Mr. Buchanan to Mr.
Hay.
American Legation, Special Mission,
Panama, January
16, 1904.
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.,
[Inclosure
1.—Translation.]
Señor de la
Espriella to Mr. Buchanan.
Republic of Panama,
Ministry for Foreign
Affairs,
Panama, January 15,
1904.
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.
[Inclosure 2.]
Mr. Buchanan to
Señor de la
Espriella.
American Legation, Special Mission,
Panama, January 16, 1904.
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.,
[Inclosure 3.]
Doctor Pierce
to Señor Arango.
Public Health and Marine-Hospital Service,
Office
of Medical Officer in Command,
Panama, January 16, 1904.
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.
Respectfully,
Claude C. Pierce,
Assistant Surgeon, Public Health and
Marine-Hospital Service.
