Sanitation in Panama

by William Crawford Gorgas

For the first year there were almost insuperable difficulties in the way of getting supplies of all kinds, but gradually these troubles were corrected. We used all the old French buildings in much the same manner as had the French. As the number of patients increased, the old French buildings were enlarged, generally by adding a second story, and a few new buildings were added, until finally the capacity of the hospital had risen to fifteen hundred beds.

Into all these buildings a piped water supply was introduced, and the bucket system for night soil was everywhere replaced by modern flush closets. Bathing facilities were also supplied wherever needed. A good sewage system connected all these buildings with the sewers of the city of Panama. The old lighting system of candles and lamps were replaced by electric lights. All the buildings were thoroughly screened with wire netting. This precaution was almost essential in the early years before we got mosquito-breeding as thoroughly under control as it later became.

In 1904 and 1905 we treated a good deal of yellow fever in this hospital, and in the wards where we treated yellow fever we had to be particularly careful. Most of the patients in these wards were non-immunes, that is, were patients who had not had yellow fever. The nurses and doctors were also generally non-immunes, who were liable to yellow fever. We had, therefore, to be absolutely certain that no mosquito which could carry yellow fever from patient to patient, or to the doctors and nurses, got into these wards.

The screening was very carefully done under the supervision of Mr. Le Prince, who formerly had charge of similar work at Havana. Only one entrance was used for each ward, and this entrance was closed by a screened vestibule, with double doors. A watchman was always on duty in this vestibule, whose business it was to see that any person entering the vestibule from the outer door, closed the outer door before opening the inner. Notwithstanding the large number of cases of yellow fever treated in the yellow-fever wards of Ancon Hospital in the years 1904 and 1905, and in spite of the fact that in these wards were a considerable number of non-immune patients who did not have yellow fever, and the further fact that most of the doctors and nurses were non-immunes, not a single case of yellow fever developed in Ancon Hospital during American control of that institution. I wish to except from this statement one of the female nurses. This nurse did have a very severe case, and came very near dying. The evidence seemed very strong that she had not contracted the disease in the hospital. She was in the habit of going down frequently into the city of Panama in the evening after sunset where infection was very rife. Soon after her recovery she married one of the young doctors connected with the hospital upon whom public opinion settled the blame for her contracting the disease, because he had so frequently inveigled her into taking trips into town.

That no case of yellow-fever infection occurred in the hospital is the greatest possible compliment to the efficiency of the system established by the authorities for its prevention. It made a very strong impression both upon the Americans and Panamanians. All could see that we had done something that had radically changed conditions as they had existed before in Ancon Hospital. Formerly, nearly every white non-immune who was taken to the hospital developed yellow fever. Now, they could see that the yellow-fever wards of Ancon Hospital were safer for a non-immune than was any part of the city of Panama. When it was explained to them that there was no mystery about this; that it had been discovered that yellow fever could not be conveyed from man to man except by the stegomyia mosquito, they were prepared to accept this as the proper explanation.

Probably, if the French had been trying to propagate yellow fever, they could not have provided conditions better adapted for this purpose than the conditions which they did establish with an entirely different object. The stegomyia were bred everywhere about the Ancon Hospital grounds in the usual numbers found in almost every tropical community, due to old cans, bottles, rain-water barrels, roof gutters, etc. As I have mentioned before, the grounds were most beautifully laid off and every kind of tropical bush and shrub carefully fostered in the various plots about the grounds. There is down there a large ant, known as the umbrella ant, that is very destructive to most shrubs and plants. A colony of these ants will, in the course of a single night, cut every leaf from a good-sized orange tree. The leaf is cut into a piece about half an inch in diameter and carried off by the ant in his nippers, and when you see a column of these ants crossing the path, hundreds and thousands of them, with these circular pieces of leaves in their nippers, it looks very much as if they were carrying them for protection against the sun. Hence their name, “umbrella ant.”

Now, in order to raise any vegetation at Ancon, the plant has to be protected from these ants. The French used for this purpose a pottery ring. The ring was filled with water and the plant was placed in the large hole in the center. This thoroughly protected the plant, as the ant was unable to cross the water. But the water in the ring was an ideal breeding-place for the stegomyia mosquito, and as there were several thousand of these earthenware rings about the grounds, close to the wards, a more perfect arrangement for the propagation of yellow fever could not have been adopted, if the authorities had this object in view.

Knowing that shrubbery protected and harbored mosquitoes, we cleared off, as was our rule, everything within two hundred yards of any of the buildings. It looked very much like vandalism on our part to see all the beautiful plants, rose bushes, flowers, etc., which had been for so many years carefully nurtured and cared for by our French predecessors, ruthlessly destroyed.

But our work was successful, and in the course of time we got rid of mosquitoes entirely in the grounds of Ancon Hospital. We continued to keep the buildings well screened, however, though I feel sure that we could now treat cases of yellow fever in Ancon Hospital in unscreened wards and still not have the disease transmitted to the non-immunes in the ward, for the reason that there are no stegomyia there to transmit the disease. This statement is not altogether theory on my part.

On the next hill, about a quarter of a mile from the old yellow-fever wards of Ancon Hospital, is the Tivoli Hotel. This hotel is owned and operated by the Canal Commission, and for the last few years has been filled with visitors from abroad, principally from the United States, who were of course entirely unacclimated. During the months of the dry season the hotel is crowded, and for the last two years it has been kept full nearly all the year round. During these last two years about thirty thousand sight-seers have visited the Isthmus.