GORGAS — NOBLE. 619 



canal by the United States. Because of this lack of general hospitali- 

 zation, deaths occurring on the line of the canal and in the cities of 

 Panama and Colon never appeared in the statistical tables of the 

 French company. The hospital rate of 65 per 1,000 per annum is 

 given as the rate of deaths for employees of the French company, 

 and it is on this basis that all comparison of French and American 

 statistics are based. The French rate of 65 per 1,000 per annum 

 was high enough to be embarrassing, but a competent observer who 

 lived in Panama during the days of construction by the French and 

 who was in a position that gave him an intimate knowledge of actual 

 conditions told General Gorgas that the French losses were not less 

 than 250 per 1,000 per annum. Allowing that a death rate of 250 

 per 1,000 per annum is too high, the rate of 65 per 1,000 is undoubt- 

 edly too low. The true rate will never be known. It was so high, 

 however, that only by great effort was it possible to keep the work- 

 ing force recruited up to a point of efficiency, that is, to obtain the 

 average output with the equipment provided. 



Many instances are recorded of the almost extinction of groups 

 of employees arriving from France, who, being assigned to various 

 stations, took up their work with enthusiasm in the expectation of 

 great accomplishments, but within two or three months 75 per cent 

 would have died, and in some cases even 100 per cent. The death 

 rate among the Catholic sisters who controlled the hospitals was 

 appalling. Travelers crossing the Isthmus did so at great risk, 

 especially those who from necessity spent the night in either Panama 

 or Colon. 



The problem was to make this pest-ridden country a place where 

 men could live at least in comparative safety, especially men from a 

 temperate climate. In fact, it was more than this, for in order that 

 these men might be contented and efficient, it was deemed advisable, 

 that they should bring their families. If the Canal Zone and the 

 cities of Panama and Colon could not be made healthful to a degree 

 that it would be possible for Americans to live there, the project 

 would have been handicapped by great mortality and increased cost 

 in time and money. Without proper sanitation the great sacrifice 

 of lives would have had its reaction on public sentiment, making 

 probable again the abandonment of the project. 



It is estimated that had French conditions persisted instead of 

 those established by General Gorgas the cost in human lives would 

 have been not less than 20,000. 



Those who opposed General Gorgas most strenuously during the 

 early days of his work on the Zone from an honest disbelief in his 

 methods, methods based on the transmission of yellow fever and 

 malaria by mosquitoes, later acknowledged their error. I heard one 



