In 1904, when we first reached Panama, yellow fever surrounded us in all directions. Guayaquil, Ecuador, on the west coast of South America, three days’ sail from Panama, was badly infected. On the west coast to the north, Corinto in Nicaragua and other ports, we knew to be infected. On the Caribbean Sea, within from one to three days’ sail, Cartagena, Colombia, Porto Caballo, La Guira, Venezuela, the port of Caracas, and other ports were having yellow fever. On the Gulf of Mexico, Vera Cruz, Mexico, was an endemic center. Progreso, the capital of Yucatan, was also having this disease. In 1905, New Orleans, Louisiana, had a sharp epidemic of yellow fever. With all these places we had frequent and close commercial relations. In 1906, Cuba had some yellow fever at many points. All these places had to be carefully guarded against by our quarantines. Bubonic plague existed endemically at Guayaquil, and several other ports on the west coast of South America, and this disease occurred sporadically at ports on the Caribbean Sea and the Gulf of Mexico. Quite a number of cases of plague developed in New Orleans during 1914. Our quarantines had to look after this disease in the same manner that yellow fever was guarded against. I have already mentioned that in 1905 plague established itself at La Boca and Ancon, in spite of our quarantines. This is no reflection upon our quarantine system. I am glad to say that under the administration of Dr. Henry R. Carter and Dr. James A. Perry, our quarantines were as efficient as could be found anywhere, but the very best quarantine will at some time allow a case of infectious disease to pass. Such accidents cannot be entirely prevented, except by the entire abolition of commerce. For the care of passengers and ships under quarantine, we built two quarantine stations, one at the north end of the Canal on the Caribbean Sea, the other at the south end on an island in the bay of Panama. Culebra Island, on which was located the Panama quarantine station, is an island of four or five acres in extent, the center of the group of islands on which are now located the fortifications protecting the southern mouth of the Canal. These islands are mountain tops projecting from fifty to three hundred and fifty feet above the surface of the waters of the bay of Panama. They are heavily wooded, and are very picturesque in appearance. They are now connected with each other and with the mainland by an artificial causeway, built during the period of Canal construction by dumping here the spoil from Culebra Cut.