Health measures during the construction of the Panama Canal
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One of the greatest challenges facing the builders of the
Panama Canal The Panama Canal ( es, Canal de Panamá, link=no) is an artificial waterway in Panama that connects the Atlantic Ocean with the Pacific Ocean and divides North and South America. The canal cuts across the Isthmus of Panama and is a conduit ...
was dealing with the
tropical disease Tropical diseases are Infectious disease, diseases that are prevalent in or unique to tropics, tropical and subtropics, subtropical regions. The diseases are less prevalent in temperate climates, due in part to the occurrence of a cold season, whic ...
s rife in the area. The health measures taken during the construction contributed greatly to the success of the canal's construction. These included general health care, the provision of an extensive health infrastructure, and a major program to eradicate disease-carrying
mosquito Mosquitoes (or mosquitos) are members of a group of almost 3,600 species of small flies within the family Culicidae (from the Latin ''culex'' meaning " gnat"). The word "mosquito" (formed by ''mosca'' and diminutive ''-ito'') is Spanish for "li ...
es from the area.


Background


US control

By the time the United States took control of the
Panama Canal The Panama Canal ( es, Canal de Panamá, link=no) is an artificial waterway in Panama that connects the Atlantic Ocean with the Pacific Ocean and divides North and South America. The canal cuts across the Isthmus of Panama and is a conduit ...
project on May 4, 1904, the
Isthmus of Panama The Isthmus of Panama ( es, Istmo de Panamá), also historically known as the Isthmus of Darien (), is the narrow strip of land that lies between the Caribbean Sea and the Pacific Ocean, linking North and South America. It contains the country ...
was notorious for
tropical disease Tropical diseases are Infectious disease, diseases that are prevalent in or unique to tropics, tropical and subtropics, subtropical regions. The diseases are less prevalent in temperate climates, due in part to the occurrence of a cold season, whic ...
s. An estimated 12,000 workers had died during the construction of the
Panama Railway The Panama Canal Railway ( es, Ferrocarril de Panamá) is a railway line linking the Atlantic Ocean to the Pacific Ocean in Central America. The route stretches across the Isthmus of Panama from Colón, Panama, Colón (Atlantic) to Balboa, P ...
and over 22,000 during the French effort to build a canal. Many of these deaths were due to disease, particularly
yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. In ...
and
malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
. At several times, construction on the Panama Railway had actually halted due to the lack of healthy workers. The high rate of deaths among workers on the Panama Canal due to disease was the source of a great deal of controversy in the United States. Newspapers, such as ''The Independent'', frequently reported on the poor conditions workers in the Canal Zone experienced, including the rampant disease.
Poultney Bigelow Poultney Bigelow (10 September 1855 – 28 May 1954) was an American journalist and author.Bigelow, Patricia, ''The Bigelow Family Genealogy'', the Bigelow Society, Flint, Michigan, 1986, vol II, p. 492; #16312.744. He was born in New York City, ...
wrote an article in ''The Independent'' in 1906 critiquing the work on the Panama Canal, which was highly influential with the American public. Among other topics, Bigelow brought attention to the poor living conditions of the workers, including pools of standing water where
mosquitoes Mosquitoes (or mosquitos) are members of a group of almost 3,600 species of small flies within the family Culicidae (from the Latin ''culex'' meaning "gnat"). The word "mosquito" (formed by ''mosca'' and diminutive ''-ito'') is Spanish for "litt ...
could breed and spread disease from. It was clear to organizers of the American effort that previous disease control efforts had been largely ineffective, as the causes of the two main diseases were unknown, but in 1897 it was proved by Britain's
Ronald Ross Sir Ronald Ross (13 May 1857 – 16 September 1932) was a British medical doctor who received the Nobel Prize for Physiology or Medicine in 1902 for his work on the transmission of malaria, becoming the first British Nobel laureate, and the f ...
in India that malaria was spread by mosquitoes.


The Sanitation effort

The Canal Commission appointed Colonel
William Crawford Gorgas William Crawford Gorgas KCMG (October 3, 1854 – July 3, 1920) was a United States Army physician and 22nd Surgeon General of the U.S. Army (1914–1918). He is best known for his work in Florida, Havana and at the Panama Canal in abating the ...
in March 1904 as head of hospitals and sanitation. Under his leadership, many new departments of sanitation were founded, covering different aspects of the sanitation problem. Commissions were also formed to look after the basic welfare of laborers. The sanitation work included clearing land and establishing quarantine facilities. The most ambitious part of the sanitation program, though, was undoubtedly the effort to eradicate the mosquitoes ''
Aedes aegypti ''Aedes aegypti'', the yellow fever mosquito, is a mosquito that can spread dengue fever, chikungunya, Zika fever, Mayaro and yellow fever viruses, and other disease agents. The mosquito can be recognized by black and white markings on its legs ...
'' and ''
Anopheles ''Anopheles'' () is a genus of mosquito first described and named by J. W. Meigen in 1818. About 460 species are recognised; while over 100 can transmit human malaria, only 30–40 commonly transmit parasites of the genus ''Plasmodium'', which c ...
'', the carriers of
yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. In ...
and
malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
, respectively, from the canal zone. There was initially considerable resistance to this program, as the "mosquito theory" was still considered controversial and unproven. However, with the support of chief engineer
John Frank Stevens John Frank Stevens (April 25, 1853 – June 2, 1943) was an American civil engineer who built the Great Northern Railway in the United States and was chief engineer on the Panama Canal between 1905 and 1907. Biography Stevens was born in ...
, who took over the post on July 26, 1905, Gorgas was finally able to put his ideas into action. Gorgas divided
Panama Panama ( , ; es, link=no, Panamá ), officially the Republic of Panama ( es, República de Panamá), is a transcontinental country spanning the southern part of North America and the northern part of South America. It is bordered by Cos ...
into 11 districts, and
Colón, Panama Colón () is a city and seaport in Panama, beside the Caribbean Sea, lying near the Atlantic entrance to the Panama Canal. It is the capital of Panama's Colón Province and has traditionally been known as Panama's second city. Originally it was l ...
, into four. In each district, inspectors searched houses and buildings for mosquito larvae. If larvae were found, carpenters were dispatched to the building, and work was done to eliminate objects or places where
stagnant water Water stagnation occurs when water stops flowing. Stagnant water can be a major environmental hazard. Dangers Malaria and dengue are among the main dangers of stagnant water, which can become a breeding ground for the mosquitoes that transmi ...
could collect. Mosquitoes lay their eggs on the surface of standing water, and when the
larva A larva (; plural larvae ) is a distinct juvenile form many animals undergo before metamorphosis into adults. Animals with indirect development such as insects, amphibians, or cnidarians typically have a larval phase of their life cycle. The ...
e hatch, they live just below the surface, breathing through a siphon in their tails. Therefore, by eliminating standing water where possible and by spreading oil on the surface of any remaining pools, the larvae could be destroyed. Gorgas also had domestic
water systems A water supply network or water supply system is a system of engineered hydrologic and hydraulic components that provide water supply. A water supply system typically includes the following: # A drainage basin (see water purification – source ...
installed in urban areas around the Canal Zone. These systems eliminated the need for
rainwater collection Rainwater harvesting (RWH) is the collection and storage of rain, rather than allowing it to run off. Rainwater is collected from a roof-like surface and redirected to a tank, cistern, deep pit (well, shaft, or borehole), aquifer, or a reservoir w ...
, which had been collected in barrels and was a place for mosquitoes to breed. The United States government also provided $20 million to give workers free medical care and burial services. Gorgas's sanitation department also provided about one ton of prophylactic quinine each year to people in the Canal Zone to combat malaria. Gorgas organized a major program to drain and fill
swamp A swamp is a forested wetland.Keddy, P.A. 2010. Wetland Ecology: Principles and Conservation (2nd edition). Cambridge University Press, Cambridge, UK. 497 p. Swamps are considered to be transition zones because both land and water play a role in ...
s and
wetland A wetland is a distinct ecosystem that is flooded or saturated by water, either permanently (for years or decades) or seasonally (for weeks or months). Flooding results in oxygen-free (anoxic) processes prevailing, especially in the soils. The ...
s around the Canal Zone. Many miles of ditches were dug, and grass and brush were cut back over wide areas. Oiling was used in a variety of means: workers with spray tanks were sent to spray oil on standing pools, and smaller streams were tackled by placing a dripping oil can over the waterway, which created a film of oil over each still patch of water in the stream. About 700,000 gallons of oil and 124,000 gallons of larvicide were used on the project. Gorgas also took another step in his efforts to eradicate mosquitoes in Panama:
fumigation Fumigation is a method of pest control or the removal of harmful micro-organisms by completely filling an area with gaseous pesticides—or fumigants—to suffocate or poison the pests within. It is used to control pests in buildings (s ...
. He fumigated the residences of Panamanians who had been confirmed to have contracted yellow fever. "''Pans of
sulfur Sulfur (or sulphur in British English) is a chemical element with the symbol S and atomic number 16. It is abundant, multivalent and nonmetallic. Under normal conditions, sulfur atoms form cyclic octatomic molecules with a chemical formula ...
or
pyrethrum ''Pyrethrum'' was a genus of several Old World plants now classified as ''Chrysanthemum'' or ''Tanacetum'' which are cultivated as ornamentals for their showy flower heads. Pyrethrum continues to be used as a common name for plants formerly inclu ...
were then placed in the rooms, the right quantity of powder was weighed out (two pounds per thousand cubic feet), and the pans were sprinkled with wood-alcohol and set alight''" (Cameron 132). When the effectiveness of this procedure was realized, fumigation was extended to all of Panama. Within a year of Stevens's appointment, every building in Panama had been fumigated, using up the entire US supply of sulfur and pyrethrum. In 1906, only one case of yellow fever was reported, and until the end of the Panama Canal's construction, there were zero. Gorgas's final means of attack on disease was to quarantine individuals infected with yellow fever or malaria from the rest of the workforce. Those who were diagnosed with either disease were put into "Portable Fever Cages", easily transportable screened structures used to prevent mosquitoes from biting an infected person and carrying the disease to others. Gorgas also had the thousands of canal workers sleep in screened verandas, as the mosquitoes that spread malaria are nocturnal and would infect the most people at night.


Outcome

The first two and a half years of the American canal effort were substantially dedicated to preparation, much of it making the area fit for large-scale human habitation. A significant part of this was the sanitation program put in place by Gorgas. Nearly $20 million was spent on health and sanitation during the ten years. In the end, these efforts were a success: by 1906, yellow fever was virtually wiped out in the Canal Zone, and the number of deaths caused by the other tropical disease, malaria, was also reduced significantly. The hospitals maintained were by far the best to be found anywhere in the tropics; some 32,000 patients were treated per year. While disease reduction dramatically improved the health of white workers, black workers—the majority of the canal workforce—continued to die in large numbers, at ten times the rate of white workers in 1906. While medical care was provided to all, housing was not provided to black workers, many of whom had to live in tents and tenements outside the mosquito-controlled zone. In the end, 350 white workers had died compared to 4,500 black workers.McCullough, p. 610 While the loss was tragic, it was far less than during the French era. Today, the Panama canal area is regarded as free of yellow fever and malaria.


Notes


References


''Travelers' Health: Yellow Book''
€”Centers for Disease Control

Ira E. Bennett * ''Building the Panama Canal'', Arthur T. Schlesinger, ''Chronicles From National Geographic''. Chelsea House Publishers, Philadelphia, 1999. * Cameron, Ian (1972). ''The Impossible Dream: The Building of the Panama Canal''. New York: William Morrow & Company, Inc.


External links

* http://ufdc.ufl.edu/AA00011604/00001/ Health and the Panama Canal

{{Panama Canal 19th-century health disasters 1900s health disasters 1904 in Panama Health in Panama Malaria Panama Canal Yellow fever