Sanitation in Panama

by William Crawford Gorgas

Attached to the hospital the French had a dairy with a very complete set of dairy buildings. In connection with this dairy was a farm of some three or four hundred acres. The water supply for the hospital during the French occupation came from three or four beautiful springs which issued from the side of Ancon mountain. Night soil was taken care of by a bucket system of closets.

The hospital system, on account of the topography, was necessarily the pavilion system. This system was probably the best that could be adopted for both the local and climatic conditions. The cooking was done at one central kitchen, and the cooked food distributed to the wards, where it was consumed.

The nursing force was composed of Catholic Sisters, assisted by negro maids and orderlies. These orderlies and maids did the manual work and rough nursing, under the supervision of the Sisters.

The medical staff consisted of a sufficient number of French physicians. The superintendent during most of the period of construction of the old company and up to the time that we took charge in 1904 was Dr. La Crosade. He remained with us for several years, and did for us most valuable and useful work.

The hospital was not popular among the French employees. The mortality there was very high, and it was soon recognized that men contracted yellow fever there; for instance, a man, otherwise well, would break his leg, be sent to the hospital, in the course of four or five days develop yellow fever, and within ten days be dead. This fear of the hospital was another reason why French employees did not go there. Most of the whites and the better class of French employees, when they were taken sick, remained in their boarding-houses and homes in the city of Panama.

In making these remarks I do not intend to reflect in any way upon the management of Ancon Hospital by the French. If we had had this hospital in 1884 we should probably have obtained no better results than they did. At that time they did not know that the mosquito transmitted yellow fever from man to man, nor did we know it then. Still, the hospital records show that in the nine years of construction under the old French Company, twelve hundred patients died in Ancon Hospital from yellow fever. These were mostly Frenchmen, and they died in the building used for white employees, the Saint Charles. This building was occupied for the first few years of our construction of the Canal by Dr. Carter and myself, with our families. The fact that we were willing to place our families in such a building, located in one of the worst yellow-fever centers, shows how thoroughly we believed that yellow fever was not infectious in the ordinary sense of the term.

This building was about the center of the hospital grounds, and occupied a most attractive site. It was situated about two hundred feet up the side of the mountain looking to the northeast. A macadam road skirted the building on the down side, and the masonry retaining-wall supported this road on the lower side. Between the border of the road and the retaining-wall was a superb row of stately royal palms. Behind the building rose the mountain for four hundred feet, covered by a perfectly impenetrable tropical forest, giving to the picture the deepest possible dark green background. The view to the north and east extended for miles and miles. To the east, over the bay of Panama, dotted with its forest-clad islands, I have many times watched from the gallery of this building that anomaly, so generally remarked at Panama, the sun rising out of the Pacific.

To the north and east were in view the various ranges of Andean Mountains which make up the backbone of the Isthmus. From this point, four or five ranges of mountains could be seen, and in the evening, when the sun was setting behind the Ancon mountain at one’s back, the play of colors was superb: light green upon the nearer ranges, changing into deep azure upon the farther ranges, with the mountain tops and higher valleys covered here and there with a robe of white mist.

For the fourteen years after the failure of the old French Company in 1889, Ancon Hospital had financially a most straightened time, and the Sisters who were in charge had to reach out in all directions to make both ends meet. They deserve a great deal of credit for the brave and successful struggle which they made in supplying the wants of the sick intrusted to them.

Major La Garde, of the United States Army, was appointed Superintendent of Ancon Hospital, and took charge in June, 1904. He rapidly and successfully proceeded to organize the hospital on such a basis that it was always able to care properly for all patients who presented themselves.