Citation
Report of the Department of Health of the Panama Canal for the year ..

Material Information

Title:
Report of the Department of Health of the Panama Canal for the year ..
Creator:
Canal Zone -- Dept. of Health
Place of Publication:
Washington, D.C.
Publisher:
U.S. G.P.O.
Creation Date:
1915
Publication Date:
Frequency:
Annual
regular
Language:
English
Physical Description:
v. : ; 20 cm.

Subjects

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

Notes

Dates or Sequential Designation:
1914-1916.
General Note:
Each report prepared by a different official.

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:
31317330 ( OCLC )
ocm31317330
AA00006093_00002 ( sobekcm )
25402269 ( ALEPH )
Classification:
RA192 .I874 ( lcc )

Related Items

Preceded by:
Report of the Department of Sanitation of the Isthmian Canal Commission ...
Succeeded by:
Report of the Health Department of the Panama Canal.

Downloads

This item has the following downloads:


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PAGE 1

'j* I x2 /P E,6 -6F Ti ; O THE" ;4; 1V TO j~; pAll

PAGE 2

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PAGE 3

REPORT OF THE DEPARTMENT OF HEALTH OF THE PANAMA CANAL FOR THE YEAR 1915 CHAS. F. MASON Lieut. Colonel, Medical Corps, United States Army Chief Health Officer, Balboa Heights, Canal Zone WASHINGTON 1916 p 7

PAGE 4

/s Ne ** s>

PAGE 5

CO N.T E NTS. Page. Letter of transmittal ---------------------------------------Pag 5 Generalremarks. .5 Vital statistics: Health of employees. 6 Health of residents of the Canal Zone. ..---------------------------10 Health of residents of the city of Panama. 10 Health of residents of the city of Colon. 10 Division of hospitals:Ancon Hospital. 11 Medical storehouse. 11 Board of health laboratory .-------14 Insane department. 15 Chronic ward. 16 Colon Hospital. 16 Palo Seco Leper Asylum. 17 Santo Tomas Hospital-------....------------------------------18 District dispensaries. ........---------------------------------------18 Sanitary division: CanalZone. ........----------------------.------------------------19 Panama. ............------------------------------------------------19 Colon.--------------.------------------------. ..28 Quarantine division: Panama and Colon. ..........----------------------------------------32 Statistics l tables: Table I. Admissions, deaths, and noneffective rates for employees; deaths of residents of Panama, Colon, and Canal Zone. 34 II. Deaths by age, color, and sex. 35 III. Deaths by nationality. .36 IV. Cause of deaths of employees. 37 V. Deaths of white Americans on the Isthmus. 38 VI. Causes of deaths of civil population (employees and nonemployees) and military and places where chargeable. 38 VII. Admissipns and deaths of employees and soldiers in hospitals of the Panama Canal. .....-------------------------------43 VIII. Consolidated hospital report. 51 IX. Consolidated admission to quarters report.--------52 X. Consolidated hospital and admission to quarters report. 53 XI. Employees: Constantly sick and noneffective rates per 1,000. 54 XII. Employees: Days' treatment per admission, hospitals, and quarters. ..........----------------------------------------54 XIII. Subsistence and operating expenses and financial statement.55 XIV. Patients other than employees treated in hospitals and amounts received for their treatment. 56 XV. Surgical operations performed in hospitals. .-----------------56 XVI. Operations and work performed in eye, ear, nose, and throat clinics. 58 XVII. Consolidated ward laboratory report of all hospitals---------58 XVIII. Report of Ancon Hospital. 59 XIX. Report of Colon Hospital. 60 XX. Report of Palo Seco Leper Asylum. 60 XXI. Report of Santo Tomas Hospital. 60 XXII. Report of board of health laboratory. ...--------------------61 XXIII. Report of issues of quinine. 63 XXIV. Sanitary work dons in Panama, Colon, and Canal Zone. 63 XXV. Quarantine transactions-. 65 XXVI. Personal report. 66 XXVII. Hospital and total cases of malaria among employees--------67 (3)

PAGE 6

4 +. +.: ..4 +. .++ +++ + 4 4 4

PAGE 7

LETTER OF TRANSMITTAL DEPARTMENT OF HEALTH, Balboa Heights, Canal Zone, January 25, 1916. Lienut. Col. JAY J. MORROW, Acting Governor of the Panama Canal, Balboa Heights, Canal Zone. Sm: I have the honor to submit the following report of the operations of the department of health for the calendar year 1915. Very respectfully, CHASE. F. MASON, Chief Health Officer. GENERAL REMARKS. One case of smallpox was removed from the Panama Railroad steamer Panama on February 10. The disease was contracted prior to arrival. on the Isthmus. Four cases of yellow fever were brought to Balboa quarantine from Buenaventura, Colombia; the first on September 27, the second on October 25, and the last two cases on December 10. Three of the cases proved fatal. These cases illustrate the necessity of very watchful quarantine against Colombian ports, as up to the time of arrival of the first case in quarantine the existence of yellow fever in Colombia had been officially denied. With these exceptions no cases of quarantinable disease originated on or were brought to the Isthmus during the year. Ten cases of typhoid fever were, however, brought to the Canal Zone by ships arriving at its ports. The shifting of population from the Canal Zone toward the Pacific end of the canal has continued during the year. A census of the zone by the police department taken as of July 10, 1915, showed the population of the zone to be 29,926-a decrease of 1,554 since the beginning of the year. Of the total population, 15,498 were living in the Balboa district. The census of the cities of Panama and Colon by the health department was completed in the latter part of December, showing an increase in the city of Panama of about 500 and a decrease in the population of Colon of 4,638. The strength of the military at the end of the year was 7,682. Corozal was abandoned as a Panama Canal town and turned over to'the military at the close of the year. The free treatment of physical defects found in school children at the annual physical examinations has been productive of good results. The annual physical examination of male gold employees was made for the second time in November and December of this year, (5)

PAGE 8

6 and the results obtained indicate that it is well worthy of continuation. Of 3,548 employees examined, over 18 per cent showed some obvious physical defect which required treatment or advice in order to prevent physical degeneration or disease. Instruction in regard to mosquito-borne diseases has been made a part of the course in the white public schools in the fifth, sixth, seventh, and eighth grades. The course is exciting a good deal of interest among the school children, who will assist in educating their parents on the matter. The great fire in Colon, April 30, rendered homeless a large part of the population, a great many of whom were cared for in box cars and tents, the number being gradually reduced until the camp was closed in November, 1915. During the year the new sanitary rules for the rat-proof construction of buildings and stables in the Canal Zone were adopted and, together with the old building regulations, published in convenient pamphlet form. Laws and executive orders relating to health matters in the Canal Zone and the ordinances of the board of health were also compiled, published, and distributed in the form of a small booklet. The Sanitary Rules and Regulations for the cities of Panama and Colon were carefully revised, elaborated, and brought up to date, and, after approval by you, were, in July last, submitted to the Panama Government for publication. Though action by that Government has been repeatedly urged, nothing has been done up to the present time. In the cities of Panama and Colon we have theoretically, according to the Taft agreement and our treaty, complete sanitary jurisdiction; but practically our work is limited to the results obtained from the amount of money contributed by the United States, and even these results are limited by the total lack of cooperation on the part of the Panama authorities in the city of Panama. On account of the close proximity of this city to the Canal Zone and its intimate relation to the welfare of the zone this condition of affairs has given me much anxiety, and may at any time become a serious menace to-the successful 7 operation of the canal. More than half of our silver employees live in Panama and are therefore directly affected by insanitary conditions there, which, under the present conditions, we can not control. w During the year 16,792 persons were vaccinated against smallpox in the cities of Panama, Colon, and the Canal Zone. In addition to this 16,325 persons were vaccinated on board vessels arriving and departing for foreign ports. VITAL STATISTICS. EMPLOYEES. The health of our employees in 1915 was better than in any. previous year and the death rate lower. The total admission rate to hospitals and quarters was 320.2Q, a compared with 401.54 for 1914 and 519 for 1913. For 2s" alone the admission rates to hospitals were 143.82 in 1915, 182.57

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in 1914, and 246.91 in 1913. This is a net reduction of 42 per cent since 1913. The total admission rate to hospitals only was 186.17, compared with 244.49 for 1914 and 351.10 for 1913. The total death rate was 5.77, as against 7.04 in 1914 and 8.35 in 1913. The constantly noneffective rate for the year, all causes, was 10.28, as compared with 12.22 for 1914 and 15.97 for 1913-a net reduction of 36 per cent since 1913. Stated in another way, these figures mean that had our various rates remained the same in 1915 as for 1913 we would have had 6,915 more admissions, 90 more deaths, and 72,243 more sick days than we did have. It is hard to estimate the actual saving in money, but the following figures will give an idea of what it is, taking the average pay of a white employee as $150 per month, and the cost of his treatment in hospital $1.82 per day, and the average pay of a black employee as $30 per month and his hospital treatment at $0.87 per day. The saving in days lost by white employees in hospital, 25,061 days, at $5 in salary and $1.83 for hospital treatment, equals $171,166.63. Black employees in hospital, 27,984 days at $1 per day salary and $0.78 per day for hospital treatment, eqialg $49,811.52, or a total saving of $220,978.15. With regard to malaria, which is our principal cause of disability, the admission rate, hospital, and quarters, was 51.20 as compared with 81.52 in 1914-a reduction of 37 per cent from the latter year. The death rate was 0.23 in 1915, 0.16 in 1914, and 0.37 in 1913-a net reduction of 38 per cent since 1913. Two whites and six blacks died of this disease; 1.19 employees per thousand were constantly sidk with malaria in 1915. In my opinion, all the permanent towns for employees in the Canal Zone are now practically free of endemic malaria, except Cristobal, Colon, and Gatun, and these towns will be free of it when the improvements planned are completed. It should be clearly understood, however, that these conditions obtain only iI' sanitated areas, and that exposure outside these areas will always in olve danger of malaria;also, that the immunity at present enjoyed in sanitated areas will continue only as long as the present maintenance work is kept up. There have been three cases of hemoglobinuric fever with one death during the year. There were 4 cases in 1914 and 19 cases and 6 deaths in 1913. The admission rate for dysentery was: Amoebic, 0.14; bacillary, 0.06; clinical, 0.55. The corresponding rates for 1914 were 0.38, D,18, and 1.24, and for 1913, 0.39, 0.07, and 1.61, a reduction of 64 per cent since 1913. There were 4 admissions for liver abscess and 1 death from the ,same disease, as compared with 8 admissions and 4 deaths in 1914, and 14 admissions and 4 deaths in 1913. Two cases of beriberi occurred during the year. The admission rate for typhoid fever was 0.11 as compared with 0.52 in 1914 and 0.67 in 1913-a reduction of 84 per cent since the

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8 MALAR IA CHART FOg 1906, 1913,19I4AND 1915 Showing the number oF hospital MALARIA cases each month among employees, and total cases For 1914 and 1915 Expressed as a percentage of the entire working Force 5hows Hosbital catse. --------Shows 7Th#l cases --Each Horlijnfa/ Line indicates 0.2 of Each Vertical One month 4H1' A~ .A I e 7% eIA 0 1906 193 4

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9 latter year. Of the total cases of typhoid fever, for employees and nonemployees, oaly 71 per cent were contracted on the Isthmus. There were 4 deaths from typhoid fever in 1913 among employees, as compared with 2 in 1915 and 4 in 1914. There were 3 cases of dengue and none of relapsing fever during the year. The five diseases causing the highest number of hospital admissions, with their rates, were as follows: Admissions. Rate. M alaria....-.-------------------..------.1,570 45.13 Venereal diseases.-------------------------------.580 16.67 M u m s ---------------------------231 6.64 beIosis ----------------------------------12 3.59 ]In fluent za .--.----. -. ---. -----. -------. ---.-.-------. ---. 97 2.79 All these diseases show a decided decrease over previous years, except tuberculosis and mumps, which show a slight increase. The five diseases causing the highest number of deaths, with their rates, were as follows: Peaths. Rate. T uberculosis....27 0.77 P neu m onia.--.---.---.-.-.--.--.-.-.-.-. .25 .72 N ep h ritis.---.-.--.----.-.-.-.-.--.-----.----.--.-.-.11 .31 Hear, organic disease of.----------------------. -------10 5 .23 These death rates, except for malaria, are much lower than for any previous year; the rate for malaria is also much lower than for any year except 1914. EFFECTS OF SEASON. The highest death rates for disease occurred in the months of october and November and the lowest in April and May. The highest admission rates for disease were in June and July and the loeset in March and April. EFFECTS OF RACE. 'The admission rate to hospitals and death rate for disease for black employees were 153.26 and 4.19 per thousand as compared with 395.85 and 3.18 from disease for white employees. The noneffective rate for disease and injuries for black employees per thousand was 8.78, as compared with 19.81 for white employees. The admission rate to hospitals and quarters for malaria was 39.08 for blacks, as compared with 128.42 for white employees. 26592--16-2

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.10 The admission rate to hospitals for disease and the death rate for disease for Americans were 267.97 and 2.63, wkile the admission rate for malaria to hospitals and quarters was 73.32. DEPORTATIONS. The number of deportations was 109, divided as follows: Employees, 68; nonemployees, 41; disease, 91; and injury, 18. This is a large falling off since the previous year, when there were 176. The principal causes of deportation were as follows: Insane, 39; tuberculosis, 23; syphilis, 12; circulatory system, 4; and paralysis, 3. CANAL ZONE. With an average population of 31,946 in the Canal Zone there were a total of 410 deaths during the year. Of these, 361 deaths were from disease, giving a rate of 11.30 per thousand, as compared with 13.24 for 1914 and 14.43 for 1913. This is the lowest rate ever reached. The birth rate for the year was 19.06. The infant mortality for white children under 1 year of age was 55 per thousand and for colored children 298, with a general average of 225. Of the total deaths from disease the percentage under 5 years of age was 51. Considering also the 31 per cent reduction in the death rate of employees, it will be noted that the reduction in the death rate in each instance is in exact proportion to the degree of sanitary control which we exercise. In the case of employees the control is practically complete. In the Canal Zone it is restricted only by limitation in funds. In the case of nonemployees in Colon it is more complete than in Panama, for the reason that most of the land is owned by the Panama Railroad and that there is a greater willingness to cooperate on the part of the local authorities. PANAMA CITY. The average population of the city for the year was 60,373, among whom there were a total of 1,810 deaths. Of these, 1,749 deaths were from disease, giving a rate of 28.97 per thousand, as compared with 32.85 for 1914 and 30.21 for 1913. This is the lowest rate recorded for the city except in the year 1909. The birth rate for the year was 51.03. The infant mortality was 221. Of the total deaths from disease the percentage under 5 years of age was 54. COLON. The average number of inhabitants for the year was 29,331, among whom there were 640 deaths. Of these, 604 were from disease, giving a rate of 20.59 per thousand, as compared with 24.20 for 1914 and 22.74 for 1913. This is the lowest rate ever recorded. The birth rate for the year was 26.97. The infant mortality was 234. Of the total deaths from disease, the percentage under 5 years of age was 45. 4

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11 ANcON HOSPITAL. PERMANENT BUILDINGS. The remaining bodies having been removed from the hospital cemetery and the site turned over to the building division on which to erect additional quarters, the crematory apparaTus was dismantled and building demolished. A new concrete crematory building was erected near the eye and ear wards, the proposed site for the permanent laboratory, and at the end of the year was practically completed and ready for use. The property storehouse of the hospital was consolidated with the medical storehouse of the health department in a permanent concrete building immediately adjacent to track facilities at the lower end of the hospital reservation. Wards Nos. 3 and 4 were vacated and demolished in August and construction of the first unit of the permanent hospital was immediately commenced by the building division. A fireproof room was built in the medical storehouse to provide for the protection of case histories and hospital cards against fire. HOSPITAL BUILDINGS TRANSFERRED TO OTHER DIVISIONS. When the insane were moved to Corozal all the asylum buildings were turned over to the supply department for remodeling into married quarters. March 1 the district quartermaster took over control and maintenance and repair of all buildings excepting those actually used for the hospital proper. The library building was vacated and turned over to the building division. ROADS. In April the main hospital road, now being more or less of a general thoroughfare between Ancon-Panama and Balboa Heights, was turned over to the municipal engineering division for future maintenance at the expense of that division. X-RAY CLINIC. Recent advances in roentgenology and radiotherapy has rendered it necessary to provide increased and better facilities for conducting work of this character. During the past year the X-ray department has moved into larger and more suitable quarters, and the latest model equipment -has been provided and installed for making modern radiographic examinations. The new equipment includes one vertical Roentgenoscope; one radiographic, stereoscopic, and fluoroscopic tube stand; one radiostereoscopic X-ray table with horizontal fluoroscopic attachments; one stereoscope; two Cooledge X-ray tubes with overhead wiring systems; a complete dark-room equipment, including a large soapstone developing tank with water cooling

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12 apparatus for the rapid development of plates under tropical conditions. To accommodate this apparatus and to provide the needed space for its satisfactory and economical operation, five rooms have been set aside for the use of this department. This arrangement provides an office and demonstrating room, examination room, fluoroscopic room, dark room, and a dressing room for patients. In view of the great increase in the amount of X-ray work at Ancon Hospital, and its extension into fields other than surgical, it has been deemed advisable to relieve the surgical clinic of the hospital from further responsibility for work of this nature. An independent department has been established, effective January 1, 1916, and designated the X-ray clinic. As chief of the clinic, an expert roentgenologist has been secured who will devote his entire time to this work. STEWARD' S DEPARTMENT. No new equipment was added during the year. All present equipment was kept in thorough state of repair and replaced where necessary. The steam line continued furnishing efficient service. The lagging was painted with tar, the one and only expense of maintenance during the year. QUARTERMASTER'S DEPARTMENT. The dairy herd was transferred to the new dairy at Corozal farm in March. The poultry flock was transferred to Corozal farm in February. The garden was discontinued in 1914. Fresh vegetables are now furnished by Corozal Hospital farm. The following fruits were gathered from Ancon Hospital grounds and were turned into the kitchen: 250 bunches of bananas, 350 papayas, 200 coconuts, 18,000 limes, 12,000 mangoes, 950 avocados, 6,000 guavas, 800 oranges. Papayas and bananas, having been found to be the most profitable products in the past, over 100 papaya trees and 200 banana suckers were set out during the year, additional ground having been gained by demolishing six poultry houses. Over 1,400 banana plants and 200 papaya trees are now under cultivation. MOTOR TRANSPORTATION. Truck No. 1, put in service March 22, was operated 11,109 miles, at cost of $1,551.15 (including depreciation), replacing $2,605.50 worth of animal transportation-a net saving to the hospital of $1,054.35 on a capital expenditure of $1,705.64. Motor hearse, put in operation September 27, has been run 981 miles on $198.67 operating expenses (including depreciation)-.U net saving over animal transportation turned in of $130.33 on a capital expenditure of $627.50. Truck No.2 was put in service December 28. Operating expense, $13.65; mileage, 130. Animal transportation it replaces will be turned in in early part of new year.

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GARBAGE COLLECTION AND POLICING OF GROUNDS. All asylum and all nonhospital buildings were transferred to the quartermaster's department early in the year. At the same time the district quartermaster took charge of the collection of all garbage on the hospital reservation, the hospital being charged its prorata of the expense of this service. The only policing now done by hospital employees is that around hospital buildings proper, balance being done by respective departments concerned. This also applies to care -of lawns, gardens, plants, and hedges. REPAIRS TO EQUIPMENT AND BUILDINGS. March 1 the district quartermaster took over the n-aintenance and repair of all buildings except those actually used for the hospital proper. The following are the more important improvements and alterations, in addition to the usual repairs to equipments and buildings, made during the year. An ice box, capacity of twenty-four 300-pound blocks of ice, was built into the kitchen in January-February. Storage space is 12 by 6 by 61 feet, entered through vestibule. Four hundred pounds is about.daily average consumption of ice. All buildings in the poultry yard were demolished except one, which has been made into quarters for the colored foreman for the purpose of additional protection against depredations upon the fruit trees. The dairy and hog barns were wrecked by Corozal farm laborers under the direction of the hospital artisans. All material, fittings, etc., possible were saved and removed to Corozal for future use. A garage made of iron roofing from the wrecked poultry houses was' erected for housing the motor transportation put in service during the year. On removal of the property storehouse, changes were made in the 'layout of the general office building resulting in more suitable and commodious quarters for the superintendent and his office force, the drug store, the library, the medical clinic, and the X-ray clinic. An additional approach and exits were made to the building. Dry closets were built into each of the nurses' rooms in the nurses' quarters prior to the transfer of building to quartermaster's department. The isolation annex was made thoroughly mosquito proof and a gravel path laid to the building. The oven of the bake shop was relined with fire brick. Extensive work was done in the medical storehouse, such as putting up shelves, installing a linen room, condemnation room, racks for chart room, dry closet for instruments, and poison locker. A clothes chute was put into ward 15. All shop work for health department was taken care of, as well as repairs on the ground at Pala Seco Leper Asylum and Corozal fHospital.

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14 DISPENSARY. No change has been made in the ambulance and hospital car services or manner of admitting line patients. The clinic has increased to such proportions that an additional physician and male nurse have been detailed for duty there. Herewith is a comparative statement showing report of patient days.: 1910, 394,406; 1911, 424,416; 1912, 415,009; 1913, 423,251; 1914, 338,901; 1915, 268,945. BOARD OF HEALTH LABORATORY. The following is a summary of work of special interest undertaken by the labpratory staff during the last half of the calendar year 1915. A similar report was submitted covering the first half of the year in the fiscal report for 1914-15. A beginning has been made of a systematic Wassermann survey of patients in hospital not suspected of syphilis, and although the number examined so far is too small to be of value, we have found nearly 20 per cent positive. During the past year the number of Wassermann examinations of blood serum and spinal fluid has increased threefold. Observations have been made in the entomological division on the breeding places of the SyrphidT; on the breeding of the larva of midges (Chironomide) in the Camacho region, where the larve, by their presence in the water supply of Cascadas and Empire, have been troublesome. Observations on the screw-worm fly (Chrysomyia nacellaris) have been continued, and also observations on the biology and life history of the coconut-tree caterpillar, Brassolis isthria. A complete report of this study has been presented before the Medical Association of the Isthmian Canal Zone, and will appear in the proceedings of that body. Examination of blood from native horses has shown that mur-rina, a disease caused by Trypanosoma hippicum, has reappeared in Panama after an absence of about four years. At present it is reported from Pecora, Republic of Panama only. At the Corozal farm balantidic dysentery has caused a moderate number of deaths among the swine. A compilation of the histories of cases of neoplasms among negroes has shown that malignant tumors, particularly carcinomata, are relatively more frequent than is shown by the available literature on the subject. An investigation of the breeding habits of Mansonia titillans and allied mosquitoes is progressing. The question is of some importance, since the larvo do not come to the surface, but remain attached to the roots of plants and are therefore difficult to kill. A fairly large collection of reptiles of the Canal Zone has been made and additions are frequently being made to it. Whenever possible the toxicity of the venom of each reptile is tested upon guinea pigs, and a report of this work will be rendered later. A large series of cases of Bright's disease has been studied with reference to the etiology of the disease on the zone, with the result that malaria, dysentery, and to a lesser degree syphilis, have been

PAGE 17

15 deinitely shown to be the underlying causes. A full report will appear in the proceedings of the Medical Association of the Isthnian Canal Zone. At the conclusion of the year an extended mosquito survey of the Isthmus was in progress. About 26,000 determinations are being made each month, and a definite idea of the numbers and seasonal variation of each species will soon be possible. Examinations of adult mosquitoes is supplemented by collections of larv which are bred out at the laboratory. A partial sanitary survey was made of Pueblo Nuevo, a suburb of Panama, and the report sent to the chief health office in August. A case of typhoid fever at Corozal Hospital was traced to a carrier among the other patients, and subsequent examinations have shown that the carrier state was probably temporary. The occasional appearance of hog cholera has led to the immunization of all hogs at the farm at intervals of three months, and as a rest the loss from this cause has been very small. A large amount of smallpox vaccine has been prepared during the year and the only difficulty encountered has been due to the practical impossibility of keeping an active strain of virus on hand, due to the small output and infrequent batches of vaccine; and as a consequence frequent importations of fresh virus from the States have been necessary. Plans for a new laboratory for the board of heal th have been prepared, which will allow adequate room and facilities for work of a varied character. INSANE ASYLUM. In April this branch of the hospital was transferred to Corozal, where remodeled quarters had been erected for their use, and was consolidated with the Corozal farm, the new institution being named "Corozal Hospital." Administrative supervision of the new institution remains with Ancon Hospital. There were 274 patients remaining in the asylum on January 1, 1915. During the year the movement was as follows: 159 admissions, 124 discharges (including 60 deportations), and 41 deaths; leaving a total of 268 patients remaining at the end of the calendar year. These 268 patients were classified as follows: Employees of the Panama Canal, 15; Panama Railroad employees, 3: Panama Government pay cases, 184; other pay cases (including 8 soldiers), 15; Canal Zone charity, 52. Total males, 156; total females, 112. On March 14 the entire male section, with the staff of nurses, attendants, etc., under the direction of an assistant physician, was removed to the new hospital at Corozal. The final transfer of the institution from Ancon to Corozal was accomplished on April 9, when the female section was removed to the new site. The new hospital is built on the pavilion plan with covered approaches. The wards are of the two-story type, well lighted and ventilated. Within the inclosure are 10 buildings, five each for the male and female patients, exclusive of the building for the laundry and sewing room, and the building for the kitchen and general mess rooms. The grounds are more spacious than the former location at Ancon, and afford a better opportunity for the

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16 more comfortable patients to be out and assist in the care of tie grounds. The remainder of the site is occupied by the office, storerooms, quarters for the employees, and quarters for the farm cripples, who assist in the work of the garden, dairy, piggery, and poultry yard. A consolidation of the Corozal Hospital for the Insane and the Hospital Farm for Disabled Employees was effected on September 1, in accordance with circular No. 625-2. The sale of plants and flowers from the garden is increasing each month, and the demand is far greater than the supply. All vegetables and fruits are sold to Ancon Hospital and the local buyer for the commissaries. The revenue from the garden for the six months ending December 31, 1915, amounted to $1,363.55. The milk production during the latter part of the year far exceeded the requirements of Ancon Hospital, the principal consumer, and the sale of milk to individuals was correspondingly increased. The total milk production during the last half of the calendar year was 46,336 quarts. The total revenue from the dairy during the period was $6,992.67. There were 74 cows and 21 calves in the herd at the close of the year. There were 334 chickens in the poultry yard at the beginning of the year, to which were added 530 chickens from the Ancon Hospital flock in February. These were all old chickens, and for economical reasons a gradual reduction was made during the year by sales, until at the end of the year but 144 remained of the original flocks. During September and October 500 young chickens were received from the United States, and it is expected that the egg production will shortly be sufficient to supply all demands. The total revenue from the poultry yard during the past six months was $786.55. The revenue from the piggery during the six months ending December 31 was $711.27. Number of pigs and hogs on hand 168. CHRONIc WARD. At the close of the year there were 26 chronic and incurable patients under treatment. The cost per patient, per day, was $0.25. Detailed statistics are shown in Table XVIII. COLON HOSPITAL. The construction of the new hospital began on June 11. The building, which is of reinforced concrete, was 80 per cent completed on December 31, and occupies the site of former buildings 17 and 19, which were razed for the purpose. It is expected that it will be ready for occupancy about April 1. The consolidation of the Cristobal dispensary with the hospital during the fall of the preceding year necessitated an increase In the hospital staff of one physician, one druggist, one female nurse and two attendants. A decrease of two male nurses was authorized during the same period. The work done at this hospital is largely emergency in character. Contrasted with the 2,115 admissions to the hospital, there were

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17 transferred from the hospital and dispensary to Ancon,Hospital and Santo Tomas Hospital, during the year, 2,775 cases of a nonemergency character. The following is a statistical summary: Cases admitted to hospital-.----. 2,115 Major surgical operations performed. 230 Minor surg operations erformed. 610 Obstetrical cases delivered .-. 47 Deathsinhospital.----------------------------------------75 Cases transferred to Ancon Hospital. 423 s transferred to Santo Tomas Hospital. 179 cases treated. 55,786 cases transferred to Ancon Hospital. 1,839 >n y cases transferred to Santo Tomas Hospital. 334 on duty, hospital and dispensary. 5 on duty, hospital and is .6 on duty, hospital and dispensary. 25 nor o nations performed in dispensary. 1,560 ons filled in pharmacy. 51,746 detailed statistics are shown in Table XIX. PALO SEco LEPER ASYLUM. There has been marked improvement during the year in conditions affecting the comfort of the patients. Much of the work incident to these improvements has been done, in whole or in part, by the patients themselves, who have shown much interest in their home and have cooperated in its improvement. This attitude of mind on the part of the patients has contributed greatly to their contentment. On the completion of the building for patients' quarters, reported last year, a new building was erected, entirely by labor of patients. It contains three rooms, which are used as superintendent's office, the dispensary, and the commissary. Friends interested in the welfare of the asylum have contributed many things conducive to the comfort and amusement of the patients. Notable among these is a moving-picture machine. The gentlemen supplying all reels for use with these machines in this territory furnish reels for use at Palo Seco without charge. During the year five entertainments were given the patients by talent furnished by the Y. M. C. A. and by soldiers from the Tenth Infantry. It became necessary to provide a congregating place for the patients in which entertainments could be given. It was decided to enlarge and remodel the building used as a dining room, to make it ale for these purposes. To do this it was necessary to move schoolhouse from its former site near the end of the dining room to the edge of the beach. The dining-room building was then extended sufficiently to give ample room for use as an entertainment hall when desired. The space under the dining room was graded, given a concrete floor, and inclosed for use as a general recreation and congregating room for the patients. It is screened in, furnished with small tables, and supplied with games and a mall library of books in English, Spa h, and French, and with magazines and daily papers. All of the buildings at Palo Seco, except two, were painted and given necessary repairs. 26592r-16-3

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18 Electricity was introduced into the reservation during the year by extending the line from the channel light near Farfan Beach. This has added greatly to the comfort of the patients, and to their safety by reducing the risk from fire. It has also proved a great economy in that it furnishes the power for pumping water into the supply tanks, which were formerly filled by the operation of a steam-driven pump. Arrangements have been made by which it will soon be practicable to establish telephone communication between the asylum and Balboa, which will greatlyfacilitate the transaction of business. The matter of systematic treatment has been left largely at the option of the patients. About July 1 all of them had abandoned continued treatment of any kind, and the belief was general among them that all proposed remedial measures caused them discomfort to a greater.or less degree, without any appreciable benefit accruing therefrom. During the last half of the year they have been encouraged to take chaulmoogra oil in as large doses as they have found that they could tolerate without much discomfort, and improvement was so marked in some cases which first began the use of the oil that the number volunteering to take it has gradually increased until at the present time approximately two-thirds of the patients are taking the oil regularly, and accurate records of its administration are being kept. It is too early to make a definite report as to what improvement, if any, may be accredited to the use of the oil at this time. Detailed statistics are shown in Table XX. SANTO TOMAS HOSPITAL. The number of patients in this hospital has continued to increase until it is now much overcrowded, and in addition many deserving patients have to be turned away. Under these conditions it has been impossible to provide adequate segregation of contagious diseases. The tuberculosis ward has overflowed into other wards, the occupants of which are thereby exposed to the danger of infection; and many advanced tuberculosis cases which should be segregated in the hospital have been refused admission, for lack of beds to place them in. The remedy for this condition is in the hands of the Panama Government, which should build a separate hospital for tuberculosis patients, leaving the space now occupied by them in Santo Tomas Hospital for the reception of other acute cases. Notwithstanding the large increase of work in this hospitality has been efficiently done, and reflects credit upon the present superintendent and his staff. Detailed. statistics are shown in Table XXI. DISTRICT DISPENSARIES. The number of line dispensaries has been reduced from 9 at th close of 1914 to 5 at the close of 1915, and 1 of these does not req the presence of a physician.

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Thesations having the highest admission rates for malaria were Gatun and corozal, with an average weekly percentage of 0.37 and 0.27, and the lowest, Ancon and Balboa, with 0.08 each. detailed statistics are shown in Table IX. SANITATION-CANAL ZONE. The year began with six sanitary inspection districts in the zone, exclusive of the terminal cities, and ended with four, the Culebra district having been m-rged with the Pedro Miguel district, and that portion of the Corozal district not occupied by the Army havng been attached to the Ancon district. The sanitary work in the zone and the expense incident thereto were constantly assuming a more satisfactory status, due to the fact that permanent improvements are now possible where previously the work and the expenditure incident thereto were largely for temporary measures to meet transient conditions incident to construction work. This change, however, has not progressed as rapidly as was anticipated, and it has been necessary to continue the occupation of quarters and to maintain communities which it was hoped would be abandoned by this time. In some districts the continued occupation of unscreened quarters which it had been intended to destroy has resulted in an increased malaria rate for those localities. This factor in the maintenance of the sick rate is being eliminated as rapidly as possible by providing for screening of all quarters, and by the gradual reduction of the force of employees, and by the provision of new quarters owned and controlled by the Panama Canal. The chief items in the expense of zone sanitation are those incident to cutting grass by scythes and machettes, the cleaning and grading of drainage ditches, and the oiling of low areas and of pools of water. Reduction of this maintenance expense is being accomplished as rapidly as funds will permit by sufficiently grading areas which require grass cutting to enable a mowing machine to do the work, by concreting ditches, and by underdraining seepage areas and pools wherever practicable. Measures for the elimination of rats from the zone have been continued in all districts and compliance with the building regulations promulgated last year is constantly diminishing the number of structures which can harbor rats. The great importance of rendering it impossible for plague to obtain a foothold on the zone lenders .it highly desirable that the rat-proofing of all buildings be accomplished as early as possible. The total cost of the division in 1915 was $145,421.54, as compared with $172,941.50 in 1914. Detailed statistics are shown in Table XXIV. SANITATION-PANAMA. During the past year there has been a very considerable increase n the area covered by this work, as there has been a great deal of new building in the western part of the city around Ancon -Aenue and Fourth of July Avenue, and there has also been a

PAGE 22

20 consistent and steady growth of the city toward Bella vista, in the Savannas. Many new buildings have been erected along Calidonia Road, as well as farther out, and the bulk of our work is now done in that part of the city. Approximately 35 per cent of the population of the city now resides east of the Calidonia bridge. TUBERCULOSIS, PULMONARY AND OTHER FORMS. This disease has always been prevalent in Panama in various forms, and under present conditions there is little hope of its eradication. Some interest is now being displayed in the nutter by the Panaman authorities, and it is hoped that before another year is over some definite organized antitubercular work can be undertaken. One of the greatest reasons for its prevalence at present is the overcrowding in rooms. This is a matter of education and economics. There is much unemployment in the city, and the West Indian and Panaman negroes and morenos, the class of people most subject to infection, are crowded in small rooms, anywhere from two to six being the average per room. These rooms are hermetically sealed at night, doors and windows being closed tight, owing to the characteristic negro dread of "night air." It will take a long course of educational endeavor along this line to cur6 this particular feature. Patients contracting the disease rarely have it recognized sufficiently early to benefit by any treatment that can be given them, and by the time they apply to the hospitals for treatment are usually in the last stages of the disease. Several cases have been reported recently of patients dying in coaches or ambulances from tuberculosis while en route to the hospital, indicating their slowness in seeking relief. When they do apply for treatment in the earlier stages of the disease the diagnosis is frequently made of bronchitis, etc., and very rarely has this office known of a patient in Panama being treated for pulmonary tuberculosis in its incipient stage. The matter of instituting a Government tuberculosis sanitarium .by the Panaman Government has been under discussion for some time past, but so far nothing definite has been done. There are many favorable sites for such an institution in the hills in the interior of the Republic, and it is to be hoped that something definite in that line will be done soon. The total number of deaths from all forms of tuberculosis was 219, giving a rate of 365 per 100,000. This exceeds the rate for colQred population of our larger southern cities. TYPHOID FEVER. During the year 18 cases of typhoid fever were reported, with 5 deaths, 4 of the cases being clinical, leaving 14 cases bacteriologically confirmed. All of the deaths occurred during the lost six months of the year; two were in cases diagnosed clinically, thus giving an actual death rate of five for 100,000 population. During February, 1915, three cases were reported from one block in Guachapali, which indicated the presence of a caie

PAGE 23

21 but afar the closing of an open sewer and an active campaign against flies in that neighborhood no further cases were reported. The low typhoid death rate during the year 1915, as well as the past years, may be ascribed principally to the requirements of the sanitary rules that every building in the city shall be connected with sewer and public water supply. There are practically no exceptions to this rule, as nearly every inhabited street or district has full water and sewer connections. In the few cases where pit closets have been allowed, constant supervision is exercised to keep them fly and mosquito proof. DIPTHERIA. There were 18 positive cases of diphtheria reported, not including many suspects, who were proved negative on bacteriological exam$nation. Four cases terminated fatally, giving a death rate for the yea rom this disease of 6 per 100,000. MEASLES. During the early part of the year a rather heavy epidemic of Dieasles occurred, nearly all of the cases being of a mild type, however. The total cases were as follows: Month. Cases. Month. Cases. January.---------------------3 August-. 241 February.-------------------19 September.------------------26 March.----------------------61 October.---------------------6 April-----------------------49 November--------------------3 May-. 4 December--------------------2 J ne. -24 July. 56 Total.-----------------1610 There were eight deaths from broncho-pneumonia, with measles named as the contributory cause. This gives a rate of 13.33 per 100,000. MALARIA. At no time during the past year has the weekly hospital admission rate exceeded the very low figure of 0.04, and of late it has been 0.01 per cent. This is a great reduction over previous years. The number of canal and railroad employees living in the city will approximate nearly 25 per cent of the population. The great majority of these are West Indian negroes living in unscreened houses. All employees suffering from malaria are admitted to Ancon Hospital for treatment, and "clinical" diagnoses are accepted from that institution. During the months of October, November, and December, 1915, to week ending January 11, out of the approximately 15,000 employees living in Panama in unscreened houses, there were only six cases of malaria admitted to Ancon Hospital. During the same months of 1914 there were 192 cases. This is the worst part of the rainy season ordinarily, and the average rainfall duin those months was as follows: 1914-October, 6.44 inches; November,

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22 10.35inches; December, 8.28inches. 1915-October,10A4inches; November, 7.05 inches; December, 3.59 inches. Experience has shown that the average rate of mosquito breeding under normal conditions almost exactly follows the average rate of rainfall. In connection with antimalaria work this office has installed, and oils and maintains, a system of earth ditches, totaling 152,867 feet in length, or approximately 29 miles. This is of course, a source of constant expense to the department, but it pays for itself in the reduced malaria rate throughout the city. Below is given a table showing the number of hospital cases of malaria, with percentages, during the year 1914 as compared with 1915: Population 50,000 Population 60,000. Total Weekly Total Weekly Month. hospital percentMonth, hospital percentcases. age. cases. age. 1914. 1915. January. .319 0.13 January. -. 127 0.04 February. 111 .06 February. 67 .0 March. .123 .06 March. 68 .03 April. 107 .05 April. 57 May. 104 .08 May. 50 .2 June. 137 .07 June. 50 .02 July. 179 .03 July.-. 71 .02 August----------274 .11 August.36 .02 September-------168 .07 September. 21 .01 October. 254 .09 October. 19 .01 November-------167 .07 November. 20 .01 December-------121 .05 December. .28 .01 There will always be some cases of malaria in the city of Panama on account of the number of infected districts just beyond the imits of the areas covered by our work, such as the Savannas, Juan Diaz, Old Panama, etc. For instance, during the month of December, 1915, at the request of the Panaman Government, the health officer and the official physician of the State of Panama made a joint inspection of the village of Juan Diaz, about 10 miles east of the city. A number of native houses were inspected, malaria being found in practi every house in the village. Mosquito breeding was rampant, a number of deaths from fever had been reported. Nothing ean be done to control such a source as this without a sadlitary inspector beig stationed there constantly, with full equipment, material, and laborers, for some time at least. Medical visits would be necessary at least daily for several weeks if not months. At the time of this visit, quinine and tonics were distributed, and recommendations made to the village authorities reg g drainage, brush cutting, etc. A return visit a few days later showed some improvement in the condition of the sick, and that some attempt had been made at improving the living condition there; but the mosquitoes, and consequently, the malaria c=n not

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23 be completely eliminated unless such work is done systematically under the direction of the health department. The conditions found at Juan Diaz exist even closer in, and there are always to be found infected mosquitoes within striking distance of the city. At old Panama, a resort much frequented at night, there is a constant focus of infection. Anopheles mosquitoes breed there in large numbers, no preventive work of any kind being carried out. Owing to the proximity of such places as these, where no work is done, and where a certain percentage of the people of Panama go from time to time, it is a practical impossibility to stamp the disease out completely in the city without extending our campaign miles beyond the city proper in every direction. The public can not be restrained from going to an infected zone, which is less than 2 miles from the heart of the city, therefore these people contribute more or less constantly to the prevalence of malaria, their infections occurring outside of the city proper. The deaths reported from malaria during the year 1915 were as follows: January. 4 August. 6 February1. September. .---------------------1 M arch. 7 October. 1 'April .--. .3 November. 1 May--.-.-1 December. 1 June. 1 July. 1 Total. 28 This gives a rate of 46 per 100,000 population. WHOOPING COUGH. During the year only 14 cases of whooping cough were reported to this office. There is no doubt that many other cases occurred in the city among children receiving no treatment, and also unreported. SCARLET FEVER. During 1915 there were no cases of scarlet fever reported to or discovered by this office, the last case reported occurring in November, 1914. EPIDEMIC AT TABOGA. In the month of July, 1915, an outbreak of contagious disease at Taboga was reported. Investigation showed that the report was caused by the presence of eight cases of measles in the village, all of a mild type. VACCINATION. The general vaccination of the population of the city, which was begun in 1914, was completed in August of this year. A total of 23,244 vaccinations were done. Several of the public schools were checked over after the work was concluded and it was found that the number of successful vaccinations aggregated 93.6 per cent of the total number made in children. 'The percentage of successful "takes" in adults is somewhat lower, as is natural.

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24 GENERAL SANITATION. MOSQUITO WORK. The usual preventive work against mosquito breeding carried on consists of scrupulous search for containers in all the houses, patios, alleys, etc., in the city by the district inspectors on their weekly rounds, which are so calculated as to permit of them visiting every building in their respective districts at least once each week. By "containers" are meant tin cans, pieces of bottles, broken crockery, or any article which will catch and hold water the requisite time to allow mosquitoes to breed in same. In addition to search for containers, the routine work consists of drainage of all wet or swampy areas, cutting of grass and brush; oiling of water-soaked surfaces by sprayer, oil-soaked waste, or any other method deemed advisable. A very important measure is the impounding of all cattle caught straying on wet or marshy places, as their hoof prints form ideal receptacles in which mosquito breeding can occur, and when hidden in grass or brush are almost impossible of detection. A large sum was expended during the year both by this division and by the Panama Land & Development Co., the owners of the Bella Vista property, in antimosquito work. Approximately 15,000 feet of ditches were installed by that company. At present it is not uncommon to spend an entire evening at Bella Vista without encountering a single mosquito. During the month of September, 1915, the area of jungle between the city proper and the Curundu River, amounting to approximately 1,742,400 square feet, was cut and as much of it as possible will be burned over during the present dry season. The cutting of this brush revealed a large number of hidden breeding places. These were oiled or drained and a marked diminution of mosquitoes was observed shortly thereafter. The list below shows the number of mosquito-breeding places found by the inspectors during their routine inspections during the year, the number of stegomyia being shown separately: Breeding pae found Month. StegoTotal myia. mosquito. January .91 406 February .78 227 March. 28 191 April.--------------------------------45 267 May.,. 33 M39 June. 121 310 July. 143 393 August. 40 19t September. 64 215 October.------------------------------------106 315 .November ..------------------------------------131 413 December .148 301 Total .,283,471

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25 These deposits of larve were destroyed. It would seem that the labors of 10 years should completely eradicate mosquitoes from the city proper. Such has not been the case. A source of mosquito influx has been found to be the railroad trains and street cars.During the month of December an examination was made of the incoming passenger trains at the Panama station, and it was found that they were at times heavily infested with mosquitoes, especially the train arriving from Colon about 7.00 p. m. As a result of the observations made at this first examination, an examination waa made of an afternoon train just before leaving Colon, and observers on the train watched for the entrance of mosquitoes along the line, No mosquitoes were detected in the cars prior to departure from Colon. The first observed, entered the train at New Frijoles station; a larger number at the meeting point near Darien, where the train had to wait some few minutes for the one coming from the opposite direction; and others were observed entering at Gamboa and New Culebra. The numbers of mosquitoes in trains depends on the number of stops and length of time of such stops. An examination was also made on the street cars running into the city at night from points beyond Bella Vista. While on the cars mosquitoes were seen entering them at points outside of which mosquito work has been carried on, some of the mosq uitoes remaining in the cars until after they had reached the city. Later an examination was made of cars in the car barn near the center of the cit and anopheles mosquitoes were found in the cars there. Chiriqui prison, as is known to those familiar with the city, is situated at the extreme point of the promontory on which the city proper is built. In the prison yard are certain wet grassy patches which, from. time to time, present anopheles breeding. From whence does the female mosquito come that deposits her eggs in this part of the city? There is no active anopheles breeding nearer than the Curundu River on the north and the Bella Vista limits on. the east, each point being nearly 2 miles from the prison yard, but the fact remains that constant watchfulness is necessary to prevent anopheles breeding at that particular point. These are factors which make complete eradication of mosquito breeding in Panama city almost unattainable. Lack of interest and cooperation on the part of ignorant natives is another feature that makes absolute success in this wprk almost an impossibility. An active campaign was instituted against the few roof gutters which had been allowed to remain on buildings. Many of them contained mosquito breeding, and, with a very few exceptions, only in cases where actual damage to property from rain water would ensue were they allowed to remain on the houses. RAT WORK. Steady progress has been made in the rat proofing of houses all through the city, and especially so in the down-town districts along. the water front and in the older part of the city, where there are many rock-mortar buildings, a good proportion of which have been atahding for many years. Attention was given to the detailed work of sealing openings around pipes with cement, also openings ii N6592-1&-4

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26 walls, sidewalks, etc. This was particularly effective at the public market. A table is given of the number of rats trapped by the dsrict inspectors in the course of their daily routine inspections Month. at. Month. ~caught.cagt Tanuary.-------------------1,159 Aug -.-.--. 610 February.-. 797 September .472 Mac---------------95 coe------------March .951 11October .634 A ...'1 719 November. 42 M8y. 587 December.----511 June. .591 July .687 Total. 8,14 All rats caught were examined for plague, but none were found infected. FLY WORK. The trapping of flies and work for the prevention of fly breeding have been followed out very closely, and favorable results have been observed. The removal of the stables, to a large extent, from the central part of the city eliminated great numbers of fly-beding places, and constant supervision is exercised over those remaining, reducing that nuisance to a minimum. The total number of flies trapped during the year amounted to 414 quarts, the estimated number of flies per quart being 13,000, which makes the total catch approximately 5,382 flies. The greater part of this fly trapping was done at the public dump and to some extent also at markets and food stores. The number of fly-breeding places discovered and eliminated by the inspectors during their routine work was as follows: Breeding Breeding Month. Month. Januay .302 August .130 re ay--------------------32Ags------bruary-------------------264 September. 19 March. 307 October.----------. ..125 W .ril. 304 November. so .ay -----------------------277 December. 119 ..200 uly. .188 Total----------. .2,435 STABLES. The opening of the new Panama Railroad stables on the Hu Bandoval tract on B Street, between the Amador and Chinme ,emeteries, on October 11, 1915, was a public improvement, the effect of which was felt almost imme. Within a very few days every stall was taken and a waiting ltwas compiled

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27 Crengt there are 248 stalls, all of them occupied, and it is hoped t t more will be constructed. These stables were one of the most important sanitary measures accomplished during thie past year. Great attention was paid to making them rat proof in every respect, the foundation extending feet down into the ground, and great care exercised in permitting no opening anywhere that would afford hiding or nesting places for rats. The grain used at the stables is kept in bins, which are considered rat proof also; and the protection afforded to the public by segregating these stables and maintaining them rat and fly proof is of inestimable benefit. The following table shows the work accomplished in the line of building construction during the year 1915: Permits Permits Buildings con-. issued. completed. demned. New buildings.--.-.178 176 Condemned buildings.--.41 118 R epairs.---....-706 650 Number of buildings. .........-.--.---.-. .-90 Demolished byHouse occupants. ..16 Owners ...53 FOOD INSPECTION. During the entire year the inspection of hotels, restaurants, clubs, bakeries, bottling works, dairies, milk' venders, etc., has been under the charge of an inspector assigned to that duty especially. During the early part of the year records were not kept of the work to any extent, but in the last few months close attention has been paid to recording this work, and a statement is given below showing what has been accomplished since August 23, 1915. Record has been kept of number of inspections made of bottling works, dairies, hotels, restaurants, clubs, and bakeries since July, 1915. Dairies, Bakeries, Hotals, Months milk candy Bottling clubs, Miscellavenders, kitchens, works. and res neous. etc. etc. taurants. Juy .....I ..----4--Auut-----------------------i -----------6-September.-.-.-.43 42 32 5 136 O6tober.-.-. 126 8 1 4 60 Novem ber.-. -.-.73 21 2 74 December. 105 29 3 96 57 Total .;. 34100 38 176 370 Inspecr .on duty with Colon Health Ofce the entire month (from Aug. 23 to -1 nluv)

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28 A continual effort is being made. to improve the quality of the milk in the city, and it is believed that our efforts in that direction are having some beneficial effect. Periodic examinations are made of the milk sold in the city, and regular inspections of the dairies are made. Four of the dairies have been forced to close up, as they werq hopelessly insanitary in their surroundings and methods, and three others have been forced to remove their plants to better surroundings. STREET CLEANING AND GARBAGE SERVICE. There has been no change in the system of street cleaning and garbage handling, it having been found from experience that the present system is the most efficient one possible with the force at our disposal. On account of the growth of the city, arrangements must be made for an increase in the garbage-service force. At Bella Vista, which is growing rapidly, no garbage service has been instituted, and the need for one is rapidly becoming very urgent, but as yet this office has no facilities for extending this work to include that district. Some considerable mosquIto breeding was noticed at the dump during the past rainy season, which was discovered to be due to the large numbers of cans, etc., piled up and accumulating water. This was promptly stopped, and all cans are now cut or flattened with hammer or hatchet, until they can not hold water before being piled up at the dump. During the year 840 garbage cans were sold to various house owners in the city, most of them being either for new buildings or to replace worn-out cans in service. Detailed statistics are shown in Table XXIV. SANITATION-COLON. The most gratifying fact about the work of the office has been the reduction of the malaria rate to a minimum. The year closed with the rate touching zero several times in close succession and without one anopheles breeding place found on Manzanillo Island for several months. THE COLON FIRE. Our work during the year was heavily affected by the great fire of April 30, which destroyed 22 blocks of the city, aboutone-third of the whole place, including much of the most populous partof -the city, and rendered temporarily homeless about 5,000 people. This added to the previous congestion of the houses, besides necessitating caring for some 2,000 in cars and tents. This office, in conjunction with that of the municipal engineer, had,.to instill immediately a water, sewer, and garbage service for these refugee camps-a work which was completed in a week after the fire. We also had to police these premises and to watch the occupants carefiilly for any cases of infectious disease.

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29 There was a heavy increase in the number of flies for a short time, due to masses of half-burned foodstuff under debris in inaccessible places. This was removed and destroyed as rapidly as possible, and adult flies were killed by larvacide spray throughput the city, soon eliminating them. At present the fly nuisance is reduced to a very low point. The fire greatly increased the work of the building inspector, as rebuilding operations commenced very quickly.' A decree of President Porras enjoined rebuilding with fireproof materials only. Most of the new construction has been concrete. Street cleaning was also largely augmented. The necessity of preventing stegomyia breeding in the numerous containers in the burned area, both after the fire and during the reconstruction, added largely to the work of the mosquito gangs. There were no epidemics or serious outbreaks of disease of any kind. The refugee camps were all eliminated by December 1, the people finding quarters in New Gatun and in new houses erected in Colon. Much praise is due the officers, both of the line and of the Medical Corps, of the United States Army for their cooperation in handling the situation created by the great conflagation. GENERAL SANITATION. A change has been made in the methods of inspection by which the whole city was divided into four sections, and each section put in charge of an inspector whose duties covered all classes of health work, except those of street cleaning, garbage removal, and building construction. The inspectors in charge have each a gang who destroy mosquito and fly larve; remove rubbish and garbage from premises and place it for the wagons; inspect every building and all yards, premises, parks, and open spaces; examine all closets, sinks, and sewer traps; and clean the beaches. Each inspector also inspects especially all docks, piers, shops, markets, bakeries, ice-cream parlors, bottling works, slaughterhouses and other industrial establishments, stables, and vegetable gardens. He serves notices against nuisances and reports cases for penalty, and attends court, if necessary, to secure convictions. He is urnished with a badge for identification. A special detail of a policeman with the inspector was secured, with beneficial results. The inspectors took a census of the city in the month of November. They assist the health officer in following up reports from the hospitals and physicians to locate cases of communicable disease and to establish quarantine connection where indicated. One is specially charged with the work of disinfection and fumigation. They also contribute to popular education in public health, incidentally to their other work, which carries them constantly into the homes of the people and brings them into close and frequent prsonal relationship with them. It is hoped to extend and crease this phase of the work in the coming year.

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30 MOSQUITO, .RAT, AND FLY WORK. In order to decrease the amount of oiling a number of new ditches were dug in the area south of the wireless station in Colon and east of the Panama Railroad stables. The expedient was tried of piling the earth taken out of the ditches in mounds instead' of throwing it alongside of the ditches, thereby allowing the surface water to run off into the ditches between the mounds. Formerly this water was retained by the elevated bank along the ditches and often did not drain into them at all. These measures as well as energetic and careful inspection and oiling completely eliminated all anopheles mosquito breeding on Manzanillo Islands for the past five months. Mosquito catching was carried on in the silver barracks at Camp Bierd, in the tents and, cars along Broadway, and other quarters and buildings, when deemed wise. It was found that Culexfatigans bred freely in the large D Street storm sewer canal when it was recently chocked. This also applies to the catch basins on the streets, which required oiling and cleaning periodically. A number of old gutters were renhoved, some tanks and other containers eliminated, and rigid work against Aedes calopus. Twenty-five shacks on the extreme southeastern edge of the island were condemned and burned because of the persistent keeping of Aedes calopus containers there. Itwas found that the small coastwise trading schooners were bringing Aedes calopus to this port in their water vessels. This matter was taken up with the quarantine office for action and for permanent relief. The antiplague work has progressed to the point when rat infestation is at a low point. There are only three buildings left which do not comply with the regulations about floors and foundation walls, and these are of people whose means are limited and to whom we have given more time. In a short time there will not be any such buildings in Colon. SCHOOLS. The examination of the schools for communicable diseases has been periodically carried out. There has been no epidemic or outbreak of infectious disease, and the health of the pupils has been good. BUILDINGS. An enormous improvement in housing conditions will result from the construction of the new concrete buildings in the burned area. At the same time, improvements in the old buildings have been required. STREET CLEANING. This work has also been much heavier this year, due to the aftereffects of the fire and the large rebuilding operations. There has been a special campaign to remove collections of rubbish in some places, such as on the beaches, around the old piers, on the edges of the hydraulic fills. The result has been a notable improve-

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31 went in the general appearance of many parts of the city and rec duction of culex breeding and rat infestation. GARBAGE REMOVAL. This work has increased considerably. A modification of the standard stand for the garbage cans in use here for several years has been made by using a concrete base and metal cover. This is much more easily kept clean and is more durable. The system of incinerating garbage by open fires has many disadvantages, and the matter of installing a more modern system demands consideration. SIDEWALKS AND VACANT LOTS. A vigorous prosecution of the work of repairing sidewalks was initiated early in the summer. A large number of places were reconcreted. Many vacant lots and patios were filled and regraded; some of them were completely concreted. Upon our recommendation the Panama Railroad is now requiring all owner of vacant lots to put in sidewalks, and is putting them on its own unleased lots. This work has eliminated many obstinate mosquitobreeding places, and also facilitated cleaning these places and reducing fly breeding. FURE FOOD. The shops, hotels, restaurants, bakeries, cafes, fruit stands, bottling works, ice-cream parlors, and all other establishments of the kind are inspected constantly. There have been no cases of disease traced to any of these sources during the year. A better system of supply of fresh milk is badly needed here, ad the dairies hitherto conducted are going entirely out of business. STABLES. Horses may now be kept in only three stables in the city-the quartermaster's department stables in Mount Hope, the Panamac Railroad stables in Colon, and the Colon stables in East Colon. This regulation is of the utmost importance in minimizing fly and rat breeding. The Fanama Railroad stables underwent a thorough renovation this year, the stalls and yards being concreted and the premises made rat proof and easy to keep clean. Colon stables have been greatly improved. One of them was condemned and torn down. Others were improved, concrete sidewalks put in, some of the stalls and alleys reconcreted. A cocrete drainage system is now being put in and the vacant lots filled and graded. A concrete roadway was installed in the sec. tion, from G Street to the dump, where the traffic is exceptionally heavy. Rat-proof grain boxes are required, and all miscellaneous loose equipment must be hung up or placed on grated platforms high enough to be swept out beneath. A large water main was carried out to these stables. All manure is required to be removed to the incinerating dump before 3 p. m. daily, and there it is destroyed at once, unless requir for fertilizing purposes, when it is handled as below described.

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32 HANDLING OF STABLEMANURE. The demand for. stable manure by the supply department and by several Chinese and other gardeners led to special efforts to facilitate this without allowing fly breeding. This problem has been solved by requiring the manure to be placed in fly-tight concrete tanks, built in two sections, one of which, when filled, must be kept for two weeks until the larvw have bred out and died. All manure in excess of that required for these purposes is burned. There is practically no fly nuisance from this source now. f reah manure is not permitted in the gardens and horses are not allowed to be kept where they wil1 contribute to fly breeding. Detailed statistics are shown in Table XXIV. QUARANTINE DIVISION. During the year 2,191 vessels were inspected at quarantine, as against 1,637 for the calendar year 1914-an increase of 554. The maximum number of ships received in any one month was 246, in July. The lowest number 98, in December, the marked decrease being accounted for by the closure of the canal. During the year special attention has been paid to the tat proofing of chicken coops and vegetable and other food containers on board of vessels which are not equipped with cold storage and which carry food animals on the hoof and fowls and vegetables on deck for use as food. These vessels practically all trade with plagues infected ports along the South American coast, and the value of these measures is apparent. .Mechanical cleanliness upon all vessels arriving at the Canal Zone ports has also been given special attention and the proper disposal of garbage has been insisted upon. The vessels above referred to, carrying cattle and other food animals on the hoof, have had in the past large accumulation of refuse around the lower decks and around the cattle and sheep pens particularly. Cleanliness of these vessels has been made obligatory, and one flagrant violation in this respect was taken to court and the master fined. In order to maintain our local regulations regarding mechanical cleanliness, the disposal of garbage, breasting off, the application of proper rat guards, etc., a daily water-front inspection has been inaugurated and maintained at both terminals of the canal and in Colon. At Cristobal and Colon also, where a number of small sail vessels engaged in coastwise traffic arrive, inspections are being made to determine whether water containers on board are breeding mos quitoes and to eliminate such breeding places by appropriate Measures of screening, etc. At the Colon quarantine station recommendations have been inade to extend the reservation, with the idea of having a larger area in connection with the scheme for a permanent station. At the Balboa quarantine station, the permanent site for the Pacific terminal of the canal, concrete sidewalks have been put li, trees and hedges planted, and a type 17, modified, cottage erecteG for ase of the additional medical officer for this station. This cot

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33 tage was occupied early in December. The Balboa quarantine landing was also completed in November and it has since been in use. Quarantine passengers who were formerly debarked at *Balboa and transferred from there to the quarantine station are now landed directly at the station from the quarantine pier. During the latter part of July an inspection trip was made by tlie chief quarantine officer to the Colombian ports of Cartagena, .Savanilla, Barranquilla, and Santa Marta. The special object of this inspection was for the purpose of investigating the high and unusual mortality reported from these places, but in addition much ,general information bearing on the subject of quarantine was obtained and made the subject of a special report. During September and October a quarantine inspection by the chief quarantine officer was made along the west coast of South America, embracing the coast ports of Ecuador, Peru, and Chile, in all 37 ports being visited. On December 27 the quarantine officer of Cristobal-Colon departed on an inspection trip to the San Blas coast of the Republic of Panama for the purpose of noting sanitary conditions along this coast, with special reference to traffic between here, particularly Port Obaldia and the Colombian coast. One case of smallpox occurred on the steamship Panama, which arrived at Cristobal February 3, 1915. One case of smallpox, practically recovered, arrived in April at Balboa on the steamship Newport. This case very likely originated in some Mexican port. Four cases of yellow fever have been received at Balboa quarantine on the. following dates: One case arrived September 26, one case arrived October 25, two cases arrived December 10. All of the above cases came from Buenaventura, Colombia, and all arrived by the steamship Jamaica. A valuable commentary upon the necessity of maintaining a protective quarantine against our neighboring Central American ports is shown in the arrival of the first yellow fever case from Buenaventura, no previous knowledge of the existence of yellow fever in this port being had by us until the arrival of this case, and no bill of health or other notation from the authorities that yellow fever was present at the port of departure of this ship. On December 10, when the two last cases were received, the bill of health from Buenaventura noted no yellow fever cases present at that time. No diseases of a quarantinable nature have originated on the Isthmus during the calendar year. Statistical reports are here.with appended. (See Table XXV.) 26592-16--5

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34 TABLE .-ADMISSIONS, DEATHS, AND NONEFFECTIVE RATEq FAl EMPLOYEES: DEATHS OF RESIDENTS OF PANAMA, COLON, ANO THE CANAL ZONE. ABSOLUTE NUMBERS. Admissions to Noneffective hospitals. from sickness Color. -cY r 9 0 Year 1915: White. 4,719 1,868 1,572 296 26 15 11 34,123 93.49 Colored. 30,066 4,608 3,431 1,177 175 126 49 96,400264.11 Total. 34,785 6,476 5,003 1,473 201 141 60 130,523357.60 Year 1914: White. 7,024 3,678 3,028 650 47 22 25 59, 480 162.96 Colored. 37,305 7,160 5,065 2,095 265 173 92138,350 379.04 Total. 44,32910,838 8,093 2,745 312 195 117 197,830542.00 PROPORTIONATE NUMBERS.1 Year 1915: White.--------4,719395.85333.12 62.73 5.51 3.18 2.33. 19.81 Colored.30,066153.26114.11 39.15 5.82 4.19 1.63. 8.18 Total.34,785186.17143.82 42.35 5.77 4.05 1.72. 10.28 Year 1914: White. 7,024 523.63 431.09 92.54 6.69 3.13 3.56 .23.20 Colored. 37,305191.93135.78 56.15 7.10 4.63 2.47 .10. y Total. 44,329244.49182.57 61.92 7.04 4.40 2.64. 12.3 'Annual average per 1,000.

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ADMISSION 'NONEFFECTIVE AND DEATH RATES PER 1oo0 From all causes, by years, among employees oF the I.C.C. and P R.R.Co. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 Noft, Privr to 10 6 adms n 0'F !_ ______ _____P/Iyes 30.68 (Lt z nth_ IS -77 _24 46 L) PE. 2 13,-26(ofcepge3.

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IF

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435 DEATvis OF RESENTS OF THE CITIES OF PANAMA, COLON, AND THE CANAL ZONE. Deaths. Annual average per 1,000. Place. opultaceo laDionExter-ExterTotal. Diesnal Total. asnal ease. causes. eas causes. Year 1915: Panama. 60,373 1,810 1,749 61 29.98 28.97 1.01 Colon. 29,331 640 604 36 21.82 20.59 1.23 CanalZone. 31,946 410 361 49 12.83 11.30 1.53 Total. 121,650 2,860 2,714 146 23.51 22.31. 1.20 Year 1914: Panama. 53,948 1,863 1,772 91 34.53 32.85 1.68 Colon. 23,265 .590 563 27 25.36 24.20 1.16 CanalZone------46,379 710 614 96 15.31 13.24 2.07 Total. 123,592 3,163 2,949 214 25.59 23.86 1.73 TABLE II.-DEATHS BY AGE, COLOR, AND SEX. White. Colored. Yellow. Total. Age. 40 -. 48 A C 0 C 0 0 0 0q 0r r. E-4~0 0 0 nderlyear. 59 47 106 489 401 890 4 2 6 552 4501,002 to 4 years. 19 17 36 191 161 352 1 1 211 178 389 5to10years. 2 4 6 25 23 48. 1 1 27 28 55 11 to 20 years.10 2 12 46 49 95 ...56 51 107 21 to 30 years. 25 15 40 259 149 408 4-. 4 288 164 452 w31 to 40 years-. 33 11 44 182 110 292 6 .6 221 121 342 41 to.50 years. 23 8 31 124 74 198 5 .5 152 82 234 51 to 60 years 22 4 26 65 35 100 4 4 91 39 130 61 to 70 y .7 5 12 34 22 56 ...41 27 68 71t80year .7 3 10 7 20 27 1. 1 15 23 38 1 t 90 y4ars. 5 3 8 4 8 12 ...9 11 20 to 100 years. .1 1 .2 2 ....3 3 nknow .3 .3 13 4 17 ...16 4 20 Total. 215 120 335 1,4391,058 2,497 25 3 281,6791,1812,860

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36 TABLE III.-DEATHS BY NATIONALITY. Nations. EmployNonemTotal. ees. ployees. Antigua. ...-------------------------------------4 29 33 Australia. ....--------------------------------------------1 Austria. ....---------------------------------------------1 Bahama Islands.--------------------------------1 4 Barbados. ....---------------------------------48 364 412 Canada -------------------------------------1 2 Chile ---------------------------------------------. .II China. .......--------------------------------------------27 27 Colombia ------------------------------------5 78 83 Costa Rica --------------------------------------------5 5 Cuba. ...-----------------------------------------------4 4 Curacao -------------------------------------1 3 4 Demerara. ..------------------------------------1 9 1 Denmark-------------------------------------1 1 2 Dominica .------------------------------------1 5 6 Ecuador. ...-------------------------------------------8 8 England. ....--------------------------------------------. .5 Fortune Islands. .-------------------------------2 2 4 France. .-. ...-. -. ..10 10 Germany. .2 2 Greece.5 5 Grenada --------------------------------------5 31 36 Guadeloupe. 6 13 1 Guiana, Briish-.---. 1 3 4 1 aiti H onduras. 1 1 India. 3 1 4 Italy .9 Jamaica. .....------------------------------------72 539 611 Japan .3 3 Martinique. ------------7 49 56 Mexico. ..---------------------------------------------5 Montserrat. 1 6 Nevis. ...---------------------------------------1 3 Nicaragua. ....-----------------------------------. --Panama. ...-------------------------------------9 1,203 1,21 Peru. 7 Porto Rico. Portugal. 1 Persia.-------------------------------------Russia. ....----------------------------------------------1 Salvador .1 Scotland. .1 St. Domingo1. St. Kitts .1 5 St. Lucia-------------------------------------3 40 411T St. Thomas .1 6 St. Vincent. 3 15 18 Spain. 1 Sweden. 1 Trinidad. ...------------------------------------3 24 27 United States. .--------------------------------18 55 73 Venezuela. .8 8 West Indies. 1 3 4 Unknown. .20 2D Total. 201 2,659 2,860 II

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~37 TABLE IV.-CAUSES OF DEATHS OF EMPLOYEES OF THE PANAMA CANAL AND PANAMA RAILROAD. Causes of death. White. Colored. Total. Disease. Alcoholism, acute and chronic..-----------. 2 .-22 A ne rm .-------.----------.------. ---. 2 2 Apoplexy-----------------------------------1 3 4 A sth m a -......-.1 1 rain. softening of. ..-----------------------------------2 2 Calculi of the urinary passages.---------------------------1 1 Cancer of intestines.---------------.1 .1 Cancer and other malignant tumors of stomach and liver. .....-----------------------------------------1 1 Cancer of organs not specified --------------------------1 1 Carbuncle.-----------.--------------------.-. .1 1 Cerbspinal fever .-------------------------------------.-r Cerbral selerosis. .----------------------------.--1 Dysenterv,uncla-ssified-------------------------1 1 2 ncephaitis. ....---------------------------------------1 1 Endocarditis, acute and chronic-------------------. 2 2 Fever, malarial, estivoautumnal. 2 6 8 Fever, typhoid----------------------------------------2 2 Gastritis, acute...------------------------------.1 Heart organic disease of .------------------------1 9 10 Hemoglobinuric fever, unqualified------------.---. .1 .-I Intestinal obstruction--------------------------1 1 2 Infective exhaustive psychosis ----------------------------1 1 Kidneys, disease of. ----------------2 2 Liver, abscess of-----..-------------------------------1 1 Liver,cirrhosisof.------------------------1 1 L ngs, abscess of-.-. ..1 Lungs, gangrene of. .---------------------.-.-.-.2 2 tis, tuberculous.-.--------------------------------3 3 M e i t s p nge--ou----------------------------------1 1 NpiTtis, hut.--------------------.------.---------1 1 Y ep riis chronic. -.-----;. .10 10 P er i is, sim ple .-.-.-.-. .1 1 Pneumonia. .....-----------.------------------2 2 Pneumonia,-bar. -------------------------------1 22 23 Pyelonephrosis.-----. --. ..1 1 Sen li y .1 .I .S.p.e.i. -.-.--.-.-------.-. .---.-. 2 2 ticemia, purulent infection and ..2 2 T etanus --. -. -. --. -. -. -. .-.3 3 Tuberculosis, abdominal -------------------------.2 2 Tuberculosis, disseminated -----------------------------11 11 -uberculosis of the bones and joints. .--------------------1 Tuberculosis, miliary. ----------------------------3 1 Tuberculosis, pulmonary-. ---------10 13 Ulcer, duodenal. .----------------------------.---------1 0 retha, dieases .of .-----------------------------------1 1 ndiagnosed--------------------------------.---2 2 Violence. Accidental traumatism, various------------------4 12 16 Drowning, accidental. 5 18 23 electric shoo ..2 2 Homicides-. 2 2 Railroad accidents. 1 12 13 Suicides .1 2 3 0ther external violence. .1 1 Total. 26 175 201

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38 TABLE V.-DEATH RATES AMONG AMERICANS ON THE ISTHMUS. Number Annual Cases. Cause of death. of average deaths. perl,000. Average number of white emDisease. 11 2.63 ployees from the United 4,187 External causes. 7 1.67 States. I lAll causes.18 4.30 Average number of white woDisease. .17 4.78 men and children from the 3,556 External causes .. United States. I TAll causes .-. 17 4.78 Average number of white emIDisease. 28 .3.61 ployees and their families 7,743 External causes. -7 -.91 from the United States. All causes--------35 4.52 Total number of Americans Disease ------------34 2.45 on the Canal Zone. 13,861 External causes. 14 1.0 Alcauses.---4 34 1 The figures representing the total number of Americans on the Canal Zone include employees and their families and the officers and men of the United States Army and their families stationed on the Isthmus. TABLE 1I.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEES AND NONEMPLOYEES) AND MILITARY AND PLACES WHERE CHARGEABLE. Diseases. I PanaCol Canal ma. Zone. General diseases. 1. Typhoid fever. 5 2 .7 Malarial fever: 4a. Estivoautumnal. 22 7 24 53 4d. M ixed. ..1 1 4e. Undermined. 1 ..-.-.1 4f. Clinical.3 1 4 4h. Hemoglobinuric fever, malarial. 2 1 .3 6. Measles. 8 2 ..10 8. Whooping cough. 2 4 9. Diphtheria and croup. 4 3 --. 7. 9a. Croup. 1 .1 9b. Diphtheria bacillus carrier. .1 .I 10. Influenza. 1 .I 14. Dysentery.-.-11 2. .13 14c. Dysentery, unclassified. 4 2 2 8 18. Erysipelas. 1 .-.-. I 19b. Chicken pox. .1 19e. Hemoglobinuric fever, unqualified. ..1 1 191. Yaws. 1 .-. .--. I 20. Purulent infection and septicemia 2 3 1 6 20a. Pyen a. 2 -2 1 5 20b. Septicemia. 10 2 .12 20c. Pyemia and septicemia, pneumococcic. 2 ..2 24. Tetanus. 7 3 1 26. Pellagra. 33 10 3 46 27. Beriberi. 1 1 1. 2 28. Tuberculosis of the lungs. -.210 601 14 284 29. Acute miliary tuberculosis .4 3 4 11 30. Tuberculous menintis. 10 4 1 1 31. Abdominal tuberculosis. 2 1 4

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39 TABLE VL--CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEB AND NONEMPLOYEES) AND MILITARY AND PLACES WHERE CHARGEABLE-Continued. PanaCanal Total. Diseases. Colon.Zone. General diseases-Continued. Tuberculosis: 33a. Of bones and joints. 1 ..1 2 4. Of other organs. 2 ..2 34d. Of the genito-urinary organs. 1 --------------35. Disseminated tuberculosis. 15 6 10 31 36. Rickets. ...------------------------1 4 .5 Syphilis: 37A .Prim ary .--.--.-.-.-. 2 ..2 57C. Tertiary .4 4 2 10 37D. Hereditary.----------------------9 2 .11 37E. Period not stated.-----------------4 ..4 38A. Gonococcus infection .-----------------------1 1 38Aa. Gonorrhea. ...----------------------------1. .-1 .1 38Ab. Gonorrheal arthritis. .1 Cancer and other malignant tumors: 39. Of the buccal cavity. 3 ---------------3 40. Of the stomach and liver. 3 1 2 6 41. Of the peritoneum, intestines, rectum.--------------------------2 .1 3 42. Of the female genital organs--------11 2 2 15 43. Of the breast .---------------------2 1. 3 45. Other organs and of organs not speci46. Other tumors (tumors of the female genital organs excepted) ..-1 .1 47. Acute articular rheumatism. 1 ..I 50A. Diabetes. .----------------------1--.-.1 .1 2 3 53 Leuchemia l. ---.-----------------.1 53a. Leuchemia lymphatic. 1. .-----1 53b. Hodgkin's disease .--------------------1------------. Anemia: 54. Chlorosis. .....1 .1 54b. Primary, pernicious---------------1 1 .2 54e. Secondary, cause not determined .5 1 .6 Alcoholism: 56. Acute or chronic. 4 1 1 6 56a. Acute. 8 2 2 12 56b. ChroniC-------. 5 3 1 9 56. Alcoholic psychosis .3 1 1 5 59a. Drug habit. .1 Diecapes of the nervous system and of the organs of special sense. 60. -Encepha1itis. 1 .2 3 61. Simple meningtis. 10 2 2 14 S61a. Cerebrospinal fever. 2 ..2 61b. Pneumococcus meningitis. 5 .1 6 62. Locomotor ataxia. 1 ..1 63. Other diseases of the spinal cord. 2 ..2 46a. Acute antrior poliomyelitis. 1 ..I 64. Cerebralhemorrhage, apoplexy. 22 10 5 .37 65. Softening of the brain. 3 2 1 66. Paralysis without specified cause---------3 2 1 67. General paralysis of the insane ..3 .1A 68. Other forms of mental alienation. 3 ..3 69. Epilepsy. 4 3 1 9 ;;4

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40 ABLE VI.-CAUSES OF DEATHS OF CIVIL;POPULATION (EIKPLOYFES AND NONEMPLOYEES) AND MILITARY AND PLACtS WHERE CHARGEABLE-Continued. Diseases. PanaColon. Canal Total. ma. Zone. Diseases of the nervous system and of the organs of special sense-Continued. 70. Convulsions (nonpuerperal, 5 years and over). ...----------------------------2 .1 3 71. Convulsions of infants (under 5 years of age). 11 6 6 23 74. Other diseases of the nervous system. 1 1 ---. 2 74a. Tumor of the brain. 4 4--------4---------4 76. Diseases of the ears ..1 6 Diseases of the circulatory system. 77. Pericarditis.-------------------. .3 2 .5 78. Acute endocarditis. 13 6 3 22 78a. Malignant endocarditis. 2 1 1 4 79. Organic diseases of the heart. 77 32 16 125 80. Angina pectoris. 6 .6 81a. Aneurysm. 3 3 4 10 81b. Arteriosclerosis. 20 1 3 24 82. Embolismand thrombosis. 1 ..-1 84. Diseases of the lymphatic system (lymphangiis, etc.).1 1 2 4a. Lymphadenitis (nonvenereal). 1. .1 85. Hemorrhage; other diseases of the circulatory system. 2 1 1 4 Diseases of the respiratory system. 86b. Myiasis of nasal fosse and sinuses. 1 .1 2 89. Acute bronchitis. 67 69 4 140 90. Chronic bronchitis. 9 5 .14 91. Bronchopneumonia. 129 24 28 '181 92A. Pneumonia (uncualified). 47 4 1 52 92B. Lobar pneumonia. 45 16 21 82 93A. Pleurisy. 3 2 .5 '93B. Empyema. 1 ..1 94. Pulmonary congestion, pulmonary apoplexy. 2 ..2 95. Gangrene of the lungs. 2 .1 3 6 96. Asthma. 5 .1 6 97. Pulmonary emphysema. .*2 2 98. Other diseases of the respiratory system (tuberculosis excepted). 1 2 98a. Abscess of lungs. .--1 .-1 Diseases of the digestive system. 99b. Stomaitis. .1. 1 100. Diseases of the pharynx. 1 ..1 101b. Stricture of the esophagus ... 103. Other diseases of the stomach (cancer excepted). -2. .2 103b. Acute gastritis. --. 15 103c. Chronic gastritis. .8 .8 103d. Acute indigestion. .4 1 2 7 104. Diarrhea and enteritis (under 2 years) 310 37 20 367 104a. Colitis. 41 7 3 51, 105. Diarrhea and enteritis (2 years and over). 1 9 4 1 14 105a. Colitis.-7 3-. .10 106. Ankvlostomiasis. 4 ..4

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41 TABE L.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYE AND NONEMPLOY-EES) AND MILITARY AND PLACES WHERE HARGEABLE-Continued. Diseases. PanaColon. Canal Total, ma. Zone. Diseaes of the digestive system-Continued. 108. Appendicitis and typhlitis. 2 ..2 108a. Acute appendicitis .1 1 2 109. Hernia, intestinal obstructions. 4 1 2 7 109a. Inguinal hernia .--..1 109b. Other hernias. ---. I 109c. Intestinal obstruction. 5 1 3 9 110. Other diseases of the intestines. 2 1 1 4 110a. Constipation. I 110b. Duodenal ulcer. I --.2 7 .1 113. Cirrhosis of the liver .7 5 12 114. Biliary calculi. ------1 1 2 115. Other diseases of the liver. .1 .1 115a. Abscess of the liver (unqualified). 10 5 1. 115b. Abscess of the liver (entamebic). ..1 116. Diseases of the spleen. .! 1 .. 117. Simple peritonitis (nonpuerperal)------10 6 1 17 118. Other diseases of the digestive system (cancer and tuberculosis excepted). ------.1 Nonvenereal diseases of the genito-urinary system and annexa. 119. Acute nephritis. 28 9 5 42 120. Bright's disease (chronic nephritis). 65 57 15 137 122. Other diseases of the kidney and annex 8 2 4 14 122c. Pyelonephrosis.--.--.-. 3 1 1 5 123. Calculi of the urinary passages. I I .2 124a. Cystitis. .:. 1 1 .2 125. Diseases of the urethra, urinary abscess, .etc. 1 .2 125a. Stricture of the urethra, (nonvenereal). 1 .1 128. Uterine hemorrhage (nonpuerperal). 1. 129. Uterine tumor (noncancerous). 1 ..1 130. Other diseases of the uterus.------------2 .1 3 132. Salpingitis and other diseases of the female genital organs. 2 1 .3 The puerperal state. 134B. Accidents of pregnancy. 1 1 1 3. 134Bb. Hyperemesis gravidarum. 2 ..2 134Bc. Abortion.1 1 2 135. Puerperal hemorrhage. .2 2 4 116. Other accidents of labor. 1 137. Puerperal septicemia. 5 1 2 8 138. Puerperal albuminuria and convulsions. .1 1 2 138a. Eclampsia. 2 3 3 8 140. Followmg childbirth (not otherwise defi ed). .1 1 Diseases of the skin and of the cellular tissue. 142. Gangrene .4 1 .5 143. Furuncle ..1 .. 143a. Carbuncle. 7. ..1 1 S 144. Acute abscess. !. I ..I .:444a. Phlegmon and callulitis. I 14519. Pemphipus contagiosus.2 ..2 U 150. Tropical ulcer_. 1 .;. .I 145T. Other diseases of.twskin and fr a. 1

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42 TABLE VI.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEES AND NONEMPLOYEES) AND MILITARY AND PLACES WHERE 'CHAR GEABLE-Continued. Diseases. PanaColon. Canal Total ma. Zone. Diseases of the bones and of the organs of locomotion. 146b. Mastoid abscess .1 ..1 146c. Osteomyelitis ...1 147. Diseases of the joints (tuberculosis and rheumatism excepted). .I .I Malformations. 150. Congenital malformations (stillbirth not included. 6 .2 8 Diseases of early infancy. 151A. Newborn child. 1 .6 7 151B. Congenital debility, icterus, and selerema 7 3 3 13 151Ba. Premature birth.---------------------33 12 13 58 151Bb. Congenital debility. 28 10 14 52 151Bd. Malnutrition. 66 38 35 139 152. Other causes peculiar to early infancy (including various consequences of labor). 12 5 .17 153. Lack of care. .,. 1 .1 Old age. 154. Senility. ..----------------------------7 4 1 12, A ffections produced by external causes. 155. Suicide: By poisoning. 4 3 .7 157. Suicide: By hanging or strangulation. .1 1 2 159. Suicide: By firearms. 5 3 1 9 163. Other suicides1. ..1 164. Poisoning by food .--------------------1 2 165. Other acute poisoning3. 3 ..3 166. Conflagration. .4 .4 167. Burns (conflagration excepted). 3 .3 6 168. Absorption of deleterious gases (conflagration excepted).,. 1 ..1 169. Accidental drowning. 5 8 23 36 Traumatism: 170. By firearms. 1 1 1 3 172. By fal-. 6 3 4 13 174. By machines. 4 1 2 7 175. By other cruslings (vehicles, railroads, landslides, etc.). 2 3 4 9 175a. Railroad traumatism.-. 4 4 4 12 177. Starvation.:. 1 .-. 1 181. Electricity (lightning excepted). .2 1 3 Homicide: 182. By firearms. 4 1 1 6 183. By cutting or piercing instruments. .1 1 2 184. By other means. 1 -------.1 185A. Fractures (causes not specified). 2 1 .3 186. Other external violence. 14 .1 15 Ill-defined diseases. 187. Illdefined organic disease. 1 .-.-3 4 188. Sudden death. 1 2 .3 189A. Cause ofdeathnot specified or ill-defined. 45 13 7 65 189Aa. Infections of undetermined origin. 3 1 3 7 -Total. 1,810 640 410 2,860 Stllbirths.,. 178 63 58 299 Grand total. 1,988 703 468 3,159.

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43 TA.E VI-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLID RS IN THE HOSPITALS OF THE PANAMA CANAL, FROM ALL CAUSES., Employees. Soldiers. Diseases. Admissions. Deaths. AdmisDeaths. sions. White. Black. White. Black. General diseases. 1. T hoid fever. .4 ---. M 1lral iever: 4a. Estivoautumnal. 211 627 2 6 162 4 Tertian. 75 146 .70 Quartan. .1 9 ... 4e. Undetermined. .... 4f. Clinical. 136 359 76. 4g. Cachexia. 1 1 ... 4h. Hemoglobinuric fever, m alarial. 3 ..-..-1 6. M easle .----.1 60 .-.-. .7. 7. Scarlet fever..1 .... 9. Diphtheria and croup. 7 10 ... 10. Intluenza. 35 62 ..33. 13. Cholera nostras. .2 14. Dysentery.4 3 1. .. 14a. Entamebic. 1 4 .3. 14b. Bacillary. .2 .1 14c. Unclassified. .12 .1 .. 17. Leprosy. .. 18. Erysipelas. 6 1 ..1 19A. Dengue.---.--. 3 ...I 19B. Chicken pox ..1 5 ...41 19C. German measles. ..1 19D. Mumps. 16 215 ..35 19E. Hemoglobinuric fever, unqualified .1 2 1 ... 19L.Y aws..-.1 ..... 19L. Kala-azar .1 ..... 19K. Filariasis ..2 .... 19L. Malta fever. ..... 19M. Acute infectious jaundie (Weil's disease). 2 2 .4 20. Purulent infection and septieemia. 2 1 .4 .. 20b. Septiemia 1. .... 2Dc. Pyemia and septicemia, pneumococcie ...... 24. Tetanus. .3 .3 26. P a .....2 S27. Berb r '. .2 .... 28. Tuberculosis of the -lugs .19 85 .9 3 1 29. Auemiliary tuberI ulosis ..6 .3 .. 30. Tuberculous meningitis .3 .3 ... 31. Abdominal tuberculo33a. Tuberculosis of bones. and joints ..3 .1 34c. Tuberculosis of the lymph glands ..1 ..-2

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44 TABLE VIl.-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLDIERS IN THE HOSPITALS OF THE PANAMA CANAL, FROM ALL CAUSE$S-Continued. Employees. Soldiers. Diseases. Admissions. Deaths. Adi-Deaths. sions. White. Black. White. Black. General diseases-Continued. 34e. Tubere lous abscess. .-.. 35. Disseminated tuberculosis. ..3 .12Syphilis: 37A. Primary. 5 10 ..10 37B. Secondary. 16 47 .. 37C. Tertiary. 6 136 ..14 37D. Hereditary. .2 .. 37E. Period not stated. 5 21. 38A. Gonococcus infection. 5 .11 ..4 38Aa. Gonorrhea. 33 9( .-. .125 38Ab. Gonorrheal arthritis. 1 11 .. 38Ac. Gonorrheal bubo. 1 6 .. 38Ad. Gonorrheal orciitis and epididym itis. 10 go .---. .. 38Ae. Gonorrheal ophthalmia .8 .. 38B. Solt chancre. 13 0 ..6i 3SBa. Adenitis chancroidal. 6 37 ..47 Cancer and other malignant tumors: 39. Of the buccal cavity .....---.......-. ..40. 01 the stomach and liver. -.. 41. Of the peritonaeunm, intestines, rectum. ... 44. Of the skin .2 ..2 45. Of other organs and of organs not specified. .5 .1 46. Other tumors (tumors of the female genital organs excepted). 1 6 ..9 47. Acute articular rheumatism ..4 13 ..5 48. Chronic rheumatism and gout. 6 22 ..6 60A. Diabetes. 1 3 ---. 53b. Hodgkin's disease. .3 .. 54c. Anemia, secondary, causenotdetermined. 1 3 .,. 2 55. Other general diseases. 8 9 ...4 55a. Serum disease 1 ...... 55b. Purpurahemorrhagica. 1 1 ... Alcoholism: 56. Acute or chronic. 2 ... 56a. Acute. 12 .1. 56b. Chronic. 2 .1 3 56c. Alcoholic psychosis .1 1 ..4 -59a. Drug habit. ....1

PAGE 49

45 TABLE VIL-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLDIERS IN THE HOSPITALS OF THE PANAMA CANAL, FROM ALL CAUSES--Continued. Employees. Soldiers. Diseases. Admissions. Deaths. Admis, Deaths. sons. White. Black. White. Black. Diseases of the nervous system and of the organs of special sense. 60. Encephalitis. .. 61. Simple meningitis .2 2 1 61b. Pneumococcus meningis. .. 63. Other diseases of the spinal chord------1 ... 63a. Acute anterior poliomyelitis. .1. .. 64. eral hemorrhage, apoplexy. 1 3 1 2. 65. Softening of the brain. ..3 .2. 66. Paralysis without speccause.--. .. 67. General paralysis of the insane. -. .2 68. Other forms of mental alienation .3 6 .1 12 68a. Dementia precox. 1 4 ..10 69. Epilepsy. 3 8 ..2 70. Convulsions (nonpuerperal, 5 years and over) 1 ..-....... 73A. Hysteria. 1 1 .4. 73B. Neuralgia. 4 2 .. 73C. Neuritis .15 15 ..7. 74. Other diseases of the nervous system. 3 4 .1 10 74a. Tumor of the brain. .-. 1. 74b. Neurasthenia. 14 2. 18 75. Diseases of the eyes and their annexa. 50 133 .55 75a. Follicular conjunctivitis. 2 .2 75b. Trachoma. 76. Disease of the ears. 26 22 .64 Dinuses of the circulatory system. 77. Pericarditis.1. 78. Acute endocarditis. 1 .1 4 1 78a. Malignant endocarditis .2 .2 79. Organic diseases of the heart. 16 30 1 4 3. 81. Diseases of the arteries, atheroma, aneurysm, etc. .2 .... 81a. Aneurysm 81b. Arteriosclerosis. .2 ... 82. Embolism and thromb0is 83. Diseases of the veins (varieshemorrhoids, phlebitis, etc.). 8 4 .10

PAGE 50

46 TABLE VI.-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLDIERS IN THE HOSPITALS OF THE PANAMA CANAL, FROM ALL CAUSES-Continued. Employees. Soldiers. Diseases. Admissions. Deaths. AdmisDeaths. sons. White. Black. White. Black. Diseases of the circulatory system-Continued. 83a. Hemorrhoids. 13 26 ..26 83b. Varices. .2 .. 83c. Varicocele. 3 2 .13 83d. Phlebitis. .2 .. 84. Diseases of the lymphatic system (lymphangitis,etc.). 5 7 ..3 .--84a. Lymphadenitis (nonvenereal). 17 42 ..44. 85. Hemorrhage; o t h e r diseases of the circulatory system ----------1. ..1 Diseases of the respiratory system. 86. Diseases of the nasal fosso. 30 3 ..31. 87. Diseases of the larynx ..2 ..87a. Laryngitis------------2. 4 88. Diseases of the thyroid body. ..2-. 89. Acute bronchitis. .39 53 .23. 90. Chronic bronchitis.-. 11 16 .3 91. Bronchopneumonia ..8 .. 92A. Pneumonia (unqualified). .12 .-. 92B. Lobar pneumonia. .2 73 1 22 3-----93A. Pleurisy. 12 60 .5 93B. Empyema------------2 2 ..94. Pulmonary congestion, pulmonaryapoplexy .1 95. Gangrene of the lungs. .1 2. 96. Asthma. 7 ...1. 97. Pulmonary emphysema-----------------. .. 98. Other diseases of the respiratory system (tuberculosis ex cepted). 4 .1 98a. Abscess of lungs------1 1 ...---98b. Hay fever. 1 ------------------Diseases of the digestive system. 99. Diseases of the mouth .and annexa. 1 1 --------------4 .99a. Diseases of the teeth and gums. 9 7 .3 99b. Stomatitis 1.--100. Diseases of the pharynx 11 12 --------------26 100a. Pharyngitis. 2 4 ---------------1 ta

PAGE 51

47 TABLE VIL-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLDIERS IN THE HOSPITALS OF THE PANAMA CANAL, FROM ALL CAUSES-Continued. Employees. Soldiers. Diseases. Admissions. Deaths. .AdmsDeaths. sions. White. Black. White. Black. Diseases of the digestive systemContinued. 100b. Follicular tonsilitis .45 30 --------------79 101. Diseases of the esopha....1 ..... la. Foign body in the esophagus .1 1 ..---..-. -. 102. Ulcer of the stomach. 7 3 --------------2 103. Other diseases of the stomach (cancer exepe tritis -------7 3 ... 103. Autegastritis---7 3 2-----------------------103c. Chronic gastritis .3 2 ..1 103d. Acute indigestion 4 11 ..3 .-. 104a. Colitis.-------. .2 ..2 105. Diarrhea and enteritis (2 years and over). .13 29 .-. 18. 105a. Colitis----------------2 5 ..4 106. Ankylostomiasis. .it .... 107. Intestine l parasites .2 9 .... 107. Aseariasis ------------------.. 108. Appndicitis and typhli i --. ..1 .... 108a. Acute appendicitis. .32 7 ..38 1 108b. Chronic appendicitis. 20 7 --------------17 109, Hernia, intestinal obstructions--------------------------------------1. 109a. Inguinal hernia. 42 80 ----------------30. 109b. Other hernias. 2 1 ..4 109c. Intestinal obstruction ...1. 2 110. Other diseases of the intestines. 71 18 ----------------46. 110a. Constipation. 15 12 ..9 110b. Duodenal ulcer .2 3 .1 2 110c. Sprue .1 ..... 113. Cirrhosis of the liver.-. 3 2 1 .1 114. Billary calculi .2 1 ..1 115. Other diseases of the liver .10 2 ..5 115a. Abscess of liver (unqualified). 1 2 .. 115b. Abscess of the liver (entamoebic). .1 .I .. 91. 1 115c. Cholecystitis .10 2 .... 117. Simple peritonitis (nonpuerperal) .2 ..... 118. Other diseases of the digestive s y s t e n (cancer and tuberculosis excepted). .3 ...

PAGE 52

48 TABLE VII.-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLDIERS IN THE HOSPITALS OF THE PANAMA CANAL, FROM ALL CAUSES-Continued. Employees. Soldiers. Diseases. Admissions. Deaths. I iiiIDeathb. White. Black. White. Black. Nonvenereal diseases of the genito-urinary system and anneza. 119. Acute nephritis. 5 5 .1 1 120. Bright's disease (chronic nephritis). 3 40 .10 '2 122. Other diseases of the kidney and annexa. 3 5 .2 1 122c. Pyelonephrosis. 2 8 .1 2. 123. Calculi of the urinary passages. 10 3 .1 5 124. Diseasesof the bladder 1 5 ...~ 124a. Cystitis. 10 4 ..3 125. Diseases of the urethra, urinary abscess, etc. 6 14 .1 5 125a. Structure of the urethra, nonvenereal. 1 18 ..4 126. Diseases of the prostate 1 ... 126a. Acute prostatitis. .1. 1 126b. Chromeprostatitis. 5 ....1. 126c. Abscess of the prostate .1 .... 126d. Hypertrophy of prostate. 2. .I. 127. Nonvenereal diseases of the male genital organs. 13 60 ..5 127a. Hematocele. ...1 127b. Hydrocele. 7 24 .2. 127d. Lymph scrotum and varix.1. 128. Uterine hemorrhage (nonpuerperal).2 129. Uterine tumor (noncancerous). .... 130. Other diseases of the uterus. 5 1 .... 130a. Metritis. 1 .... 132. Salpingitis and other diseases of the female genital organs. 2 ... 133. Nonpuerperal diseases of the breast (cancer excepted). .. The puerperal state. 134Bc. Abortion. .2 .... 135. Puerperal hemorrhage. 1 ..... 138. Puerperal albuminuria and convulsions. ... 140. Following childbirth (not otherwise defined). 1 ....

PAGE 53

49 TAB& VII.-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLDIIES IN THE HOSPITALS OF THE PANAMA CANAL, FROM ALL CAUSES--Continued. Employees. Soldiers. Diseases. Admissions. Deaths. AdmisA -Deaths. s1ons. White. Black. White. Black. Diseases of the skin and of the cellular tissue. 142. Gangrene. .4 .1 143. Furuncle. 7 5 ..4 143a. Carbuncle.10 4 1 .-3. 44. Acute abscess. 31 63 .34 144a. Pblegmon and cellulitis 18 24 ..12 145B. Scabies. 1 ... 145E. Pemphigus contagiosus .1 ..1 145G. Ground itch. ..1. .. 145K. Dhobie itch. 2 1 .10. 145M.Ulcer of the skin. .8 8 .. 1450. Tropicalulcer. .2. .. 145Q. petigo contagiosa. 3 1 ..1 145R. ticaria.1. 145S. Ingrowing nail. 9 1 .18 145T. Other diseases of the skin and annexa. .18 17 ..28 Diseases of the bones and of the organs of locomotion. 146. Diseases of the bones (tuberculosis excepted). 13 10 .4 146a. Carries (nontubercuIOus). .1. .. 146b. Mastoid abscess. .4 ... 146c. Osteomyelitis 2. .1 146d. Periostitis. 2 2 ..1 147. Diseases of the joints (tuberculosis and rheumatism excepted).2. 2 147a. nkylosis. 1 ... 147b. Arthritis. 8 40 ..4 147c. Synovitis .7 2 .8. 148 Amputations .4 25 ..1 149. Other diseases of the organs of locomotion. 29 19 .13 Malformations. 150. Congenital malformations(stillbirth not ). .1 ... Old aqe. 154. Senility .1 ..1 .... *A

PAGE 54

50 TABLE VIL-ADMISSIONS AND DEATHS OF EMPLOYEES AND SOLDIERS IN THE HOSPITALS OF THE PANAMA CANAL FROM ALL CAUSES-Continued. Employees. Soldiers. Diseases. Admissions. Deaths. sin.Deaths. White. Black. White. Black, A ffections produced by external causes. Suicide: 159. By firearms. 1 .1 ...-. 160. By cutting or piercing instruments. 1 ... 164. Poisoning by food. 31 18 ..7 165. Other acute poisonings. 6 4 .-. .-. 5 165b. Snake bite. 1 ..... 166. Conflagration----------------1 .---------167. Burns (conflagration excepted). 7 29 .--. 1 2 168. Absorption of deleterious gases (conflagration excepted). 1 1 .. 170. Traumatism by firearms. 1 6 ..17 171. Traumatism by cutting or piercing mstruments. 29 176 .. 172. Traumatism by fall. 18 95 1 3 13 173. Traumatism in mines and quarries--------.14 .. 174. Traumatism by machines. 7 61 .2 1 175. Traumatism by other crushings (vehicles, railroads, landslides, etc.). 19 180 .2 5 175a. Railroad traumatism. -------28 .3 2 175b. Dynamite traumatism ----------2. .. 175c. Traumatism by landslides. .8 -------1 176. Injuries by animals. .3 ..3 179. Effects of heat. 1 ... 179b. Heat exhaustion.-. 1 2 ----------------180. Lightning. .1 .. 185A. Fractures (cause not specified). 26 88 ..29 185B. Dislocations.----------5 10 .7 185C. Sprains. 20 37 -------------. 186. Other external violence 120 412 -------------. Ill-defined diseases. 187. Ill-defined organic disease----------------6 3 189A. Cause of death not specifiedorill-defined 1 2 -----2 189Aa. Infections of undetermined origin-------11 22 ..3 189Ba. No disease------------4 11 .. 189Bb. Feigned disease-------1 ...2 Total. 1,866 4,708 16 128 4897 5 A:;

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51 TABLE VIII.-CONSOLIDATED HOSPITAL REPORT. Re-RemainAdDisTransmaining mitted. Died. charged. ferred. Ing Jan. 1. Dec. 31. W. C. W. C. W. C. W. C. W. C. W. C. ANCON HOSPITAL. Panama Canal employees.--. 45 1761,334 2,845 10 661,3352,813 9 24 25 117 Panadia Railroad employees. 9 34 173 9M6 2 34 12 895 2 6 6 75 Pana n pay patients. --....-. .. Other pay patients 147 453,5001,126 41 1183,472 996 23 9 111 48 Charity patients. 16 40 2671 429 9 58 259 356 2 15 13 41 Total. 217 29515,2745,378 62 27615,23815,060 36 55 155 282 Insane department. Panama Canal employCos. 5 13 3 51 .1 2 4 1 2 5 10 Panama Railroad employees. .7 1 2. .1 1 1 .4'. 3 Panamapaypatients .13 160 12 81. 26 7 31. 20 18 165 Otherpaypatients 6 2 29 8 1 2 23 2 1 1 9 5 Charity patients. 10 58 1 181. 5 2 8 1 19 8 45 Total.-. 34 240 46 114 1 35 35 46 3 46 40 228 Grand total. 251 5355,32015,492 63 3115,2735,106 39 101 195 510 Corozalfarm. Panama Canal employees .8135 5 25 ..3 14 ..11 45 Chronic ward. Charity patients----------28 .29 ...28 .3 .26 COLON HOSPITAL. Panama Canal employM s. 5 11278 447 4 6 247 340 31 107 1 5 Panama Railroad employees. 3 12 85 433 1 17 73 282 13 136 1 10 Panamapaypatients. 1 1 38 185 2 15 8 24 30 145. 1 Otherpay patients. 8 1 359 167 5 8 289 117 61 37 11 5 Charity patients. 1. 42 95 3 5 29 55 8 36 3 1 Total. 18 25 8021,327 15 51 646 818 143 461 10 22 PALO SECO LEPER ASYLUrM. Panamapaypatients. 2 31' 1 7. 2. 1. 3 35 Chriy atets. 2 15 .3 .....2 18 Total. --. 4 46 1 10 .2 .----..5 53

PAGE 56

52 TABLE VIII.-CONSOLIDATED HOSPITAL REPORT-Continued. ReRemainAdDied DisTans m ing mitted. i charged. ferret. ing Jan. 1. Dec.31. W. C. W. C. W. C. W. C. W. C. W. GRAND TOTALS. Panama Canal employees. 63 2351,6203,322 14 731,5873,171 41 133 42 177 Panama Railroad employees. 12 53 2591,411 3 52 2461,178 15 146 7 89 Panama pay patients. 16 192 51 275 2 43 .15 56 30 166 21 202 Other pay patients. 161 48 3,888 1,301 47 128 3,7841,115 85 47 131 58 Charity patients. 29 141 310 574 12 68 290 447 11 73 26 131 Total.,. 281 6696,1286,883 78 3645,9225,967 182 565 227 656 TABLE IX.-CONSOLIDATED QUARTERS REPORT. ReRe mainAdDied DisTransmaining mitted. charged. ferret. ing Stations. Jan. 1. Dec.3L W. C. W. C. W. C. W. C. W. C. W. C. Naos Island. ..2 3 ..2 1 .2-. Ancon.432. 1, 410 4 22 .5. Balboa. ..816 367 ..724 189 89 172 3 Corozal.2 310 40 ..299 37 13 3 Pedro Miguel. ..158 2 ..147 2 9 .2 Paraiso.2 238 161. .206 124 33 35 1 2 Culebra. .1 21 21. .21 21. 1 Gamboa. ..2. 6 1 5 1 1. Gatun.2 165 75. 162 66 4 7 1 Colon. 4 14 850 616 ..850 615 2 4 2 11 Total. 15 153,9941,295.3,8221,064 173 225 14 21 CONSOLIDATED REPORT OF DAYS LOST IN QUARTER. Stations. White. Colored. Total. Naos Island. 3 2 5 Ancon.-. 3,780 124 3,904 Balboa. 1,998 846 2,84 Corozal. 928 72 1,000 Pedro Miguel. 508 7 515 Paraiso .'.525 460 985 Culebra. 47 56 103 Gamboa. 2 18 2D Gatun. 479 389 868 Colon. 2,399 4,763 7,162 Total-. 10,669 6,737 17,406

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53 TABE X.-CONSOLIDATED I!OSPITAL AND ADMISSION TO QUARTERS REPORT. ReRemamiAdmitted Died. DisTransmaining charged. ferred. ing Jan. 1. Dec. 31. W. C. W. C. W. C. AV. C. W. C. Hospital. 281 669 6,1286,883 78 3645,9225,967 182 565 227 656 Quarters.--. 15 15 3, 994 ----. .3,8221,064 1731225, 14' 21 Total.--.-.296 684 10,1228.178 78 364 9,744 7,031 355 790 241 677 White. Colored. Total. Total admissions to hospitals, excluding Corozal Farm and chronic ward.--. 6,123 6,829 12,952 Total admissions of employees to quarters -----------3,994 1,295 5,289 -Total .-----------------.-.------.--10,117 8,124 18,241 Less number of patients transferred from quarters to hospitals, and between hospitals whose admissions are duplicated in above figures. 355 787 1,142 Yet admissions to hospitals and quarters. 9,762 7,337 17,099 Net admissions of employees to hospitals and quarters.----. ---. --. --.--.----.--.---.-----.---. 5,639 5,499 11,138 Annual average per thousand of admissions of emi ployees to hospitals and quarters. .------------1,194.96 182.90 320.20 CONSOLIDATED DISPENSARY REPORT OF ALL CASES TREATED BUT YOT EXCUSED. Employees. Nonemployees. Total. W hite C-Total W1te C otal. W ite dI Total. ored. ored. rd aosIsland .1,308 8,333 9,641. ..1,308 8,333 9,641 Ancon .28,222 43,483 71,705 19,731 25,028 44,759 47,953 68,511116,464 Balboa.--.-38,911 45,245 84,156 8,674 5,431 14,105 47,585 50,676 98,261 Corozal.--. 12,493 15,262 27,755 9,401 1,869 11,270 21,894 17,131 39,025 Pedro Miguel. 8,024 12,448 20,472 8,284 2,411 10,695 16,308 14,859 31,167 Para".,. 11,294 29,458 40,752 6,959 9,070 16,029 18,253 38,528 56,781 ra .441 588 1,029 420 584 1,004 861 1,172 2,033 Gamboa .623 1,874 2,497 263 4,597 4,860 886 6,471 7,357 Gatun.-. 7,878 17,538 25,416 13,310 10,768 24,078 21,188 28,306 49,494 Colon.-----10,310 27,279 37,589 8,280 9,917 18,197 18,590 37,196 55,786 Total-.1119,504 201,508321,012 75,322 69,675 144,997-194,826 271,183,466,009

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54 TABLE XI.-AVERAGE NUMBER OF EMPLOYEES CONSTANTLY SICK IN HOSPITALS AND QUARTERS. White. Colored. Total Ancon ......------------------------------------56.51 228.84 285.35 Colon. ......--------------------------------------7.75 16.81 24.56 Total---------------------------------64.26 245.65 309.91 Treated in quarters: Naos Island.---.-------------------------------.01 .01 02 Ancon. .....----------------------------------10.35 .34 10.69 Balboa.--.---. 5.47 2.32 7.79 Corozal. 2.55 .19 2.74 Pedro Miguel. 1.39 .02 1.41 Paraiso .144 1.26 2.70 Culebra.-. .13 .15 .28 Gamboa-.--. .01 .05 .06 Gatun. 1.31 1.07 2.38 Colon. 6.57 13.05 19.62 Total.-. 29.23 18.46 47-69 AVERAGE NUMBER OF EMPLOYEES CONSTANTLY SIcK. Hospitals. 64.26 245.65 309.91 Quarters. 29.23 18.46 47.69 Total. 93.49 264.11 357. G AVERAGE NUMBER OF EMPLOYEES CONSTANTLY SICK PER THOUSAND. Hospitals. 13.62 8.17 8.91 Quarters.-. 6.19 .61 1.37 Total .-.-.........-. -19.81 8.78 10.28 TABLE XII.-AVERAGE LENGTH OF STAY IN HOSPITALS OR QUARTERS FOR EACH ADMISSION OF SICK EMPLOYEES. White. Colored. Tota Hospitals: Days. Days. Da Ancon Hospital.-. 13.42 21.61 19.28 Colon Hospital-.-. 7.66 6.91 7.13 Total .12.30 18 16.99 Quarters: Naos Island.-. 1.50 .67 1.00 Ancon.-. 2.64 31.00 2.72 Balboa. 2.46 2.34 2.42 Corozal. 2.97 1.80 2.84 Pedro Miguel. 3.26 3.50 3.26 Paraiso. 2.20 2.89 2.47 Culebra. 2.24 2.55 2.40 Gamboa.--. 1.00 3.00 2.50 Gatun. 2.88 5.33 3.63 Colon .2.81 7.69 4.87 Total. 2.67 5.23 3.29

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55 TABLE XIU.-SUBSISTENCE AND OPERATING EXPENSES. Subsistence expenses: Hospitals. Number of days' rations issued to patients---------.-----------323,482 Cost of rations issued to patients. ...-------------------------$78,213.52 Cost rf subsistence per patient per day. .-----------------------$0. 241 Operating expenses: Number of days' relief furnished patients. ..--------------------323,482 Cost of operation. .....----------------------------------$ $443,722.23 Cost per capita per day. ......----------------------------------$1.371 Cost of operation with amount received from outside patients, etc., deducted. ........-------------------------------------------$193,030.90 Cost per capita per day with above deduction.------------------0.596 Cost of dispensaries. ....----------------------------------41, 231.24 FINANCIAL STATEMENT. Health Health department department expendiexpenditares calentures calendar year dar year 1915. 1914. Administration. .---------------------------------------$28,106.95 Medical storehouse. ...--------------------------------------6,399.73 Ancon Hospital----....-----------------------341,548.86 461,056.64 Colon Hospital. ....------------------------------44,903.53 34,099.71 Taboga Sanitarium. ....---------------------------------------867.39 Santo Tomas Hospital. ...-------------------------11,383.11 10,883.50 Palo Seco Leper Asylum. ..-----------------------25,055.93 16,943.94 Corozal Hospital. .....-----------------------------55,898.09 14,462.55 Other hospitals and dispensaries. .-----------------49,487.65 73,007.06 Quarantine. ......--------------------------------59,122.08 51,107.31 Sanitatsion: Panama. .....-------------.-------------------43,891.83 34,904.10 Colon. ....----------------------------------31,850.64 26,368.42 Zone. ......------------.----------------------145,421.54 172,941.50 Street cleaning, etc.: Panama. ......--------------------------------54,104.47 54,215.05 Colon.-. 25,870.94 21,940.52 Repairs to buildings. 2,966.66 9,091.46 Total. .....--------------------------------891,505.33 1,016,395.83 NOTE.-In 1915 administration and cost of operating medical storehouse prorated into operating accounts. Repairs to buildings charged direct to operating accounts since April, 1915.

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56 TABLE XIV.-PATIENTS OTHER THAN EMPLOYEES TREATED IN HOSPITALS, INCLUDING PALO SECO LEPER ASYLUM, AND AMOUNTS RECEIVED FOR THEIR TREATMENT. RemainAdNumber ing emitted Total. of Amount. Jan. 1. treated. Paid for by Panama Republic: Insane .173 92 265 64,978 $48,833.30 Colon Hospital. .2 221 223 477 1,156.44 Lepers------------------32 8 40 13,383 9,489.75 Total.------------207 321 528 78,838 59,479.49 For whom department of civil government pays $2,400 per year (charity) -. 269 860 1,129 43,399 -.Outside pay patients--------30 973 1,003 13,532 75,965.1 Families of employees, etc. (Zone). 85 2,780 2,865 38,320 49,65716 Soldiers---------------------94 1,897 1,991 26,151 43,344.72 Residents of Panama, emergency charity cases ..1 24 25 155 .--. Total.-----------------686 6,855 7,541 200,395 228,446.47 TABLE XV.-SURGICAL OPERATIONS PERFORMED IN HOSPITAL ber. Died, Der d Amputations: Herniotomy-Continued. Shoulder------------3 2 Femoral. 2 Thigh.--------------3 .Ventral. 9 Leg. 13 1 Combined (any two Foot. 3 .of the above) .3 Digits, multiple. .38 .3 Strangulated.;. 5 Arm and leg. 1 -----Genito-urinary: Operations on bones: Nephrotomy--------3 CraniectomyNeprectomy. .1 Decompressive. .6 2 Ureterotomy.--.I Exploratory-----1 .Cystotomy. 2 Laminectomy -------1 ----Ostiectomy .---------12 1 ---------19 --Resection of wrist. 1 .External---. 20 Wiring of fracturesProstatectomy.,. 6 2 Simple. .-36 Varicocele,radicalcure 11 Compound------24 HydroceleAdenectomy: Single, radical dervica -----------cure. 36 Cervical. 10 -----Double, radical Axillary --------------2 cure. InguinalOrchidectomy. 3 Single----------244 -----Epididymotomy. 94 Double 7-----------76 .--Amputation of scroFemoral. .--------13 1tum. Herniotomy: Curetage uteri. 97 2 L InguinalPerineoplasty. 4 Single-----157 .Trachelorrhaphy. 5 Double. 22 .Vaginalpunctures. 4

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57 TABLE XV.-SURGICAL OPERATIONS PERFORMED IN HOSPITALSContinued. Num-. Nm ber. Died. .erNu.Died. Obstetrical: Laparotomy-Continued. Caesarian section: Gastro-enterostomy. 18 2 Abdominal------1 .Entero-enterostomy. 2 Vaginal. 1 .Enterectomy. 2 Ace-ouchent force. .1 1 Appendectomy. 183 High forceps.-. .3 --.-. With local periLow forceps--------15 .-. tonitis. 18 1 Version.5 1 With general periPerineorrhaphy------13 .tonitis---------2 1 Thorax: Appendicostomy. 1. Thoracotomy. 6 1 Resection of rectum1. PneumothoracotomNy 1 1 Cholecystostomy-----11 Excision of breast. 2 .Cholecystectomy.-.-. 4. Excisionof breast and Choledochotomy. 1. ala.-.3 1 Abscess of liverRectum: Laparo -hepatotHemorrhoids, radical omy for. 8 3 cure. .100. Thoraco -hepatoFistula in anus, extomy for. 1. vision of. 9 .Splenectomy---------1. General: Pan-hysterectomy. -7 Thyroidectomy.---. 6 .-Supravaginal hysteNervestretching. 2 .rectomy. 47 1 Varicose veins, exHysteromyomectomy. 24 vision of. 13 .Myomectomy. 2 Tenorr y. --------13 .SalpingectomyExcision of surface Single. 10 neoplasms.--.-. 39 1. Double. 2 Stab wound of soft Salpingo -oophorectparts, operation for. 2 .omy. 11 E ytensive injuries to Ovarian cystectomy .4. softparts, operation Oophorectomy -------2. for.-3 .Suspensio-uteri. 39 Plastic operation forPlastic operation for Congenital defect -1 1 chronic pelvic periSevereinjuries.-.12 1 tonitis.----10 Effects of disease. 9 .For ectopicgetation 3 Skin graft. 25 .For trauma: Laparotomy: General peritonitis. 3 1 For general peritoniGunshot wound of tis. 3 1 abdomen. 1 1 For tuberculous periMajor operations, various tonitis. 4 2 other. 242 1 For intestinal obMinor operations, various. 1,623 struction-----------9 2 Exploratory. 7 2 Total.3,602 37

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58 TABLE XVI.-OPERATIONS AND WORK PERFORMED IN EYE, EAR NOSE, AND THROAT CLINICS. Operations. ied. Operations. Died Abscess, brain, drainage Plasticof. ...---------------1 .Eyeball---------.3. Adenectomy-----------122 .-. Eyelid.-------------4 Advancement of interFace ---------------2 nal rectus. ..N ose..-. 5 Capsulectomy---------1-----PterygiumCataract, needling -|1 -.-. Excision Cauteryto ulcer of nose. 1 .Transplantation 27 Enucleation.-. --5-.--.Removal of nasal polyp Evisceration.-----------3 .Rhinoplasty--------.! 1 Excision of chalazion -2 -----Removal of nasal spur. Expression for trachoma 4 -----Chalazaion excision. 1 Extraction of cataract .--. Sinusotomy--------13 Excision of endothelioSubmucous resection of ma of nose. 1 -. nasalseptum. 64 -Fracture of nose-------2 -----Tenotomy-----------1 -. Incision of surgical ab Tonsillectomy.-. 202 scess-----------------1 .Turbinectomy-.I.-Iridectomy------------12 -----Various minor operaKeratotomy-----------1 .-. tions. 233 Lachrymal duct dilated. 2 Mastoidectomy---------15 1 Total.---------770 Naso-dachryocystosRefractions----------2,529 tomy----------------1 .Outside cases treated. 8,240 Papilloma, vocal cords, removal of.-----------3 .-. Grand total------11,539 1 TABLE XVIL-CONSOLIDATED WARD LABORATORY REPORT-AL HOSPITALS. Blood examinations. 10,500 Stool examinations-Contd. Estivoautumnal.-----1,817 Bilharzia. 9 Tertian -----------------290 Pus and blood.964 Mixed tertian and estiBalantidium coli----4 voautumnal. 59 Entameba, histolytica, Quartan----------------17 and tetragena. 34 Differential blood counts 625 Guaiac tests--------.142 Leucocyte -------------1,288 Cercomonas, intestinalis. 12 Red blood counts .71 Tenis, saginata dispar White blood counts. --. 10 (ova). .-----------2 flemoglobin estimations. 940 Blood and mucus.2 Secondary anemia .6 Benzidine tests. 22 Lymphocytosis .4 Oxyuris. 2 Polsicocvtosis----------5 Urine examinations-----22,578 Anisocytosis.-. 5 Albumen.----------6,656 Filariasis.-----1 Albumen and casts. 3,713 Stool examinations---------6,659 Sugar.-. 115 Ascaris lumbricoides. 91 Pus and blood-------. 6,185 Uncinaria ova----------590 Indican. 627 Tricocephalus dispar .-373 Epithelium. 4,577 Strongyloides intestinalis 221 Bile------------. --. 242 Amoba.---------.-.-. 51 Trichomonas vaginalis. 3 Entameba-----------. .3 Hemi crystals------. 9 Ciliated monads .155 1 Guaiac tests------. 209

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59 TABLE XVIL--CONSOLIDATED WARD LABORATORY REPORT-ALL HOSPITALS-Continued. Urine examinations-Contd. Sputum examinations .2,874 Ciliated monads. 14 Tubercle bacilli .-.--.344 Tripleammonium phosPus cells.-.2 phate. 6 Pneumococcus. 2 Amorphous phosphates 4 Miscellaneous examinations Red blood cells .8 ofQuantitative estimation Pleural effusions.-.-3 of albumen in urine. .7 Various smears and disUrea determinations. 12 charges---------------391 Sugar, quantitative 7 Spinal fluid. 48 Albumen, quantitative. 23 Vaginal and urethral disBenzidine tests. 7 charges. 229 Acetone tests-----------13 The eye. 46 Urea. 1 Breast secretion .2 Calcium exalates-----2 Urine sediment. 5 Uric acid crystals 2 TABLE XVIII.-ANCON HOSPITAL-NATIONALITY OF PATIENTS. Americans. Other nations. Class. Number treated. White. Colored. White. Colored. PanamaCanal employees. 4,400 857 8 350 3,185 Panama Railroad employees. 1,192 102 ---------60 1,030 Panama pay patients -----------2 .----------------------2 Other pay patients. 4,818 2,834 1 773 1,210 Charity patients----------------752 181 ---------52 519 Total. 11,164 3,974 9 1,235 5,946 Insane department. Panama Canal employees. 26 1 ---------8 17 Panama Railroad employees. 10 1 ----------------9 Panama pay patients. 266 ----.-. 1 21 244 Other pay patients--------------45 23 ---------6 16 Charity patients. 87 7 ---------5 75 Total. 434 32 1 40 361 Grand total. 11,598 4,006 10 1,275 6,307 Number of days' relief furnished patients. ..------------------------267,945 Cost of subsistence per patient per day .....--------------------------0.237

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60 TABLE XIX.-COLON HOSPITAL-NATIONALITY OF PATIENTS. Americans. Other nations. Number Class.treated I hite. Colored. White. Color Panama Canal employees .741 177 .104 460 Panama Railroad employees. 533 62 .29 442 Panama pay patients. 225 5 .37 Other pay patients. 535 206 --------.164 Charity patients. 138 27 .18 93 Total. 2,172 477 .352 ,34 Number of days' relief furnished patients. 14,003 Cost of subsistence per patient per day. 0.327 NOTE.-Operations at Ancon and Colon Hospitals (see report of all operations). Laboratory reports of Ancon and Colon Hospitals (see ward laboratory report). TABLE XX.-PALO SECO LEPER ASYLUM-NATIONALITY OF PATIENTS. Americans. Other nations Class. Number treated. White. Colored. White. Colored Panama pay patients--------------41. .4 37 Charity patients. 20 .2 18 Total---------------------61 ..6 55 Number of days' relief furnished patients-. 191152 Cost of subsistence per patient per day. $0.23 TABLE XXI.-SANTO TOMAS HOSPITAL. RemainARdman Aiitd Died Class. ing d.Died. hag. ing Jan. 1. harg Dec. 31 Pay patients. 50 1,240 27 1,223 40 Charity patients. 45 10,043 889 9,188 411 Total. 495 11,283 916 10,411 451 Average number of days' treatment per patient.---------------14.69 Average number of patients constantly sick. 455.9 Number of days' relief furnished patients. 166, 422 Cost of subsistence per patient per day.-. .0.312

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61 NATIONALITY OF PATIENTS. Americans. Other nations. Class. Number treated. White. Colored. White. Colored. Pay cases4. 1,290 33 .62 795 Charity patients. 10,488 85 1,079 9,319 Total. 11,778 118 5 1,541 10,114 OPATIONS. Number. Died. Major .1,247 68 'Minor .406 Total. 1,652 68 DISPENSARY. Class. White. Colored. Total. Natives. 713 6,222 6,935 Foreigners. 819 7,339 8,158 Total. 1,532 13,561 15,093 TABLE XXIL-BOARD OF HEALTH LABORATORY. Number. Number. acteriological examinaExaminations: tions: Determination of phenol Fluids and exudates. 177 coefficient of liquor Blood cultares. .164 cresolas compositus. 1 Throat cultures (diphExperiment in feeding heria suspects). 497 rats with clams for Culturesfrom autopsies. 42 ptomaine. I -stool cultures. 223 Stools for parasites. 17 Urine cultures. 331 Leper suspects. 11 .75 Aimals. 35 .1 Rats. 11,135 (curettings).,. 1 Blood for malaria .113 Yaws suspect. 1 Fabrics for superintendFresh meat for B. anent. 2 .35 Blood counts differenSpleens (bovine) for B. tial .78 anthrafs .57 Gonococcus stains. 2 Culture from eye .I Mosquito identification .2 lots. .19 .3 Pyorrhea cases. a_

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62 TABLE XXII.-BOARD OF HEALTH LABORATORY-Continued. Number. Number. Chemical examinations: Chemical examinationsSodium fluoride. 1 Continued. Electrolytes for storage Cake.-batteries. 23 Soil, Chiriqui Province. 1 Disinfectant ------------1 Commercial acetic acid. I Cottonseed cake. 1 Purina dairy feed. 1 Carbolic acid. .2 Rice. 2 Specimen for division of Beans.I police. .1 Mecuric chloride soluUrinary calculus .1 tions. Stools-------------------2 Renal calculus. 1 Belladonna suppository. 1 Calibration of lactometer. 1 Alcoholic beverages. 27 Spinal fluid ------------2 Stomach contents. 8 Bark.-------------------7 Urine. 651 Miscellaneous: Various liquids, fluids, Agglutination reactions. 34 etc. 24 Autopsies.---------------. .2 Various metals. 2 Bodies eml almed----Sugar cane. 1 Pathological tissues preDrugs and chemicals for pared: purity. 4 Frozen----------.56 Milk. 257 Paraffin------------3,788 Articles of clothing. 1 Surgical pathological tisCommercial product sues and neoplasms re"Pypo" ----------------1 ported. 266 Quinine hydrochloride. 1 Dark field examinations. 2 Ether for anesthesia 1 Vaccination, smallpox. 6 Driied beet pulp .2 Vaccine inoculations, Condensed milk .2 antityphoid.----6 "Jarabe de Ipacac". .1 Vaccine treatment, auAspirin tablets. 2 togenous, prepared. 4 Methyl alcohol. 1 Wassermann reactions. 4,208 Soap.-------------------2 Animal inoculations.-_ 3 Manufacture of liquid Preparations of salvar"Tanglefoot" .-.1 -sanized serum for inPotassium bitartrate. 1 traspinous treatment. 11 "Sal soda". -------------1 Medical-legal investigaMarine-engine oil. 9 tions-------------6 Gasoline. 8 Vaccine points manufacKerosene. 13 tured. 27,265 Crude petroleum. 1 Tuberculin test, cattle. 78 Epsom salts. 1 Immunization of hogs Water. 1 with hog cholera serum. 109 Opium. 2 Cremations. 51 Chloronaptholeum. .' 1 Interments. 299 Solution acid phosphate. 1 Autogenous blood serum Almond meal. 1 preparations. 2 Glutin flour. 2 Animals autopsied. 41 Concrete detection of Placental blood for mablood. 1 laria. 23 Latex of chingumbo tree. 1

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63 TABLE XXIII.-ISSUES OF QUININE. Kon.Ponds, KiloPounds, Month. gramavoirduMonth. gramavoirdugrams. grams pois: January. 40.00 88.18 September. 23.00 $5 71 February. 42.00 92.59 October. 34.33 75.68 March. 24.60 54.12 November. 42.33 93.32, April. 27.50 60.50 December--------6.16 13.59 May. 35.00 77.16 June. 13.66 30.11 Total. 371.18 818.06 July. 39.40 86.86 Average per month. 30.93 68.17 August. 43.20 95.24 TABLE XXIV.-SANITATION. CITY OF PANAMA.Mosquito, rat, and fly work: Miles of ditches cleaned. 84.4 Miles of ditches dug. -14.5 Square yards of pools oiled.;.4,989'436 Water containers treated .-. 258i,683 Mosquito-breeding places found. 3,471 Fly-breeding places found.-.-. .2,435 Quarts of flies trapped. 414 Rats trapped. 8,136 Disinfection work: Rooms disinfected. ...100 Material used: Crude oil. .gallons. 44,17 K erosene oil ...-.do. .. Larvacide.do .8,419 Inspection of houses and yards: Houses and yards inspected. 64,737 Notices served and nuisances abated. 2,921 Number of old buildings condemned. 193 Number of buildings demolished. 63 Number of yards cleaned.-.-. 49 Buildings: Number of plans for new buildings approved. .178 Number of permits granted for repairs to old buildings. 747 Garbage collection: Number of loads of garbage removed to dump and burned. 55,444 Total number of cans garbage emptied .1,296,713 Street cleaning: Number of square yards of streets cleaned daily. 600,000 Number of square yards of streets sprinkled daily. 90,000 Vaccinations: Number of persons vaccinated. 10,133 COLON, CRISTOBAL, AND MOUNT HOPE. Water and sewers: Number of connections made during the year. 60 Total number of connections made to date. 1,226 Number of outstanding permits. 744 Number of houses in which extensions were made. 58 Itouses: Plans approved. 155 Permits to repair issued. .831 Permits to occupy issued. 69 Number of bills collected for work for private parties. 1,233 Sanitation of Colon: Loads of yard garbage removed. 6,160 Average number of cans of garbage removed daily. 2,161 N Acres of vegetation removed. 404. Acres of streets cleaned. 9,941

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64 Sanitation of Colou--Continued. Private propts cleuned. ..-. 2;929 Square yards of pools oiled .. Mosquito-reedmg places destroyed.----Water receptacles trea ted.5407 Miles of ditches maintained.-..-.-.-. 18 Mosquitoesucaught i---. .-.--. .....--.-9,750 Nuisances abated.-. 2,600 Buildings in sp e cte d.-.-.-.-.-.-.-.-. 53,392 Rats killed -3599 Acres of alleys cleaned...,449 Acres of streets sprinkled. .--. 32D Fly-breeding places destroyed.-.-.-. 930 Gallons of larvacide used. .-----------------------------.784 Gallons of crude oil used. 081 Doses of quinine issued-. 4 Dog killed---------------------Dog kiyleds ..861 Cubic yards rooms fumigated -------------------------------6,1 Square yards of streets oiled. 94 Gallons of oil used for streets .100 Number cubic yards filling Panama Railroad stables .6 Sanitation of Cristobal: Square yards of pools oiled. 400 Water receptacles treated. 4 Mosquito-breeding places destroyed.-. 182 Fly-breeding places destroyed. 92 Buildings inspected. 3,795 Gallons of larvacide used. .-----------------------------46 Gallons of crude oil used. 431 Loads of yard garbage removed. 183 Cans of garbage removed. .-----------------------------1549 Acres of vegetation removed. .-------------------------17 N uisances abated.-.-.g4 Sanitation of Mount Hope: Square yards of pools oiled.*. 1,374,720 Water receptacles treated. 183,180 Miles of ditches maintained. 84 Mosquito-breeding places destroyed. ..---------------------1,251 Miles of ditches constructed. 3 Mosquitoes killed in outfit cars. 20,619 Mosquitoes killed in barracks. 34,878 Gallons of crude oil used. ...------------------------------30,498 Gallons of larvacide used. 3,32O Cans of garbage removed .-------------------------------22,191 Acres of vegetation removed.-.-.-. 349 Fly-breeding places destroyed. ..-------------------------14 Private properties cleaned. Vaccinations: Persons vaccinated. 261 CANAL ZONE. Work requests on supply department: Grass cutting. .......------------------------------------153 Screen repairing. M Miscellaneous. .-----------------------------------105 Work requests on the engineering department. .----------------Work requests on other departments. .----------------------20 Notice served for abatement of nuisances. 403 Arrests for violation of sanitary regulations.-.19 Convictions.18 Building permits approved.-----------------------------. 7 Inspections of-closets. ...-----------------------------------------17,M Stores.------------------------------------.459, Restaurants.-. .-------------------------------------14 Shops.--------------------------------------1)411 Garbage cans em tied --. -.-.-. -. -. -.9 00 Closets disinfected ..... H ouses disinfected .-.,.-..-. 4

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65 Rat traps used daily (divided by 12).-.-.-.).-. 1,319 Water and sewer connections made.a.d. I Adult anopheles destroyed at houses. 14 762 Containers found with seomia larvw -----------------------------94 Adult stegomia destroyed inhoss -------------40 Sower conneons made ..2 Material used: Larvacide.gallons 7,827 Crude oil.do 151,337 Kerosene used.-.-. 4,926 Rats destroyed.-. 5,566 TABLE XXV.-QUARANTINE SERVICE. PORTS OF PANAMA-BALBOA AND COLON--CRISTOBAL. Vessels inspected and passed .2,062 Vessels detined in quarantine. 129 Supplementary inspections of vessels detained. 16 Vessels funmiated on arrival. 99 Vessels fumigated prior to departure. 17 Crew inspected.-.-. 144,720 Passengers inspected. 53,083 Total number of persons inspected. 197,803 Supplementary inspections. 6,943 Persons vaccinated at ports of arrival because of compulsory vaccination law. 6,854 Persons vaccinated at ports of departure or en route because of compulsory vaccination law. 9,471 Total number of persons vaccinated. 16,325 Persons held in quarantine at the detention stations to complete period of incubation of yellow fever or plague. 3,639 Persons held in quarantine on board vessels to complete period of incubation of yellow fever or plague. 16,946 Total number of persons held in quarantine. 20,585 Persons landed from foreign ports: Cabin. 23,464 Steerage. 14,430 Total. 37,894 Persons embarked for foreign ports: Cabin. 24,782 Steerage. 17,238 Total. 4 Apparent decrease for the year from foreign ports: 0. aini.M. 1 Steerage. Total. 4,126 Fersns arriving from coast towns on small craft. 25,019 Famous embarked for coast towns on small craft. 19,552 Apparent increase for the year from coast towns. 5,467 total number of persons landed. 62,913 Total number of persons embarked. 61,5"h Excess over number'embarked. 1,341

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Less number for Pacific ports. 2,65 Total apparent decrease for the year.-.-.1 Immigrants recommended for rejection. Bills of health visaed. 1 Inspections of docks. Inspections of vessels at docks.-. 4 BOCAS DEL TORO. Vessels inspected and passed.-.206 Crew inspected and passed. 15,897 Passengers inspected and passed. 2,533 Passengers, in transit inspected and passed--.--. 2,78 Persons held to complete period of incubation of yellow fever--. 11 Persons held to complete period of incubation of plague. 8 TABLE XXVI.-PERSONNEL REPORT. [Average monthly number of employees at work during year.] Dec. 31, 1915. 1915 1914 Officer Skilled and emand Total. ployees. labor. Chief health office. 4 13 4 .4 Medical storehouse. 8 8 5 3 8 Quarantine service. 42 40 21 17 38 Health office: Panama. 162 142 21 152 173 Colon. 153 130 18 153 171 Ancon Hospital. 333 431 257 93 350 Colon Hospital. 36 30 28 11 39 Santo Tomas Hospital. 5 6 .6 Palo Seco Leper Asylum. 27 19 11 16 27 Zone sanitation. 118 125 18 122 140 Hospital farm. 49 47 5 50 55 Dispensaries: Ancon. .. Balboa. 6 6 .6 .6 Corozal. 4 5 .. Cristobal. .4 .. Culebra. 2 4 .. Empire. 5 Gamboa. 1 1 1 .1 Gatun. 4 5 5 .5 Margarita Point. 1 1 .. Naos Island. 1 2 .... Paraiso. 4 4 4 .4 Pedro Miguel. 3 3 3 .3 Porto Bello. 3. Toro Point. 2. Total. 963 1,040 413 617 1,030

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MALARIAL RATE or CANAL ZONE (AL% CASEO> FROM 1909-1914 Expressed in percentage of employees living in the Canal Zone ~XII 1171 1171 11 LI1 1 7 7 -~ -------------I AA tIt --------0 0 1910 17 2s s1 'o 3 24 A 1910 T T~ I I I Ij -T------------_ 191 19z 29 2.22 2 s 1913 5 12 21 1 1 1 -TI TTr1 L 169 -6 (21 aac pag 16 W 6 .). zI 191 jl 7 1----2T'?-I I--fRI1R ERAR AC PI AY J11V41NFty 1 AGU7 JULYF OBEORLRNoILMBrR OCEMBIR 25592-16. (To face page 613.)

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4s V|

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67 TABLE XXVII.-OSPITAL AND TOTAL CASES OF MALARIA AMONG EMPLOYEES,1915. Admissions. Died. Total cases. White., Colored. White. Colored. osTotal. HosTotal HosTotal. HosTotal HosTotal. pital. pital. pital. pital pital. anuary. 33 53 104 115 1 1 1 1 137 168 February. 38 53 83 84 ..-. ..-----121 137 March.-. .35 53 80 81 ..1 1 115 134 .------15 21 59 60 --------------------74 81 ...--------37 43 54 54 ....91 97 June.69 79 178 178 ..1 1 247 257 July.---70 105 193. 199 1 1 1 1 263 304 .48 71 138 146 ...186 217 tember. 25 45 107 110 ...132 155 October. 25 37 57 58 ...-2 2 82 95 November. 15 20 43 43 ....58 63 December------18 26 46 47 ....64 73 Total.428 606 1,142 1,175 2 2 6 6 1,570 1,781 Annual average Annual average death rate per 1,000. cases per 1,000. Number of emHosployees. loTotal. If(sTotal. pital. pital. anuary;. ..--------------------------0.67 0.67 46 57 35,618 February.----------------------------.-------42 48 34,266 March. ...---------------------------.35 .35 40 47 34,218 A .il. .--------------------------26 28 34,125 1ay. ......32 34 34,600 June....--...33 .33 81 82 36,564 July.-._.--..-..67 .67 88 101 35,981 August..-.-.-.*. 59 72 36,024 Se tember. ..45 53 34,827 .er .-. .72 .72 29 34 33,419 November. ..20 22 34,224 December. ..23 26 33,551 Total. .23 .23 45.13 51.20 34,785 0

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