idea about Panama seems to be that we shall suffer as the French did and as all European venturers in Panama did, and that, instead of dying as we do in New York, at the rate of twenty per thousand per year, we shall die, as sometimes occurred to the French and others at Panama, at the rate of five or six hundred per thousand per year. Other men of experience in the tropics, and who have been at Panama for some time, maintain that the matter of sanitation is exceedingly simple and easy, and that the health of the Panama strip ought to be as good as that of most parts of the United States. Both opinions, it seems to me, are extreme, and the truth will fall somewhere between the two. Any health officer with experience in dealing with a practical question of this kind will know how exceedingly difficult it will be in a population of about fifteen thousand (that is the population of the villages along the Canal line) people infected with malaria to devise and apply any system by which the cases can be individually recorded and treated. Personally I approach the problem with hope and expectation of having approximately the same success that rewarded similar efforts applied by our military authorities in Cuba. But it is

no simple matter. We shall, no doubt, meet with disappointments and discouragements, and shall succeed in the end only after many modifications of our plans and after many local failures."

Before describing the present health conditions in the Zone, it will be well, by way of furnishing a comparison, to give a brief statement of what they were during the period of French occupancy. The first work on the Canal was done in 1881, but few men were employed until the following year, when the force numbered nearly 2,000. It was gradually increased until in 1884 the average number of laborers carried on the pay rolls was 17,635. During the eight years in which the operation was carried on by the Panama Canal Company and its successor, an aggregate of 86,812 men were employed, giving an annual average of 10,881. The number treated for illness was 52,814. The number of deaths was 5,627, giving an average per year of 6,535 sick and 703 deaths in a force of less than 11,000.

At the present time all classes of employes on the Canal are comfortably housed and furnished with wholesale food at low cost. In fact, the majority of them live under conditions con

siderably better in this respect than they would enjoy at home. Extensive provision is made for their recreation, including several club houses at different points operated by the Young Men's Christian Association.

During the year 1908, the death rate among an average white force of 12,058 was 15.34 per one thousand; and among the 5,000 American employes, 8.14 per one thousand. In the force of blacks, averaging 31,000, the mortality was 19.48 per thousand, or less than the average of the City of New York.

During the year 1909, the health conditions in the Zone showed an improvement over the preceding year. The total admissions of employes to hospitals and sick camps, including those sick in quarters, amounted to 46,194, representing for the year 23.49 as the number of men sick daily out of every thousand names on the pay rolls, as against 23.85 for the preceding year. This is a percentage of considerably less than 3, and the majority of the cases were of trivial consequence. The total number of deaths was 530, and assuming that the average number of names on the pay rolls for the various months of the year amounted to 44,261, the number of deaths would be equivalent to a

rate of 11.97 per thousand, as against 18.32 for the preceding year.

This truly wonderful showing is the more remarkable when it is considered that a large proportion of the West Indian laborers who are imported arrive in an underfed condition and many of them suffering from disease. In great degree the improvement in the vital statistics is attributable to the fact that in recent years the negroes have been compelled to take good and sufficient food under the ration regulations. Formerly the matter of food was left entirely to themselves, with the result that many ate irregularly and insufficiently.

The gold employes are compelled to take six weeks vacation in each year, during which full pay is allowed. Until recently they were required to go out of Panama for their holiday, but since the Commission has learned to appreciate the salubrious climate and healthful conditions of the Province of Chiriqui, employes have been allowed to spend their vacations there, if they desire. The establishment of a sanitarium in Chiriqui for the sick and convalescent is under consideration.

Exercising the right acquired under the treaty with the Republic of Panama, the Com

mission made the most extensive improvements in the terminal ports. Both cities have been paved, cleansed, and supplied with sewer and water systems. In fact, they have been so transformed that they bear little resemblance to the foul and unsanitary centres we found on our arrival at the Isthmus. This work was dictated by practical business policy and an agreement provides for the repayment of the cost of it by the Republic. Had Panama and Colon been left in their former state, the sanitation of the Zone could not have been of much avail. Furthermore, unless these ports are entirely divested of their old reputation as foci of disease, when the Canal is opened to commerce, shipping will take an alternative route whenever that is possible.

When we took over the Canal, the City of Panama was a dirty town of narrow streets, paved with cobble stones. It had neither water nor sewer systems, and the streets were imperfectly drained by means of gutters which were frequently clogged by refuse. The population depended for its water supply upon barrels and cisterns, which were the most favorable breeding places possible for the stegomyia, or yellow fever mosquito. The patios of the