elch and I had with President Roosevelt, he keenly felt this difficulty
and promised to do his best to have it rectified. It is an open secret
that at first, as was perhaps only natural, matters did not go very
smoothly, and it took a year or more to get properly organized. Yellow
fever recurred on the Isthmus in 1904 and in the early part of 1905. It
was really a colossal task in itself to undertake the cleaning of the
city of Panama, which had been for centuries a pest-house, the mortality
in which, even after the American occupation, reached during one
month the rate of 71 per thousand living. There have been a great many
brilliant illustrations of the practical application of science in
preserving the health of a community and in saving life, but it is safe
to say that, considering the circumstances, the past history, and the
extraordinary difficulties to be overcome, the work accomplished by
the Isthmian Canal Commission is unique. The year 1905 was devoted to
organization; yellow fever was got rid of, and at the end of the year
the total mortality among the whites had fallen to 8 per thousand,
but among the blacks it was still high, 44. For three years, with a
progressively increasing staff which had risen to above 40,000, of whom
more than 12,000 were white, the death rate progressively fell.

Of the six important tropical diseases, plague, which reached the
Isthmus one year, was quickly held in check. Yellow fever, the most
dreaded of them all, never recurred. Beri-beri, which in 1906 caused
sixty-eight deaths, has gradually disappeared. The hookworm disease,
ankylostomiasis, has steadily decreased. From the very outset, malaria
has been taken as the measure of sanitary efficiency. Throughout the
French occupation it was the chief enemy to be considered, not only
because of its fatality, but on account of the prolonged incapacity
following infection. In 1906, out of every 1000 employees there were
admitted to the hospital from malaria 821; in 1907, 424; in 1908, 282;
in 1912, 110; in 1915, 51; in 1917, 14. The fatalities from the disease
have fallen from 233 in 1906 to 154 in 1907, to 73 in 1908 and to 7 in
1914. The death rate for malarial fever per 1000 population sank from
8.49 in 1906 to 0.11 in 1918. Dysentery, next to malaria the most
serious of the tropical diseases in the Zone, caused 69 deaths in 1906;
48 in 1907; in 1908, with nearly 44,000, only 16 deaths, and in 1914,
4.(*) But it is when the general