sanitary rules and regulations, and the conditions existing in all of them have been greatly improved since the system was started.

Barber shops also come under this classification, and regular inspection is also made of these establishments to see that they comply at all times with the sanitary regulations.

Of the new and important sanitary ordinances which were referred to in my annual report for the calendar year, slow but steady progress has been made with all except that relating to the reporting and registration of births and deaths. This ordinance, which was approved by you on October 17 last, has not been published by the Panama Government, and therefore we are not getting these very important reports. The ordinance has been the subject of considerable correspondence, and I recommend that the publication and enforcement by the Panama Government be insisted upon.

When the street cleaning in Panama City was taken over by the Isthmian Canal Commission September 1, 1913, it was estimated that it could be done for $48,000 a year, and it was agreed that the Isthmian Canal Commission would contribute $10,000 of this amount, the remaining $38,000 being paid by the Panama Government. The agreement contained a clause that it might be terminated at the end of any 12 months thereafter, provided that notice was served two months in advance by either party to the agreement.

Since this arrangement was made the population of Panama has increased at least 33 per cent, and the area of streets and yards to be cared for and the amount of garbage to be removed has increased in the same proportion, rendering it impossible to do the work properly for the amount agreed upon. The Panama Government has therefore been notified of our desire to amend the existing arrangement so as to allow at least $60,000 for street cleaning, of which the Panama Government should furnish $50,000.

Detailed statistics are shown in Table XXV.

COLON.

The broad aim of the health work in Colon for the past year was to supplement the excellent work of the past years with certain measures specially designed to meet requirements for the opening and operation of the canal. Among these there were a number of structural improvements necessary to prevent rat infestation, as well as to diminish the accumulation of rubbish, and containers for Stegomyia and flies. Such were the condemnation and demolition of the Pacific Mail pier and the old Panama Railroad pier No. 1; another was the rat proofing of the Panama Railroad freight depot. Part of Panama Railroad pier No. 11 was repaired, and while it is not yet fully rat proof, it is greatly improved. The new Piers Nos. 8 and 9 are rat proof, as will also be No. 7, now in process of construction.

A notable improvement effected has been the concrete sea wall along Folks River water front, in the southern part of the city. This section had a low sloping beach, which had long been full of rubbish and the accumulation of filth from the tides as well as from the considerable schooner and cayuca trade which centered there. The wall runs from near the Consumer's Laundry to the canal corral, and the ground there is filled with cinders to street level, making the beach clean and neat, besides greatly improving the traffic facilities.

In cooperation with the alcade of Colon, many sidewalks were repaired. Better concrete was also put in this work than that formerly used. Houses in the city were condemned and demolished or replaced to the number of 82, and a larger number were repaired for sanitary reasons, the main repairs consisting of concreting the floors and side foundation walls.

The Panama Railroad corral was radically improved with concrete floors, pavements, and drains in and about all the stalls and vehicle sheds.

Structural repairs were made in the Colon market, the roof and floor being repaired, the toilets overhauled, marble and concrete slabs being placed in the meat and fish markets, and rat-proof chicken coops of standard type installed.

All

The Colon private stables were overhauled; one new and improved stable was built according to our plans; four stables were condemned. Further improvement of these stables is in progress. pigs and live stock are required to be kept out of the city, either at these stables or at other designated centralized places. In extension of the plague-prevention work it was decided to diminish food supplies for rats by requiring all fowls and other pet animals whose food was usually exposed to be kept in standard rat-proof coops or cages. Feed for horses and cattle was also ordered to be properly kept in ratproof containers. The killing of rats was carried on by two rat catchers with good results. The traps were the E. Z. K. killing trap and the Marty cage trap. A special mouse trap was designed and made and found effective. In certain cases poison was used.

Mosquito work was facilitated by several new measures. Some bad swamps in the southern end of Cristobal and near the cemetery in Mount Hope were filled in by hydraulic filling. Many vacant lots in Colon were filled by property owners at the request of this office. Large numbers of water barrels and other containers were eliminated by the condemnation and destruction of certain premises in Colon and in Mount Hope. The use of drip barrels of crude oil on ditches in Colon was commenced at places indicating their use. A notable work of mosquito elimination on Telfers Island was effected by drainage ditches and by admitting sea water into some low places. The locality known as Guava Ridge in Mount Hope, which was an obstinate breeding place, was ditched and drained. Special ditching of a breeding ground behind the radio station in Colon, caused by the settling of the hydraulic fill at the station, has been undertaken.

The campaign against flies was carried on by some measures additional to those already used with success. These were the improvement of the stable districts mentioned above, the better cleaning of garbage cans and stands, and the better policing of the premises around the cold-storage and manufacturing plant of the commissary. The great fire in Colon caused an increase in flies by canned goods bursting open under fallen structural material, but reduction of these flies was effected by spraying them with a solution of larvacide and by liberal use of fly paper.

The collection and destruction of garbage has been carried on as previously, except that the work in Cristobal district formerly done by the Quartermaster's Department, together with the grass cutting, was consolidated with that done in Colon under this office.

The general plan of periodic inspections has been carried on by having one inspector assigned to all building work, making a complete daily round of the city of Colon to see that new buildings and repairs are carried out according to regulations as well as to inspect the condition of all buildings.

Another inspector is given charge of the streets and alleys, garbage collection and destruction, grass cutting and ditching, and of the markets and slaughter houses. Another inspects daily the bakeries, bottling works, restaurants, hotels, grocery shops, barber shops, laundries, and all industrial establishments requiring sanitary attention, besides overseeing the rat work, conducting any special investigations of complaints as required, and seeing that orders for abatement of nuisances are enforced.

Another has charge of the daily mosquito and fly work, using a small gang of laborers, and covering the whole of Manzanillo Island at least once a week.

A periodical examination of the schools is carried on, both of the pupils and of their general sanitary conditions. No serious epidemic has occurred, the only infectious disease of an epidemic character during the year involving the schools having been that of mumps, which seems to have spread in the beginning from the colored population through domestics in the homes of the school patrons. The disinfection of school books, the use of sanitary paper cups, special lectures on hygiene and public health, the introduction of courses of study on these lines in the schools, and the coordination of the work of the teachers, the governmental and private physicians, and the health office have also been instituted.

The dredges in Colon Harbor have been regularly inspected and their condition improved.

There has been started a systematic card-reporting plan for keeping the health office informed at once of all notifiable diseases. The canal physicians, those of the Panama Government, and all private practitioners are required to report at once every case coming under observation with data adequate for dealing with the case as may be required. In the matter of tuberculosis control, some poor patients were sent to hospitals for treatment at the initiative of this office. This was made a notifiable disease, and premises are disinfected against it. Both by posters and by personal oral instruction by the health officer and inspectors a campaign of education has been carried on. The use of the public press has also been resorted to, and it is intended during the current year to increase these measures in a number of ways. Vaccination work was carried out by examining 22,866 persons; 22,275 were found protected, 591 were vaccinated.

The great fire in Colon of April 30, which destroyed 23 blocks of the city and rendered temporarily homeless about 5,000 people, naturally produced special sanitary problems and demanded energetic measures. Three hundred and fifty Army tents were loaned the homeless and set up on Broadway from Ninth Street to Colon Beach, as well as on several vacant lots. Some 50 box cars were also loaned by the Panama Railroad for use as shelter. A census taken soon after the fire showed only 37 vacant rooms in the whole city, and these were all special cases reserved for one reason or another. In installing this refugee camp, closets were set up on the street and trapped to the sewers. Some pit closets were used where

water connections were not available. Washing and bathing were provided for. Pipes for drinking water were laid down. A detail of a sanitary inspector and a gang of men was made to work solely around these camps. A camp dispensary was established in charge of an Army medical officer, while the general care of the camp was in his hands, assisted by nine men from the Hospital Corps of the United States Army. No serious sickness occurred in or has been traceable to these camps. The health office cooperated as much as possible with the local Red Cross in its relief work. Inspectors distributed meal tickets and helped to locate and report needy cases. The inspectors did a good deal of personal relief work incidentally to the rounds of duty.

The burned area was cleaned up thoroughly and with commendable dispatch by forces of the Panama Railroad. The débris was packed into a dump on the hydraulic fill east of Broadway between Eleventh and Fourteenth Streets.

The general rise in rents throughout the city of Colon and the fact that there has been no rebuilding whatever has resulted in increasing rather than decreasing the number of persons who must be sheltered. The tents loaned by the Army are rapidly going to pieces and will last but a few months longer, and unless some other arrangement can be made for the sheltering of these people an acute situation will soon arise.

In order to accumulate information bearing on infant mortality and morbidity, the registration and control over midwives was made more effective. The cooperation of the Colon municipality was secured in this matter, and the records of the city are compared with the statistics of this office as a means of checking the reports.

Plans are now on foot for giving illustrated lectures on public health before the public and private schools in English and Spanish and for increasing the general educational influence of the work. Detailed statistics are shown in Table XXV.

QUARANTINE DIVISION.

During the fiscal year the quarantine station on the Atlantic side was moved from the old quarantine reservation to the new one, on the Colon Hospital grounds. Small repairs were made to the buildings here, screening renewed, etc., and the arrangements for the comfort and care of detained passengers much improved.

At the Pacific entrance to the canal the quarantine station was removed from its old site, on Culebra Island, to the mainland, on the Balboa dump, the buildings being transferred and reconstructed. The present area, while farther from the anchorage grounds of incoming vessels, is very satisfactorily located, and the reservation well laid out, partially graded, and the new permanent landing stage nearly completed. Completion of grading, the laying of concrete walks, and the inclosing of the reservation is expected to place this station in very good condition.

The number of passengers inspected during the fiscal year was not nearly so many as during the previous year, practically falling off a third-probably due to the European war and the consequent financial depression occurring in other countries. On the other hand, the increase of vessels inspected on account of the opening of the canal

amounted to 583, the number for 1914 being 1,447, with 2,030 for the fiscal year just ended.

One case of smallpox, taken sick on February 7, on the Panama Railroad steamship Panama, arriving at Cristobal February 3, was removed to Balboa quarantine on February 10. One practically recovered case of smallpox was received at Balboa quarantine in April from the Pacific Mail steamship Newport, this case probably originating in some Mexican port. No other disease of a quarantinable nature arrived at and none occurred in our ports during the year. Detailed statistics are shown in Table XXVI.

INDEX OF STATISTICAL TABLES SUBMITTED WITH REPORT OF THE CHIEF HEALTH OFFICER, PANAMA CANAL.

TABLE I. Admissions, deaths, and noneffective rates for employees; deaths of residents of Panama, Colon, and Canal Zone.

II. Deaths by age, color, and sex.

III. Deaths by nationality.

IV. Causes of deaths of employees.

V. Deaths of white Americans and white foreign employees.

VI. Causes of deaths of employees and civil population and places where chargeable.

VII. Admissions and deaths of employees and soldiers in hospitals of The Panama Canal.

VIII. Consolidated hospital report.

IX. Consolidated sick camp and admission to quarters report.

X. Consolidated hospital and admission to quarters report.

XI. Employees: Constantly sick and noneffective rates per 1,000.

XII. Employees: Days' treatment per admission, hospitals, and quarters.
XIII. Subsistence and operating expenses and financial statement.

XIV. Patients other than employees treated in hospitals and amounts received for their treatment.

XV. Surgical operations performed in hospitals.

XVI. Operations and work performed in eye, ear, nose, and throat clinics.
XVII. Consolidated ward laboratory report of all hospitals.

XVIII. Report of Ancon Hospital.

XIX. Report of Colon Hospital.

XX. Report of Palo Seco Leper Asylum.

XXI. Report of Santo Tomas Hospital.

XXII. Report of Santo Tomas Hospital (continued).

XXIII. Report of board of health laboratory.

XXIV. Report of issues of quinine.

XXV. Sanitary work done in Panama, Colon, and Canal Zone.

XXVI. Quarantine transactions.

XXVII. Personnel report.

XXVIII. Hospital and total cases of malaria among employees.

TABLE I.-Admissions, deaths, and noneffective rates for employees: Deaths of residents of Panama, Colon, and the Canal Zone.