CHAPTER XXII. The Work of the Sanitary Department of Panama

THE WORK OF THE SANITARY DEPARTMENT OF PANAMA

The work of the Sanitary Department of Panama has without question been a most useful adjunct in the construction of the Canal. It has enabled this work to be carried through with a minimum of loss, both in regard to sickness and death among employees engaged in construction work in the Canal Zone. We have no means of telling what was the sick rate with the French during the period of construction under the old French Company, from 1881 to 1889, but we know that it was very large.

Our Army in Cuba during the Santiago campaign had during the last two months of our stay there a constant sick rate of over six hundred per thousand. Undoubtedly, the French rate approximated this during their period of active work, and we can safely calculate that their constant sick rate was at least three hundred and thirty-three per thousand, or one-third their force.

Our force during the ten years of construction averaged thirty-nine thousand men. If we had had a similar constant sick rate, we should have had thirteen thousand sick employees in our hospitals every day during the ten years of construction. As it was, we had only twenty-three per thousand sick each day, a total of nine hundred for the whole force; that is, we had about twelve thousand fewer men sick every day than had the French. This twelve thousand men per day saved from sickness must be credited to the sanitary work done on the Isthmus.

Now let us consider the totals: We had an average of 900 men sick every day. For the year, this would give us 328,500 days of sickness, and for the ten years 3,285,000 days of sickness. If our rate had been 300 per 1,000, a very moderate figure compared with what it was under the French, we should have had 11,700 sick every day. For the year, this would have given us 4,270,500 days of sickness and for the ten years, 42,705,000, a saving of 39,420,000 days of sickness during this period. This saving must justly be credited to sanitation.

It cost us about one dollar a day to care for a sick man on the Isthmus. The Commission cared for the sick free of charge. Every day, therefore, of sickness prevented on the Isthmus lessened the expense which the Commission had to bear by one dollar. The Commission was therefore saved by this sanitary work, if we consider the whole ten years of construction, $39,420,000.

This represents only one phase of the saving due to sanitation, merely the saving due to decrease in the numbers of sick who had to be cared for. But the sanitary work really saved much more than this. If three hundred men out of every one thousand of our employees had been sick every day, the efficiency of the other seven hundred would have been correspondingly decreased. The other seven hundred would have been more or less debilitated, and more or less depressed, and the amount of work turned out daily by each man would have been considerably less than it actually was for the employee enjoying good health and cheerful surroundings. We should have had to pay considerably higher wages, if the Isthmus had continued to bear the reputation during our period of construction which it had always borne during the years preceding 1904; if, for instance, it had been known that three out of every ten men going to work on the Canal would be sick all the time, and that two out of every ten would die each year, and that the whole ten would be dead at the end of five years.

Great loss was caused to us in the first years on the Isthmus by the demoralization among the working force, and almost stoppage of work which took place during periods of exacerbation in the yellow-fever condition, or when prominent employees died of that disease. Great loss also occurred to the French on this account. Mr. Bunau-Varilla described very graphically the condition of his force as the result of such conditions. Mr. Bunau-Varilla was one of the most prominent of the French engineers for the old French Company, and was their chief engineer from 1885 to 1887.

I do not think that anyone familiar with the conditions would question the statement that a larger sum in dollars and cents was saved to the Commission in these ways than was saved by the direct decrease in the number of sick.

Considering all these factors, it will not be considered an exaggerated estimate to state that eighty million dollars was saved to the United States Government by the sanitary work done on the Isthmus during the ten years of construction. That is, granting that the construction work could have been accomplished under such conditions as had existed during the construction period of the old French Company, or which existed on the Isthmus of Panama at any time prior to 1904, and granting that public sentiment in the United States would have allowed the prosecution of the work with such mortality among the laboring force as had previously occurred, it would have cost the United States eighty million dollars more than it actually did cost to accomplish the results it has attained on the Isthmus.

I go into these figures to demonstrate that there is great financial profit resulting from money spent on such sanitary measures as we inaugurated on the Isthmus. This is the purely commercial side of the question. Of much greater importance is the moral argument that can be adduced from the saving of life and suffering that results from such measures.

During the ten years of construction, we lost by death seventeen out of every thousand of our employees each year. That is, from the whole force of 39,000 men, 663 died each year, and for the whole construction period we lost 6,630 men. If sanitary conditions had remained as they had been previous to 1904, and we had lost, as did the French, two hundred of our employees out of each one thousand on the work, we should have lost 7,800 men each year, and 78,000 during the whole construction period.

We therefore claim for the work of the Sanitary Department the saving of 71,370 human lives during the building of the Panama Canal. Where one man died, probably three would have returned home broken in health, with months and years of suffering and invalidism ahead of them. Sanitation on the Isthmus has saved this heavy toll to the devoted people engaged in this great work, and was, therefore a most wise and lucrative investment to our Government, and played a most important part in aiding the construction work in that great enterprise.

But I believe that this aiding in the construction of the Canal is not the most important function that the sanitary work at Panama has played. The Canal Zone, for the past four hundred years, ever since it has been known by the white man, has been one of the most unhealthy spots in all the tropical world, and this fact has been generally known and recognized by all nations which have had any commercial importance.

About the time of the discovery of America, Europeans began to visit and colonize the tropics, but it was early discovered that the white man could not live and thrive with such conditions and surroundings as existed there. It seemed to be demonstrated that there was something in the climate that sapped his constitution and broke his health. This statement applies to white children to an even greater extent than to the adult.

The great colonizing nations had been the Spaniards, the Portuguese, the Dutch, the French and the English. Their experience had all been exactly similar from the beginning of the sixteenth century to the present time—that the white man could not live and thrive in the tropics, nor could he leave behind him in those regions a healthy progeny. By all men everywhere it was believed that this was due to tropical climatic conditions, which could not be combated, and that therefore the white man was permanently barred from building up any great civilization in these regions.

Man, like all other animals, must necessarily have developed in one locality. If we accept the modern explanation, generally received by educated persons, Darwinism, all life at present on the globe must have descended from one single cell. If we take some individual animal at present living, a dog, for instance, we could trace his ancestry back to the first cell, if we could obtain all the facts in the case. By very slow changes, genus after genus and species after species developed from this first cell, each genus and each species differing slightly from the one preceding.

An individual varying very slightly from the other individual of his species, becomes the progenitor of a new species, provided the variation accords with his surroundings so as to fit him better for the struggle of life. But all of the new species must descend directly from the one pair which produces these favorable variations in their progeny. Every species, therefore, such as the dog, must originate in some one locality. If at any time this species of animal is found in all parts of the world, it must have slowly spread from the locality in which it originated. The dog, therefore, came to his present development in some one part of the world. As he is now found in all parts of the world, he must have spread from this one locality in which he originated.

Exactly the same argument applies to man. If we consider man’s condition in his earlier stages, we can see that there must have been a period when he had neither fire nor clothing. At this time he must have lived in parts of the world where the temperature was that now found between the tropics of Cancer and Capricorn. As we know him now, he could survive the year around without fire and clothing only within this region. He might live a little north and south of these parallels of latitude, but not very far. Very few individuals of a community which attempted to spend a winter in the latitude of Washington, without either fire or clothing, would be alive when the warm weather of spring returned. It is pretty certain, therefore, that man lived exclusively in the tropics, up to the discovery of fire and clothing.

There was a period, then, in man’s existence when the environment found in the tropics was better suited to his life than that found in the present temperate zones. Conditions gradually changed, until affairs were exactly reversed, and the temperate regions became better suited for man’s healthy life than the tropical regions. This was the condition of affairs when we first begin to get some knowledge of man, at the early dawn of history. When we first begin to learn anything about him historically, the most vigorous and healthy races, mentally and physically, were to be found in the temperate zones. The conditions that brought about this change of habitat in man were probably the spread of the various infectious diseases within the tropics. The hot tropical regions were much better fitted for the life of the germs which caused these infectious diseases than were the temperate regions, for exactly the same reasons that these tropical regions better suited the life and development of man. Due to his superior intelligence and superior powers of locomotion, man was enabled to spread through and occupy the tropical regions long before the germs of the various infectious diseases were able to do so.

Yellow fever, for instance, was able to extend very little beyond the region where it originally developed, until man came along with his ships, and in this way enabled the yellow-fever germ to begin its travels about the world. As yellow-fever developed in America, the germ did not begin its travels until Columbus brought his ships into the Caribbean Sea. As the infections spread through the tropics, the environment in those regions became unfavorable to man, to such an extent that he ceased to be able to improve in his mental and physical characteristics. But as the environment of regions outside the tropics was still more unfavorable, actually deadly, he had no escape.

At this period, then, man found himself inhabiting tropical regions where sanitary conditions, the infections, were very unfavorable to him, and he was unable to migrate to the temperate zones, because the sanitary conditions there, cold, were deadly to him.

About this time, two great sanitary discoveries, the most important ever made by man, namely, fire and clothing, came to the knowledge of our tropical ancestors. The greatest sanitarian that the human race has ever produced was probably the individual who discovered fire, and next in importance, the individual who first wore some kind of clothing. These two discoveries enabled man to overcome the hitherto insurmountable sanitary obstacle of the temperate regions, namely, cold. With the application of these two sanitary discoveries, the human race was enabled to migrate from the tropics and continue healthy development in the temperate regions.

At the present time, we have just reversed the process; we have just made sanitary discoveries that will enable man to return from the temperate regions to which he was forced to migrate long ages ago, and again live and develop in his natural home, the tropics. These sanitary discoveries are those that have enabled us to control yellow fever and malaria.

The practical application of these great discoveries has just been demonstrated during the construction of the Panama Canal. This was not the first demonstration with regard to either disease. But the conditions were such at Panama that they have attracted the attention of the whole world, and probably the general knowledge that the white man can live and thrive in the tropics will date in future times from the construction of this great work.

A given amount of labor applied to land will produce a very much larger amount of wealth than will the same labor applied in the same way produce in the temperate regions. The white man, of all the races of the human family, is the most eager in his pursuit of wealth. As it becomes generally known that he can live in the tropics and maintain his health, necessarily a large emigration will occur from the present civilized temperate regions to the tropics. The largest areas of land suitable for cultivation lie in the tropics, and much the largest bodies of rich alluvial lands, such as the valleys of the Amazon and the Congo. Not only are these lands more productive than the lands of the temperate zone, but climatic conditions enable the farmer to produce several crops a year. The tropics, when occupied and cultivated by the white man, will produce many times the amount of food now produced in the temperate regions.

The great civilizations of man are now already established and developed in the temperate zones of Europe and America, and it is probable that, for centuries to come, these great empires will be located where they are at present, and that the tropics will be the agricultural, food-producing regions from which these centers of civilization will be supplied.

In the early stages of the development of mankind it was all that each individual could do to supply his own necessities. As he advanced in civilization, he produced more than he himself needed, and thereby had a surplus to exchange with his neighbors for things which he desired. As his productive capacity increased, a larger number of men were enabled to apply themselves to the arts and sciences. The degree of civilization to which a community can reach is in the main governed by the amount of the necessities of life that the labor of one man applied to the land can produce. If one man’s labor can produce enough of the necessities to support himself and one other man, we have a certain degree of civilization and refinement. If his labor produces enough to support himself and two other men, a higher degree of civilization results. In the tropics one man’s labor applied to natural opportunities is able to support more men than the same amount of labor applied in any other part of the world. In the long run, therefore, the great civilizations of the future will be located in the tropics.

No doubt the great centers of civilization will remain for centuries much as they are at present. The white settlers will go to the valleys of the Amazon and Congo, building up large agricultural communities which will supply the European and American centers located as they are at present with their food supply. But in the course of ages the centers of civilization will move to where a given amount of labor will produce the largest amount of food. Of course, other things must be equal. I am assuming that the government in these new communities is as good as the government with which we are comparing it in the temperate zone. When this great migration of population has fully commenced, I believe that the peoples of that day will look back upon the sanitary work done at the Canal Zone as the first great demonstration that the white man could live as well in the tropics as in the temperate zone.

I am inclined to think that at this time the sanitary phase of the work will be considered more important than the actual construction of the Canal itself, as important to the world as this great waterway now is, and will be for generations to come.

The discovery of the Americas was a great epoch in the history of the white man, and threw large areas of fertile and healthy country open to his settlement. The demonstration made at Panama that he can live a healthy life in the tropics will be an equally important milestone in the history of the race, and will throw just as large an area of the earth’s surface open to man’s settlement, and a very much more productive area.

INDEX

Agramonte, Dr., 11, 16, 41.

Albertini, Dr. Antonio, 12.

American Medical Association, interest of, in Panama sanitation, 142.

Ancon Hospital, 209, 224-234, 236-238, 241-247. care of insane at, 242. clinic for tropical diseases at, 238. equipment at, 241. eye department at, 242. management of, 243, 244. organized by La Garde, 229-232. records of, under French company, 227. researches at, 238. services of, to Canal employees, 247. sewage system installed at, 230. statistics of, 247. treatment of yellow fever at, 230-231.

Angeles, Sister Maria de los, 268.

Anopheles. See Mosquito, malarial.

Augustin, on yellow fever, 117.

Avila, Pedro Arias de. See Pedrarias.

Balboa in Panama, 132, 133, 134, 135, 168.

Bubonic plague in Panama, 271, 276-278.

Camp Columbia, yellow-fever experiments at, 19, 20, 25, 26, 30.

Camphor fumigation, 54, 55.

Carroll, Dr., on Sanarelli’s researches, 7, 11. mosquito experiments of, 16, 19, 41.

Carter, Dr. Henry R., quarantine work of, 271. system of, for transportation of sick in Panama, 210-212. yellow-fever researches of, 10, 27, 28, 29.

Cemeteries in Panama, 214-217.

Chloroform, use of, against mosquitoes, 199.

Coffin story, 240.

Colon Hospital, 209.

Colon, yellow fever in, 150.

Colonization and disease, 114, 284.

Columbus in Panama, 131.

Concrete floors, as anti-plague measure, 277-278.

Cook, Dr. R. P., yellow-fever experiments of, 36.

Correspondence, Reed-Gorgas, 77-109.

Cost of sanitary measures in Panama, 148, 151, 152, 239, 240, 241.

Culebra Island, quarantine at, 271-274.

Darling, Dr. Samuel, 190, 238.

Davis, George W., General, 152.

Deeks, Dr. W. W., 238.

Dispensaries in Panama, 213, 220-223.

District physician, duties of, 212-214.

Drainage as anti-malarial measure, 184-189, 194-196, 201, 235.

Drake in Panama, 137, 163, 168, 176, 177, 178, 179.

Emergency and temporary hospitals in Panama, 210.

Emigration, effect of control of tropical disease on, 289, 293.

Finlay, Dr. Carlos, mosquito theory of, 13, 14, 27.

Flemenco Island cemetery, 215.

French Panama Canal Co., hospital service of, 224-227. yellow fever and malaria under, 138, 149, 227.

Fumigation for yellow fever, 52, 53, 54, 55, 150, 151, 261, 263.

Garbage disposal as anti-plague measure, 278.

Gillette, Cassius E., Major 143.

Grass-cutting in anti-malarial work, 187.

Guiteras, Dr. John, 12, 41, 45, 48.

Havana, sanitary measures in, 5, 6, 56-61. yellow fever in, 3-7, 22, 23, 41, 125.

“Her ladyship,” 43-46.

Herrick, Dr. A., 238.

Hospital system in Panama, 207-214, 223. dispensaries in, 213-214, 220-223. equipment in, 207-210. medical districts in, 212-214. transportation of sick in, 210, 211.

Hospitals, emergency and temporary, in Panama, 210.

Hygiene Congress, Gorgas, Wm. C., at, 141. value of certificate of, 25.

Immunity, yellow-fever, 22-24, 64, 118, 119, 261-263.

Insane, care of, in Panama, 242.

Inspection. See Sanitary inspection.

International Sanitary Congress, demonstration of mosquito theory at, 48.

Kerosene oil, in anti-malarial work, 188. in yellow-fever work, 61.

La Boca, bubonic plague in, 276.

La Crosade, Dr., 226.

La Garde, Louis A., Major, 143, 206. organizes Ancon Hospital, 229.

Larvacide in anti-malarial work, 190-191.

Las Animas Hospital, yellow-fever experiments in, 19, 26, 41, 43, 45. yellow-fever treatment in, 50-51.

Lazear, Dr., on Sanarelli’s researches, 11. mosquito experiments of, 16, 19.

Leper colony in Panama, 256.

Le Prince, Joseph, anti-malarial work of, 159, 186, 198-200, 202, 203, 204. fumigation experiments of, 55. rat trap devised by, 277. in Ancon Hospital, 230-231.

Lyster, Theodore C., Major, 242.

Malaria, importance of control of, to human race, 289-293. at Ismalia, 140. at Porto Bello, 165, 166. preventive work in, drainage and, 183-189. kerosene oil and, 188. quinin dispensation and, 220. sanitary districts organized for, 160. screens and, 196-198. statistics of, 73, 275. transmission of, 219.

Malarial mosquito. See Mosquito, malarial.

Mason, Colonel, 243.

Medical districts organized in Panama, 209, 212, 213.

Medical practice, ancient and modern, 110-113.

Medical service in Panama, sanitary advantage of, 212-214.

Mosquito, malarial, at Ismalia, 141. sanitary control of, 61, 159, 183-191, 194-196, 198-205. yellow fever, Army board experiments on, 16-20, 26, 30-36, 38, 41-49. breeding conditions of, 2, 56, 58, 59, 60, 192, 204, 233, 265. fumigation and, 52, 53, 54, 55.

Mosquito, yellow fever, in Ancon Hospital grounds, 232-234. kerosene oil, use of, and, 61.

Mosquito-catcher in anti-malarial work, 198-202.

Mosquito theory of yellow-fever transmission, 13, 14, 32, 36, 48, 157.

Mosquitoes, different species compared, 191-195.

Mount Hope cemetery, 216.

Mott, Dr. J. C., 13.

Panama, fumigation for yellow fever throughout, 150, 151. hospital service in, 207-214, 223. medical districts in, 209. Sanitary Department of, 148, 153, 154. sick rate statistics at, 280, 281. Spanish rule in, 134-135, 168, 176-180. yellow fever in, 136, 150.

Pedrarias in Panama, 132, 133.

Perry, Dr. James A., 265, 271, 276.

Phillips, Colonel, 244.

Pizarro in Panama, 133, 135.

Porto Bello, cemetery at, 216, 217. commerce and fair at, 161-162, 163, 164. malaria in, 165, 166.

Public Health Service, Board of, 10.

Pyrethrum, fumigation with, 54, 263.

Quarantine, for bubonic plague, 276. for yellow fever in Havana, 63, 64, 72. in Panama, 260.

Quinin, dispensation of, 220-223.

Rats, relation of, to bubonic plague, 276-278.

Reed, Dr. Walter, mosquito experiments of, 16, 19-21, 26, 30-36, 38, 41. on Sanarelli researches, 7, 11.

Reed-Gorgas correspondence, 77-109.

Ross, Dr. John W., 35, 45, 143, 206.

Ross, Dr. Ronald, anti-malaria work of, 74, 141.

San Blas Indians, 167-174.

Sanarelli, Giuseppi, yellow-fever researches of, 7-11.

Sanarelli’s organism, Army board investigation of, 11, 12.

Sanitary Department in Panama, accounts of, 239, 241. cemeteries under control of, 214-216. changes in, 153, 154. financial and moral value of, 280-284. free medical service of, 214.

Sanitary department in Panama, organization of, 148. undertaking and, 239-240.

Sanitary districts for anti-malarial work, 160, 182, 183.

Sanitary inspection, in Havana, fumigation for yellow fever and, 52-55. screens and, 50-52. water supply and, 56-62. in Panama, drainage and, 184-195, 201. fumigation for yellow fever and, 150, 151, 261, 263. grass-cutting and, 183-184. mosquito-catching and, 198-202. screens and, 196-198.

Screens, as anti-malaria measure, 196-198. in treatment of yellow fever, 50-51, 230, 231.

Smith, Patrick, Private, Sanarelli’s organism and, 11.

Stegomyia. See Mosquito, yellow-fever.

Sternberg, George M., General, 7, 138.

Stevens, John F., 155.

Suez Canal, sanitation at, 139, 140.

Sulphur fumigation, 53, 263.

Taboga, sanitarium at, 248, 249.

Tobacco fumigation, 55.

Transportation of sick in Panama, 210-212.

Umbrella ants at Ancon Hospital, 232-234, 236-237.

U. S. Army, sick rate in, 4, 206, 279.

Vaccination, yellow-fever, 42, 47.

Water supply, at Ancon Hospital, 229. in Havana, and mosquito-breeding, 56, 58, 59, 60. at Suez Canal, 140.

Wood, Gen. Leonard, 19, 40.

Yellow fever, description of, 21, 115, 122. direct transmission of, 37-38. effect of, on shipping, 3. endemic areas of, 125-126, 127, 128, 270. epidemic area of, 129, 130. epidemics of, 1, 128, 129, 130. experiments at Camp Columbia, 19, 20, 21, 25, 26, 27, 30. fumigation for, 52-55, 150, 151, 261, 263. importance of control of, to human race, 289-293. in Africa, 127. in Brazil, 126. incubation period for, 10, 27-30, 38. in Ecuador, 24, 119.

Yellow fever in French Panama Canal Co., 138, 149, 227. in Havana, 3-7, 22, 23, 41, 125. in U. S. Army, 4. in Vera Cruz, 3, 117, 121, 127, 128. investigation of, by Army board, 11, 12, 16-20, 26, 30-36, 38, 41-46. old treatment of, 65, 66, 67, 68, 69, 70. origin of, 117-118, 119, 120, 121, 287. quarantine regulations for, 63, 64, 72, 260. Sanarelli’s researches in, 7-11.

Yellow fever, ship infection cases of, 264-269. spread of, 115, 116, 124, 125, 126, 127. statistics of, 71, 72. transmission of, 13, 14, 21, 27, 32-36, 37-38. treatment of, at Ancon Hospital, 230-232, 233,234. screens in, 50-51, 230, 231.

Yellow-fever immunity, 22-24, 64, 118, 119, 261-263. value of certificate of, 25.

Yellow-fever mosquito. See Mosquito, yellow-fever.

Yellow-fever vaccination, 42, 47.

Transcriber’s Notes

pg 102 Text missing at the end of sentence: The sending of clothing and bedding for disinfection to Las Animas, in yellow-fever cases, was stopped about

pg 112 Changed: making no attempt whatever to prevent dsease to: making no attempt whatever to prevent disease

pg 121 Changed: account of cocolitzle as it occured to: account of cocolitzle as it occurred

pg 189 Changed: lake made by the damming of the Chargres to: lake made by the damming of the Chagres

pg 232 Changed: both upon the Americans and Panamans to: both upon the Americans and Panamanians