CHAPTER V

HEALTH ON THE ISTHMUS AND THE FUTURE OF THE WHITE RACE IN THE TROPICS

_Yellow Fever._

THE cities of Colon and Panama have never been particularly unhealthy to the Panamanian born, whether white or coloured, or to the West Indian stranger.

This population has merely been subject to the malaria common to equatorial towns, especially when in the neighbourhood of swamps, and to the evils which attend imperfect sanitation in a hot climate.

The intervening country is very malarious in the low-lying parts, less so on the hilly divide, differing in no way from other similar localities in the same latitude.

The reputation of the Isthmus of Panama as a death-trap is due to the sickness which (previous to 1906) has always been prevalent among white strangers, and most other visitors, and particularly to the high percentage of death from yellow fever. To this short, sharp, and most deadly disease the native-born is immune; hence the affairs of the city of Panama have gone on well enough for centuries, as far as the residents are concerned, except that travellers by the Isthmian route tarried no longer than they could help. Whenever large numbers of strangers have congregated on the Isthmus, as during the Californian gold-rush, the construction of the railway, and the Canal construction of the French Companies, there has been an epidemic of yellow fever among them, and a very large proportion of cases have terminated fatally.

The immunity which the West Indian negro enjoys from this disease gave him a superiority over other labourers on the Isthmus which, since the extinction of the disease, is no longer his.

During the American occupation of Havana, after the American-Spanish War, yellow fever broke out among the strangers, and the mere cleaning up of the city, though carried out with military thoroughness, had no effect in checking the disease. A medical board was sent to study the matter. This was in 1900, four years after Major Ronald Ross, of the Indian Medical Service, had discovered the cause of malaria. Ross had proved that the cause of malaria in man was the presence in his blood of an organism introduced by the attack of the _anopheles_ gnat (or mosquito), and that the species was only poisonous to man if it had itself become infected with the germ of this organism in biting a man suffering from malaria. Thus man and _anopheles_ act alternately as hosts to the organism, which apparently requires their co-operation for the continuance of its species.

Gnats, or mosquitoes, as they are indifferently termed, being thus under more than suspicion as an immediate cause of tropical fevers, the medical board turned their attention to them, and Mr. Reed, a member of the board, tracked the yellow fever to another gnat, the _stegomyia_, and, aided by the heroic devotion of his assistants, proved beyond shadow of doubt that this disease is due to the activity of another minute organism, which lives a double life in man and _stegomyia_. Mere contact with the clothing, &c., of yellow-fever patients was proved to be no source of infection.

The _stegomyia_ lives three months. It becomes dangerous only by imbibing the organism through attacking man during the first three days of yellow fever, and, even then, twelve days elapse before its bite is infectious. Six days after a man has been bitten by an infectious _stegomyia_ he develops yellow fever, and for the next three days (as has been already said) he is infectious to the _stegomyia_.

During the American occupation of Cuba attempts were made to obtain immunity from yellow fever, but it was found impossible to regulate the disease when voluntarily communicated by the bite of the mosquito, and at present immunity is only enjoyed by persons who inherit the privilege.

The _stegomyia_ does not breed in open swamps or large bodies of water, but needs shelter, and is also incapable of sustaining a long flight. It breeds chiefly in and near towns, depositing its larvæ upon the surface of cisterns or stagnant pools.

Colonel W.C. Gorgas, M.D., took charge of the Department of Sanitation of the Commission in July, 1904. "The experience of our predecessors," he writes,[27] "was ample to convince us that unless we could protect our force against yellow fever and malaria we would be unable to accomplish the work."

[27] "Sanitation in the Canal Zone," by W.C. Gorgas _Journ. Am. Med. Assoc._, July 6, 1907, vol. xlix.

At this time there was but little yellow fever on the Isthmus, and, in spite of the arrival of a large number of non-immunes, no alarming outbreak occurred during the first ten months. During April, 1905, however, the administration building in Panama, in which worked some 300 non-immune employees of the Commission, became infected. In that month there were 9 cases and 2 deaths; in May, 33 cases and 8 deaths, of which 21 cases and 2 deaths were among employees of the Commission. In June there were 19 deaths from yellow fever on the Isthmus, and in July 13. The Commission reported[28] that:--

"A feeling of alarm, almost amounting to panic, spread among the Americans on the Isthmus. Many resigned their positions to return to the United States, while those who remained became possessed with a feeling of lethargy or fatalism, resulting from a conviction that no remedy existed for the peril. There was a disposition to partly ignore or openly condemn and abandon all preventive measures. The gravity of the crisis was apparent to all."

[28] Annual Report, 1905, p. 30.

Colonel Gorgas writes[29] of this time:--

"We could readily see that if the conditions as they existed in 1905 were to continue the Canal would never be finished."

And he adds that:--

"The Executive Board of the Commission itself, as late as June, 1905, stated that the sanitary work of the Isthmus had been a failure and recommended that the _personnel_ be changed and other methods tried. But the Supreme Authorities ... gave us steady support, and by the following December yellow fever had disappeared from the Isthmus."

[29] "Sanitation in the Canal Zone."

The total deaths among employees of the Commission from yellow fever during the 12 months October 1, 1904, to September 30, 1905, was 37, among about 17,000.[30] The total from yellow fever among the whole population, including Canal employees, during the four months May 1 to August 31, 1905, was 47, while the number of deaths from malaria during the same period was 108. The effect of malaria in impairing physical efficiency was even more in excess than these figures indicate, for the fatal cases are a small proportion of the whole in malaria, and a very large proportion in yellow fever. The moral effect of the imminence of the more sudden and fatal form of disease was, however, as these reports show, much the greater, and it was this moral effect which caused the crisis above described.

[30] In 1883-84 the French Company lost by yellow fever 66 men out of about the same number of employees.

* * * * *

Previous to February, 1905, the Department of Sanitation had done little to improve the hygienic conditions of Colon and Panama, chiefly owing to the opinion until then maintained by the legal advisers that there was no authority to expend money in those cities, which are not within the Canal Zone.

In April the yellow fever broke out; the number of men employed by the Department of Sanitation was increased to the huge total of 4,100, and the battle with yellow fever began in earnest. All cases were either transported to screened buildings, or, if left in their own homes, these were carefully screened with fine-meshed copper gauze. The object of this isolation was to prevent the patient from infecting healthy _stegomyia_ mosquitoes.

Every dwelling in Colon and Panama was thoroughly fumigated with pyrethrum powder or with sulphur, and then cleared of dust and refuse, which, with the insensible but not always dead mosquitoes, was then burnt. The complete, and, it is hoped, final freedom from yellow fever in Colon and Panama has been obtained by means of a proper water supply and universal paving with brick or cement, as well as the supply of proper drainage. Formerly water for domestic use was stored in cisterns, tanks, tubs, jars, and so forth, and, after rain, water stood stagnantly in a thousand ruts and holes in the unpaved squares, streets, and lanes. These breeding-places of the _stegomyia_ have now been done away with completely in Panama, and almost completely in Colon. The latter city is so low-lying and flat, and subject to such heavy rainfall, that pools of stagnant water will form. They can, however, be oiled, which kills the larvæ, and, moreover, it is Panama, and not the wind-swept, salt-saturated, town of Colon, which has been the chief source of yellow fever.

The last case of the disease in Panama occurred in November, 1905, and in May, 1906, there was an isolated case in Colon. The infection is considered to be at an end in a city three months after the last case, that being the lifetime of _stegomyia_. After this period, all infected _stegomyia_ having died, those that remain are powerless for harm. Nevertheless, the stringent measures for their destruction are not relaxed, as, while _stegomyia_ exists, the germ, if re-introduced, will be rapidly disseminated.

Thus the yellow fever, having taken toll for four hundred years of those who crossed the Isthmus, has been completely eradicated by. Colonel Gorgas and his assistants. It is a triumph of science and of despotic government combined; and only in this combination can preventive medicine achieve full success.

There is one other aspect of the yellow fever campaign which must be mentioned before going on to describe the fight with malaria.

Yellow fever, unlike malaria, does not occur in all tropical countries. Its home is the West Indies, Central, and parts of South, America, and, before its extinction in Havana, it has been a serious scourge in the Southern United States. In the New World cases have occurred as far north as Quebec, in Europe cases have occurred in Wales and France, and there have been serious epidemics in Spain. It has never been known east of Genoa, whether in Europe or elsewhere. Thus in Africa it is known on the west but not on the east coast. The fact that it is unknown in India is very remarkable, seeing that _stegomyia_ is a very prevalent variety of mosquito there. It follows from this that if yellow fever once got hold in India it would probably spread and might work great havoc. The same is true of China in an even greater degree, for such preventive measures as have been taken in Panama would be far more difficult to carry out in the great cities of India, and altogether impracticable in those of China. Thus, as Colonel Gorgas has pointed out, if the Canal had been constructed in spite of yellow fever, and if that disease had been allowed then to persist at Panama, the disease might not improbably have been carried to Asia, for the three months of life of _stegomyia_ is ample for the voyage. In this event the Panama Canal might have proved a curse rather than a boon to mankind.

_Malaria._

The campaign against malaria has been conducted on somewhat different lines. The _anopheles_, which transmits that disease, deposits its larvæ in clean water where grass and algæ grow, and is therefore almost entirely a mosquito of country districts. But Colon and Panama, both small cities, are exposed to the disease, as are about seventeen little towns and forty villages for labourers along the line of the Canal. As the flight of _anopheles_ is not more than one hundred, or possibly two hundred yards, the working population can be in great measure protected from their attack by destroying the breeding places for such a distance on either side of the dwelling and working places. This in itself is a large task, which could not be carried out in a short time, and while in progress the Sanitary Department relied mainly upon the erection of buildings completely screened (including the verandahs) with fine copper gauze, which effectually shields the employees against mosquito attack within doors, and therefore during the particularly dangerous hours of night.

In addition, the employees are supplied with quinine, and recommended to take three grains daily while in health. This "cinchonises" the blood and renders it unwholesome to the malarial parasite.

The effect of screening is shown by the following example from the report of the Commission, December, 1906:--

"The first shipload [of European labourers] arrived during the dry season, when mosquitoes were most scarce, and were quartered in unscreened buildings. Within six weeks of their arrival 33 per cent. of these labourers had been taken sick with malaria. The second shipload arrived during the rainy season, and were quartered in a camp not 200 yards distant from that of their predecessors. The buildings of the camp were screened. Sickness among the men was infrequent, and when they had been upon the Isthmus six weeks it was found that only 4 per cent. had found their way to the hospitals."

* * * * *

The destruction of larvæ, and of their hiding places, is commenced by the clearing of grass and bushes, which are cut down with the _machete_, a short cutlass with which the Panamanian is very expert, _machete_ work being, indeed, the principal _rôle_ in which the Panamanian is employed by the Commission. Also ditches are cleaned out, and heavy oil poured upon the water in trenches and pools, and land-crabs are caught and the holes in which they dwell are filled in or oiled. Finally the soil is drained, which is the only means of making the ground permanently unfit for mosquito breeding. Subsoil draining is the best, a tile drain being put in; for, even in concreted gutters, pools will form, owing to accidental obstruction, and remain sufficiently long for the deposition and hatching of the larvæ. Such is the work of the _anopheles_ brigade, and the _stegomyia_ brigade carry out similar operations, in the neighbourhood more particularly of Panama.

With regard to the effect of these operations upon the numbers of the mosquitoes I may narrate my own experience. I arrived at Colon first in January, 1907, and spent one or two nights on board my ship. This was two years and a half after the commencement of the mosquito campaign, and the officers of the ship congratulated themselves upon the absence of the swarms of mosquitoes which formerly attacked them at night on their vessel. I found, however, that although there was no swarm of mosquitoes, such as I have seen, _e.g._, when on board ship in the harbour of Colombo, Ceylon, yet that the individuals who remained certainly caused me discomfort, and I think some subsequent indisposition. In April, 1908, however, during two days at Colon, I did not so much as see a single mosquito.

At Panama, in January, 1907, my wife and I stayed in the Commission's screened hotel on Ancon Hill, not caring to face the dirt and squalor of the old city. In April, 1908, finding the city properly paved, drained, and plumbed, we took up our quarters at the Hotel Central in the town, where we spent a fortnight in perfect health; and although this building, not being under the Commission, is unscreened, I was only bitten by mosquitoes, to my knowledge, twice during that time, and this without subsequent ill effect. I may add that the picturesque surroundings, not unlike those of some city on the Mediterranean, greatly enhance the pleasure of a stay on the Isthmus, now that they can be enjoyed without squalid accompaniments. I did not, except on one or two nights, even draw the mosquito curtains. Out of doors, in the city of Panama, I was not bitten once, though I was attacked once or twice by solitary mosquitoes when walking on roads or paths with shrub or jungle adjoining. This was near the end of the dry season. When the rains commence a greater number of mosquitoes must be expected.

Natives of the Isthmus and the West Indies are not immune from malaria, and in 1904-5 about one-half of the inhabitants who were examined proved to have the parasite of malaria in their blood. As the _anopheles_ becomes infectious through biting a malarious man, it is evident that such a dissemination of the parasite throughout the blood of the human population renders mosquitoes especially dangerous. In the same proportion as the population becomes less malarious, so the mosquitoes become less dangerous, and theoretically a millennium is possible in which man and _anopheles_, mutually purged of the malarial organism, may live happily together. Unfortunately, a malarious man it is believed remains infectious to _anopheles_ for no less than three years, instead of the three days' limit of yellow fever, and this greatly increases the difficulty of exterminating malaria.

During 1906, with a force of 26,000, there were 21,739 cases of malaria admitted to the Commission Hospitals, and the death-rate from this disease was among whites 2 per thousand, among negroes 8 per thousand.

In 1907, with a force of 39,000, there were 16,753 cases, the death-rate among whites being 3 per thousand and among negroes 4 per thousand. The increase among whites was due to the greater proportion of the European labourers, whose circumstances are different from those of the skilled artisans and the "screened" clerical staff of Americans.

The total death-rate from all causes in 1907 is shown below:--

--------------------------------------------------------- | Average | Total | Annual Death | Number. | Deaths. | Rate per | | | Thousand. --------------------+---------+---------+---------------- White Employees | 10,709 | 179 | 16.71 Black Employees | 28,634 | 953 | 33.28 |---------+---------+---------------- Total | 39,343 | 1,132 | 28.77 ---------------------------------------------------------

--but accidents account for a considerable proportion of the deaths.

During the same period the average number of American women and children in Commission quarters was 1,337, among whom occurred nine deaths, an average annual death-rate of 6.73 per thousand.

In addition to malaria there is one other disease which proves fatal to considerable numbers of employees, attacking principally the black labourers. This is pneumonia, to which are attributed altogether 328 deaths as against 154 from malaria.

It appears that special research is needed into the cause and prevention of this disease among negroes in the tropics.

* * * * *

In 1907 no less than 71,000 persons arrived on the Isthmus, all of whom had to pass the Commission doctor at the entrance port. All but transients are vaccinated on arrival, and great watchfulness is exercised against the introduction of any new disease from abroad. Thus, when bubonic plague broke out at Guayaquil, the Department of Sanitation commenced a campaign against rats as a precaution against the spread of the disease (which is propagated by the rat flea) in case quarantine measures failed to keep it out.

Again, when one or two cases of rabies recently occurred on the Isthmus, all dogs for whom an owner could not be found were at once destroyed.

_Life on the Isthmus, and on the Future of the White Man in the Tropics._

The Canal Zone now being healthy, the life of the Americans is a cheerful as well as a busy one. The climate, to which the local diseases used to be attributed, is not by any means wholly bad. There are really two climates, that of the Atlantic seaboard and that of the Pacific side. Colon is somewhat trying on account of the humidity, but a healthy trade-wind blows. The town of Panama, though receiving much less rain, is also somewhat humid, owing to there being less breeze. The temperature, however, is lower than that of the great cities of the United States, even in the North, during summer heat-waves, the hours of sunshine are shorter, and the general feeling of oppression is, I think, distinctly less. The Ancon suburb, where the Commission buildings are situate, is free from the humidity of the low-lying city. The high lands at or near Culebra, where a large part of the American population now resides in screened wooden buildings, enjoy in the dry season a bracing climate, a fresh dry wind blowing across the divide, imparting a sense of exhilaration, which is heightened by the fine scenery, the pleasant scents of the surrounding woodland, and the ordered activity of the life. Amidst such circumstances the Canal official finds it easy to work hard. I noticed in this a great contrast to the condition ten years ago at Ismailia, the headquarters of the Suez Canal Administration. This place, before Major E. Ross's discoveries, suffered severely from malaria, and the officials of the Administration, some of whom had resided there for twenty years or more, were in many cases saturated with malarial poison. Work for them was a burden, bravely borne indeed, but taken up each day with a sigh. I spent about a fortnight there in a hot season conducting some investigations upon the forms and movement of drifting sand-dunes. I suffered during part of the time from fever, and only kept on working with an effort, whereas on the Isthmus I enjoyed more than usual vigour. At Culebra, indeed, the dry season is so bracing that the arrival of the rains is welcome for the soothing effect of greater humidity, as well as on account of diminished dust. The white woolly cloud or mist which then wraps round the hill-tops is no longer the "white death," as it was called in the days of the French Company, when the vapours were credited the poison which really lurks in the mosquito. Even now, however, there is an increase in the number of mosquitoes, and some increase in malaria, when the rains come.

Not only do the men look well, but the women and children also. The women in general have the same appearance as in the United States; perfectly dressed, as always, quiet in manner, and apparently happy, though occasionally somewhat bored. To the wife, not having the absorbing interest of the Canal work, the Isthmus is generally less interesting than to her husband, but of late there have grown up organisations for promoting intellectual and other social intercourse which are rapidly relieving the threatened ennui.

The children, on the other hand, look actually happier and stronger than they do in the cities of the United States. They are in the open air all day, for sunstroke is rare on the Isthmus; they are bronzed, active, fearless in bearing, and apparently thoroughly satisfied with themselves and with their surroundings. Even when within doors they are still in a sense in the open air, for the windows are unglazed, and the houses are constructed so as to secure a free circulation of air.

It has been said that the possession of India taught the English the value of the cold bath, an institution which has been slowly adopted from us by other Northern nations in Europe. Perhaps the possession of the Canal Zone will lead to the salutary open-window habit, which is not yet general in the United States.

The Commission clubs for gold-employees at the principal stations are commodious structures, admirably designed for social recreation; their management is entrusted to the Young Men's Christian Association. There are well-equipped reading and writing rooms and gymnasia, mainly used by the men, but the interests of the women and children are not neglected, and for the last playrooms are provided. The large halls are used for entertainments and for meetings of the numerous benevolent "secret" societies which have been so important a factor in the preliminary organisation of American society in newly settled territories. In the clubs only "soft" drinks are provided, but I can testify to their excellent effects.

The question whether the white race can make a home in the tropics depends ultimately upon the tropical baby--upon his own health and that of his mother. The American occupation is still recent, but as far as experience goes it seems that the white children born on the Isthmus have not shown unusual delicacy, and the mothers have made a normal, though sometimes rather slow, recovery from confinement.

The views of Colonel Gorgas upon the future of the white race in the tropics deserve quotation. He writes[31]:--

"I think the sanitarian can now show that any population coming into the tropics can protect itself against these two diseases [malaria and yellow fever] by measures that are both simple and inexpensive; that with these two diseases eliminated life in the tropics for the Anglo-Saxon will be more healthful than in the temperate zones; that gradually, within the next two or three centuries, tropical countries, which offer a much greater return for man's labour than do the temperate zones, will be settled up by the white races, and that again the centres of wealth, civilisation and population will be in the tropics, as they were in the dawn of man's history, rather than in the temperate zone, as at present."

[31] "Sanitation in the Canal Zone."

In this connection I may perhaps be permitted to refer to an interesting suggestion made in the course of conversation by Colonel Gorgas, although I omitted to inquire if it had been published. This suggestion was that the records of the movements of great armies under the rulers of ancient Mesopotamia and Egypt indicate that malaria did not then exist in the nearer East, and that malaria, like yellow fever, was once a local disease.

From what I have seen as tourist and traveller (not as resident) in the West Indies and in the Orient, I have arrived at the following tentative conclusions, viz.:--

That the debilitating effect which the tropics have been observed to exercise upon those who come from temperate regions has been due mainly to the presence of certain diseases which can be done away with.

That the rapid deterioration of the white stock which is usually noticed in the tropics, especially near the equator, is mainly due to the same cause.

But that Anglo-Saxons cannot perform nearly the same amount of hard bodily labour in a constantly hot climate as they can in the temperate zone, and Anglo-Saxon immigrants never will be able to do so. In this I think the Mediterranean races--at all events the Spaniards and Italians--are our superiors.

Whether the descendants of Anglo-Saxon stock who have settled in a tropical country purified from tropical diseases will be able to support continued hard bodily labour better than their immigrant ancestors is a matter about which we have at present no direct evidence.

It may possibly be worth noting, however, that some years ago, when wintering in Manitoba, I found that some of the farmer immigrants from England felt the cold more as the years went by, but that their children born in the country were unaffected by it.

It is the case that in the tropics, particularly in the equable equatorial belt, many evils of the temperate zone are avoided, chiefly those due to cold and to sudden changes of temperature. It is this equatorial belt of equable temperature and heavy rainfall that I chiefly have in mind, for it comprises those vast regions of prolific vegetation which appear capable of supporting so large a population.

The white man already rules, or has marked off for rule, the whole of the equatorial belt, but who is to be the peasant cultivating this belt? In those parts of tropical Asia already peopled by industrious Orientals there can never be a white peasantry. Equatorial Africa presents great differences in different parts with respect to native population, and the question of a possible future for white peasantry is there a complicated one. In South America, however, there are vast equatorial regions either wholly unpeopled, or sparsely inhabited by tribes of that Indian stock which has elsewhere proved so slight an impediment to the establishment of the white labourer. Served by a system of rivers unrivalled elsewhere in equatorial regions, already partitioned among Christian Governments, and for the most part uninhabited, the forests and savannahs of Equatorial South America offer the readiest field for the establishment on a vast scale of a white peasantry under the equator.

By clearing the scrub within one or two hundred yards of his cottage, and by employing wire screens, the cultivator can protect himself against malaria, and his crops come not once, but several times a year.

If the Spanish, Portuguese, and Italian peasant were to turn his attention to this field, instead of, or in addition to, that of navvy work, great things might come of it. The circumstance that South America is a Roman Catholic continent, where the Latin races are dominant, would enormously favour the experiment. On the Zone, the Spanish labourer works in order to save and to depart, the _milieu_ being foreign to him and unattractive. In a Latin State it would be different.

In writing of the possibilities of the white race in the equatorial zone it is understood that the problem relates to the lowlands. There are, of course, favoured highlands, such as those of Colombia, where the temperature is at the same time moderate and equable and the climate appears admirably adapted to white men.

A healthy city life in the tropics would be easily attainable in a new country settled wholly by white people and under a medical despotism.

The general, but non-specialist, opinion upon the Isthmus is not as sanguine as that of Colonel Gorgas upon the hygienic future of the white race in the tropics. The general opinion among Americans seems to be that, as far as they are concerned, they would, if engaged in the tropical parts of South or Central America, avail themselves of the improving means of transit to revisit frequently the United States, and would rely upon such vacations in higher latitudes for the retention of their native vigour.