Sanitation in Panama

by William Crawford Gorgas

With the object of getting as many people as possible to take quinin every day, each district physician had attached to his staff one or more quinin dispensers. This quinin dispenser was a man furnished with quinin in various forms, who spent the day going about among the laborers offering them quinin. It was the endeavor of the district physician to have each laborer once a day offered quinin. The dispenser carried with him what was known on the Isthmus as quinin tonic. This was a quinin solution made up so that each ounce should contain five grains of quinin. Other ingredients were added so as to make it attractive in smell, taste and appearance. The quinin dispenser also carried with him quinin pills, capsules and tablets, and the patient was allowed his choice.

The Commission ran a large number of hotels and eating-houses, where all classes of employees were fed. Quinin tonic and quinin tablets were placed on the tables of all these eating-houses and messes, and an educational campaign was vigorously pushed among the employees, with the idea of teaching them what was aimed at by taking quinin in this way. No attempt was ever made to force anyone to take this prophylactic quinin, but explanation and persuasion were used to their fullest extent.

By these methods we succeeded, when the use of quinin was at its maximum, in getting our force to take about forty thousand doses per day. The men responded very heartily and loyally to this system of education. I was very much gratified at the results, and feel confident that no system of compulsion could have been as successful. I am satisfied that during the early years of construction, before our other anti-malarial work had produced results, this giving of prophylactic quinin on so large a scale was of the very greatest use to us.

Under some circumstances we required our employees to take quinin. At Taboga, down in Panama Bay, we had a convalescent hospital where the men were sent to spend a week or two when convalescing from the severer forms of malarial fever. A man with malarial parasites in his blood was a source of infection and of danger to his well companions. With the idea of being certain to kill all the parasites in his blood, he was required to continue large doses of quinin for a week or ten days after the stoppage of his fever. But such is the nature of man that as soon as you begin to force him to do a thing, from that moment he begins to seek ways by which he can avoid doing the thing you are trying to force upon him.

A certain number of men, when they were given their daily dose of quinin in the dispensary, would manage to throw their tablets out of the dispensary window. The old turkey-gobbler that was the pet of the hospital seemed to like the stimulating effect of the quinin and gobbled up all the tablets he could find. He became so dissipated in this way that he finally developed quinin amblyopia. This amblyopia is a species of blindness that is sometimes caused by too much quinin. The doctor finally had to confine his old gobbler and keep him away from quinin tablets until he recovered his sight. I cannot vouch for this story, but I was often twitted with it as an illustration of how the men were treating prophylactic quinin. Even if this story were true, it could not be used as an argument against prophylactic quinin on the Isthmus. In general, no attempt was made at compulsion, and there would therefore be no object in a man taking quinin and throwing it away.

I have noted before that our hospital system was planned upon the scheme of some forty sub-district hospitals, or rest camps, which fed about twenty district hospitals. These twenty district hospitals, by means of hospital trains, fed two base hospitals, situated respectively at the northern and southern end of the Canal, Colon and Panama. The one at the southern end was much our largest hospital, containing at its maximum about fifteen hundred beds.

The city of Panama is situated on a peninsula, stretching into the bay of Panama. Just north of the city rises Ancon mountain, some six hundred and fifty feet in height. This mountain is only accessible to a pedestrian; the trail is too rough and precipitous for horse or mule. The northern suburb of the city of Panama is known as Ancon, and this village nestles about the southern foot of Ancon mountain. The line dividing United States territory from Panama passes between Ancon and the city of Panama. Ancon is therefore under the jurisdiction of the United States.

Ancon Hospital is beautifully located along the southern and eastern front of Ancon mountain. The French early in their construction period, about 1882, commenced building their main hospital there. The side of the mountain was graded for roads and laid off in the most beautiful and picturesque manner. Every variety of tropical shrub and plant was introduced from other parts of the tropical world and planted around the grounds. Every opportunity for picturesque location of buildings was seized, and over thirty hospital buildings of various kinds were located over a large area, extending along the northern and eastern sides of Ancon mountain.

The maximum bed capacity under the French was about seven hundred beds. The hospital built by them was well manned and equipped, and was a very much better institution than any hospital in America that I know of at the same period carried on by a firm or corporation. The French did most of their work by contract so that almost all of their patients were employees of the various contractors. Each contractor was made responsible for sick employees whom he sent to the hospital, and was charged one dollar a day for each sick employee as long as he remained in the hospital. A dollar a day was a very moderate charge for the care and attention given a sick man in Ancon Hospital, and I know that the charge did not cover the cost to the old company.

It is the general belief among the people on the Isthmus, who were there during the general construction work of the old French Company, that a very small portion of the employees of the contractors came into the hospital. Notable among these is Sir Claude Mallet, who was the English representative in the city of Panama during the period referred to, and who is at present the British minister to the Panaman Government. From my knowledge of human nature I feel sure that the French contractors did not send a large proportion of their sick to Ancon Hospital. I am surprised that under these circumstances the hospital ever contained seven hundred patients. If we had been doing the work and had twenty-five or thirty American contractors employing sixteen or seventeen thousand men, I should be very much surprised if we at any time had seven hundred patients in the hospital, if the contractors were required to pay one dollar per day for each of the seven hundred patients.