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Sanitation in Panama - Welcome to · PDF filethey landed at Siboney as could probably be got-ten together, but after two months’ campaigning in this tropical jungle, and after several

Aug 14, 2018

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  • Concreted Ditch. Ancon.

  • SANITATIONIN PANAMA

    BYWILLIAM CRAWFORD GORGAS

    CHIEF SANITARY OFFICER, PANAMA CANAL, SURGEON GENERAL, U. S. A.,MAJOR GENERAL, U. S. A.

    I L L U S T R A T E D

    NEW YORK AND LONDOND . A P P L E T O N A N D C O M P A N Y

    1915

  • Preface to the electronic edition 2017

    WilliamGorgaswas amedical officerwith theU.S. Armyin the early 20th century. He was in charge of sanita-tion in the city of Havana when Walter Reed conductedthere his pioneering work on the transmission of yel-low fever. Reed proved that a mosquitoknown thenas Stegomyia, but today as Aedes aegyptiis the solecarrier of this disease. While not immediately involvedin Reeds experimental work, Gorgas followed it closely,and after the conclusion of Reeds trials, he immedi-ately launched a campaign to drive the mosquito, andwith it the disease, from the city.

    In the first seven chapters of this book, Gorgas givesa vivid account of these events. For his mosquito erad-ication campaign, Gorgas waged a veritable battle ofmaterial. One of his routine measures was to fumigatethe homes of yellow-fever patients with pyrethrum, ofwhich he used one pound for every 1,000 cubic feet ofenclosed space (see page 55). In commenting on thismeasure, an astonished Reed suggests that one ouncemay be sufficient for such a task (see page 83). However,Gorgas ultimately carried his point by surprising Reedand everyone else by driving the disease from Havanawithin a year.

    Gorgas was subsequently put in charge of sanitationin Panama during the construction of the canal. There,he took a similarly determined approach to drive outyellow fever. He subjected every house in the city ofPanama to three successive rounds of sulphur fumiga-tion, stating that we used up . . . some hundred andtwenty tons of insect powder, and some three hundredtons of sulphur (page 151).

    After successfully smoking out yellow fever, Gorgasfocused mostly on the suppression of malaria. While

  • eradication could not be achieved, morbidity and mor-tality due to this disease were very significantly re-duced. Gorgas here gives an overview of this work, butdoes not go into very much technical detail; he clearlywrote for a general audience, for whose benefit he lib-erally sprinkled this book with anecdotes and generalhistory.

    A much more thorough account of the sanitary workat Panama has been given byMalcolmWatson, anotherpioneer of malaria control, who visited the Canal Zonein 1913. His book Rural Sanitation in the Tropicsalso describes Watsons own, no less impressive workin South East Asia, and it gives a good idea of the stateof the art at the beginning of the 20th century. Anelectronic version of Watsons book is available frommy website.

    About this edition

    This electronic version was produced from page scans ofthe printed book that I obtained from archive.org. Thepage scans were subjected to OCR using tesseract,and the output was post-processed to generate LATEXmarkup based on the TikZ package that produces aclose semblance of the original layout. The font usedhereTEX Gyre Schola, which is derived from CenturySchoolbookalso resembles that used in the originalquite well.

    While I did proofread the OCR-generated text, someerrors likely still remain. If you want to help with proof-reading, you can find a copy that shows the originalpage scans next to the recreated pages on my website.

    Michael Palmer, April 2017

    http://watcut.uwaterloo.ca/mikesbooks.htmlhttps://archive.org/details/sanitationinpana00gorgrich

  • CONTENTS

    CHAPTER PAGE

    I. Yellow Fever and the Discovery of ItsTransmission . . . . . . . . . . . . . . . . 1

    II. The Experiments of the Reed Board . . 18III. The Discoveries of the Reed Board . . . 32IV. The Sanitary Board of Havana . . . . . . 40V. Sanitary Work at Havana . . . . . . . . . 50

    VI. The Results Accomplished in Havana . . 63VII. Correspondence with Dr. Reed . . . . . 77VIII. History of Yellow Fever . . . . . . . . . 110IX. Geographical Limits of Yellow Fever . 124X. Appointed Chief Sanitary Officer for

    the Isthmus . . . . . . . . . . . . . . . . . 138XI. Preliminary Organization and Work

    at Panama . . . . . . . . . . . . . . . . . . 148XII. Yellow-fever Work at the Isthmus . . . 159XIII. Nombre de Dios . . . . . . . . . . . . . . . . 175XIV. The Work of the Sanitary Inspectors . 182XV. The Work at the Hospitals . . . . . . . . 206

    XVI. Malaria Work and the Hospital System 219

  • CONTENTS

    CHAPTER PAGE

    XVII. Medical and Surgical Service of AnconHospital . . . . . . . . . . . . . . . . . . . 241

    XVIII. The Sanitarium at Taboga . . . . . . . . . 248XIX. The Leper Colony . . . . . . . . . . . . . . 256XX. Quarantine System . . . . . . . . . . . . . 260XXI. Measures Against Bubonic Plague . . . 275XXII. The Work of the Sanitary Department

    of Panama . . . . . . . . . . . . . . . . . . 279Index . . . . . . . . . . . . . . . . . . . . . . 293

  • LIST OF ILLUSTRATIONS

    FacingPage

    Concreted Ditch. Ancon . . . . . . . . . . . FrontispieceMap of the Panama Canal Zone, Showing Hospi-

    tals of the Sanitary Department . . . . . . . . 1Stegomyia Squad. Havana . . . . . . . . . . . . . . 52Screened Water Barrel. Havana . . . . . . . . . . . 52Concreted Ditch. Gatun . . . . . . . . . . . . . . . . 112Screened Yellow-fever Ward. Ancon Hospital,

    Panama . . . . . . . . . . . . . . . . . . . . . . . 150St. Charles Ward, Ancon Hospital. Building in

    Which Twelve Hundred Frenchmen Died ofYellow Fever . . . . . . . . . . . . . . . . . . . . 150

    Oilers at Work in Marsh . . . . . . . . . . . . . . . 184Burning Out Ditch with Oil Spray . . . . . . . . . 184Old French Engine Tender Used as Storage Tank

    for Oil . . . . . . . . . . . . . . . . . . . . . . . . 194Mule for Packing Oil to Oilers . . . . . . . . . . . . 194Distilled Water Cart. Culebra . . . . . . . . . . . . 220Ward at Ancon Hospital . . . . . . . . . . . . . . . 220Stoned Ditch near Tivoli Hotel. Ancon, Panama . 234Bad Anopheles Breeding-ground on Artificial Fill.

    La Boca . . . . . . . . . . . . . . . . . . . . . . . 234

  • Map of the PanamaCanal Zone,ShowingHospitals of theSanitaryDepartment.

  • SAN I TAT IONIN PA N AM A

    CHAPTER I

    YELLOW FEVER AND THE DISCOVERIES OF ITS TRANS-MISSION

    YELLOW FEVER for two hundred years be-fore the Spanish-American War caused greatloss of life and much destruction of wealth. Everyfew years portions of the United States would be-come infected with this disease. In the earlierpart of this period the disease was more or lesslocal. As the Mississippi valley became morethickly populated, the extent of the disease and theinjury caused became very much augmented. Theepidemic of 1878 was probably the deadliest andmost extensive epidemic of yellow fever which everaffected the United States. In this epidemic overthirteen thousand people in the Mississippi valleyalone lost their lives, and the loss of wealth isestimated at considerably more than one hundredmillions of dollars.

    It is very difficult to convey to a reader any ideaof the conditions which exist during an epidemicof yellow fever. All business is entirely para-

    1

  • SANITATION IN PANAMA

    lyzed, the quarantines not allowing any communi-cation between the affected districts and thosenot affected. In an epidemic of any extent thismeans hundreds of local quarantines. Some ideaof the condition of affairs can be obtained by pic-turing what would occur in any community if allthe income of that community should entirelycease for six months. And this was the conditionof business all over the Mississippi valley everytime yellow fever gained entrance.

    The population originally feared yellow feveron account of the poverty, suffering and businessdepression always caused by the quarantineswhich had to be enforced to prevent its spread,and in time people came to associate this idea ofdread with yellow fever itself. When this diseasewas announced in a town, everybody left whocould. The sick were frequently left without care,and often a great deal of cruelty and cowardicewas shown. If a person escaped from an infectedregion and became sick with the disease, or sickfrom any other cause, he was generally treatedas if he were a leper, and would often be left tostarve or die on the roadside.

    It requires continuously warm weather for theyellow-fever mosquito to breed in sufficient num-bers to propagate yellow fever; therefore, thisdisease never became endemic in the UnitedStates. I mean by endemic, existing all the year

    2

  • YELLOW FEVER AND ITS TRANSMISSION

    round and over a number of years. The frostsof winter, wherever they occur, either destroy allthe yellow-fever mosquitoes, or reduce their num-ber below the point at which yellow fever could bepropagated.

    It was known in the United States that yellowfever was always brought somewhere from thelittoral of either the Gulf of Mexico, or the Carib-bean Sea, and the city of Havana, located on thenorthern coast of the island of Cuba, was known tobe the center of this endemic area.

    Yellow fever in 1898 was looked upon as theexample of a filth disease, par excellence, and itwas thought that if Havana were put in a properstate of cleanliness, it might cease to be the greatpoint of infection for the United States. It wasknown that yellow fever had existed in the cityof Havana continuously for one hundred and fiftyyears. It is interesting to note that the endemicinfection of Havana occurred in 1762, when Ha-vana was besieged and captured by Americantroops. I say American troops, because the expe-dition was largely composed of men from the pres-ent United States, then colonies of Great Britain.It is also interesting to note that this infection wa

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