Monday, June 6, 2011     17:19
 

Importance of sanitation brigades

Upon the completion of all negotiations concerning the assets of the Interoceanic French Canal Company, Colonel William C. Gorgas arrived on the Isthmus of Panama in 1904, leading a distinguished team of physicians.

On the heels of his triumph over malaria and yellow fever in Havana, President Theodore Roosevelt picked Dr. Gorgas to attempt a repeat of his previous success. He was to provide the appropriate working conditions, with sanitation as the principal factor, and push forward this monumental task at which the French had failed.

Sanitary Conditions in the cities of Panama and Colon were dismal, but in other areas close to the excavation works, they could be termed non-existent.

Disorder reigned in a kingdom of mosquitoes. The anopheles (malaria) and stegomya fasciata, later called Aedes Aegypti (yellow fever and dengue) were the ever-present monarchs, daily increasing the mortality statistics.
Anopheles Mosquito

At that time it was not important whether it was Finlay or Walter Reed who had identified the vector that propagated the aforementioned dreaded disease. Eventually history would give each one his rightful due and acknowledge their scientific contribution.

At that time, the situation in the Canal was very politicized, above all, and required speedy action to prevent a repetition of the dreaded mistakes of the previous company.

The powerful northern nation could not persist in following disastrous work plans, and they obviously needed to change their focus from the very start.

Gorgas had to wage long and hard battles to gain acceptance for his theory that sanitation must precede construction. He had to struggle persistently for the approval of budgets requesting large amounts of money to acquire protective netting, large quantities of crude oil, fumigating materials, and above all for labor in its early stages. These ideas were the target of derisive sarcasm in high circles of government in Washington.

After the heated arguments surrounding this project, it got a much-needed boost from the unconditional endorsement by President Roosevelt who, after studying Gorgas’ proposal, made a wise decision to support it.

Sanitation activities were undertaken quite effectively and the success of the Panama Canal could now be viewed as more viable.

Gorgas himself, appointed Chief of Sanitation, described that one of his first visits after having arrived on the Isthmus was to a camp of very robust and healthy soldiers who were living on a nearby hillside, under the best possible environmental conditions. Nevertheless, after only 30 days of living in Panama, 170 of the 450 had already contracted malaria.

If this could happen to a group of strong, well-fed soldiers, Gorgas reasoned, then what was to be expected of other workers of lower physical conditions?

His appreciation of the problem, as well as his response to it, was swift. If measures were not taken to improve the current sanitary conditions, mortality figures would equal or exceed those of the French period, and failure would be just as resounding.

The task at hand was clearly cut out for them. The entire city had to be cleaned and placed under a strict system of sanitary inspection and control; unnecessary deposits of water had to be dried up, and mosquitoes controlled throughout.

Garbage collection had to be subject to sanitary measures, and a test for malaria had to be administered to the entire labor force to maintain accurate records.

A treatment of quinine was initiated for all identified cases, which were given close follow-up until they were cured.

These measures technically eliminated man as a focus of constant reinfection.

During the period the French were working on the Canal, mortality statistics were never precise, nor even approximate. This was owing to the fact that the contractors of the various works had to pay five francs daily for the hospital care of their workers; inasmuch as they tried to avoid paying the costs of medical care, it was speculated that many workers died in their own homes.

Gorgas estimated that the number of deaths annually during the French era could have been 240 for every 1,000, a very alarming figure. It later decreased to 2.1 for every 1,000—bearing evidence to the efficacy of the sanitation controls implemented.


Before construction
 
A dredge in the city of Colon
 

After construction

Sanitation works began by putting in place a drainage system and cleaning all streets, as well as providing plenty of potable water for the entire population.

Later, the real battle focused on the two mosquitoes responsible for yellow fever and malaria.

The fumigation brigades began discharging their duties immediately. In many instances they were rejected by the very inhabitants of Panama and Colon, since the fumigation interrupted their daily family activities, which is still true today, as it was inconvenient to have strangers working in the home—not a very pleasant situation to endure.


Even in the face of this passive resistance from the population, the diplomacy and tact displayed by Gorgas and his assisting staff managed to prevail.

Other brigades that played an important role in these tasks were those that used chloroform to anesthetize the mosquitoes for subsequent microscopic study to determine whether they were vectors or not. Any positive findings would immediately unleash a painstaking search of possible existing contagion foci to isolate them and prevent the propagation of the disease.

The oil sprayers were another important group in the sanitation of canal townsites. Backpacking their containers, they would go about spraying wherever they found water puddles, wells, latrines, or toilets. They came to be very familiar figures back then.

The campaign against malaria was conducted within the following parameters:

  • Three grams of quinine daily for all patients
  • Mosquito netting for doors and windows in hospitals and homes
  • Capture and destruction of all mosquitoes by special brigades
  • Eradication of anopheles by elimination of all puddles and accumulated fluids
  • Oil sprayed over any pools of water to exterminate the mosquito larvae
  • Clearing grass and underbrush from the grounds surrounding townsites.

The positive outcomes of these measures:

  • In 1906 malaria accounted for 6.8% of hospital cases
  • In 1911 this figure was down to 1.5%
  • In 1906 employee deaths numbered 233
  • In 1911 it decreased to 47
  • Yellow fever was completely eradicated

Little by little, the initial resistance from the population in the terminal cities was being countered, until it turned into full-fledged cooperation, as they were able to realize and value the greatly beneficial results, which were very evident to the entire community.

Families now opened their doors willingly, affording ready access now that their earlier rejection was overcome.

The Americans won a decisive victory in this environmental battle of preventive medicine, a front on which the French were not effective.

History has not bestowed the proper importance on the quiet and intense work conducted by the various sanitation brigades of the Panama Canal nor on their extraordinary contribution to the successful conclusion of this undertaking.

It was with much care and dedication that they carried out the roles they had to play in the monumental wonder of building and interoceanic canal.

They were true anonymous heroes, among others, in the overall contribution toward the success achieved.

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