Sanitation in Panama

by William Crawford Gorgas

CHAPTER X
APPOINTED CHIEF SANITARY OFFICER FOR THE ISTHMUS

Early in the year 1902, while still stationed at Havana, I wrote to Surgeon-General Sternberg concerning the discoveries made by the Reed Board, and the application made of these discoveries to the eradication of yellow fever in Havana, and invited attention to the fact that they would have a most important bearing upon the work of the construction of the Panama Canal.

I invited General Sternberg’s attention to the enormous loss of life that had been caused among the French working at Panama, due to tropical diseases; that by far the most important of the diseases were yellow fever and malaria; that if we could protect our laborers on the Canal as we had the people of Havana, we should be able to build the Canal without anything like such losses as had occurred to the French. I also invited his attention to the fact that while there was a considerable difference in the conditions and environment at Havana, still I believed that the methods worked out at Havana could be so modified as to be applied successfully at the Isthmus.

General Sternberg approved the idea, and recommended that, on account of my experience in similar work at Havana, I be placed in charge of the sanitary work on the Isthmus.

In all discussion with regard to canal construction at this time Nicaragua was looked upon as the point where the United States would build its canal. Delays entirely unexpected to the authorities occurred on account of the failure of the treaty with Colombia, and it was not until the fall of 1903 that it was settled that we were to build a canal at Panama, under a concession from the Republic of Panama.

I was relieved from duty at Havana in the fall of 1902 and ordered to the United States, in order that I might be in personal contact with the preparations for canal work on the Isthmus. While waiting for the organization to commence, I was sent to Egypt as the representative of the Medical Department of the United States Army to the first Egyptian Medical Congress, and I was directed while on this duty to examine into what had been the sanitary conditions during the construction of the Suez Canal.

This turned out to be a very interesting trip, though I did not get much information that was useful to us at Panama. The conditions were so entirely different at the Isthmus of Suez from the conditions at the Isthmus of Panama from a sanitary point of view that there was no similarity in the sanitary measures applicable to the two places. The route of the Suez Canal was through a dry, sandy desert, where, at the time of construction, they suffered from neither yellow fever nor malaria. The route of the Panama Canal lay through a low, swampy country, alternating with rugged mountainous regions, where the rainfall was excessive, and yellow fever and malaria prevailed to an alarming extent.

During my visit there, however, I found that they were suffering severely from malaria at Ismalia, a town on the canal about half-way across the Isthmus, and the headquarters of the Canal Company. During the early period of their construction work they had a great deal of trouble supplying their laborers with drinking water. They were obliged to carry this on camel-back a number of miles from the nearest branch of the Nile. I was informed that, at one time, they had to employ some sixteen hundred camels in this work.

In order to obviate this expense and inconvenience, De Lesseps reopened the old canal of the Israelites, leading up from the Nile through the land of Goshen. This old canal came within a few miles of the present route of the Suez Canal. The French extended it to the Suez Canal, and then made a small canal parallel with the route of the Suez, which conveyed fresh water all along this route. Wherever in the desert fresh water is applied to the soil, the land becomes very fruitful and productive. At Ismalia, this sweet-water canal, just described (the Arabs usually refer to fresh water as sweet water), was used for irrigation purposes. When I saw the canal in 1902, the town and neighborhood were covered with a beautiful growth of trees and shrubbery, and vegetation appeared on every side. Unfortunately, the water which produced this wonderful oasis in the desert also bred the malarial mosquito freely and Ismalia had become a hotbed for malaria.

Sir Ronald Ross, the great English sanitarian, who had taken so prominent a part in discovering that malaria was carried by the anopheles mosquito, was employed by the French Company to advise them how they should protect themselves against this plague. The plans which he advised were carried into execution, and Ismalia in a short time was entirely free from malaria.