CHAPTER XI. Preliminary Organization and Work At Panama

PRELIMINARY ORGANIZATION AND WORK AT PANAMA

From the very beginning insuperable difficulties arose in the way of getting supplies. Very little could be obtained on the Isthmus, and the supply departments in the United States were so slow in being organized that, during the first year, very few requisitions that were sent to the United States were filled.

The attempt of the first Commission to manage from Washington the work at Panama in all its details was fatal, and the arrangement whereby the Sanitary Department was made one of the bureaus of the Government, having no access to the Chairman, the real executive, except through the Governor, was equally fatal. In June, 1904, however, we all commenced work with a great deal of enthusiasm, determined to do the best we could under the circumstances.

The $50,000 worth of supplies taken down, and the personnel brought along at the same time, enabled us to make a good start in all branches of the Sanitary Department, as outlined in the recommendations made in March. If it had not been for the supplies and personnel taken down at this time, we could have made no better showing than did the Engineering Department or the Quartermaster Department during the same period.

We realized that the subject of yellow fever was by far the most important phase of sanitation with which we had to deal. We appreciated that, if the Americans were subject to this disease to any considerable extent, we should have great difficulty in keeping them at Panama, and in order to induce them to stay, we should have to increase wages to such an extent that the cost of the work would be very greatly increased. That even if we should find a white American force which would be willing to stay, and if we could afford to pay sufficiently high wages to induce them to stay, Congress, in all probability, would not sanction the continuance of the work, if we lost from yellow fever fifteen or sixteen hundred Americans every year.

From the best statistics which I could get on the Isthmus, I found that the French lost yearly by death from yellow fever about one-third of their white force. If we lost in the same ratio it would give us about thirty-five hundred deaths among our Americans yearly. We, therefore, during the first year made yellow fever the first consideration, and gave it the most attention.

The two principal foci of infection for yellow fever were the towns at either end of the railroad, Colon at the northern end, on the Caribbean Sea, and Panama at the southern end, on the Pacific Ocean.

As I have mentioned in a former chapter, when we got through at Havana, we all thoroughly believed that the great virtue of our work there lay in the killing of infected mosquitoes by fumigation. So when we commenced work in the city of Panama, we relied principally upon this method. We carried fumigation in Panama, however, much further than we had ever dreamed of doing at Havana. Beside carrying out the method which we had developed at Havana of fumigating the house where a case of yellow fever had occurred, together with all the contiguous houses, we adopted the following plan.

Panama compared with Havana was a very small town. Havana in 1904 had a population of 250,000; Panama, about 20,000. Instead of waiting for the slow process of fumigating the house where a yellow-fever case occurred, with the contiguous houses, and thereby killing the infected mosquitoes concerned in that particular case, we ought to be able, we said, in a small town like Panama to fumigate every house in the city within a comparatively short time, and thereby get rid of all the infected mosquitoes at one fell swoop.

This would certainly have been the result if our premises had been correct, namely, that it was the fumigation that had caused the disappearance of yellow fever at Havana. With this object in view, we commenced at one end of the city and fumigated every building. It took us about a month to get over the whole town. Cases of yellow fever still continued to occur after we had finished. We therefore went through the procedure a second time. Still other cases occurred, and we went over the city a third time. We used up in these fumigations in the course of about a year some hundred and twenty tons of insect powder, and some three hundred tons of sulphur. These quantities of material give some idea of the amount of fumigation.

This draft of one hundred and twenty tons of insect powder represented the whole supply of the United States for a year, and we actually used up at Panama all the insect powder that could be found in the market of the United States.

An interesting incident occurred during this first year with regard to insect powder. Knowing that there would be some yellow fever to be dealt with in Colon and Panama, we estimated and made requisition for eight tons of insect powder. The reviewing authorities were very much shocked and surprised at the size of our requisition, and seized upon this one item of eight tons of insect powder to demonstrate the wildness of our estimates. It was some satisfaction to us for the Commission to see that we had not only not been wild and extravagant in our estimates, but that we had been obliged to use actually fifteen times as much as we had estimated for.

From the very beginning the Commission underestimated the magnitude of the sanitary operations, as well as their cost, and when the sanitary authorities urged upon them more extensive preparation and larger expenditure, they thought us visionary and more or less lost confidence in us. This was very unfortunate both for the sanitary authorities, and for the Commission, and came very near being the cause of the complete collapse of sanitation.

General George W. Davis, the governor, was the only member of the Commission who lived continuously on the Isthmus. He was the only member of the Commission who had any adequate idea of the difficulties with which the Sanitary Department was confronted. He gave us his heartiest support.

Our force of unacclimated whites liable to yellow fever rapidly increased during the winter of 1904 and spring of 1905. Yellow fever increased with still greater rapidity. The authorities became more and more alarmed. In January, 1905, the first Commission was asked to resign, and a new Commission was appointed.

Even after this change the Sanitary Department was in no better condition than it had been under the former Commission. The chief sanitary officer was still subordinate to the governor of the Canal, and had no means of access to the chairman, except through the governor. Such sanitary measures were carried through the importance of which the chief sanitary officer could impress upon the governor. Those, the importance of which the governor could not see, were with great difficulty carried into effect.

This condition of affairs was unfortunate. The authorities had no sanitary training, and as they looked upon the ideas of the sanitary officials with regard to the method of conveyance of yellow fever by the mosquito as being wild and visionary, they could not be expected to have rose-colored views as to what would be the results of attempting to carry these views into effect.

The sanitary authorities had no doubt of their ultimate success, and felt confident that they could eradicate yellow fever in Panama, as they had just done in Havana, if they could only hold on long enough and get reasonable support from the superior authorities.

Conditions with regard to yellow fever kept going from bad to worse during the first six months of 1905. In April, 1905, several of the higher officials died of yellow fever. This caused widespread panic among the whites, and very great demoralization to the work itself. A considerable sprinkling of our white force had either been in Cuba with us, or knew what had been accomplished there with regard to yellow fever, but the rank and file of the men began to believe that they were doomed just as had been the French before them.

Finally, in June, 1905, the Governor and Chief Engineer, members of the Executive Committee of the Commission, united in a recommendation to the Secretary of War that the Chief Sanitary Officer and Dr. Carter and those who believed with them in the mosquito theory, should be relieved, and men with more practical views be appointed in their stead. They stated that the sanitary authorities had visionary ideas with regard to the cause of yellow fever, and no practical methods even for carrying these ideas into execution.

Fortunately for the cause of sanitation, the then President of the United States had been in office when the work at Havana had been done by us. He told the Commission that the mosquito theory had been established beyond peradventure; that its application had been entirely successful at Havana, where yellow fever had been more firmly established and established for a longer time than at Panama. He declined to sanction the change recommended, and directed that every possible support and assistance be extended to the sanitary officials. It was really fortunate for the sanitary work that matters were brought to a head in this way.

Mr. John F. Stevens about this time was appointed chief engineer and member of the Commission, to fill a vacancy which had been caused by the resignation of the former Chief Engineer. From his arrival on the Isthmus Mr. Stevens expressed confidence in the Sanitary Department, and gave us his undivided support. The moral effect of so high an official taking such a stand at this period, when the fortunes of the Sanitary Department were at so low an ebb, was very great, and it is hard to estimate how much sanitation on the Isthmus owes to this gentleman for its subsequent success.

During the fall of 1905 the Chairman of the Commission recommended that the Sanitary Department be made an independent bureau, reporting directly to himself. This enabled the chief sanitary officer to make known directly to the chairman of the Commission the needs of the department. The chairman, also, when thus informed of our needs, gave us loyal support.

This period was the high-water mark of sanitary efficiency on the Isthmus, and more sanitation was done at this time than during any other period of the construction of the Canal.

During the fall of 1905 yellow fever rapidly decreased, and by November, the last case of this disease had occurred in Panama. This fact quieted alarm on the Isthmus, and gave the sanitary officials great prestige, not only among the now large body of Canal employees, but also among the native population living on the Isthmus.

In looking back over our ten years of work, these two years of 1905 and 1906 seem the halcyon days for the Sanitary Department. It was really during this period that our work was accomplished. By the fall of 1907 about all of our sanitary work had been completed. Our fight against disease in Panama had been won, and from that time on our attention was given to holding what had been accomplished.

One more case of yellow fever occurred in Colon during the following May, but since May, 1906, now more than eight years, not a case of yellow fever has originated on the Isthmus.

It is interesting to speculate upon what might have been the result if the recommendation in regard to changing the sanitary officials had been carried into effect. At that time, in June, 1905, most of the physicians who had had experience with yellow fever had not been won over to the truth of the theory of its transmission by the mosquito. It was reported on the Isthmus that one of the most prominent and ablest of these physicians, who did not believe that the mosquito transmission of yellow fever had been proved, and who was convinced that he himself had controlled yellow fever acting upon the filth theory of its causation, had been settled upon as my successor. Had this been the case he would undoubtedly have stopped mosquito work and devoted his attention entirely to cleaning up, as is indicated by the filth theory of the causation of the disease. He would have been the more inclined to this course, as it accorded with the beliefs and prejudices of the authorities on the Isthmus.

This would probably have been kept up for two or three years, and there is no reason for believing that our condition on the Isthmus in 1908 would have been any better than was that of the French at the height of their work, when they were having a death-rate of 250 per thousand per year of their employees.

It would apparently have been demonstrated that nothing could control yellow fever on the Isthmus, and the belief then generally held that it was the most unhealthy place in the world would have been still further confirmed. And while it is probable that eventually the mosquito theory of yellow fever would have become established somewhere else, its apparent failure at Panama would have given it a blow from which it would have taken years to recover.

It seems singular that, after the demonstration at Havana, there should have been any doubt in the mind of anyone with regard to the mosquito transmission of yellow fever.

Moreover, the reputation of Dr. Carter, Dr. Ross, Mr. Le Prince and myself, as sanitary officials, would have been irretrievably ruined. We took a tremendous risk and came very near failing from causes hinted at in the foregoing pages.

Even if the dangers had been as great as they were under the French, and the deaths as numerous, I believe we would have found a sufficient number of men who were willing to go to the Isthmus, just as did the French. There is always a certain element which is attracted by danger and adventure, and to whom exposure to risk is a sufficient reward for their labor. This characteristic I have always found particularly strong among the Americans. But if we had lost from disease thirty-five hundred of our Americans every year (for the French lost in about this ratio), I am inclined to think that public opinion would not have backed any work involving such loss of life, and that Congress would not have made the appropriations for continuing the work.