Mr. Buchanan to Mr. Hay.

No. 29.]

Sir: Referring to my No. 22 of the 9th instant, and to the copy of my note of the same date to this Government concerning what I thought might be done toward the lessening of contagious diseases hereabouts, I beg to inclose a translation of a note I have just received in reply from his excellency the minister for foreign affairs.

You will, I am sure, be gratified to note that my suggestions have been cordially met by this Government, and to learn that the junta on hygiene has already waited upon Doctor Pierce and requested that he give them his views and advice as to the steps they ought to take in the hospital of San Tomas, located in the center of this city, to improve its condition. There were two deaths in this hospital within the past forty-eight hours, both from yellow fever, and on Doctor Pierce reporting to me that no precautions of any kind were taken therein [Page 556] to prevent the spread of the disease, I immediately followed up the subject of my note by making the doctor’s observation the subject of a long personal talk with the members of the junta, the result being the step I have above spoken of as having been taken by the junta of hygiene.

For the Department’s information I inclose a copy of Doctor Pierce’s note to the medical junta, and beg to add that I have requested Consul-General Gudger and Doctor Pierce to follow things up closely here, and for the first to call the attention of the Government in my absence to any negligence or lack of care shown by the health authorities here in the matter of yellow fever especially.

I feel sure you will approve my action in this regard, as well as in that of assuring Doctor Pierce, as I have, that I felt certain Surgeon-General Wyman would be more than glad to have him answer every possible demand that might be made by the medical authorities here on his knowledge and assistance in the direction of preserving the public health here.

I also beg to inclose a copy of a note I am to-day sending to this Government with regard to the same general subject.

* * * * * * *

Consul-General Gudger is very conversant with the subject of health here, and assures me that it will be a great pleasure for him to follow up the steps I have taken vigorously and promptly.

The subject is one of such importance that I trust every aid will be given him and Doctor Pierce in doing what can be done with the health authorities here toward checking any probability of yellow fever breaking out here.

I have, etc.,

Wm. I. Buchanan.
[Inclosure 1.—Translation.]

Señor de la Espriella to Mr. Buchanan.

Excellency: Your excellency’s note of the 9th, regarding cooperation in the matter of the prevention of contagious epidemics on the Isthmus, referred to a subject under the direction of the ministry of government; I transmitted said note to the minister of government, who has advised me that he has addressed the national hygiene junta as follows:

“I inclose herewith an authentic copy of a note addressed to his excellency the minister for foreign affairs on the 9th, by his excellency the minister of the United States, regarding cooperation in the matter of the measures proposed by him for his Government in connection with the steps that may be taken to keep contagious diseases from appearing on the Isthmus.

“The Government of the Republic hopes that the junta of hygiene, over which you so worthily preside, will charge itself with the importance of the suggested measures, and that you will lend Dr. Claude C. Pierce and any others of the medical corps referred to by the minister every facility that may assist him or them in successfully carrying out his work.”

Before sending your excellency’s communication to the minister, as I have above referred to, he informed the junta of government that steps would be at once taken to carry out the excellent suggestions made by your excellency, and that among other things sanitary authorities would be instructed to render medical officers of your excellency’s Government every possible aid in their work.

I take, etc.,

Francisco V. de la Espriella.
[Page 557]
[Inclosure 2.]

Mr. Buchanan to Señor de la Espriella.

Your Excellency: I have the honor to acknowledge the receipt of your excellency’s note of the 15th, replying to mine of the 9th, and informing me of the steps that have been taken by your excellency’s Government toward making practicable the suggestions I took the liberty to submit to your excellency with regard to the precautions that might be taken and the cooperation that I thought might be advantageously effected between your excellency’s national health authorities and the United States medical inspectors stationed here to do what could be done toward lessening the probabilities of any contagious epidemic hereabouts.

I am most grateful to your excellency for the prompt and practical attention that your excellency’s Government has been good enough to give to the suggestion I had the honor to submit.

Doctor Pierce Informs me that he has had an interview with your authorities concerning San Tomas Hospital and that he has complied with their request that he should give them his views concerning the steps best to be taken there.

I am sure that the carrying into effect by your excellency’s Government of the plans that may be thus formulated at any time will very materially lessen the dangers felt here by travelers and visitors from yellow fever.

In connection with the general subject I have to advise your excellency that I have made Consul-General Gudger and Doctor Pierce conversant with the correspondence exchanged between us, and have requested the first to leave nothing undone that would aid in bringing about the heartiest cooperation between Doctor Pierce, who bids me assure your excellency of the great pleasure it will give him to serve your excellency’s Government in any way, and your excellency’s health authorities, and to lend every assistance to see all practical suggestion resulting from such cooperation carried into effect.

May I say on the subject of precautions that may be taken against the spread of contagious diseases that I am given to understand that under Colombian law no obligation was imposed upon physicians here to report at once all cases of contagious diseases that came under their notice. The absence of such a law, which is in effect in all countries wherein such diseases abound, will. I am sure, be very early remedied by your excellency’s lawmakers, since it is not too much to say that a heavy fine should be everywhere imposed by law upon omissions to report cases of contagious diseases coming to the knowledge of physicians and nurses in charge of hospitals or infirmaries of any kind.

I am transmitting your excellency’s note to my Government and need not assure your excellency how gratified I know the Department of State will be to read the same.

I take this occasion, etc.,

Wm. I. Buchanan.
[Inclosure 3.]

Doctor Pierce to Señor Arango.

Sir: In compliance with your request that I make some suggestions as to the manner in which the Hospital de Santo Tomas in Panama could be rendered less likely to spread contagious diseases and be conducted more in keeping with modern ideas of sanitation, I have the honor to make the following suggestions, which can be carried out at small expense and at the same time save many lives.

The most important measure to inaugurate is to rearrange the patients so as to group the cases of similar diseases, placing all the tuberculous patients in one ward, with the proper separation of the sexes, the malarial diseases in another, the surgical cases in another, and to provide a ward in which the cases of yellow fever could be isolated and protected from the bites of mosquitoes.

The wards in which the yellow-fever and malarial patients are to be kept should be made adsolutely mosquito proof, and for this purpose galvanized-iron or copper-wire gauze should be used. The window screens should be accurately fitted to cover the entire opening, and fixed on the outside of the windows so that the screens do not open.

[Page 558]

The windows can be opened or closed from the inside without disturbing the screens. The doors should be fitted around the edges, both at the bottom, top, and sides, with a margin of sheet rubber, so as to provide for shrinkage during dry weather.

A vestibule should be constructed at the entrance, so that in passing through the double doors mosquitoes that might be on the clothing could be brushed off. Especial attention should be paid to screening all openings, such as the spaces between the corrugated-iron roof and the timbers supporting the same, the open work around the top of the walls provided for ventilation, and all places where mosquitoes could enter, as a very small opening will admit many mosquitoes or allow the infected ones to escape.

The wire gauze and other material needed for the work can be obtained from any wholesale hardware firm in New York City.

In regard to the patients suffering with pulmonary tuberculosis, they should be provided with spit cups in which they should be compelled to expectorate. The pattern suggested is the one having heavy paper within a square tin case. This case has a handle upon it and can be conveniently carried by the patient. The paper linings containing the sputum are to be removed once daily and burned. The tin cases should be sterilized or washed in a strong antiseptic solution every other day. The wards from which the tuberculous patients are taken should be scrubbed with a one to one thousand solution of mercuric chloride, both the walls, ceiling, and floors. The ward in which they are to remain should be kept mechanically clean and be scrubbed with the mercuric solution often enough to keep the room from becoming infected.

The patients in the surgical ward should be furnished with gowns or pajamas and not allowed to wear their own ordinary clothing.

The above suggestions, if carried out, will lessen the danger of infection to a great extent. The most important change to make is to isolate the yellow-fever cases in mosquito-proof wards, as it is now accepted by the entire medical profession that malaria, yellow fever, and some other less important diseases are transmitted by certain mosquitoes and in no other way.

To keep patients suffering with yellow fever in a general ward with other diseases, with no screens or other precautions taken, is to invite the transmission of the disease to all non-immunes who are exposed.

The hospital should also be equipped with an apparatus for the sterilization of water for the patients and employees, and precaution should be taken to have the stools of all patients suffering with any intestinal derangement thoroughly disinfected and removed to such a place as will be remote from any possible water supply.

The changes recommended are only such as can be quickly and easily carried out, and which seem to be urgently needed at once. The general efficiency of the entire establishment will be developed and increased by the doctors in charge in proportion as they are supported by the medical and sanitary authorities.

If I can be of any assistance to you in making the above changes please command me at any and all times.


Claude C. Pierce,
Assistant Surgeon, Public Health and Marine-Hospital Service.