is seized with a violent fit of coughing of the laryngeal type, which lasts for several minutes. Beyond this, there appears to be little inconvenience suffered from these treatments.

This

Dr. Horwitz has been able during the past year or more to parole as probable cures twenty-odd patients. Of course, they are required to report to him every three months. number of patients paroled represents approximately 20 per cent of those at the colony. You can understand what even that one-in-five hope means to those inmates. And, it is much more far-reaching than merely the encouragement of those already there, for those patients who are released, go back home to spread the glad tidings, and to urge other suspects to seek medical aid while yet there be hope of a permanent cure. This will gradually break down the age long custom of hiding these lepers by their immediate families from the authorities as long as it is humanly possible. Once again, I beg, let us give grateful acknowledgment to that intrepid physician, Dr. Philip Horwitz, for consecrating his skill and his life to this important work. The inmates of the leper colony are almost all of Panamanian, West Indian, or Chinese birth.

It is primarily due to the wisdom and foresight of the framers of the treaty between the United States and the Republic of Panama that a provision was inserted giving the Zone health officer the exclusive control over the sanitation of the Republic of Panama, and the right of appointment of an American physician as health officer in each of the cities.

One of the outstanding vital achievements of the development of the Canal

Zone has been the cleaning up of Panama City and Colon.

When we first began operations on the Isthmus, conditions in those two cities were unspeakable. The task was well-nigh hopeless. Even as late as 1915, when I first visited those cities, there was but little outward evidence of improvement, whereas, today, those cities are even more scrupulously cleanly than is our own capital city. They are so free from breeding places for the mosquito and the housefly that screens are unnecessary. This change has been due in no small part to the skill, tact, and firmness of Dr. Henry Goldthwaite, who has been health officer of Panama City for the past nine years. That which has been said of Panama City and Dr. Goldthwaite, is equally true of Colon and Dr. J. L. Byrd.

An efficient quarantine division is the surest guarantee for the future prosperity and good health of the Isthmus.

This department of the Canal Zone administration has always been a strong, virile one, but never more so than at the present time under the direction of Dr. C. P. Knight, a surgeon of the United States Public Health Service, who, like those from the United States Army Medical Corps, has been loaned, as it were, for health work in the Zone.

This department safeguards not only the Zone, Colon, and Panama City against the introduction of communicable disease, but in a measure, all the nations of the world as well. Ships from every quarter of the globe constantly pass to and fro through the canal, where all may be and many are, fumigated and disinfected at a

minimum cost, even though they do not land either merchandise or human beings on the Isthmus.

Turning for a moment, to a consideration of the hospital situation, I may truly say that no section of the entire world is better supplied with hospital facilities than is the Isthmus.

Foremost of all these institutions stands the justly celebrated Ancon Hospital, built in 1919, on the site of, and to take the place of, the old frame French hospital. It is up to the minute in every detail of equipment and practice. It is gratifying to us to know that the new Ancon Hospital was erected under the direction of Col. D. C. Howard, who was Chief Health Officer of the Canal Zone during that period, and who, at the present time, is the Superintendent of Garfield Memorial Hospital, which hospital is now being remodelled and brought up-todate under his immediate supervision. The medical men responsible at the present time for the high standard maintained by Ancon Hospital are Colonel W. L. Pyles, the Superintendent, who is a recognized authority in hospital construction and management, Colonel Roger Brooke and also Dr. T. W. Earhart, Chief of the Surgical Service, and Dr. R. C. Connor, Chief of the Medical Service, and under whom is a large corps of able assistants. Ancon Hospital always has for its Superintendent an officer chosen from the United States Army Medical Corps, who is especially skilled in hospital management.

At Colon the Health Department maintains an efficient Emergency Hospital of 75 beds, under the direction of Dr. J. L. Byrd.

Perhaps second only to Palo Seco in interest for me was Corozal, the hospital for the insane of the Zone and the Republic of Panama. Captain G. E. Hesner, of the United States Army Medical Corps, is the present Superintendent of Corozal. Under Captain Hesner's management this institution has been brought up to its present high standard of efficiency, and by him the associated activities have been largely developed. While Corozal is much more extensive than Palo Seco, yet it possesses in its way, equal attractiveness and commands the profound admiration of anyone who takes the time to go through it leisurely.

The patients confined at Corozal receive not merely custodial care, but are given such treatment as each case requires. As Dr. Curry, Assistant Chief Health Officer, puts it "Corozal is not just a madhouse, but a busy, thriving, industrial colony, where the mentally sick are trained in useful work, and their minds are steadied into directed channels."

In connection with the hospital is maintained a constantly enlarging dairy and truck farm, a broom factory, a toy shop, and other occupational activities suited to women as well as men. Here again one is struck by the atmosphere of happiness and contentment among the inmates.

It is at Corozal that the Hydnocarpus weightiana trees, from the fruit of which the chaulmoogra oil is obtained, have been successfully grown for the first time in United States territory. The fruit contains several large oblong seeds, from which the oil is expressed. These trees are definitely either male or female, and the

fruit or nut is found exclusively on the female trees.

In Panama City is located the Santo Tomas Hospital which is in process of development. Those buildings which are already erected and occupied are second to no hospital buildings anywhere with which I am familiar, and the equipment is well up to the last word. These buildings, as well as the ambitious, comprehensive plans for future expansion are almost entirely the work of Captain E. A. Bocock, who was for some years Superintendent of Hospital work in Panama City. The funds for hosThe funds for hospital construction, as well as maintenance, come from the Lottery Company, a Panamanian national enterprise. At the present time the management of the Santo Tomas hospital has been taken over by the Panamanians, but is still under the supervisory control of the Health Officer of the Zone.

One of the important adjuncts to the medical work on the Isthmus is the Board of Health Laboratory, which, though not as extensive as some laboratories, yet is considered second to none in the world. To Colonel F. B. Russell is largely due the credit for this attractive and well designed building, and its up-to-date equipment. Dr. Louis Bates, the present Head of the Laboratory, maintains the high quality of the work turned out by this department. Here are made all the chaulmoogra acid esters and the castor oil acid esters which are used at Palo Seco.

The splendid achievements which the United States has obtained on the Isthmus have been due to the form of government adopted for the Canal

Zone, which permitted an efficient administration by technical men.

It is greatly to the credit of our country that the men to whom has been entrusted the construction and operation of the Canal, and the essential associated activities, have been uniformly of such a high type.

The Governor-General is the supreme administrative officer in the government of the Canal Zone. Like his predecessors in office, the present Governor-General, Colonel Merriweather Walker, is a man of the highest engineering and administrative ability.

The Health Department of the Zone in which we as medical men are especially interested operates under the administration of the Governor-General. This department at the present time is under the immediate direction of Colonel W. P. Chamberlain, of the Medical Corps of the United States Army. Colonel Chamberlain's accomplishments as Chief Health Officer of the Zone entitle him to the highest praise.

The Health Department of the Canal Zone consists of the Division of Hospitals, and Charities, the Division of Quarantine, and the Division of Sanitation.

The Division of Quarantine is under the immediate direction of Dr. C. P. Knight, a surgeon of the United States Public Health Service, under whose administration this department is maintained at a high degree of efficiency.

The Division of Sanitation is under the direction of Dr. D. P. Curry, former State Sanitary Engineer of Kentucky, who is doing an invaluable service in his field, by the extension of

permanent sanitation, wherever possible, rather than by temporary

measures.

The various hospitals are under the direction of United States Army medical officers, who are especially skilled in hospital administration, and among whom are such distinguished men as Lieut. Colonel Pyles, Lieut. Colonel

Roger Brooke, Dr. Earhart, Dr. Connor, and Captain Hesner.

In closing, I wish to express my grateful appreciation of the many courtesies shown me, and the exceptional opportunities afforded me for observation by all those officials with whom I came in contact during my visit on the Isthmus.

THE ARMY MEDICAL LIBRARY

T

HE Army Medical Library, formerly known as the Surgeon-General's Library, is the great National Medical Library of the United States. It is also second in

size and importance only to the Library of the Medical Faculty

of Paris. The latter library is the largest of the world, and in 1920 the Paris collection contained 310,000 volumes, 450,000 pamphlets, 170,000 theses, 7350 sets of periodicals (850 current), 85 medical incunabula and 767 medical manuscripts. In the same year Surgeon-General Ireland estimated the number contained in the Washington collection as 274,373 volumes and 367,000 pamphlets making a total of 641,373 printed items;

in addition to these there were 6400 portraits of physicians, 149 medical engravings and 316 caricatures. The current periodicals numbered nearly 1500; and there were over 300 incunabula. As far as the the collection of medical periodicals is concerned there can be no doubt that the Washington collection is the largest and best one in the world. This fact makes this library the most important reference library in the world in so far as the bibliography of modern investigative medicine is concerned; and the library authorities have done all in their power to make this collection available to the medical profession of

the United States. The librarians

have given personal aid to the physicians visiting the library; and every medical meeting held in Washington that brings to it physicians from places outside of Washington sees in the library an influx of readers and workers

with their lists of references not available elsewhere. This has been one of the great functions of this library, and one of the best reasons for holding medical meetings and congresses in Washington. All possible help has been given to such research workers by the officers of the library. Cubicles with special book shelves have been provided for researchers, and even a special private room. inter-library loan system has also been one of the most important features of the library; and through it any medical investigator in any part of the country may obtain book-loans under certain conditions through the library

An

of his school or town. While this service has been of the greatest advantage to the worker far removed from Washington and to whom the library is inaccessible, the consequent wear and tear upon the books themselves must necessarily greatly restrict the future extension of interlibrary loans as far as old and rare books are concerned. Another great service to medical researchers has been the development of the Card Index and Index Catalogue of which several