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:
1924
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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W. P.


CHAMBERLAIN


Colonel, Medical Corps, United States Army
Chief Health Officer









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AF
S.


CONTENTS.


Page.


T itle ...... ....... :. ....... .. ...... ........... ......
Vital statistics regarding employees only.......... .. .. .. ..
Vital statistics for the Canal Zone, employees and nonemployees.
Vital statistics for Panama City, employees and nonemployees...
Vital statistics for Colon, employees and nonemployees..........


M alara .... .. . .
.. M osquito control......... .. .. ..
Garbage disposal and fly prevention. ......
Infant mortality. .
Child health education and child hygiene...
Physical examination of school children .
Diseases of animals.... . .


Quarantine Division. ..... .
Ancon Hospital. ..... .. ...
Corozal Hospital...........
SColon Hospital..... .. .. ..
Santo Tomas Hospital.... ..
Pafo Seco Leper Colony......
Board of Health Laboratory..
Tables . . .


* .
* .


. .


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PANAMA


CANAL,


HEALTH


DEPARTMENT


Z., May


BALBOA HEIGHTS,


SIR: I have the honor to submit the following report tf the op

tions of the Health Department for the calendar year 1924..


Respectfully,


CHAMBERLAIN,.


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Chief


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LETTER OF


TRANSMITTAL


THE


Colonel M


WALKER,


Governor, The


Panama Canal,


Balboa Heights,


Canal Zone.




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HEALTH


DEPARTMENT.


OPERATION


AND


ORGANIZATION.


!The operation and


organization


Health


. bame as described in the Report for the. Calendar

PERSONNEL.


Department
Year 1923.


The personnel employed by the Health Department is the


that shown in the Report of the Calendar Year 1923,
ing exceptions:


same as


with the follow-


Col.


Weston P


Chief Health Offi


Army,


who


. Chamberlain, M
cer, replacing Col.


was relieved


from


medical Corps,
Henry C. F


duty


with


S. Army


isher
The


became


, Medical Corps,


Panama


Canal


effective June 22,


1924.


Surgeon Carlisle P


. Knight,


S.P.


, became Chief Quarantine


Officer


, replacing Surgeon


Rucker


who was re-


lived from duty with


Maj.T
intendent


om S.


Mebai


, Colon Hospita


The Panama Canal
ne, Medical Corps,


, replacing Maj


, effective Apri


Army


Thomas


1924.


became Super-
Leary, Medical


- Corps,
Canal,


Army


effective June 22,


The personnel of Santo


who was relieved


from


1924.
Tomas Hospita


duty with


Panama


The


Panama


ceased to be under


the jurisdiction of The Panama Canal,


effective September


1924.


. The internes at Ancon Hospital completed their internships in


June


and July


1924


, and were replaced by Dr


Edward Pevser


Eugene


G. Free, [
.Hewitt, [
- Dewey E.
- August 11


Norman


North


Spalding,


Westerman


Elmer J


Thomas


Wenaas


Arrasmith,


. Richard M.


and


The service of the l-ast named was terminated


1924.


The following physicians were employed during the year


by detai


from the Medical Corps of the Army or by selection through the Civ


Service


Commission


Maj


. Conger,


Maj


lliam


Murohv.


CaDt.


Frank W.


Romaine


. Cant


Pau


CaDDs.


a a r


Harry


N


B 4


W




___________________~~~~~~~~.H H_________ _________ ___~_~


SUMMARY


VITAL


1 STATISTICS REGARDING


EMPLOYEES ONLY."


admission


rate


and


quarters,


from


cau


has been as follows:


Year.


Average
number
employed.


,547
,238
,890
,167
,802
,876
,893
,654
,329
,785
,176
,589
,520
,204
,673
,389
'447
,976
,625


Rate.


a--!~r


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From


disease alone


130.32, as compared


the admission


133.48


rate


to hospital


1923, and


139.47


1924
1922.


.was
The


total


admission


rate


to 'hospitals only


was


151.57


1924,


as corn-


pared with 155.90 in 1923, and 167.61 in


The death rate, frbm all causes,


1922.


has been:


Average
' number
employed.


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


Rate.


I -


The


hospitals


with


Year.


I ,,




jjri~wr..:. .
^,'i:,..-


- The death rate from.disease alone for 1924 was 5.51,as compared with
: 6.10 in 1923, and 6..13 in 1922.

The noneffective rate, from all causes, has been:


Years


1906
1907
'1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
'1921
1922
1923
1924


Average
number
employed.


,547
,238
,890
,167
,802
,876
,893
,654
,329
,785
,176
,589
,520
,204
,673
,389
,447
,976
.625


Rate.


The 6 diseases
with their rates,


causing the highest number of hospital admissions,
were as follows:


Ven r diseases .... .. ....
M alaria ...... . ...
Diseases of the eyes and their annexa
Bronchitis (acute and chronic).......
Tuberealosis (various organs)... ....
Nephritis (acute and chronic) ......


The 6


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


diseases causing


I .


highest


Admissions.


Rate.


number


Admissions.


deaths,


Rate.


with


16.69
16.34
7.14
3.53
2.41
2.06

their


rates,


were as follows:


Tuberculouia (various organs)...
'- Nephritis (acute and chronic)..
Organic disease of the heart....
... 'Cancer (various organs) .. ...
. Pneumonia (broncho and lobar).


1923.


Deaths.


Rate.


Deaths.


-- F I


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8


SUMMARY OF VITAL STATISTICS FOR THE CANAL


AND


N,ONEM PLdYEES.


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From an average population of 33,723 in the Canal Zone, there wt&; Li
..n. .


72 0 of these were from disease


7.08 for 1i


, as compared
Tuberculobis


, as compared with 7.14 for 1923, and


and


0.64


1921


per cent of all deaths from disease during the year.


There were 694 live births reported during the year
te of 20.58. (See Table VII. Da e 51). Of these. 255'


a o ,


Of the total births reported


,giv
were


5 per cent were


Deaths among children under 1 year of age, from all caut
, of which 12 were white and 54 were black, giving an infan


Year.


1905
1906
1907
1908
1909
1910
1911


1913
1914
1915.
1916
1917
1918
1919
1920
1921
1922
1923


Popula-
tion.


1 rJ U t' I


Deaths.


1,047
710
410
343
328
286
247
242
236
254
253


number of live


123.01


births reported d
for black children


during
, anc


Sfor all ages, 22 per cent occurred amoi
and 37 per cent among children under


showing the death


Rate.


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*....1"... .S
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ing a ti:ulrtKI .
white, a-,il
S:.: "
stilib i ."i


a ) : ::.. ....
nes, thotalded;H!HH

'the year, ::


5 yeaws 0oH,
Il *U ,, ;


rates for the Canal Zone fro


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S I


EMPLOYEES


anf


5 03 deaths during the year


rate of 8.01


1923


The death rate from tuberculosis was 1.01


0.74 for


1922


ra


439 were black.


rate


based


on the


47.06 for white children


average of 96.54.


Of the tota


death


under 1 year of age,
age.


Below is a
1905 to 1924.


table


from all causes


Ii


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She- 6 diseases causing
es, were as follows:


noni (broncho and lobar). ....... ....
roulociB variousa organs) ...............
hea and enteritia includingg colitis).....
de diseaaee of the beart. ....... ......
sr Cri oi organs) ..................


he death rate from


the highest number


. ... .. .

. *


Deaths.


Rate.


Deaths.


tuberculosis was 3.20, as compared


1923, and 3.76 for 1922. Tuberculosis caused approximately
cent of all deaths from disease, as compared with 18 per cen<
3, 18 per cent in 1922, and 17 per cent in 1921.


"here


th rate of 35.95.
:hs.


* live births reported during the year, giving a
Of the total births reported, 6 per cent were still-


S. There were 296 deaths among children under 1 year of age, giving an
infant mortality rate, based on the number of births reported during the
year, of 138.06.

Of the total deaths for all ages, 25 per cent occurred among children
under 1 year of age, and 39 per cent among children under 5 years of age.
Below is a table showing the death rates in Panama City from 1905


to 1924, from all causes:


Ye


ar.


' 1905
1906
1907,.
1908'
1909
1910
1911
1912
1913'
, 1914
- 1915
4 1916
1917
1918
1919
1.. 920


=- :


Popula-
tion.


,984
,518
,548
,073
,801
,591
,555
,057
,172
,948
,373
,778
,074
,369
,369
,500


Deaths.


Rate.


deaths,


with


their


were 2,144


with 3.35


t in


I


w




-U L .. pi~Iit
*j .. :


SUMMARY


AND


COLON--


NONEMPLOYEES.


From a population of 31,285, there were 475 deaths during the')
these, 455 were from disease, giving a rate of 14.54, as comp
th 12.05 for 1923. and 13.41 for 1922.


The 6 disea


ses causing the highest


number of


deaths,


with


1


were as 'follows:


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


The death rate from


tuberculosis


Deaths.


wa


for 1923, 2.55 for 1922, and 2.30 for 1921


Rate.


1924.

Death.. I Ir


s 2.62, as compared with
. Tuberculosis caused app]


mately 18 per cent of all deaths from disease, as compared with 1i


cent in 1923, 19 per cent in 1922, and 13 per cent in 1921.
There were 690 live births reported during the year, giving a I


OF VITAL STATISTICS FOR


irth~


rate of 22.06. Of the total births reported, 5 per cent were stillbirths.
There were 79 deaths among children under 1 year of age, giving an
infant mortality rate, based on the number of live births reported


during the year, of 114.49. .
Of the total deaths for all ages, 17 per cent occurred among children
under 1 year of age, and 27 per cent among children under 5 years of age.
Below is a table showing the death rates in Colon from 1905 to 1924,


ca u ses


Popula-
tion.


Deaths.


Rate.


.I




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* .. .111

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*
A


EMPLOYEES


of
Wi


rates,


from all


Year.


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MALARIA.


The admission rate of employees from malaria was


16 per


1,000 for


the year 1924.


While the figures naturally vary somewhat from time


to time, it should be noted


that there has been a practically constant


residual rate for this disease during the past 9 years, the only marked


deviation being a rise to 31


1,000 in


1919,


which occurence is ex-


plained


fact


that in


1919


many


infected


native


Panaman


laborers were imported into the Zone to take the place of striking West


Indian employees.


As in the past, much of the malaria developing in


the Canal Zone was contracted outside the sanitated areas of


the Zone.


The admission rate from malaria among employees has been:


Year.


1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924


Average
number
employed.


,547
,238
,890
,167
,802
,876
,893
,654
,329
,785
176
,589
,520
,204
,673
,389
,447
,976
.625


The admission rate from malaria was 18.00 for white employees, and
- 15.75 for black employees.


Two employees d
Dredging Division,
to unsanitated areas


lied


from


malaria.


Both


urere


employed


working at night in parts of Gatun Lake adjacent
. One was a colored West Indian, the other a white


A .ar- nn '


*I k r I ...nt r flrl


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nt n SI


''*I **i l ** tIU* II *EU .I *U.j.*& *.* *I *rI-IJ *' ****I*


Rate.


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The death rate from malaria among eMployees hat ent .:i

.. *. ... A


1906
1907
1908
1909
1910
1911
1912
.1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924


26, 547
39,238
43,890
47,167
50,802
48,876
50,893
56,654
44,329
34,785
33,176
32,589
25,520
i 24,204
20,673
14,389
10,447
10.976


I.
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*


The noneffective rate from malaria among employees ir


0.31


,as compared with 0.55 in 1923,


MOSQUITO


and 0.46 in 1922.


CONTROL.


There has been no slackening of efforts to reduce mosquito


Ditching of large swamps in


Hope and


year d
toward
board.


Gatun


rainage


the east wil


the cattle pastures'adjacent


has been pushed from


areas


between


both directions.


Canal


and


be completed from Gaturi to the Car


S.. ". ..:. .. '.
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tiM.A
I 1924
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West of the Canal, in the northern district, much new work
done. The large main drainage ditch on "Fill 3" has been deeply
sea' level, the laterals have been cleaned and regraded, and a w
tension has been dug at the northern end for the purpose of inter
the run-off from the hills and discharging it directly into the old


Canal.


Boggy


streams


being cleaned


and


straight


teined t


as
a '


n...... .. .:':... ..."..
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Fre ,
oiii i

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H i3i formeso

Haty season


t.ite' extent of these swamps near the Atlantic end of the


even if only a


very small


percentage of


the


ry bred in them reached Colon and Cristobal,


becarne noticeable,


especially in


Fortunately the control in


e mosquitoes
nevertheless


the early weeks of each


these regions is a conipara-


tively simple matter of shallow spade wide ditches which permit flood


*.waters to escape and sea water to circulate freely through al
the low land.


In' the southern


district


, mosquito


part


breeding along the entire shore


line of Miraflores Lake and its numerous arms is now prevented by oil-


ing when necessary
ticed in only one sn


. Up to a few years ago mosquito control was prac-


ial


lying immediately behi


arm of this lake-the Pedro Miguel
ind the town of Pedro Miguel. In


River inlet
this arm all


vegetation was kept removed from the shallow margins and oi


mixed


with phenol-soap emulsion, was freely applied. A considerable force of
men, at a cost ranging between $600 to $750 a month, was almost con-


stantly employed on


shore line.


this limited area


More recently it has been


control the entire shore
over 25 miles in extent.


which had


found


barely


advisable


miles of


to keep under


ne of Miraflcrres Lake and its arms,


V


Through the use of oiling boats, from


ihich is
which


heated oil is sprayed upon the grassy lake margins, it has become prac-


ticable to prevent mosquito emergence


this greatly increased area


with a crew of 3 men and at a cost of less than $250 a month for


abor


and


materials.


The oil


heated


solely


to enable


it to


pass


readily


through the nozzles of the spray pump so that it will emerge in a finely
divided state-practically a mist-which creates an efficient film upon


the water.


The


shore line of Miraflores Lake is very shallow for


most part and in its grassy margins our most potent malaria


vector


Anopheles albimanus,


finds


ts favorite breeding place.


A considerable


part of the time of one man (a colored West Indian of long experience
- "and.training) is spent in searching these lake edges for mosquito larve,


both before.
discovered.


and after oiling. Oiling is carried out only when larvae are
This method of control has been found to be very efficacious.


.. In the vicinity of Corozal some large streams are being straightened
a..d the bottoms lined with nre-cast concrete sections of 14-inch width.


.


.


.




ip.


and a ful


formerly the


had


time sanitary inspector was placed in charge of it,


where


inspector in charge of mosquito control in Panama Ci


to give some of hi


sanitation


time to other duties connected with municip


As a result of this change it has been possible to inaug


rate within the new di
out in the Canal Zone.


strict a policy more in accord with that carii


A new limit has been established


of 1 mile from the farthest house in Bella Vista


standing water will be drained away


, ata distan'


, within which bound


the streams


will be


and much permanent work (concrete bottoms and tile) wil


train


be install


"'ii
: 1. HJ



:j.."


Hi
tjr
In

ce

4:
d.4...,


as rapidly as may be practicable.


The change has made it possible to


to better advantage


the forces of


other Canal Zone sanitary .


inspectors


edition


for a
their


5515


tance


own


in this


districts


work during


permit.


such


During the


times


past


as the con-


years so


much work of a permanent nature has been done


in the southern dis-


trict of the Canal Zone that only one-third as many men are required


for mosquito control


accomplished
in which the


as was formerly the case


throughout


Canal


SPOSAL OF


those portions of


one authorities


WASTE AND


the same result can be
: Republic of Panama


are responsible for sanitation.


FLY


For some years past the garbage of Panama,


neighboring Army)


PREVENTION


Ancon


Balboa


and the


posts has been disposed of by burying in low swampy


ground east of Panama City


the management of th


dump being under


* *
I
A.

..



:4.
i
I. :i
i1


immediate


supervision


health


officer


Panama..


The


method
Health


E


which has been described in
department is successful ir


previous
i caring f


annual


reports
garbage


with


minimum of nuisance and expense


odors are not marked


rats are nrot


attracted


and


flies


breed


any


troublesome


extent.


The


situation as


fuel


surface of


regards flies


for the


the garbage


has recently


been improved by substituting.


arvacide formerly used to spray over the covered


besides


being


more destructive to fly larva


and


pupae,


the oil


is much cheaper.


New composting pits


have been constructed near the Panama gar-


S r / ". r ,


:11


~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~-~~~~-~~~ ~~~~~~~---~-~~~-"~~ ~-"~ :1!: ...:',n3WUflPC~j


D


I I I_ I


1 ~I


d i




*. *1 *.1


.4r


6 4-nch layer of mud which is then sprayed with heated fue


During


the first two or three days thousands of maggots work their way to the


surface and perish


in the oil


the concrete curb prevents their escape


into the soil at the sides and ends.


Manure is sold from these compost


pits only on certain days of the week and as soon as the day'
removed the exposed face of the composted manure is again


sales are
plastered


with mud and oiled


. It has been found


that


manure of the type pro-


duced


Panama


City


, even


when


composted


as Ion


as 6


months,


still proves attractive


to flies when


exposed


weather in


piles.


Consequently


, gardeners are required to put the manure into theground


or to spread
purchase.


t in a thin top dressing within 24 hours from the


time of


INFANT


MORTALITY.


The


Panama,
follows:


death


and


rate


1.000


Canal


live
one,


births


the past


cities


Colon


and


6 years have been as


Colon.........
Panama.......
Canal Zone: -
White.....
Black.....


Total (whit


*.. .. .. .
. . . .
e Ind black)...........


34.36
130.00
95.09


39 28
73.95.


1922.


47.06
123 01
96.54


CHILD


HEALTH


EDUCATION


AND


CHILD


HYGIENE.


Prior to 1924 no organized child health movement existed on the Canal


Zone.


January,


1924


, Miss Sally L.


Jean,


Director of


the Health


Education Division of the American Child Health Association, and M


Julia W


. Abbott


Associate Director of that Divi


-. Zone at'the invitation of Governor J


Morrow


sion, visited
. These lad


I the Canal


studied


the conditions existing
mittee consisting of thd


here and


e Governor


made


recommendations


the chief health


officer


to a


com-


the chief


quartermaster, the secretary of the bureau of clubs and playgrounds,


the superintendent of schools,


and others.


The recommendations sub-


- ---~




u .. ".. *. .: ... :* f


H:.....


16

designed to arouse general interest in child hygiene, postcr
the clubhouses, and talks on health subjects delivered at the
or before the various organized societies of the Canal Zone.
On February 4th a.health center was inaugurated at the ;


house
age,
total


At first this was limited to children between 6 an


at in Apri


service was extended to those over 2 ye.


of 2,137 examinations were made on 721 children anm


mothers visiting the center was


293.


Forty-three


4
at
Eli


4IiC
NP


~t~.lii~1'



the mit#'HI


children


referred for dental treatment and 62 were sent to the various clinics.


*flXh I


Ancon


Hospital


18 corrective operations were secured.


similar center was organized at Cristobal.


officer


and Dr


Hearne, port quarantine officer


to give one afternoon a week to this work.
center was organized in connection with t


has been highly successful and


the work


Byrd
each


i]n .Crg*:"t
c~ity fi~i~i
volupee~1.


In April pre- and post-na" ".
the Colon dispensary. -TM&iiH
is carried on semiweekly by'tj


Levy.


A mothers


' club was organized in Balboa on Apri


Morrow was elected president


at the first meeting


was 103.


On April


. There were 75 charter


, and the total membership at th
21 a similar club was organized a


Hearne was elected president.


enrolled at the first meeting.


a meeting and


decided


There were 36


In May the women of I


to unite with


Balboa cl


1925 when they planned to organize their own unit.
Three May Day health pageants were held in co


American 4
Campaign.


on May


Health Association National


The pageant at


n


May


Balboa was given on


and in Cristobal on May 3.


attended these pageants.


Approxima


A health talk was one of th


pageant.
A public health and school nurse for the Pacific si


by the Health Department in August.


She immedial


natal course of instruction for expectant mothers.
The child hygiene campaign during the year 1924 w
n.I l- I ,,r nrnl -in tF n.,nrha c n'Tt n fl- 7 r oIMno I 9flfl i


11, and rs.Jj> iJs!
member, en"roflld M
e close of, tte'at4:
t Cristotsi ........


.. *. :
charter mt....- :.....
)edro Migud :4eW~g

lub until ear
-, .*. .. .. ** .I. .- ... :

junction wi" i
Day Health N sin'
Say i; pin Git i1
tely 2,5001 pe
.e features of e, ., .:
j- -* X C

f *... :.' :X


de was em yH
tely openeal a "

Sasmain2ly ........
ias mainly "mpo"


* *. .
HP. i.H
.. .
SI


31


of


A:




'i:n:" l" JuR~" FLI


.iM .. .:" M .
". .. *."
': I;
C.:


the children were examined with the clothing removed to the waist,
tbdibeing made possible because of the presence of a health department


nurse during the proceedings.


An invitation was extended each mother


tQ attend the examination of her child and approximately


15 per cent


pupil


examined


were


so accompanied


The


results


examination were as follows


Number of children examined. ..... ..... ....
Number of childrenn found needing medical treat-


nieri t. ........ .... .....
Defects found'rewuiring treatment:
SDiefective viamon.............
SDefetive hearing............
Defective naeal breathing.....


Hypertrophied tonsils....


2114


. .. .
*. .. .. .


Defects found requiring treatment-(Continued):
Pulmonary disease........ .............


Cardiac disease ......... ....... ..
Chorea and other nervous diseases..
Orthopedic defects................


Malnutrition.......
Defective teeth.....
Contagious diseases


II. .II. .
. -. .


DIS


SES


AN IMALS.


The veterinary force of the health department carries


out the quaran-


tine inspection


Panama


and


animal


Colon


across the Isthmus;
slaughtered for food


entering
inspection


Canal


animals


the ante- and post-mortem


and


the inspection of


Zone or


transported
inspection of


dairies


, dairy


cities of


animals


herds


and


milk


handling.


Quarantine work in 1924 included the examination of 27,487


cattle


and 100 horses and mules
Panama and Colon, from
from other countries. TI


brought


into the Cana


Zone


or the cit


the interior of the Republic of Panama,


andi


tere were 7,563 cattle and 6,154 hogs inspected


for rail shipment across
Mount Hope abattoirs
made on 24,153 cattle,


were


condemned


ante-


Forty-o


account of extensive bru


ticemia,
i on ac


on account


:count


icterus


sthmu
and


which
ne of


ises al
of pr
.and


tuberculous cows came from


s.


post-mortem
) carcasses a
e carcasses s


Colon


Panama


examinations


Lnd
were


nd septic wound


leumonla,


2 on


on account


and


were-


726 edible parts
condemned on
account of sep-


account of Te:


tuberculosis


ocal dairies in Panama where


sas fever,,
is. The 2
they con-


tracted


pure


the (
bred


disease on


stock


premises presumably infected by importation


from


Europe.


Fortunately,


no tuberculosis has


.


1111111111111111111 242
111111111111111(111 21~


s, 3 on




*HiLl ~
.1 *rj'2 *.
H


troyed in


Panama.


Fortunately


post-mortem findings


that in only a few instances were the inroads of the disease
advanced to render the milk supply dangerous.


* ,H iim. :.
.H
H: :B'C

H.
4j'*'


Regular inspections of dairies are conducted to insure cleanlinessand


acceptable conditions.


at frequent


intervals


In addition to this, samples of milk are take


chemical and


which serves as a check on careless produce


the Zone and


cities of


bacteriological examination,
tion. The entire milk supply


Panama and


Colon


.'i
' 'x1
* .:. -
'* '* .a


pasteurizoiegl


before being delivered to the consumers.


Of 23,061
cysticercosis,


hogs


slaughtered,


119 on account of cholera


were condemned


on account f


, 21 on account of pneumonia,


2 on account of


Icterus,


9 on account of


pyemia,


12 on


account of


pyrexia, and 3 on account of tuberculosis.
from a lot fed on garbage collected at hotels


The tubercular hogs were


and restaurants.


Cholera


has been found among hogs slaughtered in Colon and


Panama to the


extent of nearly one-half of one per cent


this


er than the natural rate for the Republic of


account of holding animals in pens
tically does not exist in the interior


the
Thi


percentage i
Panama, or


during long period


'es


s. Ch


Cysticercosis has decre


ast 5 years from 15 per cent to 3 per cent of all hogs s
reduction is due to the work done by the Panaman G


assisted by the International Health Board,
the spread of hookworm disease of man. Tl


with a view to
ie decrease in c


has caused a saving of about $50,000 per year in the cost o


plied the cities


of Panama and Colon alone.


much high- :".
;umably 0n .
lolera pra-
ased within- .2
laughttered.,
overnmettt .
preventing: .
ysticetcosis '
f pork sup- :


None of


more dangerous


and


destructive diseases of


animals


exist on the Isthmus


at this time.


Anthrax has not occurred in cattle


for about 2 years,


and when present it was confined almost entirely to


wampy pastures of the Atlantic side.


Contagious abortion,


which


occurred several years ago has disappeared.


Foot and mouth diseases


and


rinderpest in cattle,


and glanders in horses and mules, have not


occurred here.
horses on the
mules, but str
---L -.. -


Maladiedu coit


Isthmus.


or dourine


Strangles was im


*ict quarantine and disinfect


,has never been found among
ported with a shipment f
tion prevented its spread to


T~~, -- CL na


l\mlra nllC tn rnlnn Ef~kl~:


h.


I





"V.:
*VEI~ :**: ...l"

;r.4


QUARANTINE


S.xx.:::.... .
* ." "!H '


DIVISION.


P;. KN HT


United States


Public


Health


Service,


Chief


Quarantine Officer.


! ;: .i.,- arantine. policies for protection of the Canal Zone have been car-
.:dediput as heretofore. It is a notable fact that of 5,958 ships calling


.*asg.. p1 Zone


ports,


only


one


was


detained


on account


quar


: aghle. disease and


this vessel was


held


solely for the purpose


completing the number of days of incubation required for craft from
Sfllw ..fever ports.
S"The chief quarantine officer made two official trips during the year,


the first to investigate an outbreak of


yellow fever in San Salvador,


and the second to continue the policy of making inspections of foreign
ports and stimulating relations between sanitary officers.


.At the request of the President of Salvador


that country was visited


0nd a.study was made of the outbreak of yellow fever in the capital.


Qa. recommendation. of the chief


quaran tine officer


experts from


Rockefeller Foundation
October the disease had


took charge of


the campaign


been stamped out.


,placed against the ports of Salvador


A rigid


and was continue


in July


and by


quarantine was
led through the


1924.


All of the ports and some of the other towns


visited and contacts were made w
authorities of these two countries.
trip indicates that bubonic plague,
.on the west coast of South Americ
-Canal. Typhus fever also exists,
among the poorer classes it has not t
the Canal ports. On account of the


ith


of Peru and Chile were


the national


and


local


health


Information received during this
both rodent and human, is present
a, and is a constant menace to the


but owing to the restricted


travel


een found on any ship that entered
presence of foot and mouth disease


.qa arantine embargo
n ception of Colombia,


was


issued


Venezuela


again


t South


America


with


British Guiana and Dutch Guiana


:. t'Hthe close of the year these quarantine restriction


A maritime


quarantine


conference


west coast of South America,


February


February


was


, dealing with


held


Delegates


were still i
problems


n force,


the city of Panama f
were accredited from


the
from
the


" : :3C a
is ";-


year


n

















Disapproving the routine partial fumigation of ships. (4)

ing the periodic fumigation of ships only when free c

Recommending the placing of seaports in the best pos.


condition at the earliest practicable date.


Record


adoption of measures needful to prevent unnecessary or

delays-to ships on account of maritime quarantine.

The amount of fumigation for the elimination of rodi


somewhat over that in previous years.


Although cyan


gas has proved very successful for the destruction of rats

through experimentation that the ordinary time and do


rodents was not sufficient to kill all roaches


furthermoi


,f cargo. H
U.. :. ....




im end in t":.

unwanantork
..a" .ii I

ents incea i i
ogen-chloride .::
... .. : ':x :.: : i:*::

,it was found.
..: ::1

sage usl fo
e, that to iI :.'d"


a ship entirely of roaches, it is necessary to repeat fumigation at short

intervals, since this gas, or any other used in fumigating ships, is not:


lethal for cockroach eggs.


A.


Very little loss has been suffered by ships through quarantine d.eten-


hion .


During the entire year there were but 3,000 ton-detention days


and 187 passenger-detention days, which shows that the cost to ship-

ping was practically nil.


Vessels inspected and passed.... ....
Vessels detained in quarantine.......
Vessels given radio pratique. .......


. .
.. .
. .


Vessels passed on sworn statement of Master......


Totals........... ..... ,. .

Supplementary inspections of vessels.
Vessels fumigated for rats...........
Crew inspected and passed... ......


. ..
... ...


Crew passed on sworn statement of Master .....
Crew passed by radio .... .......... ...........
Passengers inspected and passed .... ..... ....
Passengers passed on sworn statement of Master..
Passengers passed on radio pratique.............
Persons detained on board vessels on account of di


Persnns detained in quarantine ..... ................... ...
Persons vaccinated .. .. .. .. . . . .


',575
1
103
2,P27


19.
1,185.


SImmigration operations continued under the division of quarantine


as heretofore.


The number of persons dealt with was 2,752


ber excluded and deported was 992;


the nurmt-


the number detained at static o


on account of immigration laws was 762, and the number detained and

later landed was 128. "


4 1

S"
x'


!.;;.';d
I
...I
.'i :1


;il;a
r.,mrJ
'i
~ "... i
iit
a
:~I
.. ''j
u
it

I:..


?; iiil


ri ii 9

i:I
''

r


~~~-~~~~~~~~~ ~~~~~~~~~~"~~~~~~~~~~~~~"~"~~"~"~~~~~"~"


1111111111111111111111111111111111111111
IIIIIIIIIIII IIIIIIIII1ILII1II


IIIIII IIIIIII IIIIIIIIII III II
IIIIIIIIII I' IIII IIII III IIIIIIIIIIIIIIIIIII II!
IIIIIIIIIIIIIIIIIII 1111111 III





JC .I .

i *
;.- i 21

' 'aftie weekly meetings of which the entire medical staff, including the
personnel of the board of health laboratory and the Ancon dispensary,


Stakes part.


Many visiting physicians attend these meetings.


$Surgical clinic.-During the year


minor operations
were performed-;


(including intravenous


1,386 major operations


injections of


and 5.684


arsphenamine)


3,384 cases visited the out-patient department


obstetrical


cases


were delivered.


Medical clinic.


,-There were .3.368 cases


treated


the out-patient


department


558 adults


were vaccinated


with


known


"takes;"


352 children,were vaccinated with 192 known
Eye and ear clinic.-There were 8,213 visits


"takes.


to the out-patient depart-


men t;


2.160


operations


were performed,


and 1,387


refractions


done.


Many new item


of equipment were placed in service


n this


clinic during


the year


the more important being


A treatment chair with incidental


equipment (making 3 now in use); an air compressor for the operation


.of sprays and forsuction treatmentof nose and


throat conditions


and


a new Halle's


universal bone surgery outfit.


Radiographic


clinic.-There


were


2,627


cases handled


which


6,452 ordinary films and 2,859 dental films were used.


During the year


.the following new equipment was received and placed in operation


'transformer unit for radiographic work


a Coolidge unit,


consisting of a


transformer


, regulator and stabi


izer


controlling the tube current;


an X-ray exposure timer with foot switch attachment


a corona-proof


overhead system


an XL


ray table with accessories for combined radio-


graphic and fluoroscopic work
out secondary radiations.


and a Bucky fluoroscopic grid to cut


Radio-therapy


clinic.--On


March


1924


, a radio-therapy clinic


was established


, the chief of which is charged with the supervision and


direction of radium therapy


ray therapy


and hydro-therapy


. Six


hundred and ninety out-patients and 268 hospital patients were treated


- -in this clinic.


The To


placed in service; 1
tubes each contain
containing 10 mgm.


owing initial new equipment


ube containing 50 mgm.


mgm.


of radium sulphate;


of radium sulphate


and an


was received and


of radium sulphate


5 needles


each


ray therapy appara-


+irc rlc'c;rrncir In Al,;ior 9f0ll (ll 1rnlt' tnrl r-i;t;n cr a nf tranfrmopr i nl._









23


an electric light cabinet, a continuous bath and a shampoo table
installed, but this unit has not been placed in operation as yet be
some of the equipment has not been received.


patients.-Six


hundred


and fifty-six


residence is outside the Canal Zone or the cities of
were treated in Ancon Hospital, and 47 in Corozal i
Operating expenses.-The following table gives th
the hospital for the past 'three years:


patients


Colon or
Hospital.


'1


Pa


i :i

** :::: : ,
*IH H3: ..!
:::
..." :. :ill. ""
,*. ,:. .::::::, .
i ":.i iiil
..*- .
: :: .* .:. .. ": ii

.. .. :m... : :
::* *. ::.


: :4 : .
:!y'



a** .:.*...
whose.
fia.... : .t


*1


e cost of operiatt


":
* *
i.": "
' ::"*:


Operating expenses '... ... *... ... -
Revenmue............................. .
N et co t. .. . . . .
Days relief furnished ... ...........
Coat per patient per day...............
Goet of subsistence supplies per patient pel
Operating expenses, Ancon dispensary.....
Revenue, Ancon dispensary..............


rday .
...... .


$525,584
312,713
212,871
112,
4
16,438
1.883


20,551.97
09,573.03
10,979.94
109,599
4.75
.34
17,952.78
4.113,.50


6558,5546a
342*41.719
21S'l3b.7S
119AMiP
t3)~
40
I7,2It.VS~
d4,OU .10


These figures do not include the salaries paid by the War Department to medical ofmoers of tie Arar.y es-
tailed for duty with The Panama Canal, which amounted to approximately 346,900 in 1922, 152300 in 1923 $5,.000
in 1924.


COROZAL

(Capacity


HOSPITAL.

400 patients.)


Capt.


HESNER


, Medical Corps,


Army


Superintendent.


Repairs and alterations.


-The second floor of ward


" which "cOn-


ted of small


custodial rooms


, has been remodeled by converting it into


a large dormitory


This change has added space for


15 patients,


and


building


better


ventilated


and


illuminated


, and


much


more


sanitary.


Routine


painting


and


repairs


woodwork


, plumbing,


steam line, etc.,


have been done wherever required by hospital artisasi


with the help of patients.


in the pasture has been commenced,


The laying of a new pipe line from a spring


with a view to furnishing a cheap


water supply for the refrigerating machines at
and for washing down the piggery and barns.


the dairy


and


kitchen


Trees and gardens.


-Two of the Hydnocarpus weightiana trees planted


a few years ago are productive and bearing at


this time a


heavy crop


Nonresident


.1 -


:j


mm





V...


li.
.4i


adtiitted was 139, as con
dis.charges and 23 deaths,


npared with 1
as compared


with


1923
113


There were


discharges


and


139-
32


Deaths last year.


There were no suicides


or deaths


due


to violence.


Of the


total


Cent) improved,


released


cent)
cent)


and


were


recovered


unimproved


, 62


. Of


(45 per


total


admissions,


55 were cases paid


Government of Panama,


a.nd theremainder were Canal Zone charity or private pay


the total number discharged


cases.


65 were deported.


Ofthe patients.


chronic medical or


-There were on


surgical


cases


December


(not


insane),


29 black and 3 white
as compared with 24


black and 3 white of this class at


the beginning of the year


. Eleven


were


admitted


died


were


discharged,


and


2 were repatriated.


All those capable of performing work are encouraged to do so.


Recreation.-Weekly


picture shows


and


band


concerts


have


been


continued


throughout


the year


amusements


provided


patients the greatest pleasure appears to be derived from the moving


pictures,
tainment.
back of t


which do not tire them as readily as do other form


of enter-


During the dry season, weekly picnics were held in a grove


hospital,


picnic


lunches


were served


and


baseball and


other sports were engaged in.


Treatment.


-Intensive specific treatment is given to patients suffer-


ing from syphilitic psychoses, these constituting about 20 per cent of


the'total admissions.


During the year


426 doses of arsphenamin were


administered intravenously, and 130


umbar punctures were performed.


The fact that the great majority of the patients are of low intelligence
and exceedingly illiterate, often makes it difficult or impossible to dis-
cuss their mental disorders with them from a physcho-analytic stand-


point.


However


, by teaching them to adapt themselves to their new


environment


, and by rendering their enforced sojourn


free


from


un-


pleasantness, it has been possible to relieve the mental stress in most


- casedg.


encouraged


engage


some


occupational


work


because it


is generally conceded


that


the mental redemption of many


cases


may


only


effected


through


diversional


employment.


The


work at


Corozal


Hospital differs


in many respects


from


that


average


occuDational


theraDv


deDartmen t.


ThPre


rnrns


I --- a -


r..


*


A




* ../. :.* K I" i.f" f
... h- ." :'
... ...l
Hi:
H '!
I 'Hin


:: : ":: H :*?
H i:-"tEJE:::i .
Occupational instruction helps the patients in both a therapeutic .a.
L economic way, because most of them have no trade or pmnfessioa H..
It come from a class which depends upon unskilled day labor forp,:
*. .. *: ..:..ii :.i


livelihood. In many instances the


have


been


result of


precipitated


the hus


employment


poverty,


history


which


band being out of work and


which


result of treatment in


was


fitted.


shows


was


that


psychose.


brought about as a


the wife unable to final


Many


such


the occupational department,


patients,


oamaB


learn something


which not only may be of financial value to them, but also may become
a means of preventing a recurrence of mental trouble. .


The total receipts


from the occupational ward amounted to $6,251.34,


of which $4,523.84 was from the sale of brooms.


The money is utilized


huh
'nlj
..4u


I.. H .
N..


S.i" i...

'N..
'a. :
S. ... "..i




V ^ :!


for purchasing material required to continue activities in thip deptit-


ment and for providing the workers with pin money.


The value of the produce taken from the patients'


consumption amounted


garden for hospital


to $3,394.72.


Farm Department.-About 20 additional acres of land were cleared,


making a total of 100 acres under cultivation.
aggregated $4,118.64, and for manure $1,015


The receipts for produce


'.97.


Dairy.


-The


herd


consists


Jersey


cows,


and


calves; 8


Holstein cows and 10 calves


and 2 bulls.


There were 76,341 quarts of


milk prod u
Piggery.


iced


and milk sales during the year amounted to.$19,522,50.


-There were 397 pigs and 50 hogs remaining on December


. Fifteen acres were added to the hog pasture,


increasing the total.


to 60 acres.


The piggery has proven very profitable,


the gross income


derived from this division of the farm amounting


to $5,376.64 for the


year.


Cemetery.


was


necessary


to enlarge


the cemetery this year .by
4


clearing off about 3 acres adjoining it on the west.

COLON HOSPITAL.


(Capacity,


80 patients.)


Maj


ToM


MEBANE


, Medica


Corps,


Army


Superintendent,


an
bu


a




::'~ ,;' ,' I
'I

1' .


b'dvlantages and benefits of refractions and correction of minor condi-
tiois without the long trip to Ancon Hospital with consequent loss of
Sme.
.iw'*


portable


bedside X-ray apparatus


been


installed,


the. hospital for the first time to diagnose and treat properly


and other ailments requiring this apparatus.


enabling
fractures


Formerly it was neces-


sary to send all such cases across the Isthmus to Ancon Hospital.


Repairs.-The interior of


the hospital


and


exterior woodwork


have been repainted during the year.
I


SANTO


TOMAS


HOSPITAL.


(Capacity


500 patient


* Major E.


BoCOCK


, Medical Corps,


Army,


Superintendent.


During August the patients were moved from the old hospital


n the


.center


city


new


reinforced


concrete


building


in the


Exposition ground


The dedication ceremonies were held September


1924


on which


date,


decree of


President


of Panama


operation of the


hospital


was


taken


over


entirely by the


Panaman


Government.


The Superintendent,


two physician


chief


nurse, and


'two ward nurses,


who had


been


Canal


employees,


were


replaced


Appointees of


the Panaman


Government.


These


six positions


had


been filled by employees of


the Panama


Canal since


1905,


under an


agreement between


two


Governments which was entered into at


that time in order to afford


more extensive hospital


facilities


people


sthmu


and


to enable the Health Department


Panama
infection


hospital
promptly


Canal


to maintain close supervision


diseases
facilities


Panaman


on the


health


Isthmu


officer


terri tory.


Santo


of Panama al


over


There
Tomas


treatment


now


ample


Hospital report


notifiable


diseases;


- saving to the
results from


United


states


Government t


the new arrangement;


change-was made by the authorities


about


$14,000


year


consequently no objection
of the Panama Canal.


nnflAT


r' nrfl


rr' 'NT V


Lr *I IIU dI *U d SI


~4;


1T~nrn


- a




Ii; *:;;;;; *. .1xi .** nfl:u: 25A


.. .:
n


lar type,


2 of the neural type, and: 7 of the mixed typ. Foear a


readmissions.


Two


these


readmiseons :were- of the mal typ4


still negative bacteriologically,
required additional treatment


but suffering from


trophic ulcers


both of these were again paroled late


in the


year


The other 2 readmissions


one of the


nodular type asd


one of ttl mixed type, were positive bacteriologically on reentry;bo0
had been paroled from the colony some years before the institution


specific


receive<
5 cc.


these
per c


treatment


doses.


with


patients died during the year.


Treatment.
acid in S cc.


Twelve patients received ethyl esters of cod liver


Three patients


injections,


5 cc.


5 per cent sodium chaulmoograte in intravenous


The chaulmoogric esters were administered


to most of these patients,


and


three times a week


weekly;


the maximum


quantity given to any one patient during the yeat was 1,021 cc.


greatest number of injections given any individual was


receiving 5 cc. daily


ing signs


1 of these died


,this cans


without show-


Five patients received no specific treatment:


and the remaining 3 were too oldt or


received


and


thymol for uncinariasis,


clinic at Ancon
violet light, and
cases were but s


was discharged


feeble to be subjected to treatment.


positive
injection!


mercurosal


Wassermann reactions, and 9-o:f


S


of


novarsenobenzol


patients


were


(0.9


treated


M mt~
. HE. .
with


all with beneficial results.


Hospital


esters


ethyl


esters


for treatments with


chemical


cautery,


chaulmoogra


X-ray


radium


ive
Wle


ultra-


Trophic ulcers in nerve type


.1n.
* .


werO


and


all capable of destroying tubercles, but fulguration with high frequency
current seemed to be the most efficient method for that purpose on
account of its penetrating power. ...
r;ltsral Y-rc Cre w rrannhls rn hIQIci P nhcnrntinn nf fhp tlhprclem.


* .:..
... ii. ... .....
1-
s .........
. ..



: :.J
.


4.
:i : *:

i. i ii
.. : : ..
"n "i ..'l .






.it
H :A
... -X. "
**.










.1 .. .
F ... .*












.i a
S....... H
.. :: :: .
:* '. :% n



.



H X %






H'.'

....... .


-Ninety-four patients were given esters of chaulmoogric


in intravenous and intramuscular injection


to others once


of overdosage.


, except Sundays,


for about 3 months


Eleven cases have shown


lose)


intravenous


Twelve


Thirteen patients were taken once a week to the radiotherapeutiti


[ high frequency current.


Injections


owly affected by the treatment.


electro-cautery


H .: ...HL'i
1H.

is
..r


.


\


I?"'




*. I. t
4. *. .
..n ..* 4

Sn- H.


* I.


4


nyiax


aluminum and frbber tubing)


60 minutes exposure to both


sides


of nasal septum, three exposures, caused absorption of leprous infiltra-


:fiinof mucous membranes of septum and turbinates,


but did not affect


the presence or number of orgfnisnmsin areas so


treated


Neither did


the ultra-violet rays (40 minutes exposure with curved quartz
pressure) affect the bacteriological picture of areas so expose


rod and


' Intra-neural injections into the fusiform swellings of ulnar and post-
tibia. nerves with esters of chaulmoogra were continued as of last year


with


beneficial results.


Exposure


filtered


rays


was capable of


causing


subjective


changes


in skin


sensation


along


areas


nerve


distribution and was very useful as an adjuvant in


trophic


the treatment of


ulcers.


The Von Pirquet test with old tuberculin was tried on 16 patients in


various stages and types of the disease.
as compared with the controls. The tim,


All showed positive reactions
e of appearance of the reactions


was delayed in most instances from 2 to 6 days. Smears taken from
nodules caused by the tuberculin were negative for B. lepre.
Lepra fever and eruptions were more numerous this year than last.


Attacks were mainly confined to new arrivals,
were also affected. A few of the patients had


sion at short intervals.


In none


however


though some old residents
several attacks in succes-
did the new tubercles so


developed


remain


long


after


fever


subsided


As in


previous


years,


these attacks occurred at period


of season change (about April-May


and November-December) when colds and


rrflUII


common


on the


Isthmus.


The effects of specific treatment for


C


were about the same as in previous years.


eprosy and
No attemr


its complications
)t is made here to


evaluate the use of the ethyl esters of cod-liver oi
moogra, as they were introduced only in the laj


1 or the soap of chaul-
st month of the year.


The cod-liver oil esters caused coughing spells similar to those occurring


when chaulmoogra is given by vein.


followed


Temperature


in practically the same manner as with


and local


reactions


chaulmoogra.


The


soap,


when given intravenously


, caused no coughing spells,


but in


stead


0 Cl1g4 t


-ra n


010ntt


I' 1-hP


ahrhAnm n


zrrrhi;r1


nrrllrrpr


LB. LzALaA& t.CLI~L L .A taL a t.A t.1 'n. atfk 1I1tt LLfEA AU1~1 LI It KL l~AA t. A~~ VT ** *Y.. A tUS~


rr~ m nl;~p


I n


r




:5
:ikii


r..

S.!


BOARD


HEALTH


LABORATORY


(Operated in connection with Ancon Hospital..)
I


BATES


, Chief of Laboratory.


typhosus.-Recovered in blood culture from 11 individuals;


4 from shipboard,


typhosus A


4 from Colon


paratyphosus B,


and 3 from the Canal Zone.


Paratyphosus C were not


, para-
recov-


ered at any time during the year from blood,


stool


or urine.


Typhoid carriers.-On December 31


under sanitary surveillance,


1923


and G.


, twotyphoid carriers were
H., both of Panama City.


Stool


specimens


from


each


were examined


monthly.


All specimens


were positive for B


typhosus.


No new carriers were discovered during


the year.
Bacillus


dysenterie.


-Dysentery


bacilli


were


recovered


from


the


tools


patients.


The


Shiga


organism were each recovered once,


baci


and


Type


and Type II organism


(Sonne)
(Flexner,


Hiss-


Russell


, etc.) was recovered from 16 patients.


Respiratory infections.


-In November quite a large number of people


on the


thmus


suffered


from


an acute


respiratory


infection.


This


infection
under as


was generally


;eptic


mild


precautions


in type.


from


Sputum


approximately


specimens


these


collected
persons


who had the severest attacks
were cultured and studied.


,and who were patients in Ancon Hospital,
The influenza bacillus was not recovered


from a single culture,


neither was the hemolytic


treptococcu


The


cultures contained only the ordinary mouth organisms.


Tonsil and adenoid examinations.


-The routine examination of ton-


and adenoids removed at operation was continued throughout the


year


Of 463 tonsi


removed alone


8or 1


.72 per cent were found to be


tuberculous


adenoids


removed


alone none were


tuberculous;


of 377


tonsils and adenoids removed together 9,


or 2.38 per cent were


tuberculou


Of thi


last 9


3 tonsils alone were tuberculous, 5 adenoids


alone were tuberculou


and in one set both tonsils and adenoids


were


- -- "


- *4


A~~r U UI IJ A -Z


Bacill


*.i
' ";: :"


and B.


.


r


m r




*. : 1*

*'i
* Inf


factor prohibited. so extensive a study.
was inaugurated, 520 rats have been thus
stained by Gram's method and examined


However, since September, wh


examined.


I microscopic


Smears of livers and


en this plan


spleens


were


Small pieces of livers and


spleens were macerated in sterile normal saline by means of a sterile mortor and pestle.
This suspension, prepared from the organs of not more than 10 rats, was then sub-
cutaneously injected into the abdominal wall of a healthy guinea pig. All pigs dying
inlaess than 7 days were autopsied, and those living 7 days were bled to death and then
aut6psied, their blood being used in the complement fixation tests. Gross inspection
and smears of liver and spleen were made in the examination of these animals. Thus
far no positive results for plague have been obtained." *


During the year 1924 the special


smear and animal inoculation work


referred to above wa


continued


Six hundred and fifty rats


were thus


examined


. No positive results for plague were obtained


. This was in


addition to the routine autopsy examination of 11,252 rat


A articles prepared and presented.-The following
at the Laboratory during the year:


papers were prepared


Studies in the Chemistry of


the Blood


Observations on the Creatinin of the


Blood, by Mr. lames E. Jacob.
Preliminary Report on Total, White and Differential counts of Bl
Healthy Individuals Dwelling in the Canal Zone, by Dr. W. C. Cox.
Preliminary Report on Investigation of Sugar Content of Blood
Tropics with Special Reference to the Canal Zone, by Dr. W. C. Coxanc
A Clinical and Bacteriological Analysis of the Bacillary Dysentery
Hospital during the Past 5 Years, by Dr. R. C. Connor and Dr. L. B.


ood


n Norma


(human) in the


IMr. J
Cases
Bates.


E. Jacob.
in Ancon


The first three of


these papers were presented at the


June meeting


the Medical Association of


Isthmian


Cana


one.


The fourth


was


read


International


Con ference


Health


Problem


Tropical America held at Kingston


Jamaica,


Jul


1924


Connor


was


also


publ


ished


International


Clinics


Vol.


, Thirty-fourth Series,


December


1924.


-In the investigation of the creatinin of the blood


it was found that the so-called creatinin reaction was not specific,


the substance giving this


and


reaction in some instances could be separated


into an alcohol-soluble and


an alcohol-insoluble


portion


Following


the presentation of this


work


in the paper noted above,


inves


tiga-


tion was continued along a different line.


An effort was


made to


estab-


lislj the presence of creatinin by the formation of the double compound


with zinc


chloride.


Contributors


to the discussion


creatinin


onepstion have rennrterl


nePrative resIlts alonnr


this


same


1 ..-


hut as


Creatinin in blood.


p







*. .: :. ....:. ..... .
:l :: E E H





**:: : :. :* '
S:.. I::
.iEE i


: .:*
4: EE:E


During the year approximately 32,000 reports have bn

This does not include duplicates.


x. E .: ':


*.

q** "^ **^l
.
:" .


U


BACTERIOLOGICAL EXAMINATIONS.


JI iIii iaii |4 i ,


IBlomd su r. ....... .f ................... ...............
B. yph, os ......... .. .. .. ... .. .... ... .. .........
Pnevaocowwu Type IV................. .................
B. mu.ncosu apsbw .,.... .......... ...... ........... .

Stapklocomus albuws.... .............. ...................
Btapkhylteccus aureus. ................................
Stools cultured Icr typhoid-dysentery goup.....................
Positive stool oultures.............. ..... ......... ....... .
.yphagua ... .. .... .. .. . .... ....,..
p mi (irom e carriers)...........................

B. dztgenteriue vrnpi Z (Shi s ) ......... ... ...... .......
B. dyseterise MannieFermenter, Group II..............
B. dayenUerwe MmizeFPermerniq, Groul III.............
Bacillus of typhoid-dysentery group (not identified)......
Urine cultured for typhoid group.............................
trine positive fcr B. typhaosw........ ...... ...... ...... ...
Urines cultured fcr organisms other than typhoid group..........
Positive urine cultures (61 of these B. celi) ..................
Throat cultures fcr B. diphtheria........ ..... ... .......
Positive for B. dipMdheri .................................*
Nasal cultures for B. dip4therize ...............................
Positive for B. dip haeriase.......... ... ......... ......
Throat cultures for arganisma other than B. diphtherise......... ..
Spinal fluid cultures...... ................. .. ..........
Positive spinas fluid cultures ....... .... ...... .... ..
B. infl ue Ta.. 1 ....................................
Pnrumoreocus Type I .......... ......................
Pueromeoacus Type II................ .... .... ..

St ap ylueocs u. re. ...... .. ................. .......


aso-ph rltpyuesl cult.s s...................................
Scul tu resi ....... ... . . .. .

Naultures -phar gel cultures ..... ..............................
CSpulture frures ... ..c .. .. ... ..... ...... .....
Culture from epin ochlesior glnd..................................


CuPletures of pus from various loction... ................ ......
AsCiti fid cul tu res................ ...... ............... ...
nee fluid cultures ,...... .. ... .... .. .
Ankle fluid culture ... .. .. ..... . .... .
Cultures for Ducrey's cillua. ............................ ....
Cultures from skin lesio ns..................................... .
Cultures of pus from various locations. ............... .........
G land culture ...a.. .. . . . .
Bile cultures .. ...
utopsiesr rom cultured. ....... ................ ....... ....
Organs, e uda tes, etc......... .. ....... ... .. ......
BSurg cal tissues cultured... .. .... ............ .... ...

Positive fcr Trep.nema paridum. .............................
Conjunctival smears..........................................
Smear from ulrer on jaw. ..... ........... ..... .......,..
Mouth smear (ulcers .e.. .r. t.. ........ ................
Sputum smears for B. tuberculosis................... ..............
Positive tr .tuberculosis..................................
Sputum examined for spirochaete. ............. .. ...........
Throat smea rs .. ............................................
Positive fcrfuifotrm bac\ius and spirinum of Vineenf' angina.
Smear from larynx (positive fcr B. tuberculois) ....................
Cervical abscemear for B. tuberculosia........ ...... ..... ...
QW.. um C*A-. *MW. .UI I..."....


i; : :: :


: ***, ,: .11 *,, ,:,,::
:. HE : .


......i... .. M .. .
*..





S ,,' ,,,,,,, ,iii
b .,, ,, .. .,-,



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** .. ...::: E. H .: iF t
** .g= K iie.: -

.a .. -: :
...
877*- .. .-




SJ1 -.
.....H.ll H.E ........

... ......... .... .
: .::: E .. .. ::...'E E

H...EE.. E .H
... .. ...........



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

-: :H.E.E..:E EE




2 .. .. I i
."'" "H .. ,..,H ll


Is E :* :::
: i..iEE ::EE .
.. ..
* . .. "......."........



.. .." .:::: .::::.
*. ...:E .... i'.. ..
... .............









".i ".
g .E .H EEEH.
-***:: ..:::.**:::*:* :: *
s :.* *ii-il
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S. ... a ::: :i



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S .:" "E:"." ": E;.; '.

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*: :E':::EEE :
*. .. .. ..1 ... .


a.- H. E E EE-
.. ..3 .. .
7 :: .:..:: ::':": ii i





Si r i i" *HEEEE HE" :E :E'.:
.1 ... :1- --
.. .. .. .". .::":: :
'^ jj- ". .:: ..:: ...::::: .



* "::". : l:.:lq .
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* II

jr*'


BACTElIOLOGICAL EXAMINATIONS--Con tinued.


fPusitive for Tertion malarial parasite........... ........
Positive for E. A. malarial paraites ....................
Positive for Quarto malaria prasites .. :...............
Pasteur treatment administered................. ........
trine examined for gonococcus ..............
Strapings from under finger nail for fungus ...................
ci.tel h contents examined for blood ............ ... .......
Water from Balboa clubhouse swimming pool................
Water from Balboa Army & Navy Y. M. C. A. awimpiag pool
Water from Arenal River ........ .... ... ........ ... ....
W after from beaches................ .....................
Water from well .................... ..................
Water from Hotel Washington swimming pool .................
Food stuffs examined:
Milk cultured for bacteria count........................
'Ice cream cultured for bacteria count...............
Pread examined for rope....... ....... ............
Culture of canned cherries ... ........ ...
Culture of canned vegetables........ ..... ..........
Culture of canned fruit salad..... ............
CaTlure of raw meat ................
Culture of salted cod fish. .. . ... ......
Autoclaves tested.... . . . . .
Miscellaneous smears and examinations ...... ............


SEROLOGICAL EXAMINATIONS.


W assermann tests............... ................
Gonococcus complement fixation tests..... ...........
Agglutination tests.. .. ....... .... .... .. ...
Blood typing ftr transfusion. ..... ... ......... ...
Examination of blood fcr coagulation time ...........
Blood sera prepared by Swift-Ellie method for intraspinal


. ....................... .
. ... .. .
. .. ..........................
. . .
injeetian.. ... ... .


16.09,
18
51
32
314
14


ANALYSIS OF WASSERMANN TESTS.


A total of 15,445 Wassermann tests were performed on the blood of

10,624 persons. The results of these tests are summarized below:

TABLE SHOWING NUMBER OF PERSONS ON WHOM WASSERMANN TESTS WERE MADE AT
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1924.


Race, sex, and status.


White, civil, U. S. citizens:
M ales. . . .
Females.. .... .... .... ..
Children.....................
White, soldiers, males, U. S. citizens


White, other than U. S. citizens:
M ales ............................................
Fem ales.. .... ..................................
Children... .......... .............. ...........


Totals.. .....


Individuals
positive.


475


lndividuaia
lzegstivq.


5,125


Total
individuals.
tested.


1,694
262
42
3,602

5,600


852


I -I-


Per cenl of
individuals
positive.


9.03
9.16
2 38
8.25

8.48


15.85


15.85


I


852


TOt~lgllllllllllll


















In addition, Wassermann tests were made on 624 spinal fluids takerH

from 501 individuals, and of these tests 115 or 18.42 per cs2t .V.


positive.


PATHOLOGICAL EXAMINATIONS.


A utopsies.-A total

of Health Laboratory.

General Diseases:
Typhoid fever ................... ..
Mnlariml fevr Wb.f.lrvwnilamnnl


M easles .........................
Inluens, .... .................
Dysentery, bacillar ... .........
J eprosy. : . .
epeticemia. ...................
Pellagra........................
Tubera lasis of the lungs. .....
Acute military tubereulmie........
Tuberculsis of bones and joints...
R Joke rs, .. .. .. .. .. .

Syphilis, tertiary. ............. ...
Cancer of the buccal cavity......
Cancer of the it~mach and liver...
Cancer of the uterus.............
Cancer of the male genital organs.
Cancer of the suprarenal glands (hJ
DiSbetes ........................
Adi~n8disons, s dies .........

Leakemi a ....... ......... ... ..
Leukemia. lymphatic............
General amyloid degeneration.....

TOt:1] .....................


Diseases of the Nervous
Simple meningitis. ... ...........
Poeumonoceus meiemngitis.........
Locomoter ataba ................
Cerebral bemrrhage, apoplexy....
Softening of the brain............
General paralysis of the insan ....
Epilepey...... ................
Convulsions of infants............

Torsi .. . .

Diseases of the Circulato
S Per icr e ditis .... ......* .. .... .
Acute endoearditis ...............
Malignant endo r litis. .........
Other organic diseases of the heart
Angna pectlnri ..... . ......
Aneurysm ...................
Arteriose lero si ..................
mrircea ......................
Hemorrhage, postoperaie........


Total .

Diseases of the Res
Bronabopueumania.......
Lobar pneumonia.........
Pleurmisy .................
Emovema. ............


of 262 autopsies were performed at

The causes of death were as follow


i i .
. .i *



. .

i . i




. i i. i
,. i .i,. ... i


. i i



ipernephromai


* .. .. .


* .. .. m .
System
*.*. ...
. .

* .

* .






* .

. .


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


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


and

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


Orgai
*.*.. .
* .



. .

* .


ns of
*.. ... .
. .


* .

* .


Special

.. .
*. .... .* .*
*. .. .. .. .
. .. *
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em:


ipiratory System:


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Genit.-Urinary System: and Asnena:


a
10



18


m m. m:. .


. .


. .

. *


uDiease of. the Bones
. dfelomatofiB.... ..........
Adutte bilateral mastoiditia.....
al- a a m


and of the Organs of Locomotion:


. :. .


....... .


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


:.. Malformations.:
S.Tql. .... ....................... ..


.. Diseases of Early Infancy:
8 .I.tewaF aeatonarum......... ................... .....
.i Prem afiire:bira .. . .
.: "' Gon .o it debilirt. ...... ... ............... ..


;.. .Atass neoa torum .. ... .. ...... ......................
.. lriury at birth( erebml hemorrhage) .......... ...

'. l :. : .. .

:,: Affections Produced by External Causes:

-S ..".u ade by drowning.................. ... .... ......
S: Agte ayenical, poimming .............................
I;:s lmieig .lpoisonipg, accidental....... .................
;' Sna (conftlgration excepted) .............. ..........
!'.' "' sirtioI of deleterious gases (conflagration excepted)...
..... .e.lt. .i- ld.ow n in g ........ ... .... ... ... ... .....................
- .'I;.. _sanx ism by firearms.... ......... .... .... .. ... .. .
'.. T aum atisa byfall........ ... ...... .......... ......
Tiaumatism.by automobile accidente.................
.a.cture ofJ~I ynx (on. bicycle colliding with tractor).....
H. 'j1* atureo i4tlull thrownn from truck).. ...... ..... ..
...-. BrBi tr e.. ...... ..... ......... ..................
:. .:.... cide by rutting or piercing instruments ..........
~:. im", :nideby. btimutinstrumentin hands of unknown party
"... ~rnamatir. 5lb blowrceived in prisefight..............
:. .. litkiple.injuawie due lo.falling B.eijon of pipe...........
iiuinin by explosive.. ....................... ......
: :. . . .

S... T otals ........ ....... ......... ....... .... ..


h:


4. .
K 14 n^e


. .. .. .




. .
.. .


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


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ft
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as


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1
1


4

4






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TABLI SHOWING THE MORE RfEQENT C.AUEB O ARATH FOUND AT AIII I
BOARD OF HEALTH .LAOfATORY, 1O4O .. Y J H


TubcruloBl...........
External caue. ..... .
Ormic heart diseam....
Pneumonia, bronoho and
Cinoer...............
Bright~ disease (acute an
Sybphilin includingg genera
Malnutrition in infants..


....Ii


ChuS.a


H~ HH


V.

*9~rli2II


TABLE SHOWING THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOA
HEALTH LABORATORY, 1904 to 1924.


'NJ:
A1 Hj;
I!
ZWi H* .1


Totals.


1.022


1.088


60
27
46
26
52
41
23
21
6
14
8
5
6
3

4'
5
3
3

370


3
24
40
26
32
30
38
37
34
38
20
17
21
6
15
29
16
19
9
29


8
23
27
25
31
37
86
27
26
12
12
20
23
12
14
11
5


10


89
36
23
11
36
10
15
8
6
5
7
3


4
54
4


3
15
12
11
17
16
20
22-
26
27
14
10
18
8a
20
16
17
- 9
12
21

814


33.
58
14
11
10

6
a
5a
2

1
a
* *



8

I


' 1'
.1

11-:,

SI
14
15
U
9
C.


' J

1

1*




U


Thia include. 32 caem of influenza.


V.~ ~ ...- ~ II
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lob~~


Id chronic nephritie)..
rl ppreais) ............







KBli JBBBBX B "i Il i l:d "J" :. .* A
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JA: f Ta SOWING.NWMBER OF AUTIOPBIES PERFORMED REVEALING THE FOLLOWING DISEASES .
.. ..~.. PER YEAR AT BOARD OF HEALTH LABORATORY. 1904 TO 1934
.. ~. :.: a ..
.. .
r, *,,,,





.. .x :. ..~ *:*

:.. .. .. .. -_ _
:. .. .
....*. ... .l .











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S !:.' 3

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'4 :". I n -"I I I _:I/o
i ,,,,,,,, -ii ,-
.. ,:...',.V .. C .
,.w I; .'.,, I-I I I I I-


1 907 .. .
.90ft....
199...
o....
1911.,;..,
1914....

1915,.. .
1 06....
91. ...
1 1 .-
": 19170...,
2019....
'o.,...i
. 1921....
1922 -...
1923.,..
1m24...


- 'Total.....


. .
2
2


* i *




. .
3







23


I
1
* .
*. .


26


2
* .


. .. .. *
* .







20
* .i .

. |.. *
* .
*i i .
*' i i i. H i

* t .b. .e
,ng ii0


.. .. *

"~ i
* .
I






4
2



m 1
.. .. I
* .


* 20
4

1





20


* .

. .



4
1
2
1
3
2
3
3
1
2
3



27'


* .

* .


* .



*.. *. .


* .


....oi.g
* ..







* H *
........
* .




......i .
* .






i... ....
iini.. is

,ii ii 3
* i *1i

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SAll cases since 1905 ,ere imported ses.


Per cent autopsied.-Four hundred and three bodies (not including 6

Sdisinterred) passed through the laboratory; 263 or 65.3 per cent were

, aptopsied, one of these autopsies having been done at Santo Tomas

Hospital before receipt at the laboratory.

*Makria carriers found at autopsy, 14.

Slntestinal parasites found at autopsy.-Nineteen cases in the 263

autopsies or 7.2 per cent, showed one or more parasites or their ova,


as follows: ,


... Cronloidas.....,....,........................


Trichocephalu u.'.............. ...... ..........
Taena, saginata...............................


TABLE SHOWING CAUSES OF DEATH FOUTND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH
' LABORATORY, 1924.


7,066


m g









4 1.i
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0218


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Eye, hgrowtk from ...... ...... ...... .........,
a oe r'om eyelids ........ ...................
N Msal i lx pe .. ... .. . .

Bpecimens.from nose, other thpa polyps.. ........
Ears, growths from.......... .. ........ .
Lip, specimens from .. . . .... .......
Mouth, tumors fro ...........................
Timsp from lower aventr proem........ ...,.....
Tongue, specimens fo .... .... .- ....
Jaw, epuiiB from lowe.r... ... . . ..
Suum iry tumor... . .... ... ....
Tonaale, one. . . . ..... ,... .
TO silsB, pair. ..... .. .... .. .......... ............
Tonsils, pairs and adenoids ............. ........
Oyst from posterior pillar of tonsil..............
Adenoids. .. .. .. .. .. .. .. .. .. ... .. .. .. .. .. .. ..

Palate, soft, growth from.... . ...... .
Parotid region, tumor of ........ ....... ...... .
SB mt nazill ry glands...... ..... .. .. .. .... .
Thyroid gland, portion of ................ .... ...
Thyroid gland. .... ..... . . ..
Vocal cord, tumors from........................
Gland. from neck and jugular vein..... ..........
Neck, tumor from ........ ........................
r ym tn .........................................
Breast, m ale. . . . ..
Breast, specimens from ........ ..... ...........
I ver, tissue from ..... ........ .. ... .. .. ..... ...
Gall bladder ............................... ...
d leen .... . . .. .. ... .
Peritoneum and momentum, specimens from........
K idney ..., .... ... .. .............. ....... ...
Herni ac, contents of.... ..... .... .... .......

Bladder, ecised specimen from..................
Prostate.... .. ... .. .. .. ... .. ...... .
Prostate, seminal vehicles and part of each vam.....
Foreskin-......... . . . ...
Peri-urethral tumor mass ....................
Penis, excised ulcer ofi ... ...... .. ....... ....
T esticle .. . . . ..
Testicle, ord.and epididymip....................
Epididymis and vaa...... ... ...... ..... ... ....

Cord, small nodule just above epididymia.........

Uterus, and adnexa ........... ..... ............
Ituteu, adtiex and appendix ....................
Uterus, specimene from ...... .... .. ... ....
Uterus, placenta and child (with or without adneza
Uterine cervix, or specimens from ...............
Tube cr tubes.. .. .. ... .... .. .. ... .
Tube or tubes with ovary or ovaries......... .....
Tibeor tubswith other specuten ...............
Ovary or ovaries. .. .. .... ... .. ..... ..
Ovary or ovies with other spenimens (kube exce
Other combinations of female genital organs.......
Specimens from external female genitalia .........
Stomach, specimens from... *.. .... ... ........
Intestine, rejected portion of, smal] ..... ..........
Appendices (including 31 removed with faale.pni
Transverse colon, specimen from.................
Rectum, specimens from .................... .
Peri-recta! fistlous tract ............. ....
Anal htulrl tract.......... .............. ..
Pilonidal cyst, cocceygeal............. ....... .
Upper extremity, or specimens from .............
T.ninar nvyipmi.lt nr anAoimana fFrwnn


.

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< .......... tumors cancerr.:
:.: "* :: ...::. ..... *.
.. :: *:*.



.* .:.... **i .. *
xsn. surgint specimens.-The principal Teions encountered



*g* **- *j ... . ........ .. ... . *
S :I* .. ** .



.. an d .e ar.... .......... ...... .. ... .. ... .... .. .. .. .. .. .


*....."........
...... 1%di ate.ge.)
:" *... .' ... ...". ......... ... ..... ............ ........... ........ .... .............. .
.... *. 4






"nait subut eou tissues..... ............ ..... ... .. .. .. .. ......... 4
.i."ne .. l .t. .... ........... .. .. ................. .. .. 4


"'r Tota: ................. ...
.behign tumors:
broma of eonjunmetivs...... ......
;Nasal'polyps...... ...... .. .
:Lymphomsa of roof of nostril.......
S. gioma of lip. ..... ...........
yapillonata of mouth.............
pillary..hemangioma of tongue. ..
.: asular fibroma of jaw ..... :.... .
.pibrous op t s............. .....
yst front poserior pillar of tonail..
'." lxe tlmor parotidd region........
: pil 6f vocal cord ....... ..
.. tuio alnd colloid goiters.......
'' e oosnb nsor nodular goiter.....
.' Fibr-adenomata of breast.........
bromama of breast ........ .. .....
... ~idea of breast .............
'. ,:.Hdenoma of brast ....... .. ......
: .ed edtnmor of peritoneum........
Papillary cystadenoma of mneentery
... ypertroahied, protate....... ....
,i rorl.es e..... .... .. .
a eme polps' ..,. .................
ffise b~tomyomstosin uteri. .....
ystie ovaries and ovarian cysts....
:... aden mat ous cy yt of ovary........
:ea id"eysteaof ovary ...........
S,: t..ian cysts.. ........'........
. ..:.. Pibroadenomao of buttocks .......
F bro-adenoma- of tre.. : .......
:' .. .teomaa,, great toe .......... ....

.:..... pi i au t .... .................
;: .. aole........... ....
* :.... .Eipit eliO cy M. ..................

. b.ocyest of sralp .. ......
-. oddtj piionidal) ..........
... ,emid cysat, cervical... .........
:.,: othgieendotheliomata (knee and 1
."t- .: ~tiDa {ckm......... ....
i.. :: ai nt cell arcamata.... ........... ...
:, Iupoma... .-.. ... ... ..............


'a.


4
I


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I
I


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S

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1

S


1
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a
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5
I
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.. r : .: *....: ... ..ii." :.... i ". i :... .... .....
i* a *. ** .. i *.
.." H .

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.K :" .. ** .....*n : ....



.L :" ... ., H ,:, .,; ,,* ,,H.
S :*. .. .c I.::* .
S**,m: ,B| a "":,,
** *.EE"*.:: E ".
Other requent" lesions" encou terd **. .'* ...t : *L. ..
4 .... H* ** ..
S. .. ..
Tnmor caused b Onhodera aoecutiea (fra a) ....





Asnotie retinae vith psnophthaha.itis). .... ......... ....... .... ..... ....^. :- p. *IuI.i
Hypewtrophy of thyroid gland with one ad n ma iaas of oc i ,.?. H:
I : I = I"1 I I I I I I U l r 4" 4k I ik dl i 4







Axiluary ade from case of acute lymphatic sn. .>i..................... ........^ ^ i.. ...^ U::;i ii^Q
BJ.sto yn'ccai. of banud..**.**..*.. *................... **... -5* ..,*., *. f *9. .iApi
(Ot] er eitnare ofen **o *s **. t .': .... .... H ...:.





odraoina r a........ ......................................................... ... ..... .. .t
AiCllmiar nodes rom pe o aue3 lym .pli le..... .. .. .. ... .... .. ...... .. ... .





Early prenancy (ovum)a in uteu..I................................ ....................... .. ..


Ectopic tubal pregnancy (1 ruptured).*u *...*...~b.....S.....:....s....I .*.H
Bilate ral fbra.denamatous (7) growth of prximalend.of tube.. *******...*.. ... .... ...q. 1 i
t roed with tainh t.............. a .. .a....... C C : .. *::.. ..
. lesy pron () in i........ s ......ii.. ..i...... ......,............... .. .... .....i.. ...... ... ..
C olrm bis n spleen. .*.. *. *. *.. *.. *. i *.... .: .



Ehtaitea pnephregn nc(1 ruptred) k e... ........ .............. ............ .........,.,.. ...








2 .!!!.. .. J
I ntan eeo. :*' .!":. ....
F uli term b m pregnant* . . . . . . .. ... ..

Earlyac ent a] b o dum .t. u. . . .. . .. ... .. .... .... .... .... ...





Miscellaneous human examinations:ximal ends of b ......... .... ............... .



o -tal o_.......... ................................................ .................. ... .


Darkfleld examinations of liver..... .......
Differential blood counts.................
Blood counts, complete ............. ........
External description of human body.......
Blood fcr filaris survey..................
Differential] leucocyte count.............
Four-month fetus..... ..................
Three and one-half month fetus...........
Three-month fetus..... ... ....... .....
Ectopie gestation complete ...............
Fetus, placenta and membranes complete..
Examination of skin lesions .............

Total... .... ...

Animals (wild and domestic), b
Cultures from animal autopsies (cattle)....
Culture of pus from shoulder abscess (cow)


Total. ....

Animals (wild
Guinea pigs (alter in
Rabbits........... .
Hens .......... ....
Dogs..... .
Pigeon .. ........
Wild turakey.......


and domestic),
oculation). ........



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


a


. ."- J


.. ., .. .. .. . . .. .. ... -. .*. ..... ...4H *

.. ....... ........................ .... ... ...... ........ i.. .
. .. . .. .. . .. .. . .. ..






:." .::d : .. f 4.
. . i .. . .. .i .. i i m 4 .. x".... .- ,"l.t..

. .. .- .. . .i .. .. . .- ... ......... : .





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.* . .** . ... * .. a i. *.. A S
.... '........ ...... .. ...





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.. i.






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



S. ... .. ...
.:*: '.h!*Z



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:. .. : ...
........... ,. ., ...,... ,, *. ** ,* .*....,.. *. :


*- x
4 : 4:4"

I b .." ....

.... ... ... ... ... ... .... IY~ .. .. .. .. .. ..+ + + .. .


...........i.....
*. .. ...


*. ..... .
---- ,,,, < :j I


nwr1u \ w6&C u(ScF0 (uracGSfl4 wnsac&&cancuiw csxamIsns:s
Cattle tissues fortuberculosis (22positivefor B.tuberculosis).................
Dog's brain for rabies . .... .. . .. .. . .. .. .
Guinea pig tissues for tuberculosis.... ...... ...........................
Tumer from lip of mule for histological examination................. ........


Rats examined. ... . . .
M us m usculus... ... ... ....... ..
M us alexandrinus .......................
A us norweg icus...... ...... .... .. ...
s ratt .. .... .. .... ... .
Rat smear examined (from liver and spleeo)....


S .. .
. S .
... ....... m

. . .


,... ** + ii if
i ...
-. .. .... ..


.. .. .
.. *a t.


. ..i. .i. .


f.. ...fl:,n


11111111111111111111


.* .


Total
~,,,~:,\


TO1B1~1IIIII




NI* H..:.

1*'t
: .4
.. I.X
~I'!
.1 Jii I. :



rig..



H~r .
~. .11
1!! .itia~~idh~~iud!oe


A
* .4.


CHEMICAL ANALYSES AND EXAMINATIONS.


r If ,


St : g'.. ." :I ...."

..I ..:i:" *.e. "r.as... t o... .....
.... .. ..............
.! .:- teanitroen 'determiaz

i,: itrhtgeni detrminationes..
:": aoc iddetmni htions ......
: l i. i :e ti: ".i. ,i.t0al. i.. .
: .! : : .UG O t )" ........





5 .. ...:: i b dioxide determinalign
:i;:' I : .= ..: i m oboride denterininatlo


.apoest determinations....


:mmi, a i determinations......


*;! .Irucatua....
b Ottodeeylc................

S' Slpeuoaeopice a.........'..
o s l e, ":;.. Killiyn ." .. i NatI*




H:tl:gH. lnd ihdeitealt ...........
..* .lboeralub.... ....
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,1Z8 PROM HOSPITALt, DEATHS, AND ND NTFEOTIVC AT hS
FOR EMPLOYEES.


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AeBaOLUTE Xl UMNB.


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2,846
8,130


- 10.17


Dibscharpe.
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544
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1.515


1.465


ANNUAL AVUaIon PEa


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tZotals


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145.03


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130.32


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120.79

133.48


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42,079

i7,308


14,301
40,899

55.200


41.72
115.28

157.00


39.18
112.05

151.23


1,000 EMPLOTErs.


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24.28

21.25


22.43


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.t-rDEATHS OF RESIDENTS AND DEATH RATES, OF THE CANAL ZONE AND THE CITIES
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. ...
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'otale.,....


i .


Totals........


Popula-
tion.


59,635
31,285
33,723

124,643


59,635
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31,793

122,713


Deaths.


Total.


1,948


1.752


Disease.


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455
270

1,853


Annual rate per 1,000
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External
causel.


Total.


15.63


14.28


Disease.


14.87


18.08
12.05
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13.71


External
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SYear 1923:
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TAmB VYI.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1924.


White employees from the United States:
Disease ............. ..........
.t terna l cau m ....................


White women and children from the United States:
D disease ...... ... : .. .. .. .. ..... .
External causes........ .... .... ..


Annual
death rate
per 1.000
population.


6.02


White employees from the United States and their families:
D iseasel .... . .. .. .. .... .. ....
Exte nal causes....................................


Number of American children born on Isthmus during the year...................................... ..
Deaths among American children under I year of age ............... .. ...... ... ...
Infant mortality rate among American children (number of deaths per 1,000 live births).............. .


TAme VII.--BIRTHS AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF


PANAMA AND COLO.N.


Place.


Year 1924:
Panama......
Colon.. .
Canal Zone...

Totals....

Year 1923:
Panama......
Colon........
Canal Zone...

Totale....


. .
. ... .


S. .


Popula-
tion.


59,635
31,285
33,723

124,643


59,635
31,285
31,793

122,713


Births.


Total.


3,727


2,163
748
623


Alive.


3 5.28


3,343


Rate per 1,000 population.


Total.


29 90


28.80


Alive.


35.95
22 06
20 58

28.30


27.24


TABLt VIII.--INFANT MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF
PANAMA AND COLON.


Place.


Live births.


Male.


Female.


Total.


Deaths among
children under
I year of age.


Number.


Rate per
1,000 live


1111111


~~11111111111111111111111111111111111111


Total; ..


Total. ...


Total .......




S


TABU IX.-TABLE SHOWING DISBCEAlGA AND JDATR IN NOfITABl;
PANAMA CANAL, .1924.


Nunaae


General dimes..


Typhoid fever.... .. .... .. .. ...
Relapsing fever........ ...... ....
Malarial fever, Estivoautumnal.....


Malarial fever,
Malarial fever,
Malarial fever,
Malarial fever,
MaaIroil feCer


Tertian......
Quartan......
mixed ...
undetermined.
fliniral


Malarial fever, Cacbexia..........
Vaccinia... .. . .
M ea les .. .......................
Scarlet fever ... ....... .. ...
Whooping cough..............
Diphtheria and croup............
Croup .. .. ....
Influenza.. ...... ............ .
Dysentery, Entamebic ...........
Dysentery, Bacillary .........
Dysentery, unclassified........
Leprosy .. . .
Erysipelas ..... .......... .....
Dengue ............... .. .....
Chicken pox....... .......... .
German measles...... .. ..
M um ps..... ... .. .. ..
Hemoglobinuric fever, unqualified.
Filariasis ...... ... .
Other epidemic diseases..........
Purulent infection and septicemia.
Septicemia................
Tetan us . . .
Mycosis ...... .
Acti nomycos i..............
Pellagra .. .. ... ...
B eriberi. . .
Tuberculosis of the lungs........
Acute military tuberculosie.......
Tuberculous meningitis...... ...
Abdominal tuberculosis..........
Tuberculosis of bones and joints..
Tuberculosis of other organs......
Tuberculosis of the skin.........
Tuberculosis of the lymph glands.
Rickets.. .. .... .. .. .


Syphilis, primary........
Syphilis, secondary .......
Sypbilis,'tertiary .....
Syphilis, cerebro-spinal.
Syphilis, hereditary......
Syphilis, period not stated
Gonococcus infection...
Gonorrhea...... .... ..
Gonorrheal arthritis......
Goncrrheal bubo ...... ...
Gonorrheal orchitis and ep


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

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53


TABs ZK-.RNOWD(G DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA
CANAL, 1924-Conti nued.


Disesm .


General diseases.-Continued.


Other tumors (tumors of the female'organs ex-


So ptped)........... ... ...
Acute arncular rheumatism...
chronic rheumtism arid gout.

Arthritis deorans..........
Diabetes ... ...... .........
Exophthalmic goiter..........
Addien's disesee...........
. Leukemia lymphatic.........
HBodgkib's disease.........
Anemia, primary, pernicious..
Anemia, secondary, cause not i
"Other general diseases..... .
Alcoholism (acute or chronic).
Aldoholimn, acue.........
Alooholism, chronic..........
Alcoholic psychosis...........
Chronic lead poisoning...... ..
Other chronic poisonings......
Drug habit..................


. .

. .

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. . .
. ............ ...
determined
. .
i ..
.. .
. . .
. . .
. .. .


.. .
. .

... .
. .


Diseases of the nersouv system and of the organs of
.. spsecil sense.

Eneephalitia................ ....... ... ..
'Z .S simple meningiti ..... .... ..............
Cerebro-upinal fever ..... ..............
SLocomnaotr ataxia ..............................
Otherdiseases of the spinal cord. ..............
Acute anterior polio-myelitis.. .....
Cerebral hemorrhage, apoplexy.............
Softening of the brain ............... .........
Paralysis without specific cause......... ....
General paralysis of the insane...............
Dementia precox ...... ..... ....... ...
Manic depressive pay'ehosis ..................
j Toxic psrchousi ............................
Other forms of mental alienation.... ... .....
Epilepey ........... ........ ...... ..
Convulnsions, nonpuerperal (5 ears and over) ..
Convusions of infants (under 5 years of age)....
:C horea .............................. .
-H ysteria. ....... .......................
N euralgi ....................................
N eurt is ...... ............... .... .
: Itbe cility. ...............................
-rganic disease of the brain.. ....... .. .
.N eure tHenia .......................... ......
S Other diseases of the nervous system. .... .
olio lar conjunctivitis............ ..... .. ..
Trachom a. .... . . . ....
Disia e of Cornea.... ....... .. .
.D i me eof I ri, .................. .. ..........


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TiBau IX-SHOWING DISCRAQGE3 AND DEATHS IN HOSPITALS OWF Iftl PA* L dI,
r s r
... : .:



*A* fl *IIH.L.


Diseases of the circulatory system.-Continued.

Arterio-sclerosi ................ ... ... ... .
Other diseases of the arteries, atheroma, etc.....
Bemorrhoids.............. ................. .
Varioes............ ........ ...
Varicocele ....................................
Phlebiti ....................................
Other diseases or the veins ..................
Lymphadenitis (nonvenereal)............ ...
Other diseases of the lymphatic system .......
Hemorrhage; other diseases of the circulatory
system . . . .


Diseases of the respiratory system.


Adenoid vegetations..........
Other diseases of the nasal foes
Lary gitis... ..... .. ..... .
Other diseases of the larynx...
Diseases of the thyroid body..
Acute bronehitis......... ....
Chrronchiti ..........
Broneho-pneumonia.......'..
Pneumonia (unqualified)......
Lobar pneumonia ...........
Pleurisy. ...................
Empyema...................
Gangrene of the lungs........
Asthma .....................


. .. .. .
m. .. .
..*. .... .
. .
. .
. ... .


*... .... .
.. ... .. *
.. n... ..
. n. n.. .
........
........d


Other diseases of therespiratory system (tubercu-
losis excepted)....... . .... ...
Abscess of lungs ....... .. ..... ..... .....


IMaeases of the digestise
Diseasee of the teeth and gume


Iyss'..


Storm atitis. . . .
Other diseases of the mouth and anneza.......
Pharyngitis. . .. .. ..............
Follicular tonsillitis.......................
Other diseases of the pharynx..............
Foreign body in the esophagus...............
Ulcer of the stomach.. .......... ...... ....
Gastrectas is ....... . .. .. ... .. .
Acute gastritis......... ..... ... ........ ...
Chronic gastritis.................. .........
Acute indigestion ................. ..
Other diseases of the stomach cancerr excepted)
Diarrhea and enteritis (under 2 years).........
C olitis.. ....... ......... ........ ...... ..
Diarrhea and enteritis (2 years andover)......
Colitis. .................... ............ ..
Ankylostomiasis............................
A ariasis ..... .......... ............... .
T eniaia s. .. ... .. .. ........ .. .. .
Strongyloidosis .. ...... .. .
Other intestinal parasite................
Amitrl4 a ...ai rJmffI


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White. Black.
.


2
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19
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.4


Taai IX.--SHOWING DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA
CANAL, 1924-Continued.


p ir


Dieseas.


Diseases of the digestive system.-Continued.

Other diseases of the digestivesystem (cancer and
tuber ulosis excepted) .....................
Nonunereaw diseases of the enito-urinary system
and anneza.
Acute nephritis,... ......... ...... ............
Bright'e\disease (chronic nephritis)..............
Ohyluria....................................
Movable klid.ey'. . . . .
Movable kidney..............................
Pydo-nepbrosis...............................
Other diseases of the kidney and annexa.........
Calculi of the urinary passages.. ...................
C ysftis ...... ................ .........
Other diseases of the bladder...... .............
Stricture of the urethra, nonvenereal ...... .....
Vejco-vaginal fitula ................... ..... .
Other diseases of the urethra, urinary abscess, etc.
Chronic prostatitis ........................ ...
Hypertrophy of prostate...... ............. ...
Other diseases of the prostate............. ....
Nonvenereal diseases of the male genital organs.
H ydrocele...... .............................
Uterine hemorrhage (nonpuerperal). .<...... ...
Uterine tumor (noncancerous)...............
M etri tis.....................................
Other diseases of the uterus ...................
Cysts and other tumors of theevary...........
Salpingitis and other diseases of the female genital
orga ns ..... ......... .. ................ .
Benign tumor of breast.................... ...
Nonpuerperal diseases of the breast (cancer ex-
cepted) ..... ... ......... ... ........... .
The purperra stale.
Normal labor r............................... ..
Accidents of pregnancy........... ...... .....
Extra-iuterine pregnancy ................... ....
Hyperemesis gravidarum.......................
AbO tiOnl ....... ... ..... ... ...................
P t ier ner he.or.r .age. . . ..
Puerperal hemorrhage.........................
Other accident. of labor.......... .... ........
Puerperal septicemia...................... .
'Puerperal albuminuria and convulsions... .......
Eclam psia ................................. .
Following childbirth (not otherwise defined)......
Puerperal diseases of the breast................


. Diseases of the skin and of the ceua"r tissue.
G angrene. .. .. .. . .
Raynaud's disease ..... ....................
Oa urdcle ..' ..... . ..... .. .
Carbuncle.. ..... . . . .
Acute abscess. . ..... ... .
Phlegmon and cellulitis .......................
EWvimnnhk-tnm*


I.5I
--a






17



24
32
1
24

21
85
20
29

34
3
II
4
5
2
41
26
13
50-
1I
95
15

131
3

8


439
61
10
14
83
3
59
2
10
1
25
18


1
1
15
8
92
,81
In-


tli







I)








11


Employees.



White. Black.


1I



I


1

6
6
6
S2
6

1I


2

2


2
.

1
2 i
. .. ..



1
* .
I

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


. .. .
. .
1
2
6
26
5


Nonemployees.


White.


Army. Others





5 4



4 7
1 t6
1
I
1 .
2 4
13 29
2 5
6 8
1
4

2

1 2
1 .
9 4
b .
6

I
42
6

. 29
. 29
9

4


182





. .. .33
. ... .... .

. .1
. .. .. .
* 7


A


Non-
residents.


Black.I White. I Black.


I


I


S


. .





*** :: I
.. *"." "* .:K*
S. i ....

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










SEmployes. N employee, rea ** *

:Diseae : Ihi .
*. ...*.
.H ..








3-g 1 White. Black. r Black. White.. Blauk. 'is:
S E Army. Others :




Other diseases of the bones (tuberculosis excepted). 50 1 6 3 28 6 7 .. '
. A nkyl ein. .. . . . 1 . . . .. ... ... .. .
Synov tia. .. ... ... .. .... ... 4 .. ..... 1 ... .. .......

Other diseases of the joints (tuberculosis and rheu-
matiam ecepted)... ..... ..... ... 11 .. .. 2 ..... 3 ...........
Am putations. .. 2 .. . 1 ...... .. ... ..
Other diseases of the organs of locomotion. .... 54 ." 15 11 9 8 6 6 ...... :
Malformations. ,=:>..
Congenital malformations (stillbirths notincluded) 9a 4 1 12 8 26 47 3 .,... ..
Diseases ofarly infancy. .
Newb orn child... .. .. 505 .. ... ... ... .. ... .... 224 281 ...... ...,.. '. '
Congenital debility, icterus, and sclerema .... 1 2 .. ... ..... ...... 1 2 ...... .......
I -em nature birth............... ... .. ... I 14 . 4 II ...... .. :
Congenital debility.. 3 ... ... .. 4 ..
M malnutrition .... ...... ... ......... 13 9 .. .. .. .. '5 16 1 .... .
Other causes peculiar to early infant y (including :
various conseq uences of label r.. 9 ... .. .... 5 9 .. .. ."
.:i..
Old age. 1 1 .

Senility ...... ... . .. 2 0 . ,
Senile dementia .. .... 2 ... .. .... 1 I .... .- .., .


H* :

Poisoning by food... .. .. 35 ... 6 4 8 7 1 ......
Venomous bites and stings... ... . 2 . .. 1 1 .. ...... ..
Snake bit es. . . . .. 1 .. .
Other acute poisoanings.. .... .... 8 1 1 2 1 2 2 ..... .
Conflagration..... .... .... .. . .. .... 1 ..
Burns (conflagration excepted) .......... 40 3 2 6 10 6 9 8 ,
Absorption of deleterious gases (conflagration ex- :..
repted)..... .. ......... ..... 6 1 1 2 1 1 2 .... .. .. .
Traumatism by firearms .. .. ... 1 ... ..... 4 7 3 1 ..... .
Traumatism by cutting or piercing instruments... 24 .. ... 2 5 6 1 6 3 1|
Traumatism by fail... ........... 141 2 11 12 38 25 38 ... 1.....
TraumaLism by machines .. .. 19 ... 2 6 4 ....1 6 .... .
Traumatism by other crushing. ..... ... 81 4 9 19 28 6 14 9 .... .
Injuries by animals ..... . . . 2 4 . .. ...
Starvation . 3 ... ... 1. .

Fractures (cause not specid) .2 2 34 8 4: 21 6 .
Dis locations .. . .. . 5 2 1 1 .. ... ... .
Sprains. ... ... .... .. ..... 6 1 5 .. ............. ...... .. .... .. .
Other external violence .. ... .. .. ... 214 3 9 98 32 8 33 341 3. .

Ildefn ed organs disease.. 1 ... 2 7 **

ll-desned organic disease .... .. .... 8 4 1 .. ... 10 ..... ... ... .
Cause of death. not specified r ill-defined.. .. .. 2 ...... ... ..... ..... 2 .... .. .. *...
Infections of undetermined riin .... 53 1 4 8 7 21 7 ....... .





1 ..,
U *.'


1**


I


'9ct-e


~Eq


- O tI


.3'-


00 .44r


conl


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.4 .01-al


*- .4
CA q


C4WU


-C..'
w~cq-


ca" nl -) 4'c 1 )rO h r- C'3, 0 1 CC ~-C'
*c .lo I- -I .
.e .
.4-


4.0201~


CO l


,r1*-I


.
c cN e q .I .i q t 4 .0 Z

bD0 C4I 1 C


- C ha


C~l Ct
04 C
CaQ


C in'-


IN. 00 Ia -
II ~
C.'II: IJNQ 1 /~~d I/Iirr :I


-sf--
onoc


0'1 CJ U


4. mCO I
I


In'


* 0

*
*


'' "


^If




H *



NJ ..


TaBLs XI.-NUTMBER OF DAYS HOSPITAL TREATMENT FURNISHED VARIOUS LASBSES
OF PATIENTS AND AVERAGE NUMBER IN HOSPITAL EACH DAY. 1924.


Clams of patient.


Ancon Hospital:
Employees........
Army and Navy.....
Panama Governmen t


Charity.......
All others.....

Totals....


. .


i.. i.. ....
.. .. i| M. ....


* ..
* I I
* ... .

* .1
*..... .


Corozal Hospital:
Employees.................... ,
Army and Navy.................
Panama Government............
C harity ........................
All otu her .. . .
All others ................... ...

Total (insane).............

Cripples ...... . ....
Chronic medical and surgical cases....


Colon Hospital:
Employees .............
Army and Navy........
Panama Government ....
Charity...... .........
All others ..............


Totals.


Palo Seco Leper Colony:
Panama Government.


Charity.............

Totals ..........

Totals by classes:
Employees.........
Army and Navy.....
Panama Government


..


. ,


..... .
. .

.w n


. .j


. .. ..


Charity, cripples, and chronic.
All others .. .... .


Grand totals.....


Number of days trew


Ameri-
can.


5,471
22,659

2,488
14.770

45,388


.. i
1,.029
. .
Ill
264


. .
. .


6,209
25,732

3,395
17,251

52,587


[Foreign.


1.103

22
1,317
13,880

16,322


366

25,420
2.664


30,730


51

O
123
1,655


2,646
.


2.646


1,520

28,088
6,023
17,81.5

53.446


Black.


26,560

223
10,405
30,567

67.815


4,799

77,922
13,051
10,246

106,018


1,433

0
2,151
4.574


20,094
9,755

29.849


32,792

98,239
53,581
45,387

229.999


Total.


33,134
22,659
245
14,270
59,217

129.525


5,165
1,029
103,342
15,826
12,790

138.152


10.405


15.782


22,740
9,755

32,495


40,521
25,732
126,327
62.999
80,453

336,032


Average number in hospital eacday.


Ameri-
can.


14.99
62.08

6.82
40.47


124.36


.30
.72

3.84
. .


1.5.87


17.01
70.50

9.30o
'47.26


144.07


Foreign.


.3.02
. .. ..
.06
3.61
38.03


44.72


84.19


0
.34
4 54


4.17

76.95
16.50
48.81


146.43


Black.


72.77


185.79


13.15

213.49
35.76
28.07

290.47


3.93
. .1

5.853
12.53


22.35


81.78


89.84

269.15
146.80
124.35

630.14


Total.


00.78
62.08
.6?
89.10
162.,

354.87


2.82
283.18.
43.06.
35.04


p 378.50

\ 26:50
28.51


6.09
5.60
0
8.41
23 14


43.24


89.03


111.03
70:.50
346.10
172.60
220.42

920.64


r These cripples require no medical attention.


HI'c
.1-i:i


*;.1i.





*" iH;

.1::i .'



H.:.,

*' H.r



I... HIY



'"ri






H:.. :I
H








jib

H.


4u S~


I


1




fl-~a .A... I~


rc.
C
CC


Dispenary.


Ancon.,.. ..
Balboa.....
Pedro Miguel.
. ltun. .......
Collm1.1 ,... .


iiiiiiiiiii


T'tIBoa. ...


Remaining
January 1,


Wbita,


Admitted.


Black.lWhite.I Black.


4

i3


20 2,913 1,395


_White.

. .


S. .. .


Black.


Discharged.


White.


Tr~anuferred


Remaining
December
31, 1924.


SBlack. White.I Black. White.I Black-


181 19y
105 132
453 467

.2,890 1,.350


. .


Dispensary furnishing treatment.


Anoon........
Balboa .......
Pedro Miguel.
Gatun........
Cok ,........

Totale....


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


Days treatment furnished.


White.


7,500


Black.


2,678
' 503
789
671
4,646


Total


16,787


Average number treated
in quarters per day.


White.


20.55


Black.


25 44


Total.


45.99


ALL CABES TREATED BUT NOT EXCUBED FROM WORK.


Dispensary


Ancon........
Balboa ......
Pedro Miguel.
Gatun........
Coln.a........

Totalhe....


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

* S S S S *.
. S *.... . .
n ... ..m... .. .. 1nn
. . .

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


Employees.


White. I Black.


7,482
12,719
2,681
4,859
5,147


12,059
15,977
5,290
10,339
14,471


Total.

19,541
28,696
7,971
15,198
19,618


Monemployeas.


White. I Black.


5,128
17,686
3,790
3,543
6,596


10,151
5,432
6,915
4,916
12.,333


Total.


15,279
23,118
10,705
8,459
18,929


Wh~ite.


12,610
30,405
6,471
8,402
11,743


32,888 158,136 191,024 136,743 139,747 176,490 169,631


Total.

Black.

22,210
21,409
12,205
15,255
26,804

97,883


Total.


34,820
51,814
18,676
23,657
38,547

167,514


Tacm XII-REPORT OF DISPENSARIES, 1924.

mEoPL7IeBs TrETaED I QUArTERS.


111111111111111111111111111111111111111

1111111111111111111111111111(1111111111




I .H*.. A *j'ji *......~


60

*
TaBn XITI.-CONBOLIDATED ADMISSION RElOR'l HOSPITALS AND DISPENSARIEB, 1924.


All classes of patients.


Admissions to hospitals, excluding Corozal farm, cripples, and chronic ward,.
Admission of employees, to quarters.......... ...... ..... .... ..... ..


Total adminieiona to haupitaks and quarters. ... *


Leas number of patients transferred between hospitals and from quarters to hos-
pitale, whose admissions are duplicated in the above figures.. .......


Net admissions to hospitals and quarters ..

Employees only.
Employees admitted to hospitals ..... ...........
Employees admitted to quarters.... .... ...


Total admissions nf employees.... ... .... ... ...... .......
Lees number transferred between hospitals and from quarters to hospitals, whose
admissions are duplicated in the above figure ..........................


Net admissions of employees..


Annual admission rate per 1,000 employees to hospitals and quarters


AVERAGE NUMBER OP DAYS IN HOSPITALS AND QUARTERS FOR EACH ADi


Hospitals:
Ancon...
Colon ..


Average for hospitals


Quarters:
Ancon........ .
Balboa..........
Pedro Miguel....
Gatun .... .. ..
Colon ........ .


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


.. ., . ..


. .
.
. .

. .


.i l *. ..


. . .
. .. .. .. .


White.

5,008
2,913

1,921


214

7.707


604
2,913

3,517

46

3,471

1.136.17


Black.

4,745
1,395

6,140


1,232
1,395

2,627

* 135

2,492


290.78


I-


IN, EMPLOY EE ONLY.


White.


10.77


Black.


21.37


4.78
9.32
12:77
5.21
9.03


-* .: *. .. .
. ..4... ::



.. r.
S 'r<. l

S:P
: *" .: ,. ..


.*IH :: :*'.: ....
4 g*.. *
.c .'....:: ..:..::

r Hi

E,, IJ,
** : :: : ...
: *"i i
<* ,. :*


Total .
9,5


*Hi!
-: k.-'

I..
4.

*1. 36 .. .


4,806w i ;'
I HI:

lsA.







5.16H
St. I
a0,5H




...




3.I.


Average for quarters.




H.:
*Ii
H.....
.;
tH ..
I ..

II,
IH .'
Krh .



r.-


**i.


61


TAfl XIV.--BURGICAL OPERATIONS PERFORMED.


. Amputations:

Fo.ot. .. .......... ........
1 Thigh..... .. .. ........ .
Leg ...... ............. .
. H and ............. .........
Digits, multiple..................
Operation. on bone:
Lakinectoly. ........ .... ... ..
.Resection of knee ..... .. ... .. .
'Wiring of fractures, simple.......
Plating of fractures, simple........
Open. operation of fractures..... ..
Open reduction of fracture........
Dislocation, reduction, compound.
Craniectomy, decompressive ......
Bone splint to fracture, simple....
Fracture reduction, simple.... ...
Adenectomny:
Cervi al.. .................... .
Inguinal, single .... .. .. .... ......
Inguinal, double...... ...... .....
Femoral. .. .. .. .. .. .. ... .. .. ..
A illary .......................
Heniotomy:
SInguinal, single.... ... .. ....
Inguinal, double .... ..............
Ventral ... .. .............
Strangulated.... ......... ...
Fem oral ... ............... .
Genito-Urinary tract:
Nephropexy.....................
Cystotomy.. ..... .
Proatae1tomS ..................
Urethrotomy, internal ...........
Urethrotomy, external ............
Varicocele, radical cure........
Hydrooele, single, radical cure ..
Hydrocele, double, radical cure..
S Nephrectomy .......... .. .... ..
Orchidectomy.. .... .........
Epididymotomy .............. .
Amputation of scrotum..........
Curettage uteri..... .. .
Perineoplasty......... .........
Trachelhrraphy................
Vaginal puncture...............
Circumcsleion..................
.' Obstetrical:
lmrrian sia .inn abhdnminal


SAccouchement forceps................
High forceps... . . . ....
Low farceps............................ .
Version. ... .................. .. .
Perineorrhaphy. .................. .......
Thoraa:
Excision of breast and axilla... .............
, Thoracotom y.............................
Rectum:
Hemorrhoids, radical cure...... .
Fistula in ano. excision of.................


An con
Hospital.


Number.


1
2
I
3
2
2

3
1
6
I
3
2
1
2
1
15

5
127
40
U,
I
5

80
14
12
2
3

5
I
2
8
5
7
4
.. .

6
63
I
200
31

4
279

6
2
2
9
6
36

41
13

66
5


Died.


1
.. .. .


Colon
Hospital.


Number. Died.


. *


1
4

I




2

I
. .



2






.......


. .
.
,


1
. .. .


I -




. .... *. .. :r. a .
S ..,. .:..:" ,,:: *:.
V..it3


Laparotomy-Continued:
Gastro-enterostomy... .............
Gastrotomy ......... .... ....
Enterectomy. . .....
Appendectomy...... ............
Appendectomy with local peritonitis...
Appendectomy with general peritonitis
Calostomy .... ........ ........ ....
Cholecystotomy ........ .. ..
Cholerystoatomy ........... .....
Cholecy3tectomy. ....... .


Abscea of liver, laparohepatotomy...
Abscess of liver, thoracohepatotomy..
Pan-hysterectomy.................
Splenectomy.. ....................
Supravagina] hysterectomy...........
Hysteromyomectomy. ...............
Myomectomy .............
Salpingectomy, single................
Salpingectomy, double...............
Salpingo-oophorectomy..............
Ovarian e3stectomy.................
Oophorectomy.......................
Suspensio-uteri .....................
Ectopic gestation.. ....... ..........
Enterrorrhaphy. ......... ..........
Lateral anastomosis intestine by eutur
Cauterizations .... ... ..... ..
Blood transfusion....... ... ........
Arspbenamin, intravenous...... .....
Salvarsan.. . .
-Novoarsenobenaol-Intravenous. ....
Major operations, various............
Minor operations, various............

T otals .............................


I


An

Number


Number.


tarn
pitaL


Died. I!
I I-


1
1


2








.......

















.n.mn. ..m.


19


U



















I.


Colon
n-q~ta'


(umber. .1
mi



6.9. ..


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

.. .U

..
I0 *.4

2 ...






*., .
- .. .
I



....... .
9







2 ..

*... ..

"2 3 '^
U
'""2. ...

4 ....











123 ...


TaBmL XIV.--SURGICAL OPERATIONS PERFORMED.-C tianed.


.1


*. ".i,


..
S .:il


.. x





n.....
.I: :ii
.: ... ...

n *:
.. 1



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*.
s






.' :










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:I'


I,11

4.. H~hhj


S.21


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*;



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)i










II.






i


63


TaaLa XV.--OPERATIONS IN THE EYE, EAR, NOSE, AND THROAT CLINICS.


Aneon
Hospital.


Eye:
Advancement.....:............
Capsulotomy...................
Cataract extractions-
Combined........ ........
Linear....... ..............
Chalasior., removal..............
Enueleation........... .........
Foreign body, removal .........
Hordeolum, inciaion.... ......
Iridectomy .... .. ....... ....
Lachrymal operations-
Ddation of ducts ............
Lid operations--
Plastic..... . .
Excision and draining of ante
-Needling ... . .
Pterygiumm.....................
Tenotomy ................ ....
Capsulectomy ................
Miner.... .. .. . .
Ear:
Furnucle, incision...............
Foreign body, removal...........
Mastoid operations-
.R;mnl.


Oasiculectomy.... ...............
Paracenteais.......... ... ... .
Polypi, removal ................
Excision of cyst from ear..........
Others ...... .. . ....
Nose:
Cauterization .. .. .... .
Foreign body, removal............
Polypi, removal .. .... .......
Rhinoplasty............. ........
Sinuses-
Ethmoid, simple..............
Frontal, simple. .......
Frontal, radical...............
MaxilLry, puncture and irrigati
MaxilUry, radical...........
Maxillary, drainage...........
Submucous resection,.............
Turbineetomy ........... ........
S M inor.... .. .............
Other. ,.. ... ..... .... ..
Pharynx:
Adenoidectomy...................
Peri naillar abscess, incision .......
Tonsillectomy... .................
Uvulectomy..................... .
Retropharyngeal abscess, incision...
M inner ...... ... ..
Larynxa:
Foreign body, removal............
Total minor...... . . ...

Totals ... .. .. ......

Refractions ....... ..................


. ......

ricr chamber
. . .
. . ..


. .
. .
. .
on
* .
. .
..
. .

.


. .


I

4
4

. 4
24
2
6
a

3

4
I
3
68
2
1
6

2
6

15
5
45
2
I
2

2
2
6
10

2

t
17
3
I
75
27
3
I

505
28
877
2
1
2

3
XI

2.160

1,387





.t .:. r
*< j 4* *. *r


64


TamU XVI.--COOR&. BMOSPIAL, STAWEENT ONFrIUMMITMl


I~a~5t~L


First admission. ... . .. .. .. .. .. ... .
Second admission .............. .... .......,,. ....... .. ..
Third admim on.. .... .... ..... ... *
fourth admission ..... ... ... .. ..... ............. ..........
Fifth iansion ........... ... .... .. .......... .. ...


Totals........


H:" j~i l K Wii flj:
.4 4r .... hFI
* :y -

.41.
lil. li ., .;
IHE V
2%i hAS m


H k-tji
*. : .Mii .
iiitp*.~

L~t:.' H


*ForaCanals but,


Male.i

i47v

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


52
w~mnd
|pmpm


-T-


.1
.2*
. .. .. .
i. ...-...


i *. .C..
SIy;..


1 1I..'.


S. .

'tAt
. i ...
-: ..: Ji ..


*-. a M.
**

.


-Ga.BmB


W eUl . . .. .
Improved....... .. ...... ... .... ....
Unimproved .................................

Totals..................................


TaBrn XVII.-FORCE REPORT.


Chief Health Officer.......
Quarantine Service.. .......
Health Officer Panama.....
Health Office, Colon........
Aneon Hospital. ......... .
Colon Hospital..... .....
Santo Tomas Hospital......


Palo Seco Leper Colony.
Zone Sanitation ........
Coroal Hospital ........ ..
Line Dispenaries.......

To as .... ......


Decemb 31, 1024.


Total.


.3'
124

381
87~
* S *
SB=
Ilie.
118
121'
-MS.


"'':"':i~i7:;LH



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PAGE 3

REPORT OF THE Health Department OF The Panama Canal FOR THE CALENDAR YEAR 1924 W. P. CHAMBERLAIN Colonel, Medical Corps, United States Army Chief Health Officer THE PANAMA CANAL PRESS MOUNT HOPE, C. Z, 1925

PAGE 4

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

PAGE 5

CONTENTS. Page. Title. 1 Vital statistics regarding employees only. .6 Vital statistics for the Canal Zone, employees and nonemployees .8 Vital statistics for Panama City, employees and nonemployees. .8 Vital statistics for Colon, employees and nonemployees .10 Malaria. .11 Mosquito control. .12 Garbage disposal and fly prevention. 14 Infant mortality. 15 Child health education and child hygiene. .15 Physical examination of school children. 16 Diseases of animals. 17 Quarantine Division. 19 Ancon Hospital. .20 C orozal H ospital. ..22 Colon Hospital. 24 Santo Tomas Hospital. .25 Palo Seco Leper Colony. 25 Board of Health Laboratory. ..28 Tables. 41 3

PAGE 6

LETTER OF TRANSMITTAL THE PANAMA. CANAL, HEALTH DEPARTMENT, BALBOA HEIGHTS, C. Z., May 1, 1925. Colonel M. L. WALKER, 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 calendar year 1924. Respectfully, W. P. CHAMBERLAIN, Chief Health Officer. 4

PAGE 7

HEALTH DEPARTMENT. OPERATION AND ORGANIZATION. The operation and organization of the Health Department is the same as described in the Report for the. Calendar Year 1923. PERSONNEL. The personnel employed by the Health Department is the same as that shown in the Report of the Calendar Year 1923, with the following exceptions: Col. Weston P. Chamberlain, Medical Corps, U. S. Army, became Chief Health Officer, replacing Col. Henry C. Fisher, Medical Corps, U. S. Army, who was relieved from duty with The Panama Canal, effective June 22, 1924. Surgeon Carlisle P. Knight, U. S. P. H. S., became Chief Quarantine Officer, replacing Surgeon W. C. Rucker, U. S. P. H. S., who was relieved from duty with The Panama Canal, effective April 30, 1924. Maj. Tom S. Mebane, Medical Corps, U. S. Army, became Superintendent, Colon Hospital, replacing Maj. Thomas J. Leary, Medical Corps, U. S. Army, who was relieved from duty with The Panama Canal, effective June 22, 1924. The personnel of Santo Tomas Hospital, Panama, ceased to be under the jurisdiction of The Panama Canal, effective September 1, 1924. The internes at Ancon Hospital completed their internships in June and July, 1924, and were replaced by Dr. Edward Peyser, Dr. Eugene G. Free, Dr. Norman T. North, Dr. Elmer J. Wenaas, Dr. Richard M. Hewitt, Dr. W. B. Spalding, Dr. Thomas M. Arrasmith, and Dr. Dewey E. Westerman. The service of the last named was terminated August 11, 1924. The following physicians were employed during the year, by detail from the Medical Corps of the Army or by selection through the Civil Service Commission: Maj. William W. Conger, Maj. William A. Murphy, Capt. Frank W. Romaine, Capt. Paul G. Capps, Dr. Harry E. Handley, Dr. Walter C. Friday, Dr. Herbert L. Phillips, Dr. Boldridge E. Kneece. The following physicians were separated from the service during the year: Dr. William B. Meares, Dr. Julian R. Hunt, and Dr. William J. Burke. Dr. Claire C. Clay, Veterinarian and Meat Inspector, replaced Dr. William F. Gross who resigned June 14, 1924. 5

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6 SUMMARY OF VITAL' STATISTICS REGARDING EMPLOYEES ONLY.2 The admission rate to hospitals and quarters, from all causes, has been as follows: Average Year. number Rate. employed. 1906 26,547 1,779 1907 39,238 1,419 1908 43,890 1,132 1909 47,167 887 1910 50,802 905 1911 48,876 896 1912 50,893 727 1913 56,654 519 1914 44,329 420 1915 34,785 320 1916 33,176 283 1917 32,589 357 1918 25,520 406 1919 24,204 550 1920 20,673 672 1921 14,389 620 1922 10,447 490 1923 10,976 485 1924 11,625 513 From disease alone the admission rate to hospitals in 1924 was 130.32, as compared with 133.48 in 1923, and 139.47 in 1922. The total admission rate to 'hospitals only was 151.57 in 1924, as compared with 155.90 in 1923, and 167.61 in 1922. The death rate, frtm all causes, has been: Average Year. number Rate. employed. 1906 26,547 41.73 1907 39,238 28.74 1908 43,890 13.01 1909 47,167 10.64 1910 50,802 10.98 1911 48,876 11.02 1912 50,893 9.18 1913 56,654 8.35 1914 44,329 7.04 1915 34,785 5.77 1 1916 33,176 6.03 J n 1917 32,589 7.09 1918 25,520 8.11 1919 24,204 7.23 1920 20,673 8 70 1921 14,J89 6.46 1922 10,447 6.89 1923 1'0 976 6,6. 1924 11,625 7.23 All rates throughout this report are computed as annual per 1,000. ,Includes all employees of The Panama Canal and the Panama Railroad on the Isthmus; that is, in the Canal Zone, and cities of Colon and Panama. Active sanitary work on the Canal Zone and in the cities of Colon and Panama was undertaken by the United States soon after the control of the property of the French Canal Company was taken over in May, 1904. Tables are therefore carried as far back toward that date as figures are available, to give a comparison of the results of work done since.

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7 The death rate from disease alone for 1924 was 5.5 1, as compared with 6.10 in 1923, and 6.13 in 1922. The noneffective rate, from all causes, has been: Average Year. number Rate. employed. 1906 26,547 28.48 1907 39,238 25.09 1908 43,890 22.31 1909 47,167 21.93 1910 50,802 24.37 1911 48,876 24.46 1912 50,893 21.11 1913 56,654 15.97 1914 44,329 12.22 1915 34,785 10.28 1916 33,176 9.20 1917 32,589 9.65 1918 25,520 11.19 1919 24, 204 14.29 1920 20,673 14.87 1921 14,389 13,96 1922 10,447 14.81 1923 10,976 13.78 1924 11,625 13.51 The 6 diseases causing the highest number of hospital admissions, with their rates, were as follows: 1923. 1924. Admissions. Rate. Admissions. Rate. Venereal diseases. 189 17.22 194 16.69 M alaria. ..212 19.31 190 16.34 Diseases of the eyes and their annexa. .93 8.47 83 7.14 Bronchitis (acute and chronic). ..37 3.37 41 3.53 Tuberculosis (various organs) .-..21 2.10 28 2.41 Nephritis (acute and chronic) ..26 2.37 24 2.06 The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1923. 1924. Deaths. Rate. Deaths. Rate. Tuberculosis (various organs) ..9 0.82 12 1.03 Nephritis (acute and chronic) ....9 .82 7 .60 Organic diseases of the heart. .8 .73 6 .52 Cancer (various organs). .........4 .36 6 .52 Pneumonia (broncho and lobar) ..7 .64 5 .43 Apoplexy. .3 .27 5 .43 The admission rate to hospitals from disease, and death rate from disease, for white employees, were 178.07 and 4.26 respectively, as compared with 113.29 and 5.95 for black employees. The death rate from disease for American (white) employees was 4.14, as compared with 4.87 for 1923, and 3.27 for 1922.

PAGE 10

8 SUMMARY OF VITAL STATISTICS FOR THE CANAL ZONEEMPLOYEES AND NONEMPLOYEES. From an average population of 33,723 in the Canal Zone, there were 305 deaths during the year; 270 of these were from disease, giving a rate of 8.01, as compared with 7.14 for 1923, and 7.08 for 1922. The death rate from tuberculosis was 1.01, as compared with 0.69 for 1923, 0.74 for 1922, and 0.64 for 1921. Tuberculosis caused 13 per cent of all deaths from disease during the year. There were 694 live births reported during the year, giving a birth rate of 20.58. (See Table VII, page 51). Of these, 255 were white, and 439 were black. Of the total births reported, 5 per cent were stillbirths. Deaths among children under 1 year of age, from all causes, totaled 67, of which 12 were white and 54 were black, giving an infant mortality rate, based on the number of live births reported during the year, of 47.06 for white children, 123.01 for black children, and a general average of 96.54. Of the total deaths for all ages, 22 per cent occurred among children under 1 year of age, and 37 per cent among children under 5 years of age. Below is a table showing the death rates for the Canal Zone from 1905 to 1924, from all causes: Year. PopulaDeaths. Rate. tion. 1905 23,463 828 35.29 1906 34,095 1,700 49.86 1907 54,036 1,708 31.60 1908 67,146 1,273 18.95 1909 76,900 1,025 13.33 1910 86,465 1,251 14.47 1911 90,434 1,385 15.32 1912 79,279 1,129 14.24 1913 61,700 1,047 16.97 1914 46,379 710 15.31 1915. 31,496 410 12.83 1916 31,447 343 10.91 1917 33,044 328 9.93 1918 33,803 286 8.49 1919 32,366 247 7.63 1920 27,459 242 8.81 1921 31,377 236 7.52 1922 31,098 254 8.17 1923 31,793 253 7.96 1924 33 723 305 9.05 SUMMARY OF VITAL STATISTICS FOR PANAMA CITYEMPLOYEES AND NONEMPLOYEES. From an estimated population of 59,635, there were 1,168 deaths during the year. Of these, 1,128 were from disease, giving a rate of 18.92, as compared with 18.08 for 1923, and 20.66 from 1922.

PAGE 11

9 The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1923. 1924. Deaths. Rate. Deaths. Rate. Pneumonia (broncho and lobar). .194 3.25 237 3 97 Tuberculosis (various organs). .200 3.35 191 3.20 Diarrhea and enteritis (including colitis). .126 2.11 104 1.74 Nephritis (acute and chronic) .....96 1.61 83 1.39 Organic diseases of the heart. ..70 1.17 77 1.29 Cancer (various organs). .40 .67 50 .84 The death rate from tuberculosis was 3.20, as compared with 3.35 for 1923, and 3.76 for 1922. Tuberculosis caused approximately 17 per cent of all deaths from disease, as compared with 18 per cent in 1923, 18 per cent in 1922, and 17 per cent in 1921. There were 2,144 live births reported during the year, giving a birth rate of 35.95. Of the total births reported, 6 per cent were stillbirths. There were 296 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of births reported during the year, of 138.06. Of the total deaths for all ages, 25 per cent occurred among children under 1 year of age, and 39 per cent among children under 5 years of age. Below is a table showing the death rates in Panama City from 1905 to 1924, from all causes: Year. PopulaDeaths. Rate. tion. 1905 21,984 1,447 65.82 1906 25,518 1,142 44.75 1907 33,548 1,156 34.45 1908 37,073 1,292 34.83 1909 40,801 1,038 25.44 1910 45,591 1,446 31.72 1911 46,555 1,456 31.27 1912 47,057 1,380 29.33 1913 47,172 1,507 31.95 1914 53,948 1,863 34.53 1915 60,373 1,810 29.98 1916 60,778 1,765 29.04 1917 61,074 1,714 28.06 1918 61,369 1,314 21.41 1919 61,369 1,211 19.74 1920 60,500 1,297 21.44 1921 60,500 1,336 22.09 1922 60,068 1,279 21.29 1923 59,635 1,106' 18.55 1924 59,635 1,168 19.59

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10 SUMMARY OF VITAL STATISTICS FOR COLONEMPLOYEES AND NONEMPLOYEES. From a population of 31,285, there were 475 deaths during the year, of these, 455 were from disease, giving a rate of 14.54, as compared with 12.05 for 1923, and 13.41 for 1922. The 6 diseases causing the highest number of deaths, with their rates, were as follows: 1923. 1924. Deaths. Rate. Deaths. Rate. Tuberculosis (various organs) ....60 1.92 82 2.62 Pneumonia (broncho and lobar) .37 1.18 56 1.79 Organic diseases of the heart. .28 .89 38 1.21 Diarrhea and enteritis (including colitis) .18 .58 37 1.18 Nephritis (acute and chronic). .37 1.18 36 1.15 Cancer (various organs) ....16 .51 18 .57 The death rate from tuberculosis was 2.62, as compared with 1.92 for 1923, 2.55 for 1922, and 2.30 for 1921. Tuberculosis caused approximately 18 per cent of all deaths from disease, as compared with 15 per cent in 1923, 19 per cent in 1922, and 13 per cent in 1921. There were 690 live births reported during the year, giving a birth rate of 22.06. Of the total births reported, 5 per cent were stillbirths. There were 79 deaths among children under 1 year of age, giving an infant mortality rate, based on the number of live births reported during the year, of 114.49. Of the total deaths for all ages, 17 per cent occurred among children under 1 year of age, and 27 percent among children under 5 years of age. Below is a table showing the death rates in Colon from 1905 to 1924, from all causes: Year. PopulaDeaths. Rate. tion. 1905 11,176 553 49.48 1906 13,651 703 51.42 1907 14,549 571 39.24 1908 15,878 418 26.32 1909 17,479 396 22.65 1910 19,535 514 26.31 1911 19,947 527 26.42 1912 20,174 493 24.44 1913 20,232 489 24.17 1914 23,265 590 25.36 1915 29,331 640 21.82 1916 24,693 696 28.19 1917 25,386 667 26.27 1918 26,078 616 23.62 1919 26,078 573 21.97 1920 26,078 554 21.24 1921 28,789 497 17.26 1922 31,393 445 14.17 1923 31,285 393 12.56 1924 31,285 475 15.18

PAGE 13

11 MALARIA. The admission rate of employees from malaria was 16 per 1,000 for the year 1924. While the figures naturally vary somewhat from time to time, it should be noted that there has been a practically Constant residual rate for this disease during the past 9 years, the only marked deviation being a rise to 31 per 1,000 in 1919, which occurence is explained by the fact that in 1919 many infected native Panaman laborers were imported into the Zone to take the place of striking West Indian employees. As in the past, much of the malaria developing in the Canal Zone was contracted outside the sanitated areas of the Zone. The admission rate from malaria among employees has been: Average Year. number Rate. employed. 1906 26,547 821 1907 39,238 424 1908 43,890 282 1909 47,167 215 1910 50,802 187 1911 48,876 184 1912 50,893 110 1913 56,654 76 1914 44,329 82 1915 34,785 51 1916 33,176 16 U 1917 32,589 14 1 1918 25,520 18 U 1919 24,204 31 1920 20,673 19 a 1921 14,389 15 I 1922 10,447 17 8 1923 10,976 19 S 1924 11,625 16 1 The admission rate from malaria was 18.00 for white employees, and 15.75 for black employees. Two employees died from malaria. Both were employed by the Dredging Division, working at night in parts of Gatun Lake adjacent to unsanitated areas. One was a colored West Indian, the other a white American who refused to see a physician until nearly moribund. In spite of repeated warnings, many employees and their families persist in exposing themselves unnecessarily at night by visiting unsanitated regions within or outside of the Canal Zone.

PAGE 14

12 The death rate from malaria among employees has been: Average Year. number Rate. employed. 1906 26,547 7.45 1907 39,238 3.51 1908 43,890 1.37 1909 47,167 .85 1910 50,802 .81 1911 48,876 .84 1912 50,893 .31 1913 56,654 .30 1914 44,329 .14 U 1915 34,785 .23 M 1916 33,176 .06 1 1917 32,589 .09 N 1918 25,520 .08 U 1919 24,204 .08 U 1920 20,673 .15 U 1921 14,389 .00 1922 10,447 .00 1923 10,976 .09 1924 11,625 .17 The noneffective rate from malaria among employees in 1924 was 0.31, as compared with 0.55 in 1923, and 0.46 in 1922. MOSQUITO CONTROL. There has been no slackening of efforts to reduce mosquito breeding. Ditching of large swamps in the cattle pastures adjacent to Mount Hope and Gatun has been pushed from both directions. In another year drainage of the areas between the Canal and the highlands toward the east will be completed from Gatun to the Caribbean seaboard. West of the Canal, in the northern district, much new work has been done. The large main drainage ditch on "Fill 3" has been deepened to sea level, the laterals have been cleaned and regraded, and a new extension has been dug at the northern end for the purpose of intercepting the run-off from the hills and discharging it directly into the old French Canal. Boggy streams are being cleaned and straightened to their -sources, and a large tidal swamp on Limon Bay just to the west of the Canal entrance has been controlled by sea-level ditches. East of the.Coco Solo River the Army sanitary authorities are draining swamps and streams up to distances ranging from 1 to 2 miles beyond the Army and Navy stations east of Manzanillo Bay. Here, as elsewhere, the Health Department and the military sanitarians are linking up their programs and cooperating for the general good.

PAGE 15

13 So great is the extent of these swamps near the Atlantic end of the Canal that, even if only a very small percentage of the mosquitoes which formerly bred in them reached Colon and Cristobal, nevertheless the invasion became noticeable, especially in the early weeks of each rainy season. Fortunately the control in these regions is a coniparatively simple matter of shallow spade wide ditches which permit flood waters to escape and sea water to circulate freely through all parts of the low land. In the southern district, mosquito breeding along the entire shore line of Miraflores Lake and its numerous arms is now prevented by oiling when necessary. Up to a few years ago mosquito control was practiced in only one small arm of this lake-the Pedro Miguel River inlet lying immediately behind the town of Pedro Miguel. In this arm all vegetation was kept removed from the shallow margins and oil, mixed with phenol-soap emulsion, was freely applied. A considerable force of men, at a cost ranging between $600 to $750 a month, was almost constantly employed on this limited area which had barely 3.5 miles of shore line. More recently it has been found advisable to keep under control the entire shore line of Miraflores Lake and its arms, which is over 25 miles in extent. Through the use of oiling boats, from which heated oil is sprayed upon the grassy lake margins, it has become practicable to prevent mosquito emergence in this greatly increased area with a crew of 3 men and at a cost of less than $250 a month for labor and materials. The oil is heated solely to enable it to pass readily through the nozzles of the spray pump so that it will emerge in a finely divided state-practically a mist-which creates an efficient film upon the water. The shore line of Miraflores Lake is very shallow for the most part and in its grassy margins our most potent malaria vector, Anopheles albimanus, finds its favorite breeding place. A considerable part of the time of one man (a colored West Indian of long experience and training) is spent in searching these lake edges for mosquito larvae, both before and after oiling. Oiling is carried out only when larvae are discovered. This method of control has been found to be very efficacious. In the vicinity of Corozal some large streams are being straightened and the bottoms lined with pre-cast concrete sections of 14-inch width. The banks have been laid back sufficiently to insure their grassing over. In October of this year mosquito control work in the Republic of Panama adjacent to Panama City, in so far as the prevention of malaria is concerned, was placed under the direct supervision of the assistant chief health officer, thus centralizing under one head all field antimosquito work carried out by the Health Department on the Isthmus. The area concerned was designated as the Panama Suburban District,

PAGE 16

14 and a full time sanitary inspector was placed in charge of it, whereas formerly the inspector in charge of mosquito control in Panama City had to give some of his time to other duties connected with municipal sanitation. As a result of this change it has been possible to inaugurate within the new district a policy more in accord with that carried out in the Canal Zone. A new limit has been established, at a distance. of 1 mile from the farthest house in Bella Vista, within which boundary all standing water will be drained away, the streams will be trained, and much permanent work (concrete bottoms and tile) will be installed as rapidly as may be practicable. The change has made it possible to utilize to better advantage the forces of other Canal Zone sanitary inspectors for assistance in this work during such times as the conditions in their own districts permit. During the past 6 years so much work of a permanent nature has been done in the southern district of the Canal Zone that only one-third as many men are required for mosquito control as was formerly the case; the same result can be accomplished throughout those portions of the Republic of Panama in which the Canal Zone authorities are responsible for sanitation. DISPOSAL OF WASTE AND FLY PREVENTION. For some years past the garbage of Panama, Ancon, Balboa, and the neighboring Army posts has been disposed of by burying in low swampy ground east of Panama City, the management of this dump being under the immediate supervision of the health officer of Panama. The method, which has been described in previous annual reports of the Health Department, is successful in caring for the garbage with a minimum of nuisance and expense; odors are not marked, rats are not attracted, and -flies do not breed to any troublesome extent. The situation as regards flies has recently been improved by substituting hot fuel oil for the larvacide formerly used to spray over the covered surface of the garbage; besides being more destructive to fly larva and pupae, the oil is much cheaper. New composting pits have been constructed near the Panama garbage dump for curing horse manure collected in the City of Panama previous to selling it to gardeners. Manure is kept in these pits a varying length of time, always sufficient, however, to insure destruction of the fly larva with which it is initially infested. The pits are about 60 feet long, 7 feet wide, and 6 feet deep, with a concrete curb extending from just above the ground level down to the rock-like indurated clay that underlies the soil at a depth of 2 or 3 feet. Each day's accumulation of manure is placed in a pit and immediately plastered over with a

PAGE 17

15 64nch layer of mud which is then sprayed with heated fuel oil. During the first two or three days thousands of maggots work their way to the surface and perish in the oil; the concrete curb prevents their escape into the soil at the sides and ends. Manure is sold from these compost pits only on certain days of the week and as soon as the day's sales are removed the exposed face of the composted manure is again plastered with mud and oiled. It has been found that manure of the type produced in Panama City, even when composted as long as 6 months, still proves attractive to flies when exposed to the weather in piles. Consequently, gardeners are required to put the manure into the ground or to spread it in a thin top dressing within 24 hours from the time of purchase. INFANT MORTALITY. The death rate per 1,000 live births in the cities of Colon and Panama, an.d in the Canal Zone, for the past 6 years have been as follows: 1919. 1920. 1921. 1922. 1923. 1924. Colon. 155 29 142.21 139.28 139.66 115.66 114.49 Panama. 154.47 155.30 173.95 147.23 141.95 138.06 Canal Zone: White. 37.23 34.36 33.22 41.32 43.69 47.06 Black. .154.00 130.00 134.73 120.27 88.31 123.01 Total (white and black). 113.67 95.09 96.65 92.62 72.76 96.54 CHILD HEALTH EDUCATION AND CHILD HYGIENE. Prior to 1924 no organized child health movement existed on the Canal Zone. In January, 1924, Miss Sally L. Jean, Director of the Health Education Division of the American Child Health Association, and Miss Julia W. Abbott, Associate Director of that Division, visited the Canal Zone at'the invitation of Governor J. J. Morrow. These ladies studied the conditions existing here and made recommendations to a committee consisting of the Governor, the chief health officer, the chief quartermaster, the secretary of the bureau of clubs and playgrounds, the superintendent of schools, and others. The recommendations submitted formed a comprehensive plan for a campaign of child health education and child hygiene, and were accepted by the committee to be put into effect by the heads of the various departments. Because of his previous training and experience in child welfare work, Dr. W. C. Cox, bacteriologist of the board of health laboratory, was selected to initiate this campaign, the work being carried on by him in addition to his regular duties. The plan included newspaper publicity

PAGE 18

16 designed to arouse general interest in child hygiene, poster exhibit in the clubhouses, and talks on health subjects delivered at the clubhouses or before the various organized societies of the Canal Zone. On February 4th a health center was inaugurated at the Balboa Clubhouse. At first this was limited to children between 6 and 16-years of age, but in April service was extended to those over 2 years of age. A total of 2,137 examinations were made on 721 children and the number of mothers visiting the center was 293. Forty-three children were referred for dental treatment and 62 were sent to the various clinics at Ancon Hospital; 18 corrective operations were secured. In May a similar center was organized at Cristobal. Dr. J. L. Byrd, city health officer, and Dr. C. A. Hearne, port quarantine officer, each volunteered to give one afternoon a week to this work. In April a preand post-natal center was organized in connection with the Colon dispensary. This has been highly successful and the work is carried on semiweekly by Dr. W. V. Levy. A mothers' club was organized in Balboa on April 11, and Mrs. J. J. Morrow was elected president. There were 75 charter members enrolled at the first meeting, and the total membership at the close of the year was 103. On April 21 a similar club was organized at Cristobal. Mrs. C. A. Hearne was elected president. There were 36 charter members enrolled at the first meeting. In May the women of Pedro Miguel held a meeting and decided to unite with the Balboa club until early in 1925 when they planned to organize their own unit. Three May Day health pageants were held in conjunction with the American Child Health Association National May Day Health Day Campaign. The pageant at Balboa was given on May 1; in Gatun on May 2; and in Cristobal on May 3. Approximately 2,500 people attended these pageants. A health talk was one of the features of each pageant. A public health and school nurse for the Pacific side was employed by the Health Department in August. She immediately opened a prenatal course of instruction for expectant mothers. The child hygiene campaign during the year 1924 was mainly carried on by volunteer workers who gave more than 1,200 hours of their time to this activity. PHYSICAL EXAMINATION OF SCHOOL CHILDREN. During November and December the annual physical examination of pupils were conducted in all white schools of the Canal Zone. For the first time since the introduction of school examinations in 1917,

PAGE 19

17 the children were examined with the clothing removed to the waist, this being made possible because of the presence of a health department nurse during the proceedings. An invitation was extended each mother to attend the examination of her child and approximately 15 per cent of the pupils examined were so accompanied. The results of the examination were as follows: Number of children examined .1,730 Defects found requiring treatment--(Continued): Number of children found needing medical treatPulmonarv disease. 13 m ent. .940 Cardiac disease. .29 Defects found requiring treatment: Chcrea and other nervous diseases. 3 Defective vision. 204 Orthopelic defects. 29 Defective hearing. .22 Malnutrition. 242 Defective nasal breathing. 71 Defective teeth. 274 Hypertrophied tonsils. 252 Contagious diseases. 4 DISEASES OF ANIMALS. The veterinary force of the health department carries out the quarantine inspection of animals entering the Canal Zone or the cities of Panama and Colon; the inspection of animals transported by rail across the Isthmus; the anteand post-mortem inspection of animals slaughtered for food; and the inspection of dairies, dairy herds, and milk handling. Quarantine work in 1924 included the examination of 27,487 cattle and 100 horses and mules brought into the Canal Zone, or the cities of Panama and Colon, from the interior of the Republic of Panama, and from other countries. There were 7,563 cattle and 6,154 hogs inspected for rail shipment across the Isthmus. At the Colon, Panama, and Mount Hope abattoirs anteand post-mortem examinations were made on 24,153 cattle, of which 59 carcasses and 726 edible parts were condemned. Forty-one of the carcasses were condemned on account of extensive bruises and septic wounds, 3 on account of septicemia, 10 on account of pneumonia, 2 on account of Texas fever, I on account of icterus, and 2 on account of tuberculosis. The 2 tuberculous cows came from local dairies in Panama where they contracted the disease on premises presumably infected by importation of pure bred stock from Europe. Fortunately, no tuberculosis has ever been found in any other native cattle slaughtered, numbering over 200,000 animals. During the year all dairy herds supplying milk to the city of Panama and the Canal Zone were given the tuberculin test. Of 2,000 cows tested,, 103 were reactors and were destroyed, the Panaman Government paying to owners of those in the Republic of Panama the valuation set by an appraisal board which acts in the case of all animals desMR 95651-2

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18 troyed in Panama. Fortunately, the post-mortem findings showed that in only a few instances were the inroads of the disease sufficiently advanced to render the milk supply dangerous. Regular inspections of dairies are conducted to insure cleanliness and acceptable conditions. In addition to this, samples of milk are taken at frequent intervals for chemical and bacteriological examination, which serves as a check on careless production. The entire milk supply of the Zone and of the cities of Panama and Colon is pasteurized before being delivered to the consumers. Of 23,061 hogs slaughtered, 707 were condemned on account of cysticercosis, 119 on account of cholera, 21 on account of pneumonia, 2 on account of icterus, 9 on account of pyemia, 12 on account of pyrexia, and 3 on account of tuberculosis. The tubercular hogs were from a lot fed on garbage collected at hotels and restaurants. Cholera has been found among hogs slaughtered in Colon and Panama to the extent of nearly one-half of one per cent; this percentage is much higher than the natural rate for the Republic of Panama, presumably on account of holding animals in pens during long periods. Cholera practically does not exist in the interior. Cysticercosis has decreased within the last 5 years from 15 per cent to 3 per cent of all hogs slaughtered. This reduction is due to the work done by the Panaman Government assisted by the International Health Board, with a view to preventing the spread of hookworm disease of man. The decrease in cysticercosis has caused a saving of about $50,000 per year in the cost of pork supplied the cities of Panama and Colon alone. None of the more dangerous and destructive diseases of animals exist on the Isthmus at this time. Anthrax has not occurred in cattle for about 2 years, and when present it was confined almost entirely to the swampy pastures of the Atlantic side. Contagious abortion, which occurred several years ago has disappeared. Foot and mouth diseases and rinderpest in cattle, and glanders in horses and mules, have not occurred here. Maladie du coit, or dourine, has never been found among horses on the Isthmus. Strangles was imported with a shipment of mules, but strict quarantine and disinfection prevented its spread to other animals. Influenza of horses, which broke out in Colon stables, has disappeared without spreading to other locations. Murrina, which appeared on the Isthmus for several years, has ceased to occur. Goats kept on low ground die of a nodular disease caused by the parasite Oesophagustoma colombianum. Hemorrhagic septicemia caused the death of about 20 cattle and a number of goats within the last year. During the year the health department supervised the disinfection of 6,000 hides and 15,250 pounds of skins which were to be shipped to the United States.

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19 QUARANTINE DIVISION. Surgeon C. P. KNIGHT, United States Public Health Service, Chief Quarantine Officer. Quarantine policies for protection of the Canal Zone have been carried out as heretofore. It is a notable fact that of 5,958 ships calling at Canal Zone ports, only one was detained on account of quarantinable disease and this vessel was held solely for the purpose of completing the number of days of incubation required for craft from yellow fever ports. The chief quarantine officer made two official trips during the year, the first to investigate an outbreak of yellow fever in San Salvador, and the second to continue the policy of making inspections of foreign ports and stimulating relations between sanitary officers. At the request of the President of Salvador, that country was visited and a study was made of the outbreak of yellow fever in the capital. On recommendation of the chief quarantine officer, experts from the Rockefeller Foundation took charge of the campaign in July, and by October the disease had been stamped out. A rigid quarantine was placed against the ports of Salvador, and was continued through the year 1924. All of the ports and some of the other towns of Peru and Chile were visited and contacts were made with the national and local health authorities of these two countries. Information received during this trip indicates that bubonic plague, both rodent and human, is present on the west coast of South America, and is a constant menace to the Canal. Typhus fever also exists, but owing to the restricted travel among the poorer classes it has not been found on any ship thatentered the Canal ports. On account of the presence of foot and mouth disease a quarantine embargo was issued against South America with the exception of Colombia, Venezuela, British Guiana and Dutch Guiana; at the close of the year these quarantine restrictions were still in force. A maritime quarantine conference, dealing with problems of the west coast of South America, was held in the city of Panama from February 25 to February 28. Delegates were accredited from the United States, Ecuador, Peru, Chile, Panama, and the Canal Zone. Unofficial observers were present from France, Cuba, and Jamaica, as well as from the Army, the Navy, and the Public Health Service of the United States. Resolutions were adopted as follows: (1) Recommending the adoption ofcyanogen-chloride mixture as the standard gas fumigant for ships. (2) Reiterating the international obligation to make regular reciprocal reports of morbidity and mortality. (3)

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20 Disapproving the routine partial fumigation of ships. (4) Recommending the periodic fumigation of ships only when free of cargo. (5) Recommending the placing of seaports in the best possible sanitary condition at the earliest practicable date. (6) Recommending the adoption of measures needful to prevent unnecessary or unwarranted delays to ships on account of maritime quarantine. The amount of fumigation for the elimination of rodents increased somewhat over that in previous years. Although cyanogen-chloride gas has proved very successful for the destruction of rats, it was found through experimentation that the ordinary time and dosage used for rodents was not sufficient to kill all roaches; furthermore, that to rid a ship entirely of roaches, it is necessary to repeat fumigation at short intervals, since this gas, or any ,other used in fumigating ships, is not lethal for cockroach eggs. Very little loss has been suffered by ships through quarantine detention. During the entire year there were but 3,000 ton-detention days, and 187 passenger-detention days, which shows that the cost to shipping was practically nil. Vessels inspected and passed. 3,575 Vessels detained in quarantine. ..i Vessels given radio pratique. 106 Vessels passed on sworn statement of Master. 2,276 Totals. 5,958 Supplementary inspections of vessels. ..2,979 Vessels fumigated for rats. .149 Crew inspected and passed. ......195,741 Crew passed on sworn statement of Master. .114,184 Crew passed by radio. ..13,023 Passengers inspected and passed. 72,169 Passengers passed on sworn statement of Master. .37,848 Passengers passed on radio pratique. .3,777 Persons detained on board vessels on account of disease. 90 Persons detained in quarantine. ..19 Persons vaccinated .1,189 Immigration operations continued under the division of quarantine as heretofore. The number of persons dealt with was 2,752; the number excluded and deported was 992; the number detained at station on account of immigration laws was 762, and the number detained and later landed was 128. ANCON HOSPITAL. (Capacity, 1,200 patients.) Lieut. Col. WILL L. PYLES, Medical Corps, U. S. Army, Superintendent. Administration.-During the year, the practice was established of holding periodic meetings of the entire staff, and monthly meetings of the head nurses. A "Clinic and Journal Club" was also established,

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21 at the weekly meetings of which the entire medical staff, including the personnel of the board of health laboratory and the Ancon dispensary, takes part. Many visiting physicians attend these meetings. Surgical clinic.-During the year, 1,386 major operations and 5,684 minor operations (including intravenous injections of arsphenamine) were performed; 3,384 cases visited the out-patient department; 266 obstetrical cases were delivered. Medical clinic.-There were 3,368 cases treated in the out-patient department; 558 adults were vaccinated with 222 known "takes;" 352 childrenwere vaccinated with 192 known "takes." Eye and ear clinic.-There were 8,213 visits to the out-patient department; 2,160 operations were performed, and 1,387 refractions done. Many new items of equipment were placed in service in this clinic during the year, the more important being: A treatment chair with incidental equipment (making 3 now in use); an air compressor for the operation of sprays and forsuction treatmentof nose and throat conditions; and a new Halle's universal bone surgery outfit. Radiographic clinic.-There were 2,627 cases handled for which 6,452 ordinary films and 2,859 dental films were used. During the year the following new equipment was received and placed in operation: A transformer unit for radiographic work; a Coolidge unit, consisting of a transformer, regulator and stabilizer for controlling the tube current; an X-ray exposure timer with foot switch attachment; a corona-proof overhead system; an X'-ray table with accessories for combined radiographic and fluoroscopic work; and a Bucky fluoroscopic grid to cut out secondary radiations. Radio-therapy clinic.-On March 1, 1924, a radio-therapy clinic was established, the chief of which is charged with the supervision and direction of radium therapy, X-ray therapy, and hydro-therapy. Six hundred and ninety out-patients and 268 hospital patients were treated in this clinic. The following initial new equipment was received and placed in service; 1 tube containing 50 mgm. of radium sulphate; 2 tubes each containing 25 mgm. of radium sulphate; 5 needles, each containing 10 mgm. of radium sulphate; and an X-ray therapy apparatus designed to deliver 200,000 volts and consisting of transformer unit, sphere gap for measuring voltages, stabilizing unit for constant tube current, two milliampere meters in series, corona-proof overhead system, Coolidge transformer for heating tube filament, treatment couch for deep therapy, treatment table for superficial therapy, treatment tube stand, two deep therapy Coolidge tubes, universal Coolidge tube for superficial therapy, and accessories. Later a diathermy apparatus was obtained. In the rooms set aside for hydro-therapy,

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22 an electric light cabinet, a continuous bath and a shampoo table were installed, but this unit has not been placed in operation as yet because some of the equipment has not been received. Nonresident patients.-Six hundred and fifty-six patients whose residence is outside the Canal Zone or the cities of Colon or Panama were treated in Ancon Hospital, and 47 in Corozal Hospital. Operating expenses.-The following table gives the cost of operating the hospital for the past three years: 1922. 1923. 1924. Operating expenses 1. $525,584.44 $520,551.97 $558,595.46 Revenue. .312,713.70 309,572.03 342,461.71 Net cost. .212,871.74 210,979.94 216,133.75 Daysrelief furnished. 112,574 109,599 129,525 Cost per patient per day. 4.67 4.75 4.31 Cost of subsistence supplies per patient per day. .34 .34 .40 Operating expenses, Ancon dispensary. .16,438.74 17,952.78 17,811.56 Revenue, Ancon dispensary. ...1,883.05 4,113.50 4,065.50 -These figures do not include the salaries paid by the War Department to medical officers of the Army detailed for duty with The Panama Canal, which amounted to approximately $46,900 in 1922, $52,300 in 1923,$58,900 in 1924. COROZAL HOSPITAL. (Capacity 400 patients.) Capt. G. E. HESNER, Medical Corps, U. S. Army, Superintendent. Repairs and alterations.-The second floor of ward "H," which consisted of small custodial rooms, has been remodeled by converting it into a large dormitory. This change has added space for 15 patients, and the building is better ventilated and illuminated, and much more sanitary. Routine painting and repairs to woodwork, plumbing, steam line, etc., have been done wherever required by hospital artisans with the help of patients. The laying of a new pipe line from a spring in the pasture has been commenced, with a view to furnishing a cheap water supply for the refrigerating machines at the dairy and kitchen and for washing down the piggery and barns. Trees and gardens.-Two of the Hydnocarpus weightiana trees planted a few years ago are productive and bearing at this time a heavy crop of the fruit from the seeds of which chaulmoogra oil, used in the treatment of leprosy, is extracted. They are reported to be the only trees of their kind on the American continent which are productive. The maintenance of the lawns, flower beds, grounds, and hedges, has been effected mainly through the use of patients and with but little expense to the hospital. insane patients.-The census on December 31, 1924, was 375, as compared with 399 on the same day of the previous year. The number

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23 admitted was 139, as compared with 153 for 1923. There were 139 discharges and 23 deaths, as compared with 113 discharges and 32 deaths last year. There were no suicides or deaths due to violence. Of the total released, 34 (24 per cent) were recovered, 62 (45 per cent) improved, and 43 (31 per cent) unimproved. Of the total admissions, 55 were cases paid for by the Government of Panama, and the remainder were Canal Zone charity or private pay cases. Of the total number discharged, 65 were deported. Other patients.-There were on December 31, 29 black and 3 white chronic medical or surgical cases (not insane), as compared with 24 black and 3 white of this class at the beginning of the year. Eleven were admitted, 2 died, 2 were discharged, and 2 were repatriated. All those capable of performing work are encouraged to do so. Recreation.-Weekly picture shows and band concerts have been continued throughout the year. Of amusements provided for the patients the greatest pleasure appears to be derived from the moving pictures, which do not tire them as readily as do other forms of entertainment. During the dry season, weekly picnics were held in a grove back of the hospital, picnic lunches were served, and baseball and other sports were engaged in. Treatment.-Intensive specific treatment is given to patients suffering from syphilitic psychoses, these constituting about 20 per cent of the'total admissions. During the year, 426 doses of arsphenamin were administered intravenously, and 130 lumbar punctures were performed. The fact that the great majority of the patients are of low intelligence and exceedingly illiterate, often makes it difficult or impossible to discuss their mental disorders with them from a physcho-analytic standpoint. However, by teaching them to adapt themselves to their new environment, and by rendering their enforced sojourn free from unpleasantness, it has been possible to relieve the mental stress in most cases. All are encouraged to engage in some occupational work because it is generally conceded that the mental redemption of many cases may only be effected through diversional employment. The work at Corozal Hospital differs in many respects from that of the average occupational therapy department. There is no corps of trained aides and no special fund for this department; yet it is self-supporting. Effort has been made to exclude fancy, complex, artistic, and unpractical crafts, and to give instruction only along lines which have some economic value to the patient or the institution. There are five basic crafts: Rug-making, basketry, needle work, broom-making, and carpentry, with allied developments and out-door work. The greater part of the material used, except that for brooms, is salvaged or gathered from the jungle.

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24 Occupational instruction helps the patients in both a therapeutic and an economic way, because most of them have no trade or profession, but come from a class which depends upon unskilled day -labor for a livelihood. In many instances the history shows that psychoses have been precipitated by poverty, which was brought about as a result of the husband being out of work and the wife unable to find employment for which she was fitted. Many such patients, as a result of treatment in the occupational department, learn something which not only may be of financial value to them, but also may become a means of preventing a recurrence of mental trouble. The total receipts from the occupational ward amounted to $6,251.34, of which $4,523.84 was from the sale of brooms. The money is utilized for purchasing material required to continue activities in this department and for providing the workers with pin money. The value of the produce taken from the patients' garden for hospital consumption amounted to $3,394.72. Farm Department.-About 20 additional acres of land were cleared, making a total of 100 acres under cultivation. The receipts for produce aggregated $4,118.64, and for manure $1,015.97. Dairy.-The herd consists of 49 Jersey cows, and 23 calves; 8 Holstein cows and 10 calves; and 2 bulls. There were 76,341 quarts of milk produced, and milk sales during the year amounted to $19,522.50. Piggery.-There were 397 pigs and 50 hogs remaining on December 31. -Fifteen acres were added to the hog pasture, increasing the total to 60 acres. The piggery has proven very profitable, the gross income derived from this division of the farm amounting to $5,376.64 for the year. Cemetery.-It was necessary to enlarge the cemetery this year by clearing off about 3 acres adjoining it on the west. COLON HOSPITAL. (Capacity, 80 patients.) Maj. Tomi S. MEBANE, Medical Corps, U. S. Army, Superintendent. Patients.-During the year, 348 major and 143 minor operations were performed; there were 812 administrations of salvarsan, and 295 obstetrical cases were delivered. The dispensary physicians made 362 house and ship visits, and treated 38,502 patients in the outpatient clinic. Special clinics.-An eye, ear, nose, and throat clinic has been established, thereby affording the residents on the Atlantic side the

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25 advantages and benefits of refractions and correction of minor conditions without the long trip to Ancon Hospital with consequent loss of time. -A portable bedside X-ray apparatus has been installed, enabling the hospital for the first time to diagnose and treat properly fractures and other ailments requiring this apparatus. Formerly it was necessary to send all such cases across the Isthmus to Ancon Hospital. Repairs.-The interior of the hospital and all exterior woodwork have been repainted during the year. SANTO TOMAS HOSPITAL. (Capacity, 500 patients.) Major E. A. BOCOCK, Medical Corps, U. S. Army, Superintendent. During August the patients were moved from the old hospital in the center of the city to the new reinforced concrete buildings in the Exposition grounds. The dedication ceremonies were held September 1, 1924, on which date, by decree of the President of Panama, the operation of the hospital was taken over entirely by the Panaman Government. The Superintendent, two physicians, chief nurse, and two ward nurses, who had been Canal employees, were replaced by appointees of the Panaman Government. These six positions had been filled by employees of the Panama Canal since 1905, under an agreement between the two Governments which was entered into at that time in order to afford more extensive hospital facilities for the people of the Isthmus, and to enable the Health Department of the Panama Canal to maintain close supervision over the treatment of infectious diseases in Panaman territory. There are now ample hospital facilities on the Isthmus; Santo Tomas Hospital reports promptly to the health officer of Panama all notifiable diseases; a saving to the United States Government of about $14,000 a year results from the new arrangement; consequently no objection to the change was made by the authorities of the Panama Canal. PALO SECO LEPER COLONY. (Normal capacity, 82 patients.) Mr. FRED D. TUCKER, Superintendent. Dr. PHILIP HORwITz, Attending Physician. Admissions and discharges.-Twenty-two cases of leprosy were admitted to the Colony during the year. Of these, 13 were of the nodu-

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26 lar type, 2 of the neural type, and 7 of the mixed type. Four cases were readmissions. Two of these readmissions were of the neural type, still negative bacteriologically, but suffering from trophic ulcers that required additional treatment; both of these were again paroled later in the year. The other 2 readmissions, one of the nodular type and one of the mixed type, were positive bacteriologically on reentry; both had been paroled from the colony some years before the institution of specific treatment with the ethyl esters of chaulmoogra oil. Five patients died during the year. Treatment.-Ninety-four patientswere given esters of chaulmoogric acid in 5 cc. doses. Twelve patients received ethyl esters of cod liver oil in intravenous and intramuscular injections, 5 cc. Three patients received 5 per cent sodium chaulmoograte in intravenous injections, 5 cc. The chaulmoogric esters were administered three times a week to most of these patients, and to others once weekly; the maximum quantity given to any one patient during the year was 1,021 cc.; the greatest number of injections given any individual was 195, this case receiving 5 cc. daily, except Sundays, for about 3 months without showing signs of overdosage. Five patients received no specific treatment; 1 of these died, 1 was discharged, and the remaining 3 were too old or feeble to be subjected to treatment. Eleven cases have shown positive Wassermann reactions, and 9 of these received intravenous injections of novarsenobenzol (0.9 gm. per dose) and of mercurosal. Twelve patients were treated with thymol for uncinariasis, all with beneficial results. Thirteen patients were taken once a week to the radiotherapeutic clinic at Ancon Hospital for treatments with X-ray, radium, ultraviolet light, and high frequency current. Trophic ulcers in nerve type cases were but slowly affected by the treatment. Injections of esters, chemical cautery, and electro-cautery were all capable of destroying tubercles, but fulguration with high frequency current seemed to be the most efficient method for that purpose on account of its penetrating power. Filtered X-rays were capable of causing absorption of the tubercles without any destruction of overlying skin. None of the above methods, however, were capable of rendering the skin bacteriologically negative at the site of the cauterized tubercle, even after its complete ablation. Daily tamponings with esters of chaulmoogra, preceded by staining of ulcerated areas with warm carbol-fuchsin stain, was capable of rendering the nasal discharges bacteriologically negative in all but a small number of cases. Radium element (50 mgm. filtered through 0.52

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27 mm. aluminum and rubber tubing), 60 minutes exposure to both sides of nasal septum, three exposures, caused absorption of leprous infiltration of mucous membranes of septum and turbinates, but did not affect the presence or number of organisms in areas so treated. Neither did the ultra-violet rays (40 minutes exposure with curved quartz rod and pressure) affect the bacteriological picture of areas so expose,. Intra-neural injections into the fusiform swellings of ulnar and posttibial nerves with esters of chaulmoogra were continued as of last year with beneficial results. Exposure to filtered X-rays was capable of causing subjective changes in skin sensation along areas of nerve distribution and was very useful as an adjuvant in the treatment of trophic ulcers. The Von Pirquet test with old tuberculin was tried on 16 patients in various stages and types of the disease. All showed positive reactions as compared with the controls. The time of appearance of the reactions was delayed in most instances from 2 to 6 days. Smears taken from nodules caused by the tuberculin were negative for B. lepre. Lepra fever and eruptions were more numerous this year than last. Attacks were mainly confined to new arrivals, though some old residents were also affected. A few of the patients had several attacks in succession at short intervals. In none, however, did the new tubercles so developed remain long after fever subsided. As in previous years, these attacks occurred at periods of season change (about April-May and November-December) when colds and "flu" are common on the Isthmus. The effects of specific treatment for leprosy and its complications were about the same as in previous years. No attempt is made here to evaluate the use of the ethyl esters of cod-liver oil or the soap of chaulmoogra, as they were introduced only in the last month of the year. The cod-liver oil esters caused coughing spells similar to those occurring when chaulmoogra is given by vein. Temperature and local reactions followed in practically the same manner as with chaulmoogra. The soap, when given intravenously, caused no coughing spells, but instead a slight transient cramp-like pain in the abdomen which occurred immediately after injection and subsided within 5 to 10 minutes. No temperature changes followed. If the solution oozed out into tissues surrounding the vein, indurations similar to those caused by the esters resulted and the lumina of veins in the neighborhood became partially occluded. Owing to its low degree of solubility (5 cc. equals 0.25 gm. of sodium chaulmoograte), this drug could be given only in very small quantities.

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28 BOARD OF HEALTH LABORATORY. (Operated in connection with Ancon Hospital.) Dr. L. B. BATES, Chief of Laboratory. Bacill* typhosus.-Recovered in blood culture from 11 individuals; 4 from shipboard, 4 from Colon, and 3 from the Canal Zone. B. paratyphosus A B. paratyphosus B, and B. Paratyphosus C were not recovered at any time during the year from blood, stool, or urine. Typhoid carriers.-On December 31, 1923, two typhoid carriers were under sanitary surveillance, H. B. and G. H., both of Panama City. Stool specimens from each were examined monthly. All specimens were positive for B. typhosus. No new carriers were discovered during the year. Bacillus dysenteri.-Dysentery bacilli were recovered from the stools of 18 patients. The Shiga bacillus and Type III (Sonne) organism were each recovered once, and Type II organism (Flexner, Hiss-Russell, Y, etc.) was recovered from 16 patients. Respiratory infections.-In November quite a large number of people on the Isthmus suffered from an acute respiratory infection. This infection was generally mild in type. Sputum specimens collected under aseptic precautions from approximately 75 of these persons who had the severest attacks, and who were patients in Ancon Hospital, were cultured and studied. The influenza bacillus was not recovered from a single culture, neither was the hemolytic streptococcus. The cultures contained only the ordinary mouth organisms. Tonsil and adenoid exarninations.-The routine examination of tonsils and adenoids removed at operation was continued throughout the year. Of 463 tonsils removed alone, 8 or 1.72 per cent were found to be tuberculous; of 10 adenoids removed alone none were tuberculous; of 377 tonsils and adenoids removed together 9, or 2.38 per cent were tuberculous. Of this last 9, 3 tonsils alone were tuberculous, 5 adenoids alone were tuberculous, and in one set both tonsils and adenoids were tuberculous. To summarize, of 850 cases in which tonsils, adenoids, or both, were examined, 17 or 2 per cent presented tuberculous lesions. Rat examination.-The following paragraph appeared in the annual report of the Health Department for 1923: "Following the appearance of an article entitled 'Plague-Infected Rats Without Visible Lesions' in United States Public Health Reports, Vol. 38, No. 33, published August 17, 1923, it was decided to use the smear and animal inoculation methods therein recommended in the examination of a portion of the rats submitted to this laboratory. It was impracticable to apply these methods to all specimens as the time

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29 factor prohibited so extensive a study. However, since September, when this plan was inaugurated, 520 rats have been thus examined. Smears of livers and spleens were stained by Gram's method and examined microscopically. Small pieces of livers and spleens were macerated in sterile normal saline by means of a sterile mortor and pestle. This suspension, prepared from the organs of not more than 10 rats, was then subcutaneously injected into the abdominal wall of a healthy guinea pig. All pigs dying in less than 7 days were autopsied, and those living 7 days were bled to death and then autopsied, their blood being used in the complement fixation tests. Gross inspection and smears of liver and spleen were made in the examination of these animals. Thus far no positive results for plague have been obtained." During the year 1924 the special smear and animal inoculation work referred to above was continued. Six hundred and fifty rats were thus examined. No positive results for plague were obtained. This was in addition to the routine autopsy examination of 11,252 rats. A rticles prepared and presented.-The following papers were prepared at the Laboratory during the year: Studies in the Chemistry of the Blood, Ill; Observations on the Creatinin of the Blood, by Mr. James E. Jacob. Preliminary Report on Total, White and Differential counts of Blood in Normal, Healthy Individuals Dwelling in the Canal Zone, by Dr. W. C. Cox. Preliminary Report on Investigation of Sugar Content of Blood (human) in the Tropics with Special Reference to the Canal Zone, by Dr. W. C. Cox and Mr. J. E. Jacob. A Clinical and Bacteriological Analysis of the Bacillary Dysentery Cases in Ancon Hospital during the Past 5 Years, by Dr. R. C. Connor and Dr. L. B. Bates. The first three of these papers were presented at the June meeting of the Medical Association of the Isthmian Canal Zone. The fourth was read at the International Conference on Health Problems in Tropical America held at Kingston, Jamaica, July 22-31, 1924, by Dr. R. C. Connor. It was also published in the International Clinics, Vol. IV, Thirty-fourth Series, December, 1924. Creatinin in blood.-In the investigation of the creatinin of the blood it was found that the so-called creatinin reaction was not specific, and the substance giving this reaction in some instances could be separated into an alcohol-soluble and an alcohol-insoluble portion. Following the presentation of this work in the paper noted above, the investigation was continued along a different line. An effort was made to establisl4 the presence of creatinin by the formation of the double compound with zinc chloride. Contributors to the discussion of the creatinin question have reported negative results along this same line, but as they have for the most part dealt with normal bloods, this work was carried out with abnormal bloods giving a very heavy creatinin reaction. No creatinin-zinc chloride was obtained, although in control experiments with a corresponding amount of creatinin, based upon the intensity of the creatinin reaction, the crystals were very readily secured.

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30 During the year approximately 32,000 reports have been rendered. This does not include duplicates. BACTERIOLOGICAL EXAMINATIONS. Blood cultures. ..240 B.typhosus. 11 Pneumococcus Type IV ...1 B. m ucosus capsulatus. I Staphylococcus albus. 8 Staphy Lc ccus aureus ..9 Stools cultured fur typhoid-dysentery group. 2,620 Positive stool cultures. ..57 B. typhosus. .5 B. typho8us (from 2 carriers). .22 B. dysenteriae Group I (Shiga). 1 B. dysenteriae Mannite Fermenter, Group II. 27 B. dsyenteriae Mannite Fermenter, Group III. 1 Bacillus of typhoid-dysentery group (not identified). ..1 Urines cultured for typhoid group. 2,110 Urine positive fur B. typhosus. .1 Urines cultured for organisms other than typhoid group .,,. 206 Positive urine cultures (61 of these B. coli). ..95 Throat cultures for B. diphtheriae. 1,359 Positive fur B. diphtheriae. 21 Nasal cultures for B. dipitheriae. 78 Positive fir B. diphtheriae. 2 Throat cultures for organisms other than B. diphtheriae. 10 Spinal fluid cultures. .79 Positive spinal fluid cultures. ...11 B .influenzae. ..1 Pn umococcus Type I. 3 Pneumococcus Type II. ...2 Staphylococcus albus. I Staphylococcus aureus. .4 Eye cultures. ..7 Ear cultures. .11 M astoid cultures. ...11 N aso-pharyngeal cultures. .3 Sputum cultures. .145 Culture from epitrochlear gland. 1 Pleural fluid cultures,. ........28 Ascitic fluid cultures. ....2 Knee fluid cultures. .18 Ankle fluid cultures. I Cultures fur Ducrey's bacillus. .25 Cultures from skin lesions. .2 Cultures of pus from various locations. .16 G land cultures. ..5 B ile cultures. ..17 Autopsies cultured. 116 Organs, exudates, etc. .I. 210 Surgical tissues cultured.,. ...7 Darkfield examinations. ...319 Positive fcr Treponema pallidum ..27 C onjunctival sm ears. ...153 Smear from ulcer on jaw. .1 M outh sm ear (ulcer). ..I Sputum smears fur B. tuberculosis. .149 Positive fur B. tuberculosis. ....26 Sputum examined for spirochaetes. 1 Throat smears. .591 Positive fcr fusiform bacillus and spirillum of Vincent's angina. .203 Smear from larynx (positive fur B. tuberculosis). .1 Cervical abscess smear fer B. tuberculosis. .1 Sm ears from venereal lesions. 313 Positive for spirilla similar to those found in Vincent's angina. ..34 Urethral sm ears. ....171 Vaginal smears. ..22 Smear from ulcer on foot. .I Urine examined for B. tub-rcuiosis. ...--. .5 Spinal fluid examined fur B. tuberculosis. 2 Cell count of spinal fluids. .6 Examination of leper suspects. ..32 Positive for B. leprae. .24 Examinations of lepers previous to parole. ..3 Examinations of paroled lepers. 3 Autogenous vaccines prepared. ..59 Feces examined for parasites and ova. 130 Blood films examined for malarial parasites. ..1,627

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BACTERIOLOGICAL EXAMINATIONS-Continued. Positive for Tertian malarial parasites. .318 Positive forE. A. malarial parasites. 118 Positive for Quartan malarial parasites. 2 Pasteur treatm ent administered. .I Urine examined for gonococcus. ..4 Scrapings from under finger nail for fungus. 1 Stomach contents examined fer blood. 1 Water from Balboa clubhouse swimming pool. 231 Water from Balboa Army & Navy Y. M. C. A. swimming pool. 15 W ater from Arenal River. ..3 Water from beaches. .21 W ater from well. .2 Water from Hotel Washington swimming pool. .15 Food stuffs examined: M ilk cultured fcr bacteria count. ..500 Ice cream cultured for bacteria count. 6 Pread examined fer rope. .2 Culture of canned cherries. ..I Culture of canned vegetables. 9 Culture of canned fruit salad. 1 Culture of raw meat. 1 Culture of salted cod fish. .1 Autoclaves tested. .4 Miscellaneous smears and examinations. 160 SEROLOGICAL EXAMINATIONS. Wassermann tests .16,069 Gonococcus complement fixation tests. ....i8 Agglutination tests. ..*--. 51 Blood typing fcr transfusion. .-. .32 Examination of blood fcr coagulation time. .3 Blood sera prepared by Swift-Ellis method for intraspinal injection. 14 ANALYSIS OF WASSERMANN TESTS. A total of 15,445 Wassermann tests were performed on the blood of 10,624 persons. The results of these tests are summarized below: TABLE SHOWING NUMBER OF PERSONS ON WHOM WASSERMANN TESTS WERE MADE AT BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1924. Individuals Individuals Total Per cent of Race, sex, and status positive. fiegative. individuals. individuals tested. positive. White, civil, U. S. citizens: M ales. 153 1,541 1,694 9.03 Females. 24 238 262 9.16 Children. .1 41 42 2.38 White, soldiers, males, U. S. citizens ...297 3,305 3,602 8.25 Totals. 475 5,125 5,600 8.48 White, other than U. S. citizens: M ales. 101 433 534 18.91 Females. 31 260 291 10.65 Children. 3 24 27 11 11 Totals. 135 717 852 15.85 Blacks and mulattoes: M ales. 547 1,550 2,097 26.08 Females. 326 1,409 1,735 1S.79 Children. ..15 273 288 5.21 Totals. 888 3,232 4,120 21.55 Chinese, males and females. 7 45 52 13 46 Grandtotals .1,505 9,119 10,624 14.17 The figures in the above table are based on the number of individuals examined and not on the number of tests made.

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32 In addition, Wassermann tests were made on 624 spinal fluids taken from 501 individuals, and of these tests 115 or 18.42 per cent were positive. PATHOLOGICAL EXAMINATIONS. Autopsies.-A total of 262 autopsies were performed at the Board of Health Laboratory. The causes of death were as follows: General Diseases: Typhoid fever. .I Malarial fever, Estivoautumnal. 3 M easles. ......2 Influenza. .I Dysentery, bacillary.4 Leprosy. 1 Septicemia. 1 Pellara. 3 Tuberculosis of the lungs. .25 Acute m iliary tubercul sis ...... Tuberculosis of bones and joints.I Rickets .2 Syphilis, tertiary. ..--. ..3 Cancer of the buccal cavity. ..1 Cancer of the stomach and liver. ..6 C ancer of the uterus. ....3 Cancer of the male genital crgans. .2 Cancer of the suprarenal glands (hypernephroma).1 D iabetes. .....1 Addison's disease. .1 Leukemia.,. .I Leukemia, lymphatic. ..1 General amyloid degeneration. .1 T ot-13. .........71 Diseases of the Nervous System and of the Organs of Special Sense: Simple meningitis. 1 Pneum acoccus m eningitis. ...I L ocom ctor ataxia. ......1 Cerebral hemcrriage, apoplexy. .5 Softening of the brain. ..I General paralysis of the insane. ......8 E pilepsy ......1 Convulsions of infants. ...2 Total. ..20 Diseases of the Circulatory System: Pericarlitis .I Acute endocarditis. 4 M alignant endocarlitis. .....2 Other organic diseases of the heart. 14 Angina pect-ris. .1 Aneurysm. .3 A rteriosclerosis. ....3 Varices. I Hemorrhage, postoperative. ..1 Total. 30 Diseases of the Respiratory System: Brinchopneumonia.8 Lobar pneumonia. .6 Pleurisy. .....2 E m pyem a. ...3 Gangrene of the lungs. I Acute respiratory infection (etiology undetermined). 2 Total. ..22 Diseases of the Digestive System: Diarrhea and enteritis (under 2 years). ....3 Diarrhea and enteritis (2 years and over). ..2 Colitis. ....1 A cute appen ieitis. ...1 Intestinal obstruction. ...1 Isehicrectal abscess. .1 Duodenal ulcer ..2 Acute yellow atrophy of the liver. ..1 Cholecystitis. .. Simple peritonitis. .a A cute pancreatitis. .....1 Total. 17

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33 Nonvenereal Diseases of the Genito-Urinary System and Annexa: Acute nephritis. ....2 Bright's disease (chronic nephritis) ....10 Acute pyelitis. ....1 Pyelonephrosis. .2 Chronic pelvic inflammatory disease. .. Total. 16 The Puerperal State: Extra-uterine pregnancy. Toxemia of pregnancy. .3 3 Eclampsia. .1. Total ...5 Diseases of the Bones and of the Organs of Locomotion: M yelomatosis. I Acute bilateral mastoiditis ..I Total. .2 Malformations: Congenital malformations.-. ...4 Total. .4 Diseases of Early Infancy: Icterus neonatorum. ...3 Prem ature birth. 9 Congenital debility. ..4 M alnutrition. ....6 Atecletasis neonatorum .....2 Injury at birth (cerebral hemorrhage) .... Total. ..25 Affections Produced by External Causes: Suicide by drowning. ......I Acute arsenical poisoning. ..1 Strychnine poisoning, accidental. .. Burns (conflagration excepted). ..2 Absorption of deleterious gases (conflagration excepted) .3 Accidental drowning. .. Traumatism by firearms. Traumatism by fall. ..2 Traumatism by automobile accidents. ....3 Fracture of larynx (on bicycle colliding with tractcr). ..... Fracture of skull (thrown from truck). I Sunstroke. ..1 Homicide by cutting or piercing instruments. .1 Homicide by blunt instrument in hands of unknown party. I Traumatism by blow received in prize fight. .I M ultiple injuries due to falling section of pipe. .I Traumatism by explosive. .1 Traumatic gangrene. .1 Totals. 29 Ill-Defined Diseases: Ill-defined ....3 Total. .3 Appendix: Stillbirths. ...19 Totals. .19 G rand total. ..262 MR 95651-3

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34 TABLE SHOWING THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH LABORATORY, 1924. Per cent Cases. of autopsies. Tuberculosis. 33 12.5 External causes. .29 11.0 Organic heart disease. .21 7.9 Pneumonia, broncho and lobar. .14 5.3 Caincer. .13 4.9 Bright's disease (acute and chronic nephritis). 12 4.5 Syphilis (including general paresis). 12 4.5 M alnutrition in infants. 10 3.8 TABLE SHOWING THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH LABORATORY, 1904 to 1924. 4;0 Date. A2 C4 0, od)OX .I 0~) I 0 C;. 1904. 6 1 1. 19015. 269 60 9 .7 3 ...2 1906. 509 191 22 50 24 23 39 15 33 .2 1907. 496 156 35 27 40 27 36 12 58 4 4 1908. 361 59 63 46 26 25 23 11 14 .7 1999. 295 55 37 26 32 31 11 17 11 1 5 1910. 451 50 91 52 30 37 36 16 10 6 4 1911. ..508 83 102 41 38 36 19 20 9 11 11 1912. 425 53 79 23 37 27 15 22 6 7 11 1913. 460 47 89 21 34 26 8 26 5 23 12 1914. 375 36 78 6 38 12 6 27 5 14 3 1915. 328 28 56 14 20 12 5 14 2 15 10 1916. 323 25 81 8 17 20 7 10 6 9 7 1917. 330 24 51 5 21 23 3 18 1 3 5 1918. 253 38 68 6 6 12 .8 .1 5 1919. 324 22 55 3 15 14 3 20 3 10 11 1920. 334 146 55 .29 11 5 16 ..6 1921. 289 14 37 4 16 5 8 17 2 4 7 1922. 262 14 29 5 19 9 4 9 3 6 10 1923. 205 6 17 3 9, 9 5 12 2 1 11 1924. 263 14 33 3 29 10 4 21 1 3 13 Totals. 7,066 1,022 1,088 370 483 377 242 314 180 118 146 This includes 32 cases of influenza.

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35 TABLE SHOWING NUMBER OF AUTOPSIES PERFORMED REVEALING THE FOLLOWING DISEASES PER YEAR AT BOARD OF HEALTH LABORATORY, 1904 TO 1924 Cd2 Date 0w 0 ca 1904 ....6 .............. 1905. .269 12 7 7 2 ..1 .... 1906'. ..509 1 5 4 ............... 1907.,. .496 .1 2 1 .......... 1908 .361 .1 2 3 ............ 1909 .,. ...295 2 .................1 ... 19 M .451 2 ....................... 1911. ..508 .1 1 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 ...1 1917 .,. 330 .7 .1 2 .... 1918 ..-. .1 253 ....2 .3 .. 1919 ...324 2 ........ 19 M .,. ...334 ......I .... 1921. ..289 ........2. -2 1922 ...,. 262 .-..13. 1923 ..205 .....I. 1924 ...263 ......2 ........ Totals ...7,066 123 26 20 20 27 3 3 1 All cases since 1905 were imported cases. Per cent autopsied.-Four hundred and three bodies (not including 6 disinterred) passed through the laboratory; 263 or 65.3 per cent were autopsied, one of these autopsies having been done at Santo Tomas Hospital before receipt at the laboratory. Malaria carriers found at autopsy, 14A. Intestinal parasites found at au topsy.-Ni ne teen cases in the 263 au .topsies, or 7.2 per cent, showed one or more parasites or their ova, as follows: -19n4. aria .12 Trichocephalus. scaris. .3 Taeniasaginata. 1 Strongyloides. .3 TABLE SHOWING CAUSES OF DEATH FOUN-D AT AUTOPSY OF LEPERS IN BOARD OF HEALTH LABORATORY, 1924. ANo.s Cause of death. Contributory causes. 16813 Acute pleuritis .4. Pulmonary congestion. 6826 Chronic nephritis. Acute pericarditis; leprosy. 6908 Leprosy ...Chronic nephritis. 6968 Pulmonary tuberculosis. .2. Leprosy. 6980 Organic disease of the heart. .Arteriosclerosis; leprosy. 6998 Acute miliary tuberculosis. .Leprosy. 197061 Ischiorectal abscess. Pulmonary tuberculosis; leprosy. Paroled case.

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NUMBER OF MICROSCOPIC EXAMINATIONS AND REPORTS ON SURGICAL SPECIMENS. Eyes, enucleated .7. 7 Eye, growth from 2. ..2 Tum ors from eyelids. 2. 2 Nasal polyps. 5 Specimens from nose, other than polyps. 6 Ears, growths from. .1 Lip, specimens from. .4 Mouth, tumors from. 3 Tissue from lower aveolar process. 1 Tongue, specimens from. .4 Jaw, epulis from lower. .1 Submaxillary tumor. 1 Tonsils, one. .3 Tonsils, pairs. 462 Tonsils, pairs and adenoids. .377 Cyst from posterior pillar of tonsil .1 Adenoids. ...10 Palate. soft, growth from. .I Parotid region, tumor of. 1 Submaxillary glands. .2 Thyroid gland, portion of. ..4 Thyroid gland. .4 Vocal cord, tumors from. .3 Glands from neck and jugular vein ...1 Neck, tumor from. ..,. .I Breast .6 Breast, male ..2 Breast, specim ens from .............10 Liver, tissue from. I G all bladder. .....5 Spleen. .....I Peritoneum and omentum, specimens from. 4 K id ney. .2 H ernia, sac, contents of. ..2 Bladder, excised specimen from. 1 Prostate. 7 Prostate, seminal vesicles and part of each vas. .I Foreskin. ..I Peri-urethral tumor mass. ... Penis, excised ulcer of. ...3 Testicle. ...... Testicle, cord and epididymis .2.2 Epididymis and vas. ....2 Cord, small nodule just above epididymis ......1 Uterus. .4 Uterus, and adnexa 59 Uterus, adnexa and appendix. .23 Uterus, specimens from. ...21 Uterus, placenta and child (with or without adnexa) ...... Uterine cervix, or specimens from. 21 Tube cr tubes. 6 Tube or tubes with ovary or ovaries. 9 Tube or tubes with other specimen. ..5 O vary or ovaries. ...3 Ovary or ovaries with other specimens (tubes excepted). .6 Other combinations of female genital organs. 2 Specimens from external female genitalia. .3 Stomach, specimens from. ...3 Intestine, resected portion of, small. .....3 Appendices (including 31 removed with female genitalia). 216 Transverse colon, specimen from. I Rectum, specimens from. .7 Peri-rectal fistulous tract. 1 A nal fistulous tract. ......6 Pilonidal cyst, coccygeal. .I Upper extremity, or specimens from. ...7 Lower extremity, or specimens from. .14 Skin and subcutaneous tissue. 31 Small pieces of tumor in left: 11th interspace. ...2 Rib, section of necrotic. I Lymph nodes, cervical. Lymph nodes, axillary ....3 Lymph nodes, inguinal. .11 Lymph nodes, inguinal and femoral. ...1 Lymph nodes, femoral. ..1 Lymph nodes, omental and mesenteric. I Lymph nodes, location not given.,. .2 Nerve, section of. 1 Colon Hospital autopsy sets of tissue (30 tissues). .14 Panama Hospital autopsy sets of tissue (3 tissues) ...I Total .1,460

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37 Lesions in surgical specimens.-The principal lesions encountered in surgical specimens other than inflammatory, were as follows: Malignant tumors (cancer): Eye and adnexa. .1 Lip. ..... Tongue. ..3 Throat (submaxillary). ....1 Breast. ..5 Peritoneum and omentum ..2 Kidney. .. Bladder and urethra I Prostate. .....2 Penis..1 Uterus ...4 External female genitals 1 Gastro-intestinal tract 4 Arm and hand ..2 Skin and subcutaneous tissues 4 Lymph nodes. .3 Total .36 Benign tumors: Fibroma of conjunctiva 1 Nasal polyps ...4 Lymphoma of roof of nostril 1 Angioma of lip. .1 Papillomata of mouth. 3 Capillary hemangioma of tongue 1 Vascular fibroma of jaw. 1 Fibrous epulis. 1 Cyst from posterior pillar of tonsil Mixed tumor parotid region 1 Papilloma of vocal cord. 3 Cystic and colloid goiters. 5 Adenomatous or nodular goiter 1 Fibro-adenomata of breast 4 Fibroma of breast. .I Chondroma of breast. 1 Adenoma of breast .1. Mixed tumor of peritoneum 1 Papillary cystadenoma of mesentery 1 Hypertrophied prostate. ..1 Hydrocele. ........1 Uterine polyps. ..3 Fibromyomata uteri. ...38 Diffuse fibromyomatosis uteri. 1 Cystic ovaries and ovarian cysts. .....47 Adenomatous cysts of ovary. ..1 Dermoid cysts of ovary. ....5 Nabothian cysts. ..5 Fibro-adenoma of buttocks ...I Fibro-adenoma of toe ...1 Osteoma, great toe. .....1 Keloid. .I Papillomata. .6 Pigmented moles. 2 Epithelial cysts. ..5 Sebaceous cysts of scalp. .1 Dermoid cyst (pilonidal) ...1 Dermoid cyst, cervical. .. Hemangioendotheliomata (knee and lip) 2 Fibromata (skin) ...5 Giant cell sarcomata ...3 Lipoma. .1 Total ..166 Specimens showing tuberculosis: Tonsils. ....11 Adenoids. ....-. 5 Tonsils and adenoids. I Lymphadenitis (facial) ... Cervical lymph nodes ...3 Peritoneum. ...I Appendix. Fistulous tract, perirectal. ...I Lymph nodes, femoral. ....*. .I Lymph nodes, location not given. ...1 Skin (lupus). ...1 Autopsy sets of tissue from Colon Hospital ...3 Total. .....30

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38 Other infrequent lesions encountered: Tumor caused by Onchocerca coecutiens (from Guatemala). 1 Amotio retinae (with panophthalmitis). I Hypertrophy of thyroid gland with one adenoma in a case of exophthalmic goiter). .1 Axillary nodes from case of acute lymphatic leukemia. 1 Blastomycosis of hand. .1 Chondroma of breast. 1 Calcification in liver. ....I Colom bian spleen. .....I Extensive pyonephrosis in resected kidney. I Intestine, 52 feet resected, gangrenous. 1 Full term abdominal pregnancy. ..1 Ruptured uterus at term with child, placenta, and adnexa. I Early pregnancy (ovum) in uterus. .1 Ectopic tubal pregnancy (1 ruptured). .3 Bilateral fibro-adenomatous (?) growth of proximal ends of tubes. ....1 M adura foot. .1 Toes with ainhum. 1 Leprosy nodule.: Total. 20 Miscellaneous human examinations: Placental blood films. .,. 275 Darkfield e aminations of liver. 1 Differential blood counts. 5 Blood counts, complete. ...1 External description of human body. 2 Blood fcr filaria survey. ..8 Differential leucocyte count., .1 Four-month fetus. .1 Three and one-half monti' fetus. 2 Three-month fetus. 1 Ectopic gestation complete. I Fetus, placenta and membranes complete. I Examination of skin lesions. 1 Total. 300 Animals (wild and domestic), bacteriological examinations: Cultures from animal autopsies (cattle). 2 Culture of pus from shoulder abscess (cow). 1 Total. .3 Animals (wild and domestic), autopsies: Guinea pigs (after inoculation). .65 Rabbits. ...:. 2 Hens. .2 Dogs. ..2 Pigeon. .I Wild turkey ...1 T otal. ..73 Animals (wild and domestic), miscellaneous examinations: Cattle tissues for tuberculosis (22 positive for B. tuberculosis). .44 D og's brain for rabies. ...1 Guinea pig tissues for tuberculosis. .1 Tumcr from lip of mule for histological examination.,. 1 T otal. .47 Rats examined. ...11,252 Mus musculus. .5,871 Mus alexandrinus. .462 Mus norwegicus. ..519 Alasraftus. ....4,400 Rat smears examined (from liver and spleen) .....1,250 Guinea pigs inoculated (from 625 rats). ...78 Microscopic slides prepared: Surgical preparations (30 frozen). ...5,098 Autopsy preparations (20 frozen). ..2,699 Animal preparations. .269 Total. ..8,066 Photographs taken during the year: Photographs taken at Board of Health Labcratrry. .....18 Photographs taken of lepers at Palo Seco. ...150 Total. ...168

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39 CHEMICAL ANALYSES AND EXAMINATIONS. Abdominal fluid, protein. Beverages .10 Beer, com plete analysis. B eer for alkaloids.1 Beverage, "Sidra," alcoholic content. I Liquor, alcoholic content. W hiskey. 2 Blood analyses. 1,026 Nonprotein nitrogen determinations. 244 Urea nitrogen determinations. 592 Uric acid determ inations. .578 Creatinin determ inations. .592 Glucose determinations. .927 Carbon dioxide determinations. 18 Sodium chloride determinations. 2 Cholesterol determ inations. .1 Calcium determinations. 2 Phosphorus determ inations. 2 Ammonia determinations. 1 Chlorides. 1 Spectroscopic. .2 Boiler scale Calculus, appendiceal. Calculus, subm axillary. .*1 Calibration of sphygmomanometers. ...3 Drugs and chemicals. 13 Acetone. 1 Alcohol,denatured.:. I A lcohol rub .1 B ay rum ...2 Bleaching powder. I Carbalic acid, crude. .1 Eosin .1 Form aldehyde. .1 Paraffin. .2 Q uinine sulphate. .2 Electrolyte. .... Feces. Food stuffs. .302 Bran. .3 B utterm ilk ...I Cream,. 3 H oney. 2 Milk, dairy. 272 M ilk, evaporated. 9 Milk, condensed. 1 Milk, unevaporated. 1 M ilk, m other's. .7 N uts. .1 R ice ..2 Gasoline. 3 Gastric analyses. ..99 G auze, cotton ..1 G lass, pow dered ....I Pathological specim ens. 2 Kidney tumor (fat). 1 Scrapings from knee. .1 Silver coin ..I Spinal fluids exam ined. 557 Colloidal gold. 7546 Ammonium sulphat ...530 Phenol ......512 Glucose. ........7 Urea nitrogen. .5 Uric acid. .5 Creatinin. ......5 Substances for identification ......23 Cocaine. ..16 Emetine. .......1 opium. ..2 Bleaching powder. .1 Zinc sulphate. ..I Sodium carbonate and sodium chloride 1 Phenyl salicylate, mercurous chloride and strychnine .I Tooth paste. .2 Toxicological, examinations. ..5 Chem. No. 8342. Stomach contents. Mercury not found .1 Cbem. No. 8740. Stomach contents. Mercury found. Chem. No. 9187. Stomach contents. Alcohol not found. ..I Chem. No. 9599. Stomach contents. Salicylic acid found.1 Chem. No. 9667. Viscera. Strychnine found. ..1

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CHEMICAL ANALYSES AND EXAMINATIONS.-Continued. Urines examined. ..470 Routine analysis. 234 Glucose determinations. ...200 Globulin and albumin determinations ..I Albumin determinations. ..2 Diacetic acid determinations ..,.1 Lead determinations. .9 Nitrogen determinations .....24 Urea determinations. .....4 Chloride determinations. ....1 Leucin and tyrosin determinatons ..I Water. .4 Alcohol recovered, liters. ...146 Aniline oil recovered, cc. ...400 Esters of cod liver oil prepared, ec ....790 Ethyl esters of chaulmoogric acids prepared, liters .....51 Ethyl esters of morrhuic acids prepared,cc ..930 UNDERTAKING DEPARTMENT. Bodies received (6 disinterred). .......409 Bodies em balm ed. 71 Bodies creamated. .....107 Bodies buried on the Isthmus. ..236 Bodies shipped from Isthmus. .85

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41 TAMIa I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES FOR EMPLOYEES. ABSOLUTE NUMBERS. Discharges from hospitals. Deaths. Ya 24: C3 B .0 ,2 C b 4. Year 1924: White. 3,055 583 544 39 19 13 6 15,229 41.72 Black. 8,570 1,179 971 208 85 51 14 42,079 115.28 Totals. 11,625 1,762 1,515 247 84 64 20 57,308 157.00 Year 1923: White. .2,846 532 483 49 17 15 2 14,301 39.18 Black. 8,130 1,179 982 197 56 52 4 40,899 112.05 Totals .10,976 1,711 1,465 246 73 67 6 55,200 151.23 ANNUAL AVERAGE PER 1,000 EMPLOYEES. Year 1924: White. ...190.84 178.07 12.77 6.22 4.26 1.96 .13.66 Black. ...137.57 113.29 24.28 7.58 5.95 1.63 13.45 Totals. ..151.57 130.32 21.25 7.23 5.51 1.72.13.51 Year 1923: White. .186.93 169.71 17.22 5.97 5.27 .70 13.77 Black. 145.02 120.79 24.23 6.89 6.40 .49 13.78 Totals ..155.90 133.48 22.42 6.65 6.10 .55 13.78

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TABLE 11.-CAUSES OF DEATH OF EMPLOYEES ARRANGED WITH REFERENCE TO COLOR, AGE, AND LENGTH OF RESIDENCE ON ISTHMUS. Cok r. Age (in years). Length of residence on Isthmus (in years). 0 ce I t-. M co0Malarial fever, estivoautumnal .1 1 ............I .. Hemoglobinuric fever, malarial. .1. ..1 ............. Tuberculosisof thelungs. 11 1 10 ..2 1 4 2 2 .......1. ...2 5 2 1 Acute miliary tuberculosis. I .1 ...1. ..........1. Syphilis, tertiary. ...3 3 .....2 ..I ............2 .1 Cancer of the stomach. 2 1 1 ....1 .1 .............. Cancerofthe throat .2 2 ...1 1. ..1 .1 Cancer of intestines and rectum 2 1 1 ...1 ..1. .........1 1 Cerebral hemcrrhage, apoplexy. 5 1 4 ..3 .1 1 .........,. 1 3 1 General paralysis of the insane .1 I ....1 ........1 Angina pectcris.1 1 ..................1 Malignant endocarditis ......1 ........1. Acuteendocarditis. 3 3 ...1 1 .I .........1 1 1 Other organic diseases of the heart. 6 3 3 .1 2 1 .2. ...1 ....1 3 Varices. I ...........1 Arterio-sclerosis. .I .................. Lobar pneumonia. ...1 2 1 .I. .........2 2 .1 Gangrene of the lungs. 1. ..............1 Other diseases ofthe respiratory system. ..2 1 1 ...1 1. ........,. ...1 .1 Acute appendicitis. 1 ...1. .........1 D uodenalulcer. ..I .......1. ..............1 Intestinal obstruction. 1 1. .....1. ......1. Other diseases of the intestines. 1 1 ..1. .....1. Chronicnepritis. 7 7.7 ...1 1 ..........4 .4 2 Cholecystitis. .1 1 ...........1. Other diseases of the digestive system. ..1 ................1 Arsenic poisoning. 1. ........1. Accidental drowning. 4 1 3 ...1 2 .............3 Suicide by drowning. I. 1. .........1 Suicide by poisoning. 1 1 ........1 Traumatism by machines. 1 1 ..1 ............I .1. Traumatism by crushing. 3 1 2 .....2 ...............2 1 Railroad traumatism. .1 1 .1 ..............1. Traumatism by fall. 3 1 2 ....3. .........2 ....1 Absorption of deleterious gasses. 4 4 _. .1 1 2 ...........1 ...3 Effects of heat. 1 1 ....1 ................1 B urns ................1 Totals. 84 19 65 ..7 10 27 15 9 11 4 .1 3 1 .1 2 2 17 30 26

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43 TAUJz II.-DEATHS OF RESIDENTS AND DEATH RATES, OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Deaths. Annual rate per 1,000 Populapopulation. Place. tion. External External Total. Disease. causes. Total. Disease. causes. Year 1924: Panama. 59,635 1,168 1,128 40 19.59 18.92 .67 Colon. 31,285 475 455 20 15.18 14.54 .64 CanalZone. 33,723 305 270 35 9.05 8.01 1.04 Totals. 124,643 1,948 1,853 95 15.63 14.87 .76 Year 1923: Panama. 59,635 1,106 1,078 28 18.55 18.08 .47 Colon. 31,285 393 377 16 12.56 12.05 .51 CanalZone. 31,793 253 227 26 7.96 7.14 .82 Totals. 122,713 1,752 1,682 70 14.28 13.71 .57

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TABLE IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1924. Sex. Color. Age (in years). Place of residence. Total Cause of death. deaths. Und Age pan_ Canal M. F. W. B. Y I year 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unama. Colon. on known General diseases. Typhoid fever. 2 1 1 2 ...1. ..1. 1 Malarial fever, Estivoautumnal. 17 12 5 10 6 1 3 2 2 2 6 1 1 _. .3 3 1 Malarial fever, Quartan .1. 1 1 1. .1. Malarial fever, undetermined. 5 4 1 2 3 ..3 1 I. 2 3 Hemoglobinuric fever, malarial 2 2 1 1 .1 1 ..1 1 Measles. ., .9 7 2 .8 7. _. .1 1 4 2 3 Whooping cough. 3 3 1 2 1 2 ..I. 2 1 Diphtheria and croup 7 6 1 7 ..6 7. .7 Influenza. ..3 1 2 1 2 1 1. 1 2 Dysentery, Entamebic 11 7 4 2 9 .4 1 2 3 .1 .6 5 Dysentery, Bacillary 5 1 4 5 2 2 .3 2 Dysentery, unclassified 2 2 .2. 2 .2.1 1 Leprosy. ..1 1 ..I. .1. .....1 Erysipelas. ..2 1 1 2 2 1 1 Hemoglobinuric fever, unqualified 2 2 .2 ..1 1. Purulent infection and septicemia 1 1 ..1 1 Pyemia. ..1 1 ...1 Septicemia. .5 2 3 1 4 2 1 ..2. .3 2 Tetanus.2 2.1 1. 2.1 1. 2 Pellagra. 16 3 13 16 .1 4 6. 4 1 9 6 1 Beriberi. ...I. 1 1 1 Tuberculosis of the lungs. 276 137 139 19 249 8 4 11 5 29 73 74 47 18 13 2 177 71 28 Acute miliary tuberculbsis 15 13 2 1 13 1 1 6 1 4 2 14 ._.5 5 5 Tuberculous meningitis. 5 2 3 1 4 1 3 1 3 2 Abdominal tuberculosis. 4. 4 .4 4 1 2 .2 2 Pott's disease. .1 1 1 .I.I Tuberculosis of bones and joints 2 1 1 2 1 1 .. Tuberculosis of the larynx. ...1 1 ......1. Disseminated tuberculosis ...3 3 .3. ...3 2 1.3 Rickets. .4 3 1 1 3 2 2 1 1 Syphilis, tertiary. 11 7 4 10 1 3 5 2 1 .4 3 4 Syphilis,hereditary. .7 4 3. 7 .5 1 .I.5 2 Syphilis, period not stated .10 8 2 .10 _. 4 2 3 1 .9 1 Cancer and other malignant tumors of the buccal cavity.5 2 2 3.1 2 1 3 1 1 Cancer and other malignant tumors of the stomach andliver. .21 12 9 5 16. 3 4 11 3 .11 5 5 Cancer and other malignant tumors of the peritoneum, intestines, rectum. 4 3 1 2 2 ...11 2 2 1 1 Cancer and other malignant tumors of the female genitalorgans. 21 1 20 .5 4 ..12 4 5

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Cancer and other malignant tumors of the breast .7 .7 2 5 ..3 2 1 1 2 Cancer and other malignant tumors of the skin. I 1 .....-. ..... Cancer and other malignant tumors of other organs andoforgansnotspecified. 22 13 9 2 15 1. ..4 6 3 5 4 16 5 1 Diabetes. .7 2 5 2 5. .....3 1 1 2. 4 1 2 Exopthalmic goiter. 1 .I ..I --. ...I. Addison's disease. .....1 1 .I -. ....... Leukemia. .2 1 1. .2 .1 .---. --. Leukemia lymphatic .-. ---. -..1. Hodgkin's disease. 1. ... Anemia, primary, pernicious .3 2 1 2. .I I 1. ...1 1 Other general diseases ..-1 1 .1. I.1. 1. Alcoholism ...2 2 1 1. .-.-.-. I I .1. Alcoholism, acute. .1 1 1 ..-. .. Diseases of the nervous system and of the organs of wpcial sens-. Encephalitis. ..2 2 1 1 ......2 .. Simple meningitis. .13 7 6 2 11 4 5 1.1 2. 10 2 1 Cerebro-spinal fever. -.-.-. -1.1 .......1. Pneumococcus meningitis.5 4 1 9 1. I. 3. Locomoto ataxia. .2 1 1 1 1...1 Other diseases of the spinal cmrd. ...1 ....1 Cerebral hemorrhage, apoplexy. .48 32 16 5 43.8 13 4 2 20 22 6 h Softening of the brain ..4 3 1 3 1 1. .-. 1 3 1 Ln Paralysis without specified cause. .2 1 1 2 ...-. 2 General paralysis of the insane. .10 7 3 10 2 5 1 1 2 7I Dementia precox ... Other forms of mental alienation.I .I I ---.I. Epilepsy ..-. ......... Convulsions of infants (under 5 years of age) .6 4 2 3 3 4.4 2 Cherea. .I .. Neuritis. ..I 1 -. .1. Other diseases of the nervous system11 1. -. ..----.1. Otitis media.I 1 .. Diseases of the circulatory system. Pericarditis. 3 3 1 1 1 ..1 2 Acuteendocarditis. 5 4 1 .5 1-1 1 I ..2 1 2 Malignantendocarditis. ..5 4 1 1 4 1 2 1 1 .2 2 1 Organic diseases of the heart. 127 82 45 27 98 2 4 1 1 3 12 22 2 .25 27 3 77 38 12 Angina pectoris. 7 4 3 4 2 1. .1 2 1 1 2 5 1 1 Aneurysm. 14 7 7 14. .6 4 3 1 ..9 5 Arterio-sclerosis.,. 13 8 5 1 11 1.-. ...4 2 4 3 6 3 4 Other diseases of the arteries, atheroma, etc. 7 5 2 7 .2 3 2. 5 2. Embolism and thrombosis. I 1 -..-. --1. Varices. ..1 1 .1. .---. Diseases of the lymphatic system (lymphangitis, etc.) I 1 ..---. I. .. Hemorrhage; other diseases of the circulatcry system 3 2 1 2 1 1 1. 2

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TAnLE IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1924.-Contd. Sex. Colcr. Age (in years). Place of residence. Total Cause of death, deaths. Under Age PanCanal M. F. W. B. Y. 1 year 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unI ama. Colon. Zone. known Diseases of the respiratory system. D diseases of the larynx. 1 .I I ........1. .....1 Acute bronchitis. 30 12 18 2 28 .17 10 3 ........15 12 3 Chronic bronchitis. 8 3 5 ..8 ..2 .2 1 ...1.2. .3 5 Proncho-pneumnonia. 208 109 99 20 187 1 85 84 7 11 2 3 3 6 5 2 .168 28 12 Pneumonia (unqualified). 26 16 10 2 24 .4 3 .1 4 3 5 2 3 1 .21 5 Lobar pneumonia. 78 65 13 6 72 .3 12 .6 16 14 10 9 8 ..48 23 7 Pleurisy. .4 3 1 .4 ..1 .I ..1 ..1 .... Empyema. 5 3 2 .5 .1 3 ...1. ....2 3 Pulmonary congestion, pulmonary apoplexy. 2 1 1 1 1 .....1 .1 .,. 2 ..Gangreneof the lungs. 2 2 ..2 .....2. ....2 .... Asthma. 4 1 3 1 3 ..1. .2. .1. .2 2. Pulmonary emphysema. 1 1 ..I ...1 ....1 Other diseases of the respiratory system (tuberculosisexcepted). .5 2 3 1 4 ...I. 2 1 .1 .4 .1 0% Diseases of the digestive system. Pharyngitis. 1 1 .I .....1.1 Other diseases of the pharynx. 1 1 ,. ................ Other disease of the esophagus .I I .....1 ....... Ulcerofthestomach,. .8 7 1 1 7 ..1 5 1 .1 .4 4. Acute gastritis. 8 2 6 1 7 .4 1 .-. .....2 .7 1 Diarrhea and enteritis (under 2 years). 138 82 56 13 124 1 108 30 .......:. ..97 30 11 Colitis. .1.1. .......... Diarrheaandenteritis(2yearsandover). 15 7 8 2 13 ..5 4 1 1 2 .2 .4 7. 4 Colitis. 3 3 .3. : .1 1. ...3. Ascarissis. ..1 ..........1. Acuteappendicitis. 7 6 1 2 5 .....1 .3 3 .....1 3 3 Chronic appendicitis. 1 1 ....1. ......1 Hernia, intestinal osbtructions. 2 1 1 2. 2 ........2. Inguinalhernia. 4 4 2 .2 2 .1 ...1 1 ...1 1 2 Other hernias. 1 .1 1 .,. .......I .. Intebtinal obstruction. 8 6 2 3 5 .2 1 1 1 .1 2 ....5 1 2 Duodenalulcer. 3 2 1 ......1 I 2. ...1 Other diseases of the intestines. 5 4 1 5 .....2 2 1 .4 .1 Acute yellow atrophy of the liver. 4 2 2 4 ........1 3 Cirrhosisoftheliver. 8 5 3 1 7 ...2 1 2 1 2. ..6 2 Abscessofliver (unqualified). 5 3 2 .4 1 ..1 2 2 ...4 1. Cholecystitis. 2 1 1 1 1 .......2 ..... Other diseases of the liver. 3 2 1 3 ..1 ...I .: 1 ..

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Simple peritonitis (nonpuerperal). 10 7 3 .9 1 2 .1 2 3 2 .:. ..7 1 2 Other diseases of the digestive system (cancer and tuberculosis excepted). 1 1 ..1 ...-1 ........-. ...-..--. I Yonvenereal diseases of the genito-urinary system and annexa. Acutenepbiritis. 30 17 13 5 25 .7 7 3 3 1 5 3 ..I .20 5 5 Brights' disease (chronic nephritis). 100 54 46 10 87 3 .I 1 .11 20 23 18 17 9 .63 31 6 Pyelo-nephrosis. 22 12 10 1 21 .5 ....1 3 5 4 3 1 .10 11 1 Other diseases of the kidney and annexa. 1 1 ...1 .1. ......I ......I .. Cystitis. 3 2 1 .3 .....,.2.2 1 Other diseases ofthe bladder. 1 1 ..1 ....... Hypertrophy of prostat. .2 2 .1 1 ...2 ..1 1 Diseaseoftheuterus. 1 .I .....-. ..... Salpingitis and other diseases of the female genital organs. 2 .2. .1 1. .1 .1 The puerpgral state. Accidents of pregnancy. 1 .11 ..-.1. ...-..1 Extra-uterine pregnancy. 2 2 2. .1 1. ..2 .. Hyperemesis gravidarum. .I .1 .1 1 1. Abcrtion. 4 1.1 3 .3 1 .1 2 1 Puerperalhemerrhage. 4 .4 ....2 2 ....2 1 1 Other accidents of labcr. 3 3 1 2 .......3. Puerperalsepticemia. 4 4 3 1. ..4 ....3 1 Puerperal albuminuria and convulsions. .6 .6 ....4 2 ....2 4 Eclampsia. 8 8 8. ....2 3 3 ....2 4 2 Puerperal phlegmasia alba dolens, embolus sudden death. .I .1 1 ..1 ..1 ... Diseases of the skin and of the cdIlular tissue. Cangrene.,. 2 1 1 .2 ......1.1 1. Phlegmonandeellulitis .2 .2. 2 ....1 1 .-.-. Other diseases of the skin and annexa. 2 2 .2 .........1 1. Discaseq of the bones and of the organs (f Icccmoticn. Osteomyelitis .1.1 ...--. 1 Diseases of the bones (tuberculosis excepted). 1 .1 ...-.-. ....1. Malfcrmaticns. Congenital malfcrmations (stillbirths not included). 1 14 4 3 14 1 17 1 ...9 4 5 Diseases of early infancy. Congenital debility, icterus, and selerema. 5 4 1 5 5. .......I ...4 .1 Premature birth .;. 59 35 24 7 51 1 59 ........30 12 17 C ongenital debility .,. 5 2 3 .5 .5 .4. .........4 .1

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TABLE IV.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON, BY CAUSE, SEX, COLOR, AGE, AND PLACE OF RESIDENCE, 1924.-Contd. SeX. Colcr. Age (in years). Place of residence. Total Cause of death, deaths. Under 1 Age Pan. Canal M. F. W. B. YIyear. 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 una .Colon Zone. known Diseases of early infancy.-Continued. Atrophy of infants. 1 1 ..-. ....-. .I. M alnutrition. .26 13 13 1 25 .18 8 ......6 11 9 Other causes peculiar to early infancy (including varioui consequences of labor). 50 29 21 7 42 1 50 .31 9 10 Old age. Senility. 12 4 8 3 9 .5 7 .7 3 2 Affections produced by external caused. Suicide by poisoning. 2 1 1 1 1 ........1 Suicide by drowning. 4 3 1 1 3 ..1 2 ..1. .1 3 Suicidebyfirearms.3 3 .....3 ..1 1 1 Otheracutepoisonings. 4 3 1 1 3 2 1 .1 2 1 9: Burns (conflagration excepted). .6 3 3 1 5 3 1.1 1 ..2 .4 Absorption of deleterious gases (conflagration excepted). 6 5 1 .6 1 1 4. .4 ..4 2. Accidentaldrowning. 17 17 .6 11 ..2 2 2 8 2 .1 5 4 8 Traumatism by firearms. 2 2 .1 I 1 ..2 ....._ .I Traumatism byfall. 16 10 6 4 12 .2 2 3 6 2 .1 11 3 2 Traumatism by machines. .1 1 1. .......1 Traumatism by other crusbings. 19 19 .6 12 1 .3 3 2 3 6 2. ..8 4 7 Railroad traumatism.,. 2 2 .1 1 .1 1. .1 1 Effects of heat.1 1. 1 ...1.I. Homicide by frearms. ...8 7 1 7 1 .2 5 1 .2 3 3 Homicide by cutting or piercing instruments. .2 1 1 1 1 .....1 1 ..I .I Homicide by other means. .1 1 .1. ...-...1 Other external violence. I 1. .I ...1 .1. Ill defined diseases. Sudden death. 2 1 1 1 1 1 .2.2 Causes of death not specified or ill-defined. .28 15 13 3 25 12 6 2 2 3 1 2 .14 68 Infections of undetermined origin.2 1 1. 2. .1. I 1. ..1 Totals. 1,948 1,125 823 263 1,654 31 442 250 53 87 206 313 237 159 143 53 5 1,168 475 305

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TABLE V.-DEATHS OF NONRESIDENTS, BY CAUSE, SEX, COLOR, AND AGE, 1924. Sex. Color. Age (in years). Cause of death. Total LessI deaths M. F. W. B. than 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-80 UnI yearknown Typhoidfever. 4. ....3 ..1. Malarial fever, estivoautumnal. 2 1 1 2. ........ Malaria, undetermined. .8 6 2 .8 2 2 2 1 1. Malarial fever, clinical.-.1 1 1. .. Hemoglobinuric fever, malarial ..-1 1 .-. 1. 1. Dysentery entimebic. .2 1 1 2 .....-. Dysentery, bacillary. .1 1 1 .1 .1. Septicemia. ...-5 4 1 5 ..I 1 1 2 Tetan as ..1 .1. ..-. 1.1. .... Tuberculosis of the lungs .23 18 5 23 1 .3 3 5 6 3 2. Acute miliary tuberculosis ..2 2 .-2. 2. Tuberculosis meningitis. ..1 -.1. Abdominal tuberculosis --. 1 I ..... Gonorrheal orehitis and epididymits. ..-. .1 1 ..1 1 Cancer of the stomach and liver. ...3 3 1 2 1 1 1 Cancer of the intestines ..-I 1 ... Cancer of the female genital organs ..*. 1 .1 .1 1 .. Cancer of other organs and organs not specified. .6 4 2 2 4 1 .1 1 2 I Diabetes. ..3 3 3 -2 1 Encephalitis. ..1 1 1 .Simple meningitis ..-.1 1 1 I Cerebral hemorrhage, apoplexy .3 2 1 1 2 1 ... Softening of the brain ...--. -. Epilepsy .-.-. Acute endocarditis. ..2 1 1 2. ..1. Organic diseases of the heart .19 17 2 7 12 -, -.1 4 1 3 4 3 Aneurysm. .I .. Arterio-sclerosis. .-.1. .....I.-. Other diseases of the arteries ..-. 1. I ..1 Broncho-pneumonia. .3 3 .3 1 1-. Pneumonia (unqualified). ...9 5 4 9 1.1 2. 3 2. Lobar pneumonia ...13 13 4.6 4 1 2 Pleurisy. 2 2 1 1. ........I. Empyema. .1 I1.I. .--I*. .. Abscess of lungs .1 1 ..*. .... Diarrhea and enteritis. ..5 4 1 1 4 1 3 ...-. Colitis. ..-. .1. .1. Ankylostoiniasis. .1 1.I. 1 11 -. .1 ......... Intestinal obstruction ....1 1 1.-. 1. Other diseases of the intestines. ..1 1 1. ---. ..-1 Duodenal ulcer. .1 1 ..I. Cirrhosis of the liver. .1 1 ..1 ..... Biliary calculi.,.1 1 1.-----.--. .....1 .. MR 95651-4

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TABLE V.-DEATHS OF NONRESIDENTS, BY CAUSE, SEX, COLOR, AND AGE, 1924.-Continued. Sex. Color. Age (in years.) Cause of death. Total Less deaths. M. F. W. B. than 1-4 5-10 11-20 21-30 31-40 41-50 51-60 61-75 76-80 Un1 year known Abscess of liver (unqualified). .2 2 ..2 ...1 1. Cholecystitis. .1. .1 ..... Other diseases of the digestive system. 1 1 ..1. ..1. Chronicnephritis. .10 6 4 1 9 ...1 3 1 3 1 1. Pyelo-nephrosis.2 1 1 2 ...... Cystitits.1. ..... Puerperal hemorrhage. ......22. 2 2 ....1 1. Eclampsia.1 .1 1 .1. .... Other accidents of labor. I 1. ..1. .....1 .. Gangrene.2. .,.2. 2 ... M astoidabscess. .I ....1. Premature birth. ..2 2 2 2. .... Burns. 2 1 1 2 2 Absorption of deleterious gases. ....... Accidental drowning.5 8 8 3. .....2 1 5. Traurnatism by.fall_. .2 2. 1 1 ..1 1. Traumatism by crushing. .3.3 1 2 Other external violence. ..1 1 1 ....I. Notspecifiedorill-defined.17 7 10 17 5 3 1 1 1 1 2 1 2 Infections of undetermined origin. 1 1 1 Totals. ...200 149 51 46 154 12 13 6 19 33 34 40 26 42 5

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51 TABLE VT.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1924. Annual death rate per 1,000 population. White employees from the United States: D isease. .,. 4.14 E xternal causes. ...1.88 Total. ..6.02 White women and children from the United States: Disease. 7.03 Externalcauses. .1.10 Total. .........8.13 White employees from the United States and their families: D isease. .......5.97 E xternal causes. .....1.39 Total. .7.36 Number of American children born on Isthmus during the year. .180 Deaths among American children under 1 year of age .9 Infant mortality rate among American children (number of deaths per 1,000 live births). .50.00 TABLE VII.-BIRTHS AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Births. Rate per 1,000 population. Place. oulaTotal. Alive. StillTotal. Alive. Stillbcrn. born. Year 1924: Panama. 59,635 2,271 2,144 127 38.08 35.95 2.13 Colon. ..31,285 726 690 36 23.21 22.06 1.15 CanalZone. 33,723 730. 694 36 21.65 20.58 1.07 Totals. 124,643 3,727 3,528 199 29.90 28.30 1.60 Year 1923: Panama. 59,635 2,163 2,043 120 36.27 34.26 2.01 Colon. 31,285 748 709 39 23.91 22.66 1.25 CanalZone. 31,793 623 591 32 19.60 18.59 1.01 Totals. 122,713 3,534 3,343 191 28.80 27.24 1.56 TABLE VIII.-INFANT MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON. Deaths among Live births. children under 1 year of age. Rate per Male. Female. Total. Number. 1,000 live births. Year 1924: Panama. 1,120 1,024 2,144 296 138.06 Colon. ..344 346 690 79 114.49 Canal Zone. 369 325 694 67 96.54 Totals. 1,833 1,695 3,528 442 125.28 Year 1923: Panama. 1,048 995 2,043 290 141.95 Colon. 370 339 709 82 115.66 Canal Zone. 315 276 591 43 72.76 Totals. 1,733 1,610 3,343 315 94.23 k4

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52 TABLE IX.-TABLE SHOWING DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1924. Nontd Employees. Nonemployees. residents. Diseases. -White. White. Black. Black. White Black. 0_ Army. Others General diseases. Typhoid fever. .10 1 4 5. Relapsing fever. .2 1 1. Malarial fever, Estivoautumnal. 358 11 32 90 33 34 172 8 Malarial fever, Tertian. 145 14 30 19 23 55 3 1 Malarial fever, Quartan. .10 .2 2 1 5 Malarial fever, mixed. 4. .3 1 Malarial fever, undetermined. .2 1 .1 Malarial fever, Clinical. .25 2 2 5 6 7 3 Malarial fever, Cachexia. 2. 2 1 1. Vaccinia. .44. .4 Measles .166 4 6 19 49 89 5 2 Scarlet fever. 3 ..2 1 Whooping cough. 7 __. 3 4. Diphtheria and croup ..6 .1 1 2 2. Croup. ...1 .1. Influenza. ..91 1 23 it 8 38 6 5 1 Dysentery, Entamebic ..12 .1 5 2 4. Dysentery, Bacillary ..4 6 1 1 7 1. Dysentery, unclassified. ..8. ..4 2. Leprosy. ..3.2 ...I. Erysipelas ..5 1 1 _. 3 1 1. Dengue. .3 2 1. Chicken pox. .42 21 1 3 16 1. German measles .3 ....1 2. Mumps. .70 1 68 ..1 Hemoglobinuric fever, unqualified ...1 Filariasis. .___.1. 1 Other epidemic diseases. .4 .2 2. Purulent infection and septicemia. 3 1 1. 1 1 1 Septicemia ..3 1 1 Tetanus. ..1 .1 1 Mycosis1. 1. 1 Actinomycosis. .I. ...1. Pellagra. ..4 3 _.7.7 Beriberi. ...8.2 3 2 1 Tuberculosis of the lungs. .65 30 5 19 17 9 35 9 1 Acute miliary tuberculosis ..1 9 .1 .8 1 Tuberculous meningitis. .2. .2.2. .2. Abdominal tuberculosis. .5.1 2 2 Tuberculosis of bones and joints. .6 1 ...6. Tuberculosis of other organs 5 ....5. 2 2 1 Tuberculosis of the skin ..1. 1 ..... Tuberculosis of the lymph glands. ..6. .2 1 1 2. Rickets. .6 ...6. Syphilis, primary ....1 3 .2 Syphilis, secondary. .19 .1 1 3 1 4 9 Syphilis, tertiary. .97 5 3 34 4 5 47 8 1 Syphilis, cerebro-spinal. .34 1 5 8 8 3 7 4. Syphilis, hereditary ..5 1. ..1 5. Syphilis, period not stated 41 1 22 4 1 9 3 1 Gonococcus infection. .20 ...5 14 1. Gonorrhea. .215 .13 64 35 12 28 60 3 Gonorrheal arthritis .5. 1 2 .1 1. Goncrrheal bubo .3 ..2 1. Gonorrheal orchitis and epididymitis .2 ..1 .1. Gonorrheal ophthalmia. 6 ...5. Soft chancre. .110 5 30 17 1 25 23 9 Adenitis chancroidal ..6 ..1 1 .2 2 Cancer and other malignant tumors of the buccal cavity,. .1 1. ..1 1 Cancer and other malignant tumors of the stomach and liver. .6 4 .3 .2 3 2 Cancer and other malignant tumors of the peritoneum intestines, rectum. .2 1 .1 1 1 Cancer and other malignant tumors of the female genitalorgans. .5 3 1 ..1 6. Cancer and other malignant tumors of the breast 10 ..... Cancer and other malignant tumors of other organs and of organs not specified. .4 3 ..1 1 1

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53 TABLE IX.-SHOWING DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1924-Continued. I NonEmployees. Nonemployees. residents. Diseases. White. White. Black. Black. White. Black. Army. Others General diseases.-Continued. Other tumors (tumors of the female organs excepted). ..16 .2 4 2 5 3 Acute articular rheumatism. .11 .2 3 3 .3. Chronic rheumatism and gout. .6 1 1 2 1 1 Gout. ..I ....1 Arthritis deformans. ....1 Diabetes g ir. .30 1 2 3 1 17 7 1 Exophthalmigoiter. .3 1 2 1 1 7 1 Addison's disease. ..1 1 Leukemia lymphatic .1 .1 Hodgkin's disease. .1. ...1 Anemia, primary, pernicious. .2 1. 1 .I I Anemia, secondary, cause not determined 3 __. .1. .2 Other general diseases. .20 1 1 1 6 13 Alcoholism (acute or chronic). .13 ..5 3 .4. Alcoholism, acute. .21 1 3 11 5 3 Alcoholism, chronic.3 1 ...... Alcoholic psychosis. .8 1 .3 1 3. Chronic lead poisoning. .2. 2 .2 Other chronic poisonings. ..1 .. Drug habit. .2. 1 .1. Disease of the nervous system and of the organs of special sense. Encephalitis. .2.1 1. Simple meningitis. .1 2 1. 2 Cerebro-spinal fever. .3. ..1 2 Locomotor ataxia. 7 1 1. ...4 2 1. Other diseases of the spinal cord. ..5 _. .1. 3 .1. Acute anterior polio-myelitis. .7 3 4. Cerebral hemorrhage, apoplexy .4 8 1 4 3 4. Softening of the brain. ...........1 I Paralysis without specific cause. 9 1 1 1 1 2 3. General paralysis of the insane. .13 7 1 1 3 11 4. Dementia precox. 74 1 3 14 14 39 5. Manic depressive psychosis. .9 .2 1 5 1 Toxic psychosis,. 4 1 .3 1 1 Other forms of mental alienation. .28 2 2 1 6 6 13 2 Epilepsy. .....1 .....13 2 5 6 Convulsions, nonpuerperal (5 years and over) .3 1 1 1 1 1 Convulsions of infants (under 5 years of age) 10 1 5 6 Chorea. .1.__. ... Hysteria. .35 1 1 11 9 10 3 Neuralgia. .2 ...1 1 Neuritis.36 12 Imbeeility. 7 .3 4. Organic disease of the brain ..2 1 1 Neurasthenia. __.34 4 .6 13 6 5 Other diseases of the nervous sytem. 38 ..8 .6 2 7 13 5 5. Follicular conjunctivitis. 27 2 9 5 2 8 1 Trachoma. ..I ..I. Disease of Cornea. 42 .2 16 9 1 11 3. Diseaseof Iris. 19 .2 8 2 1 6 Diseaseof Lens.19 4 3 2 2 7 1. Diseaseof Fundus.21 .1 6 5 1 7 1. Other diseases of the eyes and their annexa ..109 ..4 26 27 1 44 7. Otitis, external. .._.36 ..2 3 15 7 8 1. Otitis media. .75 1 2 4 29 13 19 9. Other diseases of the ears. .13 .2 .6 2 2 1. Diseases of the circulatory system. Pericarditis. .2 1 ..1 1 1. Acute endocarditis. .4 4 2 .2 3 1. Malignant endocarditis. .3 1 1 1_ Organic diseases of the heart. 40 16 7 10 5 6 24 4. Angina pectoris ...I .1 Aneurism .4 1 ..3 2

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54 TABLE IX.-SHOWING DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1924-Continued. NonI Employees. Nonemployees. rdnresidents. Diseases. t White. White. Black. Black. White. Black. Army. Others Diseases of the circulatory system.-Continued. Arterio-sclerosis. 31 2 2 6 2 6 17. Other diseases of the arteries, atheroma, etc. 7 2 .3 .1 4 1. Hemorrhoids. _7. ..9 19 24 10 9 6. Varices. 9 1 2 4 .2 1 1. Varicocele. .5 ..1 3 1 .. Pblebitis. .2. .1 ...I. Other diseases of the veins. 3. ...1 1 .. Lymphadenitis (nonvenereal). 79 .3 15 18 8 19 16. Other diseases of the lymphatic system. 24 .2 4 6 5 5 1 1 Hemorrhage; other diseases of the circulatory system. 17 2 2 4 2 6 5. Diseases of the respiratory system. Adenoid vegetations. 194 ..1 90 103. Other diseases of the nasal foss. 121 .13 8 59 22 12 7. Laryngitis.6. ..1 1 3 1 Other diseases of the larynx. 1 ..1. Diseases of the thyroid body. 9 1 1 ..5 3 1 Acute bronchitis. 235 .23 16 43 58 76 17 2 Chronic bronchiti .13 .1 1 4 3 3 1. Bronclio-pneumonia. .38 11 .1 2 5 41. Pneumonia (unqualified). 1 1 |. ..1 1 Lobar pneumonia. 36 18 1 10 6 5 27 3 2 Pleurisy. ._.39 1 5 12 2 8 6 7. Empyema._. .4 1 .2 1 1 1. Gangrene of the lungs. ..I. 1 Asthma. 32 5 2 5 12 5 2 1 Other diseases of the respiratory system (tuberculosisexcepted). ..19 1 5 5 3 3 2 2. Abscess of lungs. .I ..1. .. Diseases of the digestive system. Diseases of the teeth and gums. 4. 41.4 3 8 6 11 9 Stomatitis. .....3 2. Other diseases of the mouth and annexa. ...12 ..1 3 2 5 1. Pharyngitis. 32 1 4 5 2 11 11. Follicular tonsillitis. 592 .56 33 109 156 229 9. Other diseases of the pharynx. 49 .6 5 11 14 12. 1. Foreign body in the esophagus. 2. ...... Ulcer of the stomach. 24.4 5 4 4 2 5 Gastrectasis. 1 ...1 .. Acutegastritis. .5 2 5 3 4 7. Chronic gastritis. 9 .1 1 3 .2 2 Acute indigestion. 16 .1 1 6 1 6 1. Other diseases of the stomach (cancer excepted). 26 ..10 .3 5 5 3 Diarrhea and enteritis (under 2 years). 20 4 .5 7 12. Colitis. 28 ..1 20 7. Diarrhea and enteritis (2 years and over) .61 2 10 12 4 11 18 8. Colitis. 19 ..1 1 9 7 1. -. Ankylostomiasis. 28 .4 1 9 13 1 Ascariasis. ..23 1 1 11 7 2 1 Teniasis. ......7 ..3 1 3 Strongyloidosis. 2 ..1 1. Other intestinal parasites. 3 ...3. Acute appendicitis...136 3 10 4 87 20 10 1 Chronic appendicitis. .83 __. 9 4 35 24 6 5. Hernia, intestinal obstructions. 3 1 ...3.__. Inguinal hernia. 123 1 8 35 33 13 24 10 1 Other hernias .....14 ..2. .1 2 4 5. Intestinal obstruction. 3 1 3 ...I Constipation. 58 5 6 8 14 18 6 1 Duodenalulcer. ..5 1 .3 2 ._ .I. .. Other diseases of the intestines. .62 2 9 10 14 16 12 3 Acute yellow atrophy of the liver. 3 2 .1 1 3. Cirrhosisof theliver. 3. .2 .. Biliary calculi. .12. ..1 7 1 2 Abscess of liver (unqualified).1. .-...1.Cholecystitis. 27 1 5 2 3 11 '5 2. Other diseases of the liver. 25 .5 1 6 2 7 4. Simple peritonitis (nonpuerperal). 6 4 2 1 3 3 ..1.

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55 TABLE IX.-SHOWING DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1924-Continued. Employees. Nonemployees. residents. Diseases. White. .White. Black. Black. White. Black. Army. Others Diseases of the digestive system.-Continued. Other diseases of the digestives ystem (cancer and tuberculosis excepted). 17 1 3 5 4 4. Nonvenereal diseases of the genito-urinary system and annexa. Acute nephritis. 24 2 1 3 4 7 9 2. Bright's disease (chronic nephritis). 32 11 4 16 1 6 10 5 1 Chyluria. .I .1 2 M ovable kidney. 21 1 Pyelo-nephrosis. 21 ..1 2 4 14 Other diseases of the kidney and annexa. 85 1 6 2 13 29 33 3 Calculi of the urinary passages. 20 .6 4 2 5 3 Cystitis. ..29 6 7 6 8 1 1 Other diseases of the bladder. .7 .2 2 1 1 1. Stricture of the urethra, nonvenereal. ..34 6 17 4 3 3 1 Vesico-vaginal fistula. ...3. 3 3 Other diseases of the urethra, urinary abscess,etc. 11 1 6.2 .2 Chronic prostatitis. .4 .1 2 ... Hypertrophy of prostate. .1 3 1 2 Other diseases of the prostate. .2 ...1 1 Nonvenereal diseases of the male genital organs. .41 2 16 9 4 6 3 1 H ydrocele. 26 2 14 6 2 2 Uterine hemorrhage (nonpuerperal). 13 1 .6 7 1 Uterine tumor (noncancerous). 50 2 1 6 :38 3 M etritis. ..1 ....1 Other diseases of the uterus. .95 2 1 42 46 4 Cysts and other tumors of the ovary. 15 ...6 8 1. Salpingitis and other diseases of the female genital organs. .131 2 2 5 29 95 2 Benign tumor of breast. 3 .2 1 Nonpuerperal diseases of the breast (cancer excepted). .1.4 3. The puerperal state. Normal labor. 4 .182 256 1 Accidents of pregnancy. 61 1 ....27 35. Extra-uterine pregnancy. 10 1 1 ..1 9. Hyperemesis gravidarum. 14 .1 ...4 9. Abortion. 83 2 .1 .45 39 Puerperal hemorrhage. 3 1 ..4. .. Other accidents of labor. 59 ...1 33 25. Puerperal septicemia. .2 1 ....3 Puerperal albuminuria and convulsions. 10 4 .....61 8. E clam psia. 1 4 ...1 4 Following childbirth (not otherwise defined). 25 ......25. Puerperal diseases of the breast. 18 ...7 10. Diseases of the skin and of the cellular tissue. Gangrene.,. I ...1 Raynaud's disease.1 1 Furuncle ..15 4 1 4 1 2 2 1 Carbuncle. 8 1 2 3 1 1. Acute abscess. .92. .7 6 13 21 31 14 Phlegmon and cellulitis. 81 7 26 11 8 21 7 1 Trichophytosis. .10 1 5 1 1 1 Scabies. .4 .1 2 1. M ycetoma. I Elephantiasis. .2. 1. Dhobie itch. 6 2.4 Ulceroftheskin. 18.4 1 10 3 Impetigo contagiosa. .10. 4 4 1 1 Urticaria. .I I .. Ingrowingnail. 13 .3 1 6 3. Other diseases of the skin and annexa. .60 7 4 15 11 9 13 1 Dis.-ases of the bones and ofthe organs of locomotion.I Caries (nontuberculous). 2 .I 1. Mastoid abscess. 4 2 .2 Osteomyelitis. 9 .3 1 1 1 3. Periostitis. 5 2 1 1 1

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56 TABLE IX.-SHOWING DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1924-Continued. Non0 Employees. Nonemployees. resident Disease. tka White. White. Black. Black. White. Black. Army. Others Diseases of the bones and of the organs of locomotion.-Continued. Other diseases of the bones(tuberculosis excepted) 50 1 6 3 28 6 7 1 Ankylosis. ....1 .. Arthritis. .60 2 7 5 8 23 15. Synovitis. .4 ..3 .1 Other diseasesof thejoints (tuberculosis and rheumatism excepted). .11 2 1 5 .3. Amputations. 2 ....1 Other diseases of the organs of locomotion. 54 15 11 9 8 5 6 Malformations. Congenital malformations (stillbirths not included 93 4 1 12 8 26 47 3 Diseases of early infancy. Newborn child. ...505 .....224 281. Congenital debility, icterus, and sclerema .1 2 ...1 2. Premature birth. 1 14 .4 11 .. Congenital debility. ..1 3 ...4. Malnutrition. 13 9. ..5 16 1. Other causes peculiar to early infancy (including various consequences of lahcr. .5 9 ....5 9. Old age. Senility. .1 1 ...2 Senile dementia. ....2. .1 1. Affetions produced by external causes. Suicide by poisoning. .2 1 .1. Poisoning by food. ..35 6 4 8 7 10. Venomous bites and stings .2 ....I .Snakebites.I ....... Other acute poisonings. 8 1 1 2 1 2 2 1. Conflagration. I I ...I -. Burns (conflagration excepted) .40 3 2 6 10 6 9 8 2 Absorption of deleterious gases (conflagration excepted). _. 6 1 1 2 1 1 2. Traumatism by firearms. .16 ..4 7 3 1 1. Traumatism by cutting or piercing instruments 24 2 5 6 1 6 3 1 Traumatism by fall. ..141 2 11 12 38 25 38 19. Traumatism by machines. ..19 .2 6 4 1 6 Traumatism by other .rushings .81 4 9 19 28 6 14 9 Injuries by animals ..6 .2 4. Starvation. .3 .2 .I Effects of heat .3 1 .1 ..3 Fractures (cause not specified). 72 2.34 8 4 21 6 1 Dislocations .9 .5 2 1 1. Sprains. 6.1 5. Other external violence. ..214 3 9 98 32 8 33 34 3 Ill-defined organs diseases. -. Ill-defined crganik disease .8 4 1 10. Cause of death not specified (r ill-defined. .2 .2. Infections of undetermined origin. 53 1 4 8 7 21 7 7 No disease. .365 15 19 56 144 78 51 2 Feigned disease ....2.1 Totals. ....865 32O 586 1,184 1,390 2,102 3,177 698 48

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TABLE X.-CONSOLIDATED HOSPITAL AND ASYLUM REPORT. Remaining January 1,1924. Admitted. Died. Discharged. Transferred. Remaining Dec. 31, 1924. Wht ht ht hieWie Wie e.White White White White White White American Foreign. foreign. Black American foreign. Bla American foreign. Black American foreign. BlackAmerican forei. Black. Ancon Hospital: Employee. ..12 6 74 448 48 1,028 8 2 43 437 45 985 .12 15 7 62 Army and Navy. 35 .1,208 .--.11 .1,164. .... Panama Government-.: .7 29q. .II. 4 6. 21.1.3 Charity.5 3 22 189 65 510 3 1 31 185 58 468 2 3 16 4 6 17 All others .34 47 89 1,272 740 1,907 16 21 91 1,236 729 1,805 1 5 27 53 32 73 Totals. 86 56 185 3,117 860 3,474 38 24 166 3,022 832 3,262 8 14 76 135 46 155 Corozal Hospital: 12 Employees .1 13 5 6.1.1. Army and Navy. 25 -4 ...... Panama Government 73 232 22 30 3 14 16 41 1 3 75 204 Charity. 1 6 42 2 4 15 3 3 1 22 ..2 ..9 30 Allothers. 2 4 25 4 16 21. 1 2 5 10 11 9 33 Totals .3 84 312 31 42 71 .4 19 32 27 80 1 5 2 94 279 Cripples. .3 25 ..1 .1 2.2 24 Chronic medical and surgical cases. 3 18 .4 30. .4 19. 3 28 Colon Hospital: Employees .2 .4 104 8 230 1 5 8 7 145 16 1 79 3 5 Army and Navy 3 .237 ...4 .181 ..53. ..2. Charity. .2 1 8 80 14 259 3 1 9 77 13. 192 ..61 2 1 5 All others .6 5 13 301 213 690 5 4 37 259 154 496 39 53 157 4 7 13 Totals .13 6 25 722 235 1,179 13 5 51 603 174 833 108 54 297 11 8 23 Palo Seco Leper Colony: 8 59 Panama Government .7 48 -1 18 .24.7. 3 Charity.2. ..6 .-. --.1 .1. 27 Totals. ..7 74 1 21 .5. .4. ..8 86 Grand totals: Employees. 14 7 91 552 56 1,263 9 2 48 523 52 1,136 16 1 91 18 8 79 Army and Navy. 38 -1,470 ...15 .1,369 .58 -.4 66 Panama Government .80 280 .30 77 3 1 16 48 .7 84 266 Charity, cripples, and chronics ..8 16 141 271 87 818 6 2 45 265 77 704 2 3 79 6 21 131 All others. 42 56 127 1,577 969 2,618 21 26 130 1,500 893 2,312 40 58 184 58 48 119 Totals .102 159 639 3,870 1,142 4,776 51 33 242 3,657 1,038 4,200 116 69 378 148 161 595

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58 TABLE XI.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED VARIOUS CLASSES OF PATIENTS AND AVERAGE NUMBER IN HOSPITAL EACH DAY, 1924. Number of days treatment. Average number in hospital each day. Class of patient. AmeriAmerican. Foreign. Black. Total. can. Foreign. Black. Total. Ancon Hospital: Employees. 5,471 1,103 26,560 33,134 14.99 3.02 72.77 90.78 ArmyandNavy. 22,659 ...22,659 62.08 ..62.08 Panama Government. .22 223 245 ..06 .61 .67 Charity. 2,488 1,317 10,4P5 14,270 6.82 3.61 28.67 39.10 All others. 14.770 13,880 30,567 59,217 40.47 W03 83.74 162.24 Totals. .45,388 16,322 67,815 129,525 124.36 44.72 185.79 354.87 Corozal Hospital: Employees. .366 4,799 5,165 ..1.00 13.15 14.15 Army and Navy. 1,029 ..1,029 2.82 ..2.82 Panama Government. .25,420 77,022 103,342 .6964 213.49 283.13 Charity. 111 2,664 13,051 15,826 .30 7.30 35.76 43.36 Allothers. 264 2,280 10,246 12,790 .72 6.25 28.07 35.04 Total (insane). 1,404 30,730 106,018 138,152 3.84 84.19 290.47 378.50 Cripples ..884 8,,789 9,673 .2. 42 24.08 26.50 Chronic medical and surgical cases. ...1, 035 9,370 10,405. ...2.83 25.68 28.51 Colon Hospital: Employees. 738 51 1,433 2,222 2.02 .14 3.93 6.09 ArmyandNavy. 2,044 ..2,044 5.60 .-5.60 Panama Government. 0 0 0 0 0 0 0 0 Charity. 796 123 2,151 3,070 2.18 .34 5.89 8.41 Allothers. 2,217 1,655 4,574 8,446 6.07 4.54 12.53 23.14 Totals. .5,795 1,829 8,158 15,782 15.87 5.02 22.35 43.24 Palo Seco Leper Colony: Panama Government. .2,646 20,094 22,740 7.25 55.05 62.30 Charity. .....9,755 9,755 ..26.73 26.73 Totals. 2,646 29,849 32,495 .7.25 81.78 89.03 Totals by classes: Employees. .6,209 1,520 32,792 40,521 17.01 4.17 89.84 111.02 Army and Navy. 25,732 .-. 25,732 70.50 ..70.50 Panama Government. .28,088 98,239 126,327 .76.95 269.15 346.10 Charity, cripples, and chronics .3,395 6,023 53,581 62,999 9.30 16.50 146.80 172.60 Allothers. 17,251 17,815 45,387 80,453 47.26 48.81 124.35 220.42 Grand totals. 52,587 53,446 229,999 336,032 144.07 146.43 630.14 920.64 These cripples require no medical attention.

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59 TABLE XII-REPORT OF DISPENSARIES, 1924. EMPLOYEES TREATED IN QUARTERS. Remaining Remaining January 1, Admitted. Died. Discharged. Transferred. December Dispensary. 1924. 31, 1924. White. Black. White. Black. White. Black. White. Black. White. Black. White. BlackAncon. 2 4 968 567 ..949 546 21 22 3 Balboa. 5 .1,201 56 .1,202 56 .4. Pedro Miguel. ..3 183 154 .181 149 2 8 Gatun. I .1 .107 136 .105 132 3 3 .1 Colon. 2 13 454 482 ..453 457 3 11 17 Totals. 10 20 2,913 1,395 ..2,890 1,350 29 44 4 21 Average number treated Dispensary furnishing treatment. Days treatment furnisheI. in quarters per day. White. Black. Total. White, Black. Total. Ancon. .2,314 2,678 4,992 6.34 7.34 13.68 Balboa. 2,993 503 3,496 8.20 1.38 9.58 Pedro Miguel. 576 789 1,365 1.58 2.16 3.74 Gatun. .332 671 1,003 .91 1.84 2.75 Colon. .1,285 4,646 5,931 3.52 12.72 16.24 Totals. ..7,500 9,287 16,787 20.55 25.44 45.99 ALL CASES TREATED BUT NOT EXCUSED FROM WORK. Employees. Nonemployees. Total. Dispensary White. Black. Total. White. Black. Total. White. Black. Total. Ancon. 7,482 12,059 19,541 5,128 10,151 15,279 12,610 22,210 34,820 Balboa. 12,719 15,977 28,696 17,686 5,432 23,118 30,405 21,409 51,814 Pedro Miguel. 2,681 5,290 .7,971 3,790 6,915 10,705 6,471 12,205 18,676 Gatun. 4,859 10,339 15,198 3,543 4,916 8,459 8,402 15,255 23,657 Colon. 5,147 14,471 19,618 6,596 12,333 18,929 11,743 26,804 38,547 Totals. 32,888 58,136 91,024 36,743 39,747 76,490 69,631 97,883 167,514

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60 TABLE XIII.-CONSOLIDATED ADMISSION REPORT, HOSPITALS AND DISPENSARIES, 1924. All classes of patients. White. Black. Total. Admissions to hospitals, excluding Corozal farm, cripples, and chronic ward. 5,008 4,745 9,753 Admission of employees, to quarters. ..2,913 1,395 4,308 Total admissions to hospitals and quarters. 7,921 6,140 14,061 Less number of patients transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. .214 422 636 Net admissions to hospitals and quarters ....7,707 5,718 13,425 Employees only. Employees admitted to hospitals. .._. 604 1,232 1,836 Employees admitted to quarters. .....2,913 1,395 4,308 Total admissions of employees ...3,517 2,627 6,144 Less number transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures ..46 135 181 Net admissions of employees ...3,471 2,492 5,963 Annual admission rate per 1,000 employees to hospitals and quarters ..1,136.17 290.7S 512.95 AVERAGE NUMBER OF DAYS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, EMPLOYEES ONLY. White. Black. Total. Hospitals: Ancon. ......11.66 24.72 20.51 C olon ........6 .86 6 .25 6 .45 Averageforhospitals. ..10.77 21.37 17.95 Quarters: Ancon. .2.43 4.78 3.30 Balboa. .2.52 9.32 2.82 Pedro Miguel. .3.20 12 77 7.62 Gatun. 3.07 5.21 4.27 Colon. 2.68 9.03 5.77 Average for quarters. .2.58 7.29 4.06

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61 TAE XIV.-SURGICAL OPERATIONS PERFORMED. Ancon Colon Hospital. Hospital. Number. Died. Number. Died. Amputations: Arm ... Foot. 2 1 Thigh.1. Leg. ..... Hand.2 1. Digits, multiple. 8. Operations on bones: Laminectomy. .3 2. Resection of knee.1. Wiring of fractures, simple. 6. Plating of fractures, simple. 1. .. Open operation of fractures. ..3. Open reduction of fracture. ... Dislocation, reduction, compound. .... Craniectomy, decompressive .... Bone splint to fracture, simple ...... Fracture reduction, simple. .5. ... Adenectomy: Cervical.5. Inguinal, single. .127 4. Inguinal, double. .40. Femoral. 7. Axillary. ........ Herniotomy: Inguinal, single. ...80 31 Inguinal, double. .14 1 4 Ventral. ..12 2. 2 Strangulated. ..2 2 1 Femoral. ......3 1. Genito-Urinary tract: Nephropexy. .5 Cystotomy ...1. Prostatectomy ........2 Urethrotomy, internal. ....8 Urethrotomy, external. 5 Varicocele, radical cure. ....7 1. Hydrocele, single, radical cure.04 4 Hydrocele, double, radical cure 1. Nephrectomy. ...1. Orchidectomy. ..6 ... Epididymotomy. ...63 1. Amputation of scrotum.1. Curettage uteri. ....200 9 1 Perineoplasty. ..31 ... Trachelorrhaphy. ..25. Vaginal puncture. ...........4 Circumcision. 279 4. Obstetrical: Cesarian section, abdominal. .6 1 2. Accouchement forceps.2. High forceps. ..2. Lowforceps. 9 11. Version.6 2. Perineorrhaphy. 36. Thorax: Excision of breast and axilla. 4. Thoracotomy. Rectum: Hemorrhoids, radical cure. 66 .27. Fistula in ano, excision of. .5 3. General: Thyroidectomy. 10 1 1. Varicose veins, excision of. 12 2. Myorrhaphy. ..3. Excision of surface neoplasms. ... Bunions .. Operations for extensive injuries to soft parts.,. ...4. Plastic operations for effects of disease. .....3 Nerve stretching. .2 Laparotomy: For tuberculous peritonitis. For general peritonitis. 2 1. Partial gastrectomy.1 Intestinal obstruction:. .1 ... Exploratory. ..13 1 3.

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62 TABLE XIV.-SURGICAL OPERATIONS PERFORMED.-Continued. Ancon Colon Hospital. Hospital. Number. Died. Number. Died. Laparotomy-Continued: Gastro-enterostomy. 7. Gastrotomy .1. Enterectomy.3 1. Appendectomy. 182 1 69 Appendectomy with local peritonitis. .10 ... Appendectomy with general peritonitis. 10 2 2. Calostomy. Cholecystotomy. 3. Cholecystostomy. 14. Cholecystectomy. ..4 Abscess of liver, laparohepatotomy. 2. Abscess of liver, thoracohepatotomy. .2. Pan-hysterectomy. ..1 Splenectomy. .1. Supravaginal hysterectomy. 63 1 23. Hysteromyomectomy. 27. Myomectomy Salpingectomy, single.1. Salpingectomy, double. .3. Salpingo-oophcrectomy. .12. 9. Ovarian cystectomy. 5. Oophorectomy.9. .2. Suspensio-uteri. .64. ... Ectopic gestation.7. .2. Enterrcrrhaphy. Lateral anastomosis intestine by suture. I. Cauterizations. .137. Blood transfusion.I. Arsphenamin, intravenous. .2,387 1. Salvarsan.675. .812 Novoarsenobenzol-Intravenous. .474. Major operations, various.1 .4 Minor operations, various. 1,732 .123. Totals. ....7,059 19 1,198 2

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63 TABLE XV.-OPERATIONS IN THE EYE, EAR, NOSE, AND THROAT CLINICS. Ancon Hospital. Eye: Advancement. I Capsulotomy. 1 Cataract extractionsCom bined. 4 Linear. ..4 Chalazior., removal. 19 Enucleatiun. 4 Foreign body, removal. ..24 Hordeolum, incision. 2 Iridectom y. ...6 Lachrymal operationsDilation of ducts. 3 Lid operationsPlastic. .4 Excision and draining of antericr chamber. .1 Needling. 3 Pterygium ......68 T enotom y ..2 C apsulectom y. ..1 M inor. 6 Ear: Furnucle, incision .2 Foreign body, rem oval. ....6 Mastjid operationsSimple. 15 Ossiculectomy. 5 Paracentesis. 45 Polypi, removal ..2 Excision of cyst from ear. I Others. 2 Nose: C auterization. 2 Fcreign body, removal. .,. ..2 Polypi, rem oval. ..6 Rhinoplasty.,. .10 SinusesE thm oid, sim ple. ....2 Frontal, simple. ..4 Frontal, radical ...1 M axilLry, puncture and irrigation. ....17 M axilLry, radical. .3 M axilkry, drainage. .1 Subm ucous resection. ..75 Turbinectomy. .27 Mincr. ..3 Other. I Pharynx: Adenoidectomy .505 Peritznsillar abscess, incision. ....28 Tonsillectomy. .877 Uvulectomy. 2 Retrapharyngeal abscess, incision. 1 M incr. .2 Larynx: Foreign body, removal. 3 Total mincr .11 T otals. 2 ,160 Refractions. .1,387

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64 TABLE XVL-COROZAL HOSPITAL, STATEMENT OF COMMITMENTS AND' DISCHARGES, 1924. COWUrrMENT8. From Canal Zone. From Panama. Total. Male. Female. Mile. Female. First admission. .47 30 30 17 124 Second admission. .5 3 3 5 16 Third adm ission. .2 ..2 Fourth admission. ....1 1 Fifth ad nission. .....1 1 Totals. 52 35 33 24 144 DISCHARGES. Male. Female. Well. 14 20 Improved. .34 26 Unimproved. 33 12 Totals. ..81 58 TABLE XVII.-FORCE REPORT. December 31, 1924. 1923. 1922. Gold. Silver. Total. Chief Health Officer.6 6 4 4 Quarantine Service. 12 22 34 33 31 Health Officer Panama. 9 115 124 154 151 Health Office, Colon. 6 58 64 78 86 Ancon Hospital. 125 206 331 352 347 Colon Hospital. 22 35 57 54 57 Santo Tomas Hospital. ....6 6 Palo Seco Leper Colony. 1 37 38 37 35 Zone Sanitation. 4 114 118 96 94 Corozal Hospital. 18 103 121 110 104 Line Dispensaries. 11 8 19 20 17 Totals. ..214 698 912 938 932

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UNIVERSITY OF FLORIDA 3 1262 08896 2542