CHAPTER XV. The Work At the Hospitals

THE WORK AT THE HOSPITALS

Dr. John W. Ross, of the United States Navy, Major Louis A. La Garde, of the Army, and I had all had a large experience in tropical military service. We were, therefore, thoroughly imbued with the idea that from the very beginning we must make ample and liberal provision for the care of a large number of sick. We were impressed with the fact that the constant sick rate of the Army in the Philippines had been ninety per thousand during the year 1898; that it had been even larger with our Army at Santiago, Cuba. We therefore thought that we should prepare to have at least fifty per thousand of our employees on the Isthmus constantly sick.

Our estimates were based upon fifty thousand employees. If, as occurred with our Army in the Philippines, we should have three hundred per thousand constantly sick, we would need a bed capacity, equipment and personnel for the care of fifteen thousand sick. If, as we hoped, it might not exceed fifty per thousand of our employees sick, we should only need a bed capacity of twenty-five hundred beds. We determined to keep at least fifty beds per thousand for our actual force; that this should be the minimum number, and that the number of beds should be increased as the force increased.

It is a matter of interest to note the fact that during the year that our force was at its maximum, fifty-eight thousand men during the calendar year 1913, we had a hospital capacity of just about twenty-five hundred beds, though the constant sick rate of our employees at this time was only about twenty-two per thousand. The hospital service had become so popular, and had acquired such a reputation for the skillful service and good care which could be obtained there, that a large number of people came to seek its benefits from various Spanish American countries north and south of us.

We had at this time some eight hundred individuals in the hospitals who were not Canal employees. Dr. Ross was determined that our hospital service should be first-class in every respect; that a sick employee of the Canal Commission on the Zone should be able to command just as skillful, and just as good care, as he could command in our largest centers in the United States.

With this object in view the hospitals were equipped with bedding and other hospital supplies of the very best kind. Very little was expended upon buildings. In general we used the buildings that had been erected by the French some twenty years before, and which were still standing in fairly usable condition.

Dr. Ross impressed upon everyone with whom he came in contact that the hospital department was organized primarily for the care of the sick, and that the comfort and happiness of the sick must always have the first consideration. This department retained this principle as its most marked characteristic during the whole period of its existence.

The very best equipment in all directions was obtained, and the very best class of young physicians and surgeons was secured from the United States. At our maximum we had, all told, one hundred and two physicians in the Sanitary Department. Our nursing force was as enthusiastic, as good and as efficient as could be found anywhere. At our maximum we had one hundred and thirty trained nurses from the best training-schools in the United States.

As I have mentioned before, the Canal extended from northwest to southeast some fifty miles, the city of Colon being at the northern end and Panama at the southern. The working force was scattered, more or less, along this line between these two points.

The French had left two large hospitals, Ancon Hospital at Panama on the southern end, and Colon Hospital at Colon on the northern end. We determined to utilize these two hospitals as base hospitals, and to bring as many patients as possible from along the line to these institutions. We divided the territory between Panama and Colon into as many medical districts as we had sanitary districts, and in each of these districts a small hospital was erected, from twenty to one hundred beds in size, where a certain number of sick could be treated, whom we thought it would not be advantageous to transport to the two base hospitals.

Many of the districts had several villages within their borders where the laborers lived. Each of these villages had in it a small hospital of from five to fifteen beds where the sick were kept until they could be moved to the district hospital. We had some forty of these sub-district hospitals, which were generally known as rest camps. This gave us, all told, some sixty hospitals.

It was evident that we could not afford to make all these sixty hospitals first-class hospitals, and we therefore decided to concentrate upon our two base hospitals and make them first-class in every respect. For instance, in the surgical line we determined to have all the instruments, equipment and personnel that could be obtained in the best equipped hospitals in our large cities. The eighteen district hospitals were well equipped to care for emergency patients, both medical and surgical, and for such as it was thought would be injured by being moved to the base hospitals. The sub-district hospitals, or rest camps, were not equipped at all for the care of surgical cases, but merely for the care of medical cases until they could be moved to the district hospitals.

The sub-district hospitals were used a great deal for the care of men who were sick only for a day or two. It was believed that there would be a certain amount of injury done in transporting the wounded by train. Some of the stations were twenty-five miles from either Ancon or Colon, but at the same time it was thought that the better care, skill and attention that the patient could get in the large and well-equipped hospitals, such as Ancon and Colon, would a great deal more than counterbalance the injury done by the long railway haul.

For the purpose of transporting the sick and wounded from the various district hospitals to the base hospitals, hospital cars were run over the road morning and evening, in both directions. The hospital cars were of local manufacture, gotten up by Dr. Carter, the then director of hospitals. He took the ordinary baggage car, rigged up iron frames over which canvas was stretched, and these frames were secured to the walls with hinges, so that when not in use they could be folded down on the side of the car, out of the way. There were sixteen of these beds in each car. The car was also arranged so that when the beds were not left down there was a row of seats available all around the car. Ordinarily, in transportation there would be five or six stretcher cases occupying beds in the car, but the large majority of the cases would be sitting up. Each car was provided with a toilet, a small supply of medicines and surgical dressings, and two small closets in which such things were stored. The car was manned by a trained white male nurse and a negro assistant. The car was screened.

The trains at Ancon and Colon were met by the necessary number of ambulances, and the patient in this way was carried to the hospital. Cases of pressing emergency were brought on special trains. The district physician could generally get a special train if he certified that there was necessity for it.

This method of transportation for the sick proved eminently satisfactory, and during our ten years of construction work on the Isthmus, it fulfilled every need. We transported a great many thousand patients in this way without a mishap of any kind due to the method of transportation.

The country along the Canal route was exceedingly rugged, and many of the district hospitals, for the first few years, were inaccessible to wheeled vehicles. So the patients who could not walk had to be carried to the hospital car on stretchers. But long before the period of construction was half through roads had been built to all these district hospitals.

In charge of the medical matters in each of our twenty districts was a district physician. This physician had charge of the district hospital, and looked after the patients there. It was also his duty to look after the families of employees. No charge was made for the medical care of an employee, or for medicine furnished him, or for surgical operations performed upon him.

The district physician had the authority to send any employee he thought best to the hospital. If the employee preferred to stay at home for treatment he was charged one dollar for each visit of the physician. These fees reverted to the Commission. The physician was paid a fixed salary by the Commission, and was not allowed to make any charge for his services. Members of families of employees were charged one dollar a day for hospital care, and could be admitted on the order of the district physician. Families of employees who received less than fifty dollars a month were charged only thirty cents per day for hospital treatment. As a rule, both employees and their families preferred to come into the hospital when sick, rather than to be treated at home. The class of employees receiving less than fifty dollars a month was almost exclusively Jamaican negroes. During the earlier years of our Isthmian work the negroes were afraid of the hospitals and did not like to come in. This applied particularly to the women and children. But as years went by we gained their confidence entirely, and during the last years of construction, the hospital accommodation for negro women and children was always full, though we were constantly extending this branch of our hospital.

In each district one or more dispensaries were maintained. In immediate charge of the dispensary was a competent druggist who had one or more men under him for assisting him about the dispensary. The district physician presided over the dispensary and advised without charge anyone who applied for treatment, and furnished him with medicines if he were unable to pay. Quinin was given at the dispensary to anyone who applied. In some of the larger districts where the population amounted to eight or ten thousand, the district physician had as many as four assistants. All the doctors on the Isthmus had to be graduates of medical schools in good standing, and, except for the first few years of construction, had to pass a civil service examination.

There was a very great sanitary advantage in our giving in this way to the whole population free medical service and medicines. It kept the district physician accurately informed of what character of sickness was occurring in his district. The sanitary authorities thus had the very earliest information with regard to such diseases as yellow fever and plague, and they were enabled to take the proper sanitary precautions at the time when they would be most efficacious. Many times information obtained in this way enabled us to stamp out these diseases in their incipiency and before they could get started as epidemics.

The district physician also had inspectorial control of all buildings within his district. He was directed to pay particular attention to hotels, eating-houses, etc. He was required to make a monthly report on these subjects. Faults reported by the district physician were carefully looked after by the central sanitary office, and were usually promptly corrected by the responsible sanitary official.

The sanitary inspector had the care of all the cemeteries in the Zone, which were twenty-odd in number. Each of the districts had a cemetery, and no burials were allowed except in these cemeteries. The inspector kept a register of all burials, and any death which was at all suspicious was investigated by the authorities of the Sanitary Department. The charge for preparing the grave was just about enough to cover the expense of digging. The control of the cemeteries by the Sanitary Department we considered very important from a sanitary point of view, as in this way we could keep an absolute register of all deaths occurring, and no death from a contagious or infectious disease could occur without the authorities being informed.

On Flemenco Island was located one of our oldest cemeteries, though small in size. Here were buried quite a number of our naval officers and sailors who had died of yellow fever on our war vessels while in the bay of Panama during the preceding fifty years. Here were buried, also, patients who died at the nearby quarantine station. The site was beautifully located about half-way up Flemenco Hill, in a dense tropical forest, with just below it, at the water line, the vine-covered ruins of an old Spanish fort. At the present time the top of Flemenco Hill has been cut away for the location of one of our batteries. The old fort has been razed for the location of another battery and the tombs and monuments of the old cemetery have been moved to the grounds of Ancon Hospital.

In the grounds of this hospital was located the cemetery where most of the employees and laborers who had died during the period of construction were buried. This also was a very picturesque place, situated on the side of Ancon mountain, looking to the north, with Culebra Cut instinctively in view. The grounds were prettily laid out and artistically planted with tropical trees and shrubbery. Here we had some two thousand interments.

But the principal cemetery was that located at Mount Hope. This was the cemetery for the city of Colon, and in all the writings of the early days on the Isthmus, it is known as “Monkey Hill.” It has been in use ever since the foundation of Colon, about 1850, and contains a large number of interments. Here sleep most of the men who died during the construction of the Panama Railroad, and many others well known on the Isthmus during the fifty years of the existence of the railroad as a transcontinental route. Dr. Connor, health officer of Colon, gave a great deal of attention and thought to the beautifying of this piece of ground, and it is now as pretty a garden of tropical trees and shrubbery as can be seen anywhere.

At Porto Bello we used the principal fort on the north side of the harbor as a cemetery. This structure, though built of brick some two hundred years before, was in a very good state of preservation. The mountain rose several hundred feet on this side of the harbor, and on the side of this mountain, to the seaward from the old fort, was located our great Porto Bello quarry, from which was obtained the stone for building the Gatun locks and the Colon breakwaters. The fort was a very strong and complete military structure for its time, and it was located at the foot of the mountain, near the water’s edge. When I first visited the ruin, it was completely covered with jungle, to such an extent that it could not be entered or recognized as a structure built by human hands. I reached it and made an entrance by having a native machete-man cut out the jungle enough for me to force my way through behind him. Large trees were growing in all parts of the old structure, some of them six or eight feet in diameter, and more than one hundred feet in height.

The interior of the fort was cleared of jungle and arranged so that it could be used as a cemetery, and here are buried the employees who died at Porto Bello within the six or seven years during which we operated the quarry. I selected it as the cemetery site, because it struck me as being appropriate that this old fort, which had seen so much of war, should finally be used for so peaceful a purpose as the last resting-place of the laborers engaged in the construction of a commercial enterprise like the Panama Canal, for which so much is hoped for the benefit of the whole human race. The old fort had been built by one set of pirates, the old Spaniards, to protect the plunder which they had wrung from the Incas and other natives of America, from that other set of pirates who infested the Spanish main, and were constantly attempting to wrest from the Spaniards this plunder.