Sanitation in Panama

by William Crawford Gorgas

An adult human being frequently has yellow fever in so mild a form that it is not recognized as yellow fever. Many Europeans are found in a yellow-fever endemic center such as Havana, who have lived there for years and not had yellow fever, as far as they themselves were aware. If, therefore, an individual could prove that he had lived for ten years continuously in a yellow-fever center, his immunity was accepted by the quarantine authorities.

If a ship had touched at a port where yellow fever prevailed, before coming to Panama, there was a possibility of infected stegomyia having gotten aboard, even though no cases of yellow fever had developed on the ship. For by chance the infected mosquitoes may not have bitten anyone, or if they had bitten persons on the ship, the biting may not have taken place a sufficient length of time for the development of the disease, before the arrival of the ship at Panama. Such a ship was considered as possibly infected, and was treated at quarantine exactly in the same way as above described in case of a ship known to be infected.

The fumigation of a ship was generally accomplished by burning sulphur, as above described in the case of fumigating a house. In the parts of a ship, such as the engine-room, where there was valuable machinery which would be injured by sulphur fumes, pyrethrum was used, just as in similar circumstances it was used in fumigating dwelling-houses. We had more elaborate machinery than the pots and pans described in the fumigation of houses, with which sulphur fumes could be developed much more rapidly and in much larger volume. This was used by us on special occasions where its use seemed desirable.

In the history of yellow fever, many curious cases of ship infection from this disease have occurred. During the fall of 1904, one of our warships, the Boston, spent several months in Panama Bay. While down the coast on gun practice, in January, 1905, she developed seven cases of yellow fever. She had been away from Panama such a length of time that the doctor knew that the cases must have received their infection aboard, and that therefore the ship was infected. The cases were well marked and most of them were severe, the doctor and one of the men dying of the disease. Nothing could be found in the sick records of the ship which would indicate that anyone belonging to the ship had contracted yellow fever ashore and developed a mild case, and thus infected the ship. All the cases were connected, directly or indirectly, with the wardroom, three of them being commissioned officers. As we were having at the time some yellow fever in Panama, the crew had not been allowed ashore. One or two of the officers, only, had been permitted to come into Panama for the transaction of necessary business.

A short time before the ship had left the harbor, New Year’s Eve, 1904, they had given a ball aboard, which had been attended by a large number of the citizens of Panama. After a careful investigation of the matter, we concluded that some one of these persons was in the initial stages of a mild case of yellow fever. It is quite possible for such a person to be up and around without appreciating that he has the disease. This person, we concluded, was bitten by some of the stegomyia aboard. At the end of two weeks these stegomyia became infectious and gave the disease to the crew.

Dr. G. A. Perry, of the Public Health Service, who had immediate charge of the work, found a small flat tub under the steps going down from the wardroom, in which stegomyia were breeding freely. This was the only place on the ship where larvæ were found, and this one piece of carelessness was responsible for the epidemic on the ship. All the mosquitoes aboard ship undoubtedly bred here. We could never find out why this tub was kept here, as the wardroom steward who was responsible, contracted the fever and died. The surgeon of the ship also died.

The ship was carefully fumigated, under the supervision of Dr. Henry R. Carter, and no more cases occurred, though the ship immediately went to sea with all of her crew aboard, with the exception of the sick, who were brought to Ancon Hospital.

As an instance of what a man sick with yellow fever may do in the way of going about, I will narrate here the case of one of our patients which will well illustrate this point.

An American machinist, coming from San Francisco to Panama, got off the steamer at Corinto, Nicaragua, got on a spree and was locked up in the Corinto jail. He was left there by the steamer, but was released from jail in time to catch the next steamer going to Panama. He reached Panama at the end of five days, went to work for the Commission, and worked one day, but being taken sick, he quit work, though he did not report to the doctor. Instead, he again commenced drinking. On the second day of his disease, he was arrested by the Panaman police, and placed in jail as being drunk and disorderly. He was released on the third day of his disease and continued his debauch. He was again arrested on the fourth day, put in jail, and was then discovered by one of our inspectors who recognized that he was sick as well as drunk. He had him brought to Ancon Hospital, where he died on the sixth day from the beginning of his attack.

The symptoms of the disease were well-marked, black vomit being profuse. An autopsy confirmed the diagnosis. Here was a man suffering from a case of yellow fever, of which he finally died on the sixth day, who, for the first five days of the disease, was about town, going from saloon to saloon, drinking immoderately, eating what came to hand, and sleeping where convenient. Twenty-four hours before he died, he rode up to the hospital in a cab and walked into the ward. He was having black vomit before he left the jail.