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