Sanitation in Panama

by William Crawford Gorgas

At the present time, we have just reversed the process; we have just made sanitary discoveries that will enable man to return from the temperate regions to which he was forced to migrate long ages ago, and again live and develop in his natural home, the tropics. These sanitary discoveries are those that have enabled us to control yellow fever and malaria.

The practical application of these great discoveries has just been demonstrated during the construction of the Panama Canal. This was not the first demonstration with regard to either disease. But the conditions were such at Panama that they have attracted the attention of the whole world, and probably the general knowledge that the white man can live and thrive in the tropics will date in future times from the construction of this great work.

A given amount of labor applied to land will produce a very much larger amount of wealth than will the same labor applied in the same way produce in the temperate regions. The white man, of all the races of the human family, is the most eager in his pursuit of wealth. As it becomes generally known that he can live in the tropics and maintain his health, necessarily a large emigration will occur from the present civilized temperate regions to the tropics. The largest areas of land suitable for cultivation lie in the tropics, and much the largest bodies of rich alluvial lands, such as the valleys of the Amazon and the Congo. Not only are these lands more productive than the lands of the temperate zone, but climatic conditions enable the farmer to produce several crops a year. The tropics, when occupied and cultivated by the white man, will produce many times the amount of food now produced in the temperate regions.

The great civilizations of man are now already established and developed in the temperate zones of Europe and America, and it is probable that, for centuries to come, these great empires will be located where they are at present, and that the tropics will be the agricultural, food-producing regions from which these centers of civilization will be supplied.

In the early stages of the development of mankind it was all that each individual could do to supply his own necessities. As he advanced in civilization, he produced more than he himself needed, and thereby had a surplus to exchange with his neighbors for things which he desired. As his productive capacity increased, a larger number of men were enabled to apply themselves to the arts and sciences. The degree of civilization to which a community can reach is in the main governed by the amount of the necessities of life that the labor of one man applied to the land can produce. If one man’s labor can produce enough of the necessities to support himself and one other man, we have a certain degree of civilization and refinement. If his labor produces enough to support himself and two other men, a higher degree of civilization results. In the tropics one man’s labor applied to natural opportunities is able to support more men than the same amount of labor applied in any other part of the world. In the long run, therefore, the great civilizations of the future will be located in the tropics.

No doubt the great centers of civilization will remain for centuries much as they are at present. The white settlers will go to the valleys of the Amazon and Congo, building up large agricultural communities which will supply the European and American centers located as they are at present with their food supply. But in the course of ages the centers of civilization will move to where a given amount of labor will produce the largest amount of food. Of course, other things must be equal. I am assuming that the government in these new communities is as good as the government with which we are comparing it in the temperate zone. When this great migration of population has fully commenced, I believe that the peoples of that day will look back upon the sanitary work done at the Canal Zone as the first great demonstration that the white man could live as well in the tropics as in the temperate zone.

I am inclined to think that at this time the sanitary phase of the work will be considered more important than the actual construction of the Canal itself, as important to the world as this great waterway now is, and will be for generations to come.

The discovery of the Americas was a great epoch in the history of the white man, and threw large areas of fertile and healthy country open to his settlement. The demonstration made at Panama that he can live a healthy life in the tropics will be an equally important milestone in the history of the race, and will throw just as large an area of the earth’s surface open to man’s settlement, and a very much more productive area.

INDEX

• Agramonte, Dr., [11], [16], [41].
• Albertini, Dr. Antonio, [12].
• American Medical Association, interest of, in Panama sanitation, [142].
• Ancon Hospital, [209], [224-234], [236-238], [241-247].
• care of insane at, [242].
• clinic for tropical diseases at, [238].
• equipment at, [241].
• eye department at, [242].
• management of, [243], [244].
• organized by La Garde, [229-232].
• records of, under French company, [227].
• researches at, [238].
• services of, to Canal employees, [247].
• sewage system installed at, [230].
• statistics of, [247].
• treatment of yellow fever at, [230-231].
• Angeles, Sister Maria de los, [268].
• Anopheles. See Mosquito, malarial.
• Augustin, on yellow fever, [117].
• Avila, Pedro Arias de. See Pedrarias.
• Balboa in Panama, [132], [133], [134], [135], [168].
• Bubonic plague in Panama, [271], [276-278].
• Camp Columbia, yellow-fever experiments at, [19], [20], [25], [26], [30].
• Camphor fumigation, [54], [55].
• Carroll, Dr., on Sanarelli’s researches, [7], [11].
• mosquito experiments of, [16], [19], [41].
• Carter, Dr. Henry R., quarantine work of, [271].
• system of, for transportation of sick in Panama, [210-212].
• yellow-fever researches of, [10], [27], [28], [29].
• Cemeteries in Panama, [214-217].
• Chloroform, use of, against mosquitoes, [199].
• Coffin story, [240].
• Colon Hospital, [209].
• Colon, yellow fever in, [150].
• Colonization and disease, [114], [284].
• Columbus in Panama, [131].
• Concrete floors, as anti-plague measure, [277-278].
• Cook, Dr. R. P., yellow-fever experiments of, [36].
• Correspondence, Reed-Gorgas, [77-109].
• Cost of sanitary measures in Panama, [148], [151], [152], [239], [240], [241].
• Culebra Island, quarantine at, [271-274].
• Darling, Dr. Samuel, [190], [238].
• Davis, George W., General, [152].
• Deeks, Dr. W. W., [238].
• Dispensaries in Panama, [213], [220-223].
• District physician, duties of, [212-214].
• Drainage as anti-malarial measure, [184-189], [194-196], [201], [235].
• Drake in Panama, [137], [163], [168], [176], [177], [178], [179].
• Emergency and temporary hospitals in Panama, [210].
• Emigration, effect of control of tropical disease on, [289], [293].
• Finlay, Dr. Carlos, mosquito theory of, [13], [14], [27].
• Flemenco Island cemetery, [215].
• French Panama Canal Co., hospital service of, [224-227].
• yellow fever and malaria under, [138], [149], [227].
• Fumigation for yellow fever, [52], [53], [54], [55], [150], [151], [261], [263].
• Garbage disposal as anti-plague measure, [278].
• Gillette, Cassius E., Major 143.
• Grass-cutting in anti-malarial work, [187].
• Guiteras, Dr. John, [12], [41], [45], [48].
• Havana, sanitary measures in, [5], [6], [56-61].
• yellow fever in, [3-7], [22], [23], [41], [125].
• “Her ladyship,” [43-46].
• Herrick, Dr. A., [238].
• Hospital system in Panama, [207-214], [223].
• dispensaries in, [213-214], [220-223].
• equipment in, [207-210].
• medical districts in, [212-214].
• transportation of sick in, [210], [211].
• Hospitals, emergency and temporary, in Panama, [210].
• Hygiene Congress, Gorgas, Wm. C., at, [141].
• value of certificate of, [25].
• Immunity, yellow-fever, [22-24], [64], [118], [119], [261-263].
• Insane, care of, in Panama, [242].
• Inspection. See Sanitary inspection.
• International Sanitary Congress, demonstration of mosquito theory at, [48].
• Kerosene oil, in anti-malarial work, [188].
• in yellow-fever work, [61].
• La Boca, bubonic plague in, [276].
• La Crosade, Dr., [226].
• La Garde, Louis A., Major, [143], [206].
• organizes Ancon Hospital, [229].
• Larvacide in anti-malarial work, [190-191].
• Las Animas Hospital, yellow-fever experiments in, [19], [26], [41], [43], [45].
• yellow-fever treatment in, [50-51].
• Lazear, Dr., on Sanarelli’s researches, [11].
• mosquito experiments of, [16], [19].
• Leper colony in Panama, [256].
• Le Prince, Joseph, anti-malarial work of, [159], [186], [198-200], [202], [203], [204].
• fumigation experiments of, [55].
• rat trap devised by, [277].
• in Ancon Hospital, [230-231].
• Lyster, Theodore C., Major, [242].
• Malaria, importance of control of, to human race, [289-293].
• at Ismalia, [140].
• at Porto Bello, [165], [166].
• preventive work in, drainage and, [183-189].
• kerosene oil and, [188].
• quinin dispensation and, [220].
• sanitary districts organized for, [160].
• screens and, [196-198].
• statistics of, [73], [275].
• transmission of, [219].
• Malarial mosquito. See Mosquito, malarial.
• Mason, Colonel, [243].
• Medical districts organized in Panama, [209], [212], [213].
• Medical practice, ancient and modern, [110-113].
• Medical service in Panama, sanitary advantage of, [212-214].
• Mosquito, malarial, at Ismalia, [141].
• sanitary control of, [61], [159], [183-191], [194-196], [198-205].
• yellow fever, Army board experiments on, [16-20], [26], [30-36], [38], [41-49].
• breeding conditions of, [2], [56], [58], [59], [60], [192], [204], [233], [265].
• fumigation and, [52], [53], [54], [55].
• Mosquito, yellow fever, in Ancon Hospital grounds, [232-234].
• kerosene oil, use of, and, [61].
• Mosquito-catcher in anti-malarial work, [198-202].
• Mosquito theory of yellow-fever transmission, [13], [14], [32], [36], [48], [157].
• Mosquitoes, different species compared, [191-195].
• Mount Hope cemetery, [216].
• Mott, Dr. J. C., [13].
• Panama, fumigation for yellow fever throughout, [150], [151].
• hospital service in, [207-214], [223].
• medical districts in, [209].
• Sanitary Department of, [148], [153], [154].
• sick rate statistics at, [280], [281].
• Spanish rule in, [134-135], [168], [176-180].
• yellow fever in, [136], [150].
• Pedrarias in Panama, [132], [133].
• Perry, Dr. James A., [265], [271], [276].
• Phillips, Colonel, [244].
• Pizarro in Panama, [133], [135].
• Porto Bello, cemetery at, [216], [217].
• commerce and fair at, [161-162], [163], [164].
• malaria in, [165], [166].
• Public Health Service, Board of, [10].
• Pyrethrum, fumigation with, [54], [263].
• Quarantine, for bubonic plague, [276].
• for yellow fever in Havana, [63], [64], [72].
• in Panama, [260].
• Quinin, dispensation of, [220-223].
• Rats, relation of, to bubonic plague, [276-278].
• Reed, Dr. Walter, mosquito experiments of, [16], [19-21], [26], [30-36], [38], [41].
• on Sanarelli researches, [7], [11].
• Reed-Gorgas correspondence, [77-109].
• Ross, Dr. John W., [35], [45], [143], [206].
• Ross, Dr. Ronald, anti-malaria work of, [74], [141].
• San Blas Indians, [167-174].
• Sanarelli, Giuseppi, yellow-fever researches of, [7-11].
• Sanarelli’s organism, Army board investigation of, [11], [12].
• Sanitary Department in Panama, accounts of, [239], [241].
• cemeteries under control of, [214-216].
• changes in, [153], [154].
• financial and moral value of, [280-284].
• free medical service of, [214].
• Sanitary department in Panama, organization of, [148].
• undertaking and, [239-240].
• Sanitary districts for anti-malarial work, [160], [182], [183].
• Sanitary inspection, in Havana, fumigation for yellow fever and, [52-55].
• screens and, [50-52].
• water supply and, [56-62].
• in Panama, drainage and, [184-195], [201].
• fumigation for yellow fever and, [150], [151], [261], [263].
• grass-cutting and, [183-184].
• mosquito-catching and, [198-202].
• screens and, [196-198].
• Screens, as anti-malaria measure, [196-198].
• in treatment of yellow fever, [50-51], [230], [231].
• Smith, Patrick, Private, Sanarelli’s organism and, [11].
• Stegomyia. See Mosquito, yellow-fever.
• Sternberg, George M., General, [7], [138].
• Stevens, John F., [155].
• Suez Canal, sanitation at, [139], [140].
• Sulphur fumigation, [53], [263].
• Taboga, sanitarium at, [248], [249].
• Tobacco fumigation, [55].
• Transportation of sick in Panama, [210-212].
• Umbrella ants at Ancon Hospital, [232-234], [236-237].
• U. S. Army, sick rate in, [4], [206], [279].
• Vaccination, yellow-fever, [42], [47].
• Water supply, at Ancon Hospital, [229].
• in Havana, and mosquito-breeding, [56], [58], [59], [60].
• at Suez Canal, [140].
• Wood, Gen. Leonard, [19], [40].
• Yellow fever, description of, [21], [115], [122].
• direct transmission of, [37-38].
• effect of, on shipping, [3].
• endemic areas of, [125-126], [127], [128], [270].
• epidemic area of, [129], [130].
• epidemics of, [1], [128], [129], [130].
• experiments at Camp Columbia, [19], [20], [21], [25], [26], [27], [30].
• fumigation for, [52-55], [150], [151], [261], [263].
• importance of control of, to human race, [289-293].
• in Africa, [127].
• in Brazil, [126].
• incubation period for, [10], [27-30], [38].
• in Ecuador, [24], [119].
• Yellow fever in French Panama Canal Co., [138], [149], [227].
• in Havana, [3-7], [22], [23], [41], [125].
• in U. S. Army, [4].
• in Vera Cruz, [3], [117], [121], [127], [128].
• investigation of, by Army board, [11], [12], [16-20], [26], [30-36], [38], [41-46].
• old treatment of, [65], [66], [67], [68], [69], [70].
• origin of, [117-118], [119], [120], [121], [287].
• quarantine regulations for, [63], [64], [72], [260].
• Sanarelli’s researches in, [7-11].
• Yellow fever, ship infection cases of, [264-269].
• spread of, [115], [116], [124], [125], [126], [127].
• statistics of, [71], [72].
• transmission of, [13], [14], [21], [27], [32-36], [37-38].
• treatment of, at Ancon Hospital, [230-232], [233],234.
• screens in, [50-51], [230], [231].
• Yellow-fever immunity, [22-24], [64], [118], [119], [261-263].
• value of certificate of, [25].
• Yellow-fever mosquito. See Mosquito, yellow-fever.
• Yellow-fever vaccination, [42], [47].