William Crawford Gorgas

“ The discovery that it is the mosquito alone that conveys the disease will enable us to manage it.
I cannot but think that the freedom of Havana from yellow fever on the 24th of August, a thing never before known, must be due to the fact that we got the infected mosquito nearly every time. The disease has been introduced freely from the outside, and yet has not spread among our thirty thousand non-immunes. I believe that our system gets them nearly every time. ”

“ Officers and men became nervous and hysterical. I commanded the base hospital at Siboney, and it was my disagreeable duty to select from day to day those who would have to remain. Many times every day the poor fellows, officers and men, would break down and cry when told that they could not leave on the next ship. I could form some idea of what it must have been among the French at Haiti when they knew that they could not get away, but had to stay and die.
Being immune to yellow fever, I made application to go with the troops that took possession of Havana. ”

“ It is very surprising and impressive to see how rapidly such a system will free a city of mosquitoes, and how after a few months of such work you cease to be annoyed by them. In yellow-fever work this system of destroying mosquito larvæ is the essential; everything else is secondary to it. In the built-up portions of a city such as Havana, caring for the cisterns, water barrels and containers is the essential work, but as you approach the suburbs, pools and puddles become more frequent, and this character of mosquito breeding-places becomes more important than containers. ”

“ But in the course of ages the centers of civilization will move to where a given amount of labor will produce the largest amount of food. Of course, other things must be equal. I am assuming that the government in these new communities is as good as the government with which we are comparing it in the temperate zone. When this great migration of population has fully commenced, I believe that the peoples of that day will look back upon the sanitary work done at the Canal Zone as the first great demonstration that the white man could live as well in the tropics as in the temperate zone. ”

“ It is considered so certain that everyone exposed to yellow fever will have the disease that proof that a man has lived in an endemic center for ten years is accepted as proof of his immunity. No quarantine is, however, absolute in any disease, in any locality, or carried out by any authority. Some people now and then will pass the quarantine who are either so slightly sick that the disease is not recognized, or who developed the disease after they had been released from quarantine. ”

“ Up to the time of the discovery of America, Europeans had been making no attempt whatever to prevent disease and with our present knowledge and point of view, we can see that any sanitary attempt on their part would necessarily have failed. They had an entirely wrong conception of disease and an erroneous theory of its cause. The mortality rates in most parts of Europe at this time were as high as its birth rates. In England, the population had not increased for several centuries, or if it had increased, the increment was so slight that it could not easily be measured. ”

“ Wherever possible, I insisted upon the sanitary inspector who was instructed in these matters doing his own work, using men employed directly by himself and under his orders and supervision. I think it is of the utmost importance in mosquito work that the health officer should have direct control of the men doing this work. The ordinary engineer has no special knowledge of the life history of the mosquito, and as the ditching and brush-cutting are done to prevent mosquito-breeding, it is not surprising that it is not successfully done by a man who has no knowledge of the mosquito. ”

“ A man of less discretion, enthusiasm and energy would have made [Pg 89] a fiasco of it. Whereas, you, my dear Gorgas, availing yourself of the results of the work at Camp Lazear, have rid that pest hole, Havana, of her yellow plague! All honor to you my dear boy! Thank God that the Medical Department of the U. S. Army, which got such “a black eye” during the Spanish-American war, has during the past year accomplished work that will always remain to its eternal credit! ”

“ I presume that a week would be long for the average life of a stegomyia mosquito, and the traveling ability of the organism would be limited by the life of the mosquito. For while the female stegomyia mosquito has to live two weeks after she has bitten the yellow-fever patient before she can convey the disease to another non-immune human being, still the average length of life in the mosquito cannot be as great as this. The various conditions of unfavorable environment, the natural enemies of all kinds, wind, etc., must kill a large proportion of mosquitoes within the first week. ”

“ The destruction of mosquitoes in a building can be accomplished with very little annoyance to the inmates but the thorough destruction of fomites causes a great deal of inconvenience and some loss.
The all important matter in yellow fever is to get your cases reported as thoroughly as possible and this can only be done with the co-operation of the people. I am therefore of the opinion that the great element of our success was due to the fact that we did away with the attempted destruction of fomites. You can readily see how one unreported case might start an epidemic. ”

“ He now began to attribute disease to abnormal conditions in the blood and tissues of the body, caused by unfavorable environment, such as filth, food, clothing, climatic conditions, etc. His efforts for the prevention of disease during all this period had little or no effect. It is probable that through long ages the human race remained stationary in numbers or increased very slowly, due principally to the fact that men were unable to affect favorably their sanitary condition, or to ward off in any way the fearful epidemic scourges that every now and then swept through the ranks of mankind. ”

“ The discovery of the Americas was a great epoch in the history of the white man, and threw large areas of fertile and healthy country open to his settlement. The demonstration made at Panama that he can live a healthy life in the tropics will be an equally important milestone in the history of the race, and will throw just as large an area of the earth’s surface open to man’s settlement, and a very much more productive area. ”

“ We now know that spirits and gods do not directly cause disease in man, but we have found out that living beings, germs, are the direct cause of all infectious diseases.
A great many of our sanitary measures, if now witnessed by our ancestors of three thousand years ago, would probably seem perfectly natural and proper. The fumigation of ships and buildings would seem a very proper mode of burning incense to the hostile god who was causing yellow fever. ”

“ Had Athens been subject to yellow fever in the time of Alcibiades, yellow fever would certainly be there to-day. All the citizens of the city of Athens would have become immune, but a sufficient number of Greeks would have been constantly coming into the city from the interior to have kept the disease endemic, exactly as has occurred in our own time at Havana. I think, then, that we can throw aside Europe and Asia as the original source of yellow fever. ”

“ We therefore claim for the work of the Sanitary Department the saving of 71,370 human lives during the building of the Panama Canal. Where one man died, probably three would have returned home broken in health, with months and years of suffering and invalidism ahead of them. Sanitation on the Isthmus has saved this heavy toll to the devoted people engaged in this great work, [Pg 284] and was, therefore a most wise and lucrative investment to our Government, and played a most important part in aiding the construction work in that great enterprise. ”

“ An individual varying very slightly from the other individual of his species, becomes the progenitor of a new species, provided the variation accords with his surroundings so as to fit him better for the struggle of life. But all of the new species must descend directly from the one pair which produces these favorable variations in their progeny. Every species, therefore, such as the dog, must originate in some one locality. If at any time this species of animal is found in all parts of the world, it must have slowly spread from the locality in which it originated. ”

“ Now it is quite evident that if in any way we can kill the parasites as they exist in man, we not only cure the individual man of malarial fever, but at the same time prevent his being a means of infection for other men who have not yet acquired the disease. ”

“ From the best statistics which I could get on the Isthmus, I found that the French lost yearly by death from yellow fever about one-third of their white force. If we lost in the same ratio it would give us about thirty-five hundred deaths among our Americans yearly. We, therefore, during [Pg 150] the first year made yellow fever the first consideration, and gave it the most attention.
The two principal foci of infection for yellow fever were the towns at either end of the railroad, Colon at the northern end, on the Caribbean Sea, and Panama at the southern end, on the Pacific Ocean. ”

“ A human being, in order that he may be liable to yellow fever, must be non-immune, and by immune I mean a person who either has had yellow fever, or has lived ten or more years in a locality where yellow fever prevails. An attack of yellow fever gives a great immunity to the disease, probably just as much as occurs in the case of smallpox. ”

“ Even if the dangers had been as great as they were under the French, and the deaths as numerous, I believe we would have found a sufficient number of men who were willing to go to the Isthmus, just as did the French. There is always a certain element which is attracted by danger and adventure, and to whom exposure to risk is a sufficient reward for their labor. ”

“ 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.
It requires continuously warm weather for the yellow-fever mosquito to breed in sufficient numbers to propagate yellow fever; therefore, this disease never became endemic in the United States. ”

“ It is well known that in a yellow-fever endemic center such as was Havana during the nineteenth century native Havanese are not liable to yellow fever. They look upon their immunity as being absolute, and in my experience of fourteen years of life in such endemic centers I am inclined to accept their belief. The immunity of the native is explained by saying that he has probably had yellow fever in childhood when the disease was very mild, and that, at the time, it was overlooked and not recognized. ”