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:
1927
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:


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PAGE 1

REPORT O THE Health Department OF The Panama Canal FOR THE CALENDAR YEAR 1927 Gift of the Panama Canal Museum W. P. CHAMBERLAIN Colonel, Medical Corps, United States Army, Chief Health OfIcer Dr. D. P. CURRY Assistant Chief Health Officer BALBOA HEIGHTS, CANAL ZONE TEE PANAMA CANAL PRESS MOUNT HOPE, C. Z. f .1928

PAGE 2

REPORT OF THE Health Department OF The Panama Canal FOR THE CALENDAR YEAR 1927 W. P. CHAMBERLAIN Colonel, Medical Corps, United States Army, Chief Health Officer Dr. D. P. CURRY Assistant Chief Health Officer BALBOA HEIGHTS, CANAL ZONE THE PANAMA CANAL PRESS MOUNT HOPE, C. Z. 1928

PAGE 3

HN 4H R N N R N N A. LN N N A N A. NN flM .I. N. N A. NULANN N Hur Num NN NUN,. H. NN A .N A A 5P N. AIN M N' NNIN A. NA A For additional copies of this publication address The Rinama Canal, Washington, D. C.P or Balboa Heights, Canal Zone. .N.Ni N. N'NN UqN A A .NL fl, NPI N RK A. M, H Niul .4% R "i N ME K: NN N N NN N. u.1 ON N v N N P NN' .N N 1NNA:-NuTAN NN .NN N. Na -Ki 1Q

PAGE 4

CONTENTS. Page. Title.-.-._ .-------------------------------. ---_.----------Operation and organization---------------------------------5 Personnel.-------------. .-----------------.------------------5 Financial statement -----------. -----------_--_----------------------8 Summary of vital statistics regarding employees only --------------------10 Summary of vital statistics for the Canal Zone, employees, and nonemployees. 13 Summary of vital statistics for Panama City ---------------------------14 Summary of vital statistics for Colon ---------------------------------16 Mosquito and malaria control work -----------------------------------17 Antiplague work---------------------------------------------------21 District nurse---------------------------------------------------24 Physical examination of school children ---------------------------------25 Health Officer, Panama City -----------------------------------------25 Health Officer, Cristobal-Colon. --------------------------------------28 Division of Quarantine--------------------------------------------31 Ancon Hospital -------------------------------------------------32 Corozal Hospital. -.-------------------_----------------------37 Colon Hospital --------------------------------------------------0 Palo Seco Leper Colony-------------------------------------------41 Board of Health Laboratory ----------------------------------------42 Tables: I. Discharges from hospitals, deaths, and noneffective rates for employees --------------------------------------------52 II. Causes of deaths of employees, arranged with reference to color, age, and length of residence on Isthmus -------------------53 III. Deaths and death rates of residents of the Canal Zone and the cities of Panama and Colon-------------------------54 IV. Deaths of residents of the Canal Zone and the cities of Panama and Colon, by cause, sex, color, age, and place of residence--------56 V. Deaths of nonresidents by cause, sex, color, and age------------61 VI. Statistics regarding American employees and their families------63 VII, Births and birth rates in the Canal Zone and the cities of Panama and Colon-_----------_.-----------------------63 VIII. Infant mortality rates in the Canal Zone and the cities of Panama and Colon------------------------------------------63 IX. Discharges and deaths in hospitals of The Panama Canal-------64 X. Consolidated hospital and colony report ------------------------70 XI. Number of days hospital treatment furnished, and average number in hospital each day, of the various classes of patients ---------71 XII. Report of dispensaries_-----------------------------------72 XIII. Consolidated admission report, hospitals and dispensaries---------73 XIV. Corozal Hospital, commitments and discharges -----------------74 XV. Force report_.--. .---.---74 3

PAGE 5

A LETTER OF TRANSMITTAL. THE PANAMA CANAL, HEALTH DEPARTMENT, BALBOA HEIGHTS, C. Z., August 27, 1928. Brigadier General M. L. WALKER, Governor, The Panama Canal, Balboa Heights, Canal Zone. SIR: I have the honor to submif the following report of the operations of the Health Department for the calendar year 1927. Respectfully, W. P. CHAMBERLAIN, Colonel, Medical Corps, U. S. Army, Chief Health O.icer a A4O

PAGE 6

HEALTH DEPARTMENT. OPERATION AND ORGANIZATION. There were no changes in the operation and organization of the Health Department. PERSONNEL. There has been no change in the higher supervisory personnel except that Col. George M. Ekwurzel, Medical Corps, U. S. Army, relieved Lieut.-Col. Will L. Pyles, Medical Corps, U. S. Army, as Superintendent of Ancon Hospital, effective May 15, 1927. On December 31, 1927, there were 260 white and 829 colored employees-a total of 1,089. The white force was divided as follows: 31 physicians, medical officers of the 14 sanitary inspectors. United States Army. 2 quarantine inspectors. 1 dentist, dental officer of the 5 veterinarians. United States Army. 7 technicians. 1 physician, surgeon, United States 9 dispensary assistants. Public Health Service. 3 pharmacists. 30 physicians, civilian. 14 miscellaneous-storekeeper, chem8 internes. ists, stewardess, carpenter, fore6 male nurses. men, mechanics, embalmer, vac103 female nurses. cinator, plumber, and super26 clerks. intendent of the leper colony. The individuals filling the higher positions on December 31, 1927, and their respective duties, were as follows: CHIEF HEALTH OFFICE. Balboa Heights. Col. Weston P. Chamberlain, Medical Corps, U. S. Army, Chief Health Officer. Dr. Dalferes P. Curry, Assistant Chief Health Officer. Surgeon John D. Long, U. S. P. H. S., Chief Quarantine Officer. Mr. Arthur L. Fessler, Office Assistant. 5

PAGE 7

6 DIVISION OF HOSPITALS AND CHARITIES. Ancon Hospital. Col. George M. Ekwurzel, Medical Corps, U. S. Army, Superintendent. Maj. William W. Conger, Medical Corps, U. S. Army, Assistant to the Superintendent. Dr. Troy W. Earhart, Chief of Surgical Clinic. Dr. Howard K. Tuttle, Assistant Chief of Surgical Clinic. Maj. Henry C. Dooling, Medical Corps, U. S. Army, Chief of Medical Clinic. Maj. Paul M. Crawford, Medical Corps, U. S. Army, Assistant Chief of Medical Clinic. Dr. Ivan E. Hix, Chief of Eye, Ear, Nose, and Throat Clinic. Capt. Ralph H. Simmons, Medical Corps, U. S. Army, Assistant Chief of Eye, Ear, Nose, and Throat Clinic. Dr. Leroy S. Townsend, Chief of X-Ray Clinic. Capt. Richmond Favour, Medical Corps, U. S. Army, Chief of Radio-Therapeutic Clinic. Maj. Burgh S. Burnet, Medical Corps, U. S. Army. Maj. Curtis D. Pillsbury, Medical Corps, U. S. Army. Maj. Allen R. Howard, Medical Corps, U. S. Army. Maj. Ned 0. Lewis, Medical Corps, U. S. Army. Maj. Laurent L. La Roche, Medical Corps, U. S. Army. Maj. Percy E. Duggins, Medical Corps, U. S. Army. Capt. Frank W. Pinger, Medical Corps, U. S. Army. Capt. James R. Hudnall, Medical Corps, U. S. Army. Capt. Marvin C. Pentz, Medical Corps, U. S. Army. Capt. Frank P. Strome, Medical Corps, U. S. Army. Capt. Robert E. Thomas, Medical Corps, U. S. Army. Capt. William F. DeWitt, Medical Corps, U. S. Army. Capt. Arthur B. McCormick, Dental Corps, U. S. Army. Lieut. William Krauss, Medical Corps, U. S. Army. Lieut. Stanley W. Matthews, Medical Corps, U. S. Army. Dr. Ezra Hurwitz. Dr. Lewis C. Lush. Internes. Dr. Theodore B. Hayne. Dr. Alva J. Floyd. Dr. Dee L. Abbott. Dr. William H. Presnell. Dr. Alfred L. Briskman. Dr. Gilbert M. Stevenson, Dr. Ralph E. Poston. Dr. George W. Tarry. Board of Health Laboratory. Dr. Lewis B. Bates, Chief of Laboratory. Maj. Paul E. McNabb, Medical Corps, U. S. Army, Pathologist. Capt. Samuel D. Avery, Medical Corps, U. S. Army, Bacteriologist. Mr. James E. Jacob, Chemist. Corozal Hospital. Capt. Cleve C. Odom, Medical Corps, U. S. Army, Superintendent. Capt. Reeve H. Turner, Medical Corps, U. S. Army. Capt. John P. Russell, Medical Corps, U. S. Army. Dr. Lawrence G. Combs, Veterinarian and Dairy Manager.

PAGE 8

Colon Hospital. Maj. John Wallace, Medical torps, U. S. Army, Superintendent. Dr. William V. Levy. Capt. Aubrey K. Brown, Medical Corps, U. S. Army. Capt. Brooke Dodson, Medical Corps, U. S. Army. Capt. Clyde D. Oatman, Medical Corps, U. S. Army. Capt. Leland E. Dashiell, Medical Corps, U. S. Army. Palo Seco Leper Colony. Mr. Henry Garland, Superintendent. Dr. Philip Horwitz, Attending Physician. Cristobal-Colon Dispensary. Dr. William V. Levy, District Physician. Gatun Dispensary. Dr. James A. Grider, District Physician. Pedro Miguel Dispensary. Dr. David G. Sampson, District Physician. Dr. John C. Wilkinson. Dr. Denver F. Gray. Balboa Dispensary. Dr. Littleton 0. Keen, District Physician. Dr. Walter C. Friday. 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. John P. Corrigan, Sanitary Inspector. Mr. E. Frederick Quimby, Sanitary Inspector. Mr. Morris M. Seeley, Sanitary Inspector. Dr. Troy S. Hopkins, Sanitary Inspector. Mr. George L. Willett, Sanitary Inspector.

PAGE 9

8 Panama Health Office-Continued. Dr. Ira C. Mattatall, Supervising Veterinarian and Meat Inspector Dr. Frederick F. Dowd, Veterinarian and Meat Inspeetor. Dr. Henry A. Lewis, Vaccinator. Cristobal-Colon Health Office. Dr. Jesse L. Byrd, Health Officer. Mr. Thomas A. Leathley, Sanitary Inspector. Mr. James L. Tolar, Sanitary Inspector. Mr. Ira W. Pickett, Sanitary Inspector. Dr. Claire C. Clay, Veterinarian and Meat Inspector. Dr. William F. Gross, Veterinarian and Meat Inspector. Canal Zone Sanitation. Mr. Charles H. Bath, Sanitary Inspector, Northern District, Gatun. Mr. Charles L. Pierce, Sanitary Inspector, Southern and Panama-Suburban Districts, Ancon. Mr. Raymond E. Forbes, Sanitary Inspector, Ancon. Mr. Charles A. Roach, Sanitary Inspector, Ancon. Mr. Carl G. Brown, Sanitary Inspector, Ancon. DIVISION OF QUARANTINE. A Surgeon John D. Long, U. S. P. H. S., Chief Quarantine Officer (See Chief Health Office). Cristobal-Colon Quarantine, Cristobal. Dr. Charles A. Hearne, Quarantine Officer. Dr. Herbert L. Phillips. Dr. Francis L. Alexaitis. Dr. Alva W. White. Balboa-Panama Quarantine, Balboa. Dr. John D. Odom, Quarantine Officer. Dr. Philip Horwitz. Dr. Samuel S. Irvin. Dr. Boldridge E. Kneece. Dr. Wayne Gilder. FINANCIAL STATEMENT. The funds for the operation of the Health Department are derived partly from a specific appropriation made annually by Congress, and partly from the earnings of the department, as shown by the following statement of expenses of the department for the calendar year 1927:

PAGE 10

9 EXPENDITURES AND EARNINGS OF SUBDIVISIONS OF HEALTH DEPARTMENT. Per cent Gross cost Expenditures. Earnings., self per ,supportpatient ing. per day. Ancon Hospital, 800 beds -------$728,189.67 $416,998.36 57 $4.66 Colon Hospital, 80 beds-124,467.80 55,126.93 44 6.15 Corozal Hospital for the insane, 600'beds ----------------3195,610.75 166,758.42 85 .98 Palo Seco Leper Colony, 108 beds 45,524.63 21,099.25 46 1.20 Maritime quarantine service -------480,221.53 27,825.81 35 Sanitation of the cities of Panama and Colon -----------------77,723.54 8,618.51 11 Street cleaning and garbage collection and disposal, cities of Panama and Colon -----------123,799.01 7100 ,810.54 781 Canal Zone sanitation ------------157,072.35 45,977.87 29 Line dispensaries---------------55,774.71 17,702.66 32-------Medical storehouse ----------------8131.46 8 ,131.46 Chief Health Office and miscellaneous.-------------------31,860.69 8.00 Totals -------------61 ,628 ,376.14 860,926.35 53 --' Includes Army pay of Army medical officers, which amounted to ..$94,267.78 SIncludes Army pay of Army medical officers, which amounted to. ..22,076.44 3 Includes Army pay of Army medical officers, which amounted to ..11,08$.74 4 Includes Public Health Service pay of U. S. P. H. S. officer, which amounted to. .....8,463.85 a Includes Army pay of Army medical officer, which amounted to ...6,238.00 e Includes Army and Public Health Service pay, which amounted to ...142,134.81 Earnings include the 75 per cent of total expense which is billed to the Republic of Panama. Gold pay roll (white employees): Panama CanaL. ---------------------------$497 ,055.52 Army pay -------------------------------133,670.96 Public Health Service pay ---------------------8,463.85 $639,190.33 Silver pay roll (colored employees) -------------------------400 ,223.57 Subsistence supplies -----------------------------------194,742.61 Ice ------------------------------------------------------5,766.51 Hospital supplies and drugs ----------------------------------70 ,555.65 Equipment ----------------------------------------------55,191.96 Miscellaneous supplies --------------------------------------,671.05 Laundry ------------------------------------------------35,200.04 Telephones -----------------------------------------------13,991.43 Repatriation of patients physically or mentally disabled ------------434.93 Medical storehouse operation ----------------------------------7202.08 Launch service-. --------------------------------------------7121.26 Electric current --------------------------------------------11 ,048 .92 Electric repairs and installations 9,-----------------------------9326 .98

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10 Water -.-.--.-. .-.-.------------------------------------------12 ,034.83 Motor transportation (except for hospitals, quarantine stations, and dispensaries) and repairs.-----------------------------------------49 ,747 .48 Building repairs and minor construction.--. .------------------------------15 ,365 .79 Rentals.-.-. ---.--.------------------------------------------------------------2,976.27 Miscellaneous charges for services of other Panama Canal departm ents.-.-.--------------------------------------------------------17,584.45 Total operating expenses .--.-..--------------------------------1,628 ,376. 14 Salaries of Army medical officers and United States Public Health Service officers, paid from appropriations for those services-------142,134.81 Total operating expenses, as charged against Health Department funds.-._. .------------------------.----------1,486,241.33 SUMMARY OF VITAL STATISTICS' REGARDING EMPLOYEES ONLY.2 The five following charts are for the total employed force, which for the year 1927 averaged 3,197 whites and 10,364 negroes. CHART No. 1.-ADmISSION RATE To HOSPITALS AND QUARTERS FROM ALL CAUSES, EMPLOYEES ONLY. Average Rate Year.' number per employed. 1,000. 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 1924 11,625 513 1925 12,180 519 1926 12, 732 474 1927 13,561 502 ,All rates throughout this report are computed as annual per 1,000. SIncludes 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 in 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.

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11 The admission rate to hospitals was 155.15 in 1927, as compared with 150.04 in 1926, and 169.79 in 1925. From disease alone the admission rate to hospitals in 1927 was 130.00, as compared with 130.77 in 1926, and 148.36 in 1925. CHART No. 2.-DEATH RATE FROM ALL CAUSEs, EMPLOYEES ONLY. Average Rate Year. number per employed. 1,000. 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 1924 11,625 7.23 1925 12,180 8.95 1926 12,732 9.03 1927 13,561 9.00 The death rate from disease alone for 1927 was 7.82, as compared with 7.46 in 1926, and 7.72 in 1925. CHART No. 3.-NONEFFECTIVE RATE FRoM ALL CAUSEs, EMPLOYEES ONLY. Average Rate Year. number per employed. 1,000. 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 1924 11,625 13.51 1925 12,180 13.77 1926 12,732 12.08 1927 13,561 13.81

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12 CHART No. 4.-ADMissioN RATE FROM MALARIA, EMPLoYg'Es ONLY. Average Rate Year. number per employed. 1,000. 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 S 1919 24,204 31 m 1920 20,673 19 U 1921 14,389 15 a 1922 10,447 17 N 1923 10,976 19 a 1924 11,625 16 W 1925 12,180 127 W 1926 12,732 14 I 1927 13 ,561 11 I Rate would be only 16 if cases from Bruja Point are omitted. See p. 16, Report of H. D. for calendar year 192. CHART No. 5.-DEATH RATE FROM MALARIA, EMPLOYEEs ONLY. Average Rate Year. number per employed. 1,000. 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 1913 56,654 .30 M 1914 44,329 .14 3 1915 34,785 .23 U 1916 33,176 .06 1 1917 32,589 .09 U 1918 25,520 .08 N 1919 24,204 .08 a 1920 20,673 .S U 1921 14,389 .00 1922 10,447 .00 1923 10,976 .00 1924 11,625 .17 I 1925 12,180 .00 1926 12, 732 .00 1927 13,561 .00

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13 The 6 diseases causing the highest number of hospital admissions among employees, with their rates, were as follows: 1926. 1927. Admissions. Rate per Admissions. Rate per 1,000. 1,000. Malaria (includes the few cases treated in quarters). 179 14.06 145 10.69 Venereal diseases. ..128 10.05 139 10.25 Diseases of pharynx and tonsils. ..102 3.01 127 9.37 Diseases of the eyes and their annexa. .62 4.87 84 6.12 Bronchitis. ...52 4.08 41 3.02 Ulcers of stomach and duodenum. 16 1.26 40 2.95 The 6 diseases causing the highest number of deaths among employees, with their rates, were as follows: 1926. 1927. Deahs. Rate per Rate per Deaths.00 Deaths. iaoep. Nephritis (acuteand chronic) ...13 1.02 16 1.18 Organic diseases of the heart ..4 .31 14 1.03 Tuberculosis (various organs) .....19 1.49 11 .81 Syphilis. ...16 1.26 10 .74 Cancer (various organs). ...3 .24 8 .59 Apoplexy. .4 .31 6 .44 The admission rate to hospitals from disease, and death rate from disease, for white employees, were 208.95 and 5.94, respectively, as compared with 95.42 and 8.39 for black employees. The death rate from disease for American (white) employees was 4.99, as compared with 6.23 for 1926 and 2.57 for 1925. SUMMARY OF VITAL STATISTICS FOR THE CANAL ZONEEMPLOYEES AND NONEMPLOYEES. From an average population of 36,794 in the Canal Zone, there were 298 deaths during the year; 265 of these were from disease, giving a rate of 7.20, as compared with 6.72 for 1926, and 6.92 for 1925. The death rate from tuberculosis was 0.49, as compared with 0.65 for 1926, 0.89 for 1925, 1.01 for 1924, and 0.69 for 1923. Tuberculosis caused 7 per cent of all deaths from disease during the year, as compared with 10 per cent in 1926, 13 per cent in 1925, 13 per cent in' 1924, and 10 per cent in 623. There were 547 live births reported during the year, giving a birth rate of 14.87. (See table VIT, page 63.) Of these, 169 were white, and 378 were black. Of the total births reported, 6 per cent were stillbirths.

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AA 14 Deaths among children under 1 year of age, from all causes, totaled 59, of which 5 were white and 54 were black, giving an infant mortality rate based on the number of live births reported during the year, of 29.59 for white children, 142.86 for black children, and a general average of 107.86. Of the total deaths for all ages, 20 per cent occurred among children under 1 year of age, and 29 per cent among children under 5 years of age. CHART No. 6.-DEATH RATE FRoM ALL CAUSES, CANAL ZONE ONLY, EMPLOYEES AND NONEMPLOYEES. Rate Year. Popula Deaths. per tion. 1,000. 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 1924 33,723 305 9.05 1925 34,840 297 8.53 1926 36,480 284 7.79 j 1927 36, 794 298 8.10 SUMMARY OF VITAL STATISTICS FOR PANAMA CITY. The recent population of Panama City, as used in Chart No. 7, is based on the census of 1920, slightly reduced in 1922 and 1923 as a result of the departure of persons who took leases on Canal Zone land 'which was thrown open to settlement in 1922. There were 1248 deaths during the year 1927. Of these 1201 were from disease; based on the population figures of 59,635, shown in Chart No. 7, this gives a death rate from disease of 20.14 as compared with 19.32 in 1926, and 18.88 in 1925. Reliable estimates indicate that the present population of Panama City is at least 70,000. On the basis of 70,000, the total death rate in 1927 would be 17.83, instead of the 20.93 shown in Chart No. 7.

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15 The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1926. 1927. Deaths. Rate per Deaths. Rate per Pneumonia. ...193 3.24 187 3.14 Tuberculosis. ......202 3.39 180 3.02 Diarrhea and enteritis (including calitis) ...128 2.15 122 2.05 Organic diseases of the heart .71 1.19 112 1.88 Nephritis (acute and chronic). ....121 2.03 105 1.76 Cancer (various organs). 52 .87 56 .94 The death rate from tuberculosis was 3.02, as compared with 3.39 for 1926, 3.67 for 1925, and 3.20 for 1924. Tuberculosis caused approximately 14 per cent of all deaths from disease, as compared with 18 per cent in 1926, 19 per cent in 1925, 17 per cent in 1924, and 18 per cent in 1923. There were 2,389 live births reported during the year, giving a birth rate of 40.06. Of the total births reported, 5 per cent were stillbirths. There were 287 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 120.13. Of the total deaths for all ages, 23 per cent occurred among children under 1 year of age, and 34 per cent among children under 5 years of .;Fage. CHART No. 7.-DEATH RATE FRoM ALL CAUSES, CITY OF PANAMA. Rate Year. PopulaDeaths. per tion. 1,000. 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 S 1921 60,500 1,336 22.09 1922 60,068 1,279 21.29 1923 59,635 1,106 18.55 1924 59,635 1,168 19.59 1925 59,635 1,169 19.60 1926 59,635 1,188 19.92 1927 59,635 1 ,248 20.93 Seef6rst paragraph under "Sumniary cf Vital Statistics for Panama City". :-E. JK4

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16 SUMMARY OF VITAL STATISTICS FOR COLON. The recent population of Colon, as used in Chart No. 8, is based on the census of 1920, modified as seemed warranted by known population shifts. There were 423 deaths during the year 1927. Of these, 404 were from disease; based on the population figures of 31,583, as shown in Chart No. 8, this gives a death rate from disease of 12.79 as compared with 13.65 for 1926 and 12.12 for 1925. Reliable estimates, based on increase in school attendance, new building permits, and occupancy of tenement houses, indicate that the present population of Colon is at least 40,000. 'On the basis of 40,000 the total death rate in 1927 would be 10.58 instead of '13.39 as shown in Chart No. 8. The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1926. 1927. Deahs. Rate per Dh Rate per Deaths. 00 r Deaths. hole 1,000. 1,000. Tuberculosis (various organs) ..77 2.46 80 2.53 Pneumonia (broncho and lobar). .49 1.57 39 1. Nephritis (acute and chronic). .38 121 37 1.17 Diarrhea and enteritis (including colitis) .20 .64 27 .85 Cancer (various organs) .14 .45 26 .82 Organic diseases of the heart ..18 .58 22 .70 The death rate from tuberculosis was 2.53, as compared with 2.46 for 1926, 2.01 for 1925, 2.62 for 1924, and 1.92 for 1923. Tuberculosis caused approximately 19 per cent of all deaths from disease, as compared with 18 per cent in 1926, 17 per cent in 1925, 18 per cent in 1924, and 15 per cent in 1923. There were 737 live births reported during the year, giving a birth rate of 23.34. Of the total births reported, 7 per cent were stillbirths. There were 80 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of live births reported dur-l ing the year, of 108.55. Of the total deaths for all ages, 19 per cent occurred among children under 1 year of age, and 25 per cent among children under 5 years Qf age.

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CHART No. 8.-DEATH RATE FROM ALL CAUSES, CITY OF COLON. Rate Year. PopulaDeatha. per tion. 1,000. 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 1924 31,285 475 15.18 1925 31,285 401 12.82 1926 31,285 452 14.45 1927 31,583 423 13.39 See first paragraph under "Summary of Vital Statistics for Colon". MOSQUITO AND MALARIA CONTROL WORK. Drainage for the control of malaria-carrying species of Anopheles was extended another two miles along the coastal plain in an easterly direction from Panama City during the year. Near the ruins of the city of Old Panama, destroyed by the pirate Morgan in 1672, were many shallow lagoons, concealed from view by the surrounding vegetation, and large areas of marshy pasture lands, all furnishing countless hordes of Anopheles albimanus during each rainy season. During the early construction days of the Canal, Old Panama could be reached only by the poorest of trails, through mud and almost uninhabited jungle, or else by way of the sea, a landing near the town being possible at flood tide. Now a broad concrete road leads to the ruins of the old city, this highway traversing a thickly settled surburban community dotted with so-called "road houses" at frequent intervals. Even for the seriously inclined the drive to Old Panama in the evening is one of charm and interest. In order to obtain sufficient depth and grade for the ditches in the low-lying marshes near Old Panama it was first necessary to lower some three feet the outlet of the Rio Abajo over a distance of about 2,000 MR 12007-2

PAGE 19

18 feet. This permitted the digging of open earth ditches with .a grade of one-tenth per cent, the banks being laid back to a "one on one" slope. The longest of these ditches has a length of 3,335 feet and a depth varying from 12 inches at the beginning, to 7 feet at the outlet through the high bank of the stream. In those parts of the ditches that exceed 2 feet in depth it was arranged that cattle shall have easy passage across at intervals of 200 feet, by cutting the opposite banks for a 'distance of 4 or 5 feet to a slope of I in 4. Based on our observation it is believed that the cattle will learn to use these passages regularly and thus save the bottoms and sides of the ditches from mutilation by hoofs along the entire length. A total of over 34,000 feet of open ditch of this character was dug in the vicinity of the old ruins. A relatively small amount of drainage remains to be installed between the above-described areas and the village of San Francisco, adjacent to the golf club, which, when done, will practically complete the work necessary to control mosquito breeding between the sea and the south side of the Sabanas road from the old to the new city. In order to establish control in an area of equal radius from Panama City on the other side of the Sabanas road there remains an area extending some three miles along the north side of that road in which are numerous streams to train and some depressions to fill or drain, but the ground is of a more rolling character than the coastal plain already controlled on the south side of the road and will present no especial difficulties. The village of San Francisco, established a few years ago on the coast just beyond the golf club at a distance of 21 miles from the city limits, has proven a popular site for homes of moderate proportions and new houses are constantly being built there. The location was not an especially salubrious one and many of the inhabitants were victims of malaria. The situation there endangered the golf club, the two race tracks and the city of Panama, particularly the Bella Vista suburb. Open earth ditching of the town site was# undertaken by the Health Department in 1927 with the expectation of putting the system in a permanent form, with subsurface rock-covered tile drains and concrete-bottomed open ditches, as soon as time and season permitted. Because of the high tide and heavy surf along this part of the coast it will be necessary to build a closed concrete flume 300 feet in length and 20 inches in diameter through the high sandy beach to the rocky* low-tide level as an outlet for the main drainage of the townsite. At the present time the outlet is blocked at every high tide by sand dunes which create a large lagoon of brackish water in which Albimanus breeds freely unless the water is subjected.to regular oilings.

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19 The breeding places of the hordes of A edes taeniorhynchus mosquitoes that annually invade the Pacific side towns for a brief season during the early weeks of the rains have been definitely located in the vast coastal marshes that extend for many miles east ward from the ruins of Old Panama City. These marshes are not tidal, for they are cut off from ordinary high tides by the dunes that are formed along the coast and across the estuaries. An occasional high spring tide, pushed by a strong south wind, may surmount these ramparts and inundate the lowlands, but this does not occur often enough to destroy the verdant Pard grass with which the marshes are covered and which makes them valuable as pastures. In order to drain these pastures without permitting the daily influx of the tides, and consequent destruction of the grass, it would be necessary to install an expensive system of tide gates at the outlets of the drainage systems and to keep these under constant patrol and adjustment so as to insure their proper operation. Where discharge is through sandy beaches it would be necessary to build concrete flumes of considerable size and strength to prevent the outlets from becoming blocked with sand at frequent intervals. It is not believed that the occasional annoyance caused by these harmless mosquitoes is of sufficient importance to justify measures of control at such great cost. A recent discovery of practical interest relates to a new larval habitat of Mansonia (Taeniorhynchus) titillans, a species of mosquito that, in the lake region and even elsewhere, ranks almost with the Aides taeniorhynchus as a pest. Previously titillans had been found only on the roots of water-lettuce (Pistia) in our lakes and ponds, although it had long been suspected from the distribution of the adults that there was some other plant upon which the larvae could attach themselves and develop. Following the appearance of increasing numbers of M. titillans at Pedro Miguel an intensive search for the source of the mosquitoes was made, in the near-by arms of Miraflores Lake. In the Pedro Miguel River inlet of the lake there had only recently appeared a new kind of floating-grass with long "runners," from the joints of which depended bunches of fine rootlets. Attached to these rootlets were found innumerable larvae of M. titillans and many adults were reared from larvae that attached themselves to specimens of the grass in breeding jars. This grass has been identified at the United States National Museum as Paspalum repens Berg. Gatun Lake and Miraflores Lake are both artificial bodies of water, created as parts of the Canal system, and being of such recent origin it is but natural that their flora and fauna should be still undergoing change and accretion. The Paspalum appears to be spreading rapidly in the lakes of the Canal;

PAGE 21

20 probably due to the tendency of large masses to detach themselves from the parent stem and float away, drifting here and there upon the surface. Since this grass is so perfectly suited, as a source of air supply, to -the peculiar needs of Mansonia titillans larvae, we are probably due to have this mosquito with us in growing numbers throughout the lake region. At Pedro Miguel an attempt is being made to destroy these larvae with the oil spray that is used for the control of surface-breathing larvae. From the egg to the adult stage there are probably several occasions on which the individual is exposed to the surface film of oil to such an extent as to be affected by it. The chief obstacle to the success of the procedure seems to be the presence of currents in the water, such as occur in the small river inlets of the lakes, which sweep the oil-film away so that there are long intervals between applications during which the water among the grass stems is free from film. In the Northern District, in which lies the sanitated area of the Atlantic side of the Canal Zone, no appreciable extension of sanitated areas has taken place in the past year, but the time not devoted to routine maintenance and control work has been profitably spent in perfecting the existing drainage systems. In these flat coastal marshes there is no deep root layer in the soil to make stable the sides of the ditches, and the underlying soil is watersoaked and oozy. Consequently the ditches must be dug with gently sloping banks and of considerable capacity if they are to function without frequent cleanings. In the pastures of Mindi dairy, near Gatun, surface drainage has converted many shallow weed-filled ponds into wet meadows in which water now stands only in cattle tracks and small depressions: A nopheles albimanus, A. tarsimaculatus, A. argyritarsis, and A. pseudopunctipennis no longer breed there save in the ditches themselves when these become blocked. In the remaining surface depressions and tracks are now found only A. apicimacula and, if sufficiently shaded, A. punctimacula in fewer numbers, neither of these latter two being considered important as transmitters of malaria. A new species of Anopheles (of the subgenus Chagasia) was discovered in the Canal Zone in December, 1927, by Mr. C. H. Bath, sanitary inspector of the Northern District of the Canal Zone, who found these peculiar larvae breeding in the swift waters of the hill streams above Agua Clara reservoir near Gatun. Many larvae were secured and a number of specimens were reared from them. The adults have not yet been taken here on the wing. Dr. H. G. Dyar, of the United States National Museum, has described this mosquito in his new work The Mosquitoes of the Americas and has given to it the specific name of bathanus in honor of the discoverer.

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21 The hitherto unknown larva of Anopheles (Stethomyia) nimbus was also discovered by Mr. Bath in shaded pools associated with A. eiseni, A. puncdimacula, and Culex declarator. Specimens of the larvae have been sent to Dr. Dyar for systematic description. In view of the great extension of sanitated areas within the past few years, coupled with the meticulous care which is taken to prevent harmful mosquito breeding within the areas under control, it becomes increasingly apparent that in the early weeks of the rainy season our towns are at times subject to some flights of malaria-carrying Anopheles from breeding places well beyond the regions under observation, even though search has been greatly extended in efforts to discover the sources of such flights. It was once thought that mosquitoes'flying long distances in search of the fructifying blood-meal had but little to do with causing malaria, but now it would appear that much of the residual malaria of the sanitated towns may be due to mosquitoes flown from comparatively far away. ANTIPLAGUE WORK. Because of the world-wide spread of bubonic plague, and especially because of its prevalence in the countries of South and Central America that have intimate relations with the Canal by means of shipping, the efforts to minimize the rat population of the terminal cities of the Isthmus are unrelenting. Soon after the arrival upon the Isthmus of Dr. John D. Long, of the United States Public Health Service, who had been detailed to the Health Department of The Panama Canal to act as Chief Quarantine Officer, he was requested by the Chief Health Officer to make a study of the conditions here regarding the possibility of the introduction and spread of bubonic plague in the Panama Canal Zone. Because of Dr. Long's extended experience in this special field it was believed that his opinion would be especially valuable. The following are extracts from his report to the Chief Health Officer, made in July, 1927: The last case of bubonic plague that originated on the Isthmus of Panama occurred in La Boca in 1905. Since that time constant trapping and poisoning of rats and rat-proofing of buildings, wharves, and other structures have been carried out. The wharves and buildings in the Ancon-Balboa district may be considered as rat-proof for all practical purposes. This is due to the fact that a substantial proportion of these structures are built of concrete, and the wooden or frame buildings are all elevated in such manner to leave ample open space underneath. Apparent confirmation of the previous statement is found in the fact that complaints of the presence of rats or of rat depredations are few, and such rats or rodents as are caught

PAGE 23

22 are usually found in the machine shops and in the vicinity of the waterfront. The absence of complaints or reports as to the presence of rats is of considerable significance, for the reason that the residents of the Canal Zone are accustomed and have been educated, over a period of years, toxreport to the Health Office at once the presence of rats, flies, mosquitoes, or other animals or insects that may be considered as potentially dangerous. In the Cristobal-Colon district substantially all buildings, wharves, or other structures of importance have been made rat-proof for all practical purposes, and constant inspection is maintained for the purpose of conserving them in that condition, and to prevent occupants from bringing about or creating conditions that may favor rat harboring, breeding, or feeding. Complaints as to the presence of rats or rat depredations are few. In the Panama City district it is estimated that from 50 to 60 per cent of the buildings and structures in the city of Panama are substantially rat-proof. All new buildings are constructed in such manner as to be rat-proof when finished. Old buildings are required to put in rat walls and remove double partitions, and in all buildings, stores, shops, factories, etc., goods, merchandise, lumber, and articlesofaU kinds must be piled and stored in such manner as to allow free access to all sides, including such elevation above the floor or ground level as to allow access or inspection underneath. Further and marked reduction in rat prevalence may be expected in Panama, due to the fact that many of the old buildings are now being torn down and replaced by new ones, usually reinforced concrete, so constructed as to complywith the rat-proofing ordinances. There are few cities that have as much of their ground surfaces paved with concrete as has the city of Panama. The other districts of the Canal Zone are rather sparsely populated, the houses are usually of wooden frame construction, elevated above the surface of the ground and open underneath, houses are usually well separated, and no doublewalls or partitions exist, so that for all practical purposes these districts can be considered substantially rat-proof. Rodents have been examined and identified as shown in the following table by years. No plague infection has been found among them: Total Norway Black Alexandrine Year. examined. rats. rats. rats. Mice. Per cent. Per cent. Per cent. Per cen*. 1920 .17.080 14.6 20.0 4.2 6OL. 1921. 18,476 12.8 23.3 7.7 51.9 1922. 13,979 15.5 24.1 12.5 43.6 1923. 14,077 10.5 20.8 12.0 56.2 1924. ..11,252 4.6 39.1 4.1 52.2 1925. .5,134 2.2 300 2.6 65.2 1926 ..5,243 2.0 51.0 1.7 44.9 1927' ...7,850 1.5 51.0 0.9 46.4 1 1927 figures inserted to bring these statistics up to date. On several widely separate occasions studies have been made as to flea prevalence and as to the species of fleas that infect the rats of the Canal Zone and the cities of Panama and Colon. All of these studies have given uniformly similar results. It has been found that these rats have been infested by an average of between 2 and 3 fleas. In no instance were there as many as 100 fleas on a single rat. Indentification of species has shown that practically all of the fleas examined (98 per cent) were .X. cheopis, the so-called' plague flea. An occasional cat or dog flea was found, but they were very rare. The investigations were carried out over sufficient periods of time, so that they may be considered as fairly representative of all seasons, though the

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23 figures available are not sufficiently detailed so as to be able to state with certainty that seasonal variations do not occur. The measures that have been most useful in bringing about the rat reduction obtained, have been rat-proofing and efficient garbage collection and disposal. Neither trapping nor poisoning have been carried out on a sufficiently large scale to have contributed much toward attaining the results obtained. Trapping and poisoning have, however, served to obtain a sufficient number of rats so that laboratory examination has been able to demonstrate the continued absence of rodent plague. It is believed that the facts warrant the conclusion that the Canal Zone and the cities of Panama and Colon could be infected with plague should the disease be introduced from without. This conclusion is based upon the fact that rats still exist aid that the X. cheopis is the prevailing flea that infests them. It is not believed that an epidemic could be produced, but an occasional isolated case or local group of cases could occur. Should infection be introduced it could, especially in the Ancon-Balboa and Cristobal-Colon districts, be-quickly eliminated with relative ease and without excessive cost, by the employment, for a few months, of additional labor and the intensification of trapping, poisoning, and rat-proofing measures. Should plague infection gain entrance into the city of Panama, there is likelihood of a larger number of human cases than in the other districts, and somewhat more time and expense would be required to bring about its elimination. This is on account of the fact that the rat population has not been reduced to so low a figure as in the other cities, and also because rat-proofing operations have been more difficult and slow on account of the large number of old frame buildings which have existed for many years, that have been maintained in a poor state of repair, and were originally constructed in such manner as to favor. rather than prevent rat harboring and breeding. In spite of these difficulties, however, a very creditable showing has been made in rat reduction, and it is not thought that a human epidemic could occur, though without much doubt the city could have cases, either singly or in small groups, that would require some time and expense to bring about complete elimination. The only known way through which plague can be introduced into the Canal Zone and adjoining cities, is through the agency of the vessels that transit the Canal or visit the ports of Cristobal and Balboa. The steamships and other vessels transiting the Canal or that call at the ports of ,Cristobal or Balboa travel over approximately 138 routes. Vessels traveling over 48 routes call regularly at ports actually infected or suspected of being infected with bubonic plague. The great majority of these vessels are fumigated in accordance with the United States Quarantine Regulations, either in ports of the United States, by officers of the U. S. Public Health Service; in British ports by the local health authority, in accordance with an understanding had with the Public Health Service; or in other foreign ports either by arrangement with local authorities or under the supervision of an officer of the Public Health Service. All vessels regularly and efficiently fumigated may be considered, for quarantine purposes, as being practically free from rats, or at least not potentially dangerous. There are, however, occasional tramp freighters without fixed itineraries, as well as certain lines of steamers that ply between Mediterranean ports and ports of South America, that are not regularly and efficiently fumigated, even though some of the ports they visit are actually infected ports. These vessels are potentially dangerous not only on account of the lack of efficient fumigation, but on account of the type of cargo they usually carry, such as nuts, almonds, cork, vegetables, hay, cotton, onions,

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24 garlic and general cargo in crates, bales, and boxes, much of which furnishes excellent facilities for the harboring, breeding, and feeding of rats. Fumigation of these vessels at the Canal Zone is practically an impossibility for the reason that they are always loaded with cargo, and efficient fumigation can not be carried out without requiring them to unload and reload, an expensive and, in most cases, an unjustifiable procedure, as well as undesirable from the Canal standpoint, for the reason that the space they would have to occupy pending completion of fumigation procedures is needed for other vessels that are constantly arriving and whose passage of the Canal must be expedited in order to prevent stagnation of traffic. When such potentially dangerous vessels arrive they are required to fend off from the docks, maintain rat guards on all lines, and the class of cargo to be loaded is investigated and if considered doubtful or dangerous is ordered unloaded into lighters and there fumigated prior to being allowed to land. There are 16 routes followed by vessels that, for the above reasons, may be considered as potentially dangerous. Fortunately, at most of the ports visited and as it # happens, at almost all of the ports where plague infection is heaviest, docking facilities do not exist, and cargo and passengers must be loaded or embarked while at anchor in the open bay or roadstead, from lighters and launches. This lack of docking facilities in the worst infected ports is a distinct and decided advantage from the sanitary standpoint, for the reason that rats are not likely to get aboard the vessels except in the cargo itself. While rats have been found in cargo and are known to have been transferred from ship to shore and vice versa in this manner, it is not a common occurrence, nor are large numbers of rats transferred in this manner. Summary and conclusion.-The possibility of the introduction of plague into the Canal Zone and adjoining cities still exists, through the agency of vessels that ply. regularly between the Canal and infected ports, and that are not regularly and efficiently fumigated. The danger is not, however, believed to be imminent, for the reason that present conditions have existed for some time without the disease having been introduced, and the Ancon-Balboa and Cristobal-Colon districts, within whose limits the ports of Balboa and Cristobal are situated, are as nearly noninfectible as it is possible to make them. However, the threat continues and, as usually happens, infection may enter when least expected. Having in mind the experience had in California where the common ground squirrel (Citellus beecheyi) became infected with plague throughout an area of approximately 13,000 square miles, thereby constituting a very large endemic focus, from which plague has never been completely eradicated, it is believed that studies should be made of the jungle rats and rodents that are said to be plentiful in the environs of the cities of the Canal Zone and vicinity. The studies recommended should consist of: 1. Capture and identification of the various types and species of rats or other rodents. 2. Study and identification of the types of fleas and other blood-sucking insects that may infest them. 3. Susceptibility and immunity studies to determine their infectibility with plague. So far, two species of jungle rats have been identified, namely, Sigmodon hispidus chiriquensis and Proechimys semispinosus panamensis. No susceptibility, immunity, nor flea studies have been made of any of them. DISTRICT NURSE. The District Nurse assisted in the annual physical examination of school children, report of which is given below. Health scores placed

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25' in the schools two years ago have proven quite beneficial in securing correction of defects. The score of each pupil, with defects if any, is shown, and in most cases they are eager to have the defect corrected in order to secure a health button. When the entire room is free from defects, it is presented with a 5-pointed star and health alphabet. There is great rivalry between the various rooms to be the first to receive this poster. The white baby clinics continue to be well patronized. The colored clinic at La Boca has a fluctuating attendance, but the mothers seem to appreciate what is being done for them. PHYSICAL EXAMINATION OF SCHOOL CHILDREN. The physical examination of the white school children of the Canal Zone revealed correctable defects as follows: Number examined.----.------2,280 Diseases of the skin------_-------40 Number having defects----------854 Cardiac lesions ----------------28 Errors of refraction------------294 Suspicious pulmonary lesions. 56 Other diseases of the eye.--------38 Hypertrophied thyroid----------11 Diseased tonsils-_------_ -------289 Nervousness-.-.-----------------5 Carious teeth ----.----------345 Fever over 1000 F---------------21 Defective hearing---------------52 Abscess -----------------------2 V The white kindergarten children, and the colored school children of the Canal Zone were also examined. HEALTH OFFICE OF THE CITY OF PANAMA. Dr. HENRY GOLDTHWAITE, Health Officer. Infant Mortality.-The death rate of children under 1 year of age per 1,000 live births for the past 5 years has been: 1923 -------------------------------------------------------142 1924 -------------------------------------------------------138 1925 -------------------------------------------------------117 1926 -------------------------------------------------------144 1927 -------------------------------------------------------120 Tuberculosis.-There were 180 deaths from tuberculosis, making a rate of 3.02 per 1,000 population. The tuberculosis curve for the city of Panama fluctuates somewhat but will probably show no real improvement until such time as the present overcrowded condition of the poorer classes is overcome by better and more adequate housing.

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-A. 26 Communicable diseases .-The following number of cases were reported: Chickenpox---------------53 Mumps------.--------5 Diphtheria.------------------188 Pneumonia (deaths).,.-.-----------185 Dysentery, amebic.---.-------24 Tetanus.-.-.-.----------------------4 German measles---------------1 Tuberculosis (deaths).-.-.--------180 Hookworm--------------.-----394 Whooping cough.-.------------18 Leprosy.-------------------4 Trachoma.-------------.11 Measles-----------------------86 Typhoid fever.------------------11 Meningitis, tubercular-----------I When a case of diphtheria is reported cultures are taken from all contacts and sent to the Canal Zone Board of Health Laboratory. Two thousand four hundred seventy-nine cultures were examined; 44 of these proved positive. With the exception of tuberculosis and whooping cough, the majority of the contagious and infectious disease cases were sent to Santo Tomas Hospital. Vaccination.-There were 9,232 vaccinations made, and 810 vaccination certificates were issued. Most of the latter were for outgoing passengers on various steamship lines which will not issue a ticket to any Latin-American country without the production of a vaccination certificate issued by the Health Department. Building inspections.-There were 1,045 building permits issued, as follows: New buildings-----------------------------.------.------------------.81 Repairs and alteration, including ventilation and rat-proofing. ------------827 Miscellaneous ----------------------------------------------16 For installation of bars, fixturesand counters in business houses and rat-proofing thereof. -----.----------------------------------------------------121 When new buildings are erected, or old ones reconstructed, they are required to be made rat-proof and kept so. Fixtures must be so installed as to furnish no harboring places for rats. Incompetent and unreliable carpenters and contractors who, heretofore, worked without permits over holidays and week ends when there was no inspection, have been debarred, with the result that we now have a very good class of men doing small jobs and repair work and the property owners, too, are better satisfied. Milk and dairy inspections.-In the city and its environs there are 29 dairies with an average monthly production of 235,826 pounds of milk. Of these dairies, 22 have agreed to form a "central" and erect a modern pasteurizing plant on Sabanas Road. In the city 3 other dairies have already ordered modern pasteurizing plants which will be installed

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27 early in the coming year. The other 4 dairies will either install their own plants, or combine with others, or be made to go out of business. For the past several years one "central" has been handling milk from 17 dairies. The further concentration of the various plants will largely facilitate the handling of milk and its supervision. Two dairies were condemned during the year, and two closed voluntarily. All milk now sold in the city is pasteurized and that sold at retail is in sanitary bottles. The only bulk milk permitted to be sold hoes to Gorgas Hospital, to the Canal Zone restaurants, and to Colon by train for bottling. Approximately 200 bottles are sold daily to individuals living in the Canal Zone. Of 2,088 dairy cattle tested for tuberculosis 63 were condemned, of which 13 were slaughtered and 50 are yet at large in the vicinity of the city for the reason that the Panama Health Office has no authority to destroy them. Garbage disposal.-The garbage from the city of Panama, Ancon, Balboa, Fort Amador, and Quarry Heights is now disposed of at the old dump at Calidonia. This'dump is within a few hundred feet of a densely populated section of the city, but we have no complain Ls regarding either flies or odors. The use of heated fuel oil to spray the garbage and its earth covering for the prevention of flies continues to be satisfactory. During the year 114,578 cubic yards of garbage was collected and buried at an approximate cost of 55 cents per cubic yard. Manure and stable sweepings in the city of Panama are collected by the stable owners and carried to our manure pits located at Pena Prieta, just outside of the Santo Tomas Hospital grounds. These pits are of concrete with tile drainage, and as the manure and sweepings are received daily an earth cover is laid over them and heavily sprinkled with oil, which prevents any fly emergence. Veterinary work.-Thirteen thousand nine hundred and ninety-five cattle were slaughtered at the municipal abattoir, of which 35 were condemned as unfit for food on account of the following conditions: Tuberculosis, 8; congestion, 6; septicemia, 5; pneumonia, 5; contusions, 5; emaciation and exhaustion, 3; anthrax, 2; gangrenous wounds, 1. There were 14,770 hogs slaughtered at the municipal abattoir, of which 794 were condemned on account of the following conditions: Cysticercosis, 661; cholera, 96; exhaustion, 19; pneumonia, 14; icterus, 2; pyemia, 2. There were 6,963 cattle and 5,838 hogs inspected for shipment to the Atlantic side. Certificates were issued for 20,474 hides from animals which had been given anteand post-mortem inspection at the munic-

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28 ipal abattoir, and from animals slaughtered in the interior, these latter hides being disinfected under the supervision of our veterinarians. General work.--Eighty thousand and six house-to-house inspections were made by the several house gangs; 1,285 mosquito-breeding places were found and destroyed. A total of $649 in fines was collected for violations of the sanitary regulations. An extensive rat-poisoning campaign was undertaken in order to ascertain in a general way the rat content of the city. It was continued for four months. There were 8,051 rodents trapped, and 5,223 caught with poison baits during period September 8, 1927, to December 31, 1927. Of these, 6,387 were classified at the Board of Health Laboratory at Ancon as follows: Three thousand two hundred twenty Mus musculus, 36 Mus alexandrinus, 22 Mus norvegicus, and 3,109 Ms raltus. HEALTH OFFICE OF THE CITIES OF COLON AND CRISTOBAL. Dr. J. L. BYRD, Health Officer. Civic improvements --Among the civic improvements are the paving of Central Avenue and the extension of Central Parkway from 9th to 13th Streets, the building of a playground on the corner of 2d and Market Streets, the construction of a modern City Hall, and the paving of several short streets. A large number of modern apartments in the Santurce district have been constructed. A new commissary warehouse and bakery is under construction at Mount Hope. The demolition of dilapidated old houses along Bolivar Highway and the making of a park of this area has been a very decided improvement. About 150 new quarters for employees of The Panama Canal and Panama Railroad were constructed in New Cristobal. A new Panama Railroad4 roundhouse was also completed and occupied. Communicable diseases.--There were no epidemics and the general health conditions remained good. The following cases were recorded: Measles.-----------68 Chicken pox----------21 Mumps---.--------23 Leprosy------.-------1 Diphtheria-----------18 Trachoma-----------Whooping cough---------8 Scarlet fever---------3 Typhoid feverA2 There were 41 cases of malaria charged to this district as compared to 100 in 1926. The tuberculosis death rate remains about the same,

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29 being 2.53 per 1,000 of population for the year. No further improvement is likely until better facilities are provided for the hospitalization and treatment of all active cases. Five thousand three hundred and twenty-three persons were vaccinated against smallpox. Cristobal Woman's Club free clinic.-This prenatal, infant welfare, dental, and eye, ear, nose, and throat clinic is operated in Colon jointly by the Cristobal Woman's Club and the Health Department. The health officer is director of the clinic and the health department district nurse is in immediate charge. Feedings are provided daily for about 35 mothers and babies. Dr. DaCosta Gomez had charge of the prenatal and infant welfare work, Dr. Harry Eno was in charge of the eye, ear, nose, and throat cases, and Dr. H. A. Doten did the dental work. These physicians and dentist gave their services gratis. The following table gives the number of cases treated, including the furnishing of formulas for babies: Babies (children under 5 years) ------------------------------------12,119 Prenatal -------------------------------------------------------1289 Dental ---------------------------------------------------------66 Eye, ear, nose, and throat -----------------------------------------1312 Infant mortality.-The rate of 109 per 1,000 live births for Colon is the lowest recorded for this city. Constant effort is made through the free clinic and the district nurse to educate mothers with respect to the proper care of their babies. The following table shows the infant mortality rate for the past six years: 1922 ------------------------140 1925-------------------------117 1923 --------------------116 1926------------------------129 1924 ------------------------114 1927--------------------.--109 Building inspection.-Three hundred leases on Panama Railroad property expired. Before renewals were permitted the structures were given a thorough examination by our building inspector and the owner or lessees were required to make all repairs and alterations necessary for them to conform to the building regulations. The sanitary conditions in many of these buildings were greatly improved, especially regarding adequate light, ventilation, and rat-proofing. Garbage disposal.-The disposal of garbage by burial has proven very satisfactory. This system was inaugurated here February 8, 1927. Fly breeeding is controlled by the use of common fuel oil as at the Panama dump. This district is almost entirely free of flies. We are collecting and disposing of approximately 60 tons of garbage daily, ata cost of about $2 per ton.

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30 Mount Hope cemetery.-The cemetery was enlarged by the addition of approximately 20 acres on the southwest. A modern concrete speaker's stand for memorial services was constructed in the new section just south of the veterans' section. The old dilapidated storehouse was replaced by a new structure. Bakeries.-One bakery was condemned and closed permanently on account of unsanitary conditions of both building and equipment. Two were closed for necessary repairs to the buildings in order to comply with the bakery regulations; they were later reopened under greatly improved sanitary conditions. Many of the bakeries were required to replace their old rough corrugated iron walls with smooth concrete walls. Old unsanitary equipment was replaced with new equipment, and skylights were installed in several buildings to afford better light. There are 13 bakeries in Colon, all of which are inspected weekly. Restaurants.-All restaurants in Colon were required to install hot running water and large double sinks for washing and scalding dishes, cooking utensils, etc. This requirement met with practically no opposition. There are 108 restaurants, coffee shops, and hotels in Colon, and a large number of canteens. All restaurants are inspected at least once a week. Ice cream parlors.-There are 21 ice cream parlors in Colon. Some make their own ice cream and some purchase it from the Coca Cola Company. The new ice cream regulations have met with practically no opposition. Dairies.-There are two dairies located at the Panama Railroad stables, the Panama Canal dairy is at Mindi, and there are about 6 small dairies in and around Catival in the Republic of Panama. The dairy at Mindi and the dairies at the Panama Railroad stables are inspected at least once a week. Those at Catival are inspected only about once a month owing to their inaccessibility, the roads being practically impassable for vehicles during the greater part of the year. All milk sold in Colon is pasteurized and bottled before delivery. There are five pasteurization plants in Colon and Cristobal which are inspected once a week. Milk from the Mindi dairy may be classed as Grade A pasteurized, and milk from all others as Grade B pasteurized. Intradermal tuberculin testing was carried out on 574 dairy cattle. One reactor was detected and destroyed. Mount Hope abattoir.-Anteand post-mortem inspections were carried out on 5,339 cattle, of which 6 were condemned on account of the following conditions: Septic contamination, 2; extensive bruises,

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31 2; extreme emaciation, 1; dying condition, 1. Ten quarters were condemned on account of extensive bruises, and 468 parts (including livers, hearts, heads, etc.), were condemned. Two carcasses were detained 21 days on account of bovine cysticercosis. There were 381 hogs inspected, 26 being condemned on account of the following conditions: Cysticercosis, 21; pneumonia, 4; cholera, 1. Turtles to the number of 85 were inspected and none condemned. One hundred and fifty-six condemned Army mules and horses were inspected for tankage for fertilizer. Colon abattoir.-Anteand post-mortem inspections were carried out on 4,243 cattle, of which 15 were condemned on account of the following conditions: Extensive bruises, 10; pneumonia, 4; peritonitis, 1. Twelve quarters were condemned on account of abscesses, and 303 other parts were condemned on account of bruises, abscesses, etc. Beef to the amount of 10,879 pounds was condemned. There were 6,515 hogs inspected, of which 381 were condemned on account of the following conditions: Cysticercosis, 336; cholera, 32; empyema, 8; septic enteritis, 2; pneumonia, 1; extreme emaciation, 1; icterus, 1. Thirty-five goats were examined and none condemned. Veterinary quarantine inspections.-Inspections were made of 30 horses, 5,579 cattle (including 1,900 in transit), 19 hogs and 383 dogs. Goats, sheep, circus animals, etc., to the number of 90, were also inspected. General.-The Mount Hope cold storage plant receives daily inspections of milk bottling, ice cream manufacture, storage of meats, butter, eggs, vegetables, etc. Eight meat markets, including Cristobal commissary and Colon market, are also inspected daily. DIVISION OF QUARANTINE. Dr. JOHN D. LONG, Surgeon U. S. P. H. S., Chief Quarantine Officer. The Division of Quarantine continued to direct quarantine activities at Balboa and Cristobal. The staff of the two stations consists of eight medical officers, two quarantine inspectors, and 23 other employees. As. in the past, all vessels entering the ports, except those granted radio pratique, were visited by medical officers on duty at the respective .stations. Particular emphasis was laid on the inspection of vessels and personnel coming from plague-infected ports. Adequate measures were also taken to prevent the introduction of smallpox and leprosy. The introduction of the other quarantinable diseases was not considered imminent during the year, since no epidemics were present in any

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32 nearby countries. A strict inspection, however, has been maintained. All ships at docks are required to breast off four feet and to use rat guards on all lines. It was not necessary to hold a single vessel nor to detain any passengers in quarantine during the year on account of quarantinable disease. The Quarantine Division continues to exercise immigration functions and during the year detained 1,256 persons at the quarantine station on account of some infraction of the immigration laws. Of this number 1,146 were deported. The following table summarizes the activities of the Quarantine Division for the year: QUARANTINE TRANSACTIONS FOR 1927. Cristobal. Balboa. Total. Vessels inspected and passed .1,341 880 2,221 Vessels granted radio pratique (Army and Navy vessels). 178 97 275 Vessels visited and passed on certificates of masters. 2,729 2,157 4,886 Total vessels. .4,248 3,134 7,382 Supplementary inspection of vessels. 3,721 1,356 5,077 Vessels fumigated. 95 35 130 Box cars fumigated. ...8 52 60 Crew inspected and passed ..79,766 40,869 120,635 Crew passed by radio. .55,996 4,117 60,113 Crew passed on certificates of masters. ..150,177 101,145 251,322 Passengers inspected and passed. ...37,407 14,041 51,448 Passengers passed by radio. .11,119 19,517 30,636 Passengers passed on certificates of masters. .42,011 21,580 63,591 Total persons received. .376,476 201,269 577,745 Persons detained on account of immigration laws. ...246 1,010 1,256 Persons deported under immigration laws. 768 378 1,146 Persons vaccinated. ..271 271 ANCON HOSPITAL. (Capacity 800 patients.) Col. GEORGE M. EKWURZEL, Medical Corps, U. S. Army, Superintendent. Personnel.-Personnel has been increased as follows: (a) Two additional officers from fhe Medical Corps, U. S. Army; an officer of the Dental Corps, U. S. Army, to establish a dental clinic under the supervision of the medical service. (b) Nursing staff increased by 18 nurses. (c) A clerk was authorized for the office of the chief of the medical clinic; one for the eye and ear clinic, and one additional clerk in the Board of Health Laboratory.

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33 Equipment.-In August an electrocardiograph machine was received and put in operation by a competent electrocardiologist under the supervision of the chief of the medical service. Wards.-The hospital population increasing to about 500 patients, it was necessary to reopen ward 2, section "A," as a semiprivate ward to take all classes of white male patients desiring these facilities, and also ward 3, section "A." All white male eye, ear, nose, and throat cases and the overflow of white male medical cases were put in the latter ward. Improvements, maintenance, and repairs.-During the year there was the usual work of maintenance and repairs of hospital buildings and equipment. Much new work was undertaken and many articles of furniture and equipment manufactured. In sections "C," and "D," 16 single windows were cut in the front and 20 double and 1 single window were cut in the rear of the basement, to provide better light and more ventilation so as to permit the use of the former storeroom as a permanent file room. Seventy-five concrete slabs were made for use as bases for file cases. At the garage a shelter over gas pump was constructed, four lockers for use of chauffeurs, and a partition to convert one of the stalls into a room for repainting motor transportation. In the rear of the kitchen a rest house was constructed for silver employees. In the kitchen, ice cream freezing apparatus was installed, part of front block wall was removed and the screened openings so made were protected by an overhanging canopy roof. In section "B" the furniture and several private rooms were repainted. The entire section "C" was repainted. Section "D" was repainted, including the furniture, and the storeroom was transferred to the basement of this section. Section "I" was connected up with the hot water line from boiler room. Extensive general repairs were made on the refrigerating room and machinery of the Board of Health Laboratory. The crematory retorts were overhauled and repaired. Electrical ranges in the general kitchen were replaced by new ranges. A new planer was received and put into operation in the carpenter shp~. In the X-ray clinic alterations were made in the filing room to provide additional space for 14" x 17" films. Apparatus for drying films was manufactured and installed. All elevators in the hospitAl were overhauled. Surgical Clinici-There were 1,572 major operations, and 5,142 inr operations, including intravenous injections of arsphenamine. MR 12007-3

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A stillbirths. Medical clini.-Ther wee6,487 ae threat u h out-pain department; 441 duts vr vaccinated, with 99 konsdesu results, and 303 r reactions of vaccinia. Eye, ear, nosw, amd thrtclinc.-There aere 14,412 visits to th out-patient department; 2,276 operations were performed, and 1,29Q0 ref ractions were made. Radiographic clinfic.-There were 4,963 cases handled, for which 10,995 films of various sizes and 3,548 dental films were used; 1,t<6t fluoroscopic examinations were made. Radio-Therapeutic clinic.-Treatments were given to 1,049 hospital patients and 1,327 out-patients, as follows: Radium therapy, 195; X-ray therapy, 532; physio-therapy, 850; hydro-therapy, 575; phototherapy, 155; massage, 41; electric baking, 28. Nonresident patients.-Seven hundred and eight patients, hs residence was outside of the Canal Zone and the cities
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35 SURGIUCL CLINIC. ANNUAL REPORT OF OPERATIONS.-Continued. Number. Died. nary traot-Continued: e, single, cure. .27 eee, double, cure. 5 ..4 ......., ..4 tion of scrotum. 2 enteri. 324. ..18. pu c ur .............3 ... tu ... oto y. ..60. elr rapby. .18. section, abdominal., 5 1 frcep. 6 .Si.n.3. eorrhapby. .4. .rax:. 8. ra ofbreast. .2. E Vision of breast and axilla.4. ion of rib. d. 4 oroids. radical ur. ..1 in ano, excision of ..4. hyorrectomy .9. isatretching .2. Tyr .y.1. Operation for extensive injuries to soft parts.2. Plastic operation for congenital defects.5 1 Plastic operation for severe injury.I. Plastic operation for effects of disease.7. Skin graft. .1. Varicose veins, excision of.7. Laparotomy: For intestinal obstruction.3 1 Exploratory. .35 Gastro-enterostomy.6 Entero-enterostomy. ..5. Enterentoiny.,. Enterorrhaphy.5 I Appendectomy. 180 1 Appendectomy with local peritonitis. .17. Appendectomy with general peritonitis.6 1 Calcostom y ...2 Calostomy.2. Resection of rectum. 1. Chilecystotomy. ..4 C olecyststoiy. Cholecystectomy,. 25 1 Choledochectomy.3. Abscess of liver, Laparo-hepatotomy for.1. Spleenectomy Pan-hysterectomy.13. Supravaginal hysterectomy. ...98. erom omectomy. .25 ryomeetom y. pingostomy, single .11 alingostomy, double.2. orectomy. .11. 4000M.a' cy t o y. ......... o.y. .10 1 nsiour. .74. Operation for topiegestation.9 ta stab wund, abdomen. ..1 1 rfad gra 1t 0.zer, wtholosure of.,.2 1 Ca en om ....... aor.oeatos Var, t e s ..........8 .... Va io s. .........2,111 .1 Cir u a iin .............202 .... Ca t rs to s ........56 .... No am nb nsl. ........2,773 .... Totls .......,. 6,714 2a

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36 EYE, EAR, N E, AND THROAT SERVICE. REPORT OF OPERATIONS. Eye: Nose-Continued Ad"Ancment. 1 oy i e o Cataract extraction. linear. removay Cataract extraction, combined. SieChalazionrem va1. A2 Etm i~ i e .. Enucleatin. .rna~i pe. Foreign b4d, removal of. iordo in o .t Varyus o erayeonp .....atiuoin rs T .....1 Mioreropera .ti Ea: F ein b. ,. ..,. 1in ron toido roum .... SPlaic A Polyreova.t6 La eine operation. Vario other opera .... Minor ear operation.h Cautninrtion, Masatd eai on. ,. ..sim la a!0 --------Plastic. .......r N-.'" -s --Polypi,removal. .3 Seboaeous cyst,. .hand. Variouoth operations. 2 Minor ear operations.,.4 ocaiertio. r Nose: Cauterition. .39 Foreign ody, removal.529 N. plasti. .eis. .47 X-RAY ACLNIC. REPORT -F0P. AIOS Total number of cas,-s handled .4,6 aueo xmntosCninued: Nature of examinations: W J41.r.,. 94 Ankle. .94 124 Abdomen. 46 lg. 126 Chest. .1 .2 Folon .3 83 Dental. .& 7. Gaso-ite52na series.38 Elbow .3 56 PP .lm. 47 Femurn. r.71 ..114. 4 Fluoroscopy-. ..t,161 SI Uses. 221 Foo. .7. 4,184 Forearm.72 .2W 4 Foreign body. 19 .3 4 Gall bladder. ..169 E S .7 Gastro-intestinal series. 385 Gastric ...32 classdisetionase, ofused: Genito-urinary tract. .2,496 Hand.1 4,284 Hip .pati.n,.4 4215 Humerus ..3548 RADIO-THERAPY CLINIC. REPOT Hit 4PERAqW.4 Radium: Hydoat Hospital patients. .2" Out-oatientsc .30 Number of treatementsamnitr 18 ?""tetetsamnseed. ,6 Skn. rlsitpainW.2,. Classifications of diseases--CasetonfdiesMalignant .16 7p int -. --' -.20 Nonmalignant. 130 4 Roentgen therapy: Elect her b in. Hospital patients. 174H Out-patients 4.O. Number of treatments adnistered.:. 5,10 .rr, .14 malignant ..80 lassiation of disease Nonmaignant.323 Joints. Neurological .2 34 4cla: Ski.n .156 .0-spital Pat!"t. ..* 2 Tuberculosis. .o i 2 r. .2 umber of 0 Physit-therapy: EXtmi bkig Hospital patients I. 307 Hospital patienti. 16 Out-atients,. ...453 Hu-ainm. .........12 Numerof treitmente adinsrd. I,0 Number; ;44 Pram s. 604 Clawsifiation of diseasesClassification of dikeasesSkin. I. 323 joints. .1 9 Neurological. ., 274 Muscular. .,. .5 Other diseases .253 Neurolgcal.,. .1

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Corozal Hospital, for the insane. Front view of new concrete ward building occupied in 1927. Normal capacity 120 patients. Upper two floors used for disturbed female patients. Basement used for surgical dressing room and for occupational therapy, including mattress factory, broom factory, sewing department, carpentry department, weaving and basketry department, etc. Since photograph was taken covered corridors have been builtconnecting it with qther wards 4nd with new mess hall.

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4

PAGE 40

Corozal Hospital, ftor the insane. Rear view of new concrete ward building, occupied in 1927. The wings contain on second and third floors, 32 indivi lual ruorrs tor violent patients.

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44

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Corozal Hospital, for the insane. End view of new concrete kitchen-mess hall building, occupied in 1928. In the foreground is dining room for 170 female patients; it is equipped with a projection room and screen for a no\ ing picture apparatus. Central portion is for dining rooms for 160 male patients and for 40 colored attendants. At extreme end are dining rooms for nurses and other white bachelor employees and for chronics and cripples (not insane). At the back of the building are the semidetached kitchen, storerooms, refrigerating rooms, etc. In the basement are the carpenter and plumber's shop,;, refrigerating machinery, and storerooms.

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s e. .dx & 6

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REOUT OF OUT-PAT11ENT CLINICS. TMNew y PresripvAt, Las. Aases. tionL. edial liie ...., ..6,487 2,087 1,798 3,960 oln!., ................4,580 1,770 1,185 212 arcii.,. 14,412 .2,613 1,6303 1,830 o~erpycine. 3,962 484 170 61 Totls .....29,595 7,063 4,779 5,893 COROZAL HOSPITAL. (Capacity 600 patients.) C .C. C. OOM, MedAical Corps, U. S. Army, Superintendent. Purpoe.-This institution cares for the insane of the Canal Zone andofthe Repu~blic of Panama, being reimbursed for the latter cdass of ptets by the Republkcat the fixed rate of $0.75 per day. It also cares fo ain employees of th~e Canal Zone disabled by reason of injuries or hroicdtseases who desire to enter the institution. Repir ajd a1teratons.-The following buildings were painted by hospit artjsans: Interior and exterior of office, interior and exterior of ard"E," interior of ward "K," roof of the new boiler shed. Toilet faclitesfor white patients were added to ward "K," and bathroom wit sower and lavatory was installed. An additional toilet, shower bahwas~h basin, and sink were installed in the female nurses' quarters. Rouinepainting and repairs to woodwork, plumbing, steam line, e.,have been made by hospital artisans, with I he help of patients. Ne u4dings.-The new 2-story concrete ward for female patients wascomleted and first occupied on November 19, 1927. Workpon the ney cocrete kitchen and dining hail was practically completed at the endofthe year but it was not placed in use owing to necessity for slghlterations to the equipment of the dining halls. New equipment valedat $&,048.73 was installed in this building. Construction of a concrete foundation for four oil tanks of 65 bar~lscapacity each was begun on the hill in rear of dairy. These are tbecpnnected by a 4-inch pipe line with a new 15-horsepower boiler, wchwiUl furnish steam pressure sufficient to operate the new bottlewsing and sterilizing machine and pasteurizer. This change will eiiate the need for running steam through a long exposed pipe line frmthe main boiler, Tesand gardens.-The following plants and trees were set out with exelnt results, in addition to the yams, yucca, sweet potatoes, etc.,

PAGE 45

38 which are planted each season: One thousand one hundred thirtyfive banana, 350 plaintains, 200 papaya, 60 orange, and 300 pineapple. Insane patients.-The census on December 31, 1927, was 544, as compared with 480 at the end of the previous year. The number admitted was 245, as compared with 217 for 1926. There were 133 discharges and 44 deaths. There was one suicide, and no other deaths due to violence. Of the 133 released, 8 were considered as cured, 81 as improved, and 44 as unimproved; 53 of those released were repatriated. Fourteen patients were transferred to Ancon Hospital for surgical treatment; 10 of these were returned to Corozal; 3 died in Ancon Hospital, and 1 remained under treatment at Ancon Hospital at the end of the year. Of the admissions, 118 were cases paid for by the Government of Panama, and the remainder were Canal Zone charity and pri-. vate pay patients. Other inmates.-There were on December 31, 1927, 34 black and 4 white chronic medical and surgical patients (not insane), as compared with 35 black and 3 white of this class at the beginning of the year. Nine were admitted, 3 died, and 2 were discharged. Seven of these patients were transferred to Ancon Hospital for surgical treatment; 3 of these were returned to Corozal Hospital, 2 died in Ancon Hospital (also one who had been transferred to Ancon Hospital during the year 1926; two remained under treatment at Ancon Hospital at the end of the year. All those capable of working were encouraged to do so. Thirteen were carried on the pay rolls employed as broom and brush makers, bandage rollers, ward attendants, janitor, laborers, and helpers. They manufactured approximately 185 brooms per week, and several hundred scrub and wall brushes. In addition, there were employed by the farm and dairy at the close of the year, 30 cripples injured while in the employ of the Canal, who require no medical or surgical care. There was an increase of two in this class. Recreation.-Weekly picture shows and band concerts have 'been continued. The patients derive considerable pleasure from the moving pictures. A new moving picture machine was installed in the new dining hall replacing the old projector donated by the Bureau of Clubs and Playgrounds many years ago. During the dry season weekly picnics were held in a grove back of the hospital where lunches were: served and baseball, handball, and other sports were engaged in.I Treatment.-Intensive specific treatment was given to patients suffering from syphilitic psychoses, these being about 16 per cent of the total number of patients. Nine hundred and ninety-three doses of arsphenamin were administered intravenously, and 261 lumbar punctures were made.

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Oeup Mwal tkcrapy.-At the end of the year there were 15 male and 44 female patients under treatment in the occupational therapy department. The men. are taught carpentry, weaving, bag making, rush work, etc.; the women are taught to make rugs, and baskets, and to sew, knit, and do rush work. The articles produced and sold were: Two hundred thirty-five rugs, 349 bags, 186 ornamental baskets, 58 card table covers, doilies, and other embroidered pieces, 92 raffia purses, iand 382 pieces of furniture. In addition to the patients engaged in various lines of work in the occupational ward, other male insane who are strong physically but can not be accommodated in the occupational ward on account of limited space, are sent to the fields and employed in agricultural activities. The value of the produce taken from the patients' garden for hospital consumption amounted to $2,471.50. The more vigorous females were assigned to tasks in the laundry, sewing room, or in the salvage department. As a result of these various undertakings, between 75 and 80 per cent of the patients are engaged in some form of work. All of the laundering, with the exception of bed sheets, pillow cases, and nurses' uniforms, is done by the patients. The total sales from the occupational ward amounted to $2,266.44, P and from the brooms and brushes manufactured by the "chronics," $4,038.80, a total of $6,305.24. This money is utilized for material required to continue activities in these departments, and for tobacco, .confections, fruit, refreshments, etc., for the patients. Dairy and farm.-Fences were maintained in good state of repair; a great number of the wooden fence posts being replaced with a more permanent type of salvaged iron or steel obtained from the scrap yard. The 30 cripples are utilized in the garden, dairy, piggery, steam plant, and cemetery. Five are tending plots of land in the farm reservation, which they cultivate as truck gardens, and are paid on an actual production basis. Their average earnings per month amounted to $44.12, in addition to subsistence which is furnished them free of charge. The receipts for produce sold by the farm aggregated $3,659.83, and for manure $1,516.07. In September, work was started on alterations in the dairy building, tearing out the former small refrigerating chamber and replacing with twQ good-sized cold storage rooms for cooling the milk produced here. A concrete lined tunnel was excavated between the dairy barn and the dairy office to house the pipe lines, which will connect the new 4-ton kg machine with the cooling rooms and milk cooler. This ,together with a 15-horsepower boiler, a pasteurizer, and other airy equipment received, cost $4,436.93. When alterations are com4e

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A 40 pleted most of this equipment, which is now set up temporarily, will be permanently installed in a modern sanitary dairy room of concrete construction, with tile floor and walls. All this work was done under the supervision of Mr. J. J. Griffin, general mechanic at Ancon Hospital. In May, 15 additional Costa Rican cows were purchased. During the year 4 heifers calved and became milk producers. One cow died, I was condemned, and 5 were butchered. The herd consisted of 83 cows, 24 heifers, 14 calves, and 2 bulls. There were 124,242 quarts ofnmilk produced, and milk sales amounted to $27,678.37. There were 69 pigs, 23 hogs, and 2 boars on hand December 31, 1927. The piggery, although not as productive as the previous year, continued to be a profitable source of revenue, and the gross income'from this division of the farm amounted to $4,077.72. COLON HOSPITAL. (Capacity, 80 patients.) Maj. JOHN WALLACE, Medical Corps, U. S. Army, Superintendent. Purpose.-Colon Hospital is operated largely as an emergency hospital and dispensary for the benefit of the Atlantic side of the Isthmus. All classes of cases are treated in the hospital except severe factures of long bones, acute communicable diseases, venereal diseases, and children. Professional work.-There were 2,239 patients admitted to the hospital. There were 256 major and 636 minor operations performed. There were 1,012 administrations of arsphenamine. Three hundred forty-six pregnant women were delivered. The dispensary physicians made 285 house and ship calls and 46,102 patients visited the outpatient clinic. Personnel.-One nurse has been added to the personnel making a total of 13 nurses. Repairs and new equipment.-Practically all of the hospital furniture has been repaired and repainted. An electric operated ammonia refrigerating plant was installed in the kitchen replacing the ordinary refrigerator. A hot water system was installed which supplies hot water for the entire hospital and nurses' quarters. Two new DodgeGraham ambulances were purchased, replacing two old and dilapidated vehicles.

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41 PALO SECO LEPER COLONY. Mr. HENRY GARLAND, Superintendent. Dr. PHILLIP HORwITz, Attending Physician. Census.-On December 31, 1927, there were in the colony 103 patients, of whom 5 were white, 1 was a Chinese, and 97 were colored. Seventy-eight of these were from the Republic of Panama for whose care the Panamanian Government pays the Health Department at the rate of 75 cents each per day. The other 25 resided in Canal Zone territory at the time of their admission to the colony, or were employees of The Panama Canal, and the Health Department receives no compensation for their care. Seven new patients were admitted during the year, and 1 former patient was readmitted, making a total of eight admissions. Three of these were Panamanians, 4 were West Indians, and 1 was Chinese. Three of these new cases had leprosy of the nodular type and 4 of the mixed type. The readmitted case was a West Indian who had been paroled in 1920 as a noncontagious clinical nerve type, but who in the interim had acquired a superimposed cutaneous infection, placing him in the mixed type class. Mortality.-Four patients died during the year, the immediate causes of death being recorded as acute disseminated tuberculosis in 1 case, gangrene of the nose, mouth and face and arteriosclerosis in 1 case, and chronic nephritis in 2 cases, one of these having in addition pneumonia, pleurisy, pericarditis, and other diseases of the heart. Treatment.-The routine treatment with derivatives of chaulmoogra and allied oils by parenteral injections was continued as in previous years. As far as it was practical, patients were given the choice of taking their treatments by intravenous or intramuscular routes and they invariably showed marked preference for the intravenous route. Oral administration of fatty acids was applied to a small number of patients in whom treatment by injections was contraindicated. Chemical and electrical cautherization of leprous skin lesions was used with fair success., Local applications of "Superoxol," a preparation of 100 volumes per cent H202, to foul-smelling trophic and nodular ulcers rendered them clean and odorless. In the nodular ulcers, as well as in the shallow trophic ulcers, a 2 per cent tannic acid solution in sterile distilled water, sprayed on at intervals of 20 minutes until a crust formed covering the entire ulcerated area, resulted in the rapid formation of granulation tissue and prompt healing of ulcers due to nondular degeneration. In

PAGE 49

42 trophic ulcers healing was somewhat slower but did take place in instances where ulceration had existed for many years. In deep trophic ulcers all forms of treatment were followed by but little improvement although some benefit resulted from deep electrocauterization followed by applications of "Superoxol." Intranasal and intraocular applications of liquid petrolatum were continued as in previous years in cases of nasal occulsions and inflammatory leprous ocular conditions with excellent results. In many cases of ulcerations of the muccous membrane discharging lepra bacilli, applications of peroxide of hydrogen followed by installation of liquid petrolatum resulted in marked improvement and rapid diminution or organisms in the discharges and scraping; in a few cases, complete disappearance of bacilli after a few weeks treatment was noted. Weekly bacteriological examinations of scrapings from the skin and mucous membranes of patients who have shown marked clinical improvements were continued throughout the year for the purpose of presenting for parole such cases as have remained free from lepra bacilli for a period of two years. One case was paroled August 13, 1927, 34 repeated examinations during the preceding three years having been negative. A new kitchen and dining room, 36 feet by 93 feet, was started in August, 1927, and was practically completed at the end of the year. BOARD OF HEALTH LABORATORY. (Operated in connection with Ancon Hospital.) Dr. L. B. BATES, Chief of Laboratory. Bacillus typhosus.-Recovered in blood culture from 14 individuals and from stool specimens of 7 others. These latter were all in the last week of clinical typhoid fever. Of the 21 cases 6 were admitted to the hospital direct from passing ships; 6 came from the same section of Panama City and are believed to have been infected by a known carrier of B. typhosus; and 9 came from different parts of the Canal Zone and Republic of Panama and were apparently sporadic. The carrier had returned to Panama City after an absence of 13 months and engaged in preparing and selling foodstuffs without the knowledge of the Health Department. Typhoid carriers.-On December 31, 1926, there was one typhoid bacillus carrier under sanitary surveillance, H. B., a colored laborer living in Panama City. His stool specimens were examined at regular IDh

PAGE 50

intervals and found positive for B. typhosus on most occasions. G. H., Chinaman, a B. typhosus carrier, returned to Panama City after an absence of over a year and is believed to have caused the 6 cases of typhoid fever in Panama City, as mentioned above; his stool specimens are still occasionally positive for the bacillus. A. G., colored, age 54 years, was in Ancon Hospital from September 27, 1927, to October 10, 1927, with typhoid fever. When discharged his stools were still positive for B. typhosus and he was discharged as a B. typhosus carrier to return to his farm at Loma Bracho in the Canal Zone. These three B. typhosus carriers were still under sanitary surveillance on December 31, 1927. Oncoba echinata.-In December 260 pounds of seeds from the Gorli plant (Oncoba echinata) grown in Costa Rica, were received from the manager of the Costa Rica Division of the United Fruit Company. These seeds are said to yield an oil which contains a large proportion of chaulmoogric acid. It is planned to extract the oil from these seeds, prepare the ethyl esters of the fatty acids and use them in the treatment of leprosy here locally. The work being undertaken along this line is solely investigative. Reports.-Approximately 46,550 reports, not including duplicates, have been made. BACTERIOLOGICAL, PROTOZOAL, AND MISCELLANEOUS EXAMINATIONS. Blood cultures. ....233 Positive for B. typhosus. 16 Positive for Staphylococcus oureus ...6 Positive for Staphylococcus albu8 hemolytic .I Positive for Staphylococcus albus. .I Positive for Pneumococcus not typed. 2 Positive for Pneunococcus Type II. 2 Positive for Pncumococcus Type II atypical. 1 Positive for Pneumococcus Type III. 1 Stools cultured for typhoid-dysentery group. 1,439 Positive for B. typhosus .44 Positive for B. typhosus (from 1 carrier). .5 Positive for B. paratyphosus B. 1 Positive for B. dysenteriae, Mannite Fermenter, Group II. .34 Positive for B. dysenteriae, Mannite Fermenter, Group III. .2 Urines cultured for typhoid group. ...810 Positive for B. typhosus. .0 Urines cultured for organisms other than typhoid group. ..545 Positive for B. coli ...174 Positive for Staphylococcus albus. .61 Throat cultures for B. diphtheriae. .2,018 Positive for B. diphtheriae ....135 Nasal cultures for B. diphtheriae.,. 1,109 Positive for B. diphtheriae .13 Throat cultures for organisms other than B. diphtheriae. 7 Positive for Nonhemolytic Streptococci and Staphylococci. 1 Positive for Staphylococcus aureus, hemolytic.Spinal fluid cultures. 141 Positive for Meningococci. .14 Positive for Pneumococcus Type I. 1 Positive for Pneumococcus Type If, atypical. Positive for Streptococcus mucosus (Pncumococcus Type III). ..1 Positive for Pneumococcus Type IV. .1 Eye cultures ..9 Positive for Staphylococcu8 aureus Positive for B. pyocyaneus .1 Ear cultures ..............10 PositiveforStaphylococcusalbs. 2 Positive for B. pyocyaneus. .2 Positive for Pneumococcus. ...2 Nasopharyngeal cultures. .15 A 41 W

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42 trophic ulcers healing was somewhat slower but did take place in instances where ulceration had existed for many years. In deep trophic ulcers all forms of treatment were followed by but little improvement although some benefit resulted from deep electrocauterization followed -by applications of "Superoxol." 0J Intranasal and intraocular applications of liquid petrolatum were continued as in previous years in cases of nasal occulsions and inOREGON -flammatory leprous ocular conditions with excellent results. In many RULE cases of ulcerations of the muccous membrane discharging lepra bacilli, Co. applications of peroxide of hydrogen followed by installation of liquid 1 -petrolatum resulted in marked improvement and rapid diminution or organisms in the discharges and scraping; in a few cases, complete -disappearance of bacilli after a few weeks treatment was noted. Weekly bacteriological examinations of scrapings from the skin and U.S. A. mucous membranes of patients who have shown marked clinical improvements were continued throughout the year for the purpose of presenting for parole such cases as have remained free from lepra bacilli for a period of two years. One case was paroled August 13, -1927, 34 repeated examinations during the preceding three years having been negative. A new kitchen and dining room, 36 feet by 93 feet, was started in August, 1927, and was practically completed at the end of the year. BOARD OF HEALTH LABORATORY. (Operated in connection with Ancon Hospital.) Dr. L. B. BATES, Chief of Laboratory. Bacillus typhosus.-Recovered in blood culture from 14 individuals -and from stool specimens of 7 others. These latter were all in the last week of clinical typhoid fever. Of the 21 cases 6 were admitted to the hospital direct from passing ships; 6 came from the same section of Panama City and are believed to have been infected by a known carrier of B. typhosus; and 9 came from different parts of the Canal Zone and Republic of Panama and were apparently sporadic. The carrier had returned to Panama City after an absence of 13 months and engaged in preparing and selling foodstuffs without the knowledge of the Health Department. Typhoid carriers.-On December 31, 1926, there was one typhoid bacillus carrier under sanitary surveillance, H. B., a colored laborer living in Panama City. His stool specimens were examined at regular

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43 intervals and found positive for B. typhosus on most occasions. G. H., Chinaman, a B. typhosus carrier, returned to Panama City after an absence of over a year and is believed to have caused the 6 cases of typhoid fever in Panama City, as mentioned above; his stool specimens are still occasionally positive for the bacillus. A. G., colored, age 54 years, was in Ancon Hospital from September 27, 1927, to October 10, 1927, with typhoid fever. When discharged his stools were still positive for B. typhosus and he was discharged as a B. typhosus carrier to return to his farm at Loma Bracho in the Canal Zone. These threeB. typhosus carriers were still under sanitary surveillance on December 31, 1927. Oncoba echinata.-In December 260 pounds of seeds from the Gorli plant (Oncoba echinata) grown in Costa Rica, were received from the manager of the Costa Rica Division of the United Fruit Company. These seeds are said to yield an oil which contains a large proportion of chaulmoogric acid. It is planned to extract the oil from these seeds, prepare the ethyl esters of the fatty acids and use them in the treatment of leprosy here locally. The work being undertaken along this line is solely investigative. Reports.-Approximately 46,550 reports, not including duplicates, have been made. BACTERIOLOGICAL, PROTOZOAL, AND MISCELLANEOUS EXAMINATIONS. Blood cultures. ......233 Positive for B. typhosus ..16 Positive for Staphylococcus aureus ....6 Positive for Staphylococcus albus hemolytic ..1 Positive for Staphylococcus albu ......1 Positive for Pneumococcus not typed. .2 Positive for Pneumococcus Type If ...2 Positive for Pneumococcus Type II atypical ..1 Positive for Pneumococcus Type III. .1 Stools cultured for typhoid-dysentery group ..1,439 Positive for B. typhosus. .44 Positive for B. typhosus 'from I carrier),. .5 Positive for B. paratyphosus B. ..1 Positive for B. dyoenteriae, Mannite Fermenter, Group II. ...34 Positive for B. dysenteriae, Mannite Fermenter, Group III. 2 Urines cultured for typhoid group. ..810 Positive for B. typhoous. ..0 Urines cultured for organisms other than typhoid group. ...545 Positive for B. coli. .174 Pcsitive for Staphylococcus albums ...61 Throat cultures for B. diphtheriae. .2,018 Positive for B. diphtheriae ...135 Nasal cultures for B. diphtheriae. ...1,109 Positive for B. diphtheriae ....13 Throat cultures for organisms other than B. diphtheriae. ..7 Positive for Nonhemolytic Streptococci and Staphylococci. ...1 Positive for Staphylococcus aureus, hemolytic. Spinal fluid cultures. ..141 Positive for Meningococci ..14 Positive for Pneumococcus Type I. .1 Positive for Pneumococcu8 Type II, atypical. ...1 Positive for Streptococcus mucosus (Pneumococcus Type III). Positive for Pneumococcuo Type IV. ...1 Eye cultures ..., .9 Positive for Staphylococcus aureus. .1 Positive for B. pyocyaneus .. Ear cultures ..... Positive for Staphylococcus albus.2 Positive for B. pyocyaneus ...2 Positive for Pneumococcus ...2 h Nasopharyngeal cultures. ..15

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44 BACTERIOLOGICAL, PROTOZOAL, AND MISCELLANEOUS EXAMINATIONS-Continued. Sputum cu ltu re s .1. 113 Positive for Pneumococcus not typed.,., .-. .,. 8 Positive for Pneumococcus Type I. 1 Positive for Pneumococcus Type II., 7 Positive for Pneumococcus Type II, atypical. I Positive for Pneumococcu8 Type II .5 Positive for Pneumococcus Type IV. 11 Positive for Staphylococcus albus. .4 Positive for Streptococcus viridans. 4 Pleural fluid cultures. 41 Ascitic fluid cultures. 15 Knee fluid cultures. .15 Positive for Staphylococcus aureus. 2 Cultures from skin lesions. .5 Cultures of pus from various locations. .21 Culture of gall bladder contents. .5 Autopsies cultured. .,. 84 Organs, exudates, etc., from above autopsies. ..114 Surgical tissues cultured. .2 Darkfield examinations. 78 Positive for Treponema pallidum. 1. Darkfield examinations for yaws. .,., 3 Conjunctival smears. ..77 Positive for gram negative intracellular diplo.occi. .9 Throat smears. ..177 Positive for fusiform bacillus and spirilluim of Vincent's angina. ..52 Sputum for B. tuberculosis. 81 Positive for B. uberculosis. 23 Spinal fluid examined for B. tuberculos. 13 Positive for B. tuberculosis. 3 Urines for B. tuberculosis. 24 Urines for leptospira icterohemorrhagiae. 20 Urethral smears. .25 Positive for gram negative intracellular diplococci,. ..6 Vaginal sm ears. .10 Positive for gram negative intracellular diplococi .2 Smears for Leishman Donovan bodies., .2 Cell count of spinal fluids., .9 Leper suspects. ,. 17 Positive for B. leprae.,. 7 Lepers for parole. .2 Paroled leper ...1 Positive for B. leprae .I Autogenous vaccines prepared. .44 Feces for parasites and ova. .87 Positive for Ameba coli. ......1 Positive for Entameba histolytica. .7 Positive for Taenia saginata. ..1 Positive for Hymenolepis nana. .1 Positive for Uncinaria. 2 Positive for Trichuria trichiura. I Blood films for malarial parasites. .839 Positive for tertian malarial parasites. ..158 Positive for E. A. malarial parasites. 123 Positive for Quartan malarial parasites .5 Positive for malarial parasites, type undetermined. .I Red blood corpuscle counts. ..5 White blood corpuscle counts. .5 Differential counts. 6 Hemoglobin estimations. .....4 Blood platelet count .....1 Fragility test of blood. ...I Blood films positive for Filariai bancrofti ..-. Blood films positive for spirillum of relapsing fever. ...5 Bile cultures. .4 Stool for sprue. ....1 Paul test for smallpox .-. Tapeworm for identification. .I Sputum for guinea pig inoculation. Positive for acid fast bacilli. Water from Balboa clubhouse swimming pool ...300 Water from Army and Navy Y. M. C. A. swimming pool. .303' Water from Pedro Miguel swimming pool. ...36 Water from Fort Amador swimming pool. .41 Water from Corozal swimming pool. Water from Fort Amador beach. .9 Water from Fort Amador. .31 Water from Lyster bag. .4 Water from ships transiting the Canal. 211 Water samples from wells, springs, etc -.....45

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45 BACTERIOLOGICAL, PROTOZOAL, AND MISCELLANEOUS EXAMINATIONS-Continued. Foodstuffs examined: Ice cream cultured for bacteria count. 6 M ilk cultured for bacteria count. .294 Oysters cultured for bacteria count ....5 Canned milk (Camp Gaillard) to determine sterility. 2 "Soft drinks" (Health Office, Colon-Cristobal) for bacteria count and R. coli. 8 Culture of liverwurst, minced ham, veal chops. 1 Examination of peanut butter for B. bohdinus. I Examination of salad dressing for B. botdinua. ..1 Miscdianeous smears and examinations. 169 SEROLOGICAL EXAMINATIONS. Wasaermann tests. .15,915 Kahn tests. 2,256 Agglutination tests .....73 Positive with B. typho8us .....16 Examination of blood for coagulation time. .5 Blood typing for transfusion -.74 Gonococcus complement fixation tests .4 Blood sera prepared by Swift-Ellis method for intraspinal injection. ..4 Analysis of Wassermann reactions. Fifteen thousand two hundred and fifty-one Wassermann tests were performed on the blood of 11,482 persons. The results are summarized below: TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT BOARD OF HEATLH LABORATORY AND RESULTS OF TESTS, 1927. Individuals Individuals Total Per cent of Race, sex, and status. positive. negative. individuals individuals tested. positive. White, civil: M ales .192 1,619 1,811 1 .60 Femafes .51 646 697 7.32 Children. 4 29 33 12.12 Totals. 247 2,294 2,541 9.72 White, military and naval: Soldiers, Continental United States .199 2,342 2,541 7.83 Soldiers, Porto Rican. 43 160 203 21.18 Sailors, United States Navy. 53 360 413 12.83 Totals. 295 2,862 3,157 9.34 Black and Mulattoes: M ales. 761 2,146 2,907 26.17 Females. 486 2,094 2.580 18.83 Children. 18 206 224 8.03 Totals. 1,265 4,446 5,711 22.15 Chinese, males and females. 9 64 73 12.33 Grand totals. 1,816 9,660) 11,482 15.82 In addition, Wassermann tests were made on 664 spinal fluids taken from 488 individuals. One hundred and twenty-nine specimens from 118 patients (24 per cent of the individuals) were positive.

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F 46 PATHOLOGICAL EXAMINATIONS. Aulopsies.-Three hundred and fifty-eight autopsies were performed at the Board of Health Laboratory. The causes of death were as follows: Epidemic, endemic, and infectious diseases: Diseases of the circulatory system-ContinuedTyphoid fever. 2 Myocarditis, chronic. .8 Malaria, estivoautumnal. 8 Aneurysm of aorta. 5 Malaria, type undetermined. ...1 Coronary sclerosis .4 Blackwater fever (malarial fever, type undeArteriosclerosis. .3 term ined). .1 Bacillary dysentery. .3 Total. 39 Leprosy. 3 Meningococcus meningitis .10 Pulmonary tuberculosis. 22 Diseases of the respiratory system: Tuberculous meningitis. 2 Chronic ulcerative rhinitis, left (suppurative Acute general military tuberculosis ..3 sinusitis). Tertiary syphilis (one autopsy at Santo Tomas Bronchopneumonia. 13 Hospital). 12 Lobar pneumonia. 14 Cerebrospinal syphilis. 2 Abscesses of lung, multiple,. 2 Congenital syphilis. .2 Septicopyemia, (Staphylococcus aureus) .1 Total. ..30 General diseases not included in above class: Carcinoma of throat. ....1 Diseases of the digestive system: Carcinoma of stomach. 4 Peritonsillar abscess. 2 Carcinoma of liver (primary). 1 Perforating gastric ulcer. .....I Carcinoma of omentum, mesentery, and periDuodenal ulcer (resection of pylorus). ..I osteum. .1 Acute enteritis. I Carcinoma of cervix uteri ...3 Subacute ulcerative enterocolitis. .I Carcinoma of vagina. ..1 Cysticerus of brain (Taenia solium). .1 Carcinoma of breast with general metastases I Acute appendicitis. 2 Carcinoma of lung (primary). 2 Sudden death 13 hours after appendectomy, Diffuse primary sarcoma of spleen. 1 cause undetermined .I Carcinoma of the pancreas. 2 Volvulus of the intestine. .2 Carcinoma of urinary bladder .22 Carcinoma of prostate. 1 Cholelithiasis. 2 Carcinomatosis, general (primary pancreas). 1 Acute hemorrhagic pancreatitis. 1. Pellagra ..4 Rickets .Total. 17 Diabetes mellitus .5 Primary anemia. ...1 Acute lymphatic leukemia. .I Nonvenereal diseases of the genito-urinary system Chronic myelogenous leukemia .I and annexa: Chronic lead poisoning. 1 Acute nephritis .4 Hemorrhagic disease of newborn. ..3 Chronic nephritis. ....17 Chronic suppurative pyelonephritis, bilateral 10 Total. 110 Acute suppurative pyelonephritis. I Pyonephrolithiasis, bilateral. .1 Diseases of thenervous system and of the organs of Stricture of urethra (extravasation of urine). 4 special sense: Hypertrophy of prostate with urinary obstrucBrain abscess ...2 tion. 1 Streptococcus meningitis. 1 Pneumococcusmeningitis. 2 Total. 29 Leptomeningitis, acute. .1 Chronic nonsuppurative leptomeningitis. 1 The puerperal state: Cerebral hemorrhage. ..4 Ectopic pregnancy, tubal, with rupture of sac 1 Cerebral thrombosis. 1 Hyperemesis gravidarum. 1 General paralysis of the insane. 11 Rupture of uterus. 1 Toxic exhaustive psychosis. .Septic endometritis, puerperal Epileptic psychosis ..1 Eclampsia gravidarum. .1 Softening of the brain. .2 Postpartum eclampsia. 1 Tumor of the brain. .2 Toxemia of pregnancy. 2 Congenital disseminated gliosis of the brain (Tuberoussder sis). 1 Total. 8 Suppurative otitis media. Total. ...31 Diseases of the bones and of the organs of locomotion: Diseases of the circulatory system: Chronic suppurative osteomyelitis. : Chronic adhesive pericarditis .1 Acute suppurative periostitis, left femur. ...1 Acute bacterial endocarditis. 1 Acute pneumococcus arthritis, suppurative, Acute endocarditis, vegetative, pulmonary left knee. ..1 valve. .. Acute endopericarditis ...1 Total. .3 Acute myocarditis. 3 Angina pectoris ...1 Malformations: Chronic endocarditis, aortic valve. ..2 Patent ductus arteriosus. .1 Hypertropby and dilatation of heart (hyper-. tension). 9 Total. .1

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47 isesses of early infancy: Afteetions produced by external causes-Contd.: Malnutrition. ..4 Stab wound of adomen, penetrating, homiPremature birth. 4 cidal .. Injuryatbirth.z Multiple fractures of the base of skull. 1 Asphyxia neonatorum. 1 Fracture of nose with hemorrhage. Atelectasis of lungs. ..3 Fracture of skull (autopsy at Santo Tomas -Hospital). 1 Total. 13 Traumatism by falling body. 3 Foreign body trauma to soft tissues about Affections produced by external causes: pharynx and larynx with marked edema KkSuicide by drowning.1 olayx. .1 Accidental burns of skin by fire, second degree Suerfia wound ofleft hand (sepiceia) 1 Suicide by firearms. 1 Total .35 Veronal poisoning, accidental. ...' Acute poisoning by lye, accidental .1 Il-defined diseases: Arsphenamine poisoning. ..Undetermined. 10 Accidental burns, explosion of gasoline .I Acute infection of undetermined origin .2 Accidental drowning.C Accidental stab wound, right chest. I. 1 Total. 12 Accidental traumatism by fall .I. 1 Appendix: Accidental traumatism by crane. ..I Stillbirth (due to accident of pregnancy). 3 Accidental traumatism by automobile. .3 Stillbirth (due to accident of labor). 7 Accidental traumatism by aeroplane 1 Stillbirth (resulting from disease of mother). 1 Accidental crushing by falling tree. .1 Stillbirth (cause undetermined). .17 Kick by horse, causing rupture of liver. 1 Nonviable fetus., ..2 Electric shock .. Accidental homicide by shot gun. 1 Total. 30 Homicide by cutting left arm with knife with severe hemorrhage. 1 Grand total. 358 THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH LABORATORY, 1927. Per cent Cause of death. Cases. of autopsies. External causes. ..35 9.77 Pneumonia (broncho and lobar). .27 7.54 Syphilis including general paresi ). .23 6.42 T culosis (acute and chronic) ...22 6.14 Bright's disease (acute and chronic nephritis). 21 5.86 Cancer. 21 5.86 Organic heart disease (acute and chronic). ..19 5.30 Cerebral hemorrhage. 4 1.11 THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH LABORATORY, 1904 TO 1927. 020 Year. -4C CS 02, 6 1 1 ... N 1905. 269 60 9 27 3 8 5 3 9 .. 1906. ..509 191 22 50 24 23 39 15 33 ....2 197. 496 156 35 27 40 27 36 12 58 4 4 1 190&. 361 59 63 46 26 25 23 11 14 .7 2 E.1' 1909 .295 55 37 26 32 31 11 17 11 1 5 1910 .451 50 91 52 30 37 36 16 10 6 41 1911. 508 83 102 41 38 36 19 20 9 11 11 1912.*. 425 53 79 23 37 27 15 22 6 7 11 2 1913 .460 47 34 26 26 5 23 12 1914 .375 36 78 0 38 12 6 27 5 14 3 5 1915. 328 28 56 14 20 12 5 14 2 15 10 9 1916. 328 25 81 8 17 20 7 16 6 9 7 15 197. 330 24 51 5 21 23 3 is 1 3 5 12 198. 263 38 68 6 6 12 .2 8 .1 5 5 1919. 324 22 55 3 15 14 3 20 3 10 11 8 1920. 334 146 55 .7 29 11 5 16 ..6 15 1921. 289 14 37 4 16 5 8 17 2 4 7 20 1922. 262 14 29 5 19 9 4 9 3 6 10 14 1923. 205 6 17 5 9 9 5 12 2 1 11 14 1924. 263 14 33 3 29 10 4 21 1 3 13 12 1925. 306 36 34 7 38 11 3 18 1 3 16 17 1926. 282 14 32 5 32 9 2 11 .5 13 25 1927. 358 27 22 10 35 17 3 19 2 1 21 23 T99.32 22 55 392 588 414 250 362 183 127 196 211 1921w. 802 147 37 4, 16( 517 2 4 72 shis inohide 32 came of influenza. 12. 22 12E9 9 31193. 25 61k,995 1 11

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48 NUMBER OF AUTOPSIES PERFORMED REVEALING THE FOLLOWING DISEASES PER YEA R AT BOARD OF HEALTH LABORATORY, 1904 TO 1927. Year. 9 7 ..................4O F .......L A O A O Y 1 9 2 T 1 7 .......N. 19 1 ..........4 0 .....2 3 ...... 1904. 6 2 31 .21. 1905.2 3. 2. 3.1 1906.530 ..I2. 1907.496 .2 .3. 1909. 3641 ...3. 1920. 3 .............i. ...... 1921.4 s. 29. ...2 1911. 22.50. 13. 192.4205 ~. .1 .. 1914.4263.2. 1914. 375. ..2. 1917.30. .1 2 .. 1918.23.8. 1921.8. 23 19 s A.s.r.d.20se. .1. or. 76 ReNetwr utp d 1924.irsfon a atos. .2. 1925i. a atps (ass. .5 1926.n.y.cas). ...4 B1927.y.ys.u. tsy. Pnescent atosiesFoud hundredy.-d evety-onaes bodtie (not inudping 4disntered)astrog the laboratory4ere, ofshiced 358, or 76 prasentswer athero aasiedws AsI aria .autpaz. rcu.92 Uncpiai f.,(ces. royoe.52 ormoreparaitfestors theirreda as follows: Ascaris and uncinaria. ...1 Ascaris and trichuris. .B CAUSES OF DEATH FOUND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH LABORATORY, 1q27. Autopay Cause of death. Contributory cause. 7772 Leprosy. ......Acute disseminated tuberculosis. 7852 Leprosy. ........Chronic nephritis; lobar pneumonia. 7956 Leprosy ........Phagendic ulceration of mouth, nose and face; ar teriosclerosis.

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49 MICROSCOPIC EXAMINATIONS AND REPORTS ON SURGICAL SPECIMENS. $rain, tumor of. ..1 Uterine cervix or specimens from.32 Eye, enucleated .7 Uterine contents (fetus and placenta). 20 Eye. specimen from. .1 Uterus, ruptured right cornual pregnancy, fibroi 2 Eyelid, specimens from. .2 tumor, left ovary. 1 Nose, specimens from .10 Tube or tubes. 7 Ear, specimen. 1 Tube or tubes with ovary or ovaries. 15 ia specimens from. 2 Tube or tubes, ovary and appendix. 6 Muth, specimens from. 5 Tube or tubes with other specimens. 4 tumor of.1 Ovary or ovaries and specimens from same. 9 Tongue, specimens from.4 Ovary and appendix. 1 Mandible, section from. ..2 External female genitalia, specimen from.2 Throat, specimens from. 4uodendix l85 Tumor submaxillary region .e.18 Parotid gland, specimens from. 4 Stomach, resection of ulcer and appendix. 1 Pyloric end of stomach .1I Tonsil. .3 Tonsil,pairs. 10 Sigmoid colon, resection of. 1 Larynx, specimens from. ...7 Rectum, specimens from. 4 Neck, specimens from. 2 Anus and anal region, specimens from. .7 Thyroid gland, or part thereof. 11 Upper extremity, amputation. 1 Breasts. .18 Lower extremity, amputation. 8 Breast, specimens from. 9 Shoulder, cyst of. I Gall bladder. .30 Tumor of right arm. I Liver, specimen from. 1 Skin and subcutaneous tissues, specimens from 32 Spleen. .1 Bone, specimens from .10 Kidneys. .3 Tendon, excision of tumor of. 1 Testicle. .4 Lymph nodes, excision of. 17 Epididymis, specimen from. 2 Axillary tumor. .1 Prepuce. .1 Abdominal pregnancy, fetus and placenta.1 Uterus. .12 Autopsy tissues (from other hospitals) (33 tissues) Uterus and adnexa. .89 sets. .13 Uterus adnexa, and appendices. .41 Uterus, specimens from (including curettings). 16 Total. 695 Lesions in surgical specimens.-The principal lesions encountered in surgical specimens other than inflammatory, were as follows: Malignant tumors (cancer): Benign tumors-Continued: Brain. I Dermoids of ovary. 4 Eye. 1 Cystadenoma of ovary. 2 Nose. .Teratoma of ovary. 1 M outh. 1 Ovarian cyst. 1 Palate, ....I Papilloma of skin. 13 Nasopharynx. I Epidermoid cyst df back.1. Larynx. Breast. 12 Ganglion of tendon sheath. 1 Liver. I Giant cell tumor (femur). I Kidney, right. 1 Nevus (mole). 5 Uterus. .2 Multilocular cystic tumor of maxillary bone. 1 Cervix. ..14 Simple cyst of cerfical region, origin undeterOvary. .3 mined. 1 Vulva1 Chrondroma. 1 Colon. 1 Condyloma. .:. 1 Rectum. Dermoid (Pilonidal sinus). 1 Stomach. 3 Dermoid cyst. I Arm ..I Exostosis. 1 Skin. .3 Fibroma. 4 Lymph nodes.2 Fibrolipoma. 3 Adenocarcinoma (origin undetermined) 1.-. I Fibro-angio-endothelioma. .I Granuloma of pharynx. I Total. 54 Lipom a. 2 Osteoma. 1 Benign tumors: Cyst of eyelid ..1 Total. 134 Papillomata, nose. 2 Nasal polyp .Specimens showing tuberculosis: Fibromaof lip. .1 Fallopian tube. 3 Papilloma of tongue. 1 Fistula in ano. 1 Papillomata, throat. 1 Lymph nodes. .6 Mixed tumor of parotid gland. 2 Meninges and brain. I -Papillomata, larynx 2 Sinus, maxillary region. 1 Multiple adenomata of thyroid gland. Sinus, perineal,. 1 Fibroadenoma of breast. 4 Skin. 1 Intracanalicular. 1 Tonsil, pairs. 2 Cystadenoma of breast. 4 Myomata of uterus. .58 Total. 16 MR 12007-4

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50 Other infrequent lesions encountered: Autopsies: Thyroglossalfistula. 1 Chicken Endometriosis, peritoneal. ..1 Dog Splenic anemia (splenectomy). 1 Fish. .1 Amebic ulceration of intestine. 2 Guinea pigs. 278 Ectopie pregnancy. ..2 Positive for B. tuberculoaia (inocuAbdominal pregnancy (31 months) ...lated with sputum).2 M ule .I Total. ..3 Miscellaneous human examinations: Total. 288 Placentae (1 positive for malarial parasites). 359 Histological examinations: Total. .Dog's brain for rabies. 1 o l. 3Autopsy tissue from cow. 1 Tissue from rat. .2 Tissues from horse. .6 WILD AND DOMESTIC ANIMALS. Total. 10 Bacteriological: Miscellaneous examinations: Culture of cattle spleen. 1 Blood films examined from horses. .24 Positive for B. anthracis. 1 Positive for Trypanoooma hippicum I Cultures of guinea pigs' spleens .256 Positive for Piroplasma cabal. .1 Positive for B. paratyphoou8 B. 205 Positive for Piroplaama equi. 1 Culture of ear from steer. 1 Culture of lung from steer. 1 Total. 24 Culture of pus from testicle of rabbit. I Blood culture, cow. 1 Rodents examined: Dog's stool examined for intestinal parasites. I Mus musculus. ...3,658 Guinea pigs inoculations. 4 Musalexandrinus. 69 White mice inoculations. 6 Mus norwegicua. 120 Positive for Pneumococci. 6 Mus rattus. 4,008 Total. 272 Total. 7,850 MICROSCOPIC SLIDES PREPARED. Surgical preparations (3 frozen). .1 ,948 Autopsy preparations (4 frozen). 3,877 Animal preparations. 82 T otal. ..5,907 PHOTOGRAPHS. Taken at Board of Health Laboratory. S Of lepers (taken at Palo Seco by Dr. Philip Horwitz). 48 Lantern slides prepared. .6 Total. .62 CHEMICAL ANALYSES AND EXAMINATIONS. A cid, crude carbolic. 2 Alcohol.I Alcohol-gas m ixture. .1 B everages ..22 Beer, alcohol determ inations. 4 Refresco, saccharine determinations. 8 Soda water, saccharine determinaqions. 10 Blood. ..2,400 Nonprotein nitrogen determinations. 1,608 Urea nitrogen determinations. 897 Uric acid determinations. .549 Creatinin determ inations. 1,085 Glucose determ inations. ..2,214 Calcium determ inations.,. 32 Carbon dioxide determinations. .23 Cholesterol determ inations. I Sodium chloride determinations. 13 Phosphorus determ inations. 7 Blood, occult, on knife. .1 Calculus, biliary. .1 Calculus, urinary. 1 Calibration of sphygmomanometers. 5 Chlorinated lim e. ..A C oal. ..6

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51 Foodstuffs ..316 B utter. ...3 Cod liver oil emulsions. 2 Condensed cream .1 Cream ..4 Flour. I Ice cream .96 Milk, dairy. 172 Milk, evaporated. 1 M ilk, mothers'. 30 Milk, for preservatives.,. .I M ilk, for sediment. 1 Oleomargarine. 1 Sugar cane. .I Sugar cane juice. 2 G astric ..628 G rass feed. .1 Protein silver. 1 R ocks, for sulphur.,. 2 Spinal fluids. 593 Collodial gold tests ..556 Ammnium sulphate test. 544 H: Phenol tests. ...544 Glucose determinations. 3 Stool, for m ercuric chloride. 1 Substances for identification. .56 C antharides ...,. 1 Cocaine. 48 Flashlight powder. 1 Lim e. 1 Narcotic, suspected. 1 opium .4 Toxicological. 7 Blood (negative for cyanides).1 Brain and liver (positive for lead).1 Liquid (positive for mercury). .1 Liver for alkaloids (negative for alkaloids). Stomach contents of mule (negative for alkaloids). 1 Stomach, for cyanides (negative) .I Stomach contents, urine, kidney, and brain (positive for veronal) .1 U rine. 125 Arsenic determinations. 2 Fat determinations. 1 Glucose determinations. .8 Lead determinations. 12 Routine analyses. 100 Urea determinations. .1 Uric acid determinations. 1 W ater, chloride determinations. 1 Alcohol, 95 per cent, recovered, liters. 290 Aniline, recovered, c. .1,000 Ethyl esters of chaulmoogric acid, prepared, liters. 41t UNDERTAKING DEPARTMENT. Bodies received (4 disinterred). .471 Bodies em balm ed. .106 Bodies cremated (1 disinterred). 124 Bodies buried on Isthmus. .266 Bodies shipped from Isthmus (2 disinterred). 78 A Faa

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GENERAL TABLES. TABLE I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES FOR EMPLOYEES. ABSOLUTE NUMBERS. Discharges from hospitals. Deaths. C.3 Year 1927: White. 3,197 734 668 66 25 19 6 17,959 49.20 Black. 10,364 1,248 '989 259 97 87 10 50,393 138.05 Totals .13,561 1,982 1,657 325 122 106 16 68,352 187.25 Year 1926: White. 3,121 729 673 56 25 18 7 16,488 45.17 Black. 9,611 1,066 897 169 90 77 13 39,6QP 108.60 Totals. .12,732 1,795 1,570. 225 115 95 20 56,128 153.77T ANNUAL RATE PER 1,000 EMPLOYEES. Year 1927: White. .229.59 208.95 20.64 7.82 5.94 1.88 .15.39 Black. 120.42 95.42 24.99 9.36 8.39 .96 .133.32 Totals. .146.15 122.19 23.97 9.00 7.82 1.18 .13.81 Year 1926: White. .233.58 215.64 17.94 8.00 5.76 2.24 ..14.47 Black. .110.41 93.33 17.58 9.36 8.01 1.35 .11.30 Totals. 140.98 123.31 17.67 9.03 7.46 1.57 .12.08 52

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'Age (in years). Length of ridence on Isthmus (in years). Tuberculosisoftherespiratorysystem 9 1 8 1 1 1 4 1 1 ....4 1 4 Disseminated tuberculosis, acute .2 2 ..2 .., 1 Tertiary syph iis ...9. 9 .1 1 2 2 1 .4 2 3 Cerebrospinal syphilis. .1 1 ...1 Cancer and other malignant tumors ofstomach and liver .2 1 1. 11. ......2 Cancer and other malignant tumors of peritoneum, intestines, and rectum. 1. ......1. Cancer and other malignant tumors ofotherorunspecifiedorgans. 5 2 31 1 1 1 1 ..3 2 Diabetesmellitus. 2 1 1 ..............1 Chronic lead poisoning .I. .....1 ....1 Simplemeningitis. 1 .1. .... Cerebralhemorrhage. 4 4 ..1 2 ...I. .....1. .3 Cerebral embolism and thrombosis. .2 1 1 ...1 1. ...I. General paralysis of the insane .3 .3 1 2 .2 1 Pericarditis. .1 1 ...1 .......1. Angina pectoris. .1 1 .I. Organic diseases of the heart .14 2 12 1 1 2 2 1 5 2 .1 1 5 7 Aneurysm. ..2 2. ..1 1 .1 1 Arteriosclerosis ..3 2 1 .1 2 ..1 2. Lobar pneumonia. 4 4 1 1 1 I .2 1 1 Ulcer of the stomach .3 3. 3 ..1 2 Chronic gastritis. .I. I~ I .....1 ........I. Enteritis. .1 1. ....1. ... Cestodes. 1 ....I Acute appendicitis. .1 1 ..........1. .1 Intestinal obstruction. 2 2 1 1 .. Cirrhosis of the liver (not alcoholic). 1 1 .1. .._. Peritonitis without specified cause 1 1 1. ...... Chronic nephritis .16 1 15 2 5 2 4 1 2 ..1 4 5 6 Pyonephritis. ..1 .1 ........1 Stricture of urethra ..5 5 1 1 2 1 ....1 .2 2 Hypertrophy of the prostate .1 1 ..... Gangrene. .1 .....I Osteomyelitis. .2 2 1 1 .1 1. Suicide by hanging ...1I. ......I. ....1. Accidental poisoning .I 1 1 Accidental burns. ..1 1. .I. ......1. Accidental drowning .3 1 2 2 .2. 1 ..2 Accidental traumatism by fall .4 1 3 1 1. ......2 1 Accidental traumatism by machines 1 1. ...... Railroad accident. 1 1 ....... Automobile accident .1 1 ........1 Landslide. .1. 1 .I .......... Accidental electric shock 1 1 Homicide by cutting or piercing instrument. .1 1 ....1. Cause of dea i-dene. ..... Injury by animal.1 1. ......... Total .122 25 97 2 7 6 11 22 18 23 9 18 4 2 .3 21 45 4 48

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54 TLstv III.-DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Deaths. Annual rate per 1,000 Pdpulapopulation. Place. tion. ExternalExternal Total. Disease. caus. Total. Disease. 'cau Year 1927: Panama. 59,635 1,248 1,201 47 20.93 20.14 .79 Colon. 31,583 423 404 19 13.39 12.79 .0 CanalZone. 36,794 298 265 33 8.10 7.20 .90 Totals. 128,012 1,969 1,870 99 15.38 14.61 .7 Year 1926: Panama. 59,635 1,188 1,152 36 19.92 19.32 Colon. 31,285 452 427 25 14.45 13.65 CanalZone. 36,480 284 245 39 7.79 6.72 1.97 Totals. 127,400 1,924 1,824 100 15.10 14.32 .78 4

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4.4 44

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TABLE IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1927. Sex. Color. Age (in years). Place of residence. Total Cause of death. deaths. Under Age Pan Canal 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 Epidemic, endemic, and infectious diseases. Typhoid fever .1 .1 .1. .... Malaria,estivoautumnal. .10 6 4 3 7 2. 4 2 .. Malaria, tertian. I I. .I .1 ......2 Malaria,typeundetermied .2 .2 .2 ...2 .... Malaria, clinical e. ..I I .2 ............ Hemoglobinuria, malarial. ......I .. Measles. .m. a. ..3 2 1 .3 .1 1 1 ....2 1.1 Whooping cough. ..1 .2 1 .I.1 1 ........ Diphtheria. 8 4 4. 8.2 5. .....8. Dysentery, amebic. .6 3 3 2 4 .2 .2 ..1 1 .5 1. Dysentery, bacillary. 2 1 1 .2 -. .......,. I Leprosy. .4 3 1 ..4 ....I ...__. ...4 Meningoooccusmeningitis .7 7 .5 2 .1 .4 2 .....25 Tetanus. .....2 2 .2 .........2 Tuberculosis of the respiratory system. 253 151 102 25 216 12 .10. .3 30 83 57 40 13 10 6 1 165 73.j5 Tuberculosis of the meninges and central nervous system. .5 2 3 1 4 .1 1 2 1 ...3 1 1 Tuberculosis of theintestines and peritoneum. 7 4 3 .7 .1 1. 1 2 .1 1 .4 3 Tuberculosis of the vertebral column .1 1 ....1 .. Tuberculosisofthelymphatiesystem. 2 1 1 1 1 ..1. .1 ...1 Acutedisseminated tuberculosis. .5 4 1 5 1 .....1 2 .1 .2 2 1 Chronic or unspecified disseminated tuberculosis. 5 2 3 1 4 1 2 1 ..1 ... Tertiarysyphilis. ..54 47 7 2 52 1. ..i8 17 7 1 35 9 10 Cerebrospinalsyphilis .4 1 3 1 3 ....1 1. .1 3 Hereditarysyphilis .16 11 5 16 4 1 2 1 .1 7 ..9 2 5 Other forms of syphilis ...I. ..1 ......1. 1. Gonococeiourethritis. .I ..1. .1 ..1. ....1. Other gonococic infection. .1 ..I. 1. ...1 ..1. .. Septicemia. 9 4 5 3 6. 3 1 ...2 .8 1. General diseases not included in the above class. Cancer and other malignant tumors of the bucoal cavity. .6 4 2 1 4 1 ....2 1. 1 2 .3 3. Cancer ad other malignant tumors of the stomach andliver. .33 23 10 4 29 ...1 .4 6 9 12 1 .24 6 3 Cancer and other malignant tumors of the peritoneum, intestines, and rectum.:. ..5 1 4 3 2 .1 .3 1 ..3 2 Cabber and other malignant tumors of the female geni r. ...22 22 .22 ...,. .4 4 9 3 1 1 .17 4 1 aer and tnttumoruthe breat. 5. 5 2 3 .2 2 .1. 1 3 1 rd t S tk. 1 .1 ..1. .I E j

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Pk -Aa A nr and either malignant tumors of other or unpeIfiern g. ..23 12 11 5 18 ..I .2 2 5 7 6 .7 10 6 Aouterheumatiefever .3 2 1 3 ..2 1 3 Pellagra. .15 4 11 .15 ..1 5 3' 1 4 1 .7 6 2 beriberi. ..1 .11. .......1 1Rikets.1. ........1 iabete litus. 5 6 2 9 ....3 5 2 1 3 3 5 Periciouaneia. 1. ..1. .... Other anemias and chorosis. ..........1 Exophthalmic goiter. 1. 1 1 ......I. .... Diseases of the parathyroid glands 1 1 ..' I ......I Dieasesofthethymusgland .5 2 3 .5. 2 .3 .....4 .I Diseasesof thespleen. ..1 1. .1. ..1. .1 Leukemia. .3 1 2 3 1 .1. ..2 I Chronic lead poisoning. .I ........... Other general diseases. .6 5 1 .6 .6. ........5 1. Diseases of the nervous system and of the organs of special sense. Encephalitis. 2 1 1 1 1 ..,. ..2 ..-..1 Simplemeningitis ..13 8 5 3 10 ....3 2 1 1 1 ..7 3 3 Nonepidemic cerebrospinal meningitis. ..1 ......,. .1 .1 Cerebral hemorrhage. .57 27 30 9 48 3 1 .1 2 8 15 9 11 6 1 35 17 5 Cerebral embolism and thrombosis.1 1. .1 ..1.1 Hemiplegia 5 .5 .5 ....1 1 3 .4 1 *Generalparalysisoftheinsane 12 11 1 1 10 1 ....2 6 3 1 .3 1 8 Toxic psychosis. ..I .1 .......1 ....1 I Epilepsy. ..5 3 2 5. ..1 2 ..2 .2 2 1 Infantile convulsions (under 5 years of age) 2 .2 2 .2 ........2 Softening of the brain. ..3 1 2 .3 .3. ..1 1 1 Tumor of the brain. .2 2 1. ..2 .....I Other diseases of the nervous system .3 1 2 2 1 .....1 1. ..2 I Diseasesoftheear. ..6 1 .6. .1 I .1 .3. .4 2. Diseases of the mastoid process .2 1 1 .1 1 ...2 Diseases of the circulatory system. Pericarditis. ..3 ........1 2 .,. .2 Acute endocarditis .15 1 31 2 4 2 2. 2 ...11 3 1 Acute myocarditis .10 6 4 1 8 1 .2 3 1 2 1 1. .3 3 4 Anginapectoris. ..6 5 1 2 4 .I ....1 1 1 2 ..2 1 3 Other diseases of the heart. .145 90 55 25 120 .3 .3 4 11 21 27 31 29 15 1 107 21 17 Aneurysm. .5 3 2 ...1 2 1 1 ..-. 3 1 1 Arteriosclerosis .24 15 9 8 16 ......1 4 9 10 .16 2 6 Other diseasesof the arteries .2 1 1 .2 ........I I ...I. 1 Thrombosis. ..1. 1. ............ Diseases of the respiratory system. Disease of the nasal fossae ....1 1. .1 ...........1 Acute bronchitis. .22 9 13 4 18 .13 5 2 ....1 .1 .14 7 1 Chronic bronchitis,.2 1 1.,. .2 .1 ..1. ......2. Bronchitis unspecified (under 5 years of age) .4 3 1 1 3 .2 2 ., ........,. 3 1 Bronehopneumonia. ..169 80 89 13 155 1 64 64 8 6 3 5 7 5 4 2 1 137 22 10

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TADLI IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1927.-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 Disease of the respiratory syatem.-Continued. Capillary bronchitis. 5 1 4 1 4 .,. 3 1 ....4 1. Lobar pneumonia. .57 41 16 4 53 4 5 2 7 7.j3. ..5 6 .30 13 14 Pneumoniaunspecified. 19 11 8 3 15 1 4 3 ...4 .3 3 2. 16 3 Pleurisy .4 4 ..4 ..1 1 .1. ..1 3 Empyema. .5 4 1 1 4 ..2 1 1 1 ...2 2 1 Congestion and hemorrhagic infaret of the lung. 7 3 4 2 5 .,. 2 1 .....2 1 .4 2 1 Gangreneofthelung. ..4 4 ..4 -. ...1 ...1 .I 1 ...3 .1 Asthma. .9 6 3 .9 .1 1 .1 1 4 1 ..9. Other diseases of the respiratory system. .3 2 1 1 2 ......1.1. 1 1 1 Diseases of the digestive system. Diseasesof themouthand annexa. .3 1 2 2 1 .., .1 ...2 ....2. ..2 Ulcer of thestomach. .10 8 2 5 5 .....1 .4 2 3 ..t 4 1 5 Ulceroftheduodenum. 3 1 2 .3 .-..2 1. Gastrectasis. ..I 1.1. .......... Acutegastritis.,. 12 6 6 2 10 .7 3 .....11 1. Chronic gastritis. 1 1 ..1 ......1. .....1 Acuteindigestion. .111. .......1. Enteritis, colitis, or entero-colitis (under 2 years of age),.:. ......129 70 59 7 121 1 108 21 ..........., .103 17 9 Intestinal autointoxication (under 2 years of age). 1 1. ...I. ...1. .....I Enteritis, colitis,orentero-colitis(2yearsand over). 28 11 17 1 27 ..9 2 3 2 2 2 4 3 1 .18 9 1 Intestinal autointoxication (2 years and over). ..1 1 ...1. ....1 .1 Ankylostomiasis. ..1 I1. I .....1 .....1. Cestodes (hydatids of the river excepted). ..I ...........1 Acuteappendicitis. 10 10 7 3 ..1 1 '3 3 2 ....4 3 3 Chronic appendicitis. 1 1 1 ....1 ...I H ernia. .2 1 1 2 ......I .1 ....I Intestinalobstruction. 11 65 3 8 ...2 5 1 2 .9 .1 Other diseases of theintestines. 3 2 1 .3 ....,.1.1 1 ..1 2. Acute yellow atrophy of the liver. 1 .1 .1 ....I. ..1 Cirrhosis of the liver specified as alcoholic. 3 2 1 3 .....2 1 ....1 2 Cirrhosis of the liver not specified as alcoholic., .9 6 3 1 8 ..1 ...1 5 1 .1 .6 1 2 Biliarycalculi. ..3 1 2 1 2 .......1 2 ...3. Abscess of the liver (unqualified). 2 1 1 .2 ..........1 1. Cholecystitis. 3 1 2 1 2 .I .1 ..1 2. Otherdiseasesof theliver .3 3 .I ...1 ....1 .1 ..2 1 Diseasesof the pancreas. 2 1 1 2 .....2. ...2 Peritonitis without specific cause (except puerperal) 3 2 1 .3. ......1 ..3. Nonvenereal diseases of the genito-urinary system and annea. Acute nephritis (including unspecified under 10 years of age). 25 16 9 .25 .6 3 2 .6 5 2 1 ..16 6 3 Chronic nephritis (including unspecified 10 years and vr). 133 78 55 13 117 3 .1 10 26 29 24 35 8 89 31 13

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ynprii.9 7 2 1 8 ..1 I 1 1 1 1 1 1 1 .6 2 1 Pylnproi .8 7 1 .6 2 .2 ...1 2 1 1 1 ., 5 8 Pyeta .d .3 ,. 3 .....1 ....,. 3 Dieae of he ldd r1 1 ......1.,.1 Strireoftherethr tr .,., 7 7.7.1 .3 21 U 2. 3 p Atecesaoftheprostate.2 2.2,. ..2 ..1 1. Hypertrophy of the prostate.1 1 ...1. ...1 Cysts and other benign tumors of the ovar.1 1. .1. ....1. Salpingitis and pelvic abscess (female). (Not gonococcio).3 3 ...2 1. ...1 1 1 Benigntumorsoftheuteru .3 3 ..3.1 1 1. ...2 1 therdiseasesofthefemalegenitalorgans. 2 1 1 ...2. ..1 1. T he puer peral at ate. Abortion (miscarriage, premature births, etc.). 2 2 1 1. ..1 1. ...,. 1AU Ectopigestation. ....2. ....1. Other accidents of pregnancy. 7. .1 .1 ......1. ... Puerperal hemorrhage ..1 1. ....1. Other surgical operations and instrumental delivery. 2 2.,. ..I I. ...1 1. Other accidents of labor. .1. .......... Puerperalsepticemia. ...5 5 5. ...3 2. ....2 .2 Puerperal phlagmasia alba dozens, embolus, sudden death. ..2 .,. .,.:. 1. 1. .1 1 Puerperal albuminuriaand convulsions .13 13 3 12. ...4 6 2 1 ....8 2 3 Diseases of the akin and of the cellular ti.ue Gangrene ..2 .2 .1 2 1. .....1 1. 1 1. Furuncole.1 1. 1. ........1 Aute abcess. .1 ..1 .....1. ...1. Diaeaea of the bones and of the organs of locomotion. Osteomyelhtis. ................. Peristitis. .1 1 .2 ...1. ..1 1 Arthritis. .,. .2 ...1 1. .,.1 1 Malformations. Congenital hydrocephalus. .7 4 3 1 5 1 7. ...,. .....5 2 Congenital malformations of the heart. ._ ..7. ....5 ..2 Other congenital malformations.4 2 2 1 2 1 4. ......2 .2 Early infancy. Congenital debility.2 1 7 .3 1 21. .........14 5 2 Icterusofthenewborn. 4. .4 ........2 -2. Malnutrition ..12 1 6. ...4 7 5 Premature birth (-1 year oy).59 33 26 9 50 .59. .......39 11. Injury at birth (-3 months only).11 8 3 11 .11. ....3 4 4 Other diseases peculiar to early infancy (-3 months only). ..21 16 5 1 20 .21. ....12 3 Old age. Senility .14 5 9. .14. ........3 10 1 9 5 lo e u ft e n w o n ........_ 13 ...................................

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TAsuL IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1927.-Conitd. Sex. Color. Age (in years). Place of residnce. Total Cause of death. deaths. Under -4Age 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 n ama. Colon. Zone. known External causes. Suicidebycorrosive substances ...1. ......-. Suicide by hanging or strangulation .1 1. 1. .--. ...... Suicide by drowning. ...2. .. Suicide by firearms ..6 6 .2 ..........2 2 Suicide by cutting or piercing instruments .1 I. .1 .._ 1. -.-.-. .... Suicide by jumping from high places .--1 1 .1. ....-. ..I. Othersuicides. ...--2 .1 1 ..1. .I __. Other acute accidental poisonings (gas excepted). 6 4 4 1 5 ..3. a ...._ ...2 3 Accidental burns (conflagration excepted). .8 4 4 3 4 1 4 1 .1 1 1 1 2 Accidental drown --.23 22 1 6 17-. 1 6 7 4 3 1.9 3 11 Accidental traumatism by firearms (wounds of war excepted). .2 2 ...........2 Accidental traumatism by cutting or piercing instruments. .-. 1. .-I. ..1. Accidental traumatism by fall. 12 9 3 3 9 ..2 1 2 3 2 2. .7 4 Accidental traumatism by machines. 2 2 ..2 .2. -. ....-1 1. .. Railroad accidents ...I. 1 1 --.--. -. ..-..1I ....1 Automobileaccidents. .9 6 3 3 6 ._ -.-.-. I .2 1 2 Aeroplane and balloon accidents .I I ..I -. -...1. ..1 Landslide, other crushing. .1 1 ...-...1.1 Injuries by animals (not poisoning) .......1. Li htning. ...1 ....... Other accidental electric shocks .2 2 1 1.-2. .2. Homicide by firearms ..2 1 1 1 1 -. .--. 22. Homicide by cutting or piercing instruments .7 5 2 1 6 .j 4 2 2. 4 2 Homicide by other means. -2 ...1. ...2. Fracture. .1 1. .... Dislocation. ..4. 1 1. .1. ... Other external violence ...-4 4-1 3 .-..4. .. Ill-defined diseases. Sudd2 death2.2' .... Caus1 of death not specified or i.e.ind -. -.--. -. ... Ill-defined .9 3 6 3 6 3 1 1 1 4 .. Not specifed or unknown. 12 7 5 2 10 7 1 2 2 Infection of undetermined origin .21 1 2 ........ Surgical operation and shock ..... Totals. .69 1,134 825 252 1,689 28 427 180 53 113 229 262 26a 183 1O 7248 423 98

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TABLE V.--DEATHS OF NONRESIDENTS, BY CAUSE, SEX, COLOR, AND AGE, 1927. Sex. Color. Age (in years). Cause of death. TalLosw deaths. M. F. W. B. than 1-4 5-10 11-20 21-30 31-46 41-50 51-60 61-75 76-90 / year. T oid fever. ..3 2 1 2 1 ..3 .... ralaria, tertian --. .---1 1 --. Malaria, clinical--. -.1 1.1. Hamoglobinuria, malarial .----------Influenza (without pulmonary complications specified) ---.----. --.--. 1 ........ Dysentery, amebic. ..4 4 ..4 1 ..I. I Dysentery, bacillary. ...-.-.-.-.-.-.-1--.1 -. Dysentery, unclassified .-1-.-.-.-.-.-.-.-.-.-.-.-1-. ...-. Meningococcus meningitis. ...5 5. 55 ....4 1 .... Tetanus. ...1 1. ..-. Tuberculosis of the respiratory system. .25 21 4 3 22. 3 5 3 9 5 Tuberculosis of the intestines and peritoneum,. 2. 2 .2 .1. Tuberculosis of the vertebral column. .1. ....---Tertiarysyphilis. 10 9 1 2 8. 1 2 3 1 2 Hereditary syphilis. .I. 1 1 ---. ... Pyemia and septicemia. 3 3 1 2. .1 1 ..-... Septicemia.,. .1. .... Cancer and other malignant tumors of the stomach and liver.4 4 .....2 1. Cancer and other malignant tumors of the peritoneum, intestines, and rectum. I I I --. 1. ---. Cancer and other malignant tumors of the female genital organs. ..22 2 2 ..1 .1. ..---Cancer and other malignant tumors of the breast. ..-.I. --. Cancer and other malignant tumors of other or unspecified organs. ....3 3 2 1. .1 2. Diseases of the spleen. .1 I .I. L1k1.-.-. .. Leukemia ...Hodgkin's disease. ..1 1. ...... Encephalitis. 1.-.-.--. 1. Simple meningitis. 2 2. ..2 1 .....--. Cerebral hemorrhage .... Other forms of mental alienation. .1 .1 1 ........ Acute endocarditis.1 1.1.,. ..... Organic diseases of the heart. .16 13 3 6 10.1 1 3 4 3 4 1. Aneurysm. -.* .,. ..1 1 .--.I .--. ..... Arteriosclerosis. .4 3 1 4 ..-.1 -1 Other diseases of the arteries.1 1 ......-. ... Bronchopneumonia. .14 11 3 10 2 3 1. ..1 3 1 1 1. Lobar pneumonia. 9 8 1 1 8. 1 1 2 1 3 1 Pneumonia, unspecified. ....3 1 2 .3 1 ..-1 1.Pleurisy. 2 1 1 ... Empyema.3 3 1 2. .2 1. Gangreneofthelung. .1 1. I -. -... Diseases of the mediastinum. 1 1. ..... Other diseases of the respiratory system (tuberculosis excepted) .1 1 .1. -... Diseases of the pharynx and tonsils ..1. .....-.

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TABLE V.-DEATHS OF NONRESIDENTS, BY CAUSE, SEX, COLOR, AND AGE, 1927.-Continued. Sex. Color. Age (in years). Cause of death. Total Less deathsM. F. W. B. than 1-4 -5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-90 UnI year. known Ulcerofthestomach ...1 1 1 1 Uleer of the duodenum. 3 2 1 2 1 ..2 1 Diarrhea and enteritis. ..1 1 .1 .1 Ankylostom iasis. 1 1 --.1 ..1 Intestinal obstruction. ..1 1. ....2 Cirrhosis of the liver (not specified as alcoholic). 3 3 ....I -. ...1 1 Biliary calculi. 1 .1. ...1. Cholecystitis. ..11 ..1 ..1I Peritonitis without specified cause. 1 .,. .1 .1. Chronicnephritis. .17 14 3 2 15. ....3 1 4 2 ..4. ... Pyonephritis ...,.,. ..1 1 .1. ...1 Calculi of the urinary passages .1. .1.-... Diseases of the bladder. ..... Diseases of the urethra, urinary abscess, etc. .1. 1 1 ..I .1 ... Abscessoftheprostate. 2 2 .I ..I. .1 .C.0 Hypertrophy of the prostate.2 2 ....2 ..W Gangrene.1 1.1. ....I .1.Acuteabscess. .I -. ..I. Osteomye!itis. .1 1. .....-. Malnutrition. 2 .2 .2 2. Premature birth (less than 1 year). .I .1 ....... Other diseases peculiar to early infancy. ...1 1 1. Suicide by firearms. ......1 1 ..1 ..1 .-. Suicide by umping from high places ....1 1 .1 ......... Accidental burns (conflagration excepted) ..2.1.1. 2 1 1 .2 .1 .1. Accidental absorption of irrespirable, irritating, or poisonous gas .3 3 2 1 ..3. Accidentaldrowning. ..10 10 4 6 1 .2 4 2 1. Accidental traumatism by fall .3 3 1 .1 2 ...3. Automobile accidents. .11. .-. Accidental electri shocks. .1 1. .I. Homicide byfirearms. .1 ....1. Homicide by other means ...11. ..1. .. Other external violence.2 2 1 1. ....... Ill-defined. ...1 1 .1. .....1. NotSpecifiedorunknown. .2 2 ..... Totals .215 176 39 64 151 14 5 3 25 37 36 34 29 24 5 3 & :N Mo

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63 TABLE VI.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1927. Annual death rate per 1,000. White employees from the United States: Disease. ..4.99 External causes. 1.43 T otal. ....6.42 Families of white employees from the United States: Disease. 3.66 External causes. .. Total. 3.66 White employees from the United States and their families: Disease .4.15 E xternal causes. ......52 Total. .4.67 Number of American children born on the Isthmus during the year. 144 Deaths among American children under 1 year of age. .4 Infant mortality rate among American children (number of deaths per 1,000 live births). 27.78 TABLE VII.-BIRTHS AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Births. Birth rate per 1,000 population. PopulaPlace. tion. Total. Alive. StillTotal. Alive. Stillborn. born. Year 1927: Panama. 59,635 2,509 2,389 120 42.07 40.06 2.01 Colon. 31,583 795 737 58 25.17 23.34 1.84 Canal Zone. 36,794 579 547 32 15.74 14.87 .87 Totals. 128,012 3,883 3,673 210 30.33 28.69 1.64 Year 1926: Panama. 59,635 2,117 2,003 114 35.50 33.59 1.91 Colon. 31,285 755 712 43 24.13 22.76 1.37 CanalZone. 36,480 669 635 34 18.34 17.41 .93 Totals. 127,400 3,541 3,350 191 27.79 26.29 1.50 TABLE VIII.-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 1927: Panama. 1,235 1,154 2,389 287 120.13 Colon .369 368 737 80 108.55 Canal Zone. 294 253 547 59 107.86 Totals. 1,898 1,775 3,673 426 115.98 Year 1926: Panama. 1,029 974 2,003 289 144.28 Colon. 363 349 712 92 129.21 Canal Zone. 326 309 635 57 89.76 Totals. 1,718 1,632 3,350 438 130.75 rN A

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64 TABnu IX.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1927. NortEmployees. Nonemployees. Disease. Wh hite BWhikte. '8. White. Black. MiliBlack. White. Riaok. Others tary. Epidemic, endemic, and infectious diseases. Typhoid fever. ..17 3 ..4 10 6 Relapsing fever (Spirillum obermieri). 13 I 2 2 3 2 Malaria, estivoautumnal. .289 8 22 65 32 32 138 Malaria, tertian .158 16 28 32 22 '7 1 Malaria, quartan. .3 ..2.1. Malaria, clinical. .91 3. 2 3. Hemoglobinuria, malarial. ....... Measles. .~ 105.7 4 69, 24 1 Scarlet fever. 4 .2 1 1 Whooping cough. ..6 ...2 4 Diphtheria. 24 .1 9 14 Diphtheria bacillus carrier 2. 2 .1 1 Influenza with pulmonary complications specified 9 .*2 2 1 2 2. Influenza without pulmonary complications speci-.3 fied. .104 12 14 57 12 7 2 Mumps. .34 2 27 2 3 Dysentery, amebic .11 3 3 2 2 Dysentery, bacillary. ..20 3.1 17.4 1 Dysentery, unclassified .3.2 1. I. Erysipelas.20. ..2 4 4 3 6 2 1 Acute anterior poliomyelitis. ..4 1. Lethargic encephalitis. .6. .3 2 1 Meningococcus meningitis. 11 9 .16 1 2 1 Chicken-pox. .....25 3 3 9 8 .2 Other epidemic and endemic diseases .3 ...3 Mycoses.1. ..1. Tuberculosis ofthe respiratorysystem.62 24 9.jJ,. 7 20 23 5 Tuberculosis of the meninges and central nervous system .1 2 .1 2. Tuberculosis of the intestines and peritoneum 13 2 3 1 1 9 1 Tuberculosis of the vertebral column .1 1 Tuberculosis of the joints. 6. .3 3. Tuberculosis of the skin and subcutaneous tissue, 1. ... Tuberculosis of the lymphatic system (mesenteric and retroperitoneal glands excepted) .4 1. .2 3. Tuberculosis of the genito-urinary system.4. .1.2.1. Z Disseminated tuberculosis, acute. ..2 2 .. Primary syphilis. 12. 1 1 4 1 2 3 Secondary syphilis ..23. 4 4 1 2 12. Tertiary syphilis.,. 98 13 5 35 5 3 50 12 1 Cerebrospinal syphilis,. ..30 2 4 4 3 8 11 2 Hereditary syphilis. 6 3 .1 8. Other forms of syphilis. 29 __. .3 5 15 6 Soft chancre. 53 1 11 17 2 8 11f 4 Chancroidal lymphadenitis ..14 .4 3 2 1 3 I Gonococcic urethritis. .137 6 34 24 5 24 37 7 Gonococcic orchitis and epididymitis ..29 3 12 6 1 1 5 oncccic arthritis ..15.7 4 2 2 Gonococcic ophthalmia.6. 5 Gonococcic vaginitis .15 5 10. Gonococcic bubo. ...8. .4 ..3 Gonococcic salpingitis .4 .4.-. Other gonococcie infection. .3. Septicemia .......1. Vaccinia .3.I.2.2. ... Yaws. ._. .....1. Other infectious diseases. .. General diseases not included in the above class. Cancer and other malignant tumors of the buccal cavity. _. ..7 .1 2 2 1 1. I Cancer and other malignant tumors of the stomach and liver. ._. .5 3 1 2 1 1 3 .* Cancerand other malignant tumors of the peritoneum, intestines, and rectum. ..12 2 4. .6 2 2 Cancer and other malignant tumors of the female K genital organs._. 27 7 ..6 27 1 Cancer and other malignant tumors of the breast. 9 3. .5 5 2 Cancer and other malignant tumors of other or 7 6 unspecified organs. 14 11 3 3 4 1 11 a

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65 TABLE IX.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1927.-Continued. NonEmployees. Nonemployces. residents. Disease. White. White. Black. MiiiBlack. White. Black. tary. Others General diseases.-Continued. Benign tumors and tumors not returned as malignant ..52 1 7 11 15 13 5 Acute rheumatic fever. 11 1 1 2 4 2 1 Chronic rheumatism, osteoarthritis, gout .16 .2 3 1 5 3 2 Pellagra. ...3 4 ..7. Rickets. ...4. ...4. 4 .. Diabetes meflitus .56 5 6 3 6 19 16 10 1 Glycosuria. .3.11 1. Pernicious anemia. .3. ...1 1 1. Other anemias and chlorosis. .7 1 .1 1 3 2 1. Diseases of the pituitary gland. .2 .2. .1 Exophthalmio goiter. 12 1 .1 .9 3. Other diseasesofthethyroidgland. 23 .2 .5 12 2 2 Diseases of the adrenals (Addison's disease). 2 ...... Diseasesof thespleen. 7 .2 .2 2 1. Leukemia. .2 3. .1 1 2 1. Hodgkin's disease. .2 .....1 1 Acutealcoholism. 30 .5 3 14 4 .4. Chronic alcoholism.7. ..4 1 .2. Alcoholic psychosis.5.3 1 .1. Other alcoholic poisoning. 5 ...3 1 .1. Chronic lead poisoning. .I. 1. Other chronic poisoning by mineral substances. .2 ...1 1. Drughabit. 2 .1 .1. Other general diseases. 39 2 4 ..22 12 3. Diseases of the nervous system and of the organs of special sense. Encephalitis. .I ...1. Simple meningitis.1 1 ..5. Tabes dorsalis locomotorr ataxia). 6 .3 ..1 1 1. Other diseases of the spinal cord. 6 1 1 .3 1 2. Cerebral hemorrhage. 13 6 .6 4 1 7 1 Cerebral embolism and thrombosis. .1 .1. H eriplegia. ..3. ...1 1 1 Other paralysis without specified cause.10 .1 1 1 .4 3. Generalparalysisoftheinsane. 14 11 2 10 2 2 8 1 Dementia precox. .80 ..4 35 15 17 9. Manic depressive psychosis. 19 ..1 2 4 8 4. Toxic psychosis. 1 1 ....2. Other forms of mental alienation. ..43 ..2 17 10 9 5. Epilepsy .30 2 .2 5 12 10 3. Convulsions (nonpuerperal; 5 years and over). 5 ...1 3 1. Infantile convulsions (under 5 years of age). 3 1 ..1 3. Neuritis. .35 .1. .4 1. 5 3 3 Hysteria. 46 .1 2 13 12 15 3 Neuralgias ..26 .6 4 4 4 6 2. Softening of the brain. .. Imbecility .5. 2. ..2. Tumorofthebrain. 1 2 ..2 1. Neurasthenia. .52 .5 .18 18 1 10. Other diseases of th nervous system. .42 1 1 5 14 10 9 4 Follicular conjunctivtis. 21 ..2 16 1 2. .. Trachoma. 3 ..1 2 Disease of cornea. ..72 .6 17 16 6 22 5 Diseaseofiris.50 3 15 14 1 13 2 2 Disease oflens. ..31 .5 2 1 8 9 6 Disease of fundus. 20 .2 3 3 3 8 1 Other disease of theeye and annexa. .105 .7 22 33 8 31 4. Disease of the ear. 119 1 6 4 58 22 25 5. Disease of the mastoid process .,. 9 ..2 1 1 5 Diseases of the circulatory system Pericarditis. 3 1 .2 .2 Acute endocarditis. 7 3 ..2 .8 Acute myocarditis. ..I .. Angina petori s. I ....1 Otherdiseaseof the heart .8. 93 25 12 25 10 19 30 12 Aneurysm.3 3. .2 1 1 2 MR 12007-5 L

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66 TAznL IX.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1927.-Continued. Non0 Employees. Nonemployees. resident. Disease. -e White. White. Black. MiiBlack. White. Black. tary. Others Diseases of the circulatory system.-Continued. Arteriosclerosis .55 3 4 13 5 18 15 3 Other diseasesof thearteries. 14 1 1 5 4 1 2 Hemorrhoids. .98 .16 9 49 7 13 4 Varices. .8 .1 1 3 1 2 Varicocele. 10 ...6 .2 2 Phlebitis. 5. .1 2 1. Thrombosis.1. .. Lymphangitis. .4 1 1 .2 .2 .. Lymphadenitis, nonvenereal. 73 .4 6 29 10 14 10. Other diseases of the lymphatic system. 4 ..1 1 2. Hemorrhage without specified cause (noncerebral) 13. 3 .4 5 1 Other diseases of the circulatory system ..27 .3 5 2 8 8 1. Diseases of the respiratory system. Disease of the nasal fossae. ...93 1 6 3 52 19 12 2. Other diseases of the nasal fossae and their annexa 55 .11 5 23 6 5 5. Diseasesofthelarynx. ..13 .2 1 4 1 3 2. Acute bronchitis. 149 .22 7 31 36 45 8 Chronic bronchitis. .52 9 3 24 8 5 3 Bronchitis unspecified (under 5 years of age). 9 ....8 1 Bronchitis unspecified (5 years and over) ..5. ....3 2 Bronchopneumonia. .28 16 .1 3 14 23 3. Lobar pneumonia. 63 17 1 21 5 5 45 3. Pneumonia unspecified. .3 ...2 ..1 Pleurisy. 47 .5 11 8 6 13 4 Empyema. .3. 3 2 1 ..1 3 Other diseases of the pleura. .2 .....Congestion and hemorrhagic infaret of the lung. 1 1 .. Asthm a. .46 6 6 1 8 17 7 1 Chronic interstitial pneumonia. 1 .....I. Other diseases of the respiratory system .4 2 ...2 1 2 1 Diseases of the digestive system. Diseasesoftheteethandgums. 45 .5 8 3 7 15 7 Stomatitis. 16 .1 2 2 8 3. Other diseases of the mouthand annexa. ...13 .1 2 3 1 4 2. Adenoid vegetations. 40. 29 11. Other diseases of the pharynx and tonsils. ..1,208 3 74 53 302 349 391 42 Diseases of theesophagus.2. .1. Ulcerofthestomach. .32 6 7 14 4 6 2 5 Ulcer of the duodenum ._,. 53 1 13 6 15 12 2 6 Acutegastritis .47 .10 12 9 6 3 5 2 Chronic gastritis .40 .10 8 6 6 8 2 Acuteindigestion ....7 ..3 .1 2 Other diseases of the stomach (cancer excepted). 102 .22 10 15 23 18 14 Enteritis, colitis, or entero-colitis (under 2 years of age) ..24 3 .14 12' 1. Intestinal autointoxication (under 2 years of age). 5 ....1 4 Enteritis, colitis, or entero-colitis (2 years and over). .....87 1 11 17 11 25 13 11 Intestinal autointoxication (2 years and over) .30 .5 2 11 5 5 2 Ankylostomiasis .49. .13 2 5 24 4. Cestodes (hydatids of the liver excepted). ..10 1 .1 1 3 6. Nematodes (other than ankylostoma). ..10. ..1 1 1 3 4. Other parasites, specified. .2. .1 1. Parasites notspecified. .I .Acute appendicitis .116 5 13 8 55 20 14 11 Chronic appendicitis ..73 2 9 1 28 19 12 6. Hernia. 154 .18 39 39 7 31 20.Intestinal obstruction .16 5 3 3 2 8 4 1 Other diseases of the intestines ..130 .23 9 20 27 28 23 Cirrhosis of the liver not specified as alcoholic. 8 2 1 2 .._. 3 1 3 Biliary calculi. ...22 2 2 1 3 7 6 5 Abscess of the liver (unqualified) ..1 ...1 Cholecystitis .87 12 9 9 35 9 13 Other diseases of the liver. ..39 1 4 4 20 5 4 3. Diseases of the pancreas. ..1 1 1 ...1.--

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67 TALE IX.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1927.-Continued. NonEmployees. Nonemployees. resi ts Disease. White. White. Black. i Black. White. Black. tary. Others Diseases of the digestive system.-Continued. Peritonitis without specified cause (except puerperal). 11 2 .1 4 1 6 I. Other diseases of the digestive system (cancer and tuberculosis excepted). ..1 ..1 Nonvenereal diseases of the genito-urinary system and anneza. Acute nephritis (including unspecified under 10 y arsofage) .20 8 .4 2 6 14 2 Chroic nephritis (including unspecified 10 years and over). 60 22 3 16 3 26 28 5 1 Pyonephritis. _. ...1 1 1 Pyelonephrosis.8. 2 1 1 4 1. Pyelitis. .120 4 5 9 43 55 4. Perinephritic abscess. 3 ...2 1. Hydronephrosis. 2 .1 ..1. Movable kidney. .2 ....1. Other diseases of the kidneys and annexa. .27 .3 3 2, 12 4 3. Calculi of the urinary passages. .45 1 13 11 6 5 4 7 Diseases of the bladder 49 1 6 6 9 19 5 5. Stricture of the urethra .29 4 .19 4 2 4 4 Other diseases of the urethra 19 1 1 3 .6 7 3. Acute prostatitis. I ....1 Chronic prostatitis. 6 1 3 1 1. Abscess of the prostate. ..1 Hypertrophy of the prostate. 6 2 2 2 1 1 1 1 Hematocele. 2 ..1 ... Hydrocele. ..22 .9 5 4 1 2 1 -Other nonvenereal diseases of the male genital organs. .24 .3 5 7 1 4 3 1 Cysts and other benign tumors of the ovary. 30 2 2 ...8 18 Salpingitis and pelvic abscess (female). (Not gonococcic). ...143 1 1 7 .22 113 1 Benign tumors of the uterus. .63 3 .2 ..7 57. Nonpuerperal uterine hemorrhage. .19 .1 ..9 8 1. Leukorrhea. .4 ..1 3. Dysmenorrhea. ...18. 1 .3 13 1. Cervicitis. ...34 1. ..13 18 2 Endometritis .23 ....5 15 3 Stenosisof cervix ..I. .1. Metritis. .I ...1. Prolapsus uteri .....2 2 1 Lacerations, old or recent, of cervix and perineum. 29 ....15 10 4. Benign tumors of the female genital organs (except of uterus). ....2 .1 1 Other diseases of the female genital organs .85 1 1 26 48 9. Nonpuerperal diseases of the breast (cancer excepted). 9 ...2 7 The puerperal state. Abortion (miscarriage, premature birth, etc.) .103 3 2 ...48 54 2. Ectopie gestation. .9 2 _. 1 10. Other accidents of pregnancy. ..43 3 ....15 31. Puerperal hemorrhage. .11 1 .1 11. Cesarean section ...33 Other surgical operations and instrumental delivery. .15 1 ..11 5. Other accidents of labor ..35 1 .6 30. Puerperal septicemia. .2 1 ..3. 3 Puerperal phlegmasia alba dolens, embolus, sudden death. I. 1 Puerperal albuminuria and convulsions. .20 5-1 ..6 17 1 Following childbirth (not otherwise defined) .6 ...1 5. Puerperal diseases of the breast. ....4. .3 1. Diseases of the skin and of the cellular tissue. Gangrene. 2 1 2. ...1 Furunile. 31 .4 3 9 4 6 5 Acuteabeceas. 186 1 20 28 30 27 55 25 2

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68 1TaL Il.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1927.-Continued. Non4; Employees. Nonemployees. residents. Disease. White. White. Black. MiliBlack. White. Black. Etary. Others Diseases of the skin and of the cellular tissue.-Continued. Trichophytosis. 38 .4 5 16 8 3 2 Scabies. .7 .1 2 .3 1. Myiasis of the skin. I ...... Dhobieitch. 4 .1 2 Prickly heat. 1 ....1 Ulceroftheskin. So .1 7 3 7 8 4. Impetigo contagiosa. 6 ..I .4 1. Impetigo simplex. 4 .I ..2 1 Urticaria. 4 ....3 1 Eczema. .2. 2 .3 .1 3 Ingrowingnail. 16 .4 .4 6 2. Other diseases of the skin and annexa. .55 .3 5 18 12 10 7. Diseases of the bones and of the organs of locomotion. Caries (nontuberculous). .1. ..1. .. Osteomyelitis. 16 2 1 4 5 3 5. Periostitis. 3 1. 1 .3. Diseases of the bones (tuberculosis and sinusitis excepted). .11. ...3 3 1 4 Ankylosis. 4 1 .3 Arthritis. .63 1 9 16 13 8 15 3 Synovitis. 11 .1 1 6 ..3 Diseases of the joints (tuberculosis and rheumatismexcepted).18 2 1 6 4 3 2. Amputations. ... Other diseases of the organs of locomotion. 63 .8 13 21 9 11 1. Malformations. Congenital malformations of the heart.2 1. ..1. 1 2 Other congenita! malformations. 77 2 1 2 11 24 39 2,. Early infancy. Congenital debility. .1 ..I Malnutrition.14 7. ..4 17. .. Premature birth (-1 year only). 6 6 ...1 11. Injury at birth (-3 months only). 1 5 .6. Other diseases peculiar to early infancy (-3 months only). 2 6 ...1 7 Lack of care (-3 months only). ...... Old age. Senility.2. 4. Senile dementia. ..... External causes. Attempted suicide by corrosive substances. 1., ....1. Suicide by hanging or strangulation. ..1 ... Attempted suicide by cutting or piercing instruments. 1. ..... Poisoning by food. .6 3 5 2 6 1. Poisoning by venomous animals. 3 .1 1. Other acute accidental poisonings (gas excepted). 19 2 3 4 3 2 9. Conflagration.1 1. Accidental burns (conflagration excepted). 37 5 3 7 3 .22 7 Accidental absorption of irrespirable, irritating or poisonous gas. 1 .....,. .I Accidental traumatism by firearms (wounds of war excepted). 21. 21 13. 3 .. Accidental traumatism by cutting or piercing instruments.59 .3 34 3 5 12 2 Accidental traumatism by fall. 176 3 20 49 33 26 29 18 4 Accidental traumatism in mines. .1 ..1 .. Accidental traumatism in quarries. 23 ..7 4 4 8. Railroad accidents.17. .1. Street car accidents. 2. ...2. 4( A

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69 TABLE IX.-DISCtARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1927.-Continued. NonEmployees. Nonemployees. residents. Disease. -White. White. Black. .Black. White. Black. tary. Others External causse.-Continued. Automobile accidents. 47 2 1 10 8 6 20 4 Aeroplane and balloon accidents.2. ...... Motorcycleaccidents. .1 3. .. Injuries by other vehicles. 12 ..4 4. 3 1 Landslide, other crushing. 48 .1 37 4 .2 4. Injuries by animals (not poisoning). 8 1 1 2 4 2. Other accidental electricshooks.4. 2 ....2. Homicide byfirearms. .1 ..I .. Homicide and attempted homicide by cutting or piercing instrumental .6 3 1 1 1 1 4 1. Homicide and attempted homicide by other means. 8 2 3 3 1 2 1. Fracture.8. 84 .6 8 36 11 16 5 2 Dislocation.5 I 2 .I .I Sprain. .21 .2 8 5 .1 5. Other externalviolence. .157 2 9 45 41 17 27 16 4 Ill-defined diseases. Sudden death. .1. .... Cause of death not specified orill-defined. 2 .I 1 Ill-defined. 51 1 3 10 12 14 7 6 Notspecifiedorunknown. 8 6 ..2 4 6 2. Infectionofundeterminedorigin. 38 1 3 3 8 7 14 4. Feigned disease.1. I ..... Normal physiological conditions. Normal pregnancy. 85 ..28 55 2. Normallabor. 602 1. ..179 421 1 Newborn child. 633 ...203 430 .. No disease (companion, observation, etc.). .346 .16 10 23 156 110 31. Totals. 10,591 389 733 1,230 1,906 2,499 3,798 766 48 Hi

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TAsLE X.-CONSOLIDATED HOSPITAL AND COLONY REPORT. RemainingJanuary 1, 1927. Admitted. Died. Discharged. Transferred. Remaining Dec. 31, 1927. Classification of patients. White White White White White White White White White White White White American foreign. Black. American foreign. BlackAmerican foreign. BlackAmerican foreign. Black. American foreign. Black. American foreign. Black. Ancon Hospital: Employees ..13 6 63 563 81 1,064 10 3 48 548 79 997 1 1 24 17 4 58 Army and Navy.1. .1,739 ..24 ..1,640 .13. 113. PanamanGovernment. ..1 6 11 .1 2 ....5 9 Charity..4. 24 187 74 642 1 .39 187 71 Sa .1. 2 23 1 .6 43 All others. 34 23 69 1,457 1,064 2,138 18 23 109 1,428 1,020 1,980 3 10 22 42 34 96 Totals. 112 34 157 3,946 1,225 3,855 53 27 198 3,803 1,170 3,538 17 18 78 185 44 198 Corozal Hospital: Employees .1 1 21 1 15 .6 1 8 ..2 1 1 20 Army and Navy .3 51 ..49 ....5 Panaman Government. .85 269 1 34 88 .,. 2 21 20 29 1 1 7 .06 300 Charity. 7 35 1 3 19 1 5 1 5 ...2 1 8 42 Allothers ..13 45 3 13 26 .1 7 3 12 7 .7 ...13 57 .Totals .,. 4 106 370 57 50 148 4 39 53 33 49 1 1 11 7 118 419 Cripples. 4 23 2 12. .2 .2 8 .4 2 Chronic medical and surgical cases. ..3 35 .11 .3.4. 7 .-3 32 Colon Hospital: Employees. 1 1 8 100 10 233 1 9 87 6 179 13 5 45 .8 ArmyandNavy. 6. 251 .4 ...190 ...52 ..11. Charity .2 1 5 45 16 290 11 47 15 262 .1 12 ..1 11 All others.,. .9 8 22 288 187 819 5 7 32 237 142 732 33 31 58 2 15 18 Totals. .18 10 35 684 213 1,342 10 7 52 581 163 1,173 98 37 115 13 16 37 Palo Seco Leper Colony: PanamanGovernment. 17 68 ..7.1 1 2 ....6 72 Charity. ..27 .1 .3 ....25 Totals. ....7 95 ..8 .4 1 2 ,. ...6 97 Totals by classes: Employees. 15 8 92 664 91 1,312 11 3 63 636 85 1,184 14 6 71 18 5 86 Armyand Navy. 60 ..2,041 .28. .1,879 ...65 ..129 PanamanGovernment. .92 338 1 40 106 .3 24 ..21 31 1 816 .102 373 Charity cripples and chronics.16 20 149 233 95 975 1 1 61 234 87 834 .5 52 14 22 178 Allothers .43 44 136 1,748 1,264 2,983 23 31 148 1,688 1,174 2,719 36 41 80 44 62 171 Grand totals. 134 164 715 4,687 1,490 5,378 63 38 298 4,437 1,387 4,788 110 58 219 205 191 808 hoInludes.1 Chinamal .Anh ldes 1 rft disior a' county 1 Crane beiweesu "n h imbera admission shown above does not ebo exactJy with igur e in text; .a., when a patient I, transferredfroi Coroma Ho)3Dl t4 Anoon 0Os cooifo o tr106160 $tw1 he turnef* t > yC. f~~p.lta4~~huoOrnlou'Wiaou to sn Cqroli~awwn

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TABLE XL-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED, AND AVERAGE NUMBER IN HOSPITAL EACH DAY, OF THE VARIOUS CLASSES OF PATIENTS, 1927. Number of days treatment. Average number in hospital each day. Class of patients. AmeriAmerican. Foreign. Black. Total. can. Foreign. Black. Total. Ancon Hospital: Employees .6,907 2,311 27,815 37,033 18.92 6.33 76.21 101 46 Army and Navy .34,866 .34,866 95.52 .95.52 Panaman Government .47 125 317 489 .13 .34 .87 1.34 Charity. __.3,390 1,772 12,082 17,244 9.29 4.85 33.10 47.24 All others. ..16,340 15,444 95,000 66,784 44.77 42.31 95.89 182.97 Totals. 61,550 19,652 75,214 156,416 168.63 53.83 206.07 428.53 Corozal Hospital: InsaneEmployees .476 395 6,781 7,652 1.31 1.08 18.58 20.97 Army and Navy .2,118 ..2,118 5.80 ...5.80 Panaman Government. 41 33,905 101,542 135,488 .11 92.89 278.20 371.20 Charity. 76 2,819 13,659 16,554 .21 7.72 37.42 45.35 Allothers. 295 4,760 18,447 23,502 .81 13.04 50.54 64.39 Totals. 3,006 41,879 140,429 185,314 8.24 114.73 384.74 507.71 Cripples .1,340 8,875 10,215 3.67 24.32 27.99 Chronicmedicalandsurgicalcases. .1,154 12,189 13,343 .3.16 33.39 36.55 Colon Hospital: Employees. ..651 99 2,242 2,992 1.78 .27 6.14 8.19 ArmyandNavy. 2,731 ..2,731 7.48 .748 Charity. .479 149 2,680 3,308 1.31 .41 7.34 9.06 All'others .1,968 1,831 7,425 11,224 5.39 5.02 20.34 30.75 Totals. 5,829 2,079 12,347 20,255 15.96 5.70 33.82 55.48 Palo Seco Leper Colony: Panaman Government. 2,011 26,218 28,229. 5.50 71.83 77.33 Canal Government. ..9,669 9,669 .26.49 26.49 Totals. .2,011 35,887 37,898 .5.50 98.32 103.82 Tot. by class: Employees. ..8,034 2,805 36,838 47,677 22.01 7.68 100.93 130.62 Armyand Navy. 39,715 ..39,715 108.80 ..108.80 Panaman Government. .88 36,041 128,077 164,206 .24 98.73 350.90 449.87 Canal Government, charity, cripples and chronics. 3,945 7,234 59,154 70,333 10.81 19.81 162.06 192.68 All others. 18,603 22,035 60,872 101,510 50.97 60.37 16677 278.11 Grand totals. .70,385 68,115 284,941 423,441 192.83 186.59 780.66 1,160.08 'These cripples require no medical attention. .R

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72 TABLE XIL-REPORT OF DISPENSARIES, 1927. EMPLOYEES TREATED IN QUARTERS. Remaining Remaining January 1, Admitted. Died. Discharged. Transferred. December Dispensary. 1927. 31, 1927. White. Black. White. Black. White. Black. White. Black. White. Black. White. Black. .ncon. 1 3 761 731 .740 680 22 47 .7 Balboa. 2 3 1,228 184 ..1,229 186 1 ..1 Pedro Miguel. ..1 197 54 .196 51 1 3 .1 Gatun. .116 163 .115 156 1 4 .3 Colon. 4 14 453 926 .455 919 ..2 21 Totals. 7 21 2,755 2,058 .2,735 1,992 25 54 2 33 Average number treated Days treatment furnished in quarters per day, Dispensary furnishing treatment. White. Black. Total. White. Black. Total. Ancon. ...1,652 3,229 4,881 4.53 8.85 13.38 Balboa. .3,130 1,042 4,172 8.58 2.85 11.43 Pedro Miguel. .591 330 921 1.62 .90 2.52 Gatun. 243 635 878 .67 1.74 2.41 Colon. .1,704 8,319 10,023 4.67 22.79 27.46 Totals ...7,320 13,555 20,875 20.07 37,13 57.20 ALL CASES TREATED. Employees. Nonemployees. Total. Dispensary. White. Black. .Total. White. Blaok. Total. White. Black. Total. Ancon,. 6,734 14,410 21,144 4,909 16,126 21,035 11,643 30,536 42,179 Balboa. 18,452 15,023 33,475 15,175 9,338 24,513 33,627 24,361 57,988 Pedro Miguel. 2,994 5,995 8,989 7,761 12,130 19,891 10,755 18,125 28,880 Gatun. 4,117 7,728 11,845 4,489 6,749 11,238 8,606 14,477 23,083 Colon. 3,581 19,430 23,011 5,059 18,032 23,091 8,640 37,462 46,102 Totals .35,878 62,586 98,464 37,393 62,375 99,768 73,271 124,961 198,232 Si

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73. TABLE XIII.-CONSOLIDATED ADMISSION REPORT, HOSPITALS AND DISPENSARIES, 1927. All classes of patients. White. Black. Total. A iions to hospitals, excluding Corozal farm (cripples and chronic ward). 6,176 5,356 11,362 Admision of employees to quarters. .2,755 2,058 4,813 Total admissions to hospitals and quarters. ..8,931 7,414 16,345 Number of patients transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in above figures. .197 258 455 Net admissions to hcapitals and quarters. .8,734 7,156 15,890 Employees only. Employees admitted to hospitals .....753 1,289 2,042 Employees admitted to quarters .2,755 2,058 4,813 Total admissions of employees. ..3,508 3,347 6,855 Number transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. .43 110 153 Net admissions of employees. .....3,455 3,237 6,702 AVERAGE NUMBER OF DAYS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, EMPLOYEES ONLY. White. Black. Total. Hospitals: Ancon. .15.64 32.06 25.92 Colon .5.86 9.62 8.42 Average for hospitals. 14.36 28.08 23.Of Quarters: Ancon ..2.17 4.42 3.27 Balboa. 2.55 5.66 2.95 Pedro Miguel. 3.00 6.11 367 Gatun. 2.09 3.90 3.15 ...3.54 8 .98 7 .27 Average for quarters. 2.66 6.59 4,34 *aL

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74 TABLE XIV.-OOROZAL HOSPITAL COMMITMENTS AND DISCHARGES, 1927. COMITMENTS. From Canal Zone. From XPanama. Insane patients only. Total. Male. Female. Male. Female. First admission. ..90 28 62 47 227 Second admission. 3 4 2 4 13 Third admission. 2 1 2 5 Totals. 9532 65 53 245 DISCHARGES. Insane patients only. Male. Female. Total. Well. 7 1 8 Improved. 54 27 81 Unimproved. ..42 2 44 Totals. 103 30 133 TABLE XV.-FORCE REPORT OF HEALTH DEPARTMENT. December 31, 1927. 1926. 1925. Gold. Silver Total. Chief Health Office. 6 0 6 5 5 Quarantine Service. 12 23 85 33 34 Health Office, Panama. .11 125 136 130 133 Health Office, Colon. 8 90 98 77 72 Ancon Hospital. 163 248 411 359 343 Colon Hospital. 24 .37 61 59 57 Palt Seco Leper Colony. .1 37 38 38 36 Zone Sanitation. 6 141 147 157 166 Corozal Hospital. 18 118 136 122 119 Line Dispensaries. .12 9 21 20 20 Totals. .261 828 1,089 1,000 985 -C MR 12O7-P-ttraina Carial-4-6 29-1,000,

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t 8 at a e 8 % e e e 4 % e 8 --:x -------------------x -.-----.--------x -------------------x ---x ------------x--------------------x --.-----------------x--..-----x ----. --------a ---. ------------------x -----------------.-------x .--x -----------x --x -----------------------------x------------x -----. ---. -----x------.---.-----. x ---------------------------------x------------x .----..---.-.--------x -----------.-----------------x-----x ------.x ----------. -------------x-. -------------: --x : -------.--------x ----------------------------------x ---------.------------.+-+.--. .-x--.:-.+ ----.-.--------------x ---.-.------------. -----x ---..--.---------..x ----. .--x -----. -------.--.---x -------

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UNIVERSITY OF FLORIDA 3 1262 08896 2401