The Panama Canal

by Frederic J. Haskin

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 2¹⁄₃. It cost $160,000 a year to feed the patients in the hospitals and $739,000 a year to operate the hospitals.