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:
1916
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_00003 ( 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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Full Text

PAGE 1

pi W -A 0, MIFF.l A Col. A 1 :7& 2.i 7* 4i ;e; -h* -: -. -h-ave -% .~~ ---... -; -l-~ UZI

PAGE 2

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PAGE 3

REPORT OF THE DEPARTMENT OF HEALTH OF THE PANAMA CANAL FOR THE CALENDAR YEAR 1916 D. C. HOWARD Lieut. Colonel, Medical Corps, United States Army Chief Health Officer, Balboa Heights, Canal Zone WASHINGTON 1917

PAGE 4

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PAGE 5

CONTENTS. Page. Lete fttrantrimttal. 5 G r nr m rr.e. 5 Relh fe a pl tyhs. 7* ealth of residents of the Canal Zone. 9 Health of residents of the city of Panama. 9 Health of residents of the city of Colon. 10 Division of hospitals: Anconitospital. 10 Corozal Hospital. 12 Board of health laboratory. 14 Colon Hospital. 21 PIalo Seco eper Asylum. 22 Santo Tomas Hospital. 23 Distict dispensaries.,. 23 Sanitary divisions: Canal Zone. 24 Panama. 24 Colon. 30 Quaantinie division. .32 Chart No. 1.-Admission rate per 1,0 mloees,.:. 35 Chart No. 1.-Death rate per 1,000 employees. 36 ChartNo. IJI.-Noneffective rate per l,0O0 employees. 37 >Chart No. IV.-Malarial fever-admission rate per 1,000 employees. 38 Chart No. V.--Malarial fever-death rate per 1,000 employees. 39 Chart~ No. VI.-Malarial fever-death rate per 1,000 population in the Canal Zone and the cities of Panama and Colon, employees and nonemployees. 40 Statistical tables: Table I. Admissions, deaths, and noneffective rates for employees; deaths of residents of Panama, Colon, and the Canal Zone.41 II. Deaths by age, color, and sex. 42 211. Deaths by nationalit&. 43 IV. Causes of deaths of employees. 44 V. Death rates among Americans on the Canal Zone. 45 VI. Causes of deaths of civil population (employees and nonemployees) and military and places where chargeable. 45 VII. Consolidated hospital report. 49 VIII. Consolidated report of employees treated in quarters; consolidated report of days lost by employees in quarters.51 IX. Consolidated hospital and employees treated in quarters report. Consolidated dispensary report of all cases treated but not excused. 51 X. Average number of employees constantly sick in hospitals and quarters. .........................53 -XI. Average length of stay in hospitals or quarters for each admission of sick employee. 53 XII. Patients other than employees treated in hospitals and amounts received for their treatment. .54 XPI. Surgical operations performed in hospitals. 54 XIV. Operations and work performed in eye, ear, nose, and throat clncs. 5 XV. Consolidated ward laboratory' report of Ancon and Colon Hos pitals. 57 XVI. 8anto TobnasiHospitaL. 58 XVII. Sn3muary of sanitary work done in Panama, Colon, and the Canali Zone. 59 XVIJJ. Quarantine transactions. 61 .XIX. Personnel report. 62 XX. Hospital an total cases of malaria among employees. 62 (3)

PAGE 6

EM li s x W 11& 4x AN, I T an. .+: .+ .+; +" g : N aI 44

PAGE 7

LETTER OF SUBMITTAL BALBOA HEIGHTS, CANAL ZONE, January 2, 1917. Liaut. Col. JAY J. MORROW, Acting Governor the Panama Canal, Balboa Heights, Canal Zone. SM: I have the honor t o submit the following report of the operations of the department of health for the calendar year 1916. Very respectfully, ..D. C. HOWARD, Chief Health Officer. GENERAL REMARKS. Health conditions on the Isthmus during the year have been excellent. A case of smallpox in a West Indian sailor recently landed was admitted to Ancon Hospital from Panama City on October 18. The disease was contracted prior to his arrival on the Isthmus. Two secondary cases resulted, both in children living in an adjoiing room from which the first patient came. Two cases recovered, but the third, a 6-weeks old infant, died November 30. No further cases appeared. With this exception, no cases of quarantinable disease originated on or were brought to the Isthmus during the year. Two cases of anterior poliomyelitis appeared in the Balboa diatrict on December 12, both in children of the same family. The last previous case of the disease on the Isthmus was in 1912. No secondary cases have appeared. The annual physical examination of school children in the Canal Zone was completed in November, a total of 1,038 being examined, in whom 918 defects were noted, treatment being required in 682 cases. Free treatment (except dental) is given for defects discoyered at these examinations, and the value of this practice is increasingly evident. The third annual physical examination of gold employees was made late in the year. The results have not yet been tabulated, but its value both to the individual and the service is generally recgzed. Four thousand two hundred persons were vaccinated for smallpox in the terminal cities and the Canal Zone during the year, and 1$,681 were vaccinated aboard incoming vessels. A census of the Canal Zone taken by the police department in bmne, 1916, showed a population of 31,048, a gain of 1,122 over the previous census taken in July, 1915. The strength of the military (5)

PAGE 8

at the end of the year was 7,060. While exact figures are no able, it is believed that the population has increased in terminal cities during the year. Over one-half of the em of the Panama Canal live in the terminal cities. While the death rates in the terminal cities from most are lower than in cities in the United States, the exceptin r found in the higher death rates for tuberculosis, especially the blacks, and in children under 1 year of age. The general health of the cities of Colon and Panama, with the two c noted, is due in part to the most excellent water supply pid all houses and a proper sewerage system. Without constant mosquito work, however, malaria would be very prevalent, asa houses in the terminal cities are unscreened. .Racial tion, overcrowding,and insufficient food are responsibl g part for the high death rates from tuberculosis in the terminal The problem, therefore, is an economic one in great par than sanitary. Steps have been taken by the health d77 in Panama, assisted by local charitable organizations, to cary work along educational and preventive lines to improve Y. and other conditions where possible in the effort to reduce tuberculosis rate in Panama. It is necessary that thev area for new buildings be increased in Panama City, and It been recommended that the water mains and sewers bed to the "Savanas" district to permit of expansion of the city :M i direction. At present building permits can not b& struction in unimproved districts. The high infant mortality rate in Panama City is clowely to poverty and malnutrition. There has been established in e nection with the health office a bureau of infant welbav, couraging results are being reported of the work alreadyd' Plans are in preparation for extending these activities promised support of influential Panamanswho are deeplyin the work of this bureau. The revised and amended "Sanitary Rules and for the terminal cities, which were submitted to the ernment in July, 1915, with request for publication, afeoy mouths of correspondence and conferences, were finally and published as official decrees, the last under date of b 14, 1916. All sanitary ordinances, including those re adopted, have been compiled and published in booklet are now in full force in both cities. Until quite recent apartment has not had the full cooperation and spprtf Panama Government in the matter of collection and of fines and penalties imposed by the health officers of and Colon for violation of sanitary regulations. It wa ee a few months ago to take the matter up with the? M ment, calling attention to the large proportion of fin. mained uncollected and to the failure of the un to carry the collected fines as an "emergency fund, A only in special cases for sanitary purposes" as req sanitary code. This matter has not yet been settle, spirit of cooperation appears evident in other matters, ad A factory adjustment is anticipated soon.

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VITAL STATISTICS. EMPLOYEES. Th healIth of employees in 1916 was better than in any previous yerduring the history of the canal. The average number of employees on the rolls of the Panama Oanlthe Panama Railroad, and contractors doing work for the Paaa Canal, for the year was 33,176, as compaedwith 34,785 fr1915, and 44,329 for 1914. Tjhe total admission rate to hospital and quarters was 282.76'1 ts cmpared with 320.20 in 1915, 401.54 mn 1914, and 519 in 1913. (SeChart I, p. 35.) There was a net reduction of 12 pr cent in t amission rate from that of the previous year, which was then helowest rate of record. For disease alone, the admission rate tpo hoepitals was 103.72, as compared with 143.82 in 1915, 182.57 i1914, and 240.91 in 1913. The total admission rate to hospitals was 140.43 as compared with 186.17 for 1915, 244.49 for 1914, 351.10 for 1913. The total death rate was 6.03 as against 5.77 in 1915, 7.04 in 1914, and 8.S5in 1913. (See Chart II, p. 36.) The death rate for disease ne was 4.58 in 1916, as against 4.05 in 1915. The constantly noneffective rate from all causes was 9.20 for 196, which is the lowest rate of record, as compared with 10.28 fo 915, and 12.22 for 1914. (See Chart III, p. 37.) Of hatclr interest is the continued improvement in rates for smalnawhich disease heretofore has been the principal cause of among employees. Malaria has now been su ed as the ledn cause of admission by the group of venereal diseases. The admission rate to hospital and quarters in 1916 was 16.49 as compared with 51.20 for 1915 (see Chart IV, p. 38), a reduction of ~68 per cent from the rate of the latter year. There were onl two dth& from malaria among employees, both blacks, mkn a dahrate of 0.06 in 1916, as compared with 0.23 in 1915 (see Chart ,, p. 3) a net reduction of 73 per cent. There were no deaths fro 'amongAmerican employees; 0.59 employees per 1,000 were constantly sick with malaria in 1916, as compared with >.k fr 1915. Withthe completion of the permanent sanitary wok now in progress, it is believed that malaria will be practical eraicted from our sanitated districts and the terminal cities, i tepresent standard of maintenance work is continued. Cases of disease may be expected to occur now and then among laborers worin outyin districts in which antimosquito work is not caridon, as wihclearing gangs, mapping parties, etc., unless individual precautions are taken. admission rate for dysentery was: Amebic, 0.24; bacillary, 0.0; cinial,0.33. The corresponding rates for 1915 were 0.14, O.and 0.55; and for 1914, 0.38, 0.18, and 1.24. Te admission rate for typhoid fever was 0.66, as compared with *.11 in 1915, and 0.52 in 1914. There were three deaths from typhoid fever among employees during the year. AI morbid1ty and mortality rates are computed as equivalent annual per 1,000. A, A

PAGE 10

8 The five diseases causing the highest number of hospital ad sions, with their rates, were as follows: Adwis..R ... Venereal diseases. .521 Malaria. 502 Diseases of the eyes and adnexa. m. Tuberculosis (various organs). 107. Influenza. The five diseases causing the the highest number of deavhb, with their rates, were as follows: Deaths. Rato. Tuberculosis (various organs). 36 1.09 Pneumonia (including lobar and broncho). 31 Bright's disease (chronic nephritis). 20 Organic disease of the heart. 12 .36 Cerebralhemorrhage. 9 There were 36 deaths from tuberculosis among employees against 27 in 1915; from pneumonia 31 deaths against 25 in 1915. The increase in the number of deaths from these two diseases account# for the slightly higher death rate for 1916. EFFECTS OF RACE, The admission rate to hospitals and death rate for disease fr white employees were 267.35 and 3.29, as compared with 77.70 and 4.79 for black employees. The noneffective rate for disease an injuries for white employees was 17.76, as compared with 7.84 for black employees. The admission rate to hospitals and quarters for malariA wa 39.54 for whites, as compared with 12.82 for black employees. The admission rate to hospitals for disease for AmericanS was 209.81; the death rate-for disease was 1.67; the admission rate for malaria to hospitals and quarters was 27.62. EFFECTS OF SEASON. The highest death rates for disease occurred in the months of April and December, and the lowest in July and August. highest admission rates to hospitals for disease were in January February, and the lowest in September and November.

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A. 9 A N CANAL ZONE. [Employees and nonemployees.] W ith ~n average population of 31,447 in the Canal Zone, there ws a total of 343 deaths during the year. Of these, 290 deaths from disease, giving a rate of 9.22, as compared with 11.30 fpr 1915 and 13.24 for 1914. -The birth rate for the year was 20.42. The infant mortality rate, upon the number of births reported for the year, was 42 for white and 149 for colored children, with a general average of 121 The percentage of stillbirths to total births was 6. Of the total deaths ffom disease, the percentage under 5 years of age was 43. M lelow is a table showing the death rates for the Canal Zone from 1905 to 1916, inclusive, including deaths from all causes among bot h employees and nonemployees: Yro.p0ulaDeaths. pae Year. Po5pii1Deaths. p e 1,000. 23,463 828 35.29 1911.90,434 1,385 -15.32 196. 34,095 1,700 49.86 1912.79,279 1,129 14.24 197. 54,036 1,708 31.60 1913.61,700 1,047 16.97 198. 67,146 1,273 18.95 1914.46,379 710 15.31 199. 76,900 1,025 13.33 1915.31,946 410 12.83 86,465 1,251 14.47 1916.31,447 343 10.91 PANAMA CITY. The population of the city, according to the census of December, 1915, was 60,778, among whom there were a total of 1,765 deaths. Of these, 1,702 deaths were from disease, giving a rate of 28, as compared with 28.97 for 1915 and 32.85 for 1914. There were~ 2,598 births reported for the year, giving a rate of 42,75. The infant mortality rate, based upon the number of births reported during the year, was 237. The percentage of stillbirths to total births was 9. Of the total deaths from disease, the percentage under 5 years of Herewith is a table showing the death rate in Panama City from 19f15 to 1916, inclusive, including deaths from all causes among both employees and nonemployees: Rate Rate Yopul.-Deaths. per Year. PUlaDeaths. per 4,000. 4000. 0. ;0 21,984 1,447 65.82 1911. 46,555 1,456 31.27 S 25518 1,142 44.75 1912. 47,057 1,380 29.33 33,54 1,156 34.45 1913. 47,172 1,507 31.95 S 37073 1,292 34.83 1914. 53,948 1,863 34.53 40801 1,038 25.44 1915.60,373 1,810 29.98 45,591 1,448 31.72 1916.60,778 1,765 29.04 8082,-17--2 NN NNF

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10 COLON. The population of the city, according to the census of Dc 1915, was 24,693, among whom there were a total of 696 death; these deaths 662 were from disease, giving a rate of 26.81, a pared with 20.59 in 1915 and 24.20 in 1914. The increased rate shown for Colon over last year is more apparent than The number of deaths was practically the same, but the year was based on a population of 29,331, while for this y 24,693, considerably less than the actual population. Herewith is a table showing the death rate in Colon from1 to 1916, inclusive, including deaths from all causes among employees and nonemployees: Year. at]Deatp. Year. topulaDeaths.p ion. 1,000.tion. 1905 .11J76 553 49.48 1911. 19,947 527 1906-------13.651 702 51.42 1912. 20,174 493 24.44 1907. 14,549 571 39.24 1913. 20,232 489 1908. 15,878 418 26.32 1914-------23,26 49 21, 1909 .17,479 396 22.65 1915. 29.331 640. 1910. -. 19.535 514 26.31 1916. .24.6969 The birth rate for the year was 33.90. The infant mo a rate, based upon the number of births reported during the was 228. The percentage of stillbirths to total births was 7. the total deaths from disease, the percentage under 5 y of age was 42. DIVISION OF HOSPITALS. ANcON HOsPITAL. The first unit of the permanent hospital, section turned over for occupancy by patients in June. All white ican male patients were taken care of in this section. The following hospital buildings were demolished to make for new construction: Building No. 287 (board of health laboratory), on site ofwc the permanent dispensary is being erected. Buildings 253, 255, and 257 (wards 1 and 2, and service buildg on whose site is being erected the second unit of thep. hospital-section "B." Building 231 (attendants' quarters), to make room for ty 1 revised, gald quarters for quartermaster's department. Building 235 (wards 13 and 14, and eye and ear clinic ad rt ing room), on the site of which the permanent board of oratory is being erected. The above new hospital buildings will be ready for o about March 1, 1917. The present crematory was turned over by the building di in January, 1916, and ha3 been in operation throughout t

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New boundary lines were defined for the hospital reservation, which removed 1,he following houses from the limits previously obaning: Nos. 201, 518, 520, '522, 334, and 335. Physician8 an-d nurses.-In 1914 there was a reduction in the for of all employees in this hospital because of a reduced number of Patents and because it was expected that the number would cniue to decrease with the anticipated reduction of the canal However, in 19Th the minimum number of patients was reached, adsince that date there has been a gradual increase in the numbe o patients. The. total number of hospital days treatment for 1916~ was 270,294, as against 268,945 for the preceding year. As a respuIt, all departments ofl,hospital have been constantly running with the minimum number of employees necessary to do the work. This has been especially true as regards physicians and nurses. Consequently there are many occasions when the de~mands on the personnel are greater than they should be to produce effiInt results. Two physicians in addition to those now authorized are needed. Another rating, with increased pay, is also recommended for such physicians as have demonstrated their efficiency. Unless this is done, it will be impossible to retain good men; better inducements and prospects being offered in other places. Four nurses, in addition to the present allowance, would relieve the present conditions. Two head nurses, one as supervising night 'nurse, are desired, .but nurses for these positions can not be spared under present conditions. There were no important changes in the nurse corps during 1916 except the appointment of five head nurses and a change in rating, giving nurses subsistence while on leave. Traneportation.--The only daily animal transportation at present in use is a double team used two hours each day to meet, the hospital cars on the noon trains, the balance being replaced by wotor transportation consisting ofDate placed in service: March, 1915.1-ton truck. December, 1915.14-ton truck. september, 1915.Hearse. Apr11, 1916.Heavy chassis ambulance. JTune, 1916.1-ton trailer. Pugust, 1916.Light chassis touring car. October, 1916.Light chassis ambulance. Th~e replacement of animal by motor transportation at Ancon ]IespitaI has effected a saving for the year of approximately 50, including depreciation. arowndi.-The usual care was taken of lawns, gardens, plants, bedge, etc., and considerable work was involved in repbanting due Sto new construction. Every e fort possible was made to ,save plants fo Ir use around the new buildings when completed. The organization of the hospital has been improved, the work of the various'clinics coordinated, and all service is being rendered aa high standard of efficiency. .-NN.

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12 Herewith following is a statistical summary of some of the work performed during 1916: Patients admitted to Ancon Hospital during year. Patients admitted to Corozal Hospital during year. 225 Chronic patients admitted to chronic ward.-. --------Crippled employees admitted to Corozal farm.--------. I~ A.* A, Major surgical operations.-----------.1, 465 Minor surgical operations.----.-------. I,333 Eye and ear operations. ----------------------------------62 Refractions.------------------------,------------------------Obstetrical cases delivered.-----------2--------------------------24 Deaths during year in Ancon Hospital-------------------------.325 Deaths during year in Corozal Hospital ..7 Patients transferred to other hospitals for treatment, etc.------------Out-patient department (medical, surgical, eye and ear clinics) : Total visits-.A. 888 Prescriptions written.-.-.-.-------------------------. 9 Average number of physicians on duty, hospital and dispensary.2Average number of nurses on duty, hospital and dispensary. Average number Vattendants on duty, hospital and dispensary. 101 Enlisted men treated at Ancon Hospital. 1916 1915 1914 1913 Number of admissions. --1,937 1,771 1, 458 394 Days relief furnished. -28, 519 24, 643 19,506 ,5 Number constantly sick.--78. 13 67.51 53. 401.0 Expenditures and revenue received from patients. 1916 1915 1914 1913 Operating expenses.-.$406,390.70 $382, 195.66 $493, 440.84 $535,112.05j Capital expenses.10,797.84 .9,152.29 ,7.5,0.4 Total expenses.-417,188.54 391,347.95 498,636.39 1543, I<74. Revenues.227,021.78 230,256.70 231,392.32 2 8 2.0 Net operating expense. 179,368.92 151, 938.96 262,068.52 36, 787.0 COROZAL HOSPITAL. Corozal Hospital haa continued under the general suprvin of the superintendent, Ancon Hospital. Great improvements hav been made in the hospital and farm during the year aa the rsl of a general reorganization. The following permanent buildings were added to the hsia during the calendar year: A modern concrete fly-proof corn s pt a carpenter shop; a modern chicken house, with concreteba -capacity 2,000 chickense; the pigeon house was improved by di Z A I A.

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13 Lion of a shelter shed; and an addition to the piggery, doubling Ad capacity, was completed. A steam plant, consisting of boiler, pipe line, and sterilizer, was completed. This plant is used in connection with the proper sterilization of all milk containers, pasteurization of milk, steam cooking in the hospital kitchen, the disinfection of beds and bedding, and will also be used in connection with the proposed hydrotherapy plant. The hospital kitchen was enlarged and an attractive dining room provided for physicians and nurses. hospital department.-There was a total of 268 patients remaining in the asylum on January 1, 1916. During the year the movement of patients was as follows: Two hundred and twenty-two admissions, 318 discharges (including 34 deportations), and 56 deaths, leaving a total of 316 patients remaining at the end of the calendar year. Of the total remaining, 187 were males and 129 females, including 31 male and 20 female nonresidents. An effort is being made -to keep complete records and histories and to provide amusement, exercise, and occupation for the patients. Farm department.-The farm department has been reorganized and the position of assistant farm manager created. The number of cripples on the farm at the beginning of the calendar year was 56, and this number had increased at the close of the year to 66, of whom 10 were whites and 56 colored. No deaths occurred among the cripples during the year. Dairy.-During the first half of the year the method of conducting the dairy was changed and an experienced man, specially trained in dairying, was placed in charge of the dairy and piggery. The standard adopted has been that of the best diaries in the States, and a careful laboratory check of the products is kept up to insure the continued standard of excellence. The results obtained at the dairy have been beyond all expectation. The daily bacterial count of raw milk averaged less than 5,000 per cubic centimeter and at times as low as 500 per cubic centimeter. Because of the demand for pasteurized milk a pasteurizer was installed. This has reduced the daily bacterial count to an average of less than 100 per cubic centimeter per day. All utensils are sterilized by steam, and every effort is made to supply milk equal if not better than that supplied from any dairy in a temperate climate. The supply of milk has been greatly increased, so that besides furnishing Ancon, Colon, and Corozal Hospitals we have been able to supply all who have been prescribed milk by a physician. Beventy-eight thousand five hundred and seventy three quarts of milk were sold during the year for a total of $13,682,72. The total -income from the dairy for the calendar year was $15,357.91. At the end of the year the herd numbered 69 cows, 36 calves, besides 2 registered Jersey bulls. Garden.-The sale of produce from the garden showed a gratifying increase at the end of the year, due to extending the area for garden truck. Flowers and plants had a ready sale all the year. The total income from the garden for the year was $4,793.38.

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14 Piggery.-At the close of the year the piggery included 4 regP. tered boars, 63 hogs, 63 pigs, and 55 sucklings, or a total qt185. The total revenue from this branch for the year was $1,681. 1 Poultry.-The flock numbered 15 cocks and 469 hens at th nd the year, but a shipment of 500 Rhode Island Red hens had a been shipped from the States. With the arrival of the new ft it is expected that all demands for eggs will be supplied. The ne flock will be placed in the new concrete chicken house, whicwa practically complete at the end of the year. Two thouwand fv hundred and four dozen eggs were sold for a total of $1,4. The revenue from the poultry yard for the year was $1,737. General.-The increased revenue from the farm during the part of the year resulted in a net income of several hundred do for this department alone for the month of December. Detailed statistics of Ancon and Corozal Hospitals arehw in Tables VII, XIII, and XV. BOARD OF HEALTH LABORATORY. A full report of the work of this laboratory during the year will appear in the Proceedings of the Medical Association of the Isthmian Canal Zone, Volume X, for 1917. The, work reported is of great interest, and it is regretted that, due to lack of space, it ca not be included in full in this report. The more important features of general interest follow: Wassermann tests.-During the year 8,633 Wassermann tests were made on 6,728 individuals, with results as follows: Positive.-. ..1, N egati e. I5, Separating these findings according to race gives the following per cent positive: White Americans. 16 Spaniards and white natiP:es.28. Blacks and mulattoes. Total-per cent positi. e -4-----------------------------------------In addition, Wassermann tests were made on 41 spinal fluids in as many individuals, and of these, 15, or 36.5 per cent, wr positive. Cultures.-During the year 913 cultures were examined fr B. diphtheria. One hundred and one positive cultures wer tained on 53 individuals. The cases were practically all sp evenly distributed over the Isthmus and throughout the year. B. typhosus was recovered from blood cultures 30 time d B. paratyphosus 4 times. Of the typhoids, 6 came from Coln, 10 from Panama, 3 f com the ships, and the rest from various s along the line. Of the paratyphosus, 2 came from shipg, r Cristobal, and 1 from New Gatup. Bacteriological examinations of stools and urines were from the inhabitants of localities in Gatun from whidi p i patients had come on two occasions, but each time with n results.

PAGE 17

15 meningococcus was recovered but once during the year. Ths patient was a soldier who had been on the Isthmus but 30 y. Serum treatment was promptly instituted and recovery urgicat pathology.-There were 560 surgical specimens received and examined at the laboratory during the year. The majority came from Ancon HospitMJ, but some were received from various points along the Canal 2Ine. Tabular statement of the findings will be published in the complete report. The following are some of the unusual findings: Two cases of leprosy found in specimens of amputated great toes. Two cases ainhum recorded. Three cases of gangrene of the feet due to chronic arterial disease. One case of Hodgkin's disease. A large chronic spleen which had bled from stellate lines of rupture in its capsule. A rudimentary kidney that had a superimposed inflammatory disease. A thyroid gland that was the eat of inflammatory disease rather than cystic change or tumor gro th. A specimen of Dermatobia cyaniventris that had been removed from an eyelid. Miscellaneous report (surgical and autopsy materials excepted).Dark field exam ations: Syphilis 54, yaws 4. Placental films examined: Two hundred and thirty-four, seven of them positive for malaria. Leper suspects examined, 30; 14 were positive. Blood films from animals .examined: Horses 13, cows 6, dogs 3. Examination of stools 3, urine 1, test meals 5, spinal fluid 1. Films searched for gonococcus: Eye 14, vagina 3. Parasites received for identification: Filaria immitis. S&kistosomum hematobium (ova in urine). Tenia saginata. Report on specimen of pleural fluid, 1. Report on examination of a lesion of the hand,.1. Inspection and report on condition of fetus, 8. -Animals. Rats examined: Mus musculus .8, 988 Mus norwegious. .6, 094 Mts rattus. 2,189 M Is alexandrinus. 130 17, 401 Heg examined. 128 n'ows and ca es examined. 62 pigs examined. 16 D .gs xal ined ..9 lbbits examined. 5 Sexamined. 3 'oeys oxamined. 3 Fo-s exa-ined. 2 orsesexa ined. .1 Armadillos examined.1 Z.p under observation: Hogs. 4 Dogs. 4 a ..1 Microscopic report on specimenw f animal tissue received 12. General remarks.-Three hundred and twenty-two autopsies were formed during the year, which represents 70 per cent of the odie' passing through the laboratory. It must, of course, be kept

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16 in mind that the mortality rate expressed for one disease dri the year does nut represent, in full, the morbidity rate f disease aming the individuals that have been autopsied. A ease may be a cause of death in oneinstance and in another smpy a contributory factor. For example, the causes of death under the titles of tuberculosis and syphilis do not indicate t true incidence of these diseases among the 322 autopsies. Syphilis, one of the most important ditases to the clinician and pathologist, escapes indictment as a cause of death more than a:y other disease that is prone to be followed with important SequaI. that can kill. This disease in its active stages seldom kills but the tendency for it to localize in the vascular system causes lesionis whic may produce aneurysm, aortic endocarditis, aortitis, cerebralhemorrhage and softening in young adults; or on the other hand some diseases like general paralysis of the insane. Because these lesions are so definitely located in a special system and are so remote from the active stages of the disease, syphilis almost never is indicated as the cause of death while tuberculosis is never lost sight of in this manner. It would appear that when syphilis could be well established by autopsy, and laboratory tests, in conditions like those named above it should be named as the disease which caused death. It is difficult to set hard and fast rules in recording causes of death. Note that many essentially, respiratory, circulatory, nervous, and digestive tract diseases are really placed under some ot the generaIJ diseases while on the other hand many diseases named under the special systems do not disclose the real etiology of these lesi s. Inspection of the anatomical report will show that during the year 1916 tuberculosis led all other diseases by a very wide margin as a cause of death. It has prevailed almost entirely among the negroes. Seldom did an autopsy disclose in this race an arrested or encapsulated lesion of tuberculosis. Sqrgical lesions among the negroes were chiefly found in lymph-nodes of the superficial s.t P and in the male external genitalia. Such a lesion in the bonead joints is far less common than is to be expected among white peple. The diseased produced by the pneumococcus (pneumonia, empyema, meningitis, arthritis, pericarditis, etc.) stand next in order as an important fatal factor. Almost on the same level belong chronic nephritis, and then comes the combined types of extend violence. It is reasonable to expect a high rate of chronic nepbrti among these young black adult laborers who have been employed under tropical conditions and who have in the past beeu the vietims of acute diseases such as malaria and dysentery, and many them in addition having suffered from syphilis and gonorrhea. Malaria, dysenteries, and other tropical diseases are at a very ebb. Evidence of the first mentioned disease is at times n autopsy but it indicates only a latent type. Uncinariasia is less frequently noted than in former years. Disregarding the c of death and considering only the most frequent pathological discovered at autopsy during the year 1916, tuberculosis an y ilis are found to stand well above all others and offer the elements to be fought in the future. Malaria is still the .os portant tropical element from an economic standpoint and fr

PAGE 19

El "LM Iy hls M lra 17 reom it is chosen with the two disease ae o aua tuy that will show incidences of the three conditions as found at au.The occurrence of the three 'most important diseases in the 322. EybE"A Syphilis. Malaria. Negroes. 81 76 35 Natives. 13 7 4 W hites.3 4 3 M es. 72 70 30 Females. 25 17 12 Children .15 5 12 Adults. 82 82 30 Wassermann positive. 73 Tertiary lues--no Wassermann. 14 Reference to the list of causes of death will show the relation tuberculosis and syphilis bear to the general incidence of the two diseases. Neoplasms.-In a young and selected population, and in one so largely composed of negroes, the malignant neoplasms are not to be expected in large numbers. However, the present year's record still bears out the belief that cancer is not as infrequent among the negroes as is generally believed. Sarcoma has been found less often than cancer. Leprosy.-No cases have come to autopsy during the year. Several suspects have been examined, as already indicated, and 14 found positive. In the chronic types of this disease showing ulcers of the feet and hands and no skin nodules or nasal lesion, experience has shown that better results toward establishing a diagnosis can be obtained by amputating a digit with an ulcer and subjecting the tissue to an examination at a more remote area than the site of the ulcer. Animals.-The rats have not revealed important findings during the year 1916. The specimens have come from all parts of the zone as well as the terminal cities, but the bulk of them have been catches at the Pacific terminus. Hogs.-Hg cholera still commands attention and is the chief fatal disease appearing among these animals. Cattle.-The presence of southern cattle fever or a disease similar to if not identical with it has been found in calves at the Corozal Hospital farm and in 25 cows and calves at the Miraflores pasture. Dogs.-No cases of rabies have been received at the laboratory. Chemical.-An examination of the Pistia plant to determine its value as a source of potassium gave the following results: Potassium constitutes 8.10per cent of the mineral matter or ash, which is 57.3 per cent of the moisture-free plant. Of this amount, 3.60 or 44.4 per cent of the entire amount may be extracted by maceration of the plant with water. The process of recovering 80820-17---3

PAGE 20

18 the potassium is seriously complicated by the high percent g of mineral matter associated with it. To remove the rg. matter sufficiently to permit of the extraction of the potsiu requires the use of external heat, which is always costly. HN ever, preliminary experiments have indicated that an electrolyti7 process might be ap plied economically without the destruction organic matter of the plant. This will be the subject of fNNrt work. -A consideration of the behavior of petroleum when used as larvacide led to the study of the methods of modifying the so that its spreading power, and therefore its efficiency, migh increased. Tests made on a small scale in the laboratory with a cracking process yielded a product that was thinner in consisten with a better spreading power, and very mxuch more rapid ini larvicidal action. Efforts to develop the process efficiently on larger scale without special equipment have not so far been cessful. Twenty-three determinations were made of the fat in the liverY of children dying of various diseases. The percentages on tbhe dry basis ranged from 6.35 to 81.98 per cent without the slightest reference to the condition found at autopsy or the age of the chijd. Mosquitoes.-The mosquito census was continued throughout the year. This consisted of examination and classification odf~al the mosquitoes taken in the daily hand catch in quarters and barracks at all line stations, military posts, and at Colon and CriAtoba, which are mailed to the laboratory after catching. A daily report is mailed to the sanitary inspector in charge of each district and to the surgeon at each post, giving the number and identification of the mosquitoes taken in his district. From January 1 to December 31. 1916, inclusive, the total numi I ber of mosquitoes of all varieties classified was 391,326; as follows: Anopheles albimanus.55, 6 Anopheles tarsimaculata. k ,; Anopheles argyritarsis. ..4 Anopheles pseudopunctipennis. .45 Anopheles apicimacula. Anopheles malefactor. 1 Mansonia titillans.242, Mansonia fasciolatus. Mansonia nigricans. Aedesiaeniorhynchus.2, Aedeomyia squamipennis Lutzia allostigma. Aedes (stegomyia) calopus. Culex and allied genera. Wyeomyia. Lesticocampa. NN Psorophora. Deinoceritis .IN Sabathes. Joblotia. Haemagogus. Damaged Anopheles., The distribution according to districts from which. the mo toes were collected will appear in the complete reprt h published.

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Aw 19 In March, 1916, our entomologist discovered the breeding places of a type of mosquito with peculiar habits and life history in the Canal Zone. This species of mosquito, known as Mansonia titillans, differs from other mosquitoes by passing its entire larval and pupal stage beneath the surface of the water attached to the water lettuce, Pistia stratiotes, which is so abundant in the canal near Gamboa, in Gatun Lake, and in several of the rivers emptying into the lake'. Ordinarily mosquito larvae live free in the water and secure their air supply at the surface of the water, but Mansonia titillans have breathing tubes in both the larval and pupal forms so modified as to enable it to pierce the rootlets of the Pistia and obtain its supply of oxygen directly from the plants at some distance from the surface of the water. Oil spread over the surface of the water is therefore not a larvacide for this species. The Pistia stratiotes is a rosette of greefi wedge-shaped leaves. The leaves are broad and flat at the apical end, with a central identation. The roots are long and filamentous. These plants gro on the surface of the water in large number near the edge of the lake and rivers, where the -4, ater is quiet, and they are protected from the winds and currents. They multiply rapidly and soon form large masses. They seem to propagate by seed and also by runners, one plant sometimes having five or six young plants attached to it, each one at the end of a slender rod-like branch or runner. Strong winds or heavy rains causing an elevation of the water tend to set these masses of plants in motion, and they float about on the surface of the water at the action of the winds or currents until they are swept into protected coves or lodge between the dead trees in the inundated area. The roots of these plants are sometimes several feet in length and hang straight downward in the water. They consist of innumerable filaments and generally have a quantity of decayed vegetable niatter and debris attached to them. It is in this mass of filamentous rootlets that the larvae and pupae of Mansonia titillans are attached. The larvae attaches itself to one of the thread-like filaments by puncturing the outer surface with its air tube, which is modified for this purpose. It then inserts the end of the air tube in the puncture and remains attached iM this manner. The pupae performs practically the same process. The roots furnish the larvae with a plantiful supply of oxygen, and the thickness of the mass serves to protect them from the small fishes. This manner of living during the immature stages of this species has been known for some time, and it has also been known for several years that the adult mosquito of this species were abundant in the Canal Zone, but the larval and pupal forms had never been DN ou nd here before. While they are found attached to the roots of the water lettuce, thousands of these plants may be examined without revealing any larvae, as certain other conditions are also necessary for a favorable breeding place, such as shade, protection from winds and currents, etc.

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20 In pursuance of investigations on this species of mosquito ad their habits the entomologist has visited various places in the zo e at different times, and has inspected the Maudingo, ChagRes, Palenque, Chilibre, Rio Grande, Cano, and Gatun Rivers. No P1sta plants were found in either the Rio Grande or Gatun Rivers. Along the edges of the Chagres are numerous small bays and inden-. tations covered with Pistia plafits, and many of them having Mawsonia larvae attached. In lower parts of the Clilibra and Palenque, near their junction with the Chagres, many acres of the plants were found covering the surface of the water, being prevented fromn floating down the Chagres by being entangled in a mass and by the dead standing timber, fallen trees, and growths of rank grass that serves to bind the plants together by growing up between them. About 5 per cent of the plants in these two rivers were found to have larvae attached. In the Cano River about 31 to 4 miles from the canal the Pistia plants were found so thick that in most places the surface of the water was entirely covered with a sold carpet of green plants growing between the dead trees. There were several square miles of masses of these plants found in this region, and about 85 per cent of them were found to be harboring larvae. The number of larvae found on the plants examined ranged from 1 to 47. In this river one plant was found with roots over 3. feet long floating on the surface, where the water was 27 feet deep, that had 44 larva attached to its roots. The Mandingo also has many acres of the plants with many larvae attached. Besides in the rivers mentioned, plants harboring larvae were also found at different places along the lake shore and in pools at some distance from the lake. The largest number of larvae attached to one plant were found on a plant about 14 inches in diameter taken from the water near~ the former site of the Bas Obispo station. This had 51 medium and large-sized larva attached to its roots. At present this mosquito greatly outnumbers any other species of mosquitoes found in the Canal Zone. The total number taken during the past year in the daily hand catches in quarters and barracks were 242,957 Mansonia titillans, against 148,369 of all other varieties of mosquitoes combined. Biting experiments were made to determine if Mansonia titillaN s would prove to be a possible factor in the transmission of dengiia fever. The one test that was made proved negative. Owing to lack of dengue patients this work could not be carried out as extensively as desired. In connection with this work the entomqJogist made a number of trips to various places on the Zone to collect larvae of this species of mosquito. Larvae of this same speiees, collected at Bas Obispo, and sent to the laboratory daily from Las Cascadas, were bred out and the adults used for this work. Observations on the biology of Dermatobia cyaniventris w made, with experiments to determine if half-grown larvae could successfully transplanted from one animal to another, which pro0d successful. Extended observations on the "screw-worm fly," CochEiein desvoidyi, have been carried out, and a complete report of this "t will be presented later.

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-21 A collection is being made of the snakes found in the Canal Zone and vicinity. During the year a total of 43 specimens were reeeived, being obtained through purchase, and by presentation to the laboratory. This number represents a total of 13 genera and 16 separate species. This includes 11 specimens of the "Coral snake," Elaps fulvius; 2 of the tropical coral snake, "Elaps Margravii;" 7 of the "Mapana," Leptodire albofusca; 3 of the "Green tree snake," Oxybelis futgidus; 1 of the "Pike-headed snake," Oxybelis accuminatus; 2 of the Large boa," Boa imperator; 1 of the "Common boa," Boa constrictor; 3 of the "Rainbow boa," Epicrates cenchris; 3 of the "Blunt-headed snake," Leptognathus catesbyi; 3 of the Red snake, Pseudo boa neuwiedii; 2 of the "Yellowbellied sea snake," Hydrus platures; 2 of the Leptocalamus torquatus; 1 of the S pilotes pullatus ; 1 of thie Erythrolamprus aesculapii; I of the Zenoden colubrinus; and 1 of unidentified "Striped snake." When sufficient data has been collected it is contemplated to catalogue the snakes of the Canal Zone, with annotations on the appearance and habits of each species and other data that may be obtained. A number of reptiles, batrachians, and mammals were received at the laboratory during the past -year and examined for ectoparasites. These consisted of the 43 snakes mentioned above, 6 toads, Bufo mcarinus; 2 large iguanas, Iquana tuberculata; 1 large lizard, CJremidophorus sp.; 1 nine-banded armadillo, Tatu novemcincturn; 1 Batty's opossum, Dideiphys marsupialis battyi, and 1 Earl of Derby's opossum, Caluromys derbianus. The iguana ticks, Amlblyomnra dissimile, in various stages of development, were found -oni about 70 per cent of the snakes, on 90 per cent of the toads, and on both the iguanas. The remainder of the collection were free from ectoparasites. Observations are being made on the development of the floating water lettuce, Pistia stratiotes, to determine the rapidity of growth with a view of discovering facts of possible value in the wholesale destruction of this plant, if this should be undertaken in the future to eliminate the breeding of Mansonia titillcms. Collections of mosquito larvoe were secured at the laboratory whenever possible from all available sources. These were bred out, and specimens of the larvie, pupao, and adult mosquitoes preserved for the collection. This work is being carried out with a view of determining the different species of mosquitoes to be found iN the Canal Zone. A good-sized collection has been secured up to date, and undoubtedly the coming dry season will yield more new species. An annotated list of the different species will be put out at a later date. COLON HosrimA,. -The routine work was carried on in the old hospital buildings until May 15.,1916. Since May 16, 1916, the new hospital has been occupied. All of the old hospital buildings proper have been torn down and removed except the morgue, chapel, stable, one old storehouse, old ward A, operating pavilion, and the nurses' section of the oild hospital buildings, which is still occupied by the nurses ANN spIANN

PAGE 24

22 as their home. Estimates have been submitted for a newn s home, which it is expected will be built the present year. The new concrete hospital and storehouse have, fter months' trial, been found very satisfactory. The quarters for silver married employees have beenioved4 are now placed along Second Street. House No. 324, now occupied by doctors and druggists of the hospital and quarantine empkyee-, has also been placed along Second Street in line with the siWr married quarters. The new four-family concrete house for ue of doctors is rapidly nearing completion. It should be ready occupancy in less than a month. Work is expected to begin soon on the new concrete garage morgue. The auto ambulance has been in operation for several weeks and is rendering excellent service. The professional work of this hospital has been carried pn high standard. The work is particularly exacting for physi and nurses on account of the large amount of emergencysugery which requires attention at irregular hours. Detailed statistics are shown in Tables VII, XIII, and XV. PALO SECO LEPER ASYLUM. A new one story building, 28 by 72 feet, containing six rooms, each 12 by 16 feet, with bathroom and toilets and front and rear porches, was completed during the year. All work with the Aception of the installing of electric lights and plumbing was done with patient labor under the supervision of the superintendent. Another building of the same dimensions containing six room, two bathrooms, and two toilets was at the close of the year aboii 50 per cent completed. The buildings will be used as quarter Or male patients and will relieve the present congested condition. Male patients formerly living in building No. 12 on the hil ".to the west of the hospital grounds proper have been transferred to the new building, and building No. 12 will be repaired and painted and used as quarters for the male employees. Building No. 5 was dismantled during the year by patient and rebuilt on a new site to the west of the hospital grounds Telephone connection with Balboa exchange was comp during the year, which greatly facilitates the transaction of bu. The water supply for the asylum, which came from a weil withi the hospital grounds,-began to fail to furnish the required su about the middle of July. It was decided to sink another farther back on higher elevation. Work was completed hy4 thee municipal engineers in September, and an ample supply of good water was found at the depth of 147 feet. Installation of the and connections was completed the latter part of Decem Due to the severe force of the surf on the southwest e. beach, the tile sewer line was broken during the year, nec a new line of 8-inch wrought iron, extending 960 feet from the of the old line, running to the southwest of the asylum ad777 eating beyond the last reef, which was installed by theun

PAGE 25

23 engineering department. One hundred and thirty--eight feet of tile sewer was laid, connecting buildings Nos. 5 and 12 with the main line. A dinghy type boat, 18 feet long, and two Evinrude motors were purchased and put in use carrying supplies to and from Balboa, eliminating the great expense of launch service. A new survey of the reservation was made during the year by the fortification department, and a portion of the reservation to the west of the asylum proper, next to the cemetery, was turned over to that department. During the year there were 17 admissions and 9 deaths, with 66 -patients remaining in the institution at the end of the year. The average number of patients constantly cared for during the year was 62.81. At the close of the year 49, or 74 per cent of the patients, are taking chaulmoogra oiL. Marked improvement in a number of cases is shown and accurate records of the results of the treatment aro being kept. Motion-picture shows were given weekly during the year, the reels being furnished the asylum by the bureau of clubhouses and playgrounds. At these entertainments ice cream and cake are served to the patients. SANTO TOMAS HOSPITAL. The number of patients treated in hospital was approximately 500 1ess than for the preceding year, the actual figures 11,282 for 1916 as against 11,778 for 1915. The hospital is taxed to the limit of its accommodations at all times. Very creditable work is being done in all departments. The necessity for a separate hospital for tuberculosis patients was commented on in the last calendar year report. The matter was taken up with the Panama Government, but due to lack of funds nothing was accomplished. The Panama Government has now agreed to reconstruct certain old buildings in the hospital grounds, which will increase the total bed capacity and provide an open-air roof ward for tubercular patients and better wards for isolation of contagious diseases. This will relieve the immediate situation but a separate institution for tubercular patients is the only satisfactory Solution of the overcrowding problem of this hospital. Detailed statistics are shown in Table VII. DISTRCT DISPENSARIES. Five line dispensaries have been maintained throughout the year. The stations having the highest admission rates for malaria were Gatun and Cristobal, with an 'average weekly percentage of 0.21 anld 0.06, and the lowest, Ancon and Paraiso, with 0.03 each. F 4; I l 'lu" q. X 7W lh hk

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24 ZONE SANITATION. The division of zone sanitation has directed its energies during 1916 along the usual lines, namely, the prevention of mosquito breeding, the maintenance of sanitary conditions throughout our towns, the elimination of flies, the extermination of rats, etc. Since malaria has been the chief factor in the constantly noneffective rate for the zone from time immemorial, and because it is beat limited by measures directed toward the suppression of malariabearing mosquitoes, a very large proportion of the men employed and the money expended by this division have been for the purpose of controlling the malaria situation. During the days of construction, the difficulties incident to absolute control of the malaria situation were insurmountable. During recent years the activities of employees have been constantly becoming more circumscribed and confined to definite localities in which conditions can be more fully brought under control than formerly. The results of the work done under recent conditions are most encouraging, the admission rate for malaria and the constantly noneffective rate due to malaria for 1916 being, roughly, one-third of the corresponding rates for the preceding year. Estimating the saving to the Panama Canal incident to this reduction in the malaria rate on a conservative basis, we find ttat it means approximately $20,000 over that of the previous year. SANITATION-PANAMA. Malaria.-The year just passed has been the best from an antimalarial standpoint that we have had since the opening of the canal work, which is reflected in the extremely small number of deaths, and in the small number of hospital admissions from this disease,. Only nine deaths were recorded during the entire year from malarial fevers, and during the last dry season, for the week ending February 26, 1916, only four hospital cases of malaria were reported, of which three were clinical. This is the low-water mark in the history of Panama to date. Again in May, a new malaria rate record was established for the 15,000 employees living in Panama city. There were no reported hospital admissions on account of malarial fever from among the employees, giving us a perfect score for the month. During 1916, it may be noted that we have had an average of slightly more than one admission per week from employees living in Panama city. In view of the fact that these employees are living in unscreened houses (the houses rented them by the property owners of Panama not being provided with screens) it wouT seem that the minimum admission rate for this disease has been reached for such a number of persons living under such circmustances. The drainage system which encircles Panama city has more than 150,000 feet of earth ditches of various sizes from 6 inches in widt to 8 feet wide, depending on the area drained. To maintain thiM work requires money, energy, and experience, yet without

PAGE 27

25 work the malaria status of the city would soon assume the frightfulness of former days. A survey was made of the outlying districts in which we carry on .ntimosquito work for the purpose of locating houses in which there were to be found cases of malarial infection. Ten such houses were located, and quinine, both in capsule and liquid form, was left with careful instructions to the occupants as to its use. These people, who are of the poorer class of Panamans, present marked anemia due to hookworm infection and chronic malaria, and are potent factors in providing the community with malaria-infected mosquitoes. The case incidence for the entire city of Panama has been reduced from 179.5 per month in 1914, and 51.1 in 1915, to 19.6 in 1916. Tuberculosis.-No improvement has been noted in the prevalence of this disease inthe city, and a gradual increase in the number of deaths from the pulmonary type, as well as all other forms, is noted from year to year. The total of deaths reported for the three years past is as follows: Pulmonary Other Year. tubercu$r0Total. forms. losis. 1914. 206 23 229 1915. 210 35 245 1916 .242 71 313 The death rate from tuberculosis in all its various forms for the year 1916 is 5.15 per 1,000 population, which is considerably in excess of the rate of 1.46 per 1,000 for the year 1915 in the registration area of the United States. Pneumorna.-In 1916 there were 209 deaths from pneumonia, including broncho-pneumonia; giving a death rate per 1,000 population of 3.44, as compared with 1.33 for the registration area of the United States in 1915. The years 1914, 1915, and 1916 show marked increases over the preceding years as a result of the rapid increase in population of Panama city from the closing down of the Canal Zone work and consequent depopulation of the towns along theline, their residents all flocking to the cities of Panama and Colon. Of this increase, Panama received the larger share. This has resulted in overcrowding of quarters as indicated in last year's census, where it was shown that there was not less than three persons per room on an average throughout the city, and while the rooms are adequately ventilated for ordinary purposes, with such overcrowding, the number of cubic feet of air space per hour per person is necessarily low. Typhoid fever.-During the year 1916, there were 19 cases of typhoid fever reported from the city, 3 of which terminated fatally. This does not include six cases which were reported as clinical forms of this disease. This gives a death rate of 0.05 per 80820-17--4

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26 1,000 population as compared with 0.12 for the registration are the United States for 1915. Diphtheria.-During the year there were 57 cases of this s in the city, with 6 deaths. This gives a rate of 0.10 per 1,000 nation, as compared with 0.16 in the registration area of the U States for 1915. Beginning with the latter part of July, there ws slight increase in the incidence of this disease which contain throughout September, but was well controlled by effective i tion methods, early administration of antitoxih, the holding patients in quarantine until negative cultures were obtained, a search for and isolation of bacillus carriers from the infec households. As a result of this active campaign there was only one case of this disease reported to the health oflice in December. Diarrhea and enteritis (under 2 years of age).-The rate of daths per 1,000 population in the registration area of the United Sta in 1915 was 0.72, as compared with the following rates in Pa City: 1914, 4.99; 1915, 5.10; and 1916, 4.59 per 1,000 population. Vaccination.-The requirement that children present satiaetory evidence of recent successful vaccination before being admitted to the schools of the city was successfully enforced, and a number of the younger children who had not been vaccinated in previous years were vaccinated prior to being admitted to the schools. An arrangement was made with the department of public in struction of the Republic of Panama whereby a record is kept in all schools of those children vaccinated, and whether successf41y or not. It is believed that this will prove of great value in the future. A total of 1,949 vaccinations were performed by the health officK during the year, which included a large number of Vaccion of adults in the district where the cases of smallpox were in November. -Bureau of infant, hygiene.-This work was started during month of November, one trained nurse being assigned bureau. Her time is divided between clinic work in the hi and making outside visits to the children in their homes, n g inspections as to conditions, giving instructions as to the px e care of the babies, etc. It is too early to make any very definite reports of this workb it is believed that by the expiration of the present year y favorable report of work accomplished can be shown. The station for this work has been established at Santo T Hospital, at which place the nurse in charge takes his children, especially of those born in the institution, exa weighs them, and makes proper records as to their progress. Midwives.-The ordinance requiring the registration ofi was put into effect during the year, and they are now supervision of this office. Their applications for regis the health office must be accompanied by certificats registered physicians and a responsible layman. One req for certification is that a midwife must have attended no 20 cases of labor under the supervision of a responsible pys

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27 UTpon~receipt of an application for registration of a midwife, an npetion is made of her premises and equipment, and an examina~tion is given her by the health officer to determine her fitness for the practice of her profession. T'he Panama Government has established a -school for midwives in the maternity wards of Santo Tomas Hospital, under the direction of the national board of hygiene of Panama, and practicing midwives who hold a diploma from that school are registered in the health office without further examination. GENERAL SANITATION. The routine work of this class was carried on throughout the year ~as effectively and with as little expense as possible. The number of districts in which the city is divided for this class of work remains the same, i. e., four, each in charge of an experienced saninepector, with a small gang of laborers, and for the largest district the inspector is assisted by a competent foreman. The work consists of routine house and patio inspections, in search of the breeding of domestic mosquitoes, the abatement and prevention of nuisances of all kinds, cooperating with the building inspector in seeing that all repairs or construction of buildings in their dietrcts is carried on strictly in accordance with the building regulations, particular attention being paid to rat-proofing features. N table.-The extensions to the Panama Railroad stables were completed, and this has provided much needed stall space, making it possible to close up any dirty or ill-kept stables which have not comnplied with the sanitary regulations governing such establishments, although they have had more than two years' time in which tQ comply with these regulations. Th~e new stables pay particular attention to the rat-proofing features, and every care is taken to avoid any fly propagation. Diaposal of manure.-The sanitary regulations provide that all mnure from each stable shall be removed at least once in 24 hours, and disposed of as may be indicated by the health officer. It is hirther provided that when being carried away it shall be done in wagons so protected as to render it inaccessible to flies. This'manure is carried to the public open-air dumps and there stored in large piles or mounds, approximating 10 by 20 by 6 feet high. The manure is then covered with rubbish, such as paper, shavings, light wood refuse, and other inflammable materials and theni ignited. A thorough charring of the outer surface of the mounds results, the ash of which is very unattractive to adult ffies; therefore it is vry rare to find any further deposits of eggs or larval development. *After standing for five or six weeks, depending on temperature and rainfall, this mound decomposes into a compost, which may then be used for garden fertilizer without liability of the further breeding No rl .-* Tihis method of manure treatment to prevent the breeding of flies a.-Nt the same time have the manure available for garden fertilizer iN considered very efficient and extremely economical, and would doubtless be suitable for many small cities which are unable to dis-

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28 VW pose of their manure completely through incineration. The revenue to be derived from the sale of the compost would offset the expense of the treatment. Milk and dairies.-Below is a recapitulation of the work performed along this line, from which will be noted that there is a cosiderable increase in the number of cows reported in the Variou" dairies. This is largely due to the fact that a large number of smal1 dairies, some distance from the city, which were not for.ery inspected, have now been included in the work of this division. This has lowered the average rating of the dairies inspected, as the most of these small "bush dairies consist of a hut in the jungle with one or two cows grazing nearby, the milk of which is handled in the most crude manner. An endeavor has been made to have a few of the better class of dairies owned by Panamans put in the best sanitary condition, so they may stand as models to other local dairies which have not attained so high a standard. Advantage has been taken of the dairy at the Corozal farm in the Canal Zone to use that as a model for all the local dairies with very good results. Dairies licensed. 66 Milk vendors licensed. 89 Dairies closed by health department. 10 Dairies closed by owners. 7 New dairies constructed. III Plans approved for new dairies. .18 Cows: 1914. .54 1915. 749 1916. 1,110 Daily output of milk: 1914.gallons. 31F 1915.do. 617 1916. .* ...do. 827 Average dairy score: 1914. 69.7 1915. 8. 1916. ....81.41 Bakeries, bottling works, candy kitchens, hotels, restaurants, eut.Regular routine inspections are made of establishments of this class by the food inspector, and the sanitary regulations affecting them are being enforced, resulting in marked improvement fi nearly all such places. Several of the leading bakeries in the city will now compare very favorably over former years, some of them having been pracic rebuilt and a marked improvement in their general condition btained. The regulation of miscellaneous food peddlers is being enfo and a list kept in the office of all such persons to whom permits hae been issued. Their wares offered to the public are required to be covered so as to be protected from flies and dust, and it ih p that this precaution will, in a measure, safeguard the health Lh patrons of these dealers. Below is a recapitulation of the work performed during the

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29 General food inspections. Dairies, Bakeries, Hotels, Month. Milk candy Bottling clubs, Miscelvendors, kitchens, works. restaulaneous. etc. etc. rants. 3anuary. 94 5 3 49 25 February. 145 36 .22 31 March. 35 2 .6 12 Apri. 187 5 3 1 71 .89 13 8 1 39 June. 78 117 1 9 84 .July. 21 53 4 49 40 'August. 48 47 9 1 34 September. 48 12 6 98 206 October. 7 26 34 12 108 November. 16 124 3 6 71 Deceber. 60 23 12 .43 Total. 826 463 83 254 764 All meat slaughtered locally is subject to inspection and action of the city veterinarian, a Panamanian official. The services of this office have been at his disposal when desired. Building inspection-Construction and repair.-There has been a general increase in activity in this line of work throughout the entire city, the prevailing type of building being of frame construction. Considerable improvement is noted in the type of tenement house, particularly as to light and ventilation, and the floor space of the rooms. Property owners find that it is advantageous to have large, airy, well-lighted rooms in order to retain their tenants. As already mentioned, the district inspectors cooperate with the building inspector, a total average of about 1,000 inspections per week being made by all of the inspectors engaged in this work. Particular attention is paid to the rat-proofing features provided for in the building regulations, great stress being laid on the proper construction and repair of roofs and ceilings, in which considerable amount of rat harboring was encountered. Many old buildings have been remodeled or repaired in order to comply with these requirements. Sanitary nuisances abated.--A total of 4,495 nuisances were abated during the year by the inspectors. These consisted principally of defects in plumbing, floors, pavements, etc., noted by the district inspectors in their daily rounds. The notices were served by them, and the work checked up by them subsequently. During the year it was necessary to clean 56 properties for private parties, the work being performed for them at their expense. In connection with this work it was necessary to impose 121 fines .on delinquents for various causes, the total amount imposed being $905, less two fines of $25 that were remitted. Street cleaning and sprinkling.-The city is now divided into three districts for the facilitation of this work, each district being in charge of a foreman and gang of push-cart street sweepers. At

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30 present the entire city is cleaned through what is known 0as h "picket system," which is found to be the most eflicient ne economical. 4 a _J In general, each sweeper is assigned a definite street area aJn bi, foreman holds him responsible for the cleanliness of his area. frequent inspections on the part of the foremen, as well as the inspector in charge of that branch of the work, the street ewe are kept up to the mark in their work, and their sections are kep fairly clean at all times. With the installation of a large number of macadam-asphait streets by the municipal engineering division during the past y, the work of street cleaning and sprinkling has been much facihtated, as this type of street in the Tropics is very much easier t clean, requires less sprinkling to keep down dust, and does afford anything like as many nuisances as the old type of macadani street. Garbage collection and disposal.-T his service has been carried o4 as efficiently and economically as possible during the year. TM entire work is now done during the day, whereas formerly it wa partly done at night and partly during the day, thus requiring extra gangs and foremen on account of the division of the work. The collection is begun in the early morning hours at a point farthes; from the dump, working always in collecting toward the dump; thus as the day advances the haul becomes less each trip. The service has been extended to include the exposition grounded, which adds a good deal to the territory covered by this work. The present means of disposal is open-air burning, which is 38 effective as it is possible to be for a climate of torrential rains. The garbage is piled in long windrows, which favors the quick running off of water after the heavy rains and also allows more wind action on the "fires, preventing their extinction as much as formerly. Considerable filling has been accomplished with refuse, 8he8, etc., from the dumps, and some very bad swampy areas have beeu eliminated near by. A modern incinerating plant is being constructed for the invineration of all garbage produced in Panama and the terminal Zone towns on the Pacific side. The erection of this plant will fill a long-felt want and aid in the elimination of many grave iuisanets which are encountered at the present dump. During the year a total of 891 garbage cans and pails were d to the residents of Panama, covers being provided for them by thi office. SANITATION-COLON. The present organization of the health office, Colon-Cistob remains the same as last year'. One sanitary inspector each i assigned to four districts; one has charge of the street-cl garbage collection, and one of the food inspection, rest hotels, etc. In each of the four districts the inspector has a small g laborers under him who eliminate mosquito-breeding places rubbish, clean premises, go through and examine every least twice a week.

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31 Mosquito control.-The elimination of mosquito breeding in Ih olon and Cristobal has been so thoroughly done that the end of the year saw the complete cessation of it, and the malarial rate is the lowest in the history of the Isthmus. The dry filling of the swamp in East Colon for the purpose of erecting new gold quarters there and the new storm sewer on G Street will practically end all danger of mosquito breeding there when the work is completed. In : Mount Hope district, where breeding has always been considerable and a source of danger to the whole Atlantic terminal, pensive work of a permanent nature has gone on this year with marked results. Large areas of swampy land have been filled both by dry and hydraulic filling, and others drained. One of the results of this has been that the highest malarial rate for 1916 was two-thirds lower than that of 1915; while the rate in 1916 touched zero and remained there for some time, five times as often as in 1915. School ins pection.-The schools in the district are periodically pected, the dispensary staff making the annual physical examination of all pupils in the Zone schools, and the health office conducting monthly inspections both of public and private schools. All children not protected against smallpox were vaccinated, and no epidemic has interfered with the work of the schools in the current year. The health office has enjoyed the hearty cooperation of the teaching staff, which has been of special value in reporting notifiable diseases. Food inspection.-The work of food inspection has been maintained and conditions have been improved. A new concrete hotel in Cristobal is nearing completion, whose construction was undertaken largely at the initiative of the health office and because the old building had become eminently unsatisfactory. Three new concrete hotels have been opened in Colon and others renovated and improved. The milk supply of the city is regularly inspected, and no cases of disease have been traced to that source. The health department has been active in getting rid of a threatened invasion of anthrax here and has secured a thorough system of inspection to prevent the sale'of infected meat. Standard-type fowl coops are in use in Colon, and no small animals for slaughter are allowed in private premises. t-All bakers are subject to physical examination and must have licenses. All bakeries have been renovated and improved notably. The pure-food work will be facilitated by the contemplated concentration of the native trade at one place on Folks River in East Colon, where a concrete pier has been erected by the Panama Railroad for their use, with a view of controlling the entrance of food Products through this channel. Nuisances.-The rebuilding of the large burned area of Colon in concrete structures has tended greatly to reduce fly and rat infetaton. .Jlies have been reduced to a minimum, due largely to the use f Inew manure-curing pits and to the strict enforcement of the rules for the egregation of horses and other animals. L pop:

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32 The demolition of a number of old buildings along the water front and the filling in of holes in the coral rocks drove the rats into the city where they are caught in traps, two men being detailed for this work all of the time. As many as 31 rats have been caught in one day by one man. In abating nuisances around premises and in the enforcement of the sanitary laws the police departments both of the Canal Z." and municipality of Colon have cooperated with the health. office in a very satisfactory manner. In Colon there have been speci details of policemen with the sanitary inspectors witi good resu4 Garbage and rubbish collection.-This work has gone on a in previous years, except that increased rapidity of collection has been noted as a result of the districting of the city and the sirter periods of routine inspection. The use of the new concrete and metal stands has resulted improved conditions and they are now installed in a majority of cases, the old wooden ones being retired as fast as they can a condemned. A barge for garbage collection and dumping into the sea of the garbage from the docks is being built and will soon be In commission. Street cleaning.-This is effected as formerly by hand labor. Some of the most used streets have been oiled to keep down the dust in the dry months. The macadam is being replaced with concrete on Bolivartret and adjoining side streets, which will facilitate the street cleanpg and permit of the use of street sweepers, an improvement over the present system. Municipal engineer changes.-The main sewer from Colon was changed to empty into the bay instead of Folks River, this chg being on account of the building of a residential section on J. k X River beach. A new pumping station and sump is being but near this new residential site. A large storm sewer is being constructed along G Street to from Ninth Street to the beach in front of Colon Hospital. sewer system at Battery Morgan was extended and consolidated, owing to the building of military barracks there. In general the rebuilding of Colon since the two recent fires resulting in vastly improved conditions affecting the generI health and appearance of the city. QUARANTINE DIVISION. A r~sum6 of the quarantine operations for the year 191, show that the activities of this division were concerned, as usual, the safeguarding of the Isthmus against the introduction ofqu tinable disease. During the time of the prevalence of iai paralysis in the States very careful inspection of incomingpa gers was made, and in the cases of all under the age of 16h. an elevation of temperature measures of isolation were care until the cause was determined. In addition to the fun quarantine, the conduct of immigration has required close a

PAGE 35

33 the part of the quarantine division, particularly since the nger boats engaged in the west coast traffic have made Cristobal their terminal port, thereby centering the immigration work to a very large extent on the Atlantic side. The matter of preventing the landing of undesirables on the Isthmus has been carried out to a very successful degree, and our ports are at the present time freer of roustabouts and undesirables than probably at any time previous. Along the first part of the year the yellow-fever situation on the t coast of Colombia, in Buenaventura and vicinity, was still Io ked on with some apprehension, due to the outbreak of this disease occurring in the latter part of 1915. The sanitary means ires, however, carried out by the commission from the Canal Zone, hae evidently had good results, and no cases have been reported this locality for some time. It has, however, been considered necessary to maintain protective quarantine against all Colombian pOrts. On the Atlantic side yellow fever has been reported on the islaids of Barbados and Martinique; because of the fact, however, that ships rarely reach the Isthmus from these ports under six days, the mater has caused us no great concern. Bubonic plague has shown no decrease in its distribution in South America during the year of this report, but on the contrary has probably extended to localities previously considered noninfected or at most only in the suspicious class. One marked increase of this disease occurred in the vicinity of Paita, Peru, and an extension of the disease northward from Guayaquil, Ecuador, has taken place, involving the country districts in the vicinity of Manta and Bahia, Ecuador; these ports are a relatively short distance below the Colombian border and the prevalence of plague in these vicinities can only mean an extension of the disease northward and closer towArd zone ports. In view of the fact that plague is so generally distributed, along the west coast of South America particularly, we have endeavored to tighten and improve our antiplague measures th reference to the ships in zone ports. Our local measures of seating off, rat guarding, raising of gangways at night, fumigation, etc., have been watched very closely because the potential danger to the zone from the standpoint of rat introduction is much greater than through the agencies of human transmission. To this eud mechanical cleanliness and improved sanitary conditions aboard ship have received careful attention, and the value of all tese measures emphasized to the local shipping interests. General measures toward the improvement of our quarantine grounds and buildings have been given attention, and at the present time the two quarantine stations are in a state of fairly good equipment. The inspection of cattle, both quarantine and ante and post u Iortem, has required very careful attention, due to the occurrence .anthrax at the end of the last dry season. Cases of this disease occurred among the cattle pastured near Colon in February, March, April, and to some extent a little later. The experience in 1914 1915 with reference to anthrax led us to expect a recurrence of t-;disease before the dry season was over. Further deaths from athrax also occurred during the month of November, due, in all

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34 probability, to overcrowding of infected pastures. The -eW4, however, outlined by the health department in the capg directed against anthrax have resulted in the absence of new c of this disease among cattle on the zone and has been due 1 to extension of pasture lands in noninfected territory, care in matter of prevention of overcrowding of old pastures which considered infected, placing of vaccinated cattle only on infected areas, and the reduction of the total number of c pastured on the zone. A most careful method of procedurew carried out with regard to ante and post mortem inspection, it is believed that cattle taken for slaughter are safeguarded in respect to a most careful degreee. During the year the following ante and post mortem inspect were made by the veterinarians of the health department for supply department: Cattle, 10,241; hogs, 20; sheep, 2. For side interests: Hogs, 13. Quarantine inspections were maAe4,7 follows: For the supply department 12,215 cattle, 20 hogs; outside interests 1,048 cattle, 603 hogs. Aw Ail

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35 ADMY.AA RATE 'PER 000 4rMPL 0 YEEs. /106 6547 /779 -.e T. 07 3$238 /4/9 430 Z657 887 -/910 600 05 aw.6 -g -----19/2 50*93 727 /,/3 664S /3/4 44J9 420 1% IS/S J47 320 M 46/76 283 CIART No. I.

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36 EATH R A TE PER 1000 EMPLOYEES. Year Vaff o /0626547 41.73 ~~~~ ~~~ /907 J9238 28.74 1-VO8 43890 /3.0/ 169.9 47/67 /0.64 /9/0 50d9O /0.98 /9/1 48876 /102 /9/2 50893 ~9.I8 MI S6654 8.35 19/4 44329 7E4 /A 4783 5.7 1916 13476 6.3 CHART No. II. A1

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37 NOMFFEC /vE PA TE pE ? 4300 CpL OYCES *J~~ae 'iSO 26547 2148 107 J92e 9 /goB 4J880 2.31 /SO 47167 .93 ID/C 5600 2437 /9// 4876 24.46 /,/* 50893 *1.11 9/J I 6664 /S97 /5/4 44329 22 /9/ 347d5 10,28 /916 J3/ 76 8.9 ChART NO. UT.

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38 MALARIAL FEV8R ADN/SS/OAN R4 iE PER / 000 emPL oYACS 144I A904 62/3 /M d /905 /51// 14 /906 R6f47 82/ /807 3923 -424 /49O8 43890 *9* /903 47/67 2/% 110 .50802 187 -w -.L A, 19I48876 /84 // 19/3 56664 76 /O/4 44329 &g /9/5 J4 9A/ /9/6 JJ/76 /6 CHART No. IV.

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39 MA A/ AL AEV5R A 4 62/J 2.66 __ ---a// -Do 16$of e6__ -__ D626.517 71 -__107 39238 is./ -/08 438so 137 /949 47167 .5 /./0 o. ./ S // 48576 .94 19/2 60895 .x3 /9/3 56654 630 104 44329 .14 -1.9/6 347#5 .23 41 916 33J76 .0N Guar No. V.

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40 A ALAR1AL 4~ vEA DEATH /fAT PEAg000 A'PULA T/O)/ /19 TNE C4NAL Z0/NE AND TrHE C/TIeS OP PAVAAlA AND COLOW AfPL 0 YEFS AND AMWVNP. OYEES. /906 7JZ64 9.49 1907/02/JJ J. /'8 (20097 3. I 1*9 /35/80 2.7 /9/0 /65/9i 1.8$ /a// 1569ja /.O ~~ i/Si 146$/C /.64 /19/T /,2/04 /32 9/4/23592 1.27 /9/ /2/65A .6/ /9/6 1/69/ .24 CHART No. VI. *F

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41 -A&MISSIONS, DEATHS AND NONEFFECTIVE RATES FOR EMPLOYEES, ABSOLUTE NUMBERS. AvAdmissions to Det.INoneffective Deaths.s erage, hospitals. foscns. % ...ber of ConCAMr ,ExterTo D ExterDays any eT-Dis-To i ploytal. ease. a tal. ease. n -nonefcauses. causes. ea. caues ed fective. ear 1916: White .4,2 1,71,217 256 21 015 91 29, 513 80.86 Colored. 28,624 3,186 2,224 96 7 3 9 2116 224.36 Tota .33,176 4,659 3,441 1,218 200 152 481 111,629 305.22 Year 1915: White .4,7191 1,868 1,572 29 6 15 1134,1231 93.49 Colored. 30, 44 1,771 175 126 49 96.40 264.11 Total. 34,785 6,476 5,003 1,473 201 141 601 130,523 357.60 PROPORTIONATE NUMBERS.2 Year 1916:1 White.4 552323.59267.35 5623 5.27 3.29 1.98 .17.7 Colored. .j28t 624 111.31 77.70 33.611 6.15 4.79 1.361. 7.84 Total. 93s 1761140.43103.72 36.71 6.03 4.58 1.45 ..9.20 Z year 1915:11 White.4719 395.85 333.12 62.73 5.51 3.18 3 .1 1 wF.C olored. 30, 066 153.26 114. 11 39.15! 5.82 4.191 1.631 19.8 'Total.53 5.77 87 -a-3 785186.17143.82 42.35 .4.051 1.721.-. 10.28 I Includes both hospitals and quarters. 2Annual average per 1,000. WRNRDN

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42 DEATHS OF RESIDENTS OF THE CITIES OF PANAMA, COLON, AND THE CA'A Z9NE. Deaths. Annual average p e 1,000. AverPlace. age population. Toa. DisExtr-nTotal. nal Total. ease. causes. ease. Year 1916: Panama-. 60, 778 1, 765 1,702 63 29.64 28. 0 .04 Colon. 24,693 696 662 34 28.19 26.81 CanalZone. 31,447 343 290 53 10.91 9.22 1. Total. 116, I8 2,804 2,654 150 23.98 22.70 1.28 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 J. Canal Zone. 31, 946 410 361 49 12.83 11.30 3. Total. 121,650 2,860 2,714 146 23.51 22.31 1.20 TABLE IL-DEATHS BY AGE, COLOR, AND SEX. White. Colored. Yellow. Total. r E-' E--4 p Under 1 year. .55 28 83 436 368 804 V 11 496 02 84 1 to 4 years. 15 16 31 189 148 337 1 3 4 205 167 5 to 10 years. 4 6 10 24 19 43 1 1 2 29 26 5 11 to 20 years. 4 5 9 43 52 95 1 1 47 58 1Q5 21 to 30 years. 38 14 52 252 174 426 5 1 6 295 189 4 31to40years. 44 11 55 191 13? 323 10. 10 245 143 41to50years. 23 10 33 123 69 192 10. 10 156 79 235 51to60years. 22 4 26 73 41 114 5., 5 100 14A 45 61 to 70 years. 16 4 20 24 19 43 3 1 4 43 24 67 71 to 80 years. 4 4 8 10 10 20 2 .2 16 4 30 81 to 90 years. .3 3 2 7 9 1 .1 3 91 tol100 years .1 .1 ...1.A. IM to110years .1. 1.I. Not stated. ..9. 9 1 .1 10.10 Total. 225 105 330 1,3781, 039 2,417 44 13 .5716461, !M8j2,84

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43 TABLE III.-DEATHS BY NATIONALITY. EmNonemNation. Total. ployees. ployees. 4VS Antigua. 3 26 29 At1eS. 3 3 Argentina. 1 1 Austria. 3 3 Bahama Islands. 41 4 Brbados. 52 411 463 Bermuda Island. .1 1 Bol.via. .1 1 .anary Islands. 1. 1 il.1 2 3 ...55 55 OQombia.5 152 157 .Co.a.Rica.3 6 9 Cura. .2 4 DO mr ca ...................3 3 Fptne Islands. 1 2 3 Frace. .11 11 germany. .2 2 Greece. 1 5 6 Grenada. 2 33 35 Guatema :a ..22 outebiala~ 2 2 Upe 3 18 21 ritish Guiana. 1 2 3 ayti ..1 6 7 Honduras .1 2 3 Ld a. ..1 1 Ia.25 26 Jamaica.68 714 782 J ap an ...2 2 rt que. 2 60 62 .........3 3 M ontserrat. 7 13 20 NaSaU ..6 6 Nevis.1 1 2 Nicaragua. .5 5 Norway. .2 2 Panama. .7 749 756 Peru.3 16 19 2hijppines. 1 1 -orto-..1 1 P o t ga .---------. ........4 4 4a. ......7----------1 2 Sotiand. 1 1 .Kit a ....1 3 4 St. Lucia. 5 57 -62 T. ..7 7 St Vincent. 5 17 22 aIn. 1 34 35 o ..I1 Tri d .227 29 k .1 1 U i.e States. 14 50 64 Venzuela. 1 9 10 WestIndies.1 1 Un own.3 13 16 Total. 200 2,604 2,804

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44 TABLE IV.-CAUSES OF DEATHS OF EMPLOYEES. Cause of death. White. Colored. Totw1. Alcoholism, acute and chronic.2 2 Aneurysm. 1 2 3 Cerebral hemorrhage. 2 7 9 Appendicitis------------------------. .1 1 Brain, softening of. .2 2 Carbuncle. .2 2 Cardio-renal disease. .-------------.-------------------1 1 Cellulitis, streptococcie. 1------Dysentery, bacillary .----------------------------------1 1 Dysentery, unclassified ..1 Diseases of the urethra, urinary abscess, etc ----------------1 1 Endocarditis, acute and chronic. .2 Epithelioma of oesophagus. .1 1 Diseases of the arteries. .2 2 Fever, malarial, estivoautumnal.-.-. .2 Fever, typhoid. ...--------------------------------------3 3 Heart, organic diseases of. 1 11 2 Hodgkin's disease--------------------------.------1 Insane, general paralysis of .-----------------------------1 1 Manic depressive psychosis.1. .1 1 Nephritis, chronic. .20 20 Pell gra ........11 Pellagra -----------------------------------------------------1 Peritgnitis, simple .I I Pneumonia, lobar. 3 28 31 Pegitis, simple-----w--------------------------1 -----2Pyelitis. .1 Pyaemia, streptococcic. .2 2 Syphilis,tertiary. .2 2 Syphilis, secondary. .1 1 Sarcoma of left hip and other structures ..1 Tuberculosis, abdominal.-.1. Tuberculosis, disseminated. .-.2 14 1 Tuberculosis, miliary. .2 2 Tuberculosis, pulmonary. 2 14 16 Tuberculosis, Psoas muscle and lymph nodes. .-1 1 Urem ia.-. .2 2 Ulcer, duodenal-. .3 Urethra, stricture of. .1 External causes. Railroad traumatism. 2 Accidental traumatism, various. 2 15 Drowning, accidental. 3 18 Dynamite explosions. .2 1 Electrocution, accidental. .2 Suicide1. Homicide by firearms. .--.Other external violence. .2Total. 24 176 200 41

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450 V -DEATH RATES AMONG AMERICANS ON THE ZONE. Average C o det Number AnaI Number. ae .of deaths.aerg per 1,000. L.ome .n.Alde eae. 43 White employees from the Disease. 7 1.67 rUnited States. 4,19 xternal causes. .6 All causes .14 *3.33 White women and children (Disease. 14 3.81 .from the United States. 3,575 .External causes 1 .27 sAll causes ..15 4.08 White employees and their (Diseased 21 2.7 i families from the United 7,7 {xtenacauses. 8 1.03 States. tAll causes.29 3.73 *AJl Americans on the Canal IDiss.29 1.85 Zone., 15, 693 External causes. 20 1.27 fAll causes .49 3.12 HIN Includes employees and their families and officers and enlisted men of the United States Army stationed on the Isthmus. TABLE VI.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEBH AND NONEMPLOYEES) AND MILITARY AND PLACES WHERE CHARGEABLE. Diseases. Colon. Total. ma. Zone. I. General diseases. Typhoid fever. 3 1 4 8 Malarial fever: Estivoautunnal. 4 5 8 17 Trtian .2 1 3 Undetermined.:. ..I CUna .2. .2 achexia-.1 1 2 Smallpox .1 .,. .1 aooid 1 ..1 Measles .2 3 .5 Whooping cough. 3 3 .6 Diphtheria and croup. 6 4 2 12 Croup.5 .** 5 D~ysentery. .3. ..3 Entemebic. 1.I. .1 Bacillary .0. .2 .2 Unclassified .1 1 1 3 Erysipelas .1 ..1 Leprosy .1. 1. Purulent infection and septicemia. ..7 1 .8 NWAa. 2 .4 Septicemia. 7 11 Tetanius .9 1 10 21 .21574 Beribri. .8121 ~Tberculosiof the lungs .24 0 2 3 Acute military tuberculosis 10 1 2 13 Tgberculosui meningitis. 10 3 1 14 AbdoinaDl tuberculosis .4 1 .5 FN diw 'sease. I 1. Tabercul1osis of other organs .W. .1 4 Dissemninated tuberculosis .44 15 1s 174 IOikets..1. 1

PAGE 48

46 TABLE VI.-CAUSES OF DEATHS OF CIVIL POPULATION (ElMPLOY-, EES AND NONEMPLOYEES) AND MILITARY A ND PLA.CIES WHERE CHAR GEABLE--Continued. Diseases. a. Colon. CanaTl al F I. General disE ed-Continued. Syphilis: Secondary.I ... Tertiary. 11 2 .13 Hereditary.12 3. Period not stated. 5 2 .7 Cancer and other malignant tumors of theBuccal cavity. 7 2 9 Stomach and liver. 6 2 1 Peritoneum, intestines, rectum. 3 2 1 6 Female genital organs. 8 .-. Breast. 1 ...1 Other organs and of organs not specified. 9 5 Acute particular rheumatism. 2. 2 Chronic rheumatism and gout .1.1 Scurvy.1 .1 Diabetes. 1 1i 3 Hodgkin's disease. .1 Anemia: Primary, pernicious. 1 1 Secondary. cause not determined. 3 1 4 Other general diseases.3. 3 Alcoholism: Acute or chronic. 3 2 2 7 Acute.-. 2 1 .3 Chrom .3 .1 4 II.-Diseases of the nervous system and of the organs of special senst. Encephalitis. 1 2 Simple meningitis. 9 .10 Cerebrospinal fecer.2. ..12 Pneumococcus meningitis. 7 2 9 Locomotor ataxia. 3. 3 Other diseases of the spinal cord .1 .2 Cerebral hemorrhage, apoplexy -. 22 16 6 44 Softening of the brain. ..24 Paralysis without specified cause .2.3 General paralysis of the insane.2 2 4 Other forms of mental alienation. 2 Epilepsy. 5 8. Convulsions (nonpuerperal) (5 years and o-er). ..1 1 Convulsions of infants (under 5 years of age). 4 3. Neuritis. Other diseases of the nervous system. 2 ... Tumor of the brain.1. t Diseases of the ears. 3 .. III-Diseases of the circulatory system. I Pericarditis. 6 1. Acute endocarditis.1 10 1 Malignant endocarditis.21. Organic diseases of the heart. 68 38 17 Y" Diseases of the arteriesatheroma, aneurysm, etc. 3 .. Aneurysm. 6 Arteriosclerosis. 20 5 Embolism and thrombosis.2 2

PAGE 49

TALE V.--CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEAND NONEMPLOYEES) AND MILITARY AND PLACES WHERE ARGEABLE-Continued. Diseases. Colon. C Total. II.--Diseases of the circulatory sytem-Contd. Diseases of the lymphatic system (lymphangitis, etc.).3. 3. .3 Hemorrhage; other diseases of the circulatory system .3 ..3 IV.-Diseases of the respiratory system. Acute bronchitis. 41 39 4 84 Chrome bronchitis. 8 22 1 31 BRoncho-pneumonia. 132 70 27 229 Pumonia (unqualified). 29 8 1 38 Lobar neumoa. 48 39 19 106 Pl u is ....2 ..2 Empyema. 2 2 .4 pulmonary congestion, pulmonary apoplexy. 7 2 .9 gangrene of the lungs. 2 ..2 Asthma. 5 .1 6 Pulmonary emphysema.1.1 Other diseases of the respiratory system.3. .3 Abscess of lungs. .1 1 2 V.-Diseases of the digestive system. Diseases of the mouth and annexa. ..1 Diseases of the pharynx. .1 1 Diseases of the esophagus. 2 .2 Ulcer of the stomach. I ..1 Other diseases ol the stomach (cancer excepted). 1 ..1 Acute gastritis. 2 1 .3 Chronic gastritis. .3 3 Acute indigestion. 4 Diarrhea and enteritis (under 2 years). 279 37 17 333 Colits. 45 4 5 54 Di'rrhea and enteritis (2 years and o er). .16 6 3 25 Colitis. 2 .3 Ankylostomiasis. 2 ..2 Intestinalyarasites ...1 Appendicitis and typhlitis.1 ..1 ?ute appendicitis. 1 2 Chronic appendicitis. .1 1 2 Hernia, intestinal obstructions. 7 2 1 10 Intestinal obstruction .7.7 2 9 Otber diseases of the intestines. 3 1 2 6 Duodenalulcer.3 2 5 Cirhosis of the liver. 8 2 1 11 Other diseases of the liver. 1 2 / bscess of liver (unqualified). 7 ..7 Cholecystitis. 2 ..2 Simple peritonitis (nonpuerperal). 11 5 1 17 Other diseases of the digestive system (cancer andtuberculosis excepted).,. 2 ..2 iVJ.--onvenereal diseases of the genito-rinary system and annexa. Acutenephritis. 32 12 5 49 right's disease (chronic nephritis). 74 68 17 159 Sdiseases of the kidney and annexa. 2 6 3 11 Pyelonephrosis. 3 2 2 7

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48 TABLE VL-CAUSES OF DEATHS OF CIVIL POPULATION (EM PLOYEES AND NO EMPLOYEES) AND MILITARY AND PLACES WHERE CHARGEABLE-Continued. Diseases. PanaColon. Canal Total. ma. Zone. VI.-Nonvenereal diseases of the genito-urinary system and annexa-Continued. Diseases of the bladder. .1 Cystitis. .1 4 Diseases of the urethra, urinary abscess, etc. .I .2 3 Stricture of the urethra, nonvenereal. 2 .24 Other diseases of the uterus. I .. Salpingitis and other diseases of the female genital organs. .2 1 3 VII.The puerperal state. Accidents of pregnancy. 1 Abortion. 1 .1 2 Puerperal hemorrhage. 5 .. Other accidents of labor. 3 1 Puerperal septicemia. 2 2 3 7 Puerperal albuminuria and convulsions. 2 2 .4 Eclampsia. 3 4 1 8 Following childbirth (not otherwise defined). .1 1 VIII.-Diseases of the skin and of the cellular tissue. Gangrene. I 2 Carbuncle. 2 1 .3 Mycetoma. 1 Other diseases of the skin and annexa. 1 .. IX.-Disases of the bones and of the organs of locomotion. Diseases of the bones (tuberculosis excepted) 2:.2 Osteomyelitis. 1 ..1. X.-Malformations. Congenital malformations (stillbirth not included). 1 8 XIL-Diseases of carly infancy. Newborn child. 1 1 3 5 Congenital debility, icterus, and sclerema. 3 2 3 8 Premature birth. 44 8 6 5$ Congenital debility. 23 6 1 3%) Atrophy of infants. 1 2 .3 Malnutrition. 49 12 15 76 OtheT causes peculiar to early infancy (including various consequences of labor. .19 7 2 28 Lack of care. ..3 .I XIL-Old age. Senility. ... XIIT.-A ffections produced by external causes. Suicide: Poisoning.:.1 2 Hanging or strangulation. Drowning. ..1 Firearms. 6 2 Cutting or piercing instruments. .._

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49 TABE VI.-CAUSES OF DEATHS OF CIVIL POPULATION (EMPLOYEES ANb NONEMPLOYEES) AND MILITARY AND PLACES WHERE' CUARGEABLE-Continued. Diseases. ma. Colon. Z Total. XL-Affections produced by external causesContinued. At.er acute poisonings. 2 1 .3 on.agration ..2 6 .8 Thrns (conflagration excepted). .1 6 Accidental drowning. 9 8 23 40 ITraumatism byFfrearMs.-. 2 1 2 5 all.---------------. 5 2 5 12 Machines.-.-------------------------------. .-.-2 .5 Other crushings. 7 4 5 16 Rajlr traumatism. 3 .3 6 Dynamite trauxmatism .3 3 Injuries byanimas-. ..--------.-. .1 1 E'etridiy (lightning excepted). .1 1 2 Homicide byFirearms.-.---------------9 3 2 14 Cutting or piercing instruments. .1 1 1 3 Other means. 1 1 2 4 Fractures (cause not specified). ..-2 2 Other external violence.----------------------4 1 .5 XIV.-Ill-defined diseases. Ill-defined organic disease. .. Cause of deatb not specified or ill-defined .41 22 4 67 lufections of undetermined origin-. 1 1 1 3 Total.----------. 1,765 696 343 2,804 Stilbiths ......3 83 2 S8tillb Ja bs----------------------------------230 58 37 325 Grani total. ..-------------------------1,995 754 380 3,129 TABLE VII.-CONSOLIDATED HOSPITAL REPORT. A XAK AReAd r~ Re.Amainin Atd Died. D -Tans maining an mtted. d charged. ferred. e 1 W. C. W. C. W. C. W. C. W. C. W. C. ANCON HOSPITAL. P.ama Canal employees. 25 1171,0071,852 9 58 9771,764 4 17 42 130 pa.na Railroad empl.yees. 6 75 142 660 3 33 135 637. 13 10 52 apaypatients. 1 2 13 .3 ..2 10 .1 erpaypatients. 111 48 3,526 1,352 45 126 3, 479 1,201 2( 17 90 56 ity patients .13 41 245 317 4 44 240 258 2 33 12 23 Total----------155 2824,9224,194 61 264 4.8313,860 31 90 154 262

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50 TABLE VII.-CONSOLIDATED HOSPITAL REPORT-CoW AdDisTanKRen emitted. Died. charged. feared. W. C. W. C. W. C. W. C. W". 4.: ANCON HOSPITAL-Con. Insane department. Panama Canal employees .-..51 10 2 9 --. 2 1 2 6 ... Panama Railroad employees .----------------3-. 8 .2. 2 ..Panama pay patients .18 165 39 94 5 34 14 22 1 15 Otherpaypatients. 9 5 31 13 2 6 29 9 2 1 7 Charity patients-------8 45 7 39 ---. 7 1 9 1 Total. 40 228 79 163 7 51 45 44 103 5 259 Grand total. 195 510 5, 0014, 357 68 3154, 876 3 904 41 127 211. Corozal farm. Panama Canal employees--. 11 45 14 45. .14 34 1 2 40 A Chronic ward. Charity patients. .26 .26 ....17 ----1 COLON HOSPITAL. Panama Canal employees. 1 5 219 274. 6 185 216 29 49 1 Q Panama Railroad employees. 1 10 105 398 .27 92 289 13 F4 1 k Panama pay patients. .1 22 132 3 11 6 23 13 F, Otherpaypatients. 11 5 365 101 9 7 294 69 61 29 1 Charity patients. 3 1 41 43 .2 38 20 5 22P Total. 16 22 752 948 12 53 615 617 1212 PALO SECO LEPER ASYLUM. Panama Canal employees. .4 ... Panama pay patients. 3 35. 9 1 5 Charity patients. 2 18-. 8 1 2 .. Total. 5 53 212 7 ..GRAND TOTALS. Panama Canal employees--. 42 1771,2422,184 9 661,1772,016 41 Panama Railroad employees.7 88 2471,066 3 62 227 928 1 Panama pay patients. .21 202 63 248 9 53 20 45 F Other pay patients. 131 58 3,92 21, 466 56 139 3,802 1, 279 Charity patients. 26 131 293 433 5 55 279 304 Total. 227 6565, 7675, 397 82 375 5,5054,572 1 4

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51 V.--CONSOLIDATED REPORT OF EMPLOYEES TREATED IN QUARTERS. ReARem nng AdDied. DisTransStations. g 1.d charged. ferred. maining San. 1. rte.Dec. 31. W. C. W. C. W. C. W. C. W. C. W. C. A w .5 .1, 238 29 ..1,223 25 20 4 .. .3 61,107 280.1,057 174 48 112 5. Miguel. .158 6 ..151 4 9 2 .. .1 2 210 55. .195 54 15 2 1 1 ...7 23 ..4 21 3 2. *. 1 2 148 61 ..143 56 5 4 1 3 Colon. 2 11 934 905 ..934 899j.2 17 Total. 14 213,802 1,359 3,7071,233 100 126 9 21 ONSoLIDATED REPORT OF DAYS LOST BY EMPLOYEES IN QUARTERS. Stations. White. Colored. Total. Ano .2,399 147 2,546 Ba. 2,815 729 3,544 Sedro Miguel. 447 18 465 araiso. 508 134 642 Gambo. 25 38 63 atun. 450 310 760 Iolon. 2,523 6,238 8,761 Total. .9,167 7,614 16,781 E JX.-CONSOLIDATED HOSPITAL AND EMPLOYEES TREATED IN QUARTERS REPORT. ReRemainA dDisTransmainIng mitted. Died. charged. ferred. ing Jan. 1. Dec.31. W. C. W. C. W. C. W. C. W. C. W. C. Is. 227 6565,767 5,397 82 3755,5054,572 163 426 244 680 ..14 213, 021,359 ..3, 707 1,233 100 126 9 21 TotaL. 241 6779,5696,756 82 3759,2125,805 263 552 253 701 gI

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52* TABLE IX-CONSOLIDATED HOSPITAL AND EMPLOYEES TRMED IN QUARTERS REPORT-Continued. White. ColoreD. ot Total admissions to hospitals, excluding Corozal farm and chronic ward. 5,753 5,326 11,07 Total admissions of employees to quarters. 3,802 1,359 6, 16 Total. 9,555 6,685 16,240 Less number of patients transferred from quarters to hospitals, and between hospitals, whose admissions are duplicated in above figures. 262 539 801 Net admissions to hospitals and quarters. 9,293 6,146 15,439 Employees admitted to hospitals, excluding Corozal farm. 1,475 3,205 4, 68G Employees admitted to quarters .3,802 1,359 5,161 Total admissions of employees. -. 5,277 4,564 9,841 Less transfers between hospitals, etc. .152 308 460 Net admissions of employees to hospitals and quarters. 5,125 4,256 Annual average per 1,000 of admissions of employees .,381 to hospitals and quarters.1,125.88 148.69 28246 CONSOLIDATED DISPENSARY REPORT OF ALL CASES TREATED BVT NOT ExqUSED. Employees. Nonemployees. Total. Stations. ColColJol White. Total. White. Total. White. Ancon. 30,520 46,827 77,347 22, 597 31,075 53,672 53,117 77, 902131,019 Balboa. 39,766 45,133 84,899 14,371 10,120 24,491 54,137 55,263109,39( Pedro Miguel. 8, 571 12,959 21,530 8,208 4,564 12,772 16, 779 17, 52 4 302 Paraiso. .11, 146 33, 047 44, 193 7,838 0,082 17,920 18, 984 43,129 Gamboa. .534 1,951 2, 485 323 4,413 4,736 857 6, Gatun. .4,896 18,059 22,955 9,891 16,734 26,625 14,787 34,793 580 Colon. 12,108 34,991 47,099 9,709 10,473 20,182 21,817 45,464 Total. 107,541 192, 9671300,508 72, 9371 87, 461 160, 398 180,478280,428 46,906 4A -'a: %W.

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53 X.-AVERAGE NUMBER OF EMPLOYEES CONSTANTLY SICK IN HOSPITALS AND QUARTERS. White. Colored. Total. An:ospital. 47.46 187.19 234.65 olon Hospital. 8.30 15.60 23.90 PaloSeco Leper Asylum. ..71 .71 Total. 55.76 203.50 259.26 Quarters: Ancon. 6.57 .40 6.97 Balboa. 7.71 2.00 9.71 Pedro Miguel. 1.22 .05 1.27 Parai-so. 1.39 .37 1.76 Gamboa. .07 .10 .17 Gau. 1.23 .85 2.08 Colon. .6.91 17.09 24.00 Total .25.10 20.86 45.96 -AVERAGE NUMBER OF EMPLOYEES CONSTANTLY SICK. White. Colored. Total. Hospitals. 55.76 203.50 259.26 Quarters .25.10 20.86 45.96 Total. ..8f86 224.36 305.22 AVERAGE NUMBER OF EMPLOYEES CONSTANTLY SICK PER 1,000. White. Colored. Total. Hospitals. .12.25 7.11 7.81 Quarters. 5.51 .73 1.39 Total. 17.76 7.84 9.20 TABLE XI.-AVERAGE LENGTH OF STAY IN HOSPITALS OR QUARTERS FOR EACH ADMISSION OF SICK EMPLOYEE. White. Colored. Total. Hospitals: Ancon Hospital. ..15.40 27.17 23.53 Colon Hospital. .9.52 8.64 8.93 Total (average). 14.10 23.31 20.44 Ancon. .1.93 5.07 2.00 Balboa. 2.55 2.55 2.55 Pedro Miguel. .2.79 3.00 2.80 Paraiso. 2.42 2.39 2.41 Gwaboa. 3.71 1.65 2.10 atun. 3.04 5.17 3.65 Colon. 2.70 6.94 4.78 Total (average). 2.41 5.60 3.25 1w

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54 TABLE XII.-PATIENTS OTHER THAN EMPLOYEES TREAT HOSPITALS AND AMOUNTS RECEIVED FOR THEIR TRA (INCLUDING PALO SEGO LEPER ASYLUM). Number of N mber of admissions. tracm t treatment. Paid for by Panama Republic: Insane. 130 65 957 Colon Hospital. 154 3. Palo Seco Leper Asylum. 10 14,9w Total. 294 81 211, For whom department of civil government pay $2,400 per year (charity patients). 687 44, 538 ,4. Outside pay patients.-. 578 9,242 4 Families of employees. 2,979 42,677 24 .2 Soldiers.-------------------------------2,021 29,557 50, Public health serx ice. 202 4, 038 Residents of Panama, emergency charity cases. ...---------------------------23 161 Total. 6,784 211,44, TABLE XIII.-SURGICAL OPERATIONS PERFORMED IN OSTA Ancon Colon Hospital. Hospital. NumDied. NumDied. N ber. ber. ber. Amputations: Shoulder. 2 .. Arm. 1 1 .16 Forearm. 2 .I Thigh. 2 1 .. Leg. 4 .... Foot. 1 ... Digits, multiple. 9 .2. Leg, double. 3 ..... Operations on bones: Craniectomy, decompressive. 5 1 .. Craniectomy, exploratory. ..1 Laminectomy. 1 1 .. Ostiectomy. 22 4. Resection of knee (arthrotomy of knee joint). 4 ...4 Wiring of fracturesSimple.22. .. Compound. 11 1 .. Bone transplantation. I ...1 Adenectomy: Cervical. 18 ...N Axillary.3 InguinalSingle. .167 .3 Double. 42 .-. .I Femoral. 16 .. jo

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55 E XIII.-SURGICAL OPERATIONS PERFORMED IN HOSPITALS-Coutinued. Ancon Colon Hospital. Hospital. Total. NumDied. NumDied. NumDied. ber. ber. ber. IngunalSingle.80. .36. .1 Double. 13 .15 .28 Femoral. 2. ..2. Ventral. 9 .9 trangulated. 1 .1 ito-uriiary tract: Nephrotomy. 2 .3 6rectomy.2. 2 N ropexy.3. ... U.r t.rotomy.2. .2. Uretotomy'iternal. 10 1 1 .-11 1 'External. 19 1 1-. 20 1 jrotatetomy. 2 .2 Varicocele, radical cure. 23 .6 .29 lHydrocelesingle, radical cure_. 24 .4 .28 Double, radical cure. 5 .5 Orchidectomy. .4. .. E ididymotomy. 109 .3 .112 A" putation of the scrotum 7 .7 nputation of the penis. 1 .1 Curetage uteri. 84 .23.107 PieOplasty.17. 17 Traichelorrhaphy. 12 .3 .15 Vaginalpunctures. .1. ..1. Obstetrical: Iosarian sectionAbdominal. 9 3 ..9 3 Vag.1. ..1 Afceou ment force. 2 1. .2 1 Hig 'forceps. 2. 1. 3. Low forceps.7. 1 .8 Version.5-. ..1 .6 Perineorrbaphy. 5 .9 Thorecotomy. 3 1 2. 5 1 Excjsion of breast and ailla.1 .. Rectum: Uemorrhoids, radical cure. 97 2 9 .16 2 Fistulain anus, excision of 20 .2 .22 ?reolapsus rectum, radical ion .. General: Thyroidectomy. 8 .8. Aneurismorrhaphy 1. ... Var$cose vems, excision of. 15 ..15. nrapy1.3. 8 .21 yyorhaphy.2. 3 .5 Ex i of surface neo.31 .4 .35 Gunshot wound of soft operation .2 .2 Sea.wou.d of.soft parts, opeatonfo ..3 .3

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56 TABLE XIII.-SURGICAL OPERATIONS PERFORMED IN. TALS-Continued. Ancon Colon Hospital. Hospital. NumNumNm NiiDied. Died. F4 ber. ber. I .r General-Continued. Extensive injuries to soft parts, operation. ..14 Plastic operation forCongenital defect .4 ..... Severe injuries. 7. Effects of disease .11 1 Skin graft .3 ... Laparotomy: For general peritonitis 5 2 ..2 For tuberculous peritonitis. 6 4 .0 A For intestinal obstruction. 6 ...6 Exploratory. 15 2 ..15 2 Gastrotomy. ..... Gastro-enterostomy. 11 2 3 .14 2 A Entero-enterostomy. 1 ... Enterectomy. 4 2 ..4 Appendectomy. 130 .43 .7 Appendectomy with local peritonitis. 19 1 5 1 24 2 Colostomy. 3 1 ...3. Sigmoidopexy. 1. ..1 Cholecystotomy. 3 ..._ Cholecystostomy. 2 ....2 .k 9. Cholecystectomy. 6 1 7 .. ChLoledoclotomy. 2 ...2 Abscess of liver: Laparo-hepatotomy for 2 ...2 Thoraco-hepatotomy for. .22 Splenectomy. .1 .2 Pan-hysterectomy.4 ~ 7 11 Supravaginalhysterectomy 51 .4 .61 Hysteromyomectomy. 40 ...40 Myomectomy.*. 1 .2 .3 Salpingectomy: Single .7 .. Double. 5. 5 Salpingo-oophorectomy. 23 .2 1 25 Ovarian cystectomy. 11 .2 1 Oophorectomy. 5 .. Suspensio-uteri. .43 .10 ..53 .-Plasticoperation for chronic pelvic peritonitis. For ectopic gestation .1 ... Pylorectomy. 3 ... Gastrectomy. 4 ..4. For trauma: Rupture of spleen. 1 ... Major operations, various others 21 2 3 Minor operations: Various. 1,341 3 98 .1,439 Various (dispensary). ..1,658. 1,05

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57 'X.V.-OPERATIONS AND WORK PERFORMED IN EYE, EAR, NOSE, AND THROAT CLINICS. Number. Number. .etomy. 182 Removal of steel from eyeball cement of internal rectus. 2 (magnet). 1 sinusotomy, intrazipal. 1 Removal of foreign body from mastoid region. 1 nose. 1 e on.,. 4 Sinusotomy, frontal. 5 E.r .2 Submueous resection of nasal E.o o alazin1. I septum. .100 .2 Sinusotomy, maxillary. 1 Ex.a. on ofbataract. 7 Tonsillectomy. 229 Ftontal sinus radical. 2 Trephine Fergus Elliott. I Ir-ectomy. .1 Trephine of schlera for chronic Mstoidectomy. 10 aucoma. 1 PlatIcvarious minor operations.,. 57 Face. 1 Turbinectomy. 27 Nose .2 PterygiumTotal. 681 Excision. 22 Refractions. 1,378 Transplantation. 17 Outside cases treated. 7,644 Perforation right antrum. 1 TABLE XV.--CONSOLIDATED WARD LABORATORY REPORT ANCON AND COLON HOSPITALS. Blood examinations. 7,901 Urine examinations. 22,357 Estivoautumnal .831 Albumin. 5,140 Tertian. 198 Casts. 4,460 Mixed tertian and estivoauSugar. 1,484 tumnal .3 Pus and blood. 8,252 Quartan. 8 Indican. 881 Differential blood counts. 271 .Epithelia. 9,575 Leucocyte counts. 946 Bile. 296 Red blood counts .69 Trichomonas vaginalis. .3 White blood counts. 115 Hemin crystals. .48 Hemoglobein estimations .1,420 Guaiac tests. 431 Filariais. 1 Ciliated monads. 35 Spirilla of relapsing fever. 3 Triple phosphates. 62 81;ol examinations.7,274 Red blood cells. 7 Ascaris lumbricoides. 110 Quantitative estimation of Unginaria ova. 301 albumen in urine. 22 Tricocephalus dispar. 258 Urea determinations .3 Strongyloides 176 Acetone tests. 84 Amoeba. 22 Calcium oxalates. 10 Entamoeba .5 Benzidine tests. 15 Ciliated monads. 167 Sputum examinations. 3,419 Bilharzia. 2 Tubercle bacilli. 313 Pus and blood. 624 Pus cells. 9 Entamoeba, histolytica and Pneumococci .8 tetragena. 38 Diphtheria. 2 GaiLac tests. 199 Smear examinations. 560 Cercomonas, intesdinalis. 22 Examinations of spinal fluid 74 Tenia saginata dispar (ova) 14 Examinations of vaginal Blood and mucous .3 and urethal discharges. 287 Benzidine tests. 1 Examinations of urine sediOxyuris1 vermiculosis. 4 ment. 15 Uneinaria (parasites). 2 Eye. 17 Various. 29 ME.

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58 TABLE XVI--SANTO TOMAS HOSPITAL. a.RemainAd class. mittd. Died charged. Pay patients. 40 840 31 Charitypatients. 411 9,991 976 Al9M1m 41O Total. 451 10,831 1,007 9,.4. .. Americans. ..rn.s. Number treated. White. Black. White. B1 5 Pay cases. 880 33 9 313 Charity cases. .10,402 52 4 993 9, Totai. 11,282 85 Number of days relief furnished patients. 16387 Average number of patients constantly sick. .407 Average number of days' treatment per patient. 14.0 Operations, surgicah Number. Died. Major. 1,237 4 Mimor.52t Total ..4,7641 ,48 DISPENSARY REPORT. Class. White. Colored. Tot41 Natives. .322 7,9 7,3 Foreigners. 568 ,O, Total. 890 1 Md

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59~ TABLE XVII.-SANITATION. Crry OF P#NAMA. to, rat, and fly work: Dch dug ..miles. 2.1 lescianed .o. 88.4 Poosoiled. .acres. 745 Water containers treated. 153,738 Mosquito-breeding places found (stegomyia-1568). 3,304 Flies trapped (13,000 to quart).quarts. 606 Fly-breeding places destroyed. 299 Vegetation removed.acres. 57 ttrapped. 12,263 pisinfection work: Rooms disinfected. 175 )iterial used: rudeil .gallons. 45,520 Larvacide.do. 6,732 erosene.do. 737 Inspection of houses and yards: Houses inspected. 52,232 Old buildings condemned. 166 dings demolished. 57 Plr for new buildings approved. 247 Permitsgranted for repairs to old buildings. 1,111 Notices served and nuisances abated. 4,495 Private properties cleaned. 55 street cleaning: aiuare yards cleaned daily. Square yards sprinkled daily. 55,209 garbage collections: Loads of garbage removed to dump and burned. 59,053 Vans of garbage emptied. 507, 931 1acinations: Persons vaccinated. 1,949 COLON, CRISTOBAL, AND MOUNT HOPE. Water and sewers: Connections made during the year. 143 Totalconnections made to date. 1,368 Outstanding permits, December 31. 30 Tousesin which extensions were made. 80 xoiies: Piansapproved. 102 Termitstoreparissued. .587 Permits to occupy issued. 186 Bills collected for work done for private parties. .1,891 Hnitation of Colon: Loads of yard garbage removed.6,943 Cans of garbage removed. 744,630 Private properties cleaned. .8,880 Acres of vegetation removed. 671 Acres of streets cleaned .9,731 Acres of alleys cleaned. 1,647 Acres of streets sprinkled .615 Linear feet of ditches constructed. 11,295 Miles of ditches maintained. 516 Acresof pools oiled. 138 Square yards ofstreetsoiled. 17,313 Gallons of oil used for streets. .6,250 Mosquitorbreeding places destroyed. 140 Waterreceptaclestreated. 608,877 cMsauToesaughtonhospitalscreens. 11,447 Fly-breedng places destroyed. 13 Buildingsinspected. ..122,971 Nuisancesaba -d. ..3,991 Rat# killed. 3,316 lDogskiled ..275 Cuibicyardsfumigated. 12,521 Gallons of crude oil used ...10,843 Gallons of larvacide issued ....1,998

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60 TABLE XVII.-SANITATION-Continued. COLOR, CRISTOBAL, AND MOUNT HOPE-Continued. Sanitation of Cristobal: Square yards of pools oiled. Acres of vegetation removed. .LO Water receptacles treated. Mosquito-breeding places destroyed. 21 Fly-breeding places destroyed. as Buildingsinspected. Nuisances abated. 57 Loads of garbage removed. 2 289 Cans of garbage removed.170,77 Gallons of crude oil used .,48 Gallons of larvacide used .2 IA Sanitation of Mount Hope: Acres of pools oiled. 0I Acres of vegetation removed. Miles of ditches maintained.49. Waterreceptaclestreated. 160,100 Mosquito-breeding places destroyed. 1,258 Miles of ditches constructed.9 Cans of garbage removed.15,085 Gallons of crude oilused.26,230Gallons oflarvacide used. 1,593 Mosquitoes caughtIn quarters. 17,882 In barracks. 25,178 On boats. 1, 197 CANAL ZONE. Work requests on supply department: Grass cutting.270 Screen repairing. 101 Miscellaneous. 103 Work requests on municipal engineering department. .18 Work requests on other departments.23 Buildings inspected: Xor screening.13,029 For mosquitoes. 63,100 For general sanitation. 27'191 For safety. 2G Inspections of stores. 394 Inspections of restaurants. I. Inspections of shops. Notices served for abatement of nuisances. 4i Arrests for violations of sanitary regulations. Convictions. 7 Garbage cans emptied daily. 2, Closets disinfected. Houses fumigated or disinfected Mosquitoes destroyed in houses: Adult anopheles. ..N ,NA Adult culices.147 Adult stegomyia. Adult mansonia. Number of containers found with stegomyia larw Fly-breeding places destroyed. Rats destroyed. Material used: Crude off. galloi. Larvacide. Kerosene.

PAGE 63

61 TABLE XVIII.-QUARANTINE SERVICE. PORTS OF PANAMA-BALBOA AND COLON-CRISTOBAL. pcted an(d passed. .2,155 d e d in quarantine .191 elsdetained but sailing in quarantine. 38 inspections of vessels detained. 664 Oeals .iged on arrival. .191 fTssels fumigated on departure. 26 {rew inspected. 134,086 IAers inspected. 44,309 Stowaways inspected. 44 otal persons examined. 178,439 upplementaryinspections. 27,203 Persons vaccinated at ports of arrival because of compulsory vaccination law. $,813 Persons vaccinated at ports of departure or en route because of compulsory vaceinationlaw. 12,868 Total persons vaccinated. 16,681 Persons held in quarantine at the detention stations to complete period of ation of yellow fever or plague. 4,375 held in quarantine on board vessels to complete period of incubation ofyellow fever and plague. 21,405 Poliomylitis suspects detained. 45 Total persons held in quarantine. 25,825 rersons landed from foreign ports: in. .20,524 Steerage. 13,821 -Total. 34,345 Persons embarked for foreign ports: Cabin ..20,483 Steerage. 15,875 Total. 36,358 Apparent decrease for the year from foreign ports: Cabia (increase). 41 Steerage (decrease) ...2,054 Total (decrease). ...2,013 Prgonsarrivingfromcoasttownsonsmallcraft. .21,510 Personsembarkedforcoasttownsonsmallcraft. .18,534 Xpparent increase for the year from coast towns. 2,976 Toalnumber of persons landed. 5855 total number of persons embarked. 54,892 Excess over number embarked. 963 L~ess number for Pacific ports. .2,774 Apparent decrease for year. 1,811 Immia recommended for rejection and deportation. 311 Wlls health issued. .2,159 issued. 290 tions of docks. 181 ions of vessels at docks. ..670 BocAs DEL TORO. ls inspected and passed. ..* .206 inspected and passed. ..15,204 inspecgted and passed. 2,718 rs, in transit, inspected and passed. .1,921 L W.

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62 TABLE XIX.-PERSONNEL REPORT. [Average number of employees it work during year.] Dec. 31,1918. 1916 1915 Gold. Silver. Tot. Chief health office. 4 4 3 .. Medicalstorehouse. 8 8 4 4 8 Quarantine service. 45 42 12 34 4A Health office: Panama. 159 162 12 140 152 Colon. 172 153 10 148 Ancon Hospital. 362 333 124 246 J7 Colon Hospital. 41 36 17 26 43 Santo Tomas Hospital. 6 5 6 .6 Palo Seco Loper Asylum. 29 27 2 34 36 Zone sanitation. 124 118 6 115 12L Hospital farm. 59 49 2 66 68 Dispensaries: Balboa. 7 6 5 3 8 Gamboa. -1 Gatun. 4 4 2 2 4 Paraiso. 4 4 2 2 4 Pedro Miguel. 3 3 2 1 3 Total. 1,028 963 210 821 1,o1a TABLE XX.-HOSPITAL AND TOTAL CASES OF MALARIA AMONG EMPLOYEES. Admissions. Deaths. Total White. Colored. White. Colored. H Total. HosTotal. HosTotal. Total. Hos pitJ pital. pital. pital. pital,. January. 10 19 30 30 ....4014. February. 15 18 26 27 ....41 March. 8 11 7 9 ....15 Apil. 6 9 12 13 ....18 May. 7 8 20 22 ... June. 20 24 38 38 ..1 1 58'. July. 26 30 88 89 .... August. 14 21 63 63 .... September. 9 10 28 29 ..... October. 18 is 19 19 ..1 1 37 November. 3 3 12 13 .... December. 8 9 15 15 .... Total.144 180 358 367. .2

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63 XX.-HOSPITAL AND TOTAL CASES OF MALARIA AMONG EMPLOYEES-Continued. Annual a-erage Annual average per 1,000 deaths. per 1,000 cases. Number of employHosTotal. Hosees. pital T pital. Total. ..15 19 31)223 ..16 18 30, 497 5 7 33,084 ....6 8 33,856 m. 9 10 34,393 0.38 0.38 22 24 3,0 ...40 42 33,787 Ags.A. ...28 30 33,609 .tember. ..13 14 33,528 r ..36 .36 13 13 33,272 ...5 5 35,031 ..8 8 34, 327 Total. .06 .06 15 16 33,176 41: Y. :n,

PAGE 66

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