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:
1933
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
AA00006092_00016 ( sobekcm )
25402926 ( ALEPH )

Related Items

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

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Full Text












REPORT

OF THE



Health Department


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'he Panama Canal

FOR THE

CALENDAR YEAR

1933


J. F. SILER
Colonel, Medical Corps, United States Army
CHIEF HEALTH OFFICER



BALROA HEIGHTS, CANAL ZONE


THE PANAMA CANAL PRESS
MOUNT HOPE, C.Z.
1934






























































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






























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*.4


CONTENTS
Page
Title ___----------- ---------------- -------------- -------------- 1
Organization and activities ----------------------------------------- 5
Personnel ---------------------------------------------- -------- 5
Financial statements ------- -------------------------------------- 6
Patient days in hospital and asylum (see also table 9, page 83) ------------ 8
Vital statistics, populations of the Canal Zone, Panama City, and Colon ---_ 10
General death rates from all causes and from disease only ------------- 10
Canal Zone ------------ ------------- ----------------- 11
Panama City----------------r ---- ---------------------- 11
Colon ----------------- ------- ------------.------------- 12
Birth rates -.--------- ---------------------- ---------------- 12
Canal Zone----- --------- -- ----------------------------- 12
Panama City ------------------------------------------- 13
Colon .----------------... ----..-------------------------- 13
Infant mortality rates-- _------------------- ----------- 13
Principal causes of death ------------------------------------ 14
Acute transmissible diseases reported ----------------------------- 15
Vital statistics, Panama Canal employees ---.----------------.--------- 16
Death rates --_-----_----------- ------- -------- ----- -------- 16
Admission rates to hospitals and quarters -------- --------------- 16
Principal causes of admission to hospital --------------------------- 17
Noneffective rates, all causes ---------------- ------------------ 17
Admission rates, malaria -- --__-- ----------------------- 17
Deaths from malaria _----------------- ---------------------- 21
Division of Hospitals, Dispensaries, and Charities ----------------------- 21
Gorgas Hospital --_--------------------------------------------- 22
Board of Health Laboratory -------------------------------- 23
Colon Hospital ---------- ---__ -------.--- ------- --------------- 26
Corozal Hospital --_---_-- ----------------------------------- 28
Palo Seco Leper Colony ---------- ------------------------- 31
Division of Sanitation -------------- ------------------------ ------. 32
Health Officer, Panama City -------- ---- ----------------- 34
Health Officer, Cristobal-Colon ------------------------------- 37
Division of Quarantine ----------------------------------------- 39
District Nurse for the Pacific side _------------ --.-- ---------------- 40
General Tables:
1. Discharges from hospitals, deaths, and noneffective rates for em-
ployees---------__ _---------------- ---------------- 43
S 2. Causes of deaths of employees arranged with reference to color,
I age, and length of residence on Isthmus ------------------- 44
*







4


CONTENTS-Continued

General Tables-Continued: Page
3. Deaths and death rates of residents of the Canal Zone and the
cities of Panama and Colon --- ----_-..--_-.- -- _____ 46
4. Deaths of residents of the Canal Zone and the cities of Panama
and Colon, by cause, sex, color, and age ---------------- 48
5. Deaths of residents of the Canal Zone and the cities of Panama
and Colon, by place of residence; absolute numbers and
annual rates per 1,000 .------.---.....---------------_- 54
6. Statistics regarding American employees and their families -...... 60
7. Discharges and deaths in hospitals of The Panama Canal, abso-
lute numbers ------..-------------------..-----------.. 62
7-A. Discharges and deaths in hospitals of The Panama Canal, rates ,-
per 1,000 population --------------------------------- .. 72
8. Consolidated hospital and colony report --------------------- 82
9. Number of days hospital treatment furnished, and average num-
ber in hospital each day of the various classes of patients --- 83
10. Consolidated admission report, hospitals and dispensaries ---_---. 83
11. Report of dispensaries -------------------------------------- 84
12. Average number of days in hospitals and quarters for each ad-
mission, employees only ------------------------------- 84

























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REPORT FOR THE CALENDAR YEAR 1933

ORGANIZATION AND ACTIVITIES

The Health Department constitutes one of the five major adminis-
trative units of The Panama Canal organization functioning directly
under the Governor, and its organization and activities were some-
what comprehensively outlined in the annual report of the Health
Department for 1930.
PERSONNEL

'The only change in personnel assigned to important key positions
.was that of Chief Quarantine Officer, Surgeon Charles V. Akin, United
States Public Health Service, having been designated as Chief Quaran-
tine. Officer, The Panama Canal, on October 14, 1933, vice Surgeon
M. Flint Haralson, United States Public Health Service, relieved on
account of termination of tour of duty with The Panama Canal.
Total personnel in the service of the Health Department on Decem-
ber 31, 1933, was 1,025, a reduction of 22 in the white American (gold)
personnel, and 79 in the colored alien (silver) personnel, under the
previous year; total reduction 101. The principal reduction in per-
sonnel (70) occurred at Corozal Hospital for the Insane, and was
occasioned by the fact that in July 1933, 592 patients, the respon-
sibility of the Government of Panama, were transferred to the
Panamanian Government asylum for the insane. The remaining re-
duction in force, 31 in number, was distributed generally among other
Health Department units and resulted from necessary curtailment
in operating expenses to balance the budget.


5"








6

Total personnel in the employ of the Health Department, by units,
for each of the five years 1929 to 1933 inclusive, has been as is indi- *
cated in the following table:
FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER, EACH YEAR :K






ChiefHealthOfee....... .. 7 7 7 77 66 5
Gorgas Hospital.......... 176 299 475 167 267 434 159 243 412 162 252 414 157 249 406
Colon Hospital ......... 25 52 77 29 54 83 32 55 87 32 55 87 29 54 8u
Coroal Hospital ........19 144 163 22 141 163 21 138 159 21 139 160 11 79 go
.Linedispensaries1.........1 9 27 16 15 31 17 15 32 161 33 18 17

Health Offie,Colon.... .9 88 9 9 87 96 8 89 97 103 8 89 7

Total............... 282 8911,173 279 8471126 284 8261,110 275 8511,126 258 7721,025

Noe.-"Gold" are white American employees, with the exception of two white aliens and one colored alien.
"Silver" ae alien employees, principally West Indians (colored).
Includes inmates paid for services rendered.

The distribution of the gold personnel (white Americans except 3)8
on the basis of professional and other special qualifications, was as1
follows:

33 physicians, medical officers of 8 dispensary assistants
"the U.S. Army 5 pharmacists and assistant phar-
1 physician, surgeon of the U.S. macists
Public Health Service 2 chemists
27 physicians, civilian 2 general mechanics
1 dentist, U.S. Army 2 stewards and stewardesses
3 senior internes 2 dietists
7 junior internes 1 storekeeper
4 male nurses I dental hygienist
95 female nurses I carpenter foreman
2 district nurses I chauffeur foreman
26 clerks 1 physio-therapy aide
12 sanitary inspectors 1 electrician
I sanitary assistant 1 embalmer
1 quarantine inspector
4 veterinarians "
8 technicians
FINANCIAL STATEMENTS

Operating expenses for the Health Department as a whole were"
$159,286 less than for 1932; and comparable earnings were $93,326 less
Operating expenses and earnings by units are set forth in the following
table:.
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7

OPERATING EXPENSES AND EARNINGS OF THE HEALTH DEPARTMENT,
CALENDAR YEAR 1933


Chief Health Office ----------------
Gorgas Hospital -----------
Colon Hospital ---------------
Corozal Hospital .----------- --------
Palo Seco Leper Colony ----------
Line dispensaries ------------------
Medical store -------------------------
Quarantine service --------------------
Sanitation of Panama City and Colon ---.-
Street cleaning and garbage collection and
disposal, Panama City and Colon.
Canal Zone sanitation --.. ----__.........

Total --_--


'$29,065.09
2703,920.95
3150,595.56
4126,73 7.28
37,624.01
97,522.63
6,629.56
568,149.64
57,346.73
132,716.75

132,625.09


$328,555.38
83,762.33
105,754.80
24,666.75
36,790.17

17,881.46
9,799.76
117,581.79

49,769.02


61.542,933.29 774,561.46


* Includes Army pay of Chief Health Officer, which amounted to................................ 6,120.00
*Includes Army pay of Army medical officers on duty in this institution, which amounted to.......... 101,680.36
Also includes cost of operation of Board of Health Laboratory.
J Includes Army pay of Army medical officers on duty in this institution, which amounted to.......... 28,290.75
Also includes cost of operating Colon dispensary.
4 Includes Army pay of Army medical officers of duty in this institution, which amounted to.......... 11,425.41
Total Army pay of Army medical officers on duty in the Health Department.............. 147,516.52
sIncludes Public Health Service pay of Public Health Service officers acting as Chief Quarantine Oficer.. 5,078.45
* Includes Army and Public Health Service pay, which amounted to............................... 152,594 97
OPERATING EXPENSES OF THE HEALTH DEPARTMENT, CALENDAR YEAR 1933,
SHOWING AMOUNTS CHARGED TO VARIOUS ACCOUNTS


Gold pay roll (white employees):
Panama Canal pay_ ---------.------------- $567,975.61
Army pay -------------------------------- 147,516.52
Public Health Service pay ----- ---------- 5,078.45
Silver pay roll (colored employees) ---------------------------
Subsistence supplies _--_ ---- _---------------
Ice- -----------------------------
Hospital supplies and drugs ------------------
Equipment ---------------------------------- -------
Miscellaneous supplies --------- --------------
Laundry----------------_-----------
Telephones _-------------------------------------
Repatriation of patients physically or mentally disabled --------
Medical storehouse operation_ -- ----------------------
Marine Division, launch and bus service for boarding parties ---.---
Electric current ---- ------------------------------ ------
Electric:repairs and installations -------------------------
Water ....- ---------------. ---------- ---_-
Freight------------------------------------------- ------
Mechanical Division, repairs and miscellaneous work.---___----


$720,570.58
372,165.57
166,411.35
4,555.90
71,329.41
18,908.75
32,360.91
26,404.66
15,037.41
955.49
6,629.56
6,173.62
16,307.18
4,349.74
9,994.00.
13,751.f5
3,813.57


47%
56%
83%
66%
38%

26%
17%
89%

38%

50%







S : ii;-.. .
8


Motor transportation charges (except for hospitals, quarantine : : ::
station, and dispensaries which operate .their own motor
vehicles). ---------------------------------------------- 47,325a 43 ::0
Repairs to motor vehicles of hospitals, dispensaries, and quarantine
station ------- -----------------------------------2,1a,84.,::
Rental of quarters.-----.------------- ---------------------- 555.82 ,
Construction Quartermaster, building repairs -------------------- 2,400.70 .:
Municipal Engineering Division, work --------------.... --....._ 2,852.70 .
Sale of buildings and surplus equipment, Corozal Hospital------ (6,446.12)
Miscellaneous expenses.-------------------------------------- '4,343.07

Total expenses ------------------------------------- 1,542,933.29

The extent to which the various units of the Health Department
have been self-supporting each year for the past 10 years is shown ip
the following table:


Gorgas Hospital.....................
Colon Hospital......... ...............
Corozal Hospital .....................
Palo Seco Leper Colony ...............
Line dispensaries ....................
Quarantine Division .................
Sanitation, Panaman and Colon.......
Street cleaning and garbage collection and
removal, Panama City and Colon....-
Zone sanitation ................. .. .
Health Department as a whole..........


Percent self-supporting
(Army pay included)
Calendar years-

1924 1925 1926 1927 1928 1929 1930 1931 1932 1931
52 53 51 57 54 52 49 46 47 41
41 39 37 44 44 52 59 52 51 I 51
81 82 80 85 76 88 86 89 94 81
40 45 38 46 41 46 55 44 65 Al
27 34 35 32 34 35 32 l1 43 31
38 46 53 35 38 49 35 32 24 2f
17 20 18 11 13 16 12 15 14 -
58 60 61 81 82 82 81 82 82 80
39 37 29 29 29 37 36 33 35 N8
48 50 49 53 51 54 52 49 51 50


PATIENT DAYS SPENT IN PANAMA CANAL HOSPITALS
NUMBER OF PATIENT DAYS IN HOSPITALS AND ASYLUMS


1929 1930 1931 1932 1933


Gorgas Hospital.........................
Corosal Hospital:
Insane patients.......................
Cripples and chronic medical and surgi-
cal cases........................
Colon Hospital........................
Palo Seco Leper Colony..................


184,506
209,794
27,623
30,755
36,568


163,975
228,862
28,923
41,158
36,102


165,050
228,327
29,883
41,508
34,947


149,812
253,240
31,802
35,379
38,543


149,292
172,41.
33,.96
31,378
34,4a


Total.............................. 489,246 499,020 499,715 508,776 421,01 .


The number of patient days spent in all Panama Canal hospitalsd!
was 421,201, representing a decline of 87,575 under the previous yeat.ag,:
The transfer in July 1933, of Panamanian insane to the Panamanuian:."
Government asylum accounts for 80,827 patient days of this reductions: i'|
the net reduction in patient days under the previous year being 6;7'ti,
The average strength of force in the employ of The Panama CanaI g .
1933 was only 277 less than in 1932, and the number of employee
patlerit days was 1,460 less (1932, 47,077; 1933, 45,617). There :; ,
a decrease of about 14,500 patient days in the group of patients d .rawn:.

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from families of U.S. Government employees, government contractors,
private patients, and others entitled to treatment. The number of
patient days chargeable to charity increased by about 5,300 (1932,
66,028; 1933, 71,379). During the past few years the military gar-
risons in the Canal Zone have increased materially (1928, 8,380; 1933,
9,817), and proportionately the number of patient days spent by
military personnel in Panama Canal hospitals has been much greater
(1929, 32,814; 1932, 50,674; 1933, 59,946)-about 10,000 more
patient days in 1933 than in 1932. The net decline in patient days
(6,748) is attributable to economic conditions (reduction in pay of
employees, and unemployment), reduction in activities of contractors
engaged in U.S. Government construction projects, and to some ex-
tent to an agreement made in October 1933, between the President
of the United States and the President of Panama, which provides
that hereafter no persons except U.S. Government employees and their
families will be entitled to treatment in Panama Canal hospitals,
except in emergency.
AVERAGE COST PER PATIENT PER DAY IN PANAMA CANAL HOSPITALS

Calendar years

1929 1930 1931 1932 1933
Gorgas Hospital:
Including total cost of Board of Health laboratory and under-
taking service ..... .............. .................... 5.08 5.40 5.07 5.03 4.71
Including only the cost of work done for this hospital by the
Board of Health laboratory and its undertaking service.. 4.87 5.16 4 83 4.76 4.47
Colon Hospital:
Including cost of Colon dispensary........................ 5.18 4.27 4.39 4.72 4.80
Including cost of Colon dispensary, also including the 5ost of
the work done for this hospital by the Board of Health
laboratory and its undertaking service ................. 5.55 4.55 4.65 5.04 5.12
Excluding cost of Colon dispensary, but including the cost of
the work done for this hospital by the Board of Health
laboratoryandits undertaking service ................. 4.84 3.96 4.11 4.39 4.47
Corozal Hospital:
Including cost of operation of dairy until December 1930; also
including cost of gardenesand cemetery .............. .90 .88 .70 ..65 .61
: Same as above, also including cost of the work done for this
hospital by the Board of Health laboratory and its under-
taking service ............................ ............ .92 .90 .72 .67 .64
Palo Beco Leper Colony:
Not including work done by the Board of Health laboratory
and its undertaking service ........................... 1.25 1.06 1.35 .96 1.09
Including -cost of the work done for this institution by the
Board of Health laboratory and its undertaking service... 1.26 1.07 1.36 .97 1.10

'NoT.-Owing to the multiplicity of f ons of the various units of the Health Department, the exact cost per
p.tihnt per day (in-patients) is impossible to determine. At Gorgas Hospital a large number of out-patients are treated
-;, the various clinic; also the Board of Health laboratory, including the undertaking establishment (which does the
eI:. alming and cremating, and handles the shipment of bodies, for all units of the-Health Department) is operated as a
pat of the hospital; the Board of Health laboratory does work for various divisions of the Health Department and for
i their departments of the Canal and for the Army. At Colon Hospital the dispensary is manned by hospital personnel
S an it isoperated as a part of the hospital; they have no undertaker, but furnish coffins and hearse service for the re-
I;:e. mra of colored patients dying therein.
i" I the foregoing table no effort is made to exclude the cost of any of the miscellaneous work of the hospitals from the
I l, o~ f eatingg for in-patiente, except that in the second figure shown of per-patient per-day cost for each institution an
If .. t has been made to include the proper percentage of expense of the Board of Health laboratory and its undertaking
i. ahble to such institution; also the cost of Colon dispensary has been deducted in the third figure of cost
iii pe-patit per-day for that institution, in order to make it more nearly comparable with Gorgas Hospital." The pro-
F. c;re: eia,."ps itheatpense of the Board of Health laboratory chargeable to eah institution was arrived at by a check of
f i: fmrik thelaboratory over a short period of time; on account of variation of the work it is more or less arbitrary.
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10 A .::i

VITAL STATISTICS. "
POPULATIONS OF THE CANAL ZONE, PANAMA CITV-"
AND COLON-
The Health Department of The Panama Canal secures, analyze
and makes reports on the vital statistics (births, deaths, and disease;
rates) of three geographical units of the population residing on :the
Isthmus of Panama, namely, .the population of the Canal Zone, oftipe
city of Panama, and of the city of Colon. *:
Properly to interpret these statistics, it is essential that there be some .
understanding of the composition of the various units of the popula-
tion, their movement, and some of the special local factors involye4d
which usually are not encountered in stabilized populations in many. '
parts of the world. These special factors were discussed somewhat in.
detail in the annual report of the Health Department for 1930 (pages
12 to 15, inclusive) which can be obtained on request to the Chief,
Health Officer, Balboa Heights, Canal Zone.
The Republic of Panama takes a census every 10 years, the last '-
enumeration having been made in 1930. In Panama City, from 1920
to 1930, the population made an average increase per year of almost
exactly 1,500, and that figure has been used as the factor in computing
the population each year since 1920 by arithmetical progression. For
1933 the population is estimated to be 79,000 (arithmetical progression).
In Colon, from 1920 to 1930, the census figures indicate an average
decrease of 150 per year, and that figure has been used as the factor
in computing the population between 1920 and 1930 by arithmetical
progression. As there is some doubt as to the accuracy of the 1930
census of Colon, 30,000 was adopted for 1931, and continued since.
The population of the Canal Zone consists of white American ema'.
ployees and their families, colored alien employees and their families,
military and naval garrisons, representatives of shipping companies,";"
contractors, church and welfare workers, etc., and colored alien agt i'.
culturists who rent land under revocable licenses. A census of the".
Canal Zone population is taken each year and all figures for this grou ii~
are actual rather than estimated.
The term "employees" as used in Heah Department reports in- -:
cludes employees of The Panama Canal pr'er and the Panama Rail-
road Company, which is a corporation owned by the United States,
Government. :*
GENERAL DEATH RATES, ALL CAUSES, AND DISEASE ONLY
Death rates from all causes for all groups of the population ha4te .:.,&
been analyzed since the beginning of construction (1905) and thosi' ;:

V .;i~









from disease only have been tabulated since 1913. Statistical tables
covering these data are incorporated in the annual report for 1931.
In this report (1933) the vital statistics incorporated will be limited,
as was done in the annual report for 1932, to a presentation and brief
discussion of death rates for the current year and a tabulation of rates
by consecutive 5-year periods to indicate general trend.
Health conditions for all groups (Canal Zone, Panama City, and
Colon) of the population were good; there were no epidemics; malaria
prevailed to a somewhat greater extent than is usual; morbidity and
mortality rates continued their downward trend and in some respects
declined to an all-time low point.
Canal Zone.-The death rate from all causes in the calendar year
1933 was 7.12 per 1,000 of population, the lowest of record (population
42,851, deaths 305). Deaths from disease only totaled 271 or a rate
of 6.32 per 1,000 of population, the lowest rate of record since 1913
except for the years 1930 and 1931, when comparable rates were 6.13
and 6.09 respectively.
The general trend of death rates in this group of the population of
the Isthmus during the past 20 years, both from all causes and from
disease only, has been very definitely a downward one as is evidenced
by the following analysis of rates for the past 20 years by 5-year periods.
CANAL ZONE DEATH RATES BY 5-YEAR PERIODS

1914-18 1919-23 1924-28 1929-33
Total death rates per 1,000 population................... 11.79 8.00 8.38 7 35
Death rates from disease per 1,000 population ............ 9.96 698 7.23 6.35

Panama City.-During 1933 the death rate from all causes was
14.95 per 1,000 of population (deaths 1,181, population 79,000), the
lowest of record (1905 to date). The death rate from disease, 14.30
per 1,000 of population (deaths 1,130, population 79,000), also was the
lowest of record. The trend in death rates from all causes and from
disease only has been continuously attaining lower levels during the
past 20 years as is clearly evidenced in the following tabulation of these
rates, by 5-year periods, since 1914:
PANAMA CITY DEATH RATES BY 5-YEAR PERIODS

1914-18 0919-23 1924-28 1929-33
.Toll death rate e 1,000 poplation.................. 28.45 20.20 18.12 17.04
Dema teas r disease, per 1,000 population............ 27.45 19.51 17.51 16.31

eo., sn-In. 1933 the death rate from all causes was 16.27 (deaths
S486, population 30,000) and from. disease: only, 15.63 (deaths 469,



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12

population 30,000). These rates are considerably in excess of the
comparable rates for any year since 1921, except for the years 1929
and 1930. The population figures for Colon have been held at the
constant figure of 30,000 since the 1930 census, as that census showed
no material change in the total population for the 10 years inter-
vening between 1921 and 1930.
The trend in death rates in Colon by 5-year periods for the past 20
years is shown in the following table which indicates that death rait
have been increasing during the past five years: :
COLON DEATH RATES BY 5-YEAR PERIODS

1914-18 1919-23 1924-28 1929-83
Total death rates per 1,000 population .................. 24.92 16.42 14.48 .1.1 "
Death rates from disease per 1,000 population............. 23.75 14.56 13.80 15.29


BIRTH RATES

Canal Zone (employees and nonemployees).-In 1933 the birth rate
for children born alive in the Canal Zone was 10.78 per 1,000.of popu-
lation (births 479, population 42,851). There were 17 stillbirths, rate
0.40 per 1,000 population, which, though slightly higher than for 1932
(0.31) is less than one-half the rate usually experienced in previous
years. The birth rate (total) for 1933 (11.18 per 1,000 population)
was less than for 1932 (11.69). The decline in birth rates for this.
group of the population has been continuous from year to year since
1924 when it was 21.65.
The persistent decline in birth rates for both groups of the popu-
lation-white and colored-can-be well appreciated by analyzing these
rates by 5-year periods for the past 15 years:
CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS, BY COLOR

1919-23 1924-28 1929-33

White Colored White Colored White Colored ,
Total birth rate per 1,000 of population............... 16.80 28.95 12.75 22.05 9.36 1 .03.
Lve birth rate per 1,000 of population.................. 16.31 27.30 12.26 20.66 9.13 14. .
Stillbirthrateper 1.000 of population ................... .49 1.64 .41 1.39 .23

As has been pointed out in previous annual reports, the low birth
rate in the white American population is influenced by the fact that the ,
unmarried military population amounting at the present time tbo:
about 10,000 individuals constitutes about one-half of this group. .: ..
The colored population is now a fairly well stabilized one. Th. 0'
total rate for this group in 1933 was 13.11 per 1,000 of population.. ..






13

_The decline in this group also has been persistent and continuous
S'since 1924 when it was 26.40. In the near future a considerable
proportion of the generation of the colored population born in the
Zone will have reached the age of reproduction, subsequent to which
time it may be anticipated that birth rates will increase.
Panama City.-In 1933 there were 2,607 children born in the city
of Panama, population 79,000 (rate 33 per 1,000 of population). Of
Sthe total births, 2,508 (31.75 per 1,000) were born alive and 99 (1.25
per 1,000) wern stillborn. There has been a continuous decline
in the rates for stillborn since 1930 when it was 1.80 per 1,000.
Incidentally it may be stated that in 1916 the rate for stillborn was
3.73. During the past 15 years birth rates have tended to decline
slightly as is evidenced in the following analysis of these rates by
5-year periods:
PANAMA CITY BIRTH RATES BY 5-YEAR PERIODS

1919-23 1924-28 1929-33
Total birth rate per 1,000 population........................ ............... 3739 34.49 34 00
Live birth rate per 1,000 population.................................... 35.24 32.74 32.47
Stillbirth rate per 1,000 population............. ......................... 2.15 1.75 1.53

Colon.-There were 851 children born in Colon (population 30,000),
the birth rate being 28.37 per 1,000 of population. Of the total births
809 were born alive, and 42 were stillborn (rates 26.97 and 1.40
respectively). The general trend of birth rates in Colon during the
past 15 years is shown in the following analysis of these rates by
5-year periods:
a COLON BIRTH RATES BY 5-YEAR PERIODS

1919-23 1924-28 1929-33
'Totalbirthrateper 1,000population ............... .................. 30.04 25.59 29.88
Live birthrate per 1,000 population............... .................. 28.38 24.21 28.46
Stillbirthrate per 1000 population................................. 1.66 1 38 1.42


INFANT MORTALITY RATES

Infant mortality (absolute numbers and rates per 1,000 of Jive
births) for the three groups of population involved were:

Cn.al Zone
Panama Colon
White Colored Total
I vetiirm (abds lBImorbers) ...................... 174 288 462 2,508 809
Daei. Sf ehldnre under one year of age(ablolute number) 6 29 35 295 93
i h lit rtE 'per l,Or ofrive births ................. 34 101 76 118 115


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Canal Zone ....: :
5-year period Panama ,
White Colored Average .
-1 2 ............................... 37.64 187.20 04.8. ....
14 :







1924-1928............................. 52.53 118.74 95.51 133.40i :
1929-1933................................ 3.19 101.13 78.69 130.18... : :.,i :" .::
---------------.--*---------* ... .....q ,*:";". ::.g'" t.
That considerable progress has been made during the past 15 a
in reducing infant mortality rates in all elements of the popu l
on the Isthmus is evident from the immediately preceding table

PRINCIPAL CAUSES OF DEATH

The principal causes of death for the past five years, for the three
groups of population involved, are set forth in the following tables:
SEVEN PRINCIPAL CAUSES OF DEATH FROM DISEASE. CANAL ZONE POPULATION, 19-403
(ABSOLUE NMsBERS AND RATEB PER 1,000) .

1929 1930 1931 1932 1183
Population.......................... 38,825 39,467 40,565 42,070 "42,89
Rate Rate Rate Rate BateB
Disease Num- per Num- per Num- per Num- per
be her 1,000 ber 1,00 her 1
Pneumonia (broncho and lobar)......... 27 .695 30 .785 23 .567 14 .333 34 .73
Cancer (various organs)............... 16 .412 15 .405 15 .370 18 .428 o .007
Tuberculosis (various organs)........... 34 .876 20 .507 19 .468 33 .784 21 .40 -
Diseases of the arteries............... ....... ..... ...... ...... 11 .271 ...... ...... 15 .5
Organic diseases of the heart............ 15 386 2 .557 ...... ...... 20 .475 14 .27
Apoplexy ......................... .. .. .. .. ...... ...... ... ...... 14 .333 12 .i2
Nephritis (aute and chronic)........... 23 .592 21 .532 18 .444 10 .238 12 ra

SIX PRINCIPLE CAUSES OF DEATH FROM DISEASE, PANAMA CITY, 1929-1933
(ABSOLUTE NUMBERS AND RATES PER 1,000): -


1929 1930 1931 1932 1933
Population............................ 73,000 74.402 76,000 77,500 "OIO
SRate Rate Rate Rate
Disease Num- Num- Num- Num- perNm
ber 1,000 ber 1000 ber 1 000 ber 1. 00
Tuberculosis (various organs).......... 204 2.79 208 2.80 218 2.87 203 2.62 S20
Pneumonia (broncho and lobar)......... 231 3.16 180 2.42 202 2.66 174 2.25 148 i
Diarrhea and enteritis, including colitis... 148 2.03 98 1.32 135 1.78 104 1.34 .
Nephritis(acuteand hronic)........... 114 1.56 113 1.52 64 .84 69 .89
Organic diseases of the heart............ 118 1.62 98 1.32 137 1.80 67 .86 ':
Cancer (various organs) ............... 67 .92 59 .79 62 .82 69 .89

SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 192-1933 08
(ABBOLUTE NUMBER AND RATES PER 1,000) )::;
------------------------ ----- ------ ..- ...:: .*.*,:*.-.. *..;... .;
1929 1930 1931 19338 198
Population......................... 29,850 29,765 30,000 30,000 S=iNS
---------------------____ -i-- --- --- --- -******.
Rate Rate Rate Rate ito
Nib_ IOD-r Nm Ol- Nob- No e 1 um-
.. ....o....r oo 1per0 w b p
1, b 1,0'N 1, 1,0w }


Tuberculosis (various orga)............
Pnemnonia (broho and lobar).........
Organic diseases of the heart..........
A .exy..... ..... ........... .....
ti (a and chronic)...........
Cane (various organs)...............


28
64


..:..


2.14
2.11
.94
.94
1.01


71
32
'4i1


2.39
1.65
1.08
1.38


90
81
32
23
24
,," .


3.00
1.70
1.07
.77
.80
... ..


74
46
30
a.
27
33
...,.. .


2.47
1.53
1.00
.90
1.10


i"H


105 8.5i0 :
51 1,70 .
34' l Im ,"
27 H:
22-


id4







15


Tuberculosis and the pneumonias continue to be leading causes
of death in all three groups of the population, maintaining first and
second places in the populations of Panama and Colon and first
rand third places in the Canal Zone population. The death rate from
tuberculosis in the Canal Zone population is less than one-fifth of
comparable rates in Panama and Colon; tuberculosis affects the
colored alien population of the Canal Zone to a far greater extent
than the white Americans. Deaths from degenerative conditions
of the arteries (arterio-sclerosis and apoplexy) are continuing to occur
with great frequency.

ACUTE TRANSMISSIBLE DISEASES

In the table appearing below is recorded the types of acute trans-
missible diseases which prevail in the Canal Zone and the cities of
Panama and Colon, and the frequency with which they occur in these
groups of the population (approximately 150,000).

CONTAGIOUS AND INFECTIOUS DISEASES-CASES AND DEATHS REPORTED TO THE
CHIEF HEALTH OFFICER DURING THE CALENDAR YEAR 1933

Residence 2
Outside the
e Panama Colon Canal Zone Zone and Total
Disease terminal cities
. New New New j New New
cases Deaths cases Deaths Deaths cases Deaths cases Deaths
Rabies ..................... ................ .......... ... 1 1
Chich enpo ........ 125 ........ 24 ........ 48 ........ 16 ........ 213 ......
Diphtheria........ 73 5 12 1 22 ........ 14 14 121 7
Dyentery, amebic... 78 9 6 2 1 1 164 10 249 22
Dysntery, bacillary
uinel sifid)... .. 1 ........ 1 ........ 3 ....... 1 1 6 1
"t tai............ 198 6 33 2 1,544 5 465 46 2,240 59
;Meslea. ............ 136 4 72 ........ 49 ........ 31 .... ... 288 4
Hangitui, f..eningo-
e u ...... ..... 1 I ........ ....... ........ .. .... ........ ........ I
........... 1 .. 2 8 ..... ....... ....... 11 ........
onia......... () 148 (') 51 () 34 () 50 ( 283
S.. ........ .. ...... ........ ....... ... 6 .......
.f .. .... ...... ........ ........ ........ 1 ........ 5 ........ 6 ........
v ...i ....... .. .......... ....... 4 ................ ....... 5 .......
S ........ 1 ................ ............... ........... .... ............
b s....... () 204 (9) 105 (.) 21 (.) 41 (9) 371
.mV ...... 11 5 6 ........ 4 2 14 1 35 8
W fvop.oou ... 5 ........ .. 34 ........ 35 ........ 5 ........ 79 ........
gt. .e ...... ............. ... !. .... ..... ...... ...... 1 ........ 2 ........
Reiun s guaratin-
IR O i qai di
Ch ta i, .. .......... ...... ....... .... ...... ............. .... ..... ................ ......
................ 7,4 ........ -
................... ......... .............. .....7 ........ 6 7......

tb i ... ... ..... a .... ........'... ........ ........ ........ ....... '........ 2 ... ......

1*4. A w U Imr sawe0 of umonia and tuberculosis. are not reported unless death occurs, this report shows only the
4 'gbeo death ftrom ese twao diseases.
l ;aores pher we are able to determine the plaoe of Ideetion fairly accurately, the place of infection instead
i tsd mKfb downB. It is usually impoeible to trace source of infection in amebic dysentery, but it is certain that
i .w m. eaa. wea uired in the seRitated area of the Canal Zone and the iies of Panama and Colon. A maloeity
alui of smladia shainr for the Canal Zone are believed to have been acquired in unsanitated areas.



.i;:"!. "... ;
'

II"0







16 .

VITAL STATISTICS, PANAMA CANAL EMPLOYEES .

To interpret properly vital statistics relating to this group iit s :
essential that one have knowledge of the conditions under which theyy:
are collected, their completeness, and other governing factors. Theei
factors were outlined in the annual reports of the Health Depat-
ment for 1930-1932 inclusive.
DEATH RATES, ALL CAUSES
The death rate for all employees (8.67 per 1,000 employees) was.
quite satisfactory (total deaths, 107; average number of employees for.;
the year, 12,344) being the lowest since 1924 (7.23). Ninety-seven
employees died of disease or at a rate of 7.86 per 1,000 employees, which"
represents the lowest rate attained since 1927 (7.82). -
The death rate from disease in the colored employees of The Panama
Canal was almost double that for white American employees, th
reasons f6r which have been discussed in the annual reports of the
Health Department for immediately preceding years. .
Death rates- in both white American and colored alien employees .
are gradually increasing, as is manifest in the following analysis of
such rates by 5-year periods, for the past 20 years: *
DEATH RATES OF EMPLOYEES, DISEASE ONLY, BY 5-YEAR PERIODS
1914-1918 1919-1923 1924-1928 1929-1933
White employees .................................... 4.51 3.20 4.94 5.38 .
Colored employees............................. ..... 5.93 7.36 8.49 10.02

The principal causes of death from disease in 1933 were: Tuber-
culosis, 15; pneumonia, 10; diseases of arteries, 9; syphilis, 8; cancer,
8; nephritis, 7; apoplexy, 5.
ADMISSIONS TO HOSPITALS AND QUARTERS
The admission rate to hospitals and quarters was 845 per 1,000
employees. As noted last year, this rate has been increasing each
year since 1926: 1926, 474; 1927, 502; 1928, 595; 1929, 602; 1930, 603iT
1931, 705; 1932, 725; 1933, 845. This increase is attributable t.:
gradual increase in the age of those employed (greater prevalence of
diseases of the chronic degenerative type).
The admission rate per 1,000 to hospitals for disease by race (whi te
and colored) has been as follows for the past five years: *
ADMISSION RATE TO HOSPITALS PER 1,000 EMPLOYEES. BY RACE (WHITE AND C OLOED)
White Colored
1929....................... ............. .. ....................... 273 1
1930............................. ...... ......... .288 180.........
1931 ......................... ...... .............................. .. 10 1
1932. ..................................... : ............ .............. .. 10 171
1933........... ......... ..... .... ... .... .................... .80







17

PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES TO HOSPITALS

The diseases causing the greatest number of admissions of em-
ployees to hospitals during the past five years are incorporated in the
following table:
EMPLOYEES, PRINCIPAL CAUSES OF ADMISSION TO HOSPITALS

1929 1930 1931 1932 1933
Disease Rate Rate Rate Rate Rate
Total per Total per Total per Total per Total per
1,000 1,000 1,000 1,000 1,000
Malaria (including the few cases treated
inquarters)....................... 337 21 410 26 276 19 177 14 328 26.57
Influen zs ......................... ............... ............ ...... 79 6 157 12.72
Diseases of pharyn and tonsils......... 184 II 136 9 153 10 97 8 146 11.83
Arteries lerosis ............... .. .. ..... ...... .. ... .. ... 124 10 120 9.72
Diseases of naal fossae ad annexa...... 153 9 .......... 270 19 ..... ..... 99 8.02
Diseases of eyes and annexa........... 113 7 ... ..... 131 9 81 6 68 5 51
Acuteabease ......................... 109 7 106 7 .... ..... 77 6 .... ......
Gonocoeeusinfeation................. 121 7 130 8 106 7 .... ................
Syphilis ............................. ...... ...... 150 10 114 8 ........... ...
Ankylostomiasis ..................... ...... ...... 113 7 ......... .. ....... .....


NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES

The noneffective rate for 1933 was 17.33 per 1,000 employees, the
highest recorded since 1912 (construction days).

ADMISSION RATES, MALARIA, EMPLOYEES (HOSPITALS AND QUARTERS)

As malaria is a most important cause of noneffectiveness in this
geographical area every effort is made properly to diagnose, treat,
make record of, and determine the source of infection in all cases
occurring in employees and other persons residing in the Canal Zone.
Since 1906 careful records have been kept of the incidence of malaria
in employees of The Panama Canal and its occurrence in this group
is shown in the following table:
MALARIA CASES, EMPLOYEES ONLY
Absolute numbers and rates per 1,000 employees

Average Number Rate Average Number Rate
Year number of per Year number of per
employed cases 1,000 employed cases 1,000
-.. ___i______ __-----_____ -----_____ I-- L -- -----___ -----______ -----_____ ______


1906 26,547 21,795 821 1920 20,673 401 19
1997 .39,238 16,637 424 1921 14,389 214 15
1908 43,890 12,372 282 1922 10,447 176 17
1909 47,167 10,169 215 1923 10,976 212 19
1910 50,802 9,487 187 1924 11,625 190 16
1911 48,876 8,987 184 1925 12,180 330 27
1912 50,893 5,623 110 1926 12,732 179 14
91. 56,654 4,284 76 1927 13,561 145 11
14 44,329 3,635 82 1928 14,260 203 14
S 34,785 1,781 51 1929 16,193 337 21
1 33,176 547 16 1930 15,524 410 26
S 32,589 473 14 1931' 14,597 276 19
5 25",520 472 18 1932 12,621 177 14
S 24,04 752 31 1933 12,344 328 27
E 3231-2


I.,


I,





4s
18

The rate per 1,000 employees for 1933 was, in round numbers, i l
(actually 26.57), the highest since 1925 when a rate of 27.09 was.bii-
tained. The malaria season for 1930, when a rate of 26.4 per.
employees was recorded, is comparable in many respects to da.
1933. .
Many factors, some known and some unknown, influence these wriaBJ
from year to year. The various factors which may possibly infueiti:i
the rate of prevalence of malaria are constantly under observatAi'it
and the results of such observations are recorded in the anal."i"
reports of the Health Department to which those especially interest
are referred. Marked annual variations in rates occur notwithsftan" ...
ing that continuously for many years the permanent drainage projects- 7
have been improved and extended and that extensive new drainar ~ ..
works have been installed.
The rate for 1933 (27) was in excess of those usually attained sin~ice
1916 (14 to 19 per 1,000) and was attributable to a number of facnlip -;
among which the following may be cited: .
(a) Continuation of large construction projects beyond the limits of '
so-called "sanitated areas."-Construction projects of this nature were'.
engaged in during 1925 (fortifications) and have been under way
since 1929 (road construction on east and west sides of the. Canal,
Pacific side, and construction of Madden Dam).
(b) Unusual prolongation of the rainy season.-Ordinarily the raii s
begin to taper off in late November and by the middle or latter part':
of December the dry season is well under way and small collections of
water suitable for anopheline breeding have dried up. In .1932 the
rains continued until the latter part of December, A. albimatnas
breeding places beyond the limits of the sanitated areas were abundant
until January 1933, and flights of A. albimanus into the sanitatedi
areas still were occurring. As a result, the malaria rate for the month": '
of January 1933 (annual basis) was 31.3 per 1,000 employees, which
is much higher than is usual (January 1932, 15.2; 1931, 23.6;, 1930, t;
20.3; 1929, 22.5; 1928, 6.7). Incidentally, it may be stated that ey
end of the rainy season in .1933 was quite similar to that iof 1934.:
and as a result the malaria rates for January 1934-when ,this '
report is being written-are unusually high (28.0 per 1,000). e: .W.i..
(c) Dredging Division projects.-In the early part of the dry senaS0CF
of 1933, the Dredging Division initiated a project including the:0al'LA
struction of a dyke damming up the Rio Grande and its tributaries i..:
the west side of the Canal just north of Balboa, with construction 4li1"
spillway at the upper end of the dyke. This area is to be used L: i
dumping purposes in dredging silt from the Canal. :Temporarily la.

2 1:.'. I
....:"









to enable the silt to settle solidly, it was necessary to bring the water
up to a high level. This level could not be lowered until some time
afterr the rainy season began and as a result a considerable amount of
fresh water accumulated in the tributaries emptying into the Rio
SGrande River. The areas were patrolled regularly and as soon as
breeding was found efforts were made to control it by oiling. It was
not possible, however, markedly to lower the level of the water until
about August or September. In the meantime the amount of breeding
was very greatly curtailed. Temporary drainage works have been
constructed in this area, the channel leading to the spillway has been
lowered, and we anticipate no great trouble, from it during the next
rainy season. A second Dredging Division project (fill) on the
Thatcher Highway in the vicinity of Farfan beach (west side of Canal,
opposite Fort Amador and La Boca) has not, as yet, settled solidly
and therefore is not adequately drained. The result was that during
the latter part of the rainy season A. albimanus bred so abundantly
as to necessitate dusting with paris green by airplane. The fill,
which consists of silt from the Canal, is still too soft to permit construc-
tion of permanent drainage systems. Fortunately, the area in the
vicinity of the Dredging Division projects has been depopulated and
there is but little opportunity for malaria-transmitting mosquitoes
to acquire infection except from individuals from the interior of
Panama awaiting ferry connections at the ferry slip on the west side
of the Canal at night. Sometimes the waiting period is a half-hour
or more.
(d) Aquatic flora, Gatun Lake.-Observations during the past few
years indicate that the amount of A. albimanus breeding in Gatun
Lake is increasing rapidly due to changes in the aquatic flora. This
problem was discussed in the Annual Report, Health Department,
Panama Canal, for 1932 (pp. 43-45) and further details are incorpo-
rated elsewhere in -this report. Evidence also in accumulating that
the dispersal flights of A. albimanus always noted at the beginning
of the rainy season, before rains are sufficient in volume to possibly
.result in breeding within the sanitated areas, are coming from the
Gatun Lake area. Anopheles breeding in the lake during April,
May, and June 1933, was materially greater than usual. Rains in
sitlicient volume to raise the lake level occurred much later than is
usual and:as a result the decline in the water level of the lake during
Sithe"dry season was approximately five and two-thirds feet rather than
thme sual five feet. Consequently materially more extensive areas of
s:atted decaying Chara were present on the surface of the lake than
i" aav re. fiou nd in its shallow parts. :As these mats afford ideal


.. "





.. ... .': :

20

food and shelter for Anopheles breeding, the amount of breeding-wa i:
much more extensive than usually is observed. There now appea.04
to be no doubt that the dispersal flights of Anopheles observ4~itd::;
throughout the Isthmus in May and June each year have their origiti";
principally in the Gatun Lake region and that the prevailing con': "
ception that A. albimanus has a short flight range requires revisitol, :'.
The flight from the lake to the Atlantic terminal is riot less than
four miles, and to the Pacific about 12 miles or more. .:'"
(e) Overhaul work on Panama Canal locks.-Overhaul of the locW
on the Pacific side was in progress from January 3 to June 9, 1933::
during which period several hundred laborers were employed on both
day and night shifts. Chronic carriers of malaria are common in
such groups. During the latter stages of this-overhaul when Anop.h-
eles flights were coming into the sanitated areas from the dredging
projects on the west side of the Canal, in close proximity to the Pacific
locks, and also from the lake area, abundant opportunity was offered:
the malaria transmitting mosquitoes to become infected through
attacks on labor forces engaged in night work on the locks. During'
the latter part of May and the first part of June the Special Seririce
Squadron of the Navy was at anchor in the basin off piers 15 and 16, -
Balboa, and for the first time in a number of years an unusually large
number of cases of malaria were undoubtedly contracted on board the
vessels.
(f) I'isits to the provincial districts of Panama.-Until recent years
but few sections of the provincial districts of the Republic of Panama
were easily accessible except by coastwise steamers, and opportunities
for employees and their families to visit these districts were greatly
restricted. This barrier greatly reduced opportunity to acquire
malaria. During the past 10 years the Public Works department"
of the Government of Panama has been actively engaged in the
improvement and extension of existing highways and the construction .....
of new ones. Tlje result has been that in increasingly large numbers,
the American employees of The Panama Canal are making automobile ,
trips to the provincial districts, building cottages in various coastal.:
areas for week-end and vacation use, and visiting with increasing fre- ..
quency interesting localities in the coastal and other areas. Not-?.
withstanding that employees are warned as to the possibility of con-
tracting malaria during visits to nonsanitated areas, and are urged to.'
safeguard themselves at night, most of them fail to do so. 'The.
result is that constantly increasing numbers of American employees *
and their families are contracting malaria through exposure in.non- .










sanitated areas. Conditions are such that it may be anticipated that
the numbers of individuals acquiring malaria from this source will
continue to increase.

DEATHS FROM MALARIA, EMPLOYEES


In 1933 two employees died of malaria, a rate of 0.16 per 1,000
employees. One of these deaths was that of an American employee
who contracted a malignant tertian infection at New Gorgona beach,
a coastal resort in the interior of Panama, had clinical symptoms for
several days before reporting to a physician, and when seen by a
Panama Canal physician was in a comatose condition. He was ad-
mitted to hospital immediately and died within three or four hours
thereafter. The second fatal case was that of a Panamanian laborer
employed at Madden Dam but living in one of the nearby nonsani-
tated native villages in the Republic of Panama. The patient was
treated for an estivo-autumnal infection in February 1933, readmitted
to hospital on April 3, 1933, and died of blackwater fever seven days
later.
Annual death rates from malaria in employees since 1906 have been
as is shown in the following table:

DEATHS FROM MALARIA AMONG EMPLOYEES ONLY
(Absolute numbers and rates per 1,000 employees)


1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919


Average
number
employed

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
24,204


Number
of
deaths

233
154
73
52
50
47
20
21
7
8
2
3
2
2


Rate
per
1.000
8.78
3.92
1.66
1.10
.98
.96
.39
.37
.16
.23
.06
.09
.08
.08


Year

1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933


Average
number
employed

20,673
14,389
10,447
10,976
11,625
12,180
12,732
13,561
14,260
16,193
15,524
14,597
12,621
12,344


Number
of
deaths

3


2
----------






1


2
----------


Rate
per
1.000

.15


.17



.06

.07

.16


DIVISION OF HOSPITALS, DISPENSARIES, AND CHARITIES

The units comprising this division and the scope of their activities
were outlined in the annual report for 1930. Brief reports of each of
thiee units for 1933 follow:





[ ":..: [ ,i" .. ": :




:.. ,::'.::.i. .. i ....

22

GORGAS HOSPITAL
(Normal capacity, 880 beds) '
Col. ORVILLE G. BROWN, Medical Corps, U.S. Army, Superinteiii
In addition to the routine work of maintenance and repair of bui i
ings and equipment by the hospital artisans during the year:, :: 'thf
following major plant improvements were made: .
1. The refrigerating plant and cold storage rooms of the hospiStl:.
main kitchen were completely overhauled and repaired at a .cost.
$3,350.
2. A new paint shop was constructed on a site adjacent to the
present shops building at a cost of $2,150. This activity was formerly
located under one of the ward buildings and, together with the storage
of inflammable material, constituted a fire menace which has now
been removed.
3. The old, worn-out galvanized iron pipes in Section "B".are being .
replaced with a new system of modern brass piping. The installati .. .
is now about 75 percent complete. All necessary material for thi ; .
work costing about $1,000 is on hand but, for reasons of economy, the
work is being accomplished only when the plumber is not otherwise
engaged.
4. The interiors of kitchen, mess halls, isolation building and section
"B" have been repainted throughout.
5. The parking site in rear of the Administration-Clinics building
was enlarged at a cost of approximately $900.
About $6,500 was expended during the year for new equipment and
replacements of worn-out or obsolete articles, of which about $1,900
was devoted to new equipment for the hospital subsistence department.
Cases treated.-There were 11,621 admissions during the year, with,
a total of 149,292 patient days. An average of 12.46 days in hospital
was spent by each patient under treatment as compared with 13.21
days per patient during 1932. The average number of beds occupied
daily during the year was 409.02. .
Surgical service.-There were 2,109 major operations (with 31t :
deaths) and 4,096 minor operations (with 2 deaths) performed during::
the year; 440 obstetrical cases were delivered, in which there wee :.
8 twin births and 14 stillbirths; 9,779 patients received treatment sn..
the out-patient service.
Medical service.-During the year, 6,216 patients were admitted ito -
and treated in the medical wards. In addition to the hospital service .:
.8,675 patients were treated in the out-patient service.
Eye, ear, nose and throat service.-There were 9,691. visits to the out-
patient department during the year; 1,610 operations were performed
and 1,065 refractions were done.








Radiographic service.-There were 7,505 cases handled, for which
4 8,472 films of various sizes were used, and in which 991 fluoroscopic
Examinations were made.
SDental service.-There were 5,088 sittings during the year; 1,360
o al examinations, 1,950 teeth extracted, 265 complete and 991
partial dental X-ray examinations.
Physio-therapy service.-Treatments were given as follows: 128
radium, 2,431 roentgen, 1,481 electro-therapy, 3,750 thermo-therapy,
3,688 actino-therapy, 4,262 massage and exercise, and 3,240 hydro-
therapy.
BOARD OF HEALTH LABORATORY
(Operated in connection with Gorgas Hospital)
Dr. L. B. BATES, Chief of Laboratory
Bacillus typhosus.-Recovered in blood culture from 13 individuals,
from the urine specimen of one other, and from four other cases at
autopsy. Six of these lived in Panama City, 3 in Colon, 3 were
transients, 2 from Madden Dam, 2 from Canal Zone towns, and 2
from Canal Zone unsanitated areas.
Typhoid carriers.-On December 31, 1932, there was only one B.
typhosus carrier, H.B., under sanitary surveillance. His stool speci-
mens were examined 10 times during the year and found positive
3 times. One new temporary carrier was found during the year.
SH.B. was the only carrier under sanitary surveillance on December 31,
1933.
SChagas' disease (Schizotrypansum cruzi).-The first case of this disease
St die in the Canal Zone or Republic of Panama, so far as is known,
was autopsied on August 7, 1933. A brief summary of the case is as
f allows: Autopsy No. 10, 203, F.B., age 3 months, 11 days; male;
tildck; residence, land license 1299 B.E., Chiva Chiva trail, Canal
Zone; place of death, residence as given above; time on Isthmus, life;
pHtcipal findings at autopsy: Schizotrypanum cruzi in myocardium,
:percarditis, otitis media, bronchopneumonia, right lower lobe, fatty
metainorphosis of liver.
: n : ake bite.-The fourth autopsy at this laboratory on an individual
J.ihg of snake bite was performed on November 2, 1933. P.B.,
.. colored, laborer, Colombian, age 25 years, was bitten October 28, 1933,
w: while obtaining a piece of sugar cane on Arinosa Farm, land license
:- Crifstobal-West. He died November 2, 1933. The snake was
Mi:,i~ i:by the victim but it was not recovered for identification. The
ii:stry : and autopsy findings were such that there was no doubt as to
J-0 &.' (death.'
: ... .* ..: .. .
"[E :E.:.... ......" .. ... ...

.." ... ...
. :T" I "...







24

SReports.-Approximately 38,900 laboratory examinations wi:re-
made. The volume and character of the work is indicated* in the i:
following summaries: '"
Bacteriological, protozoal, and miscellaneous examinations.--Ct-. t;
tures of blood, 213; cultures of stools (typhoid-dysentery), 946; cultures i
of urine, 1,266;cultures from nose and throat, 1,576; cultures of sputum, ,.
58; cultures of spinal fluid, 178; cultures of miscellaneous material
(eye, pleural fluid, skin lesions, pus,A bile, glands, autopsy tissues.
etc.), 189; darkfield examinations, 81; staining and examination of
smears conjunctivall, throat, urine, urethral, vaginal, sputum, etc.),- i
272; autogenous vaccines, 52; examination of lepers and leper sus-.
pects, 10; examination of urine for tuberculosis, 4; examination bf
spinal fluid for tuberculosis, 153; examination of feces for ova of
parasites and protozoa, 103; blood films for malaria parasites,
8,018; bacteriological examinations of water, 743; bacteriological
examinations of foodstuffs (cultures of milk, cream, ice cream, soft
drinks, etc.), 756.
SEROLOGICAL EXAMINATIONS
Wassermann tests ................... ........................................................... 18307
K ahn tests...... .................. .......................................................... 2,317
A gglutination tests........... ................. ....... ......................................... 210
Positive with B. tpho5us (Eberthella typhi) ................................... ........... 15
Positive with B. proteue X, ( Proteus sulgaris)........................................... 5
Fragility tests ........................................ ..................... .............. 4
Blood typing for transfusion ...................................................................... .
Examination of blood for coagulation time ........................... ............................ 4

Analysis of Wassermann reaclions.-There were 17,488 Wassermann
tests performed on the blood of 13,201 persons. The results are
summarized below:
TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1933
Total Percent of
Race, sex, and status Individuals Individuals individuals individuals
positive negative tested positive
White, civil:
Males................ .............. ............ 74 1,688 1,762 4,2
Females ............................. .......... 29 592 621 4.6
Children .............. ... ........... ........... 3 111 114 2.6
Total .. ..................... .............. 106 2,391 2,497 '. 4
White, military and naval:
Soldiers, continental United States................... 119 3,953 4,072 .9 *'
Sailors, U.S. Navy ................................. 21 270 291-. 6.8:
Total.................................... .. 140 4,223 4,363 3.8
Black and mulattoes: ':
Males......................................... 435 2,711 3,146 13.8
Females............................................ 245 2,646 2,891 8.1
Children ....................................... 14 230 244 6.7 "
Total..................................... 649 5.587 6,281 11.0
Chinese, males and females ............................. 4 56 60 6 '
Grand total .................................. 944 12,257 13,201 7.1
______________________________ _____ __o_ ,.__ \ r









In addition, Wassermann tests were made on 819 spinal fluids taken
from 612 individuals. The results are summarized below:
Individuals positive ........................................................................... 58
Individuals negative ..................................................................... 554
Total individuals tested ........................................................................ 612
Percent of individuals positive.................. ... .. .............. .......... ............ .... 9.48

PATHOLOGICAL EXAMINATIONS

Autopsies.-There were 3 I autopsies performed at the Board of
Health laboratory. The more frequent causes of death were as
follows:
Percent of
Cause of death Cases autopsies
External causes .................................... .... .......................... 44 13.88
Tuberculosis (acute and chronic)..... ............................................... 29 9 14
Organic heart disease (acute and chronic) .............................................. 26 8 20
Pneumonia (broncho and lobar) ................ .................. ......... ......... 25 7.88
Cancer.................................................. ..................... 23 7.25
Syphilis (including 4 general paralysis) ................. ........................ .... 20 6.30
Cerebral hermorrhage...... ....... .........................................14 4.41
Bright's disease (acute and chronic nephritis) ................. ...... ................. 8 2 52

Bodies autopsied.-The annual report for 1930, page 54, contains a
table showing the number of autopsies performed for the years 1904-
1930 in certain diseases that but rarely come to autopsy in this area.
The additions to this table for 1933 were as follows: Yellow fever, 0;
beriberi, 0; ankylostomiasis, 0; tetanus, 0; infectious diseases of
children, 1; plague, 0; smallpox, 0.
Five hundred and two bodies (not including 54 for storage only and
2 disinterred) passed through the laboratory; 317, or 63.14 percent
were autopsied.
There were 27 malaria carriers found at autopsy.
There were 30 cases of syphilis found at autopsy.
Three cases autopsied, or 0.94 percent, showed intestinal parasites.
Ascaris lumbricoides were found in each of the three cases; no search
for ova made.
Laboratory examinations of wild and domestic animals.-Cultures
* from guinea pigs, rabbits, etc., 36; autopsies and histological ex-
aminations of cows, hogs, parrots,. guinea pigs, rabbits, etc., 72;
examinations of rats for plague, 2,855.
Preparation of tissues for examination (slides), 8,864.
Chemical analyses and examinations.-Alcohol, 7; beverages, 16;
analyses of blood (nitrogen, urea, uric acid, creatinin, glucose, calcium,
Carbon dioxide, cholesterol, icterus index, phosphorus, sodium chloride,
etc., 2,311; analyses of foodstuffs, drugs, and chemicals, 616; gastric
:analyses, 532; spinal fluid, 854; drugs, for identification, 23; toxi-
cological examinations, 7; quantitative analyses of urine, 205.







26
4,
In addition to the more highly technical laboratory work ..
the Board of Health laboratory, the various sections of::*-
Hospital have laboratories in which routine clinico-pathologicalwqi
is done. The amount and character of work done by these unitaii*!
be judged from the following summaries of their activities: BIl !1:.
films examined for malaria, 13,898; red cell counts, 7,749; white i,':
counts, 9,127; differential counts, 9,030; coagulation time deterPtitia*"*' r::i .
tion, 18; Van den Berg tests, 45; sickletells, 51; qualitative naly. i :u a ::;
urine, 24,406; phenolsulphonephthalein test urine, 66; urethral smi ar.
107; vaginal smears, 170; prostatic smears, 315; stools for o.vai&.
parasites, 10,182; sputum for tuberculosis, 1,804; cell count spinal fluiily:
274; throat smears, 33; gastric contents for occult blood, 76. "
UNDERTAKING DEPARTMENT
Bodies received (including 2 disinterred and 54 for storage)........................................... S '
Bodies em balm ed ................................................................. ......... .
Bodies crem ated. .. ...... ... ........... ........................ ........................... ..... l :
Bodies buried on Isthm us ......................................................................... .i
Bodies shipped from Isthmus (including 2 disinterred) ............ ........ ... ... ..... ..... ... ..
s ..
Bodies buried at sea.......................................................................... ..

COLON HOSPITAL
(Capacity, 135 beds)
Maj. DEAN F. WINN, Medical Corps, U.S. Army, Superintendent, .
This hospital has continued to function essentially as an emergency
hospital although definitive treatment has been given to a wide range
of cases. Individuals requiring certain special examinations, for which::.;
equipment is inadequate, those with venereal and contagious diseases,
and mental and tuberculosis cases, were transferred to Gorgas Hospital
The utilities department has been active in preserving the appeatl-
ance of buildings and grounds and the upkeep of the various depart-
ments.
New construction.-The new nurses' quarters was completed add
occupied in April. This is a 2-story reinforced concrete building
with tiled roof, located just east of the inain hospital building tiaI-
facing Limon Bay. It affords commodious quarters for 16 nurs I::i::
including a suite of two rooms and bath for the chief nurse, anid '.
common bath and lavatory for each two rooms. On the second 0flSioi
there is an attractive lounge and on the first floor a reception haii:::
parlor and dining room. The kitchen and pantries are equipp iei
but have not yet been used for a separate mess. Bedrooms k:1:id%
living rooms have been equipped with new furniture. 'KI,
In August the old nurses' quarters was remodeled and cccupiei;:t
by the dispensary. The building is detached -from the main hospit ;;al
buildings. It houses the gold and maternity-pediatric clinic, t :i:t



A:.








silver clinic, laboratory, X-ray rooms, emergency dressing room, and
pharmacy. In addition, rooms are provided for the officer of the day,
dispensary office, and for temporary isolation. There are. ample and
Convenient suites of offices, waiting rooms and examining rooms for the
clinics. The laboratory is large and well lighted. The pharmacy
is well arranged and has adequate storage space. The building is so
arranged as to segregate completely white and colored patients.
In August a concrete and wood covered walk was constructed to
connect the new dispensary with the hospital. This has proven a
great advantage during the past rainy season.
In October the lower floor of the west wing of the main hospital
building was remodeled. This section, formerly occupied by the
dispensary, laboratory, X-ray department, and eye, ear, nose and
Throat department, has been converted into a ward containing eight
private rooms and a 6-bed ward. The west end of this section was
utilized for the construction of a suite of rooms for an eye, ear, nose and
throat clinic. An operating room for this department was constructed
by remodeling the existing porte coch6re.
A filing room for storing clinical records, etc., has been equipped
in the service building with steel shelving with a capacity of some
45,000 charts.
The shop and laundry facilities have been enlarged by the con-
struction of a covered area with concrete floor and a large insulated
drying room. This room is heated by an ingenious construction of
the flue leading from the fire box over which emergency laundry is
boiled.. There is no expense for fuel as only waste material, such as
old packing boxes, crates, etc. is used.
Movement of sick.-There were 4,160 admissions during the year with
a total of 31,378 patient days, the average being 7.5 days per patient.
Army personnel accounted for 8,305 patient days. There were 53,612
:' visits to the dispensary, including eye, ear, nose and throat and
surgical clinics, a daily average of 147. There were 19,384 white
Patients and 34,228 colored patients. The average number of beds
occupied daily was 86.
.< ?argical serrice.-There were 481 major operations. Included in
these there were: Appendectomy, 166; hernia repair, 48; hemorrhoid-
Sect.my,;, 4; hepatic abscess, 3; intestinal obstruction, 8; perforated
peptic. ulcer, 5; hysterectomy, 17; cesarean section, 6; uterine sus-
pension, 16; miscellaneous gynecological operations, 79. There were
S|lin2or operations; 177 fractures were treated.
r "i: ~qh0 .of new items of equipment were added. Among these
a :Iw. electric, dressing sterilizer, gas-oxygen anesthesia outfit,
and eIetinc cautery.


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







28 ...

Obstetrical senrice.-There were 368 deliveries during the year.,;
There were 17 sets of twins, 11 forceps deliveries, and 6 cesareat '
sections. An active well-conducted prenatal clinic is maintained.,
Medical service.-The general scope of the work has been satisfactory :.
in both volume and variety. No serious epidemics occurred during;
the year.
Eye, ear, nose and throat service.-This service was established in the
latter part of 1932. It has grown to be one of the largest and most -
important departments of the hospital and has filled a very definite.
need for the population on the Atlantic side of the Isthmus. During -
1933, 1,176 operations were performed; 9,503 treatments were recorded
for hospital patients and 5,713 treatments were given out-patients. *
Refractions numbered 698. The following abbreviated statistical.
report of operations is submitted as an indication of the scope of the.';
work performed: Mastoidectomy, 8; cataract operations, 20; ptery-
gium transplant, 94; trephine, 6; enucleation, 5; foreign body (cornea),
33; plastic of eye, 19; correction of ptosis, 3; correction of squint, 12;
submucous resection, 139; sinusotomy, 40; radical antrum, 7; radical .
frontal, 11; ethmoidectomy, 10; plastic (nose), 8; plastic (ear), 4;
cartilage inlay (face), 1; miscellaneous, 756.
X-ray department.-There were 1,349 examinations made during
the year. New and modern equipment was installed upon completion
of the new dispensary building so that this department is now able
to do a more satisfactory and varied type of work than formerly.
Laboratory.-Only routine work is done, serological and pathological
work being performed by the Board of Health laboratory, Ancon, C.Z.
The laboratory in the new dispensary building is well lighted and
adequate space for expansion is provided.
Dispensary.-The Colon dispensary is conducted as a department
of Colon Hospital. The combined gold and maternity-pediatric
clinic is under the direction of the district physician who is also in
general charge of the entire dispensary. Both white and colored
patients are cared for in this clinic but the hours and waiting and.
examining rooms are so arranged as to segregate the races. The' .;:;:
silver clinic is conducted by members of the hospital staff assigned ,.:
in rotation.
COROZAL HOSPITAL
(Capacity, 550 patients) ..
Maj. F. H. DIXON, Medical Corps, U.S. Army, Superintendent

Purpose.-Until recently this institution served to accommodate the
insane of the Canal Zone and of the Republic of Panama, the latter

:tI.








class of patients being cared for at the expense of the Republic at a
fixed rate of 75 cents per day. However, during June and July of
1933, all of the latter class, totaling 592 patients were transferred
to the Retiro Matias Hernandez, an asylum located on the Sabahas
road about five miles from Panama City, and erected during recent
years for this purpose. American or alien employees of the Panama
Canal, disabled by reason of injuries or chronic diseases, or enfeebled
by advanced age, who desire to enter the institution, are cared for in
Corozal Hospital.
As a result of the exodus of this great number of patients, six of the
old wooden structures were sold and torn down, and all male and
female insane patients consolidated in the new 2-story concrete
building completed in November 1931, while the cripples and chronic
patients are now quartered in the concrete structure formerly used
as a ward for insane women patients. To make these buildings
suitable for this purpose certain alterations were necessary, such as
removal of sliding doors and screens, constructions of new doorways,
installation of handrails along stairways, the erection of new walls and
partitions to separate the male from the female patients, and arranging
space for dining halls. These changes were all made by hospital
personnel under the supervision of the general mechanic. The
concentration of all insane patients in one building promotes efficiency
and also makes it possible to operate with more limited personnel.
At the same time, removal of the six wooden structures which were
no longer needed reduces the cost of maintenance for painting and
repairs. One building, ward "B," also of wood construction, being of
nore recent origin, was retained to provide for emergencies and will
accommodate about 160 patients.
A new cemetery tool shed to replace the old building, which was
too small for present requirements and in bad state of repair, is being
erected by hospital labor under the supervision of the general mechanic,
at an estimated cost of $350. This tool shed is more centrally located
than the old building, since the cemetery area has been enlarged and
new roads constructed in the 40-acre plot recently added. Con-
diderable work remains to be done in connection with the enlargement
of the cemetery, and it will be necessary to relocate the boundary
fence, erect additional gates and construct paths through the new
Section.
Routine, painting and repairs to woodwork, steel doors, window
frames, plumbing, boiler and steam lines, and filling and grading of
hospital grounds, have been performed by hospital artisans with the
help' of patients.







30 lI

Insane patients.-The census on December 31, 1933, was 178, a
compared with 748 at the end of the previous year. The nntuBe:
admitted was 247, as compared with 338 for 1932. There wre :8i
discharges and 3.1 deaths. There were 'no suicides, but one -de aiith'4:"
resulted due to altercation between two patients.
Other patients.-There were, on December 31, 73 black and 6 w ite" ':::i6
chronically ill or crippled inmates (not insane), as compared with 59'
black and 5 white of this class at the beginning of the year. Twet...:
four were carried on the pay rolls, employed as broom-makers, janitor,
and laborers. The broom-makers manufactured approximately 260 .
brooms per week.
Recreation.-Because of the reduction in the number of patients and"
the limited personnel, the weekly moving picture shows were di.-
continued in July 1933. However, band concerts through the courtesy
of the 1lth Engineers Band, Corozal, are provided about every other
week, unless Army maneuvers or other duties prevent. Refreshments.
in the form of candies, cookies, cigarettes, tobacco, etc., are distributed .
among the chronic and insane patients, the latter receiving tbis.0'
distribution in lieu of cash in case they are employed on the patients
pay roll. Church services were conducted once a week for the Cath- I
olic and Protestant patients. However, in view of the limited number
of Catholics remaining since the transfer of patients to Matias Her-
nandez asylum, such services have been discontinued since July 1933.
Treatment.-Intensive specific treatment was given to patients :
suffering from syphilitic psychoses. Three hundred and seventy-
three doses of arsphenamin were administered intravenously, and 219
lumbar punctures were made. At the end of the year there were 29
patients suffering from neuro-syphilis in some form; 25 of these were
males and 4 females.
Occupational therapy.-Because of the transfer of approximately ":
77 percent of our insane patients, the very limited number of remaining
patients and the need for economy, the occupational ward was d4iu.
continued and the services of the female nurse formerly in charg..t .
dispensed with.. .
In addition to the male patients engaged in the occupational ward::.
there were others employed in agricultural activities. The value .. .C'.
the produce taken from the patients' garden for hospital .consumptIop' .
amounted to $1,209. The more vigorous females were assigned to. ",
tasks in the laundry, sewing room, or salvage department. Aa,. ..
result of these various undertakings, between 75 and 80 percent of tit -.:
patients are engaged in some form of work. All of the hospita..'::i
laundering, with the exception of some bed sheets and. pillowca% '
and all of the nurses' uniforms, was done by the patients. ,:

':








Farm.-Repairs to fences were made, and pastures cleared of brush
P- during the dry season by cutting and burning pasture. There were
24 cripples employed on the farm and hospital at the close of the year
as.compared With 22 at the beginning of the year. These men are
employed in the garden, piggery, steam plant, cemetery, etc. Seven
(including two chronic patients) are tending plots of land in the farm
reservation, which they cultivate as gardens andthey are paid on an
actual production basis.
PALO SECO LEPER COLONY
Dr. EZRA HURWITZ, Superintendent
There were 106 patients at the Leper Colony on January 1, 1933.
Seven new cases were admitted, seven patients died during the year;
none were paroled and none absconded. At the close of the year 106
patients remained, 91 for the Republic of Panama and 15 for the Canal
Zone.
: Of the 7 deaths of lepers, all were autopsied at the Board of Health
laboratory and, in accordance with the preference of the Manual of
Joint Causes of Death of the Bureau of the Census, the cause of
death was recorded as leprosy in all cases; the contributing causes of
death .were as follows: One chronic glomerulonephritis; 1 amyloid
disease of the kidneys; 1 abscess, lower lobe, left lung, ruptured into
pleura; 1 pulmonary tuberculosis; tuberculosis of the vertebral column;
I peptic ulcer; perforated duodenum; peritonitis, acute, generalized;
in 2 cases no lesions other than those of leprosy were found.
Intramuscular administration of the iodized esters of Hydnocarpus
uightiana was continued as the routine treatment. Injections were
given twice weekly, and although attendance was not compulsory, all
patients except six reported with regularity for treatment:
In April the Municipal Division completed installation of the water
Sline from Balboa to the colony. The well, which has been the
p principal source of water (highly mineralized), but had never given a
sufficient supply during the dry season, has not been abandoned, but
will be kept in condition for use in emergency.
SIn June, electric equipment consisting of two ranges (replacing
the unsatisfactory oil-burning ranges), one stock pot and one water
Shelter were installed in the kitchen.
i., In July a graded road with a light surface of crushed stone was
""i.eed between Thatcher Highway and Palo Seco; and the launch
Pi:. ::Seco HI which had been used for transportation until then was
!!Eii ed' oer to e the Section of Surveys. The colony was provided
ti..ril:::lb~ance which is adequate for the present needs of the
qF4~lony







32

A number of patients W'ere permitted to visit.relati-es in Paniinl ij:
City, always attended by an officer of the Panama Health office,'ari':~'
one patient, with the permission of the Panamanian authorities: iwa: 's:
permitted to visit her aged mother in Los Santos. .*;:
It would be desirable to separate patients in their quarters accotding*:l
to the severity of infection. Under present conditions this is practiP.::
call impossible, as patients iA the same approximate stage of *: ii
fections are often temperamentally unfit to associate peacefully. ::Idi
planning future building at the colony, arrangement should,.be mhde'
for each patient to be quartered in a separate room.
With profits accruing out of the resale storeroom, the colony ptr-. .
chased a new projector for talking motion pictures. Three motion
picture agencies in Panama (Metro-Goldwyn-Mayer, Paramount, 1
and Radio-Keith-Orpheum) each furnish the colony with one show:
weekly, without charge. The excellent pictures shown have been a.
great source of pleasure and contentment to the patients.
The Palo Seco band received as gifts a saxophone from Mr. Danner,
of the American Mission to Lepers, and a clarinet from Dr. Barbour:
of Boston, Mass. Other donations received, were from Woman's
Auxiliary of Gatun Union Church, $10; Cristobal Women's Club, $5;
and gifts of clothing to each patient .were given through Father.
Lawler of St. Mary's Church.
The allowances made to the patients during the year was 11,896;"
$1,164.33 worth of farm produce was bought from 29 patients; 54:..
patients were employed in the colony and earned $3,110.73.

DIVISION OF SANITATION ,
The end of the dry season of 1933 was notable for an apparently .
unusually large invasion of anopheline mosquitoes into the sanitated
areas, the probable reasons for which have been discussed elsewhere ii
this report. The continued growth and spread of Chara and other'
aquatic plants in Gatun Lake contributed largely to the increase in
the numbers of anophelines. -
In the Rio Grande hydraulic fill west of the Canal near Balboa, I&:..
large drainage channel made in the soft mud by dynamite loweredii:!
the surface of the waters somewhat, but this area cannot be brouighti:,
under satisfactory control until the whole area of more than a squaree' *::
mile is filled to an elevation of several feet higher, or an additional '::
spillway, with its sill at a considerably lower elevation, is built. The!"
Rio Grande fill and spillway at first impounded a large lake of brackish-::':"
water with no outlet at low stages, simulating quite nearly the largij i
brackish swamps of the Atlantic sided and here, for the first time it.'.:.;:,;
*






33

our experience, Anopheles tarsimaculatus was found breeding on the
Pacific side of the Canal Zone. Adults were taken on the screens of
Nearby quarters and at Fort Clayton, two miles away.
The large hydraulic fill in the Thatcher Highway area developed, as
is customary in such fills, myriads of deep cracks during the dry season,
arid when the rains and run-off from the hills had filled these with
water they became prolific in breeding of Anopheles albimanus and
.,Aedes taeniorhynchus larvae. It was necessary on two occasions
S(November 20 and December 21) to dust this fill with paris green
from an airplane.' A five percent mixture of paris green with pulver-
ized clay was sufficient to destroy most of the A nopheles.
It was not necessary to use the airplanes in dusting the swamps at
Old Panama during the rainy season of 1933. Straightening of the
channel of the Rio Matias Hernandez through the western part of the
swamp improved the drainage of this part considerably and the fact
that cattle were not pastured in it as much as usual gave the swamp
vegetation a chance to krow and shade the area. Breeding occurred
only in small patches and was controlled by hand blowers dusting
with a one percent paris green mixture.
The new golf club building in the Sabanas northeast of Panama
City has proved very popular as an evening resort for its members and
guests, therefore it was necessary to improve the drainage of this area
to prevent mosquito breeding. The open streams were trained and
paved with 14-inch wide hemicylindrical precast concrete sections,
4,523 linear feet being so installed. At acute bends the banks of the
streams were rip-rapped with large stones. Also, 903 feet of subsoil
Stile were installed there. The golf club furnished part of the material
and the greater part of the labor for this undertaking.
SExperiments were begun with mechanical and animal traps to
catch adult mosquitoes, but the work has not sufficiently progressed to
"report results as yet.
Malaria surveys of employees of the Canal and contractors engaged
in large Canal undertakings in unsanitated areas were continued
throughout the year. All persons found carrying the plasrfiodia of
Snalaria were treated in an effort to reduce the number of carriers and
': clinical cases. It is believed that the results have justified the effort
i:. and expense.
!; : he enlarged new open grate incinerator at Summit, for the destruc-
;ii.n .of the garbage of Ancon, Balboa, and Panama City, was placed
;in 3o:pere'ation in April 1933. While during the dry season, with brisk
orth ..i s, the.garbage burns almost completely in 24 hours, it was
giwiauqt dusting was necessary on Ja uary 9, 1934

.......
'.ii"i:.: :....." :i ': i iE. ..: .




: L::. ..:!

34, !

found that during the season of rains and variable winds it reqit .
at times, nearly 72 hours for complete incineration. Theref~oreii
incinerator was trebled in size over its first design, allowing -grg:l.
.capacity for 3 days collection in serial order on the grate. "It disp .
of about 300 cubic yards of mixed garbage and rubbish, inclidt
large dead animals, daily. Because of its location in the ope^i til:::.
try 12 miles from Panama, the smoke.causes little or no nuisait&i.l:
The garbage is unloaded from a ramp near the city by motor d~. i
trucks, into chain cradles in specially constructed steel railroadt"'1 4
and hauled to the grate by rail. It is unloaded from the cars by...
crawler type tractor drawing out the chain cradles and emptying then.
on the grate, 15 to 20 cubic yards at a pull.
The grates of the incinerator are constructed of old railroad rails;
cut in half-lengths, and no trouble has been experienced from bucdift
of the rails as no fire or accumulation of ashes is permitted beneath;theb
grates. Comparatively very little fuel is used to burn the garbage.
The fires are started by small piles of scrap'wood, old railroad ti;,:
and rubber tires laid at intervals on the grates before the garbageis.
placed upon it. Once started, the fires burn through the. pile, within "a'
single stoker on hand to keep pulling unburned garbage over into 6thi.
burning piles. Wet manure from dairy and horse barns proved most
difficult to burn, the principal feed here, even in city stables, being....
green grass brought in from the country. This difficulty was o'v`',::..
come by dumping all manure into the sea, over a high sea wall, where
the tides effectually dispose of it without nuisance,
Notwithstanding that the breeding of various species of flies ap-
parently was under'careful control.at the garbage disposal dump in,
Panama City during the last three years of its operation, the change in
method of disposal-discontinuance of disposal dump and removal iof
all garbage from the city and its incineration at Summit-has resulted-
in a still further reduction in number of flies in Panama, more partie..-
larly those species which breed in decaying animal matter. :.
(See pages 18 to 21 for additional information on anti-malaria- wok

REPORT OF THE HEALTH OFFICER-PANAMA' :i..
Dr. JESSIE L. BYRD, Health Officer '
Dairy farm inspections.-All dairy cattle are tested 'once a yeai rf
T.B. reactors; any reactors found are either slaughtered or isolat
from the dairy herds. Three thousand one hundred fifty-two. dairyf
cattle were tested for T.B. during 1933, the intradermal test bfein:i'
used, and 264 reacted positively to the test. Ninety-one of th
'








actors were from two farms, the owners of which have never given
this department any cooperation in the prompt handling or disposal
of their reactors. .The other 18 dairy farms are practically free from
:.: T,.B. at present. All dairymen are improving their stock by the
importation of pure-blooded Holstein, Guernsey or Jersey cattle, and
by crossing them with the native stock. Most of the dairy farms now
have dipping vats and their cattle are almost free from ticks.
Milk inspection.-This work starts at the dairy farms, where the
inspector makes frequent checks on the sanitation of equipment,
methods of handling, technique of milking, etc. He collects samples
at the dairy, at the pasteurization plant, in stores and from delivery
trucks. All milk sold retail in Panama is pasteurized and bottled at
one of 4 pasteurization plants. While the consumption of fresh milk
in Panama City is increasing, and will, no doubt, continue to increase
somewhat, it is my opinion that fresh milk will never become a national
drink or food here to the extent that it is in other countries. The
present supply (about 1,300 gallons per day) is more than adequate
to supply the demand (about 5,500 bottles or 1,100 gallons). Only
about five percent of the population can afford to purchase fresh
milk and have iceboxes or refrigerators in which to keep it. Milk
-usually is sold in bottles containing one-fifth of a gallon. The present
retail price is 15 cents a fifth-bottle (75 cents a gallon). Five years
ago the the retail price was $1 a gallon. The fresh milk on sale in
Panama City is considered grade "A" pasteurized milk. However,
there are one or two dairy farms which could improve their product
and they*will no doubt do so when the new milk ordinance goes into
effect. It will allow us to grade raw as well as pasteurized milk, and
in that way will prevent the mixture of good and poor grade milk as
sometimes happens now.
;::Public health.-There have been no epidemics during the year. The
communicable disease rate remains about the same as last year, except
for amebic dysentery which shows a great increase during the past
seven months as shown by the following number of cases reported:
June, 14; July, 11; August, 26; September, 23; October, 25; November,
"41; December, 58.
The reason for this sudden increase in amebic dysentery is unknown,
but is probably due to better reporting on the part of Santo Tomas
Hospital physicians. The infection in more than two-thirds of these
i.t.as.e was.definitely traced to places in the interior of Panama, where
.*Mtajority of the patients resided. The deaths of residents of Panama
so::. !amiebic dysentery have been as follows for the past five years:
i;:, i930Q, 1; 1931, 3; 1932, 2; 1933, 9.
i .. :. : '....

D1:11aF"i I.t.
0 ? .. '/: .:i, .",
M'i',:. .Er:':' .: .: '":::::: E. :: a : "it'." .';' ..::, .,,







36

Garbage collection and disposal, and street cleaning.-
tollected nightly in Panama City, Ancon, Balboa, and Alb ikA
an area of three square miles, and a population of appr
91,500 people, with the following equipment and force: Oneasil1
inspector (American); 2 foremen; 30 laborers; 7. trucksof itpti.
(one of which collects rubbish and manure during the day:) i
average a little more than 8 loads daily.
The following shows the gross cost of garbage collection, andi
posal of garbage and rubbish from Panama City, Ancon, Bab.8 u
Albrook Field, and Fort Amador, and of street cleaning in Panarnzti
during the year. The tonnage shown is considered fairly acurM
and was arrived at by the actual measurement of the trucks wjlh -ji
without top-load. The six night trucks average three cubic yard
without built-up sides and without top-load, and five and omejp
cubic yards each. with built-up sides and top-load. These Asp"l
check almost exactly with the yardage of the garbage cars whbid
known to be 75 cubic yards each. Three cubic yards are fipure4d
weighing one ton:
Garbage and rubbish collection, Panama City: ..K.4
Collected by Health Department -------------------tons ."29,41
Cost of collection-
Total.-----.------- -------------------------- 10010M39
Per ton ---------------------------------------- -------_ _
Per capital (79,000 population). ---------- .-- ------ -
Garbage collection, A ncon, Balboa, Quarry Heights, Albrook Field: (Rubbish n hig
places not collected by Health Department):
Collected by Health Department-------------------------tons-.. 64
Cost of collection-
Total_------------.---------------. ----------------- A16,3S
Per ton ----------------------- ------------------ --
Per capital (10,700)------------- ------------------------, fi t
Garbage disposal, Panama City, Ancon, Balboa, Quarry Heights, Albrook .Rdil#iu
.A mador:
Collected by Health Department-------------------------tons- 3
Delivered to railroad garbage cars by others ----------- -- tons -
Total garbage disposed of------------------------ --ton!s-, i
Cost of disposal-
Total.------.--.--_--_----------------- ------------ $252367
Per ton ----------- ---------------------- ----r------ --tf
^er capital (91,500 population)__ _......------------- ..
Rubbish disposal, Panama City, Ancon, Balboa:
Manure dumped over sea wall (October to December) ---ton
Delivered at dump by Health Department-- --------...----tons-
Delivered at dump by others ---.---,--t ---.-.. -tons 1
Total-------------- -- --------------- ------------tonsf.f Sl

.. .. ..

I.. .
I:*.* :-* .r -.




g :. .......


S. 37
*:". Ci::ty ... ;
: 1 tosa, Pana*a City, A con, Balboa-continued:
.Cost of disposal (salary of one man arid maintenance of road)-
S : tal --.--.-------------------------------------------- $988.00
"ii Per ton_.-------------- -- -- ------------------------- 07
I,: Per capital (88,700 population) ---------------------------- .01
b' STREET CLEANING-PANAMA
,l Total co .of street cleaning ------------------------------------- $22,771.63
I0 'Otf t street cleaning per capital (79,000). --------------------- .29
"'::n April 1933, the enlarged open-grate incinerator at Summit was
:;;t into operation, and since then all garbage from the Pacific terminus
hak been disposed of there; also, all manure from the city of Panama
rw*as'isposed of there from April until October 1933, since which time
i?: has been dumped over the sea wall on the edge of Panama City,
without creating a nuisance.
: The tow cost of collecting garbage is due to the system in effect.
which may be described briefly, as follows: The laborers are divided
into what is known here as pullerss or players," loaders and replacers.
The puller precedes the. trucks by about two hours in residential
districts and collects the garbage from each household can, placing it
into a large galvanized tub; when the tub is full he empties it into a
S.regulation garbage can and places the full can alongside the street.
,..he truck hs a driver and three loaders; two of the loaders ride on the
'-.unning board of the truck and when the truck stops for a can there
i;1is.no delay; the can is passed quickly to the loader on the truck who
empties it and passes it back, all in one motion. In the business and
i. tenement sections the pullers precede the trucks only about 30 minutes
.!: ;p ope hour so that cans will not remain on sidewalks to be upset by
iil.schievous boys and by dogs. This method permits rapid loading and
~*di uces truck hours to the minimum. The average round-trip time
Pe truck in the residential districts of Ancon and Balboa is about 60
iiu:ainutes; this-time is reduced to 50 minutes in Panama City where the
uilasity of population is much greater.

lPO$RT OF THE HEALTH OFFICER-CRISTOBAL-COLON
Dr. JESSE C. ELLINGTON, Health Officer
!emra k.-There were no epidemics during the year and the com-
ble. disease report. compares favorably with reports for previous
The general death rate of 16.27 is only slightly higher than the
average. The infant mortality rate of 114.96 is much higher
tI"rate for 1932, but only slightly higher than the average for
p.. 1927-1931. The infant mortality rate andthe tuber-
-trate of 3.5 no doubt reflect the poor economic conditions
.. t ..' .. ... ..
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fMt. Hope cemetery.-One thousand forty (1,040) square "yar
new road were constructed in the cemetery during the year by M 4
ipal Engineering Division forces, which greatly facilitates thrhi
dling of funeral processions. There were 493 burials, the recSi
amounting to $3,413. Miscellaneous receipts amounted to .$2i'2,.:
Street cleaning, garbage collection and disposal.-No changes wete
made in the methods of handling this work and the results wen
entirely satisfactory. Burning and burying of garbage and rubittWI
at the dump was carried out without fly breeding or other sanitary
nuisances.
i: .' '
Garbage and rubbish collection, Colon:
Collected by Health Department------------------------- tons-- 17,916
Cost of collection-
Total.--.-------.-------- ---------_ _----_ _----------_ $26,0304.
Per ton --------------------------------------- --- ------
Per capita'(30,000 population) ---------------------------------.

Garbage collection, Cristobal and Mount Hope: ..c





"." ." .
Garbage disposal, Colon, Cristobal, Mount Hope, France Field:
Delivered by Health Department ----------------------- tons- 18 107




Delivered by others-----------------------------------tons.. 254

Total---------------------------------------------tons.. 18,3f1
Cost of disposal-
Total_ ---------------------------___---------------- 11,57.4 i
Per ton -------------------------------- ----.--------- .3
Per capital (37,047 population).... ---------. -- -----

Rubbish disposal, Colon, Cristobal, and Mount Hope:, F ce Fel:
Delivered by Health Department---------------------- tons-. 2,8





Delivered by others----------------------------------- -tons 3,8
.'. ----










Total ----------------------------_ _------------ tons.. 6,628'
Cost of disposal-
Total .-----------------.--.----------------------,5---- $6500
Per ton --------------- ---------------------------.----
Per capital (36,247 population)--------.. ------.... ---- ---- -- -i

ureebb disposal, Colon ( not including New CriMtobal): ...."'.'
Delivered by Health Department .....-----------------..... ........... -, .
Delivered by others ---- ---- ---- ----- ---- )_---- _tons_- .



Total cost$---- -------------------- ---------t 6,.."
Per ton s,-etp------------------------------------
Per capital (36,247 population) J--.---------------

Street cleaning, Colon (not including New CriMtobal): ": ,: ..
Total cost------ ---------'-----
Cost of street cleaning per capital (28,000 population) ------- -.----.,









I ; Free clinic-Following is report of cases treated and other work
Done during the year:
Eye, ear, nose and throat (clinic visits) ---------------------------- 506
Prenatal and postnatal (clinic visits)_--. ---.----_------------ ---- 1,897
Babies (clinic visits) ----------------------------------------...... 2,230 .
Dental (referred to Dr. Doten) -----------------..----------------- 20
Formulae prepared---------------------------------------------- 8,741
Medical and surgical (clinic visits). -------------------------------- 131
Referred to hospitals ---------------------------------- -------- 125
Other work by district nurse:
Home visits ----------------------------.-- ----..-------------. 2,973
Vaccinations-----------------------------.------------------ ---- 3,109
Specimens to laboratory ------------------------------------------ 454
Mosquito and rat work.-Very few mosquito complaints were regis-
tered during the year, except during seasonal flights from points out-
side the city. Daily catches were made as an index.
Rat catching to serve as an index was also carried out throughout
the year and 4,704 traps were set, 1,152 rats caught, and 386 rats sent
to the laboratory for examination.
Inspection of food establishments.-Two hundred ard three permits
were issued to restaurants, hotels, dairies, milk plants, bottling plants,
soft drink places, etc., and 48 permits were subsequently canceled due
*to establishments going out of business. Inspections were made as
follows: Bakeries, 666; dairies, 196; milk plants, 421; bottling plants,
355; markets, 1,466; ice cream plants, 357; restaurants, 2,233;
soft drink places, 2,119. Samples of soft drinks, milk, ice cream,
caustic solutions and foodstuffs to the number of 592 were sent to the
laboratory.
Dairies were maintained in good condition and 1,979 cattle were
tested for tuberculosis. Five reactors were slaughtered.
Animal quarantine inspections.-Inspections were made as follows:
Cattle, 186; mules, 120; horses, 58; dogs, 18; monkeys, 15; guinea
pigs, 10; circus animals, 10; miscellaneous, 21.

REPORT OF THE DIVISION OF QUARANTINE AND
IMMIGRATION

Dr. CHARLES V. AKIN, Surgeon, U.S.P.H.S., Chief Quarantine Officer

The activities of the division show an increase over the year 1932,
most of the increase taking place during the closing months of the year.
No significant changes in quarantine procedure took place, but the
.:;closing month of 1933 saw a general tightening up in immigration
I;equiiireinents. Every effort will be made in the future to restrict




t.. "
' ..4 :"
I ".








40


admissions to the Canal Zone and to the Republic of Panamai: ti
such persons as give every guarantee that they will not become.pi*. 4
charges.
In addition to the duties incident to quarantine and immigr
procedure the Chief Quarantine Officer is assisting in reviszm %
sanitary code for the cities of Panama and Colon and in prozt
personal hygiene activities among the civilian employees of the.':
with particular reference to school groups.
The Chief Quarantine Officer also acts for the United States i
Health Service as medical officer in charge of medical rpliei
merchant seamen and other beneficiaries of the service. ,
The following table summarizes the activities for the year;.. .

Balboa Cristabel T


Vessels boarded and passed ....................... ............
Vessels granted pratique by radio.........................................
Total ..............................................................
Crew passed for quarantine...............................................
Passengers passed for quarantine...................................... ....
T total ................. ... ............................... ...........
Airplanes inspected and passed............................................
Crew of airplanes inspected and passed. ................. .................
Passengers of airplanes inspected and passed...............................
Total .................................................
Vessels detained in quarantine................... ..... ...... ..........
Crew and passengers detained aboard ship for quarantine ....................
Persons admitted to station on account immigration laws.....................
Number of detention days for the year..................................
Persons held for investigation and released...................................
Persons deported under immigration laws...................................
Supplementary sanitary inspection of vessels ................................
Vessels fumigated. ................. .........................
Box ears fumigated.......................................................
Deratization exemption inspections................... ..........
Revenues
Subsistenee........................... .... .... ... .......................
Night boarding of vessels....... .........................................
Fumigation of vessels...................................................
Fumigation of box cars...................................................
Deratisation exemption inspections ..................................... ...
Rations issued ...........................................................
Rats recovered after fumigation of vessels..................................


Numb
Averaj
Averaj


2,426
30
2,462
123,571
37,077
160,648
30


5 ,
.

4`01i
47 A 8

~.,8 ;


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i"


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129 3.331 8
2 2 ........... ,
735 .......... 3 :
985 ..........
5,698 .......... ..; .
8 42 S
438 490
745 2.740 ", i.
13 26 3.
91 34 12t
6 4 i. 4
$8,849.45 .......... ss, AtL:
2,550.00 3,850.00 6.40
890.50 1,205.10 2.SS
106.21 48.25 1
120.00 60.00 17aIfl


10,978 .........


*t[


REPORT OF THE DISTRICT NURSE FOR THE

PACIFIC DISTRICT ::

er of baby clinics maintained--.---------------------------- :.
ge number of babies enrolled per month-.--..------,---------,--
ge number ot babies visiting clinics per month -------------.---

U. ., : l
... ...., .



....... .. ....
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41

.Tntoal numbrier of visits to clinics -- ---------------------------- 4,553
Sta~ber of visits to cases of tuberculosis --------------------------- 56
iotal number of house visits ------------------------------------- 960

'. Rid Cross home hygiene classes were continued weekly at La.
Soc. a and Red Tank until the course was finished. At La Boca, 15
i" girls took the final test on April 27, and 14 received certificates from
Wi shington on June 24. At Red Tank, 11 girls took the final test
Son June 30, and 7 received certificates on August 18 from Washington.
The district nurse assisted with the examination.of school children
on the Pacific side, and with the tubeiculin tests which were started
late in the year and are still underway.
In December the baby clinic at Ancon was temporarily discontinued
and a baby clinic started at the Panama Health Office, Panama City,
Sat the request of the mothers in Panama who had been coming to
Ancon.









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GENERAL TABLES


TABLa I.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES
FOR EMPLOYEES

ABSOLUTE NUMBERS
A


Year 1933:
White.............
Black.................

Total .............
Year 1932:
White.................
Black................

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


3,244
9,100

12,344

3.387
9.234

12,621


Discharges from and
deaths in hospitals


E-

1,153
1,873

3,026

1,113
1,821

2,934


1,070
1,593

2,663

1,050
1,583

2,633


83
280

363

63
238

301


ANNUAL RATE PER 1,000 EMPLOYEES


Year 1933:
White................. ........ 355.43 329.84 25.59 4.93 4.62 .31 ........ 19.49
Black................. ........ 205.93 175.16 30.77 10.00 9.01 .99 ........ 16.57

Total.................... 245.14 215.73 29.41 8.67 7.86 81 ........ 17.33
Tear 1982:
White................. ........ 328.61 310.01 18.60 5.02 4.43 .59 ........ 17.06
Black...................... 197.21 171.43 25.77 10 40 9 42 .98 ........ 17.06

Totl.................. 232.47 208.62 23.85 8.95 8 08 .87 ........ 17.06


. '*


Total deaths


is


5 -





23,072
55,026

78,098

21.151
57,666

78,817


I
-d



1
9

10

2
9

11


.5


15
82

97

15
87

102


E-

16
91

107

17
96

113


-C.

0


. 4


63.21
150 76

213.97

57 79
157.56

215.35


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46 ,' .


TABLE 3.-DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND TE CITI8 OPF
PANAMA AND COLON *
a':"i


Place



Year 1933:
Panama ................
Colon. ....... .. ..
Canal Zone ............

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

Year 1932:
Panama... .. ....
Colon...... ............
Canal Zone..............


Popula-
tion



79.000
30,000
42,851


Deaths
. ,


Total


1,181
488
305


Disease


1,130
469
271


External
causes


51
19
34


Annual rate n 1,000 ::'
populatd on


Total


14.95
16.27
7.12


Disease


14.30
15.63
6.32


151,851 1.974 1,870 104 13.00 12.31 1


77,500
30,000
42,070


1,232
433
307


Total .............. 149,570 1.972


1,171
405
272

1,848


61
28
35

124


15.90
14.43
7.30

13.18


15.11
13.50
6.47

12.35


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TABLE 6.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES,. 1l.


White employees from the United States:
D disease .............. .................................. ......... ............. .........
External causes ........................................................................
Total ................................ .............................................
Families of white employees from the United States:
Disease ..............................................................................
External causes.........................................................................
Total .............................................................................
White employees from the United States and their families:
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External causes ................................................................
Total .............................................................

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


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Tan. 9.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED AND AVERAGE NUMBER IN
HOSPITAL EAGH DAY OFJTHE VARIOUS CLASSES OF PATIENTS, 193.

Number of days treatment Average number in hospital each day
Class of patients
Ameri Ameri-
can Foreign Black Total can Foreign Black Total
tn ForeignIBlckToa


Garga Hospital:
Employees ......... ..........
Army............. ......
Navy ........................
Panamanian Government ........
Charity ......................
All others .......................


8,090
48,690
1,539
4
5,248
11,895


3,423

5
2,306
10,436


19,603

56
6,257
31,740


Total.................... 75,466 16,170 57,656


Corosal Hospital:
Employees....................
Army .................. .....
Navy ........................
Panamanian Government........
Charity .......... ...........
All others ....................
Total.....................
Cripples. ...... ..... .......
Chronic, medicalandurgical cases..
Colon Hospital:
Employees.................
Army.............. .....
Charity .......................
All others ...................
Total .....................
Palo Seco Leper Colony:
Panamanian Government........
Canal Zone Government........


226
3,059
6
675
2,136
6,102



864
8,197
738
3,101
12,900


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


Total by classes:
Employees....................
Arm y............... .........
Navy........... -.........
Panamanian Government........
Canal Zone Government, charity,
cripples and chronics........
All others...................
Grand total..............


9,180
59,946
1,545
4

6,661
17,132


197

17,077
4,190
6,591
28,055
1,095
1,836

25

288
1,751
2,064


9,355


90,327i
9,335
29,239
138,256
7,118
23,647

3,834
2,441
10,139


16.414 31,378


1,460 26,757
182 6,023


31,116
48,690
1,539
65
13,811
54,071
149,292

9,778
3,059
6
107,404
14,200
37,966
172,413
8,213
25,483

4,723
8,197
3,467
14,991


22.16
133.40
4.22
.01
14 38
32.59
206.76

62
8.38
.01
1.85
5.85
16.72



2.37
22.46
2 02
8.50
35.34


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6,205 .......


1,642 32,780 34,422


3,645

18,542
9,897
18,778


32,792

117,140
54,821
71,118


45,617
59,946
1,545
135,686
71,379
107,028


25.15
164.24
4.23

18.25
46.94


94,468 50,862 275,871 421.201 258.82


9.38

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6.32
28.59
44.30

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46.79
11.48
18.06
76.86
3.00
5.03

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.79
4.80
5.65

4.00
.50

4.50

9.99

50.80
27.12
51.45


53.71

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17.14
86.96
157.96

25.63

247.47
25.58
80.11
378.78
19.50
64.79

10.50
6.69
27.78
44.97

73.31
16.50
89.81

89.84

320.93
150.19
194.84


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85.25
133.40
4.22 H
18
37.84
148.14

409 02

26.79
8.38
.01
294 26
38.90
104 02
472.36
22.50
69 82

12.94
22.46
9.50
41.07
85.97

77.31
17 00
94.31


124.98
164.24
4.23
371.74
195.56
293.23


1,153.97 '


TAsla 10.-CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1933

All classes of patients White Black Total

Admissions to hospitals, excluding Corosal farm (cripples and chronic ward)..... 9,189 6,855 16,044
Admissions of employees to quarters....................................... 3,646 3,882 7,528
Total admissions to hospitals and quarters............................ 12,835 10,737 23,572
Lea number of patients transferred between hospitals and from quarters to hos-
pitale, whose admissions are duplicated in the above figures ................ 250 338 588
Net admissions to hospitals and quarters. .......... ............ 12,585 10,399 22,984

Employes only
Employees admitted to hospitals........................................... 1,171 1,960 3,131
Employees admitted to quarters .......................................... 3,646 3,882 7,528
S Total admiione of employees........................................... .4,817 5,842 10,659

Cli mber transferred between hospitals and from quarters to hospitals, whose
S dmis ns are duplicated in the above figures ........................... 55 174 229

*. etadnimioMa of employees..................................... 4,762 5,668 10,430
S adiionratepr ,000employees to hospitlsand quarters.............. 1,467.94 622.86 844.94





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TABLE 11.--REPORT OF DWPENSARIES, 1933 8


EMPLOYEES TREATED IN QUBTBRS


SDispensary

I X4`


Remaining
January 1,
1933

White Black


Admit


Whe# ]


Ancon ........ 1 13 764 1
Balboa .. 3 1,516
Pedro Miguel....... ....... 342
Gatun.......... I .. : 139
Colon................... 8 26 874 1
Madden Dam.......... ...... 1 11

Total............... 15 43 3P646 3


Dispensary furnishing treatment


ted Died Discharged Transferred Deatembe : :
-- ----- ----- --- -- ---- "-;
31,, 1983i nl

Black Wlite Black White Black White Black White B] ikl

3 ...... ...... 735 1,140 29 62 '1 .g
771 .... ...... 519 774 ...... 2
450 ........... 342 446 ...... ...
226 ...... ...... 135 218 5 7 .....:
,124 ...... ...... 881 1,130 ............ .1
118 ...... .... 11 111 ..... 8 .

,882 ..... ...... 3,623 3,819 34 80 1 i.

Average number torqs.tt m
Days treatment furnished in qartes p ar .i;


S White Black Total White Black Tota


Ancon............................................. 1,851 5,930 7,781 5.07 10.25 .21,1
Balboa. ...................................... 4,9271 4,7151 9,643 13.50 12.92 4A. 4:
Pedro Miguel.................................... 9834 1,6771 2,661 2.69 4.60 7.29 0
Gatun.................. .... ................... 275' *1,0501 1,326 .75 2.88 3.& i
Colon................ ....... .... ... .......... 3,1401 10,0251 13,166 8.60 27.47 36s. :
Madden Dam............ ........................ 16 427 443 .04 1.17 1.21

Total..................................... 11,194 23,826 35,020 30.67 65.28 85.,9


ALL CASES TREATED


J.:

"..i
I'.i


Employees Nonemployees Total-
Dispensary
White Black Total White Black Total White Black .Total

Aneon.................... 7,222 17,204 24,426 7,217 16,138 23,355 14,439 33,342 47,781
Balboa.... ..............11,493 15,044 26,537 16,089 13,575 29,664 27,582 28,619 5,201:
PedroMiguel............. 3,826 7,898 11,724 6,509 15,999 22.508 '10,335 23,897 34,232
Gatun.................. 3,098 6,786 9,884 4,040 8,221 12,261 7,138 15,007 22,14.
Colon.................... 5,812 14,789 20,601 13,258 19,439 32,697 19,070 34,228 83;29
Madden Dam.............. '3,949 '6,926 10,875 31,208 '2,509 3,717 5,157 9,471 14.628 i
Total................. 35,400 68,647 104,047 48,321 75,881 124,202 83,721 144,564 228,:$5

I Includes 3,330 contractors' employees. Includes 4,897 contractors' employees. a Includes 1,043 members jF
families of contractors' employees. 4 Includes 2,093 members of families of contractors' employees.

TABLE 12.-AVERAGE NUMBER OF DAYS IN HOSPITAL AND QUARTERS FOR EACH ADMISSION
EMPLOYEES ONLY, 1933

White Black Total

Hospitals:
Gorgas................................. ................... ... 10.88 18.93 .5 ::
Colon ..................... ......................................... 6.59 9.13 8.51 I.

Average for hospitals............................................. 10.33 16.72 14.,:1j .

Quarters: r. '
Ancon ....... ........... ............ ..................... 2.52 5.24 At
Balboa.. ...................... ....... .......................... 3.25. .12 ,
Pedro Miguel. ................. .............................. 2.88 3.75 :8a. 0
Gatun....................................................... .06 4.80
Colon.................... ... .. ............................ .... 3.59 8.92
Madden Dam................................................ ....... 1.45 8.88 .

Average for quarters. .......................................... 3.10. 6.7 .4
"- __....._"__:_:" "--- ....


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Full Text

PAGE 1

P0 REPOI KW 4 t 4

PAGE 2

Y 4 4 4 1 d h i 4 ( t ; -4 i a t ; b ; -b 4 n T * 4 T 4 A 6 ; 4 4 p ; ? ) ? I x & #4 ; a 4 a e 4 9 Y 6 T C ; e e a 4 4 4 A A 4 4 4: n * 4 5 $ u ; 1 4 i e b a -----A ; r s i # -; 3 a 4 & 4 3 4 d 6 4 9 N > ; 4 ; y ; b ; } Y C ; 4 s 4 4 e x 1* b a 9 5 As ; a T Y 4 % 9 9 ; ;

PAGE 3

REPORT OF THE Health Department OF The Panama Canal FOR THE CALENDAR YEAR 1933 J. F. SILER Colonel, Medical Corps, United States Army CHIEF HEALTH OFFICER BALBOA HEIGHTS, CANAL ZONE THE PANAMA CANAL PRESS MOUNT HOPE, C.Z. 1934

PAGE 4

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

PAGE 5

CONTENTS Page Title -----------------------------------------------------------1 Organization and activities ------------------------------------------5 Personnel--------------------------------------------------------5 Financial statements -----------------------------------------------6 Patient days in hospital and asylum (see also table 9, page 83) -----------8 Vital statistics, populations of the Canal Zone, Panama City, and Colon ---10 General death rates from all causes and from disease only ------------10 Canal Zone -----------------------------------------------11 Panama City ----------------------------------------------11 Colon ---------------------------------------------------12 Birth rates --------------------------------------------------12 Canal Zone -----------------------------------------------12 Panama City ----------------------------------------------13 Colon ---------------------------------------------------13 Infant mortality rates -------------------------------------------13 Principal causes of death -----------------------------------------14 Acute transmissible diseases reported -------------------------------15 Vital statistics, Panama Canal employees -------------------------------16 Death rates --------------------------------------------------16 Admission rates to hospitals and quarters ---------------------------16 Principal causes of admission to hospital ----------------------------17 Noneffective rates, all causes -------------------------------------17 Admission rates, malaria -----------------------------------------17 Deaths from malaria --------------------------------------------21 Division of Hospitals, Dispensaries, and Charities ------------------------21 Gorgas Hospital -----------------------------------------------22 Board of Health Laboratory --------------------------------------23 Colon Hospital -----------------------------------------------26 Corozal Hospital -----------------------------------------------28 Palo Seco Leper Colony -----------------------------------------31 Division of Sanitation ---------------------------------------------32 Health Officer, Panama City -------------------------------------34 Health Officer, Cristobal-Colon -----------------------------------37 Division of Quarantine --------------------------------------------39 District Nurse for the Pacific side ------------------40 General Tables: 1. Discharges from hospitals, deaths, and noneffective rates for employees.----------------------------------------------43 2. Causes of deaths of employees arranged with reference to color, age, and length of residence on Isthmus -------------------44 3

PAGE 6

4 CONTENTS-Continued General Tables-Continued: Page 3. Deaths and death rates of residents of the Canal Zone and the cities of Panama and Colon ----------------------------46 4. Deaths of residents of the Canal Zone and the cities of Panama and Colon, by cause, sex, color, and age -----------------48 5. Deaths of residents of the Canal Zone and the cities of Panama and Colon, by place of residence; absolute numbers and annual rates per 1,000 ---------------------------------54 6. Statistics regarding American employees and their families -----60 7. Discharges and deaths in hospitals of The Panama Canal, absolute numbers ----------------------------------------62 7-A. Discharges and deaths in hospitals of The Panama Canal, rates per 1,000 population ----------------------------------72 8. Consolidated hospital and colony report ---------------------82 9. Number of days hospital treatment furnished, and average number in hospital each day of the various classes of patients ---83 10. Consolidated admission report, hospitals and dispensaries ------83 11. Report of dispensaries ------------------------------------84 12. Average number of days in hospitals and quarters for each admission, employees only --------------------------------84

PAGE 7

REPORT FOR THE CALENDAR YEAR 1933 ORGANIZATION AND ACTIVITIES The Health Department constitutes one of the five major administrative units of The Panama Canal organization functioning directly under the Governor, and its organization and activities were somewhat comprehensively outlined in the annual report of the Health Department for 1930. PERSONNEL 'The only change in personnel assigned to important key positions was that of Chief Quarantine Officer, Surgeon Charles V. Akin, United States Public Health Service, having been designated as Chief Quarantine Officer, The Panama Canal, on October 14, 1933, vice Surgeon M. Flint Haralson, United States Public Health Service, relieved on account of termination of tour of duty with The Panama Canal. Total personnel in the service of the Health Department on December 31, 1933, was 1,025, a reduction of 22 in the white American (gold) personnel, and 79 in the colored alien (silver) personnel, under the previous year; total reduction 101. The principal reduction in per" sonnel (70) occurred at Corozal Hospital for the Insane, and was occasioned by the fact that in July 1933, 592 patients, the responsibility of the Government of Panama, were transferred to the Panamanian Government asylum for the insane. The remaining reduction in force, 31 in number, was distributed generally among other Health Department units and resulted from necessary curtailment in operating expenses to balance the budget. 5.

PAGE 8

6 Total personnel in the employ of the Health Department, by units, for each of the five years 1929 to 1933 inclusive, has been as is indicated in the following table: FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER, EACH YEAR 1929 1930 1931 1932 1933 C' MT E 0 0l EC i ChiefHealth Office. 7. 7 7. 7 7. 7 6. 6 5. 5 Gorgas Hospital. 176 299 475 167 267 434 169 243 412 162 252 414 157 249 406 Colon Hospital. 25 52 77 29 54 83 32 55 87 32 55 87 29 54 83 Corozal Hospital ..19 144 163 22 141 163 21 138 159 21 139 160 11 79 90 -Line dispensaries. 18 9 27 16 15 31 17 15 32 16 17 33 18 17 35 Palo Seco Leper Colony. 2 36 38 1 28 29 1 28 291 1 28 29 1 28 29 Quarantine service. 10 23 33 11 20 31 12 20 32 12 19 31 9 18 27 Health Office, Panama. 11 128 139 11 118 129 11 118 129 11 105 116 8 106 114 Health Office, Colon. 9 88 97 9 87 96 81 89 97 8 95 103 8 89 97 Zone sanitation .5 112 117 6 117 1231 6 120 1261 6 141 147 7 132 139 Total.2 8911,173 279 8471,126 284 8261,1101 275 8511,126 253 7721,025 NoTE.-"Gold" are white American employees, with the exception of two white aliens and one colored alien. "Silver" are alien employees, principally West Indians (colored). Includes inmates paid for services rendered. The distribution of the gold personnel (white Americans except 3) on the basis of professional and other special qualifications, was as follows: 33 physicians, medical officers of 8 dispensary assistants .the U.S. Army 5 pharmacists and assistant phar1 physician, surgeon of the U.S. macists Public Health Service 2 chemists 27 physicians, civilian 2 general mechanics 1 dentist, U.S. Army 2 stewards and stewardesses 3 senior internes 2 dietists 7 junior internes 1 storekeeper 4 male nurses 1 dental hygienist 95 female nurses 1 carpenter foreman 2 district nurses I chauffeur foreman 26 clerks I physio-therapy aide 12 sanitary inspectors 1 electrician 1 sanitary assistant 1 embalmer 1 quarantine inspector 4 veterinarians 8 technicians FINANCIAL STATEMENTS Operating expenses for the Health Department as a whole were $159,286 less than for 1932; and comparable earnings were $93,326 less. Operating expenses and earnings by units are set forth in the following table:

PAGE 9

7 OPERATING EXPENSES AND EARNINGS OF THE HEALTH DEPARTMENT, CALENDAR YEAR 1933 Operating expenses Earnings Chief Health Office -----------------------$29,065.09-------------------Gorgas Hospital -------------------------2703,920.95 $328,555.38 47% Colon Hospital --------------------------3150,595.56 83,762.33 56% Corozal Hospital ------------------------4126,737.28 105,754.80 83% Palo Seco Leper Colony -------------------37,624.01 24,666.75 66% Line dispensaries -------------------------97,522.63 36,790.17 38% Medical store --------------------------6,629.56-----------------Quarantine service -----------------------568,149.64 17,881.46 26% Sanitation of Panama City and Colon 57,346.73 9,799.76 17% Street cleaning and garbage collection and 132,716.75 117,581.79 89% disposal, Panama City and Colon. Canal Zone sanitation ----------------132,625.09 49,769.02 38% Total --_-61,542,933.29 774,561.46 50% 'Includes Army pay of Chief Health Officer, which amounted to. ..$6,120.00 Includes Army pay of Army medical officers on duty in this institution, which amounted to. 101,680.36 Also includes cost of operation of Board of Health Laboratory. 3 Includes Army pay of Army medical officers on duty in this institution, which amounted to. 28,290.75 Also includes cost of operating Colon dispensary. 4 Includes Army pay of Army medical officers ori duty in this institution, which amounted to .11,425.41 Total Army pay of Army medical officers on duty in the Health Department. ...147,516.52 s Includes Public Health Service pay of Public Health Service officers acting as Chief Quarantine Officer. 5,078.45 'Includes Army and Public Health Service pay, which amounted to. .152,594 97 OPERATING EXPENSES OF THE HEALTH DEPARTMENT, CALENDAR YEAR 1933, SHOWING AMOUNTS CHARGED TO VARIOUS ACCOUNTS Gold pay roll (white employees): Panama Canal pay -------------------------$567,975.61 Army pay --------------------------------147,516.52 Public Health Service pay --------------------5,078.45 $720,570.58 Silver pay roll (colored employees) ----------------------------372,165.57 Subsistence supplies ----------------------------------------166,411.35 Ice -------------------------------------------------------4,555.90 Hospital supplies and drugs ----------------------------------71,329.41 Equipment ------------------------------------------------18,908.75 Miscellaneous supplies ---------------------------------------32,360.91 Laundry --------------------------------------------------26,404.66 Telephones -------------------------------------------------15,037.41 Repatriation of patients physically or mentally disabled ------------955.49 Medical storehouse operation ----------------------------------6,629.56 Marine Division, launch and bus service for boarding parties 6,173.62 Electric current ----------------------------------16,307.18 Electric repairs and installations 4,------------------------------4349.74 Water -----------------------------------------------------9,994.00 Freight ---------------------------------------------------13,751.15 Mechanical Division, repairs and miscellaneous work -------------3,813.57

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8 Motor transportation charges (except for hospitals, quarantine station, and dispensaries which operate their own motor vehicles)------------------I ----------------------_--$47,325.43 Repairs to motor vehicles of hospitals, dispensaries, and quarantine station-------------------.----------------------------2,182.84 Rental of quarters-------------------------------------------555.82 Construction Quartermaster, building repairs -------------------2,400.70 Municipal Engineering Division, work -------------------------2,852.70 Sale of buildings and surplus equipment, Corozal Hospital ---------(6,446.12) Miscellaneous expenses -------------------------------------'4,343.07 Total expenses --------------------------------------1,542,933.29 The extent to which the various units of the Health Department have been self-supporting each year for the past 10 years is shown in the following table: Percent self-supporting (Army pay included) Calendar years1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Gorgas Hospital. 52 53 51 57 54 52 49 46 47 47 Colon Hospital. 41 39 37 44 44 52 59 52 51 56 Corozal Hospital. 81 82 80 85 76 88 86 89 94 83 Palo Seco Leper Colony. 40 45 38 46 41 46 55 44 65 66 Line dispensaries. 27 34 35 32 34 35 32 91 43 38 Quarantine Division. 38 46 53 35 38 49 35 32 24 26 Sanitation, Panaman and Colon. .17 20 18 11 13 16 12 15 14 17 Street cleaning and garbage collection and removal, Panama City and Colon. ...58 60 61 81 82 82 81 82 82 89 Zone sanitation. 39 37 29 29 29 37 36 33 35 38 Health Department as a whole. 48 50 49 53 51 54 52 49 51 50 PATIENT DAYS SPENT IN PANAMA CANAL HOSPITALS NUMBER OF PATIENT DAYS IN HOSPITALS AND ASYLUMS 1929 1930 1931 1932 1933 Gorgas Hospital.y. 184,506 163,975 165,050 149,812 149,292 Corozal Hospital: Insane patients. 209,794 228,862 228,327 253,240 172,413 Cripples and chronic medical and surgical cases. 27,623 28,923 29,883 31,802 33,696 Colon Hospital. 30,755 41,158 41,508 35,379 31,378 Palo Seco Leper Colony ...36,568 36,102 34,947 38,543 34,422 Total.,. 489,246 499,020 499,715 508,776 421,201 The number of patient days spent in all Panama Canal hospitals was 421,201, representing a decline of 87,575 under the previous year. The transfer in July 1933, of Panamanian insane to the Panamanian Government asylum accounts for 80,827 patient days of this reduction, the net reduction in patient days under the previous year being 6,748 The average strength of force in the employ of The Panama Canal in 1.933 was only 277 less than in 1932, and the number of employee patierit days was 1,460 less (1932, 47,077; 1933, 45,617). There was a decrease of about 14,500 patient days in the group of patients drawn

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9 from families of U.S. Government employees, government contractors, private patients, and others entitled to treatment. The number of patient days chargeable to charity increased by about 5,300 (1932, 66,028; 1933, 71,379). During the past few years the military garrisons in the Canal Zone have increased materially (1928, 8,380; 1933, 9,817), and proportionately the number of patient days spent by military personnel in Panama Canal hospitals has been much greater (1929, 32,814; 1932, 50,674; 1933, 59,946)-about 10,000 more patient days in 1933 than in 1932. The net decline in patient days (6,748) is attributable to economic conditions (reduction in pay of employees, and unemployment), reduction in activities of contractors engaged in U.S. Government construction projects, and to some extent to an agreement made in October 1933, between the President of the United States and the President of Panama, which provides that hereafter no persons except U.S. Government employees and their families will be entitled to treatment in Panama Canal hospitals, except in emergency. AVERAGE COST PER PATIENT PER DAY IN PANAMA CANAL HOSPITALS Calendar years 1929 1930 1931 1932 1933 Gorgas Hospital: Including total cost of Board of Health laboratory and undertakingservice. ..5.08 5.40 5.07 5.03 4.71 Including only the cost of work done for this hospital by the Board of Health laboratory and its undertaking service. .4.87 5.16 4.83 4.76 4.47 Colon Hospital: Including cost of Colon dispensary .5.18 4.27 4.39 4.72 4.80 Including cost of Colon dispensary, also including the Cost of the work done for this hospital by the Board of Health laboratory and its undertaking service .5.55 4.55 4 .65 5.04 5.12 Excluding cost of Colon dispensary, but including the cost of the work done for this hospital by the Board of Health laboratory and its undertaking service. 4.84 3.96 4.11 4.39 4.47 Corozal Hospital: Including cost of operation of dairy until December 1930; also including cost of gardens and cemetery. .90 .88 .70 .65 .61 Same as above, also including cost of the work done for this hospital by the Board of Health laboratory and its undertakingservice. .92 .90 .72 .67 .64 Palo Seco Leper Colony: Not including work done by the Board of Health laboratory and its undertaking service. 1.25 1.06 1.35 .96 1.09 Including cost of the work done for this institution by the Board of Health laboratory and its undertaking service. 1.26 1.07 1.36 .97 1.10 NoTE.-Owing to the multiplicity of fu ons of the various units of the Health Department, the exact cost per patient per day (in-patients) is impossible to determine. At Gorgas Hospital a large number of out-patients are treated in the various clinics; also the Board of Health laboratory, including the undertaking establishment (which does the embalming and cremating, and handles the shipment of bodies, for all units of the Health Department) is operated as a part of the hospital; the Board of Health laboratory does work for various divisions of the Health Department and for other departments of the Canal and for the Army. At Colon Hospital the dispensary is manned by hospital personnel and it is operated as a part of the hospital; they have no undertaker, but furnish coffins and hearse service for the remains of colored patients dying therein. In the foregoing table no effort is made to exclude the cost of any of the miscellaneous work of the hospitals from the cost of caring for in-patients, except that in the second figure shown of per-patient per-day cost for each institution an effort has been made to include the proper percentage of expense of the Board of Health laboratory and its undertaking service chargeable to such institution; also the cost of Colon dispensary has been deducted in the third figure of cost per-patient per-day for that institution, in order to make it more nearly comparable with Gorgas Hospital: The proportion of the expense of the Board of Health laboratory chargeable to each institution was arrived at by a check of the work of the laboratory over a short period of time; on account of variation of the work it is more or less arbitrary.

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10 VITAL STATISTICS POPULATIONS OF THE CANAL ZONE, PANAMA CITY, AND COLON The Health Department of The Panama Canal secures, analyzes, and makes reports on the vital statistics (births, deaths, and disease rates) of three geographical units of the population residing on the Isthmus of Panama, namely, the population of the Canal Zone, of the city of Panama, and of the city of Colon. Properly to interpret these statistics, it is essential that there be some understanding of the composition of the various units of the population, their movement, and some of the special local factors involved which usually are not encountered in stabilized populations in many parts of the world. These special factors were discussed somewhat in detail in the annual report of the Health Department for 1930 (pages 12 to 15, inclusive) which can be obtained on request to the Chief Health Officer, Balboa Heights, Canal Zone. The Republic of Panama takes a census every 10 years, the last enumeration having been made in 1930. In Panama City, from 1920 to 1930, the population made an average increase per year of almost exactly 1,500, and that figure has been used as the factor in computing the population each year since 1920 by arithmetical progression. For 1933 the population is estimated to be 79,000 (arithmetical progression). In Colon, from 1920 to 1930, the census figures indicate an average decrease of 150 per year, and that figure has been used as the factor in computing the population between 1920 and 1930 by arithmetical progression. As there is some doubt as to the accuracy of the 1930 census of Colon, 30,000 was adopted for 1931, and continued since. The population of the Canal Zone consists of white American employees and their families, colored alien employees and their families, military and naval garrisons, representatives of shipping companies, contractors, church and welfare workers, etc., and colored alien agriculturists who rent land under revocable licenses. A census of the Canal Zone population is taken each year and all figures for this group are actual rather than estimated. The term "employees" as used in Heai Department reports includes employees of The Panama Canal pr er and the Panama Railroad Company, which is a corporation owned by the United States Government. GENERAL DEATH RATES, ALL CAUSES, AND DISEASE ONLY Death rates from all causes for all groups of the population have been analyzed since the beginning of construction (1905) and those

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11 from disease only have been tabulated since 1913. Statistical tables covering these data are incorporated in the annual report for 1931. In this report (1933) the vital statistics incorporated will be limited, as was done in the annual report for 1932, to a presentation and brief discussion of death rates for the current year and a tabulation of rates by consecutive 5-year periods to indicate general trend. Health conditions for all groups (Canal Zone, Panama City, and Colon) of the population were good; there were no epidemics; malaria prevailed to a somewhat greater extent than is usual; morbidity and mortality rates continued their downward trend and in some respects declined to an all-time low point. Canal Zone.-The death rate from all causes in the calendar year 1933 was 7.12 per 1,000 of population, the lowest of record (population 42,851, deaths 305). Deaths from disease only totaled 271 or a rate of 6.32 per 1,000 of population, the lowest rate of record since 1913 except for the years 1930 and 1931, when comparable rates were 6.13 and 6.09 respectively. The general trend of death rates in this group of the population of the Isthmus during the past 20 years, both from all causes and from disease only, has been very definitely a downward one as is evidenced by the following analysis of rates for the past 20 years by 5-year periods. CANAL ZONE DEATH RATES BY 5-YEAR PERIODS 1914-18 1919-23 1924-28 1929-33 Total death rates per 1,000 population. .11.79 8.00 8,38 7.35 Death rates from disease per 1,000 population. 9.96 6.98 7.23 6.35 Panama City.-During 1933 the death rate from all causes was 14.95 per 1,000 of population (deaths 1,181, population 79,000), the lowest of record (1905 to date). The death rate from disease, 14.30 per 1,000 of population (deaths 1,130, population 79,000), also was the lowest of record. The trend in death rates from all causes and from disease only has been continuously attaining lower levels during the past 20 years as is clearly evidenced in the following tabulation of these rates, by 5-year periods, since 1914: PANAMA CITY DEATH RATES BY 5-YEAR PERIODS 1914-18 1919-23 1924-28 1929-33 Total death rates per 1,000 population. 28.45 20.20 18.12 17.04 Death rates from disease, per 1,000 population. 27.45 19.51 17.51 16.31 Colon.-In 1933 the death rate from all causes was 16.27 (deaths 488, population 30,000) and from disease only, 15.63 (deaths 469,

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12 population 30,000). These rates are considerably in excess of the comparable rates for any year since 1921, except for the years 1929 and 1930. The population figures for Colon have been held at the constant figure of 30,000 since the 1930 census, as that census showed no material change in the total population for the 10 years intervening between 1921 and 1930. The trend in death rates in Colon by 5-year periods for the past 20 years is shown in the following table which indicates that death rates have been increasing during the past five years: COLON DEATH RATES BY 5-YEAR PERIODS 1914-18 1919-23 1924-28 1929-33 Total death rates per 1,000 population. ..24.92 16.42 14.48 16.13 Death rates from disease per 1,000 population ..23.75 14.56 13.80 15.29 BIRTH RATES Canal Zone (employees and nonemployees).-In 1933 the birth rate for children born alive in the Canal Zone was 10.78 per 1,000 of population (births 479, population 42,851). There were 17 stillbirths, rate 0.40 per 1,000 population, which, though slightly higher than for 1932 (0.31) is less than one-half the rate usually experienced in previous years. The birth rate (total) for 1933 (11.18 per 1,000 population) was less than for 1932 (11.69). The decline in birth rates for this group of the population has been continuous from year to year since 1924 when it was 21.65. The persistent decline in birth rates for both groups of the population-white and colored-can be well appreciated by analyzing these rates by 5-year periods for the past 15 years: CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS, BY COLOR 1919-23 1924-28 1929-33 .hite Colored White Colored White Colored Total birth rate per 1,000 of population .16.80 28.95 12.75 22.05 9.36 15.03 Live birth rate per 1,000 of population ..16.31 27.30 12.26 20.66 9.13 14.09 Stillbirth rate per 1,000 of population ....49 1.64 .41 1.39 .23 .94 As has been pointed out in previous annual reports, the low birth rate in the white American population is influenced by the fact that the unmarried military population amounting at the present time to about 10,000 individuals constitutes about one-half of this group. The colored population is now a fairly well stabilized one. The total rate for this group in 1933 was 13.11 per 1,000 of population.

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13 The decline in this group also has been persistent and continuous since 1924 when it was 26.40. In the near future a considerable proportion of the generation of the colored population born in the Zone will have reached the age of reproduction, subsequent to which time it may be anticipated that birth rates will increase. Panama City.-In 1933 there were 2,607 children born in the city of Panama, population 79,000 (rate 33 per 1,000 of population). Of the total births, 2,508 (31.75 per 1,000) were born alive and 99 (1.25 per 1,000) were stillborn. There has been a continuous decline in the rates for stillborn since 1930 when it was 1.80 per 1,000. Incidentally it may be stated that in 1916 the rate for stillborn was 3.73. During the past 15 years birth rates have tended to decline slightly as is evidenced in the following analysis of these rates by 5-year periods: PANAMA CITY BIRTH RATES BY 5-YEAR PERIODS 1919-23 1924-28 1929-33 Total birth rate per 1,000 population. 37.39 34.49 34.00 Live birth rate per 1,000 population. 35.24 32 74 32.47 Stillbirth rate per 1,000 population ..2.15 1.75 153 Colon.-There were 851 children born in Colon (population 30,000), the birth rate being 28.37 per 1,000 of population. Of the total births 809 were born alive, and 42 were stillborn (rates 26.97 and 1.40 respectively). The general trend of birth rates in Colon during the past 15 years is shown in the following analysis of these rates by 5-year periods: COLON BIRTH RATES BY 5-YEAR PERIODS 1919-23 1924-28 1929-33 Total birth rate per 1,000 population ....30.04 25.59 29.88 Live birth rate per 1,000 population. .28.38 24.21 28.46 Stillbirth rate per 1,000 population ..1.66 1.38 1.42 INFANT MORTALITY RATES Infant mortality (absolute numbers and rates per 1,000 of live births) for the three groups of population involved were: Canal Zone Panama Colon White Colored Total Live births (absolute numbers) ...174 288 462 2,508 809 Deaths of children under one year of age (absolutenumbers) 6 29 35 295 93 Mortality rate per 1,000 of live births. ..34 101 76 118 115

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14 INFANT MORTALITY RATES BY 5-YEAR PERIODS Canal Zone 5-year period Panama Colon White Colored Average 1919-1923. 37.64 127.20 94.86 154.82 139.53 1924-1928. 52.53 118.74 96.51 133.40 114.50 1929-1933. 36.19 101.13 78.89 130.18 103.10 That considerable progress has been made during the past 15 years in reducing infant mortality rates in all elements of the population on the Isthmus is evident from the immediately preceding table. PRINCIPAL CAUSES OF DEATH The principal causes of death for the past five years, for the three groups of population involved, are set forth in the following tables: SEVEN PRINCIPAL CAUSES OF DEATH FROM DISEASE, CANAL ZONE POPULATION, 1929-1933 (ABSOLUTE NUMBERS AND RATES PER 1,000) 1929 1930 1931 1932 1933 Population. 38,825 39,467 40,565 42,070 42,851 Rate Rate Rate Rate Rate Disease Numper Numper Numper Numper Numper ber 1,000 ber 1,000 ber 1,000 her 1,000 her ,000 Pneumonia (broncho and lobar). .27 .695 30 .785 23 .567 14 .333 34 .793 Cancer (various organs) .16 .412 15 .405 15 .370 18 .428 26 .607 Tuberculosis (various organs) ..34 .876 20 .507 19 .468 33 .784 21 .490 Diseases of the arteries. ....11 .271 ..15 .350 Organic diseases of the heart. 15 .386 22 .557 ...20 .475 14 .327 Apoplexy. .......14 .333 12 .280 Nephritis (acute and chronic) ...23 .592 21 .532 18 444 10 .238 12 .280 SIX PRINCIPLE CAUSES OF DEATH FROM DISEASE, PANAMA CITY, 1929-1933 (ABSOLUTE NUMBERS AND RATES PER 1,000) 1929 1930 1931 1932 1933 Population. 73,000 74,402 76,000 77,500 79,000 Rate Rate Rate Rate Rate Disease per Nuper Numper Num per Num per her 1,000 ber 1,000 her 1,000 ber 1,000 ber 1,000 Tuberculosis (various organs) ...204 2.79 208 2.80 218 2.87 203 2.62 204 2.58 Pneumonia (broncho and lobar). 231 3.16 180 2.42 202 2.66 174 2.25 148 1.87 Diarrhea and enteritis, including colitis. 148 2,03 98 1.32 135 1.78 104 1.34 140 1.77 Nephritis (acute and chronic). 114 1.56 113 1.52 64 .84 69 .89 82 1.04 Organic diseases of the heart. 118 1.62 98 1.32 137 1.80 67 .86 67 .85 Cancer (various organs). 67 .92 59 .79 62 .82 69 .89 62 .78 SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 1929-1933 (ABSOLUTE NUMBERS AND RATES PER 1,000) 1929 1930 1931 1932 1933 Population. 29,850 29,765 30,000 30,000 30,000 Rate Rate Rate Rate Rate Disease her per Nuper Numper Nuxper Nuni per 1,000 er 1,000 ber 1,000 her 1,000 ber 1,000 Tuberculosis (various organs). .64 2.14 71 2.39 90 3.00 74 2.47 105 3.50 Pneumonia (broneho and lobar) .63 2.11 49 1.65 51 1.70 46 1.53 51 1.70 Organicdiseasesoftheheart. 28 .94 32 1.08 32 1.07 30 1.00 34 1.47 Apoplexy. .28 .94 ..23 .77 27 .90 27 .90 Nephritis (acute and chronic). 30 1.01 41 1.38 24 .80 33 1.10 24 .80 Cancer (various organs). .........22 .73

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15 Tuberculosis and the pneumonias continue to be leading causes of death in all three groups of the population, maintaining first and second places in the populations of Panama and Colon and first and third places in the Canal Zone population. The death rate from tuberculosis in the Canal Zone population is less than one-fifth of comparable rates in Panama and Colon; tuberculosis affects the colored alien population of the Canal Zone to a far greater extent than the white Americans. Deaths from degenerative conditions of the arteries (arterio-sclerosis and apoplexy) are continuing to occur with great frequency. ACUTE TRANSMISSIBLE DISEASES In the table appearing below is recorded the types of acute transmissible diseases which prevail in the Canal Zone and the cities of Panama and Colon, and the frequency with which they occur in these groups of the population (approximately 150,000). CONTAGIOUS AND INFECTIOUS DISEASES-CASES AND DEATHS REPORTED TO THE CHIEF HEALTH OFFICER DURING THE CALENDAR YEAR 1933 Residence Outside the Panama Colon Canal Zone Zone and Total Disease terminal cities New New New Dah e e cases Deaths ca Deaths a deaths cae Deaths caes Deaths Rabies. ..1 1 1 1 Chickenpox. 125 .24 .48 .16 .213 Diphtheria. 73 5 12 1 22 .14 1 121 7 Dysentery, amebic. 78 9 6 2 1 1 164 10 249 22 Dysentery, bacillary (unclassified). .1 .I .3 .1 1 6 1 Malaria. 198 6 33 2 1,544 5 465 46 2,240 59 M easles. 136 4 72 .49 .31 .288 4 Meningitis, meningococcus. .1 1 ..... M um ps. ..2 .8 ...11 Pneumonia. (1) 148 () 51 (1) 34 () 50 283 Poliom yelitis. 1 .3 .2 ...6 Relapsingfever. .1. 5. 6 Scarletfever. ..I .4 ..5. T rachom a .I .........1 Tuberculosis. (x) 204 (z) 105 (1) 21 (1) 41 (1) 371 Typhoid fever. 11 5 6 .4 2 14 1 35 8 Paratyphoid fever. ... Whoooping cough 5 34 35 .5 .79. Encephalitis lethariea .....2 Maritime quaranfinabLe diseases Cholera. .. Leprosy. .1 .7 4 6 7 Plague .. Smallpox .... Yellow fever. ..... Typhusfever. 2 ....2 As many cases of pneumonia and tuberculosis are not reported unless death occurs, this report shows only the number of deaths from these two diseases. 2 In cases where we are able to determine the place of infection fairly accurately, the place of infection instead of residence is shown. It is usually impossible to trace source of infection in amebic dysentery, but it is certain that very few cases are acquired in the sanitated areas of the Canal Zone and the cities of Panama and Colon. A majority of cases of malaria shown for the Canal Zone are believed to have been acquired in unsanitated areas.

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16 VITAL STATISTICS, PANAMA CANAL EMPLOYEES To interpret properly vital statistics relating to this group it is essential that one have knowledge of the conditions under which they are collected, their completeness, and other governing factors. These factors were outlined in the annual reports of the Health Department for 1930-1932 inclusive. DEATH RATES, ALL CAUSES The death rate for all employees (8.67 per 1,000 employees) was quite satisfactory (total deaths, 107; average number of employees for the year, 12,344) being the lowest since 1924 (7.23). Ninety-seven employees died of disease or at a rate of 7.86 per 1,000 employees, which represents the lowest rate attained since 1927 (7.82). The death rate from disease in the colored employees of The Panama Canal was almost double that for white American employees, the reasons f6r which have been discussed in the annual reports of the Health Department for immediately preceding years. Death rates in both white American and colored alien employees are gradually increasing, as is manifest in the following analysis of such rates by 5-year periods, for the past 20 years: DEATH RATES OF EMPLOYEES, DISEASE ONLY, BY 5-YEAR PERIODS 1914-1918 1919-1923 1924-1928 1929-1933 Whiteemployees. 4.51 3.20 4.94 5.85 Colored employees. 5.93 7.36 8.49 10.02 The principal causes of death from disease in 1933 were: Tuberculosis, 15; pneumonia, 10; diseases of arteries, 9; syphilis, 8; cancer, 8; nephritis, 7; apoplexy, 5. ADMISSIONS TO HOSPITALS AND QUARTERS The admission rate to hospitals and quarters was 845 per 1,000 employees. As noted last year, this rate has been increasing each year since 1926: 1926, 474; 1927, 502; 1928, 595; 1929, 602; 1930, 603; 1931, 705; 1932, 725; 1933, 845. This increase is attributable to gradual increase in the age of those employed (greater prevalence of diseases of the chronic degenerative type). The admission rate per 1,000 to hospitals for disease by race (white and colored) has been as follows for the past five years: ADMISSION RATE TO HOSPITALS PER 1,000 EMPLOYEES, BY RACE (WHITE AND COLORED) White Colored 1929. .273 154 1930. 288 ISO 1931. ..310 187 1932. ...:. .310 171 1933. ...330 175

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17 PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES TO HOSPITALS The diseases causing the greatest number of admissions of employees to hospitals during the past five years are incorporated in the following table: EMPLOYEES, PRINCIPAL CAUSES OF ADMISSION TO HOSPITALS 1929 1930 1931 1932 1933 Disease Rate Rate Rate Rate Rate Total per Total per Total per Total per Total per 1,000 1,000 1,000 1,000 1,000 Malaria (including the few cases treated in quarters). .337 21 410 26 276 19 177 14 328 26.57 Influenza. ........79 6 157 12.72 Diseases of pharynx and tonsils ..184 11 136 9 153 10 97 8 146 11.83 Arteriosclerosis. ....124 10 120 9.72 Diseases of nasal fossae and annexa. 153 9 ..270 19 ..99 8.02 Diseasesofeyesandannexa. 113 7 ..131 9 81 6 68 5.51 Acuteabscess. 109 7 106 7 .77 6. Gonococcus infection. 121 7 130 8 106 7. Syphilis. 150 10 114 8. Ankylostomiasis. ...113 7 .. NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES The noneffective rate for 1933 was 17.33 per 1,000 employees, the highest recorded since 1912 (construction days). ADMISSION RATES, MALARIA, EMPLOYEES (HOSPITALS AND QUARTERS) As malaria is a most important cause of noneffectiveness in this geographical area every effort is made properly to diagnose, treat, make record of, and determine the source of infection in all cases occurring in employees and other persons residing in the Canal Zone. Since 1906 careful records have been kept of the incidence of malaria in employees of The Panama Canal and its occurrence in this group is shown in the following table: MALARIA CASES, EMPLOYEES ONLY Absolute numbers and rates per 1,000 employees Average Number Rate Average Number Rate Year number of per Year number of per employed cases 1,000 employed cases 1,000 1906 26,547 21,795 821 1920 20,673 401 19 1907 39,238 16,637 424 1921 .14,389 214 15 1908 43,890 12,372 282 1922 10,447 176 17 1909 47,167 10,169 215 1923 10,976 212 19 1910 50,802 9,487 187 1924 11,625 190 16 1911 48,876 8,987 184 1925 12,180 330 27 1912 50,893 5,623 110 1926 12,732 179 14 1913 56,654 4,284 76 1927 13,561 145 11 1914 44,329 3,635 82 1928 14,260 203 14 1915 34,785 1,781 51 1929 16,193 337 21 1916 33,176 547 16 1930 15,524 410 26 1917 32,589 473 14 1931 14,597 276 19 1918 25,520 472 18 1932 12,621 177 14 1919 24,204 752 31 1933 12,344 328 27 MR 39231-2

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18 The rate per 1,000 employees for 1933 was, in round numbers, 27 (actually 26.57), the highest since 1925 when a rate of 27.09 was attained. The malaria season for 1930, when a rate of 26.4 per 1,000 employees was recorded, is comparable in many respects to that of 1933. Many factors, some known and some unknown, influence these rates from year to year. The various factors which may possibly influence the rate of prevalence of malaria are constantly under observation and the results of such observations are recorded in the annual reports of the Health Department to which those especially interested are referred. Marked annual variations in rates occur notwithstanding that continuously for many years the permanent drainage projects have been improved and extended and that extensive niw drainage works have been installed. The rate for 1933 (27) was in excess of those usually attained since 1916 (14 to 19 per 1,006) and was attributable to a number of factors among which the following may be cited: (a) Continuation of large construction projects beyond the limits of the so-called "sanitated areas. "-Construction projects of this nature were engaged in during 1925 (fortifications) and have been under way since 1929 (road construction on east and west sides of the Canal, Pacific side, and construction of Madden Dam). (b) Unusual prolongation of the rainy season.-Ordinarily the rains begin to taper off in late November and by the middle or latter part of December the dry season is well under way and small collections of water suitable for anopheline breeding have dried up. In .1932 the rains continued until the latter part of December, A. albimanus breeding places beyond the limits of the sanitated areas were abundant until January 1933, and flights of A. albimanus into the sanitated areas still were occurring. As a result, the malaria rate for the month of January 1933 (annual basis) was 31.3 per 1,000 employees, which is much higher than is usual (January 1932, 15.2; 1931, 23.6; 1930, 20.3; 1929, 22.5; 1928, 6.7). Incidentally, it may be stated that the end of the rainy season in 1933 was quite similar to that of 1932, and as a result the malaria rates for January 1934-when this report is being written-are unusually high (28.0 per 1,000). (c) Dredging Division projects.-In the early part of the dry season of 1933, the Dredging Division initiated a project including the construction of a dyke damming up the Rio Grande and its tributaries on the west side of the Canal just north of Balboa, with construction of a spillway at the upper end of the dyke. This area is to be used for dumping purposes in dredging silt from the Canal. Temporarily and

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19 to enable the silt to settle solidly, it was necessary to bring the water up to a high level. This level could not be lowered until some time after the rainy season began and as a result a considerable amount of fresh water accumulated in the tributaries emptying into the Rio Grande River. The areas were patrolled regularly and as soon as breeding was found efforts were made to control it by oiling. It was not possible, however, markedly to lower the level of the water until about August or September. In the meantime the amount of breeding was very greatly curtailed. Temporary drainage works have been constructed in this area, the channel leading to the spillway has been lowered, and we anticipate no great trouble from it during the next rainy season. A second Dredging Division project (fill) on the Thatcher Highway in the vicinity of Farfan beach (west side of Canal, opposite Fort Amador and La Boca) has not, as yet, settled solidly and therefore is not adequately drained. The result was that during the latter part of the rainy season A. albimanus bred so abundantly as to necessitate dusting with paris green by airplane. The fill, which consists of silt from the Canal, is still too soft to permit construction of permanent drainage systems. Fortunately, the area in the vicinity of the Dredging Division projects has been depopulated and there is but little opportunity for malaria-transmitting mosquitoes to acquire infection except from individuals from the interior of Panama awaiting ferry connections at the ferry slip on the west side of the Canal at night. Sometimes the waiting period is a half-hour or more. (d) Aquatic flora, Gatun Lake.--Observations during the past few years indicate that the amount of A. albimanus breeding in Gatun Lake is increasing rapidly due to changes in the aquatic flora. This problem was discussed in the Annual Report, Health Department, Panama Canal, for 1932 (pp. 43-45) and further details are incorporated elsewhere in this report. Evidence also in accumulating that the dispersal flights of A. albimanus always noted at the beginning of the rainy season, before rains are sufficient in volume to possibly result in breeding within the sanitated areas, are coming from the Gatun Lake area. Anopheles breeding in the lake during April, May, and June 1933, was materially greater than usual. Rains in sufficient volume to raise the lake level occurred much later than is usual and as a result the decline in the water level of the lake during the dry season was approximately five and two-thirds feet rather than the usual five feet. Consequently materially more extensive areas of matted decaying Chara were present on the surface of the lake than usually are found in its shallow parts. As these mats afford ideal

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20 food and shelter for Anopheles breeding, the amount of breeding was much more extensive than usually is observed. There now appears to be no doubt that the dispersal flights of Anopheles observed throughout the Isthmus in May and June each year have their origin principally in the Gatun Lake region and that the prevailing conception that A. albimanus has a short flight range requires revision. The flight from the lake to the Atlantic terminal is not less than four miles, and to the Pacific about 12 miles or more. (e) Overhaul work on Panama Canal locks.-Overhaul of the locks on the Pacific side was in progress from January 3 to June 9, 1933, during which period several hundred laborers were employed on both day and night shifts. Chronic carriers of malaria are common in such groups. During the latter stages of this overhaul when Anopheles flights were coming into the sanitated areas from the dredging projects on the west side of the Canal, in close proximity to the Pacific locks, and also from the lake area, abundant opportunity was offered the malaria transmitting mosquitoes to become infected through attacks on labor forces engaged in night work on the locks. During the latter part of May and the first part of June the Special Service Squadron of the Navy was at anchor in the basin off piers 15 and 16, Balboa, and for the first time in a number of years an unusually large number of cases of malaria were undoubtedly contracted on board the vessels. (f) Visits to the provincial districts of Panama.-Until recent years but few sections of the provincial districts of the Republic of Panama were easily accessible except by coastwise steamers, and opportunities for employees and their families to visit these districts were greatly restricted. This barrier greatly reduced opportunity to acquire malaria. During the past 10 years the Public Works department of the Government of Panama has been actively engaged in the improvement and extension of existing highways and the construction of new ones. The result has been that in increasingly large numbers, the American employees of The Panama Canal are making automobile trips to the provincial districts, building cottages in various coastal areas for week-end and vacation use, and visiting with increasing frequency interesting localities in the coastal and other areas. Notwithstanding that employees are warned as to the possibility of contracting malaria during visits to nonsanitated areas, and are urged to safeguard themselves at night, most of them fail to do so. The result is that constantly increasing numbers of American employees and their families are contracting malaria through exposure in non-

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21 sanitated areas. Conditions are such that it may be anticipated that the numbers of individuals acquiring malaria from this source will continue to increase. DEATHS FROM MALARIA, EMPLOYEES In .1933 two employees died of malaria, a rate of 0.16 per 1,000 employees. One of these deaths was that of an American employee who contracted a malignant tertian infection at New Gorgona beach, a coastal resort in the interior of Panama, had clinical symptoms for several days before reporting to a physician, and when seen by a Panama Canal physician was in a comatose condition. He was admitted to hospital immediately and died within three or four hours thereafter. The second fatal case was that of a Panamanian laborer employed at Madden Dam but living in one of the nearby nonsanitated native villages in the Republic of Panama. The patient was treated for an estivo-autumnal infection in February 1933, readmitted to hospital on April 3, 1933, and died of blackwater fever seven days later. Annual death rates from malaria in employees since 1906 have been as is shown in the following table: DEATHs FROM MALARIA AMONG EMPLOYEES ONLY (Absolute numbers and rates per 1,000 employees) Average Number Rate Average Number Rate Year number of per Year number of per employed deaths 1,000 employed deaths 1,000 1906 26,547 233 8.78 1920 20,673 3 .15 1907 39,238 154 3.92 1921 14,389 1908 43,890 73 1.66 1922 10,447 1909 47,167 52 1.10 1923 10,976 1910 50,802 50 .98 1924 11,625 2 .17 1911 48,876 47 .96 1925 12,180 1912 50,893 20 .39 1926 12,732 1913 56,654 21 .37 1927 13,561 1914 44,329 7 .16 1928 14,260 1915 34,785 8 .23 1929 16,193 1 .06 1916 33,176 2 .06 1930 15,524 1917 32,589 3 .09 1931 14,597 1 .07 1918 25,520 2 .08 1932 12,621 1919 24,204 2 .08 1933 12,344 2 .16 DIVISION OF HOSPITALS, DISPENSARIES, AND CHARITIES The units comprising this division and the scope of their activities were outlined in the annual report for 1930. Brief reports of each of these units for 1933 follow:

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22 GORGAS HOSPITAL (Normal capacity, 880 beds) Col. ORVILLE G. BROWN, Medical Corps, U.S. Army, Superintendent In addition to the routine work of maintenance and repair of buildings and equipment by the hospital artisans during the year, the following major plant improvements were made: 1. The refrigerating plant and cold storage rooms of the hospital main kitchen were completely overhauled and repaired at a cost of $3,350. 2. A new paint shop was constructed on a site adjacent to the present shops building at a cost of $2,150. This activity was formerly located under one of the ward buildings and, together with the storage of inflammable material, constituted a fire menace which has now been removed. 3. The old, worn-out galvanized iron pipes in Section "B" are being replaced with a new system of modern brass piping. The installation is now about 75 percent complete. All necessary material for this work costing about $1,000 is on hand but, for reasons of economy, the work is being accomplished only when the plumber is not otherwise engaged. 4. The interiors of kitchen, mess halls, isolation building and section "B" have been repainted throughout. 5. The parking site in rear of the Administration-Clinics building was enlarged at a cost of approximately $900. About $6,500 was expended during the year for new equipment and replacements of worn-out or obsolete articles, of which about $1,900 was devoted to new equipment for the hospital subsistence department. Cases treated.-There were 11,621 admissions during the year, with a total of 149,292 patient days. An average of 12.46 days in hospital was spent by each patient under treatment as compared with 13.22 days per patient during 1932. The average number of beds occupied daily during the year was 409.02. Surgical service.-There were 2,109 major operations (with 31 deaths) and 4,096 minor operations (with 2 deaths) performed during the year; 440 obstetrical cases were delivered, in which there were 8 twin births and 14 stillbirths; 9,779 patients received treatment in the out-patient service. Medical service.-During the year, 6,216 patients were admitted to and treated in the medical wards. In addition to the hospital service, .8,675 patients were treated in the out-patient service. Eye, ear, nose and throat service.-There were 9,691 visits to the outpatient department during the year; 1,610 operations were performed and 1,065 refractions were done.

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23 Radiographic service.-There were 7,505 cases handled, for which 18,472 films of various sizes were used, and in which 991 fluoroscopic examinations were made. Dental service.-There were 5,088 sittings during the year; 1,360 oral examinations, 1,950 teeth extracted, 265 complete and 991 partial dental X-ray examinations. Physio-therapy service.-Treatments were given as follows: 128 radium, 2,431 roentgen, 1,481 electro-therapy, 3,750 thermo-therapy, 3,688 actino-therapy, 4,262 massage and exercise, and 3,240 hydrotherapy. BOARD OF HEALTH LABORATORY (Operated in connection with Gorgas Hospital) Dr. L. B. BATES, Chief of Laboratory Bacillus typhosus.-Recovered in blood culture from 13 individuals, from the urine specimen of one other, and from four other cases at autopsy. Six of these lived in Panama City, 3 in Colon, 3 were transients, 2 from Madden Dam, 2 from Canal Zone towns, and 2 from Canal Zone unsanitated areas. Typhoid carriers.-On December 31, 1932, there was only one B. typhosus carrier, H.B., under sanitary surveillance. His stool specimens were examined 10 times during the year and found positive 3 times. One new temporary carrier was found during the year. H.B. was the only carrier under sanitary surveillance on December 31, 1933. Chagas' disease (Schizotrypanum cruzi).-The first case of this disease to die in the Canal Zone or Republic of Panama, so far as is known, was autopsied on August 7, 1933. A brief summary of the case is as follows: Autopsy No. 10, 203, F.B., age 3 months, 11 days; male; black; residence, land license 1299 B.E., Chiva Chiva trail, Canal Zone; place of death, residence as given above; time on Isthmus, life; principal findings at autopsy: Schizotrypanum cruzi in myocardium, percarditis, otitis media, bronchopneumonia, right lower lobe, fatty metamorphosis of liver. Snake bite.-The fourth autopsy at this laboratory on an individual dying of snake bite was performed on November 2, 1933. P.B., colored, laborer, Colombian, age 25 years, was bitten October 28, 1933, while obtaining a piece of sugar cane on Arinosa Farm, land license 765, Cristobal-West. He died November 2, 1933. The snake was killed by the victim but it was not recovered for identification. The history and autopsy findings were such that there was no doubt as to the cause of death.

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24 Reports.-Approximately 38,900 laboratory examinations were made. The volume and character of the work is indicated in the following summaries: Bacteriological, protozoal, and miscellaneous examinations.-Cultures of blood, 213; cultures of stools (typhoid-dysentery), 946; cultures of urine, 1,266; cultures from nose and throat, 1,576; cultures of sputum, 58; cultures of spinal fluid, 178; cultures of miscellaneous material (eye, pleural fluid, skin lesions, pus, bile, glands, autopsy tissues, etc.), 189; darkfield examinations, 81; staining and examination of smears (conjunctival, throat, urine, urethral, vaginal, sputum, etc.), 272; autogenous vaccines, 52; examination of lepers and leper suspects, 10; examination of urine for tuberculosis, 4; examination of spinal fluid for tuberculosis, 153; examination of feces for ova of parasites and protozoa, 103; blood films for malaria parasites, 8,018; bacteriological examinations of water, 743; bacteriological examinations of foodstuffs (cultures of milk, cream, ice cream, soft drinks, etc.), 756. SEROLOGICAL EXAMINATIONS Wassermann tests. 18,307 K ahn tests. .2 ,317 A gglutination tests. ...210 Positive with B. typhosus (Eberthella typhi). 15 Positive with B. protest X e, (Proteus vulgaris). .5 Fragility tests. 4 Blood typing for transfusion. .59 Examination of blood for coagulation time. 4 Analysis of Wassermann reactions.-There were 17,488 Wassermann tests performed on the blood of 13,201 persons. 'The results are summarized below: TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1933 Total Percent of Race, sex, and status Individuals Individuals individuals individuals positive negative tested positive White, civil: M ales. .74 1,688 1,762 4.2 Females. 29 592 621 4.6 Children. .3 111 114 2.6 Total. 106 2,391 2,497 4.2 White, military and naval: Soldiers, continental United States. 119 3,953 4,072 2 9 Sailors, U.S. Navy. 21 270 291 6.8 Total. 140 4,223 4,363 3.2 Black and mulattoes: M ales. 435 2,711 3,146 13.8 Fem ales. 245 2,646 2,891 8.1 Children. .14 230 244 5.7 Total. .649 5,587 6,281 11.0 Chinese, males and females.4 56 60 6.6 Grand total. 944 12,257 13,201 7.1

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25 In addition, Wassermann tests were made on 819 spinal fluids taken from 612 individuals. The results are summarized below: Individuals positive. .5S Individuals negative ...554 Total individuals tested. ...612 Percent of individuals positive. .9.48 PATHOLOGICAL EXAMINATIONS Autopsies.-There were 317 autopsies performed at the Board of Health laboratory. The more frequent causes of death were as follows: Percent of Cause of death Cases autopsies External causes. 44 13.88 Tuberculosis (acute and chronic). 29 9 14 Organic heart disease (acute and chronic). 26 8 20 Pneumonia (broncho and lobar). ..25 7.88 Cancer. .23 7.25 Syphilis (including 4 general paralysis). 20 6.30 Cerebral bermorrhage. .14 4.41 Bright's disease (acute and chronic nephritis). 8 2.52 Bodies autopsied.-The annual report for 1930, page 54, contains a table showing the number of autopsies performed for the years 19041930 in certain diseases that but rarely come to autopsy in this area. The additions to this table for 1933 were as follows: Yellow fever, 0; beriberi, 0; ankylostomiasis, 0; tetanus, 0; infectious diseases of children, 1; plague, 0; smallpox, 0. Five hundred and two bodies (not including 54 for storage only and 2 disinterred) passed through the laboratory; 317, or 63.14 percent were autopsied. There were 27 malaria carriers found at autopsy. There were 30 cases of syphilis found at autopsy. Three cases autopsied, or 0.94 percent, showed intestinal parasites. Ascaris lumbricoides were found in each of the three cases; no search for ova made. Laboratory examinations of wild and domestic animals.-Cultures from guinea pigs, rabbits, etc., 36; autopsies and histological examinations of cows, hogs, parrots, .guinea pigs, rabbits, etc., 72; examinations of rats for plague, 2,855. Preparation of tissues for examination (slides), 8,864. Chemical analyses and examinations.-Alcohol, 7; beverages, 16; analyses of blood (nitrogen, urea, uric acid, creatinin, glucose, calcium, carbon dioxide, cholesterol, icterus index, phosphorus, sodium chloride, etc., 2,311; analyses of foodstuffs, drugs, and chemicals, 616; gastric analyses, 532; spinal fluid, 854; drugs, for identification, 23; toxicological examinations, 7; quantitative analyses of urine, 205.

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26 In addition to the more highly technical laboratory work done in the Board of Health laboratory, the various sections of Gorgas Hospital have laboratories in which routine clinico-pathological work is done. The amount and character of work done by these units can be judged from the following summaries of their activities: Blood films examined for malaria, 13,898; red cell counts, 7,749; white cell counts, 9J27; differential counts, 9,030; coagulation time determination, 18; Van den Berg tests, 45; sickle'tells, 51; qualitative analyses, urine, 24,406; phenolsulphonephthalein test urine, 66; urethral smears, 107; vaginal smears, 170; prostatic smears, 315; stools for ova of parasites, 10,182; sputum for tuberculosis, 1,804; cell count spinal fluids, 274; throat smears, 33; gastric contents for occult blood, 76. UNDERTAKING DEPARTMENT Bodies received (including 2 disinterred and 54 for storage) ..558 B odies em balm ed .82 Bodies cremated. 104 Bodies buried on Isthmus ..400 Bodies shipped from Isthmus (including 2 disinterred). 5 Bodies buried at sea. .1 COLON HOSPITAL (Capacity, 135 beds) Maj. DEAN F. WINN, Medical Corps, U.S. Army, Superintendent This hospital has continued to function essentially as an emergency hospital although definitive treatment has been given to a wide range of cases. Individuals requiring certain special examinations, for which equipment is inadequate, those with venereal and contagious diseases, and mental and tuberculosis cases, were transferred to Gorgas Hospital. The utilities department has been active in preserving the appearance of buildings and grounds and the upkeep of the various departinents. New construction.-The new nurses' quarters was completed and occupied in April. This is a 2-story reinforced concrete building with tiled roof, located just east of the main hospital building and facing Limon Bay. It affords commodious quarters for 16 nurses, including a suite of two rooms and bath for the chief nurse, and a common bath and lavatory for each two rooms. On the second floor there is an attractive lounge and on the first floor a reception hall, parlor and dining room. The kitchen and pantries are equipped but have not yet been used for a separate mess. Bedrooms and living rooms have been equipped with new furniture. In August the old nurses' quarters was remodeled and occupied by the dispensary. The building is detached from the main hospital buildings. It houses the gold and maternity-pediatric clinic, the

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27 silver clinic, laboratory, X-ray rooms, emergency dressing room, and pharmacy. In addition, rooms are provided for the officer of the day, dispensary office, and for temporary isolation. There are, ample and convenient suites of offices, waiting rooms and examining rooms for the clinics. The laboratory is large and well lighted. The pharmacy is well arranged and has adequate storage space. The building is so arranged as to segregate completely white and colored patients. In August a concrete and wood covered walk was constructed to connect the new dispensary with the hospital. This has proven a great advantage during the past rainy season. In October the lower floor of the west wing of the main hospital building was remodeled. This section, formerly occupied by the dispensary, laboratory, X-ray department, and eye, ear, nose and throat department, has been converted into a ward containing eight private rooms and a 6-bed ward. The west end of this section was utilized for the construction of a suite of rooms for an eye, ear, nose and throat clinic. An operating room for this department was constructed by remodeling the existing porte cochere. A filing room for storing clinical records, etc., has been equipped in the service building with steel shelving with a capacity of some 45,000 charts. The shop and laundry facilities have been enlarged by the construction of a covered area with concrete floor and a large insulated drying room. This room is heated by an ingenious construction of the flue leading from the fire box over which emergency laundry is boiled. There is no expense for fuel as only waste material, such as old packihg boxes, crates, etc. is used. Movement of sick.-There were 4,160 admissions during the year with a total of 31,378 patient days, the average being 7.5 days per patient. Army personnel accounted for 8,305 patient days. There were 53,612 visits to the dispensary, including eye, ear, nose and throat and surgical clinics, a daily average of 147. There were 19,384 white patients and 34,228 colored patients. The average number of beds occupied daily was 86. Surgical service.-There were 481 major operations. Included in these there were: Appendectomy, 166; hernia repair, 48; hemorrhoidectomy, 64; hepatic abscess, 3; intestinal obstruction, 8; perforated peptic ulcer, 5; hysterectomy, 17; cesarean section, 6; uterine suspension, 16; miscellaneous gynecological operations, 79. There were 510 minor operations; 177 fractures were treated. A number of new items of equipment were added. Among these were a new electric dressing sterilizer, gas-oxygen anesthesia outfit, and electric cautery.

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28 Obstetrical service.-There were 368 deliveries during the year. There were 17 sets of twins, 11 forceps deliveries, and 6 cesarean sections. An active well-conducted prenatal clinic is maintained. Medical service.-The general scope of the work has been satisfactory in both volume and variety. No serious epidemics occurred during the year. Eye, ear, nose and throat service.-This service was established in the latter part of 1932. It has grown to be one of the largest and most important departments of the hospital and has filled a very definite need for the population on the Atlantic side of the Isthmus. During 1933, 1,176 operations were performed; 9,503 treatments were recorded for hospital patients and 5,713 treatments were given out-patients. Refractions numbered 698. The following abbreviated statistical report of operations is submitted as an indication of the scope of the work performed: Mastoidectomy, 8; cataract operations, 20; pterygium transplant, 94; trephine, 6; enucleation, 5; foreign body (cornea), 33; plastic of eye, 19; correction of ptosis, 3; correction of squint, 12; submucous resection, 139; sinusotomy, 40; radical antrum, 7; radical frontal, 11; ethmoidectomy, 10; plastic (nose), 8; plastic (ear), 4; cartilage inlay (face), 1; miscellaneous, 756. X-ray department.-There were 1,349 examinations made during the year. New and modern equipment was installed upon completion of the new dispensary building so that this department is now able to do a more satisfactory and varied type of work than formerly. Laboratory.-Only routine work is done, serological and pathological work being performed by the Board of Health laboratory, Ancon, C.Z. The laboratory in the new dispensary building is well lighted and adequate space for expansion is provided. Dispensary.-The Colon dispensary is conducted as a department of Colon Hospital. The combined gold and maternity-pediatric clinic is under the direction of the district physician who is also in general charge of the entire dispensary. Both white and colored patients are cared for in this clinic but the hours and waiting and examining rooms are so arranged as to segregate the races. The silver clinic is conducted by members of the hospital staff assigned in rotation. COROZAL HOSPITAL (Capacity, 550 patients) Maj. F. H. DIXON, Medical Corps, U.S. Army, Superintendent Purpose.-Until recently this institution served to accomodate the insane of the Canal Zone and of the Republic of Panama, the latter

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29 class' of patients being cared for at the expense of the Republic at a fixed rate of 75 cents per day. However, during June and July of 1933, all of the latter class, totaling 592 patients were transferred to the Retiro Matias Hernandez, an asylum located on the Sabanas road about five miles from Panama City, and erected during recent years for this purpose. American or alien employees of the Panama Canal, disabled by reason of injuries or chronic diseases, or enfeebled by advanced age, who desire to enter the institution, are cared for in Corozal Hospital. As a result of the exodus of this great number of patients, six of the old wooden structures were sold and torn down, and all male and female insane patients consolidated in the new 2-story concrete building completed in November 1931, while the cripples and chronic patients are now quartered in the concrete structure formerly used as a ward for insane women patients. To make these buildings suitable for this purpose certain alterations were necessary, such as removal of sliding doors and screens, constructions of new doorways, installation of handrails along stairways, the erection of new walls and partitions to separate the male from the female patients, and arranging space for dining halls. These changes were all made by hospital personnel under the supervision of the general mechanic. The concentration of all insane patients in one building promotes efficiency and also makes it possible to operate with more limited personnel. At the same time, removal of the six wooden structures which were no longer needed reduces the cost of maintenance for painting and repairs. One building, ward "B," also of wood construction, being of more recent origin, was retained to provide for emergencies and will accommodate about 160 patients. A new cemetery tool shed to replace the old building, which was too small for present requirements and in bad state of repair, is being erected by hospital labor under the supervision of the general mechanic, at an estimated cost of $350. This tool shed is more centrally located than the old building, since the cemetery area has been enlarged and new roads constructed in the 40-acre plot recently added. Considerable work remains to be done in connection with the enlargement of the cemetery, and it will be necessary to relocate the boundary fence, erect additional gates and construct paths through the new section. Routine painting and repairs to woodwork, steel doors, window frames, plumbing, boiler and steam lines, and filling and grading of hospital grounds, have been performed by hospital artisans with the help of patients.

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30 Insane patients.-The census on December 31, 1933, was 178, as compared with 748 at the end of the previous year. The number admitted was 247, as compared with 338 for 1932. There were 782 discharges and 3,1 deaths. There were no suicides, but one death resulted due to altercation between two patients. Other patients.-There were, on December 31, 73 black and 6 white chronically ill or crippled inmates (not insane), as compared with 59 black and 5 white of this class at the beginning of the year. Twentyfour were carried on the pay rolls, employed as broom-makers, janitor, and laborers. The broom-makers manufactured approximately 260 brooms per week. Recreation.-Because of the reduction in the number of patients and the limited personnel, the weekly moving picture shows were discontinued in July 1933. However, band concerts through the courtesy of the 11th Engineers Band, Corozal, are provided about every other week, unless Army maneuvers or other duties prevent. Refreshments in the form of candies, cookies, cigarettes, tobacco, etc., are distributed among the chronic and insane patients, the latter receiving this distribution in lieu of cash in case they are employed on the patients' pay roll. Church services were conducted once a week for the Catholic and Protestant patients. However, in view of the limited number of Catholics remaining since the transfer of patients to Matias Hernandez asylum, such services have been discontinued since July 1933. Treatment.-Intensive specific treatment was given to patients suffering from syphilitic psychoses. Three hundred and seventythree doses of arsphenamin were administered intravenously, and 219 lumbar punctures were made. At the end of the year there were 29 patients suffering from neuro-syphilis in some form; 25 of these were males and 4 females. Occupational therapy.-Because of the transfer of approximately 77 percent of our insane patients, the very limited number of remaining patients and the need for economy, the occupational ward was discontinued and the services of the female nurse formerly in charge dispensed with. In addition to the male patients engaged in the occupational ward there were others employed in agricultural activities. The value of the produce taken from the patients' garden for hospital consumption amounted to $1,209. The more vigorous females were assigned to tasks in the laundry, sewing room, or salvage department. As a result of these various undertakings, between 75 and 80 percent of the patients are engaged in some form of work. All of the hospital laundering, with the exception of some bed sheets and pillowcases, and all of the nurses' uniforms, was done by the patients.

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31 Farm.-Repairs to fences were made, and pastures cleared of brush during the dry season by cutting and burning pasture. There were 24 cripples employed on the farm and hospital at the close of the year as compared with 22 at the beginning of the year. These men are employed in the garden, piggery, steam plant, cemetery, etc. Seven (including two chronic patients) are tending plots of land in the farm reservation, which they cultivate as gardens andthey are paid on an actual production basis. PALO SECO LEPER COLONY Dr. EZRA HURWITZ, Superintendent There were 106 patients at the Leper Colony on January 1, 1933. Seven new cases were admitted, seven patients died during the year; none were paroled and none absconded. At the close of the year 106 patients remained, 91 for the Republic of Panama and 15 for the Canal Zone. Of the 7 deaths of lepers, all were autopsied at the Board of Health laboratory and, in accordance with the preference of the Manual of Joint Causes of Death of the Bureau of the Census, the cause of death was recorded as leprosy in all cases; the contributing causes of death were as follows: One chronic glomerulonephritis; 1 amyloid disease of the kidneys; 1 abscess, lower lobe, left lung, ruptured into pleura; 1 pulmonary tuberculosis; tuberculosis of the vertebral column; 1 peptic ulcer; perforated duodenum; peritonitis, acute, generalized; in 2 cases no lesions other than those of leprosy were found. Intramuscular administration of the iodized esters of Hydnocarpus wightiana was continued as the routine treatment. Injections were given twice weekly, and although attendance was not compulsory, all patients except six reported with regularity for treatment. In April the Municipal Division completed installation of the water line from Balboa to the colony. The well, which has been the principal source of water (highly mineralized), but had never given a sufficient supply during the dry season, has not been abandoned, but will be kept in condition for use in emergency. In June, electric equipment consisting of two ranges (replacing the unsatisfactory oil-burning ranges), one stock pot and one water heater were installed in the kitchen. In July a graded road with a light surface of crushed stone was opened between Thatcher Highway and Palo Seco; and the launch Palo Seco II which had been used for transportation until then was turned over to the Section of Surveys. The colony was provided with an ambulance, which is adequate for the present needs of the colony.

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32 A number of patients were permitted to visit relatives in Panama City, always attended by an officer of the Panama Health office, and one patient, with the permission of the Panamanian authorities was permitted to visit her aged mother in Los Santos. It would be desirable to separate patients in their quarters according to the severity of infection. Under present conditions this is practically impossible, as patients in the same approximate stage of infections are often temperamentally unfit to associate peacefully. In planning future building at the colony, arrangement should be made for each patient to be quartered in a separate room. With profits accruing out of the resale storeroom, the colony purchased a new projector for talking motion pictures. Three motion picture agencies in Panama (Metro-Goldwyn-Mayer, Paramount, and Radio-Keith-Orpheum) each furnish the colony with one show weekly, without charge. The excellent pictures shown have been a great source of pleasure and contentment to the patients. The Palo Seco band received as gifts a saxophone from Mr. Danner, of the American Mission to Lepers, and a clarinet from Dr. Barbour of Boston, Mass. Other donations received, were from Woman's Auxiliary of Gatun Union Church, $10; Cristobal Women's Club, $5; and gifts of clothing to each patient were given through Father Lawler of St. Mary's Church. The allowances made to the patients during the year was $1,896; $1,164.33 worth of farm produce was bought from 29 patients; 54 patients were employed in the colony and earned $3,110.73. DIVISION OF SANITATION The end of the dry season of 1933 was notable for an apparently unusually large invasion of anopheline mosquitoes into the sanitated areas, the probable reasons for which have been discussed elsewhere in this report. The continued growth and spread of Chara and other aquatic plants in Gatun Lake contributed largely to the increase in the numbers of anophelines. In the Rio Grande hydraulic fill west of the Canal near Balboa, a large drainage channel made in the soft mud by dynamite lowered the surface of the waters somewhat, but this area cannot be brought under satisfactory control until the whole area of more than a square mile is filled to an elevation of several feet higher, or an additional spillway, with its sill at a considerably lower elevation, is built. The Rio Grande fill and spillway at first impounded a large lake of brackish water with no outlet at low stages, simulating quite nearly the large brackish swamps of the Atlantic side, and here, for the first time in

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33 our experience, Anopheles tarsimaculatus was found breeding on the Pacific side of the Canal Zone. Adults were taken on the screens of nearby quarters and at Fort Clayton, two miles away. The large hydraulic fill in the Thatcher Highway area developed, as is customary in such fills, myriads of deep cracks during the dry season, and when the rains and run-off from the hills had filled these with water they became prolific in breeding of Anopheles albimanus and Aedes taeniorhynchus larvae. It was necessary on two occasions (November 20 and December 21) to dust this fill with paris green from an airplane.' A five percent mixture of paris green with pulverized clay was sufficient to destroy most of the Anopheles. It was not necessary to use the airplanes in dusting the swamps at Old Panama during the rainy season of 1933. Straightening of the channel of the Rio Matias Hernandez through the western part of the swamp improved the drainage of this part considerably and the fact that cattle were not pastured in it as much as usual gave the swamp vegetation a chance to grow and shade the area. Breeding occurred only in small patches and was controlled by hand blowers dusting with a one percent paris green mixture. The new golf club building in the Sabanas northeast of Panama City has proved very popular as an evening resort for its members and guests, therefore it was necessary to improve the drainage of this area to prevent mosquito breeding. The open streams were trained and paved with 14-inch wide hemicylindrical precast concrete sections, 4,523 linear feet being so installed. At acute bends the banks of the streams were rip-rapped with large stones. Also, 903 feet of subsoil tile were installed there. The golf club furnished part of the material and the greater part of the labor for this undertaking. Experiments were begun with mechanical and animal traps to catch adult mosquitoes, but the work has not sufficiently progressed to report results as yet. Malaria surveys of employees of the Canal and contractors engaged in large Canal undertakings in unsanitated areas were continued throughout the year. All persons found carrying the plasmodia of malaria were treated in an effort to reduce the number of carriers and clinical cases. It is believed that the results have justified the effort and expense. The enlarged new open grate incinerator at Summit, for the destruction of the garbage of Ancon, Balboa, and Panama City, was placed in operation in April 1933. While during the dry season, with brisk north winds, the garbage burns almost completely in 24 hours, it was A subsequent dusting was necessary on January 9, 1934. MR 39231--3

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34 found that during the season of rains and variable winds it required, at times, nearly 72 hours for complete incineration. Therefore the incinerator was trebled in size over its first design, allowing grate capacity for 3 days collection in serial order on the grate. It disposes of about 300 cubic yards of mixed garbage and rubbish, including large dead animals, daily. Because of its location in the open country 12 miles from Panama, the smoke .causes little or no nuisance. The garbage is unloaded from a ramp near the city by motor dump trucks, into chain cradles in specially constructed steel railroad cars and hauled to the grate by rail. It is unloaded from the cars by a crawler type tractor drawing out the chain cradles and emptying them on the grate, 15 to 20 cubic yards at a pull. The grates of the incinerator are constructed of old railroad rails cut in half-lengths, and no trouble has been experienced from buckling of the rails as no fire or accumulation of ashes is permitted beneath the grates. Comparatively very little fuel is used to burn the garbage. The fires are started by small piles of scrap wood, old railroad ties, and rubber tires laid at intervals on the grates before the garbage is placed upon it. Once started, the fires burn through the, pile, with a single stoker on hand to keep pulling unburned garbage over into the burning piles. Wet manure from dairy and horse barns proved most difficult to burn, the principal feed here, even in city stables, being green grass brought in from the country. This difficulty was overcome by dumping all manure into the sea, over a high sea wall, where the tides effectually dispose of it without nuisance. Notwithstanding that the breeding of various species of flies apparently was under careful control at the garbage disposal dump in Panama City during the last three years of its operation, the change in method of disposal-discontinuance of disposal dump and removal of all garbage from the city and its incineration at Summit-has resulted in a still further reduction in number of flies in Panama, more particularly those species which breed in decaying animal matter. (See pages 18 to 21 for additional information on anti-malaria work.) REPORT OF THE HEALTH OFFICER-PANAMA Dr. JESSIE L. BYRD, Health Officer Dairy farm inspections.-All dairy cattle are tested once a year for T.B. reactors; any reactors found are either slaughtered or isolated from the dairy herds. Three thousand one hundred fifty-two dairy cattle were tested for T.B. during 1933, the intradermal test being used, and 264 reacted positively to the test. Ninety-one of these

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35 reactors were from two farms, the owners of which have never given this department any cooperation in the prompt handling or disposal of their reactors. The other 18 dairy farms are practically free from T.B. at present. All dairymen are improving their stock by the importation of pure-blooded Holstein, Guernsey or Jersey cattle, and by crossing them with the native stock. Most of the dairy farms now have dipping vats and their cattle are almost free from ticks. Milk inspection.-This work starts at the dairy farms, where the inspector makes frequent checks on the sanitation of equipment, methods of handling, technique of milking, etc. He collects samples at the dairy, at the pasteurization plant, in stores and from delivery trucks. All milk sold retail in Panama is pasteurized and bottled at one of 4 pasteurization plants. While the consumption of fresh milk in Panama City is increasing, and will, no doubt, continue to increase somewhat, it is my opinion that fresh milk will never become a national drink or food here to the extent that it is in other countries. The present supply (about 1,300 gallons per day) is more than adequate to supply the demand (about 5,500 bottles or 1,100 gallons). Only about five percent of the population can afford to purchase fresh milk and have iceboxes or refrigerators in which to keep it. Milk usually is sold in bottles containing one-fifth of a gallon. The present retail price is 15 cents a fifth-bottle (75 cents a gallon). Five years ago the the retail price was $1 a gallon. The fresh milk on sale in Panama City is considered grade "A" pasteurized milk. However, there are one or two dairy farms which could improve their product and they will no doubt do so when the new milk ordinance goes into effect. It will allow us to grade raw as well as pasteurized milk, and in that way will prevent the mixture of good and poor grade milk as sometimes happens now. Public health.-There have been no epidemics during the year. The communicable disease rate remains about the same as last year, except for amebic dysentery which shows a great increase during the past seven months as shown by the following number of cases reported: June, 14; July, 11; August, 26; September, 23; October, 25; November, 41; December, 58. The reason for this sudden increase in amebic dysentery is unknown, but is probably due to better reporting on the part of Santo Tomas Hospital physicians. The infection in more than two-thirds of these cases was definitely traced to places in the interior of Panama, where a majority of the patients resided. The deaths of residents of Panama from amebic dysentery have been as follows for the past five years: 1929, 3; 1930, 1; 1931, 3; 1932, 2; 1933, 9.

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36 Garbage collection and disposal, and street cleaning.-Garbage is collected nightly in Panama City, Ancon, Balboa, and Albrook Field, an area of three square miles, and a population of approximately 91,500 people, with the following equipment and force: One sanitary inspector (American); 2 foremen; 30 laborers; 7 trucks of 1 tons each (one of which collects rubbish and manure during the day) which average a little more than 8 loads daily. The following shows the gross cost of garbage collection, and of disposal of garbage and rubbish from Panama City, Ancon, Balboa, Albrook Field, and Fort Amador, and of street cleaning in Panama City during the year. The tonnage shown is considered fairly accurate, and was arrived at by the actual measurement of the trucks with and without top-load. The six night trucks average three cubic yards each without built-up sides and without top-load, and five and one-half cubic yards each with built-up sides and top-load. These figures check almost exactly with the yardage of the garbage cars which is known to be 75 cubic yards each. Three cubic yards are figured as weighing one ton: Garbage and rubbish collection, Panama City: Collected by Health Department -----------------------tons. 29,445 Cost of collectionTotal ---------------------------------------------$39,962.40 Per ton------------------------------------------------1.36 Per capita (79,000 population)-----------------------------.51 Garbage collection, A ncon, Balboa, Quarry Heights, Albrook Field: (Rubbish in these places not collected by Health Department): Collected by Health Department ------------------------tons6,293 Cost of collectionTotal ------------------------_--------------------$16350.41 Per ton -------------------------------------------------2.60 Per capita (10,700) ------------------------------------1.53 Garbage disposal, Panama City, Ancon, Balboa, Quarry Heights, Albrook Field, Fort .A mador : Collected by Health Department---------------------tons-_ 32,983 Delivered to railroad garbage cars by others -------------tons-3,032 Total garbage disposed of-------------------------tons-. 36,015 Cost of disposalTotal.------------------------------------------------$25,236.72 Per ton ------------------------------------------------.70 Per capita (91,500 population) ----------------------------.28 Rubbish disposal, Panama City, Ancon, Balboa: Manure dumped over sea wall (October to December) -----tons155 Delivered at dump by Health Department -------------tons-. 2,600 Delivered at dump by others --------------------------tons-12,000 Total -------------------------------------tons-. 14,755

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37 Rubbish disposal, Panama City, A ncon, Balboa-continued: Cost of disposal (salary of one man and maintenance of road)Total ------------------------------------------------$988.00 Per ton ----------------------------------------------.07 Per capita (88,700 population) ---------------------------.01 STREET CLEANING-PANAMA Total cost of street cleaning -------------------------------------$22,771.63 Cost of street cleaning per capita (79,000) ---------------------------.29 In April 1933, the enlarged open-grate incinerator at Summit was put into operation, and since then all garbage from the Pacific terminus has been disposed of there; also, all manure from the city of Panama was disposed of there from April until October 1933, since which time it has been dumped over the sea wall on the edge of Panama City, without creating a nuisance. The low cost of collecting garbage is due to the system in effect. which may be described briefly, as follows: The laborers are divided into what is known here as "pullers or placers," loaders and replacers. The puller precedes the trucks by about two hours in residential districts and collects the garbage from each household can, placing it into a large galvanized tub; when the tub is full he empties it into a regulation garbage can and places the full can alongside the street. The truck has a driver and three loaders; two of the loaders ride on the running board of the truck and when the truck stops for a can there is no delay; the can is passed quickly to the loader on the truck who empties it and passes it back, all in one motion. In the business and tenement sections the pullers precede the trucks only about 30 minutes to one hour so that cans will not remain on sidewalks to be upset by mischievous boys and by dogs. This method permits rapid loading and reduces truck hours to the minimum. The average round-trip time per truck in the residential districts of Ancon and Balboa is about 60minutes; this time is reduced to 50 minutes in Panama City where the density of population is much greater. REPORT OF THE HEALTH OFFICER-CRISTOBAL-COLON Dr. JESSE C. ELLINGTON, Health Officer General.-There were no epidemics during the year and the communicable disease report compares favorably with reports for previous years. The general death rate of 16.27 is only slightly higher than the five-year average. The infant mortality rate of 114.96 is much higher than the rate for 1932, but only slightly higher than the average for the five years 1927-1931. The infant mortality rate and the tuberculosis death rate of 3.5 no doubt reflect the poor economic conditions prevailing in Colon throughout the year.

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38 Mt. Hope cemetery.-One thousand forty (1,040) square yards of new road were constructed in the cemetery during the year by Municipal Engineering Division forces, which greatly facilitates the handling of funeral processions. There were 493 burials, the receipts amounting to $3,413. Miscellaneous receipts amounted to $272.75. Street cleaning, garbage collection and disposal.-No changes were made in the methods of handling this work and the results were entirely satisfactory. Burning and burying of garbage and rubbish at the dump was carried out without fly breeding or other sanitary nuisances. Garbage and rubbish collection, Colon: Collected by Health Department ----------------------tons 17,916 Cost of collectionTotal ---------------------------------------------$26,030.20 Per ton ------------------------------------------------1.46 Per capita (30,000 population) -----------------------------.87 Garbage collection, Cristobal and Mount Hope: Collected by Health Department ----------------------tons 3,014 Cost of collectionTotal ----------------------------------------------$5,570.34 Per ton ------------------------------------------------1.84 Per capita (6,247 population) ------------------------------.89 Garbage disposal, Colon, Cristobal, Mount Hope, France Field: Delivered by Health Department ----------------------tons18,107 Delivered by others --------------------------------tons 254 Total ----------------------------------------tons18,361 Cost of disposalTotal ---------------------------------------------$11,557.84 Per ton -----------------------------------------------.63 Per capita (37,047 population) -----------------------------.31 Rubbish disposal, Colon, Cristobal, and Mount Hope: Delivered by Health Department ----------------------tons 2,823 Delivered by others -------------------------------tons-3,805 Total---------------------------------------tons-. 6,628 Cost of disposalTotal ----_--------------------------------------------$650.00 Per ton-----------------------------------------------.10 Per capita (36,247 population) -----------------------------.02 Street cleaning, Colon (not including New Cristobal): Total cost --------------------------------------------$14,611.06 Cost of street cleaning per capita (28,000 population) -------------.52

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39 Free clinic-Following is report of cases treated and other work done during the year: Eye, ear, nose and throat (clinic visits) ------------------------------506 Prenatal and postnatal (clinic visits) ---------------------------------1,897 Babies (clinic visits) ---------------------------------------------2230 Dental (referred to Dr. Doten) ------------------------------------20 Formulae prepared ---------------------------------------------8,741 Medical and surgical (clinic visits) ----------------------------------131 Referred to hospitals --------------------------------------------125 Other work by district nurse: Home visits ---------------------------------------------------,973 Vaccinations ---------------------------------------------------3109 Specimens to laboratory -----------------------------------------454 Mosquito and rat work.-Very few mosquito complaints were registered during the year, except during seasonal flights from points outside the city. Daily catches were made as an index. Rat catching to serve as an index was also carried out throughout the year and 4,704 traps were set, 1,152 rats caught, and 386 rats sent to the laboratory for examination. Inspection of food establishments.-Two hundred and three permits were issued to restaurants, hotels, dairies, milk plants, bottling plants, soft drink places, etc., and 48 permits were subsequently canceled due to establishments going out of business. Inspections were made as follows: Bakeries, 666; dairies, 196; milk plants, 421; bottling plants, 355; markets, 1,466; ice cream plants, 357; restaurants, 2,233; soft drink places, 2,119. Samples of soft drinks, milk, ice cream, caustic solutions and foodstuffs to the number of 592 were sent to the laboratory. Dairies were maintained in good condition and 1,979 cattle were tested for tuberculosis. Five reactors were slaughtered. Animal quarantine inspections.-Inspections were made as follows: Cattle, 186; mules, 120; horses, 58; dogs, 18; monkeys, 15; guinea pigs, 10; circus animals, 10; miscellaneous, 21. REPORT OF THE DIVISION OF QUARANTINE AND IMMIGRATION Dr. CHARLES V. AKIN, Surgeon, U.S.P.H.S., Chief Quarantine Officer The activities of the division show an increase over the year 1932, most of the increase taking place during the closing months of the year. No significant changes in quarantine procedure took place, but the closing month of 1933 saw a general tightening up in immigration requirements. Every effort will be made in the future to restrict

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40 admissions to the Canal Zone and to the Republic of Panama to only such persons as give every guarantee that they will not become public charges. In addition to the duties incident to quarantine and immigration procedure the Chief Quarantine Officer is assisting in revising the sanitary code for the cities of Panama and Colon and in promoting personal hygiene activities among the civilian employees of the Canal, with particular reference to school groups. The Chief Quarantine Officer also acts for the United States Public Health Service as medical officer in charge of medical relief for merchant seamen and other beneficiaries of the service. The following table summarizes the activities for the year: Balboa Cristobal Total Vessels boarded and passed. ..2,426 3,222 5,648 Vessels granted pratique by radio. 36 42 78 Total. ..2,462 3,264 5,726 Crew passed for quarantine. 123,571 229,006 352577 Passengers passed for quarantine ...37,077 86,905 123,982 Total. ...160,648 315,911 476,559 Airplanes inspected and passed. 30 462 492 Crew of airplanes inspected and passed. 61 1,470 1,531 Passengers of airplanes inspected and passed. .68 1,861 1,929 Total. 129 3,331 3,460 Vessels detained in quarantine.2 2 Crew and passengers detained aboard ship for quarantine. 735 735 Persons admitted to station on account immigration laws. .985 .985 Number of detention days for the year. 5,698 .5,698 Persons held for investigation and released. .8 42 50 Persons deported under immigration laws. ...438 490 928 Supplementary sanitary inspection of vessels. 745 2,740 3,485 Vessels fumigated. ...13 26 39 Box cars fumigated. ..91 34 125 Deratization exemption inspections. .6 4 10 Revenues Subsistence. .$8,849.45 .$8,849.45 Night boarding of vessels. 2,550.00 3,850.00 6,400.00 Fumigation of vessels. .890.50 1,205.10 2,095.60 Fumigation of box cars. .106.21 46.25 152.46 Deratization exemption inspections. 120.00 50.00 170.00 Rations issued. 10,978 ..10,978 Rats recovered after fumigation of vessels. 7 114 121 REPORT OF THE DISTRICT NURSE FOR THE PACIFIC DISTRICT Number of baby clinics maintained --------.------------------------6 Average number of babies enrolled per month -----------------------578 Average number of babies visiting clinics per month ------------------239

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41 Total number of visits to clinics-----------------------------------4,553 Number of visits to cases of tuberculosis ----------------------------56 Total number of house visits -------------------------------------960 Red Cross home hygiene classes were continued weekly at La Boca and Red Tank until the course was finished. At La Boca, 15 girls took the final test on April 27, and 14 received certificates from Washington on June 24. At Red Tank, 11 girls took the final test on June 30, and 7 received certificates on August 18 from Washington. The district nurse assisted with the examination of school children on the Pacific side, and with the tuberculin tests which were started late in the year and are still underway. In December the baby clinic at Ancon was temporarily discontinued and a baby clinic started at the Panama Health Office, Panama City, at the request of the mothers in Panama who had been coming to Ancon.

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-x x w e' x x -x

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GENERAL TABLES TABLE 1.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES FOR EMPLOYEES ABSOLUTE NUMBERS Discharges from and deaths in hospitals Total deaths Year 1933: White. .3,244 1,153 1,070 83 16 15 1 23,072 63.21 Black. 9,100 1,873 1,593 280 91 82 9 55,026 150.76 Total. ......12,344 3,026 2,663 363 107 97 10 78,098 213 97 Year 1932: White. ......3,387 1,113 1,050 63 17 15 2 21,151 57.79 Black .........9,234 1,821 1,583 238 96 87 9 57,666 157.56 Total. .......12,621, 2,934 2,633 301 113 102 11 78,817 215.35 ANNUAL RATE PER 1,000 EMPLOYEES Year 1933: White. ..355.43 329.84 25.59 4.93 4.62 .31 ..19.49 Black ..205.93 175.16 30,77 10.00 9.01 .99 ....16.57 Total ....245.14 215.73 29.41 8.67 7.86 .81 ..17 33 Year 1932: W hite ..328. 61 310.01 18.60 5.02 4.43 .59 .17.06 Black ..197.21 171.43 25.77 10.40 9.42 .98 ...17.06 Total. ..232.47 208.62 23.85 8.95 8.08 .87 .17.06 43

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TABLE 2.-CAUSES OF DEATHS OF EMPLOYEES ARRANGED WITH REFERENCE TO COLOR, AGE, AND LENGTH OF RESIDENCE ON ISTHMUS, 1933 Color Age (in years) Length of residence on Isthmus (in years) Disease w 0 -D Typhoidfever. 1 ...1 .................. Influenza with respiratory complications specified. 1 1 ....................1. Dysentery, amebic.I. 1 ................. Tuberculosis of the respiratory system,. 15 2 13 1 .1 1 2 2 6 2 ....1. ......11 1 2 Syphilis. 8 ..8 ....1 1 5 ..1 ........1 7 .. Malaria 2 1 1. I. .............1 1 Cancer and other malignant tumors ofthebuccalcavityandpharynx. 2 .2 .1 .1 ..........2 Cancer and other malignant tumors of the digestive tract and peritoneum. 3 .......2 ...........3. Cancer and other malignant tumors of the male genitourinary organs. 1 .I. .........1 .. Cancer and other malignant tumors of other orunspecified organs. 2 .2. ...2 ......2 Diseasesof thespleen. 1 .I. 1 .....1. ............ Simplemeningitis. 1 1 .....1 ............1.--. Cerebralhemorrhage. ..3 1. ....5 Endocarditis, specified as chronic, and other valvular diseases. 1 .1 ....1 ............ Diseases of thecoronary arteries. 6 2 4 ..2 1 .3 ......5 Other and unspecified diseases of theheart. 3 3. ....2. 1 ..........1 2 .. Aneurysm (except of the heart) 2.2. .2 .........2. Arteriosclerosis (diseases of the coronaryarteriesexcepted). 7 1 6 ....1 2 .1 1 2 ...1 6. Bronchopneumonia. 6 2 4 ...1 ..1 2 .1 1 ........1 5 Lobar pneumonia.3. ...1 .1. .1 ....3. Pneumonia, unspecified. I ..............1 Ulcer of thestomach. 1 1. ...........I.:~ ...Ulcer of theduodenum. 2 1 .......1. .......... Hernia. 2 2 .....2 ..2. Diseases of the gall-bladder and biliarypasaes.,,.2 .2.1 1. .......2. Acutenephritis. .1. I .............-.1 .. Chronic nephritis. 6 1 5 ....1 2 1 2 ......5 1 Other diseases of the kidneys and ureters. 3 1 2 ...2 1 .....3. Calculioftheurinary passages. .I ..........--. 1 ..-.-..

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Stritureoftheurethra. 4 .4 ...1 2 1 4 Diseasesoftheprostate. 2 .2 ....1 .1. Senility .;. 1 .I ......1 .. Suicide by drowning.I. I. ... Suicide by firearms. 1 1 .1 ....... Homicide. 1. 1 ...-. 1.1 Accidental burns (conflagration excepted). ..I.1. ................... Accidental drowning.I.1. .1. Accidental traumatism by fall.2 2 1 ..1. Ill-defined.I.1. I. .....1. ............1. Machinery accident.1 1 1. ... Automobile accident .1 1. I. ..I. .................1 Total. 107 16 91 2 1 4 3 12 29 24 8 18 5 1 1 1 ...5 85 5 9

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46 TABLE 3.-DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON Annual rate per 1,000 Place PopulaDeaths population tion External .External Total Disease causes Total Disease cuse Year 1933: Panama. .79,000 1,181 1,130 51 14.95 14.30 .64 Colon. .30,000 488 469 19 16.27 15.63 .63 CanalZone. .42,851 305 271 34 7.12 6.32 .80 Total. 151,851 1,974 1,870 104 13.00 12.31 .69 Year 1932: Panama ....77,500 1,232 1,171 61 15.90 15.11 .79 Colon. 30,000 433 405 28 14.43 13.50 .93 CanalZone. 42,070 307 272 35 7.30 6.47 .83 Total. 149,570 1,972 1,848 124 13.18 12.35 .83

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x. -a x: x x

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TALE 4.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON BY CAUSE, SEX, COLOR, AND AGE, 1933 Sex Color Age (in years) Total Cause of death deaths Under Age M F W B Y one 1-5 6-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unyear known Infectious and parasitic diseases Typhoidfever. 7 2 5 1 6 I .2 3 1. ... Measles. 4 1 3 1 3 .3. .. Diphtheria. 6 4 2 2 4 .5. .. Influenza with respiratory complications specified. 3 1 2 2 1 .......2. Influenza without respiratory complications specified. .2 1 1 1 1 ....1. ..... Dysentery, amebic. 12 6 6 1 11 .2 1 .2 2.,. .2.2.4. Dysentery, unspecified or due to other causes.1 ....1. Erysipelas. .I I ..........1. Epidemiccerebrospinalmeningitis. 1 .1 .I ..I 1 .. Tetanus. 2 2 ...2 ....I .,. 1 Tuberculosis of the respiratory system. 308 172 136 38 264 6 8 8 4 62 65 65 50 25 17 4. Tuberculosis of the meninges and central nervous system 13 5 8 3 9 1 ..6 2 3 1 .I Tuberculosis of the intestines and peritoneum. 1 .1 .1 ......1. Tuberculosis of the vertebral column. 1 1 ..1 .1. ... Disseminated tuberculosis, acute. 4 2 2 .4 .3. I. ... Disseminated tuberculosis, unspecified.,. 3 2 1 .3 .2 1 .... Leprosy. ..7 5 2 .7 .....2 2 2 1 Syphilis .69 52 17 3 66 .3 4 ....1 2 10 30 8 10 1. Purulent infection, pyemia (nonpuerperal). 3 2 1 .3 .1 .1 ..I Malaria. 15 10 5 5 10 .1 1 2 3 1 3 2 2. Other diseases caused by helminths. 1 1 ..I ..1 ... Cancers and other tumor Cancer and other malignant tumors of the buccal cavity and pharynx. 6 5 1 3 3 ..2 3 1 Cancer and other malignant tumors of the digestive tractandperitoneum .47 27 20 13 33 1 ....1 1 2 11 16 14 2. Cancer and other malignant tumors of the respiratory system .3 1 2 1 2. .2. ... Cancer and other malignant tumors of the uterus. 29 .29 3 26 .1 5 9 5 7 2. Cancer and other malignant tumors of other female genital organs.2. 2 1 1. ....... Cancer and other malignant tumors of the breast. 8 .8 2 6 .....j 4 1 2. Cancer and other malignant tumors of the male genitourinary organs. 4 4 .1 3 .....2 2 Cancer and other malignant tumors of the skin. 1 .1 .L ....... Cancer and other malignant tumors of other or unspecified organs. 10 5 5 3 7 ..3 4 1 .2. Nonmalignanttumors of the uterus. 5 .5 .5 ...1.1 2. 1 1. Nonmalignant tumors of other organs. 1 1 .I .....I. ......

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Rheumatic diseases, nutritional diseases, diseases of the endocrine glands and other general diseases $ Acuterheumaticfever. .2 .2 .2. ..1 1. w Diabetesmellitus.1. 11 4 7 2 -9 ..I. .-. ....... SScurvy. 1 1 ....... Pelagra.--.-. 1.1. ..... Rickets. .1 1. -...... Myxedemaandcre4inism. 1 .1 1......-. I ... Diseases ofthe thymus gland. 1 1. .-.--. .......... Othergeneraldiseases. 1. ......... Diseases of the blood and blood-making organs Primarypurpuras. .... Otheranemias. 2 .2 .2 ..1. .. Pseudoleukemias (Hodgkin's disease). 1 1. ....1. ..... Djseasesofthespleen. 3 3 ..3 ..2 1. ... Diseases of the nervous system and of the organs of special sense Encephalitis (nonepidemic). .I1 .1 1.-. ----.-I .-.-I -. Simplemeningitis. 10 3 7 2 8 .3 1 1 1 1 2. Nonepidemic cerebrospinal meningitis. 2 1 1 1 1 .2. ... Progressive locomotor ataxia (tabes dorsalis). 1 .I.1 .1 .......... Other diseases of the spinal cord. 1 1. -.1 -I -----. .---.------. ----.---------.---2. 1 Cerebralhemorrhage. 71 44 27 10 59. .-. .1-. ..17 13 1 Cerebral embolism and thrombosis. 3 1 2 1 2 .......--. Softening of the brain. 3 1 2 .3 ..........2. 2 Hemiplegia and other paralysis, cause unspecified. 6 2 4 2 4 .....2 .I. 3 Generalparalysisof theinsane. 7 5 2 .7 ......3 1 3. Dementia precox and other psychoses .5 4 1 .5 ....2 1 1 Epilepsy. 1 .......... Convulsions(under5yearsofage). 3 2 1 1 2 .1 2 .....-. Other diseases of the nervous system. 3 3 .1 2 ..2 ....... Diseases of the circulatory system Pericarditis. .3 .3 .......1 1 .. Endocarditis, specified as acute. 9 6 3 4 5 ....2 3 1 2. 1 Endocarditis, unspecified (under 45 years of age). 3 1 2 .3 ....1 1 ..... Endocarditis, specified as chronic, and other valvular diseases. 27 16 11 6 20 1 ..1 2 .1 9 7 5 2 Endocarditis, unspecified (45 years and over). 4 2 2 .3 1 ......1 2 1. Myocarditis, acute. 1 1 .1 .........1 Myocarditis, unspecified (under 45 years of age). 4 2 2 4. ..1 2 1 Myocarditis, chronic, and myocardial degeneration. ..47 23 24 12 35 ...1 1 6 8 6 14 8. Other diseases of the myocardium, unspecified. 7 1 6 2 5 .......1 3 .2 1 Angina pectoris. 3 2 1 1 2 .....3 .--. -Diseases of the coronary arteries. 16 15 1 8 8 ..5 7-.-.-

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TABLE 4.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON BY CAUSE, SEX, COLOR, AND AGE, 1933-Continued Sex Color Age (in years) Total Cause of death deaths Under Age M F W B Y one 1-5 6-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unyear known Diseases of the circulatory system-Continued. Functional diseases of the heart. I 1.I. .......... Other and unspecified diseases of the heart. 29 19 10 4 25 .1 1 1 4 2 3 7 3 5 2. Aneurysm(exceptoftheheart). 7 6 1 7. ....3 2 1 1. Arteriosclerosis (diseases of the coronary arteries excepted). 43 23 20 13 30 ....5 6 23 6. Gangrene. .4 2 2. 4.I. .2 ..1. Otherdiseasesofthearteries. .1. I --. .......... Idiopathic anomalies of the blood-pressure. 5 .5 1 4 ...1 4 .... Diseases of the respiratory system Diseases of the annexae of the nasal fossae. 1 1 ..---. .I ....... Diseasesofthelarynx. 2 2 .1 1 ...1 ..1. ..Bronchitis, acute. 17 8 9 3 14 9 7 1 ....... Bronchitis, chronic.1 I. Bronchitis, unspecified (under 5 years of age). 3 3 .2 1 .2 1 -Bronchopneumonia. 147 81 66 19 127 1 67 41 6 4 5 4 6. 7. S. 2. Capillary bronchitis. .1 1 ..1 .I .-. ----Lobarpneumonia. 68 48 20 6 62 .7 7 2 4 6 6 10 13 10 2 1 Penumonia,unspecified .17 12 5 1 16 .3 2 ..1 3 2 2 .1 3. Pleurisy. 3 1 2 1 2. I 1 1. .... Other congestive conditions of the lungs. 6 2 4 2 4 ....I 1. 1 1 2. Asthma. .2 1 1 1 1. 2. .. Chronic, interstitial pneumonia including occupational diseases of the respiratory system. 1 1 .........I .... Other diseases of the respiratory system, including gangrene of the lung (tuberculosis excepted). 1 1 ...1 .......... Diseases of the digestive system Diseases of the pharynx and tonsils. 2 .2 1 1 ....2. .-. Other diseases of the buccal cavity and annexa (including adenoid vegetations). 1 1 .I 1. ......--Ulcer of thestomach. .14 8 6 2 11 1 ....... Ulcer of the duodenum. 6 6 .2 4 ....1 3 2. Other diseases of the stomach (cancer excepted). 2 1 1 .2 .1 ...1 .. Diarrhea and enteritis (under 2 years of age). 153 85 68 15 136 2 116 37 ..... Diarrhea and enteritis (2 years and over). 9 6 3 .9 ...7 11 ....--.1 Appendicitis. .15 10 5 5 9 1 .1 1 5 2 ..4 1 1 -. Hernia. 7 5 2 3 4 ..1 .I 1. ...1 -. Intestinalobstruction.8 2 6 .8 2 ..4 .2 -.

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Otherdiseasesoftheintestines. 3 3 .1 2 ..I ..1 1. Cirrhosis of the liver, specified as alcoholic. .3. ......I .1. Cirrhosis of the liver, not specified as alcoholic. 13 7 6 3 10 .1 ...1 2 5 3. Otherdiseasesoftheliver. 6 5 1 1 5 1. I I .....1 1 1 1 Biliarycalculi. .3 1 2. 2 1 .....1 ..1 Other diseases of the gall-bladder and biliary passages. 3 3 .1 2 ......2. .. Peritonitis, cause nor specified. 2 1 1 .2 .....1 Diseases of the genitourinary system Acute nephritis (including unspecified under 10 years of age). .21 9 12 1 19 1 4 4 3 1 3 2 3 1. Chronicnephritis. ..89 49 40 9 78 2 1. ..7 13 23 18 22 4 1 Nephritis, unspecified (10 years and over). 8 2 6 2 6 .2. .2 3. .1. Other diseases of the kidneys and ureters (puerperal diseasesexcepted). 16 12 4 2 14 .4 1 ..1 .1 5 1 1 2 Calculi of the urinary passages. 2 2 .2 ....... Diseases of the bladder (tumors excepted). 1 1 ..1 .,. ....... Stricture of the urethra. .9 9 .8 1 ...1 2 4 .2 Other diseases of the urethra, urinary abscess, etc. 2 2 .2 ...2. Diseases of the prostate. 5 5 ..5 ....2 2 1 Cystsoftheovary. .1. .1 .I ...1. Other diseases of the ovaries and diseases of the tubes and parametrium .6 .6 2 4 ...3 3 Diseases of the uterus (not specified as venereal). 2 ..2 ..2 ....... Diseases of pregnancy, childbirth, and the puerperal state Abortion with septic conditions .2. 2 .2 ....2 Placentaprevia.1 .1 ......... Other puerperal hemorrhages. 2 .2 .2 ....1 ..... Puerperal septicemia and pyemia (not specified as due toabortion). ...5. .5.5. ...2 3. .... Puerperal tetanus (not specified as due to abortion). 1 .1. I .....I1. .. Puerperal albuminuria and eclampsia. 8 8 3 5. ...2 2 4. ... Other toxemias of pregnancy. .2. 2.2. ..1 I. .... Cesarean operation. .1 .....1. Other accidents of childbirth.2. 2 .2 ....,. .... Diseases of the skin and cellular tissue Furuncle, carbuncle.1. ..1 ..... Phlegmon, acute abscess. 4 2 2 1 2 1 ..1 2 1. Other diseases of the skin and annexa, and of the cellular tissue. 5 1 4 2 3 .1 2 ..1. Diseases of the bones and organs of locomotion Osteomyelitis. .1 1 ..1 .... Diseases of the joints (tuberculosis and rheumatism excepted). 1 .1.1 ..1.

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TABLE 4.-DEATHS OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF PANAMA AND COLON BY CAUSE, SEX, COLOR, AND AGE, 1933-Continued T Sex Color Age (in years) Total Cause of death deaths Under Age M F W B Y one 1-5 6-10 11-20 21-30 31-40 41-50 51-60 61-75 76-100 unyear known Congenital malformations (stillbirths not included) Congenital hydrocephalus. 3 1 2 .3 .1 2. Congenital malformations of the heart. 3 2 1 .3 .2 1. Other congenital malformations. 5 4 1 2 3 .4 ...1. Diseases of early infancy Congenital debility (under 1 year of age) .47 29 18 3 44 ..47. Premature birth (under 1 year of age). .56 34 22 12 44 .56 .. Injury at birth, Cesarean operation (under 3 months of age). 3 2 1 1 2 .3. .... Injury at birth, without Cesarean operation (under 3 monthsofage). 11 10 1 2 9 .11. .. Atelectasis (under 3 months of age). 22 12 10 1 21 ....22. Icterus of the newborn (under 3 months of age). 2 2 .1 1 .2 ... Sclerema(under3 months of age). 1. ..I ........ Other diseases peculiar to early infancy (under 3 months of age). 20 12 8 1 19 ..20. ..... Senility Senility. 9 4 5 3 6 ....5 4 Violent and accidental deaths Suicide by solid or liquid poisons, or by absorption of corrosive substances. 7 4 3 2 5 ..3 2 1 1. Suicide by hanging or strangulation. 1 1 ...I .I. ... Suicide by drowning. 1. ........ Suicide by firearms. 5 5 .4 1 ......1 3 Suicide by jumping from high places .1 1. I. ....I. ... Homicidebyfirearms. 4 2 2 2 2 .....2 2. Homicide by cutting or piercing instruments. 7 3 4 .7 ....3 3 1. Homicide by other means. 3 2 1 ..3 ..2 1. Attack by venomous animals. ..1 1. 1. ....1. Other acute accidental poisonings (gas excepted). 3 1 2 .3 ..1 ..I .1 Accidental burns (conflagration excepted). 4 3 1 .4 .1 2 1 ... Accidentaldrowning.,. 21 21 .3 18 .1 5 6 2 Accidental traumatism by firearms (wounds of war excepted). 2 2 2. .......I Accidentaltraumatismbyfall. ..16 13 3 3 13 ..1 .3 3 4 ..2. Accidental traumatism by crushing, landslide .1. 1 .....1 .... Excessiveheat. 1 1 1. ...I.1. ,. ... Foreignbodies. 3 1 2f. 2 ..1 ..1 ..1. Other accidents. 1 1 .1 ... Violent deaths of which the nature (accident, suicide, homicide) is unknown. 1 I ....,. .....

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Ill-defined causes Suddendeath. .12 10 2 2 9 1 .....4 3 2 2 1 Ill-defined. 16 8 8 4 12 .1 ....3 3 1 1 Notspecifiedorunknown. 5 1 4 .5 .1 1 ..I ..1 1. Supplemental violent and accidental deaths Other machinery accidents. 2 2 ..2. ....,. .... Other railroad accidents. ..1 1 1 .1 .-. I .....-.--. ....I Automobile accidents (primary). 16 15 1 4 12 ..2 1 2 7 3 .1 Water transportation accidents. 1. 1. ...... Air transportation accidents. 1 1 .......1 ..... Total. 1,974 1,132 842 314 1,635 25 424 179 33 144 185 215 305 206 203 73 7 Cn

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TABLE 5-DEATHS OF RESIDENTS, BY PLACE OF RESIDENCE, ABSOLUTE NUMBERS AND ANNUAL RATES PER 1,000, 1933 ABSOLUTE NUMBERS ANNUAL RATES PER 1,000 ALL CASES (including employees) ALL CASES (including employees) CANAL ZONE CANAL ZONE ATLANTIC SIDE PACIFIC SIDE ATLANTIC SIDE PACIFIC SIDE Disease Army .Army City City Eld Army Army City City Excluding and Excludig and of of Total Exmlad and Excluding and o -of Total Army and Navy Navy Army and Navy Navy Colon PanArmy and Navy Navy Army and Navy Navy Colon Pan(officers (officers ama (officers (officers ama .and enA .and en.and en.and enAmenOthers listed anr Others listed AmenOthers listed AmenOthers listed cans men) cans men) cans men) Cans men) POPULATION. .............151,851 1,972 10,338 5,933 6,682 12,847 5,079 30,000 79,000 Infectious and parasitic diseases Typhoid fever. .7 ...I ...5. .....063 M easles. ......4 .026 .......050 Diphtheria .6. ...1 5 .04 ......033 .063 Influenza with respiratory complications specified. .3. .1. .2 .02 .......025 Influenza without respiratory complications specified. 2 .......2 .013 .....025 p Dysentery, amebic. 12 ....2 9 .079 ......067 .114 Dysentery, unspecified or due to other causes. 1 .......1 .007 ..012 Erysipelas. ..1 .007 .....012 Epidemic cerebrospinal meningitis. ..1 .007 ........012 Tetanus. ...2 ..013 ......067 Tuberculosis of the respiratory system. 308 4 1 1 14 .98 190 2.03 ..39 .17 .15 1.01 .3.267 2.40 Tuberculosis of the meninges and central nervoussystem. .13 ..2 11 .086 ......067 .139 Tuberculosis of the intestines and peritoneum .1 ...1 .007 .......012 Tuberculosis of the vertebral colum n. 1 ........1 ...007 .......033 Disseminated tuberculosis, acute. .4 1. ...2 1 .026 ..097 ....067 .012 Disseminated tuberculosis, unspecified 3. .......2 1 .02 ._. .067 .012 Leprosy.7 ....7 .4. ..544 ... Syphilis. 69 1 5 ..3 .16 44 .454 .51 .483 ..233 .533 .557 Purulent infection, pyemia (nonpuerperal). 3 .I ....2 .02 ..097 ..025 M alaria. .15 .2 1 2 1 3 6 .099 ..193 ..15 .16 .20 .10 .076 Other diseases caused by helminths .1 ......1 .007 ........012 Cancers and other tumors Cancer and other malignant tumors of the buccalcavityandpharynx. 6 ...1. 4 .04 ..097 ...07. .050 Cancer and other malignant tumors of the digestive tract and peritoneum. 47 .2 .4 3 .8 30 .31 ..193 ..60 .233 _. .267 .38 Cancer and other malignant tumors of the respiratory system. 3 ....1 2 ....033 .025

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Cancer and other malignant tumors of the uterus. .29 .1 .1 3 1 9 14 19 ...097 ..15 233 .20 .30 .177 Cancer and other malignant tumors of other female genital organs. .2. ...I. ...0 ........012 Cancer and othermalignant tumors of the breast 8 1 ..3 1 3 .053 .51 ...033 .038 Cancer and other malignant tumors of the male genitourinary organs. 4 ........2 2 .026 ...067 .02 Cancer and other malignant tumors of the skin. 1 .....1 .007 ...02 Cancer and other malignant tumors of other or .12 unspecified organs. 10 .4 ....1 5 .067 ..39 ...063 Nonmalignant tumors of the uterus. 5. ..3 2 .033 ..0 .025 Nonmalignant tumors of other organs. I .....1 .007 ..10.012 Rheumatic diseases, nutritional diseases, diseases of the endocrine glands and other general diseases Acute rheumatic fever. 2 ........2 .... Diabetesmellitus. I I ..| 3 ...4 4 .072 .050 Scurvy. .1. ..1 .007 ....012 Pellagra. .........8 Rickets. ...1 .007. .......012 Myxedema and cretinism.1. I ........7 .... Diseases of the thymus gland. .1. ..1 .007 ..012 Other general diseases. 1 ......1 .007 ...012 Diseases of the blood and blood-making organs Primary purpuras .I ......1 .007 ....012 Other anemias. ....1. .1 .013 .....078 .012 Pseudoleukemias (Hodgkin's disease). I. ........ Diseasesof thespleen. .3. .2. ............ Diseases of the nervous system and of the orgaps of special sense Encephalitis (nonepidemic). 1 .......1 ..007 ....20 Simplemeningitis .10 3 ..1 6 .066 ...76 Nonepidemic cerebrospinal meningitis. 2 .....1 1 .013 ..033 .012 Progressive locomotor ataxia (tabes dorsalis). .1 ..I1. .....033.01 Other diseases of the spinal cord. 1 1 .......007 .51 Cerebral hemorrhage. 71 1 1 2 1 7 .26 33 .468 .51 .097 .337 .15 .544.867 .417 Cerebral embolism and thrombosis. 3 ...1 2 .02 ....033 .025 Softening of the brain. ...3 ....1 ......078 ..033 .012 Hemiplegia and other paralysis, cause unspecified. .,. 6 ....I .3 2 .04 .....078. ..10 .025 General paralysis of the insane. 7 ....6 ..1 .046 .....47. ...012 Dementia precox and other psychoses. 5 ....4 ..1 .033 .......012 Epilepsy. ..1 ......1 .007 ....012 Convulsions (under 5 years of age). 3 ....1 2 .02 ....033 .025 Other diseases of the nervous system. 3 .3 .02 ......038

PAGE 58

TABLE 5-DEATHS OF RESIDENTS, BY PLACE OF RESIDENCE, ABSOLUTE NUMBERS AND ANNUAL RATES PER 1,000, 1933-Continued ABSOLUTE NUMBERS ANNUAL RATES PER 1,000 ALL CASES (including employees) ALL CASES (including employees) CANAL ZONE CANAL ZONE ATLANTIC SIDE PACIFIC SIDE ATLANTIC SIDE PACIFIC SIDE Disease Excluding Army Excluding Army C City Excluding Army Excluding Army City City Total Army and Navy and Army and Navy and t of Total Army and Nay and Army and Navy and of Navy Navy Of PanNavy Navy o Pan(officers (officers ama (officers (officers olon ama and en.and enand enand enAmeriOthers listed AmeriOthers listed AmeriOthers listed AmeriOthers listed cans men) cans men) cans men) cans men) Diseases of the circulatory system Pericarditis. .3. .......1 2 .02 .......033 .025 Endocarditis, specified as acute .9. .2 2 1 3 .059 ...17 ..16 .394 .033 .038 Endocarditis, unspecified (under 45 years of age) 3 .........3 .02 ........038 Endocarditis, specified as chronic, and other valvulardiseases. .27 1 2. ..13 11 .178 ..097 ...433 .14 Endocarditis, unspecified (45 years and over). 4 ......1 3 .026 ....033 .038 Myocarditis, acute. 1 .....1 .007 .....012 M yocarditis, unspecified (under 45 years of age). 4 ......1 3 .026 ..033 .038 Myocarditis, chronic, and myocardial degeneration. 47. ...4 12 31 .31 .......40 .392 Other diseases of the myocardium, unspecified.7. .......7 .046 ........089 Angina pectoris. .3 ......1 2 .02 .......033 .025 Diseases of the coronary arteries. 16 .2 .2 2 .2 8 .105 ...193 ..30 .16 ..067 .101 Functional diseases of the heart. 1 .....I. .0 ....... Other and unspecified diseases of the heart.,. 29 .4 ..2 1 7 15 .19 ..39 ...16 .20 .233 .19 Aneurysm (except of the heart). 7 ....2 .2 3 .046 .....067 .038 Arteriosclerosis (diseases of the coronary arteries excepted). 43 .1 .5 6 1 8 22 .28 ....748 .47 .20 .267 .278 Gangrene.4 1 ....2 1 .026 ..07 ..067 .012 Other diseases of the arteries. I ......1 .007 ...012 Idiopathic anomalies of the blood pressure. 5 ...3 .1 1 .033 ....233 ..033 .012 Diseases of the respiratory system Diseases of the annexae of the nasal fossae. 1 ....1 ....007 ...078 ... Diseases of the larynx. 2 ...2 ..013 ... Bronchitis, acute.,. 17 ......5 12 .11 ......167 .152 Bronchitis, chronic. .1. ...I. ...7 ...078 Bronchitis, unspecified (under 5 years of age). 3 ........3 .02 ...,. .038 Bronchopneumonia. 147 2 6 .1 10 1 27 100 .97 1.01 .58 ..15 .78 .20 .90 1.26 Capillary bronchitis. I ............ Lobar pneumonia. 68 7 .,. 6 .20 35 .45 .677 ...7 ..667 .443 Pneumonia, unspecified.17 ....3 13 .11 ....078 ..10 .164

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Pleurisy. .., 1. ...2 .02 ,. ....15 ...._025 Other congestive conditions of the lungs.,. 6 ........5 .04 ....078 ..063 Asthm a. ...1. .1 .I ........3 Chronic interstitial pneumonia including bccupational diseases of the respiratory system .1 ......1 .007 .........012 Other diseases of the respiratory system including gangrene of the lung (tuberculosis excepted).1. .1. ..007 ...078 ... Diseases of the digestive system Diseases of the pharynx and tonsils. 2 .......2 .013 .....025 Other diseases of the buccal cavity and annexa (including adenoid vegetations). I ....1 .007 ........012 Ulcer of thestomach.14 ..6 8 .092 .....20 .101 Ulceroftheduodenum. .1 1 ..3 .04 .097 ..15 .078 ...038 Other diseases of the stomach (cancer excepted) 2 ......2. ..013 .....067 .. Diarrhea and enteritis (under 2 years of age). 153 ..1 .18 134 1.02 .....078 ...60 1.70 Diarrhea and enteritis (2 years and over). 9 ......3 6 .059 .....10 .076 Appendicitis. 15 .1 2 1 ..1 2 8 .099 ..097 .337 .15 ..20 .067 .101 H ernia. ...7 .1 1 1 ...1 3 .046 ..097 .17 .15 ...033 .038 Intestinal obstruction. 8 ....1 4 3 .053 ..078 ..133 .038 Other diseases of the intestines. 3 1 1. ..1. ..02 .51 ..17 ....033 Cirrhosis of the liver, specified as alcoholic. 3 ....3 .02 .......038 Cirrhosisoftheliver,notspecifiedasalcoholic. 13 2 1. ..5 5 .09 ..193 ..15 ..167 .063 Other diseases of the liver.6. ..1 5 .04 ......033 .063 a Biliary calculi. 3. ...3. ......2. Other diseases of the gall-bladder and biliary passages. ..3 ...,. .I .1 1 .02 .....078 .,033 012 Peritonitis, cause not specified. 2 ...2. ....... Diseases of the genitourinary system Acute nephritis (including unspecified under 10 yearsofage). .21 .2 .5 13 .14 ..193 ...078 ..167 .164 Chronic nephritis. 89 1 5 ..3 18 62 .59 .51 .483 ..233 ..60 .784 Nephritis, unspecified (10 years and over). 8 ........1 7 .053 .....033 .088 Other diseases of the kidneys and ureters (puerperal diseases excepted). 16 .I .2 1 .6 6 .105 ..097 ..30 .078 ..20 .076 Calculi of the urinary passages. 2 ...2 .....013 ....30 .... Diseases of the bladder (tum ors excepted). 1 ........1 .007 .........012 Stricture of the urethra. .9 ...1 6 .059 ..097 ...078 ..033 .076 Other diseases of the urethra, urinary abscess, etc .2. 1 1 .013 ...033 .012 Diseases of the prostate.5. ....I .1 3 .032 .......033 .038 Cysts of the ovary.1. 1 .007 ......012 Other diseases of the ovaries and diseases of the tubes and parametrium .6 ....I ..1 4 .039 ......033 .050 Diseasesoftheuterus(notspecifiedasveneral). 2 ....1 1 013. .....033 .012

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TABLE 5-DEATHS OF RESIDENTS, BY PLACE OF RESIDENCE, ABSOLUTE NUMBERS AND ANNUAL RATES PER 1,000, 1933-Continued ABSOLUTE NUMBERS ANNUAL RATES PER 1,000 ALL CASES (including employees) ALL CASES (including employees) CANAL ZONE CANAL ZONE ATLANTIC SIDE PACIFIC SinE ATLANTIC SIDE PACIFIC SIDE Disease Excluding Arny Excluding arnm City of Excluding Army Excluding arn City City Total Army and Navy Navy Army and Navy Navy of PanTotal Army and Navy Navy Army and Navy Navy of Pan(officers (officers Colon ama (officers -(oicers Coloo ama .and en.and en.and en.and enAmenOthers listed AmenOthers listed Ameri Others listed *m Others listed cans men) cans men) cans men) cans men) Diseases of pregnancy, childbirth, and the puerperal state Abortion with septic conditions. ..2. .1 1 .013 ..033.012 Placenta previa. ...I. .007 .033. Other puerperal hemorrhages. ....2 ......2 .013 .....025 'Puerperal septicemia and pyemia--(not specified as due to abortion). 5 ....2 .3 .032 _. ..16 ..038 Puqrperal tetanus-(not specified as due to abortion). ..I 1 ....007 097 ., .. Puerperal albuminuria and eclampsia ..S. 4 4 .053 ..133 050 00 Other toxemias of pregnancy. .2. ..2 ..013. .067. Cesarean operation .1. I ....1 .007 .....012 Other accidents of childbirth. ...2 ..1 1 .013 ..033.012 Diseases of the skin and cellular tissue Furuncle, carbuncle. .I.1 .007 .7.078. Phlegmon, acute abscess. .4. I ..026 ....033 .025 Other diseases of the skin and annexa, and of the cellular tissue. .5 ...1 1 3 .033 ..20 .033 .038 Diseases of the bones and organs of locomotion Osteomyelitis .1. I ......1 .007 ..012 Diseases of the joints (tuberculosis and rheumatism excepted). 1 .....007 ..097 ... Congenital malformations (stillbirths not included) Congenital hydrocephalus.3. ......1 2 .02 ......033 .025 Congenital malformations of the heart, : ..3 ......3 .02 ..038 Other congenital malformations.,. 5 .2 ...2 .033 ..193 ...078 ..025 Diseases of early infancy Congenital debility (under 1 year of age. 47 4. ..16 26 .31 ..39 ....533 .33 Premature birth (under 1 year of age). 56 .4 ...26 21 .37 ..39 ...8. 67 .266

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Injury at birth, Cesarean operation (under 3 months of age).3 ...2 .02 .....20 ..025 Injury at birth without Cesarean operation (under3monthsof age). 11 .....1 10 .072 .....033 .126 Atelectasis (under 3 months of age) .22 ......1 \.21 .144 ........033 .266 Icterus of the newborn (under 3 months of age) 2 ..2 .013 ......025 Sclerema (under 3 months of age). I. ....1 ..007 ....033. Other diseases peculiar to early infancy (under 3 months of age).,. 20 ...2 .1 16 .13 ..097 ..16 .033 .20 Senility Senility. .9 ....3 5 .059 ...078 ..10 .063 Violent and accidental deaths Suicide by solid or liquid poisons, or by absorption of corrosive substances.,. 7 .....6 .046 ......078 ...076 Suicide by hanging or strangulation. I .....1 .007 ....012 Suicide by drowning. 1 ...1 .....033 Suicide by firearms .5 ..1 1 1 1 1 .033 ...15 .078 .20 .033 .012 Suicide by jumping from high places.,. I 1. ....007 .51 Homicide by firearms. 4 .1 .--.--. .3 .026 ....078 ..038 Homicide by cutting or piercing instruments .7 ...2 5 .046 .....067 .063 Homicide by other means. 3 ....1 1 .02 ...078 .033 012 Attack by venomous animals. .1 I .....007 ..097 Other acute accidental poisonings (gas excepted) 3 .....1 2 .02 ......033 .025 Accidental burns (conflagration excepted) 4. .....4 .026 ...050 C Accidentaldrowning. 21 .5 3 .3 .2 8 .14 ..483 .51 ..233 ..067 .101 0 Accidental traumatism by firearms (wounds of warexcepted). ..2 1 .1 ......013 .51 ..17 Accidental traumatism by fall. 16 .1 .1 ..6 8 .105 ..097 ..15 ...20 .101 Accidental traumatism by crushing, landslide. 1 ...I. ........ Excessive heat. ..1. ........1 .007 ........012 Foreign bodies.3. ..-. ...2 .02 ......025 Other accidents.:. 1 ...I ........ Violent deaths of which the nature (accident, suicide, hom icide) is unknown. 1 .......1 .007 ........012 Ill-defined causes Sudden death.12. ..8 4 .079 ....267 .050 Ill-defined. .16 I. ..2 .5 8 .105 097. .6 ...167 .101 Not specified or unknown. ......3 2 .033 .....10 .025 Supplemental violent and accidental deaths Other m achinery accidents. ..2 ....I. ..1 .013 .....078 ....012 Other railroad accidents. I ....1. ...007 ...... Automobile accidents (primary). 16 ..I .2 1 5 7 .105 ...17 ...16 20 .167 .088 Water transportation accidents. I .1 ..007 .... Air transportation accidents. .1. ...1 ...0. .....20. Total. 1,974 10 88 14 33 145 15 488 1,181 13.01 5.07 8.51 2.36 4.94 11.29 2.95 16.27 14.95

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60 TABLE 6.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1933 Annual death rate per 1,000 White employees from the United States: D isease. ..3 .89 External causes. .35 T otal. ...4.25 Families of white employees from the United States: D isease. ...14 .45 External causes. ..36 T otal. .4 .81 White employees from the United States and their families: D isease. .4 .27 External causes ..3. ...36 T otal. 4 .62 Number of American children born on the Isthmus during the year. 198 Deaths among American children under 1 year of age. 7 Infant mortality rate among American children (number of deaths per 1,000 live births). 35.35

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s 4 & x

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TABLE 7-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933 ABSOLUTE NUMBERs ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY ATLANTIC SIDE PACIFIC SIDE Disease Total Excluding Army Army and Excluding Army Army and City of City of Nonand Navy Navy (offiand Navy Navy (offiColon Panama residents White Black cers and cers and enlisted enlisted Americans Others men) Americans Others men) POPULATION. 3,244 9,100 151,851 1,972 10,338 5,933 6,682 12,847 5,07930,000 79,000 Infectious and parasitic diseases Typhoid fever.2 17 .1 2 1 2 4 6 Relapsing fever .6. .....1 1 3 Measles. ...31 4 2 3 4 7 1 2 7 1 Scarletfever. ..7 2 1 2 2 W hooping cough ...6 1 ..4 ..1. Diphtheria. .2 22 ..4. .3 8 .3 4 Diphtheria bacillus carrier. .4 .....2 ..2 Influenza with respiratory complications specified. 5 13 53 2 8 13 7 1 2 16 2 2 Influenza without respiratory complications specified so 59 397 13 10 25 105 24 134 22 57 7 Dysentery, amebic. .1 1 8 .....2 2 3 Dysentery, bacillary. 2 ..2.2. Dysentery, unspecified or due to other causes. .I. ....1 Erysipelas. 6 2 17 1 2 1 3 .1 5 4. Acute poliomyelitis and acute polioencephalitis. ..4 .24 .2. 2. Lethargic or epidemic encephalitis. ....2 ...I I ... Epidemic cerebrospinal meningitis. 1. ... Rabies. I Tuberculosis of the respiratory system .11 22 103 4 9 7 6 15 8 22 25 7 Tuberculosis of the meninges and central nervous system ..4 ...........2 2. Tuberculosis of the intestines and peritoneum. ...... Tuberculosis of the vertebral column. .12. ..3 ...1 7 1. Tuberculosis of the skin and subcutaneous cellular tissue. .1 ....... Tuberculosis of the lymphatic system (bronchial, mesenteric and retroperitoneal glands excepted). .2 7 1 .2 .1 3. Tuberculosis of the genitourinary system. .2 3 .1 ..1 Tuberculosis, disseminated, acute. ...3. 2. .... Tuberculosis, dissem inated, unspecified. ....2 .......2 Syphilis, primary.8. ..2. 1 .2 2 Syphilis,secondary. 4 7 45, .2 6 2 6 11 1 11 6 Syphilis, tertiary. ..4 28 81 2 6 2 2 13 4 21 22 0 Syphilis, cerebrospinal. ..4 17 .1 1 .3 1 8 3 Syphilis, hereditary. .7 .I. .1 .1 4

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Softchancre. 6 11 104 .3 11 4 7 58 8 9 4 Chancroidal lym phadenitis. ....6 1. I ....5 Gonocoecicurethritis. 12 38 239 1 17 13 2 28 119 19 27 13 Gonococcic arthritis. 9 ..4 ...3 2. Gonococcic ophthalmia. .9 ....1 4 2 2 Gonococcie vaginitis. ..6 .1 .9 3 Other gonococcic infections and other venereal diseases. ..15 ...1 12 .1 Purulent infection, pyemia and septicemia (nonpuerperal). .1 4 ..1 ..1. .2. Septicemia ...1 3 Malaria, estivoautumnal. 41 200 803 14 124 52 65 201 84 56 120 87 Malaria, tertian. 45 39 375 13 27 37 77 45 87 20 50 19 M alaria,quartan. 1 1 13 2 1 1 .1 5 2 Malaria, mixed. .2.2. .... Malaria, clinical (symptomatic, parasites not found). ..2 1 .1. Hemoglobinuria, malarial. ......1 Yaws. .I. Oriental sore (Leishmaniasis). ..,. ...1. Other diseases due to-protozoal parasites. 1. ..1. ... Ankylostomiasis. .4 4 45 .6 3 1 12 1 5 11 6 Filariasis. 1 1 1 .. Other diseases caused by helminths. I .24 .1 7 1 6 6 Othermycoses. 1 1 9 1 1 4 ...1 2. Chickenpox. .7 22 .3 .8 3 2 5 1 German measles. 2. .2. ... Miliary fever. ..1 1. ... M um ps. ..1 .....1. Vaccinia. .....I .......... Cancers and other tumors Cancer and other malignant tumors of the buccal cavity and pharynx. 1 5 10 2 2 ...2. .3 1 Cancer and other malignant tumors of the digestive tract andperitoneum ..2 24 .2 1 9 5 .1 5 1 Cancer and other malignant tumors of the respiratory system ..-. ..,. ..1 ......1 ... Cancer and other malignant tumors of the uterus. ..27 1 3 .2 7 .6 5 3 Cancer and other malignant tumors of other female genital organs. .2. ..... Cancer and other malignant tumors of the breast. ..12 1 1 .1. ..4. Cancer and other malignant tumors of the male genitourinary organs. 1 1 4 1 1 ...2. Cancer and other malignant tumors of the skin. .1 4 .....3 Cancer and other malignant tumors of other or unspecified organs. ..3 11 .6 1 .29. ...3 1 Nonmalignant tumors of the uterus. 3 6 97 3 7 .12 14 .27 29 5 Nonmalignant tumors of other female genital organs. ........ Nonmalignant tumors of the brain. ..2 .,. .2. .... Nonmalignant tumors of other organs. 1 5 33 4 3 8 1 3 5 4 5. Tumors of the uterus (nature unspecified). .I. ...1. Tumors of other organs (nature unspecified). .2 2 14 4 2 1 2 1 2 1 1.

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TABLE 7-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued ABSOLUTE NUMBERS ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY Disease ATLANTIC SIDE PACIFIC SIDE Total Excluding Army Army and Excluding Army Army and City of City of Nonand Navy Navy (offiand Navy Navy (offiColon Panama residents White Black cers and cers and Americans Others enlisted .enlisted men) Americans Others men) Rheumatic disease, nutritional diseases, diseases of the endocrine gland8 and other general diseases Acute rheumatic fever ...8 ..1 2 .2 3. Chronic rheumatism, osteoarthritis. ..14 56 2 5 5 7 7 12 8 9 1 G out ...1 .2 2 .. Diabetesmellitus. 5 7 75 2 18 1 6 1. ...3.5 Glycosuria.1 2. ......2. Pellagra. ...1 .I. .. Rickets. ...3. .. Diseases of the pituitary body. ..3 1 .1 ...1. Simple goiter. 3 1 11 1 .1 3 .2 1 3 Exophthalmic goiter. .1. .5 1 .1 .1 1. ....2 M yxedem a and cretinism ....4 ..I ..1 1 Tetany.3. ......3 Other diseases of the thyroid and parathyroid glands. 1 6. .1 3. 1 ..1 Othergeneraldisease-. 3 1 41 5 10 1 2 4 2 14 3. Diseases of the blood and blood-making organs Pernicious anemia., .I .5 1 1 ..2 Other anemias. 1.1 9 1. .2 1 41 Trueleukemias. .2 ..I .I. Pseudoleukemias (Hodgkin's disease). .I. ...... Diseases of the spleen. ..1 1 4 .....1 1 1 1. Chronic poisonings and intoxicants Acutealcoholism .6 2 36 3 2 3 5 1 13 5 3 1 Chronic alcoholism. .8 1.2. 4 .. Alcoholicpsychosis. I .15 ..5 2 .3 2 3 Drug habit. .2. ...... Lead poisoning ......4.4. Under observation for lea poisoning .: 11 17 1 .*. .44_. a.

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Diseases of the nervous system and of the organs of special sense Encephalitis (nonepidemic). ..4 .... S Simple meningitis. ...1 5 .1 ...2 Progressive locomotor ataxis (tabes dorsalis). 2 .3 1 ...... Other diseases of the spinal cord. .....7. 1 3 1 Cerebral hemorrhage. .11 20 .1 1 .4 7 2 Cerebral embolism and thrombosis.4. 1 2 1 Softeningofthebrain. ..1 ---. .......-1. S H em iplegia ..7 15 .I ...6 .3 4 1 Other paralyses, cause unspecified. .4 13 3 4 ..1 2 3 Generalparalysisoftheinsane. .3 28 .2 1 .2 1 2 15 5 Dementia precox. .3 444 .6 14 .4 11 43 238 128 M anic depressive psychosis. .47 ..2 ..1 2 28 14 Other psychoses. .1 .103 1 1 8 .5 9 12 42 25 Epileps y. ....so ...4 1 6 1 2 37 29 Convulsions (under 5 years of age). ..2 .2. Neuralgia. .6 4 26 3 1 4 2. .2.4. Neuritis. 12 7 44 2 3 8 11 4 4 3 9 Convulsions, nonpuerperal (5 years and over). ..3 1 ..I ..1 Chorea. ..2 Hysteria. 1 1 40 3 2 3 6.6 4 Im becility. ..6 ......1 5 Neurasthenia. 3 1 16 2 2 .1 1 6 1 3. Other diseases of the nervous system. 27 3 214 16 6 49 39 4 69 6 15 10 4 Trachoma. .....1 .----. ...----. -------. .-. ...1 Diseaseofcornea. 2 18 68 1 12 5 3 12 ...9 6 Diseaseof iris.,. 1 8 40 1 2 1 1 4 11 4 10 6 Diseaseoflens. 3 6 18 2 6 .3 ..6 1. ..... Disease of fundus. ..4. .I .-1 --Other diseases of the organs of vision ..4 6 120 1 14 27 4 9 12 31 4 Diseasesoftheear,. 6 5 83 3 4 20 8 5 28 4 8 3 Diseasesofthemastoidprocess. .1 12 1 .4 2 ..4 1. Diseases of the circulatory system Endocarditis, specified as acute. .1 7 .I .2 2 .I1 Endocarditis, specified as chronic, and other valvular diseases. .2 1 19 .2 1 5 1 2 1 4 3 Endocarditis, unspecified (45 years and over). ...1 ....... Myocarditis, acute. ........I ... M yocarditis, unspecified (under 45 years of age) ......:. 1 .....-.--. -. -.-Myocarditis, chronic, and myocardial degeneration.,,. 9 7 34 3 3 .6 9 .4 9. Other diseases of the myocardium, unspecified. ..4 ....1 2. Angina pectoris. ..2 .2 1 ..1 .. D iseases of the coronary arteries. .1 2 .....1 Functional diseases of the heart. 2 3 27 ..4 2 3 7 6 3 2 Other and unspecified diseases of the heart. .7 22 1 3 ..5 .5 6 2 Aneurysm (except of the heart). ......1 27 .-. Arteriosclerosis (diseases of the coronary arteries excepted). 33 87 213 19 35 ..45 24 4 27 53 6 Gangrene. .3 ..1 2

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TABLE 7-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued ABsoLuTE NUMBERS ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY ATLANTIC SIDE PACIFIC SIDE Disease ____________ Total Exldn ry Army and Fxldn ry Army and City Of City of NonT__ ___Excluding Army ry n Excluding Army Na (offiColon Panama residents Wte Bakand Navy Navy (offianNvyay White Black _____cers and -n avy cers and enlisted .enlisted Americans Others men) Americans Others men) Diseases of the circulatory system-Continued Other diseases of the arteries. .......1 1 .-. .2 .1 14. Hemorrhoids. 14 29 157 9 8 34 12 12 50 17 14 Varices. 3 1 23 2 2 3 .2 8 1 3 2 Varicocele. 2 S 1. 3 1 .2 .1 Phlebitis. 2 1 12 1 .1 2 2 2 1 3. Thrombosis of vein. ..1. ...I-. ..... Other diseases of the veins. .4 13 1. I ....5 3 3 Lymphangitis.1 8 .3 1 .2 1 1 Lymphadenitis,.nonvenereai. 8 23 210 1 16 14 11 18 104 16 24 6 0 Other diseases of thelymphatic system.,. .,. 2 5 ..1 .2. Idiopathic anomalies of the blood-pressure. 9 25 2 8 23 1 Hemorrhage without specified cause. 1 1 11 1 ..3 1 2 1 3. Other diseases of the circulatory system.1 -. I ....--.--. .... 'Diseases of the respiratory system Diseasesofthenasalfossae. 52 34 406 19 16 108 45 14 132 37 28 7 Diseases of the annexae of the nasal fossae. ..6 7 63 3 1 16 5 3 21 3 7 4 Diseases of the larynx. ...2 1 2 1 2. Bronchitis, acute. 36 11 343 23 9 17 68 29 96 32 58 11 Bronchitis, chronic. 8 2 68 3 2 24 13 2 15 4 1 4 Bronchitis,unspecified (under5 years of age), ....4 ..2 ..2. Bronchitis, unspecified (5 years and over). 1 2 4 2 1 ..4 2.1. ...2 4 Bronchopneumonia. 11 12 160 3 4 8 12 15 53 20 41 4 Ca ilary bronchitis. .I. ..I ..-.1. Lo rpneumonia. .22 70 2 13 2 9 1 25 11 6 Pneumonia, unspecified. .I ..3 Pleurisy. ..5 25 .4 3 2 4 3 .3 4 2 Empyema. Pneumothorax. ........ Other diseases of the pleura. ......1.---.--.-Congestion of the lungs. 2 1. ...I .---.Asthma ..19 19 114 2 9 17 13 9 5 32 25 2 Chronic interstitial pneumonia including occupational diseases of the respiratory system.1 4 12 1 ..1 .4 13

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Gangrene of thelung. .......1 ... Other diseases of the respiratory system (tuberculosis excepted). 7 10 32 1 4 1 6 7 2 .6 5 Diseases of the digestive system Diseases of the pharynx and tonsils. 78 68 1,287 69 171 241 186 66 194 210 127 23 Diseases of the teeth and gums. 24 10 111 9 7 7 28 18 13 4 20 5 Stom atitis. ..7 ...3 1 1 1 Adenoids. .....2. ...1. ... Other diseases of the buccal cavity and annexa. 3 13 2 .2 2 .2 .5. Diseases of the esophagus. .2 6 .1 .2 3 Ulcerofthestomach. 2 5 20 ..3 3 .3. 1 Ulcer of the duodenum. 15 10 66 9 3 1 15 1 12 9 19 7 Acutegastritis. 11 32 119 1 9 11 7 16 39 19 12 5 Chronicgastritis. 8 4 53 7 4 9 3 3 20 3 2 2 Acuteindigestion. .2 1 .....5 Other diseases of the stomach (cancer excepted). 8 2 36 4 3 .12 1 7 4 54. Diarrhea and enteritis (under 2 years of age). ..33 1 1 .3 3 .4 17 4 Intestinal autointoxication (under 2 years of age). ..8 1 ..4. ..3. Diarrhea and enteritis (2 years and over) ...21 38 234 6 16 27 41 27 44 18 41 14 Appendicitis, acute. 4 8 234 6 7 59 17 6 77 28 19 15 Appendicitis, chronic. 5 9 104 2 6 15 19 8 31 9 7 7 Hernia. 23 58 198 11 22 14 27 20 24 29 39 12 Intestinalobstruction ...6 .1 ....3 1 1 Intestinal autointoxication (2 years and over) ..1 .4 .. Other diseases of the intestines. 24 38 306 16 27 28 26 35 91 25 47 11 Cirrhosis of the liver, not specified as alcoholic. .2. I Abscess of the liver (unqualified). ..3 ....... O ther diseases of the liver. ..1 ....:. ....1. Biliary calculi. ...14. .4 2 2 Cholecystitis .16 6 84 7 3 4 28 6 9 8 11 8 Other diseases of the gall bladder and biliary passages. 4 4 28 2 1 2 .3 11 4 5 Peritonitis, cause not specified. 1 1 15 ..2 2 4 1 1 3 2 Diseases of the genitourinary system Acute nephritis (including unspecified under 10 years of age) .6 12 .1 1 2 .4 3 1 Chronicnephritis.!. 2 6 25 1 4 1 .3 ..,. 13 3. Nephritis, unspecified (10 years and over). .2. .I ..... Pyonephritis. ., ..2 5 ....1 2 ...A. 1 1 Pyelonephrosis. .....* '1 7 ....._,2 1 .1 1 Pyelitis. .4 15 169 9 19 14 23 18 23 36 22 5 Perinephritic abscess.1 11. ..2 1. .3 3 .5 Hydronephrosis. ..2 2 1. 2 ..1. Movable kidney. .2 Other diseases of the kidneys and ureters (puerperal diseases excepted). 1 1 23 2 ..1 4 3 10. Calculioftheurinarypassages. 11 3 45 4 .2 14 4 9 3 7 Diseases of the bladder (tumors excepted) .10 13 123 11 9 10 17 15 33 8 14 6 Strictureoftheurethra. 1 19 36 ., -. .5 2 .7 1 8 9 4 Other diseases of the urethra, urinary abscss, etc. -3 11 42 1 4 2 .3 5 14 6 7 --.

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TABLE 7-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued ABSOLUTE NUMBERS ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY Disease ATLANTIC SIDE PACIFIC SIDE Total Excluding Army Army and Excluding Army Army and City of City of Nonand Navy Navy (offiand Navy Navy (offiColon Panama residents White Black cers and cers and enlisted enlisted Americans Others men) American3 Others men) Diseases of the genitourinary system-Continued Acute prostatitis. ..4 3 22 ..3 3 1 10 .5 Chronicprostatitis. 7 6 53 1 1 17 7 2 18 1 4 2 Abscess of the prostate. ..1 ......I Hypertrophy of the prostate. .4 13 24 2 3 .4 6 .3 5 1 Other diseases of the prostate. 1 .1 ..... Hematocele. ..I. 4 H ydrocele. .9 23 .2 1 2 2 2 4 8 2 Other diseases of the male genital organs, not specified as venereal. 3 15 58 .5 8 5 5 13 11 10 1 00 Cystsoftheovary. 2 .30 1 4 .4 4 .6 9 2 Salpingitis and pelvic abscess, female. 1 2 104 3 8 .7 20 .29 34 3 Other diseases of the ovaries and diseases of the tubes and parametrium. ..18 .I ..4 10. Leukorrhea.1 1 .4 .....I .3 Dysmenorrhea. ..3 2 .3 2 Cervicitis. .1 74 4 8 .22 14 .1 1 22 3 Endometritis. 1 1 30 2 5 .3 3 .6 10 1 Stenosis of the cervix. ...2 .I I Prolapse ofuterus.4. ....,. I. Uterine hemorrhage (nonpuerperal). .21 .1 2 .5 3 .7 2 Other diseases of theuterus not specified as venereal. 1 4 115 8 10 .17 22 .15 40 3 Nonpuerperal diseases of the breast (cancer excepted). ..23 1 2 3 4 .4 7 2 Other diseases of the female genital organs, not specified as venereal. .1 1 30 2 3 .7 6 .4 7 1 Diseases of pregnancy, childbirth, and the puerperal state Abortion with septic conditions. ..6 ....1.,. 4 Abortion without mention of septic conditions (to include hemorrhages). I .142 8 14 .28 13 .39 37 3 Ectopic gestation, without mention of septic conditions. ...9 ..3 .2 4. Other accidents of pregnancy (not to include hemorrhages). ..13 1 2 .2 2 .1 5 Placentaprevia. .........3. ... Otherpuerperal hemorrhages. .9. .1 ..2 ..1 5

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Puerperal septicemia and pyemia-not specified as due to abortion. ..6 1. 1 1. .I. .3 Puerperal albuminuria and eclampsia. 22 .8 1 .5 6 Other toxemias of pregnancy,. ..53 3 7 .3 5 .16 17 2 Cesarean operation. .2 .1. .... Lacerations, puerperal, old or recent, of cervix and perineum. ...15. 4 4 .4 .1 4 Other surgical operations and instrumental delivery on accountofchildbirth. ...48 3 3 ..10 5 .10 13 4 Other accidents of childbirth. ..17 .1 .4 4 .2 6 Puerperal disease of the breast. .4 1 ..2 1. Following childbirth (not otherwise defined). .....3. Diseases of the skin and cellular tissue Furuncle,carbuncle. 3 10 54 6 3 4 6 8 5 7 14 1 Phegmon, acute abscess. 17 44 255 10 25 15 28 33 37 36 44 27 Trichophytosis. 11 7 127 6 1 38 14 5 55 1 4 3 Scabies. ., ..7 .1 2 ..2 1 1. Elephantiasis. ..I .1 ... Prickley heat. ..2. ......2 Ulcer of skin.,. 1 3 20 .1 3 1 4 2 5 2 Tropical ulcer .....1 .... Impetigocontagiosa. ....10 1 3 2 1 1 ..2 Impetigo simplex. ..1. I ..1 3. Urticaria. 7 1 1 .2. ..1 Eczem a ....2 .1 ....1 .. Ingrowingnail .1 2 29 44 5 1 4 5 3 1 Other diseases of the skin and annexa, and of the cegular tissue. .13 14 115 5 7 22 15 7 26 17 9 7 Diseases of the bones and organs of locomotion Osteomyelitis. .3 5 22 2 2 2 2 2 3 6 1 2 Periosteitis,. 1 1 5 ......1 2 1. Other diseases of the bones (tuberculosis excepted). 3 3 12 .2 1 3 .1 4 1. Ankylosis. .2 6 1 1 1 ....2 ...1 Acute arthritis. 4 12 46 1 2 1 8 11 7 6 10. Synovitis. 1 2 22 .2 4 1 1 12 .2. Other diseases of the joints (tuberculosis and rheumatism excepted). .2 4 41 2 2 12 2 1 14 3 4 1 Other diseases of other organs of locomotion .28 32 182 9 7 30 28 13 65 3 22 5 Congenital malformationk (stillbirths not included) Congenital hydrocephalus.3. ....1 2. Spina bifidaand meningocele. ..17. 9 1 .2 5 Congenital malformations of the heart. ..3 ....,. I ..1 1 Othercongenitalmalformations. .1 4 126 4 45 17 7 8 14 11 17 3

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TABLE 7-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued. ABSOLUTE NUMBERs ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY _. ATLANTIC SIDE PACIFIC SIDE Disease Total Excluding Army Army and Excluding Army Army and City Of City of Nonand Navy Navy (offiand Navy Navy (offiColon Panama residents White Black cers and cers and Americans Others enlisted Americans Others enlisted men) men) Diseases of early infancy (under one year of age) Malnutrition. ..-.------.18 ..I.3 2.2 10. Other congenitaldebility. ------.--. 12 .2 .3. 1 6 Prematurebirth.32 .-2 -----5 2 .-15 6 2 Injury at birth, Cesarean operation. ..--. .-. .1 3 1. Injury at birth, without Cesarean operation. ..44 ...14 1 18 Atelectasis. ... Other diseases peculiar to early infancy. ..2 .1 ...... 0 Senility Senility.3 44 55 2 9 ..9 .18 17 Senile dementia .26 1. .I .Violent and accidental causes Suicide and attempted suicide by solid or liquid poisons, or 7.2 1 2 1 1. ..-. by absorption of corrosive substances. 1.-.-.-1. Suicide and attempted suicide by firearms. I .3 .------Suicide and attempted suicide by cutting or piercing instru1 ments. ...I.1. .1. .I. .... Homicide andatempted homicide byfiearms .......I .......-. ...1 ....-. ...-. ...-.-. Homicide and attempted homicide by cutting or piercing mi strum ents. a-ph c b--1 7 ...I ..2 1 1 .. Homicide and attempted homicide by other means. 1 3 11 .2 4 1 -1 ---.-.-. Attack by venomous animals. 2 1 10 1 3 1 2 1 1 1 --.--.--Poisoning byfood. ....I -.---.--.-. I Accidental absorption of poisonous gas. 1 5 ._ .....-.1 -.-. Other acute accidental poisonings (gas excepted) ..3 17 ....4 3 4 4 9 5 15 4 Accidental burns (conflagration excepted). 3 9 50 2 4 17. Accidental drowning or submersion. ..2. 2 ..1 ..... Accidental traumatism by firearms (wounds of war ex-1 2.2 cepted). ............-.--.---. ....Accidental traumatis by cutting or piercing instruments .. (woundsof warexcepted). .1 8 39 1 1 1 1 10 9 8-8 .J z

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Accidental traumatism byfall. .7 19 95 .3 1 9 -1&, 16 5 35, 8 Accidental traumatism by crushing, landslide. .4 14 ..I .....6 .2 Injuriesbyanimals. .1 1 10 ......8 8 .1 Hunger and thirst. ........2 .I Excessive heat.6. .......2. 2 ..2. Accidentaduetoelectric currents. 2 1 4 1 ...2 .1. Foreignbodies. 1 18 .3 3 3 4 1 2 1 1 Fractures. 13 57 329 5 32 43 26 39 51 68 45 20 Dislocations. 6 28 .1 8 3 2 8 1 4 1 Sprains ..12 25 100 4 3 1 17 16 21 11 17 10 Explosion. ..I ..-. ..-. .-. ...1 Lackofcare. ...4 -. ...4 .... Other accidents and external violence. 24 123 376 11 38 32 23 37 41 85 70 39 Ill-defined causes Suddendeath. 1 3 6 .I .2 1 2. Ill-defined. 20 40 167 6 4 15 30 25 27 10 42 8 Infection of undetermined origin. ..1 10 ..3 1 .,. .4 2. Notspecified orunknown. ..1 2 .I ..... Supplemental violent and accidental causes Accidents from agricultural machinery. ...2 ....... Othermachineryaccidents. I .7 ..-. ...-. O ther railroad accidents. .....7 7 ....3 .4 Other street car accidents. ..2 ... Automobile accidents (primary). 4 3 48 1 1 5 6 14 1 14 6 M otorcycleaccidents. 1 2 3 ...1 1 ..1 Other land transportation accidents. 1 2. ...1. .1. Water transportation accidents. .,.1. ......I-. Normal physiological conditions Norm alpregnancy. ...84 4 8 .10 17 .16 23 6 Normallabor.3 672 31 82 .72 103 .215 163 6 Newbornchild. 694 35 87 .77 104 .216 168 7 No disease (companion, observation, etc.) .40 35 669 58 27 67 119 47 168 63 76 44 Total. 1,113 1,916 16,180 688 1,385 1,497 1,948 1,772 2,645 2,282 3,002 961

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TABLE 7-A-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933 RATES PER 1,000 ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY ATLANTIC SIDE PACIFIC SIDE Army Army City City Disease Total Excluding and Excluding and of of Army and Navy Navy Army and Navy Navy Colon PanWhite Black (officers (officers ama. and .and AmernOthers enlisted AmerOthers enlisted cans men) cans men) POPULATION ..3,244 9,100 151,851 1,972 10,338 5,933 6,682 12,847 5,079 30,000 79,000 Infectious and parasitic diseases Typhoidfever. .22 .11. ...150 .156 .197 .067 .506 Relapsing fever. ....04. ..169.033 .012 Measles. .....20 2.03 .193 .505 .598 .545 .197 .067 .088 Scarlet fever ....046 1.01 .097 .337 .299. Whooping cough. ..04 .51 ..598 ..012 Diphtheria. ..22 .145 ..387 ...449 .622 ,. .10 .051 D i theria bacillus carrier. ...026 ....156 ...025 In uenza with respiratory complications spesified. 1.54 1.43 .35 1.01 .773 2.19 1.05 .077 .394 .533 .025 Influenza without respiratory complications specified. 24.66 6.48 2.61 6.59 .967 4.21 15.712.65 26.38 .733 .721 Dysentery, amebic. ..31 .11 .053 ....150 .....067 .025 Dysentery, bacillary. ...013 .....156 ..... Dysentery, unspecified or due to other causes. ..11 .007 ....012 Erysipelas. ..1.85 .22 .11 .51 .193 .169 .449 ..197 .167 .051 Acute poliomyelitis and acute polioencephalitis. ...026 ....299 ...067 Lethargic or epidemic encephalitis. ...013 ...169 .150 ... Epidemic cerebrospinal meningitis. ...7 ......... Rabies. .0. ........ Tuberculosisoftherespiratorysystem. 3.39 2.42 .678 2.03 .87 1.18 .898 1.17 1.57 .733 .316 Tuberculosis of the meninges and central nervous system. ...026 .......067 .025 Tuberculosis of the intestines and peritoneum.,. ..007 ..033. Tuberculosis of the vertebral column. ...079 ...29 ....197 ..233 .012 Tuberculosis of the skin and subcutaneous cellular tissue. ...007 ....197 .... Tuberculosis of the lymphatic system (bronchial, mesenteric and retroperitoneal glands excepted). ..22 .046 ..097 ....156 ...033 .038 Tuberculosis of the genitourinary system. .22 .02 ..097 ..15 ...012 Tuberculosis, disseminated, acute. .0 2.93 ......033. Tuberculosis, disseminated, unspecified. ....013 .....067 Syphilis,primary. ...11 .053 ...337 ..077 197 ..025

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gyp *lis,secondary. .1.23 .77 .296 ..193 1.01 .299 .467 2.17 .033 .139 Syphiis,tertiary. 1.23 3.08 .533 1.01 .58 .337 .299 1.01 .787 .70 278 Syphilis, cerebrospinal. .1.097 .169. ..233. .033 .101 8yhilis, hereditary. ..046 ..097 ..077 ..033 .050 Soft chancre. .1.85 1.21 .684 ...29 1.85 .60 .544 11.42 .267 .114 Chancroidal lymphadeniis. .....04 ...097 ....984 Gonococci urethritis. .3.70 .4.18 1.57 .51 1.64 2.19 .299 2.18 23.43 .633 .341 Gonococcic arthritis. ..059 .....674 ...590 .067. Gonucoccic ophthalmia. .........197 .133 .025 Gonocoecic vaginitis. ...125 ..58 ....077 ..30 .038 Other gonococcic infections and other venereal diseases. ...99 ....077 2.36 ..012 Purulent.infection, pyemia and septicemia (nonpuerperal). ..11 .026 ..097 ...077 .025 Septicemia. ,. ......077 ...038 Malaria,estivoautumnal. 12.64 21.98 5.29 7.10 12.00 8.76 9.73 15.65 16.53 1.87 1.52 Malariatertian. 13.87 4.29 2.47 6.59 2.61 7.17 11.52 3.50 17.12 .667 .633 Malaria,quartan. .31 .11 .086 1.01 .097 .169 .15 ..197 .167. Malaria, mixed. ..013.3. .... Malaria, clinical (symptomatic, parasites not found). ...013 .51 ...169. Hemoglobinuria, malarial. .007. ...... Yaws.4. ...07. .97.097. .... Oriental sore (iLisaasi ..11 .7. ......033. Other diseases due to protozoal parasites. ...007 ...15 Ankylostomiasis. .1.23 .44 .296 ...58 .51 .15 .934 .197 .167 .139 Filariasis. ..11 .007 .51 .. Other diseases caused by helminths. .31 .158 ..097 ..45 .544 ..033 .076 Othermycoses. ...31 .11 .059 .51 .097 .674 .197 .067 Chickenpox. ...77 .145 ..29 .1.19 .233 ..067 .063 W German measles. .03.299. .. M iliary fever. ...007 .51 Mumps. ..11 .02 .097 ...197 .012 Vaccinia. ....007 ......012 Cancers and other tumors Cancer and othermalignant tumors of the buccal cavity and pharynx. .31 .55 .066 1.01 193 ..156 ...038 Cancer and other malignant tumors of the digestive tract and peritoneum ., ....22 .158 .-. .193 .169 1.35 .389 ..033 .063 Cancer and other malignant tumors of the respiratory system ....007. .079 ... Cancer and other malignant tumors of the uterus. ..178 .51 .29 ..299 .545 ..20 .063 Cancer and other malignant tumors of other female genital organs. ...013 ...079 ...012 Cancer and other malignant tumors of the breast. ...079 .51 .097 ..748 .079 ...051 Cancer and other malignant tumors of the male genitourinary organs. .31 .11 .026 .51 .097 ............025 Cancer and other malignant tumors of the skin. ..11 .026 ....197 ..038 Cancer and other malignant tumors of other or unspecified organs. ..33 .072 ..58 .169 ....038 Nonmalignant tumors of the uterus ...92 .66 .639 1 52 .677 .1.80 1.09 ..90 .367 Nonmalignant tumors of other female genital organs .0 ....079. Nonmalignant tumors of the brain. .013 ...394 Nonmalignant tumors of other organs. .31 .55 .217 2.03 .29 1.34 .15 .233 .984 .133 .063 Tum ors of the uterus(nature unspecified)......007 ...............012 Tumors of other organs (nature unspecified). ......62 .22 .092 2.03 193 .169 .299 .079 .394 .033 .012

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TABLE 7-A-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued RATES PER 1,000 ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY ATLANTIC SIDE PACIFIC SIDE Army Army City City Disease Total Excluding and Excluding and of of Army and Navy Navy Army and Navy Navy Colon PanWhite Black (officers (officers ama and and AmeriOthers enlisted AmeriOthers enlisted cans men) cans men) Rheumatic diseases, nutritional diseases, diseases of the endocrine glands and other general diseases Acute rheumatic fever .....053. ...15 .156.067 .038 Chronic rheumatism, osteoarthritis. .2.16 1.54 .369 1.01 .483 .842 1.05 .545 2_36 .267 .114 Gout. .31 .013 1.01 Diabetesmellitus. .1.54 .77 .494 1.01 1.74 .169 .897 1.40 .197 .367 .165 Glycosuria. ...11 .013. ..........025 Pellagra .007. ......079 .. Rickets. ...11 .02 ..097 ..15 ...012 Diseases of the pituitary body. ..02 .51 ...169 ...197 .. Smie goiter ..92 .11 .072 .51 ..169 .45 ..394 .033 .038 Exophthalmic goiter. ..31 ..033 ..097 .169 .15 ...025 Myxedema and cretinism. .026. ....15. .033 .012 T etany .0.2. ......02 ............038 Other diseases of the thyroid and parathyroid glands. .31 ..04 ....17 .45 ..197. Othergeneraldiseases. ...92 .11 .27 2.53 .967 .17 .299 .311 .394 .467 .038 Diseases of the blood and blood-making organs Pernicious anemia. .033 .51 .097 ..156. Otheranemias. ..11 .059 .51 ...156 ..033 .051 Trueleukemias. ..31 .013. .013 ....17 .15 Pseudoleukemias (Hodgkin's disease). ..00. ..077 Diseases of the spleen.*. .31 .11 .026 ........077 .197 .033 .012 Chronic poisonings and intoxicants Acutealcoholism. .1.85 .22 ,237 1.52 .193 .51 .748 .077 2.56 .167 .038 Chronic alcoholism ....053 .51 ..337 ...787 ..012 Alcoholic psychosis. .31 ..099 ...842 .299 ....591 .067 .038 Drug habit. .31 ..02 1.01 ._. ....197. .. Lead poisoning.1. 1.23 ..026 ....599 .. Under observation for lead poisoning. 1'.54 1.21 .111 .51 ...599 .311.10 .063

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Diseases of the nervous system and of the organs of special sense Encephalitis (nonepidemic). ....026 ....337 ...033 Simple meningitis.11 .033 .7 .0*7. :. .077 .197 ..025 Progressive locomotor ataxis (tabes dorsalis). .62 ..02 .51 ..17 Other diseasesof thespinalcord. ....11 .046 .51 ..17 ..033 038 Cerebralhemorrhage. ..1.21 .131 ...097 .17 .15 .311 ..133 .087 Cerebral embolism and thrombosis. ...026 ....033 .025 Softening.of the brain.,. ....007 ....033. H em iplegia. ..77 .099 ..097 ....467 ..10 .051 Other paralyses, cause unspecified. ...44 .086 ..29 .674 ...197 .067 .038 Generalparalysisoftheinsane. ..33 .184 ..193 .17 ...156 .197 .067 .19 Dementiaprecox. .33 2.92 ..58 2.36 ..311 2.17 1.43 3.01 Manic depressive psychosis. .31 ...337 ...197 .067 .354 Other psychoses. ...678 .51 .097 1.35 ..389 1.77 .40 .531 Epilepsy.31 .11 .527. ..674 .15 .467 .197 .067 .468 Convulsions (under 5 years of age). ....013 .......067 Neuralgia. .1.85 .44 .171 1.52 .097 1.18 .599 ...591 .067 .051 Neuritis. ..3.70 -.77 .29 1.01 .29 1.35 1.64 .311 .787 .10 .114 Convulsions, nonpuerperal (5 years and over). ....02 .51 ..17 Chorea. ..,. .....013. .012 Hysteria ..31 ..11.263 1.52 .193 .51 .898 .311 1.97 .067 .076 Imbecility.,. .......033 .063 Neurasthenia. ..92 .11 .105 1.01 .193 ..15 .077 1.18 .033 .038 Other diseases of the nervous system. .8.32 .33 1.41 8.11 .58 8.26 5.84 .311 5.37 .20 .19 Trachoma. .007. ...... Diseaseof cornea. .62 1.98 .447 .51 1.16 .842 .45 .934 .984 .50 .113 CJ Diseaseofiris. .31 .88 .263 .51 .193 .17 .15 .311 2.16 .133 .126 D iseaseoflens. .92 .66 .118 1.01 .58 ..45 ....20 .012 Disease of fundus. ....026 ...17 .15 ..197 Other diseases of the organs of vision ....1.1.23 2.86 .79 .51 1.35 4.55 .599 .70 2.36 1.03 .228 Diseasesoftheear. .1.85 .55 .55 1.52 .387 3.37 1.20 .39 5.51 .133 .101 Diseases of the mastoid process. ..11 .079 .51 ..674 .299 ...133 .012 Diseases of the circulatory system Endocarditis, specified as acute. .11 .046 .., .17 ...156 .393 .012 Endocarditis, specified as chronic, and other valvular diseases. .62 .11 .125 ....193 .17 .748 .077 .393 .033 .051 Endoarditis, unspecified (45 years and over). W ...077. Myocarditis, acute.007. ..033 Myocarditis, unspecified (under 45 years of age). ..007 ..077. Myocarditis, chronic, and myocardial degeneration. ..2.77 .77 .224 1.52 .29 ..898 .70 .133 113 Other diseases of the myocardium, unspecified. ..026 ...17 .....033 .025 Angina pectoris. .62 ..013 .51 .15 Diseases of the coronary arteries. .11 .013 .........012 Functional diseases of the heart. .62 .33 .178 ...674 .299 .233 1.38 .20 .038 Other and unspecified diseases7of the heart. ....77 .145 .51 .29 ...39 .1.67 .076 Aneurysm (except of the heart). ..22 .02 ...077 ..033 .012 Arteriosclerosis (diseases of the coronary arteries excepted) .10.17 9.56 1.40 9.63 3.38 ..6.73 1.87 .788 .90 .671 G angrene. .31 ..02 ........033 .025 Other diseases of the arteries. ..11 .007 ..033 .. Hemorrhoids.,. .4.31 3.19 1.03 4.56 .773 5.73 1.80 .934 9.84 .567 .177

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TABLE 7-A-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued RATES PER 1,000 ALL CASES (including employees) EMPLOYEES CANAL ZoNE ONLY ATLANTIC SIDE PACIFIC SIDE ExldigArmy .Army City Disease Excluding and Excluding and City of Total Army and Navy Navy Army and Navy Navy of PanWhite Black (officers (officers Colon ama and .and AmernOthers enlisted AmerOthers enlisted calls men) cans men) Diseases of the circulatory sytem-continued Voices ..92 .11 .151 1.01 .193 .51 ..156 1.57 .033 .038 Varicocele. .62 ..053 .51 ...51 .15 ...393 Phlebitis. .62 .11 .079 .51 ..17 .299 .156 .393 .033 .038 Thrombosis of vein ...007. .15 Other diseases of the veins ..44 .086 ..096 ..077 ..167 .038 Lymphangitis. .31 .053 .51 .15 ..393 .033 .012 Lymphadenitisnonvenereal. 2.47 2.53 1.38 .51 1.55 2.36 1.64 1.01 20.47 .533 .303 Other diseases of the lymphatic system. ..22 .033 ..096 .17 ..156. ...012 Idiopathic anomalies of the blood-pressure.1.85 1.54 .513 1.01 .773 ..1.35 1.95 .393 .267 .291 Hemorrhage without specified cause. .31 .11 .072 .51 ..45 .077 .393 .033 .038 Other diseases of the circulatory system. .31 .007 ....15 .-.-----Diseases of the respiratory system Diseasesof thenasal fossae. 16.03 3.74 2.67 9.53 1.55 18.20 6.73 1 2 123 Diseases of the annexae of the nasal fossae. 1.85 .77 .414 1.52 .10 2.70 .75 .23 4.13 .10 .09 Diseasesofthelarynx. .31 .052. ...30 .08 .39 .03 .03 Bronchitis, acute. 11.10 1.21 2.26 11.66 .87 2.86 10.18 2.26 18.90 1.07 .73 Bronchitis, chronic. .2.47 .22 .448 1.52 .19 4.04 1.95 .16 2.95 .13 .01 Bronchitis, unspecified (under 5 years of age). ..026. .19 ...--.07Bronchitis, unspecified (5 years and over). ..31 .22 .026 1.01 .10 ......03 Bronchopneumoma.3.39 1.32 1.05 1.52 .39 1.35 1.80 1.17 10.44 .67 Capillary bronchitis. ---. ..007 ......08.14 Lobarpneumonia. 2.42 .46 1.01 1.26 .34 .15 .70 20 .80 Pneumonia, unspecified. .31 33 .046 .51 .19 ...08 ...05 Pleurisy. ...55 164. .39 .51 .30 .31 .59 .10 Empyema. ...007 .....08 Pneumothorax.007. .-. --. Other diseases of the pleura.11 .007. .I ...08 ------.--.--.-.Congestion of the lungs. .....013 ....15 .08 Asthma .5.86 2.09 .75 1.01 .87 2.86 1.95 .70 .810 3 Chronic interstitial pneumonia including occupational diseases of the 20 04 respiratory system ..31 .44 .079 .51 .17 .0. Ganene f the lung ...007. .08 Other diseases of the respiratory system (tuberculosis excepted) .2.16 1.10 .21 .51 .39 .17 .90 .54 .39 .I.08

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Diseaes of the digetive system Diseases of the pharynx and tonsils. 24.04 7.47 8.47 34.99 16.54 40.62 27.84 5.14 38.20 7.00 1.61 Diseasesoftheteethandgums. 7.40 1.10 .73 4.56 .68 1.18 4.19 1.40 2.56 .13 .25 Stom atitis .....046 ....45 .08 .20 .03 .01. Adenoid ..02 ....30 ....03 Other diseases of the buccal cavity and annexa. .9i .11 .086 1.01 ..34 .30 ..39 ..06 Diseasesoftheesophagus. ..22 .04 ..10 ..30 .23 Uleer of thestomach,. .62 .55 .131 ...51 .45 .1.38 .10 .04 Ulceroftheduodenum. 4.62 1.10 .434 4.56 .29 .17 2.24 .08 2.36 .30 .11 Acutegastritis. 3.39 3.52 .783 .51 .87 1.85 1.05 1.24 7.68 .63 .15 Chromogastritis. 2.47 .44 .35 3.55 .39 1.52 .45 .23 3.94 .10 .03 Acute indigestion. ..01. .Other diseases of the stomach (cancer excepted). 2.47 .22 .237 2.03 .29 ...1.80 .08 1.38 ..06 Diarrhea and enteritis (under 2 years of age). ...217 .51 .10 ..45 .23 ...22 Intestinal autointoxication (under 2 years of age). .053 .51 ...60 ...04. Diarrheaandenteritis(2yearsandover). 6.47 4.18 1.54 3.04 1.55 4.55 6.14 2.10 8.66 .60 .52, Appendicitis,acute. 1.23 .88 1.54 3.04 .68 9.94 2.54 .47 15.16 .93 .24 Appendicitis,chronic. 1.54 .99 .69 1.01 .58 2.53 2.84 .62 6.10 .30 .09. Hernia. .7.09 6.37 1.30 5.58 2.13 2.36 4.04 1.56 4.73 .97 .49 Intestinal obstruction. .04 .097. ..10 .01 Intestinal autointoxication (2 years and over). ..33 .033 ...17 ...13 Otherdiseasesoftheintestines. 7.40 4.18 2.02 8.11 2.61 4.72 3.89 2.72 17.92 .83 .59 Cirrhosis of the liver, not specified as alcoholic ..31 .02 ....30 ..20 Abscess of the liver (unqualified). ....02 .....08. .07 Other diseases of the liver. .007 Biliarycalculi. ..092 1.01 ...15 .23 ..13 .03 Cholecystitis. 4.93 .66 .55 3.55 .29 .67 4.19 .47 1.77 .27 .14 Other diseases of the gall bladder and biliary passages. 1.23 .44 .18 1.01 .097 .34 ..23 2.17 .13 .06 Peritonitis,causenotspecified. ..31 .11 .099 ..34 .30 .31 .20 .03 .04 Diseases of the genitourinary system Acute nephritis (including unspecified under 10 years of age). ..66 .079 ..097 .17 ..16 ...13 .04 Chronicnephritis. .62 .66 .16 .51 .39 .17 ..23 ..43 .04 Nephritis, unspecified (10 years and over). ..013 ..097. ..03 Pyonephritis. ...22 .033 ....15 .16 .1. ..01 Pyelonephrosis. ..11 .046 ....30 .08 ..10 .01 Pyelitis. .1.23 1.65 1.11 4.56 1.84 2.36 3.44 1.40 4.53 1.20 .28 Perinephritic abscess. ..11 .072 ...34 .15 ..59 ..06 Hydronephrosis. .31 ..053 ..19 .34 .15 ..39 ..01 M ovable kidney. .31 ..013 1.01 ....... Otherdiseasesofthekidneysandureters(puerperaldiseasesexcepted). .31 .11 .15 1.01 ..17 .60 .23 1.97 .10 Calculioftheurinarypassages. 3.39 .33 .30 2.03 ..34 2.09 .31 1.77 .10 .09 Diseases of the bladder (tumors excepted). 3.08 1.43 .81 5.58 .87 1.69 2.54 1.17 6.50 .27 .18 Strictureoftheurethra. .31 2.09 .24 ..48 .34 ..54 .20 .27 .11 Other diseases of the urethra, urinary abscess, etc. .92 1.21 .28 .51 .39 .34 .45 .39 2.76 .20 .09 Acuteprostatitis. 1.23 .33 .14 ...51 .45 .08 1.97 ..06 Chrome prostatitis. 2.16 .66 .35 .51 .097 2.86 1.05 .16 3.54 .03 .05 Abscess of the prostate. ...007 .......01 Hypertrophyoftheprostate. 1.23 1.43 .16 1.01 .29 ..60 .47 ..10 .06 Other diseases of the prostate. .31 ..007 ....15 ...

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TABLE 7-A-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued RATEs PER 1,000 ALL CASES (including employees) EMPLOYEES CANAL ZoNE ONLY ATLANTIC SIDE PACIFIC SIDE Disease Excluding Army Army City City DgaeEcuigand Excluding and of of Total Army and Navy Navy Army and Navy Navy Colon Pan-. White Black (officers (officers ama and and AmeriOthers enlisted AmeriOthers enlisted cans men) cans men) Diseases of the genitourinary system-continued Hematocele. ..11 .007 .....03 H ydrocele ...99 .15 ..19 .17 .30 .16 .39 .13 .10 Other diseases of the male genital organs, not specified as venereal. ..92 1.65 .38 ..48 1.35 .75 .39 2.56 .37 .13 Cystsoftheovary. ..62 ..20 .51 .39 ..60 .31 ...20 .11 Salpingitisandpelvicabscess,female ..31 .22 .69 1.52 .77 .1.05 1.56 ..97 .43 Other diseases of the ovaries and diseases of the tubes and parametrium. ..12 .097. ..23 ..13 ,13 Leukorrhea. .31 ...026 .....08 ...10 .00 Dysmenorrhea. .11 .12 2.03 .097 .17 .30 .39 ..10 .03 Cervicitis. ..11 .49 2.03 .77 .3.29 1.09 ..03 .28 Endometritis. .31 .11 .20 1.01 .48 ..45 .23 ..20 .13 Stenosis of the cervix. ....013 .......03 .013 Prolapse ofuterus .,. .03 .51 .10 ....,. .03 .013 Uterine hemorrhage (nonpuerperal). .31 ..14 .51 .19 ..75 .23 ..23 .025 Other diseases of the uterus not specified as venereal. .31 .44 .76 4.06 .97 ...2.54 1.71 ..50 .51 Nonpuerperal diseases of the breast (cancer excepted). ....15 .51 .19 ..45 .31 ..13 .089 Other diseases of the female genital organs, not specified as venereal. ..31 .11 .20 1,01 .29 .1.05 .47 ..13 .089 Diseases of pregnancy, childbirth, and the puerperal state Abortion with septic conditions. ....04 .....078 ....03. Abortion without mention of septic conditions (to include hemorrhages) .31 ..94 4.06 .14 .4.19 1.01 .1.30 .47 Ectopie gestation, without mention of septic conditions. ...066 .23 ..07 .051 Other accidents of pregnancy (not to include hemorrhages) ....09 .51 .19 .30 .16 ..03 .063 Placenta previa.03 ..45 ...03 .013 Other puerperal hemorrhages. ..06 ..10 ...16 ..03 .063 Puerperal septicemia and pyemia-not specified as due to abortion. .04 ..10 ...078 .. Puerperal albuminuria and eclampsia. ...14 ..19 ..15 .62 ..17 .076 Other toxemias of pregnancy ..35 1.52 .68 ..45 .39 ..53 .22 Cesarean operation .....013 ..10 ...03 Lacerations, puerperal, old or recent, of cervix and perineum. .,. ..10 .51 .10 ..60 .31 ..03 .051 Other surgical operations and instrumental delivery on account of childbirth .,. ........32 1.52 .29 1.50 .39 ..33 .18

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Other dents of childbirth ...11 ..10 .31 .0 7 .076 Puerperaldisease of the breast. ...03 .51. ..067 .013 Following childbirth (not otherwise defined). .03 ........038 Diseases of the skin and cellular tissue Furunclecarbuncle. .92 1.10 .36 3.04 .29 .67 .90 .62 .98 .23 .18 Phliegmon, acute abscess. 5.24 4.84 1.68 5.07 2.42 2.53 4.19 2.57 7.28 1.20 .56 Triohophytosis. 3.39 .77 .84 3.04 .10 6.40 2.09 .39 10.83 .03 .051 Scabies. ...05 ..10 .34 ...16 .20 .03 Elephantiasis. ...007.10 ..... Prickley heat. .007 ......03 Ulcerof skin. .31 .33 .13 ..10 .51 .15 .16 .79 .067 .063 Tropical ulcer. ...007 ...17 .. Impetigocontagiosa. ..025 go sim plex. ..31 ...03 .51 ...15 .....10 Ur caria. ....31 ..05 .51 .10 .,. .30 .16 ...013 Eczema.,. 013 .15 ..03 Inowingnail,. .31 .22 .19 1.01 .39 .67 .75 .078 .79 .17 .038 erdiseasesof theskinand annexa,andof the cellular tissue. .4.01 1.54 .76 2.54 .68 3.71 2.24 .54 5.12 .57 .11 Diseases of the bones and organs of locomotion Osteomyelitis. .92 .55 .14 1.01 .19 .34 .30 .16 .59 .20 .013 Periosteitis ..31 .11 .033 ..097 .17 ....067 .013 Otherdiseasesofthebones(tuberculosis excepted). .92 .33 .079 ..19 .17 .45 ..20 .13 .013 Ankylosis. ...22 .04 .51 .097 .17 ...39 ..013 Acutearthritis. 1.23 1.32 .30 .51 .19 .17 1.20 .86 1.38 .20 .127 Synovitis ..31 .22 .14 ..19 .67 .15 .078 2.36 ..025 Other diseases of the joints (tuberculosis and rheumatism x.62 .44 .27 1.01 .19 2.02 .30 .078 2.76 .10 .05 Otherdiseasesofotherorgansoflocomotion. 8.63 3.52 1.20 4.56 .68 5.06 4.19 1.01 12.80 .10 .28 Congenital malformations (stillbirths not included) Congenital.hydrocephalus ...02. ......033 .025 Spina bifidaandmeningocele. .....11 ..87 .17 ...39 ..06 Congenital malformations of the heart. .02 ..078 ...013 Other congenitalmalformations. .31 .44 .83 2.03 4.35 2.87 1.05 .62 2.76 .367 .215 Diseases of early infancy (under one year of age) M alnutrition. ....12 .09. .097 ..45 .16 ..067 .13 Other congenital debility. .,.45 ....033 .08 Prematurebirth. .....21 ..19 ..75 .16 .50 .08 Injury at birth, Cesarean operation. ..033 ...15 .23 ..033 .. Injury at birth, without Cesarean operation. .29 .2.09 .54 ..033 23 A telectasis. ....007 ..........013 Other diseases peculiar to early infancy. ..013. .097 ...78 ..

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TABLE 7-A-DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1933-Continued RATES PER 1,000 ALL CASES (including employees) EMPLOYEES CANAL ZONE ONLY ATLANTIC SIDE PACIFIC SIDE Army Army City City Disease Excluding and Excluding and Of Of Total Army and Navy Navy Army and Navy Navy Colon PanWhite Black (officers (officers ama and and AmeriOthers enlisted AmeriOthers enlisted cans men) cans men) senility Senility ....92 4.83 .36 1.01 .87 ...70 ..60 .215 Senile dementia. ....17 ..097 .,. ..033 .19 Violent and accidental causes Suicide and attempted suicide by solid or liquid poisons, or by absorption of corrosive substances. ..046 ..34 .15 .16 .20 .033. Suicide and attempted suicide by firearms. .31 ..02 ...17 .15 .,. .03300 Suicide and attempted suicide by cutting or piercing instruments. ...007 ...7 .. Homicide and attempted homicide by firearms. .31 ..007 ....15 Homicide and attempted homicide by cutting or piercing instruments ...11 .046 ...17 ..16 .20 .067 .013 Homicide and attempted homicide by other means,. .31 .33 .072 ..19 .67 .15 .16 .20 .033. Attack by venomous animals. ..62 .11 .066 .51 .29 .17 .30 .078 .20 .033. Poisoning by food. ..007 ... Accidental absorption of poisonous gas. .31 .11 .033 .....15 ..20 .067. Other aute accidental poisonings (gas excepted). .33 .11 ..17 .15 .23 .59 .10 .076 Accidental burns (conflagration excepted). .92 .99 .33 1.01 .39 .51 .60 .31 1.77 .17 .19 Accidental drowning or submersion.0. .17. ...033 .. Accidental traunatism by firearms (wounds of war excepted). ...059 .51 .39 ..16 Accidental traumatism by cutting or piercing instruments (wounds of warexcepted). .31 .88 .26 .61 .097 .17 .15 .78 1.77 .10 Accidentaltraumatism byfall. 2.16 2.09 .63 ..29 .17 1.35 1.40 3.15 .17 .44 Accidental traumatism by crushing, landslide. ..44 .09 .....17 ...076 Injuries by animals ..31 .11 .066 ....15 ..1.58 ..013 Hunger and thirst. ...02 ....39 ..013 Excessiveheat. .31 .22 .04 ....15 078 .39 .025 Accidents due to electric currents. .62 .11 .026 .51 ....16 ...0 i Foreign bodies. ..11 .12 ..29 .51 .45 .31 .20 .067 .0i3 Fractures. .4.01 6.26 2.17 2.54 3.09 7.24 3.89 3.04 10.04 2.27 .57 D islocations. ...66 .18 ...1.35 .45 .16 1.58 .03 .05 s.--. 3.70 2.75 .66 2.03 ..17 2.54 1.24 4.13 .37 .22 E x l sion ..,. ...W 7 ......' Lackofeare. ..,. .026 .........79 Other accidents and external violence .7.40 13.52 2.48 5.58 4 8.07 2.83 .89

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Ill-defined causes Sudden death ..31 .33 .04 ....30 .078 ..025 Ill-defined. ...6.17 4.40 1.10 3.04 .2.53 4.49 1.95 5.32 1.97 .53 Infection of undeterm ined origin. ...11 .066 .....17 ..13 .025 Notspecified or unknown. .11 .013 ...03 Supplemental violent and accidental causes Accidents from agricultural machinery. .....013 ......15 ..20 Other machinery accidents. ..31 ..046 ...17 .60 Other railroad accidents. ..77 .046 .....23. .051 Other street car accidents. ..013 ..17 .15 Automobile accidents (primary). 1.23 .33 .32 ...75 .47 2.76 033 .18 M otorcycle accidents. .31 .22 .02 .....15 .078 ....013 Other land transportation accidents. ..11 .013 ..078 ..033 W ater transportation accidents. .... Normal physiological conditions Normal pregnancy. ......55 2.03 .77 ..1.50 1.32 53 .29 Normal labor.,. ..92 .4.43 15.72 7.93 .10.77 8,02 .7.17 2.06 Newborn child. ......4.57 17.75 8.42 ..11.52 8.10 ..7.20 2.13 Nodisease (companion, observation, etc.). 12.33 3.85 4.41 29.41 2.61 11.29 17.81 3.66 33.08 2.10 .96 Total. 343.09 210.55 106.55 348,88 133.97 252.32 291.53 137.93 520.77 76,.07 38.00

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TABLE 8-CONSOLIDATED HOSPITAL AND COLONY REPORT, 1933 Remaining January 1, 1933 Admitted Died Discharged Transferred Remaining Dec. 31, 1933 Classification of patients White White White White White White White White White White White White American foreign Black American foreign Black American foreign Black American foreign Black American foreign Black American foreign Black Gorgas Hospital: Employees. 17 5 62 818 201 1,461 9 4 79 810 193 1,360 4 1 28 12 8 56 ArmyandNavy. 101 ..3,185 .11 ..3,156 17. ..102 Panam anian G ov't. ......10. ..1 4 ........9 2 .1 9 Charity. 6.89 435 1.21. 178.84 3892 1 31.14 All others. 40 37 66 1,732 843 2,654 25 19 145 1,701 829 2,488 5 5 30 41 27 57 Total .164 46 148 5,927 1,134 4,560 57 27 245 5,845 1,106 4,238 28 8 98 161 39 127 Corozal Hospital: Employees ....1 26 2 .14 ...6 1 .4 .1 1 1 .29 A rm y and N avy .3 ..87 ....,. .82 ....7 Panamanian Gov't. .96 474 .8 81 .4 14 .100 537 ..4. Charity. 1 11 24 1 1 20 ..5 .2 8 ..5 2 10 26 Allothers. 4 18 90 11 6 25 ...2 5 7 34 2 .1 8 17 78 Total. 8 126 614 101 15 140 .4 27 88 109 583 3 1 11 18 27 133 Cripples. 3 20 .1 2 ...1 .I .3 20 00 Chronic, medical and surgical cases. .5 59 .2 59 .......3. 1 42 .6 73 Colon Hospital: Employees. 2 .13 147 3 485 1 .17 133 1 408 13 2 65 2 8 Army and Navy. 28 .9. .9 7 .4. .891 ...109 ..11 Charity. ..2 1 5 63 31. 267 1 .18 62. .1.2 1 3 Allothers. 10 3 22 555 2251,397 9 4 71 514 198 1,251 30 2 81 12 4 16 Total. 42 4 40 1,752 259 2,149 15 4 106 1,600 230 1,907 152 24 149 27 5 27 Palo Seco Leper Colony: Panamanian Gov't. .4 83 ..6 ..2 ....4 87 Charity. ..19 .....5 ..1 14 Total. .4 102 .1 6 .7 ....5 101 Total by classes: Employees. 19 6 101 967 204 1,960 10 4 102 944 194 1,772 17 4 94 15 8 93 ArmyandNavy. 132 .4,259. .15 ..4,129 .127 ..120 .. Panamanian Gov't. .100 557 .9 97 .4 16 .100 538.1 13. 4 87 Charity, cripples and chromes. 9 24 147 256 125 783 13 4 49 240 117 649 2 3 82 10 25 150 All others. 54 58 178 2,298 1,074 4,076 34 23 218 2,22d 1,034 3,773 37 27 112 61 48 151 Grand total 214 188 983 7,780 1,412 6,916 72 35 385 7,533 1,445 6,732 183 35 301 206 85 481

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83 TABLE 9.-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED AND AVERAGE NUMBER IN HOSPITAL EACH DAY OF THE VARIOUS CLASSES OF PATIENTS, 1933 Number of days treatment Average number in hospital each day C lass of patients -A merican Foreign Black Total can Foreign Black Total Gorgas Hospital: Employees. 8,090 3,423 19,603 31,116 22.16 9.38 53.71 85.25 Army. 48,690 .48,690 133.40 ..133.40 N avy. 1,539 4. .1,539 4.22 .4.22 Panamanian Government .4 5 56 65 .01 .01 .15 .18 Charity. 5,248 2,306 6,257 13,811 14.38 6.32 17.14 37.84 Allothers. 11,895 10,436 31,740 54,071 32.59 28,59 86.96 148.14 Total. 75,466 16,170 57,656 149,292 206.76 44.30 157.96 409.02 Corozal Hospital: Employees. 226 197 9,355 9,778 .62 .54 25.63 26.79 Arm y.,. .3,059 ..3,059 8.38 ..8.38 N avy. 6 ..6 .01 ....01 PanamanianGovernment. .17,077 90,327 107,404 .46.79 247.47 294.26 Charity. 675 4,190 9,335 14,200 1.85 11.48 25.58 38.90 Allothers. 2,136 6,591 29,239 37,966 5.835 18.06 80.11 104.02 Total. 6,102 28,055 138,256 172,413 16.72 76.86 378.78 472.36 Cripples. .1,095 7,118 8,213 .3.00 19.50 22.50 Chronics, medical and surgical cases ..1,836 23,647 25,483 .5.03 64.79 69.82 Colon Hospital: Employees. 864 25 3,834 4,723 2.37 .07 10.50 12.94 Army. 8,197 .8,197 22.46 .22.46 Charity.,. 738 288 2,441 3,467 2.02 .79 6.69 9.50 Allothers. 3,101 1,751 10,139 14,991 8.50 4.80 27.78 41.07 Total. 12,900 2,064 16,414 31,378 35.34 5.65 44.97 85.97 Palo Seco Leper Colony: PanamanianGovernment. .1,460 26,757 28,217 .4.00 73.31 77.31 Canal Zone Government. .182 6,023 6,205 ..50 16.50 17.00 Total. .1,642 32,780 34,422 ..4.50 89.81 94,31 Total by classes: Employees. 9,180 3,645 32,792 45,617 25.15 9.99 89.84 124.98 Army ..59,946 .59,946 164.24 ..164.24 Navy. 1,545 ..1,545 4.23 ...4.23 PanamanianGovernment,. 4 18,542 117,140 135,686 .50.80 320.93 371.74 Canal Zone Government, charity, cripplesandchronics. 6,661 9,897 54,821 71,379 18.25 27.12 150.19 195.56 Allothers. 17,132 18,778 71,118 107,028 46.94 51.45 194.84 293.23 Grand total. 94,468 50,862 275,871 421,201 258.82 139.35 755.81 1,153.97 TABLE 10.-CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1933 All classes of patients White Black Total Admissions to hospitals, excluding Corozal farm (cripples and chronic ward). 9,189 6,855 16,044 Admissions of employees to quarters. 3,646 3,882 7,528 Total admissions to hospitals and quarters. .12,835 10,737 23,572 Less number of patients transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. ., ..250 338 588 Net admissions to hospitals and quarters .12 0 22,984 Employees only Employees admitted to hospitals. 1,171 1,960 3,131 Employees admitted to quarters.,. 3,646 3,882 7,528 Total admissions of employees ...4,817 5,842 10,659 Less number transferred between hospitals and from quarters to hospitals, whose admissions are duplicated in the above figures. 55 174 229 Net admissions of employees. 4,762 5,668 10,430 Annual admission rate per 1,000 employees to hospitals and quarters. ..1,467.94 622.86 844.94

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84 TABLE 11.-REPORT OF DISPENSARIES, 1933 EMPLOYEES TREATED IN QI#RTERS Remaining Remaining January 1, Admitted Died Discharged Transferred December Dispensary 1933 31, 1933 White Black White Black White Black White Black White Black White Black Ancon .1 13 764 1,93 ..735 1,140 29 62 1 4 1Balboa.5 3 1,516 -771 .1,519 774 ..2 Pedro Miguel .342 450 .-. 342 446 3 .1 G atun 1. .I .139 226 ..135 218 5 7 .1 Colon .8 26 874 1,124 .881 1,130 ..1 20 Madden Dam. ..1 11 118 ...11 11 .8 ... Total.15 43 3,b46 3,882 .3,623 3,819 34 80 4 26 Average number treatedA Days treatment furnished in quarters per day Dispensary furnishing treatment White Black Total White Black Total Ancon. .1,851 5,930 7,781 5.07 16.25 21.32 Balboa. 4,927k 4,715k 9,643 13.50 12.92 26.42 PedroMiguel. 9831 1,6771 2,661 2.69 4.60 7.29 Gatun. 2752 1,0501 1,326 .75 2.88 3,63 Colon. .3,140k 10,0252 13,166 8.60 27.47 36.07 Madden Dam. 16 427 443 .04 1.17 1.21 Total. .11,194 23,826 35,020 30.67 65.28 95.95 ALL CASES TREATED Employees Nonemployees Total Dispensary White Black Total White Black Total White Black Total Ancon. 7,222 17,204 24,426 7,217 16,138 23,355 14,439 33,342 47,781 Balboa. 11,493 15,044 26,537 16,089 13,575 29,664 27,582 28,619 56,201 PedroMiguel. 3,826 7,898 11,724 6,509 15,999 22,508 10,335 23,897 34,232 Gatun. 3,098 6,786 9,884 4,040 8,221 12,261 7,138 15,007 22,145 Colon. 5,812 14,789 20,601 13,258 19,439 32,697 19,070 34,228 53,298 Madden Dam. 13,949 26,926 10,875 31,208 42,509 3,717 5,157 9,471 14,628 Total. 35,400 68,647 104,047 48,321 75,881 124,202 83,721 144,564 228,285 Includes 3,330 contractors' employees. 2 Includes 4,897 contractors' employees. 3 Includes 1,043 members of families of contractors' employees. 4 Includes 2,093 members of families of contractors' employees. TABLE 12.-AVERAGE NUMBER OF DAYS IN HOSPITAL AND QUARTERS FOR EACH ADMISSION, EMPLOYEES ONLY, 1933 White Black Total Hospitals: G orgas.:. 10.83 18.93 15.59 Colon. .6.59 9.13 8.51 Average for hospitals. 10.33 16.72 14.28 Quarters: Ancon. .2.52 5.24 4.17 Balboa. 3.25 6.12 4.22 Pedro M iguel. ...2.88 3.75 3.37 Gatun. .2.06 4.80 3.76 C olon ..3 .59 8.92 6.59 MaddenDam. .1.45 3.88 3.66 Average for quarters ...3.10 6.27 4.72 MR 39231-Panama Canal-8-21-34-1,000 ? 0'

PAGE 87

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