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 HEALTH CONDITIONS IN THE CANAL ZONE 
 
 BY 
 
 COL. W. C. GOKGAS, U. S. A. 
 
 Chief Sanitary Officer 
 CANAL ZONE 
 
 Twenty-four years ago the great French company 
 financed by M. de Lesseps began work on the Panama 
 Canal, under circumstances similar to those that have 
 confronted ns. The only difference is that they took no 
 sanitary precautions whatever in connection with their 
 work; and if we had followed their example, conditions 
 on the isthmus would probably be now what those of the 
 French were, at the same length of time after they began 
 their work. 
 
 The United States has had control of the canal for a 
 little over one year. If, therefore, we consider what the 
 sanitary conditions among the French workers were at 
 the end of their first year, the comparison with our 
 present state will be a fair one. I have no intention of 
 criticising the French. If we had come down here 
 twenty-four years ago, situated as they were, I am not 
 sure that we could have done very much better. In the 
 first place, no one knew at that time how malaria or 
 yellow fever was conveyed from one person to another; 
 and in the second place, the French were building the 
 canal just as we build a railroad in the United States. 
 They were a private corporation, and could not control 
 the sanitary arrangements along their route — a matter 
 which was entirely in the hands of the Colombian 
 government. 
 
 Now let us see what the conditions of the French were 
 as to health at the end of their first year. I think prob- 
 ably the best measure that I can take of this condition is 
 their death-rate. The report of the old French company 
 for the year 1881 shows that they had, on an average, 
 UP®, 928 employees per day at work ; of this number 630 per 
 1,000 were taken sick, and 67 per 1,000 died; but the 
 
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 French records are known to be very inaccurate; the 
 actual state of affairs was much worse than their reports 
 show. 
 
 The canal was divided into sections, and the construc- 
 tion work on these sections w r as let out by contract. The 
 contractors were charged $1 a day for every one of 
 their employees who went to the hospital. The tendency, 
 was, therefore, to discharge a man as soon as he became 
 sick, so that he would not be a charge against the con- 
 tractor, and no one not actually in the employment of 
 the company itself, or of the contractors, was received 
 into the hospitals. The probability would be, therefore, 
 that deaths would occur not among those actually 
 employed, but at the villages along the line of the canal, 
 among the men who had been discharged by the con- 
 tractors. And this is the opinion in Panama among 
 the people who were here at the time of the French con- 
 struction, namely, that many deaths occurred along the 
 line, of which the French authorities have no record. 
 Now when the French sanitary officer reports that 67 
 men per 1,000 of the French employees in the year 1881 
 died, he means that, on the average, they had at work 
 every day 928 men along the whole line of the canal, and 
 that 67 per 1,000 of this number died in hospital in the 
 course of the year. He only knows, and takes account 
 of the men who died in their hospital. He knows noth- 
 ing of any man who was discharged by the contractor at 
 Culebra, say, on account of being sick, and died a week 
 or ten days afterward in the village of Culebra. 
 
 Personally, I think it would not be unfair to say that 
 instead of losing 67 per 1,000, they lost considerably 
 more than 100 per 1,000, but this is mere guess and 
 supposition. I only know that they lost more than 67 
 per 1,000; how many more it is impossible to say. 
 
 Now let us .turn our health conditions at the end of 
 a year, measured by the same standard. I will take the 
 month of March, as that is the last month of which 
 I have a report. I cannot compare the whole year, as 
 the figures for such comparison have not yet been col- 
 lected ; but I am quite certain that March w r as an average 
 month, and that the comparison is fair. We had on the 
 rolls at the end of the month 9,000 men, and of these 
 401 per 1,000 a year were taken sick, and 14.66 per 
 1,000 a year died. I mean by this that the rate of sick- 
 ness and death which we had during March, if extended 
 
3 
 
 over the whole year, and applied to an average of 9,000 
 men, would have given us this rate of sickness and death. 
 
 Our report includes everything. When we say 14.66 
 of our laborers per 1,000 have died, it means that every 
 man in the employment of the Commission at the isthmus 
 is counted, and every one of these men who dies, if he 
 was an employee of the Commission at the time he was 
 taken sick, is also considered. The Commission cares 
 for all its employees free of charge, so that all employees 
 who are sick come to the hospitals; and, besides, the 
 Sanitary Department has control of the towns of Colon 
 and Panama, and the intervening country along the 
 canal; and it has accurate records of all the deaths occur- 
 ring in these regions. Therefore, when we say that 14 
 per 1,000 died, the statement is accurate and compre- 
 hensive. 
 
 I think it is fair then to make this summary : that, 
 taking March as an average, both in numbers of men 
 and in mortality, we have lost by death during the first 
 year of our work 14.66 per 1,000 of our men (which for 
 9,000 men, would mean 132 deaths) ; and we have sick- 
 ness to the extent of 401 per 1,000, which, for the whole 
 force, would give 3,605 sick. Taking the French mor- 
 tality for their first year, as. showing what would have 
 occurred with no sanitary precautions, we would have 
 had, instead of 132 deaths, 620 deaths ; instead of 3,605 
 sick, 5,850 sick. Now this^ it seems to me, clearly means 
 that our sanitary work for this first year has saved 488 
 lives and 2,238 cases of sickness. 
 
 Now, as to the measures that we claim to have been 
 instrumental in this saving of human life, on the 
 isthmus we find, from reading of the experiences of our 
 predecessors, that the two principal diseases to be feared 
 are malaria and yellow fever; our measures, therefore, 
 have been directed against these diseases. The authori- 
 ties of the Panama Republic placed the sanitation of the 
 towns of Colon and Panama in our charge. We have 
 established health departments in these towns, cleaned 
 the streets, collected the garbage, ditched and oiled all 
 the districts possible, for the destruction of mosquitoes, 
 covered all fresh-water receptacles in the city of Panama, 
 and fumigated the whole town from one end to the other 
 for the destruction of infected mosquitoes. 
 
 At this writing, April 18, we have not a single case of 
 yellow fever in the city of Panama, the last case having 
 
 
4 
 
 occurred March 23; and while it is premature to make 
 any statement yet with regard to the extermination of 
 yellow fever, I personally believe that we have seen the 
 last case of yellow fever in Panama. 
 
 We have established health departments in all the 
 towns extending along the fifty miles of canal route 
 between Colon and Panama, ditched and drained all 
 low ground in the neighborhood of these villages, cut 
 away all the undergrowth in and about the villages and 
 in the neighborhood of all dwellings and buildings, 
 cleaned up the villages, and inaugurated systems of gar- 
 bage disposal. 
 
 We have also established a very good quarantine sys- 
 tem, by the aid of which I feel confident that all foreign 
 infection will be prevented from entering. We have also 
 established an immigration bureau, with the idea of 
 examining all arriving laborers, seeing that they are 
 vaccinated, and deporting such as are likely to be a 
 charge upon the Commission. 
 
 We have a system of hospitals for the care of the 
 employees of the Commission, and for any cases of dis- 
 ease that may be infectious, even though it may be among 
 the population not employed by the Commission. In 
 these hospitals we are at present treating about 300 
 patients. 
 
 We have established a laboratory for the investigation 
 of diseases in connection with our hospital work. In 
 doing all this sanitary work we have on our rolls at 
 present considerably over a thousand men. 
 
 The results accomplished so far have been that our 
 laboring force has -been kept in about as good a state 
 of health as a similar number of men in any healthy part 
 of the United States would have been. This, I think, 
 judging by the light of past experiences, is a very great 
 accomplishment and fully justifies the expenditure so 
 far made on sanitation at Panama. As I have already 
 stated, our death rate among 9,000 laborers along the 
 canal for the month of March was at the rate of 14.66 
 per 1,000 per year — that is, if the rate of March was 
 kept up for a year, we would lose by death fourteen out 
 of every 1,000. Hew York City for the year 1900 had a 
 death-rate of 20 per 1,000, Philadelphia 21, Washington 
 22. This means that in Hew York City, in the year 
 1900, out of every 1,000 people twenty died; in Phila- 
 delphia, twenty-one died, and in Washington, twenty- 
 
5 
 
 two died; but among the laborers on the isthmus only 
 14 per 1,000 died in our first year of work, extending 
 from May, 1904, to May, 1905. If we select at random 
 a thousand people in Philadelphia and a thousand of 
 our laborers on the isthmus, the thousand people in Phila- 
 delphia would lose by death six more in the course of a 
 year than the thousand laborers on the canal ; a thousand 
 people in Washington eight more than a thousand labor- 
 ers on the canal. I do not pretend that this is a just 
 comparison; Philadelphia and Washington have a large 
 population of children, while the laborers are all adults, 
 mostly in the prime of life, but it conveys some idea of 
 what has been accomplished in the way of improving 
 health conditions. 
 
 We expect to continue our work along the lines which 
 I have described. Within the next year, for instance, 
 we expect to provide Panama with a good water-supply, 
 a good sewerage system, and good pavements; in other 
 words, the work of the Sanitary Department will be 
 perfected in every direction. In Colon we expect to 
 have the whole island filled in with material dredged 
 from the canal, so that instead of being a swamp it will 
 be 12 or 15 feet above the water level. We expect to 
 have the streets paved, a good water-supply brought in 
 from the country, and a sewerage system installed. All 
 these projects are now under way. Along the line we 
 expect to continue our mosquito work, continue the 
 organization of the local health departments, place water 
 and sewerage systems in several of the larger towns, and 
 have systems of disposal of night-soil established in all 
 the others. 
 
 We have been authorized by the Commission to 
 increase the hospital accommodations to a thousand beds. 
 To do this we need a considerable amount of construc- 
 tion, which we expect to have finished within the coming 
 year. We expect to establish small receiving hospitals 
 and dispensaries at all the villages along the line, both 
 for treating the sick, and for keeping a close sanitary 
 supervision of diseases occurring in the strip. We expect 
 to improve our quarantine department in the way of 
 buildings for the purpose of housing people under obser- 
 vation and looking after laborers and immigrants until 
 they can be properly distributed, and conveniences gen- 
 erally for carrying on this work. 
 
 Now a word about yellow fever. It is too early to make 
 any positive statement to the effect that we have elimi- 
 
<3 
 
 nated the disease, but I believe, nevertheless, that we 
 have, for this reason: The town of Panama was pretty 
 generally infected; yellow fever was occurring in every 
 part. The number of non-immunes here, the only people 
 liable to yellow fever, has been steadily increasing; yet 
 on adopting the measures we used in Havana, . Cuba, the 
 same results have apparently occurred. 
 
 In the city of Panama during the month of January 
 we had 9 cases ; in February, 13 ; in March, 7 ; and none, 
 so far, in April; the last case occurred March 23. The 
 measures adopted, which were the same as those used 
 in Havana, resulted from the discovery that the disease 
 was transmitted by the female stegomyia mosquito. 
 
 * Every house in Panama has been carefully closed and 
 fumigated so as to kill every mosquito inhabiting it, the 
 idea being to kill all the infected mosquitoes. At the 
 same time, all cases of yellow fever as they occurred were 
 carefully screened so that mosquitoes could not get at 
 them and thus reinfect the town. 
 
 It is not a very difficult thing to keep yellow fever out, 
 and I feel entirely confident that our present quarantine 
 service will succeed in doing so. In Havana they have 
 been free of it since 1901. 
 
 About malaria I cannot speak so positively ; but our 
 experience, so far as to the effect mosquito extermination 
 has on decreasing the disease here at Panama, is very 
 much the same as it was at Havana, and I feel greatly 
 encouraged at the outlook. 
 

 
 
 
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