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:
1923
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 ...

Downloads

This item has the following downloads:


Full Text




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REPORT


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artmen


Panama


FOR


THE


CALENDAR


YEAR


1923


-I


FIS:


Colonel, Medical Cdrps, United States Army
Chief Health Officer


Canal













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For additional copies of this publication address The Panama Canal Washington D. 0., or albos Hei


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CONTENTS.


Title.....


:, operationn and
? N Feosnnel.....
:;. Vital statistics
SVital statistics
Vi~al statistics
Vital statistics
Malaria... ..


Page.
1


organization......


regarding employees only....... . .
for the Canal Zone, employees and nonemployees
for Panama City, employees and nonemployees.
for Colon, employees and nonemployees.........


. .Mosquito control...... .
i ,.. Antiplague work.. ..... .
:,; Fly prevention... . .
"'iTyphoid fever .....
. ifant mortality....... .
'. Physical examination of school ch
: Health Office, Panama City......
:. :Health Office, Colon-Cristobal...


.:Q rantine Division....
..Ancon Hospital........
,..Cbrozal Hospital......
: Colon Hospital.........
. Santo Tomas Hospital..
. Pal t Seco Leper Colony.
:Board of Health Laborat


craT~bles
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ildren


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. .


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orv. .


[, Discharges from hosp
flofyeJPPe s


itals, deaths, and


noneffective rates for em-


V.J W . . .. .
Causes of deaths of employees by color, age, and length of residence on
Isthmus .........


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V.
VI.

VII.



xi.
SX.

X;
XI.
:XIl.
XIII.
::!


Deaths of residents and death rates of the Canal Z(
of Panama and Colon .. . . .
Deaths of residents of the Canal Zone, and the citi
Colon, by cause, sex, color, age, and residence.
Deaths of nonresidents by cause, sex, color, and ag
Deaths by nationality or nativity..... ... ... .
Statistics regarding American employees and their


Births and birth rates in the Canal Zone, and the
C olon . .. . . .
Infant mortality rates in the Canal Zone, and the
C olon ... . . .. ..
Deaths of infants by cause, sex, color, age, and
Cases treated in hospitals. .... . .
Consolidated hospital and asylum report......
Number of days hospital treatment furnished v
tients and average number in hospital each
D isnensari es ...............................


H*ii*XV


citi


mne, and the cities

es of Panama and

;e, . .

families. .
ies of Panama and


cities of Panama and

place of residence...


variouss classes of pa-
Sday . .


...... ... 88


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88


immm d


IIIIII


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Balboa Heights, Canal Zone.


SIR:


S0F


h:.y.:11

HE,.
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1 have the honor to submit the following report of th op"
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nons or the Health Department for the year 1
'
923.


Respectfully


S.:H. C. Fa1

Chief HeaL


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District Dentists at-

Cristobal.

Gatun.

Pedro Miguel.
S"Ancon.

Balboa.

La. Boca.

Division of Sanitation-

Panama Health Office.
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HEALTH


OPERATION' AND


kDepartment operates under the direction of the Governor
ma Canal. It is maintained from funds designated for

Panama Canal appropriations, and revenues derived from


Ltions.


It exercises jurisdiction in health matters over the


mnd the cities of Panama and Colon, Republic of Panama,


operatess


with


Panamanian


her parts of the Republic.


zation of the health department consists of:

Health Office, Balboa Heights.

division of Hospitals and Charities-

Ancon Hospital, Ancon.

-Board of Health Laboratory.


Corozal.


Colon.


Tomas Hospital, Panama,


Santo


h iffl-re


DEPARTMENT.


ORGANIZATION.


Government


health


Corozal Hospital

Colon Hospital, I


R. P.


Palo Seco Leper Colony.

Dispensaries at-

Colon Hospital.


Gatun.


Pedro Miguel.

-Ancon Hospital.


Balboa.


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PERSONNEL.


HEALTH


OFFICE.


Balboa Heights.


Fisher,
. Curry
Fessler


J. S. Army, Chief Health Officer.
Assistant Chief Health Officer.
Office Assistant.


DIVISION OF HOSPITALS AND CHARITIES.


A necon Hospital.


Army, Superintendent.


S. Army,


Assistant to the Superinte


Earhart, Chief of Surgical Clinic.


, Assistant Chief of Surgical Clinic.


(December 31, 1923.)


Roland C.


William


Connor, Chief of Medical Clinic.
. Braithwaite, Assistant Chief of Medical Clinic.


Capt. Henry E. Keely


Army


,Chief of Eye,


Ear


Nose and Throat


Clinic.


Dr. Ivan E.


Leroy S.


Hix, Assistant Chief of Eye, Ear


Townsend


Chief of


Nose and Throat (


R4y Clinic.


Physicians.


Lieut.
Maj.
Maj.


Roger Brooke,


Henry L. Krafft,


Claude D.


Holmes


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Army.


S. Army.


Army.


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CHIEF


Col.


Henry C.


Dr. Dalferes P


Mr.


Arthur L.


Col.


Lieut.
Capt.


Pyles,


James B. Anderson,


ent.


Troy W


Dr. Howard K. Tuttle


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Internes.


Dr. Cdric H.
Dr.i Ivyl C. B


Walter W


Dr. Mack M.


Otto A.


Nelson.
edwell.


Kostal.


Dr. Augustus H.


. Benton.
Shafer.


Foster


True P. Gottschalk.
Arnold L. Jenson.


Board


Health


Laboratory.


Dr. Lewis B.


Bates, Chief of Laboratory.


Capt.
Capt.


Virgil H


Wesley C.


Cornel


Cox


Army, Pathologi


Army


Bacteriologist.


James E.


Jacob,


Chemist.


Corozal Hospital.


Capt. George E.


Hesner


Army


Superintendent.


Dr. David G.


Sampson.


Capt.


Henry


Hayes,


Army.


Colon


Hospital.


Maj.


Thomas J


Leary


Army


, Superintendent.


Physicians.


Maj


H~.. *:
Hi:


Dr.
Capt.
Capt.
Capt.


Tom S.


iilliam


Walter F
George J.
John M.


Mebane
J. Levy.


. Hamilton


. Schirch
Tamraz.


Army.


Army


S. Army


Army


Santo Tomas Hospital (Panama).


Maj.


Edgar A.


Bocock


Army,


Superintendent.


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Cristobal-Colo 'ip'nsary.
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William


Levyi


Gatun


James A.


District


Physician.
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Dispensary.


Grider,


District Physician.


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Pedro Miguel Dispensary.


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William B.


Meares,. District Physician.


Wayne Gilder.


Balboa Dispensary.


Dr. Littleton O.


Harley G.

Julian R.


Keen


, District Physician.


Bickford.


Hunt.


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Ancon


Dispensary.


t.:
.:HC


Panama Heath Office.


Hen'ty Gbldthwaite, Health Officer


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Carppirow, Sanitary rhispector.


Irspectbri.


Inspector.


Morris M. Seeley, Sanitary Inspector.


Av Lewis


Vaccinator.


Dowd,


Walter


Olson


District


Physician.


Dr. George Eugene.


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DWIS~ONT


OF SANITATION.:


Mr.


James M.


Mr. Charles L.

Mr. Everett F:


PierCe; Sahi'tary


Qtiimby,


Dr. Henry


Sai.nitary


Vrederick F


Veterinarian and Meat InspG
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Ih, Sanitar Inspector, Northern District, Gatun.


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... lett, Sanitary inspector, Southern District,
.-L.Willett, Sanitary Inspector, Southern District,


...... ... ... .
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iran.


Corrigan,


Sanitary


Inspector,


Ancon-Balboa


4


H
t
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Tolar, Sanitary Inspector (Relief)


Pedro Miguel.


DIVISION


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OF QUARANTINE.


Chief Quarantine Ofice.


Balboa Heights.
At


William C. Rucker,


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S. "H.." .Al::.
: .


- Cristobal-Colon Quarantine, 'Cristobal, C. Z.



Dr. Charles A. Hearne, Quarantine Officer

Dr. William J. Burke.

Di. Francis L. Alexaitis.

"Dr. Ernest E. Nunnery.



Balboa-Panama Quarantine, Balboa, C. Z.



Dr. John..D. Odom, Quarantine Officer.

Dr. Philip Horwitz..

.iDr. Samuel S. Irvin. .



,





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Ancon.


District,


, Chief Quarantine Officer.


,......:....:.


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.























Year.


1906
1907
1908
1909
1910
1911
1912
1913
1914.
1915
1916
1917
1918
1919
1920
1921
1922
1923


Average
number
employed


39,
43,
47,
50.,
48,
50,
56,
44,
34,
33,
32,
25,
24,
20,
14,
10,
10.


Rate.


1, 79
1,419
1.132.
887
905.
896
727
519
420
320
283
357
406
550
672
620
490
485.


admission rate to hospitals only was 155.90 in 1923, as

16.7.61 in 1922, and 211.20 in 1921.

The death ratefromall s.. .


.C ~ ~A z~A


Year,.


1906
1907
1908
1909
1910
1911
1912
1913
1914
1915


Average
number
employed


I --


,547
238
,890
,167
,802
,876
,893
,654
,329
,785


Rate.


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For disease alone the admission rate to hospitals in 1*


as compared


with


139.47


1922,


and


180.35


19


A" .. ::..:


923 was 13* a
fh. .!


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The death- rate from disease alone for 1923 was
tb6..lai, 1922, and 5.70 in 1921.
The nnbofeetive rate, from aW causes, has been:


6.10, as


compared


:. ...




........1910

" I1912
S191308
1909
19140
191
1912
1913
1914
1915
19162
1917
1918
4919
1920
1921
1922
1923


AvIenupe
number
e~iplo~ed.


,238
,890
,167
,802
,876
,893
,654
,329
,785
,176
,589
,520
,204
,673
,389
,447
.976


The admission rate for malaria fever has been


Year.


19084
1905
1906
1907
: 1908
1909
..:1910
wii
1912

: 1913



- 191
r 1916


I.-. t919


a


employed.


i,213

,547
,238
,890
,167
.802
,876
,893
,654
,329
,785
,176
,589
,520
,.204


Rate.


*l .4~


A.


".," "


Rate.


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11%


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1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923


0.46 in 1922


,213
,511
,547
,238
,890
,167
,802
,876
,893.
,654
,329
.785


,589
,520
,204
,673
,389
.447


and 0.33 in 1921.


2.66
5.57
7.45
3.51
1.37
.85:
.81
.84
.31
.30
,14
.23


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The 6 diseases causing the highest nuinber of hospital .ad..i.

with their rates, were as follows: *
S....... .... ... i.", :


Venereal disease s.. ... ...............
Diseases of the eyes and their annexa.
Bronchitis (acute and chronic)........
Nephritis (acute and chronic)......
Tuberculouis (various organ)...,..


4
' '.
. .


Y


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H.


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Ad. esic*s. R ate *.' Adjmi


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134


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The


rates


6 diseases


were as follows:


causinIg fthl *highest Tumb
H -.il I C


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The noneffective rate for malaria in 1923 was 0,55


* 4


J


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wn'r&te to hospitals and quarters for malaria was 20.03


Iryees, as compared with 19.07 for black employes.


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: ate-.from disease .for


'ppjf


..::


. ASH


A,


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eaths rfrom


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ths.
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."' : :
...eaths.

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2t3,463
34,095
*,4 036
67 146
76,900



, r, : *.i e;;; _e


FOR


NDD


THE


American


(white)


employees was


and 2.43 for 1921.


.CANAL


ZONE-EM PLOYEES


N' EMPLOYEES.


average population of 31


during the year


, as compared with 7.08 for 1922,


:h rate from tuberculosis was 0.69


0.64 for


1921


Tuberculosis caused


793 in.the Canal Zone


there were


, giving a


and 6.72 for 1921


, as compared with


0.74


10 per cent of all


disease during the year


3re 591


live births reported during the year


(See Table


re black.


VIII, page 77.)


Of these


Of the total births reported


xnong children under


1 9 were white,
on the number


white children


total deaths,


year of age,


giving a birth


206 were white


5 per cent were still-


from all causes totaled


and 34 were black, giving an infant mortality
;r of live births reported during the year, of


88.31 for black children, and a general average


per cent occurred among children


under


, and 32 per cent'among children under 5 years of age.


a table showing the death rates for
!3, from all causes:


Deaths.
A


1,700
1,708

.I1,025
1,251
" 1,385


1. 129


Rate.


F


*n 'A


I


Canal


Zone from.


.j. red with 3.27 fo1922,


of these were from disease


.... \


i


i










.14


.* : *.. ,," ..-.
* .:* *. .*. .H I
...
db...:.. ~ ...


VITAL STATISTICS FOR PANAMA CITY


NONEMPLOYEES.


. mm


From an estimated oooulation


during the year.
18.08, as compared


The


rates,


6 diseases


59,635,


there were


1,106


Of these 1,078 were from disease, giving a .ra
with 20.66 for 1922, and 21.26 for 1921.. .
.;: ; r .rX


causing the


highest


were as follows


wi th i
-,, It :.
". -H


Tuberculosis (various organs)...............
Pneumonia (broncho and Jobar)......... *.
Diarrhea and enteritis (including colitis).....
Nephritis (acute and chronic). ............
Organic diseases of the heart...............
. Cancer (various organs) ...................


. . .


Deaths.


Dedip~.


I.:


1:
;.J'. H f f j
;:Sr


The death rate from tuberculosis was 3.35,


for 1922, and 3.67 for 1921.


as compared wit.lif %


Tuberculosis caused approximately 18


cent of all deaths from disease, as compared with 18 per cent ini.19l


17 per cent in 1921


rate of 34.26.


infant


mortality


and 16 per cent in 1920.


Of the total births reported, 6 per cent


rate,


based


on the


number


of live


during the year, of 141.95.


total


26 per cent occurred among ci


year of age, and 39 per cent among children under 5 yi
Below is a table showing the death rates in Panama


to 1923, from all cau


ses:


..H I

r, giving a bzr*;
were stillbipt llhs;*
)f age, giFai
.. ..i


S. births.
:i tl ^' J.L ^*!

.."". ...
weildre tillnUn&.i.



)ars of age.ii:H

City fro .]t)
births r *.........
......


Year.


1905
1906
1907
1908
1909
1910
1911


Popula-
tion.


I a


,984
,518
,548
,073
,801
,591
,555


Deaths.


,447
,142
,156
,292
,038
,446
,456
'An~f


Rate.


I o flfl IJ~


*. *:*'
v. :-. H.- ..
.L 'il.. .bi


:.H I::~

Hi *H:H I H
H
V.


,number ot


deaths,~i


There were 2,043 live births reported during the yeal


There were 290 deaths among children under 1 year c


deaths,


I


I




.fl.S.H : 'ar.:H~t *
iiP..
Hr. Hf:



K44~ k H H .1 ~


'ATISTICS


FOR


COLON--EMPLOYEES


AND


NON-


EMPLOYEES.


: w..on a population of 31,285;' there were 393 deaths during the year.
OIf these, 77 were from disease, giving a rate of 12.05, as compared with
3A1.4for 1922, -and 16.25 for 1921.
. 5 The" 6 diseases causing the highest number of deaths, with their
rates, were as follows:
mm a "id .V"


..:. beutosia variouss organs) ................
InDtinS. (bronco and lobar).. : .... .
eplritis (acute and chronic).. .. ...... .. .....
nQrini diseases of the heart .............. ..
.r hmmand enteritie (including colitis).... .
nce (Vrious argna).. ...... .......... .. ...


* .::
. .


Deaths.


Deaths.


The death rate from


tuberculosis


was


1.92


,as compared with 2.55


for 1922,


and


2.30


1921.


Tuberculosis caused


approximately


per cent of all deaths from disease, as compared with


19 per


cent


1922, 13 per cent in 1921


SThere were
rate of 22.66.


, and 21 per cent in 1920.


709 live births reported during the year, giving a birth
Of the total births reported, 5 per cent were stillbirths.


There were 82 deaths among children under 1


year of age, giving an


.. infant mortality
during the year,


rate,


of 115.66.


Of the total deaths,


per cent occurred among children


under


year of age, and 29 per cent among children under 5 years of age..
Below is a table showing the death rates in Colon from 1905 to 1923,
from all causes:


Year.

*?- .. 4-. ....^ -
i%: *1996
-1908
t'. 1:: T
l'- .. to 8
-.' A. r 7
1%9 b


1. 910o
; .< .1911
?. r;F4


Popula-
tion.


I-t,1o76
13,651
14,549
15,878
17,479
19,535
19,947


Death.


.553
703
571
418
396
514
527


Rate.


.49.
51.
39.
26.
22.
26.
26.


based


on the


number


births


reported


r


I





















Probable place
of ipetioan.


Canal Zane anitated
arnns..... .
Cattle cam ps
-nd panptures......
Otjserrananitated
aeamin.Zone......
Colon...'. .- ......
Midiaelaneou. unman-
itated area out-
Bide Zo7.e .........


Annual rate per 1,000.


Rap lays~


Nunem~apalara


820 1,250 1,376
8.7911.76 12.27


HX
~i~diH


9T.1


'BC...


z White-Cases 57, rate 20.08.


* Military only-Caes 851, rate 91.87.


Black-Cams 15, rate 19.07.


Others-Cames 543, rate 87.


iiH
r. i:4:
:: :L.H!J


'Ca


Although the sanitated areas of the Zone are gradually being.
H


, principally


ditching


larger outlying swamps


ti


lands


* there has been a slight increase in the malaria rates.


among employees, yet the increase is not as large as might havtl
'C..


expect
poses,


ed. On opening the Zone to repopulation for agricultu
chiefly by former employees of The Panama Canal, ita i


that


, whatever benefits might. be derived


, there would surely)


tremendous infection with malaria, and that If spite of our preca4
in locating these settlers at a distance .of.a mile or more froi tlh i
e-..


Zone town


*~ThisQ


added
offset


s, our employees would necessarily be infi


has doubtless


percentage of


by the


improved


tekeni Uita case


irl'~oirsae in.stanci


malaria so incurred has: surely


economic condition


.the


ected foff

be "
pu been ...
popu.ltioi


chief reasons for the increase in the rate for employees can ri
:i .: *::
be laid to the facts that the Dredging Division has had exte eli'
jects under way in Gaillard Cut, necessitating night Work = i|
p : .,i.


contiguous


cattle


pastures


and


other


unsanitated
l:: *".


* Si -. .. S.r


**
'a: jl


9.


!-"W^H


: ..ili
#,d:::::


'i" :


_A


",


m


..1


a


TO~t~18111111


d : ,











..a... ...
: *i... .. .. ". .


,,



..-:M& a te:.a
e fo::li ..
CI.. ,.j







i" ": "..: ". ":' .
T heat e tel


i to the enlisted man's propensity for wandering about the


ill hours and seasons,


Naval


as well as


to the location


some


bases in-areas least favorable for sanitating.


w cases occurred among the commissioned personnel and
s. Many of the cases charged against the military popu-
ported as recurrent cases.


v-up


treatment given


by, the


physicians of The


Panama


i ': after the "clinical cure" of acute cases of malaria, to completely
lutre;r sterilize.them, is apparently efficacious in all forms of the disease,
.2:.arecurrent case being rare when the patient has taken the prescribed
"'treatment. This consists of administering 10 grains of auinine. nre-


'-


'-


A


ferably


liquid


form


children,


in proportion)


every


evening


* :before


the patient retires,


' fritn acute symptoms.


for a


period of 8 weeks following his


r


This treatment is practically compulsory


elief
for


employees of The Panama Canal and their families.


Upon others it is


.strongly urged.


While


t is difficult to state positively whether a case


is recurrent or a fresh infection


relatively few repeated


cases


the same individual make it certain that recurrence of an original infec-
ltion is rare, even in tertian malaria.
:-:.Thecombined death rate in the Canal Zone and the cities of Panama


- adi Colon from malaria has been


* "" 1906
' ...'-. 19 o8
... -1908'
19.09

","- = 9 -.
; ":1911:
1912
|;.:913-y


"" i915

I.....
H, ,,' 'A917


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


Popula-
tion.


I 73.264


. 120,097
135,180
151,591
156,936
146,510.
129,104
123,592
121,650
, 116,918
114,003
109,737


113,958
114,037
120,666


1


Rate.


9.49
5.37
3.36
2.07
1.89
1.82
1.64
1.32
1.27
.51
.21
..18
.18
.16
.08
.16


I-


iiUi


I


j -- --


~E~zi~.
.-r































Zetek, formerly entomologist of the Health Department f
Panama Canal, says: H
The big difference, and only one, .between it '(Tarsimaclata) and that s ..
- manus), is the broad white band on the palpus, thus making three white bands
Salbimnanus has but two. But this middle white band is often represented by oti
white scales, and from such a condition, by more and more white, until.the
tarsimaculata type is obtained. All such variations.may occur mina single. oto@
taken from the same place, and what is of greater significance, true anbimaust...
obtained from this same lot. This fact establishes the pint that tarsin .
can not be considered a distinct species, that at most it is only a variety of ..
There is, however, a preference for brackish water by arssa4
whilealbimanus will live in both fresh and brackish water.-"The Pacani,
Species of the Genus A noiheles," Proceedings af the Medical A ssocikdion .f ti iF
Canal Zone, Vol. XIII, p. 29. .. :..
The other seven (or eight) species of anopheles. -kibow t
-.. -.
in Panama (A. argyritarsis, A. pseudopuinncptipennis, A. spi
A. punctimacula, A, eiseni, A. neivai, A. nimba, A. hyltili
l g. ".. i..i... i
of relatively less importance. Although pseudopnchpan
A. argyritarsis have been expenimeptally infected withcmai&.
are not so numerous now min the vidnity of quarters, nor.d d ..
apparently enter houses so readily or Hy as far as theA.l4:
:i : l" :" "::l'li















3I-E 3E


utP. na reus
*.I1o **. *" ." d *es-
: :.. : .. .. **
.......... .: :s:w it.
*"$'i e 1 ..". "


*Cii'.


.... :,.. ,,


p o:ce. practicable.,
SCta:d.., to divide x
iwc k. ulex, Stegoi
: all that were not (


JLUUSL


UZ1LL~


18 genera and 135 species.z


39 species.
Aedes and


the last


Ia list


9 (10?)


two.


ie mosquitoes


The


Culex are


But


days of


mosquitoes into only three classes for pre-


nd the first class in-
distinction whatever


abits of


ed,;


,tpid '-between


... *..y. H It
.Bi ... ..limits

:::... .T I L
... ..1 i..c e ...
i..:B .."3C : .. .
..... .. h
i::. :: 'n .*.. ** "
il ". "" i iii ., ^
Indl:; inaicat
p... .
H, Wi41
ri....t ..







ri'.""" ": : ". S..... .: ..
Hatti, stra




..he.."Li a..'"


,,;.showed the pre
.UrEoaenia geon


arm of Miraflor


pheles
nail st


species


years,


anopheles


however


these mosquitoes,


reported


breeding


reams,


and


sexice only


with
and


albimanus


of A


erica) of which none were present in, the adult
Turning from the cattle pasture to an adjoining
res Lake, the probable source of the albimanus
Had the pasture been evacuated and oiled and


e been entailed

reports for the
pumped into it


nearest


because,


better


extension


pasture


by spoil


in the


appreciation
n of sanitati


areas


was


fairly


on


two miles and over from in-


these


effectively


anopheles
A search


as the


only


in hoof-


that


as greatly to impede access to it by a boat or otherwise.
* I t r3. i r r I 1


Thirty-one species of Wyeomyia


Anopheles.


re- harmful or especially annoying to man.


in the early


construction


nyia and Anopheles,


later


of control at that time, such distinctions were of little


'to areas one and even


it '" comes


necessary
9-


n order to sanitate economically
tion of this:


takl


minsector


e advantage
as well as e:


dawn and dusk catches in a Canal Zone town.


resultedd in the discovery and report that there was con-


in the
I the r


removed and


recommendd action


the' pasture oiled.


breeding-out


made


Further investigation


of hundreds of


pseudopunctipennis (associated


economic loss would havi


which has been described in our annual
4< -


has been rendered so shallow


i;


c.











In another instance


included


anopheles


Mount


Hope


4 ...* -E".. "i ";."" = .ggi
**** :..::* 'i
..* "":.. :: ::.
.. _. .. _j...: i* .
".x i i :
.i i. .a : ::. : ....
at Mqunt Hope nthe adult mosquito .
fonly the. *pr" ".. ** a *l *.
Sonly t~he'p ure tarsmuacula i v=a iet :,


breeding as was occurring in the controlled areas furhnishf
.t" ". ........ i.... '":
and other less common species but no distinct arsmacuioa. itil
tinued search revealed that in a remote undrained corner of a. .H
.* *** .* i ... ".".


"S| A. H 3 W i
10 'Ifi
i lO lVhi


Anopheles tarsimaculata true to
This swamp is now being dr i


swamp in a former pasture,
breeding in large numbers.


which


of. the


district,


includes


swamps surrounding Cristobal and Colon at the Atlantic en


the Canal


we have continued


to extend


pasture lands south of Mount Hope.


the drainage system


The cattle have been


. ....
. A **:il
*.: .:Fl: : '
"rHd-


from
from


the dairy


Silver


fresh and


sea-level


pasture of


City


brackish


channel


Gov.


negro


swamps


the old


Arcia


suburb
in this


French


, lying


between


Cristobal)


pasture have


diversion


and


been


on the


1r and '2n
the 16ow49
,A H


connected J
east-.anhd t i


French Canal on the west. Though these ditches may not achi'e
complete measure of success m dryng the lowest parts of the area;-.." .t b
~ ~ .* ,:. .. :i h :

will at least insure a free influx of sea water at each tide and favor: .
A : nf 11 X t :.r" "..
di tcl-- rib t-i n f\ the e p^r eai e~fcnt f eed-^^anin -mi nn-ro' ". l1


s r u o o v r s o ng n ows.


C -- :a gt",
In the Gatun district the completion of the drainage in the nor.th.
rt of the large hydraulic fill between the French Canal an*'t
... *.. ::a u


Chagres River has, been authorized.


original ditch, dug


and draining the southern


part,


is being widened and deep


level and a new ditch will be dug in the north end, interceptingH.
run-off from a low range of hills and draining intothe French Caniarl
-- a a a


the north end of


the fill.


the entire length of the fill thro.


of the rainy season


to the year


the burden


ann -. nC


1919 this hll was inundated


Formerly this flood water had


ugh the first ditch, and iti.the:h'
was too great for its capacity. H P.,
H ,


throughout each rainy


and


produced


vast


quantities


- anopheles,


catch


anopheles


in quarters


many thousands a month.


Gatun


Now


varying


is rare


from


that


several hi
a single:


an dpt


is caught


these


same


quarters.


addition


valuable banana plantations, gardens and homes are'bein


H~yw


- -


pa


"ii "I


*


1--q





!i Ai! !! s Si ......- .i
:** .. .:s *I*H HFU.:* **
...** ..
:, ,,:: **" ,
i. I i ". ii "I I H -
H."


: : Mi. i F* :::** : ... ::.
.. .. ... ... ... ..
..** ** *. ,,, ,, .
,, ,,, ,,, = -
.:i. .. ...moachment
el otranophbe1es
*4..1t tiat frequei



uI..I.an A. pseudopj
S.. top minnows are
, ",":, ,'-*
:,** *, *.::: ,*, : *
illi' .::. .. ,* ,,, ,, ,: ,


., spcime ons ofos i
'it il.urers of mosquito
H : ,* :


Le small lakes surrounding


Pedro


Miguel is


With silting from the Canal and watershed


of vegetation into the
production have gradi
ntly throughout much


e, breeding


profusely


now
and


shallow waters, the areas
ally increased. It is re-
of the lake margins Ano-


while


in ditches


nail pools a short distance away, only
unctipennis will be found.


present in


suitable


sthmian waters


several varieties show them


larvae.


They


are hardy


s, hoof
argyvri-


and lab-


to be voracious de-


and survive in


almost


:.y kind of natural
as :/& ..the sole means


water


, but dependence can not be placed on them


mosquito


control


Many


forms


plant


: afford the larve adequate protection from these


: fo;oloesa, described in last year'
1*


fish.


The plant,


Chara


report as a favorable shelter for larvae


H and


.which


seemed


- -


spreading


to all


bodies


shallow


water,


practically disappeared with
surface of the water-but it


ast rainy season-at least from


s reappearance is expected as a result of


thedclearer water and more sunshine of the dry season.


.'Ona December 1


Dr. P


B uxton


of the London School of Trbpical


: .Mdicine, arrived at' Colon,


en route to the Islands of Samoa


to under


udies for the control of filariasis in those islands,


said to be due


mosquito Stegomyia


the chief health


pseudoscutellaris.


officer


to supply


him


had previously re-


with


a stock


.%. take


j" ... .
:1 ". I in



:'S-.. Sa
N...:
mm :. ,,,I :
iik.hio
jul11H--BLf** L kt


vs here, as he feared there were no suitable fish of that kind in the


toan Islands. On his arrival here
rninnows caught'in fresh and br
se have. been identified as Poec


Buxton was given about 450


ackish


ilia


water near


sphenops,


Mount


, a viviparom


Hope.
is fish


..''atm to "sa affinisin appearance and habits.
i H. :x, "",,,


In


Eny are vry effective against all kinds ot aquatic iarve.


; an aquarium
These were


aced on board the ship in .two five-gallon kerosene tins and started


thelonig journey.to the Antipodes via New Zealand.


.teir^^hardine


$ss


As evidence


Dr.. Buxton writes from Samoa:


te(


..


";.,..


'


i






























propagation in


UrIIStODaL.


conditions have .improved


ancon ana


SalDoa, on me..


to such an extent that 1


sanitary inspector of those towns were shared with


ing most of


the year.


Being particularly proficiex


this inspector has been detailed to devote .half his. t


and building inspection in the city of Panama.


especially unfavorable for antirat work.


, dating from early Spanish days.


and materials are high in


year to year in


past times;


spaces in and between buildings;


cellar to


a population


roof with merchandise;


cost.


H


Much of


Building spa


Flimsy construct


tortuous narrow pass;


warehouses and
foodstuffs expose


- i A "1


the serv
Panama Ci
.. I.

.... .:

the town.i
***. E. .. .... -,,." .
:* .Y ^::"


ice is: at a:
on, adde..
ages. and, 0.n
storesp.. "
d everywh'e.'
MEO,. ..'i e"-*.t .J :


indifferent for the most part to sharing their he
'% ."


possessions with


rats;


these present


but


editions as they once existed in Panama City


a faint picitue
While nmuIc te
.i ^ A- ~. %^c &.J


be done, an excellent start has been made and many of the w


editions corrected, especially in the methods of storing c


in shops and warehouses.


supervised
enforced.


and


New


compliance


construction


with


and repa


rat-proofing regular


n *- 'S r~ yin n -.


H. ... .M..j
.: .. *: .. ..: : :*::. *
i .. ~Ia
ion :.iH-
.* '... r .*...
**T "Sn.h.. .
.... 1 ..... .





r


...:















rainy


ES!SJ4Y


I:: .. C.
ft ion


an d


season


disposal


ir ot freeedom from fies.


tess


reeaol


garbage


and


occurs.
manure


ne care
mainly


TYPHOID FEVER.


typhoid fever were reported to the chief health


.4 HflH*' *-
4 '-
.... .. ~~
*r".e":ce y an r'
( -* : ...* ...
I*.:. :'. **. .,*
.I'u "" : :*. *. ".


were from the city of


who


had contracted


Panama


the


ive of the nonresident cases


lived) died.


8 from Colon


disease. elsewhere


, and
than


(including one white


Four of the cases in Colon were in one


icre was no apparent connection between the other cases that


H:.::M *c:':::: tally


flu .



b~~ii~
Ig~~t~~


In this family, one case


nedic


1 i
d.


a boy


years old,


:al attention until a few hours before death.


was


On being


"of the diagnosis the health -officer ordered the contacts ex-


and typhoid vaccine administered to the remaining 5


ra


raiily:


. ":" u.. L." .. .j "j
* H 45i were seit t
.n^A jfeese"t




ttes. that


......ed." c(S
^^~^iS~'"'* \
"Si""V~ ""'":" *. o^


members


The day following the administration of the vaccine,


brothers)


were found


o the hospital,
in each case.


SIt is


occur


have elevated


temperatures


where a positive diagnosis of


No other


cases followed in


this


typhoid


family


believed that carriers are responsible


here.


In every


case


ers .among the contacts resulted


the disease,


a careful


in no careers


se report of Board of.Health Laboratory,


being


page 52.)


.i


Lie CaaI;i. Zo


.. -


)!if
j" :
H. V

|h
liiii.
A "F


't: :".. :..:" .
,. ....

S. .
iijfi'
| UlLLa
::A*:;y~ ~iuyii 6 ^'
^*'^"^H^^^
..se* ~ ~ ~ ~ ~ 'Y iy. < Bs !**


:1
il*..


.. .* : .


*


INFANT MORTALITY.


mortality rates of the cities of Colon and Panama,
id "for the past 5'years have been as follows:


pI'r.S -**** ..


; .41d
. -. F*-'-


* 4 *. 4*


* *. q.. .


I q *.- .


i. .


-r"


154.47


37.28
154.00
113.67


142.21
155.801


IsojoG
95.09


139.28
173.95
338.22.
134.73


139.66
147.23
41.32
120,27
93.62


i.:


Irri. *4l-ije'aa nlAhE'ahnt! (r n nrMaintl an 'hirt 1 rxralfar


*6fli.


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

t: cas. e


and


i':' ~.- -;- r' rrr::"


, 115.66
141.95

88.31
72.76


`,:~"-----c`


.





















T




T
it w


A


as c


1916.
1917.
1918.
1919


.onar. lea ... ":
ho lelthoweea nism" r Oe.. ..--,1nos. ... . .. .* 'i "
-. 1 .. C. (ardiao disease. *.q .i... .... .... .
hose with defective teeth as only physical Chorea and other nervous dieasees.. .."
defect.. ..... ........ 354 Orthopedic defects.. ... .......:... .. .
a found requiring treatment: Malnutrition...................... ..... .. ..'.
delective vision. .. .1.......... ... ....... 35 Defeetive teeth..: ... .. ... ....... I
feective hearing . ...... .... 15 Contagious diseasm................ .. ..i

'he colored school children were also examined and all whoreqir
ere vaccinated against. smallpox..
I.:
: .:. *.:.i!.

HEALTH OFFICE PANAMA CITY. -Nt
C
DR. HENRY GOLDTHWAITE Health Officer. "I.
.* ** .. ... h ;
falaria.-The following is a table of the malaria cases reported
ontracted in this city during the years 1916 to 1923: .....

Number.I Rate Number 1.Rte"
Year. of per Year. of "pe ..
eases, thousand, e se .thoue.H:
**. "! ":" EEE':
....................... 123 3.87 1920 ........................ I 100 1-
... ......187 3.06 1921................... ..... 67 H .11
..................... 97 1.58 1922 .............-.. .... 106. .. t t
................ ....... 181 2.95 1923........................ 78 -.
______________________________________________I________________ '
.*-I.: .:: .
|1 -.-" :. ".----

t is probable that most of the cases were contracted in the en'r f '
he city or in the unsanitated areas beyond.. ... .
.... .".... .........:.....
)il has been used in antimosquito work during the past se e..
rs as follows: .. ... ..
.G.u I..: :..
Gallons. .hGll
................0 + .. '. .. ................... ........... "'"'

........................,828 1923 ................... ................. ..
9,365. .. ." ...
.. 1. :....,#


'his saving of oil Cand labor) has resulted from the drainage o:
e swamps and other places once oiled freely, and the gradual lilting
>f the swampy areas in which the garbage from Ancon Bal
Panama is being buried. .


II


of t


yeai


T


larg


and




Ph: r V
H H ..S.
H..:.IH;I;


.:.. .. .* .: *
"..."l:."i::." *. ..
.. .. ..: ..*:
S. ::: *. *.:

.... rte.could-
:: ..
i l ...
:.H,..H ..n'c.m=,rcairx s' V
uH


. h.. fine


..~' itAlse was
.: tessary"
H.bn.c ove

.H ross, an(
;. .. pl yed by


:ase in


this


rate


continues


a gratifying


manner


be much further reduced if economic conditions permitted
it of the regulations covering housing conditions.
fund, from which the wage of the public welfare or prenatal


paid, reached such a low figure in


to discontinue her services.


r and paid by the Cana


October last that


She has,


however


since


t was
been


Zone Chapter of the American Red


1 is performing practically the same


the Panama health office.


:" "year that she worked,


functions as when


During the


ten months


em-
the


she made 3,315 house visits, 1,654 women came


to the clinic for treatment, and 900 babies were brought there.


Diphtheria.-I n


July,


1922, owing to the increase in diphtheria,


started taking throat


cultures from all school children in


an effort


locate, any carriers;


9.927


cultures were taken in


1922


the work


....as completed in the early months of


1923


when 1.187


cultures were


taken, making a total of 1.1


,114 cultures taken in the city


almost


tirely


from


schools.


Thirty-seven


cases


were


found


harbor


virulent B.


diphtheria.


..* Tuberculosis.-The deaths from tuberculosis during the years 1914 to
1923 have been as follows:


S.1914.
191.::
1917.
1918.


.i .. .... ., .
"i i i i i i i i.


Number
or
deaths.


Rate
per
thousand.


l i l l l i l l .l l *i. i l i l i


Number
of
deaths.


Rate
per
thousand.


It will be noted that there has been very


..rate-for several years, and


little change in this death


believed that there will be no rapid im-


.. provement in the situation until such time as the Republic of Panama


, constructs a sanitarium in a suitable location


of high


altitude.


Fines.-There were 604 fines imposed for violation of the sanitary


rules and


regulations


during


year,


and


$1,093


collected


.result thereof.


This money is held as


an "emergency fund,


to be used


fF


.


":


























During the past year this office has taken up the ainte
all dairy herds tuberculin "tests. Forty .reactors hav beif't
negotiations are in progress to have the Republic of .PAIli W
S..reasonable valueto the owners for. be" nim
reasonable value to the owners for tubercdlar animals" ""o" """""-


killed.


this connection it is interesting to, state, that in


abattoir four native animals have been found with- t iberciuo


by the veterinarian;


it is commonly said here that none of


cattle have bovine tuberculosis.


HEALTH OFFICE


JESSE L.


COLON-CRISTOBAL.


Health 'Officer.


H


Malaria.-The following is a table of theinalaria'cases
having been contracted in Colon and Cristobal during thi


. ... .: S:::....
* .h


.1
..........................................................................................
'p.! ,


. .-..s :

:
r,, ,S1
- vv L **U i ,H E
,, ,hf ,, ,, ,,,,,,,,


to 1923


.. .


.. 1 ..


.i F
. .. *
dy A~g
I r ** d *
* fi


. +


.i ;,jE
i~~* Hi *H;,~ p~
* ii *'- cir.
.t:i.tt H


Mosquito


flights.-Several


comparatively


small


fli


1 L .. l..
C. : : ....... :' : """: .
:<" ..."" n"i ... .
"" : 2: .."::


were


noted


during


advent of


raiflly


season.


made on


A edes


flights.


the screens of


Occasionally,


along with the aedes.


within
certain


a radius of


that


Le Washington H(
found to be the


however,


a fe


As there is no anoph


over two


miles


from..


C


anopheles is actually flying


tel ..and Colono H"I
,, ,, ', ":. .
S ..:: :::":...: ..
predorninati ..
w anopheis '..iii*
eles. breediig to: 1i
SC = IAJ i l =
** .....* l
olon HornytalAtH1
".. .. ":" ::" .. ".
g a, dietmargqc e f


f..


taeniorhynchus was


Illlrllll: r


III II II II IIII IIIII I


iiiyrl(i.


rr


BltRD














:ulosis may


R#.rn~mI.


3e par


:ly aue


.42'
.. Hi EE.a
* I


K.;.


0iopv^ercrowded conditions in many of the tenement sections
. :.. i. x1 i :i F' .. .
iie... the repopulation pf the Zone, and to better living condi-

jsimg the laboring people.
l i ia y This rate shows a continued gratifying decrease


iM Hryears. The principal factors response
qitiHhave been the betterment in the econo
.... increased d
t-b" owing to.more employment, increased


L(principall
Hill:: H nditions in C
HA.... b b.i
l. .. th -
: .. .


F' ...The inf
........ ..... ;f t


... ..
CfK A -K *-* **vC- ** --
H i. i .

: :. :.
M' :. ... .. ".......




I. .: he: T he|infant mo

C-om prison (
S: realityy rate ol

k: is ~perbaps shove
oUne.'.': and E
Il;: x .. -. =








.H...ij. .. ying in crowde
..... ....t a" m 6
WeadIdyian
'E. .. -
*... .. .












* "" .. "
ri':; and oc c anpied in
i: "' "" : .. i
; .. ..
-Ii *- '' r n c* w de






im:::,..t.." be, &1:
-* fl: &3 : 1 U a.,


I:- :: l.;- F
r.' '
.... ..* ....
" SS- .. ^ ^ ..... .. r... ^ ^ ,
Hi *.. ....
. 4.,.:: ..: .. : : .. .. \
S-i. :E S, x .
W ":: ": .x ::; .: ** -. : ~X n H j ** *


y in
3lon.


the Canal Zone)


and


the advice and


ble for this improve-


status


agricultural


opera-


relief from overcrowded living


treatment afforded mothers


ugh the medium of the Cristobal Woman


ant death rates of Colon from 1917 to 1923,


245.14
186. 16
155.29
142.21


* .
* ,. l
i i i i


u. .m.m.


)rtality rate for Silver City for 1923 was


's Club


Free


have been


* .


139.28
139 66
115.66.


88.5.


of the death rate from tuberculosis and the infant
f Colon in 1923, with those of Silver City, is of interest
iing graphically the results due to difference in envi-


~COfOnomx


conditions.


The


population


Colon


'anamanians and West Indians (especially the latter),
d tenements, and a great proportion of whom have no


Lent.


Silver City is a new suburb of Cristobal in which


ployees of the Panama Canal dwell in model quarters


Panama


1919;


Canal


style of


construction.


was


built


its population last year averaged 3,350:


* .
* .
* *


rrsI


Woman's Club


Free Clinic.--Al


cases needing medical


LL a ~~~n .- q. ..nf


~*1


.4


*


IlrIl III Il I II III IIII '' ''''''''''''


k


Ir~7rC


r :Bilver. CitJi, 19%9.....,


Iti City. loat.............
IIII Illlrlrl.l'lill IrlrIl I
he per itWIO live birtbe. .....


L1 ~ r ~1~ s.


TT







* i:.Hi'jiii


Vaccinations.--The


number


of vaccinations


t" .... l "

performed was ;3,S


The visiting nurse keeps a record of all births


and whenachl r"rchb


the age of three months it is vaccinated.. In this way the populatiqk H
will eventually become practically immune to smallpox. The ch6i IQ
method of vaccinating is used entirely and is unquestionably the mo .. .


satisfactory method in our hands.


Building


inspection.-Owing


to the


expiration


of leases on


number


of lots


belonging to the


Panama Railroad


Company, it has


been possible for this office to have the houses on these lots put: i,
proper sanitary condition before new leases were issued, and in. thi.i....
way many dark and poorly-ventilated tenements have been converted:. ..
into buildings fit for human habitation. .:.i&
A: '.:; :i H
A mi-plague measures.-"Build the rat out" is the motto of this office.
but as this is naturally and in some cases necessarily a slow Drocess ."..'.


r- t..


other methods


are deemed


bulky materials and


necessary adj uncts,


such


as the elev


food supplies on permanent storage r


properly spaced in order to facilitate inspection,


poisoning.
Panama Ra


many
tion.
.tobal


The


various


departments


road have cooperated in a


improvements


have


been made


The


cleaning,
; Panama


trapping
Canal


very satisfactory manner


through


their


hearty coo


The greatest improvement has been accomplished at the


stores and store yard


store yard
Garbage


been


the improved sanitary


condition


very gratifying.


addition


50-ton


unit


Hope incinerator has proved satisfactory in every way. The han
and disposal of garbage in this district is thoroughly satisfactory


would be difficult to improve upon.


conspicuous


by their absence.


amounted to 22,098 tons


There are so few flies that the


Garbage incinerated during the


, at a cost of $1.03 per ton.


The incine


is operated by the Municipal Engineering Division.


QUARANTINE


Surgeon


WILLIAM


Chief (


COLBY


DIVISION.


RUCKER


7huarantine Officer.


atioi
S .. ." i "l :



H s'
S. ...d :".i




,,,a
i. ..." .i.. .
4... ... ".... "



t'*1d .
:*.. m.: : k' is:





y anr e^==
Sr l .. ..




IIi


.a: .. t.: ::m



.ra t- .. i::,
ou nt' .... f" ":::










-.1
F,,, '
d li ........ HH

1: ** *










: :


disposal.-The












its .t- thLeir por


~s, MUc


:o assist anc


stimulate t


ie placing


H H

4!'r "" H'~~~

*~. H:. uatntine


g.'m -Honduras,
H.::: ade with-
tutr.ies. At th


ning of those ports


in such a condition as to prevent


centers for the -iJtribution of


communicable


diseases.


arantine officer made several extensive journeys during


te purpose of


division.


Salvador,


carrying into effect


the foreign policy


The Pacific coast ports of Costa Rica,


and


national


request


Guatemala


and
the


local


were


health


Surgeon


visited


and


authorities


General


Nica-
con-


f these
United


lttes'Public Health Service, and also in the interest of The Panama
;C"a:-"... al1 he visited the Caribbean ports of Costa Rica, Nicaragua, Hon-


~H.;". ."";"diu: 'ais, Gu;
H.:;i" Ed::n." .r."i i
. ....

S ...His repi
i.....i .. A H
.... ui anntir
i... ....
.i # H.. ": : .. ..


., fe.


atemala and British Honduras. Lat
in the Pacific coast ports of Ecuador


orts


indicate


e problem.


that


yellow


fever


. As a matter of fact


er he studied sanitary
. Peru and Chile.


has almost


ceased


, sanitary conditions


in the


re are such that there is no practical danger of the spread of


'er even
it when
r of C


though
yellow


olombia


it should


fever


was


, -the only


be introduced.


discovered
restrictions


This


bele


IS SO


Bucaramanga,


placed


on travelers


o" ,..iifm Atlantic coast ports of that country were that their temperatures
..".. tild be taken daily by the ship's surgeons and a record thereof be
l. .. :


ft.
* T"


H'::

ISA

1t
Hi
;:ir


nished


*the


quarantine


boarding


officer


and


port to the latter daily to complete six days.


i. order, to have their temperatures taken.
.; Th.e sanitary inspections of the chief q


lwe....rwer,


that


passengers


from port of departure


[uarantine


officer


indicate,


that bubonic plague on the west coast of South America is


~".,iery genuine: menace.


.As ..a result of the South American journey


martatida a conference to meet in Panama,
HX *


*the President of Panama


February 25-29,


1924


S.ihe..purpose of standardizing and rationalizing the maritime quaran-
:"..... .......:.....


. : .
i..... .......
i .., ..
q::l.:" :...
"E:: .E:: :" "." ...


tins of the countries involved-Panama,
::it is .believed. that out of this conference
operation which will be mutually bene
: *
,eoopera
, .,rn r ,.


Ecuador,


will


Sficial


[row
to al


Peru and


Chile.


an international


1


countries


con-


~::: ::: ,i


::


a





.


ol


[


g













fairly good-sized lumps,


and when prepared in this war the


not come off rapidly enough to constitute a fire hazard,


process is


unduly


hatches it was


slow.


found


By hanging the .generators. j


that considerable time is saved.


diffusion
achieved


obtained.


satisfactory


have


by following this method that cyanogen


been


chloride


has tee
"..
:, "*


made
rapid,


the standard
satisfactory


fumigant
fumigant,


of The


and


Panama


when


Canal.


demurrage


It isB a


losses


* .1 :'
c. a '
,.i .." "H
bE. HA'*I X *


sidered it is


the cheapest method,


costing less than half as .mulr


Iphur dioxide, and about fifteen per cent less than hydrocyanadt..E'
A radical departure from previous methods was made in Decenib
mmm a mm


1923


when


an order was


issued


requiring .that


quarantine deda


tions shall


be sworn


by masters and surgeons of


arriving


Quarantine offers


have


legal authority


'i


to administer oaths


for this


purpose have


guards the method.


declaration.


the powers of notaries. This adequately -sat:
The following is the text of the new quaraan.t,,.
CGj


THE


PANAMA


CANAL


HEALTH DEPARTMENT


QUARANTINE E


QUARANTINE


DIVISION


DECLARATION.


Instructions-This Declaration should be prepared but not signed prior to theentry of the vesl.toaCail
Itmust be sworn and subscribed to in the presence of the Quarantine Ofider .before pratique willbegranted.
vessel han received radio pratique, this declaration shall be signed and filed with the Quarantine Officer of
entry. To facilitate the entry of vessels, the Quarantine Bearding Officer should be given a listofpasengers


"::: pr -: *: : i::
t ..:. :5
n t.. *....



.he. ".." .
H.... .;M .l
r,.r!
I s .. .... ..
-Itt'. ..


the Canal Zone, in order that they may be given immigration inspection.


The undersigned,


which arrived from


Master and Surgeon of the S.


S ......... _.. .-


........... --- ------... ... on .....-.......-..................---------


(place)


certify that no case of Cholera,


us Fever


Yellow Fever


(date)
, Plague,


Small]


, Leprosy or other diseases that may become a daa


'. .
:. : .: "-" ::
.do reI
: ":: .. ":EE


gerpr tok; t -a


Canal Zone or


Republic of


Panama


has occurred


Sboard- ., :|i
i .. .. ....
.


vessel during the present voyage


that all on board


class,..


class


....... .. 3d


class


and ...


..-.... ..Officers


and.


P0Ifl


are in good health (except as noted on reverse hereof)i


.that there.,


. =1-


*.
* 1.;i


u


I:: ,


I ---,


1!!


' *. .. sss


N


I I .. ?


InCLtlBlng_,.-,.i~:~';r*$:


%


Ir


r r












::I rI


I.... ::. #:
-! :1.:: -


attiC


LI


ingress


O0 rodents


out effectively.


-. i. .-- .--..i. -... ....- .-.... .... ......- ..... M aster


'.l S BSc RIBED TO in my presence. .. ... --...... .................. ...... ......
: (date)


"Sn


Quarantine Officer.


tr.. '.
A.-,.


(Reverse.)


..,4b


10 fof Executive Order of February 6,


Hg...... ,..XV,of

ii tiII regulation
..n..am and C


Officers


hereby


1917


authorized


states:


to administer


oaths,


purpose they shall have the powers of a notary public."


Executive Order of March 31


s for the Canal Zone,
Solon, states:


and


1920


, regarding quaran-


the harbors of


the cities of


... K ... ... *;
U "nH n,

fi..ni .mt" .. .
.... .. Inst
. .. JU.. X. ** -..
:r:: *.. : :* :: .* ..g
Ad ... .. .
. i .. .:. *' *: H..


.. .** ... .. '



.::. ... ..I f '"' .. s h p
** ... H... 4 "



**3- ** *E ..*.. i".
: I m c :i. **". I
: *:* *" .i ..:! : pn
.I. :dteCourt, in
u......s.H...


,. N........... K. .





3 :: : .. : : .. *.*.
I: :..H. n t h







Holl
.hj"i" ""- ''f Y n
..... .... tt hraio




.p":" "' i. tt... fl ed nt
K'= .. .c inipr

*.. ...K ..

H...- H. t .
..... ^ ...t


n failing to observe the requirements of these regulations


ructions issued by the Governor of The Panama


with these regulations,


Canal


shall be punished by a fine not


hundred dollars, or by imprisonment in jail not exceeding
)r both such fine and imprisonment at the discretion of


conformity with the Act
of these regulations."


comes from a clean port and has a


Congress authorizing


clean


on is accepted and no inspection is made.


ratique is granted,
he quarantine office.


of health,


cases in


the declaration is signed at sea and
It is possible to do this with safety


secondary sanitary lines of defence in the Canal Zone,


false oath is not likely to occur
isonment.


it being punishable by


actions; have been made in the quarantine tariff.
e for the benefit of the Canal and the Republic


Quar-


h


hhe Panama: Canal to give its clientele as much services
Serefore the charges for night quarantine inspection were
Fthe osts of fumigation were reduced in order that shio-


111111


mm
a


rIYWIYi' j k.. m


Wi


.n~~~














The following is a compilation showing the diminishinglop


suffered


by ships through quaranti


at a basis for comparison,


the loss


ton-detention-day, and five dollars

Naval crew and vessel detention ar
4


Total tons
received.


9,717.452
10,779,529
17,793,683
20,232,456
20,898,873
37,313.867


ne detentions. In oder pto.

is arbitrarily set at ifty ".

per passenger-detention-daty ;
xx *^-' ,* !, :.. **,,,**-
e.not included in this table:.: ::. ....
::. i*, .: *,*...E:6;
S"! "*S'jL. r
___________ WN


Total ton
detention days.


154,176
161,376
48,172
80,786


Total pauses-
ger and rew
detention days.


38,169
18,570
33,436
14,161
113
330


Total is..
T 0l.lom
"-


2067,933.00.
173",538.(O:.
191,66,00.
111,.198.00 :
565.00
*2,887.00


QUARANTINE OPERATIONS, CALENDAR YEAR 1923.


Vessels inspected and passed. ......................
Vessels passed on certificate of ships' medical officers..
Vessels detained in quarantine.................. ...
Vessels given provisional pratique .. ......... .
Vessels given ratio pratiqdle. .. ........... .. .


Total arriving vessels ......... .. ...... ...

Supplementary inspection of vessels ..........
Number of days vessels were held................
Vessels fumigated..... .... ........ ... ....

Crew inspected on arrival ....... ........... .... .
Passengers inspected on arrival..................
Crew passed on certificate of medical officers ....
Personnel of Atlantic Fleet passed on certificate of
Passengers passed on certificate of medical officers.
Crew passed by radio pratique ..................
Passengers passed by radio pratique .............

Total persons arriving... .... ... .... ........


Cristobal. ]

3,475
'185
1I
1I
53

3,715

1,925
1
107
1QO 1"f


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


. .


medical


Supplementary inspections of persons on detained vessels.
Persons detained in quarantine stations ................
Number of days detained in quarantine stations .........

Persons detained on board esasels ................... ..
Number of days detained on board vessels.... ....... .


Persons vaccinated ..... .. .. .....
Number of rate found on vessels fumigated..

Persons detained for immigration reasons....
Persons deported under immigration laws....


. .. I


292.087


". .... .

a 2,250

21.7
252,

797
1,054


Balboa.


2,512
4..



2,644

17
*17
22

117,463

2,410
""". 466,


144.411


. 106000
6 863
75,581

3,8QD
',6,.000


. ,-....-


.1886
814;


..!;. : .


":". ":" ":::
.. ii; M ::i.:
.. .- H
H. ,,
..
u'^::.::: .3E
.. *x *" !
:: "* : *"i

" i* *

,,,5
I
,b


....
". *'


a,


... -


5, ,,
.49



...................,
*



,,, ,, .
,:,


.: .%.::... ,
* '


-: 1,^


Immi


tember


a


- .


gration operations have continued as in the past. On.,~

13, 1923, an executive order was issued covering a"d"ii i'


- ,- -m i -i .. ..:H.


i.l;0


" ,


'I'


o~cers
p~sm,:::::::::::::l


, l11AA s


....


I


ill




S : *" s.. *. ... ... : ..:
Il ji i ... ..... "" i ..
.=, H:O'-,-::" :, -. ,:
"H*- ^K i*f i' ::. =*.. .* *! '. .
.- :... ....., .
l* i. : *.:. ."



!!!X .! *. ". :' : .
N.:: :.. : :::* .




: i *...
.. ...
.H .. N ....
.. N : .*
......
..... .. .... .. .


.ANCON


~1i~.'*VY ILL i-.


I


HOSPITAL.


PYLES, -U


Army


Superintendent.


N. H:.''. :
'' ..:iu.ic" uung the year, 1,460 major operations and 4,377


riags kions (including intravenous injections of
..::.i: ,: : : 1 ^


rnec,


cases


.: a ** *-
Srescriptinons were
'. were..
| ,* :, ~ ,,


visited


the out-patient


written, and


arsphenamine)
department for


244 obstetrical cases


were


I clni-.---There were 2,694 cases treated in the out-patient


'tuitm for. whom


.::, ...... :* .."*." .. %.. .:" i .
yAatcipaed,
~....... .. :. *

.....I......th 115 kn
.;ych and ear clin
H 1 i55 '" i visttea the
i::.. .' ::. .-y: : '
:.. *. .... :. *' ...


...l w written; 1,5z
E ... .. -4.... .... ..






.I..,. 1 kand




F|I air cooled;
H cinic.i X-ray
Si:: 3,852 films,














!" *4.. ,* ...
1.* .
..H .. t hi








:P. *:: ". .* .
.* """. .. "











andof t*e yea
fx.. A -. *: T..: .... ... .... .. .n.










imthea remain t
i n. ... .
"i..""" .. ," j"" .:' .e:"


L .. .. *.. ..

"Ia... ign on the
:... 9" ready f oir





It... ..
"'tai ecei v. hydor o-t
.HN n .. H ..
'"N'"'"o the yea
,.:" ." ...


f:iM ^ Beff: I .."


1.704


vith 256 known


)wn,


prescriptions


"takes;"


were written


adults


296 children were vaccin-


"takes."


ic..-Seven thousand nine hundred and seventy-four
ut-patient department, for whom 1,508 prescriptions


15 operations were performed, and


There


were


2,721


cases


handled,


, and 2,254 dental films were used


1,044 refractions
S


whom


1,133


215 treatments


the year.


therapy.-In December


following equipment


.e room formerly used as a waiting room


one quartz lamp,
a photo-therapy


addition


apparatus
room assign


water cooled


1


the ab
and a
red. for


eight,
)ove
supp


this


one quartz


a Universalmode;


which were' put into


there
ly of


was o
radium


equipment,


ordered


new


construction


and


it is


being


;s installation and use as soon as received.
-In the basement, a former storeroom was prepared


:herapy apparatus,


Lr:


control table,


the following being installed


shower


, perineal douche, and slop


ring equipment for this department arrived in non-
and until all the apparatus is received and installed,
ril not be put into service.
tesnt..- During the year 109,599 rations were issued


!'I
* I~ i


fCE


~,4V3


T







ivi
Hr ~:::i


Motor transportation.-During the year all


cars were


kept in
ft~~.ljp.-J.J,


state of repair


In addition to the work on hospital transport


the chaffeur-foreman also had immediate inspection of all motor -=ti'


portation


and


Department


bicycles


located in


belonging to


An con


the several


Corozal


units of


Pedro


the He,


Miguel


* i. ii I
.in"...


Panama


City


and made most of


the issues of


, gasoline


these vehicles.


July


a new Ford chassis was received for which .
wnlcn


ambulance


body


was


1-. .:l


L


service.


Grounds.-During th4
furnished by the Depart


locations.


Eugenia
spyros e


folia,


Quercus


pol


C'


, Litchi ,


Avocado itsama


1 Afanzgo


domeslicum.


sandersha
Fruits


hospital reservation for


Bananas (bunches) .....
Papayas ..... .
Bread fruit. ..... ....


Mangoes.......
Avocados......
Guavas. ......
Liwpes .. ..
Coconuts .....
Oranges ....
Sour saps......


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


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


Tomatoes (pounds).
Pineapples......


I


These havematerially
Maintenance and repay
in the rear of the hospit
slide was estimated at


in the


slide was held


head of


the pow
in check


de broke the 1


1 1 1 I ...--- _-


'nan....: 4-...,


n n *t C- r~t


n-ri


n.. 4


JUIAL UY Lilt: llUbplLdiI rI LIdlb aclILL JJLLL fl1U&Ma.-*
"" '" *:: I. :: **: *
X i::. .

e .year, fruit trees of the following varities"til
ment of Agriculture, were set out in perinnanet
,stachya, Quercus thomsoni, Quercus truncaa;^
aslanea diversifolia, Lagerstroemia, Coyo, D ,:.i
chinensis, Rhedia madruno, Macadamia ter
avocado panchoy, Avocado cancel, Avocado *imni H.i
, Phyllocarpus septentrionalis, and Lansiilit
and vegetables have been gathered from -the-'H
consumption by patients, as follows:. .

1921. 1922. 19233 1 .:: .....i
": """ :? EE.Ei:i
..................................... 502 377 .......: .


.... ....... ...... ........ ...... .. ... 2.835 2 600 ,-. ii
..... 846 214 .
.. .. .. .. .4,100 1,150 .
..... .............. ..... ... .... ......... 3 24 "2 5 t" "
S11.:1 : :2 ; .:: YE3* 1:1
..................................... 9 2.. .. ..4- '...
10 ". *::: **n:*
... ... l
.. .: .:::: :: .::::.

H .... ...
I::u ::"
improved and lessened the cost of patients'di H.
\irs.-On October 9, 1923, a landslide occurred
*... .: :::::


.. ... : *" :***I". **S ::.::


by the power plant shop building, pressure at
light curtain wall in the rear of the bake shop;i: ";


Balboa


pini~er)


.benaster


rea r


..:......__


, ef~-~.,


A




* ~. a.


I *..:: "




* :: ::: : ::. *
*. i..
., ,* : i: .,,'. "1
H :H ., **** .. .
"" 2.: ." ,







-Che !'; kge !ljf li
..... : : .


" .. "


engineering division,


immediately started to work and


6e slide material from the hospital buildings and grounds.
is of damage done tp the hospital consisted of: in bakery,


nor. wallstora~ge ruoni L4VtI mi,


Stiric.t motors put out of comn
Saother materials washed awe
:. '"'e electric motor put out
a, dt.e broken, and a consi
pse.es; in the isolation ward,
Seed with mud, machinery of p
: ered with mud and put out
:: .


"machine put out of
tiered unserviceable
covered with mud.


commission


and
Roads


roof caused to


Mission, and


Ly;


, two 3-horsepower


considerable flour,


in the carpenter shop, one


bread


7-horse-


of commission, window frames, doors
derable stock of hardware was rendered


, entire


ground


floor flooded


and


cov-


passenger and dumb waiters completely
of commission, motor of dish-washing


considerable


furniture,


and


floors


curbs were


hospital


and


walls


broken


property


ren-


basement


down


many


plates by


trucks


hauling


debris


, lawns


1,were


badly


scored,


and


several fine budded mango and avocado trees were lost.


Nonresident


Patients.-Patients whose


residence


is outside


Canal Zone


Colon


or Panama


City


were treated as follows


606 in


Ahicoqn Hospital, and 81 in Corozal Hospital


10 died in Ancon


Hos-


pital,


and


7 died in Corozal Hospital


total days treatment in Ancon


Hospital was 13,796,


and in


Corozal Hospital


1.8.055.


The following table gives the cost of operating the hospital for the


past


three years:


O.peOating e.pen,. ................ .. ....
.Oe awnue.i g expe a.. . . ....
.. ~ cot. ..... ............ ..... ............
. (Cost per patient per day ...... ..............
... Caet of subsistence supplies per patient per day.
. Oierati g expense, dispensary... ............
, ReLYenue, dispensary........... .... .... .. ....


(577,086.50
312,132.40
264,954 10
4.62
.39
18,518.85
572.50


.1922.


5525,585 44
312.713.70
212,871.74
4.67
.34
16,438.74
1.883.05


$520,551.97
309.572.03
210,979.94
4.75
.34
17,952.78
4,113.50


a C'-
r -.


-COROZAL


Capt.


GEO.


HOSPITAL
HESNER. U.


FOR


THE


Army,,


INSANE.


Superintendent.


Buildings.-An addition to Ward


(female ward) was erected at


)f $2;000, for the


purpose of housing


hydro-therapeutic ap-


j


A


r:


.









H.


i '


to roof


done


inspector


, thus making each Individual


hospital labor


pit fly-proof,


under, the direction


5qqlg


H~
A::...:


iii.. *.~H ~4~irk~~oJ~
hi H H..
.JL.!


district


-UI


-w


qn i:cflnji


at a cost of approximately $1,000.


platform and


boiler shed,


with


coal


Sn f.. r *co:n p .
refofor ed.'con


construction,


was erected


housing the new steam boiler


received,


reaction


this


work also


being done by hosDital labor under


.. "..,: S. ,..'"
the district sanitary inspector, at a cost of appr'"")a
"* *^" !


$600.


Hj
IN.


A storage tank of 4,800 gallons capacity was moved to ,the ho


inclosure and placed on


a concrete


tower


feet


high, at a coStH.*


$500.


C


This tank is to catch overflow from the refrigerating machine
Cl. -im l I' *1 .. l C -


an.o water thus collected willbeutilized in thelaundrystearn


The


partitions


between


porches


and


dining


rooms


man


female patients were renmo
each of these dining rooms,
to the comfort of the patiel


ved, thus adding 800 feet of floor spa
improving the circulation of air, and adi
r T j--


itrs.


repainted.


By the removal of partitions in ward


ing room to building No.


hne interiors of rnese rooms were g
....


and transferring opei
wing room), 150 feet


530 (laundry and se


floor space was added to the occupational ward.


Routine painting and repairs to woodwork, sco


line


have been


done


when


required,


S. ." : ,
U 1m a


reens, plum ing, ma
hospital artisans* "|
*. .'. *


the help of the patients.


4*.


Grounds.-Of


the various foreign


tropical plants,, received


courtesy


United


States


Department


Agriculture,


planted during the past two years within the hospital inclosure1, a


have


been budded with considerable success.


The following apj


to be thriving in the soil under local climatic conditions.:


Hydnocarpus weightiana


Litchi chinensis


Saigon mango


Kavas


Lansium domesticum
Garcinia livingstoniana
Garcinia mangostana


i;v t +n fI tb i- alnrr' nil rrinnra ni francM /r ruiahn a


Ji Patel mango


Rosa


Mango de


Amini mango,


- I ...

'ii
:: ::. :*
H H .
ii.
.* :.. :. ...::' liii '
S ... .. .
::4 : ".H


oils.: ni. fin as ~ .kJn ~


.1. ~. H..


v:11:11


Kala Alphonse mango.


;I


:?'a


i'.. :.


iB.WRIMul"H:


------








x.K :::HA& -


i:
* .. *


*:: :: K. ..::::::: .S : : ** :" :: .
.:.* .. :: :*
: *.. ... .. .. .....
...* *.
I^ "': "i.+.i i:
:* ".. .
'^^~li *'*; *' *i?.


S *K.::


** i .


* .


A':E; .i. .


X*:m "X m: .. .. .
* .* : .. *3:: ::
*.. *. .... ..



16.:== -........................
....


,r". t .h i ,, "I
,%s ,, ::" : ,,:::
... .. "
HaI.
, K---.-. --


I* --:: .-x:II; ..v -
": :E.s:::. ":E.* "..."
KK.!.. .



K : a: a*:. :..
::.



| :.... .::. .
.:*: :: ... .
i iiii ::: v -." *
"..!ir .KiiNrUi!








iia
.. .. x




:' : *: : f
I.: :








I. .. : ii.
:*. ** .... ... *.



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


r" .i: xL..I.







...... .
: ':. *' Pa. I
... r





...r. :. .. .i
I- ,tQ 0


"iir -" **
f....
1.. ---C ... t e










:. : .. .


i


-Kii'
ht';


wiIKHe xtade .to replace some


i to. England,


i i -


these


on December


with


species


which


. .prove successful as the results obtained with other
-a- lants. leads us to believe that most of these can be grown
underr local conditions.
..d .lns


5'and numerous flower beds have been maintained through-


,ear by the patients under the supervision of


I pounds and roads
'ed for, and grass cut,
ts.--The census of tl


are kept


with but


clean


hospital


*ompared with 389 on the same day of the previous year.


admitted was
who had bee


153, as compared


TI


transferred


with


surgical


toward the close of 1922,


charges and 32 deaths, as compared
is last year. Of the total released. 2(


r --


(49 per cent) were improved, and 32 (21
total admissions, 90 were cases paid for


1922


also


treatment


, hedges


an attendant.





flower


158 discharges and


6 (23 per cent) were recov-


8 per cent) unimproved.
by the Government of


, and the remainder were Canal Zone .charity or private pay
Fifty-four of the total number discharged were deported, 26


united States, 2
a. 1 to Mexico,


:otal of 72 per ceht of discharged patients
comparess favorably with the best institution


ted States.


-The great majority of


and have received little educati


discuss their


mental


disorders


i:"tic -standpoint. I ney are encour
" :.. I:: .. ."H. .. .
nationall work; they are furnishe

I lgph graphic concerts,. church services,


with


aged
d re


these patients are of low
on, making it difficult at


6 them
to do


ading,


weekly band concerts,


to Norway


Indies.
or im-


was
The
two


An con


bks in the vicinity of the hospital, and games such as indoor baseball,
Sticoet, picnic outings, etc.
i Special.treatrentis furnished patients suffering from specific organic


ord es.


great number of


mental


disorders


caused


'hilsand alcoholism. esoeciallv the


former


Intensive antisyphi-


.C.


trimmed


little expense to the hospital.


1923


were returned in 1923.


There were


to Germany
a


1 to the Philippines, and 21 to the West


recovered


U rf


for the insane in


from a psycho-
some interesting
moving pictures,


daily


J







. .: ..


as mental


disorders,


with


idea


assigning


patients


.*r. -3 "'
show! si
'"r ** "!


higher intellectual capacity to the occupational ward, where


are taught woodwork,


of brooms.


ing,
and


both


IC


toy making, decorating, tin work,


The ferfiale patients are instructed in the arts of i


hand


and


various kinds of


on looms


needlework.


tional ward amounted to $4,818,66


ceived


brooms;


, embroidery,


crocheting,


The total sales from thl
of this amount $3,418.6


some of this is utilize


bunches


rnal


t
Ir


I


1,203
192
282
652
5.58
26,700
547
179
1,225
1,867


taken


ward. c


Pineapples....
Plantains ....
Sweet potatoes
Pumpkins....
Spinach.......
Squash.......
Tomatoes.....
Yams.. .....
Yucca........


in from


Ca


exce


and maldn


-ug wesav-".
basketl[":4
e occupa-..
:..i.:.ii:
0iO was *re9 .':ri
d for the
alt"k: .,.9


purchase of material required to continue activities in this departme


and the balance is turned in


for credit to the hospital.


A surplus


$350 was thus turned in during the year.


Some of
commodate


are sent


assigned to
apartment.


patients wh(
in account o


in agriculture, while
y, sewing room, and
laundering, with the


i in the occupatic
the fields to assis
tasks in the laun(
All of the hospital


sheets and nurses' uniforms, is done by the
these various undertakings between 75 and 81
are engaged in some form of work at all time
In order to encourage these patients to wo
sums of money with which they are able to
tobacco, confections, fruits, and commodities
discharged from the hospital they are given th


from


their


earnings.


Following


patients


Bananas. ............


Beans. string.....
Cabbage.......
Cucumbers......
Limes ..........
Mangoes .......


Okras ... .. .... ..
Oranges ............
Papaya..... .. .
Alligator pears......


The value


.... ...... .. .pounds.
................. pounds.
.............. .. pounds


* .. .
. .
...i.
..ll


............. each.
........pouneach.
........... pounds.
........ ...pounds.
... ............each.


of the


produce


garden


truck and


fr


patients. A
0 per cent of


:j*f *::..i
: ":.. .: :1
.... *** ..*" ii




deOH..



of '


the patients


1..: :. "H5..
s ..": "...
rk, they are allowed small
purchase in the hospital,;::
of a like nature. Wheni .
Hr.* h
e money they have saved
*""1
uit which were produced .I:



S..... ................. ..each..
............. .. a.ich.. 2 82, .
.. .pounds..
........ ............ ...po d .,*1 .
............. ....... ..pounds.. ....
. ............. .... ... jpounds.i 16 i.. ,
...... .... ....... ... pounds.. .1. .
*.. :::. .. .d4
.. ..::.p..:* .1
a..t ..j:

the patients' garden for


from the sale of corn


the physically stronger male


a can not. be
f limited spa
the females


salvage
option of 1
is a result


is a list of


garden




..H:II
:* l


.. .. .."


.:


4%i..IHI..Il
II" l iH* H
*am:HNN :. .
H *


** : *...**L. ** i
*.. ...... ... ... .. ...
lat grar
i'
.-Z ......" ,
;l =H ,a1I=iwnts 'i
""!" 5, ...
i. i .. I. i .. ... .
i'. .. .. ."' M i .." l
i':" :. .* H .l i
<: 1'*. i J.
:."" *g:" .*t a iii f n


f ying, and similar results are anticipated


with


the female


hen: the new hydro-therapeutic apparatus is installed.
trqno suicides or deaths due to violence among the patients.


e^ atpresent 24 black lnd 3 white chronic medical


(not insane
of the year
to do so.


..: ".. ws(one suffer
' .M. "a spinal cord,
S : .. .. .


and sur-


as compared with 2.1 black and 2 white at the
All those capable of performing work are en-


Some make


ring from ulcers of


bandages,


the leg,


and three legless men),


employed


ii


one with organic


making
lesion


and a number assist with the


ard. work. These men are paid a small amount f<
eiirform. During the year the output of the broor
:.creased by the installation of additional machinery


or the work they


n


plant


been


, so that the pro-


; Auction for the entire year has averaged more
.i.. 'week


Farm Department.-Twenty addition


than


acres of land


brooms


were cleared,


a part of which was planted in bananas, making a total of 80 acres now


.under cultivation.


We have


been able to plow


about


50 acres


and


With the modern farm machinery recently received,
carried on more effectively and extensively. Six m
: are used for farm work.


cultivation will be
lules and one horse


. Repairs


to fences were made wherever necessary


,and


rods of


new four-wire fencing was added


enlarging the dairy pasture by


acres.


... crop of


Twenty acres of


guinea grass is


been


being produced


cleared
on it.


of brush


and


a good


The hog pasture was


increased by


30 acres.


:There were 29 cripples on the farm at the close of the year


, pared with 30 at the beginning of the period
..." 'i


as com-


one having died during


-the year. One is under treatment in Ancon Hospital for tuberculosis,
:while..another was found guilty of selling liquor in the Canal Zone and


rwas deported by the police. 1
-z'ed by the farm in the garden,


The services of these cripples were util-


guinea pig warren (to supply


animals


Board


Health


Laboratory)


dairy,


piggery


and


cemetery;


one as a helper on the motor truck, one as a teamster, one as a fireman


at the steam plant, and others as helpers
.. i .. 9 ,


n the kitchen.


There are five


w i r


r. ....


I































































pas year amount to e;" ............ .
pa ea ::....... Hihir~

Equipment.-The following equipment was received and' -
..............................................=.....-= *..- ..
in this hospital: ..* ;
*.. .
n n *~l :. ,"Hl:. *

5H A
1 b. .ip obf r. .1.'. .
1n ho a............lf........ ,cl a ......... .... ..,........... ,-.. ** ~:i. :
1 "* II. I.:I"* 1* "*** ** :m ...
pOdaon .lre .
1reFrigeratorplac tfor kithe.. ................. ..."..... .. ................. ..., ..
iblanksigrth'splortabfor Bte. ...........,.... ........,,.....-.......................;......... .



.. ... .. .. n. ,.. ., .*,, .:. .. ..... i.
1 blacoksmith's portable forge IIII :. :. lllll : ':: ::":.II IIIll llilll;119

.mo...m.chme .'." .'.::J......................................... ......
1 40-harsepowe retten-tuoe boiler '':teurisermlpartableankingmadrmeat. air.. : ""rlmild
Complete eet of hydr.-therapeutic. .,,... .. .. t.. '::... ......=
1 6- hoel balence frame oultivatta" .......... :...,.... '" :::..;.... ';i
ll~aweoll lliaaii moo fo pateui en potsl m mm in m m~impa m m m ~t:;j, :m :X m l =[ Zmg m aad=' i 'l dm1 ....:H" .







lii ll i:iliiii !* l":"" *i :: i< i
H* .. .
* LI ....... .....H .


*::* X:i ".. : ... .
k .. I '.:* i.. '. :: .. ...
H"*.:::4* ::4 .
: : ,
*H... : I;:I' 4 ::"


iir.. SI. *.. "
r
8~ 9FH
I -: !
'Iii TE;H.


~jj~A the inRk o.f't
i i: "i n aurse,

me*tili and: allo
..it dd the work


hee patients in the occupational ward


this has


who was able to devote only part of her
rs her toQ give more time and attention t


time


The


H.:.. H I........i. .
IH L."" ...J.... .. .
*:i ** ** A *
i:4 .. 4e! ... ... H"i ,"
.i:: *:i*":::" .: .: ::*" ..* : : I
... .......* : ...::.: ::K!!* ii --*. .


rgijs a spe .
*,, :i *, .. *i ,, ,,, ..
i.:4, iey Hsary r
i........ *.:: .i .:* .*l
.t:;" f.t:an: Eg sc]
'"- "H'q. g
. i"" .. .
H. ii a sJ the attend
Hi il4i .:4 3l .. .. ., :4

_. ... .
.. P. p er*tion am ion
:.E" .r:. .
.:! ": .a* .. *.:"
HH:4I H .:4:4
i :. **::4 A .* _


.: : """
.!i': :. ...!h. : 4 ..
H ". **" .. "


.bP .::.: !'"." t ne a *
..: .. i "
: .1 *' .. ."



: 7 iv lS erinitend en t,
: ... .Army



...:.... Hperioned to
. :

I I. ,p ,.a
.'V ... .. "*, "A



...H *-
pH.,'rtioned to


H;;.
wt .
II. IL.
*~I. H. I
I Al
~ I~.HV
Nor's.
....
I.
HIIIII .
.INI
IiSI!IIH.HJH 1
.i~.
I
N1
*~..IHSI~
n~. lEjI
II.


. w --.-


rks.-Ac training school


purpose


instructing


nd the care of the insane.


ase


prevails.


in Army


resulted.


and


employees


In addition


i course in hydro-therapy was given to those possessing


preliminaryy


qualifications.


hool an improvement


Since


has been


the organization


noted


idants and maids showing great interest in everything


ie welfare of
ig employees


COLON HOSPITAL


Colon


LEARY,


Army,


d Organization.-The hospital is rl
A*
I cooperation of the staff is excellent.
staff at present consists of 6 physici
all except one being detailed from t


reduced


Navy


The


unning


ward


smoothly


Medical


personnel


increase


Corps


There are at present no internes, as the hospital as at
ited is too small and the service offered too restricted


:ssary interne


this hospil


Physicians .on duty.
m- This hospital has a dual
ps ..y.and out-patient sel

:: dy ill. VWith the increc
:Atntic side of the Canal
ieal- consultation service


ii rough the
.: : *P"" E" .


training.


seriously


alI


function


to perform,


the
th(


i. e.,


two


internes


on the


shipping


Canal has increased the number of Public Health Service
* i ai .


: in th wards


ms6 obm ammn4ed since the creation of these new positions have demon-
tfurAthat th need for-themnwas an actualonne


, laundry, storeroom, etc.


silver
silver


attendants was


the regular


throughout the


the "patients, and a spirit


general


Superintendent.


'ans, including the


The loss of


number


rice, and hospitalization of the more seri-


providing dis-


an increased and active medical and sur-


i":x ===="


. I *i










42


physician


is without


such


help.


One


physician


is .assi;


colored dispensary and one to the. white dispensary.


to
pe


" .x .: .*:: :: .......***
. .. H* .. .
" .H:. .. :i i i

. :... ...i N
N .. IiH
N. .


The problem that this hospital has been called upon to solve has be .
th i f ii i t" "i "..: "
give the maximum of service at a minimum expense, with tami
rsonnel, equipment and hospital space. That it has been faidy' I


successful is


evidenced by the improved regard of the Atlantic :side ri


Colon


Hospital


There has always been considerable dissatisfaction


on this side that sick or injured relatives must, in so many cases, be


transferred to Ancon Hospital for treatment,


due to lack of physici s.


trained in specialties,


lack of


the Atlantic side hospital.


necessary equipment,


This situation


can


and limited spa c
be improved to a


certain extent with the hospital continuing to draw on the Army Mfedi


Corps for its physician


specializing


in X-ray,


and laboratory work


eye,


As replacement


nose


and


throat


should be obtained


s are required, physician
, genito-urinary disease,


In addition to carrying on


5 .H
I .....
" .' '..

.. .
. "a
"" : i



.:; .i i
'"Bii^Sa


the routine work of the hospital, these men would have an opportuit-:
ity to handle a certain number of cases in their speciality, particularly:


those requiring only


dispensary treatment.


By so doing the cost of


. :i :-ii
. .
:l.: ::'.ll
H .....
" .. .. ....
H....
x. .. !-
":.A~


transportation


to Ancon Hospita


would be saved the government in


many cases,


and employ


would lose


time from their work :to


mention only a few of


nursing personnel
present needs.


important advantages of th


consists of


female nurses.


plan.


The:.


This is adequate fot:
mm "'tm a


Buildings.


-The


buildings


in excellent condition


e li.


with


ception of the part of the old hospital allowed


isolation
buildings,
too close


appearance of


ward


The


resurfacing


necessitated by ru


surface


hospital.


to stand for use as an.'.
S. ".
....


exterior


concrel


ting through of the reinforcements placed"


been completed and


The


painting of


adds much


hospital


bett


I!
* .H***^
* 'S::::::::5


..... ..I
I::... :
*: a.:**H
..
... ":! h K::L,
": ..... ...
...
t H
.N.....


continued


during the year


The work has


been done by the hospitaL


personnel as


they could be spared from other tasks.


. i r


SANTO


TOMAS


HOSPITAL.


,. S.
H


;
~~1hi~~t


I II : II jjll II I:I





re:.;.


.i""iii" Iy


RHRIMII..im


....




**.. ..:*' :... ..:* ...:: .. :.
**:. :4 *. **
.. "" .* .

.. .: ::" :** :. .
:.*...... H.
*:::. .
*...: *..... *

... .** ii



11m
... t.. o
...........Tonr 1k ik


approaching


Las Hospital,


date


policy of


inauguration


New


this institution during the past


* .WH: W~IhI.q.
fin. ... 1 -
rH..I
H".. ii. .
tnetl


~has


largely


been


devoted


iods previously in effect,


toward


intensifying


improving


enlarging and training the staff on hand,


'H.i -


Atnd generally raising to a higher plane the administration of the pres-
eti' institution.


By Presidential Decree


October


, the reorganiza-


tiont of the hospital


. .was


entrusted


in the (


capital towns of the provinces
Superintendent of Santo To


I


of the
nas


subject to the supervision of the Board of Directors of this in
.and since the date mentioned an active campaign of reorganize


been under way with the result that the close of


Repub-
lospital,


stitution,
:ation has


1923 finds five of the


provincial


hospitals


(Colon,


Bo


David) each having capacity of


ready to carry out
they are intended.


material


and


function


Month


equipment


and


cas
30
ns


Toro


beds


by month


genera


wel


, Santiago,
i equipped,


emergency station
, the accounting,
administration of


Chitre
staffed


ns


and
and


for which


supplying


these


subsid-


iary institutions is being improved


and it is


felt that within the coming


year they wil


be in all


Tomas Hospital, that v
A dministration.-On
of twelve nurses conc
training school. Aplr


respects credit tab
vill be inaugurate


January


luded t
'opriate


heir


1923


course


exercises


branches of


the New Santo


d about September


19


, the eighth graduating


e of
were


training


held


in the


and


24.
class


hospital
majority


of the graduates have been employed


of its branches.


either


in thi


hospital or


Particularly creditable seems the record of the


ing school from its inauguration in


"haVe been graduated,


and of this


nu


1915
Timber


since


that date 61


in one
train-
nurses


, 29 are now employed in the


Republic,
: republics,


18 have married,
and 3 have died.


have secured positions in neighboring


In several


departments it has


been


necessary


to secure additional


employees,


and invariably the vacancy has


- Panama when one was available.


been filled by a citizen of


Throughout the year


it has been


necessary to make increases in salary, particularly to the orderlies and


C -


S


a .-


1 ___ .- .--- -.-


im:


r.


*.


a .






: .. ll .. :: lflE::
"" "i ... ii
.. ." ..
.:. :
"" d H. i"" .M
he.


on hand.


This amount will probably


be irtilized jn it


equipment for


new


hospital,


thereby bbviatin the


S


using old apparatus in the new buildings.


Steward's


department.


--During the year,


pared and issued at dn average cost of 31.8 c


During


been


edition


the year,


grounds and


given sufficient attention


until


necessary


sections,


new


to entirely


and student


hospital


renovate


nurses


; : '*:: :" ::
24,639 rationswekH
.


tilt~s .per -r


buildings of


to maintain


is ready


the


lal


Quarters.


- ---I


them in
occupancy


)oratory, mo.
since these b


aflI:n Q r=
a ..... ." ..



y. It .:.i
rgue, ..ma *
""e; "-'<- ir
ung"we '
iifling wer "' .

very


bad


condition and


would


without considerable repair work.


keep for the buildings and grol


stand an additional year 'oE:
The average monthly cost of :lg


funds amounted to $475.18. "
professional work for the year has beent


successful and has shown marked progress over past years. The'in
..* *....: *,
ber of patients admitted was 9,769, as compared with 8,624 for the ym
1922; the average stay of patients in the hospital has been reduc~ted:l..,


9 days,


from 10 days as in 1922.


New diagnostic method


ids


have b..


introduced as promptly as proven


practicable in other


new medicines of value have been given a reasonable tri


system of filing records and statistics was instituted


th


... r" :1
.. fu.....
hospitals;, i it
ial, and.a n!ii
ereby maid
S.. .:


these accessible for scientific papers that may be prepared by the,


pita


staff in


the future.


a,"'~


The medical service cared for


these
-


7,241


patients during the years... :"
*" H:: .!i


, a considerable number were infectious diseases, since a shlin A"
-S -~ il


epidemic of measles with a number of broncho-pneumqnia. cas


present in Panama during the latter months of the year.


The drug store,


in addition to furnishing all medicines and chenmi


the hospitals of


12,746 prescriptions.


the interior and


this number,


the National


3.221


Government ..


were issued free,


-. i


the remainder were charged to patients


referred by corporations


companies and to persons able to pay for their medicines. Practi
all drugs used were purchased in wholesale lots direct fromthe t*49
fac .u rers..
facturers. ". .. :: .,. ...


::m


:Ii HX*l


Professional


services.--The


"~: ,, lii:


I. r.


-. :.:V T??


'''















DL IZ.


..\.i *-.
iA: H. .*


B:l||rHosyear
I.. 4 lk in an enti

S... ..."een.. necessary

p |tqts,. withaonly
i.--that these'
o::s j ta at ..
: : ::.:........ : ..: .:... .: H a
ra i spita nation
'- '.! ,:,. .j ..i:::. h a v e :. *. "
I? raie nurses have

I .. : "i::: .
: L ..aas
....... .* .=--*. H l d

::!/i :.::::::'.:" '

..l":. E. ...: .: : .." ..* : .."...
H1.:* i-: ..' *1: ** *r



: E : :.:" .. ::. ."J
:!!.. .'::. : .....: .. .
H.......



e I =:. *r 4 .

S. ... t


.f .. ." **..: .. 4 ". .

.' .CaatLfptients. 4
i *. .'V .. -.. W hite"


L .. .. ..... .. .... .. .

:: il. .. .' : O ne: ~.
S...... ..1 p...
.... i' .. ...... ...H .. t..: r a di n
H .... e




... : : .. A.. f ,
:" .. "* H .is :
| Wh*1 B *iim:*
K $. .. q.* i T.. -*: *

H. .:,'I ... ..
'K ;: :n .. : -^ *.*


....----..u"*n r *.
::.:.::.: : ......... ..l .....
.. .. J -M .:
F H ........ ........ .*
HA .. -I Blean u Wahi

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

.... .........
*.. ..H" --
S* r .." .' .: "
tL *... .h

iM'H


iIOna


s, a shortage of


care


White. Black.
I


-.1...... .


1


to carry


rely satisfactory manner has been experienced.


to maintain entire wards


, handling from 30 to


the services of internes and pupil nurses, and it


employees,


o give to the patients the class of


demands.


been


employed


notable


er available is


L0 SECO

ERICK D.


.IP HORWITZ, Attending Physician.


patients follow


making.


Black.


70


Admitted.


White.


Black.

3
- -. .


Paroled.


Black.


S. :.
..


ijeonj. chinese.' 3 Two Chinese and 5 Panamans.

patients was as follows:


Deaths.


Plemoa


le. I


Black;


Male.


White.

- .. ...


Black.


"'* 1


Female.


White.


Black.


......11


several additional


improvement


not as yet sufficient to meet


COLONY


Remaining
Dec. 31. 1923.


White.

37
. .


Black.


48
26

74


White.


. .. .
* .


Black.


. .. .
monaI


[y.I .


oI patients


amounted


competent


personnel


without


necessary


During the year


supervision,
service that


with


LEPER


TUCKER, Superintendent.


Black.


White,.


White.


Parolee.


Female.


6 i a


1


III III 1111111111


"1


.. ..


/..'





*ii


The
were:


plans


nationalities
33 British W(
4 Colombians


An average of


wage averaging $7.95


patients


est Indians;
: 2 Chinese


remaining


December


5 French West Indians;


1 Haitian


iH
ii~i i

:6.1
I.i~
Hi


35 Panama;i-


and 1 Ecuadorian.


patients were given employment,


their monthIl


each.


.iii:!
ii.:


A. .
%L ..ii


. :' ..' -...:" :: !
I .. ., ". i r
SI"

"ii..:.ii
1.' ...


and
of t


cash allotments


patient,


totaled


, which vary according to the degree of disability


$1,557.50.


Thus


the total annual


income of


patients amounted to $4,205.43,


or an average per patient of $52.37


Total cash sales at the local store anmiounted to $2,938.55.


During


the year


pigs


from


there are 5 pigs remaining on


Weekly


were


greatly


perienced
During


movie"


exhibition


enjoyed by


local


the farm.


were continued


people.


Increasing


during


difficulty


year
was


an(
ex


in obtaining an operator for the moving picture machine.


year


concerts


5 vocal concerts by colored W


Chri


visited
cand v
visited


colored


West


Indian bands


are


est Indian choirs were given.


tmas week the Ancon Girl Scouts


the colony, sang Chri


the people.


stmas carols


from


the drug were given as follows


intramuscular injections to 67 patients.


injections to 41 patients.


and songs,


and di


stributed


Panama Rotary Clult


interest in the place and work


and have promised a radio receiving set for the colony


ocal carnival


13th of February


The visiting


the first
and was


physician


in our history


took place the 10th to th(


i tremendous success.


leper


report:


Specific


Treatment.


chaulmoogra acid


-The


was


for the preceding year


7,325 cc
10,205 cc
1.710 cc


n 1,465 weekly


,043 biweekly intravenous


in 342 triweekly


intravenous injections to 3 patients.


administrat


colony


ion of


make


the


following


ethyl


esters


; ....n i i...X ii.
."., *. ": ,iH



.. *iJ
ia ii iX:

..H
":" i .
: :. :: i ::::

N:!:
.::.* ":"*: :" !
I ",,,,,,,,
.:..: :
..=:=..
....N.....
*=H-.iI
".. iii

S .i S
1 :"
," ,, ":,


. .. .. ..
>... .N.



f *3! iin ~i:. .

-.== ..." *.:i i iii'
N ...i .







HH. H....
N H..... "


Local products were purchased from patients to the amountof $143.61


farm were killed for food


A deputation


as is their annual custom


the colony and expressed great


26,375 cc of


followed along the general routine laid down


i;





~I .... *: .:* *
*:.. :**:: ::" "


- =" L "iz ==;** *=;" :H.:
.. *:.:: **. n H


ii. : .




..: *. *



SH. :
s n on r fed
i:,. :. H... r r --

Hif ajd.<~i 43*Au
... H ..H
; ..:.x. x
5 .. : *UL
Npi 1 III* ruHf. t 1 n *

.:. .,. : "hn p e fo.
I ..... .


auction of dose or cessation of treatment for short periods.
did any alarming symptoms develop as a result of treat-


the esters.
*


C


bers given above as under treatm
of the colony, with the exception
o withstand the reactions following
ultimate recovery was considered nil


ent include the total
of 3 who were too old
injections, and whose
i.


C


Treatment of complications was given as follows:


1. Lues.-In several
the proper treatment f<
Wassermann reaction.
Wassermann reaction.
.ment. Seventeen cases
cases became negative
completing treatment,
2; Uncinaria.--Sixte
tiunr. All became nej
worms or ova.
3. Utcers.-Twenty
Among these, plantar
were ulcerations of the


C i


ase8


it was found that syphilitic infection


or leprosy. Eighteen such cases had show
Antilepric treatment had no effect i
These patients were, therefore, put on an
received 170 grams of Neosalvarsan in 189 i
after 103 grams in 114 injections. One
and 5 cases are still under treatment.


en


cases


interferes


n a positive
n modifyin
ti-syphilitic
njections. I
case died


were treated for uncinaria with thymo


1 with
blood
g the
treat-
Eleven
before


or chenopo-


native as was shown by repeated examination of stools for


pa


itients


perforatinE
fingers an


and forearms. The following' met
elevated position if edema was
solution; (c) Continuous applicat


were given


regular


treatment


trophic


g ulcers were most common; next in fre
d toes, and occasional shallow skin ulcers
hods were used: (a) Rest to affected memi
present; (b) Continuous application of I
ion of warm, sterile N. S. S. (d) Cauteriza


ulcers.
quency
of legs
ber-in
Dakin's
Ltion of


callous margins in


ai


by application of e
'chiulmoogra oil; i
.. injections. (vide A
.4. Local Lepric
types were given (


" '** :


I: -:
,,,H:"i


th chemical or
either Dakin's s
(e) Fifteen pat
LnnuaI Report


i


electro-cautery in ch
solution or 1 to 4 per


ronic indolent ulcers, followed
cent benzol chloride in crude


ients received 4,109 cc "Oscol" in 840 intravenous
1922.)


Conditions. Eyes.-Lepromata


mne-fourth to 5 per cent


eyes several times daily. Nasal ui
patients were discharging large a
they were subjected to periodic


" of benzol chloride in equal parts of
. In several instances injections of
absorption of the latter; chemical
the same effect. Nerves.--Intran
: f ulnar and peroneal nerves wer


the estel


lcers.-Owing to thm
umbers of bacilli (f
spraying of nasal c
crude chaulmoogra
the esters into nod


r(
a

Ul


eves


in nodular


rs in albolene d:
fact that the ma
om active nasal
cities with 1 to
il and albolene.
les resulted in tl


and electro-cautery was also capable


mixed


dropped into
jority of the
ulcerations)
2 per cent
Nodules.-
he complete


of producing


eural injections of the esters into fusiform swellings
e tried tith marked success for amelioration of


*




I~










HI*' I
HI:







H..~I~EIYI~&Y~1L ~T~r~l;~.r 8.. -. i :-


u-ia

1q I

Ernl' cm



IP ~YI



*hV

oC 09 0





















Vf








H
















ii

























.i










H::: ** *.h:.. *. n* ".*.* **
.... *'..L .. : *" .. ....
** : ** : *. :. .. ,: :,, .:

: ,,, .*, ,,,, i x: :"..: :
.. .. it. .. *' H
'* .* .::::.. :. .. : ::.. :.*.*:"
H ....


muscular injections of the esters. In aJanuary 192,.^ eaa .f -" ""
were negative, so patient was put on provoGati dsesa of K L ... ..........
to 40 grs. daily,. then developed .slight attacks of lepra fever and-.rupti ui&.
taken on the 3d of February, .1.922, from both sides of the. nassaluteptu.aiu'S
of right ear were positive for B. Leprae. K. ..was discontinued on tha. .Ial
February 14, 1922, patient wasgiven the esters.iatravenouslyt~rioueekly.d
to the intramuscular administrations. Intravenous doses were'mnadndly*W'.M


until maximum
trained up to Oc
reached on Apri
esters weekly.


of 14
tober
128,
On


Patient was again pu
following administrate
1922, proved to be p
intolerance to the larn
ent vomiting, eleva
discontinued on that
for chaulmoogra tre
weekly. On Januar


WC
. d.


Is


then put on


cc at a dose was reached on August S., 1922, .and .w'aa~
*. ,:, ,*:: i ,:iii:
,1922, the.maximum of the intramuscular doses .h0&ij.
1922, .at 20 cc; thus, this patient received about.-..4 8'~,a '-
August 15, 1922, smears from nasal septum .we.re "g
t on K. I., 15 grs. daily. She developed no symptoms.tbia$
tion of K. I., but smears taken from nasal-septum .n ..S.
". .* *X .* .
positive. October 19, 1922, patient developed 'rathi. ......
d f th-t-hih : s::d by""""** ..
ge doses of the enters, which was manifested by nausea. .
tion of temperature, and loss of weight; este*rs 't
date. October 26, 1922, collodial antimony .was s.bt.. i...l.
atment, and was given. in *5 cc doses intravenously 'ti
.* : ***.... :**: :*" "!^
y 5, 1923, patient showed negative smears from nas:al .ti:.
gradually increasing doses of K. I. until maximum of .l.i'
^ ', ,"r i .u ... "^* i..:


was reached on April


these


doses


were


continued to date" tf


. : :.


Patient did not show any reaction following these large doses of K. I. and: -
examinations during this period from cauterized mucous:.membrane of nasat at
as well as skin of ears and old scars. of pigmented areas failed to reveal the pvea '
of B. Leprae. Clinically, however, patient showed no changes; there W..as s.
enlargement of both ulnar nerves, partial anesthesia of skin of extremit.. i.c ...
partial paralysis of terminal phalanges of little fingers. i "me .ii
4. Case No. 64. R. W.; male; .West Indian;, age 41 years.; timen. ..
years; nodular type; received a total of 1,317 cc of the esters via intramusutl|.
intravenous, routes; was paroled May 15, 1923. : *.
Patient was admitted to the colony April 19, 1911. '


Progress record: Although
nodular eruption in 1913, hih
was instituted here in August
disease with the exception of
organisms. During entire co
have become apparent with
swellings of lower extremities
of iodide of potassium given
patient January 155, 1922; at
daily. Several attempts to r


patient had an acute attack of lepra'fe.verti
: ::.:

s lesions gradually cleared up when specifi ..
1921; patient presented .an almost arretedd state i
smears from lobule of left ear which have sho
urse of treatment another manifestations. of ithtn .
the exceptions of influimmnations on un tN
s following provocative administrations of ma4 .
to elicit symptoms, K. I. was first.. M
that time he could not tolerate doses higher. thaiC
epeat administration of K. I. during the
... ..u :"- .:. *Cii $. .


n








'"C.
HI:
E~.!df,-. .L.


was again put oh increasing doses of K. I.;


rtj well,


The largest, of K.


this time he tolerated the drug


was reached on March 31


, 1923-120 grs.


rMMg .this time he neither showed repetition of symptoms formerly produced by
Sd istcations of iodide, nor was the presence of organisms demonstrated in smears


rX tn et ear, skin, nasal mucous membrane, or other parts of the body.


l-l":;:: .." ""
S ..5
g..: .,
."^ T- *tk
H: ::=^ r a4 W


;C~e
antb;


male


Panamanian


46 years


received 210 cc of the' esters


time in colony,


via intramuscular route


year
was


p!Xl.ed Septenber 4, 1923. ,
. -'Tziq patient was admitted to the colony on


July


30, 192


never


had any


open ltsions or ulcers, and the only positive bacteriological finding was on


July


1921, in a crippled finger (ring finger of left hand) which was amputated for exami-


nation..


The report was as follows:


* "Microscopic Report: Atrophic leprosy (sparse number bacilli found in nerves
and subepithelial layer)."


Progress record:


Index finger of left hand having been amputated,


treated and healed in a short time.


Patient was placed on


Intravenous


stump was
injections of


coloidal antimony


three times a week


increased to 5 cc three times a week.


This usually caused a sharp rise in temperature followed by extreme weakness.
Smencing October 26, 1922, intramuscular injections of 5 cc of the esters w<
Q once. weekly in addition to the colloidal antimony twice weekly. On April


'colloidal antimony was discontinued, patient receiving
.*weeldy, intramuscularly; patient still presented con
condition had improved considerably, and on June 3,


as
4,


Corn-
given
1923.


ig but one injection of the esters
traction of both hands, but his


1923, he


was given provocative


.dmes of potassium iodide, 5 grains t.


.,and gradua


increased until the


maximum


Sof120 grains t.


d. was reached, which was continued for 14 days.


the:potassium iodide treatment did patient show any reaction.


At no time during
Smears taken from


., both sides of


nasal septum, from


lobules


of both ears, ani


from the discolorized


patches on skin, arm,
6. C6. ase No. 186.


proved to be negative for leprosy bacilli.


C. L.;


e; Panamanian;


age, 26 years;


time in colony, 71


years;


nerve type;


...... paroled December 2


received 241 cc of the esters via intramuscular route
2, 1923.


- Note:


Previous parole, February 7,


1920.


Readmitted February, 1920,


as clinic


. type. .He was discharged for insubordination and was readmitted because he could
S...-. not .ake a living outside. This case is of no clinical interest.


All" these patients were subjected


to the provocative ora


adminis-


I,.tration


y- accinations


potassium


.have


iodide


been


before


successfully


parole.


addition


performed


them


, smallpox


without


ii.:ausing any untoward reactions.


: (NOTE.--Vaccination


in active


cases


of leprosy has been


reported


cause


,:" very severe reaction.)
flaa. nan I~ na'. iF. ____Cl~ nnnn Cm nr -.n an I- rio ( nl + alt arI~ rrnc +r i-h0r~IP nrrr


Ii.g


..


No.. 310


inere type


was



































s been completely destroyed. ." .. :'" I; "i:
.. [: .:: "" ." 5 *. :*
Eye lesions were found to be benefited by lo-il appicati -
ters in diluted form, especially when- combined witt: int


spray


or better still


ulcerated areas of


tamponss soaked in pure esters and appleid
S* ..:. 'S ::


the nasal mucous membrane.


It .is p 1


eye infections are the result of contiguity to" the intra-nasal co"


and that the organism is carried upward via the nasal duct.-
jEA
a.
.


.... : .....*.::...
*. "" ..' '
- ..u :4.


BOARD

(Dr. L.


HEALTlH


BATES


i-


LABORATORY.


, Chief of Laboratory.


(Operated in connection with Ancon Hospital.


). :
)


There have been no epidemics to deal with during the:


Bacillus typhosus-Recovered in


blood culture from 13:
'C


S i.H iH.


I.
*. .ME::::...H
.' .: : 5 H
.. ..:. :... :** :
.. ...t. .... :. :" :
.. .. ,


4 from


shipboard,


from


Peru,


1 from Porto Rico, :aid


Canal Zone and Republic of Panama.


Pa~a~y~hiu&$vcsrjl


once in blood culture from a colored woman who lived-
..[: ::


.(Cristobal).


Typhoid Carriers.-On December


1922


,4 typhoid


nhdI~EL


...... .
4 ,,, ,":4,,


1:..


under


sanitary


surveillance


and


of Panaina


and C.


stool carriers.


de L. of


Colk


B.and(


- 4


a- C-' I


- .. .: '. ""I. ',''
^H^ ^P W ** I *** :* A ***
> ~ ~ "' :" : .' ^',e .":^: E :* :: M:I f ifiiB
3. H. still remain positive- :.,
S1. .t .... .. a .... :' : .: .: .t:4.
/ r ..._ ," : "::- J :4:."J l Y:: '. E :ei


ha


est


ii
-:


lb.


f


= === = = m


,r


---- w


r


w












Adenoid


routine, examination


noids removed at operation was continued throughout
"i. *::** "f. ov e w .
S: .Oi....i tonsil.ere veed alone, 5 or 1.6 per cent were found
1j :. l. usu ;.;of 17 adenoids removed alone, 2, or 11.8 per cent


-.. .er...e ;"
..: ,H":.* :*i.: r i.

r~.. H HH$,i tdeno.dc
=:^il^3 a a uni
.. .. lb .. **:: **
Hl.... HH were exa
.. .... ...... ._.

-., ~it'r: ........ ..er ps .
i*.. ** i .: .. : .

.*H ::... .. .* t
: .:: i .:*:. *
--'* .'... : :: ":. ss i ..,.:.. ..


of 322 tonsils and adenoids


Is


were found


t were:
nined,
resent.


ut none of


Cultures


noved


from


tuberculous.


652 cases in which


1.07


and


removed


together


The totals, considering
their tonsils or adenoids


cent in which tuberculosis


Mycotic fungi were frequently found in the


these .suggested actinomycosis


these


were


2 cases of


not made.


or other


Tonsi


and


phlyctenular conjunctivitis


One tonsil in one of these cases showed tuberculous


lidss in


(Tropical


the other case showed


laughing phagedena)


tuberculous foci.


-Thi


condition,


)ugh said to be common in the tropics, is very seldom seen
dl:Zotie... However, during the .year one typical case was


*****Ahn..Hospital. .A. C. W., No. 252596, white Am<
. :d to the hospital with large phagendenic ulcers on
|:. "".:. external maleoli.. He gave a typical te


:onset and progress of the condition.


erican


in the
seen at


was admit-


both legs over
Sxtbook history


He had been prospecting on the


i.: t:ani;a-Colombia border, goirg barefoot i
;. t.he lesieons showed enormous numbers o
-IH." I..f ito 15 hturnsand many fusiform ba(
It'I ti present but these immediately disa
....i.F.. tSle The spirilla and fusiform
. .:... H 1: t" "
H HHKI.ll.. 'JThe fusiform bacillus was rec
S*. i -: .
.... cnt erum agar, iicubated an mrobic
H. :.. .d er. atts'" method. Efforts to isolate tl
. .'d' .". ."" ." ... ". .. < '1
S3 at.I oculauns were unsuccessful.
!**. aed ollwn the app'
p.. ..e Rats. Without Visible
Hb.j.ii ath. Reports," Vol. 38, No. 33
iP~r H" -.i -A -: V l 'No


most of the time.
f large coarse s


:11!!.


Smears from
pirille having


There were also staphy-


Appeared when treatment was


bacilli
coveredd


however


were


in pure culture


very
in 20


ally according to Krumwiede
he spirills were unsuccessful.


earance of an article entitled


Lesions"


"United


published August


States


1923


- S a


V


II.:...
:i:!


r' ,;;.n"





Exa~ziita~ions .--The


i


.


" 'Y' '' r







,rI~jH:::r


of not more than ten rats,


was then subcutanebotlly injected


abdominal wall of a healthy guinea pig.


seven days were autopsied,


and


All pigs dying in


those living seven days wei


.."".i:: .E" .:::
S" ". *" .: :: ":* "!
. ..* .. : ::
.. d .: .. ."
eiltSe h :.
'e bltedtn'H


death and then autopsied, their blood


fixation tests.
made in the ex<


being used .in the complemetJ


Gross inspection and smears of liver and .sple 'We
imination of all these animals. Thus far no vpi.itive^ eI
v ~ [ ", ^ ;:': .^ :":: ...:..* ** ***


results for plague have


been obtained.


The above is in additigx Ht


routine autopsy examination of 14,077 rats.


Swimming pool.-Periodic examinations of the water in


Swimming Pool were continued throughout the year.


Thi


the Balbo i
M C .flsi i..i:"
ese co.n..it .
-1>::x I1


of bacteria counts and examinations for B.


used for disinfecting the pool until


very difficult


coli.


Chloride of lime wasi


the last week in August


to get chloride of lime having


chlorine content, and


or no disinfection.
Canal Physiologist,


the deteriorated


On August
introduced


a satisfactory


product, of


course, g


Bunker


the chlorine


gas method of


T W lli. .
I". "'''
availablei A
ravelit .

..:::. : a ....
H I
... H
U~f..Z... H


ing the pool


modifying the method of introducing the gas to


requirements of the pool.


three times per week,
is added to the pool.


Ions.)
count


The pool is emptied,


scrubbed


ar


and each evening 2 to 3 pounds of chl
(The pool contains approximately 43(


The specimens for examination are taken in the morni:


now


properly


10 cc


is seldom above 100


distributed
quantities,


When


throughout the pool,


but when


added


the chlori


coli are seldon


those not skilled i


meet: th&.:

Lorinegits
..a... ::i
S* =. :: :..
*. :".=
ne. ...
oni p=resent:i
Sii .-. :...

in itue ...i ... ",..'.


the desired results are not obtained. I:Sc.l.
Library.-The laboratory library is well supplied with current tuixj i:S
.... .MCWSK^


cal journals dealing with


laboratory and closely allied subjects.


library is invaluable to the laboratory


profession


in general


always


been


staff.


Its use by the medi


encouraged.


The


.. .::::: :. .'a i


has seen a most noticeable increase in its use by the hospital staff.. H'H"
Embalming.-The embalmer-cremator has introduced a inaif
i"..i....
tion to the routine method of embalming which causes a much -*aS
thnrnrrhnli fIvotlnn nF tbi 0i;ccc The rnrnl-rnn rhnci*ta *f at i.*..*M
J, IZ LI &U I :::..


H.H~


'sLBBS


* .:: ...


a
















S.. ."


1... :.:Jng the year'approximately
". .! *" :

H:LtSw not include duplicates.


llil. .. :-- *. *: BACTERIOLO(
H:' HHEr.
Hill H H

UE .:. .. __a. ..ul tee..,;;..-...... = .. .. .. ..... ..........
....:::* : :**
... :: H lA... M AJI-e
Ht ,,,:44
SH.:...i,:: ., .-.
oos nC cua dpcae


*. :. *
H .
... .


r'.





I:;


11

Hf
* IIH:


1'I



I;'


^. ....p -.o.w. .............

B. cl ...................... ...

. ,sko~l rCcue ourue ............
slfhy.lo .s. a.bu ..............
Sitrponeaua no-&tmotyfic.......
d~s-. o.o.s idans. ............
S lured for Typhoid Dysentery


33,000 reports have been rendered.


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

group.


.. r P itv e s topI culturea........ ... ..........
-. B .... iyphon e............ .. ..... .......
I. R -&. typhuosua on carriers (4 carriers)........
S. .. ".B. dsengrise Group I Shi). ............
S" B dfsenter.oe Mannie Fermenter Group II
S. B. dysantertieOraup III................
Binea culthued fortyphoid group.................
Pcimtive urine cultures..................
.. B a~ByphoAasue on carriers (1 carrier)........
TJdin. cultured for organisms other ihan Typhoid
SPaitive urine culture (53 of those B. coli)....
... dat cultures for B. diphLeriae ................
q .,., Poidtive for B. diph triue ..................
N'asl eidturep for B. diphheriae.......... .....
SCultuer from earfor B. dip.thcrie ...............
:- Thrst culture for organisms other than B. diphthei
Bar SIult..... .... ... .... .
hiMatoid cultures........ ................. .

aop ...ha...ngea cul.ture.......................
Amflu e.lturej..............................
.." .;a fluid cultures ............................
..uemoeoccus Type I. .......................
i Brekpoeccw n Remolyicw...................
il fluid culture ............ .. .
"Adw luid cultures ...........................
.Knee flid enltures.... .... .,. ......... ...
Cuftureu for Durey'e bacillus ................
oitive for baillu of Duerep......... .....
.. ltures from.kin lesions .....................
1 a from suterior chamber, left eye .............
P fom perartieur abscess..................
froa abseee on lip ..... .... ........ ......*
Pi~e rom knee... ..... . . . .


*.-":
. ;.f%. JWftrm faUopian tube. .....,...,........
Pus from sutum........ ......... ... ....
I r :- 1P from left .tube.and ovwry...... .........
_..-.Pul froman bladder..............., .......
|~.: .. ... fs um .:.nkle joit.,... .... .............



..q" % ... Iro lhemo. .
''. .. %a Sm rem ee.. ......... ................
I.,"* ... A o .fiic ultn e e.,..'........ .......... .. ....




l ".... .. lo t ru aoe......... ..................
-* ""'-f-Is from edteig o left o..la...........


. .
. .
. .
. .


. .
. .
. .
.. .
* S
* .
* .
* .
* .


......

* .
. .. .

. .
. .
group

. .


.....

rice...
. .





. ... .-



. .

... .

. .

. .

. .
.. .

... .

. .
. .








. .
** .















. .

. .. .
.i .
* .



. .

I I .


9
1
2
2
5
3
1
3
. .. .
100







9


go


.
73

90





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


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

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

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

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



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


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





. . . S


S......... ~ ... ....... .......... .S


190









8,176







2,884


I1s

2,125

88
1
I
6
a
7
7
5
47
64


18
3
112

11

1
1
1
I
3
1
I
4
I
1
1
2
2

1
2
133

9
1
1
2
133

0
I
i
2


;ICAL REPORT







" H".


I!..


H


a mm


56





BACTEROLOGICAL REPORT-Continued.


Drkfield e .mu.ioni..... ....*................
PositiveforTrsponema pa idum................
Darkfield examinations for 'aws.... .. .. .-
Suitum far dlarkfield ezamination.......... ..

Blood film a examined for malarial pa.ats. .......
Positive for Tertian Malarial Parsit ..........
Paitie for E. A. Maksrva Paraite.............
Positive for Quartan Malarial Parasuisa.... .....
Blood film examined for spiroeabete. of relapsing fever
Blood for red ceil count.......... ...... .... ...... .
Blood for white cell count ............ ..............
Blood for differential count........................
Blood for haemoglobin estimation.................
Blood examined for filaria ....... .... .. ......... .


I i* *. *t A...* J^f f .j *^..
de d aPi H di I i m I ii i i m i iI a mdk m

| k a g dD | m H ., | d g | *


.....[......




.. .n .





i .. .


Eye sm earse........... .... .... .................. ...........
Throat mhears.........y .....................................
Smears from nasal ulcer-................. ................... .
Urethral sm ears. ....... .... . . .. .
'Vaginal sm ears... .. .. .. .. .. ... .. . .
Smears from venereal lesions........ ................. .......
Rectal sm ears... .... . ... .* *. .. ...
Smears for Leiahman-Donovan bodies..... ...............
Feces examined for parasites and ova ..... .......... ..........
Stool for fermentation test........................ .... .. ....
Cell count of spinal fluids..... ...... .., ...... ........... .....
Rat virus cultured .... .. . ........ .... ...... .. .....
Autogenous vaccines prepared........... .... .... .... .... ......
Water from Balboa Swimming Pool ... ....... ....... ......
Water from Panama Health Office for bacteriological examination.
Water from Colon Health Office for bacteriological examination...
Water from Fort Grant Beach..............................:
Water from Bella Vista Be-ach.................................
Drinking water for bacteriological examination..................


Food stuffs examined: -.
Milk cultured for bacteriological count ........
Mother's milk for culture....................
Dill pickle for culture................ .....
Hash for examination. ....... ..............
Bread examined for rope...................
Bread examined for mold................ .....
Miscellaneous smears and examinations........ ....

SEROLOG


. .
.. .* .


..- ... .. .
. ..*.... .

. .

REPORT


. .. .. .. .. S '. *t|






. .. .. **. .. .. *. .p
.* ..













*.. .. .. ... .
.* *. S. *. .. .











. .. . .* *
. *.........* ... .4.... *.....


*................................ .. .
....-... ....... .......

.. l.l.. ll. .. l.. l .. ..l
i. .. l l. ll .. l. l n
. .. l.. .. l.. .. ..
. .l. .. l.. l.. l.. l.. .. ..
.. l l .. .. l. lll l
.l. .. l.. .l ..l..l.. .. ..l..
. .. l.. .. .
.............. l..... p...
........................
... l ...................
.. .. .l... .... ... .. .. .
. ... ... ... ... ... ..
..l.. .n .l. l l. l l l.
...... .. l. .. .ll. ..
... ..... I ll.. .. .... l
..... ... .... ... ..l ll

..l l. l.... .l l .. .l


. .
. .



S.. .
*. .*
.. .


S
~H *....' H*Ii*ii.Hfl '** *fli*k
.1' .1....
H ES
*~* ..: --
iI~ N.: ,k *..~ .
.. .. .
4.. .. .. *i**L.*
A i.~ .~ .!*~* .S:~:j' I,
HE
.. .. 'I::
H
In

.5 H'~ H..:
A ...
i~1 ..
*
I ..j~ a
4.. 1 S
4*** *


H
* L ~ .4 '~bquc~
'j. H hU~
42....


* ... ... C.. **~~*.:
*1-- -
. ~ -
too


b*... a..
* i*~ *4* *Ih
.1.
* h ~ ~ *





* .
* S *** .~* .


. I ~ ~
~ h U


* C





* U U ~ ~ ~ ~ .
. . *


* .



* .
* C ~ *



Lire'
* .
* .1.
I.
* I
* S
A.'


W asmermann tests ...................................................
Tuberculosis complement fixation tests................................
Gonococcus complement fixation tests..... ... ........ .... .........
B. mallei complement fixation tests. ......... . .. . .
Agglutination testa............. .... .. ........................... .
Blood typing for transfusion......................................... .
Examination of blood for coagulation time............................
Blood serum prepared by Swift-Ellis method for intraspinal injection......
Preparation of autogenous serum for asthma............................


. .
... . .


... ..... ....m a
... ... ... ... i


S..n n
* .- .


* i .
n n n-


S
S
* 'WI
A',.

















4-,:::..-.-..;WASSEkMANN REACTIONS DURING THE YEAR 1923
......... the.year 14,648 Wassermann tests were performed on 9,(
.i. ... ....
......... ...

I.H. .. .. ..
.. .. .
.. .:...*:... .. .. IiI I

H I ".I
:... -- .." .. a *

"'" .. .1+' I Pasitive. Native. Toti
I "ITotal,"


S: -, :. .

., .....
.. ... .. ...
:.. .. P .-
r -.. .. .






m : j. ** 4**t .S ......
*. 1-
....gmg am...........


." ... o




RII;SI S.... IIm umima i *ge m*m m *mu**m me m*g .*
.. ...




:.. -......


-w ....*...-. T o..................................... .
... *.. .: .
X.. :H.L t L~


.. ::.1 *


.. ... -

.. i

.. ...* H H .
r 4. *
... :" .*.




.The figures in the above table are based
iN .Hals examined and not on the number of teE

n-adito. .. Wassermann tests were mad
. ........











. a... any individuals, and of these 113 or 17

PATHOLOGICAL.


uriigthe year, 205 autopsies were p

.jte alth ILaboratory. The cass-fd-t
.. .. ..H..


.** *** : .. *. *
aliymi:** 1S ***** -
....H ..
-, :.. :am"n'.:,m ."., D Kl'..... ... ..... .. .. .. . ..














...Hm..f_ hIc : .. u .. S. S.*. ........ ..... .. .. .. ..
.. .
.. .... .. .....
J,,.u...,Bsih ry....*.::..
















:.. .".."... I idi e i o i ** i . .... . . .. .. .
i.....
















....
*.* ........ :" .**.. .
...... ". .....I..... .... . .


612
294
'9

925


4,469


2,980


2,183
!.410
308

3,i05


i80
ng


I t
ire.


11. 69


28.03
20.76
6.20

23.68


31.66

16.85


on the number of individ-

sts made.

le on 631 spinal fluids from

.90 per cent were positive.


formedd at the Board of
rere as follows:


r -.iIi


243 1.688 1,931 !
19 140 159 1,
1 29 30
329 2,612 2,941 1


n,




















Diseases of the Nervous System and of the Orga


i plme ningitis........................
Glioma (neural-epithelioma) of spinal eord...
Sarcoma of spinal cord ....................
Cdmbined sclerosis of the spinal cord........
Cerebral hemorrhage, apoplexy.............
Softening of the brain ................ .....
General paralysis of the insane.............
Dementia precozx......... .. .. .. .. ..
Manic depressive psychosis.................
le y. .. . . . .
Im becility ..............................


Diseases of the Circulatory System:


Organic diseases of the heart.......
Sclerosis of the coronary artery.....
Aneurysm .......... ... .... ... ..
Arterio l s....... ...... ...
Embolism and thrombosis ..........

T ota.. .j. . .


Diseases of the Respiratory System:


Acute bronuchitis .........
Chronic bronchitis........
Bronchopneumonia.......
Lobar pneumonia.........
Pleurii.v ..... ........


. .. .
. .. .


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


. .. .
. .
.i *
* I w i n i


.i .... .. i i" : ..." I

.i. H ........... :.. .
S**i ,,,,
I ..j
:" ":. !!" .


.: ": .'l

". : :: : :



i**..** ** *- :*|.







-. HI......
-- -* H,








. . . .. . i .. .:









* . . .. l:


S......
,, ,, i i i








.-- .


.. .

: .': ." ...x..*


Total ....
*"


I. ;


Diseases of the Digestive Systeim:


Tonsillar abeces, bilateral (Phlegmon and cellulitis). .. . . ... .. ... .
Ulceration and gangrene of esophagus with perforation of left kn*onchus (aspiration pneumania).........
Diarrhea and enteritie (under two yeare)................ .... .............. .... ...................
0 0 1. sh e....... ... ... ... .. .......... ... .... .... .... .... .. .............. ............


. .


Diarrhea and enteritis (two years and
Acute appendicitis ....... ........ ..
Operation for bilateral femoral hernia
Intestinal obstruction ...........
Acute yellow atrophy of the liver....
Cirrhosis of the liver............
Abscessm of liver .......... ........


. .. .
t operative


hemorrhage and simple peritonitis)..


* .
I *
. .
. ..
. .
. .


. U..
. U .. *...*
.. .. .. -.

.. .

.*U.......
O1i| 1I1
1 1 1 i i'



, inI -~


Nonrenereal Diseases of the Genito-urinary System and Annexa:


Acute nephritis. ................ ...
Bright's disease chronice nephritis)...
Acute pyonephritis. ...... ..........
Pyelonephrosis....................
Rupt ed. urethra..................


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


The Puerperal State:

Incomplete abortion.........
IAklk iii^ -c wen. 4 :n*


. .. .. ..
. .. .
. U.


* U 1 1


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


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


*H li**j


1.
*11r~


:1..
-ii: 'Hi~
:4 I' :


. n :5.. l..l'
"H


:3 LEE
HI1 Ed

I
"":IHI


14tI


~E6T~.1
_ Hl II

:::yit'


*A ..:* ."..ai=-


. ... .. ... .. ... ... .....*. .. ....t. ... ..s. .i ...i n .


Total,,


Tbtal ,








H : 6. .. .. I.
Hi ... .


HI.



;.:..i : :. ..*:::, = .
S i .. ....






e=", fasme of Early Infhncy:
........t.a birth. ..... ... ..... ........ .. .. ."* i....... ... ....



.. .. f .r ition ... ................ .. ................
."*Mon .. ................. .. .. .

S................... ... ............ ......... . .
1 .. .. .. n . . . .


. .
.


Old Age:


baiIi.r. h .
To l I.................


Affections Produced by External Causes:


.Bmaa conflagrationn excepted).
Aeeidetal drowning.......
'um.tiam by fall. ..........
la.matiam by vehicle-......
Tziumatfim by landslides......

,.- T ota l-. ... . ...


ill-Defined Diseases:


2
1


Appendix:


t~i ni~b folwn fiIc. I iZ..


IhToaul ,I'oaI .


. .


I: '
.1
*1


The most frequent causes of death found at autopsy for the year


were:


:.,Sfalil (including general paresis)......
' &tf~~:i.r,;re


Cmi..,


Per cent
of
autopiei.


1


6
12
2

20


2


1
2
2
3
I


16
1

17

205


.::::::


::':::


mi~es~ea. ..
In~action of undetermined origin ................... .........


TOtOl~ I







































































1904 ......
1905 ......
1906......
1907 .....
1908. ... .
1909 .. .
1910. .
1911......


C,
a


C -:


Table showing the more common. tcauses:pf

of HeaMlth aborator


1904....
1905...
1906..-.
1907..,.
1908....
1909....
1910....
1911....
1912....
1913....
1914...
1915....
1916...
1917....
1918....
1919....
1920....
1921....
3922....
1923...


Total.


4,

a~ -4



a Ma

fi9I -r I


ioou


1.055


a..
OIb


*0
: i

U


24 23
40 27
.26 25
32 .81
30 37
38 36
37 '27
34 26
38 12
20 12
17 I. 20
21 23
6 12
15 14

16 5
19 9
9 9

454 367


' This includes 32 cases of influenza.


autopsies


a


performed


revealing


I I I ; .: *.


,r...





r ... .
It rj,.H .,f.1I1 .






ai atsuto ni*


a8 -] 'K *11.

15~~NH ,.a 1,
81~~. 25151


3.. .ao ft3 '.

S..5 4 t. .; ..! ii.H f:

;i.
.5 .ii

j S4H~ VjIJx


aM


*

4'

I.


Ii
1


t I "II. "

.. .ill.. .
I. H .I!l
S' .. : ::*........ H
*1 *J .i. "*X* i..i. .. .
6 : .. ..

.. > <.. ... .N., .-w J
2 6 I ...... .-- .

-.. ... : *

50 1 5 4 ....-..~ ....- ... .
S. 0 ., i i: i i..

2 i. :7... :*.*.. .:
9 2 : ..i
S6. ...... 1 3 ... .. -. ... .. ..
361 .. 1. 2 3.:: ;: : : *:*:
.O 295 . . .. .. ... .- -k. ::
451 2f . -. .. ... ... .. .i..i
I 508 ........ 1 .1 ... .. ........ ....
2 SH I .? : .
451 i "" 'qI II I I'''I I"'w"I+" '+'I
... ,, ,, .. '-
I l &! t


6
269
509
.496
361
295
451
508
425
460
375
328
323
330
253
324
334
289
262
205


Table


showing


number


diseases per year


5Ef


i?:ii:iei;C:ll


'bfae








*ss **, :**9 '.>*X**
il -u l'slii :. .... -:": .=-" ." *"" ., -1 --i, ::-
H a:. .. .. X E ..: .*.
:iia:: .:..." : *e :* .. .,:: .. .. .. ." .
""" ". *::" ...: .. .H.. *. *. : *:
.. ..... i .: ".:.-...... *: .0::-. 1 .. .. ...i
... ** ::. .*: .. ..* ** ..
1 : 1. ... .
.. .. .. .. .. ***. .
'.. ::n"** .. .... ...
........................................ .......... .. ....... .... ..........1
illii. Hihh.* .i ..19
Y" .i H" .* ...""-
..li i ."i"i.. ." :. ," .. .." ... n. r m



iii". ; ... .... ....i... .
i ., ,: ,, ,
*AHL A1
[Hi e hundred a~nd twenty-tour bodies pasdthrough thiaboram-
ElE E. .E h. """"

~*Ait'tn the- year 1923;- 205 or 63.3 per cent were autopsied.
i ..... : .... .







I.. ...a .u at o sy... .. .. --... -... --... ... ....1 8


.: ....i.There.were 50:cases in the 205 autopsies, or 24.39 per


* t whch responded either during life or at autopsy or both in a

P~itve-fimanner to the Wassermann test.


F"l" .tl..". Womsinan teat and pimitive for eyphilitic ion..............
i: irt:. ,-i .e:Wamermann utest and no definite syphilitic leuions.......... .....
S......ma. test a..nd. p tive for yphilitic l.on ......... .......
.: i** .. *
MS-2 ***-f ** A

'r." .lnal"" parasites.- There were 29 cases in the
p :si"i .:: ^" :: "* "
! a ......

i ,.14.I per cent showing one or more forms of parasites
h ::" *i *

..: ... ....,.. .... ... ... .. 12 Oxyuria.......... ... .
. ....... "*- 7Ti h m n ......... .
.I H ... .. H.5 ~
a : : ... .. -*,* *
. :: .. .
Hq'f" :iu '.. "" .


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


205 autopsies, or


or their ova.


.. . ..


H
if
I


",: 1 Lerosy.-There.. were
Ae" :, "" A *
caises of death are give
.HiI! ... "; a se
4n.
LJH*" H
i=H.I H
id =!! !!! : '* :"
..::. :.. .*** ..
' :u .. .r ;:. -
- ,,,, ,, ,
.T^^M id, 6 's Causfe of death.
H i.:o..::: **
: ,,,, ,,,i,,, "i .. l
IJSp :.- :* : *i7 r I' .. .- *~ ^ -----
. .^^^ ":"1 6g 4 Iepro y *.-........-.. .....
^W- g"" "" "" m'Ut T ^ ^
.8 I.ep.....................
.. .o..i.. i Lenprosy....... ...... ... ....
..-.




H.P.
|. : 805 Iepray..... ... ......... ....
: *' 1'

1 :*. 1 .
Bg~Mlr ^ wcopic examinations and
; :X e.. *.-




.".::4 \; :* A ge i B.(p). .. .. . . .
E *:.. .......if oa B ~..... .... ........ ...
... ey idat*
R::?: :p mefomxtrl a ms....... IId|





: *. : *..* g. ..u, ... .
::: \. l I n...... ...........
nB ahrB..... RI......

u. ::...* .o al.. cito .... .:




: *. u...f. ro face..;..... -
: .." ...: h~ l e ".. .. .










EB^" .:: '^(*ESis vett opal of neck-.....
..* .












.1!. SE:Hi: uimneC ~i'ifi'ozza t izeci d. ....***.. .... **

": o. *q er extainaitios..... -.
.... ....Hih l owe.. w....... .







Hilec^ siBtrifram
B I.'". ct' .pfz U .rN. ....t .S.S...
H HHawfroP lifr.I adj.ae. t ti... s.. .I
H. .. .







-...... ... ...... ..........
** *:h.9~ n~~ "fn m?1n i i m..- i i mim
".. ". 1 r mlag.gmmg~immm
. ......e t at. ... 4 ii i Dim d












... ... .... Ra a na..
.... ..... -mh o i a al .


i- .. .---------


S4 lepers in the autops

Sin the table below:


y


Contributory causeD.


Chronic nephritis, psycheois, undetermined.
Tuberculosis, pulmonary.
Tuberculosis, pulmonary.
Chronic nephritis, pulmonary congestion and edema.


reports on surgical specimens:


i . . .

S. .. . i . .
. .. ........... ....... ........






. . . i


. . . S S S*.**.
. . . i


* ... S . *
. S S *
. .. .. .
i i S S 4 i i i *


*. d. .. .. .. S**5 *. .. .. .
ii* i S i h 5
. . U .
ii.. .... .... .... .... ...
iiii i
................i... ii... i.. i i. i


series.


Their









.r* ** : *a* : 4 **: ::..
S." '.*: i'" ..H **" .:::

.". ..." : .; .: :. .. ..
... : .ii:..

62


S* :....

Microscopic examinations and retorts on surgical secifrnes..---ContiuuL.. .


Specimens from rectum and anus..
Specimen from perineal fistula.....
Specimens from cysts of buttocks..
Specimens from skin (various locat
E yes.. ... .................... *
Submaxillary gland (salivary).....
Thyroid glands .... ............
rm ... ........ ............. .
Breasts ....... .*.... .... ..
Spleen . . .
Kidney ....... .. ... ... .
Appendices (27 with female gentalh
Cervix uteri. .. . .
Uterusa .. .. ................
Uterus and tubes....... ........


Uterus, tube and ovary..
Uterus, tubes and ovarie


Tube and ovary (2
Tube and ovary..
'Tube.. ... ....
Tube and ovaries..


Ovaries......
Prostate....
Testicles ...
Leg and foot.
Toe.........


Lymph
Lymph
Lymph
Lymph
Lymph
Lymph
Lymph
Fetus..


nodes,
nodes,
nodes,
nodes,
nodes,
nodes,
nodes,


ectop
. .
. .
* .
. .
. .
.

.


scalp. ..
submaxill
cervical..
axillary
mesenteri
inguinal
location n


. .

ic pregnant






..ry and e.
. -

* -
. .

* .



ary and cel

. .


..ot

iot


stated
ot...her


other


. .
* .


'onus
* .



* .
. .
* *

a)..

. .


* .
cy>
. .

. .





* .


**--------------****







. n -


. .


rvrical.


. m
. .. -
. .. ..... .......


.. -


PRINCIPAL LESIONS ENCOUNTERED IN


SURGICAL SPECIMENS


THAN INFLAMMATORY


Malignant tumors (cancer)


rl ,


""" .. s.,
S ... .. .
OTHER H

** H



il** i .
... ..


l m e i .i l l i i n n i l l i


Nose. .
Face (skin).....
Mouth, lips and
Jaw .
Neck (skin)....
Larynx. .....
Mediastinum .
Breast ........
Stomach......
Gallbladder...
Ovary.. ....
Uterus ........
Bladder..... .
Testicle .....


. .


...
.~~ ~ *
tongue

nn...
. .

..

........ .
* .

. n..
i* .

* .
a.aaa.
. .


* .


Epithelioma (location not stated)..... ..
Round cell sarcoma of gum .........
T.vmnnhmiurnrn. of axillarv LvmDh nodes.


ti.:::: :.r
.*** *.....................:...:"..; *. *I...iH...i
*.. ..*E .. .

*- --* --- --*- -:.- -- --.K".:..:S.
......~..... .... -- -- --..... .... -- --!-. .
.:



< .. ...I ..--




- - --. .... .. .
S . l ..- ..
- - - - -- .
*. .:* : **

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


Simcimenu fromeerotum............


Fetus and placenta....... .
Placentas .......
Autopsy sets of tissue from
Miscellaneous. ...


Total .......


- i


-. -ait "H....i
m ... .m .. ....:

*- *h .. 1.



*- .. ..

H- : -. .
* ...:
t :4: ... .








.- ":il.0
.. ..i... ... .







. :, S !
**** A I .






.. .* ... f. .
*-- .. .Gn
.. 1 .
S.... .. *...








*H ~*.*. "i


S. .E ..
'.

1-



.ii..

: :.. 3.
d .....
H ... ..
.
















... : i..Si.of breast.... .. .
B l~i:::",i ,i|,, nf ......... ... ..
i : *ri". **............... ......




,,,.: ,asa css ............... ......
....' tdaca ova*y..........
S ..: .. ......
.ii i. ...






H.:::" .*s. *., ,.
S. :: ....................
: :. ~"~ .4.








Be::** *' .;:: of ix.............'.



Hi ^abothian cyst. ................... ....
l cyst of labia majorntn.........








!!'.;.;g ir p* *...*om* buttock .......... ..... ..
I .. at. y . .

.amat of air ............ ..
....- ..:








S. Moles, warts, etc.....................
H- .' a taoma of -f cet.... ...
.... a n*so.
.ae:dt, .f.i ., 1r . .





Inthzmn, of foot. .. .... .. .. .. ... .. .


. .


Specimens showing tuberculosis:

STans l ... .. ...... ......................... .

HCervial lymph nodes.. .............. ........
SAsilary lymph nodes. .................. .......
. ... Inginal lymph nodes.... .....................
: .Igui~allymph nodes and fintulous tract.........
,.i Prmetal fistula... ........................
. Aappendi .r ... . . . .
i Inteatine (ileum) and mesenteric nodes... .....

;.. B tmr (wrst)...... ..........................
TberculosiB cutie (leg)............ ..........
.adoametritis and salpingo-oophoritis .......... ...
al.pimgo-oophoritis, bilateral....................
= *ehitia, epididymitis and funiculitis .............

-. T ote l. .i.... .... ....... ....... .. .. .

Qfher infrequent lesions encountered:
*


Conjunctival follieusis (tumor of eyelid) ................. .
ScGiumna o.f tongue .................. ............. ...
S. rCat of vocal cord.. ......... . .... .
: ...Exo hthalmi goiter............. .............. .... ....
Aaceeuorv thyroid.. ............ ..... ........ ........... ..
. roncholit. .... .. . . . .
.. Lbrdenoms of male breast...... .. .......... ..........
, Nei~rolithiasis ................................... .... ..
*.. Ruptured malarial spleen (traumatic)............... ........
S... Caldfed msenteric node... ... .. ..... ............ ..
":. App.mdikel fecalith ......... ......... ..... ....... .. .. .
Appeidiifeted with oxyuris vermicularis............. .
,ystadena o of ovary with pse.domyxoms of peritoneum. ...
. in in ..
.Condylomata of vulva and anal region with entamebic invasion...
' :. Chronic phlebolecleroais and arterioeclerejs of leg and foot with ga


ngrene of footl


Miscellaneous human examinations:


aental blood films(one mitive for E. A.malria).....


. .


I
4
2
1
52
1
3
1
33
.5
2
I
1
2
4
2
16
I

145
I4S


2
2
I
2

I
I
I
I
I
I
I
I
I


I
I
1
1
I
I
I
I
I
1
1
I
2
I
I'
17
+,


245


.....


:::':::


.,,.111111111 1 1111111 11111 '11 I III I 1I1 1111 111


.


TOtg~lLIIIIIIILII II I













































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


The principal diseases encounter

domestic animals were as follows:

Cattle.-Tuberculosis; anthrax; blackleh

Guinea pigs.-Paratyphoid B infection.

Dogs.-Dochmiasis (canine uncinariasis)

Mlarmoset.-Fungus pneumonia.

Mule.-Sarcoma.
Rate examined... ..................... .... .
M us Ml ............. ,.......................
M A a se uadr iin ja........ .. ..-.. .............
Mua arocua .................. ...... .... ........

Rat smeared examined (from liver and epleen). ........
Guniea pis inoculated (from 520 rata)........... ........

Microscopic slides prepared:
Surgical preparations (43 froen)..... ............. .....
Autopsy preparations (83 frozen) ................... .....
Animal preparations (5. froen) .............. .....,..



Photographs taken:
Lantern slides prepared........ .... ... ............
Photographs taken at Board of Health Lg boto ry.......
Photographs taken of lepers at Palo Seeo.........,.......

Total.. ........ .. .. .. ........ ,..


CHEMICAL ANALYSES AND


a --U U-


... ....... ... .......... ..i .. ... "

S L' .:,!
.:* ** : ....
........ .
*, ..., *. : t ." **::"i" i
is
.. ." / *. ...Y:,

red that 'were important ''(

.'
** ...:" : ....
.. .. :*E:
g. .
sl i i.ii

:' ,iM.., :,, i iH. h.
:. : .....!A. *!
Sten.asis; distemper. .Hii.i
:. *-:" *


I .j ***.. .:: : *
i '* : ..-. :

a i-'* .
".H" .-".. E
S. . . ,* ** .. x.. .i
.. . ... ... ... ,.... .. ... ..|:


-- .:,,



. . ... .:.. ..; .., t ,. |

. i i i .i .p i i. n I l l p .- : 'i : i

: *" I .... .i i .l .""
.*"... ,"" JE ,i- i ... i

S.. .1 .. -...
** :. :* :* :ii
...........-.. .... ...... m... ...Ik 1 I"S

.. :: ***.
1; *;llm l =!:-^ "=" l ti H
""" .. ... T.. ........
.EXAMINATIONS MADE"." : .: "." H'..
S .. ...* .. .. ".
Wj.,u ,4


Marmouet...............
Tmkey,........, .. ... :
Pig.. .. .

Total. ...






















:1w.." .
"llliir!liw.':


UlSA J


flux.s


lA-MINATIONB MADE.--Continued.


meor e sa iane apparatus .





OjP... .@i u M e-. ... ...... ... .. *



lr ll.. fa mlthyl alcohol .
.H...... p o w s ..
:. ... ...'" c,. .. .. .,
F :-... S..**.*-a..... .. E..I. .
1,r &, ohmiluld g. **.* *









Ii; .=H. **:., ^ ean m eal. -. . .
d. .................. '


.. ,, ,, ,,*,m *. ........, **. .
'...la........ M jasth .* *.
,ni,1d .e. .i. .







....', ..daiy. e water.....!''''''''''''''' i




S.. *.. f i evaporated .......... ..... .



|M ie vo r a d td t e.at i . .* *.. .*. .
fau. fuozdetectioof awap

;u.. .F. aish.,. .. .


1pml Si Luida neami.nd..a..... *


idal gold........

flH: *:.:. .-- ,


..G. a o .... .
C ij ig j j ....Lt e..JjJ .......

















:. ... .r pi.e .. . .. .o .




p* .:. i : d ete rm.ina.o i... ... ** -
: ...: ; u...ica in.eh.der ni. ide.......
... .. imi-iiei ........' .. .


|..... .. p u m............... ,



" "'.. iti a.deter iti........... ..







!-ed p a .
S. determination.. ...................

,. n., o~ne determinations.ol M....... .. ,
-.. a..in dee" naation.. ... 'ma ..m "**
.. ...












.. H Albm .- Sindetemnatio. .......

!!, :Ana deto nmi) io's....f.- ....... .
Sietne br ie determination.













S.de m nation..... .... ......
fc^'i I.' 1, u.dela g .............. .
,,, ,um mmIh m m















..B. l ""ation ..... ............ .



.....hm e k ...omnitu, .Mer..y n.t fou.

....~l. .....iatomachcne Chloalor

Ic : iik "El: ig~~i~a .".jtma nene ".me or R


." .









. .

. .

. .







.* .




.








*~~~ .



.
.










.m e. .

* .






*v.ro.n* l .


. in .m
. .















. n n n .
. .
" i n. .
S i .
******--**





















- i.


















. i n .
. n i

i .
* n i n
. i i
. i n

. n .
. .- .






















. .
. i i
11*******--



































. . .















. n .
i .

m m n p .

n n i i .




. n n i m
.
























n m n *

.t .fo. ..d ...
. *******-
. ..****
. i *


. I. .
. ****---
. . -
- -
* *
1111111 1







""'11"1
111111 1
111 1 1
1 1 1
111-1 -
11mmme .

11mag1






t 1.11


. -


. -



. ..
--.-.-. .

. i








* -
---------.








. .





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


. .

-------.






.--. .

. .
* .


* .


.. ... *




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


. .- ..


- .







. .



. -



-- ---. .


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







. .
* .






**** .



. .
* .







. *
. .
found .
. .
. .
. .
S.. .
. .

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

found1

. .
. .


. .





I
I
1
2
2
4
22

I
1
1,




II
. .
. .



2

2

1
2


. .. .

. .
. .
514
509
508



32
42
18
24
1







261
42







S
18










I
5
I
1
I
2

5
1
a




I
51










I
1

1

1
1








1
I
1
1


:::::::


-


i.iiiii.i
ii.,iiiD
Diin.iiii
i-iniiini
il.nili.
mmmmiDn
m.,mmmmm
mm.mmnnl
ilmm..mmn
minmmmmD
nmmmmnl
m nm.,im
.immm.
poisons
minm|nm
m|mimn
....-- -

















TaBLE I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES


I ..----
rH
:~xn iij
9k..........
.1.~.*
'I, 'ft."
l.n?.7
H:X

zroaaiiw* .~


I
.1g..


aDEDLUrh 1IUMDUBB.


Year 1923:
White:....
Colored....


'rotla..


Year 192..
Wlhitd....
Colored.....


Totals.


.... .
,...........m m


i-
Cd
.0

00

:Lb0


2,846
8,130

10,976


2,827
7,620

10.447


Discharges
from hospitals.


o
F-


1,179

1,711


1.193


1.457


I

I

Ii


Deadu.,


-3
"S
o


S;
DO
N8
CI
B*
*5


o'I


S
0


8


55.200


12,942
43,546.

560,488


" l-^. :^ ..o!
...... ::. :
..:...:
.** M.:.
.o


S .. .. '- .. .9


S.d.


* .1'Y

~t~.1. H
w I .
~s :A H..le
~jH.S.II.
q.e: ;;I
1tgsniiii


ANNUAL AVERAGE PEa 1,000 EMPLOYmsB.


Year 1923:
White..
Colored


Totals.....


Year 1922;
White.........
Colored.........


Totals....


.........1


186.93
145.02

155.90


197.39
156.56

167.61


169.71
120.79

133.48


179.70
124.54

139.47


17.22
24.23

22.42


17.69
32.02

28.14


6.65


I 6.89


6.73


, l *


.......


.77


Jll.
13.1
18.1

-13-.


C9rl




-4
FI'. Hi
-


.I


.
.4...I *

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


.1.


I ...





*.S "...1
*:..:I:
..:: ,:.." : :a
'".^'.i::l:



...... .. .
"
I. IIfl


." l :""i"i::
*I ..** H:
I ...
::. .
* X.. .J


i





HI -


i.. Hi

-:i ., :.4


t i: A"R .1.
*- : .F: :


1 "
Si




H ."



Hi.

:I.:
ri**A K






ii~fl*~"*
..- :

















Ca


tabubn~
-U"


* *.
* I
* .


* .
* d


-I .-d .-~
*
*


* .
* -^ *
* .
* .


gTa~tv


rl tQ *


*


r~rS


.-. *ca


* .
* .


* .
* .
* *
**
5I H 5


* m
* *
* l ^ 0

*w
* 0
01


* .
* *
* .


n i




~F'










A..
p40:
C,

















&; z





WI
N

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w~





-; "~'


'" 4


S: : .
*** l** *
J .

SI ii ii! I I. : ;


9 i m *
B
.
.* *

S .
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Colombia.. ......
Costa Ri.a., ....:
Cubs... ..........
Deaerar....... ..
Dominica.........
Ecuador.........
Egypt...........
England..........
France. ......... ,

Greece. .........
Grnada.........

Guadeloupe.......



Ita.............
Jreand..........

*ta ... .. .

Japan..... ......
Martinique. ......
Mexico...........


Monan~emrra


. m


Nauau..........
Nicaragua.......
Panama.......
Peru ... .....
Philippine Islande
Porto Rico.......
Riusia...........
St. Andrews ......
St. Kitt ... .
St. Lucia .......
St. Thomas......
St, Vincent.......
pain............ .
Switzerland... ..
Triidad....... .
United States..:.
Venezuela....
Virgin Islads....
Unknown.......'.


I


* .

S*
* *
* .


*
* .
* .



*
*
* .

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


Total.......


* .
* I
. .
* I

* *I
* .
* .


* *I
*
* *
* .
* .
* .


*
* *
* .
. .




* .
* .
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* .
i
. .
* .
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. *
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* .
* .

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


. .


Emjioyne


.Mal., j Female.


*. .. .
i1
i
15
. . .

.... *....















2
. . .





























23


2
. .. ..i
i.. .. .
S. *a ......





. ... .














... .......
.. 1.
. . .
2
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23

. .i. .

- .. .. 1


.*.. .. .. .. .

. .. .

1
2
*. ... .

2



*. .


.. Neniplvea.


* a.. .
1 ~i"


3:
1

1
101

1
27
40

3
a
3
a
2
1
. *. .-

5

4
7
5
2*


*. *. .. *

183
1
16
.~4
6
1
1
323
10
1-
I






1
1
2t
14'

8
I






13
H
I
1





42
6
14

17
II


F~pngln.


*.. .
'3'




'70




4.
1



*1
82

.1



*1
1
1
1
2
.5



1




1




.
1



403
3
246
* .

15








2
a
7
. ...

16
1
1
6


;r~;ii cI"
I AXSX~


Mt


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S .-@ ... .n .


SI


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I


I l 3* .




1.





27
* I *. i
3.




1
18
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2

326
10
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3..'
16

10

8

571

1
17


::. .' i::X" VM
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a.

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403




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7 1


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^*imlSilE* "
w" w X .
c"" Hl


a VH.'-8T483TIC8 REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES.
*4 1 ,


. .. .' .


-I-...


h i ..* ...* .: *
..::.:: ".




ti^NiaM tmn the United States:
* H. .

**.YV ~ *:..? _l sl
m: i:.m l li l


i i. i i i i i i i i i i i iii .ii.....i....i....i.... n........... ii ii .


Annual
death rate
per 1.000
population.


5t"l" % iiW4'4,e s sand children from the United States:
** ** iF .S..n........................ .
S ..l i::"- ..: .... .S .......... ........ ...................................... .. ..............
I..








: i:r emoee frcon thqe United States and thdir families:
.. .j;* H i' .. ."* *.


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






*:!..:'* ... *
....HH ". I e ofAm. children on Sn dIsthmus du ing the ear 1923.i....... ............. .. ...... 123



i;:;... .'.m.talit. among America children. (number of.death per 1,000 live births) ....... ..... .. .. 32.52
:.*: I **... **.......



Wls vua.---sTH AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND-
o: :". .. ..... ...... ......... .....
Hil:l:.:! 7 h hld Births. Rate per 1,000 population.
";... ,,:- Pop45a-




Hl.^:l .i. .- e ti8


m i :* i" :. .
::
........... .


.. '..... y ""t "
...i... n
g. ... : .: .... :." .: ... ....
D*1*.-


* .. .
.. ., ;..U*.


a....



* .

S. .. C
i 4
.


59,635
31,285
31,793

122,713


60,068
31,393
31,098


122.559


:...::.. -* :.I i"Totas. ....... .. .

. ..H.a *.. ..
: iiii" ,, 's ,,
.r::. .... .' .i. ... ...*..... .

l..... .-.... .....
": *." : *,: : .. *.
*** .. -s* *.. .: *
-.i ... "- .. : .. ....... ..
.t "* .l i **:: .




.. ... :. .
- -i* .: -
kuaA JX *UW M t"M ***A* I


r! *i 4 "
.xH .. .
.. Hl H*

I : r .::*:*:: l." .H *b .
... 7 ... .. .. **&

.a*.. ., ; : .. .. .
.I,,,,, :g,, ,


Total.


2,163
748
623

3,534


Alive.


120
39
32

191


TJotal.


36.27
23.91
19.60

28.80


30.14


Alive.


27.24


28.62


Live births.


his's.,


Female.


Total


Deaths among
children under
1 year of age.


Number.


Rate per
S1000 live
i births.


MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA
AND COLON.
S


n


1


I




























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' General diseases.


Typhoid fever.......... ........
Typhoid bacillus carrier........
'T3phoid p.phylaxiS ......... .
Paratypboid ferer..... .......
Relapsing fever..................
Malarial fever, Estivoautumnal....
Malarial fever, Tertian...........
Malaria. fever, Quart. ........ .
Malarial fever, mixed.............
Malarial fever, undetermined.....
Malarial fever, Clinical ...... ....
mea poxle ... ... ... ........ .
Scarlet fever....................
Whooping Eough .................
Diphtheria and croup .............
Diphtheria bacillus arrier......
Influenza ............. ..........
Cholera nostras .... .............
Dymentery, entamebic..... ......
Dysentery, bacillary.............
Dysentery, unclasaified........
Plague............ ..... ..... ... .
Yellow fever ......... ..........
Lepro y. ..... ... ... ..
Erysipelas... .. .. .. .
Dengue.I.... . ...
Chickenpox.......... ........... .
M um ps .... .. .. ... ... ... ..
Hemoglobinuric fever, unqualified.
Filariasis. . .
Acute infectious jaundice (Weil'e
disease)... . .
Other epidemic diseases..........
Purulent infection and septicemia..
Pyenia... .. .. .. .
Tetanus .......... .. ..... ....
M ycoBis, ........... ...... ... .
Pell gra..... ........ .....
Beriberi. .................. ...
Tuberculosis of the lungs.........
Acute milary tuberculoi. ...... .
Tuberculous meningitis.........
Abdominal tuberculosin........
Pott' di sease...............,. .... .
Tuberculosis of bones and joints...
Tuberculosis of other organs......
Tuberculoui of the skin........
Tuberculosis of the lymph glands
Tuberculosis of the gemito-urin-
ary organs... ..... ........
Tuberculous absces ............


.. ... "' ....B .. ": ":': :-" -i' i^=



SEminployee. Nonenployes .^ tf
0 ,,, ,, ,,M- 3 ,,
.. W ite .. .. : I

SWhite. Black. Blck- -Whit Ba
R E Amy. Others .


.. .. ... :-. :. :.:. w ~.
"'...." .. ......::H
10 4 .. 1 2 *... ,.: it.

.. .. ...... .. ... ......*.... .. *.. h.. ."j

.... .......... 23 1 2 1 31 1 .. ..,
1 . .. .t. .......* .*. ..*...
1 .... ..".*... i



2 1 7 :. sp8



95 2...... 1 1 0 385
14 ."..".I. 1 .t t ." .". : "i i ." "".



4 11 1
*111 >1(11 -1111 *11i 2 1 ** A A ** .* -: *'i ^ :!"^^




.. .. .. .. ..... . *:* H
12 .!....: ...... 41 1 ... 3 51 ...... .. .







8 3 1 2 ..11. 6 ......
12 : .i: -..
0 ...... I' ... ..' ".... .'" "...T ".."- ..'" '""'" '" "
2 .... .. ..... .... 1 "' 1 '" .l E S* i
1 ****... ..



-. I .. .
1 1. ..... ... .. ...... 1.. .... .. ..... .... ,
so 9 I s I I' /a s I H .. l .
.. .: .: .i -
11. l .. .. .. '




...... A...... H....... .. r



S 3 1.. .. .
S4 in I a .* ..







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3. ..... .. ..... .. ... ... ... .. ... -. ."
1. .. ..... ... ..... *... .. ....... ...... ***.** rc...... .. wj.iIH:.i.
1 ...... J. 1 g ....1 ., *F1 .
8 ..... .... ... 1 ...... *. ... .. ...i

.. .- 1 r : : :: t
._- .. ...... ...
S ...... ..... ...... ...... ... ...... ....... ..
. . . ./ .. .. *. s *. ..... .... ...




*. .... ,, ..... ,*.. ... ...... ..... .... .... .. .


.. 1 1 .' .
......... I',.. ..... .. .. .... .' : I. .. ..l.:. ..'. :..:,,.-....
.. 1 1 ... .. .* .. **1 .... .. *.u *
1 ..-: l. .. .










.1W.




ti.






I. ... :7..
iti.:.
HI


:.b.:.
."

..HI
H.


TamLB Xi-CASES TREATED IN HOSPITALS, 1923.--Continued.


a,'-.~b


l disedaea.---Continued.


Gonocoecus infection-Continued.
Goncrbearl bubo...............
SGounarrheal ochitie and epididy-

oimaerhel ophthalmia.........
Soft chani are.................. '..
Adenitis dbancroidal ..........
Cancer and other malignant tu-
more of the buccal cavity.... ..
Gianer and other malignant tumors
Sof the stomach andliver.... ..
Cancer andpther malignant tumors
of the peritoneum, intestines,
te tum .. ...... .........
SOUaeer and other malignant tumors
.of thefemale genital organs...
Chncerand other malignant tumors
of the breast. .........
(aner and other malignant tumors
..- of'the akin... ................
Canes another malignant tumor
o. f other organs and of organs
.petifiod..... a.
.-. Other tumors (tumors of the female
genital orgaiis excepted)......
Acute particular rheumatism.... ..
Chronic rheumatism and gout.....


Art


1mph


Anumi
Ohit
Ann"i


rtia deformans... ......
t.m i . . .
tnhi..lmic goitre ...... :......
EUkanial l m p h .. . .
ia mphati...........
ta- chlorosi ................

ter nJ.ed ................
general dia6eeB...........
lrm (acute or chronic)....
boliasm, acute.... ........
li n, c ron ...........

ioead psoing.m.t.........
brai oecupabional poisoin-
Sha it........ .... ..... .
ighalic ...-... ....,....


Bum..a of te ,sewrsP~4n qata nd of
flu mg-. f sid Mule.


Panama Canal Hospitals.


43
0*


9
6
151
12

2

9


2

10

9

1


2

19
11I
6
2
19


13
5
.
.3
.. .
I
"1

4
II1
9
g
11
5
4
2

1
1
. .... r


li&Iitim I '


a


'I-


. .






1

5


1

5

1
.5
.


I

5


1



I

. .


Employees.


White. Black


2

4
. .


3

29
2


Nonemployees.

White.


Army.





2



58
7


.....


. .

. .


Others


3
I

. .3

3


I


3

3
2
1
1


3

.... i.





I


* n


enon-
residents.


Black. I W~hi teIBiack.


m. .
. .


. .
m


Santo
Tomas
Hospital.


a
a,
0


4

3

1
I


6

.. ...







. .


3 I......


--


m m m m








--












































































Dhueaamua f thu lruphat'ouystem. 14 [....... 8 .. ... .2 1' 2 I~.
Hemnorrhare; other LisLL of the .....: ..
circulatory aystem....... 9t E:I .... 1....
:ol e d ,.%~... .... ., g.:
*** .jr r



































H+:..A *...
D i. oft.e".I......Zju....'m+

..,.. ..... 1,5 .+.. 0"1 :. *..Y : s. ..I H
Diteau, of the .aa.lf-- "....... 80 :...... 5 10 88 16..
.L.:mlrv"w: +.
r- n. .s a e
nlka ~ ~ + +iP..~ )Pi,,.I''' 1': i




































Diseases of the naml foam. .. 80 5 10 88 12 1 :: 6 -... ., ..
*. ". :::.. .:*
..................s... ....== =us... .humm:m =www=>",, .....=*"
thk.... &m.... nt the inewnw --- .. .:: .--. 14



















V




H.1

*d ****ath **d *** .**:.*




.~ i .. ...,...



. ~,.a'.: ......
: ..- l :**
a. ...... .
.-. ........


..: .*Llk1..Y- in taespags.

,,,4.: : ***


....'l ..lll.


a~i~i .bfthe .tam~a h ~an

**;Pof tahenteritia (under a

a { a), o..
.... ~...... ..........
deuteritis(2yrlearand



i ... .... .

... ~basltim. ...............

,..nu
S,, -i. edi d),.......,
.... :mr,.,,.........,,... ...



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


4.1.p 3It. i t Phi ..*
.31 ita .. ... .
**ia *..*.. .....
*. ... ... .. .

dbgfruotion. ...... .

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

..s1~ph of bh-,..

........ ......
...V45&Ulir d.hl...h......
.r. ..............


*. 2,*
pad -
...... .l.a..... .. .


* ..


- Panama Canal Hospitals.


79
31
31
.3
11
a

1

88
.......
109
10
6


1

1
2

.8

2l
-23
1


:
.8


'a
.4.
.1

0


1


. *


Employees.


White. Black.


I

4
... *.-
44
*. .


3

.i
1


a
4
1


*. .. ..


10
"io

15

6
1

5
2
S

. i .
1
. .

1
5

1
J li


* .
*
2
22
1
. .
. ..*.i
1
4
-1
I


16
I

7
*. ... .
. .
*. .. *
8
3



a
*. .. .
-37
* .
* .
14

- ..

. .
* .

2
. .
. .
1


?Jouemployeue.


WhiArmy. Other

Army.l Others


6

12
5
75
*. .
.. .
1
* .
I


a
3
a
2

. .
. ...


25
... .. .
27
. .
3
3
. .
1
7
1

*. .. .

5
8.
* .
1


15
14
11
1

4
. .


22
30
80

3
I
8
. .

2*
* ..



6 .
4
.
2


ron-
realdenta.


Black.I White I Black.


2

2
2


1
. .




4
1


17 13
7 ......








..........
7 .








" ... ... .. 4
8 7




...... 2 .
I I







Si ...
8 a
. *. .
19 15




5 1



2 1
2 5


2 12


2
21 2





3 3
1 .. .
4 1


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n
.)


221
* .
na
6

132
3
. .




10
*.

*. ...




70


97
.
80


. .
119
971



283
*. .
177
. .
. .
*. .. .
56
. *

. ...

11
21
. .




9
5


W

2
'a










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S.


I......
* ., ..






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1
. ..



*.' .



5
. .
. .
.. .
. .
* .



2

1
i
2
12


Sanrta
Toma.
Hospital.


on,..


|


I


I


~Y~Rita
















T.aB. XI.--CASEBS TREATED IN HOSPITALS,, 193.-


Di-.ae


Nonveneral diseases of the gemilo-
urinary system and annao.-
Continued.

Diseases of the prostate... ... ..
Acute prostatitis.... ... .
Chronic prostatitis...........
Hypertrophy of prostate .......
Nonvenereal diseases of the male
genital organs. ......... ....
Hematocele.. ... ..
Hydrocele .......................
Uterine hemorrhage (nonpuerperal)
Uterine tumor (noncancerous).....
Other diseases of the uterus........
M etritis. ..... ... .. .. .. .
Cysts and other tumors of the ovary
Salpingitis and other diseases of the
female genital .rgans.........
Non puerperal diseases of the breast
(cancer excepted)......... ...
Benign tumor of breast.........


The puerperal state.


Normal labor ....................
Accidents of pregnancy ..........
lEtra-uterine pregnancy. ...... .
Hyperemesis gravidarum.... ...
Abortion .. .... . .. .
Puerperal hemorrhage .......... .
Other accidents of labor..........
Puerperal septicemia ...........
Puerperal albuminuria and con-
vulsions. .................. .
Eclam peia ... ........ .......
Puerperal phlegmasia alba dolens..
Following childbirth (not otherwise
defined)............ ......
Puerperal diseases of the breast....

Diseases of the akin and of the cefu-
lar flssue.

Gangrene. .... . .
Furuncle ................... .. .
Carbune le................ .. .
Acute abscess. ............. : ...
Phlegmon and cellulitis........
Trichophytosis ........ .... .
Scabies .......... . .
Pemphigus contagiosa...........
Elephantiseis...... ..... .....


Panama Canal Hospitals.


ad
4-c
Cd

f-c


.. .i.
3
1


3

*
o
E-


......


Employees.


White. Black.


1
. .. I


2


11
1
8


Black.1 Whi


6
. .
5
4
30
46
1
9


lNon-
ri


Black.


. .. .


5
* i .


1i


.


.. .. .
1


4
. *. ..
2


. .
. .

. .. .
......


0 theM


*Ss^ .::.N:.::
...HvI

Si* i:


a
gol


37..







210

65
. .


ii,~r




66
2


I:

*:


- (.
* .. 't !F"
H *.11
.. N

Ki 4.'I~ii
:H I




* .z
Hr
.:.. -
h* .*:.:
HC



*i ..:.q

iie



I.,.


*


..... 6 8 ...... ..... 1 .. ...




. *.V. 5 2 .. ..* .* ". : ::.
--i H ... H

.:.. ."

2 .. ...
4 6 3 2 -.. .- l -i

9 2 24 6 3 138: .. l
0' 6 16 1 .. .*..4. -
S1 .. .... .... .. ..'. ..
1 1 1 1 .. .. ::i
... 1... ... .... .. ."..-... : 'j-


I
ii:

I


Nanemployeee.


Wbite


_


* H -Jr : '*. ta !.

kr

Hiir: iH

.I.
... H .,
-'4xI











85


TABtn XT.-CASES TREATED IN HOSPITALS, 1923.--Continued.


Newborn child ......... ......... ..
.Cngaital debility, icterus, and


, Congeaital debility.............

otherr causes peculiar to early in-
..,, fancy includingg various conse-
" =' anencd la a bnr)............


Panama Canal Hospitals.


82



52
I
9


11
2
38
a
3.


40




93



4 11
4














6
SI

5
I .






E-






I

. .. .
aI





I
1


.* ,
i i* *
* .

* .


.




1



9

19


7I



a


adp-y poisoning........... ...... 2 .
eifd .. .. .. .. .. ... .
Badieby. food ............... 9 .....
ioaum.bhites and stings....... 1. .... .
ajiute: poioni ng..... .. 12
ae Mixt^Q ddelefarion gases
(eofiuation ecepted)...... 5 ..... .
mnastar by rearms....... 14 .
as ".tia csitting or piercing


Employes.


White.l Black.


4

3
2
' pl~


* .
* .
* .
* .


. .



* .
. .. .




* .
* .

* .
2
6

. .
. .
I


a


3

I

12

'3


PT


S* 3


Nonemployeea,


White.


Army.






15


2
* *


.
.



I

.


Others


12 j


1
1


1




5




Is8



191




4


2



2
i l n


1

I
1
2
2

. .


Non-
residents.
n


Black.I Whitel Black.


12
. .

2
4

2
11-




11




58



220

3


34


11



5


a

2



5



2




1'


* .



1
* .


. .
4
B


Santo
Tomas
Hospital.


2


35
















15
3















3
* .


* .

27
3
11


















28
23




35



975











15
3





*. i


10
27



1'A


0
4I


'69

I



6



I


*


r




































































no memese .... ....... I. .. .

Feigned diamee. .... ., ......,...


. Totals.. . .


7.781


582 1,194


].181


.. .


* 1 .v .


r4.
h..i
A *l


*.ii~iH
.14



*::AH..:
I.
H*i' fii








II ..: i r:i




;d -i H.Er.



I i. E.::..
.M '' l
ii .....
flu.:
::p:iw'
H H


IIIc
"'V I







:1.
HC S
**H~F i.H Hli.: =


:



























* =. I~ *
~~.*:* qj
*~1hl~
I-....
.


:4. '-1
if
-


^i..:' .. .. ^ **"*
*.:* w* **! .
inIt


Iii i lb/a
-*!* s !s .
;. *S .* *%




*** w as *


1.9





r


tnt
H~l


.:.H.1:


:F&. .| y


L%

*I


QeI! r

As
1Ei


4


- r~
SI..W


-S4~


h
. *


P *
mm


04"P *rt.-
A-.c


-CMI


*


YEQ~


'-4 0


-4 lC


wan P


O4D C'1e0
t


w .aQcqaO
*r


*
04 C~ *m
.04
*
-
*
*
*


'0~ l C C
1~ *010l
-r -to


oa Onco
- w-- *4
*


== I .. =


O1 la
a~~0


*aqI
ac


C .aok--
~rc 4


-- ..I I


* 4.


S


rAq o*.-l*
4O~
*r


a,
C &c


,r ~ '--
ehI1j
*
b~caa I a

At- M~
S. IrP ~ .fL

3-.:>.~P

A


@0


-* ..' --.':- w n- 1 1 II .


-I OOMCSIQ
*Cq r-
m .


. -.,- ,


C~ an n '


I. IiI l'' ~ I


Q CD CO


.-c.2t-


4.O 0041


00.-. N 04
rlrcn04
-r rla


*COCO
*eoooc Q
* O


* -4


*M
*taqow C


eIl~ .cl
-I


k-c mornr)


morn-9
eq~8
-S -


M o '""'
- .o n-,o


* Nt- ha
..oc cD


:.i *r =qc *ct -I rlNL
kC *CC CC .. ON 00

.' -. ', ~I ,


0 .fl-4
cCt@OG


- II


o *040


- N C**
*~ C^ O 0
-M^


.1 ,
*f


I:


~I __


I --- .. .. ... ~ -~ I


g


mm ammm


I


~IP~ N
I C4 ~ rl


10 N~


fo


r,, ,, ,











:88


'I.'

11'


.. TaPw XIII-NUMBER O DAYS B HOSPITAL TREATM5NT1fiB
OP.PATIENTS AND AVERAGE NUMBER IN HOSPITAL.
i ,,, *.,,, ,-. I


Chsuufwmptient.


Ancon Hompital:
Employees..... ,'......
Army and Navy.........
Panama Government.....


Charity..........
All others........


Corzal Hcpital:
Employees... .. ...
Army and Navy...........
Panama Government.......
Charity... .. .
All others,...... ... .....


Total (insane)..


Cripples ........... .. .
Chronic medical and surgical cases

Colon Hospital:
Employees . ..
Army and Navy..... ... ......
Panama Governm ent............
Charity ...... ... ..... ...
All others.. ... .. .


1alo Seoo Leper Colony:
Panama Governmenl.......


- .


Totals......


Totals by classes:
Employees.................
Army and Navy.............
Panama Government .........
Charity, cripples, and chronies
All others............. .


Grand totals....


Number of days treaeien


*Ajn4i


cap,


19,772
... .. .
2,500
11,222

37,402


2. 6. .
278


* *


503
1,793

4,286


4,352
21,594


42.790


Foreign.


3,088


11,078

15,302


27,374
1.617
1,411

31,000


43
115
1,123


1,509


1.887


3,914

29,349
5,048
13,612

51,923


Bla4l


25,480


4,977
26,252

56.895


87,442
14.911


113,.823


9,434
8.297


5.356


17,542
0,884


27,426


30,504
12
it,529
49,035
39.223

224,303


*Ttal.


32.476
19,772
231
8,508
48,552

109,599


. 4,453
276
114,816
16,668
9.801

146.014


10,789'
9.167


1,841
1,558
402
2.150


14,223


I19.420


29,318


38,.70
21,606
134,878
57,226
86,625

319.105


,..::ixii Ut!.


2**i l* .,.,.
;APi ~~. .... .. .~i~~ii~


10-fl
14,17


102.47


.i76

.38
2.12


1.22
.4.24

1.3891
4.91

11.75


11.02
59.16


S37.78

117.48 I


S -

. 8.40,

'"^12i -


4ll2g


Itae.


- -<(r1
* *^ $A l Hi


~71 *.4.

155.10


_____..,i


75.00


. -. .
.12
.32
3.08

4.14


5.17


10.72

80.41


142'.26


=... ..-'i^
... .fafri~i
^^^iiE^HxI1
1' ..
.t:f
.
.S.
*I
...


2 .Bi. .
40.856..
20.56


i 25i5~
22q78


48 .06
i 27.08


'83.57
.053
289.123
154.34
107 46-

6<4,.3


' These cripples require no medical attention.


~ei~-..III
H*::i


I*I. ** i
.. .. .....



A il




.... :I j .
* .. H,



,. 4...:" I i
:- ,, i,
::"* *:


TABLE XIV.-REPORT OF DISPENSARIES, 1923.


. .H, .,
Si,,,,:"


EWx.rOE TREnJ iAiD I QUTABB~E


Place.


Remaining
January 1,
1923.


Admitted.


Disohnzged.


Tram xac


I I


Ri lOit H~
4%ah~ -


I. .. .


....B.B .. .


1111111111111


I


,;R


~pp~- i
I


TOt~BIIIIII


Totals,


ChariB.


... I




S.H. .-F:" 4 ... i ." .. .. .... ...







.rr "!"* "" i ." ..t urnihed quarters each day.
S *ite. Tota* ....t Bk .a l,
.. .. ..* ..I .
:." : .4. *. : : :B ** .. ..6 .5 0

560 1028 1,588 13 2 82 4.35


















l'... 191 196 387 52 .54 1 06
.F .. .* .* .


.. Total.


:Bl.. :r ................... ........1 235 1105 22,310 11463 6,030 17493 .698 17,105 39803
...... ...... .... .. 3 3 10258 .031 353 5512 8865 7,126 15,70 22896






.y4miBh tetw. Days treatment furnshed, in quarters each day.

.44. r" .. White. Black. TotaL White. Black. Total.

.. .4..".. ............. .. ...... ... ...... ............. 1 813 2,548 4.361 4.g7 6.gg 11 a
S.H...a s 955 416 2371 5.36 1.14 6.50
So ................... ... 920 14,009 17 6,487 12,825 1,589.312 1.530,407 2.82 4.35241
... t ...- ... ... ..... 2. 9 1 196 387 52 554 1 06
.....P... 1221 7 3.34 18 02 21.36


T.otal.... .......... .............. ....... 5,740 10,765 16.505 15.72 29.50 45.22





SP... aEmploye. employeey. Total.
S. White. Black. Total. White. Black. Total. White. Black. Total.

......................"... ................ .,39 i1,uoe 18,307 4,616 12,990 17,606 11-015 24.898 35.913
.. ........ ..... 11,235 11,075 22,10 11,463 6,030 17,4 22,698 17,105 39,803


.4 4 .......................... 3,773 10.258 14I031 3.353 5.512 8,865 7i126 15,770 22.896
+htvbal......... ........... ....... 3,920 14.000 17,029 6,487 12,825 10,312 10,407 26,834 37,241



l *:.... ..* m a a


Tat.L XV.--CONSOLIDATED ADMISSION REPORT, HOSPITALS AND DISPENSARIES. 1923.


All classes of patients.


Adnilsmion to hospitals, excluding Corosal farm, cripples, and chronic ward....
Itnjuiiaion of employees, to quarters..........................

*.. .--.. Total admissions to hospitals and quarters.....................
*.S number of patients transferred between hospitals and from quarters to hos-
F, pitals, whose admissions are duplicated in the above figures .............


Net admissions to hospitals and quarters...


Employees.
: employees admitted to hospitals ....... .....
Employees admitted to quarters...... .. .......


..... .


1 Total admissions of employees ... ..................... .......
' eIi number transferred between hospitals and from quarters to hospitals, whose
II. .admissions are duplicated in the above figures.................... .. ..

..4, Net admissions of employees ................ .. .. .

r::'" A' nual admission rate per 1,000 employees to hospitals and quarters......... .


White.


6,267


2,784

978.21


Black.


5,915


5.462


2,665


312.05


Total.


12,386

657

11,729


5,321

484.78


~vuu.eu
l.a..
ItIL C
frH4!I S
...- *0~
Ill. -~.


NUMBER OF DAYbS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, EMPLOYEES.


I White.


Black.


p Total.


. 1an jn


tli~ tX .


" "'


e n TO


In I


























































Blod corpu ies...... ..., .. .. .... ., ..... *. .. ... .
Sm and oo. .... .. ...... .. ...... m. *.. .pm..*.*...* *mm
P. B and muh u., .. ... ....................... .. .. .. *.....

Pun, blood and mucus..... ..,... ,..,. .... ,.....,... ,. .... -........... ..
Guaiac test for occult blood............... .... ........... ....... ..
-.Uriue exatiiii ationB (total).... .. ............................... .........*...... ,..

A ce. .. .. ............ 1 .. .* "" "

: R .. .. .. ......" ...*............. .'............ ........mI il mm




G3 aia1e r f0r Occult blood.,... ; .... .......:.... ... ........ ....... ... ,
S. ed im enta .......... .. ... ... .. ..... .. .. .... .... ....... ... ,. ... .
Epithea5 cells..... .... *:** ****:
*. .
SB lile ..... .. .. .... .. ... .. .. .. .
yaline i st u a........ -............... ...... .... .. *..'.. .. .".... .... ~ ...... -. ....
l cellr ;. '- i- ... .. ..*.. 0,"
G ranullar ca t .. .....',;. ... .. .. .. ... ... .. ... .. ..... ....:. .... ... .. ., a.


Pu cas..t......... ...
IPIB ceJID... ..... .
Red blood corpuscles... ...
Pus and blood...... .....
Gonococ Ei ................
Tuberle bacilli...........
Hexin crystals...........
Functional kidney teats....
Sputum eauination (total)...
TUberDle bacli...........


S* a

. ... .
. .. .9 .

4 .* .* I
. .

.. .
. .. .p
... *m*
mmm*m*m


. .:h : j*. .

r 4 A "*

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

m.. .


* *. .. S

. m
. .. m.


.


m mlll l Siml 4 *

S :. .* ... .
. ..' 4
4 m N ma l



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


* ~ .
m. ... m ....


...lll... ..


ji *- b' *.q *. 5..4 .

* S -... .
4.

. ... .... 4.:.* **
* ii.. ...
m h m ... ,m


. .. m .. .m m m m mm I

. m m m *la l : M. m

. l.. .-. k .I I. .:


. ..p .1
.. .. .4...
* .. ...
N. q .."
* I. ,
- *'-L S* ^*








* 4 ^*%*A
s......,




* :. q x4
-. .. ..


* ,
. 1 ..- I.:
. lil


. I
. ':5 .
4..
.*~. ..
-S....
* .~.. *


t4k
. .*. .
.. tiS.- ih%*
* S I~ ** *
S
* .
4


::~ot~' 'k


* .. ii
* ...Hq* ~,p "s&7
* ha~.
814" t'~
V
glMpj.
1,0w rr
*. :i:as
4~48?
*1.8I5~

khV

*ti*ig
H
* .aasao~
miv 4fl.~
eq
I.IT :at.

*a
N.H






'$1


8,111

'Ii
4*1


SHep t. o u s ., m m



B .
:** .Pneumococu ",, :
C ell counts... .... .. .' ." ..... .......... ...... ...... ...,.,"....- .,-..........*.=.. .:=




Urethral.--:. :.. : .. . .. *. ..
Va' init*" "C: ^'.iB*"t S
__T i,~it -i.* .pi. .... .* ,. *. : ..:*:* .U E

E es. ......... ................ .. ..........., ... '. .. .. .: "j .".. .
mlsm i i i m m i* -l l lI .
R m i. r. .. .*. ; "*... ** l^ %'_*.!i


Bpinal fluid examinations (total)....
Sears of sediment............































Fi.
~~;~I. .



!r.
'rK i
It~'I~iii i


*.g'.g l :c *''Am m m* *, ,m ** *, ,
i ,.. ... *


.a t..ji..B. m ltip... ..
misltojdigitB kmultiple....


. lnh la... ..S...q.S.S
manill. ...i.. I ....
h p i i .
ractures saimple......
ra otres, compound..
y, ezplatoay. .....


, dobigle....
, double, *....


ra --.. 'ir elIZlq....s.

j Jfguinial. mingle..;.

H*H~ H -ai-nf- -"-Un
Swam muactd


H. H...111H5-
.. ..
H. H.. H..
: :. II. *



a Hi
IvlrI~i
HI


Ia:.,

'P IIH.

..V
H~iii


6wmj, internal..i

*.rmdiaaloure........
.1w nwo ~lr n~aI ir


S...lS.t4oe. double, radical cure.... -
.. 'rsde.tomy'......... .........
!! : ~Epididotomy.................
.lrlial t ieeetion of bladder.......
.ae tam .. '" ... ...... .. ..
4;..ii:,Amputstiau:of erotoum..... .....
:.: Apuarwa on wf pedie.U............
:i..- ila"ut of penis and scrotum..
.. !:... Cf t ee uteri.. .. ..... ........
~ a.ie~t e ........ ........-

HY ih I Si.... .. .... -
....o-". ..... .... .....

I.. -tie:tbGcOa drainage of,


n aB ltioedn...... ............l.
5 foracep,...... .........,i.
' ,. .... ,. .....,...
irogtL. '.:, ., ." .. ... ... ; I.
.. .,*, ...,., ,. *...


.f. uu.. .ii& .he., .
I ,aMd. sils..


Anoon
Hasepital.


.: .....L.. .. ..



.. n ::- ..::. : .


Died.


Colon
Hospital.


Number.








3

3




. l


5

2
. .


Number.










7
1

I

16
2
I

39
177
28
7
4

89
9
9
2
I
1

. .


9
1
7
8
21
2
8
88
1
I

9


157
24
2
4
12
7
248
. S S .

5
2
6
.
45

I
4
i,


Banto

HospitaL


Died. Number.


4
2

6
2
1
1
21
1


3


a5
2



153
25
7
2

11l
45
25
4
10

3.
'5
2
41
13
9
29
1
10
11
* -
4
4
7
1
107
7


*. i^
* -
~1
.*U
j


4

I


13
IS
2
3.

1
. ..... *


I








H 4. .


TaBs XVII.--luadRlOAL OPERATIONS PEBJORRMOED.-Cputinued.


General-Continued:
Plastic operations for tattoo remove
Plastic operations for effects of disea
Nerve stretching .................
8kin graft ................ .....
Laparotomy:
For general peritonitis....... .....
Intestinal obstruction...........
Exploratory.......... ...... .
Gastro-enterostomy...............
Gastrotomy ..... ...... ........
Entero-enterostomy ...............
Enterectomy .... ...........
Appendectomy.... .. ....... ... .
Appendectomy with local peritonitis
Appendectomy with general peritoni
Calostom y... ..................
Cholecystotomy..................
Cholecystoitomy. ...... ....... ...
Cholecystectomy ... .............
Choledochectomy.................
A bscess of liver, laparobepatotomy..
Abscess of liver, thoraoohepatotomy
Pan-hysterectomy .................
Splenectomy ...
Supravaginal hysterectomy ........
Hysteromyomectomy..............
M yomectomy ...... ..............
Salpingectomy, single........
Salpingectomy, double............
Salpingo-oophorectomy...........
Ovarian cystectomy...........
Oophorectomy....................
Plastic operation for chronic peritoni
Suspensio-uteri .. ..............
Ectopic gestation ...... .. ..
Enterrorrhaphy .................
Rupture of spleen.. .......... .....
Rupture of liver .............
Cauterizations ... ............ .


Ancon
Hospital.


Number.


I .
ae


5,824


Died.



. *. .. .


. .

1
*"i.





. .* .


Cole,
Hompit


Number.





mm,
* *. .
*. -. ... I






1


.... ....
J2


12
4







13
* .











1
*. .















8
1







3
6
* .*
* -... ..









"""i"



* *






8

12
* 6.1. .







61
*. .. i

*. .

t61 .


1,021


*.:i .N


hi.i


O `TW~'HI. '.;



*id H *ti:.l

Hi.


.Tans.
fl.aata.J~I.ai
AMW4M"flYi HN
__ __ H H
III~- *llj.


*. .
11
II
1


I
3
5
4
2

1
150
33
9
1
1
10

3
5
4
8

56
8
3
12

'.'"20"
10
15
a




51
S7
4
12






110
2,637
12
1,469


2,846


-.. ...g
--

!:' .. .. a
S .. SS





. :.. ...
...


i: .. j

..
..: ..i








...i:




.1 .... I.
.p* .....: *
".. i




"".
S:: .






*"ai i.










:: K. :4.:E
E j. .. .
NJ ....



V .
N .ha


i ..: iFi

:: .. N** H:: "


.- *. 4


1.
29
17

1 1:
Is
'46

: 8
&..
4..
2.
4
37.

S2
S
.f .
SI
<36
11
50'
9
2.
go
90


.0..
108 -.



155
.; 82.
.


1. .
..8

* ...
S


. .. ....... .
* .. i
59
.


..


. .
. .


. .




tiE.
*

*. .


.. .
* .






.. .
. .


. .
tis.


.. *
.. *

. .

. *
. ..


Arspbenamin, intravenous
Major operations, various.
Minor operations, various..
Salvarsan ....... .....


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

.. .


I


....nemmn


Totals .




* .d. ". .. ...
-

N n n
:E= :n n *
n.. n n .


ii.i


..fl~l.... -



Hi..



.I.
fliii -













r H~.
.flH. jE


















H *.... ......
It,.


-.


n n.1n
HIn


TVIII-OPETIN I THE YE, EARNOE, AND TROAT CLINICS.
TABL XVIU-OPERATIONS IN THE EYE, EAR, NOSE, AND THROAT CLINICS.


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

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

. . .

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


3aBulotomy. ...............
ataract .extractiona-
SiS..e ....
Combine ed..................
inearz....... . .
:halasion, removal ....... ....
ulterior chamber irrigtion.....
inlfeleation...................
foreign body, removal... ......
Iordeolum, incision ...........
omrneal ulcer-cirettement.......
ridectomy.......... .. .... .. .
Para cen teai .. ..................
.achrymal operations--
Dilation of ducts .... ......
Extirpation lachyrmal gland
1id operatious-
Excision of tumors........
Plastic ............ .......
'eedling. . .
Pterygium ...... ..........
future of lacerated eyebrow.....
renotomy.* ... . .
minor ... . . .

lruncle, incision ..............
becems, poet aural.............
Foreign body, removal..........
Maatoid operations-
Sim ple........ . .
Radical... . .
Parscenteaie ..................
Plasti.. ...... . .
Polypi, removal............. ..
Excision, mole, cheek ..........


Cauteriation .............
-:: -Foreign body, removal ........
Polypi, removal.': ...........
.. Rhinoplasty..................
j... -jt m . .
.. Ethmoid, simple...........
:i. Frontal, simple ............
( ". Frontal, radical...........
Hllf Maxillary, puncture and irrii
.i Maxillary, radical .........
::;. .. Maxillary, drainage........
- -ubmucous resetion...........
-..; Turbinectomy..... ..... .....
M inbr eto. ... . .

... Prip illi ab e, nion....
... ..: a d loectm y ................

** ..i .
la:::i.: oleotcy...... ....... ...
..ino. .... .. ... ...

SFreign body remove. ... .. .. .

f Exploratory operation of trost.

F:- foreign body, removal..........
ST ac l omy........... .......


Ancon
Hospital.


1

2
5
5
21
1
7
47
4
1
I
8
1

4
1

1
2
2
53
1

1

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I
7


1
2
5
11

3
11
1
28
7
1
41
19
8

424
23
655
2
4

1
1I

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I


Santo
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Hospital.


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TA~zw Xl-SANTO THOMAS HOSPITAL, STATISTICS, 1923,
PATfIlTBEs T a .
i i ^ *


Clase.


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treated.

1,080
09,115


10.140


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HOSPITAL, STATEMENT 01 00


AND DISCHARGES, 1923.


SCOMMITNMNTS.


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. .
. i
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. .i. . . . . . 43
~~. ,..


Female.


18
.. i


46 33
7 5
. .. .I

97 58


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of birth.


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. .. .





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Improved.


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1
1
1
1

1
6

. .

1


1


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1


30


Female. Male.


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' '8




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.. ..... .


2

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28


Female.


4


TaBrn XXII.-FORCE REPORT.


December 31, 1923.


Gold.


4
. .. ..-.ii-

8
27
132
20
6
1
4
21
12


Silver.


22
146
71
220
34

36
02
89


Total.


4

31
151
86
347
57
6
35
94
104
17


Unimproved.


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UNIVERSITY OF FLORIDA
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PAGE 1

-* I n~ 14 WAA Y~ n3 a~a 44 *e j k 1A

PAGE 3

REPORT OF THE Health Department OF The Panama Canal FOR THE CALENDAR YEAR 1923 ZONE H. C. FISHER Colonel, Medical Corps, United States Army Chief Health Officer THE PANAMA CANAL PRESS MOUNT HOPE, C. Z. 1924

PAGE 4

For additional copies of this publication address The Panama Canal. Washington, D C., or Balboa Heights, Canal Zone. 2

PAGE 5

CONTENTS. Title. .Pae Operation and organization. .5 Personnel. .6 Vital statistics regarding employees only. ....10 Vital statistics for the Canal Zone, employees and nonemployees. .13 Vital statistics for Panama City, employees and nonemployees .14 Vital statistics for Colon, employees and nonemployees. 15 Malaria. ...16 Mosquito control. ..17 Antiplague work. ..22 Fly prevention. ...22 Typhoid fever. 23 Infant mortality. ...23 Physical examination of school children ..24 Health Office, Panama City ...24 Health Office, Colon-Cristobal. ..26 Quarantine Division. ....28 Ancon Hospital. ......33 Corozal Hospital. ...35 Colon Hospital. ....41 Santo Tomas Hospital. ....42 Palo Seco Leper Colony. ....45 Board of Health Laboratory. ...52 Tables: I, Discharges from hospitals, deaths, and noneffective rates for employees. ...66 II. Causes of deaths of employees by color, age, and length of residence on Isthmus ...67 III. Deaths of residents and death rates 6f the Canal Zone, and the cities of Panama and Colon. ...68 IV. Deaths of residents of the Canal Zone, and the cities of Panama and Colon, by cause, sex, color, age, and residence. .69 V. Deaths of nonresidents by cause, sex, color, and age .74 VI. Deaths by nationality or nativity. ........76 VII. Statistics regarding American employees and their families. 77 VIII. Births and birth rates in the Canal Zone, and the cities of Panama and Colon. 77 1X. Infant mortality rates in the Canal Zone, and the cities of Panama and Colon. 77 X. Deaths of infants by cause, sex, color, age, and place of residence. 78 XI. Cases treated in hospitals. .80 XII. Consolidated hospital and asylum report ...87 XIII. Number of days hospital treatment furnished various classes of patients and average number in hospital each day. ..88 XIV. Dispensaries. ......88 XV. Consolidated admission report, hospitals, and dispensaries .89 XVI. W ard laboratory reports. ...90 XVII. Surgical operations performed. ..91 XVIII. Operations. in the eye, ear, nose and throat clinics. ...93 XIX. X-ray department, Ancon Hospital. ....94 XX. Santo Tomas Hospital statistics. ....94 XXI. Corozal Hospital, commitments and discharges. .95 XXII. Force report. 95 3

PAGE 6

LETTER OF TRANSMITTAL THE PANAMA CANAL, HEALTH DEPARTMENT, BALBOA HEIGHTS, C. Z., January, 10, 1924. Brig. Gen. JAY J. MORROW, Governor, The Panama Canal, Balboa Heights, Canal Zone. SIR: I have the honor to submit the following report of the operations of the Health Department for the year 1923. Respectfully, H. C. FISHER, Chief Health Officer. 4

PAGE 7

HEALTH DEPARTMENT. OPERATION AND ORGANIZATION. The Health Department operates under the direction of the Governor of The Panama Canal. It is maintained from funds designated for sanitation in Panama Canal appropriations, and revenues derived from its own operations. It exercises jurisdiction in health matters over the Canal Zone, and the cities of Panama and Colon, Republic of Panama, and also cooperates with the Panamanian Government in health matters in other parts of the Republic. The organization of the health department consists of: Chief Health Office, Balboa Heights. Division of Hospitals and CharitiesAncon Hospital, Ancon. Board of Health Laboratory. Corozal Hospital, Corozal. Colon Hospital, Colon. Santo Tomas Hospital, Panama, R. P. Palo Seco Leper Colony. Dispensaries atColon Hospital. Gatun. Pedro Miguel. Ancon Hospital. Balboa. District Dentists atCristobal. Gatun. Pedro Miguel. Ancon. Balboa. La Boca. Division of SanitationPanama Health Office. Cristobal-Colon Health Office. Canal Zone Sanitary DistrictsNorthern District; Office, Gatun. Southern District; Office, Ancon. Ancon-Balboa District; Office, Ancon. Division of QuarantineChief Quarantine Office, Balboa Heights. Cristobal-Colon Quarantine. Balboa-Panama Quarantine.

PAGE 8

6 PERSONNEL. (December 31, 1923.) CHIEF HEALTH OFFICE. Balboa Heights. Col. Henry C. Fisher, U. S. Army, Chief Health Officer. Dr. Dalferes P. Curry, Assistant Chief Health Officer. Mr. Arthur L. Fessler, Office Assistant. DIVISION OF HOSPITALS AND CHARITIES. A ncon Hospital. Lieut. Col. Will L. Pyles, U. S. Army, Superintendent. Capt. James B. Anderson, U. S. Army, Assistant to the Superintendent. Dr. Troy W. Earhart, Chief of Surgical Clinic. Dr. Howard K. Tuttle, Assistant Chief of Surgical Clinic. Dr. Roland C. Connor, Chief of Medical Clinic. Dr. William W. Braithwaite, Assistant Chief of Medical Clinic. Capt. Henry E. Keely, U. S. Army, Chief of Eye, Ear, Nose and Throat Clinic. Dr. Ivan E. Hix, Assistant Chief of Eye, Ear, Nose and Throat Clinic. Dr. Leroy S. Townsend, Chief of X-Ray Clinic. Physicians. Lieut. Col. Roger Brooke, U. S. Army. Maj. Henry L. Krafft, U. S. Army. Maj. Claude D. Holmes, U. S. Army. Capt. James F. Brooke, U. S. Army. Capt. James M. Bryant, U. S. Army. Capt. John J. Moore, U. S. Army. Capt. David L. Robeson, U. S. Army. Capt. Julius G. Newgord, U. S. Army. Capt. Adolph T. Gilhus, U. S. Army. Capt. Charles R. Mueller, U. S. Army. Capt. Edwin R. Strong, U. S. Army.

PAGE 9

7 Internes. Dr. Cedric H. Nelson. Dr. Otto A. Kostal. Dr. Ivyl C. Bedwell. Dr. Augustus H. Foster. Dr. Walter W. Benton. Dr. True P. Gottschalk. Dr. Mack M. Shafer. Dr. Arnold L. Jenson. Board of Health Laboratory. Dr. Lewis B. Bates, Chief of Laboratory. Capt. Virgil H. Cornell, U. S. Army, Pathologist. Capt. Wesley C. Cox, U. S. Army, Bacteriologist. Mr. James E. Jacob, Chemist. Corozal Hospital. Capt. George E. Hesner, U. S. Army, Superintendent. Dr. David G. Sampson. Capt. Henry J. Hayes, U. S. Army. Colon Hospital. Maj. Thomas J. Leary, U. S. Army, Superintendent. Physicians. Maj. Tom S. Mebane, U. S. Army. Dr. William V. Levy. Capt. Walter F. Hamilton, U. S. Army. Capt. George J. Schirch, U. S. Army. Capt. John M. Tamraz, U. S. Army. Santo Tomas Hospital (Panama). Maj. Edgar A. Bocock, U. S. Army, Superintendent. Physicians on Panama Canal Roll. Dr. William L. McNamara. Dr. Edgar W. Davis. Palo Seco Leper Colony. Mr. Frederick D. Tucker, Superintendent. Dr. Philip Horwitz, Attending Physician.

PAGE 10

8 Cristobal-Colon Dispensary. Dr. William V. Levy, District Physician. Gatun Dispensary. Dr. James A. Grider, District Physician. Pedro Miguel Dispensary. Dr. William B. Meares, District Physician. Dr. Wayne Gilder. Balboa Dispensary. Dr. Littleton 0. Keen, District Physician. Dr. Harley G. Bickford. Dr. Julian R. Hunt. Ancon Dispensary. Dr. Walter K. Olson, District Physician. Dr. George Eugene. DIVISION OF SANITATION. Panama Health Office. Dr. Henry Goldthwaite, Health Officer. Mr. James M. Carpprow, Sanitary Inspector. Mr. Charles L. Pierce, Sanitary Inspector. Mr. Everett F. Quimby, Sanitary Inspector. Mr. Morris M. Seeley, Sanitary Inspector. Dr. Henry A. Lewis, Vaccinator. Dr. Frederick F. Dowd, Veterinarian and, Meat Inspector. Cristobal-Colon Health Office. Dr. Jesse L. Byrd, Health Officer. Mr. Thomas A. Leathley, Sanitary Inspector. Mr. Ira W. Pickett, Sanitary Inspector. Dr. Ira C. Mattatall, Supervising Veterinarian and Meat Inspector. Dr. William F. Gross, Veterinarian and Meat Inspectpr.

PAGE 11

9 Canal Zone Sanitation. Mr. Charles H. Bath, Sanitary Inspector, Northern District, Gatun. Mr. George L. Willett, Sanitary Inspector, Southern District, Ancon. Mr. John P. Corrigan, Sanitary Inspector, Ancon-Balboa District, Ancon. Mr. James L. Tolar, Sanitary Inspector (Relief), Pedro Miguel. DIVISION OF QUARANTINE. Chief Quarantine Office. Balboa Heights. Surgeon William C. Rucker, U. S. P. H. S., Chief Quarantine Officer. Cristobal-Colon Quarantine, Cristobal, C. Z. Dr. Charles A. Hearne, Quarantine Officer. Dr. William J. Burke. Dr. Francis L. Alexaitis. Dr. Ernest E. Nunnery. Balboa-Panama Quarantine, Balboa, C. Z. Dr. John D. Odom, Quarantine Officer. Dr. Philip Horwitz. Dr. Samuel S. Irvin.

PAGE 12

10 VITAL STATISTICS, REGARDING EMPLOYEES ONLY.2 The admission rate to hospitals and quarters, for all causes, has been as follows: Average Year. number Rate. employed. 1906 26,547 1,779 1907 39,238 1,419 1908 43,890 1 132 1909 47,167 887 1910 50,802 905 1911 48,876 896 1912 50,893 727 1913 56,654 519 1914 44,329 420 1915 34,785 320 1916 33,176 283 1917 32,589 357 1918 25,520 406 1919 24,204 550 1920 20,673 672 1921 14,389 620 1922 10,447 490 1923 10,976 485 For disease alone the admission rate to hospitals in 1923 was 133.48, as compared with 139.47 in 1922, and 180.35 in 1921. The total admission rate to hospitals only was 155.90 in 1923, as compared with 167.61 in 1922, and 211.20 in 1921. The death rate, from all causes, has been: Average Year. number Rate. employed. 1906 26,547 41.73 1907 39,238 28.74 1908 43,890 13.01 1909 47,167 10.64 1910 50,802 10.98 1911 48,876 11.02 1912 50,893 9.18 1913 56,654 8.35 1914 44,329 7.04 1915 34,785 5.77 1916 33,176 6.03 1917 32,589 7.09 1918 25,520 8.11 1919 24,204 7.23 1920 20,673 8.70 1921 14,389 6.46 1922 10,447 6.89 1923 10,976 6.65 All rates throughout this report are computed as annual per 1,000. 2Includes all employees of The Panama Canal and the Panama Railroad on the Isthmus; that is, in the Canal Zone, and cities of Colon and Panama. Active sanitary work on the Canal Zone and in the cities of Colon and Panama was undertaken by the United States soon after the control of the property of the French Canal Company was taken over in May, 1904. Tables are therefore carried as far back toward that date as figures are available, to give a comparison of the results of work done since.

PAGE 13

11 The death rate from disease alone for 1923 was 6.10, as compared with 6.13 in 1922, and 5.70 in 1921. The noneffective rate, from all causes, has been: Average Year. number Rate. employed. 1906 26,547 28.48 1907 39,238 25.09 1908 43,890 22.31 1909 47,167 21,93 1910 50,802 24.37 1911 48,876 24.46 1912 50,893 21.11 1913 56,654 15.97 1914 44,329 12.22 1915 34,785 10.28 1916 33,176 9.20 1917 32,589 9.65 1918 25,520 11.19 1919 24,204 14.29 1920 20,673 14.87 1921 14,389 13,96 1922 10,447 14.81 1923 10,976 13.78 The admission rate for malaria fever has been: Average. Year. number Rate. employed. 1904 6,213 125 1905 16,511 514 1906 26,547 821 1907 39,238 424 1908 43,890 282 1909 47,167 215 1910 50,802 187 1911 48,876 184 1912 50,893 110 1913 56,654 76 1914 44,329 82 1915 34,785 51 1916 33,176 16 U 1917 32,589 14 1 1918 25,520 18 U 1919 24,204 31 M 1920 20,673 19 0 1921 14,389 15 a 1922 10,447 17 M 1923 10;976 19 M

PAGE 14

10 VITAL STATISTICS, REGARDING EMPLOYEES ONLY The admission rate to hospitals and quarters, for all causes, has been as follows: Average Year, number Rate. employed. 1906 26,547 1,779 1907 39,238 1,419 1908 43,890 1 132 1909 47,167 887 1910 50,802 905 1911 48,876 896 1912 50,893 727 1913 56,654 519 1914 44,329 420 1915 34,785 320 1916 33,176 283 1917 32,589 357 1918 25,520 406 1919 24,204 550 1920 20,673 672 1921 14,389 620 1922 10,447 490 1923 10,976 485 For disease alone the admission rate to hospitals in 1923 was 133.48, as compared with 139.47 in 1922, and 180.35 in 1921. The total admission rate to hospitals only was 155.90 in 1923, as compared with 167.61 in 1922, and 211.20 in 1921. The death rate, from all causes, has been: Average Year. number Rate. employed. 1906 26,547 41.73 1907 39,238 28.74 1908 43,890 13.01 1909 47,167 10-.64 1910 50,802 10.98 1911 48,876 11.02 1912 50,893 9.18 1913 56,654 8.35 1914 44,329 7.04 1915 34,785 5.77 1916 33,176 6.03 1917 32,589 7.09 1918 25,520 8.11 1919 24,204 7 .23 1920 20,673 8.70 1921 14,389 6.46 1922 10,447 6.89 1923 10,976 6.65 'All rates throughout this report are computed as annual per 1,000. 2Includes all employees of The Panama Canal and the Panama Railroad on the Isthmus; that is, in the Canal Zone, and cities of Colon and Panama. Active sanitary work on the Canal Zone and in the cities of Colon and Panama was undertaken by the United States soon after the control of the property of the French Canal Company was taken over in May, 1904. Tables are therefore carried as far back toward that date as figures are available, to give a comparison of the results of work done since.

PAGE 15

11 The death rate from disease alone for 1923 was 6.10, as compared with 6.13 in 1922, and 5.70 in 1921. The noneffective rate, from all causes, has been: Average Year. number Rate. employed. 1906 26,547 28.48 1907 39,238 25.09 1908 43,890 22.31 1909 47,167 21,93 1910 50,802 24.37 1911 48,876 24.46 1912 50,893 21.11 1913 56,654 15.97 1914 44,329 12.22 1915 34,785 10.28 1916 33,176 9.20 1917 32,589 9.65 1918 25,520 11.19 1919 24,204 14.29 1920 20,673 14.87 1921 14,389 13.96 1922 10,447 14.81 1923 10,976 13.78 The admission rate for malaria fever has been: Average. Year. number Rate. employed. 1904 6,213 125 1905 16,511 514 1906 26,547 821 1907 39,238 424 1908 43,890 282 1909 47,167 215 1910 50,802 187 1911 48,876 184 1912 50,893 110 1913 56,654 76 1914 44,329 82 1915 34,785 51 1 1916 33,176 16 U 1917 32,589 14 1 1918 25,520 18 U 1919 24,204 31 M 1920 20,673 19 1921 14,389 15 8 1922 10,447 17 U 1923 10,976 19 M

PAGE 16

12 The death rate from malaria fever has been: Average Year. number Rate. employed. 1904 6,213 2.66 1905 16,511 5.57 1906 26,547 7.45 1907 39,238 3.51 1908 43,890 1.37 1909 47,167 .85 1910 50,802 .81 1911 48,876 .84 1912 50,893 .31 M 1913 56,654 .30 m 1914 44,329 14 U 1915 34,785 .23 M 1916 33,176 .06 1917 32,589 .09 a 1918 25,520 .08 U 1919 24,204 .08 U 1920 20,673 .15 U 1921 14,389 *.00 1922 10,447 .00 1923 10,976 .09 The noneffective rate for malaria in 1923 was 0.55, as compared with 0.46 in 1922, and 0.33 in 1921. The 6 diseases causing the highest number of hospital admissions with their rates, were as follows: 1922. 1923. Admissions. Rate. Admissions. Rate. Malaria. .176 16.85 212 19.31 Venereal diseases. 191 18.28 189 17.22 Diseases of the eyes and their annexa. .60 5.74 93 8.47 Bronchitis (acute and chronic). ..41 3.92 37 3.37 Nephritis (acute and chronic) .28 2.68 26 2.37 Tuberculosis (various organs). .34 2.25 23 2.10 The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1922. 1923. Deaths. Rate. Deaths. Rate. Tuberculosis (various organs). .12 1.15 9 0.82 Nephritis (acute and chronic). .* 4 .38 9 .82 Organic diseases of the heart. .9 .86 8 73 Pneumonia (broncho and lobar). ..2 .19 7 .64 Cancer (various organs). 6 .57 4 .36 Apoplexy. ...6 .57 3 .27 The admission rate to hospitals, and death rate from disease for white employees were 169.71 and 5.27 respectively, as compared with 120.79 and 6.40 for black employees.

PAGE 17

13 The admission rate to hospitals and quarters for malaria was 20.03 for white employees, as compared with 19.07 for black employes. The death rate from disease for American (white) employees was 4.87, as compared with 3.27 for 1922, and 2.43 for 1921. VITAL STATISTICS FOR THE CANAL ZONE-EMPLOYEES AND NONEMPLOYEES. From an average population of 31,793 in the Canal Zone, there were 253 deaths during the year; 227 of these were from disease, giving a rate of 7.14, as compared with 7.08 for 1922, and 6.72 for 1921. The death rate from tuberculosis was 0.69, as compared with 0.74 for 1922, and 0.64 for 1921. Tuberculosis caused 10 per cent of all deaths from disease during the year. There were 591 live births reported during the year, giving a birth rate of 18.59. (See Table VIII, page 77.) Of these, 206 were white, and 385 were black. Of the total births reported, 5 per cent were stillbirths. Deaths among children under 1 year of age, from all causes totaled 43, of which 9 were white, and 34 were black, giving an infant mortality rate, based on the number of live births reported during the year, of 43.69 for white children, 88.31 for black children, and a general average of 72.76. Of the total deaths, 17 per cent occurred among children under I year of age, and 32 per cent among children under 5 years of age. Below is a table showing the death rates for the Canal Zone from 1905 to 1923, from all causes: Year. PopulaDeaths. Rate. tion. 1905 23,463 828 35.29 1906 34,095 1,700 49.86 1907 54,036 1,708 31.60 1908 67,146 1,273 18.95 1909 76,900 1,025 13.33 1910 86,465 1,251 14.47 1911 90,434 1,385 15.32 1912 79,279 1,129 14.24 1913 61,700 1,047 16.97 1914 46,379 710 15.31 1915 31,496 410 12.83 1916 31,447 343 10.91 1917 33,044 328 9.93 1918 33,803 286 8.49 1919 32,366 247 7.63 1920 27,459 242 8.81 1921 31,377 236 7.52 1922 31,098 254 8.17 1923 31,793 253 7.96

PAGE 18

14 VITAL STATISTICS FOR PANAMA CITY-EMPLOYEES AND NONEMPLOYEES. From an estimated population of 59,635, there were 1,106 deaths during the year. Of these 1,078 were from disease, giving a rate of 18.08, as compared with 20.66 for 1922, and 21.26 for 1921. The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1922. 1923. Deaths. Rate. Deaths. Rate. Tuberculosis (various organs). ....226 3.76 200 3.35 Pneumonia (broncho and lobar). 168 2.80 194 3.25 Diarrhea and enteritis (including colitis). 152 2.53 126 2.11 Nephritis (acute and chronic). .....135 2.25 96 1.61 Organic diseases of the heart. ..71 1 18 70 1.17 Cancer (various organs). .58 0.97 40 0.67 The death rate from tuberculosis was 3.35, as compared with 3.76 for 1922, and 3.67 for 1921. Tuberculosis caused approximately 18 per cent of all deaths from disease, as compared with 18 per cent in 1922, 17 per cent in 1921, and 16 per cent in 1920. There were 2,043 live births reported during the year, giving a birth rate of 34.26. Of the total births reported, 6 per cent were stillbirths. There were 290 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of live births reported during the year, of 141.95. Of the total deaths, 26 per cent occurred among children under 1 year of age, and 39 per cent among children under 5 years of age. Below is a table showing the death rates in Panama City from 1905 to 1923, from all causes: Year. PopulaDeaths. Rate. tion. 1905 21,984 1,447 65.82 1906 25,518 1,142 44.75 1907 33,548 1,156 34.45 1908 37,073 1,292 34.83 1909 40,801 1,038 25.44 1910 45,591 1,446 31.72 1911 46,555 1,456 31.27 1912 47,057 1,380 29.33 1913 47,172 1,507 31.95 1914 53,948 1,863 34.53 1915 60,373 1,810 29.98 1916 60,778 1,765 29.04 1917 61,074 1,714 28.06 1918 61,369 1,314 21.41 1919 61,369 1,211 19.74 1920 60,500 1,297 21.44 1921 60,500 1,336 22.09 1922 60,068 1,279 21.29 1923 59,635 1,106 18.55

PAGE 19

15 VITAL STATISTICS FOR COLON-EMPLOYEES AND NONEMPLOYEES. From a population of 31,285, there were 393 deaths during the year. Of these, 377 were from disease, giving a rate of 12.05, as compared with 13.41 for 1922, and 16.25 for 1921. The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1922. 1923. Deaths. Rate. Deaths. Rate. Tuberculosis (various organs). .80 2.55 60 1.92 Pneumonia (bronco and lobar). ....31 .99 37 1.18 Nepbritis (acute and chronic) ....42 1.34 37 1.18 Organic diseases of the heart .396 I28 .89 Diarrhea and enteritis (including colitis) .41 1.31 18 .58 Cancer (various organs). .7 .22 16 .51 The death rate from tuberculosis was 1.92, as compared with 2.55 for 1922, and 2.30 for 1921. Tuberculosis caused approximately 15 per cent of all deaths from disease, as compared with 19 per cent in 1922, 13 per cent in 1921, and 21 per cent in 1920. There were 709 live births reported during the year, giving a birth rate of 22.66. Of the total births reported, 5 per cent were stillbirths. There were 82 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of live births reported during the year, of 115.66. Of the total deaths, 21 per cent occurred among children under I year of age, and 29 per cent among children under 5 years of age. Below is a table showing the death rates in Colon from 1905 to 1923, from all causes: Year. PopulaDeaths. Rate. tion. 1905 11,176 553 49.48 1906 13,651 703 51.42 1907 14,549 571 39.24 1908 15,878 418 26.32 1909 17,479 396 22.65 1910 19,535 514 26.31 1911 19,947 527 26.42 1912 20,174 493 24.44 1913 20,232 489 24.17 1914 23,265 590 25.36 1915 29,331 640 21.82 1916 24,693 696 28.19 1917 25,386 667 26.27 1918 26,078 616 23.62 1919 26,078 573 21.97 1920 26,078 554 21.24 1921 28,789 497 17.26 1922 31,393 445 14.17 1923 31,285 393 12.56

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16 MALARIA. The following table shows the number of cases of malaria reported -to the Chief Health Officer for the past 5 years: Probableplace Employees. Nonemployees. Totals. of infection. 1919. 1920. 1921. 1922. 1923. 1919. 1920. 1921. 1922. 1923. 1919. 1920. 1921. 1922. 1923. Canal Zone sanitated areas. 236 138 87 111 118 637 438 611 8541 922 873 5761 698 9651,040 Cattle camps and pastures. 301 111 17 8 16 28 6 ..1 329 117 17 8 17 0 t h er unsanitated areasinZone. 21 18 18 12 16 47 17 42 48 129 68 35 60 60 145 Colon. 70 20 9 5 13 69 21 23 52 42 139 41 32 57 55 Panama. 62 30 17 4 12 119 70 50 102 66 181 100 67 106 78 Miscellaneous unsanitated areas outside Zone .62 84 66 36 37 462 268 524 320 234 524 352 590 356 271 Totals.752 401 214 176 212 1,362 820 1,250 1,376 1,3942,1141,221 1,46411,55211,6 Annualrate per 1,000. 31.07 19.40 14.94 16.85 119.3115.17 8.79 11.76 12.27 212.47 18.56 10.70 12.10'12.6513.09 White-Cases 57, rate 20.03. Black-Cases 155, rate 19.07. Military only-Cases 851, rate 91.67. Others-Cases 543, rate 5.87. Althougri the sanitated areas of the Zone are gradually being extended, principally by ditching of the larger outlying swamps and wet lands, there has been a slight increase in the malaria rates, especially among employees, yet the increase is not as large as might have been expected. On opening the Zone to repopulation for agricultural purposes, chiefly by former employees of The Panama Canal, it was feared that, whatever benefits might be derived, there would surely result a tremendous infection with malaria, and that in spite of our precautions in locating these settlers at a distance of a mile or more from the Canal Zone towns, our employees would necessarily be infected from them. This has doubtless been the case in some instances, but the small added percentage of malaria so incurred has surely been more than offset by the improved economic condition of the population. The chief reasons for the increase in the rate for employees can probably be laid to the facts that the Dredging Division has had extensive projects under way in Gaillard Cut, necessitating night work in areas contiguous to cattle pastures and other unsanitated places, and to the recent policy of allotting to employees garden plots in which they work mostly during the hours of dusk, when the anopheles are most active. Damage to the Panama Railroad, water supply lines, and electric transmission lines during the October floods also required a large force of laborers to work at night in unsanitated areas. The military population of the Canal Zone continues to furnish a large proportion of the malaria cases. Their high rate is due largely to necessary practice maneuvers in the unsanitated sections of the

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17 Isthmus, and to the enlisted man's propensity for wandering about the country at all hours and seasons, as well as to the location of some Army posts and Naval bases in areas least favorable for sanitating. Relatively few cases occurred among the commissioned personnel and their families. Many of the cases charged against the military population are reported as recurrent cases. The follow-up treatment given by the physicians of The Panama Canal after the "clinical cure" of acute cases of malaria, to completely cure or sterilize them, is apparently efficacious in all forms of the disease, a recurrent case being rare when the patient has taken the prescribed treatment. This consists of administering 10 grains of quinine, preferably in liquid form (to children, in proportion), every evening before the patient retires, for a period of 8 weeks following his relief from acute symptoms. This treatment is practically compulsory for employees of The Panama Canal and their families. Upon others it is strongly urged. While it is difficult to state positively whether a case is recurrent or a fresh infection, the relatively few repeated cases in the same individual make it certain that recurrence of an original infection is rare, even in tertian malaria. The combined death rate in the Canal Zone and the cities of Panama and Colon from malaria has been: Year. PopulaRate. tion. 1906 73,264 9.49 1907 102,133 5.37 1908 120,097 3.36 1909 135,180 2.07 1910 151,591 1.89 1911 156,936 1.82 1912 146,510 1.64 1913 129,104 1.32 1914 123,592 1.27 1915 121,650 .51 i 1916 116,918 .21 U 1917 114,003 .18 3 1918 109,737 .18 3 1919 113,958 .16 U 1920 114,037 .08 1 1921 120,666 .16 U 1922 122,559 .15 U 1923 122,713 .15 U MOSQUITO CONTROL. An attempt is made to control all forms of mosquito breeding in the sanitated areas. Within a radius of approximately one mile from the residential sections, in addition to installing new drainage (subsoil or rock-covered tiling where practical), open ditches are kept to grade MR 91030-2

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18 and free from vegetation, and oil is applied when indicated. Beyond the mile limit large areas of anopheles production are controlled by open ditching. These latter ditches receive sufficient attention to keep them efficient as drains, but no labor is expended upon the small amount of breeding that may occur in the ditches and isolated small puddles and cattle tracks. In some cases, where conditions favored only the production of Anopheles eiseni and repeated observations showed only this form present, such as in rock pools and streams near Gatun, oiling was abandoned and the trees allowed to grow along the banks t6 produce dense shade. This anopheles is distinctly sylvan in habits, always breeds in clean, shaded water free from algae, is not caught in houses, apparently does not fly from the jungle and, although its malaria-carrying propensities are not known, may safely be disregarded here. The group known as Anopheles albimanus-tarsimaculata may be considered the one important carrier of malaria in Panama. While the group is described by some as' two distinct species, Mr. James Zetek, formerly entomologist of the Health Department of The Panama Canal, says: The big difference, and only one, between it (tarsimaculata) and that species (albimanus), is the broad white band on the palpus, thus making three white bands, whereas albimanus has but two. But this middle white band is often represented by only a few white scales, and from such a condition, by more and more white, until the typical tars-iJnaculaNa type is obtained. All such variations may occur in a single lot of pupae, taken from the same place, and what is of greater significance, true albimanus is also obtained from this same lot. This fact establishes the point that tarsimaculata can not be considered a distinct species, that at most it is only a variety of albimanus. * There is, however, a preference for brackish water by tarsimaculata, while a/bimanus will live in both fresh and brackish water.-"The Panama Canal Species of the Genus A nopheles," Proceedings of the Medical Association of the Isthmian Canal Zone, Vol. XIII, p. 29. The other seven (or eight) species of anopheles known to exist in Panama (A. argyritarsis, A. pseudopunctipennis, A. apicimacula, A. punctimacula, A. eiseni, A. neivai, A. nimba, A. hylephilus) are of relatively less importance. Although A. pseudopunctipennis and A. a;.yritarsis have been experimentally infected with malaria, they are not so numerous now in the vicinity of quarters, nor do they apparently enter houses so readily or fly as far as the A. albimanustarsimaculata group. A. eiseni, as above stated, is strictly sylvan, and rema-ins in the shaded jungle where it breeds. A. apicimacula and A. punctimacula are also more sylvan than otherwise and experiments failed to infect the latter; they are considered by some to be only variants of the same species. A. nimba, A. neivai and A. hylephilus are plant breeders and are of very rare occurrence on the Isthmus. The above-quoted article by Mr. Zetek contains a splendid, simple key to our Anopheles and has proven of great value to the sanitary inspectors and the department.

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19 Doctor Dyar has recently published a list of the mosquitoes of Panama, which includes 18 genera and 135 species.' The Culex are the most numerous, with 39 species. Thirty-one species of Wyeomyia have been reported, 11 Aedes and 9 (10?) Anopheles. But few of these species are harmful or especially annoying to man. It was once practicable, in the early days of construction of the Panama Canal, to divide mosquitoes into only three classes for prevention work, Culex, Stegomyia and Anopheles, and the first class included all that were not of the last two. No distinction whatever was made between the species of anopheles because, in the fairly narrow limits of control at that time, such distinctions were of little importance. In later years, however, with better appreciation of the specific habits of these mosquitoes, and extension of sanitation, where indicated, to areas one and even two miles and over from inhabited centers, it becomes necessary to take advantage of these distinctions in order to sanitate economically as well as effectively. As an illustration of this: A sanitary inspector reported albimanus as the only anopheles present in the dawn and dusk catches in a Canal Zone town. A search for breeding resulted in the discovery and report that there was considerable anopheles breeding in the nearest pasture areas, in hoofprints and small streams, and the recommendation was made that the cattle be removed and the pasture oiled. Further investigation of the pasture, and collection and breeding-out of hundreds of the larva, showed the presence only of A. pseudopunctipennis (associated with Uranotaenia geometrica) of which none were present in. the adult catches in the town. Turning from the cattle pasture to an adjoining small arm of Miraflores Lake, the probable source of the albimanus breeding was found. Had the pasture been evacuated and oiled and the lake not considered, an economic loss would have been entailed with no material benefit. This lake, which has been described in our annual reports for the past two years, has been rendered so shallow by spoil pumped into it from the Canal as greatly to impede access to it by a boat or otherwise. Under a few inches of water are many feet of soft mud; upon the surface of the water aquatic plants thrive vigorously and afford protection to the mosquito larve. Only by launching a boat on the surface of the water and mud and digging channels in advance from the boat was it at last feasible to reach all parts of the lake and apply oil. It is probable that arsenic (paris green) could have been used successfully against anopheles larve here, but culex breeding was also present and we prefer in areas so close in, to control all the breeding. 'The Mosquitoes of Panama, by Harrison G. DI ar, Insecutor Inscitiae Menstruus. Vol. XI, 1923.

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20 In another instance, at Mount Hope, the adult mosquitoes caught included anopheles of only the pure tarsimaculata variety. Such breeding as war occurring in the controlled areas furnished albimanus and other less common species but no distinct tarsimaculata. Continued search revealed that in a remote undrained corner of a brackish swamp in a former pasture, Anopheles tarsimaculata true to type were breeding in large numbers. This swamp is now being drained. In the Mount Hope district, which includes all of the low-lying swamps surrounding Cristobal and Colon at the Atlantic entrance to the Canal, we have continued to extend the drainage systems in the pasture lands south of Mount Hope. The cattle have been removed from the dairy pasture of Gov. Arcia, lying between 11 and 2 miles from Silver City (a negro suburb of Cristobal), and the low-lying fresh and brackish swamps in this pasture have been connected by sea-level channels to the old French diversion on the east and the French Canal on the west. Though these ditches may not achieve a complete measure of success in drying the lowest parts of the area, they will at least insure a free influx of sea water at each tide and favor the distribution of the ever present top-feeding minnows. In the Gatun district the completion of the drainage in the northern part of the large hydraulic fill between the French Canal and the Chagres River has been authorized. The original ditch, dug in 1919, and draining the southern part, is being widened and deepened to sea level and a new ditch will be dug in the north end, intercepting the run-off from a low range of hills and draining into the French Canal at the north end of the fill. Formerly this flood water had to traverse the entire length of the fill through the first ditch, and in the height of the rainy season the burden was too great for its capacity. Prior to the year 1919 this fill was inundated throughout each rainy season and produced vast quantities of anopheles, the catch of adult anopheles in quarters at Gatun varying from several hundreds to many thousands a month. Now it is rare that a single anopheles is caught in these same quarters. In addition to this benefit, valuable banana plantations, gardens and homes are being established by former Canal laborers where once was the mucky swamp. In the southern sanitary district the installation of concrete and subsoil (rock covered) tile drains has continued where seasonal conditions have favored the release of the sanitary gangs from the routine work of maintenance and mosquito control. Due to the proximity o' Balboa and the Canal harbor (over one mile however) to a large wet cattle pasture west of the Pacific entrance to the Canal, the cattle were removed to localities further away, and the streams of the pasture were trained and the swampy areas drained.

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21 A larger area of the small lakes surrounding Pedro Miguel is now requiring control. With silting from the Canal and watersheds, and further encroachment of vegetation into the shallow waters, the areas suitable for anopheles production have gradually increased. It is remarkable that frequently throughout much of the lake margins Anopheles albimanus will be breeding profusely, while in ditches, hoof prints, streams and small pools a short distance away, only A. argyritarsis and A. pseudopunctipennis will be found. Top minnows are present in all suitable Isthmian waters, and laboratory specimens of several varieties show them to be voracious devourers of mosquito larvm-. They are hardy and survive in almost any kind of natural water, but dependence can not be placed on them as the sole means of mosquito control. Many forms of plant life afford the larvae adequate protection from these fish. The plant, Chara foliolosa, described in last year's report as a favorable shelter for larve and which seemed to be spreading to all bodies of shallow water, practically disappeared with the last rainy season-at least from the surface of the water-but its reappearance is expected as a result of the clearer water and more sunshine of the dry season. On December 1, Dr. P. A. Buxton, of the London School of Tropical Medicine, arrived at Colon, en route to the Islands of Samoa, to undertake studies for the control of filariasis in those islands, said to be due to the mosquito Stegomyia pseudoscutellaris. He had previously requested the chief health officer to supply him with a stock of top minnows here, as he feared there were no suitable fish of that kind in the Samoan Islands. On his arrival here, Dr. Buxton was given about 450 top minnows caught in fresh and brackish water near Mount Hope. These have been identified as Poecilia sphenops', a viviparous fish similar toGambusia affinis in appearance and habits. In an aquarium they are very effective against all kinds of aquatic larve. These were placed on board the ship in two five-gallon kerosene tins and started on the long journey to the Antipodes via New Zealand. As evidence of their hardiness, Dr. Buxton writes from Samoa: "We only had, I think, 40 deaths between 1 December, when you handed me the fish in Panama and 20 January, when we landed them here. They came right through in the original tins. I fed them on toast crumbs, grated fresh lettuce, and rubbedup liver. And I changed the water once a day only except on very hot days." No doubt these fish will be effective against tank-breeding mosquitoes. Identification by Dr. Barton A. Bean, Assistant Curator of Fishes, U. S. National Museum, who says: "The 8 top minnows forwarded are Poecilia sphenops Cuvier and Valenciennes. This well-known devourer of mosquito larve is one of the most variable and abundant of its family, ranging from Mexico to the Panama Canal Zone."

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22 ANTIPLAGUE WORK. Morbidity reports from other countries, and the visits of the chief quarantine officer to Central and South American ports having commercial intercourse with and through the Panama Canal, emphasize the continual need for alertness on the part of the health department of The Panama Canal against the introduction of plague into the Canal Zone and the Republic of Panama. In addition to maritime quarantine provisions against ship-borne plague (see report of Quarantine Division following), the campaign against the native rat population of the Canal terminal cities has been unrelenting. Destruction of old unserviceable buildings and proper reconstruction of those undergoing repair have eliminated many of the worst conditions favoring rat propagation in Cristobal. In Ancon and Balboa, on the Pacific side, conditions have improved to such an extent that the services of the sanitary inspector of those towns were shared with Panama City during most of the year. Being particularly proficient in antirat work this inspector has been detailed to devote half his time to rat control and building inspection in the city of Panama. Here, conditions are especially unfavorable for antirat work. Much of the town is very old, dating from early Spanish days. Building space is at a premium and materials are high in cost. Flimsy construction, added to from year to year in past times; tortuous narrow passages and concealed spaces in and between buildings; warehouses and stores packed from cellar to roof with merchandise; foodstuffs exposed everywhere; and a population indifferent for the most part to sharing their houses and possessions with the rats; these present but a faint picture of conditions as they once existed in Panama City. While much remains to be done, an excellent start has been made and many of the worst conditions corrected, especially in the methods of storing of merchandise in shops and warehouses. New construction and repairs are closely supervised and compliance with rat-proofing regulations is rigidly enforced. FLY PREVENTION. House flies are never so numerous in the Canal Zone as to constitute a plague, or even a sanitary menace. Only occasionally is there an influx of these so noticeable as to occasion comment. Should any such increase in numbers occur, a thorough search is at once instituted for the breeding place, usually with success. It is true also, that such small variations in numbers as occur are usually seasonal, the beginning and end of the rainy season being marked by a relatively

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23 greater abundance of flies. During the windy dry season and the wettest months of the rainy season less breeding occurs. The care given to collection and disposal of garbage and manure is mainly responsible for our freedom from flies. TYPHOID FEVER. Nineteen cases of typhoid fever were reported to the chief health officer. Of these, 2 were from the city of Panama, 8 from Colon, and 9 were nonresidents who had contracted the disease elsewhere than on the Isthmus. Five of the nonresident cases (including one white soldier, recently arrived) died. Four of the cases in Colon were in one family; there was no apparent connection between the other cases that developed locally. In this family, one case, a boy 14 years old, was without medical attention until a few hours before death. On being informed of the diagnosis the health officer ordered the contacts examined and typhoid vaccine administered to the remaining 5 members of the family. The day following the administration of the vaccine, three of these (brothers) were found to have elevated temperatures and were sent to the hospital, where a positive diagnosis of typhoid fever was made in each case. No other cases followed in this family or the contacts. It is believed that carriers are responsible for the few cases that occur here. In every case of the disease, a careful search for carriers among the contacts resulted in no carriers being discovered. (See report of Board of Health Laboratory, page 52.) INFANT MORTALITY. The infant mortality rates of the cities of Colon and Panama, and the Canal Zone for the past 5 years have been as follows: 1919. 1920. 1921. 1922. 1923. Colon. ..155.29 142.21 139.28 139.66 115.66 Panama. .154.47 155.30 173.95 147.23 141.95 canal Zone: White. .37.23 34.36 33.22 41.32 43.69 Black. ...154.00 130.00 134.73 120.27 88.31 Total (White and Black) ....113.67 95.09 96.65 92.62 72.76 In addition to the establishment of free prenatal and child welfare clinics in Panama and Colon, an effort is being made to educate the mothers in the care of themselves and their children by means of the daily press. Short articles by recognized authorities are published frequently in Spanish and English, and the newspapers have demonstrated a readiness to print such articles when they are kept within due bounds as to space. Other articles, under the title "How to Keep Well," of general interest and value to the reader, have frequently appeared.

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24 PHYSICAL EXAMINATION OF SCHOOL CHILDREN. An examination of the white school children of the Zone was made in December, 1923, and the results were as follows: Number of children examined. ....1,738 Defective nasal breathing. .60 Number of children found needing treatment. ...869 Hypertrophied tonsils ...270 Those with defects other than those of teeth Pulmonary disease. ..5 only. 515 Cardiac disease. 12 Those with defective teeth as only physical Chorea and other nervous diseases. .6 defect. 354 Orthopedic defects. 14 Defects found requiring treatment: Malnutrition. ...2 Defective vision. 135 Defective teeth. 504 Defective hearing. 15 Contagious diseases. .12 The colored school children were also examined and all who required it were vaccinated against smallpox. HEALTH OFFICE, PANAMA CITY. DR. HENRY GOLDTHWAITE, Health Officer. Malaria.-The following is a table of the malaria cases reported as contracted in this city during the years 1916 to 1923: Number Rate Number Rate Year. of per Year. of per cases. thousand. cases. thousand. 1916. .235 3.87 1920. ..100 1.65 1917. 187 3.05 1921. 67 1.11 1918. 97 1.58 1922. 106 1.76 1919. 81 2.95 1923 .78 1.31 It is probable that most of the cases were contracted in the environs of the city or in the unsanitated areas beyond. Oil has been used in antimosquito work during the past several years as follows: Gallons. Gallons. 1917. ...44,896 1921 -. .7,170 1918--. 15,701 1922. 4 496 1919 -. .17,828 1923,. 2,394 1920. .9,365 This saving of oil (and labor) has resulted from the drainage of large swamps and other places once oiled freely, and the gradual filling in of the swampy areas in which the garbage from Ancon, Balboa, and Panama is being buried. Infant mortality.-The following shows the annual death rate of infants under one year of age, from 1914 to 1923: Rate per Rate per 1,000live 1,000 live births. births. 1914. ...272 1919. .154 1915. ..221 1920 ....155 1916. ..236 1921. .174 1917. ..238 1922. .....147 1918. .188 1923. 142

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25 The decrease in this rate continues in a gratifying manner; the rate could be much further reduced if economic conditions permitted enforcement of the regulations covering housing conditions. The fine fund, from which the wage of the public welfare or prenatal nurse was paid, reached such a low figure in October last that it was necessary to discontinue her services. She has, however, since been taken over and paid by the Canal Zone Chapter of the American Red Cross, and is performing practically the same functions as when employed by the Panama health office. During the ten months of the year that she worked, she made 3,315 house visits, 1,654 women came to the clinic for treatment, and 900 babies were brought there. Diphlheria.-In July, 1922, owing to the increase in diphtheria, we started taking throat cultures from all school children in an effort to locate any carriers; 9,927 cultures were taken in 1922, and the work was completed in the early months of 1923, when 1,187 cultures were taken, making a total of 11,114 cultures taken in the city, almost entirely from the schools. Thirty-seven cases were found to harbor virulent B. diphtherix. Tuberculosis.-The deaths from tuberculosis during the years 1914 to 1923 have been as follows: Number Rate Number Rate Year. of per Year. of per deaths. thousand. deaths. thousand. 1914. .229 3.82 1919 ..241 3.93 1915. .245 4.06 1920 ...206 3.40 1916. ...313 5 15 1921 .222 3.67 1917. 319 5.22 1922 .226 3.76 1918. 254 4.14 1923 ...200 3.35 It will be noted that there has been very little change in this death rate for several years, and it is believed that there will be no rapid improvement in the situation until such time as the Republic of Panama constructs a sanitarium in a suitable location of high altitude. Fines.-There were 604 fines imposed for violation of the sanitary rules and regulations during the year, and $1,093 collected as a result thereof. This money is held as an "emergency fund, to be used only in special cases for sanitary purposes," as provided in sanitary regulations. Veterinary work.-Fees collected for the services of the veterinarians attached to this office amounted to $1,175.21, as compared with $1,074.38 for the previous year; these charges are for the quarantine inspection of cattle and swine, and for the disinfection of hides. In addition to this the city of Panama paid to the Panama Canal

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26 $2,700 for the anteand post-mortem inspection at the municipal abattoir of animals slaughtered, as follows: Cattle slaughtered. .13,607 Septicemia. ..4 Cattle condemned on account of having: Tuberculosis. ..I Anthrax. .1 Hogs slaughtered. .12,990 Cancer. ...1 Hogs condemned on account of having: Contusions. 10 Cholera. .48 In dying condition. .3 Cysticercus cellulosae. ..480 Gangrene. .I Fever, undetermined. 7 Pericarditis. 1 Pneumonia. ..43 Pneumonia. 3 Pyemia. .3 During the past year this office has taken up the matter of giving all dairy herds tuberculin tests. Forty reactors have been found, and negotiations are in progress to have the Republic of Panama pay a reasonable value to the owners for tubercular animals condemned and killed. In this connection it is interesting to state that in the local abattoir four native animals have been found with tuberculous lesions by the veterinarian; it is commonly said here that none of the native cattle have bovine tuberculosis. HEALTH OFFICE, COLON-CRISTOBAL. Dr. JESSE L. BYRD, Health Officer. Malaria.-The following is a table of the malaria cases reported as having been contracted in Colon and Cristobal during the years 1916 to 1923: 1916 .162 1920. ...98 1917 ...105 1921. .44 1918 .41 1922. ...107 1919 ..281 1923. 90 Mosquito flights.-Several comparatively small flights into Colon were noted during the advent of the rainy season. From catches made on the screens of the Washington Hotel and Colon Hospital, Aedes taeniorhynchus was found to be the predominating mosquito in the flights. Occasionally, however, a few anopheles were noted along with the aedes. As there is no anopheles breeding to be found within a radius of over two miles from Colon Hospital, it seems certain that the anopheles is actually flying a distance of over two miles into Colon. Tuberculosis.-The following table shows the number of deaths from tuberculosis of residents of Colon for the past ten years: Number Rate f Number Rate of deaths. per 1,000. of deaths. per 1,000. 1914. 86 3.69 1919. .101 3.87 1915. 74 2.52 1920. 109 4.18 1916. .91 3.69 1921. 66 2.30 1917. ..113 4.45 1922 .80 2.55 1918. 116 4.45 1923. .60 1.92

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27 The decreased death rate from tuberculosis may be partly due to relief from overcrowded conditions in many of the tenement sections as a result of the repopulation of the Zone, and to better living conditions among the laboring people. Infant mortality.-This rate shows a continued gratifying decrease from former years. The principal factors responsible for this improvement have been the betterment in the economic status of the population owing to more employment, increased agricultural operations (principally in the Canal Zone), relief from overcrowded living conditions in Colon, and the advice and treatment afforded mothers and babies through the medium of the Cristobal Woman's Club Free Clinic. The infant death rates of Colon from 1917 to 1923, have been as follows: 1917. .245.14 1921. 139.28 1918. ...186.16 1922. .139.66 1919. .155.29 1923._ _. ...115.66 1920. .142.21 The infant mortality rate for Silver City for 1923 was 88.5. Comparison of the death rate from tuberculosis and the infant mortality rate of Colon in 1923, with those of Silver City, is of interest as perhaps showing graphically the results due to difference in environment and economic conditions. The population of Colon is largely native Panamanians and West Indians (especially the latter), living in crowded tenements, and a great proportion of whom have no steady employment. Silver City is a new suburb of Cristobal in which West Indian employees of the Panama Canal dwell in model quarters of the standard Panama Canal style of construction. It was built and occupied in 1919; its population last year averaged 3,350: Deaths from tuberculosis in Silver City, 1923. ..3 Annual rate per 1,000. ..0.89 Number of live births in Silver City, 1923. ...........113 Deaths under 1 year of age. .10 Annual infant mortality rate per 1,000 live births. ..88.5 Cristobal Woman's Club Free Clinic.-All cases needing medical or surgical treatment have been transferred to the Colon Charity Hospital, which was opened by the Panamanian Government about the middle of the year. The free clinic is now a health center for better babies and better mothers. The following table shows the number of cases receiving treatment and advice at the clinic during the year: Surgical cases .4,829 Baby cases. .3,177 Medical cases ....3,172 Dental cases .637 Prenatal cases. .....365 Eye, ear, nose and throat cases. .4,948

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28 Vaccinations.-The number of vaccinations performed was 3,735. The visiting nurse keeps a record of all births, and when a child reaches the age of three months it is vaccinated. In this way the population will eventually become practically immune to smallpox. The chisel method of vaccinating is used entirely and is unquestionably the most satisfactory method in our hands. Building inspection.-Owing to the expiration of leases on a large number of lots belonging to the Panama Railroad Company, it has been possible for this office to have the houses on these lots put in proper sanitary condition before new leases were issued, and in this way many dark and poorly-ventilated tenements have been converted into buildings fit for human habitation. Anti-plague measures.-"Build the rat out" is the motto of this office, but as this is naturally and in some cases necessarily a slow process, other methods are deemed necessary adjuncts, such as the elevation of all bulky materials and food supplies on permanent storage racks, properly spaced in order to facilitate inspection, cleaning, trapping and poisoning. The various departments of The Panama Canal and Panama Railroad have cooperated in a very satisfactory manner, and many improvements have been made through their hearty cooperation. The greatest improvement has been accomplished at the Cristobal stores and store yard; the improved sanitary condition of this store yard has been very gratifying. Garbage disposal.-The addition of the 50-ton unit to the Mount Hope incinerator has proved satisfactory in every way. The handling and disposal of garbage in this district is thoroughly satisfactory and would be difficult to improve upon. There are so few flies that they are conspicuous by their absence. Garbage incinerated during the year amounted to 22,098 tons, at a cost of $1.03 per ton. The incinerator is operated by the Municipal Engineering Division. QUARANTINE DIVISION. Surgeon WILLIAM COLBY RUCKER, U. S. P. H. S., Chief Quarantine Officer. There has baen a constant expansion throughout the year of the policies laid down in previous annual reports. These briefly are: (1) To facilitate in every way compatible with safety to the public health of the Canal Zone and the Republic of Panama, the passage of ships through the Canal, and (2) To maintain cordial cooperative quarantine relations with other countries, in order to secure accurate timely knowledge of the sani-

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29 tary conditions of their ports, and to assist and stimulate the placing and the maintaining of those ports in such a condition as to prevent their becoming centers for the distribution of communicable diseases. The chief quarantine officer made several extensive journeys during the year for the purpose of carrying into effect the foreign policy of the quarantine division. The Pacific coast ports of Costa Rica, Nicaragua, Honduras, Salvador, and Guatemala were visited and contacts made with the national and local health authorities of these countries. At the request of the Surgeon General of the United States Public Health Service, and also in the interest of The Panama Canal, he visited the Caribbean ports of Costa Rica, Nicaragua, Honduras, Guatemala and British Honduras. Later he studied sanitary conditions in the Pacific coast ports of Ecuador, Peru and Chile. His reports indicate that yellow fever has almost ceased to be a quarantine problem. .As a matter of fact, sanitary conditions in the Canal Zone are such that there is no practical danger of the spread of yellow fever even though it should be introduced. This belief is so strong that when yellow fever was discovered at Bucaramanga, in the interior of Colombia, the only restrictions placed on travelers from Atlantic coast ports of that country were that their temperatures should be taken daily by the ship's surgeons and a record thereof be furnished the quarantine boarding officer, and that the passengers report to the latter daily to complete six days from port of departure in order to have their temperatures taken. The sanitary inspections of the chief quarantine officer indicate, however, that bubonic plague on the west coast of South America is a very genuine menace. As a result of the South American journey, the President of Panama has called a conference to meet in Panama, February 25-29, 1924, for the purpose of standardizing and rationalizing the maritime quarantines of the countries involved-Panama, Ecuador, Peru and Chile. It is believed that out of this conference will grow an international cooperation which will be mutually beneficial to all countries concerned. In November, 1922, the quarantine division adopted tentatively the use of cyanogen chloride as a ship fumigant. The formula used at that time called for the addition of talc with a view to eliminating any explosion or fire hazard. This method was not found to be wholly satisfactory. While the gas is an efficient fumigant and has a very high safety factor, it generates so slowly that it prolongs unduly the period of fumigation. Another formula was finally used which omitted the talc entirely and reduced the quantity of sodium chlorate

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30 thirty-three and a third per cent. The cyanide eggs are cracked into fairly good-sized lumps, and when prepared in this way the gas does not come off rapidly enough to constitute a fire hazard, although the process is not unduly slow. By hanging the generators just inside the hatches it was found that considerable time is saved and good. diffusion of gas obtained. So satisfactory have been the results achieved by following this method that cyanogen chloride has been made the standard fumigant of The Panama Canal. It is a most rapid, satisfactory fumigant, and when demurrage losses are considered it is the cheapest method, costing less than half as much as sulphur dioxide, and about fifteen per cent less than hydrocyanic acid. A radical departure from previous methods was made in December, 1923, when an order was issued requiring that quarantine declarations shall be sworn to by masters and surgeons of arriving vessels. Quarantine offiers have the legal authority to administer oaths and for this purpose have the powers of notaries. This adequately safeguards the method. The following is the text of the new quarantine declaration THE PANAMA CANAL HEALTH DEPARTMENT QUARANTINE DIVISION QUARANTINE DECLARATION Instructions-This Declaration should be prepared but not sign d prior to the entry of the vessel toa Canal Zone port. It must be swern and subscribed to in the presence of the Quar antine Officer before pratique will he granted. In case the vessel has received radio pratique, this declaration shall be signed and filed with the Quarantine Officer of the port of entry. Tofacilitatetheentryofvessels, the QuarantineBcarding Officer shouldbegiven a listof passengers landing in the Canal Zone, in order that they may be given immigration inspection. The undersigned, Master and Surgeon of the S. Swhich arrived from_ ..-. -.on-.-------------do hereby (place) (date) certify that no case of Cholera, Yellow Fever, Plague, Smallpox, Typhus Fever, Leprosy or other diseases that may become a danger to the Canal Zone or the Republic of Panama, has occured on board this vessel during the present voyage; that all on board, including-_.1st class, ------2d class,_.3d class, and .----Officers and crew, are in good health (except as noted on reverse hereof); that there has been no communication with any vessel since leaving.-.------on (place) _(except as noted on reverse hereof); that there have been (date) no deaths on the voyage (except as noted on reverse hereof); that this ship was fumigated on --..at------.--.--as witnessed by (date) (place) fumigation certificate displayed to the quarantine boarding officer; that while in all ports visited on this voyage al requirements of

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31 the Panama Canal for the prevention of the ingress of rodents to ships have been carried out effectively. Master. -.Surgeon. SWORN AND SUBSCRIBED TO in my presence___. (date) Quarantine Officer. (Reverse.) Section 10 of Executive Order of February 6, 1917, states: "Quarantine Officers are hereby authorized to administer oaths, and for that purpose they shall have the powers of a notary public." Section XV, of Executive Order of March 31, 1920, regarding quarantine regulations for the Canal Zone, and the harbors of the cities of Panama and Colon, states: "Any person failing to observe the requirements of these regulations or of any instructions issued by the Governor of The Panama Canal in conformity with these regulations, shall be punished by a fine not exceeding five hundred dollars, or by imprisonment in jail not exceeding ninety days, or both such fine and imprisonment at the discretion of the Court, in conformity with the Act of Congress authorizing the establishment of these regulations." If the ship comes from a clean port and has a clean bill of health, this declaration is accepted and no inspection is made. In cases in which radio pratique is granted, the declaration is signed at sea and later filed in the quarantine office. It is possible to do this with safety because of the secondary sanitary lines of defence in the Canal Zone, and because a false oath is not likely to occur, it being punishable by fine and imprisonment. Several reductions have been made in the quarantine tariff. Quarantine is done for the benefit of the Canal and the Republic. It is the policy of The Panama Canal to give its clientele as much service as it can, and therefore the charges for night quarantine inspection were taken off, and the costs of fumigation were reduced in order that shipping lines may be stimulated to have their vessels fumigated, vessels being now charged only the actual cost of fumigation plus 10 per cent. Inspections are made until 10 p. m. If a vessel arrives after that hour and desires to bunker, it is taken to the fuel dock in quarantine and allowed to spend the night in refueling, thus being ready to resume the journey immediately after quarantine inspection in the morning.

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32 The following is a compilationshowing the diminishinglossper year suffered by ships through quarantine detentions. In order to arrive at a basis for comparison, the loss is arbitrarily set at fifty cents per ton-detention-day, and five dollars per passenger-detention-day; U. S. Naval crew and vessel detention are not included in this table: Total passenLoss per Year. Total tons Total ton ger and crew Total loss. 1,000 tons received. detention days. detention days. received. 1918. 9,717,452 154,176 38,169 $267,933.00 $27.57 1919. .....10,779,529 161,376 18,570 173,538.00 16.10 1920. .17,793,683 48,172 33,436 191,266.00 10.75 1921. 20,232,456 80,786 14,161 111,198.00 5.50 1922. .20,898,873 .113 565.00 .027 1923. .37,313,867 2,474 330 2,887.00 .077 QUARANTINE OPERATIONS, CALENDAR YEAR 1923. Cristobal. Balboa. Total. Vessels inspected and passed., ..3,475 2,512 5,987 Vessels passed on certificate of ships' medical officers. .1185 ..185 Vessels detained in quarantine. .1 2 4 5 Vessels given provisional pratique. ..1. Vessels given ratio pratiqie. 53 3 128 181 Total arriving vessels. ..3,715 2,644 6,359 Supplementary inspection of vessels. 1,925 17 1,942 Number of days vessels were held. .1 217 18 Vessels fumigated. 107 22 129 Crew inspected on arrival. .183,176 117,463 300,639 Passengers inspected on arrival. ...52,775 24,072 76,847 Crew passed on certificate of medical officers. .* .10,252 2,410 12,662 Personnel of Atlantic Fleet passed on certificate of medical officers. .18,798 ...18,798 Passengers passed on certificate of medical officers ....13,618 466 14,084 Crew passed by radio pratique., .8,287 .8,287 Passengers passed by radio pratique. .5,181 .5,181 Total persons arriving ...292,087 144,411 436,498 Supplementary inspections of persons on detained vessels. ...4 16,000 16,000 Persons detained in quarantine stations. .s300 6 863 1,163 Number of days detained in quarantine stations. s2,250 75,581 7,831 Persons detained on board vessels. 217 43,800 4,017 Number of days detained on board vessels. .....252 4 16,000 16,252 Persons vaccinated. 797 491 1,288 Number of rats found on vessels fumigated. ..1. ,05 1,054 Persons detained for immigration reasons. .166 1,165 1,331 Persons deported under immigration laws. .708 364 1,072 Immigration operations have continued as in the past. On September 13, 1923, an executive order was issued covering the admission under bond of persons liable to become public charges, and on November 24, 1923, the Governor issued Circular No. 714-2, regulating the way in which guarantees may be made for the admission of such persons. -One hundred and twenty-four of this number were vessels of the Atlantic Fleet, U. S. Navy. 2 Vessels of the Pacific Fleet, U. S. Navy. 3 Sixty-five of this number were vessels of the Pacific Fleet, U. S. Navy. 4 Account quarantine of units of Pacific Fleet, U. S. Navy. s Crew of Atlantic Fleet. 6 Seven hundred eighty-nine of this number were members of crew of vessels of Pacific Fleet, U. S. Navy. 7 Five thousand five hundred and three of this number were members of crew of vessels of Pacific Fleet, U. S. Navy, and were detained on account of measles.

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33 ANCON HOSPITAL. Lieut. Col. WILL L. PYLES, U. S. Army, Superintendent. Surgical clinic.-During the year, 1,460 major operations and 4,377 minor operations (including intravenous injections of arsphenamine) were performed, 2,405 cases visited the out-patient department for whom 330 prescriptions were written, and 244 obstetrical cases were delivered. Medical clinic.-There were 2,694 cases treated in the out-patient department, for whom 1,704 prescriptions were written; 851 adults were vaccinated, with 256 known "takes;" 296 children were vaccinated, with 115 known "takes." Eye and ear clinic.-Seven thousand nine hundred and seventy-four cases visited the out-patient department, for whom 1,508 prescriptions were written; 1,525 operations were performed, and 1,044 refractions done. X-ray Clinic.-There were 2,721 cases handled, for whom 1,133 plates, 3,852 films, and 2,254 dental films were used; 215 treatments were given during the year. Electro and radio therapy.-In December, the following equipment was installed in the room formerly used as a waiting room: one quartz lamp, air cooled; one quartz lamp, water cooled; a Universalmode; a vibrator; and a photo-therapy light, all of which were put into operation. In addition to the above there was ordered a new high-power X-ray apparatus and a supply of radium; construction was begun on the room assigned for this equipment, and it is being made ready for its installation and use as soon as received. Hydro-therapy.-In the basement, a former storeroom was prepared to receive hydro-therapy apparatus, the following being installed by the end of the year: control table, shower, perineal douche, and slop sink. The remaining equipment for this department arrived in nonusable condition, and until all the apparatus is received and installed, this department will not be put into service. Steward's Department.-During the year 109,599 rations were issued to patients, and 80,605 to hospital personnel, a total of 190,204 rations, the net cost of which was $65,415.75. There were 25,161 rations issued to pay boarders, for which $17,033.55 was received. A total of 207,004 pounds of bread were made, at a cost of $0.0439 per pound. In March the following new equipment was installed in the bakery: motor-driven dough mixer with automatic brake, flour elevator and flour bin. MR 91030-3

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34 Motor transportation.-During the year all cars were kept in good state of repair. In addition to the work on hospital transportation, the chaffeur-foreman also had immediate inspection of all motor transportation and bicycles belonging to the several units of the Health Department located in Ancon, Balboa, Corozal, Pedro Miguel, and Panama City, and made most of the issues of oil, gasoline, etc., for these vehicles. In July, a new Ford chassis was received for which an ambulance body was built by the hospital artisans and put into service. Grounds.-During the year, fruit trees of the following varities, furnished by the Department of Agriculture, were set out in permanent locations. Quercus polystachya, Quercus thomsoni, Quercus truncata, Eugenia (sp. pittier), Castanea diversifolia, Lagersiroemia, Coyo, Diospyros ebenaster, Litchi chinensis, Rhedia madruno, Macadamia ternifolia, Avocado itzama, Avocado panchoy, Avocado cantel, Avocado nimlioh, Mango sandersha, Phyllocarpus septentrionalis, and Lansium domesticum. Fruits and vegetables have been gathered from the hospital reservation for consumption by patients, as follows: 1921. 1922. 1923. Bananas (bunches). .502 377 294 Papayas ...173 39 235 Bread fruit. ....1,377 1,115 1,801 Mangoes ..2,835 2,600 4,368 Avocados. .846 214 566 Guavas ..4,100 1,150 2,450 Liwies. .._. .13,237 5,525 1,760 Coconuts ....249 283 173 Oranges .....192 ... Sour saps ( .... Tomatoes (pounds) ...265 P ineapples ....20 These have materially improved and lessened the cost of patients' diet. Maintenance and repairs.-On October 9, 1923, a landslide occurred in the rear of the hospital. The quantity of material involved in the slide was estimated at 700 cubic yards, which came down the ravine in the rear of the power plant. While the greatest amount of the slide was held in check by the power plant shop building, pressure at head of slide broke the light curtain wall in the rear of the bake shop, and considerable water, mud, and rock flowed through the bake shop into the street. Another part of the slide flowed around the electric shop, a considerable quantity going through the windows into the carpenter shop, but the larger portion continued down the hill, the mud and water going into the basement of the isolation section and out through the front door. Isolation section was immediately evacuated of patients. The bake shop and carpenter shop were put out of service. A force of laborers and trucks, under the supervision of

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35 the municipal engineering division, immediately started to work and removed all the slide material from the hospital buildings and grounds. The larger items of damage done to the hospital consisted of: in bakery, rear wall storage room caved in, roof caused to leak, two 3-horsepower electric motors put out of commission, and considerable flour, bread and other materials washed away; in the carpenter shop, one 7-horsepower electric motor put out of commission, window frames, doors and screens broken, and a considerable stock of hardware was rendered useless; in the isolation ward, entire ground floor flooded and covered with mud, machinery of passenger and dumb waiters completely covered with mud and put out of commission, motor of dish-washing machine put out of commission, considerable hospital property rendered unserviceable, and furniture, floors and walls of basement covered with mud. Roads and curbs were broken down in many places by trucks hauling out debris, lawns were badly scored, and several fine budded mango and avocado trees were lost. Nonresident Patients.-Patients whose residence is outside of the Canal Zone, Colon, or Panama City, were treated as follows: 606 in Ancon Hospital, and 81 in Corozal Hospital; 10 died in Ancon Hospital, and 7 died in Corozal Hospital; total days treatment in Ancon Hospital was 13,796, and in Corozal Hospital 18,055. The following table gives the cost of operating the hospital for the past three years: 1921. .1922. 1923. Operating expenses. ..$577,086.50 $525,585.44 $520,551.97 Revenue. .312,132.40 312,713.70 309,572.03 Net cost. ....264,954.10 212,871.74 210,979.94 Cost per patient per day. 4.62 4.67 4.75 Cost of subsistence supplies per patient per day. ...39 .34 .34 Operating expenses, dispensary. ....18,518.85 16,438.74 17,952.78 Revenue, dispensary. .572.50 1,883.05 4,113.50 COROZAL HOSPITAL FOR THE INSANE. Capt. GEO. E. HESNER, U. S. Army, Superintendent. Buildings.-An addition to Ward "I" (female ward) was erected at a cost of $2,000, for the purpose of housing hydro-therapeutic apparatus. An annex to the kitchen was constructed of reinforced concrete, at at a cost of $4,000, to house the new and up-to-date refrigerating plant which has now been installed therein. The concrete compost pit was enlarged by the addition of approximately 60 per cent storage space, and the old worn-out wooden roof replaced by one of concrete which has proven much more sanitary. Walls separating the various compartments were extended from base

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36 to roof, thus making each individual pit fly-proof. This work was done by hospital labor under the direction of the district sanitary inspector, at a cost of approximately $1,000. A platform and boiler shed, with coal bin of reinforced concrete construction, was erected for housing the new steam boiler recently received, this work also being done by hospital labor under the direction of the district sanitary inspector, at a cost of approximately $600. A storage tank of 4,800 gallons capacity was moved to the hospital inclosure and placed on a concrete tower 15 feet high, at a cost of $500. This tank is to catch overflow from the refrigerating machinery, and water thus collected will be utilized in the laundry, steam plant, etc. The partitions between porches and dining rooms for male and female patients were removed, thus adding 800 feet of floor space to each of these dining rooms, improving the circulation of air, and adding to the comfort of the patients. The interiors of these rooms were also repainted. By the removal of partitions in ward "F," and transferring operating room to building No. 530 (laundry and sewing room), 150 feet of floor space was added to the occupational ward. Routine painting and repairs to woodwork, screens, plumbing, steam line, etc., have been done, when required, by hospital artisans with the help of the patients. Grounds.-Of the various foreign tropical plants, received through the courtesy of the United States Department of Agriculture, and planted during the past two years within the hospital inclosure, some have been budded with considerable success. The following apppear to be thriving in the soil under local climatic conditions.: Hydnocar pus weightiana Saigon mango Litchi chinensis Kavas Ji Patel mango Lansium domesticum Mango de Rosa Garcinia livingstoniana Amini mango Garcinia nzngostana Kala Alphonse mango Six of the chaulmoogra oil trees (Hydnocarpus weightiana) planted a few years ago appear to be flourishing particularly well, and some of them are bearing fruit. Among those plant immigrants which have been planted and failed to grow successfully are: Taraktogenous kurzii Butler avocado Hydnocarpus castanea Pollock avocado Telfairia Simmonds avocado Hayden mango

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37 Further efforts will be made to replace some of these species which have failed to prove successful, as the results obtained with other foreign tropical plants leads us to believe that most of these can be grown successfully under local conditions. The lawns and numerous flower beds have been maintained throughout the year by the patients under the supervision of an attendant. Hospital grounds and roads are kept clean, hedges trimmed, flower beds cared for, and grass cut, with but little expense to the hospital. Patients.-The census of the hospital on December 31, 1923, was 399, as compared with 389 on the same day of the previous year. The number admitted was 153, as compared with 183 for 1922; also two patients who had been transferred for surgical treatment to Ancon Hospital toward the close of 1922, were returned in 1923. There were 113 discharges and 32 deaths, as compared with 158 discharges and 33 deaths last year. Of the total released, 26 (23 percent) were recovered, 55 (49 per cent) were improved, and 32 (28 per cent) unimproved. Of the total admissions, 90 were cases paid for by the Government of Panama, and the remainder were Canal Zone charity or private pay cases. Fifty-four of the total number discharged were deported, 26 to the United States, 2 to England, 1 to Germany, 1 to Norway, 1 to Esthonia, 1 to Mexico, 1 to the Philippines, and 21 to the West Indies. The total of 72 per cent of discharged patients recovered or improved compares favorably with the best institutions for the insane in the United States. The great majority of these patients'are of low intelligence and have received little education, making it difficult at times to discuss their mental disorders with them from a psychoanalytic standpoint. They are encouraged to do some interesting occupational work; 'they are furnished reading, moving pictures, phonographic concerts, church services, weekly band concerts, daily walks in the vicinity of the hospital, and games such as indoor baseball, cricket, picnic outings, etc. Special treatment is furnished patients suffering from specific organic disorders. A great number of the mental disorders are caused by syphilis and alcoholism, especially the former. Intensive antisyphilitic treatment is given to all patients suffering from syphilitic psychoses, which form about 17 per cent of the total admissions. During the year, 604 doses of arsphenamin were administered intravenously, and 178 Jumbar punctures performed, in addition to oral medications. The results obtained in the cases of cerebral syphilis have been remarkable. In the occupational activities, an endeavor is made to group the patients according to their intellectual and mental capacity as well

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38 as mental disorders, with the idea of assigning patients showing higher intellectual capacity to the occupational ward, where the men are taught woodwork, toy making, decorating, tin work, and making of brooms. The female patients are instructed in the arts of rug weaving, both by hand and on looms, embroidery, crocheting, basketry, and various kinds of needlework. The total sales from the occupational ward amounted to $4,818,66; of this amount $3,418.60 was received from the sale of corn brooms; some of this is utilized for the purchase of material required to continue activities in this department, and the balance is turned in for credit to the hospital. A surplus of $350 was thus turned in during the year. Some of the physically stronger male patients who can not be accommodated in the occupational ward on account of limited space, are sent to the fields to assist in agriculture, while the females are assigned to tasks in the laundry, sewing room, and the salvage department. All of the hospital laundering, with the exception of bed sheets and nurses' uniforms, is done by the patients. As a result of these various undertakings between 75 and 80 per cent of the patients are engaged in some form of work at all times. In order to encourage these patients to work, they are allowed small sums of money with which they are able to purchase in the hospital, tobacco, confections, fruits, and commodities of a like nature. When discharged from the hospital they are given the money they have saved from their' earnings. Following is a list of garden truck and fruit which were produced in the patients' garden: Bananas. .bunches. 1,203 Pineapples. .each. 929 Beans. string.,.pounds. 192 Plantains. .each. .3,134 Cabbage,. .pounds. 282 Sweet potatoes.pounds. 22,045 Cucumbers. ...pounds. .652 Pumpkins. ..pounds. 123 Limes. .each. .558 Spinach.pounds. 2,129 Mangoes. .each. 26,700 Squash .pounds. 788 Okras. .pounds. 547 Tomatoes. pounds. 550 Oranges.each. 179 Y3as.pounds. 13,535 Papaya. .pounds. 1,225 Yucca. ..pounds .16,966 Alligator pears. ..each .1,867 The value of the produce taken in from the patients' garden for hospital consumption amounted to $3,017.85. These figures are not quoted to show any special financial gain, but simply to demonstrate that the patients are occupied in healthful, real work, which relieves them from their mental stress and improves their physical condition. All male patients suffering from acute mental disorders receive hydro-therapeutic treatment daily, the number ranging from 35 to 45. The effects of this treatment among the male patients have been

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39 most gratifying, and similar results are anticipated with the female patients when the new hydro-therapeutic apparatus is installed. There were no suicides or deaths due to violence among the patients. We have at present 24 black and 3 white chronic medical and surgical cases (not insane), as compared with 21 black and 2 white at the beginning of the year. All those capable of performing work are encouraged to do so. Some make bandages, 5 are employed making brooms (one suffering from ulcers of the leg, one with organic lesion of the spinal cord, and three legless men), and a number assist with the ward work. These men are paid a small amount for the work they perform. During the year the output of the broom plant has been increased by the installation of additional machinery, so that the production for the entire year has averaged more than 100 brooms per week. Farm Department.-Twenty additional acres of land were cleared, a part of which was planted in bananas, making a total of 80 acres now under cultivation. We have been able to plow about 50 acres, and with the modern farm machinery recently received, cultivation will be carried on more effectively and extensively. Six mules and one horse are used for farm work. Repairs to fences were made wherever necessary, and 300 rods of new four-wire fencing was added, enlarging the dairy pasture by 100 acres. Twenty acres of this has been cleared of brush, and a good crop of guinea grass is being produced on it. The hog pasture was increased by 30 acres. There were 29 cripples on the farm at the close of the year, as compared with 30 at the beginning of the period, one having died during the year. One is under treatment in Ancon Hospital for tuberculosis, while another was found guilty of selling liquor in the Canal Zone and was deported by the police. The services of these cripples were utilized by the farm in the garden, guinea pig warren (to supply animals to the Board of Health Laboratory), dairy, piggery, and cemetery; one as a helper on the motor truck, one as a teamster, one as a fireman at the steam plant, and others as helpers in the kitchen. There are five who are not employed by the hospital; these are each given a plot of land on the farm reservation to cultivate, and are paid on an actual production basis. Under this plan they are able to earn more than they would at a fixed rate of pay. This method encourages industry, giving them a greater incentive to apply themselves to their tasks, and eliminates the need for constant supervision. Their average earnings per month amount to $38.96, and subsistence is furnished them free of charge.

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40 A nursery, from which various plants are furnished whenever there is a call for them, is also maintained. Manure is composted and besides filling our own needs is sold to' truck gardens in Panama and its suburbs. The sales of produce aggregated $3,218.37, and of manure $1,139.37. Dairy. -The herd consists of 50 Jersey grade cows, and 31 calves; 10 Holstein cows, 12 calves, and 2 bulls. There were 75,782 quarts of milk produced, and milk sales during the year amounted to $18,642.90. Tuberculin tests, under the supervision of the Supervising Veterinarian of the Department, have been carried out periodically, as a result of which 10 reactors were killed; in addition to these, 5 cows died or were killed on account of being otherwise diseased or nonproductive. The butter-fat content of the milk continues high. All of the milk is pasteurized, and examinations are made of specimens at the Board of Health Laboratory at frequent intervals. These examinations have shown uniformly low bacterial counts. On account of the high standard and excellent quality of this milk it would be possible to dispose of a greater quantity than is now produced; however, production has steadily decreased because of the gradual reduction of the herd. At the present time we have 12 heifers, which will soon be added to the dairy herd as producers, and help to increase the milk supply. Piggery.-There were 401 pigs and 56 hogs remaining at the end of this calendar year. The piggery has been maintained on a profitable basis, and the total income from this division of the farm during the past year amounted to $3,107.82. Equipment.-The following equipment was received and installed in this hospital: Value. 1 farm wagon. ...$130.00 I Fordson tractor. .498.00 1 refrigerator plant for kitchen. 2,181.00 1 blacksmith's portable forge. ..30.00 1 mowing machine. 66.00 1 40-horsepower return-tube boiler. 1,285 00 Complete set of hydro-therapeutic apparatus. ......1,356.00 1 6-shovel balance frame cultivator. .57.50 1 one-horsepower electric motor for pasteurizer and portable washing machine at dairy ...53.00 2 electric light cabinets (These were received, but owing to the damaged condition in which they arrived, have not yet been connected with electric current) ....each. 48700 Personnel.-During the year two new positions were created on the gold roll: That of general mechanic, whose duty is to supervise the work of the silver artisans, keep up necessary repairs of machinery and equipment, and make various adjustments required from time to time in the steam plant, refrigerating machinery, plumbing, pipe line, etc. The second position created was that of occupational aide, who

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41 supervises the work of the patients in the occupational ward; this has relieved the chief nurse, who was able to devote only part of her time to that work, and allows her to give more time and attention to the supervision of the work in the wards, laundry, storeroom, etc. The results obtained since the creation of these new positions have demonstrated that the need for them was an actual one. General Remarks.-A training school for silver attendants was organized for the purpose of instructing silver employees in ward management, and the care of the insane. In addition to the regular course, a special course in hydro-therapy was given to those possessing the necessary preliminary qualifications. Since the organization of this training school an improvement has been noted throughout the wards, the attendants and maids showing great interest in everything pertaining to the welfare of the patients, and a spirit of general cooperation among employees prevails. COLON HOSPITAL Colon, R. de P. Maj. T. J. LEARY, U. S. Army, Superintendent. Personnel and Organization.-The hospital is running smoothly. The morale and cooperation of the staff is excellent. The medical staff at present consists of 6 physicians, including the superintendent, all except one being detailed from the Medical Corps of the Army. There are at present no internes, as the hospital as at present constituted is too small and the service offered too restricted to provide necessary interne training. The loss of the two internes apportioned to this hospital has seriously reduced the number of physicians on duty. This hospital has a dual function to perform, i. e., providing dispensary and out-patient service, and hospitalization of the more seriously ill. With the increase in Army and Navy personnel on the Atlantic side of the Canal an increased and active medical and surgical consultation service has resulted. The increase in shipping through the Canal has increased the number of Public Health Service cases treated, and there has been a greater demand for physicians to board boats to examine cases. The work of the professional personnel has been apportioned as follows: The superintendent of the hospital has also acted as chief of the surgical service. The district physician has acted as chief of the medical and obstetrical service; he is also school physician. It has been the custom to detail a physician or interne as assistant on each of these services. At present with shortage of personnel, the district

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42 physician is without such help. One physician is assigned to the colored dispensary and one to the white dispensary. The problem that this hospital has been called upon to solve has been to give the maximum of service at a minimum expense, with limited personnel, equipment and hospital space. That it has been fairly successful is evidenced by the improved regard of the Atlantic side for Colon Hospital. There has always been considerable dissatisfaction on this side that sick or injured relatives must, in so many cases, be transferred to Ancon Hospital for treatment, due to lack of physicians trained in specialties, lack of necessary equipment, and limited space of the Atlantic side hospital. This situation can be improved to a certain extent with the hospital continuing to draw on the Army Medical Corps for its physicians. As replacements are required, physicians specializing in X-ray, eye, nose and throat, genito-urinary diseases, and laboratory work should be obtained. In addition to carrying on the routine work of the hospital, these men would have an opportunity to handle a certain number of cases in their speciality, particularly those requiring only dispensary treatment. By so doing the cost of transportation to Ancon Hospital would be saved the government in many cases, and employees would lose less time from their work, to mention only a few of the important advantages of this plan. The nursing personnel consists of 11 female nurses. This is adequate for present needs. Buildings. -The buildings are in excellent condition with the exception of the part of the old hospital allowed to stand for use as an isolation ward. The resurfacing of the exterior of the concrete buildings, necessitated by rusting through of the reinforcements placed too close to the surface, has been completed and adds much to the appearance of the hospital. The painting of the hospital has been continued during the year. The work has been done by the hospital personnel as they could be spared from other tasks. SANTO TOMAS HOSPITAL. Panama, R. de P. Maj. EDGAR A. BOCOCK, U. S. Army, Superintendent. This hospital is maintained by the Republic of Panama, but is under the supervision of the Chief Health Officer of The Panama Canal, and the Superintendent, 2 physicians, chief nurse, and 2 nurses are paid by The Panama Canal.

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43 Realizing the approaching date of the inauguration of the New Santo Tomas Hospital, the policy of this institution during the past year has largely been devoted toward intensifying and improving methods previously in effect, enlarging and training the staff on hand, and generally raising to a higher plane the administration of the present institution. By Presidential Decree No. 57 of October 1, 1923, the reorganization of the hospitals in the capital towns of the provinces of the Republic was entrusted to the Superintendent of Santo Tomas Hospital, subject to the supervision of the Board of Directors of this institution, and since the date mentioned an active campaign of reorganization has been under way with the result that the close of 1923 finds five of the provincial hospitals (Colon, Bocas del Toro, Santiago, Chitre, and David) each having capacity of 30 beds, well equipped, staffed, and ready to carry out the functions of emergency stations, for which they are intended. Month by month, the accounting, supplying of material and equipment and general administration of these subsidiary institutions is being improved, and it is felt that within the coming year they will be in all respects creditable branches of the New Santo Tomas Hospital, that will be inaugurated about September 1, 1924. Administration.-On January 31, 1923, the eighth graduating class of twelve nurses concluded their course of training in the hospital training school. Appropriate exercises were held and the majority of the graduates have been employed, either in this hospital or in one of its branches. Particularly creditable seems the record of the training school from its inauguration in 1915. Since that date 61 nurses have been graduated, and of this number, 29 are now employed in the Republic, 18 have married, 11 have secured positions in neighboring republics, and 3 have died. In several departments it has been necessary to secure additional employees, and invariably the vacancy has been filled by a citizen of Panama when one was available. Throughout the year, it has been necessary to make increases in salary, particularly to the orderlies and maids. Also, in several instances, doctors and graduate nurses have been given increases in order to retain their services, since the supply of such personnel is limited and difficult to procure, and well qualified employees have been hard to replace. Finances.-The total appropriations and income for the year amounted to $248,576.61, while the expenditures for the year were $232,434.63, leaving an excess of assets over liabilities of $16,141.98. On the last day of the year, the hospital's bank account showed $31,213.69 cash

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44 on hand. This amount will probably be utilized in the purchase of equipment for the new hospital, thereby obviating the necessity of using old apparatus in the new buildings. Steward's department.-During the year, 243,639 rations were prepared and issued at an average cost of 31.8 cents per ration. During the year, the grounds and buildings of the hospital have been given sufficient attention to maintain them in serviceable condition until the new hospital is ready for occupancy. It has been necessary to entirely renovate the laboratory, morgue, maternity sections, and student nurses' quarters, since these buildings were in very bad condition and wduld not stand an additional year of use without considerable repair work. The average monthly cost of upkeep for the buildings and grounds amounted to $475.18. Professional services.-The professional work for the year has been successful and has shown marked progress over past years. The number of patients admitted was 9,769, as compared with 8,624 for the year 1922; the average stay of patients in the hospital has been reduced to .9 days, from 10 days as in 1922. New diagnostic methods have been introduced as promptly as proven practicable in other hospitals; all new medicines of value have been given a reasonable trial, and a new system of filing records and statistics was instituted, thereby making these accessible for scientific papers that may be prepared by the hospital staff in the future. The medical service cared for 7,241 patients during the year. Of these, a considerable number were infectious diseases, since a sharp epidemic of measles with a number of broncho-pneumonia cases was present in Panama during the latter months of the year. The drug store, in addition to furnishing all medicines and chemicals to the hospitals of the interior and the National Government, filled 12,746 prescriptions. Of this number, 3,221 were issued free, while the remainder were charged to patients referred by corporations and companies and to persons able to pay for their medicines. Practically all drugs used were purchased in wholesale lots direct from the manufacturers. The ambulance service made 1,947 calls during the year, or a daily average of 6. The cost of operating this service amounted to $2,798.51 The surgical service of the hospital, which includes the X-ray clinic, the eye, ear and nose clinic, and the venereal clinic, was particularly active during the year. This service performed 1,651 major, and 2,024 minor operations, gave 3,654 doses of salvarsan, and made 16,021 examinations, dressings and minor treatments.

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45 The total cost of the professional care of patients amounted to $82,024.36 for the year. As in previous years, a shortage of competent personnel to carry on the work in an entirely satisfactory manner has been experienced. It has been necessary to maintain entire wards, handling from 30 to 60 patients, with only the services of internes and pupil nurses, and it is obvious that these employees, without the necessary supervision, can not be expected to give to the patients the class of service that modern hospitalization demands. During the year, several additional graduate nurses have been employed with notable improvement in results, but the number available is not as yet sufficient to meet the demand. PALO SECO LEPER COLONY. Mr. FREDERICK D. TUCKER, Superintendent. Dr. PHILIP HoRWITz, Attending Physician. Statistics regarding patients follow: Remaining. Admitted. Died. Paroled. Dec. 31, 1923. Class of patients. ________ ________ ________ ________ ________ White. Black. White. Black. White. Black. White. Black. White. Black. Panama pay. 7 42 1 *13 21 3 .4 37 48 Zone charity. .28 ...2 .26 Totals. 7 70 1 13 1 3 .6 7 74 One was a readmission. 2 Chinese. 3 Two Chinese and 5 Panamans. Classification of the patients was as follows: Admissions. Deaths. Paroles, Male. Female. Male. Female. Male. Female. White. Black. White. I Black. White. Black. White. Black. White. Black. White. Black. WestIndian. .2 .* .3. 4. Panaman 5 ....1 Chinese. ...... Totals .7 1 6 1 3 The average age at time of admission was 34 years for males, and 35 years for females; 1 male and 1 female were married; 1 male was a widower, and 3 females widows; remaining admissions were single. The average age at death was 46 years; average length of time with leprosy, 10 years; average length of stay at Palo Seco, 5 years. The average age on parole was 40 years for the males; the female paroled was 22 years of age. Average length of time with leprosy, of those paroled, was 6 years for the males, and 4 years for the female; average length of stay at Palo Seco was four and one-half years.

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46 The nationalities of the patients remaining December 31, 1923, were: 33 British West Indians; 5 French West Indians; 35 Panamanians;. 4 Colombians; 2 Chinese; 1 Haitian, and 1 Ecuadorian. An average of 26 patients were given employment, their monthly wage averaging $7.95 each. Local products were purchased from patients to the amount of $143.61, and cash allotments, which vary according to the degree of disability of the patient, totaled $1,557.50. Thus the total annual income of patients amounted to $4,205.43, or an average per patient of $52.37. Total cash sales at the local store amounted to $2,938.55. During the year, 5 pigs from the local farm were killed for food; there are 5 pigs remaining on the farm. Weekly "movie" exhibitions were continued during the year and were greatly enjoyed by the people. Increasing difficulty was experienced in obtaining an operator for the moving picture machine. During the year, 2 concerts by colored West Indian bands, and 5 vocal concerts by colored West Indian choirs were given. Christmas week the Ancon Girl Scouts, as is their annual custom, visited the colony, sang Christmas carols and songs, and distributed candy to the people. A deputation from the Panama Rotary Club visited the colony and expressed great interest in the place and work, and have promised a radio receiving set for the colony. A local carnival, the first in our history, took place the 10th to the 13th of February, and was a tremendous success. The visiting physician of the leper colony makes the following report: Specific Treatment.-The administration of the ethyl esters of chaulmoogra acids was followed along the general routine laid down for the preceding year; 26,375 cc of the drug were given as follows: 7,325 cc in 1,465 weekly intramuscular injections to 67 patients. 10,205 cc in 2,043 biweekly intravenous injections to 41 patients. 1.710 cc in 342 triweekly intravenous injections to 3 patients. The balance was utilized for local application to eyes in eye lesions, as a spray to nasal mucous membranes and as injections into nerves and nodules. The above doses and methods were found suitable to the tolerance of the average patient. The maximum amount given a single patient was 15 cc per dose. The effect of saturation or over-saturation with the drug was manifested by the following symptoms: anorexia, nausea, vomiting, loss of weight and acidosis with glycosuria. These symptoms promptly sub-

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47 sided on reduction of dose or cessation of treatment for short periods. At no time did any alarming symptoms develop as a result of treatment with the esters. The numbers given above as under treatment include the total population of the colony, with the exception of 3 who were too old and feeble to withstand the reactions following injections, and whose chance for ultimate recovery was considered nill. Treatment of complications was given as follows: 1. Lues.-In several cases it was found that syphilitic infection interfered with the proper treatment for leprosy. Eighteen such cases had shown a positive blood Wassermann reaction. Antilepric treatment had no effect in modifying the Wassermann reaction. These patients were, therefore, put on anti-syphilitic treatment. Seventeen cases received 170 grams of Neosalvarsan in 189 injections. Eleven cases became negative after 103 grams in 114 injections. One case died before completing treatment, and 5 cases are still under treatment. 2. Uncinaria.-Sixteen cases were treated for uncinaria with thymol or chenopodium. All became negative as was shown by repeated examination of stools for worms or ova. 3. Ulcers.-Twenty patients were given regular treatment for trophic ulcers. Among these, plantar perforating ulcers were most common; next in frequency were ulcerations of the fingers and toes, and occasional shallow skin ulcers of legs and forearms. The following methods were used: (a) Rest to affected member-in elevated position if edema was present; (b) Continuous application of Dakin's solution; (c) Continuous application of warm, sterile N. S. S. (d) Cauterization of callous margins with chemical or electro-cautery in chronic indolent ulcers, followed by application of either Dakin's solution or 1 to 4 per cent benzol chloride in crude chaulmoogra oil; (e) Fifteen patients received 4,109 cc "Oscol" in 840 intravenous injections. (vide Annual Report 1922.) 4. Local Lepric Conditions. Eyes.-Lepromata of eyes in nodular and mixed types were given one-fourth to 5 per cent of the esters in albolene dropped into eyes several times daily. Nasal ulcers.-Owing to the fact that the majority of the patients were discharging large numbers of bacilli (from active nasal ulcerations) they were subjected to periodic spraying of nasal cavities with 1 to 2 per cent of benzol chloride in equal parts of crude chaulmoogra oil and albolene. Nodules.In several instances injections of the esters into nodules resulted in the complete absorption of the latter; chemical and electro-cautery was also capable of producing the same effect. Nerves.-Intraneural injections of the esters into fusiform swellings of ulnar and peroneal nerves were tried with marked success for amelioration of pain, cramps, and contractions of digits in nerve type cases. Medical cases requiring hospital care were transferred to Ancon Hospital for treatment. New admissions.-Fourteen cases were admitted to the colony during the year; of these, 3 were of nodular, 4 nerve, and 7 of the mixed type of the disease. These patients were divided for treatment as follows: All mixed type cases, as well as 2 of the nodular types were given bi-weekly intravenous and weekly intramuscular injections.

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48 The neural cases were given weekly intramuscular injections and one nodular case received triweekly intravenous injections. Deaths.-Four patients died at the colony during the year. These had received a total of 1,745 cc of the esters via intramuscular route. Three had the nerve type, and 1 the tubercular. Causes of death as revealed by autopsy included leprosy in all cases, 3 of which showed positive organisms in films, from skin or mucous membrane. Contributory-chronic nephritis, 2; chronic pulmonary tuberculosis, 2. Paroles.-Six patients were paroled during the year. 1. Case No. 198, H. C., male; West Indian; 56 years; time in colony, 2 years and 3 months; nodular type; received a total of 1,400 cc of the esters via intramuscular and intravenous routes; was paroled October 1, 1923. The board of examination of leper cases and suspects issued the following report concerning this patient, on June 17, 1921: "Smearsfrom nodules on the forehead are positive for leprosy bacilli. (Smears from both sides of nasal septum negative for acid fast organisms). Smears from nodules on the forehead contained an enormous number of slender acid fast bacilli, single, in parallel groupings and in cell nests. The smears were stained by the Gabbett method for acid fast organisms." Patient was admitted to the colony on June 20, 1921. The progress. record follows: September 16, 1921, put on intramuscular injections of ethyl esters. October 13, 1921, infiltration of forehead shows signs of subsidence; it is somewhat softer in consistency and shows moderate amount of scaling. January 9, 1922, complains of burning and pricking sensations over small areas on both forearms, legs and thighs. Examination shows round, decolorized macules on inner surface of both forearms and exterior surfaces of thighs and legs; some of the macules show single pigmented points in their centers; these macular areas are extremely sensitive to touch, producing burning sensations. February 16, 1922, sensitive macules described above have been continually losing hypersensitiveness, and at present maintain simular sensation as rest of skin. Aigust 18, 1922, macules described above maintain normal sensation; anesthetic prominence of infiltration of forehead almost entirely subsided; however, skin still remains pigmented and somewhat indurated. September 14, 1922, patient received increased intravenous doses of the esters, given in doses as high as 10 cc twice weekly in addition to 5 cc intramuscular injection; this usually gave sharp rise in temperature following treatment, and somewhat weakened patient so that he showed decrease in weight of about 5 pounds. November 25, 1922, patient received decreased doses of the esters, 5 cc weekly, up to April 4, 1923, when infiltration described above and as shown in photograph had entirely subsided., April 4, 1923, smears taken from nasal septum and from infiltration of forehead were negative. May 2, 1923, patient was put on solution of arsphenamine Squibb. May 18, 1923, put on novarsenobenzol and continued for 8 weeks; at the end of this time he had recuperated and showed increase in weight of 3 pounds. July 7, 1923, patient was put on saturated solution K. I. (grs. 5), gradually increasing in dosage till maximum of 120 grs, t. i. d. was reached on September 1, 1923. Through this period, smears from nasal septum and from puncture made where infiltration was present, proved to be negative. Patient did not show any reaction during K. I. treatment. On September 25, 1923, he was examined by the leprosy board and recommended for parole. In their recommendation the board wrote as follows:

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Cut No. 1 Cut No. 2 Case No. 198. H. C.-At time of admission to Palo Case No. 198. H.C. At time of parole from Palo Seco eco Leper Colony.-See page 48 Leper Colony, 2 years and 3 months after admission. The skin of the forehead is smooth, altho pigmentel areas remain which give an appearance of corrugation in the photograph.-See page 48.

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49 "To-day, September 25, 1923, he presents no evidence of leprosy. The nodules and infiltration have entirely disappeared from the forehead, and smears from both sides of the nasal septum and from site on the forehead where lesions previously were located, are all negative for acid fast bacilli. The skin over this area is much more darkly pigmented than skin on rest of face. "As he is physically able-bodied, has no open lesions, as his disease is apparently arrested or cured, and as he desires to be discharged, it is recommended that he be granted parole" (see cuts No. 1 & 2). 2. Case No. 213. G. M.; male; West Indian; time in colony, 1 year; nerve type; received a total of 217 cc of the esters via intramuscular route; was paroled on September 3, 1923.' Patient was admitted to the colony, September 12, 1922, on the following report of the special board for the examination of leprosy cases and suspects: "September 7, 1922. Smears from forehead, both sides of nasal septum, aspiration of left ulnar nerve, and from gangrenous fourth right toe were all negative for leprosy bacilli. There were a few single acid fast bacilli in smears from the forehead but none which could be diagnosed as B. Leprae. September 8, 1922; fourth right toe (amputated): Three films made from subperiosteal regions near line of amputation. All positive for leprosy bacilli. Cell nests and scattered bacilli found in all films. "The smears were stained by the Gabbett method for acid fast organisms." Progress record: After amputation of fourth toe, right foot, smears made from this member were found to contain leprosy bacilli. The wound was treated and dressed daily and completely healed in 8 weeks. Patient was then permitted to do general work about the grounds. Intramuscular injections of the esters were started Sept. 14, 1922, 5 cc being given once weekly and continued until paroled. On December 18, 1922, patient complained of pain and numbness in left forearm and hand, and 2 cc of esters was injected into ulnar nerve-result good. On June.3, 1923, patient was placed on provocative doses of K. I. until the maximum dose of 120 grs. t. i. d. was reached, and continued for 2 weeks. During this period numerous smears were taken from the apparent macules on back and nasal septum; all were negative for leprosy bacilli. 3. Case No. 174. G. B. female; Panamanian; age, 22 years; time in colony, 4 years; mixed type; received a total of 1,262 cc of the esters via intramuscular and intravenous routes; was paroled May 15, 1923. Patient admitted to the colony March 14, 1919, on following report of the leprosy diagnosis board: "Smears made from both sides of nasal septum, positive for B. Leprae. Smears made from lobule of right ear, positive for B.Leprae. The smears were stained by the Ziehl-Neelsen and Gabbett's method for acid fast bacilli. In all nasal smears there were many characteristic clumps of slender acid fast rods and many similar discrete bacilli." Progress record: On admission to the colony in 1919,.patient showed positive smears from mucous membrane of both sides of nasal septum, and of skin of lobule of right ear. Smears from nasal septum taken at the colony, August, 1921, were also positive. Smears from skin of ears were negative. August 25, 1921, put on the intraY This patient died outside of the colony, January 5, 1924; *autopsy performed by Dr. V. H. Cornell, Pathologist, Board of Health Laboratory, Ancon Hospital. Findings show: "Smears for B. leprae-A few large acid fast bacilli seen but nottypical of B.Leprae. These smears were taken from both sides of the nose, skin of left forearm, and the periosteum of the fingers of the left hand and toes of the right foot. Cause of death-Acute serofibrinous pleuritis. ContributoryPulmonary congestion and edema. MR 91030 4 IFa

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50 muscular injections of the esters. In January, 1922, smears from nasal septum were negative, so patient was put on provocative doses of K. I. She tolerated up to 40 grs. daily, then developed slight attacks of lepra fever and eruption. Smears taken on the 3d of February, 1922, from.both sides of the nasal septum and tubercle of right ear were positive for B. Leprae. K. I. was discontinued on that date. On February 14, 1922, patient was given the esters intravenously twice weekly in addition to the intramuscular administrations. Intravenous doses were gradually increased until maximum of 14 cc at a dose was reached on August 8, 1922, and was maintained up to October, 1922, the maximum of the intramuscular doses having been reached on April 28, 1922, at 20 cc; thus, this patient received about 48 cc of the esters weekly. On August 15, 1922, smears from nasal septum were negative. Patient was again put on K. 1., 15 grs. daily. She developed no symptoms this time following administration of K. I., Lut smears taken from nasal septum on August 19, 1922, proved to be positive. October 19, 1922, patient developed rather marked intolerance to the large doses of the esters, which was manifested by nausea, persistent vomiting, elevation of temperature, and loss of weight; esters treatment discontinued on that date. October 26, 1922, collodial antimony was substituted for chaulmoogra treatment, and was given in 5 cc doses intravenously 3 times weekly. On January 5, 1923, patient showed negative smears from nasal septum and was then put on gradually increasing doses of K. I. until maximum of 120 grs., t. i. d. was reached on April 9; these doses were continued to date Cf parole. Patient did not show any reaction following these large doses of K. I. and repeated examinations during this period from cauterized mucous membrane of nasal septum as well as skin of ears and old scars of pigmented areas failed to reveal the presence of B. Leprae. Clinically, however, patient showed no changes; there was still an enlargement of .both ulnar nerves, partial anesthesia of skin of extremities, and partial paralysis of terminal phalanges of little fingers. 4. Case No. 64. R. W.; imale; West Indian; age 41 years; time in colony, 12 years; nodular type; received a total of 1,317 cc of the esters via intramuscular and intravenous routes; was paroled May 15, 1923. Patient was admitted to the colony April 19, 1911. Progress record: Although patient had an acute attack of lepra fever and marked nodular eruption in 1913, his lesions gradually cleared up when specific treatment was instituted here in August 1921; patient presented an almost arrested state of the disease with the exception of smears from lobule of left ear which have shown a few organisms. During entire course of treatment no other manifestations of the diesase have become apparent with the exceptions of inflammations of conjunctivae and swellings of lower extremities following provocative administrations of small doses of iodide of potassium given to elicit symptoms. K. I. was first administered to patient January 15, 1922; at that time he could not tolerate doses higher than 5 grs. daily. Several attempts to repeat administration of K. I. during the year 1922, invariably brought on repetition of symptoms; these symptoms always subsided with discontinuance of the drug. Local injections of the esters, of colloidal antimony, and applications of caustics to lobule of left ear during the year 1922, failed to show any effect upon the presence of organisms, repeated examinations of smears from skin of that ear during that year always proving positive. In September, 1922, patient was puton large doses of the esters, viz: two doses of 10 cc each intravenously, one 5 cc intramuscular weekly; local applications to ear were discontinued. Smears taken on December 7, 1922, from left ear were negative. (Smears from any other part of the body or nose were always negative.)

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51 Patient was again put on increasing doses of K. I.; this time he tolerated the drug fairly well. The largest of K. I. was reached on March 31, 1923-120 grs. t. i. d. During this time he neither showed repetition of symptoms formerly produced by administrations of iodide, nor was the presence of organisms demonstrated in smears from left ear, skin, nasal mucous membrane, or other parts of the body. 5. Case No. 210 J. W.; male; Panamanian; 46 years; time in colony, 1 year 1 month; nerve type; received 210 cc of the esters via intramuscular route; was paroled September 4, 1923. This patient was admitted to the colony on July 30, 1922. He never had any open lesions or ulcers, and the only positive bacteriological finding was on July 26, 1922, in a crippled finger (ring finger of left hand) which was amputated for examination. The report was as follows: "Microscopic Report: Atrophic leprosy (sparse number bacilli found in nerves and subepithelial layer)." Progress record: Index finger of left hand having been amputated, stump was treated and healed in a short time. Patient was placed on intravenous injections of colloidal antimony 1 cc, three times a week, increased to 5 cc three times a week. This usually caused a sharp rise in temperature followed by extreme weakness. Commencing October 26, 1922, intramuscular injections of 5 cc of the esters was given once weekly in addition to the colloidal antimony twice weekly. On April 4, 1923, colloidal antimony was discontinued, patient receiving but one injection of the esters weekly, intramuscularly; patient still presented contraction of both hands, but his condition had improved considerably, and on June 3, 1923, he was given provocative doses of potassium iodide, 5 grains t. i. d., and gradually increased until the maximum of 120 grains t. i. d. was reached, which was continued for 14 days. At no time during the potassium iodide treatment did patient show any reaction. Smears taken from both sides of nasal septum, from lobules of both ears, anI from the discolorized patches on skin, arm, proved to be negative for leprosy bacilli. 6. Case No. 186. C. L.; male; Panamanian; age, 26 years; time in colony, 7, years; nerve type; received 241 cc of the esters via intramuscular route; was reparoled December 22, 1923. Note: Previous parole, February 7, 1920. Readmitted February, 1920, as clinical type. He was discharged for insubordination and was readmitted because he could not make a living outside. This case is of no clinical interest. All these patients were subjected to the provocative oral administration of potassium iodide before parole. In addition, smallpox vaccinations have been successfully performed on them without causing any untoward reactions. (NOTE.-Vaccination in active cases of leprosy has been reported to cause very severe reaction.) General results.-Specific treatment definitely arrests the progress of the disease in early and fairly advanced stages. In nodular and mixed types, improvement is very marked in the first few months after establishment of treatment. From that time on progress is much slower, almost imperceptible, yet improvement continues as long as the patients are under treatment. Interruption of treatment does not result in regression, but complete withdrawal is invariably followed by relapse.

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52 In nerve type cases of fairly early stages, where destruction has not set in, its inception is prevented; anesthetic patches disappear and paralyses are stayed. The improvement does not follow the same course as in nodular attacks, but is of a gradual, steady growth; in late cases the destructions are probaly irreparable. Here it may be well to mention that intraneural injections are of distinct value in arresting further trophic changes, especially when combined with the intramuscular or intravenous methods. The results of treatment in trophic ulcers were found to depend largely on the response of the patient to general treatment. All the methods employed are valuable, but none can completely close a large perforating plantar ulcer on a mutilated foot where the nerve supply has been completely destroyed. Eye lesions were found to be benefited by local applications of the esters in diluted form, especially when combined with intra-nasal spray, or better still, tampons soaked in pure esters and applied to the ulcerated areas of the nasal mucous membrane. It is possible that eye infections are the result of contiguity to the intra-nasal condition, and that the organism is carried upward via the nasal duct. BOARD OF HEALTH LABORATORY. (Dr. L. B. BATES, Chief of Laboratory.) (Operated in connection with Ancon Hospital.) There have been no epidemics to deal with during the year. Bacillus typhosus-Recovered in blood culture from 13 individuals; 4 from shipboard, 1 from Peru, 1 from Porto Rico, and 7 from the Canal Zone and Republic of Panama. B. paratyphosusB was recovered once in blood culture from a colored woman who lived in Silver City .(Cristobal). Typhoid Carriers.-On December 31, 1922, 4 typhoid carriers were under sanitary surveillance, H. B. and G. H. of Panama City, and J. S. and C. de L. of Colon. J. S. was a urinary carrier, the others stool carriers. H. B. and G. H. still remain positive. The last culture from J. S., obtained on June 21, 1923, was positive. Shortly after that he left the country. Cultures from C. de L. in July, August, October, and December were negative. R. P., a seaman, who was admitted to Ancon Hospital on September 4, 1923, in the last week of typhoid fever, developed the carrier state. He was discharged from the hospital and sent to the United States on November 15, 1923. There were two typhoid carriers under sanitary surveillance on December 31, 1923, H. B. and G. H. of Panama City.

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53 Tonsil and Adenoid Examinations.-The routine examination of tonsils and adenoids removed at operation was continued throughout the year. Of 313 tonsils removed alone, 5 or 1.6 per cent were found to be tuberculous;.of 17 adenoids removed alone, 2, or 11.8 per cent were tuberculous; of 322 tonsils and adenoids removed together no tonsils or adenoids were found tuberculous. The totals, considering each case as a unit were: 652 cases in which either tonsils or adenoids or both were examined, and 7 or 1.07 per cent in which tuberculosis was found to be present. Mycotic fungi were frequently found in the tonsillar crypts, but none of these suggested actinomycosis or other pathogenic forms. Cultures of these were not made. Tonsils and adenoids were removed from 2 cases of phlyctenular conjunctivitis in the above series. One tonsil in one of these cases showed tuberculous foci, and the adenoids in the other case showed tuberculous foci. Ulcus tropicum (Tropical sloughing phagedxna).-This condition, although said to be common in the tropics, is very seldom seen in the Canal Zone. However, during the year one typical case was seen at Ancon Hospital. A. C. W., No. 252596, white American, was admitted to the hospital with large phagendenic ulcers on both legs over internal and external maleoli. He gave a typical textbook history of onset and progress of the condition. He had been prospecting on the Panama-Colombia border, going barefoot most of the time. Smears from the lesions showed enormous numbers of large coarse spirillx having from 10 to 15 turns and many fusiform bacilli. There were also staphylococci present but these immediately disappeared when treatment was instituted. The spirillw and fusiform bacilli however, were very resistant. The fusiform bacillus was recovered in pure culture in 20 per cent serum agar, incubated anaerobically according to Krumwiede and Pratt's method. Efforts to isolate the spirille were unsuccessful. Animal inoculations were unsuccessful. Rat examination.-Following the appearance of an article entitled "Plague-Infected Rats Without Visible Lesions" in "United States Public Health Reports," Vol. 38, No. 33, published August 17, 1923, it was decided to use the smear and animal inoculation methods therein recommended in the examination of a portion of the rats submitted to this laboratory. It was impracticable to apply these methods to all specimens as the time factor prohibited so extensive a study. However, since September, when this plan was inaugurated, 520 rats have been thus examined. Smears of livers and spleens were stained by Gram's method and examined microscopically. Small pieces of livers and spleens were macerated in sterile normal saline by means of a sterile mortar and pestle. This suspension, prepared from the organs

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54 of not more than ten rats, was then subcutaneously injected into the abdominal wall of a healthy guinea pig. All pigs dying in less than seven days were autopsied, and those living seven days were bled to death and then autopsied, their blood being used in the complement fixation tests. Gross inspection and smears of liver and spleen were made in the examination of all these animals. Thus far no positive results for plague have been obtained. The above is in addition to routine autopsy examination of 14,077 rats. Swimming pool.-Periodic examinations of the water in the Balboa Swimming Pool were continued throughout the year. These consisted of bacteria counts and examinations for B. coli. Chloride of lime was used for disinfecting the pool until the last week in August. It was very difficult to get chloride of lime having a satisfactory available chlorine content, and the deteriorated product, of course, gave little or no disinfection. On August 28, Mr. G. C. Bunker, the Panama Canal Physiologist, introduced the chlorine gas method of disinfecting the pool, modifying the method of introducing the gas to meet the requirements of the pool. The pool is emptied, scrubbed, and refilled three times per week, and each evening 21 to 3 pounds of chlorine gas is added to the pool. (The pool contains approximately 430,000 gallons.) The specimens for examination are taken in the morning. The count now is seldom above 100 per cc. When the chlorine gas is properly distributed throughout the pool, B. coli are seldom present in 10 cc quantities, but when added by those not skilled in its use the desired results are not obtained. Library.-The laboratory library is well supplied with current medical journals dealing with laboratory and closely allied subjects. This library is invaluable to the laboratory staff. Its use by the medical profession in general has always been encouraged. The past year has seen a most noticeable increase in its use by the hospital staff. Embalming.-The embalmer-cremator has introduced a modification to the routine method of embalming which causes a much more thorough fixation of the tissues. The modification consists of attaching an aspiration bottle to the canula in the jugular vein and maintaining negative pressure in this bottle throughout the embalming approximately equal to the positive pressure in the bottle on the arterial side containing the embalming fluid. Autopsies subsequent to embalming have demonstrated that practically all the blood is removed from the body by this method and that the embalming is much more thorough.

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55 During the year approximately 33,000 reports have been rendered. This does not include duplicates. BACTERIOLOGICAL REPORT. Blood cultures. ..190 B. typhosus. B. paratyphosus B. .1 B. coli. ..2 Pneumococcus Type II. ...2 Staphylococcus aureus. .5 Staphylococcus albus. ..3.3 Streptococcus non-hemolytic. ..1 Streptococcus iiridans. ...3 Stools cultured for Typhoid Dysentery group ..3,176 Positive stool cultures. ..100 B. typhosus. 33 B. typhosus on carriers (4 carriers). .21 B. dysenteriae Group I (Shiga). .1 B. dysenteriae Mannite Fermenter Group II. .44 B. dysenteriae Group III ...1 Urines cultured for typhoid group. ..2,884 Positive urine cultures. ..9 B. typhosus on carriers (1 carrier). .9. 9 Urines cultured for organisms other than Typhoid group ..118 Positive urine cultures (53 of these B. coli). ..73 Throat cultures for B. diphtheriae. ..2,125 Positive for B. diphtheriae. .....90 Nasal cultures for B. diphtheriae. .-.....88 Culture from ear for B. diphtheriae. ....I Throat culture for organisms other than B. diphtheriae. ..I Ear cultures. .6 Mastoid cultures. ..7 Eye cultures. .7 Naso-pharyngeal cultures. .5 Sputum cultures. ...47 Spinal fluid cultures. ...64 Pneumococcus Type II. 1 Streptococcus hemolyticus. .....1 Pleural fluid cultures. ...18 Ascitic fluid cultures. .....3 Knee fluid cultures. ....23 Cultures for Ducrey's bacillus. 112 Positive for bacillus of Ducrey. 3 Cultures from skin lesions. .11 Pus from anterior chamber, left eye. ..1 Pus from periarticular abscess. 1 Pus from abscess on lip. .1 Pus from knee. 3 Pus from fallopian tube. .I Pusfrom scrotum ...4 Pus from left tube and ovary. ..1 Pus from gall bladder. I Pus from ankle joint. .2 Pus from liver. 2 Pus from liver abscess. ..4 Pus from rectum. 1 Pus from abscess of leg. ..2 Autopsies cultured. 133 Organs, exudates, etc. .228 C ultures of surgical tissues. .......9 Culture from lachrymal duct. ..I Culture from nose. ......1 Cultures from dressing of left axilla. .2 Culture of fluid from wrist joint. 1 Cultures of bile. 5 Culture of fluid from duodenum. 1 Culture of vaginal discharge. ....I Gland cultures (inguinal glands). 3 Culture from dressing of right knee. ....1 Cultures of tropical uleer. ..1 Examinations of leper suspects. .38 Positive for B. leprae. ..15 Examinations of lepers previous to parole. 7 Examinations of paroled lepers. .3 Sputum examined for B. leprae. I Sputum smears for B. tuberculosis. ....108 Positive for B. tuberculosis. ..20 Urine examined for B. tuberculosis-. 11 Spinal fluid examined for B. tuberculosis. .......7 Pus for B. tuberculosis. I

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56 BACTEROLOGICAL REPORT-Continued. Darkfield exam inations. ...334 Positive for Treponema pallidum ..42 Darkfield examinations for yaws. 9 Sputum for darkfield examination. .I Blood films examined for malarial parasites ..622 Positive for Tertian Malarial Parasites. 155 Positive for E. A. Malarial Parasites. 74 Positive for Quartan M alarial Parasites. ...3 Blood film examined for spirochaetes of relapsing fever (positive) ......1 Blood for red cell count. 1 Blood for white cell count. ...1 Blood for differential count. .3 Blood for haemoglobin estimation. .1 Blood examined for filaria. 9 Eye smears. .,. 112 T hroat sm ears. ...720 Sm ears from nasal ulcer. .....I Urethral smears. 138 Vaginal smears. .24 Smears from venereal lesions. ....46 R ectal sm ears. ....4 Smears for Leishman-Donovan bodies. 5 Feces examined for parasites and ova. 140 Stool for fermentation test. 1 Cell count of spinal fluids. 2 Rat virus cultured. ......1 Autogenous vaccines prepared. .65 Water from Balboa Swimming Pool. ...132 Water from Panama Health Office for bacteriological examination. ....I Water from Colon Health Office for bacteriological examination ..4____.4 Water from Fort Grant Beach. 3 Water from Bella Vista Beach ..3 Drinking water for bacteriological examination ......3 Food stuffs examined: Milk cultured for bacteriological count. ...470 Mother's milk for culture. ....1 Dill pickle for culture. ..1 Hash for examination. .1 Bread examined fcr rope. ..8 Bread examined for mold. ..1 Miscellaneous smears and examinations. ._. ...150 SEROLOGICAL REPORT W assermann tests. ....15,279 Tuberculosis complement fixation tests .....128 Gonococcus complement fixation tests. ..1 B. mallei complement fixation tests. ..2 Agglutination tests. .38 Blood typing for transfusion. ....16 Examination of blood for coagulation time ...4 Blood serum prepared by Swift-Ellis method for intraspinal injection ..1 Preparation of autogenous serum for asthma. ..

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57 WASSERMANN REACTIONS DURING THE YEAR 1923 During the year, 14,648 Wassermann tests were performed on 9,680 persons. The results of these tests are summarized in the following table: Per cent Positive. Negative. Total, positive. White civilian: M ales. .243 1,688 1,931 12.58 Females. ....19 140 159 11.94 Children. 1 29 30 3.33 Whitesoldiers. .329 2,612 2,941 11.18 Totals. 592 4,469 5,061 11.69 Spanish and white natives: M ales. 71 392 463 15.33 Females. 24 147 171 14.03 Children. 1 19 20 5.00 Totals. 96 558 654 i4.68 Blacks and mulattoes: M ales. ..612 1,571 2,183 28.03 Females. ..294 1,122 1,416 20.76 Children. ...19 287 306 6.20 Totals. .925 2,980 3,905 23.68 Chinese, males and females. 19 41 60 31.66 Grand totals. .1,632 8,048 9,680 16.85 The figures in the above table are based on the number of individuals examined and not on the number of tests made. In addition, Wassermann tests were made on 631 spinal fluids from as many individuals, and of these 113 or 17.90 per cent were positive. PATHOLOGICAL. During the year, 205 autopsies were performed at the Board of Health Laboratory. The causes of death were as follows: General Diseases: Typhoid fever. ....2 Malarial fever, Estivoautumnal. .3 Influenza ....1 Dysentery, Entamebic. ..2 Dysentery, Bacillary. .3 Leprosy. ..4 Purulent infection and septicemia. 2 Tetanus. .1 Tuberculosis of the lungs. .14 Disseminated tuberculosis. .._ .3 Rickets. ....I Syphilis, tertiary. 4 Syphilis, cerebro-spinal. ..2 Syphilis, hereditary. .1 Cancer of the lower jaw. .1 Cancer of the stomach. .5 Cancer of the duodenum. ..I Cancer of cervix uteri Cancer of the lungs. .... Cancer of liver, ribs and mediastinal and peritoneal nodes Adrenal neurocytoma (sarcoma). ....1 D iabetes. .1 Leukemia. .. Alcoholism, acute ....... Alcoholism, chronic. ......1 Alcoholic psychosis. ....1 Total. ..59

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58 Diseases of the Nervous System and of the Organs of Special Sense: Simple meningitis. ...3 Glioma (neural-epithelioma) of spinal cord. ..I. 1 Sarcoma of spinal cord. .1 Combined sclerosis of the spinal cord. I Cerebral hemorrhage, apoplexy. ....4 Softening of the brain. ........3 General paralysis of the insane. ...7 Dementia precox .6 Manic depressive psychosis. .1 Epilepsy. 3 Imbecility. .I T otal. ..3 1 Diseases of the Circulatory System: Organic diseases of the heart. .12 Sclerosis of the coronary artery. .1 Aneurysm. 2 Arteriosclerosis ..3 Embolism and thrombosis .I Total. .19 Diseases of the Respiratory System: Acute bronchitis. ...1 Chronic bronchitis. .1 Bronchopneumonia. .2 Lobar pneumonia. .4 Pleurisy. ..1 Total. .9 Diseases of the Digestive System: Tonsillar abscess, bilateral (Phlegmon and cellulitis). .....1 Ulceration and gangrene of esophagus with perforation of left bronchus (aspiration pneumonia). 1 Diarrhea and enteritis (under two years).1 Colitis. 9 Diarrhea and enteritis (two years and over) ..1 Acute appendicitis. ..2 Operation for bilateral femoral hernia (post operative hemorrhage and simple peritonitis) ..1 Intestinal obstruction. ....I Acute yellow atrophy of the liver. ..1 Cirrhosis of the liver. .1 Abscess of liver. .1 Total. .14 Nonvenereal Diseases of the Genito-urinary System and Annexa: Acute nephritis. 2 Bright's disease (chronic nephritis). .9 Acute pyonephritis. 1 Pyelonephrosis. .2 R uptured urethra. .......1 T otal. ...15 The Puerperal State: Incom plete abortion. ...I M alpresentation and rupture of uterus ...I Total. .2 Diseases of the Skin and of the Cellular Tissue: Gangrene of the foot. .1 Dermatitis venenata. 1 Total. 2 Diseases of the Bones and of the Organs of Locomotion: Maxillary sinusitis. .I Osteomyelitis. ..1 T otal. ..2

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59 Malformations: Congenital malformations. .. Total. .1. .. Diseases of Early Infancy: Premature birth. ...6 Malnutrition. .12 Atelectasis neonatorum. ..2 Total. ..20 Old Age: Senility. .2. 2 Total. .2 Affections Produced by External Causes: Burns (conflagration excepted). ...1 Accidental drowning. ..-.2 Traumatism by fall. .....2 Traumatism by vehicles. ...3 Traumatism by landslides. .-.1 Total. ..9 Ill-Defined Diseases: Ill-defined. ..2 Infection of undetermined origin .....I Total. ...3 Appendix: Stillbirths. ........16 Stillbirths following dystocia due to fetal hydrocephalus 1 T otal. ..17 Grand Total. 205 The most frequent causes of death found at autopsy for the year were: Per cent Cases. of autopsies. Tuberculosis,. .17 8.2 Syphilis (including general paresis). 14 6.8 Malnutrition in infants. 12 5.8 Organic heart disease. 12 5.8 Cancer. .11 5.4 External forms of violence. 9 4.4 Chronicnephritis. ..9 4.4 Pneumonia ..6 2.9

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60 Table showing the more common causes of death at autopsy in the Board of Health Laboratory. 0 a) a Date Z 90 1904. 6 1 1 1905 .269 60 9 27 3 8 5 3 9 ..2 1906 .509 191 22 50 24 23 39 15 33 2 1907 ..496 156 35 27 40 27 36 12 58 4 4 1908. .361 59 63 46 26 25 23 11 14 7 1909. 295 55 37 26 32 31 11 17 11 1 5 1910. 451 50 91 52 30 37 36 16 10 6 4 1911. .508 83 102 41 38 36 19 20 9 11 11 1912 .425 53 79 23 37 27 15 22 6 7 11 1913. 460 47 89 21 34 26 8 26 5 23 12 1914. 375 36 78 6 38 12 6 27 5 14 3 1915. 328 28 56 14 20 12 5 14 2 15 10 1916. 323 25 81 8 17 20 7 10 6 9 7 1917. 330 24 51 5 21 23 -3 18 1 3 5 1918. 253 38 68 6 6 12 .8 .1 5 1919. 324 22 55 3 15 14 3 20 3 10 11 1920. 334 146 55 .29 11 5 16 ..6 1921. 289 14 37 4 16 5 8 17 2 4 7 1922. 262 14 29 5 19 9 4 9 3 6 10 1923. 205 6 17 3 9 9 5 12 2 1 11 Totals. 6,803 1,008 1,055 367 454 367 238 293 179 115 133 This includes 32 cases of influenza. Table showing number of autopsies performed revealing the following diseases per year. a)e Date 1904 ..6 1905 ..269 12 7 7 2 0 .......9 .4. 19067. -. .9. 49 ...119078. .....496 ....1 2 1 ........ 1909 .....362 ...2 3 ........... 1910. I -...--2 52. .-. 4I -. 1910.:. .2. 191. 9 1 4 1 1912. 509 1 .4. 191. .49 .1 241 2. 191. 3 -..1 .2 3 2 .. 191. ..2 2. 1910 ......3 3 .2 .452 1911. ..30 .-1. 1912. 425 ..4. 1913. 34 ..2 3 1. 1921. ..37.I. ..2 2 1922. ..32 3 ..1 3 .. 1916.323 2. .I 3 -I 1920 .-. ..334. ..1. Totals. 6,803 223 26 20 20 25 3 3 'Scarlet fever. 2 All nonresidents, since 1905.

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61 Three hundred and twenty-four bodies passed through the laboratory during the year 1923; 205 or 63.3 per cent were autopsied. Malaria carriers found at autopsy .-------.-.--.-.-18 Syphilis.-There were 50 cases in the 205 autopsies, or 24.39 per cent, which responded either during life or at autopsy or both in a positive manner to the Wassermann test. Cases with positive Wassermann test and positive for syphilitic lesions ..36 Cases with positive Wassermann test and no definite syphilitic lesions. ..18 Cases with negative Wassermann test and positive for syphilitic lesions. ..4 Intestinal parasites.-There were 29 cases in the 205 autopsies, or 14.1 per cent showing one or more forms of parasites or their ova. Tricocephalus .9 Strongyloides. 3 Uncinaria. .12 Oxyuris. .3 Ascaris. 7 Trichomonas. .I Leprosy.-There were 4 lepers in the autopsy series. Their causes of death are given in the table below: Autopsy No. Cause of death. Contributory causes. 6740 Leprosy. ..Chronic nephritis, psychosis, undetermined. 6751 Leprosy .Tuberculosis, pulmonary. 6771 Leprosy, ...Tuberculosis, pulmonary. 6805 Leprosy. .Chronic nephritis, pulmonary congestion and edema. Microscopic examinations and reports on surgical specimens: Tonsils (pairs). 312 Tonsil. .1 Tonsils (pairs) and adenoids. .322 Adenoids. ...17 Specimen from scalp. I Specimens from eyelid. 5 Specimen from external canthus. .I Specimens from ear. ..4 Specimens from nose. 27 Specimen from nasopharynx. .. Specimen from lip. 1 Specimens from oral cavity. .10 Specimens from face. .4 Specimens from larynx ..3 Specimens from cyst of neck. .2 Specimens from thyroid. .3 Specimens from neck. ....2 Specimens from upper extremities. .7 Specimens from lower extremities. ...6 Specimens from breasts. .6 Specimen from rib and adjacent tissue. ..1 Specimen from pleural cavity. 1 Specimens from abdominal wall. 3 Specimen from pylorus.,. .2 Specimens from intestines. 2 Specimen from gall bladder. .1 Specimen from kidney sinus. ._. ...1 Specimen from hernial sac, inguinal. ..__. .1 Specimen from space of Retzius. ..1 Specim en from ovary. ..1 Specimen from bladder wall. ......1 Specimen cervix uteri. 3 Specimens from uterus. 13 Uterine contents. .4 Specimen from vaginal wall. ...1 Specimen from labial tissue. 3 Specimen from epididymis,.-. Specimen from penis. ....1 Specimens from foreskin. 3

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62 Microscopic examinations and reports on surgical specimens.-Continued. Specimens from scrotum. ..2 Specimens from rectum and anus. .....y.7 Specimen from perineal fistula. .. Specimens from cysts of buttocks. ...2 Specimens from skin (various locations). ...13 Eyes. .6 Submaxillary gland (salivary). ... Thyroid glands. ...5 Arm. ..1 Breasts. ..6 Spleen. .... K idney f. ........1 Appendices (27 with female gentalia). .191 Cervix uteri. ..10 Uterus.,. ...3 Uterus and tubes. 4 Uterus, tube and ovary. .5 Uterus, tubes and ovaries. ..60 Tube and ovary (2 ectopic pregnancy) .16 Tubes and ovary. ..3 Tube. ...3 Tube and ovaries. 2 Ovaries. ..6 Prostate. .. Testicles. ..6 Leg and foot. ......I Toe. ..I Lymph nodes, scalp. .1 Lymph nodes, submaxillary and cervical 1 Lymph nodes, cervical. 5 Lymph nodes, axillary .3 Lymph nodes, mesenteric 1 Lymph nodes, inguinal 15 Lymph nodes, location not stated. Fetus. Fetus and placenta. .3 Placentas .3 Autopsy sets of tissue from other hospitals 25 M iscellaneous ....9 Total. .1,216 PRINCIPAL LESIONS ENCOUNTERED IN SURGICAL SPECIMENS OTHER THAN INFLAMMATORY Malignant tumors (cancer): Ear .. Nose .2 Face (skin). ..3 Mouth, lips and tongue. 3 Jaw. .....1 Neck (skin). ....1 Larynx. 2 Mediastinum. .. Breast,. 6 Stomach. 2 Gall bladder 1 Ovary .4 Uterus. 14 Bladder. 1 Testicle. 1 Epitheliomna (location not stated) 1 Round cell sarcoma of gum. I Lymphosarcoma of axillary lymph nodes Melanosarcoma of thigh. ....I Total. ..47 Benign tumors: Fatty and fibrous tumor of eyelid. ..I Vascular tumor of eyelid. .. Mucous polyp from nose. .. Epulis. ..1 Cyst of vocal cord. ... Brachial cyst. ....1 C yst from neck ....I Sim ple colloid goitre. ..2 Papillary cystadenoma of thyroid. I

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63 Benign tumors.-Continued. Adenocystoma of breast. Fibro-adenoma of breast. ..4 Hematosalpinx. ....2 Tubal cyst. Simple ovarian cysts and cystic ovaries 52 Parovarian cysts. Cystadenoma of ovary 3 Fibromyoma of ovary 1 Fibromyomata-uteri 33 Uterine polyps. ...5 Cystadenoma of cervix 2 Nabothian cyst. .. Epithelial cyst of labia majora .. Cyst from buttock. .....2 Lipomata. ...4 Hemangiomata of skin .2 Moles, warts, etc .16 Xanthoma of foot. T otal ....145 Specimens showing tuberculosis: Tonsils. 5 Adenoids ...2 Cervical lymph nodes ..2 Axillary lymph nodes. ..1 Inguinal lymph nodes. ...2 Inguinal lymph nodes and fistulous tract I Perineal fistula ... Appendix. .. Intestine (ileum) and mesenteric nodes. ...I Hernia sac. Bursa (wrist). ....1 Tuberculosis cutis (leg). .I Endometritis and salpingo-oophoritis .I Salpingo-oophoritis, bilateral. Orchitis, epididymitis and funiculitis .1 T otal ...22 Other infrequent lesions encountered: Conjunctival folliculosis (tumor of eyelid) 1 Gumma of tongue .. Cyst of vocal cord. ....1 Exophthalmic goiter. ..1. .. Accessory thyroid 1 Broncholith. 1 Fibro-adenoma of male breast I Nephrolithiasis I Ruptured malarial spleen (traumatic) I Calcified mesenteric node ....1 Appendiceal fecalith .1. Appendix infected with oxyuris vermicularis 1 Cystadenoma of ovary with pseudomyxoma of peritoneum 1 Ainhum. ...2 Condylomata of vulva and anal region with entamebic invasion. 1 Chronic phlebosclerosis and arteriosclerosis of leg and foot with gangrene of foot T otal ...........17 Miscellaneous human examinations: Placental blood films (one positive for E. A. malaria) 245 Blood examined fcr filaria. ..16 Differential blood counts. 3 Blood counts, complete. ....2 External examination of fetus. Total .267 Animals (wild and domestic), bacteriological examinations: Cattle spleen examined for B. anhracis (positive) ._ Nasal secretion from mule. Spleen from calf fcr blackleg. Cultures of guinea pig spleens (Positive for B. paratyphosus B 39) 52 Cultures from animal autopsies. 3 Total. .58

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64 Animals (wild and domestic), miscellaneous examinations: Scrapings from skin lesions of horses. 2 Blood films from horses. 11 Fetlock of horse (histological examination). ..1 Round cell sarcoma of liver, lung, spleen of mule (histological). .1 Autopsy set of tissues from bull. ...1 Autopsy set of tissues from cow. 1 Dogs held under observation. .6 Spinal cord of dog for Negri bodies (from Colombia). 1 D og feces for ova ....1 Rabbit corneas inoculated with virus for smallpox test (Paul's test) .3 Lung abscess of rat. .......1 Lice from sheep. 1 Animal tissues for tuberculosis examination. 17 Agglutination tests (goat serum against M. meliteni.s). 6 Total ...-53 Animals (wild and domestic) autopsies: Guinea pigs. ...140 Dogs. ..16 Squirrel. ...1 Cat. ...1 Chickens. .6 Marmoset.,. 1 Turkey. ..1 P ig ..._ ._ .2 T otal .....168 The principal diseases encountered that were important among domestic animals were as follows: Cattle.-Tuberculosis; anthrax; blackleg. Guinea pigs.-Paratyphoid B infection. Dogs.-Dochmiasis (canine uncinariasis); teniasis; distemper. Marmoset.-Fungus pneumonia. Mule.-Sarcoma. R ats exam ined. ...14,077 Musmusculus.,. 7,945 M us alexandrinus. ...1,697 Mus norwegicus. ....1,485 M usratus. ....2,950 Rat smears examined (from liver and spleen). ...1,040 Guniea pigs inoculated (from 520 rats). ..61 Microscopic slides prepared: Surgical preparations (43 frozen). .4,104 Autopsy preparations (83 frozen). .2,899 Animal preparations (5 frozen). ...352 Total. .7,355 Photographs taken: Lantern slides prepared. ..62 Photographs taken at Board of Health Laboratory. ..21 Photographs taken of lepers at Palo Seco. 68 Total. .151 CHEMICAL ANALYSES AND EXAMINATIONS MADE. Arsenical cattle dip. ..1. .I Ascitic fluid, albumin. .2 Beverages for alcoholic content. ...7 Blood analyses. .677 Non-protein nitrogen. .356 Urea nitrogen determinations. .399 Uric acid determinations. .,. 402 Creatinin determinations ..389 Chloesterol determinations. 7 Glucose determinations. ..612 Sodium chloride determinations. ..6 Acetone plus di-acetic acid determinations. 1 Lead determinations. 2 Beta-hydroxy-butyric acid determinations. .1 Carbon dioxide determinations. .13

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65 CHEMICAL ANALYSES AND EXAMINATIONS MADE.-Continued. Calibration of Haldane apparatus. ..I Calibration of sphygmomanometers. 48 Clay for oil., ...1 Coal. .2 Drugs and chemicals. .36 Acetyl salicylic acid. ........ Alcohol. .1 Alcohol, for m ethyl alcohol. ...1 Bleaching powder ..2 Cinchona bark, alkaloids. 2 Crude carbolic acid. ....4 Neoarsphenainine. 22 Oxygen in cylinder. .1 Tincture of iodine. .1 Quinine sulphate. .1 Electrolyte. ..5 Food stuffs. ..31 Bean meal .1 Ice cream. .2 Milk, dairy. ..6 M ilk, m other's. .11 Milk, condensed. 2 M ilk, dairy, for water,. ..4 Milk, evaporated. 2 Milk for adulteration. ..:. 1 Rice for detection of sea water. .2 Gastric analyses. .48 G astric analyses, fractional. ..32 Oil (crude petroleum). I Spinal fluids examined. 598 Colloidal gold. 514 Ammonium sulphate. ...509 Phenol. 508 Glucose. 1 Substances for identification. .119 Cocaine hydrochloride. 32 M orphine. .....42 Novocaine hydrochloride. .18 Opium. 24 Talcum powder. ..1 Unidentified. 2 Surgical tissue, uric acid. Urines examined ..443 Routine analysis. ..158 Glucose determinations. .261 Acetone determinations. .6 Diacetic acid determinations. .2 Urea determinations. 5 Examination of pigment. 1 Lead determ inations. ....5 Hemoglobin determinations. 1 Creatinin determ inations. .1 Albumin determinations. 1 Ammonia determinations. .2 Acetone bodies determinations. ..5 Nitrogen determinations. 57 Nitrogen partition determinations. ....-1 Chlorides determinations. 2 Detection of salicylic acid. .-1 Urobilin and urobilinogen determinations. .1 Toxicological exam inations. 6 Chem. No. 7189. M eat. Arsenic found....1 Chem. No. 7237. (Human Autopsy No. 6700) Alkloids or other organic poisons not found .1 Chem. No. 7569. Stool. Mercury not found. 1 Chem. No. 7570. Vomitus. Mercury not found. 1 Chem. No. 7614. Stomach contents. Chloral or veronal not found. Chem. No. 7615. Urine. Veronal found. Water specimens examined ..4 Wood for silica .1 Alcohol, 95 per cent, recovered, liters. ...12 Alcohol, absolute, recovered, liters. ....-. -.53.6 Ethyl esters of chaulmoogric acids prepared, c. c ...32,010 UNDERTAKING DEPARTMENT. Bodies received (3 disinterred) ...327 Bodies em balm ed. ...53 Bodies cremated. .106 Bodies buried on Isthmus. .......185 Bodies shipped from Isthmus. .42 MR 91030-5

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66 TABLE I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES FOR EMPLOYEES. ABSOLUTE NUMBERS. Discharges from hospitals. Deaths. Yea 192c: 0 a)C, ~ dd Cd S.t 4) 4) 7i,. t.Cu Year 1923: White. 2,846 532 483 49 17 15 2 14,301 39.18 Colored. 8,130 1,179 982 197 56 52 4 40,899 112.05 Totals. 10,976 1,711 1,465 246 73 67 6 55,200 151.23 Year 1922: White. .2,827 558 508 50 13 10 3 12,942 35.46 Colored. 7,620 1,193 949 244 59 54 5 43,546 119.30 Totals. 10,447 1,751 1,457 294 72 64 8 56,488 154.76 ANNUAL AVERAGE PER 1,000 EMPLOYEES. Year 1923: White. 186.93 169.71 17.22 5.97 5.27 .70 .13.77 Colored. 145.02 120.79 24.23 6.89 6.40 .49 .13.78 Totals. ..155.90 133.48 22.42 6.65 6.10 .55 .13.78 Year 1922: White. .197.39 179.70 17.69 4.60 3.54 1.06 .12.54 Colored. 156.56 124.54 32.02 7.75 7.09 .66 .15.66 Totals. 167.61 139.47 28.14 6.89 6.73 1 .77 .14.81

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TABLE II.-CAUSES OF DEATH OF EMPLOYEES ARRANGED WITH REFERENCE TO COLOR, AGE, AND LENGTH OF RESIDENCE ON ISTHMUS. Color. Age (in years). Length of residence on Isthmus (in years). .ar .-1 ----Malaria.1 I. .......1. ...........1. Tuberculosisofthelungs. 9 2 7 ..1 3 1 2 1 1. 1 1 3 2. Syphilis, tertiary. .3 3. 3 ...I .1 -1 ........1 2. Cancer of the stomach. 4 2 2 .....1 .-. .4. Diabetes. 1 ......-. Alcoholism, acute. 1 -. .....-.I. Alcoholism, chronic. .I .I .1 -1. Apoplexy. 3 1 2.1 2 2 Diseases of the ears.-. 1 1.1 -. General paralysis of the insane ..2 2 .....-. .1 1 Disease of the spinal cord. 1 --.--.-. ..1. Organic disease of the heart. .8 3 5 .1 1 1 2 1 2 3 Aneurysm. 3 3. 1 1. ..1 -3 Softening of the brain. 1 1 .......C. 1 Acute bronchitis. 2 1 1 ...-. .-. 1 2 'Chronic bronchitis. ...1. ._ ...I ... Broncho-pneumonia. 3 1 2 .1 1. .1. -. 1 .I Lobar-pneumonia. 4 .4 ..1 ...1 2 1 Other diseases of the respiratory system. .1 1 ...-...1. ........1 Disease of the esophagus. 1 -....-. Disease of the stomach.1 1 -. --. .1 .... Hernia. ..1 ..-.-.--1. ...1 Simple peritonitis. .-. 1 I ...2. ... Chronic nephritis. 9 9 .2 2 1 1 3. .1 3 3 2 Gangrene. .I-. .1. Disease of the uretha. ..1. -I.-. ...... Acute abscess. 1 1 -.-.-.-.-.1.1. Burns. ..2 1 1 1 .-. --. .-. ..2. Accidental drowning .1 1 I -. I 1 Traumatisin by fall. .1 .I Trauatim b fal. 1 ....... Trauinatism by crushing. 2 1 1 1.-I1. .1. Homicide by cutting or piercing instruments. ..1. ... Totals .73 17 56 1 3 11 10 9 9 9 13 5 1 2 20J26 2 19

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68 TABLE III.-DEATHS OF RESIDENTS AND DEATH RATES, OF THE CANAL ZONE, AND THE CITIES OF PANAMA AND COLON. Deaths. Annual rate per 1,000 PopulaI population. Place. tion. External T External Total. Disease a Total. Disease cases Year 1923: Panama. 59,635 1,106 1,078 28 18.55 18.08 0.47 Colon. 31,285 393 377 16 12.56 12.05 .51 CanalZone. 31,793 253 227 26 7.96 7.14 .82 Totals. 122,713 1,752 1,682 70 14.28 13.71 .57 Year 1922: Panama. 60,068 1,279 1,241 38 21.29 20.66 0.63 Colon. 31,393 445 421 24 14.17 13.41 .76 CanalZone .31,098 254 220 34 8.17 7.08 1.09 Totals. 122,559 1,978 1,882 96 16.14 15.36 .78

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Tarn IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1923. Se. Color. Age (in years). Place of residence. Total ~ Cause of death. deaths. Under Age PanCanal M. F. W. B. Y. 1 year. 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unama. Colon. Zone. known General Diseases. Typhoid fever. .1 1 .1 ...... Malarial fever, Estivoautumnal. 12 8 4 3 9 .1 2 3 2 .2 ...1 6 1 5 Malarial fever, Tertian. .2 1 1 1 1 .....2 ..2. .2 Malarialfever,undetermined. 5 2 3 .4 1 .1 1 1 .1 1 .2 2 1 Measles. ..3 2 1 1 2 .1 2 ....3 Whooping cough.1. .1 .,. 1 .,. ...... Diphtheria and croup. 2 2 .1 1 .2. ..2. .2. Influenza. I .1 .I .,. .1 Dysentery, Entamebic. 3 1 2 .3. 1 .1 1. ..2 1 Dysentery, Bacillary. .5 3 2 .5 ..4 1 .4 Leprosy. ..2 2. .2. .....1 1. .2 Purulent infection ..2 2 2 .......'' .* ....1 Septicemia. 12 8 4 2 10 .2 .1 3 2 1 1 2 .9 2 1 Tetanus. .5 3 2 5. 5. 1 2 1 1 2 3 .. Actinomycosis. .1 1. 1. ....1. Pellagra. 0 .10 10 ..4 5 1 .4 5 1 Beriberi. .2 1 1 .2 .....1 1. Tuberculosisofthelungs. 249 131 118 15 228 6 6 1 1 21 66 80 40 22 8 3 1 178 53 18 Acutemiliarytuberculosis.3 2 1 3. ....1 1 1 Tuberculous meningitis. 10 4 6 .10 1 6 2 1 ...6 3 1 Abdominaltuberculosis. 6 2 4 .6 .1 2 .1 2 5 1 Pott's disease.1. 1 .1 .1. .. Disseminated tuberculosis. 13 8 5 13 1 8. ..2 1 1 2 1 Rickets .3 1 2 3 2 1 1 1 1 Syphilis, tertiary. 15 11 4 2 13 .1 8 4 1 1 6 5 4 Syphilis, cerebro-spinal. 1 1 ..1 .1 Syphilis,hereditary. 7 4 3 .7 6 1. 5. 2 Syphilis,periodnotstated. 2 2 _. 1 ..2. .2 Cancer and other malignant tumors of the buccal cavity. .3 1 2 .3 ...1 2 ...1 1 1 Cancer and other maignant tumors of the stomach andliver.,. 22 16 6 6 16 ...5 4 6 5 2 .16 4 2 Cancer and other malignant tumors of the peritoneum, intestines, rectum. ..5 3 2 1 4 .....1 3 1 ...3 1 1 Cancer and other malignant tumors of the female genitalorgans. .14 .14 4 10 ...3 5 3 3 ..8 1 5 Cancerandothermalignant tumors of the breast. .3 .3 .3 ...11 1 ...3 Cancer and other malignant tumors of the skin.,. 2 1 1 2 ...2 .1 1 Cancer and other malignant tumors of other organs andoforgansnotspecified.18 9 9 7 11 .1 .3 6 3 3 .1 10 4 4

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TAB1z IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1923.-Contd. Sex. Color. (Age (in years). Place of residence, Total Cause of death. deaths. Under Age PanCanal M. F. W. B. Y. I year 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unama. Colon. Zone. known General Disease.-Continued. Other tumors (tumors of the female genital organs excepted) 2 .2 1 1 ....2. ....1 1 Acute articular rheumatism ,. 1 1 .1 .......1 1 Scurvy. 2 1 1 2 2 ..2. ....1 Diabetes. .9 2 7 5 4 ..5 2 2 ..6 1 2 Leukemia. .1 1 ......1 Alcoholism, acute. ..3 2 1 2 1 ....2 1. ....2 I Alcoholism, chronic. .1 1 ..I ..........1 Alcoholic psychosis .11 1. .............1 Diseases of the nervous system and of the or gans of of special sense. Simplemeningitis. ..21 9 12 2 19 9 8 1 I 2 ....15 4 2 Pneumococcusmeningitis. .4 3 1 4. 4. 1 .I1 .I. I. 3 1. Other diseases of the spinal cord .5 2 3 5 ..3 1 1 ....1 2 2 o Cerebral hemorrhage, apoplexy 52 29 23 8 41 3 2 ..1 2 3 9 9 10 15 1 .36 10 6 Softening of the brain. 2.2.21 1. I I .2.1 ......2 Paralysis without specified cause. 1 1 .--.I ..1 .. General paralysis of the insane 8 6 2 2 6 ..4 2 1 1 ..2 .6 Dementiaprecox. .6 3 3 1 5 ....1 2 3. ..I .5 Epilepsy. ..4 4 4 _.2 1 1. ......2 .2 Convulsions (nonpuerperal) (5 years and over) .2 2 2 .2. ........2 Convulsions of infants (under 5 years of age) 8 5 3 .8 .7 1 .....7 1 Tumor of the brain.1 I1. 1. .I .......1. Other diseases of the nervous system 1 1 ....1. .....-.1 Otitismedia. 2 1 1 1 1 1 .I -1. ....1 1 Diseases of circulatory system. Pericarditis. 3 1 2 3 ......2 1. Acute endocarditis. .9 6 3 3 6 1 2 1 1 3 ..1 ..5 2 2 Malignant endocarditis. ..2 .2 2 .....1. 1 ..2. Organic diseases of the heart. 120 68 52 15 105 4 1 2 8 13 26 17 23 12 13 1 70 28 22 A ngina pectoris. .,. ...I .1 ..I ........I ..1 ...I-.-.I I-. -Diseases of the arteries, atheroma, etc .9 8 1 9 ...1 2 4 1 1 ..6 3. Aneurysm. ..4 11 3 .14. ..4 4 4 1 1 .9 3 2 Arterio-sclerosis. 21 5 16 4 17 ...~1 .1 2 7 11 .16 3 2 Embolism and thrombosis. .2 1 1 .I I ...2 .._. ..:. .1 Diseases of lymphatic system (lymphangitis, etc.) 3 2 .I 3 .3 .....1 Hemorrhage; other diseases of the circulatory system 1 1 ..1 ..1. ....1.

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Diseases of the respiratory system. Acute bronchitis ....36 21 15 4 31 1 20 12 2 1 .1 ....19 11 6 Chronic-bronchitis. .2 1 1 .2 ......I .-...1 .1 Broncho-pneumonia. 165 82 83 12 151 2 76 61 7 2 4 6 .4 4 1 .143 15 7 Pneumonia(unqualified). .27 14 13 4 23 .3 5 1 3 1 1 3 5 5 ..20 5 2 Lobarpneumonia. .58 38 20 5 53 .6 3 .4 14 9 9 5 8 ..31 17 10 Pleurisy.1 1 1 ---I. .1 .......-1 Empyema. 2 1 1 .2 .1 1 ..... Pulmonary congestion, pulmonary apoplexy. 3 1 2 2 1 ....1 1 1 .3 Asthma. .3 1 2 .3 .....1 1. .1. 3 Other diseases of the respiratory system (tuberculosis excepted). 7 5 2 1 6.1 1. ..2 2 .1. Diseases of the digestive system. Diseasesof the pharynx.1. 1 .1 1 ........1.--.Diseasesof theesophagus. 3 3 .3 .2 1.2 1 Ulcer of thestomach. 2 2 .2. 1 1 ..2 Other disease of the stomach (cancer excepted). 1 1 .1 -.1. .............1 Acutegastritis. 9 2 7 1 8 .5 1 ....2. 1 .9. Chronicgastritis.,. .1 ......1 ..-. .-.1. Acute indigestion. 2 .2 ..2 .2 ......2. Diarrhea and enteritis (under 2 years). 129 58 71 13 116 .97 32 ..........107 15 7 Colitis(under2years). 4 2 3 .5 ..1 3 ....3 .1. I Diarrheaandenteritis(2yearsandover). 15 7 8 1 14 .5 1 3 1 2 .2 .1 .11 2 2 Colitis (2 years and over). 6 4 1 .5 ..1 1 2 .I .I .5 1. Acuteappendicitis. 11 5 6 2 8 1 .2 .4 2 1 2 ....7 4 Chronic appendicitis. .1 ..1 .1 ....1 ..........1 .. Hernia, intestinal obstructions. 2 1 1 1 1 .............2 Inguinalhernia. 3 2 1 3. .....2. 1 ....1 2 Other hernias. .3 3 .1 2 .......I. .2 ....1 2. Intestinalobstruction. 6 5 1 1 5 .1 1 .2.2. ...4 2. Other diseases of the intestines. 2 2 .1 1 ..1 1. ...1 1 -.Duodenalulcer. ....2 1 1 .2 ...1. ....1 1. Acute yellow atrophy of the liver.,,. .2 2 .1 1 ...2 ...1. ....I Cirrhosisoftheliver. .10 7 3 1 9 .....1 1 3 .4 1 .-5 5 Other diseasesof theliver. ...3 3 ..3 ..1 ...1 1 ...3 Abscess of liver (unqualified). 2 1 1 ..2. ......1 ...1. Abscess of the liver entamebic. 1 1. ............11.C holecystitis. ..2 .2 .2 .1 ........1 1 Diseases of the spleen. 1 1 .-. I ..-1. ..-.-.----.1.-. Simple peritonitis (nonpuerperal). ..8 4 4 .8 .,. ....1 .3 3 1 -. .1 7. Other diseases of the digestive system (cancer and tuberculosisexcepted). 5 5 .1 4 .....1 1 1 1 1 ..5. Nonvenereal diseases of the genito-urinary system and annexa. Acutenephritis. .30 12 18 3 27 .5 8 5 3 2 4 2 1 ..19 7 4 Brights' diseases (chronic nephritis). 115 73 42 16 97 2 .1 2 2 12 28 21 16 18 '15. 77 30 8 Other diseases of the kidney and annexa. 1 .1 .1 .........1.

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TABrz IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1923.-Contd. Sex. Color. Age (in years). Place of residence. Total Cause of death. deaths. Under Age PanCanal M. F. W. B. Y1 year. 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unama. Colon. Zone. known Nonvenereal diseases of the genito-urinary system and annexa.-Continued. Pyelo-nephrosis. 9 5 4 1 8 1 2 ..1 4. ..3 3 3 Cystitis. I .1 .....-. ....-.-.I .---.1 Diseases of the urethra, urinary abscess, etc. 2 2 .2. .1 1 ....1 1 Salpingitis and other diseases of the female genital organs. ...2 .2 .2 ......2 ........2 The puerperal state. Extra-uterine pregnancy. 3 .3 .........1 ....2 1. Hyperemesis gravidarum. 1 .1 .1 .....1 .....1 -. Abortion. 1. .1. ..I. 1 -. ..--IPuerperal hemorrhage. ..4.4. 4 ....2 2. ....4. 4 Otheraccidentsoflabor. I. .1 .......1 .......I .. Puerperalsepticemia. .4 4 1 3 .....1 2 1 ...3 1 Puerperal albuminuria and convulsions. I .1 1 .....-. .....1 --. Eclampsia. .3 1 2. .....1 1 1. ..1 1 1 Diseases of the Skin and of the Cellular Tissue. Gangrene. 4 2 2 1 3 .1. 1 ...2 2. Acuteabscess. 2 1 1 .2 .1 .........2 Phlegmon and cellulitis. .2 1 1 .2 ...2. .......2. Ulcer of theskin. 1 .1 .1 ....I ......I. .. Impetigo contagiosa. 1 1 .1 ...I ....-........ Otherdiseasesoftheskinandannexa. 3 3 .3 2 ......1 2 Diseases of the bones and of the organs of locomotion. Diseases of the bones (tuberculosis excepted). 1 .1 ...1. ....1. .....-. Mastoidabscess. .1. .........--. .I Osteoamyelitis. 1. 1. 1. .1. ......1. Diseases of the joints (tuberculosis and rheumatism excepted).,.1 1. .1. ..I ...... Arthritis. .1. 1 ......-.-. ... Amputations. .1. I .........----. Malformations. Congenitalmalformations (stillbirth not included). 4 1 3 .4 4 ....--......2

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Diseases of early infancy. Congenital debility, icterus, and slerema. 5. 4 1 4 1. .......1 1 Premature birth. ...50 24 26 6 44 ..50 ..., .......22 17 11 Congenital debility. 2 1 1 1 1 .2 ............I. 1 1 Atrophy of infants. 1 .........-. ....1 ... M alnutrition. .50 29 21 4 46 .34 16 ....13 21 16 Other causes peculiar to early infancy (including various consequences of labor). 41 26 15 5 36 41. ....22 14 5 Old age. Senility. 9 3 6 1 8 ...1 2 6 6 2 1 Affections produced by external causes. Suicideby poisoning. ..2 2 .2 ..1 1 ......1 1 Suicide by hanging or strangulation.3 3 1 .......2 .1 Suicidebydrowning. 1 1 ...1 ...1. ..I. Suicidebyfirearms. .2 2 .2 ....1 .1 .....1 Suicide by cutting or piercing instruments. 1 1 ...1 ......1 Burns (conflagration excepted). .5 4 1 2 3 1 2 ..1 ...3 .2 Absorption of deleterious gases (conflagration excepted). .1 1 ..1. ............-. -Accidentaldrowning. 24 20 4 9 14 1 .3 5 11 4 1 ...5 6 13 Traumatismbyfirearms. .1 1 1. .1. ........--1 4 Traumatism by cutting or piercing instruments. 1 1 ..1. ....1 .... Traumatism by fall ..9 8 1 1 8 ..1 .2 4 2 .....5 4 Traumatism by other crushings (vehicles, etc.) 9 8 1 2 7 .2 3 3 1 ....6 1 2 Traumatism by landslides. .,. ..2 2 .2 ...1 .....1 2 .. Injurieebyanimals.1 1 1. ..1 Lightning.1 1.1. I ... Homicidebyfirearms.,. 1 1 .1 .........Homicide by cutting or piercing instruments. 2 2 ..1 1 _. .......1 1. Homicide by other means. 1 11. .....1 .....1 Fractures (cause not specified). 1 1 .......-. 1. .----.--.--1 Other external violence. ..........2 Ill-defined diseases. Causeofdeathnotspecifiedorill-defined. 12 7 5 2 10 1 2 2 1 1 .3 1 ..1 5 4 3 Infections of undetermined origin. 2 1 1 1 1 ...1 .-. 1 1 Totals .1,752 961 791 215 1,515 22 415 213 46 79 206 282 190 135 122 58j 6 1,106 393 253

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TABLE V.-DEATHS OF NONRESIDENTS, BY CAUSE, SEX, COLOR, AND AGE, 1923. S x. Color. Age (in years). Cause of death. Total Less deaths M. F. W. B. than 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-80 Un1 year known Typhoid fever. .4 4 3 1 ..1 2 1. Malarial fever, estivoautumnal ..6 4 2 1 5 2 1 1 ....1. Malarial fever, undetermined. ..4 3 1 .4 1 1 2.2. Malarial fever, clinical. ...2 1 _. .. Hemoglobinuric fever, malarial ..1 .-1. .. Measles. ...1. 1 .1 1. ..--.-.-. ..-. Diphtheria and croup. ..1 1.1 ..-.-.-.1 Septicemia. .4 2 2 1 3 1 1 ..1 Tetanus. .2 2 .2 1 .1. Tuberculosis of the lungs .24 18 6 4 20 6 6 8 4. Abdominal tuberculosis. .1 1 _. 1 Disseminated tuberculosis ....2 2 22 2 1 1. Syphilis, tertiary. ....1 .-. ... Syphilis, hereditary. _ ...1 1 1 -.-..-. Cancer of the stomach. .6 5 1 3 3 ..1. 2 2 1. Cancer of female genital organs ..-. .1 .1 1.-. ..1. Cancer of organs not specified_ .4 4 2 2 .I 2. 2. Pueumococcus meningitis. .-.-. ..1 .1. .-. General paralysis of the insane ....1 .1 1. .. Apoplexy. ...-. ..1 1 1.-. _. Softening of the brain ...1 1 1 __ -. .-.1 Epilepsy. .-I ------..1 1. Disease of the ears. ...I I .--Acute endocarditis. .2 1 1 .2 ....I .. Organic diseases of the heart ...12 8 4 2 10 2 5 3 1 1. Diseases of the arteries .2 2 1 1 .1 1. ... Arterio-selerosis. ._ ..I I ..1 -. ....-.. Embolism and thrombosis. ....1 1. 1 --. Aneurysm. ....1 1 ..1. Aebronchi isno. ..3 2 1 1. .I ....I. Acute bronchitis. ......I I Broncho-pneumonia. .3 2 1 3 1 ..1. Pneumonia, unqualified. .5 4 1 1 4 2 1 1 Lobar pneumonia. ....14 12 2 2 12 .2 4 I 3 1 3. Diseases of the pharynx ....1 1 I__ I-. .... Pharyngitis. ......1 1. 1 Diarrhea and enteritis. ...1 1I I 1_ .1 --Colitis.1 11. Ankylostomiasis. .-. Intestinal obstruction. ..-. 1 Other diseases of the intestines ..1 Acute appendicitis. ..3. ..... Inguinalheinia. ..2 2 .1 1 1. ...

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Biliary calculi 1 1 Cirrhosis of the liver .....2 2 ..2 .-.1... Abscess of liver. ....2 2 .1 1 -. .--1 -. Cholecystitis. -. .--. --. -. .I 1. --. .1. Simple meningitis .....1 1 ..---.-. 1 I Acute nephritis. -.-. ...1 1 -. -I. ... Chronic nephritis ....5 4 1 5 .1.2 1 2. Uterie tu or (n ncan erous .........1.-.I.1 ....2.I. .I2. .... Puerperal septicemia .-...1 Elampsia. .-........-.-. Carbuncle2. .-2. Arthritis1. 2 2 2 1 Premature birth1. 2 1 1 1 1 2 --Maln hngiong.-. ...1 1. .1.-.I. .-. ..-. ... Acutepoidoning ...6. 1 .3 1 .-. 2. 1 2. ... cie b ningr .----....2. Accidental drowning ...2 2 ..2.2 Traumatism by firuahisg.-. .2 2.2. ....2. .... Traumatism by fall ...2 2 ..-. Traum atism by crushing .......-.....2 2 ...2 -.......2 ................. Effects of heat. ..--1 1. ... Homicide by firearms .-.-.I-. .1. .1. .. Homicide by piercing instruments ..-.-. I. ..1.1. Fractures.-.-. .1 .... Totals. 168 132 36 42 126 7 7 4 13 38 36 35 17 9 1 1 C^

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76 TABLE VI.-DEATHS BY NATIONALITY OR NATIVITY, 1923. Country. Employees. Nonemployees. Total. Grad Mal .Female. Male. Female. Male. Female, total. Africa. .-...I .1 1 A ntigua. .....3 3 ...6 A ntilles 1. ....I Austria. j ..I 1 1 2 Bahama Islands 1 .I ..2 .2 Barbados. 15 .101 70 116 70 186 Canada. ....1 1 1 Chile. ....1 .1 China. ...27 8 27 8 35 Colombia. 2 .49 44 51 44 95 Costa Rica. ...6 6 6 6 12 Cuba. ..3 1 3 1 4 Demerara. ..3 1 3 1 4 Dominica. ...2 5 2 5 7 Ecuador. ..1 2 1 2 3 Egypt. ...1 1 1 England. ...3 1 3 1 4 France. ..5 1 5 1 6 Germany. ...1 I 1 Greece. .4 1 4 1 5 Grenada. .7 5 7 5 12 Guadeloupe. 2 .5 6 7 6 13 Haiti. ...2 2 .2 Holland. ..2 .2 2 India ...3 .3 .3 Ireland. .....1 .1 1 Italy. 1 2 3 3 3 6 Jamaica. 23 183 146 206 146 352 Japan. ..11 M artinique. .16 13 18 13 31 Mexico. ..4 4 .4 M ontserrat. .6 1 6 1 7 N assau. .1 ..2 2 N icaragua. ...1 1 1 1 2 Panama. ....323 403 326 403 729 Peru. ..10 3 10 3 13 Philippine Islands. .1 1 PortoRico. ..9 4 9 4 13 Russia. .1 1 St. Andrews. .....1 .1 I St.Kitts. ..1 .2 2 3 2 5 St. Lucia. 2 .14 15 16 15 31 St. T hom as ....2 2 2 St. Vincent. .2 .8 3 10 3 13 Spain. ..13 7 15 7 22 Switzerland. ...1 ..I I Trinidad. ....3 3 3 3 6 United States. .5. .42 16 57 16 73 Venezuela. ..6 1 6 1 7 Virgin Isladds. .1 1 1 1 2 Unknown. ..17 6 17 6 23 Totals. ..73 888 791 961 791 1,752

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77 TABLE VII.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES. Annual death rate per 1,000 population. White employees from the United States: Disease. 4.87 E xternal causes ......81 Total. 5.68 White women and children from the United States: Disease. 4.06 E xternal causes. ...24 Total. 4.30 White employees from the United States and their families: Disease. 4.36 External causes. .45 T otal. ....4.81 Number of American children born on Isthmus during the year 1923. ...123 Deaths among American children under 1 year of age. .4 Infant mortality rate among American children (number of deaths per 1,000 live births) ...32.52 TABLE VIII.-BIRTHS AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Births. Rate per 1,000 population. Place. Population. Total. Alive. StillTotal. Alive. Sbtr born.bon Year 1923: Panama. 59,635 2,163 2,043 120 36.27 34.26 2.01 Colon. 31,285 748 709 39 23.91 22.66 1.25 CanalZone. 31,793 623 591 32 19.60 18.59 1.01 Totals. 122,713 3,534 3,343 191 28.80 27.24 1.56 Year 1922: Panama. 60,068 2,162 2,058 104 35.99 34.26 1.73 Colon. 31,393 810 759 51 25.80 24.18 1.62 Canal Zone. 31,098 722 691 31 23.22 22.22 1.00 Totals. 122,559 3,694 3,508 186 30.14 28.62 1.52 TALE IX.-INFANT MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Deaths among Live births. children under 1 year of age. Place, Rate per Male. Female. Total. Number. 1,000 live births. Year 1923: Panama. 1,048 995 2,043 290 141.95 Colon.,. 370 339 709 82 115.66 CanalZone. 31 276 591 43 72.76 Totals. ..1,733 1,610 3,343 315 94.23 Year 1922: Panama. .1,093 965 2,058 303 147.23 Colon. 381 378 759 106 139.6I6 Canal Zone. 334 357 691 64 92.62 Totals. .1,814 1,700 3,708 473 127.56 MIN._ _ _ _ _ _

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TAILE X,-DEATHS OF INFANTS BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1g23. Sex. Clor. Age (in months). Place of residence. Cause of death. Total -1 week [ deaths M. F. W. B. week -1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 PanaColon. Canal month. ma. Zone. Malarial fever, estivoautumnal. 1 .1 .1 ..1 ..... Measles.,.1 1. .1. .1 ..1. Whooping cough.1. 1 .1. .1 ..... Influenza. ..1 1 ..1 ....I. ....1 Septicemia. 2 1 1 .2 .1 1 .2.2. Tetanus. I .1 ..1 ......I Tuberculosisofthelungs. 6 4 2 6. ...1 1 I. 1 2 5 1. Tuberculous meningitis. 1 1 ..1 .....1 ..I. I Abdominal tuberculosis. ..1 ...1.1. Disseminated tuberculosis. 1 ..1 .....I Rickets.2 1 1.2. ......1 1 1. Syphilis, tertiary.1.1.1. ...I ....1 1. Syphilis, hereditary-. 6 4 2 .6 1 3 1 1 ..5 1. Cancer and other malignant tumors of other organs and of organs not specified. I 1. ...I. 1 ....11. Simplemeningitis. .9 6 3 2 7 .2I .2 1 .1 1 1 8 I Cerebral hemorrhage, apoplexy. 2 2 .2 1 .1 .2. Convulsionsofinfants. 7 3 4 .7 5 ...1 7 Otitismedia.I. 1 __. 1. .......I. .I Acute endocarditis. I .1. 1 1 Organic diseases of the heart. .4 2 2 1 3 1 ...1 I .4. Diseases of the lymphatic system (lymphangitis, etc.). .3 2 1.3. 1. ...1. ..2 1 Acute bronchitis ..20 9 11 10 10 .2. ..2 .2 2 1 2 4 3 1 12 6 2 Broncho-pneumonia. 76 41 35 4 72 __. 2 10 9 12 10 8 6 4 2 3 7 3 68 6 2 Pneumonia (unqualified). 3 2 1 1 2 1 .1 ....3. Lobar pneumonia. 6 3 3 .6 .1 ..2 1 .2 .5 1. Empyema. 1 .I. 1 .....-I. .1. Other diseases of the respiratory system (tuberculosis excepted).,. 1 1 ....I. Diseases of the pharynx. 1 I I .1. Acutegastritis. .5 1 4 .5 _. 1 .1 2 ...5. Acute indigestion. .2 .2 2 ....1 .1 ...2 Diarrhea and enteritis. 97 *45 52 10 87 1 3 8 20 10 6 .7 7 8 8 9 3 7 83 9 5 Colitis. .1. .1 .._. 1 ..1. Intestinal obstruction. I. 1 ..1. ..1. Acutenephritis. .5 1 4 .5 ..1 ....1 1 3 1 1 Pyelo-nephrosis. 1. 1 .1 ._ ..I. 1. Acute abscess. 1. 1 .1 .1 Other diseases of the skin and annexa. 2 2 ..2 .1 ......2 Congenital malformations (still birth not included). 4 1 3 .4 1 1 .......1 2 2 Congenital debility, icterus, and slerema. 4 4 ..4 1 1 1 ..1 ..3 1.

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Prematurebirth. ..50 24 26 6 44 39 6 .2 1 1 1 22 17 11 Congenital debility. .2 1 1 1 1 1. ..* ..2 Atrophy~~~~~~~~~~~~~~~~~~~ ofifns.1.1. ..1 Atrophy of infants. ..I .I .1 Malnutrition. 34 19 15 3 31 1 2 5 3 R 1 5 3 1 1 2 4 3 10 17 Other causes peculiar to early infancy (including various consequences of labor) ..41 26 15 5 36 37 2 ..2 .23 13 5 Burns (conflagration excepted). 1 .1 .1 Other external violence. 1 .1 1 .1. ... Cause of death not specified or ill-defined .1 1. .1. Totals. 415 211 204 45 370 89 26 34 45 35 22 29 27 20 17 25 27 19 290 82 43

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80 TABLE XI.-CASES TREATED IN HOSPITALS, 1923. Santo Panama Canal Hospitals. Tomas I ~Hospital. NonDiseases. Ui Employees. NonemployeesNoidns White. 2 thite. Black. Black. White Black. 0 0 Army. Others General diseases. Typhoidfever. 10 4 .1 2 1 3 6 1 4 Typhoid bacillus carrier. 1. ..1. Typhoid prophylaxis. .I ..1. .. Paratyphoid fever. 1 ..1 Relapsing fever. 2 ....1 ...1 Malarial fever, Estivoautunal. 394 8 35 112 43 43 156 12 1 416 6 Malarial fever, Tertian. 128 .23 19 29 17 31 8 1. Malarial fever, Quartan. 4 ..1 2 1. Malarial fever, mixed. 4 ....4. Malarial fever, undetermined. 6 .1 .4 1 ..128 5 Malarial fever, Clinical. 24 .2 1 9 2 7 3 188. Smallpox. .0 0 ...0 0 Measles. 95 1 1 50 38 5 ..104 Scarlet fever. .5 ...1 1 2 1. Whooping cough.3. .2 1 ...1. Diphtheria and croup. 13 1 .1 1 6 6 .57 1 Diphtheria bacillus carrier ., I ...1 Influenza. 37 1 13 6 4 8 4 2 1 70 4 Cholera nostras. 1 .. Dysentery, entamebic. 12 ..1 3 3 4 Dysentery, bacillary. 8 3 1 2 1 .7. Dysentery,unclassified. 3 .I ...2 52 5 Plague.,. .0 0 .........0 0 Yellowfever. 0 0 ......0 0 Leprosy.2 .....I Erysipelas. .5 .1 .2 1 1 13 1 Dengue.1 ...... Chickenpox. .2 29 1 12 23 .1 17. Mumps. 11 ...10 .1. Hemoglobinuric fever, unqualified. 1 ..1. .. Filariasis. .1 ........... Acute infectious jaundice (Weil's disease). ..1. ...... Other epidemic diseases. ........116 Purulent infection and septicemia. 2 3 1 .1 1 2 ..40 20 Pyemia.1. ...1 .. Tetanus. ....2 ......2 .....2 Mycosis. ..... Pellagra. .4 1 ...4 1 13 10 Beriberi. .3 ....3. ..12 2 Tuberculosis of the lungs. 46 20 2 12 6 10 19 17 .107 127 Acute miliary tuberculosis. ..........1 Tuberculous meningitis.2 ....2 ..2 4 Abdominal tuberculosis.I ...1 .,. .3 2 P ott's disease. .........1 1 Tuberculosis of bones and joints. 15 .1 3 .1 9 1. Tuberculosis of other organs. 3 ..2 1 ....22 3 Tuberculosis of the skin. 1 ...1 Tuberculosis of the lymph glands 7 ..2 .1 3 1. Tuberculosis of the genito-urinary organs.3. ....3. .. Tuberculous abscess. .2 ....2 .. Disseminated tuberculosis. 2 3 .1 ..4 ..1 10 Rickets. 1 1 ...1 1 .3 Syphilis, primary. 17 .1 8 .1 6 1 390 2 Syphilis, secondary. 48 .5 8 22 1 4 8 .32. Syphilis, tertiary. 122 7 1 43 6 9 63 6 1 214 16 Syphilis, cerobro-spinal. 34 3 6 4 3 4 6 14. Syphilis, hereditary. 6 1 ....7 Syphilis, period not stated. 9 1 1 4 1 .3 1. .. Gonococcus infection. 22 ...2 19 1 .272. Gonorrhea. 245 .9 94' 49 12 27 50. 4 74. Gonorrheal arthritis. 5 1. .II 2 .1

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81 TABLE XI.-CASES TREATED IN HOSPITALS, 1923.-Continued. Santo Panama Canal Hospitals. Tomas Hospital. NonDiseases. Employees. Nonemployees. residents. -0 -te White. White. Black. Black. White Black. Army. Others General disease8.-Continued. Gonocopcus infection-Continued. Gonorrheal bubo. 2 ...2 Gonorrheal orchitis and epididymitis. 9 .2 3 ..4. Gonorrheal ophthalmia. 6 ...5 .1 Softchancre. 151 .4 29 58 3 12 42 3 151 Adenitis chancroidal. 12 ..2 7 1 1 1 12 Cancer and other malignant tumors of the buccal cavity. .2 1 ...2 1 5 1 Cancer and other malignant tumors of the stomach and liver .9 5 3 4 1 3 2 1 .12 10 Cancer and other malignant tumors of the peritoneum, intestines, rectum. 2 1 ...1 1 .1 5. Cancer and other malignant tumors of the female genital organs. 10 5 .....1 12 2 .29 4 Cancer and other malignant tumors ofthebreast. 9 1 ....2 8 ..8 3 Cancer and other malignant tumors of the skin.1. ...1. .. Cancer and other malignant tumors of other organs and of organs specified. 2 5 .1 .3 2 1 .27 6 Other tumors (tumors of the female genital organis excepted) .19 1 5 4 3 8 ...26. Acute articular rheumatism. 11 .1 2 2 2 4 .5. Chronic rheumatism and gout. 6 .1 1 .1 1 2. Arthritis deformans. 2 ....1 1. Scurvy. 1 1 ...2. Diabetes. _.13 2 4 4 .5 .2 .4 Exophthalmic goitre. 5 ...3 2 Leukemia. 1. ...1. Leukemia lymphatic. 3. ....3 Anemia, chlorosis. ....17 3 Chlorosis. ...1 Anemia, secondary, cause not determined. ..4 ......2 2. Other general diseases. 11 .1 .6 2 2 .7 Alcoholism (acute or chronic) 9. ..3 4. 2. 42 Alcoholism,acute. 11 1 1 4 3. .3 1. Alcoholism, chronic. 5 1 1 1 1 1 1 1. Alcoholic psychosis. 4 1 ..2 1 2. Chroniclead poisoning. 2 ..1 _. 1. Other chronic occupational poisonings. i I. 1. Drug habit. 1 ....1. Other chronic poisonr1gs. .3. .. Diseases ofthe nervous system and of the organs of special sense. Encephalitis. .1 ....1. Simple meningitis. 4 3 ..3 4 ..6 Cerebro-spinal fever. .1 1. .. Pneumococcus meningitis. ....4. 4 Locomotor ataxia. 1. ..7 Other diseases of the spinal cord. .5 2 1 1 3 1 1 2 Acute anterio polio-myelitis ..1 ......1 Cerebral hemorrhage, apoplexy. 6 4 3 2 1 4 .18 14 Softening of the brain. ...3 1. 1 1 -. Paralysis without specified cause. 5 .1 1 1 1 1 .16 4 General paralysis of the insane. 12 8 .3 1 5 7 4. Other forms of mental alienation. .41 .3 .11 8 12 7 47 Dementiaprecox. 51 5 1 .14 10 24 4 3 Manic depressive psychosis. 13 1 ...3 9 2 .. Toxic psychosis.2. .. Epilepsy. 17 2 3 1 1 2 8 4 .35 1 91030-6

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82 TABLE XI.-CASES TREATED IN HOSPITALS, 1923.-Continued. Santo Panama Canal Hospitals. Tomas Hospital NonDiseases. .i Employees. Nonemployees. residents. White. 't -a White. Black. Black. White Black. Army. Others Diseases of the nervous system and of the organs of special sense-Contd. Convulsions (nonpuerperal) (5 years and over). ..5 Convulsions of infants (under 5 yearsof age). 1. ...1 .. Chorea. .I ..... Hysteria.31.,.4 9. 4 2. Neuralgia.5. .1 1 1 1 1 .6. Neuritis.17. .4 3 03 2 5 ..1 Imbecility. 5._ ....1 4 .... Organic disease of the brain. 2 ...1 1 Neurasthenia. 28 2 1 6 10 7 2. Other diseases of the nervous systeM. 26 1 2 6 4 7 5 .2 1 28. Follicular conjunctivitis. 24 .2 7 1 3 10 1. Disease of Cornea.-. 56 .2 22 10 2 18 1 1. Diseaseofiris. 32 .1 8 5 1 12 4 1. Disease of lens. 19 .1 2 3 3 8 2. Disease of fundus. 9 .1 4 2 .2 Other diseases of the eyes and their annexa. 98 .6 37 12 4 31 6 2 128. Otitis, external. 272 .15 3 5 2. Otitis media. 66 .4 3 23 17 12 7. Otitis, internal.6. ..1 2 1 2 .. Other diseases of the ears. 8 ....4 1 2 1 .15. Diseases of the circulatory system. Pericarditis. 1 .....3 1 Acute endocarditis. 2 2 1 .1 2 ..3 4 Organic diseases of the heart. 37 8 5 -9 2 4 20 5 .98 61 Angina pectoris. ..3 .3 .....5 Aneurysm.4. ...2 ..2 .10 5 Arterio-sclerosis. 18 1 .10 1 8 ..4 1 Other diseases of the arteries. 4. .1 1 2 ..27 15 Embolism and thrombosis. .1 ...I .,. .1 1 Hemorrhoids. 66 .12 13 25 7 6 3. Varices. 9 .1 2 3 .1 1 1 Varicocele. 15 .__. 1 1 12. .1. .. Phlebitis. .3 ..1 ..1 1 .. Other diseases of the veins. 5 ..2 .1 2 ..55 Lymphadenitis (nonvenereal). 90 .7 20 25 4 17 13 4. Diseases of the lymphatic system. 14 .8 .2 2 2 .75. Hemorrhage; other diseases of the circulatory system. 9 .1 1 3 .4 ..6 2 Diseases of the respiratory system. Adenoid vegetations. .141 .1 .1 66 73 Diseasesofthenasalfossw. 80 5 10 33 12 14 6 .23. Laryngitis .3 .1 .1 1 ... Other diseases of the larynx. ...........5. Diseases of the thyroid body. 8 ..1 2 1 4 .3. Acute bronchitis. 183 1 18 15 18 51 71 11 .39 Chronic bronchitis. 1,1 1 4 2 1 1 1 3 .53 3 Broncho-pneumonia. 24 8 .1 3 3 23 1 1 51 34 Pneumonia (unqualified). 2 ....1 1 ..-. Lobar pneumonia. 41 12 .11. 7 5 27 .2 1 -,57. Pleurisy. 24 1 1 10 2 6 1 4 1 25 2 Empyema.3 .1 ..,. 16 2 Pulmonary congestion. pulmonary apoplexy. ........ Gangreneofthelungs. 2 ..1. ..... Asthma. .24 .4 4 1 3 6 6 .40 Other diseases of the respiratory system (tuberculosis excepted) 10 .1 ..4 2 3. ..

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83 TABLE XI.-CASES TREATED IN HOSPITALS, 1923.-Continued. Santo Panama Canal Hospitals. Tomas Hospital. NonDiseases. Employees. Nonemployees. residents White. White. Black. Black. White Black Army. Others Diseases of the digestive system. Diseases of the mouth and annexa. 9 ..3 2 2 2 .22. Diseases of the teeth and gums 21 1 .6 7 5 2 Stomatitis.8 .3 5 Diseasesofthepharynx. 49 .4 7 12 8 15 2 1 6 1 Pharyngitis. 16 .2 5 4 3 2 Follicular tonsillitis. 494 .44 22 75 137 199 16 1 132 2 Diseasesof theesophagus. ..1 ...3 Foreign body in the esophagus. .I ...,. ... Stricture of the esophagus. 1 ........1 Ulcerofthestomach. 4 1 3 1 1 .._ ..1 Acutegastritis. ..18 1 4 .2 6 4 1. Chronic gastritis. 19 .3 1 1 3 7 4. Acuteindigestion. 10 .1 1 1 4 1 1 1 Other diseases of the stomach (cancer excepted). 23 1 6 1 4 3 8 2 70 3 Diarrhea and enteritis (under 2 years). 18 2 ..3 17 7 7 Colitis (under 2 years) ..23 2 ..15 10. Diarrhea and enteritis (2 years and over). 79 .9 16 6 15 17 13 3 50 11 Colitis(2yearsandover). 31 .4 1 3 14 7 .2. .. Ankylostomiasis. .31 .1 7 .11 8 3 1 119. Intestinal parasites. 3 ..2 1 .97 1 Ascariasis.11 .2 4 .5. 8. Teniasis. .3 1 ......2. Strongyloidosis. 2 ....1 1. Appendicitis and typhlitis. 1 1. ..283 Acute appendicitis. 139 3 10 8 68 22 11 23. Chronic appendicitis. 88 .15 3 25 30 8 7. Hernia, intestinal obstructions .......177 5 Inguinal hernia. 109 1 6 37 27 6 19 15 .. Other hernias.,. 10 1 ..3 5 1. Intes'inal obstruction. 6 1 1 .3 1 2. ... Constipation .57 .5 14 3 8 21 5 1 56 Duodenalulcer .4 .2 1 .1 Sprue .1 ..1 .. Other diseases of the intestines. 65 .9 6 7 24 15 4 .19. Acute yellow atrophy of the liver. 1 1 .1 ..1 .1 Cirrhosis of the liver. 2 .I ...11 6 Biliary calculi .6 1 .:. .1 3 2 1 21 2 Abscess of liver (unqualified). 5 1 .2 .2 2. Cholecystitis. .21 1 2 5 6 4 2 1 1 Other diseases of the liver. 23 .5 8 4 3 3 34 1 Diseases of the spleen.1 1 1. ......9 2 Simple periotonitis (nonpuerperal). 8 2 1 1 1 2 4 1 5 12 Other diseases of the digestive system (cancer and tuberculosis excepted). 14 .5 2 .5 2. Nonveneral diseases of the genitourinary system and annexa. Acute nephritis. .26 5 .3 1 4 22 1 24 14 Bright's disease (chronic nephritis). 33 17 2 21 1 4 19 2 1 103 49 Chyluria. .1 ...1 ..4. Movable kidney.1 ..1 Pyelo-nephroiis .30 1 .3 4 5 18 1. Other diseases of the kidney and annexa. .40 1 2 4 15 12 4 12 3 Calculi of the urinary passages. 27 .14 3 6 2 1 1 5 1 Diseases of the bladder. 8 .2 2 2 2 .43 1 Cystitis .52 .3 6 3 19 20 1 2 Diseases of the urethra, urinary abscess, etc. 15 .2 2 2 4 3 2 7. Stricture of the urethra, nonvenereal. .37 1 41 18 1 5 5 5 73 2 11k.,

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84 TAL XI.-CASES TREATED IN HOSPITALS, 1923.-Continued. Santo Panama Canal Hospitals. Tomas Hospital. NonDisease. Employees. Nonemployeesresidents. bb White. White. Black. Black. Whitel Black. Army. Others Nonveneral diseases of the genitourinary system and annexa.Continued. Diseases of the prostate. ...5. Acute prostatitis. 1 ..1 ...41 Chronic prostatitis. 3 ..2 ... Hypertrophy of prostate. I .1 Nonvenereal diseases of the male genitalorgans. 35 .5 11 4 3 6 5 1 37. Hematocele. 1 ...1 -Hydrocele. 17 .8 2 1 5 1. Uterine hemorrhage (nonpuerperal) 12 1 ..7 4 .12 1 Uterine tumor (noncancerous). 36 ....5 30 1 .63 1 Other diseases of the uterus. 76 1 5 3 .17 46 6 .154. Metritis.6 1 ..4 1 Cystsandothertumorsoftheovary 16 ..I ..6 9 .31. Salpingitis and other diseases of the femalegenital rgans. 86 2 1 1 .16 68 2 .210. Nonpuerperal diseases of the breast (cancer excepted). 12 .I ..1 10 .25. Benign tumor of breast. 2 .....1 1. The puerperal state. Normal labor. .414 ....177 236 1 .985. Accidents of pregnancy. 55 ...11 44 ..157 1 Extra-uterine pregnancy. 8 1 1 3 5 ..4 1 Hyperemesis gravidarumn. 15 ...4 11 Abortion. .67 1 ....34 34 ..99 Puerperal hemorrhage. I. ....1 .8 3 Other accidents of labor. 42 1 1 17 25 ...66 1 Puerperal septicemia. .3. ...2 1 ..2 1 Puerperal albuminuria and convulsions. .13 1. ...6 8 ..7 2 Eclampsia. ..4 1 ...1 4 .3 1 Puerperal phlegmasia alba dolens. ......1. Following childbirth (not otherwise defined) ..11. ...2 9. Puerperal diseases of the breast. 6 1 ....5 2. Diseases of the skin and of the cellular tissue. Gangrene. ..I .2 ....10 5 Furuncle. .18 .2 1 4 6 3 2 19 1 Carbuncle. .4 .1 ..2 .1 .5. Acute abscess. 60 5 11 9 2 24 6 3 138 1 Phlegmon and cellulitis. .61 2 3 21 6 6 16 11. Trichophytosis .4 ..1 2 1. Scabies. 6. 1 1 1 1 1 1. Pemphigus contagiosa. ..1. ..1. Elephantiasis. I. 1 .. Dhobieitch. .4 .1. .2 1. Pricklyheat. 2. 1 1 Ulcer of the skin. .22 .4 8 1. 3 5 1 124 Oriental sore (Leishmaniosis). ....... Tropical ulcer ...3 ....1 1 1. Ulcerating granuloma of the pudenda. ...1 Impetigo contagiosa .15. ..5 1 3 6. Urticaria. 6 ..1 1 1 2 1 Ingrowing nail. .10 ..2 1 4 2 1 Other diseases of the skin and annexa. 42 2 6 4 14 6 9 5 25 a4

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85 TABLE XI.-CASES TREATED IN HOSPITALS, 1923.-Continued. Santo Panama Canal Hospitals. Tomas Hospital. NonDisease. G Employees. Nonemployees. residents 3 n .e White. .d White. Black. Black. White Black. Cd E E #Army. Others Diseases ofthe bones and of the organs of locomotion. Diseases of the bones (tuberculosis excepted). .52 1 8 3 15 12 12 3 43 1 Caries (nontuberculous). 2 .2 Mastoid abscess,. 1 .. Osteomyelitis ..9 1 .3 2 1 2 2 Periostitis.4. .4. Diseases of the joints (tuberculosis and rheumatism excepted). 11 4 1 3 2 1 27 1 Ankylosis. 2 ...1 1 3 Arthritis. .38 3 12 5 1 11 5 1 11. Synovitis. 5 2 3. .. Amputations. ........2. Other diseases of the organs of locomotion. 40 .7 13 2 5 11 2 23. Malformations. Congenital malformations (stillbirths not included). 93 1 .7 10 18 58 1 35 Diseases of early infancy. Newborn child. 411 ..191 220 .975 Congenital debility, icterus, and sclerema. .3 1 ....3 1 15 68 Premature birth. 4 9 ..4 9. ...... Congenital debility. ........13 1 Malnutrition. 20 19 ...4 34 1 ..8 Other causes peculiar to early infancy (including various consequencesof labor). 6 7 ...2 11 .3 6 Old age. Senility. .5 3 ...2 5 1 15 1 Senile dem entia. ........3 Affections produced by external causes. Suicide by poisoning. ..2 ..1 1. Other suicides. ..._. Poisoningbyfood. 9 .2 5 1 1 .1. Venomous bites and stings. 1 ....1 Other acute poisonings. 12 .2 ..2 5 3 10 Burns (conflagration excepted). 37 2 6 3 3 2 9 12 4 27 1 Absorption of deleterious gases (conflagration excepted) 5. 5 ..5 Traumatism by firearms. 14 1 .3 3 4 1 4 28 1 Traumatism by cutting or piercing instruments. 37 1 1 10 .2 13 8 4 126 1 Traumatismbyfall. 108 2 .6 13 22 13 43 12 1 18 Traumatism in mines and quarries. 4 ..1. 3. 3. Traumatismbymachines. 10 .1 1 2 .1 5 2. Railroad traumatism. 1 .....1 Traumatism by landslides. 1 .....I. Traumatism by other crushings. 62 5 9 17 13 6 16 5 1 4 1 Injuries by animals. 5 1 1 .3 1 1. Starvation. .....2 Effects of heat.2 1.1 2 I. .. Insolation .1. ..1. .. Heat exhaustion. 3 ..2 Homicide by other means. ... Fractures (cause not specified). 101 .5 40 12 12 24 8 154 6

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86 TABU XL-CASES TREATED IN HOSPITALS, 1923.-Continued. Santo Panama Canal Hospitals. Tomas Hospital. NonDisease. Employees. Nonemployees. residents. White. White. Black. Black. White. Black. Army. Others Affections produced by external cause.-Continued. Dislocations. 2. I ...1. .22 Sprains. .24 .4 11 3 2 2 2. Other external violence. 201 .12 88 40 10 37 12 2 86. Ill-defined diseases. Ill-defined organic disease. 12 .2 2 1 3 3 .1 1. Cause of death not specified or illdefined. .3. ..2 1 .. Infections of undetermined origin 33 2 6 5 3 8 10 3. No disease. 240 .14 15 28 80 69 32 2 5 Feigned disease. ......165. Totals. 7,781 272 532 1,194 1,151 1,658, 2,794 653 71 9,041 733

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TABLE XII.-CONSOLIDATED HOSPITAL AND ASYLUM REPORT. Remaining January 1, 1923. Admitted. Died. Discharged. Transferred. Remaining Dec. 31, 1923. Clans of patient. White White White White White White White White Bak White White Blc. White White Bak American Foreign. Black. American foreign. Black American foreign. Black erican foig Black ea foig Black. a forig Black Ancon Hospital: 7 Employees. 8 7 72 390 69 1,020 7 3 38 379 65 972 2 8 126 74 ArmyandNavy. 45 951 ..7 .953 ..-..-35. APand Nvyrmt. I.8 22. .1. .1.920. 20 .. Panama Government. ...,. .1 951 22.1. 0 Charity. .3 3 12 194 74 369 4 3 12 187. 69 332 12 15 5 3 22 All others. .30 29 60 1,013 622 1,671 7 12 81 1,000 585 1,541 2 7 20 34 47 89 Totals ., 86 40 145 2,548 733 3,082 25 18 132 2,519 719 2,847 4 20 63 86 56 185 Corozal Hospital: Employees.,. .1 9 1 8 .2 .-. 1 13 Army andNavy .5 I 14. 18 1.4 .-I ---..73 232 Panama Government. .2. 28 65 7 22 .20. 42.2 Charity. 4 39 2 2 11 __ ..-1 1 -.-.2. 7 .2. ...6 42 Allothers. 3 2 21 3 12 13 .4 10 9 ...2 4 25 Totals. 8 79 302 19 43 97 7 25 23 31 59 1 3 3 84 312 Cripples. .4 27 2 4 ...3 6 .3 25 00 Chronic medical and 4 9 3 18 surgical cases. .2 21 .5 7.1 4. Colon Hospital: Employees :. ...6 78 11 263 .6 68 9 175 8 2 84 2 4 Armyand Navy. 6 ..209 .1 7 .-. .-156 .91 49 ... Panama Government ...2 20 1 15 .10 49 Charity ...6 56 14 199 1 1 7 52 12 166 1.24 2 1 8 All others.3 1 10 291 131 731 2 4 21 234 95 556 52 28 151 6 5 13 Totals. 9 1 24 634 176 1,349 10 6 49 510 126 947 110 39 352 13 6 25 Palo Seco Leper Colony: Panama Government. .7 42 .1 13 1 3 .-. -....7 48 Charity. ..28 .....2. 26 Totals. 7 70 .1 13 1 3. ..6 ...7 74 Grand totals: Employees. 8 8 87 468 81 1,291 7 3 46 447 75 1,148 8 4 93 14 7 91 ArmyandNavy .56 ..1,174 .1 14 .1,. 1 51 .-. 38.-. Panama Government. .80 278 .1. 557 9 .30 9 .18 1 ..84 Charity. 3 13 133 252 97 5905 4 21 240 88 522 2 2 398 16 141 All others .36 32 91 1,307 765 2,415 9 16 102 1,238 690 2,106 54 35 171 42 56 127 Totals. 103 133 589 3,201 1,000 4,552 35 32. 210 3,052 883 3,874 115 59 418 102 159 639

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88 TABLE XIII.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED VARIOUS CLASSES OF PATIENTS AND AVERAGE NUMBER IN HOSPITAL EACH DAY, 1923. Number of days treatment. Average number in hospital each day. Class of patient. AmeriAmerican. Foreign. Black. Total, can. Foreign. Black. Total. Ancon Hospital: Employees. 3,908 3,088 25,480 32,476 10.71 8.46 69.81 88.98 Army and Navy. 19,772 ..19,772 54.17 .54.17 Panama Government ..45 186 231 ..12 .51 .63 Charity. 2,500 1,091 4,977 8,568 6,85 2.99 13.64 23.48 Allothers. 11,222 11,078 26,252 48,552 30.74 30.35 71.92 133.01 Totals. .37,402 15,302 56,895 109,599 102.47 41.92 155.88 300.27 Corozal Hospital: Employees. 598 3,855 4,453 .1.64 10.56 12.20 Army and Navy. 276 ..276 .76 ...76 Panama Government. ..27,374 87,442 114,816 .75.00 239.57 314.57 Charity. -.140 1,617 14,911 16,668 .38 4.43 40.85 45.66 Allothers. 775 1,411 7,615 9,801 2.12 3.87 20.86 26.85 Total (insane). .1,191 31,000 113,823 146,014 3.26 84.94 311.84 400.04 Cripples .1,355 9,434 10,789 .3.71 25.85 29.56 Chronicmedicalandsurgicalcases .870 8,297 9,167 .2.38 22.73 25.11 Colon Hospital: Employees. .444 228 1,169 1,841 1.22 .62 3.20 5.04 Army and Navy. 1,546 .12 1,558 4.24 ..03 4.27 Panama Government. .43 359 402 .12 .98 1.10 Charity. 503 115 1,532 2,150 1.38 .32 4.20 5.90 Allothers. 1,793 1,123 5,356 8,272 4.91 3.08 14.67 22.66 Totals. 4,286 1,509 8,428 14,223 11.75 4,14 23.08 38.97 Palo Seco Leper Colony: Panama Government. 1,887 17,542 19,429 .5.17 48.06 53.23 Charity. .9,884 9,884 ..27.08 27.08 Totals. ..1,887 27,426 29,313 .5.17 75.14 80.31 Totals by classes: Employees. .4,352 3,914 30,504 38,770 11.92 10.72 83.57 106.21 Army and Navy. ...21,594 12 21,606 59.16 ..03 59.19 Panama Government. .29,349 1t,529 134,878 .80.41 289.12 369.53 Charity, cripples, and chronics .3,143 5,048 49,035 57,226 8.61 13.83 134.34 156.78 All others. .13,790 13,612 39,223 66,625 37.78 37.29 107.46 182.53 Grand totals. 42,879 51,923 224,303 319,105 117.48 142.26 614.52 874.26 These cripples require no medical attention. TABLE XIV.-REPORT OF DISPENSARIES, 1923. EMPLOYEES TREATED IN QUARTERS. Remaining Remaining January 1, Admitted. Died. Discharged. Transferred. December Place. 1923. 31, 1923. White. Black. White. Black. White. Black. White. Black. White. Black. White. Black. Ancon. 1 7 819 524 ..804 501 14 26 2 4 Balboa. .800 89 ..796 89 .5. Pedro M iguel. 3 3 143 148 ..146 148 ...3 Gatun. 1 1 111 105 ..99 102 12 4 13 Cristobal. 1 18 404 508 1 398 507 4 5 2 13 Totals. 7 29 2,277 1,374 .1 2,243 1,347 30 35 10 20

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89 TABLE XIV.-REPORT OF DISPENSARIES, 1923.-Continued. NUMBER OF DAYS TREATMENT FURNISHED EMPLOYEES IN QUARTERS AND AVERAGE NUMBER TREATED IN QUARTERS EACH DAY. Average number treated Days treatment furnished, in quarters each day. Dispensary furnishing treatment. White. Black. Total. White. Black. Total. Ancon. .,. 1,813 2,548 4,361 4.97 6.98 11.95 Balboa. 1,955 416 2,371 5.36 1.14 6.50 Pedro Miguel. 560 1,028 1,588 1.53 2.82 4.35 Gatun. ..191 196 387 .52 .54 1.06 Colon. .1,221 6,577 7,798 3.34 18.02 21.36 Totals,. .5,740 10,765 16,505 15.72 29.50 45.22 ALL CASES TREATED BUT NOT EXCUSED FROM WORK. Employees. Nonemployees. Total. Place. White. Black. Total. White. Black. Total. White. Black. Total. Ancon ..6,399 11,908 18,307 4,616 12,990 17,606 11,015 24,898 35,913 Baioa ..11,235 11,075 22,310 11,463 6,030 17,493 22,698 17,105 39,803 Pedro Miguel .2,468 7,334 9,802 1,924 6,275 8,199 4,392 13,609 18,001 Gatun .3,773 10,258 14,031 3,353 5,512 8,865 7,126 15,770 22,896 Cristobal .3,920 14,009 17,929 6,487 12,825 19,312 10,407 26,834 37,241 Totals. .27,795 54,584 82,379 27,843 43,632 71,475 55,638 98,216 153,854 TABLE XV.-CONSOLIDATED ADMISSION REPORT, HOSPITALS AND DISPENSARIES, 1923. All classes of patients. White. Black. Total. Admission to hospitals, excluding Corozal farm, cripples, and chronic ward. ...4,194 4,541 8,735 Admission of employees, to quarters. .2,277 1,374 3,651 Total admissions to hospitals and quarters ...6,471 5,915 12,386 Less number of patients transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. ...204 453 657 Net admissions to hospitals and quarters. ..6,267 5,462 11,729 Employees. Employees admitted to hospitals ....549 1,291 1,840 Employees admitted to quarters. ...2,277 1,374 3,651 Total admissions of employees. .2,826 2,665 5,491 Less number transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. .42 128 170 Net admissions of employees. ..2,784 2,537 5,321 Annual admission rate per 1,000 employees to hospitals and quarters .978.21 312.05 484.78 AVERAGE NUMBER OF DAYS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, EMPLOYEES. White. Black. Total. Hospitals: Ancon. .13.18 22.67 19.76 Colon. 6.56 5.30 5.61 Average for hospitals 12.12 19.09 17.03 Quarters: Ancon. 2.09 4.67 3.10 Balboa 2.40 5.10 2.66 Pedro Miguel 4.31 11.22 7.82 Gatun 5.27 6.15 5.68 Colon .2.71 12.38 7.89 Average for quarters 2.61 8.26 4.69

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90 TABLE XVI.-WARD LABORATORY REPORTS. Ancon Colon Hospital. Hospital. Blood examinations (total). 6,045 1,737 Estivoautumnal malaria. 522 136 Tertian malaria. ..245 54 Mixed, tertian and estivoautumnal malaria. 5 3 Quartan malaria. 3 2 Spirillum or relapsing fever. ..12 .. White blood counts. .2,144 505 Red blood counts. 716 42 Differential counts. ..683 412 Hemoglobin estimations. .3,340 107 Crescents. 1. Stool examinations (total). ..9,582 1,741 Ameba coli. ..49. Entameba hystolytica. ...27 1 Uncinaria ova. 808 57 A scaris ova ....379 17 Tricocephalus dispar. 597 30 Tineasaginata. 10 1 Strongyloides. ....264 36 T richuris. ..110 6 Ciliated monads (includes cerecomonas hominis and trichomonas vaginalis). .50 9 Balantidium coli. .5 3 Pus cells. ..91 46 Blood corpuscles. 94 11 Pus and blood.,. ....119. Pus and mucus. ..-.1 Pus, blood and mucus. .123 4 Guaiac test for occult blood. ..374 6 Urine examinations (total). ...21,828 5, 71a Acetone.i. 1,064 96 Diacetic acid. ..185 3 Albumen. ..4,487 2,737 Sugar. ..1,695 15 Bile. ..288 62 Indica .3 Guaiacntest for occult blood. 460 8 Sedimental. ...3,120 799 Epitheli cells. ...11,299 1,641 Cylindroids. 407 21 Hyaline cast. .2,797 581 Granular casts. .2,246 522 P us casts. ..2 ,059 26 Pus cells. .10,964 3,368 Red blood corpuscles. 1,923 568 Pus and blood.1,165. Gonococci.53. Tubercle bacilli. 44 Hemin crystals. 1,542 Functional kidney tests. .228 8 Sputum examinations (total). .3,039 498 Tubercle bacilli. 357 24 Spinal fluid examinations (total). .399 20 Smears of sediment. 169 5 Streptococcus.10 Pneum ococcus. ... Cell counts. ..316 2 Smear examinations (total). ..2,678 126 U rethral. ...1,399 95 Vaginal. .644 37 Eyes. .9 2 Nasal. 3 1 Throat. ...5 3 Breast. .I Indican. ....24. Prostatic. ..418 Skin. .. Others .2 1

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91 TABLE XVIL-SURGICAL OPERATIONS PERFORMED. Santo Ancon Colon Tomas Hospital. Hospital. Hosita. Number. Died. Number. Died. Number. Amputations: Arm .......4 Foot. 2 Thigh. ...6 Thigh, double .....2 Leg. 1 1 1 13 Leg, double. .1 Resection of digits, multiple ...1 3 21 Operations on bones: Ostiectomy. 3.3 I Excision of maxilla. 1. Resection of hip. ....2 Wiring of fractures, simple.16 3 Wiring of fractures, compound.2. 2 Craniectomy, exploratory. ..... Adenectomy: Cervical. ..13 Inguinal, single. ..........177 5 153 Inguinal, double. ..28 .25 Femoral. .....7 ..2 7 Axillary. ......4 2 Herniotomy: Inguinal, single. ....89 22 119 Inguinal, double. ......9 10 45 Ventral. .9 1 2 25 Strangulated. ..2 .4 Femoral.I 10 Genito-urinary tract: Nephropexy. 3 Cystotomy. .......15 Prostatectomy. ........1 2 Urethrotomy, internal. 9 .41 Urethrotomy, external. .....7. 13 Varicocele, radical cure. 8 2 9 Hydrocele, single, radical cure. .21 1 29 Hydrocele, double, radical cure. .2 -1 Orchidectomy. 8 1 10 Epididymotomy. ...88 1. -8 1.11 Partial resection of bladder. .. Vasectomy. ....1 .4 Amputation of scrotum. .9 4 Amputation of penis. .7 Amputation of penis and scrotum. 1 Curettage uteri. ...157 .16 107 Perineoplasty. ...24 2 7 Nephrectomy. 2 Nephrotomy. .4 I Trachelorrhaphy. 12 .. Vaginal puncture. ...7. Circumcision. ..248 Perinephritic abscess, drainage of. Obstetrical: Cesariansection. 5 1 1 6 High forceps.2. 2 Low forceps. ..6 13 Version. ..-. 2 Perineorrhaphy. .45 3 .15 Thorax: Excision of breast. .1 1 4 Excision of breast and axilla. .4. .4. Thoracotomy. 11 Rectum: Hemorrhoids, radical cure. .52 27 53 Fistula in ano, excision of. 1 3 29 Prolapsus rectum, radical cure. ...2 General: Thyroidectomy. .7 2 Varicose veins, excision of. .... Tenorrhaphy. 2 6 Myorrhaphy. ..-. Excision of surface neoplasms. ....4 8 38 Excision of tongue. Operations for gunshot wounds of soft parts .1 Operations for extensive injuries to soft parts. 4 1 3 Plastic operations for severe injuries. .. Plastic operations for congenital defects. .2

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92 TABLE XVII.-SURGICAL OPERATIONS PERFORMED.-Continued. Santo Ancon Colon Tomas Hospital. Hospital. Hospital. Number. Died. Number. Died. Number. General-Continued: Plastic operations for tattoo removal. .....1 Plastic operations for effects of disease 11 ..2 Nerve stretching. ._. ..1 Skin graft,. ...-.7 Laparotomy: For general peritonitis. ...1. Intestinal obstruction. .3 .1 4 Exploratory .5 1 1 29 Gastro-enterostomy. ..4 2 1 17 Gastrotomy. 2 1 I Entero-enterostomy ..-. ...... Enterectomy. ......1. Appendectomy. ..150 84 546 Appendectomy with local peritonitis .33 12 8 Appendectomy with general peritonitis. .9 1 4 .5 Calostomy.1 .4 Cholecystotomy. .---.1 .2.2 Cholecystostomy. ...10 1 1 4 Cholecystectomy. .....I 37 Choledochectomy .3 ......3 2 Abscess of liver, laparohepatotomy. ....5 1 2 Abscess of liver, thoracohepatotomy .4. Pan-hysterectomy. .8 1 36 Splenectomy ---. ..11 Supravaginal hysterectomy ..56 13 1 50 Hysteromyomectomy ...1.8. 9 Myomectomy. ..3 ..2 Salpingectomy, single .12 1 90 Salpingectomy, double ..Salpingo-oophcrectomy ..20 8 95 Ovarian cystectomy ..15. 1 Oophorectomy. 15 3 82 Plastic operation for chronic peritonitis .2. Suspensio-uteri .51 6 155 7 1 3 Ectopic gestation. 7 Enterrorrhaphy.4 1 Rupture of spleen ..-.1. Rupture of liver .. Cauterizations. .110 Arsphenamin, intravenous. .2,637 Major operations, various ..12 ..50 Minor operations, various .1,469 126 572 Salvarsan. ....616. Totals. ..824 13 1,021 4 2,846

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93 TABLE XVIII.-OPERATIONS IN THE EYE, EAR, NOSE, AND THROAT CLINICS. Ancon Santo Ho Tomas hospital Hospital. Eye: Capsulotomy. ..1 2 Cataract extractionsSimple. 2 70 Combined. ..5 Linear. ....5 Chalazion, removal. ..21 1 Anterior chamber irrigation. ..1. Enucleation. 7 6 Foreign body, removal. 47 8 Hordeolum, incision. 4 Corneal ulcer-curettement. .1. Iridectomy. ..8 11 Paracentesis. .1 2 Lachrymal operationsDilation of ducts. 4 Extirpation lachyrmal gland. ..1 1 Lid operationsExcision of tumors. Plastic. Needling ...2 1 Pterygium. .53 35 Suture of lacerated eyebrow. ...1 Tenotomy. ...3 Minor.1 Ear: Furuncle, incision. ..2 1 Abscess, post aural. ...1. Foreign body, removal. ..7 1 Mastoid operationsSimple. ...7 2 Radical. ...2 9 Paracentesis. 81 1 Plastic. ...3 .. Polypi, removal. ..3. Excision, mole, cheek. .1 Nose: Cauterization. ..1 5 Foreign body, removal.2. Polypi, removal. .5 3 Rhinoplasty. .....11 Sinuses:, Ethmoid, simple. .3. Frontal, simple. 11 Frontal, radical. ...1. Maxillary, puncture and irrigation. ...28 1 M axillary, radical.7. Maxillary, drainage. ......I. Submucous resection. 41. Turbinectomy. .19 12 Minor. ...8. Pharynx: Adenoidectomy. ....424 11 Peritionsillar abscess, incision. ....23 1 Tonsillectomy. ........655 121 Uvulectomy. .....2. Minor. .4. 4. Larynx: Foreign body, removal. .1 Exploratory operation of throat. .. Trachea: Foreign body, removal. ...1. Tracheotomy. ...I Totals. .1,525 307 Refractions. ...1 ,044.

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94 TABLE XIX.-REPORT OF X-RAY DEPARTMENT, ANCON HOSPITAL. Ancon Hospital. Arm ....16 Arm and forearm. ..82 Chest. 316 Teeth. 493 Elbow. ..67 Fluoroscopy. ....270 Foot and ankle. 177 Foreign body. .6 Urinary bladder. ...88 Gastro-intestinal tract. .190 Hand. .144 Head.,.,. 86 Hip. ....24 Jaw.,. 64 Knee. ..59 Leg.,. 91 Liver and gall bladder. 13 Mastoids. .43 Pelvis. ....27 Shoulder. .87 Sinuses. .85 Spine. 55 Thigh., .....44 Treatments. .....225 Wrist. .93 Others. ..8 PLATES USED. 61"x8j". .989 8" x 10". ..466 10"x12".,. .443 14" x 17". .428 Films: 8" x 10". .701 10" x 12". .1,178 14" x 17". ..780 D ental film s. ....2,254 TABLE XX.-SANTO THOMAS HOSPITAL STATISTICS, 1923. PATIENTS TREATED. Remaining Remaining, Class. January Admitted. Died. DisDecember 1,1923. charged. 31, 1923. Pay cases. ..33 997 28 968 34 Charity cases. ..343 8,772 706 8,037 336 Totals. 376 9,769 734 9,041 370 Number American. Other nations. treated. White. Black. White. Black. Pay cases-. ..1,030 13 .388 629 Chantycases. 9,115 20. 1,098 7,997 Totals. .10,145 33 .1,486 8,626 Number of days relief furnished patients. .137,858 Average number of patients daily. 373 Average number of days treatment for each patient admitted. ....days. .9 Cost of subsistence per patient per day. $1.687 DISPENSARY REPORT. White. Black. Total. Natives treated .3*555 3,993 7,548 Foreigners treated .424 2,586 3,010 Totals. .3,979 6,579 10,558

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95 TABLE XXI.-COROZAL HOSPITAL, STATEMENT OF COMMITMENTS AND DISCHARGES, 1923. COMMITMENTS. Male. Female. From Canal Zone: First admission. .......43 18 Second admission. ... Third admission. ...1 From Panama: First admission ...46 33 Second admission. -7 5 Third admission. .....1 Totals. ...97 58 DISCHARGES. Well. Improved, Unimproved. Place of birth. Male. Female. Male. Female. Male. Female. Barbados. .2 1 1. China. .1. Colombia. ....1 England. .1. France. ...1 Germany. ......1 Jamaica. 2 2 6 13 2 1 Martinique. ... Mexico. ... Norway. 1 Panama. 6 4 9 8 6 2 Philippines. ..1 Spain. 1 .1. St. Lucia. ..1 1 1 Sweden. ..1. UnitedStates. 1 1 5 2 18. Venezuela. ..1. Others. 1. Totals. .13 13 30 25 28 4 TABLE XXII.-FORCE REPORT. December 31, 1923. 1922. 1921. Gold. Silver. Total. Chief Health Office. 4 .4 4 3 M edical storehouse. ....8 Quarantine Service. 11 22 33 31 35 Health Office, Panama. 8 146 154 151 155 Health Office, Colon. 7 71 78 86 94 Ancon Hospital. 132 220 352 347 329 Colon Hospital. .20 34 54 57 56 Santo Tomas Hospital. .6 .6 6 7 Palo Seco Leper Colony. 1 36 37 35 31 Zone sanitation. 4 92 96 94 116 Corozal Hospital. 21 89 110 104 104 Line dispensaries ..12 8 20 17 2 Totals. .226 718 944 932 9

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UNIVERSITY OF FLORIDA 3 1262 08896 2393