Panama Canal Sanitation - 1903-1914

The first order of business was to eliminate the malaria, yellow fever, and typhoid that made the isthmus unsuitable for human habitation. Unlike his French predecessors, Army Doctor William Gorgas knew that the troublesome diseases were transmitted by mosquitoes. Using techniques he had developed in Cuba after the Spanish-American War, he ordered houses fumigated and screened, swamps and marshes drained, sewers installed, and streets paved.

William Crawford Gorgas (October 3, 1854 - July 3, 1920) entered Bellevue Hospital Medical College in New York in 1876 and was graduated in 1879 after three years of financial difficulties. Following an internship in Bellevue Hospital he was appointed, on June 16, 1880, an assistant surgeon in the medical corps of the army. For nearly two decades thereafter Gorgas' life was that of the average medical officer of the period. Shortly after the beginning of his army career he went through an epidemic of yellow fever at Fort Brown, Texas, and was himself stricken with the disease. Thereafter, as an immune, he was frequently drafted for service where yellow fever existed. This accounts for his long service at Fort Barrancas, a post in a section notorious for its epidemics and itself frequently subject to visitations of the disease. He was promoted to captain June 16, 1885, and to major July 6, 1898. To Gorgas, as to others, yellow fever was an enigma. Its suddenness of appearance, its puzzling choice of victims, and the inutility of ordinary means of disease prevention were quite beyond understanding. In 1898 he was sent to Cuba and early in 1899 he became chief surgeon of the Department of Havana.

It was not until the board, of which Major Walter Reed was the head, furnished proof that the Stegomyia mosquito was the carrier of the disease that truly effective methods could be instituted. The Stegomyia, since more accurately named Aëdes Aegypti, was the common mosquito pest of the city. It is a highly domesticated insect, breeding in all kinds of water containers in and around habitations. The surest control of the insect was deemed to be the elimination of its breeding places. This plan was adopted and, though the task had many difficulties, Havana was not only freed of its mosquitoes but was permanently rid of yellow fever. The results obtained by Gorgas' work in Havana brought him an international reputation as a sanitarian.

There was early recognition of the necessity for expert sanitary advice upon the Panama Canal project and in 1902 Gorgas was transferred from Havana to Washington and assigned to this work. In March 1903 Congress raised him to the grade of colonel in recognition of his services in Havana. For two years he studied the canal problem, reviewing the experience of the French on the isthmus and making visits to the Suez Canal and to Panama. Actual work upon the canal commenced in 1904, and Gorgas with his staff of assistants arrived in June of that year. He early encountered administration difficulties.

Despite the positive knowledge that the French failure had been due to disease [among other causes] the American administration was disinclined to support adequate measures for preventing a repetition of that experience. The first Canal Commission, headed by Admiral John C. Walker, had strongly in mind the prevention of graft and extravagance. Expenditures for sanitary improvements were regarded as falling under the latter head. It required a visitation of yellow fever, starting in November 1904, to obtain for Gorgas any substantial support for his work. He began in the Canal Zone the measures which had been highly successful in Havana. Again the mosquito was to be deprived of breeding places and cases of yellow fever segregated and protected from mosquitoes.

The situation in Panama presented more difficulties than that in Havana and results were far less prompt. It was well into 1905 before yellow fever bad been eradicated, and in the meantime determined effort were being made to discredit Gorgas' work and to supplant him. It is probable that these could have been successful but for the interest aroused by a report made by Dr. Charles A. L. Reed of Cincinnati to the American Medical Association in March 1905, in which the obstructive hand of Commissioner Carl E. Grunsky was so largely featured.

The discharge of the Walker Commission at about this time and the appointment of another headed by Theodore P. Shonts did little to mitigate Gorgas' troubles. Yellow fever was still prevalent and the new commissioners were dissatisfied that the first interest of the sanitary service was the elimination of mosquitoes rather than the general improvement of the cities of Panama and Colon. They recommended the removal of Gorgas which not only drew the disapproval of President Roosevelt but caused an order for active support of his work.

In November 1906 the President paid a visit to Panama and shortly thereafter Gorgas was made a member of the canal commission. For a time he had practically a free hand, but after the reorganization of the commission in 1908, with Colonel George A. Goethals as chairman and chief engineer, his troubles began anew. Goethals, given unusual powers by executive order, ruled the Canal Zone with a despotic control. He was free in criticism and centered his attacks upon the expense of the sanitary service.

Because the mosquito carrying yellow fever was found in urban areas, Gorgas concentrated his main efforts on the terminal cities. "Gorgas gangs" dug ditches to drain standing water and sprayed puddles with a film of oil. They screened and fumigated buildings, even invading churches to clean out the fonts of holy water. They installed a pure water supply and a modern system of sewage disposal. Goethals reportedly told Gorgas that every mosquito killed was costing the United States US$10. "I know, Colonel," Gorgas reportedly replied, "but what if one of those ten-dollar mosquitoes were to bite you?" Despite the difficulties thrown around his work, due to lack of cooperation from the chief commissioner, Gorgas not only freed the Canal Zone from yellow fever but he made the cities of Panama and Colon models of sanitation comparable with any city of the United States. In the meantime his reputation had extended until he was generally regarded as the world's foremost sanitary expert.

Gorgas's work is credited with saving at least 71,000 lives and some 40 million days of sickness. The cleaner, safer conditions enabled the canal diggers to attract a labor force. By 1913 approximately 65,000 men were on the payroll. Most were West Indians, although some 12,000 workers were recruited from southern Europe. Five thousand United States citizens filled the administrative, professional, and supervisory jobs. To provide these men with the comforts and amenities to which they were accustomed, a paternalistic community was organized in the Canal Zone.

On 16 January 1914 Gorgas received the notification of his appointment as Surgeon General of the Army, with the rank of brigadier general. He returned to the United States in April to take up his new duties, and on March 4, 1915, he was advanced to the grade of major general. The recently organized International Health Board enlisted him as an advisor, and in 1916 sent him with a staff of assistants for a tour of South and Central America with a view to continuing the fight on yellow fever in these sections. Following this trip, a plan for the elimination of yellow fever was adopted and Gorgas was made director of the work. As the man whose sanitary skill made possible the construction of the Panama Canal, his name will always be linked with that gigantic work. His achievement at Havana which first brought him to fame is overshadowed by his later and greater work. He published Sanitation in Panama (1915) but wrote comparatively little for publication, leaving his work to speak for itself and to be reported upon by others.