous). ........1 Other diseases of the uterus. ..1 ..1 Metritis. .... Cysts and other tumors of the oi arv. ...... Salpineitis and other diseases of the female genital organs .. The puerperal state. Extra-uterine pregnancy ...2 Abortion. ....... Diseases of the skin and of the cellular tissue. Furuncle. 1 1 ..... Carbunle. .... Acute abscess. 2 S .4 1 5. Phlewmon and cellt-litis. 4 7 3 3 6 3 5 Trichopytosis. Scabies. Dhobie itch. 1 .2. Ulcer of the stin. 2 2 1 3 Tropical ulcer. Impetiro contagiosa ..1 1 ... Urticaria .I1 ...... Inrowing nail. ...T Other diseases of the si in and annexa. .1 2 2 45 3 2 Diseases of the bones ard of the organs of locomotion. Diseases of the bones (tuberculosis excepted). 2 1 ....I Caries (nontuberculous). .1 ... Osteomvelitis. ...1 Periostitis. ..2 .. Diseases of the joints (tuberculosis and rheumatism excepted). .1 1 Ankvlosis 1 .....I .... Arthlritis.1 .4 8 3 1 7 Synovitis. 2. ..1 1 Amputations. .......0. Other diseases of the organs of locomotion. 1 3 3 .1 .4 1 A1formations. Congenital malformations. ..1 1 .3

PAGE 89

83 ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE-Continued. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. _______ Grand total. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. 1 ...1 ..3 .....1 ..2 10 12 1 .2 .2 .1 .3 1 2 .2 .2 1 25 26 ..2 ..3 .3 1 ....1 .......* ....1 .I ......1 .....2 .2 2 3 .3 1 2 .2 1 .2 ..4 .2 10 26 36 .12 .3 .4 .2 .4 ..3 .2 3 32 35 ....2 2 1 .1. 1 ......1.1 6 2 8 1 ........1 ...1 1 2 ......1 2 .....-. -.-. ..........2 2 ........5 5 .1 1 2 2 ..1 1 .2 .3 .1 7 12 19 ......1 ..1 ..1 ..1 1 2 1| 6 1 2 1 5 2 1 1 2 4 3 5 2 2 3 21 39 60 211 2 3 5 1 5 8 2 1 1 8 .3 2 4 32 50 82 .......1. ....1 1 .1. ........2 ..5 5 10 2 .2 .1 .2 3 4 .2 1 6 1 5 6 34 40 ..I ...........1 1 2 ............1 3 2 5 .I. .............1 .1 5. 2 ..1 .2 .1 .....11 1 12 8 3 2 .2 2 2 8 3 5 4 1 .2 3 1 33 32 65 3 2 2 4 2 .2 1 11 2 3 3 1 2 .1 17 16 33 .............1 2 ..-. -.-. ......-. -. 1 ..1 .......3 3 ...-. ...1 -. .1 .i .1 56 ....1 ....1 ..5 1 6 .....1 ......1 1 2 3 2 -. ..3 -1 .4 1 22.1 14 30 44 1. 1 ....1 ....1 ..6 2 8 ............1 .....1 1 3 .1 3 .1 2 2 .4 2 1 2 2. 22 14 36 .1 .2 1 ..2 .1 .1 .2 .2 13 15

PAGE 90

8AN 84 TABLE IX.-DISCHARGES OF EMPLOYEES FROM HOSPITALS, SHOW A Jan. Feb. Mar. Apr. Cause of admission. W. B. W. B. W. B. W. B. Affections produced by external causes. Suicide by poisoning. Poisoning by food. 1 4 3 1 Other acute poisonings. .......9 Venomous bites and stings Sna-e bites. ..... Conflagration. ..1 .... Burns conflagrationn excepted). 2 3 1 3 3 8 1 6 Absorption of deleterious gases (conflagration excepted). ....... Accidental drowning. 1 I I I Traumatism by firearms. .1 ...2 .1 Traumatism by cutting or piercing irstruments. 1 12 .10 2 11 1 9 Traumatism by fall. 2 8 .4 .5 1 7 Traumatism in mines and quarries. ......1 Traumatism by maehines. 1 1 1 5 1 3 2 4 Tran matism by other crushings. 1 10 1 6 4 5 .7 Railroad traumatism. 1 3 .1 1 .1 Dynamite traumatism. ..... Traumatism by landslides ..... Injuries by animals .....1. Effects of heat. ..... Heat e -haustion. 1 Electricity (li zhtning excepted) ..... Homicide by cutting or piercing instruments. ..... Fractures (cause not speciled). 4 11 1 6 3 5 3 3 Dislocations. .I .2 .2 1 Sprains. 3 ..2 2 .1 Other external violence.5 34 9 45 9 I 35 10 42 IlV-2efine2 diseases. ]ll-deined organic disease. .. Infections of undetermined oriin. 2 2 .3 .1 1 4 No disease. ...... Total. 1391 2121 109 239 131 231 104 267

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85 ING CAUSE OF ADMISSION AND MONTH OF DISCHARGE-Continued. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. _______ ______ ___ __ ___ __ ___ Grand total. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. W. B. .............1 ....1 1 1 1 3 1 .1 1 1 2 1 .3 1 1 14 25 39 .1 .1 .1.3 3 .1.1 1 1 2 2 4 ................1. 11 .2 14.13 2 4 ...12 37 49 ..............2 .2 .2 ...1 1 .2 .1 .2 .1 1 .1 10 11 3 7 .8 1 6 1 8 1 14 1 6 2 11 3 21 16 123 139 2 10 .5. 5 1 7 4 4 1 12 .5 1 7 12 79 91 .................1 1 3 3 .1 .2 1 3 .2 .2 1 1 .2 10 29 39 1 8 1 4 ..1 3 .1 1 1 .2 3 6 13 53 66 2 1 .2 .1 .3 .1 .1 .1 .3 16 19 ..I ........1 1 ...1 .1 ..2 2 1 3 .1 ...1 .....2 5 7 1 .......-. ...-.1 .. ..1 .1 .......1 1 .......11 1 3 4 5 4 4 5 1 5 2 4 1 6 1 3 .28 56 84 2 .1 ...1 .2 ....1 11 12 2 ..2 .5 .2 1 .1 ..1 4 18 22 7 36 6 31 3 34 3 34 4 34 7 50 8 28 3 35 74 438 512 .........18 9 5 3 3 2 4 .4 .4 2 5 3 2 4 7 1 .18 39 57 2 2 1 ..2 2 3 6 2 2 2 2 12 14 26 150272 144 243 122 257 111 309 126 330 127,355 123i293 102 4 3,325 4,813

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86 TABLE X.--CONSOLIDATED HOSPITAL REPORT. ReRemaining AdDied DisTransmaining Jan. 1, mitted. charged. ferred. Dec. 31, 1917. 1917. W. C. W. C. W. C. W. C. W. C. W. C. ANCON HOSPITALS. Panama Canal employees. 42 1301,0371,852 16 751,0361,800 3 41 24 66 Panama Railroad employees. 10 52 1911,124 3 53 183 1,020. 21 15 82 Panama pay cases. 0 1 .5 .1 .5 0 0 Other pay cases. 90 564,1751,620 37 1564,1131,41532 25 83 80 Charity cases. 12 23 485 391 5 32 452 327 4 30 36 25 Total. 154 262 5,888 4 9921 61 31715,84,562 391 1221158 253 CoroZvd Hospital --~ (insane). Panama Canal employees. 0 6 3 7 ..3 5 Panama Railroad em10 ployees. 0 1 .6 ..4 ..0 3 Panama pay cases. 37 188 25 64 3 19 9 28. 5 50 200 ,Other pay cases. 7 2 35 17 1 6 33 7 2 .6 6 Charity cases. 13 62 4 32 .1 9 23. 1 8 69 Total. 57 259 67 126 4 26 51 70 2 6 67 283 Coroz2lfzrm. ~ Panama Canal employees. 10 54, 9 45. 10 46. 2 9 51 Chronic ward. Charity cases .0 24 .39 ..8 .32 .23 COLON HOSPITAL. Panama Canal employees. 6 8 196 341 2 13 164 253 31 78 5 [5 Panama Railroad employees. 1 8 125 359 2 14 106 242 15 102 3 9 Panama pay cases. 0 1 27 101 51 12 8 251 14 63 ff 2 Other pay cases. 12 1 629 159 10 11 507 100 98 44 26 5 Charity cases. 1 0 651 34 1 4 57 16 7 12 1 2 Total. 20 181 042 994 20 54 842 636 165 299; 35 23 PALO SECO LEPER ASYLUM. Panama pay cases .2 39 .3. 5 1 ...1 37 Charity cases. 1 24 11 7 1 1. 1 1 1 28 Total. 3 63 1 10 1 6 1 1 .1 2 65 GRAND TOTALS. Panama Canal employs. 58 1981,2452,245 18 881,2102,107 34 121 41 127 Panama Railroad emI ployees. 11 61 3161,489 5 67 289 1,266 15 123 18 94 Panama pay cases. 39 229 52 173 8 37 18 53 14 73 51 239 Other pay cases. 109 594,8391,796 48 173 4,6531,522 132 -69 115 91 Charity cases. 27 133 555 503 71 381 518 375 11 761 46 147 Total. 244 680,7,00716,206 861 403'6,68815,323 206 462 271 698

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87 TABLE XI.-CONSOLIDATED REPORT OF EMPLOYEES TREATED IN QUARTERS. Remain-Remaining Jan. Admitted. Died. DisTrans-. ing Dec. S1,1917. charged. feared. 31, 1917. Stations. W. B. W. B. W. B. W. B. W. B. W. B. Ancon. 1,004 7 ..996 7 6 .2 Balboa. 1,804 125 ..1, 776 72 30 51 3 2 Pedro Miguel. ..168 13 ..153 11 131 2 2. Paraiso. 1 1 94 131. 86 116 9; 16. Gamboa. ..12 13 ..11 10 1 3. Gatun. 1 3 146 59 ..1391 57 8 5. Colon. 2 171, 1042, 140 .1,_105 2 142 .1 15 Total. 9 214,3322,488 .4,2662415 671 77 8 17 CONSOLIDATED REPORT OF DAYS LOST IN QUARTERS BY EMPLOYEES. Station. White. Colored. Total. Ancon. 2,027 24 2,051 Balbo. 4,215 404 4,619 Pedro Miguel. 409 60 469 Paraiso. 335 331 666 Gamboa. 32 27 59 Gatun. 490 206 696 Colon. 2,624 9,882 12,506 Total. 10 10 ,934 21,056

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88 TABLE XI.-CONSOLIDATED HOSPITAL AND EMPLOYEES TREATED IN QUARTERS REPORT. ReRe'main-, mainminditd id DisTransmam ing Admitted. Died. charged. ferred. ing Jan. 1, Dec. 31, 1917. 1917. W. B. W. B.W.WB. W B. W. B.W.1B. Hospitals. 244 680 7,007 6,206 86 403 6,6885,323 206 462 271 698 Quarters. 9 21 4,3322,488. 4,2662,415 67 77 8 17 Total. 253 70111,3398,694 86 40310,9547,738 273 539 279 715 White. Colored. Total. Total admissions to hospitals, excluding Corozal farm and chronic ward. 6,998 6, 122 13,120 Total admissions of employees to quarters. 4,332 2,488 6,820 Total. 11,330 8,610 19,940 Less number of patients transferred from quarters I to hospitals, and between hospitals, whose admissions are duplicated in the above figures. 327 505 778 Net admissions to hospitals and quarters. 11, 057 8,1051 19, 162 EMPLOYEES. Total admissions of employees to hospitals. 1,552 3,689 5,241,6 Total admissions of employees to quarters. 4,332 2,488 6,820 Total .5,884 6,177 12,061 Less number of employees transferred from quarters to hospitals, and between hospitals. whose admissions are duplicated in the above figures. 116 319 435 Net admissions of employees to hospitals and quarters .5,768 5,858 11,626 Annual average per 1,000 admissions of employees. 1, 198.17 179.75 356.75 CONSOLIDATED DISPENSARY REPORT OF ALL CASES TREATED BUT NOT EXCUsED. Employees. Nonemployees. Total. Station.Co-o-Co-oWhite. o. White. oWhite. oed White. oTotal. Ancon .23,662 56,210 79,872 19, 880 42,538 62.418 43,542 98, 748 142,290 Balboa. 47,993 48,156 96,149 48,484 15,943 64,427 96,477 64, 099 160,576 *Pedro Miguel. 15,351 21,279 36,630 13,025 7,504 20,529 28,376 28,783 57,159 Paraiso. .8,888 28,912 37,800 8,146 9,016 17,162 17,034 37,928 54,962 4G a .i ..1,052 3,683 4, 735 503 3,225 3,728 1,555 6,908 8,463 o G. .3,303 13,189, 16, 492 6, 405 10,489 16,894 9,708 24,488 34,196 .Colon. 22, 806 70, 858 93, 664' 14,753 22,079 36,832 37,559 92,937 130,496 Total. 123,0.55 242,287 365,342 11, 196110,794 221, 990 234,251353,891 588,142

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89 TABLE XIII.-AVERAGE NUMBER OF EMPLOYEES CONSTANTLY SICK IN HOSPITALS AND QUARTERS. White. Colored. Total. Hospitals: Ancon Hospital. 49.99 181.45 231.44 Colon Hospital. 7.54 17.76 25.30 Total ..57.53 199.21 256.74 Quarters: Ancon. 5.55 .07 5.62 Balboa. 11.55 1.10 12.65 Pedro Miguel. 1.12 .17 1.29 Paraiso. .92 .91 1.83 Gam boa. .09 .07 .16 Gatun. 1.34 .57 1.91 Colon. 7.19 27.07 34.26 Total ..27.76 29.96 57.72 Average number of employees constantly sick: Hospitals. 57.53 199.21 256.74 Quarters.-. 27.76 29.96 57.52 Total. 85.29 229.17 314.46 Average number of employees constantly sick per 1,000: Hospitals. 11.95 5.77 17.72 Quarters. 7.17 1.08 8.25 Total. .7.88 1.77 9.65 TABLE XIV.-AVERAGE NUMBER OF DAYS STAY IN HOSPITALS OR QUARTERS FOR EACH ADMISSION OF SICK EMPLOYEE. White. Colored. Total. Hospitals: Ancon Hospital. 14.65 21.75 19.74 Colon Hospital. 8.60 9.23 9.02 Quarters: Ancon. 2.02 3.43 2.04 Balboa. 2.33 3.20 2.39 Pedro Miguel .2.46 4.61 2.62 Paraiso. 3.52 2.51 2.93 Gamboa. 2.66 2.08 2.36 Gatun. 3.33 3.32 3.33 Colon. .2.37 4.61 3.81 Average number of days treatment for each employee admitted to either hospitals or quarters. 5. 27 13.57 9.51 9

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90 TABLE XV.-PATIENTS OTHER THAN EMPLOYEES TREATED IN HOSPITALS AND REVENUE RECEIVED FROM THEIR TREATMENT. Number Number of admisof days Revenue sions. treatment received. Paid for by Panama Republic: Insane. 89 90,858 $68,261.25 Colon Hospital. 128 479 1, 495.72 Palo Seco Leper Asylum. 4 14,023 10,531.75 Residents of Panama, emergency charity patients.35 310. Total. 256 105,670 80,288.72 Charity patients (zone). 981 53,325 Outside pay patients .391 6,976 30,941.39 Families of employees. 3,746 46, 128 61,637.47 Army and Navy patients. 2,604 35,242 69,046.93 Public-health service patients .261 5,216 8,549.92 Total.7,983 146,887 170,175.71 Grand total.-. 8,239 252,557 250,464.43 TABLE XVI.-SURGICAL OPERATIONS PERFORMED IN ANCON AND COLON HOSPITALS. Ancon HosColon HosTotal pital. pital. Num-i NumDNumDied. ber. ber. ber. Amputations: Forearm. 1. .1. Hand. ..1. I Hip joint.1. ... Thigh. 1. 1 .. Leg. 5 1 ..-1 Foot. 1 .1 .2 Digits, multiple. 11. 4 .15. Thigh, double. ..1 .1. Operations on bones: Craniectomy, decompressive. 1 1 2 1 3 2 Craniectomy, exploratory. ..1 .1. Laminectomy. .1 1 ..1 1 Ostiectomy. 10 .8 .18. Resection of shoulder. 1 ...1 Resection of knee. ..2 Wiring of fracturesSim ple. 30 ... Compound. ..5. Bone transplantation. 4 .2 .6 Adenectomy: Cervical. 13. I. ..14 Axillary. 2. ...2. InguinalSingle. 177 .11 .188. Double. 48 .2 .50 Femoral. 20 .20.

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TABLE XVf.-SURGICAL OPERATIONS PERFORMED IN ANCON AND COLON HOSPITALS-Continued. Ancon HosColon HosTotal. pital. pital. NuDDied. NumDied Num-. ber. ber. ber. Herniotomy: Ingiiinal Single. 123 ..36 .159 Double. .35 .--------14. .49----Ventral. I .16 Strangulated. .1--. 6 1 7 1 (enito-ormiary tract: Nephrotomy. 1 --------6 1 Nepbrectomy. I ... Nephropexy. 4 ..4. tystotom y. 2 ...2 UrethrotomyInternal. 16 .1 .11 External. 20 2 1 .21 2 Prostatectomy. 2 1 ..2 1 Xaricocele, rad ical cure. 23 .--.-. 30 Ilydrocele Single, radical cure. 31 ...36 Double,radicalcure. 9 .4 .13 Orchidectomy. 10 .10. Epididymotomy. .86 .86 Amputation of the scrotum: 25 ..25. Amputation of the penis 2 .2. Curettage uteri. 100 .15 .115. Perineoplasty. 14 --------.2. 16 Trachelorrhaphy .9 .-. 5 .14 Vaginal punctures .1. 1 1 .2 1 Undescended test icle, double. ---. 1 .1 Obstetrical: Caesarian section, abdominal. 6 2 5 1 11 3 Accouchment force .2 ..2. High forceps. 4 ...4 Low forceps. 11 ....11 Version. 3 ..5 Perineovrhaphy. 6 ...7 -. Jhorax: Thoracotomy.9 1.---9 1 Pneumothoracotomy1 1 ...1 1 Excision of breast .2 .2 Excision of breast and axilla. .-------.1 Rectum: Hemorrhoids, radical cure. 125 .22 .147. Fistula in anus, excision of. 19 .3 .22 Ischio-rectal abscess with general septicemia. ..1 1 1 General: Thyroidectomy .8 1 -------. 8 1 Nerve stretching.2. .2 Aneurismorrhaphy. ..1 1 Varicose veins, excision of 20 .2 .22 Tenorrhaphy. 12 .12 Excision of surface neoplasms. 37 ..3 ..40

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92 TABLE XVI.-SURGICAL OPERATIONS PERFORMED IN ANCON AND COLON HOSPITALS-Continued. Ancon HosColon HosTotal. pital. pital. NumDied. ber. NumDied. ber. Nume Ded ber. General--Continued. Gunshot wound of soft parts. I .4 -------5. Stab wound, operation for ..3 ------3----Extensive injuries to soft parts.-. .1 ..13 -------14. Plastic operation forCongenital defect .4 ..4----Severe injuries .-..1 .6 Effects of disease. 14 .1 .15. Skin graft .2 ...2. Laparotomy: For general peritonitis. 10 4 1 1 11 5 For tuberculous peritonitis 2 .1 .3 2 For intestinal obstruction. 6 2 1 .: 7 2 Exploratory. 15 6 2 ------.17 6 Gastro-enterostomy. 9 1 2 .11 1 Entero-enterostomy 1 ....1. Enterectomy. 1 1 1 1 Appendectomy. 104 .I 50 .154. Appendectomy with local peritonitis ..20 .7 .27. Appendectomy with general peritonitis. .2 5 3 Cholecystotomy. 4 ...4. Cholecystostomy. 1 ..1 Cholecystectomy. .1 .6. Abscess of liverLaparo-hepatotomy for 1 I .2 1 Thoraco-hepatotomy for .2 ...21 Pan-hysterectomy. 3 1 1 .4 1 Supravaginal hysterectomy 82 1 2 .84 1 Hysteromyomectomy 42 1 2 .44 1 Myomectomy. 4 .1 .5. SalpingectomySingle. 8 .2 .10 Double. 6 .3 .9 Salpingo-oophorectomy. 30 .2 .32 Ovarian cystectomy .8 .3 .11 Oophorectomy. 2. 3 .5. Suspensio-uteri. 75 .5 .80 Plastic operation f o r chronicpelvicperitonitis. 9 1 .9 For ectopic gestation -. 8 1 1 .9 Trauma: Stab wound of abdomen. 2 1 ..2 1 Major operations, various other 46 ..2 .:. 48. Minor operations, various. 1,775 4 120 .1,895 4 Total--. 3,443 39 416 8 3,859 47

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93 TABLE XVII.-OPERATIONS PERFORMED IN EYE, EAR, NOSE, AND THROAT CLINIC-ANCON HOSPITAL. Number. Number. Adenoidectomy .145 Plastic on eyeball. 3 Adenoidectomy and tonsillecPlastic, nose .2 tomy. 90 Pterygium, transplantation .71 Cataract needling. 1 Removal of nasal polyp .2 Chalazion. 12 Submucous resection of nasal Evisceration. 5 septum .209 Excision of chalazion. 3 Tonsillectomy.-. 183 Expression, both eyes. 1 Turbinectomy .47 Extraction of cataract. 17 Trephine of schlera. 5 Fracture of nose, reduction of. ..2 Urlectomy .4 Iridectomy. 5 Various minor operations. 43 Lachrymal sac, incision and drainage. 1 I Total. .856 Mastoidectomy. 5 Refractions. 1,108 TABLE XVIII.-WARD LABORATORY REPORT-ANCON AND COLON HOSPITALS. Ancon. Colon. Total. Blood examinations. 8,251 1,468 9,719 Estivoautumnal. 447 1 204 651 Tertian. 188 39 227 Mixed tertian and estivoautumnal .2 .2 Quartan. 15 1 16 Differential blood counts. 345 48 1 393 Leucocyte counts. 1, 085 Red-blood counts. 92 31 123 White-blood counts. 116 141 257 Hemoglobein estimations .2 867 2,929 Filaria. 12 .12 Stool examinations---. 71,151 1 483 7,634 Uncinaria ova. 347 8 355 Ascaris lumbricoides.98 98 Trichocephalus dispar. 233 233 Strongyloides intestinalis. 249 33 282 Ameba. .51 2 53 Entameba.3 3 Ciliated monads. 67. .38 105 Bilharzia.----. 3 .3 Pus and blood. 704 134 838 Bilantidium coli .8 8 Entameba, histolytica, and tetragena. 14 1 15 Guaiac tests--. 252 252 Cercomonas, intestinas.28 28 Tenia saginata dispar.12 12 Oxyuris, vermicularis. 16 16 Uncinaria (parasites) (ova). 119 1 120 Urine examinations---. 26,105 1,651 27,756 Albumen. 6, 438 181 6,619 Casts-. --. .4,670 90 4,760 Sugar. 7,274 2 7,276 Pus and blood. 12,546 469 13,015 Indican. .2,355 Epithelia. 11,202 .11,202 Bile. ...150 9 159 Trichomonas vaginalis .2 2 Hemin crystals.62 62 Guaiac tests. 1,414 .1,414 Ciliated monads.15 15 Red-blood cells. 81 15 96

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94 TALE XVIII.--WARD LABORATORY REPORT-ANCON AND COLON HOSPITAL-Continued. Ancon. Colon. Total. Urine examinations-Continued. Quantitative estimation of albumen in urine. 28 .28 Acetone tests.;. 77 .77 Sputum examinations. 4,171 253 4,424 Tubercle bacilli. 344 19 363 Smear examinations. 670 87 757 Examinations of spinal fluid. 157 3 160 Examinations of vaginal and urethral discharges. 531 26 557 Examinations of the eye. 21 5 26 Examination of urine sediment. 4 .4 Throat cultures. 14 14 Sputum. 11 Blood cultures. 5 5 Fluid from knee. 2 2 Miscellaneous. 8 .8 TABLE XIX.-SANTO TOMAS HOSPITAL. RemainRemaining Jan. m d Died. chrged g Dec. 1, 1917. 31, 1917. Pay patients. 15 1,101 34 1,052 30 Charity patients. 416 9,450 990 8,486 390 Total. 431 10,551 1,024 9,538 420 Average number of days' treatment per patient admitted .15.21 Average number of patients constantly sick. 440.01 Number of days relief furnished patients. 160,648

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95 SURGICAL OPERATIONS PERFORMED. Amputations: Number. General: Number. Forearm. 1 Excision of tongue. I Hand. 2 Thyroidectomy. 1 Leg. 4 Varicose veins, excision of. 3 Foot. .1 Excision of surface neoplasms. 8 Digits, multiple. 6 Gunshot wound of soft parts, Operations of bones: operation for .2 Ostiectomy. 2 Stab wound of soft parts, opResection of ankle. 1 eration for. 2 Wiring of fracturesPlastic operation for severe Simple. 3 injuries. I Compound. 2 Skin graft. 110 Adenectomy: -Laparotomy: Cervical. 13 For intestinal obstruction. 2 Axillary. 3 Exploratory. I InguinalGastrotomy. 1 Single. :. 111 Entero-enterostomy. 1 Double. 24 Appendectomy. 98 Herniotomy: Appendectomy with local perInguinalitonitis. 2 Single. 95 Appendectomy with general Double. 10 peritonitis. 3 Femoral. 2 Colostomy. 3 Ventral. 13 Resection of rectum. 1 Strangulated. 8 Cholecystotomy. 2 Genito-urinary tract: Cholecystectomy .2 Perinephritic abscess, drainAbscess of liverage of. 1 Lapro-hepatotomy for. 4 Cystotomy. 3 Thoraco-hepatotomy for. 6 UrethrotomySplenectomy. 3 Internal. 38 Pan-hysterectomy. 19 External. 46 Supravaginal hysterectomy. 17 Hydrocele-Hysteromyomectomy. 5 Single, radical cure. 23 SalpingectomyDouble, radical cure .7 Single. 23 Orchidectomy. 7 Double. 22 Epididymotomy. 1 Salpingo-oophorectomy. 46 Amputation of the penis. 2 Ovarian cystectomy. 2 Curettage uteri. 104 Oophorectomy .8 Perineoplasty .3 Suspensio-uteri. 65 Trachelorrhaphy. 25 ior ectopic gestation. 1 Vaginal sections.:. 25 Eye, ear, nose, and throat: Circumcision. 196 Adenoidectomy.48 Obstetrical: Tonsillectomy. 128 Caesarian section, abdominal. 1 Mastoidectomy. 4 Perineorrhaphy .1 Enucleation eye. 4 Thorax: Pterygium. 14 Excision of breast. 2 Cataract. 6 Rectum: Incision of eye. 3 Hemorrhoids, radical cure. 53 Iridectomy. 9 Fistula in anus, excision of. 17 Cyst of eyelid .2 Prolapsus rectum, radical exMajor operations, various other. 100 eision ..1 Minor operations, various. 798 Total. 2,418 TABLE XX.-BOARD OF HEALTH LABORATORY. Bacteriological examinations: Fluids and exudates. 91 Blood cultures. 253 Throat cultures (diphtheria suspects). 1,543 Cultures from autopsies. 19 Stools. 502 U rines. 346

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964 Bacteriological examinations-Continued. Sputum .128 Cultures, miscellaneous. 66 Leper suspects. 31 Agglutination reactions. .3H Blood for trepanosomes (positive 6).-. 18 Dairy milk from Panama and Colon, bacteriological counts. 37 Dairy milk from Corozal, bacteriological counts. 327 Park field examinations. 26 Ice cream .22 Blood for malaria. 5 Smears, gonomoccus. 41 Smears, various. .30 Water. 13 Miscellaneoas. 24 Chemical examinations: Milk from private dairies supplying Panama and Colon. 37 Mother's milk. 30 Milk for Corozal dairy. 44 Urines. 251 Various alcoholic liquors. 8 Fluids, various .26 M etals, various .8 Condensed milk. 25 Spinal fluids. 724 Ice cream .14 Soil, samples of. 4 W ater. 5 K erosene oil. 3 Powder for opium. 1 Blood. 1 Stomach contents. 1 Various. 44 Pathological tissues prepared: Pathological tissues, prepared, frozen. 20 Pathological tissues, prepared, paraffin. 3,566 Surgical pathological tissues and neoplasms reported. 501 Rats examinedMus alexandrinus. 740 Mus musculus .10,024 Mus norvegicus .4,131 M us rattus. 2,255 17,150 Autopsies performed. 329 Animals autopsied. 208 Placental smears examined .191 Foetus inspections. 11 Blood films from horses. 33 Blood films for malaria. 18 Cadavers examined for police. 2 Ameba, examination of appendix for. I Brain smears examined for Baberia bigemina (positive 126). 132 Blood films, various .56 Rabies, dogs under observation for. 8 Buzzards examined for blood muscle and ectoparasites. 199 Animal tissue films examined. 13 Cattle blood films. 24 Pog blood films. 20 Miscellaneous. .17 General: Antityphoid vaccinations. 40 Animal inoculations .62 Wassermann reactions. 12,483 Vaccine points manufactured. .3,214 Autogenous vaccines prepared. 34 Toxicological examinations .3 Entomological examination of flour. 2 Throat smears for Vincent's angina .2 Anthrax serum tested .1 Thermometers calibrated .22

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97 Undertaker's department: Bodies embalmed. 72 Interments at Corozal Cemetery. 173 Bodies removed to Panama for burial. 51 Bodies removed to Paraiso for burial. 2 Bodies shipped to Mount Hope for burial. 22 Bodies shipped to the United States. 47 Cremations. .138 TABLE XXI.-QUARANTINE SERVICE. PORTS OF BALBOA-PANAMA AND COLON-CRISTOBAL. Vessels inspected and passed. 2,664 Vessels passed on medical officer's certificate. 11 Vessels transiting canal in quarantine. 117 Vessels held in quarantine. 123 Total vessels entered .2,915 Supplemental inspections of vessels at docks. 1,293 Bills of health issued .2,502 Bills of health vis6d .1, 5&3 Vessels fumigated on arrival. 182 Vessels fumigated prior to departure. 13 Persons vaccinated at port of arrival because of compulsory vaccination law .3,145 Persons vaccinated at port of departure because of compulsory vaccination law .9,857 Total persons vaccinated. 13,002 Persons held at quarantine stations to complete period of incubation of yellow fexer and bubonic plague. 3,527 Persons held on board vessels to complete period of incubation of yellow fever and bubonic plague .25,593 Total persons held in quarantine .29, 120 Persons landed from foreign ports: Cabin. 12, 652 Steerage .14,258 T otal. 26,910 Persons arriving from coast towns in small launches and sailing craft .19,024 Persons embarked for coast towns on small launches and sailing craft .17,730 Crew inspected ..160, 286 Passengers inspected .59,168 Stowaways found on board of incoming vessels .30 Persons passed on medical officer's certificate .5, 462 Total persons inspected or passed. 224,946 Passengers and crew examined at supplementary inspectious. 19,455 Immigrants recommended for rejection and deportation .360 PORT OF BOCAS DEL TORO. Vessels inspected and passed. 203 Crew inspected and passed .10, 968 Passengers inspected and passed. 2,353 Passengers in transit, inspected and passed. 3,438 Persons held in quarantine to complete period of incubation of yellow fever and bubonic plague.

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98 TABLE XXI.-REPORT OF ROUTINE SANITARY WORK PERFORMED IN THE CANAL ZONE AND PANAMA AND COLON. Panama. Colon. Canal Zone. Miles of new ditches dug. 13.0 322 Acres of pools oiled. 558 6 516.7 Acres of vegetation removed. 499.7 945 3 Mosquito breeding places destroyed. 2,553 1,0(2 Buildingsinspected. 53,044 120,319 40,364 Houses disinfected or fumiaated. 201 .179 Number of private properties cleaned. 108 40, 228. Nuisances abated .3,440 6, 407 39 Number of cans of garbage emptied daily. 1,440 2,717 3,611 Number of rats killed. 11,643 6,011 6,600 Mosquitoes caught: Culex and mansonia. .15,683 598, 294 Anopheles. .30,326 16,050 Ste
PAGE 105

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PAGE 110

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