CHAPTER XVIII

THE FIGHT WITH FEVER

It was realised by judicious observers at the outset of the Isthmian canal enterprise that the work of sanitation was of supreme importance, and especially the elimination of yellow fever, which, if not the most destructive of diseases there, was decidedly the most terrifying and demoralising. Nearly a century before, Humboldt had written that yellow fever and other diseases at Panama were due to the marine plants, mollusks, etc., on the beach at low tide, exposed to the heat of the sun, while on the Caribbean coast, at Porto Bello and elsewhere, bilious fever was due to putrescent emanations from rank vegetation. The world knows better than that now, having learned of the bacterial nature of those diseases and of the part played by certain varieties of mosquitoes in propagating them-the Stegomyia yellow fever and the Anopheles malaria. The attention of sanitarians at Panama was, therefore, given largely to the destruction of those insects, and to the guarding of non-immune people against their bites. In his address to the members of the Canal Commission, on their entrance upon their duties in the spring of 1904, President Roosevelt said:

"There is one matter to which I wish to ask your special attention the question of sanitation and hygiene. You will take measures to secure the best medical experts for this purpose whom you can obtain, and you will, of course, make the contractors submit as implicitly as your own employees to all the rules and regulations of the medical department under you."

It was remembered that epidemic diseases had been among the most formidable of the difficulties which the French

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companies had encountered on the Isthmus, though there was encouragement in the fact that conditions had generally improved since the beginning of De Lesseps's enterprise. To that effect some statistics may be cited from Dr. Lacroisade, who was for many years director of the great French hospital at Ancon Hill, Panama. From 1881 to 1888 under the original company the number of employees averaged 10,854, and the mean yearly percentage of disease was 62.58, and of mortality 5.97 (though for a time there was the appalling death rate of 60 per cent. a year). From 1889 to 1894, under the receivership, the average number of men was only 971 and the percentage of disease was 49.68, and of mortality 2.88. Under the new French company, from 1895 to 1901 the number of men averaged 2,703, and the percentage of disease was 37.17, and of mortality 2.61. Moreover, of this last mortality percentage, 2.61, European diseases amounted to 2.10, and characteristic tropical diseases to only 0.51. From 1892 to 1897 there was no yellow fever on the Isthmus. With these figures before them, it behooved the American administrators to improve, if possible, upon the record.

As early as January 7, 1904, Mr. Buchanan, the American Minister to Panama, conferred with Rear-Admiral Glass, in command of the United States ships at Panama, concerning measures to prevent the importation of disease from Ecuadorean or other South American ports, and two days later he wrote to Señor Espriella, the Panaman Minister for Foreign Affairs, congratulating him upon the fact that there then existed upon the Isthmus no case of yellow fever, smallpox, or bubonic plague, and suggesting an active and intimate coöperation of Panaman and American authorities for the preservation of that immunity. To this Señor Espriella responded cordially, and the practical work of hospital reorganisation and quarantine improvement was promptly begun. The Provisional Board of Government of Panama on January 21 issued a decree imposing severe penalties upon all physicians and pharmacists who should fail at once to report to the National Board of Hygiene any cases of con

tagious diseases coming under their notice. Nevertheless, a few cases of yellow fever presently appeared. Two deaths from that disease occurred in the hospital of San Tomas, Panama, on January 15, and other cases occurred at intervals during the year. On July 1, 1904, the American sanitary officers assumed charge of the Canal Zone, and from that date to December 20 following there were ten cases of yellow fever, of which two resulted fatally. Four of these cases occurred in the first two weeks of December, and two of them were known to Secretary Taft and his party on their visit to Panama at that time. Secretary Taft was, indeed, greeted on his arrival with the fearsome whisper that a case or two had just occurred. No public proclamation was made of the fact, for fear of creating a panic, but the fact was perfectly well known to the visitors, and was variously regarded. Some were frightened, while others pooh-poohed and scorned the idea that yellow fever could make any serious headway under American administration. But it did make headway. Week by week new cases occurred, steadily increasing in numbers. The rainy season came on, making almost every square foot of the wretched cobblestone pavements a breeding ground for the Stegomyia. To make the situation worse, many of the streets were torn up for the laying of sewers and water-mains, and, under the torrential tropic rains, were transformed into sluggish rivers of mud. Meantime demoralisation grew apace in the minds of the American colony. Among many fear and fright developed into absolute panic. As for those who had formerly scoffed, they assumed a cynical bravado and fatalism. The refrain of their daily song was the old

"One cup for the dead already,

And hurrah for the next that dies!"

They professed contempt for the mosquito theory, and ostentatiously tore holes in the nettings which had been placed over the windows of the canal building, or removed them altogether, and disregarded all the sanitary precau

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tions and regulations which had been prescribed by the health officers.

It would be ungracious to dwell in too great detail or with too much emphasis upon responsibility for this state of affairs. Careful investigation and conservative consideration warrant, however, the charging of it chiefly to two causes. One was, the failure of the Canal Commission to support the efforts of the sanitary officers with the promptness and liberality which were required if those efforts were to be in the highest degree successful. There was too much "red tape." Those sanitary officers were in the positions of army officers on the firing line. It was necessary that they should have all the arms and munitions of sanitary warfare that they wanted, and should have them right away. The enforced waiting for weeks or months sometimes meant disaster. It is not for a moment to be supposed the Canal Commissioners were careless in the matter. They were as desirous as anybody that the fever should be suppressed and the sanitary conditions of the Isthmus should be improved. But at Washington they did not and could not realise the urgency of the case as fully as did the men at Colon and Panama. Moreover, they were under the restraint of caution lest they should be charged with looseness of business methods and with opening the door to "graft." In former years the name of Panama had been synonymous with scandal and corruption. These men proposed to avoid a repetition of that state of affairs, and if in doing so they erred, they erred on the side of caution.

The other cause of trouble was, the haste of the American nation to have the canal built. Because of that heedless haste, the cart was put before the horse. The canal work was begun before essential preparations for it were complete. This should have been realised at the outset. In its original bargain with the new-born Republic of Panama for the construction of the canal, the United States Government contracted to do a vast work of sanitation in the cities of Panama and Colon and in the whole stretch of country between

them. It undertook to create in them a sewer system, a water supply system, and civilised street pavements, and to do its utmost to destroy the Anopheles and Stegomyia mosquitoes, so as to banish malarial and yellow fevers. It was not through pure benevolence to Panama that the United States undertook such tasks, but in order to facilitate and expedite the construction of the canal; for it was seen that, if the canal was to be built, the Isthmus must be rendered fit for the builders to live in. There were those then who thought this preparatory work of sanitation should be done first, and that nobody should be set to work on the canal until yellow fever had been completely stamped out, as it had been years before in Cuba-under the direction of the same health officer, Colonel Gorgas, who is now in charge at Panama. But the popular impatience for the canal, and the President's desire "to make the dirt fly," were too strong to be at once resisted. The work of sanitation was begun, but without waiting for it to be completed several thousand men were also set at work upon the canal. The result was not exactly disastrous, but it was deplorable and demoralising.

The state of affairs in May, 1905, when Governor Magoon arrived upon the scene, may be summed up in three words— panic, lethargy, bravado; and the three together meant demoralisation. In that month there were thirty-eight cases of fever on the Isthmus, with a threat of a large increase in June. Governor Magoon arrived on May 25, and it did not take him long to perceive two things. One was that the first supreme and necessitous duty of the administration was to get rid of yellow fever, whether a single spadeful of earth was dug on the canal or not. The other was that the first step toward getting rid of the fever must be to restore the public mind-that of the non-immune Americans, especially -to sanity. He began by frankly and publicly declaring that he, personally, was afraid of the fever, and that in his opinion all non-immunes who professed not to be afraid were "talking rot!" Then he ordered all the window screens to