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:
1931
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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Full Text

PAGE 1

AY REPORT OF THE Health Department OF The Panama Canal FOR THE CALENDAR YEAR 1931 Al Gift of the Panama Canal Museum "0 %.99w 3. F. SILER Colonel, Medical Corps, United States Army CHIEF HEALTH OFFICER BALBOA HEIGHTS, CANAL ZONE THM PANAMA CANAL PRESS PI" MOUNT HOPE, C. Z. 1932 O'9M M

PAGE 2

gX REPORT OF THE Health Department OF The Panama Canal FOR THE CALENDAR YEAR 1931 J. F. SILER Colonel, Medical Corps, United States Army CHIEF HEALTH OFFICER BALBOA HEIGHTS, CANAL ZONE THE PANAMA CANAL PRES MOUNT HOPE, C. Z. 1932

PAGE 3

0)< For additional copies of this publication address The Panama Caoal, Washington, D. C., or Balboa Heights, Canal Zone. 2

PAGE 4

CONTENTS. T.t.e -... Page 1 0 : -Organization and activities----------------------Personnel----------.----------.------.---5 Financial statement .7 Vital statistics, populations of the Canal Zone, Panama City, and Colon-----10 General death rates, all causes, and from disease only: Canal Zone------------------------11 Panama City------------------------13 Colon. ------.-----.------------15 Birth rates: Canal Zone-------------------------16 Panama City -----------------------18 ColonK. .-19 Infant mortality rates, Canal Zone, Panama City, and Colon-------20 Principal causes of death: Canal Zone ---------------------------------------------1 -Panama City -. 2------------------2----------------2 HColon_.-----------------------------------------------23 Acute transmissible diseases reported n 193-----------------------23 Vital statistics, Panama Canal employees ------25 Death rates, all causes-. f-------------26 Death rates, disease only._ 27--------------------------..27 Admission rates to hospitals and quarters 8---------------------------Principal causes of admission to hospital ----------------------------29 Noneffective rates, all causes ---------------------------------30 Admission rates, malaria. 31 Admission, death, and fatality rates, malaria, by race3-----------------4 Death rates, malaria-.------------------------------------------35 Division of Hospitals, Dispensaries, and Charite------------------36 Annual Report, Gorgas Hospital, 1931 37 Annual Report, Board of Health Laboratory 1931 38 Annual Report, Colon Hospital, 1931. 45 Annual Report, Corozal Hospital, 1931 ----------------------------6 Annual Report, Palo Seco Leper Colony, 1931 ----------------------49 Division of Sanitation: Organization and activities .50 Routine and special activities undertaken durng 1931 ------------------50 Routine activities. .50 Special projects undertaken in 193 ----------------------------0 Medical care of the population in the Madden Dam area 50 Anopheline mosquitoes of the Isthmus----------------------2 Special projects undertaken in Northern District-------------55 Special projects undertaken in Southern Division-Pedro M guel, Ancon-Balboa, and Panama-Suburban Districts-----------55 3

PAGE 5

CONTENTS-Continued. Division of Sanitation-Continued: Malaria in colored settlers (farmers) living $n the Canal Zone. Mosquito breeding areas in the vicinity of Panama City, and their cn trol by dusting with Paris green from air plas. 5 Drainage work---.-.-.-.-.-.-.-.-.-.-Trypanosomiasis in animals.--------.-------.....66 Experiments in composting manure Disposal of garbage, Pacific entrance to the CanaL--.--.-.---68 Health services in the terminal cities, Panama and Colon .69 Annual Report, Health Officer, Panama City--.-------69 Annual Report, Health Officer, Cristobal-Colon .------.--71 Annual Report, Division of Quarantine.-----------79 Annual Report of the District Nurse .81 Medical examination of school children .-. 8 Lead poisoning.------.----.-----General Tables: 1. Discharges from hospitals, deaths, and noneffective rates for employees--------.--------------2. Causes of deaths of employees arranged with reference to color, age, and length of residence on Isthmus----.-------86 W3. Deaths and death rates of residents of the Canal Zone and the cities of Panama and Colon-.-88 4. Deaths of residents of the Canal Zone and the cities of Panama and Colon, by cause, sex, color, and age ----------.90 5. Deaths of residents of the Canal Zone and the cities of Panama and Colon, by place of residence, absolute numbers and annual rates per 1,00--------._-----9.6. .9 6. Deaths of nonresidents by cause, sex, color, and age-.--.-.-.102 7. Statistics regarding American employees and their families. 104 8. Discharges and deaths in hospitals of The Panama Canal, absolute numbers------------------------.--.-. 106 8-A. Discharges and deaths in hospitals of The Panama Canal, rates per 1,000 population -----------------.16 9. Consolidated hospital and colony report..----.-125 10. Number of days hospital treatment furnished, and average number in hospital each day of the various classes of patients-.------.126 11. Consolidated admission report hospitals and dispensaries .126 12. Report of dispensaries--.----------------------------.127

PAGE 6

CALENDAR YEAR REPORT, 1931. HEALTH DEPARTMENT. ORGANIZATION AND ACTIVITIES. The Health Department is one of the five departments of the Panama Canal organization functioning directly under the Governor. It is charged with sanitation and the control and prevention of transmissible diseases in the Canal Zone and in Panama City and Colon, the treatment and hospital care of United States Government employees and their dependents, and others entitled to such care, the enforcement of quarantine regulations and the compilation of vital statistics for the Canal Zone and the cities of Panama and Colon. Its activities are conducted under the four principal divisions indicated in the organization chart on the following page. The administrative functions and activities of the various divisions were described briefly in the annual report for 1930. PERSONNEL. As the Panama Canal hospitals are used as general hospitals for the care of sick and injured military personnel of the Army on duty in the Panama Canal Department (military), a number of officers of the Medical Department of the Army (32 physicians and 1 dentist) ordinarily serve for a tour of duty of three years with the Panama Canal. During the year the usual changes incident to termination of tour of duty of such personnel have occurred. The principal changes in personnel assigned to key positions during the year as a result of termination of assignments, have been as follows: Superintendent of Colon Hospital, Maj. H. P. Makel, relieved by Maj. D.~ F. Winn. Chief of Medical Service, Gorgas Hospital, Maj. H. C. Dooling, relieved by Lieut. Col. E. R. Gentry. Assistant to Superintendent, Gorgas Hospital, Maj. J. W. Sherwood, relieved by a. .Co .i th5

PAGE 7

CHIEF HEALTH OFFICER ASSIST ANT CHIEf HEALTH OFFICERS SIONCWIOSPITI DIVISION Of SANITATION DIVISION OF HYOIENEI I SIO AT 11A HSPIT FIELD SANIT ATION -ME LTN OMFCER D B NURSING Dot ITOR L ICmELDSA PANAMA RL DA COLORRHIR LDWRIC [RN DIVISION NtALTh OFFICIJAttA A A;O COLON CHILD WILFrI,9 UA~a PALO P A N JAIPMNARIEN -l ORGANIZATION CHART HEALTH DEPARTMENT IALQA ANlGHT5, CAA E rEC.,E u1 pq3 ........ 0I

PAGE 8

The total personnel in the service of the Health Department on December 31, 1931, by units, as compared with the strength for preceding four years, is shown in the following table: FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER, EACH YEAR. 1927. 1928. 1929. 1930. 1931. S 0 E-4 E40 0 1CHief~ealthOffice. 6 .5. 5 7 7.,. 7 7 7 Gorgas Hospital. 163 248 411 166 259 425 176 299 475 167 267 434 169 243 412 ColonHospital. 24 37 61 24 38 62 25 52 77 29 54 83 32 55 87 Corozal Hokpital. 18 118 136 21 126 147 19 144 163 22 141 163 21 138 159 Linedispensaries. 12 9 21 14 9 23 18 9 27 16 15 31 17 15 32 PaloSecoLeperColony. 1 37 38 1 37 38 2 36 38 1 28 29 1 28 29 Quarantineservice. 12 23 35 12 25 37 10 23 33 11 20 31 12 20 32 Health Office, Panama. 11 125 136 10 125 135 11 128 139 11 118 129 11 118 129 HealthOffice,Colon. 8 90 98 8 85 93 9 88 97 9 87 96 8 89 97 Zoneanitation. 6 141 14 5 124 129 5 112 117 6 117 123 6 120 126 Total .261 8281,089 266 8281,094 282 8911,173 279 8471,12 284 8201,110 NoT.-"Gold" are white American employees, with the exception of two white aliens and one colored alien. "Silver" are alien employees, principally West Indians (colored). The distribution of the gold personnel, on the basis of professional or other qualifications, was as follows: 32 physicians, medical officers of the 8 dispensary assistants. U. S. Army. 5 pharmacists and assistant phar1 physician, surgeon of the U. S. macists. Public Health Service. 2 chemists 31 physicians, civilian. 2 general mechanics 1 dentist, U. S. Army. 2 stewardesses. 11 internes. 3 dietists. 9 male nurses. 1 storekeeper. 105 female nurses. 1 dental hygienist 2 district nurses. 1 vaccinator. 35 clerks. I carpenter foreman. 11 sanitary inspectors. 1 chauffeur foreman. 1 sanitary assistant. 1 ph.ysio-therapy aide. 2 quarantine inspectors. 1 electrician. 5 veterinarians. 1 embalmer. 8 technicians. FINANCIAL STATEMENT. The funds for the operation of the Health Department consist of direct appropriations from the Congress and earnings from various sources.

PAGE 9

4; OPERATING EXPENSES AND EARNINGS OF TE HEALTH DRPAJTMEN, CALENDAR YEAR 1931. Gross V8"' OperatingEPatien ds expelNes. ppra B _ tori Gorgas Hospital -..1$836,A6,67 $388,700.91 46 $5.07 $4.83 Colon Hospital.-. .2182,01574 95,094.35 52 4.39 4.65 Corozal Hospital (for the insane, chronics and cripples). 3181,024.26 161,651.95 89 .70 .72 Palo Seco Leper Colony. 47,214.57 20,759.50 44 1.35 1.36 Maritime QuarantineService. 578,823.48 25,305.76 32 Sanitation of Panama City and Colon -.-.-._.778,025.27 11,740.42 15 Street cleaning and garbage collection and disposal, Panama City and Colon--.139,375.37 '113,907.24 82 Canal Zone sanitation .144,018.98 47,291.10 33 Line dispensaries. 91,649.29 28,045.25 31 Medical storehouse .---.8,279.61 Chief Health Office and miscellaneous.-.-.-. 440,557.61 2,312.63 6 Total..._ 61,827,845.00 894,809.11 49 'Includes Army pay of Army medical offieio on duty in this institution which amounted to .$125Ai5.49 Also Includes cost of operation of Board of Health Laboratory. Includes Army of Army medial oers on dty in this institution whicb amounted to .26,502.40 Also includes cost of operating Colon Dispensary. Includes Army pay of Army medical officers on duty in this institution which amounted to .15,305.54 4 Includes Army pay of Chief Health Officer which amounted to .7,200.00 Total Army pay of Army medical officers on duty in Health Department. .174,5863. S Includes Public He I ervlce pay of Public Health Officer acting as Chief Quarantine Officer, which 4 amounted to. ..5,457.00 Includes Army and Publie Health Service pay, which amounted to. ..180,020.63 7 Includes $5,289 transferred to fine fund. SEarnings include the 75 per cent of total expense, plus 10 per cent overhead, which is billed against the Republic of Panama. 9 The Board of Health Laboratory is under the administrative jurisdiction of Gorgas Hospital for economy of operation and amounting, all expenses thereof being charged to Gorgas Hospital. This causes the cost per patient per day at Gorgas Hospital to appear higher than it actually is. Only about one-half of the work of the Labora as for Gorgas Hospital, and in order to arrive at a more accurate figure of cost per patient per the expenses of the Laboratory have been prorated to the hospitals on the basis of amount of work done for them, resulting in the revised figures shown for cost per patient per day. OPERATING EXPENSEs OF THE HEALTH DEPARTMENT, CALENDAR YEAR 1931 SHOWING AMOUNTS CHARGED TO VARIOus AccoUNTs. Gold pay roll (white employees): Panama Canal pay--. .$677,097.30 Army pay-.-. 174,563.63 Public Health Service pay -5,457.00 $857,111.93 Silver pay roll (colored employees) .-439,969".1, Subsistence supplies -. .210,769.70 Ice. .-. ..4,537.50 Hospitals supplies and drugs .78,749.03 Equipe nt ...16,167.86 Miscellaneous material and supplies .44,522.14

PAGE 10

01,000,00 -500,000 Toffil hospital patfie nt -da l' ; Tot Incomle 800,000 400,000 LuJ 600,000 300,000 Q Income hg sources below -----------Commercial 400,000 -----~ Misce llaneous income is f'ron -Nov% of he -Governmentfal Depor fments anc Ganal Divi ions. 200,000 Emplogees ~~-----_ ___ __ _Miscellaneous 0 _______ 11Z3 194 195 1926 19Z7 1928 19Z9 1930 031 CUT No. I.-Showing total hospital patient days, total earnings, and earnings by sources.

PAGE 11

-xx a s

PAGE 12

Laun ry .----. ----------..-. --.$39,255.14 Telephones .--.-.--.------------14,749.90 Rptriation of patients physically or mentally d isable--------423.17 >MedcaI storehouse operation --~-----------8,279.61 Launich service-.-.---------------------.6,289.85 Mechanical Division repairs, oxygen, and new launch for Palo Seco ~ 8,485.59 Electric current------------------------14,799.10 Electric repairs and installations-----------------3,347.21 Water.--.-------------------------12,339.94 :~Freight----__.----------------.------1,806.72 Motor transportation charges (except for hospitals, quarantine station, and dispensaries which operate their own motor vehices)--------------------------49,019.47 Repairs to motor vehicles of hospitals, dispensaries and quarantine station----.--------------.--------1,912.73 Rentals of quarters--------.---------------1,862.21 Building repairs and minor construction---------------3,918.23 Miscellaneous charges----------------------9,522.87 Total expenses-----------------1,827,845.00 The funds for the operation of the Health Department consist -of direct appropriations from Congress and earnings from various sources. -The extent to which the Health Department has been selfsupporting during the calendar years 1923 to 1931 inclusive, is shown in the following table: Gross operating Earnigs Per cent expenses. self-supporting. 1923. 5$1,415,944.19 5685,596.02 48 1934. 1,476,385.27 703,137.81 48 1925. .1,430,484.91 721,005.34 50 1926. 1,542,473.15 755,843.70 49 1927. 1,628,376.14 860,926.35 53 1928. 1,821,696.73 937,469.38 51 1929. 1,902,222.27 1,022,940.76 54 1930. 1,910,689.69 995,733.57 52 19i .1,827,845.00 894,809.11 49 The extent to which the various units of the Health Department were self-supporting during the years 1923-1931 is indicated in the following table: Per cent self-supporting (Army pay included) ____________Calendar years1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. G Hospital.50 52 53 51 57 54 52 49 46 C UlHopita. 39 41 39 37 44 44 52 59 52 Cra Hospita. ....82 81 82 80 85 76 88 86 89 &aoecGLeperCozny. 39 40 45 38 46 41 48 55 44 Liedsesre. 31 27 34 35 32 34 35 32 31 QurnieDivision. ....60 38 48 53 35 38 49 35 32 SaittinPanama and Colan. 13 17 20 18 11 13 16 .12 15 Street cleaning and garbage collection and removal, Panama City and Colon. 51 58 60 61 81 82 82 81 82 Zonemanitation. 43 39 37 ,29 29 29 37 38 33 whole. ........48 48 50 491 53 51 54 52 49

PAGE 13

10 The average cost per patient per day for hospital care and treatment in the various Panama Canal hospitals during the calendar years 1927 to 1931 has been as is indicated in the following table. These costs include operations, maintenance, and full salaries (that is, including the Army pay of Army medical officers assigned to the various hospitals), and the cost of operating the Board of Health Laboratory. Capital charge for construction, interest on physical plant values, and amortization charges are not included: Calendar years. 1927. 1928. 1929. 1930. 1931. Gorgas Hospital: (a) Including cost of Ancon Dispensary until September, 1929; also coet efBoard of Health Laboratory .4.66 4.68 5.08 5.40 5.07 (b) Including cost of Ancon Dispensary until September, 1929, but excluding cost of the Board of Health Laboratory chargeable to other divisions and outsiders. ......4.40 4.44 4.87 5.16 4.13 Colon Hospital (a) Including cost of Colon Dispensary. .8 .15 6.43 5.18 4.27 4 .39 (6) Including cost of Colon Dispensary; also including the cost of the work done for this hospital by the Board of Health Laboratory.,.6.70 8.96 5.55 4.55 4.05 Corosal Hospital: (a) Including coat of operation of dairy until December, 1930; also including cost of operating gardens and cemetery ..94 1.00 .90 .88 .70 (b) Same as above, also including cost of the work done for this hospital by the Board of Health Laboratory ...96 1.03 .92 .90 .72 Palo Seco Leper Colony (a). ............12 .9 12 .61 (i) Including cost of the work done for this institutioniby the~ .0 13 .5 L6 13 Board of Health Laboratory. 1.21 1.40j 1.26 1.07 1.30 VITAL STATISTICS-POPULATIONS OF THE CANAL ZONE, PANAMA CITY, AND COLON. The Health Department of the Panama Canal secures, analyzes and makes reports on the vital statistics (births, deaths, and disease rates) of three geographical units of the population residing on the Isthmus of Panama, namely, the population of the Canal Zone, of the city of Panama, and of the city of Colon. Properly to interpret these statistics, it is essential that there be some understanding of the composition of the various units of the popula. tion, their movement, and some of the special local factors involved which usually are not encountered in stabilized populations of communities in the various parts of the world. The special factors involved were discussed somewhat in detail in the annual report of the Health Department for 1930 (pages 12 to 15, inclusive). This report can be obtained on request to the Chief Health Officer, Balboa Heights, Canal Zone.

PAGE 14

11 The Republic of Panama takes a census every 10 years, the last enumeration having been made in 1930. In Panama City, from 1920 to 1930, the population made an average increase per year of almost exactly 1,500, and that figure has been used as the factor in computing the population each year by arithmetical progression, using the 1920 and 1930 census figures as the bases. For 1931, the factor was again ddto the 1930 census total, and 76,000 was adopted, the round numbers to indicate an estimate and not actual enumeration. In Colon, from 1920 to 1930, there was an average decrease of 150 per year, and that figure has been used as the factor in computing the population each year by arithmetical progression, using the 1920 and 1930 census figures as the bases. As there is some doubt as to the accuracy of the 1930 census of Colon, 30,000 was adopted for 1931. The population of the Canal Zone consists of white American employees and their families, colored alien employees and their families, military and naval garrisons, representatives of shipping companies, 'contractors, church and welfare workers, etc., and colored alien agriculturists who rent land under revocable licenses. The term "employees" as used in Health Department reports includes employees of the Panama Canal proper and the Panama Railroad Company, which is a corporation owned by the United States Government. GENERAL DEATH RATES, ALL CAUSES, AND FROM DISEASE ONLY. Population, Canal Zone.-Death rates from all causes are available since the beginning of construction (1905) and those from disease only are readily available since 1913. These data are incorporated and shown graphically in the two tables following:

PAGE 15

DEATHS FROM ALL CAUSES, CANAL ZoNE POUAONEPLESAN %N AE P.YEEK) Absolute numbers and rates per 1,000 of popuatioi. SDeaths Rate Year. Populafrom all per tion. cauSes. 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. 1927 36,794 298 8.10 1928 37,056 316 8.53 1929 38,825 -298 7.67 1930 39,467 282 7.14 1931 40,565 305 7.52 DEATHS FROM DISEASE ONy, CANA: ZONE POPULATION (EMPLOYES ANqN NONEMPLOYEES). Absolute numbers and rates per 1,000 of population. Deaths Rate Year. Popuila-~ from dieper tion. eas IN-y .,0 N. 1913 61,700 890 14.43 1914 46,379 614 13.24 1915 31,496 361 11.30 1916 31,447 290 9.22 1917 33,044 273 8.26 1918 33,803 216 6.36 1919 32,366 207 8.40 1920 27,459 211 7.68 1921 31,377 211 6.72 1922 31,098 220 7.08 1923 31,793 227 7.14 1924 33,723 270 8.01 1925 34,840 241 6.92 1926 36, 480 245 6.72 1927 36, 794 265 7.20 1928 37,056 273 7.37 1929 38,825 263 6.77 1930 39,467 242 6.13 1931 40,565 247 6.09 L.x ..4 .N N

PAGE 16

13 There has been gradual reduction in total death rates as well as death rates from disease, though the former rose slightly in 1931 over the low 7.14 in 1930. The rate of reduction can best be determined by comparing rates during the latter part of the construction period with those prevailing during recent years. These comparisons by S-year periods for the Canal Zone are as CANAL ZONE DEAiTH RATES BY 5-YEAR PERIODS. 1912-16. 1917-21. 1922-26. 1927-31. Ttal death rates per 1,000 population ..14.54 8.47 8.29 7.78 ath razfromisease perlOO0 population. .12.60 7.07 7.16 6.69 S1913-16. The progress being made in health conservation is best measured by comparing the death rates for disease only. The new factor now affecting the population of the Canal Zone is the advancing age of the employee, more particularly the colored element. With advancing age and greater prevalence of chronic degenerative diseases in this group it is doubtful if further material reduction in death rates can be attained. It is worthy of note that the death rate for disease only for 1931 was the lowest ever recorded in the population of the Canal Zone. Panama City.-Total death rates and those for disease only are incorporated and presented graphically in the tables following: DEATHS FROM ALL CAUSES, CITY OF PANAMA. Absolute numbers and rates per 1,000 of population. Deaths Rate Year. Populafrom all per tion. causes. 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 6p,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 59,458 1,297 21.81 1921 61,000 1,336 21.90 1922 62,500 1,279 20.46 1923 64,000 1,106 17.28 1924 65,500 1,168 17.83 1925 67,000 1,169 17.45 1926 .68,00 ,188 17.34 1927 70,000 1,248 17.83 1928 71,;500 1,434 20.06 1929 73,000 1,413 19.36 1930 74,402 1,307 1.57 9 76,00 1,341 17.64

PAGE 17

14 DEATHS FROM DISEASE ONLY, CITY OF PANAMA. Absolute numbers and rates per 1,000 of population. Deaths Rate Year. Populafrom disper tion. ease only. 1,000. 1913 47,172 1,425 30.21 1914 53.948 1,772 32.85 1915 60,373 1,749 28.97 1916 60,778 1,702 28.00) 1917 61,074 1,661 27.20 1918 61,369 1,284 20.92 1919 61,369 1,165 18.98 1920 59,458 1,246 20.96 1921 61,000 1,286 21.08 1922 62,500 1,241 19.86 1923 64,000 1,078 16.84 1924 65,500 1,128 17.22 1925 67,000 1,126 16.81 1926 68,500 1,152 16.82 1927 70,000 1,201 17.16 1928 71,500 1,390 19.44 1929 73,000 1,370 18.77 1930 74,402 1,251 16.81 1931 76,000 1,274 16.76 The death rate for disease only for Panama City, in 1931, was the lowest for any year of record. Examination of these tables indicates that the rates have gradually decreased. The trend downward, particularly for disease only, can best be appreciated by considering the rates by 5-year periods: PANAMA CITY DEATH RATES BY 5-YEAR PERIODS. 1912-16. 1917-21. 1922-26. 1927-31. Totaldeathrates per1,000population. 30.91 22.59 18.05 18.48 Death rates from disease per 1,000 population ..29.91 21.83 17.48 17.77 '1913-16. City of Colon.-The general death rates and those from disease only are presented and shown graphically in the tables following:

PAGE 18

1Y5 DEATHS FROM ALL CAUSES, CITY OF COLON. Absolute numbers and rates per 1,000 of population. Deaths Rate Year. POPulafrom all per tion. causes. 1,000. 1905 11,176 553 49.48 1906 13,651 703 51.50 1907 14,549 571 39.25 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 31,203 554 17.75 1921 31,050 497 16.01 1922 30,900 445 14.40 1923 30,750 393 12.78 1924 30,600 475 15.52 1925 30,450 401 13.17 1926 30.300 452 14.92 1927 30,150 423 14.03 1928 30,000 442 14.73 1929 29,850 492 16.48 1930 29,765 518 17.40 .1931 30,000 482 16.07 DEATHS FROM DISEASE ONLY, CITY OF COLON. Absolute numbers and rates per 1,000 of population. Deaths Rate Year. Populafrom disper tionease only. 1,000. 1913 20,232 460 22.74 1914 23,265 563 24.20 1915 29,331 604 20.59 1916 24j693 662 26.81 1917 25,386 642 25.29 1918 26,078 587 22.51 1919 26,078 536 20.55 1920 31,203 517 16.57 1921 31,050 468 15.07 1922 30,900 421 13.62 1923 30,750 377 12.26 1924 30,600 455 14.87 1925 30,450 379 12.45 1926 30,300 427 14.09 1927 30,150 404 13.40 1928 30,000 426 14.20 1929 29,850 467 15.64 1930 29,765 490 16.46 1931 30,000, 457 15.23

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16 The records indicate a downward trend in both rates until a 1924, since which time there has been a tendency to increase. general trend can best be shown by comparing the average rates for 5-year periods: COLON DEATH RATES BY 5-YEAR PERIODS. 1912-16. 1917-21. 2 1927-. Totaldeathrates per 1,000population. 24.71 20.79 14.1 1.4 Death rates from disease per 1,000 population. 23.47 19.67 13.4f 14.18 .1913-16. The trends fpr general death rates and death rates for disease only were downward between 1911 and 1923, since which time there has been an increase. The increase during recent years is probably a seeming rather than an actual one. The recorded population figures of Colon for 1930 show an actual decrease in population since 1921. It has been suggested that enumeration of the population was not complete during the last census (1930) and that as a matter of factthere has been slight but continuous increase in population since 1921. BIRTH RATES, CANAL ZONE, PANAMA CITY, AND COLON. In analyzing birth rates it is important for many reasons to have knowledge not only of the total rate for the new born, but to know also the rate of those born alive and of the stillborn. The data necessary for such tabulation are available since 1916. BIRTHS, CANAL ZONE POPULATION (EMPLOYEES AND NONEMPLOYEES). ABSOLUTE NUMBER AND RATES PER 1,000 OF POPULATION. Births. (Absolute numbers.) Rate per 1,000 population. Year. Population. Born StillBorn S&il Total. .Total. alive. born. 1916. 31,447 673 640 33 21.40 20.35 1.05 1917. 33,044 712 669 43 21.55 20,25 1.30 1918. 33,803 770 725 45 22.78 21.45 1.33 1919. 32,366 732 695 37 22.62 21.47 1.14 1920. 27,459 667 631 36 24.29 22.98 1 1921. 31,377 807 776 31 25.72 24.73 -.9 1922. 31,098 722 691 31 23.22 22.22 1.00 1923. 31,793 623 591 32 19.60 18.59 1.01 1924. 33,723 730 694 36 21.65 20.58 1.07 1925. 34,840 651 616 35 18.68 17.68 1.00 1926. 36,480 669 635 34 18.34 17.41 .9q 1927. 36,794 579 547 32 15.74 14.87 .87 1928. 37,056 550 513 37 14.84 13.84 1.00 1929. 38,825 538 508 30 13.85 13.08 77 1930. 39,467 524 492 32 13.28 12.47 .81 1931. .40,565 515 480 35 12.69 11.83 .86

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17 A cursory examination of this table discloses the fact that there has been a striking decrease in birth rates in the Canal Zone since 1916 which can best be appreciated by comparing the average rates by 5-year periods: CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS. 1917-21. 1922-26. 1927-31. Total birth rate per 1,000 population. 23.33 20.22 14.04 Livebirthrateper1,000population. 22.12 19.22 13.18 Stillbirth rate per 1,000 population. 1.21 1.00 .86 The marked decrease in total birth rates during recent years is attributable in large measure to the following factors: Advancing age of the employees who entered service during the construction period; large proportion of generation born in Canal Zone has not yet attained maturity and married; and large unmarried group of military population. The crude birth rate for 1931 was the lowest of record. That progress is being made in maternity welfare activities is evidenced by the fact that the rate for the stillborn is gradually decreasing: 1917-1921, 1.21; 1927-1931, 0.86. The population of the Canal Zone is made up of two quite distinct elements, (a) white American employees, Army and Navy officers and their families, and Army and Navy enlisted personnel, and (b) colored alien employees and agriculturists and their families. It is possible to examine more in detail the birth rates for these two elements of the population. It should be remembered, however, that the large number of unmarried enlisted personnel of the Army and Navy (approximately 9,300 during 1931) results in an abnormally low birth rate among the white population. The rates for the two groups are incorporated in the two tables following: BIRTHS, CANAL ZONE-WHITE ONLY. Births, absolute numbers. Rate per 1,000 population. Year. White population. T Born StillBorn StillTotalalive. born. Total. alive, born. 19161,. 15,063 186 172 14 12.35 11.42 .93 1917. 18,108 237 225 12 13.09 12.43 .66 1918. .18,220 266 255 11 14.60 14.00 .60 1919. 14,694 250 242 8 17.01 16.47 .54 1920. 14,224 239 231 8 16.80 16.24 .56 1921. .16,442 311 301 10 18.91 18.30 .61 1922. 14,083 247 242 5 17.54 17.18 .36 1923. 15,483 212 206 6 13.69 13.30 .39 1924. 16,187 267 255 12 16.49 15.75 .74 1925. 15,817 201 193 8 12.71 12.20 .51 1926. 17,036 230 222 8 13.50 13.03 .47 1927. .16,521 173 169 4 10.47 10.23 .24 1928. 16,712 178 170 8 10.65 10.17 .48 1929. 16,967 181 176 5 10.66 10.37 .29 1930. 16,511 159 154 5 9.63 9.33 .30 1931. 18,157 186 178 8 10.24 9.80 .44 MR 31053--2

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18 BIRTHS, CANAL ZONE-COLORED ONLY. Births, absolute number. Rate per 1,000 population Year Colored population. Bon Sill T Born Stll Total. alie. br. Total. alv, ban. 1916 ..16,384 487 468 19 29.72 28.56 1.10 1917. 14,936 475 444 31 31.80 29.73 2.07 1918. 15,583 504 470 34 32.34 30.16 2.18 1919. .17,672 482 453 29 27.27 25.63 1.04 1920. ..13,235 428 400 28 32.34 30.22 2.12 1921. 14,935 496 475 21 33.21 31.80 1.41 1922. 17,015 475 449 26 27.92 26.39 .V 1923. 16,310 411 385 26 25.20 23.61 1.59 1924. 17,536 463 439 24 26.40 25.03 1.37 1925. 19,023 450 423 27 23.66 22.24 1.42 1926. 19,444 439 413 26 22.58 21.24 1.34 1927. 20,273 406 378 28 20.03 18.65 1.38 1928. 20,344 372 343 29 18.29 16.86 1.43 1929. 21,858 357 332 25 16.33 15.19 1.14 1930. ..22,956 365 338 27 15.90 14.72 1.18 1931. .22,408 329 302 27 14.68 13.48 1.20 It will be noted that since 1924 birth rates have gradually declined in both groups of the Canal Zone population. The rate'of decline has been much greater in the colored population than in the white American. The low birth rate in the white population as compared with the colored is attributable in part to the inclusion in the white population of the large group of unmarried military and naval personnel (approxi: mately 9,300). The rate of decline in both groups can best be appreciated by comparing average rates by 5-year periods: CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS, BY COLOR. 1917-21. 1922-26. 1927-31. White. IColored. White. Colored. White. Colored. Total birth rate per 1,000 of population. .....15.95 31.23 14.72 25.05 10.33 16.96 Livebirthrateperl,000ofpopulation. 15.35 29.36 14.22 23.61 9.98 15.70 Stillbirth rate per 1,000 of population. .60 1.87 .50 1.44 .35 1.26 Panama City.-The birth rates for Panama City are incorporated in the following table: BIRTHS, PANAMA CITY. ASOLUT NUMBERS AND RATES PE 1,000 F POPULATION. Births, absolute numbers. Rate per 1,000 population. Year. Population. Ya.Pplto.Born. stillBorn. stillTotal. alive. .Total. alive. born. 1916. 60,778 2,598 2,371 227 42.75 39.01 3.73 1917. 61,074 2,772 2,578 194 45.39 42.21 3.18 1918. 61,369 2,472 2,308 164 40.28 31.61 2.67 1919. 61,369 2,359 2,214 145 38.44 36.08 2.36 1920. 59,458 2,532 2,376 156 42.58 39.96 2.62 1921. 61,000 2,311 2,173 138 37.89 35.62 2.26 1922. 62,500 2,162 2,058 104 34.59 32.93 1.66 1923. 64,000 2,163 2,043 120 33.80 31.92 1.88 1924. 65,500 2,271 2,144 127 34.67 32.73 1.94 1925. .67,000 2,339 2,220 119 34.91 33.13 1.78 1926. .68,500 2,117 2,003 114 30.91 29.24 1,67 1927. 70,000 2,509 2,389 120 35.84 34.13 1.71 1928. 71,500 2,578 2,458 120 36.06 34.38 1.68 1929. 73,000 2,517 2,392 125 34.48 32.77 1.71 1930 .74,402 2,760 2,626 134 37.09 35.29 1.80 1931. .76,000 2,527 .2,408 119 33.25 31.68 1.57

PAGE 22

19 The total rates for Panama City have been fairly stationary for the (past 15 years, with a slight tendency to decrease for the period as a whole. Increasingly larger numbers of prospective mothers are now admitted to hospital for confinement, and it is estimated that at the present time, of all births in Panama City, about 50 per cent are born in Santo Tomas Hospital. The midwives, during recent years, have been more closely supervised, arnd during the past two years their work has been under the constant supervision of a visiting nurse with special training in midwifery. That these measures are beginning to show results is evidenced by the downward trend in the stillbirth rates. The rate for stillborn during 1931 was the lowest of record. The trend of total birth rates, live birth rates, and stillbirth rates is shown in the following averages of rates by 5-year periods for the past 15 years: PANAMA CITY BIRTH RATES BY 5-YEAR PERIODS. 1917-21. 1922-26. 1927-31. Total birth rate per 1,000 population. .40.90 33.75 35.33 Live birth rate per 1,000 population. 38.28 31.97 33.64 Stillbirthrateperl,000population. .,. .2.62 1.78 1.69 Colon.-The data concerning birth rates for the city of Colon are incorporated in the following table: BIRTHS, COLON. ABSOLUTE NUMBERS AND RATES PER 1,000 OF POPULATION. Births, absolute numbers. Rate per 1,000 population. Year. Population. Born. StillBorn. StillTotalalive. born. Total. alive. born. 1916. 24,693 814 757 57 32.96 30.66 2.31 1917. .25,386 958 891 67 35.77 33.25 2.52 1918. 26,078 861 795 66 33.02 30.49 2.53 1919. 26,078 964 908 56 36.97 34.82 2.15 1920. 31,203 1,014 962 52 32.50 30.83 1.67 1921. 31,050 969 919 50 31.21 29.60 1.61 1922. 30,900 810 759 51 26.21 24.56 1.65 1923. 30,750 748 709 39 24.33 23.06 1.27 1924. 30,600 726 690 36 23.73 22.55 1.18 1925. 30,450 800 769 31 26.27 25.25 1.02 1926. 30,300 755 712 43 24.92 23.50 1.42 1927. 30,150 795 737 58 26.37 24.44 1.92 1928. 30,000 801 760 41 26.70 25.33 1.37 1929. 29,850 866 822 44 29.01 27.54 1.48 1930. 29,765 912 877 35 30.64 29.46 1.18 1931. 30,000 919 870 49 30.63 29.00 1.63 The general trend in birth rates for Colon since 1917 has been a declining one though not so noticeable as for Panama City. Considering the rate by 5-year periods for the past 15 years, the averages for each period are as follows: 1917-21. 1922-26. 1927-31. Total birth rate per 1,000 population ...34.09 25.09 28.66 Live birth rate per 1,000 population .32.01 23.78 27.15 Stillbirth rate per 1,000 population. 2.08 1.31 1.51

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20 The increase in birth rates for the last 5 years is probably a seeming rather than actual one attributable in all probability to error in population figures. INFANT MORTALITY RATES, CANAL ZONE, PANAMA CITY, AND COLON. Records of infant mortality for the three groups of population concerned, Canal Zone, Panama City, and Colon, have been compiled since 1916 and the data are presented in the following table: INFANT MORTALITY, CANAL ZONE, PANAMA CITY, AND COLON. (Deaths of children under one year of age.) ABSOLUTE NUMBERS AND RATES PER 1.000 OF LIVE BIRTHS. Canal Zone. Panama. Colon. Live births. Deaths. Live Live Absolute American Foreign births. Deaths. births. Deaths. Year. numbers. (white). (colored). Total. Ye -r .-r 1916, ..172 468 640 7 42 70 149 77 120 2,371 616 260 757 185 244 1917. 225 444 669 4 18 80 180 84 126 2,578 668 259 891 222 249 1918. 255 470 725 5 20 55 117 60 83 2,308 414 180 795 156 197 1919 ...242 453 695 9 37 70 155 79 114 2,214 342 154 908 141 155 1920. ..231 400 631 8 34 52 130 60 95 2,376 369 155 962 137 142 1921. ...301 475 776 10 33 65 137 75 97 2,173 378 174 919 128 139 1922. ....242 449 691 10 41 54 120 64 93 2,058 303 147 759 106 140 1923. 206 385 591 9 44 34 88 43 73 2,043 290 142 709 82 116 1924. ..255 439 694 12 47 55 125 67 97 2,144 296 138 690 79 115 1925 ..193 423 616 7 36 41 97 48 78 2,220 260 117 769 90 117 1926. .222 413 635 1 13 59 44 107 57 90 2,003 289 144 712 92 129 1927. .169 378 547 5 30 54 143 59 108 2,389 287 120 737 80 109 1928. ..170 343 513 1 16 94 43 125 59 115 2,458 364 148 760 79 104 1929. ...176 332 508 8 45 40 120 48 94 2,392 339 142 822 95 116 1930. .154 338 492 8 52 32 95 40 81 2,626 319 121 877 95 108 1931 ..178 302 480 5 28 29 96 34 71 2,408 342 142 870 95 109 The better to visualize any results being obtained in the reduction of infant mortality rates in the three groups of the population concerned, the average rates for each group by 5-year periods 1917-1921, 19221926, and 1927-1931, are tabulated below: INFANT MORTALITY RATES FOR 5-YEAR PERIODS, CANAL ZONE AND CITIES OF PANAMA AND COLON. Canal Zone. Period. Panama. Colon. White. Colored. Total. 1917-21. 28.71 143.62 102.40 186.37 175.20 1922-26. 45.62 108.11 86.46 137.37 123.39 1927-31. .50.77 116.95 94.49 134.52 109.20

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21 Canal Zone.-Infant mortality rates in the white American population of the Canal Zone have been quite satisfactory, ranging between 18 and 59 per 1,000 live births for the years 1917 to 1931 inclusive, except for 1928 when the rate was 94. For the colored population the variation during the sanle period has been between 88 and 180. The infant mortality rates in this group were considerably in excess of 100 (107 to 143) during the years 1926 to 1929 inclusive, and for 1931 they still were 96. Efforts are being made to lower these rates through a visiting nurse service. As a result of a low rate in the white American population (28) the general infant mortality rate for the Canal Zone for 1931 was the lowest of record (71). Panama City.-Considerable progress has been made since 1917 in reducing infant mortality rates in Panama City. The rates for the 5-year period 1917-1921 average 186 per 1,000 live births, whereas for the period 1927-1931 they had been reduced to 135. Colon.-Excellent progress has been made in reducing the infant mortality rates in Colon. For the 5-year period 1917-1921 the rate averaged 175, whereas for the period 1927-1931 it had been reduced to 109. PRINCIPAL CAUSES OF DEATH, CANAL ZONE, PANAMA CITY, AND COLON. It has been customary in the Health Department annual reports of recent years to report the six principal causes of death from disease in Panama Canal employees and in the populations of the cities of Panama and Colon. Commencing with last year's report, comparable data for the entire population of the Canal Zone have been included. The statistics for the past five years for the three population groups involved, Canal Zone, Panama City, and Colon, are being included in this report. Comparable rates for Panama Canal employees are included in a subsequent section. Principal causes of death, Canal Zone population.-The data on this subject are incorporated in the following table: SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, CANAL ZONE POPULATION, 1927-1931. ABSOLUTE NUMBERS AND RATES PER 1,000. 1927. 1928. 1929. 1930. 1931. Population. .36,794 37,056 38,825 39,467 40,565 Rate Rate Rate Rat e Rate Disease. Numper Numper Nunfper Numper Numper ber. 1,0o0. ber. 1,000. her. 1,000. ber. 1,000. her. 1,000. Pneumonia (broncho and lobar) 24 .652 36 .972 27 .695 30 .785 23 .567 Tuberculosis (various organs) .18 .489 25 .674 34 .876 20 .507 19 .468 Syphilis. .18 .489 11 .297 11 .283 10 .253 11 .271 Organicdiseasesoftheheart. 17 .462 11 .297 15 .386 22 .557. Nephritis (acute and chronic). ..16 .435 19 .513 23 .592 21 .532 18 .444 Cancer (various organs). .13 .353 16 .432 16 .412 15 .405 15 .370 Diseasesof thearteries. .......11 .271

PAGE 25

22 Tuberculosis and pneumonia usually take the greatest toll of life in' the population of the Canal Zone; diseases of the chronic degenerative type such as nephritis, cancer, and organic disease of the heart are being noted with greater frequency as the principal cause of death, although deaths from heart disease declined td nine in 1931. Tuberculosis and the pneumonias affect the colored populations to a far greater extent than the white. For the current year the death rates from these two diseases ranged slightly lower than for any year during the past four years. Principal causes of death, Panama City.-The six principal causes of death in the population of Panama City for the past five years are shown in the following table: SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, PANAMA CITY, 1927-1931. ABSOLUTE NUMBERS AND RATES PER 1,000. 1927. 1928. 1929. 1930. 1931. Population. .70,000 71,500 73,000 74,402 76,0%-_ Rate Rate Rate Rate Rate Disease. Num pr Numper -Nume ber. 1, b ,o0.ber. 1,000.bDre 1,o00. per. 1,000. Pneumonia(bronchoandlobar). 187 2.67 248 3.47 231 3.16 180 2.42 202 2.86 Tuberculosis (various organs). ...180 2.57 227 3.17 204 2.79 208 2.80 218 2.87 Diarrhea and enteritis, including colitis. 122 1.74 117 1.64 148 2.03 98 1.32 135 1.78 Organicdiseasesoftheheart. 112 1.60 105 1.47 118 1.62 98 1.32 -137 1.80 Nephritis (acute and chronic). 105 1.50 115 1.61 114 1.56 113 1.52 64 .84 Cancer (various organs) ..56 .80 ....67 .92 59 .79 62 .82 Syphilis. ....48 .67 ... As is the case with the population of the Canal Zone, tuberculosis and the pneumonias are the leading causes of death. Death rates from these two diseases are much higher in Panama City than in the population of the Canal Zone. The death rates from tuberculosis in the Canal Zone ranged between 0.47 and 0.88 per 1,000 population for the years 1927-1931, whereas comparable rates in Panama City ranged between 2.57 and 3.17. The differences in rates are attributable in large measure to housing conditions in Panama City and the economic status of the populations affected. A similar disparity will be noted between death rates from the pneumonias in Panama City and the Canal Zone. The very high rates in Panama City as compared with the Canal Zone are attributable to the factors cited in the-case of deaths from tuberculosis. Principal causes of death, Colon.-The six principal causes of death in the population of Colon, for the years 1927 to 1931, are shown in the following table:

PAGE 26

23 SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 1927-1931. ABSOLUTE NUMBERS AND RATES PER 1,000. 1927. 1928. 1929. 1930. 1931. Population .30,150 30,000 29,850 29,765 30,000 Rate Rate Rate Rate Rate Diseases. Numper Numper Numper Numper Numper ber. 110W. ber. 1,000. ber. 1,000. ber. 1,000. ber 1,000. Tuberculosis (various organs) 80 2.65 63 2.10 64 2.14 71 2.39 90 3.00 Pneumonia(bronchoandlobar). 39 1.29 68 2.27 63 2.11 49 1.65 51 1.70 Nephriti (aeute and chronic ). .37 1.23 23 .77 30 1.01 41 1.38 24 .80 Diarrhea and enteritis,including colitis. 27 .90 27 .90 31 1.04 34 114 26 .87 Cancer daiou orgh. .26 .86 26 .87 Organi dsaeof~theheat. .22 .73 ..28 .94 32 1.08.32 1.97 Apoplexy. ...19 .63 28 .94 ..23 .77 Syphilis. ......26 .87. It will be noted as was the case in the other groups of the population of the Isthmus, that the leading causes of death are tuberculosis and the pneumonias. The most interesting point to be noted is that the death rates from both tuberculosis and the pneumonias are very materially lower in Colon than in Panama City, the higher rate for tuberculosis in Colon in 1931. being an exception. The average rates per 1,000 population per annum for the 5-year period 1927-1931 are as follows: AVERAGE DEATH RATES PER 1,000 POPULATION PER ANNUM FOR 5-YEAR PERIODS, 1922-1926, AND 1927-1931, FROM PNEUMONIAS AND TUBERCULOSIS. Panama. Colon. Pneumonias, 1922-1926. ...2.89 1.38 Pneumonias,1927-1931. 2.87 1.80 Tuberculosis, 1922-1926. 3.14 2.37 Tuberculosis, 1927-1931. .2.84 2.46 The factors probably responsible for this discrepancy are not known. On the average, housing conditions in Colon are better than in Panama City. The rates for Panama City are artificially high due to the fact that the principal Panamanian Government hospital (Santo Tomas) is located in Panama City and patients treated in that hospital who actually reside in the provincial districts not infrequently give a Panama City address as their place of residence. ACUTE TRANSMISSIBLE DISEASES REPORTED IN 1931. Beginning with the annual report of 1929, a table was introduced showing the number of cases of transmissible diseases reported to the Health Department of the Panama Canal The reports for the Canal Zone are quite complete, but for Panama City and Colon they are not

PAGE 27

24 so complete, especially for the less serious diseases such as whooping cough, mumps, etc. The cases reported during 1931 are incorporated in the following table: CONTAGIOUS AND INFECTIOUS DISEASES, CASES AND DEATHS, REPORTED TO THE CHIEF HEALTH OFFICER DURING THE YEAR 1931. Reported place of infection. Outside the Panama Colon. Canal Zone. Zone and termiTotal. Disease. nal cities. New New New New New eases. Deaths. cases. Deaths. Ce. Deaths. cases. Deaths. cam. Deaths. Chickenpox. 81 24 53 16 .174 .. Diphtheria. 57 1 20 7 32 2 116 3 Dysentery, amebic. 18 3 4 ., 2 24 .48 3 Dysentery, bacillary (unclassified). 1 1 1 1 1 1 3 3 Malaria. 234 6 62 2 1,235 13 586 23 2,117 44 Measles. 372 1 45 1 43 28 488 2 Meningitis, meningococcus. 1 2 1 3 1 3 9 2 M umps. .4 ....2 1 7 Pneumonia. () 202 () 51 (1) 23 (s) 52 (r) 328 Poliomyelitis. ....1 2. Relapsing fever .1 Scarletfever. 2 10 7 1 20 Trachoma.,. Tuberculosis. .() 218 ) 90 9 45 372 Typhoidfever. 3 5 1 1 8 .17 1 Paratyphoid fever Whooping cough 26 3 .55 1 40 12. .3. .5 Maritime quarantinable diseaes. Cholera. Leprosy. 1 2 .5 5 8., 8 Plague. Smallpox ..2.2 Yellow fever. Typhus fever .2 .2 As many cases of pneumonia and tuberculosis are not reported unless death occurs, this report shows only the number of deaths from these two diseases. j Sporadic cases which in some respects resembled clinically mild typhus as itoccurs in the United States (Brill's disease), giving positive Weil-Felix reaction. This table gives one a definite conception of the types of transmissible diseases that are most commonly encountered in this region. In general terms the data show the following facts so far as the populations of the Canal Zone, Panama City, and Colon are concerned. The so-called intestinal group of diseases (typhoid and para-typhoid fevers and the dysenteries) are of rare occurrence. The fatality rate in diphtheria is very low. While measles is of not uncommon occurrence it is but seldom complicated by pneumonias and the fatality rate is low. Scarlet fever and meningococcus meningitis but rarely occur and usually a considerable proportion of the few cases of meningitis occur in military personnel, the disease having been contracted in the United States (recruits en route to foreign service). In cities so closely surrounded by a large rural population heavily infected with malaria the difficulties in deciding as to the place of infection with malaria parasites are obvious. Pneumonia and tuberculosis are very common, with high fatality rates.

PAGE 28

25 VITAL STATISTICS, PANAMA CANAL EMPLOYEES. Statistics covering this particular group of the population are quite complete. Force reports showing total number of employees are constantly available, and when time is lost on account of illness record is made of that fact. Reports of diagnosis of cases in quarters on account of convalescence after hospitalization or on account of minor complaints, ordinarily are not recorded in morbidity reports, except in the case of malaria. Malaria constitutes the most important cause of noneffectiveness in employees and all clinical cases requiring treatment by a physician (hospital or quarters) are made the subject of a special report and included in the statistics on malaria, and in data relating to admission rates to hospitals and quarters and noneffective rates. In August, 1930, a new policy was put into effect that should have a tendency to reduce the malaria rates among employees. In large construction projects in nonsanitated areas, much of the labor is drawn from nearby villages-sometimes as high as 50 per cent-and a considerable number of the laborers from such sources are carriers of the malarial parasite but have no clinical symptoms. Formerly, not until these laborers became ill, and upon being sent to the District physician were found to have malaria, did they receive treatment for malaria: In August, 1930, the policy was adopted of making routine monthly blood surveys of laborers engaged on such projects, and administering quinine regularly to those found to be positive, irrespective of the fact that they had no clinical symptoms. It can be assumed that a certain proportion (just what proportion we do not venture to estimate) of the individuals so treated would, if not so treated, come down with subjective and objective symptoms of malaria at one time or another. The individuals found positive for malaria in this group, practically all of whom are residents of native villages and employed temporarily by the Panama Canal, are not included in the Health Department malaria statistics unless they become ill and lose time from their work on account of malaria. The routine survey and treatment of this group should tend to bring about a slight reduction in general malaria rates in employees. It should also be pointed out that statistics relating to employees are not representative of a homogeneous geographical group of the population. The American white employees of the Canal reside in the Canal Zone under hygienic and environmental conditions that are quite satisfactory. The Panama Canal, however, employs approximately 11,000 colored alien individuals only about one-third of whom live T, 0

PAGE 29

26 in the Canal Zone, the remainder, with their families, living in Panama City, Colon, and elsewhere, under much less favorable hygienic conditions. In the interpretation of statistics relating to employees, it is therefore necessary to give consideration to the factors outlined above, as well as to those mentioned in this report in the introductory paragraphs on vital statistics for the Isthmus of Panama. (See page 10 of this report and page 12 of the annual report for 1930.) EMPLOYEES, GENERAL DEATH RATES, ALL CAUSES. Death rates among employees from all causes for the period 1906 to 1931 are incorporated in the following table: EMPLOYEES, DEATHS FROM ALL CAUSES. Absolute numbers and rates per 1,000 employees. Average Number Rate Year. number Of per Yea employed. deaths. 1,000. 1906 26,547 1,105 41.70 1907 39,238 1,132 28.85 1908 43,890 571 13.01 1909 47,167 502 10.64 1910 50,802 558 10.98 1911 48,876 539 11.02 1912 50,893 467 9.18 1913 56,654 473 8.35 1914 44,329 312 7.04 1915 34,785 201 5.77 1916 33,176 200 6.03 1917 32,589 231 7.09 1918 25,520 207 8.11 1919 24,204 175 7.23 1920 20,673 180 8.70 1921 14,389 93 6.46 1922 10,447 72 6.89 1923 10,976 73 6.65 1924 11,625 84 7.23 1925 12,180 109 8.95 1926 12,732 115 9.03 1927 13,561 122 9.00 1928 14,260 142 9.96 1929 16,193 168 10.37 1930 15,524 180 11 59 1931 14,597 133 9.11 Since 1921, the general tendency has been for death rates for employees to increase, though the rate for 1931 was an exception. The rates during the early construction period were high (1906-1910, 18.63). After completion of the Canal when the population became stabilized and the employees were still comparatively young, the death rates attained their lowest ebb (1921-1925, 7.23).

PAGE 30

27 During recent years the average age of this group has gradually increased, a larger proportion of individuals are becoming disabled with and dying as the result of diseases of the so-called chronic degenerative type, and the general death rates are gradually increasing (1927-1931, 10.05). EMPLOYEES, DEATH RATES, DISEASE ONLY. Death rates from disease only for all Panama Canal employees and the racial distribution of these rates (white and colored) are incorporated in the following table: EMPLOYEES, DEATHS FROM DISEASE ONLY. ABSOLUTE NUMBERS AND RATES PER 1,000, WHITE, COLORED, AND TOTAL. Number of deaths from Death rate per 1,000, Year. Number of employees, disease only. disease only. White. Colored. Total. White. Colored. Total. White. Colored. Total. 1906. 5,106 21,441 26,547 19 1,024 1,043 3.72 47.76 39.29 1907. 10,604 .28,634 39,238 97 848 945 9.15 29.62 24.08 1908. 12,383 31,507 43,890 90 291 381 7.27 9.24 8.68 1909. .11,662 35,505 47,167 75 281 356 6.43 7.91 7.55 1910. 13,021 37,781 50,802 64 317 381 4.92 8.39 7.50 1911. 12,251 36,625 48,876 72 302 374 5.88 8.25 7.65 1912. 12,553 38,340 50,893 58 266 324 4.62 6.94 6.37 1913. 11,943 44,711 56,654 43 254 297 3.60 5.68 5.24 1914. 7,024 37,305 44,329 47 265 312 6.69 7.10 7.04 1915. 4,719 30,066 34,785 15 126 141 3.18 4.19 4.05 1916. 4,552 28,624 33,176 15 137 152 3.29 4.79 4.58 1917. 4,814 27,775 32,589 22 165 187 4.57 5.94 5.74 1918. 4,408 21,112 25,520 16 166 182 3.63 7.86 7.13 1919. 4,523 19,681 24,204 8 142 150 1.77 7.21 6.20 1920. 4,688 15,985 20,673 17 136 153 3.63 8.51 7.40 1921. 3,855 10,534 14,389 10 72 82 2.59 6.83 5.70 1922. 2,827 7,620 10,447 10 54 64 3.54 7.09 6.13 1923. 2,846 8,130 10,976 15 52 67 5.27 6.40 6.10 1924. 3,055 8,570 11,625 13 51 64 4.26 5,95 5.51 1925. 3,123 9,057 12,180 9 85 94 2.88 9.39 7.72 1926 .3,121 9,611 12,732 18 77 95 5.77 8.01 7.46 1927. 3,197 10,364 13,561 19 87 106 5.94 8.39 7.82 1928. 3,308 10,952 14,260 19 112 131 5.74 10.23 9.19 1929. 3,505 12,688 16,193 23 128 151 6.56 10.09 9.33 1930. 3,589 11,935 15,524 27 148 175 7.52 12.40 11.27 1931. 3,551 11,046 14,597 21 96 117 5.91 8.60 8.02 Americans only. The death rates were the lowest of record for the past three years in whites, and for the past four years in colored. The above table discloses an interesting point. During the 26-year period, death rates of white employees were lower than colored without an exception, and considerably lower in a number of years. This difference in death rates is further emphasized by comparing the rates by race, for 5-year periods, as follows: 1908-1912. 1917-1921. 1922-1926. 1927-1931. Whiteemployees. .5.8 3.28 4.34 6.36 Coloredemployees. .8.1 7.16 7.42 10.02 EL-

PAGE 31

28 The death rates in colored employees range from 40 per cent to 118 per cent higher than those in white employees. The comparatively low rates in white employees are attributable to many factors favorable to such employees, among which may be mentioned: Rates of pay, scale of living, physicial stamina, intelligence, education, and hygiene and sanitation in the home and immediate environment. Another important factor is that while in both racial groups the average age has gradually increased to such an extent that diseases of the so-called chronic degenerative type are becoming more common, they are affecting the colored employees proportionately to a greater degree than white employees, and increasingly larger numbers of colored employees are dying of such diseases while still in active service. It is to be noted that in recent years death rates in both groups of employees are attaining higher levels, although the 1931 rates are a notable exception. The diseases which usually cause the highest mortality were much less fatal in 1931 than the preceding year. Death rates for heart disease declined 63 per cent; for tuberculosis, 40 per cent; for nephritis, 38 per cent; and fofr cancer, 35 -per cent. ADMISSIONS OF EMPLOYEES TO HOSPITALS AND QUARTERS. The basic data from which admission to hospitals and quarters are compiled and the types of cases included are explained in the general discussion of vital statistics for Panama Canal employees appearing on page 12 of the annual report for 1930. The annual rates for the period 1906-1931 are shown in the following table:

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29 EMPLOYEES, ADMISSIONS To HOSPITALS AND QUARTERS FROM ALL CAUSES. Rates per 1,000 employees. 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 1928 14,260 595 1929 16,193 602 1930 15,524 603 1931 14,597 705 The average age of both white and colored employees is gradually increasing and, as is to be anticipated under such conditions, the admission rate to hospitals and quarters has increased slightly from year to year during the past six years. The admission rate increased markedly during 1931 and is the highest since 1912. The admission rate per 1,000 to hospitals for disease by race (white and colored) has been as follows for the past five years: ADMISSION RATE PER 1,000 EMPLOYEES, BY RACE (WHITE AND COLORED). Year. White. Colored. 1927. ...209 95 1928. 240 128 1929. ..273 154 1930. ..288 180 1931. .....310 187 PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES TO HOSPITALS. The six diseases causing the greatest number of admissions of employees to hospitals during the past five years ate incorporated in the following table:

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30 EMPLOYEES, PRINCIPAL CAUSES OF ADMISSION TO HOSPITALS 1927. 1928. 1929 1930. 1931. Total. Rate Total. Rate Total. Rate TOW.l Rate Total. Rat 1,000. 1,000. 1,000. 1,000. 1000 Malaria (including the few cases treated inquarters).,. 145 11 203 14 337 21 410 26 276 19 Diseasesofpharynxandtonsils. 127 9 121 8 184 11 136 9 153 10 Diseases of nasal fossae and annexa. ..49 4 153 9 ..270 to Diseasesofeyesandannexa. 84 6 103 7 113 7 .131 g Gonococcus infection. 66 5 94 7 121 7 130 8 106 7 Syphilis .57 4 70 5 .150 10 114 a Ankylostomiasis. ..113 7 Bronchitis (acute and chronic). 41 3 ... Acute abscess. .....7 106 NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES. These rates are shown in table below: NONEFFECTIVE RATES FROM ALL CAUSES, EMPLOYEES. Rates per 1,000. 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 1928 14,260 14.66 1929 16,193 15.23 1930 15,524 14.90 1931 14,597 15.45 Noneffective rates apparently have become stabilized though increases have occurred during the past five years over the preceding five years (average 1922-1926, 13.53; 1927-1931, 14.90).

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31 ADMISSION RATES, MALARIA, HOSPITAL AND QUARTERS, EMPLOYEES. Malaria is the most important disease prevention problem in which the Health Department is engaged., Every effort is made to diagnose and report in morbidity statistics all clinical cases seen by Panama Canal physicians. Statistical records of cases of malaria occurring in employees are the most accurate and complete that are compiled for any special group of the population residing on the Canal Zone, except military personnel, as employees absent from duty must secure a certificate from a physician to cover absence on account of illness in order to be paid for time lost. The admission rates per 1,000 per annum for all employees for the years 1906 to 1931 inclusive, are incorporated in the following table: MALARIA CASEs, EMPLOYEES ONLY. Absolute numbers and rates per 1,000 employees. Average Number Rate Year. number of per employed. cases. 1,000. 1906 26,547 21,795 821 1907 39,238 16,637 424 1908 43,890 12,372 282 1909 47,167 10,169 215 1910 50,802 9,487 187 1911 48,876 8,987 184 1912 50,893 5,623 110 1913 56,654 4,284 76 1914 44,329 3,635 82 1915 34,785 1,781 51 1916 33,176 547 16 1917 32,589 473 14 1918 25,520 472 18 1919 24,204 752 31 1920 20,673 401 19 1921 14,389 214 15 1922 10,447 176 17 1923 10,976 212 19 1924 11,625 190 16 1925 12,180 330 27 1926 12,732 179 14 1927 13,561 145 11 1928 14,260 203 14 1929 16,193 337 21 1930 15,524 410 26 1931 14,597 276 19 When malaria control measures (drainage, oiling, screening, etc.) on a large scale are first carried out in heavily infected areas in various parts of the world the initial reduction in malaria is spectacular. Such a reduction occurred in employees of the Panama Canal during the

PAGE 35

32 construction period when the malaria rates were gradually reduced from 821 cases per 1,000 in 1906 to 76 in 1913: After the opening of the Canal for traffic in 1914, the population became stabilized and between 1916 and 1931 the annual rates per 1,000 has ranged between 11 and 31. It may be said that the rate of malaria in employees under normal conditions, when large field projects are not being undertaken in nonsanitated areas, ranges from about 14 to 19 cases per 1,000 of employees each year. The relatively high malaria rates prevailing in 1925, 1929, and 1930 were due to the fact that large construction projects were under way beyond the areas in which permanent drainage and other malaria control measures are undertaken as a matter of routine. (See pages 35 and 36 Annual Report 1930.) During 1931, the principal construction projects in which Panama Canal forces were engaged, beyond the limits of the so-called sanitated areas, were a continuation of work in the Madden Dam area and construction of the Thatcher Highway on the west side of the Canal. The usual malaria control measures instituted in temporary construction projects beyond the permanently sanitated areas are: Screening of all buildings to be occupied by human beings, elimination of mosquito breeding in the immediate vicinity of the camps, the capture of adult mosquitoes inside screened buildings every morning, hospitalization of individuals with malaria, and the provision of ample, varied and nutritious food for laborers. During part of the year 1930, and in 1931 for the entire year, there were added to the control measures mentioned above monthly blood surveys of all individuals engaged on projects of this nature and the treatment of those found to be carriers of malarial parasites. There was marked reduction in malaria rates in employees in 193119 per 1,000 as compared with 26 per 1,000 in 1930. The malaria season for the year 1930 was one of the worst experienced for a number of years on the Isthmus and in the Republic of Panama, whereas the 1931 malaria season was of the type usually encountered. The rate for 1931 (19) was appreciably lower than the comparable rate for 1929 (21) notwithstanding that large field projects were unde* way during both years. It is probable that the monthly surveys, with treatment of individuals harboring parasites in the blood but without symptoms, were factors of importance. Extensive field projects were under way during the years 1925, 1929, 1930, and 1931. Excluding the malaria occurring in individuals engaged in such field projects, the rates of these years would be: 1925, 17;

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33 1929, 14; 1930, 19; 1931, 16. That substantial progress is being maintained in reducing the prevalence of malaria among employees, is evident when we exclude from consideration the cases chargeable to field projects in nonsanitated areas. On this basis, the average annual rate per 1,000 employees for the 5-year period 1922-1926 was 17; whereas for the 5-year period 1927-1931, it had declined to 15. The lowest rate so far attained in Canal Zone employees was that of 11 per 1,000 in 1927. MR 31053---3 *1 4

PAGE 37

MALARIA, EMPLOYEES ONLY. ADMISSIONS TO HOSPITALS AND QUARTERS, AND DEATHS BY RACE. ABSOLUTE NUMBERS, MORBIDITY AND MORTALITY RATES PER 1,000 EMPLOYEES, AND FATALITY BATES PER 1,000 CASES. Admissions. Deaths. Number of employees. Fatality rates per 1,000 cases. Year. Absolute numbers. Rate per 1,000 employees. Absolute numbers. Rate per 1,000 employees. White. Colored. Total. White. Colored. Total. White. Colored. Total. White. Colored. Total. White. Colored. Total. White. Colored. Total. 1906. 5,106 21,441 26,547 5,080 16,715 21,795 995 779 821 14 219 233 2.74 10.21 8.78 2.76 13.10 10.69 1907. 10,604 28,634 39,238 8,071 8,566 16,637 761 299 424 35 119 154 3.30 4.16 3.92 4.34 13.89 9.26 1908. 12,383 31,507 43,890 6,352 6,020 12,372 513 191 282 42 31 73 3.39 .98 1.66 6.61 5.15 5.90 1909. 11,662 35,505 47,167 4,347 5,822 10,169 373 164 215 26 26 52 2.23 .73 1.10 5.98 4.47 5.11 1910. 13,021 37,781 50,802 4,884 4,603 9,487 375 122 187 15 35 50 1.15 .93 .98 3.07 7.60 5.27 1911. 12,251 36,625 48,876 4,175 4,812 8,987 341 131 184 26 21 47 2.12 .57 .96 6.23 4.36 5.23 1912. 12,553 38,340 50,893 2,746 2,877 5,623 219 75 110 11 9 20 .88 .23 .39 4.00 3.13 3.56 1913. 11,943 44,711 56,654 1,477 2,807 4,284 124 63 76 10 11 21 .84 .25 .37 6.77 2.24 4.90 1914. 7,024 37,305 44,329 1,260 2,375 3,635 179 64 82 2 5 7 .28 .13 .16 1.59 2.11 1.93 1915. 4,719 30,066 34,785 606 1,175 1,781 128 39 51 2 6 8 .42 .20 .23 3.30 5.11 4.49 1916. 4,552 28,624 33,176 180 367 547 40 13 16 .,. 2 2 ..07 .06 .5.45 3.66 1917. 4,814 27,775 32,589 126 347 473 26 12 14 1 2 3 .21 .07 .09 7.94 5.76 6.34 1918. 4,408 21,112 25,520 62 410 472 14 19 18 .2 2 ..09 .08 .4.88 4.24 1919. 4,523 19,681 24,204 103 649 752 23 33 31 .2 2 ..10 .08 .3.08 2.66 1920. 4,688 15,985 20,673 85 316 401 18 20 19 3 .3 .64 ..15 35.29 .7.48 1921. 3,855 10,534 14,389 70 144 214 18 14 15 ....... 1922. 2,827 7,620 10,447 56 120 176 20 16 17 .. 1923. 2,846 8,130 10,976 57 155 212 20 19 19 ......... 1924. .3,055 8,570 11,625 55 135 190 18 16 16 1 1 2 .33 .12 .17 18.18 7.41 10.53 1925. 3,123 9,057 12,180 84 246 330 27 27 27 1926. 3,121 9,611 12,732 58 121 179 19 13 14 1927. 8,197 10,364 13,561 38 107 145 12 10 11 .. 1928. 3,308 10,952 14,260 53 150 203 16 14 14 ....... 1929. 3,505 12,688 16,193 69 268 337 20 21 21 .1 1. .08 .06. 3.73 2.97 1930. 3,589 11,935 15,524 81 329 410 23 28 26 ....... 1931. 3,551 11,046 14,597 63 213 276 18 19 19 1 _. 1 .28 ..07 .7. 3.62 Records 1908-1913 cover cases in hospitals. Records 1914-1930 cover cases in hospitals and quarters. Apt

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-35 The interesting point shown in the racial distribution of malaria in Panama Canal employees is the fact that admission rates per 1,000 were much higher in white employees than in colored during the period of construction of the Canal (1906-1914) and in fact until 1917, since which time the rates in both races have tended to be equal. This finding (high rates in white Americans during the construction period) supports other epidemiological evidence which suggests strongly that the inhabitants of tropical countries in which malaria has been of common occurrence for centuries, gradually have acquired a tolerance or immunity to the disease and that it is the new arrival from nonmalarial countries whosuffers most severely. DEATH RATES, MALARIA, EMPLOYEES. The death rates from malaria, Panama Canal employees, are shown in the following table: DEATHS FROM MALARIA AMONG EMPLOYEES ONLY. Absolute numbers and rates per 1,000 employees. Average Number Rate Year. number of per employed. deaths. 1,000. 1906 26,547 233 8.78 1907 39,238 154 3.92 1908 43,890 73 1.66 1909 47,167 52 1.10 1910 50,802 50 .98 1911 48,876 47 .96 1912 50,893 20 .39 1913 56,654 21 .37 1914 44,329 7 .16 1915 34,785 8 .23 1916 33,176 2 .06 1917 32,589 3 .09 1918 25,520 2 .08 1919 24,204 2 .08 1920 20,673 3 .15 1921 14,389 1922 10,447 1923 10,976 1924 11,625 2 17 1925 12,180 1926 12,732 1927 13,561 1928 14,260 1929 16,193 1 .06 I 1930 15,524 1931 14,597 1 .07 As will be noted from the table, a death from malaria among employees has but seldom occurred during recent years. One death attributable to malaria occurred among Panama Canal employees dur-

PAGE 39

36 ing 1931. This case was that of a policeman who acquired his infection while on night duty. There was delay in his reporting to hospital, the infection was a malignant one of the cerebral type, the patient was comatose when admitted, and death occurred before quinine could affect the course of the disease. It is well known that estivo-autumnal (so-called malignant type) malaria is the type of most common occurrence on the Isthmus, and that not infrequently it manifests itself clinically as the cerebral form which may be fulminating and quickly result in death. When individuals report with temperatures above normal, every effort is made to ascertain as quickly as is practicable if they have malaria. When a death from malaria does occur it usually is found that the individual has delayed in reporting for treatment and is en extremis when first seen by a physician. DIVISION OF HOSPITAL, DISPENSARIES, AND CHARITIES. The Panama Canal maintains two general hospitals to meet the medical and surgical requirements of the population residing in the Canal Zone (Panama Canal employees and their dependents, Army personnel, other Government employees, and others entitled to treatment). Gorgas Hospital (formerly known as Ancon Hospital), constructed at a cost of $2,000,000 with a normal capacity of 800 patients, is located in Ancon on the Pacific side, and Colon Hospital, constructed at a cost of $255,000 with a capacity of 130 patients, serves the population at the Atlantic terminal. The insane from the populations of the Canal Zone and the Republic of Panama are cared for in an asylum for the insane maintained by the Health Department at Corozal, two miles north of Balboa, near Miraflores Locks. A new concrete fireproof ward for male patients was completed and occupied during the year. All cases of leprosy found in the Canal Zone and in the Republic of Panama are treated in the Palo Seco Leper Colony, maintained by.: the Health Department of the Panama Canal in an isolated locality on the west side of the Canal at the Pacific entrance. The Health Department maintains dispensaries in the more important permanent towns, staffed by from one to three physicians and the necessary number of dispensary assistants, ambulance drivers, and attendants. The physicians on duty in these dispensaries have regular office hours during which employees and their families consult them free of charge.

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37 In addition to the charity work done in its general hospitals and in the institutions for the care of the insane and lepers, the Health Department also cares for crippled employees, those suffering from chronic disabling diseases, and those unable to work on account of advancing age, in a special department located on the reservation of the Corozal Hospital for the insane and administered under the direction of the superintendent of that institution. The annual reports of the various institutions comprising this division of the Health Department follow: GORGAS HOSPITAL. (Normal capacity 880 beds.) Col. ARTHUR M. WHALEY, Medical Corps, U. S. Army, Superintendent. There has been no new construction of buildings during the year. However, climatic conditions necessitate constant attention and considerable work to prevent deterioration of hospital buildings and equipment. The routine work of maintenance and repair, including repainting of furniture and equipment, also the maintenance of plumbing and electrical repairs, were done by the hospital artisans, also certain alterations and many articles of furniture and equipment were made by the hospital maintenance force. New equipment and replacements of worn-out or obsolete articles, amounting to approximately $12,000, have been purchased and installed during the year. Cases treated.-There were 12,239 admissions during the year, with a total of 165,150 patient days, making an average of 13.08 days spent in hospital per patient. The average number of beds occupied daily during the year was 452.47. Surgical service.--There were 2,317 major operations (with 31 deaths) and 5,010 minor operations (with 1 death) performed during the year; 452 obstetrical cases were delivered, in which there were 5 twin births and 27 stillbirths; 8,983 patients received treatment in the out-patient clinic. Medical service.-The medical service is organized to furnish a complete service in internal medicine, including consultation service for both medical and surgical services of this hospital. During the past year 6,006 patients were treated in the medical wards. In addition to the hospital service, an active out-patient clinic is conducted where 8,646 patients received treatment.

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38 Eye, ear, nose and throat services.-There were 11,387 visits to the out-patient department; 2,424 operations were performed and 1,307 refractions were done. Radiographic service.-There were 6,946 cases, for which 16,560 films of various sizes were used, and in which 932 fluroscopic examinations were made. Dental service.-There were 6,496 sittings during the year; 1,838 oral examinations and surveys; 3,209 teeth extracted; 582 complete and 818 partial X-ray examinations. Physio-therapy service.-Treatments were given to 1,146 out-patients and 974 hospital in-patients, during the year. REPORT OF OUT-PATIENT SERVICES. Total New Pay visits. cases. cases. Medicalservice. .8,666 1,861 1,141 Surgical service. 8,983 2,530 335 Eye, ear, nose and throat service. .11,387 4,266 853 Physiotherapy service. .6,501 266 108 X-ray service. .1,313 982 300 Dental service. 1,272 648 747 Total. 38,122 10,553 3,484 BOARD OF HEALTH LABORATORY. (Operated in connection with Gorgas Hospital.) Dr. L. B. BATES, Chief of Laboratory. Bacillus typhosus.-Recovered in blood culture from 6 individuals and from stool specimens of 4 others. Two of the latter were from typhoid fever contacts. Of the 8 cases, 3 were from Colon, 2 from New Cristobal, 2 from Panama City, and 1 from a ship in transit. Typhoid carriers.-On December 31, 1930, there was only one B. typhosus carrier, H. B., under sanitary surveillance. His stool specimens were examined monthly and found positive on seven occasions. No new carriers were found during the year. He was still under sanitary surveillance on December 31, 1931. Typhus fever.-Typhus fever has been practically an unknown disease in the Canal Zone and in the Republic of Panama. The diagnosis in the few suspicious cases has been open to reasonable doubt. Two blood specimens submitted for Weil-Felix agglutination tests during the present year have agglutinated B. proteus X-19 in rather high dilutions. Both patients ran clinical courses consistent with those seen in typhus fever.

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39 CASE 1. Mr. A. A., patient in the Panama Hospital, age 32, white, a resident of Panama City for four years, gave a positive Weil-Felix reaction in a dilution of 1-640 on the 15th day of the disease just as the temperature was coming to normal. CASE 2. Mr. R. R. A., patient in Santo Tomas Hospital, a'ge 28, white, a resident of Panama City, gave a positive Weil-Felix reaction in a dilution of 1-1280 on the 16th day of illness, two days after the temperature became normal. It is believed that these were both bona fide cases of typhus fever. Mononucleosis.-During the months of January and February, 1931, blood films from 14 patients suspected of having infectious mononucleosis were examined in the Board of Health Laboratory in conjunction with those from other patients in whom this disease was not considered. All but 3 of the 14 suspected cases had a slight but definite increase in the percentage of monocytes. In the 3 cases, the per cent of monocytes was 1, 4, and 10 respectively. The percentage in the remaining cases ranged from 12 to 26, the average being 20 per cent. The total leucocyte count raged from 5,200 to 15,000 cells per cubic millimeter. The average leucocyte count for the 14 cases was 9,096. All but T cases were adults, with severe prostration, slight fever, occasional glandular enlargement and symptoms of upper respiratory infection, suggestive of influenza. The acute symptoms lasted from 3 days to 1 week, but the patients did not fully recover for 2 or 3 weeks. The findings on these patients were not sufficiently marked to establish a.diagnosis of mononucleosis. These cases were probably mild forms of influenza. Reports.-Approximately 53,368 reports not including duplicates have been made. BACTERIOLOGICAL PROTOZOAL AND MISCELLANEOUS EXAMINATIONS. Blood cultures. ..., 294 Positive for B. typhosus. 6 Positive for Staphylococcus albus. ....5 Positive for Staphylococcus aureus. 9 Positive for Streptococcu8 hemolyticus. .1 Positive for Streptococcus viridans. ..4 Positive for Streptococcus viridans and Staphylococcus albus. .2 Positive for Pneumococcus and Staphylococcus albus. .-. I. 1 Positive for Pneumococcus. ..3 Positive for B. coli .....1 Stools cultured for typhoid dysentery group. ..1,131 PositiveforB.typhosus. 16 Positive for B. typhosus on carriers. ..7 Positive for B. dysenteriae, Group II. ...4 Positive for B. dysenteriae, not classified. .1 Urines cultured for typhoid group. 648 Positive for B.typhosus. 3 Urines cultured for organisms other than typhoid group. .418 Positive for B .coli Positive for B.coli and Staphylococcus albus. 1 Positive for Staphylococcus albuss. ..20 Positive for Staphylococcus aureuse. .4 Positive for Streptococcus hemolytic. ...2 Positive for Streptococcus non-hemolytic. I Positive for Gram negative bacilli. .2 Throat cultures for B. diphtheriae. 1,083 Positive for B. diphtheriae. ..56 Nasal cultures for B. diphtheriae. .337 Positive for B. diphtheriae. ..13. .1 3 OF-

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40 Throat cultures for organisms other than B. diphi. ..46 Positive for Streptococcua viridan .9 Positive for Streplococcus hemolyticus .4 Positive for Streptococcus anhemolyticus. 1 Eyecultures. ..32 Positive for Saphylococcus aureu. 3 Positive for Staphylrcoccus auree and albus. .1 W orm from eye for identification. I Earcultures. .2 M astoid cultures. .1 Nasopharyngeal cultures. ...42 Positive for M eningococci. ..4 Sputum cultures. ,. 36 Positive for Pneumococcua Type I. Positive for Pneumococcus Type II. 1 Positive for Pneumococcus Type IV. 2 Positive for Streptococcus viridana and Staphylococcus albus. 2 Sputum for yeast. .. Positive for yeast. ..2 Spinal fluid cultures. 127 Positive for Meningococcua. 8 Positive for Staphylococcus aureus. .I Positive for B. pyocyanesa. .I Positive for Genus proteue. .4 Surgical tissues oulturedL. ..._ ..2 Positive for Clostridium welchii. I Pleural fluid cultures. .31 Positive for Streptococcus ,iridans. .1 Positive for Pneumacoccus. 2 Knee fluid cultures. 15 Wrist fluid cultures. ...1 AsEcitic fluid cultures. .I Positive for Pneumococcus. I Cultures from skin lesions. ..20 Cultures of pus from various sources. 25 Positive for Staphylococcus albus. .;.2 Positive for Staphylococcus aureus. ..7 Autopsies cultured. ...36 Organs, exudates, etc ..27 Bile cultures. .12 Breast milk, microscopic examination. .I Mold cultures from paintings in Administration Building. 1 Darkfield examinations. ...62 Conjunctival smears.'. 58 Positive for Gram negative intracellular diplocci. .19 Positive for Koch Weeks bacillus. .2 Throatsm ears. .55 Positive for fusiform bacilli and spirilla of Vincent'a angina. 20 Smears from venereal lesions. .5 Smear from skin for Leishmania. .1 Smear from skin for fungus. .2 Urethral smears. 54 Positive for Gram negative intracelular diplcoci. .16 Vaginal smearsfo. .56 Positive for Gram negative intracellular diplococci .14 Sputum smears for B. tuberculosis. 74 Positive for B. tuberculosis., ...7 Urineexamined for B. tuberculosis. .2 S spinal fluid for B. tuberculosis. 24 Positive for B. tuberculosis. 2 Ce fount of spinal ids .,. 7 Examination of leper suspects .10 Positive for B.leprae.r. 9 Examination of lepers previous to parole ... Examination of paroled lepers. .6 Positive for B.leprae s.a ,.10 Autogenous vaccinesprepared ...33 Feces examined for parasites and ova. ...104 Positive for Uncinaritzova. .....-... Positive for Endamoeba hisfolytica .,. Positive for Endamoeba coli. .1 Positive for Taenia saginata (segments and ova). I Positive for Ascaris lumbricoides ova. ..1 Positive for Strongyloides larvae. I Differential counts. ..8 Red blood counts. .IS White blood counts. 10 Blood films examined for malarial parasites. 5" Positive for Tertian malarial parasites. 264 Positive for E. A. malarial parasites. 221 Positive for Quartan malarial parasites. 3 Positive for Tertian and Quartan malarial parasites combined .....' Positive for Tertian and E. A. malarial parasites combined. 3 Blood films examined for Trypanosomes. ..I

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41 Water from Balboa Clubhouse swimmi 297 Water fromBalboa Army and Navy Y A. awwimming pool. .291 Waterfrom Pedro Migel Clubhouse swimming pool. .153 .~ ~ ~ W er r m no lb wi in 9 0. ...............21 Water from Union Clu swrmng p o o l 21. Water from Fort Clayton swimming pool. ..2 W ater from Fort Amador. .., ..165 W ater from Corozal. 10 WaterfromQuarry Heights. 1 later from FortRandolph. .5 later from France Field. I Water from Fort Sherman. 1 Water from Submarine Base, Coco Solo. 6 Water from reserve reservoir, Gaillard. .2 Water from matadero, Panama. .,. 2 Water from Madden Dam. 5 Water from Chorrera, Republic of Panama. I W after from Santa Clara Inn. .,. 1 Well water from Santa Clara Beach Project. .3 Water from Volcan, Republic of Panama. 1 W ater from Nicaragua. ..3 Dairy water submitted by Health Office, Panama.:. _. 22 Dairy water submitted by Health Office, Cristobal. 4 W ell water from Panama City. .11 W ell water from Paja. I Well water from Pina Guapa Island. .3 Ice from ice factory at Chorrera, Republic of Panama ..22 Foodstuffs examined: Cultures of fish. 2 Ice cream cultured for bacterial count. 14 Cultures of milk, condensed ....2 Milk cultured for bacterial count (dairy). .577 Culture of milk, powdered ..1 Cultures of sausage (positive for B. coli). 1 Soda water for B. coli. ..358 Syrups used in soda water. ..4 SEROLOGICAL EXAMINATIONS. W assermann tests. ..22,118 K ahn tests. ..III Agglutination tests. 105 Positive with B. typhosus. .14 Positive with B. paratyphosusB. 1 Positive with B. dyenteriae Group II. I Positive with B. proteus X 19. .2 Fragility tests.,. 10 Blood typing for transfusion. ..45 Examination of blood for coagulation time. 3 Examination of blood for bleeding time. 1 Analysis of Wassermann reactions.-Twenty-one thousand two hundred and forty-two Wassermann tests were performed on the blood of 15,717 persons. The results are summarized below: TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1931. Total Per cent of Race, sex, and status. Individuals Individuals individuals individuals positive. negative. tested. positive. White, civil: Males. 145 2,068 2,213 6.55 Females. .35 624 659 5.31 Children. .35 35 Total. ..180 2,727 2,907 6.19 White, military and naval: Soldiers, Continental U.8. 230 4,285 4,515 5.09 9 Sailors, U. S. N .32 378 410 7.80 Total .262 4,663 4,925 5.32 Black and mulattoes: M ales.,. 841 3,385 4,226 19.90 Females. .521 2,808 3,329 15.65 Children. 17 285 302 5.63 Total. ...1,379 6,478 7,857 17.55 Chinese, males and females. ..11 17 28 39.29 Grand total. ..1,832 13,885 15,717 11.66

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42 In addition, Wassermann tests were made on 876 spinal fluids taken from 707 individuals. The results are summarized as follows: Individuals positive. ..70 Individuals negative. ..67 Total individuals tested. .707 Per cent of individuals positive. ....90 THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH LABORATORY, 1904 TO 1931. 1904. 8 1 1. 1905. 269 60J 9 .27 3 .2 1906. 509 191 22 50 24 23 39 15 33 ..2 1907. 496 156 35 27 40 27 38 12 58 4 4 1 1908. ..361 59 63 46 26 25 23 11 14. 7 2 1909. ..295~ 55 37 26 32 31 Ii 17 11 1 5 1910. ..451 50 91 52 30 37 38 18 10 6 4 -J 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 89 21 34 26 8 28 5 23 12 11 1914. ..375 36 78 6 38 12 6 27 5 14 3 5 1915. 328 28 56 14 20 12 5 14 2 15 10 9 191G. .323 25 81 8 17 20 7 10 8 9 7 15 1917. ..330 24 51 5 21 23 3 18 1 3 5. 12 1918. ..253 38 68 6 8 12. 8 ....1 5 5 1919. ..324 22 55 3 15 14 3 20 3 10 11. 8, 1920. 334 *46 55 .,. 29 11 5 18 ..6 15 1921. ..289 14 37 4 18 5 8 17 2 4 7 20 1922. 262 14 29 5 19 9 4 9 3 6 10 14 1923. ..205 8 17 3 g 9 5 12 2 1 11 14 1924. 263 14 33 3 29 10 4 21 1 3 13 12 1925. 306 15 34 7 38 11 3 18 1 3 18 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 1928. 436 45 40 8 40 20 3 13 2 10 19 46 1929. 453 40 44 6 48 21 5 10 4 11 23 37 1930. 375 26 40 2 45 28 1 23 3 1 15 48 1931. 388 31 34 11 8 16 3 20 1 10 17 41 Total. 9,664 1,220 1,334 419 789 497 262 428 193 159 270 383 1 This includes 32 ca6e 8 of influenza. The 1930 Annual Report, page 54, contains a table showing number of autopsies performed from 1904 to 1930 in certain rare diseases. The 1931 additions to this table are as follows: Yellow fever 0, beriberi 1, anklyostomiasis 0, tetanus 0, infectious diseases of a children 1, plague 0, smallpox 0: Per cent bodies auto psied.-Five hundred and sixty-nine bodies (not including 11 for storage only and 6 disinterred) passed through the laboratory; 388 or 68.19 per cent were autopsied. 1a3aria 6 arrer found at au3opy. 38 yphii found at autopsy (cas4). ..41 Glycosuriafoundat autopsy (cases). ......26 1 ...4

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43, Intestinal parasites found at autopsy.-Twenty-nine cases in 388 autopsies performed at the laboratory, or 7.47 per cent, showed one or more parasites or their ova, as follows: Ascaris,. .15 Oxyuris. .. Uncinaiia. .17 Trichocephalus dispar. .3 Trichuris ..3 Multiple infections occurred as follows: Ascaris and uncinaria.6 Uncinaria and trichuris. 2 Asearis and trichuris. ....I Trichocephalus dispar and uncinaria. ..I Ascaris, uncinaria and trichocephalus.1 CAUSE OF DEATH FOUND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH LABORATORY, 1931. Autopsy Cause of death. Contributory cause. No.CasofdahCotiuoycue 9337 Leprosy. .Acute vegetative endocarditis. 9346 Leprosy. .Acute gangrenous appendicitis. 9362 Leprosy. .Pulmonary tuberculosis. 9366 Leprosy. .Severe furunculosis. 9402 Leprosy. .Arteriosclerosis, general. 9442 Leprosy. ....Acute enterocolitis. 9602 Leprosy. ..Syphilitic aortitis. WILD AND DOMESTIC ANIMALS. Bacteriological: Autopsies: Blood smear from cow for Trypanosomes Boars. .2 and Piroplasma (negative). 1 Guinea pigs. ..35 .Blood smears from horses for Trypanosomes Rabbits ..25 and Piroplaama (negative). ..5 Blood smears from horses for Trypanosomes Total. .62 (negative). 3 Cattle ear for anthrax (negative) ...1 .I Histological examinations: Cultures of autopsy material (guinea pigs) 2 Autopsy tissues from cows. 14 Spleen cultures from guinea pigs. .8 Positive for B. tuberculosis ...7 Positive forB. paratyphosus B. 5 Positive for Pneumococcus. 2 Spleen cultures from rabbits (negative). .23 Gut and lung cultures from turkey (negaTotal ...14 tive). I Organs and exudate cultures fron bird Rats examined: (negative). ....1 Mus musculus. .2,109 Mus alezandrinus. ..81 Total. .45 Mus norwegicus. ....302 Mus rattus. 2,014 Serological: Complement fixation test for glanders Total. .4,506 on mule (negative).I Total.I MICROSCOPIC SLIDES PREPARED. Surgical tissue preparations (6 frozen). .2,280 Autopsy tissue preparations. ...6,554 Animal tissue preparations. ..181 .T otal. ....9 ,015 PHOTOGRAPHS. M. F., Gorgas Hospital No. 330355-acromegalia .5 M. B., Gorgas Hospital No. 323712-harelip. ..2 A. R. H., Colon Hospital No. 94302-tumor. ..2 Property Clerk, Gorgas Hospital-valve on oxygen tank,. ..2 Total. .11 CHEMICAL ANALYSES AND EXAMINATIONS. Alcohol analyses. .......7 Berager 22 Kafir, alcohol determinations ..3 Soda water for sacharine. 12 Soda water for salicylic acid. .5 Positive for salicylic acid. .5 Whisky, alcohol determinations. .. L i.

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Blood ............2,j = Nonprotein nitrogen determinations. 1,651 Urea nitro en determinations .235 Uric aciddeterminations ...,. .to Creatinin determinations. 631 Glucose determinations. .1,826 Calcium determinations. .18 Cholesterol determinations. .3 Carbon dioxide determinations. 15 Sodium chloride determinations. .2 Carotin determinations. I Ieterus index. ...127 Van den Bergh tests .I Calibration-sphygmomanometer. .8 Chlorine solution. ..1 Drugs and chemicals. .17 Boricaid. ...2 Calx chlorinata. ..2 Carbolic acid, crude. 3 Cattle dip, arsenical. .8 Creosote, Beechwood. I Sodium thiosulphate. .I Foodstuffs. In B utter. .5 Cream. 4 Fruit, canned (sugar). .3 Iee cream. ..84 Lard. 1 Milk, condensed, unsweetened. .........I Milk, condensed, sweetened. .1 Milk, dairy. ..560 Milk, evaporated. .1 M ilk, mothers. 7 Milk, powder. 2 Oleom argarine. ..4 Garbage (moisture, combustible matter and ash). .4 Gastric analyses. 521 M ud for corrosive agents. 1 Naphthalene in gas. 2 Oils, specific gravity. 5 Oil, viscosity. .2 Phosphorus determination (roach paste). .1 Salt, pickling, nitrate determination. 2 Sodasolution, washing. .76 Spinal fuids. 878 Colloidal gold tests. 839 Globulin tests. .838 Glucose determinations. 39 Substances for identification. 6 Cocaine. ..i Morphine, solution.1 N arcotic (negative). ...1 Opium, suspected (negative). ...I Oxalie acid in magnesium sulphate crystals. 1 Oxalic acid in magnesium sulphate solution. I Toxicological. 14 Fish (arsenic, trace). 1 Meat (positive for strychnine). 1 Phosphorus tests (yellow phosphorus). 7 Banana (positive for phosphorus). 7 Chickens (2 positive for phosphorus). 5 Dog (negative). .I Stomach and contents (negative for volatile poisons, alkaloids and heavy metals). I Stomach and contents (negative for corrosive metals). I Stomach and contents (negative for alkaloids). 1 Stomach, intestines and liver (positive for phosphorus) ...1 Water for poisons (negative).1 Urine. 272 Acetone. 6 Blood. I Diacetic acid determinations. 6 Glucose determinations. ..19 Hemglobin ...I Lead eterminations (124 positive). 194 Mercury determinations (negative). .1 Routine analyses. 44 Vomitus, for blood. .....3 Water for chlorides. .17 Water for mineral analyses. 3 Acetone, recovered (liters). ..6 Alcohol, recovered (liters). .278 Bensol, recovered (liters). 64 Chaulmoogra esters prepared (liters). 20 Dakins solution prepared (liters). .698 Termite poison prepared (liters). ..3

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45 UNDERTAKING DEPARTMENT. Bodies received (including 6 disinterred). 586 Bodies embalmed. 101 Bodies ur onted 4ainclui isin ed) Bodies shipped from Isthmus (including 4 disinterred). 74 COLON HOSPITAL. (Capacity 130 patients.) Maj. DEAN F. WINN, Superintendent. This hospital functions essentially as an emergency hospital although definitive treatment is provided for a wide range of cases. Individuals requiring special investigation, for which physical equipment is inadequate, those with venereal diseases, and eye, ear, nose and throat cases, are transferred to Gorgas Hospital. There has been no increase in the number of beds during the year. No noteworthy additions to the hospital plant were made during 1931 but the utilities department has been active in preserving the generally excellent appearance of the buildings and grounds and the upkeep of the various departments. The bearing capacity of the foundation bed for the new nurses' quarters has been tested and plans for this building as well as those for remodeling the old nurses' quarters for use as a dispensary, and for the construction of a new ward for private patients in the present dispensary section, have been approved. This work should be completed during the coming year. The plans for the dispensary provide for a more commodious and convenient arrangement of examining rooms, laboratory, X-ray, and pharmacy in a detached building. This will relieve a great deal of congestion in the hospital proper. The new ward will afford accommodations for 12 semiprivate ward patients and 8 private rooms and will answer a long-felt need by relieving the congestion in ward "C" and permitting a more satisfactory segregation of patients. There were 4,505 admissions during the year, with a total of 41,508 patient days, an average of 9.02 days in hospital per patient. Surgical service.-During the year there were 465 major operations and 888 minor operations. These afforded an interesting variety of surgical pathology and active emergency service. In addition, this service gave definitive treatment to 228 fractures. Spinal anesthesia-neocaine-was extensively used. Except in one case, in which failure was unexplained, it has proven entirely satisfactory, and preferable to ether in many cases. No accidents or untoward operative or post-operative symptoms occurred. I9 utwr prtv rps

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46 Obstetrical service.-This service is yearly becoming more active, there having been 522 deliveries during 1931 as compared with 489 in 1930. Of this number there were 29 forceps deliveries and 8 Caesarian sections. There were 18 stillbirths. The majority of the cases were colored women among whom a surprising number of complications were encountered, eclampsia and pernicious vomiting being exceedingly common. An active and well-conducted prenatal clinic is maintained. Medical service.-The general medical service has increased in proportion to the added bed capacity. Except for contagious diseases, mental diseases, and cases of tuberculosis, which are transferred to Gorgas Hospital, the general scope of the work has been satisfactory in both volume and variety. X-ray department.-There were 1,585 examinations made during the year. This department is not equipped for giving Roentgen therapy. Laboratory.-Only routine work is done. Serological and pathological work is performed for the hospital by the Board of Health laboratory at Ancon, C. Z. Dispensary.-The Colon dispensary is an integral part of Colon Hospital. Its professional staff is frequently interchanged with that of the hospital proper. Through it comes a large percentage of hospital admissions. It is divided into three sections, viz., a silver clinic, a gold clinic, and a maternity and pediatric clinic. The number of persons examined and treated in the dispensary during 1931 averaged 177 daily. Of the 64,689 patients treated, 24,909 were white and 39,780 were colored. In addition, physicians on duty made 338 calls on patients at their homes and patients on board ships. COROZAL HOSPITAL. (Capacity, 750 patients.) Maj. S. L. CHAPPELL, Medical Corps, U. S. Army, Superintendent. This institution cares for the insane of the Canal Zone and of the Republic of Panama, being reimbursed for the latter class of patients by the Republic at the rate of $0.75 per day. It also cares for alien employees of the Panama Canal and the Panama Railroad disabled by reason of injuries or chronic diseases, who desire to enter the institution. The new 3-story male ward "A" (Building No. 525), on which construction work was started August 11, 1930, was completed and

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47 occupied by patients on November 5, 1931. This building has a capacity of approximately 225 patients and embodies a number of improvements made since the construction of the female ward completed in 1927. Buildings 531 and 532, formerly known as wards "D" and "B," were purchased and razed by private bidders, patients from these buildings having been transferred to the new structure. Routine painting and repairs to woodwork, plumbing, boiler, steam line, etc., have been made by hospital artisans, with the help of patients. Insane patients.-The census on December 31, 1931, was 649, as compared with 598 at the end of the previous year. Of 3 transferred to Gorgas Hospital and remaining there at the end of 1930, 2 died and 1 was returned. The number admitted was 297, as compared with 296 for 1930. There were 189 discharges and 51 deaths. There were no suicides or deaths due to violence. Of the 189 discharged, 21 were considered as cured, 106 as improved, 62 as unimproved; 93 were repatriated. Eighteen patients were transferred to Gorgas Hospital for treatment; 11 of these were returned -to Corozal (also 1 who remained under treatment December 31, 1930), 4 died, I was returned from there to Palo Seco Leper Colony, and 2 remained in Gorgas Hospital at the end of the year. Of the admissions, 135 were cases paidfor by the Government of Panama and the remainder were Canal Zone charity cases or private pay patients. Other patients.-There were on December 31, 47 black and 3 white chronically ill or crippled inmates (not insane), as compared with 53 black and 6 white of this class at the beginning of the year. Seventeen were admitted, 2 repatriated to St. Vincent and Nicaragua, 1 died, and 3 were transferred to insane status. Thirty-eight of these patients were transferred to Gorgas Hospital for treatment, and of these, 28 were returned to Corozal Hospital, 6 died while in Gorgas Hospital, 1 was repatriated to Jamaica, and 3 remained under treatment at Gorgas Hospital at the end of the year. In addition to the 50 carried on the census as of December 31, 1931, there were 10 remaining out on pass at the end of the year. All those capable of performing work were encouraged to do so. Eighteen were carried on the pay rolls, employed as broom makers, bandage rollers, janitor, laborers, and helpers. The broom makers manufactured approximately 220 brooms per week. Recreation.-Weekly picture shows and band concerts have been continued, and the patients appear to derive considerable pleasure from these forms of entertainment. Picnics were held twice a month, during the dry season in a grove back of the hospital, and during the rainy seasonin the basement of one of the new ward buildings. Church services were held once a week for both the Catholic and Protestant

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48 patients. The former are held in the chapel near entrance to hospital road, and the latter are conducted in the basement of the new women's ward. Treatment.-Intensive specific treatment was given to patients suffering from syphilitic psychoses. Five hundred and thirty-two doses of arsphenamin were administered intravenously, and 365 lumbar punctures were made. At the end of the year there were 50 patients suffering from neuro-syphilis in some form; 33 of these were males and 17 were females. Occupational therapy.-On December 31, 1931, there were 16 male and 28 female patients under treatment in the occupational therapy department. The men are taught carpentry, weaving, bag making, recaning of chairs, rush work, etc.; the women are taught to make rugs and baskets, and to sew, knit, embroider, crochet, and make articles of raffia. The items produced and sold were: 172 rugs, 128 bags, 114 ornamental baskets, 132 card-table covers, doilies and other embroidered pieces, 402 raffia purses, 387 pieces of furniture, 9 boats in bottles, 12 knotted bags, 6 knotted belts, and 29 pieces of rush work. Sixteen pieces of furniture were painted and repaired. Other male insane who were strong physically but could not be accommodated in the occupational ward on account of limited space were sent to the fields and employed in agricultural activities. The value of the produce taken from the patients' garden for hospital use amounted to $1,524.91. 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, pillowcases, and nurses' uniforms, was done by the patients. The total sales from the occupational ward amounted to $1,491.70, and from the brooms manufactured by the "chronics," $4,432.15, a total of $5,923.85. This money is utilized for material required to continue activities in these departments, and for tobacco, confections, fruit, refreshments, etc., for the patients. Farm.-Repairs to fences were made, and pastures weie cleared of brush during the dry season by cutting and burning. There were 24 cripples employed on the farm at the close of the year, as compared with 26 at the beginning of the year. During this period 1 was admitted, 2 quit, and 1 was repatriated to Jamaica. These men are employed in the garden, piggery, steam plant, cemetery, etc. Six (including one chronic patient) are tending plots of land in the farm reservation-, which they cultivate as gardens and are paid on an actual

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'49 production basis. Their average earnings per month amounted to $33.68. Subsistence was furnished them free of charge. The receipts for produce sold aggregated $3,372.68, and for manure, $476.25. There were112 pigs, 56 hogs, and 2 boars on hand December 31, 1931. Net revenue from the sale of pigs during the year amounted to $361.61; the gross revenue was $2,695.46. PALO SECO LEPER COLONY. Dr. EZRA HURWITZ, Superintendent. During the year, 34,947 days treatment were furnished. There were 99 patients on January 1, 1931; 9 new patients were admitted, 3 paroled patients were readmitted, 8 patients died, 2 were paroled and 2 eloped, leaving 99 patients in the colony at the close of the year. Of these, 79 were for the account of the Republic of Panama and 20 were Canal Zone charity cases. Administration of the iodized ethyl esters of chaulmoogric acids continued as the routine treatment. The average dose was 5 cc., given intramuscularly. Sixty-one patients received injections semiweekly, 23 weekly, and 20 biweekly. Three received crude chaulmoogra oil by mouth, and 4 patients refused treatment. Seven patients were transferred to Gorgas Hospital for special treatment; 3 for orthopedic service, 2 for obstetric service, 1 for major surgical service, and 1 for treatment of the eye. Housing facilities of the colony continued to be entirely inadequate. Only 29 rooms were available for 70 men, and 9 rooms for 23 women patients. There was one marriage among the patients during the year. There are now three married couples living together and two married couples living apart, in the colony. Of the two pregnancies that occurred, one aborted at the seventh month, the other terminated in normal labor at term, but the child lived only one and one-half months. The total of the monthly gratuitous allotments to the patients amounted to $1,516.50. In addition they received for labor performed for the colony, $3,485.64, and for produce sold the colony, $481.15. Gifts of useful articles were donated by Rev. A. E. Gay, the Panama Red Cross Society, the Women's Auxiliary of the Gatun Union Church, and the Cristobal Women's Club. Bishop H. R. Carson gave an excellent Christmas dinner, and the Sociedad Espanola de Beneficencia MR 3103-4 aIJ

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50 of Panama donated special refreshments on Columbus day. Mot pictures were shown weekly throughout the year. Four con were given by as many amateur bands of Panama, and two exhibitions of ventriloquism and magic were givenaby itinerant artists. The shortwave radio set, the phonograph, the two pool tables, the motion picture and recreation building continued to give pleasure to the patients throughout the year. DIVISION OF SANITATION. Organization and activities.-The plan of organization of this division and the principal activities in which it is engaged were outlined somewhat in detail in the annual report for 1930, pages 73 to 77, to which publication reference should be made for detailed information. ROUTINE AND SPECIAL ACTIVITIES UNDERTAKEN DURING 1931. Routine activities were the usual mosquito control work, including maintenance work on permanent drainage projects, oiling, weekly outof-doors catches of mosquitoes (6 to 8 p. in.) at designated stations throughout the Zone with identification and report of species captured, search for and identification of larvae, and special inspection, of all drainage systems near the end of the dry season with removal of ohstructions, repair of ditches, regrading of ditch bottoms, straightening and training of stream beds, and digging of new ditches when necessary. SPECIAL PROJECTS UNDERTAKEN DURING 1931. (a) Medical care of the population in the Madden Dam area.-It was pointed out in the annual report for 1930 that the construction of the Madden Dam would begin in 1931. This dam is located on the Chagres River about 12 miles above Gamboa, the point at which the river discharges into the Canal. When completed the dam will provide an adequate reserve supply of water and a hydroelectric plant for all Canal requirements for many years to come. The surface area of the reservoir will be approximately 22 square miles and its capacity will be 22 billion cubic feet of water. Contracts for construction were awarded September 12,1931, and the contractor began work October 13, 1931. It is probable that construction activities will continue in that area for about 4 years and the strength of the force (Panama Canal and contractor's) engaged on the work will range, during the period, somewhere between 500 and 1,000 men. For the past two years or more the Gorgas Institute, in cooperation with the Health Department, has been making special studies of the malaria situation in the popula-

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SANITATED AREABef'ore 1919 1919 -1924 19251926 'It IE L/A I !it LIO IXX IIX -t I DEVELOPMNT OF LITATON (tit ATIAN LMDCNA CUT No. 2.Showing the area now sanitated, and regularly inspeCted, at the AtlantiC end of the Canaii I

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4 4 x.,

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tions living in the vicinity of the dam area. These villages are located on the Chagres River and alongside the Madden Road leading from the Canal to the Madden Dam. The Madden Road (concrete, 18 feet in width) was completed in April, 1930, and since its completion large numbers of farmers have occupied small areas in the immediately adjacent parts of the Republic of Panama. It is estimated that the population in that area has increased by about 200 persons during the past year. The population in the 5 villages of the Chagres River near the site of the Madden Dam is about 600. The average parasite rate in these villages for a year under monthly surveys and voluntary quinine administrations, was 25.6 per cent for children and 16.2 per cent for adults. The average parasite rate for the year on total population in the 5 Chagres River villages was 21.6 per cent. The Madden Road population, total about 250, slightly exceeded this rate. Prior to initiation of the monthly blood surveys, followed by voluntary quinine treatment, the 5 Chagres River villages revealed a paraM, site rate of 56.5 per cent for children and 37.2 per cent for adults. The average monthly parasite index for the labor forces under the direct control of the Panama Canal in the camps of Madden Dam and the Thatcher Highway was 4.4 per cent. The records indicate that if all individuals constituting the populations were observed throughout a period of a year it would be found that practically 100 per cent of them have malaria at one time or another. The monthly blood surveys of these populations with treatment of those infected will be continued during 1932. This control measure is being carried out in the hope that the number of gamete carriers in the Madden Dam area may be reduced to some extent, thus influencing, in some degree, the possibility of mosquitoes acquiring infection. In 1932 it is proposed to supplement the regular quinine treatment with plasmochin. In the construction camps located in the area the Health Department has put into effect the following malaria control measures: 1. Adequate screening of all buildings to be occupied by human beings. 2. Elimination of mosquito breeding in the immediate vicinity of the camp. 3. Insistence that all persons not engaged in work that necessarily requires exposure at night should remain in screened houses between dusk and daylight. At times night shifts will be on duty. 4. Catches or mosquitoes inside barracks each morning, with identification of species captured. 5. Monthly blood surveys of all persons living in the camps, with treatment (quinine and plasmochin) of those infected. It is hoped that this routine treatment F

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A 52 may possibly reduce the number of carriers of malarial organisms and it certainly will lessen the labor turnover. 6. A dispensary service at the camp to care for accidents and injuries and to provide a medical service for minor ailments. Injuries and illnesses of a serious nature are transferred to Gorgas Hospital in Ancon, at the Pacific terminus of the Canal. To carry on these activities the Health Department maintains the following organization at the dam site: 1 dispensary physician. 1 pharmacist. 2 attendants (colored assistants in the dispensary who also act as chauffeurs). 1 ambulance. 1 sanitary inspector, part time, in charge of mosquito control activities. I foreman, colored, and gang of 6 men who maintain drainage, search for and oil mosquito breeding areas, capture mosquitoes in barracks, and administer quinine to colored laborers and other infected persons living in the area. The cost of this service to the Government (including maintenance and operation only) averages about $1,600 per month. THE ANOPHELINE MOSQUITOES OF THE ISTHMUS. (By D. P. Curry.) The known anophelines (tribe Anophelini) of the Isthmus now number 15, as follows: Stelhomyiakompi Edwards. Chagasiabathanus Dyar. Anopheles (Nyssorhynchus)albimanus Wiedemann bachmanni Petrocchi strodei Root tarsimaculatus Goeldi (?) variety aquasalis Curry variety aquacaelestis Curry argyritarsis Robineau-Desvoidy albitarsis Lynch Arribllzaga (Anopheles)eiseni Coquillet pseudopunctipennis Theobald punctimacula Dyar and Knab apicimacula Dyar and Knab neomaculipalpus Curry (Kertesia)cruzii Dyar and Knab

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53 Of this rather imposing list it seems that only one species, Anopheles albimanus, is important as a malaria carrier. Of the two listed varieties of A. tarsimaculatus, one or both may be valid species and not really A. tarsimaculatus Goeldi; this was discussed in' a paper recently presented by Dr. Curry.' The fresh water species or variety, A. (t.) aquacaelestis, has been found breeding in enormous numbers in the vast, densely shaded swamps of the lower Chagres River on the Atlantic side of the Isthmus. Along the edge of the swamp near the Mojinga River (a small tributary of the Chagres) many hundreds of aquacaelestis were taken in a few minutes one evening with a small sweep-net swept back and forth in the beam of a pocket flash-light; the air seemed to swarm with them as the light played on their glistening white hind tarsi. Early next morning myriads of these rested on the twigs and leaves of the dense vegetation. In spite of the presence of so many of these mosquitoes, but few of them attacked the searching party. Only an occasional one alighted on human skin or clothing. A sanitary inspector, sleeping at night in an unscreened shelter in the swamp, purposely left his mosquito net open throughout the night. Next morning in his net were found seven engorged A. punctimacula and but one aquacaelestis, although in the catch with the sweep-net there were hundreds of the latter to every one of the former. The evidence seems conclusive that A. tarsimaculatus variety aquacaelestis is but slightly homophilous. Neither variety of A. tarsimaculatus has been taken or found breeding on the Pacific side of the Isthmus or in the higher inland country. A. albitarsis, recently reported from the Canal Zone, breeds prolifically in surface patches of bladderwort (Utricularia mixta) in Gatun Lake and has as yet been found in no other habitat. It is especially prevalent in the latter part of the dry season when the amount of this plant exposed on the surface is vastly increased by reason of the lowered water of the lake. At such time the total area of exposure of this plant over the shallower parts of the 165 square miles of Gatun Lake must be enormous. Yet in unscreened homes and the tents of military personnel encamped nearby only engorged A. albimanus are taken in the morning, indicating that perhaps albitarsis, too, is but slightly interested in mankind and therefore is perhaps not so important as a malaria carrier. Associated with A. albitarsis in the bladderwort patches have been taken larvae of A. albimanus, A. bachmanni and A. strodei. A. bachmanni had not heretofore been taken except in association with the aquatic aroid, water lettuce (Pistia stratiotes), and its recent 'Observations on the Nyssorhynchus group of the Anopheles of Panama. Amer. Jour. Hyg., Vol. XV, pp. 556-572.

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54 appearance in the bladderwort patches may perhaps be explained by the fact that the Pistia has of late largely disappeared from the waters of the Canal Zone. In many ponds, sluggish streams and lake inlets that formerly were nearly choked with a luxuriant growth of water lettuce, can now be found hardly a plant of it. On the other hand, the Utricularia and one or more species of Chara are on the increase in lake waters. It is not to be wondered at that these changes are occurring. It must be remembered that less than 20 years ago where Gatun Lake now lies was rolling hill land and jungle and running streams. Changes in the plant and animal life of the region must continue for many years to come as nature adjusts herself to the tremendous alteration that has been forced upon her by the construction of the Canal and its tributary lakes. Even as striking as the limitation of A. albitarsis to Utricularia is the even greater prevalence of A. albimanus in similar patches of Chara. Chara has apparently been established in the lake waters here for a longer time than the Utricularia. At least it is more widespread' there is much more of it, and when the greater amount of sunlight and the lowered lake of the dry season have carpeted acres of water surface with this ideal source of food and shelter the larvae of A. albimanus teem upon it. For some time it has been noted that toward the end of the dry season there have been flights of A. albimanus into the sanitated areas, apparently from unknown distant sources, before the fall of enough rain to create new breeding places. It is now suggested that perhaps these flights have their source in the large amount of breeding taking place in the patches of Chara in the lake area, probably Jn the nature of periodic or seasonal "dispersal" flights. Certainly the time of the flights corresponds with the time of optimum breeding conditions in the lake. Moreover, the increase of Anopheles breeding in lake areas has a direct bearing on the question of the "Zone settlers" who have been permitted to occupy every available piece of land suitable for banana raising on the shores of Gatun Lake. When the traffic through. the Canal becomes so great that night transits are necessary, these settlers will have become such a source of infection with malaria that the problem will have to be dealt with either by depopulation or by sanitation at a cost that now seems prohibitive. The influence of Zone settlers on the occurrence of malaria in permanent Canal Zone towns, Army stations, and the city of Colon, all located in the area north of Gatun, was discussed briefly in the annual report for 1930. Further studies of the situation were made and the

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results of these studies and recommendations incident thereto are incorporated in pages 56 to 59 of this report. Pending permanent solution of the problem of Zone settlers, the Health Department is continuing frequent blood surveys of certain groups of the settlers and treatment of those found to be infected. Special projects, northern distrit.-The work of the northern district, so largely composed of tidal swamps and marshes of vast extent, is now largely one of maintenance. Considerable attention has been given to the study of the mosquitoes breeding in some of the nearer undrained areas, as in tle Mojinga swamp of the lower Chagres River, but no breeding areas of Anopheles albimanus of such extent as to merit concern have been discovered. The Medical Department of the Army, which maintains sanitation in the immediate vicinity of the Army posts, has continued extending the drainage east of Fort Randolph as far as the Zone boundary line, chiefly for the control of Anopheles tarsimaculatus (variety aquasalis). Special projects undertaken in southern division--Pedro Miguel, Ancon-Balboa, and Panama suburban districts.-In addition to the usual maintenance and control work done in this area, the inspector in charge of the division and his subordinates furnished personnel and material to assist in the experiments with airplane dusting (see pp. 59 to 64), and undertook the malaria control work in the Madden Dam area. The construction of the Thatcher Highway, extending from the west side of the Canal at Balboa to the Zone boundary at Arraijan, has opened up a new area to which employees will have access, including a swimming beach at the mouth of the Farfan River. Considerable drainage will need to be installed in the vicinity of the road proximal to Balboa. The large mangrove swamps along the west bank of the Canal, which formerly were inundated daily by the tides, are being filled by a hydraulic dredge and will require sanitary control where none was needed before. At the present time these areas contain large pools of fresh or brackish water into which it is impossible to venture because of the bottomless mud underlying them. The tangled roots of mangrove (Rhizophora mangle) preclude the use of boats. With the advent of the rains an attempt will be made to control mosquito breeding in these swamps (Anopheles and A edes taeniorhynchus) with fuel oil sprayed from an airplane by Lieut. R. T. Zane of the Army Air Corps, Aeronautical Aide to the Governor of the Panama Canal, who has for some months been experimenting with a small equipment designed by himself for this purpose. In areas such as that described above and where

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56 culcines other than Anopheles are to be dealt with, the proposed method seems to offer perhaps the only practicable means of control. MALARIA IN COLORED SETTLERS (FARMERS) LIVING IN THE CANAL ZONE. In 1921-1922 the policy was adopted of permitting individuals to rent limited areas of land in the Canal Zone for farming purposes for the reasons set forth below: (a) On completion of the Canal a large reduction in the number of employees was necessary. Many colored laborers (West Indians) were left without employment ancbthe opening of the Zone to settlement as an emergency measure would relieve the unemployment situation and the congestion of population in Panama City and Colon. (b) It was assumed that the settlers, through their farming activities, would materially increase the supply of fresh vegetables, fruits and other foodstuffs for local consumption. (c) It was thought that these settlers would provide a reservoir from which adequate numbers of laborers could be drawn to meet special or emergency conditions. The first of the above intentions, that of relieving unemployment and congestion of population was accomplished to some extent. But little has been accomplished in supplying fresh vegetables and fruits for sale except bananas, and changes in soil content are adversely affecting this latter industry in the lake region. As a result of rapid increase in the population of Panama City an adequate reserve of labor is available. At the present time (1931) these so-called "Zone settlers" number about 4,200. They live in various parts of the Canal Zone but are not permitted to build houses and live on land within one mile of permanent Canal Zone settlements or military stations. The principal settlements are located as follows: An area known as the Chiva Chiva trail to the east of Fort Clayton, with a population of 713; the Pedro Miguel valley to the north of Pedro Miguel, population 190; the area along the Gaillard Highway between Gamboa and the Experimental Gardens at Summit, population 149; Frijoles (a station ort the Panama Railroad) in the Gatun Lake region, population 848; the Loma Bracho-Chagres River basin-Gatun area, population 284; and more or less isolated farms on the shores and islands of Gatun Lake, population 1,295. This group of the population of the Canal Zone has greatly increased the amount of malaria and other diseases in the Zone. It can be assumed that the present population will increase gradually even though no additional land licenses are granted, and eventually

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57 the result will be that the Panama Canal Government will be faced with the problem of a large rural population consisting of aliens, without nearby schools, physicians, or sanitation, unless the Government is prepared to furnish these at great cost. From the viewpoint of hospitalization alone these settlers already have become a problem for the Health Department. As a rule the amount of produce raised permits them to eke out only a bare existence and but few of them can pay the nominal fee of from 50 cents to $1 per day charged for hospitalization. During the calendar years 1930 and 1931 the total amount of hospital charges against these settlers (at the rates mentioned above) was $5,881.95. Of this amount only $1,343.04 or 23 per cent has been collected. The principal interest of the Health Department in the situation is, however, a much broader one, namely, that of sanitation and malaria control. If the Canal Zone is to remain somewhat thickly settled with a resident population of this type, or is to become more densely settled with the natural increase that will occur, it may be anticipated that, to protect this class of residents, Panama Canal employees, military forces, and shipping from malaria and other acute transmissible diseases common to the Tropics, it will be necessary to extend routine disease control measures to all inhabited parts of the Zone. At the present time comparatively small areas of the Canal Zone-those in the vicinity of permanent Canal Zone settlements-are intensively sanitated against malaria. The magnitude of the problem can be appreciated when it is understood that Gatun Lake covers an area of 165 square miles with much over 1,000 miles of shore line and that, in addition, 300 square miles of land area are involved. The area in which malaria rates in Canal Zone employees, military personnel and others are most seriously affected by Canal Zone settlers is that north of the Gatun Locks in which are located the towns of Gatun and Colon, several military stations (Fort Davis, Fort Sherman, Fort Randolph, and France Field) and the Naval station, Coco Solo. The malaria problem in this area was reported to the Governor in 1930 and pending further study he directed that no additional licenses be granted in the area; that no transfers of licenses would be permitted, and that licenses would be cancelled when practicable (see pp. 80 and 81, Annual Report, 1930). This problem was given special consideration during 1931 by a Health Department committee consisting of Dr. D. P. Curry, Assistant Chief Health Officer; Mr. W. H. W. Komp, Sanitary Engineer, U. S. Public Health Service; and Maj. Geo. C. Dunham, Medical Corps, U. S. Army, and the committee made the following recommendations: 1.I

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58 (a) The committee recommends that the Loma Bracho area, the Chagres River basin below the spillway, the shore of Gatun Lake to a distance of three miles south of the spillway, and the Majagual and Escondido areas east of Margarita Road be depopulated of the so-called Zone settlers by the revocation of licenses and purchases of improvements. It were better that not even agricultural operations be be permitted in these areas, as the Anopheles albimanus, one of the most potent carriers of malaria, breeds best and almost exclusively in water well exposed to the sun. Therefore, operations involving clearing of the land favor the incidence of malaria. (b) It is further recommended that, if it becomes practicable by reason of construction of a highway along the Panama Railroad beyond Gatun, the "banana dock" at Gatun Lake be removed to a point at least one mile from the town so as to remove the considerable number of natives who regularly congregate at night at this point en route to and from settlements on Gatun Lake. (c) It has long been the policy of those engaged in malaria control work on the Isthmus to utilize the maintenanCe and control gangs during the dry season for the further extension and improvement of the regularly sanitated areas. This policy should, of course, be continued, as it is believed that by reason of it in the past the Zone as a whole has arrived at and maintained its really excellent results in the reduction of malaria. The report of the committee was concurred in by the Chief Health Officer and submitted to the Governor for consideration. It was referred by him to a general committee consisting of the Chief Health Officer, the Auditor, the Executive Secretary, and the Land Agent, Panama Canal, with directions that recommendations be made as to the disposition of the settlers should depopulation be carried into effect, the source from which funds could be obtained to cover reimbursements for improvements and transportation charges for repatriation, and the time limits that should be set for accomplishing depopulation. The committe found that no funds were available and recommended that they be secured from Congress. This recommendation was approved by the Governor and funds to carry it into effect will be requested of Congress when economic conditions warrant their inclusion in the budget. In the meantime special efforts are being made to reduce the number of settlers throughout the Zone by cancellation of licenses. That some results are being obtained is evidenced by the following data showing number of licenses in effect as of June 30 for the years 1922 to 1931: Fiscal years1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. Agricultural licenses, number of. 1,026 1,805 2,154 2,112 2,012 2,019 2,041 2,123 2,112 1,927 Average number of acres leased .7.6 9.1 7.8 8.3 8.9 8.3 7.7 6.9 6.8 I .3

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59 During this year the policy was continued of making monthly blood surveys for malaria of the agricultural population living in the vicinity of permanent Canal Zone settlements and military stations and treating with quinine the individuals having malarial parasites in the blood. A few interesting facts have been disclosed by these surveys, namely: (a) There are two small villages, Frijoles and Monte Lirio, on the Panama Railroad in the lake region in which no malaria control measures are carried out except as is indicated below. In one of these small villages, Monte Lirio, the habitations are adequately screened. One survey was made of this population (total 24, of which 14 were examined) in 1931 and the average percentage of individuals carrying malarial parasites was 7.1 per cent. In the other village, Frijoles, the houses are not screened and the comparable average percentage carrying malarial parasites for the five surveys averaged for 144 individuals, 16.3 per cent. (b) Eight surveys were made of the inmates and police guards of the Canal Zone penitentiary at Gamboa (average population 69; average number examined 58) and the average malaria infection rate found was 1.5 per cent. The institution is effectively screened and the prisoners must ,of necessity remain indoors during the night. (c) The blood survey rates for malaria in the population living on the fringes of the areas in which intensive malaria control work is constantly being done were considerably lower than the rates prevailing in representative samples of the population in the lake region: Chiva Chiva trail, scattered rural, mostly Afro-West Indians------10.0% Pedro Miguel valley, scattered rural, mostly Afro-West Indians-----3.9% Escobal, native village, Gatun Lake -------------------------19.7% Limon, native village, Gatun Lake------------------------22.2% Observations similar to those recorded under (a) and (b) above have been made in this region for many years, namely, that adequate screening of houses occupied by humans, of itself alone, constitutes a most important measure in malaria control work. MOSQUITO BREEDING AREAS IN THE VICINITY OF PANAMA CITY, AND THEIR CONTROL BY DUSTING WITH PARIS GREEN FROM AIRPLANES. In mosquito control work on the Isthmus it has been the policy of the Health Department, for many years, to rely principally on permanent drainage work. In some situations (along the shore line of the lakes supplying water for the Miraflores Locks) it has been the custom Iw

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60 to use oil applied as a spray from boats. In this particular Si this method of control is the most efficient and satisfactory that be applied on account of the low cost of oil and the fact that m q toes which constitute a pest, as well as anophelines, are controlled. During recent years the city of Panama has been gradually ex eastward along the shore line, and suburban areas are being developed along the highway extending from Panama City to Chepo (Pueblq Nuevo, San Francisco de la Caleta, Juan Diaz, Pacora). The area between the city proper and Juan Diaz is now quite thickly settled. During the year a blood survey of representative samples of the population living in this area was made by malaria control units of the Health Department of the Republic of Panama under the direction of Dr. Paul F. Carley of the Rockefeller Foundation, and showed that from 12 to 43 per cent of the population carry malarial organisms. Surveys repeated at frequent intervals would show a much higher actual rate of infection. It also was noted that as the distance from Panama City increased the malaria infection rate increased. The improved highway from Panama to Chepo runs along the foot-hills and between it and the sea is a strip of lowlands (marshes and swamps) from one to about three mileskin width that becomes inundated with brackish or fresh water during the season of rains (May to December). This area, 40 or more miles long and from I to 3 miles wide, affords ideal breeding conditions for many species of mosquitoes and particularly for Anopheles albimanus, the most important mal. transmitter in this section, and for the Aides taeniorkynchus, the outstanding nondisease bearing mosquito pest on the Isthmus, from to about August. The Aides taeniorhynchus breeds in enormous. bers in the coastal marshes mentioned above and at certain times large numbers are observed in Panama City and the Zone that undoubtmdh y have made sustained flights from marshy areas 10 to 20 miles or r distant. It has been observed that the initial Rlights, presu nuptial, as a large proportion of males was present, are infinitely large some years than others. In 1931 one of these enormous flights occu On the night of June 9, 1931, about 7 p. m., myriads of thes iosquitoe. suddenly appeared in all parts of Panama City, Ancon, Balboa, and elsewhere on the Pacific side. At the time of their appearance a young people's meeting was being held in the Baptist church (unscreened) about 200 yards from the Panama Canal administration building, Balboa Heights, and their swarming myriads caused the adjournment of the service. The following morning thousands were observed resting on the walls and ceilings of the adminstration building

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& & s

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Ion. s~~~~~~ 6 po&y /ne2 do All 61 Sbee Ying fcevi 5upper/f kMate. Ci No. 3. -Hopper f. r carrying nixture of dust and Paris green, with mechanism for releasing the mixture.

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61 (unscreened), particularly on the third floor. There were hundreds of dead males on the inside sills of the closed windows of the Baptist church. Part of the same flight made its way inland as far as the Madden Dam area, not nearer the coastal swamps than 20 miles. This flight came from the coastal swamps east of Panama City, certainly from 15 to 20 miles or more distant from Balboa. A second large flight (considerably smalley than the first) occurred several days later. In checking back on similar flights it was found that the last one of like proportions occurred in 1927 and curiously enough the flight that year was on the night of June 10, whereas the one in 1931 occurred on June 9. The control of this pest is impracticable under existing conditions. It has been possible, however, gradually to extend drainage projects in this area and during the past few years the marshy areas from the city proper to Old Panama have been drained, chiefly for the control of Anopheles albimanus however. Between Old Panama and Juan Diaz there exists a low marshy area, from one to two miles in width and four miles long, which is used for pasturing cattle. The Health Department has been observing mosquito breeding conditions in this area for a number of years and it is known that at times each year Anopheles albimanus breeds prolifically there. In 1931 consideration was given to the possibility of preventing Anopheles breeding in this area. Estimates based on surveys indicated that the installation of a drainage system would cost about $25,000. There was also some question as to whether a drainage system could be installed without the use of tidal gates. Assuming that the drainage system could be installed, the maintenance costs would be very high. This project was therefore abandoned as being impracticable. Consideration was then given to the feasibility of controlling Anopheles breeding by the use of Paris green dust, distributed by airplane. The matter was broached to Lieut. R. T. Zane, Aeronautical Aide to the Governor, and he considered it feasible. The experiments we had in view were heartily approved by Maj. Gen. Preston Brown, Commanding General, Panama Canal Department, and his cooperation was, secured. He very kindly directed the Air Corps to cooperate with us by furnishing airplanes for the experiments. A hopper with mechanism for releasing the mixture of dust and Paris green, easily installed and quickly removable from the airplane, was constructed after the design of one used by the United States Marine Corps in dusting with Paris green the shores of Lake Managua in Nicaragua, photographs and descriptions having been furnished by Lieut. Commander J. F. Neuberger, Medical Corps, U. S. Navy, who

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62 was in charge of the work there. It was found essential to install an agitating device, actuated by a small wind-driven propeller, in the throat of the hopper to insure a uniform feed of the dust mixture; also the controls were changed to permit them to be operated from the pilot's cockpit. These changes added much to the efficiency of the apparatus. A plane of the bomber type was selected, as large amounts of Paris green mixture could be carried, and the equipment could be installed or removed in about 15 minutes without modifying the structural features of the plane. Paris green of the proper quality was quickly made available through cooperation on the part of Dr. Paul F. Carley, of the Rockefeller Foundation. A clay somewhat similar to fire clay that, when dried, was easily pulverized into a fine dust, was found to be available on Diablo Hill about one mile from Balboa. The area to be dusted was and still is being used as a cattle pasture and during the rainy season is trampled into a quagmire; the innumerable water-filled depressions afford ideal breeding conditions for A. albimanus and other species of mosquitoes., It is covered with ParA grass and aquatic plants from one to five feet in height and it was felt that the first step should be to determine the concentration of Paris green that would be required to assure that it would filter down through the vegetation and kill the Anopheles larvae. The effectiveness of the dusting in this experimental work was checked by placing flat, white enameled developing trays containing a small amount of water and known numbers of A. albirnanus larvae on the ground in representative parts of the area. On July 10, inspection of the area showed profuse A nopheles breeding and the first experimental dusting was done on July 17; 600 pounds of Paris green and dust mixture (Paris green 20 per cent, dust 80 per cent, by weight) was used per trip and two trips were required to dust the entire area. The dusting material was loaded into HE plane at the Panama National Airport, Paitilla Point, about two mile west of the ruins of Old Panama. The area dusted is approximately4 miles east of Balboa. The time required for each flight'was only HU to 20 minutes, actual dusting operations requiring 10 to 12 minu The altitude maintained during dusting operations was from 100 to feet. At present the bombers are located at France Field on the Atlanti side and the total time required for the flight across the Isthmus, loading and making two flights over the area dusted and returning to base, is about two hours.

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4 e

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A4 C0 r No. 4.Bonbier dusting with Paris green.

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F441 pk * + -r CriNo. 5. Another view of dusting operation.

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6

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63 .n.e.o.after the first dusting showed from 80 to 90 per cent of e trays used as controls were killed and the results in appeared to be even better. T second dusting was done July 28, under the same conditions as first, 86 per cent of the larvae in the trays being killed. A third dusting was carried out on August 4, under the same condias for the first two dustings except that the concentration of Paris in the dusting mixture was reduced from 20 to 16 per cent, the amount of mixture used for the two trips being increased from 1,200 pounds to 1,500 pounds. Approximately 80 per cent of the larvae in the trays were killed. T experiment was repeated September 11, under the same condis a previously, except that the Paris green in the dusting mixture was stI further reduced to 10 per cent, the total amount of the mixture beig~ increased to 2,400 pounds. The results obtained were even better, owing probably to better distribution of the Paris green. Further c fntrolchecks (distribution of trays containing definite numbers of larvae), re considered unnecessary. W kl inspections of the area for breeding were continued and it was necessary to dust by airplane again on December 18; 2,400 pounds f t mixture, 10 per cent Paris green, being used, the same as on Sep11. No living larvae could be found in the marsh on the folday. e method of control gave excellent results in this area and it is Intention to continue it during 1932 and possibly extend it to a special area on the west side of the Canal near Balboa where a temporary breeding area has been created by dredging operations in connection with the construction of the Thatcher Highway. The costs of Anopheles control in the area dusted (about one and one-half miles in length by one mile in width), exclusive of cost of airpkane service which was furnished free of charge by the Army as a coopealive measure, were as follows: Equipm"nt (hopper and attachments).------------------------$385.59 Operating charges, basd on work required to accomplish one dusting of the area by airplane: Inspection of area for breeding.-.----.-----.--------18.68 Paris green, 240 pounds at $0.2154 per pound.-.---------------51.70 Dust, dried and delivered at Ancon, 2,160 pounds at $0.05--.-.-. 10.80 Mixing dust and Paris green---------------------------------4.40 Loading, transporting, and delivery of mixture at airport----. 10.80 Total operating charges, exclusive of airplane service and interest and depreciation on equipment.------.---.--. 96.38 M -O

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-~~~~~~~~~N Obevtoso reigcniin i hsae niaeta i mum~~UN No 7t10d Ig ahriysaoa ekyitras ilb Ti Nro ar NeN. VRIAE OK FN th bRhfi faNti.a-NNreswohaedangepolm similar to our ow~~~~~~~~~N olwn ealdinomto eadn d is ~ AI Aade Hs Nhw Fn Ct NN. 6.Bton ieofpp ( nLs ni diNeer A -Ho nn Negh n n it o e ii lrivr (N Mnhe Nie nhsdep niemauEm t)aeud deep Nut th. eate sNe Nf thKri r oddaoete vr (Cut No. 6). There is, of course,~ ony csia edfrsuhd be drains.~~~~~ Jriarl MAI use eithe thNsb Oiltlso tecnr di nt p oniered. mr ha .%gae teoe eton r sal more~~~ ~~~~ siif oy sbigese ofre Nro sLt.ors ag ny susrfc tml Nsisalda n rpatclyn rd fnc ay din p vrngte "N thedring racks, the ile are i etdy .cd ne water intesalwtnssonAnCtN .8t uefr2 hour. Tey ae ten tackd i theope unil nede. Thse ilJ are~q CId= Hnyi h an esnadte ancnieal nsrnt durig th 6 mnthsor mre f exosur to heNN. s The~~~~~~~~~w setoa inetfr ad ssoninCtN.9 TRe 2N ANn mak q: tq7 etosi a tacs f4 et

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or avrequired Aby grate. 34 34 i3 1 /ON10 34" ~ ~ ~ ~ ~ 4 36 3 "/1,1. 36' 9 bi!/ 19 19" if / /0 /4CUT No. 0. (I.-"Double decker" drain with grassed sloping banks. (S(-e page 64.) b.-Shallow excavation for laying a "double decker." (See page 64.) c.Arrangement of side bars and separators (pallets) for casting alternately right and left curve sections. (See page 65.) d-.-Method of laying curves of various radii. (See' page 65.1)

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s 4

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e#

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Cu'r No. 7.-Machine for making 6" x concrete tile. The two men make 400 Pieces per day of 8 hours. CUT No. 8. After standing overnight on tli' drying racks, the tiles are next day placed in the shallow tanks (foreground) to cure for 24 hours under water. They are then stacked in the open until needed. Cur No. 9.--Tables for casting sectional concrete inverts; the usual siZ' is 36" long. 14" wide (inside measurenent.)

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65 ~per section~. The usual procedure is to make the 6-inch tiles every other dsections the alternate days, so as to leave the sections n the frms for 36 hpurs or more after pouring them. The semii rcore is made from galvanized sheet iron 1/16 inch thick, and tto nearly a half-circle with a 7-inch radius. The side bars are 3 inches wide, I inch thick, and 3 feet long. A i-inch space between the ends of each pair of bars where they are bolted gter and to the table by means of a cast clip-angle. Into this -like space fit freely the sides of the bronze pallets, or separators, i vide the cast sections and give form to the male and female ifeach section. The sections are laid without cement, the male dg easily into the female end. The straight sections are all 3 t but provision is made for laying smoothly jointed curves by casting some sections with one side shorter than the other. These Mgar sections are cast on the same straight core by making alterright or left curves (Cut No. 6). By varying the length irregular sections the curves can be made of varying radius. Section 36 inches long on one side and 34 inches on the opposite il lay exactly a curve of 27 feet radius; half-size sections (19 inches one side,17 inches other) will lay a curve of 14' feet radius; j-size sections (12 inches one side, 10 inches other) will lay a curve of 9 feet ra (Cut No. 6). By slightly opening the joint in the inner or outer side between two sections, the degree of curvature may be to any required degree. ear one end of each of the shorter sections, and at both ends of the est sections, are placed wire loops (see Cut No. 9, front end of newly cast section at right). These wires are used to pry or lift the sections the core -after setting, and they also facilitate their handling on -carriage (Cut No. 9 left) and in the field. tons are made with Portland cement, sharp sand, and gravel en one, in the standard 1-2-4 mix (machine mix). After r i plave for 24 hors they can be removed and stored on end (Cut No. 8, right background). To remove from the the weights (short pies of railroad steel) are removed, the g wooden sideboards lifted, and the endmost pallet tapped loose of the slots. The front section can then be pried loose ed the table, later to be carried out on the 2-wheeled cart. Sections in the field the area to be drained is first the levels beig determined by a surveyor's level the use ef which the sanitary inspectors are proficient). The the proposed grades are carefully plotted on aR *15-

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66 profile paper and the utmost care is taken to secure a neat-appearing workmanlike job. Batterboards are set at 50-foot intervals. Since the grade is often as slight as 0.1% (1 foot in 1,000) the eleva-tons are read closely with the level. The depth of cut may be determined f a tightly stretched cord, but the final laying of the concrete paving is done by measurement from a taut steel wire. The distance from the wire to the bottompf the invert is measured off on a smooth hard stick (a broom handle does nicely) and a slight nick is made at such a distance from one end that when the invert is at the proper point the nick just fits on the stretched wire. Before backfilling is done at the sides of the sections they are aligned carefully by observing them from a suitable distance so as to determine if the tangents are straight and the curves gracefully made. A little extra attention to this detail greatly improves the appearance of the completed drain. Reference to page 6 of our annual report for 1919, will show the type of precast concrete inverts used up to 1928; this has a large bell. end which necessitated extra excavation at the end of each piece. The concrete inverts now used, as shown in these illustrations, have' an unbroken straight surface on the botton and sides, and are vastly easier to lay. When the sections were cast in the old way, each section in a separate form, the inside finished by troweling, it was practically impossible to get them of even thickness and shape, so that considerable labor was required to get them laid to an even and continuous grade. The continuous core with cast separators for the sections as now made, insures uniformity so that the male and female ends interlock without the least difficulty. TRYPANOSOMIASIS IN ANIMALS. In the annual report for 1930 (pages 78 and 79) the occurrence of. trypanosomiasis (murrina) in animals was discussed. Cooperative work on the part of the Gorgas Memorial Institute, the Army, the Supply Department and the Health Department of the Panama Canal, and the Panamanian Government was continued during 193t and the Gorgas Institute has made important contributions t* ou knowledge of the disease. No epidemics occurred in horses or mules on the Canal Zone during the year. Occasional cases (13) have been found in horses belonging to colored farmers on the Zone and the history of the animals involved indicates that infected animals were brought into the Zone from infected areas in the Republic of Panama. During the year blood film surveys of horses and mules were made throughout the Canal Zone and along the highways in the Republic

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411 c. -E S -/-C -cSt,, L -r OF-rt Al466 ,74-1~ h.q7j. d Cr No. 10.Details of form for making precast concrete inverts for paving -drainage ditch~es. (Designed by Dr. D. P. Curry.) (See page 65.) THE PANAMA\ CAN V. WPA I 1710711 U l' I1 4 DRAINAGE DITCH -ofm (5t -6;; 1'7

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67 Sof Panama on either side of the Canal Zone extending to the east as far as Chepo (42 miles) and to the west as far as Aguadulce and Las Tablas (about 200 miles). Only 29 cases were found in these areas and they were distributed as follows: Summit, Canal Zone.--3 Pacora to Chepo, Republic of Panama 12 Chiva Chiva, Canal Zone---.-.-.-.5 Aguadulce to Las Tablas, Republic of Hooper Farm (Gatun, C. Z.).-.1 Panama--.---. .4 U.S. Army, Fort Davis (Gatun, C. Z.) 4 The Army animals apparently contracted the disease during maneuvers. The present foci of the disease are in the provinces of Cocl6, Herrera, and Los Santos, Republic of Panama, which lie to the west of the Canal Zone, and in the Province of Panama, 30 miles southeast of Panama City, in the sabanas. The epidemiological evidence already secured indicates that with the extension of good roads from Panama to Chiriqui Province (which -is the border province next to Costa Rica) the disease is extending. The disease has no't as yet reached Chiriqui Province, but doubtless will do so in the near future. During the year, through cooperation on the part of the Panama Canal, it was possible for the Gorgas Memorial Institute to establish a research veterinary station on the west side of the Canal at Miraflores. This has made possible considerable expansion of the investigation of trypanosomiasis by the Gorgas Memorial Institute. As a result of the experimental and other work done by the staff of that institute, much important information has been added to our knowledge of the disease.' The most important points may be summarized as follows: 1. If an infected herd is surveyed (clinical examination plus blood survey) and all infected animals placed in isolation two miles or more distant from the uninfected herd, it appears that the disease can be eliminated, provided several resurveys are made at short intervals (three to four days) and the occasional supplementary case removed. 2. The disease can be transmitted to guinea pigs, rabbits, and other lower animals but the duration of life after infection is short in such animals. 3. The parasite occurs in nature in cattle and can be transmitted. In cattle the infection does not cause any appreciable symptoms but they provide a dangerous reservoir. z Dunn, L. H.--Experiments in the transfer of Trypanosom'hippicrum Darling with the Vampire Bat .Jour. Prey. Med., 6, Sept., 1932. EEE :I Et

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68 4. The disease can be transmitted from animal to animal by vampire bats (Desmodus rotundus murinus Wagner) and the evidence indicates that the mechanism of transmission is a biological rather than a mechanical one. 5. The fact that cattle can become infected without symptoms, thus acting as reservoirs for the spread of infection, makes the problem of control a most difficult one where equines and bovines occupy the same range. In this respect the trypanosomiasis (murrina) of the Isthmus parallels that (surra) of the Philippine Islands. In this region cattle are reservoirs; in the Philippines, carabao. More details regarding 4 and 5 will appear in later publications by the Gorgas Memorial Institute. The quarantine against the transfer of animals from the west to the east side of the Canal, in the Gatun area, has been continued in force throughout the year. Recent surveys of animals in the quarantined area have failed to disclose any infected cases. If repeated surveyscontinue to show absence of infection, it is planned to raise the quarantine in 1932. EXPERIMENTS IN COMPOSTING MANURE. In the Annual Report for 1930 (pages 79 and 80) the methods of disposal of manure to prevent fly breeding were discussed. The results of some experiments, including a modification of the existing system, were recorded. Further experiments during 1931 indicate that if the manure is sealed tightly in concrete pits for a period of one week, then ventilated and oxygen is allowed to circulate freely throughout the mass for a period of from two and one-half to three weeks, the resulting humus has appreciably less odor, is not so attractive to Musca domestica (the house fly) as is raw manure, but still retains its attraction for Stomoxys calcatrans (the biting stable fly). The resulting humus apparently does not reach the advanced stage of decomposition reported in certain garbage disposal plants in the United States and in Italy for the so-called Beccari system for the disposal of garbage. Some experiments were undertaken with mixtures of representative samples of garbage and manure with unsatisfactory results. Further experimentation has been discontinued for the time being. DISPOSAL OF GARBAGE, PACIFIC ENTRANCE TO THE CANAL. It was pointed out in the 1930 annual report that for a number of reasons it would be necessary, in the immediate future, to abandon the present method of disposal of garbage for the communities located

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69 at the Pacific terminus of the Canal (Panama City, Ancon, Balboa, Quarry Heights, and Fort Amador). During the year a thorough study was made of the various possibilities and disposal by burning in an open grate incinerator was decided -upon as being the most economical and practicable at the present time and under existing conditions. The incinerator is to be located near Summit, 12 miles north of Panama near the main line of the Panama Railroad. HEALTH SERVICES IN THE TWO TERMINAL CITIES, COLON AND PANAMA. The Health Department, Panama Canal, maintains health services in the cities of Panama and Colon the principal activities of which are: To prevent the occurrence of epidemics of diseases that might interfere with or tend to delay the transit of shipping; to enforce such health regulations as will reduce to the lowest minimum practicable the occurrence of diseases prevailing in this section, of which malaria is an example; and to reduce the prevalence of the insect transmitters of such diseases as yellow fever and plague to such an extent that even if introduced on the Isthmus their spread would be either markedly curtailed or would be impossible. The scope of the health work done in the cities of Panama and Colon by the Health Department, Panama Canal, the activities carried on by the Health Department, Republic of Panama, costs of such work to the Panama Canal and conditions (treaty agreements) under which the work is done, were summarized briefly in the annual report for 1930 (pages 82-84). REPORT OF THE HEALTH OFFICER-PANAMA. Dr. JESSE L. BYRD, Health Officer. The proposal to coordinate better the health services rendered by the Panama Canal and the Republic of Panama in Panama City, mentioned in the report for 1930, was taken under advisement when the new government came into being in January, 1931. An agreement tentatively acceptable to both parties, has been eyolved and has now reached the stage of translation of final draft. In Panama City it has been the practice until recently, to permit adjoining buildings to leave a space of from 2 to 12 inches between the adjacent walls. This practice was not only contrary to the building regulations, but provided many additional rodent propagating areas. The present practice provides for the elimination of all unnecessary spaces which might provide rat harborage. We are sometimes handicapped in trying to provide adequate ventilation for tenement rooms and in some apartments by an old Panamanian law which prohibits

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70 the opening of a window that faces another owner's property if the walls of said building are located on the property line. Since most of the houses in the older parts of the city are located on property lines, this law prevents many owners from securing adequate light and ventilation for their houses. However the present policy of limiting the coverage to 80 per cent of the building area or lot, and using 20 per cent of such space to the best advantage in distributing light and ventilation has proved satisfactory. There were 1,008 building permits issued as follows: N ew b u ildin gs -.-.-.-.-.78 Repairs and alterations to existing buildings. .-.-.-. .258 M iscellaneous repairs. 6-4--..647 Installation of fixtures and counters, and rat-proofing sa meie. .25 The building inspector makes numerous follow-up inspections on all permits issued, to insure compliance with the sanitary and building regulations. There were 1,965 rats and 2,456 mice caught in the city during the' year; 3,978 were forwarded to the Board of Health Laboratory for examination and were classified as follows: M us m usculus .--.-. .1,986 M us alexandrinus .--.---.--. 52 Mus norwegicus. ....216 Mus ratus.--. ----------------. 1,724 Dairy and milk inspection.-There are 23 dairies supplying milk to the city, a small part being sent to the Canal Zone and Colon. These dairies contain 2,724 animals; 37 dairy cattle and calves were imported from the United States and 190 head from Costa Rica during the year. All dairy cattle including importations were tested for tuberculosis during the year, 66 giving a positive reaction. All reactors were slaughtered. The total milk production during the year was approximately 450,000 gallons or 2,250,000 bottles of 1/5 gallon each. There has been an improvement in the handling of milk by milk vendors. Practically all pasteurized milk is being kept properly cooled and the practice of selling splits or parts of a bottle is gradually being' eliminated. There is no bulk milk sold and dipping is prohibited. All dairies and pasteurization plants receive weekly inspections and samples are taken monthly for laboratory examination. Ice cream.-The regulations require the pasteurization of the mix, and a minimum of eight per cent butter fat. These plants are required to keep their places scrupulously clean and in proper sanitary condition at all times. They are given a thorough inspection at least once a week.

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71 Soft drinks.-There are four bottling plants in the city. Each plant is equipped with modern machinery, such as mechanical bottle washers and automatic bottle filling and capping machines. These plants receive frequent inspection to insure the purity and cleanliness of their products. General food inspection.-Restaurants, hotels, clubs, markets, cantinas, ice cream and solf drink parlors, stores and all other places where food is prepared, manufactured, stored, sold or offered for sale, receive frequent inspections in order to insure their maintenance and operation in proper sanitary condition and that all products therefrom are sound, pure and wholesome. The following plants are given frequent inspection: Municipal markets, 2; private markets, 67; bakeries, 16; bottling plants, 4; breweries, 2; clubs, 3; ice cream plants, 4; ice cream parlors, 30; soft drink vendors, 33; hotels, 7; restaurants, 64. Meat inspection.-At the municipal abattoir, 13,875 cattle were given ante and post-mortem inspections; 58 were condemned as unfit for food on account of the following conditions: Natural death, 24; extensive bruises, 15; septicemia, 3; emaciation, 1; pneumonia, 2; asphyxia, 1; tuberculosis, 7; congestion, 3; hepatitis, acute, 1; sapremia, 1. There were 15,846 hogs slaughtered and given ante and post-mortem inspections at the municipal abattoir. Six hundred and eighty-five were condemned as unfit for food on account of the following conditions: Cysticercosis, 464; cholera, 189; icterus, 4; septicemia, 12; sunstroke, 16. Quarantine inspections were given 9,802 cattle and 2,707 hogs that were shipped to Colon. Hide inspection certificates were giveri on 11,932 hides for shipment. Diphtheria immunization.-This special work was continued during the year, as follows: 1st injections, 12,844; 2d injections, 1,167; 3d injections, 766. Total injections, 14,011; positive reactors, 1,160. Garbage.-During the year, garbage, rubbish, and manure to the amount of 36,877 tons were disposed of. Of this amount, 29,851 tons were from the city of Panama and 7,026 tons were from the Canal Zone, including Fort Amador. The cost of collection per ton in Panama City was $1.50; in the Canal Zone, $2.54. The cost of disposal was $0.50 per ton. REPORT OF THE HEALTH OFFICER-CRISTOBAL-COLON. Dr. JESSE C. ELLINGTON, Health Officer. Personnel.-The personnel of this office consists of the following: Americans (white), 1 health officer, 1 nurse, 1 clerk, 2 veterinarians and

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72 meat inspectors, 3 sanitary inspectors. Aliens (colored), 89 street sweepers, scavengers, sanitary patrolmen, etc. No changes in the personnel were made during the year, except the present Health Officer assumed charge of the office on July 29, relieving Dr. D. G. Sampson, who returned to his regular station at Pedro Miguel. Colon sanitation.-The force engaged is composed of 1 sanitary inspector, 6 colored sanitary patrolmen, 1 laborer, and 3 scythemen, and has to do with the general sanitation of the city of Colon proper. This includes inspections of all alleys, patios, toilets, kitchens, etc., in the tenement houses, and the control of fly and mosquito breeding in the tenement district. The system of requiring house owners to provide adequate janitor service for their houses and having each house cleaned daily, with the Health Department confining its activities to inspections, follow-up and advisory work, which was started during the latter part of 1930, was continued throughout the year. The city is divided into six districts, with a -sanitary patrolman in each, whoseduty it is to notice general cleanliness of all buildings, alleys, patios, kitchens, toilets, etc., and look for evidences of mosquito, fly, or rat breeding. Whenever any sanitary nuisance is found the patrolman attempts to have it abated, but if unable to do so it is reported to the sanitary inspector in charge of the work. Each sanitary patrolman can cover his district in from five to seven days. On the whole, this system has worked very well, but there appears to be a need for some training for the sanitary patrolmen. Persistent violators of the sanitary regulations are brought before the Health Officer and fined. During 1931, fines to the amount of $242.50 were assessed, collected, and turned over to the municipal treasurer. Street cleaning and garbage collection.-One sanitary inspector and 63 colored employees are engaged in this work. The collection of garbage from Cristobal and Colon is done every night, beginning in the residential sections at 10 o'clock, using 4 trucks and 21 men. Rubbish from the city is collected daily by the pick-up truck with 2 men. All garbage and rubbish is taken for disposal to the dump in Silver City, where there is a gang of 17 men. All combustible rubbish is burned and garbage is buried. The method of garbage disposal is as follows: After being dumped by the trucks, garbage is spread afid then covered by matting and a layer of dirt about a foot deep. Each night's haul is spread in one row, and four rows of garbage are maintained. This does away with haphazard methods of spreading and is a large factor in controlling fly breeding, as each row of garbage is further covered every fourth night before the larvae can complete their

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73 development. This method also saves time and reduces expenses, as not as many laborers are required. Fly breeding is controlled by this method due to the heat generated in the decomposing garbage, plus spraying of the face of the dump with a mixture of crude oil 10 parts, kerosene and creosote 2 parts each, to kill the few "hoppers" that emerge. During the year, garbage and rubbish to the amount of 27,910 tons were disposed of at the dump. Of this amount, 21,295 tons were from the city of Colon and 6,615 tons from the Canal Zone, including France Field. The cost of collection per ton in Colon was $1.51, and the cost of disposal, 54 cents per ton. The operation of the dump was satisfactory throughout the year, with the exception of a few fires due to spontaneous combustion. These fires are persistent and require the time of about three men for about two or three hours a day in controlling them. To control them both the "dry" method, that is, covering with earth to exclude air, and the "wet" method of saturating the burning area with water have been tried, and the results so far seem to indicate that the "wet" method is preferable in that it more adequately excludes oxygen and takes less time to control the fires. The street cleaning department was reorganized during the year and several changes were made in the methods of sweeping the streets. These changes were made to overcome the following defects in the old system: (a) Lack of a definite system, resulting in overlapping of the work, neglect of some streets, inability to detect slow or inefficient workmen, and inability to fix the blame in case of dirty or carelessly cleaned streets. (b) Loss of time by men traveling between the one place of checking in and their places of work. (c) Inability of the sweepers to scrape up hardened manure, etc., from the streets with the wooden backs of the brooms. To meet these objections, the sweeping gang of 21 men was divided into 7 groups of 3 men each. Each group, with one or two exceptions, was assigned to an area 2 city blocks wide and approximately 9 blocks long, extending east and west across the city from Front Street to "G" Street and New Colon. The exceptions were in cases of thinly populated areas, such areas being apportioned according to the amount of work and travel time involved. This did away with overlapping and made it possible to fix blame in cases of neglected streets. Each group begins at Front Street and works east, and as there is approximately the same amount of work in each district, all the groups make about the same progress, so slow or indifferent workmen are easily detected and it is also easy to locate the men at any hour. To do away with objection (b) the men were assigned to groups

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74 according to the section of the city in which they lived and having four of the groups check in at a tool house near the Health Office. This eliminates unnecessary loss of time in men traveling to their places of work. To enable the men to better scrape up manure, etc., from the streets, a metal strip, or scraper, was attached to the back of each broom. Metal plates were also fastened to the ends of the brooms to prevent the wearing off of the end fibers by the low concrete curbs. These plates have resulted in much longer life of the brooms. Three of the principal streets in Colon are cleaned four times a day on week days and three times on Sundays. The five streets next in importance are cleaned three times a day on weeks days and twice on Sundays. The other streets are cleaned twice daily on week days and once on Sundays. The inspector in charge of this work also does the mosquito and rat work. He has one silver man as larva hunter and rat trapper. During the year, 3,664 traps were set; 683 rats were caught of which 410 were sent to the Board of Health Laboratory for examination. During the month of March, 110 rat-poison baits, the lethal ingredient of which was arsenic, were set out on the mole at Cristobal and in the dry dock and corral at Mt. Hope. Fifty-three were recovered intact, 36 were lost in ground holes, leaving only 21 partially or cornpletely eaten by rats. After using this poison no dead rats were seen or smelled in these places. In one of them (the corral) 10 traps were set the day after the bait was used and 4 rats were caught. The figures are not impressive, but it would seem to indicate that the poison bait is not very attractive to rats and further experiments are indicated. The practice of investigating all mosquito complaints was continued throughout the year. In most of these cases some cause was found, either in mosquito breeding on the premises in pots, vases or other containers holding water, or in adjacent buildings. Routine mosquito catching and hunting of larvae was continued all over the city during the year. Mt. Hope cemetery.-The cemetery work during the year was chiefly routine work of burials and maintenance. There were 512 burials. Receipts from burials were $3,692, from sale of flowers, $721.51, and miscellaneous receipts, $10. Much new land was cleared of bush and made ready for use. To reach this new area, partial grading and drainage of a prospective road was done. Building work.-There were 1,028 building permits issued as follows: New buildings and major repairs, 118; minor repairs, 910. All these were closely followed up to see that the sanitary regulations regarding toilets, ventilation, rat-proofing, etc., were followed to the

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75 letter. Inspections were also made of all buildings the leases of which expired during the year. Sanitation in vicinity of Canal quarters.-This work consists of nuisance abatements in Cristobal, Silver City, Camp Bierd, and New Cristobal, cleaning of garbage cans in Panama Canal quarters, and cleaning of beaches. Mosquito breeding in wash tubs in Panama Canal quarters, which had been troublesome, was eliminated through the cooperation of the District Quartermaster in grading the bottoms of the tubs to insure drainage. Dairies.--There are 19 dairies, including the Panama Railroad dairy at Mindi, which supply about 1,000 gallons of milk daily to this district. The majority of the dairies are located along the coast near the village of Cativa, and on the shores of Gatun Lake. They all meet the minimum requirements of the sanitary regulations and were under the supervision of the Health Department during the year, although inspections were not as frequent as is desired, due to their inaccessibility. The tuberculin test was given to 2,268 cattle during the year and 8 reactors were found and subsequently slaughtered. During the year, the use of a chlorine solution for washing milk cans, bottles, other utensils, and milkers' hands was started. Cooperatidn of the dairymen was fairly good and results are shown in the decreased bacteria counts of the milk reaching Colon. No attempt was made to examine all dairymen and milk handlers for possible disease carriers because all the milk is pasteurized before use. All milk is brought to Colon in boats, trucks, and by mule back and pasteurized in three modern pasteurizing plants, two of which are privately owned and the third is the Panama Railroad plant at Mt. Hope. The bacteria count of the milk reaching these plants was correlated with the time period between milking and the time of arrival at the plant. After pasteurization the average bacteria count was from 20,000 to 30,000. During the year, 421 inspections of dairies and milk plants were made, an average of 19 inspections per plant per year. Two completely new dairies were constructed during the year and repairs and improvements were made to several others. Two new pasteurizers and a new bottle washing machine were added to the equipment at the Mt. Hope plant. Ice cream.-There are five plants manufacturing ice cream in this district, and ice cream made in Panama was sold by two dealers. Two hundred and twenty-seven inspections of the five plants were made to insure the purity of raw materials used and their handling in a sanitary manner. All ice cream mix is pasteurized. Samples of ice cream were taken at frequent intervals for bacteriological examinations and butter

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76 fat content. The results of the bacteriological examinations are shown in the following table: Number of Per cent Colonies of bacteria per o.c. samples of samples examined. examined. 100,000 and under. 52 77.7 100,000 to 200,000. ...8.9 200,000to300,000. .6 8.9 300,000 to 400,000 .3 4.5 Total. ..67 100.0 In view of the fact that legal bacterial standards for ice cream in various cities of the United States range from 100,000 to 800,000, it is obvious that ice cream produced in this district is of excellent quality as regards bacteria and it all meets the regulation requiring 8 per cent butter fat. Soft drinks.-There are seven plants, including the one of the Commissary Division, that bottle soft drinks in this district. Four hundred and two inspections of them were made during the year and monthly specimens were taken for bacteriological examination. Samples of' washing solutions were also taken monthly, or oftener, for determination of the alkali content. During the year a campaign was begun to have all soft drink bottling plants install automatic filling and capping machines and bottle washing machines. This was successful, with three new outfits installed. Only one plant is without a bottle washing machine, which has been ordered. Other minor sanitary improvements were made in all soft drink manufacturing plants. Food inspections, markets, etc.-Inspection of food was carried on throughout the year and the following foodstuffs were condemned and destroyed as unfit and dangerous to the public health: Meat (fresh and salt), 9,418 lbs.; English walnuts, 125 lbs.; figs, 200 lbs.; candy, 500 lbs.; onions, 3,300 lbs.; plantains, 200 lbs.; yucca, 4,700 lbs.; potatoes, 1,800 lbs.; dairy feed, 300 lbs.; grapes, 2,400 lbs.; bananas, 1 stem; carrots, 1 crate; cabbage, 2 crates; lettuce, 10 crates; cantaloupes, 5 crates; celery, 2 crates; pears, 20 crates; pineapples, 1 crate; milk, 22 tins. Markets, meat shops, bakeries, restaurants, soft drink stands and other places handling food are under Health Department supervisiorif and inspections were as follows: Restaurants and soft drink parlors, 3,041; bakeries, 585; markets and stores, 1,001. There was gradual improvement in the sanitation of food places during 1931 and there were very few prosecutions for violations of the sanitary regulations, as warnings to the owners usually resulted in elimination of any insanitary conditions. Meat inspection, Colon abattoir.-During 1931 there were 4,190 cattle slaughtered, of which 4,147 were passed and 43 were condemned as unfit for food on account of the following conditions: Actinomycosis, 1;

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77 died in pen, 4; emaciation, 18; extensive bruises, 8; gangrene, 3; pneumonia, 2; septic wounds, 4; tuberculosis, 3. Parts condemned: Parasitic livers, 295; bruised quarters, 8; head, actinomycosis, 1. Also, 6,007 hogs were slaughtered and 5,640 were passed, 367 being condemned as unfit for food on account of the following conditions: Cholera, 119; cysticercosis, 112; died in pen, 83; emaciation, 12; extensive bruises, 6; icterus, 2; melanosis, 1; pneumonia, 15; pyemia, 4; septic condition, 1; septicemia, 12. Meat inspection, Mt. Hope abattoir.-There were 6,268 cattle slaughtered during the year, of which 6,251 were passed and 17 were condemned as unfit for food on account of the following conditions: Died in pen, 4; emaciation, 4; gangrene, 1; icterus, 1; pneumonia, 1; pyemia, 1; septicemia, 2; tuberculosis, 1; extensive bruises, 2; Parts condemned: Parasitic livers, 199; bruised quarters, 12; heads, actinomycosis, 7. Also, 9,460 hides were examined and certificates issued for their shipment. Veterinary quarantine inspections.-Inspections of the following animals entering the port of Cristobal were made and certificates issued: Cattle, 3,228; horses, 78; mules, 156; hogs, 26; sheep, 34; dogs, 2; monkeys, 7; tigers, 2; tapir, 1; lion, 1; parrots, 8. Sanitation of swimming pools.-There are two pools in the city, both of which were under supervision throughout the year. Two water samples from each pool were taken weekly for bacteriological examinations. The pools are thoroughly scrubbed weekly, the water is chlorinated, and otherwise they are kept in a sanitary condition. Some work was done on investigating the amount of pollution of the bathing beaches in Colon and New Cristobal by the discharge of raw sewage into the bay. Bacteriological examinations of the water have been made, but the results as yet are not conclusive or of a sufficient quantity to draw conclusions. Communicable diseases.-The following table shows the number of cases of communicable diseases that were reported in Colon during 1931 and 1930: Year. Year. Disease. Disease. 1931. 1930. 1931. 1930. Chicken pox. 24 105 Mumps. .2 Diphtheria. 20 43 Pneumonia .51 49 Dysentery, amebi. 4 5 Poliomyelitis. 1 1 Dysentery, bacillary. 1 3 Scarlet fever. 10 2 Malaria. 62 107 Tuberculosis 1. 90 72 Measles. .45 49 Typhoid fever. 5 7 Meningitis, menigoeoccus 2 4 Whooping cough .55 42 Leprosy. ...2 2 'Deaths Oniy.

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78 The above table shows a marked decrease in the incidence of chicken pox, diphtheria, and malaria, and a slight increase in the number of deaths from tuberculosis. The decrease in diphtheria is believed due to the immunization of many children in Colon with toxin antitoxin, which was completed early in 1931. The increase in deaths from tuberculosis is no doubt explained by the adverse economic conditions prevailing during 1931, which caused widespread unemployment with its resultant malnutrition. Health conditions were very good throughout the year and there were no epidemics. The communicable diseases occurring were mild and complications and deaths were very rare. Total death rates, maternal and infant mortality.-Statistics on death rates, etc., will be found in the statistical section. Due to the uncertainty of the exact population of Colon, too much reliance can not be placed on the total death rates, but the figures compare very favorably with cities in the southern part of the United States which have above 25 per cent negro population. The maternal deaths include two from abruptio placenta, two from toxemia of pregnancy, one from eclampsia, and one from septicemia. An exceptionally large number of deliveries in Colon are made by midwives and the women have practically no prenatal care, yet the. maternal death rate is low and probably could be still further reduced. if there were better facilities for prenatal care for the poor. Infant mortality in Colon has been gradually decreasing, especially deaths from diarrhea and enteritis and pulmonary infections. However, these causes are still large factors. Infant deaths from malnutrition and congenital causes, however, are apparently not decreasing, and it is believed that further reductions in the infant mortality rate can only be looked for in more education of mothers in infant feeding and improved clinical facilities for prenatal care and treatment of syphilis. The leading causes of infant deaths are as follows: per a" Cause of death deaths 4Linfoats. P re m a tt rityty -.----.-.-.--.--.-.---..-..--.-.-22 Diarrhea and enteritis .-.-.-.-.----------------------------------------------21 Congenital causes (miscellaneous)..-.-.-.-----------------------------------18 Pneumonia and bronchitis.------------------------------------------. 13 M alnutrition-. --.-. .----------.......------------------. ------. 11 A ll o th er ca u ses.--.-----.-. .-...12 Free clinic.-The Health Department, in cooperation with the Cristobal Woman's Club, operates this clinic chiefly for prenatal, infant,

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79 and preschool work among the poor of Colon. However, medical and minor surgical work among the adult poor is done as far as time and funds permit. The health officer is director of the clinic, with the nurse in direct charge. The following is a record of formulas prepared and work done during 1931: Feedings (formulas) for infants.-------.-----9,568 Infants and preschool children, medical and surgical treatments-----.-----2,658 Prenatal and postnatal cases treated--------_------------_------------249 Eye, ear, nose and throat treatments-------.----.---.--575 Eye and ear cases referred to Dr. Eno--------------------------------107 Dental cases referred to Dr. Doten----------------------------------70 Cases referred or sent to hospitals--------------------. .----------434 Medical and surgical treatments (adults)_.--------------------------1,858 The number of infants and preschool children attending the clinic for care and treatment increased approximately 25 per cent over the previous year and it is believed that continued work along this line will result in a further decrease in the infant mortality. Acknowledgment is made of the help of Dr. Harry Eno and staff of the Samaritan Hospital, and Dr. H. A. Doten, who donated their services for the eye, ear, nose and throat work and the dental work, respectively. The following work was also done by the district nurse: Routine smallpox vaccinations, 2,374; typhoid immunizations, 114; home visits (communicable diseases, maternal and infant work) 3,910; specimens taken to be sent to laboratory, 653. REPORT OF THE DIVISION OF QUARANTINE FOR THE CALENDAR YEAR 1931. Dr. M. FLINT HARALSON, Surgeon, U. S. P. H. S., Chief Quarantine Officer. There was no change in quarantine procedure during the past year. As in preceding years, all vessels entering the ports of Balboa and Cristobal, except those granted radio pratique, were boarded upon arrival by quarantine officers. Inspection of vessels, passengers, and members of the crew was made to prevent the introduction of any of the quarantinable diseases into the Canal Zone. It was not necessary to detain any vessel or any person on board an arriving vessel on account of the presence of such a disease. During a portion of the year it was deemed advisable to maintain more strict supervision over all vessels and persons arriving at Cristobal from Colombian ports on account of the reported presence of a disease; resembling in some respects yellow fever, in the province of Santa Marta. Nothing of a suspicious nature was detected.

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80 The medical officers attached to the Division of Quarantine also serve as immigration officers of the Panama Canal. In the performance of this duty the division cooperates with the Republic of Panama in the enforcement of their immigration laws. All persons destined for Panama who have complied with immigration requirements for the Republic are discharged directly from the vessel upon which they arrive. When regulations have not been satisfied, such persons are temporarily detained pending action by the proper Panamanian authority. The volume of work performed by the Division of Quarantine was materially less than that done during the previous year, since 1,085 fewer vessels entered the two ports. The number of persons entering the Canal Zone was correspondingly decreased, a total of 617,393 having entered in 1930 and 547,310 during the current year. However, 282 more persons were detained at the quarantine station on account of infraction of immigration regulations than were detained during the, preceding year. The following table summarizes the activities of the division for the year 1931: REPORT OF DIVISION OF QUARANTINE FOR CALENDAR YEAR 1931. Balboa. Cristobal. Total. Vessels inspected and passed. 548 3,252 3,800 Vessels granted pratique by radio. 121 91 212 Vessels passed on certificates of masters. ............2,008 22 2,028 Vessels issued provisional pratique. 0 0 9 Total. ..........2,7 358,4 Crew inspected and passed. 24,507 83,709 108,210 Crewpasaed byradio. 30,238 29,728 59,908 Crew passed on certificates of masters. .............111,523 130,563 242,086 Passengers inspected and pased. 10,817 78,165 88,982 Passengers passed by radio. 436 5,325 5,761 Passengers passed on certificates of masters. .............31,253 10,202 41,455 Total. 208,774 337,892 548,408 Airplanes inspected and passed. 5 382 387 Crew of airplanes inspected and passed. 14 857 871 Passengers of airplanes inspected and passed. .........12 901 913 Total. 28 1,818 1,844 Vessels detained in quarantine. 0 0 0 Crew detained in quarantine on board ship .....0 0 0 Passengers detained in quarantine on board ship.,.,. 0 0 0 Crew admitted to station account of quarantine laws. .........0 0 0 Passengers admitted to station account of quarantine laws. ......0 0 0 Number of detention days at station for year. 0 0 0 PersonB admitted to station account of immigration laws. .......1,070 0 1,070 Number of detention days for year. 5,315 0 5,315 Persons held or detained for investigation and released ......148 109 255 Persons deported under immigration laws. ......431 853 1,084 Supplementary sanitary inspection of vessels. ..........434 3,171 3,606 Vessels fumigated. 15 42 57 Box cars fumigated. .....6 139 145 Number of rat recovered after fumigation. ....:. .......78 90 108 .A H4

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81 REPORT OF DIVISION OF QUARANTINE FOR CALENDAR YEAR 1931--continued. Balboa. Cristobal. Total. Istions iinued: a passengers. ...695 0 695 .r. 4,521 0 4,521 Gold employees ....781 0 781 Silver ployees. 5,776 0 5,776 Total. .11,883 0 11,883 'otal cost of rations. .$4,701.40 averagee daily cost, each ration. .40 REPORT OF DISTRICT NURSE. Miss LoUISA KURATH, Public Health Nurse, Pacific District. The public health nurse has continued to supervise the operation of the five baby clinics once each week. While there has been a slight decrease in the average monthly enrollment of infants and young children, the number of visits to the clinics has practically doubled during the year. Mothers are urged to bring their babies to a clinic each week for regular weighing and measuring. They are advised as to methods of :are and supervision. Dietary precautions and feedings are discussed mnd matters relating to personal hygiene are brought to their attention. Timely pamphlets and reading matter are distributed as inLicated, and every effort is made to encourage mothers to increase their knowledge in the general care and rearing of their children. The nurse assisted in the annual medical examination of school children, devoting the morning hours to this work during the period >f examination. She continued to give health talks to classes in the various schools to complete the series begun last year. All cases of tuberculosis are reported to the nurse, and periodic visits to the homes of such patients are made to advise the family as to the proper care of the patient and to insist upon the necessary precautions for the protection of other members of the family. The public health nurse organized a class of colored girls in La Boca luring March and supervised their instruction in the course of home hygiene and care of the sick as prepared by the American Red Cross Society. This class continued its work through the month of June. At the termination, and following a written examination, Red Cross rtificates were issued to 18 members of the class. In addition to the activities mentioned above, the nurse visits all stered midwives on the Pacific side of the Zone. She checks their ork, gives them instruction, and insures compliance with the reuirements. MR 31053-6

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82 The following table summarizes the activities of the public health nurse for the year 1931: N um ber of baby clinics ...-. Average number of babies enrolled per month_._. .431 Average number of babies visiting clinics per month.-.-. 226 Total num ber of visits to cl13ics0..--.-. -.-.--. -.,. Number of visits to cases of tuberculosis.-. .8. 85 Total number of house visits .-. --.-.-. ..---. --,Q74 Number of talks given in schools ...38 MEDICAL EXAMINATION OF SCHOOL CHILDREN, 193J Owing to lack of funds the Health Department was unable to appoint a regular school physician. All of the white school children of the Canal Zone were examined by a physician of the Quarantine Division assigned to this duty. The fact that the same physician made the examinations on both the Atlantic and Pacific sides of the Zone insured more uniform noting of defects than has been the case in~ the past when one examining physician did the work on the Altantic side and another on the Pacific. A total of 2,621 American children (white) were examined, 1,023 whom were in attendance at schools on the Atlantic side of the Z and 1,598 on the Pacific side. There were examined 1,400 boys 1,221 girls. The most prevalent defect observed was in the condition of the teeth. Practically one-fourth of all children were noted as having defective teeth. This includes children with one or more carious teeth, either temporary or permanent, or teeth in faulty position. The second most common defect was in weight. The age-heightweight scale as accepted in the United States was used for obtaining this figure. Children more than 10 per cent above or below the aver for this scale were classified as defective in weight, the majority be.ng underweight. It is not believed that the percentage recorded is a true indication of the local condition because the Health Department feels that the normal average weight of Canal Zone children is noti less than for children of the same age in the temperate climate of United States. The percentage of children suffering with defective tonsils appeared to be rather high. Notices were sent to parents only in the cases wh it seemed advisable to have the children referred to a throat specialist for treatment. The majority of ear conditions were the result of fungus growth impacted cerumen. Very few children with defective hearing e found.

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83 All boys were examined for phimosis and hernia. There were 148 found to have elongated prepuces but only one to have hernia. The examination of the children in the colored schools will begin in the early part of 1932. LEAD POISONING. As the Panama Canal employs a considerable number of individuals who habitually handle lead products, a special study was made of this subject in 1931 with a view to determining whether the precautionary measures in force were adequate to prevent lead poisoning. One of the features of the study was a survey in hospital of all employees whose work involved habitual exposure to lead paints, powdered lead products, or lead fumes. The survey included a general physical examination and special examinations of the blood, urine, and nervous system to exclude objective or subjective symptoms of lead poisoning. The minimum stay in hospital was 2 days. A total of 240 individuals was examined and of this number 5 presented symptoms of lead poisoning. Three of these individuals were known to have lead poisoning at the time the survey was undertaken. The survey therefore brought to light only 2 new cases of lead poisoning or less than 1 per cent of the 240 men examined. It was planned to institute annual surveys of this nature provided the first survey showed any material number of cases. The results 6btained from the initial survey, only 2 cases of 240 examined, show that the safeguards now in force afford such a high degree of protection that annual surveys will not be required. The instructions now in force relative to the prevention of lead poisoning in employees of the Panama Canal are incorporated in the following circular: To all concerned: PROTECTION OF EMPLOYEES AGAINST LEAD POISONING. 1. In view of the fact that occasional cases of lead poisoning occur among painters and others in the employment of The Panama Canal who work with lead products, the following measures will be taken to reduce this hazard: 2. Prior to employment all applicants for positions that involve habitual exposure to lead paints, powdered lead products, or lead fumes, will be directed to report to a Panama Canal hospital for examination for evidence of previous lead poisoning, and for examination of their fitness for such employment. 3. The following instructions will be imparted to all employees who are liable to exposure to the danger of lead poisoning: Lead poisoning is a dangerous disease which results from the introduction of compounds of lead into the body. This introduction may be by breathing powdered

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#AN 84H lead products or lead fumes into the lungs; through the mouth by swallowing particles of lead when eating or smoking; or possibly by absorption through the pores or cuts in the skin. The greatest care is necessary on the part of all people who handle lead compounds in order to prevent lead poisoning. The following precautions are hereby prescribed to be followed by all persons handling lead: (a) All paint, red lead putty, dry pigments, and metallic lead particles should be thoroughly removed from the face and hands when stopping work for lunch and at the close of the day's work. If necessary, kerosene or petroleum spirits should be used for removing paint; but soap and water should always be used. (b) Special working clothes should be worn by painters, paint mixers, and others working with paint or powdered lead. These clothes should be worn only when working, should not be kept in the same locker or depository as are the clothes worn to work, and they should be washed frequently enough to keep them reasonably clean. (c) All employees should guard against getting lead in the mouth when eating food, smoking, chewing tobacco, eating fruit, etc. (d) Employees in paint mixing rooms must wear respirators when dry pigments are being handled. (e) Floors, platforms, tables, etc., in paint mixing rooms must be kept clean and free of dust at all times. Mops and brooms used for cleaning purposes must be dampened to prevent stirring up dust. (f) Lead burners and acetylene cutters should guard against inhaling fumes while at work. (g) Employees having any of the following symptoms should report the fact to their foreman as any one or more of these complaints may indicate beginning lead poisoningPersistent headache, cramps in abdomen, soreness of mouth, constipation, loss of energy, muscular tremor, loss of strength of wrists. 4. Supervisors of men engaged in occupations involving danger of lead poisoning will by means of frequent inspections assure themselves that the above instructions are being carried out; and they will immediately send to a dispensary for examination any employee reporting symptoms of lead poisoning. H. BURGESS, Governor.

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GENERAL TABLES. TaBai 1.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES FOR EMPLOYEES. ABSOLUTE NUMBERS. Discharges from and deaths in hospitals. Total deaths. Year 1931: White. .3,551 1,201 1,102 99 27 21 6 22,849 62.60 Black. 11,046 2,440 2,069 371 106 96 10 59,460 162.88 Total .14,597 3,641 3,171 470 133 117 16 82,299 225.48 Year 1930: 'White .--. .3, 589 1,123 1,034 89 29 27 2 19,94q 54.65 Black .,. .11,935 2,547 2,145 402 151 148 3 64,451 176.58 Total .15s,524 ,7 3,179 41 8 7 5 84,400 231.23 ANNUAL PATE PER 1,000 EMPLOYERS. Year 1931: White ...338.21 310.33 27.88 7.60 5.91 1.69 ..17.63 Black ..220.89 187.31 33.59 9.60 8.69 .91 .14.75 .Total. ..249.43 217.23 32.20 9.11 8.02 1.09 .15.45 Year 1930: White .,. .,1 312.90 288.10 24.80 8.08 7.52 .56 .15.23 Black ..213.41 179.72 33.68 12.65 12.40 .25 .14.80 Total ..236.41 204.81 31.63 11.59 11.27 .32 .14,90 85

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TAstx 2.-CAUSES OF DEATHS OF EMPLOYEES ARRANGED WITH REFERENCE TO COLOR, AGE, AND LENGTH OF RESIDENCE ON ISTHMUS, 1931. Color. Age (in years.) Length of residence on Isthmus (in years.) Disease. 3 i Malaria,estivoautumnal. 1 1. .....I. ......... Dysentery,amebic. 1 .1 -..........--. ..-. Leprosy. 1 -. 1. -..I-. .-. ..-.-. -. ..-.... Tuberculowi of the respiratory system. 13 1 12 .2. 3 1 2 4 1. ..1 ..11 -. Teriary syphlis .11 1 10 ....4 3 1 3 8 3 CerebroepMalsyphili. ....1 ...-. .......-. Cancer and other malignant tumors ofthestomachandliver. 4 1 3 ...1 2 ...4 -. Cancer and other malignant tumors of the peritoneum, intestines, andrectum. 1 1 .......1.---.-.-.-. .....1 Cancer and other malignant tumors of other orunspecified organs. 3 3 ....1 1 1. ....... Diabetes mellitus. 1 1 .--. -..1............... Anemia. .1 .1 --. ...-.-..-. ....--. Chronicalcoholism.1 1 ...-.-. ....I ...-. .--..1. Encephalitis. 1 .1.-. 1. ..-...-+. .......... Nonepidemiceerebrospinal meningitis 1 .I. ....+. .1. .-. .......I .. Cerebral hemorrhage. 3 .3 -. ..1.1 1.......-..3. General paralysis of the insane. 5 .5 ....2 .2 .1 ......1 2 .2 Tumoro thebrain. I 1. .I. ..........-.--. .-. Pericarditis. .1.,......1 -........---I---.Acuteendoearditis. 1 ..--. ..1. .-. ----. .....+-. I Acute myocarditie.1.-. .-..1.-. ......I .. Organic diseases of the heart. 6 3 3 .....1 3 1 ..-.....5 1 Ane. .1. .-. ...I .....-. ......... Artriosclerois. 3 2 1 ..............3 .. D isease of thelarynx .I I-...-. I .............I-.-...--. -...w+ -. .--. -.--. ------. .-.-. I----. A cute b it! ....II ..............I-.-. -.s -----. ...------.---.--.------1 -Bronchopnemonla. 3 3 .-1 1 1 -. .......I 1 I Lobar pneumonla. 13 1 12 1 2 3 .3 2 2 .......1. 1 4 4 3 Pneu111.unspecified. I .......I ....... P. ....................... Congestion and hemorrhagic infaret 1 ofthelung. 1 .I ....1 ..........-.... Other diseases of the respiratory system(tuberculosis excepted). 2 .2 .1. ...1. .........2 .. DkI=S Softh pharx andtons&. 1 .....1. .-. .........1 Uker of the stomach .2 1 1 ...........2

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gas r ...2 ....1. .1 .....Hernia t. .3 1 2 ....1. ... tedi neobstruction. 2 7. ....2. .....-. ..1 .. CIrrhodis of the liver, not specified as1 2 1 1 -acohie. .6 4 2 .1 ..1 ... Acute dnep ritis .I. ...-. ..-----------.-. ---. .. Chrome nephritis .10 3 7 .2. ......... y nphrois. 2. 11 1. .....-.-. ...... aci eof the Urary passages I .1. ..................-.-Sacide bydrowningb. 1 1 ..1. ..........1 .. Apidental ;f burns (conflagration toxepted)e. .1 .I. ....-. .-----. .... Accidental drown ..2 1 1 .1 ........-.----.-. .Accidentaltrauatismby firearms. I ..............Accidental traumatism by fall .5 1 4 ....1 2 ......1 ..........3 A utom obile accidents. 1 1 ....I ..-. .......: ....-.------.---...-.----.-. ...------------------------Accidental traum atism by landslide. I I ...I. ....--.-. ..-.--.I ...-----..---. -. .--------. ---. -. .--.--.--A ccidentalelectric shook .....I. .......I .I .......--.--.---.-------. -----. .----. ---. .--. ---.----Homicide by cutting or piercing instruments. .3 1 2 ..i ..............2 1 Causeof deathidefined. 1 .1. .....1. .........-. .f -. Notspecified,orunknown. 1 .1 ......1 .....1.. Total. 133 27 106 2 9 3 19192921 17 6. 2 .1 1 2 1 1 88411 21 06

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88 TABiu 3.-DEATHS AND DEATH MATE8 OF RESIDENTS OF THE CANAL ZONE AND THE CETIE 1 PANAMA AND COLON. Annual rate par ,00w Dea_-_ _populatoi. Place. _O Total. Diseaue. um. Total. Disaw. Year1931: Panama. 76,000 1,341 1,274 67 17.64 16.76 Colon. 30,000 482 457 25 16.07 15.3. CanalZone. 40,56 306 247 58 7.52 6.09 1.41 Total. 146585 2,128 1,978 150 14.52 13.50 1.0 Year 1930: Panama. 74,402 1,307 1,251 56 17.57 16.81 .75 Colon. 29,765 518 490 28 17.40 16.46 .04 CanalZone. 39,469 282 242 40 7.14 6.13 1.01 Total .143,636 2,107 1,983 124 14.67 13.81 .16 A4 %W

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t I I I a

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TABLz 4.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AND AGE, 1931. Sex. Color. Age (in years). Total Disease. deaths. Under Age M. F. W. B. Y. one 1-5. 6-10. 11-20. 21-30. 31-40. 41-50. 51-60. 61-75. 760100. unyear. known. Epidemic, endemic, and infectious diseases. Typhoid fever. .1. .... Malaria, estivoautumnal. 17 7 10 3 14 ..10 2 ...2. 3. Malaria, tertian. 1 .2. 1 ...... Malaria, type undetermined. 1. .1.,. .... MalarIa,clinical.2 2. 1. ...I .1. ... small. ., ..0 ... 1 .e.a. .2 .2. Inuenza, without pulmonary complications specified 1 1 ..1 .....1. Dysentery, amebic ..3 2 1 .3 .......I I1 Dysentery,bacillary. ..2 1 1 .2 .1 .1. Dysentery,unclassified 1 ....I. .. Leprosy.7 3 4. .6. 1 3 .3. Men ownsnmeingitis. 2 2 ...I.0 Tetanus. .......3 2 1 .3 .......1 .. Tuberculosis of the respiratory system. .....305 152 153 28 270 7 8 11 4 46 74 65 53 25 17 1 1 Tuberculosis of the menines and central nervous system. 10 4 6 2 8 ..4 3 1 2. Tuberculosisoftheintestinesandperitoneum. 7 3 4 1 6 ....3 3 Tuberculosis of the vertebral column. .1. I. ..I ..I.1. Disseminated tuberculosis, acute. 3 2 1 1 2 .1.1. Disseminated tuberculosis, chronic or unspecified. ...I I ..1 ..1 Tertiarysphib .44 37 7 6 37 1 ....1 5 21 12 3 ...2 Cerebrospinal syphilis. 6 6 .1 5 ..1 .1 3 1 Hereditarysyphis. .12 9 3.,. ... Pyemiaandsepticenia. .1 1 ..1. ...1. P y eI -.. It. 4 7 1 10 .3. 5 1 .. General diseases not included in the abo,. class. Cancer and other malignant tumors of the buceal cavity. 6 4 2 3 3 ......1. .2 .3. Cancer and other malignant tumors of the stomach and liver. .30 23 7 8 21 1 ...1 2 10 7 9 1 Cancer and other malignant tumors of the peritoneum, intestines and rectum. 7 2 5 2 5 .....,. .1 1 2 2 1 Cancer and otler malignant tumors of the female genital organs. 23 ..23 3 20 ...2 6 4 3 6 2 CaUcer and other malignant tumors of the breast. 2 .2. 2 ...1 ...I Cancer and other malignant tumors of other or unspei-fld organs. ...21 11 10 3 18 ..,. .2 1 .4 6 7 1

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A e wn atuor eye r. ....... A rheumatic fever. 8 2 3 1 4 ..1 2 1 .1 .1 1 .., ..1 ..... ellagra.I. .9 2 7 1 8 ....1 1 .3 1 2 1 B eriberi .I .I ...I. 1 ................ Diabetesmellitus. 12 2 10 1 11 ...1 2 2 3 Perni ious anemia. 1 1 ......... Othfrl emiassand lorosis .6 1 5 .6 .3 .2 .1. .I E x op thalmiegoiterr. 2 .2 .2 ......... Diseeaeof the thymunglaud. 2 1 1 2 2 2. ........ Diseasesof thespleen. 1 .1 .1 Leukei4a .-.3 1 .3. .2. W.3 ..... Hodgkin's disease. 1 1. 1 ..... Chr*ni*alco hm. ..2. 1 2. ........ Drug habit. 1 .....1. .... Othergeneral diseases. 6 3 3 6 5. ....1 .... Diseases of the nertious system and of the organs of special sense. Enephalitis. 4 4 1 .1 3 ....2. ... Simple meningitis .16 10 6 2 13 1 4 4 1 2 1 1 2 .1 Non epide m ice erebrospinal meningitis. 2 2 ..2 ........1 Cerebral hemorrhage. 65 43 22 8 54 3 2 ..1 2 4 14 14 23 2 3 Cerebral embolism and thrombosis 3 1 2 3. ...1. ..1 Hemiplegia 4 4 3. ...,. .. Oeueral paralysisof theinsane.23 21 2 .22 1. .3 to 4 6'. .6 D em entia precox ..........,. .. Manic depressive psychosis. 1 .......1 Other forms of mental alienation. 1 1. ......1. ... Epilepsy. 2 2. 2. ........ Convulsions (nonpuerperal;5 years and over). 1 1 .I. ....... Softening of the brain. 2 2 .2 .......1 1 Tumor of the brain. .4 2 2 4. ..1. ..1 1. .I Neurasthenia. .I ..1. ..... Other diseases of the nervous system. 4 4 .2 2 .1. .1 2. Diseasesoftheear. 2 1 1 .2 .I I. Diseases of the mastoid process. 1 1. .I. ....... Diseases of the circulatory system. Pericarditis.4. 4.2. 2 Acuteendocarditis.7 2. .1 1 ,. Acute myocarditis. .5 4 1 1 4 .....1 .1 2 1. Anginapectoris .4 2 2 2 2 ...1 1 1. .. Other diseases of the heart. 178 107 71 26 143 9 1 1 1 6 7 22 47 48 33 11 1 Aneurysm .6 5 1 3 3 .......1 .1 2 1 1. Arteriosclerosis. 41 24 17 16 24 1 .4 1 11 17 8. Other diseases of the arteries .3 3. 2 1 .....2 ... Embolismandthrombosis(notcerebral). 4 3 1 1 3 .....1 1 2. Phlebitis. 1 1. .1 ...... Other diseases of the circulatory system. 2 1 1. 1 .........,.

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TAIa~s 4.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AND AGE, 1931.-Continued. Sex. Color. Age (in years). Total Disease. deaths. Under Age M. F. W. B. Y. one 1-5. 6-10. 11-20. 21-30. 81-40. 41-60. 51-00. 61-76. 76-100. unyear. known. Diseases of the respiratory system. Diseasesofthenasalfoosaeandannexa. 5 2 3 1 4 .2 .2 .. Acute bronchitis. 11 6 5 1 9 1 7 3 ....1. Chronic brown hitis. 3 2 1 .3 ..2 ......1. Bronchitis, unspecifed under5 years of age.). 4 1 3 .4 .2 2 .... Brouchopneumonia. 162 93 69 16 141 5 66 45 4 2 8 8 10 10 4 6 C bronhitis. I .I ..-.-.-----.---.----.--.----.--.-.---.-. neumona8.,. 86 48 38 14 70 2 7 11 3 6 13 9 13 is 2 4. Pneumonia,unspecified. 27 17 10 .27 .2 2 .6 3 2 2 2 7 1 Pleurisy. .3 3. 3 -. ....1. ..1 .. Empyema. 6 4 2 1 5 1 1 1 1 1. .... Congestion of thelung. ..2 ..1 1 ....I. 1. Edemeofthe lunge.4 3 1. I ....I 1. Infarction of the lune. .1 .1 ..-. -. ..1. fther Congestion adinfant of thelungs1. I I ..1...I ..... Gangreofthelung. ....... Asthma. 3 2 1 1 2 ..1 ,. ..... Pumonaryemphysema.11. I.-1 .I .-I ..I .........1. Otherdiseasesoftherespiratorysystem. 5 4 1 1 4 1. .1 .1 1 1. -. Disease. of the digestive system. Stomatita. .1 I ..1 ........ Otherdiseasesofthemouthandamexa. 1 ..1 ........1. -. ... Diseasesofthepharynxandtonsils. 3. 1 2 ..... Ulnerofthestomach. 6 5 1 2 4 .2. 2 .2 1 1 U os of the duodenum .2 2 .1 .I ..2 -A tastrti. ...7 6 1 2 41 2. ...2 1 1 Chrome 2 1 1 .2. ..I I ..-.-.Acu te.,. .2 1 1 .2. 2. I I .......... Euteriti, colitis, at entereodlitia (under 2 years of age.). 156 90 6 17 139. 136 20 ........ Inteal autintaxication (under 2 years of age.). 2 1 1 .2 2 ...I -Enteritcolitl,orentervooolitiu(2yersandover). 10 8 2 .10 *. .4 2 2 ..1 autointoxtio (2yerYo and ve. 2 2. 2 .....1. ... ..2 1 1 1 1. .-. ..... piriislt note f. I .3 2 1 .3 .i 1 1.-. ....--A .". ..13 7 a 1 12 ...1 5 3 .2 1 1 .10 7 3 3 6 ..1 ....2 2 .2 .11 7 4 1 10 .2 .1 1 2 3 1 .-. ..H.P-----.----1 ipniiiiili.ii .iii .iiAWdimlimi iM E EW Hii mlmsa.ma. s a ..

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W2 rp FIT 2 ..1. ..... 1. 1 Ab es o t e ie ~ n o d ..2 ................ Ch l *8 ...I. ........................... theliver .1 1 1 1I 1 PrItitit without npecifiedause (except puerpera. 6 3 3 1 5 ...2 .1 Nonteaeral diessaes of the genito-uwiary sjtem and anneza. MAete npbritia (including unspecified under 10 years of ofAgo.). I. 31 20 11 7 24 .4 11 a 2 1 42 1 1 ...... ChroIe .)ritis (including unspeciied 10 years and O. .75 47 28 18 57 .3 3 2 13 12 10 24 7 1 y r. 6 3 3 2 3 1 .I 1. 1.1 2 1. 'tioeph e i. ...............4 1, ....... ....1 3 ..4 .I .y ...1 1 .......1. C eolf theuretra.I .....1 Acutepreta ti1. Softheprotate. .4 .2. ..2 t other ntumoroftheovary .6 ......1. .... pIngiti.and pelvic abces(female). (Ntgonococcic) .1 .... Bpnetumoru of the uterus. 4. .4 1 3 .....2 1. .. ign t u mors of th e ovary ..(.E. I ...........................1 .................#. ........ uterus).,. 1 .1 .I .. T he puer peral skzte. pigesttIon. .3 3 3. ..2 1. era tIdeutsofprenancy. .4 4 4. .2 2. a emo age. .6 .1 5. ........... Ceeareaniection. .I.22. ..1 .Otheraccidntacflabor.,.2 2 2. ... terus) .i. 5 .5 1 ...2. .. W eg.in r ....2 2 1 Disease of ihe skin and of the cellular tissue. Gangrene. ..1 1. ..1. Acute absce r. .6 .7 4 2 r sin 1.1 ...1. Other diseases of theak andanea. 1. ... Pa sentig. a ....1. ...1. 2 2 1 .. arene. .1 1. I. .......... Malformatione. Congen talmswortionsofthehear .,. .9.2 .6 3 3 64 .7 2. Other oongea .t.esknnann.6 4 2 2 4. ....

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TA 4.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AND AGE, 1931.-Continued. Sex. Color. Age (in years). Disease.Total Disease. deaths. Under Age M. F. W. B. Y. one 1-5. 6-10. 11-20. 21-30. 31-40. 41-50. 51-60. 61-75. 76-100. unyear. known. Early infancy. Congenitaldebility. .21 16 5 .20 1 21 ...-. lterusof thenewborn. ..6 6 6. 6 .... Malnutrition. ...1.4. ..... Other diseases under this title ..; 2 1 1 ..2 .2. ..-. .. Prematurebirth(-Iy.only) .82 49 33 13 68 1 82 ..-.-. .. In uryatbirth (-3m. only). .25 19 6 -. 24 1 25 .... Oter diseases peculiar to early infancy (-3 m. only) .10 10 .2 8 ..10. .... Old age. Senility .14 6 8 1 11 2 ...3 10 1 Eziernal causes. NO Suicide by solid or liquid poisons (corrosive substances at }. .1 1 ...1 ..... 2ped 2.3.1.3. aucdeb corrosive substances. 4 2 2 3 1 ..I .....fseide byhanging or strangulation. 3 3 1 2 ...2 1 .....+. ----.Suicide by drowning. 6 5 1 2 4 .....3 2 1 ...... Suicidebyfirearms .9 7 2 7 2 ...2 6 1. ... Suicide by cutting or piercing instruments. ....5 5 .3 2 ....2 2 1 .. Su de by jumping from highplao.2 2 1 1 ...1. ... P.venomous .I ..-..1. ......... Other acute accidental poisonings(gas excepted). 2 .2 .2 .1 .1 ...... Acldent burns (conxagrationexcepted) ...7 4 3 3 4 .1 4 ........ Accidental absorption of arreepirable,irritating, or poisonu.g.s. 2. ...-. Accidentadrownin2. 22 20 2 a 14 .2 2 3 2 Amcidental triumathat by firearms (wounds of war exaepted).5 5 3 2. 3 I. ... Accidentltraumatim by fall. .12 10 2 3 9 ..1 3 4 1 .I I .R.oadacident. .-I .1 I Automobile soldent. ...2 20. ....20 ..1 a 3 9 5 I I I I Airplane andballoonaccident .6 6 6 ..1 4 1 .... Landaids. other rubbing ..32. a a .2 1 .1 2 ..... ..........1 1 2 4 3 Aala i;ta '.cti !ck .......-...

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iimllde by cutting or pierce ininstruments. 4 3 1 1 3 1 .. ami e by othermeans. 4 3 1 2 2 ...A .I t ....1 1 ..-. ......-1 --. ---. -..E ...1 1 ...-. .....-. .... W t e~r ext0#n9 Violence -. II. .......--4. ..---.--.-. -. ------. ....---. "-defined diseases. k dde death,. .2 2 ..2 ....1 .1. e ned.*. -.12 9 3 1 11 ..2 5 .1 .2 .1 .. Notspecied orunknown. 3 2 1 1 2 .2 ........ Infection ofundetermined origin. 5 4 1 4 1 3 1. ..... Grand total ..2,128 1,272 856 333 1,748 47 471 189 53 150 207 240 289 232 209 73 16 c,1

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TABLE 5.-DEATHS OF RESIDENTS, BY PLACE OF RESIDENCE, ABSOLUTE NUMBERS AND ANNUAL RATES PER 1,000, 1931. ABSOLUTE NUMBERS. ANNUAL RATES PER 1,000. ALL CASES (including employees). ALL CASES (including employees). CANAL ZONE. CANAL ZONE. Amiric SIE. PACIFIC SIDE. ATmTC SIDE. PAcIFIC Swa. Disease. T Excluding Excluding myExcluding ExclCmy t Total. AmanNayNvy Army and Nay ad o of Total EMluin Cond Exldn nf Of .Army and Navy. Navy Army and NavyNavy Colon PanT Army and Navy. Navy Army and Navy. Navy Colon. Pan(officers (officers ama. (officers (officers ama. and enandenand enandenOthers. listed Amer Others Anr thers listed Ame Others. cans, men.) Cam. r. men.) cu Ohr.men.) "ano, mtes aed. POPULATION. ...146,565 1,884 10,160 5,373 6,453 12,248 4,447 30s000 76,000 Epidemic, endemic, and infectious disease. Typhoid fever. ...I ....... Mal" .estivoautumual. 17 .8 ..I. 3 1 3 2 .115 ..787 .....408 .224 .099 .026 Malaria,tertian. 3. ....2 1 .02. .....066 .013 Malaria, type undetermined. I .I .............. Malaria, clinical. 2. ....2 .013. ......026 0 .po. .......... 2 .....*. .1 1 .013 ......013 Whooping cough. ..1 3 '027. ...033 .039 Dhtea. 1. ....1 .007. .......013 Inuenza without pulmonary complications specified. ..1 .007 ......013 Dysentery,amebic. 3 ........3 .02 .....039 Dysentery,bacillary.2. .1. .1 .013 ..081 ..013 Dysentery,unclassified. .1. ..1 ..007 ..... Leprosye. 5. ...82 20. .08 ...571 .... M 2 .I .3 .08. .081 ..033 T e*us ......e .......................3 .............................., ...1 2 .0. ...................................0 3 3 .0 2 6 Tuberculosis of the respibra osystem. 305 .9 .9 .82 205 2.08 ..885 ..734 .2.67 2.69 Tuberculosis of the meninges and central ner-I vuansystem. ..3. ...1 .02. ..081 ..099 .078 Tuberculosis of the Intestines and peritoneum. 7 ...._. ..2 5 .047 .......066 .06 Tuberculosis of the vertebral Column. I ......1 .007 .........013 Disseminated tuberculous, acute ....1. 1 .02 ...066 .013 Disseminsted tuberculosis,.hroni.or.unspecified ....I ..007 ..., ... Tertiary SyPhilis. .44 ..5 .2 2 .8 27 .30 ..492 ..309 .163 ..267 .-U S Cee r s ia ii. ...........6 ..I. I ...._ 1 4 .04 ...186 ...*. ..033, .052 erdt r y '. ..ill .1. I. .I. ..3 8 .081 ..098 .......m g .106 Pyemisa aadsepticemza. I ...1. ........033 Pyemi1. I ...... Septa. ala. ..14 ...033 .118 #pp J %

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General diseases not included in Ciae. I.C anoerand other malignant tumors of th buccal Ie cavity .6 ....2 ...4 .04 ....309 ....052 SCaner and other malignant tumors of the stomachandliver. 30 3 1 2 .7 17 .204 ..295 ..154 .163 ..233 .223 'Cancer and other malignant tumors of the period eu" inteethin ,and rectum .7 ....1 ...6 .047 ....154 ....078 Cooper and other malignant tumors of the 'femalegenital orans. .....3 19 .156 .....081 ..099 .25 Cancer and other malnant tumorsof the breast 2 .............013 Coer and other malignant tumors of other or unspecified organs. 21 .4 .2 15 .143 .....326 ..066 .197 Benign tumors and tumors not returned as malignant. (Tumors of the female genital organs excepted.). I ........007 .......033 Acuterheumatic fever. .5 ...3 .2 .034 .......026 Scurvy. 1 ..1 .007 .......013 Pellaa. 9 1. .1 3. 4 3 .061 ..098 ...081 ..133 .039 Beriberi.1. ..1 .007 ......013 Diabetesmellitus.12 ..1 4 7 .081 .....081 ..133 .092 Pernicious anemia1. 1 .,. .......013 Otheranemiasandchlorosis. 6 1 ..3 .2 .04 ..098 .244 ...026 Exophthalmic goiter. 2 .I ....1 .013 ..098 .......013 Diseases of the thymus gland.2. .......2 .013 .......026 Diseasesof thespleen. .1. ..1 .007 ...013 Leukemia. 4 ........066 .013 Hodgkins' disease. I .1 ..007 ..081 Chronic alcoholism. 2 .1 ..1 .013 ..154 ..013 Drug habit. ...1 .007 ........013 Other general diseases. 6. ...1 3 2 .04 ..081 ..099 .026 Diseases of the nervous system and of the organs of special sense. Encephalitis. 4 .1 1 ...2 ...098 .186 ..066 Simplemeningitis. 16. .....2 14 .109 .....066 .184 Nonepidemic cerebrospinal meningitis.2. .....1 1 .013 .......033 .013 Cerebral hemorrhage 65 7. 1 22 35 .443 ..688 ...081 ..733 .46 Cerebral embolism and thrombosis. 3. ......1 2 .02 .....033 .026 Hemiplegia.4 1 ..2 1 .027 ..098 .....066 .013 Generalparalysisoftheinsane. 23 3. .3 9 8 .156 ..295 ..244 ..30 .105 D em entia precox. I .......1 .007 ........013 Manic depressive psychosis,. ..1. .....1 .007 ........013 Other forms of mental alienation. 1 ......1 .007 ........013 Epilepsy. ..2. .....1 .013. ..4 ....013 Convulsions (nonpuerperal; 5 years and over). 1 ....,. .1 ...... Softening of the brain.2 ....1 1 .013 ....,. ..033 .013 Tumor of the brain .4. ...1 1 2 .027 ..081 ..033 .026 Neurasthenia. I .1. ......1 .007 .......013 Other diseases of the nervous system. 4 .2 ..2 .027 ..163 ...026 D iseasesof theear.,. 2 .......1. 2 .013 .......026 Diseases of themastoid process.1. ......1 .007 ...013

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TABLE 5.-DEATHS OF RESIDENTS, BY PLACE OF RESIDENCE, ABSOLUTE NUMBERS AND ANNUAL RATES PER 1,000, 1931.-Continued, ABSOLUTE NUMBERS. ANNUAL RATES PER 1,000. ALL CASES (including employees). ALL CASES includingg employees). CANAL ZONE. CANAL ZONE. ATLANrIC SIDE. PACIFIC Sin .ATLANTIC SWI. PACInUj Sins. Disease. EAruinm xcydn Army Ct CiyArmy *Army City City Toal AyaExcluding a Exludinay C Excluding and Excluding and of Amy and Navy. Navy Army and Navy. Navy Colon PanT .Army and Navy. Navy Army and NavyNavy Colon. Pan(officers (officers ama. (officers (officers ama. and en.and en.and enand encane Others. cas a Others. list1-Others. listed Others. listed men.) men.) men.) Canmen.) Diseases of the circulatory system. Pericarditis. .4 ...1 1 2 .027 ...033 .026 Acute endocarditis. .7. ...4 2 .047 ..,. ..154 ..133 .026 Acute myocarditis. 1 ..2 2 .034 ..098 ....066 .026 Angina pectois. ..4 1 1. 1 1 .027 ..098 .186.033 .013 Other diseases of the heart. ..178 1 4 1 3 ..32 137 1.214 .53 .393 .186 .464 .1.066 1.80 Aneurysm. 6 ....1 4 .04 .......033 .052 Arteriosclerosis. 41 3 .,. 3 2 1 8 24 .279 ..295 .464 .163 .224 .267 .315 s Other diseases of the arteries. 3. ....I_ .3. .....0 Embolism and thrombosis (not cerebral). 4 .1 ..3 ..027 .... Phlebitis. ....1 .007 ......013 Other diseases of the circulatory system.2 1. ...1 ..013 .53 ......033 Diseases of the respiratory system. OX diseases of the nasal fossae and annex. .5 .3 ..1. 1 .034 ..295 ...081 ...013 A1 bronchitis. ...1 9 .075 ..098 .....033 .118 Chronic bronchitis. .3. .....2 1 .02 ......066 .013 Bronch ,uni.(under 5 .years of age)4. 46. ...3 1 .027 .......099 .013 rohopeumoa. 162 1 3 .2 4 .*26 126 1.104 .53 .295 ..309 .326 ..867 1.65 C r broncitis. 88 ...007 .....033 rneumni. 86 1 6 ...4 1 16 58 .586 .53 .59 .326 .224 .533 .73 Pneumonia, unspecified. 27 1 ....8 18.184. .......267 .236 Pleurisy. ..3. ......2 1 .02 ......06 .013 Empyema ..1 5 .....033 .065 Congution of thelungs. 2 ......I 1 .013 .....033 .013 E=erof the n111. .4 .....027. .033 .039 In r tion of the g. .I ........1 1 .007 ..........013 O t er c ng sto a d n ar t fth ungs. I .................1 .007 ................013 Gangrene thelung. 2 .., .2 .413 ........026 Asth m a ma. -. ...2 1 .02 .....088 .013 Pulmonary emphysem. 1. ..1 ..007 .... Other disease t.of therespiratory system (tuber-0 01u1014 excepted) .4 .I .....4 .A 34 ....098 ........052

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Dieae of he ditgesatie system. 1 .007 ........013 Sd es t h ..... Uleroftheduodenu 2 .1 .013I .0 .22 .0 Acutegastritis. ...-1 ---.04 ...-...2 .03 .03 Chronife t .2. .1 .013 ....0 ..3 A inestion. ..2. ...2 ..13 .....-.-.-. Enteritis, colitis, or entero-colitis. (Under 2 years ofae). 156 4.-. .3 24 125 063.393. .0 1.64 Intestinal autointoxioation. (Under 2 years of t r). 2 1.1 .013. .8. .....013 age). ..-.-. --I --. .-Ententis, colitis, or entero-colitis. years andover). .10 .......9 .06 ..118. Intestinal autointoxication. (Two years and 2 ..013 .066 over) ..2 ..2. ... over ...--. .---.-. ---f 0 3 2 AnkyOtOiSi. 2. .0 ..... Par' tesnotspecified. --.-.----.----. ....099 0 Acuteappendicitis.13 1. I --.3 7 .088 ....163.167 .052 Hernia. 10 1. ....5 4 068 .53. .7. 1 Intestinalobstruction.11 -2 ...3 6 .075. .196. ....099 .078 Other diseases of theintestines. ..2. I .....-9 ..-.-. .-1 .0 Acute yellow atrophy of the liver.1.1.007. 1 ---1, -.3 .7.-. Cirrhosis of the liver, specifed as alcoholic. .1 ....-. .1 .007 .013 Oirrhosis of the liver, notspeCified as al.oholic. 22 3. ......5 12 1590 .013 Biliary calculi. .2 ....1 1 .013 ...026 Abscess of the liver (unqualified). ..2 ...-. --. ..-.2 .013. .-. Cholecystitis. I ..-I. .-----. .-. 07 .......03 Otherdiseasesoftheliver. .2. 1 1 .013 .033 .013 Peritonitis without specified cause (except 066 .039 puerperal). ..6 1 ....2 3 04 Nonreneral diseases of the genito-urinary system and annexa. Acute nephritis (including unspecified under 10 2 1 1 5 22 .211 .196 .186 224 .167 .289 years of age). ..31 2 Chronic nephritis (including unspecified 10 yearsandover). 75 4 3 .2 5 19 42 1 2.12 .295.309 .408.633 .552 Pyonephritis. ..6. -...6 .04 ..078 Pyelonephrosis. ....4 .1 2 1 .027 .-.-.----. 0 .066 .013 Pyelitis. 1. ......--.W Calculi of the urinary passages.1. ...1 .007 ........ Stricture of theurethra. 6 .1 ...2 3 .047.098. .066 .039 Acute prostatitis. ........1 .007 ...-......013 Hypertrohy of theprostate. 7 ...4 .047 ...081. .066 052 Cysts and other benign tumors of the ovary. 1 ....1 ..,. ..7 ....... Salpingitis and pelvic abscess (female). (Not gonococie).1. ............ Benigntumorsof theuterus. 4 ....3 1 .027 ...099 .013 Endometritis. .I ........1 .007 .......013 Benign tumors of the female genital organs 1 013 (except of uterus). 1. .-.-. .--. 1 .007. .-.-.-

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TABLz 5.-DEATHS OF RESIDENTS, BY PLACE OF RESIDENCE, ABSOLUTE NUMBERS AND ANNUAL RATES PER 1,000, 1931.-Continued. ABSOLUTE NUMBERS. ANNUAL RATES PER 1,000. ALL CASES (including employees). ALL CASES (including employees). CANAL ZONE. CANAL ZONE. AmArxNc SID. PACIFIC SIm. ATLANTic BID:. PAcIric Sm:. Disease. Excluding t7 Excluding A4my City Cty A yludig Arm Cit City andondaflo Tota. Ecldin and Eavc.uding and of o Total. Army and NavyNavy Army and Navy. Navy Colon. Pannd Navy. Navy Army and Navy Navy Colo. Pan-. (officers (officers ama. offir (officers ama. .and en.andenandenandenA nerT O thers. As e A merir O others. cn.Ohr.men.) cans. Ote mlsed. amn-. Ot .lsed. am.mnThe puerperal state. Ectopiegestation.3. ...1. 2 .02 ....081 ..026 Other accidents of pregnancy. 4 ......3 .027 ....081 ..039 Puerperalhemorrhage. 6 1 .6. ......2 3 .04 .53 ..068 .039 Cesarean section. 2 .......2 .013 .....028 Other accidents of labor. 2. .....1 1 .013 .....033 .013 Puerperalsepticemia. 5 .......5 .034 ..065 Puerperal albuminuria and convulsions S .....1 3 .034 .098. ....033 .039 Diseases of the skin and of the cellular tissue. Gangrene. ...I ........ Acuteabscess. 7 1 ....1 5 .047 ..098 ......033 .065 Ulcer of the skin .1. .....1 .007 ....013 Other diseasesof thek and annexa. ....I. .007 ....154 Diseases of the bonea and of the organs of locomotion. O teoiylitil. 2 .....1 ..013 .....081 .03. Arthritis. 1 ...1 .007 .......013 Malformatione. Congenital malformations of theheart. 0 ..3 .1 5 .061 .....244 ..033 .0065 OtherCongenital malformations. 6 ...1. .2 3 .04 ..154. .066 .039 Early in~fancy. Congenit.ldeblity. 21 ...6 15 .143 .......20 .197 Icterusofthenewborn. 6 ..,. .2 .1 3 .04 ..163 .063 .039 M alnutrition. .14 ..2 ...I .6 5 .095 ..196 ...0 1 ..20 .065 Other diseases under this title. 2 .....2. .....M Prematurebirth (-year only). 82 1 6 ...21 50 .559 .53 .59 ...326 ..70 .58 ~Iaryst birth (-mouths only). .2 .I ..4 20 .7 ..n ..133 .263 Oterdsese ec lir "oerlyv #nc ...10 .I .......0 8 ....098 ................119

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Old age. S y. .14 .--. 2 ....3 9 .095 ..196 .....099 .118 External cau8eA. Suicide by solid or liquid poisons (corrosive substances excepted). ..I ..-..--.--..---.-. .1 .007 ....I. ....013 Suicide by Aorrosive substances. 4 .....1.-.-. ..3 .027 ......039 Suiie by hanging qr strangulation. .3 ......2 .02 ...186 ....026 Sic ide drowning. 0 .2 1 1 1 .I ..04 ..196 .186 .154 ... Sulideby firearms 9. .3. 2 4 .061 ...558 ...066 .052 Suiclde by cutting or piercing instruments S. ...3 .2 .3 .034 .....039 Suicide by jumping from high places.2. .....1 1 .013 ......033 .013 Poionig by venomous animals. I .....1 ........081 Other'acute accidentalpoisonings (gas excepted) 2 ..1 1 .013 ......033 .013 Accidental burns (conflagration excepted). 7 1 ...2 3 .047 .53 ..6 ...066 .039 Accidental absorption of irrespirable, irritating, 2 026 or poisonous gas .2 ....0 ... Acciddntaldrowning. 22 .5 4 .2 2 7 .15 ..492 .744 .i63 .449 .066 .092 Accidental traumatism by firearms (wounds of warexcepted) ..5 ...2 3 .......163 .674. Accidental traumatimby fal. .12 .1 1 .1 5 .081 ..098 .186 .154 .244 ..033 .065 Accidental traumatism by railroad accidents 1 ........1 .007 ..013 Accldental traumatismby automobile accidents. 28 .....1 1 8 18 .19 .....081 .224 .267 .236 Accidental traumatism by airplane and balloon accidents. .6 .......1.116 ..... Accidental traumatism by landslide, other crushing.3.3. .......... Injuries by animals (not poisoning). .1 .........1 .007 ......013 Gunshot wound of war. 11. ..1. ..10 .075 ..154 ..131 Starvation (deprivation of food or water). 1 ....I ....... Accidentalelectric shocks.1. .......... Homicide by firearms .1. .3 2 .04 ..186 ....099 .026 Homicide by cutting or piercing instruments. 4 ...1. .2 1 .027 ...154 ...066 .013 Homicide by other means. .4. 4 ...2 .1 1 .027 ....309 ...033 .013 Fracture. 1 ......1 .007 ......013 Explosion. 1 ...., .1. ...4. .. Other external violence. ..1. .......007 ....... Ill-defined di8ease8. Suddendeath. ..2. .2 ..013 ... 1ll-define& .1. .....5 7 .081 ......167 .092 Notspecified or unknown. 3. ...1 .1 1 .02 .....081 ..033 .013 Infection of undetermined origin .3. 5 .....1 1 .034 ..295 ....033 .013 Total .2,128 15 114 25 31 105 15 482 1,341 14,517 7.96 11.2 4.652 4.80 8.572 3.373 16.06 17.64

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TAaBL 6.-DEATHS OF NONRESIDENTS BY CAUSE, SEX, COLOR, AND AGE, 1931. Sex. Color. Age (in years). Cause of death. Total Less deaths. M. F. W. B. Y. than 1-4 5-10 11-20 21-30 31-40 4140 51-60 61-75 76-110 UnIyear. known Malariaestivoautumnal ..6 1 5 .6 ...2. 2 2 .1. .. Malaria,tertian. ...6 1 5 4 2 ..-. --. Malaria, quartan ..I I ...-1 .1.-.-. Malaria, clinical (symptomatic, parasites not found). .7 3 4 ..7 ..-. Hemoglobinuria, malarial .-.---. --.1. Whog cough. .1 ---. .. iph .. Dysentery, bacillary ...1. Leprosy. .-. ...I. .1. Erysipelas. .....--...--. etanuse, ...-. 13 1. 3 ...:. 1.I. Tetanus. .--. -3.3 Tuberculois of the respiratory system ....45 25 20 3 41 1. .....13 3 7. 1. Septicemia. ...4 4 .1 3 ..3 .2. Cancer and other malignant tumors of the stomach and liver. .5 4 1 1 4 ----. Cancer and other malignant tumors of the peritoneum,intestines, and rectum. 3 1 2 2 1.2 ..-. Cancer and other malignant tumors of the female genital organs. ...4 4 4 ...-I .1 1 Cancer and other mahgnant tumors of other or unspecified organs. 6 5 1 1 5 .Diabetes mellitus. ..-. Anemia,unsecifid. ---.+-Diseasesof the thymusgland .-. I I ----Diseases of the spleend. ...1 -. Leukemia. ..1 1. -Chronio alcoholism. ......-. --. ..--. I .. Other alcoholism. .1 ..1-...... Simple memtis .3 2 1 .3 .----. 1 1 Cuobral hemorrhage. ..9 6 3 1 6 2. 2 3 2 1. Hemiplegia. ---. -----. -.-.-.-1-. .-.-. General paralysis of the insane .----. --. 1. -.-. Manic depressive psychosis ..--. Infantile convulsions (under 5 years of age) ..1 1-. .I -I ..... Diseases ofthe ear. .I --. --. .....--.---. iarditis. -. ....... eanic diseases of the heart. .37 28 9 4 33 .. ce ..6 3 3 2. ..-.-.-. 4 3 1 1 Embolism and thrombosis (not cerebral). .....3 3 -. .... Diseasesof thelaryn. .1 1 ..-I Br2hp e m .......2 1 4. .3 1 .. Loar pneumoiaa. .24 18 6 3 .1 1 oaneumonia. ..24 18 6 3 21 .1 4 7 4 2 3 1 1 Em vm ..........4. ....14 ..4I. ..I ----. OthE rdise a ofth er p r t .ry .....I I ------.-------Diher es there d"tle.m. ..1 ...-. ...--. -. DPWeuOWA0fhp r and taI ...I ...... AH>

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AU lr o a ed o nu .........3 3 .. chronic ........a.trit.1.1 rset.s 2. .2. ... te oitis.,. 1 1 ....1. ... ..2 2. .... atobsincation. .1 1. .......1. &F~its ccWitis, or entero-colitie (2 years and over) .2. 2. 2 -. .I -. I. .1. AemUtoeye. .y. .1 1 ..1.1. PArhs teotpecie.2 2. ..2. A c ap udi. .......2. .y.22.2. ..... acrtee no ( di speifid .yrd. .1 2 1 Acutephiof the ., ..13 2.1. 1 2. .... Dileay calc .d. ....... holytrith o1. ................. Acute n pelio atr cdioftesliei.ed.n.e.e). .,. 1 .....1 .1. Chninepbrs (nlutr specified .ol.e 6. ..2 1 ....22 P o ofteri. ....1 ..1. Aio 1. .1. ...I h rpe ra fti e a. ....1 1. -1 ........ Auep rbitisapl icrabcs (femle). .2 ...1. .I Ganigrnuemorsoftheuefus. .... Croni abseris(.,. ..1 .1 1. ......2 Aohritis ..1. 1 .1 ...... P rear af th b ar ..1 1 ......1. .... IPuryea both m ont atd onln.s. .1 1 ..I.1 ..... SGaingiebyane. pelri ascer. a(no.1 1. ..1 A u more by f teas. .1. ....1 Aut ei .1 ... Aeationur ir.(1yearaonx). d).1 14.1.,. .. Anueryalrto i n. -..1. I ...... Aucideral aumingr angcultions. ...I ....1. .. Gainr cideb.e.n.s. ...2.1.1. Acute accident s.,., ... Aciries burns (clagration.d. ..1 3. .2 ..1 Arean id roI. ....1. ..1 3 5. ..1 2.2.1.1. Iry brth a 3ma ts yonyi. ..p.4 .2 Raelroahdait.s. 1 1 .1. ..... homicide by firearms. ..4 2 1 ..4. .1 ... cutecidenbyt joining sxcepte).1 1. .... Acdextal bi olenli. t). 4 1. 3. .... Accidental drowing. 8 7 1 31 1. ....1 2 2 1 1. Acdendaleeat. 1 1 ..1 ... ilodiccidents. I I. ..,. Huomicie bycutcird irig ntuents. ..1 .I. ........ Othure exther vilee.-. -.-. 2. .2. ....2 .. Illdefined. ....2 1 1 1. 1.. Snurydyenmats.oi. 1 1 ..I ..1. ....17. 1 Notspecifiedorunknown. 1. ..4 Infection ofundetermined origin.1 1. .1. .1 Grand total. .319 212 107 55 257 7 15 29 13 23 46 54 45 45 34 12

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104 TALIN 7.-STATISTICS REGARDING AMERICAN EMPLOYEE BAND THEIR FAMILIES, 1931. Annual death rate per 1,000 White employees from the United States: Disease. 5.45 Externalcauses. .1.21 Total. 6. 06 Families of white employees from the United States: Disease.--.--. ..3.16 External causes. ....67 Total. 3.83 White employees from the United States and their families: Disease. .3.07 External causes.I. .86 Total. 4.83 Number of American children born on the Isthmus during the year. .19 Deaths among American children under 1 year of age Infant mortality rate among American children (number of deaths per 1,000 live births) 40 20

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x-----e--a ..... x---.. I y

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TABLE 8.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931. ABsoLUTE Numazis ALL CASES (including employees). EMPLOYEES CANAL ZONE. ONLY. ATLANTIC SIDE. PACIFIC Sm. Disease. Total. Excluding Army Army and Excluding Army Army and City of City of Nonand Navy. Navy (offiand Navy. Navy (offiColon. Panama. residents. White. Black. cers and cere and enlisted enlisted Americans. Others. men). Americans. Others, men). Epidemic, endemic, and infectious dieeasea. Typhoid fever. .1 12 4 ....1 4 2 1 Typhoid or paratyphoid baccillus carrier ...I ......... Re easing fever (Spirillum obermeieri) -. -I -.....--. Malaria, estivoautumnal. .30 179 768 12 130 46 44 250 30 57 122 67 Malaria, tertian. .31 32 329 22 23 46 43 66 52 30 38 9 Malaria, quartan ...1 8 .-. .._-. 1 5 1 Malaria,clinical. ..1 4 2 ...1 Small ox .2 ...1 ...-.M l .7 60 3 6 .8 11 3 13 14 2 Scarletfever. .*. .10 3 1 3 .1 1 1 Whooing cough. .18 2 1 2. .1 6 6 Dip teria. ...I. 9 1. I 1 ..2 4 D htheria bacillus c1r4er .-. ...-. 2 ......2 Iuensa with pulmonary complications specified. 2 7 1 9 _. ..2 Iniuensa without pulmonary complications specified .8 3 44 8 4 163 1 .9 Mumps.y. ...1.---.----.----. % s ntery, ameb c. ._. .2 9 1 ..3 i ..... sentery, bacillary. .4. ...----.1..2-orosy .1 1. ......,. .........-.---Erysipelas. .3 17 3 2 Acute anterior poliomyelitis. ...2 1.-.-. ...1 Meningoeoccu meningitis. ...-.----9 -.-2 4 1 1 Chicken pox. .14 25 6 1 9 1 6 Germanmeasles. .1.5.2. .2 Otherepidemicandendemicdiseases.1 9. -2 3 1 1 2. Tetanus ..... Tuberculosis of the respiratory system. 14 23 146 4 8 13 9 13 Is i T7bercul1is of the me.nnd 2. ...2 Tue alsis ogte e es, and central nervous orystem. .7. .. Tutberculoos'of the inetie acound .nu. -. ..I. ..1. Tubercuosis o the. ._ _. .I. ......_. Tuberculosis ofthejoMats. .3 1. I. I.1. .I. Tuberculosis of the s"i and subcutaneous tissue ..I. ....I. Tuberculogis of the lymphatic system (inesenteric and retroperitoneal glands exceptel). .1 4 ...

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Tuberculosis of the genito-urinary .te. ..1 .. be rculosisof otherorg ns .......... ine ina tuberculosis, acute .....2. ........1 na tuberculosis, chronic or unspecified. ..1. .. Primarysyphilis.2 5 23. 6 1 4 a 1 oondkryq philis. 1 3 28 2 4 4 ..5 4 4 5 Tertiary UZI&..2 99 221 2 37 8 39 6 43 .80 6 Cerebros a h is .., ...2 ..3 1 .2 1 1 1 2& 1 2 .1. .2.1. eredi A yp 16 .....I. ..8 ..........12 ..... .it 21 207 2 12 49 1 11 93 6 17 16 Clisan roidal lym adenitio. .S 35 1 2 10 .1 14 3 1 3 tie. 15 86 330 4 29 36 22 92 67 42 33 Gonoccio orchitis and epididymitis.1 1 10 I I. .4 1 1 2 Gonococcic arthritis. .2 5 1 1 ...1. .I I I Gonococcicophthalmia. 1 14 .1 1 1 3 7 ..... Gonococcie vaginitis ....32 .5 .4 2 .10 8 3 Other gonococcio infections. ...15 .1 4 .2 4 2 .2 Septicemia. .1. ....1. .. Vaccidia. ............ Furiais ...1. ... Other infectious diseases.,.2. .2. General diseases not included in Class I. Cancer and other malignant tumors of the buccal cavity .6. ..3 .2 1 Cancer and other malignant tumors of the stomach and liver. 1 4 14 .3 .3 5 1 Cancer and other malignant tumors of the peritoneum, intestines, andrectum.2 6 2 ..2 ...I 1 Cancer and other malignant tumors of the female genital organs.,. ..23 1 1. ...-7 9 3 Cancer and other malignant tumors of the breast. ..7 1. 1 ..1. .4 1 Cancer and other malignant tumors of other or unspecified organs. ..2 10 29 2 7 1 2 3 1 4 8 1 Benign tumors and tumors not returned as malignant (tumors of the female genital organs excepted) .4 11 83 6 9 18 5 7 12 17 7 2 Acuterheumatiefever. .1 9 ,. 1 .1 3 2. I Chronic rheumatism, osteoarthritis, gout. 3 13 29 1 4 3 .3 3 it 4 Pellagra. ..1 ...I .2 ... Rickets, ....2 .1 .......I. Diabetes mellitus.,. 5 7 59 6 7 .4 8 1 t 20 2 G lycosuria. ....1. ....1 Pernicious anemia. .3 ...I Other anemias and chlorosis. 3 1 18 ..4 .3. Diseases of the pituitary gland. .2 5 .2 .2. ..-... Exophthalmic goiter. 2 .8 .1 2 3 2. Other diseases of the thyroid gland. 4 .34 7 2 2 9 1 5 3 2 3 Diseasesofthespleen. 2 1 7 1 1 ...1 2 2 Leukem ia. ..3. ..,.,. ...Hqdlgkins' disease. 2. .1 .... Acute alcoholism ...2 1 37 3 .14 4 1 5 3 1 6 Chronicalcoholism. .2 14. 2 4 .1 1 4 2 Alcoholiepsychosis. .1 10 3 2. .I ..2 1

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TABLz 8.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931-Continued. AnsoLuTE Niuumas. ALL CASES (including employees). EmPLoYEaS CANAL ZON. ONLY. ATLANTIC SID. PACIIC Smm. Disease. ___________ Total. Excluding Army Army and Exeludin Army Army and City of City of Nonand Navy. Navy (offiand Navy. Navy (offiColon. Panama. residents. White. Black. cers and eers and enlisted .enlisted Americans. Others. men). Americans. Others. men). Alcoh 1. 3 ....2. Chronic lad poisonin g. ...I 10 12 ...2 ..1 9 Other chronic poisoning by mineral substances. 3 5 .....2 2 Drug habit. ...2 ...5 Other general diseases ........4. Diseases of the nermous system and of the organs of special sense. Encephalitis. ...2 4 1 1 1. .,. ....ISimemeningitis. ..2 .....1 1 None emicerebrospinalmeningitis. ...1.00 Tabee dorsalis (locomotor ataxia). ..-. Other diseasesof thespinal cord. ..2 ....2 Cerebralhemorrhage. ...19 1 4 ..10 2 1 Cerebralembolism and thrombosis. ....... H erciplg6 ...3 7 .I ..I .2 3 ..... Other paralyses withoutspecifedcause,. .1 4 13 1 2 .1 .1 3 2 3. G rlparalysiaoftheinsane. 6 28 .4 1 1 1 .10 9 2 D entia precox. .1 85 .2 18 1 3 30 3 15 13 M anic depressive psychosis ...12. .12 ..1 1 11 5 Toxic achous.2. I ....I. ......1 2 ..1 .....1 Otherformsofmentalalienation. ..1. 77 3 .11 5 1 24 7 20 6 1 1 20 1 i 2 2 3 3 3 3 ow (nopuereral ;5yearsandover). 1 3 14 .2 .1 2 .5 3 1 IufantIlc conlsions under 5 years of age). .6 .....5. Chorea.1.1. Neuritis. ..16 5 45 8 3 2 it 2 5 0 7 1 Hysterka. ..2 4 36 1 5 1 3 2 4 12 8. Otherneuragas.--.6 4 25 1 .4 8 1 3 2 3 3 of brain ..-..1 Tuorenof the brain-. .....4. ...2. X411111t20.4.0.2.1. .1 3 A .8 ft rdssao h evu ytm .00181 4 13 26 4 204 1

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Follicular onjunctivitis .............. Disease of corneae. 6 27 78 2 11 4 4 7 3 17 23 7 Diheuseofiris. 11 15 69 3 8 6 2 11 11 10 16 2 iseaaeoflen. 1 5 15 .3 .1 3 .4 3 1 Mea eoffundus.3 6 20 3 2 2 1 2 2 3 5 .Other diseases of the eye and annexa. 16 41 192 13 27 34 4 25 16 31 32 10 Diseasesoftheear. 10 11 194 18 11 52 -20 13 35 13 30 2 Diseasesofthemastoidproces. ..7 ..2 .2 .2 1 Diseawee of the circulatory system. Pericarditis.1 2. ........ Aputeendocarditis. 1 3 10 .2 .2 1 .4 1. Acutemyocarditie. .1 3 .1 ... Anginapeotorim. ..16 .....24.3 4 Other diseases of the heart. 17 is 126 8 15 9 14 10 Aneurysm. 2 3 7 .2 1. 1 3 Arteriosolerosis. 11 45 101 1 22 16 1 6 19 32 4 Othr sees of the arteries.3 2 8 1 3 ..2 Emboism and thrombosis (not cerebral). .1 3 ..1. ....1 Hemorrhoids. 17 23 177 8 8 55 16 13 42 15 16 4 Varices. 5 4 30 2 4 2 4 2 10 5 .1 Varloocele. .1 10 .1 5 .1 2. .I Phlebitis.2 .8 1 ...1 3 1 Thrombosis. ..1 5 .1 ...3 .. Other diseasesoftheveins. ..1 6 11 .4 .2 .2 3 2 Lymphangitts.3 1 13.2 3 1. Lymphadenitis, nonvenereal. 13 32 184 4 13 33 9 11 22 33 9 Ly ph ectasis.t .,. ..4 ....2 ..2. Other diseases of the lymphatic system ..,. 1 4 .3 .... Hemorrhage without specified cause (noncerebral). 1 2 5 ...2 .. Other diseases of the circulatory system. 10 36 124 11 11 1 8 30 2 12 49. Diseases of the respiratory system. Diseaseofthenasalfosaae. 28 15 128 16 11 17 27 10 30 5 12. Other diseaes of the nasal fosae and annexa .86 141 481 13 24 30 124 91 19 17 150 13 Diseasesofthelarynx. .1 2 11 2 .2 1 1 .5 Acute bronchitis. 35 53 344 23 30 34 43 11 53 93 49 8 Chronic bronchitis. 6 1 36 5 3 8 5 1 8 4 2. Bronchitis, unspecified (under 5 years of age). ..2 .1 ..... Bronchopneumonia. 3 7 53 3 5 .6 2 .17 14 6 Ca illary bronchitis. ...._. .. Loar pneumonia. 2 31 109 2 8 1 1 13 4 18 53 9 Pneum oniaj unspecified ..2 6 .I. ..,. ..1 2 3 ..... Pleurisy. 3 12 62 2 4 5 3 14 4 11 13. Empyema. .1 6. ....1 1 6 Other diseases of the pleura ..1 2 Infarction ofthelung .,. 1 .1 ..., ypostatic pneumonia.,. .1 1 .....2. Asthma. 5 10 89 7 9 8 11 12 1 720 Other diseases of the respiratory system (tuberculosis excepted). 2 9 19 2 3 .4 1 2 2 3 2

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TABL 8.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931-Continued. ABsoLuTz NuBmEsR ALL CASES (including employees). EMPLoYEES CANAL ZONE. ONLY. ATLANIc Swm. PAcIFC SIDE. Disease. Total. Excluding Army Army and Exeluding Army Army and City of City of Nonand Navy. Navy (offiand Navy. Navy (offi. Colon. Panama. residents. White. Black. cers and -erand enlisted enlisted Americans. Others, men). Americans. Others. men). Diseases of the digestive system, Diseasesoftheteethandgums. 30 39 157 16 16 20 14 17 12 23 30 9 Stomatitis. ....1 12 .1 -.2 1 2 2 3 1 Other diseases of the mouth and annexa. 2 1 19 .3 4 5 1 3 3 Adenoidvegetations. .16 5 2 .3 3 1 1 1 Other diseases of the pharynx and tonsils. 87 66 1,156 114 74 114 203 126 144 130 231 20 Diseases of the esophagus. ....6 2 1 1. ...I .2 Uleerofthestomach. 3 12 21 .4 9 2 1 2 3 6 1 Ulcer of the duodenum. 19 14 75 7 5 16 15 3 14 2 10 3 Gastrectasis. 2 3 1 ....2 Acutegastritis. 7 16 57 2 4 5 4 8 6 10 3 Chronicgastritis. 5 5 16 4 1 ....3 4 1 Acuteindigestion ..1 2 18 3 2 6 1 ..4 2 Otherdiseasesofthestomach(cancerexcepted). 24 17 111 17 8 10 21 13 13 8 17 4 Enteritiscolitisorentero-colitis (under2yearsofage). .3 49 1 7 .2 9 .10 18 2 In al autointoxication (under 2years of age). 16 1 1 ..4 ...10 tis, colitis, or entero-colitis (2 years and over). 21 26 225 11 20 47 23 14 45 20 31 a Intestinal autointoxication (2yearsand over). 2 49 3 2 12 7 3 3 10 8 1 Ankylostomiasis. .10 56 128 .12 2 3 33 .12 49 17 Cestodes (hdatids of the liver excepted) 4 I 1. ..6 I Nematod other than ankylostoma). 1 1 19 .1 2 4 1 2 6 3 Other Intestinal paaitaspecified. .2 ....... Parasites not specified. ..1. Aouteappendicitis. 12 14 290 5 8 56 20 24 its 22 26 13 Chronicappendicitis. 11 7 159 8 4 8 26 12 67 2 27 5 Hernia. 21 60 176 8 17 5 20 30 29 26 31 10 Intetinalobstruction. 2 1 11 .1 1 3 1 4 1 Other diseases of the intestines. 28 63 336 14 30 49 26 as 49 39 79 17 Cirrhosisoftheliver,notspecifiedasalcoholic. 4 2 7 1 1 2. ..3 Biliary alculi ..1. 16 1 2 .1 4 .3 Abeceuaoftheliver(uqualilied). 1 3 ....1 .I 17j:% w 't 78 41 12 3 IS3 C111 i 1. .17 ofhe 0 of liver. .4 1 44 1 2 1j 2' 4 8 4 4 3 Peritonitis without specifed cause (except puerp oai). 4 .20 2 ,31. 3

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Nonwenera4 disease of Ihe geito-urinzry jystem an~d anneza. Aeuteuephriti incluunapecifiedunder10yearsofage). 2 1 29 .5 .4 2 7 10 1 onephrit includingg unspecified 10 years and over). 4 24 68 4 10 6 2 21 18 2 'yr. .--.-. --. .. ..... Pyeopbrais. .1 12 ...2. 2 ov.ble i.ne. .1 2 7 2 ..1 3 1 Other 4iseases of the kidneys and annex (puerperal3 2 7 2 1 nephritisexcepted). 16 1.2 3 2 2 8 CnWeulioftheurinarvpassages. 10 5 50 72 8 1 14 2 6 5 Diseases of the blad er. 11 10 89 6 6 10 23 8 5 11 17 3 Strictureoftheurethra. 1 17 32 .6 1 2 6 1 5 10 1 Otherdiseasesoftheurethra. 2 5 18 1 4 2 4 1 4 1 1 Acuteprostatitis. 2 1 6 ..1 .1 Chronicprostatitis. 2 .8 .1 .2 .1 1 2 Hypertrophy of the prostate. .7 1 .2 2 .1 Hematocele. ...-.--.--. ..27. 3-1 ---. -. Uydronele ...1 12 27 .3 2 2 2 10 6 Other nonvenereal diseases of the male genital organs 3 (excet varicocele).3 23 50 1 6 4 1 6 7 11 11 Cystm an otber benign tumors of the ovary ...38 1 4 .2 11 5 14 Salpingitis and pelvic abscess (female) (not gonococcic.) ..124 1 12 4 18 .30 58 1 Bewgntumorsoftheuterus.3 3 92 1 15 .9 11 .3 29 4 Nonpuerperaluterinehemorrhage.1 1 19 1 2 .6 2 3. 3 2 Le korrhea. ......8 2 ....5 1. Dysm enorrhea .2 .15 1 ..4 5 .2 Cervicitis. .1 Endometritis. 1 1 30 .4 ..8. .4 10 Stenosis of cervix. 2. .,. ..2. Prolap usutr -. ......6 1 .....-2 3-. Lacerations, old or recent, of cervix and perineum. .1 21 2 1 .10 .1 6 Benigntumors of the female genitalorgans(exceptofuterus) ..2 ...2 Otherdiseasesofthefemalegenitalorgans. 1 6 168 13 15 .19 25 .47 .481 Nonpuerperal diseases of the breast (cancer excepted). .35 1 14 ..1 3 .6 10. The puer peral state. Abortion (miscarriage, premature birth, etc.). ..134 8 13 .16 22 .40 33 2 Ectopic gestation. ..6. 6 ....2. 22. Other accidents ofpregnancy. .51 5 12 10 1 7 2 Puerperal hemorrhage. ..16 2.3 2 .5 4 Cesareansection. ...8 1 .3 3. Other surgical operations and instrumental delivery. ..36 2 2 Other accidents of labor.-.-.Puerperalsepticemia. ..9. .1. .4 4.> ------. Puerperal albuminuria and convulsions. ...41 4 6 .2 12 11 Follow childbirth (not otherwise defined). ..2 ...2. Puerpera diseases of the breast. ..12 1 3 ..1 2. -5--

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TAU. 8.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931-Continued. ABSoLUTE Numams. ALL CASES (including employees). EXPLOYMS CA5B ZONE. ONLY. ATLAItC SMS. PACIFIC SIDE. Diseae.-------Total. Excluding Amy Army and Excluding Army Army and City of City of Nonand Navy. Navy (offiand Navy. Navy (offiC40n Panama. residents. White, Black. cers and -erand enlisted .enlisted Americans. Others. men). Americans. Others men) Dieea8s of the skin and of the cellular tissue. Gangrene ..2 6 ....1 ...1 2 Furuncle. 5 15 56 6 6 8 7 4 3 12 6 4 Acuteabecess. 28 46 294 15 21 35 30 22 35 69 48 19 Trichophytois. 12 16 88 4 5 11 21 6 12 10 17 2 Scabies. 1 1 12 ...1 3 2. .5 I My4asis of the akin .1. .... Dhobieth1. I 1 3 .I .......I0 Pricklylheat. ..4 ..1 I .1I Ulceroftheskin. 3 10 28 1 5 1 3 3 2 2 7 4 Orientalsore (Leih sania ia). ...1. ...1 Impetigocontagiosa. ..1 1 1 .,, .2 1 1 Inpe 0 8 le ...2 ..I ....I .I .......... Ur 12 2 ...1 3. Eoze=1. ..1 2 nail.5 3 39 7 7 3 25 6 4 1 diseeeofthekin and annexa. 13 7 80 7 10 15 7 2 15 10 8 8 Diseases of the bones and of the organs of locomotion. Caries (no berculous). ..1 2 ..1 ....1. '= 'iti 2S .1 28 1 1 5 2 3 1 8 4 3 r,.2 2. 1 ..1. othr diseases f *th~e* 'bone* *(tuberculWosi',* sinusiltis, and malignancyexcepted). .1 6 ...1 1 1.1 1 1 A nkylo s. .......I Arthritis,.:. .102 0 0512 12 1 71 "2 0 o5 271 8ywitis ...6 17 1 1 1 .4 52 3 ter diseases of the jote (tuberculosis and rheumatism ex.e.t.d) ....31 3 1 Am =tato ..I A m u a i n .......I .2 .........I .... Otherdiseasesoftheorgasoflocomotion. 28 28 167 8 10 25 30. .5 1 1 1. .2.R ... /L

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I r.aljprinatione. ICogenitilmalformationsoftheheart ..2 Othero ngen fita t faloritions .14 104 5 20 2 6 21 54 18 3 Early infancy. Co i enitaY ebility. ..6 ... I nr s of thetnewbirn. n. ...3 ....2 .I .. M triton ...25 5. 1 2 .9 7 1 Premature birth (-1 year oly. .24 3 .2 .1 3 .10 5 iury atbirth (-3 monthsony). ...8 8. 0 'erQ diseases peculiar to early infancy. ..3 ...1. Old age. Senility. .1 10 29 3 4 .4. 6 7 Senilodementia. .2 ...1 1 External causes. Suicide and attempted suicide by solid or liquid poisons (corrosive substances excepted). ..1 ...1. ...... Suicide and attempted suicide by corrosive substances. ..2. ..1. ....j Suicide and attempted suicide by poisonous gas. ..1 .......1. Suicide and attempted suicide by firearms. .., ...1 .. Suicide and attempted suicide by cutting or piercing intruments ...2 2. .. Suicide and attempted suicide by crushing.1 1 ...-. Poigoningby food. ..2 .54 .1 .35 3. 1 1.8 Poisoning by venomous animals. ..3 1 .1 ...1 Other acute accidental poisonings (gas excepted) .1 2 22 3 1 .1 .2 8 6 1 Accidentalburns(conflagrationexcepted). 3 13 49 2 6 6 1 6 4 11 8 5 Accidental absorption of irrespirable, irritating, or poisonousgas. -..1 .....I Accidental traumatism by firearms (wounds of war excepted). 3 .27 ..7 4 .11 2 2 1 Accidental traurnatism by cutting or piercing instruments. 3 32 54 1 2 2 .2. 19 1 2 21 6 Accidental traumatism by fall. 17 37 175 5 7 10 18 31 28 13 48 15 Accidentaltraumatismbymachines. .17 25 2 ...15 2 Accidental traumatism by railroad accidents. .3 6 ..I I .3 1 Accidental traumatism bystreet car accidents .6. .....I ... Accidental traumatism by automobile accidents. 8 20 86 1 2 2 7 13 9 8 37 7 Accidental traumatism by airplane and balloon accidents. .2. .2 .... Accidental traumatism by motorcycle accidents. .1 3 ....1 2 Accidentaltraumatism byothervehicles. 53 ..2 1 1 .I Accidental traumatism by landslide, other crushing. 1 5 13 .2 2 .2 1 .4 Injuriesbyanimals(notpoisoning). 2 11 .1 1 1 3 5 Gunshotwoundofwar. .1 ..1 ....... Starvation (deprivation of food or water). .3.3. .1 Excessiveheat. .2 5 .1 2 ... Accidental electric shocks. 1 3 1. ...1.

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TAstv 8.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL 1931-Continued. AcsoLuTz Nmmzms. ALL CASES (including employees). EMPLOwrES CANAL ZoN1. ONLY. ATLA nc Bu. PAcmc Sma. Diseme. Total. Excluding Army Army and Excluding Army Army and City of City of Nonand Navy. Navy (offiand Navy. Navy (off. ClOu. Panama. residents. White. Black. cers and cars and enlisted enlisted Americans. Others. -men). Americans. Others. men). Homicide and attempted homicide by firearms. ..8 ..3 ..3 1 Homicide and attempted homicide by cutting or piercing instruments. ..5 .Is. ..1 ....2 1 Homicideand attempted homidde by other meats. .I1 ..-...-. I .------. .---.--.-+ I -. Fracture. is 45 217 10 23 46 10 13 14 73 14 14 Didoestio.2 10 ..3 ...1 3 .3 31 64 .7 2 7 9 1 28 6 .2 2 5 ...1 ..*. 3 1 erexternalviolence. 34 147 450 25 46. 4 12 35 30 108 77 39 Ilhbd4ed disease. Undia n s d. ....I ....1 -.--. ..-.--.--. ---. +---.---..-------+. --I 37 .3 9 2 3 4 3 .2 5 ....2 ...2. of undeterminedorigin .7.7 46 8 -4 10 5 .10 4 die e. .....1 ....-.-shoo. ..1. .... 802 40 79 71 101 .32 17 13 859 48 81 82 95 348 193 12 Noies~opnolobrvatIon,eto.). 50 123 663 73 28 5.104 78 81 45 192 31 moa-eia srvey of lead workers (no lead .., ., ",. ,1 r .nd.total. 1,1.4 ,4. 18,302 944 1,488 1,473 1,687 I,944 1,737 ,92 393 744 ...............94 1 ...9 6 ..161 ..o134fs 32 4 047 I4 9 I wures ( lea ur~y z

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4p 02 f MII 4*I T t .o .I Q. *k Xv .W, 44*

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TABLE 8-A.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931. RATzs PER 1,000. EMPLOYEES ALL CASES (including employees). ONLY. CANAL ZoN. ATLANTIC SIDE. PACIFIC SmD. Army Army City Disease. Excluding and Excluding and City of Total. Army and Navy. Navy Army and Navy. Navy of PanWhite. Black. (officers (officers Colon. ama. and .and AmenOthers. enlisted nOthers. enlited Cans, men). cane. men). PoPULAnoN .3,551 11,046 146,565 1,884 10,160 5,373 6,453 12,248 4,447 30,000 76,000 Epidemic, endemic, and infecgious diseases. Typhoidfever.09 .08 2.12. ..08 ..13 .03 Typhoid or paratyphoid bacillus carrier. .07. .. Relapsing fever ( pirillum obermeieri). .28 ..007 ....08 .. Malaniaeotivoautumnal. 8.45 16.20 5.29 6.37 12.79 8.56 6.83 20.81 7.87 1.90 1.0 Malaria, tertian. 8.73 2.90 2.27 11.68 2.20 8.56 6.67 5.39 11.69 1.00 .50 Malaria, quartan ..28 .09 .06 ....16 ..22 .17 .01 CA Malariatinioa. ..28 .09 .03 1.06 ..03 .01 8m all ox. .28 ..01 ....16 .... M.se. .63 .41 1.59 .59 .1.24 .90 .67 .43 .18 Scarletfever. ...07 1.59 .10 ..47 ..22 .03 .01 Who cough. ..12 1.06 .10 ..31 ...03 .08 D ip a ...1 .28 ..06 .53 ...16 .08 ..07 .05 iphtheria bacillus carrier. ....09 .03 ..31 ....03 ensswith pulmonary complications specified. ...56 .18 .05 1.06 .30 ....07 Infunawithoutpulmonarycomplicationsspecified. 2.25 .27 .30 4.25 .39 2.98 .47 .08. .30 Mumps ..007. ......-------.---Dysentery,amebic. .18 .06 .53 .20 .19 ....10 .03 Dysenterytbacillary. .03 ...22 ..0 Lep y .....08. .I .. EA ipela. .84 .45 .12 1.59 .10 ..16 .08 ..03 .11 A" to anterior poliomyelitis ...............01 ..10 ...I. ..I. .03 ... Meningoocoous meningitis. ..06 ...19 ..16 .90 .03 .01 Chicken po ...1.27 .17 ..59 ..16 .73 ..03 .08 Germ me ..28 .09 .03 ...19 .31 ...03 Other epidem and endemic diseases. ...06 ..20 Tetpa us .'.*#. ....01 ..I. ..08 ...01 Tubulos Oftherespir y .3.94 2.08 1.01 .2.12 .79 2.42 1.40 1.06 3.37 .90 .62 Tubrloos of ut nt nrvousyatem. .05 ..10 ...10 ..10 .01 Turaudwss of the neuie and peritoneum .....0 ....,I. .....,. ..01 T b r uo i f hev re r c um ..............007 .3 ......4 .------.------

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Tuberoulosisof the joints. ....02 ...10 ....08 .....01 "'ubercu oeia of the skin and aubcutaneoua tissue. ....007 ........ I Tuberculosis of the lymphatic system (mesenterio and retroperitoneal glands excepted). .....09 .03 ......08 .22 .03 .01 Tuberoulosisof thegeito-urinarysytem. ..02 ....08 .22 ..01 Tuberoultis of other cranw than above. ...007. ....01 Diaaemin d tuberculosis, acute. .01 .....03 .01 Dia' tuberculosis, chronic or unspecified. .007 ..03. P=imaryeyphilIa4. .58 .45 .16 ..1.12 .16 ..67 .13 .11 Secondarysyphilis. .28 .27 .19 1.06 .39 .74 .1.12 .13 .05 ertiarysyphilis ..5 8.96 1.52 1.06 3.64 1.49 .3.18 1.35 1.43 1.05 Cerebrospinal sypluis. ...18 .06 ..56 .16 ..50 .03 .01 Hreditaryyphilis. ..06 ..20 ..16 .16 ..03 .03 o tchancre. 3.10 1.90 1.43 1.06 1.18 9.12 .16 .90 20.91 .20 .22 hancroidallymphadenitis. .45 .24 .53 .20 1.86 ..08 3.15 .10 .01 Gonococcicurethritis. 4 22 7.79 2.27 2.12 2.85 .6.70 .78 1.80 20.69 2.23 .55 Gonococicorchitisandepididymitis. .28 .09 .07 ..10 .19 ..90 .03 .01 Goxq cocioarthritis .....18 .03 .53 .10 .....03 .01 Gonococeic ophthalmiia. .09 .10 ..10 ..16 .08 .22 .10 .09 Goococcievaginitis. ...22 ..49 .8. 62 .16 .33 .11 Othergonococcicinfections. ..10 ..10 .74 ..16 .90 .07. Septicemia. ...007. ......03. Vaccinia. ..007 ... Filariaais. ...09 .007 ...19. Other infectious diseases. ..01 ........07. General diseases not included in Class I. Cancer and other malignant tumors of the buccal cavity. .., .04. ..47. .03 Cancer and other malignant tumors of the stomach and liver ...28 .36 .10 ..30 ..47 .08 .03.07 Cancer and other malignant tumors of the peritoneum, intestines, and rectum. ..8.04 1.08. ..31. ...01 Cancer and other malignant tumors of the female genital organs. ..16 .53 .10 .-. .16 ...23 .12 Cancer and other malignant tumors of the breast. ..05 .10. .08 ..05 Cancer and other malignant tumors of other or unspecified organs. .56 .91 .20 1.06 .69 .19 .31 .24 .22 .13 .11 Benign tumors and tumors not returned as malignant (tumors of the female genital organs excepted). 1.13 1.00 .57 3.18 .89 3.35 .78 .57 2.70 .57 .09 Acute rheumatic fever. ..09 .06 .,-. .20 ..16 .24 ..07 .01 Chronic rheumatism, osteoarthritis, gout. .84 1.18 .20 .53 .39 .56 .-24 .67 .37 .05 Pellagra. .....09 .03 ..10 ...08 ..07 Rickets.,.,. ....01 .10. .10 .......01 Diabetesmellitus. 1.41 .63 .41 3.18 .69 -. .62 .65 .22 .7 26 Glycosuria. ....18 .01 ..10 .......01 Pernicious anemia. ..28,.,. .02 _. ....16 .08 Otheranemiasandchlorosis.,. ..84 .09 .12 ..39 ..16 .41 ..10 07 Diseasesofthepituitarygland. ...18 .03 ..20 ..31 ...22 E cophthalm ic goiter .....56 ..06 ..10 .37 .47 ....03 Other diseases of the thyroid gland. ..1.13 ..23 3.72 .20 .37 1.40 .08 1.12 .10 .03 Diseases of the spleen. .56 .09 .05 .53 .10 .22 .07. Leukemia. ....02 .....,08 .03 .01 H odgkins' disease ...........01 Acutealcoholism. .56 .09 .25 1.59 .2.61 .62 .08 1.12 .10 .01

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TABLE 8-A.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 193I.-Continued. RATES PaR 1,000. EMPLOYEES ALL CASES (including employees). Ony. CANAL ZONE. Amwuno Smv. PAcVIPI SmE. Army Cityi Disease. Excluding Ifd and of Total. Army and Navy. Navy Army and avy. Navy cO.f PantWhite. Black. _ __ (officers am&. and .and Others. enlisted AmerOthers. related CANs. -men). nwmen). Chronic alcoholism ....56 ..10 ..7. .62 ..22 .03 05 Alcoholicpsychosis .....09 .07 1.59 ..37 ...08 .22 ..03 Alcohol In. .........................,. .02 ....16 ..45 ......... Chronic c edpois oning. ..28 .91 .08 ....31 ....a Other chronic poiaonming by mineral substauces. ..27 ...10 .....07 08 Drughabit. .01 ..19. .-. .. Othergeneral diseases. ....42 5.84 .98 ..33 .1.03 .07 Disazw of the nerou system and of the organs oi special sense. 18 .03 .53 .10 .19 ...-03 imp m ti. ...0. ...0 K leni .m enin.i. ......007 ..-.-. ..-. .-----.----.-+ -. ---Nonpidemio aerebrospiual meningitis. ...0 .007. .------Tabei dorsalis locomotorr atauis). .28 ..007 .53 ... Other diseases of the Spinal cord ...........1. ..-.......-. ...--. .*.-. ... =ere bralhemorrhag. ..1 33 .0 C r ra embolism and thrombosh; ..............007 .53 .............-. .10 ..08 ..07 .04 vie houtpeciedau.28 ..3 .09 .53 .20 .19 .08 .67 .07 04 outo ane. .39 .19 "**'*~~~0 *" -" -.6.0.3.0.9 ..8 ..7 .0 .0 theiapree. .9 .20 3. 0 foder sofz Iieo. .....2 ..7--. .A -.09 .21 ..2 ..... -A-l .1 ....14 .5184.3 1 .16. 1.) .,. ...1 0g (11; Few an Ove) ..28 .1% .P,. 2 L nan l ari Years aw:0. ..,. ....04 ... b re ..........., ...............-. ....-. .4 w4 o.2 ..1.171 .611 2 ..1' as d h ..............A.S .4.1 5 .4tnn fte6== .............................0 7 --------

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Ot er d seaeaoth nerrousysem m. .....2.82 .84 .74 7 9o .39~ 2.42 4.03 .33 4.50 .41 .48 Folicuar onjnciviis .........09 .007 ....,. ..10 Dies fcre. 1.09 2.44 .64 1.08 1.08 ~ .74 .62 .57 .67 .57 .30 thrdineasesof the eyeand annexa 4.51 3.71 1.32 8.90 2.60 0.33 .82 2.04 3.60 1.06 .42 easesoftheoar.2.2 1.00 1.34 9.55 1.08 9.68 3.10 1.08 7.87 .43 .39 piessofthe mnntoid procesa.28 .05 .20.1.03 Diaeaaes of *hee r rulator* y 2yatem Aute endooarditia.28 .27 .07 .20 .31 .08 .13 .01 A g'ap tr ....A.0 ...0. Othr disesame of the heart.4.1.03 .87 4.25 1.48 1.67 2.17 .82 1 80 .80 .45 A.y.56 .27 .05. .31 .08 .03 .04 Ar.r.3.10 4.07 .70 .53 2.16. .2.48 08 1.5 .63 .42 Oter dieae sfethe arteries. ....84 8 .06 .53 .30 ..31 .07 Emolimandthrombus(otcerebral). .09 .02. .19. ...03. Hemorrhoids. 4.79 2.08 1.22 4.25 .79 10.24 2.48 1.08 9.44 .50 .21 Vaes. 1.41 3 .21 1.08 .39 .37 .62 .16 2.25 .17 Varicocele. ..09 .07 ....10 .93 .08 .45 .01 Phlebitis. ...5806 ......22 .10 .01 Thrombosis. ..1 .09 .03 ..10. .67 .01 Otherdiaeaaeaoftheveins. ...28 .54 .08 .39 ...16 ..07 .04 Lymphangitis. .....84 .5 .0 .09. ..20 .74 .16 .16 .10 .01 Lymphadenitis,nonvenereal. .3.66 2.90 1.2 2.12 1.26 6.14 1.40 .90 11.24 .73 .43 Ly angiectas ...03. .18. ..07 Oth diseases of thelymphaticsystem. ....09 03. .30. ...22 Hemorrhage without specified cause (nocerebral). .28 18 03 .....47 .16 .. Other diseases of the circulatory system. .............2.82 3.26 .85 5.84 1.08 .19 1.24 2.45 .45 .40 .64 Diseases of the piratory system. Diseaseofthenasalfssae. 7.89 1,36 .88 8.49 1.08 3.16 4.19 .82 6.75 .17 .16 Otherdiseaes ofthenaalfossaeand annexa. .24.22 12.76 3.31 6.90 2.36 5.58 19.23 7.43 4.27 .57 1.97 Diseasesofthelarynx. ..28 .18 .08 1.06 ...37 .16 .08 ...07 Acutebronitis .9.86 4.80 2.37 12.21 2.95 6.33 6.67 .90 11.92 .0 .64 Chronic bronchitia. .1.70 .09 .25 2.65 .30 1.49 .78 .08 1.80 .13 .03 Bronchitis, unspecified (under5years of age). .0. ..0. Bronchopeumona.,. .7.84 .B3 .37 1.59 .49 ....93 .16 ...57 .18 Capillary bronchitis. .I ..6.007. ....03 .04 Lobarpneroia. .56 2.81 .75 1.06 .79 .19 .16 1.06 .90 .60 .70 Pneumonia, unspecified. .18 .94. .....22 .07 .04 Pleurisy. 1.84 1.09 .43 1.06 .39 .93 .47 1.14 .90 .37 .17 Empyema. 02. ......03 .01 Other diseases ofthelpleura.28 .09 .04 ......

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TABLE; 8-A.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931.-Continued. RATES PER 1,000. EMPLOYES ALL CASES (including employees). ONLY. CANAL ZONE. ATLANTIC SmE. PACIFIC Sms. Disease. Excluding Exlu City City Total, Army n Navy an Exldiad ofOf Total. Army and Navy Navy Army and Navy. Navy Coon pa White. Black. (officers (officers ama. Ameriand A and Ans. h enlisted Others. enlisted cans. Others. men). cans. men). Infarction of the lung. ..28 ..007 ...16 Hypostatie pneumonia. ..09 .007 ...01 Asthma. 1.41 .91 .61 3.72 .89 1.49 1.71 .98 .22 .57 .26 Other diseases of the respiratory system (tuberculosis excepted) ..56 .81 .13 1.06 .30 ..62 .08 45 .07 .04 Disease of the digestive system. Diseases of the teeth and gums. 8.45 3.53 1.08 8.49 1.57 3.72 2.17 1.39 2.70 .77 .39 tQ Stomatitis, ..09 .08 ..10 ..31 .08 .45 .07 .04 0 Other diseases of the mouth and annexa. ..56 .09 .13 ....30 .74 .78 .08 .67 .10 Adenoid vegetations ......, .11 2.65 .20 ...47 .24 .22 .03 .01 Other diseases of the pharynx and tonlls. 24.50 5.98 7.97 60.51 7.28 21.22 31.49 10.29 32.38 4.33 3.04 Diseasesoftheesophagua. ....04 1.06 .10 ...22 ..03 Uleeroftheatomach. ..84 1.09 .14 ..39 .37 .31 .08 .45 .10 .08 Ulceroftheduodenum ...5.35 1.27 .52 3.72 .49 2.98 2.33 .24 3.15 .07 .13 Gastrectasis .....18 .02 ...10 .....07 A gaatritis ..1.97 1.45 .39 1.0 .39 .93 .62 .65 3.37 .20 .13 C 0gtritis ...1.41 .45 .11 2.12 .10 ..47 ...10 .05 A.i.d.gest. .n .......28 .18 .12 1.59 .20 1.12 .16 ...13 .03 Other diasses of the stomach (cancer excepted) .6.76 1,54 .76 9.02 .79 1.86 3.26 1.06 2.92 .27 .22 Enteritis colitisor entero-coliti (under2years of age). ...27 .34 .53 .69 ..31 .73 ..33 .24 Intetna au tointoxieation(undpr2yearsofo ge).-. .....11 .53 .10 ...62 .....13 Enteritis,oblitis,orentero-colitis(2yearsandover). 5.91 2.35 1.55 5.84 1.97 8.75 3.57 1.14 10.12 .87 .41 Intestinalautointoxication(2yearsandover). .18 .34 1.59 .20 2.23 1.09 .24 .67 .33 .11 Ankylostomiasis. 2.82 5.07 .88 .1.18 .37 .47 2.69 ..40 .64 Cestodes (hydatida of the liver excepted). .03 ..10 ..16 ....01 Nematodes(otherthanankylostoma). .28 .09 .13 ...19 .31 .33 .22 .07 Other intestinal parasites, specified. .01. .19 ..01 ParasiteanotSpecified. ..0 .......... Acuteappendicitia. 3.38 127 2.00 2.65 .79 10.42 3.10 1.6. 288 77 .34 Chronicappendiitis. 3.10 .63 1.10 4.25 .39 1.49 4.03 .99 15 ...5 4 1.21 4.25 2.45 intestinal obstrucei.n. ..66 .9 .As ...10 .19 .47 ...0.5

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thediseasesoftheinteste. 7.89 5.70 2.32 7.43 2.95 9.12 4.03 2.70 11.02 1.30 1.04 %irrhop of the liver, not spefied as alcoholic. .1.13 .18 .05 .53 .10 ..31 ..10 ilar c lcui .....09 .11 .53 20 .16 .33 ..10 .07 'bodes of the liver (unqualified). ...28 ....02 ....16 ..22 .... sCheqytitis. 4.79 .72 .52 2.12 .30 1.12 4.03 .65 1.57 .10 .21 .Otherdiaeaiemoftheliver. 1.13 .09 .30 .53 .20 2.98 .31 .33 1.80 .13 .05 Peritonitis without-specified cause (except puerperal). .1.13 ..14 1.06 .10 .19 .47 .08 ..10 .11 Non.nrsal $igeames of the genito-urinr y system and anneza. Acte nepriti includingg unspecified under 10 years of age) ..56 .09 .20 4. ..33 .45 .23 .13 Chronicneplritis (including unspecified 10years and over). 1.13 2.17 .47 2.12 .98 .37 .47 .49 .45 .70 .24 luri. ......01 Pyonephritis. ....09 .07 ..20 ...08 .22 .07 .05 Pyelonephrosis. .09 .10 1.59 ....16 .24 ..20 .01 Pyelitis. ..2.82 .81 1.04 6.37 1.57 1.12 5.89 .57 3.15 1.17 .28 Movable kidney. ..28 .18 .05 1.06 ......22 .10 .01 Otherdiseasesof thekidneys and annex (puerperal nephritis excepted). .84 .09 .11 .53 -. ..31 .24 .45 .07 .08 Catcufi oftheurinarypassages. 2.82 .45 .34 3.72 .20 .93 1.24 .08 3.15 .07 .08 Diseases of the bladder. 3.10 .91 .61 3.18 .59 1.86 3.57 .65 1.12 .37 .22 Strictureoftheurethra. .28 1.54 .22 ..59 .19 .31 .49 .22 .17 .13 Otherdiseasesoftheurethra. .56 .45 .12 .53 .39 .37 .62 .08 .13 .01 Aeuteprostatitis. .56 .09 .04 ..10 ..16 ..45 .03 .01 Chrome prostatitis.,. .56 ..06 .I. .10 ..31 ..22 .03 .01 Hypertrophy of theprostate. ....05 .53 ...31 .16 ..01 H em atocele. .....8. Hydrocle ..28 1.09 .19 ..30 .37 .16 .16 .45 .33 .08 Other nonvenereal diseases of the male genital organs (except varicocele). .84 2.08 .34 .53 .59 .74 .16 .49 1.57 .37 .14 Cystsandotherbenigntumorsoftheovary. ....26 .53 .39 ..31 .90 ..17 .18 Salpingitisandpelviabscess(female) (notgonococeie). ...45 .85 .53 1.18 ..62 1.47 .1.00 .76 Bebugntumorsoftheuterus. .84 .27 .63 .53 1.48 .1.40 .90. .77 .38 Nonpuerperal uterine hemorrhage. .28 .09 .13 .53 .20 ..93 .16 ..10 .04 Leukorrhea. .......06 1.06 ......17 .01 Dysm enorrhea. .56 ..10 .53 ...62 .4 ....10 .03 Cervicitis. .,. .28 .45 .51 3.18 .39 .1.40 1.06 ..27 .43 Endoinetritis. .28 .09 .21 .39 ..93 .49 ..13 .13 Stenosis of cervix. .01. ........07 Prolapsusuteri. ..04 .53 .....07 .04 Lacerations, old or recent, of cervix and perineum ...09 .14 1.06 .10 ...82 ..03 .08 Benign tumors of the female genital organs (except of uterus). ..01 ....16 .. Other diseases of the female genital organs. .28 .54 1.16 6.90 1.48 .2.95 2.04 .1.57 .63 Nonpuerperal diseases of the breast (cancer excepted). ........24 .53 1.38 .16 .24 .20 .13 The puerperal state. Abortion (miscarriage, premature birth, etc.). ..92 4.25 1.28 .2.48 1.80 .1.33 .43 Ectopic gestation. ...04 ....16 ..07 .03 Other accidents of pregnancy. ...35 2.65 1.18 .31 .82 ..43 .09 Puerperalhemorrhage. ...11 ..20 ..47 .16 ...17 .05 Cesareansection. .06 .53 ....08 ..10 .04 Other surgical operations and instrumental delivery.,. ..25 4.25 .20 ..47 .08 ..73. Otheraccidentsoflabor. ....09 .25 1.59 .20 .31 .57 ..37 .14

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TAst 8-A.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931.-Continued. RATs PER 1,000. EMPLOY__S ALL CASES (including employees). OMv. CANAL ZONS. AvANFic Sm. PAcIrnC SMi. Disease. Excluding Excluding .E Of Total Army and Navy. Navy Army and avy. Navy Colon. PanWhite. Black. (era (officers ama. .and and AmerinlisnliAmted ans Others. en).te Aow, Others. enlisted an~smen). cans. men). Puerperals eptiw emi. ......06 ..10 .....13 .05 Purperal albuminuria and oonvutsions. .....28 2.12 .59 ..31 .98 ..37 .08 efllowing childbirth (not otherwise defined) ......01 .....16 ... Puerperal diseases of thebreast. ....08 .53 .30 ,. ..08 ..07 .07 Diaeasem qf the akin and of the celular tissue. Gangrene. .18 .04 .19. ..01 tb Furunole. 1.41 1.36 .39 3.18 .59 1.49 1.09 .33 .67 .40 .08 t Acuteabscees. 7.89 4.16 2.03 7.96 2.95 6.81 4.65 1.80 7.87 2.30 .68 TriAhophytois. 3.88 1.45 .61 2.12 .49 2.05 3.26 .49 2.70 .33 .22 Seabie. .28 .09 .08 ...16 .24 .45 ..07 of thskin. .007 ....22 .. itch. .......... Mrel host. ..................,. ........3 ..,. .19 .16 ..22 .0 oftheskin. .,. .84 .91 .19 .58 .49 .19 .47 .24 .44 .07 .09 talore(Leishmanimeib).,. .28 ..007 .... Imti ontas ...09 .07 1.06 .10 ..31 .08 .22 .03 .03 ........01 ...1 .....08 U. ..28 .18 .08 1.06 .20 .19 .47 ..08 .04 En e a .........28 .Am .0 ..10 .......08' .0 .,. ..1.41 .27 .27 3.72 .69 .74 .47 .16 1.12 .20 .0A 0 r of the skin and annea. ..3.66 .63 .55 3.72 .98 2.79 1.09 .16 3.87 .3 .11 Dimiat of On. bonns and of the organ. of locomotion. C re (no t b ruo s. .............09 .1 ..10 .........ot ....56 .00 .10 .Ji8 .10 .og .31 .24 .22.7.0 ................................-di of the boune (tubernlsaisd ma nanq e.....--.--1 -.70

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OterdseQt fthe organs o ocmon. ..7.89 2.53 1.5 4.25 .98 4.0 4 05 1.22 p.09 .6i3 .26 Malformagion. ptbrcogena1 m ltionm.28 1 7.72 2.65 1.97 .37 .93 1.71 1.12 .80 .24 E~arlin ffanicy. t debility. ..04 .41 ......03 I.tru ofthenewborn.0. 2. .1 8 ..03. Prematurebirth (-1 year only).17 1.59 .20 ..18 .24 ..33 .07 Irn-gry at bjrth(.-3 months only). .12 .53 .10. ...27 .11 Other isesaes peculiar to early infancy. .02. ........07 .01 Old age. Senility.28 .91 .20 1.59 .39 ..78 .33 ..20 .09 8enile dementia. ..1. .....01 External causes. 8ulcide and attempted suicide by solid or liquid poisons (corrosive subSuicide and attempted suicide by corrosive substances. ....01. ...16 ... suicide and attempted suicide by poisonous gas. ....007 ......03 8uleide and attempted euicide by firearns. ....02. ..19. .08 .22 .. Suicide and attempted suicide by cutting or pier4ng inatruments. ..1. .....45 .. Suicide and attempted suicide by~crushing. ...007 .....08 ..Poisoningbyood. .8 .7.01 Poisoningby venomous animals. ..27 06 .53 .10 ...08 .07 .04 Otheracuteaccidentalpoisonings(gaaexcepted). .28 .18 .15 1.59 .10 .,, .16 ..45 .27 .08 Accidental burn conflagrationn excepted). ............84 1.18 .34 1.06 .59 1.12 .16 .49 .90 .37 .11 Accidental absorption of irrespirable, irritating, or poisonous gas. ...007. ...01 Accidentaltraumatimbyfl.earn.s(wound.ofwarexcepted). .8 .19 .1.30 .62. 2.47 .07 .03 Accidental traumatism by cutting or piercing instruments. ......84 2.90 .37 .53 .20 .37. 1.55 .22 .07 .28 Accidentaltrau. atismbyfall .4.79 3.35 1.21 2.65 .69 1.8 2.79 2.53 6.29 .43 .63 Accidentaltrauatism.by machine ..1.54 .17 .20 .16 .41. .20 Accidental traumatism by railroad accidents.27 .04 .....08 .22 ..04 Accidental traumatisi by street car accidents. .007. ..22 .. Accidentaltraumatismbyautomobileaccidenta. 2,25 1.81 .59 .53 .20 .37 1.09. i.06 2.02 .27 .49 Accidental traumatism by airplane and balloon accidents. ..01. ..37 ...--. Accidental traumatism by motorcycle accidents. .09 .02. ....0. ..0 .. Accidental traumatiam by other vehicles. .09 .03. .31 .08 .22 ..01 Accidental traumatism by landslide, other crushing. .28 ,45 .09 .20 .37 .16 .22 .0 Injuriesbyanimals(notpoisoning). .08 ..10 .19 .16 .24 1.12. Gunshotwound of war .....007. ..19 ......---.-. Strvation (deprivation of food or water). .09 .02 .......0 .0. ExceSsiveheat. .01 ....01

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TABUE 8-A.-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1931-Continued. RATES PER 1,000. EmPLOTEPS ALL CASES (including employees). ONLT. CANAL ZONE. ATLANTIC SnE. PACIFIC SM. Armyse Army yCt Disease. Total Excluding and Excluding and City C White. Black. Army and Navy. Navy Army and Navy. Navy Colon. (officers (officers am2. and .and can. Others. enlisted Others, enlisted cnmen). cans. men". Accidental electric shocks. ...09 .02 .1.,. .10 .....03 .01 Homicide and attempted homicide-by firearms ...._ .06 ...56 ...08 .1. 1. .10 .01 Homicide and attempted homicide by cutting or piercing instruments .03 ..19. .22 .07 .01 Homicide and attempted homicide by other means. .09 .007 ....01 Fracture. ..4.22 4,07 1.50 5.31 2.26 8.56 1.55 1.06 3.15 2.43 .18 Dislocation. ..56 ,. ..07 ....56 ..03 .04 Strain ..84 2.81 .44 .9 1.30 .31 .57 2.02 .03 .33 I. 0xplosion. ..56 .18 .03 .....16 ...10 .01 to Otherexternalviolence. .958 13.31 3.10 13.27 4.53 14.51 1.86 2.86 6.75 3.60 1.01 t' Ill-defined diseases. Undiagnosed. ..007 ..10 .... Ill-dened. .1.6 .25 2.65 .30 1.12 1.40 .16 .45 .10 .05 Notspecified or unknown. .28 .18 .03 ..1 ...03 Infection of undetermined origin. 1.41 .63 .32 2.65 .79 .74 1.55 .41 ..33 .05 Fe 'eddisease. .28. ..01 ...10 ...03 Srgcal operation and shock. .007. .......01 Normal phyiological conditions. Normal pregnancy. ..95 4.78 1.28 .1.86 1.80 .1.50 .43 Normal labor. ..28 .5.53 21.24 7.77 .10.91 8.25 .10.77 2.30 Newborn child. --. .5.92 25.49 7.97 .12.72 7.76 .11.60 2.54 No disease (companion, observation, etc.) .14.08 11.14 4.57 38.76 2.56 10.05 16.13 6.20 13.72 1.50 2.53 Medical survey of lead workers (no lead detected). .84 4.16 .38 ..1.97. ..1.17 Total. .327.80 224.97 112.35 501.06 146.46 273.98 261.69 158.72 390.60 96.40 44.64 4 *7

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Taa 9.-CONSOLIDATED HOSPITAL AND COLONY REPORT. Remaining January 1, 1931. Admitted Died. Discharged. Transferred. Remaining Deo. 31, 1931. ClaahificatiQn of patients. White White White White White White White White White White White White American foreign. Black. American foreign. Black. American foreign. Black. Ameican foreign. Black. American foreign. Black. American foreign. Black. OrgS Hotitah: plqyee". .17 7 65 763 275 1,991 16 2 67 745 274 1,883 .1 31 19 5 75 Army and Navy .95 ..2,469 ..10 ..2,441 .18 ..95 Panam anian G ov't. ..4 .2 i9 .4 ....2 19 .. Charity. 10 3 11 191 85 465 6 3 30 189 73 407 1 6 22 5 6 17 All others .40 26 112 1,679 1,085 3,215 17 29 129 1,671 1,053 3,040 2 4 40 29 25 118 Total .162 36 192 5,102 1,447 5,690 49 34 230 5,046 1,400 5,330 21 13 112 148 36 210 Coroal Hospital: Xmployees. .1 15 .14 .8.3. ..1 18 Army and Navy. 6 ...97 ..7. .....6 ...... Panam an Gov't. .87 366 .28 110 .6 24 .18 39 .2 10 89 403 Charity. 1 10 18 2 4 13 ..4 1 2 6 1 2 1 1 10 20 Allothers. 5 20 69 6 7 26 1 1 8 4 6 8 1 1 3 5 19 76 Total. 12 118 468 105 39 163 1 7 44 101 26 56 2 5 14 13 119 517 Cripples. .3 24. .7. ........9 3 22 Chronic, medical and surgicalcases. .6 53 ..56 ...2 11 .1 50 3 47 U1 Colon Hospital: Employees. 6 1 14 169 36 579 3 .22 141 32 452 27 5 105 4 14 Army and Navy 23. .853 5 ..663 ..184 ..24 Charity. I .9 94 41 374 4 1 18 90 39 348 ..8 1 1 9 Allothers. 17 2 40 570 199 1,590 9 7 73 515 176 1,382 54 17 145 9 1 30 Total. 47 3 63 1,686 276 2,543 21 8 113 1,409 247 2,182 265 22 258 38 2 53 Palo Seco Leper Colony: PanamanianGov't. .3 75. .11 ..7 ...1 a1 2 77 Charity. ..21 ..1 .1 ..1 ..20 Total. .3 96 ...12 ..8 .8. ..2 .1 1 2 97 Total by classes: Employees. 23 9 94 932 311 2,584 19 2 97 886 306 2,338 27 6 136 23 6 107 Army and Navy. 124 ..3,419 ..-1. .15 ..3,200 .126 .202 ..1264 Panamanian Gov't. .90 445 3,419 14 ..3,20. .....9. Charity, cripples and chroms. 12 22 136 287 130 916 10 4 54 280 116 773 2 9 90 7 23 135 All others. 62 48 221 2,255 1,291 4,831 27 37 210 2,190 1,235 4,430 57 22 188 43 45 224 Grand total. .221 169 896 6,893 1,762 8,471 71 49 396 6,556 1,675 7,581 288 42 444 199 165 946 Paroled. 2 Eloped.

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126 TABva 10.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHID AND AVERAGE NUMBER N HOSPITAL EACH DAY OF THE VARIOUS CLAS8M OF PA'IENT8, 191. Number of d:ys treatment. Averags umber In hospital o day. Class Of PatientsAmeriAei 044. Foreign. Black. Total. .Foreign. Black. TooL. 0 'Hoptal: S. 10,285 3,581 28,202 42,048 28.18 9.76 77.27 215.20 Army. ..41,835 ..41,835 114.02 .. Navyn.t. .2,560 ..2,50 7.01 .. PanamanianGovernment. .27 890 917 ..07 2.44 2.51 Charity. 3,929 1,634 4,246 9,809 10.76 4.48 11.63 All others. 14,600 9,743 43,538 67,881 40.00 26.69 119.28 18.A Total. 73,209 14,965 70,876 165,050 200.57 41.00 210.02 451.19 Corosal Hospital: Employee. 365 5,756 8,121 .1.00 15.77. Army. 3,082 ..3,082 8.44 ...8.44 Navy. .210 ..210 .58 ..58 Panamanian Government. 31,850 141,090 172,940 .87.26 386.55 473.81 Charity. 576 3,792 6,244 10,612 1.58 10.39 17.11 29.07 All others .2,094 6,898 26,370 35,362 5.74 18.90 72.25 96.85 Total. 5,962 42,905 179,460 228,327 16.33 117.55 491.67 025.55 Cripples. ..1,095 8,405 9,500 .3.00 23.03 26.0 Chronicmedicalandsurgical aues. .1,293 19,090 20,383 .3.54 $2.30 55.84 Colon Hospital: Employees .1,290 238 5,104 6,632 3.53 .65 13.98 13.17 Army ..9,117 ..9,117 24.98 ..24.98 Charity .938 404 3,396 4,738 2.57 1.11 9.3) 12.98 All others .4,519 1,914 14,588 21,021 12.38 5.24 39.97 57.59 Total. 15,864 2,556 23,088 41,508 43.46 7.00 63.26 113.72 Palo Seco Leper Colony: PanamanianGovernment. .706 27,171 27,877 ., 1,93 74.44 .76.38 Canal Zone Government. ..7,070 7,070 .19.37 19.37 Total. .706 34,241 34,947 1.93 93.81 95.75 Total by classes: Employees. 11,575 4,164 39,062 54,801 31.71 11.41 107.02 150.14 Army. 54,034 ...54,034 148.04 ..148,04 Navy. 2,770 ..2,770 7.59 .7.59 Panamanian Government ..32,583 169,151 201,734 .89.27 463.43 552.70 Canal Zone Government, charity, cripples, and chronics. 5,443 8,218 48,451 62,112 14.91 22,52 132.74 170,17 All others. .21,213 18,555 84,496 124,264 58.12 50.84 231.50 340.44 Grand total. 95,035 63,520 341,160 499,715 260.37 174.03 934.68 1,389.08 TABLu 11.-CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPEN8ARIES, 1931. All classes of patients. White. Black. Total. Admissions to hospitals, excluding Corozal farm (cripples and chronic ward). 8,655 8,398 17,051 Admissions of employees to quarters. ..2,741 4,020 0,781 Total admissions to hospitals and quarters .11,396 12,418 =0811 Less number of patients transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. 353 4&1 -834 Net admissions to hospitals and quarters .11,043 11,935 22,978 Employees only. Employees admitted to hospitals ...1,243 2,584 3,827 Employees admitted to quarters. 2,741 4,020 6,761 Total admissions of employees ..3,984 6,004 10,588 Less number transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figure. 58 233 -291 Net admissions of employees. 3,926 6,371 10,297 Annual admission rate per 1,000 employees to hospitals and quarters. 1,056.04 576.77 705.42

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127 TAsbx 12.-REPORT OF DISPENSARIES, 1931. EMPLOYEES TREATED IN QUARTERS. mailing Remaii January 1, Admitted. Died. Discharged. Transferred. December Dbpenarzy. 1931. 31, 1931. WhIt Black. White. Black. White. Black. White. Black. White. Black. White. Black. A wn. .3 7 721 1,327 ..695 1,228 25 97 4 9 B b1. .1 5 1,063 1,061 ..1,060 1,060 ..4 6 ...129 405 ..129 402 ....3 ..174 212 .174 212 ... olon. 10 25 654 1,015 ..661 1,015 ..3 Total.14 37 2,741 4,020 .2,719 3,917 25 97 11 43 Average number treated Days treatment furnished. in quarters per day. SDispensary furnishing treatment, White. Black. Total. White. Black. Total. A .1,793 5,890 7,683 4.91 16.14 21.05 Balboa. 2,544 3,244 5,788 6.97 8.89 15.86 P.Migu. 298 1,694 1,992 .82 4.64 5.48 465 1,097 1,562 1.27 3.00 4.28 0 n. .2,010 8,463 10,473 5.51 23.19 28.69 TotW. 7,110 20,388 27,498 19.48 55.86 75.34 A CAMEB TREATED. Employees. Nonemployees. Total. Dispensary. White. Black. Total. White. Black. Total. White. Black. Total. Ancon. 5,708 19,326 25,034 6,966 18,093 25,059 12,674 37,419 50,093 Balba. 9,478 11,883 21,361 14,436 9,713 24,149 -23,914 21,596 45,510 Pedro Miguel. ..3,278 8,228 11,506 6,433 13,135 19,568 9,711 21,363 31,074 Gatun. ..3,802 7,270 11,072 5,158 8,991 14,149 8,960 16,261 25,221 Colon. 9,127 16,805 25,932 15,782 22,974 38,756 24,909 39,779 64,688 Total. .31,393 63,512 94,905 48,775 72,906121,681 80,168136,418216,586 TVA=L 13.-AVERAGE NUMBER OF DAYS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, EMPLOYEES ONLY, 1931. White. Black. Total. Roppitaka: Go.ga. .3.69 16.94 15.83 olo ..745 8.82 8.46 Average for hospitals ..12.66 15.12 14.32 Ancon. 2.49 4.44 3.75 Balboa. 2.39 3.06 2.73 .dolu ..2.31 41 3.73 Pedro Miguel. .....4.18 37 Gatu .2.67 5.17 4.05 Con. .3.07 8.34 6.28 Average for quarters .2.59 5.07 4.07 MR 31053-Panama Canal--I 17-32-1000 .,

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