Burning Out Ditch with Oil Spray 184 Old French Engine Tender Used as Storage Tank for Oil 194 Mule for Packing Oil to Oilers 194 Distilled Water Cart. Culebra 220 Ward at Ancon Hospital 220 Stoned Ditch near Tivoli Hotel. Ancon, Panama 234 Bad Anopheles Breeding-ground on Artificial Fill. La Boca 234 [Illustration: Map of the Panama Canal Zone, Showing Hospitals of the Sanitary Department.] SANITATION IN PANAMA CHAPTER I YELLOW FEVER AND THE DISCOVERIES OF ITS TRANSMISSION Yellow fever for two hundred years before the Spanish-American War caused great loss of life and much destruction of wealth. Every few years portions of the United States would become infected with this disease. In the earlier part of this period the disease was more or less local. As the Mississippi valley became more thickly populated, the extent of the disease and the injury caused became very much augmented. The epidemic of 1878 was probably the deadliest and most extensive epidemic of yellow fever which ever affected the United States. In this epidemic over thirteen thousand people in the Mississippi valley alone lost their lives, and the loss of wealth is estimated at considerably more than one hundred millions of dollars. It is very difficult to convey to a reader any idea of the conditions which exist during an epidemic of yellow fever. All business is entirely paralyzed, the quarantines not allowing any communication between the affected districts and those not affected. In an epidemic of any extent this means hundreds of local quarantines. Some idea of the condition of affairs can be obtained by picturing what would occur in any community if all the income of that community should entirely cease for six months. And this was the condition of business all over the Mississippi valley every time yellow fever gained entrance. The population originally feared yellow fever on account of the poverty, suffering and business depression always caused by the quarantines which had to be enforced to prevent its spread, and in time people came to associate this idea of dread with yellow fever itself. When this disease was announced in a town, everybody left who could. The sick were frequently left without care, and often a great deal of cruelty and cowardice was shown. If a person escaped from an infected region and became sick with the disease, or sick from any other cause, he was generally treated as if he were a leper, and would often be left to starve or die on the roadside.