J R Army Med Corps: first published as 10.1136/jramc-50-05-11 on 1 May 1928. Downloaded from 391 ~Ul'l'ent '1Ltterature. Reduction in the Incidence of Malaria Among Residents of Canal Zone Towns_ and the Cities of Panama and Colon.-The statistics just released by Colonel W. P. Chamberlain, Chief Health Officer of the Panama Canal, show that the Health Department has met with unprece­ dented success in its efforts to control malaria during the calendar / year HJ27. - Sanitary regulations in the Canal Zone and the cities of Panama and Colon require that all cases of malaria be reported by the attending physician to the Chief Health Officer. Each such report is at once carefully investigated by the Health Department with a ~iew to confirming - the diagnosis, if necessary, and determining the locality_ where the disease was probably contracted. The figures are analysed each week and tabulated, the cases being charged to the places where infection is considered to have occurred. Protected by copyright. TABLE I.-CASES OF MALARIA REPORTED TO THE HEALTH DEPARTMENT AMONG EMPLOYEE OF THE- PANAMA CANAL -AND THE PANAMA RAILROAD. Cases Aver~ge fOTce -- Rate per 1,000 Calenuar year strength White Black Total ----------------------------------- 1905 .. .. 16,511 .. 8;483 5HO 1906 .. .. 26,547 5,134 16,659 21,793 820'9 1907 .. .. 39,238 7,973 8,682 16,655 ~2~-5 1908 .. .. 43,890 6,352 6,020 12,372 281'9 1909 : .. ., 47,167 4,347 5,822 10,169 215-6 1910 .. .. 50,802 4,884 4,603 9,487 186'7 http://militaryhealth.bmj.com/ 1911 .. .. 48,876 4,175 -4,812 8,987 1839 1912 .. .. 50,893 2,746 2,877 5,623 110'5 1913 .. .. 56,654 1,477 2,807 4,284 75'6 1914 . , .. 44,329 950 2,664 3,614 8l'5 1915 .. .. 34,785 606 1,175 1,781 512 1916 .. .. 33,176 180 367 547 16'5 1917 .. .. 32,589 127 346 473 H'5 1918 . - .. 25,520 64 410 474 18-6 1919 .. .. 24,204 103 649 752 31'1 1920 .. .. 20,673 85 316 401 19-~ 1921 .. .. 14,389 70 144 214 lU 1922 .. .. 10,447 56 120 176 16'9 1923 .. .. 10,976 57 155 212 19'3 1924 .. .. 11,625 55 135 190 16'3 1925 .. .. 12,180 84 246 330 27'1 on September 26, 2021 by guest. 177 1119 1196 116'1 1926 .. .. 12,732 58 121 179 H'l 1927 .. .. 13,560 38 107 H5 10'7 NOTE.-Number of cases from 1905 to 1913, inClusive, are those admitted to hospital only. Those shown in 1914, and since, are aU cases, whether or not admitted to hospital. I Excluding Bruja Point, where a gang of workmen (nominally Canal employees) was installing large guns for the Army in 1925. Over balf these men acquired inalaria in five montbs. Since then the area bas been sanitated by the Army and very few cases occurred among these workmen in 1926 and 1927. J R Army Med Corps: first published as 10.1136/jramc-50-05-11 on 1 May 1928. Downloaded from 392 Current Literature . Statistics for employees of the Panama Canal and the Panama Railroad are naturally the most accurate and complete which are received by the Health Department, because any illness which prevents a man· from doing a full day's work is sure to be recorded and can be completely investigated. The following table shows the remarkable reduction in malaria among employees which has been effected since 1904, when the United States took over construction'work from the French company. Investigation showed that twenty-one of the thirty-eight cases of malari9. during the year 1927 undoubtedly obtained their infections while outside of the sanitated towns. Probably a complete knowledge of all the facts would show that some of the other seventeen cases should also have been charged to un sanitated areas. These figures indicate how little risk there is . of contracting malaria when living in the p1'Otected towns provided visits are nohnade to olltlying regions after sunset. The protected tow:ns are Colon, Cristobal, Mount Hope, Gatun, Paraiso, Pedro Miguel, Red Tank, Corozal, Ancon, Balboa,La Boca and Panama City. The-following table gives striking evidence of the progressive improve­ ments in sanitation during the last five years :- Protected by copyright. TABLE-n.-CASES OF MALARIA (EMPLOYEES, NON-E~rpLOYEES, MILITARY AND NAVAL) REPORTED TO THE HEALTH DgPARTMENT AND CHARGED TO THE SPECIFIED SANITATgD AREAS. Calendar year Sanitated ~reas 1923 1924 1925 1920 1927 -------------;:--------------------- Fort Amador-Balboa-La Boca-Ancon 123 118 133 98 82 -Panama City Corozal-Fort Clayton .. .. .. 155 117 121 103 80 Pedro Miguel-Red Tank-Paraiso' .. 65 50 19 30 22 -------------- http://militaryhealth.bmj.com/ Totals for Pacific side sanitated areas 343 285 273 231 184 --------------- Gatun-Fort Davis " .. 169 158 155 184 90 Cristobal- Colon-Mount Hope .. .. 96 100 61 100 51 Fort Randolph-France Field-Coco Solo 258 158 154 168 85 Fort Sherman .. .. .. .. 147 1'1'2 157 115 62 -------------- Totals for Atlantic side sanitated areas 670 588 527 567 288 -------------- Grand Totals .. .. 1,013 873 800 798 472 Every case of malaria was charged to the sanitated area in which the . patient lived unless the Health Department found clear indications that on September 26, 2021 by guest. infection took place outside the sanitated areas. It is believed that many cases in Table II which are charged to sanitated areas were actually infected outside, the fact of exposure being either forgotten or wilfully concealed by the patient. The progressive reduction in the incidence of malaria within the sanitated towns, as shown by Table II and other statistics, is believed to have resulted mainly from consistent extensions and improvements bf the -anti-mosquito drainage systems. This. kind of work has been prosecuted J R Army Med Corps: first published as 10.1136/jramc-50-05-11 on 1 May 1928. Downloaded from Reviews 393 very intensively during the last three years by the Health Departmellt of the Panama Canal. Material benefit has also resulted in recent years from the extensions and improvements of antimosquito sanitation in and about the military stations, this task being carried out under the auspices of the Medical Department of the United States Army. ,In the employed force, ranging between 10,500 and 13,500, there have been but two deaths frornmalaria during the last seven yean; these were in 1924, one being a white man and the other a black. Both men worked at night, engaged in dredging operations beyond the sanitated areas . • . lRe\)tews. THE EAR,NoSE AND THROAT IN GENEUAL PUAC'l'ICE. By D. A. Crow, M.B., Ch.B.Edin. London: Humphrey Milford. 1927. Pp. x + 150. Price 10s. 6d. An excellent book in every way and one which would be a profitable Protected by copyright. addition to the library of every practitioner. The manner in which it is written is an object lesson to those all too numerous authors who emphasize matter of no g~eat rnoment instead of laying supreme stress upon important. everyday problems. The author very rightly emphasizes in no uncertain fashion· the super­ lative importance of ~he early performance of a myringotomy on cases of otitis media with retention in the tympanum. It is no exaggeration to state that an early myringotomy in a case of otitis media is as important as an early appendicectomy is in a case of appendicitis. In these enlightened http://militaryhealth.bmj.com/ days a practitioner would consider himself deserving of censure if he allowed a case of appendicitis to remain undiagnosed and untreated before the onset of general peritonitis, yet too often the same practitioner would feel no qualms of professional conscience if in it known case of otitis media . under his care he permitted the drum to perforate. Given a little practice, with the aid of an electric auriscope as suggested . by the author, a practitioner would soon become sufficiently proficient to diagnose those aural conditions which urgently demand the performance of a myringotomy and either perform the operation himself, or send the case t.o a specialist. on September 26, 2021 by guest. Since otitis media is one of the commonest complications of the exanthemata it is very important that all doctors in medical charge of fever cases should have sufficient aural training to enable them to recognize arid treat aural cases in the pre-perforation stage. The dire results of omitting to perform this simple operation are amply and graphically shown in this book. It is possible that the forceful and dogmatic statements of the author will bring about adverse criticism in some quarters. .