Panama: sanitary inspection reports; logistics

13.1	The weekly and monthly inspection reports

I have tried in the foregoing pages to show the nature of the work done by the Department of Sanitation in order to control disease; I now wish to speak of reports and inspections which enable the head of the Department and others to estimate the sanitary condition of the zone from week to week and from month to month. As the disease of most consequence, malaria comes first, and each week there is compiled “The Weekly Report of Malaria.” It is the duty of each sanitary inspector to keep up to date the chart of the amount of malaria in each station, and the materials for this chart are carefully compiled by the district physician. Below reproduce an example in full (see Section 20.3.1).61

All the weekly reports are sent to the office of the chief sanitary officer, and in a slightly condensed form a return of the employees of the whole of the stations is sent to each sanitary inspector. In this way each inspector sees the result obtained in other stations, and is encouraged to make his best efforts. In the actual form in which it was issued, I reproduce that for the week ending 5th July 1913 (see Section 20.3.2).

In one respect only is the weekly report incomplete. It deals only with employees living in defined localities in the Canal zone, and takes no account of employees living in the cities of Panama or Colon, nor of those who live outside of the defined settlements in the jungle. There are a large number thus excluded from the weekly statistics; but while they may not appear in the weekly malaria report, all admissions to hospital and all deaths on the zone and cities appear in the monthly and annual statistics. The reason for the omission from the weekly reports above referred to is the impossibility of obtaining accurate figures each week of the number of people who live outside the defined areas.

13.2	Monthly report of sanitary inspections

It is not necessary to say much on this subject, because the form of the report which I now give [see Section 20.3.3] is a sufficient indication of the care which must be given, and as a matter of fact is given, to the work. In what excellent order the screening is kept may be judged from what I have written; and all the work appeared to me on the same level.

The district physician also has various reports to make, and from him comes a special report on kitchens, as follows [see Section 20.3.4.]

13.3	Water supplies

I have already mentioned something about the water supplies of the zone, in connection with my visit to Gatun, Gorgona, and Empire; but it may be convenient if I give this subject further attention here. For much of the information, I am indebted to a paper62 by Mr John R. Downes, physiologist, who is in charge of the water supplies. From this paper we learn that the water-supplies are obtained from various small impounded streams:

A few places are supplied directly from the Chagres River or smaller streams, but these towns are also furnished with condensed water for drinking purposes.

The impounded supplies are [listed in Table 13.1]. The watersheds and catchment areas have been depopulated and are patrolled by police. A watchman is in charge of each reservoir to prevent trespassing. In addition to these precautions, chemical, bacteriological, and microscopical examinations are made monthly. Small gangs of men keep down all vegetation for a distance of from 50 to 150 feet from high water.

In 1906 and 1907, two 1,500,000-gallon New York Continental pressure filters were installed; one at Ancon, to filter the Rio Grande supply for Ancon and Panama, and the other at Mount Hope, to filter the Brazos supply for Cristobal and Colon. From a bacteriological standpoint, these filters are not required. They, however, serve to remove the iron-organic matter from the waters, greatly improving their appearance and palatability.

The Ancon plant worked well when set up in the standard way. The Mount Hope plant could not carry the load imposed by the heavy iron-organic content of the Brazos water, and the filters were plugged to a standstill inside of two hours.

I recommended the use of preliminary coagulation and sedimentation. A basin of 400,000 gallons capacity was accordingly built. … The water on entering the basin is dosed with sulphate of alumina, which flows by gravity from the solution storage tanks. The bulk of the precipitate is obtained in the first three sections of the basin. In all about 90 percent of the flock and impurities are removed by the basin, and the filters can then handle the water easily.

This plant has since then been much enlarged.

I will state that in general all these waters are soft, being practically rainwater. They have, however, taken up a large amount of organic matter, which at times causes a disagreeable appearance and taste. The worst that can be said of them from a sanitary standpoint is that, when present, this disagreeable appearance and taste prevent the drinking of sufficient quantities of water.

Each reservoir has an individuality which must be considered. Brazos Brook is characterized by water of high colour, and high iron content, which gives it a very disagreeable appearance, as well as a disagreeable, brassy taste at times. No algae of any importance ever occur in this reservoir.

Carabali Reservoir at Gorgona is characterised by its adaptability for alga growth, especially of the obnoxious Anabaena. The water is clear and of good appearance and taste when these growths are not present. This is the only reservoir giving much trouble from this cause. Camacho Reservoir at Empire gives the least trouble of any from all causes. Rio Grande is noted particularly for the foul odours which it produces at times. These odours have never been traced to alga growths, but, as in the case of Brazos Brook, are due to chemical or bacteriological changes which take place in the lower strata of water where there is no oxygen. … Time and again complaints of foul odours in the waters have been followed up, and the trouble always located in the stagnation of the lower strata of water. … The trouble occurs equally in periods of heavy rain and when it is dry; and also in the change from the dry to the rainy season, and from the rainy to the dry. Invariably the trouble is the same: i.e. lack of oxygen in the lower strata from which the water is being drawn. The points at which the oxygen shows rapid diminution are always marked by an abrupt drop in the temperature of the water, which accounts readily for the stratification.

I cannot follow all the points of this most interesting paper; it deals with technique for dissolved oxygen work, as well as with the bacteriology of the supplies. Perhaps I have over-emphasised that part of the paper which deals with the unpleasant taste of the water; but I have specially referred to it because it is a real difficulty in connection with the Panama supplies which has not yet been overcome, and it is one which might at any time present itself to the sanitarian in the tropics. But if the experience of typhoid fever is to be taken as a test of the purity of the water supplies and of the state of general sanitation in the zone, then the typhoid death rate of 13.3 per 100,000 in 1909 will compare favourably with that of most cities in or out of the tropics.

13.4	Sewage System

Of this I know practically nothing, except that it is a separate system, no rainwater gaining an entrance to the sewers. Such sewers as I saw were the smaller ones, and consisted of glazed earthenware pipes.

For many years English sanitarians in the tropics have hesitated to lay down a system of water-carried sewage; chiefly because it was feared that Asiatics would so abuse it that the sewers would become blocked; and to a less degree, because, from the water-seals of the traps becoming lost through evaporation, foul gases and rats would gain an entrance to houses. There can be little doubt the dangers of a sewer system have been exaggerated; and that where the water supply is sufficiently abundant, it will be universally adopted in tropical towns in the next fifty years. It has been a success in Manila; and a system is now nearing completion in Singapore. In Panama I saw nothing to lead me to suspect there was any difficulty with the sewers; nor did inquiry discover that any existed. The sewer system is a part of the sanitary system which calls for no more attention than it does in a non-tropical country; and, since in Panama nine-tenths of the population consist of negroes, the best testimonial it can get is that one neither sees, smells, nor hears about it.

13.5	The Commissary and Subsistence Department

When the number of employees on the zone began to increase, the price of everything rose to an absurd height. To have allowed this to continue would have been simply to add to the difficulty of recruiting both whites and blacks; so a great system of stores was established, called the Commissary.

It has buyers in the United States; and as European goods can enter without paying duty to the Republic of Panama, many articles cost less than they do in the United States; such a thing as clothing is much cheaper on the zone. The articles bought range from the proverbial needle to the anchor; in fact, everything that is required for a household is to be found in the Commissary. The headquarters are at Cristobal, and from there a special train runs across the isthmus every morning taking supplies to the local commissaries along the line.

In addition to supplying people from the local commissaries or stores, the Subsistence Department operates a number of places where cooked meals can be obtained. These consisted, in 1912, of nineteen line hotels, such as the one I visited at Gatun, for whites; eighteen European labourers’ messes; and eighteen common labourers’ kitchens for negroes and others of that class; in addition there were three night restaurants. The Hotel Tivoli at Ancon, which has accommodation for 300 people, is also under the Subsistence Department. I lived in it during my stay on the zone, and found the management excellent. While this department is of the highest service to the residents of the zone in many ways, I have found that a good deal of misconception exists as to the feeding of the native labour force on the zone. By many it is supposed that the whole of the labour is supplied with cooked meals, which is very far from being the case. In the Annual Report I find the following: “The average daily attendance during June 1912, was 2682 at the line hotels, 2834 at the messes, and 1446 at the kitchens.” From these figures it is clearly seen that under 3 percent of the labourers are supplied with cooked rations.