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:
1920
Publication Date:
Frequency:
Annual
regular
Language:
English
Physical Description:
v. : ; 20 cm.

Subjects

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

Notes

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

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
This item is a work of the U.S. federal government and not protected by copyright pursuant to 17 U.S.C. §105.
Resource Identifier:
225670417 ( OCLC )
ocn225670417
25402926 ( ALEPH )

Related Items

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

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This item has the following downloads:


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Iemarth Ok ce........

tbal Health Office.


lepitBI....... ... .
[m h ita. .........
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:: ato Tas opital. .....
: P" l.See Leper Asylum....
Berd of Health Laboratory
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:::. i Admisuion rate per 1,000 eml
2 Death rate per 1,000 employ
.. 3 Noneffeotive rateper 1,000 e
S4 Malarial fever--Admisson n
.." 5 Malarial fever-Death rate 1
S... Malarial fever-Death rate
: ." *itieb of Panama and Col
!,ablea:
. : L. Disachars from hospitals, d

~I.: Causes deaths of employee

Canal Zone.. .....
SIV. Deaths of residents of the (
":. by cause, sex, color, age, 4
SIV.-A." Deaths of nonresidents...
.'.. V.. DeSths by nationality or nal
VI. Statiti' re American empl(
:: VII. Birth and birthrates in the
::::. VI Infant mortality rates in the
.". IX. Deatheof infantaby cause, a
S X. Di'harges and deaths in
S*. XI. Consolidated hospital and a
..:-.. .. XII, Cnsolidated dispensary rep
:::.. XIII. Coisolidated admission rejp
:.. ." XIV. Number of employees coanst
.. XV. Aver~A number of days in
r;}" :p1 ... ? ..oye... h p.
:..." .: .. .XVYL. Number days hospital t


ployeus, all causes......
see, all causes.........
mployee.............
ite per 1,000 employees
ner 1,000 employees....
per 1,000 population in
on-Employees and not


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


. .. ..i


the Canal Zone and the
lemployees............


deaths, and noneffective rates for employees.....
B by color, age, andlength of residence on Isthmus.
ith rates of the cities of Panama, Colon, and the

Janal Zone and the cities of Panama and Colon,
and residence. ... .. .. .. .. .... ..


tivity. . .
oyees and their families..
Canal Zone and the cities


of .Pa and Colon. .
ofPanama and Colon.


Canal Zone and the cities of Panama
rex, color, age, and place of residence.
the hospitals of The Panama Canal.
sylum report. ... ....... ...

rt. . . ... .. .. .
intly aick in hospitals and quarters...
Hospital or quarters for each admina

mtment furnished various classes of pa


and Colon






ion of sick


ktients.


Page.
1
6
7
10
13
23
26
27
33
38
40
41
43
44

63
64
65
66
67

68

69
70

72

74
84
88
89
90
91

94
110
112
113
113

114
114


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LETTER


OF TRANSMITTAL.


THE


PANAMA


CANAL,


HEALTH


DEPARTMENT,


BALBOA


HEIGHTS,


March


1921.


ht;
h..



V.


Col..jA J. MORROW,
Governor, The Panama Canal,


Balboa


SSR: I have the honor to submit the following report of the opera-
tions of the health department for the year 1920.


Respectfully,


FISHER,


Chief


Health Officer.


Heights, Canal Zone.


'




















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

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* II. -
.. TDi

. .. ..
-;;::' *** th::
;:, ../-


Col. H. C."Fisher, U. S. Army, Chief Health Officer.
Dr D. P: Curry, Assistant Chief Health Officer.
, :*


DIVISION OF 'HOSPITALS AND CHARITIES.


-A ncon


a


Dr.
Dr.


.L.
T.
W.
R.

A.
T.
L.


I


Hess, U.
Earhart,
Hubbarc
Connor,
'. Braithw
Ryan, Cl
Odineal,
Townsen(


Hospital.


S. Army, Superintende
Chief of Surgical' Clinic
d, Assistant Chief of Sur
Chief of Medical Clinic.
raite, Assistant Chief of
lief of Eye and Ear Clin
Assistant Chief of Eye
. Chief of X-rav Clinic.


- -J


nt.

gical Cli

Medical
iLC.


inic.

Clinic.


and Ear Clinic.


Physicians.


Dr.
Dr.
Dr.
Dr.


George Eugene.
H. G. Hambleton.
L. S. Chapman.
M.A. V. Smith.


D. L. Hollis.


c.
H.
P.
Jar


D. Briscoe.
K. Tuttle.
G. Pomero'


nes


B urrow.


- Internes.


Dr. H, S. Liggett.
SDr. F. E. Hyde.
Dr. R. L. Ross.


Board of


Dr. J. G. Stoelzle.
Dr. H. G. Campbell.


Health Laboratory.


---. r
.
---


Dr. L.
.. xDr H.


B. Bates, Chief of Laboratory,
C. Clark. Pathologist.


V.


-- m'l-


------_-:~r


-n




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S..Panama Halth. Office.


..s.
.1.
1Hjkk?,i

I:*
.ti:.....:.








0r:
i.,

SI'
.1

h.


Dr.
Dr.


Dr i
flr.H


Henry. Goidthwaite,


Carpprow, Sanitary Inspector/
Pieree, Sanitary Inspector.
Anderson, Sanitary Inspector.
, Searcy, Sanitary Inspector.
Quinby, Building Inspector.
.Lewis, Vaccinator.
. T. Eisenman, Veterinarian an
SL. Casey, Veterinarian and M


Byrd, Health


C.H. Bath, Sanitary Inspector.

Tb A. Leathley, Sanitary Inspector.
M, M. Seeley, Sanitary Inspector.
SE. K. Turner, Sanitary Inspector.
Geo. Campbell, Sanitary Inspector.
.W. S. Chidester, Sanitary Inspector.


Emil Becker, Sanitary Insl
Dr. I. C. Mattatall, Super
Dr. W. F. Gross, Veterinai
Dr. F. F. Dowd, Veterinar
Can

E. F. Quimby, Sanitary I
I. W. Pickett, Sanitary In,
Geo. L,. Willett, Sanitary
5I John P, Corrigan, Sanitary
E J. L. Tolar, Sanitary Inspec

I DIVISI

i. Chie


Surgeon C. Rucker, I.
*
". Cristabal-Coo
B....:. n r .
i~i


pector.
vising Vet
rian and
:ian and Mi


Hlpz rns


Health


Officer.


d Meat Inspector.
[eat Inspector.


Officer.




t


:erinarnan and I
Meat Inspector.
IA n 4 1n I n tr


LaQ L .1 Ri A L's e


' r.


Inspector.


al Zone Sanitation.
inspector, Gatun District.
spector, Pedro Miguel District.
Inspector, Ancon-Corozal District.
r Inspector, Balboa District.
:tor (Relief).

[ON OF QUARANTINE.

f Quarantine Office.
Balboa Heights.


Chief


Quarantine Of


licer.


On11r2 nwi ne Oflfiwrsr


H.1
1K?:l
A).:
H.~


Health Office.


Pn Quarantine, Cristobal, C. Z.


Colon


Meat


























r.i


t. -n.I


T.. :..


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







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of. 9
.L ..... 0


S.rate to -hospitals anddeath rate from disease, for
:were .267.06, and 3.63 respectively, as compared
I..-1 for black employees.
n:rate to hospitals a -id quarters for malaria was 20.05
iyees, as compared with 19.21 for black employees.


rate from disease for Americans was 3.32,
9: 1t9, 19and 3.;38 in 1918.


CANAL


as compared


ZONE.


EMPLOYEES AND NONEMPLOYEES.


roma an average population of 27,469 in the Can
a total of 242 deaths during the year. Of these, 2
ra disease, giving a rate of 7.68 as compared with
:969 for 191$.


tuberculosis was


and


1.02


1.84 for-'1918.


al
11


Zone


there


deaths were


7.81


1919


, as compared with 0.83
Tuberculosis caused 13


cett of alldeaths from disease during the year.
here were 631 live births reported during the year
-of 22.98. (See Table VII.) Of these 231 were


e black.
deaths
led 60,


(


M the otal births reported,


Irst.1 V


I1


5 per cent were


among cmmren, unaer i year ot age,
of which 8 were white, and 52 black;


from


, giving a birth
white, and 400


stillbirths.


causes,


giving an infant


tality rate, based on the number of births reported for the year,
4.36 for white, and 130 for black children, with a general average
5:09 per 1,000 births. "
if the total deaths, 25 per cent occurred among children under 1
r of age, and 38 per cent among children under 5 years of age.
lelow is a table showing the death rates for the Canal Zone


from 1905 to 1920, inclusive, from all causes among both employees


I" : ; I1
V.. :, -
q J !E :. .: ," P.p u l a r .
H. .. Y.


*..." .. .. 234 3 828,
I .. -. I .. '
"-H..:K.jA. .E. S... .-. 1 2 8
'. 19B.....i... 3.096 1.70
.. ..- 67, 1 1,273
/.... ...;.. .; 'm. 1 02


Rate
per
1,000.


1913.
1914.
1918;.
1916.
1917.


. .. .. .
* E


Popula-
tioan.


Deaths.


Rate
per
1 ,ao.


'.. .' .. -'


'he death rate from
the'preceding year


Year.


~I


l




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u~i~..i.~ -,I:!. ~ ainP*EB
......r.H
*H* ace.
SI.


I H
itt. -I
*., (seat.L


H .I.LE ..: .
p.: .
:1: ';
H. H..ltb Fe


.itiR Qnaluding colitis)..

.a : chro.). ... ..... .
r ,Bd broa.ho)..........
thwartt ............


I'U......


S. .
...-.'.


4
. U 1 U U


Sratse from tuberculosis was 4.18,
diang year, and 4.45 for 1918." O
erculosis caused 21 per cent.


1920.


as compared with 3.87
f the total deaths from


:.There were 962 live births reported during the year, giving a birth
ate qf 38.& Of the total births reported, 5 per cent were stillbirths.
Thee were 137 deaths among children under 1 year of age, giving
an infant mortality'rate, based on the number of births reported dur-
g.. the year, of 142.41.
OTf the total deaths, 25 per cent occurred among children under
Sar of, age, and 35 per cent among children'under 5 years of age.
..' Below is a table showing the death rate in Colon from 1905 to 1920,
Sicimsiy t, froix all causes among both employees and nonemployees:


fl ~.r fl7
A


Year.


.w..* ^
a- ---
Slt).
urn-r


. .
*...* a


*. .... .
*,J *. .*.


Fopula-
'ion.


11,
13,

15,
17,
19,
S20,


-Deaths.


5.53
703
571
41i
394
514
527
493


Rate
per
1.000.


Year.


1913-.
1914..
1915..
1916..
1917..
19Ls..
1919..
1920..


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


II. .


. .* a. a


Popula-
tion.


20,
23,
29,
24,
I- 25,
26,
26,
26.


Deaths.


489
590
640
696
667
8616
573
554


Rate
per
1,000.


: 1 GEN

SX x.ala.ie --The number
,"Rartf s&.hows a gratifying
...... .. "I.PATT STATEMENT OF
::. "" "" ... DURING THE
, .. ::. .
,, i,,:,,'
: : :


ERAL


REMARKS.


of admissions for malaria to hospitals and
g decrease from that of the previous year.
TOTAL NUMBER OF MALARIA CASES REPORTED
CALENDAR YEARS 1919 AND 1920.


Employees.


Nonomployees.


,Total.


canA I *crnn na ,-aaa


1..~"'~Y
(Y11


inrn


rAnh


1II~A


rA, a


rnrrr




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,.N..Hi


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1... ....
.... ...
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? .: *"< n
a?^4" -a: J
::...: :H. h. -: u
* I .. ...H. I .. $
C. ll, ......^ :- ", ... l



IH ... ".
S ,,......., 4 ... j
I .:*fr .^.. ... ..S


.... .... .. M n -l
*. .. 1 "I::".E." h ---
: X..% = 1 .." .. :
r I- -.. ...&


'1ti previous year). was blocked, and the river
"" shallow, -widespread, meandering- stream.
discharging into the stream were choked with silt,
Sinorp1hous xnateriM completely filled the rock and tile
t iot of P araisohill, necessitating its removal.
undone, in' a few weeks, practically all of the excellent
u .... e. in' a. the
t previousyear in this area by the district sanitary inspec-
iiw "ing thewithdrawal of the hydraulic dredge, the Dredging
frnilhed, the sanitary inspector a gang of men who cleaned
o the ditches and did what was possible to restore the
,system, but without being. able .to restore its former
v.Wnor will it be practicable to do so if, as seems likely, this


t:. a.bto oi e used again as a dumping ground for spoil from the Canal.
z'*dei present conditions, only temporary expedients and costly
!': a::nce can be attempted. The Chief Hydrographer has
? l e plan for raising this arm of Miraflores Lake to the height
..of. tun LIke (from 54 to 85 feet, approximately), thus giving the
:.. f't an increase of depth of over 30 feet, and a considerably larger
S.eae .While this has been proposed mainly because of its effect on
l .: the iater supply of Gatun Lake and the surges in the cut affecting
shipping, it would greatly benefit the sanitation of Pedro Miguel,
Stkhroiugh the conversion ,of a large, wet area into a deep lake with
fa. ly clean, steep banks.
In the. Ancon-Corozal. district nearly 10,000 feet of permanent
S forctcovered and open concrete ditches were constructed. The
latter type of construction-that of the open half-round, sectional,
Dotwrete ditch bottom, as described in the report for 1918, of which
S.sev.ral thousand feet have been installed, has not been found as
sa.t.sactory as was at first hoped. In the jungle, where there are
many large deciduous trees casting their foliage, these drains easily
:, a.,f frequently b..ecorme blocked, allowing the formation of many
: small collections of water, and requiring to be cleaned frequently.
S. though. more easily swept and maintained than open earthen
, --it : the constant care necessary to prevent breeding during
H:t' t: slight precipitation makes them a constant source of danger
ew.:. e nse; therefore most of the ditches qf this type are being
:::.. sn. by sectional cast covers and broken rock. In future con-
rction practically all permanent work will be done with 6. or
4'* cnrete -tilemade ky this department, and covered with
..a a..stone.. O(n in the Mount. Hope district, where there are
,*tiea 3 u, ioat. alu marshes, and where there is a scarcity of
:... .. .. ...... ..,. ., .. .. .. ,4** IY




















.l:, : .: ::7":' '. '

. .. *g ...... -.
M,,, ... .. X .. t
.. :.: ( ..: : : .
.. *: : *: : **, : -: h: *
S:; ,. :" : .-*. .. ::.:*.::y 5 a

g y .. .p '9 :.*

.' .'... .. .. *
i.'p ",..... a .



... F the c.nsro1 of mor
ttifis fbhat, as part of
aits purpose, drains and


.* i .


1920.


1.12
47.38


1919.


2.43
54.37
1


iglas


66.037


squito breeding the Army sanitary inspector
the permanent work with the allotment for
fills were made by him as follows:


-r


,
.. ^i


S~tatiou.


i. *;
*0E


. eraif...
.. 1 F~ChemT.. '.:.
..Porm .platon.-
r'uusat
PM%9!El*DUI.B


. .


. i .


. I.


. .


S..,. *
. 1fto...


.I I:


- .

..* -

* I i*


'Dit
drahm.


,295
135
,200
,000
,223
,734
.436


62.203


Concrete
drains.


Feet.
1,902


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


1.902


Rock and tile.


6" tile.


Feet.
2,095
428


2


I I..I.. .. .
I I I I I I I I


8' tile.


Feet.
.. .. .. ..


. 575


5.314


Fills.


Cu. yd.
665
200


1,350
* i i Sl i *


3.21


flp id finer-There were 36 cases of typhoid fever, of whom 9
di. Five employees, 11 none'mployee residents of the Isthmus,


am 9 .:.nonresidents had the disease. Of these,;

I n:-; .. ..iloyee (black), and 5 nonresidents (4
"."..e fiottaSidents were all ill upon arrival on sl
t ti| necd upon the Isthmus. The cases dev
i. ,except for 4 cases in one family from a
...y. ne r Patanal City. No other cases
l. i ty after the discaoery of.the infection.
.! k *.. .

.. H" .....l case w af fully investigated a
*ate minamined bacilli, resulting
MIt i. ,rf.lft.... 1ftf east in the Army an
**:: a ** .
:gh .. .. .*: ,* *. i I .... .. ..


3 employees (black),
)lack, 1 white) died.
lips and did not be-
reloping locally were
L small pueblo in the
developed in that


s to its origin; com-
g in the discovery d
d the other a patieAt




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H, ,, ,
"1.!


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..iii


a |"':! i :." '
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:,, :,, ::
l:"" .*
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,:" '","
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111



. .. :
,,* irt
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.:11
.......
. .ii" .

,e *..r
......... '/


Ki"


.14 l.
1k .4'W
'.-...-


1.ae~


h ithe laboratory, to which all rats, alive or
NtiZ W decomposed) are sent for examination. No
itiata kave been found...
.oSltil, .barium carboyiate has proved most effective.
jf p:treprig thepoisoned baits' were tried, in addition
e riethodes of nixing with meal, flour, or chopped fresh
a dd.cnmiemsary storehouse, the powder sprinkled on a
mie caused the death of 24 rats in one night. The health


:.iSl .':C'ir~.. orts the best results, as well'as facility in handling
Vbifom mnxitng the barium carbonate in proper proportions
Srit baking as a loaf of bread. Split cucumbers, with the
#nie prinekld inside, also proved alluring to the rodent appetite.
*l'. Isattenipted to catch rats by means of a viscous, slow-
Siititshs-spread on baited metal plates, hoping thereby to
" tci aot::only fthe rats, but their fleas as they left the dead bodies.
ethEdproved more efficacious in catching mice, as the rats
wet neraly too wary to become entangled in the varnish. It was
"hown, however that once a rat stepped upon the plate his death
l certain. .
iAfsgeg disposal.-The new incinerator at Colon was completed
Stently to place it ...in-operation in September.
S.'At this inciner tor is destroyed all the garbage of the cities of Colon
Sad Cristobal. Previously the garbage had been burned in the open
o. di mps, and later, dn a temporary, unsheltered, rail incinerator.
.During the rainy season especially .it was very difficult to destroy the
: .grbtage by these methods; flies were bred abundantly and numbers
of rats were attracted and fed. Following the. beginning of opera-
Stiens by the new incinerator the fly infection of the two cities was
k tably decreased and now the district is as comparatively free


S., u: eas Cab be expected.
Wh :incinerator on Gavilan Island, destroying garbage from

S* ia ima Ancon, .Balboa, Amador, and other places at the Pacific
"jiinaif the Canal, was closed for repairs in December, necessi-
I:^ titig,:i"r. "e" time being at least, other methods of handling the.
S.* The Health Officer of Panama undertook to dispose of this
!"' iEothe: dump near the beach just outside the city. Each
".. 'et.. ..tiqn wastbrciight out in the morning, beginning very
: Evey liad as. it arrived and was dumped as thoroughl
wMithWa solution of larvacide (crude phenol, lye, resin soap
t iest r adult files and as iany larve as possible. After
S...:. A .rnnntn-in .Eli. it O the arh"a w"a o r


... :.












i...
.' S .... : .'. ... M en." "
] :i *..l:'' .4 "
S L::....* .::. ,* ;*..., .. ..* *. *
-* ** X *** 4 I ** ** i *q I
.p. ..uaetlir ... ..e..... ...... .... -.. .... 37 r

.. .: s. N ** S..* .... .. *. .:. .*
..: :I:-- ..i .... ... .. ...* .. *. .. :.*



... ........ ..... .. .. .... "....... 340

.a ...st Niivy e positive, 261 negative, 26 doubtful,

to he .i nfecte, this figure is conservative and

e. It is also ralized that of the 60 apparently cure
*iiambetnay remain infectious, because of the known d
tEn ** ....






#nd also from the fact that the women usually take a chemical
Wire :coming. to the clinic for examination. Three success.
ti~ smears are, required before the case is discharged.
Average number of visits of inffected ien to the clinic
Staio bthat butinittle benefit could be expected from the a tr
Given Not a man ever completed the course of ant isyphilit
si ent ... The. chief progress was achieved, with syphilitic
tist of whom, being compelled to come xto the clinic.
m ; ha .... ,. could b.


sufficient treatment t
leat.,
The Panama venere,
Tomas Hospital has
Spysician and two nl
became necessary to a
average of 30 or 40 p
1. iOa dayi menr and T
The fee for service


Women.

364
256
60


r cent of
probablyy
ed as a
d" cases
difficulty
ications,
I douche
ve nega-

c was so
eatment
ic treat-
women,
received


3 render them noninfectious for the present at


al cliic.-The
been especially


work of this
valuable.


clinic
At first


urses were employed, but as the w(
Add a second physician to the staff.
patients daily, the number, has grove
women coming on separate days.
in the clinic is 10 cents for each


ar

vn


at .Santo
but one
k grew it
From an
to over


applicant


,.. .gitered. .This purchases an admission ticket vhich thereafter
Sentitles the holder to entrance to the clinic. Drugs or prescriptions
.to: be taken to the patient's home are sold at actual cost and patients
thtT are absolutely unable to .pay are given free medicine. No
ihar is. made for medicines or dressings used in the clinic. For
x-i We~nrmn teststhe fee is $2 when the'patient is able to pay, but it
;a E isS"fen without charge to the poorer patients. Salvarsan is sold at
i. !~t prices; to patients who are well able to pay, $5 per dose
.. W idv patients unable .to pay full price,... but capable of con-


P'' ""' ~';" "~-~ "~ ~ ~" u- ---~-----~~-


- ..-. ------




I~












.ta. yeTereal disease is of little coi
- fi fsble at the present time to c
ac plis more than.a limited amoi
.. thMhoped'o for no is to spread
a 'as possible and to attempt to, educ
lHweit 'a litt le later, laws. may be enacti
: .... 7 H. S th aboition of commercial prostitution.
|....s a.well asithe popuilace are against any a
I-.en' tly it would be futile even to think


sequence, that it is
irry on a campaign
unt of good results.
1 as much favorable
:ate the people to a
ed which will bring
At present the law-
ttempt at abolition;


of ac


S d- the present government. However, by cai
:a onal work in a vigorous manner for a few yean
uniltmiiately. be possible to secure the passage
.... teliminaterecognized prostitution from the city
: tnin m the incidence of venereal disease.
i; : Fem.aot of school children.-The annual physic
"1 4: f sbh It children of the Canal Zone was made, start
7 : The results for the white children were as follows:
j.: ; nne of childreBn. i.............. i .... [ i .. ............

". .. .er fouiu. needing treatment ...
:. .:hm er with,.defetive teeth aaonly defect............................
f. ,..i ib' with defects other than teeth only.............. .. .. ....
,::.- .D ef e.s found ... \ . ... ....................... .........
,u* r I .
."" ......:... = s.. .... .. ........ .... .. ....

a

SNl i.. ... .... .
".. h pe d. e o d e S *. ..... . . -
S i. . .



.... ..
:-' -The parents were notified in each case when defect
advised as'to proper treatment either by the district
anama..Canal. hospital, or by a dentist. Of the to'
fiund, biate.221 were reported .as having been treated.
i epted as an accurate figure, however, as treatment
S ly-given in may cases, but not reported to the dis
made the original, physical examination. No r
So the di tsfound in the colored children, but pro
Stiyt tihe.t itn of examination by ethe district physi
|...=. .... or byadnit.OYh o


complishing it
rrying on the
s, it is felt that
of laws which
and limit to a

al examination
ng in October.


was found
physician
tal 935
rhis can
was un'


id,


860
398
462
935
519
143
12
33
167
4

11
3
10
28
193
and


n, in a
defects
not be
doubt-


strict physician
record was kept
per advice was
cian.




















e .:.., andit is a constant fght. u .
id. a iries.-The' milk situation continues to improve.
.e'!....or iss flexible standard of 300,000 bacteria per cubic centi-
,.. rtr raw milk has been set by this office, and the present bacterial
!." hows many samples having considerably less than 100,000
.. ..b ...cic centi meer, With the passage of time, the dairy
i: "':'y them, It is but a repetition of the history of all cities
I w ere supervision of the milk supply has been attempted. Possibly
rI... hav had less trouble than in any place in the United States
Sof sdiilar sie,flnainly for the reason that the orders from this office
.re mandatory, and there is practically no appeal therefrom./
: ei. eceia Central," or central plant to which all milk'from
te various dairies is sent, was opened for servicee in January, 1920,
i.. which time no milk has been sold in the city except that which
mis.pasteurized at this plant. The lecheria is owned and operated by
the ..dairymen's association. A limited quantity of clean, fresh butter
'is also produced by the plant. As soon as an adequate supply of
bottles of the standard size (1/5 gallon) -can be secured it will be
,: eired that all mil-ka be also bottled at the plant and that no loose
r: $ibe sold.
F'ines.-There were 1,425 fines imposed for violation of sanitary
Sregslations.and $2,684.50 collected as a result thereof.
.' O .iarge disposal.-A t the time this report is written we are burying
:I Iarge froznthe City of Panama and the terminus of the Canal,
owi .g th thinecessity for extensive repairs on the Gavilan Island
;. ieirator. his method of disposal is' being done at an approximate
0 of $ 1,2.65 per month for the total work, as against a 3-year
|^ S4 1064 per month for incineration of the garbage from
.1b Ct Panama alone.
'll Ysenteasesu.-During the year 395 cases of syphilis were
ap' t.prt4s to 1 this ffice and 1,111 cases of gonorrhoea; 'this. by rio
........r dsents.the A.ctual total, as it is almost an' impossibility
-.:: :-!d!" .., 'H'he,. City o Panama th. trn oh














S fl... bi-ds oii ':during the entire year.
[. ik$ h ugh. .y with the other ingredients
S*.:sd.nme, baked itt the ordinary loaf was found
at...' ethod of usrng this p ison.

Sre r rk for private ,parties in Colon.
.... .such w oWrk during 920
.. .... ": ..... .'. .*. : 4, -. *

... *...*..:- *. .....', ...,
.: ..G. .. : *. .I...*.. ...'."* i..t .: *'.. .w. .. .. .. .. *-***
... .. mortem nspe tion:

ir ..
SS ... .. *
.
.. *.kis.. a ttb. .. ..... S........

S.. :: .. ....... ................... .............. .--
". a. "::" .. -- .. I.... *
S't
!i. ." S S ". ". '
S' P" ..f.ri L'.
. .. '.*. -' ...- S ^ l -. i S .%. -
.... a.. *.. ..... i. .... ..*.. .. . .
.." .. .. .A r :." m mm.m a m m amm gim m o n m u a m m ..
: .f. .. :* . . ........
... tS .
t n f 25 f l d 10 II nl r


"t" .l L IJJcUL1LUIi UI Ul L.3 I tIL L U1 LdSLLIC: dllU 1'
S..per head is made against-the Colon abattoir. The col
- work since this charge was authorized (August 10, 1
StI98205.a ..
* ;:: Jood inspection.-.During the.past 2 months one sal
'"Ws assigned to food inspection only. The results
gratifying as shown by the improvement in the gen


Barium
of bakers'
to be the


aborers to
e collected


29,159
..... 10,876
.... 30,771
..... t10,731
..... 35


150
1,200

162
354


1,350

516


ifrc hnri nn


elections for this
920) amounted


unitary inspector


haw
eral
C


Been very
cleanliness


..... nd amnary conditi.on.o bakeries, dairies, ice cream parlors, restau-
:..,i~ kts, ..hotels, messes,. etc. The following establishments are now
:. r' receiving regular and systematic inspection by the food inspector:
: ::0 h ot0ts, 37, restaurants, 3 messes,. 18 bakeries, 5 bottling works, 8
.:. .Iarsk'ets, 48 vendors, 14 ice cream parlors and soft drink stands,' 6

SMaiudt.H.n iope district.--As conditions warrant, antimalarial work
..Mount. ope district has been gradually extended; 30,242 linear
A""!: asf .qpen drains were installed during the year. The installation
Sve ry. narow drains in low swampy areas is being tried out exten-
: .il y. in this district and they have proved very satisfactory.
Hi T.:..,he antimalarial work in the'district has been effective this year,
I::. shown by the low malarial rate compared to former years.
tl."ontemptplat-d to install an extensive system of tile drains
.. ,. t lllaIt the dnistfrint dilrinro the nPxt drv pnesnn in nrder to reduce




I~




































policy :o the quarantine service.
p free of quarantinable disease, and
is -of bringing this about for their o
aim of quarantine should be the al
ourselves in against outside danger


.... .
.i .
. *
1*
: ... .. .
:. *.
i .. .
S* .. .



:I *.
.i.... ..

H




". .
." '
C'*
.:' "'

in:" ..i ... -;'
i. i.
rj' .
e ,
.., .. *.


I


".: .u imat; tour of inspection was made of the western ports of South
J Sret. The following quotations from 'Doctor Grubbs' report
idca the results accomplished:
* : .


. N tisns are attached hereto in the form of notes on the ports visited,
:i$ditin, aa trip was made' to Quito to express to the President of Ecuador and
ath.r efc4a. the interest and appreciation felt for the radical manner in which
ys fer rehas. been eliminated 'from Guayaquil, to assure them that we are
ti tte protdptly recogn such work by modifying our quarantine procedure
at4Lt agebt that similar steps be taken against bubonic plague.
-, i~n a similnecal was made, at the suggestion of the American Ambassador,
Sitheraamnt to express our interest in the extensive sanitary campaign he
BiUtSi u ed tin Paern and especially in the efficient work now being done in the
'imnce of Piura.


i4

Uid


:thee: js no yellow fever at Guayatiuil, and the city is probably noninfectable
, it is evident that the quarantine against persons from that port should
azy" "reioded so l.onglas such conditions are maintained. This action will be
mCest possible incentive to. have the present conditions maintained. As
im po..r. of Ecuador were always infected from Guayaquil, their quarantine
similarlyy be tdt. d The fumigation of all freight from Paita should be stopped
tir .. t ba all lighters at that port fumigated whenever used for
S.oiur ships, and for the fumigation of all dried hides, which are the only
ft.l.atf carryy .ate. As Paits is'frg from yellow fever and from etegomyia
to sal thesquarantine officers, in their discretion, to count such
e... have biet setit i t Pait or Talara as against the quarantine period of


..*,i I ~v:I *;,


i


I~ I*


.:..:














ICI'::<:s
r ,,
!.Hl5 ..:A
X' J ..": .


Hr:
'........., "... "

........"" *


ire
4.
H:..:i ,..":...
i:,: : ., .
... C' !
;:'i. ,.: :.::.
E*x" :x "..:*H

.:.:Lx...................
..i ':" :; :
.::..:* > '

ss. J.
,,,K, ,":{A *


,, ,,J ,, *_*
,,.H '"t '*




*a; *' "r1


C::n .
.4


Ii~
Ho'3


a :-,e pi nswuDai was aerauea to maKe an
... .Mand Tumaco, Colombia, with a view to
quarantine restrictions should be enforced
ie fdtdwing excerpts from that officer's report


a: The rainfall is about' 400 incites annually and is well dis-
lout the year.' The tide enters the lower levels of the town, and
Iis ani qpotantsfactor in keeping the town in a habitable condition.
E-butdidraot encounterr any mosquitoes. The water containers are
IThis I the port for Call, Manizales, and other places. In my
ia, bee nao yellow :fever here since 1915 and then the infection was
hcetd from Guayaquil.


-. Its. itBaiinended:' .
..:. i atthe qiuarantine be lifted, provided that within 3 montl
mrirLte campaign be underway.
-a 2 Tat the COlombian- Government finance this campaign and
biatfu;of the gm-ernment direct the work.
:.~3, Itr. suggested that in carrying out the work,. the sanitary
cooperation Sad assistance of Mr. Walsh, the American Consul.
'4. That'-Qur attitude at the end of 3 months depend on the
th:e:. ove .e.omuendations are carried out, as shown by reports
:aWthdr oinplince with suggestions offered by him.
Ti'uemacs: This towns 537 milesfrom Balboa and issitgiated in


hs an active anti-

that the sanitary

officer secure the

manner in which
from Mr. Walsh,


the southwestern


' oaoriertf Colombia. It has a population of 6,000 and is located on an island which
- is about $ feet above sea level. The soil is sandy and no water remains after the
wins, except that collected in screened tanks and barrels. The sanitary conditions
are the best I have seen in any of the smaller towns of Latin America. There is no
trace of quarantinable disease having occurred here for at least 15 years. It is
earnetly recommended that the quarantine be lifted at once.


...Following the
.wreisnMed"


receipt


this


report


following


instructions


H "' the Quarantine Officers, Cristobal and Balboa:
.. The 6-day detention period for passengers in
ippg required.
2 The 6-day, detention period for passengers in
.... is prisionally lifted.


good health from Tumaco is no

good health from Buenaventura


S: D u.ing .the year the general quarantine instructions have been
entirely revised afd amendments relative to night quarantine service
: have been. prodmulgated. On February 5, 1920, the quarantine regu-
i:: tatdons were extended to include influenza and similar diseases as
ma ritime quarantinable diseases.

S The: following instructions relative to vaccination have been
.. ... -olowed throughout the year:
.:. -:Tb ~uarntinte Offcers: In order to facilitate travel aqd to avoid unnecessary
:...'.... w a ation of passengers Who are amply protected against smallpox, quarantine
e a.inthorized -to issue a certificate of vaccination which will be good for 5
;.. :, : erthey have vacciated an individual and have personally observed either




















Lu%.H:.n
...............;' H *..

Hp.:. A. H' .
......... Hj;'.. H. *


'iA : V
H.
""' i bH.


1Ir2.. *


:vea swere.ltheld in quarantine...
,rni iectis of vuT s.. .. ... ..


* *. *. .i ..
* *.-. b .


, C ... ... .. .. .. .. .. .. .. .. .
S s. .. Cd .


Na n...... ... ..
SO, and Na Cn........


2,363

6
1,575

18
7
6
49
2
25


... .. .. .. .. .. .. 118,136
S. . . . 43,657
. .. . . 43,618
. . .. . . 10.814


a '1!otm11 a
o a... . .. .. ..* .. *


216,225


:.: apl:..ary inspections of persons on detained vessels.
P.. esna ataiued in quarantine aption...................
Snibeof day held...............................


* ..- .


* . .


4,612
1,725
3.452


I. mletgrotin.--The inspection of
previous years.
.-


ANCON


immigrants has continued as in


HOSPITAL.


(Col. L.


HESS,


S. Army, Superintendent.)


1w4.,V.

II!:'~t


1..:..::,


i:i:? P1 :X
II..


;' --p


IHH: -E..


Buildings and grounds.-A 2-story addition was built to the power-
last building; on the ground floor is the new carpenter shop,


*..". mm $ "
d., ttich
sidter,
--M


. .. .


as large as the former one.


and


on the secoi


nd floor are


the


shop and miscellaneous stores of the electrician, carpenter,
and plumber. Following the change, the hospital bakery
dsferred from the kitchen-mess hall building into the portion
*e-tplant building formerly used as plumbing and carpenter
d tbeh &ner bakeshop was occupied by the general me-


m.


department


$IE .. *d- A.m a a we


* U* 4 tn. ni- n ..


S.. -.. U

impe td on oiml. ......,.............
ea opted on-arrival.................
paged on ertifitate of medical officer......
aem pae ed on ertifoate of medical officer.


it:


wiok as *si and storeroo
Storage a receiving.rom


undertaker's


4 SW- -c -


ri~l'~ll rrr


Iiillriirli


IrE1Se:


a


I


. .




I~















*. .."* y i ^ S&: 4 m:* ea/>'^ *'
.. :, I ,*. *"* ,. *.. ,,
il; Ir taii ..! *, : *. ** : : :
S**I .* *
i.:. .. .: .. .
.1 .5A, ,* .. *..*..* *.* .*
.1 *E .* .* I
.: h > "i." ** :* .. *.




a- I '
H I:I ..*::. :* .


.. :.: : ....* ** :.. *. .
*...: i,. ...*.*.6_. .: .. I *. m .... a s .
*. .. n.. ...r : r e .
... .. :F .

.. .. .. .. .: ..... .
* p .. 4| ., .. .

:..O -...... ... .

%* H*** ," ,*,



": .. "" .. MO* grOFT

. ". ... *.** *
.
.. F .. .. .. .. .. .. .


. .


* "L .



1920..


.Toital number.treated.
* ... _


Coroat
Hospital.


Total.


350
581
939
1.304


.-874.
510
`"883
hri; 25~O


a PATIENT PER DAY


.
J *
, **


* Ir
** *4* *5.. U.. U *


*U..C... *. r.
* ** *. ***


U/au. U





* .
* U Um* *


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


S. .
* U U


CON HOSPITAL ONLY).

.. ... ....... *0.463
.... .... ..: .. .3495
. .............. .315

...... ..... .. .2522
.... ... .. .2372
............. .. 253


ENTS, NONRESIDENTS OF CANAL ZONE.


Died.


Ancon
Hospital.


7
- 9
19
16


Corozal
Hospital


- .. I.

.1~ *~* F I .1


* J


,* ...1
I:, Chronic patients
." aToa .mber

:.. Avr ge num



^: "2 p m.bu
I:.. .*. .. kA:e n-
r.. -dA -w n !
S'uumZrlrs
.~l t tPa


Oito~


:IIIasr2t*


treated.. ... .. ...
of days treatment.......
lr of patients per day....


ta coat. ..... .
r patients:
adlumiozil.....
days& relief....
constantly sick.


l


1920.


833
S. '9,626
. .26
. $0.315


. ...... 860
.. 15,134
.... 41.35


9,783
170
7
12


S9.972


Total.


1919.


34
9,710
27
50.2654

1,392
22,217
60.90

10,503
151
8
17


10.679


Days treated.


Aneon
Hospital.


5,101
7,667
15,434
24.418


191'5.


38
8,603
26
$0.2602

4,165
49,067
134.49

12,153
229
13
39


12.436


Corozal
Hospital.


21,396
20,431
17,245
15.979


1917.


63
9,836
27
50.2520

2,469
33,494
91.76

10,880
191
45
54

11,170


Total.


26,497
28,089
31,779
40,397


1916.


52.
9,174
2*5
30.2400'

1,937
28,519'
78.13.

911.
*225-
26.
59-


9,426-


a. ........ *U**** .i.
.'. U.{ U *
*.

*... U U
*a
11111(

man*
hI


I


I













YE.!I


i '
ffnf


Sno,: smutable


means' of


out-door


! navmg
exercise


-uDer-
i now


.. ""I
S..s i:r. hqulde *. rade for a sanitorium at some suitable
.i theCanal Zone.for the treatment of tuberculosis, with a.
"L"-' this class of patients. Under present conditions,
S ase sent. into Ancon Hospital, for -segregation in the
.i.n which. not- well adapted nor of sufficient size for

ti^ t: ag rge t-nsi courts and a swimming pool should be con-
Sh..te use of gold personnel in close proximity to the
!iu4arters. Some form of exercise is absolutely necessary in
tIte to:maintain hospital employees in the state of physical
Idemndedby their duties.
.. a nurses' quarters at the present time do not provide
sauflileat quarters far the nursing staff; it has been necessary to
dqi uy ins few rooms,, and for others to be quartered elsewhere.
iTke nfes home provides quarters for only 70 nurses, while 78 are
:.d "Suceongestion is not-conducive to the best interests of
S :'isfiesom and provision should be made so that each nurse will
**g y *.:.Foom .
gq :sxt sBion-Section.- Build an addition (basement and two
toriioes.) to rear of service section. This addition is needed so that the
?U*. t ooms in a portion of this section will have an outside corridor
. "i''to :'that of the other private .rooms. At present these rooms.
. desirable'for use of private patients on account of the sun
.....n.g directly into the rooms during the days when it shines and
Hi". 4 .ginclement weather the windows have to be kept closed,
Cwhcht- renders the rooms stuffy, and is a source of constant com-
l it. friom private pay patients. Also, such an addition would give
etoom for the diet kitchen which at present is entirely too small
fwp6per and efficient service of patients' diets. Further, it would
i-drd ore comimwdious reception rooms on first and second floors
Sf viitore'and incoming and 'outgoing patients, and in the

...used for experimental and diagnostic work


W. 0eatf-prole altcheckinaboratgry are kept iroe rooms which are
Srfoa separate, suiet-able building for an animal house. At pres-
.tanma as en used for experimental and diagnostic work
totoe &t-dsreepiLabo ntory are kept in rooms which are
omacngad possibe, the odor therefrom is















a t384patiens the 8rst day of the year.; 10 were admit-
2,- add 145 were discharged or transferred, leaving 377
i atLthe. end of the year.. We have endeavored to deport all
I Iwh. uid be sent back to thefr homes; the total deportations
U:.. ibefatrr fnhbered 80. patients. .
: ** Ttic upatioward, which was established in the early part of
..,.49 ...a 4proverr--a great success. Nearly- 40 patients are in this
'... rtmtt making various articles, -whereby they spend their
ttun a: cogenial manner which produces a beneficial effect upon
:: H 'tir Stental condition. Owing to the lack of accommodations, our
S'cfional undertakings are scattered in various parts of the
S.hospimtal .grounds; however, we have succeeded in finding some sort
.. ': work to employ about 80 per cent of the female patients and 60
Percent. of the males. An- open, spacious, well-ventilated building
|:>i ",:; where more patients could be brought during the ddy to be instructed,
would increase the efficiency of the occupational therapy and benefit
is dthe patients to a greater extent. Over $4,660 worth of produce was
. ...taken from the patients' garden and utilized for their own mess.
^ Undertakings. of this character do not entail any expense to the
H Health Department and yet are a material benefit to the patients
'themselves.
!:.' Broom-making machinery arrived recently and steps have been
i.:, taken whereby some of the insane patients, and some of the chronic
1:i who were transferred from Ancon Hospital, will be induced to make
br ooms. Several chronic have already taken up this kind of work
|,. and-.are earning a little money in order to enable them to purchase
i'i small luxuries and other articles.
,, : : The.grounds in the hospital inclosure have been kept in order by
patients detailed for that purpose.
= paiat etiedfr ht=upoe
.IH.


Gi'" a i
K -x
:.. "
4. ,..
=:. =v

I: .. *.

.nE ;.
Ni:,* ..


FARM


DEPARTMENT.


Gencral.-The number of cripple employees has beep reduced from
SO.to 29, by obtaining employment more remunerative for them
tht their work on the farm warranted us in paying. This, with
the reorganization of the farm, has reduced its running expense to a
great extent.
D i"ry.--Our herd consists atpresent of 59 Jersey and 16 Holstein
awa4s4, 2 Jersey bulls, 1 Holstein bull, and 25 calves. With the regular
atval of feed from the United States and. the pastures being in
i f St;'S t w 'a .. J n* .> f I I r>




I~












H..






H' H
*.~ ""
.3

:.5
f M~~*:,*
fr: 1
*~
1'" "~**


H.
a'
.9.
.3

H..
I
I..
ii
a..'
V

'I'
H


q.
H:


H.
v ..I.
I:.- -
.:-


*w,~;~". .. ** *. ** .*1*'S:*
rm:...."4$.H.Hi i
*HV:L."l'l::


. *

A. Bococ,
m y e ,


U. S.


Army,


Superintendent.)


.. ..to tmas Hospital. is notentirey under the jurisdiction
is, more or less, intimately associated wi
h..-Hiepartment by virtue of the agreement between t
j I .of PPgarma and The Panama Canal dated October 1
tjI reafas as tfolows:
e affairs of Santo Tomas Hospital will be administered
.y:.i board of Directors of five members, three of whom will
.'"N pinted.by the President of the Republic of Panama and
tlr by the Governor of the Canal Zone. Of the three directors
appointed .by the President, one shall be the Treasurer of the
IHpspial, and one the Secretary of the Board. The Chief
Health officer of the'Canal Zone, thereupon, will be the Presi-
dent .of the Boaird of Directors. The Superintendent, two
.internese and three graduate nurses shall be appointed by the
Governor of the Canal Zone and their salaries paid from the
i, fiids ofthe Canal Commissioni."


on
th
he
.7,


..... Under the provision of this agreement, Santo Tomas Hospital has
continued to operate under the joint administration mentioned and
under the direct supervision of the Chief I Health Officer of The
Panama Canal.
Tl year 1920 has been a particularly successful one for the hospital
. .i.. iany, ways. The auditing and property accounting department,
: i: called in 1919, has been perfected and enlarged with use, until it is
npow functioning efficiently and satisfactorily. All outstanding debts
of the institution, have been canceled and current monthly bills
:are now paid as soon as received. The revenues of the past year
..ihrave amounted to $245,414.96, while the actual operating expenses
; "have been $231,939..97, leaving a balance of $13,474.99 available
': for use.-.An excess of approximately $1,000 of revenues above
: expenses is now being shown monthly.
.. i. .eort has been made to _improve the purchasing department
of the hospital to the point where the best possible supplies and
". equipment can be obtained for the least expenditure of money.
:H" Wast.and extravagance have been lessened and economy and
Hif:.jn every department advocated and enforced.
The buildings, many of which are very old and practically falling
S:,dowa,have enx erypaired, repainted, and rendered habitable until
i: e construction of the new Santo Tomas Hosnital shall be conmnleted.






























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: ;B the yearthe asylum buildings wererepainted, both exterior
and ittior, byiy the patients. Trees and hedges were set out, lawns
maaked out and graded, and gravel connecting walks put. in. The
"task f altering. te baths and toilets of the nine quarters buildings
sc peted a -ventilator was built on the' office-commissary
:: bding; a vegetable storeroom and a carpenter shop was put in
.atd tthe fronts of two quarters were changed, doing away with the
long and dangerous front steps. A new panga was built. All repairs
to buildings, furniture, plumbing, etc., were made by our own labor.
-. rass and bush cutting and sanitary work also were kept up.-
One new building was completed by outside labor and occupied
Sduhiing the year, to be used as a detention ward for mental and unruly
cases among the patients.
.Weekly moving picture exhibitions were given as usual; several
dances were held and entertainments were given by some local talent,
others by Girl Scouts, the Penn State Quartette, etc. National
holidays were celebrated, and, thanks to the great generosity of
frierids on the Isthmus and in the States, our Christmas was a real
on., .with 'i tree, ice cream, cake, turkey, and presents. A small
a -..


::. .organ given by States friends contributed greatly to the success o1
. these times.
.During the year 11 patients were admitted, 5 died, 2 were repatri-
S'. atd, 1 ..mental case was transferred to Corozal Hospital, and 6 cases,
i after:-exhaustive examinations, were discharged. Patient popula-
i.. j tion December 31, 1920, was 74.
.A monthly average of 30 patients were employed, the .-payroll
.. averaging $193;.21 per month. The value of products purchased from
..,. t e..patients-for the asylum for the year was $811.02. Total cash
S.saleat the local store, operated by the asylum, amounted to

i t*696.28. ."
.- The oral administration of chaulmoogra oil was continued this

.Hl ySaf with rather more willingness on the part of the patients, due
S o the fact .tht several cases were discharged in 1919 "apparently
catd'" or at least in whom there were no active lesions or bacteriolog-
.rfnzltI" fl n" A A n..qi k ,ann '. g a flL:.S






























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B*xao cu.ttrea-
T.tal number of blood cultures....
Positive blood cultures.........
QrJ`nifz? covered in blood cultures:


I~il
R".... .


1:.3y ..


n....
I.
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i ? ..
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44, HJAJL /^Ut UtiI l X JY, LlIb U KI p lLILI Wll a

H *t R..I mcreasie. positive cases, seems to be about
S4aivi.ed between influenza and noinfluenza patients.
lp : .eEna.in our fatal influenza cases-seem to have been
Variety oft organisms. In no instance were the lungs

1ai ax id in most cases some of t9Ja organisms found in the upper
'' tr tct were also found irr the consolidated lung tissue.
t oughpdiikient about offering any:opinion on account of the
lntteness: f. our. work we quote the. following paragraph of
C wig as. stating our views at present: "The whole clinical
ad ..t olog cal picture becomes intelligible if we can postulate a

.irtty etiological agent actifig locally upon the respiratory surfaces
%.e. oally through its toxic products in such a manner as to
prepare the Way for invasion by the prevailing respiratory flora."
.itring the year the pathologist reviewed sinusitis, otitis media and
m.astdiditis in the 3,376 autopsies which had been performed by him
this laboratory. Much valuable data is collected in this paper and
:the .1920 number of, the Proceedings previously referred to will
contain this article in full. -
.The :entomologist prepared an article upon the Panama Canal
.species of the Genus Anopheles, bringing synonomy up to date,
and treating particularly upon the taxonomy of the species and
-the collection and care of material for study. The article with 13
illustrations has been printed by the Health Department as a mono-
graph, and will also appear in the Proceedings.
At various times.throughout the year blood films showing malarial
parasites, smears, cultures, intestinal parasites and ova and other
laboratory specimenshave been forwarded to medical schools
requesting them.


BACTERIOLOGICAL REPORT.


B.itphAsw (a5 cases). .....


- Pno. o.uu. .. ......
.'Typ.e !... .oo.... ...... ..
.. P.L, ...
.. T pe .: -...... .. .

Tre-' pe" i de.... .. ,....
LSi~F~~i~~C Tvnp IV


Aesmo~aywiw
*5...:..


* .


... . . . I I .t *
* i i. S i i* n i S i i* i ih i* ia i n i i*


. . .


.... ... .. .. ... .. ... ... .
* a. n S a i i p n m i n i i a m*m S n i 5i a S S n a i n S H m i i S 2



m u m n S i. i n i S i n i i 6
n".@ n m is i U i n m a m ai m m i ai gi gna nm nmmimn m i i n |m i i


*. a U S S S S S S S . a 12
..-.. .. .. .12.. .
-i a S S S S 5 S S


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.-.""-" :... : *- h. 5 .
. ..
.** .* .*. ....
:.. ..... ...

-... ,,,, ..- i. *.
ss.t pa lvaaa I mva


ad organs, en dateu, etc,


i.S .... i*- --*.
.*:*:. *. ...
.'': .' ..." "mkl,*,@- a d.D m m d i d w e m I me

.~~~~ .... .' ..; .. **.
""" i i" ." .. ... .. .. ..%. .. a

w.., ,- ,, ,,.-,-.. for B. ... ..r.. l.ui....,
."i****. .. ,.:g eu ,, m a.. ... ,
*... ..:" ". .1 .*


...


*ii j::i:.:Ltif bq~i*S. & B.. LwuuIa....
... .......... .....*



*d ....
:4". i-fn t.....sf .. ..- .. ........
*...:. .Co d...li o ..m* *







*!.."...!* gi~idvacoiue ..
nof tropical .
*.:~ ~ ~~~.' .... WhHggaWMA

~.of.. -AO tspg .....j-g ...


.w at 5,. ., i. .. ... ..... ... .....
.... .u ..i tipt. ..i .* .

K. LI* a". .
"Jih i ad bateiiogil count..
.*-.. .. ..


h ... .. .


"' ..iice re7port:(animals)

U: !.- :Cftlh ears (.19.5 pitive for B. anthbracis).
ide lt dorB. anthraia. ..... .. ..


537)l. -


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ill in lln11


. .


icilustyphoasms was recovered in blood culture from 25 individuals;

oftiiw cases were from shipboard and 13 from the Canal Zone
tie-:t Rblic f' Panama. The -two cases from which Bacillus

tjha A. wee recovered were from shipboard; the two ships
S~r *




111































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g ..-r s ". ..... r...... ..n... ...... .
:. .. .. U *** a





4 t*'T it.. . .. ..... .. .. .
Sn ... ..*. ... ... .. .
l ,. *... .. .. a

aI el.s of bone and ints................

e'.. .".. .... U ..
~.~. t..... .. .... ...........
S Canerof thestomaPh and liver (eophagus).....
.l Cani tubreaot.u ..................a...un..




::" acerf. other organs................. ."......
lH.M A a dinias dsry, nause not t determined........

|. ": l..--. -. .ag i. ... ........ .. ...... .
..1'su,.pizTelrh.... ..a". ....- -... ... ..
1, |-


3
1
2
2
17
9
2
1
2
1
23
2
3
2
1
1
4
1
1

123


Diseases of the nervous system and of the organs of the special senses,
S.* *.


4 3I*-.* .
Enoephalis. .................
S0i0plel ,...,...

y8... .. .....- .v .....
.eiaemRorrhage, apoplexy.
"ioe.muf th:e brain.. ,......
GiiraL tparuiyd of the inaeane.
w j6 5te s... .. .. .


. .. a . S S .




* .k. S U b .. .. S
* U n n -* ...a,..,a.
n ~ n n m ~ i | 1i i m
mn | l~i | | mmgI
~~~~~~~~~~~ LI I n inn


: i .."
: :... .... .. ., ..l .*

" ^:r ..nt *1,, J.'reiiIi ne 1Jl4M *in


2
4
4
. 1
6
2
8
1
2

30


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: ....... ................... .......
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32 95 t
.... .H
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r. ......... -. h.... ... .. ... ... .. .... .. *.. 11 ".4
.-. ..W........,-...............................*.... 10 2.

"* ":"* O w~ amw e~ w ha e~ = II Im t a i I.
I ~~~~~~~~ ~ 1 2.a*9'mtaaH~gMmgABM~~ HMHBAHA
-m -- =-- .-e


causes


dleatl/


autopsy


the-:


Health Laboratory.


be
*1"


24
40
26
ta-az
30
38


8
.23
.27
25
31

36


j


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3
'15
12
11
17
*16
20


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14

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frojia m ba tok.........

L ~iom of external genital .
ma fr omP petWW and anu.....
From akn of upper extremity.
f from akin of lower extremities.
wf-rom akin of chest and abdomen,


from intestines..
rom rectum...,
from stomach...
from larynx and
dil


Thyeoid. ymnd...........
pe. mn ro brai...
:Sai:y glands..........
Uterua and apipendages...
X uterei..i.........
Tubes nd ovarie.......
pn paled from or





.Bladder, dmens from..
. .roetat glzaxds.........

nu.*M*ii l tL IS1L*_-*


.


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i


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~ns:~ft


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uterine



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nljiga

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." A. pua ted lower e-rm itie.. ..: .................... ...........................
!" Apated paper extremities.............. ..... ... . ...................



|j7 s aBj ftStejl myu ffrom ....... .. . .- . ... .*
S. .,u ,am ury.m .of....................... .....................................,-
S. erical......... ........ ....... .... ...
.. .. ade, su raelvicular..... . ... .. .. ... .. .. ....
". ia submarillary....... .......
l'.* .ot m e de ua x l a .. .. .... .- .> a


E:3:7i1*3n, cng "icn a......l i......... .......... .................
......u :iI- u. _d uupr-acasz... r .... .. .. . .. .. .. .. ... i... .. ..
. l.i.:. eaa .r.... .... ........................ ..... ...
. H .us, a...r....uw..... ,l flf l..

,, ",, ,,- ,,, ~ % :


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8
13
7

174
m
6
14
2
2
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2
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2
51
II
42
18
2
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7
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.41


I


f -1 .
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. i.iaro n .. .. .... ...

n andlegd ampatataed.
Ran uaannhiu


.4~~


eIa (Ist. from -eternal aditory
StouyrgoeiS.........,,... ........
im of an inguinal'lymph node......
kimn diue.ae ........... ....... ...
ai of ididymis and lymph node.
i of an auinal iap node.. -..


* .C..
a .






canal)
* S *

* a .

* a *


I. .a...
. iII


SI*Ii i i
I


, ,* *. ., -

.1 .fi'"...iges t on so. .. ...... ...... .. ... .. .. ............. .. .. ... .. 1
*btna peuhated in pelvis 14 years............... .. .. . .. .. I

I"i. ........ ..... ... .. ...... ....... .. ......... ... ..
: che. ... ..... .......... ...... ..... 1

l :-:.i o .torpic.pra (two at full term in. broad ligament and tube).......... ........... 6
H ..... a *... .. .. .. .... ... .. ..... .. .. .. 2
...^.it. iBd rth oxy is', veTwnucularis parates ...........,.. ....... ......... ..
H.r:* .:%f ....^ _



4 .review af the meningitis autopsy records during the years
t.: t tS~ 1920, intRusive was made and the following table was. com-
i ig Bacteriological examinations were conducted at autopsy.
tlutntion off the recovered organisms was carried out but* no
m n mm a m


H i H

































...ara.yfOhonsS B. (tuinea pis)..
: .... septicemia (three hogs).
44: ,44"J" ,,," ,, : :" :.. : """ .* S .
".. my e iss (one calf).


... :. *. *~i *

***"*..... J'4:1 .. .." .. ... ..
x. ** *


. ... Ar .t. ..t.
................... ..... ........
.....:. ..". . . .. ... . .
ii. :. .. :4 .
.. .. *
Sai expritation.

i. .,...i g experiments with the deer and cattle ti

Spii ped on either animal -as a host. Deer piropla
r;t. .a alf and cattle piroplasmosis was given a faw

iMy. n each case the infections were light as shc
Blin sos. Work is to be continued.
i**:.. ::::: :: ,: .. ..

1:;L: .; ae .miscellaneous examinations, human:
:.... ** .. *

p..iS:: '!m from the maternal surface of placentae (8 were positive
a. 3aa. ..
Biwdfil'., _m_ i ied for mal-ria................... ..............
.* *. .. .** ** **
t .. .. m:4fo Bwd pssgs ..**...*...............

a..'*:u tej fm"'' ..r..u..'.. n .... ... .. ..... .. .. .. ..


Ji]i":4 ,,!. ., lee .ia .topeied u.......................
jmn h A* *J m ** l .. .
... on .. V. ... ,. .. .
*: ** .. .* **I*



.;^;:i^.. .. .Dgr p r a...'. .. .. ... .. .. .. .
I8... .........'.. .... ... .. .. .. .. .* .. ., .. .
::: :: :.. *: : ::




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


*S... ".. 1*fi .- .. *


2,508
3.521


cks.


Both


types


Lsmosis was given
!n raised in cap-
)wn by blood film


for malaria, 2.8
*a a..S b S .
* S *S b a Su *
* S ** *= SSU*S* *S *


. i *b i C *t


* I.. .


* .* .. a .
*. S *. .
gliaie M ei g
. ~ ~ ~ ~ .. ... .. .


. i i a. *.I


* a i.**a i..*


284
9g2


.6,140

1.608


11.182a


IlllrtllllrlCIl


* J


















1.:.. C:ee~i~~. .. -


ri. *. .. .- K.

;:r*;D ......i


i 1*b


.| .. :.:.: . .
.il *". ." ........
*.. ..:t. .. .... ... .
.. rII .. -. i l Ir ..... d .i .. .. .
* .. *.
... mm .
p -.

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


***i** h
........
i;iW:.. ..bwf *:" .e" ,a.lue1tif1.......
*. .. i e, n or .s u c,....,. ,


i .



.Wa.hi* from milk botttle......


* tL


** Um *

S* -
* *. k. .* S Sq


I I I I I I Ir r 11


.. ...... ................i. .... .. .64

i i




U .. .. .. .. . 11


n S U S S *.* S *.S **iW* ... 3


i S *
i Sm*Sm m l
#mnninmu


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


i..

I..

F.-,.








I:.
I::


: The work of the chemical laboratory during the year 1920 has
onisted mostly of routine analytical work, which is given in the
j.bo0 e tabulated form.
,." The working out of a method for the utilization of two shipments of
S.:utde, carbolic acid received at the larvicide plant consumed con-
.., durable time. While conforming to specifications as to "'tar acid"

: intent and specific gravity, these two shipments differed from the
crude carbolic acid received heretofore in somg manner yet not
thonaughly understood, and were not capable of being worked into a
i.' satisfactory larvacide by the method which has been in use at the
SIarnidde plant .for .several years. In all our previous experience
S* th thAe manufacturee of larvicide no crude carbolic acid similar to
bhese two shipments has been received, and no trouble has ever
b*iore been experienced in the manufacture of larvicide. After con-
be...experimental work in the laboratory it was found that
slforation of the crude carbolic acid by treatment with concen-
a .d sulphuric acid and heat would so alter its deportment in the
-laal process of. manufacture as to produce a .satisfactory larvicide.
iTi .iethod was tried at the larvicide plant on a larger scale and

H.. *tpoduce a good larvicide. The whole of the two shipments
....::.~ .ccarbe.lic acid were made into larvicide with this additional
H,.. ...X... ,.S ". ._.. L...--


Hi
IH.


'''' I` -''









































hH ,. -~. ... S. 35
.1.:


iilS41
liii i +m: ::,"--.-













.. H"d 0m mI tti lt.i I.*d.e.
...Id j. + .. 6 ,oi




:;etio sextenamg ALLJs~ohL auu'ltt mosquiitoes recelvea. ior
S.. ... .. .. ... .. ,.* 1 r






'Nrixdtwr kept of thfe ~e numberr of lots received
,,,, ~ *~ S4 ,I, ,




~~'a' *6 Qjs'quito lanro came from Panama Cit~y and
::i .: .V.. -i i sidere tat practia: each: lot meant a
.. ... : ....- .... v rwl..




.iiryWt~'lfd'.te lglia~eorthe-Health.
-F:..* ':*. 114 s .. of sam
H i an. "







.hntin iehh tat a o* *l~era .le 0
''* ti~t a amount ofmosq uito
octiri he lty i t Ar regu nations were 4
:..:.................t.....aarchtospectore rmmove4. T large percentage
A. u.. aa aIS a --......... t d' :, ni:,'.. .. a.....t L .l & aea. ot













"''''o- : .. ere~ kepre of the number os eeved
" "* .*. ,, *
.8.... *. .. .. .. ,. .* ... .,.

~~R.:*... _..ry e! o r ,..
qutolracme fromg Panamrga, Cumnd
*" pnbidrthathontderacble..acamount o mosqntoa
.

*:"*". .....'.".. ". i tob d* l" hat a.on ""al ".a ."ut o m o q u t -
..... i cty" "ff .the Amnerica.n regulations were
....,.. .. ityinspectos .rtkmoved, The large per'centage-
.....' ...." .hdwri~in :.tihe above table beig those of the yellow fever








































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CART NO. 37 '


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n


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m a 4


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4 n. 'I.I


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:.:: Wike. :.'....
S.Cof d.....
*p. *
Total......


yar 9i9:t
White...
Colred..


Toal.


*. .


......*.. rl
.. .. .. .


S. '...t


.Urti'


Lien. DiSK.


.. U.i... NUUIBIEIR .

Ambolun Numnans.


4,688
15,985

20.673


4,523
19,681

24,204


Dieshare frm :
hospitals and deaJtas.


1,393
3,183

4.576


1,271
3.834


5.106


1,252,
S2,550i

3.802


1,141
3.121


4.262


I,
S

a
3
Ne
rz


,* APIL


INEFFECTIVE RATES


DeathS.


E-
* 'r

22
158


I


180

153


8
1428

150I


27


.2
23


Nonesfective
from sickness.


~I-

S31,775 86.81
; 80,760220.65

112,535 307.46


27,338 74.90
98,891270.93


251126.229.345 83


*i,
*PROORTIONATE NUMBERS."
!


year* 1920:
v.it ..
.Colored..


s *


Total.......


Year, 1919:
hite.....
lored .


- TotaL


41,688
16,985

2Ofl6731


4,523
19.681

24.294


297.14
199.12


267.06
159.53


221.351183.91


281.011252.27


210.92


176.09


30.08
39.59


37.44


28.79
36.23

34.83


1.06
1.37

1.30


0.44
1.17

1.03


. .


. .


18.52
13.80

14.87


16.55
13.77

14.29


* Annual average per 1,000 employees.


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un-
known.


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Pama


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4
1



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29






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1
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1
169
8
5

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4


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11


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Pan-
ama.


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Colon.


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6
1
0
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Zone. taL


Place of residence.


I


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S* U' *
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Place of residence.


Pan-
ama.
I


n i *


Colon.


r-


30
7
17


19.
3


2 .. .
1 3


1 .
19

1 6
152 43'
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Zone. Ilt


1 1.......


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1
1
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3 5


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3 1,297


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F~COSS ldeClPciln


l J.Colon. ne.Tot I


2,093.


111


.-/


1





















* ..S.I:':
* .... I...
f i: x


Age 0uPyears).


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** 75


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known.


. .
-


Total.


5
7
8
1
3.
1
27
1
4
3
2
























lb. -;" KH~~: .r -
p:: ~:\;:lu~~liC.1':
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2

1


a'


Ae (in year).


I 21-30


* a...*


* .
* i .





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U. .* *

1


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aga e

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-a


31-40


41-5 0


l1-60O


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11 ir
* U

I.....
a *

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* U U *


61-75


Orer


amem@ I
* .. .
. .. .
* *

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*,

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* *
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- a U *

* g l .

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* .
* *

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known


p* .
* a .

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p* i U

* U a

* U I *

p* U *U

* U U

* U *

* U U

ft* .

* U* U

* U U

* f

* *


* .

* U U *


Total .


re nct taken up in the statistical charts relating to Panama. Colon, and the Canal Zone.


4.,



ii.
*
I
IL -





















:.' ." :.
* ".:/ j
* .. ** .


...::l




H ...~
"? ..
II" .


Annual
death rate
per 1,000
population.


::X A..

.l:n :. ..


:'!' :.



i..


.. ".


....loh fr the United Stats:
* a. .. .. .
a e .. ..... ..


**. ,


*.b .


. .I


Wteien and children from the United States:
itfllaaa_- -a


ti.tal . .
~rEalruie....... ......


* .
. .


. S *
* ..* .


* ... i i i i i i .
*i. .i. i g. *i* .i* .. .. a


1Total........


..... .. .


I..


. White ployes from the United States and their families:


aI~Mme


External caule.......


. .


i. a..I ..
* U U .


* U U ..


3.80
.72


4.52




3.69
.82


Total...


Ij;.


number


erican children born on the Isthmus during year 1920..


Deaths among American children under 1 year of age.................. ..........
: Infant mortality rate among American children (number of deaths per 1,000 births)...
iii i. .


205
10
48.78


he:
A.
Sr .."
ei", ,


L I I I i iai


'~ '' '''


*r


L rllll


111111111111


m


..















A 5
i
* H~i
:n,.. .. ..


wR


TAt


' RATES IN THE CANAL ZONE AND THE CITIES


/--O AXWAMA AND COLON.


. ...* ::. ". ** .w /


S.... .......'..... *.. i.
... n.. ,-. :,, ,: .
::: .: ..., ,



S...I .




r m 4 -
. ". .. .. ,
..... Tot



,, A,


." "


'1".
V.


Ph Cor..


....... .


.n. *


Pt.


aM9v. ...


atrO


i*nni..nII

*.*


i i U .
i....d i ..i.... i
..... ..... ....


.i. i. .. .


: on .'T....
"Ca taZone.

- Total...


Average
popula-
tion.


60,500
25,.078
27,459

114,087


61,369
26,078
26,511

113.958


iBirths..


Male.


Fe-
male.


1,150
503


2.001


1,190
479
355


2.024


1,226
459
283


1,968


1,024
429
340

1.793


Total


2,376
962
631


3,969


'2,214
908
695

3.817


Deaths


among
children
under 1
year of


Death
rate per
1,000
births.


155.30
142.41
95.09


142.61


154.47
155.29
113.67

147.24


.t.'
**.*I


X,, H .. **


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i
i"


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3-4


SAge (fr months)..


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1*

1












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1
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1











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ft* .* *


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13
* .f. .

....
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2

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* ft I


4 5--6 67

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7-8


8-9


1 S F i


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* *



2

2


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* *
* .. .
* .


24
I

* ....
* *


* *



2


m.. I


I11-I2/


Place of residence.


2

2

6
1
6
1
1
1
1
.3
1
1
1
1
1
2
1
1
9

" 43

3
2


U..... i
1
9
1
119
8



1
2'
7

2 2,
a


Colon. Zanal
Zone.


3





* .. ..
* .


2


1
33.
2
2
1




1


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4









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6 0N


Total.


V.


1


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1 *


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42
11
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PAGE 1

rZr Al T C -66 R JJX. a1~< e DEPARTMENT I A. F77 -VI Chie ii*tAMe a a s~ 4W4 4?4 ZI. 744 4,, ilk'7 ;,

PAGE 2

REPORT OF THE HEALTH DEPARTMENT OF THE PANAMA CANAL FOR THE CALENDAR YEAR 1920 H. C. FISHER Colonel, Medical Corps, United States Army Chief Health Officer THE PANAMA CANAL PRESS MOUNT HOPE, C. Z. 1921

PAGE 3

For additional copies of this publication address The Panama Canal, Washington, D. C., or Balboa Heights, Canal Zore. (2)

PAGE 4

CONTENTS Page. T itle .1 Organization and operation. 6 Personnel .7 V ital Statistics. 10 G eneral R em arks. .13 Panam a H ealth Office. 23 Colon-Cristobal Health Office. 26 Division of Quarantine .27 A ncon H ospital. .33 C orozal H ospital. 38 C olon H ospital. .40 Santo Tomas Hospital .41 Palo Seco Leper Asylum. .43 Board of Health Laboratory. 44 Charts: 1 Admission rate per 1,000 employees, all causes .....63 2 Death rate per 1,000 employees, all causes. 64 3 Noneffective rate per 1,000 employees. 65 4 Malarial fever-Admission rate per 1,000 employees. 66 5 Malarial fever-Death rate per 1,000 employees. 67 6 Malarial fever-Death rate per 1,000 population in the Canal Zone and the cities of Panama and Colon-Employees and nonemployees .68 Tables: I. Discharges from hospitals, deaths, and noneffective rates for employees. 69 II. Causes of deaths of employees by color, age, and length of residence on Isthmus. 70 III. Deaths of residents and death rates of the cities of Panama, Colon, and the C analZone .72 IV. Deaths of residents of the Canal Zone and the cities of Panama and Colon, by cause. sex, color, age, and residence. 74 IV.-A. Deaths of nonresidents. 84 V. Deaths by nationality or nativity. 88 VI. Statistics re American employees and their families. 89 VII. Births and birth rates in the Canal Zone and the cities of Panama and Colon. 90 VIII. Infant mortality rates in the Canal Zone and the cities of Panama and Colon 91 .IX. Deaths of infants by cause, sex, color, age, and place of residence .92 X. Discharges and deaths in the hospitals of The Panama Canal. 94 XI. Consolidated hospital and asylum report .110 XII. Consolidated dispensary report. 112 XIII. Consolidated admission report. 113 XIV. Number of employees constantly sick in hospitals and quarters. 113 XV. Average number of days in hospital or quarters for each admission of sick em ployee .114 XVI. Number of days hospital treatment furnished various classes of patients .114 XVII. Ward laboratory reports. .115 XVIII. Surgical operations performed. .117 XIX. Report showing number of operations in the eye, ear, nose and throat clinic. 120 XX. Report of X-ray department, Ancon Hospital .122 XXI. Santo Tomas Hospital .123 XXII. Corozal Hospital-Statement of commitments and discharges. 128 XXIII. Contagious and infectious diseases reported. 129 XXIV. Force report of Health Department. .129 (3)

PAGE 5

THE PANAMA CANAL. HEALTH DEPARTMENT. Operating under the direction of the Governor of The Panama -Canal. Maintained from funds designated for sanitation in Panama Canal appropriations and revenues derived from its own operations. It exercises jurisdiction in health matters over the Canal Zone and the cities of Panama and Colon, Republic of Panama, and also cooperates with the Panaman Government in health matters in other parts of the Republic. (4)

PAGE 6

LETTER OF TRANSMITTAL. THE PANAMA CANAL, HEALTH DEPARTMENT, BALBOA HEIGHTS, C. Z., March 17, 1921. Col. JAY J. MORROW, Governor, The Panama Canal, Balboa Heights, Canal Zone. SIR: I have the honor to submit the following report of the operations of the health department for the year 1920. Respectfully, H. C. FISHER, Chief Health Officer. (5)

PAGE 7

6 HEALTH DEPARTMENT. ORGANIZATION AND OPERATION. The organization of the health department consists of: Chief Health Office, Balboa Heights: Division of Hospitals and CharitiesAncon Hospital, Ancon. Colon Hospital, Colon. Corozal Hospital, Corozal. Santo Tomas Hospital, Panama, R. P. Palo Seco Leper Asylum, Palo Seco. Dispensaries atColon Hospital. Gatun. Pedro Miguel. Ancon Hospital. Balboa. District Dentists atColon. Gatun. Pedro Miguel. Ancon. Balboa. La Boca. Medical Storehouse, Ancon. Division of SanitationHealth Office, Panama. Health Office, Colon. Chief Sanitary Inspector, Canal Zone, Balboa HeightsDistrict Sanitary Inspectors atGatun. Pedro Miguel. Ancon. Balboa. Division of QuarantineChief Quarantine Office, Balboa Heights. Quarantine Station, Colon. Quarantine Station, Fort Amador. Quarantine Station, Bocas del Toro.

PAGE 8

7 PERSONNEL. (December 31, 1920.) Chief Health Office. Balboa Heights. Col. H. C. Fisher, U. S. Army, Chief Health Officer. Dr. D. P. Curry, Assistant Chief Health Officer. DIVISION OF HOSPITALS AND CHARITIES. Ancon Hospital. Col. L. T. Hess, U. S. Army, Superintendent. Dr. T. W. Earhart, Chief of Surgical Clinic. Dr. W. E. Hubbard, Assistant Chief of Surgical Clinic. Dr. R. C. Connor, Chief of Medical Clinic. Dr. W. W. Braithwaite, Assistant Chief of Medical Clinic. Dr. A. F. Ryan, Chief of Eye and Ear Clinic. Dr. T. H. Odineal, Assistant Chief of Eye and Ear Clinic. Dr. L. S. Townsend, Chief of X-ray Clinic. Physicians. Dr. George Eugene. Dr. C. D. Briscoe. Dr. H. G. Hambleton. Dr. H. K. Tuttle. Dr. L. S. Chapman. Dr. P. G. Pomeroy. Dr. M. A. V. Smith. Dr. James Burrow. Dr. D. L. Hollis. Internes. Dr. H. S. Liggett. Dr. J. G. Stoelzle. Dr. F. E. Hyde. Dr. H. G. Campbell. Dr. R. L. Ross. Board of Health Laboratory. Dr. L. B. Bates, Chief of Laboratory. Dr. H. C. Clark, Pathologist. Capt. J. H. St. John, U. S. Army, Bacteriologist. Mr. J. E. Jacob, Chemist. Mr. L. H. Dunn, Entomologist. Corozal Hospital. Dr. Louis Wender, Superintendent. Physicians. Dr. D. G. O'Neil. Dr. D. G. Sampson.

PAGE 9

8. Colon Hospital. Maj. T. J. Leary, U. S. Army, Superintendent. Physicians. Dr. W. V. Levy. Dr. W. W. Cook. Dr. J. C. Scott. Dr. J. S. Vance. Internes. Dr. F. R. Brunot. Dr. Wayne Gilder. Santo Tomas Hospital (Panama). Maj. E. A. Bocock, U. S. Army, Superintendent Physicians on Panama Canal Roll. Dr. C. C. Phillips. Dr. N. B. Kupfer. Palo Seco Leper Asylum. Mr. F. D. Tucker, Superintendent. Cristobal-Colon Dispensary. Dr. W. V. Levy, District Physician. Gatun Dispensary. Dr. J. A. Grider, District Physician. Pedro Miguel Dispensary. Dr. W. B. Meares, District Physician. Balboa Dispensary. Dr. I. E. Hix, District Physician. Dr. L. 0. Keen. Dr. R. L. Harvey. Dr. J. R. Ernst. Ancon Dispensary. Dr. W. K. Olson, District Physician. Dr. H. G. Bickford.

PAGE 10

9 DIVISION OF SANITATION. Panama Health Office. Dr. Henry Goldthwaite, Health Officer. J. M. Carpprow, Sanitary Inspector. C. L. Pierce, Sanitary Inspector. N. C. Anderson, Sanitary Inspector. 0. W. Searcy, Sanitary Inspector. B. C. Quinby, Building Inspector. H. A. Lewis, Vaccinator. Dr. F. T. Fisenman, Veterinarian and Meat Inspector. Dr. H. L. Casey, Veterinarian and Meat Inspector. Colon Health Office. Dr. J. L. Byrd, Health Officer. C. H. Bath, Sanitary Inspector. T. A. Leathley, Sanitary Inspector. M. M. Seeley, Sanitary Inspector. E. K. Turner, Sanitary Inspector. Geo. Campbell, Sanitary Inspector. W. S. Chidester, Sanitary Inspector. Emil Becker, Sanitary Inspector. Dr. I. C. Mattatall, Supervising Veterinarian and Meat Inspector. Dr. W. F. Gross, Veterinarian and Meat Inspector. Dr. F. F. Dowd, Veterinarian and Meat Inspector. Canal Zone Sanitation. E. F. Quimby, Sanitary Inspector, Gatun District. I. W. Pickett, Sanitary Inspector, Pedro Miguel District. Geo. L. Willett, Sanitary Inspector, Ancon-Corozal District. John P. Corrigan, Sanitary Inspector, Balboa District. J. L. Tolar, Sanitary Inspector (Relief). DIVISION OF QUARANTINE. Chief Quarantine Office. Balboa Heights. Surgeon W. C. Rucker, U. S. P. H. S., Chief Quarantine Officer. Cristobal-Colon Quarantine, Cristobal, C. Z. Dr. C. A. Hearne, Quarantine Officer. Dr. E. T. Lake. Dr. E. W. Torrey. Dr. P. Horwitz. Balboa-Panama Quarantine, Fort A mador, C. Z. Dr. J. D. Odom, Quarantine Officer. Dr. J. C. Hubbard. Bocas del Toro (R. P.) Quarantine. Dr. W. J. Burke, Quarantine Officer.

PAGE 11

10 VITAL STATISTICS.EMPLOYEES. The average number of employees on the rolls of The Panama Canal and the Panama Railroad, for the year was 20,673, as compared with 24,204 for 1919, and 25,520 for 1918. The total admission rates to hospitals and quarters was 671.84, as compared with 550.21 in 1919, and 405.67 for 1918. For disease alone the admission rate to hospitals was 183.91, as compared with 176.09 in 1919, and 136.60 in 1918. The total admission rate to hospitals only was 221.35, as compared with 210.92 in 1919, and 163.17 in 1918. (See Chart No. 1.) The total death rate was 8.70, as compared with 7.23 in 1919, 8.11 in 1918, 7.09 in 1917, 6.03 in 1916, 5.77 in 1915, and 7.04 in 1914. The death rate from disease alone was 7.40 as compared with 6.20 in 1919, and 7.13 in 1918. (See Chart No. 2.) The constantly noneffective rate from all causes was 14.87, as compared with 14.29 in 1919, and 11.02 in 1918. (See Chart No. 3.) The admission rate for malaria, to both hospitals and quarters, was 19.40, as compared with 31.07 for 1919, and 18.55 for 1918. The noneffective rate for malaria was 0.45, as compared with 0.99 for 1919, and 1.13 for 1918. (See Charts 4, 5, and 6.) The admission rate for typhoid fever was 0.24, as compared with 0.17 for 1919, and 0.24 for 1918. Three deaths from typhoid fever among employees occurred during the year. The five diseases causing the highest number of hospital admissions with their rates, were as follows: 1919. 1920. Ad..AdRate. missions. numssions. Influenza. 305 12.60 621 30.04 Venereal diseases. 540 22.31 552 26.70 Malaria. 678 28.01 401 19.40 Diseases of the eyes and their annexa .194 8.02 152 7.35 Tuberculosis (various organs). 81 3.34 82 3.97 The five diseases causing the highest number of deaths, with their rates, were as follows: 1919. 1920. Deaths. Rate. Deaths. Rate. Tuberculosis (various organs). .23 0.95 30 1.45 Pneumonia (broucho and lobar).,. .19 .78 22 1.06 Influenza. ....1 .04 21 1.02 Nephritis (acute and chronic). 21 .87 13 .63 Organicdiseasesoftheheart. 18 .74 11 .53 All rates given are computed as equivalent annual per 1,000.

PAGE 12

11 EFFECTS OF RACE. The admission rate to hospitals and death rate from disease, for white employees, were 267.06 and 3.63 respectively, as compared with 159.53 and 8.51 for black employees. The admission rate to hospitals and quarters for malaria was 20.05 for white employees, as compared with 19.21 for black employees. The death rate from disease for Americans was 3.32, as compared with 1.08 for 1919, and 3.38 in 1918. CANAL ZONE. EMPLOYEES AND NONEMPLOYEES. From an average population of 27,469 in the Canal Zone, there was a total of 242 deaths during the year. Of these, 211 deaths were from disease, giving a rate of 7.68 as compared with 7.81 for 1919, and 9.69 for 191F. The death rate from tuberculosis was 1.02, as compared with 0.83 for the preceding year, and 1.84 for 1918. Tuberculosis caused 13 per cent of all deaths from disease during the year. There were 631 live births reported during the year, giving a birth rate of 22.98. (See Table VII.) Of these 231 were white, and 400 were black. Of the total births reported, 5 per cent were stillbirths. Deaths among children, under 1 year of age, from all causes, totaled 60, of which 8 were white, and 52 black; giving an infant mortality rate, based on the number of births reported for the year, of 34.36 for white, and 130 for black children, with a general average of 95.09 per 1,000 births. Of the total deaths, 25 per cent occurred among children under 1 year of age, and 38 per cent among children under 5 years of age. Below is a table showing the death rates for the Canal Zone from 1905 to 1920, inclusive, from all causes among both employees and nonemployees: PopulaRate PopulaRate Year. tion. Deaths. per Year. tion. Deaths. per 1,000. 1,000. 1905. 23,463 828 35.29 1913. 61,700 1,047 16.97 1906. 34,095 1,700 49.86 1914. 46,379 710 13.31 1907. 54,036 1,708 31.60 1915. 31,946 410 12.83 1908. 67,146 1,273 18.95 1916. 31,447 343 10.91 1909. 76.900 1,025 13.33 1917. 227,543 313 11.36 1910. 86,465 1,251 14.47 1918. 222,290 236 10.59 1911. 90,434 1,385 15.32 1919. 26,511 229 8.64 1912. .79,279 1,129 14.24 1920. 27,469 242 8.81 2 Average population, excluding military population for last 6 months of 1917, the year 1918. and the first 6 months of 1919. PANAMA CITY. EMPLOYEES AND NONEMPLOYEES. From a population of 60,500, based on a census taken this year by the Panamanian Government, there was a total of 1,297 deaths

PAGE 13

12 during the year. Of these, 1,246 were from disease, giving a rate of 20.60, as compared with 18.98 for 1919, and 20.92 for 1918. The principal causes of deaths as compared with the preceding year, were as follows: Deaths in1919. 1920. Tuberculosis (various organs). 241 206 Diarrhea and enteritis (including colitis). 152 175 Pneumonia (broncho and lobar) .171 167 Nephritis (acute and chronic) .84 77 Premature birth. ..25 47 Cancer (various organs) .35 46 The death rate from tuberculosis was 3.40, as compared with 3.93 for 1919, and 4.14 for 1918. Tuberculosis caused approximately 16 per cent of all deaths from disease during the year, as compared with 20 per cent for the preceding year, and 19 per cent for 1918. There were 2,376 live births reported during the year, giving a birth rate of 41.55. Of the total births reported, 6 per cent were stillbirths. There were 369 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of births reported during the year, of 155.30. Of the total deaths, 28 per cent occurred among children under 1 year of age, and 40 per cent among children under 5 years of age. Below is a table showing the death rate in Panama City from 1905 to 1920, inclusive, from all causes among both employees and nonemployees. Rate Rate Year. PopulaDeaths. per Year. PopulaDeaths. per tion. 1,000. tion1,000. 1905. ..21,984 1,447 65.82 1913. .47,172 1,507 31.95 1906 .25,518 1,142 44.75 1914. .53,948 1,863 34.53 1907 .33,548 1,156 34.45 1915. 60,373 1,810 29.98 1908. 37,073 1,292 34.83 1916 .60,778 1,765 29.04 1909. 40,801 1,038 25.44 1917. 61,074 1,714 28.06 1910. 45,591 1,446 31.72 1918. 61,369 1,314 21.41 1911. 46,555 1,456 31.27 1919. 61,369 1,211 19.74 1912. .47,057 1,380 29.33 1920. 60,500 1,297 21.44 COLON. EMPLOYEES AND NONEMPLOYEES. From an estimated population of 26,078, a total of 554 deaths occurred during the year. Of these, 517 were from disease, giving a rate of 19.82, as compared with 20.55 for the preceding year, and 22.51 for 1918.

PAGE 14

13 The principal causes of death, as compared with last year, follow: 1919. 1920. Tuberculosis (various organs). 101 109 Diarrhea and enteritis (including colitis). .55 49 Nephritis (acute and chronic). 56 45 Bronchitis (acute and chronic). 38 37 Pneumonia (lobar and broncho). 74 36 Organic diseases of the heart. 46 28 The death rate from tuberculosis was 4.18, as compared with 3.87 for the preceding year, and 4.45 for 1918. Of the total deaths from disease, tuberculosis caused 21 per cent. There were 962 live births reported during the year, giving a birth rate of 38.88. Of the total births reported, 5 per cent were stillbirths. There were 137 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of births reported during the year, of 142.41. Of the total deaths, 25 per cent occurred among children under 1 year of age, and 35 per cent among children under 5 years of age. Below is a table showing the death rate in Colon from 1905 to 1920, inclusive, from all causes among both employees and nonemployees: I Rate Rate Year. PopulaDeaths. per Year. PopulaDeaths. per tion. 1,000. tion. 1,000. 1905. 11,176 553 49.48 1913. 20,232 489 24.17 1906. 13,651 703 51.42 1914. 23,265 590 25.36 1907. 14,549 571 39.24 1915. 29,331 640 21.82 1908. 15,878 418 26.32 1916. 24,693 696 28.19 1909. 17,479 396 22.65 1917. 25,386 667 26.27 1910. 19,535 514 26.31 1918. 26,078 616 23.62 1911.:. 19,947 527 I 26.42 1919. 26,078 573 21.97 1912. 20,174 493 1 24.44 1920. 26,074 554 21.24 GENERAL REMARKS. Malaria.-The number of admissions for malaria to hospitals and quarters shows a gratifying decrease from that of the previous year. COMPARATIVE STATEMENT OF TOTAL NUMBER OF MALARIA CASES REPORTED DURING THE CALENDAR YEARS 1919 AND 1920. Employees. Nonemployees. Total. 1919. 1920. 1919. 1920. 1919. 1920. Canal Zone, sanitated areas .236 138 637 438 873 576 Canal Zone, cattle camps, etc .301 111 28 6 329 117 Canal Zone, miscellaneous unsanitated areas. 21 18 47 17 68 35 Colon. 70 20 69 21 139 41 Panama .62 30 119 70 181 100 Miscellaneous outside Zone (unsanitated). 62 84 462 268 524 352 Total. 752 401 1,326 820 2,114 1,221

PAGE 15

14 The reduction in the total number of admissions is marked in every district, but more especially in those areas where the greatest effort and improvement have been made in sanitation. In the report for last year was noted the heavy infection at Colon and Cristobal, the cause being located in the large swamps that lie to the south and east of these cities. Direct flights of Anopheles albimanus and tarsimaculata were demonstrated to have occurred into the northern part of Colon from the Margarita Road swamp, over a distance of 2 miles, 1 mile of which was across the open water of Manzanillo Bay. The work of draining these swamps has been carried on steadily through the past year. The Army sanitary inspector has extended and elaborated his system of ditches in the Margarita Road swamps until this area is practically free from any extensive mosquito breeding places. Pastures lying within 1 mile of Mount Hope and the Cristobal dry dock were evacuated of their cattle and open drainage ditches installed. The sanitary inspector of the Mount Hope district (Cristobal), having about completed the installation of earth ditches in most of his wet areas, has begun permanent construction by converting them into rock and tile drains where it is possible to do so, or by laying sectional half-round concrete bottoms where flat grades or absence of rock preclude the use of the covered tile. Not only has the malaria incidence shown a great decrease, but the capture of adult anopheles (a work carried on both as an index and as a valuable antimalarial measure) indicates that the sources of the great majority of these mosquitoes have been effectually controlled. No new work has been done in the Gatun district, except for the change of the drains of a small area immediately adjacent to the west side of the locks from an open ditch system to rock and tile, and the filling of a small pond and a few unnecessary old ditches. The adult mosquito catch of the past wet season demonstrated that the draining (in 1919) of the large swamp west of the old French canal has abolished the chief source of the hordes of anopheles that annually had invaded this city. (See Report for 1919.) The new Army camp at Fort Davis was completed and occupied in October. While the sanitation done by the Gatun district inspector affords a large degree of protection to this post, its situation north of Gatun, toward the low-lying swampy pastures of The Panama Canal dairy, will require much further extension of work in that direction in order to fully protect the camp. The Pedro Miguel district is being further improved by conversion of open ditches in the adjacent former cattle pastures to rock-covered tile drains. The removal of the cattle from these pastures has greatly reduced the number of adult anopheles caught, and has also lessened the cost of control of these areas. The Dredging Division, pumping from the canal prism spoil deposited there as a result of recent movements in the slide at Cucaracha, found it necessary to spill this material into the old Rio Grande valley opposite Paraiso. The heavier material was deposited satisfactorily, forming a porous fill that can be easily drained. The lighter material, however, was carried down the stream, to be deposited in the arm of Miraflores Lake adjacent to Pedro Miguel locks, converting much of this area into a shallow lagoon, barely covered by water, which, as vegetation becomes established, will

PAGE 16

15 doubtless be converted into a troublesome and costly breeding place. The new channel of the Rio Grande (straightened and dug by the Health Department the previous year) was blocked, and the river once more became a shallow, widespread, meandering stream. Drainage ditches discharging into the stream were choked with silt, and this fine amorphous material completely filled the rock and tile band ditch at the foot of Paraiso hill, necessitating its removal. Thus was undone, in a few weeks, practically all of the excellent work of the previousyear in this area by the district sanitary inspector. Following the withdrawal of the hydraulic dredge, the Dredging Division furnished the sanitary inspector a gang of men who cleaned out some of the ditches and did what was possible to restore the drainage system, but without being able to restore its former efficiency, nor will it be practicable to do so if, as seems likely, this area is to be used again as a dumping ground for spoil from the Canal. Under present conditions, only temporary expedients and costly maintenance can be attempted. The Chief Hydrographer has presented a plan for raising this arm of Miraflores Lake to the height of Gatun Lake (from 54 to 85 feet, approximately), thus giving the former an increase of depth of over 30 feet, and a considerably larger area. While this has been proposed mainly because of its effect on the water supply of Gatun Lake and the surges in the cut affecting shipping, it would greatly benefit the sanitation of Pedro Miguel, through the conversion of a large, wet area into a deep lake with fairly clean, steep banks. In the Ancon-Corozal district nearly 10,000 feet of permanent rock-covered and open concrete ditches were constructed. The latter type of construction-that of the open half-round, sectional, concrete ditch bottom, as described in the report for 1918, of which several thousand feet have been installed, has not been found as satisfactory as was at first hoped. In the jungle, where there are many large deciduous trees casting their foliage, these drains easily and frequently become blocked, allowing the formation of many small collections of water, and requiring to be cleaned frequently. Although more easily swept and maintained than open earthen ditches, the constant care necessary to prevent breeding during times of slight precipitation makes them a constant source of danger and expense; therefore most of the ditches of this type are being closed in by sectional cast covers and broken rock. In future construction practically all permanent work will be done with 6or 8-inch concrete tile, made by this department, and covered with broken stone. Only in the Mount Hope district, where there are large, nearly flat, alluvial marshes, and where there is a scarcity of stone, will the open form of concrete ditch be constructed to any great extent. Fort Clayton, north of Corozal, was finished and occupied in October. A number of malaria cases have developed there among the enlisted personnel and the catch of adult anopheles has been large. The Army sanitary inspector has devoted his efforts to clearing the jungle from the edges of streams and in valleys adjacent to the post, and has uncovered many springs, obstructed streams and seepage places. The Rio Cardenas, flowing by the south side of the camp, has many pools caused by bars, rocks, and drift, overhung with grass, in which prolific breeding occurs. These conditions are being

PAGE 17

16 corrected as rapidly as time and funds permit, with considerable improvement already to be noted in the malaria and anopheles index. In the Balboa district the large hydraulic fill west of the Canal, opposite Pier 18, has given rise to anopheles breeding in those parts where fresh water from the high land at the back runs out over the fill. Some of this material is still too soft to bear the weight of a man and it has been found possible to spread a mixture of black oil and larvacide by throwing waste, soaked in the mixture, out onto the fill. In order to determine whether malaria occurs on vessels visiting Canal ports or transiting the Canal, the Surgeon General of the Navy was requested to have medical officers of Navy ships visiting the Canal report directly to the Chief Health Officer any cases of malaria developing aboard ship following such visit. Blanks for reporting cases have been prepared and will be supplied to the ships by quarantine officers on arrival. The Panama Health Officer still emphasizes the need for sanitating the Sabanas area east of the city. The greater number of cases occurring in Panama live in the San Miguel and Calidonia districts, east of the Panama Railroad, and near the Sabanas car line. Doubtless many of these cases are contracted directly from visits to the unsanitated areas, but there is also the probability that anopheles fly into the city from the Sabanas. These sections of the city are occupied mainly by West Indians living in unscreened tenements. In the foregoing table, the only increase in number of malaria cases is in that of employees contracted in "miscellaneous unsanitated areas outside the Zone." It has required frequent reminders to the residents of the Zone, that, although malaria is not so prevalent in the sanitated areas as it once was, the danger exists in other sections of the Isthmus in unabated form. In fact, the comparative safety of the sanitated areas does much to lull their apprehension of other areas and many carelessly take risks that are unjustifiable. Malaria from cattle camps and plantations also shows a marked reduction, believed to be due largely to the continued use of prophylactic quinine. While it is admitted that this procedure is not ideal, and that, under ordinary circumstances, there are better ways of controlling malaria, the isolation of these camps, their temporary nature, and the class of labor (these being largely recruited from the infected native population) seem absolutely to require the use of quinine. Every evening for the first two months following the beginning of employment, each man is given 21 ounces of an alcoholic solution, containing 10 grains of quinine sulphate. After this first period of 2 months, each man is given the same dose morning and evening of each Wednesday as long as he remains in camp. While this treatment is not compulsory, by the cooperation of the foremen it is fairly well carried out, and the malaria incidence has been lowest in those camps where the prescribed measures have been followed closely. For the sterilization of malaria carriers and the "follow up" treatment of cases of malaria the Chief Health Officer has approved, as the standard for routine treatment, the administration of 10 grains of quinine sulphate by mouth, every evening before retiring for a period of 8 weeks. This is the procedure recommended by the subcommittee on medical research of the National Malaria Committee.

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17 Malaria at Army poss.-The Department Surgeon of the Army reports a gratifying improvement in the malaria rate of troops on the Canal Zone, the rate for 1920 being better than in any previous year. The comparative rates for the past 3 years are: 1920. 1919. 1918. Noneffective rate per 1,000. 1.12 2.43 1.92 Admission rate. 47.38 54.37 66.037 For the control of mosquito breeding the Army sanitary inspector reports that, as part of the permanent work with the allotment for this purpose, drains and fills were made by him as follows: Dirt Concrete Rock and tile. Station. drains. Cans. 6" tile. 8" tile. Fills. Feet. Feet. Feet. Feet. Cu. yds. Corozal. 2,295 1,902 2,095 139 665 Fort Clayton. 135 .428 .200 Panam a secondary. 1,200 .... Fort Davis. 2,000 ..1,000 Fort Sherman. 11,223 .2,791 575 1,350 France Field. 19,734 Fort Randolph. 24,436 ..... Totals. 62,203 1,902 5,314 714 3,215 Typhoid fever.-There were 36 cases of typhoid fever, of whom 9 died. Five employees, 11 nonemployee residents of the Isthmus, and 19 nonresidents had the disease. Of these, 3 employees (black), 1 nonemployee (black), and 5 nonresidents (4 black, 1 white) died. The nonresidents were all ill upon arrival on ships and did not become infected upon the Isthmus. The cases developing locally were sporadic, except for 4 cases in one family from a small pueblo in the country near Panama City. No other cases developed in that vicinity after the discovery of the infection. Every local case was carefully investigated as to its origin; contacts were examined for typhoid bacilli, resulting in the discovery of but 2 carriers, 1 an enlisted man in the Army and the other a patient of the hospital for the insane. Influenza.-There were 1,314 cases of influenza reported from the Canal Zone and adjacent territory, of whom 62 died (see Tables IV, X, and XXIII). The epidemic started the first part of March, 1920. Cases of influenza were reported as follows: March, 801; April, 314; May, 40; June, 138. The first cases were from Colon, but later cases were reported also from all parts of the Canal Zone and Panama and its suburbs. The schools, picture shows, and other places of assembly were closed for a period of 2 weeks. The majority of cases reported were among people who were ill-fed and physically weak-owing to MR 77731-2

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18 their poverty-which condition was markedly prevalent immediately after the strike of February 24 to March 4. The epidemic probably started from the fleet of United States Navy vessels stationed in Colon Bay from February 19 to March 1, of which the steamship Colombia had 10 cases and the steamship Pennsylvania 5 cases on board; the fleet reported 30 cases before arrival in Colon. The rise shown in number of cases reported during the month of June was the result of a local epidemic at the cattle pasture camp at Manawa, there being 82 cases from this camp during June. On March 21, 1920, a ship from Ecuador was received at Balboa quarantine with 6 cases of influenza on board; June 23, 1920, a ship from Peru was received at this station with 23 cases on board; in both instances the local passengers were detained in quarantine 3 days, and the crew and other contacts among agents and port employees were observed and temperatures taken for 3 days. No new cases developed. Smallpox.-There were reported 25 cases of smallpox during the year, 14 from Panama City and 11 nonresidents. The disease did not at any time become epidemic. The chief source of the infection is from the interior of the Republic, in which smallpox remains-endemic, as but few native Panamans outside the cities of Colon and Panama are vaccinated. There were no deaths from smallpox. Rats and anti-plague work.-Second only to malaria control is the problem of rendering the Isthmus safe from an invasion of bubonic plague. But two cases have originated on the Isthmus since the American occupation. (In 1905 at La Boca, 2 laborers devel,oped the disease and died. A vigorous rat campaign in the vicinity followed and but one infected rodent was found. Apparently the disease was stamped out.) But bubonic plague exists in North, Central, and South American ports, necessitating strict care in quarantine and internal measures against rats. In building Panama Canal piers and docks every precaution was taken to make them rat-proof. In addition to rat-proof construction of buildings, a circular of the Governor requires all building material, forage, and other stores to be placed so as to discourage rat harboring and favor their elimination. One of the -most valuable measures is the placing of practically all kinds of materials on elevated racks, with a minimum of 12 inches clear :space below, with open aisles at short intervals between, permitting inspection, trapping, and poisoning and also discouraging the wary rodent from nesting therein. In keeping food from rats the utmost vigilance is exercised. In shops and warehouses have been designated certain places only in which the men may eat their lunches so as to facilitate the collection and removal of all scraps of food. The keeping of chickens and pet animals in the Zone is restricted in order not to furnish food for rats. Evidence accumulates as to the very large quantity of rats living in the jungles and pastures. At times migrations seem to occur and they have been seen swimming in large numbers in the Canal and lock chambers. The sylvan rat is not so wary as his city brother and is easily seen and caught. During clearing operations about one of the new Army camps the laborers killed hundreds of rats daily. A number of these rats were captured and they and their fleas have been sent to the Bureau of Biological Survey at Washington for identification. Fleas are numerous on the jungle rats.

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19 Trapping and poisoning is regularly done in the terminal cities, chiefly to obtain rats for the laboratory, to which all rats, alive or dead (if not too-badly decomposed) are sent for examination. No plague-infected rats have been found. Of the poisons used, barium carbonate has proved most effective. Many ways of preparing the poisoned baits were tried, in addition to the routine methods of mixing with meal, flour, or chopped fresh meat. In one commissary storehouse, the powder sprinkled on a half cantaloupe caused the death of 24 rats in one night. The health officer of Colon reports the best results, as well as facility in handling the baits, from mixing the barium carbonate in proper proportions in dough and baking as a loaf of bread. Split cucumbers, with the powder sprinkled inside, also proved alluring to the rodent appetite. It was also attempted to catch rats by means of a viscous, slowdrying varnish spread on baited metal plates, hoping thereby to catch not only the rats, but their fleas as they left the dead bodies. This method proved more efficacious in catching mice, as the rats were generally too wary to become entangled in the varnish. It was shown, however, that once a rat stepped upon the plate his death was certain. Garbage disposal.-The new incinerator at Colon was completed sufficiently to place it in operation in September. At this incinerator is destroyed all the garbage of the cities of Colon and Cristobal. Previously the garbage had been burned in the open on dumps, and later, on a temporary, unsheltered, rail incinerator. During the rainy season especially it was very difficult to destroy the garbage by these methods; flies were bred abundantly and numbers of rats were attracted and fed. Following the beginning of operations by the new incinerator the fly infection of the two cities was notably decreased and now the district is as comparatively free from flies as can be expected. The incinerator on Gavilan Island, destroying garbage from Panama, Ancon, Balboa, Amador, and other places at the Pacific terminal of the Canal, was closed for repairs in December, necessitating, for the time being at least, other methods of handling the garbage. The Health Officer of Panama undertook to dispose of this material on the dump near the beach just outside the city. Each day's collection was brought out in the morning, beginning very early. Every load as it arrived and was dumped was thoroughly sprayed with a solution of larvacide (crude phenol, lye, resin soap liquid) to destroy adult flies and as many larve as possible. After placing on the dump and leveling it off, the garbage was covered with 4 to 6 inches of earth to prevent infection by flies. Twice daily thereafter, for 10 days following placing in position, the surface of the dump was sprayed with the larvacide solution. The results were surprisingly good. Large areas of low wet land were filled, with some subsequent sinking, of course, but not enough to restore their bad features. Nuisance from odors and unsightliness did not develop. Some flies, of course, emerged and escaped without being destroyed, but there was nothing like the tremendous breeding that occurred at Colon when garbage was burned in the open. Rats have not been apparent about the dump. Possibly they are repelled by the crude carbolic acid emulsion spray with which the ground is sprinkled. The operation of the dump proved to be much cheaper than incinerating.

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20 Should it prove advisable to continue this method of garbage disposal, there are troublesome low areas, such as the ditches alongside the Curundu River flume, that can be filled with garbage and other refuse, with great permanent advantage to the sanitation of those places. Venereal disease campaign.-In its basic elements the venereal disease situation remains practically unchanged. Situated at the terminals of the Panama Canal, the cities of Colon and Panama are daily visited by hundreds of seamen of commercial vessels of various nationalities and sailors of the United States Navy, and also by soldiers of the United States Army on the Canal Zone. The constant influx of this type of transient males is naturally calculated to attract a multitude of prostitutes from other countries, as well as native ones, who, learning of the rich harvest to be reaped here, and the light restrictions on their freedom, consider these cities fruitful fields for their activities. A very large proportion of these women, as may be expected, are infected with venereal diseases. Intimately associated as are the Americans and others living on the Canal Zone with the two Panamanian cities, the problem of venereal disease causes the greatest concern to the authorities of the Canal. Since 1904 there have been about 30,000 cases of venereal diseases among employees and their families treated by Canal physicians. Doubtless a great number of infections escaped being treated and reported. At a meeting of representative American and Panamanian citizens in 1919 was adopted the "Program of Attack on Venereal Disease" as outlined by the Surgeon General of the United States Army during the World War; but this program has never been satisfactorily carried out because of the radically different viewpoint of the Panamanian people. In the beginning of the campaign it was not considered advisable to attempt radical law enforcement measures. Effort was directed toward means for diagnosis, treatment and prophylaxis of venereal disease, and toward a general campaign of education to build up sound and clean public opinion, hoping that proper laws and their enforcement might be a later development. Venereal disease clinics were established at Colon and Panama. The clinic at Colon, opened March 1, 1920, is maintained by the A merican Red Cross. The Panama clinic was opened August 25, 1919, at Santo Tomas Hospital. The Colon venereal clinic.-In the 10 months of operation of the Colon venereal clinic, 666 patients were admitted, classified as follows: Men. Women. Syphilis. 56 54 Gonorrhea. 183 57 Chancroid. 71 25 Syphilis and gonorrhea. 8 28 Gonorrhea and chancroid. 6 5 Syphillis, gonorrhea, and chancroid. ..3 Miscellaneous (nonvenereal). 45 125

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21 Men. Women. Arsphenamine (doses given). 94 364 Mercury injections. 18 256 Discharged apparently cured. .37 60 Average number of visits to clinic. 4 () Sent to hospital for treatment. 12 101 Dark field examinations. 10 5 Prophylactic treatm ents. 340 Wassermann tests: Ninety-one positive, 261 negative, 26 doubtful. Although the above table shows a fraction less than 58 per cent of the women to be infected, this figure is conservative and probably misleading, as wherever a record is doubtful it is counted as a negative. It is also realized that of the 60 "apparently cured" cases a number may remain infectious, because of the known difficulty of curing chronic gonorrheal endocervicitis by topical applications, and also from the fact that the women usually take a chemical douche before coming to the clinic for examination. Three successive negative smears arerequired before the case is discharged. The average number of visits of infected men to the clinic was so small that but little benefit could be expected from the treatment given. Not a man ever completed the course of antisyphilitic treatment. The chief progress was achieved with syphilitic women, most of whom, being compelled to come, to the clinic, received sufficient treatment to render them noninfectious for the present at least. The Panama venereal clitic.-The work of this clinic at .Santo Tomas Hospital has been especially valuable. At first but one physician and two nurses were employed, but as the work grew it became necessary to add a second physician to the staff. From an average of 30 or 40 patients daily, the number has grown to over 100 a day, men and women coming on separate days. The fee for service in the clinic is 10 cents for each applicant registered. This purchases an admission ticket which thereafter entitles the holder to entrance to the clinic. Drugs or prescriptions to be taken to the patient's home are sold at actual cost and patients that are absolutely unable to pay are given free medicine. No charge is made for medicines or dressings used in the clinic. For Wassermann tests the fee is $2 when the patient is able to pay, but it is given without charge to the poorer patients. Salvarsan is sold at varying prices; to patients who are well able to pay, $5 per dose is charged; patients unable to pay full price, but capable of contributing something, are charged $2 per dose; charity cases are furnished free injections when they have no money and would be a menace to the public health if left untreated. Spinal punctures are charged for in the same manner and at the same rate as the Wassermann tests. At present the receipts from the clinic are sufficient to meet all its expense and it is now entirely self-sustaining. All laboratory work for the clinic is done by the laboratory of the hospital and prescriptions are filled and stock remedies supplied by the hospital pharmacy. A complete record of every case is kept by the nurse in charge of the records of the clinic. Patients are given literature covering the Attendance compulsory.

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22 principal points in their disease, and advice as to how to get well by carrying out certain measures and how to prevent the spread of their disease to noninfected individuals. Every new case is investigated in order to locate the source; when the origin can be found, the infected individual is rounded up by the police and held in the detention ward at the hospital for treatment. In connection with the department of treatment a prophylactic station is maintained and kept open day and night. This station has been widely advertised to the local population and to all incoming ships, and many sailors have taken advantage of the privilege. Since the clinic has been in operation 3,263 prophylactic treatments have been given to men of many nationalities. A third department is also operated by the clinic, in which all prostitutes that report under the provision of Degree No. 12 of 1918 (Panama) are examined. Under existing laws all these women are supposed to report weekly for examination, but this state of affairs has never yet been, and never will be, realized. By working in connection with the health officer of the city and the inspector of police, it has been possible to increase greatly the number of prostitutes who report weekly. In the beginning only a small number came, but at present this has about been trebled, and the outlook is encouraging. A physical and microscopical examination is made on each case, and every woman found in an infectious state is confined to the hospital for treatment. The noninfected individuals are allowed to return to their abodes. Free antiseptics are furnished these women to take to their homes, with instructions as how they are to be used, and at each weekly visit to the clinic they are questioned regarding their supply and its application. While in the hospital the infected women are not idle, since a large workroom has been established in which they are made to sew, roll bandages, and pack gauze and cotton, while being treated. It is found that this exercise tends to encourage these people and to maintain them in a more cheerful and tractable frame of mind. It is shortly planned to add a small hand laundry to the work which they are now doing. In addition to helping the hospital while they are confined there, it is hoped to teach at least a part of them an occupation, and later to secure positions for them, so that it will not be necessary for them to return to their former lives upon release from the hospital. In the accompanying report of Santo Tomas Hospital (q. v.) are given the statistics of the work of the clinic for the year 1920. It is felt that the educational advantage of the clinic can not be overestimated. Patients report to the clinic from homes which are in many instances wonders of squalor, filth, and disorder. Some of them have been previously treated by quackdoctorsorby physicians poorly equipped both in knowledge and appliances. To visit a clean, well-furnished room, equipped with shining modern appliances and in charge of a competent physician and nurse, works a wonderful transformation in the minds of these patients. They feel that something worth while is being done for them, and the mental attitude is so much improved that their physical condition reacts accordingly. The patient is made more-hopeful, and not only does he return as directed until his condition is improved, but he spreads the news of his recovery to many people of his acquaintance.

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23 While the results that have been accomplished are gratifying, it is thoroughly realized that the field has hardly been touched. So widespread is the feeling in the Republic that prostitution is a necessary evil and that venereal disease is of little consequence, that it is practically impossible at the present time to carry on a campaign that will accomplish more than a limited amount of good results. The best that can be hoped for now is to spread as much favorable propaganda as possible and to attempt to educate the people to a point where, a little later, laws may be enacted which will bring about the abolition of commercial prostitution. At present the lawmakers as well as the populace are against any attempt at abolition; consequently it would be futile even to think of accomplishing it under the present government. However, by carrying on the educational work in a vigorous manner for a few years, it is felt that it may ultimately be possible to secure the passage of laws which will eliminate recognized prostitution from the city and limit to a minimum the incidence of venereal disease. Examination of school children.-The annual physical examination of school children of the Canal Zone was made, starting in October. The results for the white children were as follows: Number of children examined .1,835 Number found needing treatment. 860 Number with defective teeth as only defect. 398 Number with defects other than teeth only. 462 D efects found .935 Teeth. ..519 Vision. 143 H earing. ..12 Nasal breathing. ..33 Hypertrophied tonsils. ...167 O rthopedic. ..4 Pulmonary. 2 Malnutrition. 3 Cardiac. 11 Chorea and other nervous diseases. .3 Contagious diseases. 10 M iscellaneous. ....28 Number vaccinated. 193 The parents were notified in each case when defect was found, and advised as to proper treatment either by the district physician, in a Panama Canal hospital, or by a dentist. Of the total 935 defects found, but 221 were reported as having been treated. This can not be accepted as an accurate figure, however, as treatment was undoubtedly given in many cases, but not reported to the district physician who made the original physical examination. No record was kept of the defects found in the colored children, but proper advice was given at the time of examination by the district physician. PANAMA HEALTH OFFICE. (Dr. HENRY GOLDTHWAITE, Health Officer, Panama City.) Malaria.-The following table of malaria cases charged to the City of Panama for the years 1914 to 1920, inclusive, shows practically the result of intensive work on the part of this office: 1914 ..2,154 1915 ..614 1916 ..235 1917 .187 1918. .97 1919 ..181 1920 ..100

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24 There is no reason to believe that the source of infection in the 100 cases reported for the year just passed, charged to the City of Panama, was from within the city; as it is hardly possible for anopheles to come to maturity within the district under charge of this office, the infection doubtless comes from areas beyond our present control. The consumption of crude oil by this office per annum shows graphically fills made and ditches straightened and eliminated: ANNUAL CONSUMPTION OF OIL. Gallons. 1917 ...44 ,896 1918. 15,701 1919 ...17,828 1920 .9 ,365 Attention is again invited to the necessity for the sanitation of that district near the city known as "Las Sabanas"; the district in question is more or less thickly populated, from the terminus of our present sanitated area, the Tumba Muerta Road, to the Rio Abajo. The area could be sanitated without much trouble, and at a moderate expense. This should be done not only for the benefit of the Panamanians but for the many employees of The Panama Canal who use the Sabanas Road for pleasure trips; the use of this road will constantly increase, with a corresponding increase in the cases of malaria, as the improvement of the Sabanas Road progresses toward Chepo. Infant mortality.-The following shows the annual death rate of infants under 1 year of age for the years 1914 to 1920, inclusive: Rate per thousand. 19 14 ..2 72 19 15 .22 1 1916 .235 .86 1917 ..237.73 1918 ...188 .27 1919 .154 .47 1920. ..155.30 Smallpox.-A total of 14 cases of smallpox was reported as having occurred in the city of Panama during the year 1920; thee cases all originated from points outside of the city. During the year 17,294 persons were vaccinated by this office. Many of these vaccinations were done on persons entering the City of Panama by water from other parts of the Republic, which is beneficial in so far as it relieves us of the care of smallpox patients and, of course, is gradually lessening the danger of infection from the interior. There was issued a total of 3,205 vaccination cards to persons leaving the Republic by sea. The majority of these individuals were West Indians. Veterinary work.-Fees collected as a result of the work of veterinarians attached to this office amounted to $3,586.99, which sum includes fees collected for inspection of cattle and swine and disinfection of hides and skins. There were 15,023 head of cattle and 11,402 hogs killed and inspected at the Panama abattoir under the supervision of our veterinarians. Of these the following were condemned: Cattle-Septicemia, 8; anthrax (died in pen), 3; infiltration and ecchymosis, 3; sunstroke, 2; tuberculosis, 1; gangrene, 1; asphyxia, 1; steers

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25 (cause not stated), 5; total, 24. Hogs.-Measles, 609; sunstroke, 59; sucklings (cause not given), 18; cholera, 10; gangrene, 3; tuberculosis, 2; tetanus, 2; pyemia, 2; urtricaria,.1; pneumonia, 1; total, 707. Flies.-The use of fly paper and fly traps has practically been abolished by this office. We are using instead wires, dipped in what might be termed "tanglefoot mixture." This method seems to be more successful, but of course the main point in the elimination of flies is in the destruction of their breeding places. This is being continually done, but no city of this size can ever hope to be absolutely flyless, and it is a constant fight. Milk and dairies.-The milk situation continues to improve. A more or less flexible standard of 300,000 bacteria per cubic centimeter for raw milk has been set by this office, and the present bacterial count shows many samples having considerably less than 100,000 bacteria per cubic centimeter. With the passage of time, the dairy owners are becoming aware of the fact that cleanliness means more money to them. It is but a repetition of the history of all cities where supervision of the milk supply has been attempted. Possibly we have had less trouble than in any place in the United States of similar size, mainly for the reason that the orders from this office are mandatory, and there is practically no appeal therefrom. The "Lecheria Central," or central plant to which all milk'from the various dairies is sent, was opened for service in January, 1920, since which time no milk has been sold in the city except that which is pasteurized at this plant. The lecheria is owned and operated by the dairymen's association. A limited quantity of clean, fresh butter is also produced by the plant. As soon as an adequate supply of bottles of the standard size (1,/5 gallon) can be secured it will be required that all milk be also bottled at the plant and that no loose milk be sold. Fines.-There were 1,425 fines imposed for violation of sanitary regulations and $2,684.50 collected as a result thereof. Garbage disposal.-At the time this report is written we are burying all garbage from the City of Panama and the terminus of the Canal, owing to the necessity for extensive repairs on the Gavilan Island incinerator. This method of disposal is being done at an approximate cost of $1,265 per month for the total work, as against a 3-year average of $2,410.64 per month for incineration of the garbage from the City of Panama alone. Venereal diseases.-During the year 395 cases of syphilis were reported to this office and 1,111 cases of gonorrhoea; this by no means represents the actual total, as it is almost an impossibility to have physicians report their venereal cases; constant urging seems to have little effect upon them. Tuberculosis.-The number of deaths from tuberculosis for the years of 1914 to 1920 inclusive, are as follows: 1914 ..229 1915 ..245 1916 .313 1917 .348 1918 .254 1919 .241 1920. 206

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26 The Health Officer is of the opinion that the number of deaths from tuberculosis will be largely reduced if we can enforce the regulation requiring each person to have at least 300 cubic feet of air space in living quarters. The enforcement of this regulation would not only tend greatly to reduce the number of deaths from tuberculosis but should naturally result in a reduction in the infant mortality rate. COLON-CRISTOBAL HEALTH OFFICE. (Dr. J. L. BYRD, Health Officer.) The new concrete Panama Railroad stables, thoroughly rat-proof, offering every facility for cleanliness, and affording accommodation for all the privately owned animals of the city, were completed during the year and all the old unsanitary private stables in the city have been demolished. The new garbage incinerator was placed in operation on September 1, and has been operating continuously ever since. It has two 30ton units, or a rated capacity of 60 tons in 24 hours, but as at present operated it is consuming an average of 60 tons in 16 hours of each day, 50 per cent more than the rated capacity. No fuel is used, yet all kinds of garbage, manure, and rubbish are consumed without. difficulty. By the addition of another unit, of 50 tons capacity, the operating expense could be reduced, possibly, by 30 per cent and much of the wear and tear of present machinery from overwork would be prevented. The improvements in stables and garbage incineration have practically eliminated all the principal fly-breeding areas in Colon and for the past 3 months the city has been remarkably free from flies. Several improvements were made in the Colon municipal market during the year. A new roof with skylights was placed on the building, the wooden vegetable counters were replaced with concrete slabs and the meat stalls were inclosed by wire netting. Infant mortality.-The infant mortality rate during 1920 was 142.41 as compared with 155.29 for 1919. The rate continues to remain high, due principally to the economical status and marital conditions of the larger percentage of the population of the city. The fresh milk supply for Colon amounts to less than 40 gallons per day, which is absolutely inadequate. The erection of a modern sanitary plant for the reconstruction of powdered milk is very greatly needed in this city. However, it seems the Panamanian authorities do not think so, for they have absolutely refused to allow the installation of such a plant in the city of Colon. Street cleaning.-Most of the streets in Colon are in a very bad condition from lack of repairs. The concreting of these streets is a much-needed improvement and would greatly facilitate cleaning. It is recommended that a modern street-sweeping machine be purchased for the purpose of sweeping all paved streets in Colon and Cristobal. This would expedite the work and reduce the force necessary to keep streets clean. Fines imposed for violation of sanitary regulations during the calendar year numbered 453, amounting to $984. Antirat work, such as rat-proofing of buildings, elevation of bulky material and foodstuffs from the floor or the ground, thorough collection and disposal of garbage every 24 hours, and poisoning and

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27 trapping for the purpose of detecting any rodents that might be plague-infected, was carried on during the entire year. Barium carbonate mixed thoroughly with the other ingredients of bakers' bread and same baked into the ordinary loaf was found to be the most satisfactory method of using this poison. This office found it necessary to employ a force of laborers to do concrete repair work for private parties in Colon. We collected $5,443.55 for such work during 1920. Veterinary work: Quarantine inspections: C attle. 29 ,159 H ogs. .10 ,876 Ante and post mortem inspection: C attle. .30 ,771 H ogs. ..10 ,73 1 Condemnations: Carcasses, cattle. .35 P arts, cattle:. ..1,350 C olon ..150 C ristobal ..1,200 Carcasses, hogs. 516 Colon. 162 Cristobal.:. 354 Hogs passed for sterilization. 141 A charge for inspection of 25 cents for cattle and 10 cents for hogs per head is made against the Colon abattoir. The collections for this work since this charge was authorized (August 10, 1920) amounted to $982.05. Food inspection.-During the past 2 months one sanitary inspector was assigned to food inspection only. The results have been very gratifying as shown by the improvement in the general cleanliness and sanitary condition of bakeries, dairies, ice cream parlors, restaurants, hotels, messes, etc. The following establishments are now receiving regular and systematic inspection by the food inspector: 10 hotels, 37 restaurants, 3 messes, 18 bakeries, 5 bottling works, 8 markets, 48 vendors, 14 ice cream parlors and soft drink stands, 6 dairies. Mount Hope district.-As conditions warrant, antimalarial work in Mount Hope district has been gradually extended; 30,242 linear yards of open drains were installed during the year. The installation of very narrow drains in low swampy areas is being tried out extensively in this district and they have proved very satisfactory. The antimalarial work in the district has been effective this year, as is shown by the low malarial rate compared to former years. It is contemplated to install an extensive system of tile drains throughout the district during the next dry season in order to reduce the cost of maintenance of open drains. DIVISION OF QUARANTINE. (Surgeon S. B. GRUBBS, U. S. P. H. S., Chief Quarantine Officer, January 1, 1920, to October 27, 1920.) (Surgeon W. C. RUCKER, U. S. P. H. S., Chief Quarantine Officer' October 28, 1920, to December 31, 1920.) It has been the constant aim of the Chief Quarantine Officer to administer the quarantine regulations with the minimum inter-

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28 ference with commerce and to reduce restrictions and delay of shipping to the lowest point compatible with reasonable safety to the health of the Republic of Panama and the Panama Canal, the personnel of vessels touching at Canal ports and of the countries to which they are destined. Communicable disease may be brought here from the entire globe, and without proper sanitary supervision, the Isthmus is capable of becoming a focus for the redistribution of disease to many far distant points; the prevention of this by maritime quarantine is a problem resolving itself into: (a) Securing accurate first-hand knowledge of the sanitary condition of ports dangerous to the Panama Canal. (b) Stimulating the owners and operators of ships to prevent the ingress of infected persons, animals, and things to their vessels. (c) The routine inspection of vessels and their personnel at ports of arrival in the Canal Zone, the isolation of infected or potentially infected persons, the fumigation of infected ships, and the periodic fumigation of vessels for the destruction of rodent and insect carriers of disease. In the application of these sanitary safeguards it has been constantly borne in mind that it is the living disease vector which is most to be feared and it is this danger, rather than the inanimate disease carrier, which accordingly has been stressed. In mid 1919, Doctor Grubbs, then Chief Quarantine Officer, was detailed to make a tour of inspection of the west coast of Central America. The ports visited were Punta Arenas, Costa Rica; San Juan del Sur and Corinto, Nicaragua; Amapala, La Union, and Acajutla, Salvador; and San Jose de Guatemala. Also the interior cities of Grenada, Managua, and Leon in Nicaragua were visited. The objects of this trip were (1) to gain first-hand information of conditions, (2) to establish personal relations in order to obtain information by more direct means, (3) to stimulate preventive measures, especially regarding yellow fever, and (4) to modify our procedure at Balboa to correspond with actual conditions and necessities. All these objects have been accomplished in a very satisfactory manner. If the Canal authorities can stimulate neighboring countries to prevent such diseases as yellow fever and plague, they will be protecting themselves and will facilitate commerce to the benefit of the Canal and the world as a whole. Not only has a warning against plague been sounded but arrangements have been made, or are pending, that will do a great deal to prevent the recurrence of yellow fever in the future. In Corinto a permanent sanitary inspector will devote his entire time to stegomyia elimination. As long as this work is continued yellow fever will spread to a very limited extent, if at all, in Corinto. As to changes in quarantine procedure:(1) La Union.-We formerly required vessels to leave the wharf at 5 p. i., otherwise they would be fumigated on arrival at Balboa. This restriction has been removed because there is no mosquito breeding on the wharf; if there were, it is doubtful if they could get aboard a vessel. The removal of this restriction is of more advantage to shipping than is at first apparent as, on account of a strong cross current, it is possible to dock only on a slack tide and a vessel moving out to anchor at night may not be able to get to the dock until noon the next day.

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29 2. Corinto.-Vessels were required to anchor in the stream at night, and the fumigation of vessels before sailing has been required since last August. Both these restrictions have been removed for the same reasons that apply at La Union. Inspection of all of Corinto -for mosquito breeding has been in progress for some time. (3). Punta Arenas.-Formerly our restrictions required that passengers who had stopped over night be quarantined; those who had been in the port during daylight only were not held. This restriction has now been removed for two reasons (1) Punta Arenas has had no yellow fever for several years nor have there been any known cases in Costa Rica and the mosquito conditions are not bad; (2) passengers can leave Punta Arenas for Cristobal via Limon against which no quarantine is maintained, and if connections are good arrive in 2 days and are not delayed. Experiences during the past month have strengthened the belief that such inspection trips are of the greatest value and should become a fixed policy of the quarantine service. We must help our neighbors to keep free of quarantinable disease, and in our quarantine we have a means of bringing this about for their own and our good, for the ultimate aim of quarantine should be the abolition of disease #and not walling ourselves in against outside dangers we take no steps to abolish. A similar tour of inspection was made of the western ports of South America. The following quotations from Doctor Grubbs' report indicate the results accomplished: Observations are attached hereto in the form of notes on the ports visited. In addition, a trip was made to Quito to express to the President of Ecuador and other officials the interest and appreciation felt for the radical manner in which yellow fever has been eliminated from Guayaquil, to assure them that we are ready to promptly recognize such work by modifying our quarantine procedure and to suggest that similar steps be taken against bubonic plague. At Lima a similar call was made, at the suggestion of the American Ambassador, upon the President, to express our interest in the extensive sanitary campaign he has inaugurated in Peru and especially in the efficient work now being done in the province of Piura. As there is no yellow fever at Guayaquil, and the city is probably noninfectable at present, it is evident that the quarantine against persons from that port should be entirely removed so long as such conditions are maintained. Tlis action will be the strongest possible incentive to have the present conditions maintained. As the minor ports of Ecuador were always infected from Guayaquil, their quarantine should similarly be lifted. The fumigation of all freight from Paita should be stopped as it is now arranged to have all lighters at that port fumigated whenever used for loading our ships, and for the fumigation of all dried hides, which are the only freight that may carry rats. As Paita is free from yellow fever and from stegomyia it will be proper to allow the quarantine officers, in their discretion, to count such time as may have been spent in Paita or Talara as against the quarantine period of passengers. All Ecuadorian ports have doubtless had yellow fever from time to time, but probably have none now. The infection undoubtedly has come in the past from Guayaquil, as quarantine has been enforced rigidly against foreign ports, but rarely against those of Ecuador. There is no quarantine physician except at Manta and here quarantine was in force against Paita and Buenaventura and enforced by keeping all vessels that had touched at these ports, no matter how many days before, in quarantine with all hands until 6 days from arrival had elapsed. Guayaquil is a city of 94,000 inhabitants on the Guayas River. Site is for the most part flat and during the torrential rains that fall in the wet season (December to March) is partly under water. During the dry season of 8 months there is practically no rainfall and the city is dry except for some brackish marshes on the outskirts. Guayaquil was destroyed by fire in 1896 and when rebuilt was laid out with wide regular streets. Active work is now going on to put down concrete and asphalt paving. Unfortunately this is being done in places before sewers are put in. The houses are mostly wood, or wood frames with stucco covering. In the poorer

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30 parts they are of wooden frames with flattened bamboo sheathing. A few ratproof concrete buildings are being constructed, but as cement costs 18 sucres ($8.00) a barrel these are the exception. Yellow fever has been endemic in Guayaquil for years and persisted in spite of several attempts at its suppression until the campaign instituted by the International Health Board. This was begun in November, 1918, and was successful, the last case being reported in June, 1919. Guayaquil is not only free from yellow fever now but is undoubtedly noninfectable. Antistegomyia work has been done in a less intense form in the small towns near Guayaquil, especially along the Guayaquil and Quito Railroad from Duran (across the river from Guayaquil) to Huirara. Bubonic plague is prevalent among the rats at Guayaquil. The last human case was reported last April.4 Considerable work is being done, probably as much as is possible under the circumstances, but this is directed as much against human cases as to the elimination of the disease among rats. The U. S. Public Health Service has for years maintained an officer at Guayaquil. Since the resignation of the last regular officer, an Ecuadorian graduate of an American medical college has been on duty. He issues the U. S. bill of health on board just before each vessel sails for a United States port. Before doing so he inspects the officers, crew, and passengers and fumigates (Clayton apparatus) the holds that have received freight, and the crew's quarters. Paita, Peru: This is northernmost port of Peru touched by regular lines; 2,700 inhabitants. The bay is a mere indentation but is protected by a point so that it is almost always calm. Weather is moderate and bright. It practically never rains. Paita is the outlet for the important valleys of the Piura and Chira rivers.' Its exports are almost entirely cotton, with some dry hides. Paita and the surrounding towns have had two severe outbreaks of yellow fever and plague within the past year. Yellow fever has almost disappeared following an antistegomyia campaign which is still in force. Plague is also improved but this is due more to the natural extinction of rats by the disease than to any human efforts. Extensive plans have been completed for the rebuilding of a sanitary and rat-proof Paita to follow the burning of the present town which is made largely of cane and mud, but delays have continued. No-yellow fever has appeared south of the Province of Piura for many years but the entire coast may be considered plague-infected.s The ports down to Callao are all open, usually quite rough, dry, and barren. Vessels all lie out one mile and load by means of open lighters. Callao (population 50,000) is the chief seaport of Peru and the port for the capital. Lima, 8 miles inland, with its suburbs is said to have 400,000 inhabitants. Yellow fever has not been reported in these cities for several years although there are many stegomyia, especially in summer. Our chief consideration is for plague, which is endemic. The health authorities are absolutely indifferent to this disease, make no efforts to catch rats or to change the form of construction even in new buildings. Callao is 4 days from Balboa by direct steamer." The following memorandum was issued by the Chief Quarantine Officer, August 26, 1920: "Memorandum for the Quarantine Officers, Cristobal and Balboa: "The 6-day detention period for passengers in good health from Guayaquil and other Equadorian ports, is no longer required. "The Province of Piura, Peru, is under yellow fever quarantine, but the ports of Paita and Talara may be considered entirely safe from yellow fever in computing the 6-day quarantine period. You are authorized to take into account the time that passengers arriving at Balboa have spent in the city of Paita, or in Talara, or the oil field adjacent thereto. The above must be considered as a distinct concession and passengers must be prepared to present evidence that will satisfy you that they have complied with this requirement, or they must remain at the quarantine station to complete the 6-day period. The object of this arrangement is to relieve those places where efficient antimosquito work is being maintained from quarantine restrictions, at the same time keeping such restrictions upon interior points where this work has not sufficiently advanced." s 4In the last 5 months of 1920, 92 cases of human plague were reported from Guayaquil. (U. S. P. H. S. Report&) s Since January 1, 1921, an extensive prevalence of yellow fever has been reported in the Department of Lambayeque, south of the Province of Piura, probably existing for some time previously. At present a 6-day quarantine is enforced at Balboa against all ports north of Callao.

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31 The Quarantine Officer of Cristobal was detailed to make an inspection of Buenaventura and Tumaco, Colombia, with a view to recommending what quarantine restrictions should be enforced against these ports. The following excerpts from that officer's report are self-explanatory: Buenaventura: The rainfall is about 400 inches annually and is well distributed throughout the year. The tide enters the lower levels of the town, and with the rainfall, is an important factor in keeping the town in a habitable condition. I slept on shore but did not encounter any mosquitoes. The water containers are well screened. This is the port for Cali, Manizales, and other places. In my opinion, there has been no yellow fever here since 1915 and then the infection was probably introduced from Guayaquil. It is recommended: 1. That the quarantine be lifted, provided that within 3 months an active antimosquito campaign be underway. 2. That the Colombian, Government finance this campaign and that the sanitary officers of the government direct the work. 3. It is suggested that in carrying out the work, the sanitary officer secure the cooperation and assistance of Mr. Walsh, the American Consul. 4. That our attitude at the end of 3 months depend on the manner in which the above recommendations are carried out, as shown by reports from Mr. Walsh, and their compliance with suggestions offered by him. Tumaco: This town is 537 miles from Balboa and is situated in the southwestern corner of Colombia. It has a population of 6,000 and is located on an island which is about 5 feet above sea level. The soil is sandy and no water remains after the rains, except that collected in screened tanks and barrels. The sanitary conditions are the best I have seen in any of the smaller towns of Latin America. There is no trace of quarantinable disease having occurred here for at least 15 years. It is earnestly recommended that the quarantine be lifted at once. Following the receipt of this report the following instructions were issued: To the Quarantine Officers, Cristobal and Balboa: 1. The 6-day detention period for passengers in good health from Tumaco is no longer required. 2. The 6-day detention period for passengers in good health from Buenaventura is provisionally lifted. During the year the general quarantine instructions have been entirely revised and amendments relative to night quarantine service have been promulgated. On February 5, 1920, the quarantine regulations were extended to include influenza and similar diseases as maritime quarantinable diseases. The following instructions relative to vaccination have been ollowed throughout the year: To Quarantine Officers: In order to facilitate travel and to avoid unnecessary vaccination of passengers who are amply protected against smallpox, quarantine officers are authorized to issue a certificate of vaccination which will be good for 5 years after they have vaccinated an individual and have personally observed either (1) successful vaccination, (2) vaccinoid, or (3) immune reaction. The following technique must be strictly followed: The part to be vaccinated (preferably deltoid insertion) should be washed with soap and water, if necessary, and in any case with alcohol. After vaccination it is advisable to expose the arm to the open air for 15 minutes before the clothing is allowed to touch it. No shield or other dressing should be applied. Vaccinate by one of the following methods: 1. Linear incision or abrasion. Use a sterile needle and with a single downward stroke for each make three scratches, each i-inch long, parallel to each other and to the humerus, and 1 inch apart. Rub vaccine into two of these scratches, using a sterile toothpick, or other instrument. The third scratch will be used for a control. 2. Drill method. A sterile drill or dental chisel, about 2 millimeters wide may be used. With a twisting motion and moderately firm pressure make three small circular abrasions, 1 inch apart, two above and one below. Rub the virus into two of these abrasions, leaving the third for control.

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32 Direct patient to return for observation on the second and fifth day. When time is limited, 24 hours may be sufficient to observe reaction of immunity and when this is established certificate may be issued. After observation of the fifth day in those not previously vaccinated, it may be necessary to have them return, on the seventh and later days. The following reactions only are recognized: 1. Successful vaccination.-In previously unvaccinated persons or in those whose immunity has completely disappeared, there should be present on the fifth day a vesicle, linear or circular, surrounded by a narrow areola, which progresses to a typical take on about the tenth day. 2. Vaccinoid.-In those whose relative immunity is somewhat low, this milder form of vaccination exhibits itself on the f.fth day as a smaller vesicle with a larger areola. The duration of the reaction is shorter and less severe. 3. Immune reaction.-Where the immunity of the individual is high, either from a previous vaccination or from an attack of smallpox, a subsequent attempt at vaccination results in a prompt, sharp reaction which reaches its maximum in about 48 hours and may entirely disappear within 4 days. At the site of the inoculation there is a small reddened papule, linear or circular, surrounded by a very narrow areola. Itching is prominent. Either of the foregoing reactions builds up or indicates immunity and warrants issuing a certificate good for 5 years. If none of these reactions occurs the result should be considered a failure and no certificate issued. Complete absence of reaction means inert virus or faulty technique. The above instructions do not prevent issuing of temporary certificates immediately after vaccinating to those who must leave at once, but these should not be given where a failure is observed unless applicant is revaccinated. THE ECONOMICS OF MARITIME QUARANTINE. Surgeon Grubbs made a study of the economics of maritime quarantine not only from the viewpoint of the indirect effect which the Canal quarantine exercises upon the health and therefore upon the commercial prosperity of ports from which shipping passes to the Canal, but also from the aspect of the actual saving which accrues directly to ships through the reduction of detentions to the lowest margin of safety. It is manifestly impracticable to arrive at an absolutely accurate figure which will represent the average tondetention-day loss of a ship in detention or an average passengerdetention-day loss for persons held in quarantine. The figure of 50 cents per ton-day for the former and $5 per passenger-day loss were therefore arbitrarily assumed. For all practical purposes these figures are accurate enough and by applying them it becomes possible to estimate and compare the results obtained from year to year. Thus in 1918, there were 151,176 ton-detention-days and 38,169 passenger-detention-days with a total direct loss of $267,935. In 1919 the loss was $173,538 and in 1920 it was $191,226. These figures show decreasing loss but unless the ratio of the loss to the total tonnage received is given the picture is not complete. In 1918 this loss was $23.15 per thousand ton received; in 1919 it was $12.02; and in 1920 it was $8.64. This is set forth in the following table: Total ton Total tonTotal pasLoss per Year. received detentionsenger-deten-, Total loss. 1,000 tons d days. tion. days. received. 1918. 11,572,473 154,176 38,169 $267,935 $23.15 1919 .14,512,721 161,376 18,570 173,538 12.02 1920. 22,128,254 48,172 33,436 191,266 8.64

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33 QUARANTINE TRANSACTIONS AT COLON AND CRISTOBAL DURING THE CALENDAR YEAR 1920. Vessels inspected and passed. 2,339 Vessels detained in quarantine. 5 Vessels given provisional pratique. 19 Total. 2,363 Number of days vessels were held in quarantine. 6 Supplementary inspections of vessels. 1,575 Vessels fumigated: For m osquitoes, SO ..18 For m osquitoes, Na Cn. 7 For mosquitoes, 80 and Na Cn. 6 For rats, 02 .49 For rats, Na Cn. 2 For rats, SO and Na C. .25 T otal. ..107 Crew inspected on arrival. 118,136 Passengers inspected on arrival. 43,657 Crew passed on certificate of medical officer. 43,618 Passengers passed on certificate of medical officer. .10,814 T otal. ....216,225 Supplementary inspections of persons on detained vessels. .4,612 Persons detained in quarantine station. 1,725 Number of days held. 3,452 Immigration.-The inspection of immigrants has continued as in previous years. ANCON HOSPITAL. (Col. L. T. HESs, U. S. Army, Superintendent.) Buildings and grounds.-A 2-story addition was built to the powerplant building; on the ground floor is the new carpenter shop, twice as large as the former one, and on the second floor are the electrical shop and miscellaneous stores of the electrician, carpenter, painter, and plumber. Following the change, the hospital bakery was transferred from the kitchen-mess hall building into the portion of the power-plant building formerly used as plumbing and carpenter shops, and the former bakeshop was occupied by the general mechanic as workshop and storeroom. A storage and receiving room for the undertaker's department was built as an addition to the Board of Health Laboratory. All chronic patients having been transferred to Corozal Hospital for the crippled and insane, the old frame building formerly occupied by these chronic cases was turned over to the Supply Department, razed, and reerected on one of their plantations. The old morgue and the old carpenter shop were evacuated and turned over to the Supply Department. Considerable work has been done toward improving the grounds by grading, sodding, planting of trees, etc. One hundred orange MR 77731-3

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34 trees, 50 grape fruit, and 25 avocado (alligator pear) trees have been set out. From trees already bearing on the hospital grounds the following amounts of fruits were gathered for use by the hospital: Bananas (stalks). 290 Papayas. 285 Bread fruits. 687 Mangoes. .7,841 Avocados. 1,089 Guavas. 2,385 Limes. 18,658 Coconuts. 234 Oranges. 285 Sour sap. 15 The hospital recommenced bakery operations in December. Thirteen thousand one hundred and twelve pounds of bread were made from 9,429 pounds of flour, the net cost per pound of bread being $0.0654. Motor transportation.-All cars were kept in good state of repair; all mechanical repairs, except emergency road repairs, are now made in the motor car house instead of in the hospital garage, by the employees of the motor car inspection department instead of by the local hospital chauffeur-foreman. This has resulted in increasing the operating cost of our transportation, without increasing the efficiency of the service in any respect. Certain of the transportation is requiring considerable repairs and will probably have to be replaced before long. Net running expenses. Mileage. Operating expenses. Cost of__________ _________ equipment. 1920. 1919. 1920. 1919. Truck No.282. $844.59 $1,170.56 $1,090.67 6,700 7,591 Truck No. 1209. 833.21 1,199.80 617.02 7,258 3,452 Hearse No.305. 1,412.74 707.33 580.09 1,248 1,605 Ambulance No. 301. ..632.50 1,320.42 1,347.05 6,917 7,597 Ambulance No. 303. 604.02 2,021.02 182.88 7,834 770 Ambulance No.307. 658.41 .1,048.76 .5,405 Ambulance No. 308. .762.30 1,975.33 1,649.94 8,935 8,035 Total. $5,747.77 $8,394.46 $6,516.36 38,892 34,445 Surgical clinic.-During the year 1,655 major operations and 5,781 minor operations wereperformed. Two thousand eight hundred forty-three cases visited the out-patient department, for whom 408 prescriptions were written, Two hundred eighty-nine obstetrical cases were delivered. Medical clinic.-There were 2,738 cases treated in the outpatient department, for whom 1,650 prescriptions were written. Eye and ear clinic.-Cases visiting the out-patient department numbered 7,542 for whom 2,650 prescriptions were written. One thousand fifty-two refractions were made and 1,215 operations performed. X-ray clinic.-There were 2,608 cases handled; 5,324 plates; 364 X-ray films; 1,533 dental films taken; 50 treatments given. Steward's department.-During the year 155,831 rations were issued to Ancon Hospital patients and 90,767 rations issued to personnel entitled to subsistence, a total of 246,598 rations; the net cost was $114,189.55. There were 36,897 rations issued to pay boarders, mostly nurses who are charged $20 per month; the payments for these amounted to $18,744.65.

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35 REPORT OF PATIENTS DAYS. 1920. .......................296,946 1919. ....................312,737 1918 .319 ,908 1917. .....311 ,451 1916. ...270,294 1915 .268,945 1914 .338 .901 COST OF SUBSISTENCE PER PATIENT PER DAY (ANCON HOSPITAL ONLY). 1920. $0.463 1919 ..3495 1918 ...315 1917. .3369 1916. ..2522 1915 ..2372 1914 .: ...253 MOVEMENTS OF PATIENTS, NONRESIDENTS OF CANAL ZONE. Total number treated. Died. Days treated. Ancon CorozalT Ancon Corozal Ancon Corozal Hospital. Hospital. Total. Hospital. Hospital. Total. Hospital. Hospital. Total. 1917. 274 76 350 7 3 10 5,101 21,396 26,497 1918. 510 76 586 9 10 19 7,667 20,431 28,089 1919. 883 56 939 19 3 22 15,434 17,245 31,779 1920. 1,250 54 1,304 16 1 17 24,418 15,979 40,397 1920. 1919. 19f8. 1917. 1916. Chronic patients: Total number treated. 33 34 38 63 52 Total number of days treatment. 9,626 9,710 8,603 9,836 9,174 Average number of patients per day. 26 27 26 27 25 Average per capita cost. 0. 315 $0.2654 80.2602 $0.2520 $0.2400 Movement of military patients: Total number of admissions. 860 1,392 4,165 2,469 1,937 Total number of days relief. 15,134 22,217 49,067 33,494 28,519 Average number constantly sick. 41.35 60.90 134.49 91.76 78.13 Admissions: To Ancon Hospital. 9,783 10,503 12,153 10,880 9,116. To Corozal Hospital. 170 151 229 191 225 To chronic ward. 7 8 13 45 26 To cripple farm. 12 17 39 54 59 Totals,. 9,972 10,679 12,436 11,170 9,426 Deaths: Ancon Hospital. ..276 343 336 368 325 Corozal Hospital. 32 43 73 30 57 Operations: Major surgical operations. 1,655 1,688 1,784 1,684 1,465 Minor surgical operations. ...5,781 5,813 4,424 1,775 1,333 Eye and ear oper.tions. .1,215 1,044 1,088 855 622 Refractions. 1,052 1,263 1,312 1,108 1,378 Obstetrical cases delivered. 289 314 321 301 246 Out-patient department: Totalvisits. 13,123 13,833 14,276 11,784 13,188 Prescriptions written. 4,708 5,424 4,230 3,798 6,289 Dispensary (district physician), Ancon: Total treated. 105,171 102,034 92,201 142,290 130,219

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36 FINANCIAL STATEMENT. 1920. 1919. Operating expenses. ..$705,836.14 $592,456.78 Revenues .438,582.01 322,222.37 Gross cost per patient per day (Ancon Hospital only) 3.82799 3.08166 Net cost per patient per day (Ancon Hospital only). 1.57536 1.65233 Operating expenses, Ancon Hospital. 592,691.54 492,366.09 Revenue, Ancon Hospital. .......348,776.06 228,367.77 Operating expenses, Corozal Hospital. 94,164.03 80,870.96 Revenue, Corozal Hospital. 88,927.95 89,330.60 Operating expenses, dispensary. .18,264.89 13,168.59 Revenue, dispensary ..643.25 528.00 A more detailed statement of operations, etc., will be found in the statistical tables at the end of this report. Among the recommendations of the Superintendent of Ancon Hospital, to cover more or less pressing needs of the institution, are the following: 1. Nearly all new hospital construction in the United States provides for hydroand electro-therapeutic apparatus, the need -for which in the tropics is greater than in the temperate zone. Residence in the tropics induces nervous conditions which are amenable to hydroand electro-therapeusis and the establishment of such a service in Ancon Hospital is recommended. Room therefor could be provided with small expense, in the basement of Administration-Clinics Building, the equipment being the main item of expense. 2. The organization of a urological-skin service, now under the !surgical service, will enable the hospital to care more satisfactorily for venereal and skin cases, which are not now, owing to the lack of a physician particularly qualified in genito-urinary work, receiving the attention they should. This proposed service can be taken care of on the third floor of the Administration-Clinics building, or in the proposed out-patient clinics building recommended below. 3. An "out-patient clinics" building, of reinforced concrete in harmony with design of present hospital structures, on the site near the dispensary is recommended for the purpose of housing the medical, surgical, and genito-urinary out-clinics and pharmacy. The present location of those clinics in the Administration-Clinics building renders them very inconvenient of access to out-patients visiting them. 4. With completion of permanent hospital buildings, steps should be taken to provide permanent quarters for hospital staff and gold employees in accordance with proposed plans. At least two of these quarters buildings should be constructed each year until completion of proposed layout. 5. A recreation hall, consisting of two large open pavilions of reinforced concrete in keeping with design of other hospital buildings, located on the hillside, is desirable for the use of convalescent patients. Such a building should be provided with covered passageways from the other sections of the hospital. The hillside should be terraced and set out in tropical plants anl trees (mostly fruit

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37 trees) and improved by walks, etc., to provide a suitable place for exercise of convalescent patients, especially those having tuberculosis, for whom no suitable means of out-door exercise is now provided. 6. Provision should be made for a sanitorium at some suitable place within the Canal Zone for the treatment of tuberculosis, with a view to segregating this class of patients. Under present conditions, these cases are sent into Ancon Hospital, for segregation in the isolation section, which is not well adapted nor of sufficient size for -their accommodation. 7. Two large tennis courts and a swimming pool should be constructed for the use of gold personnel in close proximity to the nurses' quarters. Some form of exercise is absolutely necessary in this climate to maintain hospital employees in the state of physical fitness demanded by their duties. 8. The nurses' quarters at the present time do not provide sufficient quarters for the nursing staff; it has been necessary to double up in a few rooms, and for others to be quartered elsewhere. The nurses' home provides quarters for only 70 nurses, while 78 are on duty. Such c6ngestion is not conducive to the best interests of the service, and provision should be made so that each nurse will have a room. 9. Exte.-ision-Section B.-Build an addition (basement and two, stories) to rear of service section. This addition is needed so that the private rooms in a portion of this section will have an outside corridor similar to that of the other private rooms. At present these rooms. are not desirable for use of private patients on account of the sun shining directly into the rooms during the days when it shines and during inclement weather the windows have to be kept closed, which renders the rooms stuffy, and is a source of constant complaint from private pay patients. Also, such an addition would give more room for the diet kitchen which at present is entirely too small for proper and efficient service of patients' diets. Further, it would afford more commodious reception rooms on first and second floors for use of visitors and incoming and outgoing patients, and in the basement provide a checking room for proper care of patients' clothing and baggage. 10. Animal house.-There should be built, in the rear of the laboratory a separate, suitable building for an animal house. At present such animals as are used for experimental and diagnostic work at the Board of Health Laboratory are kept in rooms which are dark, and although kept as clean as possible, the odor therefrom is very objectional and permeates not only through the laboratory building itself, but also to the street. People walking the road in front of the laboratory get the odor and a great many inquiries are made as to whether the odors are due to decomposing bodies in the laboratory. Aside from these facts, in the present location the animal rooms are not a suitable place to keep animals in a healthy condition. They should be kept in a separate building, especially designed to give. them sunlight, plenty of ventilation, etc., and also to reduce to a minimum an insanitary nuisance. 11. Because of the difficulty in getting hot dry steam to all parts of the hospital and laboratory, due mainly to improper location of the steam plant, it is recommended the power plant be relocated

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38 near the road back of the Board of Health Laboratory, about the present site of the attendants' quarters, and that a laundry be built in connection with the power plant, of sufficient capacity to handle the hospital linen. While the immediate expense may be considerable, with such a plant installed it would mean an immense saving to the hospital over the present arrangement. 12. Considerable equipment requires replacements and additional items are needed; the most important ones are, beds, cribs, mattresses, pillows, blankets, desks and office equipment for clinic offices, file cases for file room, china and silverware for private rooms and white sections, bakeshop and kitchen equipment, to include ice cream freezer and apparatus for ice manufacture, a pipe-cutting machine, a new ambulance and a new body for hearse (the present body is practically rotted out and will not last very much longer). COROZAL HOSPITAL. (Dr. Louis WENDER, Superintendent.) Corozal Hospital, for the insane, is located at Corozal, 3 miles from Panama. The hospital wards occupy an area of about 5 acres and include 10 ward buildings for the insane. The management of this hospital also includes that of the farm of 150 acres, 30 cultivated and 120 pasture, on which the hospital is located. This institution operates a piggery and a dairy, furnishing milk for hospitals, and some for the small children in the Canal Zone and for adults on physicians' prescriptions. In addition, a home for cripples injured in the service of The Panama Canal is provided and operated under the hospital management. BUILDINGS. There were no new buildings constructed at Corozal Hospital during this year, but a few alterations were made. The nurses' quarters were enlarged, making their rooms more spacious and adding two rooms, enabling us to accommodate our full organization of female nurses and stewardess. Ward "F," which has been utilized for the past year as an occupational ward for the male and female patients, was enlarged to accommodate more patients. This alteration was made in November at a cost of $1,200, which will be reimbursed by the income from articles sold from the occupational ward; already $500 has been turned in to be credited to this construction. The feeding platform for the piggery has been surrounded by a concrete wall in order to make it more sanitary and prevent food from slopping off the platform, thus preventing flies breeding. The platform has also been resurfaced, the work being done by the patients. A refrigerating machine has been installed in the dairy. The kitchen and the second story porches and roofs and part of the wards were painted during the year. A new concrete coal bin has been built at the railroad station by the hospital help, to facilitate the handling of coal for the hospital and quarters.

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39 HOSPITAL DEPARTMENT. There were 384 patients the first day of the year; 170 were admitted, 32 died, and 145 were discharged or transferred, leaving 377 remaining at the end of the year. We have endeavored to deport all those who could be sent back to their homes; the total deportations for the year numbered 80 patients. The occupational ward, which was established in the early part of 1919, has proven a great success. Nearly 40 patients are in this department making various articles, whereby they spend their time in a congenial manner which produces a beneficial effect upon their mental condition. Owing to the lack of accommodations, our occupational undertakings are scattered in various parts of the hospital grounds; however, we have succeeded in finding some sort of work to employ about 80 per cent of the female patients and 60 per cent of the males. An open, spacious, well-ventilated building where more patients could be brought during the day to be instructed, would increase the efficiency of the occupational therapy and benefit the patients to a greater extent. Over $4,660 worth of produce was taken from th6 patients' garden and utilized for their own mess. Undertakings of this character do not entail any expense to the Health Department and yet are a material benefit to the patients themselves. Broom-making machinery arrived recently and steps have been taken whereby some of the insane patients, and some of the chronics who were transferred from Ancon Hospital, will be induced to make brooms. Several chronics have already taken up this kind of work and are earning a little money in order to enable them to purchase small luxuries and other articles. The grounds in the hospital inclosure have been kept in order by patients detailed for that purpose. FARM DEPARTMENT. General.-The number of cripple employees has been reduced from 50 to 29, by obtaining employment more remunerative for them than their work on the farm warranted us in paying. This, with the reorganization of the farm, has reduced its running expense to a great extent. Dairy.-Our herd consists at present of 59 Jersey and 16 Holstein cows, 2 Jersey bulls, 1 Holstein bull, and 25 calves. With the regular arrival of feed from the United States and the pastures being in fairly good condition, we have been able to keep our regular supply of milk up to a good standard. Of the 25 Holsteins, which were imported from the United States in December, 1919, and immunized here against tick fever, 6 died as a result of the inoculation and 3 from other causes. The remaining 16 are doing well and we are at present milking 7 of them. With the installation of the refrigerator, whereby the milk can be cooled by mechanical refrigeration, we are able to save on labor and ice approximately $75 per month. Not only has this proven a success financially, but from a sanitary viewpoint, as the exposure and handling of the milk is reduced by one-third. We continue to pasteurize our milk after each milking as previously.

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40 Piggery.-There was a total of 272 pigs on December 31, 1920. During the year we purchased barrows and 30 sows from the Supply Department. These sows were of native stock and in very poor condition, but after being fattened were bred and are raising quite a number of pigs. There was only one death among the young pigs from hog cholera, as all our pigs are immunized at regular intervals against this disease. We have endeavored to supply Ancon Hospital with all its pork, selling the surplus to the Cattle Industry. Garden.--During the year a nursery was started in order to enable us to supply the Isthmus with various hedges and flowers. We have continued to raise vegetables, which are sold to the hospitals and the commissaries. The rose garden has been enlarged and we are able to supply the demands for roses from time to time. General remarks.-The general health of the patients, cripples, and chronics remains good. With the continued increase in the number of female patients, steps will have to be taken to construct a small ward to accommodate about 25 or 30 patients, due consideration being given to separate rooms for private patients, white Americans, and others who are willing to pay the extra cost, there being at present no suitable accommodations for the latter class of patients. COLON HOSPITAL. (Maj. T. J. LEARY, U. S. Army, Superintendent.) HOSPITAL WORK. The work is going along nicely. Many demands are made that the ordinary hospital is not called upon to meet, due to the fact that this institution combines an emergency hospital with a busy dispensary service. In addition to this work, quite a few calls are made by our physicians into the town and to ships in the harbor. BUILDINGS. These are very satisfactory. The painting of the hospital was finished during December and it now presents a neat and pleasing appearance. Ward "A" of the old hospital group has been given a slight overhauling, and is in condition to care for isolation cases coming to us for overnightto be transferred to Ancon Hospital the following day. The most urgent need of the hospital is an up-to-date X-ray equipment. The X-ray opeFator could replace one of our present force, and it would be of still greater advantage if he were competent to do gas-oxygen anesthesia and apparatus for gasoxygen anesthesia were installed at the hospital. The addition of such equipment would be a great time and labor saver and would be more suitable for emergency work than ether anesthesia. If any policy of expansion for Colon Hospital will be given consideration, it is believed the first addition to the present group should be a modern isolation wing. Colon will doubtless continue to grow rapidly in importance from year to year and in order to meet its growing requirements, the hospital facilities on this side should be expanded to the point of being able to hospitalize all of the sick from the Atlantic side. The principal objection to the present system is the separation of the sick from their families and friends.

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41 SANTO TOMAS HOSPITAL (Panama). (Maj. EDGAR A. BOCOCK, U. S. Army, Superintendent.) While Santo Tomas Hospital is not entirely under the jurisdiction of The Panama Canal it is, more or less, intimately associated with the Health Department by virtue of the agreement between the Republic of Panama and The Panama Canal, dated October 17, 1905, which reads as follows: "The affairs of Santo Tomas Hospital will be administered by a Board of Directors of five members, three of whom will be appointed by the President of the Republic of Panama and two by the Governor of the Canal Zone. Of the three directors appointed by the President, one shall be the Treasurer of the Hospital, and one the Secretary of the Board. The Chief Health Officer of the Canal Zone, thereupon, will be the President of the Board of Directors. The Superintendent, two internes, and three graduate nurses shall be appointed by the Governor of the Canal Zone and their salaries paid from the funds of the Canal Commission." Under the provision of this agreement, Santo Tomas Hospital has continued to operate under the joint administration mentioned and under the direct supervision of the Chief Health Officer of The Panama Canal. The year 1920 has been a particularly successful one for the hospital in many ways. The auditing and property accounting department, installed in 1919, has been perfected and enlarged with use, until it is now functioning efficiently and satisfactorily. All outstanding debts of the institution have been canceled and current monthly bills are now paid as soon as received. The revenues of the past year have amounted to $245,414.96, while the actual operating expenses have been $231,939.97, leaving a balance of $13,474.99 available for use. An excess of approximately $1,000 of revenues above expenses is now being shown monthly. An effort has been made to improve the purchasing department of the hospital to the point where the best possible supplies and equipment can be obtained for the least expenditure of money. Waste and extravagance have been lessened and economy and thrift in every department advocated and enforced. The buildings, many of which are very old and practically falling down, have been repaired, repainted, and rendered habitable until the construction of the new Santo Tomas Hospital shall be completed. The usual routine of repairs of furniture and equipment by hospital artisans has been accomplished. All new furniture, wooden legs, crutches, coffins, etc., are manufactured in the carpenter shops. All beds and tables have been reenameled and electric and plumbing fixtures installed and repaired. In fact, all maintenance and upkeep work has been done by the hospital personnel, thereby saving an enormous expense. Professional service.-All attention possible has been devoted to improving the professional service of the hospital and while it is still far from being ideal, it is undoubtedly advancing in efficiency. During the year, 14,584 patients have been treated; 155,593 days,

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42 relief have been furnished, an average of 422 patients per day during the entire year. The average length of stay in hospital, for each patient was 10 days. Eight hundred. fourteen deaths occurred in the hospital. During the year, 1,960 major operations and 2,721 minor operations were performed by the surgical service. Eight hundred seventyseven obstetrical cases were delivered. In the dental clinic, 4,756 treatments were given and 1,384 teeth extracted. There were 8,421 cases treated by the medical service in the hospital, and 8,840 patients treated in the dispensary; 12,489 prescriptions were filled in the pharmacy of the hospital. The ambulance service which operates under this department made 1,946 calls, and the dispensary vaccinated 17,270 persons against smallpox. During the year, 5,121 cases were examined and treated in the eye and ear clinic; 456 operations were performed; 11 refractions were made and 1,221 prescriptions furnished to patients. A total of 1,248 cases was handled in the X-ray clinic. Three thousand one hundred twenty-six plates and 522 dental films were used and 91 treatments administered. Marked success has been attained by the venereal clinic. During the entire year, 2,512 new cases have been admitted, of which 1,825 were men and 687 women; 18,206 treatments and 1,548 consultations have been given; 1,682 injections of salvarsan, 2,120 injections of mercury and 598 operations have been done on clinic patients. The patients treated in this clinic have been relieved as follows: Six hundred twenty-seven cured, 374 discharged improved, 221 still under treatment, and the remainder left the clinic without authority from the doctor. Of the cases treated, 321 were diagnosed as syphilis and 746 as gonorrhea. Prophylactic treatment has been given to 3,046 men. Wassermann tests have been done on 4,187 persons and of this number 26.8 per cent have been positive. The revenue derived from the clinic amounted to about $8,000. A vigorous campaign of advertising throughout the entire city has been kept up and excellent results secured therefrom. During the year, 251,593 rations were issued and prepared by the steward's department for the patients and personnel of the hospital. Of this number 96,000 were for the personnel and 155,593 for patients. The average cost of each ration per person per day was $0.317. The cost of hospitalization for each patient has amounted to $1.515 per day, including subsistence. The total cost of operating this department has been $90,764.83. NEW HOSPITAL SANTO TOMAS. The work of construction of the new Santo Tomas Hospital has been pushed energetically during the entire year of 1920. This enormous project was begun on November 15, 1919. All the grading and filling, consisting of approximate y 92,000 cubic yards of earth and rock, has been completed and a municipal work, including streets, water and sewer lines, and electrical conduits have been installed. Materials in form of steel, lumber, and cement, have been acquired from the United States and placed on the hospital site. The plans of all of the buildings have been completed by the drafting department. Two

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43 buildings, the isolation and tuberculosis sections, have been practically completed with the exception of the finishing work which will not be done until all the buildings are ready for completion. LEPER ASYLUM, PALO SECO. (Mr. F. D. TUCKER, Superintendent.) During the year the asylum buildings were'repainted, both exterior and interior, by the patients. Trees and hedges were set out, lawns marked out and graded, and gravel connecting walks put in. The task of altering the baths and toilets of the nine quarters buildings was completed; a ventilator was built on the office-commissary building; a vegetable storeroom and a carpenter shop was put in and the fronts of two quarters were changed, doing away with the long and dangerous front steps. A new panga was built. All repairs to buildings, furniture, plumbing, etc., were made by our own labor. Grass and bush cutting and sanitary work also were kept up. One new building was completed by outside labor and occupied during the year, to be used as a detention ward for mental and unruly cases among the patients. Weekly moving picture exhibitions were given as usual; several dances were held and entertainments were given by some local talent, others by Girl Scouts, the Penn State Quartette, etc. National holidays were celebrated, and, thanks to the great generosity of friends on the Isthmus and in the States, our Christmas was a real one, with a tree, ice cream, cake, turkey, and presents. A small organ given by States' friends contributed greatly to the success of these times. During the year 11 patients were admitted, 5 died, 2 were repatriated, 1 mental case was transferred to Corozal Hospital, and 6 cases, after exhaustive examinations, were discharged. Patient population December 31, 1920, was 74. A monthly average of 30 patients were employed, the payroll averaging $193.21 per month. The value of products purchased from the patients for the asylum for the year was $811.02. Total cash sales at the local store, operated by the asylum, amounted to $4,696.28. The oral administration of chaulmoogra oil was continued this year with rather more willingness on the part of the patients, due to the fact that several cases were discharged in 1919 "apparently cured," or at least in whom there were no active lesions or bacteriological evidence of infection. A diagnostic board, consisting of the Chief of the Medical Clinic and the Chief of Laboratory of Ancon Hospital and the Assistant Chief Health Officer, which board passes on every case admitted to the asylum, met four times during the year to consider carefully those cases at the asylum whose improvement seemed to warrant their discharge. As a result of these examinations, six cases were discharged during 1920. The Board of Health Laboratory is beginning to produce an ethyl ester of chaulmoogra oil; it is expected that in the near future there will be available for hypodermic use a sufficient amount of this derivative to enable the asylum to greatly obviate the discomfort that is caused by administration of the oil by mouth.

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44 On December 31, of our 74 patients, 62 (83.7 per cent) were taking chaulmoogra oil by mouth. As inability to tolerate the oil is given as their objection by practically all those not accepting the treatment, it is hoped that by the improved method of administration soon to be followed it will be possible to induce every one to be treated. BOARD OF HEALTH LABORATORY. (Dr. L. B. BATES, Chief of Laboratory.) (Operated in connection with Ancon Hospital.) The work of the laboratory during the year has necessarily been largely routine. The following report has been prepared in the form of tables in so far as it was practicable to do so. The following paragraph is quoted from the rules of Ancon Hospital to show the amount and variety of work now required of the laboratory: "The Board of Health Laboratory is the official laboratory for Ancon Hospital, Colon Hospital, Corozal Hospital, the District Physicians, the Quarantine Stations, Palo Seco Leper Colony, Health Officers of Panama and Colon, the Coroner, the Veterinary Service of the Health Department, and the Colon Free Clinic for Venereal Diseases. It also serves as a Department Laboratory for the Panama Canal Department, U. S. Army, and for the Fifteenth Naval District, U. S. Navy, when so designated by those services." In addition, considerable work has been done for other departments, private hospitals, and private physicians. An epidemic of influenza started on the Canal Zone about the middle of March and commenced to wane in the middle of April. A bacteriological study of the cases was commenced early in the epidemic and the results reported before the Medical Association in May, at which time about 400 cases had been studied.6 Nasopharyngeal cultures, sputum cultures, blood cultures and cultures from autopsy material were made whenever possible. Subsequent work has not changed the conclusions which were drawn at the time from the study of these cases. The conclusions drawn were as follows: 1. No one organism has been predominant in our cases. A variety of organisms has been recovered from lesions which were apparently the same, the appearance of the lesion being no criterion as to the organism present. 2. Streptococcus hemolyticus has been found in but small prop rtion of our cases and when found they were few in number and not widely distributed. We may safely say that the Streptococcus hernolyticus has played an unimportant part in this epidemic. 3. The influenza bacillus has been recovered from 15 per cent of the throats cultured during this epidemic; during an examination of 140 6 The paper is entitled "The Bacteriology of the Influenza E -idemic on the Canal Zone during March and April, 1920," by Dr. Lewis B. Bates, and Dr. J. H. St. John, and is being published in the 1920 Proceedings of the Medical Association of the Isthmian Canal Zone.)

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45 throats in this hospital made in February, 1919, this organism was not recovered. The increase in positive cases seems to be about equally divided between influenza and noninfluenza patients. 4. The pneumonias in our fatal influenza cases seem to have been caused by a variety of organisms. In no instance were the lungs sterile and in most cases some of the organisms found in the upper respiratory tract were also found in the consolidated lung tissue. 5. Although diffident about offering any opinion on account of the incompleteness of our work we quote the following paragraph of Cummings7 as stating our views at present: "The whole clinical and pathological picture becomes intelligible if we can postulate a primary etiological agent acting locally upon the respiratory surfaces and generally through its toxic products in such a manner as to prepare the way for invasion by the prevailing respiratory flora." During the year the pathologist reviewed sinusitis, otitis media and mastoiditis in the 3,376 autopsies which had been performed by him at this laboratory. Much valuable data is collected in this paper and the 1920 number of the Proceedings previously referred to will contain this article in full. The entomologist prepared an article upon the Panama Canal species of the Genus Anopheles, bringing synonomy up to date, and treating particularly upon the taxonomy of the species and the collection and care of material for study. The article with 13 illustrations has been printed by the Health Department as a monograph, and will also appear in the Proceedings. At various times throughout the year blood films showing malarial parasites, smears, cultures, intestinal parasites and ova and other laboratory specimens have been forwarded to medical schools requesting them. BACTERIOLOGICAL REPORT. Blood cultures: Total number of blood cultures. 405 Positive blood cultures. ..73 Organisms recovered in blood cultures: B .typhosus (25 cases). 33 B .paratyphosus A ..2 B .coli. 2 Pneum ococcus. .15 Type I .3 T ype II .2 TypeIII. ..4 Type IV .6 Streptococcus viridans ..3 Streptococcus hemolyticus. .6 Staphylococcus .12 Blood cultures made from 76 cases of influenza uncomplicated with pneumonia were all sterile; blood cultures made from 24 cases of influenza complicated with pneumonia were positive in 10 instances, the pneumococcus being recovered each time. (Type II, 2; Type III, 2; Type IV, 6.) Blood cultures were not made routinely in cases of lobar pneumonia. Fifteen cases were cultured and the pneumococcus recovered 5 times. (Type l, 3; Type III, 2.) 7 Studies of Influenza in Hospitals of the British Armies in France, 1918. Introduction by Col. S. L. Cummings, C. M. G., A. M. S.

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46 Dark field. Dark field examinations of skin lesions. .10 Number positive for Treponema pallidum. 1 Number positive for Treponema pertenue. 5 Dark field examinations of venereal ulcers ....142 Number positive for Treponema pallidum. 25 Number positive for Treponema perfringens. .2 Many of the ulcers were mere abrasions. Some were too old or had received enough treatment to render the finding of the treponema pallidum improbable. In typical cases of chancre two or more examinations were made when possible. Two of the positive cases included in the above had the positive lesion on parts other than the genital organs. The ulcer in one case was on the lip, in the other case on the umbilicus. Sputums. Sputums from various sources were cultured for B. influenzae and Pneumococcus, from August to December, inclusive, this work beginning three months after the subsidence of the influenza epidemic. Number of sputums cultured. ..74 B. influenzae. 9 Pneumococcus (Type I, 1; Type II, 6; Type i 1, 3; Type IV, 11) ..21 Spinal Fluid Cultures. Total number of cultures (52 cases). .123 Positive cultures (18 cases). .34 B. influenzae .1 B. inftuenzae and Staphylococcus albue. 1 B. influenzae and Streptococcus viridans. 1 M eningococcus (type normal). .1 Pneumonococcus. .4 (Type 1; Type II 1; Type IV, 2.) Staphylococcus aureus and Pneumonococcus (type IV) .1 Streptococcus viridan ..2 Streptococcus hemolyticus. 1 Staphyloccus aureus.,. 4 Streptococcus hemolyticus and Staphylococcus aureus. ...:. 1 B. tuberculosis. 1 Autogenous vaccines prepared. 63 Stools cultured for typhoid-dysentery group. 1,057 Urines cultured for typhoid group. .551 Urines cultured for other organisms. 303 Milks: Corozal Hospital dairy. .243 M indi dairy ..211 Panama dairies (through Health Officer, Panama). 738 Com m issaries. 2 C ondensed. 11 Panama ice cream (through Health Officer, Panama). 11 Colon dairies (through Health Officer, Colon). .18 Colon ice cream (through Health Officer, Colon) .5 Commissary ice cream .2 Powdered milk. 1 M iscellaneous. 5 Naso-pharyngeal cultures. 551 Sputum cultures. .597 Throat cultures (Positive for B. diphtheriae, 66 cases, 190). 1,939 Throat cultures (other organisms than B. diphtheriae). 13 Plaques in buccal cavity. 51 Membrane from throat. .1 E ar cultures. 81 E ye cultures., 17 Ear casts. .17

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47 M astoid cultures. 4 Pus from chest. .2 Pus from abscess. 1 Pleural fluid cultures. 13 Acitic fluid cultures. 3 Fluid from knee joint. 3 Fluid from gall bladder. .2 Gland cultures. 9 Conjunctival cultures. .2 Phenol coefficient test of salvarsan and neosalvarsan .2 Phenol coefficient test of hycol. .1 Autopsies cultured (heart's blood, organs, exudates, etc, 537). 184 Source not given. 1 Vaccination scab. 1 R oot of tooth ..1 M axillary sinus. 1 Throat smears. 95 Sputums examined for B. tubercuosis. .143 Urines examined for B. luberculosis. 6 V aginal sm ears. 150 U rethral sm ears. .103 Conjunctival sm ears. .122 Skin lesions. ..3 Lesion on forearm .I Dermatitis of fingers ...1 Blood for embryo of filaria hominis. 1 Coagulation tim e of blodd. .1 Test of typhoid vaccine. 1 Examination of tropical ulcer. 1 C an of oysters. 1 Can of asparagus tips. 1 Water cultures. .3 Flour cultures. 5 M eat from sandwich. 1 Fish for culture and bacteriological count. 1 Bacteriological report (animals). Cattle ears (195 positive for B. anthracis). 317 H ide cultured for B. anthracis. .2 H orse ears. 3 H og ears. 1 R at glands. 4 G land culture. 1 C ulture from cow .1 B lood cultures:. .33 Autopsies cultured. 89 H orse's hoof cultured. 1 U rine cultured .1 Stool cqltured. 3 Skin scrapings from horse. 1 Bacillus typhosus was recovered in blood culture from 25 individuals; 12 of these cases were from shipboard and 13 from the Canal Zone or the Republic of Panama. The two cases from which Bacillus paratyphosus A. were recovered were from shipboard; the two ships coming from Chile and Peru, respectively. Typhoid carriers.-On December 31, 1919, two typhoid carriers, were under sanitary surveillance. One of these, a white American woman, has since returned to her home in the United States. The other, a colored laborer, is still a carrier and is still paroled under sanitary surveillance. Two additional carriers were detected during the year; one was a white American soldier who has since been transferred to the Walter Reed General Hospital, the other a colored woman who was and still is an inmate of the Corozal Hospital for the Insane.

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48 Survey for meningococcus carriers.-A case of Meningococcus meningitis developed in Co. B, M. P., Fort de Lesseps, C. Z., October 8, 1920, a survey for the detection of carriers was undertaken. Num ber swabbed. 67 N um ber positive. 7 Types of Meningococcus recovered.-Normal, 3; intermediate, 3; para, 1. Subsequent swabbing of these patients proved them to be but temporary carriers of the Meningococcus. The meningitis patient referred to above became a chronic carrier of the meningococcus and at this date is still held in isolation. Leprosy. Number of examinations made for leprosy. 76 Number positive for B. leprae (new cases). 18 (In addition, three old cases reexamined were positive.) Photographs are now taken at the laboratory of all cases of leprosy as soon as a diagnosis is made. These are taken for purposes of record, also for purposes of comparison at a later date to show results obtained after a course of chaulmoogra esters or other treatment. Anaerobic bacilli.-Anrobic bacilli of the gas gangrene group were recovered from two cases of human gas gangrene. During the year 13,566 Wassermann tests were performed on 9,234 persons. The results of these tests are summarized in the following tables: WASSERMANN REACTIONS DURING THE YEAR 1920. (Based on 1he number of individuals examined and not on the number of tests made.) Per Positive. Negative. Total. cent I -positive. White, civil: M ales. 209 1,919 2,128 9.82 Females. 13 204 217 5.99 White,soldiersmales. 108 1,150 1,258 8.58 Total. 330 3,273 3,603 9.15 Spanish and white natives. Males. 117 607 724 16.16 Females. 24 194 218 11.00 Total. 141 801 942 14.19 Blacks and mulattoes: M ales. 770 2,458 3,228 23.85 Females. '334 1,106 1,440 23.19 Total. 1,104 3,564 4,668 23.65 Chinese, males and females .7 14 21 33.33 Grand total .1,582 7,652 9,234 17.13 In addition Wassermann tests were made on 358 spinal fluids from as many individuals, and of these, 72, or 20.11 per cent, were positive.

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49 PATHOLOGICAL. During the year 334 autopsies were performed at the Board of Health Laboratory. The causes of death were as follows: General diseases. Malarial fever, estivoautumnal. 2 Scarlet fever.1. Influenza. 32 Dysentery, entamebic. 1 Dysentery, bacillary. 4 Leprosy. 2 Hemoglobinuric fever, unqualified. 1 P yem ia .2 Septicem ia .3 Pyemia and septicemia, pneumonococcus. 1 T etanus. 2 Pellagra. 2 Tuberculosis of the lungs. 17 Acute miliary tuberculosis. 9 Tuberculous m eningitis. 2 Abdom inal tuberculosis. .I Pott's disease. 2 Tuberculosis of bones and joints. 1 Disseminated tuberculosis. 23 Syphilis, tertiary. 2 Syphilis, cerebrospinal. 3 Syphilis, hereditary. 2 Cancer of the stomach and liver (esophagus). 1 Cancer of the breast. 1 Cancer of other organs. 4 Anemia, secondary, cause not determined. 1 Purpura hemorrhagica. I T otal. 123 Diseases of the nervous system and of the organs of the special senses, Encephalitis. 2 Sim ple m eningitis. ...4 Pneum onococcus meningitis. .4 M yelitis. .1 Cerebral hemorrhage, apoplexy. 6 Softening of the brain. 2 General paralysis of the insane. 8 D em entia precox. 1 D isease of the ears. 2 T otal. .30 Diseases of the circulatory system. Pericarditis. .1 M alignant endocarditis. 4 Organic disease of the heart. 10 Angina pectoris. 1 Aneurysm ..1 Arteriosclerosis. 2 Embolism and thrombosis. 1 Phlebitis. .1 T otal. ..21 MR 77731 4

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50 Diseases of the respiratory system. Broncho-pacumonia. .Lobar pneumonia .11 Gangrene of the lungs .1 Total. ...15 Diseases of the digestive system. Follicular tonsillitis. 1 Acute appendicitis. ..2 Intestinal obstruction. 3 D uodenal ulcer. 1 Cirrhosis of the liver ..1 Biliary calculi. .....1 T otal. ..9 Nonvenereal diseases of the genito-urinary system and annexa. Chronic nephritis. 11 Pyo-nephritis and pyelitis. 3 Hypertrophy of the prostate gland. 1 Salpingo-oophoritis. 1 T otal. 16 The puerperal state. Accidents of pregnancy. .1 Puerperal albuminuria and convulsions. I T otal. ..2 Diseases of the skin and cellular tissue. Phlegm on and cellulitis. 2 Diseases of the bones of the organs of locomotion. Diseases of the bones and joints (tuberculosis excepted) .2 Malformations. Congenital malformations (stillbirth not included) .10 Diseases of early infancy. Prem ature birth. .4 Malnutrition. 25 Other diseases peculiartoearlyinla 7y. T otal. 36 Affections produced by external causes. Suicide by firearms .1 Acute poisonings (food excepted).I. 3 Burns (conflagration excepted). I Accidental drowning. 1 Traumatism by a fal. 4 Traunmatism by machines. 2 Traumatism by railroad crushing. 3 Traumatism by other crushings. 5 Lightning. 1 Electricity (lightning excepted). 1 H omicide by firearm s. .1 Homicide by cutting instrument. 1 Homicide by other means. 1 Other forms of external violence. 1 Legal execution by hanging. 3 T otal. 29

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51 Ill-defined diseases. Ill-defined organic disease .2 Infection of undetermined origin. 1 Total ...3 Stillbirths and nonviable fetus. Stillbirths (at or near full term). 23 Nonviable fetus. 15 T otal ...36 Grand total. 334 The most frequent causes of death listed for the year were: Cases. Per cent. Tuberculosis. ..55 16.4 Influenza. 32 9.5 External affections (trauma) .29 8.6 Malnutrition. .25 7.4 Diseasesof theheart. 16 4.7 Acute respiratory diseases .15 4.4 N ephritis, chronic ..11 3.2 Congenital malformations. 10 2.9 Table showing the more common causes of death at autopsy in the Board of Health Laboratory. Co. A~ :1 Date. .P .c Z ~ .-0 "a Aa KO W -4 I, ~ ~ k; 0 = Q N EE1904. 6 1 1 .. 1905. 269 60 9 27 3 8 5 3 9 1906. 509 191 22 50 24 23 39 15 33 .2 1907. 496 156 35 27 40 27 36 12 58 4 4 1908. 361 59 63 46 26 25 23 11 14 .7 1909. 295 55 37 26 32 31 11 17 11 1 5. 1910. 451 50 91 52 30 37 36 16 10 6 41911. 508 83 102 41 38 36 19 20 9 11 11 1912. 42& 53 79 23 37 27 15 22 6 7 11 1913. 460 47 89 21 34 26 8 26 5 23 12' 1914. 375 36 78 6 38 12 6 27 5 14 3 1915. 328 28 56 14 20 12 5 14 2 15 10' 1916. 323 25 81 8 17 20 7 10 6 9 7 1917. 330 24 51 5 21 23 3 18 1 3 5. 1918. 253 38 68 6 6 12 8 1 51919. 324 22 55 3 15 14 3 20 3 10 11 1920. 334 846 55 29 11 5 16 ..6 Total. 6,047 974 972 355 410 344 221 255 172 104 105. 8 This includes 32 cases of influenza.

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52 Table showing number of autopsies performed revealing the following diseases per year. Date. 1904. 6 1905. .269 12.2 .1 1906. 509 1 5 4 1907. 496. 1 2 1. 1908. 361. 1 2 3. .. 1909. 295 2. ...1 1910. .451 2 1911. 508 .1 1 Y 1:. 1 1912. 425 1. 1 4 1913. 460. .2 3 1 .. 1914. 375 ..1. 4 2. 1915. 328 3 1. 2 1 1916. 323.2. 3. .' 1917. 330. 7. 1 2. 1918. 253. 2.3. 1919. 324 2.3 1920.334. ... Total. 6,047 23 26 20 18 20 3 1 Scarlet fever. Four hundred seventy-three bodies passed through the labor tory ~during the year 1920; of these 9 had been autopsied at Colon Hlospital, of the remaining 464, 334, or 71.9 per cent, were autopsied at this laboratory, 28.1 per cent were not autopsied. MALARIAL CARRIERS FOUND AT AUTOPSY (EXCLUDING 2 CASE3 DYING OF MALARIA). Caaes. Caaes. January.4 August. .3 February. 1 September.2 March.3 October.2 1. 3 November. S. 1 December. .3 une.6 J1y.2Totl. 35 Three hundred thirty-four autopsies minus 2 deaths from malaria show 35 out of 332 autopsies revealing pigment and parasites~ in scant manner in rib marrow and spleen films or a per cent of 10.5. Their local residences were as follows: C ol n. ... atun. 1 Panama City (suburbs). 4 Chagres River village .......1 Cattle Industry pastures. ....8 Culebra. .r Peruvian sailor. 1 Coroal .Fo6,0y7o23. 1 Scarldfever

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53 Microscopic examinations and reports on surgical specimens. Tonsils (pairs). 262 Tonsils (pairs) and adenoids. 172 A denoids. .34 Specimens from eyes and eyelids. .22 Specimens from nose (nares). .98 Specimens from nose (cutaneous). .9 Specimens from external auditory canals. 19 Specimens from skin of face (nose excepted). 15 Specimens from oral cavity (tonsils and adenoids excepted) .10 Specimens from skin of back. 5 Specimens from skin of buttocks. 2 Specimens from skin of external genitalia. .11 Specimens from perineum and anus. 6 Specimens from skin of upper extremities. 13 Specimens from skin of lower extremities. 7 Specimens from skin of chest and abdomen. 3 A ppendix. 174 Specim ens from intestines. 6 Specim ens from rectum .14 8pecim ens from stom ach. 2 Specimens from larynx and trachea. 2 C arotid body ..1 Thyroid gland. .13 Specimen from brain .1 Salivary glands .2 U terus and appendages. 51 C ervix uteri. ..11 Tubes and ovaries. .42 Specimens passed from or taken from uterine cavity. .18 Sperm atic cord .2 E pididym is. ..4 T estes. 5 K idneys. .2 Bladder, specimens from ..2 Prostate glands. 4 M am m ary glands. 12 G all bladder. ..7 Omentum specimens from ..3 M uscles, specimens from .3 Tendons, specim ens from .I Amputated lower extremities. .4 Amputated upper extremities. .1 N erve, ulnar. ..1 Joints, specim ens from .2 Bones, specim ens from .3 Artery, aneurysm of. I Lym ph nodes, cervical. 16 Lymph nodes, supraclavicular. 1 Lymph nodes, submaxillary .' Lym ph nodes, axillary .4 Lymph nodes, epitrochlear. .3 Lymph nodes, inguinal and femoral.,. 7 Lymph nodes, retroperitoneal. ..I Lymph nodes, meso-appendiceal. I Lymph nodes, location unknown. .1 Colon Hospital autopsy sets of tissues. 43 T otal. 1,160 PRINCIPAL LESIONS ENCOUNTERED IN SURGICAL SPECIMENS OTHER THAN INFLAMMATORY. Malignant tumors (repeated specimens same case excluded). U terus. .5 B reast. .5 N ose ...6 R ectum .3

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54 Malignant tumors-Continued. Bladder and prostate .2 Lower lip .3 The nares .2 Scalp and cheek. 1 F ace .2 Stom ach .I Penis. ..1 L arynx. 1 E yelids. 1 Floors of mouth and tongue. 1 Scrotum and perineum .1 Vagina and inguinal glands. .1 B ack of hand .1 Omentumn (primarygrowthunknown). 1 T ube and ovary. 1 Leg. 1 O vary ...1 Lower maxilla. .1 Carotid body with metastases. ..1 T otal. 44 Benign tumors. Fibro-adenoma of breast. 4 Intracanalicular adeno-fibroma of breast. 3 M ixed tumor of parotid gland. 4 Psam moma of the brain. 1 Osteo-chondrom a of a rib. 1 Lipoma of the back. 1 E pulis, upper jaw .1 Fibro-myom ato-uteri. 22 Derm oid cyst of the ovary .3 Cystadenom a of the ovary. 1 Sim ple cysts cf the ovary. .11 C ystic thyroid glands. 7 E xophthalm ic goiter. 1 H em angiom a of the lip. I Fibro-hemangioma of the chest. 1 Sublingual cyst. 1 Fibrom ata of the skin. .4 Sebaceous cysts in wall of abdomen. 1 Sebaceous cysts of face. 1 Rectal polyp. 1 N asal polyp. 12 Polyp of the endometrium .2 Pigmented papilloma of the back. I Papillom a of the face. 3 Papillom a of the hand. 2 Papilloma of the tonsils. 2 Papilloma of the lip. 1 Papillom a of the tongue. 1 Papilloma of the external auditory canal. 1 T otal. ..I. 93 Specimens showing tubercu!osis. E pididym is. .3 T esticle. 1 Bladder and prostate. .I Sinus in perineum .1 Sinus in scrotum .1 Fallopian tube. .2 Abscess of the buttock. 1 A bscess of thigh .I

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55. Specimens showing tuberculois-Continued. A ppendixp. .5 O m entum .1. Tongue (ulcer at root). 1 T endon sheath. .1 Skin of the neck. ..1 Tonsils (pairs) and adenoids. 3 A denoid .1 Lym ph nodes, cervical. .10 Lyirph nodes, supraclavicular. .1 Lym ph nodes, axillary. 2 Lym ph nodes, epitrochlear. 2 Lymph nodes, unknown location. 1 Total. .40 Other infrequent lesions encountered. Leprosy. .7 Sole of foot. 1 Palm ulcer. .1 U lnar nerve. .1 Skin nodule. 1 Foot and leg amputated. 1 N asal septum .I Pterygium ..1 Otomycosis (casts from external auditory canal). 17 Dermatom ycosis. .2 M ycosis of an inguinal lymph node. 1 H odgkin's disease ..2 Filariasis of epididymis and lymph node. ..1 Filariasis of an inguinal lymph node. 1 Gas gangrene, amputated leg. 1 A inhum ..1 Jigger infestation sole of foot. .1 Gauze sponge encapsulated in pelvis 14 years. 1 U m bilical chancre. 1 Intussusception. .1 Congenital cyst of the trachea. .1 Congenital cystic kidney. 1 Ectopic pregnancy (two at full term in broad ligament and tube). 6 D uodenal ulcers ..2 Appendices filled with oxyuris vermicularis parasites. 5 Total. 52 A review of the meningitis autopsy records during the years 1907 to 1920, inclusive was made and the following table was compiled. Bacteriological examinations were conducted at autopsy. Agglutination of the recovered organisms was carried out but no typing done. Pneumococcus meningitis. ..66 (This excludes pneumococcus meningitis which occurred as a lesion in pneumoccoccus septicemia or pyemia.) Simple meningitis (atreptococcue, staphylococcus, etc.). 56 (This also excludes septicemia and pyemia of these natures associated with meningitis.) Tuberculous meningitis. 30 (This excludes cases of disseminated tuberculosis in which the memnges revealed a lesion.) Cerebrospinal fever (epidemic form) ..11 (This excludes one case which died long after an attack of meningitis in which the only lesions found were meningococcic arthritis-shoulder and hip abscesses.) Influensal m eningitis. 3

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56 The following table shows how scattered in time these cases appeared: Autopsy Dateadmitted. Race. Age. Local residence. No. Year. 1295 December 25, 1907. Martinique negro. 22 Gatun, C. Z. 1804 September 10, 1909. Martinique negro. 25 Gatun, C. Z. 1815 September 20, 1909. Colombian negro .30 Gatun, C. Z. 3760 December 15, 1913. Jamaican .11 Panama City. 3766 December 23, 1913. Mexican. 24 S. S. City of Para, Balboa Harbor 3919 April 10, 1914. .Jamaican. 26 Pargiso, C. Z. 4941 May 22, 1917. American. .S. S. Huntington, Balboa Harbor. 5052 August 31, 1917 .West Indian negro. 11 Panama City. 5244 May 28, 1918 ...Japanese. .S. S. Anyo Maru, Balboa Harbor. 5377 November 25, 1918. .West Indian negro 27 Panama City. 5446 February 20, 1919. West Indian negro. 30 Panama City. Animals (wild and domestic), autopsies: Cattle. .35 Calves. 18 Hogs. .11 H orses. 5 D ogs. 23 G oats. 2 C at. .1 Chickens. .3 Guinea pigs. 34 R abbits. .7 D eer. .15 M onkeys. 2 Iguana. 1 Porcupine.'1 P igeon ...1 Saura (native opossum ). 1 F ish ..1 T otal. 161 Animals (wild and domestic), examination: Tissue specimens from cattle. 7 Tissue specimens from hogs. 4 Tissue specimens from dogs. 3 Blood films from cattle. 640 Blood film s from deer. 57 Bloodfilm from dog. 41 Blood film s from iguana. 8 Blood films from horse. .6 Blood film from porcupine. .1 Hemoglobin tests on cattle. 49 Hemoglobin tests on dogs. 28 Brain film s from cattle. 33 D og stools. 43 D og urine. 5 T otal. .929

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57 The principal diseases encountered that were important among domestic animals were as follows: Anthrax (cattle). Piroplasmosis (cattle, horse, dog, deer.) Hog cholera. Tuberculosis (dairy cattle and hogs). Umbilical infections (calves). Myiasis (screw-worm infections of hide sores and umbilicus). Poisoning by cattle dip contaminations. Oesophagostomiasis nodularis (goats). Uncinariasis (chiefly dogs and young calves). Bacillus paratyphosus B. (Guinea pigs). Gas bacillus septicemia (three hogs). Actinomycosis (one calf). Rats and mice examined ..17,080 M u8 m usculus. .10,326 M u. alexandrinus. 725 M us norvegicus. 2,508 M us rattus. .3,521 Animal experimentation. Biting experiments with the deer and cattle ticks. Both types developed on either animal as a host. Deer piroplasmosis was given to a calf and cattle piroplasmosis was given a fawn raised in captivity. In each case the infections were light as shown by blood film examinations. Work is to be continued. General miscellaneous examinations, human: Films taken from the maternal surface of placentae (8 were positive for malaria, 2.8 per cent). ..284 Blood films examined for malaria. 922 Stools. 3 Urine. ..3 Films from ulcer on wrist (Oriental sore). 1 Films from nasal passages. .1 Films from ulcer in palate of mouth. 1 Cigarette tobacco molds. .1 External descriptions of bodies not autopsied. 5 Feces examined for parasites and ova. 101 Microscopic slides prepared: Surgical preparations. .6,140 Autopsy preparations. 4,404 Animal tissue preparations. .1,608 T otal. .12,152 Paraffin preparations. .12,034 Frozen preparations. 118 Total. ..12,152 CHEMICAL DEPARTMENT. Arsenical cattle dip. 9 Acetone. 2 A lcohol. ..1 Alkaloids, for identification. 3 Anthrax serum, pheno content. ..1

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58 CHEMICAL DEPARTMENT-continued. Beverages: For preservatives. 1 For alcohol content. 14 For denaturants. .5 C otton .1 Bloods examined. 176 Nonprotein nitrogen. 140 Urea nitrogen. 156 U rea. 156 Uric acid ..142 Creatinin .142 Glucose. 134 Cholesterin .11 Carbon dioxide. 6 Calcium .1 Bread. 3 Bullet. .1 Butter .5 ,Cream,. 1I Crude carbolic acid .4 Calibration of clinical thermometers. 1,000 Cocoa, powdered glass.,. 1 C lay .2 Clay, for arsenic. 1 Caterpillars, for arsenic. 3 Coconut m eal. 3 Calf m eal. 2 C igarettes. .1 Cognac. ...1 Drug, narcotics. I1 Eggs. ...1 Fluid, forarseni. .1 Feed, forarsenic. .1 Flour. .5 H ide, for arsenic. 9 Hide scrapings, for arsenic. 1 Gastric analyses. 31 G asoline. .6 H ydrogen, peroxide. I H om iny, lye. ..1 iron ore. .I Icee cream .27 K erosene. 1 Lard substitute. .1 M atches, safety. 21 Milks, dairy, food value. 184 Milks, dairy, for preservatives. ..3 M ilks, condensed. 7 M ilks, evaporated. 2 Milks, mothers' .25 M ilks, powdered. I M ahogany filler. .1 M ineral. 1 Oil, Diesel .2 Oil, castor. 1 O il, fuel. 2 Opium, for identification .3 Oleom argarine. 24 Oysters, canned, lot. 1 Oysters, fresh, lot .1 Potatoes. 1 Powder, vegetable .1 Rice .3 R osin .d. ...I Spinal fluids i. Spinal .luids: Colloidal gold. ..294 Butyric acid.288 Ammonium sulhate .288 Phenol. 289

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59 CHEMICAL DEPARTMEN-Continued. Stom ach of cow, arsenic. ..t Stomach contents of horse, phenols. I Silk. Sugar, percentage of sucrose ..9 Sugar cane. ..1 Soil, for arsenic. .,. 2 Toxicological examinations. ..7 U m ber ...1 Urine exam inations. 106 R outine. 64 A rsenic. 1 U rea. .4 Urea nitrogen. 5 A cetone bodies. .11 G lucose. 21 N itrogen partition. ..2 L ead ..11 M ercury .1 C alcium .1 R enal function .3 Urine, bovine, for arsenic. 4 V in egar. 1 V om itus. 1 W ater, complete analysis. .1 W ater, for arsenic. ..3 W ashings from m ilk bottle. 1 The work of the chemical laboratory during the year 1920 has consisted mostly of routine analytical work, which is given in the above tabulated form. The working out of a method for the utilization of two shipments of crude carbolic acid received at the larvicide plant consumed considerable time. While conforming to specifications as to "tar acid" content and specific gravity, these two shipments differed from the crude carbolic acid received heretofore in some manner yet not thoroughly understood, and were not capable of being worked into a satisfactory larvacide by the method which has been in use at the larvicide plant for several years. In all our previous experience with the manufacture of larvicide no crude carbolic acid similar to these two' shipments has been received, and no trouble has ever before been experienced in the manufacture of larvicide. After considerable experimental work in the laboratory it was found that sulfonation of the crude carbolic acid by treatment with concentrated sulphuric acid and heat would so alter its deportment in the usual process of manufacture as to produce a satisfactory larvicide. This method was tried at the larvicide plant on a larger scale and found to produce a good larvicide. The whole of the two shipments of crude carbolic acid were made into larvicide with this additional treatment. The following shipments of acid have been of the same grade as was received previous to the two unsatisfactory lots, so that it has not been necessary to use the sulfonation process recently. An intensive study, from the laboratory standpoint, of the colloidal gold reaction with spinal fluids has been carried on during the greater portion of the year, with special attention to the preparation of the colloidal gold. This work will be carried on during the coming year, as in the past, in connection with the routine performance of the colloidal gold reaction. The preparation of the ethyl esters of the fatty acids of chaulmoogra oil has been started and about 700 grams prepared to date.

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60 Sufficient experimental work has been done to place the production of the esters on a safe working basis, and the preparation in sufficient quantities for use at the leper colony has been commenced. PHOTOGRAPHY. A considerable number of photographs were taken at the laboratory during the year. These represented a variety of medical, surgical, dermatological, pathological, and entomological subjects. A number of miscellaneous objects of a medico-legal character, or other material in cases where photographs were desired as part of a permanent record were photographed. ENTOMOLOGICAL REPORT. In the entomological department work was carried on in practically all branches of entomology throughout the year, and insects belonging to the various orders examined and classified. Investigations on various problems in connection with medical, agricultural, and general entomology were conducted. The examination and classification of adult mosquitoes collected in habitations was continued throughout the year. A large percentage of the specimens received consisted of adults taken in the daily hand catches in married quarters, military posts, camps, etc., in the Zone. Camps outside the Zone, such as the U. S. Army camp at David, R. P., and field camps at other points, also sent in catches of adult mosquitoes for identification at frequent intervals. This was of considerable value in establishing an index to the various types present at the camps and in determining the prevalence of species concerned with the transmission of disease. Specimens collected on board ships, shortly after their arrival from ports where mosquito-borne diseases were potentially present, were also received from time to time. A considerable number of lots of mosquito larvae were received from various points in the Zone and the cities of Colon and Panama, for identification during the year. The value of this work in indicating the types and prevalence of mosquitoes breeding in the different areas is quite apparent. More especially is this important at points where no hand catches of adults are being made. The following table shows the number of species of adult mosquitoes and larvae classified during the year: Lots of Adults. I larvae. Culicini: Anopheles albimanus. 6,023 22 Anopheles tarsimaculata. 4,613 15 Anopheles pseudopunctipennis. 469 8 Anopheles punctimacula. 111 2 Anopheles apicimacula. .31 6 Anopheles argyritarsis. .4 5 Anopheles eiseni. 2 3 Total number of anopheles. 11,253 59

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61 Lots of Adults. larvae. Culicini-Continued: Aedes calopus. 497 492 Aedes taeniorhynchus. 2,330 10 Mansonia titillans. 1,684 1 Mansonia nigricans.15. Mansonia fascillatus.10. Aedeomyia squamipennis. 5 Culex quinquefasciatus. 5,719 152 Culex coronator. 4 34' Culex corniger. .20 Culex proxim us. .6 C ulex factor. ..5 Culex equivocator. .5 O ulex leprincei. .4 C ulex elevator. .2 Culex jubilator,. ..2 Culex revelator. .2 Culex declarator. .1 C ulex extricator. .1 C ulex reflector. .1 Culex chrysonotum ..1 Culex spp. 4,012 71 Psorophora lutzii.47. Uranotaenia geom etrica. ..I Haemogogus, lutzii, deinocerites, etc. 81 4 Total culicini minus anopheles. 14,404 817 Sabethini: Wyeomyia, etc. .353 3 Total of mosquitos identified. 26,010 879 During the period extending from March to December, inclusive, there were 1,274 separate lots of adult mosquitoes received for identification. No records were kept of the number of lots received during January and February. Nearly all of the mosquito larvae came from Panama City and Colon and when it is considered that practically each lot meant a breeding place it speaks very well for the vigilance of the Health Department of Panama and Colon in locating so large a number. It also indicates that, even after nearly 16 years of American sanitation, it is quite probable that a considerable amount of mosquito breeding would occur in the city if the American regulations were relaxed or the sanitary inspectors removed. The large percentage of larvae as shown in the above table being those of the yellow fever mosquito, Aedes calopus Miegen, emphasizes the necessity for constant vigilance in controlling mosquito-breeding and the maintaining of close quarantine restrictions. The entomologists made a number of inspection trips of various kinds to different points in the Zone throughout the year. Among these inspections were included: Juan Mina citrus grove to observe insects of economic importance; Farfan Camp to investigate mosquito-breeding; Corozal for examination of Larro cattle feed; Paraiso, Darien, and other points on the line to observe mosquito flights; Corozal Hospital to determine if fleas were infesting the wards, and many other investigations of various kinds.

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62 Identifications were niade of many ticks, fleas, lice, flies, fly larvae causing myiasis in man and in animals, termites, beetles, scale insects, etc. Life history and control studies were conducted on the papaya fruit fly, toxotrypana curvicauda Gerst, and the spiny citrus white fly, Aleurocanthus woglumi Ashby. Reports were made on the control of the Banyan Thrips (Cuban Laural Thripes); the Fall Army worm; and various insects attacking trees and foliage in Ancon Hospital grounds. A survey and identification of the fleas found infesting the different species of rats in the Canal Zone and Panama is being made. Observations on certain phases of the bionomics of the yellow fever mosquito, Aedes calopus Miegen, are being conducted. UNDERTAKING DEPARTMENT. In October an addition of one room was built onto the laboratory. This room is approximately 14 by 24 feet and occupies the space between the main laboratory building and the crematory building. This room provides space for the sealing, crating, and temporary storing of embalmed bodies, free access to the refrigerator, and is also used as a general utility room by the undertaker. Number of bodies received (5 disinterred). 473 Number of bodies embalmed. 71 Number of bodies cremated. .168 Number of bodies buried on Isthmus. 252 Num ber of bodies shipped. 50

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63 ADMISSION RATE PER 1,000 EMPLOYEES. HOSPITALS AND QUARTERS. ALL CAUSES. 0( 2(547 17q 07 39Z38 14 iq 08 43890 1132E 17 E 09 471/o7 867 10 508OZ qC 14 48=4M 1, 375 32 8 255 6 4 CHART No. 1.

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64 DEATH RATE PER 1,000 EMPLOYEES. ALL CAUSE. 06 -zs47 41.B /73Y238 207 08 43890 0q 47147 IM V2 50893 r6%654g5 4 4A43R .04 \5 3P85 tU7 16 3V16 6A Z2040i CHART No. 2.

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65 NONEFFECTIVE RATE PER 1,000 EMPLOYEES. A --------06 26543 MA 0943890 22.31 DR 4 7147 21qS \0 508 02 207 4I8876 244 gz 08q3 1.11 13 6654 IS17 14 44,52 q2 15 795 o. 16 3 q2 17 3sszsq .6 21Z04I 3012067s4 CHART No. 3. MA 77731-5

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66 MALARIAL FEVER. ADMISSION RATE PER 1,000 EMPLOYEES. A______PA___ I I 04 4tra tz 4 43762)4 q a 4 00 356ci 60 1732 14 jq Z4204 31 CHART No. 4.

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67 MALARIAL FEVER. DEATH RATE PER 1,000 EMPLOYEES. 05 'G$! %U1.64'! 04( ---07 4Z3L5 98 3q0 L3 "7 rz -qc --44 S893 .31 I9 5%654 .30 ---a5 p5 )7 zseq -Oc 19 242004 0 00 o .I, CHART No. 5.

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68 MALARIAL FEVER. DEATH RATE PER 1,000 POPULATION IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. --. -.M: -YE AND NoN7Mrwouuue as momQ 33 oq 1351802407,q 13 tz4104 QZ I.M CHART No. 6.

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69 TABLE I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES FOR EMPLOYEES. ABSOLUTE NUMBERS. Discharges from Deaths. Noneffective hospitals and deaths. from sickness. 00 Year, 1920: White .4,688 1,393 1,252 141 22 17 5 31,775 86.8! Colored .15,985 3,183 '2,550 633 15& 136 22 80,760 220.65 Total ...20,673 4563,802 74 10 153 27 112,535 307.46 Year, 1919: White .4,523 1,271 1,141 130 10 8 .2 27,338 74.90 Colored .19,681 3,834 3,121 713 165 142 23 98,891270.93 Total ..24,204 515422 843 15 150 2126,229 358 PROPORTIONATE NUMBERS." Year, 1920: White. 4,68829714267.06 30.08 4.69 3.63 1.06 .18.52 Colored. 15,985 199.12159.53 39.59 9.88 8.51 1.37. 13.80 Total. 20,673 221.35 183.91 37.44 8.74013 1.30 .14.87 Year, 1919: White. 4,523 281.01252.27 28.79 2.21 1.77 0.44. 16.55 Colored. 19.681 194.81 158.58 136.23 8138 7.21 1.17 .8. 13.77 Total. 24,204210.92176.09 34.83 7.23 6.20 1.0. 14.29 Annual average per 1,000 employees.

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70 TABLE II.-CAUSES OF DEATHS OF EMPLOYEES BY COLOR, Color. Age (in years). Cause of death. O o o e O eq CO C' Typhoid fever. 3 1 ....2 Malarial fever, estivoautumnal.3. ..1 Influenza. .2 19 2 5 6 .3 2 1 Dysentery, entamebic. ..1 ..... Tetanus.1. .... Pellagra.1. .1. Tuberculosis of the lungs. .19 1 3 1 9 2 3 Abdominal tuberculosis. .....1 Pott's disease. .2. 1 .. Disseminated tuberculosis. .8 .1 2 1 4 Syphilis, tertiary. .4 ..I .. Cancer and other malignant tumors of the stomach andliver. ..... Cancer and other malignant tumors of the peritoneum, intestines, rectum .1 ........ Cancer and other malignant tumors of other organs and of organs not specified. 2 ...1 1 Purpura hemorrhagica.1. .1 ... Encephalitis. 2 ....1 Pneumococcus meningitis. .2 .1 ..1 Cerebral hemorrhage, apoplexy. 1 5 .... Softening of brain ..1 1 General paralysis of the insane. .2 .1 1 Malignant endocarditis. .1 .1. Organicdiseasesoftheheart.11 .1. 2 2 2 2 Aneurysm.3. .2 Arteriosclerosis. ..2. Embolism thrombosis. 1 .. Acute bronchitis. Broncho-pneuimomna. 11 .3 4 2 Pneumonia (unqualified). 1 1 Lobar pneumonia. 1 8 .2. 2 1 1 Gangrene of the lungs.1 .1 ... Other diseases of the respiratory system. .1 .1 Ulcer of stomach. .1 ..1 .. Acute gastritis. ....1 Acute appendicitis.1 1. 1 Inguinalhernia.2. ...1 Other hernias.1. .. Intestinal obstruction. .1. 1. 1 Duodenal ulcer. ... Cirrhosis of the liver. 1.1 Bright's disease. 2 11 .2 1 1 5 Salpingitis and other diseases of the female genital organs. .... Phlegmonand celulitis. .1. .. Diseases of the bones. 1. .I .1 Suicide by firearms. ..;. 1 .. Acute poisonings. .1 .1 .. Burns.1. .1. .--I Accidentaldrowning. 1 6 1 1 1 1 1 1 Traumatism by cutting or piercing instruments.1. ...1 Traumatisn by fall. ..1 2 ...1 Traumatism by machines. 1 1 -.. -Traumatism by other crushings. 2 3 .1 1 1 1 1 Railroad traumatism.3. .2 .1 Electricity. ..1 1 .-. 1 ----Homicide by cutting or piercing instruments1. I I 1 Other external violence. .1. 1 .. Cause of death not specified or ill-defined. ...1 ... Total. 22 158 6 22 29 33 25 28

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71 AGE, AND LENGTH OF RESIDENCE ON ISTHMUS. Age tn years)Length of residence on Isthmus (in years). Continued. C: Uint k ut Om 40 so to -t 00 C', .63 e e i. M MI co 10 1 1. .4 1. .......1 .1 3 ......3 1 ...1 1 .1 .....1 2 1 4 1 ..9 1 21 1. ..............I ....1 ..........1. ...1 1 .2 1 1 7 3 .4 19 1 ...................I. .I .1. ....2 2 .4 .1 1 8 2 ..1. .1. 1 1 4 ....................1 ...... ..........1 S. .....1 ........I. ....-...1. .I. .........1. 1 .1. ..........2. 2 1 1 ...4 ....1I .1 1 1 .1 .1 6 .2:. ....I. .I ....2 2 1 1 2 ..2 1. ....I ...2 ............* .1 ...---i. .1 .1 .1 1. ....1 1. ...1 .1 ......1 1. .. 1. .......1'' 13 13 .9 11 1 ......1.I .. 11 1 1 .....2 ..1 .1 .....1 1. ..........1. ..1 1 1 ....2 11 .1. .. S. ......... 1 .................................................. 2 1 1 ...1. ..5 2 .13 .~ ~ ......1 ... ..........2. .... 1 .1 1 1 1 .1 S. .1 1 1 .-1 .....~:::ii~ i~ IjE: ..7 1 2 .2 S1 ..1 3 .M. .........1. .2 3 S. ...1 2.1 3 1 1 ....2 1 ...1 1 1 13 1 102 12 13 11 8 6 15 1154 21 3 25 29 180

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72 TABrz III.-DEATHS OF RESIDENTS, AND DEATH RATES, OF THE CITIES OF PANAMA, COLON, AND THE CANAL ZONE. Deaths. Annual rate per 1,000 Average population. Place. population. Total. Disease. Total. Disease. 'E'm a causes. MOM Year, 1920: Panama. 60,500 1,297 1,246 51 21.44 20.60 0.84 Colon. 26,078 554 517 37 21.24 19.82 1.42 Canal Zone. 27,459 242 211 31 8.81 7.68 1.13 Total. 114,037 2,093 1,974 119 18.35 17.31 1.04 Year, 1919: Panama. 61,369 1,211 1,165 46 19.73 18.98 .75 Colon. 26,078 573 536 37 21.97 20.55 1.41 Canal Zone. 26.511 229 207 22 8.64 7.81 .83 Total. 113,958 2,013 1,908 105 17.66 16.74 .92

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x : ..----x -x x me z. s --x-::. x x

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74 TABLE IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE PLACE OF S Sex Color. Age (in years). Cause of death. ____ ____ MwF. Un) M. F. W. B. Y. der 1-4 5-10 11-20 1 yr. General diseases. Typhoid fever. 3 1 4 ..1 Paratyphoid fever. 1 1 .2 .. Malarial fever, estivoautumnal. 7 2 6 3 ..2 2. Measles. .1. 1 .. Scarlet fever.1 .1 ..1 Whoopingeough. .2 .2 .2 .. Diphtheria and croup. 5 2 .7 .1 4 2 Influenza. 39 23 10 52 6 5 1 5 Dysentery. .1 .1 .... Entamebic. 4 .1 3 .1 Bacillary. 4 ..4 .3 1 .. U nclassified. .1 ..1 Leprosy. 4 2 1 5 ....1 Mumps. .1. ..1 Hemoglobinuric fever, unqualified. .I .1 .... Purulent infection and septicemia .3 2 .4 1 ... Pyemia. 1 1 1 1 1. .1. Septicemia .5 4 2 7 .2 .1 Pyemia and septicemia, pneumococcic. 1 1 .2. .. Tetanus. 2 1 3 ...1 Pellagra. 1 6 1 6 ....1 Beriberi. 1 ...1. ... Tuberculsis ofthe lungs .140 122 21 232 9. ..23 Acute military tuberculosis. 5 10 2 13 .3 9 1. Tuberculous meningitis. .4 5 3 5 1 1 6 1 1 Abdominal tuberculosis. 3 .3 ..1 1 Pott's disease.: .3 ..3 ....1. White swellings: Tuberculosis of bones and joints. 1 .1 ...I Tuberculosis of other organs. I ..... Tuberculosisof thelarynx. 1 1. .1 ....1 Tuberculosis of the lymph glands. I .1 ....1 Tuberculosis of the genito-urinary organs. 2 1 .3 Disseminated tuberculosis. 29 14 .42 1. ..4 Rickets. ..1 .. Syphilis, tertiary. 10 4 14. ...I Syphilis,hereditary. 8 1 3 6 .9 .. Syphilis, period not stated. 3 1 .3 1 ... Cancer and other malignant tumors of the buccal cavity. 3 3 2 4. Cancer and other malignant tumors of the stomach, liver, esophagus, and pharynx. 8 5 2 11 .... Cancer and other malignant tumors of the peritoneum, intestines, rectum. 3 .2 1 Cancer and other malignant tumors of the female genital organs. .12 12 ...2 Cancer and other malignant tumors of the breast. .1 .1 ... Cancer and other malignant tumors of the skin.1 ..1 Cancer and other malignant tumors of other organs and of organs not specified. 16 5 4 16 1 ...

PAGE 76

75 CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND RESIDENCE. Age (in years)-Continued. Place of residence. 21-30 31-40 41-50 51-60 61-75 76-100 UnPanColon. Canal Total. known. ama. Zone. 1 2 .........1 4 2 ..2 ...2 2 2 1 ...4 1 4 9 1 .......1 .........1 26. ...2 I ...................5 2 .7 26 12 6 1 .29 10 23 62 1 ..1 .1 1 ....3 1 .4 .1 1 2 4 ...........................I .......* .1 1 2 1 1 ..2 1 3 6 ......1 ......1 1 ......1 1 1 2 1 1 ..2 2 15 2. ...2 2 2 1 I 1 2 ..4 2 3 9 ...2 1 1 .......1 2 3 2 3 1 .5 1 1 7 1 ....1 .1 106 73 27 16 3 .169 83 10 262 1 1 ....8 3 4 15 ....5 2 2 9 1. ......3 3 1 1 ...2 3 1. ..............1 1 ..1 ...1 1 ..1 .1 2 ..1 .1 1 ...1 2 .3 7 8 5 6 ..18 14 11 43 .1 .1 2 5 3 2 1 ..10 2 2 14 ....................6 3 .9 1 2 1 ....4 ...4 1 2 .2 1 .5 1 .S 1 1 4 3 3 1 .8 2 3 13. 1 2 ...2 ..1 3 2 2 3 3 ...10 2 .12 1 ........1 .....1. 1 2 4 7 .5 2 .17 2 2 21

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76 TABLE IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE PLACE OF Sex. Color. Age (in years). Cause of death. UnM. F. W. B. Y. der 1-4 5-1011-20 General diseases.-Continued. Other tumors (tumors of the female genital organs excepted) .1. Actearticular rheumatism .i. ..1. Chronic rheumatism and gout. 2 1 .. Scurvy. .1 ....1. Diabetes .I Addison's disease.1 1 ....1 Anemia, chlorosis. 1 1 .2 ... Anemia, primary, pernicious. .1 .1 Anemia, secondary, cause not determined. 1. 2 2 Other general diseases. .1 1. Purpura hemorrhagica. 1 ..1. Alcoholism, acute. 1 1 .2. Alcoholism, chronic. 4 2. Diseases of the nerwoussystem and of the organs of spmials ense. Encephalitis. 4 2 .6 1 i .1 Simplemeningitis. 11 5 6 9 1 7 3 2 1 Cerebrospinal fever .2 3 1 4 .1 .3 Pneumococcus meningitis-. 7 4 1 10 .3 2 .1 Locomotor ataxia. 1 .I Other diseases of the spinal cord. 3 .3. Cerebral hemorrhage, apoplexy. 23 29 14 38 1 .I Softening of the brain. 2 1 2 1. Paralysis without specified cause .1 2 2 1. 1. General paralysis of the insane. 9 1 5 5 *.I Other forms of mental alienation. 1 .1 Dementia precox. .. Epilepsy. 1 1 ..1. Convulsions of infants (under 5 years of age). 2 4 2 4 .3 3 N euritis. ..1 .1 1 Tumorofthebrain .1 .. Diseasesof theears. 2 ..2 .1 1 Otitismedia. 4 2 .6 .2 4 Diseases of the circulatory system. Pericarditis. 2 5 1 6 .1 1 1. Acute endocarditis. 6 4 1 9 2 3 Malignant endocarditis. 4 2 .6 1 1 1 Organic diseases of the heart. 48 31 7 68 4 .1 7 Angina pectoris. ..1 1. Diseasesof the parties, atheroma,etc. ...2 .. Aneurysm. 15 2 2 15 Arteriosclerosis .14 12 3 22 1 Embolism and thrombosis. 2 .1 Phlebitis. 1. .1. ..1. Diseases of the lymphatic system (lymphangitis, etc.). .2 2 .2 Lymphadenitis (nonvenereal). .1 .1 ... Hemorrhage; other diseases of the circulatory system. .1

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77 CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND RESIDENCE.-Continued. Age (in years)--Continued. Place of residence. Age PanCoo.Canal 21-331-40 41-50 51-60 61-75 76-100 unaColon. Zone. Total. known. ......2 ...2 1. .....I ..1 .1. ...2 1 .3 1. .....1 ..1 1 1 ....1 1 2 .............1 1 1 ....11 .2 1 ......1 ......1. ....2 1 .........1 1. ............................................1 1 1 ......2 2 1 1 1 1 ....2 2 .4 1 1 1. ..2 2 2 6 1 2. ...14 1 1 16 1 ....3 1 1 5 3 2 .....7 2 2 11 1 .......I ......1 1 ...2 1 6 7 12 11 11 3 .40 6 6 52 2 ..1 .2 3 1 .3 .3 1 4 4 ....7 1 2 10 1 ...1 ...1 1 .................. 1 ...2 .2 1. ..2. .2 5 .1 6 ...1 ...1 1 .1 1 .1 2 1 1 4 6 1 2 1 ...6 1 .7 1 2 1 1 ...7 2 1 10 1 2 ...5 1 .6 8 22 12 14 10 5 .43 28 8 79 1 .* 1 1 ....1 ..2 2 6 3 3 2 .1 12 4 1 17 1 5 11 4 5 .20 5 1 26 1 1 ....1 1 2 1 ..1 .................2 ..2 ............................... ...................

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78 Ting IV. -DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE PLACE OF Sex. Color. Age (in years). Cause of death. UnM. W. B. Y. der 1-4 5-10 11-20 1 yr. Diseases ofthe respiratory system. Diseases of the larynx .1. .1 1 .. Laryngitis. 2 .2 1. Acute bronchitis. 30 18 2 46 .27 17 2 Chronic bronchitis. 5 7 2 10 .3 4 1 Broncho-pneumonia. 73 55 20 108 .51 34 6 3 Pneumonia (unqualified). 12 10 4 18 .3 7 2 Lobar pneumonia. 47 19 6 59 1 5 4 .. 'Pleurisy. 2 5 1 6 .1 1. Empyema .1 1 2 ...2 'Pulonary congestion, pulmonary apoplexy. 3 1 1 3 .... Gangrene of the lungs. 3 3 6. .... Asthma.2.1 1. Other diseases of the respiratory system (tuberculosis excepted). 2 ..2 .1 .. Abscess of the lungs. 3 1 1 3 1 .I Diseases of the digestive system. Diseases of the pharynx: Follicular tonsillitis. 1 1. 1 Stricture of the esophagus. .2 .2 .. Ulcer of the stomach.4 1 3 .1 .. Other diseases of the stomach (cancer excepted): G astrectasis. .1 .1 ..... Acute gastritis. 14 7 2 19 .9 6 .. Acuteindigestion. 4 4 1 6 1 3 2 Diarrhea and enteritis (under 2 years) 99 102 15 185 1 156 45. Colitis (under 2 years). 6 6 3 9.10 2. Diarrhea and enteritis (2 years and over) .1 6 7 .1. ..8 2 Colitis (2 years and over). 1 3 .4 .2 1 Appendicitis and typhlitis: Acute appendicitis. 7 2 5 4 .1 3 Chronic appendicitis. 1 ..1.1 Hernia, intestinal obstructions. .1 .1 ..1 Inguinal hernia.4. Other hernias. 1 1 2 Intestinal obstruction .8 2 1 8 1 ..1 Other diseases of the intestines. ..2 1 1. Constipation. .I .1 Duodenal ulcer.1. Acute yellow atrophy of the liver .1 1. Cirrhosisoftheliver .9 ill Biliary calculi. 4 2 2. Other diseases of the liver. .2 .2. .2 1 1 Abscess of the liver (unqualified) 1 1 1 1. \ Abscess of theliver (entamebic) 1 ..I. Cholecystitis. .1. .. Diseases of the spleen.1 1 Simple peritonitis (nonpuerperal). 2 4 1 5. Other diseases of the digestive system (cancer and tuberculosis excepted) I 1 ...

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79 CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND RESIDENCE.-Continued. Age (in years)-Continued. Place of residence. Age 21-30 31-40 41-50 51-60 61-75 76-100 unPanColon. Canal Total. known. ama. Zone. .I ..1 1 ..2 ..2 1. ...1 ..17 30 1 48 1. ..I .3 7 2 12 7 13 4 2 6 2 .108 17 3 128 2 3 3 1 .1 .22 ..22 24 12 7 9 5. .37 19 10 66 3 .2 ...4 3 .7 ......2 ..2 ...1 3 1 .4 3 1 2 ....3 3 .6 S. .I I ..2 ..2 .....I ......2 .2 ..2 ....2 2 .4 .......1 1 ....2 ..2 I 2 ...1 3 .4 ...........I ....* 1 2 3 ....19. 21 2 ..I ...1 6 1 8 .152 43 8 201 .10 2 .12 1 1 ..1 ..10 3 .13 1 .3 1 .4 2 1 1 1 ..6 .3 9 ..........1 ......... ........1 .........1 1 2 .1 ...3 1 4 2 .....1 1 2 2 -3 ..3 5 2 10 1 ...1 1 .2 1 ...............1 1 ....1 .1 1 .......* ..1 2 4. ...3 ..10 4 2 16 2 1 .1 .2 2 .4 ...2 ..2 1 .1 ...2 .2 1 ....1 .1 .1. ..1 ..1 1. 1 ..1 1 1 1. 3 3 .6 I ......1 1

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80 TABLE IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE PLACE OF Sex. Color. Age (in years). Cause of death. -I UnM. F. W. B. Y. der 1-4 5-10 11-20 Nonvenereal diseases of the genitourinary system and anneza. Acute nephritis. 7 14 2 19 .10, 5 3 1 Bright's disease (chronic nephritis). 70 40 23 84 3 ...3 Other diseases of the kidney and annexa. 3 2 .5. 1 Pyelo-nephrosis. 8 5 2 11 .4 3 Calculi of the urinary passages. .1 .1 Cystitis. 2 1 .3. Diseases of the prostate. 1 .1 Hypertrophy of prostate. 1 ..1. Uterine tumor (noncancerous). .4.4. Other diseases of the uterus. .2 2. Salpingitis and other diseases of the female genital organs. .7 1 6. The puerperal state. Acidents of pregnancy. 2 2. Extra uterine pregnancy. .2 2. Hyperemesis gravidarum. .1 1. Puerperal hemorrhage. .7 1 6. Other accidents of labor. .4 1 3 .1 Puerperal septicemia. .8 3 5 .2 Puerperal albuminuria and convulsions. .4 1 3. Eclampsia. .10 1 9 Diseases of the skin and of the cellular tissue. .Acute abscess: Phlegmon and cellulitis. 2 1. 3 Diseases of the bones and of the organs of locomotion. Diseases of the bones (tuberculosis excepted). 2 1. 1 Malformations. Congenital malformations (stillbirth not included). 12 12 3 21 .21 3 Diseases of early infancy. Congenital debility, icterus, and sclerema. 21 10 3 27 1 31 .. Prematurebirth. 40 30 9 60 1 70 Atrophy of infants. 1 ..1 1 .. Malnutrition. 28 20 48 4. Other causes peculiar to early infancy (including various consequences of labor). 19 16 2 32 1 35 ...

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81 CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND RESIDENCE.-Continued. Age (in years)-Continued. Place of residence. I -Age PanColon Ca Total 21-30 31-40 41-50 51-60 61-75 76-100 kn ama. Cone. Total known. 2 ...14 6 1 21 12 22 26 20 16 8 1 63 39 8 110 1 1 2 ....4 1 .5 1 2 .1 .2 6 5 2 13 1. .....I ..1 1. ..2 ..3 ..3 .1. ..........1 1 ..............., ...1 ..... .3 .4 1 1 ...1 1 .2 4 3 .....3 4 .7 2 .......1 1 2 11 ......1 2 ....................................1 4 2 1 ....5 1 1 7 2 1 .....2 2 .4 4 2 ...7 .1 8 3 1 .....1 2 1 4 7 1 1 .....5 4 1 10 1 1 .....3 ..3 1. ...1 2 10 5 9 24 .21 9 1 31 47 13 10 70 .I .1 17 15 16 48 22 9 4 35 MR 77731--6

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82 Tau IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE PLACE OF Sex. Color. Age (in years). Cause of death. ~UnM. F. W. B. Y. der 1-4 5-10 11-20 l yr. Old age. Senility. .5 6 3 8 .... Affections produced by external causes. Suicide by firearms. 8 .5 3 ...2 Suicide by cutting or piercing instruments. 2 ..1 1 Acute poisonings. 3 3 2 4 Burns (conflagration excepted) .3 2 1 4 .4 Accidental drowning. .16 3 6 13 ..1 4 Traumatism by firearms. .1 .....1 Traumatism by cutting or piercing instruments. .1. .. -'raumatismn by fall. 12 2. ..8 .7 1 Traumatism by machines. I ..I ... Traumatism by other crushings (vehicles, etc). 18 2 6 14 ..1 2 2 Railroad traumatism. 6 1 1 6 ..I Dynamite traumatism. 1 ..1 .1. Injuries by animals.1.1. 1. Starvation. 1.1 Lightning.1. .... Electricity (lightning excepted). 2 1 .3. Homicide by firearms. 4 6 2 8 .3 Homicide by cutting or piercing instruments. 6 2 2 5 1 Homicide by other means. 3 .2 .I Fractures (cause not specified). 1 1. Other external violence. 3 ..1 Legal execution. 3 ..3 IM-defined diseases. Ill-defined organic disease. 2 2 .1 Sudden death .3 2.3 ..1 Cause of death not specified or illdefined. 13 10 2 21 .9 8 2 Infections of undetermined origin .2 1 1 2 .1 Grand total. 1,204 889 296 1,760 37 567 245 50 104

PAGE 84

83 CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND RESIDENCE.-Continued. Age (in years)-Continued. Place of residence. Age pan'Cna 21-30 31-40 41-50 51-60 61-75 76-100 unan' Colon. Canal Total. knw.ama. Zone. known. .1 3 7 .9 2 .11 5 ....1 2 5 1 8 1 1 ....1 1 .2 1 2 .....3 2 1 6 1 .....2 2 1 5 5 6 2 1 ...5 6 8 19 ......W. ...........I 1 1. .....1 2 2.2 2 ...6 3 5 14 ... 6 5 1 .3 ..10 4 6 29 2 3 1 ....4 1 2 7 .....1 1 .....1 ..1 .. ...............................1 1 .1 1 ....3 .3 6 1 ..7 3 .10 4 3 1. ...2 3 3 8 1 2 .....1 1 1 3 ..1 .1 ..1 1 1 .....2 1 a 2 1 ........3 .3 1 ....1 1 2 1 2 ..I ..5 ..5 4 ...14 6 3 23 2 ......1 1 1 3 324 313 199 146 97 45 3 1,297 554 242 2,093

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84 TABLE IV-A.-DEATH8 Sex. Color. Less than Cause of death. t M. F. W. B. year. Typhoid fever. 4 1 5 Malarial fever, estivoautumnal. 6 1 1 6 Influenza. 7 1 6 2 Hemoglobinuric fever, unqualified. 1 .1 Septicemia. ..3. Tetanus. 1 Tuberculosis of the lungs. 20. ...20. Acute miliary tuberculosis. 1 ..1 Disseminated tuberculosis. 3 1 .4. Syphilis, tertiary.2. Syphilis. period not stated. .1 Cancer and other malignant tumors of the buccal cavity. 1. Cancer and other malignant tumors of the stomach and liver. 3 .1 2 Cancer and other malignant tumors of the female genital organs. 2 1 1 Cancer and other malignant tumors of other organs and of organs not specified. 1 1. Diabetes. 2 .1 1 Anemia, secondary, cause not determined. I .... Encephalitis. 1. .. Cerebrospinal fever .I .1 .I Pneumococcus meningitis. .. Cerebral hemorrhage, apoplexy. 1 ..1. Epilepsy. .. Neurasthenia. .. Pericarditis. I ..1 Acute endocarditis. 1 1 1 1. Malignant endocarditis. .2. ,Organic diseases of the heart. 12 4 6 10. A neurysm .1. Arteriosclerosis .2 Hemorrhage; other diseases of the circulatory system. ..1 Diseases of the thyroid body. 1 .1. Acute bronchitis. ..1 1 Broncho-pneumonia .. Pneumonia (unqualified). 1 .1. Lobar pneumonia. 12 .3 9 Pleurisy. 1 ..1. Ulcer of thestomach. 2 .1 1 Diarrhea and enteritis (under 2 years). 2 ..2 1 Diarrhea and enteritis (2 years and over) .1 .... Acute appendicitis.2 2 .2 Inguinal hernia. 1 1. Other diseases of the intestines.1. 11 Cirrhosis of the liver .3 .1 2 -Other diseases of the liver. 1. .. Simple peritonitis. 1 .1 Brights disease (chronic nephritis) .13. 3 5 11 Other diseases of the kidney and annexa. 1 ..I .. Pyelo-nephrosis. ...1 Cystitis. 2 .2 Stricture of the urethra, nonvenereal. 1 ..1 .Uterine tumor (noncancerous). Accidents of labor.1. .. Puerperal hemorrhage. 2 .2 Eclam pj ia. .1 Phlegmon and cellulitis. Includes deaths of all nonresidents, passengers off incoming ships, etc. Deaths of nonresidents

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OF NONRESIDENTS.Age (in years). Total. 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 Over Un75 known. .2 1 1 1 ....5 1 1 1 2 1 ..1 ...7 1 3 2 1 ...8 .I ..1 1 1 1 .....3 1 .1 10 8 4 4 .1 .27 1 .........1 1 .2 .1 ...4 2 1 ..3 1 1 .......2 1 ..............1. ....., ...... .2 .1 .3 1 1. .....2 2 .....2 .....1 .........................2 1.1 ....1 ..1.1 ....1 ........1 1 .....I I ..1 ....1 .............I .....I ..1 S. .......................................1 1. ....2 1 .I. .2 4 4 5 .2 .12 51 ...1 1. .... 11 ...2 ..1 ...I .....1 .1 2 1 .1 ..6 1. ........6 1.1 6 1 2 1 ..12 .......1 2 ...2 1 ...2 1 ....1 2 .......2 1 ....................1 2 .........................2 2 .1 ..3 1 ........1 ...1. .1 1 3 4 4 3 1 ..16 ...1 1 ....I 2 ...2 1 ..1 1 ......1 1 .....1 1 .1 ....2 .......1 1 ....... are not taken up in the statistical charts relating to Panama, Colon, and the Canal Zone.

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86 TABLE IV-A.-DEATHS Sex. Color. Less than Cause of death. 1 M. F. W. B. year. Diseases of the bones. 1. Congenital malformations. .1 1 1 Congenital debility, icterus, and sclerema ...1 1 Premature birth. 2 1 .3 3 Malnutrition ..1 .I 1 Senility. 1 1. Suicide by drowning. I. Suicide by cutting or piercing instruments. 1 .1 Burns. .1. ..... Absorption of deleterious gases. 1 1. Accidental drowning. 7 1 5 3 Traumatism by cutting or piercing instruments. 1 .1 Traumatism by fall. 5 .3 2 Traumatism by machines. 1 .. Railroad traumatism. 1 .. Homicide by'firearms. 3 .1 2 Homicide by cutting or piercing instruments. 2 .2 .. Homicide by other means. 1. Cause of death not specified or ill-defined. 2 .f 1. Total. 164 40 73 131 8 2 Includes deaths of all noaresidents, passengers off incoming ships, etc. Deaths of nonresident 1

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87 OF NONRESIDENTSu-Continued. Age (in years). Total 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 Over Un_75 known ...1.I .....1 11 11 ....................................................1 .............I. ....1 ...1 .....1 ...1. .....1 2 ..1 2. 1 11 .* ....2 3 12 ...... ..........1 .1 2. .: ........2 ..112 ......13 2. .....2 5 1 13 63 46 35 20 10 2J 1 204 are not taken up in the statistical charts relating to Panama, Colon, and the Canal Zone.

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88 TABLE V.-DEATHS BY NATIONALITY OR NATIVITY, YEAR 1920. Employees. Nonemployees. Total. Country. Male. Female. Male. Female. Male. Female. Antigua. 6 4 4 10 4 14 A frica. .........I ...1 Barbados. 38 1 159 134 197 135 332 1h ...1 -Bahamas. .1 .1. 2 2 British Guiana ..2 2 2 4 Chile. 4 2 4 2 6 China. 39 3 39 3 42 Colombia. 8 .59 40 67 40 107 Costa Rica. 1 9 4 10 4 14 Cuba. .4 1 4 1 5 Curacao. 1 2 1 2 3 Demerara. .2 4 3 4 7 Dominica. ..4 1 4 1 5 England. ..2 2 2 2 4 Ecuador. .6 3 6 3 9 France. 2 4 5 6 5 11 Fortune Island.1 1 1 2 1 3 Grenada. 5 11 9 16 9 25 Greece.1 3 1 4 1 5 Guadeloupe. 5 1 5 4 10 5 15 Germany. ..1 .1 Guatemala. .1 ...1 1-.Haiti. .1. 2 .3 3 Honduras. .2 1 2 1 3 India. .2 1 2 1 3 Italy ....** ***' 1 ....8 3 9 3 12 Jamaica. 33 .247 219 280 219 499 Japan. ..3 1 3 1 4 Martinique .4 .20 24 24 24 48 Mexico. I .4 2 5 2 7 Montserrat. 1 .5 3 6 3 9 Nicaragua. .3 1 3 1 4 assau. 1 .4 1 5 1 6 Norway. ..1 .1 .I.-. 1 Panama. 26 1 ....0 326 331 6 Peru.1 7 8 8 8 16 PortoRico. ...I ..1 St. K itts ..1 ...-..-..-.-..-i 1 St. Lucia .5 .19 16 24 40 St. Thomas. ..5 3 5 3 8 St.Vincent. .3 6 4 9 4 13 Scotland. ..1 -1 Spain. 19 5 20 5 25 Trinidad 2 1 7 8 9 9 18 United States. 16 33 15 49 15 64 Venezuela. 1 4 5 5 5 10 VirginIslands. 1 ...1 1 Holland ..1 Poland. ..1 Palestine. ..1 1 Portugal. .-.-. 1 Philippines. ...1 Santo Domingo. ..1 .1 1 Syria. ..1-. I Switzerland. ....1 --.1 1 Denmark.1 --.--1 I Hungary. 1 ....1 1GrandCayman. ..I 1 1. Roumania. ..1 Unknown. .7 4 7.11 Totals. 171 4 1,035 884 1,206 888 2,094

PAGE 90

89 TAIBLIB VI.-STATISTICS RE AMERICAN EMPLOYEES AND THEIR FAMILIES. Annual death rate per 1,000 population. White employees from the United States: Disease. .3.32 External causes. .........95 Total. .....4.27 White women and children from the United States: Disease. .3.80 External causes. ..72 Total. ....4.52 White employees from the United States and their families: D isease. 3.59 External causes. .82 Total. 4.41 Number of American children born on the Isthmus during year 1920. 205 Deaths among American children under 1 year of age ..10 Infant mortality rate among American children (number of deaths per 1,000 births).48.78

PAGE 91

90 TABLE vrI-BIRTHS AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Births. paper 1,000 popAverage lation. Place. popula-----tion. still. Still. Total. Aliveborn. Total. Alive. born. Year, 1920: Panama. 60,935 2,532 -2,376 156 41.55 38.99 2.56 Colon. 26,078 1,014 962 52 38.88 36.89 1.99 Canal Zone. 27,459 667 631 36 24.29 22.98 1.31 Total. 114,472 4,213 3,969 244 36.80 34.67 2.13 Year, 1919: Panama. 61,369 2,359 2,214 145 38.44 36.08 2.36 Colon. 26,078 964 908 56 36.97 34.82 2.15 Canal Zone. 26,511 732 695 37 27.61 26.22 1.39 Total. 113,958 4,055 3,817 238 35.58 33.50 2.09

PAGE 92

91 TABLz VIII.-INFANT MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Deaths Births. among Death Average children rate per Place. populaunder 1 1,000 Mlon. Feyear of births. Mae. male. Total. age. Year, 1920: Panama. .60,500 1,150 1,226 2,376 369 155.30 Colon. 26,078 503 459 962 137 142.41 Canal Zone. 27,459 348 283 631 60 95.09 Total. 114,037 2,001 1,968 3,969 566 142.61 Year, 1919: Panama. 61,369 1,190 1,024 2,214 342 154.47 Colon. 26,078 479 429 908 141 155.29 CanalZone. 26,511 355 340 695 79 113.67 Total.113,958 2,024 1,793 3,817 562 147.24

PAGE 93

92 TABLE IX.-DEATHS OF INFANTS BY CAUSE Sex. Color. +1 Cause of death. -1 week week. -1 M. F. W. B. month. Measles ..1. I.1. W hooping cough.2.2 2 .2 Diphtheria and croup. 1 ..I Influenza. 4 2 1 5 D ysentery. 1 ..I Dysentery, bacillary. 2. 2 .. Pyemia. ... Tuberculosisofthelungs. 1 4 .5 Acute military tuberculosis. 2 1 1 2. Tuberculous meningitis. 1 ..1 Disseminated tuberculosis.*. 1 2 .3 Syphilis, hereditary. 8 1 3 6 3 2 Encephalitis.1 ... Simplemeningitis. 6 1 2 5 Cerebro-spinal fever. 1. 1 Pneumococcus meningitis. 2 1 .3. Cerebral hemorrhage, apoplexy. 1 .1 Epilepsy.1 .1. Convulsions ofinfants. 1 2 1 2 1. Diseases of the ears. 3 Pericarditis.1. I .. Acute endocarditis. 1 .2 Malignant endocarditis. 1 .1. P hlebitis. 1 ..I Diseases of the lymphatic system (lymphangitis, etc.) .2. 2 ..2. 2 Diseases of the larynx. 1 ..I Laryngitis. ..1 I Acute bronchitis. 19 9 1 27 1 3 Chronic bronchitis. .1. Broncho-pneumonia. .29 22 8 43 2. Pneumonia (unqualified). 2 1 .3. Lobar pneumonia. 2 3 1 4 ..1 Other diseases of the respiratory system (tuberculosis excepted). I ..1 1 Abscessof lung.1. .. Ulcer of the stomach. 1 ..1. Acute gastritis. .. Acute indigestion. 2 1 3 1 Diarrhea and enteritis. 78 78 16 140 2 9 Colitis. 4 6 3 7 Intestinal obstruction.3. .3. Cirrhosis of the liver. ... Other diseases of the liver. ..1. 1 Acute nephritis. ...9. 1 Other diseases of the kidney and annexa. 1 .... Pyelo-nephrosis. 4 4 Congenital malformations (stillbirth not included) .9 12 3 18 0 Congenital debility, icterus, and sclerema. 16 7 1 22 175 Premature birth. 40 30 9 61 64 5 Congenital debility. 5 -2 1 6 5 1 Atrophy of infants. .1. .. M alnutrition .23 20 43 2 2 Other causes peculiar to early infancy (including various consequences of labor). 19 16 1 34 27 5 Acute poisonings. 1 1 .. Ill-defined organic disease .1 ..1 Cause of death not specified or ill-defined. 4 5 1 8 3 1 Infections of undetermined origin. .I. 1 Totals. .321 245 59 507 139 39

PAGE 94

93 SEX, COLOR, AGE, AND PLACE OF RESIDENCE. Age (by months). Place of residence. 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 Panama Colon. Canal Total. Zone. 1. ......1 1. .....1 2 .2 ......I ..........1 S. 1 2 1 .1 2 .4 6 ..........1 ..I S. ...I .....1 1 2 1 ................................................I I 1 .1 2 1 ......5 5. ...5 1 .2 .,. 2 1 3 1 .........1 1 1 1 .2 1 3 2 .......1 1 .6 3 9 ...1 .1 ...I 2 ..2 .1 1 .1 .6 1 .7 1 ....1 ..I 1 1. ...1 ....1 1 3 1. ......1 ...1 1 ...1. ..1 ...1 ...3 1.1 .2 ..1 .2 3 1 ......1 1 ....1 ...1 ..1 2 ...I ....1. ... 1 .....1. ...1 1 1 .......2 ...2 1. ........1. 1 ............. 3 4 .3 2 4 1 2 3 2 9 19 .28 .1 ......., 1 .2 .2 2 7 4 6 2 6 3 8 2 2 7 43 7 1 51 1 .I .I ..1 1 3 3 1 2 .1 .....2 2 1 5 11 1. ..............1 .1 ..........1. I .1 1 ...........................I .......... 1 2 2 ...2 2 ...9 ..9 .......1 ...1 1 1 3 1 23 10 13 7 9 9 15 24 12 12 119 33 4 156 2 2 .1 .1 1 1 1 1 8 2 .10 2 .I ..2 1 3 ...........................I ....1 .............I ........I 1 2 1. 1 1 1 .2 7 2 1 10 1 ...........1 1 ......I ..2 .2 1 1 4 1 3 ..1 ..1 1 .9 4 8 21 1. ........14 9 .23 1 ........47 13 10 70 1 ..........6 .1 7 .1 ...........1 I 6 8 5 4 3 3 2 4 1 1 2 is 15 13 43 1 1 ....1 .21 9 5 35 1. .........1 .I 1 .........19 1 ..1 .2 ...1 6 1 2 9 I. ..1. 1 31 63 40 33 27 27 32 40 36 27 32 369 137 60 566

PAGE 95

94 TiAB~ X.-DISCHARGES AND DEATHS IN THE HOSPITALS Employees. Discharges. Deaths. Diseames. White. Black. White. Black. M. F. M. F. M. F. M. F General di8eae. Typhoid fever. ..2 ...3 Typhoid bacillus carrier. ..1 Paratyhoid fever. .. Relapsing fever. I .1 .. Malaria. .I Estivoautumnal. 45 8 218 4 3 Tertian. .30 3 62 1. Quartan. ..6. Mixed. 1. Clinical.1 5. Cachexia. Smallpox. .I. .1. Varioloid. Vaccina. 8. Measles. 2 1 14. Scarlet fever. 1 Whooping cough. .1. Diphtheria and croup. 2--. Diphtheria bacillus carrier. Influenza. 156 27 414 4 2 18 Dysentery, entamebic.,.6 .5 ..1 Dysentery, bacillary ..6. Leprosy. Erysipelas. .. Chiekenpox.25 1. .. Mumps. 1 9. Hemoglobinuric fever, unqualified. .. Yaws. 2. ... Filiariasis. .1. .... Purulent infection and septicemia. 2 11 4. Pyemia. .. Septicemia. ..... Pyemia and septicemia, pneumococcic .. Tetanus. 1 Pellagra. ..1 ...I Tuberculosis of the lungs. 4 1 37 2 .13 Acute miliary tuberculosis .... Tuberculous meningits. Abdominal tuberculosis. .1. .. Pott's disease. 2 Tuberculosis of bones and joints. .. Tuberculosis of other organs. 1 .I Tuberculosis of the larynx ...... Tuberculosis of the skin. ..-.

PAGE 96

95 OF THE PANAMA CANAL FOR THE YEAR 1920. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White Black. M. M. F. M. F. M M. F. M. F. M. F. M. F. M. F. M. F. 2 1 3 4 .1 8 ...4 1 ..20 9 4 .........5 1 ........1 5 .....7. .............1 21 21 20 27 31 1 ...1 12 1 3 ...2 .411 7 12 16 12 13 26 ..10. 2 .....187 1. 1 .........8 ............1 2 1 2 .........11. ..1 ........1 1 4 11 6 .......1 .....24 1. .........1 ........................................8 .. 8 30 28 9 7 .............99 2 1 1 .....1 ........5 1 .3 5 4 .............13 5 11 6 7 14 ...1 .........45 1 1 ...............................I 32 52 63 32 57 3. 2 4 11 42 2 6 .2. 1 887 43 1 1 .2 .....11 .......26 1 3 .1 .......8 3 1. ......1 1 ....2 1 1 2 .....1 .3 .....7 2 30 21 4 4. 1 1 1. 90. 25 6 1 3 4 ...I .2 .1 .....52 1 1 ..........1 1 2 ..........5. 1. .........I 2 1. 1 .1 1 .......12 1 1 ............1 1 1 .........1 2 1 2 2 .........5 1 ..........2 1 1 .......2 2 6 3 8 3 12. 2 .4 7 15 .1 .3 ...92 29 4 5 ........1 9 1 .1 1 .2 .........2 3 1 1 3 ....1 .......7 1 3 ....3 2 3 1. ......4 1 1 .....1 .......3 1. ...........1. ...............I

PAGE 97

96 TABLE X.-DISCHARGES AND DEATHS IN THE HOSPITALS Employees. Discharges. Deaths. Diseases. White. Black. White. Black M. F. M. F. M. F. M. F. General dieases.-Continued. Tuberculosis of the lymph glands. .5. Tuberculosis of the genitourinary organs. 1 .1. Tuberculous abscess. ....... Disseminated tuberculosis. ......10. Rickets. Syphilis: Primary. .6 .... Secondary. .2 .9 ... Tertiary. 7. 94 .... Cerebro-spinal. 13 .13 ....2 Hereditary. Period not stated. .....2. 2. Gonococcus infection. ..... Gonorrhea. 33 .211 ... Gonorrheal arthritis. .7 Gonorrheal bubo. .2. ... Gonorrheal orchitis and epididymitis .4 .3 Gonorrheal ophthalmia. 2. ... Soft chancre. 13 .121 .. Adenitis chancroidal. .1 .5 Cancer and other malignant tumors of the buccal cavity. 1 ....... Cancer and other malignant tumors of the stomach and liver, esophagus, and pharynx. .1. Cancer and other malignant tumors of t.e3 er.o.-. .neum, intestines, rectum. ...1 .. Cancer and other malignant tumors of the female genital organs. .... Cancer and other malignant tumors of the breast. ..... Cancer and other malignant tumors of the skin. ...1. Cancer and other malignant tumors of other organs and of organs not specified .3 .3 .2. Other tumors (tumors of the female genital organs excepted). 3 .9 1. Acute articular rheumatism .. Chronic rheumatism and gout. 1 .I. Gout. Arthritis deformans. .. Scurvy. .. Diabetes. 2. 1. Glycosuria. Exopthalmic goiter. 1. .. Leukem ia .. H odgkin's disease. Anemia, secondary, cause not determined ..1 1 41.

PAGE 98

97 OF THE PANAMA CANAL FOR THE YEAR 1920-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. 02 *Black. Black. White. Black. White Black. 0 0EM. M. F. M. F. M. M.jF. M.F. M. F. M. F. M. F. M. F. 1 3 4 3. ..16. ...2 .....3 ....2 ..............3. 1 ..1 ....7 .1. .224 ....2 .....1 .....3 8 1 ..1 ....1 .3 .....36 11 .3 2. ....17 1. ....46 9 3 7 668. .1 21. 4 .....219 2 6. 4 3 ...........45 4 4 1 ...1 ....52 ..4. ...2 ...5. 3 1 13 .....13 1. .....31 20 1 .24 5 .....123 .1 .....441. ...........12 1. .1. ...1. ..7. S ....5 .....13. 1 1 .2 5 ............11 5 2 .1 12 3. ....125 ....297. S ......13 .......19 1 .............4 1 1 1. ...11 3 1. ...9 3 3 ....1. ......2 ..........I1. .......12 1 2 .1 ....1. ......3 1 1. ........1. ......23 I. .I ...1 1. 1. ..8 4 1. 4.3 ....2. 1. 26 3. .2. ..1. ...,. ...............3 ...............1 1 ......2. ...1 .2. .........1 2 .* .............5 I ..............1 2. 2. .... I. .2. .....1. MR1 777.--. 2 1 .2 .....21 21.1. MR 77731-7

PAGE 99

98 TABua X.-DISCHARGES AND DEATHS IN THE HOSPITAL DIcharge Deaths. Diseases. White. Black. White. Black. M. F. M P. M. F. M. F. General disease-Continued. Other generaldiseases. ..5 1 1 Purpura hemorrhagicam.h aia. ...I Alcoholism (acute or chronic) .11 .1 Alcoholism, acute ...14 .2 ..... Alcoholism, chronic. .3 Alcoholic psychosis. ........ Chronic lead poisoning .2 3 Other chronic occupational poisonings. Other chronic poisonings. 1. Drug habit. Diseases of the nervous system and of the organs of special sense. E n ep aliti .......1 Simple meningitis. ....1 Cerebrospinal fever. .1. ..1 Pneumococcus meningitis. ... Locomotor ataxia. Other diseases of the spinal cord. Acute anterior polio-myelitis Cerebral hemorrhage, apoplexy. ..I .1 1 .3. Saftening of the brain. ....I Paralysis without specified cause. 3 .. General paralysis of the insane. ... Other forms of mental alienation. ..1. Dementia precox. .3. Manic depressive psychosis. .. Toxic psychosis. I. .. Epilepsy. 7. .. Convulsions, nonpuerperal (5 years and over). ..1. Convulsions of infants (under 5 years of age). Chorea. Hysteria. 2 2. Neuralgia. 2 .2. Neuritis.1.6 ... Other diseases of the nervous system. 6 5 8. Organic disease of the brain. 1 .. Tumor of the brain. Neurasthenia. 9 3 3 Diseases of the eyes and their annexa. .9 1 57 1 Follicular conjunctivitis. .2. Trachoma.7. ... Cornea. 17 .28 Iris. 7 1 17.

PAGE 100

99 OF THE PANAMA CANAL FOR THE YEAR 1920.-Continued. Nonemployees. Nonresidents. Discha~rges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White Black. 8 E E M. M. F. M F. M M. F. M F. M F. M. F. M. F. M. F. 15 12 4 3 ......2 .......43 .....~ ......7 ............. 12 12 1 2 1 ....8 .......30. 11' 3 ....-* ....-, -* ., ..35 1 3 4 ...I ...2 ........13 1 S ...2 ....1 .......3 3. 4. .1. ....... S. ...... .................. .....1. 1 .............2 ...............2 1 1 2 .1 1 .......6 1 .....I ......I2 1 1. .1 1 .......5 ...1 ...1 ....2 1 ............ ..............2 3 ....4 ........ .1. ..1 .......1 1.1 2 .....I ......12 36 ..4 ..* 5 .........9 6 3 3 9 14 .......2 .1 ....39 12 1 2 22 19. 1 ..1 9 .1 .....69 3 .1 .............. 2 .2. ...9. ......4 1. ..3 .....2 .......14 3 .............5 2 ..1 3 .1 ...........5 13 .............4 2 3 6 1 2 .....1 ........19. 12 .1 .............8 .. 1 4 5 1 2 .....5 ....38 3 4 6 .1 ....4 3 ......40. 1 ...............3. ..6. ........4 I 8 2 7 .12 .....15 1 ......60 19 9 3 10 28 .....6 .......1. 1 .7 1. ....1. ... 5 1 ..~~~. ......I 1 .......-.1 1 9 3 4 28. ....4 ......1 4 6.11 9.4.I. 1. 45

PAGE 101

100 TAma XL-DISCHARGES AND DEATHS IN THE HOSPITALS Employees. Discharges. Deaths. Diseases. White. Black. White. Black. M. F. M. F. M. F. M. F. Diseases of the nervous sy& em and of the organs of special sense.-Continued. Diseases of the eyes and their annexa-Continued: Lens. 4. Fundus. .. Diseases of the ears.3 .1. Otitis, external. 3 2 7. Otitis media. 4 4 7 1. Diseases ofthe circulatory system. Pericarditis. 1. .. Acute endocarditis. ..... Malignant endocarditis. ..1. .2 Organic diseases of the heart. 6 .12. 6. Angina pectoris. 1. .. Diseases of the arteries, atheroma, etc. .... A neurysm ...4 ...1 Arteriosclerosis. 1 .1 ....1 Diseases of the veins (varices, hemorrhoids, phlebitis, etc.). 2. 3. Hemorrhoids. 20 .20 1. Varices. 2. 1 .. Varicocele.3 .5 ... Phlebitis ..... diseases of the lymphatic system (lymphangitis, etc.) 12 .13. Lymphadenitis (nonvenereal) .21 1 41. Hemorrhage; other diseases of the circulatory system. 6. 1 .. Diseases of the respiratory system. Diseases of the nasal fossae. 30 11 22. Adenoid vegetations. Myiasis of nasal fossae and sinuses. 1 Diseases of the larynx. .I. .. Laryngitis. Diseases of the thyroid body. .2. Acute bronchitis. 23 5 55 3 Chronic bronchitis.4 2 Broncho-pneumonia. 1 2 ..3 Pneumonia (unqualified). .1 Lobar pneumonia. .1 12. Pleurisy. 2 E m pyem a ... Pulmonary congestion, pulmonary apoplexy.

PAGE 102

101 OF THE PANAMA CANAL FOR THE YEAR 1920.-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White Black. 9 M.M.F. M. F. M. M. F. M. F. M. F. M. F. M. F. M. 'F. S. 2 ............. 2 .1 .3 .....1 ....... 2 .2 .2 .....2 .......12 .. 17 4 7 i 1 .....10 .......54 10 6 12 2 5 ...2 .4 .......55 2 .1 .........1 ..........3 1 2 ....3 1 1 ..I ....1 ......1 .3 4 3 3 3 18 ....2 5 11 ..1 ....51 9 ......................1 ................. .....1 1 .....1 .......3 .......................................5 1 1 1 11. ....2 11 .1 .....8 4 2 1 1 1 2 .....3 1 ......16 15 2 5 1 11 .....11 1 1 .....88 4 .I .................8 .. 9 1 ..I ..............19 ......I ......5 1 .2 4 4 6 ......2 ......46 16 2 3 12 5 ......16 .3 .....120 3 3 ..2 2 .....3 .....20 32 13 17 2 10 .....7 4 1 .a ...149 .. 9 8 4 ...0. ... 17 43 ..4. 1. ..1. ....... 1. 2 .....3 1 5 2 ......1 12 1 40 41 18 23 ..2 16 2.I. .5 1 4 6 1 3 ..6 1 2 .30. S. 4 4 .2 2 3 2 ..1 ..3 1. ...i 2 4 11 1 4. 5 1 11 49 26 61 2 3 4 11. .9 1 1. .41 1 2 .1 ....8. ..1. .1 1.,

PAGE 103

102 T"LE~ X.-DISCHARGES AND DEATHS IN THE HOSPITALS Employees. Discharges. Deaths. Diseases. White. Black. White. Black. M.F. M. F. M. F. M. F. Diseases of the respiratory system-Continued. Gangrene of the lungs ..... Asthm a. 1 j 13 Pulmonary emphysema.1. Other diseases of the respiratory system (tuberculosis I excepted). Abscess of lungs. 2 ........ iseae8 of the digestive system. Diseases of the mouth and annexa. ...4 1 Diseases of the teeth and gums. .3 3 13 1 Stomatitis. ... Diseases of the pharynx. 3. 7 ... iPharyngitis. 7 .3 ... Follicular tonsillitis. 57 30 44 2 Ulcer of the stomach.8 .4 ... Other diseases of the stomach (cancer excepted) .4 .6 ... Acute gastritis. 13 .15 Chronic gastritis. ..4 .7 Acute indigestion. .10 1. Diarrhea and enteritis (under 2 years). ..----. Colitis (under 2 years). .... Diarrhea and enteritis (2 years and over) ...11 .4 .... Colitis (2 yearsand over). 3 7 4. Ankylostomiasis. .9 Intestinal parasites. 4 .9.A scariasis .2 .... Bilharziasis, intestinal. .--. .-. Teniasis.1. ... Strongyloidosis. 1 .. Appendicitis and typhlitis. .... Acute appendicitis. 11 3 5 .2. Chronic appendicitis. 17 6 3 Hernia, intestinal obstructions. .--.-Inguinalhernia. .26 1 7 .... Other hernias. 4 .3 1 1 ... Intestinal obstruction. ....... Other diseases of the intestines. 21 9 9 3 .. Constipation. 9 2 18 ...-Duodenal ulcer. 4 .I ...1 Acute yellow atrophy of the liver. .Cirrhosis of the liver. 2. .1 ... Biliary cal otlie. 1 Other diseases of the liver .15' .I ..-. .--. ----

PAGE 104

103 OF THE PANAMA CANAL FOR THE YEAR, 1920.-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. .White. Black. Black. White. Black. White Black. M. M. F. M. F. M.M.F. M. F. M. F. M. F. M. F. M. F. ..1. ......1 3 2 7 1 4 ....2 .2 .....37 1 2 ......1 .......4. SI. .....1. ...2 .....2 .... 5 3 1 1 2 .....2 .......21 1 1 2 10 1 8 .....5 1 ......481. 1 ., 1 3 .............5 2 4 2 1 2 .....3 1 1 .....26 1 4 5 .1 .....2 .......23 76 104 118 38 100 ....1 18 7 2 .....596 1 1 3 .......2 ......18 1 3 2 3 .4 ...1 2 .....251 6 3 2 2 7 .....8 .......56 3 2 1 .1 .....3 .......2 1 3 1 4 .............19 1 1 4 2 ...2 .........81 2 1 4 1 2 .....2 .......10 1 3 6 .4 .2 3 1 2 ...35 2 2. 5 2 2 .4 1 ....30. 2 1 1 .1 1 3 .....39 1 .2 .2 .2 1 1 .., 2 1 1 4. 5 5 ..201. 1 ................1 1 3 ....51. ..1 ...... 1 .1 .............3 64 9 29 2 9 ..1 1 .10 3 ..2 145 6 10 2 21 .5 .....5 3 1 ..73 1 1 ......I ...1. 3 33 10 4 22 2 ...25 .5 ..179 3 4 1 6 3 5. ....1 1 29 1 1 .....3 .....1 4 7 8 12 4 19 .16 2 ..110 1 2 8 4 5 .....10 3 1 ...63 1 1 1 .......4 .......12 1 1 ........ 1 1.2. 3. .....8 3 8 .1. ..1 1. ..14 2 3 1 1 1. .....7 1 1.2l

PAGE 105

104 ABE X.-DISCHAGES AND DEATHS IN THE HOSPITALS Employees. Discharges. Deaths. Diseases. White. Black. White. Black. M. F. M. F. M. F. M. F. Diseases of thE digestiwe system.-Continued. Other diseases of the liver-Continued: Abscess of liver (unqualified). 1 .I Abscess of the liver, entamebie .1 Cholecystitis.4 2 1 Diseases of the spleen. ... Simple peritonitis (nonpuerperal). 2 .-. .. Other diseases of the digestive system (cancer and tuberculosisexcepted) .3 Nonsenereal diseases of the genito-urinary system and anneza. Acute nephritis.'. .. Bright's disease (chronic nephritis). ..7 .20 .2 .8 Other diseases of the kidney and annexa. 4 2 1. Movable kidney. ...1. Pyelo-nephrosis. 5 1 3 Calculioftheurinary passages. 16 1 2 Diseases of the bladder. 2 Cystitis. 4 3 1 2. Diseases of the urethra, urinary abscess, etc. 3 1 8. Stricture of the urethra, nonvenereal. 6 .24. Vesico-vaginal fistula. ... Diseases of the prostate. .. Acute prostatitis. I. .. Chronic prostatitis. 3 Abscess of the prostate. ... Hypertrophy of prostate .1. ....... Nonvenereal diseases of the male genital organs .8 .46. Hydrocele. 5 .1 .. Lymph scrotum and varix. Uterine hemorrhage (nonpuerperal). ..1 .... Uterine tumor (noncancerous). ...1 Other diseases of the uterus. 6 5 Metritis. .1 Cysts and other tumors of the ovary. .. Salpingitis and other diseases of the female genital I I 1 organs ..3 .2 Nonpuerperal diseases of the breast (cancer excepted) .-----Benign tumor of breast. ...-. T he puerperal state. Normal labor. -. Accidents of pregnancy. Extra-uterine pregnancy. .Hyperemesis gravidarum. Abortion. .1. 8 2 Puerperal hemorrhage.

PAGE 106

105 OF THE PANAMA CANAL FOR THE YEAR, 1920.-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White Black. M. M.F.M F. M. M. F. M. F. M. F. M. F. M.F. M. IF. .~~ ~ ~ ~ .....................2 1 ..............I ..........2 4 ..6 .1 ......2 1 ......21 2 ......1 ...., .I .......3 3 ..8 .............1 1 1 .......1. .....1. 1 4 ..7 7 ....2 1 ........22 2 3 3 2 3 5. 1 3 5 3 7. I. 2 ..51 24 3 .16 2 18 ...3 1 1 1 ......48 4 .2 ...*...I ........5 .1 21 2 9 ...2 .F 4 2 ..M. ...54 2 3, 3 7 3 .......2 .1 .....38 1 .2 .........6 3 1 7 .10 ....3 1 .....35. 2.1 1 2 1 ....6 ....23 2 1 .....3. ..40 12 .............2 1 4 .7 ......22 .2 2 .........3 ....1 ..........3 1 1 ................I 1 .2 .............4 5 6 .30 .11 .2 .....108 4 1 .5 ......3 ........30 1 ..........3 ........3 7 .1 ......18 24 .25 ....3 .2 ......31 3 .29 .72 ......9 .1 ....122 4 .6 ...........11 .8 .24 .............34 19 .61 ...4. 2 .....87 5 ..3 .11 .............14 1 .1 ..... .210 .121 ......1 .....333 716 .26 ..I .........43 3 .7 ....I ......11 ...8 .15 ............23 51 .24 ...4 ......86 3. .....1 ..........1 ..

PAGE 107

106 TABLE X.-DISCHARGES AND DEATHS IN THE HOSPITALS Employees. Discharges. Deaths. Diseases. White. Black. White. Black. M. F. M. F. M. F. M. F. The puerperal state.-Continued. Other accidents of labor. ... Puerperal septicemia. Puerperal albuminuria and convulsions. Eclam psia. ....................... Following childbirth (not otherwise defned). Puerperal diseases of the breast. Diseases of the skin and of the celltdar tissue. Gangrene. .. Raynaud's disease. Puruncle. 10 .2 Carbuncle. 5 .2 Acute abscess. 9 .34. Phlegmon and ellulitis. 22 ...1 Trichophytosis. 1 1 3. Scabies. .3 Chiggers (Pulex penetrans). Elephantiasis. Myiasisof skin.1. .. Dhobieitch. .2 Prickly heat. 8. .. Ulcer of the skin. .44 .. Oriental sore (Leishmaniasis). .... Tropical ulcer. ..1. Impetigo contagiosa. 2. Urticaria. Ingrowing nail. 6 3 Other diseases of the skin and annexa. 22 3 19 1. Diseases of the bones and of the organs of locomotion. Diseases of the bones (tuberculosis excepted). 3 1 ..1 Caries (nontuberculous). Mastoid abscess. 4. Osteomyelitis. 2 .3 Periostitis. 4 .1. Diseasesof the joints (tuberculosis and rheumatism excepted). .4 .. Ankylosis. Arthritis. Synovitis. .1 .2 Other diseases of the organs of locomotion. 19 3 27 3. Malformations. Congenital malformations (sti'lirth not included). 2 .6'.

PAGE 108

107 OF THE PANAMA CANAL FOR THE YEAR, 1920.-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White Black. -o .o M. M. F. M. F. M. M F. M. F. M. F. M. F. M. F M. F 22 .15. 2 .1. 2 ......39 3 SI ............1 3 8 ....3 ........11 3 2 6 ....5 ........8 5 ............1 1.4 .............5 ....................................2 .. .................1 2 3 2 2 2 .....9 .|. ....32 1 1 2 ..1 .......12 4 7 11 12 15 ....1 8 1 3 .....104 1 5 2 5i 6 4 ....1 16 .2 ......127 2 1 ...1 ....7 2 2 ......9 ..1. .1. .~~~~ ~ ~ ~ 1. ...3 ..............3 3 .....3. .. 1 4 1 2 1 ......I ...........22 1. ...9 1 2 2 2 .....6 .1 59 1 ........1 ..........4 1 7 2 3 1 .....3 ..1 21. 1 2 1 ........1 ....6 2 1 6 ...........19. 4 10 10 4 10 .....25 1 ...109. 3 .3 1 1 .1 ...I ....13 2 .......I .......1 1 2 1.1 ..............9 1 1 2 1 .......1 .......11 5 2 .1 4 .....1. ...13. 1. ......1 .......2. 3 2 2 6 ..4 1 2 .....48. 1 .1 .1. .6 9 2 6 .3 .....6 .78. 5 21 3 10 3 2 1 1 1 2 .52 5

PAGE 109

108 Tarns X.-DISCHARGES AND DEATHS IN THE HOSPITALS Employees. Discharges. Deaths. Diseases. White. Black. White. Black. M. F. M. F. M. F. M. F. Diseases of early infancy. Newborn child. Premature birth. Congenital debility. Atrophy of infants. Malnutrition. Other causes peculiar to early infancy (including various consequences of labor) Old age. Senility. ...... Senile dementia. Affections produced by external causes. Suicide by firearms. I .. Suicide by cutting or piercing instruments. Poisoning by food. 9 1 5 Other acute poisonings. 1 .1 Venomous bites and stings. .1 Burns (conflagration excepted). 8 1 22 .1 Absorption of deleterious gases (conflagration excepted)r.a.n.tm by f .... Traumatism by firearms. .2 Traumatism by cutting or piercing instruments. .10 ...114 ...1 Traumatism by fall. .27 6 118 .1 .1 Traumatism in mines and quarries. ... Traumatism by machines. ii .12i. ... Traumatism by other crushings. 11 4 54: .. Railroad traumatism. ..... Injuries by animals. .2. ... Excessive cold. .. Effects of heat. ..I ..*. Heat exhaustion.3. .. Lightning. ...Electricity (lightning excepted). 1 .2. Homicide by firearms. .. Homicide by cutting or piercing instruments. --.. Homicide by other means ..... Fractures (cause not specified). 5 ..7. Dislocations .3. .. Sprains.5 1 14. Other external violence. 35 .247. Ill-defined diseases. Ill-defined organic disease. ... Suddendeath .1 .... Cause of death not specified or ill-defined. .1 Infections of undertermined origin. 14 2 12. 2. No disease. 8 7 32 1 Feigned disease. -Totals. 1164 214 3048 58 16 .1141 2

PAGE 110

109 OF THE PANAMA CANAL FOR THE YEAR, 1920.-Continued. Nonemployees. Nonresidents. Discharges. Deaths. Discharges. Deaths. White. White. Black. Black. White. Black. White. Black. m M. M. F. M. F. M. M. F. M. F. M. F. M. F. M. F. M. F. 117 110 60 63 .............350 2 1 3 .2 ...6 ........6 8 213 .2 ..........2 ..........,. .... 9 4 18 6 ...12 10 ........37 22 1.1 3 ...5 3 ........5 8 1 1 ..............3 1 ..............1 .. 2 .............1 2 ..............1 ...........1 3.1 .....5 2 ......26 1 1 3 2 .............12 1 1 1 .....,. .......................3 ... 2 5 3 6 5. 1 1 .13 .2 ......67 3 131. .......6 9 1 .1 3 1 ....1 .......17, 1 1 3 .1 3 7. 6 .2 ....147 1 15 7 8 26 10 2 1. 2 37. 5. .259 7 1 .............. 1 1 1 3 .....9 ...1 ...49 2 16 8 4 13 1 3 1 ...8 .......119 5 2 ...1 1 1 ..1 1 1 .......6 3 2 1 .1 ......1 ......7 .............1 .... .2 ......3 .............I ......1 .5 1. .......... 1. ........3 2 .....3 ........1. 1 ......................... 5 3 2 6 8 ....4 2 ....42,. 2 1 1 .2 .....3 .......12 3 .1 .......9 ........33 27 6 2 19 6 ...I ..35 .5 ....382 1 1. .1 ...1 ........2 1 S. 1. ..2 1 ....1 1. .....3 16 6 9 1 8 ...I I I .I .....70 4 27 35 89 19 54 .....24 17 ......313 2. ......2. 1. ....5. 878 848 1417 726 1500 15 33 22 98 119 1121 120 128 2 4 111224 449

PAGE 111

110 TABLE XI.-CONSOLIDATED HOSPITAL AND ASYLUM REPORT. (A.= White Americanm; F.= White foreigners; B = Black.) Remainug 1 Admitted. Died. Discharged. January 1, 1920. A. F. B. A. F. B. A. F. B. A. F. B. Ancon Hospital: Employees. 24 15 159 981 143,2,882 9 3 83 965 144 2,810 Army and Navy patients. .20 ..827 .4 .768 .. Panama pay patients. ..I. .3 12 .2 .I Other pay patients. .49 62 561,560 989 1,696 16 23115'1,539 996 1,572 Charity patients .10 6 16 343 50 318 4 1 17 333 53 278 Total. 103 832323,7111,1854,908 33; 2721713,6051,1944 669 Corozal Hospital (insane): Employees. .1 2 151 1 15 ..2 1 1 8 Army and Navy patients. ..25. ...24 .. Panama pay patients.3 59209 20 66 .8 17 .8 53 Other pay patients. 2 4 16 4 5 16 .I ..5 7 11 Charity patients. 1 9 63 2 .15 ..41 1 1 17 Total. 7 741303 32 26 112'. 9 23 311 171 89 Grand total .110 157 5353,743 1,211 5,020 33. 36 24013,6361,21114,758 Corozal farm (cripples): Employees. .9 41 .I II ...6 26 Chronic ward: Charity patients. ..26 .1 61 .2 ..2 Colon Hospital: Employees. 2 .14 289 52 698 5. 30 240 30 -303 Army and Navy patients. ...105 .6.68 Panama pay patients. .2 17 129 ..3 15 1 Other pay patients. 12 5 7 412 316 526 11 17 47 323 193 347 Charity patients. 2 ..62 9 78 1. 5 55 8! 54 Total. 16 5 21 870 394jI,431 23 20 071 687 233 728 Palo Seco Leper Asylum: Panama pay patients. .3 41 .2 5 .4 Charity patients. .1 32 .4 ..1 5 Total. 4 73 .2 9 .4 1 9 Grand totals: Employees .27 26 229 1 2711 197,3,606 14 3 1151, 206 1813,156 Army and Navypatients. 20 .957.10. 860 Panama pay patients. 3 62 251 2 42 212 ...11 371 1 11 81 Other pay patients. 63 71 79 1,9761,31012,238 271 41 162 1,8671,1961,930 Charity patients. 13 16 137 407 60 421 5 2 30 389 631 355 Total. 126175 696 4,613 1,609 6,477 56 57 344 4,3231,4515,522

PAGE 112

111 TABLE XI.-CONSOLIDATED HOSPITAL AND ASYLUM REPORT.-Continued. (A. = White Americans; F. = White foreigners; B. = Black.) RemainTransing Average number conferred. December stantly in hospital. 31, 1920. A. F. B. A. F.B. A. F. B. Total. Ancon Hospitat: Employees. 1 5 53 30 6 86 29.20 10.69151.99 191.88 Army and Navy patients. 12 ..63. .39.01. .39.01 Panama pay patients. .2 11 ....101 .16 .26 Other pay patients. 5 1 18 49 31 47 55.32 48.23 63.12 166.67 Charity patients. .1 26 16 1 13 10.31 2.93 15.36 28.60 Total. 18 9 108 158 38 146133.84 61.95230.63 426.42 Corozal Hospital (insane): Employees. ..1 2 24 .49 1. 12 18.96 20.57 Army and Navy patients. ....2.45 .2.45 Panama pay patients. .1 5 3 62 196 3.00 60.73 188.18 251.91 Other pay patients. .1 1 21 1.85 3.49 16.00 21.34 Charity patients. 2 2 8 55 139 8.441 55.06 63.89 Total. 1 7 8 73 2961 8.18 73.78278.20 360.16 Grand total. 18 10 115 166 111 442142.10136.03!509.30 787.43 Corozal farm (eripples): Employees. 4 2 4.87 28.94 33.81 Chronic ward: Charity patients. 3 .1 25 .46 25.91 26.37 Colon Hospital: Employees. 45 21 369 1 1 10 4.3( .99 11.14 16.43 Army and Navy patients. 31 ..1.8C .1.86 Panama pay patients. 1 12 89 ..1 .01 .14 .80 .95 Other pay patients. 84 104 129 6 7 10 8.8 5.30 11.12 25.24 Charity patients. 6 1 171 2 .21 1.53 .16 1.22 2.91 Total.16 138 6041 9 8 23 16.52 6.59 24.28 47.39 Palo Seco Leper Asylum: Panama pay patients. .5 39 4.01 39.34 43.35 Charity patients. ..30..88 32.01 32.89 Total ...5 691 .4.89 71.35 76.24 Grand totals: Employees. 46 26 422 32 13 146 33.99 17.67211.03 262.69 Army and Navy patients. 43 ..64 ..43.32 .43.32 Panama pay patients. 1 15 105 3 67 236 3.01 64.98228.48 296.47 Other pay patients. 89 105 1471 56 39 78 65.99 57.02 90.24 213.25 Charity patients.6 2 481 20 10 125 12.23 12.87129.56 154.66 Total .185 148 7221 175 129 585 158.50 152.64 659.31 970.39

PAGE 113

112 TABLE XH.-CONSOLIDATED DISPENSARY REPORT. EMPLOYEES TREATED IN QUARTERS. ReRemainAdDisTransiainDays lost. ig mitted. Diedcharged. ferred. "1g Jan. 1, Dec.31, Place. 1920. 1920. W. B. W. B. W. B. W. B. W. B. W. B. W. B. Total. Ancon. 3 71,9381,704 .1,9071,660 33 43 1 8 4,468 5,331 9,799 Balboa. 3 .2,458 32 ..2,455 31. .6 1 5,474 225 5,699 Pedro Miguel 1 1 248 135 ..241 128 8 8 ..742 403 1,145 Gatun. .211 80 ..202 76 8 4 1,. 672 242 914 Cristobal. 5 261,2571,297 ..1,2151,263 38 48 9 12 3,29317,91111,204 Total. 12 34 6,112 3,248 ..6,020 3,158 87 103 17 21 14,649 14,112 28,761 ALL CAsEs TRmEARD BuT NOT EXCUSED. Employees. Nonemployees. TotaL Place. White. Black. Total. White. Black. Total. White. Black. Total. Ancon .14,979 59,496 74,475 12,323 18,373 30,696 27,302 77,869 105,171 Balboa .52,079 18,929 71,008 50,572 14,482 65,054 102,651 33,411 136,062 Pedro Miguel. 9,774 27,270 37,044 17,664 26,749 44,413 27,438 54,019 81,457 Gatun. 4,079 22,815 26,894 7,071 10,425 17,496 11,150 33,240 44,390 Cristobal. 17,307 37,081 54,388 20,517 27,236 47,753 37,824 64,317 102,141 Total. 98,218 165,591 263,809 108,1471 97,265 205,412 206,365 262,856 469,221 IN

PAGE 114

113 TABLE XIII.-CONSOLIDATED ADMISSION REPORT. White. Black. Total. Admissions to hospitals, excluding Corozal farm and chronic ward. 6,220 6,460 12,680 Admissions of employees to quarters. 6,112 3,248 9,360 Total admissions to hospitals and quarters .12,332 9,708 22,040 Less number of patients transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. 453 738 1,191 Net admissions to hospitals and quarters. .11,879 8,970 20,849 EMPLOYEES. Employees admitted to hospitals. 1,467 3,595 5,062 Employees admitted to quarters. 6,112 3,248 9,360 Total admissions of employees. .7,579 6,843 14,422 Less number transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures.:. 92 441 533 Net admissions of employees. 7,487 6,402 13,889 Annual admission rate per thousand employees to hospitals andquarters. 1,597.05 400.50 671.84 TABLE XIV.-NUMBER OF EMPLOYEES CONSTANTLY SICK IN HOSPITALS AND QUARTERS. White. Black. Total. Hospitals: 224 Ancon. 41.50 170.95 212.45 Colon. ..5.29 11.14 16.43 Total. 46.79 182.09 228.88 Quarters: Ancon. 12.20 14.57 26.77 Balboa. 14.96 .61 15.57 Pedro M iguel. .2.03 1.10 3.13 Gatun. 1.83 .67 .2.50 Colon. 9.00 21,61 30.61 Total. .40.02 38.56 78.58 MR 77731-8

PAGE 115

114 TAm XV.-AVERAGE NUMBER OF DAYS IN HOSPITALS OR QUARTERS FOR EACH ADMISSION OF SICK EMPLOYEE. White. Black. Total. Hospitals: Ancon. 12.38 19.58 17.59 Colon. .5.77 5.69 5.72 Total (average). 10.85 16.91 15.17 Quarters: Ancon. 2.38 3.33 2.82 Balboa. 2.22 7.00 2.28 Pedro Miguel. 2.87 3.10 2.95 Gatun. 3.24 3.01 3.19 Colon. 2.74 5.97 4.40 Total (average). 2.44 4.44 3.13 TAsLz XVI.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED VARIOUS CLASSES OF PATIENTS. Class. American. Foreign. Black. Total. Ancon Hospital: Panama Canal employees. 10,686 3,911 55,629 70,226 Army and Navy patients. 14,239 ..14,239 Panama Government pay patients ..36 58 94 Other pay patients. 20,195 17,606 23,038 60,839 Charity patients. 3,764 1,072 5,606 10,442 Total. .48,884 22,625 84,331 155,840 Corosal Hospital (insane): Panama Canal employees. 181 412 6,940 7,533 Army and Navy patients. 893 ..893 Panama Government pay patients. 1,098 22,166 68,686 91,950 Other pay patients. 683 1,273 5,835 7,791 Charity patients. 142 3,081 20,097 23,320 Total. 2,997 26,932 101,558 131,487 Corosal farm (injured employees): Panama Canal employees. 1,781 10,561 12;342 Chronic ward: Charity patients. .169 9,457 9,626 Colon Hospital: Panama Canal employees. 1,575 361 4,079 6,015 Army and Navy patients. 679 ..679 Panama Government pay patients .5 52 295 352 Other pay patients. 3,221 1,936 4,055 9,212 Charity patients. 559 58 444 1,061 Total. 6,039 2,407 8,873 17,319 Palo Seco Leper Asylum (lepers): Panama Government pay patients. .1,465 14,360 15,825 Charity patients. .324 11,682 12,006 Total. .1,789 26,062 27,851 Grand totals. 57,920 55,703 240,822 354,445

PAGE 116

115 TABLE XVII.-WARD LABORATORY REPORTS. Ancon Colon Santo Hospital. Hospital. Tomas Hospital. Blood examinations (total number). .5,656 2,124 2,917 Estivoautumnal. 368 158 248 Tertian. 157 69 83 Mixed, tertian, and estivoautumnal. 17 9. Quartian. 10 2 4 C rescents. 9 Spirillum of relapsing fever. 7. 7 6 1 White blood counts. 2,842 560 145 Red blood counts. 242 50 69 Differential counts. 716 261 136 Hemoglobin estimations. 3,804 381 794 Stool examinations (total number): 6,822 1,855 6,493 Ameba coli. 47 5 12 Entameba histolytica. .20 10 77 Uncinaria ova. 705 105 2,096 Ascaris ova. 376 62 895 Tricocephalus dispar. ..476 61 1,102 Bilharzia ova. .. Tinea saginata. 7 3.6 Strongyloides. 235 35 578 Trichuris. .9 8 192 Ciliated monads. 57 15 127 Balantidium coli. ..12 7 Pus cells. 257 92 918 Blood corpuscles. 118 32 107 Pus and blood. 93 1 119 Pus, blood and mucus. 40 13 244 Guaiac test for occult blood. .139 37 Clonorchis sinensis. ..I Urine examinations (total number). 25,698 5,385 7,646 Acetone. ...382 362 21 Diacetic acid. ...48 .4 Albumin. 5,550 1,963 1,660 Sugar. 2,328 83 55Bile .457 10 17 Guaiae test for occult blood .42 22 6 Indican.:. 415 .804 Sediment. 8,674 404 Epithelial cells. 7,600 635 462 Cylindroids. 260 .240 Hyaline casts. 2,624 3. 7 1,051 Granular casts. 1,838 278 927 Pus casts. 840 206 57 Puscells. 8,006 1,927 1,807 Red blood corpuscles. 1,250 468 151 Pus and blood. 1,366 12 349 Gonococci. 104 3 2 Tubercle bacilli. 1 31 Hemin crystals. 14 .3 Functional kidney tests. .51 11 Sputum (total examinations). 3,988 1,458 1,312' Tubercle bacilli. 340 87 243 Pneumococci. 5 9 2Spinal fluid. 405 11 97 Smears of sediment. 87 1 72' Pneumoeoccus. 3 .8 M eningococcus. 1 .2 Streptococcus. Straphylococcus. 3 Other organisms. .* Cell count. 351 3 28' Ross Jones test.21.

PAGE 117

116 TAR" XVIL-WARD LABORATORY REPORTS.-Continued. Ancon Colon Santo Hospital. Hospital. Tomas Hospital. Smear examinations (total numbeb).r. 1,101 145 6,455 Urethral. 850 98 251 Vaginal. .195 12 5,579 Eyes. ..34 3 18 Nasal. .2 4 34 Throat. 15 12 946 Others. 56 2 34 Pleural fluid. ..5 Flood (for malaria). .4. Widal reactions. .40 Urobilin. ..12.

PAGE 118

117 TABLE XVIII.-SURGICAL OPERATIONS PERFORMED. Ancon Colon Santo Tomas Hospital. Hospital. Hospital. Num.Num.Number. Diedber. Died. ber. Died. Amputations: Arm ...1. .. Forearm .1. Hand. .1. ... H ip joint. ....2 Thigh. .2 2. L eg. 4 1 2 .6 F oot. ....2 Digits, multiple. 20 .7 .15 A rm double. ....1 Operations on bones: Craniectomy decompressive. 3 .8 2 1 Craniectomy, exploratory ...2 2. Bone transplantation, simple. 4 ... Laminectomy. .2 .1. Ostiectomy. 4 ...2. Excision of maxila. ..1 ... Resection of elbow. .....1. Wiring of fractures, simple. 13 .I .3. Wiring of fractures, compound .2 .1. .. Plating of fractures, simple. 4 Teeth extractions. 11 .. Adenectomyr Cervical. 16. ....18. Axillary.5. ....6 Inguinal, single. 254 ..5 .158 Inguinal, double. 52. ...65 Fem oral. 20 ....1 Vaginal. ........1 .1 Herniotomy: Inguinal, single. 128 .16 .104 Inguinal, double. 37 .5 .13 Femoral. 4 .1 ..3. Ventral. 23 ..19. Combined (any two of above). .3. Strangulated. 4 1 4 2 1 Genito-urinary tract: Nephropexy. 4 .... Cystotomy. .3. .7 Prostatectomy. 2 1. Urethrotomy, internal. 15 ..50. Urethrotomy, external. 13 .2 .20. Varicocele, radical cure. 23. ..15. Hydrocele, single, radical cure. 38 .4 .22. Hydrocele, double, radical cure. 5 ...13. Orchidectomy. 5. .8. Epididymotomy. 73. 3 .1 Vasectomy. 9. Amputation of scrotum. 2 ...2. Amputation of penis. 1. ...1. Amputation of penis and scrotum. .20. Curettage uteri .205 .4 .117. Perinepolasty. .17 .1 .43. Nephrectomy. 10 Nephrotomy.2 Trachelorrhaphy .4 1 2 Vaginal punctures. 4 2 V aginal section ......... Vaginal hysterectomy. ....23

PAGE 119

118 TaBnz XVIII.-SURGICAL OPERATIONS PERFORMED.-Continued. Ancon Colon Santo Tomas Hospital. Hospital. Hospital. NumNum De. ber. Died. ber. Died. ber. Died. Genito-urinary tract-Continued: Circumcision. 291 1. Ureterotomy. 1 Obstetrical: Caearian section, abdominal. 4 1 2. Highforceps. 1. Low forceps. 7 .6 1 Accouchement forceps. 3 .3. Version. I .1 6 Perineorrhaphy. 27 ..1. Thorax: Excision of breast. 2 .1 ..2. Thoractomy. 8 3. Thoracoplasty.1. .. Rectum: Hemorrhoids, radical cure. 98 .34 Fistula in ano, excision of. ..2 .13. Abscess, Ischio-rectae. ..1 Resection of. I .... General: Thyroidectomy. 8 1 .3. Varicose veins, excision of. 8 ...4. Tenorrhaphy. ...1. 2. Excision of surface neoplasms .4 ... Stab wounds of soft parts, operation for 1 1 1. Extensive injuries soft parts, operation for. 1 .. Gun shot wounds of soft parts, opera3 tion for. Plastic operations for severe injuries. 9 1 414. Plastic operations for chronic peritonitis.:. ..1 ..1 Plastic operations for congenital defects 3 .1 Plastic operations for effects of disease 7 .....1 .4. Skingraft. 2 ..16 Aneurismorrhaphy.1 ....-. Enterorrhaphy. ...1. Laparotomy: For general peritonitis. .2 For tubercular peritonitis. 3 For intestinal obstruction. 1. 2 Exploratory. 26 1 4 1 17. Gastro-enterostomy. 4 ...-4. Entero-enterostomy. 2 1 Enterectomy. .2 Appendectomy. 24. .188 Appendectomy with local peritonitis. 9 .24 3 2 Appendectomy with general perionitis. 10 3 6 ..5. Colostomy.1. Cholecystotomy. ..2 .4 Cholecystostomy. 6 .1 .6 Cholecystectomy. 4 .....8 Abscess of liver, laparo-hepatotomy. 1 ..2 Abscess of liver, thoraco-hepatotomy. 1 ..-------Splenectomy. .46 Pan-hysterectomy. 1 ..1 .. Supravaginal hysterectomy. 36 .5 1 86. Hysteromyomectomy. 16 .I .16 M yomectomy. 3 .I .1

PAGE 120

119TABLE XVIII.-SURGICAL OPERATIONS PERFORMED.-Continued. Ancon Colon Santo Tomas Hospital. Hospital. Hospital. NumNumNumber. Died. ber. Died. ber. Died. Laparotomy-Continued: Salpingectomy, double. 2 .5 3. Salpingectomy. 7 .4 Salpingostomy, single. 3 .1 1. Salpingostomy, double. 4 ..129. Salpingo-oophorectomy. 18 .16 .164. Ovarian cystectomy. 10. 2 .17. Oophorectomy. 4 4 .67 Suspensio-uteri. 71 .13 .88. Ectopic gestation. 6 1 2. .2. General peritonitis. 2. .... Rupture of liver. .... Rupture of spleen .... Gunshot wound of abdomen. ... Hematoperitoneum. ... Mayo bunion operation. .1 Araphenamine, intravenous. 3,619 Cauterization. 228 Minor operations, various other. 1,579 1 168 1 806. Major operations, various other. 32 .21 1 179 Total. 7,415 14 437 27 2,767 1

PAGE 121

.120 TABLE XIX.-REPORT SHOWING NUMBER OF OPERATIONS IN THE EYE, EAR, NOSE AND THROAT CLINIC. ANCoN HoSPITAL. Eye: Cataract extraction: Combined. 7 L inear ..2 Charlazion, rem oval. 46 C onjunctival flap. 1 Enucleation. 9 Evisceration. .1 Foregn ody re oval. ...16 Foreign body, remoa 16. Hordeolum, incision. 7 Irideetomy. 5 Lachrymal operations: Dilation of ducts .7 Lid operations: Expression of lids. 2 Plastic. 1 N eedling .8 Paracentesis. 4 Pterygium .66 R efractions. ..1,052 Sclerotom y ..1 Cautery of cornea. 2 Ear: Furuncle, incision. 8 Foreign boy, removal. 3 Mastoid operation: Sim ple .17 R adical. 1 Paracentesis. 66 Plastic. 2 Polypi, rem oval. 5 Nose: Cauterization. 4 P lastic. 1 Polypi, removal. ....12 R hinoplasty .6 Sinuses: Ethm oid, sim ple. 10 Ethm oid, radical. I Frontal simple. 12 Frontal, radical. 2 Maxillary, puncture and irrigation .26 Sphenoid, sim ple. 1 Spur, rem oval. .1 Submucous resection:. 64 Tuberinectom y. 45 M axillary sinus, radical. 1 Pharynx: A denoidectom y. 253 Cleft palate. 1 Peritonsillar abscess. 32 Tonsillectom y. 431U vulectom y. 5 Plastic throat. 1 Trachea: Tracheotomy .I SANTO ToAs HoSPITAL. Eye: Cataract extraction:Simple. .71 Combined. ...6 Chalazion, rem oval. 7 E nucleation ...6

PAGE 122

121 SANrO. TOMAS HoSPITAL-Continued. Eye-Continued: Eviesceration. 3 Foreign body, removal. 28 Hordeolum, incision. 9 Iridectom y ....14 P aracentesis. 2 P terygium ..19 R efractions. .11 Ear: Furuncle, incision. 4 Foreign body, removal.,. 12 Mastoid operation: Simple. 6 Radical. 1 Polypi, removal. .3 Nose: C auterization ..9 Foreign body, removal ..10 P lastic ..2 Polypi, removal. 9 Subm ucous resection. 3 Tubinectom y. .33 Pharynx: Adenoidectom y. .17 Cleft palate. ..2 Peritonsillar abscess. 23 Tonsillectomy. .129 Larynx: Foreign body, rem oval. 6 Trachea: Tracheotom y. .7

PAGE 123

122 TAua XX-REPORT OF X-RAY DEPARTMENT, ANCON HOSPITAL. Nature of examinations: Abdomen ...3 A rm .139 C hest ........u ........** '*. 278 C olon ._-*.* ---** *. .......*. 4 D ental. ..417 E elbow ....79 F inger. .2 Foot and ankle. 319 Foreign body. .18 G all bladder. .70 Hand. 221 Head. 44 H eart ..1 H ip ..I O Jaw. 67 Kidney. 136 K nee. 90 Leg. 93 Liver .7 Pelvis. 20 R ibs. 43 Shoulder. 106 Sinuses. 108 Spine. .84 Spleen. I Stom ach ....177 T high ..46 Toe. I Treatment. .52 W rist. ..129 CLASSIFICATION OF X-RAY PLATES USED. 5 x 7 ..6 6 1*x8. 1,225 8 x 0 .1,616 10x 12. 2,283 14 x 17. 1,005 D ental film s. .1,533 X-ray films. .364 Total. .8,032 5A

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123 TABLE XXI.-SANTO TOMAS HOSPITAL. PATIENTS TREATED. Remaining Remaining Class. Dec. 31, Admit Died. Dis Dec. 31, 1919. ted. charged. 1920. Pay cases. ..15 980 36 931 28 Charity cases .397 8,472 778 7,748 343 Total .412 9,452 814 8,679 371 Class. Number American. Other nations. treated. White. I Black. White. Black. Paycases. 1,307 27 526 754 Charity cases. 13,277 28 ..1,530 11,779 Total. 14,584 55 .2,056 12,533 Number of days relief furnished patients. .155,593 Average number of patients constantly sick. 422 Average number of days treatment for each patient admitted. ...10 Cost of subsistence per patient per day,.$0. 371 Cost of hospitalization per patient per day. $1.515 DISPENSARY REPORT. Class. White. Black. Total. Natives treated. 16 6,060 6,076 Foreigners treated. 149 2,605 2,764 Total. ..165 8,665 8,840

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124 TABLE SHOWING Nuuiii oir DIsC HARGE AND DUATUB. DisDied. charged Typhoid fever 2 1 Malaria ..201 3 Malarial fever, estivoautumnal.146 5 Malarial fever, tertian. .. SmaLpox. .4 Measles. .119 Scarlet fever. I Whooping cough .4. Diphtheria and croup .79 4 Influenza ..367 17 Dysentery ..56 2 Dysentery, entamebic. 2 1 Leprosy .4. Erysipelas .11 .. Dengue .3 Chicken pox .72. M umps ...........:. ..................1 Purulent infection and sejpiem. .....35 Anthrax .ss. 3 1 Tetanus .y. 2 2 Pellagra .3 3 Beriberi. 2 Tuberculosis of the lungs. .80 170 Acute military tuberculosis. 2 1 Abdominal tuberculosis. 2. Pott's disease. 2 1 Tuberculosis of bones and joints. 1 Tuberculosis of other organs. .165 Tuberculosis of the lymph glands .2 Disseminated tuberculosis .2 3 Rickets .b.1 Syphilis, primary.3. 302 Syphilis, tertiary .74 12 Gonococcus infection d r ..04 3 Gonorrhea t g.s.120 1 Gonorrheal arthritis. 108. Gonorrheal bubo .20 .,,r. Soft chancre .1211 Adenitis chancroidal .32 Cancer and other malignant tumors of the buecal cavity .8.3 Cancer and other malignant tumors of the stomach, liver, esophagus, and pharynx. 4 2 Cancer and other malignant tumors of the perit oneuin, intestines, rectum 5 2 Cancer and other malignant tumors of the female genital organs. 7 4 Cancer and other malignant tumors of the breast. 6. Cancer and other malignant tumors of the skin. 2. Cancer and other malignant tumors of other organs and of organs not specified .8 4 Other tumors. 14 4 Acute articular rhenmatism. 12 Chronic rheumatism and gout .14. Gout. 2 Diabetes. .2. 2 Addison's disease. .1. Leukemia. Anemia, chlorosis .5 Other general diseases. 241 Alcoholism .54 1 Drug habit. 2. Encephalitis. Simple meningitis. Locomotor ataxia Other diseases of the spinal cord ..1. Acute anterior poliomyelitis Cerebral hemorrhage, apoplexy. .55

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125 TABLE SHowING NUMBER oF DIsCHARGES AND DEATHS. DisDied charged. Softening of the brain. .1 Paralysis without specified cause. 17 4 Other forms of mental alienation. 18 1 Epilepsy ..33 Convulsions of infants. .i H ysteria. .4 N euritis. ..8 Other diseases of the nervous system. 14 2 Neurasthenia. .1 Diseases of the eyes and their annexa. 111 1 Cornea. 10 D iseases of the ears. 15 2 Otitis media. 4. Pericarditis. 3 3 Acute endocarditis. .3 4 Organic diseases of theheart. 33 24 A ngina pectoris. 1 Diseases of the arteries, atheroma, etc. 30 12 Arteriosclerosis. 6 Embolism and thrombosis. Diseases of the veins. 34 H em orrhoids. 21 1 Diseases of the lymphatic system. 87 1 Lym phadenitis. ... Hem orrhage.2 4 Diseases of the nasal fossae. 32. Diseases of the larynx. .. Laryngitis. .3 Diseases of the thyroid body. .1 Acute bronchitis ...118 Chronic bronchitis. 33 6 Broncho-pneum onia. 46 25 Pneumonia, unqualified. 20 20 Lobar pneum onia. .40 26 Pleurisy .24 2 Empyema. 2. Gangrene of the lungs. 2. Asthm a. 16 Other diseases of the respiratory system. 11 H ay fever. 2 1 Diseases of the mouth and annexa.,. 2 1 Diseases of the teeth and gums. 21 2 Diseases of the pharynx. 115. Follicular tonsillitis. 36 Ulcer of the stomach. 5 Other diseases of the stomach. .47 9 Gastrectasis. 3. Acute gastritis. 4 Diarrhea and enteritis (under 2 years) .29 24 Colitis (under 2 years). ..21 6 Diarrhea and enteritis (2 years and over). .28 13 Colitis (2 years and over). 4 1 Ankylostomiasis. 135 2 Intestinal parasites. 254 3 Strongyloidosis. 2 Appendicitis and typhlitis. 108 3 Acute appendicitis. 11. Chronic appendicitis. .5 Hernia, intestinal obstructions. 144 8 Constipation. 59 1 Duodenal ulcer. 14 Cirrhosis of the liver. 10 4 B iliary calculi. .5 Other diseases of the liver. 16 6 Abscess of liver (unqualified). 2 1

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126 TABLa SuowuG NuimBIn or DISCHARGES AND DEATHS. DisDied charged. Abscess of the liver, entamebic. ..2 Cholecystitis. .5 Diseases of the spleen. 13 1 Simple peritonitis, nonpuerperal. 4 6 Other diseases of the digestive system. 6 Acute nephritis. .3 7 Bright's disease. ..157 77 Other diseases of the kidney and annexa. 6 3 Pyelo-nephrosis.1 1 Calculi of the urinary passages.3 Diseases of the bladder. 32 4 C ystitis. 4 1 Diseases of the urethra, urinary abscess, etc. 52 Stricture of the urethra, nonvenereal. 44 Vesico-vaginal fistula. .1 .. Diseases of the prostate 3. 3 Nouenerealdiseasesofthemalegenitalorgans. 46 1 H ydrocele. 12 1 Uterine hemorrhage, nonpuerperal. 3 Uterine tumor, noncancerous. 42 2 Other diseases of the uterus. 23 1 Metritis .137 1 Cysts and other tumors theovary. 20 1 Salpingitis and other diseases of the female genital organs .203 3 Nonpuerperal diseases of the breast, cancer excepted. 4 Normal labor. 840 Accidents to pregnancy. 157 3 Puerperal hemorrhage. ...1 3 Other accidents of labor. .8 1 Puerperal septicemia. .1 Puerperal albuminuria and convulsions. E clam psia. Following childbirth, not otherwise defined. 4 Puerperal diseases of the breast.1 G angrene. 1 Furuncle. 14 1 Acute abscess. 101 1 Phlegmon and cellulitis.5 Scabies. 30 Elephantiasis.2 Ulcer of the skin. 175 Other diseases of the skin and annexa. 58 Diseases of the bones, tuberculosis excepted. 56 Periostitis. .. Diseases of the joints, tuberculosis and rheumatism excepted. 19 Arthritis. .. Amputations. ..2 Other diseases of the organs of locomotion. ..11 1 Congenital malformations. 49. Newborn child. 705 Ieterus and selerema. 87 109 Other causes peculiar to early infancy, including various consequences of labor. .1 Senility .29 .. Suicides. .I Poisoning by food. 2 1 Other acute poisonings. 5 1 Burns, conflagration excepted. 33 3 Traumatism by firearms. 22 2 Traumatism by cutting or piercing instruments. 86 2 Traumatism by fall. 61 3 Traumatism by machines.10 Traumatism by other crushings. 41 2 Traumatism by landslides. Injuries by animals. .10

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127 TABLE SHOWING NUMBER OF DIsCHARGES AND DEATHS. DisDied. charged. Lightning ... Electricity, lightning excepted. .1 Homicide by firearms. ..2 Fractures, cause not specified. .34 3 Sprains. .22 1 Other external violence.78 Cause of death not specified or ill-defined. .2. 2 1 Infections of undetermined origin. 5 No disease. .36 Feigned disease. 138

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128 TABLE XXI.-COROZAL HOSPITAL-STATEMENT OF COMMITMENTS AND DISCHARGES. COMMITMENTS. Male. Female. From Canal Zone: First admission. 62 19 Second admission .1 2 From Panama Government: First admission. 46 31 Second admission. 7 2 Totals. 116 54 DISCHARGES. Well. Improved. Unimproved. Male. Female. Male. Female. Male. Female. Antigua. 1 .1. Barbados. 3 6 7 6 1 3 Bolivia. .....1 Chile. ..... Colombia. .2 England. ..I. France. ..1. Granada. ....2. Jamaica .3 3 6 8 2 M artinique. 1 ..2 1. Nicaragua. ....1 Porto Rice. 1 .. Panama. 12 4 6 5 4 2 Peru. ..1 Spain.,.1 ... St. Lucia. ..I .I UnitedStates. 8 .12.11 Venezuela. 1. .... Trinidad. 2 .1. Turk's Island. .. Sweden. .1. Russia. .1. Totals. 35 15 41 22 22 10

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129 TABLE XXIIL-CONTAGIOUS AND INFECTIOUS DISEASES. Reported during the year 1920. PanaCanal Nonma. Colon. Zone. resident. Tota!. Acute contagious conjunctivitis (pink eye). 4 ..4 Chicken pox. 79 24 105 9 217 Diphtheria. 95 37 37 3 172 Dysentery. 41 16 11 36 104 G erm an m easles. .I ..1 Erysipelas. 9 3 1 6 19 Favus.1. .1 Hookworm ..2 1 3 Influenza. 313 482 473 46 1,314 Relapsing fever. I .3 5 9 Leprosy. .4 .3 2 9 M alaria. 100 41 13728 352 1,221 Measles. 154 89 103 8 354 Meningitis, tuberculous. 3 1 3 2 9 M umps. 21 15 73 3 112 Ophthalmia neonatorum. 1 3 .4 Para-typhoid. I ..1 2 Pellagra. 5 3 1 2 11 Pneumonia. 175 56 34 40 305 Acute anterior poliomyelitis. .6 .1 2 9 Scarlet fever.,. 4 5 3 1 13 Septic sore throat. ..1 1 Sm allpox. .11 25 Tetanus. 5 1 1 7 Tuberculosis. 311 121 70 105 607 Typhoid fever. 8 9 2 17 36 W hooping cough. 4 69 70 .143 13 576 cases sanitated area, 117 cases cattle camps and plantations, 35 miscellaneous unsanitated areas. TABLE XXIV.-FORCE REPORT. December031, 1920. 1919. 1918. Gold. Silver. Total. Chiefhealthoffice .3 .3 3 4 Medical storehouse. 4 4 8 8 9 Quarantine service .11 33 44 47 48 Health office, Panama. 12 109 121 164 158 Health office, Colon. 14 145 159 173 155 Ancon Hospital. 134 226 360 368 338 Colon Hospital. 25 35 60 55 50 Santo Tomas Hospital .7 7 6 6 PaloSecoLeperAsylum. .2 48 50 40 34 Zone sanitation. 5 138 143 223 168 Corozal Hospital and farm. 16 82 98 113 114 Dispensaries. 11 8 19 16 25 Total. 244 828 1,072 1,216 1,109

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UNIVERSITY OF FLORIDA 3 1262 08896 2534