Sanitation in Panama

by William Crawford Gorgas

With this object in view the hospitals were equipped with bedding and other hospital supplies of the very best kind. Very little was expended upon buildings. In general we used the buildings that had been erected by the French some twenty years before, and which were still standing in fairly usable condition.

Dr. Ross impressed upon everyone with whom he came in contact that the hospital department was organized primarily for the care of the sick, and that the comfort and happiness of the sick must always have the first consideration. This department retained this principle as its most marked characteristic during the whole period of its existence.

The very best equipment in all directions was obtained, and the very best class of young physicians and surgeons was secured from the United States. At our maximum we had, all told, one hundred and two physicians in the Sanitary Department. Our nursing force was as enthusiastic, as good and as efficient as could be found anywhere. At our maximum we had one hundred and thirty trained nurses from the best training-schools in the United States.

As I have mentioned before, the Canal extended from northwest to southeast some fifty miles, the city of Colon being at the northern end and Panama at the southern. The working force was scattered, more or less, along this line between these two points.

The French had left two large hospitals, Ancon Hospital at Panama on the southern end, and Colon Hospital at Colon on the northern end. We determined to utilize these two hospitals as base hospitals, and to bring as many patients as possible from along the line to these institutions. We divided the territory between Panama and Colon into as many medical districts as we had sanitary districts, and in each of these districts a small hospital was erected, from twenty to one hundred beds in size, where a certain number of sick could be treated, whom we thought it would not be advantageous to transport to the two base hospitals.

Many of the districts had several villages within their borders where the laborers lived. Each of these villages had in it a small hospital of from five to fifteen beds where the sick were kept until they could be moved to the district hospital. We had some forty of these sub-district hospitals, which were generally known as rest camps. This gave us, all told, some sixty hospitals.

It was evident that we could not afford to make all these sixty hospitals first-class hospitals, and we therefore decided to concentrate upon our two base hospitals and make them first-class in every respect. For instance, in the surgical line we determined to have all the instruments, equipment and personnel that could be obtained in the best equipped hospitals in our large cities. The eighteen district hospitals were well equipped to care for emergency patients, both medical and surgical, and for such as it was thought would be injured by being moved to the base hospitals. The sub-district hospitals, or rest camps, were not equipped at all for the care of surgical cases, but merely for the care of medical cases until they could be moved to the district hospitals.

The sub-district hospitals were used a great deal for the care of men who were sick only for a day or two. It was believed that there would be a certain amount of injury done in transporting the wounded by train. Some of the stations were twenty-five miles from either Ancon or Colon, but at the same time it was thought that the better care, skill and attention that the patient could get in the large and well-equipped hospitals, such as Ancon and Colon, would a great deal more than counterbalance the injury done by the long railway haul.

For the purpose of transporting the sick and wounded from the various district hospitals to the base hospitals, hospital cars were run over the road morning and evening, in both directions. The hospital cars were of local manufacture, gotten up by Dr. Carter, the then director of hospitals. He took the ordinary baggage car, rigged up iron frames over which canvas was stretched, and these frames were secured to the walls with hinges, so that when not in use they could be folded down on the side of the car, out of the way. There were sixteen of these beds in each car. The car was also arranged so that when the beds were not left down there was a row of seats available all around the car. Ordinarily, in transportation there would be five or six stretcher cases occupying beds in the car, but the large majority of the cases would be sitting up. Each car was provided with a toilet, a small supply of medicines and surgical dressings, and two small closets in which such things were stored. The car was manned by a trained white male nurse and a negro assistant. The car was screened.

The trains at Ancon and Colon were met by the necessary number of ambulances, and the patient in this way was carried to the hospital. Cases of pressing emergency were brought on special trains. The district physician could generally get a special train if he certified that there was necessity for it.