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PUBLIC RECORD OFFICE

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Reference :-

mmimmim C.O. 885

22 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

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as are available indicate that the terminal cities were sometimes free from reported cases for several successive years, it is believed with good reason that the disease was constantly present in an endemic form, and that the introduction of a sufficient number of non-immunes would, in any year, have resulted in an epidemic. This, at any rate, was the belief in which the sanitary authorities of the United States commenced, in the spring of 1904, to take measures for protecting the labour force from yellow fever. The problem was concerned almost entirely with the eradication of the disease from the cities of Panama and Colon, and with preventing its reintro- duction into them; and the measures taken included, in addition to a great campaign for the detection and isolation of people suspected to be suffering from yellow fever, and the thorough fumigation of every house with the object of destroying infected mosquitoes, such measures as the establishment of complete health departments for the towns and of quarantine arrangements for the ports, the preparation and con- struction of water-supply and sewage systems, the construction, paving, and drainage of streets, the demolition and rebuilding of insanitary houses, the reclaiming of large tide-washed areas and water-logged swamps, the abolition or effective covering of every water-receptacle in the towns, and the screening of houses.

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In the early days of these admirable sanitary works the difficulties were great. Much local prejudice had to be overcome and there was considerable delay in obtaining necessary materials. The construction of the water-supply system for Panama was sanctioned in August, 1904, but owing to the non-arrival of the iron water-mains the work could not be completed until July, 1905. Sewers were not laid until the fall of 1905, and street paving not until the end of that year. Mr. W. F. Johnson's book entitled " Four centuries of the Panama Canal contains the follow- ing passages regarding this matter: "Requisitions for supplies, even for things urgently needed in the hospitals and by the sanitary squad, in cases where every hour was precious, had to be sent to Washington, deliberated upon by the Commissioners, and then, if approved, advertised, awarded, and finally filled weeks and months after date. It took many weeks to get mosquito-netting for the windows of the Canal office building, and then not enough was supplied. The chief sanitary officer wanted netting for all the official buildings in the Canal zone. This request was refused as extravagant and unnecessary. Then he asked for at least enough to enclose the verandahs of the hospitals. This, too, was refused, and he was told that there was no need of enclosing more than half the verandahs, and that even then a part of the space should be solidly boarded up instead of screened."

In the meantime, however, yellow fever broke out among the Canal employees and, according to Colonel Gorgas," the force on the Isthmus was much demoralised thereby. It was difficult to get men to come down, and when they did come they were generally panic stricken and left us. This fear affected all ranks of employees from the highest to the lowest, and while there were hundreds of exceptions and plenty of plucky men who were not affected by the prevailing panic, we could readily see that, if the conditions as they existed in 1905 were to continue, the canal would never be finished."

There is no doubt that this outbreak was a chief factor in procuring for the sanitary authorities such facilities as afterwards enabled them, uninterruptedly and almost without regard to expense, to bring the Canal zone into a sanitary condition which has certainly not been equalled in any other area of similar size in the tropics. In General Abbot's book entitled "Problems of the Panama Canal," it is stated that the yellow fever panic on the Isthmus reached its height in June, 1905, but prior to that date an order by the President of the United States had announced that "the practical result of the operations of the Isthmian Canal Commission appointed and acting under previous executive orders has not been satisfactory, and requires a change in the personnel of the Commission and in the instructions for its guidance."

The new arrangements promulgated in that order came into force early in the summer of 1905, and since that time sanitation in the Canal zone has proceeded steadily and swiftly towards completeness.

In attempting to give an idea of present conditions it is necessary to deal separately with the Commission towns of Ancon and Cristobal and the native cities of Panama and Colon. Complete freedom from yellow fever and almost complete freedom from stegomyia mosquitoes is the outstanding character of the present condition of Ancon and Cristobal, and it appeared to me very improbable that, if present arrangements are maintained, these towns would ever again be infected with yellow fever. In the first place they are quite separate from the native cities—

towns."

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they are examples of the adoption of the principle of segregation of the non-immune. In the second, although all the dwelling houses and most of the public buildings are built of wood, these centres of population are in every necessary respect "model The arrangements for sanitary control, and the systems of sewerage, water-supply, drainage, lighting, street paving and general cleanliness are exceed- ingly thorough, and every house is screened with wire gauze in such a manner that mosquitoes are effectually excluded from the verandahs and the whole interior of the house. In the third place the inhabitants consist entirely of Commission employees, who are not only under strict control, but voluntarily co-operate and assist in all measures for the elimination of mosquitoes-of which, it may be added, they are in wholesome dread. The result is that in these towns stegomyia mosquitoes are almost non-existent. We cannot say, however, that they have been entirely eradicated, because on April 7th, 1912 (which was near the end of a period of five months almost unprecedentedly dry weather), I was able to catch several adult stegomyia fasciata in my bedroom in the Tivoli Hotel in Ancon; but there can be no doubt that they have been reduced to such a degree that, even if undiscovered cases of yellow fever were introduced, the disease would not spread; and on the whole I conclude that these towns are uninfectible.

The cities of Panama and Colon still remain under the Republic of Panama, but the authorities of the United States have jurisdiction in all that relates to health conditions, and the standard of sanitation which they have set themselves to attain is much higher than that aimed at in any other tropical town with which I am acquainted-and very much higher, of course, than in many non-tropical towns of the same size in Europe or America. The original state of both cities was exceedingly bad. Dr. Lacroisade, who for many years was medical director of the French Company's hospital near Panama, described the roads in Colon as being "veritable sewers and in Panama as being "in a repulsive condition of filth.

Most of the houses were dilapidated wooden structures erected on piles over swampy areas and roadside ditches, which, being clogged with rubbish and house refuse of all kinds, formed a succession of stagnant pools. There were no systems of sewerage or water-supply, and as it was necessary for the inhabitants to store water for use in the dry season, every house had its cistern, and every yard contained a large supply of water collecting tubs and tins which were the source of enormous swarms of mosquitoes. The sanitary works carried on continu- ously since 1904, and still in active progress, have effected a remarkable change in these conditions. Regulations now permit the condemnation and demolition of insanitary buildings, they prohibit the erection of any building which cannot be connected with the water-supply and sewage systems, and require that the whole ground on which a house and its yard are built must be concreted, that the house must be connected with the water-supply and sewage system, must have water- closets, shower baths and sinks in the proportion of one complete set for every fifteen people, and must have no outside roof gutters, and no cistern or other receptacle for the storage of water. The alleyways between houses must be concreted and must slope towards the centre of the alley and towards the street paving and drains. These rules, and those regarding the paving of the streets and macadamising of the roads, will bring about the result that within the area built over there is no space that is not concreted or in some other manner made hard and smooth so that water cannot lodge.

The radical sanitary works just outlined do not as yet extend throughout the whole areas of the cities, and on the outskirts the conditions are very different from those in the main sections. Much of the site on which Colon is built was originally below the level of the sea, and, although the town proper is now on land which by extensive filling operations has been raised from three to eight feet above sea level, it is almost surrounded by low-lying marshes and swamps which cannot be effectively drained; and on'some of these areas there are hamlets in the old style. In Panama City, also, the conditions on the outskirts are reminiscent of the original state of affairs and a number of houses remain to be sanitated and to be connected with the sewerage system. Roof gutters and other potential breeding-places of stegomyia mosquitoes are also to be found, and the great amount of building that is going on, as well as the extension of the existing water-supply and sewerage systems. produce conditions requiring constant inspection and control. An idea of the nature and amount of this kind of work, as well as of other sanitary effort, will be gained from the following statement, which refers to 1910-the last year for which the information is available to me :-

83411

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