Sanitation in Panama

by William Crawford Gorgas

This method of transportation for the sick proved eminently satisfactory, and during our ten years of construction work on the Isthmus, it fulfilled every need. We transported a great many thousand patients in this way without a mishap of any kind due to the method of transportation.

The country along the Canal route was exceedingly rugged, and many of the district hospitals, for the first few years, were inaccessible to wheeled vehicles. So the patients who could not walk had to be carried to the hospital car on stretchers. But long before the period of construction was half through roads had been built to all these district hospitals.

In charge of the medical matters in each of our twenty districts was a district physician. This physician had charge of the district hospital, and looked after the patients there. It was also his duty to look after the families of employees. No charge was made for the medical care of an employee, or for medicine furnished him, or for surgical operations performed upon him.

The district physician had the authority to send any employee he thought best to the hospital. If the employee preferred to stay at home for treatment he was charged one dollar for each visit of the physician. These fees reverted to the Commission. The physician was paid a fixed salary by the Commission, and was not allowed to make any charge for his services. Members of families of employees were charged one dollar a day for hospital care, and could be admitted on the order of the district physician. Families of employees who received less than fifty dollars a month were charged only thirty cents per day for hospital treatment. As a rule, both employees and their families preferred to come into the hospital when sick, rather than to be treated at home. The class of employees receiving less than fifty dollars a month was almost exclusively Jamaican negroes. During the earlier years of our Isthmian work the negroes were afraid of the hospitals and did not like to come in. This applied particularly to the women and children. But as years went by we gained their confidence entirely, and during the last years of construction, the hospital accommodation for negro women and children was always full, though we were constantly extending this branch of our hospital.

In each district one or more dispensaries were maintained. In immediate charge of the dispensary was a competent druggist who had one or more men under him for assisting him about the dispensary. The district physician presided over the dispensary and advised without charge anyone who applied for treatment, and furnished him with medicines if he were unable to pay. Quinin was given at the dispensary to anyone who applied. In some of the larger districts where the population amounted to eight or ten thousand, the district physician had as many as four assistants. All the doctors on the Isthmus had to be graduates of medical schools in good standing, and, except for the first few years of construction, had to pass a civil service examination.

There was a very great sanitary advantage in our giving in this way to the whole population free medical service and medicines. It kept the district physician accurately informed of what character of sickness was occurring in his district. The sanitary authorities thus had the very earliest information with regard to such diseases as yellow fever and plague, and they were enabled to take the proper sanitary precautions at the time when they would be most efficacious. Many times information obtained in this way enabled us to stamp out these diseases in their incipiency and before they could get started as epidemics.

The district physician also had inspectorial control of all buildings within his district. He was directed to pay particular attention to hotels, eating-houses, etc. He was required to make a monthly report on these subjects. Faults reported by the district physician were carefully looked after by the central sanitary office, and were usually promptly corrected by the responsible sanitary official.

The sanitary inspector had the care of all the cemeteries in the Zone, which were twenty-odd in number. Each of the districts had a cemetery, and no burials were allowed except in these cemeteries. The inspector kept a register of all burials, and any death which was at all suspicious was investigated by the authorities of the Sanitary Department. The charge for preparing the grave was just about enough to cover the expense of digging. The control of the cemeteries by the Sanitary Department we considered very important from a sanitary point of view, as in this way we could keep an absolute register of all deaths occurring, and no death from a contagious or infectious disease could occur without the authorities being informed.

On Flemenco Island was located one of our oldest cemeteries, though small in size. Here were buried quite a number of our naval officers and sailors who had died of yellow fever on our war vessels while in the bay of Panama during the preceding fifty years. Here were buried, also, patients who died at the nearby quarantine station. The site was beautifully located about half-way up Flemenco Hill, in a dense tropical forest, with just below it, at the water line, the vine-covered ruins of an old Spanish fort. At the present time the top of Flemenco Hill has been cut away for the location of one of our batteries. The old fort has been razed for the location of another battery and the tombs and monuments of the old cemetery have been moved to the grounds of Ancon Hospital.

In the grounds of this hospital was located the cemetery where most of the employees and laborers who had died during the period of construction were buried. This also was a very picturesque place, situated on the side of Ancon mountain, looking to the north, with Culebra Cut instinctively in view. The grounds were prettily laid out and artistically planted with tropical trees and shrubbery. Here we had some two thousand interments.