The Sanitary Department
The story of the sanitation of the Canal Zone
constitutes one of the most dramatic examples that the world affords of what
medical science can accomplish when properly backed by a government. With
the eyes of the world focused upon the big undertaking, there was that degree of
the spectacular in the work that is required to command universal attention, and
so it has come to pass that one of the greatest benefits that the Panama Canal
will bring to the people of the earth is the splendid lesson it has taught
humanity — the lesson that contagious or infectious disease may be controlled
and held in check.
To any one who has visited the Canal Zone, no statistics are necessary to show what has been, and what may be, accomplished by sanitation. His own eyes tell him of the wonderful transformation that has taken place, as he travels across the isthmus and sees where thousands of mosquito paradises have been transformed into disease-free spots. He looks from the vantage point of an observation car at the fifty-mile parkway across the isthmus. But to others, it need only be said that the death rate for the population of Panama, Colon and in the Canal Zone has been cut down from the forty-two per thousand that obtained when the Americans went to Panama to the twenty-two per thousand that existed when the canal became a completed waterway Apply that wonderful decline to our own country and see what results: If our growth as a nation has been normal since 1910, our present population must approximate a hundred million souls. A saving of twenty lives per thousand would mean to us the saving of 2,000,000 lives a year, and a saving of at least 5,000,000 cases of sickness. There is the measure of what has been accomplished at Panama.
This wonderful liberality with which the United States provided for health purposes on the isthmus is revealed by the fact that nearly $20,000,000 was appropriated for carrying forward that work during the ten years of the construction period — which appropriations covered the hospitals, medical attendance, sanitation and other activities. Of this about $2,000,000 went to sanitation proper. Now, when we remember that the population of the Canal Zone was only 62,000 and that the area of that part of the Zone under active sanitary control amounts to only 1,200 acres, it will be understood that there was no lack of funds with which to prosecute the work. It is not to be presumed, however, that the entire Canal Zone has been cleaned up and converted from an untamed jungle into a place fit for the residence of men; as a matter of fact, except for the 1,200 acres in the settlements along the canal and the few little clearings made by negroes for their tiny yam patches, all of the 278,000 acres of the Canal Zone's area lie outside of the sanitary district.
When we come to look elsewhere we find that equally brilliant results were accomplished with the expenditure of very much less money. That is true of Porto Rico. When the Americans took possession of that island the death rate was practically the same as the death rate at Panama when we took over the canal strip. Today the death rate in Porto Rico is just as low as it is at Panama, notwithstanding the fact that Porto Rico is the most densely populated island on earth. The same density per square mile, if applied to the United States would give us a population of nearly a billion. Dr. Bailey K. Ashford, who cleaned up Porto Rico, had only a small percentage of the funds per capita or per acre at his disposal that Colonel Gorgas had at Panama. But in Porto Rico they could afford to count the cost. There was not a great international project a stake, nor would the world have suffered from failure in that country as it would have suffered from disaster at Panama.
When the United States started into build the Panama Canal, all eyes turned to Dr. William Crawford Gorgas, then a surgeon in the United States Army with the rank of major, as the man of all men best fitted to take charge of the work of sanitation. He was fresh from his successes in Cuba, where he had, under General Leonard Wood, applied the lessons of sanitation that had been learned by Dr. Walter Reed and his associates in their remarkable series of experiments with yellow fever. Although he had gone into the work of ridding Havana of yellow fever with a skepticism that he afterward admitted, he had carried it to a highly successful conclusion. As late as 1902 he stated that he had doubted the conclusion of Reed that yellow fever was caused only by mosquitoes, adding that he had not believed it was even the ordinary, much less the only cause.
But his own work proved a cure for his skepticism, and from that day to this he has stood out as the world's most famous master of tropical sanitation. He went to Panama with the first forces that steered their course that way after the American occupation. He laid out his sanitary campaign in the utmost detail, in which he was assisted by a number of experienced surgeons, as well as by Major Roland Ross, the man who had proven the mosquito theory of the causation of malaria, and upon whose work Reed and his associates builded in making out their case against the yellow fever mosquito.
Dr. Gorgas returned to the States for a few months, and then went back to his work of cleaning up the isthmus. From the first he was handicapped. A commission of seven men of equal authority never was known to do things promptly under any circumstances; and when it came to a commission, a part of whose members were in Washington and another part in Panama, it was worse than ever — so that more money came to be spent on telegraph and cable tolls than was spent on sanitation. But Colonel Gorgas was a patient man; and though Major General George W. Davis, then Governor of the Zone, and managing commissioner, was somewhat out of sympathy with him, he did the best he could and hoped the day would come when he could do better. Finally General Davis was relieved, and Gorgas was made acting governor and given temporary free rein.
Chief Engineer Wallace was somewhat distrustful of Gorgas's ability to control yellow fever, and at one time Mr. Taft seemed to hold the same opinion. But when Charles E. Magoon became Governor of the Canal, he told Colonel Gorgas that he wanted him to understand that all the resources of the Canal Commission were behind him. with this inspiriting assurance, Colonel Gorgas set out to undo the damage that had been done. Stegomyia had been tried and convicted in Cuba, but had moved for a new trial in Panama and had obtained it. With the outbreak of the epidemic of 1904-5 some of the people settled down to the conviction that the mosquito was of responsible for the yellow fever; many of them went so far as to tear the screens off their windows as a protest against the theory. Every ship that left the isthmus carried a full passenger list, and those who had to remain behind were under daily fear of contagion.
But Governor Magoon changed things. The chiefs of divisions were held responsible for keeping of the doors and windows of the rooms of their employees properly screened. Guards were stationed around to see that screening orders were obeyed and office doors kept closed. Wherever there was a case of yellow fever the antecedents of the patient were investigated with extreme care. Here was a man who was registered at a Panama Hotel. He was sick and some one feared he had yellow fever. When the authorities came to look him up, he had disappeared. The next day he was found in the streets intoxicated and suffering from yellow fever. He was taken to the hospital, where he died. Then they looked for his associates. Nobody seemed to know him. Finally it was heard that some his countrymen frequented a certain bar room. Here again no one knew him, but several of them had heard him talking with an Italian. The Italians of the entire City of Panama were canvassed, and at last the man who had talked with him was found, but the man knew him only slightly. However, he did know that the man was acquainted with the watchman at a certain little theater. This watchman was hunted down and was found to be ill with yellow fever himself. Then a little girl who frequented the theater was found to have taken the disease. Every case was thus rigidly investigated and all sources of infection run down. The result was that the last case of yellow fever was stamped out in the early part of 1906, and a second and final decision was rendered against the mosquito, this time in the court of last resort — a decision which the world owes to the energetic measures of Colonel Gorgas, and the support of Gov. Magoon.
From that day forward Colonel Gorgas enjoyed the confidence of the world and of the canal engineers alike. In more recent years there was up some feeling between the partisans of Colonel Goethals and those of Colonel Gorgas. Acting upon the order of President Taft that the actual work of digging ditches, cutting grass, and the like, would be placed in the hands of the Quartermaster's Department, under the supervision of the Sanitary Department, Colonel Goethals directed that this course be pursued. It resulted in no loss of sanitary efficiency, and in a considerable saving of money. But the friends of Colonel Gorgas always felt that Colonel Goethals was responsible for the order, whereas it was issued at the direction of the President himself and in spite of Colonel Goethals's views in the matter. Colonel Goethals never has failed to commend the excellence of the sanitary work at Panama, upon all proper occasions.
The first work of protecting the health of the people of the Canal Zone always had been that of holding the mosquito in check, for malaria and yellow fever had to be controlled — the one kept down and the other kept out, if the sanitary work was to be successful. There are upward of a hundred species of mosquitoes on the isthmus, but only the anopheles and the stegomyia families have evil reputations.
The habits of the mosquitoes lend themselves easily to the needs of man in his war of extermination against them. They lay their eggs in the water, and when their larvae hatch out, they must come to the surface for a breath of air. By spreading oil upon the surface of standing water the larvae are destroyed.
Numerous methods of "pouring oil on the troubled waters" have been in use at Panama. One of the favorite methods is to put a wick in a piece of pipe soldered into a large ash can. The can is filled with oil and set on a board that spans the little streamlet it is meant to protect. Drop by drop the oil in the can passes down and along with the waters, and when they reach quiet levels there is a scum of oil over the placid surface of the water from bank to bank. Another method of applying the oil is to strap a spraying tank filled with it upon the back of a husky negro and then send him forth to "nose out" all little pools of stagnant water in the neighborhood and to cover them with a film of oil. In these ways about 700,000 gallons of oil and 124,000 gallons of larvicide were used annually.
But with all that, there were still breeding places that could not be found, so it was necessary to keep down the grass and brush, to the extent of about twenty million square yards of the former and about half as much of the latter every year. And then some two million feet of ditches had to be kept clean and about a quarter of a million feet of new ones dug for drainage purposes.
Yet with all of this war against the mosquitoes, a few of them still managed to perpetuate their species, and this required the expenditure of about a million dollars for screens for shutting them out of the houses. Even then some few would manage to et inside, and these were either caught in traps or killed. About a quarter of a million malarial adult mosquitoes were so destroyed.
While the quarantine on the Canal Zone was a very rigid one, it did not include malaria in the list of diseases to be excluded. But for those diseases which were banned it was as unrelenting as fate.
Shortly after the United States began operations on the Canal Zone a ship load of deck passengers from Martinique was brought over. When it was announced that they had to be vaccinated, one of their number, a voodoo doctor, led a mutiny against inoculation, in which a hundred and fifty took part. He pronounced it an attempt to put "the inextinguishable mark" upon the, so that they could never escape from the isthmus. They declared they would rather suffer martyrdom abroad than to be held captive ashore, and it was only after three days of unsuccessful parleying that the mutiny was broken up[ by their being driven ashore by the police. Still protesting, they were rounded up, in spite of their efforts to escape, vaccinated, and the next day sent to work.
A quarantine station was maintained at each end of the canal, and will be continued under the permanent organization. Every ship arriving was boarded, and if a clean bill of health could be presented, nothing remained to be done except for every passenger and member of the crew to be examined for quarantinable disease. But if the ship had come from an infected port there was trouble — all passengers went to the quarantine station until it was safe to pass them through the lines.
The government furnished all of its employees with free medicines, free medical attendance, and free hospital and burial services. It dispensed about a ton of quinine a year, provided camps here the laborers who were not ill enough to go to the hospital could rest and be treated, and ran one or two hospital cars on every passenger train that crossed the isthmus.
The hospitals maintained were by far the best to be found anywhere in the tropics. The one at Ancon is very large, perfectly appointed, and situated in attractive grounds. It is a monument to the Catholic sisters who conducted the institution and beautified the grounds under the French regime. The hospitals had an average of about 600 whites and 1,200 negroes as patients, and during each year there were admitted and discharged some 18,000 whites and 14,000 negroes. About 5,000 whites and 1,000 negroes were treated annually in the sick camps. The total number sick in hospitals, camps, and quarters in 1913 were 48,000. Applications to the dispensaries for treatment amounted to 311,000 among the whites in 1912 and 322,000 among the colored employees.
A modern sanitarium was maintained at Taboga, where the white employees who had passed through the hospitals were sent to recuperate. The number of white employees on the sick list ranged around forty per thousand, while the number of colored employees averaged around seventeen per thousand, in spite of the fact that the death rate among the colored people was higher. The cost of operating all the hospitals, sick camps, and dispensaries of the Sanitary Department amounted to $739,000 in 1912, at an average cost of $1.22 per day in the hospitals and forty-seven cents in the sick camps.
The Sanitary Department not only looked after the physical health of the people, but after their spiritual health as well. The churches were under its jurisdiction and it carried some fifteen ministers of the gospel on its pay rolls. It also took care of the cemeteries and conducted the undertaking and embalming business required for the canal army.
Looking over the history of sanitation on the Canal Zone, it must be pronounced a wonderful record. Any careful analysis of the figures of expenditures of the Sanitary Department must show that the work was expensive, that it cost perhaps more, result for result, than sanitation anywhere else in the world. But that does not detract from the fact that it was successful, and that it was worth far more to the United States than its cost. Carrying with it that degree of publicity that enabled it to arrest the attention of the world, it ever will stand out as the creating force of a world-side movement in the direction of better sanitation. And in that way it has done more for the health movement that is sweeping over the world than any other single agency in the history of man.
The success of the American army surgeon has been universal, whether his work is at Panama, in Porto Rico, in the Philippines, or at home. There is glory enough for them all, and if the successful work at Panama serves to awaken the American people to a knowledge of the fact that they have medical triumphs to be proud of wherever the American army surgeon has gone, its benefits will extend far beyond the limits of the Canal Zone.
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from: The History of the
by Ira E. Bennett, 1915
March 24, 1999