Panama, past and present/Chapter 12
CHAPTER XII
HOW THE ISTHMUS WAS MADE HEALTHY
THE New French Canal Company lost no time in accepting the $40,000,000, and its representative on the Isthmus formally turned over possession to the United States on May eighth, 1904. At this time, only about six hundred West Indians were working in the Cut, with a few side-excavators and trains of four-wheeled dump-cars, and an impatient call went up from the American people for their government to "make the dirt fly!" But for the next two and a half years, there was very little digging and a great deal of preparation.
Instead of hurrying thousands of laborers to the Isthmus to have them die there, as they did in the fifties and eighties, of fever and insufficient food, we cleaned house before we moved in. Clearings were made in the jungle, swamps were drained, old French houses were repaired and new ones were built. A line of steamers fitted with cold storage brought food from New York, and hotels or mess-houses served it to the men. The French hospitals at Ancon and Colon were enlarged, and the dirty little cities of Panama and Colon were cleaned and made sanitary. But though the filth was gone the fever remained.
In the same way, Havana and Santiago de Cuba, cities which old shipmasters declared they could smell ten miles 
SURGEON-GENERAL WILLIAM C. GORGAS.
to sea in an offshore breeze, had been thoroughly cleaned by our army as soon as the Spaniards evacuated Cuba in 1898, but still our soldiers had kept dying of yellow fever there. Everything that medical science could suggest was done to stop the spread of the disease, but without effect. Thousands sickened and hundreds died, while the doctors stood by, as one of them declared, "in utter perplexity and wonder."
No one knew how yellow fever was spread, though its ravages had been only too well known for two centuries and more. It had killed over thirty-six thousand people in Havana and a hundred and thirty thousand in Spain; it had swept our coast from Massachusetts to Florida, killing one person out of every ten in Philadelphia in 1793, and over forty thousand in New Orleans between then and the end of the nineteenth century. Though other diseases, notably tuberculosis, have caused and still are causing much more direct suffering and loss of life, they were less feared because they lacked the terror of the unknown. When yellow fever broke out in a city, it was as if the very Angel of Death had come, walking invisible and slaying without cause. Then followed wild stampedes, brutally checked by "shotgun quarantines," looting, debauchery, and a wide-spread paralysis of business, causing altogether a loss of life and property impossible to compute.
Two things held yellow fever in check; frost stopped it, and those that recovered from the first attack were immune for the rest of their lives. Several regiments of these "immunes" were raised during the Spanish-American War, but there were not enough of them to garrison, all Cuba, and the disease soon broke out among the other troops sent there. Among non-immunes, and below the frost-line, what hope was there of stopping the spread of yellow fever? Only that some hero might strip this giant of his invisible coat, and, by showing what path he followed from death-bed to death-bed, enable us to guard and close it. That hero came, and in all our history there is no nobler story than that of his triumphant sacrifice.
It had long been suspected by several doctors that the germs of yellow fever were carried to fresh victims, neither by contact nor in infected clothing, but by certain species of mosquitos. Dr. Carlos Finlay, an old Havana physician, had declared this belief as early as 1883. But no one could say for certain, because yellow fever is a disease that attacks only human beings, and to make the necessary experiments there were required, not mice or guinea-pigs, but living men.
One night in July, 1900, four surgeons of the United States Army Medical Corps met in Havana, where they had been sent as a Yellow-Fever Commission, and decided that the time had come when these experiments must be made. With full knowledge of the fearful nature of the disease, these doctors agreed that before they called for others to volunteer, they would make the first experiments on their own bodies.
But one of the four, Dr. Aristides Agramonte, a Cuban, was an immune and therefore could take no part in the tests; and another, Major Walter Reed, was almost immediately recalled to Washington. The two others, Jesse William Lazear, an American, and James 
SANITARY SQUAD CLEANING PANAMA CITY.
Carroll, an Englishman, let themselves be bitten by mosquitos that had sucked the blood of yellow-fever patients. The experiment was but too successful. Both took the disease, Carroll recovered, but Lazear died. "Greater love hath no man than this, that a man lay down his life for his friends."
A tablet, erected to the memory of Lazear, in Johns Hopkins Hospital at Baltimore, bears this inscription, written by President Eliot of Harvard University:
"With more than the courage and the devotion of the soldier, he risked and lost his life to show how a fearful pestilence is communicated and how its ravages may be prevented."
Volunteers were called for, that further experiments might be made, and General Leonard Wood, then military governor of Cuba, offered to pay each a reward of $200. When this was explained to the first men who came forward, two young soldiers from Ohio, John R. Kissinger and John J. Moran, both refused to accept it, declaring that they had volunteered "solely in the interest of humanity and the cause of science." Major Reed, to whom this declaration was made, rose to his feet, raised his hand to his forehead as if in the presence of his superior officer and said to these humble enlisted men, "Gentlemen, I salute you." When Major Reed told of this incident, not long afterwards, he declared, "In my opinion, this exhibition of moral courage has never been surpassed in the annals of the army of the United States."
Thanks to the skill of Major Reed, none of the thirteen men who followed the splendid example of Carroll and Lazear lost their lives; though some permitted themselves to be bitten by infected mosquitos and so took the fever, while their comrades entered a little room as dark and airless as the Black Hole of Calcutta, and slept there for three weeks, between blankets taken from the beds where yellow-fever patients had died. These last suffered nothing worse than discomfort, and it was conclusively proved that yellow fever is carried by the bite of a single species of mosquito; the Stegomyia fasciata, and by nothing else. This discovery, which has been truly said to be worth more than the entire cost of the Spanish War, gave the doctors something tangible to fight. Reed and Carroll drew up a complete program for protecting patients and killing off the mosquitos, and by putting it vigorously into effect, freed Cuba from yellow fever within a year.
Among Major Reed's assistants in Havana was Dr. William C. Gorgas, who was made chief sanitary officer of the Canal Zone shortly after the Americans came to Panama. Here he was confronted with a problem almost exactly like that which he had already seen solved in Cuba. All that was required was the intelligent and vigorous application of the principles discovered by the sacrifice of Lazear and elaborated by Carroll and Reed. Unfortunately, Dr. Gorgas was badly handicapped at the start by the failure of the United States Government to supply him with the force and funds necessary to do this.
The natural result was an outbreak of yellow fever, in Panama, in the spring and summer of 1905. Thirty-five of the American employees died, and hundreds more fled north as fast as they could find deck-room on the crowded ships. There they filled the newspapers with panic-stricken interviews and doleful prophecies that the Canal would never be built, and fervidly quoted this well-known stanza from the works of Gilbert, the poet of Colon.
Beyond the Chagres River,
'T is said (the story's old)
Are paths that lead to mountains
Of purest virgin gold;
But 't is my firm conviction,
Whate'er the tales they tell,
That beyond the Chagres River,
All paths lead straight to Hell!
"There are three diseases in Panama," declared Mr. John L. Stevens, who became chief engineer at this time. "They are yellow fever, malaria, and cold feet; and the greatest of these is cold feet."
But now Dr. Gorgas was given his long-delayed medical supplies, his water-pipes, porch-screens, and plenty of money. Thousands of men were taken from the excavating force to swell the sanitary-squad. Best of all, the new governor of the Canal Zone—to whom the head of the Department of Sanitation was then subordinate—was Mr. Charles E. Magoon, who helped Dr. Gorgas with the greatest good-will and energy.
The first thing was to establish a rigid quarantine at both ports, to prevent new cases being brought in from other countries by sea. Every ship that came from a yellow-fever port was thoroughly fumigated to kill any infected mosquitos that might be on board, and all the passengers were kept in a screened house, where no local mosquitos could get at them, until long after the time required for the development and discovery of any possible fever-case among them. Without sick people to bite, the mosquitos could get no germs to carry, and, contrariwise, without the Stegomyia mosquito, the germs could not be carried from one person to another. Dr. Gorgas and his little army attacked the enemy from both directions at once.
The two great strongholds of the disease were the cities of Panama and Colon. Here the sanitary control which we had obtained by treaty-right was greatly helped by the fortunate fact that the first President of the Republic of Panama was Dr. Manuel Amador Guerrero, a well-trained physician and an authority on tropical diseases. At his suggestion, native doctors were appointed sanitary inspectors, and they did their work far more tactfully and with less friction than American inspectors could possibly have done, among a Spanish-speaking population, virtually all of whom were immune to yellow fever and had no idea of sanitation. They submitted with the greatest good-nature to having their houses entered and searched for yellow-fever patients, and during the worst of the epidemic, every house in Panama City was visited every day. As soon as a new case was discovered, the sick man was carried to the hospital in a screened ambulance, and his house and those of his neighbors were tightly sealed up with strips of paper and fumigated with sulphur, after which the dead mosquitoes were carefully swept up and burned. Then detective work would begin in two different directions: watching 
for new cases caused by mosquitos that might have bitten this man; and tracing back the source of his infection to some earlier and perhaps hitherto undiscovered case.
This would have been a well-nigh impossible task if the yellow-fever mosquito had been as strong on the wing as the more harmless species we know so well at home, most of whom can fly for miles with a favorable breeze. Fortunately, the Stegomyia is a feeble creature, usually living in or about houses, and rarely flying more than a hundred yards from its birthplace in some stagnant pool. The favorite breeding-places of these insects in Panama City were the rain-water barrels and cisterns, which were first screened and afterwards destroyed when the new waterworks were finished.
The old waterworks consisted of two or three large Spanish wells, that received most of the drainage from the graveyard, and a few carts, from which the man who owned the graveyard used to peddle this water through the streets, for five cents a gallon. It was much better for his business than for the people who drank it. The Americans stopped this, and piped in good water from a reservoir made by damming the Rio Grande. There was a great celebration on the Fourth of July, 1905, when the water was turned on in the Cathedral Plaza. The President, and the Governor, and all the other dignitaries, both Panamanian and American, attended a solemn high Mass in the cathedral, and at the elevation of the Host and the stroke of noon, the water was sent spurting into the air outside, and the Panamanian Republican Band struck up what it thought was the American national anthem. It was a popular tune of the period, called "Mr. Dooley"!
Sewers were laid at the same time as the water-pipes, and the big clumsy cobblestones were ground up in portable rock-crushers to make a concrete bed for the smooth new pavements of vitrified brick. Formerly, garbage of all sorts was thrown out into the streets to rot there or be eaten by the hundreds of vultures that were the only
THE OLD WATER DEPARTMENT OF PANAMA.
street-cleaning department. But now the streets are swept every night by gangs of negroes, employed by the Panamanian Government, under American supervision.
In sanitation as in politics, we found Panama a city of the Middle Ages. Our doctors discovered a few wretched lunatics chained to the damp walls of the seventeenth-century dungeons, hewn out of the rock beneath the sea-wall; and lepers, who lived on the beach outside the city wall, and dared not come too near, lest people call out, "Unclean! Unclean!" and stone them, exactly as they did in Old Testament times. Though these unfortunates had no claim on our charity, our government at once built a modern insane asylum, first at Miraflores, and later at the Ancon hospital, and moved the lepers to a very beautiful little settlement called Palo Seco. There they are so well cared for that one man, whom our army doctors cured of a slight case of the disease, begged to be allowed to stay in that place for the rest of his life, and was made a hospital orderly there.
Driven out of the two cities, the harried Stegomyia found no refuge in the Canal Zone. There Dr. Gorgas's men cut down hundreds of acres of sheltering brush and high grass, dug miles of drainage ditches and covered all undrained pools and swamps with heavy oil that killed the mosquito larvae whenever they came to the surface to breathe. Holes were blown in old French dump-cars to keep them from holding water. To throw an empty tin can where it might become a breeding-place for mosquitoes was made a finable offense.
The epidemic of 1905 came to an end in September and the panic stopped with it. The last case of yellow fever on the Isthmus was in November, 1906. To-day, the Stegomyia mosquito is virtually extinct there, and so long as it is kept down and all foreign cases of the disease kept out, there will never be any more danger of an epidemic of yellow fever at Panama than at the North Pole. There is still a certain amount of "Chagres fever," which is nothing more or less than malaria. For the Anopheles mosquito, that carries the germ of this disease—a fact discovered by Dr. Ronald Ross of the British Army, in India in 1898—is a much stronger and hardier insect than the Stegomyia, and it is almost impossible to destroy it completely, especially round the smaller construction camps in the jungle. But there is much less malaria in Panama than in most parts of the United States.
One of the greatest and least-known triumphs of Dr. Gorgas and his organization was keeping the Isthmus free from the bubonic plague, at a time when this terrible disease, the "Black Death" that swept through Europe in the fourteenth century, was raging in the other Pacific ports both north and south of Panama. There it was confined to the three original cases brought in by sea, all of which proved fatal. This disease is carried, not by mosquitos, but by fleas, that travel on the backs of rats. A reward of ten cents was promptly offered for every rat tail brought in, and the rat is now a very scarce animal in Panama.
Dr. Gorgas was promoted to the rank of colonel in the United States Army Medical Corps, and made a member of the Isthmian Canal Commission in 1907.[1] Though he has turned Panama from a pest-hole into a health resort, there is still no lack of work there for him and for those who will come after him, for only by constant vigilance and costly sanitation can large bodies of Northern white men be kept healthy in the tropics. Moreover, if yellow fever or any other dangerous disease were ever again allowed to break out there, after Panama has become one of the great highways of the world, the Canal might easily prove as great a curse to humanity as it promises to be a blessing, for then ships would carry the sickness all too swiftly to all parts of the earth. Few physicians have ever had laid upon them a heavier burden or a more sacred trust than that of the chief sanitary officer of the Canal Zone, and all the world knows how well General Gorgas has discharged it. His name will go down in history as that of the man who freed the Isthmus from its most terrible enemy.
But General Gorgas would be the last man to deny that if it had not been for the work of his old chief and associates in Cuba in 1900-01, neither he nor any other man would have known how to fight yellow fever on the Isthmus in 1905. And if ever a fitting monument is raised, either in Panama or in the United States, to celebrate the building of the Canal and the victory of mankind over yellow fever, there should be graven high upon it the names of Reed and Carroll and Lazear.
- ↑ He was appointed Surgeon-General of the United States Army, January 16, 1914.