Medicine Saves Engineering Feat

Added on Jul 30, 2015

Today, with healthcare graciously inviting engineering-types to help with patient safety and quality, we are less surprised to hear an engineering feat has saved lives in patient care. We tend to forget those instances where medicine saved an engineering feat – and saved lives. Note the high reliability organizing principles in the story.

The Panama Canal is now 100 years old, and we forget the size of the struggle. Read about it in The Path Between the Seas by David McCullough. The French tried and failed in the 19th century. The French faced too many technical problems in excavating the huge Culebra cut through the mountains and far too many public health problems from malaria and yellow fever. In 1884 the death rate was over 200 workers per month. The French were bankrupt in 1889 after losing 22,000 workers.

The Americans succeeded in building the canal in the early 20th century because of better digging machines and much better public health.The doctors built the canal. Or at least the doctors saved the workers who built the canal. Only 5,600 workers died of disease and accidents during the U.S. digging.

Hospital Safety

Colonel William Crawford Gorgas, a U.S. Army doctor, built on the work of another U.S. Army doctor, Walter Reed, who built on the work of Cuban doctor, Carlos Finlay, to prove that yellow fever was transmitted by the mosquito. Gorgas contained the fever in Florida, then Havana, and then Panama in 1904. The mosquitos were controlled by draining swamps, eliminating standing water, oil film for water that could not be eliminated, screens for homes and hospitals, and special screens (inset right) to protect the infected patients. (The mosquitos had to bite an infected patient to transmit the disease. Now that is reluctance to simplify interpretations.)

Before Dr. Gorgas, both diseases were thought to be caused by filth and decay. The word malaria is derived from the Italian for “bad air.” Gorgas’ work is still state-of-the-art today. A vaccine was developed for yellow fever – a virus - in 1937. Malaria – a parasitic protozoan – still has no vaccine. One’s only protection against malaria is don’t get it.

The Mayo brothers said about Dr. Gorgas – “men who achieve greatness do not work more complexity … but more simply.”

(The Americans also had deference to expertise. Digging was difficult but understood – disposing of the spoils was the problem. John Frank Stevens, a railroad builder with the Great Northern, was tasked to manage the canal construction. Stevens devised a rail-based method to remove all of that dirt.)