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communication with those countries by regular lines of steamships. The latter is the existing problem, and it will be convenient to review it before considering the new problems that will arise from the construction of the Panama Canal.

So far as I have been able to learn, the trans-Pacific steamship traffic of the New World is at present carried :—

(1) From Vancouver by the ships of the Canadian Pacific Railway Company, which maintains one service via Yokohama and Shanghai to Hong Kong, and another via Honolulu and the Fiji Islands to New Zealand and Australia.

As Vancouver is far above the zone in which yellow fever can occur, there

is no danger of the conveyance of yellow fever by those ships.

(2) From San Francisco by some eight or nine lines of steamships, the details of which are given in the section of this report dealing with Honolulu. Most of them trade as far as Honolulu only, but the ships of the l'acific Mail Steamship Company run to Japan, China, and Hong Kong; and the United States army transports and some freight steamers go to the Philippines.

San Francisco is in regular shipping communication with the coast ports down to Panama, the journey to that place taking from 26 to 30 days: but it lies at latitude 37° north of the Equator, and although the possibility that it might suffer from short outbreaks of yellow fever cannot be entirely dismissed, such an event, in view of the thorough protective measures in force, is very unlikely, and any case it is most improbable that it would become a centre for the dissemination of the disease.

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(3) From Manzanillo and Mazatlan by the ships of the Toyo Kisen Kaisha Company and the Eng Hook Fong Company, which run viâ Honolulu to Japanese and Chinese ports and Hong Kong.

(4) From Salina Cruz by the ships of the American Hawaiian and the Toyo Kisen Kaisha Companies to Honolulu and to Japan and China, and by one or more lines to Tahiti and New Zealand.

The Mexican ports just named are, I think, of most importance from our present point of view, for there are a number of reasons in favour of the opinion that yellow fever may become seriously prevalent in them. Salina Cruz is especially important as being the Pacific terminus of the Mexican inter-oceanic railway across the Isthmus of Tehuontepec, the connecting ports on the Atlantic being Puerto Mexico and Vera Cruz, which is the largest port in the country. was opened in January, 1907, and has since carried an immense amount of traffic. The railway By this route the distance from San Francisco to New York is shorter by about 1,000 miles, and from Honolulu to New York by nearly 2,000 miles, than by the route across the Isthmus of Panama, and it has, therefore, been said that the railway may prove a formidable rival to the Panama Canal. Already it connects on the Atlantic side with eight lines of steamships and on the Pacific side with six, and is the route used for nearly all the freight traffic between Hawaii and the Atlantic coast, the American-Hawaiian Steamship Company alone carrying every year about 300,000 tons of sugar from Honolulu to Salina Cruz en route to New York and Philadelphia. Another factor favouring an increase of trade in Mexican Pacific coast ports is the extension of the Southern Pacific section of the Pan- American railroad as far as Mazatlan, and it must not be forgotten, also, that those ports will be principally affected by the increased commercial activity that will follow the opening of the Panama Canal. Salina Cruz is not reported as being indigenously affected with yellow fever at present, but as recently as February, 1912, seven imported cases occurred there on a ship from Guayaquil, a severely infected Ecuadorian port of which a separate account is given in Section III.; and, in addition, it must be noted that there is much coasting trade between the port and suspected ports in Guatemala, Salvador, Nicaragua, Colombia, and Peru, and that during recent years the national railways of Mexico have brought it within easy reach of dangerous areas on the Gulf coast. It should be added that the Mexican Pacific coast port of San Blas is believed to be the port from which in 1826 mosquitoes were first introduced into Hawaii, and that in October, 1910, a case of yellow fever was discovered at Honolulu on a ship from Manzanillo.

(5) From South American Pacific coast ports as far down as Valparaiso and Coronel by the ships of the Toyo Kisen Kaisha Company. In this connexion it is important to note, however, that the ships just mentioned, after calling at Salina Cruz, enter upon a coasting voyage as far down as Coronel and return by the same route, so that for the trans-Pacific voyage, Salina Cruz is really the port of departure from the continent. The voyage from Valparaiso to Yokohama by this route takes

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considerably more than two months. The ships do not call at Guayaquil or at Tocopilla, which are the only ports on the Pacific coast of the New World definitely reported as being indigenously affected with yellow fever at present.

I have not been able to obtain details of the sailing ship lines engaged in trans-Pacific trade, but the two charts* which I append show the tracks followed by sailing ships in the Pacific Ocean, and that information is sufficient for our present purpose.

The chief conclusion to be drawn from the above summary is that at present most of the traffic to the East starts from ports such as Vancouver and San Francisco, which are not now, and are not likely in the future to be, infected with yellow fever, but that there is also (and has been for some years) a moderate amount of traffic from ports, especially on the Mexican coast, which at least must be regarded with suspicion.

Turning now to the new problems that will arise when the Panama Canal is open for traffic, I may say at once that it is by no means sure that the canal will increase the risk of the spread of yellow fever to the extent that has been antici- pated. In this connexion it must be noted that the yellow fever situation on the Atlantic side of the canal and in the canal zone itself is now very different from what it was in 1903, when Sir Patrick Manson first drew attention to the dangers now under consideration. Since that time measures have been taken which have gone far to cause the disappearance of yellow fever from places which formerly were severely affected and to check materially the facilities for its dissemination from places where it is still endemic. Very important facts are that Panama, Colon, Havana, and other Cuban ports, New Orleans, Rio de Janeiro, and nearly all the West India Islands are at present free from the disease, and that, as regards such ports on the Atlantic side of the canal as are likely to be engaged in trans- Pacific trade, we cannot name any that are definitely believed to be endemically affected at present. In addition, great importance must be attached to the knowledge that every possible precaution has already been taken, and will doubtless be continued, to prevent the canal from being a route by which disease may be spread. It is realised that the extensive use of the canal as a commercial highway would be greatly affected by the failure of those precautions, and it is very improbable that the United States will in the future neglect their great responsibility in regard to them. As conditions in the canal zone stand at present, a ship proceeding, say, from New York to Honolulu, and calling only at Colon and Panama, would be as safe from the danger of being infected with yellow fever as if she had not passed through the endemic area at all. This being so, it will be clear that, if the canal attracts traffic which at present crosses Central America by one of the inter-oceanic railways and leaves from suspected ports on the Pacific coast, it may well be a safeguard rather than a danger. It may happen, for example, that the through traffic between New York and Honolulu and Japan, which at present goes by way of Puerto Mexico and Salina Cruz, will in future be carried by direct shipping through the canal, and this would be a safer route.. The shipping from Salina Cruz to Tahiti and New Zealand may be affected in the same way. On the other hand, of course, the increased "local" trade may add to the present distribution of yellow fever and introduce new dangers which cannot at present be foretold; and it is clear, also, that we cannot be entirely without apprehension regarding the possible risks from places like New Orleans and other ports in which several years' freedom from yellow fever has been followed by a cessation of vigorous anti-stegomyia measures, and that, even as regards the canal, its safety as trade route depends upon the continuance of the present very efficient arrangements in the zone and terminal ports.

This completes the summary so far as it relates to the degree of danger at the source of yellow fever and the risk that ships will start their voyages across the Pacific in an infected condition; and it is necessary next to trace the routes of ships from the endemic arca to their destinations in Asia. The details on this subject are given in Section III., and only the following points need be summarized here.

(1) At present all ships which leave America for the trans-Pacific voyage to the East from San Francisco and more southerly ports use the Hawaiian Islands as the first place of call. The conditions in these islands are throughout the year favourable to the existence of yellow fever, but up to the present the disease has

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