On June 28, 1904, Dr. William Crawford Gorgas, nurse Marie Eugenie Hibbard and a few others arrived in Colon as the advance medical team for the construction of the Panama Canal. Another physician, Dr. Manuel Amador Guerrero --- Panama’s first president --- imposed sufficient order throughout the Republic of Panama, and granted Gorgas and his people sufficient powers outside the just-created Canal Zone to make a legendary sanitary revolution possible.
What ensued is an often-told story, a tale of clean water systems and sanitary sewers installed, city streets of pestilential mud being paved, garbage being systematically collected and mosquito breeding areas drained or covered with oil. By 1905, the dreaded yellow fever had been eliminated from Panama. Clearly, the Americans had left their first and most famous imprint on Panamanian medicine.
But was it, as the construction era accounts published in the United States tended to portray it, purely and simply a matter of superior American know-how?
According to Dr. Jorge Motta, a cardiologist by vocation and a medical historian on the side, it wasn’t that simple. Motta, who used to work at Gorgas Hospital, spoke about the subject at the June 2 meeting of the Panama Historical Society. His presentation was but one of several events commemorating the centennial of the establishment of American medical science on the isthmus.
The canal builders’ main health concerns were malaria and yellow fever --- psychologically the latter, even though the former claimed many more lives. Looking at mortality statistics that date back to the meticulous records kept by the French during their late 19th century attempt to build a canal, the death tolls from cholera (an infection cause by contaminated water or food) and beriberi (a form of malnutrition caused by a lack of thiamine in the diet and often aggravated by alcoholism) were also very high.
Earlier in that century, it is said that some 6,000 workers died building the 47-mile-long Panama Railroad across the isthmus, but according to Motta, it’s hard to find reliable data about that.
Even further back in isthmian history the records are even more imprecise, but there are reliable accounts of great plagues sweeping through here.
Was it always thus? Was Panama always a pesthole of horrible infections before the Americans arrived?
Not really, Motta argues. Neither malaria nor yellow fever, nor cholera, are native to the Americas. “Malaria is easy to transport,” he pointed out, noting that it most likely came here from Africa by way of European ships, although there is another theory that it got to this hemisphere with seafaring Pacific islanders visiting the coast of Peru.
Because of the life cycles of the virus that causes yellow fever, the Aedes mosquitos that spread it around human communities and the “windows of opportunity” during which afflicted people are infectious, it probably wouldn’t be possible for yellow fever --- probably an African monkey disease in its origins --- to survive a middle passage by sailing ship from Africa to Panama. And indeed, the first yellow fever cases recorded in the Americas were in the 16th century in the easternmost islands of the Caribbean, Barbados and Guadeloupe, a shorter passage that the disease and its vectors could survive on a slave ship.
Cholera was from India, and didn’t make its appearance in Panama until the 19th century.
The word “malaria” derives from Italian, and from the belief that the disease was caused by something bad in the air. At the time that the Panama Railroad was built, the concept of infection by microbes was unknown and the idea that such germs could be spread by insects was unsuspected.
When the French began their attempt at building a canal, Louis Pasteur had just pioneered the germ theory of infection and developed his smallpox vaccine. About the time that the digging started, the Cuban Dr. Carlos Finlay published a paper suggesting, based on anecdotal observations, that yellow fever is spread by mosquitos. (Years later, in 1900, the American Dr. Jesse Lazear tested that theory by allowing himself to be bitten by an infected mosquito and confirmed Finlay’s hunch by dying an agonizing yellow fever death.)
Dr. Louis Companyo, the French canal project’s medical director, required all workers to be vaccinated for smallpox. But from the study upon which the French canal medical system was based, Motta surmises that he still didn’t get it. “It’s amazing --- there’s not one mention of the concept of infection.”
The French built Ancon Hospital, one of the world’s finest medical facilities of its time, for the benefit of canal construction workers. But even so, “these people got slammed with the most terrible diseases.” And meanwhile in Panama City health conditions were even worse, with a 10 percent annual death rate during the heyday of the French Canal.
But then the company went broke, its directors were enmeshed in financial scandals and most of the work force left Panama. As the population plummeted, so did the death rate.
A subsequent spike in Panama’s mortality rate in 1902 is testament to something else that’s usually not emphasized in US accounts of Panamanian independence, the massive devastation caused in Panama by Colombia’s Thousand Day War. (For those who prefer to denigrate this country as a made-in-the-USA imposition on a passive local population, it’s convenient to ignore the suffering that Panamanians had to endure because they were subject to Colombia’s never-ending civil warfare and the political passions that suffering engendered.)
With the 1902 mortality spike explained and the experience of the French canal effort, Motta went back to the less precise but rather well known historical record of the plagues that swept across the isthmus. In the days when the gold and silver that the Spaniards stole from Peru passed through Nombre de Dios, then Portobelo, en route to Spain (or when the pirates had their way, often to Great Britain or its possessions), it turned out that these early trade centers suffered their worst disease outbreaks precisely during the times of the great trade fairs, when large crowds descended upon those usually sleepy towns. Likewise, cholera and other diseases ravaged the transit zone when the California Gold Rush brought hordes of Americans through here.
All this leads Motta to conclude that this country’s experience of great plagues is more than anything else a tale of nature’s response to great masses of human beings being overcrowded in unsanitary conditions. Using charts and historical records, he demonstrated the relationship between population density and outbreaks of deadly infectious diseases.
But as the gangs of workers from all over the world descended upon Panama for the American canal construction effort, Gorgas and his team disrupted this cycle by rigorous sanitation methods that suppressed the disease vectors.
Ah, but history is never static and nature abhors a vacuum. And so it was with Panama’s mortality rate, even as it went steadily down in the face of Gorgas’s offensive. “You plug one hole, and another pops up,” Motta noted, pointing to a rise in pneumonia deaths in the jam-packed construction workers’ barracks and a terrible toll from the traumatic injuries suffered in workplace accidents. As the health and safety authorities in the old Canal Zone began to get those problems under control, heart disease and cancer made their first appearances on the list of leading causes of death in this country.
The Americans went on to build an impressive complex of hospitals in the Canal Zone, in which many prominent doctors practiced. In 1906 a Dr. Darling published the first scholarly medical article from the Canal Zone, and over the years many more followed. The Americans also established the Gorgas Memorial Laboratory, which was originally intended to be a medical school but was never used for that purpose due to a lack of funding.
The Second World War brought a major expansion of the Canal Zone’s hospital facilities, most of which never saw the massive influxes of war casualties for which they were built and were later converted for non-medical purposes. (One of those, Coco Solo Hospital, was built by the US Navy and later turned over to the Panama Canal Company, and now lives on as the Policlinica Hugo Spadafora. Another, built in 1943 at the former Fort Gulick, went on to be the notorious School of the Americas where dictators who ruled most of Latin America studied, and was then converted into the present luxurious Hotel Melia Panama Canal.)
Unlike certain political theorists who like to declare an end to history when their side is winning, Dr. Motta isn’t predicting and end to death and disease. In fact he thinks that yellow fever and malaria could once again terrorize the isthmus.
Considering the probability that the yellow fever virus probably lives on in some monkey reservoirs, the massive increase in Aedes aegypti mosquitos that breed in the rainwater that collects in urban refuse and some pretty appalling overcrowding in San Miguelito and parts of Panama City, he warns that “we only need two or three infected people to create a catastrophe.”
And then there’s malaria, one of the world’s most prevalent and deadly infectious diseases to this day. Noting a recent increase in reported malaria cases in this country, Motta notes that a couple of the worst afflicted areas, Kuna Yala and Bocas del Toro, are attracting more and more tourists. “Something is going to have to be done,” Motta concluded.
Also in this section:
When the Americans brought their medicine to Panama
How figs keep wasps from cheating
Termite evolution
Biological climate control
Interpersonal violence as a public health issue
