Sanitation in Panama

by William Crawford Gorgas

The medical and surgical service of Ancon Hospital rapidly developed so as to win the confidence of the civil population all around. Not only did patients come to us from the Zone and the Republic of Panama, but patients also applied for admission, and many of them, from the west coast as far south as Chili, and as far north as Mexico. Many hundreds of people who formerly went to Europe and the United States for surgical care and treatment, now go to the Ancon Hospital.

The charges for this treatment are so arranged that it costs the Commission nothing, but is actually a source of considerable profit. Hundreds of patients who can never hope to have means enough to go to Europe or the United States for medical or surgical relief, are able to go to Ancon and pay the very moderate charges there.

This is another item of peculiar charge on the Isthmus. If it costs $30,000 a year to care for these patients, in our accounts this $30,000 is charged to sanitation, but the $50,000 which the Commission receives for these patients is not credited to sanitation, but to construction and engineering.

An eye department was also established at Ancon by Major Theodore C. Lyster, of the United States Army, and was equipped with all modern appliances for eye, ear, nose and throat work. This department developed along the same lines as did the surgical work of the hospital, and was soon attracting patients from all the west coast north and south of us.

The hospital also had a well-appointed department for the insane. This grew from very small dimensions to considerable size. In 1913, we had two hundred and fifty patients in this section of the hospital. When we first went to Panama, the insane of the Republic were very poorly cared for. In most parts they were confined in the jails, and cared for with the ordinary prisoners. Knowing that, as time went on, we would have a considerable number of insane from the people in the Zone for whom we had to make provision, we proposed to the Panaman Government that we should take care of their insane in our institution, at a per capita cost of seventy-five cents per day. This they readily agreed to, and at present, considerably more than half of these two hundred and fifty patients are sent in by the Panaman Government.

The cost of caring for these Panaman patients was charged to the Department of Sanitation, but the seventy-five cents per day which was received by the Isthmian Canal Commission from the Panaman Government, was turned over to the construction of the Canal.

A large and well-equipped laundry was attached to Ancon Hospital, furnished with all modern appliances. It was originally intended merely to do hospital work, but it was so difficult for employees to get washing done that the functions of the laundry were gradually extended and work was done for Canal employees other than those sick in hospitals. A reasonable charge was made for this outside work, and it finally came about that the income from this outside work went a considerable way in paying the expenses of the laundry.

Under Colonel Mason, who succeeded Colonel Phillips in the management of the hospital, the waste fats and tallow from the kitchen were saved, and enough soap made not only to supply the laundry, but in good part to supply the hospital.

The amount of surgical work in this hospital was very large, and the quantity of surgical dressings enormous. A considerable portion of these surgical dressings were not at all soiled, or very little so. Colonel Mason had these picked over, washed and sterilized, and found that he could thus make a large saving in his surgical dressings.

In the early years of the hospital we bought such milk as we could get from the surrounding country at one dollar and twenty cents a gallon. Colonel Phillips brought cows from the United States and established a dairy on the hospital grounds, which accommodated about one hundred cows. After the dairy was well under way, he found that his milk cost him only from thirty to forty cents per gallon.