# Popular Science Monthly/Volume 83/September 1913/The Lesson of Canal Zone Sanitation

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* THE LESSON OF CANAL ZONE SANITATION
By J. S. LANKFORD, M.D.
SAN ANTONIO, TEX.
WE have learned two great lessons in the construction of the Panama Canal. One is that with money, modern machinery and men who are healthy and happily situated there is hardly anything impossible in civil engineering and building. This matchless piece of work now nearing completion testifies to the constructive genius of man, and can not be studied at close range in all its colossal proportions without exciting wonder and admiration. It is impossible to get any adequate conception of its magnitude without personal investigation. The first impression is the unlimited audacity of man in ripping open the mountains, draining marshes and lakes, penetrating the jungles and impounding rushing rivers in an effort to throw two great oceans together. It is the greatest assault ever made upon nature; but the white man, brushing aside all obstacles and scorning danger, will Boon have finished this greatest of all monuments of marching civilization. It is impossible to escape a deep interest in the employees and their environment; in the systematic and effectual supervision of the material, the supplies and the work, and in the general progress that has been made. The bigness of it all and its possibilities in changing the commerce of the seas, the destiny of nations and the history of peoples appeals to the imagination as well as to sober thought.
But these things are soon lost sight of temporarily in the contemplation of the greater lesson which is as broad as the human family of the present and of the future, for it touches human suffering and sorrow, and human happiness—the lesson of sanitation and health. The unhealthiest section of the globe, so acknowledged by all the world, has been converted into the healthiest. Accurate and unbiased records and reports have demonstrated this repeatedly and conclusively. The land of the jungle where the mosquito sang her weird song of death unmolested for four hundred years vying with the germs of dysentery, typhoid fever and pneumonia in the destruction of human life; the country where death with grim terror reigned as king, queen and prime minister has yielded to modern methods of sanitation and has become the home of health and happiness, a plain fact almost approaching the miraculous.
It is a mistake to think this has been done under military power. It has been accomplished by the forceful and efficient efforts of a corps ​of intelligent sanitarians who have proven themselves master pioneers in the prevention of tropical diseases, and it stands out as a startling lesson that none should fail to learn. Nor has this great work been very expensive, as some newspaper writers assume without warrant. Taking the number of men employed and the amount spent for the prevention of disease it is found that about one cent per day per man has been expended. In comparison with similar expenditures in American cities it should not be forgotten that practically nine tenths of the cost of sanitation in the Zone is in mosquito fighting and quarantine. In order to appreciate what has been accomplished it is necessary to understand the condition of the country at the beginning of the occupancy.
The Canal Zone, ten miles wide and forty-five miles long, is composed of mountains of moderate height, marshy swamps, numerous small lakes, jungles, almost impenetrable in some places, and streams, the most important of the latter being the Chagres River, celebrated for malignant malarial disease. The temperature ranges from 65° to 100°, March being the hottest month. The average annual rainfall varies strangely in different localities from 75 to 125 inches. The fog, clouds and hot sun follow each other in quick succession. The heavy rainfall insures permanent stagnant water where the larva? of the yellow fever and malarial mosquitos thrive in countless millions; the perpetual moisture, warmth and rich soil lead to extravagant growth of hundreds of varieties of tropical grasses, plants, flowers, vines and trees, furnishing favorable harbor for the insects; and there is an almost constant stream of decaying vegetable and animal matter pouring into lakes and marshes that are never drained. Decaying animal matter leads to the generation of innumerable flies, ever ready to convey disease, and the water supply is polluted, and pregnant with disease germs.
This is the condition of things now in the surrounding country, and was the condition of the Canal Zone when the United States took charge. It was bad enough in the wilds of nature, but worse in the habitation of man. Colon had no sewer system, and human excrement was disregarded; there was no proper water supply; the cisterns, puddles and lakes furnished convenient breeding places for mosquitos; the streets and sidewalks were in horrible condition, and sanitary ordinances were lamely drawn and poorly executed. There were no screens, and flies literally swarmed over the food.
The conditions were little better in Panama City and in the intermediate towns. Yellow fever had been endemic for hundreds of years, and epidemic when new material was available. Malaria was ever present, consuming the life blood and limiting the capacity of generation after generation of the native population, and attacking the unacclimated with vigor and fatality. Typhoid fever was very common, and the ravages of dysentery were sorely distressing. The history of ​the Isthmus is inseparably linked with disease and death. For more than three hundred years it was the favorite highway from ocean to ocean and many thousands perished en route from tropical disease.
The Panama railroad is only forty-five miles long, but it took five years to build it, and the cost in human life has never been satisfactorily estimated. Two different times a thousand imported men all died within one year.
One of the most pathetic incidents in all the history of human effort was the failure of the French, and the awful toll of death the French people and the laborers paid for their ignorance of scientific sanitation, which came later and is now universally accepted. Gorgas himself says that the Americans could have done no better than the French without the knowledge of the mosquito as a disease carrier. De Lesseps stood at the very head of his class in his field, and he had the best engineers of his time, and the brainiest supervisors; he had ample money and the latest machinery; but death stood in the path of every effort, defying progress. His annual death rate for the eight years was about 240 per thousand, and, after spending over $260,000,000 he met with complete failure, a failure that glares like a death dragon from the old discarded machinery and seems to breathe forth from the very silence of many thousands of graves. Colon, with a population of ten thousand, has a cemetery with one hundred and sixty-seven thousand graves.
And this is the country from which yellow fever has been banished for more than six years; where the mortality from typhoid fever and dysentery has been reduced to the minimum; where malaria has become mild and controllable; the country where the deaths per thousand among canal employees, instead of De Lesseps's 240, is only seven and one half. It is almost unbelievable, but it is true. Among white American employees the death rate is less than three per thousand. The lowest death rate of any considerable number of people in the world is now found in the Canal Zone.
How this has been done is the interesting question and therein lies the great lesson. After a short-lived error which threatened a repetition of the French disaster the government wisely decided to improve the sanitary conditions first, and not send workmen to the slaughter. The unconquerable Gorgas with a good force of physicians, surgeons, nurses, expert sanitarians, skilled engineers and helpers, with ample supplies of disinfectants, were put in the lead. It was recognized that Colon and Panama City must be made habitable the first thing. The little city of Christobal was started by the side of Colon. Houses were built well off the ground, arranged for good ventilation, provided with scientific plumbing, and carefully screened so that the operatives might be protected from mosquitoes during sleeping hours. Colon and Panama City are in the Zone but do not belong to the United States ​government. Sanitary and police authority over these places, however, had wisely been retained by treaty rights. The unsanitary condition of Colon was vigorously attacked. Lakes were drained and filled and oil was used freely where draining was impracticable; a good sewer system was installed and connection required; an adequate supply of pure water was brought from a distance and cisterns abolished; streets were graded and sidewalks built; wharves were constructed, and the tide water controlled; suitable ordinances were passed, order was established and sanitary regulations of every kind were rigidly enforced. A quarantine system was inaugurated that was unyielding and of great value. As soon as possible a modern hospital was built with up-to-date equipment and every possible facility for scientific investigation and the most skilled surgical and medical treatment. This hospital has grown to great dimensions and has few equals in results. The annual death rate of Colon under this method has been reduced from 50 to less than 20 per thousand.
Panama City, not quite so bad as Colon, was treated in a similar manner. Adjoining Panama City is Ancon, the attractive American suburb, where are established the administration buildings, and the great Ancon hospital, which has no superior anywhere, furnishing the employees every facility for recovery that money can buy.
The problems confronted in the intermediate country were somewhat different, but similar in principle. The trains were screened and regulations put in force for the protection of the public health. A number of living stations for employees were arranged along the railroad and every house was built well off the ground and screened. Now the real war against disease was begun, lakes and swamps that had never been drained since nature made them poured out their accumulated filth to the sea; those that could not be drained were oiled; ditches were dug only after the lines of skilled engineers so that drainage might be perfect; a large force of men were kept busy oiling three or four times a month all lakes, puddles, sluggish streams and marshes, 60 that mosquitoes could not breed. Each little station or town was furnished a pure water supply, brought down from the distant hills in some instances, and provided with an efficient system of sewers, or in some rare instances well arranged cesspools. The jungle was cut away some distance from all residences so that the mosquito could find no resting place. Plague-carrying rats and other vermin were destroyed. Disinfectants were freely used, and fumigation resorted to when necessary in handling contagious diseases. Potting vegetable and animal matter, offal and garbage, were burned. The life and habits of the men were carefully regulated. Government dining halls furnished good meals, well cooked, and protected by screens; sleeping quarters were €lean and neatly screened and comfortable; the hours of rest and labor ​were well arranged; prohibition was strictly enforced; good dispensaries were established in convenient places; a hospital car was run with every train for the ill or the injured; medical and surgical service was skilled and prompt, and the hospital attention was second to none. But it was the one cent per day per man expended for the prevention of disease that worked the miracle.
It was a tremendous undertaking beset by human hardship and hazard and surrounded by difficulties apparently insurmountable. But the canal will soon be finished, and its construction has been made possible only by the intelligent application of our most recent knowledge of sanitation. It will mark a distinct era in human civilization, an era in which all else must and shall be subordinated to the prevention of disease. And this will not be altogether humanitarianism, for a human life has its commercial value, a definite value worthy of consideration.
One of the first results of this remarkable sanitary crusade will be noticed in Central and South America. Idle money of several nations is now restless and seeking investment; tropical peoples, depressed by climate, and enervated by centuries of disease, have not kept pace with the progress of the world, and opportunities for good dividends are easily found; and capital will throw every protection around employees for selfish reasons. Great commercial, agricultural and industrial development immediately follows new and important lines of transportation; and, in addition to the enormous investments of the United States government in the Zone, private capital will flow into the country in a steady stream. No individual, corporation or nation can afford to ignore this striking lesson in sanitation. The country will first be made fit for habitation and then development will follow. This movement will be far reaching, and will have its effect upon the history of Central and South American republics.
If this can be done in Panama, most unhealthy of all countries, what should we not accomplish in our own country, with so many superior advantages? Shall we go on permitting hundreds of thousands of people to die of preventable diseases like typhoid fever, malaria and tuberculosis? The heavy mortality from these and other diseases is highly discreditable to an enlightened people. It is a lamentable fact that while this marvelous transformation was taking place in the Canal Zone, poisoning patent-medicine makers and conscienceless food adulterators were spending money by the millions to defeat the purpose of the people to establish a health bureau in Washington to prevent disease and promote the public health. Our national state and municipal health officers, and our citizens, should study this great lesson well and profit by it. Thorough instruction of our twenty millions of school children on practical sanitation would result in ​reducing the mortality from preventable diseases by half in one generation. This proposition was demonstrated beyond all question in a great educational campaign on the mosquito in the San Antonio public schools several years ago in which the mosquito was completely exterminated.
It is an inspiring sight to witness this unseemly, death-ridden tropical country, changed into a place of beauty and a veritable health resort, right in the midst of disease and death. The Panama Canal is a wonderful feat of engineering, and we can easily imagine civil engineers attempting in the near future to conserve and utilize the motor power of the ocean waves and the trade winds. All due honor to the engineers.
But when the world's vessels sail through Lake Bohio, whose waters will be impregnated with millions of dollars worth of the rusting iron of the French failure, it will be a glorious triumph of scientific sanitation, and a great lesson to all nations and peoples down the centuries; an example that will be emulated and add much to human health, happiness and longevity.