SANITATION
Primarily, the conquest of the Isthmian barrier was the conquest of
the mosquito. Not mountains to be leveled, nor wild rivers to be
tamed, nor yet titanic machinery to be installed, presented the
gravest obstacles to the canal builders. Their most feared enemies
were none of these, but the swarms of mosquitoes that bred in myriads
in every lake, in every tiny pool, in every clump of weeds on the
rain-soaked, steaming, tropical land. For these mosquitoes were the
bearers of the dread germs of yellow fever and of malaria; and the
conditions that encouraged their multiplication bred also typhoid and
all manner of filthy disease. Each mosquito was a potential messenger
of death. The buzzing, biting pests had defeated the French in Panama
without the French ever having recognized the source of the attack. It
was because the Americans, thanks to Great Britain and to Cuba, knew
the deadly qualities of the mosquitoes that they were able to plan,
under the leadership of Col. W. C. Gorgas, a sanitary campaign of
unprecedented success. It achieved two victories. One was that it made
of the Canal Zone the most healthful strip of land under tropic skies.
The other is the Panama Canal.
When one looks about in an effort to place the credit for these great
sanitary achievements he must go back to Cuba, where the yellow fever
commission, consisting of Reed, Carroll, Lazear, and Agrimonte, made
the remarkable investigations proving that yellow fever is
transmissible only through the bite of a mosquito. He must go still
further back to Maj. Roland Ross of the British Army, and his
epoch-making discovery that malaria is conveyed only by the bite of
another kind of mosquito. And, if he is just to all who have
contributed to the establishment of the insect-bearing theory of
disease, he must not forget Sir Patrick Manson who first proved that
any disease could be transmitted by insect bites. It was he who
discovered that filariasis is transmissible by this method alone. It
was from him that Ross gathered the inspiration that is releasing
humanity from one of the most insidious of all the diseases to which
mortal flesh is heir. And it was from Ross's malaria discoveries, in
turn, that Reed carried forward to successful proof the theory which
had persisted in some quarters for generations that yellow fever was
transmissible through mosquitoes; a theory already partially proved by
Dr. Carlos Finley, of Havana, 20 years earlier.
[Illustration: COL. WILLIAM C. GORGAS
THE HOSPITAL GROUNDS, ANCON]
[Illustration: LIEUT. FREDERIC MEARS
THE OLD PANAMA RAILROAD]
But all of the surmises and theories came short of the truth until
Reed, Carroll, Lazear, and Agrimonte (Lazear at the cost of his life
and Carroll at the cost of a nearly fatal attack of yellow fever) took
up the work of proving that there was only one way in which yellow
fever could be transmitted; namely, by the bite of the mosquito.
Sleeping with patients who had yellow fever, wearing the clothes of
those who had died from it, eating from utensils from which yellow
fever victims had eaten--in short, putting to the most rigid test
every other possible method of infection, they proved by every
negative test that yellow fever could not be produced in any way other
than by the bite of a mosquito.
The next step was to give affirmative proof that yellow fever was
caused by the bite of the female "stegomyia"--she of the striped
stockings and the shrill song. This meant that someone had to have
enough love for humanity to risk his life by inviting one of the worst
forms of death to which human flesh is heir. Those doctors knew that
they could not as brave men ask others to undergo the risks that they
themselves might not accept, so in a little council chamber in Havana
the three Americans--Reed, Carroll, and Lazear--entered into a compact
that they themselves would permit infected mosquitoes to bite them.
Reed was called home, but Carroll and Lazear stood with the keen and
cold eyes of scientists and saw the mosquitoes inject the fateful
poison into their blood. Later, after Lazear had died and Carroll had
stood in the jaws of death, soldiers of the American army in Cuba
volunteered in the interest of humanity to undergo these same risks.
And it was thus, at this price, that the world came to know how yellow
fever is caused, and that the United States was to be able to build
the Panama Canal.
After the guilt of the female "stegomyia" mosquito was firmly
established the next problem was to find a method of combating her
work. Dr. Reed and his associates thought that it might be done
through a process of immunization, using the mosquito to bite patients
with very mild cases, and after the necessary period of incubation, to
transmit the disease to those who were to be rendered immune. It was
soon found, however, that there was no method of transmitting a mild
infection, and the next problem was to combat the work of the mosquito
by isolation of yellow fever patients, and by the extermination of the
mosquitoes themselves.
In Havana at this time there was another army surgeon who was destined
to write his name high upon the pages of medical achievement. He was
Dr. William C. Gorgas. Under the patronage of Gen. Leonard Wood,
himself a physician and alive to the lessons of the yellow fever
commission's investigations, Major Gorgas undertook to apply the
doctrine of yellow fever prevention promulgated by the commission, and
his efforts were attended with brilliant success. The result was that
Havana, in particular, and Cuba, in general, were freed from this
great terror of the Tropics. When President Roosevelt came to provide
for the building of the Panama Canal one of his earlier acts was to
appoint Dr. Gorgas the chief sanitary officer of the Canal Zone.
At first there was difficulty in establishing practical sanitation in
Panama. The chief sanitary officer was then a subordinate of the
commission, and, along with all of the other men who were trying to do
things on the Isthmus, he found himself hindered by unsatisfactory
conditions both as to supplies and as to force; consequently, his work
was no more satisfactory to himself than it was to the commission or
to the American people. Under these conditions an epidemic of yellow
fever broke out in Panama in 1905, and it was not long before the
yellow fever mosquito had seemingly established an alibi and had
secured a reopening of her case before the jury of public sentiment.
People, to emphasize their disbelief in the mosquito theory of the
transmission of the disease, tore the screens from their doors and
windows, and otherwise proclaimed their contempt for the doctors and
their doctrines. This matter went so far that the Isthmian Canal
Commission proposed not only a change in method but a change in
personnel as well.
At this juncture Charles E. Magoon became governor of the Canal Zone,
and he declared that Dr. Gorgas should have adequate financial and
moral support. He was determined that the panic which the yellow fever
outbreak had engendered should be halted--and a panic it was, for men
rushed madly to Colon and defied the efforts of the commission, and of
the captains and crews of the Panama Railroad steamships, to prevent
them from returning to the States without other transportation
arrangements than a determination to get aboard and stay there until
the Statue of Liberty had been passed in New York Harbor. So great was
this panic that Chief Engineer Stevens declared that there were three
diseases at Panama: Yellow fever, malaria, and cold feet: and that the
greatest of these was cold feet. The newspapers of the United States
at that time quoted the poetry of such writers as Gilbert, who said:
"Beyond the Chagres River
'Tis said (the story's old)
Are paths that lead to mountains
Of purest virgin gold;
But 'tis my firm conviction
What e'er the tales they tell,
That beyond the Chagres River
All paths lead straight to hell."
It did not matter that in four months there were only 47 deaths on the
Isthmus from yellow fever as compared with 108 from malaria in the
same period--men do not stop to study mortality tables and to compare
the relative fatalities of diseases when yellow fever stares them in
the face.
But after all, the yellow fever panic of 1905 served a good purpose,
for if the mosquito thereby secured a reopening of its case, it
stirred the United States Government to give to the sanitary officers
of the Canal Zone the powers they needed, and the means required to
prove finally and forever in the court of last resort, the guilt of
the mosquito, and to establish for once and all the method of
combating its stealthy work.
The whole world recognizes the remarkable results in sanitary work
that have been achieved at Panama. While it must be remembered that
the population of the Canal Zone is made up largely of able-bodied
men, and that, therefore, the death rate naturally would be lower than
under like conditions with a normal population of infancy and old
age, the fact remains that sanitary science has converted the Zone
from a mosquito paradise of swamp and jungle into a region where
mosquitoes have all but disappeared, and where men are as free from
danger of epidemic diseases as in the United States itself.
The sanitary statistics of the Canal Zone, and of the cities of Panama
and Colon, were based for several years upon an erroneous assumption
of population. The Department of Sanitation estimated the population
of the Canal Zone by deducting the recorded emigrants from the
recorded immigrants and assumed that the difference represented a
permanent addition to the Zone's population. Under this method of
estimating population a serious error crept in, since hundreds of
people came into Panama from the Panaman outports and were recorded as
arrivals, but who, departing in small sailing vessels and launches at
night after the port officers had gone home, were not recorded as
having departed. In this way the sanitary department estimates of
population in the Canal Zone reached a total of 93,000 in 1912. The
census taken that year showed only 62,000 population in the Zone. This
served to make the death rate given out by the Department of
Sanitation 50 per cent lower than was justified by actual population
conditions.
But one does not need to consider figures to realize what has been
accomplished at Panama. Anyone who goes there and sees the remarkable
evidence of the success of the efforts to conquer the disease of the
tropical jungles, finds a lesson taught that is too impressive to
need the confirmation of medical statistics.
The United States, after the yellow fever outbreak of 1905, never
counted the cost when the health of the canal army was at stake. Not
only was Uncle Sam successful in his efforts to make the Canal Zone
and the terminal cities of Panama and Colon healthful places of abode,
but no worker on the canal was denied the privilege of the best
medical care. An average of $2,000,000 a year was expended in the
prevention of sickness and the care of those who were sick. At Ancon
and at Colon large hospitals were maintained where the white American
and the West Indian negro had their respective wards. At Taboga a
large sanitarium was maintained to assist the recuperation of those
who had recovered sufficiently to leave the hospital. Besides this
there were rest camps along the line for those not ill enough to be
removed to the hospitals, and dispensaries where those who felt they
were not in need of other medical attention could consult with the
physicians and get the necessary medicines. All medical services to
the employees of the Canal Commission and the Panama Railroad were
free, and only nominal charges were made for members of their
families. No passenger train crossed the Isthmus of Panama without
carrying a hospital car for taking patients to or from the hospitals.
No way station was without its waiting shed bearing the inscription:
"For Hospital Patients Only." Each community had its dispensary, its
doctor, and its sanitary inspector.
During the year 1912 there were 48,000 cases of sickness in the Canal
Zone, of which 26,000 were white and 22,000 colored. During the same
year 633,000 trips to the dispensaries were made by employees and
nonemployees, divided almost evenly between white and colored. The
average number of employees constantly sick in Ancon Hospital was 712;
in Colon Hospital 209; and in Taboga Sanitarium 54. An average of 119
were in the sick camps all the time and 50 in the quarters. The
average number of days' treatment per employee in the hospitals was a
little over 14; in the sick camps a little under 3; and in quarters
2-1/3. It cost $160,000 a year to feed the patients in the hospitals
and $739,000 a year to operate the hospitals.
The work of sanitation proper cost some $400,000 a year. This includes
many items. During one year about 16,000,000 square yards of brush
were cut and burned; a million square yards of swamp were drained;
30,000,000 square yards of grass were cut; 250,000 feet of ditches
were dug; and some 2,000,000 linear feet of old ditches were cleaned.
During the same year nearly a million garbage cans and over 300,000
refuse cans were emptied. In addition to looking after the health of
the Canal Zone itself, it was necessary to care for that of the cities
of Panama and Colon. In the city of Panama 11,000 loads of sweepings
and 25,000 loads of garbage were removed in one year; 3,000,000
gallons of water were sprinkled on the streets and as much more
distributed to the poor of the city.
During one year the quarantine service, which keeps a strict lookout
for yellow fever, bubonic plague, and other epidemic diseases,
inspected over 100,000 passengers coming into the Zone. It required
about 150,000 gallons of mosquito oil a year to keep down the
mosquitoes. There are 50 known breeds of these insects on the Isthmus
and perhaps some 20 species more which have not been identified. Of
the 50 or more species of mosquitoes 11 belonged to the
malaria-producing family--anopheles. Their cousins of the
yellow-fever-producing family--the stegomyias--boast of only two
species. What the other 40 or more kinds are doing besides annoying
suffering humanity has not been determined. The mosquito is
comparatively easy to exterminate. Its life habits are such that a
terrific mortality may be produced among them during infancy. The
average young mosquito, during its "wriggler" state of development,
lives under the water and has to make about 8,000 trips to the surface
for air before it can spread its wings and fly. If oil is poured upon
the water it can get no air and death by asphyxiation follows. Two
classes of larvaecide are used on the waters to exterminate the baby
mosquitoes: One is an oil used to make a scum over the surface; the
other a carbolic solution which poisons the water. At the head of
every little rivulet and tiny, trickling stream one sees a barrel out
of which comes an endless drip! drip! drip! These drops of oil or
poison are carried down the stream and make inhospitable all of the
mosquito nurseries of the marshes through which the waters flow. In
addition to these barrels, men go about with tanks on their backs,
spraying the marshy ground and the small, isolated pools of water with
larvaecides.
[Illustration: SANITARY DRINKING CUP]
[Illustration: MOSQUITO OIL DRIP BARREL]
[Illustration: SPRAYING MOSQUITO OIL]
[Illustration: TYPICAL QUARTERS OF THE MARRIED LABORER]
[Illustration: A NATIVE HUT]
This method of treatment has not exterminated all mosquitoes on the
Isthmus, but it has so materially reduced their number that one may
stay in the Zone for weeks without seeing a single one. This is a
freedom, however, that must be paid for by vigilance of the most
painstaking and unremitting sort. The moment the work is relaxed the
mosquitoes again spread over the territory.
The United States Government will have to continue with the utmost
care its work of sanitation and quarantine at Panama. If, after the
canal is completed, an epidemic of bubonic plague or yellow fever
should break out, it might very seriously interfere with the operation
of the canal in several ways. To begin with, it would demoralize the
operating force. Further than this, India and China are afraid of
yellow fever because in both of these countries the stegomyia mosquito
abounds. If the disease should obtain a foothold there it would be
difficult to exterminate. Europe, also, might be expected to
quarantine against Panama under such conditions. A 10,000-ton
freighter carrying cargo through the canal would lose at least a
thousand dollars for every day it was detained in quarantine by reason
of having visited the canal.
A shrewd observer has said that the successful sanitation of the
Isthmus of Panama is a triumph at once of medical science and of
despotic government. Probably this does not overstate the case. The
methods employed at Panama were arbitrary, and had to be. They
probably could not be enforced at all in a democratic community in
ordinary times. The people would rebel against the severity of the
regulations and against the incidental invasion of their privacy. But
strike any community, however free, with the fear of a swift and
deadly disease and it will submit--as witness the shot-gun quarantines
that used to demark the northern limits of the yellow fever zone in
our own Southern States, or the despotism that governed New Orleans in
the terror of 1905. At Panama this fear is ever present, so there is
little danger that a responsible majority there ever would resist the
sanitary work on the grounds of outraged democracy. It may be that a
popular government would become careless, or inefficient, but it would
not renounce the pretension. This has been proved in Cuba.
The sanitarians at Panama gave to the workers there a sense of
security that contributed no little to the spirit of determination so
universally remarked and commended by visitors to the Zone during the
era of construction. While there was no immunity from sickness and
death, yet there was no panic, no constant dread, such as destroyed
the morale of the French force. The Isthmus of Panama still remained
hot, its inhabitants still were forced to take the precautions that
aliens must take in the Tropics; but they were inspired with a
confidence that if these precautions were taken they would not be in
any greater danger than if they had remained in their northern homes.
Pestilence, the scourge of the on-sweeping epidemic, the plague of
swift death that is only a little worse than the panic of fear it
inspires--this was the thing that was stamped out.
Not since the Science of Healing opened its doors to the Science of
Prevention have physicians scored a greater victory in their fight
against disease and death than on the Isthmus of Panama. Not only did
they help to build the canal; they demonstrated that tropical diseases
are capable of human control and thereby opened up a vista of hope
undreamed of to all that sweltering and suffering mass of humanity
that inhabits the Torrid Zone.