198 
and on account of the fact that for their respective countries they 
are points of centralization and distribution. 
As infected places their relative importance is subject to wide 
variation, but as infectible areas they are equally important from 
a general quarantine standpoint. 
Hawaii, particularly its principal port, Honolulu, is from its 
geographical location the natural strategic point in this vast 
arena. 
The judicious use of Honolulu as a port of call will greatly 
modify, if not absolutely eliminate, the danger of any one of the 
above named ports from a quarantine- standpoint. 
The trade between the Pacific coast of the United States and 
the Hawaiian Islands, Japan and China will always have the 
same relative bearing upon the quarantine status of the Pacific 
Arena that it has at present. That is to say, while the opening 
of the isthmian canal will greatly increase the commerce in the 
Pacific Arena, the old and established route just mentioned, al- 
though its trade will probably be proportionately increased, will 
show no relative difference in the amount of quarantinable dis- 
ease transmitted. That the increase in the trade in the Pacific 
Arena and especially the changes in the trade routes will influ- 
ence if not reorganize quarantine procedure, is a fact which 
seems absolute. 
In the report of the Isthmian Canal Commission it is predicted 
that for each decade up to the opening of the canal, commerce in 
the Pacific Ocean will increase 25%. It is also predicted that by 
the year 1924, traffic will be further increased by 62^4% of what 
it is at present. But it is not the increase in the traffic which inter- 
ests the student of quarantine so much as the new trade con- 
nections which will be formed between disease centers hitherto 
widely separated. The present trade route between the Pacific 
Coast ports and China and its bearing upon the transmission of 
quarantinable diseases is fairly well understood at the present time 
and an increase in volume of that traffic can be easily met by a re- 
lative increase in administrative equipment. But a prospective 
increase of trade involving new routes, new climates, and new 
diseases naturally opens up a new problem in the quarantine work 
in the Pacific Arena. 
In considering the present and prospective trade in the Pacific 
Arena and its probable bearing upon the general public health, 
mention of the principal ports and the character of the trade car- 
ried on in them will be necessary. 
The ports in the Pacific Arena may be divided into North 
American, Central American, Isthmian, South American, Aus- 
tralasian, Philippine Island, Pacific Island, Chinese and Japanese. 
The North American ports are the shipping points for food pro- 
ducts, iron and steel manufactured supplies, the basic materials 
of industry and general merchandise. The Central and South 
American ports are the shipping points for wool, nitrate of soda, 
